• Journal of Chest Surgery
• /
• v.33 no.7
• /
• pp.531-540
• /
• 2000

Baclgrpimd; Recent studies have suggested that the cardioprotective effect of ischemic preconditioning(IP) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G)-free perfusate. Material and Method; Hearts isolated from New Zealand white rabbits(1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45 min global ischemia followed by 120 min reperfusion with IP(IP group, n=13) or without IP(ischemic control group, n=10). IP was induced by single episode of 5 min global ischemia and 10 min reperfusion. In the G-free preconditioned group(n=12), G depletion was induced by perfusionwith G-free Tyrode solution for 5 min and then perfused with G-containing Tyrode solution for 10 min; and 45 min ischemia and 120 min reperfusion. Left ventricular functionincluding developed pressure(LVDP), dP/dt, heart rate, left ventricular end-distolic pressure(LVEDP) and coronary flow (CF) were measured. Myocardial cytosolic and membrane PKC activities were measured by 32P-${\gamma}$-ATP incorporation into PKC-specific peptide and PKC isozymes were analyzed by Western blot with monoclonal antibodies. Infarct size was determined by staining with TTC(tetrazolium salt) and planimetry. Data were analyzed by one-way analysis of variance (ANOVA) and Turkey's post-hoc test. Result ; In comparison with the ischemic control group, IP significantly enhanced functional recovery of the left ventricle; in contrast, functional significantly enhanced functional recovery of the left ventricle; in contrast, functional recovery were not significantly different between the G-free preconditioned and the ischemic control groups. However, the infarct size was significantly reduced by IP or G-free preconditioning(39$\pm$2.7% in the ischemic control, 19$\pm$1.2% in the IP, and 15$\pm$3.9% in the G-free preconditioned, p<0.05). Membrane PKC activities were increased significantly after IP (119%), IP and 45 min ischemia(145%), G-free [recpmdotopmomg (150%), and G-free preconditioning and 45 min ischemia(127%); expression of membrane PKC isozymes, $\alpha$ and $\varepsilon$, tended to be increased after IP or G-free preconditioning. Conclusion; These results suggest that in isolated Langendorff-perfused rabbit heart model, G-free preconditioning (induced by single episode of 5 min G depletion and 10 min repletion) colud not improve post-ischemic contractile dysfunction(after 45-minute global ischemia); however, it has an infarct size-limiting effect.

• Sleep Medicine and Psychophysiology
• /
• v.24 no.2
• /
• pp.106-117
• /
• 2017

Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). Methods: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. Results: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and ${\ddot{O}}stberg$ questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. Conclusion: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.

• Journal of Intelligence and Information Systems
• /
• v.23 no.4
• /
• pp.33-56
• /
• 2017

As Internet usage is becoming more common worldwide and smartphone become necessity in daily life, technologies and applications related to mobile Internet are developing rapidly. The results of the Internet usage patterns of consumers around the world imply that there are many potential new business opportunities for mobile Internet technologies and applications. The location-based service (LBS) is a service based on the location information of the mobile device. LBS has recently gotten much attention among many mobile applications and various LBSs are rapidly developing in numerous categories. However, even with the development of LBS related technologies and services, there is still a lack of empirical research on the intention to use LBS. The application of previous researches is limited because they focused on the effect of one particular factor and had not shown the direct relationship on the intention to use LBS. Therefore, this study presents a research model of factors that affect the intention to use and actual use of LBS whose market is expected to grow rapidly, and tested it by conducting a questionnaire survey of 330 users. The results of data analysis showed that service customization, service quality, and personal innovativeness have a positive effect on the intention to use LBS and the intention to use LBS has a positive effect on the actual use of LBS. These results implies that LBS providers can enhance the user's intention to use LBS by offering service customization through the provision of various LBSs based on users' needs, improving information service qualities such as accuracy, timeliness, sensitivity, and reliability, and encouraging personal innovativeness. However, privacy concerns in the context of LBS are not significantly affected by service customization and personal innovativeness and privacy concerns do not significantly affect the intention to use LBS. In fact, the information related to users' location collected by LBS is less sensitive when compared with the information that is used to perform financial transactions. Therefore, such outcomes on privacy concern are revealed. In addition, the advantages of using LBS are more important than the sensitivity of privacy protection to the users who use LBS than to the users who use information systems such as electronic commerce that involves financial transactions. Therefore, LBS are recommended to be treated differently from other information systems. This study is significant in the theoretical point of contribution that it proposed factors affecting the intention to use LBS in a multi-faceted perspective, proved the proposed research model empirically, brought new insights on LBS, and broadens understanding of the intention to use and actual use of LBS. Also, the empirical results of the customization of LBS affecting the user's intention to use the LBS suggest that the provision of customized LBS services based on the usage data analysis through utilizing technologies such as artificial intelligence can enhance the user's intention to use. In a practical point of view, the results of this study are expected to help LBS providers to develop a competitive strategy for responding to LBS users effectively and lead to the LBS market grows. We expect that there will be differences in using LBSs depending on some factors such as types of LBS, whether it is free of charge or not, privacy policies related to LBS, the levels of reliability related application and technology, the frequency of use, etc. Therefore, if we can make comparative studies with those factors, it will contribute to the development of the research areas of LBS. We hope this study can inspire many researchers and initiate many great researches in LBS fields.

• Neonatal Medicine
• /
• v.18 no.1
• /
• pp.82-88
• /
• 2011

Purpose: This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes. Methods: Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively. Results: Gestational age was 27.8${\pm}$2.5 weeks and birth weight was 1,110${\pm}$307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19${\pm}$7 day, 30.6${\pm}$2.4 weeks, 1,285${\pm}$365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2${\pm}$0.7 days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6${\pm}$4.1 mg/dL. Mean blood pressure increased from 25.0${\pm}$5.4 mmHg to 35.0${\pm}$5.3 mmHg, 38.3${\pm}$8.0 mmHg and 41.9${\pm}$6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9${\pm}$0.6 mL/kg/hr to 4.1${\pm}$3.4 mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0${\pm}$2.9 $\mu$g/kg/min to 8.0${\pm}$2.3 $\mu$g/kg/min, and to 5.5${\pm}$3.4 ${\mu}g$/kg/min after 24 hours. Serum sodium concentration was increased from 130${\pm}$4 mEq/L to 136${\pm}$4 mEq/L, serum potassium concentration was decreased from 6.1${\pm}$1.1 mEq/L to 4.6${\pm}$0.6 mEq/L before and 12 hours after hydrocortisone administration. Conclusion: In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.13
• /
• pp.869-895
• /
• 2000

The US supports the Information and Communication (IC) industry as a strategic one to wield a complete power over the World Market. However, several other countries are also eager to have the support for the IC industry because the industry produces a high added value and has a significant effect on other industries. Korea is not an exception. Korea recently succeeded in the commercialization of CDMA for the first time in the world, after the successful development of TDX. Hence, it is highly likely to get tracked by the US. Although the IC industry is a specific sector of IT, there is a concern that there might be a trade friction between the US and Korea due to a possible competition. It will be very important to prepare a solution in advance so that Korea could prevent the friction and at the same time increase its share domestically and globally. It will be our important task to solve the problem with the minimum cost if the conflict arises unfortunately in the IT area. The parties that have a strong influence on the US trade policy are the think tank group and the IT-related interest group. Therefore, it would be important to have a close relationship with them. We found some implications by analyzing the case of Japan, which has experienced trade frictions with the US over the long period of time in the high tech industry. In order to get rid of those conflicts with the US, the Japanese did the following things : (1) The Japanese government developed supporting theories and also resorted to international support so that the world could support the Japanese theories. (2) Through continual dialogue with the US business people, the Japanese business people sought after solutions to share profits among the Japanese and the US both in the domestic and in the worldwide markets. They focused on lobbying activities to influence the US public opinion to support the Japanese. The specific implementation plan was first to open culture lobby toward opinion leaders who were leaders about the US opinion. The institution, Japan Society, were formed to deliver a high quality lobbying activities. The second plan is economic lobby. They have established Japanese Economic Institute at Washington. They provide information about Japan regularly or irregularly to the US government, research institution, universities, etc., that are interested in Japan. The main objective behind these activities though is to advertise the validity of Japanese policy. Japanese top executives, practical interest groups on international trade, are trying to justify their position by direct contact with the US policy makers. The third one is political lobby. Japan is very careful about this political lobby. It is doing its best not to give impression that Japan is trying to shape the US policy making. It is collecting a vast amount of information to make a correct judgment on situation. It is not tilted toward one political party or the other, and is rather developing a long-term network of people who understand and support the Japanese policy. The following implications were drawn from the experience of Japan. First, the Korean government should develop a long-term plan and execute it to improve the Korean image perceived by American people. Second, the Korean government should begin public relation activities toward the US elite group. It is inevitable to make an effort to advertise Korea to this elite group because this group leads public opinion in the USA. Third, the Korean government needs the development of a relevant policy to elevate the positive atmosphere for advertising toward the US. For example, we need information about to whom and how to about lobbying activities, personnel network who immediately respond to wrong articles about Korea in the US press, and lastly the most recent data bank of Korean support group inside the USA. Fourth, the Korean government should create an atmosphere to facilitate the advertising toward the US. Examples include provision of incentives in tax on the expenses for the advertising toward the US and provision of rewards to those who significantly contribute to the advertising activities. Fifth, the Korean government should perform the role of a bridge between Korean and the US business people. Sixth, the government should promptly analyze the policy of IT industry, a strategic area, and timely distribute information to industries in Korea. Since the Korean government is the only institution that has formal contact with the US government, it is highly likely to provide information of a high quality. The followings are some implications for business institutions. First, Korean business organization should carefully analyze and observe the business policy and managerial conditions of US companies. It is very important to do so because all the trade frictions arise at the business level. Second, it is also very important that the top management of Korean firms contact the opinion leaders of the US. Third, it is critically needed that Korean business people sent to the USA do their part for PR activities. Fourth, it is very important to advertise to American employees in Korean companies. If we cannot convince our American employees, it would be a lot harder to convince regular American. Therefore, it is very important to make the American employees the support group for Korean ways. Fifth, it should try to get much information as early as possible about the US firms policy in the IT area. It should give an enormous effort on early collection of information because by doing so it has more time to respond. Sixth, it should research on the PR cases of foreign enterprise or non-American companies inside the USA. The research needs to identify the success factors and the failure factors. Finally, the business firm will get more valuable information if it analyzes and responds to, according to each medium.

• Journal of Korean Medical classics
• /
• v.20 no.4
• /
• pp.91-117
• /
• 2007

Through a simple study of the medical classics in the '$\bar{A}yurveda$', we have summarized them as follows. 1) Traditional Indian medicine started in the Ganges river area at about 1500 B. C. E. and traces of medical science can be found in the "Rigveda" and "Atharvaveda". 2) The "Charaka" and "$Su\acute{s}hruta$(妙聞集)", ancient texts from India, are not the work of one person, but the result of the work and errors of different doctors and philosophers. Due to the lack of historical records, the time of Charaka or $Su\acute{s}hruta$(妙聞)s' lives are not exactly known. So the completion of the "Charaka" is estimated at 1st${\sim}$2nd century C. E. in northwestern India, and the "$Su\acute{s}hruta$" is estimated to have been completed in 3rd${\sim}$4th century C. E. in central India. Also, the "Charaka" contains details on internal medicine, while the "$Su\acute{s}hruta$" contains more details on surgery by comparison. 3) '$V\bar{a}gbhata$', one of the revered Vriddha Trayi(triad of the ancients, 三醫聖) of the '$\bar{A}yurveda$', lived and worked in about the 7th century and wrote the "$A\d{s}\d{t}\bar{a}nga$ $A\d{s}\d{t}\bar{a}nga$ $h\d{r}daya$ $sa\d{m}hit\bar{a}$ $samhit\bar{a}$(八支集)" and "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$(八心集)", where he tried to compromise and unify the "Charaka" and "$Su\acute{s}hruta$". The "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$" was translated into Tibetan and Arabic at about the 8th${\sim}$9th century, and if we generalize the medicinal plants recorded in each the "Charaka", "$Su\acute{s}hruta$" and the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", there are 240, 370, 240 types each. 4) The 'Madhava' focused on one of the subjects of Indian medicine, '$Nid\bar{a}na$' ie meaning "the cause of diseases(病因論)", and in one of the copies found by Bower in 4th century C. E. we can see that it uses prescriptions from the "BuHaLaJi(布哈拉集)", "Charaka", "$Su\acute{s}hruta$". 5) According to the "Charaka", there were 8 branches of ancient medicine in India : treatment of the body(kayacikitsa), special surgery(salakya), removal of alien substances(salyapahartka), treatment of poison or mis-combined medicines(visagaravairodhikaprasamana), the study of ghosts(bhutavidya), pediatrics(kaumarabhrtya), perennial youth and long life(rasayana), and the strengthening of the essence of the body(vajikarana). 6) The '$\bar{A}yurveda$', which originated from ancient experience, was recorded in Sanskrit, which was a theorization of knowledge, and also was written in verses to make memorizing easy, and made medicine the exclusive possession of the Brahmin. The first annotations were 1060 for the "Charaka", 1200 for the "$Su\acute{s}hruta$", 1150 for the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", and 1100 for the "$Nid\bar{a}na$", The use of various mineral medicines in the "Charaka" or the use of mercury as internal medicine in the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", and the palpation of the pulse for diagnosing in the '$\bar{A}yurveda$' and 'XiZhang(西藏)' medicine are similar to TCM's pulse diagnostics. The coexistence with Arabian 'Unani' medicine, compromise with western medicine and the reactionism trend restored the '$\bar{A}yurveda$' today. 7) The "Charaka" is a book inclined to internal medicine that investigates the origin of human disease which used the dualism of the 'Samkhya', the natural philosophy of the 'Vaisesika' and the logic of the 'Nyaya' in medical theories, and its structure has 16 syllables per line, 2 lines per poem and is recorded in poetry and prose. Also, the "Charaka" can be summarized into the introduction, cause, judgement, body, sensory organs, treatment, pharmaceuticals, and end, and can be seen as a work that strongly reflects the moral code of Brahmin and Aryans. 8) In extracting bloody pus, the "Charaka" introduces a 'sharp tool' bloodletting treatment, while the "$Su\scute{s}hruta$" introduces many surgical methods such as the use of gourd dippers, horns, sucking the blood with leeches. Also the "$Su\acute{s}hruta$" has 19 chapters specializing in ophthalmology, and shows 76 types of eye diseases and their treatments. 9) Since anatomy did not develop in Indian medicine, the inner structure of the human body was not well known. The only exception is 'GuXiangXue(骨相學)' which developed from 'Atharvaveda' times and the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$". In the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$"'s 'ShenTiLun(身體論)' there is a thorough listing of the development of a child from pregnancy to birth. The '$\bar{A}yurveda$' is not just an ancient traditional medical system but is being called alternative medicine in the west because of its ability to supplement western medicine and, as its effects are being proved scientifically it is gaining attention worldwide. We would like to say that what we have researched is just a small fragment and a limited view, and would like to correct and supplement any insufficient parts through more research of new records.

• Journal of the Korean Society of Food Science and Nutrition
• /
• v.35 no.4
• /
• pp.464-469
• /
• 2006

This study was conducted to evaluate a knowledge on food components of muscle and adductor muscle of pearl oyster (Pinctada fucata martensii) as pearl processing byproducts. The concentrations of mercury and chromium as heavy metal were not detected in both pearl oyster muscle and adductor muscle, and those of cadmium and lead were 0.06 ppm and 0.11 ppm in only pearl oyster muscle, respectively. Thus, the heavy metal levels of pearl processing byproducts were below the reported safety limits. The volatile basic nitrogen (VBN) content and pH of pearl oyster muscle were 11.6 mg/100g and 6.31 and those of abductor muscle were 8.6 mg/100 g and 6.33, respectively. It was concluded that pearl oyster muscle and adductor muscle might not invoke health risk in using food resource. The contents of crude protein (16.5%) and total amino acid (15,691 mg/100 g) of adductor muscle were higher than those of muscle (11.2% and 10,131 mg/100 g) and oyster (12.1% and 11,213 mg/100 g) as a control. The contents of calcium and phosphorus were 95.4 mg/100 g and 116.0 mg/100 g in muscle, 75.2 mg/100g and 148.1 mg/100 g in adductor muscle, respectively. The calcium level based on phosphorus was a good ratio for absorbing calcium. The free amino acid contents and taste values were 635.5 mg/100 g and 40.2 in muscle, and 734.9 mg/100 g and 24.1 in adductor muscle, respectively, but that (882.8 mg/100 g and 40.2) of oyster was higher than those of pearl processing byproducts. Based on the results of physicochemical and nutritional properties, pearl oyster muscle and adductor muscle can be utilized as a food resource.

• Journal of Global Scholars of Marketing Science
• /
• v.18 no.2
• /
• pp.223-252
• /
• 2008

In this study, we attempt to propose a choice-based diffusion model with switching cost, which can be used to forecast the dynamic substitution and competition among previous and new products at both individual-level and aggregate level, especially when market data for new products is insufficient. Additionally, we apply the proposed model to the empirical case of substitution and competition among Analog Cable TV that represents previous fixed charged broadcasting service and Digital Cable TV and Internet Protocol TV (IPTV) that are new ones, verify the validities of our proposed model, and finally derive related empirical implications. For empirical application, we obtained data from survey conducted as follows. Survey was administered by Dongseo Research to 1,000 adults aging from 20 to 60 living in Seoul, Korea, in May of 2007, under the title of 'Demand analysis of next generation fixed interactive broadcasting services'. Conjoint survey modified as follows, was used. First, as the traditional approach in conjoint analysis, we extracted 16 hypothetical alternative cards from the orthogonal design using important attributes and levels of next generation interactive broadcasting services which were determined by previous literature review and experts' comments. Again, we divided 16 conjoint cards into 4 groups, and thus composed 4 choice sets with 4 alternatives each. Therefore, each respondent faces 4 different hypothetical choice situations. In addition to this, we added two ways of modification. First, we asked the respondents to include the status-quo broadcasting services they subscribe to, as another alternative in each choice set. As a result, respondents choose the most preferred alternative among 5 alternatives consisting of 1 alternative with current subscription and 4 hypothetical alternatives in 4 choice sets. Modification of traditional conjoint survey in this way enabled us to estimate the factors related to switching cost or switching threshold in addition to the effects of attributes. Also, by using both revealed preference data(1 alternative with current subscription) and stated preference data (4 hypothetical alternatives), additional advantages in terms of the estimation properties and more conservative and realistic forecast, can be achieved. Second, we asked the respondents to choose the most preferred alternative while considering their expected adoption timing or switching timing. Respondents are asked to report their expected adoption or switching timing among 14 half-year points after the introduction of next generation broadcasting services. As a result, for each respondent, 14 observations with 5 alternatives for each period, are obtained, which results in panel-type data. Finally, this panel-type data consisting of $4{\ast}14{\ast}1000=56000$observations is used for estimation of the individual-level consumer adoption model. From the results obtained by empirical application, in case of forecasting the demand of new products without considering existence of previous product(s) and(or) switching cost factors, it is found that overestimated speed of diffusion at introductory stage or distorted predictions can be obtained, and as such, validities of our proposed model in which both existence of previous products and switching cost factors are properly considered, are verified. Also, it is found that proposed model can produce flexible patterns of market evolution depending on the degree of the effects of consumer preferences for the attributes of the alternatives on individual-level state transition, rather than following S-shaped curve assumed a priori. Empirically, it is found that in various scenarios with diverse combinations of prices, IPTV is more likely to take advantageous positions over Digital Cable TV in obtaining subscribers. Meanwhile, despite inferiorities in many technological attributes, Analog Cable TV, which is regarded as previous product in our analysis, is likely to be substituted by new services gradually rather than abruptly thanks to the advantage in low service charge and existence of high switching cost in fixed charged broadcasting service market.

• The Korean Nurse
• /
• v.29 no.2
• /
• pp.48-65
• /
• 1990

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

• Progress in Medical Physics
• /
• v.22 no.1
• /
• pp.42-51
• /
• 2011

Nuclear medicine images (SPECT, PET) were widely used tool for assessment of myocardial viability and perfusion. However it had difficult to define accurate myocardial infarct region. The purpose of this study was to investigate methodological approach for automatic measurement of rat myocardial infarct size using polar map with adaptive threshold. Rat myocardial infarction model was induced by ligation of the left circumflex artery. PET images were obtained after intravenous injection of 37 MBq $^{18}F$-FDG. After 60 min uptake, each animal was scanned for 20 min with ECG gating. PET data were reconstructed using ordered subset expectation maximization (OSEM) 2D. To automatically make the myocardial contour and generate polar map, we used QGS software (Cedars-Sinai Medical Center). The reference infarct size was defined by infarction area percentage of the total left myocardium using TTC staining. We used three threshold methods (predefined threshold, Otsu and Multi Gaussian mixture model; MGMM). Predefined threshold method was commonly used in other studies. We applied threshold value form 10% to 90% in step of 10%. Otsu algorithm calculated threshold with the maximum between class variance. MGMM method estimated the distribution of image intensity using multiple Gaussian mixture models (MGMM2, ${\cdots}$ MGMM5) and calculated adaptive threshold. The infarct size in polar map was calculated as the percentage of lower threshold area in polar map from the total polar map area. The measured infarct size using different threshold methods was evaluated by comparison with reference infarct size. The mean difference between with polar map defect size by predefined thresholds (20%, 30%, and 40%) and reference infarct size were $7.04{\pm}3.44%$, $3.87{\pm}2.09%$ and $2.15{\pm}2.07%$, respectively. Otsu verse reference infarct size was $3.56{\pm}4.16%$. MGMM methods verse reference infarct size was $2.29{\pm}1.94%$. The predefined threshold (30%) showed the smallest mean difference with reference infarct size. However, MGMM was more accurate than predefined threshold in under 10% reference infarct size case (MGMM: 0.006%, predefined threshold: 0.59%). In this study, we was to evaluate myocardial infarct size in polar map using multiple Gaussian mixture model. MGMM method was provide adaptive threshold in each subject and will be a useful for automatic measurement of infarct size.