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    PSMA ํ‘œ์  ์„ธํฌ์น˜๋ฃŒ ๋ฐ ์„ธํฌ์ถ”์ ์„ ์œ„ํ•œ ์„ธํฌ๋ง‰๊ณตํ•™ ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต๋Œ€ํ•™์› : ์œตํ•ฉ๊ณผํ•™๊ธฐ์ˆ ๋Œ€ํ•™์› ์‘์šฉ๋ฐ”์ด์˜ค๊ณตํ•™๊ณผ, 2023. 2. ๊น€์ƒ์€.์„ธํฌ์น˜๋ฃŒ์ œ๋Š” ์ค„๊ธฐ์„ธํฌ ๋˜๋Š” ๋ฉด์—ญ์„ธํฌ ๋“ฑ ์„ธํฌ๋ฅผ ๊ธฐ๋ฐ˜์œผ๋กœ ํ•˜๋Š” ์น˜๋ฃŒ๋ฒ•์ด๋‹ค. ํŠนํžˆ, ๋ฉด์—ญ์กฐ์ ˆ์„ธํฌ์น˜๋ฃŒ์ œ๋Š” ์ˆ˜์ง€์ƒ์„ธํฌ(dendritic cell), ์ž์—ฐ ์‚ดํ•ด ์„ธํฌ(natural killer cell), T ์„ธํฌ ๋“ฑ์˜ ๋ฉด์—ญ์„ธํฌ๋ฅผ ์ด์šฉํ•˜์—ฌ ๋ฉด์—ญ๋ฐ˜์‘์„ ํ™œ์„ฑํ™”์‹œ์ผœ ์งˆ๋ณ‘ ์น˜๋ฃŒ์— ์‚ฌ์šฉ๋˜๋Š” ์˜์•ฝํ’ˆ์ด๋‹ค. ๋ฉด์—ญ์กฐ์ ˆ์„ธํฌ์น˜๋ฃŒ์ œ ์ค‘ ์ตœ๊ทผ ์ž„์ƒ์ ์œผ๋กœ ํ™œ๋ฐœํžˆ ์—ฐ๊ตฌ๊ฐ€ ์ง„ํ–‰๋˜๊ณ  ์žˆ๋Š” CAR-T๋Š” ํ‚ค๋ฉ”๋ฆญ ํ•ญ์› ์ˆ˜์šฉ์ฒด(chimeric antigen receptors, CARs)๋ฅผ ๋ฐœํ˜„ํ•˜๋Š” ์œ ์ „์ž๋ฅผ T ์„ธํฌ์— ๋„์ž…ํ•˜์—ฌ ๋ฐœํ˜„ํ•˜๋Š” ๊ฐœ๋…์œผ๋กœ, ํ˜„์žฌ ๊ตญ์™ธ์—์„œ๋„ ์Šน์ธ์ด ๊ธฐ๋Œ€๋˜๋Š” ์‹ ๊ธฐ์ˆ  ๋ถ„์•ผ์ด๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋Ÿฌํ•œ CAR-T ์น˜๋ฃŒ๋ฒ• ์—ญ์‹œ ์ถฉ๋ถ„ํ•œ ํ‘œ์ ํ™”๊ฐ€ ์ด๋ฃจ์–ด์ง€์ง€ ์•Š์„ ๊ฒฝ์šฐ on-target/off-tumor effect์˜ ๋ถ€์ž‘์šฉ์œผ๋กœ ์ธํ•œ ํ•œ๊ณ„์ ๋„ ๊ฐ€์ง€๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ํ‘œ์ ๋Šฅ์˜ ํ•œ๊ณ„์™€ ๋ถ€์ž‘์šฉ์„ ๊ทน๋ณตํ•˜๊ธฐ ์œ„ํ•ด ์ด์ค‘ํŠน์ด์„ฑ(bispecific) CAR-T๋ฅผ ๊ฐœ๋ฐœํ•˜๊ฑฐ๋‚˜ CAR์˜ ์„ฑ๋Šฅ๊ณผ ํšจ๋Šฅ์„ ํ–ฅ์ƒ์‹œํ‚ค๊ธฐ ์œ„ํ•œ ๋…ธ๋ ฅ์ด ์ด๋ฃจ์–ด์ง€๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ CAR-T ์„ธํฌ์™€ ๊ฐ™์€ ๋ฉด์—ญ์„ธํฌ์น˜๋ฃŒ์˜ ๋ฌธ์ œ์ ์„ ๊ทน๋ณตํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ๋ฉด์—ญ์„ธํฌ์™€ ์ข…์–‘์„ธํฌ ๊ฐ„์˜ ์ƒํ˜ธ์ž‘์šฉ(cell-cell interaction)์ด ์ค‘์š”ํ•˜๋ฉฐ, ํŠนํžˆ ์ด๋Š” ์„ธํฌ ํ‘œ๋ฉด์˜ ๋ฆฌ๊ฐ„๋“œ์™€ ์ˆ˜์šฉ์ฒด ๊ฐ„์˜ ๊ฒฐํ•ฉ์ด ์ค‘์š”ํ•˜๊ฒŒ ์ž‘์šฉํ•œ๋‹ค. ์˜ˆ๋กœ, CAR-T์— ์ด์šฉ๋˜๊ณ  ์žˆ๋Š” CD20, CD22, HER2 ๋“ฑ์ด ์ข…์–‘์„ธํฌ์˜ ํ‘œ์ ํ™”์— ์ด์šฉ๋˜๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ๋‘ ์„ธํฌ๋“ค ๊ฐ„์˜ ๊ฒฐํ•ฉ์ด ๊ฐ•ํ™”๋˜๋ฉด ๋ณด๋‹ค ํšจ๊ณผ์ ์ธ ํ•ญ์•”์น˜๋ฃŒ๋ฅผ ๊ธฐ๋Œ€ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ตœ๊ทผ ๋‹น๋Œ€์‚ฌ๊ณตํ•™(metabolic glycoengineering)์„ ์‚ฌ์šฉํ•˜์—ฌ ์„ธํฌ ํ‘œ๋ฉด์—์„œ ๋‹น๊ตฌ์กฐ๋ฌผ์˜ ๋ฐœํ˜„์„ ์กฐ์ ˆํ•œ ๋‹ค์Œ, ์ƒ๋ฌผ์ง๊ต ํ™”ํ•™(bioorthogonal click chemistry)๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์ธ๊ณต์ ์ธ ํ‘œ์  ๋ฆฌ๊ฐ„๋“œ์™€ ๊ฐ™์€ ๊ตฌ์กฐ๋ฅผ ๊ฒฐํ•ฉํ•˜๋Š” ๋ฐฉ๋ฒ•์ด ์ œ์‹œ๋˜๊ณ  ์žˆ๋‹ค. ๋‹น๋Œ€์‚ฌ๊ณตํ•™์€ ์ธ๊ณต ๋‹น๊ณผ ๋‹น๋‹จ๋ฐฑ์งˆ ํ•ฉ์„ฑ๊ณผ์ •์„ ์ด์šฉํ•˜์—ฌ ์„ธํฌ ํ‘œ๋ฉด์— ํ™”ํ•™์  ํ‘œ์ง€๊ฐ€ ๊ฐ€๋Šฅํ•œ ์ˆ˜์šฉ์ฒด๋ฅผ ๋„์ž…ํ•  ์ˆ˜ ์žˆ๋Š” ๊ธฐ์ˆ ์ด๋‹ค. Azide ๋ฐ˜์‘๊ธฐ๋Š” N-azifoacetyl-mannosamine(Ac4ManNAz) ๋“ฑ์˜ ๊ธฐ์งˆ์„ ์ด์šฉํ•˜์—ฌ ํ™”ํ•™์  ํ‘œ์ง€๋ฅผ ์œ„ํ•ด ์„ธํฌ ํ‘œ๋ฉด์— ํ˜•์„ฑ๋  ์ˆ˜ ์žˆ๋‹ค. ์ดํ›„ ์ƒ๋ฌผ์ง๊ต ํ™”ํ•™๋ฐ˜์‘์œผ๋กœ ๊ฒฐํ•ฉ์ด ๊ฐ€๋Šฅํ•œ ๋‹ค์–‘ํ•œ ๊ตฌ์กฐ๋ฌผ์„ ์‰ฝ๊ณ  ๋น ๋ฅด๊ฒŒ ์‹œํ—˜๊ด€ ๋‚ด ๋˜๋Š” ์ƒ์ฒด๋‚ด์—์„œ ๊ฒฐํ•ฉํ•  ์ˆ˜ ์žˆ๋Š” ์žฅ์ ์ด ์žˆ๋‹ค. ๋ณธ ํ•™์œ„ ๋…ผ๋ฌธ์˜ ๋ชฉํ‘œ๋Š” ๋‹น๋Œ€์‚ฌ๊ณตํ•™ ๋ฐ ํด๋ฆญ ๋ฐ˜์‘์„ ์ด์šฉํ•˜์—ฌ ๋ฉด์—ญ์„ธํฌ์น˜๋ฃŒ์ œ์—์„œ ์ „๋ฆฝ์„ ํŠน์ด๋ง‰ํ•ญ์›(prostate specific membrane antigen, PSMA)์— ๋Œ€ํ•œ ํ‘œ์ ํ™” ๋Šฅ๋ ฅ์„ ๋†’์ด๊ณ  PET ์˜์ƒ์„ ์ด์šฉํ•˜์—ฌ ์„ธํฌ์ถ”์ ์„ ์‹œ๊ฐํ™”ํ•˜๋Š” ๊ฒƒ์ด๋‹ค. THP-1 ์„ธํฌ๋ฅผ ๋‹ค์–‘ํ•œ ๋†๋„(0, 5, 10, 20, 50, 100 ฮผM)์˜ Ac4ManNAz์™€ ํ•จ๊ป˜ 24 ์‹œ๊ฐ„ ๋™์•ˆ ์ฒ˜๋ฆฌํ•˜์—ฌ ์„ธํฌ ํ‘œ๋ฉด์— ๋ฐ˜์‘์„ฑ ์ž‘์šฉ๊ธฐ๋ฅผ ๋ฐœํ˜„์‹œ์ผฐ๋‹ค. ๋‹น๋Œ€์‚ฌ์กฐ์ž‘๋œ ์„ธํฌ๋ฅผ DBCO-bearing fluorophore (ADIBO-Cy5.5)๋ฅผ ์ด์šฉํ•˜์—ฌ 1 ์‹œ๊ฐ„ ๋™์•ˆ ๋‹ค์–‘ํ•œ ๋†๋„์กฐ๊ฑด(0, 5, 10, 20, 50, 100 ฮผM)์—์„œ ์ฒ˜๋ฆฌํ•˜์—ฌ ์—ผ์ƒ‰ํ•˜์˜€๋‹ค. ์ด๋ฅผ ๊ณต์ดˆ์  ํ˜•๊ด‘ ํ˜„๋ฏธ๊ฒฝ ๋ฐ ์œ ์„ธํฌ ๋ถ„์„๋ฒ•์„ ์ด์šฉํ•˜์—ฌ ๋ถ„์„์„ ์ง„ํ–‰ํ•จ์œผ๋กœ์จ ๋‹น๋Œ€์‚ฌ๊ณตํ•™ ๋ฐ ํด๋ฆญ ๋ฐ˜์‘์„ ์ด์šฉํ•˜์—ฌ THP-1 ์„ธํฌ์˜ ํ‘œ๋ฉด์—์„œ ์ƒ์ฒด์ง๊ต ๊ฒฐํ•ฉ์ด ์ผ์–ด๋‚จ์„ ํ™•์ธํ•˜์˜€๋‹ค. THP-1 ์„ธํฌ์˜ ํ‘œ๋ฉด์— PSMA ํ‘œ์ ํ™” ๋ฆฌ๊ฐ„๋“œ๋ฅผ ๋ฌด์žฅ์‹œํ‚ค๊ธฐ ์œ„ํ•ด Ac4ManNAz๊ฐ€ ์ฒ˜๋ฆฌ๋œ THP-1 ์„ธํฌ์— ์ตœ์ข…๋†๋„ 100 ฮผM์˜ DBCO-PSMA ligand (ADIBO-GUL)๋ฅผ ์ฒ˜๋ฆฌํ•˜๊ณ  1 ์‹œ๊ฐ„ ๋ฐฐ์–‘ํ•˜์˜€๋‹ค. ์„ธํฌ ์ธ์‹์— ๋Œ€ํ•œ ํšจ๊ณผ๋ฅผ ํ‰๊ฐ€ํ•˜๊ธฐ ์œ„ํ•ด, PSMA ๋ฆฌ๊ฐ„๋“œ๊ฐ€ ๋ฌด์žฅ๋œ THP-1 ์„ธํฌ(์ž‘์šฉ ์„ธํฌ)์™€ PSMA ์–‘์„ฑ ์ข…์–‘์„ธํฌ์ธ 22RV1 ์„ธํฌ ๋˜๋Š” PSMA ์Œ์„ฑ ์ข…์–‘์„ธํฌ์ธ PC3 ์„ธํฌ(ํ‘œ์  ์„ธํฌ)๋ฅผ Effector-to-target ๋น„์œจ 3:1๋กœ ๊ณต๋™๋ฐฐ์–‘ ํ•˜์˜€๋‹ค. ์ด๋•Œ THP-1 ์„ธํฌ(์ž‘์šฉ ์„ธํฌ)์™€ ํ‘œ์  ์„ธํฌ ์‚ฌ์ด์˜ ์ƒํ˜ธ์ž‘์šฉ์„ ๊ณต์ดˆ์  ํ˜•๊ด‘ ํ˜„๋ฏธ๊ฒฝ์„ ์ด์šฉํ•˜์—ฌ ํ™•์ธํ•˜์˜€๊ณ , PSMA ํ‘œ์ ๊ตฌ์กฐ๋ฅผ ํฌํ•จํ•˜์ง€ ์•Š์€ THP-1 ์„ธํฌ๋ฅผ ์Œ์„ฑ ๋Œ€์กฐ๊ตฐ์œผ๋กœ ์ด์šฉํ•˜์˜€๋‹ค. [89Zr]Zr(oxinate)4๋Š” ์Œ์ด์˜จ ๊ตํ™˜ ์นดํŠธ๋ฆฌ์ง€๋ฅด ์ด์šฉํ•˜์—ฌ oxalate ๊ตฌ์กฐ๋กœ๋ถ€ํ„ฐ ํ•ฉ์„ฑ๋˜์—ˆ๋‹ค. ํ•ฉ์„ฑ๋œ [89Zr]Zr(oxinate)4์˜ ์นœ์œ ์„ฑ์„ ํ™•์ธํ•˜๊ธฐ ์œ„ํ•ด LogD7.4๊ฐ€ ์ธก์ •๋˜์—ˆ๋‹ค. ์ดํ›„ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€๋œ THP-1 ์„ธํฌ๋ฅผ ์ค€๋น„ํ•˜๊ธฐ ์œ„ํ•ด, ~740 kBq ์ˆ˜์ค€์˜ [89Zr]Zr(oxinate)4๋ฅผ ์ด์šฉํ•˜์—ฌ 5ร—106 ๊ฐœ์˜ ์„ธํฌ๋ฅผ ํ‘œ์ง€ํ•˜์˜€๋‹ค. ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€๋œ ์„ธํฌ๋Š” ๊ฐ๋งˆ ์นด์šดํ„ฐ๋ฅผ ์ด์šฉํ•˜์—ฌ ์„ธํฌ์— ํ‘œ์ง€๋œ ๋ฐฉ์‚ฌ๋Šฅ์„ ์ธก์ •ํ•˜์˜€๊ณ , MTS ๋ฐฉ๋ฒ•์„ ์ด์šฉํ•˜์—ฌ ์ตœ๋Œ€ 7์ผ๊นŒ์ง€์˜ ์„ธํฌ ์ƒ์กด๋Šฅ์„ ํ™•์ธํ•˜์˜€๋‹ค. [89Zr]Zr(oxinate)4๋กœ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€๋œ PSMA ํ‘œ์  ๋ฆฌ๊ฐ„๋“œ ๋ฌด์žฅ THP-1 ์„ธํฌ๋ฅผ ์ •์ƒ ๋งˆ์šฐ์Šค์˜ ๊ผฌ๋ฆฌ ์ •๋งฅ์„ ํ†ตํ•˜์—ฌ ํˆฌ์—ฌํ•œ ๋’ค 2 ์‹œ๊ฐ„, 1, 4, 6์ผ์— ๊ฐ๊ฐ PET ์˜์ƒ์ด ํš๋“๋˜์—ˆ๋‹ค. ์„ธํฌ๋…์„ฑ์‹œํ—˜์—์„œ, THP-1 ์„ธํฌ๋Š” Ac4ManNAz ๋˜๋Š” ADIBO-Cy5.5์˜ ์ตœ๋Œ€ ์ฒ˜๋ฆฌ ๋†๋„์ธ 100 ฮผM๊นŒ์ง€ ์–ด๋– ํ•œ ๋…์„ฑ๋„ ํ™•์ธ๋˜์ง€ ์•Š์•˜๋‹ค. ๊ณต์ดˆ์  ํ˜•๊ด‘ ํ˜„๋ฏธ๊ฒฝ ์˜์ƒ๊ณผ ์œ ์„ธํฌ ๋ถ„์„๋ฒ•์—์„œ, THP-1 ์„ธํฌ๋Š” ADIBO-Cy5.5์˜ ์ฒ˜๋ฆฌ์šฉ๋Ÿ‰์— ๋น„๋ก€ํ•œ ํšจ์œจ์  ํ‘œ์ง€๋ฅผ ํ™•์ธํ•˜์˜€๋‹ค. ํšจ์œจ์  ์„ธํฌ ํ‘œ๋ฉด ํ‘œ์ง€์— ๋Œ€ํ•œ ์ตœ์ ๋†๋„๋กœ์จ 100 ฮผM์ด ์ดํ›„ ์‹คํ—˜์—์„œ ์‚ฌ์šฉ๋˜์—ˆ๋‹ค. ์ž‘์šฉ ์„ธํฌ์™€ ํ‘œ์  ์„ธํฌ ์‚ฌ์ด์˜ ๊ฒฐํ•ฉ์€ PSMA ์Œ์„ฑ์ธ PC3 ์„ธํฌ์—์„œ ๊ด€์ฐฐ๋˜์ง€ ์•Š์•˜๋‹ค. 22RV1 ์„ธํฌ์—์„œ๋„ ์Œ์„ฑ ๋Œ€์กฐ๊ตฐ์œผ๋กœ ์‚ฌ์šฉ๋œ THP-1 ์„ธํฌ์™€์˜ ์„ธํฌ ๊ฐ„ ๊ฒฐํ•ฉ์ด ๋‚˜ํƒ€๋‚˜์ง€ ์•Š์•˜๋‹ค. ํ•˜์ง€๋งŒ PSMA ๋ฆฌ๊ฐ„๋“œ ๋ฌด์žฅ THP-1 ์„ธํฌ์™€ 22RV1 ์„ธํฌ ์‚ฌ์ด์˜ ์„ธํฌ ๊ฐ„ ๊ฒฐํ•ฉ์ด ํ™•์ธ๋˜์—ˆ์œผ๋ฉฐ, ์ด๋Š” ๋‘ ๊ฐ€์ง€ ์œ ํ˜•์˜ ์„ธํฌ ์‚ฌ์ด์—์„œ ์„ธํฌ ํ‘œ๋ฉด์˜ ํ‘œ์ ํ™” ๋ฆฌ๊ฐ„๋“œ์— ์˜ํ•œ ์„ธํฌ ๊ฐ„ ์ธ์‹์ด ์ผ์–ด๋‚จ์„ ๋ณด์—ฌ์ค€๋‹ค. [89Zr]Zr(oxinate)4์˜ LogD7.4 ์ธก์ •๊ฐ’์€ 1.47 ยฑ 0.02๋กœ, ์นœ์œ ์„ฑ์„ ํ™•์ธํ•˜์˜€๊ณ , ์„ธํฌ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€ ํšจ์œจ์€ 54.4 ยฑ 17.8%์˜€๋‹ค. ๋‹จ์ผ ์„ธํฌ ๋‹น 0.09 ยฑ 0.03 Bq๋กœ ํ‘œ์ง€๋œ THP-1 ์„ธํฌ๋Š” ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€ ํ›„ 7์ผ๊นŒ์ง€ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€๊ฐ€ ๋˜์ง€ ์•Š์€ ๋Œ€์กฐ๊ตฐ THP-1 ์„ธํฌ์™€ ๋น„๊ตํ•˜์—ฌ ์œ ์˜ํ•œ ์„ธํฌ๋…์„ฑ์„ ๋‚˜ํƒ€๋‚ด์ง€ ์•Š์•„ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€์— ์˜ํ•œ ์„ธํฌ ๋…์„ฑ์€ ํ™•์ธ๋˜์ง€ ์•Š์•˜๋‹ค. ๋งˆ์šฐ์Šค์— ํˆฌ์—ฌ๋œ THP-1 ์„ธํฌ๋Š” ๊ฐ€์žฅ ๋จผ์ € ํ์— ๋†’์€ ๋น„์œจ๋กœ ์ถ•์ ๋˜์—ˆ๋‹ค๊ฐ€, ์ดํ›„ ์‹œ๊ฐ„์ด ์ง€๋‚จ์— ๋”ฐ๋ผ ์ ์ฐจ ๊ฐ„, ๋น„์žฅ ๋“ฑ์˜ ๋‹ค๋ฅธ ์žฅ๊ธฐ๋กœ ์ด๋™ํ•จ์„ ํ™•์ธํ•˜์˜€๋‹ค. ์œ„ ๋ฐฉ๋ฒ•์„ ํ†ตํ•˜์—ฌ PSMA ํ‘œ์  ์„ธํฌ๋ฅผ ์ค€๋น„ํ•˜๊ธฐ ์œ„ํ•ด 100 ฮผM์˜ Ac4ManNAz๋ฅผ ์ฒ˜๋ฆฌํ•˜๊ณ , PSMA ํ‘œ์  ๋ฆฌ๊ฐ„๋“œ(ADIBO-GUL)๋ฅผ ์ด์šฉํ•˜์—ฌ ํšจ์œจ์ ์œผ๋กœ ์„ธํฌ๋ฅผ ๋ฌด์žฅํ•  ์ˆ˜ ์žˆ์Œ์„ ์„ฑ๊ณต์ ์œผ๋กœ ์ž…์ฆํ•˜์˜€๋‹ค. ๋˜ํ•œ [89Zr]Zr(oxinate)4๋ฅผ ์ด์šฉํ•˜์—ฌ ์„ธํฌ์— ๋Œ€ํ•œ ๋…์„ฑ ์—†์ด ์„ธํฌ๋ฅผ ๋ฐฉ์‚ฌ์„ฑ ํ‘œ์ง€ ํ•  ์ˆ˜ ์žˆ์Œ์„ ํ™•์ธํ•˜์˜€๋‹ค. ์ด๋Š” PSMA ๋ฆฌ๊ฐ„๋“œ ๋ฌด์žฅ ์„ธํฌ ์š”๋ฒ•์ด ์„ธํฌ ํ‘œ์ ํ™” ๋Šฅ๋ ฅ์„ ๊ฐœ์„ ํ•˜๊ณ  PET ์˜์ƒ์„ ์ด์šฉํ•˜์—ฌ ์„ธํฌ์˜ ์ฒด๋‚ด ์ด๋™์„ ์ถ”์ ํ•  ์ˆ˜ ์žˆ์Œ์„ ์ œ์•ˆํ•˜์˜€๋‹ค.Cell therapy is based on cells such as stem cells and immune cells. In particular, immunomodulatory cell therapy treats diseases by activating the immune response using immune cells such as dendritic cells, natural killer cells, and T-cells. Among them, a concept of introducing a gene expressing a chimeric antigen receptor into T cells (CAR-T) has been developed recently for cancer treatment and is expected to be approved internationally. However, these CAR-T-based therapies have some limitations due to side effects of on-target/off-tumor effects when adequate targeting is not achieved. To overcome the limitations and side effects of these targeting capabilities, efforts are being made to develop bispecific CAR-T cells or to improve the performance and efficacy of CARs. Metabolic glycoengineering is a technology that can introduce receptors that can be chemically labeled on the cell surface using artificial sugar and glycoprotein synthesis. Reactive azide groups can be formed on the cell surface for chemical labeling using a substrate such as N-azidoacetyl-mannosamine (Ac4ManNAz). After that, it can easily and quickly combine various structures that be conjugated by bioorthogonal chemical reactions in vitro or in vivo. This study aimed to increase the targeting ability against PSMA in cell therapy using metabolic glycoengineering and click reaction and visualize cell trafficking using PET imaging. THP-1 cells were incubated with Ac4ManNAz at various concentrations (0, 5, 10, 20, 50, and 100 ยตM) for 24 h to incorporate reactive functional groups on the cell surface. Metabolically glycoengineered cells were stained by DBCO-bearing fluorophore (ADIBO-Cy5.5) for 1 h at different concentrations (0, 5, 10, 20, 50, and 100 ยตM) and analyzed by confocal fluorescence microscopy and flow cytometric assay. For PSMA ligand attachment to THP-1 cells, Ac4ManNAz treated THP-1 cells were incubated with DBCO-PSMA ligand (ADIBO-GUL) at a final concentration of 100 ยตM for 1 h. To evaluate the effect on cell recognition, PSMA ligand-armed THP-1 cells (as effectors) were co-cultured with PSMA-positive, 22RV1 cells or PSMA-negative, PC3 cells (as target cells) at a 3:1 effector-to-target cell (E/T) ratio. The interaction between THP-1 and target cells was monitored by confocal fluorescence microscopy. THP-1 cells were used without a PSMA targeting motif as a negative control. [89Zr]Zr(oxinate)4 was prepared from its oxalate form by using an anion exchange sep-pak cartridge. LogD7.4 assay was performed to confirm the lipophilicity of the synthesized [89Zr]Zr(oxinate)4. For preparing the radiolabeled THP-1, the cells were treated at the activity level of ~740 kBq of [89Zr]Zr(oxinate)4/5ร—106 cells. Radiolabeled cells were analyzed for determination of cell-associated radioactivity by gamma counting and cell viability was measured up to 7 day by MTS assay. PSMA targeting ligand armed THP-1 cells radiolabeled with [89Zr]Zr(oxinate)4 was injected into normal mice through the tail vein. PET images were obtained at 2 hours, 1, 4, and 6 days after injection. In the cytotoxicity assay, THP-1 cells did not present cytotoxicity even when the Ac4ManNAz or ADIBO-Cy5.5 treated concentration was 100 ยตM. In confocal imaging and flow cytometric assay, ADIBO-Cy5.5 efficiently labeled THP-1 cells in a dose-dependent manner, and the dose of 100 ยตM was the optimum concentration for the following experiments. Intercellular gluing was not observed in PSMA negative PC3 cells. 22RV1 cells did not show cell-to-cell gluing with non-armed THP-1 cells. However, the clusters of PSMA ligand-armed THP-1 cells and 22RV1 were identified, indicating cell-cell recognition over the cell surface between two types of cells. LogD7.4 of [89Zr]Zr(oxinate)4 was determined as 1.47 ยฑ 0.02. Cell radiolabeling efficiency was 54.5 ยฑ 17.8%. THP-1 labeled with 0.09 ยฑ 0.03 Bq/cell showed no significant cytotoxicity compared to unlabeled THP-1 up to 7 days. Injected THP-1 cells accumulated in the lung and gradually moved to other organs, such as the liver and spleen, over time. Ac4ManNAz treated cells were prepared efficiently and labeled with ADIBO-GUL for preparing the PSMA-targeted cells. [89Zr]Zr(oxinate)4 can be used to label cells without toxicity. The study results suggest that PSMA-ligand armed cell therapy could improve cell targeting efficacy and be monitored by PET imaging.Chapter 1. Introduction 1 1.1. Cell therapy 1 1.2. Bioorthogonal engineering 1 1.3. Cell trafficking by PET 5 1.4. PSMA 7 1.5. Research objectives 9 Chapter 2. A feasibility study of cell membrane engineering for PSMA-targeted cell therapy and trafficking 10 2.1. Background 10 2.2. Experimental 11 2.3. Results and discussion 19 2.4. Summary 33 Chapter 3. Conclusion 34 Appendix 35 References 36 Abstract in Korean 40์„

    ํ•œ๊ตญ ์ดˆ๋“ฑํ•™์ƒ๋“ค์˜ ์˜์–ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์— ์˜ํ–ฅ์„ ์ฃผ๋Š” ์š”์ธ ๋ถ„์„

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ์™ธ๊ตญ์–ด๊ต์œก๊ณผ(์˜์–ด์ „๊ณต), 2021. 2. ์†Œ์˜์ˆœ.Reading is an important skill that needs to be established in the early stages of learning to read, but many second language learners find it difficult to successfully form its foundations. In order to verify the potential sources of English reading difficulty of Korean-speaking children learning English, the present study conducted a Component-skills analysis to L2 reading comprehension with four major linguistic variablesโ€”word decoding, vocabulary, morphosyntax, and listening comprehension. To this end, a total of eighty-seven students in fourth and sixth grades were asked to take both standardized and non-standardized tests specifically designed for elementary school students according to four different language skills. A series of correlation analyses and multiple regression were conducted using SPSS in order to analyze how the studentsโ€™ performance on each component correlates with their level of reading comprehension. The results showed that the model including word decoding, vocabulary, morphosyntax, and listening comprehension as predictors was suitable for explaining reading comprehension for both fourth grade (R2 = .616) and sixth grade (R2 = .578). While all component skills were correlated with reading comprehension, regression results indicated that the power of predictability among component skills was different by grade. In fourth grade, word decoding was the most powerful predictor of reading comprehension but was no longer salient in sixth grade. On the other hand, vocabulary and listening comprehension, which were not significant in fourth grade, exerted a great contribution to reading comprehension in sixth grade. This result substantiates the previous research that there exists a developmental trajectory in L2 reading comprehension: Once word decoding skills are fully acquired, the impact of other language skills such as vocabulary and listening comprehension to reading is increased in later stages of reading development. Findings from the current study shed light on using the componential approach as a diagnostic tool to evaluate oneโ€™s level of L2 reading and apply this knowledge in further educational practices.์ฝ๊ธฐ ๋Šฅ๋ ฅ์€ ํ•™์Šต ์ดˆ๊ธฐ์— ๋ฐ˜๋“œ์‹œ ํ™•๋ฆฝ๋˜์–ด์•ผ ํ•  ์ค‘์š”ํ•œ ์–ธ์–ด๊ธฐ๋Šฅ์ด๋‚˜, ๋งŽ์€ ์ œ 2 ์–ธ์–ด ํ•™์Šต์ž๋“ค์€ ๊ธฐ์ดˆ์ ์ธ ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ํ˜•์„ฑํ•˜๋Š” ๋ฐ ์–ด๋ ค์›€์„ ๊ฒช๋Š” ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๋‹ค. ์˜์–ด๋ฅผ ๋ฐฐ์šฐ๋Š” ํ•œ๊ตญ ์ดˆ๋“ฑํ•™์ƒ๋“ค์˜ ์˜์–ด ์ฝ๊ธฐ ์–ด๋ ค์›€์— ๊ธฐ์—ฌํ•˜๋Š” ์š”์ธ์„ ๋ฐํ˜€๋‚ด๊ธฐ ์œ„ํ•˜์—ฌ, ๋ณธ ์—ฐ๊ตฌ๋Š” ๋„ค ๊ฐ€์ง€ ์–ธ์–ด ์š”์ธโ€”๋‹จ์–ด ํ•ด๋… ๋Šฅ๋ ฅ, ์–ดํœ˜ ์ง€์‹, ํ˜•ํƒœํ†ต์‚ฌ์ง€์‹, ๋“ฃ๊ธฐ์ดํ•ด๋Šฅ๋ ฅโ€”์„ ๊ธฐ๋ฐ˜์œผ๋กœ ์ œ 2 ์–ธ์–ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ์ด๋ฅผ ์œ„ํ•ด ์ด 87 ๋ช…์˜ 4, 6 ํ•™๋…„ ํ•™์ƒ๋“ค์„ ๋ชจ์ง‘ํ•˜์˜€์œผ๋ฉฐ, ๋„ค ๊ฐ€์ง€ ์–ธ์–ด๊ธฐ๋Šฅ๊ณผ ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ์ธก์ •ํ•˜๋Š” ๋‹ค์„ฏ ๊ฐ€์ง€ ํ‘œ์ค€ํ™”์‹œํ—˜ ๋ฐ ๋น„ํ‘œ์ค€ํ™”์‹œํ—˜์— ์ฐธ์—ฌํ•˜๊ฒŒ ํ•˜์˜€๋‹ค. ๊ฐ ๊ธฐ๋Šฅ์— ๋Œ€ํ•œ ํ•™์ƒ๋“ค์˜ ๋Šฅ๋ ฅ์ด ์ž์‹ ๋“ค์˜ ์ฝ๊ธฐ ๋Šฅ๋ ฅ๊ณผ ์–ด๋– ํ•œ ๊ด€๊ณ„๋ฅผ ๊ฐ–๋Š”์ง€ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ์ƒ๊ด€๋ถ„์„๊ณผ ๋‹ค์ค‘ํšŒ๊ท€๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ๊ทธ ๊ฒฐ๊ณผ, ๋„ค ๊ฐ€์ง€ ๊ธฐ๋Šฅ์„ ์˜ˆ์ธก๋ณ€์ธ์œผ๋กœ ํ™œ์šฉํ•˜๋Š” ๋ชจ๋ธ์ด 4 ํ•™๋…„๊ณผ 6 ํ•™๋…„ ์ฝ๊ธฐ ๋Šฅ๋ ฅ์˜ ๋ณ€์ธ์„ ์„ค๋ช…ํ•˜๋Š” ๋ฐ ์ ํ•ฉํ•œ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋ชจ๋“  ๋…๋ฆฝ ๋ณ€์ธ์€ ์ฝ๊ธฐ ๋Šฅ๋ ฅ๊ณผ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๊ฐ–๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ์œผ๋‚˜, ํšŒ๊ท€๋ถ„์„ ๊ฒฐ๊ณผ์—์„œ๋Š” ๊ฐ ๋ณ€์ธ ๊ฐ„ ์˜ˆ์ธก๋ ฅ์˜ ํฌ๊ธฐ๊ฐ€ ํ•™๋…„์— ๋”ฐ๋ผ ๋‹ค๋ฅธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. 4 ํ•™๋…„์—์„œ๋Š” ๋‹จ์–ด ํ•ด๋… ๋Šฅ๋ ฅ์ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ์˜ˆ์ธกํ•˜๋Š” ๋ฐ ๊ฐ€์žฅ ํฐ ์„ค๋ช…๋ ฅ์„ ๋ณด์˜€์œผ๋‚˜, 6 ํ•™๋…„์—์„œ๋Š” ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜๋ฏธํ•œ ์„ค๋ช…๋ ฅ์„ ๊ฐ–์ง€ ๋ชปํ•˜๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์™€ ๋ฐ˜๋Œ€๋กœ, 4 ํ•™๋…„์—์„œ๋Š” ์œ ์˜๋ฏธํ•œ ์„ค๋ช…๋ ฅ์„ ๊ฐ–์ง€ ๋ชปํ–ˆ๋˜ ์–ดํœ˜ ์ง€์‹๊ณผ ๋“ฃ๊ธฐ์ดํ•ด๋Šฅ๋ ฅ์ด 6 ํ•™๋…„์—์„œ๋Š” ๊ฐ€์žฅ ์˜ํ–ฅ๋ ฅ์ด ๋†’์€ ์˜ˆ์ธก ๋ณ€์ธ์ธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์™€ ๊ฐ™์€ ๊ฒฐ๊ณผ๋Š” ์ œ 2 ์–ธ์–ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์—๋Š” ๋ฐœ๋‹ฌ ๋‹จ๊ณ„๊ฐ€ ์กด์žฌํ•œ๋‹ค๋Š” ๊ธฐ์กด์˜ ์„ ํ–‰ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ์™€ ์ƒ์‘ํ•œ๋‹ค. ์ฝ๊ธฐ ๋ฐœ๋‹ฌ์˜ ์ดˆ๊ธฐ ๋‹จ๊ณ„์—์„œ๋Š” ๋‹จ์–ด ํ•ด๋… ๋Šฅ๋ ฅ์ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์— ํฐ ์˜ํ–ฅ๋ ฅ์„ ๋ฏธ์น˜๋Š” ๋ฐ์— ๋ฐ˜ํ•˜์—ฌ, ํ›„๊ธฐ ๋‹จ๊ณ„์—์„œ๋Š” ๋‹จ์–ด ํ•ด๋… ๋Šฅ๋ ฅ์ด ๋Šฅ์ˆ™ํ•ด์ง์— ๋”ฐ๋ผ ์–ดํœ˜ ๋Šฅ๋ ฅ์ด๋‚˜ ๋“ฃ๊ธฐ์ดํ•ด๋Šฅ๋ ฅ๊ณผ ๊ฐ™์€ ๋‹ค๋ฅธ ๋ณ€์ธ๋“ค์˜ ์˜ํ–ฅ๋ ฅ์ด ๋†’์•„์ง„๋‹ค๋Š” ๊ฒƒ์ด๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์ œ 2 ์–ธ์–ด ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ๋ถ„์„ํ•  ๋•Œ ๊ทธ ํ•˜์œ„ ์š”์†Œ๋ฅผ ๋น„๊ต๋ถ„์„ํ•˜๋Š” ์ ‘๊ทผ๋ฒ•์ด ํ•™์Šต์ž์˜ ์ฝ๊ธฐ ๋ฐœ๋‹ฌ ๋‹จ๊ณ„๋ฅผ ์ง„๋‹จํ•˜๋Š” ๋ฐ ์œ ์šฉํ•˜๋‹ค๋Š” ์‹œ์‚ฌ์ ์„ ์ด๋Œ์–ด๋‚ด์—ˆ๋‹ค. ์ฝ๊ธฐ ํ•™์Šต ์ดˆ๊ธฐ์— ๊ธฐ์ดˆ์ ์ธ ์ฝ๊ธฐ ๋Šฅ๋ ฅ์„ ํ™•๋ฆฝํ•  ์ˆ˜ ์žˆ๋„๋ก ํ–ฅํ›„ ์ œ 2 ์–ธ์–ด ์ฝ๊ธฐ ์ง€๋„์— ๋ณธ ๋ถ„์„๋ฒ•์„ ์ ๊ทน์ ์œผ๋กœ ํ™œ์šฉํ•ด์•ผ ํ•  ๊ฒƒ์ด๋‹ค.Abstract i Table of Contents iii List of Tables v List of Figures v Chapter 1. Introduction 1 1.1 Background and Purpose of the Study 1 1.2 Research Questions 5 1.3 Organization of the Thesis 6 Chapter 2. Literature Review 7 2.1 Reading Comprehension Studies 7 2.2 Factors Influencing Reading Comprehension 12 2.2.1 Word Decoding 13 2.2.2 Vocabulary 15 2.2.3 Morphosyntax 16 2.2.4 Listening Comprehension 18 2.3 Reading Comprehension Factors by Age/Proficiency 20 Chapter 3. Methodology 26 3.1 Participants 26 3.2 Materials 28 3.2.1 Word Decoding 28 3.2.2 Vocabulary 29 3.2.3 Morphosyntax 31 3.2.4 Listening Comprehension 33 3.2.5 Reading Comprehension 34 3.2.6 Survey 35 3.3 Data Collection 35 3.3.1 Pilot Study 35 3.3.2 Main Study 38 3.4 Data Analysis 39 Chapter 4. Results and Discussion 41 4.1 Results 41 4.1.1 Relations Between Reading Comprehension and its Component Skills 41 4.1.2 The Contribution of Component Skills to Reading Comprehension 44 4.2 Discussion 47 4.2.1 Relations Between Reading Comprehension and its Component Skills 47 4.2.2 The Contribution of Component Skills to Reading Comprehension 48 Chapter 5. Conclusion 55 5.1 Summary of Major Findings 55 5.2 Pedagogical Implications 58 5.3 Limitations and Suggestions for Future Research 61 References 63 Appendices 73 Appendix A: Word Decoding Test: WRF (Word Reading Fluency) Subtest 73 Appendix B: Receptive Vocabulary Test Stimuli 74 Appendix C: Sentence Imitation Task Stimuli 75 Appendix D: An Example Set in Listening Comprehension Test 76 Appendix E: An Example Set in Reading Comprehension Test 77 Appendix F: Survey 79 ๊ตญ ๋ฌธ ์ดˆ ๋ก 80Maste

    Association of opioid receptor gene polymorphisms with drinking severity and impulsivity related to alcohol use disorder in a Korean population

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    AIMS: Recent evidence suggests that the opioid system is implicated in the pathophysiology of alcohol use disorder (AUD). We aimed to examine the genetic influence of opioid receptors on susceptibility to AUD and its clinical and psychological characteristics including harmful drinking behavior and various aspects of impulsivity in AUD patients. METHODS: Three ฮผ-opioid receptor gene (OPRM1) variants and two ฮบ-opioid receptor gene (OPRK1) variants were examined in 314 male patients with AUD and 324 male controls. We applied the Alcohol Use Disorders Identification Test (AUDIT), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Dependence Scale. AUD patients also completed the stop-signal task, delay discounting task, balloon analogue risk task, and the Barratt Impulsiveness Scale version 11 (BIS-11). RESULTS: No significant differences in genotype distributions or haplotype frequencies were found between AUD patients and controls. However, OPRK1 SNP rs6473797 was significantly related to the severity of alcohol-related symptoms as measured by AUDIT and OCDS and a haplotype containing rs6473797 was also related to OCDS scores in AUD patients. For other psychological traits, OPRM1 SNP rs495491 was significantly associated with scores on the motor subfactor of the BIS-11. CONCLUSION: Genetic variations in opioid receptors may contribute to symptom severity and impulsivity in AUD patients.ope

    Dysfunctional Metacognitive Beliefs in Patients With Obsessive-Compulsive Disorder and Pattern of Their Changes Following a 3-Month Treatment

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    Introduction: Metacognitions are considered to be crucial factors for the development and maintenance of pathologic anxiety. The present case-control study aimed to examine how metacognitive beliefs are associated with the diagnostic status and subtypes of obsessive-compulsive disorder (OCD). In addition, we examined the pattern of changes in metacognitive beliefs after a 3-month pharmacological treatment in patients with OCD. Methods: A total of 562 cases with OCD and 236 healthy controls were assessed with the Metacognitions Questionnaire (MCQ) and various measures of OC symptom severity. Multivariate analyses of variance (MANOVAs) with covariates were conducted to explore the relationship between subdimensions of metacognitive beliefs and OCD disease status. In addition, for the OCD patients, Pearson's correlation was performed between baseline MCQ subdimensions and Obsessive-Compulsive Inventory-Revised-Korean subscales (OCI-R-K). Finally, in a subset of drug-free OCD patients (n = 144), the MCQ was reassessed after 3 months of treatment and patterns of changes in subdimensions of the MCQ were examined. Results: Patients with OCD scored significantly higher on the four dimensions of the MCQ. There were significant associations between all MCQ subdimensions and OCI-R-K subscales. In the repeated-measure MANOVA, a significant group (non-responders vs. responders)-by-time interaction effect was found only for the negative beliefs about the uncontrollability and danger of worry (NB) subdimension (F = 10.75; ฮท2 = 0.072; p = 0.001). Conclusion: The presence of dysfunctional metacognitive beliefs in OCD subjects and their association with OCD characteristics suggest that dysfunctional metacognitions may play a crucial role in the pathophysiology of OCD. Improvement of metacognitive beliefs in the NB dimension may be a clinically meaningful correlate of good treatment response in the pharmacological treatment of OCD.ope

    Status assessment and cause of herbarium database errors

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› ๋†์—…์ƒ๋ช…๊ณผํ•™๋Œ€ํ•™ ์‚ฐ๋ฆผ๊ณผํ•™๋ถ€, 2017. 8. ์žฅ์ง„์„ฑ.ํ‘œ๋ณธ์€ ์ˆ˜ ๋ฐฑ ๋…„ ๊ฐ„์˜ ์ž์—ฐ์‚ฌ ์ •๋ณด๋ฅผ ์ถ•์ฒ™ํ•˜๊ณ  ์žˆ์œผ๋ฉฐ ์ƒ๋ฌผ๋‹ค์–‘์„ฑ ์—ฐ๊ตฌ์— ์žˆ์–ด ํ•ต์‹ฌ์ ์ธ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•ด ์™”๊ณ  ํ˜„์žฌ๋Š” ํ‘œ๋ณธ ์ •๋ณด๋ฅผ ๋””์ง€ํ„ธํ™” ํ•˜์—ฌ ์˜จ๋ผ์ธ์—์„œ ์ œ๊ณตํ•จ์œผ๋กœ์จ ๊ทธ ๊ฐ€์น˜๊ฐ€ ์ œ๊ณ ๋˜๊ณ  ์žˆ๋‹ค. ๊ตญ๋‚ด์—์„œ๋„ 2000๋…„๋Œ€ ์ „ํ›„๋ฅผ ์‹œ์ž‘์œผ๋กœ ํ‘œ๋ณธ์ •๋ณด์˜ ๋””์ง€ํ„ธํ™”์™€ ๋ฐ์ดํ„ฐ๋ฒ ์ด์Šค ๊ด€๋ จ ์‚ฌ์—…์ด ์ถ”์ง„๋˜๊ณ  ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์‹œ์Šคํ…œ์˜ ๊ตฌ์ถ•์ด๋‚˜ ์ž๋ฃŒ์˜ ์–‘์„ ๋Š˜๋ฆฌ๋Š”๋ฐ ๋น„ํ•ด ์ž๋ฃŒ์˜ ์งˆ์— ๋Œ€ํ•œ ๊ด€์‹ฌ, ์ฆ‰ ์ž๋ฃŒ ์ •์ œ์˜ ์ค‘์š”์„ฑ์— ๋Œ€ํ•œ ์ธ์‹์€ ๋ถ€์กฑํ•˜๋‹ค. ์ด์— ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๊ตญ๊ฐ€๊ธฐ๊ด€ ํ‘œ๋ณธDB์™€ ํ‘œ๋ณธ์˜ ๊ด€๋ฆฌ ํ˜„ํ™ฉ์— ๋Œ€ํ•œ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•˜๊ณ , ์˜ค๋ฅ˜๋ฅผ ์ ๊ฒ€ํ•˜๋ฉฐ, ์˜ค๋ฅ˜์˜ ์œ ํ˜• ๋ถ„์„์„ ํ†ตํ•ด ์›์ธ์„ ํŒŒ์•…ํ•ด ๋ณด๋ฉฐ ๋ถ€๋ถ„์ ์œผ๋กœ๋‚˜๋งˆ ์˜ค๋ฅ˜๋ฅผ ์ •์ œํ•  ์ˆ˜ ์žˆ๋Š” ๋ฐฉ๋ฒ•์„ ์ œ์‹œํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ๋Œ€์ƒ์€ ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์› ์‚ฐ๋ฆผ์ƒ๋ฌผํ‘œ๋ณธ๊ด€(KH)๊ณผ ๊ตญ๋ฆฝ์ƒ๋ฌผ์ž์›๊ด€(KB)์— ์†Œ์žฅ๋œ ์‹๋ฌผํ‘œ๋ณธ๊ณผ ํ‘œ๋ณธ์ •๋ณด๋กœ ์–‘ ๊ธฐ๊ด€์—์„œ ๋ชฉ๋ณธ 17,517 ์ ์˜ ์ขŒํ‘œ์ •๋ณด๋ฅผ ํฌํ•จํ•œ ์‹๋ฌผํ‘œ๋ณธ์ •๋ณด(์ผ์ฐจ์ข…๋ฐœ์ƒ์ •๋ณด)๋ฅผ ์ œ๊ณต๋ฐ›์•„ DBํ˜•์‹์œผ๋กœ ์ „ํ™˜ํ•˜๊ณ  ์ง์ ‘ ํ‘œ๋ณธ๊ด€์„ ๋ฐฉ๋ฌธํ•˜์—ฌ ํ‘œ๋ณธ์„ ๋™์ •ํ•˜์˜€๋‹ค. ๊ณต๊ฐ„์  ์˜ค๋ฅ˜์˜ ๊ฒฝ์šฐ ์ขŒํ‘œ ์ •๋ณด์˜ ๋ถ€์žฌ๊ฐ€ ๋ฌธ์ œ๊ฐ€ ๋˜์—ˆ๋‹ค. ๋ถ„๋ฅ˜ํ•™์ ์ธ ์˜ค๋ฅ˜์˜ ๊ฒฝ์šฐ ์กฐ์‚ฌ๋Œ€์ƒ ์ „์ฒด์˜ ํ‰๊ท  ์˜ค๋™์ •๋ฅ ์€ 10.4%์ •๋„์˜€๋Š”๋ฐ, ์˜ค๋™์ •์ด ์—†๋Š” ๋ถ„๋ฅ˜๊ตฐ๋ถ€ํ„ฐ 67.07%๋กœ ๋งค์šฐ ๋†’์€ ๋ถ„๋ฅ˜๊ตฐ๋“ค์ด ์„ž์—ฌ ์žˆ์œผ๋ฉฐ ์˜ค๋™์ •๋ฅ ์— ์žˆ์–ด ๋ถ„๋ฅ˜๊ตฐ๋ณ„ ๊ฒฝํ–ฅ์„ฑ์„ ์ฐพ๊ธฐ๊ฐ€ ์–ด๋ ค์› ๋‹ค. ์ด๋Š” ์ž๋ฃŒ๋ฅผ ์‚ฌ์šฉํ•จ์— ์žˆ์–ด ์‹ ๋ขฐ๋„๋ฅผ ํฌ๊ฒŒ ๋–จ์–ด๋œจ๋ฆฌ๋ฉฐ ์ž๋ฃŒ ์‚ฌ์šฉ ์ž์ฒด์— ๋Œ€ํ•œ ํ˜ผ๋ž€์„ ์•ผ๊ธฐํ•  ์ˆ˜ ์žˆ๋‹ค. ์˜ค๋ฅ˜์˜ ์ •์ œ์— ์žˆ์–ด ๊ณต๊ฐ„์ ์ธ ์˜ค๋ฅ˜๋Š” ์ง€๋ฆฌ์ฐธ์กฐ์—ฐ์‚ฐ์„ ์ด์šฉํ•ด ์ •์ œ๊ฐ€ ๊ฐ€๋Šฅํ•˜๋ฉฐ ๋ถ„๋ฅ˜ํ•™์ ์ธ ์˜ค๋ฅ˜๋Š” ๋ถ„ํฌ์ง€์—ญ ๋น„๊ต ๋ฐ ๋ถ„ํฌ๋„ ์ž‘์„ฑ์„ ํ†ตํ•ด 25.6% ์ •๋„๋ฅผ ํƒ์ง€ํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. DB์˜ ๊ด€๋ฆฌ ํ˜„ํ™ฉ ์ ๊ฒ€์—์„œ ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์› ๋ฌผํ‘ธ๋ ˆ๋‚˜๋ฌด์†๊ณผ ์ˆ˜์ˆ˜๊ฝƒ๋‹ค๋ฆฌ์† DB์™€ ์‹ค์ œ ํ‘œ๋ณธ์„ ๋Œ€์กฐ, ๋น„๊ตํ•ด๋ณธ ๊ฒฐ๊ณผ DB์™€ ์‹ค์ œ ํ‘œ๋ณธ ์‚ฌ์ด์— 30-38% ์ •๋„์˜ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ๋‹ค. DB๊ด€๋ฆฌ์— ์žˆ์–ด ํ•ต์‹ฌ์€ ์ž๋ฃŒ์˜ ๋ฐ์ดํ„ฐ๋ฒ ์ด์Šคํ™”๋กœ ํ‘œ๋ณธ์˜ ์ฑ„์ง‘๋ถ€ํ„ฐ ๋””์ง€ํ„ธํ™”, ์˜ค๋ฅ˜์˜ ์ ๊ฒ€, ์ •์ œ์™€ ์˜ˆ๋ฐฉ์˜ ๋ชจ๋“  ๊ณผ์ •์€ ๋ฐ์ดํ„ฐ๋ฒ ์ด์Šค๋ฅผ ํ†ตํ•ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•œ๋‹ค.์ œ1์žฅ ์„œ ๋ก  1 1. ์—ฐ๊ตฌ ๋ฐฐ๊ฒฝ 1 2. ์—ฐ๊ตฌ ๋ชฉ์  7 ์ œ 2์žฅ ์—ฐ ๊ตฌ ์‚ฌ 8 ์ œ 3์žฅ ์žฌ๋ฃŒ ๋ฐ ๋ฐฉ๋ฒ• 12 1. ์—ฐ๊ตฌ ๋Œ€์ƒ 12 2. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 14 ์ œ 4์žฅ ๊ฒฐ ๊ณผ 17 1. ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์›(KH) ํ‘œ๋ณธ DB ํ˜„ํ™ฉ ๋ฐ ํ’ˆ์งˆ 17 1.1. ํ‘œ๋ณธ DB ํ˜„ํ™ฉ 17 1.2. ํ‘œ๋ณธ DB ํ’ˆ์งˆ 20 1.2.1. ๋ช…๋ช…๋ฒ•์  ๋ฌธ์ œ 20 1.2.2. ๋ถ„๋ฅ˜ํ•™์  ์ •๋ฐ€์„ฑ 20 1.2.3. ๊ณต๊ฐ„ ์ •๋ณด์˜ ์ถฉ์‹ค๋„ 25 2. ๊ตญ๋ฆฝ์ˆ˜๋ชฉ์›(KH)๊ณผ ๊ตญ๋ฆฝ์ƒ๋ฌผ์ž์›๊ด€(KB) ํ‘œ๋ณธDB์˜ ๊ณต๊ฐ„์  ๋ฐ ๋ถ„๋ฅ˜ํ•™์  ์˜ค๋ฅ˜ 26 2.1. ๊ณต๊ฐ„์  ์˜ค๋ฅ˜ 26 2.2. ๋ถ„๋ฅ˜ํ•™์  ์˜ค๋ฅ˜ (์˜ค๋™์ •) 27 2.2.1. ๋ถ„๋ฅ˜ํ•™์  ์˜ค๋ฅ˜์˜ ํ˜„ํ™ฉ๊ณผ ๊ฒฝํ–ฅ์„ฑ 27 2.2.2. ๋ถ„๋ฅ˜ํ•™์  ์˜ค๋ฅ˜์˜ ์œ ํ˜• 33 3. ๋ถ„ํฌ๋„ ์ž‘์„ฑ์„ ํ†ตํ•œ ์˜ค๋ฅ˜์˜ ์˜ˆ์ธก 37 3.1. ๋ถ„ํฌ๋„์™€ ์˜ค๋ฅ˜์˜ ํƒ์ง€ 37 3.2. ์ข…๋ณ„ ๋ถ„ํฌ ์œ ํ˜•๊ณผ ์˜ˆ์ธก์˜ ๊ฒฐ๊ณผ 42 ์ œ 5์žฅ ๊ณ  ์ฐฐ 45 1. ํ‘œ๋ณธ ์ž๋ฃŒ ๋ฐ์ดํ„ฐ๋ฒ ์ด์Šคํ™”์˜ ์˜๋ฏธ 45 2. ์˜ค๋ฅ˜์˜ ์œ ํ˜•๋ณ„ ์ •์ œ ๋ฐฉ๋ฒ•์— ๋Œ€ํ•œ ๋…ผ์˜ 48 3. ๊ด€๋ฆฌ ์ ˆ์ฐจ ๋‹จ๊ณ„๋ณ„ ๋…ผ์˜ 57 ์ œ 6์žฅ ๊ฒฐ ๋ก  62 ์ธ์šฉ ๋ฌธํ—Œ 63 Appendix 74 Abstract 94Maste

    The Influence of Death Education on Medical Studentsโ€™ Attitudes towards Endโ€ofโ€Life Care: A Preliminary Study

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    End-of-life care competencies have been perceived as important and essential, so it has been suggested that end-of-life care be studied in undergraduate medical education. However, end-of-life care curriculum has mostly focused on acquisition of knowledge and skills rather than attitudes. Therefore, we aimed to explore whether education about death affects medical studentsโ€™ attitudes towards care for dying patients and perception of death anxiety, meaning in life, and self-esteem. A total of 15 first- or second-year medical students were surveyed with questionnaires before and after completing a 6-week death education course. Paired data analysis showed that participantsโ€™ attitudes towards caring for terminally ill patients and their caregivers improved significantly (t=-2.84, p=0.013) with an effect size of 0.73. In contrast, no significant changes were found in death anxiety, meaning in life, or self-esteem. All participants agreed that formal teaching about death and dying must be encouraged in medical schools. Our results suggest that death education may positively influence attitudes towards end-of-life care. Although replication with larger samples is necessary, this preliminary finding may support the importance of developmentally appropriate end-of-life care education in medical schools.ope

    ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ์˜ ์„ค์น˜ ํšจ๊ณผ ๋ถ„์„

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ํ™˜๊ฒฝ๋Œ€ํ•™์› : ํ™˜๊ฒฝ๊ณ„ํšํ•™๊ณผ(๊ตํ†ตํ•™์ „๊ณต), 2016. 8. ์ด์˜์ธ.๊ต์ฐจ๋กœ ๋‚ด ํ˜น์€ ๋ถ€๊ทผ์—์„œ ๋ฐœ์ƒํ•˜๋Š” ๊ตํ†ต์‚ฌ๊ณ ๋Š” ์ฐจ๋Ÿ‰ ํ”ผํ•ด ์™ธ์— ์‹ฌ๊ฐํ•œ ์ธ๋ช…ํ”ผํ•ด๋ฅผ ๊ฐ€์ ธ์˜ฌ ์ˆ˜ ์žˆ๋‹ค. ๊ต์ฐจ๋กœ์—์„œ ๋ฐœ์ƒํ•˜๋Š” ์‚ฌ๊ณ ์˜ ์›์ธ์œผ๋กœ๋Š” ์†๋„์œ„๋ฐ˜๊ณผ ์‹ ํ˜ธ์œ„๋ฐ˜์ด ํฐ ๋ถ€๋ถ„์„ ์ฐจ์ง€ํ•˜๊ณ  ์žˆ๋‹ค. ์ด์— ๊ต์ฐจ๋กœ์˜ ์‚ฌ๊ณ  ๊ฐ์†Œ์™€ ์ธ๋ช…ํ”ผํ•ด ๊ฐ์†Œ๋ฅผ ๋ชฉํ‘œ๋กœ ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ๋ฅผ ์„ค์น˜ํ•˜์—ฌ ์šด์˜ํ•˜๊ณ  ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๊ต์ฐจ๋กœ์˜ ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ์˜ ์„ค์น˜ ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ์—ฌ๋Ÿฌ ๊ฐ€์ง€ ์ง€ํ‘œ๋ฅผ ์„ ์ •ํ•œ๋‹ค. ๊ธฐ์กด ์—ฐ๊ตฌ์—์„œ ์‚ฌ์šฉํ•˜์˜€๋˜ ์‚ฌ๊ณ ๊ฑด์ˆ˜, ์‚ฌ๋ง๋ฅ  ๋“ฑ์˜ ์ง€ํ‘œ ๋Œ€์‹  ์†๋„์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ์˜ ์„ค์น˜ ํšจ๊ณผ ์ง€ํ‘œ๋กœ ์‚ฌ์šฉ๋˜๋Š” ์†๋„ ๋ฐ ๊ฐ๊ฐ€์†๋„์™€ ํ•จ๊ป˜ ์ฐจ๋Ÿ‰์˜ ํ†ตํ–‰ ํŠน์„ฑ์„ ๋ฐ˜์˜ํ•˜๋Š” ๋”œ๋ ˆ๋งˆ์กด์„ ์ง€ํ‘œ๋กœ ์„ ์ •ํ•œ๋‹ค. ๋˜ํ•œ, ๋”œ๋ ˆ๋งˆ์กด ์ง€ํ‘œ์˜ ๊ฒฝ์šฐ ๊ธฐ์กด์— ์‚ฌ์šฉํ•˜๋˜ ์‚ฐ์ •์‹์ด ์•„๋‹Œ ์กฐ๊ธˆ ๋” ํ˜„์‹ค์˜ ํ†ตํ–‰ ํŠน์„ฑ์„ ๋ฐ˜์˜ ํ•  ์ˆ˜ ์žˆ๋„๋ก ๋”œ๋ ˆ๋งˆ์กด ์‹œ์ž‘์ ๊ณผ ๋์ ์— ๊ฐ๊ฐ ๋‹ค๋ฅธ ํ†ตํ–‰ ์†๋„๋ฅผ ์ด์šฉํ•˜๋Š” ์‚ฐ์ •์‹์„ ์ ์šฉํ•œ๋‹ค. ์ž๋ฃŒ ์กฐ์‚ฌ๋ฅผ ์œ„ํ•ด์„œ ์„œ์šธ์‹œ ๋‚ด์˜ ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ๊ฐ€ ์„ค์น˜๋œ ๊ต์ฐจ๋กœ ์ค‘ ๋„๋กœ์„ ํ˜•, ์ข…๋‹จ๊ตฌ๋ฐฐ ๋“ฑ ๋„๋กœ์˜ ๊ธฐํ•˜๊ตฌ์กฐ๊ฐ€ ์กฐ์‚ฌ์— ์˜ํ–ฅ์„ ๋ฏธ์น  ์ˆ˜ ์žˆ๋Š” ๊ณณ์„ ์ œ์™ธํ•˜๊ณ , Landscape View๊ธฐ๋ฒ• ์ดฌ์˜์ด ์šฉ์ดํ•œ ๊ต์ฐจ๋กœ 6๊ฐœ(๋‚œ๊ณก์‚ฌ๊ฑฐ๋ฆฌ, ๋ด‰์ฒœ๋กœ์‚ฌ๊ฑฐ๋ฆฌ, ์–‘ํ‰๋™์‚ฌ๊ฑฐ๋ฆฌ, ๋ฌธ๋ž˜๋™์‚ฌ๊ฑฐ๋ฆฌ, ์„œ์šธ๋Œ€์ž…๊ตฌ์—ญ์‚ฌ๊ฑฐ๋ฆฌ, ์›๋‹น์ดˆ๊ต์ž…๊ตฌ์‚ฌ๊ฑฐ๋ฆฌ)๋ฅผ ์„ ์ •ํ•˜์˜€๋‹ค. ์กฐ์‚ฌ ์‹œ๊ฐ„์€ ๊ฐ ์ฐจ๋Ÿ‰์— ๋Œ€ํ•ด ์„ ํ–‰ ์ฐจ๋Ÿ‰์˜ ์˜ํ–ฅ์ด ์—†์–ด์•ผ ํ•˜๋ฏ€๋กœ ๊ตํ†ต๋Ÿ‰์ด ์ ์€ ์ƒˆ๋ฒฝ์‹œ๊ฐ„๋Œ€๋กœ ์ง„ํ–‰ํ•˜์˜€๋‹ค. ์†๋„ ์ง€ํ‘œ์˜ ๊ฒฝ์šฐ 6๊ฐœ์˜ ๊ต์ฐจ๋กœ ๋ชจ๋‘ ๋ฏธ๋‹จ์†์ง€์ ์— ๋น„ํ•ด ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ๊ฐ€ ์„ค์น˜๋œ ๋‹จ์†์ง€์ ์—์„œ ๋” ๋‚ฎ์€ ๊ฐ’์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๊ณ , ์†๋„์˜ ํ‘œ์ค€ํŽธ์ฐจ ์ง€ํ‘œ๋Š” 6๊ฐœ์˜ ๊ต์ฐจ๋กœ ์ค‘ 4๊ฐœ์˜ ๊ต์ฐจ๋กœ์—์„œ ๋ฏธ๋‹จ์†์ง€์ ์— ๋น„ํ•ด ๋‹จ์†์ง€์ ์ด ๋‚ฎ๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋‹จ์†์ง€์ ์˜ ์ „์ฒด ์ฐจ๋Ÿ‰ ํ†ตํ–‰ ์†๋„์˜ ๊ฐ์†Œ์™€ ํ‘œ์ค€ํŽธ์ฐจ๊ฐ€ ๋‚ฎ๊ฒŒ ๋‚˜ํƒ€๋‚œ ๊ฒƒ์€ ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ ์„ค์น˜์˜ ํšจ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚œ ๊ฒƒ์œผ๋กœ ํ•ด์„๋œ๋‹ค. ๋”œ๋ ˆ๋งˆ์กด ์ง€ํ‘œ๋Š” ๋ชจ๋“  ๊ต์ฐจ๋กœ์— ๋Œ€ํ•ด ๋‹จ์†์ง€์ ์—์„œ์˜ ๋”œ๋ ˆ๋งˆ์กด ๊ธธ์ด๊ฐ€ ๋ฏธ๋‹จ์†์ง€์ ์—์„œ์˜ ๋”œ๋ ˆ๋งˆ์กด ๊ธธ์ด๋ณด๋‹ค ์งง๊ฒŒ ๋‚˜ํƒ€๋‚ฌ์œผ๋ฉฐ, ๋”œ๋ ˆ๋งˆ์กด์˜ ์œ„์น˜ ๋˜ํ•œ ์ •์ง€์„ ์— ๊ฐ€๊น๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋”œ๋ ˆ๋งˆ์กด์˜ ๊ธธ์ด๊ฐ€ ๊ฐ์†Œํ• ์ˆ˜๋ก ๊ต์ฐจ๋กœ๋ฅผ ๋ถˆ์•ˆ์ „ํ•˜๊ฒŒ ํ†ต๊ณผํ•˜๋Š” ๊ตฌ๊ฐ„์ด ์งง์•„์ง€๋Š” ๊ฒƒ์ด๋ฏ€๋กœ ์‚ฌ๊ณ  ๊ฐ์†Œ์˜ ํšจ๊ณผ๊ฐ€ ์žˆ๋‹ค. ์†๋„ ์ง€ํ‘œ, ๋”œ๋ ˆ๋งˆ์กด ์ง€ํ‘œ ๋ถ„์„ ๊ฒฐ๊ณผ ๋ชจ๋‘ ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ์˜ ์„ค์น˜์˜ ํšจ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚˜๋Š” ๊ฒƒ์œผ๋กœ ๋ถ„์„๋˜์—ˆ๋‹ค.โ… . ์„œ๋ก  1 1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์  1 2. ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ 2 3. ์—ฐ๊ตฌ์˜ ๋ฐฉ๋ฒ• ๋ฐ ํ๋ฆ„๋„ 2 โ…ก. ์„ ํ–‰ ์—ฐ๊ตฌ์˜ ๊ณ ์ฐฐ 4 1. ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ 4 1) ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ ๊ฐœ์š” 4 2) ์‹ ํ˜ธ์œ„๋ฐ˜ ๊ฒ€์ง€๊ธฐ๋Šฅ 4 3) ์‹ ํ˜ธ์œ„๋ฐ˜ ๋‹จ์†๊ธฐ๋Šฅ 4 4) ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ ํšจ๊ณผ ๋ถ„์„ ๊ด€๋ จ ์—ฐ๊ตฌ 5 2. ์†๋„์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ 6 3. ๋”œ๋ ˆ๋งˆ์กด 7 4. ์„ ํ–‰์—ฐ๊ตฌ์˜ ํ•œ๊ณ„์  ๋ฐ ๋ณธ ์—ฐ๊ตฌ์™€์˜ ์ฐจ๋ณ„์„ฑ 9 โ…ข. ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ ์„ค์น˜ ํšจ๊ณผ ๋ถ„์„ ์ง€ํ‘œ 11 1. ์†๋„ ์ง€ํ‘œ 11 1) ํ‰๊ท  ์†๋„ 11 2) ์†๋„ ๋ถ„์‚ฐ ๋ฐ ํ‘œ์ค€ํŽธ์ฐจ 11 3) ํ‰๊ท  ๊ฐ๊ฐ€์†๋„ 12 2. ๋”œ๋ ˆ๋งˆ์กด ์ง€ํ‘œ 13 1) ์ •์˜ ๋ฐ ๊ฐ€์„ค ์„ค์ • 13 2) ๋”œ๋ ˆ๋งˆ์กด์˜ ์‹œ์ž‘์  14 3) ๋”œ๋ ˆ๋งˆ์กด์˜ ๋์  14 4) ๊ธฐ์กด ๋”œ๋ ˆ๋งˆ์กด ์‚ฐ์ •์‹๊ณผ์˜ ๋น„๊ต 15 โ…ฃ. ๋ถ„์„ ์ง€ํ‘œ ์ ์šฉ 16 1. ์ ์šฉ ๋ฐฉ๋ฒ• 16 1) ์ž๋ฃŒ์ˆ˜์ง‘ 16 2) ์ž๋ฃŒ ์ถ”์ถœ ๋ฐ ์ ์šฉ 22 2. ๋ถ„์„ ๋ฐฉ๋ฒ• 24 1) ๊ต์ฐจ๋กœ ์†๋„ ์ง€ํ‘œ ๋น„๊ต ๋ถ„์„ 24 2) ์ฐจ๋Ÿ‰ ํ†ตํ–‰ ํŠน์„ฑ ๋ถ„์„ 31 3) ๊ธฐ์กด ๋”œ๋ ˆ๋งˆ์กด ์‚ฐ์ •์‹๊ณผ ์ ์šฉ์‹ ๋น„๊ต๋ถ„์„ 35 4) ์‹ ํ˜ธ์œ„๋ฐ˜ ๋ฌด์ธ๋‹จ์† ์นด๋ฉ”๋ผ ์œ ๋ฌด ์ง€์  ๋น„๊ต ๋ถ„์„ 40 5) ์†Œ๊ฒฐ 46 โ…ค. ๊ฒฐ๋ก  48 1. ๊ฒฐ๋ก  48 2. ์—ฐ๊ตฌ์˜ ํ•œ๊ณ„ ๋ฐ ํ–ฅํ›„๊ณผ์ œ 50 ์ฐธ๊ณ  ๋ฌธํ—Œ 51 Abstract 53Maste

    ๋„๋‚ ๋“œ ์›Œ๋งฅ(Donald Reid Womack)์˜ ํ”ผ๋ฆฌ ๋…์ฃผ๊ณก <๊ธˆ๊ฐ•์ „๋„> ๋ถ„์„์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์Œ์•…๋Œ€ํ•™ ์Œ์•…๊ณผ, 2018. 2. ๊น€๊ฒฝ์•„.19์„ธ๊ธฐ ๋ง์˜ ๊ฐœํ™”๊ธฐ์— ์šฐ๋ฆฌ๋‚˜๋ผ์— ์„œ์–‘์Œ์•…์ด ์†Œ๊ฐœ๋˜๋ฉด์„œ ๊ตญ์•…์— ์ž‘๊ณก์ด๋ผ๋Š” ๊ฐœ๋…์ด ๋„์ž…๋œ ์ดํ›„, ํ˜„์žฌ๊นŒ์ง€ ๊ตญ์•…๊ธฐ์™€ ๊ตญ์•… ์–ด๋ฒ•์„ ํ™œ์šฉํ•œ ์™ธ๊ตญ ์ž‘๊ณก๊ฐ€๋“ค์˜ ๊ตญ์•…์ฐฝ์ž‘์ด ์ด๋ฃจ์–ด์ง€๊ณ  ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ๋ฏธ๊ตญ์˜ ์ž‘๊ณก๊ฐ€ ๋„๋‚ ๋“œ ์›Œ๋งฅ์˜ ์ฒซ ๋ฒˆ์งธ ํ”ผ๋ฆฌ๋…์ฃผ๊ณก (2017)๋ฅผ ์—ฐ๊ตฌ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€์œผ๋ฉฐ ๋ณธ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ์ฒซ์งธ, ๋Š” ์ด 122๋งˆ๋””๋กœ, Intro์™€ "A"โˆผ"J"์˜ ์ด 11๊ฐœ ๋ถ€๋ถ„์œผ๋กœ ์ด๋ฃจ์–ด์ ธ์žˆ์œผ๋ฉฐ, ๊ฐ ๋ถ€๋ถ„์„ ๋‚˜๋ˆ„๋Š” ๊ธฐ์ค€์€ ์ฃผ์Œ์˜ ์ด๋™๊ณผ ๋ฐ•์ž ํ˜น์€ ํ…œํฌ, ์Œ์—ญ์˜ ๋ณ€ํ™”์ด๋‹ค. ์ด ๋ถ€๋ถ„๋“ค์€ ๊ณก์˜ ํ…œํฌ์™€ ์ฃผ์ œ์— ๋”ฐ๋ผ 4๊ฐœ์˜ ๋‹จ๋ฝ์œผ๋กœ ๊ตฌ๋ถ„ํ•  ์ˆ˜ ์žˆ๋‹ค. ๋‘˜์งธ, ์ฃผ์ œ๋ณ„๋กœ ํŠน์ • ์„ ์œจํ˜•์„ ํ™œ์šฉํ•˜์˜€๋‹ค. ์ด ๊ณก์€ ๊ธˆ๊ฐ•์‚ฐ ์‚ฐํ–‰์˜ ๊ณผ์ • ๋ฐ ๊ทธ์— ๋”ฐ๋ฅธ ์‹ฌ๋ฆฌ์ƒํƒœ๋ฅผ ํ‘œํ˜„ํ•œ ๊ฒƒ์œผ๋กœ ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ์‚ฐํ–‰ ์ „์ธ Intro ๋ฐ "A"์™€ ์‚ฐํ–‰ ํ›„์ธ "J"์— ๊ฐ™์€ ์„ ์œจํ˜•์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์‚ฐํ–‰์„ ์‹œ์ž‘ํ•˜๋Š” "B"์˜ ์„ ์œจํ˜•์€ ์‚ฐํ–‰์„ ์žฌ๊ฐœํ•˜๋Š” "E"-"F'"์— ํ™œ์šฉํ•˜์˜€๋‹ค. ์‚ฐํ–‰ ์ค‘๊ฐ„์„ ํ‘œํ˜„ํ•œ "C"์˜ ์„ ์œจํ˜•์„ ๋ณ€ํ˜•์‹œ์ผœ ๋’ค์ด์–ด ๋‚˜์˜ค๋Š” ํœด์‹ ๋ถ€๋ถ„์ธ "D"์—์„œ ์‚ฌ์šฉํ–ˆ๋‹ค. ์‚ฐํ–‰์ด ๊ณ ์กฐ๋˜๋Š” "G-"H"-"I" ๋ถ€๋ถ„์—๋Š” ์‚ฐํ–‰ ์ดˆ์ž…์ธ "A" ์˜ ํ›„๋ฐ˜๋ถ€์™€ ์‚ฐํ–‰์„ ์‹œ์ž‘ํ•˜๋Š” "B"์˜ ์ „๋ฐ˜๋ถ€์˜ ์„ ์œจํ˜•์„ ํ™œ์šฉํ•˜์˜€๋‹ค. ์…‹์งธ, ์•…๊ณก์˜ ์กฐํ‘œ๊ฐ€ ์•„๋‹Œ ์ž„์‹œํ‘œ ๋ฐ ์ฃผ์Œ๊ณผ 5์Œ์„ ํ†ตํ•ด ์Œ๊ณ„๋ฅผ ์œ ์ถ”ํ•  ์ˆ˜ ์žˆ๋‹ค. ์ž‘๊ณก๊ฐ€๋Š” ์ฃผ์Œ๊ณผ 5์Œ์„ ์‚ฌ์šฉํ•˜์—ฌ ์Œ์˜ ๋ฐฐ์—ด์„ ์˜๋„ํ•˜์˜€์œผ๋ฉฐ, ์Œ๊ณ„๋Š” ๋Œ€๋ถ€๋ถ„ 1-2์Œ๊ณผ 5-6์Œ์ด ๋ฐ˜์Œ์ธ ํ”„๋ฆฌ์ง€์•ˆ ์„ ๋ฒ•์œผ๋กœ ์ด๋ฃจ์–ด์ ธ์žˆ๋‹ค. ๋„ท์งธ, ๊ณก์˜ ๊ธด์žฅ๊ณผ ์ด์™„์„ ์กฐ์ ˆํ•˜๋Š” ๊ฒƒ์€ ํ…œํฌ์˜ ๋ณ€ํ™”, ํ”ผ๋ฆฌ ์„ ์œจ์˜ ์Œ์—ญ, ๋„์•ฝ์˜ ๋†’๋‚ฎ์ด, ์žฅ๊ตฌ ๋ฆฌ๋“ฌ์˜ ๋ณ€ํ™”, ์…ˆ์—ฌ๋ฆผ ๋“ฑ์ด๋‹ค. ๋‹ค์„ฏ์งธ, ์ด ๊ณก์— ๋‚˜ํƒ€๋‚œ ์ „ํ†ต์Œ์•…์  ์š”์†Œ๋Š” ๋‹ค์–‘ํ•œ ์ข…๋ฅ˜์˜ ๋†์Œ, ํ‡ด์„ฑ, ์ถ”์„ฑ ๋“ฑ์˜ ์‹œ๊น€์ƒˆ์™€ ์ „ํ†ต์„ ์œจ์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ๊พธ๋ฐˆ์Œ์ด๋ผ๊ณ  ๋ณผ ์ˆ˜ ์žˆ๋Š”๋ฐ, ์ด๋Š” ์•…๊ธฐ์˜ ํŠน์„ฑ์„ ์‚ด๋ฆฐ ๊ฒƒ์ด๋ผ๊ณ  ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ๋˜ํ•œ ํ•œ๊ตญ ์ „ํ†ต์Œ์•…์  ์š”์†Œ๋Š” ์•„๋‹ˆ์ง€๋งŒ ์•…๊ธฐ์˜ ํŠน์ง•์œผ๋กœ ์ธํ•œ ์š”์†Œ๋Š” ์ฃผ๋ฒ•์„ ์ด์šฉํ•œ ํฌ๋ฅดํƒ€๋ฉ˜ํ† , ๊ทน์ ์ธ ์…ˆ์—ฌ๋ฆผ ํ‘œํ˜„, ํ‰์ทจ์™€ ์—ญ์ทจ๋ฅผ ์ด์šฉํ•œ ๋‹ค์–‘ํ•œ ์Œ์ƒ‰์˜ ๋ณ€ํ™”์ด๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด ๋ฐœ๊ฒฌํ•œ ๋‚ด์šฉ ์ค‘ ๊ฐ€์žฅ ์ฃผ๋ชฉํ•  ๋งŒํ•œ ์ ์€ ์ž‘๊ณก๊ฐ€๊ฐ€ ์ „ํ†ต์˜ ๊ฐœ๋…์„ ๊ตญ์•… ์–ด๋ฒ•์ด ์•„๋‹Œ ์•…๊ธฐ ์ž์ฒด์—์„œ ์ฐพ๊ณ  ์žˆ๋‹ค๋Š” ๊ฒƒ์ด๋‹ค. ์ž‘๊ณก๊ฐ€๋Š” ์—ฐ์ฃผ์ž์™€์˜ ๊ต๋ฅ˜์™€ ์•…๊ธฐ์— ๋Œ€ํ•œ ๊นŠ์€ ์ดํ•ด๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ๋ณธ ๊ณก์— ํ”ผ๋ฆฌ์˜ ํ•ต์‹ฌ์ ์ด๊ณ  ์ง๊ด€์ ์ธ ํ‘œํ˜„์„ ํ™œ์šฉํ•˜๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ๋ฐฉ์‹์€ ํฌ์ŠคํŠธ๋ชจ๋”๋‹ˆ์ฆ˜ ์‚ฌ์กฐ์˜ ํŠน์„ฑ์„ ์ง€๋‹Œ ํ˜„๋Œ€์Œ์•…์—์„œ ๋ณธ ๊ณก์ด ๋…์ž์„ฑ์„ ๊ฐ–๋„๋ก ํ•˜๋Š” ์š”์†Œ๋กœ ๋ณผ ์ˆ˜ ์žˆ๋‹ค.โ… . ์„œ๋ก  1 1. ๋ฌธ์ œ์ œ๊ธฐ ๋ฐ ์—ฐ๊ตฌ๋ชฉ์  1 2. ์„ ํ–‰์—ฐ๊ตฌ ๊ฒ€ํ†  8 3. ์—ฐ๊ตฌ๋ฒ”์œ„ ๋ฐ ์—ฐ๊ตฌ๋ฐฉ๋ฒ• 12 โ…ก. ๋ณธ๋ก  14 1. ์ž‘๊ณก๊ฐ€์˜ ์Œ์•…์  ๋ฐฐ๊ฒฝ ๋ฐ ์ž‘ํ’ˆ ๊ฐœ์š” 14 1) ์Œ์•…์  ๋ฐฐ๊ฒฝ ๋ฐ ์ž‘ํ’ˆ ํ™œ๋™ 14 2) ์ž‘ํ’ˆ ๊ฐœ์š” ๋ฐ ์•…๊ณก ๊ตฌ์กฐ 21 2. ๋ถ„์„ 26 1) ๊ฐ ๋ถ€๋ถ„์˜ ์ถœํ˜„์Œ ๋ฐ ์Œ๊ณ„ 26 2) Intro : ์ œ1-5๋งˆ๋””(5๋งˆ๋””) 28 3) "A" : ์ œ6-14๋งˆ๋””(9๋งˆ๋””) 32 4) "B" : ์ œ15-26๋งˆ๋””(12๋งˆ๋””) 39 5) "C" : ์ œ27-48๋งˆ๋””(22๋งˆ๋””) 45 6) "D" : ์ œ49-54๋งˆ๋””(6๋งˆ๋””) 50 7) "E" : ์ œ55-77๋งˆ๋””(23๋งˆ๋””) 56 8) "F" : ์ œ78-89๋งˆ๋””(12๋งˆ๋””) 60 9) "G" : ์ œ90-99๋งˆ๋””(10๋งˆ๋””) 65 10) "H" : ์ œ100-108๋งˆ๋””(9๋งˆ๋””) 67 11) "I" : ์ œ109-117๋งˆ๋””(9๋งˆ๋””) 70 12) "J" : ์ œ118-122๋งˆ๋””(5๋งˆ๋””) 74 3. ํ”ผ๋ฆฌ ์ฃผ๋ฒ• ๋ฐ ์‹œ๊น€์ƒˆ ๋ถ„์„ 81 1) ํฌ๋ฅดํƒ€๋ฉ˜ํ†  82 2) ๋†์Œ 87 3) ํ‡ด์„ฑ 100 4) ์ถ”์„ฑ 101 โ…ข. ๊ฒฐ๋ก  105 ์ฐธ๊ณ ๋ฌธํ—Œ 107 Abstract 111 ์ž‘๊ณก๊ฐ€์™€์˜ ๊ต๋ฅ˜ ๋‚ด์šฉ 114 ์•…๋ณด 130Maste

    A Comprehensive Framework and Approaches for Enhancing Mental Health in Medical Students

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    Research suggests that medical students frequently experience mental health problems such as stress, burnout, and depression, which may, in turn, affect suicidal ideation and behaviors. Since mental health problems profoundly impact academic achievement and professionalism, it is vital to understand factors influencing studentsโ€™ mental health and identify strategies to provide the necessary support. Some relevant influencing factors range from the personal level, including gender, personality traits, perfectionism, and social support, to the environmental level, including the grading system, educational phases, exposure to patientsโ€™ death, mistreatment, and culture of medicine. In this regard, a comprehensive mental health support system that encompasses environmental interventions, as well as personal-level support, is needed. Simultaneously, proactive approaches that address the improvement of self-care and alleviation of systemic burdens are essential, together with the predominant reactive approaches focusing on problems and deficits. Altogether, we proposed a framework for enhancing mental health constructed by four categories (personal-reactive, environmental-reactive, personal-proactive, environmental-proactive) based on the intervention level and goal of support. All four categories have important implications, and one cannot replace the other, but expanding environmental-proactive support will allow more students to learn how to pursue health independently. We expect that this comprehensive framework for enhancing mental health could expand support systems for medical studentsโ€™ personal and professional development.ope

    Social Cognitive Theory and Medical Education: How Social Interactions Can Inform Learning

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    The structures and processes of medical education have changed little since the publication of Flexnerโ€™s report, which stressed the scientific orientation of medical education and the curricular structure of 2 years of formal knowledge education and 2 years of clinical experience. However, the previous perspectives on medical education are facing challenges, and these call for new pedagogy and theories on which to base medical education practice. Considering that social dimensions of learning have been emphasized in practice, perspectives that integrate these aspects are needed. Among the various learning theories, social cognitive theory refers to the theoretical framework which contends that learning occurs within interactions with others and environments. From a social cognitive standpoint, learning through observation is a critical component in human functioning. Indeed, observational learning has particular significance in medical education in that it provides the context for which the importance and meaning of role models can be understood. In addition, as theoretical constructs such as self-efficacy and outcome expectations allow us to establish an effective learning environment, exploring the concepts of the theory could be beneficial to medical education practice. In this context, the present review article aims to provide a glimpse of the fundamental assumptions and theoretical concepts of social cognitive theory and discusses the implications the theory has on teaching and learning. Further, a review of previous studies could help explain how the theory has informed medical education practice. Finally, the author will conclude with the implications and limitations of applying social cognitive theory in medical education.ope
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