Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial

When hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick's equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r = - 0.06, P = 0.677; the second changes, r = - 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed - expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [- 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery.ope

The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study

Background: Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients. Methods: Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale. Results: A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm2 to 6.01 ± 2.21 cm2 , which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively). Conclusions: In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences.ope

Associations of creatinine/cystatin C ratio and postoperative pulmonary complications in elderly patients undergoing off-pump coronary artery bypass surgery: a retrospective study

Sarcopenia along with nutritional status are associated with postoperative pulmonary complications in various surgical fields. Recently, the creatinine/cystatin C ratio and CONtrolling NUTritional status score were introduced as biochemical indicators for sarcopenia and malnutrition, respectively. We aimed to investigate the associations among these indicators and postoperative pulmonary complications in elderly patients undergoing off-pump coronary artery bypass surgery. We reviewed the medical records of 605 elderly patients (aged ≥ 65 years) who underwent off-pump coronary artery bypass surgery from January 2010 to December 2019. Postoperative pulmonary complications (pneumonia, prolonged ventilation [> 24 h], and reintubation during post-surgical hospitalisation) occurred in 80 patients. A 10-unit increase of creatinine/cystatin C ratio was associated with a reduced risk of postoperative pulmonary complications (odds ratio: 0.80, 95% confidence interval: 0.69-0.92, P = 0.001); the optimal cut-off values for predicting postoperative pulmonary complications was 89.5. Multivariable logistic regression analysis revealed that age, congestive heart failure, and creatinine/cystatin C ratio < 89.5 (odds ratio 2.36, 95% confidence interval 1.28-4.37) were independently associated with the occurrence of postoperative pulmonary complications, whereas CONtrolling NUTritional status score was not. A low creatinine/cystatin C ratio was associated with an increased risk of developing postoperative pulmonary complications after off-pump coronary artery bypass surgery.ope

Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study

We investigated the role of echocardiographic indices consisting of left ventricular end-diastolic area (LVEDA) in combination with Doppler-derived surrogates of diastolic compliance and filling (E/E', E'/S', E'/A'; early transmitral flow velocity (E), tissue Doppler-derived early (E') diastolic, late (A') diastolic, or peak systolic (S') velocity of the mitral annulus) in predicting fluid responsiveness in off-pump coronary surgery. Hemodynamic and echocardiographic variables were prospectively assessed under general anesthesia before and after a fluid challenge of 6 mL/kg during apnea at atmospheric pressure in 64 patients with LV ejection fraction ≥40%. Forty patients (63%) were fluid responders (≥15% increase in stroke volume index). E/E' and E'/S' could predict fluid responsiveness with area under the receiver operating characteristic curve (AUROC) of 0.71 (95% confidence interval [CI], 0.56-0.85; p = 0.006) and 0.68 (95% CI, 0.54-0.82; p = 0.017), respectively. The combination of LVEDA and E/E' showed incremental predictive ability for fluid responsiveness compared with LVEDA (AUROC, 0.60; p = 0.170) or pulse pressure variation (AUROC, 0.70; p = 0.002), yielding the highest AUROC of 0.78 (95% CI, 0.66-0.90; p < 0.001). The combined index of echocardiographic variables reflecting LV dimension (LVEDA) and diastolic compliance and filling (E/E') is a potentially useful predictor of fluid responsiveness.ope

High Preoperative Serum Syndecan-1, a Marker of Endothelial Glycocalyx Degradation, and Severe Acute Kidney Injury after Valvular Heart Surgery

Degradation of endothelial glycocalyx (EG) is associated with inflammation and endothelial dysfunction, which may contribute to the development of acute kidney injury (AKI). We investigated the association between a marker of EG degradation and AKI after valvular heart surgery. Serum syndecan-1 concentrations were measured at induction of anesthesia and discontinuation of cardiopulmonary bypass in 250 patients. Severe AKI was defined as Kidney Disease: Improving Global Outcomes Criteria Stage 2 or 3. Severe AKI occurred in 13 patients (5%). Receiver operating characteristic analysis of preoperative syndecan-1 to predict severe AKI showed area under curve of 0.714 (95% confidence interval (CI), 0.575-0.853; p = 0.009). The optimal cut-off value was 90 ng/mL, with a sensitivity of 61.5% and specificity of 78.5%. In multivariable analysis, both preoperative syndecan-1 ≥ 90 ng/mL and Cleveland Clinic Foundation score independently predicted severe AKI. Severe tricuspid regurgitation was more frequent (42.4% vs. 17.8%, p < 0.001), and baseline right ventricular systolic pressure (41 (33-51) mmHg vs. 33 (27-43) mmHg, p = 0.001) and TNF-α (1.85 (1.37-2.43) pg/mL vs. 1.45 (1.14-1.92) pg/mL, p <0.001) were higher in patients with high preoperative syndecan-1. Patients with high preoperative syndecan-1 had longer hospital stay (16 (12-24) days vs. 13 (11-17) days, p = 0.001). In conclusion, a high preoperative syndecan-1 concentration greater than 90 ng/mL was able to predict severe AKI after valvular heart surgery and was associated with prolonged hospitalization.ope

Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation

Background: Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of -2 to -3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation. Methods: We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled. Results: In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr). Conclusions: We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.ope

Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study

Background: Lung transplantation (LT) is an accepted therapeutic modality for end-stage lung disease patients. Intensive care unit (ICU) readmission is a risk factor for mortality after LT, for which consistent risk factors have not been elucidated. Thus, we investigated the risk factors for ICU readmission during index hospitalization after LT, particularly regarding the posttransplant condition of LT patients. Methods: In this retrospective study, we investigated all adult patients undergoing LT between October 2012 and August 2017 at our institution. We collected perioperative data from electronic medical records such as demographics, comorbidities, laboratory findings, ICU readmission, and in-hospital mortality. Results: We analyzed data for 130 patients. Thirty-two patients (24.6%) were readmitted to the ICU 47 times during index hospitalization. At the initial ICU discharge, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR], 1.464; 95% confidence interval [CI], 1.083-1.978; P=0.013) and pH (OR, 0.884; 95% CI, 0.813-0.962; P=0.004; when the pH value increases by 0.01) were related to ICU readmission using multivariable regression analysis and were still significant after adjusting for confounding factors. Thirteen patients (10%) died during the hospitalization period, and the number of ICU readmissions was a significant risk factor for in-hospital mortality. The most common causes of ICU readmission and in-hospital mortality were infection-related. Conclusions: The SOFA score and pH were associated with increased risk of ICU readmission. Early postoperative management of these factors and thorough posttransplantation infection control can reduce ICU readmission and improve the prognosis of LT patients.ope

Equal Ratio Ventilation Reduces Blood Loss During Posterior Lumbar Interbody Fusion Surgery

Study design: A prospective randomized double-blinded study. Objective: The aim of this study was to compare the effect of two different ventilator modes (inspiratory to expiratory ratio [I:E ratio] of 1:1 and 1:2) on intraoperative surgical bleeding in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. Summary of background data: During PLIF surgery, a considerable amount of blood loss is anticipated. In the prone position, engorgement of the vertebral vein increases surgical bleeding. We hypothesized that equal ratio ventilation (ERV) with I:E ratio of 1:1 would lower peak inspiratory pressure (PIP) in the prone position and consequentially decrease surgical bleeding. Methods: Twenty-eight patients were randomly assigned to receive either ERV (ERV group, n = 14) or conventional ventilation with I:E ratio of 1:2 (control group, n = 14). Hemodynamic and respiratory parameters were measured at 5 minutes after anesthesia induction, at 5 minutes after the prone position, at the time of skin closure, and at 5 minutes after turning to the supine position. Results: The amount of intraoperative surgical bleeding in the ERV group was significantly less than that in the control group (975.7 ± 349.9 mL vs. 1757.1 ± 1172.7 mL, P = 0.030). Among other hemodynamic and respiratory parameters, PIP and plateau inspiratory pressure (Pplat) were significantly lower and dynamic lung compliance (Cdyn) was significantly higher in the ERV group than those of the control group throughout the study period, respectively (all P < 0.05). Conclusion: Compared to conventional ratio ventilation, ERV provided lower PIP and reduced intraoperative surgical blood loss in patients undergoing PLIF surgery.Level of Evidence: 2.ope

Analysis of High School Art Textbooks according to the Perspective of Gender Equality Education : Focusing on the 2015 Revised Art Textbook

급변하는 사회에서 다양한 변화에 적응하기 위해서는 고정적인 틀에 매여서 살아가는 편협한 사고보다 상황에 따라 유연하게 반응할 수 있고 효과적으로 대처할 수 있는 역량을 지닌 학생의 육성이 필요하다. 그러나 이전의 가부장적인 사회로부터 이어진 전통적인 성 역할의 구별과 고정관념은 한 개인에게 나타날 수 있는 다양한 인간상에 대한 가능성을 발휘하지 못하게 만들었으며 각자의 성별 울타리에 갇혀 편협한 사고 속에서 행동하게 만들었다. 현대 사회로 변화함에 따라 여성의 지위와 역할도 발전하며 사회적인 성역할의 큰 변화를 겪고 있지만 여전히 우리 사회 곳곳에 잔존하는 남성 중심의 모습은 다시금 남성 중심적 관점과 제도에 익숙해지도록 한다. 따라서 우리 사회의 지배 담론인 이원화된 정체성이 아니라 자유롭게 인간적인 가치를 추구하는 삶의 방식을 모색할 수 있고, 젠더 간의 대립 갈등을 풀어 갈 수 있는 양성평등교육이 실현될 수 있도록 학교 교육의 지속적인 노력이 요구되는 바이다. 이에 본 연구에서는 시대, 문화, 언어의 장벽을 뛰어넘어 소통하고 비판적 사고력으로 시각문화를 해석할 수 있는 미술과목의 성격을 바탕으로 교과서 이미지에 나타나는 성 역할, 성 차별적 요소에 대한 분석을 하고 현대 사회를 살아가는데 학생들이 올바른 양성평등의식을 함양할 수 있도록 교육내용을 살펴봄으로서 시대적 요구에 부응할 수 있는 미술교육을 위한 토대가 되어 다양한 연구와 발전에 기여하는데 그 목적이 있다. 우선 교과서 분석에 앞서 양성평등교육에 대한 이론적 배경과 선행연구 조사를 통해 미술교육과의 연관성에 대해 고찰하고 미술 교과서의 주된 학습내용인 미술 교과서 시각자료의 기능 및 역할을 살펴보았다. 또한 데이비드 새드커와 마이라 새드커(1997)가 제시한 교수·학습 자료에 나타난 성 차별성에 대한 6가지 기준을 바탕으로 시각자료 분석에 적합한 성역할 고정관념, 희소성과 불균형, 비현실성 4가지를 추출하였으며 이를 활용하여 미술교과에서 활용할 수 있는 분석기준으로 등장인물의 성별 비율, 성별 직업 및 역할 분포, 남성과 여성의 이미지 묘사 3가지로 제시하였다. 등장인물의 성별 비율, 성별 직업 및 역할 분포는 세부기준에 따라 교과서의 수록된 이미지를 모두 계수하여 전체 인물 표현 중 남성과 여성이 각각 어느 정도 분포하는지와 남성과 여성의 성비를 계산하였고, 남성과 여성의 이미지 묘사에 대한 부분은 교과서에 수록된 교육내용과 시각자료의 사례를 발췌하여 결과를 도출하였다. 분석 대상은 2015 개정 고등학교 미술 교과서 전체에 해당하는 10권이며, 교과서 분석 결과는 다음과 같다. 첫째, 등장인물의 성별 비율은 교과서 별 편차가 있었다. 전체적으로 봤을 때 작가 작품 및 삽화의 도판 이미지 속 인물의 성별 비율은 비교적 성비가 균형적으로 맞추어 지고 있으나 10권의 교과서가 동등하지 못하고 출판사 별 차이가 있음을 알 수 있었다. 또한 학생 작품 속에 등장하는 인물의 성별 비율과 여성과 남성의 누드 표현 비율은 여성이 남성보다 많이 등장하고 있어 학생 작품과 누드 작품에서 남성 표현의 희소성과 불균형이 우려되었다. 둘째, 성별 직업 및 역할 분포에서는 여전히 성역할 고정관념이 드러났다. 사실 오늘날 현대 사회는 이전 보다 사회에서 여성이 차지하는 역할이 많이 커지고 있으며 여성과 남성의 역할도 대부분 분담되어있다. 그러나 교과서에서는 아직도 여성의 역할은 가사나 육아의 일로 소극적이고 종속적이며 전통적 역할을 담당하고 있고 남성은 공적이고 성취 지향적이며 적극적인 다양한 직업인으로 등장하고 있었다. 미술 교과서이기에 더욱 아쉬운 점을 문화·예술 분야에 있어서도 남성의 등장이 여성보다 많았으며 전통적으로 미술계가 남성 작가 중심이었기 때문이라 해도 근, 현대 작가 소개 역시 여성 작가의 출현이 상대적으로 적어 학생들이 은연중에 유명한 작가들은 남성이라고 느낄 수 있는 위험이 있었다. 셋째, 남성과 여성의 이미지 묘사는 현실과 동떨어져 아쉬운 부분이 있었다. 남성과 여성의 이미지 묘사를 파악하기 위해 가정, 사회, 학교라는 배경을 중심으로 살펴보았는데 가정과 사회에서는 앞서 성별 직업 및 역할 분포에서 알 수 있듯이 남성과 여성의 묘사가 전통적인 고정 관념으로 표현되어 있었고 세부 내용에 있어서도 여성은 남성보다 무희, 소비자, 요부, 팜므파탈 등 부정적인 이미지로 그려지고 있어 학생들이 교과서 속 여성이미지를 통해 무의식적으로 여성에 대한 편협한 사고를 형성할 수 있고, 그에 따른 설명이 교과내용에 충분하지 못하다면 여성에 대한 왜곡된 시선과 편견을 그대로 수용할 가능성이 있어보였다. 학교라는 공간은 남성과 여성의 균등하게 등장하며 인물들의 묘사도 비교적 현실성 있게 표현되었지만 가정과 사회에 비해 양이 적어 영향이 크게 미치지 못할 것으로 예상되었다. 결론적으로 양성평등교육 관점으로 고등학교 미술 교과서를 분석해 봤을 때 이전보다 2015 개정 교육과정에 따른 미술 교과서는 많은 개선점이 보였지만 세부적으로 성비의 불균형, 성역할 고정관념을 유발 할 수 있는 시각자료의 내용이나 구성에 있어서는 조금 더 세심한 보완이 필요했다. 마지막으로 2015 개정 고등학교 미술 교과서를 사용하고 있는 고등학교 현직 교사들을 대상으로 인터뷰를 실시하여 현장의 목소리를 담아 결론 및 제언으로 연구를 마무리 하였다. 이번 연구는 고등학교 미술 교과서의 전체 출판사를 대상으로 한다는데 큰 의의가 있었으며 본 연구에서 고찰한 내용을 바탕으로 우리 교육과정에서 놓치고 있는 성 역할 고정관념이나 성 차별성을 극복하고 학생들에게 올바른 양성평등의식을 심어줌으로서 세계화 시대의 따른 민주시민 육성을 위한 미술 교육의 다양한 연구와 발전에 기여하기를 바란다.;In order to adapt to our rapidly changing society, it is a necessary to cultivate students who have the capacity to respond flexibly and effectively to situations from their closed-minded attitude. Yet, the distinction and stereotypes of conventional gender roles within Korea’s society, which have been inherited from the former patriarchal society, have made individuals to be trapped and performed in their respective gender fences, which in turn has limited their exertion to various possibilities of human characteristics. Likewise, although our modern society has changed along with the improvement in women’s societal status and roles, current society still remains its androcentric values which it leads us to become familiar with its viewpoint and system again. Therefore, continuous efforts on school education to realize gender equality should be made since it could enable us to freely purse human values and resolve our confrontational conflicts among genders which has been deeply rooted in our society as the dominant discourse. In this context, this study aims to develop the foundation for art education, which has the characteristics to communicate and interpret visual culture with critical thinking ability by transcending the barriers of time, culture and language, by analyzing the gender role and gender discrimination elements that appear in modern art textbook images. Moreover, this paper would like to foster a proper sense of gender equality to students who live in current society by examining how the contents of modern art education implies gender biased terms. First of all, prior to the textbook analysis, the theoretical background and prior research surveys of gender equality education were examined to rationalize the relationship with art education. Meanwhile, the function and role of visual materials in art textbooks were examined since those methodologies performs as the main learning contents. In addition, among the six criteria for gender discrimination in teaching and learning materials presented by David Sadker and Myra Sadker (1997), this research paper has extracted four criteria that are suitable for visual material analysis: gender role stereotypes, invisibility, imbalance and unreality. Subsequently, three categories were proposed as the analysis criteria that can be used in art subjects: gender ratio of characters, gender occupation and role distribution and depiction of male and female images. For the analysis of gender ratio, gender occupation and role distribution of the characters, all images contained in the textbook were counted to calculate the ratio of male and female and the distribution of male and female characters among the overall character expressions. For the analysis of depiction of the image of men and women, the results were derived by extracting examples of educational contents and visual materials that were contained in textbooks. To this point, a methodologically rigorous case selection of entire 10 volumes of 2015 revised high school art textbooks were conducted into analysis; and the textbook analysis results are as follows. First, the gender ratio of the characters differed by textbook. Overall, the gender ratio of the characters in the image of the artist&amp;apos;s work and illustrations is relatively balanced, but it can be seen that the 10 textbooks are not equal and there are differences between publishers. In addition, since the expression of characters in student works and nude expressions were biased more to women, the invisibility and imbalance of male expressions in student works and nude works could be taken into concerns. Second, gender role stereotypes were still revealed in gender occupation and role distribution. Looking thoroughly inside our modern society, the women’s role has been explicitly improved so that the role distribution among gender has been fairly equally shared. However, through the analysis of textbooks, women’s roles are still portrayed as passive, subordinate and traditional, whereas the men’s roles are appeared as public, achievement-oriented and active professionals. Moreover, while the men appeared more than women in the field of culture and art, the introduction of recent and modern artists showed relatively few female artists, which in turn could lead to the potential risk of implicitly generalizing famous artists as a masculine factor to students. Third, the images of men and women was depicted regrettably apart from reality. In order to understand the image description of men and women, the background of home, society, and school was respectively taken into consideration. In home and society, the descriptions of men and women were expressed in traditional stereotypes, as this paper have successfully sought from the distribution of gender occupations and roles. In terms of women, women were portrayed more negatively than men, such as dancers, consumers, coquettes or femme fatales. This, in turn, could lead students to unconsciously form intolerant thoughts toward women through the image of women in textbooks if the explanation of its contents does not suffice. In other words, the insufficient explanation towards women’s image in textbooks could arouse the possibility of students to adopt distorted gaze and prejudice toward women. On the other hands, in consideration with the background of school, the depiction of characters was expressed in a relatively equal and realistic way yet was lacking in its quantitative respect to reach equivalent effect as how background of home and society have. In conclusion, through analyzing high school art textbooks from the viewpoint of gender equality education, even though the 2015 revised curriculum art textbooks have approached a significant improvement than before, the necessity for detailed supplementation on its contents or compositions of visual materials is required to eliminate any gender imbalance and gender role stereotypes. Finally, interviews were conducted with incumbent high school teachers, who are using the 2015 revised high school art textbooks, to voice their suggestions from their field to reach this research’s conclusions. Likewise, this study has reached its significance by targeting the entire publisher of high school art textbooks to overcome any gender role stereotypes and gender discrimination that were passed into silence in our current education curriculum. Furthermore, this research aims to contribute to diverse research and development of art education for democratic civic development in the globalization era by providing students with a proper sense of gender equality.Ⅰ. 서론 1 A. 연구의 목적 1 B. 연구의 내용 4 Ⅱ. 이론적 배경 6 A. 양성평등교육 6 1. 양성평등교육의 개념 6 2. 양성평등교육의 필요성 8 3. 학교교육과정에서의 양성평등교육 9 B. 교수학습 자료에서의 성차별성 12 1. 미술 교과서의 교수학습 자료 12 2. 교육내용에서의 성차별성 기준 14 C. 고등학교 미술 교과서 특징 20 1. 고등학교 미술 교과서의 종류 20 2. 교과용 도서의 편찬 22 Ⅲ. 연구방법 26 A. 분석대상 26 B. 분석 기준 및 방법 28 1. 분석 기준 28 2. 분석 방법 30 Ⅳ. 연구결과 및 논의 34 A. 연구결과 34 B. 논의 83 Ⅴ. 결론 및 제언 85 참고문헌 88 ABSTRACT 9

A Study on the Communication Pattern Showed on the Blog - Centered on the Viewpoint of Digital Storytelling

본 논문에서는 디지털 스토리텔링의 결과물인 디지털 컨텐츠가 전시되는 개인 사이버 공간 중에서, 제작자와 열람자 사이의 관계가 열려있는 블로그(blog)에 주목하였다. 블로그와 블로그를 통해 전시하는 창작물을 조사 대상으로 선정하였고 연구 대상은 4가지 기준으로 선정된 개인 블로그 100개와 각 블로그에 담긴 컨텐츠로 한정지었다. 블로그의 개념이 명확히 정의된 연구가 없었기에 본 논문에서는 블로그가 가져야할 최소 조건을 규정하여 조사 대상에 대한 일관된 개념을 설정하였다. 그리고 노라 폴(Nora Paul)이 제시한 디지털 스토리텔링의 요소인 매체(media)와 행위(action), 관계(relationship), 맥락정보(context), 커뮤니케이션(communication)을 준거의 틀로 블로그의 분석을 시도하였다. 분석 결과에 의하면 블로그가 다른 개인 사이버 공간과 가장 큰 차이점을 보이는 부분은 노라 폴의 스토리텔링의 요소 중 커뮤니케이션 요소라 하겠다. 블로그는 쌍방향(two-way) 커뮤니케이션이 일어나는 공간으로, 덧글과 트랙백 기능은 컨텐츠 제작자와 열람자의 연결 관계를 가시적으로 보여준다. 일반적으로 블로그는 블로그를 방문한 방문객의 열람과 덧글로 인해 일 대 다(one-to-many) 커뮤니케이션이 행해지는 공간이다. 그러나 블로그의 트랙백 기능은 일 대 다의 관계에서 벗어난 일 대 일(one-to-one) 커뮤니케이션 또한 이루어지게 한다. 블로그에서 나타나는 일 대 일 커뮤니케이션은 기존 일 대 일 커뮤니케이션의 폐쇄적인 성격과는 달리, 제 삼자의 열람과 참여가 가능한 개방적인 커뮤니케이션이라 할 수 있다. 본 분석을 통해 블로거 사이의 소통은 다층적으로 소화될 수 있는 구조적 특징을 지녔음이 발견되었다. 블로그는 제작자와 수용자 사이의 의사소통을 구조적으로 가능하게 하는 도구이고, 복합적 커뮤니케이션 또한 가능하게 하는 공간임이 밝혀진 것이다. 이와 같은 특징은 블로그라는 매체에만 해당되는 것이 아니라 다른 사이버 공간에도 적용될 수 있다는 점에서 의의를 가진다. 본 연구는 지금까지 다양하게 해석되어 왔던 블로그의 개념을 형식과 형태의 특징을 중심으로 정리하였으며, 그 결과 여타의 사이버 공간과 구별되는 블로그 특유의 커뮤니케이션 형태를 발견하였다는 점에서 의의가 있다. 그러나 디지털 스토리텔링 이론화에 지니는 의미를 규명하지 못 한 점이 본 연구의 한계이다. 블로그로 현상화되는 디지털 스토리텔링의 이론화 작업은 추후의 연구 과제로 상정한다.;This study was to concentrate on the Blogs opened the relations between the producer and inspector among the individual cyber space that the digital contents, results of digital storytelling, were displayed. And, this study was to select the Blogs and the works displayed through the Blogs as research samples. Also, this study was to confine the 100 individual Blogs selected on the four bases and the contents contained in each Blog. There was no research that the concept of Blog was defined clearly, so this study was to define the minimum conditions that the Blogs needed and establish the consistent concept of object of investigation. And, this study was to try to analyze the Blogs with the factors of digital storytelling that Nora Paul has suggested like media, action, relationship, context, and communication as applicable frames. According to the result of analysis, the difference the Blog had most compared with the other individual cyber space could be a factor of communication among the factors of storytelling by Nora Paul. The Blog is a space that it produces two-way communication. And, the function of reply/comment and trackback show the connection between the producer and inspector of contents visibly. Generally, the Blog is a space that the one-to-many communication has been done with the read and reply/comment by the users who visited the Blogs. However, the one-to-one communication can be realized by the function of trackback, not one-to-many communication. The one-to-one communication executed in the Blogs can be open communication in which the third party can read and participate contrary to the closed communication showed on the past one-to-one communication. Through this analysis, the communication among the Bloggers found out that it had structural characteristics that could be assimilated in multi-level. This study found out that the Blog was an instrument that made the communication between the producer and receiver structurally possible, and that it was a space made the complex communication possible, not single communication. It was significant for such characteristics to apply to any other cyber space, not correspond to the media like Blogs. This study was to arrange the concept of Blogs that has interpreted variously up to date centered on the characteristics of type and pattern. Consequently, this study was meaningful that it found out the pattern of peculiar communication that the Blog had distinct from the other cyber spaces. However, there are limits in this study that it did not clarify the meaning in the digital storytelling theorized. The theorized work for digital storytelling formed with the Blog can be put forward it as future research task.I. 서론 = 1 Ⅱ. 이론적 논의 = 5 A. 서사 구조 = 5 B. 디지털 스토리텔링의 요소 = 10 III. 개인 사이버 공간 개괄 = 27 IV. 블로그에 대한 고찰 = 32 A. 블로그의 개념 = 32 B. 블로그의 형태 = 36 C. 한국 블로그의 특징 = 42 V. 블로그와 블로그 컨텐츠 분석 = 56 A. 분석대상 블로그의 선정 기준 = 56 B. 블로그에 나타난 서사 요소 = 63 C. 블로그에 나타난 디지털 스토리텔링 요소 = 66 VI. 이론적 함의와 결론 = 81 참고 문헌 = 95 참고 사이트 = 95 Abstract = 10