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Clinical Characteristics of the Patients with Mycobacterium avium Complex Pulmonary Disease (Mycobacterium avium complex 폐질환 환자의 임상적 특징)

  • Koh, Won-Jung;Kwon, O Jung;Kang, Eun Hae;Jeon, Ik Soo;Pyun, Yu Jang;Ham, Hyoung Suk;Suh, Gee Young;Chung, Man Pyo;Kim, Hojoong;Han, Daehee;Kim, Tae Sung;Lee, Kyung Soo
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.1
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    • pp.33-44
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    • 2003
  • Background : Mycobacterium avium complex(MAC) is the most common respiratory pathogen in nontuberculous mycobacterial pulmonary disease. This study described the clinical characteristics of the patients with pulmonary disease caused by MAC. Materials and Methods : The clinical characteristics of 24 patients with pulmonary disease caused by the MAC, who fulfilled the 1997 American Thoracic Society diagnostic criteria for nontuberculous mycobacterial pulmonary disease, were retrospectively analyzed. Results : Fourteen patients(58%) were male and the median age at diagnosis was 61 years(range 46-75). Of the 24 patients, 16(67%) had a M. intracellulare infection, 7(29%) had a M. avium infection and one patient was not identified. Coughing (92%) and sputum (88%) were most frequently observed symptoms. The sputum smear for acid-fast bacilli was positive in 17(71%) patients. Fourteen(58%) patients had the upper lobe cavitary form and 10(42%) patients had the nodular bronchiectatic form. In a comparison between the patients with the upper lobe cavitary form and those with the nodular bronchiectatic form, significant differences were found according to sex(male 86% vs. 20%, p=0.003), smoking history(79% vs. 10%, p=0.008), the presence of an underlying disease(64% vs. 20%, p=0.036), the pulmonary function(% forced vital capacity, median 71% vs. 88%, p=0.022; % forced expiratory volume in one second, median 69% vs. 89%, p=0.051) and bilateral disease at chest radiography(29% vs. 90%, p=0.005). The time from the onset of symptoms to diagnosis was longer in those with the nodular bronchiectatic form(median 72 months, range 8-132) than those with the upper lobe cavitary form(median 22 months, range 6-60) Conclusions : MAC pulmonary disease occurs in two distinct populations with two distinct clinical presentations. For a correct diagnosis of MAC pulmonary disease, knowledge of the diverse clinical and radiological findings is essential.

Continuous Positive Airway Pressure during Bronchoalveolar Lavage in Patients with Severe Hypoxemia (심한 저산소혈증 환자에서 기관지폐포세척술 시 안면마스크를 이용한 지속성 기도양압의 유용성)

  • An, Chang Hyeok;Lim, Sung Yong;Suh, Gee Young;Park, Gye Young;Park, Jung Woong;Jeong, Seong Hwan;Lim, Si Young;Oui, Misook;Koh, Won-Jung;Chung, Man Pyo;Kim, Hojoong;Kwon, O Jung
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.1
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    • pp.71-79
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    • 2003
  • Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.

A Literature Study of Ophthalmotolaryngologic Diseases from the Viewpoint of Onbyeong; On the Basis of Imjeungjinamuian (溫病學에서의 眼耳鼻咽喉科 疾患에 대한 文獻考察;臨證指南醫案을 중심으로)

  • Cho, Jae-Hun;Chae, Byung-Yoon;Kim, Yoon-Bum
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.15 no.1
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    • pp.198-218
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    • 2002
  • On the basis of Imjeungjinamuian(臨證指南醫案), authors investigated the pathogenesis and treatment of ophthalmotolaryngobgic diseases from the viewpoint of Onbyeong(溫病). 1. The symptoms and diseases investigated according to department were as follows;. 1) Ophthalmology : blepharitis, blepharedema, lacrimal hypersecretion, hyperemia, ophthalmalgla, photopsia, visual disturbance, mydriasis 2) Otology : full-feeling, otorrhea, otalgla, mastoiditis, tinnitus, hearing disturbance, vertigo 3) Rhinology : rhinorrhea, nasal obstruction, sinusitis, epistaxis 4) Laryngology : sore throat, hoarseness 5) The Others : headache, cough, asthma 2. The pathogenesis and treatment of ophthalmotolaryngologic diseases were as follows. 1) When the pathogenesis of hyperemia, otorrhea, otalgia, mastoiditis, hearing disturhance. epistaxis, sore throat, headache and cough are wind-stagnanc(風鬱), wind-warm(風溫), wind-fire(風火), wind-dryness(風燥), dryness-heat(燥熱), the treatment of pungent-cool-evaporating(辛凉解表) with Dajosan(茶調散), Mori Folium(桑葉), Lonicerae Flos(金銀花), Forsythiae Fructus(連翹), Viticis Fructus(蔓荊子), Prunellae Spica(夏枯草), Arctii Fructus(牛蒡子), etc can be applied. 2) When the pathogenesis of hoarseness, cough and asthma are cold(寒), cold with endogenous heat(寒包熱, 外冷內熱), water retention(水邪), fluid retention(伏飮), impairment of YangKi by overexertion(勞傷陽氣), the treatment of pungent-warm-evaporating(辛溫解表) with Mahaenggamseoktang(麻杏甘石湯), Socheongryongtang(小靑龍湯), Jeongryeokdaejosapyetang(정력대조사폐탕), Gyejitang(桂枝湯), Armeniacae Amarum Semen(杏仁), etc can be applied. 3) When the pathogenesis of photopsia, otorrhea, otalgia, rhinorrhea, sinusitis, epistaxis, sore throat, hoarseness, headache and cough are stagnancy-induced heat(鬱熱), wind-dryness(風燥), wind-heat(風熱), summer heat(暑熱), summer wind(暑風), insidious summer heat(伏暑), autumn heat(秋暑), autumn wind(秋風), autumn dryness(秋燥), dryness-heat(燥熱), heat in Ki system(氣分熱), insidious warm(溫伏), brain discharge by fire in Ki system(氣火 腦熱), heat in stomach(胃熱), endogenous fire by deficiency of Yin(陰虛內火), deficiency of Yin in stomach(胃陰虛), the treatment of Ki-cooling(淸氣) with Bangpungtongseongsan(防風通聖散), Ikweonsan(益元散), Gyejibaekhotang(桂枝白虎湯), Geumgwemaekmundongtang(금궤맥문동탕), Gyeongokgo(瓊玉膏), Sojae Semen Praeparatum(두시), Scutellariae Radix(黃芩), Phyllostachys Folium(竹葉), Adenophorae Radix(沙參), Mori Cortex(桑白皮), Fritillariae Cirrhosae Bulbus(貝母), etc can be applied. 4) When the pathogenesis of blepharitis, hyperemia, ophthalmalgia, full-feeling, otorrhea, otalgia, tinnitus, hearing disturbance, sinusitis, hoarseness, headache and cough are fire in liver(肝火), fire in gallbladder(膽火), ministerial fire in Soyang system(少陽相火), wind-stagnancy(風鬱), stagnancy-induced fire(鬱火), brain discharge by phlegm-fire(痰火 腦熱), the treatment of mediation(和解) with Gardeniae Fructus(梔子), Moutan Cortex(牧丹皮), Saigae Tataricae Cornu(羚羊角), Artemisiae Annuae Herba(靑蒿), Cyperi Rhizoma(香附子), Poria(적복령), etc can be applied. 5) When the pathogenesis of blepharedema and cough are dampness in both spleen and lung(脾肺濕) damp-heat(濕熱), damp-phlegm(濕痰), the treatment of dampness-resolving(化濕) with Poria(백복령), Coicis Semen(薏苡仁), Tetrapanacis Medulla(通草), Armeniacae Amarum Semen(杏仁), Talcum(滑石), etc can be applied. 6) When the pathogenesis of vertigo and cough are deficiency of Yong(營虛), heat in Yong, system(營熱), the treatment of Yong-cooling(淸營) with Rehmanniae Radix(生地黃), Liriopis Tuber(麥門冬), Biotae Semen(柏子仁), Lilii Bulbus(百合), Phyllostachys Folium(竹葉), etc can be applied. 7) When the pathogenesis of epistaxis are heat in blood system of heart(心血熱), reversed flow of fire(火上逆), overexertion(努力), the treatment of blood-cooling(凉血) with Rhinoceri Cornu(犀角), Rehmanniae Radix(生地黃), Moutan Cortex(牧丹皮), Salviae Miltiorrhizae Radix(丹參), Scrophulariae Radix(玄蔘), etc can be applied. 8) When the pathogenesis of nasal obstruction is pathogen-stagnancy(邪鬱), the treatment of resuscitation(開竅) with Sosang(少商, LU11) acupuncture can be applied. When the pathogenesis of hoarseness is evil Ki(穢濁), the treatment of resuscitation(開竅) with Arctii Fructus(牛蒡子), Lasiosphaera Seu Calvatia(馬勃), Curcumae Radix(鬱金), etc can be applied. When the pathogenesis of headache is stasis of both Ki and blood(氣血瘀痺), the treatment of resuscitation(開竅) with Cnidii Rhizoma(川芎), Asari Herba Cum Radice(細辛), Scorpio(全蝎), moxibustion(灸), etc can be applied. 9) When the pathogenesis of lacrimal hypersecretion, visual disturbance, mydriasis, tinnitus, hearing disturbance, sinusitis, epistaxis, hoarseness and cough are deficiency of Yin(陰虛), deficiency of kidney(腎虛), deficiency of both liver and kidney(肝腎虛), deficiency of both heart and kidney(心腎虛), brain discharge by deficiency of Yin(陰虛 腦熱), exuberance of Yang in liver(肝陽上亢), overexertion(勞損), the treatment of Yin-replenishing(滋陰) with Yukmijihwanghwan(六味地黃丸), Hojamhwan(虎潛丸), Jeobutang(猪膚湯), Lycii Fructus(枸杞子), Polygoni Multiflori Radix(何首烏), Rehmanniae Radix(生地黃), Schizandrae Fructus(五味子), Liriopis Tuber(麥門冬), Asini Gelatinum(阿膠), etc can be applied. 10) When the pathogenesis of ophthalmalgia, mydriasis, vertigo and headache are deficiency of Yin in liver(肝陰虛), exuberance of Yang in liver(肝陽上亢), endogenous wind(內風), excess in upper and deficiency in lower part(上實下虛), the treatment of Yin-replenishing(滋陰) and endogenous wind-calming(熄風) with Rehmanniae Radix Preparat(熟地黃), Lycii Fructus(枸杞子), Polygoni Multiflori Radix(何首烏), Paeoniae Radix Alba(白芍藥), Ostreae Concha(牡蠣), Saigae Tataricae Cornu(羚羊角), Chrysanthemi Flos(菊花), etc be applied. 11) When the pathogenesis of mydriasis, sinusitis, hoarseness, headache, cough and asthma are exhaustion of vital essence(精氣無收藏), brain discharge(腦髓不固), floating Yang(陽虛浮), exsanguination(失血), deficiency of both Yin and Yang(陰陽不足), overexertion(勞損), deficiency of Yang in kidney(腎陽虛), the treatment of Yang-restoring and exhaustion-arresting(回陽固脫) with Yangyeongtang(養營湯), Cheonjinhwan(天眞丸), Bokmaektang(복맥탕), Geonjungtang(建中湯), Dogihwan(都氣丸), Singihwan(腎氣丸), Jinmutang(眞武湯), Ostreae Concha(牡蠣), Nelumbinis Semen(蓮子肉), etc can be applied. 12) When the pathogenesis of lacrimal hypersecretion, vertigo and headache are deficiency of stomach and endogenous wind(胃虛內風), endogenous wind with phlegm(內風挾痰), liver check of stomach(肝木橫擾), the treatment of concomitant-treating of both liver and stomach(肝胃同治) with Paeoniae Radix Alba(白芍藥), Uncariae Ramulus Et Uncus(釣鉤藤), Gastrodiae Rhizoma(天麻), Astragali Radix(황기), Pinelliae Rhizoma(半夏), etc can be applied. When the pathogenesis of asthma is failure of kidney to promote inspiration(腎不納氣), the treatment of kidney-tonifing and inspiration-promoting(補腎納氣) with Singihwan(腎氣丸), Psoraleae Fructus(補骨脂), Juglandis Semen(胡桃), Aquilariae Resinatum Lignum(沈香), etc can be applied. When the pathogenesis of asthma is deficiency of Ki(氣虛), the treatment of Ki-reinforcing(補氣) with Sagunjatang(四君子湯), Insamgeonjungtang(人參建中湯), etc can be applied.

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A study on Palpation of the back-shu points (배유혈(背兪穴) 안진(按診)에 관(關)한 고찰(考察))

  • Hong, Mun-Yeup;Park, Won-Hwan
    • The Journal of Dong Guk Oriental Medicine
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    • v.8 no.2
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    • pp.155-173
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    • 2000
  • The diagnosis in Oriental medicine is done by inspection, auscultation and olfaction, interrogation, four diagnostics of pulse feeling and palpation, and various system of identification like identification according to Qi(vital energy), Xue and body fluids, identification according to fair principles, identification according to principles of Wei, Qi, Ying and Xue, identification according to Sanjiao(the triple heater), identification according to four type physical constitution. Sometimes, symptoms and diagnosis techniques according to symptoms is selectively applied for the diagnosis. Among them the pulse feeling and palpation diagnosis technique using the sense of finger and palm of the hand is divided into feeling of pulse and palpation and pressing maneuver. Pressing maneuver is a diagnosis technique pressing and rubbing the affected part in order to attain data of identification including inside and outside condition of the body with regard to the nature, condition and relative seriousness of disease. There are palpation of the skin, palpation the hand and foot, palpation the chest and the abdomen, palpation shu points in pressing maneuver. The diagnosis of the Back Shu points is a technique to examine the change of disease condition from pressure ache, spontaneous ache, tension, relaxation, solidification revealed through channels and collaterals. I investigates starting disease and an attack of disease of twelve pulse and pulse condition through the study relative to the substance and technique of pressing maneuver, and adjusts diagnosis techniques of a region for acupuncture and matters to be attended. The conclusions are as follows. 1. The Shu or stream points in which pathogenic factors go are important to medical treatment of dormant diseases like bowels disease, cold symptom complex and insufficiency symptom complex. 2. Disease classified by system is diagnosed by the condition of process part like pro-trusion, cave-in, tension, relaxation, pressure ache through palpating the Shu or stream points, that is pressing upward or downward left and right sides of the backbone process by hands. 3. In real clinic pressing maneuver of one's back side is very important to patient's diagnosis treatment. Thus, pressing maneuver of one's back side have to be done without omission. 4. Diagnosis must be accomplished through the perception about the diversity of diagnosis technique of bowels disease, the exact knowledge about pressing maneuver of one's back side for enlargement of treatment range and rising of treatment rate, and pressing maneuver of the Shu or the stream points.

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M-mode Ultrasound Assessment of Diaphragmatic Excursions in Chronic Obstructive Pulmonary Disease : Relation to Pulmonary Function Test and Mouth Pressure (만성폐쇄성 폐질환 환자에서 M-mode 초음파로 측정한 횡격막 운동)

  • Lim, Sung-Chul;Jang, Il-Gweon;Park, Hyeong-Kwan;Hwang, Jun-Hwa;Kang, Yu-Ho;Kim, Young-Chul;Park, Kyung-Ok
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.736-745
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    • 1998
  • Background: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatic contribution to chest wall motion. Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. Methods: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(l6 medical students, 12 age-matched control) and 17 COPD patients. Ultrasonographic measurements were performed during tidal breathing and maximal respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducer. Measurements were taken in the supine posture. The ultrasonographic probe was positioned transversely in the midclavicular line below the right subcostal margin. After detecting the right hemidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-mode at this position were made throughout the test. Measurements of diaphragmatic excursion on M-mode tracing were calculated by the average gap in 3 times-respiration cycle. Pulmonary function test(SensorMedics 2800), maximal inspiratory(PImax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. Results: During the tidal breathing, diaphragmatic excursions were recorded $1.5{\pm}0.5cm$, $1.7{\pm}0.5cm$ and $1.5{\pm}0.6cm$ in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients ($3.7{\pm}1.3cm$) when compared with medical students, age-matched control group($6.7{\pm}1.3cm$, $5.8{\pm}1.2cm$, p< 0.05}. During maximal respiratory efforts in control subjects, diaphragm excursions were correlated with $FEV_1$, FEVl/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maximal expiratory pressure), age, and %FVC. In multiple regression analysis, the combination of PEmax and age was an independent marker of diaphragm excursions during maximal respiratory efforts with COPD patients. Conclusion: COPD subjects had smaller diaphragmatic excursions during maximal respiratory efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. These results suggest that diaphragm excursions during maximal respiratory efforts with COPD patients may be valuable at predicting the pulmonary function.

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An Analysis on the Conditions for Successful Economic Sanctions on North Korea : Focusing on the Maritime Aspects of Economic Sanctions (대북경제제재의 효과성과 미래 발전 방향에 대한 고찰: 해상대북제재를 중심으로)

  • Kim, Sang-Hoon
    • Strategy21
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    • s.46
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    • pp.239-276
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    • 2020
  • The failure of early economic sanctions aimed at hurting the overall economies of targeted states called for a more sophisticated design of economic sanctions. This paved way for the advent of 'smart sanctions,' which target the supporters of the regime instead of the public mass. Despite controversies over the effectiveness of economic sanctions as a coercive tool to change the behavior of a targeted state, the transformation from 'comprehensive sanctions' to 'smart sanctions' is gaining the status of a legitimate method to impose punishment on states that do not conform to international norms, the nonproliferation of weapons of mass destruction in this particular context of the paper. The five permanent members of the United Nations Security Council proved that it can come to an accord on imposing economic sanctions over adopting resolutions on waging military war with targeted states. The North Korean nuclear issue has been the biggest security threat to countries in the region, even for China out of fear that further developments of nuclear weapons in North Korea might lead to a 'domino-effect,' leading to nuclear proliferation in the Northeast Asia region. Economic sanctions had been adopted by the UNSC as early as 2006 after the first North Korean nuclear test and has continually strengthened sanctions measures at each stage of North Korean weapons development. While dubious of the effectiveness of early sanctions on North Korea, recent sanctions that limit North Korea's exports of coal and imports of oil seem to have an impact on the regime, inducing Kim Jong-un to commit to peaceful talks since 2018. The purpose of this paper is to add a variable to the factors determining the success of economic sanctions on North Korea: preventing North Korea's evasion efforts by conducting illegal transshipments at sea. I first analyze the cause of recent success in the economic sanctions that led Kim Jong-un to engage in talks and add the maritime element to the argument. There are three conditions for the success of the sanctions regime, and they are: (1) smart sanctions, targeting commodities and support groups (elites) vital to regime survival., (2) China's faithful participation in the sanctions regime, and finally, (3) preventing North Korea's maritime evasion efforts.

Clinical Efficacy of Erdosteine in Patients with Acute or Chronic Bronchitis -A Randomized, Double Blind, Comparative Study vs. Ambroxol- (급.만성 기관지염 환자에서 엘도스$^{(R)}$(Erdosteine)의 임상효과 -염산 암브록솔과의 무작위 이중맹검 비교시험-)

  • Kim, Seok-Chan;Lee, Sang-Hoak;Song, So-Hyang;Kim, Young-Kyoon;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1296-1307
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    • 1997
  • Background : Erdosteine is a thiol derivative developed for the treatement of chronic obstructive bronchitis, including acute infective exacerbation of chronic bronchitis. Erdosteine has mucomodulating and antioxidant properties and especially exhibits excellent gastrointestinal tolerability. Methods : The study was conducted as a prospective evaluation, with 2 comparative groups orally treated with erdosteine 300mg (bid.) or ambroxol 30mg (b.i.d.) for 7 days and the design of trial was double-blind. The treatments have been assigned randomly to patients (n=80) with acute or chronic bronchitis. The primary end-point used to determine efficacy in this study was subjective symptoms including expectorating frequence, expectoration volume, expectorating difficulty, expectoration viscosity, cough intensity and dyspnea. The secondary end-points of efficacy was the result of arterial blood gas analysis and pulmonary function test. Safety was evaluated with adverse drug reactions and laboratory tests monitoring. 61 patients was included in the efficacy analysis, due to the fact that 19 patients drop-out for different reasons. The obtained values have been analyzed with paired Hest., ANOVA test., multivariate $t^2$-test, repeated measures analysis of covariance, two sample t-test, loglinear-logit model analysis, Fisher's exact test. Results : 1) There was no significant difference on demographic data and vital signs between erdosteine and ambroxol treated groups. 2) The comparison between erdosteine and ambroxol treated groups showed no significant difference in improvement of each symptom in spite of the more favorable efficacy obtained with erdosteine. No difference on the contrary was observed for arterial blood gas analysis and pulmonary function test. 3) As safety is concerned, no clinical significant changes in laboratory test and symptom were induced in erdosteine and ambroxol treated group and two patients in ambroxol treated group drop-out for adverse reactions in symptom. 4) In the evaluation of final clinical efficacy, erdosteine improved more effectively patient's overall symptoms {very good effect (11/31), good effect (12/31), moderate effect (6/31), no effect (2/31), aggravation (0/31)} than ambroxol {very good effect (6/30), good effect (14/30), moderate effect (5/30), no effect (4/30), aggravation (2/30)}. And the probability of symptomatic improvement by erdosteine compared to ambroxol was 2.5 times. (p<0.05). Conclusion : This study showed that erdosteine was clinically effective and safe drug for treatment of acute and chronic bronchitis.

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APPLICATION OF FUZZY SET THEORY IN SAFEGUARDS

  • Fattah, A.;Nishiwaki, Y.
    • Proceedings of the Korean Institute of Intelligent Systems Conference
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    • 1993.06a
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    • pp.1051-1054
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    • 1993
  • The International Atomic Energy Agency's Statute in Article III.A.5 allows it“to establish and administer safeguards designed to ensure that special fissionable and other materials, services, equipment, facilities and information made available by the Agency or at its request or under its supervision or control are not used in such a way as to further any military purpose; and to apply safeguards, at the request of the parties, to any bilateral or multilateral arrangement, or at the request of a State, to any of that State's activities in the field of atomic energy”. Safeguards are essentially a technical means of verifying the fulfilment of political obligations undertaken by States and given a legal force in international agreements relating to the peaceful uses of nuclear energy. The main political objectives are: to assure the international community that States are complying with their non-proliferation and other peaceful undertakings; and to deter (a) the diversion of afeguarded nuclear materials to the production of nuclear explosives or for military purposes and (b) the misuse of safeguarded facilities with the aim of producing unsafeguarded nuclear material. It is clear that no international safeguards system can physically prevent diversion. The IAEA safeguards system is basically a verification measure designed to provide assurance in those cases in which diversion has not occurred. Verification is accomplished by two basic means: material accountancy and containment and surveillance measures. Nuclear material accountancy is the fundamental IAEA safeguards mechanism, while containment and surveillance serve as important complementary measures. Material accountancy refers to a collection of measurements and other determinations which enable the State and the Agency to maintain a current picture of the location and movement of nuclear material into and out of material balance areas, i. e. areas where all material entering or leaving is measurab e. A containment measure is one that is designed by taking advantage of structural characteristics, such as containers, tanks or pipes, etc. To establish the physical integrity of an area or item by preventing the undetected movement of nuclear material or equipment. Such measures involve the application of tamper-indicating or surveillance devices. Surveillance refers to both human and instrumental observation aimed at indicating the movement of nuclear material. The verification process consists of three over-lapping elements: (a) Provision by the State of information such as - design information describing nuclear installations; - accounting reports listing nuclear material inventories, receipts and shipments; - documents amplifying and clarifying reports, as applicable; - notification of international transfers of nuclear material. (b) Collection by the IAEA of information through inspection activities such as - verification of design information - examination of records and repo ts - measurement of nuclear material - examination of containment and surveillance measures - follow-up activities in case of unusual findings. (c) Evaluation of the information provided by the State and of that collected by inspectors to determine the completeness, accuracy and validity of the information provided by the State and to resolve any anomalies and discrepancies. To design an effective verification system, one must identify possible ways and means by which nuclear material could be diverted from peaceful uses, including means to conceal such diversions. These theoretical ways and means, which have become known as diversion strategies, are used as one of the basic inputs for the development of safeguards procedures, equipment and instrumentation. For analysis of implementation strategy purposes, it is assumed that non-compliance cannot be excluded a priori and that consequently there is a low but non-zero probability that a diversion could be attempted in all safeguards ituations. An important element of diversion strategies is the identification of various possible diversion paths; the amount, type and location of nuclear material involved, the physical route and conversion of the material that may take place, rate of removal and concealment methods, as appropriate. With regard to the physical route and conversion of nuclear material the following main categories may be considered: - unreported removal of nuclear material from an installation or during transit - unreported introduction of nuclear material into an installation - unreported transfer of nuclear material from one material balance area to another - unreported production of nuclear material, e. g. enrichment of uranium or production of plutonium - undeclared uses of the material within the installation. With respect to the amount of nuclear material that might be diverted in a given time (the diversion rate), the continuum between the following two limiting cases is cons dered: - one significant quantity or more in a short time, often known as abrupt diversion; and - one significant quantity or more per year, for example, by accumulation of smaller amounts each time to add up to a significant quantity over a period of one year, often called protracted diversion. Concealment methods may include: - restriction of access of inspectors - falsification of records, reports and other material balance areas - replacement of nuclear material, e. g. use of dummy objects - falsification of measurements or of their evaluation - interference with IAEA installed equipment.As a result of diversion and its concealment or other actions, anomalies will occur. All reasonable diversion routes, scenarios/strategies and concealment methods have to be taken into account in designing safeguards implementation strategies so as to provide sufficient opportunities for the IAEA to observe such anomalies. The safeguards approach for each facility will make a different use of these procedures, equipment and instrumentation according to the various diversion strategies which could be applicable to that facility and according to the detection and inspection goals which are applied. Postulated pathways sets of scenarios comprise those elements of diversion strategies which might be carried out at a facility or across a State's fuel cycle with declared or undeclared activities. All such factors, however, contain a degree of fuzziness that need a human judgment to make the ultimate conclusion that all material is being used for peaceful purposes. Safeguards has been traditionally based on verification of declared material and facilities using material accountancy as a fundamental measure. The strength of material accountancy is based on the fact that it allows to detect any diversion independent of the diversion route taken. Material accountancy detects a diversion after it actually happened and thus is powerless to physically prevent it and can only deter by the risk of early detection any contemplation by State authorities to carry out a diversion. Recently the IAEA has been faced with new challenges. To deal with these, various measures are being reconsidered to strengthen the safeguards system such as enhanced assessment of the completeness of the State's initial declaration of nuclear material and installations under its jurisdiction enhanced monitoring and analysis of open information and analysis of open information that may indicate inconsistencies with the State's safeguards obligations. Precise information vital for such enhanced assessments and analyses is normally not available or, if available, difficult and expensive collection of information would be necessary. Above all, realistic appraisal of truth needs sound human judgment.

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Pareto Ratio and Inequality Level of Knowledge Sharing in Virtual Knowledge Collaboration: Analysis of Behaviors on Wikipedia (지식 공유의 파레토 비율 및 불평등 정도와 가상 지식 협업: 위키피디아 행위 데이터 분석)

  • Park, Hyun-Jung;Shin, Kyung-Shik
    • Journal of Intelligence and Information Systems
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    • v.20 no.3
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    • pp.19-43
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    • 2014
  • The Pareto principle, also known as the 80-20 rule, states that roughly 80% of the effects come from 20% of the causes for many events including natural phenomena. It has been recognized as a golden rule in business with a wide application of such discovery like 20 percent of customers resulting in 80 percent of total sales. On the other hand, the Long Tail theory, pointing out that "the trivial many" produces more value than "the vital few," has gained popularity in recent times with a tremendous reduction of distribution and inventory costs through the development of ICT(Information and Communication Technology). This study started with a view to illuminating how these two primary business paradigms-Pareto principle and Long Tail theory-relates to the success of virtual knowledge collaboration. The importance of virtual knowledge collaboration is soaring in this era of globalization and virtualization transcending geographical and temporal constraints. Many previous studies on knowledge sharing have focused on the factors to affect knowledge sharing, seeking to boost individual knowledge sharing and resolve the social dilemma caused from the fact that rational individuals are likely to rather consume than contribute knowledge. Knowledge collaboration can be defined as the creation of knowledge by not only sharing knowledge, but also by transforming and integrating such knowledge. In this perspective of knowledge collaboration, the relative distribution of knowledge sharing among participants can count as much as the absolute amounts of individual knowledge sharing. In particular, whether the more contribution of the upper 20 percent of participants in knowledge sharing will enhance the efficiency of overall knowledge collaboration is an issue of interest. This study deals with the effect of this sort of knowledge sharing distribution on the efficiency of knowledge collaboration and is extended to reflect the work characteristics. All analyses were conducted based on actual data instead of self-reported questionnaire surveys. More specifically, we analyzed the collaborative behaviors of editors of 2,978 English Wikipedia featured articles, which are the best quality grade of articles in English Wikipedia. We adopted Pareto ratio, the ratio of the number of knowledge contribution of the upper 20 percent of participants to the total number of knowledge contribution made by the total participants of an article group, to examine the effect of Pareto principle. In addition, Gini coefficient, which represents the inequality of income among a group of people, was applied to reveal the effect of inequality of knowledge contribution. Hypotheses were set up based on the assumption that the higher ratio of knowledge contribution by more highly motivated participants will lead to the higher collaboration efficiency, but if the ratio gets too high, the collaboration efficiency will be exacerbated because overall informational diversity is threatened and knowledge contribution of less motivated participants is intimidated. Cox regression models were formulated for each of the focal variables-Pareto ratio and Gini coefficient-with seven control variables such as the number of editors involved in an article, the average time length between successive edits of an article, the number of sections a featured article has, etc. The dependent variable of the Cox models is the time spent from article initiation to promotion to the featured article level, indicating the efficiency of knowledge collaboration. To examine whether the effects of the focal variables vary depending on the characteristics of a group task, we classified 2,978 featured articles into two categories: Academic and Non-academic. Academic articles refer to at least one paper published at an SCI, SSCI, A&HCI, or SCIE journal. We assumed that academic articles are more complex, entail more information processing and problem solving, and thus require more skill variety and expertise. The analysis results indicate the followings; First, Pareto ratio and inequality of knowledge sharing relates in a curvilinear fashion to the collaboration efficiency in an online community, promoting it to an optimal point and undermining it thereafter. Second, the curvilinear effect of Pareto ratio and inequality of knowledge sharing on the collaboration efficiency is more sensitive with a more academic task in an online community.

Yesterday and Today of Twelve Excellent Sceneries at Banbyeoncheon Expressed in Heojoo's Sansuyucheop (허주(虛舟) 산수유첩(山水遺帖)에 표현된 반변천(半邊川) 십이승경(十二勝景)의 어제와 오늘)

  • Kim, Jeong-Moon;Rho, Jae-Hyun
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.30 no.1
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    • pp.90-102
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    • 2012
  • Sansuyucheop by Heojoobugun(虛舟府君) as the subject of this study is a 십이-width picture album by the eldest grandson of 11 generations for Goseong Lee family, Lee Jong Ak(李宗岳: 1726-1773), a figure having five habits(五癖) for ancient documents(古書癖), playing the gayageum(彈琴癖), flowering plant(花卉癖), paintings and calligraphic works(書畵癖) and boating(舟遊癖) etc., who boated with 18 relatives, and those by marriage from old home, home of mother's side, wife's home, and his home for 5 days Apr. 4 through 8, 1763, starting from Imcheonggak, through Yangjeong(羊汀), Chiltan(七灘), Sabin Auditorium(泗濱書院), Seonchang(船倉), Nakyeon(落淵), Seonchal(仙刹), Seonyujeong(仙遊亭), Mongseongak(夢仙閣), Baekwoonjeong(白雲亭) and Naeap Village(川前里), Iho(伊湖), Seoeodae(鮮魚帶) to the returning point, Bangujeong(伴鷗亭), cruised magnificent views around Banbyeoncheon called 'Andong 8 Gyeong' or 'Imhagugok', and whenever the boat anchored, appreciated the scenery at each point, and enjoyed and loved arts playing the geomungo. This study reached following findings through grasping physical, ecological, visual and aesthetic changes about the places, sceneries, plant elements and past and current scenery of the width pictures expressed at this Sansuyucheop. The refinement on the boat seeing the clear river water, white sand beach, fantastically-shaped cliffs expressed at this Sansuyucheop, exchanging poems and calligraphies, and enjoying the geomungo is a good example displaying the play culture of high-class in Joseon Dynasty. Also construction of Imha Dam and Andong Dam has caused serious visual and ecological changes, making us not enable to feel the original mood of the background spots such as Yangjeonggwabeom(羊汀過帆), Chiltanhuseon(七灘候船), Sasubeomjoo(泗水泛舟), Seonchanggyeram(船倉繫纜), Nakyeonmosaek(落淵莫色), Mangcheonguido(輞川歸棹), Ihojeongdo(伊湖停棹), but only discern then landscape or sentiment through the landscape described at the canvas. The 1st picture(Donghohaeram, 東湖解纜), and the 11th picture(Seoeobanjo, 鮮魚返照) of Heojoobugun's Sansuyucheop expressed trees thought to be fallen, brad-leaf tall trees, and the 9th picture(Unjeongpungbeom, 雲亭風帆) formed a pine forest called 'Gaeho(開湖)' by Uncheongong planting 1,000 pine trees with the village people in 1617. In addition, Seunggyeongdo expressed ever-green needle leaf trees at the natural topography, and fallen-leaf tall trees around the pavilion and building. Comparative consideration of Heojoobugun's Sansuyucheop and Shinam's Dongyusipsogi(東遊十小記) showed that the location of Samgok is assumed to be Macheon and Chiltan, so Imhagugok is assumed to start from Baekunjeong of Ilgok, Igok from Imcheon and Imcheon auditorium, Samgok from Mangcheon and Chiltan, Sagok from Sabin Auditorium of Sasoo, Ogok from Songseok, Yukgok from Sooseok of Seonchang, Chilgok from Nakyeonhyeonryu, Palgok from Seonchalsa and Seonyoojeong, and Gugok from Pyong Yuheo. This study can be significant in that it could clarify that Heojoobugun's Sansuyucheop is judged to be valuable in exquisitively expressing the coast of Banbyeon River, the biggest branch stream in the Nakdong River at the latter half of Joseon Dynasty, and as a vital diagrammatical historical data to make a comparative analysis of currently rarely-seen ancestors' life traces and landscape factors with present ones.