• Title/Summary/Keyword: EXTENSIVE MANAGEMENT

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Drug resistance of Mycobacterium tuberculosis in children (소아 결핵 환자에서의 항결핵제 내성 II)

  • Lee, Soo Jin;Ahn, Young Min;Kim, Hee Jin
    • Clinical and Experimental Pediatrics
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    • v.52 no.1
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    • pp.61-67
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    • 2009
  • Purpose : The rate of drug-resistant tuberculosis (DR-TB) in children is an indicator of the effectiveness of TB control programs in the community. This study aimed to assess the prevalence of DR-TB in children and evaluate TB management. Methods : Between January 1999 and July 2007, drug susceptibility tests for anti-TB drugs were employed for patients aged less than 19 years with culture-positive TB. Results : A total of 607 cases (16.6%) were resistant to at least one anti-TB drug as follows: isoniazid (INH; 13.8%), rifampin (8.9%), pyrazinamide (4.2%), streptomycin (3.7%), ethambutol (EMB; 5.9%), and para-aminosalicylic acid (PAS; 1.9%). Multidrug-resistant (MDR) TB was found in 276 cases (7.6%); extensive drug resistant (XDR) TB, in 5 cases (0.2%). The rate of resistance to at least one anti-TB drug in children aged >15 years (16.1%) was significantly lower than that in children aged <15 years (20.5%) (P=0.016). The rate of resistance to at least one anti-TB drug and multidrug-resistance in this survey decreased significantly (P<0.001) as compared to the previous survey (1987-1995). The rate of resistance to INH, EMB, and PAS also significantly decreased (P<0.05). Conclusion : The rate of DR-TB in children in Korea has decreased over time; however, it remains higher than that in other countries. MDR-TB and XDR-TB are the emerging problems in Korean children. Therefore, the selection of effective drugs through drug susceptibility tests and evaluating risk factors of resistant TB is essential to successful therapy and a decreased incidence of DR-TB.

A Qualitative Study on Facilitating Factors of User-Created Contents: Based on Theories of Folklore (사용자 제작 콘텐츠의 활성화 요인에 대한 정성적 연구: 구비문학 이론을 중심으로)

  • Jung, Seung-Ki;Lee, Ki-Ho;Lee, In-Seong;Kim, Jin-Woo
    • Asia pacific journal of information systems
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    • v.19 no.2
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    • pp.43-72
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    • 2009
  • Recently, user-created content (UCC) have emerged as popular medium of on-line participation among users. The Internet environment has been constantly evolving, attracting active participation and information sharing among common users. This tendency is a significant deviation from the earlier Internet use as an one-way information channel through which users passively received information or contents from contents providers. Thanks to UCCs online users can now more freely generate and exchange contents; therefore, identifying the critical factors that affect content-generating activities has increasingly become an important issue. This paper proposes a set of critical factors for stimulating contents generation and sharing activities by Internet users. These factors were derived from the theories of folklores such as tales and songs. Based on some shared traits of folklores and UCC content, we found four critical elements which should be heeded in constructing UCC contents, which are: context of culture, context of situation, skill of generator, and response of audience. In addition, we selected three major UCC websites: a specialized contents portal, a general internet portal, and an official contents service site, They have different use environments, user interfaces, and service policies, To identify critical factors for generating, sharing and transferring UCC, we traced user activities, interactions and flows of content in the three UCC websites. Moreover, we conducted extensive interviews with users and operators as well as policy makers in each site. Based on qualitative and quantitative analyses of the data, this research identifies nine critical factors that facilitate contents generation and sharing activities among users. In the context of culture, we suggest voluntary community norms, proactive use of copyrights, strong user relationships, and a fair monetary reward system as critical elements in facilitating the process of contents generation and sharing activities. Norms which were established by users themselves regulate user behavior and influence content format. Strong relationships of users stimulate content generation activities by enhancing collaborative content generation. Particularly, users generate contents through collaboration with others, based on their enhanced relationship and specialized skills. They send and receive contents by leaving messages on website or blogs, using instant messenger or SMS. It is an interesting and important phenomenon, because the quality of contents can be constantly improved and revised, depending on the specialized abilities of those engaged in a particular content. In this process, the reward system is an essential driving factor. Yet, monetary reward should be considered only after some fair criterion is established. In terms of the context of the situation, the quality of contents uploading system was proposed to have strong influence on the content generating activities. Among other influential factors on contents generation activities are generators' specialized skills and involvement of the users were proposed. In addition, the audience response, especially effective development of shared interests as well as feedback, was suggested to have significant influence on contents generation activities. Content generators usually reflect the shared interest of others. Shared interest is a distinct characteristic of UCC and observed in all the three websites, in which common interest is formed by the "threads" embedded with content. Through such threads of information and contents users discuss and share ideas while continuously extending and updating shared contents in the process. Evidently, UCC is a new paradigm representing the next generation of the Internet. In order to fully utilize this innovative paradigm, we need to understand how users take advantage of this medium in generating contents, and what affects their content generation activities. Based on these findings, UCC service providers should design their websites as common playground where users freely interact and share their common interests. As such this paper makes an important first step to gaining better understand about this new communication paradigm created by UCC.

Preliminary Results of Management for Primary CNS Lymphoma (원발성 중추신경계 림프종의 치료에 관한 예비적 결과)

  • Ahn, Seung-Do;Chang, Hye-Sook;Choi, Eun-Kyong
    • Radiation Oncology Journal
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    • v.11 no.1
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    • pp.79-82
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    • 1993
  • From October 1989 to March 1992, ten patients diagnosed as primary central nervous system (CNS) lymphoma were treated with radiation therapy at Asan Medical Center. To obtain pathologic diagnosis, five patients had stereotactic biopsy and the others underwent craniotomy & tumor removal. According to the classification by International Working Formulation, seven of 10 patients showed diffuse large cell types and the remaining 3 had diffuse mixed cell types. Computed tomographic scans of the brain disclosed solitary (6 cases) or multiple (4 cases) intracranial lesions. All patients received 4000 cGy/20 fx to the whole brain followed by an additional 2000 cGy/10 fx boost to the primary lesion. Six patients with initial cerebrospinal fluid (CSF involvement were treated with whole brain irradiation and intrathecal Methotrexate (IT-MTX) chemotherapy. One of them received an additional spinal irradiation after 3 cycles of IT-MTX chemotherapy because of MTX induced arachnoiditis. One patient received 3 cycles of systemic chemotherapy prior to rodiation therapy and one received 5 cycles of salvage chemotherapy for recurrence. With a median follow up time of 8 months, all patients were followed from 7 to 26 months. Radiologically seven patients showed complete remission and the remaining three showed partial remission at one month after radiotherapy. The 1 and 2 year survival rate was $86{\%}\;and\;69{\%}$ respectively. Until now, two patients expired at 7 and 14 months. These patients developed extensive CSF seeding followed by local failure. Considering initial good response to radiation therapy and low incidence of extraneural dissemination in primary CNS lymphoma, we propose to increase total tumor dose to the primary lesion by hyperfractionated radiotherapy or stereotactic radiosurgery. For the patients with CSF involvement at diagnosis, we propose craniospinal irradiation with IT MTX chemotherapy.

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Comparison of Single vs Combined Modality Treatment in Locally Advanced Non-Small Cell Lung Cancer (국소 진행된 비소세포 폐암에서 복합요법과 단일요법의 비교)

  • Kim, Ae-Kyoung;Jeong, Seong-Su;Shin, Kyoung-Sang;Park, Sang-Gee;Jo, Hai-Jeong;Lee, Jong-Jin;Seo, Jee-Won;Kim, Ju-Ock;Kim, Sun-Young
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.502-512
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    • 1995
  • Background: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. Method: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. Result: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. Conclusion: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.

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A Geographical Study of Therapeutic Spaces after the Disaster of the MV Sewol in a Local Community (세월호 참사 이후 지역 커뮤니티에 형성된 치유의 공간에 대한 지리적 고찰)

  • Park, Sookyung
    • Journal of the Korean Geographical Society
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    • v.52 no.1
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    • pp.25-53
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    • 2017
  • The ultimate goal of this research is to examine the geographical characteristics of therapeutic spaces where have been appeared in Wa-dong and Gojan-dong, Ansan-si after the disaster of the MV Sewol. As looking into the inside, the aim of the therapeutic spaces, which cover each target group (victims) individually, is various and different because the disaster of the MV Sewol generated various direct and indirect victims requiring healing. The therapeutic spaces are estimated at about 10 organizations and are leaded by private agents predominantly. Furthermore, the therapeutic spaces are located near, but are aside from Danwon high school where many students are reported killed and injured in the incident. And the therapeutic spaces provide simple and repetitive diversions, for example, having a meal, knitting and studying, rather than special programs to restore a broken daily life to the original state. On the basis of such a background, the geographical characteristics of the therapeutic spaces related to the disaster of the MV Sewol can be summarized as follows; first, it seems that target groups accept the therapeutic spaces as the concept of place gradually. Even though most of the therapeutic spaces were suggested by third parties at first, target groups are involved in the management and recollection of their own therapeutic spaces as well as the plan for a future direction now; and consider the therapeutic spaces as exclusive properties. Second, the disaster of the MV Sewol have embedded collective trauma to not only direct victims, but extensive groups such as parents, brothers and sisters, relatives, friends and neighbors as noted earlier. Therefore, the therapeutic spaces support comprehensive target groups; but each therapeutic space is not overlapped each other. However, to solve collective trauma in a local community effectively, the therapeutic spaces are networked closely and build a regular cooperative system. Third, a continuous memory is mentioned as an important point to overcome collective trauma, but some phenomena such as fatigue and conflict with neighbors, out-migrants and a faded atmosphere as time passes act as risk factors in Ansan-si. To keep a continuous memory, the therapeutic spaces attempt the recovery of local communities and devise various events, for example, cultural performances; furthermore, are closely connected with external organizations.

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A Study on the Spatial and Visual Composition of Yi Ung-Jae's Old House, Dundeok-ri (둔덕리 이웅재고가(李雄宰古家)의 공간 및 경관 구성적 특성에 관한 연구)

  • Rho, Jae-Hyun;Lee, Jung-Han
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.38 no.2
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    • pp.60-76
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    • 2020
  • The purpose of this study was to examine the spatial and visual arrangement characteristics of Imsil Yi Ung-jae's old house's spatial and visual aspects in order to discover the value of landscape and traditional house garden. The results of this study are as follows. Dongchon-village in Dundeok-ri, where old house is located, is a typical form of with "Back to the mountain and facing the water(背山臨水)", and is located in the north of the three streams of water, forming a Jeonchaghugwan(前窄後寬). Dongchon Village, which has a traditional scenic spot between Danguidae(丹丘臺) and Samgyeseokmun(三溪石門), is understood to be the main street of Nojeokbong Peak and Gyegwanbong Peak, which is Ansan(案山), where the "A centipede flying in the sky(飛天蜈蚣形)". Yi Ung-jae's old house is the oldest existing high-priced house in the North Jeolla region and the closing price of a royal family of the Joseon Dynasty, which was arranged by Chunseongjeong(春城正), Yi Dam-son(李聃孫) in the mid-16C. The Japanese Invasion of Korea in 1592 and Japanese colonial era, the loyalty of the gate quarters, the filial piety of the gate quarters, and the faithfulness of the tablet(扁額) and Juryeons(柱聯) are enough to contribute to the rise of the value of a physical house. The men's quarters(Sarangchae), which are placed on a high-pocket or a layout without going against the sloping terrain, have the effect of making the distance as far as possible, enhancing its dignity and hierarchy as a royal building. In addition, the entrance to the main quarters(Anchae) through the four pillar gates(四柱門), the extensive support and the appropriation of the Chaewon(vegetable garden), and the official base for the Anchae are very unique compared to the general nobility. However, in the context of the postwar relationship, the shrine seeks to realize Confucian ideals while harmonizing with nature by arranging wide sponsorships around it. On the other hand, it is confirmed that there was a pond in the form of a circle in a square(方池圓島型) with a relatively large area, which is now disturbed and damaged. Written by the high priced planting species are sponsored pine trees, hackberry, persimmon trees, Japanese apricot flower, Ohmomiji, and plum tree in the side garden, as well as cotyledon trees in the outside garden. However, although flower bed(花階), which is built on the stone axis, is a place that clearly shows the expensive garden, it seems to have lost the texture of the plant due to the extremely high variety of species and the splendor that does not match the plant landscape of the flower world. Yi Ung-jae's old house is highly valuable as it is a portrait house of a prince of the blood in the mid-Joseon Dynasty. Based on these findings, this study proposed a plan to improve the management of high prices that could be met.

A Study of the Golden Royal Seals Made by the Directorate for the Restoration of the Golden Royal Seals(金寶改造都監) in 1705 (1705년 금보개조도감(金寶改造都監) 제작 금보 연구)

  • Je, Ji-Hyeon
    • Korean Journal of Heritage: History & Science
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    • v.50 no.1
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    • pp.42-57
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    • 2017
  • The Joseon Dynasty (1392~1910) had a long tradition of making official seals to commemorate the granting of official royal titles, including posthumous honorary titles, to its kings, queens, crown princes and queen dowagers. These royal seals were typically gold-plated or made of jade. After the death of its holder, each seal would be stored in the royal seal depository in the Royal Ancestral Shrine. Extensive efforts were made to restore the traditions and culture of the royal family of Joseon during the reign of King Sukjong (r. 1674~1720). In 1705, discussions were held about the royal ceremonial objects, including the royal seals, stored in the Royal Ancestral Shrine, resulting in the reproduction of a set of accessories related with the storage of royal seals and ten golden royal seals which had been lost during wars or had yet to be made. With these reproductions, each shrine chamber of the Royal Ancestral Shrine would have had at least one seal. The details of the reproduction project were meticulously recorded in The Royal Protocol by the Directorate for the Restoration of Golden Royal Seals("金寶改造都監儀軌"). Given that the restoration project was the single event that led to the reproduction of all the golden royal seals, it is reasonable to conclude that the directorate had fulfilled a historically significant function. In this study, the main discussion is focused on the establishment of the directorate and the storage and management of the damaged royal seals. The discussion includes the manufacturing process of the golden seals, for which The Royal Protocol is compared with other similar documents in order to gain more detailed knowledge of the measurements of the turtle knob, the lost-wax casting technique, the gold plating with mercury amalgamation technique, and other ornamentation techniques. The discussion also covers the activities of the artisans who made the royal seals, based on a study of the royal protocols; the styles of the artifacts, based on an examination of the remaining examples; and the techniques used by the Directorate for the Restoration of Golden Royal Seals to produce the royal seals in 1705.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

  • Kim, Chul;Sung, Jidong;Lee, Jong Hwa;Kim, Won-Seok;Lee, Goo Joo;Jee, Sungju;Jung, Il-Young;Rah, Ueon Woo;Kim, Byung Ok;Choi, Kyoung Hyo;Kwon, Bum Sun;Yoo, Seung Don;Bang, Heui Je;Shin, Hyung-Ik;Kim, Yong Wook;Jung, Heeyoune;Kim, Eung Ju;Lee, Jung Hwan;Jung, In Hyun;Jung, Jae-Seung;Lee, Jong-Young;Han, Jae-Young;Han, Eun Young;Won, Yu Hui;Han, Woosik;Baek, Sora;Joa, Kyung-Lim;Lee, Sook Joung;Kim, Ae Ryoung;Lee, So Young;Kim, Jihee;Choi, Hee Eun;Lee, Byeong-Ju;Kim, Soon
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.248-329
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    • 2019
  • Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Factors for Survival and Complications of Malignant Bone Tumor Patients with a Total Femoral Replacement (대퇴골 전치환술 받은 악성 골종양 환자의 생존인자와 합병증)

  • Cho, Wan Hyeong;Jeon, Dae-Geun;Song, Won Seok;Park, Hwan Seong;Nam, Hee Seung;Kim, Kyung Hoon
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.3
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    • pp.244-252
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    • 2020
  • Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

The Interrelationship between Riparian Vegetation and Hydraulic Characteristics during the 2020 Summer Extreme Flood in the Seomjin-gang River, South Korea (2020 여름 섬진강 대홍수시 하안식생과 수리 특성의 상호관계)

  • Lee, Cheolho;Lee, Keonhak;Kim, Hwirae;Baek, Donghae;Kim, Won;Kim, Daehyun;Lee, Hyunjae;Woo, Hyoseop;Cho, Kang-Hyun
    • Ecology and Resilient Infrastructure
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    • v.8 no.2
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    • pp.79-87
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    • 2021
  • Because active interactions occur among vegetation, hydrology, and geomorphology in riparian systems, any changes in one of these factors can significantly affect the other two. In this study, we evaluated these interactions at four sites (two in Gajeong and two in Hahan) along the Seomjin-gang River that was substantially devastated by an extreme flood in 2020. We examined the relationship between the riparian vegetation and the hydraulic characteristics of the flood using remote sensing, hydraulic modeling, and field surveys combined. The evaluation results showed that the floods caused a record-breaking rise of up to 43.1 m above sea level at the Yeseong-bridge stage gauge station (zero elevation 27.4 m) located between the Gajeong and Hahan sites, with the shear stress being four times higher in Hahan than in Gajeong. Additionally, the water level during the flood was estimated to be a maximum of 1 m higher depending on the location in the presence of riparian plants. Furthermore, both sites underwent extensive biological damage due to the flood, with 78-80% loss in vegetation, with preferential damage observed in large willow species, compared to Quercus acutissima. The above findings imply that all plant species exhibit different vulnerabilities towards extreme floods and do not induce similar behavior towards events causing a disturbance. In conclusion, we developed strategies for effectively managing riparian trees by minimizing flood hazards that could inevitably cause damage.