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박강근,김한철,최영화 대구대학교 2006 대구대학교 학술논문집 Vol.1 No.2
캐이블 구조물은 여러 가지 형태를 가진 대공간 구조계에 적용되고 재료에 대해서도 효과적으로 적용된다. 캐이블 구조의 재료적인 특성은 축방향 강성이 크고 휨강성은 적다. 또한 케이블 구조는 초기에는 불안정 구조물이다. 이러한 유연 구조물은 기하학적으로 비선형을 고려하여야 하고 초기에 불안정 구조물이고 대변위 현상이 발생되기 때문에 구조해석을 수행하기 전의 평행된 형태를 연구하여야 한다. 비선형 정적해석은 Total Lagrangian 식과 수정된 Newton Raphson 법을 이용하였다. 본 연구에서는 케이블 돔의 변형형태를 해석하고 비선형 유한요소법으로 케이블 부재의 기하하적 비선형 해석을 하였다.
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Choi-Kwon, Smi,Han, Sung W.,Kwon, Sun U.,Kang, Dong-Wha,Choi, Ji M.,Kim, Jong S. Ovid Technologies Wolters Kluwer -American Heart A 2006 Stroke Vol.37 No.1
<P>BACKGROUND AND PURPOSE: The efficacy and safety of the selective serotonin reuptake inhibitor fluoxetine have rarely been studied in the treatment of poststroke emotional disturbances. METHODS: Stroke patients (152) who had poststroke depression (PSD), emotional incontinence (PSEI), or anger proneness (PSAP) were studied. PSD was evaluated by Beck Depression Inventory and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PSEI by Kim's criteria, and PSAP was assessed by Spielberger Trait Anger Scale. Subjects were randomly given either fluoxetine 20 mg/day (n=76) or placebo (n=76) for 3 months. Follow-up evaluations were done 1, 3, and 6 months after the beginning of the treatment. The primary outcome measurement was the scores of emotional disturbances at each follow-up assessment. The secondary outcome measurements were the percentage changes of the scores and the subjective responses of the patients. RESULTS: Although patients in the fluoxetine group more often dropped out because of adverse effects, fluoxetine administration was generally safe. Fluoxetine significantly improved PSEI and PSAP, whereas no definitive improvement of PSD was found. Improvement of PSAP was noted even at 3 months after the discontinuation of the treatment. CONCLUSIONS: Fluoxetine is efficacious in the treatment of PSEI and PSAP. Its effect on PSD is not solidly confirmed.</P>
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Kim, Bum Joon,Kim, Na-Young,Kang, Dong-Wha,Kim, Jong S.,Kwon, Sun U. American Heart Association, Inc. 2014 Stroke Vol.45 No.12
<P><B>Background and Purpose—</B></P><P>Right-to-left shunt (RLS) via the patent foramen ovale is an important cause of cryptogenic stroke. The Valsalva maneuver provokes or enhances RLS, but RLS can also occur during normal respiration. This study examined whether the ischemic lesion pattern differs depending on the character of RLS.</P><P><B>Methods—</B></P><P>All consecutive patients with a patent foramen ovale (diagnosed by transesophageal echocardiography) who had a cryptogenic stroke and underwent transcranial Doppler–patent foramen ovale test (monitoring of microbubbles in the right middle cerebral artery by transcranial Doppler after hand-agitated saline injection) were divided according to whether RLS was constant (microbubbles detected both at baseline and after the Valsalva maneuver) or provoked (microbubbles detected only after the Valsalva maneuver). The groups were compared in terms of clinical and imaging characteristics.</P><P><B>Results—</B></P><P>Seventy-six patients met the eligibility criteria: 50 had constant RLS and 26 had provoked RLS. Provoked RLS patients were significantly younger. The ischemic lesions in provoked RLS patients were located predominantly in the vertebro-basilar circulation (73.1% versus 28.0%; <I>P</I>=0.002), whereas constant RLS patients were more likely to have multicirculatory lesions (16.0% versus 0.0%; <I>P</I>=0.045). After adjusting for confounders, provoked RLS associated independently with a vertebro-basilar lesion location (OR=3.306; <I>P</I>=0.03).</P><P><B>Conclusions—</B></P><P>The predominance of posterior-circulatory infarction in provoked RLS patients suggests that the Valsalva maneuver may promote RLS and paradoxical embolization to the posterior circulation.</P>
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김인숙,김기경,이한주,김의숙,고일선,김주희,이태화,강경화,이춘옥 연세대학교 간호정책연구소 1999 간호학탐구 Vol.8 No.2
Health care is the one of the most important element for the people in 21st century. With the enormous change in our health care system, nurses are required to change their roles more diversified and comprehensive with expertise. Nurses should prepare the new roles so that they function effectively within the new health care system. Since 1990, nurses in Korea have discussed actively on the development of the advance nurse practitioner program. The discussion is based on the existing rules and regulations about specialized nurses in medicine law and the regulations of the Ministry of Health and Welfare. The purpose of the study is to propose the definition of advanced nursing practice, and definition, requirements, roles and practice of advanced nurse practitioners that should be included in advanced nurse practitioner law as essential elements. Proposed were followings: 1. Definition of Advance Nursing Practice: The skills and abilities essential for the advanced nursing practice are include: quality control, improvement of nursing care, and management of acute and chronic health problem in hospital; provision of primary care with advanced knowledge, expertise and autonomy to the clients within the community; pivotal role in the coordination and integration of other health care professionals. 2. Definition of Advance Nurse Practitioner: a nurse who works in the area of advanced nursing practice with licensure as a registered nurse 3. Requirements for Advanced Nurse Practitioner 1) graduate degree and minimum 3-year experience in the designated area of practice and pass the certificate exam of the national board of nurses, and certification of the ministry of health and welfare with recommendation of the association of specialized nurses. 2) validation period of certification is 3 years since the achievement of certification; completion of continuing education given by the national board of nurse every 3 years to renew the certification. 3) establishment of rules about grace period for existing specialized nurses to become Advance Nurse Practitioners through the legislation process. 4. Roles of Advanced Nurse Practitioners 1) Independent practice, and operation and management of nursing related facilities 2) Case management 3) Coordination and collaboration with other health care providers 4) Conduction researches, evaluation, and utilization of the research findings 5) Liaisons between education and practice 5. Areas of Advance Nurse Practitioners 1) Nurse midwifery 2) Nurse anesthetists 3) Nurse practitioner: clinical nurse specialist (e.g., operation, colostomy, dialysis, cancer, infection, etc.), emergency nurse practitioner, public health nurse practitioner (e.g., school health, occupational health, etc.), home health care nurse practitioner, psychiatric nurse practitioner, geriatric nurse practitioner, nurse administration practitioner, health promotion practitioner, family nurse practitioner, hospice nurse practitioner, women' s health nurse practitioner, pediatric nurse practitioner. The national board of nurses should develop the legal background for the specialization areas of nurse practitioners to reflect the changes of social environment.
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Right-Left Propensity and Lesion Patterns Between Cardiogenic and Aortogenic Cerebral Embolisms
Kim, Hye-Jin,Song, Jong-Min,Kwon, Sun U.,Kim, Bum-Joon,Kang, Duk-Hyun,Song, Jae-Kwan,Kim, Jong S.,Kang, Dong-Wha Ovid Technologies Wolters Kluwer -American Heart A 2011 Stroke Vol.42 No.8
<P>Based on thrombus location and nature and anatomic features of aorta and cerebral arteries, we hypothesized that cardiogenic embolisms (CE) and aortogenic embolisms (AE) might have different right-left propensity and lesion patterns.</P>
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Kang, Hyun Goo,Kim, Bum Joon,Lee, Sang Hun,Kang, Dong-Wha,Kwon, Sun U.,Kim, Jong S. S KARGER AG 2018 Cerebrovascular Diseases Vol.45 No.3
<P><B><I>Background:</I></B> Lateral medullary infarction (LMI) is not an uncommon disease. Although lesions are usually restricted to the lateral medullary area, some patients have additional infarcts in other parts of the brain. The clinical features and prognosis of isolated LMI (pure LMI, LMIpr) have been investigated. However, it remains unclear whether clinical characteristics, prognosis and factors associated with prognosis differ between patients with LMIpr and those with additional lesions (LMI plus, LMIpl). <B><I>Methods:</I></B> Patients with LMI identified by MRI were enrolled. The demographic and clinical characteristics, in-hospital outcome (intensive care unit [ICU] admission, pneumonia and modified Rankin scale [mRS] at discharge), and long-term residual symptoms (vertigo/dizziness, sensory disturbances, dysphagia) and outcomes (occurrence of stroke, acute coronary syndrome [ACS], death, and mRS at follow-up) were compared between LMIpr and LMIpl patients. Factors associated with poor functional outcome (mRS 2–6) at the follow-up were analyzed. <B><I>Results:</I></B> Among 248 LMI patients, 161 (64.9%) had LMIpr and 87 (35.1%) had LMIpl. During admission, patients with LMIpl more frequently experienced ICU care, pneumonia and had a higher discharge mRS (3 vs. 2; <I>p</I> < 0.001) than LMIpr patients. The occurrence of stroke, ACS, frequency of death and functional outcome was not different during follow-up. However, residual neurologic symptoms such as dizziness (<I>p</I> = 0.002), dysphagia (<I>p</I> = 0.04) and sensory symptoms (<I>p</I> < 0.001) were more frequent in LMIpr than in LMIpl patients. In LMIpr patients, the rostral location of LMI was associated with poor functional outcome (<I>p</I> = 0.041), whereas in LMIpl patients, the presence of medial posterior-inferior cerebellar artery lesion was associated with good functional outcome (<I>p</I> = 0.030). <B><I>Conclusion:</I></B> Although the short-term outcome is poorer in LMIpl than LMIpr patients, long-term residual symptoms are more common in LMIpr patients. The location of the LMI and extra-medullary lesion affects the long-term functional outcome of LMIpr and LMIpl patients respectively.</P>
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