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    ์ง€๋ฐฉ์กฐ์ง ์œ ๋ž˜ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์„ ํ™œ์šฉํ•œ ์ˆ˜์ง€์ƒ์„ธํฌ ๋งค๊ฐœ ๋ฉด์—ญ๋ฐ˜์‘ ํ–ฅ์ƒ

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์˜๊ณผ๋Œ€ํ•™ ์˜๊ณผํ•™๊ณผ, 2020. 8. ์กฐ๋‚จํ˜.์„œ๋ก : ์ˆ˜์ง€์ƒ์„ธํฌ๋Š” ๊ฐ€์žฅ ๊ฐ•๋ ฅํ•œ ํ•ญ์› ์ œ์‹œ ์„ธํฌ์ด๋‹ค. ์ˆ˜์ง€์ƒ์„ธํฌ๋Š” ์ข…์–‘์ด๋‚˜ ๋ณ‘์›์ฒด๋กœ๋ถ€ํ„ฐ ํ•ญ์›์„ ํš๋“ํ•˜์—ฌ ๋ฆผํ”„์ ˆ์˜ ๋ฏธ์ ‘์ด‰ T ์„ธํฌ์— ํ•ญ์›์„ ์ „๋‹ฌํ•˜์—ฌ ์ ์‘๋ฉด์—ญ์„ ์‹œ์ž‘ํ•  ์ˆ˜ ์žˆ๋„๋ก ํ•œ๋‹ค. ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ์ด๋Ÿฐ ๋Šฅ๋ ฅ ๋•๋ถ„์— ์ˆ˜์ง€์ƒ์„ธํฌ ํ•ญ์•”๋ฉด์—ญ์น˜๋ฃŒ์ œ๊ฐ€ ๊ฐœ๋ฐœ๋˜์—ˆ์ง€๋งŒ ๊ธฐ๋Œ€ํ–ˆ๋˜ ๊ฒƒ๋ณด๋‹ค ์ž„์ƒ์‹œํ—˜ ๊ฒฐ๊ณผ๋Š” ์ข‹์ง€ ์•Š์•˜๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ˆ˜์ง€์ƒ์„ธํฌ ๋งค๊ฐœ ๋ฉด์—ญ ๋ฐ˜์‘์„ ํ–ฅ์ƒ์‹œํ‚ค๊ธฐ ์œ„ํ•ด์„œ ์ง€๋ฐฉ ์กฐ์ง์—์„œ ์ถ”์ถœํ•œ ๊ธฐ์งˆ์„ธํฌ๋ฅผ ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ํ™œ์„ฑ์„ ๋†’์ผ ์ˆ˜ ์žˆ๋Š” ๊ตฌ์กฐ์  ํ”„๋ ˆ์ž„์œผ๋กœ ํ™œ์šฉํ•˜์˜€๋‹ค. ๋ฐฉ๋ฒ•: ์ง€๋ฐฉ ์กฐ์ง ์œ ๋ž˜ ๊ธฐ์งˆ ์„ธํฌ๋ฅผ ์–ป๊ธฐ ์œ„ํ•˜์—ฌ ๋‚ด์žฅ ์ง€๋ฐฉ๊ณผ ํ”ผํ•˜ ์ง€๋ฐฉ์œผ๋กœ๋ถ€ํ„ฐ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์„ ๋ถ„๋ฆฌยท๋ฐฐ์–‘ํ•˜์˜€๋‹ค. 6~10์ผ ๋™์•ˆ ๋ฐฐ์–‘ํ•œ ํ›„, ์ŠคํŽ˜๋กœ์ด๋“œ ๋ฐฐ์–‘ ์šฉ๊ธฐ์— ๋„ฃ๊ณ  ๋ฐฐ์–‘ํ•˜์—ฌ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์„ธํฌ๋กœ ๊ตฌ์„ฑ๋œ ์ŠคํŽ˜๋กœ์ด๋“œ๋ฅผ ์ƒ์„ฑํ•˜์˜€๋‹ค. ๋‹จ์ผ ์„ธํฌ ํ˜•ํƒœ์™€ ์ŠคํŽ˜๋กœ์ด๋“œ ํ˜•ํƒœ์˜ ์œ ์ „์ž ๋ฐœํ˜„ ์ฐจ์ด๋ฅผ ์ธก์ •ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ qPCR๊ณผ RNA ์‹œํ€€์‹ฑ ๋ถ„์„์ด ์ˆ˜ํ–‰๋˜์—ˆ๋‹ค. ์ˆ˜์ง€์ƒ์„ธํฌ๋Š” Rag2 ๊ฒฐ์† ๋งˆ์šฐ์Šค์—์„œ ๊ณจ์ˆ˜๋ฅผ ๋ถ„๋ฆฌํ•œ ํ›„, 6์ผ ์ด์ƒ ๋ฐฐ์–‘ํ•˜์—ฌ ์–ป์„ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ˆ˜์ง€์ƒ์„ธํฌ๋Š” LPS๋ฅผ ์ฒ˜๋ฆฌํ•˜์—ฌ ํ™œ์„ฑํ™”์‹œํ‚ค๊ณ  ์‹คํ—˜์— ์‚ฌ์šฉํ•˜์˜€๋‹ค. ํ•ญ์› ์ „๋‹ฌ์„ ์œ„ํ•ด ์‚ฐํ™”์ฒ -์‚ฐํ™”์•„์—ฐ ๋‚˜๋…ธ์ž…์ž์— ์‚ฐํ™”์•„์—ฐ์— ๊ฒฐํ•ฉํ•˜๋Š” ํŽฉํ‹ฐ๋“œ๊ฐ€ ๋ถ™์–ด์žˆ๋Š” ๋‚œ๋ฐฑ์•Œ๋ถ€๋ฏผ ์ž…์ž๋ฅผ ๊ฒฐํ•ฉ์‹œํ‚จ ํ›„, ์ˆ˜์ง€์ƒ์„ธํฌ์— ์ฒ˜๋ฆฌํ•˜์˜€๋‹ค. ์ŠคํŽ˜๋กœ์ด๋“œ ํ˜•ํƒœ์˜ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš๊ณผ ์ˆ˜์ง€์ƒ์„ธํฌ์— ์˜ํ•ด ์ƒ์ฒด ๋‚ด์—์„œ ํ˜•์„ฑ๋˜๋Š” ๊ตฌ์กฐ๋ฅผ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•ด ์‹ ์žฅ๋ง‰ ์•ˆ์— ์ด์‹ํ•˜์˜€๋‹ค. ์ƒ์ฒด ๋‚ด ๊ตฌ์กฐ๋Š” ๊ณต์ด›์  ํ˜•๊ด‘ ์ด๋ฏธ์ง• ๊ธฐ์ˆ ๊ณผ H&E ์—ผ์ƒ‰์œผ๋กœ ๋ถ„์„ํ•˜์˜€๋‹ค. ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš๊ณผ ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ์ƒํ˜ธ์ž‘์šฉ์€ ํ•จ๊ป˜ ๋ฐฐ์–‘ํ•˜์—ฌ ์ธก์ •ํ•˜์˜€๋‹ค. ํ•ญ์› ํŠน์ด์  ๋ฉด์—ญ๋ฐ˜์‘ ์ธก์ •์„ ์œ„ํ•ด ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ์™€ ์ˆ˜์ง€์ƒ์„ธํฌ๋ฅผ ๋งˆ์šฐ์Šค์— ๋ฉด์—ญํ•˜์˜€๊ณ  OVA-ํŠน์ด์  ์ฃผ์กฐ์ง์ ํ•ฉ์„ฑ ๋ณตํ•ฉ์ฒด ํ…ŒํŠธ๋ผ๋จธ๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์—ผ์ƒ‰ํ•œ ํ›„ ์œ ์„ธํฌ ๋ถ„์„๊ธฐ๋กœ ๋ถ„์„ํ•˜์˜€๋‹ค. ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš๊ณผ ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ํ•ญ์•”ํšจ๋Šฅ์„ ๊ฒ€์ฆํ•˜๊ธฐ ์œ„ํ•˜์—ฌ B16MO5 ์ข…์–‘์„ธํฌ๋ฅผ ๋งˆ์šฐ์Šค ์˜†๊ตฌ๋ฆฌ์— ์ฃผ์ž…ํ•œ ํ›„ 1์ฃผ์ผ ๊ฐ„๊ฒฉ์œผ๋กœ ์ด 3๋ฒˆ ๋ฉด์—ญํ•˜์˜€๊ณ , ์ข…์–‘์˜ ํฌ๊ธฐ์™€ ์ƒ์กด์œจ์„ ์ธก์ •ํ•˜์˜€๋‹ค. ๊ฒฐ๊ณผ: ๋ฐฐ์–‘๋œ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์€ ํ‘œํ˜„ ํ˜•์งˆ๊ณผ ๊ธฐ๋Šฅ์ด ๋ฆผํ”„์ ˆ ๊ธฐ์งˆ์„ธํฌ์™€ ์œ ์‚ฌํ•œ ์„ธํฌ๋“ค๋กœ ๊ตฌ์„ฑ๋˜์–ด ์žˆ๋‹ค๋Š” ์‚ฌ์‹ค์„ ํ™•์ธํ•˜์˜€๋‹ค. ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ๋Š” ํ˜ˆ๊ด€๊ณผ ์œ ์‚ฌํ•œ ๊ตฌ์กฐ๋ฅผ ์ƒ์ฒด ๋‚ดยท์™ธ์—์„œ ํ˜•์„ฑํ•˜์˜€๋‹ค. ๋˜ํ•œ, ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ๋Š” ๋ฉด์—ญ์„ธํฌ๋ฅผ ๋ถˆ๋Ÿฌ์˜ค๋Š” ์ผ€๋ชจ์นด์ธ๋“ค์„ ๋ฐœํ˜„ํ•˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•˜์˜€๊ณ , ์ƒ์ฒด ์™ธ ์‹คํ—˜์—์„œ ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ์ด๋™์„ ์ด‰์ง„ํ•˜๋Š” ๊ฒƒ์œผ๋กœ ํ™•์ธ๋˜์—ˆ๋‹ค. ๋˜ํ•œ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš๊ณผ ํ•จ๊ป˜ ๋ฐฐ์–‘ํ•œ ์„ฑ์ˆ™ ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ํ™œ์„ฑํ™” ์ •๋„์™€ ๋ถ„์—ด๋Šฅ๋ ฅ, ์ƒ์กด๋Šฅ์ด ์ฆ๊ฐ€ํ–ˆ์Œ์„ ํ™•์ธํ•˜์˜€๋‹ค. ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ์™€ ์ˆ˜์ง€์ƒ์„ธํฌ๋ฅผ ์‹ ์žฅ๋ง‰์— ์ด์‹ํ•œ ๊ฒฐ๊ณผ, 2์ฃผ ํ›„ ์ฃผ์ž…ํ•œ ์ž๋ฆฌ์— ๋Œ€์กฐ๊ตฐ๋ณด๋‹ค ํ›จ์”ฌ ๋งŽ์€ ์ˆซ์ž์˜ T ์„ธํฌ๊ฐ€ ๋ชจ์—ฌ ์žˆ๋Š” ๊ฒƒ์„ ํ™•์ธํ•˜์˜€๋‹ค. ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ์™€ ํ•ญ์›์„ ํƒ‘์žฌํ•œ ์ˆ˜์ง€์ƒ์„ธํฌ๋ฅผ ๋ฉด์—ญํ•œ ๋งˆ์šฐ์Šค์—์„œ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ๋งŒ ๋ฉด์—ญํ•˜๊ฑฐ๋‚˜ ์ˆ˜์ง€์ƒ์„ธํฌ๋งŒ ๋ฉด์—ญํ•œ ๋งˆ์šฐ์Šค๋ณด๋‹ค ํ•ญ์› ํŠน์ด์  T ์„ธํฌ ๋ฉด์—ญ๋ฐ˜์‘์ด ํ–ฅ์ƒ๋˜์–ด ์žˆ์Œ์ด ๊ด€์ฐฐ๋˜์—ˆ๋‹ค. ๊ฒŒ๋‹ค๊ฐ€, ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš ์ŠคํŽ˜๋กœ์ด๋“œ์™€ ์ˆ˜์ง€์ƒ์„ธํฌ๋ฅผ ์ฃผ์ž…ํ•œ ๋งˆ์šฐ์Šค์—์„œ๋Š” ์ข…์–‘์— ๋Œ€ํ•œ ํ•ญ์•” ํšจ๊ณผ๊ฐ€ ๋Œ€์กฐ๊ตฐ์— ๋น„ํ•ด ์œ ์˜ํ•˜๊ฒŒ ํ–ฅ์ƒ๋˜์–ด ์žˆ์Œ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๊ฒฐ๋ก : ์ข…ํ•ฉํ•ด ๋ณผ ๋•Œ, ๋ฐฐ์–‘ํ•œ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์€ ๋ฆผํ”„์ ˆ ๊ธฐ์งˆ์„ธํฌ์™€ ์œ ์‚ฌํ•œ ์„ธํฌ๋ฅผ ๋งŒ๋“œ๋Š”๋ฐ ์‚ฌ์šฉ๋  ์ˆ˜ ์žˆ๊ณ , ์ˆ˜์ง€์ƒ์„ธํฌ์˜ ํ™œ์„ฑ์„ ์ฆ๊ฐ€์‹œํ‚ฌ ์ˆ˜ ์žˆ๋‹ค. ์ด๋Š” ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์ด ์ˆ˜์ง€์ƒ์„ธํฌ ๋ฉด์—ญ์น˜๋ฃŒ์˜ ํ•ญ์› ํŠน์ด์  ๋ฉด์—ญ ๋ฐ˜์‘์„ ์ฆ๊ฐ€์‹œํ‚ค๊ณ , ์ข…์–‘์— ๋Œ€ํ•œ ํ•ญ์•”ํšจ๊ณผ๋ฅผ ํ–ฅ์ƒ์‹œํ‚ค๋Š” ๊ฒƒ์„ ํ†ตํ•ด ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๊ทธ๋Ÿฌ๋ฏ€๋กœ ๋ณธ ์—ฐ๊ตฌ๋Š” ์ง€๋ฐฉ ์กฐ์ง์—์„œ ๋ถ„๋ฆฌํ•œ ๊ธฐ์งˆํ˜ˆ๊ด€๋ถ„ํš์„ ํ™œ์šฉํ•˜์—ฌ ์ˆ˜์ง€์ƒ์„ธํฌ ๋งค๊ฐœ์˜ ๋ฉด์—ญ ๋ฐ˜์‘์„ ํ–ฅ์ƒ์‹œํ‚ฌ ์ˆ˜ ์žˆ๋Š” ์ƒˆ๋กœ์šด ๋ฐฉ๋ฒ•์„ ์ œ์‹œํ•˜์˜€๋‹ค.Introduction: Dendritic cell (DC) is the most potent antigen presenting cell. The DCs capture antigens from tumors or invading pathogens and delivery them to naive T cells in the lymph node, thereby priming an adaptive immune response. Based on the potency of DCs as professional antigen presenting cells, DCs have been applied to cancer immunotherapy. However, clinical outcomes have not been satisfactory. To improve the efficacy of DC-based therapy, stromal cells collected from fat tissues were applied as structural frames that support the functionality of DCs for priming and boosting antigen-specific T cell responses in vivo. Methods: To acquire the stromal cells, stromal vascular fractions (SVFs) were isolated from visceral and subcutaneous fat tissues of C57B/L6 mice via enzymatic digestion. SVF spheroids (SPHs) were generated by culturing SVFs in vitro for 6~10 days and seeding them in a spheroid-forming film. To assess differential gene expression in SVF and SPH, transcriptome and quantitative real-time RT-PCR were performed. DCs were prepared from bone marrow (BM) cells in Rag2 -/- mice. BMDCs were loaded with Fe3O4-ZnO core-shell nanoparticles (FZ-NPs) and ZnO-binding peptide (ZBP)-ovalbumin (OVA) complex and activated by lipopolysaccharides. In vivo organogenesis by SPHs and a mature DC mixture was examined after the renal subcapsular transplantation. In vivo structure was observed by confocal image and histological image. Antigen-specific immune responses were assessed after the immunization of mice with SPH and DC complexes, followed by staining with MHC-tetramer specific to OVA-peptide. The anti-tumor effect of immunization with SPH and DC complexes was also examined in mice bearing transplanted B16 melanoma expressing OVA. Results: This study found that cultured SVFs consisted of cells phenotypically and functionally similar to LN stromal cells. SVF SPHs generated vessel-like structures in vitro and in vivo. Moreover, SVF SPHs expressed various chemokines and attracted DCs in vitro. In addition, mature DCs co-cultured with SVFs showed enhanced activation and survival. Transplantation of SVF SPHs complexed with mature DCs also recruited T cells into the injection site in the kidney subcapsule. Immunization with SVF SPHs and OVA antigen-loaded DCs significantly improved antigen-specific T cell responses when compared with the administration of SVF SPHs or DCs alone. Moreover, the treatment of SVF SPHs and DC complexes showed significantly enhanced tumor suppression when compared with control groups. Conclusion: Taken together, cultured SVFs can be used as a functional frame mimicking LN stromal cells and can support the functionality of DCs, leading to enhanced antigen-specific T cell responses and an anti-tumor effect. Therefore, the present study suggests that SVFs isolated from fat tissues could be applied as promising cellular resources to improve DC-mediated immune response.1. Abstract 1 2. Contents 4 3. List of Tables and Figures 5 4. List of Abbreviations 7 5. Introduction 9 6. Materials & methods 14 7. Results 24 8. Discussion 70 9. References 75 10. ๊ตญ๋ฌธ ์ดˆ๋ก 87Docto

    Alliance Management of the US and China over Two Koreas' Nuclear Weapons Programs

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ๊ตญ์ œ๋Œ€ํ•™์› ๊ตญ์ œํ•™๊ณผ, 2021. 2. ์‹ ์„ฑํ˜ธ.By examining the alliance management of the US and China over two Koreas nuclear weapons programs, this dissertation finds the cause of nuclear restraint from security commitment. It asserts that a patron takes entrapment risk and increases security commitment when it fears nuclear proliferation greater than entrapment. This dissertation employs the combination of a case comparison method and a within-case method because nuclear restraint is a complex process that follows multiple steps, including rollback, suspension, or resumption of the nuclear weapons program. From 1974 to 1982, the US provided South Korea with an increasing commitment level because Washington worried more about nuclear proliferation than entrapment. The US perceived high risk of nuclear proliferation, which might cause a major destabilizing effect in Asia, where Washington built a security network of bilateral alliances. To avoid nuclear proliferation, the US took entrapment risk and terminated South Koreas nuclear weapons development. In contrast, from 1993 to 2009, China provided North Korea with a decreasing commitment level because Beijing was more concerned with entrapment than nuclear proliferation. China perceived high risk of entrapment from a possible North Korean regime collapse and a massive refugee influx across the border. To avoid entrapment, China remained at a low commitment level to North Korea, which eventually conducted nuclear tests and withdrew from nuclear negotiations. This finding expands our knowledge about the commitment by differentiating the risks of entrapment and nuclear proliferation. It also emphasizes the role of positive security commitment for nuclear restraint.์ด ๋…ผ๋ฌธ์€ ๋‚จ๋ถํ•œ ํ•ต๊ฐœ๋ฐœ์— ๋Œ€ํ•œ ๋ฏธ๊ตญ๊ณผ ์ค‘๊ตญ์˜ ๋™๋งน ๊ด€๋ฆฌ๋ฅผ ์—ฐ๊ตฌํ•จ์œผ๋กœ์จ ํ•ต๋ฌด๊ธฐ ๊ฐœ๋ฐœ ์ œ์ง€์˜ ์›์ธ์„ ์•ˆ๋ณด ๊ณต์•ฝ์—์„œ ์ฐพ๊ณ , ํ›„๊ฒฌ๊ตญ์ด ์—ฐ๋ฃจ๋ณด๋‹ค ํ•ตํ™•์‚ฐ์„ ๋” ๋‘๋ ค์›Œํ•  ๋•Œ ์—ฐ๋ฃจ์˜ ์œ„ํ—˜์„ ๊ฐ์ˆ˜ํ•˜๋ฉด์„œ ์•ˆ๋ณด ๊ณต์•ฝ์„ ์ฆ๊ฐ€ํ•œ๋‹ค๊ณ  ์ฃผ์žฅํ•œ๋‹ค. ํ•ต ์ œ์ง€๋Š” ํ•ต๊ฐœ๋ฐœ์˜ ๋กค๋ฐฑ(rollback), ์ž ์ •์ค‘๋‹จ, ์žฌ๊ฐœ ๋“ฑ ์—ฌ๋Ÿฌ ๋‹จ๊ณ„๋ฅผ ๊ฑฐ์น˜๋Š” ๋ณต์žกํ•œ ๊ณผ์ •์ธ ์ ์„ ๊ณ ๋ คํ•˜์—ฌ, ์‚ฌ๋ก€ ๋น„๊ต์™€ ๋‹จ์ผ ์‚ฌ๋ก€ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ•์„ ํ™œ์šฉํ•œ๋‹ค. 1974๋…„๋ถ€ํ„ฐ 1982๋…„๊นŒ์ง€ ๋ฏธ๊ตญ์€ ์—ฐ๋ฃจ๋ณด๋‹ค ํ•ตํ™•์‚ฐ์„ ๋” ๋‘๋ ค์›Œํ–ˆ๊ธฐ ๋•Œ๋ฌธ์— ํ•œ๊ตญ์— ๋Œ€ํ•œ ๊ณต์•ฝ์„ ์ฆ๊ฐ€ํ–ˆ๋‹ค. ๋ฏธ๊ตญ์€ ์–‘์ž ๋™๋งน ํ˜•ํƒœ์˜ ์•ˆ๋ณด ๋„คํŠธ์›Œํฌ๋ฅผ ๊ตฌ์ถ•ํ•œ ์•„์‹œ์•„์—์„œ ์ฃผ์š”ํ•œ ๋ถˆ์•ˆ์ • ํšจ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚  ๊ฒƒ์œผ๋กœ ๋ณด๊ณ  ํ•ตํ™•์‚ฐ์˜ ์œ„ํ—˜์„ ๋†’๊ฒŒ ์ธ์‹ํ–ˆ๋‹ค. ๋ฏธ๊ตญ์€ ํ•ตํ™•์‚ฐ์„ ํšŒํ”ผํ•˜๊ธฐ ์œ„ํ•ด ์—ฐ๋ฃจ์˜ ์œ„ํ—˜์„ ๊ฐ์ˆ˜ํ–ˆ๊ณ , ํ•œ๊ตญ์€ ํ•ต๊ฐœ๋ฐœ์„ ์ข…๋ฃŒํ–ˆ๋‹ค. ์ด์™€ ๋Œ€์กฐ์ ์œผ๋กœ 1993๋…„๋ถ€ํ„ฐ 2009๋…„๊นŒ์ง€ ์ค‘๊ตญ์€ ํ•ตํ™•์‚ฐ๋ณด๋‹ค ์—ฐ๋ฃจ๋ฅผ ๋” ๋‘๋ ค์›Œํ–ˆ๊ธฐ ๋•Œ๋ฌธ์— ๋ถํ•œ์— ๋Œ€ํ•œ ๊ณต์•ฝ์„ ๊ฐ์†Œํ–ˆ๋‹ค. ์ค‘๊ตญ์€ ๋ถํ•œ ์ฒด์ œ ๋ถ•๊ดด ๋ฐ ๋Œ€๊ทœ๋ชจ ๋‚œ๋ฏผ ์œ ์ž… ๊ฐ€๋Šฅ์„ฑ์„ ๋ณด๊ณ  ์—ฐ๋ฃจ์˜ ์œ„ํ—˜์„ ๋†’๊ฒŒ ์ธ์‹ํ–ˆ๋‹ค. ์ค‘๊ตญ์€ ์—ฐ๋ฃจ๋ฅผ ํšŒํ”ผํ•˜๊ธฐ ์œ„ํ•ด ๋‚ฎ์€ ์ˆ˜์ค€์˜ ๊ณต์•ฝ์„ ์œ ์ง€ํ–ˆ๊ณ , ๊ฒฐ๊ณผ์ ์œผ๋กœ ๋ถํ•œ์€ ํ•ต์‹คํ—˜์„ ๊ฐํ–‰ํ•˜๊ณ  ํ•ตํ˜‘์ƒ์œผ๋กœ๋ถ€ํ„ฐ ์ฒ ์ˆ˜ํ–ˆ๋‹ค. ์ด๋Ÿฌํ•œ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋Š” ์—ฐ๋ฃจ์™€ ํ•ตํ™•์‚ฐ์˜ ์œ„ํ—˜์„ ๊ตฌ๋ณ„ํ•จ์œผ๋กœ์จ ์•ˆ๋ณด ๊ณต์•ฝ์— ๋Œ€ํ•œ ์ง€์‹์„ ํ™•์žฅํ•˜๋Š”๋ฐ ๊ธฐ์—ฌํ•˜๋ฉฐ, ํ•ต ์ œ์ง€(nuclear restraint)๋ฅผ ์œ„ํ•œ ์ ๊ทน์  ์•ˆ์ „๋ณด์žฅ(positive security assurance)์˜ ์—ญํ• ์„ ๊ฐ•์กฐํ•œ๋‹ค.I. INTRODUCTION 1 1. Puzzle 2 2. Alliance and Nuclear Weapons 7 Alliance Management in Nuclear Restraint 7 Client's Motivation: Fear of Abandonment 9 Patron's Motivation: Nuclear Nonproliferation 12 3. Argument 19 4. Plan of Dissertation 24 II. THEORIES OF ALLIANCE MANAGEMENT 27 1. Theoretical Overview 27 Patron's Management Tool: Commitment 27 Patron's Management Challenge: Entrapment 32 Avoiding Entrapment: Withdrawal 35 Limits of Withdrawal 41 2. Theoretical Framework 46 Options of a Nuclear Weapons Program 47 Definition and Scope of Commitment 52 Avoiding Nuclear Proliferation: Commitment 58 Hard and Soft Commitments 69 3. Research Design 80 Case Selection 82 Sources 89 III. THE US AND NUCLEAR NONPROLIFERATION IN SOUTH KOREA 91 1. US Risk-taking Alliance Policy 91 Containment and the Hub-and-Spoke System 91 Dtente and Peace Through Partnership 97 Peace Through Strength and Alliances 106 2. South Korea from 1974 to 1976 112 Withdrawal and Warnings of Proliferation 112 Withholding of Nuclear Energy Cooperation 120 Assurance Despite Disengagement 123 South Korea's Reluctant Ratification of the NPT 130 3. South Korea from 1977 to 1982 134 A Proposal for Complete Withdrawal 134 The 1981 Summit to Restore the Alliance 143 Termination of the Nuclear Weapons Program 150 4. Conclusion 153 IV. CHINA AND NUCLEAR PROLIFERATION IN NORTH KOREA 161 1. China's Risk-averse Alliance Policy 161 A Reluctant Intervention in the Korean War 161 The Alliance of Lips and Teeth 165 Non-Alignment and the New Security Concept 171 2. North Korea from 1993 to 1994 180 Disengagement and the Yongbyon Reactor 180 Strategic Dilemma and Entrapment Fear 186 Opposition to International Pressure 190 Praise for the Agreed Framework 194 3. North Korea from 2003 to 2009 197 Devotion to Reform and Opening 197 Shuttle Diplomacy and the Six-Party Talks 204 Failed Nuclear Restraint 210 4. Conclusion 213 V. CONCLUSION 221 1. Main Argument and Findings 221 2. Policy Implications 228 Bibliography 233 Appendix 1. List of Important Visits by Chinese Leaders to North Korea 263 Appendix 2. List of Important Visits by North Korean Leaders to China 265 Abstract in Korean 267 Acknowledgments 268Docto

    Development and Application of the Program to Improve Pre-Service Chemistry Teachers Performance Assessment Professionalism

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ๊ณผํ•™๊ต์œก๊ณผ(ํ™”ํ•™์ „๊ณต), 2019. 2. ๋…ธํƒœํฌ.In order for a national curriculum that emphasizes the student-centered, level-based instruction to be settled appropriately in the actual school site, the assessment should also be changed correspondingly. Performance assessment can judge the level of individual students achievement reasonably compared to paper-based assessment which estimates the relative rank of students. In addition, performance assessment is an ideal assessment system that can implement constructivist assessment, which is a paradigm of current science education. As the achievement standards-based assessment system has recently been introduced, improving teacher's performance assessment professionalism becomes more important. However, many teachers have difficulty in planning and implementing performance assessment constructively. Therefore, seeking effective strategies to improve science teachers' performance assessment professionalism is needed. In the development of performance assessment, various pedagogical content knowledge (PCK) components such as science curriculum, science instructional strategies, students, subject matter, and orientation to science assessment are utilized with the knowledge of science assessment. Therefore, it can be useful to develop performance assessment professionalism through programs which provide assessment-related activities can use their PCK effectively. As basic research for the development of the program to improve science teachers performance assessment professionalism, the current status and problems of the science teachers assessment professionalism were investigated, and the necessity of education at the level of pre-service teacher was derived (Study I). Therefore, the characteristics of the processes of developing performance assessment tasks considered by pre-service chemistry teachers were investigated in terms of the PCK components and their integrations (Study II). After analyzing the results of studies I and II to construct strategies and activities, the program to improve pre-service chemistry teachers performance assessment professionalism was developed based on the principles of effective professional development. After applying this program to pre-service chemistry teachers, the characteristics of the PCK components and their integrations in the processes of developing performance assessment tasks were investigated and compared with the results of study II (Study III). In study I, actual and preferred cases of assessment of 92 secondary school science teachers were investigated with the focus on the purpose and the method of assessment. The use of formative assessment according to the background information of the teachers was also investigated. The analysis of the actually implemented assessments in their responses revealed that most science teachers tended to aim at traditional summative assessment purposes, and that multiple-choice was the most prevailing assessment method followed by experiment, report, and essay. For hypothetical performance assessment situations, they exhibited their preferences for various types of constructivist assessment methods, whereas their purposes of the assessment still remained to be traditional. In the experiment and open inquiry situations, those who had a relatively constructivist perspective toward assessment showed a statistically significant preference for using formative assessment than their counterparts (p=.018, p=.023). Through the study I, the importance of enhancing the perception of constructivist assessment of teachers was derived. However, it is difficult to achieve in a short period of time. In order to spread the constructivist performance assessment, education should begin at the pre-service teacher level, which can provide systematic and long-term education. As a result, the goal of this study could be embodied to improve pre-service chemistry teachers performance assessment professionalism. In study โ…ก, the characteristics of the PCK components and their integrations of pre-service teachers considered in the processes of developing performance assessment tasks were investigated. Eight pre-service chemistry teachers participated in this study. After brief workshop for performance assessment, they developed the performance assessment tasks through individual task development process and small group discussion process. Individual task development process consisted of the planning step and the embodying step. Their activities were recorded and videotaped. Semi-structured interviews were also conducted. It was found that the PCK component considered in individual task development process was concentrated on the knowledge of science assessment. The proportions of the knowledge of science curriculum, science instructional strategies and students were found to be relatively low. The feedback on students performance was not considered at all. The orientation to traditional assessment which emphasized the objectivity of assessment, was stronger in the embodying step rather than in the planning step. During the planning step, the integrations among the PCK components mainly appeared with the knowledge of science instructional strategies. However, they hardly appeared in the embodying step and small group discussion process. The main characteristics of the PCK in small group discussion process were similar with those in the embodying step. Some PCK components were considered more in small group discussion process, but most discussions were in the traditional perspectives. These results suggested that providing simple opportunities for developing performance assessment tasks had a significant limitation to improve pre-service teachers' performance assessment professionalism, and more substantive assistance should be provided in the aspect of utilization of the PCK components. In study III, the program to improve pre-service chemistry teachers performance assessment professionalism was developed by combining the results of studies I and II, based on the principles of effective professional development and professional development design framework. Considering the results of study II, the program provided the opportunity to utilize and develop PCK for them. Checklist and student misconception materials were also provided. Based on the results of study I, collaborative discussions between the researcher and pre-service teachers and discussions in the dual situation as a student and a teacher were conducted simultaneously to integrate theory and practice in constructivist performance assessment. Eight pre-service teachers who participated in the program for 3 weeks developed the performance assessment tasks in the same way as study II. Methods of data collection and analysis were also the same as study II to compare the results of two studies. In addition, the think-aloud method was used to investigate their developing processes of the performance assessment tasks. In individual task development process, the analysis of the results revealed that the PCK component considered in the planning step showed similar frequencies for the knowledge of science assessment, science instructional strategies, students, and subject matter components. In the embodying step, the knowledge of science assessment component was the most frequent. In small group discussion process, the frequencies for the knowledge of science assessment, science instructional strategies, and students components were similar. The integrations among the PCK components were found to be centered on the knowledge of science instructional strategies component in the planning step and the knowledge of students component in the embodying step. In small group discussion process, the knowledge of students was actively considered and provided an opportunity to integrate various PCK components. They also tried to overcome the gap between theory and practice in constructivist performance assessment toward a constructivist way. However, the knowledge of science curriculum component and the subcomponent of science process skill were rarely used. The knowledge of science curriculum and subject matter components were also rarely integrated with other PCK components. On the basis of the results, the role of researchers participating in collaborative discussions and specific ways for effective small group discussions were discussed in order to complement the program developed in this study. Also, specific plans for applying this program to the courses of the college of education and the need for a support system to connect a researcher and pre-service teachers were suggested in order to make effective use of the program.ํ•™์ƒ ์ค‘์‹ฌ์˜ ์ˆ˜์ค€๋ณ„ยท๋งž์ถคํ˜• ์ˆ˜์—…์„ ๊ฐ•์กฐํ•˜๋Š” ๊ตญ๊ฐ€ ์ˆ˜์ค€์˜ ๊ต์œก๊ณผ์ •์ด ํ•™๊ต ํ˜„์žฅ์— ์˜ฌ๋ฐ”๋ฅด๊ฒŒ ์ •์ฐฉํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ํ‰๊ฐ€๋„ ์ด์— ๋ถ€ํ•ฉํ•˜๋„๋ก ๋ณ€ํ™”ํ•ด์•ผ ํ•œ๋‹ค. ์ˆ˜ํ–‰ํ‰๊ฐ€๋Š” ํ•™์ƒ๋“ค์˜ ์ƒ๋Œ€์ ์ธ ์„์ฐจ๋ฅผ ์‚ฐ์ถœํ•˜๋Š” ์ง€ํ•„ํ‰๊ฐ€์— ๋น„ํ•ด ๊ฐœ๋ณ„ ํ•™์ƒ์˜ ์„ฑ์ทจ์ˆ˜์ค€์„ ํƒ€๋‹นํ•˜๊ฒŒ ํŒ๋‹จํ•  ์ˆ˜ ์žˆ๋Š” ํ‰๊ฐ€ ๋ฐฉ๋ฒ•์ด๋ฉฐ, ํ˜„์žฌ ๊ณผํ•™๊ต์œก์˜ ํŒจ๋Ÿฌ๋‹ค์ž„์œผ๋กœ ์ž๋ฆฌ ์žก์€ ๊ตฌ์„ฑ์ฃผ์˜์  ํ‰๊ฐ€๋ฅผ ๊ตฌํ˜„ํ•  ์ˆ˜ ์žˆ๋Š” ์ด์ƒ์ ์ธ ํ‰๊ฐ€ ์ฒด๊ณ„์ด๋‹ค. ์ตœ๊ทผ ์„ฑ์ทจํ‰๊ฐ€์ œ๊ฐ€ ๋„์ž…๋จ์— ๋”ฐ๋ผ, ๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์€ ๋”์šฑ ์ค‘์š”ํ•ด์ง€๊ณ  ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๋งŽ์€ ๊ณผํ•™๊ต์‚ฌ๋Š” ์ˆ˜ํ–‰ํ‰๊ฐ€๋ฅผ ๊ตฌ์„ฑ์ฃผ์˜์ ์œผ๋กœ ๊ฐœ๋ฐœํ•˜๊ณ  ์‹คํ–‰ํ•˜๋Š” ๋ฐ ์–ด๋ ค์›€์„ ๊ฒช๊ณ  ์žˆ๋‹ค. ๋”ฐ๋ผ์„œ ๊ณผํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์„ ์œ„ํ•œ ์ „๋žต์˜ ๋ชจ์ƒ‰์ด ํ•„์š”ํ•˜๋‹ค. ์ˆ˜ํ–‰ํ‰๊ฐ€์˜ ๊ฐœ๋ฐœ ๊ณผ์ •์—๋Š” ๊ณผํ•™ ํ‰๊ฐ€์— ๊ด€ํ•œ ์ง€์‹๋ฟ ์•„๋‹ˆ๋ผ ๊ณผํ•™๊ต์œก๊ณผ์ •, ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต, ํ•™์ƒ, ๊ณผํ•™ ๋‚ด์šฉ์— ๊ด€ํ•œ ์ง€์‹๊ณผ ๊ณผํ•™ ํ‰๊ฐ€์— ๊ด€ํ•œ ์‹ ๋… ๋“ฑ ๋‹ค์–‘ํ•œ ๊ต๊ณผ๊ต์œกํ•™ ์ง€์‹(pedagogical content knowledgePCK) ๊ตฌ์„ฑ์š”์†Œ๊ฐ€ ํ™œ์šฉ๋œ๋‹ค. ๋”ฐ๋ผ์„œ PCK๋ฅผ ํšจ๊ณผ์ ์œผ๋กœ ํ™œ์šฉํ•  ์ˆ˜ ์žˆ๋Š” ํ‰๊ฐ€ ๊ด€๋ จ ํ™œ๋™์„ ์ œ๊ณตํ•˜๋Š” ํ”„๋กœ๊ทธ๋žจ์„ ํ†ตํ•˜์—ฌ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์„ ๋„๋ชจํ•˜๋Š” ์ ‘๊ทผ ๋ฐฉ๋ฒ•์€ ์œ ์šฉํ•  ์ˆ˜ ์žˆ๋‹ค. ๊ณผํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ ํ”„๋กœ๊ทธ๋žจ์„ ๊ฐœ๋ฐœํ•˜๊ธฐ ์œ„ํ•œ ๊ธฐ์ดˆ ์—ฐ๊ตฌ๋กœ์„œ ์ค‘๋“ฑ ๊ณผํ•™๊ต์‚ฌ์˜ ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ์— ๊ด€ํ•œ ์ˆ˜์ค€๊ณผ ๋ฌธ์ œ์ ์„ ์กฐ์‚ฌํ•˜์˜€๊ณ , ์˜ˆ๋น„๊ต์‚ฌ ๋‹จ๊ณ„์—์„œ์˜ ๊ต์œก ํ•„์š”์„ฑ์„ ๋„์ถœํ•˜์˜€๋‹ค(์—ฐ๊ตฌ I). ์ด์— ์ค‘๋“ฑ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ํŠน์ง•์„ PCK ๊ตฌ์„ฑ์š”์†Œ์™€ ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด ์—ฐ๊ณ„์˜ ์ธก๋ฉด์—์„œ ์กฐ์‚ฌํ•˜์˜€๋‹ค(์—ฐ๊ตฌ II). ์ดํ›„ ์—ฐ๊ตฌ I๊ณผ II์˜ ๊ฒฐ๊ณผ๋ฅผ ๋ถ„์„ํ•˜์—ฌ ์ „๋žต๊ณผ ํ™œ๋™์„ ๊ตฌ์„ฑํ•˜๊ณ , ๊ต์‚ฌ ์ „๋ฌธ์„ฑ ๊ฐœ๋ฐœ ์›๋ฆฌ์— ๊ธฐ์ดˆํ•˜์—ฌ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์„ ์œ„ํ•œ ํ”„๋กœ๊ทธ๋žจ์„ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ๊ฐœ๋ฐœํ•œ ํ”„๋กœ๊ทธ๋žจ์„ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์—๊ฒŒ ์ ์šฉํ•œ ํ›„, ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ํŠน์ง•์„ PCK ๊ตฌ์„ฑ์š”์†Œ์™€ ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด ์—ฐ๊ณ„์˜ ์ธก๋ฉด์—์„œ ์กฐ์‚ฌํ•˜๊ณ  ์—ฐ๊ตฌ II์˜ ๊ฒฐ๊ณผ์™€ ๋น„๊ตํ•˜์˜€๋‹ค(์—ฐ๊ตฌ III). ์—ฐ๊ตฌ I์—์„œ๋Š” 92๋ช…์˜ ์ค‘๋“ฑ ๊ณผํ•™๊ต์‚ฌ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ๊ทธ๋“ค์ด ์‹ค์‹œํ•˜๋Š” ๊ณผํ•™ ํ‰๊ฐ€์™€ ์ง€ํ–ฅํ•˜๋Š” ํ‰๊ฐ€ ์‚ฌ๋ก€๋ฅผ ํ‰๊ฐ€ ๋ชฉ์ ๊ณผ ๋ฐฉ๋ฒ•์˜ ์ธก๋ฉด์—์„œ ์กฐ์‚ฌํ•˜์˜€๋‹ค. ๊ต์‚ฌ์˜ ๋ฐฐ๊ฒฝ ๋ณ€์ธ์— ๋”ฐ๋ฅธ ํ˜•์„ฑํ‰๊ฐ€์˜ ํ™œ์šฉ ์ •๋„๋„ ์กฐ์‚ฌํ•˜์˜€๋‹ค. ๊ต์‚ฌ๋“ค์ด ์‹ค์‹œํ•˜๋Š” ๊ณผํ•™ ํ‰๊ฐ€ ์‚ฌ๋ก€๋ฅผ ๋ถ„์„ํ•œ ๊ฒฐ๊ณผ, ๋Œ€๋ถ€๋ถ„์˜ ๊ต์‚ฌ๋“ค์€ ์ „ํ†ต์ ์ธ ์ด๊ด„ํ‰๊ฐ€ ๋ชฉ์ ์˜ ํ‰๊ฐ€๋ฅผ ์‹ค์‹œํ•˜๋Š” ๊ฒฝํ–ฅ์ด ์žˆ์—ˆ๊ณ , ์„ ๋‹คํ˜• ํ‰๊ฐ€, ์‹คํ—˜, ๋ณด๊ณ ์„œ, ๋…ผ์ˆ ํ˜• ํ‰๊ฐ€๊ฐ€ ๊ฐ€์žฅ ๋งŽ์ด ์‚ฌ์šฉํ•˜๋Š” ํ‰๊ฐ€ ๋ฐฉ๋ฒ•์ด์—ˆ๋‹ค. ์ „ํ˜•์ ์ธ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ƒํ™ฉ์—์„œ ๊ณผํ•™๊ต์‚ฌ๋“ค์€ ๋‹ค์–‘ํ•œ ์œ ํ˜•์˜ ๊ตฌ์„ฑ์ฃผ์˜์  ํ‰๊ฐ€ ๋ฐฉ๋ฒ•์„ ์ง€ํ–ฅํ–ˆ์ง€๋งŒ, ์—ฌ์ „ํžˆ ์ „ํ†ต์  ํ‰๊ฐ€ ๋ชฉ์ ์—์„œ ๋ฒ—์–ด๋‚˜์ง€๋Š” ๋ชปํ•˜์˜€๋‹ค. ์‹คํ—˜ ๋ฐ ์ž์œ ํƒ๊ตฌ ์ƒํ™ฉ์—์„œ ๊ตฌ์„ฑ์ฃผ์˜์  ๊ณผํ•™ ํ‰๊ฐ€๊ด€ ์ˆ˜์ค€์ด ๋†’์€ ๊ต์‚ฌ๊ฐ€ ํ˜•์„ฑํ‰๊ฐ€๋ฅผ ์ง€ํ–ฅํ•˜๋Š” ๋น„์œจ์€ ๊ตฌ์„ฑ์ฃผ์˜์  ๊ณผํ•™ ํ‰๊ฐ€๊ด€ ์ˆ˜์ค€์ด ๋‚ฎ์€ ๊ต์‚ฌ๋“ค์— ๋น„ํ•ด ์œ ์˜๋ฏธํ•˜๊ฒŒ ๋†’์•˜๋‹ค(p=.018, p=.023). ์—ฐ๊ตฌ I์„ ํ†ตํ•˜์—ฌ ๊ต์‚ฌ์˜ ๊ตฌ์„ฑ์ฃผ์˜์  ํ‰๊ฐ€์— ๋Œ€ํ•œ ์ธ์‹ ํ•จ์–‘์˜ ์ค‘์š”์„ฑ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ํ•˜์ง€๋งŒ ์ด๋Š” ๋‹จ๊ธฐ๊ฐ„์— ์ด๋ฃจ์–ด์ง€๊ธฐ ์–ด๋ ค์šฐ๋ฏ€๋กœ ๊ตฌ์„ฑ์ฃผ์˜์  ์ˆ˜ํ–‰ํ‰๊ฐ€์˜ ํ™•์‚ฐ์„ ์œ„ํ•ด์„œ๋Š” ์ฒด๊ณ„์ ์ด๊ณ  ์žฅ๊ธฐ์ ์ธ ๊ต์œก์ด ๊ฐ€๋Šฅํ•œ ์˜ˆ๋น„๊ต์‚ฌ ๋‹จ๊ณ„์—์„œ๋ถ€ํ„ฐ ๊ต์œก์ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•œ๋‹ค. ์ด์— ์ด ์—ฐ๊ตฌ์˜ ๋ชฉํ‘œ๋ฅผ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์œผ๋กœ ๊ตฌ์ฒดํ™”ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ II์—์„œ๋Š” ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ 8๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” PCK ๊ตฌ์„ฑ์š”์†Œ์™€ ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด ์—ฐ๊ณ„์˜ ํŠน์ง•์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ์ด๋“ค์€ ๊ฐ„๋‹จํ•œ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์›Œํฌ์ˆ ํ›„ ๊ตฌ์ƒ ๋‹จ๊ณ„, ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„๋กœ ์ด๋ฃจ์–ด์ง„ ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •๊ณผ ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์„ ๊ฑฐ์ณ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ๋ฅผ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ํ™œ๋™ ๊ณผ์ •์— ๋Œ€ํ•œ ๋…น์Œ ๋ฐ ๋…นํ™”์™€ ๋ฐ˜๊ตฌ์กฐํ™”๋œ ๋ฉด๋‹ด์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ๋ถ„์„ ๊ฒฐ๊ณผ, ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚œ PCK ๊ตฌ์„ฑ์š”์†Œ๋Š” ๊ณผํ•™ ํ‰๊ฐ€์— ๊ด€ํ•œ ์ง€์‹์— ํŽธ์ค‘๋˜์–ด ์žˆ์—ˆ๋‹ค. ๊ณผํ•™๊ต์œก๊ณผ์ •, ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต, ํ•™์ƒ์— ๊ด€ํ•œ ์ง€์‹์˜ ๋น„์œจ์€ ๋‚ฎ์•˜์œผ๋ฉฐ ํ•™์ƒ์—๊ฒŒ ์ œ๊ณต๋˜๋Š” ํ”ผ๋“œ๋ฐฑ๋„ ๊ณ ๋ ค๋˜์ง€ ์•Š์•˜๋‹ค. ๊ตฌ์ƒ ๋‹จ๊ณ„๋ณด๋‹ค ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„์—์„œ ํ‰๊ฐ€์˜ ๊ณต์ •์„ฑ๊ณผ ๊ฐ๊ด€์„ฑ์„ ์ค‘์‹œํ•˜๋Š” ์ „ํ†ต์  ํ‰๊ฐ€ ์ง€ํ–ฅ์ด ๊ฐ•ํ•˜๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„๋Š” ๊ตฌ์ƒ ๋‹จ๊ณ„์—์„œ ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต์— ๊ด€ํ•œ ์ง€์‹์„ ์ค‘์‹ฌ์œผ๋กœ ์ด๋ฃจ์–ด์กŒ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„ ๋ฐ ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์—์„œ PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„๋Š” ๊ฑฐ์˜ ๋‚˜ํƒ€๋‚˜์ง€ ์•Š์•˜๋‹ค. ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚œ PCK ๊ตฌ์„ฑ์š”์†Œ์˜ ํŠน์ง•์€ ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„์™€ ์œ ์‚ฌํ•˜์˜€๋‹ค. ์กฐ๋ณ„ ๋…ผ์˜๋ฅผ ํ†ตํ•˜์—ฌ ์˜ˆ๋น„๊ต์‚ฌ๋“ค์ด ๊ณ ๋ คํ•˜์ง€ ๋ชปํ–ˆ๋˜ ์ผ๋ถ€ PCK ๊ตฌ์„ฑ์š”์†Œ๊ฐ€ ๋ณด์™„๋˜์—ˆ์œผ๋‚˜ ๋…ผ์˜๊ฐ€ ์ฃผ๋กœ ์ „ํ†ต์  ๊ด€์ ์—์„œ ์ด๋ฃจ์–ด์กŒ๋‹ค. ์ด๋Š” ๋‹จ์ˆœํžˆ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ธฐํšŒ๋ฅผ ์ œ๊ณตํ•˜๋Š” ๊ฒƒ๋งŒ์œผ๋กœ๋Š” ์˜ˆ๋น„๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ์— ํฐ ํ•œ๊ณ„๊ฐ€ ์žˆ์œผ๋ฉฐ, PCK ๊ตฌ์„ฑ์š”์†Œ์˜ ํ™œ์šฉ ์ธก๋ฉด์—์„œ ๋”์šฑ ์‹ค์งˆ์ ์ธ ๋„์›€์ด ์ œ๊ณต๋˜์–ด์•ผ ํ•จ์„ ์‹œ์‚ฌํ•œ๋‹ค. ์—ฐ๊ตฌ III์—์„œ๋Š” ์—ฐ๊ตฌ I๊ณผ II์˜ ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•˜์—ฌ ๊ต์‚ฌ ์ „๋ฌธ์„ฑ ๊ฐœ๋ฐœ ์›๋ฆฌ์™€ ์ „๋ฌธ์„ฑ ๊ฐœ๋ฐœ ์„ค๊ณ„ ํ”„๋ ˆ์ž„์„ ๋ฐ”ํƒ•์œผ๋กœ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ ํ”„๋กœ๊ทธ๋žจ์„ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ II์˜ ๊ฒฐ๊ณผ๋ฅผ ๊ณ ๋ คํ•˜์—ฌ ์˜ˆ๋น„๊ต์‚ฌ๋“ค์ด PCK๋ฅผ ํ™œ์šฉํ•˜๊ณ  ๊ณ„๋ฐœํ•  ๊ธฐํšŒ๋ฅผ ์ œ๊ณตํ•˜์˜€์œผ๋ฉฐ, ์ ๊ฒ€ํ‘œ์™€ ํ•™์ƒ ์˜ค๊ฐœ๋… ์ž๋ฃŒ๋ฅผ ์ œ๊ณตํ•˜์˜€๋‹ค. ์ด์™€ ๋™์‹œ์— ์—ฐ๊ตฌ I์˜ ๊ฒฐ๊ณผ๋ฅผ ํ† ๋Œ€๋กœ ๊ตฌ์„ฑ์ฃผ์˜์  ์ˆ˜ํ–‰ํ‰๊ฐ€์— ๋Œ€ํ•œ ์ด๋ก ๊ณผ ์‹คํ–‰์„ ํ†ตํ•ฉํ•  ์ˆ˜ ์žˆ๋„๋ก ์—ฐ๊ตฌ์ž-์˜ˆ๋น„๊ต์‚ฌ ์‚ฌ์ด์˜ ํ˜‘๋ ฅ์  ๋…ผ์˜ ๋ฐ ๊ต์‚ฌ์™€ ํ•™์ƒ์˜ ์ด์ค‘์  ์ž…์žฅ์—์„œ์˜ ๋…ผ์˜ ํ™œ๋™์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ 8๋ช…์ด 3์ฃผ ๋™์•ˆ ํ”„๋กœ๊ทธ๋žจ์— ์ฐธ์—ฌํ•œ ํ›„ ์—ฐ๊ตฌ II์™€ ๊ฐ™์€ ๋ฐฉ๋ฒ•์œผ๋กœ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ๋ฅผ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ์ž๋ฃŒ ์ˆ˜์ง‘ ๋ฐ ๋ถ„์„ ๋ฐฉ๋ฒ•๋„ ์—ฐ๊ตฌ II์™€ ๊ฐ™๊ฒŒ ํ•˜์—ฌ ๋‘ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋ฅผ ๋น„๊ตํ•˜์˜€๊ณ , ์ถ”๊ฐ€๋กœ ๋ฐœ์„ฑ ์‚ฌ๊ณ ๋ฒ•์„ ํ™œ์šฉํ•˜์—ฌ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ์˜ ๊ฐœ๋ฐœ ๊ณผ์ •์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ ๋ถ„์„ ๊ฒฐ๊ณผ, ๊ตฌ์ƒ ๋‹จ๊ณ„์—์„œ๋Š” ๊ณผํ•™ ํ‰๊ฐ€, ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต, ํ•™์ƒ, ๊ณผํ•™ ๋‚ด์šฉ์— ๊ด€ํ•œ ์ง€์‹์ด ๊ฑฐ์˜ ๋™์ผํ•œ ๋น„์œจ๋กœ ๋‚˜ํƒ€๋‚ฌ๊ณ , ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„์—์„œ๋Š” ๊ณผํ•™ ํ‰๊ฐ€์— ๊ด€ํ•œ ์ง€์‹์ด ์ฃผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์—์„œ๋Š” ๊ณผํ•™ ํ‰๊ฐ€, ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต, ํ•™์ƒ์— ๊ด€ํ•œ ์ง€์‹์˜ ๋น„์œจ์ด ๊ฑฐ์˜ ๊ฐ™์•˜๋‹ค. PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„๋Š” ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ ๊ตฌ์ƒ ๋‹จ๊ณ„์—์„œ ๊ณผํ•™ ๊ต์ˆ˜ ์ „๋žต์— ๊ด€ํ•œ ์ง€์‹์„ ์ค‘์‹ฌ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๊ณ , ๊ตฌ์ฒดํ™” ๋‹จ๊ณ„์—์„œ๋Š” ํ•™์ƒ์— ๊ด€ํ•œ ์ง€์‹์„ ์ค‘์‹ฌ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์—์„œ๋Š” ํ•™์ƒ์— ๊ด€ํ•œ ์ง€์‹์ด ์ ๊ทน์ ์œผ๋กœ ๊ณ ๋ ค๋˜๋ฉด์„œ ๋‹ค๋ฅธ PCK ๊ตฌ์„ฑ์š”์†Œ์™€์˜ ์—ฐ๊ณ„๊ฐ€ ํ™œ๋ฐœํ•˜๊ฒŒ ์ด๋ฃจ์–ด์ง€๋Š” ๊ณ„๊ธฐ๊ฐ€ ๋˜์—ˆ์œผ๋ฉฐ, ๊ตฌ์„ฑ์ฃผ์˜์  ์ˆ˜ํ–‰ํ‰๊ฐ€์— ๋Œ€ํ•œ ์ด๋ก ๊ณผ ์‹คํ–‰์˜ ๊ฐ„๊ทน์„ ๊ตฌ์„ฑ์ฃผ์˜์ ์ธ ๋ฐฉํ–ฅ์œผ๋กœ ๊ทน๋ณตํ•˜๋ ค๋Š” ๋…ธ๋ ฅ๋„ ์ด๋ฃจ์–ด์กŒ๋‹ค. ํ•˜์ง€๋งŒ ๊ณผํ•™๊ต์œก๊ณผ์ •์— ๊ด€ํ•œ ์ง€์‹๊ณผ ํ•˜์œ„ ์š”์†Œ ์ค‘ ๊ณผํ•™ ๊ณผ์ • ์ง€์‹์„ ๊ณ ๋ คํ•œ ๊ฒฝ์šฐ๋Š” ๋“œ๋ฌผ์—ˆ๊ณ  ๊ณผํ•™๊ต์œก๊ณผ์ •๊ณผ ๊ณผํ•™ ๋‚ด์šฉ์— ๊ด€ํ•œ ์ง€์‹์ด ๋‹ค๋ฅธ PCK ๊ตฌ์„ฑ์š”์†Œ์™€ ์—ฐ๊ณ„๋˜๋Š” ๊ฒฝ์šฐ๋Š” ์ ์€ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์ƒ์˜ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ์ด ์—ฐ๊ตฌ์—์„œ ๊ฐœ๋ฐœํ•œ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ ํ”„๋กœ๊ทธ๋žจ์„ ๋ณด์™„์„ ์œ„ํ•ด ํ˜‘๋ ฅ์  ๋…ผ์˜์— ์ฐธ์—ฌํ•˜๋Š” ์—ฐ๊ตฌ์ž์˜ ์—ญํ•  ๋ฐ ์กฐ๋ณ„ ๋…ผ์˜๊ฐ€ ํšจ๊ณผ์ ์œผ๋กœ ์ด๋ฃจ์–ด์งˆ ์ˆ˜ ์žˆ๋„๋ก ํ•˜๋Š” ๋ฐฉ์•ˆ์— ๋Œ€ํ•˜์—ฌ ๋…ผ์˜ํ•˜์˜€๋‹ค. ๋˜ํ•œ, ํ”„๋กœ๊ทธ๋žจ์˜ ํšจ๊ณผ์ ์ธ ํ™œ์šฉ์„ ์œ„ํ•˜์—ฌ ์‚ฌ๋ฒ”๋Œ€ํ•™์— ๊ฐœ์„ค๋œ ๊ฐ•์ขŒ์— ์ด ํ”„๋กœ๊ทธ๋žจ์„ ์ ์šฉํ•˜๋Š” ๊ตฌ์ฒด์ ์ธ ๋ฐฉ์•ˆ ๋ฐ ์—ฐ๊ตฌ์ž์™€ ์˜ˆ๋น„๊ต์‚ฌ์˜ ์—ฐ๊ฒฐ์„ ์œ„ํ•œ ์ง€์› ์ฒด๊ณ„์˜ ํ•„์š”์„ฑ์„ ์ œ์–ธํ•˜์˜€๋‹ค.๊ตญ ๋ฌธ ์ดˆ ๋ก โ…ฐ ๋ชฉ ์ฐจ โ…ณ ํ‘œ ๋ชฉ ์ฐจ โ…ท ๊ทธ ๋ฆผ ๋ชฉ ์ฐจ โ…น ๋ถ€ ๋ก ๋ชฉ ์ฐจ โ…บ ์ œ 1 ์žฅ. ์„œ ๋ก  1. ์—ฐ๊ตฌ ๋ฐฐ๊ฒฝ๊ณผ ๋ชฉ์  1 2. ์—ฐ๊ตฌ ๋‚ด์šฉ 9 3. ์—ฐ๊ตฌ์˜ ์ œํ•œ์  11 4. ์šฉ์–ด์˜ ์ •์˜ 13 ์ œ 2 ์žฅ. ์ด๋ก ์  ๋ฐฐ๊ฒฝ ๋ฐ ์„ ํ–‰์—ฐ๊ตฌ 1. ๊ณผํ•™๊ต์‚ฌ์˜ PCK์™€ ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ 1.1 PCK 15 (1) PCK์˜ ๊ฐœ๋… 15 (2) PCK์˜ ๊ตฌ์„ฑ์š”์†Œ 18 1.2 ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ 21 (1) ํ•™์ƒํ‰๊ฐ€์˜ ๊ฐœ๋…๊ณผ ๋ชฉ์  21 (2) ์ˆ˜ํ–‰ํ‰๊ฐ€์˜ ์ •์˜์™€ ํŠน์ง• 24 (3) ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ์˜ ๊ฐœ๋…๊ณผ ๊ตฌ์ธ 33 1.3 PCK์™€ ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ์˜ ๊ด€๊ณ„ 38 2. ๊ณผํ•™๊ต์‚ฌ์˜ ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ 2.1 ๊ณผํ•™๊ต์‚ฌ์˜ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ 42 (1) ๊ต์‚ฌ ์ „๋ฌธ์„ฑ ๊ฐœ๋ฐœ ์›๋ฆฌ 43 (2) ์ „๋ฌธ์„ฑ ๊ฐœ๋ฐœ ์„ค๊ณ„ ํ”„๋ ˆ์ž„ 49 2.2 ๊ณผํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ๊ด€๋ จ ์„ ํ–‰์—ฐ๊ตฌ 55 (1) ํ‰๊ฐ€ ์‹คํƒœ์™€ ์ธ์‹ ์กฐ์‚ฌ 55 (2) ํ‰๊ฐ€ ๋ชจํ˜•, ๋„๊ตฌ, ๊ณผ์ œ ๊ฐœ๋ฐœ 58 (3) ํ‰๊ฐ€ ์ฑ„์  ๋ฐ ์ธก์ • 61 (4) ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ 63 ์ œ 3 ์žฅ. ์ค‘๋“ฑ ๊ณผํ•™๊ต์‚ฌ์˜ ๊ณผํ•™ ํ‰๊ฐ€ ์‹คํƒœ์™€ ์ง€ํ–ฅ (์—ฐ๊ตฌ I) 1. ์„œ ๋ก  67 2. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 69 2.1 ์—ฐ๊ตฌ ์ฐธ์—ฌ์ž 69 2.2 ์—ฐ๊ตฌ ์ ˆ์ฐจ 70 2.3 ๋ถ„์„ ๋ฐฉ๋ฒ• 71 3. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋ฐ ๋…ผ์˜ 73 3.1 ์ค‘๋“ฑ ๊ณผํ•™๊ต์‚ฌ์˜ ๊ณผํ•™ ํ‰๊ฐ€ ์‹คํƒœ 73 (1) ํ‰๊ฐ€ ๋ชฉ์  73 (2) ํ‰๊ฐ€ ๋ฐฉ๋ฒ• 76 3.2 ์ค‘๋“ฑ ๊ณผํ•™๊ต์‚ฌ์˜ ๊ณผํ•™ ํ‰๊ฐ€ ์ง€ํ–ฅ 78 (1) ํ‰๊ฐ€ ๋ชฉ์  78 (2) ํ‰๊ฐ€ ๋ฐฉ๋ฒ• 84 4. ๊ฒฐ ๋ก  88 ์ œ 4 ์žฅ. ์ค‘๋“ฑ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” PCK ๊ตฌ์„ฑ์š”์†Œ์˜ ํŠน์ง• (์—ฐ๊ตฌ II) 1. ์„œ ๋ก  91 2. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 92 2.1 ์—ฐ๊ตฌ ์ฐธ์—ฌ์ž 92 2.2 ์—ฐ๊ตฌ ์ ˆ์ฐจ 93 2.3 ๋ถ„์„ ๋ฐฉ๋ฒ• 97 3. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋ฐ ๋…ผ์˜ 99 3.1 ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ 99 3.2 ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„ 107 3.3 ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ ๋ฐ ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„ 110 4. ๊ฒฐ ๋ก  119 ์ œ 5 ์žฅ. ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ ํ”„๋กœ๊ทธ๋žจ์— ์ฐธ์—ฌํ•œ ์˜ˆ๋น„ ํ™”ํ•™๊ต์‚ฌ์˜ ์ˆ˜ํ–‰ํ‰๊ฐ€ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์—์„œ ๊ณ ๋ ค๋œ PCK ๊ตฌ์„ฑ์š”์†Œ ๋ฐ ์—ฐ๊ณ„์˜ ํŠน์ง• (์—ฐ๊ตฌ III) 1. ์„œ ๋ก  122 2. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 125 2.1 ์—ฐ๊ตฌ ์ฐธ์—ฌ์ž 125 2.2 ์ˆ˜ํ–‰ํ‰๊ฐ€ ์ „๋ฌธ์„ฑ ํ–ฅ์ƒ ํ”„๋กœ๊ทธ๋žจ 125 2.3 ์—ฐ๊ตฌ ์ ˆ์ฐจ 132 2.4 ๋ถ„์„ ๋ฐฉ๋ฒ• 134 3. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋ฐ ๋…ผ์˜ 135 3.1 ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ 135 3.2 ๊ฐœ๋ณ„ ๊ณผ์ œ ๊ฐœ๋ฐœ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„ 143 3.3 ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ 154 3.4 ์กฐ๋ณ„ ๋…ผ์˜ ๊ณผ์ •์˜ PCK ๊ตฌ์„ฑ์š”์†Œ ์‚ฌ์ด์˜ ์—ฐ๊ณ„ 161 4. ๊ฒฐ ๋ก  166 ์ œ 6 ์žฅ. ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 1. ์—ฐ๊ตฌ์˜ ์š”์•ฝ 169 2. ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 171 3. ์ถ”ํ›„ ์—ฐ๊ตฌ ๊ณผ์ œ 174 ์ฐธ๊ณ  ๋ฌธํ—Œ 177 ๋ถ€ ๋ก 200 ABSTRACT 214Docto

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    A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.ope

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    ๋ณธ ๋…ผ๋ฌธ์—๋Š” ์ฐจ์„ธ๋Œ€ ๋ฌด์„ ๋žœ ์‹œ์Šคํ…œ์— ์‚ฌ์šฉ๋  5GHz ๊ด‘๋Œ€์—ญ ๋ฌด์„ ํ†ต์‹ ์ฑ„๋„์˜ ์ธก์ •๊ณผ์ • ๋ฐ ์—ฐ๊ตฌ๊ฒฐ๊ณผ ๊ฐ€ ๋‚˜ํƒ€๋‚˜ ์žˆ๋‹ค. ์ธก์ •์‹œ์Šคํ…œ์€ ์œ ์‚ฌ์žก์Œ ์ƒ๊ด€๊ธฐ๋ฒ•์„ ์ด์šฉํ•˜์—ฌ ๋ฐœ์ƒ์‹œํ‚จ ๋Œ€์—ญํญ 100MHz์˜ ๊ด‘๋Œ€์—ญ ์‹  ํ˜ธ๋ฅผ ๋ฌด์ง€ํ–ฅ์„ฑ ์•ˆํ…Œ๋‚˜๋ฅผ ํ†ตํ•ด ์ฃผ๊ณ ๋ฐ›๋Š” ๋ฐฉ์‹์œผ๋กœ ๊ตฌ์„ฑ๋˜์—ˆ์œผ๋ฉฐ, ์ธก์ •์‹คํ—˜์€ ํ•œ๊ตญ์˜ ๋Œ€ํ‘œ์ ์ธ ๊ฑฐ์ฃผ ํ™˜๊ฒฝ์ธ ์•„ํŒŒํŠธ์—์„œ ์ด๋ฃจ์–ด์กŒ๋‹ค. ์†ก์‹ ๊ธฐ๋Š” ํŠน์ •ํ•œ ๊ฐ€์ •์˜ ํ•œ ๊ฐ€์šด๋ฐ ์ง€์ ๊ณผ ๋ฌด์„ ๋žœ์„ ๊ฐ€์žฅ ๋งŽ์ด ์‚ฌ์šฉ ํ•  ๊ฒƒ ๊ฐ™์€ ์ง€์ , 2๊ณณ์— ์„ค์น˜ํ•˜์˜€๊ณ  ์ˆ˜์‹ ๊ธฐ๋Š” ๊ฐ๊ฐ์˜ ์†ก์‹ ๊ธฐ ์œ„์น˜๋งˆ๋‹ค ๊ทธ ์ง‘ ๋‚ด๋ถ€์™€ ์ธ์ ‘ํ•œ ์ง‘๋“ค์˜ ์ฃผ์š”์ง€์ ์„ ์ด๋™ํ•˜๋ฉด์„œ ์†ก์‹ ์‹ ํ˜ธ๋ฅผ ์ธก์ •ํ•˜์˜€๋‹ค. ๊ทธ ๊ฒฐ๊ณผ, ์†ก์‹ ๊ธฐ๊ฐ€ ๊ฐ€์˜ฅ ๊ฐ€์šด๋ฐ์— ์กด์žฌํ•˜๋Š” ๊ฒƒ์ด ๊ฐ€ ์˜ฅ ๋‚ด์˜ ๊ณ ๋ฅธ ์ „ํŒŒํŠน์„ฑ์„ ์œ ์ง€ํ•˜๊ณ  ์ด์›ƒ์ง‘์œผ๋กœ์˜ ๊ฐ„์„ญ์„ ์ค„ ์ผ ์ˆ˜ ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋ณด์ด๋ฉฐ, ์‹œ์Šคํ…œ ์„ค๊ณ„ ์‹œ์— ์•ž ๊ฑด๋ฌผ์— ๋ฐ˜์‚ฌ๋˜์–ด ๋“ค์–ด์˜ค๋Š” ์‹ ํ˜ธ์— ๋Œ€ํ•œ ์ถฉ๋ถ„ํ•œ ๊ณ ๋ ค๊ฐ€ ์žˆ์–ด์•ผ ํ•  ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๊ฐ„์„ญ ๋ฌธ ์ œ์˜ ๊ฒฝ์šฐ, ์ด์›ƒ์ง‘์— ๋ฏธ์น˜๋Š” ๊ฐ„์„ญ์ด ์œ„, ์•„๋žซ์ง‘์— ๋ฏธ์น˜๋Š” ๊ฒƒ๋ณด๋‹ค ํฐ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค

    ๊ฐ€๊ฒฉ ๊ฒฝ์ง์„ฑ๊ณผ ์‚ฌํšŒํ›„์ƒ

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    ๋ณธ๊ณ ๋Š” ์‹ ์ถ•์  ๊ฐ€๊ฒฉํ•˜์—์„œ์˜ ๊ฒฝ์ œ, ์ฆ‰ ์ธํ”Œ๋ ˆ์ด์…˜์ด ์™œ๊ณก์„ ์œ ๋ฐœํ•˜์ง€ ์•Š๊ณ  ์ด์ƒ์‚ฐ์ด ํ•ญ์ƒ ์ž์—ฐ์‚ฐ์ถœ๋Ÿ‰ ์ˆ˜์ค€์„ ๋‹ฌ์„ฑํ•˜๋Š” ๊ฒฝ์ œ๊ฐ€ ๊ณผ์—ฐ ๊ฒฝ์ง์  ๊ฐ€๊ฒฉํ•˜์—์„œ์˜ ๊ฒฝ์ œ๋ณด๋‹ค ์‚ฌํšŒํ›„์ƒ์ธก๋ฉด์—์„œ ํ•ญ์ƒ ๋” ๋ฐ”๋žŒ์งํ•œ์ง€์— ๋Œ€ํ•ด ๋…ผ์˜ํ•œ๋‹ค. ํŠนํžˆ ๊ธˆ์œต์‹œ์žฅ์ด ๋ถˆ์™„์ „ํ•˜๊ณ ,๋ถ€๋ฌธ ๊ฐ„ ๋ช…๋ชฉ ๊ฒฝ์ง๋„๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ๋‹ค๋ฅด๋ฉฐ, ์‚ฌํšŒํ›„์ƒ ์ตœ๋Œ€ํ™”๋ฅผ ๋ชฉ์ ์œผ๋กœ ํ†ตํ™”์ •์ฑ…์ด ์šด์˜๋˜๋Š” ๊ฒฝ์šฐ, ๊ฒฝ์ง์  ๊ฐ€๊ฒฉ์ด ๊ฐ€๊ณ„ ํ›„์ƒ์— ๋” ์œ ๋ฆฌํ•˜๋‹ค๋Š” ์ ์„ ๋ฐํžŒ๋‹ค. ๋ถˆ์™„์ „ ๊ธˆ์œต์‹œ์žฅ์€ ์†Œ๋น„์™€ ์ƒ์‚ฐ์˜ ๋น„ํšจ์œจ์ ์ธ ๋ฐฐ๋ถ„์„ ์ดˆ๋ž˜ํ•œ๋‹ค. ํ†ตํ™”์ •์ฑ…์€ ๋ช…๋ชฉ ๊ฒฝ์ง์„ฑ ๋ฐ ๋ถˆ์™„์ „๊ธˆ์œต์‹œ์žฅ์œผ๋กœ ์ธํ•œ ํ›„์ƒ์†์‹ค์„ ์™„ํ™”ํ•  ์ˆ˜ ์žˆ์œผ๋‚˜, ์ด๋Š” ๊ฒฝ์ง์  ๊ฐ€๊ฒฉํ•˜์—์„œ์˜ ๊ฒฝ์ œ์— ์„œ๋งŒ ์œ ํšจํ•˜๋‹ค

    Learning Curve for Robot-Assisted Laparoscopic Radical Prostatectomy for Pathologic T2 Disease

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    PURPOSE: To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period. MATERIALS AND METHODS: Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient's perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin. RESULTS: There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p<0.001) and estimated blood loss (p<0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680). CONCLUSIONS: Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuouslyope

    ๋…์ผ ํ†ต์ผ๊ณผ ๋™๋…์ธ๋“ค์˜ ์„œ๋… ์œ ์ž… ๋ฌธ์ œ

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    ์ง€๋‚œ ํ•ด ์—ฐ์ด์€ ๋ถํ•œ ์ฃผ๋ฏผ๋“ค์˜ ํƒˆ๋ถ์‚ฌํƒœ๋Š” ์—ฐ๋ง์— ๊น€๊ฒฝํ˜ธ ์”จ ์ผ๊ฐ€ 17๋ช…์ด ์ง‘๋‹จ์œผ๋กœ ๋ถํ•œ์„ ํƒˆ์ถœํ•ด ์ค‘๊ตญ์„ ๊ฑฐ์ณ ๋‚จํ•œ์— ๋„์ฐฉํ•จ์œผ๋กœ์จ ์ •์ ์— ๋‹ฌํ–ˆ๋‹ค. ์—ฐ๋ณ€์„ ๋น„๋กฏํ•ด ์ค‘๊ตญ ์ผ๋Œ€์— ๋– ๋Œ๊ณ  ์žˆ๋Š” ํƒˆ๋ถ์ž๋“ค์˜ ์ˆ˜๊ฐ€ 300์—ฌ๋ช…์— ์ด๋ฅธ๋‹ค๋Š” ์–ธ๋ก  ๋ณด๋„๋„ ์žˆ์—ˆ๋‹ค. ์ •๋ถ€๋„ ๋ถํ•œ์˜ ์‹๋Ÿ‰๋‚œํŒŒ ๋งž๋ฌผ๋ ค ์•ž์œผ๋กœ ํƒˆ๋ถ์ž์˜ ์ˆ˜๊ฐ€ ์ ์  ๋Š˜์–ด๋‚  ๊ฒƒ์ด๋ผ๊ณ  ๋ณด๊ณ  ์ด์— ๋Œ€ํ•œ ๋Œ€์ฑ… ๋งˆ๋ จ์— ๋‚˜์„œ๊ณ  ์žˆ๋‹ค. ์ด๋Ÿฌํ•œ ์ผ๋ จ์˜ ์‚ฌํƒœ๋ฅผ ๋†“๊ณ ์„œ ๋‹ค์†Œ ์„ฃ๋ถ€๋ฅธ ๊ฐ์ด ์žˆ๊ธฐ๋Š” ํ•˜์ง€๋งŒ ๋ถํ•œ์˜ ์ฒด์žฌ ๋ถ•๊ดด๋ฅผ ์ ์น˜๋Š” ์ด๋“ค๋„ ์žˆ๋‹ค. ์ด์™€ ๊ด€๋ จํ•˜์—ฌ ์šฐ๋ฆฌ๋ณด๋‹ค ํ†ต์ผ๊ณผ์ •์„ ๋จผ์ € ๊ฒช์€ ๋…์ผ์˜ ๊ฒฝ์šฐ์—๋Š” ํƒˆ๋™๋…์˜ ์ƒํ™ฉ์ด ์–ด๋– ํ–ˆ์œผ๋ฉฐ ์ด์— ๋Œ€ํ•ด ๋…์ผ ์ •๋ถ€๋Š” ์–ด๋–ป๊ฒŒ ๋Œ€์ฒ˜ํ–ˆ๋Š”์ง€๋ฅผ ์‚ดํŽด๋ณด๋Š” ์ผ์€ ํ†ต์ผ์„ ์ค€๋น„ํ•˜๋Š” ์šฐ๋ฆฌ์—๊ฒŒ ๋งค์šฐ ์˜๋ฏธ ์žˆ๋Š” ์ผ์ผ ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ๋‹น์—ฐํ•œ ๊ด€์‹ฌ์‚ฌ๊ฐ€ ์•„๋‹ ์ˆ˜ ์—†๋‹ค
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