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The Effect of the Degree of Competition of the Hospital Market Regions on Clinic's Rate of Antibiotics Prescription (병원시장지역 내 경쟁 정도가 의원급 의료기관의 항생제 처방률에 미치는 영향)

  • Jo, Changik;Lim, Jae-Young;Lee, Soo Yeon
    • KDI Journal of Economic Policy
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    • v.30 no.2
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    • pp.129-155
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    • 2008
  • The rate of antibiotics prescription for an acute airway infection significantly varies depending upon the diagnosis type, specialty, and the location of the hospital along with many other related factors. The objective of this study is to empirically investigate the possible relationship between the antibiotics prescription rates for an acute airway infection and the degree of competition in the hospital market regions of mainly the providers of primary medical care services such as clinics, internal medicines, pediatrics and otorhinolaryngology department. Using the data from Health Insurance Review and Assessment Service (HIRA) regarding the hospitals' antibiotics prescription rates for the acute airway infection and controlling for selected variables of demand and supply sectors, this study tries to figure out that the degree of competition in the hospital market, regardless of what type of competition indexes we employed, has a statistically significant effect on the variations of antibiotics prescription rate of the clinics in local areas. This result implies that as an economic consideration itself, the change in the degree of competition in the hospital market can play a crucial role influencing the treatment behaviors of the medical doctors. More specifically, this study reveals that as the degree of competition increases the antibiotics prescription rate goes up. This result means that if the market becomes more competitive in a specific region so that it might cause a reduction in doctor's income, doctors with rational decision-making process, recognize that the benefit created from inducing patients' seemingly unnecessary demand for medical care (income effect) would be higher than the costs associated with sustaining their targeted income (substitution effect). It is because that the doctors are more likely to prescribe antibiotics which create relatively higher margins than other medical care services in order to sustain their targeted income when the hospital market competition becomes tighter. Even though this study empirically confirms that antibiotics prescription can be affected by the economic incentives, it still raises following issues as limitations of the study: first issue is about the representativeness of the hospital regions segregated for this study, which might be weak in explaining whether these regions are mutually exclusive in reality. Patients actually consider the quality of services, transportation cost, time costs, and any other related factors choosing the doctors or hospitals, and in that sense, this study rules out 'border-crossing' in using the medical care services. Second issue arises in capturing the data of antibiotics prescription rate. Since we use the average rate for each medical institution, we cannot figure out the average rate for each patient so that we are not able to control for the variation of patients' medical conditions. It is because of the unavailability of data regarding each patient's medical condition from HIRA. Thirdly, since this study mainly analyzes the medical institutions providing primary care such as clinics, internal medicines, pediatrics, and otorhinolaryngology department, it is skeptical of whether those institutions can represent the hospital market in respective regions and truly reflect the degree of competition. It needs to extend the study areas and disease types as well as any micro data for future studies.

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The Scope and the Meaning of 'Time of Arrival' in Carriage of Passengers by Air : Focused on the Germanwings GmbH v. Ronny Henning, Case C-452/13 (2014). (항공여객운송에서의 지연보상과 도착시각의 의미 - EU 사법재판소 2014. 9. 14. 판결(ECLI:EU:C:2014:2141)을 중심으로 -)

  • Sur, Ji-Min
    • The Korean Journal of Air & Space Law and Policy
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    • v.33 no.2
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    • pp.267-290
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    • 2018
  • This paper reviews and criticizes the EU Case of C-452/13, Germanwings GmbH v. Ronny Henning. Under this case, Ronny Henning later sued Lufthansa's budget carrier Germanwings after it refused to pay him 250 euros compensation for a delay he said totalled more than three hours. Germanwings, however, maintained his flight had arrived only two hours and 58 minutes behind schedule. In those circumstances, the following question to the European Court of Justice (ECJ) for a preliminary ruling: What time is relevant for the term time of arrival used in Articles 2, 5 and 7 of Regulation [No 261/2004]: (a) the time that the aircraft lands on the runway (touchdown); (b) the time that the aircraft reaches its parking position and the parking brakes are engaged or the chocks have been applied (in-block time); (c) the time that the aircraft door is opened; (d) a time defined by the parties in the context of party autonomy? ECJ says that the situation of passengers on a flight does not change substantially when their aircraft touches down on the runway at the destination airport, when that aircraft reaches its parking position and the parking brakes are engaged or when the chocks are applied, as the passengers continue to be subject, in the enclosed space in which they are sitting, to various constraints. Therefore, it is only when the passengers are permitted to leave the aircraft and the order is given to that effect to open the doors of the aircraft that the passengers may in principle resume their normal activities without being subject to those constraints. ECJ rules that it is apparent that Articles 2, 5 and 7 of Regulation No 261/2004 must be interpreted as meaning that the concept of 'arrival time', which is used to determine the length of the delay to which passengers on a flight have been subject, corresponds to the time at which at least one of the doors of the aircraft is opened, the assumption being that, at that moment, the passengers are permitted to leave the aircraft.

Development of tracer concentration analysis method using drone-based spatio-temporal hyperspectral image and RGB image (드론기반 시공간 초분광영상 및 RGB영상을 활용한 추적자 농도분석 기법 개발)

  • Gwon, Yeonghwa;Kim, Dongsu;You, Hojun;Han, Eunjin;Kwon, Siyoon;Kim, Youngdo
    • Journal of Korea Water Resources Association
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    • v.55 no.8
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    • pp.623-634
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    • 2022
  • Due to river maintenance projects such as the creation of hydrophilic areas around rivers and the Four Rivers Project, the flow characteristics of rivers are continuously changing, and the risk of water quality accidents due to the inflow of various pollutants is increasing. In the event of a water quality accident, it is necessary to minimize the effect on the downstream side by predicting the concentration and arrival time of pollutants in consideration of the flow characteristics of the river. In order to track the behavior of these pollutants, it is necessary to calculate the diffusion coefficient and dispersion coefficient for each section of the river. Among them, the dispersion coefficient is used to analyze the diffusion range of soluble pollutants. Existing experimental research cases for tracking the behavior of pollutants require a lot of manpower and cost, and it is difficult to obtain spatially high-resolution data due to limited equipment operation. Recently, research on tracking contaminants using RGB drones has been conducted, but RGB images also have a limitation in that spectral information is limitedly collected. In this study, to supplement the limitations of existing studies, a hyperspectral sensor was mounted on a remote sensing platform using a drone to collect temporally and spatially higher-resolution data than conventional contact measurement. Using the collected spatio-temporal hyperspectral images, the tracer concentration was calculated and the transverse dispersion coefficient was derived. It is expected that by overcoming the limitations of the drone platform through future research and upgrading the dispersion coefficient calculation technology, it will be possible to detect various pollutants leaking into the water system, and to detect changes in various water quality items and river factors.

Surrogate Model-Based Global Sensitivity Analysis of an I-Shape Curved Steel Girder Bridge under Seismic Loads (지진하중을 받는 I형 곡선거더 단경간 교량의 대리모델 기반 전역 민감도 분석)

  • Jun-Tai, Jeon;Hoyoung Son;Bu-Seog, Ju
    • Journal of the Society of Disaster Information
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    • v.19 no.4
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    • pp.976-983
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    • 2023
  • Purpose: The dynamic behavior of a bridge structure under seismic loading depends on many uncertainties, such as the nature of the seismic waves and the material and geometric properties. However, not all uncertainties have a significant impact on the dynamic behavior of a bridge structure. Since probabilistic seismic performance evaluation considering even low-impact uncertainties is computationally expensive, the uncertainties should be identified by considering their impact on the dynamic behavior of the bridge. Therefore, in this study, a global sensitivity analysis was performed to identify the main parameters affecting the dynamic behavior of bridges with I-curved girders. Method: Considering the uncertainty of the earthquake and the material and geometric uncertainty of the curved bridge, a finite element analysis was performed, and a surrogate model was developed based on the analysis results. The surrogate model was evaluated using performance metrics such as coefficient of determination, and finally, a global sensitivity analysis based on the surrogate model was performed. Result: The uncertainty factors that have the greatest influence on the stress response of the I-curved girder under seismic loading are the peak ground acceleration (PGA), the height of the bridge (h), and the yield stress of the steel (fy). The main effect sensitivity indices of PGA, h, and fy were found to be 0.7096, 0.0839, and 0.0352, respectively, and the total sensitivity indices were found to be 0.9459, 0.1297, and 0.0678, respectively. Conclusion: The stress response of the I-shaped curved girder is dominated by the uncertainty of the input motions and is strongly influenced by the interaction effect between each uncertainty factor. Therefore, additional sensitivity analysis of the uncertainty of the input motions, such as the number of input motions and the intensity measure(IM), and a global sensitivity analysis considering the structural uncertainty, such as the number and curvature of the curved girders, are required.

Factors influencing the axes of anterior teeth during SWA on masse sliding retraction with orthodontic mini-implant anchorage: a finite element study (교정용 미니 임플랜트 고정원과 SWA on masse sliding retraction 시 전치부 치축 조절 요인에 관한 유한요소해석)

  • Jeong, Hye-Sim;Moon, Yoon-Shik;Cho, Young-Soo;Lim, Seung-Min;Sung, Sang-Jin
    • The korean journal of orthodontics
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    • v.36 no.5
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    • pp.339-348
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    • 2006
  • Objective: With development of the skeletal anchorage system, orthodontic mini-implant (OMI) assisted on masse sliding retraction has become part of general orthodontic treatment. But compared to the emphasis on successful anchorage preparation, the control of anterior teeth axis has not been emphasized enough. Methods: A 3-D finite element Base model of maxillary dental arch and a Lingual tipping model with lingually inclined anterior teeth were constructed. To evaluate factors influencing the axis of anterior teeth when OMI was used as anchorage, models were simulated with 2 mm or 5 mm retraction hooks and/or by the addition of 4 mm of compensating curve (CC) on the main archwire. The stress distribution on the roots and a 25000 times enlarged axis graph were evaluated. Results: Intrusive component of retraction force directed postero-superiorly from the 2 mm height hook did not reduce the lingual tipping of anterior teeth. When hook height was increased to 5 mm, lateral incisor showed crown-labial and root-lingual torque and uncontrolled tipping of the canine was increased.4 mm of CC added to the main archwire also induced crown-labial and root-lingual torque of the lateral incisor but uncontrolled tipping of the canine was decreased. Lingual tipping model showed very similar results compared with the Base model. Conclusion: The results of this study showed that height of the hook and compensating curve on the main archwire can influence the axis of anterior teeth. These data can be used as guidelines for clinical application.

The Changes in the Electrical Properties of $\textrm{BaTiO}_3$-based PTCR Materials due to the addition of (Ca, Sr)$\textrm{TiO}_3$ ($\textrm{TiO}_3$첨가에 의한 $\textrm{BaTiO}_3$계 PTCR 물질의 전기적 특성변화에 대한 연구)

  • Joo, Ji-Won;Kim, Jong-Hwan;Kim, Hwan;Park, Soon-Ja
    • Korean Journal of Materials Research
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    • v.7 no.4
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    • pp.347-353
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    • 1997
  • BaTiO$_{3}$물질은 뛰어난 유전체로 널리 알려져 왔으며 특히 Heywang등이 제안한 PTCR특성은 이 물질의 응용범위를 세라믹 필터, 회로보호소자, 온도감지소자 및 저항가열장치 등으로 확대시켰다. 이러한 특성의 발현기구는 아직까지 밝혀지지 않은 상태이지만 제 특성을 향상시키기 위한 노력은 계속되어왔다. 특히 개발목적에 맞게 온도에 따른 정저항 특성(PTCR; Positive temperature constnat of resistivity phenomena)을 설계하려는 시도가 계속되어 왔으며 그 중에서도 페로브스카아트계의 2가와 4가의 양이온 자리를 등가나 원자가가 다른 양이온으로 치환하여 특성을 개선하려는 시도가 계속되어 왔다. 특히 $Ca^{2+}$나 Sr$^{2+}$$Ba^{2+}$자리를 치환할 수 있는 물질로 개별적인 첨가에 대한 연구는 많은 연구자들에 의해 진행된 상태이지만 최종적인 영향이나 해석에 대해서는 연구자들간에 이견이 많은 상태이다. 이번 실험에서는 BaTiO$_{3}$계에 합성한 (Ca, Sr)TiO$_{3}$를 Ca와 Sr의 상대적인 비를 변화시키면서 전체적인 첨가량을 변화시켜 그에 따른 전기적 특성 및 미세구조를 살펴보았다. (Ca, Sr)TiO$_{3}$의 첨가로 상온저항 및 PTCR특성을 변화시킬 수 있었으며 이를 통해 PTCR물질의 활용범위를 넓힐 수 있는 발판을 마련할 계기가 되었다. 특히 기존의 연구가 주로 개별적인 Ca나 Sr의 첨가에 의한 미세구조와 전기적 특성변화의 연구에 치중해 있었던 것과는 달리 Sr과 Ca을 함께 치환하여 상대적인 비가 특성에 더 중요한 영향을 끼치는 것을 확인하였으며 적절한 합성비를 선택하면 퀴리온도에서의 저항변화폭을 유지하면서 상온저항을 낮출 수 있음을 확인하였다.문했던 연구소인 Shanghai Research Center of Biotechnology, Shanghai Institute of Industrial Microbiology 및 Scientific Research Institute of Food and Fermentation Industry을 소개하고저 한다. 짧은 기간의 방문이라 주로 해당연구소의 자체소개 자료를 중심으로 방문하면서 느낀점을 기술하고저 한다.초염기성암 기원의 사문암이 열수변질작용을 받아 생성되었음을 명확하게 지시하며, 따라서 활석 광석내에 존재하는 녹니석은 활석의 근원 광물로서 녹니석편암 및 녹니석 편마암 매의 녹니석이 활석화되고 남은 잔존광물이 아니라, 주변암에 의해 성분상의 영향을 받은 열수와 사문암과의 변질교대작용에 의한 활석화과정 중에 주로 생성된 것으로 추정된다. 이러한 결과는 연구지역의 활석광상이 초염기성암의 사문암화 작용과 활석화 작용의 두 가지 변질작용에 의해 형성되어졌음을 알려준다.농도 증가 없이 폐 조직에 약 50배 정도의 고농도 cisplatin을 투여할 수 있었으며, 또한 분리 폐 관류 시 cisplatin에 의한 직접적 폐 독성은 발견되지 않았다이 낮았으나 통계학적 의의는 없었다[10.0%(4/40) : 8.2%(20/244), p>0.05]. 결론: 비디오흉강경술에서 재발을 낮추기 위해 수술시 폐야 전체를 관찰하여 존재하는 폐기포를 놓치지 않는 것이 중요하며, 폐기포를 확인하지 못한 경우와 이차성 자연기흉에 대해서는 흉막유착술에 더 세심한 주의가 필요하다는 것을 확인하였다. 비디오흉강경수술은 통증이 적고, 입원기간이 짧고, 사회로의 복귀가 빠르며, 고위험군에 적용할 수 있고, 무엇보다도 미용상의 이점이 크다는 면에서 자연기흉에 대해 유용한 치료방법임에는 틀림이 없으나 개흉술에 비해 재발율이 높고 비용이 비싸다는 문제가 제기되고 있는 만큼 더 세심한 주의와 장기 추적관찰이 필요하리라 사료된다.

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The Implication and Recognition of International Garden Exposition Suncheon Bay Korea 2013 on Blogs (블로그(Blog)를 통해 본 2013순천만국제정원박람회에 대한 인식)

  • Jang, Min-Ji;Choi, Jung-Min
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.4
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    • pp.60-75
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    • 2014
  • The purpose of this study was to look for useful implications in its next application or similar planning by assessing visitors' recognition of International Garden Exposition Suncheon Bay Korea 2013. To do this, blogs acknowledged as powerful communication media in modern information society were used. After searching for blogs related to International Garden Exposition Suncheon Bay Korea in the portal site ranked first in the domestic market share, this study classified 300 cases. This study was able to grasp the consciousness as bloggers gave descriptions of information and impressions and experiences of spaces without making any adjustments. The survey results are as follows: First, Dutch gardens were the most preferred, followed by Korean gardens, Chinese gardens and French gardens; in general, visitors were not satisfied with the national gardens. Inquiry is needed into the method of determining diverse cultural identity rather than a sample garden type through blogs delivering regret regarding the world gardens. Second, the survey results showed that the level of awareness of designers' gardens was low. This study judges that more emphasis should be placed on their roles as places speaking for the original purpose of the garden exposition which introduces gardening art and design through experimental design. Third, it was understood that many bloggers were deeply impressed by ephemeral landscapes like the change in landscape consequent on the elapse of time, distinctive atmosphere, and detailed-landscapes. These aspects are important landscape elements, and those elements should be addressed with weight in a subsequent study. Fourth, the most impressive places are 'Suncheon Lake Garden' and 'Bridge of Dreams', which are establishing themselves as icons of International Garden Exposition Suncheon Bay Korea 2013. However, relatively, public attitude towards the world gardens and designers' gardens are weak. Fifth, bloggers were providing a variety of information like transportation, events schedules, ticket purchasing & prices, discount information, etc. Ticket price was commented on the most, and most of the bloggers thought ticket prices were 'expensive'. This study understands such a phenomenon as a result of the general population's non-establishment of the perception that it's proper to view gardens at visitors' own expense. Generally, bloggers expressed satisfaction with International Garden Exposition Suncheon Bay Korea 2013, but with criticism as well. Their criticism included disappointing matters, to be improved upon and wishes without any distortion, providing meaningful implications deserving reference for similar cases. In this context, a blogger could be called a citizen-reviewer while a blog could be referred to as 'a field of informal discourse' for the public. As a research method of this study, blogs are difficult to interpret as they are subjective and personal, and have limited data analysis through their quantifications; however, blogs as methods of recognition survey are channels for varied, concrete and detailed awareness which are hard to grasp through a questionnaire survey or interviews. This study judges that such an aspect of a blog could be a useful means of grasping and reflecting upon visitors' attitude in future studies.

Comparison Analysis of Environmental Performance between Reconstruction and Remodeling Alternatives for Aged - Focused on CO2 Emissions Analysis - (공동주택 재건축과 리모델링의 친환경성 비교분석 - CO2 배출량 분석을 중심으로 -)

  • Kim, Chibaek;Shin, Dongwoo;Han, Juyeon;Hwang, Youngkyu
    • Korean Journal of Construction Engineering and Management
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    • v.15 no.1
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    • pp.87-100
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    • 2014
  • Environmental problems and the shortage of natural resources are currently gathering more attention in Korea and international countries. With these problems, it is reported that most current domestic buildings are emitting approximately 138 million tons of greenhouse gas. According to a recent report from the investigation of Korean housing population, the total number of households is approximately 12.9 millions, and the apartments that were built more than 15 years ago amounted to 3.1 millions. This shows that the rates of old apartment housings are increasing. Therefore, it is necessary to consider the deteriorated facilities and environmental improvement. Also, the construction industry is benefited by improving these housings which may need either remodeling or reconstruction. Environmental friendly buildings are a rising consideration for remodeling and reconstruction projects; it helps to determine many business matters in construction. The main purpose of this research is to improve environmental condition in apartments with comparison analysis between remodeling and reconstruction alternatives. This research is focused on characteristics of remodeling and reconstruction and it sets up the same condition with each level in order to evaluate the value of environmental friendliness and analyze its definition. The result of this research provides a unique emitting rate at a novel framework and this will cause the reduction of $CO_2$. It is analyzed that the remodeling construction can reduce the great amount of $CO_2$. Therefore, it will be a good decision guideline in selecting the most eco-friendly alternative to improve environment for building construction. Although reconstruction is a popular alternative nowadays in Korea, this research can provide a reason why decision makers should put more emphasis on remodeling as an environment-friendly alternative.

Development of a Real-Time Mobile GIS using the HBR-Tree (HBR-Tree를 이용한 실시간 모바일 GIS의 개발)

  • Lee, Ki-Yamg;Yun, Jae-Kwan;Han, Ki-Joon
    • Journal of Korea Spatial Information System Society
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    • v.6 no.1 s.11
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    • pp.73-85
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    • 2004
  • Recently, as the growth of the wireless Internet, PDA and HPC, the focus of research and development related with GIS(Geographic Information System) has been changed to the Real-Time Mobile GIS to service LBS. To offer LBS efficiently, there must be the Real-Time GIS platform that can deal with dynamic status of moving objects and a location index which can deal with the characteristics of location data. Location data can use the same data type(e.g., point) of GIS, but the management of location data is very different. Therefore, in this paper, we studied the Real-Time Mobile GIS using the HBR-tree to manage mass of location data efficiently. The Real-Time Mobile GIS which is developed in this paper consists of the HBR-tree and the Real-Time GIS Platform HBR-tree. we proposed in this paper, is a combined index type of the R-tree and the spatial hash Although location data are updated frequently, update operations are done within the same hash table in the HBR-tree, so it costs less than other tree-based indexes Since the HBR-tree uses the same search mechanism of the R-tree, it is possible to search location data quickly. The Real-Time GIS platform consists of a Real-Time GIS engine that is extended from a main memory database system. a middleware which can transfer spatial, aspatial data to clients and receive location data from clients, and a mobile client which operates on the mobile devices. Especially, this paper described the performance evaluation conducted with practical tests if the HBR-tree and the Real-Time GIS engine respectively.

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A study on the Standardization of Design Guidelines for Geographic Information Databases (지리정보 DB 설계 지침의 표준화 연구)

  • Lim, Duk-Sung;Moon, Sang-Ho;Si, Jong-Ik;Hong, Bong-Hee
    • Journal of Korea Spatial Information System Society
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    • v.5 no.1 s.9
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    • pp.49-63
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    • 2003
  • Recently, two international standard organizations, ISO and OGC, have done the work of standardization for GIS. Current standardization work for providing interoperability among GIS DB focuses on the design of open interfaces. But, this work has not considered procedures and methods for designing GIS DB. Eventually, GIS DB has its own model. When we share the data by open interface among heterogeneous GIS DB, differences between models result in the loss of information. Our aim in this paper is to revise the design guidelines for geographic information databases in order to make consistent spatial data models, logical structures, and semantic structure of populated geographical databases. In details, we propose standard guidelines which convert ISO abstract schema into relation model, object-relation model, object-centered model, and geometry-centered model. Furthermore, we provide sample models for applying these guidelines in commercial GIS S/Ws. Building GIS DB based on design guidelines proposed in the paper has the following advantages: the interoperability among databases, the standardization of schema definitions, and the catalogue of GIS databases through.

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