• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1252-1264
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• 1998

Background : Patients with established ARDS have a mortality rate that exceeds 50 percent despite of intensive care including artificial ventilation modality, Mortality has been associated with sepsis and organ failure preceding or following ARDS ; APACHE II score ; old age and predisposing factors. Revised ventilator strategy over last 10 years especially at ARDS appeared to improve the mortality of it. We retrospectively investigated 40 ARDS patients of respiratory-care unit to examine how these factors influence outcome. Methods : A retrospective investigation of 40 ARDS patients in respiratory-care unit with ventilator management over 46 months was performed. We investigated the clinical characteristics such as a risk factor, cause of death and mortality, and also parameters such as APACHE II score, number of organ dysfunction, and hypoxia score (HS, $PaO_2/FIO_2$) at day 1, 3, 7 of severe acute lung injury, and simultaneously the PEEP level and tidal volume. Results : Clinical conditions associated with ARDS were sepsis 50%, pneumonia 30%, aspiration pneumonia 20%, and mortality rate based on the etiology of ARDS was sepsis 50%, pneumonia 67%(p<0.01 vs sepsis), aspiration pneumonia 38%. Overall mortality rate was 60%. In 28 day-nonsurvivors, leading cause of death was severe sepsis(42.9%) followed by MOF(28.6%), respiratory failure(19.1 %), and others(9.5%). There were no differences in variables of age, sex, APACHE II score, HS, and numbers of organ dysfunction at day 1 of ARDS between 28-days survivor and nonsurvivors. In view of categorized variables of age(>70), APACHE II score(>26), HS(<150) at day 1 of ARDS, there were significant differences between 28-days survivor and nonsurvivors(p<0.05). After day 1 of ARDS, the survivors have improved their APACHE II score, HS, numbers of organ dysfunction over the first 3d to 7d, but nonsurvivors did not improve over a seven-day course. There were significant differences in APACHE II score and numbers of organ dysfunction of day 3, 7 of ARDS, and HS of day 7 of ARDS between survivors and nonsurvivors(p<0.05). Fatality rate of ARDS has been declined from 68% to less than 40% between 1995 and 1998. There were no differences in APACHE II score, HS, numbers of organ dysfunction, old age at presentation of ARDS. In last years, mean PEEP level was significantly higher and mean tidal volume was significantly lower than previous years during seven days of ARDS(p<0.01). Conclusions : Improvement of HS, APACHE II score, organ dysfunction over the first 3d to 7d is associated with increased survival Decline in ARDS fatality rates between 1995 and 1998 seems that this trend must be attributed to improved supportive therapy including at least high PEEP instead of conventional-least PEEP approach in ventilator management of acute respiratory distress syndrome.

• Proceedings of the Korean Institute of Intelligent Systems Conference
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• 1993.06a
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• pp.1051-1054
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• 1993

The International Atomic Energy Agency's Statute in Article III.A.5 allows it“to establish and administer safeguards designed to ensure that special fissionable and other materials, services, equipment, facilities and information made available by the Agency or at its request or under its supervision or control are not used in such a way as to further any military purpose; and to apply safeguards, at the request of the parties, to any bilateral or multilateral arrangement, or at the request of a State, to any of that State's activities in the field of atomic energy”. Safeguards are essentially a technical means of verifying the fulfilment of political obligations undertaken by States and given a legal force in international agreements relating to the peaceful uses of nuclear energy. The main political objectives are: to assure the international community that States are complying with their non-proliferation and other peaceful undertakings; and to deter (a) the diversion of afeguarded nuclear materials to the production of nuclear explosives or for military purposes and (b) the misuse of safeguarded facilities with the aim of producing unsafeguarded nuclear material. It is clear that no international safeguards system can physically prevent diversion. The IAEA safeguards system is basically a verification measure designed to provide assurance in those cases in which diversion has not occurred. Verification is accomplished by two basic means: material accountancy and containment and surveillance measures. Nuclear material accountancy is the fundamental IAEA safeguards mechanism, while containment and surveillance serve as important complementary measures. Material accountancy refers to a collection of measurements and other determinations which enable the State and the Agency to maintain a current picture of the location and movement of nuclear material into and out of material balance areas, i. e. areas where all material entering or leaving is measurab e. A containment measure is one that is designed by taking advantage of structural characteristics, such as containers, tanks or pipes, etc. To establish the physical integrity of an area or item by preventing the undetected movement of nuclear material or equipment. Such measures involve the application of tamper-indicating or surveillance devices. Surveillance refers to both human and instrumental observation aimed at indicating the movement of nuclear material. The verification process consists of three over-lapping elements: (a) Provision by the State of information such as - design information describing nuclear installations; - accounting reports listing nuclear material inventories, receipts and shipments; - documents amplifying and clarifying reports, as applicable; - notification of international transfers of nuclear material. (b) Collection by the IAEA of information through inspection activities such as - verification of design information - examination of records and repo ts - measurement of nuclear material - examination of containment and surveillance measures - follow-up activities in case of unusual findings. (c) Evaluation of the information provided by the State and of that collected by inspectors to determine the completeness, accuracy and validity of the information provided by the State and to resolve any anomalies and discrepancies. To design an effective verification system, one must identify possible ways and means by which nuclear material could be diverted from peaceful uses, including means to conceal such diversions. These theoretical ways and means, which have become known as diversion strategies, are used as one of the basic inputs for the development of safeguards procedures, equipment and instrumentation. For analysis of implementation strategy purposes, it is assumed that non-compliance cannot be excluded a priori and that consequently there is a low but non-zero probability that a diversion could be attempted in all safeguards ituations. An important element of diversion strategies is the identification of various possible diversion paths; the amount, type and location of nuclear material involved, the physical route and conversion of the material that may take place, rate of removal and concealment methods, as appropriate. With regard to the physical route and conversion of nuclear material the following main categories may be considered: - unreported removal of nuclear material from an installation or during transit - unreported introduction of nuclear material into an installation - unreported transfer of nuclear material from one material balance area to another - unreported production of nuclear material, e. g. enrichment of uranium or production of plutonium - undeclared uses of the material within the installation. With respect to the amount of nuclear material that might be diverted in a given time (the diversion rate), the continuum between the following two limiting cases is cons dered: - one significant quantity or more in a short time, often known as abrupt diversion; and - one significant quantity or more per year, for example, by accumulation of smaller amounts each time to add up to a significant quantity over a period of one year, often called protracted diversion. Concealment methods may include: - restriction of access of inspectors - falsification of records, reports and other material balance areas - replacement of nuclear material, e. g. use of dummy objects - falsification of measurements or of their evaluation - interference with IAEA installed equipment.As a result of diversion and its concealment or other actions, anomalies will occur. All reasonable diversion routes, scenarios/strategies and concealment methods have to be taken into account in designing safeguards implementation strategies so as to provide sufficient opportunities for the IAEA to observe such anomalies. The safeguards approach for each facility will make a different use of these procedures, equipment and instrumentation according to the various diversion strategies which could be applicable to that facility and according to the detection and inspection goals which are applied. Postulated pathways sets of scenarios comprise those elements of diversion strategies which might be carried out at a facility or across a State's fuel cycle with declared or undeclared activities. All such factors, however, contain a degree of fuzziness that need a human judgment to make the ultimate conclusion that all material is being used for peaceful purposes. Safeguards has been traditionally based on verification of declared material and facilities using material accountancy as a fundamental measure. The strength of material accountancy is based on the fact that it allows to detect any diversion independent of the diversion route taken. Material accountancy detects a diversion after it actually happened and thus is powerless to physically prevent it and can only deter by the risk of early detection any contemplation by State authorities to carry out a diversion. Recently the IAEA has been faced with new challenges. To deal with these, various measures are being reconsidered to strengthen the safeguards system such as enhanced assessment of the completeness of the State's initial declaration of nuclear material and installations under its jurisdiction enhanced monitoring and analysis of open information and analysis of open information that may indicate inconsistencies with the State's safeguards obligations. Precise information vital for such enhanced assessments and analyses is normally not available or, if available, difficult and expensive collection of information would be necessary. Above all, realistic appraisal of truth needs sound human judgment.

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.184-193
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• 2006

Background: Off-pump coronary artery bypass grafting (OPCAB) has been proven to result in less morbidity. The patients who have left ventricular dysfunction may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The present study compared early and midterm outcomes of off-pump versus on-pump coronary artery bypass grafting (On pump CABG) in patients with severe left ventricular dysfunction. Material and Method: Ninety hundred forth six patients underwent isolated coronary artery bypass grafting by one surgeon between January 2001 and Febrary 2005.. Data were collected in 100 patients who had left ventricular ejection fraction (L VEF) less than $35\%$ (68 OPCAB; 32 On pump CABG). Mean age of patients were 62.9$\pm$9.0 years in OPCAS group and 63.8$\pm$8.0 years in On pump CABG group. We compared the preoperative risk factors and evaluated early and midterm outcomes. Result: In OPCAB and On pump CABG group, mean number of used grafts per patient were 2.75$\pm$0.72, 2.78$\pm$0.55 and mean number of distal anastomoses were 3.00$\pm$0.79, 3.16$\pm$0.72 respectively. There was one perioperative death in OPCAB group ($1.5\%$). The operation time, ventilation time, ICU stay time, CK-MB on the first postoperative day, and occurrence rate of complications were significantly low in OPCAB group. Mean follow-up time was 26.6$\pm$12.8 months (4${\~}$54 months). Mean LVEF of OPCAB and On pump CABG group improved significantly from $27.1\pm4.5\%$ to $40.7\pm13.0\%$ and $26.9\pm5.4\%$ to $33.3\pm13.7\%$. The 4-year actuarial survival rate of OPCAB and On pump CABG group were $92.2\%,\;88.3\%$ and the 4-year freedom rates from cardiac death were $97.7\%,\;96.4\%$ respectively. There were no significant differences between two groups in 4 year freedom rate from cardiac event and angina. Conclusion: OPCAS improves myocardial function and favors early and mid-term outcomes in patients with severe left ventricular dysfunction compared to On pump CABG group. Therefore, OPCAB is a preferable operative strategy even in patients with severe left ventricular dysfunction.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.269-274
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• 2006

Background: Tetralogy of Fallot (TOF) with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAS) is complex lesion with marked heterogeneity of pulmonary blood supply and arborization anomalies. Patients with TOF with PA and MAPCAS have traditionally required multiple staged unifocalization of pulmonary blood supply before undergoing complete repair. In this report, we describe recent change of strategy and the results in our institution. Material and Method: We established surgical stratagies: early correction, central mediastinal approach, initial RV-PA conduit interposition, and aggressive intervention. Between July 1998 and August 2004, 23 patients were surgically treated at our institution. We divided them into 3 groups by initial operation method; group I: one stage total correction, group II: RV-PA conduit and unifocalization, group III: RV-PA conduit interposition only. Result: Mean ages at initial operation in each group were $13.9{\pm}16.0$ months (group 1), $10.4{\pm}15.6$ months (group II), and $7.9{\pm}7.7$ months (group III). True pulmonary arteries were not present in f patient and the pulmonary arteries were confluent in 22 patients. The balloon angioplasty was done in average 1.3 times (range: $1{\sim}6$). There were 4 early deaths relating initial operation, and 1 late death due to incracranial hemorrhage after definitive repair. The operative mortalities of initial procedures in each group were 25.0% (1/4: group I), 20.0% (2/10: group II), and 12.2% (1/9: group III). The causes of operative mortality were hypoxia (2), low cardiac output (1) and sudden cardiac arrest (1). Definitive repair rates in each group were 75% (3/4) in group I, 20% (2/10, fenestration: 2) in group II, and 55.0% (5/9, fenestration: 1) in group III. Conclusion: In patients of TOF with PA and MAPCAS, RV-PA connection as a initial procedure could be performed with relatively low risk, and high rate of definitive repair can be obtained in the help of balloon pulmonary angioplasty. One stage RV-PA connection and unifocalization appeared to be successful in selected patients.

• Journal of Global Scholars of Marketing Science
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• v.19 no.3
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• pp.17-27
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• 2009

Price promotion typically reduces the price for a given quantity or increases the quantity available at the same price, thereby enhancing value and creating an economic incentive to purchase. It often is used to encourage product or service trial among nonusers of products or services. Thus, it is important to understand the effects of price promotions on quality perception made by consumer who do not have prior experience with the promoted brand. However, if consumers associate a price promotion itself with inferior brand quality, the promotion may not achieve the sales increase the economic incentives otherwise might have produced. More specifically, low qualitative perception through price promotion will undercut the economic and psychological incentives and reduce the likelihood of purchase. Thus, it is important for marketers to understand how price promotional informations about a brand have impact on consumer's unfavorable quality perception of the brand. Previous literatures on the effects of price promotions on quality perception reveal inconsistent explanations. Some focused on the unfavorable effect of price promotion on consumer's perception. But others showed that price promotions didn't raise unfavorable perception on the brand. Prior researches found these inconsistent results related to the timing of the price promotion's exposure and quality evaluation relative to trial. And, whether the consumer has been experienced with the product promotions in the past or not may moderate the effects. A few studies considered differences among product categories as fundamental factors. The purpose of this research is to investigate the effect of price promotional informations on consumer's unfavorable quality perception under the different conditions. The author controlled the timing of the promotional exposure and varied past promotional patterns and information presenting patterns. Unlike previous researches, the author examined the effects of price promotions setting limit to pretrial situation by controlling potentially moderating effects of prior personal experience with the brand. This manipulations enable to resolve possible controversies in relation to this issue. And this manipulation is meaningful for the work sector. Price promotion is not only used to target existing consumers but also to encourage product or service trial among nonusers of products or services. Thus, it is important for marketers to understand how price promotional informations about a brand have impact on consumer's unfavorable quality perception of the brand. If consumers associate a price promotion itself with inferior quality about unused brand, the promotion may not achieve the sales increase the economic incentives otherwise might have produced. In addition, if the price promotion ends, the consumer that have purchased that certain brand will likely to display sharply decreased repurchasing behavior. Through a literature review, hypothesis 1 was set as follows to investigate the adjustive effect of past price promotion on quality perception made by consumers; The influence that price promotion of unused brand have on quality perception made by consumers will be adjusted by past price promotion activity of the brand. In other words, a price promotion of an unused brand that have not done a price promotion in the past will have a unfavorable effect on quality perception made by consumer. Hypothesis 2-1 was set as follows : When an unused brand undertakes price promotion for the first time, the information presenting pattern of price promotion will have an effect on the consumer's attribution for the cause of the price promotion. Hypothesis 2-2 was set as follows : The more consumer dispositionally attribute the cause of price promotion, the more unfavorable the quality perception made by consumer will be. Through test 1, the subjects were given a brief explanation of the product and the brand before they were provided with a $2{\times}2$ factorial design that has 4 patterns of price promotion (presence or absence of past price promotion * presence or absence of current price promotion) and the explanation describing the price promotion pattern of each cell. Then the perceived quality of imaginary brand WAVEX was evaluated in the scale of 7. The reason tennis racket was chosen is because the selected product group must have had almost no past price promotions to eliminate the influence of average frequency of promotion on the value of price promotional information as Raghubir and Corfman (1999) pointed out. Test 2 was also carried out on students of the same management faculty of test 1 with tennis racket as the product group. As with test 1, subjects with average familiarity for the product group and low familiarity for the brand was selected. Each subjects were assigned to one of the two cells representing two different information presenting patterns of price promotion of WAVEX (case where the reason behind price promotion was provided/case where the reason behind price promotion was not provided). Subjects looked at each promotional information before evaluating the perceived quality of the brand WAVEX in the scale of 7. The effect of price promotion for unfamiliar pretrial brand on consumer's perceived quality was proved to be moderated with the presence or absence of past price promotion. The consistency with past promotional behavior is important variable that makes unfavorable effect on brand evaluations get worse. If the price promotion for the brand has never been carried out before, price promotion activity may have more unfavorable effects on consumer's quality perception. Second, when the price promotion of unfamiliar pretrial brand was executed for the first time, presenting method of informations has impact on consumer's attribution for the cause of firm's promotion. And the unfavorable effect of quality perception is higher when the consumer does dispositional attribution comparing with situational attribution. Unlike the previous studies where the main focus was the absence or presence of favorable or unfavorable motivation from situational/dispositional attribution, the focus of this study was exaus ing the fact that a situational attribution can be inferred even if the consumer employs a dispositional attribution on the price promotional behavior, if the company provides a persuasive reason. Such approach, in academic perspectih sis a large significance in that it explained the anchoring and adjng ch approcedures by applying it to a non-mathematical problem unlike the previous studies where it wis ionaly explained by applying it to a mathematical problem. In other wordn, there is a highrspedency tmatispositionally attribute other's behaviors according to the fuedach aal attribution errors and when this is applied to the situation of price promotions, we can infer that consumers are likely tmatispositionally attribute the company's price promotion behaviors. Ha ever, even ueder these circumstances, the company can adjng the consumer's anchoring tmareduce the po wibiliute thdispositional attribution. Furthermore, unlike majority of previous researches on short/long-term effects of price promotion that only considered the effect of price promotions on consumer's purchasing behaviors, this research measured the effect on perceived quality, one of man elements that affects the purchasing behavior of consumers. These results carry useful implications for the work sector. A guideline of effectively providing promotional informations for a new brand can be suggested through the outcomes of this research. If the brand is to avoid false implications such as inferior quality while implementing a price promotion strategy, it must provide a clear and acceptable reasons behind the promotion. Especially it is more important for the company with no past price promotion to provide a clear reason. An inconsistent behavior can be the cause of consumer's distrust and anxiety. This is also one of the most important factor of risk of endless price wars. Price promotions without prior notice can buy doubt from consumers not market share.