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How to Implement Quality Pediatric Palliative Care Services in South Korea: Lessons from Other Countries (한국 소아청소년 완화의료의 발전 방안 제언: 국외 제공체계의 시사점을 중심으로)

  • Kim, Cho Hee;Kim, Min Sun;Shin, Hee Young;Song, In Gyu;Moon, Yi Ji
    • Journal of Hospice and Palliative Care
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    • v.22 no.3
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    • pp.105-116
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    • 2019
  • Purpose: Pediatric palliative care (PPC) is emphasized as standard care for children with life-limiting conditions to improve the quality of life. In Korea, a government-funded pilot program was launched only in July 2018. Given that, this study examined various PPC delivery models in other countries to refine the PPC model in Korea. Methods: Target countries were selected based on the level of PPC provided there: the United Kingdom, the United States, Japan, and Singapore. Relevant literature, websites, and consultations from specialists were analyzed by the integrative review method. Literature search was conducted in PubMed, Google, and Google Scholar, focusing publications since 1990, and on-site visits were conducted to ensure reliability. Analysis was performed on each country's process to develop its PPC scheme, policy, funding model, target population, delivery system, and quality assurance. Results: In the United Kingdom, community-based free-standing facilities work closely with primary care and exchange advice and referrals with specialized PPC consult teams of children's hospitals. In the United States, hospital-based specialized PPC consult teams set up networks with hospice agencies and home healthcare agencies and provide PPC by designating care coordinators. In Japan, palliative care is provided through several services such as palliative care for cancer patients, home care for technology-dependent patients, other support services for children with disabilities and/or chronic conditions. In Singapore, a home-based PPC association plays a pivotal role in providing PPC by taking advantage of geographic accessibility and cooperating with tertiary hospitals. Conclusion: It is warranted to identify unmet needs and establish an appropriate PPD model to provide need-based individualized care and optimize PPC in South Korea.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

  • Kim, Chul;Sung, Jidong;Lee, Jong Hwa;Kim, Won-Seok;Lee, Goo Joo;Jee, Sungju;Jung, Il-Young;Rah, Ueon Woo;Kim, Byung Ok;Choi, Kyoung Hyo;Kwon, Bum Sun;Yoo, Seung Don;Bang, Heui Je;Shin, Hyung-Ik;Kim, Yong Wook;Jung, Heeyoune;Kim, Eung Ju;Lee, Jung Hwan;Jung, In Hyun;Jung, Jae-Seung;Lee, Jong-Young;Han, Jae-Young;Han, Eun Young;Won, Yu Hui;Han, Woosik;Baek, Sora;Joa, Kyung-Lim;Lee, Sook Joung;Kim, Ae Ryoung;Lee, So Young;Kim, Jihee;Choi, Hee Eun;Lee, Byeong-Ju;Kim, Soon
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.248-329
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    • 2019
  • Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Successful Management and Operating System of a UNESCO World Heritage Site - A Case Study on the Wadi Al-Hitan of Egypt - (유네스코 세계자연유산의 성공적인 관리와 운영체계 - 『이집트 Wadi Al-Hitan』의 사례 -)

  • Lim, Jong Deock
    • Korean Journal of Heritage: History & Science
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    • v.44 no.1
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    • pp.106-121
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    • 2011
  • The number of World Natural Heritage Sites is smaller than that of World Cultural Heritage Sites. As of 2010, the total number of natural sites was 180, which is less than 1/3 of all cultural sites. The reason why the number of natural sites is smaller can be attributed to the evaluating criteria of OUV(outstanding universal value). Only 9 fossil related sites were designated as World Heritage Sites among 180 Natural Sites. This study compares their OUVs including the academic value and characteristics of the 9 World Heritage Sites to provide data and reference for KCDC(Korean Cretaceous Dinosaur Coast) to apply as a World Natural Heritage Site. This study was carried out to obtain information and data on the Wadi Al-Hitan of Egypt which was designated as a World Natural Heritage Site. The study includes field investigation for whale fossils, interviews of site paleontologists and staff, and inspections of facilities. Three factors can likely be attributed to its successful management and operating system. First, there is a system for comprehensive research and a monitoring plan. Secondly, experts have been recruited and hired and professional training for staff members has been done properly. Finally, the Wadi Al-Hitan has developed local resources with specialized techniques for conservation and construction design, which matched well with whale fossils and the environment at the site. The Wadi Al-Hitan put a master plan into practice and achieved goals for action plans. To designate a future World Natural Heritage Site in Korea, it is important to be recognized by international experts including IUCN specialists as the best in one's field with OUV. Full-time regular-status employees for a research position are necessary from the preparation stage for the UNESCO World Heritage Site. Local government and related organizations must do their best to control monitoring plans and to improve academic value after the UNESCO World Heritage Site designation. As we experienced during the designation process of Jeju Volcanic Island and Lava Tubes as the first Korean World Natural Heritage Site, participation by various scholars and specialists need to be in harmony with active endeavors from local governments and NGOs.

A Study on the Sanctuary of the Residence in East China Sea Skirts Area (동중국해권 민가의 성역(聖域)에 관한 연구)

  • Youn, Lily;Onomichi, Kenji
    • Korean Journal of Heritage: History & Science
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    • v.43 no.2
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    • pp.60-81
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    • 2010
  • Jeju Island, in Korea, shows many characteristics that are differentiated from the rest of Korea. Its culture is rooted in mythology which advocates a egalitarian, rather than hierarchical, social structure, the place of women in the home is relatively high, and the formation of buildings, the separation of cooking and heating facilities, and the living format of residential homes is dissimilar. These disparities in culture indicate that Jeju Island's heritage was not formed only from influences from the North, but also from other places as well. To fill in the blanks, residential homes in Jeju Island were compared with those scattered throughout the East China Sea, which connect the southern coastline of the Korean peninsula and Jeju Island. The regions encompassed by the East China Sea, sharing the Kuroshio current and a seasonal wind, can be considered as one cultural region integrating cultural aspects from the continental North and the oceanbound South. The unique characteristics of southern culture as seen in southern residences was examined through an investigation of the sacred places in which gods were considered to dwell. First, the myths of these areas usually concerned with the ocean, and a sterile environment made sustenance impossible without a dual livelihood, usually taking on the forms of half-farming and half-fishing, or half-farming, half-gardening. Although family compositions were strongly matricentric or collateral thanks to southern influence, a patriarchical system like those found in the North were present in the upper classes and in the cities. Therefore, residential spaces were not divided based on age or gender, as in hierarchical societies, but according to family and function. Second, these areas had local belief systems based on animism and ancestor worship, and household deities were closely related to women, agriculture and fire. The deities of the kitchen, the granary and the toilet were mostly female, and the role of priest was often filled by a woman. After Buddhism and Confucianism were introduced from mainland Korea, China and Japan, the sacred areas of the household took on a dual form, integrating the female-focused local rites with male-centered Buddhist and Confucian rites. Third, in accordance with worship of a kitchen deity, a granary deity, and a toilet deity led to these areas of the home being separated into disparate buildings. Eventually, these areas became absorbed into the home as architectural technology was further developed and lifestyles were changed. There was also integration of northern and southern cultures, with rites concerning granary and toilet deities coming from China, and the personality of the kitchen deity being related to the southern sea. In addition, the use of stone in separate kitchens, granaries, and toilets is a distinguishing characteristic of the East China Sea. This research is a part of the results gained from a project funded by the Korea Research Foundation in 2006.

The Back Garden Structure and the Symbolism of Immortal World of Gangwon Provincial Office in Late Joseon Dynasty (조선후기 강원감영의 후원조영(造營)과 신선세계)

  • Lee, Sang Kyun
    • Korean Journal of Heritage: History & Science
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    • v.49 no.3
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    • pp.12-31
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    • 2016
  • Gangwon Provincial Office, which is Historical Landmark No. 439, existed from 1395 to 1895. It played a significant role of provincial administration. Gangwon Provincial Office was rebuilt in the $17^{th}$ Century when governors' additional job system began. It had 50 buildings and 670 sections. During the Japanese colonial era and the Korean War, most of the buildings were demolished, and in 2005 partially restored. Currently, after the old Wonju City Post Office was demolished, the back garden facilities of the Provincial Office are being restored. The back garden of Gangwon Provincial Office was completely destroyed when the Japanese army base at Wonju made it a playing field during the Japanese colonial era. After demolishing the old post office in the back garden, excavation and investigation were made. A pond and building relics were found, but they were too damaged to be restored. However, this thesis found that there were Bongraekak, Yeongjusa(Kwanpungkak), Cheyako, Joojeong Rainbow Bridge after studying literature and paintings. There were also Hwansunjeong and Bangjangdae outside the pond. The names of the back garden and how they were made are related to hsien. In the pond, they made 3 islands signifying Mt. Samshin(immortal world) in the legend and built pavilions on that. The pavilions of the back garden were named Bongrae, Yeongju, and Bangjang, and the titles of other pavilions also had the names of hsien. The back garden of Gangwon Provincial Office was made like an immortal world, befitting its role of governing Mt. Bongrae(Mt. Geumgang.) The governors of Gangwon Province often went to the back garden and enjoyed becoming a hsien. They regarded themselves as the owners of Bongrae, i.e., the immortal world. Gangwon Provincial Office has a unique historical significance because it implemented an immortal world, making use of the characteristic of Gangwon Province.

A Study on the Ordering Status of Traditional Landscape Design Service in Cultural Heritage (문화재의 전통조경설계용역 발주실태 연구)

  • Kim, Min-Seon;Kim, Choong-Sik;Lee, Jae-Yong
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.39 no.3
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    • pp.33-41
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    • 2021
  • This study identified the scale that traditional landscape design has taken up by analyzing a total of 1037 services for design of cultural heritage that had been ordered by the government agencies from 2018 to 2020, and has drawn characteristics of traditional landscape design focusing on major cases. The results are as follows. First, the number of order cases for traditional landscape design has shown differences annually in the services of design of cultural heritage, but the design amount has been found to have the similar average annually, which confirmed that the same level has been maintained each year. It was found that the number of cases of traditional landscape design requiring responsibilities or participations of landscape engineers for 3 years in the entire design had a high proportion of approximately 26%. Second, the traditional landscape design has required professional knowledge and experiences of landscape engineers that could not be replaced by the business operator for design of cultural heritage consisting of architects. The expertise has been shown differently depending on types of construction. First, the topographical design for the work to build a foundation has required understanding of ground shapes and its elevations and professional knowledge on calculation of the amount of the earth work and the remains maintenance technique etc. The plantation design has required basic knowledge on growth characteristics of trees and the environment for growth and understanding of the vegetation landscape of the past. Meanwhile, the design for traditional pavement and traditional landscape structures and facilities has required the expertise on traditional materials that are different from the modern ones and their processing and construction methods. The understanding of changes to water paths and ecosystem, the principles of fluids, and characteristics of each type of fluid was essential for the design for the ecological landscape work including the maintenance of a water system such as rivers etc. As such, the traditional landscape design has a scale accounting for approximately one fourth of the entire cultural heritage design and requires the expertise differentiated from other fields. This improves the provisions of the current law on limiting the actual design, suggesting the need for the establishment of a traditional landscape design company so that all traditional landscape designs can be carried out by landscape engineers.

Development of A Material Flow Model for Predicting Nano-TiO2 Particles Removal Efficiency in a WWTP (하수처리장 내 나노 TiO2 입자 제거효율 예측을 위한 물질흐름모델 개발)

  • Ban, Min Jeong;Lee, Dong Hoon;Shin, Sangwook;Lee, Byung-Tae;Hwang, Yu Sik;Kim, Keugtae;Kang, Joo-Hyon
    • Journal of Wetlands Research
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    • v.24 no.4
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    • pp.345-353
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    • 2022
  • A wastewater treatment plant (WWTP) is a major gateway for the engineered nano-particles (ENPs) entering the water bodies. However existing studies have reported that many WWTPs exceed the No Observed Effective Concentration (NOEC) for ENPs in the effluent and thus they need to be designed or operated to more effectively control ENPs. Understanding and predicting ENPs behaviors in the unit and \the whole process of a WWTP should be the key first step to develop strategies for controlling ENPs using a WWTP. This study aims to provide a modeling tool for predicting behaviors and removal efficiencies of ENPs in a WWTP associated with process characteristics and major operating conditions. In the developed model, four unit processes for water treatment (primary clarifier, bioreactor, secondary clarifier, and tertiary treatment unit) were considered. Additionally the model simulates the sludge treatment system as a single process that integrates multiple unit processes including thickeners, digesters, and dewatering units. The simulated ENP was nano-sized TiO2, (nano-TiO2) assuming that its behavior in a WWTP is dominated by the attachment with suspendid solids (SS), while dissolution and transformation are insignificant. The attachment mechanism of nano-TiO2 to SS was incorporated into the model equations using the apparent solid-liquid partition coefficient (Kd) under the equilibrium assumption between solid and liquid phase, and a steady state condition of nano-TiO2 was assumed. Furthermore, an MS Excel-based user interface was developed to provide user-friendly environment for the nano-TiO2 removal efficiency calculations. Using the developed model, a preliminary simulation was conducted to examine how the solid retention time (SRT), a major operating variable affects the removal efficiency of nano-TiO2 particles in a WWTP.

Utility and Care Patterns of Lotus Shown in Classic Poetries and Proses, Painting (고전 시문과 회화를 통해 본 연(Nelumbonucifera)의 활용과 애호 행태)

  • Kim, Myung-Hee;Hong, Hyoung-Soon
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.29 no.4
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    • pp.1-13
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    • 2011
  • The purpose of this study is to consider practical examples of the method of utilizing plant material 'lotus' used by the ancients, and the value and meaning they wanted to get from it. The method of this study to do this is descriptive study to consider and interpret poem and painting reflecting impression and concept world of lotus. Summary of this study is as follows. First, ornamental value of lotus could be divided in effect of group plant and detail value held by the flower, the leaves and the stem. Especially, group plant lotus in large site provides unique landscape differentiated form other flowering plants. As well, another feature of lotus is its high ornamental value spread in detail elements including the flower, the leaves, the stem and the lotus seed. Second, fragrance expressed 'Hyang-won-ik-cheong(香遠益淸)' is an important charm of lotus. Lotus was utilized as olfactory element providing fragrance. The ancients considered lotus fragrance not only for enjoy but as symbolic object comparing noble man's dignity so that they expressed it in poem and painting. Third, lotus was utilized as acoustical element. That is, the sound of raindrops harmonizing the surface of water and wide lotus leaves was called 'hearing lotus fond and rain', enjoying it as classic grace. Fourth, summer play lotus sightseeing was called mind wash up meaning 'washing the mind polluted by the mundane world'. Such poetic taste was widely enjoyed by various classes from general public to royal family. Besides, poetic taste related with lotus is the method of drinking alcohol using the feature of big lotus leave and vacant stem, called 'Beog-tong-ju(碧筒酒)'. And in the Joseon dynasty period, when the distinction between the man and the woman influenced by Confucian, lotus seed and 'lotus collecting song' was important sign to express romance between man and woman. Lotus has been enamored by wide classes transcending cultural background as thought and religion since ancient times. Due to such reasons, various symbolic meaning of lotus and planting examples related to religious facilities as temples could not be considered in various manner is limitation of this study, and which is research project for the future.

Stability and Damage Evaluation of the Buddha Triad and 16 Rock-Carved Arhat Statues at Seongbulsa Temple in Cheonan, Korea (천안 성불사 마애석가삼존과 16나한상의 손상도 및 안정성 평가)

  • Yang, Hyeri;Lee, Chan Hee;Jo, Young Hoon
    • Korean Journal of Heritage: History & Science
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    • v.53 no.4
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    • pp.78-99
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    • 2020
  • The Buddha triad and 16 Arhat statues carved on the rock surface at Seongbulsa temple is the only domestic remaining example of all 16 Arhats, so its academic value is very high. However, it is severely damaged and so required a stability evaluation through study of digital documentation and precise diagnosis for the purpose of comprehensive conservation. This process established that the Buddha statues were of similar scale, while the Arhats showed a wide variety of sizes, and the two kith and kin in the volume were larger than the Arhats. It was estimated that the statues of food for Buddha are similar to the Arhat statues, and most of the statues are well-formed. The rock used to carve the Buddha statues is banded gneiss with distinct foliation, alternating between white bands of quartz and feldspar and black bands composed of biotite. The Buddha statues have been damaged by physical weathering, discoloration, and biological contamination. In damage evaluations, joint (3.6 crack index), peeling (5.2%), exfoliation (1.7%), and falling off (0.1%) were observed on the rock surface of the Buddha statues. In particular, due to severe biological weathering, stage 9 and 10 biological coverage of the rock surface accounted for 57.5% of the total area, and stages 5 to 8 also accounted for a high share at 22.3%. The discoloration factors were shown to be dark brown and white with Fe, Ca, and S, and a large amount of C detected in the blackened contaminants, and the damage weight high in all areas. Discontinuities in different directions were identified in the rock surface. Analysis of potential rock failure types indicated that there is a possibility of plane and toppling failure, but wedge failure is unlikely to occur. The mean ultrasonic velocity of the main rock surface was 2,463m/sec, the lower part of the left side with a large number of joints was relatively low, and the highly weathered (HW) type to the completely weathered (CW) type concentrated distribution, showing weak properties. For the Buddha statues, conservation treatment is required for about 14.9% of micro cracks and 58.9% of exfoliation cracks. In addition, in order to improve the conservation environment of the Buddha statues, maintenance of drainage and ground preparations for the rock surface gradient and plants are necessary, and protection facilities should be reviewed for long-term conservation and management purposes.

Reconstruction of the Origin of the Gudle (구들의 기원지(起源地) 재고(再考))

  • Oh, Seunghwan
    • Korean Journal of Heritage: History & Science
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    • v.54 no.1
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    • pp.100-119
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    • 2021
  • This paper has been written to verify the existing theory that districts occurred independently in various parts of the world, including the Korean Peninsula. Song Giho (2006) claims that the origin of the Gudle, is an example of polygenism that occurred in various areas in the world, including the Korean peninsula. This argument has been corroborated by a large number of researchers. However, it is difficult to understand the lineage of Gudle and its process of development, if a theory of polygenism is continued to be taken into account. The place which is targetet by this theory is the North-West area of the Korean peninsula, south of Primorsky Krai, and in the northern area of Zabaikal-Mongolia. This means that these areas developed independently because they were far from each other and had no direct cultural relationship. However, the structure of Gudle, shape, and assemblages of earthenware it cannot be explained by polygenism, as they are the same in every place. Furthermore, it is also questionable as to the timing and region of emergence of the culture in East Asia over a limited time frame of 3-2 BC. Gudle are formed by furnaces with roofs and walls, Gorae, which saves heat, and it has smoke ventilation that draws smoke out. Therefore, the Gudle is not a structure that anyone can make without advanced technical understanding. So far, the only facility with furnaces and smoke ventilation that appear before the Gudle is Buttumak. Thus, the Gudle is likely to have been invented in the place where Buttumak were used. The area as known for the origin of Gudle was observed to verify the existence of the Buttumak's structure, but none of these facilities were found. The Gudle suddenly appeared within a new culture that had never existed before. That means that none of the three places had the conditions under which the Gudle could be invented, so it must have been introduced from outside. In conclusion, the three places that I mentioned above are not the origin of Gudle. So, the origin of Gudle has to be found elsewhere.