7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

초내열합금 CM247LC의 미세조직 및 인장 특성에 미치는 진동 및 접종처리의 영향

徐晟文,芮大喜,金仁守,趙昌龍 대한금속재료학회 2002 대한금속·재료학회지 Vol.40 No.12

Effects of vibration(V) and inoculation(I) during casting on the microstructure and tensile properties of nickel-base superalloy CM247LC were investigated. The vibration treatment with a frequency of 10 ㎐ was effective to refine the grain size and decrease the microporosity level to some extent. The vibration treatment for the inoculated mold developed the grains of the casting into fine equiaxed grains compared with columnar grains of the casting with vibration free inoculated mold. The existing phases of CM247LC alloy such as finely dispersed cuboidal γ', MC, and grain boundary precipitates were not influenced by the vibration and/or inoculation treatment. The fine equiaxed grained CM247LC had excellent tensile properties compared with those of the columnar grains. The tensile behavior of CM247LC alloy at 760℃ showed different aspects with respect to the grain size change and which was carefully analyzed by fractographic investigations.

대학생을 위한 효율적인 학습습관 훈련 프로그램

이희백,천성문,안병환 대진대학교 교육대학원 교육연구소 1999 교육연구 Vol.1 No.1

The development of the efficient learning habit improves the learning ability and helps the adjustment of school life and self-development. Therefore this study is to develop the various training programs for learning habit improvement of college students and apply them to school.

공통과학(화학) 수행평가의 적용 효과

이석희,이상은,박종근,문성배 부산대학교 사범대학 과학교육연구소 2001 科學敎育硏究報 Vol.28 No.-

The purpose of this study is to examine the effects of the application of experimental practices, descriptive tests, and research papers among the performance assessments on the students' accomplishment, their scientific research abilities and their attitudes to science in high schools. Two classes among the first grade ones were selected and assigned to the control group and the experimental group respectively. T-analysis of pre-test showed that the two groups have the same quality(p>.05). The questionnaire made by the Korean Educational Development Institute(KEDI) was used. Its reliability is .689. The experimental process was evaluated on the basis of the criterion table and reports. T-tes and ANOVA were enforced with the SPSS/WIN(ver10.0) for the purpose of analyzing the mean difference between the two groups. The results of this study are as follows. First, though the application of the performance assessments showed that there were little significant differences between the scientific research abilities of the experimental group with the experimental practice and those of the control group(p>.05), and the results of the pre-test and the post-test on the experimental group revealed that there were significant effects on improving the students' scientific research abilities(p<.05). Second, the result of the test using ANOVA at each research course factor showed that there was no significant difference at most research course factors that there were significant differences between the two groups in expanding the scientific research abilities of classification and measurement(p<.05). Finally, the results of the pre-test and the post-test by application of the performance assessments showed that they had significant effects on changing the students' attitude to science subject positively(p<.05). In addition, the results of the pre-testing and the post-testing on the sub-factors of the attitude related to science showed that there were significant changes in the concept of 'self-consciousness' and the attitude to learning(p<.05). In conclusion, the application of the performance assessments has positive effects on improving the high school students' scholastic achievement, scientific research abilities, and attitudes to related to science. Consequently, science teachers should be willing to use various performance assessments in the class.

1866∼7년 데이 드레스(day dress)의 설계 및 디자인 분석

김문숙,이서희,오현남,한성지,김현주 서울여자대학교 자연과학연구소 1996 자연과학연구논문집 Vol.7 No.-

As the current stage of the fashion begins to follow the styles of the past, the study on the past costume is getting more important, and as the methodology of the study accurately approached study through the rehabilitation of the past costume is more needed than the simple rearrangement of the historical documents. By this methodology, this study can be positioned as a recreation activity. The results of the study are as follows. 1) Style : The general silhouetts is the late crinoline style which is the period from 1860s to just before bustle. The dress is one-piece composed of fitted bodice, and skirt which the front is flat, side and back is triangular shape to the skirts. 2) Color and Material : the main color is pale stone and the sub-color is ivory and blue. The dress is made of a silk surface and cotton back and partly satin and velvet. 3) Pattern and sewing : the dress is together sewing comnined with lining and fabric. The skirt is gored skirt, the number of patterns is plenty because of the plenty of width of skirt. The double piping has various effect not only to decorate but also to conceal the seam, support the silhouette. 4) Detail : The general detail is double piping which are repeatedly used to decorate stand collar, bands of sleeve, froint bodice and gored panel seam of skirt. And the fringe and velvet ribbon are used to decorate the dress. 5) Structural characteristics : The double piping, velvet ribbon and twilled cotton are used to emphasize structural characteristics of crinoline style. And the waistband which is backed with a webbing band to reinforce it is also the structural characteristics. Synthetically, the 1886~7 day dress has the characteristics of transitional stage in which the chararcteristics of the costume of 1860s and the remnants of the characteristics of the previous costume style, and shows the characteristics of day dress well in terms of the style, color and fabrics, pattern and sewing, detail, and structural characteristics.

제6차 교육과정에 따른 고등학교 화학Ⅰ 교과서의 STS 내용 분석

이석희,김용권,문성배 부산대학교 사범대학 과학교육연구소 2001 科學敎育硏究報 Vol.28 No.-

The STS contents, emphasized in the 6th curriculum, in the chemistry Ⅰ textbooks were analyzed. The STS contents of textbooks showed average of 10.7%. The Chapter in "water and air" were included 34.8% in STS contents, 11.0% in "metal and nonmetal", 9.7% in "organic compound" and 15.1% in "our livelihood and medicine goods". When the STS contents were analyzed by STS topics of Piel, the results are as follows; 51.1% on environmental quality and utilization of natural source, 38.6% on effect of technological developments. 9.5% on energy, 0.8% on sociology of science. However, there were no topics on human engineering, population, space research and national defense. When the STS contents were analyzed by student activities of SATIS, most of the activities were research study and case study. There were few field activities of practical investigation, role play, simulation, and research design.

폐굴껍질을 산성토양 적용시 토양의 화학적 특성변화에 관한 기초 연구

임진희,문종익,김성우,성낙창,이영형,윤태경 동아대학교 환경문제연구소 1999 硏究報告 Vol.22 No.2

Oyster shell has caused environmental problems in the coast. But it is possible to be used as an acidic soil amendment because it is the alkalic material of pH 9.0. In order to evaluate the utility of the crushed oyster shell as a soil amendment, acidic sandy loam soil was amended with it and then Chinese cabbages were cultivated in pots. The amount of the oyster shell was ⅰ)none, ⅱ)0.5kg/㎥, ⅲ)1.0kg/㎥, ⅳ)1.5kg/㎥, ⅴ)2.0kg/㎥ and ⅵ)2.3kg/㎥. The particle size of oyster shell consists of 34.88% of 40∼100mesh and 14.98% of larger than 100 mesh. It increased pH and the contents of available P₂O_(5) and SiO₂ and exchangeable Ca in used soil The application of oyster shell also increased the height and diameter of Chinese cabbages.

압출용 다이스의 Melt-고분자 열유동 기초연구

정효희,김재열,최진호,유신,윤성운,홍철,김종문 한국공작기계학회 2008 한국공작기계학회 춘계학술대회논문집 Vol.2008 No.-

As importance part of extruder, hopper(Hopper) been raw material supply wealth, main frame that screw and barrel that transformation of supply raw material attains are because deformed raw material is fearful finally extrusion to done dies attain. Extruder is divided by greatly above 3 but hopper has assembled in dehumidification of raw material and supply of smooth raw material, and make in Melt state as raw material is stabilized because main frame consists of screw and barrel and Melt does anaphora as done material is stabilized. And dies that is last part between barrel with screw anaphora done Melt material as is stabilized without causing change that is much depending on anaphora of screw from dies way out as correct product produce make to. In this treatise, make anaphora can present ideal dies basis design using CFdesign that is heat & flow analysis programs so that can produce detailed product through pipe channel flow analysis of stable dies applying anaphora value of do polymer raw material in Screw.

실험·실습법에 의한 수행평가 실시가 중학생의 학업성취도 및 정의적 영역에 미치는 영향

이석희,문성배 부산대학교 사범대학 과학교육연구소 2001 科學敎育硏究報 Vol.28 No.-

The purpose of this study is to see the effects of an application of the experimental practice which is one of the performance assessments on student's accomplishment and affective domain in the middle school science department. The results of this study are following. First, the experimental group with the experimental practice was better than the control group in the achievement (p<.05). It also showed that there was a significant differences in the "mid" and "low" groups. In case of the "high" group, there was little differences. Second, there was not significant differerences at affective domain(p>.05), while control group changed negatively, experimental group changed positively. In all three groups, there was no significant effect in the item 'self-consciousness'(p>.05). But the result showed that experimental practice was efficient for the students' attitude on learning in the "mid" and "low" groups(p<.05). And it also showed that experimental practice was efficient for the students' studying habit in the 'low' group(p<.05).

과학과 교수·학습에서 ICT 활용 수업의 적용에 관한 연구

김경희,문성배 부산대학교 사범대학 과학교육연구소 2006 科學敎育硏究報 Vol.33 No.-

The main purpose of this thesis is to make a comparative study of the effects on learning achievement by using ICT, science learning attitude and promote the ability of searching in science. This study shows that an application of teaching-learning lesson conducted by using ICT increases student's learning achievement in the science classes and influences an ability of searching for science affirmatively. Therefore, in order for students to study spontaneously and to develop their creativity and ability to think, a proper integration and application of the developed teaching-learning pattern and ICT applied methods to each unit are absolutely necessary.