• Tuberculosis and Respiratory Diseases
• /
• v.47 no.3
• /
• pp.321-330
• /
• 1999

Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.

• Journal of the Daesoon Academy of Sciences
• /
• v.32
• /
• pp.77-108
• /
• 2019

The purpose of this paper is to clarify the characteristics of 'Podeok' in Daesoon Jinrihoe. The term Podeok can cause some misunderstanding as the same word Deok (德 virtue) has long been used in the Eastern Tradition. In other words, for most people who are used to traditional thought, Podeok may be conflated with the similar word 'Deok (virtue)' as used within Confucianism. People who are familiar with Confucian culture might thereby misunderstand the term Podeok as an aspect of Confucian moral ethics, or they could misconstrue Daesoon Jinrihoe as having appropriated and misused Confucian ideas. Furthermore, there are other problems that could arise if people compare Daesoon Jinrihoe's 'Podeok' with 'Deok (virtue)' as used by Laozi. While Deok in Laozi's usage represents the ability of an individual who can exercise his or her rationality with excellence, Deok in Daesoon Jinrihoe indicates the idea of actualizing Mutual Beneficence and the conditions that enable Mutual Beneficence. If one understands Deok as used by Laozi to contain the meaning of Mutual Beneficence, then it is possible to think that the two tradition share a similar meaning of Deok as Podeok in Daesoon Jinrihoe pursues Mutual Beneficence as its ultimate value. In order to preemptively correct these misunderstandings, I need to clarify how the idea of Deok was born out of traditional thought and what meanings it embodies. Additionally, it is necessary to examine how it became meaningful in Confucianism, and how it was criticized and ascribed new meanings in Laozi's thought. Through these clarification, it will become clear that Deok originally indicated a religious ritual that the king of the Zhou Dynasty performed after receiving the heavenly mandate and assuming rule over the nation. Later, this idea was transformed into a moral virtue and norm by Confucius. This moral virtue and norm was criticized by Laozi as an unnatural form of control as it was understood by Laozi as a teleological argument justifying whether or not lives were to be saved or sustained based on the perceived merits of each individual. On the contrary, Deok in Daesoon Jinrihoe and traditional thought stand on a totally different theological bases. Deok in Daesoon Jinrihoe is a means to practice and realize the truth of the earthly paradise of the Later World and the truth of Mutual Beneficence which were posited to the world through Kang Jeungsan's Works of Haewon (grievance resolution) that resolved the pattern of mutual conflict that characterized the Former World. Therefore, the idea of Podeok in Daesoon Jinrihoe gains completion only on the premises of Haewon Sangsaeng (resolution of grievances for mutual beneficence) and Boeun Sangsaeng (reciprocation of favors for mutual beneficence), and the way to practice Podeok is to practice Haewon Sangsaeng and Boeun Sangsaeng. In addition, the subordinate virtues such as loyalty, filial piety, and faithfulness that exist within Daesoon Jinrihoe's religious practice are not same as those of traditional thought. They are new concepts of virtues drawn from the cosmological laws of Daesoon Jinrihoe. To be specific, the virtues of Daesoon Jinrihoe are not rules that create discrimination and mutual conflict, but are instead ethical rules established upon the basis of Heaven and Earth having been newly organized, and thus, they will bring virtuous concordance, harmonious union, and mutual beneficence. The idea of 'Podeok' in Daesoon Jinrihoe can be understood as a religious practice that requires doctrinal understanding and tangible practice in daily life of followers. In other words, it is not the same Deok of earlier traditional thought in East Asia, but is instead a religious truth by which practitioners realize the truth of Sangje's Works of Haewon in human world as they practice Haewon Sangsaeng and Boeun Sangsaeng.

• Journal of Distribution Research
• /
• v.17 no.5
• /
• pp.1-23
• /
• 2012

The conflict between major corporations and small and medium-sized businesses is being aggravated, the trickle down effect is not working properly, and, as the controversy surrounding the effectiveness of the business limiting system continues to swirl, the plan proposed to protect the business domain of small and medium-sized businesses, resolve polarization between these businesses and large corporations, and protect small family run stores is the suitable business type designation system for small and medium-sized businesses. The current status of carrying out this system of selecting suitable business types among small and medium-sized businesses involves receiving applications for 234 items among the suitable business types and items from small and medium-sized businesses in manufacturing, and then selecting the items of the consultative group by analyzing and investigating the actual conditions. Suitable business type designation in the service industry will involve designation with priority on business types that are experiencing social conflict. Three major classifications of the service industry, related to the livelihood of small and medium-sized businesses, will be first designated, and subsequently this will be expanded sequentially. However, there is the concern that when designated as a suitable business type or item, this will hinder the growth motive for small to medium-sized businesses, and designation all cause decrease in consumer welfare. Also it is highly likely that it will operate as a prior regulation, cause side-effects by limiting competition systematically, and also be in violation against the main regulations of the FTA system. Moreover, it is pointed out that the system does not sufficiently reflect reverse discrimination factor against large corporations. Because conflict between small to medium sized businesses and large corporations results from the expansion of corporations to the service industry, which is unrelated to their key industry, it is necessary to introduce an advanced contract method like a master franchise or local franchise system and to develop local small to medium sized businesses through a franchise system to protect these businesses and dealers. However, this method may have an effect that contributes to stronger competitiveness of small to medium sized franchise businesses by advancing their competitiveness and operational methods a step further, but also has many negative aspects. First, as revealed by the Ministry of Knowledge Economy, the franchise industry is contributing to the strengthening of competitiveness through the economy of scale by organizing existing individual proprietors and increasing the success rate of new businesses. It is also revealed to be a response measure by the government to stabilize the economy of ordinary people and is emphasized as a 'useful way' to revitalize the service industry and improve the competitiveness of individual proprietors, and has been involved in contributions to creating jobs and expanding the domestic market by providing various services to consumers. From this viewpoint, franchises fit the purpose of the suitable business type system and is not something that is against it. Second, designation as a suitable business type may decrease investment for overseas expansion, R&D, and food safety, as well negatively affect the expansion of overseas corporations that have entered the domestic market, due to the contraction and low morale of large domestic franchise corporations that have competitiveness internationally. Also because domestic franchise businesses are hard pressed to secure competitiveness with multinational overseas franchise corporations that are operating in Korea, the system may cause difficulty for domestic franchise businesses in securing international competitiveness and also may result in reverse discrimination against these overseas franchise corporations. Third, the designation of suitable business type and item can limit the opportunity of selection for consumers who have up to now used those products and can cause a negative effect that reduces consumer welfare. Also, because there is the possibility that the range of consumer selection may be reduced when a few small to medium size businesses monopolize the market, by causing reverse discrimination between these businesses, the role of determining the utility of products must be left ot the consumer not the government. Lastly, it is desirable that this is carried out with the supplementation of deficient parts in the future, because fair trade is already secured with the enforcement of the franchise trade law and the best trade standard of the Fair Trade Commission. Overlapping regulations by the suitable business type designation is an excessive restriction in the franchise industry. Now, it is necessary to establish in the domestic franchise industry an environment where a global franchise corporation, which spreads Korean culture around the world, is capable of growing, and the active support by the government is needed. Therefore, systems that do not consider the process or background of the growth of franchise businesses and harm these businesses for the sole reason of them being large corporations must be removed. The inhibition of growth to franchise enterprises may decrease the sales of franchise stores, in some cases even bankrupt them, as well as cause other problems. Therefore the suitable business type system should not hinder large corporations, and as both small dealers and small to medium size businesses both aim at improving competitiveness and combined growth, large corporations, small dealers and small to medium sized businesses, based on their mutual cooperation, should not include franchise corporations that continue business relations with them in this system.