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Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital

  • Kim, Kyoung Hwan;Han, Sung Ho;Chon, Soon-Ho;Kim, Joongsuck;Kwon, Oh Sang;Lee, Min Koo;Lee, Hohyoung
    • Journal of Trauma and Injury
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    • v.32 no.1
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    • pp.1-7
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    • 2019
  • Purpose: The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region. Methods: We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups. Results: No significant differences were found in the annual patients' average age ($54.1{\pm}20.0$ vs. $52.8{\pm}18.2$, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: -0.358, -0.271 vs. post-trauma group: 1.071, 0.958). Conclusions: There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

A Study on Improvement of Storage Safety through Quality improvement of Torpedo Propulsion Battery (어뢰 추진전지 품질개선을 통한 저장안정성 향상에 관한 연구)

  • Jang, Min-Ki
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.7
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    • pp.291-298
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    • 2019
  • We describe the improvement of insulation performance and the prevention of electrolyte leakage in a single cell in order to prevent the fuming phenomenon caused by leakage of electrolyte in a lithium secondary battery in a submerged weapon (torpedo) operated in Korea. A torpedo using lithium secondary battery as a main power source (propulsion battery) can induce the heat and fuming phenomenon, which makes it inconvenient for naval equipment operation in Korea. In the simulation test, the electrolyte of some battery cells leaked in the battery pack unit, leading to a short circuit between the main power circuit and the terminal tab of the high voltage part. We analyzed the characteristics and mechanism of the lithium secondary battery during this heat generation and fuming phenomenon. In order to prevent leakage of the electrolyte in the lithium secondary battery, the design was improved via fundamental (terminal tap enhancement) and complementary (insulation block selection and installation) measures. Comparison of the performance test before and after the improvement showed that the tensile strength of the tap terminal was improved about 2 times and the withstand voltage characteristic was improved. The application of quality improvement measures resulted in no fuming even after more than 3 years of field operation. This result is expected to improve the operation and storage stability of the torpedo propulsion cell.

Intravenous Fluid Selection for Unruptured Intracranial Aneurysm Clipping : Balanced Crystalloid versus Normal Saline

  • Kang, Jian;Song, Young Joo;Jeon, Sujeong;Lee, Junghwa;Lee, Eunsook;Lee, Ju-Yeun;Lee, Euni;Bang, Jae Seung;Lee, Si Un;Han, Moon-Ku;Oh, Chang Wan;Kim, Tackeun
    • Journal of Korean Neurosurgical Society
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    • v.64 no.4
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    • pp.534-542
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    • 2021
  • Objective : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

A Comparative Study of Machine Learning Algorithms Based on Tensorflow for Data Prediction (데이터 예측을 위한 텐서플로우 기반 기계학습 알고리즘 비교 연구)

  • Abbas, Qalab E.;Jang, Sung-Bong
    • KIPS Transactions on Computer and Communication Systems
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    • v.10 no.3
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    • pp.71-80
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    • 2021
  • The selection of an appropriate neural network algorithm is an important step for accurate data prediction in machine learning. Many algorithms based on basic artificial neural networks have been devised to efficiently predict future data. These networks include deep neural networks (DNNs), recurrent neural networks (RNNs), long short-term memory (LSTM) networks, and gated recurrent unit (GRU) neural networks. Developers face difficulties when choosing among these networks because sufficient information on their performance is unavailable. To alleviate this difficulty, we evaluated the performance of each algorithm by comparing their errors and processing times. Each neural network model was trained using a tax dataset, and the trained model was used for data prediction to compare accuracies among the various algorithms. Furthermore, the effects of activation functions and various optimizers on the performance of the models were analyzed The experimental results show that the GRU and LSTM algorithms yields the lowest prediction error with an average RMSE of 0.12 and an average R2 score of 0.78 and 0.75 respectively, and the basic DNN model achieves the lowest processing time but highest average RMSE of 0.163. Furthermore, the Adam optimizer yields the best performance (with DNN, GRU, and LSTM) in terms of error and the worst performance in terms of processing time. The findings of this study are thus expected to be useful for scientists and developers.

Development and application of TPACK based STEAM program - Focused on the excretory organs in the 'structure and function of our body' unit - (TPACK 기반 융합프로그램 개발 및 적용 - '우리 몸의 구조와 기능' 단원 중 배설 기관을 중심으로 -)

  • Ko, Dong Guk;Hong, Seung-Ho
    • Journal of Korean Elementary Science Education
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    • v.40 no.4
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    • pp.443-459
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    • 2021
  • In this study, a TPACK-based STEAM program was developed and applied under the theme of excretory organs in the 'Structure and Function of Our Body' of the elementary science curriculum. The program was produced and conducted through curriculum analysis and learning goal detailing, learning environment analysis, teaching·learning method and technology selection, TPACK elements arrangement and teaching·learning material development, application and effectiveness verification. Teacher's TPACK considered in STEAM program design process is content knowledge (appearance and work of excretory organs), pedagogical knowledge (STEAM, problem-based learning, research learning, discussion learning, cooperative learning, scientific writing) and technology knowledge (3D printer and smart device application technology). The program consisted of a total of 8 hours of project learning activities and was applied to 29 students in the fifth grade as an experimental group. A program of the same theme developed mainly from textbooks was applied to 27 students in the fifth grade of a comparison group. As a result of the application of the program, the experimental group showed significant improvement in creative problem-solving ability and scientific attitude compared to the comparison group, and the class satisfaction with the STEAM program was also high. However, there was no significant difference in academic achievement ability.

The Effects of Music Interventions on High-risk Neonates in NICUs: Systematic Review and Meta-analysis (신생아집중치료실 고위험 신생아 대상 음악중재연구에 대한 체계적 문헌고찰 및 메타분석)

  • Kim, Hye Rang;Park, Hye Young
    • Journal of Music and Human Behavior
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    • v.20 no.2
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    • pp.115-142
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    • 2023
  • The purpose of this study was to analyze and evaluate music intervention research conducted with high-risk neonates in NICUs in both domestic and international settings. Seventeen music intervention studies were identified, and their characteristics, including type of music, music provider, and treatment frequency, and outcomes (i.e., neonatal vital signs) were reviewed and analyzed along with meta-analysis. For music interventions targeting high-risk neonates in NICUs, the effect sizes of the neonates' vital signs were classified as either medium or large. In addition, larger effect sizes were associated with a combination of live and recorded music, nonmusical therapists as the music providers, and treatment frequency of one to five sessions per week. These research findings verify the clinical value of music for high-risk neonates and provide insights into the selection of music elements, music delivery methods, and music providers in NICU music interventions.

Effect of dietary inclusion of Bacillus-based probiotics on performance, egg quality, and the faecal microbiota of laying hen

  • Habeeb Tajudeen;Sang Hun Ha;Abdolreza Hosseindoust;Jun Young Mun;Serin Park;SangIn Park;PokSu Choi;Rafael Gustavo Hermes;Apichaya Taechavasonyoo;Raquel Rodriguez;JinSoo Kim
    • Animal Bioscience
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    • v.37 no.4
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    • pp.689-696
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    • 2024
  • Objective: Our study examined the impact of propriety blends of Bacillus strain probiotics on the performance, egg quality, and faecal microflora of laying hens. Methods: A total of 183 Institut de selection Animale (ISA) brown laying hens aged 23 weeks with an average body weight of 1,894±72 g were randomly allocated into 3 groups as control (corn-soybean meal based diet, CON), 0.5 g/kg Enterosure probiotics (ET1, 3×108 colony-forming unit [CFU]/kg feed), and 5 g/kg Enterosure probiotics (ET2, 3×109 CFU/kg feed) administered in mashed form. At the completion of each phase hen day egg production (HDEP), average egg weight (AEW), feed intake, and faecal microbiota were evaluated. Results: HDEP and AEW were higher (p<0.05) in the ET2-supplemented diet in phase 3 (week 9 to 12) compared with CON. Egg mass (EM) was higher (p<0.05) in phase 2 at ET2, and also higher (p<0.05) in phase 3 at the ET1 and ET2-supplemented diets compared with CON. Feed conversion ratio was lower (p<0.05) in phase 3 at the ET1 and ET2-supplemented diets, with ET2 being the lowest compared with ET1 and CON. Yolk colour was higher (p<0.05) in the ET-supplemented diets at phase 3 compared with CON. Bifidobacterium spp. was higher (p<0.05) in the ET2- supplemented diet compared with CON in phase 2, while in In phase 3, Lactobacillus spp. and Bifidobacterium spp. were higher (p<0.05) in the ET-supplemented diets compared with CON. Coliforms were lower (p<0.05) in the ET-supplemented diets compared with CON in phase 3. Conclusion: The propriety blends of Bacillus strain probiotics supplements at 0.5 g/kg and 5 g/kg could improve the production and quality of eggs with more significance at 5 g/kg for HDEP, AEW and EM, which was achieved via the increase of beneficial microbiomes such as Lactobacillus spp., Bifidobacterium spp., and the decrease of pathogenic microbiomes like Escherichia coli and Coliforms which was speculated to improve gut barrier function and the reproductive hormone.

A Performance Improvement Method using Variable Break in Corpus Based Japanese Text-to-Speech System (가변 Break를 이용한 코퍼스 기반 일본어 음성 합성기의 성능 향상 방법)

  • Na, Deok-Su;Min, So-Yeon;Lee, Jong-Seok;Bae, Myung-Jin
    • The Journal of the Acoustical Society of Korea
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    • v.28 no.2
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    • pp.155-163
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    • 2009
  • In text-to-speech systems, the conversion of text into prosodic parameters is necessarily composed of three steps. These are the placement of prosodic boundaries. the determination of segmental durations, and the specification of fundamental frequency contours. Prosodic boundaries. as the most important and basic parameter. affect the estimation of durations and fundamental frequency. Break prediction is an important step in text-to-speech systems as break indices (BIs) have a great influence on how to correctly represent prosodic phrase boundaries, However. an accurate prediction is difficult since BIs are often chosen according to the meaning of a sentence or the reading style of the speaker. In Japanese, the prediction of an accentual phrase boundary (APB) and major phrase boundary (MPB) is particularly difficult. Thus, this paper presents a method to complement the prediction errors of an APB and MPB. First, we define a subtle BI in which it is difficult to decide between an APB and MPB clearly as a variable break (VB), and an explicit BI as a fixed break (FB). The VB is chosen using the classification and regression tree, and multiple prosodic targets in relation to the pith and duration are then generated. Finally. unit-selection is conducted using multiple prosodic targets. In the MOS test result. the original speech scored a 4,99. while proposed method scored a 4.25 and conventional method scored a 4.01. The experimental results show that the proposed method improves the naturalness of synthesized speech.

Stress Responses of Cultured Fishes Elicited by Water Level Reduction in Rearing Tank and Fish Transference during Selection Process (양식어류의 선별과정중 수심감소와 어류의 수조이동에 따른 스트레스 반응)

  • HUR Jun Wook;CHANG Young Jin;LIM Han Kyu;LEE Bok Kyu
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.34 no.5
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    • pp.465-472
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    • 2001
  • The effects of water level reduction in rearing tank and fish transference during fish selection process on the stress response (hematological factors, cortisol, glucose, lactic acid and osmolality) of tank-reared olive flounder Paralichthys olivaceus of large (FL), small (FS) and Japanese croaker, Nibea japonica (JC) were examined in running seawater culture system. The water level of rearing unit was lowered from 33 cm to 8 cm in the course of 2 minutes in the water level reduction experiment. The fish were removed from rearing tank (12 ton) to 450 L tank in 30 seconds after capture in the fish transference experiment, In water level reduction, the hematocrit of FL was significantly increased from $14.6\%$ at beginning to $23.5\%$ after 10 hours, However, it decreased to the value of beginning after 46 hours. Plasma cortisol concentration of FL was the highest concentration (13.7 ng/mL) after 22 hours, but it decreased to 4.0 ng/mL at the end of experiment. Cortisol concentration of FS did not show any significant difference during the experiment. The cortisol concentration of JC were significantly higher at 4 hours (282.3 ng/mL) and 22 hours (350.5 ng/mL), Glucose concentration of JC was the highest (138.0 mg/dL) at 22 hours. Lactic acid concentration was not different between experimental groups. In the fish transference experiment, red blood cell of FL was increased from $1.9\times10^6\;cell/{\mu}\;L\;to\;4.2\times10^6\;cell/{\mu}L$ in 24 hours. Blood hemoglobin of JC were significantly elevated in 24 hours. At 1 hour after transference, plasma cortisol concentrations in both fish species were increased to 95.3 ng/mL in FL and 175.5 ng/mL in JC. Glucose concentration of JC was increased to 132.5 mg/dL at 1 hour, 129.5 mg/dL at 3 hours after transference.

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The Multi-door Courthouse: Origin, Extension, and Case Studies (멀티도어코트하우스제도: 기원, 확장과 사례분석)

  • Chung, Yongkyun
    • Journal of Arbitration Studies
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    • v.28 no.2
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    • pp.3-43
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    • 2018
  • The emergence of a multi-door courthouse is related with a couple of reasons as follows: First, a multi-door courthouse was originally initiated by the United States government that increasingly became impatient with the pace and cost of protracted litigation clogging the courts. Second, dockets of courts are overcrowded with legal suits, making it difficult for judges to handle those legal suits in time and causing delays in responding to citizens' complaints. Third, litigation is not suitable for the disputant that has an ongoing relationship with the other party. In this case, even if winning is achieved in the short run, it may not be all that was hoped for in the long run. Fourth, international organizations such as the World Bank, UNDP, and Asia Development Bank urge to provide an increased access to women, residents, and the poor in local communities. The generic model of a multi-door courthouse consists of three stages: The first stage includes a center offering intake services, along with an array of dispute resolution services under one roof. At the second stage, the screening unit at the center would diagnose citizen disputes, then refer the disputants to the appropriate door for handling the case. At the third stage, the multi-door courthouse provides diverse kinds of dispute resolution programs such as mediation, arbitration, mediation-arbitration (med-arb), litigation, and early neutral evaluation. This study suggests the extended model of multi-door courthouse comprised of five layers: intake process, diagnosis and door-selection process, neutral-selection process, implementation process of dispute resolution, and process of training and education. One of the major characteristics of extended multi-door courthouse model is the detailed specification of individual department corresponding to each process within a multi-door courthouse. The intake department takes care of the intake process. The screening department plays the role of screening disputes, diagnosing the nature of disputes, and determining a suitable door to handle disputes. The human resources department manages experts through the construction and management of the data base of mediators, arbitrators, and judges. The administration bureau manages the implementation of each process of dispute resolution. The education and training department builds long-term planning to procure neutrals and experts dealing with various kinds of disputes within a multi-door courthouse. For this purpose, it is necessary to establish networks among courts, law schools, and associations of scholars in order to facilitate the supply of manpower in ADR neutrals, as well as judges in the long run. This study also provides six case studies of multi-door courthouses across continents in order to grasp the worldwide picture and wide spread phenomena of multi-door courthouse. For this purpose, the United States and Latin American countries including Argentina and Brazil, Middle Eastern countries, and Southeast Asian countries (such as Malaysia and Myanmar), Australia, and Nigeria were chosen. It was found that three kinds of patterns are discernible during the evolution of a multi-door courthouse model. First, the federal courts of the United States, land and environment court in Australia, and Lagos multi-door courthouse in Nigeria may maintain the prototype of a multi-door courthouse model. Second, the judicial systems in Latin American countries tend to show heterogenous patterns in terms of the adaptation of a multi-door courthouse model to their own environments. Some court systems of Latin American countries including those of Argentina and Brazil resemble the generic model of a multi-door courthouse, while other countries show their distinctive pattern of judicial system and ADR systems. Third, it was found that legal pluralism is prevalent in Middle Eastern countries and Southeast Asian countries. For example, Middle Eastern countries such as Saudi Arabia have developed various kinds of dispute resolution methods, such as sulh (mediation), tahkim (arbitration), and med-arb for many centuries, since they have been situated at the state of tribe or clan instead of nation. Accordingly, they have no unified code within the territory. In case of Southeast Asian countries such as Myanmar and Malaysia, they have preserved a strong tradition of customary laws such as Dhammthat in Burma, and Shriah and the Islamic law in Malaysia for a long time. On the other hand, they incorporated a common law system into a secular judicial system in Myanmar and Malaysia during the colonial period. Finally, this article proposes a couple of factors to strengthen or weaken a multi-door courthouse model. The first factor to strengthen a multi-door courthouse model is the maintenance of flexibility and core value of alternative dispute resolution. We also find that fund raising is important to build and maintain the multi-door courthouse model, reflecting the fact that there has been a competition surrounding the allocation of funds within the judicial system.