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Die Fahrlässigkeit im medizinischen Behandlungsfehler (의료사고에 있어서 과실 - 과실판단에 대한 판례의 태도를 중심으로-)

  • Yi, Jaekyeong
    • The Korean Society of Law and Medicine
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    • v.17 no.2
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    • pp.29-56
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    • 2016
  • $F{\ddot{u}}r$ den Schadensersatzhaftung des Arztes, sog. die Arzthaftung, ist es vornehmlich vorauszusetzen: die $Sch{\ddot{a}}digungsbehandlung$ des Arztes, die Rechtswidrigkeit und das Verschulden. Zur Problematik der $Fahrl{\ddot{a}}ssigkeit$ in der Stufe des Verschuldens handelt sich es in dieser Beitrag um die Kritisierung der Rechtsprechung. $F{\ddot{u}}r$ die Entscheidung des Verschulden im medizinischen Fehler kommt es darauf an, ob die Sorgfaltspflicht des Arztes verletzt wird. $Daf{\ddot{u}}r$ wird der medizinische Standard rekurriert, den die Rechtsprechung nicht aus materieller, sondern aus normativer Sicht begreift. Erstaunlich $un{\ddot{u}}bereinstimmend$ mit deren Leitsatz wird der medizinische Standard als $Ma{\ss}stab$ der Sorgfaltspflicht materiell - zutreffend nur im Ergebnis - behandelt. Die Sorgfaltspflicht in der Medizin bedeutet nicht die natur-wissenschaftliche Erkenntnisse, sondern eine "Best-$M{\ddot{u}}ssen$" Pflicht. Demnach ist der Standpunkt der Rechtsprechung, wonach den med. Standard normativ bewertet und die Sorgfaltspflicht darduch wieder normativ entscheidet, nicht anders als eine $w{\ddot{o}}rtliche$ Wiederholung. Die Arzthaftung in der Rechtsprechung ist aufgrund mit der Verneinung von der Sorgfaltspflichtverletzung nicht angenommen, welche in der Tat jedoch aus verschiedenen $Gr{\ddot{u}}nden$, wie die Rechtswidrigkeit, die $Fahrl{\ddot{a}}ssigkeit$ oder $Kausalit{\ddot{a}}t$, nicht angenommen. Der $Fahrl{\ddot{a}}ssigkeitsbeweis$ in der Rechtsprechung entwickelt sich mit dem Beweis nach objektivem $Ma{\ss}stab$, der Vermutung nach Anschein-Beweis und der $Beschr{\ddot{a}}nkung$ mit der Wahrscheinlichkeit. Bei Letzterem $geh{\ddot{o}}rt$ es $schlie{\ss}lich$ zum medizinischen Bereich. Ein Eintritt in den fachliche Bereich im Rahmen der Beweislast stellt der Beweiserleichterung $gegen{\ddot{u}}ber$. Aus diesem Hintergrund ist ${\S}630$ h Abs. 5 BGB bemerkenswert, wonach das Vorliegen eines groben Behandlungsfehler $regelm{\ddot{a}}{\ss}ig$ zur Vermutung von der $Kausalit{\ddot{a}}tszusammenhang$ $f{\ddot{u}}hrt$. Dieser Paragraph ist inhaltlich als Beweislastumkehr angesehen. Damit ist es von Nutzen im Fall des groben Fehler, der beim - elementaren - kunstgerechten Verhalten nicht entstanden $h{\ddot{a}}tte$, wie $Hygienem{\ddot{a}}ngel$, ${\ddot{U}}berdosierung$ des Narkotikum.

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Suppressive Mechanism of Soil-borne Disease Development and its Practical Application -Isolation and Identification of Species of Trichoderma Antagonistic to Soil diseases and its activities in the Rhizosphere- (토양병의 발병억제 기작과 그 실용성 -길항성 Trichoderma spp.의 분리, 동정 및 근권내 활동-)

  • Kim, S.I.;Shim, J.O.;Shin, H.S.;Choi, H.J.;Lee, M.W.
    • The Korean Journal of Mycology
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    • v.20 no.4
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    • pp.337-346
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    • 1992
  • Trichoderma spp. are an effective control agent for damping-off or other plant diseases. The interaction between. T. hamatum and Rhizoctonia solani on the rhizosphere or surface soil were examined to assess the possible roles of antibiosis or competition in the mechanisms of biological control agents as a basic research. In a proportional comparison, total bacteria, fungi, actinomycetes and Trichoderma spp were 65%, 8.8%, 25.9% and 0.28% respectively in their distribution in the soil. Among Trichoderma spp isolated, the 5 species of Trichoderma spp were indentified as T. koninggii, T. pseudokoninggii, T. aureoviridi, T. hamatum and T. viride respectively. In a mycoparasitic test, one isolate of T. hamatum strain Tr-5 showed an enzymatic ability to break fungal hyphae into piecies and infected on the R. solani hyphae showing a parasitism. Spore germination of the all isolates of Trichoderma spp showed a 1.7-7.3% of germination in natural soil conditions, but the percentage was high in sterile soil indicating all the natural soil were fungistatic on conidia of Trichoderma spp. In rhizosphere competent assay in pea plant, the antagonistic T. hamatum, T. viride, T. koninggii, T. pseudokoninggii showed a colonizing upper soil depth in rhizosphere around 1-3 cm in root zone, but the colonizing ability was much reduced along the deeper the soil depth. Propagule density was decreased in deeper the soil layer. Disease development rate treated alone with plant pathogens, Fusarium solani, Rhizoctonia solani, Cylindrocarpon destructans increased, but disease incidence rate reduced in treatment with combinations with antagonistic T. hamatum strain Tr-5.

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Estimation of Genetic Parameters of Body Weight by Growth Periods for Hanwoo Using Animal Model (개체모형에 의한 한우의 성장단계별 체중의 유전모수 추정)

  • Choi, J.G.;Jeon, K.J.;Lee, C.W.;Na, G.J.;Lee, C.;Kim, J.B.
    • Journal of Animal Science and Technology
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    • v.45 no.5
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    • pp.667-678
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    • 2003
  • The objectives of this study were to investigate the genetic characteristics of body weight by growth periods for Hanwoo. A total of 1,736 records were used for body weight. The data for body weights were collected from 1990 to 2000 in Daekwanryong branch, National Livestock Research Institute(NLRI). Estimates of (co)variance components were obtained by derivative-free Restricted Maximum Likelihood (DF-REML). The results are summarized as follows; The means for the weights were 25.60, 79.31, 98.91, 145.40, 283.26, 392.32, 545.65kg at birth, 3, 4, 6, 12, 18, 24month postpartum, respectively. The effects of calving year-season were significant for the milk yield of cow. Heritability estimates of direct genetic effects for birth weight were 0.54(all), 0.52(female), 0.36(male) in modelⅠ, 0.45(all), 0.41(female), 0.24(male) in modelⅡ, and heritabilities estimates of direct genetic effects for 4 month(weaning) weight were 0.47(all), 0.33(female), 0.28(male) in modelⅠ, 0.38(all), 0.21(female), 0.21(male) in modelⅡ. Heritability estimates for male and female data differed from those for combined data. The estimates became smaller for the body weights at 12 month or later(0.13~0.05). The heritabilities of average daily gain were smaller than those for body weights, but showed that the similar pattern to body weights.

A Study on the Screening of the Novel Genes Associated with Lysosomal Trafficking and Mutation Detection in Fibroblasts of the Patients with Mucolipidosis type II and III (리소좀 교통 이상을 초래하는 뮤코지방증 2형과 3형 환자의 섬유아세포를 이용한 신규 유전자 탐색 및 돌연변이에 대한 연구)

  • Song, Seng Mi;Chang, Soo Hee;Paik, Kyung Hoon;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.5 no.1
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    • pp.65-75
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    • 2005
  • Purpose: To understand genetic differences and similarities between mucolipidosis and control. Methods: Using the fibroblast of the mucolipidosis II and control, forward and reverse subtracted libraries were constructed. Among these clones, we investigated mutations in the GNPTA (MGC4170) gene, which codes for the ${\alpha}/{\beta}$ subunits of phosphotransferase, and in the GNPTAG gene, which codes for the ${\gamma}$ subunits in 5 Korean patients with mucolipidosis type II or IIIA. Result: Several differentially expressed cDNAs were cloned and their sequences were determined. Mutation analysis of the interested gene, GNPTA was performed and we identified 7 mutations in the GNPTA gene, but none in the GNPTAG gene. The mutations in type II patients included p.Q104X(c.310C>T), p.R1189X(c.3565C>T), p.S1058X(c.3173C>G), p.W894X(c.2681G>A) and p.H1158fsX15(c.3474_3475delTA), all of which are non-sense or frame shift mutations. However, a splicing site mutation, IVS13+1G>A (c.2715+1G>A) was detected along with a non-sense or a frame shift mutation (p.R1189X or p.E858fsX3(c.2574_2575delGA)) in two mucolipidosis type IIIA patients. Conclusion: This report shows that mutations in the GNPTA gene coding for the ${\alpha}{\beta}$subunits of phosphotransferase, and not mutations in the GNPTAG gene, account for most of mutations found in Korean patients with mucolipidosis type II or IIIA.

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Method Comparison of Chemical-Resistance Level Determination and Field Resistance of Two-Spotted Spider Mite, Tetranychus urticae Koch to Benzomate, Cyhexatin, and Dicofol (점박이응애의 약제저항성(藥劑抵抗性) 수준결정방법(水準決定方法) 비교(比較)와 Benzomate, Cyhexatin 및 Dicofol 저항성(抵抗性) 조사(調査) 연구(硏究))

  • Lee, S.C.;Kim, W.Y.;Kim, S.S.
    • Korean journal of applied entomology
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    • v.25 no.3 s.68
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    • pp.133-138
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    • 1986
  • This study was conducted to compare the methods of slide dip and leaf dip techniques in the resistant level determination of spider mites to acaricides used; .and to investigate resistant levels of two-spotted spider mite, Tetranychus urticae Koch to benzomate, dicofol and cyhexatin in Honam region of Korea. Comparisons of the resistant strains and susceptible strain based on $LC_{50}$ values were summarized. Using the slide dip and leaf dip techniques with benzomate acaricide, the Keumchun strain of T. urticae showed 75-and 69-fold resistant levels, respectively, as compared with the Kwangju susceptible strain, but the Hackyo strain was 38-and 35-fold resistant levels, respectively. There was no significant difference (P>0.05) between the slide dip and leaf dip methods. With dicofol acaricide, resistant levels of the Keumchun strain of T. urticae were 71 times by using the slide dip and 74 times by using the leaf dip as resistant as the Kwangju susceptible strain while the Hackyo strain was 24 times by the former method and 23 times by the later method. There was also no significant difference (P>0.05) between both the methods. The slide dip technique is more recommendable than the leaf dip technique for determination of degree of chemical resistance to the spider mites with accuracy and less variation of the results. Using the slide dip method with cyhexatin, the Bia, Keumchun and Hackyo strains of T. urticae were 19-, 18- and 9-fold resistant levels, respectively, over the Kwangju susceptible strain.

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Quality Characteristics and Antioxidant Activity of Spirulina added Yogurt (스피루리나 첨가 요구르트의 품질 특성 및 항산화능)

  • Shin, Yu-Mi;Son, Chan-Wok;Sim, Hyun-Jung;Kim, Min-Hee;Kim, Mi-Yeon;Kwon, Oh-Yun;Kim, Mee-Ree
    • Korean journal of food and cookery science
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    • v.24 no.1
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    • pp.68-75
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    • 2008
  • The aim of this study was to evaluate the quality characteristics and antioxidant activity of yogurt containing spirulina. Yogurt base was prepared from skim milk added with $0.25{\sim}1%(w/v)$ spirulina powder and fermented with lactic acid bacteria (S. thermophilus : L. bulgaricus = 1 : 1) at $40^{\circ}C$ for 12 hr. Kiwi puree and oligosaccharides were then added. The addition of 1% spirulina powder stimulated the growth of lactic acid bacteria, which showed the highest viable cell count ($3.4{\times}10^9$ CFU/mL), and increased the titratable acidity (1.10%). The viscosity range of the yogurt was 6,000 to 9,000 cP, and the sugar content of the yogurt was around 18 $^{\circ}Brix$. The antioxidant activities were determined using the DPPH method, and the hydroxyl radical scavenging activity of the yogurt containing spirulina was higher than that of the control. The sensory evaluation scores for appearance, odor, taste, overall acceptability and buying intention were higher in the yogurt containing 0.25% spirulina than in the other groups. The amount of macronutrients in the yogurt containing spirulina was higher than that in the control. In addition, the amounts of micronutrients in the yogurt containing spirulina was significantly increased. According to these results, the optimum concentration of spirulina powder is around 0.25%.

Reevaluation of Clinical Efficacy of Peripheral Vasodilator: Ethaverine HCl (말초혈관(襪梢血管) 확장제(擴張劑) Ethaverine HCl의 임상효과(臨床效果)의 재평가(再評價))

  • Kim, Yoon-Young;Cho, Young-W.
    • The Korean Journal of Pharmacology
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    • v.11 no.1 s.17
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    • pp.33-38
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    • 1975
  • The clinical efficacy of Ethaverine, a peripheral vasodilator, was studied according to a double-blind, non-cross over method in 29 diabetic patients with peripheral arterial diseases. The clinical improvement was assessed from the history of patients including the incidence and frequency of intermitten claudication. Ethaverine, after 4 weeks of therapy, was not effective in improving clinical symptoms compared to placebo. Ethaverine, however, was an efective vasodilator than placebo. The quality of vasodilation induced by Ethaverine, was similar to that of alcohol. A new clinical method of studying peripheral vasodilator was presented. The clinical symptoms of peripheral vascular arterial disease in the lower extrimities include reduced intensity of palpable pulses, coldness, and discoloration of the skin. Intermittent claudication may be present. Pathologic changes in vessel architecture precede the symptoms, and recognition of impending vascular insufficiency is a determining factor in selecting vasodilating therapy or surgical management. Also, post-operative patients who have chronic peripheral vascular arterial disease may be candidates for subsequent vasodilating therapy. Peripheral vasodilators, according to the series of reports, may be indicated in vasospastic peripheral vascular condition rather than an occlusive vascular disease and the vessel responds best when a relatively large vascular beds are involved rather than a small, capillary beds. Recently, the clinical efficacy of peripheral vasodilators have been challanged by many clinical investigators and clinicians. In this study, we have re-evaluated the efficacy of Ethaverine HCl as peripheral vasodilator in patients with vasospastic peripheral arterial disease. Ethaverine is claimed to be two to four times as potent a spasmolytic agent as papaverine in a variety of laboratory and clinical work.

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Variations of Fish Community and Fish Density on Artificial Reefs (인공어초어장의 어류 군집상과 어획량 변동)

  • LEE Jeong-Woo;KANG Young-Shil
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.27 no.5
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    • pp.535-548
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    • 1994
  • Community structures and fish densit were investigated on three different types of artificial reefs, dice, turtle artificial reef and tubes, constructed in the Korean waters. Variations of fish fauna according to type of artificial reef and the proper artificial reef in each area for optimizing harvest were discussed. Fish were captured by trammel gill net during May, June, September and November, 1988 and both identified and counted. Fourty-five fish species were found in the artificial reefs. Of these, Sebastes spp., Hexagrammos otakii, Pleuronectidae, Navodon modestus and Stephanolepis cirrhifer showed high occurrence-frequency. The dominant species groups were coastal settlement, demersal or rock fishes such as Pleuronectidae, Rajiformes, Stephanolepis cirrhifer, Navodon modestus, Hexagrammos otakii and Sebastes spp. in all of the Artificial reefs except the oceanic area of southern waters. Scomber japonicus was predominant in the oceanic area of southern waters. Composition of demersal, rock and pelagic fishes were different depending on the types of artificial reef. Dice artificial reefs were occupied by rock fish, on the other hand turtle artificial reefs were dominated by dermersal fish. Fish density was high at the dice artificial reef in all survey areas except the middle area of Eastern waters, with high fish density evident in the Tube artificial reef. Fish community structures were remarkably different between Dice and Turtle artificial reefs. The Tube artificial reef showed intermediate characteristics between the above two types of artificial reefs. The coastal areas of Southern waters and the middle and southern areas of Western waters revealed similar fish fauna. Results from the oceanic areas of Southern waters were well associated with the middle and southern areas of Eastern waters.

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Influences of Dietary Fats and Oils on Concentration of Lipids in Serum and Liver of Rats on Hypercholesterolemic Diet -On the Perilla oil and the File fish Oil- (섭취유지(攝取油脂)의 종류(種類)가 고(高)콜레스테롤식이(食餌) 흰쥐의 혈청(血淸) 및 간장(肝臟)의 지질성분(脂質成分)에 미치는 영향(影響) -들깨기름과 말쥐치기름을 중심(中心)으로-)

  • Chung, Seung-Yong;Seo, Maeng-Hee;Park, Pil-Sook;Kang, Jin-Soon;Kang, Jeong-Ock
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.15 no.1
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    • pp.75-81
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    • 1986
  • In order to investigate the effect of file fish oil and perilla oil on lipid components in serum and liver of rats on hypercholesterolemic diet, concentrations of total cholesterol, triglyceride and phospholipid in serum and liver were measured along with high density lipoprotein cholesterol concentration of the serum. Body weight gain and amount of food intake did not differ significantly among different dietary groups. Concentration of total-cholesterol in serum was significantly lower with 5% lard+5% soybean oil, 5% lard+5% perilla oil and 5% lard+5% file fish oil diets than with 10% lard diet. High density lipoprotein cholesterol concentration was highest in 5% lard+5% file fish oil group. Ratio of high density lipoprotein cholesterol to total cholesterol was highest in 5% lard +5% file fish oil group. Concentrations of total cholesterol in liver were not significantly different among all groups, but were slightly low in 5% lard+5% file fish oil and 5% lard+5% perilla oil groups. Concentration of serum triglyceride was significantly lower in 5% lard+5% soybean oil and 5% lard+5% perilla oil groups compared with 10% lard group. Concentration of serum phospholipid was lowest in rats on 5% lard+5% file fish oil diet and was lower in 5% lard+5% soybean oil and 5% lard +5% perilla oil groups than in 10% lard group. Concentration of triglyceride and phospholipid in liver were not significantly different among all groups. but tended to be relatively low in rats on 5% lard+5% perilla oil diet, In conclusion, the results suggest that perilla oil and file fish oil have depressing effects on serum levels of total cholesterol, triglyceride and phospholipid.

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Electrochemical Characterization of Anti-Corrosion Film Coated Metal Conditioner Surfaces for Tungsten CMP Applications (텅스텐 화학적-기계적 연마 공정에서 부식방지막이 증착된 금속 컨디셔너 표면의 전기화학적 특성평가)

  • Cho, Byoung-Jun;Kwon, Tae-Young;Kim, Hyuk-Min;Venkatesh, Prasanna;Park, Moon-Seok;Park, Jin-Goo
    • Journal of the Microelectronics and Packaging Society
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    • v.19 no.1
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    • pp.61-66
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    • 2012
  • Chemical Mechanical Planarization (CMP) is a polishing process used in the microelectronic fabrication industries to achieve a globally planar wafer surface for the manufacturing of integrated circuits. Pad conditioning plays an important role in the CMP process to maintain a material removal rate (MRR) and its uniformity. For metal CMP process, highly acidic slurry containing strong oxidizer is being used. It would affect the conditioner surface which normally made of metal such as Nickel and its alloy. If conditioner surface is corroded, diamonds on the conditioner surface would be fallen out from the surface. Because of this phenomenon, not only life time of conditioners is decreased, but also more scratches are generated. To protect the conditioners from corrosion, thin organic film deposition on the metal surface is suggested without requiring current conditioner manufacturing process. To prepare the anti-corrosion film on metal conditioner surface, vapor SAM (self-assembled monolayer) and FC (Fluorocarbon) -CVD (SRN-504, Sorona, Korea) films were prepared on both nickel and nickel alloy surfaces. Vapor SAM method was used for SAM deposition using both Dodecanethiol (DT) and Perfluoroctyltrichloro silane (FOTS). FC films were prepared in different thickness of 10 nm, 50 nm and 100 nm on conditioner surfaces. Electrochemical analysis such as potentiodynamic polarization and impedance, and contact angle measurements were carried out to evaluate the coating characteristics. Impedance data was analyzed by an electrical equivalent circuit model. The observed contact angle is higher than 90o after thin film deposition, which confirms that the coatings deposited on the surfaces are densely packed. The results of potentiodynamic polarization and the impedance show that modified surfaces have better performance than bare metal surfaces which could be applied to increase the life time and reliability of conditioner during W CMP.