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Weaning Following a 30 Minutes Spontaneous Breathing Trial (30분 자가호흡관찰에 의한 기계적 호흡치료로부터의 이탈)

  • Shin, Jin;Koh, Young-Min;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1326-1331
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    • 1997
  • Background : Weaning is the process of switching a patient from mechanical ventilator to spontaneous breathing. A number of different weaning techniques can be employed. At recent study, conventional spontaneous breathing trial was superior to other techniques, such as intermittent mandatory ventilation(IMV) or pressure support ventilation(PSV). But adequate observation time of the spontaneous breathing trial was not determined. We reported the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotrachial tube. In this study, we tried to shorten the spontaneous breathing time from 60 minutes to 30 minutes. If weaning success was predicted after 30 minutes spontaneous breathing, extubation was done without reconnection with ventilator. Methodes : Subjects consisted of 42 mechanically ventilated patients from August 1994 to July 1995. The weaning trial was done when the patients recovered sufficiently from respiratory failure that originally required ventilatory assistance, the patients became alert and showed stable vital sign, and arterial $O_2$ tension was adequated($PaO_2$ > 55 mmHg) with less than 40% of inspired oxygen fraction. We conducted a careful physical examination when the patients was breathing spontaneously through the endobronchial tube for 30 minutes. We terminated the trial if a patients was any of following signs of distress; cyanosis, diaphoresis, tachypnea(above 30 breaths per minute), and extreme tachycardia. Patients who had none of this features during spontaneous breathing for 30 minutes were extubated promptly. Result : 17 weaning trials of 15 patients were done in 42 mechanically ventilated patients. Successful weaning and extubation was possible in 14 trials of total 17 trials. In this 14 patients, 8 patients were extubated after 30 minutes spontaneous breathing, 3 patients were extubated after 60 minutes spontaneous breathing, and 3 patients needed over 3 hours for extubation from weaning. We found similar overall success rate compared with weaning following a 60 minutes spontaneous breathing trial. Conclusion : From the result of present study, we believe that weaning and extubation from mechanical ventilation following a 30 minutes spontaneous breathing with $O_2$ supply through the endotracheal tube is a simple and effective method.

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Study on Legal Position of Aviation Security Subject in Aviation Safety and Security (공항보안요원의 법적 지위에 관한 연구)

  • Hwang, Ho-Won
    • The Korean Journal of Air & Space Law and Policy
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    • v.21 no.2
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    • pp.157-179
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    • 2006
  • According to the Annex 17 to the Convention on International Civil Aviation, an appropriate authority of each contracting state has to define and allocate tasks and coordinate activities between the departments, agencies and other organizations of the State, airport and aircraft operators and other entities concerned with or responsible for the implementation of various aspects of the national civil aviation security programme. The airport has to take leading role in implementing security tasks at airport area because the airport operator is the provider of airport facilities and services to its customer and the security activities belong to its services. So Republic of Korea Government enact the Law, Aviation Safety and Security. The Purpose of this Act is to prevent any unlawful act in airport facilities with international conventions, including the ICAO to provide for standards, procedures and mandatory matters needed to ensure the safety and security of civil aviation. But the Act has some error. So is this paper to review the revision of aviation security regulation and the changes of aviation security responsibilities and task assignment. There is the term "aviation security personnel", who are charged with the task of preventing any act of disrupting the order and safety in airport. But there is no term "security screening personnel" who performs to detect or search for dangerous object, such as weapons or explosives, which may be used for the unlawful obstruction.

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Survival and Problems after Repair of Tetralogy of Fallot (Fallot 4징 교정수술후의 생존 및 문제점)

  • 손세정;한재진;이영탁;김성호
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.237-248
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    • 1999
  • Background: The late results of repair of tetralogy of Fallot(TOF) are favorable in most patients. Some portion of the patients with tetralogy, however, require reoperation for residual lesions or result in late death. The outcome of patients after tetralogy repair performed during the past 13 years was studied, with an emphasis on postrepair survival and problems including reoperations. Material and Method: A retrospective review of clinical, echocardiographic and catheterization data was performed in 569 of 775 patients with TOF who underwent corrective repair between 1983 and 1995 at Sejong General Hospital, Buchon, Korea. Result: Of 28(4.9%) early deaths(defined as 30 days postrepair), 12 deaths(42.9%) were <1 year of age, with an operative mortality of 15.4%. The surviving 541 patients(age 2.8 months to 43.4 years, median 23 months) have been followed up from 1 month to 12.6 years(median 35 months) postoperatively. Most patients were in good functional class and had normal right ventricular(RV) function. Postrepair results were compared between the transatrial-transpulmonary approach and the conventional right ventriculotomy. The former technique provided a lesser incidence of significant pulmonary regurgitation(P<0.001) and alesser degree of RV dysfunction(P<0.05) compared with those in the latter. There were 10(1.8%) late deaths during the follow-up period and 6 of the deaths were directly related to reoperation or ventricular dysfunction. The 10-year actuarial survival rate was 96.7%. There were 44 reoperations(8.1%) in 39 patients(7.2%), with an operative mortality of 10.3%. The main indications or reoperation included residual ventricular septal defect(VSD) (n=6), pulmonary stenosis(PS) (n=11), VSD with PS(n=17), pulmonary regurgitation(n=7), and tricuspid regurgitation(n=2). The 5- and 10-year freedom from reoperation were 89.4% and 76.1%, respectively. Conclusion: Although the majority of patients with repaired TOF are clinically well, with a high rate of survival, approximately 7% of patients have residual lesions that require surgical therapy. Therefore, the timely and meticulous corrective repair is mandatory to avoid reoperation, and continued close surveillance is also needed for the early detection of residual problems.

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Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection (소아 요로감염에서 Escherichia coli의 빈도와 항생제 감수성에 대한 연구)

  • Chi Hye-Mi;Kwahk Jae-Hyok;Lee Jun-Ho;Park Hye-Won
    • Childhood Kidney Diseases
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    • v.10 no.1
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    • pp.18-26
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    • 2006
  • Purpose : Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs. Methods : A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than $37.5^{\circ}C$, significant bacteriuria with single strain growth of at least 10s colony forming units/mL urine, and leukocyturia >5/HPF. Results : E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobctcter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillinsulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced ex tended - spectrum beta-lactamase(ESBL). Conclusion : Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future. (J Korean Soc Pediatr Nephrol 2006;10:18-26)

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The Applicable Laws to International Intellectual Property License Contracts under the Rome I Regulation (국제 지식재산권 라이센스 계약 분쟁의 준거법 결정 원칙으로서 로마I 규정의 적용에 관한 연구)

  • Moon, Hwa-Kyung
    • Journal of Legislation Research
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    • no.44
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    • pp.487-538
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    • 2013
  • It is the most critical issue in recent international intellectual property licence disputes to decide the applicable laws to the license contracts. As Korea and the European Union(EU) reached free trade agreement(FTA), and the EU-Korea FTA entered into force on July 1, 2011, the FTA has boosted social, economic, cultural exchanges between the two. As a result of the increased transactions in those sectors, legal disputes are also expected to grow. This situation calls for extensive research and understanding of the choice of law principles applicable to international intellectual property license contracts in the EU. To decide the laws applicable to issues arising from international intellectual property license contracts disputes, the characterization of those issues is necessary for the purpose of applying private international law principles to them. In terms of characterization, intellectual property license contracts fall within contractual matters. In the EU, the primary rule of choice of law principles in contractual obligations is the Rome I Regulation. Because the choice of law rules, such as private international law principles, the Rome Convention(1980), and the Rome I Regulation, differ in the time of application, it is essential to clarify the time factor of related contracts. For example, the Rome I Regulation applies to contracts which were concluded as from December 17, 2009. Although party autonomy in international contracts disputes is generally allowed, if there is no choice of law agreement between the parties to the contracts, the objective test rule of private international law doctrine could be the best option. Following this doctrine, the Rome I Regulation Article 4, Paragraph 1 provides the governing law rules based on the types of contracts, but there is no room for intellectual property license contracts. After all, as the rule for governing law of those contracts, the Rome I Regulation Article 4, Paragraph 2 should be applied and if there are countries which are more closely connected to the contracts under the Rome I Regulation Article 4, Paragraph 3, the laws of those countries become the governing laws of the contracts. Nevertheless, if it is not possible to decide the applicable laws to the license contracts, the Rome I Regulation Article 4, Paragraph 4 should be applied in the last resort and the laws of the countries which are the most closely connected to the contracts govern the license contracts. Therefore, this research on the laws applicable to intellectual property license contracts under the Rome I Regulation suggests more systematic and effective solutions for future disputes in which Korea and the EU countries play the significant role as the connecting factors in the conflict of laws rules. Moreover, it helps to establish comprehensive and theoretical understanding of applying the Korean Private International Law to multifarious choice-of-law cases.

A Cohort Study of Mental, Physical and Behavioral Impacts of Early(at Age 55) Compulsory Retirement in Korea (조기 정년퇴직자의 정신. 육체. 행위적 경향연구)

  • Duk-Sung Kim;Sae-Kwon Kong;Kong-Kyun Ro
    • Korea journal of population studies
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    • v.11 no.1
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    • pp.204-229
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    • 1988
  • This paper documents and discusses trends and differentials in youth's participation in the labor force and employment. Youth in this study is defined asthe young aged 15-29. Youth passes through a series of life-course transitions,which include school completion own family formation(marriage and childbirth) .mandatory service in the army (by males) , and their economic activities are affectedby those life-course events. Accordingly we show how and to what extent youth'slabor force participation and employment varies with age and how the age patternhas changed over time.Throughout the 1980's and 1990's, youth's labor force participation showeddifferent trends by age group Labor fDrce participation rate of the 15-19 agedsteeply decreased, while that of the 25-29 steadily increased during the twodecades, the rate fsr the 20-24 aged showing not much variation. The former is dueto the increased rate of school enrollment among the age group, while the lattercould be attributed, in part, to the young women s increased and more steadyparticipation in the labor force over time.While labor force participation could be considered as a result of one's choicesand preferences, employment opportunities are more or less restricted by labormarket structure and institutions . This study documents how the structuralconstraints have interacted with individual and group attributes to differentiateemployment opportunities between individuals (educational background) and groups(especially sex diffrences) . One of the most salient feature of youth's em[ploymentstructure is the recent high unemployment rate of the college graduates. We discusshow that is related to the'credential society'in which one's educational credentials and it's social status play major role in determining who gets what in terms of job opportunities. Also is discussed the discordance between school and labor marketsupply and demand system, which is apparent in the prolonged oversupply of thecollege graduates, which is due to the consistently high rate of college entranceobserved since the early 1980's. Theoretically the job market for college graduates isviewed not as the'neoclassical'wage competition market but as job competition market in which one's (good) job opportunity is determined by one s position in thejob queue, which is in turn heavily dependent on from which college one get shis/her college degree as well as one's sex.

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An Investigation of the Delivery of Public Rental Housing in Redevelopment Site in Korea (재개발임대주택 공급제도의 도입상황 및 특징분석)

  • Park, Shinyoung
    • Land and Housing Review
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    • v.12 no.3
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    • pp.51-65
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    • 2021
  • There were strong criticisms against the joint development method: the redevelopment corporation and developers would achieve the whole development profit. The existing tenants who lost their housing in the site argued their right to reside in the site after the development was completed. There was also strong political pressure that the Roh Tae-woo governing administration should resolve the social inequality caused by the situation. In such circumstances, it was introduced that a certain proportion of public rental housing should be built in the redevelopment site; then the government took over the dwellings at a price of construction and allocated them to the existing tenants. The aims of this paper are to understand the rationale behind the inclusion of the public rental housing in the redevelopment sites; and to investigate to what extent the legislation was implemented appropriately. Although the legislation was introduced in Seoul from August 1989, it was not until May 2005 when it was implemented nationwide. At the beginning, there was an ambiguous rule that the number of public housing to be included should be limited to the number of households who would want to remain in the redeveloped site. In 2005 the Seoul metropolitan authority introduced a mandatory proportion; 17% of the total housing delivered in the site should be public rental homes. Since then the proportion. The proportion has been fluctuated by the political agenda of each ruling party: the conservative tended to reduce the proportion, whilst the opposition parties increased the proportion. Currently the proportion is 20% of the total stock to be built. Initially the size of the public housing was exceptionally small- less than 40 m2 but it has increased up to 60 m2 since 2010. The rental price was reasonably lower than market rent. The competition toward redevelopment rental housing that are vacant due to move or death of tenants was very high; it was given to one household out of nine eligible households in 2020.

The structural analysis and design methods considering joint bursting in the segment lining (조인트 버스팅을 고려한 세그먼트 라이닝 구조해석 및 설계방법)

  • Kim, Hong-Moon;Kim, Hyun-Su;Jung, Hyuk-Il
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.20 no.6
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    • pp.1125-1146
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    • 2018
  • Segment lining applied to the TBM tunnel is mainly made of concrete, and it requires sufficient structural capacity to resist loads received during the construction and also after the completion. When segment lining is design to the Limit State Design, both Ultimate Limit State (ULS) and Service Limit State (SLS) should be met for the possible load cases that covers both permanent and temporary load cases - such as load applied by TBM. When design segment lining, it is important to check structural capacity at the joints as both temporary and permanent loads are always transferred through the segment joints, and sometimes the load applied to the joint is high enough to damage the segment - so called bursting failure. According to the various design guides from UK (PAS 8810, 2016), compression stress at the joint surface can generate bursting failure of the segment. This is normally from the TBM's jacking force applied at the circumferential joint, and the lining's hoop thrust generated from the permanent loads applied at the radial joint. Therefore, precast concrete segment lining's joints shall be designed to have sufficient structural capacity to resist bursting stresses generated by the TBM's jacking force and by the hoop thrust. In this study, bursting stress at the segment joints are calculated, and the joint's structural capacity was assessed using Leonhardt (1964) and FEM analysis for three different design cases. For those three analysis cases, hoop thrust at the radial joint was calculated with the application of the most widely used limit state design codes Eurocode and AASHTO LRFD (2017). For the circumferential joints bursting design, an assumed TBM jack force was used with considering of the construction tolerance of the segments and the eccentricity of the jack's position. The analysis results show reinforcement is needed as joint bursting stresses exceeds the allowable tensile strength of concrete. This highlights that joint bursting check shall be considered as a mandatory design item in the limit state design of the segment lining.

A Study on Risk Factor Identification by Specialty Construction Industry Sector through Construction Accident Cases : Focused on the Insurance Data of Specialty Construction Worker (건설재해사례 분석에 의한 전문건설업종별 위험요인 탐색 : 전문건설업 근로자 공제자료를 중심으로)

  • Lee, Young Jai;Kang, Seong Kyung;Yu, Hwan
    • Journal of Korea Society of Industrial Information Systems
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    • v.24 no.1
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    • pp.45-63
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    • 2019
  • The number of domestic construction company is expanding every year while the construction workers' exposure to disaster risk is increasing due to technological advancements and popularity of high-rise buildings. In particular, the industry faces greater fatalities and severe large scale accidents because of construction industry characteristics including influx of foreign workers with different language and culture, large number of aged workers, outsourcing, high place work, heavy machine construction. The construction industry is labor-intensive, which is to be completed under given timeline and consists of unique working environment with a lot of night shifts. In addition, when a fixed construction budget is not secured, there is less investment in safety management resulting in poor risk management at the construction site. Taking account that the construction industry has higher accident risk rate and fatality rate, risky and unique working environment, and various labor pool from foreign to aged workers, preemptive safety management through risk factor identification is a mandatory requirement for the construction industry and site. The study analyzes about 8,500 cases of construction accidents that occurred over the past 10 years and identified risk factor by construction industry sector to secure a systematic insight for risk management. Based on interrelation analysis between accident types, work types, original cause materials and assailing materials, there is correlation between each analysis factor and work industry. Especially for work types, there is great correlation between work tasks and industry type. For reinforced concrete and earthwork are among the most frequent types of accidents, and they are not only high in frequency of accidents, but also have a high risk in categories of occurrence.

Evolution of Aviation Safety Regulations to cope with the concept of data-driven rulemaking - Safety Management System & Fatigue Risk Management System

  • Lee, Gun-Young
    • The Korean Journal of Air & Space Law and Policy
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    • v.33 no.2
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    • pp.345-366
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    • 2018
  • Article 37 of the International Convention on Civil Aviation requires that rules should be adopted to keep in compliance with international standards and recommended practices established by ICAO. As SARPs are revised annually, each ICAO Member State needs to reflect the new content in its national aviation Acts in a timely manner. In recent years, data-driven international standards have been developed because of the important roles of aviation safety data and information-based legislation in accident prevention based on human factors. The Safety Management System and crew Fatigue Risk Management Systems were reviewed as examples of the result of data-driven rulemaking. The safety management system was adopted in 2013 with the introduction of Annex 19 and Chapter 5 of the relevant manual describes safety data collection and analysis systems. Through analysis of safety data and information, decision makers can make informed data-driven decisions. The Republic of Korea introduced Safety Management System in accordance with Article 58 of the Aviation Safety Act for all airlines, maintenance companies, and airport corporations. To support the SMS, both mandatory reporting and voluntary safety reporting systems need to be in place. Up until now, the standard of administrative penal dispensation for violations of the safety management system has been very weak. Various regulations have been developed and implemented in the United States and Europe for the proper legislation of the safety management system. In the wake of the crash of the Colgan aircraft, the US Aviation Safety Committee recommended the US Federal Aviation Administration to establish a system that can identify and manage pilot fatigue hazards. In 2010, a notice of proposed rulemaking was issued by the Federal Aviation Administration and in 2011, the final rule was passed. The legislation was applied to help differentiate risk based on flight according to factors such as the pilot's duty starting time, the availability of the auxiliary crew, and the class of the rest facility. Numerous amounts data and information were analyzed during the rulemaking process, and reflected in the resultant regulations. A cost-benefit analysis, based on the data of the previous 10 year period, was conducted before the final legislation was reached and it was concluded that the cost benefits are positive. The Republic of Korea also currently has a clause on aviation safety legislation related to crew fatigue risk, where an airline can choose either to conform to the traditional flight time limitation standard or fatigue risk management system. In the United States, specifically for the purpose of data-driven rulemaking, the Airline Rulemaking Committee was formed, and operates in this capacity. Considering the advantageous results of the ARC in the US, and the D4S in Europe, this is a system that should definitely be introduced in Korea as well. A cost-benefit analysis is necessary, and can serve to strengthen the resulting legislation. In order to improve the effectiveness of data-based legislation, it is necessary to have reinforcement of experts and through them prepare a more detailed checklist of relevant variables.