• Title/Summary/Keyword: cause

Search Result 30,584, Processing Time 0.07 seconds

The Evaluation of Hybrid-Volumetric Modulated Arc Therapy for Lung Cancer Radiation Therapy (폐암 방사선 치료 시 Hybrid-Volumetric Modulated Arc Therapy의 유용성 평가)

  • Lee, Geon Ho;Kang, Hyo Seok;Choi, Byoung Joon;Park, Sang Jun;Jung, Da Ee;Lee, Du Sang;Ahn, Min Woo;Jeon, Myeong Soo
    • The Journal of Korean Society for Radiation Therapy
    • /
    • v.29 no.2
    • /
    • pp.19-26
    • /
    • 2017
  • Objectives: In the Lung, the VMAT rotates continuously and examines radiation. That increases the low doses to normal lung. Due to that, the incidence of radiation pneumonia among radiation side effects may increase. The cause of radiation pneumonia is the lower dose area of the lungs. The H-VMAT was applied to patients who applied to reduce radiation in the lower doses of the lungs. We wanted to assess the usefulness of the H-VMAT by comparing the radiation doses to the low dose areas of the lungs and the normal organs. Materials and Methods: A total of 26 patients who applied for a H-VMAT procedure were applied to the patient. The prescription dose applied to total dose 44 Gy from 22 divisions. For each patient, a plan was implemented with Conventional RT, VMAT and H-VMAT. Conventional RT was carried out in four to five fields each, considering the size, location, shape, and location of the PTV. In the case of a VMAT plan, the two Half ARC, three Half ARC method and the two Full ARC were planned. The H-VMAT was planned by adding two Static fields in the VMAT, taking into account the dose of the lung and the tolerance dose of the organs. Results: In the NSCLC, the lung doses $V_5$ and $V_{10}$ of the lungs except for the treatment plan volume were the lowest with $55.40{\pm}13.39%$ and $32.05{\pm}11.37%$ of H-VMAT. And, in the SCLC, the lung doses of V5 and V10 were the lowest at $64.32{\pm}16.15%$ and $35.50{\pm}9.91%$, respectively. The spinal dose of VMAT in NSCLC was $21.15{\pm}4.02Gy$, which was 7.94 Gy lower than other treatment methods. The lowest spinal dose was delivered at $19.72{\pm}1.82Gy$ for SCLC. The mean dose delivered to the esophagus was also $17.44{\pm}2.04Gy$ and $17.84{\pm}9.20Gy$ in SCLC and NSCLC, respectively. Conclusion: When comparing the value of the surrounding normal organ dose, the VMAT showed that less doses were transmitted from the heart, esophagus and spinal cord than the rest of the treatment plan. However, it was similar to VMAT in normal organs except for the spinal cord. VMAT has increased doses of some normal organs but did not exceed the tolerance dose. It showed a low value in $V_5$, $V_{10}$. When comparing Conventional RT, VMAT, and H-VMAT, If the dose to the heart, esophagus and spinal cord is lower than the tolerance dose, it is thought to reduce the incidence of radiation pneumonia by applying H-VMAT that show the benefits of low doses of the lungs.

  • PDF

A Structural Relationship among Job Requirements, Job Resources and Job Burnout, and Organizational Effectiveness of Private Security Guards (민간경비원의 직무요구 직무자원과 소진, 조직유효성의 구조적 관계)

  • Kim, Sung-Cheol;Kim, Young-Hyun
    • Korean Security Journal
    • /
    • no.48
    • /
    • pp.9-33
    • /
    • 2016
  • The purpose of the present study was to find out cause-and-effect relationship between job requirements and job resources, with job burnout as a mediator variable, and the effects of these variables on organizational effectiveness. The population in the present study was private security guards employed by 13 private security companies in Seoul and Gyeonggi-do areas, and a survey was conducted on 500 security guards selected using purposive sampling technique. Out of 460 questionnaires distributed, 429 responses, excluding 31 outliers or insincere responses, were used for data analysis. For analysis, data were coded and entered into SPSS 18.0 and AMOS 18.0, which were used to analyze the data. Descriptive analyses were performed to find out sociodemographic characteristics of the respondents. The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the validity of the measurement tool, and the Cronbach's Alpha coefficients were calculated to test the reliability. To find out the significance of relationships among variables, Pearson's correlation analysis was performed. Covariance Structure Analysis (CSA) was performed to test the relationship among latent factors of a model for job requirements, job resources, job burnout, and organizational effectiveness of the private security guards, and the fitness of the model analyzed with CSA was determined by the goodness-of-fit index ($x^2$, df, p, RMR, GFI, CFI, TLI, RMSEA). The level of significance was set at .05, and the following results were obtained. First, even though the effect of job requirements on job burnout was not statistically significant, it had a positive influence overall, and this result can be considered such that the higher the perception of job requirements by the member of the organization, the higher the perception of job burnout. Second, the influence of job resources on job burnout was negative, which can be considered that the higher the perception of job resources, the lower the perception of job burnout. Third, even though the influence of job requirements on organizational effectiveness was statistically nonsignificant, it had a negative influence overall, and this result can be considered that the higher the perception of job requirements, the lower the perception of organizational effectiveness. Fourth, job resources had a positive influence on organizational effectiveness, and it can be considered that the higher the perception of job resources, the higher the perception of organizational effectiveness. Fifth, the results of the analysis between job burnout and organizational effectiveness revealed that, even though the influence of job burnout on organizational effectiveness was statistically nonsignificant, it had partial negative influences on sublevels of organizational effectiveness, and this may suggest that the higher the perception of job burnout by the organization members, the lower the organizational effectiveness. Sixth, the analysis of mediating role in the relationship between job requirements and organizational effectiveness, job burnout was taking partial mediating role between job requirements and organizational effectiveness. These results suggest that reducing job burnout by managing job requirements, organizational effectiveness that leads to job satisfaction, organizational commitment, and turnover intention can be maximized. Seventh, the analysis of mediating role in the relationship among job requirements, job resources, and organizational effectiveness, job burnout was assuming a partial mediating role in the relationships among job requirements, job resources, and organizational effectiveness. These results suggest that organizational effectiveness can be maximized by either lowering job requirements or burnout management through reorganizing job resources.

  • PDF

Steel Plate Faults Diagnosis with S-MTS (S-MTS를 이용한 강판의 표면 결함 진단)

  • Kim, Joon-Young;Cha, Jae-Min;Shin, Junguk;Yeom, Choongsub
    • Journal of Intelligence and Information Systems
    • /
    • v.23 no.1
    • /
    • pp.47-67
    • /
    • 2017
  • Steel plate faults is one of important factors to affect the quality and price of the steel plates. So far many steelmakers generally have used visual inspection method that could be based on an inspector's intuition or experience. Specifically, the inspector checks the steel plate faults by looking the surface of the steel plates. However, the accuracy of this method is critically low that it can cause errors above 30% in judgment. Therefore, accurate steel plate faults diagnosis system has been continuously required in the industry. In order to meet the needs, this study proposed a new steel plate faults diagnosis system using Simultaneous MTS (S-MTS), which is an advanced Mahalanobis Taguchi System (MTS) algorithm, to classify various surface defects of the steel plates. MTS has generally been used to solve binary classification problems in various fields, but MTS was not used for multiclass classification due to its low accuracy. The reason is that only one mahalanobis space is established in the MTS. In contrast, S-MTS is suitable for multi-class classification. That is, S-MTS establishes individual mahalanobis space for each class. 'Simultaneous' implies comparing mahalanobis distances at the same time. The proposed steel plate faults diagnosis system was developed in four main stages. In the first stage, after various reference groups and related variables are defined, data of the steel plate faults is collected and used to establish the individual mahalanobis space per the reference groups and construct the full measurement scale. In the second stage, the mahalanobis distances of test groups is calculated based on the established mahalanobis spaces of the reference groups. Then, appropriateness of the spaces is verified by examining the separability of the mahalanobis diatances. In the third stage, orthogonal arrays and Signal-to-Noise (SN) ratio of dynamic type are applied for variable optimization. Also, Overall SN ratio gain is derived from the SN ratio and SN ratio gain. If the derived overall SN ratio gain is negative, it means that the variable should be removed. However, the variable with the positive gain may be considered as worth keeping. Finally, in the fourth stage, the measurement scale that is composed of selected useful variables is reconstructed. Next, an experimental test should be implemented to verify the ability of multi-class classification and thus the accuracy of the classification is acquired. If the accuracy is acceptable, this diagnosis system can be used for future applications. Also, this study compared the accuracy of the proposed steel plate faults diagnosis system with that of other popular classification algorithms including Decision Tree, Multi Perception Neural Network (MLPNN), Logistic Regression (LR), Support Vector Machine (SVM), Tree Bagger Random Forest, Grid Search (GS), Genetic Algorithm (GA) and Particle Swarm Optimization (PSO). The steel plates faults dataset used in the study is taken from the University of California at Irvine (UCI) machine learning repository. As a result, the proposed steel plate faults diagnosis system based on S-MTS shows 90.79% of classification accuracy. The accuracy of the proposed diagnosis system is 6-27% higher than MLPNN, LR, GS, GA and PSO. Based on the fact that the accuracy of commercial systems is only about 75-80%, it means that the proposed system has enough classification performance to be applied in the industry. In addition, the proposed system can reduce the number of measurement sensors that are installed in the fields because of variable optimization process. These results show that the proposed system not only can have a good ability on the steel plate faults diagnosis but also reduce operation and maintenance cost. For our future work, it will be applied in the fields to validate actual effectiveness of the proposed system and plan to improve the accuracy based on the results.

Rapid Rural-Urban Migration and the Rural Economy in Korea (한국(韓國)의 급격(急激)한 이촌향도형(離村向都型) 인구이동(人口移動)과 농촌경제(農村經濟))

  • Lee, Bun-song
    • KDI Journal of Economic Policy
    • /
    • v.12 no.3
    • /
    • pp.27-45
    • /
    • 1990
  • Two opposing views prevail regarding the economic impact of rural out-migration on the rural areas of origin. The optimistic neoclassical view argues that rapid rural out-migration is not detrimental to the income and welfare of the rural areas of origin, whereas Lipton (1980) argues the opposite. We developed our own alternative model for rural to urban migration, appropriate for rapidly developing economies such as Korea's. This model, which adopts international trade theories of nontraded goods and Dutch Disease to rural to urban migration issues, argues that rural to urban migration is caused mainly by two factors: first, the unprofitability of farming, and second, the decrease in demand for rural nontraded goods and the increase in demand for urban nontraded goods. The unprofitability of farming is caused by the increase in rural wages, which is induced by increasing urban wages in booming urban manufacturing sectors, and by the fact that the cost increases in farming cannot be shifted to consumers, because farm prices are fixed worldwide and because the income demand elasticity for farm products is very low. The demand for nontraded goods decreases in rural and increases in urban areas because population density and income in urban areas increase sharply, while those in rural areas decrease sharply, due to rapid rural to urban migration. Given that the market structure for nontraded goods-namely, service sectors including educational and health facilities-is mostly in monopolistically competitive, and that the demand for nontraded goods comes only from local sources, the urban service sector enjoys economies of scale, and can thus offer services at cheaper prices and in greater variety, whereas the rural service sector cannot enjoy the advantages offered by scale economies. Our view concerning the economic impact of rural to urban migration on rural areas of origin agrees with Lipton's pessimistic view that rural out-migration is detrimental to the income and welfare of rural areas. However, our reasons for the reduction of rural income are different from those in Lipton's model. Lipton argued that rural income and welfare deteriorate mainly because of a shortage of human capital, younger workers and talent resulting from selective rural out-migration. Instead, we believe that rural income declines, first, because a rapid rural-urban migration creates a further shortage of farm labor supplies and increases rural wages, and thus reduces further the profitability of farming and, second, because a rapid rural-urban migration causes a further decline of the rural service sectors. Empirical tests of our major hypotheses using Korean census data from 1966, 1970, 1975, 1980 and 1985 support our own model much more than the neoclassical or Lipton's models. A kun (county) with a large out-migration had a smaller proportion of younger working aged people in the population, and a smaller proportion of highly educated workers. But the productivity of farm workers, measured in terms of fall crops (rice) purchased by the government per farmer or per hectare of irrigated land, did not decline despite the loss of these youths and of human capital. The kun having had a large out-migration had a larger proportion of the population in the farm sector and a smaller proportion in the service sector. The kun having had a large out-migration also had a lower income measured in terms of the proportion of households receiving welfare payments or the amount of provincial taxes paid per household. The lower incomes of these kuns might explain why the kuns that experienced a large out-migration had difficulty in mechanizing farming. Our policy suggestions based on the tests of the currently prevailing hypotheses are as follows: 1) The main cause of farming difficulties is not a lack of human capital, but the in­crease in production costs due to rural wage increases combined with depressed farm output prices. Therefore, a more effective way of helping farm economies is by increasing farm output prices. However, we are not sure whether an increase in farm output prices is desirable in terms of efficiency. 2) It might be worthwhile to attempt to increase the size of farmland holdings per farm household so that the mechanization of farming can be achieved more easily. 3) A kun with large out-migration suffers a deterioration in income and welfare. Therefore, the government should provide a form of subsidization similar to the adjustment assistance provided for international trade. This assistance should not be related to the level of farm output. Otherwise, there is a possibility that we might encourage farm production which would not be profitable in the absence of subsidies. 4) Government intervention in agricultural research and its dissemination, and large-scale social overhead projects in rural areas, carried out by the Korean government, might be desirable from both efficiency and equity points of view. Government interventions in research are justified because of the problems associated with the appropriation of knowledge, and government actions on large-scale projects are justified because they required collective action.

  • PDF

The Effects of the Perceived Motivation Type toward Corporate Social Responsibility Activities on Customer Loyalty (기업사회책임활동적인지인지동기류형대고객충성도적영향(企业社会责任活动的认知认知动机类型对顾客忠诚度的影响))

  • Kim, Kyung-Jin;Park, Jong-Chul
    • Journal of Global Scholars of Marketing Science
    • /
    • v.19 no.3
    • /
    • pp.5-16
    • /
    • 2009
  • Corporate social responsibility (CSR) activities have been shown to be potential factors that can improve corporate image and increase the ability of corporations to compete. However, most previous studies related to CSR activities investigated how these activities influence product and corporate evaluation, as well as corporate image. In addition, some researchers treated consumers' perceptions of corporate motives as moderator variables in evaluating the relationship between corporate social responsibilities and consumer response. However, motive-based theories have some weaknesses. Corporate social responsibility activities cause two motives(egoistic vs. altruistic) for consumers, but recently, Vlachos et al. (2008) argued that these motives should be segmented. Thus, it is possible to transform the original theory into a modified theory model (persuasion knowledge model, PKM). Vlachos et al. (2008) segmented corporate social responsibility motives into four types and compared the effects of these motives on customer loyalty. Prior studies have proved that CSR activities with positive motives have positive influences on customer loyalty. However, the psychological reasons underlying this finding have not been determined empirically. Thus, the objectives of this research are twofold. First, we attempt to determine why most customers favor companies that they feel have positive motives for their corporate social responsibility activities. Second, we attempt to measure the effects of consumers' reciprocity when society benefits from corporate social responsibility activities. The following research hypotheses are constructed. H1: Values-driven motives for corporate social responsibility activities have a positive influence on the perceived reciprocity. H2: Stakeholder-driven motives for corporate social responsibility activities have a negative influence on the perceived reciprocity. H3: Egoistic-driven motives for corporate social responsibility activities have a negative influence on perceived reciprocity. H4: Strategic-driven motives for corporate social responsibility activities have a negative influence on perceived reciprocity. H5: Perceived reciprocity for corporate social responsibility activities has a positive influence on consumer loyalty. A single company is selected as a research subject to understand how the motives behind corporate social responsibility influence consumers' perceived reciprocity and customer loyalty. A total sample of 200 respondents was selected for a pilot test. In addition, to ensure a consistent response, we ensured that the respondents were older than 20 years of age. The surveys of 172 respondents (males-82, females-90) were analyzed after 28 invalid questionnaires were excluded. Based on our cutoff criteria, the model fit the data reasonably well. Values-driven motives for corporate social responsibility activities had a positive effect on perceived reciprocity (t = 6.75, p < .001), supporting H1. Morales (2005) also found that consumers appreciate a company's social responsibility efforts and the benefits provided by these efforts to society. Stakeholder-driven motives for corporate social responsibility activities did not affect perceived reciprocity (t = -.049, p > .05). Thus, H2 was rejected. Egoistic-driven motives (t = .3.11, p < .05) and strategic-driven (t = -4.65, p < .05) motives had a negative influence on perceived reciprocity, supporting H3 and H4, respectively. Furthermore, perceived reciprocity had a positive influence on consumer loyalty (t = 4.24, p < .05), supporting H5. Thus, compared with the general public, undergraduate students appear to be more influenced by egoistic-driven motives. We draw the following conclusions from our research findings. First, value-driven attributions have a positive influence on perceived reciprocity. However, stakeholder-driven attributions have no significant effects on perceived reciprocity. Moreover, both egoistic-driven attributions and strategic-driven attributions have a negative influence on perceived reciprocity. Second, when corporate social responsibility activities align with consumers' reciprocity, the efforts directed towards social responsibility activities have a positive influence on customer loyalty. In this study, we examine whether the type of motivation affects consumer responses to CSR, and in particular, we evaluate how CSR motives can influence a key internal factor (perceived reciprocity) and behavioral consumer outcome (customer loyalty). We demonstrate that perceived reciprocity plays a mediating role in the relationship between CSR motivation and customer loyalty. Our study extends the research on consumer CSR-inferred motivations, positing them as a direct indicator of consumer responses. Furthermore, we convincingly identify perceived reciprocity as a sub-process mediating the effect of CSR attributions on customer loyalty. Future research investigating the ultimate behavior and financial impact of CSR should consider that the impacts of CSR also stem from perceived reciprocity. The results of this study also have important managerial implications. First, the central role that reciprocity plays indicates that managers should routinely measure how much their socially responsible actions create perceived reciprocity. Second, understanding how consumers' perceptions of CSR corporate motives relate to perceived reciprocity and customer loyalty can help managers to monitor and enhance these consumer outcomes through marketing initiatives and management of CSR-induced attribution processes. The results of this study will help corporations to understand the relative importance of the four different motivations types in influencing perceived reciprocity.

  • PDF

An Exploratory Study on Channel Equity of Electronic Goods (가전제품 소비자의 Channel Equity에 관한 탐색적 연구)

  • Suh, Yong-Gu;Lee, Eun-Kyung
    • Journal of Global Scholars of Marketing Science
    • /
    • v.18 no.3
    • /
    • pp.1-25
    • /
    • 2008
  • Ⅰ. Introduction Retailers in the 21st century are being told that future retailers are those who can execute seamless multi-channel access. The reason is that retailers should be where shoppers want them, when they want them anytime, anywhere and in multiple formats. Multi-channel access is considered one of the top 10 trends of all business in the next decade (Patricia T. Warrington, et al., 2007) And most firms use both direct and indirect channels in their markets. Given this trend, we need to evaluate a channel equity more systematically than before as this issue is expected to get more attention to consumers as well as to brand managers. Consumers are becoming very much confused concerning the choice of place where they shop for durable goods as there are at least 6-7 retail options. On the other hand, manufacturers have to deal with category killers, their dealers network, Internet shopping malls, and other avenue of distribution channels and they hope their retail channel behave like extensions of their own companies. They would like their products to be foremost in the retailer's mind-the first to be proposed and effectively communicated to potential customers. To enable this hope to come reality, they should know each channel's advantages and disadvantages from consumer perspectives. In addition, customer satisfaction is the key determinant of retail customer loyalty. However, there are only a few researches regarding the effects of shopping satisfaction and perceptions on consumers' channel choices and channels. The purpose of this study was to assess Korean consumers' channel choice and satisfaction towards channels they prefer to use in the case of electronic goods shopping. Korean electronic goods retail market is one of good example of multi-channel shopping environments. As the Korea retail market has been undergoing significant structural changes since it had opened to global retailers in 1996, new formats such as hypermarkets, Internet shopping malls and category killers have arrived for the last decade. Korean electronic goods shoppers have seven major channels : (1)category killers (2) hypermarket (3) manufacturer dealer shop (4) Internet shopping malls (5) department store (6) TV home-shopping (7) speciality shopping arcade. Korean retail sector has been modernized with amazing speed for the last decade. Overall summary of major retail channels is as follows: Hypermarket has been number 1 retailer type in sales volume from 2003 ; non-store retailing has been number 2 from 2007 ; department store is now number 3 ; small scale category killers are growing rapidly in the area of electronics and office products in particular. We try to evaluate each channel's equity using a consumer survey. The survey was done by telephone interview with 1000 housewife who lives nationwide. Sampling was done according to 2005 national census and average interview time was 10 to 15 minutes. Ⅱ. Research Summary We have found that seven major retail channels compete with each other within Korean consumers' minds in terms of price and service. Each channel seem to have its unique selling points. Department stores were perceived as the best electronic goods shopping destinations due to after service. Internet shopping malls were perceived as the convenient channel owing to price checking. Category killers and hypermarkets were more attractive in both price merits and location conveniences. On the other hand, manufacturers dealer networks were pulling customers mainly by location and after service. Category killers and hypermarkets were most beloved retail channel for Korean consumers. However category killers compete mainly with department stores and shopping arcades while hypermarkets tend to compete with Internet and TV home shopping channels. Regarding channel satisfaction, the top 3 channels were service-driven retailers: department stores (4.27); dealer shop (4.21); and Internet shopping malls (4.21). Speciality shopping arcade(3.98) were the least satisfied channels among Korean consumers. Ⅲ. Implications We try to identify the whole picture of multi-channel retail shopping environments and its implications in the context of Korean electronic goods. From manufacturers' perspectives, multi-channel may cause channel conflicts. Furthermore, inter-channel competition draws much more attention as hypermarkets and category killers have grown rapidly in recent years. At the same time, from consumers' perspectives, 'buy where' is becoming an important buying decision as it would decide the level of shopping satisfaction. We need to develop the concept of 'channel equity' to manage multi-channel distribution effectively. Firms should measure and monitor their prime channel equity in regular basis to maximize their channel potentials. Prototype channel equity positioning map has been developed as follows. We expect more studies to develop the concept of 'channel equity' in the future.

  • PDF

A Study on the Timing and Method of the Final Price of Air Ticket in Computerised Booking System (인터넷 항공권 예약시스템에서의 '최종가격' 표시시기와 방법 - 2015년 1월 15일 EU사법재판소 C-573/13 판결을 중심으로 -)

  • Sur, Ji-Min
    • The Korean Journal of Air & Space Law and Policy
    • /
    • v.32 no.1
    • /
    • pp.327-353
    • /
    • 2017
  • The issue submitted to the Court of Justice on the merits of case C---573/13 originated from a claim brought in the context of a dispute between Air Berlin and the German Federal Union of Consumer Organisations and Associations. The challenge concerned the way in which air fares were displayed in Air Berlin's computerised booking system. The system was organised in such a way that, after selecting a date and a departure airport, one would find all possible flight connections in a summary table. However, the final price of the ticket was displayed only for the clicked connection, and not for all connections, thus preventing customers from being able to compare such price with the prices of other connections. The German Federal Union took the view that this practice did not meet the requirements laid down by Article 23 of Regulation (EC) No. 1008/2008, which requires transparency in the prices set for air services. This led the German State to bring an injunctive action to cause Air Berlin to discontinue said practice. The claim was upheld at both the application and appeal stage of the relevant proceedings. Subsequently, Air Berlin submitted the matter to the German Federal High Court, which decided to stay the proceedings and ask for a preliminary ruling from the Court of Justice as to 1. whether Article 23 of Regulation (EC) No. 1008/2008 must be interpreted as meaning that, during the computerised booking process, the final price to be paid must be indicated at all times when prices of air services are shown, including when they are shown for the first time; and 2. whether, during the computerised booking process, the final price must be indicated only for the air service specifically selected by the customer or for each air service shown. In a nutshell, the Court, by the here---discussed judgment determined that Article 23 of Regulation (EC) No. 1008/2008 must be interpreted as meaning that, in the context of a computerised air ticket booking system, the final price to be paid must be indicated not only for the air service specifically selected by the customer, but also for each air service in respect of which the fare is shown. Clearly the above judgment will place air companies under an obligation to update and adjust (when needed) their computerised ticket booking and payment systems, in consideration of the primary need for consumers to be aware at all times of the actual price payable for a ticket and be able to compare the price of the service selected with the prices for other air services in respect of which the fare is shown.

  • PDF

Weaning Following a 60 Minutes Spontaneous Breathing Trial (1시간 자가호흡관찰에 의한 기계적 호흡치료로부터의 이탈)

  • Park, Keon-Uk;Won, Kyoung-Sook;Koh, Young-Min;Baik, Jae-Jung;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
    • /
    • v.42 no.3
    • /
    • pp.361-369
    • /
    • 1995
  • Background: A number of different weaning techniques can be employed such as spontaneous breathing trial, Intermittent mandatory ventilation(IMV) or Pressure support ventilation(PSV). However, the conclusive data indicating the superiority of one technique over another have not been published. Usually, a conventional spontaneous breathing trial is undertaken by supplying humidified $O_2$ through T-shaped adaptor connected to endotracheal tube or tracheostomy tube. In Korea, T-tube trial is not popular because the high-flow oxygen system is not always available. Also, the timing of extubation is not conclusive and depends on clinical experiences. It is known that to withdraw the endotracheal tube after weaning is far better than to go through any period. The tube produces varying degrees of resistance depending on its internal diameter and the flow rates encountered. The purpose of present study is to evaluate the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube. Methods: We analyzed the result of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube in 18 subjects from June, 1993 to June, 1994. They consisted of 9 males and 9 females. The duration of mechanical ventilation was from 38 hours to 341 hours(mean: $105.9{\pm}83.4$ hours). In all cases, the cause of ventilator dependency should be identified and precipitating factors should be corrected. The weaning trial was done when the patient became alert and arterial $O_2$ tension was adequate($PaO_2$ > 55mmHg) with an inspired oxygen fraction of 40%. We conducted a careful physical examination when the patient was breathing spontaneously through the endotracheal tube. Failure of weaning trial was signaled by cyanosis, sweating, paradoxical respiration, intercostal recession. Weaning failure was defined as the need for mechanical ventilation within 48 hours. Results: In 19 weaning trials of 18 patients, successful weaning and extubation was possible in 16/19(84.2 %). During the trial of spontaneous breathing for 60 minutes through the endotracheal tube, the patients who could wean developed slight increase in respiratory rates but significant changes of arterial blood gas values were not noted. But, the patients who failed weaning trial showed the marked increase in respiratory rates without significant changes of arterial blood gas values. Conclusion: The result of present study indicates that weaning from mechanical ventilation following a 60 minutes spontaneous breathing with $O_2$ supply through the endotracheal tube is a simple and effective method. Extubation can be done at the same time of successful weaning except for endobronchial toilet or airway protection.

  • PDF

The Respiratory and Hemodynamic Effect of Prone Position in Patients with ARDS (급성호흡부전증후군에서 Prone Position의 호흡 및 혈류역학적 효과)

  • Lim, Chae-Man;Koh, Youn-Suck;Jung, Bok-Hyun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
    • /
    • v.44 no.5
    • /
    • pp.1105-1113
    • /
    • 1997
  • Background : Prone position improves oxygenation in some patients with ARDS. According to some authors, prone position can also improve the deteriorated hemodynamics induced by PEEP. But these respiratory and hemodynamic effects of prone position has not yet been fully established. Methods : Twentythree consequtive patients with ARDS(M : F= 11 : 12, $62.1{\pm}20.8yrs$) were the subjects for this study. ABGA, static compliance of the respiratory system, mean arterial pressure and pulse rate were obtained in supine position and at 5min, 0.5h and 2h of prone position. Positive respiratory response was defined as 20mmHg or more increase in $PaO_2/FIO_2$ within 2h of prone position. Early of late respiratory responses were defined if the positive response was observed within of after 3 day of ARDS onset, respectively. Positive hemodynamic response was defined as 10mmHg or more increase in mean arterial pressure at 5min of prone position. Results : Fifteen patients (65%) showed positive respiratory response. In the respiratory responders, $PaO_2$ was $69.8{\pm}17.6mmHg$ in supine position, $83.2{\pm}22.6mmHg$ in prone position 0.5h, $96.8{\pm}22.7mmHg$ in prone position 2h(p<0.001), and $PaO_2/FIO_2$ was $108{\pm}41mmHg$, $137{\pm}57mmHg$, $158{\pm}50mmHg$, respectively(p=0.001). Age, sex, cause of ARDS, supine $PaO_2$ and $PaO_2/FIO_2$ were not different between the respiratory responders and the nonresponders. The respiratory responders, however, showed higher mean arterial pressure than the nonresponders($91.1{\pm}13.1mmHg$ vs. $76.0{\pm}18.7mmHg$, p=0.035), and tendency of higher survival rate(9/15 vs. 2/8, p=0.074). Static compliance of the respiratory system was decreased in prone position 0.5h($28.4{\pm}7.9ml/cm$ $H_2O$ vs. $23.8{\pm}7.6ml/cm$ $H_2O$, p=0.007). The overall rate of early response(n=23) and late response(n=11) were similar(14/23 vs. 7/11, p>0.05). But patient without early response showed late response only in 25%(1/4), while patient with early response showed late response in 85.7%(6/7)(p=0.072). Five patients(22%) showed positive hemodynamic response, two of them being respiratory nonresponders. There were no differences in the baseline mean arterial pressure or the level of PEEP applied in supine between the hemodynamic responders and the hemodynamic nonresponders. Conclusions : Prone position either improved oxygenation or increased arterial pressure in significant proportion of patients with ARDS. And the respiratory response to prone position was thought to be determined in the early stage of ARDS.

  • PDF

Effect of Strength Increasing Sizes on the Quality of Fiberboard (섬유판(纖維板)의 증강(增强)사이즈제(齊)가 재질(材質)에 미치는 영향(影響))

  • Shin, Dong So;Lee, Hwa Hyoung
    • Journal of Korean Society of Forest Science
    • /
    • v.30 no.1
    • /
    • pp.19-29
    • /
    • 1976
  • The fiberboard and paper mills in this country are much affected by the price hikes and shortage of phenolic resins, since phenolic acid as a raw material depends on imported good. It is prerequisite to fiberboard industry to help replace with other sized and stabilize the prices and supply of them, improving the quality of boards. Thus, the present study was carried out to examine the effect of strength increasing sized such as urea formaldehyde resin (anion and cation type) and urea melamine copolymer resin, on the quality of the wet forming hardboard, and comparing them with two types of proprietary modified melamine resins, and ordinary size, phenol resin. The Asplund pulp was prepared from wood wastes mixed with 20 percent of lauan and 80 percent of pines as a fibrous material. After sizing agents were added at a pH of 4.5 for 10 minutes with alum in the beater, the stock was made in the form of wet sheet, prepared, and then performed by hot pressing cycle: $180^{\circ}C$, $50-6-5kg/cm^2$, 1-2-7 minutes. The properties of hardboard were examined after air conditioning. The results obtained are summarized as follows: 1. There is a significant difference in specific gravity among hardboards that were treated with strength increasing resins, but no difference is effected by the increase in the resin content. In the case of modified melamine resin, its specific gravity is highest. The middle group comprises cation type of urea resin, anion type of urea resin, and acid colloid of urea-melamine copolymer resin. The lowest is phenolic resin. 2. The difference of the moisture content of hardboard both by the resins and by the amount of each resin applied is significant. The moisture content of hardboard becomes lower along with the increase of each resin content, but there is no difference between 2 and 3 percent. 3. For water absorption, there is a significant difference both in the adhesives used and in the amount of paraffin wax emulsion. The water resistance becomes higher inn proportion to the content of the paraffin wax emulsion. To satisfy KS F standards of the water resistance, a proprietary modified melamine resin (p-6100) and modified cation type of urea resin (p-1500) do not require any paraffin wax emulsion, but in the case of anion type of urea resin, cation type of urea resin, and urea-melamine copolymer resin, 1 percent of paraffin wax emulsion is needed, and 2 percent of paraffin wax emulsion in the case of phenolic resin. 4. The difference of flexural strength of hardboard both by the resins and by the amount of each resin is significant. Modified melamine resin shows the highest degree of flexural strength. Among the middle group are urea-melamine copolymer resin, p-1500, anion type of urea resin, and cation type of urea resin. Phenolic resin is the lowest. The cause may be attributable to factors combined with the pressing temperature, sizing effect, and thermal efficiency of press platens heated electrically. 5. Considering the economic advantages and properties of hardboard, it is proposed that urea-melamine copolymer resin and cation type of urea resin be used for the development of the fiberboard industry. It is desirable to further develop the modified urea-melamine copolymer resin and cation type of urea resin through continuous study.

  • PDF