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급변하는 오늘날의 현대 사회는 유아들에게 지금까지 강조되었던 지능 및 인지적인 학업 성취 능력뿐만 아니라 더 나아가 창의적 표현력, 비판적 사고, 탐구적 문제 해결 능력 등을 가진 인간으로 성장하기를 원하고 있다. 이러한 사회적 요구에 부응하여 교육계도 변하고 있으며 음악교육의 필요성과 함께 유아음악의 중요성이 강조되고 있다. 유아음악교육은 크게 음악감상하기, 노래 부르기, 악기 다루기, 동작으로 표현하기 등의 음악 활동으로 구분되어 진다. 이러한 음악 활동들은 분리되어 다루어지기도 하지만 최근에는 여러 영역 간의 통합교육 형태를 보이고 있는 것이 특징이다. 통합 교육 과정이란 영역 간이나 교과목 간의 구별이 되지 않는 단일화된 교육 과정으로, 전통적인 교과나 영역의 경계를 넘어서서 주제를 중심으로 필요한 영역들이 연합되는 것이다. 즉, 이는 통합적인 경험을 통해 한 가지 주제나 개념을 다양하고 유용하게 교육시키는 접근 방법을 모색하고 있다. 이러한 통합적 접근법을 유아음악교육에 접목 시킨 예로 `음악극`이 있다. 음악극은 유아가 좋아하는 요소들인 음악, 이야기, 무용, 시각예술, 상상적 요소 등이 포함된 교육활동으로 음악적, 극적, 미술적 경험뿐만 아니라 창의적, 정서적인 경험을 제공하기도 하며 유아의 삶을 직, 간접적으로 표현하기도 한다. 통합적 음악활동으로서의 음악극에 대한 연구와 함께 음악 극의 교육적 효과가 입증되고 있어 그 중요성이 날로 높아지고 있으나 아직까지 이에 대한 연구는 미약한 편이다. 이에 본 연구는 통합적 음악활동으로서의 음악극의 특성과 교육적 가치에 주목하여 유아들이 음악극을 교과 과정 속에서 체계적으로 경험할 수 있도록 하기 위한 지도방안을 연구하고자 한다. Recently, the importance of music education for young children has been increasingly emphasized. In line with educational trend that aimed at comprehensive and holistic education, music education for young children also seeks for holistic development of young children through comprehensive music education that integrates separated music areas. Comprehensive music education enhances the quality of learning by integrating not only music curriculums but also other subject areas. Comprehensive music activity escapes from passive and non-creative music education that focuses on the acquirement of musical techniques and tries to make children freely express their thought and feelings through music. In this study, music drama was presented as an effective alternative of music education for young children. According to previous research, music drama generates a variety of positive effects such as improvement in musical ability, improvement in language ability, the establishment of self-concept, and the facilitation of growth development. In the study, the importance of music for young children and the values of music drama were explored through theoretical background. Then, a method of teaching comprehensive music drama was produced from teaching methods in separate music areas. With the observation that music drama is a form of dramatic play, the study developed music drama into mine stages on the basis of Shaftel`s eight-stage process for dramatic play. Based on this, the study aimed at presenting a method of teaching music drama that integrates not only separate music areas but also other subject areas. In the fourth unit, `music drama class in practice`, Kongjwi and Patjwi, a popular Korean fairy tale, was written in scenario for music drama and music drama class was planned. A teaching method that integrated music and other subject areas, with a focus on the tale`s main theme that good is rewarded and evil is punished, ability to resolve difficult problems, and personality to help people in need, was presented. In order to prove the suitability of the method of teaching music drama, nine sessions of class involving 20 young children (10 girls, 10 boys) aged 5 were actually conducted. As a result, works produced by children and their changed behaviors indicated that children successfully learned the fairly tale`s theme and lesson as had been planned. In addition, as seen in terms of the improvement in music ability and theoretical background, the class proved various educational values of music drama. Music drama that enables comprehensive learning can achieve various objectives of education. Teachers of young children need to notice the accomplishments of comprehensive music education by music drama and plan music drama class that attempts to integrate various areas. Furthermore, they should make efforts to develop teaching methods to conduct various and interesting music dramas at actual classes.
Objective : To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods : From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). Results : Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Conclusion : PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.
The purpose of ventilation during CPR is to maintain adequate oxygenation and sufficient elimination of carbon dioxide. Rescue breaths are less important than chest compressions during the first few minutes of resuscitation from witnessed VF cardiac arrest and could reduce CPR efficacy due to interruption in chest compressions and the increase in intrathoracic pressure that accompanies positive pressure ventilation. Advanced airway placement in cardiac arrest should not delay initial CPR and defibrillation for VF cardiac arrest. The routine use of cricoid pressure in cardiac arrest is not recommended. Oropharyngeal airways and nasopharyngeal airways may aid in the delivery of adequate ventilation with a bag-mask device by preventing the tongue from occluding the airway. The provider should deliver approximately 600 mL of tidal volume sufficient to produce chest rise over 1 second. Providers must be aware of the risks and benefits of insertion of an advanced airway during a resuscitation attempt. If advanced airway placement will interrupt chest compressions, providers may consider deferring insertion of the airway until the patient fails to respond to initial CPR and defibrillation attempts or demonstrates ROSC. The endotracheal tube was once considered the optimal method of managing the airway during cardiac arrest. However, intubation attempts by unskilled providers can produce complications, such as trauma to the oropharynx, interruption of compressions and ventilations for unacceptably long periods, and hypoxemia from prolonged intubation attempts or failure to recognize tube misplacement or displacement. Frequent experience or frequent retraining is recommended for providers who perform endotracheal intubation. Intubation with a supraglottic airway does not require visualization of the glottis and can be done successfully without interrupting chest compressions. During CPR, the supraglottic airway is a reasonable alternative to bag-mask ventilation and endotracheal intubation. Once an advanced airway is inserted, providers should confirm and fix the tube. And the 2 providers should no longer deliver cycles of CPR. The compressing provider should give continuous chest compressions at a rate of at least 100 per minute, without pauses for ventilation. The provider delivering ventilation should provide 1 breath every 6 to 8 seconds (8 to 10 breaths per minute). Providers should avoid delivering an excessive ventilation rate because doing so can compromise venous return and cardiac output during CPR. Although 100% oxygen may have been used during initial resuscitation, providers should titrate inspired oxygen to the lowest level required to achieve an arterial oxygen saturation of ≥94%, so as to avoid potential oxygen toxicity. It is also important to maintain normocapnia to achieve a PETCO2 of 35 to 40 mm Hg or a PaCO2 of 40 to 45 mm Hg.
Objective : This study was designed to analyze surgical strategies for patients with intractable supplementary sensorimotor area[SSMA] seizures. Methods : Seventeen patients who had surgical treatment were reviewed retrospectively. Preoperatively, phase I [non-invasive] and phase II [invasive] evaluation methods for epilepsy surgery were done. Seizure outcome was assessed with Engel's classification. The mean follow-up period was 27.2 months [from 12 months to 54 months]. Results : An MRI identified structural abnormality in eight patients and 3D-surface rendering revealed abnormal gyration in three. PET, SPECT, and surface EEG could not delineate the epileptogenic zone. Video-EEG monitoring with a subdural grid or depth electrodes verified the epileptogenic zone in all patients. Surgical procedures consisted of a resection of the SSMA and simultaneous callosotomy in two patients, a resection of the SSMA extending to the adjacent area in seven, a resection of a different area without a SSMA resection in seven, and a callosotomy in one. Seizure outcomes were class I in 11 [65%]. class II in five [29%], class III in one [6%]. Conclusion : In patients with intractable SSMA seizure, surgery was an excellent treatment modality. Precise delineation of the epileptogenic zone based on multimodal diagnostic methods can provide good surgical outcomes without neurological complications.
Purpose: The purpose of this study is an investigation of the changes in static balance and gait parameters after treadmill walking with using a smartphone in various head positions. Methods: The subjects of this study were 20 healthy college students (7 male, 13 female). Subject walked in treadmill at the speed of 2km/h for 3 minutes without using smartphone and with both hands using smartphone in straight ahead and down head. During the task, static balance and gait parameters were collected. A one-way repeated analysis of variance with the level of a significant level of .05 was used. And Bonferroni correction (α=.05/3=.0017) executed to evaluate the significance of between-exercise pairwise comparisons. Results: Our result presented that center of gravity way velocity sway velocity and total sway distance with the eyes closed on the unstable sponge surface, ware significantly greater in walking without using a smartphone condition than head straight ahead. There were no significant differences in gait parameter. Conclusion: Walking with straight ahead would enhance the equilibrium information and cause a positive effect on static balance only
Objective : Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. Methods : We compared the volumetric analysis with Wada test, and studied the clinical potential of volumetric analysis to assess language laterality in large surgical candidates with temporal lobe epilepsy (TLE). To examine the efficacy of volumetric analysis to determine language lateralization during presurgical evaluation, we compared the volumetric analysis of the bilateral planum temporale with the results of Wada test in 59 patients with chronic intractable TLE (rTLE, n=32; lTLE, n=27) who underwent epilepsy surgery. We measured the gray matter volumes of planum temporale (PT) of each patients using the VoxelPlus2 program (Mevisys, Daejeon, Korea). Results : Overall congruence of the volumetric analysis with the Wada test was 97.75% in rTLE patients and 81.5% in lTLE patients. There were more significant leftward asymmetry of the PT in rTLE patients than lTLE patients. In lTLE patients, relatively high proportion (37%) of the patients showed bilateral or right hemispheric language dominance. Conclusion : These results provide evidence that the volumetric analysis of the PT could be used as an alternatives in language lateralization. Also, the results of the Wada test suggested that there was considerable plasticity of language representation in the brains of patients with intractable TLE and it was associated with an earlier age of brain injury.
A 55-year-old female patient presented with lower back pain and neurogenic intermittent claudication and underwent L3-L4 posterolateral fusion. To prepare the bone fusion bed, the transverse process of L3 and L4 was decorticated with a drill. On the 9th post-operative day, the patient complained of a sudden onset of severe abdominal pain and distension. Abdominal computed tomography revealed retroperitoneal hematoma in the right psoas muscle and iatrogenic right L3 transverse process fracture. Lumbar spinal angiography showed the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm and coil embolization was done at the ruptured lumbar artery pseudoaneusyrm. Since then, the patient's postoperative progress proceeded normally with recovery of the hemodynamic parameters.
Background Maximum standardized uptake value (SUVmax) and maximum tumor diameter (MTD) have been shown to reflect survival outcome in diffuse large B cell lymphoma (DLBCL). However, applying these values to primary extranodal DLBCL is difficult because they are separate nosological entities with differences in genetic origin. We therefore decided to evaluate whether SUVmax and MTD on 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18-FDG) positron emission tomography (PET) would affect the survival outcome in primary extranodal DLBCL. Methods From October 2005 to November 2010, 76 primary extranodal DLBCL patients receiving R-CHOP therapy were analyzed. All patients had undergone an initial 18-FDG PET/CT and conventional computed tomography (CT) of the neck, chest, abdomen, and pelvis for staging. Median follow-up period was 35 months. Results The SUVmax and MTD cut-off values were 11.0 and 7.5 cm, respectively. SUVmax≥11.0 predicted a short progression free survival (PFS, P=0.002) and overall survival (OS, P=0.002). MTD≥7.5 cm was associated with poor PFS (P=0.003) and OS (P=0.003). High International Prognostic Index (IPI) was also associated with the survival outcome (PFS, P=0.046; OS, P=0.030). Multivariate analysis revealed that SUVmax≥11.0 (PFS, hazard ratio [HR]=10.813, P=0.024; OS, HR=6.312, P=0.015); MTD≥7.5 cm (PFS, HR=5.631, P=0.008; OS, HR=4.072, P=0.008); and high IPI (PFS, P=0.027; OS, P=0.046) were independent prognostic factors. Conclusion It appears that both MTD and SUVmax can be independent prognostic factors in primary extranodal DLBCL.
Primary atypical teratoid/rhabdoid tumor[AT/RT] of the central nervous system is a recently described, highly malignant neoplasm that usually occur in the posterior fossa of children. Although AT/RT usually occurs in young children, AT/RT is being recognized in adults with increasing frequency. The authors report 49-year-old man with multiple AT/RT lesions [right lateral ventricle, right temporal lobe and right cerebellum]. Histopathologic findings showed typical rhabdoid cells with eccentric nuclei and prominent nucleoli. Eventhough the tumor was removed, a patient was dead in one month after surgery due to recurrence and rapid regrowth of the tumor.