• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.1
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• pp.104-112
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• 2022

Backgrounds/Aims: In moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up. Methods: We reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared. Results: TSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan-Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004). Conclusions: In moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.

• Journal of Science Education
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• v.48 no.2
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• pp.121-129
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• 2024

There are many expectations and concerns regarding the introduction of the high school credit system as an educational innovation. To address concerns about the management of science courses in the high school credit system, we analyzed the characteristics of Alabama's science curriculum to identify potential implications. By analyzing Alabama's science curriculum, curriculum guide, and high school curriculum catalog of Madison City Schools, we found that, first, the system offers a variety of science subjects and operates on a non-graded basis. Second, the curriculum provides essential college and career preparation for all students in grades 9~12. Third, it consistently covers the same academic core ideas across grade levels in a logical progression. Fourth, it emphasizes interdisciplinary connections to enhance science and engineering literacy. The implications of these findings for managing science courses in Korea's high school credit system are, first, that Korea's system lacks course diversity compared to the U.S., making it is necessary to offer a wider variety of courses. Second, students should be guided to choose science subjects aligned with their career paths. Third, a hierarchy of science subjects should be established to reduce the burden between courses. Fourth, consideration should be given to interdisciplinary connections with other subjects to foster students' scientific literacy. Based on these suggestions, it is necessary to explore the appropriate provision of science courses in the Korean high school credit system.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.1
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• pp.50-61
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• 2023

Objective: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. Methods: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. Results: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. Conclusions: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

• The Korean journal of internal medicine
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• v.39 no.4
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• pp.603-611
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• 2024

Background/Aims: There is limited knowledge regarding the management of duodenal subepithelial lesions (SELs) owing to a lack of understanding of their natural course. This study aimed to assess the natural course of asymptomatic duodenal SELs and provide management recommendations. Methods: Patients diagnosed with duodenal SELs and followed up for a minimum of 6 months were retrospectively investigated. Results: Among the 443,533 patients who underwent esophagogastroduodenoscopy between 2008 and 2020, duodenal SELs were identified in 0.39% (1,713 patients). Among them, 396 duodenal SELs were monitored for a median period of 72.5 months (interquartile range, 37.7-111.3 mo). Of them, 16 SELs (4.0%) showed substantial changes in size or morphology at a median follow-up of 35.1 months (interquartile range, 21.7-51.4 mo). Of these SELs with substantial changes, tissues of two SELs were acquired using endoscopic ultrasound-guided fine needle aspiration biopsy: one was a lipoma and the other was non-diagnostic. Three SELs were surgically or endoscopically removed; two were diagnosed as gastrointestinal stromal tumors, and one was a lipoma. An initial size of 20 mm or larger was associated with substantial changes during follow-up (p = 0.016). Conclusions: While the majority of duodenal SELs may not exhibit substantial interval changes, regular follow-up with endoscopy may be necessary for cases with an initial size of 20 mm or larger, considering a possibility of malignancy.

• Journal of Technology Innovation
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• v.5 no.2
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• pp.1-21
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• 1997

The objective of this paper is to think about what structural reforms of the Korean government S&T development management system might be. Korean society is currently experiencing a drastic socio-economic transformation. The results of this transformation should be reflected on the determining process of the directions and breadths of structural reforms of government S&T development management system. Because the government system design will be based on the premises of socio-economic conditions under which administrative activities perform and also this socio-economic changes can influence on changes of the premises of government management system design. Moreover, S&T development management system is a subsystem of government system so that the directions of structural reform of those subsystems should be considered in the broad framework changes in the development management system of the government. For the last forty years, the Korean government S&T development management system has been based on the premises including transformation from an agrarian society to an industrial society, authoritarianism and centrally controlled institutions, and exteremely small portions of private investments for science and thechonology R & D of the total. Recently, however, the premises of Korean government S&T development management system have rapidly changed. the characteristics of these changes are including tranformation from an industrial society to a knowledge and information intensive society, globalization, localization, and relatively large portion of private investments for science and technology R & C of the total. The basis of government reforms in Korea was the realization of the performances and values through the enhancement of national competitive capacity, attainment of lean government, decentralization and autonomy. However, the Korean government has attached a symbolic value of strategic organizations representing strong policy intentions of government for the science and technology based development. Most problems associated with the Korean government S&T development management system have grown worse during 1990s. Many people perceive that considerable part of this problem was generated because the government could not properly adapt itself to new administrative environment and the paradigm shift in its role. First of all, the Korean government S&T development management system as a whole failed to develop an integrated vision under which processes in formulating science and thechology development goals and developing consistent government plans concerning science and technology development are guided. Second, most of the local governments have little organizational capacity and manpowers to handle localized activities to promote science and technology in their regions. Third, the measure to coordinate and set priorities to invest resources for the development of science and technology was not effective. Fourth, the Most has been losing its reputation as the symbol of ideological commitment of the top policy maker to promote science and technology. Various ideas to reform government S&T development management system have been suggested recently. Most frequently cited ideas are as follow : (ⅰ)strengthen the functions of MoST by supplementing the strong incentive and regulatory measures; (ⅱ)create a new Ministry of Education, Science & Technology and Research by merging the Ministry of Education and the MoST; (ⅲ)create a new Ministry of Science & Technology and Industry ; and(ⅳ)create a National Science and Technology Policy Council under the chairmanship of the President. Four alternatives suggested have been widely discussed among the interested parties and they each have merits as well as weaknesses. The first alternative could be seen as an alternative which cannot resolve current conflicts among various ministries concerning priority setting and resource allocation. However, this alternatives can be seen as a way of showing the top policymaker's strong intention to emphasize science and technology based development. Second alternative is giving a strategic to emphasize on the training and supplying qualified manpower to meet knowledge and information intensive future society. This alternative is considered to be consistent with the new administrative paradigm emphasizing lean government and decentralization. However, opponents are worrying about the linkages and cooperative research between university and industry could be weakening. The third alternative has been adopted mostly in nations which have strong basic science research but weak industrial innovation traditions. Main weakness of this alternative for Korea is that Korean science and technology development system has no strong basic science and technology research traditions. The fourth alternative is consistent with new administrative paradigms and government reform bases. However, opponents to this alternative are worried that the intensive development of science and technology because of Korea's low potential research capabilities in science and technology development. Considerning the present Korean socio-economic situation which demands highly qualified human resources and development strategies which emphasizes the accumulations of knowledge-based stocks, I would like to suggest the route of creating a new Ministry of Education, Science & Technology and Research by intergrating education administration functions and science & technology development function into one ministry.

• Journal of Environmental Impact Assessment
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• v.4 no.3
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• pp.41-48
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• 1995

In former times the protection of our environment didn't play an important role due to the fact that emissions and effluents were not considered as serious impacts. However, opinions and scientific measurements meanwhile confirmed that the impacts are more serious than expected. Thus measures to protect our earth has to be taken into consideration. A part of these measures in the Environmental Impact Assessment (EIA). One of the most important parts of the EIA is the collection of basic datas and the following evaluation. Experience out of the daily business of Gerling Consulting Group shows that the content of the EIA has to be revised and enlarged in certain fields. The historical development demonstrated that in areas in which the population and the industrial activities reached high concentration there is a high necessity to develop strict environmental laws and regulations. Maximum values of the concentration of hazardous materials were fixed concerning the emission into and water. Companies not following these regulations were punished. The total amount of environmental offences increased rapidly during the last decade, at least in Germany. During this development the public consciousness concerning environmental affairs increased as well in the industrialized countries. But it could clearly be seen that the development in the field of environmental protection went into the wrong direction. The technologies to protect the environment became more and more sophisticated and terms as: "state of the art" guided more and more to lower emissions, Filtertechnologies and wastewater treatment for example reached a high technical level-but all these sophisticated technologies has one and the same characteristic: they were end-of-the pipe solutions. A second effect was that this kind of environmental protection costs a lot of money. High investments are necessary to reduce the dust emission by another ppm! Could this be the correct way? In Germany the discussion started that the environmental laws reduce the attractivity to invest or to enlarge existing investments within the country. Other countries seem to be not so strict with controlling the environmental laws which means it's simply cheaper to produce in Portugal or Greece. Everybody however knows that this is not the correct way and does not solve the environmental problems. Meanwhile the general picture changes a little bit and we think it changes into the correct direction "End-of-the-pipe" solutions are still necessary but this word received a real negative touch and nobody wants to be brought into connection with this word received a real negative touch and nobody wants to be brought into connection with this word especially in connection with environmental management and safety. Modern actual environmental management starts in a different way. Thoughts about emissions start in the very beginning of the production, they start with the design of the product and modification of traditional modes of production. Basis of these ideas are detailed analyses of products and processes. Due to the above mentioned facts that the public environmental consciousness changed dramatically a continous environmental improvement of each single production plant has to be guarantied. This question is already an important question of the EIA. But it was never really checked in a wholistic approach. Environmental risks have to be taken into considerations during the execution of an EIA. This means that the environmental risks have to be reduced down to a capable risk-level. Environmental risks have to be considered within the phase of planning, during the operation of a plant and after shut down. The experience shows that most of the environmental relevant accidents were and caused by human fault. Even in highly protected plants the human risk-factor can not be excluded during evaluation of the risk-potential. Thus the approach of an EIA has to regard technical evaluations as well as organizational thoughts and the human factor. An environmental risk is a threat to the environment. An analysis of the risk concerning the organizational and human aspect however never was properly executed during an EIA. A possible solution could be to use an instrument as the actual EMAS (Environmental Management System) of the EC for more accurate evaluation of the impact to the environment during an EIA. Organizations or investors could demonstrate by an approved EMAS or even by showing their installment of EMAS that not only the technical level of the planned investment meets the requested standards but as well the actual or planned management is able to reduce the environmental impact down to a bearable level.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.167-173
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• 2013

Purpose: This study is to evaluate the efficacy of the CBCT and EXACTRAC the image on the spine stereotactic body radiation treatment. Materials and Methods: The study compared the accuracy of the dose distribution for changes in the real QA phantom for The shape of the body of the phantom was performed. Novalis treatment artificially set up at the center and to the right, on the Plan 1 mm, 2 mm, 3 mm in front 1 mm, 2 mm, 3 mm and upwards 1 mm, 2 mm, 3 mm and $0.5^{\circ}$ by moving side to side Exactrac error correction and error values of CBCT and plan changes on the dose distribution were recorded and analyzed. Results: Cubic Phantom of the experimental error, the error correction Exactrac X-ray 6D Translation in the direction of the 0.18 mm, Rotation direction was $0.07^{\circ}$. Translation in the direction of the 3D CBCT 0.15 mm Rotation direction was $0.04^{\circ}$. DVH dose distribution using the results of the AP evaluate the change in the direction of change was greatest when moving. Conclusion: ExacTrac image-guided radiation therapy with a common easy and fast to get pictures from all angles, from the advantage of CBCT showed a potential alternative. But every accurate information compared with CT treatment planning and treatment of patients with more accurate than the CBCT ExacTrac the location provided. Changes in the dose distribution in the experiment results show that the treatment of spinal SBRT set up some image correction due to errors at the target and enter the spinal cord dose showed that significant differences appear.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.131-136
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• 2013

Purpose: Quantitative comparative evaluation of the difference in eye lens absorbed dose when measured by MVCT and kV-CBCT, though such a dose was not included in the original IMRT treatment plan for the nasopharyngeal cancer patient. Materials and Methods: We used CT (Lightspeed Ultra 16, General Electric, USA) against an Anderson rando phantom (Alderson Research Laboratories Inc, USA) and established the plan for tomotherapy treatment (Tomotherapy, Inc, USA) and linear accelerator treatment (Pinnacle 8.0, Philips Medicle System) for the achieved CT images on the same condition with the nasopharyngeal cancer patient treatment plan. Then, align the ther-moluminescence dosimeter (TLD100 Harshaw, USA) with the eye lens, shot the lens with Tomotherapy MVCT under 3 conditions (Fine, Normal, and Coarse), and shot both lenses with kV-CBCT under 2 conditions (Low Dose Head and Standard Dose Head) 3 times each. Results: When we analyzed the eye lens absorbed dose according to MVCT and kV-CBCT images by using both Tomotherapy and Pinacle 8.0, we achieved the following result; According to Tomotherapy MVCT, RT 0.8257 cGy in the Coarse mode, LT 0.8137 cGy, RT 1.089 cGy and LT 1.188 cGy in the Normal mode, and RT 2.154 cGy and LT 2.082 cGy in the Fine mode. According to Pinacle 8.0 kV-CBCT, RT 0.2875 cGy and LT 0.1676 cGy in the Standard Dose mode and RT 0.1648 cGy and LT 0.1212 cGy in the Low-Dose mode. In short, the MVCT result was significantly different from that of kV-CBCT, up to 20 times. Conclusion: We think kV-CBCT is more effective for reducing the amount of radiation which a patient is receiving during intensity modulated radiation treatment for other purposes than treatment than MVCT, when we consider the absorbed dose only from the viewpoint of image-guided radiation therapy. Besides, we understood the amount of radiation is too sensitive to the shooting condition, even when we use the same equipment.

• Journal of Korean Academy of Nursing
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• v.20 no.2
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• pp.227-248
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• 1990

The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

• The korean journal of orthodontics
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• v.27 no.2
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• pp.221-230
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• 1997

It has been known that head posture may influence directly and/or indirectly the growth and development of craniofacial morphology and can also be influenced by the funtional demand of physiologic activity. It was reported that facial morphology has close relationships with hyoid bone position and head posture. In many previous studies, Natural Head Posture(NHP) was guided, and also it was shown that NHP has high degree of reproducibility. Otherwise, There was few study about the relationship of head posture, with routine cephalometric film which is used for clinical orthodontic purpose. In this study, according to the Wits and ANB of initial cephalometric film which was taken with vertical pendulum as representative of true vertical reference line. We classified the subjects which is comprised of 60 adult female patients into Class I, II, III (Cl I, II, III)and we tried to find out the correlation of head posture and hyoid bone position according to the classification of malocclusion. As a result of our research, we found the followigs. 1. In comparison of vertical position of hyoid bone relative to the cranial base. the position of hyoid bone of Cl III was lower than that of Cl II. 2. In comparison of anteriorpostes or position of hyoid bone, relative to the cervical column. The position of hyoid bone of Cl III was more anterior than that of a II 3. in comparison of vertical position of hyoid bone relative to mandible. There was no significant correlation aumoug the groups of malocclusion. 4. ANB and Wits showed no significant correlation with hyoid bone position. 5. The relative extension of head, which was noted in Cl II, showed negative with Sum, ANB. 6. In Cl II and Cl III, Post to Ant facial height showed positive correlation with NSL/VER.