• Journal of Korean Academy of Nursing Administration
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• v.3 no.1
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• pp.51-64
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• 1997

The purpose of the study was to introduce an integrated approach of new Casuistry and specified principlism in resolving ethical problems and studying nursing ethics. In studying clinical ethics and nursing ethics, there is no systematic research method. While nurses often experience ethical dilemmas in practice, much of previous research on nursing ethics has focused merely on describing the existing problems. In addition, ethists presented theoretical analysis and critics rather than providing the specific problems solving strategies. There is a need in clinical situations for an integrated method which can provide the objective description for existing problem situations as well as specific problem solving methods. We inherit two distinct ways of discussing ethical issues. One of these frames these issues in terms of principles, rules, and other general ideas; the other focuses on the specific features of particular kinds of moral cases. In the first way general ethical rules relate to specific moral cases in a theoretical manner, with universal rules serving as "axioms" from which particular moral judgments are deduced as theorems. In the seconds, this relation is frankly practical. with general moral rules serving as "maxims", which can be fully understood only in terms of the paradigmatic cases that define their meaning and force. Theoretical arguments are structured in ways that free them from any dependence on the circumstances of their presentation and ensure them a validity of a kind that is not affected by the practical context of use. In formal arguments particular conclusions are deduced from("entailed by") the initial axioms or universal principles that are the apex of the argument. So the truth or certainty that attaches to those axioms flows downward to the specific instances to be "proved". In the language of formal logic, the axioms are major premises, the facts that specify the present instance are minor premises, and the conclusion to be "proved" is deduced (follows necessarily) from the initial presises. Practical arguments, by contrast, involve a wider range of factors than formal deductions and are read with an eye to their occasion of use. Instead of aiming at strict entailments, they draw on the outcomes of previous experience, carrying over the procedures used to resolve earlier problems and reapply them in new problmatic situations. Practical arguments depend for their power on how closely the present circumstances resemble those of the earlier precedent cases for which this particular type of argument was originally devised. So. in practical arguments, the truths and certitudes established in the precedent cases pass sideways, so as to provide "resolutions" of later problems. In the language of rational analysis, the facts of the present case define the gounds on which any resolution must be based; the general considerations that carried wight in similar situations provide warrants that help settle future cases. So the resolution of any problem holds good presumptively; its strengh depends on the similarities between the present case and the prededents; and its soundness can be challenged (or rebutted) in situations that are recognized ans exceptional. Jonsen & Toulmin (1988), and Jonsen (1991) introduce New Casuistry as a practical method. The oxford English Dictionary defines casuistry quite accurately as "that part of ethics which resolves cases of conscience, applying the general rules of religion and morality to particular instances in which circumstances alter cases or in which there appears to be a conflict of duties." They modified the casuistry of the medieval ages to use in clinical situations which is characterized by "the typology of cases and the analogy as an inference method". A case is the unit of analysis. The structure of case was made with interaction of situation and moral rules. The situation is what surrounds or stands around. The moral rule is the essence of case. The analogy can be objective because "the grounds, the warrants, the theoretical backing, the modal qualifiers" are identified in the cases. The specified principlism was the method that Degrazia (1992) integrated the principlism and the specification introduced by Richardson (1990). In this method, the principle is specified by adding information about limitations of the scope and restricting the range of the principle. This should be substantive qualifications. The integrated method is an combination of the New Casuistry and the specified principlism. For example, the study was "Ethical problems experienced by nurses in the care of terminally ill patients"(Um, 1994). A semi-structured in-depth interview was conducted for fifteen nurses who mainly took care of terminally ill patients. The first stage, twenty one cases were identified as relevant to the topic, and then were classified to four types of problems. For instance, one of these types was the patient's refusal of care. The second stage, the ethical problems in the case were defined, and then the case was analyzed. This was to analyze the reasons, the ethical values, and the related ethical principles in the cases. Then the interpretation was synthetically done by integration of the result of analysis and the situation. The third stage was the ordering phase of the cases, which was done according to the result of the interpretation and the common principles in the cases. The first two stages describe the methodology of new casuistry, and the final stage was for the methodology of the specified principlism. The common principles were the principle of autonomy and the principle of caring. The principle of autonomy was specified; when competent patients refused care, nurse should discontinue the care to respect for the patients' decision. The principle of caring was also specified; when the competent patients refused care, nurses should continue to provide the care in spite of the patients' refusal to preserve their life. These specification may lead the opposite behavior, which emphasizes the importance of nurse's will and intentions to make their decision in the clinical situations.

• Korean Journal of Microbiology
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• v.49 no.4
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• pp.424-428
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• 2013

To identify risk factors for Legionella contamination, water quality variables routinely measured in examination of natural and city waters were meta-analyzed for significance of correlation to Legionella incidences. For evaluation of abundance of Escherichia coli as a risk factor, which is currently used as an indicator of Legionella contamination in an official guideline in Korea, odds ratio (OR) of above-cutoff total coliform counts for Legionella presence/absence was used as the effect size in the meta-analysis. The OR was estimated as 1.05 (0.36-3.12, 95% CI), and the probability of having identical odds reached 0.92. Also, ORs from individual studies showed significant heterogeneity (P=0.008), which contributed to 63% of total variance of the ORs. In the case of heterotrophic plate count (HPC), the OR for Legionella presence/absence was 2.72 (2.04-3.63) with highly significant deviation from identical odds (P<0.0001). ORs from different studies were seemingly homogeneous ($Q_{df=8}$=12.7, P=0.12). Turbidity and concentrations of chlorine, iron ion and cupper ion were other routine variables that could be considered as risk factors. However, statistical measures from different studies were not uniform enough to develop an appropriate effect size while the number of studies reporting the variables was also small (3-5). In conclusion, HPC appeared to be appropriate as indicator of Legionella contamination, rather than fecal bacteria contamination. HPC may imply abundance of habitats (amoebas and biofilms) of Legionella in water. This result warrants further studies for standardizing protocols and cutoff values to infer Legionella risks from HPC.

• Journal of Korean Society of Transportation
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• v.31 no.6
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• pp.43-52
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• 2013

A roundabout is a form of circular intersection in which traffic travels counterclockwise around a central island and in which entering traffic must yield to circulating traffic. It has been known that a roundabout provides substantially better operational and safety characteristics than other intersections including rotaries. Recently, a roundabout has started to be constructed due to its efficiency, safety, and other advantages of a roundabout comparing other intersections in Korea. However, there has been no guideline to be used to decide appropriate intersection types considering given conditions of the intersections. To solve this problem, the guideline with traffic volume to choose the suitable intersection types was developed based on analysis results using the SIDRA software which is generally used to analyze operational effects of roundabouts. It was found that a roundabout is more efficient than signalized intersection when the traffic volume is between 125 and 450 veh/h on one lane road and roundabout is not recommended when there are more than 30% left turn traffic. The optimal traffic volume provided in this research will be usefully used in planing and designing roundabouts in Korea.

• Journal of Environmental Health Sciences
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• v.41 no.6
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• pp.449-457
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• 2015

Objectives: In Korea, the system of management of medical waste largely relies on the incineration method. Our study aimed to identify any regional imbalances between the generation and treatment of medical waste, and provide reference data for future policy in Korea. Methods: We analyzed data on the amount of medical waste from 2,000 hospitals in 2012, 2013, and 2014 obtained from the Korea Environment Corporation. In the Arc GIS program (version 10.2.3), the addresses of hospitals and incinerators were transformed into map coordinates. The amount of waste generated by each hospital and the amount incinerated were represented by density and size of a triangle symbol, respectively. Results: As of 2014, the total amount of medical waste from the top 2,000 hospitals was 136,073 tons, out of which about half (49%) was generated in the capital area. Eleven incineration companies (three in the capital area, two in the Chungcheong Provinces area, one in the Jeolla Provinces area, and five in the Gyeongsang Provinces area) treated this waste. For the years 2012, 2013, and 2014, about 60% of the medical waste generated from the hospitals in the capital area was treated within the capital area and about 40% was transported to other areas, especially the Gyeongsang Provinces area, for treatment. On the other hand, about 90% of the medical waste incinerated in the capital area originated from the capital area. Conclusion: Our results suggest a spatial imbalance between the generation and treatment of medical waste in Korea and warrants multilateral policies, including the expansion of on-site treatment, strengthening regulation of the containment of medical wastes, promoting reductions in medical waste and more.

• Journal of Gastric Cancer
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• v.18 no.3
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• pp.230-241
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• 2018

Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GCERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. Materials and Methods: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. Results: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). Conclusions: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

• Journal of The Korean Association For Science Education
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• v.31 no.5
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• pp.694-708
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• 2011

In this study, we developed tasks including cognitive scaffolding for students to explain scientific phenomena using valid evidences in science classroom and sought to investigate how tasks influence the development of small group scientific argumentation. Heterogeneous small groups in gender and achievement were organized in one classroom and the tasks were applied to the class. Students were asked to write down their own ideas, share individual ideas, and then choose the most plausible opinion in a group. One group was chosen for investigating the effect of tasks on the development of small group argumentation through the analysis of discourse transcripts of the group in 10 lessons, students' semi-structured interview, field note, and students' pre- and post argument tests. The discrepant argument examples were included in the tasks for students to refute an argument presenting evidences. Moreover, comparing opinion within the group and persuading others were included in the tasks to prompt small group argumentation. As a result, students' post-argument test grades were increased than pre-test grades, and they argued involving evidences and reasoning. The high level of arguments has appeared with high ratio of advanced utterances and lengthening of reasoning chain as lessons went on. Students had elaborate claims involving valid evidences and reasoning by reflective and critical thinking while discussing about the tasks. In addition, tasks which could have various warrants based on the data led to students' spontaneous participation. Therefore, this study has significance in understanding the context of developing small group argumentation, providing information about teaching and learning context prompting students to construct arguments in science inquiry lessons in middle school.

• Physical Therapy Korea
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• v.19 no.3
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• pp.31-39
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• 2012

The lower trapezius muscle is an important stabilizer and primary mover of the scapula. The potential use of ultrasound imaging to evaluate scapular muscle function warrants investigation. The purpose of this study is to use ultrasound imaging for determining the effectiveness of 4 different isometric exercises for maximally activating the lower trapezius muscles in healthy subjects. Twenty-eight (14 men and 14 women) volunteers were recruited for this study. Thickness measurements of the lower trapezius muscles were recorded during 4 exercises: latissimus pulldown (LP), prone V-raise (PV), prone row (PR), and modified prone cobra (MP). Lower trapezius muscle thickness was measured 3 times by 2 investigators at a point 3 cm lateral to the lateral edge of the T8 spinous process. The order of 4 exercise execution was randomized for each participant. To identify statistical significance, one-way ANOVA with repeated measures was used with the significance level of .05. Intraclass correlation coefficient (ICC) for intra-reliability was .86~.98 and inter-rater reliability .83~.96 for the lower trapezius, respectively (p<.01). Thickness changes in the lower trapezius muscles between the relaxed and contracted states in men were as follows: LP ($7.37{\pm}2.68mm$, 182%), MP ($4.69{\pm}1.74mm$, 167%), PV ($4.52{\pm}1.47mm$, 149%), and PR ($3.84{\pm}1.72mm$, 133%). In women the values were as follows: LP ($4.64{\pm}1.24mm$, 163%), MP ($2.79{\pm}.81mm$, 131%), PV ($2.78{\pm}.85mm$, 129%), and PR ($2.21{\pm}1.26$ mm, 100%). Thickness of the lower trapezius muscles significantly differed between exercises in both the gender (p<.01). The LP was the most effective exercise for increasing the activation of the lower trapezius muscle in both the gender. We recommend performing the LP exercise for strengthening the lower trapezius muscles.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.122-133
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• 2014

Purpose: We conducted a descriptive correlational study to determine a relationship between nurses' awareness of good death and attitudes toward terminal care, which in turn could be used as basic data for improvement of the quality of terminal care at geriatric hospitals. Methods: From April 3, 2013 through April 22, 2013, data were collected from 230 nurses working at geriatric hospitals. Results: Nurses' attitudes toward terminal care showed no significant correlation with awareness of good death, but it was positively correlated with a sense of closeness, a subfactor of awareness of good death. There was negative correlation between emotions regarding a deathbed, a subfactor of attitudes of nurses in charge of terminal patients, and awareness of good death. We found positive correlation between terminal care performance and awareness of good death. Conclusion: This study warrants the need for nursing education catered to characteristics of geriatric hospitals and development of diverse intervention strategies to help them to attain a positive attitude toward death by familiarizing themselves with the concept of good death and enhancing job satisfaction.

• Geophysics and Geophysical Exploration
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• v.14 no.1
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• pp.25-41
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• 2011

AVO analysis was conducted on hydrocarbon-bearing structures by applying the crossplot and offset-coordinate amplitude polynomial techniques. To evaluate the applicability of the AVO analysis, it was conducted on synthetic data that were generated with an anticline model, and field data from the hydrocarbon-bearing Colony Sand bed in Canada. Analysis of synthetic data from the anticline model demonstrates that the crossplot method yields zero-offset reflection amplitude and amplitude variation with negative values for the upper interface of the hydrocarbon-bearing layer. The crossplot values are clustered in the third quadrant. The results of AVO analysis based on the coefficients of the amplitude polynomial are similar to those from the crossplots. These well correlated results of AVO analysis on field and synthetic data suggest that both methods successfully investigate the characteristics of the reflections from the upper interface of a hydrocarbon-bearing layer. Analysis based on the incident-angle equation facilitates the application of various interpretation methods. However, it requires the conversion of seismic data to an incident angle gather. By contrast, analysis using coefficients of the amplitude polynomial is cost-effective because it allows examining amplitude variation with offset without involving the conversion process. However, it warrants further investigation into versatile application. The two different techniques can be complement each other effectively as AVO-analysis tools for the detection of hydrocarbon reservoirs.

• Journal of Korean Society for Atmospheric Environment
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• v.33 no.5
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• pp.445-457
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• 2017

In this study, we developed an approach to better account for uncertainties in estimated contributions from fine particulate matter ($PM_{2.5}$) modeling. Our approach computes a Concentration Correction Factor (CCF) which is a ratio of observed concentrations to baseline model concentrations. We multiply modeled direct contribution estimates with CCF to obtain revised contributions. Overall, the modeling system showed reasonably good performance, correlation coefficient R of 0.82 and normalized mean bias of 2%, although the model underestimated some PM species concentrations. We also noticed that model biases vary seasonally. We compared contribution estimates of major source sectors before and after applying CCFs. We observed that different source sectors showed variable magnitudes of sensitivities to the CCF application. For example, the total primary $PM_{2.5}$ contribution was increased $2.4{\mu}g/m^3$ or 63% after the CCF application. Out of a $2.4{\mu}g/m^3$ increment, line sources and area source made up $1.3{\mu}g/m^3$ and $0.9{\mu}g/m^3$ which is 92% of the total contribution changes. We postulated two major reasons for variations in estimated contributions after the CCF application: (1) monthly variability of unadjusted contributions due to emission source characteristics and (2) physico-chemical differences in environmental conditions that emitted precursors undergo. Since emissions-to-$PM_{2.5}$ concentration conversion rate is an important piece of information to prioritize control strategy, we examined the effects of CCF application on the estimated conversion rates. We found that the application of CCFs can alter the rank of conversion efficiencies of source sectors. Finally, we discussed caveats of our current approach such as no consideration of ion neutralization which warrants further studies.