The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study

Kim Kyung-Ran,Park Hyo Jung,Baek Sun-Young,Choi Soo-Han,Lee Byung-Kee,Kim SooJin,Kim Jong Min,Kang Ji-Man,Kim Sun-Ja,Choi Sae Rom,Kim Dongsub,Choi Joon-sik,Yoon Yoonsun,Park Hwanhee,Kim Doo Ri,Shin Ar 대한의학회 2024 Journal of Korean medical science Vol.39 No.21

Background: We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. Methods: A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001–2008) and the post-intervention (2009–2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patientdays, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ2 . Results: The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = −16.5; 95% confidence interval [CI], −30.6 to −2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881). Conclusion: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.

Real-Time Progress Management System for Steel Structure Construction

Kim, Kyonghoon,Kim, Gutaek,Kim, Kyunghwan,Lee, Yoonsun,Kim, Jaejun Architectural Institute of Japan 2009 JOURNAL OF ASIAN ARCHITECTURE AND BUILDING ENGINEE Vol.8 No.1

<P>Progress management is demanding because of the volume of information exchanged among the various parties involved in a project. In particular, steel structures for high-rise construction projects are among the major work items that require more intensive progress management. This research aims at developing a real-time progress management system through an automated module for scheduling estimates and using an RFID system for real-time construction progress. We propose a new technique that preconstruction engineers can use to build a schedule estimation using 3D-CAD and a Database. By using these tools, engineers can visualize then analyze real-time, actual construction progress with on-site RFID and robot systems. The real-time progress management system developed in this study maintains the continuity of the information from 3D design, the accuracy of lists of materials, the automation of expected progress, and the management of actual progress.</P>

고혈관성 종양으로 오인된 Trichophyton verrucosum에 의한 두피 백선종창 1례

Kim Kyung-Ran,Park Hwanhee,Kim Doo Ri,Yoon Yoonsun,Jeon Chiman,Lee Sanghoon,Lim So Young,Kim Ji Hye,Kim Yae-Jean 대한소아감염학회 2022 Pediatric Infection and Vaccine Vol.29 No.2

A dermatophyte is a zoonotic infection that causes infection on the skin, hair, and nails and is transmitted through contact. The species of Microsporum, Trichophyton, and Epidermophyton are the major dermatophytes that infect humans. Tinea capitis is a dermatophyte infection in the scalp, and it may progress to kerion celsi, including severe redness, swelling, and pus formation. Kerion celsi is sometimes misdiagnosed as a bacterial infection or a tumor. Trichophyton verrucosum is a zoophilic dermatophyte that mainly causes infection in cattle. It can be spread to dairy farmers or ranchers who have frequent contact with infected cattle. We report a pediatric case who received scalp tumor excision and a split-thickness skin graft for extensive and severe inflammatory scalp tumors that occurred after contact with cattle with ringworm. Finally, the patient was diagnosed with kerion celsi caused by T. verrucosum infection. This was based on the patient’s medical history, clinical manifestations, and histopathologic findings. 피부사상균은 접촉을 통해 피부, 모발, 손발톱 등에 감염을 일으키며, 심한 경우 백선종창으로 진행되기도 한다. 건강했던 4세 여자 환자가 심한 두피병변으로 내원하여 세균, 진균감염뿐만 아니라 고혈관성 종양도 의심되어 두피 종양 절제술과 피부이식까지 받았다. 저자들은 면밀한 병력청취와 신체 진찰 및 임상양상을 토대로 Trichophyton verrucosum을 의심하여, 최종적으로 조직병리검사 소견을 종합하여 T. verrucosum에 의한 백선종창으로 진단 및 치료한 증례 1 례를 보고하는 바이다.

Malignancy in Patients With Inborn Errors of Immunity Beyond Infectious Complication: Single Center Experience for 30 Years

( Doo Ri Kim ),( Kyung-ran Kim ),( Hwanhee Park ),( Joon-sik Choi ),( Yoonsun Yoon ),( Sohee Son ),( Hee Young Ju ),( Jihyun Kim ),( Keon Hee Yoo ),( Kangmo Ahn ),( Hee-jin Kim ),( Eun-suk Kang ),( Ju 대한소아감염학회 2023 Pediatric Infection and Vaccine Vol.30 No.3

목적: 선천면역장애 환자들은 감염에 취약할 뿐만 아니라, 면역이 정상인 사람들에 비해 암 발생률도 높은 것으로 알려져 있다. 본 연구는 단일 기관에서 추적 중인 선천면역장애 환자들에서의 암 발생을 조사하여 보고자 하였다. 방법: 1994년 11월부터 2023년 9월까지 삼성서울병원에서 선천면역장애 진단 하에 추적하는 환자를 대상으로 후향적으로 의무기록을 리뷰하였다. 선천면역장애 환자 중에서 암으로 진단된 환자를 확인하였다. 결과: 총 194명의 선천면역장애 환자 중, 7명(3.6%)의 환자에서 암이 진단되었다. 5명의 환자가 림프종으로 진단받았으며 그 중 4명의 환자는 Epstein-Barr 바이러스 연관 림프종이었다. 나머지 암은 위암과 다발 골수종이었다. 암 진단 당시 나이는 중앙값 18세 (범위, 1세-75세)였다. 암이 발생한 환자들의 면역결핍 질환은 X-linked lymphoproliferative disorder-1 (XLP-1) 3명, activated phosphoinositide 3-kinase delta disease (APDS) 2명, cytotoxic T-lymphocyte antigen 4 (CTLA-4) haplo-insufficiency 2명이었다. 개별 질환별로 분석하였을 때, XLP-1 환자의 75.0%, APDS 환자의 40.0%, CTLA-4 환자의 50.0%에서 암이 발생하였다. XLP-1 환자는 APDS 및 CTLA-4 haplo-insufficiency 환자에 비해 더 이른 나이에 암이 발생하였다 (중앙연령 5세, P<0.001). 한 명은 조혈모세포 이식 치료 중 사망하였다. 결론: 국내 단일 기관에서 진료받는 선천면역장애 환자들의 3.6%에서 암이 발생하였다. 선천면역장애 환자들을 진료하는 의료진들은 이들 환자에서 감염이나 염증 등의 문제외에도 암 발생의 가능성, 특히 Epstein-Barr 바이러스 감염과 연관된 암의 비중이 높은 것에 대한 인식을 갖는 것이 중요하다 Purpose: Cancer incidence is known to be higher in patients with inborn errors of immunity (IEI) compared to the general population in addition to traditionally well-known infection susceptibility. We aimed to investigate cancer occurrence in patients with IEI in a single center. Methods: Medical records of IEI patients treated at Samsung Medical Center, Seoul, Korea were retrospectively reviewed from November 1994 to September 2023. Patients with IEI and cancer were identified. Results: Among 194 patients with IEI, seven patients (3.6%) were diagnosed with cancer. Five cases were lymphomas, 4 of which were Epstein-Barr virus (EBV)-associated lymphomas. The remaining cases included gastric cancer and multiple myeloma. The median age at cancer diagnosis was 18 years (range, 1-75 years). Among patients with cancer, underlying IEIs included X-linked lymphoproliferative disease-1 (XLP-1, n=3), activated phosphoinositide 3-kinase delta syndrome (APDS, n=2), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) haplo-insufficiency (n=2). Seventy-five percent (3/4) of XLP-1 patients, 40.0% (2/5) of APDS patients, and 50.0% (2/4) of CTLA-4 haplo-insufficiency patients developed cancer. Patients with XLP-1 developed cancer at earlier age (median age 5 years) compared to those with APDS and CTLA-4 (P<0.001). One patient with APDS died during hematopoietic cell transplantation. Conclusions: Cancer occurred in 3.6% of IEI patients at a single center in Korea. In addition to infectious complications and inflammation, physicians caring for IEI patients should be aware of the potential risk of cancer, especially in association with EBV infection

Preview Control of High Mobility tracked Vehicle Suspension with Multiple Wheels

Yoonsun Kim,Youngjin Park 제어로봇시스템학회 2002 제어로봇시스템학회 국제학술대회 논문집 Vol.2002 No.10

Fabrication of Barium- and Strontium-Doped Silica/Titania Hollow Nanoparticles and Their Synergetic Effects on Promoting Neuronal Differentiation by Activating ERK and p38 Pathways

Kim, Sojin,Jang, Yoonsun,Oh, Wan-Kyu,Kim, Chanhoi,Jang, Jyongsik Wiley (John WileySons) 2014 Advanced Healthcare Materials Vol.3 No.7

<P>Pristine, barium-doped, and strontium-doped hollow nanoparticles (p-HNPs, Ba-HNP, and Sr-HNP; HNPs) are prepared by sonication-mediated etching and redeposition (SMER) method and alkali-earth-metal hydroxide solution treatment. The HNPs are investigated to facilitate synergetic neuronal differentiation through alkali-earth-metal doping and in conjunction with nerve growth factor (NGF). PC12 cells are used as model cells for neuronal differentiation. The differentiation efficiency is improved in the presence of the HNPs+NGF, and the neurite length is in the order of Sr-HNP+NGF > Ba-HNP+NGF > p-HNP+NGF > NGF. Silica/titania have increasing effect on both differentiation efficiency and neurite length, and doped barium/strontium influences additional elongation of the average neurite length. Take advantage of hollow structure, NGF is encapsulated into HNPs, and they are further applied for directly inducing differentiation. The maximum differentiation efficiency is 67% in presence of the NGF-encapsulated Sr-HNP, which was 1.3 times higher than previous research. Furthermore, the neurite length is also 2.7 times higher than MnO2 decorated poly(3,4-ethylenedioxythiophene) nanoellipsoids. Ba- and Sr-HNP may offer a possibility for novel application of metal-hybrid nanomaterials for cell differentiation, and can be expanded to other cellular applications.</P>

Development of a 3D optical scanning-based automatic quality assurance system for proton range compensators : Automatic QA system for proton range compensators

Kim, MinKyu,Ju, Sang Gyu,Chung, Kwangzoo,Hong, Chae-Seon,Kim, Jungkuk,Kim, Jinsung,Ahn, Sung Hwan,Jung, Sang Hoon,Han, Youngyih,Chung, Yoonsun,Cho, Sungkoo,Shin, Dongho,Choi, Doo Ho Published for the American Association of Physicis 2015 Medical physics Vol.42 No.2

<P>A new automatic quality assurance (AutoRCQA) system using a three-dimensional scanner (3DS) with system automation was developed to improve the accuracy and efficiency of the quality assurance (QA) procedure for proton range compensators (RCs). The system performance was evaluated for clinical implementation.</P>

Impact of Nonpharmacological Interventions on Severe Acute Respiratory Infections in Children: From the National Surveillance Database

Yoon Yoonsun,Lee Hye Sun,Yang Juyeon,Gwack Jin,Kim Bryan Inho,Cha Jeong-ok,Min Kyung Hoon,Kim Yun-Kyung,Shim Jae Jeong,Lee Young Seok 대한의학회 2023 Journal of Korean medical science Vol.38 No.40

Background: Nonpharmacological interventions (NPIs) reduce the incidence of respiratory infections. After NPIs imposed during the coronavirus disease 2019 pandemic ceased, respiratory infections gradually increased worldwide. However, few studies have been conducted on severe respiratory infections requiring hospitalization in pediatric patients. This study compares epidemiological changes in severe respiratory infections during pre-NPI, NPI, and post-NPI periods in order to evaluate the effect of that NPI on severe respiratory infections in children. Methods: We retrospectively studied data collected at 13 Korean sentinel sites from January 2018 to October 2022 that were lodged in the national Severe Acute Respiratory Infections (SARIs) surveillance database. Results: A total of 9,631 pediatric patients were admitted with SARIs during the pre-NPI period, 579 during the NPI period, and 1,580 during the post-NPI period. During the NPI period, the number of pediatric patients hospitalized with severe respiratory infections decreased dramatically, thus from 72.1 per 1,000 to 6.6 per 1,000. However, after NPIs ceased, the number increased to 22.8 per 1,000. During the post-NPI period, the positive test rate increased to the level noted before the pandemic. Conclusion: Strict NPIs including school and daycare center closures effectively reduced severe respiratory infections requiring hospitalization of children. However, childcare was severely compromised. To prepare for future respiratory infections, there is a need to develop a social consensus on NPIs that are appropriate for children.

고속 궤도 차량의 예견 제어에 관한 연구

김윤선(Yoonsun Kim),박영진(Youngjin Park) 대한기계학회 2002 대한기계학회 기타 간행물 Vol.2002 No.11

고속 궤도 차량의 예견 제어에 관한 연구

김윤선(Yoonsun Kim),박영진(Youngjin Park) 한국자동차공학회 2002 한국자동차공학회 Symposium Vol.2002 No.11

In this study, we examined the feasibility of the preview control to improve the performance of the tracked vehicle system. We proposed a method to apply a robust H_∞ preview control to the tracked vehicle ystem. To avoid the complexity of modeling the track subsystem and kinematical nonlinearity in the trailing arm suspension system, we classified these as unknown dynamics and disturbances. To derive the robust H_∞ preview control theory, we modified a robust H_∞ control theory for linear discrete-time systems with norm bounded nonlinear uncertainties by augmenting previewed road profile signal. We have verified by computer simulation that the proposed method shows good robustness to modeling uncertainty including the case when the unsprung mass is assumed to be twice heavier than the model parameters. Secondly we used Time Delay Control(TDC) method to make sprung mass dynamics follow that of linear preview controlled tracked vehicle model. We have verified by computer simulation that the proposed method shows good robustness to nonlinearity and uncertainties