Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 492 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p < 0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (1.5% in Off-Pump CABG versus 1.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p <0.05), lower rate of usage of inotropics (p < 0.05), shorter mean ventilation time (p <0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p < 0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.
Earthquake Hazard Mitigation Law was activated into force on March 2009. By the law, the obligation to monitor the effect of earthquake on the facilities was extended to many organizations such as gas company and local governments. Based on the estimation of National Emergency Management Agency (NEMA), the number of free-surface acceleration stations would be expanded to more than 400. The advent of internet protocol and the more simplified operation have allowed the quick and easy installation of seismic stations. In addition, the dynamic range of seismic instruments has been continuously improved enough to evaluate damage intensity and to alert alarm directly for earthquake hazard mitigation. For direct visualization of damage intensity and area, Real Time Intensity COlor Mapping (RTICOM) is explained in detail. RTICOM would be used to retrieve the essential information for damage evaluation, Peak Ground Acceleration (PGA). Destructive earthquake damage is usually due to surface waves which just follow S wave. The peak amplitude of surface wave would be pre-estimated from the amplitude and frequency content of first arrival P wave. Earthquake Early Warning (EEW) system is conventionally defined to estimate local magnitude from P wave. The status of EEW is reviewed and the application of EEW to Odesan earthquake is exampled with ShakeMap in order to make clear its appearance. In the sense of rapidity, the earthquake announcement of Korea Meteorological Agency (KMA) might be dramatically improved by the adaption of EEW. In order to realize hazard mitigation, EEW should be applied to the local crucial facilities such as nuclear power plants and fragile semi-conduct plant. The distributed EEW is introduced with the application example of Uljin earthquake. Not only Nation-wide but also locally distributed EEW applications, all relevant information is needed to be shared in real time. The plan of extension of Korea Integrated Seismic System (KISS) is briefly explained in order to future cooperation of data sharing and utilization.
There has been no general agreement about optimal time for nerve surgery in the closed brachial plexus injury(BPI). From our early experiences, we knew by chance that spontaneous recovery in BPI patients may begin even later than 8 months after injury. Authors' strategy, which was based on our early experiences, for the treatment of closed fresh injury was 'wait and see' unlit 8 months after injury. From 1985 to 1994, we observed 103 patients with BPI. All of them did not have any operation until 8 months after injury. There were 95 men and 8 women with a mean age of 29 years. Motorcycle injury(31%) and vehicle accident(28%) were main causes of injury. Whole plexus types were observed in 56 patients(54%), upper plexus types in 29(28%), lower plexus types in 3(3%), and infraclavicular types in 15(15%). Electromyography was performed in all patients. This was repeated every three months to detect the recovery. Results were evaluated by authors' criteria, in which AMA system of brachial plexus impairment was modified. Duration of follow up was average 25 months. 47 patients(46%) showed spontaneous improvement, which was initially detected at average 7.8 months(range,3 months-16 months) after trauma by electromyography. The average score of these 47 patients improved from 14.8 points to 39.8 points.31 patients(30%) had nerve surgery such as nerve graft, neurotization or neurolysis. Average duration from injury to nerve surgery, was 10 months. Among 31 patients who had nerve surgery, 16 patients improved from preoperative 21.5 points to postoperative 36.3 points in average. Because spontaneous recovery began in average 7.8 months after injury, we think that it would be better to 'wait and see' for at least one year in patients with closed BPI expecting spontaneous recovery.
The Korean distribution industry is gearing up for an endless competition. Greeting low growth era, less competitive parties will be challanged seriously for their survival. But for large discount stores, they have shown steady annual growth for years. However, because of the saturation for numbers of stores, the difficulty of gaining new sites, and the changes in the consumer's consumption behavior caused by the recession, now they are seeking for a new customers-based business formats. Accordingly, a large corporate comopanies made supermarkets which are belonged to affiliated companies of large corporate comopanies. They based on the strong buying power, focused on SSM(Super Super Market) ave been aggressively develop nationwide multi-stores. The point is that these stores are threatening at small and medium-sized, community-based private supermarkets. Private supermarkets and retailers, who are using existing old operation systems and their dilapidated facilities, are losing a competitive edge in business. Recent the social effects of large series of corporate supermarkets for traditional markets has been very controversial, and commercial media, academia, and industry associated with it have been held many seminars and public hearings. This may slow down the speed in accordance with the regulations, but will not be the crucial alternative. The reason for this recent surge of enterprise-class SSM up, one of the reasons is a stagnation in their offline discount mart, so they are finding new growth areas. Already in the form of large supermarkets across the country got most of the geographical centre point and is saturated with stages. Targeting small businesses that do not cover discount Mart, in order to expand business in the form of SSM is urgent. By contrast, private supermarkets are going to lose their competitiveness. The vulnerability of individual supermarkets, one of the vulnerabilities is price which economies of scale can not be realized so they are purchasing a small amount of products and difficult to get a quantity discount. The lack of organization and collaboration, and education which is not practical, caused the absencer of service-oriented situations. As a first solution, making specialty shops which are handling agricultures, fruits and vegetables and manufactured goods is recommended. Second, private supermarkets franchisees join the organization for the organization and collaboration is recomaned. It can be meet the scale of economy and can be formed a alternative business formats to a government. Third, the education is needed as a good service will get consumer's awareness. In addition, a psychological stores operating is also one way to stimulate consumer sentiment as SSM can't operate. Japan already has a better conditions of their lives through small chain expression. This study includes the vulnerabilities of private supermarkets, and suggests a competitiveness reinforcement strategies.
Travel by airplane using airport in globalized modern society is familiar to our life but such airport can be a target of terrorists who would threaten our safety. However, aviation terrorism which is represented by 9.11 terror gives horror beyond our imagination to modern people. Since the first airplane hijacking in Peru in 1931 happened, security organization in each nation has taken various prevention measures to block aviation terrorism. The most realistic measures to prevent aviation terrorism would be security check activity to control approach of terrorist that passengers on airplane and cargos are checked to find out dangerous article like explosive etc. But security check activity in Korea shifted to security check activity focused on private security for efficiency of airport operation differently from security check activity in advanced countries where public interests is strengthened according to risk of terror after 9.11 system. That is, since Incheon airport opened in March 2001, security check system focused on the police was changed. Now Incheon international airport Corporation instructs and supervises security check job and private security personnel are in charge of actual security check activity. But this check system has limitation in blocking terror activity by terrorists which is systematized and intelligent as time passes due to deteriorated job satisfaction of private security personnel and confusing supervising system. Accordingly, it is suggested to introduce risk management skill which is one of management strategy of private corporation for security check activity to prevent terror activity. With this skill, risk factors of aviation terror are identified and analyzed regularly, and each process such as setting of priority, activity to reduce risk, and assessment of security is carried out. And it would be necessary to do efforts, for example, to properly change level of security check according to threat of terror such as to place policeman at airport security in case threat of terror is severe. On the other hand, it is necessary to establish national police organization for good communication of security check activity in field and supervising function, which can encourage systematization and specialization of aviation security job.
Recently, thoracic sympathicotomy for craniofacial hyperhidrosis (FH) is increasingly avoided contrast to palmar hyperhidrosis. We recently demonstrated that selective T2 sympathicotomy for FH in woman might be recommended because of differences of the postoperative satisfaction between man and woman. Therefore, this study was designed to analyze the postoperative long term results, evaluate the effectiveness of T2 sympathicotomy and establish the new strategy in treatment of FH in woman. Material and Method: From May 1998 to July 2001, 27 cases of FH in woman that were performed T2 sympathicotomy and minimum 2 years have passed since then at the follow up period. Among them, 20 cases were evaluated by telephone review and medical record. Bilateral sympathetic trunks were severed on the 2nd rib with 2mm thoracoscopic instruments. 7 patients combined with gustatory sweating (GS). Ages ranged from 25 to 62 (mean age, 46.4 years). Result: All patients were relieved of symptom immediately after operation. At postoperative 1 week, all patients were satisfied: 15 patients, “very satisfaction” and 5 patients, “relatively satisfaction”. However, during long term follow up period (from 25 to 63 months postoperatively), 9 patients (45%) were relatively satisfied, 8 patients (40%) complained that there was no difference of postoperative satisfaction and 3 patients (15%) complained of non satisfactory results (regret for surgery). 16 patients (80%) had complaint of uncomfortable feeling because of postoperative GS. Some degree of compensatory sweating (CS) had occurred in all patients: severe 10 patients (50%), severe but acceptable 6 patients (30%), and just conventional 4 patients (20%). The sites of CS were trunk, back, axilla and extremities. Conclusion: Thoracoscopic T2 sympathicotomy is relatively considerable method for FH in woman and the postoperative satisfaction depends on GS and the degree of individual adaptation for CS. Therefore, it is required that the prediction of preoperative risk factors for GS and CS and then careful selection of patients to increase the postoperative satisfaction, and the development of acceptable new treatment modalities.
Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.
Journal of The Korean Association For Science Education
/
v.24
no.3
/
pp.442-458
/
2004
This study was conducted to develop a plan for a large-scale implementation of the Girl Friendly Science Program based on the results of analysis and investigation of its current pilot implementation, Girl Friendly Science Program materials, which was first developed in 1999 with the support from Ministry of Gender Equality, consist of 1) five theme-based units that are specifically targeted individual students' unique ability, aptitude, and career choice, and 2) differentiated learning materials for 7th through 10th grade female students. All the materials are available at the homepage (http://tes.or.kr/gfsp.cgi) of 'Teachers for Exciting Science(the organization of science teachers in Seoul area)'. Since the materials are well organized by topic and grade level and presented in both Korean word process document and html format, anyone can easily access to the materials for their own instructional use. Ever since its launch the number of visitors to the homepage has been constantly increasing. The evaluation results of the current pilot implementation of the materials that targeted individual students' ability and aptitude showed that it scored high in terms of its alignment to the original purpose, content, level, and effectiveness to implement in classrooms. However, its evaluation scores were low in terms of the convenience for teachers to guide the materials, and its organization and operation. The results also showed a significant change in students' perception of science, and students' positive experiences of science through various interdisciplinary activities. On the other hand, the evaluation of students' experiences with the materials showed that students' assessment about an activity was largely depending on a success or failure of their experiences. Overall, students' evaluation of activities scores were low for simple activities such as cutting off or pasting papers. According to students' achievement test results, differences between pre and post test scores in the Affective Domain was statistically significant (p<0.05), but not in Inquiry Domain. Based on teachers observations, numerous schools where have run this program reported that students' abilities to cooperate, discuss, observe and reason with evidences were improved. In order to implement this program in a larger scale, it is critical to have a strong support of teachers and induce them to change their teaching strategy through building a community of teachers and developing ongoing teacher professional development programs. Finally, there still remain strong needs to develop more programs, and actively discover and train more domestic woman scientists and engineers and collaborate with them to develop more educational materials for girls in all ages.
This study has estimated Gyeongju National Park's natural environment and cultural relic value in the same way and then been performed to compare the size of the value. Representative method to measure environmental property is contingent valuation methods, CVM. The variables and estimated models adopted for the calculation were same and the respondents were asked by distinguishing between the amount which they would pay to preserve the natural environment and that which they were willing to pay to preserve the cultural relics. As the result, WTP(Willing to pay), the amount that they were willing to pay to preserve the natural environment of Gyeongju National Park was 17,838 won per person and that to preserve the cultural relics appeared to be 316,248 won per person. Based on this, it was estimated that the value of the natural environment with which Gyeongju National Park provided annual visitors was 47 billion won and that the annual value of the cultural relics was 845.7 billion. If the natural environment and the cultural relics value elements are united, it can be estimated that the natural environment and cultural relic value got at the time of people's first visit to Gyeongju National Park is 334,086 won and that the annual value is 893.4 billion won. In this study, the value of the cultural relics has been estimated 18 times higher than that of the natural environment. This reason was that visitors judged that a total of 66 cultural properties including 11 national treasures, 23 treasures, 13 historic places, one historic sites and scenic spot and 18 local cultural properties, etc. which were distributed in Gyeongju National Park were worth far more than the natural environment. Based on the result of this study, the operating management plan of Gyeongju National Park should include a differentiated operation strategy through consultation with relevant experts by taking into account characteristics of the physical components.
This study is aimed to analyze problems of police budgetary execution and to suggest better ways for establishing effective budget implementation as well as legitimacy of securing budget in the field of police work. For this purpose, this paper analyzed the annual reports on police budgetary execution, from 2009 to 2012, conducted by National Assembly Budget Office. In result, most parts of the police budgetary execution were not satisfied with the audit standard, and especially in terms of management of budgetary execution, it showed 40% in inappropriateness. In addition, excessive and underestimate appropriation in the police budgetary execution, which happened frequently in other offices, was recorded on the second place. 10% of the amount of budget was executed for ordinance violence. Given results analyzed from each division, Transportation Division occupied 40% of the amount of related problems and all of types in the field did not meet the audit standard, thus it is required to manage budgetary execution effectively. In terms of Public Safety Division, the problem was related to budgetary allocation prior to execution, such as overlap in other works, excessive and underestimate appropriation, and inappropriate business plans. Director General for Planning and Coordination did not meet the standard of law system maintenance, Given the light of the result of analyzing programs, traffic safety and securing communication was the most problematic and support for police administration, crime prevention and protecting the disadvantaged, educating professional police officers, and establishment of policing infrastructure were required to be reformed in sequence. In order to resolve these problems, it is demanded to check budgetary execution and the process in business plans on a regular basis. Additionally, in case of using budget in inappropriate parts, tough penality including reduction of budget in related to the local police should be implemented to increase the importance of budgetary execution. Moreover, because of the fact that a part of problem of budgetary execution was originally caused by the budgetary allocation, it is advised to allocate police budget using the budget proposal of National Finance Act and Ministry of Strategy and Finance.
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