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Purpose: Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients. Methods: Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS) ≥16) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC. Results: Patients were mostly male, aged 51.9±17.8 years, with an injury severity score of 24.1±12.4. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60). Conclusion: ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation. (J Korean Soc Traumatol 2012;25:72-78)
이동언(Dong Eun Lee), 이재령(Jae Ryung Lee), 김영우(Young Woo Kim), 권영규(Young Kyu Kwon), 변성희(Sung Hui Byun), 신상우(Sang Woo Shin), 서성일(Seong Il Suh), 권택규(Taeg Kyu Kwon), 변준석(Joon Seok Byun), 김상찬(Sang Chan Kim) 한의병리학회 2005 동의생리병리학회지 Vol.19 No.2
우리나라 우주발사체 개발에 대한 청소년들의 흥미 유발과 로켓에 대한 과학적 접근을 쉽게 할 수 있도록 고등학생을 대상으로 하는 로켓 교육프로그램을 개발하였다. 고등학교 물리 1,2, 화학 1,2를 분석한 후 로켓의 추진 원리와 연계하였고, 추진 원리의 이해를 바탕으로 모델로켓 엔진을 제작하는 과정을 설명하였다. 또한 모델로켓에서 추진제로 사탕, 육포, 초콜릿 등과 같은 고열량 식품들을 사용하여 추진제를 제작하였다. 특히 교육프로그램은 식품을 이용한 추진제 제작, 연소 온도 측정, 추력 측정과 모델 로켓의 제작, 발사 등으로 구성하였으며 연구 결과를 통해 사탕을 이용한 제작한 추진제와 솔비톨로 제작한 추진제의 성능을 비교 분석하였다. 또한 프로그램을 적용한 후 학생들의 성취도 평가를 측정하기 위하여 기술적, 교육적 목표를 제시하고 프로그램의 운영을 통하여 목표 달성 여부도 판단하였다. This paper aims to design an educational science program based on rocket propulsion for high school students. Curriculum in high school physics and chemistry were evaluated to find out scientific match with basic principles in rocket propulsion. Also model rocketry was implemented as a part of the educational program. Solid propellants were prepared by the combination of sorbitol and candy after a selection process for solid propellant from several high caloric food candidates. Specially, this program was intended to give an opportunity to organize basic knowledge of high school science with model rocketry by measuring combustion temperature, thrust level of developed propellants. A pilot operation of the program was done with four high school students to evaluate the achievement of final goals of the program both in technical and educational aspect.
The architecture of 'familiarization' based on the metaphor is trite through the habitual reference. So 'defamiliarization' based on the metonymy has arisen in architecture against the familiarized architecture. Thus, this paper investigates metaphor and metonymy as the grounds for the relationship between architecture and them, rethinks of it by Jakobson's and Derrida's metonymy that G. Ulmor suggests the montage and the montage-allegory as devices of 'defamiliarization', and finds the limitation each in architecture. Therefore, this paper suggests that the possibility of 'metonymic metaphor' be reconsidered as the alternative and searches theorization of 'Familiarization based on Defamiliarization' in architecture.
김인혁 ( In Hyuk Kim ), 서강석 ( Kang Suk Seo ), 이미진 ( Mi Jin Lee ), 박정배 ( Jung Bae Park ), 김종근 ( Jong Kun Kim ), 류현욱 ( Hyun Wook Ryoo ), 안재윤 ( Jae Yun Ahn ), 문성배 ( Sungbae Moon ), 이동언 ( Dong Eun Lee ), 박용석 ( Yong S) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: The terminology that represented major trauma was vague, inconsistent, and lacked validation. The objective of this study is to investigate the new definition of polytrauma in adult patients of major trauma. Methods: A retrospective data of adult major trauma patients [Age≥15, 16≤Injury Severity Score (ISS)<75] from a regional trauma center were collected in period between July 2011 and December 2013 and divided into two groups: polytrauma and non-polytrauma. We compared the demographic, laboratory characteristics, and outcomes in patients with major trauma, polytrauma and non-polytrauma. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine the parameters associated with in-hospital mortality and early death. Results: A total of 662 patients met the inclusion criteria for major trauma. Of these, 150 (22.7%) met the new polytrauma definition. In the major trauma group, the mean ISS was 22, in-hospital mortality rate was 23.4%, and early death rate was 20.7%. In the polytrauma group, ISS was 27, in-hospital mortality rate was 44.7%, and early death rate was 38.7%. In the non-polytrauma group, ISS was 20, in-hospital mortality rate was 17.2%, and early death rate was 15.4%. Of the five physiologic parameters (systolic blood pressure≥90 mmHg, Glasgow Coma Scale≥8, base deficit≥6, international normalized ratio≥1.4/activated partial thromboplastin time≥40 seconds, age≥70 years), the lowest in-hospital mortality was found when one parameter was involved (2.5%), and the highest mortality was found when all parameters were involved (100%). Conclusion: Based on “The new Berlin definition”, polytrauma was associated more with in-hospital mortality and early death than non-polytrauma in adults. The five physiologic parameters were correlated with in-hospital mortality.
조재완 ( Jae Wan Cho ), 서강석 ( Kang Suk Seo ), 이미진 ( Mi Jin Lee ), 박정배 ( Jung Bae Park ), 김종근 ( Jong Kun Kim ), 류현욱 ( Hyun Wook Ryoo ), 안재윤 ( Jae Yun Ahn ), 문성배 ( Sungbae Moon ), 이동언 ( Dong Eun Lee ), 김윤정 ( Yun Je) 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.4
Objective: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. Methods: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. Results: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Fortytwo (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979). Conclusion: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
서현일 ( Hyun Il Seo ), 박용석 ( Yong Seok Park ), 이미진 ( Mi Jin Lee ), 안재윤 ( Jae Yun Ahn ), 김종근 ( Jong Kun Kim ), 문성배 ( Sungbae Moon ), 이동언 ( Dong Eun Lee ), 손유동 ( You Dong Sohn ), 이숙희 ( Suk Hee Lee ), 최재영 ( Jae You) 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.4
Purpose: This study aims to investigate how variability of bystander cardiopulmonary resuscitation (CPR) willingness may change depending on special situations and to find out factors that enhance CPR willingness in each situation and ways to increase the ratio of bystander CPR. Methods: A population-based, nationwide study using a structured questionnaire via telephone survey regarding CPR was done in 2015 (n=1,000). A stratified cluster sampling was conducted to assess the impact of age and gender on CPR willingness. The contents of the questionnaire consisted of basic characteristics, CPR training experience, and status. Additionally, respondents were presented with five hypothetical scenarios of cardiopulmonary arrest; family member, stranger, elderly person, preschool child, and pregnant woman. Results: Willingness to perform CPR was low for pregnant women (52.1%) or elders (59.3%), moderate for strangers (73.3%) or children (71.3%), but high for a family members (90.4%). Age, awareness of CPR, training experience of CPR, CPR training by manikin practice, recent CPR training (≤2 years), experience of bystander CPR, family history of severe illness, and awareness of Good Samaritan law all influenced the willingness to perform CPR on bystander in each scenario. Conclusion: The willingness of bystander CPR decreased in special situations, especially for elderly and pregnant woman. However, recent CPR training group were more willing in the elderly, and CPR experienced group also showed increased tendency in pregnant woman. It is expected that the rate of bystander CPR can be increased by emphasizing that performing bystander CPR for children, pregnant women, and elders is not different from the general population.
박용석 ( Yong Seok Park ), 서강석 ( Kang Suk Seo ), 박정배 ( Jung Bae Park ), 이미진 ( Mi Jin Lee ), 류현욱 ( Hyun Wook Ryoo ), 문성배 ( Sungbae Moon ), 김종근 ( Jong Kun Kim ), 이동언 ( Dong Eun Lee ), 안재윤 ( Jae Yun Ahn ) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: This study investigated the association between the initial red cell distribution width (RDW) and mortality in patients with severe trauma. Methods: We conducted a retrospective analysis between January and December 2014. Severe adult trauma patients (age ≥18, Injury Severity Score≥16), who were treated in our emergency department, were included in this study. We classified patients into four groups in accordance with their RDW (group 1: RDW≤12.3%, group 2: 12.4%≤RDW≤12.6%, group 3: 12.7%≤RDW≤13.2%, group 4: 13.3%≤RDW). They were compared based on the characteristics of their groups. We also compared the baseline characteristics of patients who survived and did not survive. Univariate and multivariate Cox proportional hazard analyses were performed to determine the association between mortality and each variable. Results: We enrolled 364 severe trauma adult patients. The mortality rate was 8.9%, 16.2%, 12.6%, and 20.4% for RDW groups 1, 2, 3, and 4, respectively; there was no statistical significance. The RDW of patients who survived (n=311) and did not survive (n=53) were 12.7% (12.4-13.3%) and 12.9% (12.5-13.6%), respectively, but this was also not statistically significant (p=0.075). Univariate Cox proportional hazard analysis showed a significant difference between the mortality and initial RDW, but a multivariate analysis did not show an independent association between initial RDW and mortality (hazard ratio, 0.729; confidence interval, 0.508-1.047; p=0.087). Moreover, multivariate analysis did not also show a significant difference between RDW quartile groups according to route of hospital visit. Conclusion: There was no independent association between the initial RDW and mortality in patients with severe trauma.
Under the influence on Modernism, Korean modern architecture had a tendency to pursue not the creativity but the materiality. Although the architectural concern about the tradition increases, against this situation, traditional Korean architectural language was not still positively reactivated. Therefore, this paper rethinks of that situation by 'Hermeneutics Debate between Gadamer and Habermas'. In reactivating the tradition, the former has the limitation of dependence on absolute power of the past as pre-understanding and the latter has the possibility of combining the realistic rationality with the original meanings of the tradition simultaneously. Therefore, this paper suggests the alternative based on the critical succession of the tradition by 'controlled distancing' in latter.