• Journal of Chest Surgery
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• v.12 no.3
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• 한국과학기술학회:학술대회논문집
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• 2015.12a
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• pp.247-278
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• 2015

Recently, as DNR prevails more and more in Korea, discussions regarding meaningless medical life-sustaining-treatment (LST) intensified. Some of the Supreme Court decisions are even discussed in mass media, causing public debates. These cases tell us that, as life-sustaining medical technologies are highly developed, more sociological and policy-related analyses are needed on them. Firstly, this study will review 40 previous studies that analyze recent discussions in Korea about LST. Secondly, this study also shows that in bioethical and policy-related perspectives, governance about LST calls for a new implications regarding thanatoethics and thanatopolitics. In this new theoretical framework, death with dignity (DwD) can be understood as a process of giving back the thanatopower to the subject who chooses his way of ending based on his sound and free will. Thirdly, some of the new LST or resuscitation technologies such as automated external defibrillators (AED) are developed in RRI framework. However, if subjects themselves choose not to apply those technologies on them, as in the case of DNR (do not resuscitate) vows, meaning of developing such technologies are to be questioned. But currently such questions regarding the limitations of RRI are seldom asked. I argue that in order to properly apply RRI framework on existing technology, we also need to consider these points.

• International Journal of Computer Science & Network Security
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• v.24 no.7
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• pp.128-142
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• 2024

Creation and implementation of export-oriented strategy is an urgent issue of economic development of any country. In an export-oriented model of economic development, exports should be a means of promoting economic growth and a tool to strengthen existing and potential competitive advantages. Agricultural production is the key factor in exports and the source of foreign exchange earnings in many countries. However, the export potential of agricultural producers may be inefficiently fulfilled due to the heterogeneity of countries in terms of economic development, trade relations and border policy. The aim of the research is to study the nature, main trends and problematic aspects of fulfilling the export potential of agricultural production in the context of aggravating food crisis. The study involved general scientific methods (induction and deduction, description, analysis, synthesis, generalization) and special (statistical method, economic analysis, descriptive statistics and interstate comparisons, graphical method). The need to ensure food security by countries around the world urges the importance of the agricultural sector as a catalyst for economic development, sources of foreign exchange earnings, investment direction, etc. The study of agricultural specialization led to the conclusion that wheat and sugar are goods with the highest export potential. It is substantiated that the countries of South America, OECD, North America and Europe have the highest level of realization of export potential of agricultural production, and African countries are import-dependent. In addition, the low export orientation of Africa and Asia due to the peculiarities of their natural and climatic conditions is established based on the assessment of export-import operations in the regional context. The internal and external export potential of each of the regions is analysed. Economic and mathematical simulation of assessing the impact of the most important factors on the wheat exports volumes was applied, which allowed predicting wheat exports volume and making sound management decisions regarding the realization of the export potential of agricultural companies. The inverse correlation between the exports volume and wheat consumption per capita, and the direct correlation between the effective size and area of land used for wheat cultivation was established through the correlation and regression analysis.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.26 no.4
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• pp.35-50
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• 2023

As urbanization progresses, there is a growing and continuous demand for green spaces that provide ecosystem services. However, increasing the quantity of green spaces within major cities is challenging. Therefore, it is essential to pursue qualitative improvements that consider ecological characteristics of existing green spaces. In this study, we focus on local neighborhood parks in Seoul and present the following two questions through an evaluation utilizing ecological design indicators and land use data: 1. Which factor, design or location, has a greater influence on the ecological quality of neighborhood parks in Seoul? 2. Additionally, when evaluating ecological characteristics, is there similarity between assessments based on land-use data and those utilizing ecological design indicators? For this study, we conducted research on 30 neighborhood parks in Seoul and classified them into mountainous types (adjacent to mountains, natural terrain parks) and urban types (independently designed within 300m without existing forests) based on previous studies. Firstly, we conducted evaluations according to park location types. When comparing the evaluation scores of urban types (14 parks) and mountainous types (16 parks), significant differences were observed with scores of 16.86 and 35.94, respectively. Statistical analysis showed a significant difference between park types. In terms of habitat quality, the average values for urban and mountainous parks were 0.33 and 0.53, respectively, and statistically significant differences were observed between park types indicating differences in ecological potential according to park location. Secondly, when comparing the results of ecological potential evaluations based on park design and external connectivity, a correlation was found between habitat quality and total scores according to evaluation indicators. The correlation analysis showed significant linear relationships between habitat quality and total scores, biodiversity scores, and ecosystem function scores, with high positive correlation coefficients of 0.829, 0.861, and 0.802, respectively. This study holds significance in analyzing the ecological aspects of urban parks through the lens of both park location characteristics and design indicators. The analysis results underscore the importance of planning and managing ecologically sound urban parks contingent upon their location. Moreover, the utilization of appropriate ecological design indicators can help alleviate environmental limitations surrounding parks. Integrating these considerations could enhance the ecological quality and ecosystem services of urban green spaces.

• Proceedings of the KOSOMBE Conference
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• v.1992 no.05
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• pp.27-47
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• 1992

Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.70-76
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• 2006

Purpose: This study presents 5 patients who had metallic anchor protrusion on glenoid after Bankart repair in anterior shoulder instability and reviewed the cause, clinical feature and arthroscopic removal technique. Method and Materials: 5 male with average age of 22 years (range 19 to 25 years) were included. 4 patients had arthroscopic Bankart repair and 1 patient had open repair for anterior shoulder instability. They had protruded metallic suture anchors on glenoid and the protruded suture anchors were removed arthroscopically using larger suture anchor empty inserter. Results: 4 patients had painful clicking sound with motion of abduction and external rotation and 1 patient showed shoulder instability. The ROM showed normal except mild degrees loss of external rotation. The position of protruded metallic anchor was 2, 3 and 5 O'clock in three patients and 4 O'clock in 2 patients. In 2 patients, the metallic suture anchor was malpositioned about 5mm off on the medial side from the anterior glenoid edge. All had Outerbrige classification Grade II-III chondral damage on humeral head and 1 patient showed glenoid cartilage destruction. None had shoulder instability after 2 years of follow-up. Constant score was 65 preoperatively and 89 postoperatively. ASES score was 67 preoperatively and 88 postoperatively. Conclusion: Symptoms of protruded suture anchor are not combined with instability. Most of symptoms were revealed from the rehabilitation period and confused with postoperative pain. Prompt diagnosis and early arthroscopic removal or impaction of protruded metallic suture anchor is recommended because of serious glenohumeral cartilage destruction. This is easy and simple and reproducible method to remove protruded metallic suture anchor arthroscopically.

• (The)Study of the Eastern Classic
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• no.68
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• pp.283-317
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• 2017

Issues over morality and profit usually address relations between moral principles and material gains. In the history of traditional Oriental philosophy, discussions about them were called "Yi-Li zhi bian." The ideas of Confucius and Mencius also contain various discussions about Yi-Li. Both Confucius and Mencius defined Yi as a value concept to represent "natural," "appropriate" or "just" and regarded Yi as an external moral principle on the one hand and an internal moral emotion on the other hand. They had, at the same time, differences, as well. While Confucius placed importance on the external and acquired nature of Yi as a goal of morality, Mencius argued for the internal and innate nature of Yi as the nature of morality partially while recognizing its externality overall. Such Yi is a general term for subjective moral emotions and objective moral principles. Li was a concept of fact to represent "gain," "profit" or "profit-making." Both of them were against private interest and emphasized public interest. As for their differences, Confucius was positive about Li to some degree by saying "One should think of Yi when making profit," whereas Mencius was almost negative about Li and perceived it to be for Yi by saying "One should give up even his own life for Yi." He meant Li's dependence on Yi and also Yi's absoluteness for Ri. Both of them found a mix of opposite features in Yi such as internality and externality, subjectivity and objectivity, specificity and generality, and uniqueness and universality and also in Li such as individuality and specialty and public and private interest. Those features have both disadvantages including theoretical irrationality and logical contradiction and advantages including ideological diversity and conceptual polysemy. If efforts are made to avoid their disadvantages and highlight their advantages, they will provide some elements to consult in the creation of new global ethics required today when East and West are becoming one. In the modern society, the Yi-Li issues can be divided into the issues of morality and economy, personal and social profit, and moral ideal and material gain. If these modern Yi-Li issues are combined with the traditional Yi-Li issues, two paths will emerge over the order of Yi-Li. Of the many perceptions of Yi-Li issues of Confucius and Mencius, the idea of "Yi First, Li Later" can be very useful for creating a new ethics theory to represent "humanism" that we all need today when everyone considers their own pursuit of profit and satisfaction of needs as the best values. Sound Yi-Li relations will be possible only through Yi's orientation toward externality based on internality and Li's pursuit of private interest on the premise of public interest according to the spirit of "Yi First, Li Later."

• Korean Journal of Agricultural Science
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• v.18 no.2
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• pp.164-179
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• 1991

Korean agriculture has encountered two problems. One is internal income disparity between rural and urbarn area and the other is external Uruguay Round trade problems as an abolition of direct and indirect import barriers, reduction in export subsidies and to reduce internal price supports. These problems will be brought severe farm problems such as decreasing farm household income and repressing agricultural growth in the near future. Considering the above inevitable facts Korean government has implemented several development projects such as rural industrial area development project, rural special production area development project, leisuresight seeing farm development project, traditional food development project, unskilled labor training project for off-farm employment and so on, to increase farm household income through off-farm income increase. This study was mainly concentrated on the identification of operational problems and post evaluation of the rural special production area development projects which aimed at increasing non-farm incomes and giving employment opportunity for rural farmers in small factories processing regional special farm products and mine products. The main findings and problems to be solved for the successful project implementation are as followed ; 1. Total number of the special production area development projects as of the end of 1991 was amount to 138, and total number of farm household participated were estimated at 2,079, and total amount of off-farm income per farm household was reached to 3,011 thousand won. 2. The total number of processed special products have increased from 21 items in 1981 to 56 items in 1991. On the other hand the total number of farm household participated in the projects have decreased from 2,518 to 2,079 during same period. 3. Total amount of investment for the projects has increased from 1,429 million won in 1981 to 24,760 million won in 1991 but the rate of G'T loan of the total investment has reduced from 24.5% to 5.2% during same period. 4. 138 special production area development project are classified into 6 kinds of commodity groups such as 19 of general industrial good production areas, 52 of folks-industrial art objects production areas, 39 of food processing areas, 9 of fiber and texstile processing areas, 18 of agricultural and fishery inputs processing areas and 1 of stone processing area. 5. The total production value in 1990 was estimated 20,169 million won of which export was amount to 2,627 million won. 6. The finacial rate of return of the UNGOK KUGIJA Tea processing Project operated by UNGOK coops and BAKSAN ginseng tea processing project were estimated at 45.4% (B/C Ratio=1.17, NPV=152.5 million won) and 17.7% (B/C Ratio=1.12, NPV=120.2 million won) respectively. 7. More favorite terms and condition of the loan including collateral problems have to be given to farmers participated. Heavy investment and G'T subsidy policies should be started for the successful project implementation anf farm household income increase. 8. To expand market demand of the rural special goods G'T have to provide special program of TV or other mass media for commodity propaganda and the total cost concerned must be supported by G'T subsidy. 9. The special farm products as GUGUJA,MOSI'Ramie', Ginseng. SOGOKJU,HEMP,Mushroom.DUGYUNJU and Chesnut processing projects have to be propelled and expanded for off-farm income increase in Chung Nam Province. 10. Direct operational pattern of the special production area by coops is more favorable to farmers and recommendable considering with off-farm income increase and market demand creation throughout Korea. 11. In rural area, special organizations for project appraisal are not exist. Accordingly special training program, project appraisal, formulation and preparation for civil servants concerned have to be prepared for project selection and sound implementation under limited budget and financial support.

• Journal of Korean society of Dental Hygiene
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• v.8 no.4
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• pp.19-30
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• 2008

This study reached the following conclusions as a result of carrying out the questionnaire survey of self-descriptions for the satisfaction after the citizens of Daejon uses the dental clinics, in order to identify the factors of satisfaction to the medical services of such dental clinics to be utilized in the patient management by dental hygienists, provide the basic data to provide the medical services desired by patients. 1. 43.9% men responded to the facilities and 56.1% women to the atmosphere for the standards of selection of dental clinics by general characteristic, and the college graduates or more to the kindness (38.2%), high-school graduates (43.2%) and middle-school graduates (25.9%) or less to the close distance for the level of educational attainment (p=0.009), which was meant to have a statistical significance. 2. The execution of reservation system for the dental clinics showed 54.7%, the reserved time was observed upon the execution of such reservation system, the dental clinics where they practice such system were 40.6%, and the confirmation methods was done through the telephone with 62.5%. 3. The experience of fear upon the dental treatment showed 74.6%. The type of fear showed the machine sound (48.7%) for men and cry of others for women (70.8%) at the highest. 70% of those under 30 at the age responded to the sharp instruments at the highest. 83.3% of Yousung-gu showed the highest by responding to the cry of others for the residential areas. The statistically significant difference was shown in both the age and residential area (p=0.000). 4. Women showed higher in the distribution of gender for the sterilization of instruments for the external satisfaction of dental clinics(p=0.000) and those under 30 at the age showed the highest with 2.98${\pm}$0.95(p=0.001). Seo-gu (3.48${\pm}$0.77) was the highest for the residential area (p=0.000), and there was statistically significant differences in the gender, age and residential area. 5. Men showed higher satisfaction than women in the clean state and the statistically significant differences were shown (p=0.000) at the age as the high satisfaction was shown for those under 30 at the age (2.35${\pm}$0.79), those having the income not less than 10 million won and not more than 20 million won (2.43${\pm}$0.78), and Seo-gu (2.63 ${\pm}$0.69) for the residential area. 6. For the internal satisfaction of dental clinic by users for the medical services in the dental clinics, 61.1% women responded to no in the ability of solving the inconvenience in the service process, and showed low ability of solving the inconvenience from 30 at the age (26.2%) and by responding to Dong-gu (22.1%) for the residential area, showing statically significant differences(p=0.000). For the re-use of dental clinics, 46.6% men (p=0.043) for the gender, 24.3% under 30 at the age and 22.9% of Dong-gu for the residential area responded to the re-use, showing statistically significant differences for the gender and residential area (p=0.000). 7. The dissatisfaction showed a high rate of 69.5% for the satisfaction to the medical services of dental clinics. 46.2% men responded to the pain and women to the feeling of foreign substance for the reason of dissatisfaction while those under 30 at the age showed 55.6% for others, those between 50 and 59 41.7% for the feeling of foreign substance. 86.3% carried out the education for cautions after the treatments and most people turned out that they do not carry out the continuous health management of mouth as 20.5% responded to that they carry out such health management.