Comparison of Melanoma Subtypes among Korean Patients by Morphologic Features and Ultraviolet Exposure

( Hong Sun Jang ),( Jee Hung Kim ),( Kyu Hyun Park ),( Jae Seok Lee ),( Jung Min Bae ),( Byung Ho Oh ),( Sun Young Rha ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.4

Background: Genetic alterations have been identified in melanomas according to different levels of sun exposure. Whereas the conventional morphology-based classification provides a clue for tumor growth and prognosis, the new classification by genetic alterations offers a basis for targeted therapy. Objective: The purpose of this study is to demonstrate the biological behavior of melanoma subtypes and compare the two classifications in the Korean population. Methods: A retrospective chart review was performed on patients found to have malignant melanoma in Severance Hospital from 2005 to 2012. Age, sex, location of the tumor, histologic subtype, tumor depth, ulceration, lymph node invasion, visceral organ metastasis, and overall survival were evaluated. Results: Of the 206 cases, the most common type was acral melanoma (n=94, 45.6%), followed by nonchronic sun damage-induced melanoma (n=43, 20.9%), and mucosal melanoma (n=40, 19.4%). Twenty-one patients (10.2%) had the chronic sun-damaged type, whereas eight patients (3.9%) had tumors of unknown primary origin. Lentigo maligna melanoma was newly classified as the chronic sun-damaged type, and acral lentiginous melanoma as the acral type. More than half of the superficial spreading melanomas were newly grouped as nonchronic sun-damaged melanomas, whereas nodular melanoma was rather evenly distributed. Conclusion: The distribution of melanomas was largely similar in both the morphology-based and sun exposure-based classifications, and in both classifications, mucosal melanoma had the worst 5-year survival owing to its tumor thickness and advanced stage at the time of diagnosis. (Ann Dermatol 26(4) 485~490, 2014)

골다공증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이남수,이상건,이상범,이상우,이선정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analyzed the relating factors. Method : A population-based sample of 1086 adults in Asan-city, Korea was investigated with questionnaires and height, weight, Information regarding the general characteristics(gender, age, economic state), lifestylef exercise, smoking, alcohol),medical history(progestin, GH, steroid, calcitonin, PTH), demographic parameter, obesity, stress, and family history was collected through an interview using a structural questionnaire. The level of obesity was measured by the body mass index(BMI). BMD(Bone mineral density) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Osteoporosis was considered to be T-score below -2.5. Results : The prevalence of osteoporosis increased progressively with age, decreased with BMI and predominant in women by the result of x^(2) -test, T-test. Age, weight, BMI were significantly correlated with osteoporosis by the result of Pearson correlation ana1ysis(P<0.05). And age, gender, BMI, family history of osteoporosis were proved to be significant risk factors of osteoporosis by the result of multiple logistic regression(P<0.05). Conclusion : These results suggest that age, gender, BMI might be the most important risk factors of osteoporosis. And the history taking about family history of osteoporosis is helpful for diagnosing osteoporosis.

Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

급성백혈병의 화학요법에서 조혈간세포 보충요법

이규보,배선근,손상균,이재태,이건수,이경혜,서장수 경북대학교 병원 1997 경북대학교병원의학연구소논문집 Vol.1 No.1

1. 목적 급성백혈병의 화학요법에 있어서 관해유도 요법시에 보다 더 강력한 항암화학요법을 시행하고 골수억제의 회복을 위하여 말초혈액에서 채취한 조혈모세포의 투여로 그 효과를 증대시키고자 시도하였다. 2. 방법 관해유도 화학요법후에 골수억제시기로부터 회복단계로서 백혈구감소증이 호전도면서 단핵세포가 증가될 때에 말초혈액에서 조혈간세포(stem cell)로 인정되고 있는 CD34+세포의 함유량이 1% 이상되는 시기를 찾아내고 그 때부터 평균 4차례의 단핵구를 분리채집을 하여 -74。C에 냉동보관하였다가 제2차 화학요법후에 해동시켜서 정맥주입하였다. 3. 결과 대상 급성백혈병환자는 6명에 23회의 조혈간세포를 함유한 단핵구 채집을 시행하였고 유효한 단핵구의 채집은 4례에서 가능하였고 2례에서는 유효한 채집이 못되었다. 채집효율은 39.0-74.5%로서 평균 49.8%였다. 채집 후에 혈액학적 변화는 혈색소의 약간 감소 (평균 1.34g/dl)와 혈소판의 감소 (평균20.25%)를 나타내었다. 해동 단핵구를 투여할시에 일과성인 불쾌감, 기침, 흉부압박감, 호흡곤란 등이 있었다. 4. 결론 자가골수이식에서 자기말초혈액조혈간세포이식으로 관심이 이행되는 현시점에 자가조혈간세포를 채집하여 수혈하는 기술이 확립되는 기초를 이루었다고 본다. 이번 대상들은 재발된 금성백혈병들에 시행하였으나, 향후에는 초발시에 제일차 관해유도 화학요법 과정에 시도해야할 것으로 생각한다. Object: Peripheral blood stem cells(PBSC) were collected after remission induction chemotherapy and reinfused after intensified chemotherapy in order to increase the chemotherapeutic efficacy. Method: Collection of mononuclear cells (MNC) was started when CD34+ cells above 1% and WBC above 1,000/ul with mononuclear cell percentage above 30%, the collection procedures were done 2-6 time in each patient of total 6 cases. The collected MNCs were stored in - 750C and reinfused after thawing in the water bath at 370C Results: Twenty three collection procedures from the 6 cases of acute leukemia had made effective MNC collection in 4 cases and mean collection efficiency was 49.8%(from 39.0% to 74.5%). Hematological changes after the procedure were mean reduction of hemoglobin 1.34g/dl and mean 20.25% of decreased platelet count. There were noticed transient symptoms of discomfort, coughing, chest tightness and dyspnea in association with the infusion of stored cells. Conclusion: The basic process for the peripheral blood stem cell transplantation (PBSCT) was accomplished with this supportive care for the consolidation chemotherapy of acute leukemia. Effective PBSCT would be warrented with more qualified process and high does chemotherapy. (Korean J Blood Transfus 6(2) : 41~47,1995)

웹 카메라를 이용한 시설 내 국화생산 광 환경 원격 모니터링

정선옥(Sun-Ok Chung),김용주(Yong-Joo Kim),이규호(Kyu-Ho Lee),성남석(Nam-Seok Sung),이철휘(Cheol-Hwi Lee),노현권(Hyun-Kwon Noh) 충남대학교 농업과학연구소 2015 농업과학연구 Vol.42 No.4

Increase of national family income improved demand of high-quality and year-round horticultural products including chrysanthemum. To meet these demand, farmers have introduced protected facilities, such as greenhouses, of which environmental conditions could be monitored and controlled. Environment management up to three weeks after transplanting is critical for chrysanthemum quality. Artificial lighting and light-blocking screen are especially important for long-day (day period > 13 hours) and short-day (night period > 13 hours) treatments. In this study, a web-camera was installed, and the image was obtained and transmitted to mobile phones to monitor the status of 3-wavelength(RGB) lighting environments. RGB pixel values were used to determine malfunctioning of the lighting lamps, and leaking out and incoming illumination status during short-day and long-day treatment periods. Normal lighting lamps provided RGB pixel values of 240~255. During long-day treatment period, G pixel values were useful to detect abnormal lighting conditions (e.g., leaking). During short-day treatment period, R pixel values were useful to determine incoming light (e.g., sun-light). Results of this study would provide useful information for remote monitoring of light conditions for protected chrysanthemum production under artificial lights.

노인의 영적 간호요구

최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

정신분열병에 대한 Risperidone의 효과 및 안전성에 관하여

신석철,왕성근,지익성,이선우,이규광,이봉희,이진영,황선희,신용재,배경도,김정란 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

In order to evaluate the efficacy and safety of risperidone, 10 patients with chronic schizophrenia were examined for 8 weeks in a silgle-open study. After the wash-out period of 1 week, risperidone was administered. Efficacy was evaluated by means of Positive and Negative syndrome Scale for Schizophernia(PANSS) and Clinical Global Impression(CGI). Safety assessment included the Extrapyramidal Symptom Rating Scale(ESRS), vital signs, body weight, ECG, and laboratory tests. The results were as follows 1) On the PANSS total score, there was significant improvement of total score after 1 week (P<.05) of administratiom. 2) On the PANSS positive and negative subscal, there were significant improvement of posotive and negative scores after 2 weeks (P<.05) of administration. 3) On the PANSS general psychopatholgy subscals, there were significant improvement of general psychopathologyscores after 1 week (P<.05) of administratiom. 4) On the CGI, there was significant decreasement of clinical impression of severity of schizophrenia score after 2 week (P<.05) of administration. 5) A statistically significant increase in body weight (P<.05) was observed after 8 weeks of administration. 6) EPS reached the peak at the end of the 1st week of administration of risperidone (11.8± 24.25) but they were easily relieved by addition of benztropine and clonazepam. There was not significant change in laboratory tests, vital sign, ECG after 8 weeks of administration. These results suggest that Risperidone is an effective antipsychotics and clinically safe except for increased body weight in chronic schizophrenia.

수종 치과재료의 제I급 와동에서의 변연 누출에 관한 실험적 연구

이선희,손흥규,최형준 大韓小兒齒科學會 1996 大韓小兒齒科學會誌 Vol.23 No.1

Microleakage is a problem of all filling materials of losted teeth structure and is clinically undetectable. Because marginal leakage may be responsible for pulp irritation, pulp inflammation, necrosis and recurrent caries, it is essential to prevent and control it. For the evaluations of microleakage of various class I filling materials, 175 extracted teeth were filled with amalgam, light curing composite resin, glass inomer cement, IRM and Fermit-N. After thermocycling, speciemens were placed in 1% methylene blue dye solution for 24 hours in an incubator set 37℃. The teeth were sectioned at filling body center and margin and degree of dye penetration was observed with a stereomicroscope. The following results were obtained. 1. Light cured composite resin has the excellent results and microleakage is increased in the order of amalgam, IRM, Fermit-N, glass ionomer cement.(SAS-6.0 system) and there was a statistically significancy in marginal leakage for each filling materials.(Kruskal-Wallis analysis, P<0.05) 2. Microleakage of the center and margin was statistically insignificant (Mann-Whitney analysis P<0.05) 3. There was less microleakage for amalgam than light cured composite resin but was statistically insignificant (Mann-Whitney analysis, P<0.05) and also showed less marginal leakage for Fermit-N compared to glass ionomer cement but also was statistically insignificant. (Mann-Whitney analysis, P<0.05).

Ergo-oxyscreen을 이용한 국민체조의 운동강도와 에너지 소모량 연구

이규동,이대선 建國大學校 敎育硏究所 1993 論文集 Vol.17 No.-

The results of analysis about the exercise capacity and energy consumption of National Gymnastics for Dept. of physical education of 18 female students are as follow. 1. The maximal H. R of National Gymnastics increased to 131.1 + 20.9 beat/min and to 38.70%, there is a significan (P<0.05). 2. The maximal VO_2max of National Gymnastics increased to 16.061 + 3.718ml/Kg and to 82.77%, there is a significance (P>0.05). 3. The MET of National Gymnastics increased to 4.556 + 0.885 and to 82.417%, there is a significance (P<0.05).

특수학교 재량활동 교육과정의 편성과 운영

이유훈,김경진,김규선,김형일 국립특수교육원 2000 교육과정의 편성과 운영 Vol.- No.1

본 연구는 제7차 특수학교 교육과정에서 많은 비중을 차지하고 있는 재량활동이 각 특수학교에서 보다 효율적으로 운영될 수 있도록 지원하기 위해 시도되었다. 이를 위해 본 연구에서는 각 시ㆍ도 교육청의 재량활동에 관한 지침서를 분석하였고, 전국 특수학교를 대상으로 재량활동 교육과정 편성ㆍ운영 방안에 대한 현장 교사들의 의견을 수렴하였다. 이러한 자료를 통해 나타난 요구와 시사점을 토대로 특수학교 재량활동 편성ㆍ운영방안을 제시하였다. 본 연구에서 다른 연구내용별 주요 연구결과를 정리하면 다음과 같다. 시ㆍ도 교육청 재량활동 지침 각 시ㆍ도 교육청에서는 특수학교 교육과정 편성ㆍ운영지침을 작성하여 이를 관내의 지역교육청과 각 학교에 제시하고 있었다. 분석한 결과에 따르면, 편제 및 시간배당 기준은 국가수준과 동일한 배정을 하고 있었다. 그리고 대부분의 시ㆍ도 교육청에서는 재량활동 시간확보 및 운영, 평가의 질 관리, 치료교육, 평가내용과 방법에 대하여 그 강조점을 두고 있었다. 그러나 일부 영역을 제외하고는 시ㆍ도 교육청 지침의 내용이 국가수준에서 제시한 재량활동의 내용과 거의 동일하였다. 따라서 지역교육청 나름의 특성을 살린 재량활동 지침을 제시할 필요가 있다고 본다. 재량활동 교육과정 편성ㆍ운영을 위한 교사요구 분석 재량활동 교육과정 편성ㆍ운영에 대한 실태조사에서 특수학교 대부분이 재량활동을 계획하고 운영하는데 있어 애로를 느끼고 있었다. 그 이유로는 재량활동에 대한 프로그램의 부재와 재량활동에 대한 교사들의 인식부족, 계획 수립 및 운영 미숙, 시설ㆍ재정적 지원의 부족을 들고 있었다. 이러한 애로점을 해소하기 위해서는 무엇보다도 먼저 재량활동에 대한 다양한 편성ㆍ운영방안과 교육 프로그램이 개발ㆍ제공되어야 한다는 것이다. 특수학교들의 재량활동 운영주체로는 학교 교육과정 운영위원회를 들고 있고, 재량활동을 편성 할 때 '학생들의 능력과 특성', 학부모 및 교사들의 의견이 반영되어야 한다는 의견이 재배적이었다. 그리고 재량활동 시간배당에 있어서는 국가수준에서 제시한 시간만으로도 충분한 것으로 여기고 있으며, 기본교육과정은 교과 재량활동과 창의적 재량활동 구분 없이 융통성 있게 활용하기를 원하고 있다. 재량활동의 지도주체에 대해 정신지체ㆍ정서장애학교에서는 담임으로 응답한 반면, 시각ㆍ청각ㆍ지체부자유학교 교사는 따라 다양한 반응을 보이고 있었다. 그러나 장애역역에 관계없이 재량활동의 하위영역에 따라 다양한 지도주체를 모색할 필요가 있다고 본다. 이것은 학습진단 구성과도 연관될 수 있는데, 많은 교사들은 현재의 집단편성 방식에서 벗어나 재량활동의 모든 하위영역에서 활동중심의 집단편성을 원하고 있었고, 특히 창의적 재량활동에서는 좀더 다양한 집단으로 구성해야 한다는 반응을 보이고 있었다. 시간운영에 있어서는 매주 정해진 날에 실시해야 한다는 반응이 대부분이었지만, 시각ㆍ청각ㆍ지체부자유학교의 범교과 학습과 자기주도적 학습에서는 좀더 다양한 시간배정이 이루어지기를 원하고 있었다. 특히, 자기주도적 학습에서 각 특수학교들이 특정한 정해진 날에 체험학습의 날이나 책가방 없는 날과 같이 별도계획으로 운영해야 한다는 학교들도 있었다. 이러한 시간 운영과 관련한 지도방법에 있어서는 하위영역에 구분됨이 없이 모든 학교가 견학과 체험학습을 선호하고 있었다. 지도내용에 있어서는 기본적인 교과목에 대한 이해를 중심으로 이루어져야 한다는 시각ㆍ청각ㆍ지체부자유학교의 반응을 제외한다면, 사회생활 적응을 위한 기초생활 지도와 일상생활 적응, 그리고 현장학습과 같은 체험학습을 통한 내용을 대부분 선호하였다. 각 특수학교에서 제시한 재량활동 프로그램을 분석한 결과 일부학교를 제외하고는 그 유형들이 비슷하고 영역도 특별활동이나 사회교과 영역과 크게 구분이 되지 않은 것으로 나타났다. 재량활도에 대한 평가는 학생들의 다양한 활동과정을 평가할 수 있는 포트폴리오 방식을 선호하고 있었다. 기타 요구사항 재량활동의 활성화 방안에 있어서는 '교수ㆍ학습자료의 개발 및 보급이 우선되어야 한다'는 반응이 가장 많았으며, 그 다음으로 '학교장의 관심과 적극적인 자원', '학교의 잡무감소', '학급당 인원의 감소'등을 요구하였다. 시ㆍ도 교육청에 대한 요구사항으로는 역시 '프로그램의 개발 보급', '잡무 감소', '체험학습 활동에 대한 경비 자원', '교과전담 교사 확보' 및 '다영한 전무교사의 확보', '교사에 대한 재량활동 관련 연수기회 제공', '학교간 재량활동 운영에 관한 정보교환 및 공동 프로그램 운영지원'등을 들고 있었다. 재량활동 편성ㆍ운영방안에 있어서는 단위학교에서 재량활동을 편성할 때 기본적인 도움이 될 수 있도록 하기 위하여 하위영역별 사항과 이에 따른 운영방안을 제시하였다. 이를 위하여 첫째, 재량활동 편성ㆍ운영방안을 하위영역별로 나누어 하위영역별 편성방향, 시간배당, 지도내용, 집단구성, 지도방법, 평가내용을 제시하였다. 둘째, 각 하위영역별 시간배당, 지도내용, 집단구성, 지도방법, 평가방안에 대한 여러가지 가능한 방안을 제시하였다. 셋째, 일반학교와 특수학교에서 실제로 활용하고 있는 다양한 예시자료를 제시하였다. 넷째, 일반학교의 재량활동 운영과 관련된 우수 연구보고서와 특수학교에서 운영히고 있는 재량활동 사례를 정리하여 부록에 제시 하여 다양한 실천 자료를 참고할 수 있도록 하였다. This study aims at groping for effective application methods of optional activities for special schools. For this purpose, a close analysis was made on the guidelines for optional activities published by Metropolitan and Provincial Office of Education(MPOE), and extensive opinion on schemes for organizing and implementing the curriculum were collected from school teachers. The data gathered in this process present requirements and suggestions for optimal designs for organizing and implementing optional activities in special schools. The results of this study can be summarized as follows: Clarification of theoretical backgrounds of optional activities. Through clarifying various theoretical backgrounds, we identified its related meaning of character, organization, implementation process and assessment. Guidelines of the Metropolitan and provincial Office of Education(MPOE) Each MPOE has worked out and provied schools with its own guiding principles on the organization and implementation of special education curricula. The systems of organization and the standards of subject time alloment are almost the same as those of state level issued by the ministry of education. Most MPOE give directions that each school should secure and implement optional activities with an emphasis on enhancing the quality of assessment management, therapy education, as well as the contents and methods of assessment. Except some areas, most directions for optional activities from MPOE of education are not much different from those of the Ministry of Education. It is, therefore, necessary that each MPOE should provide its own directions as to optional activities. Analysis of teachers' needs about effective application method of optional activity. An investigation into actual condition activities reveals that most special schools have difficulty in planning and operating the activities, because of lack of diverse programs, shortage of knowledge about the activities, unskilled planning and implementation of the activities, insufficient facilities and financial support. The first thing to break these obstacles is to develop and provide diverse programs and devices for the organization and operation of the activities. The curriculum steering committee is regared as the primary implementation body for optional activities in special schools. Optional activities should reflect each student's ability and specially as well as the opinions of his/her parents and teachers. The time allotted by the Ministry of Education is regarded enough for individual school's optional activities. There are two kinds of optional activities: one by subject matters and the other by creative optional activities, but basic curriculum requires flexible application of both. As to the measurement of optional activities, schools for mentally retarded or handicapped students responded their home-room teachers should take the initiative, but school for the blind, the deaf, or the crippled said that different teachers in different fields should take the lead in their respective major subjects. Regardless of handicap degrees, it is necessaty to set various teaching intiatives according to sub-areas of optional activities, which is closely related to the organization of learning groups. Many teachers wanted to form groups geared to focus on more creative optional activities in sub-areas rather than their present groupings. Most teachers reponded that the time for the activities should be fixed on a specific weekday. Teachers also wanted that more various time should be allotted to the integrated study and self-directed study of the schools for the blind, the deaf, or the crippled. Some special schools had the opinion that self-directed study should be operated on a fixed day as the same way as the day for learning through experience or the day without schoolbag goes. As to the teaching methods, all the schools preferred the field study or learning through experience without regard to the division of sub-areas of optional activities. The contents of special school teaching were maintained to be focused on understanding the basic subjects, but most schools wanted optional activities to comprise learning the basic social life, getting acquainted with everyday life, and on-the-spot learning. An analysis on optional activities of special school showed that most activity types of the schools are nearly the same, and their areas of activities are not greatly different from those of club activities or social science subjects designed by the Ministry of Education. As for the assessment method for optional activities, the protfolio system is most preferred because it assesses each student's process of diverse activities. Other requirements In order to activate the optional activities, most schools preferred the development and distribution of teaching-learning materials. Next comes the school principal's concern and support for the activities, diminishing teachers' sundry duties, and reducing class-size. Teachers also required that each MPOE should take active measures to develop and distribute diverse teaching programs, reduce teachers' odd jods, give more financial support for discretionary activities, secure subject teachers, provide training opportunities for optional activities, exchange information on the operation of optional activities among schools, and support joint operation programs. Designs and various examples of its organization and implementation. With analyais of these results, we developed the designs of its organization and implementation method of optional activities for special schools. First, in our designs of its organization and implementation, we approached the sub-activity divisions which composed of two. the first one is optional activities of subject matters which involves the in-dept and supplementary study of therapy education activities and the in-dept and supplementary study of elective-centered subject matters. the second one is creative optional which involves integrated and self-directed study. Second, we conducted to figure out various possible methods in each sub-activities about time allotment, learning group, class time management, teaching method, teaching contents, assessment method. Third, when design of organization and implementation of optional activity, we usually use diverse optional activity examples from regular and special schools. Forth, in appendix of this book, we provided the cases of discretionary activity of regular and special schools's. So, it enables teachers to use as practice resource material, in their schools.