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Artificial Intelligence-Based Identification of Normal Chest Radiographs: A Simulation Study in a Multicenter Health Screening Cohort

  • Hyunsuk Yoo;Eun Young Kim;Hyungjin Kim;Ye Ra Choi;Moon Young Kim;Sung Ho Hwang;Young Joong Kim;Young Jun Cho;Kwang Nam Jin
    • Korean Journal of Radiology
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    • v.23 no.10
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    • pp.1009-1018
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    • 2022
  • Objective: This study aimed to investigate the feasibility of using artificial intelligence (AI) to identify normal chest radiography (CXR) from the worklist of radiologists in a health-screening environment. Materials and Methods: This retrospective simulation study was conducted using the CXRs of 5887 adults (mean age ± standard deviation, 55.4 ± 11.8 years; male, 4329) from three health screening centers in South Korea using a commercial AI (Lunit INSIGHT CXR3, version 3.5.8.8). Three board-certified thoracic radiologists reviewed CXR images for referable thoracic abnormalities and grouped the images into those with visible referable abnormalities (identified as abnormal by at least one reader) and those with clearly visible referable abnormalities (identified as abnormal by at least two readers). With AI-based simulated exclusion of normal CXR images, the percentages of normal images sorted and abnormal images erroneously removed were analyzed. Additionally, in a random subsample of 480 patients, the ability to identify visible referable abnormalities was compared among AI-unassisted reading (i.e., all images read by human readers without AI), AI-assisted reading (i.e., all images read by human readers with AI assistance as concurrent readers), and reading with AI triage (i.e., human reading of only those rendered abnormal by AI). Results: Of 5887 CXR images, 405 (6.9%) and 227 (3.9%) contained visible and clearly visible abnormalities, respectively. With AI-based triage, 42.9% (2354/5482) of normal CXR images were removed at the cost of erroneous removal of 3.5% (14/405) and 1.8% (4/227) of CXR images with visible and clearly visible abnormalities, respectively. In the diagnostic performance study, AI triage removed 41.6% (188/452) of normal images from the worklist without missing visible abnormalities and increased the specificity for some readers without decreasing sensitivity. Conclusion: This study suggests the feasibility of sorting and removing normal CXRs using AI with a tailored cut-off to increase efficiency and reduce the workload of radiologists.

Trend in Measles Seroprevalence in the Western Pacific Region: A Systematic Review

  • Ji Won Park;Young June Choe
    • Pediatric Infection and Vaccine
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    • v.31 no.1
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    • pp.1-11
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    • 2024
  • Despite improvements in vaccine coverage, a resurgence of measles has been reported, especially in the infant and adult populations in recent years. We conducted a systematic review of seroprevalence studies conducted in the Western Pacific Region (WPR) to provide insights into seropositivity trends in different countries. This systematic review aimed to collect data from all available measles seroprevalence studies to characterize the differences in population immunity against measles in different countries. We searched the online databases PubMed and Embase to identify: 1) observational studies that investigated seroprevalence in all age groups, and 2) results reported as antibody levels. The following variables were extracted from different study arms: paper identification (title, first author, publication year), inclusion and exclusion criteria, study site, age of subjects, number of subjects, country/area, population, methods, and seropositivity (%). The search yielded a total of 69 studies included in the review. Among the 1-6-year-old group, seropositivity remained relatively high, at 81-100% in China, 86-94% in Korea, and 77-91% in Australia. In adolescents aged 7-18-years old, seropositivity was relatively constant in China and Australia over time; however, a decreasing trend was noted in Korea in 2011 (66%), 2014 (69%), and 2014 (50%) in this age group. A similar downward trend was observed among Korean adults aged 19-39 years in 2011 (74%), 2019 (71%), and 2019 (64%). Children are likely to be protected by universal vaccination programs in WPR countries and regions. However, susceptible individuals with waned immunity may be present among the adult population.

Pharmaceutical Affairs Act Issues Related to Self-administration of Medicines by Medical Personnel (의료인의 자가 투약 관련 약사법 쟁점)

  • Sungmin Park
    • The Korean Society of Law and Medicine
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    • v.24 no.3
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    • pp.3-26
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    • 2023
  • This paper reviewed the Pharmaceutical Affairs Act issues in case of self-administration of medicines by medical personnel without going through the general process (prescription, dispensing, distribution, administration). If a medical personnel self-medicates, the medicine supplier or medical personnel may be subject to criminal punishment under the Pharmaceutical Affairs Act. The core reprehensibility of the punishment lies in undermining the order in distribution of medicines stipulated in the Pharmaceutical Affairs Act. First, the sale of medicines by a medicine supplier to medical personnel may be the violation of Article 47 of the Pharmaceutical Affairs Act. However, if it was distributed for the case where medical personnels can dispense it directly under the Pharmaceutical Affairs Act, it can be justified under the general provision of the Criminal Act (justifiable act, the exclusion of illegality). If medicine suppliers distribute medicines knowing that the medical personnel acquires medicines for selfadministration, they can be punished as the violation of Article 47 of Pharmaceutical Act. Second, when a medical personnel acquires a medicine for the purpose of self-administration, the medicine supplier distributes the medicine under the false pretense that the medical personnel acquires the medicine for the case in which the medical personnel can directly dispense the medicine according to the Pharmaceutical Affairs Act. At this time, even if the medicine supplier has received all the payment for the medicines, the distribution of the medicines by deceit can constitute the fraud under the Criminal Act. Third, self-administration by medical personnel is a the violation of Article 23 of the Pharmaceutical Affairs Act. It is not a justifiable act under the general provision of the Criminal Act. This is because it is the abuse of the special status granted to medical personnel in the Pharmaceutical Affairs Act, which undermines the order in distribution of medicines.

The actual aspects of North Korea's 1950s Changgeuk through the Chunhyangjeon in the film Moranbong(1958) and the album Corée Moranbong(1960) (영화 <모란봉>(1958)과 음반 (1960) 수록 <춘향전>을 통해 본 1950년대 북한 창극의 실제적 양상)

  • Song, Mi-Kyoung
    • (The) Research of the performance art and culture
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    • no.43
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    • pp.5-46
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    • 2021
  • The film Moranbong is the product of a trip to North Korea in 1958, when Armangati, Chris Marker, Claude Lantzmann, Francis Lemarck and Jean-Claude Bonardo left at the invitation of Joseon Film. However, for political reasons, the film was not immediately released, and it was not until 2010 that it was rediscovered and received attention. The movie consists of the narratives of Young-ran and Dong-il, set in the Korean War, that are folded into the narratives of Chunhyang and Mongryong in the classic Chunhyangjeon of Joseon. At this time, Joseon's classics are reproduced in the form of the drama Chunhyangjeon, which shares the time zone with the two main characters, and the two narratives are covered in a total of six scenes. There are two layers of middle-story frames in the movie, and if the same narrative is set in North Korea in the 1950s, there is an epic produced by the producers and actors of the Changgeuk Chunhyangjeon and the Changgeuk Chunhyangjeon as a complete work. In the outermost frame of the movie, Dong-il is the main character, but in the inner double frame, Young-ran, who is an actor growing up with the Changgeuk Chunhyangjeon and a character in the Changgeuk Chunhyangjeon, is the center. The following three OST albums are Corée Moranbong released in France in 1960, Musique de corée released in 1970, and 朝鮮の伝統音樂-唱劇 「春香伝」と伝統樂器- released in 1968 in Japan. While Corée Moranbong consists only of the music from the film Moranbong, the two subsequent albums included additional songs collected and recorded by Pyongyang National Broadcasting System. However, there is no information about the movie Moranbong on the album released in Japan. Under the circumstances, it is highly likely that the author of the record label or music commentary has not confirmed the existence of the movie Moranbong, and may have intentionally excluded related contents due to the background of the film's ban on its release. The results of analyzing the detailed scenes of the Changgeuk Chunhyangjeon, Farewell Song, Sipjang-ga, Chundangsigwa, Bakseokti and Prison Song in the movie Moranbong or OST album in the 1950s are as follows. First, the process of establishing the North Korean Changgeuk Chunhyangjeon in the 1950s was confirmed. The play, compiled in 1955 through the Joseon Changgeuk Collection, was settled in the form of a Changgeuk that can be performed in the late 1950s by the Changgeuk Chunhyangjeon between 1956 and 1958. Since the 1960s, Chunhyangjeon has no longer been performed as a traditional pansori-style Changgeuk, so the film Moranbong and the album Corée moranbong are almost the last records to capture the Changgeuk Chunhyangjeon and its music. Second, we confirmed the responses of the actors to the controversy over Takseong in the North Korean creative world in the 1950s. Until 1959, there was a voice of criticism surrounding Takseong and a voice of advocacy that it was also a national characteristic. Shin Woo-sun, who almost eliminated Takseong with clear and high-pitched phrases, air man who changed according to the situation, who chose Takseong but did not actively remove Takseong, Lim So-hyang, who tried to maintain his own tone while accepting some of modern vocalization. Although Cho Sang-sun and Lim So-hyang were also guaranteed roles to continue their voices, the selection/exclusion patterns in the movie Moranbong were linked to the Takseong removal guidelines required by North Korean musicians in the name of Dang and People in the 1950s. Second, Changgeuk actors' response to the controversy over the turbidity of the North Korean Changgeuk community in the 1950s was confirmed. Until 1959, there were voices of criticism and support surrounding Taksung in North Korea. Shin Woo-sun, who showed consistent performance in removing turbidity with clear, high-pitched vocal sounds, Gong Gi-nam, who did not actively remove turbidity depending on the situation, Cho Sang-sun, who accepted some of the vocalization required by the party, while maintaining his original tone. On the other hand, Cho Sang-seon and Lim So-hyang were guaranteed roles to continue their sounds, but the selection/exclusion patterns of Moranbong was independently linked to the guidelines for removing turbidity that the Gugak musicians who crossed to North Korea had been asked for.

Clinical Results and Risk Factor Analysis of Surgical Treatment for Esophageal Perforation (식도천공의 수술적 치료의 임상결과와 위험인자 분석)

  • Cho, Sung-Woo;Hong, Ki-Woo;Kim, Shin;Lee, Hee-Sung;Kim, Hyoung-Soo;Lee, Jae-Woong;Choi, Goang-Min;Shin, Yoon-Cheol;Shin, Ho-Seung;Lee, Won-Yong
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.347-353
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    • 2008
  • Background: Esophageal perforation is an emergency that. requires early diagnosis and effective treatment. A delay in diagnosis and treatment. significantly increases morbidity and mortality. Material and Method: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival inpatients. Result: Patients ranged in age from 21 to 87 years, with an average age of $52.7{\pm}16.98$ years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). Conclusion: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.

Soil Water and Nutrient Movement Model Under Different Soil Water Conditions -I. Determination of Retardation and Hydrodynamic Dispersion Coefficient of Solute of an Unsaturated Sandy Loam Soil (토양수분(土壤水分) 분포(分布)에 따른 토양내(土壤內) 양수분(養水分) 이동(移動) 모형(模型) -I. 불포화(不飽和) 토양(土壤)에서 용질(溶質)의 이동지연(移動遲延)과 수리동적(水理動的) 분산계수(分散係數)의 측정(測定))

  • Jung, Yeong-Sang;Woo, Deog-Ki;Lim, Hyung-Sik
    • Korean Journal of Soil Science and Fertilizer
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    • v.23 no.1
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    • pp.8-14
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    • 1990
  • Retardation and hydrodynamic dispersion coefficient necessary for model of water and solute movement in a soil were determined for horizontal soil column with different initial soil water conditions. The soil columns were compacted with sandy loam soil. The bulk density was $1,350+50kg/m^3$, and initial water contents were 0.05, 0.08 and 0.14. Advancement of 0.05% $CaSO_4$ solution was used as the standard and advancements of 0.5% KCl, $CaCl_2$ and $KH_2PO_4$ were compared. Retardation of non-reactive $Cl^-$ was related with the initial soil water content, ${\theta}n$, as ${\theta}/({\theta}-{\theta}n)$, and anion exclusion was ignored. Retardations of active $K^+$, $Ca^{{+}{+}}$ and $H_2PO_4{^-}$ were related as 1/(R+1) $^*{\theta}/({\theta}-{\theta}n)$, in which R was retardation coefficient. Measured R was 0.64 for $K^+$, 0.80 for $Ca^{{+}{+}}$ and 2.6 for $H_2PO_4{^-}$, respectively. Calculated R using Langmuir adsorption isotherm showed fair degree of applicability. Soil water diffusivity, $D({\theta}),m^2/sec$, calculated for different initial water content showed unique function as $$log(D({\theta}))=13.448{\theta}-9.288$$ Hydrodynamic dispersion coefficient of $Cl^-$ above soil water content 0.36 was similar to soil water diffusivity and decreased to near self diffusion coefficient at soil water content near 0.2. Those of $K^+$, $Ca^{{+}{+}}$ $H_2PO_4{^-}$ at soil water content of 0.38 were $5.5{\times}10^{-6}$, $2.4{\times}10^{-6}$ and $7.1{\times}10^{-7}m^2/sec$ and decreased rapidly with decreasing soil water content lower than 0.36.

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Mild Impairments in Cognitive Function in the Elderly with Restless Legs Syndrome (노인 하지불안증후군에서의 인지기능 저하)

  • Kim, Eun Soo;Yoon, In-Young;Kweon, Kukju;Park, Hye Youn;Lee, Chung Suk;Han, Eun Kyoung;Kim, Ki Woong
    • Sleep Medicine and Psychophysiology
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    • v.20 no.1
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    • pp.15-21
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    • 2013
  • Objectives: Cognitive impairment in restless legs syndrome (RLS) patients can be affected by sleep deprivation, anxiety and depression, which are common in RLS. The objective of this study is to investigate relationship between cognitive impairment and RLS in the non-medicated Korean elderly with controlling for psychiatric conditions. Method: The study sample for this study comprised 25 non-medicated Korean elderly RLS patients and 50 age-, sex-, and education- matched controls. All subjects were evaluated with comprehensive cognitive function assessment tools- including the Korean version of Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K), severe cognitive impairment rating scale (SCIRS), frontal assessment battery (FAB), and clock drawing test (CLOX). Sleep quality and depression were also assessed with Pittsburgh sleep quality index (PSQI) and geriatric depression scale (GDS). Results: PSQI and GDS score showed no difference between RLS and control group. There was no significant difference between two groups in nearly all the cognitive function except in constructional recognition test, in which subjects with RLS showed lower performance than control group (t=-2.384, p=0.02). Subjects with depression ($GDS{\geq}10$) showed significant cognitive impairment compared to control in verbal fluency, Korean version of Mini Mental Status Examination in the CERAD-K (MMSE-KC), word list memory, trail making test, and frontal assessment battery (FAB). In contrast, no difference was observed between subjects who have low sleep quality (PSQI>5) and control group. Conclusions: At the exclusion of the impact of insomnia and depression, cognitive function was found to be relatively preserved in RLS patients compared to control. Impairment of visual recognition in RLS patients can be explained in terms of dopaminergic dysfunction in RLS.

An Empirical Study on the Changes in Tax Payments under Consolidated Tax Return (연결납세와 개별납세간의 법인세부담액 차이에 대한 실증연구)

  • Jeong, Jae-Yeon;Shin, Hyun-Geol
    • 한국산학경영학회:학술대회논문집
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    • 2004.11a
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    • pp.101-123
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    • 2004
  • This study examines empirically the significant changes in tax payments when the consolidated tax return is introduced in the future. We estimate the consolidated tax payments under the eight cases which are classified as such : whether only 100% ownership subsidiaries should be included or 80% and over, whether all subsidiaries should be included or only subsidiaries with loss, and whether unrealized profits from intercompany transactions should be excluded or not. After estimating the consolidated tax payments, we test the difference between the consolidated tax payments and the sum of the individual tax payments of the subsidiaries. The results of the test show that the consolidated tax payments are significantly less than the sum of the individual tax payments of the subsidiaries. We interpret that the inclusion of the losses of the subsidiaries in the consolidated tax base makes the tax payment decrease. Based on our analysis about 3.8 billion Won per each parent company would decrease due to the introduction of the consolidated tax return. And we find that under the mandatory consolidated tax return system the significant difference between the consolidated and individual tax payment exists except that the only 100% ownership subsidiaries are included and unrealized profits from intercompany transactions are not excluded. However, when the parent companies have the discretion to select the consolidated subsidiaries, the consolidated tax payments are significantly less than the sum of the individual tax payments of the subsidiaries regardless of the ownership percentage, inclusion of the loss of the subsidiaries and exclusion of the unrealized profits.

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The Liability for Damage and Dispute Settlement Mechanism under the Space Law (우주법상 손해배상책임과 분쟁해결제도)

  • Lee, Kang-Bin
    • Journal of Arbitration Studies
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    • v.20 no.2
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    • pp.173-198
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    • 2010
  • The purpose of this paper is to research on the liability for the space damage and the settlement of the dispute with reference to the space activity under the international space treaty and national space law of Korea. The United Nations has adopted five treaties relating to the space activity as follows: The Outer Space Treaty of 1967, the Rescue and Return Agreement of 1968, the Liability Convention of 1972, the Registration Convention of 1974, and the Moon Treaty of 1979. All five treaties have come into force. Korea has ratified above four treaties except the Moon Treaty. Korea has enacted three national legislations relating to space development as follows: Aerospace Industry Development Promotion Act of 1987, Outer Space Development Promotion Act of 2005, Outer Space Damage Compensation Act of 2008. The Outer Space Treaty of 1967 regulates the international responsibility for national activities in outer space, the national tort liability for damage by space launching object, the national measures for dispute prevention and international consultation in the exploration and use of outer space, the joint resolution of practical questions by international inter-governmental organizations in the exploration and use of outer space. The Liability Convention of 1972 regulates the absolute liability by a launching state, the faulty liability by a launching state, the joint and several liability by a launching state, the person claiming for compensation, the claim method for compensation, the claim period of compensation, the claim for compensation and local remedy, the compensation amount for damage by a launching state, the establishment of the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea regulates the definition of space damage, the relation of the Outer Space Damage Compensation Act and the international treaty, the non-faulty liability for damage by a launching person, the concentration of liability and recourse by a launching person, the exclusion of application of the Product Liability Act, the limit amount of the liability for damage by a launching person, the cover of the liability insurance by a launching person, the measures and assistance by the government in case of occurring the space damage, the exercise period of the claim right of compensation for damage. The Liability Convention of 1972 should be improved as follows: the problem in respect of the claimer of compensation for damage, the problem in respect of the efficiency of decision by the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea should be improved as follows: the inclusion of indirect damage into the definition of space damage, the change of currency unit of the limit amount of liability for damage, the establishment of joint and several liability and recourse right for damage by space joint launching person, the establishment of the Space Damage Compensation Review Commission. The 1998 Final Draft Convention on the Settlement of Disputes Related to Space Activities of 1998 by ILA regulates the binding procedure and non-binding settlement procedure for the disputes in respect of space activity. The non-binding procedure regulates the negotiation or the peaceful means and compromise for dispute settlement. The binding procedure regulates the choice of a means among the following means: International Space Law Court if it will be established, International Court of Justice, and Arbitration Court. The above final Draft Convention by ILA will be a model for the innovative development in respect of the peaceful settlement of disputes with reference to space activity and will be useful for establishing the frame of practicable dispute settlement. Korea has built the space center at Oinarodo, Goheung Province in June 2009. Korea has launched the first small launch vehicle KSLV-1 at the Naro Space Center in August 2009 and June 2010. In Korea, it will be the possibility to be occurred the problems relating to the international responsibility and dispute settlement, and the liability for space damage in the course of space activity. Accordingly the Korean government and launching organization should make the legal and systematic policy to cope with such problems.

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Sensitivity of Polymerase Chain Reaction for Pleural Tuberculosis according to the Amount of Pleural Effusion Specimens (흉막 결핵의 진단에 있어서 흉수 검체양에 따른 중합효소연쇄반응 검사의 민감도)

  • Moon, Jin Wook
    • Tuberculosis and Respiratory Diseases
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    • v.62 no.3
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    • pp.184-191
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    • 2007
  • Background: For the diagnosis of pleural tuberculosis, polymerase chain reaction (PCR) of pleural effusion specimens has shown very low sensitivity, which might be due to the small number of bacilli in the samples. The purpose of this investigation is to determine whether the sensitivity of PCR testing can be improved when increasing the amount of pleural effusion specimens. Methods: We prospectively analyzed pleural effusion specimens obtained from 53 patients for whom the exclusion of the possibility of tuberculous pleural effusion was necessary. We performed Mycobacterium tuberculosis PCR testing using the Cobas Amplicor MTB test (Roche Diagnostic Systems) with three different amounts (10ml, 25ml, and 50ml) of pleural effusion specimen in each patient. Pleural tuberculosis was defined as having one of the following: culture-positive pleural fluid sample, histopathologic finding consistent with tuberculosis on pleural biopsy, culture-positive sputum specimen, and/or positive response to anti-tuberculous medication without other possible causes of pleural effusion. Results: Of the 53 patients, 26 received the diagnosis of pleural tuberculosis. The sensitivities of AFB smearing, Mycobacterium tuberculosis culture of pleural effusion specimen, pleural biopsy, and measurement of ADA were 3.8%, 15.4%, 84.6%, and 88.5%, respectively. The results of PCR testing were positive for 3 (11.5%), 4 (15.4%), and 3 (11.5%) of the 26 patients when using 10ml, 25ml, and 50ml of pleural effusion specimens, respectively. These results did not show a statistically significant difference in the sensitivity of PCR testing when increasing the amount of pleural effusion samples (p>0.05, symmetry exact test). Conclusion: For specimens such as pleural effusion, in which the bacillary load is very low, the clinical utility of PCR testing seems highly limited with the kits designed for the diagnosis of pulmonary tuberculosis. An increased amount of pleural effusion sample does not improve the sensitivity of PCR testing.