• Journal of Hospice and Palliative Care
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• v.14 no.2
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• pp.91-100
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• 2011

Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.

• Hwankyungkyoyuk
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• v.6 no.1
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• pp.63-99
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• 1994

The international environmental activities and environmental education began in 1970's. Environmental education in Korea was emphasized since the Forth National Curriculum. 'The Environmental Education Curriculum' will be separated as one of the most important parts in the Sixth National Education Curriculum in Korea. The purpose of this study was development. of 'Environmental Science' of high school appropriate to Sixth National Education Curriculum. First step was to state goals of environmental education in detail based on analysis of goals about environmental education in our country and other countries. Second was to analyse seven environments-related texts of Korea, America and England. Third, to measure how much environmental education has achieved in Fifth National Curriculum of Korea. Fourth, to develop a new environmental text of high school level. Fifth, to verify the effect of developed environmental text. The environmental part of 'Science I'(unit V. Life and Environments) and high school environments-related reference text(Survival and Environments) in Korea, American knowledges. American 'Environments' was stressed in many skills but they didn't include various teaching strategies. On the other hand, American 'Science-Technology-Society(S-T-S)' and British 'Science and Technology in Society(SATIS)' were stressed in knowledges and skills, and they included many teaching strategies and student actions. American 'S-T-S' was the only one stressed in values and attitudes. And all seven texts were not interested in behaviors and participations. To measure the achievement of environmental education by questionnaire, 497 high school students in total were selected from five different schools. Actually, most students had a positive thinkings and attitudes in their hearts about environmental problems, about environmental problems, but many of them did not take actions to solve environmental problems and to protect environments. The higher the score students got in 'knowledges and informations', the higher the score in 'skill'. It implies that learning of skills is based on learning of knowledges and informations about environments. On the other hand, much knowledges and information about environments has not always ensured positive thinkings and attitudes or active behaviors and participations to solve environmental problem. In view that ultimate aim of environmental education is forming responsible environmental behaviors and the goals of values and behaviors are as important as knowledges and skills. A new environmental text of high school level was developed and it was based on analysis of seven texts and environmental education in Fifth Korean Curriculum. This text have seven units, 1. Habitates : What're the meanings?, 2. Nuclear Energy : Can't be Avoid?, 3. Acid Rain : What're the Messages?, 4. Ethanol : Is this Future Fuel?, 5. Wastes : A New War!, 6. What're the National and Gloval Environmental education and avoided from the array of knowledges. Therefore included various teaching strategies and independent actions of students. 'Open-ended value learning' and 'free behavior learning' in text were special learning parts for aquisition of values and formation of behaviors. To verify the effects. of new developed environmental text, the direct learning was carried out by 286 students in total. Post test scores of experimental groups per each units were significantly higher than those of control groups from five different schools were as follows. For validity of selecting contents for units, 74% of respondent replied positively. For classification and presentation of four goal-groups, 90% replied positively in validity and 82%, in utility. For validity of various teaching strategies, 88% and for the degree of including student-centered independent actions, 86% replied positively, For importances and expected effects of 'open=ended value learning' and 'free behavior learning', showed positive responses respectively, 88%, 92% Therefore this text is effective to achieve four goals of environmental education equally.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.323-328
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• 2010

Purpose : To verify the effect of hyperglycemia on mortality rates in critically ill children and to identify the blood glucose level that influences prognosis. Methods : From July 2006 to June 2008, a total of 206 patients who were admitted to the pediatric intensive care unit (PICU) at Asan Medical Center and who survived for more than 7 days were retrospectively reviewed. We analyzed the maximum glucose value within 7 days in PICU, PRISM-III score and SOFA score within 24 hours, and mortality. We did not perform an adjustment analysis of drugs affecting glucose level. Results : The maximum glucose level within 7 days in PICU was higher in the nonsurvival group than in the survival group. Using 4 cutoff values (125, 150, 175, and 200 mg/dL), the mortality of patients with hyperglycemia was found to be 13.0 %, 14.4%, 19.8%, and 21.1%, respectively, and the cutoff values of 175 and 200 mg/dL revealed significant differences in mortalities between the hyperglycemic and normoglycemic groups. The PRISM-III score was not significantly different between the hyperglycemic and normoglycemic groups under a glucose cutoff value of 175 mg/dL, but the SOFA score was higher in the hyperglycemic group. Under a glucose cutoff value of 200 mg/dL, the PRISM-III score was higher in the hyperglycemic group, and the SOFA score did not differ between the 2 groups. Conclusion : Hyperglycemia with a maximal glucose value ${\geq}175\;mg/dL$ during the first 7 days after PICU admission was associated with increased mortality in critically ill children.

• Journal of the Korean association of regional geographers
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• v.7 no.1
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• pp.83-95
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• 2001

The purpose of this study is to examine that we can estimate land use by land values in 5 great cities. For this purpose, I calculated the percentage that each lot value makes up of the highest land values in the city as a indicator. I think this rate is very useful in the comparative study about many cities. At first, I set up four hypotheses based on my preceding studies. Hypothesis 1, the range of CBD can be estimated as having about 10% of the peak land values. Hypothesis 2, when the peak rate of concentric circle of land values seperated from CBD circle is about 30% of the peak land values, that is sub-CBD. Hypothesis 3, generally, a lot of having about 5% of the peak land values represents residential land commercial land use. Hypothesis 4, a lot of having about 3% of the peak land values represents only residential land use. The data on land values in five great cities were got from public notification on land values(1999) of the Ministry of Construction & Transportation. I selected highest lot values from many standard lot value in each Tong(the minimum administrative unit) in each cities. And I drew land values isopleth. Through that isopleth, I identified CBD cmd sub-CBD. Through the book of public notification on land values, I identified what land use are lots of having over 10%, about 5%, below 3% of the peak land values. As a result, we identified land use can be estimated by the percentage that each lot value makes up of the highest land values in the city. The bigger urban size becomes and the more stable land use becomes, the higher fitness of hypotheses becomes. The lowest degree of fitness about 4 hypotheses among 5 great cities showed in Inchon. Because Inchon lies adjacent to the greatest Seoul. The percentage that showed the lowest degree of fitness is 5% of the highest land values. The land use on lots of having about 5% of the peak land values is different from each other according to regional character in city.

• Journal of the Korean association of regional geographers
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• v.4 no.1
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• pp.99-120
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• 1998

The purpose of this study is to clarify the industrialization process, and locational factors and linkages of manufacturing in Jangyu-Myun, a suburb of Metropolitan Pusan, toward which heavy decentralization of manufacturing from Pusan has been done. Hard data and soft data were used as the basic data. Hard data used for this study were both the statistical data which consists of the number of establishments and employee classified by product type, firm size, organizational type and unit area(dong) which were listed in statistics yearbooks, and the list of the owner's names, addresses, employee number, products and headquarters of firms which were listed in firm directories. Soft data were the results of the interviews with the 53 owners of firms surveyed among the firms selected by Proportional Stratified Sampling Method. The major findings were as follows: (1) Manufacturing location in Jangyu-Myun was regularized in 1980's in which decentralization of manufacturing was activiated. Though the industrialization of study area resulted from the birth, relocation and establishment of branches of the firms originated from the other regions, the relocation of small outer-oriented firms from the central city was the most important factor among them. (2) The main locational factors which induced the decentralizing manufacturing from the central city into Jangyu-Myun are closely related to land, transportation, personal factor, raw material suppliers and market. (3) The differences of important locational factors by the size and organizational type of firms are relevant to the characteristics of manufacturing location. (4) The changes of linkages attendant upon locational changes of firms were not so great and were localized in labor supply and marketing. (5) The strength of linkages is strong in the procurement of materials, in the subcontraction and in the marketing, but not in the ordering. (6) The main factors influencing on the formation of linkages are different by the types of linkages: monopolistic and oligopolistic supply are important in procurement linkages; characteristics of products and production capacity in the subcontraction and ordering; characteristics of products and the subsequent difficulties, in the marketing. (7) With the exception of procurement linkages, the strength of linkages with the outside of the study area are stronger than the linkages with the inside. The strength of linkages with the outside has distance-decay-function and strong linkages with the central city. (8) These spatial characteristics of linkages are different by products type, firm size and organizational type of firms: the spatial ranges of linkages are wider in the multi-location firms than in the single-location firms; the larger the firm size, the wider the spatial range of linkages: there is no consistent trend by products type. In conclusion, some facts described above were proved to be consistent with the results of proceeding studies in the other areas: influence of central city manufacturing relocation on industrialization in the suburb: different decentralization by products type, firm size and organizational types of firms: different locational factors by products type, firm size and organizational types of firms; linkage changes attendant upon locational changes of firms; spatial differences of linkages by products type, firm size and organizational type of firms. Some other factors were proved to be partly consistent: locational factors and spatial characteristics of linkages. Accordingly I think that the results of previous studies on the other areas can be applicable to the explanation of the location and linkage of manufacturing in Jangyu-Myun. For the better explanation on the characteristics of manufacturing decentralization from the central city, more empirical case studies on the location and linkage of manufacturing in the suburb areas are necessary.

• Journal of Korean Academy of Nursing
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• v.11 no.2
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• pp.5-8
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• 1981

This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.861-870
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• 1997

Background : Though acute respiratory distress(ARDS) often occurs in the early stage of severe acute pancreatitis and significantly contributed to the mortality of the condition, the characteristics of the group who develops ARDS in the patients with acute pancreatitis have not been fully found. The objective of this investigation was to identify predictable factors which distinguish a group who would develop ARDS in the patients with acute pancreatitis. Method : A retrospective analysis of 94 cases in 86 patients who were admitted the Medical Intensive Care Unit with acute pancreatitis was done. ARDS were developed in 13 cases among them (13.8%). The possible clinical factors related to the development were analyzed using univariate analysis and $x^2$-test. Results : The risk of ARDS development was increased in the patients with abonormal findings of chest X-ray at admission compared to the patients with normal chest X-ray (p<0.05). The risk was also increased according to the sevecrity index score in abdominal computed tomography at the time of admission (p<0.05). The higher APACHE III score of the first day of admission, the more risk increment of ARDS development was observed (p<0.01). Patients with more than one points of Murray's lung injury score showed higher risk of ARDS compared to the patients with 0 points of that. The patients with sepsis and the patients with more than three organ dysfunction at admission had 3.5 times and 23.3 times higher risk of the development of ARDS compared to the patients without sepsis and without organ failure in each (p<0.05, p<0.01). Conclusion : The risk of ARDS development would be higher in the acute pancreatitis patients with abnormal chest X-ray, higher CT severity index, higher APACHE III or Murray's lung injury score, accompanying sepsis, and more than three organ failure at admission.

• Journal of Korean Home Economics Education Association
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• v.26 no.1
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• pp.119-134
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• 2014

This research looks at the effects of portfolio-based lessons to help female middle school students understand and develop their self identity, and to examine the influence of various factors within the school and home environment. The participants were 256 female middle school students in Gangneung-si, Gangwon-do and the analysis was done using the SPSS/WIN 12.0 program. The 6 portfolio-based teaching lessons were made with the aim of developing each subordinate scope in every module for development of self-receptiveness, uniqueness, closeness, tendency of planning the future, and independence. Results of the pre and post-test revealed that scores of self-receptiveness and uniqueness increased. Content analysis revealed that the students pursued their talents and interests through the portfolio activities, and made specific plans for their future careers. In sum, the results demonstrate that the students became specifically and systematically concerned about their future career. The results of hierarchical regression showed that self-receptiveness developed when their parents' attitudes were not rejecting and their peer relationships were positive. Uniqueness was shown to develop as the fostering attitudes of parents were receptive. Closeness developed as fostering attitudes of parents were receptive and as their relationships with peers were positive. The students' tendency to plan the future developed as fostering attitudes of parents were receptive and as their relationships with teachers were good, and independence was shown to develop as the fostering attitudes of parents were not rejecting. Results of a two-year follow-up study appeared that self-receptiveness scores decreased as time passed, so students had highest scores in their first year and lowest scores in their third year. Scores of uniqueness, tendency of planning the future, and identity increased in the students' second year and then remained steadily afterward.

• Journal of Hospice and Palliative Care
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• v.12 no.1
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• pp.20-26
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• 2009

Purpose: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. Methods: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. Results: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. Conclusion: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.

• Journal of the Korean Geographical Society
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• v.40 no.2 s.107
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• pp.221-241
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• 2005

Land Use and Land Cover Changes (LUCC) occur over a wide range of space and time scales, and involve complex natural, socio-economic, and institutional processes. Therefore, modelling and predicting LUCC demands an understanding of how various measured properties behave when considered at different scales. Understanding spatial and temporal variability of driving forces and constraints on LUCC is central to understanding the scaling issues. This paper aims to 1) assess the heterogeneity of land cover change processes over the landscape in northern Ghana, where intensification of agricultural activities has been the dominant land cover change process during the past 15 years, 2) characterise dominant land cover change mechanisms for various spatial scales, and 3) identify the optimal spatial scale for LUCC modelling in a savanna landscape. A multivariate statistical method was first applied to identify land cover change intensity (LCCI), using four time-sequenced NDVI images derived from LANDSAT scenes. Three proxy land use change predictors: distance from roads, distance from surface water bodies, and a terrain characterisation index, were regressed against the LCCI using a multi-scale hierarchical adaptive model to identify scale dependency and spatial heterogeneity of LUCC processes. High spatial associations between the LCCI and land use change predictors were mostly limited to moving windows smaller than 10$\times$10km. With increasing window size, LUCC processes within the window tend to be too diverse to establish clear trends, because changes in one part of the window are compensated elsewhere. This results in a reduced correlation between LCCI and land use change predictors at a coarser spatial extent. The spatial coverage of 5-l0km is incidentally equivalent to a village or community area in the study region. In order to reduce spatial variability of land use change processes for regional or national level LUCC modelling, we suggest that the village level is the optimal spatial investigation unit in this savanna landscape.