• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.350-362
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• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Journal of Intelligence and Information Systems
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• v.27 no.1
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• pp.1-21
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• 2021

As the global business environment changes, uncertainties in technology development and market needs increase, and competition among companies intensifies, interests and demands for R&D activities of individual companies are increasing. In order to cope with these environmental changes, R&D companies are strengthening R&D investment as one of the means to enhance the qualitative competitiveness of R&D while paying more attention to facility investment. As a result, facilities or R&D investment elements are inevitably a burden for R&D companies to bear future uncertainties. It is true that the management strategy of increasing investment in R&D as a means of enhancing R&D capability is highly uncertain in terms of corporate performance. In this study, the structural factors that influence the R&D capabilities of companies are explored in terms of technology management capabilities, R&D capabilities, and corporate classification attributes by utilizing data mining techniques, and the characteristics these individual factors present according to the level of R&D capabilities are analyzed. This study also showed cluster analysis and experimental results based on evidence data for all domestic R&D companies, and is expected to provide important implications for corporate management strategies to enhance R&D capabilities of individual companies. For each of the three viewpoints, detailed evaluation indexes were composed of 7, 2, and 4, respectively, to quantitatively measure individual levels in the corresponding area. In the case of technology management capability and R&D capability, the sub-item evaluation indexes that are being used by current domestic technology evaluation agencies were referenced, and the final detailed evaluation index was newly constructed in consideration of whether data could be obtained quantitatively. In the case of corporate classification attributes, the most basic corporate classification profile information is considered. In particular, in order to grasp the homogeneity of the R&D competency level, a comprehensive score for each company was given using detailed evaluation indicators of technology management capability and R&D capability, and the competency level was classified into five grades and compared with the cluster analysis results. In order to give the meaning according to the comparative evaluation between the analyzed cluster and the competency level grade, the clusters with high and low trends in R&D competency level were searched for each cluster. Afterwards, characteristics according to detailed evaluation indicators were analyzed in the cluster. Through this method of conducting research, two groups with high R&D competency and one with low level of R&D competency were analyzed, and the remaining two clusters were similar with almost high incidence. As a result, in this study, individual characteristics according to detailed evaluation indexes were analyzed for two clusters with high competency level and one cluster with low competency level. The implications of the results of this study are that the faster the replacement cycle of professional managers who can effectively respond to changes in technology and market demand, the more likely they will contribute to enhancing R&D capabilities. In the case of a private company, it is necessary to increase the intensity of input of R&D capabilities by enhancing the sense of belonging of R&D personnel to the company through conversion to a corporate company, and to provide the accuracy of responsibility and authority through the organization of the team unit. Since the number of technical commercialization achievements and technology certifications are occurring both in the case of contributing to capacity improvement and in case of not, it was confirmed that there is a limit in reviewing it as an important factor for enhancing R&D capacity from the perspective of management. Lastly, the experience of utility model filing was identified as a factor that has an important influence on R&D capability, and it was confirmed the need to provide motivation to encourage utility model filings in order to enhance R&D capability. As such, the results of this study are expected to provide important implications for corporate management strategies to enhance individual companies' R&D capabilities.