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조선 유학이 독자적 사상 체계를 형성하고 주자학을 심화해가는 사상사의 흐름 한가운데서 정암은 실천성을 담보하여 도학파의 역사의식을 계승하고자 하였다. 이런 입장에서 정암은 ‘어떻게 실천성을 확보할 수 있는가'하는 문제의식을 가졌으며, 주자학의 실천성을 확보하기 위해 ‘도덕 주체확립'을 강조하였다. 정암은 공부의 가능성과 목적, 그리고 공부의 주체를 ‘리'에 입각하여 밝히고, 실제 공부의 실천은 ‘기'에 중점을 두는 방법을 통해 공부의 지향점과 실행 방안을 구조화함으로써 내성외왕(內聖外王)의 목표에 다가서고자 하였다. 공부의 실제에 있어 기(氣)에 주목하는 정암은 기질변화(氣質變化)의 맥락과 존천리알인욕(存天理?人欲)의 맥락에서 각각 성(誠)과 경(敬)의 공부방법론을 제시하였다. 이어 성(誠)의 실천성을 경(敬)으로 더 구체화하면서, 마음을 지키는 방법으로 경 공부의 중요성을 제시하였다. 이어서 정암은 성(誠) 공부와 경 공부를 구체적으로 실천하는 방안들을 별도로 제시하는데, 물망물조장(勿忘勿助長), 신독(愼獨), 심강(心剛) 공부의 세 가지를 특히 강조하고 있다. 공부의 실제에 있어서 정암은 『소학』과 『근사록』을 중시하였고 특히 일용동정(日用動靜) 간에 『소학』에서 제시하는 심신의 검속을 철저히 실천하였다. 또한 정암 공부의 실제에서는 정좌(靜坐)가 두드러진다. 지치(至治)로 대표되는 경세론이 정암 사상의 핵심이라고 여기기 쉽다. 그러나 정암을 정암이도록 하는 것은 이론이나 사상이 아니다. 끊임없는 성찰과 심신의 수양을 통해 순선한 본성을 자각하고 함양하고자 했던 노력, 그것이 정암 사상의 중핵(中核)이며 정암 지치론(至治論)의 근간이다. 조선도학파의 역사의식과 실천정신이 여실히 투영된 정암 공부론의 이 같은 정신은 이후 조선 유학을 지탱하는 기둥이 되었으므로, 정암은 결코 실패하지 않았다. Jung-am had critical mind, ‘how can we secure the practice of Neo-Confucianism?'and put emphasis on ‘establishment of moral subject'to secure the practice of Neo-Confucianism. He paid attention to Li[理] for goal setting in self-discipline as well as Ki[氣] in actual self-discipline. When it comes to actual self-discipline, he focused on Ki and suggested self-discipline of each Sincerity[誠] and Refrain and reverence[敬] within the context of temperament change and Jon-chen-li-al-in-yok. Giving shape into practice of Sincerity as Refrain and reverence, he proposed the importance of self-discipline of Refrain and reverence as a way to protect the peace of mind. Moreover, he suggested additional ways to put Sincerity and Refrain and reverence into practice concretely; especially, he put emphasis on Mul-mang-mul-jo-jang, Shin-dok and Yong-sim-gang. In terms of actual self-discipline, he put stress on Sohak and Geunsalok and especially, set his body and mind right in conformity with the teaching of Sohak. Also, his actual self-discipline features sitting in meditation remarkably. Many researchers evaluate him as an immature, radical and failed politician but he exercised strict self-discipline and used better discretion than anyone else. Reflecting on the meaning of ‘little power of study'as Toegye said, it implies that his self-discipline was not completed but his group of like-minded persons were not grown enough at the same time. The meaning of Jung-am's studies is not found in politics. The endless self-reflection and practice of right behavior to realize the human nature and expand it; that is the best part of his self-cultivation theory as well as basis of his political theory. His self-cultivation theory, as the reflection of historical consciousness and practical spirit in Confucianism in Joseon Dynasty, fully supported the Confucianism in Joseon Dynasty and thus he never failed.
Twinkling artifact, described by Rahmouni et al in 1996, appears as a rapidly alternating red and blue color Doppler signal behind certain stationary objects, such as stone. It has been reported mainly association with urinary calculi in only a handful of studies, showing the usefulness in equivocal case on sonography. For better visualization of distal ureter and ureterovesical junction(UVJ) on transabdominal sonography, full bladder technique by oral fluid ingestion has been usually performed at radiology department. However, it is time consuming work-up with some limitation, therefore not appropriate with many cases in busy urban ED. For rapid bladder distension on sonography, some authors suggested effective alternative approach, rapid intravenous hydration, rarely reported in related English literatures. I report a case with UVJ stone confirmed by twinkling artifact and alternative quick bladder filling with transabdominal ultrasonography.
고봉은 리가 발하여 기의 방해를 받으면 사단도 중절하지 않을 수 있다고 함으로써 리발이 반드시 순선한 감정과 행동으로 이어지지 않음을 주장하였다. 이에 퇴계는 리가 발한 사단의 순선함을 강조하면서 기질에 좌우되는 일반감정을 천리에서 유래한 도덕감정과 혼동해서는 안 된다고 하였다. 고봉은 다시 성인이 아닌 이상 사단의 중절을 유지하기 어려우며 주자도 사단부중절을 언급하였다고 반박한다. 퇴계는 `부중절은 기질 때문이지 순선한 사단이 왜곡되거나 사라지는 것은 아니다`라는 취지의 반론을 작성했으나 고봉에게 전달하지 않았고 고봉도 이 문제를 더 이상 언급하지 않았다. 퇴계는 만년에 『성학십도』 등에서 사단의 순선함을 여전히 자신의 기본 입장으로 천명하면서도 기의 엄폐로 인한 사단부중절 현상도 인정함으로써 절충적 의견을 내놓았다. 그러나 사단이 기의 간섭으로 부중절할수 있다는 것은 어디까지나 형이하의 영역에 한해서이다. 퇴계가 고봉의 주장을 일부 수용한 것처럼 보이나 본원의 측면에서는 여전히 리가 발한사단의 순선함을 견지하였다. 퇴계는 현실적 차원에서 리가 발하여 부중절할 가능성을 인정하였고 그 부중절을 막을 방안을 강구하였다. 곧 본성의 순선함을 인식함으로써 자신이 도덕적 주체라는 강한 믿음을 확보하고, 아울러 부단한 공부를 통해 그 리를 도덕행위로 완성하는 능력을 확보하고자 한 것이다. 이것은 주체성과 실천성 부족이라는 주자학의 단점을 보완하는 것이고, 나아가기의 간섭에 주목하기보다는 리를 공부 대상으로 삼아 완전히 장악하고자 하는 양명학에 대응하는 것이기도 하다. 그런데 퇴계가 리발을 `리의 능동성`으로 주목하고 이를 통해 본성의 온전한 발현이 가능함을 강조하였다는 연구들이 있다. 그러나 퇴계의 `리발`은 도덕행위의 동기를 뜻하는 것이지 리발만으로 도덕행위가 완성된다는 것은 아니다. 따라서 `리의 능동성`에 주목하여 리발을 도덕행위 성립의 충분조건으로 간주하는 견해들을 재고할 필요가 있다. 퇴계가 리발이라는 테제를 통해 강조한 것은 본성의 적극적 인식을 통한 도덕 주체의 확립과 기의 간섭을 극복하여 리가 발한 순선한 감정을 온전히 실현하는 것이었다. Kobong Ki Daeseung asserted that if Ki is interrupted after Li was revealed, Four Beginnings could not be equilibrium, and the revelation of Li is not necessarily manifested into good deeds. For this argument, T`oegye Yi Hwang said that general emotion governed by Ki should not be confused with ethical emotion originated from law of nature, emphasizing good of Four Beginnings. Kobong disputed that unless as a saint again, it is difficult equilibrium of Four Beginnings to maintain, and Chu Hsi also argued like this. T`oegye made a counterargument `Anti-equilibrium is due to Ki, and Four Beginnings are not distorted or disappeared,` but he did not send it to Kobong, and Kobong did not mention it any more. In his later years, T`oegye came up with a compromised opinion that Four Beginnings could be Anti-equilibrium due to interruption of Ki, at 『Four Beginnings』, etc. However, it is limited that Four Beginnings might be Anti-equilibrium due to interruption of Ki only into range of physical and material. Even though it looks T`oegye accommodated the assertion of Kobong, it holds firmly the goodness of Four Beginnings which Li was still revealed, in terms of the origin. T`oegye made people realize the goodness of nature and have strong faith, `oneself is moral agent. In addition, he developed the ability to complete good nature in moral deeds, via endless efforts. This complements the drawback of Learning of Master Zhu, lack of self-direction and practice, and it reacts the Yang-ming Studies, targeting only Li as target of cultivating. The revelation of Li, T`oegye said, means the motive of moral deeds, not that if Li is manifested, moral deeds are complete. Therefore, it needs to review opinions for Li has already inherent to ability of moral deeds, based on concept of `activity of Li`. T`oegye mentioned the `revelation of Li` in order to establish moral agent, in realizing good nature. Based on this, he consistently oriented the `securing power of ethical practice for fulfillment of nature`.
This paper presents the modeling and power quality analysis of Jeju island power system connected with wind farm, and thermal power plant. It is for indicating the influence of wind farm operation in steady and transient state in Jeju island power system during the HVDC system overhaul period. For the computer simulation, three kinds of main item are modeled, which are 67[㎿] wind farm, thermal power plant and Jeju power load. To analyze the influence of the wind power generation to the Jeju power system, two kinds of simulations are carried out by using the PSCAD/EMTDC program. One is the steady state operation under the variable speed wind, and the other is the transient state operation when all of wind farms in Jeju island are disconnected from the Jeju power grid instantaneously on the rated power output. With the comparison of these results, it is useful for analyzing the power quality of Jeju power system versus wind power generation.
Purpose: With the very wide range of known toxicants, the correct early management of fatal toxic exposure can be delayed. Past epidemiologic data on fatal toxic exposure would be helpful to emergency physician. The aim of this study was to investigate reports of toxicants on fatal toxicology research during the past two decades in Korea, with a focus on emergency symptoms. Methods: This study analyzed basic information and abstracts of about 200,000 articles from approximately 500 journals between 1980 to 2003, which were retrieved from Medical Research Information Center and Research Information Center for Health and focused on fatal toxicology related to emergency medicine. The search terms used were the names of toxicants and related terms. Results: A total of 88 toxicants were found to be related to research on fatal toxic exposure. The number of articles increased sharply after 1995. Frequently involved toxicants were carbon monoxide (in 93 articles), followed by paraquat (in 84), and organophosphate pesticide (in 37). Original articles exceeded case reports in number for these three most frequent toxicants. Articles on paraquat were more numerous than those on organophosphate pesticide or carbon monoxide especially after the late 1980s. Conclusion: The result suggest that over a 24-year-period, carbon monoxide, paraquat, and organophosphate pesticides have been prominent in both the incidence and severity of fatal toxic exposure in Korea, which underscore the need for review of them.
A 45-year-old, alcoholic liver cirrhosis patient presented to the Emergency Department(ED) with complaint of acute intense pain and weakness in the right lower extremity without trauma; hip flexor grade 3/5, knee extensor 2/5, and others normal. Initially, emergency physician diagnosed radiculopathy due to high lumbar disc herniation; however, plain a radiograph and an MRI of the lumbar spine did not revealed definitive compression of the nerve root. On the second hospital day at emergency department, swelling, tenderness of anterior proximal thigh and right inguinal pain were detected and computerized tomography (CT) of the abdomen was performed, which revealed diffuse swelling of right iliacus muscle with acute hematoma. Despite extravasation of contrast for CT imaging, the patient was managed conservatively because of improved neurologic deficit and coagulation abnormality of liver cirrhosis. An early correct diagnosis of femoral nerve palsy caused by iliacus hematoma in the ED is unlikely because of its rare incidence and it is difficult for complete history taking during physical examination involving some special case of severe pain such as this case.
Purpose: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. Methods: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator`s training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. Results: A total of 613 ETIs attempts using Glidecope? were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator`s training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator`s training level. Among the predicting factors for difficult laryngoscopy, mormorbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). Conclusion: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.
Purpose: Tooth injuries are common complaints presenting at emergency departments, so emergency physicians (EP) should play an important role in the initial care of dental trauma. However, there has been little interest in and research on this subject. Examining the various clinical factors helpful for the emergency physician's care of tooth injuries, we attempted to acquire basic data for establishing treatment guideline. Methods: A retrospective analysis was done by reviewing the dental charts of 214 patients who presented to the emergency departments of one secondary hospital and one teriary hospital following tooth injuries during a 1-year period (Oct. 2000-Sept, 2001). The following variables were extracted and examined: age, mechanism of injury, number & location of injured teeth, radiograph performance, diagnosis, type of treatment. Results: With the 1992- WHO classification, 9 types of tooth injuries were found (multiple response): in adults, concussion (23.5% of cases), subluxation (16.7%), pulp-exposed crown fracture (16.7%), avulsion (10.8%), and non-pulp-exposed crown fracture(15.7 %); in children subluxation (20.2%), luxastion (17.2 %), avulsion(17.2 %), and concussion (11.1 %), Seven types of treatment were performed based on single most difficult treatment recorded per patient: 91 conservative cares (42.5% of cases), 9 pulp cappings (4.2 %), 49 splints (22.9 %), 7 replantations (3.3 %), 17 pulpectomies (7.9 %), 30 extractions (14.0 %), and 10 others. Conclusion: Considering that the most prevalent treatments were splints and conservative cares, we think emergency medicine could play a wide role in the initial management of tooth injuries and suggest a further co-study with a dentist.
Benign paroxysmal positional vertigo (BPPV) is a commonly presenting problem at the emergency department. Three types have been recognized based on the pathogenesis of BPPV. The first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. With the first two types of BPPV, an otolith-repositioning manuever can be performed quickly at the bedside with rapid results, often providing much satisfaction to both patient and physician. However, in the case of horizontal-canal cupulolithiasis, no established repositioning maneuver existed until recently. In 2000, Jo et al. developed a new repositioning maneuver and reported excellent results. We report a case of BPPV horizontal-canal cupulolithiasis that immediately responded to the maneuver of et al. and strongly recommend use of this repositioning maneuver at the emergency department.