• Title/Summary/Keyword: general causation

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Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion

  • Cushman, Taylor R.;Haque, Waqar;Menon, Hari;Rusthoven, Chad G.;Butler, E. Brian;Teh, Bin S.;Verma, Vivek
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.97.1-97.12
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    • 2018
  • Objective: Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods: The National Cancer Database was queried for patients ${\geq}70$ years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

Legal Interest in Damages Regarding Loss of Treatment Chance (치료기회상실로 인한 손해배상에 있어서 피침해법익)

  • Eom, Bokhyun
    • The Korean Society of Law and Medicine
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    • v.20 no.3
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    • pp.83-139
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    • 2019
  • Recognition of liability for damages due to medical malpractice has been developed largely on the basis of two paths. First is the case where there is an error in a physician's medical practice and this infringes upon the legal interests of life and body, and the compensation for monetary and non-monetary damages incurred from such infringement on life and body becomes an issue. Second is the case where there is a breach of a physician's duty of explanation that results in a infringement on the patient's right of autonomous decision, and the compensation for non-monetary damages incurred from such infringement becomes an issue. However, even if there is a medical error, since it is difficult to prove the causation between the medical error of a physician and the infringement upon legal interests, the physician's responsibility for damage compensation is denied in some cases. Consider, for example, a case where a patient is already in the final stage of cancer and has a very low possibility of a complete recovery even if proper treatment is received from the physician. Here, it is not appropriate to refuse recognition of any damage compensation based on the reason that the possibility of the patient dying is very high even in the absence of a medical error. This is so because, at minimum, non-monetary damage such as psychological suffering is incurred due to the physician's medical error. In such a case, our courts recognize on an exceptional basis consolation money compensation for losing the chance to receive proper treatment. However, since the theoretical system has not been established in minutiae, what comes under the benefit and protection of the law is not clearly explicated. The recent discourse on compensating for damages incurred by patients, even when the causation between the physician's medical error and infringement upon the legal interests of life and body is denied, by establishing a new legal interest is based on the "legal principle of loss of opportunity for treatment." On what should be the substance of the new legal interest, treatment possibility argument, expectation infringement argument, considerable degree of survival possibility infringement argument and loss of opportunity for treatment argument are being put forth. It is reasonable to see the substance of this protected legal interest as "the benefit of receiving treatment appropriate to the medical standard" according to the loss of opportunity for treatment argument. The above benefit to the patient is a value inherent to human dignity that should not be infringed upon or obstructed by anyone, and at the same time, it is a basic desire regarding life and a benefit worthy of protection by law. In this regard, "the benefit of receiving treatment appropriate to the medical standard" can be made concrete as one of the general personal rights related to psychological legal interest.

The safety, immunological benefits, and efficacy of ginseng in organ transplantation

  • Lim, Sun Woo;Luo, Kang;Quan, Yi;Cui, Sheng;Shin, Yoo Jin;Ko, Eun Jeong;Chung, Byung Ha;Yang, Chul Woo
    • Journal of Ginseng Research
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    • v.44 no.3
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    • pp.399-404
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    • 2020
  • Korean ginseng (Panax ginseng) is associated with a variety of therapeutic effects, including antioxidative, anti-inflammatory, vasorelaxative, antiallergic, antidiabetic, and anticancer effects. Accordingly, the use of ginseng has reached an all-time high among members of the general public. However, the safety and efficacy of ginseng in transplant recipients receiving immunosuppressant drugs have still not been elucidated. Transplantation is the most challenging and complex of surgical procedures and may require causation for the use of ginseng. In this regard, we have previously examined the safety, immunological benefits, and protective mechanisms of ginseng with respect to calcineurin inhibitor-based immunosuppression, which is the most widely used regimen in organ transplantation. Using an experimental model of calcineurin inhibitor-induced organ injury, we found that ginseng does not affect drug levels in the peripheral blood and tissue, favorably regulates immune response, and protects against calcineurin inhibitor-induced nephrotoxicity and pancreatic islet injury. On the basis of our experimental studies and a review of the related literature, we propose that ginseng may provide benefits in organ transplant recipients administered calcineurin inhibitors. Through the present review, we aimed to briefly discuss our current understanding of the therapeutic benefits of ginseng related to transplant patient survival.

SEASON OF BIRTH, BIRTH ORDER AND MATERNAL AGE IN INFANTILE AUTISM (유아(幼兒) 자폐증(自閉症)의 출생계절(出生季節), 출생순위(出生順位)및 산모연령(産母年齡)에 관한 연구(硏究))

  • Lee, Young-Sik;Min, Kyung-Joon;Choi, Jin-Sook;Kim, Dong-Hyun;Cho, Soo-Churl;Lee, Kil-Hong;Hong, Kang-E
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.4 no.1
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    • pp.46-53
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    • 1993
  • To find some involvement of environmental factors in autism, season of birth, birth order, and maternal age at birth of autistic children were investigated Total number of clinical outpatient autistic children was 357, which consisted of 319 male and 38 female, then male-to-female sex ratio was 8.4 to 1, and all subjects were born during $1986{\sim}1988.$ These data were compared with those of controlled general populations. The results were as follows : 1) In monthly and seasonal distributions of birth, autistic children were not different from normal control 2) Comparing with control group by Slater's and Greenwood-Yule's birth order calculation methods, there was no significant difference in birth order of autistic children 3) The maternal ages at birth in autistic group were significantly higher than those of control group(P<01) 4) High-risk pregnancies were significantly frequent in autistic group compared with control group(p<01)Our study supported the idea that at least some environmental factors, especially at-risk pregnancy, are involved in autism causation.

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Implementation Techniques for the Seafarer's Human Error Assessment Model in a Merchant Ship: Practical Application to a Ship Management Company (상선 선원의 인적과실 평가 모델 구축기법: 선박관리회사 적용 실례)

  • Yim, Jeong-Bin
    • Journal of Navigation and Port Research
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    • v.33 no.3
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    • pp.181-191
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    • 2009
  • In general, seafarer's human error is considered to be the preponderant muse for the majority of maritime transportation accidents in a merchant ship. The implementation techniques for Human Error Model (HEM) to assess possible accident risk by deck officers including captain, chief officer, second mate and third mate are described in this study. The scope of this work is focused to 642 deck officers in the ship management company with 130 vessels. At first, HEM can be constructed through the statistical analysis and expert's brainstorming process with human data to 642 deck officers. Then the variables $\upsilon$ for the human factors, the evaluation level EP($\upsilon$) for $\upsilon$, the weight $\alpha$ of $\upsilon$, and the title weight $\beta$ of each deck officers can be decided. In addition, through the analysis of ship's accident history, the accident causation ratios by human error ${\gamma}_H$ and by external error ${\gamma}_B$ can be found as 0.517(51.7%) and 0.483(48.3%), respectively. The correlation coefficients to $\upsilon$ are also shown significant for a 95% confidence interval (p < 0.05) for each coefficient. And the validity of HEM is also surveyed by the analysis of normal probability distribution of risk level RL to each deck officer.

A Influence Effect of Mid-life Religious Life and Faith Maturity on the Couples' Life Satisfaction (중년기 종교 활동과 신앙성숙도가 부부생활만족도에 미치는 영향분석연구)

  • Jeong, Jin-O;Byeon, Sang-Hae;Kim, Jong-Su
    • 한국벤처창업학회:학술대회논문집
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    • 2009.10a
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    • pp.265-288
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    • 2009
  • The study has found that the main reasons affecting to the mature conjugal relations of middle-aged persons are closely related with sede factors brought about after marriage. Comparatively the factors before marriage have more or less weak power on the conjugal relations. They are mature relations wp between husbands and wives, stable and enough incede, and religious activities, which have deep relations with the satisfactory conjugal relations. C. G. Jung divided the whole life span as self-assuredness period in the first half and self-convergence period in the second half. The first is the period when one does his or her best to get external and physical self. On the contrary, the second is the middle-aged period one finds his or her meaning of life in the religious, philosophical, intuitional, and spiritual world, which lead life into harmony and integration. Therefore if one overcomes some psychological crisis related with middle-aged development he or she can enjoy happy senescence(old age). The study has suggested through literature investigation the definition of middle age and the developmental traits of middle age, and the relations between religions and conjugal relations of middle-aged husbands and wives. Futhermore, it has analyzed the theories which religions have close relations with the life satisfaction of middle-aged conjugal relations. In order to give an analysis the influence of the variable of religious activities and religious maturity, with the degree of conjugal satisfaction, 400 middle age are selected as the object of the study whose ages are ranging from 35 years to 60 years, and who reside in Seoul or near Seoul. They were asked to fill out the questionnaires asking about religious activities, religious maturity, and the conjugal satisfaction from March 25th to April 30th, 2009. The results of the survey have been statistically processed and analyzed. First, the higher religious maturity gives positive influence on the general religious activities including public service, human relations, and spiritual stability. That is, this result indicates that the individual, spiritual, and formal religious activities give to a degree influence on the religious maturity. Second, the maturity of religious life resulting from religious activities has a causation with the satisfaction of conjugal life. In more details, religious activities has a positive influence on the satisfaction of conjugal life(T=31.36, p<.001) In more details, religious activities has a positive influence on the religious maturity(T=31.36, p<.001), and religious activities has a positive influence on the satisfaction of conjugal life(T=33.81, p<.001), and the religious maturity has a positive influence on the satisfaction of conjugal life(T=28.64, p<.001) Third, as we analyze the main effects which religious activities and the religious maturity could give influence on the satisfaction of conjugal life, it is found that both religious activities(F=15.95, p<.001) and the religious maturity(F=23.94, p<.001) give a positive influence on the satisfaction of conjugal life. In conclusion, it is sure that religious activities and the religious maturity have a close relations with the satisfaction of conjugal life. Therefore it can be said that religious activities at the protestant religion, buddhism, and catholic religion can give an important influence on the satisfaction of middle-aged conjugal life.

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