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A Case of Childhood Obstructive Sleep Apnea Syndrome with Co-morbid Attention Deficit Hyperactivity Disorder Treated with Continuous Positive Airway Pressure Treatment (지속적(持續的) 상기도(上氣道) 양압술(陽壓術)을 시행(施行)하여 치료효과(治療效果)를 본 주의력(注意力) 결핍(缺乏).과잉(過剩) 운동장애(運動障碍)를 동반(同伴)한 소아기(小兒基) 폐쇄성(閉鎖性) 수면무호흡증(睡眠無呼吸症) 1례(例))

  • Sohn, Chang-Ho;Shin, Min-Sup;Hong, Kang-E;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.3 no.1
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    • pp.85-95
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    • 1996
  • Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

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A Geographically Weighted Regression on the Effect of Regulation of Space Use on the Residential Land Price - Evidence from Jangyu New Town - (공간사용 규제가 택지가격에 미치는 영향에 대한 공간가중회귀분석 - 장유 신도시지역을 대상으로-)

  • Kang, Sun-Duk;Park, Sae-Woon;Jeong, Tae-Yun
    • Management & Information Systems Review
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    • v.37 no.3
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    • pp.27-47
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    • 2018
  • In this study, we examine how land use zoning affects the land price controlling other variables such as road-facing condition of the land, land form, land age after its development and land size. We employ geographically weighted regression analysis which reflects spatial dependency as methodology with a data sample of land transaction price data of Jangyu, a new town, in Korea. The results of our empirical analysis show that the respective coefficients of traditional regression and geographically weighted regression are not significantly different. However, after calculating Moran's Index with residuals of both OLS and GWR models, we find that Moran's Index of GWR decreases around 26% compared to that of OLS model, thus improving the problem of spatial autoregression of residuals considerably. Unlike our expectation, though, in both traditional regression and geographically weighted regression where residential exclusive area is used as a reference variable, the dummy variable of the residential land for both housing and shops shows a negative sign. This may be because the residential land for both housing and shops is usually located in the level area while the residential exclusive area is located at the foot of a mountain or on a gentle hill where the residents can have good quality air and scenery. Although the utility of the residential land for both housing and shops is higher than its counterpart's since it has higher floor area ratio, amenity which can be explained as high quality of air and scenery in this study seems to have higher impact in purchase of land for housing. On the other hand, land for neighbourhood living facility seems to be valued higher than any other land zonings used in this research since it has much higher floor area ratio than the two land zonings above and can have a building with up to 5 stories constructed on it. With regard to road-facing condition, land buyers seem to prefer land which faces a medium-width road as expected. Land facing a wide-width road may have some disadvantage in that it can be exposed to noise and exhaust gas from cars and that entrance may not be easy due to the high speed traffic of the road. In contrast, land facing a narrow road can be free of noise or fume from cars and have privacy protected while it has some inconvenience in that entrance may be blocked by cars parked in both sides of the narrow road. Finally, land age variable shows a negative sign, which means that the price of land declines over time. This may be because decline of the land price of Jangyu was bigger than that of other regions in Gimhae where Jangyu, a new town, also belong, during the global financial crisis of 2008.

Live Load Distribution in Prestressed Concrete I-Girder Bridges (I형 프리스트레스트 콘크리트 거더교의 활하중 분배)

  • Lee, Hwan-Woo;Kim, Kwang-Yang
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.21 no.4
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    • pp.325-334
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    • 2008
  • The standard prestressed concrete I-girder bridge (PSC I-girder bridge) is one of the most prevalent types for small and medium bridges in Korea. When determining the member forces in a section to assess the safety of girder in this type of bridge, the general practice is to use the simplified practical equations or the live load distribution factors proposed in design standards rather than the precise analysis through the finite element method or so. Meanwhile, the live load distribution factors currently used in Korean design practice are just a reflection of overseas research results or design standards without alterations. Therefore, it is necessary to develop an equation of the live load distribution factors fit for the design conditions of Korea, considering the standardized section of standard PSC I-girder bridges and the design strength of concrete. In this study, to develop an equation of the live load distribution factors, a parametric analysis and sensitivity analysis were carried out on the parameters such as width of bridge, span length, girder spacing, width of traffic lane, etc. As a result, the major variables to determine the size of distribution factors were girder spacing, overhang length and span length in case of external girders. For internal adjacent girders, the determinant factors were girder spacing, overhang length, span length and width of bridge. For internal girders, the factors were girder spacing, width of bridge and span length. Then, an equation of live load distribution factors was developed through the multiple linear regression analysis on the results of parametric analysis. When the actual practice engineers design a bridge with the equation of live load distribution factors developed here, they will determine the design of member forces ensuring the appropriate safety rate more easily. Moreover, in the preliminary design, this model is expected to save much time for the repetitive design to improve the structural efficiency of PSC I-girder bridges.

Dynamic Traffic Assignment Using Genetic Algorithm (유전자 알고리즘을 이용한 동적통행배정에 관한 연구)

  • Park, Kyung-Chul;Park, Chang-Ho;Chon, Kyung-Soo;Rhee, Sung-Mo
    • Journal of Korean Society for Geospatial Information Science
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    • v.8 no.1 s.15
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    • pp.51-63
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    • 2000
  • Dynamic traffic assignment(DTA) has been a topic of substantial research during the past decade. While DTA is gradually maturing, many aspects of DTA still need improvement, especially regarding its formulation and solution algerian Recently, with its promise for In(Intelligent Transportation System) and GIS(Geographic Information System) applications, DTA have received increasing attention. This potential also implies higher requirement for DTA modeling, especially regarding its solution efficiency for real-time implementation. But DTA have many mathematical difficulties in searching process due to the complexity of spatial and temporal variables. Although many solution algorithms have been studied, conventional methods cannot iud the solution in case that objective function or constraints is not convex. In this paper, the genetic algorithm to find the solution of DTA is applied and the Merchant-Nemhauser model is used as DTA model because it has a nonconvex constraint set. To handle the nonconvex constraint set the GENOCOP III system which is a kind of the genetic algorithm is used in this study. Results for the sample network have been compared with the results of conventional method.

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A Study on the Locational Decision Factors of Discount Stores : The Case of Cheonan (종합슈퍼마켓의 입지 결정 요인에 관한 연구 : 천안상권을 중심으로)

  • So, Jang-Hoon;Hwang, Hee-Joong
    • Journal of Distribution Science
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    • v.10 no.5
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    • pp.37-44
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    • 2012
  • In this paper, we investigate several factors that affect the locational decision of discount stores by using previous studies on the marketing area and the location of commercial facilities. We selected 21 primary variables that are expected to influence the decision of store location and, by factor analysis, grouped them into five underlying factors. Among these, the demographic factor, which shows the potential purchasing power level, had the greatest impact on the locational decision for the store. However, we found individual stores positioned according to unique locational characteristics in addition to the demographic factor. It means that we have to additionally consider if the vicinity of the market is based on any physical properties. Many previous studies proposed four decision factors for store location: the economic factor, the demographic factor, the land utilization factor, and traffic factor. However, the fivefold factors-our distinctive contribution-are more concrete and persuasive according to Korean reality. We show that location preference is based on the following criteria: (1) the area is densely populated, (2) houses stand close together, (3) residents have a high income level, (4) road traffic is developed and easy to access, and (5) public transportation is well developed. The demographic factor has the greatest impact on the location of a discount store. The number of households has a greater relevance to the demographic factor than does the individual consumer. Second, discount stores relatively prefer places where houses are located close together because such places offer easy access to the market. Third, a place whose residents have a high income level will be preferred, with its large cars and excellent traffic conditions. Fourth, a location would be highly rated if the roads around commercial facilities are well developed and their accessibility is good. Finally, discount stores must be located close to bus stops because female consumers, including housewives-the most important customers-evaluate stores based on distance. In this research, the variable of consumer attitude and preference was excluded, and the location factors of discount stores were analyzed according to a microscopic view through physical spatial data. In the future, the opening of new discount stores based on the five factors indicated above will require a comparatively shorter time from the first project feasibility analysis. In addition, the result of our study can be applied to the field of public policy for constructing and attracting large-scale distribution facilities.

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Comparison of Positional and Non-Positional Obstructive Sleep Apnea Patients by Nocturnal Polysomnography (야간수면다원검사를 이용한 자세성 및 비자세성 수면무호흡증 환자의 비교 연구)

  • Park, Min-Woo;Cho, Jung-Hwan;Park, Won-Kyu;Nam, Jin-Woo;Yun, Chong-Il;Chung, Jin-Woo
    • Journal of Oral Medicine and Pain
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    • v.34 no.4
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    • pp.371-377
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    • 2009
  • Objectives: The aim of this study was to evaluate the differences in the polysomnography data between positional and non-positional obstructive sleep apnea (OSA) patients. Methods: Forty-seven patients diagnosed with OSA were evaluated using full night polysomnography. According to the criteria of Cartwright et al., the patients were classified into two groups with 37 positional (supine apnea-hypopnea index [AHI] $\geq$ 2x's the lateral AHI) and 10 non-positional (supine AHI < 2x's the lateral AHI) OSA patients, and the differences of polysomnography data between the two groups were evaluated. Results: There were no significant differences in demographic variables (age, gender, and BMI), daytime sleepiness, overall AHI, total arousal index, and percent time of snoring between two groups. However, AHI, arousal index, and mean oxygen saturation ($SpO_2$) of the REM sleep stage were significantly more severe in the positional OSA group than the non-positional OSA group. Mean $SpO_2$ and the lowest $SpO_2$ during overall sleep stage were also significantly lower in the positional OSA group than the non-positional OSA group. Conclusions: Our results of differences in the polysomnography data of REM sleep stage suggest that non-positional OSA patients may have higher collapsibility of the oropharyngeal airway during sleep than positional OSA patients.

Size and Retention of Tongue Bulb for Tongue Retaining Device (혀 유지구의 크기와 유지력 평가)

  • Park, Nam-Seon;Lee, Ki-Ho;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.32 no.3
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    • pp.283-292
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    • 2007
  • In several treatment modalities for snoring and obstructive sleep apnea (OSA), oral appliances mainly including mandibular advancement appliance (MAA) and tongue retaining device (TRD) are recognized as a non-invasive, reversible alternative with favorable results. Tongue bulb is a major component of TRD which prevents the tongue from approaching the posterior wall of the pharynx and can be combined with MAA. Determination of tongue bulb size for the patient is important for therapeutic effect, but frequently needs time-consuming work. For effective fabrication and standardization of tongue bulbs, this study aimed to categorize tongue bulb size for healthy young men and to examine its relation with maximum retention force and with physical parameters including tongue-related variables. 36 non-snoring, asymptomatic young men with normal occlusion were voluntarily participated in this study (mean age: $24.47{\pm}2.58$ years). Experimental procedures consisted of prefabrication of tongue bulb set (20 types with a width of 27-36mm and thickness of 8 and 10 mm), determination of tongue bulb size and the maximum retention force for each subject, and measurement of physical parameters including body mass index (BMI), neck circumference and width, thickness and length of tongue. This study showed that there was significant difference of retention force among the bulb size-related groups both in upright and supine position (p<0.05) and that retention force increased with bulb size. Correlation of tongue bulb size with physical parameters was not clearly verified and there was no significant difference in retention force between upright and supine positions. Based on our results, it can be suggested that retention force relates with tongue bulb size, ultimately with tongue volume. A further study needs to be performed in the patients with snoring and OSA.

Predicting the Performance of Recommender Systems through Social Network Analysis and Artificial Neural Network (사회연결망분석과 인공신경망을 이용한 추천시스템 성능 예측)

  • Cho, Yoon-Ho;Kim, In-Hwan
    • Journal of Intelligence and Information Systems
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    • v.16 no.4
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    • pp.159-172
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    • 2010
  • The recommender system is one of the possible solutions to assist customers in finding the items they would like to purchase. To date, a variety of recommendation techniques have been developed. One of the most successful recommendation techniques is Collaborative Filtering (CF) that has been used in a number of different applications such as recommending Web pages, movies, music, articles and products. CF identifies customers whose tastes are similar to those of a given customer, and recommends items those customers have liked in the past. Numerous CF algorithms have been developed to increase the performance of recommender systems. Broadly, there are memory-based CF algorithms, model-based CF algorithms, and hybrid CF algorithms which combine CF with content-based techniques or other recommender systems. While many researchers have focused their efforts in improving CF performance, the theoretical justification of CF algorithms is lacking. That is, we do not know many things about how CF is done. Furthermore, the relative performances of CF algorithms are known to be domain and data dependent. It is very time-consuming and expensive to implement and launce a CF recommender system, and also the system unsuited for the given domain provides customers with poor quality recommendations that make them easily annoyed. Therefore, predicting the performances of CF algorithms in advance is practically important and needed. In this study, we propose an efficient approach to predict the performance of CF. Social Network Analysis (SNA) and Artificial Neural Network (ANN) are applied to develop our prediction model. CF can be modeled as a social network in which customers are nodes and purchase relationships between customers are links. SNA facilitates an exploration of the topological properties of the network structure that are implicit in data for CF recommendations. An ANN model is developed through an analysis of network topology, such as network density, inclusiveness, clustering coefficient, network centralization, and Krackhardt's efficiency. While network density, expressed as a proportion of the maximum possible number of links, captures the density of the whole network, the clustering coefficient captures the degree to which the overall network contains localized pockets of dense connectivity. Inclusiveness refers to the number of nodes which are included within the various connected parts of the social network. Centralization reflects the extent to which connections are concentrated in a small number of nodes rather than distributed equally among all nodes. Krackhardt's efficiency characterizes how dense the social network is beyond that barely needed to keep the social group even indirectly connected to one another. We use these social network measures as input variables of the ANN model. As an output variable, we use the recommendation accuracy measured by F1-measure. In order to evaluate the effectiveness of the ANN model, sales transaction data from H department store, one of the well-known department stores in Korea, was used. Total 396 experimental samples were gathered, and we used 40%, 40%, and 20% of them, for training, test, and validation, respectively. The 5-fold cross validation was also conducted to enhance the reliability of our experiments. The input variable measuring process consists of following three steps; analysis of customer similarities, construction of a social network, and analysis of social network patterns. We used Net Miner 3 and UCINET 6.0 for SNA, and Clementine 11.1 for ANN modeling. The experiments reported that the ANN model has 92.61% estimated accuracy and 0.0049 RMSE. Thus, we can know that our prediction model helps decide whether CF is useful for a given application with certain data characteristics.

The Prediction of Currency Crises through Artificial Neural Network (인공신경망을 이용한 경제 위기 예측)

  • Lee, Hyoung Yong;Park, Jung Min
    • Journal of Intelligence and Information Systems
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    • v.22 no.4
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    • pp.19-43
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    • 2016
  • This study examines the causes of the Asian exchange rate crisis and compares it to the European Monetary System crisis. In 1997, emerging countries in Asia experienced financial crises. Previously in 1992, currencies in the European Monetary System had undergone the same experience. This was followed by Mexico in 1994. The objective of this paper lies in the generation of useful insights from these crises. This research presents a comparison of South Korea, United Kingdom and Mexico, and then compares three different models for prediction. Previous studies of economic crisis focused largely on the manual construction of causal models using linear techniques. However, the weakness of such models stems from the prevalence of nonlinear factors in reality. This paper uses a structural equation model to analyze the causes, followed by a neural network model to circumvent the linear model's weaknesses. The models are examined in the context of predicting exchange rates In this paper, data were quarterly ones, and Consumer Price Index, Gross Domestic Product, Interest Rate, Stock Index, Current Account, Foreign Reserves were independent variables for the prediction. However, time periods of each country's data are different. Lisrel is an emerging method and as such requires a fresh approach to financial crisis prediction model design, along with the flexibility to accommodate unexpected change. This paper indicates the neural network model has the greater prediction performance in Korea, Mexico, and United Kingdom. However, in Korea, the multiple regression shows the better performance. In Mexico, the multiple regression is almost indifferent to the Lisrel. Although Lisrel doesn't show the significant performance, the refined model is expected to show the better result. The structural model in this paper should contain the psychological factor and other invisible areas in the future work. The reason of the low hit ratio is that the alternative model in this paper uses only the financial market data. Thus, we cannot consider the other important part. Korea's hit ratio is lower than that of United Kingdom. So, there must be the other construct that affects the financial market. So does Mexico. However, the United Kingdom's financial market is more influenced and explained by the financial factors than Korea and Mexico.

The Effect of the Degree of Competition of the Hospital Market Regions on Clinic's Rate of Antibiotics Prescription (병원시장지역 내 경쟁 정도가 의원급 의료기관의 항생제 처방률에 미치는 영향)

  • Jo, Changik;Lim, Jae-Young;Lee, Soo Yeon
    • KDI Journal of Economic Policy
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    • v.30 no.2
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    • pp.129-155
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    • 2008
  • The rate of antibiotics prescription for an acute airway infection significantly varies depending upon the diagnosis type, specialty, and the location of the hospital along with many other related factors. The objective of this study is to empirically investigate the possible relationship between the antibiotics prescription rates for an acute airway infection and the degree of competition in the hospital market regions of mainly the providers of primary medical care services such as clinics, internal medicines, pediatrics and otorhinolaryngology department. Using the data from Health Insurance Review and Assessment Service (HIRA) regarding the hospitals' antibiotics prescription rates for the acute airway infection and controlling for selected variables of demand and supply sectors, this study tries to figure out that the degree of competition in the hospital market, regardless of what type of competition indexes we employed, has a statistically significant effect on the variations of antibiotics prescription rate of the clinics in local areas. This result implies that as an economic consideration itself, the change in the degree of competition in the hospital market can play a crucial role influencing the treatment behaviors of the medical doctors. More specifically, this study reveals that as the degree of competition increases the antibiotics prescription rate goes up. This result means that if the market becomes more competitive in a specific region so that it might cause a reduction in doctor's income, doctors with rational decision-making process, recognize that the benefit created from inducing patients' seemingly unnecessary demand for medical care (income effect) would be higher than the costs associated with sustaining their targeted income (substitution effect). It is because that the doctors are more likely to prescribe antibiotics which create relatively higher margins than other medical care services in order to sustain their targeted income when the hospital market competition becomes tighter. Even though this study empirically confirms that antibiotics prescription can be affected by the economic incentives, it still raises following issues as limitations of the study: first issue is about the representativeness of the hospital regions segregated for this study, which might be weak in explaining whether these regions are mutually exclusive in reality. Patients actually consider the quality of services, transportation cost, time costs, and any other related factors choosing the doctors or hospitals, and in that sense, this study rules out 'border-crossing' in using the medical care services. Second issue arises in capturing the data of antibiotics prescription rate. Since we use the average rate for each medical institution, we cannot figure out the average rate for each patient so that we are not able to control for the variation of patients' medical conditions. It is because of the unavailability of data regarding each patient's medical condition from HIRA. Thirdly, since this study mainly analyzes the medical institutions providing primary care such as clinics, internal medicines, pediatrics, and otorhinolaryngology department, it is skeptical of whether those institutions can represent the hospital market in respective regions and truly reflect the degree of competition. It needs to extend the study areas and disease types as well as any micro data for future studies.

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