교과용도서 정책 변화과정 탐색

강경탁 한국체육대학교 2012 국내석사

기술기반 벤처기업의 연구개발 투자 중 정부 지원금 비중이 경영성과에 미치는 영향 : 신제품 및 개선제품 매출에 미치는 영향을 중심으로

강경탁 고려대학교 기술경영전문대학원 2018 국내석사

Investment in SMEs in the national R & D program is steadily increasing and in the perspective of national competitiveness it is important to analyze how this investment has a positive effect on business performance. This study examines the relationship between R & D investments and business performance in terms of government grants by examining the necessity of investment in R & D. In this study, venture companies are defined as companies that satisfy the requirements of the ‘Act on Special Measures for the Promotion of Venture Company’. From the previous research, three hypotheses about R & D investment, government subsidy, and business performance were derived. There are 404 samples excluding the missing data from 460 samples of firms that have received government subsidies in 2012 or 2013 in the "Venture Company Precise Actual Survey". First, it is found that R & D investment has a positive relationship with management performance. Second, government subsidies in R & D investment and management performance were positively related, but the effect was lower than R & D investment. Third, the proportion of government subsidies in R & D investment has a moderating effect on sales of new products. Especially, when the ratio exceeds 80%, it has a statistically significant negative effect. In this research First, through the analysis of the actual indicators, we confirmed the positive impact of R & D investment and gained the right of investment. Second, government subsidies also positively influenced business performance, and government support was effective. However, if the portion of the subsidy is too high, it will have a negative effect and the excessive government support should be avoided. 국가연구개발사업의 중소기업에 대한 투자는 꾸준히 증가하고 있으며 이 투자가 기업의 경영성과에 얼마나 긍정적인 영향을 주는지 분석하는 것은 국가경쟁력 관점에서 중요하다. 본 연구는 개별 기업 단위로 연구개발 투자와 경영성과 사이의 관계를 정부 지원금 관점에서 설명하여 국가연구개발 투자의 당위성을 검증해 본다. 이 연구에서는 벤처기업을 ‘벤처기업육성에 관한 특별조치법’의 요건을 만족하는 기업으로 정의했다. 선행연구를 통해 연구개발 투자, 정부 지원금, 경영성과에 관한 크게 3개의 가설을 도출하였다. 표본은 중소벤처기업부에서 매년 실시하는 ‘벤처기업정밀실태조사’대상 기업 중 2012년과 2013년 각각 정부 지원금 수혜 경험이 있는 기업의 460개 표본에서 결측치가 있는 데이터를 제외한 404개 표본을 사용하였다. 분석 결과 첫째, 연구개발 투자와 경영성과는 양의 관계를 갖는 것으로 나타났다. 둘째, 연구개발 투자 중 정부 지원금과 경영성과는 양의 관계를 갖지만 그 효과는 더 낮았다. 셋째, 연구개발 투자 중 정부 지원금 비중은 신제품 매출에 대해서만 조절효과가 있었으며 특히 그 비중이 80%를 넘어가면 통계적으로 유의한 음의 영향을 주었다. 이 연구를 통해 첫째, 실제 지표를 통한 분석으로 연구개발 투자의 긍정적인 영향을 확인하여 투자의 당위성을 얻었다. 둘째, 연구개발 투자 중 정부 지원금도 경영성과에 긍정적인 영향을 주었으며 정부의 지원이 효과가 있었다. 하지만 지원금 비중이 너무 과다하면 오히려 부정적인 영향을 주며 이에 따라 과다한 정부 지원은 지양해야 한다.

청각장애인의 생활체육 참여와 자신감 및 생활만족의 관계

강경탁 광운대학교 교육대학원 2015 국내석사

Th purpose of the present study is to examine the relationship between the continually increasing participation of hearing-impaired person in sports for all and self-confidence and life satisfaction, call attention to the need for and significance of sports for all for the disabled, and further contribute to boosting sports for all for the disabled. The population of the study was selected from the hearing impaired who participate in sports for all and the hearing impaired who do not participate in sports for all. And from sports for all clubs, welfare centers, and universities located in S city, K city, and D city, and B city, 425 hearing impaired persons were sampled by making use of purposive sampling method among nonprobability sampling. Among questionnaires collected, 35 were excluded due to their insincere responses or some of the survey responses missing, and data of 390 respondents were used for actual analysis. Questionnaire for self-confidence was a modified and complemented version of those used by Hong Ran-ah(2010), Lim Kwang-yeol (2011), etc. And questionnaire for life satisfaction was a modified version of those used by Lim Jong-ho(2004), Choi Woo-young(2009), etc. According to the purpose of analysis, data went through computational processing by using the statistical program of SPSS Version 18.0, and then factor analysis and reliability analysis were conducted on each variable. In order to examine the general characteristics of the subjects of survey, frequency analysis was conducted. In order to examine the differences between self-confidence and life satisfaction, t-test and one-way ANOVA were conducted, and post-verification was carried out by using Scheffe, LSD. The results of the research are as follows First, as for self-confidence of the hearing impaired according to the demographic characteristics, there were significant differences in time of impairment occurrence, way of communication, and job type except sex, age, and family income. As for sex, age, and family income, there was no significant difference in leadership of instructor, physical / mental preparation, proven ability, and social support. As for differences according to time of impairment occurrence, congenital impairment was higher in leadership of instructor and proven ability than acquired impairment (t=3.356, p<.01),(t=3.074, p<.01). As for way of communication, speech was higher in social support than sign language (F=5.361 p<.01). As for job type, office job was higher in social support than student group and the unemployed (F=2.402 p<.05). Second, as for life satisfaction according to demographic characteristics, there were significant differences in sex, age, time of impairment occurrence, way of communication job type, and family income. In terms of sex, male was higher in negative attitude to future than female (t=2.343, p<.05). In terms of age, the group above 36 years old was higher in negative attitude to future than the group of 30 to 35 years old (F=5.938 p<.01). The group of 30 to 35 years old was higher in positive attitude to future than the group above 36 years old (F=3.168 p<.05). In terms of time of impairment occurrence, congenital impairment was higher in negative attitude to future than acquired impairment (t=2.597, p<.01). In terms of way of communication, speech was higher in negative attitude to future than sign language (F=3.274 p<.05). In terms of job type, the group of technicians and skilled workers and the group of students were higher in negative attitude to future than office job workers (F=4.050 p<.01). Office job group was higher in positive attitude to present than the group of students and the group of the unemployed (F=4.610 p<.01). Office job group was higher in positive attitude to future than the unemployed group (F=2.773 p<.05). In terms of family income, the income group of 1 million and 2 million won was higher in negative attitude to present than the income group of 2.01 million to 3 million won and the income group above 3.01 million won (F=3.460 p<.05). The income group below 1 million won and the income group of 1 million to 2 million won were higher in negative attitude to future than the income group 0f 2.01 million to 3 million won (F=4.132 p<.01). The income group above 3.01 million won was higher in positive attitude to future than the income group under 1 million won and the income group of 1 million to 2 million won (F=2.638 p<.01) Third, as for differences in self-confidence according to whether the impaired person participates in sports for all or not, the group participating in sports for all was higher in leadership of instructor, physical/mental preparation, proven ability, and social support than the group not participating in sports for all. Accordingly, it was concluded that the hearing impaired participating in sports for all were higher in self-confidence than the hearing impaired not participating in sports for all (t=4.727, p<.001), (t=3.182, p<.01), (t= 3.234, p<.01), (t=4.067, p<.001). Fourth, as for differences in life satisfaction according to whether the hearing impaired person participates in sports for all or not, the group participating in sports for all was higher in positive attitude to present and positive attitude to future than the group not participating in sports for all (t=2.558, p<.05), (t=2.057, p<.05). Accordingly, it has been concluded that the hearing impaired participating in sports for all were higher in life satisfaction than the hearing impaired not participating in sports for all. Fifth, as for differences in satisfaction with participation according to the type of instructor, instructor with hearing impairment was higher in satisfaction with participation than instructor with no hearing impairment (t=-3.291, p<.01). It has been concluded from this that satisfaction of the hearing impaired with participation in sports for all was higher when instructor with hearing impairment teach them. Sixth, there was no significant difference in self-confidence about participation and life satisfaction according to the type of instructor of sports for all. Seventh, as for life satisfaction of the hearing impaired participating in sports for all according to the type of instructor, instructor with hearing impairment was higher in negative attitude to future than instructor with no hearing impairment (t=-3.057, p<.01). Instructor with hearing impairment was higher in positive attitude to present than instructor with no hearing impairment (t=-1.996, p<.05). Eighth, there was no significant difference in self-confidence according to frequency of participation in sports for all. Ninth, as for difference in life satisfaction according to frequency of participation in sports for all, participation once a week and participation 3 times a week were higher in positive attitude to present than participation 4 times and more a week (F=4.053 p<.01). Participation 3 times a week was higher in positive attitude to future than participation once a week and participation 4 times and more a week (F=3.082 p<.05). It has been concluded from this that life satisfaction is higher in those with hearing impairment who participate in sports for all 3 times a week than those who participate once a week and 4 times and more a week. 본 연구는 지속적으로 증가하고 있는 청각장애인의 생활체육 참여와 자신감 및 생활만족의 관계를 규명하여 장애인 생활체육에 대한 필요성과 의의를 환기시키고, 나아가 장애인 생활체육의 활성화에 기여할 수 있도록 하는 데에 그 목적이 있다. 본 연구의 대상은 생활체육 참여, 생활체육 비 참여 청각장애인을 모집단으로 선정하여, 2014년 S시, K시, D시, B시에 소재하고 있는 생활체육 동호회, 복지관, 대학교 등에서 425명을 비확률표본추출방법(nonprobability sampling)중 유의표집(purposive sampling) 방법을 이용하여 표집 하였다. 회수된 설문지 중, 설문을 불성실하게 응답하거나, 조사 내용 중 일부가 누락된 자료 35부를 제외하고, 최종 390명의 대상자의 자료가 실제 분석에 사용되었다. 자신감 설문지는 홍란아(2010), 임광열(2011) 등이 연구에서 사용한 설문지를 수정·보완하여 사용하였고, 생활만족 설문지는 임종호(2004), 최우영(2009) 등의 연구에서 사용된 설문지를 수정·보완하여 사용하였다. 분석 목적에 따라 통계 프로그램인 SPSS Version 18.0을 이용하여 전산처리를 한 후, 각 변인의 요인분석과 신뢰도 분석을 실시하였다. 조사대상자의 일반적인 특성을 알아보기 위해 빈도분석(frequency analysis)을 실시하였다. 자신감과 생활만족의 차이를 알아보기 위해 t-검정과 일원변량분산분석(one-way ANOVA)을 실시하였고, Scheffe, LSD를 사용하여 사후 검정하였다. 이상의 연구절차에 따라 얻은 결론은 다음과 같다. 첫째, 인구통계학적 특성에 따른 청각장애인 자신감에서는 성별, 연령, 가족소득을 제외하고 장애발생시기, 의사소통방법, 직업유형에서 유의한 차이가 나타났다. 성별, 연령, 가족소득에 따라서는 지도자 지도력, 신체/정신준비, 능력입증, 사회적지지에서 유의한 차이가 나타나지 않았다. 장애발생시기에 따른 차이에서는 선천적 발생인 경우가 후천적 발생인 경우보다 지도자 지도력, 능력입증에서 높게 나타났다(t=3.356, p<.01), (t=3.074, p<.01). 의사소통방법에 따라서는 구화가 수화보다 사회적지지에서 높게 나타났다(F=5.361 p<.01). 그리고 직업유형에 따라서는 사무직이 학생 군, 무직보다 사회적지지에서 높게 나타났다(F=2.402 p<.05). 둘째, 인구통계학적 특성에 따른 생활만족에서는 성별, 연령, 장애발생시기, 의사소통방법, 직업분류, 가족소득에서 유의한 차이가 나타났다. 성별에 따라서는 남자가 여자보다 미래부정에서 높게 나타났다(t=2.343, p<.05). 연령에 따라서는 36세 이상 집단이 30세~35세 집단보다 미래부정에서 높게 나타났다(F=5.938 p<.01). 30세~35세 집단이 36세 이상 집단보다 미래긍정에서 높게 나타났다(F=3.168 p<.05). 장애발생시기에 따라서는 선천적 발생인 경우가 후천적 발생인 경우보다 미래부정에서 높게 나타났다(t=2.597, p<.01). 의사소통방법에 따라서는 구화가 수화보다 미래부정에서 높게 나타났다(F=3.274 p<.05). 직업유형에 따라서는 기술, 숙련공 직업군과 학생 군이 사무직보다 미래부정에서 높게 나타났다(F=4.050 p<.01). 사무직이 학생 군과 무직보다 현재긍정에서 높게 나타났다(F=4.610 p<.01). 사무직이 무직보다 미래긍정에서 높게 나타났다(F=2.773 p<.05). 가족소득에 따라서는 100만원~200만원 소득집단이 201만원~300만원 소득집단과 301만원 이상 소득집단보다 현재부정에서 높게 나타났다(F=3.460 p<.05). 100만원 이하 소득집단과 100만원~200만원 소득집단이 201만원~300만원 소득집단보다 미래부정에서 높게 나타났다(F=4.132 p<.01). 301만원 이상 소득집단이 100만원 이하 소득집단과 100만원~200만원소득집단보다 미래긍정에서 높게 나타났다(F=2.638 p<.01). 셋째, 생활체육 참여여부에 따른 자신감의 차이에서는 생활체육 참여집단이 생활체육 비참여집단보다 지도자 지도력, 신체/정신준비, 능력입증, 사회적지지에서 높게 나타났다. 이에 따라 청각장애인 중 생활체육 참여자가 비참여자에 비해 자신감이 높다는 결론을 얻었다(t=4.727, p<.001), (t=3.182, p<.01), (t= 3.234, p<.01), (t=4.067, p<.001). 넷째, 생활체육 참여여부에 따른 생활만족의 차이에서는 생활체육 참여집단이 생활체육 비참여집단보다 현재긍정, 미래긍정에서 높게 나타났다(t=2.558, p<.05), (t=2.057, p<.05). 이에 따라 청각장애인 중 생활체육 참여자가 비참여자에 비해 생활만족이 높다는 결론을 얻었다. 다섯째, 생활체육 참여시 지도자유형에 따른 참여만족의 차이에서는 청각장애인 지도자가 일반 지도자보다 참여만족에서 높게 나타났다(t=-3.291, p<.01). 이로부터 청각장애인 지도자가 지도할 때 청각장애인 생활체육 참여자의 참여만족이 높다는 결론을 얻었다. 여섯째, 생활체육 참여시 지도자유형에 따른 생활만족 참여 자신감의 차이에서는 유의한 차이가 나타나지 않았다. 일곱째, 생활체육 참여시 지도자유형에 따른 청각장애인 생활체육 참여자의 생활만족에서는 청각장애인 지도자가 일반 지도자보다 미래부정에서 높게 나타났다(t=-3.057, p<.01). 청각장애인 지도자가 일반 지도자보다 현재긍정에서 높게 나타났다(t=-1.996, p<.05). 여덟째, 생활체육 참여빈도에 따른 자신감의 차이는 유의한 차이가 나타나지 않았다. 아홉째, 생활체육 참여빈도에 따른 생활만족의 차이는 주 1회 참여와 주 3회 참여가 주 4회 이상 참여보다 현재긍정에서 높게 나타났다(F=4.053 p<.01).주 3회 참여가 주 1회, 주 4회 이상 참여보다 미래긍정에서 높게 나타났다(F=3.082 p<.05). 이로부터 주 1회, 주 4회 이상 참여보다 주3회 참여 빈도의 적정한 생활체육 참여자들의 생활만족이 높다는 결론을 얻었다.

부동산처분금지가처분의 효력에 관한 연구

강경탁 전북대학교 법무대학원 2013 국내석사

보전처분은 본안재판이 오래가면서 뒤에 본안판결이 나도 권리실현이 어렵게 될 위험을 방지하기 위하여 본안재판이 나기 전에 신속하게 취하는 잠정조치 내지 처분절차이다. 그 중 처분금지가처분은 가처분채권자의 목적물건에 대한 피보전권리의 행사를 용이하게 하는 것을 목적으로 하는 가처분이다. 이러한 처분금지가처분은 실무상 거의 부동산에 대하여만 행해지며 다른 절차와의 경합으로 인한 등기 및 그 효력에 관하여 문제가 되는 경우가 대부분이다. 본 연구에서는 처분금지가처분 중 부동산처분금지가처분의 효력과 그와 관련된 문제를 살펴보고 해결방안을 제시하고자 한다.

농업신용보증제도에 대한 연구: 농림수산업자신용보증기금 통합을 중심으로

강경탁 경상대학교 대학원 2006 국내석사

The agriculture field of Korea has been opened for each stage after the launching of the WTO system that the government and farmers have invest substantial capital for the strengthening of competitiveness in agriculture. And, the Credit Guarantee Fund for Farmers and Fishermen (“CGF”) also has supported the agriculture policy for the government as well as the credit guaranty affairs for farmers who lacked the security in a way of contribution of growth and facilitation of agriculture. However, the current “CGF” has been encountered with substantial difficulties in fund management due to the fund insolvency and fund depletion from the drastically increasing subrogation and increase of ratio for reimbursed credit. In addition, “CGF” has been recommended to be integrated with General Credit Guaranty Fund from the fund management valuation group in 2004 due to the possible overlap in business, issue of conflict of interest from the trust management system of Nonghyup, decline in specialty and efficiency in management, and other causes. However, agriculture has been expanded for commercialization and specialization that the importance on capital investment on agriculture has been greatly increased. Therefore, the role of the “CGF” has been more important now. Accordingly, the purpose of this study is to present the needs of “CGF” and the improvement plan of the management of the “CGF” system. In order to present the needs of “CGF” and the improvement plan of the management of the “CGF” system, this study reviewed the pertinent advance studies on the credit guaranty system in agriculture, and to help understanding on “CGF”, it took a look at the credit guaranty system and the theories of the agricultural financing. The credit guaranty system is an independent financing system to reduce the debt default risk by reliable third party, on the basis of its credibility, for the flawless fund procurement of the companies with vulnerable credibility. And the credit guaranty system undertakes the roles of performance of economic policies, promotion of the development in financing economy, building up the foundation for credit economy and others. The agricultural financing means the relationship of monetary transaction in loans that supplies the funds for the farmers under the condition to repay the borrowings with interests in certain period. And, the agricultural financing has the special characteristics in small, seasonal and mixed use due to the particularity of agriculture. In the meantime, when the lending transaction is consummated, the credit limit on the borrower has to be inevitable so long as the asymmetry of information is present even when the financial institution is under control, and the way to resolve such a problem for credit limit is the credit guaranty system. Within the credit guaranty system in agriculture of Korea, “CGF” is a systematic device for the financial funding supply in the agriculture field and it began its guaranty works in 1972, and since then, it had provided the credit guaranty of approximately 64 trillion won to 5 million farmers who lacked the collaterals by 2004 with significant contribution for the development of “CGF” in Korea. However, the current “CGF” encounters with the problems from moral hazard following trust management system, credit valuation capability, and moral hazard on credit valuation at the time of trust guaranty, and the soundness of fund. And, on top of the above problems, it has other problems arising, including the insolvency of funds following the drastic increase of the subrogation, issue of basic assets, issue of guaranty fees, and issues of reimbursed credit management. In the meantime, in conducting this research, the comparison and review of similar credit guaranty system in agriculture of foreign countries were made with the reference to the credit guaranty system in agriculture of Japan and Taiwan. Looking into the capital structure on the credit guaranty fund for agriculture of each country, Korea depends 95% or more of capital investment other than the operation profit for the government, however, Japan has the government invest 50% for the policy funds. In the meantime, Taiwan has the central government investing for 65%, banks for 30%, and agricultural cooperative credit division for 5% under the law. And, the guaranty limit of Korea and Taiwan is set for up to 20 times of the basic assets while Japan has the supply of up to 40 times of the basic assets for agriculture credit insurance association and national cooperative union guaranty center for risk management. In addition, Taiwan has had several years of economic downfall with substantial new guaranties to make it unstable, but the situation for the funds is getting better with the post management system and internal innovation. Lastly, in order to present the realistic improvement plan for the “CGF”, the questionnaire survey on 193 farmhouses was conducted. 72.8% of respondents to the survey had the experience of using the service of “CGF” for the recent 3 years, and from these farmhouses, 80% or more responded as average or better satisfaction. Looking into the survey on methodology for integration of “CGF” with other general credit insurance, 35.8% of respondents had ‘supplement the current system of Nonghyup management’, 33.2% for ‘independent operation of “CGF”’, and 14% for ‘maintaining the current system’ that the farmers wanted to make gradual independence. In addition, the task for “CGF” to improve with priority had 49% of respondents for ‘establishment of sound and efficient business operation management system’, 19% for ‘establishment of reasonable assessment system for the fund management’, and 13% for ‘establishment of fund mission and vision’. On the basis of the above study, considering the importance of agriculture, the current reality of agriculture in Korea, and special nature of the agricultural financing, “CGF” that is the systematic device for flawless fund supply in the agriculture field under the credit guaranty system in agriculture has to be operated independently. And, the improvement plan on “CGF” is classified into the improvement plan on specialization of guaranty affairs, plan to improve the moral hazard, and efficient management plan of fund. For the specialization of guaranty affairs, the guaranty service by using Nonghyup has to continue for gradual independence from Nonghyup. And, the differentiated guaranty rate has to be applied depending on the credit rating, and the guaranty management system for each guaranty type has to be structured. And, for the improvement of the moral hazard, the award and punishment system on employees has to be introduced and the right of personnel has to be separated from Nonghyup. And, the credit survey standard that the financial institutions implement has to be strengthened, and the partial guaranty ratio has to be upgraded from the current 10% to 20% or more on a long term. Lastly, in order to make efficient management of the fund, the education and publicity campaign have to be strengthened to make the farmers understand that the increase of guaranty fees would increase the stability and efficiency of the fund. And, at a time when the subrogation has rapidly increased to cause the insolvency of the funds, the financial institutions have to contribute the funds from handling the guaranty works without making fund contribution. In addition, the insurance system and the secondary guaranty system like Japan have to be reviewed as a part of long-term risk management system.

DSM에서 죠인 인덱스를 이용한 관계 질의처리 연산 알고리즘에 관한 연구

강경탁 慶熙大學校 1988 국내석사

Lamb wave를 이용한 결함이 있는 복합재료 평판의 신호 특성 연구

강경탁 연세대학교 대학원 2008 국내석사

만성경막하혈종의 두께와 임상 증상에 대한 고찰

강경탁 부산대학교 대학원 2020 국내석사

서론: 현재까지 만성경막하출혈(CSDH)의 치료에 있어서 gold-standard로 활용 되는 것은 천두술 및 혈종 배액술이었으나, 최근 연구 경향에서는 약물(statins, corticosteroids, angiotensin-converting enzyme inhibitors 와 tranexamic acids등)을 통한 치료를 시도하거나 중간 수막 동맥의 색전술을 활용하는 방법이 떠오르고 있다. 또한 몇몇 연구에서는 수술적인 치료 없이 만성경막하출혈이 호전되는 경우도 보고되고 있다. 현재까지 명확하게 수술적인 치료와 비 수술적인 치료의 적응증에 대한 기준이 나와있지 않는 실정이어서, 다수의 신경외과 의사들은 환자의 증상의 심한 경우 수술적 치료를 진행하거나, 증상이 경미한 경우에는 혈종의 양에 따라서 치료 방침을 결정하고 있다. 후자의 경우에서, 만약 혈종의 두께와 증상의 경중이 서로 연관성이 있다면, 혈종의 두께를 측정하는 것으로 수술적 치료가 필요한 경우에 대해서 예측해볼 수 있을 것이다. 본 연구는 혈종의 두께와 임상 증상에 대하여 비교 분석을 시행한 연구이며, 위험인자 분석도 같이 진행하였다 방법: 268명의 환자를 대상으로 후향적 분석을 진행하였고, 각 증상에 따라 나누어 분류하였다. ‘경미한 증상’은 비특이적 두통과 피로감을 가지는 경우로 정의하였고, ‘심각한 증상’은 심한 두통(VAS 8점 이상)과 운동능력의 변화 혹은 의식변화가 생기는 경우로 정의하였다. 기타 동반 질환이나 임상 데이터는 따로 확보하여 정리하였다. 혈종의 두께는 좌측 혈종의 경우 좌측을, 우측의 경우는 우측을 측정하였고, 양측의 경우에는 더 측정값이 큰 쪽으로 결정하였다. 중심선 이동(midline shifting)여부 또한 기록하였다. 각 측정값으로 수신기 작동 특성(receiver operating characteristic; ROC)과 곡선 밑면적(area under the curve; AUC)분석을 진행하였다. 잠재적 관련 인자는 로지스틱 회귀분석을 통해서 분석하였다. 결과: 총 포함된 환자에서, 143 (53.4%) 명이 ‘심각한 증상’ 군으로 (group S), 125 (46.6%) 명은 ‘경미한 증상’ 군으로 설정되었다 (group M). 연령대는 60.86±17.97(group M) 과 68.59±13.64(group S) 로 나타났다(p<0.001). 우측 혈종의 두께 평균값은 16.21±6.75mm (group M) 와 19.93±6.32mm (Group S) 로 나타났으며 (p=0.001). 좌측의 경우는 17.05±6.07mm (group M) 와 20.16±7.09mm (group S) 로 나타났다(p=0.002). 양측성 혈종의 경우는 17.45±6.00mm (group M) 와 21.14±6.24mm (group S) 로 나타났다(p<0.001). 중심선 이동(midline shifting) 은 각각 7.22±5.24mm (group M) 와 8.61±5.13mm (group S) 로 나타났다(p=0.032). 당뇨, 고혈압, 뇌혈관 질환, 심질환, 간질환, 만성신부전, 알코올 남용력, 외상력, 항혈소판제제 혹은 항응고제 복용력은 그룹간 유의미한 차이는 없었다. ROC 분석은 좌우측 관계없이 혈종의 두께가 19.9mm가 넘는다면, 심한 증상의 위험도가 유의하게 증가하는 것으로 나타났다 (p<0.001, area under curve (AUC)=0.667; sensitivity 60.8%, specificity 60.7%). 로지스틱 회귀분석결과, 증상과 혈종의 두께가 유의한 연관성을 가지는 것으로 확인되었다 (p= 0.013, odd ratio=1.93, 95% confidence interval=1.149~3.253). 또한, 혈종의 두께 뿐만 아니라 연령 과도 연관성을 보이고 있어서, 추가로 연령별로 혈종의 증상 별 두께 변화에 대한 세차(longitudinal difference)를 분석해보았다. 우측 만성경막하출혈에서 연령대별로 3mm의 공차(tolerance difference) 변화를 보였다. 좌측과 양측성 출혈에서는 이러한 차이가 나타나지 않았다. 결론: 본 연구는 만성경막하혈종의 두께가 19.9mm 이상이 될 경우 심각한 증상을 보일 가능성이 있다는 점을 보여주었다. 우측의 혈종에서만 나이에 따른 공차 값이 존재함을 보여주었고, 연령대별로 3mm 정도의 차이를 보였다. 이 설정 값이 비 수술적인 치료와 수술적 치료를 결정하는 기준으로 보기에는 아직 무리가 있으나, 본 연구가 추후 비 수술적인 치료에 대한 적응증을 결정하는데 좋은 참고자료가 될 것이라고 생각한다.

시각장애인 안마사의 고용 활성화 방안 연구

강경탁 조선대학교 2010 국내석사

ABSTRACT A Study on Promoting Employment Related to Massager of People with Visual Impairment Kang, Kyong Tag Advisior : Prof. Kim, Yong-Seop Ph.D. Department of Social Welfare Graduate School of Policy, Chosun University A massager's job is to administer physical treatment on the human body by means of massaging or finger pressure, or with the help of electrical devices or other stimulating therapeutic methods. Compared with other disabled people as well as the non-disabled, the visually-impaired have been considered to be in a disadvantageous position because of mobility and job access problems. In our country, in order to assure the visually-impaired their livelihood and protection from unfair competition, Jesaengwon, the first school for them, was established in 1913. Since that time, massaging and finger pressure have been reserved for the visually-impaired. Furthermore, the Art. 82 of the Medicare Act (Act No.: 9386) gives qualifications for massagers only to the visually-impaired as provided for in the Disabilities Welfare Act. This study is intended to take a look at how the occupation of massagers and massaging have developed over the years and to seek ways to improve the massaging occupation and employment conditions for massagers. Owing to the lack of prior research on the visually-impaired massagers, this study relied on research on job rehabilitation for the visually -impaired and other literature in its search for alternatives and historical perspectives. By doing so, this study aims to find out the status quo of the massage industry, to seek improvements to the industry and to come up with ideas to galvanize massager employment. The problems and improvements to be made in the Korean massaging industry that are derived with the above scope and method in mind are as follows: Massage Parlors had better transform and innovate their management forms and some steps should be taken to enable them (including massage-acupuncture parlors) to offer therapies legally. In a era when therapy education in high school is not regarded as a professional training, finger-manipulating therapies like massage and finger pressure should be reserved for high school level and other professional training like acupuncture should be given in other professional educational institutions. In order to secure the professionalism of therapy education, special educational institutions should be set up at the vocational college level, where efforts should be made to raise therapy instructors, to make therapy education more professional and to introduce two-tiered massager qualification. It is expected that the establishment of therapy institutions would bring the promotion, awareness improvement and legal stability with respect to massaging and acupuncture by the visually-impaired massagers. The two-tiered massager qualification system is needed so as to give rise to the development and competitiveness of the massaging industry. The license can be classified into type I and type II. Type II can be awarded to people who have graduated from high school for the blind or massage training centers. They should be allowed to administer finger-manipulating therapy. Type I should be reserved for people who have graduated from special educational institutions and be allowed to perform stimulating therapies like acupuncture. Some measures should be taken so that massage is reserved for the visually-impaired: drastic improvements of massage parlors, revamp of law and institution, crackdown on unqualified massagers, strengthening of therapy education in school for the blind and massage training centers. The most important thing measure is for massagers themselves to ameliorate their skills and to foster pride in their occupation. The way to improve the massage industry is to establish college-level institutions for professional therapy training in a bid to reserve massage for the visually-impaired and, on top of that, to establish a stable massage industry by nurturing therapists, bifurcating massage license and including acupuncture in the job scope of massagers. The following steps are suggested in order to galvanize the employment of massagers. First, there should be improved awareness regarding massage. In that respect, it is imperative to promote the value and effect of massage in order to bring about demand creation and recognition transition. It should be proactively promoted that massage has become one of alternative medical therapies that enhances the functions of muscles, joints and intestines by coordinating them and calm the agitated state of the nervous system. Second, the Medicare Act and the massage institution are to be revamped. The Medicare Act does not provide for any license and therapy standards regarding blind massagers and the massaging industry. The job of massagers as alternative medical providers has its legal base on the Art. 82 of the Medicare Act, which is feeble in comparison with other medical professionals. There are not any strong regulations for cracking down on unqualified massagers and illegal massaging, which brings about a weak job security for visually-impaired massagers. In keeping with that, legal provisions should be specified in the first place and medical coverage should be given to massage therapy. Third, there should be enhanced massager professionalism. There should be a system where professional massagers are trained in order to meet the varying demands of people. In that respect, it is necessary to upgrade entrance qualifications to massager training schools and to administer license exams. In an attempt to upgrade education quality, therapy colleges should be established, where acupuncture is taught. In addition to that, massage management institutes should be set up to do research and development on a continuous basis. Fourth, there should be diversified employment for massagers. For example, companies can employ in-house health keeps to treat employees and other clients. In this way, massager employment opportunities can be expanded into private and public sectors. Exemplary workplaces could usher in professional massage parlors to create employment. Small-scale parlors for treatment can be set up and support for massage parlor startups should be offered. Medical institutions and welfare halls can employ massagers and more efforts can be made to create massage employment. In this way, contributions can be made toward job security for the visually-impaired. The efforts described above would be of great help in providing the visually-impaired with opportunities for social participation and in enabling them to play their proud role as social members. When the visually-impaired can earn their living by engaging in job activities, social integration, which is the ideal for the welfare of the disabled will come true sooner

Computational analysis for knee-joint mechanics of PCL and PLC evaluations using subject-specific in vivo material properties

강경탁 Graduate School, Yonsei University 2016 국내박사

슬관절 후외측 구조의 손상은 일반적으로 전방십자인대 또는 후방십자인대 파열과 함께 동반되지만 십자인대들의 손상에 가려져 슬관절 검사에서 간과되기 쉽다. 인대부상을 겪은 735개의 슬관절을 종합적으로 검토해본 결과 1.6%만이 슬관절 후외측 구조의 급성 단독 손상으로 치료를 받았다. 더 나아가 슬관절의 급성 손상 중 절반에 가까운 44%를 차지하는 후방십자인대 손상에서 재건술을 필요로 하지 않은 후방십자인대의 단독 손상인 경우는 오직 전체의 3.5%를 차지하고 있었다. 후방십자인대 손상과 동반되는 손상 중 가장 높은 빈도를 보이는 것은 후외방 불안정성을 야기하는 후외측 구조의 손상이다. 슬관절 후외측 구조의 손상은 심각한 장애를 초래하며 최근 들어 질환에 대한 임상적 이해와 연구가 발전함에 따라 진단되는 빈도수가 점차 늘어나는 추세이다. 후외측 구조는 정상적인 슬관절 안정성을 지지하는 동적 및 정적 요소들로 구성되어 있으며, 후외측 구조의 주요소들은 외측측부인대, 슬와건, 슬와비인대가 있다. 후방십자인대와 후외측 구조간 상관관계의 보다 명확한 정립을 위해 후외측 구조가 받는 힘과 경-대퇴골 및 슬개-대퇴골 관절에서의 접촉력은 그 동안 몇몇 생체역학적 연구들을 통해 평가되었다. 하지만 대부분의 연구는 준정적 상태에서 사체를 이용한 시험을 바탕으로 이루어졌다. 더 나아가 알려져 있는 한 경-대퇴골 및 슬개-대퇴골 관절에서 후방십자인대와 후외측 구조의 상관관계와 후외측 구조를 일생생활 하중조건에서 생체역학적으로 분석한 연구는 전무하다. 생체 외 실험을 이용한 연구를 통해 매우 유용한 정보를 얻을 수 있지만 일상생활에서 생체 내 근육과 관절의 운동학적 재현에는 한계가 있다. 반면 경-대퇴골 및 슬개-대퇴골 관절에서의 접촉력과 인대에 가해지는 힘의 측정은 유한요소모델을 이용하여 가능하며, 이는 관절의 구조적 병변에 영향을 미칠 수 있는 인자들에 대한 이해에 있어 매우 중요하다. 슬관절 유한요소모델 검증의 중요성은 이전 연구에서도 강조되어 왔으며, 더 나아가 재료의 물성치와 같이 모델을 구성하고 있는 각 요소들의 복잡한 기능은 모델을 통해 얻어지는 예측값의 정확도에 매우 큰 영향을 미칠 수 있다. 생체 내 피험자맞춤형 물성치는 생체역학 분야에서 지속적으로 중요하게 대두되고 있는 인자이다. 피험자맞춤형 물성치의 정확한 예측은 슬관절에서의 응력과 변형율 측정에 있어 매우 중요하게 작용한다. 제 2장에서는 후방십자인대와 후외측 구조의 상관관계에 대한 생체역학적 분석을 위해 피험자맞춤형 유한요소모델을 이용하여 새로운 검증 기술을 연구하였다. 이 방법을 통해 피험자맞춤형 유한요소모델을 보다 효과적으로 검증할 수 있게 되었다. 더 나아가 확률론적 유한요소모델과 진단의료영상을 이용하여 생체내 물성치의 측정을 수행하였다. 제 3.1장과 3.2장에서는 체중부하와 굽힘 자기공명영상과 최적화 분석을 통해 관절면의 물성치를 예측 및 검증하였다. 제 3.3장과 3.4장에서는 확률론적 유한요소모델을 이용하여 슬관절 이완 시험와 컴퓨터 단층촬영 결과의 정합을 통해 주요 인대들의 생체 내 물성치를 예측 및 검증하였다. 제 4장에서는 생체 내 물성치가 적용되어 검증된 유한요소모델에 피험자의 근육력을 적용하기 위해 근전도 검사 결과를 이용하여 근골격계 동적 모델을 개발 및 검증하였다. 후방십자인대와 후외측 구조의 상관관계를 정립하기 위해 후외측 구조 인대들과 후방십자인대를 제거하며 각각 후방십자인대와 후외측 구조 인대에 가해지는 힘을 보행과 굴슬운동 상태에서 모두 측정하였다. 현재 만성질환 3급에 해당하는 후외측 구조의 손상을 치료하고 슬관절 불안정성을 복원하기 위해 다양한 수술법들이 임상적으로 제안되고 사용되고 있다. 하지만 이러한 수술법들을 이용한 술 후 슬관절의 생체역학적 분석 및 연구는 현재까지 매우 부족한 실정이다. 따라서 본 연구에서는 십자인대들에 가해지는 힘과 경-대퇴골 및 슬개-대퇴골 관절에서의 접촉력을 비교•분석하는데 그 목적을 두었다. 제 5장에서는 일생생활 하중조건에서 후외측 구조의 3급 손상을 치료하기 위해 사용되는 3가지 수술법인 경골 기반 재건술과 비골 기반 재건술을 평가하였다. 3가지 모델에서 전방십자인대와 후방십자인대에 가해지는 힘은 내측 경-대퇴골에서의 접촉력을 제외하고 모두 정상상태 슬관절 모델과 비교하여 다른 결과를 보였다. 슬개-대퇴골에서의 접촉력은 정상상태 슬관절 모델과 비교하여 모두 증가하였다. 경골 기반 재건술과 개선된 비골 기반 재건술을 사용하였을 때의 경-대퇴골과 슬개-대퇴골에서 십자인대에 가해진 힘과 관절면의 접촉력은 기존의 비골 기반 재건술을 사용하였을 때의 결과와 비교하여 정상상태 슬관절 모델과 보다 근사하다는 결과를 확인할 수 있었다. 결론적으로 슬와건은 슬외측 구조 요소들 중 십자인대에 가해지는 힘에 있어 가장 우성적인 안정장치임을 확인할 수 있었다. 또한 후방십자인대의 제거는 일상생활 하중조건에서 동적 안정장치인 슬와건에 가해지는 힘을 증가시키고 이는 슬개-대퇴골 관절의 조기퇴행을 야기할 수 있다고 보여진다. 마지막으로 해부학적 경골 기반 재건술과 비골 기반 재건술은 경-대퇴골과 슬개-대퇴골에서 십자인대에 가해지는 힘과 접촉력에 있어 큰 차이가 없음을 확인할 수 있었다. Isolated injury of the posterolateral corner (PLC) structures of the knee is generally uncommon, and may easily get overlooked during knee joint inspections, particularly in cases with concomitant anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears. In a comprehensive review of 735 knees treated for ligamentous injury, only 1.6% were reported to have acute, isolated posterolateral injury. In addition, PCL injuries constitute 44%, or nearly 50%, of all acute knee injuries; however, isolated PCL injuries without repair and/or reconstruction of associated ligamentous injuries have been reported to represent as little as 3.5% of all cases. The most frequent type of injury associated with PCL is the injury of PLC structures, leading to posterolateral rotatory instability. Injury to the PLC structures of the knee causes severe disability and is increasingly being diagnosed due to our improved understanding of this injury. PLC structures include dynamic and static components that provide proper knee joint stability. The main components of PLC are the lateral collateral ligament, popliteus tendon (PT), and popliteofibular ligament (PFL). To better understand the underlying mechanism of correlation between PCL and the PLC structures, several biomechanical research studies have evaluated the force exerted on the PLC structures and contact forces on the tibiofemoral (TF) and patellofemoral (PF) joints. The majority of these were experimental, using cadavers in quasi-static conditions. Furthermore, to the best of our knowledge, no study has investigated the biomechanical effects of the correlation between PCL and the PLC structures on TF and PF and the PLC structures under dynamic loading conditions. In vitro experimental studies provide useful knowledge; however, these studies are limited by unrealistic replication of muscle and joint loading experienced during daily activity. In contrast, deformable body finite element (FE) models enable the evaluation of the ligament forces and contact stresses on the TF and PF joints, which is important for understanding the factors that may affect structural joint deterioration. The importance of the verification of computational knee joint models has been emphasized in previous studies. Furthermore, the accuracy of model predictions may be affected by complex function of each component in the model (material properties, for instance), and the importance of each component is likely to be dependent upon the use of the model. In vivo subject-specific material properties have persisted as difficult-to-characterize targets in biomechanics. A reliable prediction of subject-specific material properties is essential for calculating stress and strain on the knee joint. In order to understand the biomechanical consequences of the correlation between PCL and PLC structures, a novel validation technique using a subject-specific FE model was developed, as described in Chapter 2. This methodology is an effective technique of validation for subject-specific model. In addition, the probabilistic FE model and medical images were used for evaluation of in vivo material properties. These properties of the articular surface were evaluated using weight-bearing and flexion magnetic resonance imaging (MRI) throughout the optimization, as described in Sub-Chapters 3.1 and 3.2. In vivo material properties of ligaments were evaluated by alignment of laxity tests and computed tomography (CT) using the probabilistic FE model, as described in Sub-Chapters 3.3 and 3.4. In order to apply a subject’s muscle force to the validated FE model with in vivo material properties, the musculoskeletal dynamic model was used, which was validated using electromyography (EMG) data, as described in Chapter 4. In order to investigate the correlation between PCL and PLC, the forces exerted on PCL, with deficiency of ligaments in the PLC structures, were evaluated; similarly, the ligament forces exerted on the PLC structures were evaluated to investigate the effect of PCL deficiency on the PLC structures. Under both gait and squat loading conditions, PT was the most significant ligament structure among the PLC structures, as described in Chapter 4. Furthermore, various surgical techniques have been reported for treating chronic grade III injuries to the PLC structures of the knee to restore knee joint instability. The postoperative biomechanical effects of the various surgical treatments on the knee joint have not been clearly understood or described. We aimed to compare the forces exerted on the cruciate ligaments and the contact stresses on the TF and PF joints. Three different tibial- and fibular-based reconstruction techniques for grade III injuries of the PLC structures were evaluated under dynamic loading conditions, as described in Chapter 5. The ACL and PCL forces in all three models differed from those in the intact model. There were no differences in the contact stresses on the medial TF joint between the three surgical techniques. The contact stresses on the PF joint increased compared with those on the intact model. The cruciate ligament forces and contact stresses associated with the tibial- and fibular-based (modified fibular sling) reconstruction techniques on the TF and PF joints were more similar to those under normal conditions compared with those associated with the fibular-based (conventional fibular sling) reconstruction technique. In conclusion, firstly, PT was found to be the most dominant stabilizer of the cruciate ligament force among the PLC structures. Secondly, PCL deficiency led to an increase in the force on PT, which is a dynamic stabilizer under dynamic loading conditions, and it may lead to a degeneration of the PF joint. Thirdly, there were no remarkable differences between the forces exerted on the cruciate ligaments and the contact stresses on the TF and PF joints among the anatomical tibial- and fibular-based reconstruction techniques.