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The Effects of the Revised Elderly Fixed Outpatient Copayment on the Health Utilization of the Elderly (노인외래정액제 개선이 고령층의 의료이용에 미친 영향)

  • Li-hyun Kim;Gyeong-Min Lee;Woo-Ri Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.196-210
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    • 2024
  • Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

Seasonal Variation in Species Composition of Estuarine Fauna Collected by a Stow Net in the Han River Estuary on the mid-western coast of Korea (한강 하구역 유영생물의 종조성과 계절 변동)

  • Hwang, Sun-Do;Rhow, Jin-Goo
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.15 no.2
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    • pp.72-85
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    • 2010
  • Seasonal variation in species composition of estuarine fauna in the Han River estuary was determined using monthly samples collected near Ganghwa Island by a bag net from February to December 2009. Total number of species was 86: 54 species of fishes, 16 species of shrimps of crustacean, 12 species of other crustacean such as craps and so on, 3 species of cephalopods and 1 species of jellyfish. Of a total of 86 species, Palaeman carinicauda (32.6%), Acetes japonicus (15.9%), Palaemon gravieri (9.9%), Portunus trituberculatus (7.7%) and Acetes chinensis (6.9%) were predominated in abundance. These 5 crustacean accounted for 73% of total. Abundance, biomass and diversity of Han River estuarine fauna were high in spring and autumn, indicating typical pattern of temperate area. Out of dominant species, the brackish residence species such as Coilia nasus, Chelon haematocheilus, Mugil cephalus, Synechogobius hasta, Lophiogobius ocellicauda, Tridentiger barbatus, Palaeman carinicauda, Palaemon gravieri were collected almost year-round and predominated in abundance. Coastal migratory fauna species such as Coilia mystus, Thryssa hamiltonii, Thryssa adelae, Sardinella zunasi, Engraulis japonicus, Portunus trituberculatus, Acetes japonicus, Collichthys lucidus, Pampus argenteus were most plentiful from spring through autumn. Their adult coastal migratory entered the estuary in spring and large numbers of their juveniles were grew in summer and autumn until moving out to deeper waters for over-wintering, indicating they use estuary as nursing ground. Diadromous fish such as Anguila japonica adults were collected in autumn during their downstream migration. Brackish fauna and crustacean, especially shrimps were predominant, and few contaminant indicator species collected in the Han River estuary, indicating this area maintains the characteristics of natural estuary ecosystem.

Characteristics of Benthic Environment and Polychaete Communities of Gamak Bay, Korea (가막만의 저서환경과 다모류군집 특성)

  • Yoon, Sang-Pil;Jung, Rae-Hong;Kim, Youn-Jung;Kim, Seong-Soo;Lee, Jae-Seong;Park, Jong-Soo;Lee, Won-Chan;Choi, Woo-Jung
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.12 no.4
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    • pp.287-304
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    • 2007
  • This study was carried out to investigate spatio-temporal variations of benthic environment and macrobenthic polychaete communities in Gamak Bay where excessive organic matters from untreated sewage effluents and fish and shellfish farming activities have been accumulated in certain regions. Such environmental variables as sediment composition, organic content, acid volatile sulfide and dissolved oxygen content etc. were measured and polychaete specimens were taken in September 1999 and February 2000. In September 1999, organic contents were up to three times higher in the northwestern part of the bay and the area closed to Gukdong harbor than in the rest of the bay. In particular, benthic environment of the northwestern part of the bay was extremely deteriorated by the occurrence of hypoxia and highly concentrated sulfide. Of 28 stations investigated in summer, 5 stations located in the northwestern part were azoic. In the rest of the stations, a total of 119 polychaete species were sampled with a mean density of 900 $ind./m^2$. While species richness was higher in the entrance and central part of the bay where water exchanges with open sea were relatively active, density was higher in the moderately enriched stations neighbouring Gukdong harbor and fish farms where such potential indicators of organic pollution as Aphelochaeta monilaris, Lumbrineris longifolia were largely dominant. In February 2000, a total of 81 polychaete species appeared with a mean density of 2,802 $ind./m^2$ from 12 stations sampled in winter. Azoic areas were recolonized by Capitella capitata, Pseudopolydora paucibranchiata and Dipolydora socialis which showed maximum density in the innermost station. On the other hand, the rest of the stations were dominated by Euchone alicaudata and Praxillella affinis. The configuration of the stations sampled in summer and winter on the multidimensional scaling plots reflected the position of each stations within the bay in which there were great differences in organic content, sulfide concentration and oxygen content rather than in sediment composition. Therefore, heterogeneities in polychaete community structure in Gamak Bay were primarily influenced by the degree of the disturbance depending on the position within the bay.

Periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to kidney transplant surgery (투석을 받고 있으며 신장 이식 수술 전 구강내 평가를 위해 의뢰된 말기 신장 질환 자의 치주 상태)

  • Youn-Kyung Choi;Hye-Mi Jeon;Ji-Young Joo;Hyun-Joo Kim;Eun-Young Kwon
    • Journal of Dental Rehabilitation and Applied Science
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    • v.40 no.2
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    • pp.46-54
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    • 2024
  • Purpose: The purpose of this study was to compare the periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to renal transplantation surgery with those having normal kidney function. Materials and Methods: Patients who had been undergoing dialysis for end-stage renal disease and been referred to the Dental Clinic Center by the Department of Nephrology at University Hospital for intraoral evaluation prior to kidney transplantation surgery. For comparison of periodontal status, subjects without abnormalities in kidney function were matched with the patients by age and gender and selected as healthy controls. The patients' age, gender, comorbidities, type of dialysis received, and duration of dialysis were investigated by reference to their medical records, and data on their periodontal status were analyzed via the relevant periodontal records. Results: A total of 102 patients, including 51 dialyzed patients and 51 healthy control group subjects, participated in this study. In the patients with end-stage renal disease undergoing dialysis with periodontal probing depth of 5 mm or more, percentage of sites with clinical attachment level of 4 mm or more, percentage of teeth with bleeding on probing, number of missing teeth, and ratio of moderate to severe periodontitis were all significantly greater than in the healthy controls. Conclusion: The periodontal status of end-stage renal disease patients undergoing dialysis and referred for intraoral evaluation prior to kidney transplantation was worse than that of healthy controls.

Bronchopleural Fistula after Surgery: Therapeutic Efficacy of Bronchial Occluders (수술 후 기관지늑막루: Bronchial Occluder Device의 치료 효과)

  • Young Min Han;Heung Bum Lee;Gong Yong Jin;Kun Yung Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.371-381
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    • 2021
  • Purpose To evaluate the usefulness and effectiveness of bronchial occluders in the treatment of postoperative bronchopleural fistula (BPF). Materials and Methods The subjects of the study were six out of seven postoperative BPF patients who underwent surgery due to tuberculosis or lung cancer between 2009 and 2019. Each patient had a bronchial occluder inserted to treat BPF that occurred after surgery. Of the six patients, five had lung cancers and one had tuberculosis. Five were male and one was female; their ages ranged from 59 to 74 years, with an average of 69 years. The diagnosis of BPF was based on findings from bronchoscopy and CT, and treatment was initiated approximately 1 to 2 weeks after diagnosis. The technical and clinical success of the bronchial occluders in the treatment of BPF was evaluated. The study assessed the postoperative clinical effects of the occluders, survival duration, and additional treatments. Results All six patients were successfully treated. Clinical success was achieved in five patients, while partial clinical success was achieved in one; there was no clinical failure. No complications during the migration of the device or device perforations were observed. Two patients were diagnosed with BPF by CT, while four were diagnosed by bronchoscopy. Lobectomy, bilobectomy, and pneumonectomy were performed on two patients each. The periods between surgery and diagnosis ranged from 1 to 34 months; the average was 10 months. Four patients (59-103 days; an average of 80.5 days) died and two (313 days, 3331 days) survived. The causes of death were aggravation of the underlying disease (n = 2), pulmonary edema and pleural effusion (n = 1), and pneumonia (n = 1). Additional catheter drainage was performed in one patient, and a chest tube was maintained in two patients. Conclusion Bronchial occluders are useful and effective in the treatment of BPF after pulmonary resection.

How Entrepreneur Competency Impacted Startup Survival During the COVID-19 Pandemic: The Mediating Role of Business Performance (코로나19 팬데믹 기간 창업자 역량이 창업기업의 생존에 미치는 영향: 경영 성과의 매개 역할)

  • Kim, Bongkeun;Yoo, Bumjoon;Hwangbo, Yun;Kim, YoungJun
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.19 no.3
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    • pp.155-172
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    • 2024
  • The COVID-19 pandemic not only posed an enormous human crisis, but also had a profound impact on firms' survival. Social distancing and global lockdown measures designed to protect human lives have paradoxically impaired the business environment. As a result, firms that sought to gain competitive advantage by leveraging external resources were cut off from the external world and faced unexpected challenges. Under these circumstances, researches were conducted in the early stage of the pandemic to explore how certain firms survived while others fell, but they were limited to re-examining business performance using traditional financial factors. However, this study aims to investigate the role of entrepreneurs' competency in crisis situations from the Resource-Based View (RBV), as such competency plays an important role in improving business performance and subsequently the probability of startups' survival. Specifically, we evaluated the performance as of end of 2019 of 1,127 startups evaluated by the Korea Technology Finance Corporation (KOTEC), which provides policy financing based on technology assessment, in 2016. We then conducted an empirical study to determine the mediating role of business performance in the relationship between entrepreneurial competencies and firm survival by verifying how many of the sample firms were still in operation at the end of June 2023, when the Korean government declared COVID-19 as an endemic. For this purpose, we defined technological, financial, and marketing competencies as the sub-factors of entrepreneurial competency, and sales growth rate and employment growth rate as the sub-factors of business performance. The results of the empirical analysis showed that technological and financial competencies of the entrepreneur had a positive impact on both business performance and firm survival, and that sales growth rate and employment growth rate mediated the relationship between technological competence and firm survival. However, the positive influence of entrepreneurs' financial competence of the survival of startups was only evident through the growth of employment. This study is the first study in South Korea to define the survival factors of startups in the context of the COVID-19 pandemic, and is expected to contribute to the theoretical and practical discussions on the importance of entrepreneurs' competency as a firms' survival factor based on RVB.

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Dokdo of Korea, A Chance for Peace and Co-Prosperity A Study Using Perspectives of Public Diplomacy and Negotiation Strategies (Memorial Lesson from fisherman, An Yong-bok as a Supreme Negotiator) (한국의 독도, 평화와 상생의 기회: 공공외교 및 협상 관점의 연구 (탁월한 소시민 협상가, 어부 안용복을 기리며))

  • Mi-ae Hwang
    • Public Diplomacy: Theory and Practice
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    • v.2 no.2
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    • pp.27-52
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    • 2022
  • Objectives: The neighboring countries of South Korea and Japan in Northeast Asia have interacted in both positive and negative ways, at times as close partners and other times adversaries, throughout their long and thorny history of extensive dynamics. The controversial dispute over Dokdo is one of the most critical issues evoking harsh tensions and arguments asserting wholly opposite claims. Dokdo is a small island between two coastal states, but significant in terms of territorial, botanical, and marine resources, and thus ownership of the island has become a point of conflict accompanied by a troubled history. But why has Dokdo been a source of conflicts and how should the controversial Dokdo issue be addressed in a way that fosters positive influence and co-prosperity? Methods: This study provides comprehensive and critical insights from a wealth of previous research and strategic suggestions for the Korean government. It utilizes the three perspectives of historical documents and political context, international regulations and legal frames, and public diplomacy. Furthermore, it applies these resources to negotiation theories and strategies to propose reasonable solutions. Results: This study suggests that it is important for Korea and Japan to try to build mutual trust through more active communication and interaction in order to understand each other before attempting to create a formal resolution via negotiation. In addition to these efforts, Korea needs to be ready for the inevitable need to take decisive action in terms of negotiation, using analytic and efficient strategies. The study proposes three solutions: 1) Strong Action Strategy, 2) International Legal Strategy, and 3) Public Diplomacy Strategy. Conclusions: From the perspective of public diplomacy, the Dokdo issue needs to be converted from a symbol of conflicts between Korea and Japan into a symbol of peace and co-prosperity. In addition to promoting a positive relationship between the two states, it can also contribute to the security environment of the Northeast Asian region and global peace.

A Study on Rationalization of National Forest Management in Korea (국유림경영(國有林經營)의 합리화(合理化)에 관(關)한 연구(硏究))

  • Choi, Kyu-Ryun
    • Journal of Korean Society of Forest Science
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    • v.20 no.1
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    • pp.1-44
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    • 1973
  • Needless to say, the management of national forest in all countries is very important in view of the national mission and management purposes. Korean national forest is also in particular significant in promoting national economy for the continuous increasing of the demand for wood, conservation of the land and social welfare. But there's no denying the fact that the leading aim of the Korean forest policy has been based upon the conservation of forest resources and recovery of land conservation function instead of improvement of the forest productive capacity. Therefore, the management of national forest should be aimed as an industry in the chain of the Korean national economy. And the increment of the forest productive capacity based on rationalized forest management is also urgently needed. Not only the increment of the timber production but also the establishment of the good forest in quality and quantity are to bring naturally many functions of conservation and other public benefits. In 1908 Korean national forest was historically established for the first time as a result of the notification for ownership, and was divided into two kinds in 1911-1924, such as indisposable national forest for land conservation, forest management, scientific research and public welfare, and the other national forest to be disposed. Indisposable forest is mostly under the jurisdiction of national forest stations (Chungbu, Tongbu, Nambu), and the tother national forests are under custody of respective cities and provinces, and under custody of the other government authorities. As of the end of 1971, national forest land is 19.5% (1,297,708 ha) of the total forest land area, but growing stock is 50.1% ($35,406,079m^3$) of the total forest growing stock, and timber production of national forest is 23.6% ($205,959m^3$) of the year production of total timber in Korea. Accordingly, it is the important fact that national forest occupies the major part of Korean forestry. The author positively affirms that success or failure of the management of national forest controls rise or fall of forestry in Korea. All functions of forest are very important, but among others the function of timber production is most important especially in Korea, that unavoidably imports a large quantity of foreign wood every year (in 1971 import of foreign wood-$3,756,000m^3$, 160,995,000 dollars). So, Korea urgently needs the improvement of forest productive capacity in national forest. But it is difficult that wood production meets the rapid increase of demand for wood to the development of economy, because production term of forestry is long, so national forest management should be rationalized by the effective investment and development of forestry techniques in the long view. Although Korean national forest business has many difficulties in the budget, techniques and the lack of labour due to outflow of rural village labour by development of national economy, and the increase of labour wages and administrative expenses etc. the development of national forest depends on adoption of the suitable forest techniques and management adapted for social and economical development. In this view point the writer has investigated and analyzed the status of the management of national forest in Korea to examine the irrational problems and suggest an improvement plan. The national forestry statistics cited in this study is based on the basic statistics and the statistics of the forest business as of the end of 1971 published by Office of Forestry, Republic of Korea, and the other depended on the data presented by the national forest stations. The writer wants to propose as follows (seemed to be helpful in improvement of Korean national forest management). 1) In the organization of national forest management, more national forest stations should be established to manage intensively, and the staff of working plan officials should be strengthened because of the importance of working plan. 2) By increasing the staff of protection officials, forest area assigned for each protection official should be decreased to 1,000-2,000 ha. 3) The frequent personnel changes of supervisor of national forest station(the responsible person on-the-spot) obstructs to accomplish the consistent management plan. 4) In the working plan drafting for national forest, basic investigations should be carefully practiced with sufficient expenditure and staff not to draft unreal working plan. 5) The area of working-unit should be decreased to less than 2,000 ha on the average for intensive management and the principle of a working-unit in a forest station should be realized as soon as possible. 6) Reforestation on open land should be completed in a short time with a debt of the special fund(a long term loan), and the land on which growing hardwood stands should be changed with conifers to increase productivity per unit area, and at the same time techical utilization method of hardwood should be developed. 7) Expenses of reforestation should be saved by mechanization and use of chemicals for reforestation and tree nursery operation providing against the lack of labour in future. 8) In forest protection, forest fire damage is enormous in comparison with foreign countries, accordingly prevention system and equipment should be improved, and also the minimum necessary budget should be counted up for establishment and manintenance of fire-lines. 9) Manufacture production should be enlarged to systematize protection, processing and circulation of forest business, and, by doing this, mich benefit is naturally given for rural people. 10) Establishment and arrangement of forest road networks and erosion control work are indispensable for the future development of national forest itself and local development. Therefore, these works should be promoted by the responsibility of general accounting instead of special accounting. 11) Mechanization of forest works should be realized for exploiting hinterlands to meet the demand for timber increased and for solving lack of labour, consequently it should promote import of forest machines, home production, training for operaters and careful adminitration. 12) Situation of labour in future will grow worse. Therefore, the countermeasure to maintain forest labourers and pay attention to public welfare facilities and works should be considered. 13) Although the condition of income and expenditure grows worse because of economical change, the regular expenditure should be fixed. So part of the surplus fund, as of the end of 1971, should be established for the fund, and used for enlarging reforestation and forest road networks(preceding investment in national forest).

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Korean Sentence Generation Using Phoneme-Level LSTM Language Model (한국어 음소 단위 LSTM 언어모델을 이용한 문장 생성)

  • Ahn, SungMahn;Chung, Yeojin;Lee, Jaejoon;Yang, Jiheon
    • Journal of Intelligence and Information Systems
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    • v.23 no.2
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    • pp.71-88
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    • 2017
  • Language models were originally developed for speech recognition and language processing. Using a set of example sentences, a language model predicts the next word or character based on sequential input data. N-gram models have been widely used but this model cannot model the correlation between the input units efficiently since it is a probabilistic model which are based on the frequency of each unit in the training set. Recently, as the deep learning algorithm has been developed, a recurrent neural network (RNN) model and a long short-term memory (LSTM) model have been widely used for the neural language model (Ahn, 2016; Kim et al., 2016; Lee et al., 2016). These models can reflect dependency between the objects that are entered sequentially into the model (Gers and Schmidhuber, 2001; Mikolov et al., 2010; Sundermeyer et al., 2012). In order to learning the neural language model, texts need to be decomposed into words or morphemes. Since, however, a training set of sentences includes a huge number of words or morphemes in general, the size of dictionary is very large and so it increases model complexity. In addition, word-level or morpheme-level models are able to generate vocabularies only which are contained in the training set. Furthermore, with highly morphological languages such as Turkish, Hungarian, Russian, Finnish or Korean, morpheme analyzers have more chance to cause errors in decomposition process (Lankinen et al., 2016). Therefore, this paper proposes a phoneme-level language model for Korean language based on LSTM models. A phoneme such as a vowel or a consonant is the smallest unit that comprises Korean texts. We construct the language model using three or four LSTM layers. Each model was trained using Stochastic Gradient Algorithm and more advanced optimization algorithms such as Adagrad, RMSprop, Adadelta, Adam, Adamax, and Nadam. Simulation study was done with Old Testament texts using a deep learning package Keras based the Theano. After pre-processing the texts, the dataset included 74 of unique characters including vowels, consonants, and punctuation marks. Then we constructed an input vector with 20 consecutive characters and an output with a following 21st character. Finally, total 1,023,411 sets of input-output vectors were included in the dataset and we divided them into training, validation, testsets with proportion 70:15:15. All the simulation were conducted on a system equipped with an Intel Xeon CPU (16 cores) and a NVIDIA GeForce GTX 1080 GPU. We compared the loss function evaluated for the validation set, the perplexity evaluated for the test set, and the time to be taken for training each model. As a result, all the optimization algorithms but the stochastic gradient algorithm showed similar validation loss and perplexity, which are clearly superior to those of the stochastic gradient algorithm. The stochastic gradient algorithm took the longest time to be trained for both 3- and 4-LSTM models. On average, the 4-LSTM layer model took 69% longer training time than the 3-LSTM layer model. However, the validation loss and perplexity were not improved significantly or became even worse for specific conditions. On the other hand, when comparing the automatically generated sentences, the 4-LSTM layer model tended to generate the sentences which are closer to the natural language than the 3-LSTM model. Although there were slight differences in the completeness of the generated sentences between the models, the sentence generation performance was quite satisfactory in any simulation conditions: they generated only legitimate Korean letters and the use of postposition and the conjugation of verbs were almost perfect in the sense of grammar. The results of this study are expected to be widely used for the processing of Korean language in the field of language processing and speech recognition, which are the basis of artificial intelligence systems.

Dose Response Relationship in Local Radiotherapy for Hepatocellular Carcinoma (원발성 간암의 국소 방사선치료 시 선량반응 관계)

  • Park Hee Chul;Seong Jinsil;Han Kwang Hyub;Chon Chae Yoon;Moon Young Myoung;Song Jae Seok;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.19 no.2
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    • pp.118-126
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    • 2001
  • Purpose : In this study, it was investigated whether dose response relation existed or not in local radiotherapy for primary hepatocellular carcinoma. Materials and Methods : From January 1992 to March 2000, 158 patients were included in present study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Radiotherapy was given to the field including tumor with generous margin using 6, 10-MV X-ray. Mean tumor dose was $48.2{\pm}7.9\;Gy$ in daily 1.8 Gy fractions. Tumor response was based on diagnostic radiologic examinations such as CT scan, MR imaging, hepatic artery angiography at $4\~8$ weeks following completion of treatment. Statistical analysis was done to investigate the existence of dose response relationship of local radiotherapy when it was applied to the treatment of primary hepatocellular carcinoma. Results : An objective response was observed in 106 of 158 patients, giving a response rate of $67.1\%$. Statistical analysis revealed that total dose was the most significant factor in relation to tumor response when local radiotherapy was applied to the treatment of primary hepatocellular carcinoma. Only $29.2\%$ showed objective response in patients treated with dose less than 40 Gy, while $68.6\%\;and\;77.1\%$ showed major response in patients with $40\~50\;Gy$ and more than 50 Gy, respectively. Child-Pugh classification was significant factor in the development of ascites, overt radiation induced liver disease and gastroenteritis. Radiation dose was an important factor for development of radiation induced gastroduodenal ulcer. Conclusion : Present study showed the existence of dose response relationship in local radiotherapy for primary hepatocellular carcinoma. Only radiotherapy dose was a significant factor to predict the objective response. Further study is required to predict the maximal tolerance dose in consideration of liver function and non-irradiated liver volume.

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