• Title/Summary/Keyword: school risk factors

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Clinical Factors Predicting the Pathologic Tumor Response after Preoperative Concurrent Chemoradiotherapy for Rectal Cancer (직장암에 수술 전 항암화학방사선 동시 병용요법 후 종양의 병리학적 반응에 영향을 주는 임상적 예측 인자)

  • Lee, Ji-Hae;Lee, Kyung-Ja
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.213-221
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    • 2008
  • Purpose: The objective of this retrospective study was to identify predictive factors for the complete pathologic response and tumor downstaging after preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. Materials and Methods: Between the years 2000 and 2008, 39 patients with newly diagnosed rectal cancer without prior evidence of distant metastasis received preoperative concurrent chemoradiotherapy followed by surgery. The median radiation dose was 50.4 Gy (range, $45{\sim}59.4\;Gy$)). Thirty-eight patients received concurrent infusional 5-fluorouracil and leucovorin, while one patient received oral capecitabine twice daily during radiotherapy. Results: A complete pathologic response (CR) was demonstrated in 12 of 39 patients (31%), while T-downstaging was observed in 24 of 39 patients (63%). N-downstaging was observed in 18 of 28 patients (64%), with a positive node in the CT scan or ultrasound. Two patients with clinical negative nodes were observed in surgical specimens. The results from a univariate analysis indicated that the tumor circumferential extent was less than 50% (p=0.031). Moreover, the length of the tumor was less than 5 cm (p=0.004), while the post-treatment carcinoembryonic antigen (CEA) levels were less than or equal to 3.0 ng/mL (p=0.015) and were significantly associated with high pathologic CR rates. The univariate analysis also indicated that the adenocarcinoma (p=0.045) and radiation dose greater than or equal to 50 Gy (p=0.021) were significantly associated with high T-downstaging, while a radiotherapy duration of less than or equal to 42 days (p=0.018) was significantly associated with N-downstaging. The results from the multivariate analysis indicated that the lesser circumferential extent of the tumor (hazard ratio [HR] 0.150; p=0.028) and shorter tumor length (HR, 0.084; p=0.005) independently predicted a higher pathologic CR. The multivariate analysis also indicated that a higher radiation dose was significantly associated with higher T-downstaging (HR, 0.115; p=0.025), while the shorter duration of radiotherapy was significantly associated with higher N-downstaging (HR, 0.028; p=0.010). Conclusion: The circumferential extent of the tumor and its length was a predictor for the pathologic CR, while radiation dose and duration of radiotherapy were predictors for tumor downstaging. Hence, these factors may be used to predict outcomes for patients and to develop further treatment guidelines for high-risk patients.

Characteristics of the Factor Structure of the Child Behavior Checklist Dysregulation Profile for School-aged Children (학령기 아동의 CBCL 조절곤란프로파일(Child Behavior Checklist Dysregulation Profile)의 요인구조와 특성)

  • Kim, Eun-young;Ha, Eun-hye
    • Korean Journal of School Psychology
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    • v.17 no.1
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    • pp.17-38
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    • 2020
  • This study examined the factor structure of the Child Behavior Checklist Dysregulation Profile(CBCL-DP) for school-aged children in Korea identified differences in the level of maladjustment and problematic behaviors between the clinical group which had characteristics of CBCL-DP and the control group which did not. Confirmative factor analysis was performed on three alternative models from the literature to determine which was the most appropriate factor structure for the CBCL-DP. The result showed that the bi-factor model fit the sample data better than both the one and second-factor models. To confirm that the bi-factor model was the most appropriate factor structure, regression paths with relevant variables examined. The showed that CBCL-DP with the bi-factor model was associated with executive function difficulty as reported by parents and with school adjustment and all sub-factors of strength and difficulty as reported by teachers. The results also showed that this model had a different relationship with anxiety/depression, aggressive behavior, and attention problems than the other models. The clinical group was shown to have more executive function difficulty, worse adjustment of school life and to be less likely to engage in desired behaviors than the control group. These results indicate the CBCL-DP is more related to negative outcomes than any other factor, and that the bi-factor model was found to best fit the sample data, consistent with other studies. The early discovery of CBCL-DP can be used to provide interventions for high-risk children who exhibit emotional and behavioral problems, making its detection a significant diagnostic tool. The implications of these result, the limitations of this study, and areas for future research are discussed in this paper.

Optimum Radiotherapy Schedule for Uterine Cervical Cancer based-on the Detailed Information of Dose Fractionation and Radiotherapy Technique (처방선량 및 치료기법별 치료성적 분석 결과에 기반한 자궁경부암 환자의 최적 방사선치료 스케줄)

  • Cho, Jae-Ho;Kim, Hyun-Chang;Suh, Chang-Ok;Lee, Chang-Geol;Keum, Ki-Chang;Cho, Nam-Hoon;Lee, Ik-Jae;Shim, Su-Jung;Suh, Yang-Kwon;Seong, Jinsil;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.143-156
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    • 2005
  • Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

The Value of Entrepreneurial Orientation and Social Capital for Enhancing Collective Performance in R&D Collaborations of Korean Ventures (벤처기업의 R&D협력에서 사회적 자본과 기업가적 지향성이 협력성과에 미치는 영향)

  • Seo, Ribin
    • Journal of Korea Technology Innovation Society
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    • v.20 no.1
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    • pp.1-33
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    • 2017
  • In the last decades, technology-oriented small firms, i.e. venture businesses, have been increasingly engaged in R&D collaborations with external parties as strategic means for technological innovation. Despite ample evidence on the benefit of such collaborations for the firms, there has been less attention to examining whether and how the firms' social interactions with cooperating partners and their managerial characteristics contribute to that benefit. Drawing on the theories of social capital and entrepreneurial orientation, this study is to remedy this gap. The theory of social capital, referring to a sum of the value and potential resources embedded in social relationships of collectives, provides an integrated view of social factors among cooperating partners, e.g. strong ties, network stability, trust, reciprocity, shared vision and value. It categorizes these factors into structural, relational, and cognitive dimensions of social capital. Entrepreneurial orientation theory captures firms' managerial characteristics as a combination of innovativeness, proactiveness, and risk-taking. This addresses firms' managerial process to utilize and combine internal and external resources for wealth creation and opportunity realization. Against this background, this study investigates what roles social capital among cooperating R&D partners and entrepreneurial orientation of the collaborating firms play for collective performance improvement in R&D collaborations. In terms of the collective performance, this study adopts two indicators: technological competitiveness and business performance. Technological competitiveness refers to the contribution of a technology developed by a cooperative R&D project to competitive advantage of a firm while business performance is defined as the financial and economic outcome of a collaboration. Using a sample of 218 Korean ventures engaging in R&D collaboration with external parties, the author finds the significant effects of social capital (i.e. structural, relational, and cognitive dimensions) and entrepreneurial orientation (i.e. innovativeness, proactiveness, and risk-taking) on both of the technological competitiveness and the business performance. Further, the higher the social capital among R&D partners, the more likely it is to foster the entrepreneurial orientation at firm-level. Most importantly, the entrepreneurial orientation at firm-level is an significant mediator of the relationship between social capital and collective performance. Beyond these novel empirical findings, this study contributes to the literature on R&D collaboration. The findings' implications for management and policy are deeply discussed in the conclusion.

Outcome of the Modified Norwood Procedure: 7 Years of Experience from a Single Institution (변형된 노우드(Norwood) 수술의 결과: 단일병원의 지난 7년간의 경험)

  • Kim, Hyung-Tae;Sung, Si-Chan;Kim, Si-Ho;Bae, Mi-Ju;Lee, Hyoung-Doo;Park, Ji-Ae;Chang, Yun-Hee
    • Journal of Chest Surgery
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    • v.43 no.4
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    • pp.364-374
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    • 2010
  • Background: We assessed the early and mid-term results of the modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome (HLHS) and its variants to identify the risk factors for hospital mortality. Material and Method: Between March, 2003, and December, 2009, 23 patients (18 males and 5 females) with HLHS or variants underwent the modified Norwood procedure. The age at operation ranged from 3 to 60 days (mean, $11.7{\pm}13.2days$) and weight at operation ranged from 2.2 to 4.8 kg (mean, $3.17{\pm}0.52kg$). We used a modified technique that spared the anterior wall of the main pulmonary artery in 20 patients. The sources of pulmonary blood flow were RV-PA conduit in 15 patients (group I) and RMBTS in 8 (group II). Follow-up was completed in 19 patients (19/20, 95%) in our hospital (mean $26.0{\pm}22.8months$). Result: Early death occurred in 3 patients (3/23, 13%), of whom 2 had TAPVC. Fourteen patients underwent subsequent bidirectional cavopulmonary connection (BCPC, stage 2) and seven underwent the Fontan operation (stage 3). Three patients died between stages, 2 before stage 2 and one before stage 3. The estimated 1-year and 5-year survival rates were 78% and 69%, respectively. On multivariate regression analysis, aberrant right subclavian artery (RSCA) and associated total anomalous pulmonary venous connection (TAPVC) were risk factors for hospital mortality after stage 1 Norwood procedure. Conclusion: HLHS and its variants can be palliated by the modified Norwood procedure with low operative mortality. Total anomalous pulmonary venous connection adversely affects the survival after a stage 1 Norwood procedure, and interstage mortality rates need to be improved.

Financial Impact of Off-Pump Coronary Artery Bypass (체외순환 없이 시행하는 관상동맥우회술의 경제성 분석)

  • Lim, Cheong;Chang, Woo-Ik;Kim, Ki-Bong;Kim, Yoon
    • Journal of Chest Surgery
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    • v.35 no.5
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    • pp.365-368
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    • 2002
  • Background: Coronary artery bypass grafting(CABG) imposes large amount of medical costs, which are greatly affected by the surgical approach, quality of perioperative care and associated co-morbidities. Recently, off-pump CABG(OPCAB) has been introduced and performed with increasing frequency. To evaluate the efficacy of OPCAB in view of financial impact, we analyzed the costs and medical resources of OPCAB and compared with conventional CABG. Material and Method: From January 1998 to July 1999, 184 patients underwent CABG operation; 111 patients with OPCAB(group I) and 73 patients with conventional CABG(group II). We prospectively collected clinical data including risk factors and retrospectively reviewed the hospital resources. Result: Preoperative parameters including risk factors, postoperative mortality, morbidity and length of hospital stay were not different between the two groups, Duration of stay in the intensive care unit(ICU) (51.3 vs 128.3 hours, p<0.01) and ventilator, support time(14.9 vs 56.2 hours, p<0.01) were significantly shorter in the OPCAB group. Total hospital coats were 17,220,000 add 21,250,000(Korean Won) in group I and II, respectively(p<0.01). There were significant differences in operation fee, costs for operative materials, transfusion and diagnostic radiology between two groups. In group I, all the resources except diagnostic radiology were significantly decreased compared with group II. Conclusion: OPCAB has a beneficial effect on hospital charge and resource utilization. Shorter duration of the ICU stay and ventilatory support time may reduce the total hospital costs.

A Study on the Seropositivity of HBsAg among Biennial Health Examinees ; A Nation-wide Multicenter Survey (1998년 한국인 성인에서 혈청 HBsAg 양성률 추정을 위한 조사연구)

  • Kim, Dae-Sung;Kim, Young-Sik;Kim, Jae-Yong;Ahn, Yoon-Ok
    • Journal of Preventive Medicine and Public Health
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    • v.35 no.2
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    • pp.129-135
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    • 2002
  • Objective : The primary objective of this study was to estimate the prevalence of HBsAg-positives in the late 1990's among Korean adults. In addition, we evaluated the association of age, a residential area, a vaccination rate, a family history of chronic liver diseases and a past history of acute liver disease with the seropositivity of HBsAg, and estimated the prevalence of chronic HBV infection by follow-up for 6 month or more. Methods : A total of 10 areas, six metropolitan and four small cities, were selected. In each cities, one health screening center was selected for recruitment of study subjects. The study subjects were enrolled from a general health examination program that is provided by medical insurance companies. Questionnaires on various risk factors were administered to the study subjects. Sera was drawn and tested for HBsAg by radioimmunoassay. HBeAg and ALT were also tested for those of HBsAg positive. The HBsAg positives was retest for HBsAg 6 months later Results : Among the study subjects (n= 1816), the seroprevalence of HBsAg was 5.5% (95% CI=4.5%-6.6%), 7.4% in men (95% CI=5.8-9.4) and 3.6% in women (95% CI=2.5-5.0). A past history of acute liver disease and a family history of chronic liver diseases was shown to be risk factors for HBsAg positivity. Among the 31 HBsAg-positives, negative seroconversion rate was estimated to be 3.2%, Thus, prevalence of chronic HBV infection was estimated to be 5.3% (95% CI=3.7-6.6). Conclusion : In this study, the HBsAg seroprevalence rate was lower than that of the other studies in 1980's, particularly in young adult and women. Considering the public health importance of liver cancer and chronic liver diseases, the further effort is needed to prevent and reduce the HBV infection.

The Effect of Social Entrepreneurship on Entrepreneurial Motivation and Intention in Social Enterprises (사회적 기업가정신 및 창업동기가 창업의지에 미치는 영향)

  • Chung, Young-Soo;Jung, Chul-Ho
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.3
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    • pp.115-125
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    • 2023
  • The purpose of this study is to empirically identify the influence of social entrepreneurship on the formation of entrepreneurial motivation and entrepreneurial intention. In order to effectively achieve the purpose of the study, a research model and hypotheses are developed based on the results of a comprehensive review of relevant prior literature. The research model is set as social entrepreneurship including innovativeness, risk-taking, initiative, and social value orientation as independent variables, and entrepreneurship motivation is divided into intrinsic and extrinsic motivation. For the study, data were collected from a total of 114 social enterprise-related prospective entrepreneurs and early start-ups, and a research model and hypotheses analysis are conducted. The results of the empirical analysis are summarized as follows. First, all four components of social entrepreneurship were found to have a positive effect on intrinsic motivation. However, it is found that innovativeness and initiative among the components of social entrepreneurship has a positive effect on extrinsic motivation, whereas risk-taking and social value orientation has no significant effect on extrinsic motivation. Second, all four components of social entrepreneurship were found to have a positive effect on the entrepreneurial intention. Third, both intrinsic and extrinsic entrepreneurial motivation are found to have a positive effect on entrepreneurial intention. Finally, in the relationship between social entrepreneurship and entrepreneurial intention, both intrinsic and extrinsic entrepreneurial motivation are confirmed to have a positive mediating effect. This study specified the factors of social entrepreneurship and entrepreneurship motivation that affect entrepreneurship awareness and behavior targeting social enterprises with differentiated characteristics from existing for-profit enterprises. And through an empirical analysis of the influence relationship between these factors, an attempt was made to derive academic and practical implications.

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Analysis Study on the use of Frequency and the Cooking Method of Leaf and Stem Vegetables in High School Foodservice (고등학교 급식식단의 엽경채류 식재료 사용 빈도 및 조리방법 분석 연구)

  • Min, Ji-Hyeon;Lee, Jong-Kyung;Kim, Hyun-Jung;Yoon, Ki-Sun
    • Journal of Food Hygiene and Safety
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    • v.31 no.4
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    • pp.250-257
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    • 2016
  • This study was conducted to extract the factors affecting the microbial safety of leaf and stem vegetables in the high school foodservice and to provide information for supplying the safe foodservice menu. The lunch and dinner menu (1,945 data) of the total 6 high schools at the Central and the South Region in March, June, September, and December were collected. The frequency analysis and the multiple correspondence analysis (MCA) based on the 3 factors (potentially hazardous food (PHF), leafy and stem vegetables in the menu, the cooking methods) were conducted. The most frequent PHF was the menu of blanched vegetables, salads, seaweeds and fried chicken. The most frequent consumed leaf and stem vegetables were spinach, chive, lettuce, Western cabbage, perilla leaf, iceberg lettuce, chicory, leek and broccoli. MCA based on the leaf and stem vegetables, the region, and the cooking method (cooked/non-cooked) showed that garlic stem and spinach were more used in the Central Region, while water drop-wort were more used in the South Region. Iceberg lettuce, Bok choy and leek were included frequently in the PHF menu. Plant products frequently used in PHF menu requires the food safety system such as Good Agricultural Practice (GAP) to reduce the microbial risk. The menu database according to raw materials based on cooking methods (heating or mixing) as well as the development and verification of menu based on the microbial safety will be contributed to provide the safer foodservice menu.

Bankruptcy Type Prediction Using A Hybrid Artificial Neural Networks Model (하이브리드 인공신경망 모형을 이용한 부도 유형 예측)

  • Jo, Nam-ok;Kim, Hyun-jung;Shin, Kyung-shik
    • Journal of Intelligence and Information Systems
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    • v.21 no.3
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    • pp.79-99
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    • 2015
  • The prediction of bankruptcy has been extensively studied in the accounting and finance field. It can have an important impact on lending decisions and the profitability of financial institutions in terms of risk management. Many researchers have focused on constructing a more robust bankruptcy prediction model. Early studies primarily used statistical techniques such as multiple discriminant analysis (MDA) and logit analysis for bankruptcy prediction. However, many studies have demonstrated that artificial intelligence (AI) approaches, such as artificial neural networks (ANN), decision trees, case-based reasoning (CBR), and support vector machine (SVM), have been outperforming statistical techniques since 1990s for business classification problems because statistical methods have some rigid assumptions in their application. In previous studies on corporate bankruptcy, many researchers have focused on developing a bankruptcy prediction model using financial ratios. However, there are few studies that suggest the specific types of bankruptcy. Previous bankruptcy prediction models have generally been interested in predicting whether or not firms will become bankrupt. Most of the studies on bankruptcy types have focused on reviewing the previous literature or performing a case study. Thus, this study develops a model using data mining techniques for predicting the specific types of bankruptcy as well as the occurrence of bankruptcy in Korean small- and medium-sized construction firms in terms of profitability, stability, and activity index. Thus, firms will be able to prevent it from occurring in advance. We propose a hybrid approach using two artificial neural networks (ANNs) for the prediction of bankruptcy types. The first is a back-propagation neural network (BPN) model using supervised learning for bankruptcy prediction and the second is a self-organizing map (SOM) model using unsupervised learning to classify bankruptcy data into several types. Based on the constructed model, we predict the bankruptcy of companies by applying the BPN model to a validation set that was not utilized in the development of the model. This allows for identifying the specific types of bankruptcy by using bankruptcy data predicted by the BPN model. We calculated the average of selected input variables through statistical test for each cluster to interpret characteristics of the derived clusters in the SOM model. Each cluster represents bankruptcy type classified through data of bankruptcy firms, and input variables indicate financial ratios in interpreting the meaning of each cluster. The experimental result shows that each of five bankruptcy types has different characteristics according to financial ratios. Type 1 (severe bankruptcy) has inferior financial statements except for EBITDA (earnings before interest, taxes, depreciation, and amortization) to sales based on the clustering results. Type 2 (lack of stability) has a low quick ratio, low stockholder's equity to total assets, and high total borrowings to total assets. Type 3 (lack of activity) has a slightly low total asset turnover and fixed asset turnover. Type 4 (lack of profitability) has low retained earnings to total assets and EBITDA to sales which represent the indices of profitability. Type 5 (recoverable bankruptcy) includes firms that have a relatively good financial condition as compared to other bankruptcy types even though they are bankrupt. Based on the findings, researchers and practitioners engaged in the credit evaluation field can obtain more useful information about the types of corporate bankruptcy. In this paper, we utilized the financial ratios of firms to classify bankruptcy types. It is important to select the input variables that correctly predict bankruptcy and meaningfully classify the type of bankruptcy. In a further study, we will include non-financial factors such as size, industry, and age of the firms. Thus, we can obtain realistic clustering results for bankruptcy types by combining qualitative factors and reflecting the domain knowledge of experts.