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Molecular Epidemiologic Study of a Methicillin-resistant Staphylococcus aureus Outbreak at a Newborn Nursery and Neonatal Intensive Care Unit

  • Kang, Hyun Mi;Park, Ki Cheol;Lee, Kyung-Yil;Park, Joonhong;Park, Sun Hee;Lee, Dong-Gun;Kim, Jong-Hyun
    • Pediatric Infection and Vaccine
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    • v.26 no.3
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    • pp.148-160
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    • 2019
  • Purpose: This study aimed to investigate the molecular epidemiology of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak at a newborn nursery and neonatal intensive care unit (NICU). Methods: During the outbreak, from August to September 2017, MRSA isolates collected from neonates and medical staff underwent genotyping and screened for virulence factors. Antibiotic susceptibilities were tested. Results: During the study period, 41 neonates were admitted at the nursery (n=27) and NICU (n=14). Of these, 7 had MRSA infections (skin infection [n=6] and sepsis [n=1]) and 4 were colonized with MRSA. Associated medical staff (n=32) were screened; three were nasal MRSA carriers. Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375 was found to be the skin infection outbreak causing strain, with multi-drug resistance including low-level mupirocin resistance. SCCmec type IVa, ST 72, and a novel spa type designated t17879, was the cause of MRSA sepsis. Many different types of MRSA were colonized on the neonates; however, SCCmec type IVa, ST 72, spa type t664 was colonized in both neonates and a NICU nurse. All MRSA isolates from colonized infants were positive for the Panton-Valentine leukocidin (PVL) toxin gene. Conclusions: The strain causing an outbreak of skin infections had multi-drug resistance. Also, MRSA colonized in the neonates were found to carry the PVL toxin gene. Because different strains are present during an outbreak, molecular epidemiologic studies are important to identify the outbreak strain and colonized strains which aid in effective control and prevention of future MRSA outbreaks.

Real Option Analysis to Value Government Risk Share Liability in BTO-a Projects (손익공유형 민간투자사업의 투자위험분담 가치 산정)

  • KU, Sukmo;LEE, Sunghoon;LEE, Seungjae
    • Journal of Korean Society of Transportation
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    • v.35 no.4
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    • pp.360-373
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    • 2017
  • The BTO-a projects is the types, which has a demand risk among the type of PPP projects in Korea. When demand risk is realized, private investor encounters financial difficulties due to lower revenue than its expectation and the government may also have a problem in stable infrastructure operation. In this regards, the government has applied various risk sharing policies in response to demand risk. However, the amount of government's risk sharing is the government's contingent liabilities as a result of demand uncertainty, and it fails to be quantified by the conventional NPV method of expressing in the text of the concession agreement. The purpose of this study is to estimate the value of investment risk sharing by the government considering the demand risk in the profit sharing system (BTO-a) introduced in 2015 as one of the demand risk sharing policy. The investment risk sharing will take the form of options in finance. Private investors have the right to claim subsidies from the government when their revenue declines, while the government has the obligation to pay subsidies under certain conditions. In this study, we have established a methodology for estimating the value of investment risk sharing by using the Black - Scholes option pricing model and examined the appropriateness of the results through case studies. As a result of the analysis, the value of investment risk sharing is estimated to be 12 billion won, which is about 4% of the investment cost of the private investment. In other words, it can be seen that the government will invest 12 billion won in financial support by sharing the investment risk. The option value when assuming the traffic volume risk as a random variable from the case studies is derived as an average of 12.2 billion won and a standard deviation of 3.67 billion won. As a result of the cumulative distribution, the option value of the 90% probability interval will be determined within the range of 6.9 to 18.8 billion won. The method proposed in this study is expected to help government and private investors understand the better risk analysis and economic value of better for investment risk sharing under the uncertainty of future demand.

Analysis of Terpenoids as Volatile Compound Released During the Drying Process of Cryptomeria japonica (삼나무 건조 중 발생하는 휘발성 유기화합물 Terpenoids의 분석)

  • Lee, Su-Yeon;Gwak, Ki-Seob;Kim, Seon-Hong;Lee, Jun-Jae;Yeo, Hwan-Myeong;Choi, In-Gyu
    • Journal of the Korean Wood Science and Technology
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    • v.38 no.3
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    • pp.242-250
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    • 2010
  • The aim of this study was to investigate the terpenoids of Total Volatile Organic Compounds (VOCs) released during drying of Cryptomeria japonica using the thermal extractor (TE). Considering the drying process of C. japonica, temperatures of TE were set at $27^{\circ}C$, $60^{\circ}C$, $80^{\circ}C$, $100^{\circ}C$, and $120^{\circ}C$, respectively. As the result, the emission factors of VOCs and terpenoids were increased as temperature increased. The amount of terpenoids included in VOCs emission factors were 87.5%, 81.6%, 83.6%, 90.1%, and 97.3% depending on above temperatures, respectively. Especially at$100^{\circ}C$ and $120^{\circ}C$, the amount of terpenoids were measured more than 90%. ${\delta}$-cadinene was the highest yield at each temperature and 32 types of terpenoids were collected. Emitted terpenoids were classified into the sesquiterpene group which consists of 15 carbon sources. These 32 sesquiterpenes were used for determining the useful bioactivity such as antifungal activity by the agar dilution. As the result, they showed the antifungal activity against Trichophyton rubrum, Trichophyton mentagrophytes, Microsporum gypseum. The 5,000 ppm concentration of terpenoids showed a strong activity with 100% against the 3 fungi. At the 1,000 ppm concentration of terpenoids, the antifungal activities against three fungi were 95.2%, 98.7%, and 97.3%, and their activities were a little inhibited at 100 ppm concentration.

Clinical Application of Stent-graft in Thoracic Aortic Diseases (흉부 대동맥 질환에서 스텐트-그라프트의 임상적 적용)

  • Kim, Kyung-Hwan;Lee, Cheul;Chang, Ji-Min;Chung, Jin-Wook;Ahn, Hyuk;Park, Jae-Hyung
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.698-703
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    • 2001
  • Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

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Clinical Observations of the Drug Induced Hepatitis during Antituberculosis Medication (항결핵제 투여 중 나타난 간기능 장애의 임상적 고찰)

  • Park, Moon-Hwan;Yun, Sang-Won;Kim, Kung-Ho;Lee, Mung-Sun;Cho, Dong-Ill;Rhu, Nam-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.4
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    • pp.405-412
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    • 1994
  • Background: In Korea, the prevalence of tuberculosis and hepatitis is high, and combined therapy with rifampicin and pyrazinamide is used in tuberculosis, so drug induced hepatitis is not only problem of tuberculosis therapy but also cause of treatment failure. However most of recent reports on drug induced hepatitis during antituberculosis medication have dealt with its pathogenesis and have stressed the biochemical, and histopathological aspects of the disorder, whereas this study was designed primarily to provide information on the clinical features. Method: The subjects of study were 1414 patients treated with antituberculosis drugs on the department of chest medicine at National Medical Center during the 5-year 6-month period from January 1, 1988, to June 30, 1993. Retrospective analysis of clinical features for the 29 patients who developed drug induced hepatitis was done. Results: 1) The incidence of antituberculosis drug induced hepatitis was 2.1%. 2) Male to fema1e ratio of antituberculosis drug induced hepatitis was 2:1, but case rates among males and females were not significantly different. 3) Rates of drug induced hepatitis according to age distribution shows the most common incidence between 35 to 49 year old age group, but rates among groups of age were not significant1y different. 4) Drug induced hepatitis was most common in the case of moderate advanced pulmonary tuberculosis(rate is 2.78%), but rates among types of tuberculosis were not significant1y different. 5) 18 cases(62%) of antituberculosis drug induced hepatitis patients had no signs or symptoms. In remaining cases, they were nausea, vomiting, jaundice, hepatomegaly, icteric sclera, right upper quadrant tenderness in order. 6) 22 cases(76%) of antituberculosis drug induced hepatitis cases had occured within the first month. 7) The duration of abnormal liver function was $28{\pm}5$(Mean${\pm}$SD), ranged from 5 days to 180 days. 8) One case of antituberculosis drug induced hepatitis died. 9) The levels of abnormal GOT ranged from 64 to 1055U/L and GPT from 68 to 931U/L. Conclusion: There are no dicided predisposing factors of antituberculosis drug induced hepatitis, so it should be done biochemical monitoring as well as close monitoring for overt signs or symptoms of hepatitis to avoid the development of irreversible hepatic reaction, especially at the treatment of the first month.

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A Dynamic Management Method for FOAF Using RSS and OLAP cube (RSS와 OLAP 큐브를 이용한 FOAF의 동적 관리 기법)

  • Sohn, Jong-Soo;Chung, In-Jeong
    • Journal of Intelligence and Information Systems
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    • v.17 no.2
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    • pp.39-60
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    • 2011
  • Since the introduction of web 2.0 technology, social network service has been recognized as the foundation of an important future information technology. The advent of web 2.0 has led to the change of content creators. In the existing web, content creators are service providers, whereas they have changed into service users in the recent web. Users share experiences with other users improving contents quality, thereby it has increased the importance of social network. As a result, diverse forms of social network service have been emerged from relations and experiences of users. Social network is a network to construct and express social relations among people who share interests and activities. Today's social network service has not merely confined itself to showing user interactions, but it has also developed into a level in which content generation and evaluation are interacting with each other. As the volume of contents generated from social network service and the number of connections between users have drastically increased, the social network extraction method becomes more complicated. Consequently the following problems for the social network extraction arise. First problem lies in insufficiency of representational power of object in the social network. Second problem is incapability of expressional power in the diverse connections among users. Third problem is the difficulty of creating dynamic change in the social network due to change in user interests. And lastly, lack of method capable of integrating and processing data efficiently in the heterogeneous distributed computing environment. The first and last problems can be solved by using FOAF, a tool for describing ontology-based user profiles for construction of social network. However, solving second and third problems require a novel technology to reflect dynamic change of user interests and relations. In this paper, we propose a novel method to overcome the above problems of existing social network extraction method by applying FOAF (a tool for describing user profiles) and RSS (a literary web work publishing mechanism) to OLAP system in order to dynamically innovate and manage FOAF. We employed data interoperability which is an important characteristic of FOAF in this paper. Next we used RSS to reflect such changes as time flow and user interests. RSS, a tool for literary web work, provides standard vocabulary for distribution at web sites and contents in the form of RDF/XML. In this paper, we collect personal information and relations of users by utilizing FOAF. We also collect user contents by utilizing RSS. Finally, collected data is inserted into the database by star schema. The system we proposed in this paper generates OLAP cube using data in the database. 'Dynamic FOAF Management Algorithm' processes generated OLAP cube. Dynamic FOAF Management Algorithm consists of two functions: one is find_id_interest() and the other is find_relation (). Find_id_interest() is used to extract user interests during the input period, and find-relation() extracts users matching user interests. Finally, the proposed system reconstructs FOAF by reflecting extracted relationships and interests of users. For the justification of the suggested idea, we showed the implemented result together with its analysis. We used C# language and MS-SQL database, and input FOAF and RSS as data collected from livejournal.com. The implemented result shows that foaf : interest of users has reached an average of 19 percent increase for four weeks. In proportion to the increased foaf : interest change, the number of foaf : knows of users has grown an average of 9 percent for four weeks. As we use FOAF and RSS as basic data which have a wide support in web 2.0 and social network service, we have a definite advantage in utilizing user data distributed in the diverse web sites and services regardless of language and types of computer. By using suggested method in this paper, we can provide better services coping with the rapid change of user interests with the automatic application of FOAF.

No Association between (AAT)n Repeat Polymorphisms in the Cannabinoid Receptor 1 Gene and Smooth Pursuit Eye Movement Abnormality in Korean Patients with Schizophrenia (한국인 조현병 환자에서CNR1 유전자의 (AAT)n 삼핵산 반복 다형성과 안구추적운동 이상에 대한 연합 연구)

  • Kim, Min Jae;Kim, Chae-Ri;Park, Jin Wan;Pak, Doo Hyun;Shin, Hyoung Doo;Choi, Ihn-Geun;Hahn, Sang Woo;Hwang, Jaeuk;Lee, Yeon Jung;Woo, Sung-Il
    • Korean Journal of Biological Psychiatry
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    • v.23 no.4
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    • pp.148-156
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    • 2016
  • Objectives According to previous studies, the cannabinoid receptor 1 (CNR1) gene could be an important candidate gene for schizophrenia. Some studies have linked the (AAT)n trinucleotide repeat polymorphism in CNR1 gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) has been regarded as one of the most consistent endophenotypes of schizophrenia. In this study, we investigated the association between the (AAT)n trinucleotide repeats in CNR1 gene and SPEM abnormality in Korean patients with schizophrenia. Methods We measured SPEM function in 167 Korean patients with schizophrenia (84 male, 83 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated allele frequencies of (AAT)n repeat polymorphisms on CNR1 gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of (AAT)n trinucleotide repeats. Results The natural logarithm value of signal/noise ratio (Ln S/N ratio) of the good SPEM function group was $4.34{\pm}0.29$ and that of the poor SPEM function group was $3.21{\pm}0.70$. In total, 7 types of trinucleotide repeats were identified, each containing 7, 10, 11, 12, 13, 14, and 15 repeats, respectively. In the patients with $(AAT)7$ allele, the distributions of the good and poor SPEM function groups were 18 (11.1%) and 19 (11.0%) respectively. In the patients with $(AAT)_{10}$ allele, $(AAT)_{11}$ allele, $(AAT)_{12}$ allele, $(AAT)_{13}$ allele, $(AAT)_{14}$ allele and $(AAT)_{15}$ allele, the distributions of good and poor SPEM function groups were 13 (8.0%) and 12 (7.0%), 4 (2.5%) and 6 (3.5%), 31 (19.8%) and 35 (20.3%), 51 (31.5%) and 51 (29.7%), 36 (22.2%) and 45 (26.2%), 9 (5.6%) and 4 (2.3%) respectively. As the number of (AAT) n repeat increased, there was no aggravation of abnormality of SPEM function. Conclusions There was no significant aggravation of SPEM abnormality along with the increase of number of (AAT)n trinucleotide repeats in the CNR1 gene in Korean patients with schizophrenia.

Clinical Characteristics of Neonatal Status Epilepticus (신생아 간질 중첩증의 임상 특성)

  • Jung, Kyeong Hun;Kim, Yun Hee;Kwon, Young Se;Jun, Yong Hoon;Kim, Soon Ki;Son, Byong Kwan
    • Clinical and Experimental Pediatrics
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    • v.48 no.12
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    • pp.1342-1347
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    • 2005
  • Purpose : Among perinatal risk factors, neonatal seizures are one of the strongest independent discriminators of adverse outcome, representing high risks of mortality and neurologic morbidity. This study was undertaken to evaluate the neurologic outcome of neonatal status epilepticus according to underlying etiology, seizure pattern, onset time, and duration. Methods : We reviewed retrospectively 36 neonates(19 males, 17 females) with status epilepticus who were admitted to the neonatal intensive care unit, Inha Hospital between July, 1988 and June, 2003. They were evaluated with neurologic examination, laboratory data, EEG findings, and neuroimaging studies etc. Results : The mean gestational period of the patients was $37.0{\pm}3.6$ weeks and birth weight was $2.70{\pm}0.82$ kilogram. Fifty two point eight percent of the neonates were male and 66.7 percent were born at term. The most common cause of neonatal status epilepticus was hypoxic-ischemic encephalopathy. In preterm babies, intracranial hemorrhages showed an especially high frequency(P=0.034). Gestational age and birth weight did not show a correlation with neurologic complications. The incidence of neurological sequelae were significantly related to prolonged seizures lasting more than 1 hour(P=0.002). Neonates with seizures within the first 72 hours tended to be more frequent among those who developed adverse outcomes(P=0.016). Generalized tonic seizures had the worst prognosis, whereas those children who had subtle seizures had better outcomes than any other type(P<0.05). Generalized tonic seizures were primarily represented on EEG by abnormal background, whereas subtle seizure showed a significantly more normal EEG than any other seizures(P<0.05). Conclusion : Our results indicate that neonatal status epilepticus with early onsets, prolonged durations. And generalized tonic types can predict an increased risk for neurologic sequelae. So, those seizures must be perceived as medical emergencies and treated aggressively with antiepileptic drugs.

A Value Analysis of Ecological Restoration Construction Considering Life Cycle Cost and Performance - Focusing on the Wet Media for Slope Revegetation - (생애주기비용과 성능을 고려한 생태복원 공법 가치분석 - 습식 비탈면 기반재를 사례로 -)

  • Li, Lan;Kim, Sung Hee;Kim, Bo Heui;Lim, Su Hyun;Kim, Sung Il;Koo, Bon Hak
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.5
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    • pp.101-109
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    • 2014
  • In order to save costs and enhance quality in construction without damaging the environment, the VE/LCC analysis method is increasingly used. This study was carried out to conduct a value analysis for the ecological restoration of a slope considering life cycle cost and performance. The construction conditions were classified into three types(A, B, C) according to the condition of each base. Three construction methods for slope ecological restoration were selected by each condition. Eventually, a value analysis was conducted for total nine conditions by analyzing the life cycle cost and performance. The gradient of slope and base of Condition 1 were below 1:1.2 and general soil, while condition 2 and 3 were below 1:1.0(reaping rock) and below 1:0.7(soft rock, blasted rock), respectively. A value analysis was conducted based on the value estimated via life cycle cost and performance analysis. The result showed that the B construction method had the highest value in Condition 1 as it showed 108.4, while A and C showed 90.3 and 45.8, respectively. When it comes to Condition 2, Construction Method A indicated the highest value as it showed 89.1(B: 47.5, C: 47.0). In Condition 3, Construction Method A(89.1) was the highest, while B and C showed 55.4 and 40.2, respectively. Based on the result of this study, in order to make a reasonable decision that can enhance quality and reduce costs in slope ecological restoration, the slope ecological restoration method must be reviewed in consideration of life cycle cost and performance.

A Study on Estimating Optimal Tonnage of Coastal Cargo Vessels in Korea (우리나라 연안화물선의 적정선복량 추정에 관한 연구)

  • 이청환;이철영
    • Journal of the Korean Institute of Navigation
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    • v.13 no.1
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    • pp.21-53
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    • 1989
  • In the past twenty years, there has been a rapid increase in the volume of traffic in Korea due to the Korean great growth of the Korean economy. Since transformation provides an infrastructure vital to economic growth, it becomes more and more an integral part of the Korea economy. The importance of coastal shipping stands out in particular, not only because of the expansion limit on the road network, but also because of saturation in the capacity of rail transportation. In spite of this increase and its importance, coastal shipping is falling behind partly because it is givenless emphasis than ocean-going shipping and other inland transportation systems and partly because of overcompetition due to excessive ship tonnage. Therefore, estimating and planning optimum ship tonnage is the first take to develop Korean coastal shipping. This paper aims to estimate the optimum coastal ship tonnage by computer simulation and finally to draw up plans for the ship tonnage balance according to supply and demand. The estimation of the optimum ship tonnage is peformed by the method of Origin -Destimation and time series analysis. The result are as follows : (1) The optimum ship tonnage in 1987 was 358, 680 DWT, which is 54% of the current ship tonnage (481 ships, 662, 664DWT) that is equal to the optimum ship tonnage in 1998. this overcapacity result is in excessive competition and financial difficulties in Korea coastal shipping. (2) The excessive ship tonnage can be broken down into ship types as follows : oil carrier 250, 926 DWT(350%), cement carrier 9, 977 DWT(119%), iron material/machinery carrier 25, 665 DWT(117%), general cargo carrier 17, 416DWT(112%). (3) the current total ship crew of 5, 079 is more than the verified optimally efficient figure of 3, 808 by 1271. (4) From the viewpoint of management strategy, it is necessary that excessive ship tonnage be reduced and uneconomic outdated vessels be broken up. And its found that the diversion into economically efficient fleets is urgently required in order to meet increasing annual rate in the amounts of cargo(23, 877DWT). (5) The plans for the ship tonnage balance according to supply and demand are as follows 1) The establishment of a legislative system for the arrangement of ship tonnage. This would involve; (a) The announcement of an optimum tonnage which guides the licensing of cargo vessels and ship tonnage supply. (b) The establishment of an organization that substantially arrangement tonnage in Korea coastal shipping. 2) The announcement of an optimum ship tonnage both per year and short-term that guides current tonnage supply plans. 3) The settlement of elastic tariffs resulting in the protect6ion of coastal shipping's share from other tonnage supply plans. 4) The settlement of elastic tariffs resulting in the protection of coastal shipping's share from other transportation systems. 4) Restriction of ocean-going vessels from participating in coastal shipping routes. 5) Business rationalization of coastal shipping company which reduces uneconomic outdated vessels and boosts the national economy. If we are to achieve these ends, the followings are prerequisites; I) Because many non-licensed vessels are actually operating and threatening the safe voyage of the others in Korea coastal routes, it is necessary that those ind of vessels be controlled and punished by the authorities. II) The supply of ship tonnage in Korean coastal routes should be predently monitored because most of the coastal vessels are to small to be diverted into ocean-going routes in case of excessive supply. III) Every ship type which is engaged in coastal shipping should be specialized according to the characteristics of its routes as soon possible.

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