Clinical Practice Guideline for Cardiac Rehabilitation in Korea
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- Journal of Chest Surgery
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- 제52권4호
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- pp.248-329
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- 2019
Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
In the field of fisheries, there is at the apex Central Federation of Fishery Cooperatives, established under the Fishery Cooperatives Law(1962), It is a multipurpose organization with a membership of 105 cooperatives, 87 regional cooperatives, 15 business-type cooperatives and 3 manufactures' cooperatives. Accordingly, this thesis examines the marketing of fishery cooperatives in Korea, and in particular considers the marketing channel strategy of fisheries products. No company can perform by itself all the activities involved in the production and distribution of its products and services to its final markets. It must work with other firms to get the job done. Thus marketing channel firms of the fisheries products include primarily the fishery cooperatives, the licensed In the field of fisheries, there is at the apex Central Federation of Fishery Cooperatives, established under the Fishery Cooperatives Law (1962). It is a multipurpose organization with a membership of 105 cooperatives, 87 regional cooperatives, 15 business-type cooperatives and 3 manufactures' cooperatives. Accordingly, this thesis examines the marketing of fishery cooperatives in Korea, and in particular considers the marketing channel strategy of fisheries products. No company can perform by itself all the activities involved in the production and distribution of its products and services to its final markets. It must work with other firms to get the job done. Thus marketing channel firms of the fisheries products include primarily the fishery cooperatives, the licensed dealers and the merchant middlemen. The goal of marketing is in matching of segments of supply and demand. Every producer seeks to the link the marketing channel firms that will help it accomplish its objective best. This thesis tries to attempt to improve the present Korean Fishery Cooperatives marketing activities. The purpose of the operation of fishery cooperatives is to guarantee the profits of fisherman as well as the interests of general consumers by eliminating the inordinate profits of middlemen and by narrowing other market margins. Fishery cooperatives marketing activity functions forming a self-helf organization for economic protection of producers themselves, and acting as a market reformational institution through its transaction by group. The following are the characteristics of fishery cooperatives marketing. \circled1 Fishery cooperatives is organized with an economic factor and a personnel factor. \circled2 Fishery cooperatives is non-profit organization. \circled3 The members of fishery cooperatives is independent constitution of economy, but they are closely connected with the cooperative. \circled4 Fishery cooperatives is a mutual aid organization. The objective of an efficient marketing strategy may be well described by the common saying provides the right product at the right time, the right place, and the right price. But it is quite true that the Korean Fishermen's Cooperative can be said to owe its development to the successful implementation of the marketing system. The use of the marketing system has resulted in the following marketing strategy. 1. The direct marketing system. \circled1 The cooperation between the fishery cooperatives and the other cooperative through the collection and delivery center. \circled2 The selling between the fishery cooperatives and the large scale retailers through the process industry. 2. The vertical marketing system. \circled1The fishermen's cooperative to be nominated by wholesaler in the terminal market. \circled2 Contracted vertical marketing system. \circled3 Abolition of selling by double auction in the landing and the terminal market. 3. The physical distribution system. \circled1 The need for adoption of cold chain system to connect production directly to consumption. \circled2 The need for more expansion of landing markets and terminal market facilities. Solutions to the problems of the Korean fishery are made possible through effective functioning of cooperative marketing activities of fishery products. The marketing concept of fishermen's cooperative lies in the satisfaction of consumer needs. According to the marketing concept fishermen's cooperative should try to satisfy customer's needs through a coodinated set of activities that allows the organization to achieve its goal. Providing satisfaction to customers is the major trust of the marketing concept. To do this, a business must find out what will satisfy customers. With this information the cooperative sells to the greatest possible number of customers through the most efficient sales and marketing channels. Economic rationality of fishermen's cooperative marketing lies in reduction of marketing cost and elimination of intermediate institutions. Cooperative marketing and direct marketing are both indispensable marketing factors for a new cooperative organization among the manu ways. The cooperation between the fishermen's cooperative and the others cooperative, and vertical marketing system are the most necessary ones. Propulsion of cooperative marketing system could not be successful without the support of the marketing instituion's help. Consequently, successful cooperative marketing ought to lead to the necessity not only for the improvement of marketing organization, but for the application of a new marketing concept in the fishermen's cooperative.
Today's financial institutions usually take environmental issues seriously into consideration as they could not evade lender liability in an increasing number of cases. On the international scene, a brand-new concept of the "Equator Principles" in the New Millenium has driven more and more international banks to adopt these Principles in project financing. Sustainable development has been a key word in understanding new trends of the governments, financial institutions, corporations and civic groups in the 21st century. The Equator Principles are a set of voluntary environmental and social guidelines for sustainable finance. These Principles commit bank officers to avoid financial support to projects that fail to meet these guidelines. The Principles were conceived in 2002 on an initiative of the International Finance Corporation(IFC), and launched in June 2003. Since then, dozens of major banks, accounting for up to 80 percent of project loan market, have adopted the Principles. Accordingly, the Principles have become the de facto standard for all banks and investors on how to deal with potential social and environmental issues of projects to be financed. Compliance with the Equator Principles facilitates for endorsing banks to participate in the syndicated loan and help them to manage the risks associated with large-scale projects. The Equator Principles call for financial institutions to provide loans to projects under the following circumstances: - The risk of the project is categorized in accordance with internal guidelines based upon the environmental and social screening criteria of the IFC. - For Category A and B projects, borrowers or sponsors are required to conduct a Social and Environmental Assessment, the preparation of which must meet certain requirements and satisfactorily address key social and environmental issues. - The Social and Environmental Assessment report should address baseline social and environmental conditions, requirements under host country laws and regulations, sustainable development, and, as appropriate, IFC's Environmental, Health and Safety Guidelines, etc. - Based on the Social and Environmental Assessment, Equator banks then make agreements with borrowers on how they mitigate, monitor and manage the risks through a Social and Environmental Management System. Compliance with the plan is included in the covenant clause of loan agreements. If the borrower doesn't comply with the agreed terms, the bank will take corrective actions. The Equator Principles are not a mere declaration of cautious banks but a full commitment of lenders. A violation of the Principles in the process of project financing, which led to an unexpected damage to the affected community, would not give rise to any specific legal remedies other than ordinary lawsuits. So it is more effective for banks to ensure consistent implementation of the Principles and to have them take responsible measures to solve social and environmental issues. Public interests have recently mounted up with respect to environmental issues on the occasion of the Supreme Court's decision (2006Du330) on the fiercely debated reclamation project at Saemangeum. The majority Justices said that the expected environmental damages like probable pollution of water and soil were not believed so serious and that the Administration should continue to implement the project seeking ways to make it more environment friendly. In this case, though the Category A Saemangeum Project was carried out by a government agency, the Supreme Court behaved itself as a signal giver to approve or stop the environment-related project like an Equator bank in project financing. At present, there is no Equator bank in Korea in contrast to three big banks in Japan. Also Korean contractors, which are aggressively bidding for Category A-type projects in South East Asia and Mideast, might find themselves in a disadvantageous position because they are generally ignorant of the environmental assessment associated with project financing. In this regard, Korean banks and overseas project contractors should care for the revised Equator Principles and the latest developments in project financing more seriously. It's because its scope has expanded to the capital cost of US$10 million or more across all industry sectors regardless of developing countries or not. It should be noted that, for a Korean bank, being an Equator bank is more or less burdensome in a short-term period, but it must be conducive to minimizing risks and building up good reputation in the long run.
하드 디스크 저장 매체의 가격이 하락함에 따라 가까운 시일 안에 개인 컴퓨터에 1TB가 넘는 하드 디스크가 기본으로 장착될 것으로 예상된다. 한 사람이 한 달에 1GB의 데이터를 저장한다고 가정하면 대략 1TB면 그 사람의 일생 동안에 걸친 데이터를 저장할 수 있다. 이에 따라 개인이 일상 생활에서 보고들은 것을 기록한 라이프로그(lifelog)를 효과적으로 관리하는 라이프로그 관리에 대한 연구가 활발히 이루어지고 있다. 지금까지 관계 데이터 모델 기반, 온톨로지 기반, 파일 시스템 기반 라이프로그 관리 시스템(LMS: Lifelog Management System) 등 다양한 LMS들이 제안되었지만, 관계 데이터 모델 기반 LMS는 질의 처리 성능이 뛰어난 반면 복잡한 질의를 잘 처리하지 못하고 온톨로지 기반 LMS는 복잡한 질의를 처리할 수 있는 반면 질의 처리 성능이 떨어지며 파일 기반 LMS는 질의만 지원하는 등 저마다 장단점을 가진다. 또한 이들 시스템들은 라이프로그 그룹을 효과적으로 관리하기 위한 기능을 제공하지 못하고 있고 효과적인 검색을 위해 라이프로그의 태그(데타데이터)를 수정하거나 새로운 태그를 추가하기 위한 편리한 인터페이스를 제공하지 못하고 있다. 본 논문에서는 이러한 문제점들을 해결하기 위해 관계 데이터 모델 기반 라이프로그 관리 시스템을 제안한다. 제안하는 시스템은 라이프로그를 관계 데이터 모델로 모델링하고 사용자 질의를 SQL로 변환해 처리함으로써 질의 처리 성능이 뛰어나다. 또한 복잡한 질의를 잘 처리하지 못하는 관계 데이터 모델 기반 LMS의 단점을 보완하기 위해 찾으려는 라이프로그와 직접적으로 관련 있는 라이프로그에 대한 정보에 기반해 라이프로그를 검색하는 단순화된 관계 질의를 지원한다. 이와 더불어, 제안하는 시스템은 라이프로그 그룹 생성, 편집, 검색, 플레이 및 공유 기능을 제공함으로써 라이프로그 그룹에 대한 효과적인 관리를 지원한다. 마지막으로 제안하는 LMS에서 제공하는 라이프로그 태깅 도구는 태그 추상화를 통해 여러 종류의 태그를 손쉽게 수정하거나 추가할 수 있는 기능을 제공한다. 본 논문에서는 제안하는 시스템의 설계 및 구현을 설명하고 이 시스템을 활용한 다양한 응용을 소개한다.
최근 인터넷 상에서 빈번하게 발생하는 내부 정보와 개인 정보 유출과 같은 보안 사고들은 보안을 고려하지 않고 개발된 웹 애플리케이션의 취약점을 이용하는 방법으로 빈번하게 발생한다. 웹 애플리케이션의 공격들에 대한 탐지는 기존의 방화벽과 침입 탐지 시스템들의 공격 탐지 방법으로는 탐지가 불가능하며 서명기반의 침입 탐지 방법으로는 새로운 위협과 공격에 대한 탐지에 한계가 있다. 따라서 웹 애플리케이션 공격 탐지 방법에 대한 많은 연구들이 웹 트래픽 분석을 이동하는 비정상행위 기반 탐지 방법을 이용하고 있다. 비정상행위 탐지 방법을 사용하는 최근의 웹 방화벽에 관한 연구들은 웹 트래픽의 정확한 분석 방법, 패킷의 애플리케이션 페이로드 검사로 인한 성능 문제 개선, 그리고 다양한 네트워크 보안장비들의 도입으로 발생하는 통합관리 방법과 비용 문제 해결에 중점을 두고 있다. 이를 해결하기 위한 방법으로 통합 위협 관리 시스템이 등장 하였으나 부족한 웹 보안 기능과 높은 도입 비용으로 최근의 애플리케이션 공격들에 대해 정확한 대응을 하지 못하고 있는 현실이다. 본 연구에서는 이러한 문제점들을 해결하기 위해 웹 클라이언트의 요청에 포함된 파라미터 값의 길이에 대한 실시간 분석을 이용하여 공격 가능성을 탐지하는 비정상행위 탐지방법을 제안하고, 애플리케이션 데이터 검사로 발생하는 성능 저하 문제를 해결할 수 있는 다중 계층 웹 필터를 적용한 웹 애플리케이션 방화벽 시스템을 설계하고 구현하였다. 제안된 시스템은 저가의 시스템이나 레거시 시스템에 적용 가능하도록 설계하여 추가적인 보안장비 도입으로 야기되는 비용 문제를 해결할 수 있도록 하였다.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70