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Pediatric Home Mechanical Ventilation in Korea: the Present Situation and Future Strategy
박미르,장혜린,설인숙,김수연,김영서,김윤희,손명현,김경원 대한의학회 2019 Journal of Korean medical science Vol.34 No.42
Background: The number of children using home mechanical ventilation (HMV) has increased markedly in Europe and North America, but little is known about the situation in Korea. We described the clinical characteristics of children using HMV and investigated the current situation of HMV utilization in children. Methods: Data on HMV prescriptions in year 2016 for children under the age of 19 was retrieved from the National Health Insurance Service for nationwide information. For more detailed information, data from year 2016 to 2018 was also retrieved from a tertiary center, Severance Children's Hospital. Results: Nationwide, 416 children were prescribed with HMV in 2016, with an estimated prevalence of 4.4 per 100,000 children, of which 64.2% were male and mean age was 6-year- old. The estimated number of patients using invasive ventilators via tracheostomy was 202 (49%). Neuromuscular diseases were the most frequent cause (217; 52%), followed by central nervous system diseases (142; 34%), and cardiopulmonary diseases (57; 14%). In the tertiary center, a total of 62 children were prescribed with HMV (19 [31%] with non-invasive ventilation; 43 [69%] with invasive ventilation]. The number of children with HMV increased from 11 in 2016 to 29 in 2018. The mean age for initiation of HMV was 3.1 years and male patients comprised 65%. The most frequent diagnostic reason for HMV was central nervous system diseases (68%), followed by cardiopulmonary diseases (19%) and neuromuscular diseases (13%). Five patients died during the study period and five patients weaned from HMV. Conclusion: This study provides insights on the present situation of HMV utilization in Korean children.
모델 포이즈닝 공격에 강건한 개인화 연합학습을 위한 부분 공유 알고리즘
박희원,김미르,권민혜 한국통신학회 2023 韓國通信學會論文誌 Vol.48 No.11
The exponential growth of decentralized data sources has propelled Federated Learning to the forefront of research. This approach facilitates the training of models across multiple devices without the need for direct data exchange. Nevertheless, the conventional federated learning method encounters inherent challenges when confronted with heterogeneous data distributions among clients. Furthermore, it remains susceptible to Byzantine attacks. To address these challenges, we propose a novel partial share algorithm. This algorithm trains local models by partitioning them into personalized and shared components, enabling clients to create personalized models that are tailored to their local data. Concurrently, it preserves robustness against potential attacks by exposing only the shared portion of the local model. Through an extensive series of experiments, we comprehensively evaluate the performance of the proposed algorithm in terms of personalization and robustness against attacks.
고해상도 입체기상관측자료 확보를 위한 기상드론과 고층관측장비의 비교 관측
이승협,박미르,전혜림,박미은 한국기상학회 2021 한국기상학회 학술대회 논문집 Vol.2021 No.10
강원영동 공동 입체기상관측 프로젝트에서는 영동대설과 강풍의 메커니즘을 이해하기 위해 3차원 관측을 수행하고 있다. 그러나 기존의 고층관측장비는 대기최하층 관측자료를 생산하는데 시공간해상도가 낮거나 정확도가 떨어지는 단점이 있다. 이에 따라 이번 연구에서는 기상드론과 고층기상관측장비(레윈존데, 윈드프로파일러, 윈드라이다)의 관측자료를 비교하여 기상드론의 대기최하층(150 m 고도 이하) 관측공백 해소를 통한 고해상도 3차원 관측자료 확보 가능성을 확인하고자 한다. 레윈존데와 윈드프로파일러는 북강릉에서 상시관측했으며, 윈드라이다는 프로젝트 기간 동안 대관령에서 관측하였다. 기상드론은 각 장비에서 30~48 m 떨어진 지점에서 비행했고, 북강릉지점에서는 최대 300 m 고도까지 연직상승 및 하강, 대관령지점에서는 150, 200, 250 m 고도에서 10분간 정지관측하였다. 관측날짜는 바람이 약해 드론 비행에 적합한 2021년 4월 23일, 5월 13일과 영동강풍 특별관측기간에 해당하는 2021년 5월 7일로 총 3일간 총 23회 비교관측을 수행하였다. 기상드론과 레윈존데의 관측결과, 기온과 습도는 200 m 고도에서 각각 1.5℃ 이상, 15% 이상 큰 편차가 나타났다. 풍속은 바람이 강했던 5월 7일 고도에 따라 2 m/s이상의 차이를 보였으나 바람이 약했던 4월 23일에는 지상부터 200 m 고도까지 1 m/s의 편차로 기상측기검정기준을 만족했다. 또한 두 장비의 상관계수(r)는 풍속과 풍향 모두 0.7 이상으로 대기최하층에서 기상드론은 3차원 관측자료 생산에 적합하다고 판단했다. 윈드프로파일러는 기상드론과 r값이 -0.85에서 0.10로 낮았으며, 특히 가장 낮은 고도인 150 m에서 풍속과 풍향의 편차가 각각 4 m/s와 80°로 가장 컸다. 이러한 윈드프로파일러의 대기하층의 부정확성과 150 m 이하의 관측공백은 기상드론으로 대체 가능하다고 생각된다. 윈드라이다와 기상드론의 풍속과 풍향의 평균편차는 각각 1 m/s와 5°이었지만, 시간에 따른 일변동 경향이 유사하고 r값은 0.86으로 높아 기상드론 자료를 통해 윈드라이다 최하층 자료 보정이 가능할 것으로 판단하였다. 이번 연구에서 레윈존데와 비교를 통해 기상드론의 대기하층 3차원 관측자료 생산가능성을 확인했으며, 기상드론과 원격관측장비인 윈드프로파일러와 윈드라이다의 비교에서는 100 150 m 고도이하의 관측공백해소와 연직해상도를 높일 수 있었다.
단일기관 소아청소년 입원 환자에서의 항생제 피부시험 현황 분석
노윤영,김하민,박미르,김수연,김종덕,김민정,이용주,김윤희,김경원,손명현 대한 소아알레르기 호흡기학회 2023 Allergy Asthma & Respiratory Disease Vol.11 No.2
Background: Routine practice of antibiotic skin test (AST) before administering antibiotics is with little scientific basis. However, AST is frequently performed in real-world practice. We aimed to explore the current practice status of AST. Methods: All admission cases in Severance Hospital between January 2019 and December 2020 of patients at less than 19 years of age were collected retrospectively. AST results for 4 penicillins (ampicillin, ampicillin-sulbactam, amoxicillin-clavulanate, and piperacillin-tazobactam) and 6 cephalosporins (cefazolin, cefotaxime, cefotiam, cefpiramide, ceftriaxone, and flomoxef) as well as adverse drug reaction (ADR) reports were collected. Results: Among 36,381 hospitalization cases, 7,589 and 16,468 were administered penicillins and cephalosporins, respectively. Penicillins were administered without AST in 2,622 cases (35%), 2 (0.08%) of which showed ADR. Of the remaining 4,967 cases who received AST, 57 (1.1%) showed a positive reaction. For cephalosporins, 15,473 cases (94%) received antibiotics without AST. Among them, 17 cases (0.1%) showed ADRs. For 995 cases that rceived AST, 22 (2.2%) revealed a positive reaction. Among 79 cases who were AST positive, 10 took the original medication. Conclusion: The current practice of AST reveals heterogeneous and inconsistent patterns. This brings the need for a standardized guideline for the safe and effective use of antibiotics. .
김윤희,한창훈,박미르,김하민,노윤영,김수연,김종덕,김민정,이용주,김경원 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.6
Purpose: The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valu able prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. Materials and Methods: The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. Results: Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760–0.848]. In univari able analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18–3.11), and the significance was maintained in multi variable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05–2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519–0.695). Conclusion: The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, espe cially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.