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A Study on the Water Quality of Reservoir Tank in the Building Complex on Jeonnam Area (대형건축물 저수조의 수질실태 및 개선방안에 관한 연구)

  • Lee, J.H.;Lee, H.H.;Kim, H.B.;Ahn, G.W.;Park, K.N.;Kim, Y.K.;Bae, J.S.;Mun, H.;Park, C.U.;Oh, E.H.;Park, S.I.;Seo, Y.G.
    • Journal of environmental and Sanitary engineering
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    • v.15 no.4
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    • pp.59-77
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    • 2000
  • This study was carried out to investigate on several factors, which contaminative the water quality through the water pipe during feeding water, in 42 largescaled apart-ments(total 84 cases) and assayed the Volatile Organic Compounds(VOCs) and concen-tration of heavy metals that inflow and outflow in reservior water in Jeonnam area(Mokpo, Suncheon, Yeosu) from January 1999 to December 1999. The results obtained were summarized as follows ; 1. The quality of the water pipe composition in the order of frequency in the quality of water pipes were Copper(45.2%)> Zinc(38.9%)> Stainless steel(9.5%)> PVC(4.8%)> PM(2.4%) in observing 42 sites. All of the drain pipes were used the cast iron quality. 2. The result of certification curve from 12 items(17kind) of VOCs was $1.0-4.0{\mu{g}}/{\ell}$ range, a coefficient of correlation was shown 0.99 over. A MDL of each substance range was within $0.1-1.0{\mu{g}}/{\ell}$. 3. The result of the assay, 5 kinds(Viny chloride, Dichloromethane, Ethylbenzene, M,P-xylene, Styrene) of the VOCs of 14 kinds was not detected and the other items were detected slightly. The detection rate of one item and over in total VOCs samples, were 25.9% in inflow and 27.9% in outflow. And frequency of detect in inflow/outflow of THM(Chloroform, Bromodichloro-methane, Dibromochloromethane, Bromoform) were shown higher than 94.1%, 97.0% each stages. It comes to the conclusion that all of the samples were reason able for drinking water standards. 4. The coefficient of correlation were reasonable, it shown 0.999 over in $0.1-1.0{\mu{g}}/{\ell}$ of a measuring range conditions of 4kinds in organic substance(Zn, Cu, Fe, Mn). 5. The results were showed suitability in 78 cases(92.9%) and unsuitability in 6 cases (7.1%), in 84 cases of in organic substances. Compare to inflow stage, mean concentrations of heavy metal, were increased slightly in Zn, Cu, Fe except Mn than outflow stage. The result of the mean concentration in organic substance inflow and outflow in the apartment water tank using Pair-compared T-test, in 95% reliance index, were $0.179mg/{\ell}(0.151-0.307mg/{\ell})$ in Zinc, $0.136mg/{\ell}(0.113-0.230mg/{\ell})$ in Copper, $0.052mg/{\ell}(0.048-0.098mg/{\ell})$ in Fe, and there was a bit growing tendency but there was no differece in Mn. 6. The mean concentration of Copper which used Cu pipe as a water supply pipe in apartment were $0.216mg/{\ell}(0.161-0.338mg/{\ell})$ in case of the Zine pipe were $0.286mg/{\ell}(0.204-0.435mg/{\ell})$. It shows that the detection rate was more higher than the other material used in Cu or Zn as the water supply pipe. We supposed to Cu and Zn substance were gushing out water supply pipe.

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The Monitoring of Heavy Metals in Human Bloods of Middle School Students (중학생의 혈액 중 중금속 모니터링)

  • Park Hee Ra;Kim Meehye;Kwun Ki-Sung;Kim Soon Ki;Heo Su-Jeong;Kim Kwang_Jin;Yum Tae-Kyung;Choi Kwang Sik;Kim Soo Yeon
    • Journal of Food Hygiene and Safety
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    • v.20 no.2
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    • pp.83-88
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    • 2005
  • This study was conducted to estimate the contents of heavy metals including lead, cadmium, zinc, copper as well as iron status(serum iron, total iron binding capacity, feritin etc)in blood samples of middle school students(n=300). The contents of heavy metals were determined using the GF-AAS (Graphite furnace Atomic Absorption Spectrophotometer). The microwave digestion method and dilution method were compared. The dilution method showed the better recovery and detection limit than microwave digestion method. The values of toxic metals in whloe blood of boys & girls were 3.46 & 3.05 for Pb,0.063 & 0.065 for Cd respectively (ug/dL). Also the values of trace metals in serum of boys & girls were 105.9 & 92.6 for Zn, 98.3 & 99.0 for Cu respectively (ug/dL). The prevalence of iron deficiency was $7.5\%$ in 146 boys and $14.3\%$ in 156 girls. The mean values of lead in girls were higher in iron deficiency, iron deficiency anemia and anemia groups than normal group. The mean values of lead and zinc were higher in boys compared to those in girls(P<0.05), the mean values of cadmium and copper in boys were similar to those in girls. Our results of toxic metals such as Pb & Cd showed lower to CDC's(Centers for Disease Control) blood lead levels of concern for children, 10 ug/dL.

Effects of Leisure Time-Use and Occupational Performance according to the Participation of a Rehabilitation Sports Program for Intellectual Disabilities Residing in a Residential Care Facility (시설 거주 지적장애인들의 재활체육 프로그램 참여에 따른 여가시간 사용과 여가활동 수행에 미치는 영향)

  • Son, Sung-Min;Lee, Kyeong-Lark;Jeon, Byoung-Jin
    • The Journal of Korean society of community based occupational therapy
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    • v.6 no.2
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    • pp.51-59
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    • 2016
  • Objective : The purpose of study is to provide basic information about the effects of leisure time use and leisure activity performance for intellectual disabilities residing in a residential care facility by participating a regular rehabilitation sports program. Methods : Participants were recruited 8 individual with intellectual disability in a residential care facility in Yong-in city and the study period lasted 12 weeks, from september 1 to November 30 in 2015. As a program, participants participated a muscle strengthening exercise using a Gym-ball and a elastic band. In order to analyze leisure time-use, time questionnaire was used every month to analyze total time and exercise frequency. Also, analyze the effects of leisure activity performance, Canadian Occupational Performance Measure(COPM) was used to performance and satisfaction of dynamic leisure activity. Collected data was encoded by item and analyzed with SPSS ver18.0. Descriptive statistics were used for the participants' general information. A non-parametric test (the Friedman test) was used to analyze leisure time-use. A non-parametric test (the Wilcoxon's signed ranked test) was used to analyze to the effects of leisure activity performance. Statistical significance was accepted outside the 95% confidence interval. Results : The results of the total time and the exercise frequency showed significant increase. Also, the results of the performance and the satisfaction showed significant increase. Conclusion : Thus, the participation of the rehabilitation sports program is a vital element to lead to change leisure time use and leisure activity performance for intellectual disabilities residing in a residential care facility. Also, through the providing and the developing a regular rehabilitation sports program systematically, intellectual disabilities residing in a residential care facility have a higher quality of life and satisfaction of the daily routine and life in a residential care facility.

Gadoteridol's Signal Change according to TR, TE Parameters in T1 Image (T1영상에서 TR, TE 매개변수에 따른 Gadoteridol의 신호강도 변화)

  • Jeong, Hyun Keun;Jeong, Hyun Do;Nam, Ki Chang;Kim, Ho Chul
    • Journal of the Institute of Electronics and Information Engineers
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    • v.52 no.9
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    • pp.117-124
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    • 2015
  • In this paper, we introduce how to control TR, TE physical MR parameters for managing $H_1$ spin's SI(Signal Intensity) which is combined with gadolinium following administration MR agent in T1 effect for diagnostic usefulness. we used MRI phantom made with 0.5 mol Gadoteridol. This phantom was scanned by FSE sequence with different TR, TE parameters. In this study, to make T1 effect, TR was 200, 250, 300, 350, 400, 450, 500, 550, 600 msec. In addition to, TE was 6.2, 12.4, 18.6, 21.6 msec. The results were as follows ; Each RSP(Reaction Starting Point) was 100, 50, 40, 30 mmol in TE 6.2, 12.4, 18.6, 21.6 msec being irrelevant to TR. In MPSI(Max Peak Signal Intensity), 4 mmol was showed in TR 200 msec while peak signal was decreased to low concentration mol in TR 250-600 msec. In terms of RA(Reaction Area), the highest SI was TE 6.2 msec in TR 200-600msec. According to the study, we are able to recognize it is possible to control enhance rates by managing TR and TE of MR parameters; moreover, we expect that enhanced T1 image in MR clinical field can be performed in a practical way with this quantitative data.

Effects Of Cultured Bone Cell On The Regeneration Of Alveolar Bone (배양골세포 이식이 치조골재생에 미치는 영향)

  • Jeong, Soon-Joon;Herr, Yeek;Park, Joon-Bong;Lee, Man-Sup;Kwon, Young-Hyuk
    • Journal of Periodontal and Implant Science
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    • v.26 no.1
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    • pp.1-26
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    • 1996
  • This study was performed to estimate the effects of cultured bone cell inoculated on porous type hydroxyaptite for the regeneration of the artificial alveolar bone defect. In this experiment 3 beagle dogs were used, and each of them were divided into right and left mandible. Every surgical intervention were performed under the general anesthesia by using with intravenous injection of Pentobarbital sodium(30mg/Kg). To reduce the gingival bleeding during surgery, operative site was injected with Lidocaine hydrochloride(l:80,000 Epinephrine) as local anesthesia. After surgery experimental animal were feeded with soft dietl Mighty dog, Frisies Co., U.S.A.) for 1 weeks to avoid irritaion to soft tissue by food. 2 months before surgery both side of mandibular 1st premolar were extracted and bone chips from mandibular body were obtained from all animals. Bone cells were cultured from bone chips obtained from mandible with Dulbecco's Modified Essential Medium contained with 10% Fetal Bovine Serum under the conventional conditions. Porous type hydroxyapatite were immerse into the high concentrated cell suspension solution, and put 4 hours for attachin the cells on the surface of hydroxyapatite. Graft material were inserted on the artificial bone defect after 3 days of culture. Before insertion of cellinoculated graft material, scanning electronic microscopic observation were performed to confirm the attachment and spreading of cell on the hydroxyapatite surface. 3 artificial bone defects were made with bone trephine drill on the both side of mandible of the experimental animal. First defect was designed without insertion of graft material as negative control, second was filled with porous replamineform hydroxyapatite inoculated with cultured bone marrow cells as expermiental site, and third was filled with graft materials only as positive control. The size of every artificial bone defect was 3mm in diameter and 3mm in depth. After the every surgical intervention of animals, oral hygiene program were performed with 1.0% chlorhexidine digluconate. All of the animals were sacrificed at 2, 4, 6 weeks after surgery. For obtaining histological section, tissus were fixed in 10% Buffered formalin and decalcified with Planko - Rycho Solution for 72hr. Tissue embeding was performed in paraffin and cut parallel to the surface of mandibular body. Section in 8um thickness of tissue was done and stained with Hematoxylin - Eosin. All the specimens were observed under the light microscopy. The following results were obtained : 1. In the case of control site which has no graft material, less inflammatory cell infiltration and rapid new bone forming tendency were revealed compared with experimental groups. But bone surface were observed depression pattern on defect area because of soft tissue invasion into the artificial bone defect during the experimental period. 2. In the porous hydroxyapatite only group, inflammatory cell infiltration was prominet and dense connective tissue were encapsulated around grafted materials. osteoblastic activity in the early stage after surgery was low to compared with grafted with bone cells. 3. In the case of porous hydroxyapatite inoculated with bone cell, less inflammatory cell infiltration and rapid new bone formation activity was revealed than hydroxyapatite only group. Active new bone formation were observed in the early stage of control group. 4. The origin of new bone forming was revealed not from the center of defected area but from the surface of preexisting bony wall on every specimen. 5. In this experiment, osteoclastic cell was not found around grafted materials, and fibrovascular invasion into regions with no noticeable foreign body reaction. Conclusively, the cultured bone cell inoculated onto the porous hydroxyapatite may have an important role of regeneration of artificial bone defects of alveolar bone.

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Overcoming Kalmia-Induced Growth Inhibition of Picea mariana by Mycorrhizal Inoculation (Picea mariana 생장(生長)을 억제(抑制)하는 Kalmia angustifolia 에 대한 외생균근(外生菌根)의 영향(影響))

  • Mallik, A.U.;Zhu, H.;Park, Young-Goo
    • Journal of Korean Society of Forest Science
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    • v.87 no.3
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    • pp.429-444
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    • 1998
  • Objective of this study was to select ectomycorrhizal fungi for black spruce(Picea mariana) inoculation to overcome the growth inhibitory effects of Kalmia angustifolia. Nineteen isolates representing 11 species of ectomycorrhizal fungi were tested for their abilities to grow and form mycorrhizae with black spruce seedlings in the presence of water leachate of leaves of Kalmia. Mycelium growth of 9 isolates were inhibited by the leaf leachate. Colony diameter and biomass of the other 10 isolates were either increased or unaffected under the same conditions. Acidic pH of the culture medium(pH 3 and 4) inhibited some of the fungi, but a combination of acidic pH and the leaf leachate was more inhibitory. Thirteen isolates were able to form ectomycorrhizae with black spruce in presence of 25% leaf leachate in pure culture. Four isolates, Paxillus involutus(NF4), Cenococcum geophilum(GB12), Laccaria laccata(GB23), and E-strain(GB45) formed mycorrhizae more successfully than the others in presence of up to 50% Kalmia leaf leachate. Black spruce seedlings pre-inoculated with these fungi were grown with Kalmia leaf leachate and live Kalmia plants during a four month greenhouse experiment. Abundant mycorrhizae(77-91% of root tips) were developed on seedlings pre-inoculated with P. involutus, L. laccata and E-strain but relatively poor mycorrhization(32% of root tips) resulted with C. geophidum. Over 90% of the short root mycorrhizae were attributed to the inoculated fungi although indigenous mycorrhizae also occurred on most seedlings. Persistence of the mycorrhizae was not affected by living Kalmia plants. Over 80% of the mycorrhizae on seedlings inoculated with P. involutus, L. laccata and E-strain and 53% of the mycorrhizae on seedlings inoculated with C. geophilum were attributable to the inoculant fungi. Control seedlings formed about 45% ectomycorrhizal short roots with indigenous fungi. The L. laccata and C. geophilum inoculated seedlings exhibited enhanced mycorrhizae formation in presence of Kalmia leaf leachate. Mycorrhizae formation with inoculant fungi was 4-15% lower at pH 4 than at pH 5, with the greatest inhibition occurring for L. laccata. Seedlings inoculated with P. involutus had the greatest shoot and root growth followed by L. laccata and E-strain inoculated seedlings. The P. involutus and L. laccata inoculated seedlings were significantly taller with more shoot dry biomass than the uninoculated(control) seedlings. E-strain inoculated seedlings had significantly higher shoot dry biomass and significantly lower number of first order lateral roots compared to the control but other growth parameters such as height, root dry weight and number of short root tips were not significantly different from the control. Seedlings inoculated with C. geophilum were not significantly different from the uninoculated seedlings in any of the growth parameters except for the number of first artier lateral roots which was significantly less than the control seedlings.

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A Study on the Amendment Scheme of Nutrient Standard Regulations for Infant Formula in Korea (우리나라 영.유아용 조제식의 영양소 규격기준 개선방안 연구)

  • Om, Ae-Son;Lee, Heon-Ok;Moon, Ji-Hea;Shim, Jae-Young;Kim, In-Hye;Won, Sun-Im;Rha, Young-Ah;Choi, Yun-Ju;Lee, Hye-Young;Park, Hye-Kyung;Kim, Myung-Chul
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.36 no.5
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    • pp.569-577
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    • 2007
  • The purpose of the present study was to propose some amendments on nutrient standard regulations of infant formula in Korea. For this purpose, we compared and analyzed the nutrient regulations of Korea, CODEX, U.S.A, Japan, EU, Australia and New Zealand. Some developing aspects of Korea's nutrient standard regulations for infant formula need to be examined as follows: firstly, both milk-based formula and soy-based formula standards would be unified into an infant formula, and the user of infant formula would be categorized for babies less than 6 month old. Secondly, nitrogen conversion factor of milk protein in the infant formula would be 6.38, which is the same as that of CODEX Revised Standard. Protein quantities could be differentiated by protein sources, and essential amino acids in human milk would be standardized according to protein contents. Thirdly, $\alpha$-linolenic acid, docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) as essential fatty acids and trans fatty acid would be standardized in terms of the contents. Fourthly, it is recommended that the unit of vitamins and minerals would be changed from g/100 g to g/100 kcal, and individual vitamins and mineral would have their maximum values. Finally, 5 nucleotides (cytidine, uridine, adenosine, guanosine, inosine 5'-monophosphate) and fluoride would be required for the strengthening the immunity and the development of teeth, respectively. In conclusion, the scientific studies on amendment scheme of nutrient standard regulations of infant formula is very important to fortify nutritional completeness for Korean infants and young children.

Stellite bearings for liquid Zn-/Al-Systems with advanced chemical and physical properties by Mechanical Alloying and Standard-PM-Route

  • Zoz, H.;Benz, H.U.;Huettebraeucker, K.;Furken, L.;Ren, H.;Reichardt, R.
    • Proceedings of the Korean Powder Metallurgy Institute Conference
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    • 2000.04a
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    • pp.9-10
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    • 2000
  • An important business-field of world-wide steel-industry is the coating of thin metal-sheets with zinc, zinc-aluminum and aluminum based materials. These products mostly go into automotive industry. in particular for the car-body. into building and construction industry as well as household appliances. Due to mass-production, the processing is done in large continuously operating plants where the mostly cold-rolled metal-strip as the substrate is handled in coils up to 40 tons unwind before and rolled up again after passing the processing plant which includes cleaning, annealing, hot-dip galvanizing / aluminizing and chemical treatment. In the liquid Zn, Zn-AI, AI-Zn and AI-Si bathes a combined action of corrosion and wear under high temperature and high stress onto the transfer components (rolls) accounts for major economic losses. Most critical here are the bearing systems of these rolls operating in the liquid system. Rolls in liquid system can not be avoided as they are needed to transfer the steel-strip into and out of the crucible. Since several years, ceramic roller bearings are tested here [1.2], however, in particular due to uncontrollable Slag-impurities within the hot bath [3], slide bearings are still expected to be of a higher potential [4]. The today's state of the art is the application of slide bearings based on Stellite\ulcorneragainst Stellite which is in general a 50-60 wt% Co-matrix with incorporated Cr- and W-carbides and other composites. Indeed Stellite is used as the bearing-material as of it's chemical properties (does not go into solution), the physical properties in particular with poor lubricating properties are not satisfying at all. To increase the Sliding behavior in the bearing system, about 0.15-0.2 wt% of lead has been added into the hot-bath in the past. Due to environmental regulations. this had to be reduced dramatically_ This together with the heavily increasing production rates expressed by increased velocity of the substrate-steel-band up to 200 m/min and increased tractate power up to 10 tons in modern plants. leads to life times of the bearings of a few up to several days only. To improve this situation. the Mechanical Alloying (MA) TeChnique [5.6.7.8] is used to prOduce advanced Stellite-based bearing materials. A lubricating phase is introduced into Stellite-powder-material by MA, the composite-powder-particles are coated by High Energy Milling (HEM) in order to produce bearing-bushes of approximately 12 kg by Sintering, Liquid Phase Sintering (LPS) and Hot Isostatic Pressing (HIP). The chemical and physical behavior of samples as well as the bearing systems in the hot galvanizing / aluminizing plant are discussed. DependenCies like lubricant material and composite, LPS-binder and composite, particle shape and PM-route with respect to achievable density. (temperature--) shock-reSistibility and corrosive-wear behavior will be described. The materials are characterized by particle size analysis (laser diffraction), scanning electron microscopy and X-ray diffraction. corrosive-wear behavior is determined using a special cylinder-in-bush apparatus (CIBA) as well as field-test in real production condition. Part I of this work describes the initial testing phase where different sample materials are produced, characterized, consolidated and tested in the CIBA under a common AI-Zn-system. The results are discussed and the material-system for the large components to be produced for the field test in real production condition is decided. Outlook: Part II of this work will describe the field test in a hot-dip-galvanizing/aluminizing plant of the mechanically alloyed bearing bushes under aluminum-rich liquid metal. Alter testing, the bushes will be characterized and obtained results with respect to wear. expected lifetime, surface roughness and infiltration will be discussed. Part III of this project will describe a second initial testing phase where the won results of part 1+11 will be transferred to the AI-Si system. Part IV of this project will describe the field test in a hot-dip-aluminizing plant of the mechanically alloyed bearing bushes under aluminum liquid metal. After testing. the bushes will be characterized and obtained results with respect to wear. expected lifetime, surface roughness and infiltration will be discussed.

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High-Resolution of Paleoenvironmental Reconstruction and Sea-Level History in Delaware Bay, the East Coast of U.S.A. (미국동부 델라웨어만의 고정밀도 해수면 역사와 고환경 복원)

  • YI, HI-IL;WEHMILLER, JOHN F.
    • 한국해양학회지
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    • v.30 no.4
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    • pp.320-331
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    • 1995
  • The closely spaced cores were analyzed to find detailed reconstruction of paleoenvironments and sealable changes along the Delaware Bay coast. Three areas, Kitts Hummock Beach mars, the St. Jones River marsh, and Bowers marsh near the St. Jones River's mouth, were chosen because these areas are compose of their own geomorphic characteristics and sea-level history. since significance of the stratigraphic correlations was to determine sedimentary fancies and paleoenvironments, multidisciplinary methods such as lithological description, grain-size analysis, organic/inorganic content, water content, mineral composition, botanical analysis, micropaleontological analysis, and /SUP 14/C datings were performed. Five major divisions of marsh environments were recognized in the stratigraphic sections: freshwater marsh, initialfreshwater marsh, slightly brackish marsh, brackish marsh, and salt marsh. Most of the lower part in the stratigraphic sections show freshwater marsh. On the top of this, either brackish marsh or tidal flat/tidal stream was recorded. The pro-Holocene sediments consist of sand, mud, and sandy mud, The pre-Holocene configuration played an important role for developing the Holocene Paleoenvironmental changes. The irregular configuration of the pre-Holocene sediments consist of sand, mud, and sandy mud. The pre-Holocene configuration played an important role for developing the Holocene Paleoenvironmental changes. The irregular configuration of the pre-Holocene surface within short distances permitted the concurrent development of variable environments such as freshwater marsh, brackish marsh or salt marsh at similar elevations. The freshwater marsh in this case was formed in the areas of isolation, so saline-water cannot encroach upon these areas. This complex development of paleoenvironments leads to a difficulty in stratigraphic correlation and interpretation of local relative sea-level changes. The deposition of subsurface sediments was affected by sediment supply, compaction, fluvial activity, biological competition, local tectonics and isostacy, climate and local relative sea-level changes. It was interpreted that the positions in the changes from freshwater environments to brackish environments or ice versa are the turning points of transgressions and regressions. Therefore, multiple transgressions and regressions were identified in the stratigraphic sections of the study area.

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Health Economic Approach to End-of-Life Care in the US: Based on Medicare (말기의료의 경제적 요소에 관한 논의: 미국 메디케어 상황을 중심으로)

  • Suk, Ryan
    • The Korean Society of Law and Medicine
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    • v.15 no.1
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    • pp.335-373
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    • 2014
  • According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

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