• 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.

• Journal of the Korean Society of Radiology
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• v.14 no.1
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• pp.15-22
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• 2020

PET(Positron Emission Tomography) devices are used as PET/CT or PET/MRI devices fused with the devices of CT or MRI for obtaining anatomical information. Therefore, the devices are constructed in circular ring-type structure whose length of gantry(the main part of filming) becomes wider and the interior depth becomes longer in comparison to other common medical equipments. scintillator, one of the components in PET devices, is inside the gantry, and as it is consisted of crystal which is sensitive to the change of temperature and humidity, large temperature change can cause the scintillator to be damaged. Though scintillator located inside the gantry maintains temperature and humidity with a thermo-hygrostat, changes in temperature and humidity are expected due to structural reasons. The output value was measured by dividing the inside of the gantry of the PET/CT device into six zones, each of which an Adafruit BME 280 temperature and humidity sensor was placed at. A thermo-hygrostat keeps the temperature and humidity constant in the PET/CT room. As the measured value of temperature and humidity of the sensor was obtained, the measured value of temperature and humidity appeared in the thermohygrostat was taken at the same time. Comparing the average measured values of temperature and humidity measured at each six zones with the average values of the thermo-hygrostat results in a difference of 2.71℃ in temperature and 21.5% in humidity. The measured temperature and humidity of PET Gantry is out of domestic quality control range. According to the results of the study, if there is continuous change in temperature and humidity in the future, the aging of the scintillator mounted in the PET Gantry is expected to be aging, so it is necessary to find a way to properly maintain the temperature and humidity inside the Gantry structure.

• Pediatric Infection and Vaccine
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• v.5 no.1
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• pp.104-114
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• 1998

Purpose : Enteroviruses are the most common cause of aseptic meningitis. The epidemics of aseptic meningitis in 1993 and 1996 were mostly caused by echovirus type 9. Identification of the causative virus of aseptic meningitis in epidemics, is very important not only for diagnosis but also for epidemiologic purpose. The purpose of this study was to identify the causative virus and investigate the relationship between aseptic meningitis, prevailed in Masan and surrounding areas in Kyoungsangnamdo in 1997, and its clinical manifestations. Methods : One hundred twenty eight cerebrospinal fluid(CSF) and 239 stool specimens were obtained from 239 patients(213 children and 26 adult patients) with aseptic meningitis were admitted to Masan Fatima Hospitals from March to October 1997. Viral isolation and serotype identification was performed by cell culture and immunofluorescent test. Enteroviruses not typed by immunofluorescent test was confirmed by reverse transcription-polymerase chain reaction(RT-PCR). Results : 1) The peak incidence was noted in June. 2) The age of 239 patients(pediatrics-213 cases, internal medicine-26 cases) that were diagnosed ranged from neonate to 35 years, the age of the patients of pediatrics ranged from neonate to 15years(mean 4.9 years), the age of the patients of internal medicine (above 16 years) ranged from 16 years to 35 years(mean 24.2 years). 3) Fifty-three(41.4%) of 128 CSF specimens were positive for enteroviruses, and 163(68.2%) of 239 stool specimens were positive for enteroviruses respectively. 4) Serotypes of 53 enteroviruses isolated from CSF were 16(30.2%) of echovirus type 30, 6(11.3%) of echovirus type 6, 1 of echovirus type 4, 4 of untyped echovirus, 1 of coxsackievirus type B5, and 24 isolates of untyped enteroviruses. Of 163 enterovirus isolated from stool were 72(44.2%) of echovirus type 30, 21(12.9%) of echovirus type 6, 1 of echovirus type 4, 17(10.4%) of undetermined subtyped echovirus, 1 of coxsackievirus type B5, 2 of A24, 3 of undetermined subtyped coxsackievirus type B, and 46 isolates of untyped enterovirus. Conclusion : There were epidemics of aseptic meningitis in the central areas of Kyoungsangnamdo from March to October 1997. The main causative organism was thought to be the echovirus type 30, and echovirus type 4, 6, coxsackievirus B5 and A24 were also thought to contribute to the epidemics.

• Childhood Kidney Diseases
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• v.18 no.2
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• pp.71-76
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• 2014

Purpose: Attention deficit hyperactivity disorder (ADHD) has been associated with impairments in frontal inhibitory function and the catecholaminergic system. ADHD is diagnosed in 3-5% of children. Children with ADHD seem develop various forms of urinary problems such as nocturnal enuresis, dysfunctional voiding, and diurnal incontinence. However, no data exist to confirm the presence of these problems in Korean children with ADHD. We investigated the clinical findings of voiding dysfunction in children with ADHD. Methods: Between October 2009 and March 2011, a total of 63 children (33 with ADHD, 30 with an upper respiratory infection, as a control group) were enrolled. ADHD was diagnosed using the diagnostic and statistical manual of mental disorders (DSM)-IV criteria. A comprehensive survey of voiding and defecation was administered. Results: The patient group included 28 boys and 5 girls; the control group comprised 20 boys and 10 girls. The mean age was $9.09{\pm}2.8$ years in the ADHD group and $8.58{\pm}3.1$ years in the control group. Children with ADHD had a statistically significantly higher incidence of urgency (P =0.017), urge incontinence (P =0.033), and constipation (P =0.045). There was no significant difference in the incidence of straining, intermittency, holding maneuvers, or nocturnal enuresis. Conclusion: Children with ADHD in Korea have significantly higher rates of urgency, urge incontinence, and constipation than those without ADHD.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.121-125
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• 2011

Purpose: The DNA-type virus HBV, discovered by D. Dane and others in 1976, is approximately 42nm big and known as the main cause of liver-related diseases around the world. HBsAg has 4 kinds of subtypes including adw, adr, ayw and ayr and besides common antigen factor a, there are d, y, r, w. From the methods of serologically testing HBV, IRMA, EIA and CLIa were developed for testing HBsAg and are being used in examining the surface antigen of HBV. In this study, among the methods for testing HBV, the recently developed RIAKEY Ultrasensitive HBsAg IRMA kit's sensitivity level and performance in detection of mutant forms were measured and compared with CLIA. Materials and methods: Two certified reference materials, which are WHO 1st International Standard 1985(80/549) and WHO 2nd International Standard 2003(00/588. subtype adw2, genotypeA), were used in the examination and the sensitivity level was measured by diluting these materials from 0.08 IU/ml to 0.005 IU/ml. The materials for examining the detection of mutant forms included 9 kinds of subtype 'ad' and one kind of subtype 'ay' purchased from DSI company. Also, with the use of positive and negative samples, they was compared with CLIA. Result: Ultrasensitive HBsAg kit based on IRMA method showed the detection of up to 0.01 IU/ml not only for WHO 1st International Standard 1985(80/549) but also for WHO 2nd International Standard 2003(00/588. subtype adw2, genotypeA) and the sensitivity level was measured as 0.01 IU/ml by WHO standard. In testing the performance for detection of mutant forms, the 9 kinds of subtype 'ad' and one kind of subtype 'ay' mutant materials were detected, demonstrating the capacity of detecting various types of mutant forms. Conclusions: With the clinical importance of sensitivity level and performance in detection of mutant forms increasing in the field of HBsAg diagnosis, the examination of IRMA's effectiveness using RIA method in the aspects of the sensitivity level and performance in detection of mutant forms was carried out and its result is as follows. The sensitivity level was measured as 0.01 IU/ml by WHO standard and it was possible to measure various types of mutant forms with high sensitivity. Thus it is suggested that more speedy and accurate reports could be produced from a nuclear medicine laboratory for clinical practitioners requiring results of various situations.

• Journal of The Korean Society of Grassland and Forage Science
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• v.30 no.4
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• pp.317-324
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• 2010

Recently, fallow paddy land located in the mid-mountain area (FPL) due to a decrease in rice consumption has increased in some regions of our country. So, grasses and forage crops available for years in once sowing should be introduced in FPL. This study was conducted to develop the technique for cultivation of grasses and forage crops using animal manure in FPL The field experiments were carried out from 2007 to 2009 on FPL at Kumsan, Chungbuk province in Korea. Cattle feedlot manure (CFM) was prepared by mixing feces and urine of cattle with rice straw in cattle feedlot for 6 months. The experimental plots were consisted of four treatments; tall fescue-based mixed pasture applied with chemical fertilizer (Control), mono-tall fescue pasture (MTFP), tall fescue-based mixed pasture (TFBMP), mono-Perennial ryegrass (MPR-FCM), mono-Italian ryegrass (MIR-FCM), mono-Red clover (MRC-FCM) and mono-Reed canarygrass (MRCG-FCM) applied with FCM. The field of tall fescue-based pasture had been sown with a grasses mixture containing 'Fawn' tall fescue, 'potomac' orchardgrass, 'Reveille' Perennial ryegrass, and 'kenblue' Kentuky bluegrass, 'Kenland' Red clover. Seeding rates were 16, 6, 4, 2 and $2\;ha^{-1}$, respectively. DM yields of forages and rates of grass coverage was higher in MTFP, TFBMP and MRCG-FCM as compated with control treatment. This result means that FPL has contained with favorable conditions for growing grass, because forage productivity is more than 15 tons per ha per year in fallow paddy land. In addition, the farmer can save the trouble of repeated plowing and sowing every year, due to the introduction of perennial grasses. The farmer must conduct the re-seeding and induce the improvement of management methods for the elevation of the persistence of red clover and perennial ryegrass, because both red clover and perennial ryegrass having high nutritive value and palatability was less persistent. Therefore, we suggest that FPL may be the good land for forage production utilizing FCM and FCM can be applied on FPL without any negative effects on DM production and the property of soil. FPL of Korea can be better utilized by applying FCM to the mono and/or mixed swards.

• Korean Journal of Food Science and Technology
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• v.39 no.4
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• pp.470-475
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• 2007

Oplopanax elatus (O. elatus) is a tall deciduous shrub that has traditionally been used for σ eating a variety of ailments such as diabetes, coughling, rheumatism, gastro-intestinal disorders, and wounds. In order to examine the safety of the ethanol extracts of O. elatus, we performed a 14-day repeated-dose toxicity study with Sprague-Dawley rats. The rats were treated with daily doses of the D. elatus ethanol extracts by gavage at 0, 500, 1000, and 2000 mg/kg/day for 14 consecutive days. We recorded clinical signs of toxicity, body weight, hematology, organ weights, gross and histological changes in target organs, and clinical chemistry analysis data for all rats. There were no significant changes in body and organ weights during the experimental period. The hematological analysis and clinical blood chemistry data revealed no toxic effects from the O. elatus ethanol extracts. Pathologically, neither gross abnormalities nor histopathological changes were observed between the control and treated rats of both sexes. Collectively, these data suggest that the ethanol extracts of O. elatus have a high margin of safety.

• Journal of The Korean Society of Grassland and Forage Science
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• v.31 no.1
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• pp.39-46
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• 2011

This study was carried out to determine the forage yield, quality, and regrowth of Italian ryegrass (IRG) and barley sown on 2 March 2009 in Suwon. The five treatments were two IRG cultivars (Kowinearly with early maturity and Kowinmaster with medium maturity), one barley cultivar (Yuyeon), and two mixtures (Kowinearly + Yuyeon and Kowinmaster + Yuyeon). The first harvest date was 26 May, which was at late heading, heading and early dough stage of Kowinearly, Kowinmaster and barley, respectively. Regrowth yield was investigated on 29 June. The heading dates of Kowinearly and Kowinmaster were 16 May and 22 May, respectively, and that of barley was 13 May. The dry matter (DM) percentage were 13.0~18.4% at first harvest, and 22.5~24.8% at regrowth in all treatments. The forage yield of barley and Kowinmaster + Yuyeon mixture at first harvest was higher than that of IRG (p<0.05), but higher regrowth yield was observed in IRG, and then IRG + barley mixtures (p<0.05). The crude protein (CP) content and in vitro DM digestibility (IVDMD) of IRG at first harvest were 16.7~17.1% and 78.3~80.4%, respectively, which were higher than those of barley (CP 12.2% and IVDMD 72.6%) and IRG + barley mixtures. The total yields of DM, CP and digestible DM were high in Kowinmaster + Yuyeon mixture as 11,628 kg, 1,669 kg and 8,457 kg per ha, respectively. In conclusion, spring seeding of IRG + barley mixtures and/or barley were recommended when early harvest. Regrowth of IRG sown in early spring was vigorous. Mixture cultivation of IRG and barley was effective, because of forage yield and stable production, and harvest at June instead of May was desirable for forage productivity of spring sown IRG and barley.

• Journal of The Korean Society of Grassland and Forage Science
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• v.39 no.4
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• pp.258-263
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• 2019

Near infrared reflectance spectroscopy (NIRS) has become increasingly used as a rapid and accurate method of evaluating some chemical compositions in forages. The objective of this study was to evaluate the potential of NIRS, applied to imported forage, to estimate the moisture and chemical parameters for imported hays. A population of 392 imported hay representing a wide range in chemical parameters was used in this study. Samples of forage were scanned at 1 nm intervals over the wavelength range 680-2500nm and the optical data was recorded as log 1/Reflectance(log 1/R), which scanned in intact fresh condition. The spectral data were regressed against a range of chemical parameters using partial least squares(PLS) multivariate analysis in conjunction with spectral math treatments to reduced the effect of extraneous noise. The optimum calibrations were selected based on the highest coefficients of determination in cross validation(R²) and the lowest standard error of cross-validation(SECV). The results of this study showed that NIRS predicted the chemical parameters with very high degree of accuracy. The R² and SECV for imported hay calibration were 0.92(SECV 0.61%) for moisture, 0.98(SECV 0.65%) for acid detergent fiber, 0.97(SECV 0.40%) for neutral detergent fiber, 0.99(SECV 0.06%) for crude protein and 0.97(SECV 3.04%) for relative feed value on a dry matter(%), respectively. Results of this experiment showed the possibility of NIRS method to predict the moisture and chemical composition of imported hay in Korea for routine analysis method to evaluate the feed value.

• Korean Journal of Food Science and Technology
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• v.41 no.3
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• pp.238-244
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• 2009

This survey was conducted as a surveillance program following the establishment of safety guidelines for agricultural products in Korea. Concentrations of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) were measured in 421 samples using a mercury analyzer or ICP-MS. The average levels of Pb in mg/kg were 0.021 for rice, 0.020 for corn, 0.028 for soybeans, 0.034 for red beans, 0.025 for sweet potatoes, 0.021 for potatoes, 0.019 for Chinese cabbage, 0.031 for spinach, 0.021 for Welsh onions, and 0.011 for radishes. The average levels of Cd in mg/kg were 0.021 for rice, 0.002 for corn, 0.020 for soybeans, 0.006 for red beans, 0.008 for sweet potatoes, 0.011 for potatoes, 0.007 for Chinese cabbage, 0.035 for spinach, 0.006 for Welsh onions, and, 0.006 for radishes. The average levels of As in mg/kg were 0.103 for rice, 0.005 for corn, 0.007 for soybeans, 0.005 for red beans, 0.005 for sweet potatoes, 0.004 for potatoes, 0.007 for Chinese cabbage, 0.015 for spinach, 0.009 for Welsh onions and, 0.006 for radishes. Finally, the average levels of Hg in ${\mu}g/kg$ were 2.3 for rice, 0.2 for corn, 0.6 for soybeans, 1.4 for red beans, 0.1 for sweet potatoes, 0.3 for potatoes, 0.5 Chinese cabbage, 2.1 for spinach, 0.5 for Welsh onions, and 0.2 for radishes. Based on the Korean public nutrition report 2005, these levels (or amounts) are calculated only at 2.6% for Pb, 8.7% for Cd, 1.2% for Hg of those presented in provisional tolerable weekly intake (PTWI) which has been established by FAO/WHO. Therefore, the levels presented here are presumed to be adequately safe.