PURPOSE: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. METHODS: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. RESULTS: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. CONCLUSION: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.
Adult ; Airway Extubation/*psychology ; Female ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; *Models, Theoretical ; Nonlinear Dynamics ; Risk Factors

PURPOSE: The purpose of this study was to develop a system dynamics model for adolescent obesity in Korea that could be used for obesity policy analysis. METHODS: On the basis of the casual loop diagram, a model was developed by converting to stock and flow diagram. The Vensim DSS 5.0 program was used in the model development. We simulated method of moments to the calibration of this model with data from The Korea Youth Risk Behavior Web-based Survey 2005 to 2013. We ran the scenario simulation. RESULTS: This model can be used to understand the current adolescent obesity rate, predict the future obesity rate, and be utilized as a tool for controlling the risk factors. The results of the model simulation match well with the data. It was identified that a proper model, able to predict obesity probability, was established. CONCLUSION: These results of stock and flow diagram modeling in adolescent obesity can be helpful in development of obesity by policy planners and other stakeholders to better anticipate the multiple effects of interventions in both the short and the long term. In the future we suggest the development of an expanded model based on this adolescent obesity model.
Adolescent ; Humans ; Internet ; *Nonlinear Dynamics ; Obesity/*pathology ; Republic of Korea ; Risk Factors ; *Risk-Taking ; Surveys and Questionnaires

OBJECTIVES: Catecholamine metabolism has been thought to be related to the pathophysiology of panic disorder. There are two human COMT alleles, coding for a low activity enzyme, COMT L(L), and a high activity enzyme, COMT H(H), respectively. We examined the distribution of COMT genotypes and the relationship between COMT genetic polymorphism and some clinical characteristics in patients with panic disorder. METHOD: We recruited 51 patients who met the DSM-IV criteria for panic disorder, and 45 normal control subjects who had neither medical nor psychiatric illnesses. Genetic polymorphism of COMT was identified in all subjects using PCR-based restriction fragment length polymorphism(RFLP) analysis. We assessed some clinical variables including treatment responses in panic patients and measured anxiety and depression levels in normal control subjects using Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). RESULT: The frequency of the homozygous LL genotype was higher in panic patients than that in control subjects (19.6% vs. 2.2%). We found that panic disorder was significantly associated with L allele (x2=8.66, p=0.003) and LL genotype(x2=8.45, p=0.015). Panic patients with LL genotype showed poorer treatment response than those with other genotypes (F=4.98, p=0.011). CONCLUSION: These results suggest that LL genotype of the COMT gene may be related to the pathophysiology and clinical courses in some patients with panic disorder.
Alleles ; Anxiety ; Catechol O-Methyltransferase* ; Clinical Coding ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Humans ; Metabolism ; Panic Disorder* ; Panic* ; Pilot Projects* ; Polymorphism, Genetic*

OBJECTIVES: Identifying children with Attention-Deficit/Hyperactivity Disorder (ADHD) and providing early therapeutic interventions for them are important to prevent secondary problems in academic achievement and emotional disturbances. The aims of the study is to examine the characteristics of K-ARS for parents and teachers, a screening questionnaire to identify children with ADHD, by age and sex of the children, to examine its clinical validity, and to provide norm data of K-ARS for school-aged children which will facilitate the use of K-ARS in clinical practice and research. METHODS: Randomly selected 1st to 6th graders of the two elementary schools (N=1044) in Anyang City participated in this study. Twenty three children diagnosed with ADHD at the child and adolescent clinic at the Hallym University Sacred Heart Hospital were included in this study for the analysis of validity. Parents and teachers completed K-ARS. Descriptive statistics, t-test and analysis of variance were performed. RESULTS: K-ARS scores showed significant difference according to the gender, with boys having higher scores than girls. There was no significant difference of the scores by ages. Validity analysis showed that K-ARS distinguishes children with ADHD from children without ADHD well. The normative data were presented by age and sex. CONCLUSION: K-ARS for parents and teachers has an excellent clinical validity to discriminate children with ADHD from children without ADHD. Different normative data of K-ARS need to be used due to the gender difference. K-ARS is a useful tool for screening and identifying children with ADHD. Future studies are required to include larger samples with adolescents in various geographic areas.
Adolescent ; Affective Symptoms ; Child ; Female ; Gyeonggi-do ; Heart ; Humans ; Mass Screening ; Parents* ; Surveys and Questionnaires

Pulmonary vascular air embolism is a rare and, universally, almost a fatal complication of positive pressure ventilation in newborn infants. Here, we report a case of this unusual complication in a very-low-birth-weight infant who showed the clinical and radiological features of this complication along with pulmonary hypoplasia and massive hydrops. The possible pathogenesis has been discussed and a brief review of related literature has been presented.
Edema ; Embolism, Air ; Humans ; Hydrops Fetalis ; Infant, Newborn ; Infant, Very Low Birth Weight ; Positive-Pressure Respiration ; Pulmonary Embolism

OBJECTIVE: It is important to identify and treat ADHD children early to prevent secondary academial and emotional problem. The Purpose of this study is to investigate the reliability and validity of Korean parent and teacher ADHD Rating Scale. METHOD: First to sixth graders in two elementary schools in Anyang City participated in this study. Teachers and parents completed ADHD Rating Scale. Additionally parents completed K-CBCL and Conners scale. Descriptive statistics, correlation, t-test and analysis of variance were performed. RESULT: A total of 1044 students participated in this study. Correlation of rater reliabilities between parent and teacher was significantly close. And Internal consistency by age was high. As correlations among ARS, K-CBCL, Conners scale were high, the ARS scores can be validated. CONCLUSION: Korean parent and teacher ADHD Rating Scale has high reliability and validity. This scale will be a useful tool for ADHD evaluations and diagnosis. A study of comparing clinical groups is suggested.
Child ; Diagnosis ; Gyeonggi-do ; Humans ; Parents* ; Reproducibility of Results*

OBJECTIVE: To assess the visualization rate and size of the cavum septum pellucidum (CSP) by transabdominal sonography in normal fetuses in the second and third trimesters of pregnancy. METHODS: The CSP was prospectively researched and measured using an axial transventricular plane in 308 consecutive uncomplicated singleton pregnancies between 15 and 41 weeks of gestation. RESULTS: The CSP was seen in 42.5% of cases at 15 weeks, 84.78% at 16-17 weeks, 100% at 18-37 weeks and 81.25% at 38-41 weeks. Compared to biparietal diameter (BPD), the visualization rate was 35.29% between 31 and 32 mm, 47.8% between 33 and 34 mm, 84% between 35 and 43 mm, 100% between 44 and 88 mm and 87.5% between 89 and 101 mm. Mean CSP width was 5.5+/-1.7 mm (range 2-9 mm). The CSP width was increased with gestational age and BPD, but with a slight decrease around term. CONCLUSION: In normal fetuses the CSP should always be visualized between 18 and 37 weeks, or with a BPD of 44-88 mm. Failure to observe the CSP in this interval, or possibly the presence of a large CSP, may indicate abnormal cerebral development and warrant further investigation. Conversely, absence of the CSP prior to 18 weeks, or later than 37 weeks, is a normal finding.
Female ; Fetus* ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy* ; Prospective Studies ; Septum Pellucidum*

We report a case of septic arthritis due to H. influenzae associated with atypical Kawasaki disease. A 2-year-old boy was admitted to our orthopedic department due to limping gait of the right leg. CT finding of right hip joint revealed fluid collection. He was diagnosed as transient synovitis and septic arthritis. He was treated with antibiotics, but no incision nor drainage was performed. During the antibiotics therapy, limping gait subsided, but high fever, skin rash and lip fissure developed. Echocardiographic finding showed both coronary artery aneurysms. We diagnosed the boy's condition as atypical Kawasaki disease, and treated it with intravenous immunoglobulin(IVIG) and aspirin. Even, with the use of IVIG, fever was persistent. A second IVIG was tried, but fever did not subside. An MRI of right hip joint was followed up. The finding was consistent with septic arthritis associated with osteomyelitis of the right femur head. An incision and drainage was performed on the right hip joint, and the pus culture revealed beta-lactamase negative H. influenzae.
Aneurysm ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Aspirin ; beta-Lactamases ; Child, Preschool ; Coronary Vessels ; Drainage ; Echocardiography ; Exanthema ; Femur Head ; Fever ; Gait ; Haemophilus influenzae* ; Haemophilus* ; Hip Joint ; Humans ; Immunoglobulins, Intravenous ; Influenza, Human ; Leg ; Lip ; Magnetic Resonance Imaging ; Male ; Mucocutaneous Lymph Node Syndrome* ; Orthopedics ; Osteomyelitis ; Suppuration ; Synovitis

Fetal alcohol syndrome is characterized by distinctive facial appearance, prenatal onset growth deficiency, an increased frequency of development and mental retardation, cardiac anomaly and genitourinary anomaly. Complete abstinence during pregnancy is recommended, since alcohol consumption in each trimester has been associated with abnormalities. We experienced a case of fetal alcohol syndrome in a 11-month-old female infant. Her mother had drunk as much as 500cc of alcohol every day from 1st trimester to 3rd trimester of pregnancy. The child was small for gestational age, other distinctive features were microcephaly, thin upper lip, short palpebral fissure, hypertelorism, low nasal bridge, hypoplasia of philtrum, dysplastic ear, developmental and mental retardation, mild pulmonary stenosis and ovarian cysts. On the basis of maternal history and clinical features mentioned above, we diagnosed the case as fetal alcohol syndrome.
Alcohol Drinking ; Child ; Ear ; Female ; Fetal Alcohol Spectrum Disorders* ; Gestational Age ; Humans ; Hypertelorism ; Infant ; Intellectual Disability ; Lip ; Microcephaly ; Mothers ; Ovarian Cysts ; Pregnancy ; Pulmonary Valve Stenosis

Fetal alcohol syndrome is characterized by distinctive facial appearance, prenatal onset growth deficiency, an increased frequency of development and mental retardation, cardiac anomaly and genitourinary anomaly. Complete abstinence during pregnancy is recommended, since alcohol consumption in each trimester has been associated with abnormalities. We experienced a case of fetal alcohol syndrome in a 11-month-old female infant. Her mother had drunk as much as 500cc of alcohol every day from 1st trimester to 3rd trimester of pregnancy. The child was small for gestational age, other distinctive features were microcephaly, thin upper lip, short palpebral fissure, hypertelorism, low nasal bridge, hypoplasia of philtrum, dysplastic ear, developmental and mental retardation, mild pulmonary stenosis and ovarian cysts. On the basis of maternal history and clinical features mentioned above, we diagnosed the case as fetal alcohol syndrome.
Alcohol Drinking ; Child ; Ear ; Female ; Fetal Alcohol Spectrum Disorders* ; Gestational Age ; Humans ; Hypertelorism ; Infant ; Intellectual Disability ; Lip ; Microcephaly ; Mothers ; Ovarian Cysts ; Pregnancy ; Pulmonary Valve Stenosis