• Title/Summary/Keyword: management risk

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Comparison of Early Complications after Peritoneal Dialysis Catheter Implantation by Laparoscopic Surgery and Conventional Surgery in Children (소아에서 복막투석도관 삽입시 복강경을 이용한 방법과 기존의 수술법에 따른 초기 합병증 발생의 차이)

  • Jeong, Soo-In;Lee, Hyun-Young;Lee, Cheol-Gu;Seo, Jeong-Meen;Lee, Suk-Koo;Kim, Su-Jin;Kwak, Min-Jung;Jin, Dong-Kyu;Paik, Kyung-Hoon
    • Childhood Kidney Diseases
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    • v.11 no.1
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    • pp.51-58
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    • 2007
  • Purpose : To assess the early complication of laparoscopic peritoneal dialysis catheter implantation in children. Methods : Medical record review was carried out on 21 laparoscopic and 16 conventional peritoneal dialysis catheter implantations which were performed in 31 children under 18 years of age between 2002 and 2006. All medical records were retrospectively analyzed. The patients were followed until 2 months after catheter placement. Patient characteristics and catheterrelated complications, such as significant bleeding, leakage, obstruction, migration, insertion site infection and peritonitis during the first 60 days after implantation were recorded. Results : After conventional operation, dialysate leakage occurred in 2 of 16 cases and all cases improved after conservative management. In 1 case, significant bleeding occurred and re-operation was performed. Three cases of obstruction due to migration were reported, 2 cases underwent reoperation and 1 case improved without intervention. After laparoscopic surgery, outflow obstruction occurred in 1 out of 21 cases, which was caused by adhesion after several reinsertions of the catheter and recurrent peritonitis. No migration was noted after laparoscopic surgery. There was no significant difference in the complication rate between the two groups. Conclusion : Laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups, with at least equivalent functional results compared to conventional surgery. The additional advantage of laparoscopic catheter insertion is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions, and to perform partial omentectomy without additional incisions.

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Serum Lipid Profile and Nutritional Status in 6~7 Year Old Obese Children (6~7세 비만아에서 혈청 지질과 영양 상태에 관한 연구)

  • Rim, Jee-Yeon;Moon, Ji-Young;Lee, Chul-Gab;Moon, Kyung-Rye
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.2
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    • pp.160-168
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    • 2008
  • Purpose: This study was designed to characterize the nutritional status and assess obesity to determine the relationship between obesity and serum lipid profiles in 6~7 year old children. Methods: In 2007, we surveyed 483 children (233 boys and 250 girls) aged 6~7 years. The total cholesterol, triglyceride levels and HDL-cholesterol were measured in the fasting state. Dietary information was obtained by a questionnaire. Results: The prevalence of obesity was 9.9%. There was no significant difference between genders. The mean caloric intake was 1,781 kcal in boys and 1,640 kcal in girls. The prevalence of excessive calories was 33% in boys and 30% in girls. The prevalence of a total cholesterol ${\geq}$200 mg/dL was 8.4%, TG ${\geq}$130 mg/dL was 5.0%, LDL-cholesterol ${\geq}$130 mg/dL was 3.1%, and HDL-cholesterol <35 mg/dL was 4.4%. The prevalence of hypertension was 2.1%. There was no significant difference between genders. The systolic blood pressure, triglyceride levels and LDL-cholesterol were significantly related to an increased obesity index (p<0.05). The mean caloric intake and nutritive component were not related to the obesity index. The obesity group was compared to the control group: for triglycerides ${\geq}$130 mg/dL the odds ratio was 4.08; for LDL-cholesterol ${\geq}$130 mg the odds ratio was 2.85; for a TC/HDL-cholesterol ${\geq}$4.0 the odds ratio was 1.16. The BMI and triglyceride levels in the group with hypertension were higher than control group (p<0.05). There were significant positive correlations between the BMI and blood pressure as well as the LDL-cholesterol and triglycerides (p<0.05). The BMI was not correlated with the mean caloric intake or nutrition. Conclusion: The prevalence of hypertension and hyperlipidemia in 6~7 year old children was significantly related to an increased obesity index. The management of obesity in 6~7 year old children should include a reduction in the risk for hyperlipidemia and hypertension.

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Prevalence of Antibodies to Hepatitis A in the Healthy Children in Inchon-Kyunggi Prefecture (경인 지역 소아의 A형 간염 항체 보유율)

  • Kwon, Young Se;Hong, Young Jin;Choe, Yon Ho;Kim, Soon Ki;Son, Byong Kwan;Kang, Moon Su;Pai, Soo Hwan;Hong, Kwang Sun
    • Pediatric Infection and Vaccine
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    • v.5 no.2
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    • pp.239-244
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    • 1998
  • Purpose : The incidence of hepatitis A virus infection in Korea has decreased recently. However, the prevalence in children and young adults is on an increasing trend in Inchon-Kyunggi prefecture. Economic development that leads to better living conditions and improves hygiene facilities has reduced the rate of HAV infection. This study was designed to evaluate the recent seroprevalence rate of hepatitis A in children and adolescents. Methods : Study population consisted of 612 children and adolescents aged 1 to 17 years in Inchon-Kyunggi prefecture. Serum samples were collected between 1996 and 1997 and tested for anti HAV by Microparticle Enzyme Immunoassay(MEIA). Results : According to age, the seropositive rates were 10.5%(male 13%, female 6.7%) in 1 year-old group, 0% in 3, 5, 11 and 13 year-old group, 6%(male 8%, female 4%) in 15 year-old group, and 11%(male 14%, female 8%) in 17 year-old group. Conclusion : This study showed that seropositive rate of HAV infection increased with age. While it revealed extremely low incidence of HAV infection in children less than 13 years old, they are also likely 10 be exposed 10 the infection. Our findings suggest that the effective administration of vaccination is needed in selected and high risk groups.

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Significance of Serum Ferritin in Multiple Trauma Patients with Acute Respiratory Distress Syndrome (다발성 외상 환자에서 발생되는 급성 호흡 곤란 증후군의 예측 인자로서 혈청 페리틴의 의의)

  • Ji, Yae-Sub;Kim, Nak-Hee;Jung, Ho-Geun;Ha, Dong-Yeup;Jung, Ki-Hoon
    • Journal of Trauma and Injury
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    • v.20 no.2
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    • pp.57-64
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    • 2007
  • Purpose: Clinically, acute respiratory distress syndrome (ARDS) occurs within 72 hours after acute exposure of risk factors. Because of its high fatality rate once ARDS progresses, early detection and management are essential to reduce the mortality rate. Accordingly, studies on early changes of ARDS were started, and serum ferritin, as well the as injury severity score (ISS), which has been addressed in previous studies, thought to be an early predictive indicator for ARDSMethods: From March 2003 to March 2005, we investigated 50 trauma patients who were admitted to the intensive care unit in Dongguk University Medical Center, Gyeongju. The patients were characterized according to age, sex, ISS, onset of ARDS, time onset of ARDS, serum ferritin level (posttraumatic $1^{st}\;&\;2^{nd}$ day), amount of transfused blood, and death. Abdominal computed topography was performed as an early diagnostic tool to evaluate the onset of ARDS according to its diagnostic criteria. The serum ferritin was measured by using a $VIDAS^{(R)}$ Ferritin (bioMeriux, Marcy-1' Etoile, France) kit with an enzyme-linked fluorescent assay method. For statistical analysis, Windows SPSS 13.0 and MedCalc were used to confirm the probability of obtaining a predictive measure from the receiver operating characteristics (ROC) curve. Results: The ISS varied from 14 to 66 (mean: 33.8) whereas the onset of ARDS could be predicted with the score above 30 (sensitivity: 90.0%, specificity: 60.0%, p<0.05). On the posttraumatic $1^{st}$ day, the serum ferritin levels were measured to be from 31 mg/dL to 1,200 mg/dL (mean: 456 mg/dL), and the onset of ARDS could be predicted when the value was over 340 mg/dL (sensitivity: 80.0%, specificity: 65.0%, p<0.05). On the posttraumatic $2^{nd}$ day, the serum ferritin levels were measured to be from 73 mg/dL to 1,200 mg/dL (mean: 404 mg/dL), and the onset of ARDS could be predicted when the value was over 627 mg/dL (sensitivity: 60.0%, specificity: 92.5%, p<0.05). The serum ferritin levels and the ISS were significantly higher on the posttraumatic $1^{st}$ and $2^{nd}$ day in the ARDS group, suggesting that they are suitable indices predicting the onset of ARDS, however relationship between the serum ferritin levels and the ISS was not statistically significant. Conclusion: In this study, we discovered increasing serum ferritin levels in multiple- trauma patients on the posttraumatic $1^{st}$ & $2^{nd}$ day and concluded that both the serum ferritin level and the ISS were good predictors of ARDS. Although they do not show statistically significant relationship to each other, they can be used as independent predictive measures for ARDS. Since ARDS causes high mortality, further studies, including the types of surgery and the methods of anesthesia on a large number of patients are essential to predict the chance of ARDS earlier and to reduce the incidence of death.

Right-Turn Vehicle Supplementary Signal Improvement at Intersections (교차로 우회전 차량 보조등 개선)

  • LEE, Nam Soo;KIM, Yu Chan;LIM, Joon Beom;KIM, Youngchan
    • Journal of Korean Society of Transportation
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    • v.33 no.5
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    • pp.441-448
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    • 2015
  • This study aims to suggest a reasonable signal operation method for right-turn traffic management. It was found that the right-turn vehicle supplementary signal is currently operated without clear regulations or criteria. It was also analyzed that right-turn supplementary signals are used without consistency, there is a risk of traffic accidents due to the discordance between supplementary signals and traffic signals of forward vehicles, there is a lack of basis for prohibition of a right turn when right-turn vehicle's supplementary signal is red and the flashing red signal is used in a different sense from the law. In order to see the effect of the installed right-turn vehicle supplementary signals on traffic signal violation, a field investigation was conducted. As the result, there was a high proportion of signal violation on the approach lane with right-turn supplementary signals and this means that right-turn supplementary signals hardly influenced the reduction in proportion of signal violation during a right turn. Additionally, a survey was carried out to see if there were differences in driver's interpretation of traffic signals depending on the installation of right-turn supplementary signals. As the result of the survey, there were no differences in interpretation of traffic signals depending on the installation of right-turn supplementary signals or the types of right-turn supplementary signals. A right turn when the signal was red did not lead to serious traffic accidents, so it is thought that there should be a careful consideration of a total ban on a right turn when the signal is red, in order to prevent driver's confusion due to the change of the signal system. Unless there is a disturbance to cars and pedestrians after a temporary stop when the signal is red, there is a need to specify that vehicles must stop temporarily in the Road Traffic Act to facilitate a right turn. What this study finally suggested is to use tri-colored arrow signals for right-turn car supplementary signals to convey a signal to a driver clearly.

Surgical Treatment of Cardiac Myxoma: A 20 Years of Experiences (심장 점액종의 외과적 치료: 20년 임상경험)

  • Seo, Hong-Joo;Oh, Sam-Se;Kim, Jae-Hyun;Yie, Kil-Soo;Baek, Man-Jong;Na, Chan-Young
    • Journal of Chest Surgery
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    • v.40 no.4 s.273
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    • pp.288-291
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    • 2007
  • Background: Myxoma makes up close to 50% of adult primary cardiac tumors, and this mainly occurs in the left atrium, and rarely in the right atrium or ventricle. The patients clinically present with symptoms of hemodynamic obstruction, embolization or constitutional changes. Diagnosis is currently established most appropriately with 2-D echocardiography. Surgical resection of myxoma is a safe and effective treatment, Material and Method: We reviewed our clinical experience in the diagnosis and management of 57 cases of cardiac myxoma that were seen over a 20-year period from July 1984 to July 2004. Result: The mean age of the patients was $53.5{\pm}14.0$ years (range: 12 to 76 years). There were 38 (67%) females and 19 (33%) males. The preoperative symptoms included dyspnea on exertion in 27 patients, palpitation in 4, chest pain in 9 and syncopal episode in 4. The diagnosis was made by echocardiography alone in 51, and by combination of echocardiography, CT and angiography in 6. The tumor attachment sites were the interatrial septum in 50, the mital valve annulus in 3 and the left atrial wall in cases, The tumor was excised successfully via biatriotomy in 33 (58%), left atriotomy in 15 (26%), the septal approach via right atriotomy in 3, Inverted T incision in 3 and the extended septal approach in 3. The follow-up time ranged from 1 to 229 months (mean follow-up: $84.0{\pm}71.3$ months). There were no early and late deaths and no recurrence during the follow-up period except for follow-up loss in 5 patients. Conclusion: It's concluded that excision of cardiac myxoma is curative and the long-term survival is excellent. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Radical tumor excision may prevent recurrences.

Analysis on Hazard Microorganisms in Raw Materials and Processing Environment for Sunsik Manufacture (선식용 곡류원료 및 제조공정에 따른 유해미생물 오염도 분석)

  • Kim, Jin-Hee;Lee, Yu-Keun;Yang, Ji-Young
    • Journal of Food Hygiene and Safety
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    • v.26 no.4
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    • pp.410-416
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    • 2011
  • Cereals are the main raw material for sunsik manufacture. As the fundamental processing step, it is very important to confirm the level of the microorganism contamination in the cereals. This study was carried out a micrbiological screening of cereal samples for sunsik from 19 companies located in South Korea. Ten kinds of cereals which were glutinous rice, barley, brownrice, blackbean, blackrice, blacksesame, sorghum, millet, perilla seed, and adlay were investigated. As the results, the contaminations of general bacterial were 3.1~8.6 log(CFU/g). The results of Escherichia coli were 1.0~3.4 log(CFU/g). There was no contamination of Salmonella. spp in any cereal samples except black sesame and mold was detected in barley. The experiment for microbiological contamination during sunsik processing was also investigated in this study. The results of general bacteria were detected as 5.1~8.5, 4.4~7.5, 1.0~2.3, 2.4~4.2, 1.0~4.0, 3.4~4.2, 4.3~5.2, and 3.3~5.5 log(CFU/g) during environment of warehousing, washing, steaming, 1st cooling, drying, 2nd cooling, grinding, and packaging process, respectively. The results of coliform were 1.0~2.0 log(CFU/g) during warehousing respectively. Mold was found in warehousing. In case of the instruments, the contaminations of general bacterial were 4.2~7.5, 0.1~2.0, 0.1~3.2, 3.7~4.0, 2.5~3.0, and 3.8~5.2 log(CFU/g) in cereals tanks, washing machines, grinding machines, packaging machines, and workrooms. The results of coliform were 2.4~4.0, 0.0~4.1 log(CFU/g) in cereals tanks and grinding machines, respectively. Mold were only found in cereals tanks, grinding machines, and workings. Therefore, the risk of hazard microorganisms contmination might be decrased as the exhaustive management is applied to the whole sunsik process.

Growth Potential of Escherichia coli O157:H7 in Lettuce Leaf Extract and on Lettuce Leaf Surface (상추잎 즙액과 표면에서 Escherichia coli O157:H7의 생장 가능성)

  • Kim, Won-Il;Jung, Hyang-Mi;Kim, Se-Ri;Park, Kyeong-Hun;Kim, Byung-Seok;Yun, Hye-Jung;Yun, Jong-Chul;Ryu, Kyoung-Yul
    • Journal of Food Hygiene and Safety
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    • v.26 no.4
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    • pp.296-301
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    • 2011
  • This study was to evaluate the growth potential of E. coli O157:H7 in lettuce leaf extracts and on lettuce leaf surface at various temperatures. The pathogen can survive and multiply in the extracts and leaf surface of lettuce. The population of E. coli O157:H7 in the lettuce extracts reached to 4.79 log CFU/mL at $37^{\circ}C$. The multiplication of pathogen in lettuce extracts initiated within 10 hours of inoculation over $15^{\circ}C$ conditions. And it can survive in the lettuce leaf extracts at $4^{\circ}C$ for 100 hours at least. And this pathogen can multiply on lettuce leaf surface and the population of pathogen on the lettuce leaf surface increased to 1.82 log CFU/g at $25^{\circ}C$. At $37^{\circ}C$, the pathogen density increased to 1.53 CFU/g within 3 days after inoculation. At all temperature, irrespective of the inoculation level, similar trends in growth of E. coli O157:H7 were observed. These results emphasize the growth potential of E. coli O157:H7 in lettuce leaf extract and on lettuce leaf surface. To reduce the risk of outbreak, it is important to maintain the cold chain system during storage before the consumption.

International Monetary System Reform and the G20 (국제통화제도의 개혁과 G20)

  • Cho, Yoon Je
    • KDI Journal of Economic Policy
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    • v.32 no.4
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    • pp.153-195
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    • 2010
  • The recent global financial crisis has been the outcome of, among other things, the mismatch between institutions and the reality of the market in the current global financial system. The International financial institutions (IFIs) that were designed more than 60 years ago can no longer effectively meet the challenges posed by the current global economy. While the global financial market has become integrated like a single market, there is no international lender of last resort or global regulatory body. There also has been a rapid shift in the weight of economic power. The share of the Group of 7 (G7) countries in global gross domestic product (GDP) fell and the share of emerging market economies increased rapidly. Therefore, the tasks facing us today are: (i) to reform the IFIs -mandate, resources, management, and governance structure; (ii) to reform the system such as the international monetary system (IMS), and regulatory framework of the global financial system; and (iii) to reform global economic governance. The main focus of this paper will be the IMS reform and the role of the Group of Twenty (G20) summit meetings. The current IMS problems can be summarized as follows. First, the demand for foreign reserve accumulation has been increasing despite the movement from fixed exchange rate regimes to floating rate regimes some 40 years ago. Second, this increasing demand for foreign reserves has been concentrated in US dollar assets, especially public securities. Third, as the IMS relies too heavily on the supply of currency issued by a center country (the US), it gives an exorbitant privilege to this country, which can issue Treasury bills at the lowest possible interest rate in the international capital market. Fourth, as a related problem, the global financial system depends too heavily on the center country's ability to maintain the stability of the value of its currency and strength of its own financial system. Fifth, international capital flows have been distorted in the current IMS, from EMEs and developing countries where the productivity of capital investment is higher, to advanced economies, especially the US, where the return to capital investment is lower. Given these problems, there have been various proposals to reform the current IMS. They can be grouped into two: demand-side and supply-side reform. The key in the former is how to reduce the widespread strong demand for foreign reserve holdings among EMEs. There have been several proposals to reduce the self-insurance motivation. They include third-party insurance and the expansion of the opportunity to borrow from a global and regional reserve pool, or access to global lender of last resort (or something similar). However, the first option would be too costly. That leads us to the second option - building a stronger globalfinancial safety net. Discussions on supply-side reform of the IMS focus on how to diversify the supply of international reserve currency. The proposals include moving to a multiple currency system; increased allocation and wider use of special drawing rights (SDR); and creating a new global reserve currency. A key question is whether diversification should be encouraged among suitable existing currencies, or if it should be sought more with global reserve assets, acting as a complement or even substitute to existing ones. Each proposal has its pros and cons; they also face trade-offs between desirability and political feasibility. The transition would require close collaboration among the major players. This should include efforts at the least to strengthen policy coordination and collaboration among the major economies, and to reform the IMF to make it a more effective institution for bilateral and multilateral surveillance and as an international lender of last resort. The success on both fronts depends heavily on global economic governance reform and the role of the G20. The challenge is how to make the G20 effective. Without institutional innovations within the G20, there is a high risk that its summits will follow the path of previous summit meetings, such as G7/G8.

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The Effects of BizCool of Vocational High School on the Understanding of Enterprise Commencement and BizCool Outcomes (전문계 고교 창업교육(BizCool)이 창업인식 및 창업교육성과에 미치는 영향)

  • Cheon, Soo-Kyung;Jung, Hwa-Young
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.4 no.4
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    • pp.89-114
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    • 2009
  • BizCool is an entry-level business education program implemented with a purpose of enhancing the entrepreneurial disposition and capability of the youth through enterprise commencement education of vocational high school students and developing them into economic pillars of future to alleviate the labor shortage crisis of small and medium enterprises and revitalize enterprise commencement. In this study, the factors were deduced and a path analysis was conducted with the purpose of proposing a revitalization plan through an effectiveness analysis of enterprise commencement education for the youth. The result of the analysis revealed that BizCool has effects on the knowledge and understanding of enterprise commencement, and enterprise commencement knowledge also has effects on the understanding of enterprise commencement. In addition, it was found that the enterprise commencement knowledge and the understanding on enterprise commencement have effects on the intention of enterprise commence. In the result of verifying the hypothesis that the understanding of enterprise commencement according to the psychological characteristics of individuals will have a positive effect on the enterprise commencement intention, it was revealed that the risk resignation disposition and patience for ambiguity are having effects but accomplishment desire is not playing a moderating variable role. Through the above path analysis, a conclusion was obtained that the enterprise commencement education has effects on the outcome of enterprise commencement education through the understanding on enterprise commencement. Additionally, the nation needs to actively lead systematic enterprise commencement education within the policy of job creation upon realizing the need for enterprise commencement education of vocational high school, and a revitalization plan was proposed on the five kinds of a conversion of social perception on vocational high school, establishment of institutes specializing in BizCool and cultivation of BizCool specialists, development of various materials and expansion of BizCool program, field-centered lessons, revitalization of enterprise commencement club and personnel and resource support by companies.

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