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Introduction: 응급실의 혼잡 및 과밀화는 대도시 대형병원 응급실의 가장 우선적 시정 과제이다. 여러 노력들로 혼잡 및 과밀화가 약간씩의 호전을 보인 경우도 있으나, 전반적으로 해결을 한 경우는 없었다. 메르스 환자 집단 발생을 경험한, 1개 지역응급의료센터에서 응급 환자 진료 및 병원 전체 입원 등의 방침을 수정하여 효율적인 응급실 과밀화 해소를 경험하여 그 내용을 보고 하고자 한다. Material & Methods: 연평균 7만여명의 환자를 보는 1개 지역응급의료센터에서 입원환자의 우선 순위 개선, 각 진료과의 환자 진료 시간 조정(30분내 대면진료, 2시간 내 입/퇴원 결정, 6시간 내 실제 입/퇴원 실시), 외래 환자 응급실 이용 제한 등의 진료규정을 개정하였다. 진료 개정 이후 기간의 일평균 환자수, 입원환자 응급실 체류시간, 귀가환자 응급실 체류시간, 전체 환자 응급실 체류 시간을 1년전 동기간 및 진료 개정 이전 3개월 동안의 수치와 비교를 하였다. Conclusion: 비교적 짧은 기간(46일) 동안의 결과이기는 하지만, 병원 전체 정책을 수정함으로 만성적으로 지속되던 응급실 혼잡 및 과밀화 현상을 응급실 환자 체류시간의 단축을 통해 해결할 수 있었다.
Purpose: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group. Results: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080). Conclusion: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients
The 89K Y-Ba-Cu-O thin films were prepared by CVD method on SrTio₃(100) substrates at 890℃ using β-diketonate chelate compouds as the precursors of Y,Ba, and Cu elements. The superconducting samples were sputtered by 1keV Ar^+ ion for 10min in 10^-10 Torr. The sputtered film showed no significant change in transition temperature (T_c). Teh property changes such as T_c, microstructure, and intrinsic XPS spectra induced by 1keV Ar^+ ion sputtering were investigated by use of Ac-four prove technique, X-ray diffraction method(XRD), scanning electron microscopy(SEM), and X-ray phothoelectron spectroscopy(XPS), etc. The spectral changes before and after sputtering Y-Ba-Cu-O films were analyzed for the XPS core spectra of Ba 3d_5/2, Cu 2p_3/2 and O ls, XPS measurements were performed with ESCA/Auger system(VSW) under UHV conditions below 1×10^-9 Torr using an Al-Kα source(1486.6eV)and a 150mm hemispherical electron analyzer. The experimental results showed that Ar^+ sputtering caused no significant change in transition temperature (T_c) ; gave rise to an oxygen depletion in the surface region and also a partial destruction of the superconducting environment of the thin films.
Purpose: There have been some studies on the hazardous effects of air pollution for patients with cardiovascular diseases. This study was designed to evaluate the possible relationship between air pollution and development of chest pain in acute coronary syndrome patients. Methods: The medical records of 109 acute coronary syndrome patients, who visited two university hospital emergency rooms in the Seoul area between January 1999 and July 2001, were reviewed. Hourly concentrations of particulate mass< 10 μm and of four gaseous air pollutants were measured at 19 different points in the Seoul area. The data were analyzed using a case-crossover approach. Results: The analysis of the data showed no definite relationship between chest pain development and either the concentrations of particulate mass<10 μm(PM_10) or of four gaseous air pollutants; namely, carbon monoxide (CO), nitrogen dioxide(NO₂), ozone (O₃), and sulfur dioxide (SO₂). However, increases in the concentrations of particulate matter, gaseous NO₂and gaseous O₃showed a positive correlation, but without statistical significance. Conclusion: This study shows no relationship between the concentrations of PM10 and other air pollutants with the development of chest pain in acute coronary syndrome patients. However, for particulate mass<2.5μm, which is currently not measured in the Seoul area, the possibility of a relationship between development of chest pain in acute coronary syndrome patients and particulate air pollutants still exists.
The Y-Ba-Cu-O thin films were prepared by chemical vapor deposition(CVD) method on SrTio_3(100) substrates at 650℃ without postannealing using β-diketonate chelate compounds as source materials. Tc and microstructure were investigated by use of Ac-four prove technique, X-ray diffraction method(XRD), and scanning electron microscopy(SEM). Also XPS measurements were performed in the normal and superconducting state with ESCA/Auger system(VSW) under UHV conditions below 1x10 exp (-10) Torr using an A1-Kα source(1486.6eV). The spectral changes below 40K were analyzed for the valence band and XPS core spectra of Ba 3d_5/_2. The experimental results showed that when the YBa_2Cu_3O_(7-X) thin film was cooled to 40K remarkable changes were found in the valence band as well as the core level spectra. This suggests that XPS study of High-Tc superconducting materials should be performed at liquid nitrogen or liquid helium temperature.