초등 사회과 개념 학습의 이해 : 생산 개념에 대한 5학년 학생들의 이해를 중심으로 한 사례 연구

학위논문(석사)--서울대학교 대학원 :사회교육과 일반사회전공,1997.Maste

(A)Hermeneutical case study of teaching dilemmas : centered on elementary social studies

학위논문(박사)--서울대학교 대학원 :사회교육과 일반사회전공,2003.Docto

Analysis and design of clinical decision support system for the peripheral neuropathy

의학과/석사[한글]말초신경병질환은 우리 몸에 수많은 말초신경이 존재해 있는 만큼 다양한 증상을 일으킬 수 있고 그 원인도 매우 다양하다. 따라서 말초신경병 환자의 진단을 위해서는 쳬계적인 검사와 진단이 수행되어져서 불필요한 시간과 자원의 낭비를 막는 것이 필요하다. 이러한 체계적인 접근을 위해서 여러 임상지침이 제시되고 있지만, 임상지침도 역시 체계가 복잡하여 이를 기억하거나 적용하기 어렵다..이 과정에서 임상결정지원시스템은 진단 각 과정에서 필요한 정보가무엇인지 알려주고(remind) , 그 정보들을 효율적으로 조직. 관리하여(reasoning) 환자의 진단결과를 제시해 줄 수 있다. 따라서 본 연구에서는 말초신경병증 진단과정에서 도움을 줄 수 있는 임상결정지원시스템(CDSS)을 개발하고 그 결과를 분석하였다. 말초신경병증 임상지침을 바탕으로 패턴분석을 통해 규칙생성, 규칙들간의 관계 분석, 변수종류 및 형태를 파악하고 이 결과를 Asbru 언어를 통해 규칙기반시스템(rule based system)으로 구현하였다. 시스템의 유효성 검사는 대도시 3차병원 전형적인 말초신경병증 증상을 보인 58명의 환자 데이터로서 시행하였다. 단발성 말초신경병증( mononeuropathy)은 민감도가 77%, 다발국소성말초신경병증(multiple mononerupathy)은 민감도가 58%, 다발성말초신경병증(Polyneuropathy) 은 민감도가 100%로 진단되었다. 한편 말초신경병증진단에 중요하게 작용하는 근전도검사나 신경전도검사가 관여하는 다발국소성말초신경병증이나 다발성말초신경병증내에서 개별질환분류에서는 민감도가 낮게 나타나므로 향후 이 근전도검사나 신경전도검사 정보를 포함한 시스템 설계 및 분석이 이루어져야 하겠다. [영문]The peripheral neuropathy brings out variable symptoms, and has many causesas many as there are a lot of peripheral nerve in our body. Therefore, in order to diagnosis the patients of suspected peripheral neuropathy, we need to reduce the unnecessary time and resources wasting with the systemic examinations and diagnosis. Although there are the suggested clinical guidelines for this systemic approach, they have complex system so that they are difficult to be remembered, and hard to be applied to the actual clinical situations. In this process, clinical decision support system (CDSS) can remind what the necessary information is at each of diagnosis procedure, and also present the diagnosis results of patients with organizing and managing (reasoning) of this information efficiently. Therefore, in this study, we designed the clinical decision support system (CDSS) which is useful for the diagnosis of the peripheral neuropathy, and analyzed the results. According to the pattern analysis based on the clinical guideline of peripheral neuropathy we achievedgenerating the rules, analyzing the relation among them, and understanding the variable types and forms. Through this experiment, we implemented the rule based system using by Asbru language. The validity test was performed by 58 suspected patients of peripheral neuropathy. From the test results, the sensitivity of mononeuropathy, multiple mononeuropathy and polyneuropathy is 77%, 58%, and 100% respectively. Meanwhile, there were low sensitivity of the multiple mononeuropathy or individual disease in polyneuropathy related to the electromyogram (EMG) or nerve conduction study(NCV), which are considered as the important exam for diagnosis of the peripheral neuropathy. Therefore, for the futurestudy, we need to analysis and design of system including the results of electromyogram (EMG) or nerve conduction study (NCV).ope

Comparative occurrence of ischemic stroke with the rhythm versus rate control strategy in a national prospective cohort of atrial fibrillation

Background/aims: Comparative occurrence of ischemic stroke for rhythm versus rate control strategy in patients with non-valvular atrial fibrillation (NVAF) is still inconclusive. The purpose of this study was to investigate whether the rhythm control strategy is associated with a lower risk of ischemic stroke compared to the rate control strategy in NVAF patients. Methods: The CODE-AF registry prospectively enrolled 6,280 consecutive patients who were treated for NVAF at 10 tertiary referral centers in South Korea. Of these, 2,513 NVAF patients (age, 67 ± 10 years; male, 61.8%) were clinically followed up for over 1-year and divided into rate and rhythm control groups. Results: Those treated with the rhythm control strategy were younger and had less proportions of underlying disease compared to those treated with the rate control strategy. After the propensity matching analysis, those treated with the rhythm control strategy had similar baseline characteristics including the CHA2DS2-VASC score compared to those treated with the rate control strategy. The rate of oral anticoagulation, all bleeding, and hospitalization were also similarly between the two groups. The incidence rate of ischemic stroke in the rhythm control group was significantly lower than in the rate control group (0.7 vs. 6.9 per 1,000 person-years, p = 0.011). Conclusion: The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy. Korean J Intern Med. 2021 Jan;36(1):114-123

Europace. 2021 Apr 6;23(4):548-556.

Aims: The aim of this study is to determine the relationship between alcohol consumption and atrial fibrillation (AF)-related adverse events in the AF population. Methods and results: A total of 9411 patients with nonvalvular AF in a prospective observational registry were categorized into four groups according to the amount of alcohol consumption-abstainer-rare, light (<100 g/week), moderate (100-200 g/week), and heavy (≥200 g/week). Data on adverse events (ischaemic stroke, transient ischaemic attack, systemic embolic event, or AF hospitalization including for AF rate or rhythm control and heart failure management) were collected for 17.4 ± 7.3 months. A Cox proportional hazard models was performed to calculate hazard ratios (HRs), and propensity score matching was conducted to validate the results. The heavy alcohol consumption group showed an increased risk of composite adverse outcomes [adjusted hazard ratio (aHR) 1.32, 95% confidence interval (CI) 1.06-1.66] compared with the reference group (abstainer-rare group). However, no significant increased risk for adverse outcomes was observed in the light (aHR 0.88, 95% CI 0.68-1.13) and moderate (aHR 0.91, 95% CI 0.63-1.33) groups. In subgroup analyses, adverse effect of heavy alcohol consumption was significant, especially among patients with low CHA2DS2-VASc score, without hypertension, and in whom β-blocker were not prescribed. Conclusion: Our findings suggest that heavy alcohol consumption increases the risk of adverse events in patients with AF, whereas light or moderate alcohol consumption does not. Keywords: Alcohol consumption; Atrial fibrillation; Heavy drinking; Hospitalization; Registry; Stroke

Clinical impact of left atrial enlargement in Korean patients with atrial fibrillation

We sought to evaluate the clinical implication of LAE based on left atrial anterior-posterior (LA AP) dimension or LA volume index (LAVI) in Korean patients with atrial fibrillation (AF). We enrolled 8159 AF patients from the CODE-AF registry. The primary outcome was rate of stroke or systemic embolism (SSE). The prevalence of mild, moderate, and severe LAE by LA AP dimension was 30.6%, 18.5%, and 21.4%, and by LAVI (available in 5808 patients) was 15.7%, 12.5% and 37.8%, respectively. Compared with no or mild LAE, patients with significant LAE (moderate to severe LAE, n = 3258, 39.9%) were associated with a higher rate of SSE (2.5% vs. 1.4%, P = 0.001). Multivariable analysis suggested presence of significant LAE by LA AP dimension was associated with a higher risk of SSE in the overall population (HR 1.57, 95% CI: 1.14-2.17, P = 0.005) and in patients using anticoagulants (n = 5836, HR 1.79, 95% CI: 1.23-2.63, P = 0.002). Patients with significant LAE by LAVI were also at higher risk of SSE (HR 1.58, 95% CI: 1.09-2.29, P = 0.017). In conclusion, significant LAE by LA dimension or LAVI was present in 39.9% and 50.2% of AF patients, respectively, and was associated with a higher rate of SSE