• Journal of Industrial Convergence
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• v.22 no.2
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• pp.73-83
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• 2024

The purpose of this study is to diagnose various problems arising around social enterprises in the sport field from the perspective of the organization and derive necessary tasks and implications. In order to achieve the purpose of the study, the study was largely divided into three stages, and the results were derived. First, the main status and characteristics of social enterprises in the sport field were examined. The current status was analyzed focusing on aspects such as background and origin, legislation and policy, organizational goals, organizational structure and procedures, and organizational characteristics. Social enterprises in the sport sector were in their early stages, and the government's social enterprise policy goal tended to focus on increasing the number of social enterprises in a short period of time through financial input. In addition, it was found that most individual companies rely on government subsidy support due to insufficient profit generation capacity. In the second stage, we focused on the situational factors that affect the functional performance of social enterprises in the sport field. As a result of reviewing the value, ideology, technology, and history of the organization, which are situational factors, it was derived that when certified as a social enterprise in the sport field and supported by the central government or local governments, political control is strong to some extent and exposure to the market is not severe. In the last third step, tasks and implications were derived to form an appropriate organization for social enterprises in the sport field. After the social enterprise ecosystem in the sport sector has been established to some extent, it is necessary to gradually move from the current "government-type" organization to the "national enterprise" organization. This is true in light of the government's limited financial level, not in the short term, but in order for the organization of social enterprises in the sports sector to survive in the long term.

• Health Policy and Management
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• v.34 no.2
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• pp.141-155
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• 2024

Background: This study aimed to identified the relationship between the risk of obstructive sleep apnea, subjective health, and health-related quality of life among the middle-aged and elderly population in Korea. Methods: Adults aged 40 or older were extracted from the total 22,559 respondents to the 2019-2020 Korea National Health and Nutrition Examination Survey VIII, and secondary analysis was conducted on a total of 6,659 middle-aged and elderly people with no missing values. Logistic regression analysis and multiple regression analysis were conducted to examine the relationship between obstructive sleep apnea risk factors and subjective health as well as quality of life. Results: The subjective health status decline in the high-risk group compared to the non-risk group for obstructive sleep apnea was statistically significantly higher, with an odds ratio of 1.84 (p<0.001). The health-related quality of life was also statistically significantly lower by 0.02 points (β, -0.02; p<0.001). As a result of subgroup analysis on specific variables, the association between the risk of obstructive sleep apnea and subjective health and health-related quality of life was statistically significant depending on gender, sleep time, presence of depression, household income, and number of household members. Based on the obstructive sleep apnea risk group, women had a higher correlation with low subjective health and lower health-related quality of life scores than men. Sleeping time of more than 8 hours or less than 6 hours was more associated with low subjective health and lower health-related quality of life score than sleeping time of 6-8 hours. Patients with depression were more likely to have low subjective health than those without depression. The lower the household income level and the smaller the number of household members, the higher the association with low subjective health and the lower the health-related quality of life score. Conclusion: It is essential to recognize that the risk of obstructive sleep apnea not only directly affects sleep disorders but also impacts individuals' subjective health and quality of life. Consequently, social support and education should be provided to raise awareness of this issue. Particularly, programs for preventing and managing obstructive sleep apnea should target vulnerable groups such as women, individuals in single-person households, low household income, and those with depression, aiming to improve their subjective health and quality of life.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.822-835
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• 1997

Background : There have been many in vitro evidences that interleukin-4(IL-4) might be the most important cytokine inducing IgE synthesis from B-cells, and interferon-gamma(IFN-$\gamma$) might be a main cytokine antagonizing IL-4-mediated IgE synthesis. Recently some reports demonstrated that IFN-$\gamma$ might be used as a new therapeutic modality in some allergic diseases with high serum IgE level, such as atopic dermatitis or bronchial asthma. To evaluate the in vivo effect of IFN-$\gamma$ in bronchial asthma we tried a clinical study. Methods : Fifty bronchial asthmatics(serum IgE level over 200 IU/ml) who did not respond to inhaled or systemic corticosteroid treatment, and 17 healthy nonsmoking volunteers were included in this study. The CD 23 expressions of peripheral B-cells, the IL-4 activities of peripheral T-cells, the serum soluble CD23(sCD23) levels, and the superoxide anion(${O_2}^-$) generations by peripheral PMN were compared between bronchial asthmatics and normal subjects. The IL-4 activities of peripheral T-cells were analyzed by T-cell supernatant (T-sup)-induced CD23 expression from tonsil B-cells. In bronchial asthmatics the serum IgE levels and histamine $PC_{20}$ in addition to the above parameters were also compared before and after IFN-$\gamma$ treatment. IFN-$\gamma$ was administered subcutaneously with a weekly dose of 30,000 IU per kilogram of body weight for 4 weeks. Results : The ${O_2}^-$ generations by peripheral PMNs in bronchial asthmatics were higher than normal subjects($8.23{\pm}0.94$ vs $5.00{\pm}0.68\;nmol/1{\times}10^6$ cells, P<0.05), and significantly decreased after IFN-$\gamma$ treatment compared to initial values($3.69{\pm}0.88$ vs $8.61{\pm}1.53\;nmol/1{\times}10^6$ cells, P<0.05). CD23 expression of peripheral B-cells in bronchial asthmatics was higher than normal subjects($47.47{\pm}2.96%$, vs $31.62{\pm}1.92%$, P<0.05), but showed no significant change after IFN-$\gamma$ treatment. The serum sCD23 levels in bronchial asthmatics were slightly higher than normal subjects($191.04{\pm}23.3\;U/ml$ vs $162.85{\pm}4.85\;U/ml$), and 11(64.7%) of 17 patients showed a decreasing pattern in their serum sCD23 levels after IFN-$\gamma$ treatment. However the means of serum sCD23 levels were not different before and after IFN-$\gamma$ treatment. The IL-4 activities of peripheral T-cells in bronchial asthmatics were slightly higher than normal subjects($22.48{\pm}6.81%$ vs $18.90{\pm}2.43%$), and slightly increased after IFN-$\gamma$ treatment($27.90{\pm}2.56%$). Nine(60%) of 15 patients showed a decreasing pattern in their serum IgE levels after IFN-$\gamma$ treatment. And the levels of serum IgE were significantly decreased after IFN-$\gamma$ treatment compared to initial values ($658.67{\pm}120.84\;IU/ml$ vs $1394.32{\pm}314.42\;IU/ml$, P<0.05). Ten(83.3%) of 12 patients showed an improving pattern in bronchial hyperresponsiveness after IFN-$\gamma$ treatment, and the means of histamine $PC_{20}$ were significantly increased after IFN-$\gamma$ treatment compared to initial values ($1.22{\pm}0.29mg/ml$ vs $0.69{\pm}0.17mg/ml$, P<0.05). Conclusion : Our results suggest that IFN-$\gamma$ may be useful as well as safety in the treatment of bronchial asthmatics with high serum IgE level and that in vivo effects of IFN-$\gamma$ may be different from its in vitro effects on the regulations of IgE synthesis or the respiratory burst of PMN.

• MISULJARYO - National Museum of Korea Art Journal
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• v.96
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• pp.89-122
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• 2019

In this paper, I argue that the Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers by Jeong Su-yeong (1743~1831, pseudonym: Jiwujae) is a record of his private journeys to several places on the outskirts of Hanyang (present-day Seoul) and that it successfully embodies the painter's subjective perspective while boating on these rivers and going on outings to nearby mountains. Around 1796, Jeong Su-yeong traveled to different places and documented his travels in this 16-meter-long handscroll. Several leaves of paper, each of which depicts a separate landscape, are pieced together to create this long handscroll. This indicates that the Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers reflected the painter's personal subjective experiences as he went along his journey rather than simply depicts travel destinations. The Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers features two types of travel: boating and mountain outings on foot. Traveling by boat takes up a large portion of the handscroll, which illustrates the channels of the Hangang and Imjingang Rivers. Mountain outings correspond to the sections describing the regions around Bukhansan, Gwanaksan, and Dobongsan Mountains. Jeong Su-yeong traveled to this wide span of places not just once, but several times. The fact that the Hangang River system are not presented in accordance with their actual locations shows that they were illustrated at different points. After visiting the riversides of the Hangang and Namhangang Rivers twice, Jeong Su-yeong delineated them in fourteen scenes. Among them, the first eight illustrate Jeong's initial trip by boat, while the other six scenes are vistas from his second trip. These fourteen scenes occupy half of this handscroll, indicating that the regions near the Hangang River are painted most frequently. The scenes of Jeong Su-yeong's first boating trip to the system of the Hangang River portray the landscapes that he personally witnessed rather than famous scenes. Some of the eight scenic views of Yeoju, including Yongmunsan Mountain, Cheongsimru Pavilion, and Silleuksa Temple, are included in this handscroll. However, Jeong noted spots that were not often painted and depicted them using an eye-level perspective uncommon for illustrating famous scenic locations. The scenes of Jeong's second boating trip include his friend's villa and a meeting with companions. Moreover, Cheongsimru Pavilion and Silleuksa Temple, which are depicted in the first boating trip, are illustrated again from different perspectives and in unique compositions. Jeong Su-yeong examined the same locations several times from different angles. A sense of realism is demonstrated in the scenes of Jeong's first and second boating trips to the channels of the Hangang River, which depict actual roads. Furthermore, viewers can easily follow the level gaze of Jeong from the boat. The scenes depicting the Imjingang River begin from spots near the Yeongpyeongcheon and Hantangang Rivers and end with places along the waterways of the Imjingang River. Here, diverse perspectives were applied, which is characteristic of Imjingang River scenes. Jeong Su-yeong employed a bird's-eye perspective to illustrate the flow of a waterway starting from the Yeongpyeongcheon River. He also used an eye-level perspective to highlight the rocks of Baegundam Pool. Thus, depending on what he wished to emphasize, Jeong applied different perspectives. Hwajeogyeon Pond located by the Hantangang River is illustrated from a bird's-eye perspective to present a panoramic view of the surroundings and rocks. Similarly, the scenery around Uhwajeong Pavilion by the Imjingang River are depicted from the same perspective. A worm's-eye view was selected for Samseongdae Cliff in Tosangun in the upper regions of the Imjingang River and for Nakhwaam Rock. The scenes of Jeong Su-yeong's mountain outings include pavilions and small temple mainly. In the case of Jaeganjeong Pavilion on Bukhansan Mountain, its actual location remains unidentified since the pavilion did not lead to the route of the boating trip to the system of the Hangang River and was separately depicted from other trips to the mountains. I speculate that Jaeganjeong Pavilion refers to a pavilion either in one of the nine valleys in Wooyi-dong at the foot of Bukhansan Mountain or in Songajang Villa. Since these two pavilions are situated in the valleys of Bukhansan Mountain, their descriptions in written texts are similar. As for Gwanaksan Mountain, Chwihyangjeong and Ilganjeong Pavilions as well as Geomjisan Mountain in the Bukhansan Mountain range are depicted. Ilganjeong Pavilion was a well-known site on Gwanaksan that belonged to Shin Wi. In this handscroll, however, Jeong Su-yeong recorded objective geographic information on the pavilion rather than relating it to Shin Wi. "Chwihyangjeong Pavilion" is presented within the walls, while "Geomjisan Mountain" is illustrated outside the walls. Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers also includes two small temples, Mangwolam and Okcheonam, on Dobongsan Mountain. The actual locations of these are unknown today. Nevertheless, Gungojip (Anthology of Gungo) by Yim Cheonsang relates that they were sited on Dobongsan Mountain. Compared to other painters who stressed Dobong Seowon (a private Confucian academy) and Manjangbong Peak when depicting Dobongsan Mountain, Jeong Su-yeong highlighted these two small temples. Jeong placed Yeongsanjeon Hall and Cheonbong Stele in "Mangwolam small temple" and Daeungjeon Hall in front of "Okcheonam small temple." In addition to the buildings of the small temple, Jeong drew the peaks of Dobongsan Mountain without inscribing their names, which indicates that he intended the Dobongsan peaks as a background for the scenery. The Handscroll of a Sightseeing Trip to the Hangang and Imjingang Rivers is of great significance in that it embodies Jeong Su-yeong's personal perceptions of scenic spots on the outskirts of Hanyang and records his trips to these places.

• (The) Research of the performance art and culture
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• no.22
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• pp.287-325
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• 2011

This paper studies the time-space and appreciation of the performance culture of Gwanseo region, which is considered to have formed a characteristic culture in late Joseon period. For this purpose, 4 gasa written in hangeul (Korean alphabet), as well as 4 yeonhaeng gasa, 108 articles of Gwanseoakbu were examined. Plus, among the 9 types of yeonhaengrok (Documents of Performance culture) written in Chinese character, those parts which describe the performance traits have been analyzed. Then, 'main list of terminology' has been deduced based on the categorization according to the following points : 1) subjects of performance and appreciation 2) time and period of performance 3) space of performance 4) contents of performance 5) background and motive for performance and 6) method of performance. Through this process, various 'nouns' and 'predicate verbs' in relation to performance culture emerged, which were systemized according to types of performance elements and categories. Major terminology includes predicate verbs and symbolic verbs such as nokuihongsang,' 'baekdaehongjang,' 'jeolsaekgeumga,' 'cheonga,' 'hwaryu,' 'gamuja,' and 'tongsoja,' as well as the terms already known such as gisaeng, iwon, yangbang, akgong, and jeonak, which refer to musicians and dancers. Subjects of performance were divided into performers and listeners, categorized into concert, music, and dance, according to performance form. In the case for music, it was divided into instrumental or vocal, solo or accompanied (byeongju, self-accompaniment). In the case for vocal music, noteworthy was the inclusion of profesional artist's singing (called gwangdae or uchang). The record of 23 names of popular artists from Gwanseo region, with mention of special talents for each person, reflects the degree of activeness and artistic level of the province. Depending on the appreciating patrons, the audience were indicated as the terms including 'yugaek (party guest),' jwasang,' 'on jwaseok,' and 'sonnim (guests).' It seems that appraisal for a certain performance was very much affected by the tastes, views, and disposition of the appreciating patrons. Therefore it is interesting to observe different comparative reviews of concerts of different regions given by literary figures, offering various criticism on identical performance. In terms of performance space, it has been divided into natural or architectural space, doing justice to special performance sites such as a famous pavilion or an on-the-boat performance. Specific terms related to the scale and brightness of stage, as well as stage props and cast, based on descriptions of performance space were found. The performance space, including famous pavilions; Yeongwangjeong, Bubyeokru, Baeksangru, Wolparu, and Uigeomjeong, which are all well-known tourist sites of Gwanseo province, have been often visited by viceroys. governors, and envoys during a tour or trip. This, and the fact that full-scale performances were regularly held here, and that more than 15 different kinds of boats which were used for boat concert are mentioned, all confirm the general popularity of boat concerts at the time. Performance time, categorized by season or time of day (am/pm/night) and analyzed in terms of time of occurrence and duration, there were no special limitation as to when to have a performance. Most morning concerts were held as part of official duties for the envoys, after their meeting session, whereas evening concerts were more lengthy in duration, with a greater number of people in the audience. In the case of boat concert, samples include day-time concert and performances that began during the day and which lasted till later in the evening. Major terminology related to performance time and season includes descriptions of time of day (morning, evening, night) and mention of sunset, twilight, moonlight, stars, candles, and lamps. Such terms which reflect the flow of time contributed in making a concert more lively. Terminology for the contents of performance was mostly words like 'instrumental,' 'pungak,' or 'pungnyu.' Besides, contextual expressions gave hints as to whether there were dance, singing, ensemble, solo, and duets. Words for dance and singing used in Gwanseo province were almost identical to those used for gasa and jeongjae in the capital, Hanyang. However, many sentences reveal that performances of 'hangjangmu' of hongmunyeon, sword dance, and baettaragi were on a top-quality level. Moreover, chants in hanmun Chinese character and folk songs, which are characteristic for this region, show unique features of local musical performance. It is judged that understanding the purpose and background of a performance is important in grasping the foundation and continuity of local culture. Concerts were usually either related to official protocol for 'greeting,' 'sending-off,' 'reports,' and 'patrols' or for private enjoyment. The rituals for Gwanseo province characteristically features river crossing ceremony on the Daedong river, which has been closely documented by many. What is more, the Gwanseo region featured continued coming and goings of Pyeongan envoys and local officers, as well as ambassadors to and fro China, which required an organized and full-scale performance of music and dance. The method of performance varied from a large-scale, official ones, for which female entertainers and a great banquet in addition to musicians were required, to private gatherings that are more intimate. A performance may take the form of 'taking turns' or 'a competition,' reflecting the dynamic nature of the musical culture at the time. This study, which is deduction of terminology in relation to the time-space and appreciation culture of musical performances of Gwanseo region in late Joseon period, should be expanded in the future into research on 'the performance culture unique to Gwanseo region,' in relation to the financial and administrative aspects of the province, as well as everyday lifestyle. Furthermore, it could proceed to a more intensive research by a comparative study with related literary documents and pictorial data, which could serve as the foundation for understanding the use of space and stage, as well as the performance format characteristic to Korean traditional performing arts.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.379-388
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• 1994

Background : In sleep apnea syndrome, arterial oxygen saturation($SaO_2$) decreases at a variable rate and to a variable degree for a given apneic period from patient to patient, and various kinds of cardiac arrythmia are known to occur. Factors supposed to affect arterial oxygen desaturation during apnea are duration of apnea, lung voulume at which apnea occurs, and oxygen consumption rate of the subject. The lung serves as preferential oxygen source during apnea, and there have been many reports related with the influence of lung volume on $SaO_2$ during apnea, but there are few, if any, studies about the influence of oxygen consumption rate of an individual on $SaO_2$ during breath holding or about the profile of arterial oxygen resaturation after breathing resumed. Methods : To investigate the changes of $SaO_2$ and heart rate(HR) during breath holding(BH) and rebreathing(RB) and to evaluate the physiologic factors responsible for the changes, lung volume measurements, and arterial blood gas analyses were performed in 17 healthy subjects. Nasal airflow by thermistor, $SaO_2$ by pulse oxymeter and ECG tracing were recorded on Polygraph(TA 4000, Gould, U.S.A.) during voluntary BH & RB at total lung capacity(TLC), at functional residual capacity(FRC) and at residual volume(RV), respectively, for the study subjects. Each subject's basal metabolic rate(BMR) was assumed on Harris-Benedict equation. Results: The time needed for $SaO_2$ to drop 2% from the basal level during breath holding(T2%) were $70.1{\pm}14.2$ sec(mean${\pm}$standard deviation) at TLC, $44.0{\pm}11.6$ sec at FRC, and $33.2{\pm}11.1$ sec at RV(TLC vs. FRC, p<0.05; FRC vs. RV, p<0.05). On rebreathing after $SaO_2$ decreased 2%, further decrement in $SaO_2$ was observed and it was significantly greater at RV($4.3{\pm}2.1%$) than at TLC($1.4{\pm}1.0%$)(p<0.05) or at FRC($1.9{\pm}1.4%$)(p<0.05). The time required for $SaO_2$ to return to the basal level after RB(Tr) at TLC was not significantly different from those at FRC or at RV. T2% had no significant correlation either with lung volumes or with BMR respectively. On the other hand, T2% had significant correlation with TLC/BMR(r=0.693, p<0.01) and FRC/BMR (r=0.615, p<0.025) but not with RV/BMR(r=0.227, p>0.05). The differences between maximal and minimal HR(${\Delta}HR$) during the BH-RB manuever were $27.5{\pm}9.2/min$ at TLC, $26.4{\pm}14.0/min$ at RV, and $19.1{\pm}6.0/min$ at FRC which was significantly smaller than those at TLC(p<0.05) or at RV(p<0.05). The mean difference of 5 p-p intervals before and after RB were $0.8{\pm}0.10$ sec and $0.72{\pm}0.09$ sec at TLC(p<0.001), $0.82{\pm}0.11$ sec and $0.73{\pm}0.09$ sec at FRC(p<0.025), and $0.77{\pm}0.09$ sec and $0.72{\pm}0.09$ sec at RV(p<0.05). Conclusion Healthy subjects showed arterial desaturation of various rates and extent during breath holding at different lung volumes. When breath held at lung volume greater than FRC, the rate of arterial desaturation significantly correlated with lung volume/basal metabolic rate, but when breath held at RV, the rate of arterial desaturation did not correlate linearly with RV/BMR. Sinus arrythmias occurred during breath holding and rebreathing manuever irrespective of the size of the lung volume at which breath holding started, and the amount of change was smallest when breath held at FRC and the change in vagal tone induced by alteration in respiratory movement might be the major responsible factor for the sinus arrythmia.

• Journal of Korean Society of Forest Science
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• v.80 no.1
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• pp.72-81
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• 1991

This study was carried out to provide necessary information for improving quarrying industry management in Korea. The results of the study are summarized as follows : 1. In aggregate and building-stone quarrying firms the managers over 40 years of age are 97% and 89.1%, the ones above education level of high school are 90% and 85% and the ones not more than 10 years of quarrying experience are 70% and 52%, respectively. Accordingly it can be pointed out that most of the managers of two types of firms are relatively old, have high educational background, while quarrying experiences of building-stone firm managers are longer than that of aggregate firm managers. 2. Most of the management forms are social corporation(60%) for aggregate quarry firms and private management(76%) for building-stone firms. Average areas of permitted stone-pits of aggregate and building-stone quarries are about 2.86ha and 1.66ha respectively. That is, aggregate quarrying firms are carried on a larger scale than building-stone quarrying firms. 3. The yearly average product of aggregate quarrying firms has increased steadily from $88.961m^3$ in 1985 to $144.028m^3$ in 1988, while, in case of building-stone quarry firms, it has significantly increased from $4.155m^3$ to $19.462m^3$ from 1985 to 1987, but reduced to $13.400m^3$ in 1988. Unstable production activities of building-stone quarrying firms may require continuous government support. 4. Major cost items are equipment rental, depreciation, salaries, repair, maintenance for aggregate quarrying firms, and salaries, depreciation, fuel, tax for building-stone quarrying firms. The yearly average rate of return is about 9.7% for aggregate quarry firms and 2.6% for building-stone quarry firms. It can be pointed out that aggregate quarrying firms is better managed than building-stone quarrying firms. 5. The production elasticity of salary for aggregate quarrying firms is 0.495, that of employees is 0.559, and that of capital service is 0.513. The sum of the elasticities is 1.257>1. Fur building-stone quarrying firms, that of employees is 0.492, that of variable costs is 0.192, and that of capital service is 0.498. The sum of elasticities is 1.172>1, thus denotes the increasing returns to scale for both types quarrying firms. 6. The ratio of marginal value product to opportunity cost of empolyees is 2.54, that of variable costs is 3.62, and that of capital service is 1.45, in aggregate quarrying firms. That of employees is 2.47, that is variable costs was 2.34, and that of capital service is 19.67 in building-stone quarrying firms. Therefore the critical factors for more expansion of management scale in aggregate quarrying firms are variable cost and employees, and are capital service in building-stone quarry ing firms. 7. The break-even points of stone sales are about 0.587 billion won and 0.22 billion won in aggregate and building-stone quarrying firms respectively. The optimum sales Level for profit maximization are about 2.0 billion and 0.5 billion in aggregate and building-stone quarry firms respectively.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.140-152
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• 1998

Background: Prone position improves oxygenation in patients with ARDS probably by reducing shunt Reduction of shunt in prone position is thought to be effected by lowering of the critical opening pressure (COP) of the dorsal lung because the pleural pressure becomes less positive in prone position compared to supine position. It can then be assumed that prone position would bring about greater improvement in oxygenation when PEEP applied in supine position is just beneath COP than when PEEP is above COP. Hemodynamically, prone position is expected to attenuate the lifting of cardiac fossa induced by PEEP. Based on these backgrounds, we investigated whether the effect of prone position on oxygenation differs in magnitude according to the level of PEEP applied in supine position, and whether impaired cardiac output in supine position by PEEP can be restored in prone position. Methods: In seven mongrel dogs, $PaO_2/F_1O_2$(P/F) was measured in supine position and at prone position 30 min. Cardiac output (CO), stroke volume (SV), pulse rate (PR), and pulmonary artery occlusion pressure (PAOP) were measured in supine position, at prone position 5 min, and at prone position 30 min. After ARDS was established with warmed saline lavage(P/F ratio $134{\pm}72$ mm Hg), inflection point was measured by constant flow method($6.6{\pm}1.4cm$ $H_2O$), and the above variables were measured in supine and prone positions under the application of Low PEEP($5.0{\pm}1.2cm$ $H_2O$), and Optimal PEEP($9.0{\pm}1.2cm$ $H_2O$)(2 cm $H_2O$ below and above the inflection point, respectively) consecutively. Results : P/F ratio in supine position was $195{\pm}112$ mm Hg at Low PEEP and $466{\pm}63$ mm Hg at Optimal PEEP(p=0.003). Net increase of P/F ratio at prone position 30 min, however, was far greater at Low PEEP($205{\pm}90$ mm Hg) than at Optimal PEEP($33{\pm}33$ mm Hg)(p=0.009). Compared to CO in supine position at Optimal PEEP($2.4{\pm}0.5$ L/min), CO in prone improved to $3.4{\pm}0.6$ L/min at prone position 5 min (p=0.0180) and $3.6{\pm}0.7$ L/min at prone position 30 min (p=0.0180). Improvement in CO was attributable to the increase in SV: $14{\pm}2$ ml in supine position, $20{\pm}2$ ml at prone position 5 min (p=0.0180), and $21{\pm}2$ ml at prone position 30 min (p=0.0180), but not to change in PR or PAOP. When the dogs were turned to supine position again, MAP ($92{\pm}23$ mm Hg, p=0.009), CO ($2.4{\pm}0.5$ L/min, p=0.0277) and SV ($14{\pm}1$ ml, p=0.0277) were all decreased compared to prone position 30 min. Conclusion: Prone position in a dog with saline-lavaged acute lung injury appeared to augment the effect of relatively low PEEP on oxygenation, and also attenuate the adverse hemodynamic effect of relatively high PEEP. These findings suggest that a PEEP lower than Optimal PEEP can be adopted in prone position to achieve the goal of alveolar recruitment in ARDS avoiding the hemodynamic complications of a higher PEEP at the same time.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.329-334
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• 2008

Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.