Purpose : The purpose of this study was to identify pediatric nurses's knowledge related to children's pain and pediatric nurses' career including educational experience and to examine whether there is a difference of their knowledge according to their career. Method : Subjects of this study was 115 pediatric nurses of one university hospital who understood purpose of this study and accepted to participate in this study. Subjects responded questionnaire by self report. The data were gathered for 7 days during the period from October 20 to October '2:7, 2003. The pediatric nurses' knowledge and attitude survey regarding pain developed by Manworren(2001) was used to identify the knowledge related to children's pain of pediatric nurses. Nurses' career consisted of level of education, presently working ward, duration of experience at clinic, pediatric clinic and presently working ward and educational experience related to children's pain during undergraduate courses, ward orientation and continuing education. Educational experience regarding children's pain was measured by whether they had education related to children's pain during undergraduate courses, ward orientation and continuing education or not and their perception on the contents of education was measured by 5 point Likert type scale. SPSS Windows was used to analyze the data. Scores of the knowledge regarding children's pain and career including educational experience of pediatric nurses were presented as mean and standard deviation. Mean percentage of correct answers responded by the subjects was presented under the category of introduction, assessment, pharmacological and nonpharmacological intervention for children's pain. The difference of scores of the knowledge regarding children's pain according to nurses' career was analyzed using t-test, ANOVA and Tukey as a post hoc. Statistical significance was accepted at the level of p<.05. Result : Pediatric nurses had deficient knowledge related to children's pain on the whole and did not trust pain complaint and underestimated the pain. They were short of concrete practical knowledge about pain assessment and pharmacological and nonpharmacological intervention for children's pain. They were excessively concerned with side effect and addiction of analgesic drugs and had a negative view point on nonpharmacological pain intervention. About 50% of the subjects received education regarding children's pain while their undergraduate courses. The number of nurses who received education regarding children's pain while their undergraduate courses was found to be greater among the recently graduated nurses. In ward orientation and continuing education, only less than 10% of the nurses received education regarding children's pain. Nurses perceived their experienced educational content deficient; experienced educational content consisted of pain introduction, assessment and pharmacological and nonpharmacological intervention for children's pain while their undergraduate course, ward orientation and continuing education. There were no significant differences of the knowledge regarding children's pain of pediatric nurses according to level of education, duration of experience at clinic, pediatric clinic and presently working ward. Scores of the knowledge regarding children's pain of nurses at neonatal ward were significantly greater than those of nurses at pediatric intensive care unit. Scores of the knowledge regarding children's pain of pediatric nurses who received education during their undergraduate course were significantly greater than those who did not receive it during their undergraduate courses. Also scores of the knowledge regarding children's pain of pediatric nurses who received one kind of educational experience were significantly greater than those who had no educational experience. Conclusion : Pediatric nurses had deficient knowledge of children's pain and underestimated the pain of children. Also they were short of concrete practical knowledge on pain assessment and intervention for children's pain.
Respiratory gated radiation therapy and stereotactic body radiation therapy require identical tumor motions during each treatment with the motion detected in treatment planning CT. Therefore, this study developed a tumor motion monitoring and analysis system during the treatments employing RPM data, gated setup OBI images and a data analysis software. A respiratory training and guiding program which improves the regularity of breathing was used to patients. The breathing signal was obtained by RPM and the recorded data in the 4D console was read after treatment. The setup OBI images obtained gated at 0% and 50% of breathing phases were used to detect the tumor motion range in crenio-caudal direction. By matching the RPM data recorded at the OBI imaging time, a factor which converts the RPM motion to the tumor motion was computed. RPM data was entered to the institute developed data analysis software and the maximum, minimum, average of the breathing motion as well as the standard deviation of motion amplitude and period was computed. The computed result is exported in an excel file. The conversion factor was applied to the analyzed data to estimate the tumor motion. The accuracy of the developed method was tested by using a moving phantom, and the efficacy was evaluated for 10 stereotactic body radiation therapy patients. For the sine wave motion of the phantom with 4 sec of period and 2 cm of peak-to-peak amplitude, the measurement was slightly larger (4.052 sec) and the amplitude was smaller (1.952 cm). For patient treatment, one patient was evaluated not to qualified to SBRT due to the usability of the breathing, and in one patient case, the treatment was changed to respiratory gated treatment due the larger motion range of the tumor than treatment planed motion. The developed method and data analysis program was useful to estimate the tumor motion during treatment.
Yoon, In Suk;Seo, Ji Young;Shin, Choong Ho;Kim, Il Han;Shin, Hee Young;Yang, Sei Won;Ahn, Hyo Seop
Clinical and Experimental Pediatrics
/
v.49
no.3
/
pp.292-297
/
2006
Purpose : In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes. Methods : The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr. Results : The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from $-0.1{\pm}1.3$ initially to $-0.6{\pm}1.0$ after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency. Conclusion : Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.
Purpose: We developed a computer-aided classifier using artificial neural network (ANN) to discriminate the cerebral metabolic pattern of medial and lateral temporal lobe epilepsy (TLE). Materials and Methods: We studied brain F-18-FDG PET images of 113 epilepsy patients sugically and pathologically proven as medial TLE (left 41, right 42) or lateral TLE (left 14, right 16). PET images were spatially transformed onto a standard template and normalized to the mean counts of cortical regions. Asymmetry indices for predefined 17 mirrored regions to hemispheric midline and those for medial and lateral temporal lobes were used as input features for ANN. ANN classifier was composed of 3 independent multi-layered perceptrons (1 for left/right lateralization and 2 for medial/lateral discrimination) and trained to interpret metabolic patterns and produce one of 4 diagnoses (L/R medial TLE or L/R lateral TLE). Randomly selected 8 images from each group were used to train the ANN classifier and remaining 51 images were used as test sets. The accuracy of the diagnosis with ANN was estimated by averaging the agreement rates of independent 50 trials and compared to that of nuclear medicine experts. Results: The accuracy in lateralization was 89% by the human experts and 90% by the ANN classifier Overall accuracy in localization of epileptogenic zones by the ANN classifier was 69%, which was comparable to that by the human experts (72%). Conclusion: We conclude that ANN classifier performed as well as human experts and could be potentially useful supporting tool for the differential diagnosis of TLE.
Kim, Yong-Gyun;Bae, Sung-Woo;Bae, Soo-Il;Yoon, Hyang-Mi;Hong, Yong-Pyo
Korean journal of applied entomology
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v.45
no.3
s.144
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pp.309-316
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2006
Three sex pheromone components (cis-8-dodecenyl acetate (Z12Ac), trans-8-dodecenyl acetate (E12Ac), cis-8-dodecenol (Z12OH)) of the Oriental fruit moth, Grapholita molesta, were chemically synthesized. Especially to increase the composition of cis-stereoisomer, a triple bond intermediate was hydrogenated at $-20^{\circ}C$ with catalytic $Pd/BaSO_{4}$. The resulting product consisted of the acetates with a stereoisomer ratio in 92:8 (Z:E). The biological activity of the synthesized pheromone compounds was analyzed both in male responses and orientation disruption. The indoor pheromone effect was determined by male flight behavior showing wing movement in response to lure. Different mixtures of the synthetic pheromone components were prepared by mixing acetate and alcohol components in 100:0, 99:1, and 90:10 (g/g) and tested with a comparison of a standard commercial pheromone lure. The highest pheromone effect was observed in only acetate mixture (100:0) and the effect was reduced with the addition of the alcohol component. This indoor pheromone effect could be observed in field monitoring trial, in which 100:0 mixture showed the highest trap catches. Orientation disruption assay was conducted indoor by using a cage, in which the center had a commercial lure on sticky plate and the four candidates were placed at 6 cm away from the central lure on each of four directions. Test males were released to the arena during overnight (12 h) and then the caught males on the sticky plate were counted. The synthesized pheromone as well as the commercial pheromone showed 100% orientation disruption. However, the orientation disruption effect was reduced with decrease in the number of the surrounding disrupting pheromone baits. These results clearly suggest that the synthesized sex pheromone of G. molesta is biologically active and can be used for field mating disruption.
The hypocenter distribution of microseismic events generated by hydraulic fracturing for shale gas development provides essential information for understanding characteristics of fracture network. In this study, we evaluate how inaccurate velocity models influence the inversion results of two widely used location programs, hypoellipse and hypoDD, which are developed based on an iterative linear inversion. We assume that 98 stations are densely located inside the circle with a radius of 4 km and 5 artificial hypocenter sets (S0 ~ S4) are located from the center of the network to the south with 1 km interval. Each hypocenter set contains 25 events placed on the plane. To quantify accuracies of the inversion results, we defined 6 parameters: difference between average hypocenters of assumed and inverted locations, $d_1$; ratio of assumed and inverted areas estimated by hypocenters, r; difference between dip of the reference plane and the best fitting plane for determined hypocenters, ${\theta}$; difference between strike of the reference plane and the best fitting plane for determined hypocenters, ${\phi}$; root-mean-square distance between hypocenters and the best fitting plane, $d_2$; root-mean-square error in horizontal direction on the best fitting plane, $d_3$. Synthetic travel times are calculated for the reference model having 1D layered structure and the inaccurate velocity model for the inversion is constructed by using normal distribution with standard deviations of 0.1, 0.2, and 0.3 km/s, respectively, with respect to the reference model. The parameters $d_1$, r, ${\theta}$, and $d_2$ show positive correlation with the level of velocity perturbations, but the others are not sensitive to the perturbations except S4, which is located at the outer boundary of the network. In cases of S0, S1, S2, and S3, hypoellipse and hypoDD provide similar results for $d_1$. However, for other parameters, hypoDD shows much better results and errors of locations can be reduced by about several meters regardless of the level of perturbations. In light of the purpose to understand the characteristics of hydraulic fracturing, $1{\sigma}$ error of velocity structure should be under 0.2 km/s in hypoellipse and 0.3 km/s in hypoDD.
This study is to evaluate the physical and mechanical properties on the Ipseok-dae columnar joints of Mt. Mudeung National Park. For these purposes, physical and mechanical properties as well as discontinuity property on the Mudeungsan tuff, measurement of vibration and local meteorology around columnar joints, and ground deformation by self-weight of columnar joints were examined. For the physical and mechanical properties, average values were respectively 0.65% for porosity, 2.69 for specific gravity, 2.68 g/cm3 for density, and 2411 m/s for primary velocity, 323 MPa for uniaxial compressive strength, 81 GPa Young's modulus, and 0.25 for Poisson's ratio. For the joint shear test, average values were respectively 3.15 GPa/m for normal stiffness, 0.38 GPa/m for shear stiffness, 0.50 MPa for cohesion, and 35° for internal friction angle. The JRC standard and JRC chart was in the range of 4~6, and 1~1.5, respectively. The rebound value Q of silver schmidt hammer was 57 (≒ 90 MPa). It corresponds 20% of the uniaxial compressive strength of intact rock. The maximum vibration value around the Ipseok=dae columnar joints was in the range of 0.57 PPV (mm/s)~2.35 PPV (mm/s). The local meteorology of surface temperature, air temperature, humidity, and wind on and around columnar joints appeared to have been greatly influenced the weather on the day of measurement. For the numerical analysis of ground deformation due to its self-weight of the Ipseok-dae columnar joints, the maximum displacement of the right ground shows when the ground distance is approximately 2 m, while drastically decreased by 2~4 m, thereafter was insignificant. The maximum displacement of the middle ground shows when the ground distance is approximately 0~2 m, while drastically decreased by 3~10 m, thereafter was insignificant. The maximum displacement of the left ground shows when the ground distance is approximately 5~6 m, while drastically decreased by 6~10 m, thereafter was insignificant.
Purpose: Partial volume effect (PVE) is the phenomenon to lower the accuracy of image due to low estimate, which is to occur from PET/CT 3D image acquisition. The more resolution is declined and the lesion is small, the more it causes a big error. So that it can influence the test result. Studied the optimum image reconstruction method by using variation of parameter, which can influence the PVE. Materials and Methods: It acquires the image in each size spheres which is injected $^{18}F$-FDG to hot site and background in the ratio 4:1 for 10 minutes by using NEMA 2001 IEC phantom in GE Discovey STE 16. The iterative reconstruction is used and gives variety to iteration 2-50 times, subset number 1-56. The analysis's fixed region of interest in detail part of image and compute % difference and signal to noise ratio (SNR) using $SUV_{max}$. Results: It's measured that $SUV_{max}$ of 10 mm spheres, which is changed subset number to 2, 5, 8, 20, 56 in fixed iteration to times, SNR is indicated 0.19, 0.30, 0.40, 0.48, 0.45. As well as each sphere's of total SNR is measured 2.73, 3.38, 3.64, 3.63, 3.38. Conclusion: In iteration 6th to 20th, it indicates similar value in % difference and SNR ($3.47{\pm}0.09$). Over 20th, it increases the phenomenon, which is placed low value on $SUV_{max}$ through the influence of noise. In addition, the identical iteration, it indicates that SNR is high value in 8th to 20th in variation of subset number. Therefore, to reduce partial volume effect of small lesion, it can be declined the partial volume effect in iteration 6 times, subset number 8~20 times, considering reconstruction time.
With the onset of the Human Genome Project, social concerns about 'genetic information discrimination' have been raised, but the problem has not yet been highlighted in Korea. However, non-medical institutions' genetic testing which is related to disease prevention could be partially allowed under the revised "Bioethics and Safety Act" from June 30, 2016. In the case of one domestic insurance company, DTC genetic testing was provided for the new customer of cancer insurance as a complimentary service, which made the social changes related to the recognition of the genetic testing. At a time when precision medicine is becoming a new standard for medical care, discipline on genetic information discrimination has become a problem that can not be delayed anymore. Article 46 and 67 of the Bioethics Act stipulate the prohibition of discrimination on grounds of genetic information and penalties for its violation. However, these broad principles alone can not solve the problems in specific genetic information utilization areas such as insurance and employment. The United States, Canada, the United Kingdom, and Germany have different regulations that prohibit genetic information based discrimination. In the United States, Genetic Information Non-Discrimination Act takes a form that adds to the existing law about the prohibition of genetic information discrimination. In addition, the range of genetic information includes the results of genetic tests of individuals and their families, including "family history". Canada has recently enacted legislation in 2017, expanding coverage to general transactions of goods or services in addition to insurance and employment. The United Kingdom deals only with 'predictive genetic testing results of individuals'. In the case of insurance, the UK government and Association of British Insurers (ABI) agree to abide by a policy framework ('Concordat') for cooperation that provides that insurers' use of genetic information is transparent, fair and subject to regular reviews; and remain committed to the voluntary Moratorium on insurers' use of predictive genetic test results until 1 November 2019, and a review of the Concordat in 2016. In the case of employment, The ICO's 'Employment Practices Code (2011)' is used as a guideline. In Germany, Human Genetic Examination Act(Gesetz ${\ddot{u}}ber$ genetische Untersuchungen bei Menschen) stipulates a principle ban on the demand for genetic testing and the submission of results in employment and insurance. The evaluation of the effectiveness of regulatory framework, as well as the form and scope of the discipline is different from country to country. In light of this, it would be desirable for the issue of genetic information discrimination in Korea to be addressed based on the review of related regulations, the participation of experts, and the cooperation of stakeholders.
This study defines influencing sections as the part of the road section where passing vehicles are traveling with the lower speed compared to speed limit due to speed humps. The influencing section was divided into 3 parts; influencing section before the speed hump, interval section, and influencing section after the speed hump. This analysis focused on the changes of each part depending on installation types, vehicle types, and daytime or nighttime. For the interval section, especially, the ratio of distance traveled with lower speed than speed limit to interval section is defined as effective influencing section ratio to be analyzed. Vehicle speed profiles were collected with a speed gun to extract influencing section lengths. The survival analysis was applied and estimated survival functions are compared with each other by several statistical tests. As a consequence, the average length of influencing section on the 50m sequential speed humps was 75.3% longer during the deceleration than that of isolated speed hump, and 18.9% during the acceleration. The effective influencing section ratio for the 30m and 50m sequential speed humps had a small difference of 81.0% and 76.0% while the absolute values of the section that passing speed were less than the speed limit were longer on 50m sequential speed humps, each being 24.3m and 38.0m. Using the log rank test, it was evident that sequential speed humps were more effective to increase the length of influencing sections compared to the isolated speed hump. Vehicle type was the strong factor for influencing section length on the isolated speed hump, but daytime or nighttime was not the effective one. This research result can be used for improving the efficiency selecting the installation point of speed humps for road safety and estimating the standard of the distance between sequential speed humps.
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