The importance of architectural planning phase has been arisen because of the changing conditions of construction market in Korea. The existing feasibility cannot fulfill its purpose in construction development projects because they are based on intuitive approach rather than systematic approach. The purpose of this study is to make a prototype of feasibility model to be a good investment. To build the model, first, risk factors which can be occurred in project had to be selected. Second, risk factors were divided into several groups in basis of characteristic risk. Third, economical risk factors were input on financial analysis. Then, to catch the relevance and influence of all risk factors, influence diagram and decision tree was made. Finally, sensitivity analysis was activated, then what the critical factors were, and how those factors could be solved. Through these procedures, the feasibility model that was made in this study could include both quantitative and qualitative factors. This model is expected to be used as a guide of feasibility study and is to serve systematic frame in planning and feasibility stage. IntroductionBecause they are based on intuitive approach rather than systematic approach, the existing feasibility methods cannot appropriately analyze risks in construction projects. With the recent rising complexities and competitive environments in the construction projects a risk management is recognized as more important management tool than the others. However, as most risk management techniques applied to the construction projects are centered around their initial finance phases and risk management.The purpose of this study is to propose a decision making model for construction risk management using simulation method. It is a tool for construction risk management which is called DPL and CRYSTAL BALL.There is a lack of an accepted method of risk assessment and management among professionals in the construction industry compared with the financial and health professions (Mulholland and Christian, 1999). Trigeorgis (1996) points out some major drawbacks of traditional quantitative capital budgeting techniques such as payback period method, internal rate of return (IRR) and decision tree analysis.The project appraisal methods should incorporate analysis of these risks. A number of capital-investment
Background: The genetic traits of pulmonary vein (PV) variants and rhythm outcomes after atrial fibrillation (AF) catheter ablation (AFCA) remain unclear. We explored the genetic and clinical characteristics and long-term rhythm outcomes of patients with AF and left common trunkus (LCT)-PVs or accessory PVs. Methods: We included 2,829 patients with AF (74.0% men, age 59.1±10.7 years, 66.3% paroxysmal AF) and available genome-wide association study, cardiac computed tomography, and protocol-based regular rhythm follow-up results from the Yonsei AF ablation cohort database. We examined 1,223 single nucleotide polymorphisms in 12 genetic loci associated with AF and long-term rhythm outcomes after AFCA. Results: We found LCT-PVs in 91(3.2%) and accessory PVs in 189(6.7%) patients. Rs9871453 (SCN10A) and rs1979409 (NEO1) were significantly associated with LCT-PV occurrence, and polygenic risk score (PRS) differed significantly between patients with LCT-PVs (p=1.64e-05) and normal PVs, but not those with accessory PVs (p=0.939). Patients with LCT-PVs had a higher proportion of the female sex(p=0.046) and CHA2DS2VASc score (p=0.026). After follow-up for 39.7±4.7 months, patients with LCT-PVs exhibited significantly greater LCT anterior wall thicknesses (p<0.001) and higher recurrence rate than those with normal PVs, particularly patients with paroxysmal AF (log-rank, p=0.042). LCT-PVs were independently associated with AF recurrence after AFCA (hazard ratio[HR], 2.26 [1.01 – 4.42]; p=0.046). Patients with LCT-PVs and higher PRSs had a higher risk of recurrent AF (adjusted HR 1.78, 95% CI 1.10?2.88, p=0.019). Conclusions: Patients with LCT-PVs have a significant genetic background. Post-AFCA recurrence rate was significantly higher in patients with LCT-PVs and higher PRSs, particularly in those with paroxysmal AF.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): a grant [2022R1I1A1A0106342211] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP) Background It has been suggested that the high dominant frequency (DF) site plays an atrial fibrillation (AF) driver, but its relationship with the atrial substrate voltage map (Vm) in the entire chamber AF map has yet to be studied. We explored the relationship between the DF site during AF and Vm in the entire chamber maps by applying the human left atrial (LA) electroanatomical map (EAM) to the digital twin AF map. Methods We acquired LA substrate Vm (at sinus rhythm, >800 points bipolar electrograms) of 110 patients with persistent AF (male 72.7%, 58.7±9.8 years old) who underwent AF catheter ablation. We applied EAM to digital twins (0.4 million nodes), reflecting anatomy, histology, and electrophysiology. We evaluated the highest 10% DF areas for 6 sec after inducing virtual AF. The correlation between the highest 10% DF and the low Vm areas (<0.2mV) was evaluated in the LA region of 10 segments. Results The mean voltage of the entire LA area was 1.96±0.85 mV (2.19±0.82 mV extra-PV area, 1.33±0.93 mV PV area) in 110 patients. The correlation between low Vm and high DF areas was not significant in the entire LA (r=0.106, p<0.001), extra-PV (r=0.157, p<0.001), and PV (r=0.079, p=0.097) areas. In the LA 10 segment regional analysis, 72 patients (65.5%) showed the co-localization of the highest DF in the region with the lowest Vm, and 14 patients (12.7%) had the lowest Vm segment in the region with the highest DF. The mean voltage where high DF appeared was 0.69±1.35 mV, and the mean voltage of the region where high DF did not appear was 0.59±1.15 mV (p=0.171). Conclusion High DF site, a parameter representing a localized focal source, had statistically significant but very poor correlations with LA extra-PV voltage substrate in patients with persistent AF.
Funding Acknowledgements Type of funding sources: None. Introduction Electrocardiography (ECG) can be easily obtained at a low cost and includes voltage and time interval representing heart conditions. We hypothesized that artificial intelligence (AI) detects a subtle abnormality in 12-lead ECG and may predict individual mortality. Methods Among 502,411 population in UK Biobank, 42,096 individuals had 12-lead ECG from 2013 to 2022. Among population with available ECG, 4,512 individuals were enrolled in this study adjusting the following inclusion criteria; age under 60 years, sinus rhythm, PR interval 120~200ms, QTc interval 350~460ms, and QRS duration 70~100ms. We developed and tested convolutional neural network (CNN) model to predict all cause death, cardiovascular (CV) death, or sudden cardiac arrest (SCA). The study population were divided into train (80%), validation (10%), and test (20%) set. Results Among 4,512 patients with median 3.7 years [IQR; 2.7-5.1] of follow-up, the rate of all-cause mortality was 11.6% (524). In overall study population, median age was 55.5 years and proportion of male sex was 42.2%. The patients with all-cause death were older (p<0.001) and had more comorbidities (p<0.001). In the train set, CNN model showed 0.93 in AUC for predicting all-cause death. In the test set, CNN model showed consistent good performance power (AUC 0.90) for all-cause death. In subgroup analysis, 102 of 4153 (2.46%) and 57 of 4065 (1.40%) patients experienced CV death and SCA, respectively. The performance power in test set were 0.90 in AUC for CV death and 0.87 in AUC for SCA. Conclusions AI detects and predicts future all-cause death, CV death, and SCA in median of 2.6 years by analyzing standard 12-lead ECG in generally looking normal sinus rhythm.
Background While the effect of a circumferential pulmonary vein isolation (CPVI) alone is unsatisfactory, that of an additional electrical posterior wall box isolation (POBI) is controversial in persistent atrial fibrillation (PeAF) patients. Increased epicardial adipose tissue (EAT) is associated with higher recurrence rates after AF catheter ablation (AFCA). Purpose We investigated the possible effects of a POBI on rhythm outcomes with varying EAT volumes. Methods We included 1,187 patients with PeAF undergoing a de novo AFCA (79.6% male, median age 60 years) into two groups including those receiving a CPVI alone (n=687) and those an additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the total EAT volume using propensity overlap weighting. Results A reduced total EAT volume was linearly associated with more favorable rhythm outcomes for an additional POBI treatment than for a CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (≤116.23 ml, the median value, n=594), an additional POBI was associated with a reduced AF recurrence risk as compared to a CPVI only (weighted hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56–0.99; weighted log-rank P=0.039). In contrast, among the remaining 593 patients with greater EAT volumes (>116.2 3mL), there was no difference in the AF recurrence risk between an additional POBI and CPVI alone (weighted HR 1.13, 95% CI 0.84–1.52; weighted log-rank P=0.410). Among 185 patients with a repeat ablation, the POBI reconnection rate tended to be higher in the large EAT group (75.0%) than small EAT group (55.4%, P=0.060). Conclusion While PeAF patients with a smaller EAT volume averted AF recurrence by an additional POBI after the CPVI, no benefit of the POBI was observed in those with a greater EAT volume. The EAT volume might identify AF patients likely to benefit from linear ablation in addition to the CPVI. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Ministry of Science, ICT & Future Planning (MSIP)Korean Ministry of Health and Welfare
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