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The Prognostic Value of Alveolar-arterial Oxygen Gradient for Community-Acquired Pneumonia in the ED
신재복,박정호,최승필,정시경,우선희,이운정 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.5
Purpose: The purpose of this study was to investigate the value of the alveolar-arterial (A-a) oxygen gradient for patients with community-acquired pneumonia (CAP) in the emergency department (ED). Methods: A prospective study of patients with CAP in the ED was performed. Patients with clinical and a radiographic diagnosis of CAP were enrolled. Inflammatory biomarkers,such as WBC (white blood cell) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and A-a oxygen gradient were measured. The severity of CAP was assessed by three prediction rules: The Pneumonia Severity Index (PSI), CURB65 (confusion, blood urea nitrogen,respiratory rate, blood pressure and age≥65 yrs), and the Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) rules. The value of each biomarker (WBC, CRP, ESR) and A-a oxygen gradient for the prediction of mortality and CAP severity were assessed. Results: A total of 126 patients with CAP were included. Sixteen patients, older and in the high-risk group, died within 30 days. Non-survivors had a significantly increased A-a oxygen gradient compared to survivors (91.20 vs. 46.71mmHg, respectively; p<.01) and a high-sensitivity to Creactive protein (158.57 vs. 91.28 mg/dL, respectively;p<.01). The median A-a oxygen gradient was significantly higher with severe disease based on the three prediction rules. In regression logistic analyses, the area under the receiver operating characteristic curve of the alveolar-arterial oxygen gradient was 0.807(95% confidence interval,0.727-0.872). The addition of A-a oxygen gradient to the three prediction rules significantly increased the area under the receiver operating characteristic curve. Conclusion: These results suggest that A-a oxygen gradient is useful for the prediction of mortality and disease severity among CAP patients in the ED. The A-a oxygen gradient, as an adjunct to CAP prediction rules, may be worth while for the assessment of prognosis and severity.
모바일 클라우드 스토리지 서비스에서의 데이터 보안을 위한 데이터 접근 제어 및 보안 키 관리 기법
신재복,김윤구,박우람,박찬익 대한임베디드공학회 2013 대한임베디드공학회논문지 Vol.8 No.6
Cloud storage services are used for efficient sharing or synchronizing of user’s data across multiple mobile devices. Although cloud storages provide flexibility and scalability in storing data, security issues should be handled. Currently, typical cloud storage services offer data encryption for security purpose but we think such method is not secure enough because managing encryption keys by software and identifying users by simple ID and password are main defectives of current cloud storage services. We propose a secure data access method to cloud storage in mobile environment. Our framework supports hardware-based key management, attestation on the client software integrity, and secure key sharing across the multiple devices. We implemented our prototype using ARM TrustZone and TPM Emulator which is running on secure world of the TrustZone environment.