• 제목/요약/키워드: partial inability

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연명의료 중단과 진료비채무에 관하여 - 대법원 2016.1.28. 선고 2015다9769 판결 - (Withdrawing Life-sustaining Treatment and Medical Expenses Obligation - The Supreme Court of Korea 2016.1.28. 2015Da9769 -)

  • 이재경
    • 의료법학
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    • 제18권2호
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    • pp.139-161
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    • 2017
  • 이 글은 대법원 2016.1.28. 선고 2015다9769 판결의 검토를 목적으로 한다. 이 사건 연명의료 중단에 관한 이전의 판례에서 대법원은 객관적 요건으로 회생불가능한 사망의 단계와 주관적 요건으로 환자의 동의가 충족되면 의료계약이 해지된다고 보았다. 그러나 환자의 동의는 의료계약 해지에 관한 동의가 아니다. 환자의 의료행위에 대한 동의는 법률행위가 아니다. 그것은 사실행위이다. 만약 연명 의료의 중단에 관한 환자의 추정적 의사가 의료계약의 해지의 의사라면, 의료계약은 연명의료 중단에 관한 소 제기시에 종료하여야 한다. 그런데 대상판결은 의료계약이 일부 해지되었다고 하면서도 진료비채무는 연명의료 허용에 관한 판결이 확정된 때부터 면제된다고 하였다. 이는 논리적으로 맞지 않다. 연명의료의 중단이 허용되면 의료급부 제공이 불가능해지기 때문에 그 부분 진료채무가 면제된다. 급부의 불능은 연명치료 중단에 관한 확정판결이 있는 때에 확정된다. 따라서 연명의료 중단에 관한 확정판결이 있은 때부터 연명의료에 대한 진료비채무가 면제된다고 한 대상판결의 결론은 타당하다. 다만 그 근거는 의료계약의 일부해지가 아니라 일부불능이다.

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1차공 결손 심방중격결손증 수술후 발생한 승모판폐쇄부전증 환자에서 승모판막대치수술 치험 1 (Severe mitral regurgitation after repair of partial form of atrioventricular canal: one case report)

  • 이두연
    • Journal of Chest Surgery
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    • 제17권2호
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    • pp.171-176
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    • 1984
  • Successful correction of the partial form of atrioventricular[AV] canal is now readily achievable. The most challenging technical features of this anomaly are the associated mitral valvular deformity and the frequent inability to obtain mitral competence. Residual mitral incompetence after repair of mitral cleft figures importantly in the causes of early and late failure. So, accurate and complete repair of the mitral valve cleft might be important. Determination of residual severe mitral regurgitation after repair is desirable to permit mitral valve replacement at the time. We have experienced one case of severe mitral regurgitation which was occurred 6 months after repair of partial form of A-V canal [ASD primum] in 22 years old virgin. Pre-op. left ventriculogram revealed severe mitral regurgitation in this patient. We preferred to perform mitral valve replacement with St. Jude valve in this patient at March 1984. Post-op. course was uneventful to now for 5 months and we report this case, review and discuss the literatures.

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악관절 강직증 환자의 임상ㆍ방사선학적 연구 (Clinico-Radiological Study of Temporomandibular Ankylosis)

  • 최선원;안형규
    • 치과방사선
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    • 제14권1호
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    • pp.99-107
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    • 1984
  • The auther studied clinically and. radiologically 48 cases which had been diagnosed as TMJ ankylosis in SNUDH (1974-1984). The purpose of this study is to analyse clinical features of TMJ ankylosis and to evaluate the effect of TMJ ankylosis on the growth of the mandible. The obtained results were as follows: 1. Total 48 cases of TMJ ankylosis patients consist of 23 males and 25 females. 65 percent of all cases of TMJ ankylosis occurred in patients between 1 and 10 years of age. The awerage age at the onset of ankylosis was 11.7 and average duration at the time of examination was 11.7 years. 2. Unilateral akylosis (81.3%) was more frequent than bilateral ankylosis (18.7%). 3. Traum a (57.9%) and infection (21.2%) were main etiology. 4. Inability to open the mouth (78.3%) and facial asymmetry (17.4%) were main chief complaints. 5. Mandibular morphology through radiographic features. (a) In TMJ ankylosis patients the ramus length of the ankylosed side was shorter than that of the non-ankylosed side. Comparing with the centrol group, ramus length of the each side was shorter than normal value. (b) The partial body length of the ankylosed side was longer than that of the non-ankylosed side. Comparing with the control group, partial body length of the each side was longer than normal value. Partial body length was related with antegonial notch depth. (c) Ratio of upper and lower ramus length at the level of mandibular foramen was smaller in ankylosed side than in non-ankylosed side. (d) Antegonial notch depth and ramus posterior contour depth were deeper in ankylosed side than in non-ankylosed side and those of both sides were deeper than normal value. (e) Gonial angle in ankylosed side was larger than in non-ankylosed side and that in both sides was smaller than normal value.

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Congenital Insensitivity to Pain with Anhidrosis 환아의 치험례 (CONGENITAL INSENSITIVITY TO PAIN WITH ANHIDROSIS : CASE REPORT)

  • 김태근;최남기;양규호
    • 대한소아치과학회지
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    • 제26권1호
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    • pp.139-145
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    • 1999
  • 본 병원에 동통을 느끼지 못하는 것으로 인한 혀나 손가락 깨물기 등의 자가 손상, 무한증, 반복적 발열등의 임상증상을 보이며 유전성이 없이 CIPA로 내원한 환아에서 보호자에게 세심한 보호와 우발사고 방지에 대한 교육이 무엇보다도 중요하며, 치면세마, 불소도포, 소와열구전색등의 예방적인 처치와 주기적으로 내원시켜 치과적인 문제를 조기에 해결하는 것이 필요하다고 사료된다.

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두개저 결손의 미세수술적 재건술 (Microvascular Reconstruction of the Cranial Base Defects)

  • 민경원;김인철;이민구
    • Archives of Reconstructive Microsurgery
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    • 제8권1호
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    • pp.71-76
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    • 1999
  • Until recently, the cranial base tumors were deemed unresectable due to the inability to diagnose the extent of the involvement accurately and to approach and excise the tumor safely. With refinements in CT and NMR scanning and development of craniofacial techniques, reconstruction becomes absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, the free tissue transfer was a useful alternative because it can provide large amount of well-vascularized tissues and reliable separation of intracranial space from bacterial flora of the upper airway. The microvascular free tissue transfer was used in 9 patients at our center to reconstruct the cranial base defects. Of these, 8 were free rectus muscle flaps, and 1 was free latissimua dorsi muscle flap. There were 1 case of partial flap loss and 1 case of postoperative wound infection. The large, complex defects were successfully reconstructed by one stage operation and the functional and aesthetic results were satisfactory with acceptable complication rates.

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Preparation of Reproducible and Responsive Scar Model and Histology Analysis

  • Kim, Sang-Cheol;ChoLee, Ae-Ri
    • Journal of Pharmaceutical Investigation
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    • 제40권1호
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    • pp.45-49
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    • 2010
  • Unlike human, with some exceptions, animals do not heal with excessive scar. The lack of suitable animal model has hindered the development of effective scar therapy. We previously reported that partial thickness rabbit ear wound model resembles human wound heal process. This study was designed to prepare a hypertropic scar wound model which can be employed for testing anti-scar therapy. Four wounds were created down to the bare cartilage on the anterior side of each rabbit ear using 8-mm dermal biopsy punch and histology analysis at post operation day (POD) 5, 28 and 48 were performed. As the outcome of scar formation is largely determined by the early inflammatory response to the wounding and the degree and the duration of occlusion, cephalodin(50 mg/kg) was injected daily and medical occlusive dressings were applied. Five micro wound and scar sections were stained with hematoxylin and eosin for quantification of epidermal regeneration and scar hypertrophy. Sections were also stained using Masson's trichrome and Sirius red to evaluate collagen organization and rete ridge formation. Wound closure process was assessed to 7wks post wounding. Complete removal of the epidermis, dermis and perichondrial layer caused delayed epithelialization, which results in hypertropic scarring. The inability of the wounds to contract and the delay in epithelialization in rabbit ear was likely due to cartilage and it created scar elevation. The results suggest that full thickness surgical punch wound model in rabbit ear could be employed as a reliable and reproducible scar wound model for testing anti-scar therapy.

Antecedents of Sustainable Competitive Advantages: A Case Study of Palm Oil Industries in Indonesia

  • HERIYANTO, Meyzi;FEBRIAN, Achmad Fajri;ANDINI, Frini Karina;HANDOKO, Tito;SURYANA, Dodi
    • The Journal of Asian Finance, Economics and Business
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    • 제8권2호
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    • pp.911-921
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    • 2021
  • Indonesian oil palm plantation industry has chance to increase a sustainable competitive advantage. The creation of a sustainable competitive advantage is determined by the ability of the palm oil industry to utilize limited resources and capabilities. The purpose of this study was to analyze the determinants of the creation of sustainable competitive advantage (SCA) in the palm oil industry in Riau, Indonesia. The model framework uses organizational-level SCA dimensions. Four dimensions are used to measure SCA in the palm oil industry in Riau, namely value, scarce resource, inability to replicate, irreplaceable. Questionnaires were distributed to oil palm industry players in Riau with 81 respondents. The analysis technique uses Structural Equation Model with Partial Least Square (SEM-PLS). The results showed that the SCA in the palm oil industry in Riau was at a moderate level. Although the competitive advantage of being sustainable in the palm oil industry in Riau is in the medium category, test results on SCA dimensions found that each latent variable forms a significant SCA framework with a reflective constructive relationship model. The three dominant and recommended dimensions that shape the construction of SCA in the palm oil industry are value, scarce resource, and irreplaceable.

Creep strain modeling for alloy 690 SG tube material based on modified theta projection method

  • Moon, Seongin;Kim, Jong-Min;Kwon, Joon-Yeop;Lee, Bong-Sang;Choi, Kwon-Jae;Kim, Min-Chul
    • Nuclear Engineering and Technology
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    • 제54권5호
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    • pp.1570-1578
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    • 2022
  • During a severe accident, steam generator (SG) tubes undergo rapid changes in the pressure and temperature. Therefore, an appropriate creep model to predict a short term creep damage is essential. In this paper, a novel creep model for Alloy 690 SG tube material was proposed. It is based on the theta (θ) projection method that can represent all three stages of the creep process. The original θ projection method poses a limitation owing to its inability to represent experimental creep curves for SG tube materials for a large strain rate in the tertiary creep region. Therefore, a new modified θ projection method is proposed; subsequently, a master curve for Alloy 690 SG material is also proposed to optimize the creep model parameters, θi (i = 1-5). To adapt the implicit creep scheme to the finite element code, a partial derivative of incremental creep with respect to the stress is necessary. Accordingly, creep model parameters with a strictly linear relationship with the stress and temperature were proposed. The effectiveness of the model was validated using a commercial finite element analysis software. The creep model can be applied to evaluate the creep rupture behavior of SG tubes in nuclear power plants.

Application of Deep Learning: A Review for Firefighting

  • Shaikh, Muhammad Khalid
    • International Journal of Computer Science & Network Security
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    • 제22권5호
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    • pp.73-78
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    • 2022
  • The aim of this paper is to investigate the prevalence of Deep Learning in the literature on Fire & Rescue Service. It is found that deep learning techniques are only beginning to benefit the firefighters. The popular areas where deep learning techniques are making an impact are situational awareness, decision making, mental stress, injuries, well-being of the firefighter such as his sudden fall, inability to move and breathlessness, path planning by the firefighters while getting to an fire scene, wayfinding, tracking firefighters, firefighter physical fitness, employment, prediction of firefighter intervention, firefighter operations such as object recognition in smoky areas, firefighter efficacy, smart firefighting using edge computing, firefighting in teams, and firefighter clothing and safety. The techniques that were found applied in firefighting were Deep learning, Traditional K-Means clustering with engineered time and frequency domain features, Convolutional autoencoders, Long Short-Term Memory (LSTM), Deep Neural Networks, Simulation, VR, ANN, Deep Q Learning, Deep learning based on conditional generative adversarial networks, Decision Trees, Kalman Filters, Computational models, Partial Least Squares, Logistic Regression, Random Forest, Edge computing, C5 Decision Tree, Restricted Boltzmann Machine, Reinforcement Learning, and Recurrent LSTM. The literature review is centered on Firefighters/firemen not involved in wildland fires. The focus was also not on the fire itself. It must also be noted that several deep learning techniques such as CNN were mostly used in fire behavior, fire imaging and identification as well. Those papers that deal with fire behavior were also not part of this literature review.

A novel Metropolis-within-Gibbs sampler for Bayesian model updating using modal data based on dynamic reduction

  • Ayan Das;Raj Purohit Kiran;Sahil Bansal
    • Structural Engineering and Mechanics
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    • 제87권1호
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    • pp.1-18
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    • 2023
  • The paper presents a Bayesian Finite element (FE) model updating methodology by utilizing modal data. The dynamic condensation technique is adopted in this work to reduce the full system model to a smaller model version such that the degrees of freedom (DOFs) in the reduced model correspond to the observed DOFs, which facilitates the model updating procedure without any mode-matching. The present work considers both the MPV and the covariance matrix of the modal parameters as the modal data. Besides, the modal data identified from multiple setups is considered for the model updating procedure, keeping in view of the realistic scenario of inability of limited number of sensors to measure the response of all the interested DOFs of a large structure. A relationship is established between the modal data and structural parameters based on the eigensystem equation through the introduction of additional uncertain parameters in the form of modal frequencies and partial mode shapes. A novel sampling strategy known as the Metropolis-within-Gibbs (MWG) sampler is proposed to sample from the posterior Probability Density Function (PDF). The effectiveness of the proposed approach is demonstrated by considering both simulated and experimental examples.