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Providing Reliable Prognosis to Patients with Gastric Cancer in the Era of Neoadjuvant Therapies: Comparison of AJCC Staging Schemata

  • Kim, Gina;Friedmann, Patricia;Solsky, Ian;Muscarella, Peter;McAuliffe, John;In, Haejin
    • Journal of Gastric Cancer
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    • v.20 no.4
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    • pp.385-394
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    • 2020
  • Purpose: Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. Materials and Methods: Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. Results: We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I-IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0-IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). Conclusions: The cStage is unreliable for prognosis, and ypStage is moderately reliable. Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

Study of The Area of Nursing Need by the Family Developmental Stage (가족발달단계에 따른 간호요구영역에 관한 연구)

  • 최부옥
    • Journal of Korean Academy of Nursing
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    • v.7 no.2
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    • pp.43-59
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    • 1977
  • The Community Health Service considers the family as a service unit and places the emphasis of its service on the health problems and the nursing needs of the family rather than the individual. From the conceptual point of view that tile community health service is both health maintenance and health promotion of the family, the community health nurse should have a knowledge of the growth and development of the family and be responsible for the comprehensive support of normal family development. The community health nurse often is in a position to make a real contribution to normal family development. In order to investigate the relationship between the areas of nursing need and family development, the following objectives were established 1. To discover the general characteristics of the study population by the stage of family development. 2. To discover specific nursing needs in relation to the family developmental stage, and to determine the intensity of the nursing needs and the ability of the family to cope with these needs. 3. To discover overall family health nursing problems in relation to the family developmental stage and determine the intensity of the nursing need and the problem solving ability of family. Definitions : The family developmental stages as classified by Dually were used stage 1. Married couples(without children) stage 2. Childbearing Families (oldest child birth to 30 months of age) stage 3. Families with preschool children (oldest child 2½-to 6 years) stage 4. Families with schoolchildren (oldest child 6 to 13 years). stage 5. Families with teenagers (oldest child 13 to 20 years) stage 6. Families as launching centers (first child gone to last child′s leaving home). stage 7. Middle- aged parents (empty nest to retirement) stage 8. Aging family member (retirement to death of both spouses) The areas of nursing need were defined as those used in the study, "A Comprehensive Study about Health and Nursing Need and a Social Diagram of the Community", by tile Nursing research Institute and Center for population. and Family Planning, July 1974. The study population defiled and selected were 260 nuclear families ill two myron of Kang Hwa Island. Percent, mean value and F- test were utilized in tile statistical analysis of the study result. Findings : 1. General characteristics of the study population by tile family developmental stage ; 1)The study population was distributed by the family developmental stage as follows : stage 1 : 3 families stage 2 : 13 families stage 3 : 24 families stage 4 : 41 families stage 5 : 50 families stage 6 : 106 families stage 7 : 13 families stage 8 : 10 families 2) Most families had 4 or 5 members except for those in stage, 1, 7, and 8. 3) The parents′ present age was older in the higher developmental stage and their age at marriage was also younger in the higher developmental stages. 4) The educational level of parents was primarily less than elementary school irrespective of the developmental stage. 5) More than half of parents′ occupations were listed as laborers irrespective of the developmental stage, 6) More than half of the parents were atheists irrespective of the developmental stage. 7) The higher the developmental stage(from stage 2 to stage 6 ), the wider the distribution of children′s ages. 8) More than half of the families were of middle or lower socio-economic level. 2. Problems in specific areas of nursing need by family developmental stage, the intensity of nursing need and the problem solving ability of the family : 1) As a whole, many problems, irrespective of the developmental stage, occurred in tile areas of Housing and Sanitation, Eating Patterns, Housekeeping, Preventive Measures and Dental care. Problems occurring ill particular stages included the following ; stage 1 : Prevention of Accident stage 2 : Preventive Vaccination, Family Planning. stage 3 : Preventive Vaccination, Maternal Health, Family Planning, Health of Infant and Preschooler. stage 4, 5 : Preventive Vaccination, Family Planning, Health of School Children. stage 6 : Preventive Vaccination, Health of School Children. 2) The intensity of the nursing need in the area of Acute and Chronic Diseases was generally of moderate degree or above irrespective of the developmental stages except for stage 1. Other areas of need listed as moderate or above were found in the following stages: stage 1 : Maternal Health stage 3 . Horsing and Sanitation, Prevention of Accident. stage 4 . Housing and Sanitation. stage 5 : Housing and Sanitation, Diagnostic and Medical Care. stage 6 : Diagnostic and Medical care stage 7 : Diagnostic and Medical Care, Housekeeping. stage 8 : Housing and Sanitation, Prevention of Accident, Diagnostic and Medical Care, Dental Care, Eating Patterns, Housekeeping. 3) Areas of need with moderate problem solving ability or less were as follows : stage 1 : Diagnostic and Medical Care, Maternal Health. stage 2 : Prevention of Accident, Acute and Chronic Disease, Dental Care. stage 3 : Housing and Sanitation, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measure, Dental Care, Maternal Health, Health of Infant and preschooler, Eating Patterns. stage 4 : Housing and Sanitation, Prevention of Accident, Diagnostic and Medical Care, Preventive Measure, Dental Care, Maternal Health, Health of New Born, Health of Infant and Preschooler, Health of school Children, Eating Patterns, Housekeeping. stage 5 . Housing and Sanitation, Prevention of Accident, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measure, Dental Care, Preventive Vaccination, Maternal Health, Eating Patterns. stage 7, 8 : Housing and Sanitation, Prevention of Accident, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measures, Dental Care, Preventive Vaccination, Eating Patterns , Housekeeping. Problem occurrence, the degree of nursing need and the degree of problem solving ability 1 nursing need areas for the family as a whole were as follows : 1) The higher the stages(except stage 1 ), the lower the rate of problem occurrence. 2) The higher the stage becomes, the lower the intensity of the nursing need becomes. 3) The higher the stages (except stages 7 and 8), the higher. the problem solving ability. Conclusions ; 1) When the nursing care plan for the family is drawn up, depending upon the stage of family development, higher priority should be give to nursing need areas ① at which problems were shown to occur ② where the nursing need is shown to be above moderate degree and ③ where the problem solving ability was shown to be of moderate degree. 2) The priority of the nursing service should be Placed ① not on those families in the high developmental stage but on those families in the low developmental stage ② and on those areas of need shown in stages 7 and 8 where the degree nursing need was high and the ability to cope low.

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EARLY DEVELOPMENT OF THE TOOTH IN THE STAGED HUMAN EMBRYOS AND FETUSES (한국인 배자 및 태아에서 유치 발생의 조직학적 변화)

  • Lim, Hee-Sik;Park, Hyoung-Woo;Oh, Hyeon-Joo;Kim, Hee-Jin;Choi, Byung-Jai
    • Journal of the korean academy of Pediatric Dentistry
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    • v.25 no.2
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    • pp.383-399
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    • 1998
  • Tooth development is usually described in four stages such as bud stage, cap stage, bell stage and crown stage. Exact time of appearance of tooth primordia is different among reports, and up to now there is no timetable regarding initial tooth development. To understand the congenital malformations and other disorders of the orofacial region, there is a need to establish a standard timetable on early tooth development. Till now, studies on the tooth development were mainly on later fetuses, and only few reports on early stage. Also, there were no reports on the time when bud stage turns to cap stage, and cap stage to bell stage. In this study, external morphology of face and the early development of the tooth, and transition of bud stage to cap stage, cap stage to bell stage were studied using 27 staged human embryos and 9 serially sectioned human fetuses. The results are as follows: 1. Mandibular region was formed by union of both mandibular arch at stage 15, and maxillary region by union of maxillary arch, medial nasal prominence, and intermaxillary segment at stage 19. 2. Ectodermal thickening which represents the primordia of tooth appeared in mandibular region at stage 13, and maxillary region at stage 15. 3. Bud stage began from mandibular primary central incisor at stage 17, and maxillary primary central incisor at stage 18. And the sequence of appearance was in the mandibular primary lateral incisor at stage 19, maxillary primary lateral incisor at stage 20, mandibular primary canine at stage 22, maxillary primary canine and primary first molar at stage 23, madibular primary first molar and maxillary primary second molar at 9th week, and mandibular primary second molar at 10th week of development. 4. Cap stage began from the primary anterior teeth at 9th week, and primary second molar still had the characteristics of cap stage at 12th week of development. 5. Transition to bell stage started from the primary anterior teeth at 12th week, and primary second molar started at 16th week of development. 6. Trnasition to crown stage started from primary anterior teeth at 16th week, and primary second molar at 26th week of development.

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The Designs of Stage Costume for 'Media Children's English Musical, The Magic Flute' ('미디어 어린이 영어뮤지컬 마술피리' 무대의상 디자인)

  • Lee, Ji-Hye;Kim, Yang-Hee
    • Journal of the Korean Society of Costume
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    • v.64 no.7
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    • pp.114-127
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    • 2014
  • Performing arts offer fun and knowledge and are directed for various purposes. Performing arts are also used as a means for education. Children's English media musical, 'The Magic Flute' is the performance reflecting all these. The author of this study took part in stage costume production, and this study was carried out aiming at designing and producing stage costume in line with educational purpose and intention. This study consists of an analysis stage for the existing performances of 'The Magic Flute', and a stage costume design and production stage for children's English media musical, 'The Magic Flute', First, this study classified and analyzed the stage design and stage costume design of the existing 'The Magic Flute' by concept, and then, examined their features, respectively. and this study unfolded the stage costume concept, based on the analyses of existing performance's stage costume and the characters' personality and features described in the current study subject's script. As the last step of this study made each character's stage costume. A total of 69 costumes for stage costume were made for 7 types of characters. This study is considered to have huge significance in that the stage costume was developed for 'The Magic Flute'.

Silver Ores and Fluid Inclusions of the Cheolam Silver Deposits (철암은광상(鐵岩銀鑛床)의 광석(鑛石)과 유체포유물(流體包有物))

  • Park, Hee-In;Woo, Young-Kyun;Bae, Young Boo
    • Economic and Environmental Geology
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    • v.20 no.1
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    • pp.1-18
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    • 1987
  • The Cheolam silver deposits are emplaced along the fractures in breccia dike and the Hongjesa granite. Breccia dike contains fragments of late Cretaceous acidic volcanic rocks and other fragments of various rocks distributed in the mine area. Therefore it is presumed that the mineralization was taken place in later than late Cretaceous time. Mineral paragenesis is complicated by multiple episodes of fracturing. Six distinct depositional stages can be recognized: stage I, deposition of base metal sulfides; stage II, deposition of base metal sulfides and silver minerals; stage III, deposition of carbonates; stage IV, deposition of silver minerals and base metal sulfides; stage V, deposition of silver minerals; stage VI, deposition of barren quartz. Silver minerals from the deposits are native silver, acanthite, pyrargyrite, argentian tetrahedrite, stephanite, polybasite, pearceite, allargentum, antimonial silver and electrum. Fluid inclusion studies ware carried out for stage I, II, IV and VI quartz and stage III calcite. Homogenization temperatures for each stage are as follows: stage I, from $225^{\circ}$ to $360^{\circ}C$; stage II, from $145^{\circ}$ to $220^{\circ}C$; stage III, from $175^{\circ}$ to $240^{\circ}C$; stage IV, from $130^{\circ}$ to $185^{\circ}C$; stage VI, from $120^{\circ}$ to $145^{\circ}C$. Salinities of ore fluids were in the range of 4 and 10 wt.% equivalent NaCl over stage I and stage VI. Ore mineralogical data of each stage indicate that temperatures are within the range of homogenization temperature of fluid inclusions and sulfur fugacities declined steadily from $10^{-9.7}atm$. to $10^{-18.7}atm$. through stage I into stage V.

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Gold and Silver Mineralization of Samhyungje Vein, the Mugeug Mine (무극광산(無極鑛山) 삼형제맥(三兄弟脈)의 금은광화작용(金銀鑛化作用))

  • Park, Hee-In;Kang, Seong Jun
    • Economic and Environmental Geology
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    • v.21 no.3
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    • pp.257-268
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    • 1988
  • The Mugeug gold deposits is consisted of more than fourteen gold and silver-bearing quartz veins emplaced in Mesozoic granodiorite mass. In the Samhyungje vein, one of the representative vein in the mine, six stages of mineralizatidns are recognized: Stage I, deposition of base-metal sulfides and gray quartz; stage II, deposition of base-metal sulfides, electrum and white quartz with pinkish tint; stage m, deposition of base-metal sulfides and dark gray quartz; stage N, deposition of native silver, argentite, Ag-tetrahedrite, polybasite, arsenpolybasite and quartz; stage V, deposition of nearly barren quartz; stage VI, deposition of transparent quartz veinlets with minor pyrite. Ag contents of electrum increase steadily from stage II to stage N; 57.25-61.44 atom. % for stage II, 62.85-69.66 atom. % for stage m, 69.79-74.12 atom. % for stage N. Homogenization temperatures of fluid inclusions are as follows; stage II, from $194^{\circ}$ to $287^{\circ}C$; stage V, from $137^{\circ}$ to $171^{\circ}C$, stage VI, from $192^{\circ}$ to $232^{\circ}C$. Salinities of fluid inclusions range from 3.7 to 7.9 wt.% equivalent NaCl in stage II and from 0.8 to 4.3 wt.% equivalent Nael in stage V. Ore mineralogy suggest that temperature and sulfur fugacity declined steadily from $290^{\circ}$ to $150^{\circ}C$ and from $10^{-10.5}$ to $10^{-19.0}$atm. through stage II into stage N. Fluid pressure during stage II inferred from data of mineral assemblages and fluid inclusions is 370bar.

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Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System

  • Shin, Jin Won;Cho, Deog Gon;Choi, Si Young;Park, Jae Kil;Lee, Kyo Young;Moon, Youngkyu
    • Journal of Chest Surgery
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    • v.52 no.3
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    • pp.131-140
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    • 2019
  • Background: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

A Study on the Process Capability Model of Knowledge Management (지식경영 프로세스 능력 모델 개발 연구)

  • Kim, Hyun-Soo
    • Asia pacific journal of information systems
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    • v.11 no.3
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    • pp.23-42
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    • 2001
  • Recently, knowledge management becomes a core management tool for efficient and effective organizations. However, there are little known researches on measuring knowledge management level. The objective of this paper is to develop a process capability model for knowledge management of an organization. We developed 5 stage process capability model for knowledge management. The 1st stage is the initial stage where no significant knowledge management activity is performed. The 2nd stage is the performed stage where planning and tracking activities are performed on organization level. The 3rd stage is the established, and the 4th stage is the predictable stage where processes and results of knowledge management can be predictable. Final stage is the optimizing stage where knowledge management process is continuously improved at an organizational level. We surveyed 37 korean companies to test the validity of the proposed stage model. Statistical tests show that the developed stage model of knowledge management is valid and sound in general conditions. The result of this study on process capability model can be a solid stepping stone for future works in this area.

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Global Gold Decoupling from the Dollar and Its implications

  • Chae, Dae-Seok;Hur, Hyung-Doh
    • International Commerce and Information Review
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    • v.8 no.1
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    • pp.371-398
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    • 2006
  • Gold prices are rising around the world in all major currencies. This is a telltale sign of a Stage Two gold bull where gold decouples from the US dollar. In this study, We analysed a confluence of factors seem to be feeding gold's gains and the typical shape of a secular gold bull---gold bulls' three stages. Stages one, two, and three of a secular gold bull are defined by the major changes. Each stage, considered in turn, makes perfect sense when described in terms of global investor demand. Since Stage One is currency-devaluation driven, the young gold bull is most noticeable in terms of the dominant eroding currency. Now after three or four years of stage one, Stage Two arrives. Stage Two marks a momentous event when gold decouples from the local-currency devaluation. In the case of our gold bull today, Stage Two will be here when gold starts consistently rising faster than the dollar is able to fall. After five or so years of Stage Two gains, gold has a chance at going ballistic in stage three. Stage Three is only ignited if the general public around the world starts growing enamored with gold investing. In summary, the first stage being when insiders and professionals invest in the market. The second stage is when the general public and financial media recognizes that the bull market is real. The third stage is the mania stage when people feel that not only is the bull market real, but it is a must own situation. Through the study we found that gold is entering it now.

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Experimental Study on a GM-type Two-Stage Pulse Tube Refrigerator for Cryopump Applications

  • Lee, S.J.;Hong, Y.J.;Park, S.J.;Kim, H.B.;Kwon, S.B.
    • Progress in Superconductivity and Cryogenics
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    • v.9 no.2
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    • pp.35-38
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    • 2007
  • A single-stage and two-stage pulse tube refrigerators have been designed for cryopump application. The different diameters of pulse tube and regenerator have been investigated at single-stage pulse tube refrigerator(PTR). Experiments have been performed on single-stage PTR to reach minimum temperature with optimum valve opening at a few frequencies. And the two-stage pulse tube refrigerators have been assembled with tested single-stage pulse tube and tested. When orifice turn is opened to 9 and double inlet is opened to 3 at a single-stage, the lowest temperature of 33.7 K is achieved. The cooling capacity at single-stage is 38 W at temperature of 80 K. A two-stage pulse tube refrigerator has 16.3K at the second stage and 59.7K at the first stage. The cooling capacity achieved is 16.5 W at 80 K, the first stage and 0.6 W at 20 K, the second stage. Some details on the design of pulse tube refrigerator and the experimental apparatus are given.