Analyzing Korean Public Health Centers' Infectious Disease Disaster Response Experiences with a Focus on Business Continuity.

Objective: This study aims to provide basic data for establishing strategies to maintain the core functions of health centers, and enable an effective response to emergency tasks in the event of future infectious disease disasters. Methods: The participants were 41 workers from two public health centers in Seoul. They all had prior experience in responding to the early and middle stages of the COVID-19 pandemic. Data were collected through Focus Group Discussions, and then analyzed using the deductive method of content analysis. Results: The participants' experiences during the infectious disease disaster crisis were examined through ten categories: governance and coordination, information management, human resources, essential medical supplies and equipment, infrastructure, administration, finance and logistics, community engagement and risk communication, delivery of essential services, security, and additional considerations for vulnerable populations. The analysis of the results made it apparent that new systems and policies were imperative for responding appropriately to the concerns and experiences of the public healthcare center staff, and for improving the response to future epidemics. Conclusion: We found that to prepare for infectious disaster situations in the future, it is necessary for health centers to establish a mid- to long-term business continuity plan to ensure the continuation and stability of their operations. Additionally, it was found that health professionals in public health centers also believe in the necessity of education and training programs on disaster preparedness, based on Business Continuity Planning proposed by the World Health Organization. They deem these essential to sustain routine tasks for the management of the health of local community residents during outbreaks of novel infectious diseases in the future.

Safety and feasibility of simultaneous endoscopic submucosal dissection for multiple gastric neoplasias.

BACKGROUND: Synchronous gastric neoplasms are not infrequently detected, thus endoscopic submucosal dissection (ESD) for multiple early gastric neoplasia is occasionally considered. However, there have been few investigations of the safety and feasibility of simultaneous ESD for multiple gastric lesions. This study aims to evaluate the safety and feasibility of simultaneous ESD for multiple gastric neoplasia. METHODS: A total of 1823 patients who underwent ESD for 1929 gastric adenomas or early gastric cancers were retrospectively reviewed in this study. Two hundred gastric adenomas or early gastric cancers among 94 patients were treated by ESD simultaneously (multiple group), and 1729 patients were treated with ESD for a single lesion (single group). RESULTS: En bloc resection (P = 0.060), complete resection (P = 0.362) and curative resection (P = 0.108) rates did not differ between the two groups. Rates of adverse events including bleeding (P = 0.317), perforation (P = 0.316) and aspiration pneumonia (P = 0.563) were not higher in the multiple group. Long-term follow-up showed more frequent local recurrence (P < 0.001), synchronous neoplasia (P = 0.041) and metachronous neoplasia (P < 0.001) per patient in the multiple group; however, local recurrence per lesion did not differ between the two groups (P = 0.103). CONCLUSIONS: Simultaneous ESD for multiple synchronous gastric neoplasms is safe and feasible compared to single ESD. However, thorough examination for local recurrence and synchronous and metachronous neoplasia is required.

Factors that affect visibility during endoscopic hemostasis for upper GI bleeding: a prospective study.

BACKGROUND: Adequate visibility is an important factor for achieving successful endoscopic hemostasis for the treatment of upper GI bleeding (UGIB). The independent factors that affect visibility during endoscopic procedures have yet to be determined. OBJECTIVE: To determine the factors that affect endoscopic visibility and to create a model that can predict in which patients unacceptable visibility is suspected before emergent endoscopic procedures for UGIB. DESIGN: Prospective, observational study. SETTING: University-affiliated tertiary care hospital in South Korea. PATIENTS: A total of 121 patients admitted because of UGIB. INTERVENTION: Analysis of the visibility score of the emergency endoscopies for UGIB. MAIN OUTCOME MEASUREMENTS: Factors affecting the visibility score of endoscopy and a classification and regression tree (CART) model for predicting of visibility. RESULTS: The EGD time and the appearance of the nasogastric (NG) tube aspirate were independent factors that were significantly associated with visibility (EGD time, P<.001; red blood appearance in NG tube aspirate, P<.001; coffee grounds appearance of NG tube aspirate, P=.006). Based on these results, a CART model was developed by using 70 patients who had been allocated to the training set. The CART generated algorithms that proposed the use of the appearance of the NG tube aspirate and the EGD time (8.5 hours) to predict visibility. The sensitivity and specificity for predicting poor visibility were 71.4% and 86.4%, respectively. CONCLUSION: The use of the CART model enables the prediction of which patients will have poor visibility during emergent endoscopy.

Preventing metachronous gastric lesions after endoscopic submucosal dissection through Helicobacter pylori eradication.

BACKGROUND AND AIM: Metachronous recurrence often occurs after endoscopic submucosal dissection for early gastric cancer, and a method for preventing recurrence is unknown. We aimed to identify risk factors for metachronous lesions, and the effects of aspirin use and Helicobacter pylori eradication on preventing recurrence. METHODS: A total of 1041 consecutive patients who underwent endoscopic submucosal dissection for early gastric cancer between January 2007 and December 2011 were retrospectively analyzed. Every patient was examined endoscopically at 2, 6, and 12 months after endoscopic submucosal dissection, and then annually. Patients were classified into the metachronous group or non-metachronous group according to the existence of metachronous lesions and subdivided by Helicobacter pylori status into three groups: not infected, eradicated after infection, and not eradicated. RESULTS: At 39 months' median follow-up, metachronous gastric lesions had developed in 35 patients (3.4%), including 16 with dysplasia and 19 cancers. Metachronous group were significantly older than non-metachronous group (P = 0.02). Although non-metachronous group took aspirin more frequently than metachronous group (15.5% vs 5.7%), the difference was statistically insignificant (P = 0.11). In the not eradicated group, the odds ratio of metachronous lesion was 7.762 compared with the not infected group (95% confidence interval, 1.483-60.854; P = 0.02). In the eradicated group, the odd ratio of metachronous lesion was 8.120 compared with not infected group (95% confidence interval, 1.950-58.985; P = 0.01). CONCLUSION: Helicobacter pylori infection was an independent risk factor for metachronous gastric lesions. However, eradication of Helicobacter pylori alone does not prevent all metachronous lesions in an inflamed stomach.

Incidence and predictive factors of irritable bowel syndrome after acute diverticulitis in Korea.

PURPOSE: Evidence indicates that irritable bowel syndrome can occur after gastroenteritis. However, little is known about its incidence after diverticulitis. This study was designed to identify the incidence and risk factors of irritable bowel syndrome after diverticulitis in Korea. METHODS: A survey regarding irritable bowel syndrome was performed in patients allocated to the cases hospitalized for acute diverticulitis and controls hospitalized for non-gastrointestinal disorders between January 2007 and June 2012. Patients meeting criteria for irritable bowel syndrome before hospitalization or with a history of bowel resection were excluded for analysis. Response rate of telephone interviews was 28.1 % (139 of 494) and 73.3 % (220 of 300) in cases and controls, respectively. After exclusion, 102 patients in the cases and 205 patients in the controls were analyzed. RESULTS: At 31 months median follow-up, irritable bowel syndrome had developed in 13 patients (12.8 %) in the cases and 11 patients (5.4 %) in the controls with significant statistical difference (p = 0.02). No clinical difference was seen between the two groups. No clinical factor was significant for the development of irritable bowel syndrome after diverticulitis, and no independent factor was associated with the development of irritable bowel syndrome. Among the 13 patients who developed post-diverticulitis irritable bowel syndrome, the diarrhea-predominant type (53.9 %) was most common. CONCLUSION: A higher incidence of irritable bowel syndrome after diverticulitis was evident in this study. However, no clinical feature for prediction of its development after diverticulitis was found. Further large-scale analysis will be needed to generalize this result.

Network modeling and energy-efficiency optimization for advanced machine-to-machine sensor networks.

Wireless machine-to-machine sensor networks with multiple radio interfaces are expected to have several advantages, including high spatial scalability, low event detection latency, and low energy consumption. Here, we propose a network model design method involving network approximation and an optimized multi-tiered clustering algorithm that maximizes node lifespan by minimizing energy consumption in a non-uniformly distributed network. Simulation results show that the cluster scales and network parameters determined with the proposed method facilitate a more efficient performance compared to existing methods.

Urine Cotinine for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES).

BACKGROUND: The level of urine cotinine is an indicator of tobacco smoke exposure. The purpose of this study is to investigate urine cotinine for the purpose of assessing the smoking status of Korean smokers and non-smokers exposed to tobacco smoke. METHODS: The subjects were identified from the 2007-2009 and the 2010 data sets of the Korea National Health and Nutrition Examination Survey (KNHANES). They were assigned as non-smokers, current smokers and ex-smokers. Non-smokers were also divided into three subset groups according to the duration of smoke exposure. Each group was stratified by gender prior to analysis. RESULTS: The median value of urine cotinine in the male current smokers was 1,221.93 ng/mL which was the highest among all groups. The difference between levels of urine cotinine for male and the female groups was statistically significant (p<0.01). In the female group, passive smoke exposure groups reported higher urine cotinine levels than non-exposure groups (p=0.01). The cutoff point for the discrimination of current smokers from non-smokers was 95.6 ng/mL in males and 96.8 ng/mL in females. The sensitivity and specificity were 95.2% and 97.1%, respectively, in males, 96.1% and 96.5% in females. However, the determination of urine cotinine level was not useful in distinguishing between passive smoke exposure groups and non-exposure groups. CONCLUSION: Urine cotinine concentration is a useful biomarker for discriminating non-smokers from current smokers. However, careful interpretation is necessary for assessing passive smoke exposure by urine cotinine concentration.

A study on software-based sensing technology for multiple object control in AR video.

Researches on Augmented Reality (AR) have recently received attention. With these, the Machine-to-Machine (M2M) market has started to be active and there are numerous efforts to apply this to real life in all sectors of society. To date, the M2M market has applied the existing marker-based AR technology in entertainment, business and other industries. With the existing marker-based AR technology, a designated object can only be loaded on the screen from one marker and a marker has to be added to load on the screen the same object again. This situation creates a problem where the relevant marker'should be extracted and printed in screen so that loading of the multiple objects is enabled. However, since the distance between markers will not be measured in the process of detecting and copying markers, the markers can be overlapped and thus the objects would not be augmented. To solve this problem, a circle having the longest radius needs to be created from a focal point of a marker to be copied, so that no object is copied within the confines of the circle. In this paper, software-based sensing technology for multiple object detection and loading using PPHT has been developed and overlapping marker control according to multiple object control has been studied using the Bresenham and Mean Shift algorithms.

Research on a Denial of Service (DoS) detection system based on global interdependent behaviors in a sensor network environment.

This research suggests a Denial of Service (DoS) detection method based on the collection of interdependent behavior data in a sensor network environment. In order to collect the interdependent behavior data, we use a base station to analyze traffic and behaviors among nodes and introduce methods of detecting changes in the environment with precursor symptoms. The study presents a DoS Detection System based on Global Interdependent Behaviors and shows the result of detecting a sensor carrying out DoS attacks through the test-bed.

Modular cementless total hip arthroplasty for multiple epiphyseal dysplasia.

We analyzed a consecutive series of 23 total hip arthroplasties that had been performed using modular cementless prostheses in 13 patients with a confirmed diagnosis of multiple epiphyseal dysplasia and end-stage osteoarthritis of the hip. The average Harris hip score improved from 40.6 to 93.8 points. Postoperatively, all hips demonstrated favorable alterations in the biomechanical parameters including hip center of rotation, femoral offset, femoral neck length, and limb length. At a mean follow-up of 4.8 years, no hip required revision because of aseptic loosening of the acetabular or femoral component. One patient (1 hip, 4.3%) underwent reoperation for polyethylene wear and osteolysis 8 years after index arthroplasty. This study shows encouraging clinical and radiographic outcomes of modular cementless total hip arthroplasties for this technically difficult condition.