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The Study on the Relationship Between the Duration of Chest Vibration prior to Endotracheal Suctioning and the Changes in Oxygen Saturation in Low-Birth-Weight Infants (저체중아에 있어 기관내 흡인전 흉부진동법의 기관과 산소포화 변화간의 관계 연구)

  • Ahn, Young-Mee
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.597-607
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    • 1995
  • 1960년대 이후 인공호흡기(mechanical ventilator)의 보급과 최근 의료과학의 발달, 간호의 질적 향상의 결과로 저체중출생아를 포함한 고위험 신생아의 생존율이 높아져왔다. 호흡장애증후군(RDS)은 일차적으로 폐포의 완전한 확장을 위해 필요한 계면활성물질(surfactant)의 부족, 미발달된 심폐기능에 의한 병리적 현상으로 저체중아의 가장 큰 원인이 되어왔다. RDS로 인해 인공호흡기에 의존해 있는 저체중아의 경우 적절한 산소공급과 이를 위한 호흡의 유지는 치료의 가장 큰 핵심이 되며, 이를 위한 기관내 흑은 비인두 흡인 (nasopharyngeal suction)은 신생아 중환자실(NICU)의 가장 중요한 간호행위가 되어왔다. 인공호흡기를 위한 기관삽관은 그 자체가 기도의 성모운동을 방해하고 기침반사를 억제시켜 폐 분비물의 효과적 배출을 억제하며, 특히 저체중아의 경우 조산과 관련하여 미발달된 흥곽운등과 심폐기능은 폐분비물의 이동을 저해하는 요소이다. 따라서 기도내의 분비물의 이동을 효과적으로 하여 흡인 시에 최대한의 효과를 돕기 위해 흥곽 물리요법(chest physiotheraphy : CPT)의 한 형태인 흉곽진동법 (Chest Vibration : CV)가 행해져 왔다. 그러나 저체중아를 위한CV의 임상적 적용은 그 대상의 생리적 특성, CV의 적용부위(site)와 기간(duration)에 대한 과학적 근거 없이 만성감염이나 폐질환을 가진 성인이나 cystic fibrosis환자를 위한 CV protocol을 무분별하게 채택하여 저체중아에게 행하여져 왔다 이에 본 연구자는 저체중아에 대한 CV의 안전성을 평가하고, 이에 기초하여 저체중아에게 바람직한CV의 형태를 알아보고자 본 연구를 시작하였다. 연구설계는 CV의 안전성을 평가하기 위한 실험연구이다. CV의 안전성은 RDS치료의 가장 일차적 목표인 oxygenation변화에 의해 평가될 수 있으므로, 본 실험 연구에서는 Pulse oximeter에 의해 계속적으로 측정된 산소포화 변화(oxygen saturation change)를 측정하였다. 실험대상은 미국동부에 위치한 대학병원의 NICU에 입원하여 RDS와 관련된 호흡장애로 인공호흡기에 의존해 있는 10명의 저체중아였다. 인공호흡기에 의존된 모든 저체중아는 Pulse oximeter와 심폐기능 측정기(cardiopulmonary monitor)에 의해 산소공급과 호흡상태가 계속 측정되고 있었다. 실험대상의 평균 출생시 몸무게는 평균 1,3050gm(SD=580.6)이었고, 임신월령 은 평균 28.6주(SD=3.1)였다. RDS가 그들의 일차적 진단명이었고, 그중 4명은 pneumonia, atelectasis의 합병증을 가지고 있었다. 10명중 6명은 intermittent mandatory ventilation(IMV)의 형태로, 4명은 continuous positive airway pressure(CPAP)의 형태로 인공호흡기에 의존되어 있었고 CV시의 FiO2는 평균 42.3(SD=21.2)였다. CV는 중환아용 소형진동기 (minivibrator)를 이용해 가각 10명 의 간호사에 의해 행하여 졌고, 최소 22초에서 최대 100초 동안 실시되었다. 50%의 간호사는 30초에서 40초간 CV를 실시하였으며, CV의 적용부위도, 전후 흉곽부위, 혹은 병변이 있는 좌 우측, 흑은 양쪽 흉벽 등으로 다양했고, 적용방법도 원형으로 돌려가며(circular motion), 혹은 아래에서 위로, 혹은 아무런 기준없이 간호사의 기호에 따라 다양하게 적용되었다. 산소포화의 변화는 CV가 행해지기 전.후로 5초동안 관찰되었다. 연구의 결과, 산소포화 변화는 비 모수통계(non parametric statistics)의 일종인 Matched Paired Wilcoxon test로 분석 한 결과 CV후에 3%의 감소를 보였다(P<.05). 저체중아에 있어 산소포화의 3%감소는 임상적으로 중요한 의미가 없다고 사료되어지며, 실제 흡인전의 과도호흡에 의해 CV를 행하기 이전의 산소공급수준으로 돌아 왔다. CV실시 기간과 산소포화와의 상관관계는 비 모수통계인 Spearman rho correlation coefficient를 이용하여 분석하였는데, 이 두 변수는 서로 관계가 없는 것으로 나타났다(P>.05) 또한 CV와 흡인 후에 각각의 간호사들에게 CV를 필요로 한 저체중아의 기준, 적용부위, 기간, 방법등에 대한 기준을 물었으나 대상의 특성에 따른 간호사정에 의존하기보다는 간호사 각자의 선호하는 방법이나 습관에 라 행하는 것으로 나타났다. 결론적으로 CV와 산소포화 변화와의 관계, NICU에서 관찰된 CV의 임상적 적용을 기초로 저체중아에게 안전한 CV protocol은 신생아용 소형 진동기를 이용하여, 양쪽 흉곽의 늑골하측 변연 부위(low lateral costal margin)에서 시작하여 흉골 중앙부위 방향으로 30초 동안 진동기를 적용하는 것이 좋은 것으로 나타났다. 이에 CV의 효과를 평가하기 위한 보다 과학적인 접근방법으로, CV와 흡인의 결과인 가래(sputum)에 대한 연구를 제언하는 바이다.

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Ground Security Activities for Prevention of Aviation Terrorism -Centered on San Francisco International Airport of the U.S.A.- (항공테러방지를 위한 지상 보안활동 -미국 샌프란시스코국제공항을 중심으로-)

  • Kang, Maeng-Jin;Kang, Jae-Won
    • The Journal of the Korea Contents Association
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    • v.8 no.2
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    • pp.195-204
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    • 2008
  • With the growth of airline management, as well as computer and IT security, the international trade in this modern society has been rapidly increasing, Along with the advancing, airplanes have become a universal means of communication. However, the complications associated with airplane safety have also been brought up as a result, the most concerning of which is terrorism. One of the main counterplans for preventing terrorism is Ground security activities the core of Ground security activities is absolute safety for passengers in both passenger terminal and freight terminal. Subastral security refers to physical protection, proximity control and 100% security search and freight guarding of the passengers' possessions, and the personnel's duties to perform such jobs are be! coming more crucial. On the other hand, Airport security check has bee n gradually developing since the 1960's, when hijacking began to take place. Although the airports have been providing more safe and comfortable services to their customers, terrorism is still happening today. When Ground security activities is minute, the users feel displeasure and discomfort, yet considering solely their convenience can brings problems in achieving safety. Since the 9.11 terror in 2001, the idea of improving and strengthening airport security was reinforced and a considerable amount of estate is being spent today for invention and application of new technology. Various nations, including the United States, have been improving their systems of security through public services; public police department is actively carrying out their duties in airports as well. In San Francisco International Airport, private police department is in charge of collection of data, national events, VIP protection, law enforcement, cooperation within facilities, daily-based patrol and traffic control. Under guidance and supervision of national organizations, such as TSA, general police department interprets X-Rays, operates metal detectors, checks passports or IDs and observes reactions to explosives. Under these circumstances, studies about advancement of cooperation and duties of general police department and private police department necessitated: especially about private police department and their training for searching equipments, decrease in number of turn over rate, invention of technology and prior settlement in estate for security. The privacy of the public, who make up the major population of airport passengers, must also be minimized. In the following research, the activities of police departments in San Francisco International Airport will be analyzed in order to understand recent actions of the United States on airport security.

Diagnosis and Improvements Plan Study of CIPP Model-based Vocational Competency Development Training Teacher Qualification Training (Training Course) (CIPP 모형 기반 직업능력개발훈련교사 자격연수(양성과정) 진단 및 개선 방안 연구)

  • Bae, Gwang-Min;Woo, Hye-Jung;Choi, Myung-Ran;Yoon, Gwan-Sik
    • Journal of vocational education research
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    • v.36 no.2
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    • pp.95-121
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    • 2017
  • The vocational competency development training teacher must complete the training course for the training of vocational competency development training instructor and get the qualification of the vocational competency development training teacher from the Ministry of Employment & Labor with the criteria set by the Presidential Decree. Therefore, it can be said that H_university 's educational performance, which is the only vocational competency development training teacher in Korea and that plays a role of mass production in the labor market, has a great influence on vocational competency development training. The purpose of this study is to identify the problems through the analysis of actual condition of vocational competency development training education based on CIPP model, Furthermore, it was aimed to suggest improvement plan of qualification training education. In order to accomplish the purpose of the research, the present situation of the training course for the vocational competency development training teacher training students was grasped. And We conducted a survey to draw out the improvement plan and utilized the results of 173 copies. We conducted interviews by selecting eight subjects for in-depth analysis and Understand the details of the results of the surveys conducted. As a result of the study, positive responses were obtained from the educational objectives and educational resources in the context factors. On the other hand, there were negative opinions about the curriculum reflecting the learner and social needs. In the input factors, positive opinions were derived from the educational objectives and training requirements. However, there were many negative opinions about the achievement of the learner's educational goals. In addition, there were many negative opinions of online contents education. In the process factors, positive evaluation was high in class related part, learner attendance management, and institutional support. However, negative opinions were drawn on the comprehensive evaluation of qualification training period, and the learner's burden due to lack of learning period appeared to be the main reason. In the factor of calculation, Positive opinions were derived from the applicability of the business curriculum for training courses for training teachers who are in charge of education and training in industry occupations. However, there were negative opinions such as learning time, concentration of learning, and communication of instructors. Based on the results of the study, suggestions for improving the operation of vocational competency training teacher qualification training are as follows. First, it is necessary to flexibly manage the training schedule for the weekly training course for vocational competency development training teachers. Second, it is necessary to seek to improve the online education curriculum centered on consumers. Third, it is necessary to seek access to qualification training for local residents. Fourth, pre - education support for qualified applicants is required. Finally, follow-up care of qualified trainees is necessary.

How to Implement Quality Pediatric Palliative Care Services in South Korea: Lessons from Other Countries (한국 소아청소년 완화의료의 발전 방안 제언: 국외 제공체계의 시사점을 중심으로)

  • Kim, Cho Hee;Kim, Min Sun;Shin, Hee Young;Song, In Gyu;Moon, Yi Ji
    • Journal of Hospice and Palliative Care
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    • v.22 no.3
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    • pp.105-116
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    • 2019
  • Purpose: Pediatric palliative care (PPC) is emphasized as standard care for children with life-limiting conditions to improve the quality of life. In Korea, a government-funded pilot program was launched only in July 2018. Given that, this study examined various PPC delivery models in other countries to refine the PPC model in Korea. Methods: Target countries were selected based on the level of PPC provided there: the United Kingdom, the United States, Japan, and Singapore. Relevant literature, websites, and consultations from specialists were analyzed by the integrative review method. Literature search was conducted in PubMed, Google, and Google Scholar, focusing publications since 1990, and on-site visits were conducted to ensure reliability. Analysis was performed on each country's process to develop its PPC scheme, policy, funding model, target population, delivery system, and quality assurance. Results: In the United Kingdom, community-based free-standing facilities work closely with primary care and exchange advice and referrals with specialized PPC consult teams of children's hospitals. In the United States, hospital-based specialized PPC consult teams set up networks with hospice agencies and home healthcare agencies and provide PPC by designating care coordinators. In Japan, palliative care is provided through several services such as palliative care for cancer patients, home care for technology-dependent patients, other support services for children with disabilities and/or chronic conditions. In Singapore, a home-based PPC association plays a pivotal role in providing PPC by taking advantage of geographic accessibility and cooperating with tertiary hospitals. Conclusion: It is warranted to identify unmet needs and establish an appropriate PPD model to provide need-based individualized care and optimize PPC in South Korea.

A reflection on the education of Confucian classics (유교경전교육(儒敎經典敎育)을 위한 반성적(反省的) 고찰(考察))

  • Chin, Sung-Su
    • The Journal of Korean Philosophical History
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    • no.25
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    • pp.223-249
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    • 2009
  • This papers focuses on the Confucian classics for the correct orientation of education as a basic task of the Confucian classics will as a necessary whether the need for education, to identify the natural history study will attempt to have. In East Asia means that classics, the classicalization process of looking at Chinese culture, classicalization of review of the cultural meaning. And this papers focuses on the historical evolution of education, and education in China and Korea in the modern world the meaning of the Confucian classics education about and looked at two dilemmas. And outside the scope of Confucian five ethical thoughts as main moral to find new values and new interpretations about the legitimacy and philosophical thinking of the meaning of the Confucian classics Education. In addition, the development of educational content to the new Confucian classics on the subject of three applies to the existing approach and to propose a new type of comparison?Review. As primitive Confucian classics is not determined by a priori, the modern understanding of the Confucian classics also thorough review process of reflection and understanding the new system will have to be reconfigured. Furthermore, in the richness of modern society as the training methods as well as the development of relevant content for the modern society that values education's development is a very important issue. In this respect, should not be overlooked here is not about education, the effect of Confucian classics is concerned about the review. To this, first of all the Confucian classics need education about the content and strict screening operation. In addition, the ability to function in modern society, modern reinterpreted and the need to find a new educational element is. Because we did not give a realistic benefits and future view and any history or civilization, is always disappear in history. This series of problems will be a reason of require that philosophical thinking of Confucian classics education.

Implications for the Direction of Christian Education in the Age of Artificial Intelligence (인공지능 시대의 기독교교육 방향성에 대한 고찰)

  • Sunwoo Nam
    • Journal of Christian Education in Korea
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    • v.74
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    • pp.107-134
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    • 2023
  • The purpose of this study is to provide a foundation for establishing the correct direction of education that utilizes artificial intelligence, a key technology of the Fourth Industrial Revolution, in the context of Christian education. To achieve this, theoretical and literature research was conducted. First, the research analyzed the historical development of artificial intelligence to understand its characteristics. Second, the research analyzed the use of artificial intelligence in convergence education from an educational perspective and examined the current policy direction in South Korea. Through this analysis, the research examined the direction of Christian education in the era of artificial intelligence. In particular, the research critically examined the perspectives of continuity and change in the context of Christian education in the era of artificial intelligence. The research reflected upon the fundamental educational purposes of Christian education that should remain unchanged despite the changing times. Furthermore, the research deliberated on the educational curriculum and teaching methods that should adapt to the changing dynamics of the era. In conclusion, this research emphasizes that even in the era of artificial intelligence, the fundamental objectives of Christian education should not be compromised. The utilization of artificial intelligence in education should serve as a tool that fulfills the mission permitted by God. Therefore, Christian education should remain centered around God, rooted in the principles of the Bible. Moreover, Christian education should aim to foster creative and convergent Christian nurturing. To achieve this, it is crucial to provide learners with an educational environment that actively utilizes AI-based hybrid learning environments and metaverse educational platforms, combining online and offline learning spaces. Moreover, to enhance learners' engagement and effectiveness in education, it is essential to actively utilize AI-based edutech that reflects the aforementioned educational environments. Lastly, in order to cultivate Christian learners with dynamic knowledge, it is crucial to employ a variety of teaching and learning methods grounded in constructivist theories, which emphasize active learner participation, collaboration, inquiry, and reflection. These approaches seek to align knowledge with life experiences, promoting a holistic convergence of faith and learning.

Comparative Analysis of Price Sensitivity for Using Environmental-Friendly Agricultural Products in University Foodservices Between Jeonnam and Gyeongnam Areas in Korea (대학급식의 친환경 농산물 이용에 대한 전남.경남지역 대학생의 가격민감성 비교)

  • Lee, So-Jung;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.8
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    • pp.1220-1230
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    • 2010
  • The purposes of this study were to compare price sensitivity analysis for using environmental-friendly agricultural products in university foodservice between Jeonnam and Gyeongnam areas in Korea and to suggest the optimum guideline for price increase. The questionnaires were distributed to 600 university students respectively in Jeonnam and Gyeongnam area from July 15 to July 25, 2008; among them, 570 students from Jeonnam area and 490 students from Gyeongnam area responded. The results of this study were as follows. First, Indifference price (IDP) were 890 won (Jeonnam area) and 1,050 won (Gyeongnam area); Optimum price point (OPP) were 1,030 won (Jeonnam area) and 1450 won (Gyeongnam area). Price stress range were 140 won (890~1030 won) in Jeonnam area and 400 won (1050~1450 won) in Gyeongnam area. Second, point of marginal cheapness (PMC) were 500 won (Jeonnam area) and 790 won (Gyeongnam area) whereas point of marginal expensiveness (PME) were 1,170 won (Jeonnam area) and 1820 won (Gyeongnam area). Range of acceptable price (RAP) were 670 won (500~1170 won) in Jeonnam area and 1030 won (790~1820 won) in Gyeongnam area. Third, on the basis of IDP percentage and RAP, students in Jeonnam area were more sensitive to meal price increase than students in Gyeongnam area. In contrast, on the basis of Price Stress, students in Gyeongnam area were more sensitive to meal price increase than students in Jeonnam area. Hence, when using environmental-friendly agricultural products in university foodservice, in Jeonnam area, meal price increase should be recommended to be in RAP (500~1170 won), and in Gyeongnam area, meal price increase should be recommended to be in RAP (790~1820 won).