• Journal of Chest Surgery
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• v.57 no.2
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• pp.120-125
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• 2024

Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

• Convergence Security Journal
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• v.24 no.1
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• pp.43-49
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• 2024

The convergence of education and technology has been emphasized, leading to the application of educational technology (EdTech) in the field of education. EdTech provides learner-centered, customized learning environments through various media and learning situations. In this paper, we designed hardware for EdTech-based educational tools for IoT security education in the field of cybersecurity education. The hardware is based on a dual microcontroller unit (MCU) within a single board, allowing for both attack and defense to be performed. To leverage various sensors in the Internet of Things (IoT), the hardware is modularly designed. From an educational perspective, utilizing EdTech in cybersecurity education enhances engagement by incorporating tangible physical teaching aids. The proposed research suggests that the design of IoT security education hardware can serve as a reference for simplifying the creation of a security education environment for embedded hardware, software, sensor networks, and other areas that are challenging to address in traditional education..

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.76-86
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• 2023

Backgrounds/Aims: The aim of this study was to describe short- and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical United Kingdom hepatopancreatobiliary unit. Methods: A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (PDAC), ampullary adenocarcinoma (AA), or distal cholangiocarcinoma (CC) from September 1st, 2006 to May 31st, 2015 was carried out. The following information was obtained: demographics, comorbidities, preoperative investigations, neoadjuvant treatment, operative details, postoperative management, complications, adjuvant treatment, five-year recurrence, and five-year survival. Effects of selected preoperative variables on short- and long-term outcomes were investigated. Results: Of 271 included patients, 57.9% had PDAC, 25.8% had AA, and 16.2% had CC. In total, 67.9% experienced morbidity and 17.3% developed a Clavien-Dindo grade ≥ III complication. The 90-day mortality was 3.3%. Clinically-relevant postoperative pancreatic fistula, bile leak, gastrojejunal leak, postpancreatectomy haemorrhage and delayed gastric emptying affected 8.1%, 4.1%, 0.0%, 9.2%, and 19.9% of patients, respectively. American Society of Anesthesiologists grade III-VI correlated with overall morbidity (p = 0.002) and major morbidity (p = 0.009), but not 90-day mortality or five-year survival. The same pattern was observed in patients with a preoperative serum bilirubin > 29 µmol/L and/or a neutrophil/lymphocyte ratio > 3.1. Five-year cancer recurrence and five-year survival were 68.3% and 22.5%, respectively. PDAC patients had higher five-year recurrence but lower five-year survival rates (both p = 0.001). Conclusions: In our series, the majority of patients experienced a complication. However, few patients experienced major morbidity. Surgical risk factors did not affect five-year survival.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.87-94
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• 2023

Backgrounds/Aims: Central pancreatectomy (CP) is associated with a higher rate of postoperative pancreatic fistula (POPF), and it is less preferred over distal pancreatectomy (DP). We compared the short- and long-term outcomes between CP and DP for low-grade pancreatic neck and body tumors. Methods: This was a propensity score-matched case-control study of patients who underwent either CP or DP for low-grade pancreatic neck and body tumors from 2003 to 2020 in a tertiary care unit in southern India. Patients with a tumor >10 cm or a distal residual stump length of <4 cm were excluded. Demographics, clinical profile, intraoperative and postoperative parameters, and the long-term postoperative outcomes for exocrine and endocrine insufficiency, weight gain, and the 36-Item Short Form Survey (SF-36) quality of life questionnaire were compared. Results: Eighty-eight patients (CP: n=37 [cases], DP: n=51 [control]) were included in the unmatched group after excluding 21 patients (meeting exclusion criteria). After matching, both groups had 37 patients. The clinical and demographic profiles were comparable between the two groups. Blood loss and POPF rates were significantly higher in the CP group. However, Clavien-Dindo grades of complications were similar between the two groups (p = 0.27). At a median follow-up of 38 months (range = 187 months), exocrine sufficiency was similar between the two groups. Endocrine sufficiency, weight gain, SF-36 pain control score, and general health score were significantly better in the CP group. Conclusions: Despite equivalent clinically significant morbidities, long-term outcomes are better after CP compared to DP in low-grade pancreatic body tumors.

• Child Health Nursing Research
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• v.30 no.1
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• pp.54-66
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• 2024

Purpose: This study investigated participation in and perceptions of antibiotic stewardship among nurses at a children's hospital. Methods: This descriptive study included 125 nurses working in the inpatient ward, intensive care unit and emergency room of a single tertiary children's hospital. The study measured 14 factors influencing antibiotic stewardship behaviors using the theoretical domains framework. Each factor was analyzed by categorizing it into components (capability, opportunity, and motivation) that have been proposed as influencing factors in the COM-B model of behavior. One-way analysis of variance and Pearson correlation coefficients were used to explore differences in antibiotic stewardship behaviors and influencing factors according to general characteristics and the correlation between antibiotic stewardship behaviors and COM-B components. Results: No statistically significant difference in antibiotic stewardship behaviors was found based on the experience of antibiotic stewardship education or the nursing department. However, significant differences were observed in the perception levels of factors related to antibiotic stewardship behaviors according to the experience of antibiotic stewardship education in skill (physical) (p=.042), knowledge (p=.027), intentions (p=.028), and social influences (p=.010). Additionally, significant differences were observed in perception levels according to the sub-components of the COM-B model, specifically physical capability (p=.042), psychological capability (p=.027), and social opportunity (p=.010). Conclusion: To expand nurses' involvement and roles in antibiotic stewardship, nurses should acknowledge the significance of appropriate antibiotic use, aiming to enhance the quality of medical care and ensure patient safety. In pursuit of this objective, tailored education aligning with the specific needs and practices of nurses is essential.

• Journal of Hospice and Palliative Care
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• v.27 no.2
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• pp.64-76
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• 2024

Purpose: End-of-life (EOL) care is a vulnerable period in an individual's life. Healthcare professionals (HPs) strive to balance the preservation of human life with respect for the patient's wishes. The aims of our study were to assess HPs' knowledge and perceptions of EOL care and to propose areas of improvement to improve the quality of care. Methods: We conducted a single-center, cross-sectional study involving HPs from a university hospital who encountered EOL care situations. We used a questionnaire divided into four sections: knowledge, practice, perception, and training. We calculated the rate of correct answers and the collective competence index. Results: Eighty-six questionnaires were analyzed, with 82.5% (71/86) completed by medical respondents and 17.5% (15/86) by paramedical respondents. Most of the respondents, 71.8% (51/71), were interns and residents. The study focused on palliative care, medical assistance in dying, aggressive medical treatment, and euthanasia, finding adequate knowledge in the first three areas. Respondents assigned to the intensive care unit and those with more than 8 years of experience had significantly higher correct answer rates than their counterparts. Seventy-five percent of respondents (65/86) reported feeling that they had little or no mastery of EOL care, primarily attributing this to insufficient training and the unavailability of trainers. Conclusion: Based on the findings of our study, which we believe to be the first of its kind in Tunisia, we can conclude that HPs possess an acceptable level of knowledge regarding EOL care. However, they require more exposure and training to develop expertise in this area.

• Imaging Science in Dentistry
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• v.54 no.3
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• pp.289-295
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• 2024

Purpose: This study examined the influence of metal artifact reduction (MAR), the application of sharpening filters, and their combination on the diagnosis of horizontal root fracture (HRF) in teeth adjacent to a zirconia implant on cone-beam computed tomography (CBCT) examinations. Materials and Methods: Nineteen single-rooted teeth (9 with HRF and 10 without) were individually positioned in the right central incisor socket of a dry human maxilla. A zirconia implant was placed adjacent to each tooth. Imaging was performed using an OP300 Maxio CBCT (Instrumentarium, Tuusula, Finland) unit with the following settings: a current of 8 mA, both MAR modes(enabled and disabled), a 5×5 cm field of view, a voxel size of 0.085 mm, and a peak kilovoltage of 90 kVp. Four oral and maxillofacial radiologists independently evaluated the CBCT scans under both MAR conditions and across 3 levels of sharpening filter application (none, Sharpen 1×, and Sharpen 2×). Diagnostic metrics were calculated and compared using 2-way analysis of variance (α=5%). The weighted kappa test was used to assess intra- and inter-examiner reliability in the diagnosis of HRF. Results: MAR tool activation, sharpening filter use, and their combination did not significantly impact the area under the receiver operating characteristic curve, sensitivity, or specificity of HRF diagnosis (P>0.05). Intra- and inter-examiner agreement ranged from fair to substantial. Conclusion: The diagnosis of HRF in a tooth adjacent to a zirconia implant is not affected by the activation of MAR, the application of a sharpening filter, or the combination of these tools.

• Clinical Nutrition Research
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• v.11 no.4
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• pp.264-276
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• 2022

Hemodialysis (HD) patients can experience appetite alterations that affect meals and nutritional status. Few qualitative studies have assessed the chronic impact of HD on the everyday diet. This study aimed to characterise comprehensively the experiences of HD patients adapting to appetite alteration. Semi-structured, face-to-face interviews were conducted in a unit of a tertiary hospital to understand patient experiences with appetite alteration. An interview guide was used to consider adaptive processes developed after reviewing the literature and based on the researchers' clinical experiences. A single researcher conducted all interviews to maintain consistency in data collection. The interview content was analysed using Nvivo 11 based on grounded theory and constant comparison analysis. As a results, the mean age and HD vintage of 14 participants were 60 and 5.8 years, respectively. We developed a self-care model based on HD patient experiences with appetite alteration based on axial and selective coding. Differences in urea sensitivity, taste alteration, and social support could be explained by timing of transitions, life events, and responses to stress. Self-care processes are adapted through the processes of "self-registration" and "self-reconstruction," starting with "disruption." At the stage of adjustment, 4 self-management types were derived based on pattern of self-care: self-initiator, follower, realist, and pessimist. The results of this study provide unique qualitative insight into the lived experiences of HD patients experiencing appetite alteration and their self-care processes. By recognising dietary challenges, health teams can better support HD patients in the transition from dietary education to self-care.

• Journal of the Korean Geographical Society
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• v.29 no.1
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• pp.65-83
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• 1994

Sevaral problems of administrative area sysem in Korea have been brought up for a long time. Because its frame has remained since Chosun and Japanese colonial period in spite of changing local administrative environment in accordance with rapid industrialization and urbanization. Recent reform of city (Shi)- county (Gun) integration is derived from this argument. But problems which permeate deeply overall system cannot be solved by partial reorganization of Shi-Gun. They may be rationalized only through the reform of the whole system. The aims of this study are to analyze problems of administrative area system entirelr and to discuss the direction of its reform from that point of view. Major problems of administrative area system are summed up into the followings. Firstly, it is found that administrative hierarchies are too many levels. Contemporary administrative hierarchical structure is 4 levels: regional autonomous government (Tukpyolshi, Jik'halshi, Do), local autonomous government (Shi, Gun), two leveis of auxiliary administrative area (Up, Myun and Ri). These hierarchies were established in late period of Chosun which transportation was undeveloped and residential activity space was confined. But today developing transportion and expanding sphere of life don't need administrative hierarchical structurl with many levels. Besides developing administrative technology reduces administrative space by degrees. Many levels of contemporary administrative hierarchical structure are main factor of administrative inefficency, discording with settlement system. Second problem is that Tukpyolshi and Jik'halshi - cities under direct control of the central government as metropolitan area - underbounded cities. Underbounded city discomforts residential life and increases external elects of local pulic services. Especially this problem is Seoul, Pusan and Daegu. Third problem is that Do-areas are mostly two larger in integrating into single sphere of life. In fact each of them consistes of two or three sphere of life. Fourth Problem is metropolitan government system that central city is seperated from complementary area, i.e. Do. It brings about weakening the economic force of Do. Fifth problem is that several cities divided single sphere of life. It is main factor of finantial inefficency and facing difficult regional administration. Finally necessity of rural parish (Myun.) is diminished gradually with higher order center oriented activty of rural residents. First of all administrative area system should corresponds with substantial sphere of life in order to solve these problems. Followings are some key directions this study proposes on the reform of administrative area system from that standpoint. 1. Principles of reorgnization -- integration of central dty with complementary area. -- correspondence of administrative hierarchical structure with settlement system. -- correspondence of boundary of administrative area with sphere of life. 2. Reform strategy -- Jik'halshi is integrated with Do and is under the contol of Do. -- Small Seoul shi (city) which have special functions as captal is demarcated in Seoul tukpyolshi and 22 autonomous distrcts of Seoul tukpyolshi is integrated into 3-4 cities. -- Neighboring cities (Shies) in single sphere of life are intrgrated into single city (Shj). -- Myun and Ri are abolished in rural region and new unit of local administrative area on the basis of lowest order sphere of life into which 3-4 Ries are integrated replaces them.

• Journal of The Korean Society of Grassland and Forage Science
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• v.34 no.1
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• pp.52-59
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• 2014

This study was conducted to estimate the Hanwoo carrying capacity when whole crop wheat, as a winter forage crop, was grown on mixed-sowing of legume forage and by applying cattle manure on the productivity and feed value of whole crop wheat during the period of 2012~2013. The experiment was conducted in a split plot design with three replications. The main plots consisted of three different culture methods such as whole crop wheat and mixed sowing combination with hairy vetch or forage pea. The subplots consisted of four different applications of cattle manure (0, 50, 100 and 150 kg N/ha). The annual amount of dry matter (DM) of whole crop wheat in Gyeongju were higher than those of in Gyeongsan and Yeongju, and the mixed-sowing of hairy vetch mixture was the highest (p<0.05) compared with the single-sowing of whole crop wheat and mixed-sowing of legume in Gyeongju. The DM amounts were increased proportionately corresponded to the applying level of cattle manure, and was found to be significantly (p<0.05) high at the level of 100 and 150 kg/ha groups. With the feed value of forage, the crude protein (CP) contents tended to be higher in the mixed-sowing of legume than the single-sowing of whole crop wheat at the wintering experimental sites of legume. For whole crop wheat, total digestible nutrients (TDN) content was the highest in the mixed sowing plots of forage pea in Gyeongsan; however, there was no significant differences among the single-sowing of whole crop wheat. The carrying capacity of Hanwoo (head/ha) was higher (p<0.05) in Gyeongju (3.83 head) than that in Gyeongsan (3.11) and Yeongju (1.35). Further, the carrying capacity in the single-sowing of whole crop wheat was lower than that in the mixed-sowing of legume, and the hairy vetch was the highest among the mixed-sowing groups (p<0.05). Overall, the present results recommend taking into account the wintering for the mix-sowing of legume in Gyeongbuk province. The cattle manure may be applied for legume in the wintering unavailable regions. In addition, applying cattle manure at the level of 100~150 kg/ha and the mix-sowing of legume may increase the productivity per unit area and feed value, including the CP, for improving the carrying capacity of Hanwoo.