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Surrogate and Shared Medical Decision Making for Unrepresented Patients (의료행위에 대한 동의에서 환자 보호자의 법적 지위와 역할 - 대행결정권과 공동의사결정을 중심으로 -)

  • Kim, SooJeong
    • The Korean Society of Law and Medicine
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    • v.20 no.2
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    • pp.43-82
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    • 2019
  • In Korea surrogate medical decision makings happen without legal grounds. The purpose of this article is to research the issues in preparing policies for decision-making on behalf of unrepresented patients. As aspects of comparative law, there are two approaches. One of them is to regulate default surrogate list. If no agent or guardian has been appointed, some legislatures provide that members of patient's family who is reasonably available, in descending order of priority of not, may act as surrogate: (1) the spouse, unless legally separated; (2) an adult child; (3) a parent; or (4) an adult brother or sister. If none of them is eligible to act as surrogate, some legislatures allow close friends to make health-care decisions for adult individuals who lack capacity. On the other hand there are other legislatures which provide no surrogate decision maker list but oblige the responsible authority to determine with advice of family members or friends of the patient. In the end the first approach can not guarantee that the surrogate decision maker like family members or friends will determine in the best interest of the patient.

p16 - a Possible Surrogate Marker for High-Risk Human Papillomaviruses in Oral Cancer?

  • Sritippho, Thanun;Pongsiriwet, Surawut;Lertprasertsuke, Nirush;Buddhachat, Kittisak;Sastraruji, Thanapat;Iamaroon, Anak
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.8
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    • pp.4049-4057
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    • 2016
  • Background: High-risk human papillomaviruses (HR-HPV), particularly types 16 and 18, have been found to play an important role in head and neck cancer, including oropharyngeal squamous cell carcinoma (OPSCC) and oral squamous cell carcinoma (OSCC). p16, a cell cycle inhibitor, has been postulated as a surrogate marker for HR-HPV, since p16 is aberrantly overexpressed in such lesions, especially in HR-HPV-positive OPSCC. However, p16 as a surrogate marker for HR-HPV infection in cancers of the oral cavity remains controversial. Objective: The objectives of the study were to investigate the expression of p16 and the presence of HR-HPV in OSCC and oral verrucous carcinoma (VC) and to determine if p16 could be used as a surrogate marker for HR-HPV. Materials and Methods: Forty one formalin-fixed, paraffin-embedded tissues of OSCC (n=37) or VC (n=4) with clinical and histopathologic data of each case were collected. Expression of p16 was determined by immunohistochemistry, focusing on both staining intensity and numbers of positive cells. The presence of HPV types 16 and 18 was detected by polymerase chain reaction (PCR). Descriptive statistics were employed to describe the demographic, clinical, and histopathologic parameters. Associations between p16 overexpression, HR-HPV and all variables were determined by Fisher's exact test, odds ratios (ORs) and corresponding 95% confidence intervals (CIs). In addition, the use of p16 as a surrogate marker for HR-HPV was analyzed by sensitivity and specificity tests. Results: p16 was overexpressed in 8/37 cases (21.6%) of OSCC and 2/4 cases (50%) of VC. HPV-16 was detected in 4/34 OSCC cases (11.8%) and HPV-18 was detected in 1/34 OSCC cases (2.9%). Co-infection of HPV-16/18 was detected in 1/4 VC cases (25%). Both p16 overexpression and HR-HPV were significantly associated with young patients with both OSCC and VC (p<0.05, OR 20, 95% CI 1.9-211.8; p<0.05, OR 23.3, 95% CI 2.4-229.7, respectively). p16 was able to predict the presence of HPV-16/18 in OSCC with 40% sensitivity and 79.3% specificity and in VC with 100% sensitivity and 66.7% specificity, respectively. Conclusions: p16 overexpression was found in 24.4% of both OSCC and VC. HR-HPV, regardless of type, was detected in 15.8% in cases of OSCC and VC combined. The results of sensitivity and specificity tests suggest that p16 can be used as a surrogate marker for HR-HPV in OSCC and VC.

Inactivation of a Norovirus Surrogate by High Pressure Treatment (고압처리에 의한 Norovirus Surrogate의 불활성화)

  • Lee, Hee-Jung;Oh, Eun-Gyoung;Yu, Hong-Sik;Shin, Soon-Bum;Park, Yu-Sun;Shin, Yun-Kyung;Park, Jung-Jun;Yoon, Ho-Dong
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.42 no.3
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    • pp.232-237
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    • 2009
  • Norovirus surrogate (feline calicivirus) was inactivated by treatment at 50,000 psi for 60 sec by 6.8-$log_{10}TCID_{50}mL^{-1}$. Tissue obtained from oyster (digestive gland, gill and mantle) was qualitatively destroyed and distorted by treatment at pressure greater than 5,000 psi for 60 sec. High pressure treatment induced progressive changes in the color of the oyster adductor muscle. High pressure treatment effectively reduced norovirus surrogate but induced conformational changes in the tissue and color of oyster flesh.

Economic Design of $\bar{X}$ Control Chart Using a Surrogate Variable (대용변수를 이용한 $\bar{X}$ 관리도의 경제적 설계)

  • Lee, Tae-Hoon;Lee, Jae-Hoon;Lee, Min-Koo;Lee, Joo-Ho
    • Journal of Korean Society for Quality Management
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    • v.37 no.2
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    • pp.46-57
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    • 2009
  • The traditional approach to economic design of control charts is based on the assumption that a process is monitored using a performance variable. However, various types of automatic test equipments recently introduced as a part of factory automation usually measure surrogate variables instead of performance variables that are costly to measure. In this article we propose a model for economic design of a control chart which uses a surrogate variable that is highly correlated with the performance variable. The optimum values of the design parameters are determined by maximizing the total average income per cycle time. Numerical studies are performed to compare the proposed $\bar{X}$ control charts with the traditional model using the examples in Panagos et al. (1985).

Comparative Study on Surrogate Modeling Methods for Rapid Electromagnetic Forming Analysis

  • Lee, Seungmin;Kang, Beom-Soo;Lee, Kyunghoon
    • Transactions of Materials Processing
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    • v.27 no.1
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    • pp.28-36
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    • 2018
  • Electromagnetic forming is a type of high-speed forming process to deform a workpiece through a Lorentz force. As the high strain rate in an electromagnetic-forming simulation causes infeasibility in determining constitutive parameters, we employed inverse parameter estimation in the previous study. However, the inverse parameter estimation process required us to spend considerable time, which leads to an increase in computational cost. To overcome the computational obstacle, in this research, we applied two types of surrogate modeling methods and compared them to each other to evaluate which model is best for the electromagnetic-forming simulation. We exploited an artificial neural network and we reduced-order modeling methods. During the construction of a reduced-order model, we extracted orthogonal bases with proper orthogonal decomposition and predicted basis coefficients by utilizing an artificial neural network. After the construction of the surrogate models, we verified the artificial neural network and reduced-order models through training and testing samples. As a result, we determined the artificial neural network model is slightly more accurate than the reduced-order model. However, the construction of the artificial neural network model requires a considerably larger amount of time than that of the reduced-order model. Thus, a reduced order modeling method is more efficient than an artificial neural network for estimating the electromagnetic forming and for the rapid approximation of structural simulations which needs repetitive runs.

A Study on Reliability of Kriging Based Approximation Model and Aerodynamic Optimization for Turbofan Engine High Pressure Turbine Nozzle (터보팬 엔진 고압터빈 노즐에 대한 크리깅 모델 기반 근사모델의 신뢰도 및 공력성능 최적화 연구)

  • Lee, Sanga;Lee, Saeil;Kang, Young-Seok;Rhee, Dong-Ho;Lee, Dong-Ho;Kim, Kyu-Hong
    • The KSFM Journal of Fluid Machinery
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    • v.16 no.6
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    • pp.32-39
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    • 2013
  • In the present study, three-dimensional aerodynamic optimization of high pressure turbine nozzle for turbofan engine was performed. For this, Kriging surrogate model was built and refined iteratively by supplying additional experimental points until the surrogate model and CFX result has effective difference on objective function. When the surrogate model satisfied this reliability condition and developed enough, optimum point was investigated. Commercial program PIAnO was used for optimization process and evolutionary algorithm was used for searching optimum point. As a result, difference between estimated value from Kriging surrogate model and CFD result converges within 0.01% and the optimized nozzle shape has 0.83% improved aerodynamic efficiency.

Development of the Jini Surrogate-based Broadband PLC Home Controller (Jini Surrogate에 기반한 광대역 PLC 홈 제어기 개발)

  • Kim Hee-Sun;Lee Chang-Goo
    • Journal of Institute of Control, Robotics and Systems
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    • v.12 no.1
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    • pp.1-8
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    • 2006
  • The home network system guarantees families a safe, economical, socially integrated and healthy life by using information appliances. And it provides a family with domestic safety, control of instruments, controllable energy and health monitoring by connecting to home appliances. This study designs the broadband PLC home controller using broadband PLC(Power Line Communication) technology which can save much cost at a network infrastructure by using the existing power line at home. The broadband PLC home controller consists of the broadband PLC module, the embedded main controller module and I/O module. The broadband PLC home controller can control various domestic appliances such as an auto door-lock, a boiler, an oven, etc., because it has various I/O specifications. In this study, selected home network middleware for the broadband PLC home controller is Jini surrogate using Jini technology designed by means of access to easily a home network system without a limitation of the devices. And a client application program is supported java servlet program to manage and monitor the broadband PLC home controller via web browser of a PC or a PDA, etc. Finally, for an application, we implemented and tested a home security system using one broadband PLC home controller.

Optimization of a horizontal axis marine current turbine via surrogate models

  • Thandayutham, Karthikeyan;Avital, E.J.;Venkatesan, Nithya;Samad, Abdus
    • Ocean Systems Engineering
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    • v.9 no.2
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    • pp.111-133
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    • 2019
  • Flow through a scaled horizontal axis marine current turbine was numerically simulated after validation and the turbine design was optimized. The computational fluid dynamics (CFD) code Ansys-CFX 16.1 for numerical modeling, an in-house blade element momentum (BEM) code for analytical modeling and an in-house surrogate-based optimization (SBO) code were used to find an optimal turbine design. The blade-pitch angle (${\theta}$) and the number of rotor blades (NR) were taken as design variables. A single objective optimization approach was utilized in the present work. The defined objective function was the turbine's power coefficient ($C_P$). A $3{\times}3$ full-factorial sampling technique was used to define the sample space. This sampling technique gave different turbine designs, which were further evaluated for the objective function by solving the Reynolds-Averaged Navier-Stokes equations (RANS). Finally, the SBO technique with search algorithm produced an optimal design. It is found that the optimal design has improved the objective function by 26.5%. This article presents the solution approach, analysis of the turbine flow field and the predictability of various surrogate based techniques.

A general active-learning method for surrogate-based structural reliability analysis

  • Zha, Congyi;Sun, Zhili;Wang, Jian;Pan, Chenrong;Liu, Zhendong;Dong, Pengfei
    • Structural Engineering and Mechanics
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    • v.83 no.2
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    • pp.167-178
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    • 2022
  • Surrogate models aim to approximate the performance function with an active-learning design of experiments (DoE) to obtain a sufficiently accurate prediction of the performance function's sign for an inexpensive computational demand in reliability analysis. Nevertheless, many existing active-learning methods are limited to the Kriging model, while the uncertainties of the Kriging itself affect the reliability analysis results. Moreover, the existing general active-learning methods may not achieve a fully satisfactory balance between accuracy and efficiency. Therefore, a novel active-learning method GLM-CM is constructed to yield the issues, which conciliates several merits of existing methods. To demonstrate the performance of the proposed method, four examples, concerning both mathematical and engineering problems, were selected. By benchmarking obtained results with literature findings, various surrogate models combined with the proposed method not only provide an accurate reliability evaluation while highly alleviating the computational burden, but also provides a satisfactory balance between accuracy and efficiency compared to the other reliability methods.