• 제목/요약/키워드: 7-year

검색결과 10,527건 처리시간 0.037초

장마 시작일 예측 모델 (A Prediction Model for Forecast of the Onset Date of Changmas)

  • 이현영;이승호
    • 대한지리학회지
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    • 제28권2호
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    • pp.112-122
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    • 1993
  • 장마는 일반적으로 6월 21-26일에 시작되는데 1961년부터 1990년까지의 일강수자료와 동부아시아의 일기도를 분석하여 장마와 늦장마 시작일의 분포를 보면 El Ni${\~{n}}$o해에는 늦어지고 La Nina현상이 나타나는 해에는 일찍 시작되는 경향이 있어서, 장마 및 늦장마 시작일과 태평양의 해수면은 도(SST) 및 북반구 500mb 고도값과의 관계를 분석하여 장마와 늦장마의 시작시기를 예측할 수 있는 모델을 구축하고자 하였다. 장마 시작일은 중태평양의 5월 평균 SST, 북부 허스슨만의 3월 평균 500mb 고도값과 유의한 상관관계를 보인다. 8월 18일경에 중서부 지방에서부터 시작되는 늦장마의 시작일은 호주 서안에 면한 인도양의 5월 평균 SST, 그리고 적도 남부 중태평양의 5월 평균 SST, 시베리아 북서부의 7월 평균 500MB 고도값과 유의한 상관관계를 나타내므로 polynomial regression을 사용하여 장마와 늦장마 시작일의 최적 예측모델을 구축하였다. 이 모델은 장마 시작일의 경우 비교적 정확하게 예측 할 수 있으나 (residual=${\pm}$5.0) 늦장마의 경우에는 평균오차가 3.3일이고 최대오차가 10일에 달하므로 보다 정확한 예측모델을 구축하기 위한 지속적인 연구가 필요하다.

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지역사회간호학 관련 논문 연구동향 분석 -학회지 발표 논문을 중심으로- (A Trend of Research in Community Health Nursing)

  • 이인숙;김윤아;최경원;진영란
    • 지역사회간호학회지
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    • 제12권1호
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    • pp.288-298
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    • 2001
  • This article makes an attempt to evaluate the extent of developing community health nursing knowledge and to suggest the direction of developing a body of knowledge henceforth through the results of analysis for contents and outcomes of all literatures. which have been published in the Journal related to community health nursing. Refer to the following for the result of this article. 1. The total number of literatures analyzed amounted to 100 pieces in Journal of community health nursing society. 78 in Journal of industrial nursing society, 134 in Journal of school health society. 40 in Journal of home care nursing society. 2. Journal of community health nursing society Health needs and educational-behavioral diagnoses, which are more concrete nursing assessments and diagnoses. formed the main current(54%) of articles published in Journal of community health nursing society since 1992. There was a quantitative growth as well as a qualitative advance. Through a classification by the type of a body of knowledge. It was found that the knowledge providing nursing practice with bases, commanded an overwhelming majority(71.8%). Also, Researches on systemic supports for nursing practice are showing a tendency to increase. 3. Journal of industrial nursing society 52.6% of research papers presented in Journal of industrial nursing society dealt with health problem of workers. assessment of risk factors, diagnosis of health behaviors. Because of the beginning of an industrial nursing, the domain of nursing management to establish the role and task, work condition, training. documentary system made up 23 percent of research, subjects. A knowledge providing nursing practice with bases have a majority, 69.2%. In addition. the subject concerning a systemic support and quality assurance was scarce but continuously presented. 4. Journal of school health society The major point of this journal is the identification of health problems and risk factors which belong to assessment and diagnosis domain(56.8%) regardless of year, Because of the interdisciplinary characteristic. The knowledge on quality assurance of nursing practice is relatively rare. But, articles related to a systemic support is plentiful. 5. Journal of home care nursing society In its infancy, there was a large number of papers concerning need assessment and diagnosis, Comparing others, this journal has introduced a good many of articles related to program management. delivery system. service fee, etc that belong to domain of systemic support for nursing practice. 6. It is showing definitely that quantity and extent of research have grown for a short period. See the analysis in terms of nursing process, studies related to the domain of assessment and diagnosis command an absolute majority regardless of kinds of journal. Although articles referring to program management and implementation is increasing in number, it is scarce to evaluate a nursing program and grope for an improvement. Also, program development based on a theoretical framework is little. Therefore much more scientific effort to ensure profession should be executed. 7. In the methodological aspect, longitudinal study needs to be carried out so that we could show the evidence based nursing theory. To develop a more general theory, we have to conduct a study of various subjects and improve a validity of tools through a repeat test. In addition, the effort for interdisciplinary cooperation is needed.

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漢江 水質保全 行政에 관한 硏究 (A Study on the Administration for the Han River Water Quality Control)

  • Kim, Kwang Hyop
    • 한국환경보건학회지
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    • 제10권2호
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    • pp.9-40
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    • 1984
  • This thesis purports to overview the diverse administrative and organizational factors and plannings developed by the government organizations, municipal or otherwise, to tackle the Han River water pollution issues in the past years. This thesis also looks into the ever-worsening Han River water pollution problems, in particular, in terms of the various government plans ostensibly designed to reduce the pollution level but with little success. Also dealt with are the efficiencies with which the laws and decrees on water pollution the administrative organizations put to use in the prosecution of the diverse antiwater pollution projects involving the Han River basin. From the early 1960's up to the 1970's the government had concentrated on the growth-oriented economic policy with the result that little attention had been paid to the water pollution and other environmental issues that are bound to arise from the massive economic growth. Belatedly, the five-year Hah River Development Project was initiated in 1982 with emphasis on reducing the water pollution level at Hah River to the minimum. The following are the gists of the thesis and recommendations for the future antiwater pollution plans by the administrative organizations: 1. Documents to date indicate that the irrigation projects along the Han River area had been the main focus of attention during the Yi Dynasty and under the Japanese rule of the country. 2. Despite that the water pollution issue became the subject of many debates among the academic and research institutions in the 1960's and in the 1970's, the administrative organizations in charge of the Han River water quality control failed to come up with a concrete plan for the river's water quality control. 3. Nevertheless, the water pollution of the Han River area in fact began in the 1950's, with the unprecedented concentration into Seoul of population and the industrial facilities on a larger scale, in particular, enforced by the government's strong growthoriented policy in its Economic Development plans in the 1960's. 4. Starting in the 1960's, the Han River water pollution level dramatically increased, but the government was reluctant to promulgate or put into effect strong measures to curb the many factors contributing to the river water pollution, thus worsening the environmental issues along the Han River basin. 5. The environmental protection law and other laws and decrees relating to the antiwater and air pollution issues that were subsequently put into effect underwent so many changes that efficient anti-water pollution policies could not be effected for the Han River basin. The frequent organizational reshuffle within the administrative units concerned with environmental problems has resulted in the undue waste in personnel management and finance. 6. The administration on the environmental protection could not be efficiently carried out due to the organizational overlapping. Under the existing law, frequent organizational frictions and inefficiency are bound to occur among the central government offices themselves, as well as between the central government and the Seoul city administration, and among the city's administrative offices over the conservation of the Han River basin and over the river's anti-water pollution issue. 7. In the planning and prosecution of the Han River project, political influences from the president down to the lower-level politicious appear to have been involved. These political influences in the past had certainly had negative influence on the project, nevertheless, it appears that in the recent years, these political influences are not all that negative in view of the fact that they serve as a positive contributing factor in developing a better water quality control project along the Han River basin. The following are a few recommendations based on the data from the thesis: First, officials in charge of the Han River water quality control should pay attention to a careful screening of the opinions and recommendations from the academic circles and from the public should be made so that the government could better grasp the core issues in the environmental problems that require preventive and other necessary measures. Second, vigorous redistribution policies of population and industrial facilities away from the Seoul area should be pursued. Third, the government should refrain from revising or revamping too frequently the laws and decrees on the anti-water pollution, which is feared to cause undue inconveniences in the environmental administration. Fourth, a large-scale streamlining should be made to the existing administrative organization in an effort to do away with the inter- and intra-organizational friction. It is recommended that a secretariat for the Hah River basis conservation be established. Fifth, High-level administrative officials, with a thorough knowledge and vision on the Han River water quality control, should be prepared to better deal with the budgeting and personnel management for the Han River water pollution control not only at the control government, but also at the Seoul city municipal government levels. Environmental issues should be kept distinct from political issues. Environmental issues should not serve as a window-dressing for sheer political purposes. Sixth, the Hah River proiect should also include, along with the main Han River basin, those areas covering North Han River, South Han River, and the tributaries to the main river basin. The 'Han River Basin Water Quality Control Board' should be established immediately as a means of strengthening the current Han River basin water quality control policy. Seventh, in drawing up the Han River proiect, the administrative officials should be aware that Han River basin is a life line for those people in the region, providing them with not only a sheer physical space, but with a psychological living space for their everyday life.

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멸종위기의 백한우(체세포복제 포함)의 성장 및 혈액학적 특성 분석 (Analysis of Growth and Hematologic Characteristics of Endangered Korean Native Cattle)

  • 김현;최창용;성환후
    • 한국수정란이식학회지
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    • 제30권3호
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    • pp.175-181
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    • 2015
  • 본 연구에 사용된 공시축은 2013년 1월부터 2014년 12월까지 국립축산과학원 가축유전자원센터에서 사육 중인 모색을 기준으로 동일연령인 일반한우(황우), 백한우 및 복제소 18두(황우 10두, 백우 7두 그리고 복제소 1두)를 대상으로 혈액학적 수치를 확인하였다. 동일연령의 복제소와 백한우의 성장 단계별 혈액학적 검사 결과에서 1년 이하에서 1~2년으로 연령이 증가됨에 따라 RBC 관련 6개의 인자의 측정수치가 정상치 범위내 임을 확인했다. 또한 일반한우와의 비교에서도 차이점이 인정되지 않았다. 하지만, 복제소를 포함하는 백한우군와 일반 한우군 간의 RBC($11.2{\sim}10.1{\times}10^6/{\mu}l$, $12.0{\sim}10.3{\times}10^6/{\mu}l$로)와 PL치($592{\sim}448{\times}10^3/{\mu}l$, $589{\sim}450{\times}10^3/{\mu}l$로)에서 각각 유의성 있는 감소(P<0.05)가 인정되었다. 또한, 복제소와 백한우의 백혈구계 검사 결과에서도 1년 이하에서1~2 년으로 연령이 증가함에 따라 WBC 수치($12.0{\sim}11.1{\times}10^3/{\mu}l$, $12.5{\sim}10.0{\times}10^3/{\mu}l$)가 감소했지만, 정상치 범위 내의 결과를 확인했다. 백혈구 분포의 백분율에서는 전반적으로 복제소 및 백한우의 림프구가 41.0~39.0%, 43.1~41.6%이며, 분엽형 호중구 수치는 32.0~29.0%, 33.9~30.9%로 나타났다. 일반 한우군과 복제소를 포함하는 백한우군 간의 백혈구계의 림프구 수치의 비교에서는 백한우군(41.6%)로, 일반한우(45.1%)에 비하여 유의적으로 낮음(P<0.05)을 확인하였다. 본 연구결과를 통하여 백한우의 귀체세포 유래의 복제소의 혈액학적 분석 결과로 건강상에 문제점이 없음을 확인하였다.

치과건강보험 요양급여비용 청구에 관한 교육요구도 조사 -대전·충청지역을 중심으로- (The investigation of the degree of the request of the education about the claim for the medical expenses in the dentistry health insurance - mainly in the Daejeon, Chungcheong area -)

  • 남용옥;김성희;김민자
    • 한국치위생학회지
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    • 제11권3호
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    • pp.325-341
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    • 2011
  • Objectives : This research has investigated the reality of the education of the claim and the degree of the education for the claimed of the dentistry recuperation organization in the Daejeon and Chuncheong are for the improvement of the problem in the medical expenses. Methods : It use as a basic data for the vitalizations of the education and performed the survey in the dentistry recuperation organization in the Daejeon and ChungCheong Nam BukDo which are registered in the evaluating organization for judging the health insurance in the present May 2010, and concluded just like the below. Results : 1. The education of the claim in the requirer in the dentistry recuperation organization, and the education of the claim was especially lacking when the dentist was studying in the university, and the dental hygienist had the similar educational experience in the school and the clinic (p<0.05) 2. Most of the requirer in the dental recuperation organization was hoping to get the education related to the claim work, but the dentist and the nurse's aid was relatively low (p<0.05) 3. For fixing the error of the claim, the participation and the extension of the judging standard of the insurance was the highest among the university subordinate dental hospital/dental hospital, but the health center was relatively low (p<0.05). 4. The dentist feels the economic burden in employing the special employee because the raising of the special judging people, compared to others, but the staffs such as the dental hygienist preferred it as one of ways to fix the error of the claim of the dental insurance (p<0.05) 5. Both dentists and the dental hygienist said proper time to teach the insurance was all needed in the school, and the clinic, but other workers relatively believed it should be held in the clinic (p<0.05). 6. The important factors to decide the participation of the lecture was in order of the contents of the lecture, the place of the lecture, the amount for the lecture, the superintendent of the lecture, whether it has gone through the educational score, and whether it has passed the conserving educational score was relatively less important in the university subordinate dentist/dentist, but the medical center was very effective as 4.50 (p<0.05) 7. Health Insurance Review and assessment service was very high as the managing department for supplying the lecture and the information, 70.5%, and the next was the Korean Dental Association/ Korean dental hygiene association, but dentists were preferring the association to manage in than the Health Insurance Review and assessment service to manage (p<0.05) 8. In preferring lecture for the inquiring the insurance, periodontal surgery was the highest as 4.51, the diagnosis standard for injection was high in the university subordinate hospital/dentists, and the more the year of the insurance inquiry, the less the doctor who was hoping for the lecture about the basic treatment. Conclusions : Taken together, it is decided that the inquiry education about the medical expense in the dentist, so the consistent and systematic education should be held to the related people, and from this, it is thought to reduce the problem of the inquiry of the medical expenses by fostering the knowledge and supplying the information which are related to the inquiry of the dentists.

Benzimidazole계 살균제의 농작업자 위해성평가 (Operator exposure risk assessment of benzimidazole fungicides on Korean agricultural condition)

  • 이제봉;신진섭;정미혜;박연기;임건재;강규영
    • 농약과학회지
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    • 제9권4호
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    • pp.347-353
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    • 2005
  • 한국 농업환경에서 benzimidazole계 살균제의 안전사용 및 농약살포자를 보호하기 위하여 단기(30일 이내) 및 장기(6개월 이상) 노출에 대한 농작업자 위해성평가를 수행하였다. 농작업자의 노출량 산출은 일본의 EPN 45% 유제 노출시나리오를 이용하였으며, 일일 작업시간은 4시간으로 가정하였고, 작업자에 대한 급성 및 만성 허용노출량(AOEL)은 단기노출은 기형독성, 만성노출은 만성독성 NOAEL로부터 산출하였다. Benzimidazole계 농약들은 US/EPA가 $Q_1^*$를 설정하여 발암성평가를 하고 있는 농약들로서 본 연구에서도 작업자의 만성 노출에 대한 발암성평가를 평균일일노출량(LADD)를 일생 동안 농업에 종사하는 연수, 농약살포 횟수, 농업형태 등을 고려하여 평가하였다. 농작업자에 대한 농약 노출량은 benomyl, carbendazim 및 thiophanate-methyl에 대하여 각각 0.2, 0.36 및 0.42 mg/kg/day 이었고, sAOEL은 0.3, 0.1 및 0.2 mg/kg/day 이었으며, cAOEL의 경우 benomyl과 carbendazim은 0.025, thiophanate-methyl은 0.08 mg/kg/day이었다. 만성 및 발암위해성평가를 위한 LADD는 benomyl 0.0038, carbendazim 0.0067 및 thiophanate-methyl 0.0081mg/kg/day로 산출되었다. 위의 수치를 이용하여 AOEL/exposure를 산출한 결과 급성위해성은 $0.28{\sim}1.5$, 만성 위해성은 $3.73{\sim}9.88$로서 작업자에 대한 급성 위해성은 보호장비를 착용할 경우 최대 90%까지 노출량이 감소하므로 보호장비 착용시 안전할 것으로 생각되었으며, 만성 위해성은 AOEL/exposure가 1 이상으로서 안전한 것으로 판단되었다. 발암위해성평가 결과는 보호장비를 착용할 경우 $9.12{\times}10^{-7}{\sim}1.13{\times}10^{-5}$으로 실제적인 농약살포 인자를 고려하여 평가하면 농약살포자에 대한 위해성은 없을 것으로 추정되나 보다 실제적인 노출성적을 이용한 농약살포 작업자 위해성평가가 필요하리라 판단된다.

농업용수의 가격구조에 관한 연구 (A Study On Irrigation Water Price Structure and Prescription)

  • 심기영
    • 한국농공학회지
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    • 제15권4호
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    • pp.3170-3180
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    • 1973
  • This study of the subject will review past and present irrigation development in Korea. Particular attention will be given to water pricing structure and a case study on the purpose of rational operation and management of irrigation water and organizations, and the optimum irrigation water and organizations, and the optimum irrigation water fee inorder to reduce farmers burden and to rationalize the farmland associations management so as to achieve development of the rural environment. In 1971, the reservoir of the Farmland Improvement A sociation (FIA) produced only 775 millison $m^3$ of irrigation water or 77% of planned capacity of 1,015 million $m^3$. It was caused by inefficient maintenance of irrigation facilities; for instance, about 21% of reservoirs, pumping stations and weirs in Korea have been silted by soil erosion which hinder to water production according to an ADC survey. The first Irritation Association was established in 1906, whcih was renamed the Farmland Assoeiation by the Rural Development Enouragement Law in 1970. By the end of 1971, 411,000 ha of rice paddies were under the control of 267 associations nationwide. The average water price assessed by Associations nationwide rose from 790 won per 0.1 ha. in 1966 to 1,886 won in 1971. The annual growth rate was 20%. The highest water price in 1971 was 4,773 won her 0.1 ha. and the lowest was 437 won. This range was caused by differences in debt burden, geographic conditions and management efficiency among the Associations. In 1971, the number of Associations which exceeded the average water price of 1,886 won per 0.1 ha. was 144, or 55.1% of all Association. In determination of water price, there are two principles; one is determined by production cost such as installation cost of irrigation facilities, maintenance cost, management cost and depreciation ect. For instance, the Yong San River Development project was required 33.7 billion won for total construction and maintenance cost is 3.1 billion won for repayment, maintenance and management cost per year. The project produces 590 million $m^3$ of irrigation water annually. Accordingly, the water price per $m^3$ is 5.25 won. The other principle is determined by water value in the crop products and in compared with production of irrigated paddy and non-irrigated paddy. By using this method, water value in compared with paddy rice vs. upland rice(Average of 1967-1971) was 14.15 won per $m^3$ and irrigated paddy vs. non-irrigated paddy was 2.98 won per $m^3$. In contrast the irrigation fee in average association of 1967-1971 was 1.54 won per $m^3$. Accordingly, the current national average irrigation fee(water price) is resonable compared with its water value. In this study, it is found that the ceiling of water price in terms of water value is 2.98 won per $m^3$ or 2,530 won per 0.1 ha. However, in 1971 55% of the associations were above the average of nationwide irrigation fees. which shows the need for rationalization of the Association's management. In connection with rationalization of the Association's management, this study recommends the following matters. (1) Irrigation fee must be assessed according to the amount of water consumption taking intoaccount the farmer's ability. (2) Irrigation fee should be graded according to behefits and crop patterns. (3) Training personnel in the operation and procedures of water management to save O&M costs. (4) Insolvent farmland association should be integrated into larger, sound associations in the same GUN in order to reduce farmers' water cost. (5) The maintenance and repair of existing irrigation facilities is as important as expansion of facilities. (6) Establishment of a new Union of Farmland Association is required to promoted proper maintenance and to protect the huge investment in irrigation facilities by means of technical supervision and guidance.

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조경기사 필기시험 중 조경시공구조 및 관리학 분야의 출제경향 분석 (An Analysis of Test Trends for Landscape Structure Construction and Management in Engineer Landscape Architecture Examination)

  • 정용조
    • 한국조경학회지
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    • 제46권4호
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    • pp.76-83
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    • 2018
  • 본 연구는 2007년부터 2016년까지 최근 10년 동안 조경기사 필기시험 응시자 및 합격자 현황, 조경시공구조 및 조경관리학 출제유형별 빈도와 추이, 유형별 출제경향과 특성을 분석하여 조경기사 필기시험 중 조경시공구조 및 조경관리학 분야의 출제경향을 파악하고자 하였으며, 그 결과는 다음과 같다. 2007년부터 2016년까지 최근 10년 동안 조경기사 필기시험 응시자 및 합격자 현황을 분석해 본 결과, 응시자는 2011년부터, 합격자는 2012년부터 줄어들고 있으며, 최근 10년 동안 조경기사 필기시험의 평균 합격률은 11.2%를 나타냈다. 조경시공구조학 기출문제에 출제된 유형별 빈도와 추이, 출제경향과 특성을 분석해 본 결과, 시공계획 및 공정관리, 조경재료, 조경식재기반, 공종별 공사, 조경적산, 기본구조역학, 측량 등 7개 항목의 키워드 중 공종별 공사를 묻는 문항이 25.2%로 가장 많았으나, 조경식재기반시설에 대한 문제는 3.3%를 차지, 타 항목보다 출제빈도가 낮아 중요성에 비해 출제빈도가 낮은 것으로 파악되었다. 조경관리론 기출문제에 출제된 유형별 빈도와 추이, 출제경향과 특성을 분석해 본 결과, 운영 및 이용 유지관리, 전정관리, 시비관리, 잡초관리, 관수 및 배수관리, 월동관리, 병해충관리, 잔디관리, 조경시설관리 등 9개 항목의 키워드 중 운영 및 이용 유지관리를 묻는 문항이 37.2%로 가장 많았으며, 시비관리와 관수 및 배수관리는 2011년부터 조경시설관리 중 수경시설관리는 2015년부터 증가 추세에 있는 것으로 파악되었다. 이상에서 조경시공구조 및 조경관리론의 출제 경향을 살펴본 결과, 광범위하고 다양한 항목들이 출제되고 있으며, 조경시공구조에서는 합리적인 가격과 우수한 품질을 확보하기 위해 공종별 공사, 조경재료, 조경적산분야, 조경관리학에서는 기후변화 등의 환경적 요인들로 인하여 시비관리, 관수 및 배수, 조경시설관리 중 수경시설관리 등에서 출제빈도가 높아지고 있는 실정이다.

고등학생의 학교폭력에 영향을 미치는 요인에 관한 연구 : 인성요인을 중심으로 (A study on factors affecting high school students of school violence - Focusing on personality factors -)

  • 이정덕;장정현
    • 시큐리티연구
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    • 제42호
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    • pp.393-422
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    • 2015
  • 학교는 학생의 효과적인 학업성취와 지적능력 개발을 위해 공교육을 실현하는 거점임과 동시에 최전선의 위치를 담당하고 있다. 비단 학업뿐만 아니라 사회의 한 구성원으로써 타인과 함께 하기위한 배려와 이해의 폭을 넓혀주는 공간이기도 하다. 그러나 우리나라 학교교육의 현실은 타인을 배려하고 책임감을 느끼는 삶의 태도와 관련된 인성교육에 대해서는 부족한 면이 많다는 지적을 받고 있다. 한 개인이 성인으로 성장해 나가는 데에는 지적능력뿐만 아니라 정서적인 측면이 반드시 필요하고, 학교에서는 그와 관련된 다양한 방법을 가르치는 것이 의무화되어 있다. 그럼에도 불구하고 우리나라 중등교육은 교사들의 과도한 행정업무를 비롯한 기타 업무로 인해 인성교육의 과정이 소홀해 지거나 형식적인 활동을 벗어나지 못하고 있다. 이러한 영향으로 학생들의 문제적 행동을 개선하지 못하는 결과를 가져왔으며, 결국 학교폭력과 같이 타인에게 직접적인 피해를 주는 심각한 사회문제를 야기한 측면이 있다. 따라서 이 연구는 교육학과 범죄학의 청소년비행 행위에 기초하여 인성의 개념을 구체화하고 학교폭력과의 관계를 경험적 연구를 통해 검증하고자 하였다. 이에 따라 2013년 7월 1일부터 2013년 9월 31일 까지 전국 277개교에 재학 중인 고등학교 3학년 학생들 중 경기도에 소재한 K대학의 입학설명회 및 모의전형에 참여한 학생들 중 무응답과 분석에 사용할 수 없다고 판단된 자료를 제외하고 최종분석에서 총 1045명의 자료가 활용되었다. 그 결과 학교폭력 피해경험이 많고, 남자학생일 수 록 학교폭력의 가해 경험이 많을 것으로 나타났다. 또한 건강한 학생일수 록 학교폭력의 가해경험이 많고, 분노조절과 공감, 배려의식이 낮은 학생이 학교폭력의 가해경험이 많은 것으로 나타났다.

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May-Thurner 증후군과 동반된 하지 심부정맥혈전환자에서 혈전제거술과 스텐트삽입술 (Pharmaco-mechanical Thrombectomy and Stent Placement in Patients with May-Thurner Syndrome and Lower Extremity Deep Venous Thrombosis)

  • 전용선;김영삼;조정수;윤용한;백완기;김광호;김정택
    • Journal of Chest Surgery
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    • 제42권6호
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    • pp.757-762
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    • 2009
  • 배경: May-Thurner 증후군은 좌측장골정맥이 우측장골동맥에 의해 눌리어 정맥 환류장해에 의해 혈전증을 일으키는 것을 말한다. 저자들은 심부 정맥혈전중의 치료를 위해 시행한 혈전 제거-용해술 및 스탠트 삽입술의 결과를 분석하고자 한다. 대상 및 방법: May-Thurner 증후군과 동반된 하지 심부정맥혈전증으로 진단받고 좌측 장골정맥에 스탠트를 삽입한 34명(평균연령 $64.6{\pm}13.7$세, 여자 25(74%)명)을 대상으로 하였다. 시술은 흡인성 혈전제거와 혈전용해 후 분지성 협착이 있는 곳에 Wall stent를 삽입하고 풍선 확장을 하였다. Multi side hole 카테타를 혈전이 있는 부위에 위치시키고 Urokinase를 시간당 8만에서 12만 International Unit을 1일 또는 2일 동안 주입하였다. 시술 중 폐동맥혈전색전증을 방지 하기 위하여 대부분 환자에서 시술 전 일시적 하대정맥 여과기(IVC Filter)를 삽입하였다. 퇴원 후 3개월간 경구용 와파린을 투여 하였으며 퇴원 전과 퇴원 후 6개월에 Multi Detector Computerized Tomography (MDCT) 혈관촬영을 이용하여 혈전의 유무를 판단하였다. 결과: 시술 48시간 이내 부종과 동통이 완전하게 소실된 환자가 2 (6%)명이었으며 증상의 완화가 있는 환자가 28 (82%)명, 증상의 호전이 없는 환자가 4 (12%)명이었다. 퇴원 시 MDCT혈관촬영에서 9 (26%)명에서 혈전없음, 21 (62%)명에서 부분 혈전, 그리고 4명(12%)에서 폐쇄소견을 보였다. 퇴원 6개월 후에 2명을 제외한 32명이 추적 MDCT혈관촬영을 하였는데 23 (72%)명에서 혈전없음을 9 (26%)명에서는 부분혈전이 관찰 되었다. 평균 5.6개월 관찰기간 동안 2 (6%)명에서 심부정맥혈전이 재발되어 재입원하였으며 하지 부종과 통증을 동반한 혈전 후 증후군은 9예(26%)에서 발생하였다. 결론: May-Thurner 증후군과 동반된 하지 심부정맥혈전환자에서 심부정맥혈전의 제거와 혈전용해술과 함께 시술된 스탠트 삽입은 효과적인 치료 방법으로 생각된다.