• Tuberculosis and Respiratory Diseases
• /
• v.43 no.6
• /
• pp.987-996
• /
• 1996

Background : We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods : Twenty-six out of 106 patients with either acute ventilatory failure (VF: $PaCO_2$ > 43 mm Hg with pH < 7.35) or oxygenation failure (OF: $PaO_2/AO_2$ < 300 mm Hg with $pH{\geq}7.35$) requiring mechanical ventilation were managed by NIV (CPAP + pressure suppon, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M : F=7 : $55.4{\pm}14.6$ yrs) and 15 out of 87 cases with OF (17.2%) (M : F=12 : 3, $50.6{\pm}15.6$ yrs) were s uilable for NIY. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of YF and 40% (6/15) of OF were successfully managed on NIV and were weruled from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV ($34{\pm}9$ /min pre-NIV, $26{\pm}6$ /min at 12 hour of NIV, p=0.045), while $PaCO_2$ ($87.3{\pm}20.6$ mm Hg pre-NIV, $81.2{\pm}9.1$ mm Hg at 24 hour of NIV) and pH ($7.26{\pm}0.04$, $7.32{\pm}0.02$, respectively, p <0.05) were both significantly decreased at 24 hour of NIV In NIV for oxygenation failure, $PaCO_2$ were not different between the successful and the failed cases at pre-NIV and till 12 hours after NIV. The $PaO_2/FIO_2$ ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6 : at baseline, 0.5h, 6h, 12h : $120.0{\pm}19.6$, $218.9{\pm}98.3$, $191.3{\pm}55.2$, $232.8{\pm}17.6$ mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9 : $127.9{\pm}63.0$, $116.8{\pm}24.4$, $100.6{\pm}34.6$, $129.8{\pm}50.3$ mm Hg, respectively, p=0.5319). Conclusion : From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rale before the reduction in $PaCO_2$ level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of $PaO_2/FIO_2$ ratio at 0.5h after application is thought to be a predictor of successful NIV.

• Journal of Sasang Constitutional Medicine
• /
• v.11 no.2
• /
• pp.151-183
• /
• 1999

The object of this study was 200 patients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center during 9 months from Jan. 1999 to sept. 1999. We proceeded the judgment of Sasang Constitution according to 'Questionnaire of Sasang Constitution Classification (I)', and 'Questionnaire of Sasang Constitution Classification II(QSCCII)' and the diagnosis by a medical specialist. The following conclusion were made in comparison with Sasang Constitution and Questionnaire. 1. We selected the 84 subjects what had the statistical value out of the 196 subjects('Questionnaire of Sasang Constitution Classification (I)' had the 71 subjects and 'Questionnaire of Sasang Constitution Classification II(QSCCII)', had the 121 subjects). And we selected again the 73 subjects('Questionnaire of Sasang Constitution Classification (I)', had the 33 subjects and 'Questionnaire of Sasang Constitution Classification II (QSCC II)' had the 40 subjects) out of the 84 subjects, because it had a repeated subjects. 2. We made the Questionnaire what has the 85 subjects, including the subjects what was approved its statistical value by 'A CLINICAL STUDY OF THE JUDGMENT OF SASANG CONSTITUTION ACCORDING TO QUESTIONNAIRE' and 'A CLINICAL STUDY OF THE TYPE OF DISEASE AND SYMPTOM ACCORDING TO SASANG CONSTITUTION CLASSIFICATION'. The subject what ask the physique and the body form was 7, the subject what ask the external appearance and the posture was 7, the subject what ask the habit and the character was 3, the subject what ask the physiology and the pathology was 3, the subject what ask the phenomenon that he has frequency was 4, the subject what ask the eating was 3, the subject what ask the symptom that he has frequency was 14, the subject what ask the work and the qualities-defects was 6, the subject what ask the friendly intercourse was 7, the subject what ask the usual mind was 5, the subject what ask the emotional inclination was I, the subject what ask the behavioral inclination was 10, the subject what ask the character was 15. 3. In the new Questionnaire, the subject what has relevance to Soyang was 84, the subject what has relevance to Soeum was 87, the subject what has relevance to Taeeum was 70. And we made the point of subject with the statistical ratio. The total point of Soyang was 7785.04, the total point of Soeum was 7742.80, the total point of Taeeum was 7746.60. 4. As a result of judgment of Sasang Constitution between the clinical diagnosis by a medical specialist and the new Questionnaire, the diagnostic accuracy of new Questionnaire was 73.33%. The diagnostic accuracy of Soyang was low, the others was high. And the Taeyang was excepted.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.6
• /
• pp.631-637
• /
• 1993

Background: In normal adults, ventilation is uneven and greater in the base than the apex of the lung in tidal volume breathing. However infants have fragile chest wall and reduced elastic recoil, resulting in easy closure of peripheral airways especially in the dependent portion of the lung. So ventilation in infants is greater in the apex than the base of the lung. We assumed that in adults whose closing volume is increased, dependent portion could be easily collapsed during tidal breathing and ventilation could be greater in the uppear than than the lower portion of the lung. Methods: We measured spirometry and closing volume(CV) in normal controls and in patients with chronic lung disease. Also we measured fractional distribution of ventilation at supine, left lateral and right lateral decubitus with $^{133}Xe$ ventilation scan in normal controls, patients with normal closing volume and patients with increased closing volume. Results: The subjects consisted of 7 normal controls(mean $age{\pm}SD$, $62.9{\pm}6.1$ years). 6 patients with normal CV($62.8{\pm}8.2$ years) and 7 patients with increased CV($63.0{\pm}15.3$ years). 1) Normal controls have mean(${\pm}SD$) FVC $104{\pm}11%$ of predicted value, $FEV_1\;120{\pm}16%,\;FEV_1/FVC\;112{\pm}5%$ and CV $86.9{\pm}12.5%$. Patients with normal CV have FVC $62{\pm}11%,\;FEV_1\;54{\pm}17%,\;FEV_1/FVC\;84{\pm}23%$ and CV $92.6{\pm}15.5%$. Patients with increased CV, have FVC $53{\pm}9%,\;FEV_1\;38{\pm}13,\;FEV_1/FVC\;69{\pm}16%$ and CV $176.1{\pm}36.6%$, CV was significantly different between two patient groups(p<0.02) 2). In normal controls mean fractional ventilation to left lung was $48.1{\pm}5.3%$ at supine, $54.1{\pm}9.8%$ at dependent and $40.9{\pm}6.5%$ at left uppermost position. In patients with normal CV mean fractional ventilation to left lung was $44.6{\pm}2.1%$ at supine, $59.7{\pm}5.6%$ at left dependent and $31.7{\pm}8.3%$ at left uppermost position. In patients with increased CV mean fractional ventilation to left lung was $48.7{\pm}4.5%$ at supine, $41.7{\pm}6.6%$ at left dependent and $60.9{\pm}15.7%$ at left uppermost position. In normal controls and patients with normal CV, ventilation to left lung at left dependent position tends to be higher than that at supine position but without statisitical significance and it was significantly lower at left uppermost than at left lung dependent position. In patients with increased CV, ventilation to left at left dependent position tends to be higher than that at supine position but without significance and it was significantly higher at left uppermost than that at left dependent position. Conclusion: These data suggest that in patients with increased CV ventilation to one side of lung could be higher at uppermost than at dependent position on lateral decubitus during tidal breathing and this fact should be taken into account in positioning of patients with unilateral lung disease.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1981.05a
• /
• pp.38.1-38
• /
• 1981

Currently in the otologic field, there are various methods of special audiometric examinations, such as, tone decay, SISI, and impedance audiometry and only a few studies has been done in these fields sporadically in Korea. The purpose of this paper is to establish norms of various special audiometric tests, so we have performed the special audiometric tests on 100 male medical students in good physical condition and the follow results were obtained. 1. All cases showed over 90% of PB scores. The mean and its 2 S.D. were 98$\pm$4.9% in the right ear and 97$\pm$5.6% in the left ear. 2. The mean and its 2 S.D. of MCL(most comfortable level) were 45$\pm$15.4 dB in the right ear and 46$\pm$17.9 dB in the left ear, and its range was 12$\pm$12.2 dB in the right ear and 13$\pm$12.6 dB in the left ear. 3. The mean and its 2 S.D. of UCL (uncomfortable level) were 102$\pm$7.9 dB in the right ear and 102$\pm$7.9 dB in the left ear and about an half in cases showed over 106 dB of UCL. 4. In 95% of cases, SISIs(short increment sensitivity index) at 1, 000 Hz and 4000 Hz was below 45% in the right ear in both frequencies and below 55% and 75% in the left ear, respectively. 5. In 95% of cases, tone decays at 2, 000 Hz and 4, 000 Hz was below 10 dB in both ears. 6. The difference between SRT and PTA (speech reception threshold minus pure tone average) was 4$\pm$9.2 dB in the right ear and 4$\pm$10.0 dB in the left ear. 7. The dynamic range(uncomfortable level minus speech reception threshold) was 98$\pm$13.5 dB in the right ear and 99$\pm$13.5 dB in the left ear. We had trouble in estimating the dynamic range in about an half in cases, in which we couldn't estimate the UCL with our conventional audiometry. 8. The results of impedance audiometric tests were as follow: A. In the tympanogram, all cases were of A type with one exception of B type in the left ear. The mean and its 2 S.D. of its peak level were 22.8$\pm$32.94mm $H_2O$ in the right ear and 23.9$\pm$29. 81mm $H_2O$ in the left ear. B. The mean and its 2 S.D. of the compliance were 0.6$\pm$0.54cc in the right ear and 0.6$\pm$0.53cc in the left ear. C. The results of stapedial reflex: a. The mean and its 2 S.D. of the controlateral stapedial reflex at 500Hz, 1, 000Hz, 2, 000Hz, 4, 000Hz were 99$\pm$17.7 dB, 87$\pm$14.4 dB, 79$\pm$13.7 dB, 77$\pm$20.0 dB in the right ear and 99$\pm$15.9 dB, 88$\pm$13.9 dB, 79$\pm$13.7 dB, 77$\pm$21.3 dB in the left ear. Depending on the tested frequencies, the stapedial reflex wasn't generated in 6 cases in the right ear and 11 cases in the left ear. b. The mean and its 2 S.D. of the ipsilateral stapedial reflex at 1, 000Hz, and 2, 000Hz were 89$\pm$16.3 dB, 82$\pm$15.9 dB in the right ear and 89$\pm$18.0 dB, 83$\pm$18.9 dB in the left ear. Depending on the tested frequencies, the stapedial reflex wans't generated in 1 case in the right ear and 2 cases in the left ear. 9. Eustachian tube function using with impedance audiometry was malfunctioned in21 cases depending on the tested pressure and the range of peak level of tympanogram was 14$\pm$26.9mm $H_2O$(tested pressure:+250mm $H_2O$), 8$\pm$21.9mm $H_2O$ (tested pressure:-250mm $H_2O$) in the right ear and 11 cases depending on the tested pressure and the range of the peak level of tympanogram was 12$\pm$22.5mm $H_2O$ (tested pressure: +250 mm $H_2O$, 9$\pm$17.3mm $H_2O$(tested pressure: -250mm $H_2O$) in the left ear.

• Economic and Environmental Geology
• /
• v.5 no.4
• /
• pp.187-209
• /
• 1972

Drilling position is one of the most important factors affecting on the blasting effects. There has been many reports on several blasting factors of burn-cut by Messrs. Brown and Cook, but in this study the author tried to compare drilling positions of burn-cut to pyramid-cut, and also to correlate burn-cut effects of drilling patterns, not being dealt by Prof. Ito in his theory, which emphasized on dynamical stress analysis between explosion and free face. According to former theories, there break out additional tensile stress reflected at the free face supplemented to primary compressive stress on the blasting with one-free-face. But with these experimented new drilling patterns of burn-cut, more free faces and nearer distance of each drilling holes make blasting effects greater than any other methods. To promote the above explosive effect rationary, it has to be considered two important categories under-mentioned. First, unloaded hole in the key holes should be drilled in wider diameter possibly so that it breaks out greater stress relief. Second, key holes possibly should have closer distances each other to result clean blasting. These two important factors derived from experiments with, theories of that the larger the dia of the unloaded hole, it can be allowed wider secondary free faces and closes distances of each holes make more developed stress relief, between loaded and unloaded holes. It was suggested that most ideal distance between holes is about 4 clearance in U. S. A., but the author, according to the experiments, it results that the less distance allow, the more effective blasting with increased broken rock volume and longer drifted length can be accomplished. Developed large hole burn-cut method aimed to increase drifting length technically under the above considerations, and progressive success resulted to achieve maximum 7 blasting cycles per day with 3.1m drifting length per cycle. This achievement originated high-speed-drifting works, and it was also proven that application of Metallic AN-FO on large hole burn-cut method overcomes resistance of one-free-face. AN-FO which was favored with low price and safety handling is the mixture of the fertilizer or industrial Ammonium-Nitrate and fuel oil, and it is also experienced that it shows insensible property before the initiation, but once it is initiated by the booster, it has equal explosive power of Ammonium Nitrate Explosives (ANE). There was many reports about AN-FO. On AN-FO mixing ratio, according to these experiments, prowdered AN-FO, 93.5 : 6.5 and prilled AN-FO 94 : 6, are the best ratios. Detonation, shock, and friction sensities are all more insensitive than any other explosives. Residual gas is not toxic, too. On initation and propagation of the detonation test, prilled AN-FO is more effective than powered AN-FO. AN-FO has the best explosion power at 7 days elapsed after it has mixed. While AN-FO was used at open pit in past years prior to other conditions, the author developed new improved explosives, Metallic AN-FO and Underwater explosive, based on the experiments of these fundmental characteristics by study on its usage utilizing AN-FO. Metallic AN-FO is the mixture of AN-FO and Al, Fe-Si powder, and Underwater explosive is made from usual explosive and AN-FO. The explanations about them are described in the other paper. In this study, it is confirmed that the blasting effects of utilizing AN-FO explosives are very good.

• Journal of Intelligence and Information Systems
• /
• v.19 no.2
• /
• pp.1-20
• /
• 2013

Nowadays, social network is a huge communication platform for providing people to connect with one another and to bring users together to share common interests, experiences, and their daily activities. Users spend hours per day in maintaining personal information and interacting with other people via posting, commenting, messaging, games, social events, and applications. Due to the growth of user's distributed information in social network, there is a great potential to utilize the social data to enhance the quality of recommender system. There are some researches focusing on social network analysis that investigate how social network can be used in recommendation domain. Among these researches, we are interested in taking advantages of the interaction between a user and others in social network that can be determined and known as social relationship. Furthermore, mostly user's decisions before purchasing some products depend on suggestion of people who have either the same preferences or closer relationship. For this reason, we believe that user's relationship in social network can provide an effective way to increase the quality in prediction user's interests of recommender system. Therefore, social relationship between users encountered from social network is a common factor to improve the way of predicting user's preferences in the conventional approach. Recommender system is dramatically increasing in popularity and currently being used by many e-commerce sites such as Amazon.com, Last.fm, eBay.com, etc. Collaborative filtering (CF) method is one of the essential and powerful techniques in recommender system for suggesting the appropriate items to user by learning user's preferences. CF method focuses on user data and generates automatic prediction about user's interests by gathering information from users who share similar background and preferences. Specifically, the intension of CF method is to find users who have similar preferences and to suggest target user items that were mostly preferred by those nearest neighbor users. There are two basic units that need to be considered by CF method, the user and the item. Each user needs to provide his rating value on items i.e. movies, products, books, etc to indicate their interests on those items. In addition, CF uses the user-rating matrix to find a group of users who have similar rating with target user. Then, it predicts unknown rating value for items that target user has not rated. Currently, CF has been successfully implemented in both information filtering and e-commerce applications. However, it remains some important challenges such as cold start, data sparsity, and scalability reflected on quality and accuracy of prediction. In order to overcome these challenges, many researchers have proposed various kinds of CF method such as hybrid CF, trust-based CF, social network-based CF, etc. In the purpose of improving the recommendation performance and prediction accuracy of standard CF, in this paper we propose a method which integrates traditional CF technique with social relationship between users discovered from user's behavior in social network i.e. Facebook. We identify user's relationship from behavior of user such as posts and comments interacted with friends in Facebook. We believe that social relationship implicitly inferred from user's behavior can be likely applied to compensate the limitation of conventional approach. Therefore, we extract posts and comments of each user by using Facebook Graph API and calculate feature score among each term to obtain feature vector for computing similarity of user. Then, we combine the result with similarity value computed using traditional CF technique. Finally, our system provides a list of recommended items according to neighbor users who have the biggest total similarity value to the target user. In order to verify and evaluate our proposed method we have performed an experiment on data collected from our Movies Rating System. Prediction accuracy evaluation is conducted to demonstrate how much our algorithm gives the correctness of recommendation to user in terms of MAE. Then, the evaluation of performance is made to show the effectiveness of our method in terms of precision, recall, and F1-measure. Evaluation on coverage is also included in our experiment to see the ability of generating recommendation. The experimental results show that our proposed method outperform and more accurate in suggesting items to users with better performance. The effectiveness of user's behavior in social network particularly shows the significant improvement by up to 6% on recommendation accuracy. Moreover, experiment of recommendation performance shows that incorporating social relationship observed from user's behavior into CF is beneficial and useful to generate recommendation with 7% improvement of performance compared with benchmark methods. Finally, we confirm that interaction between users in social network is able to enhance the accuracy and give better recommendation in conventional approach.

• Journal of The Korean Society of Grassland and Forage Science
• /
• v.32 no.1
• /
• pp.59-74
• /
• 2012

Buffer solubility and protein fractionation were evaluated from the hays (timothy, alfalfa and klein) and straws (tall fescue and rice), and $In$ $vitro$ trial was conducted to examine the effect of buffer extraction on fermentation characteristics, degradability and gas ($CO_2$ and $CH_4$) production. Buffer soluble protein (SP) content and A fraction in total protein were highest in alfalfa hay as 61% and 41.77%, respectively while lowest in rice straw (42.8% and 19.78%, respectively). No difference was observed in B1 fraction among forages but B2 fraction was slightly increased in klein hay (12.34%) and tall fescue straw (10.05%) compared with other forages (6.34~8.85%). B3 fraction of tall fescue was highest as 38.49% without difference among other forages while C fraction was highest in rice straw. pH in incubation solution was higher in all forages after extraction than before extraction at 3h (P<0.01) and 6h (P<0.05), and pH from hays of timothy and alfalfa was higher than the other forages at 6h (P<0.05) and 12h (P<0.001). Regardless of extraction, ammonia-N concentration from alfalfa hay was increased at all incubation times and extraction effect was appeared only at 3h incubation time (P<0.01). Total VFA concentration from alfalfa hay was highest up to 24h incubation while those from tall fescue straw and rice straw were lowest. Buffer extraction decreased (P<0.01~P<0.001) the total VFA concentration. Acetic acid proportion was increased (P<0.001) before extraction of forages but no difference was found between forages. Propionic acid($C_3$) proportion was also increased(P<0.001) before extraction in all forages than in straws at 3h, 24h and 48h incubations, and $C_3$ from hays were mostly higher (P<0.05) than from straws. Butyric acid proportion, however, was not affected by extraction at most incubation times. Parameter 'a' regarding to the dry matter (DM) degradation was increase (P<0.001) in all forages before extraction, and was decreased (P<0.05) in tall fescue straw and rice straw compared with hays. Parameter 'b' was also increased (P<0.001) before extraction but no difference was found between forages. Effective degradability of DM (EDDM) was higher (P<0.001) before extraction in most forages except for rice straw. Buffer extraction decreased (P<0.05) all parameters (a, b, and c) regrading to the crude protein (CP) degradation but no difference was found between forages. Effective degradation of CP (EDCP) was lower (P<0.05) in straws than in hays. Parameters 'a' and 'b' regarding to the NDF degradation (P<0.01) and effective degradability of NDF (EDNDF, P<0.001) were also higher in forages before extraction than after extraction but no difference was found between forages. Buffer extraction reduced (P<0.05~P<0.001) $CO_2$ production from all the forages uo to 24h incubation and its production was greater (P<0.05~P<0.01) from hays than straws. Methane ($CH_4$) production was also greater (P<0.01~P<0.001) in all forages at all incubation times, and its production was greater (P<0.05) from hays than from straws at most incubation times. Based on the results of the current study, it can be concluded that buffer solubility and CP fractionation might be closely related with $In$ $vitro$ VFA concentration, degradability and gas ($CO_2$ and $CH_4$) production. Thus, measurement of buffer solubility and protein fractionation of forages might be useful to improve TMR availability in the ruminants.

• The Korean Nurse
• /
• v.20 no.4 s.112
• /
• pp.27-38
• /
• 1981

오늘 저희에게 주어진 주제, 내일에 타당한 간호사업 및 간호교육의 향방을 어떻게 정하여야 하는가의 논의는 오늘날 간호계 주변에 일어나고 있는 변화의 실상을 이해하는 데서 비롯되어져야 한다고 생각하는 입장에서 먼저 세계적으로 건강관리사업이 당면한 딜레마가 어떠한 것이며 이러한 문제해결을 위해 어떠한 새로운 제안들이 나오고 있는가를 개관 하므로서 그 교육적 의미를 정의해 보고 장래 간호교육이 지향해야할 바를 생각해 보려 합니다. 오늘의 사회의 하나의 특징은 세계 모든 나라들이 각기 어떻게 전체 국민에게 고루 미칠 수 있는 건강관리체계를 이룩할 수 있느냐에 관심을 모으고 있는 사실이라고 봅니다. 부강한 나라에 있어서나 가장 빈궁한 나라에 있어서나 그 관심은 마찬가지로 나타나고 있읍니다. 보건진료 문제의 제기는 발달된 현대의학의 지식과 기술이 지닌 건강관리의 방대한 가능성과 건강 관리의 요구를 지닌 사람들에게 미치는 실질적인 혜택간에 점점 더 크게 벌어지는 격차에서 발생한다고 봅니다. David Rogers는 1960년대 초반까지 갖고 있던 의료지식의 축적과 민간인의 구매력 향상이 자동적으로 국민 건강의 향상을 초래할 것이라고 믿었던 순진한 꿈은 이루어지지 않았고 오히려 의료사업의 위기는 의료지식과 의료봉사간에 벌어지는 격차와 의료에 대한 막대한 투자와 그에서 얻는 건강의 혜택간의 격차에서 온다고 말하고 있읍니다. 균등 분배의 견지에서 보면 의료지식과 기술의 향상은 그 단위 투자에 대한 생산성을 낮춤으로서 오히려 장애적 요인으로 작용해온 것도 사실이고 의료의 발달에 따른 일반인의 기대 상승과 더불어 의료를 태성의 권리로 규명하는 의료보호사업의 확대로 야기되는 의료수요의 급증은 모두 기존 시설 자원에 압박을 초래하여 전래적 의료공급체제에 도전을 가해 왔으며 의료의 발달에 건 기대와는 달리 인류의 건강 문제 해결은 더욱 요원한 과제로 남게 되었읍니다. 현시점에서 세계인구의 건강문제는 기아, 영양실조, 안전한 식수 공급 및 위생적 생활환경조성의 문제에서부터 가장 정밀한 의료기술발달에 수반되는 의료사회문제에 이르는 다양한 문제를 지니고 있으며 주로 각개 국가의 경제 사회적 여건이 이 문제의 성격을 결정짓고 있다고 볼수 있읍니다. 그러나 건강 관리에 대한 요구는 영구히, 완전히 충족될 수 없는 요구에 속한다는 의미에서 경제 사회적 발달 수준에 상관없이 모든 국가가 공히 요구에 미치지 못하는 제한된 자원문제로 고심하고 있는 실정입니다. 또 하나의 공통된 관점은 각기 문제의 상황은 달라도 오늘날의 건강 문제는 주로 의료권 밖의 유전적 소인, 사회경제적, 정치문화적인 환경여건과 각기 선택하는 삶의 스타일에 깊이 관련되어 있다는 사실입니다. 따라서 오늘과 내일의 건강관리 문제는 의학적 견지에서 뿐 아니라 널리 경제, 사회, 정치, 문화적 관점에서 포괄적인 접근이 시도되어야 한다는 점과 의료의 고급화, 전문화, 일변도의 과정에서 소외되었던 기본건강관리체계 강화에 역점을 둔 다양하고 탄력성 있는 사업전개가 요구되고 있다는 점입니다. 다양한 건강관리요구에 적절히 대처할 수 있기 위한 그간 세계 각처에서 시도된 새로운 건강관리 접근과 그 제안을 살펴보면 대체로 4가지의 뚜렷한 성격들로 집약할 수 있을 것 같습니다. 그 첫째는 건강관리사업계획 및 그 수행에 있어 지역 사회의 적극적 참여를 유도하는 일, 둘째는 지역단위의 일차보건의료에서 부터 도심지 신예 종합병원, 시설 의료에 이르기까지 건강관리사업을 합리적으로 체계화하는 일. 셋째로 의료인력이용의 효율화 및 비의료인의 훈련과 협조 유발을 포함하는 효과적인 인력관리에 대한 제안과 넷째로 의료보험 및 각양 집단 의료유형을 포함하는 대체 의료재정 운영관리에 관련된 제안들을 들 수 있읍니다. 건강관리사업에 있어 지역사회 참여의 의의는 첫째로 사회 경제적인 제약이 모든 사람에게 가능한 최대한의 의료를 모두 고루 공급하기 어렵게 하고 있다는 점에서 제한된 정부재정과 지역사회가용자원을 보다 효율적으로 이용할 수 있게 하는 자조적이고 자율적인 지역사회건강관리체제의 구현에 있다고 볼 수 있으며 둘때로는 개인과 가족 및 지역민의 건강에 영향하는 많은 요인들은 실질적으로 의료권 외적 요인들로서 위생적인 생활양식, 식사습관, 의료시설이용 등 깊이 지역사회특성과 관련되어 국민보건의 실질적 향상을 위하여는 지역 주민의 자발적인 참여가 필수여건이 된다는 점 입니다. 지역 단위별 체계적인 의료사업의 전개는 제한된 의료자원의 보다 합리적이고 효율적인 이용을 가능하게 하며 요구가 있을때 언제나 가까운 거리에서 경제 사회적 제약을 받지 않고 이용할 수 있는 일차건강관리망을 통하여 건강에 관련된 정보를 얻으며 질병예방, 건강증진 및 기초적인 진료의 도움을 얻을 수 있고 의뢰에 대한 제2차, 제3차 진료에의 길은 건강관리사업의 질과 폭을 동시에 높고 넓게 해 줄 수 있는 길이 된다는 것입니다. 인력 관리에 관련된 두가지 기본 방향으로서는 첫째로 기존보건의료인력의 적정배치 유도이고 둘째는 기존인력의 역할확대, 조정 및 비의료인의 교육훈련과 부분적 업무대체를 들수 있으며 이러한 인력관리의 기본 방향은 부족되는 의료인력의 생산성을 높이고 주민들의 자조적 능력을 강화시킨다는 데에 두고 있음니다. 대체적 의료재정운영안은 대체로 의료공급과 재정관리를 이원화하여 주민의 경제능력이 의료수혜의 장애요소로 작용함을 막고 의료인의 경제적 동기에 의한 과잉치료처치에 의한 낭비를 줄임으로써 의료재정의 투자의 효과를 증대하는 데(cost-effectiveness) 그 기본방향을 두고 있다고 봅니다. 이러한 주변의료 사회적인 동향이 간호교육의 미래상에 끼치는 영향은 지대한 것이라 봅니다. 첫째로 장래 세계인구의 건강문제는 정치, 사회, 경제, 환경적인 의료권 밖의 요인들에 의해 더욱 크게 영향 받는다고 전제한다면 건강문제해결에 있어서도 전통적인 의료사업의 접근에서 더나아가 문제발생의 근원이 되는 생활개선이라는 차원에서 포괄적 접근을 생각하여야 하고 이를 위해선 정치, 경제, 사회전반에 걸친 깊이있는 이해과 주민의 생활환경에 직접 영향하는 교통수단, 통신망 mass media, 전력문제, 농업경영방법 및 조직적 사회활동 등 폭넓은 이해가 요구된다고 봅니다. 둘째로, 지역사회참여의 의의를 인정한다면 지역민의 자발적 참여를 효과적으로 유발시킬수 있고 의료집단과 각종 주민조직과 일반주민들 사이에서 협조적으로 일할수 있는 역량을 기르기위한 교육적 준비가 요구된다고 봅니다. 셋째로, 지역주민의 건강관리 자조능력 강화를 하나의 목표로 삼는다면 치료자에서 교육자로, 지도자에서 촉진자로, 제공자에서 지원자료의 역할의 변화 내지 다양화를 요구하게 될 것이므로 그에 대처할 수 있는 준비가 필요하다고 봅니다. 넷째로, 생각되어야 할 점은 지역중심건강관리사업을 지향하는 보건의료의 이념적 방향과 그에 상응하는 구체적 접근방법을 효율적으로 적용하기 위해서는 종횡으로 연결되는 의사소통체계의 정립과 민활한 정보교환이 이루어질 수 있어야 한다는 점에서 의사소통의 구심체로서 역할할 수 있는 역량을 함양해야 할 교육적 과제가 있다고 봅니다. 마지막으로 생각되어야 할 점은 지역중심으로 전개될 건강관리사업은 건강증진 및 질병예방적 측면과 질병진료 및 회복과 재활에 이르는 종합적이고 포괄적인 사업이어야 한다는 점에서 종래 공공 의료부문과 사설의료기관 사이에 나누어져 있던 예방의학과 치료의학의 통합 뿐 아니라 정부주축으로 이루어 지고 있는 지역사회개발사업 및 농촌지도사업과 종교 및 각종 민간인 집단이 벌이고있는 사업들과의 전체적인 통합적 접근이 이루어져야 한다고 생각하는 입장에서 종래 간호교육이 강조하지 않던 진료의 의무와 대외적 조직활동에 대한 보완적인 교육조치가 요구된다고 봅니다. 간호의 학문체계로서의 입장은 오랜 역사를 두고 논의의 대상이 되어왔으나 아직까지 뚜렷이 어떤 것이 간호 특유의 지식체계이며 건강문제에 관련하여 무엇이 간호특유의 결정영역이며 이 결정과 그 결과를 어떠한 방법으로 치료적 행위로 옮길 수 있는가에 대한 확실한 답을 얻지 못하고 있는 실정이라고 봅니다. 다만 근래에 제시된 여러 간호이론들 속에서 공통적으로 이야기되어지고 있는 개념들로선 우선 간호학문을 건강과 질병에 관련된 인간의 전인적이고 전체적인 상황을 다루는 학제적 과학으로서보는 입장이 있고 따라서 생물신체적인 면 외에 정신심리적, 사회경제적, 정치문화적 환경과의 상호작용 속에서 인간의 건강과 질병문제를 생각한다는 지향을 갖고 있다고 말할 수 있겠읍니다. 간호교육은 간호계 내적인 학문적, 이론적 체계화의 요구에 못지않게 대민봉사하는 전문직으로서의 사회적 책임을 감당해야하는 중요과제를 안고있어 변화하는 사회요구에 효과적으로 대처해 나가야 할 당면문제를 안고 있읍니다. 간효역할 확대, 보건진료원훈련 등 이러한 사회적 요구에 대응하려는 조치가 되겠읍니다. 이러한 시점에서 간호계가 분명히 짚고 넘어가야 할 사실은 이러한 움직임들이 종래의 의사들의 외업무공급을 연장 확대하는 입장에 서서 간호의 특수전문직 명목을 흐리게 할수있는 위험을 감수할 것인지 아니면 가능한 대체방안을 갖고 간호전문직의 독자적인 진로를 개척하면서 다각적인 도전을 받아들일 준비를 갖추든지 그 방향을 뚜렷이 해야할 일이라 생각합니다. 저로서는 이미 잘 훈련된 간호원들과 조산원들의 교육적, 경험적 배경을 기반으로 지역사회 최일선 건강관리요원으로 사회적 효능을 다 할수 있는 일차건강관리간호조직의 구현을 대체방안으로 제시하고 싶습니다. 간호원과 조산원들의 훈련된 역량과 건강관리체제의 구조적 변화를 효과적으로 조화시킨다면 대부분의 세계인구의 건강문제는 해결가능하다고 보는 입장입니다. 물론 정책과 의료와 행정적지원이 활성화되어지는 환경속에서만 그 기대하는 결과가 확대되리라는 점 부언하는 바입니다. 마지막으로 언급하고 싶은 점은 바로 오늘의 주제 ''교육의 동역자-선생과 학생''이라는 개념입니다. 특히 상회정의적 입장에서 보는 의료사업전개에 지역민 내지 의료소비자의 참여를 강조하는 현시점에 있어 교육자와 학생이 교육의 현장에서 서로 동역자로서 학습의 책임을 나누는 경험은 아주 시기적으로 적합하여 교육적으로 지대한 의미를 갖는 것이라고 생각합니다. 이에 수반되어져야 할 역할의 변화에 수용적인 자세를 갖고 적극 실제적용하려 노력하는 선생앞에서 자주적 결정을 행사해본 학생이야말로 건강관리대상자로 하여금 같은 결정권을 행사할수 있도록 촉구하여 주민의 자조적 역량을 기르고 의료사업의 민주화, 인간화를 이룩할 수 있는 길잡이가 될 수 있으리라 믿는 바입니다.

• Journal of Korean Philosophical Society
• /
• v.105
• /
• pp.49-74
• /
• 2008

Le but de notre recherche est $d^{\prime}{\acute{e}}clairer$ la nature du $d{\acute{e}}passement$ de soi aux actes humaines dnas le Thomisme. Dans le Thomisme la nature humaine qui a la raison et la $volont{\acute{e}}$ a une $intentionnalit{\acute{e}}$ ver la fin ultime. De sorte que les actes humaines qui $corr{\grave{e}}spondent$ cette nature humaine a un $caract{\grave{e}}re$ du $d{\acute{e}}passement$ de soi visant toujours plus que le $pr{\acute{e}}sent$. Le fondement de cet acte du $d{\acute{e}}passement$ de soi est $l^{\prime}{\hat{a}}me$ rationelle qui est la forme substantielle de l'homme et de soi subsistante. Chez st. Thomas ce $caract{\grave{e}}re$ du $d{\acute{e}}passement$ a trois ${\acute{e}}taps$ distinctes : (1)le $d{\acute{e}}passement$ dans l'ordre du $progr{\grave{e}}s$ naturel (2)le $d{\acute{e}}passement$ de soi dans l'ordre morale (3)le $d{\acute{e}}passement$ de soi dans l'ordre de la religion. Le $d{\acute{e}}passement$ dans l'ordre du $progr{\grave{e}}s$ naturel apparaît d'abord au $caract{\grave{e}}re$ de $l^{\prime}{\hat{a}}me$ rationelle. St. Thomas $d{\acute{e}}finit$ les vertus rationelles comme $^{\prime}pl{\acute{e}}nitude$ dans le $f{\acute{e}}blesse$, parce qu'il $consid{\grave{e}}re$ la vertu rationelle comme $finalit{\acute{e}}$ des $facult{\acute{e}}s$ du sens $ext{\acute{e}}rieur$. L'homme par le sens $ext{\acute{e}}rieur$ reçoit des $esp{\grave{e}}ces$ sensibles(especies sensibilis), et $poss{\grave{e}}de$ les images. Puis cette images sensible devenant la $r{\acute{e}}alit{\acute{e}}$ spirituelle sous forme du $m{\acute{e}}moire$ et du souvenir, devient aussi la partie de son existence. Donc chez st. Thomas la vertue rationnelle n'est pas simplement un $facult{\acute{e}}$ $sp{\acute{e}}culative$, mais elle est dans l'ordre du devenir et du $pl{\acute{e}}nitude$. A cette raison st. Thomas compare la raison(ratio) comme $g{\acute{e}}n{\acute{e}}ration$(generatio) et l'intelleigence(intellectus) comme ${\hat{e}}tre$(esse). C'est-${\grave{a}}$-dire la raison $d{\acute{e}}passe$ le sensible et l'intelligence $d{\acute{e}}passe$ la raison. Le $d{\acute{e}}passement$ de soi dans l'ordre morale $li{\acute{e}}$ au $progr{\grave{e}}s$ de la conscience. Chez st. Thomas la perception de l'objet $ext{\acute{e}}rieur$ ayant pour but d'avoir conscience de soi, se perfectionne ${\grave{a}}$ ceci. D'avoir conscience de soi signifie d'avoir $l^{\prime}identit{\acute{e}}$ de soi, et de-$l{\grave{a}}$ apparaît l'acte moral en tnat qu'acte $sp{\acute{e}}cifique$ humain. La raison pour laquelle la vie morale elle-$m{\hat{e}}me$ a un $caract{\grave{e}}$ du $d{\acute{e}}passement$, c'est que l'acte humaine qui corresfonde ${\grave{a}}$ $l^{\prime}identit{\acute{e}}$ du soi est une vie qui vise toujours plus que le $pr{\acute{e}}sent$ ou $l^{\prime}id{\acute{e}}al$. Quant au problem du $d{\acute{e}}passement$ dans l'ordre de la religion, chez st. Thomas en raison de $l^{\prime}affinit{\acute{e}}$ entre Dieu et l'homme, $o{\grave{u}}$ il y a des vertues infuses(virtutes infusas), il y a une sorte du $d{\acute{e}}passement$ religieux. Car ces vertues infuses signifie la communication entre Dieu(${\hat{E}}tre$ absolu) et l'homme(${\hat{e}}tre$ fine) et cela signifie le $d{\acute{e}}passement$ de l'humain vers le divin. Cette $id{\acute{e}}e$ thomiste permet de penser que $o{\grave{u}}$ il y a un $d{\acute{e}}passement$ de soi dans la vie religuse d'une personne, il y a une intervention $r{\acute{e}}elle$ de la providence divine. Cette $pens{\acute{e}}e$ thomiste sera alors un $caract{\grave{e}}$ $r{\acute{e}}aliste$ face ${\grave{a}}$ la $pens{\acute{e}}e$ $id{\acute{e}}aliste$ qui n'admette que le $d{\acute{e}}passement$ absolu comme $d{\acute{e}}passement$ religieux.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.25 no.1
• /
• pp.34-40
• /
• 2021

Purpose If a new test is introduced or reagents are changed in the laboratory of a medical institution, the characteristics of the test should be analyzed according to the procedure and the assessment of reagents should be made. However, several necessary conditions must be met to perform all required comparative evaluations, first enough samples should be prepared for each test, and secondly, various reagents applicable to the comparative evaluations must be supplied. Even if enough comparative evaluations have been done, there is a limit to the fact that the data variation for the new reagent represents the overall patient data variation, The fact puts a burden on the laboratory to the change the reagent. Due to these various difficulties, reagent changes in the laboratory are limited. In order to introduce a competitive bid, the institute conducted a full investigation of Radioimmunoassay(RIA) reagents for each test and established the range of reagents available in the laboratory through comparative evaluations. We wanted to share this process. Materials and Methods There are 20 items of tests conducted in our laboratory except for consignment tests. For each test, RIA reagents that can be used were fully investigated with the reference to external quality control report. and the manuals for each reagent were obtained. Each reagent was checked for the manual to check the test method, Incubation time, sample volume needed for the test. After that, the primary selection was made according to whether it was available in this laboratory. The primary selected reagents were supplied with 2kits based on 100tests, and the data correlation test, sensitivity measurement, recovery rate measurement, and dilution test were conducted. The secondary selection was performed according to the results of the comparative evaluation. The reagents that passed the primary and secondary selections were submitted to the competitive bidding list. In the case of reagent is designated as a singular, we submitted a explanatory statement with the data obtained during the primary and secondary selection processes. Results Excluded from the primary selection was the case where TAT was expected to be delayed at the moment, and it was impossible to apply to our equipment due to the large volume of reagents used during the test. In the primary selection, there were five items which only one reagent was available.(squamous cell carcinoma Ag(SCC Ag), β-human chorionic gonadotropin(β-HCG), vitamin B12, folate, free testosterone), two reagents were available(CA19-9, CA125, CA72-4, ferritin, thyroglobulin antibody(TG Ab), microsomal antibody(Mic Ab), thyroid stimulating hormone-receptor-antibody(TSH-R-Ab), calcitonin), three reagents were available (triiodothyronine(T3), Tree T3, Free T4, TSH, intact parathyroid hormone(intact PTH)) and four reagents were available are carcinoembryonic antigen(CEA), TG. In the secondary selection, there were eight items which only one reagent was available.(ferritin, TG, CA19-9, SCC, β-HCG, vitaminB12, folate, free testosterone), two reagents were available(TG Ab, Mic Ab, TSH-R-Ab, CA125, CA72-4, intact PTH, calcitonin), three reagents were available(T3, Tree T3, Free T4, TSH, CEA). Reasons excluded from the secondary selection were the lack of reagent supply for comparative evaluations, the problems with data reproducibility, and the inability to accept data variations. The most problematic part of comparative evaluations was sample collection. It didn't matter if the number of samples requested was large and the capacity needed for the test was small. It was difficult to collect various concentration samples in the case of a small number of tests(100 cases per month or less), and it was difficult to conduct a recovery rate test in the case of a relatively large volume of samples required for a single test(more than 100 uL). In addition, the lack of dilution solution or standard zero material for sensitivity measurement or dilution tests was one of the problems. Conclusion Comparative evaluation for changing test reagents require appropriate preparation time to collect diverse and sufficient samples. In addition, setting the total sample volume and reagent volume range required for comparative evaluations, depending on the sample volume and reagent volume required for one test, will reduce the burden of sample collection and planning for each comparative evaluation.