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Voriconazole Therapeutic Drug Monitoring is Necessary for Children with Invasive Fungal Infection (소아에서 보리코나졸 치료적 약물 농도 모니터링의 임상적 의의)

  • Kang, Hyun Mi;Kang, Soo Young;Cho, Eun Young;Yu, Kyung-Sang;Lee, Ji Won;Kang, Hyoung Jin;Park, Kyung Duk;Shin, Hee Young;Ahn, Hyo Seop;Lee, Hyunju;Choi, Eun Hwa;Lee, Hoan Jong
    • Pediatric Infection and Vaccine
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    • v.21 no.1
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    • pp.9-21
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    • 2014
  • Purpose: To determine the clinical significance of voriconazole therapeutic drug monitoring (TDM) in the pediatric population. Methods: Twenty-eight patients with invasive fungal infections administered with voriconazole from July 2010 to June 2012 were investigated retrospectively. Fourteen received TDM, and 143 trough concentrations were analyzed. All 28 patients were assessed for adverse events and treatment response six weeks into treatment, and at the end. Results: Out of 143 samples, 53.1% were within therapeutic range (1.0-5.5 mg/L). Patients administered with the same loading (6 mg/kg/dose) and maintenance (4 mg/kg/dose) dosages prior to initial TDM showed highly variable drug levels. Adverse events occurred in 9 of 14 patients (64.3%) in both the TDM and non-TDM group. In the TDM group, voriconazole-related encephalopathy (n=2, 14.3%) and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation (n=8, 57.1 %) occurred with serum levels in the toxic range (>5.5 mg/L), whereas blurred-vision (n=2, 14.3%) occurred within the therapeutic range (1.18 mg/L and 3.9 mg/L). The frequency of voriconazole discontinuation due to adverse events was lower in the TDM group (0.0% vs. 18.2%, P =0.481). Overall, 57.2% of the patients in the TDM group versus 14.3% in the non-TDM group showed clinical response after 6 weeks (P =0.055), whereas 21.4% in the TDM group versus 14.3% in the non-TDM group showed response at final outcome (P =0.664). In the TDM group, >67.0% of the serum levels were within therapeutic range for the first 6 weeks; however 45.5% were within therapeutic range for the entire duration. Conclusion: Routine TDM is recommended for optimizing the therapeutic effects of voriconazole.

A Study on the Consumer's Service Quality Perception Based on the Types of Life-style (소비자의 라이프스타일에 따른 서비스품질 지각 차이에 관한 연구)

  • Park, Yoon-Seo;Lee, Seung-In;Choi, In
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.2
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    • pp.53-67
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    • 2009
  • For the last decades, service quality has been studied as one of the most important tools for a service company to compete with the other companies. Based on these past researches, it has been agreed that the service quality is a basic and powerful tool to create the competitive advantage. Due to similar reason, many service marketing practitioners have been also focused on the service quality to retain the existing consumers and collect the new consumers. However, service quality is subjectively perceived by individual consumers. Consumer evaluation of service quality can be different from each other. Especially consumers with one life-style may evaluate the service quality differently from the consumers with the other life-styles. Therefore we need to know whether there are differences in service quality perception on the categories of life-style. Life-style refers to a distinctive mode of living in its aggregate and broadest sense. It embodies the patterns that were developed and emerged from the dynamics of living in a society. Since the concept of life-style and its relationship to marketing was introduced in 1963 by William Lazer, methods of measuring the life-style and their application have been developed. Life-style has been usually used to segment the marketplace because it offers marketers a unique and important view of the market. When Life-style is combined with clustering methods, life-style segmentation can generate identifiable whole persons rather than isolated fragment. Life-style segmentation begins with people instead of products and classifies them into different life-style types, each characterized by a unique style of living based on a wide range of activities, interests, and opinions(Plummer, 1974). In this study we applies the life-style segmentation based on the AIO(Activities, Interests, and Opinions) to the consumers of the large discount stores. In Korea, the large discount store market has entered into maturity stage so that the market differentiation strategy is becoming a more critical issue to the marketing practitioners. One of the most important tools to differentiate from the competitors in large discount store market is continuously to provide service of better quality than competitors. This study tries to find answers about the following questions: 1) How can we categorize the consumer life-styles in the large discount store? 2) What are the characteristics of the categorized groups? 3) Are there any differences in service quality perception among the consumers with different life-styles 4) Are there any differences in consumer behavior among them in the large discount store? For the purpose, we collected survey data from consumers and analyzed the data with the SPSS package where we had $X^2$-test, factor analysis, ANOVA, MANOVA, and cluster analysis. The survey was made during one month in the April of 2008. Among the collected 306 copies of questionnaires, 281 copies were chosen as the effective samples for empirical analysis except 25 copies with wrong responses. To identify the life-style patterns, we used the measures employed by Kim and Kwon(1999), where 44 items on a seven-point scale were used to measure factors of the life-style patterns. The Principal Component Method was used for factor extraction, and the VARIMAX orthogonal factor rotation was employed. The 7 items showing low factor loading were eliminated. The results of the factor analysis suggested that nine factors of the life-style patterns were identified as follows: 1) the equality-of-sexes and pursuit-of-independence tendency 2) self-management tendency 3) sociable tendency 4) self-display tendency 5) degree of a dilettante life 6) pursuit-of-information tendency 7) bargain hunter tendency 8) TV preference tendency 9) pursuit-of-leisure tendency. Next, after the K-means cluster analysis was performed with nine factors of the life-style patterns, the life-styles of the respondents were classified into four groups which are named as the 'progressive practicality-oriented group', 'positive success-oriented group', 'sociable ostentation-oriented group', 'stable conservation-oriented group'. The analysis results for usage behavior between the market segments showed statistically significant differences in the frequency of usage, duration time in the store, consumer satisfaction, and loyalty. Also, we tried to investigate whether the large discount store consumers differently perceive the quality of service based upon the types of life-style. To measure the service quality of large discount store, we adapted several measurement models measuring the service quality such as SERVPERF, BCP, R-SERVPERF, R-BCP. MANOVA and One-Way ANOVA were performed to confirm the difference in service quality perception based on the market segments. The results have also shown significant differences between life-style types in service quality perception. These findings show that the large discount store marketers should consider consumer life-style as one of the most important market segments for marketing and understand the difference in service quality perception between life-style types. Our findings give important implications to marketers of large discount stores as well as life-style researchers. First, this study showed there were significant differences in consumer's service quality perception and usage behavior between the types of life-style. It provides evidence that the life-style approach can be a important basis in segmenting the large discount store market and will make consumers perceive the service quality high. Second, most previous researches on service quality have been in aggregate level. However, our results imply that the future research on service quality have to focus on segment level.

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LONGEVITY AND FAILURE ANALYSIS OF FIXED RESTORATIONS SERVICED IN KOREA (국내에서 제작된 고정성 보철물의 수명과 실패 요인 및 양상)

  • Shin Woo-Jin;Jeon Young-Sik;Lee Keun-Woo;Lee Ho-Yong;Han Dong-Hoo
    • The Journal of Korean Academy of Prosthodontics
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    • v.43 no.2
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    • pp.158-175
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    • 2005
  • Statement of problem. Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however desired level of development has not to be made in this field yet. Purpose. This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of flxed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows : Results. 1. Length of service of fixed restorations serviced in Korea was 6.86$\pm$0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51$\pm$0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21$\pm$0.66) and that of the teen age group(3.39$\pm$0.28) was shortest (p<0.05). 4. Longevity of fixed restorations of women (7.38$\pm$0.18 years) was longer than that of men (6.00$\pm$0.26) (p<0.05). 5. As for the provider factor (such as unlicensed performers, university hospitals, and private clinic), there was no statistically significant difference in longevity of fixed restorations. 6. Defective margin (34.78%). periodontal disease (12.15%), periapical involvement (11.73%), was the most frequent causes of failure and poor esthetics group showed the longest life above all (p<0.05). Actual frequent causes of failure after removing old prosthetics were defective margin, periapical involvement, periodontal disease and uncemented restoration. In 75.67% of the cases, abutment state after removing old prosthetics was good enough for loading another prosthetics. 7. There was found to have statistically significant influence between longevity of single crown (6.35$\pm$0.20 yr) and that of 3 unit fixed restorations (7.60$\pm$0.30 y) (p<0.05). In each case the most frequent cause of failure was defective margin. 8. The number of cantilever pontic, pontic/abutment ratio, oral hygiene status were found to have no statistically significant influence on longevity of fixed restorations in all groups (p>0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60$\pm$0.40 yr) semi precious and precious trailing behind(p<0.05). 10. Group function group (37.04%) and partial group function group (44.62%) were predominant in frequency but showed no correlation between them and among different types of occlusal plane and different types of occlusal surface (p>0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35$\pm$0.62) (p<0.05) among different types of occlusal interference. Conclusion. We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of axed restorations, unified research design. overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

Optimum Capacity of Retention Basin for Treating Nonpoint Pollutants and Its Removal Efficiency in Industrial Complex Areas (산업단지내 비점오염물질 처리를 위한 적정 저류조 용량 산정 및 처리효율)

  • Kim, Lee-Hyung;Lee, Byung-sik;Kwon, Soo-Youl
    • Journal of Wetlands Research
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    • v.7 no.3
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    • pp.75-85
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    • 2005
  • The Construction of industrial complex areas means the increase of imperviousness rate and the increase of nonpoint pollutant emissions during a rainfall. Generally the retention basin can become the alternative for removing and controling these nonpoint pollutants. Recently Ministry of Environment are trying to change the purpose of retention basins from flooding control to nonpoint pollutant control. In order to propel the stormwater management program, administration plan of stormwater management is enacted in Spring, 2005. Hereafter, in a newly developing area, the best management practices should be established to control the nonpoint pollutant. Landuses of the research area are classified to the categories of the 1st manufacturing industry, metal industry, fiber and chemical product manufacturing industry, etc. Therefore, this research was performed to understand washed-off characteristics of stormwater and to suggest the controling method of nonpoint pollutants. The optimum capacity of the retention basin can be determined by analyzing the relationships among data of rainfall, runoff, washed-off pollutants from the areas. The rainfall analysis using the data of normal year, recent 2, 5 and 10 years shows that the 80% rainfall frequency was occurred on 10mm accumulated rainfall, but which is not considered the first flush effect. However, by considering the first flush effect, the appropriate treatment capacity of rainfall can be decreased to 4-5mm accumulated rainfall. Using the criteria, the optimum capacity of retention basin is determined to $12,000m^3$ in the research area. The washed-off nonpoint pollutant loading from the areas have beeb calculated to 435ton/yr for TSS, 238ton/yr for COD, 8,518kg/yr for TKN and 1,816kg/yr for TP. The mass of 78.3ton/yr for TSS, 20.4ton/yr for BOD, 128.6ton/yr for COD, 4.6ton/yr for TKN and 980kg/yr for TP can be reduced by constructing the retention basin. The sediment accumulation rate is also calculated by $6.53kg/m^2-hr$.

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Integrated Rotary Genetic Analysis Microsystem for Influenza A Virus Detection

  • Jung, Jae Hwan;Park, Byung Hyun;Choi, Seok Jin;Seo, Tae Seok
    • Proceedings of the Korean Vacuum Society Conference
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    • 2013.08a
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    • pp.88-89
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    • 2013
  • A variety of influenza A viruses from animal hosts are continuously prevalent throughout the world which cause human epidemics resulting millions of human infections and enormous industrial and economic damages. Thus, early diagnosis of such pathogen is of paramount importance for biomedical examination and public healthcare screening. To approach this issue, here we propose a fully integrated Rotary genetic analysis system, called Rotary Genetic Analyzer, for on-site detection of influenza A viruses with high speed. The Rotary Genetic Analyzer is made up of four parts including a disposable microchip, a servo motor for precise and high rate spinning of the chip, thermal blocks for temperature control, and a miniaturized optical fluorescence detector as shown Fig. 1. A thermal block made from duralumin is integrated with a film heater at the bottom and a resistance temperature detector (RTD) in the middle. For the efficient performance of RT-PCR, three thermal blocks are placed on the Rotary stage and the temperature of each block is corresponded to the thermal cycling, namely $95^{\circ}C$ (denature), $58^{\circ}C$ (annealing), and $72^{\circ}C$ (extension). Rotary RT-PCR was performed to amplify the target gene which was monitored by an optical fluorescent detector above the extension block. A disposable microdevice (10 cm diameter) consists of a solid-phase extraction based sample pretreatment unit, bead chamber, and 4 ${\mu}L$ of the PCR chamber as shown Fig. 2. The microchip is fabricated using a patterned polycarbonate (PC) sheet with 1 mm thickness and a PC film with 130 ${\mu}m$ thickness, which layers are thermally bonded at $138^{\circ}C$ using acetone vapour. Silicatreated microglass beads with 150~212 ${\mu}L$ diameter are introduced into the sample pretreatment chambers and held in place by weir structure for construction of solid-phase extraction system. Fig. 3 shows strobed images of sequential loading of three samples. Three samples were loaded into the reservoir simultaneously (Fig. 3A), then the influenza A H3N2 viral RNA sample was loaded at 5000 RPM for 10 sec (Fig. 3B). Washing buffer was followed at 5000 RPM for 5 min (Fig. 3C), and angular frequency was decreased to 100 RPM for siphon priming of PCR cocktail to the channel as shown in Figure 3D. Finally the PCR cocktail was loaded to the bead chamber at 2000 RPM for 10 sec, and then RPM was increased up to 5000 RPM for 1 min to obtain the as much as PCR cocktail containing the RNA template (Fig. 3E). In this system, the wastes from RNA samples and washing buffer were transported to the waste chamber, which is fully filled to the chamber with precise optimization. Then, the PCR cocktail was able to transport to the PCR chamber. Fig. 3F shows the final image of the sample pretreatment. PCR cocktail containing RNA template is successfully isolated from waste. To detect the influenza A H3N2 virus, the purified RNA with PCR cocktail in the PCR chamber was amplified by using performed the RNA capture on the proposed microdevice. The fluorescence images were described in Figure 4A at the 0, 40 cycles. The fluorescence signal (40 cycle) was drastically increased confirming the influenza A H3N2 virus. The real-time profiles were successfully obtained using the optical fluorescence detector as shown in Figure 4B. The Rotary PCR and off-chip PCR were compared with same amount of influenza A H3N2 virus. The Ct value of Rotary PCR was smaller than the off-chip PCR without contamination. The whole process of the sample pretreatment and RT-PCR could be accomplished in 30 min on the fully integrated Rotary Genetic Analyzer system. We have demonstrated a fully integrated and portable Rotary Genetic Analyzer for detection of the gene expression of influenza A virus, which has 'Sample-in-answer-out' capability including sample pretreatment, rotary amplification, and optical detection. Target gene amplification was real-time monitored using the integrated Rotary Genetic Analyzer system.

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Evaluation for Rock Cleavage Using Distributional Characteristics of Microcracks and Brazilian Tensile Strengths (미세균열과 압열인장강도의 분포 특성을 이용한 결의 평가)

  • Park, Deok-Won
    • Korean Journal of Mineralogy and Petrology
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    • v.33 no.2
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    • pp.99-114
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    • 2020
  • The characteristics of the Brazilian tensile strengths(σt) parallel to the rock cleavages in Jurassic granite from Geochang were analysed. The evaluation for the six directions of rock cleavages was performed using the parameter values on microcrack length and the above strength. The strength values of the five test specimens belonging to each direction were classified into five groups. The strength values of these five groups increase in order of group A < B < C < D < E. The close dependence between the above microcrack and strength was derived. The analysis results of this study are summarized as follows. First, the chart showing the variation and characteristics of strength among the three rock cleavages were made. In the above chart, the strength values of six directions belonging to each group were arranged in order of rift(R1 and R2), grain(G1 and G2) and hardway(H1 and H2). The strength distribution lines of the five groups concentrate in the direction of R1. And the widths among the above five lines indicating strength difference(Δσt) are the most narrowest in R1 direction. From the related chart, the variation characteristics among the two directions forming each rock cleavage were derived. G2(2)-test specimen shows higher value and lower value of the difference in strength compared to the case of G1(1)-test specimen. These kinds of phenomena are the same as the case between the test specimen H2(2) and H1(1). The strength characteristics of the above test specimens (2) suggest lower microcrack density value and higher degree of uniformity in the distribution of microcracks arrayed parallel to the loading direction compared to those of test specimens (1). The six strength values belonging to each group were arranged in increasing order in the above chart. The strength values of the test specimens belonging to both group D and E appear in order of R1 < R2 < G1 < H1 < G2 < H2. Therefore, the strength values of group D and E can be indicator values for evaluating the six directions of rock cleavages. Second, the correlation chart between slope angle(θ) and strength difference(Δσt) were made. The values of the above two parameters were obtained from the five strength distribution lines connecting between the two directions. From the chart related to rift plane(G1-H1, R'), grain plane(R1-H2, G') and hardway plane(R2-G2, H'), the slope values of linear functions increase in order of R'(0.391) < G'(0.470) < H'(0.485). Among three planes, the charts related to hardway plane show the highest distribution density among the five groups. From the related chart for rift(R1-R2, R), grain(G1-G2, G) and hardway(H1-H2, H), the slope values of linear functions increase in order of rift(0.407) < hardway(0.453) < grain(0.460). Among three rock cleavages, the charts related to rift show the highest frequency of groups belonging to the lower region. Taken together, the width of distribution of the slope angle among the three planes and three rock cleavages increase in order of H' < G < R' < R < G' < H. Third, the correlation analysis among the parameters related to microcrack length and the tensile strengths was performed. These parameters may include frequency(N), total length(Lt), mean length(Lm), median length(Lmed) and density(ρ). The correlation charts among individual parameters on the above microcrack(X) and corresponding five levels of tensile strengths for the five groups(Y) were made. From the five kinds of correlation charts, the values of correlation coefficients(R2) increase along with the five levels of strengths. The mean values of the five correlation coefficients from each chart increase in order of 0.22(N) < 0.34(Lt) < 0.38(ρ) < 0.57(Lmed) < 0.58(Lm). Fourth, the correlation chart among the corresponding maximum strength for group E(X) and the above five parameters(Y) were made. From the related chart, the values of correlation coefficient increase in order of 0.61(N) < 0.81(Lt) < 0.87(ρ) < 0.93(Lm) < 0.96(Lmed). The two parameters that have the highest correlations are median length with maximum strength. Through the above correlation analysis between microcrack and strength, the credibility for the results from this study can be enhanced.

CLINICAL CHARACTERISTICS OF CHILD AND ADOLESCENT PSYCHIATRIC INPATIENTS WITH MOOD DISORDER (입원한 기분장애 소아청소년의 임상특성 - 주요 우울증과 양극성장애의 우울삽화 비교를 중심으로 -)

  • Cho, Su-Chul;Paik, Ki-Chung;Lee, Kyung-Kyu;Kim, Hyun-Woo;Hong, Kang-E;Lim, Myung-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.11 no.2
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    • pp.209-220
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    • 2000
  • The purpose of this study is to find out the characteristics of depressive episode about major depression and bipolar disorder in child and adolescent. The subjects of this study were 34 major depression patients and 17 bipolar disorder patients hospitalized at child and adolescent psychiatry in OO university children's hospital from 1st March 1993 to 31st October 1999. The method of this study is to review socio-demographic characteristics, diagnostic classification, chief problems and symptoms at admission, frequency of symptoms, maternal pregnancy problem history, childhood developmental history, coexisting psychiatric disorders, family psychopathology and family history and therapeutic response through their chart. 1) The ratio of male was higher than that of female in major depressive disorder while they are similar in manic episode, bipolar disorder. 2) Average onset age of bipolar disorder was 14 years 1 month and it was 12 years 8 months in the case of major depression As a result, average onset age of major depression is lower than that of bipolar disorder. 3) The patients complained of vegetative symptoms than somatic symptoms in both bipolar disorder and depressive disorder. Also, the cases of major depression developed more suicide idea symptom while the case of bipolar disorder developed more aggressive symptoms. In the respect of psychotic symptoms, delusion was more frequently shown in major depression, but halucination was more often shown in bipolar disorder. 4) Anxiety disorder coexisted most frequently in two groups. And there coexisted symptoms such as somartoform disorder, mental retardation and personality disorder in both cases. 5) The influence of family loading was remarkable in both cases. Above all, the development of major depression had to do with child abuse history and inappropriate care of family. It is apparent that there are distinctive differences between major depression and bipolar disorder in child and adolescent through the study, just as in adult cases. Therefore the differences of clinical characteristics between two disorders is founded in coexisting disorders and clinical symptoms including onset age, somatic symptoms and vegetative symptoms.

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