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The Study of Comparative Legal Review According to Data Exclusivity of Pharmaceutical Marketing Authorization - In preparation for the development of drugs and vaccine of COVID-19 - (의약품 자료독점권(Data Exclusivity)에 대한 비교법적 고찰 - COVID-19 치료제 및 백신 개발을 대비하여 -)

  • Park, Jeehye
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.223-259
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    • 2020
  • With COVID-19 spreading rapidly around the world, research and development issues on treatments and vaccines for the virus are of high interest. Among them, Remdesivir was the first to show noticeable therapeutic effects and began clinical trials, with each country authorizing the use of the drug through emergency approval. However, Gilead Co., Ltd., the developer of Remdesivir, received a lot of criticism from civic groups for submitting the application for the marketing authorization as an orphan drug. This is because when a new drug got a marketing authorization as an orphan drug could be granted an exclusive status for seven year. The long-term exclusive status of an orphan drug comes from the policy purpose of motivating pharmaceutical companies to develop treatment opportunities for patients suffering from rare diseases, which was not appropriate to apply to infectious disease treatments. This paper provides a review of the problems and improvement directions of the domestic system through comparative legal consideration against the United States, Europe and Japan for the statutes which give exclusive status to medicines. The domestic system has a fundamental problem that it does not have explicit provisions in the statute in the manner of granting exclusive status, and that it uses the review system to give it exclusive status indirectly. In addition, in the case of orphan drugs, the "Rare Diseases Management Act" and the "Regulations on Examination of Items Permission and Reporting of Drugs" provide overlapping review periods, and despite the relatively long monopoly period, there seems to be no check clause to recover exclusive status in the event of a change in circumstances. Given that biopharmaceuticals are difficult to obtain patents, the lack of such provisions is a pity of domestic legislation, although granting exclusive rights may be a great motivation to induce drug development. In the United States, given that the first biosimilar also has a one-year monopoly period, it can be interpreted that domestic legislation is quite strictly limited to granting exclusive status to biopharmaceuticals. The need for improvement of the domestic system will be recognized in that it could undermine local pharmaceutical companies' willingness to develop biopharmaceuticals in the future, and in that it is also necessary to harmonize international regulations. Taking advantage of the emergence of COVID-19 as an opportunity, we look again at the problems of the domestic system that grants exclusive rights to medicines and hope that an overall revision of the relevant legislation will be made to establish a unified legal basis.

Dual Plate Fixation for Periprosthetic Femur Fracture after Total Knee Arthroplasty (슬관절 전치환술 후 발생한 대퇴골 삽입물 주위 골절의 이중 금속판 고정술)

  • Kim, Dong Hwi;Cha, Dong Hyuk;Ko, Kang Yeol
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.1
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    • pp.26-33
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    • 2021
  • Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

Clinical Result of a Staged Reimplantation of Fungus Related Periprosthetic Joint Infection after Total Knee Arthroplasty (슬관절 전치환술 후 인공관절 주위 진균 감염의 임상적 결과)

  • Kim, Hyung Joo;Bae, Ki Cheor;Min, Kyung Keun;Choi, Hyeong Uk
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.52-58
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    • 2019
  • Purpose: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. Materials and Methods: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. Results: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p<0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). Conclusion: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.

The Characteristics and Operation System of the Staff Officials at Jongbusi (Court of the Royal Clan) in the Late Joseon Period - Based on Jongbusi nangcheong seonsaengan (Register of Staff Officials at the Court of the Royal Clan) Kept at Jangseogak Archives (조선 후기 종부사(宗簿寺) 낭청(郎廳)의 실태 및 운영체계 - 장서각 소장 『종부사낭청선생안(宗簿寺郎廳先生案)』을 중심으로 -)

  • Kim, Dong-geun
    • (The)Study of the Eastern Classic
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    • no.69
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    • pp.83-114
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    • 2017
  • The purpose of this article is to analyze the standings of working-level officials belonging to Jongbusi (Court of the Royal Clan) holding the rank of "jeong" and below between the 18th and mid-19th Century. Jongbusi, which was headed by a Grade-3 official, was in charge of the compilation of royal genealogy and supervision of royal relatives. During the late Joseon Period, its officials were composed of its chief, jeong, jubu (Grade-6 official), and jikjang (Grade-7 official). By 1864, it was incorporated into Jongchinbu (Office of the Royal Relatives). Jongbusi nangcheong seonsaengan (Register of Staff Officials at the Court of the Royal Clan), which is preserved at the Jangseogak Archives of the Academy of Korean Studies, lists the officials who served at the office between 1794 and its incorporation into Jongchinbu in 1864. The register also includes the officials' ranks, names, DOBs, family clans, their ranks in the offices they were transferred from, their ranks in the office they were transferred to, etc. Those interested view it as a precious relic that provides valuable information on the officialdom of the dynasty. A majority of the officials who served at Jongbusi were those who passed the higher civil service examination. Many of them at the level of jikjang were those who passed the licentiate examination. Their designation as an official was part of the "muneum" system, which granted official posts to descendants of those who accomplished a distinguished service for the country or served as a high-ranking official. They were those transferred from equal or lower positions in another office. Many of jubu-level officials of Jongbusi were those transferred from honorable and important posts of other offices or local administrative offices. Many of jikjang-level officials of Jongbusi were those who previously served as dosa (assistant officials) at Uigeumbu (Bureau of Crime Investigation) headed by a Grade-1 official. The officials' transfer to an office with a lower position like Jongbusi appears to have been for the provision of placing them in working-level positions rather than letting them remain in positions only carrying an honorary title. As for the transfer of officials of Jongbusi to other offices, many of those with the rank of jeong were transferred to lower positions. Supposedly it was because not many Grade-3 positions were vacant. Many of them were transferred to honorable and important posts. Some of them were also transferred to positions at local government offices, supposedly to avoid an excess of personnel at the central government. Those at the level of jubu or jikjang of Jongbusi were transferred to equal or higher posts in other offices. Particularly, most of those holding the position of jikjang (Grade-7) were transferred to higher posts. The family clan that produced the largest number (10%) of Jongbusi officials was the Jeonju Yi Clan, which produced the largest number of those who passed the higher civil service examination. It was also found that the top 20 family clans produced about half of the entirety of Jongbusi officials. According to the aforesaid Jongbusi nangcheong seonsaengan, about 90% of the cases of promotion of Jongbusi officials occurred after the revision of Seonwon boryak (Royal Genealogy of the Joseon Dynasty). It is speculated that the supervision of royal family members, one of the two leading functions assigned to Jongbusi, was suspended in the late Joseon Period. The relevant function does not appear even in chronicles pertaining to the Joseon Dynasty. The reason being had something to do with the sharp decrease in the number of royal family members during the reign of King Injo (r. 1623-1649). Their number was decreased to the extent that royal ceremonies could not be adequately carried out. Naturally, the meaning of supervising royal family members faded. Witnessing such a sorry state of the royal family, Heungseon Daewongun, King Gojong's father who served as the regent, incorporated Jongbusi into Jongchinbu in an effort to enhance the status and authority of the royal family.

Interpretation of Praying Letter and Estimation of Production Period on Samsaebulhoedo at Yongjusa Temple (용주사(龍珠寺) <삼세불회도(三世佛會圖)>의 축원문(祝願文) 해석(解釋)과 제작시기(製作時期) 추정(推定))

  • Kang, Kwan-shik
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.155-180
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    • 2019
  • Samsaebulhoedo(三世佛會圖) at Yongjusa Temple(龍珠寺), regarded as a monumental masterpiece consisting of different elements such as Confucian and Buddhist ideas, palace academy garden and Buddhist artist styles, unique traditional and western painting styles, is one of the representative works that symbolically illustrate the development and innovation of painting in the late Joseon dynasty. However, the absence of painting inscriptions raised persistent controversy over the past half century among researchers as to the matters of estimating its production period, identifying the original author and analyzing style characteristics. In the end, the work failed to gain recognitions commensurate with its historical significance and value. It is the particularly vital issue in that estimating the production period of the existing masterpiece is the beginning of all other discussions. However, this issue has caused the ensuing debates since all details are difficult to be interpreted to a concise form due to a number of different records on painters and mixture of traditional buddhist painting styles used by buddhist painters and innovative western styles used by ordinary painters. Contrary to other ordinary Buddhist paintings, this painting, Samsaebulhoedo, has a praying letter for the royal establishment at the center of the main altar. It should be noted that regarding this painting, its original version-His Royal Highness King, Her Majesty, His Royal Crown Prince主上殿下, 王妃殿下, 世子邸下-was erased and instead added Her Love Majesty慈宮邸下 in front of Her Majesty. This praying letter can be assumed as one of the significant and objective evidence for estimating its production period. The new argument of the late 19th century production focused on this praying letter, and proposed that King Sunjo was then the first-born son when Yongjusa Temple was built in 1790 and it was not until January 1, 1800 that he was ascended to the Crown Prince. In this light, the existing praying letter with the eulogistic title-Crown Prince世子-should be considered revised after his ascension to the throne. Styles and icons bore some resemblance to Samsaebulhoedo at Cheongryongsa Temple or Bongeunsa Temple portrayed by Buddhist painters in the late 19th century. Therefore, the remaining Samsaebulhoedo should be depicted by them in the same period as western styles were introduced in Buddhist painting in later days. Following extensive investigations, praying letters in Buddhist paintings in the late 19th century show that it was usual to record specification such as class, birth date and family name of people during the dynasty at the point of producing Buddhist paintings. It is easy to find that those who passed away decades ago cannot be revised to use eulogistic titles as seen by the praying letters in Samsaebulhoedo at Yongju Temple. As "His Royal Highness King, Her Majesty, His Royal Crown Prince" was generally used around 1790 regardless of the presence of first-born son or Crown Prince, it was rather natural to write the eulogistic title "His Royal Crown Prince" in the praying letter of Samsaebulhoedo. Contrary to ordinary royal hierarchy, Her Love Majesty was placed in front of Her Majesty. Based on this, the praying letter was assumed to be revised since King Jeongjo placed royal status of Hyegyeonggung before the Queen, which was an exceptional case during King Jeongjo's reign, due to unusual relationships among King Jeongjo, Hyegyeonggung and the Queen arising from the death of Crown Prince(思悼世子). At that time, there was a special case of originally writing a formal tripod praying letter, as can be seen from ordinary praying letter in Buddhist paintings, erasing it and adding a special eulogistic title: Her Love Majesty. This indicates that King Jeongjo identified that Hyegyeonggung was erased, and commanded to add it; nevertheless, ceremony leaders of Yongju Temple, built as a palace for holding ceremonies of Hyeonryungwon(顯隆園) are Jeongjo, the son of his father and his wife Hyegyeonggung (Her Love Majesty)(惠慶宮(慈宮)). This revision is believed to be ordered by King Jeongjo on January 17, 1791 when the King paid his first visit to the Hyeonryungwon since the establishment of Hyeonryungwon and Yongju Temple, stopped by Yongju Temple on his way to palace and saw Samsaebulhoedo for the first and last time. As shown above, this letter consisting of special contents and forms can be seen an obvious, objective testament to the original of Samsebulhoedo painted in 1790 when Yongju Temple was built.

Changes of Housing in the FCS Curricular from the 1st to 2009 Revised of Secondary School (중등학교 가정과 교육과정의 주생활 영역 내용 변화 - 1차 교육과정부터 2009 개정 교육과정을 대상으로 -)

  • Heo, YoungSun;Kim, NamEun;Choi, MinJi;Baek, MinKyung;Gwak, SeonJeong;Cho, JaeSoon
    • Journal of Korean Home Economics Education Association
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    • v.25 no.1
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    • pp.95-118
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    • 2013
  • The purpose of this study was to analyze the contents of housing related to characters, objectives, and contents of FCS curricular from the 1st to 2009 revised curriculum of secondary school. The data were downloaded from the NCIC homepage(http://www.ncic.re.kr/2012. 04. 08) from the 1st(1955. 08) to 2009 revised curriculum(2012. 03) of secondary school. After examining the characters and objectives of each curriculum, contents of housing was analyzed by units and context elements of middle and high school separately. The titles of the subject, the objectives, the instructions, the leaning spheres, weekly hours, grade and gender of candidates, the emphasis of the instruction, etc. have been changed through the curriculum revision. The 6th curriculum was the main period to open to both genders, the $7^{th}$ was the period to combine with technology, the 2007 version was to change the structure of contents of home economics, and the 2009 version switched technology home economics from mandatory to optional in high school. The character of the courses was presented at the 1st curriculum, but it was left out from the $2^{nd}$ to $5^{th}$ curriculum. From the $6^{th}$ curriculum, the characters were separately given to middle and high school. The character of housing area started to appear only in high school home economics from the $7^{th}$ curriculum. The course objectives were described in all curriculum of both middle and high school. This applies to housing area as well. The course objectives have been modified in order to reflect value changes due to social issues. During each curriculum, contents of housing continued to change in context, course load, and candidates. Reflection of housing trends and social needs were the main causes of the change. 2009 version emphasizes on eco-life and sense of community.

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An Analysis of Nursing Behavior and Unit of Treatment Cost of Non- Insurance Patients (종합병원의 비보험환자 처치행위 양상과 수가분석에 관한 연구)

  • 오세영
    • Journal of Korean Academy of Nursing
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    • v.10 no.1
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    • pp.41-55
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    • 1980
  • The medical care insurance system, being put into practice nearly for three years, seem to have brought about some considerable problems as serious for the government as to consider a revision of that system. As one of the most serious problems of present system, the treatment cost of insurance patients is so remarkably low in comparison with than of non-insurance cases that normal operation of hospitals is threatened and care services of low quality are induced. The researcher carried out this survey to analyze and bring to light several aspects of treatment cost of non-insurance patients as a material for a re-assessment of the cost of insurance cases which shows a a considerable difference in amount at the standpoint of hospitals with than of non-insurance cases and further, hoping the significant blind spot of present insurance system(that is, the absence of regulations' for cost assessment by patterns or types of health care treatment) will be mended in near future. The survey was carried out with the treatment invoice sheets of total 902 in-hospital Patients of a general hospital in Seoul during the period of the 2 nd quarter of the year(1979). Among total 902 patients, 694 cases were used for analysis, because those disease or syndromes shared by less than 10% of the patients were put aside before procession. The data were analyzed by kinds or types of diseases, demographic characteristics of patients, hospitalization patterns, types of nursing treatment, etc. The result of analysis was as follows 1. Among all the non-insurance cases, those who received one or more kinds of nursing treatment mounted up to 96. 7 %. The invoice issue frequency per person was 7.2 times, while that frequency per day for a person was 0.8, : the treatment cosr per person was ₩22,650 while its daily average was ₩2,430, due to the average 9.3 in-hospital days per person. 2. As to the nursing treatment types by the demographic characteristics of patients and hospitalization patterns. a. The unit cost female patients was generally more expensive them that of males, and independent nursing service was more given than other types of treatment. As to age, higher age groups received independent nursing service most, while the youngest group received instrumental and integrated nursing services. b. As to room grade, the unit cost of I.C.U. cases was the highest : and the cast of private room patients was higher than that of public room patients. By in-hospital days, the curve of function showed L. type : that is, the longer stay, the lower function. 3. State of treatment types by kinds of disease were ; a. Dependent nursing service showed comparatively high availability in surgical and neurologic disease and independent nursing service was most received by medical, obstetrical and urological patients, while instrumental and integrated services were most available for respiratory disease and obstetrical and neurologic diseases next. b. The invoice issue frequency per day for a patient was highest in obstetrical disease 3.8 times, and the unit cost(per one invoice sheet) was also highest in obstertrical disease(₩10,880) and next in neurologic cases(₩ 4,690 ). 4. As to the pertained departments. a. Cost amount per person was highest in department of Psychiatries daily cost was highest in obstetrical cases : while the invoice issue frequency was highest in obstetrics and next in pediatrics. b. In departments in need of surgical operation, dependent nursing care was highly availabl : while in internal medicine and obstetrics, independent service was higher. Psychiatrics showed the highest the of integrate nursing while pediatrics and obstetrics higher of instrumental services. The variation co-efficien of treatment cost came out to be relatively in high in special surgery, opthalmology and internal medicine. 5. State of treatment cost by types of nursing behavior was. a. The average frequency of invoice issue was 3.5 (times). Among the type four types of treatment, instrumetal service (4.3) and independent nursing behavior(3.9) showed higher frequency than average respectively. But as to unit cost (per invoice). dependent (₩5,200) and integrated (₩5,340) nursing care services were higher than average and considerably higher than the other two types. b. In repect patient distribution. independent nursing behavior(80.3% ) was the highest and depend ent nursing (31.7% ) the lowest. The variation co-efficient of treatment cost appeared highest in dependent nursing be havior as a whole, and among that, doctor's diagnosis showed the highest coefficient value (100.7). In conclusion, the variaty of treatment cost(treatment itself ) by various characteristics and treatment types pro- that treatment various sort of patients and treatment cost of various types of nursing behavior cannot be uniform. Therefore, to attain the equalization of health care service and its cost both for insurant and non-insurant patients, a more specific provision for assessment of cost should be added to the present medical care insurance system and, in addition, the cost of nursing treatment is desired to be inserted into the treatment invoice.

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A Study on Teaching-Learning and Evaluation Methods of Environmental Studies in the Middle School (중학교 "환경" 교과의 교수.학습 및 평가 방법 연구)

  • 남상준
    • Hwankyungkyoyuk
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    • v.7 no.1
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    • pp.1-17
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    • 1994
  • This study was performed to determine appropriate teaching-learning and evaluation methods for Environmental Studies. To promote the relevance of our study to the needs of the schools and concerned educational communities of environmental education, we reviewed related literature, conducted questionnaire surveys, interviewed related teachers and administrator, held meetings with experts, and field-tested our findings. For selecting and developing teaching-learning methods of Environmental Studies, findings of educational research in general are considered. moreover, principles of environmental education, general aim of environmental education, orientations of environmental education, and developmental stages of middle school students in educational psychology were attended. In addition, relevance to the purpose of the Environmental Studies curriculum, appropriateness for value inquiry as well as knowledge inquiry, small group centered class organization, social interaction centered teaching-learning process, regional environmental situation, significance of personal environment, evaluation methods of Environmental Studies, multi- and inter-disciplinary contents of the Environmental Studies textbook, suitability to the evaluation methods of Environmental Studies, and emphasis on the social interaction in teaching-learning process were regarded. It was learned the Environmental Studies can be taught most effectively in via of holding discussion sessions, conducting actual investigation, doing experiment-practice, doing games and plate, role-playing and carrying out simulation activities, and doing inquiry. These teaching-learning methods were field-tested and proved appropriate methods for the subject. For selecting and developing evaluation method of Environmental Studies, such principles and characteristics of Environmental Studies as objective domains stated in the Environmental Studies curriculum, diversity of teaching-learning organization, were appreciated. We categorized nine evaluation methods: the teacher may conduct questionnaire surveys, testings, interviews, non-participatory observations; they may evaluate student's experiment-practice performances, reports preparation ability, ability to establish a research project, the teacher may ask the students to conduct a self-evaluation, or reciprocal evaluation. To maximize the effect of these methods, we further developed an application system. It considered three variables, that is, evaluates, evaluation objectives domains, and evaluation agent, and showed how to choose the most appropriate methods and, when necessary, how to combine uses of different methods depending on these variables. A sample evaluation instrument made on the basis of this application system was developed and tested in the classes. The system proved effective. Pilot applications of the teaching-learning methods and evaluation method were made simultaneously; and the results and their implications are as follows. Discussion program was applied in a lesson dealing with the problems of waste disposal, in which students showed active participation and creative thinking. The evaluation method used in this lesson was a multiple-choice written test for knowledge and skills. It was shown that this evaluation method and device are effective in helping students' revision of the lesson and in stimulating their creative interpretations and responces. Pupils showed great interests in the actual investigation program, and this programme was proved to be effective in enhancing students' participation. However, it was also turned out that there must be pre-arranged plans for the objects, contents and procedures of survey if this program is to effective. In this lesson, non-participatory observation methods were used with a focus on the attitudes of students. A scaled reported in general description rather than in grade. Experiment-practice programme was adopted in a lesson for purifying contaminated water and in this lesson, instruction objectives were properly established, the teaching-learning process was clearly specified and students were highly motivated. On the other hand, however, it was difficult to control the class when some groups of students require more times to complete their experiment, and sometimes different results. As regards to evaluation, performance observation test were used for assessing skills and attitudes. If teachers use well-prepared Likert scale, evaluation of all groups within a reasonablely short period of time will be possible. The most effective and successful programme in therms of students' participation and enjoyment, was the 'ah-nah-bah-dah-market' program, which is kind of game of the flea market. For better organized program of this kind, however, are essential, In this program, students appraise their own attitudes and behavior by responding to a written questionnaire. In addition, students were asked to record any anecdotes relating to self-appraisal of changes on one's own attitudes and behaviours. Even after the lesson, students keep recording those changes on letters to herself. Role-playing and simulation game programme was applied to a case of 'NIMBY', in which students should decide where to located a refuse dumping ground. For this kind of programme to e successful, concepts and words used in the script should be appropriate for students' intellectual levels, and students should by adequately introduced into the objective and the procedures of the lessons. Written questionnaire was used to assess individual students' attitudes after the lesson, but in order to acquire information on the changes of students' attitudes and skills, pre-test may have to be made. Doing inquiry programme, in which advantages in which students actually investigated the environmental influence of the areas where school os located, had advantages in developing students' ability to study the environmental problems and to present the results of their studies. For this programme to be more efficient, areas of investigation should be clearly divided and alloted to each group so that repetition or overlap in areas of study and presentation be avoided, and complementary wok between groups bee enhanced. In this programme, teacher assessed students' knowledge and attitudes on the basis of reports prepared by each group. However, there were found some difficults in assessing students' attitudes and behaviours solely on the grounds of written report. Perhaps, using a scaled checklist assessing students' attitudes while their presentation could help to relieve the difficulties.

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Modified Blalock-Taussig Shunt for the Patients with Complex Congenital Heart Defects in Early Infancy (조기 영아기에 시행된 복합 심기형 환자들에서의 변형 Blalock-Taussig 단락술)

  • Lim Hong Gook;Kim Woong-Han;Hwang Seong Wook;Lee Cheul;Kim Chong Whan;Lee Chang-Ha
    • Journal of Chest Surgery
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    • v.38 no.5 s.250
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    • pp.335-348
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    • 2005
  • Background: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. Material and Method: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was $23.1\pm16.2$ days ($5\~81\;days$), and the mean body weight was $3.4\pm0.7\;kg\;(2.1\~4.3\;kg)$. Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. Result: There were 11 ($19.0\%$) early, and 5 ($10.6\%$) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients ($41.4\%$) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. Conclusion: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.

A Taxonomic Study of the Genera Acanthogobius and Synechogobius (Pisces : Gobiidae) from Korea (한국산(韓國産) 문절망둑 속(屬)과 풀망둑속(屬) 어류(魚類)의 분류학적(分類學的) 연구(硏究))

  • Lee, Yong-Joo
    • Korean Journal of Ichthyology
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    • v.4 no.2
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    • pp.1-25
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    • 1992
  • Taxonomic study of the five species (Acanthogobius elongata, A. flavimanus, A. lactipes, A. luridus and Synechogobius) from Korea was carried out based on morphometric, cephalic sensory canal and ecological characters. Taxonomic revision and classificational keys are provided. Synechogobius hasta is easily distinguished from four species of the genus Acanthogobius in eleven characters, i. e., the number of dorsal and anal fin rays, the transverse scales, the vertebral numbers, the formula of interneural spine of the first dorsal fin, the number of interhemal spine anterior to the first hemal spine, the number of epipleural and pleurals, the ratio of caudal peduncle length, the ratio of caudal peduncle depth and the regular variations in the ratio of body parts with the body length. In the genus Acanthobobius, A. elongata is distinguished from other 3 congeneric species in the ratio of body parts and the oculoscapular sensory canal. Moreover, A. flavimanus differs from other 3 congeneric species in the lateral scales, the transverse scales, the number of predorsal scales, the vertebral number, the number of epipleural and pleurals. Sensory papillae rows of S. hasta is not similar that of the genus Acanthogobius in having a singular sensroy papillae rows. A. elongata has no oculoscapular sensory canal D and A. flavimanus has transverse sensory papillae in cheek, and these are one of the unique characters distinguished form other congeneric species. In the spawning period inferred from gonadosomatic index, A. elongata varied from late March to late June ; A. flavimanus, January to April ; A. lactipes, May to September ; A. luridus, early May to early July and S. hasta, early March to early May.

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