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A prognosis discovering lethal-related genes in plants for target identification and inhibitor design (식물 치사관련 유전자를 이용하는 신규 제초제 작용점 탐색 및 조절물질 개발동향)

  • Hwang, I.T.;Lee, D.H.;Choi, J.S.;Kim, T.J.;Kim, B.T.;Park, Y.S.;Cho, K.Y.
    • The Korean Journal of Pesticide Science
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    • v.5 no.3
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    • pp.1-11
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    • 2001
  • New technologies will have a large impact on the discovery of new herbicide site of action. Genomics, combinatorial chemistry, and bioinformatics help take advantage of serendipity through tile sequencing of huge numbers of genes or the synthesis of large numbers of chemical compounds. There are approximately $10^{30}\;to\;10^{50}$ possible molecules in molecular space of which only a fraction have been synthesized. Combining this potential with having access to 50,000 plant genes in the future elevates tile probability of discovering flew herbicidal site of actions. If 0.1, 1.0 or 10% of total genes in a typical plant are valid for herbicide target, a plant with 50,000 genes would provide about 50, 500, and 5,000 targets, respectively. However, only 11 herbicide targets have been identified and commercialized. The successful design of novel herbicides depends on careful consideration of a number of factors including target enzyme selections and validations, inhibitor designs, and the metabolic fates. Biochemical information can be used to identify enzymes which produce lethal phenotypes. The identification of a lethal target site is an important step to this approach. An examination of the characteristics of known targets provides of crucial insight as to the definition of a lethal target. Recently, antisense RNA suppression of an enzyme translation has been used to determine the genes required for toxicity and offers a strategy for identifying lethal target sites. After the identification of a lethal target, detailed knowledge such as the enzyme kinetics and the protein structure may be used to design potent inhibitors. Various types of inhibitors may be designed for a given enzyme. Strategies for the selection of new enzyme targets giving the desired physiological response upon partial inhibition include identification of chemical leads, lethal mutants and the use of antisense technology. Enzyme inhibitors having agrochemical utility can be categorized into six major groups: ground-state analogues, group specific reagents, affinity labels, suicide substrates, reaction intermediate analogues, and extraneous site inhibitors. In this review, examples of each category, and their advantages and disadvantages, will be discussed. The target identification and construction of a potent inhibitor, in itself, may not lead to develop an effective herbicide. The desired in vivo activity, uptake and translocation, and metabolism of the inhibitor should be studied in detail to assess the full potential of the target. Strategies for delivery of the compound to the target enzyme and avoidance of premature detoxification may include a proherbicidal approach, especially when inhibitors are highly charged or when selective detoxification or activation can be exploited. Utilization of differences in detoxification or activation between weeds and crops may lead to enhance selectivity. Without a full appreciation of each of these facets of herbicide design, the chances for success with the target or enzyme-driven approach are reduced.

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Expectations of the First Visit to Orofacial Pain Clinic for the Patients with Temporomandibular Disorders (구강안면통증클리닉에 처음 내원한 턱관절장애 환자들의 내원 목표)

  • Won, Sang-Yeon;Kim, Hye-Kyung;Kim, Mee-Eun
    • Journal of Oral Medicine and Pain
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    • v.35 no.4
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    • pp.265-273
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    • 2010
  • Understanding patients' expectation for health visits and providing appropriate care may increase patients' satisfaction with health care, leading to more positive treatment outcome. The study aimed to investigate expectations of the patients with temporomandibular disorders (TMD) at their first visit to university-based orofacial pain clinic and to evaluate any relation with duration of pain, presence of previous treatment, pain severity and pain interference. Inclusion criterion was patients aged over and 18 years old and diagnosed as TMD during 3 months' period from Aug to Nov 2010. They were asked to complete the questionnaires for patients' expectation and the Brief Pain Inventory (BPI) at waiting room prior to consultation. 322 TMD patients participated in the study(M:F=1:1.5, mean age=36 years old). The study indicated that the most important top 3 expectations were 'cure of pain', 'understanding their problem' and 'doctor-patient communication' in order. This finding was not affected by gender, duration and previous treatment history but affected by sub-category of TMD and BPI pain severity and pain interference. 'Pain relief' and 'understanding their problems' were relatively highlighted in the patients with muscle disorders and combination (joint-muscle) disorders of TMD than those with joint disorders who wanted communication and further investigation relatively more (p=0.000). While expectation for pain relief was expected more with increase of pain severity and interference, patients with mild level of pain severity and interference expected communication and further investigation relatively more (p=0.000, 0.017, respectively). Based on the results of the study, though pain relief was the primary concern for TMD patients suffering from pain, their satisfaction with care may be increased by explanation for etiology and mechanism of TMD to make them understand their problems better and doctor-patient communication and collaborative decision-making for treatment. Importance of patient-centered consultations and availability of written material or web sites for patient information should be stressed out.

Reconsideration of Rare and Endangered Plant Species in Korea Based on the IUCN Red List Categories (IUCN 적색목록 기준에 의한 환경부 멸종위기 야생식물종에 대한 평가)

  • Chang, Chin-Sung;Lee, Heung-Soo;Park, Tae-Yoon;Kim, Hui
    • The Korean Journal of Ecology
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    • v.28 no.5
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    • pp.305-320
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    • 2005
  • Recently 64 species in Korea have been ranked as rare and endangered taxa by the Ministry of Environment using two categories, I and II. The original threat categories produced by the Ministry of Environment were developed to provide a standard for specifying animals and plants in danger of extinction and has been influential sources of information used in species conservation in Korea. However, the criteria by Ministry of Environment were applied to the whole taxa only by regional boundaries, especially in South Korea, rather than international context, and it also lacked an explicit framework that was necessary to ensure repeatability among taxa because of the absence of quantitative criteria to measure the likelihood of extinction. The World Conservation Union (IUCN) has developed quantitative criteria for assessing the conservation status of species. The threatened species categories, the 2000 IUCN Red List, proposed by SSC (Species Survival Commission) of IUCN have become widely recognized internationally. Details of threatened Korean plants, identified by applying the IUCN threat categories and definitions, were listed and analyzed. The number of species identified as threatened was only 34 out of 64 taxa (48.4%), while the rest of taxa were rejected from the original lists. Many of the species (51.6%, 33 taxa) excluded from the original list proposed by Ministry of Environment do not qualify as Critically Endangered, Endangered or Vulnerable because these taxa were widely distributed either in Japan or in China/far eastern Russia and there is no evidence of substantial decline in these countries. An evaluation of taxa in Korea has been carried out only based on subjective views and qualitative data, rather than quantitative scientific data, such as rates of decline, distribution range size, population size, and risk of extinction. Therefore, the national lists undermine the credibility of threatened species lists and invite misuse, which have been raised by other cases, qualitative estimate of risk, political influence, uneven taxonomic or geographical coverage. The increasing emphasis on international responsibilities means that global scale is becoming more significant. The current listings by Environment of Ministry of Korea should be challenged, and the government should seek to facilitate the resolution of disagreements. Especially the list should be flexible enough to handle uncertainty and also incorporates detailed, quantitative data. It is suggested that the highest priorities for the Red List should be given to endemic species in Korea first. After setting up the list of endemic species to Korea, quantitative data on population size and structure, distributional range, rated of decline, and habitat fragmentation should be collected as one of long term projects for the Red list categories. Transparency and accountability are the most important key factors. Also, species assessors are named and data sources referenced are required for the future objective evaluations on Korean plant taxa.

Prediction of Nitrate Contamination of Groundwater in the Northern Nonsan area Using Multiple Regression Analysis (다중 회귀 분석을 이용한 논산 북부 지역 지하수의 질산성 질소 오염 예측)

  • Kim, Eun-Young;Koh, Dong-Chan;Ko, Kyung-Seok;Yeo, In-Wook
    • Journal of Soil and Groundwater Environment
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    • v.13 no.5
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    • pp.57-73
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    • 2008
  • Nitrate concentrations were measured up to 49 mg/L (as $NO_3$-N) and 22% of the samples exceeded drinking water standard in shallow and bedrock groundwater of the northern Nonsan area. Nitrate concentrations showed a significant difference among land use groups. To predict nitrate concentration in groundwater, multiple regression analysis was carried out using hydrogeologic parameters of soil media, topography and land use which were categorized as several groups, well depth and altitude, and field parameters of temperature, pH, DO and EC. Hydrogeologic parameters were quantified as area proportions of each category within circular buffers centering at wells. Regression was performed to all the combination of variables and the most relevant model was selected based on adjusted coefficient of determination (Adj. $R^2$). Regression using hydrogelogic parameters with varying buffer radii show highest Adj. $R^2$ at 50m and 300m for shallow and bedrock groundwater, respectively. Shallow groundwater has higher Adj. $R^2$ than bedrock groundwater indicating higher susceptibility to hydrogeologic properties of surface environment near the well. Land use and soil media was major explanatory variables for shallow and bedrock groundwater, respectively and residential area was a major variable in both shallow and bedrock groundwater. Regression involving hydrogeologic parameters and field parameters showed that EC, paddy and pH were major variables in shallow groundwater whereas DO, EC and natural area were in bedrock groundwater. Field parameters have much higher explanatory power over the hydrogeologic parameters suggesting field parameters which are routinely measured can provide important information on each well in assessment of nitrate contamination. The most relevant buffer radii can be applied to estimation of travel time of contaminants in surface environment to wells.

A Study on Korea Coast Guard Intelligence Centered on legal and Institutional comparison to other organizations, domestic and international (해양경비안전본부 정보활동의 법적·제도적 측면의 문제점 분석 및 개선방안 연구)

  • Soon, Gil-Tae
    • Korean Security Journal
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    • no.44
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    • pp.85-116
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    • 2015
  • Found in 23 Dec 1953 to cope with illegal fishing of foreign ships and coastal guard duty, Korea Coast Guard was re-organized as an office under Ministry of Public Safety since the outbreak of sinking of passenger ship "Sewolho". In the course of re-organization, intelligence and investigation duty were transferred to Police Department except "Cases happened on the sea". But the definition of intelligence duty is vague and there are lots of disputes over the jurisdiction and range of activities. With this situation in consideration, the object of this study is to analyse legal and institutional characteristic of KCG Intelligence, to compare them to that of Police Department, foreign agencies like Japan Coast Guard and US Coast Guard, to expose the limit and to suggest solution. To summarize the conclusion, firstly, in the legal side, there is no legal basis on intelligence in [The Government Organization Act], no regulation for mission, weak basis in application act. Secondly, in the institutional side, stated in the minor chapter of [The Government Organization Act], 'the cases happened on sea' is a quite vague definition, while guard, safety, maritime pollution duty falls under 'on the sea' category, intelligence fell to 'Cases happened on the sea' causing coast guard duty and intelligence have different range. In addition, reduced organization and it's manpower led to ineffective intelligence activities. In the case of Police Department, there is definite lines on 'administration concerning public security' in [The Government Organization Act], specified the range of intelligence activities as 'collect, make and distribute information concerning public security' which made the range of main duty and intelligence identical. Japanese and US coast guards also have intelligence branch and performing activities appropriate for the main missions of the organizations. To have superiority in the regional sea, neighboring countries Japan and China are strengthening on maritime power, China has launched new coast guard bureau, Japan has given the coast guard officers to have police authority in the regional islands, and to support the objectives, specialized intelligence is organized and under development. To secure maritime sovereignty and enhance mission capability in maritime safety duty, it is strongly recommended that the KCG intelligence should have concrete legal basis, strengthen the organization and mission, reinforce manpower, and ensure specialized training administrative system.

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A Study on the Awareness of Dental Hygiene Freshmen of Major and Occupation (치위생과 신입생들의 전공 및 직업의식에 관한 연구)

  • Lim, Mi-Hee
    • Journal of dental hygiene science
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    • v.6 no.4
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    • pp.277-284
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    • 2006
  • The purpose of this study was to examine the perception of dental hygiene freshmen about their major and their occupational consciousness. The subjects in this study were 361 dental hygiene freshmen at three different colleges in Gyeonggi province. After a survey was conducted, the collected data were analyzed with SPSS WIN 11.5 program. The findings of the study were as follows: 1. As for their view of occupation, the students made a well-paying job a priority(M = 2.97), and looked upon an occupation as a means of living(M = 1.60). Regarding the use of the profits of dental hospitals and clinics, they believed that they should reinvest their profits in a purchase of machinery, an expansion of facilities or technical development(M = 2.00). 2. Concerning relations between their motivation of college entrance and their satisfaction with their major, 96.6 percent of those who found their major satisfactory or quite satisfactory considered it to right up with their alley. 82.6 percent of them chose their major to get a stable job, and 62.8 percent of them did it through the advice of their families, relatives or regular teachers. 59.1 percent of them did it in consideration of their college entrance examination scores. Every student who were pressed for economic reasons to choose their major were unsatisfied with it. Thus, their motivation of college entrance made a statistically significantly wide difference to their satisfaction with major(p < 0.01). 3. They got a mean of 3.10 in occupational consciousness. By sub- category, they scored highest in interpersonal and work ethics(3.19 respectively). They got a mean of 3.04 in academic ethics, and got a mean of 2.99 in professional ethics, which was the lowest mark. 4. As to connections between their general characteristics and occupational consciousness, their occupational awareness was significantly different according to their motivation of college entrance and information they acquired at the time of college entrance(p < 0.05). In regard to the relationship of their satisfaction with major to their occupational awareness, their occupational consciousness statistically significantly varied with their department, their willingness of staying as a dental hygienist, the future prospect of dental hygienist (p < 0.01).

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Neuropsychological Mechanism of Delusion (망상의 신경심리학적 기전)

  • Lee, Sung-Hoon;Kim, Dong-Wha;Park, Yun-Zo;Park, Hae-Jung;Shin, Yoon-Sik
    • Sleep Medicine and Psychophysiology
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    • v.7 no.1
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    • pp.60-66
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    • 2000
  • Objectives: The Psychopathology of schizophrenia was expected to be related with focal dysfunction of brain while schizophrenia is recognized and studied as the brain disease. Authors studied correlation between neuropsychological tests and delusion which is representative symptom of schizophrenia in patients with head trauma and psychiatric patients in order to explore the functional localization of brain in delusional symptom. Methods: Halstead Reitan Neuropsychological Test Battery and Korean Weschler Intelligent Scale and Minnesota Multiphasic Personality Inventory(MMPI) were administered to one hundred ninteen patients consisted of sixty nine psychiatric patients and fifty patients with brain damage. We tested correlation between results of neuropsychological tests and delusional scale made from twenty four items related with delusion in MMPI. T-test between eighteen higher delusion scorers and twenty one lower scorers was examed in psychiatric group. Results: In brain damage group, signigicant correlations were found in the tests related with function of frontal lobe such as category test, trail making AB test, tactual performance test, digit symbol test and fingertip number writing test, and significant correlations were also noted in the tests related with function of left temporal and parietal lobes such as information, comprehension, vocabulary, similarities and speech sound perception test. The tests related with the function of right hemisphere such as tactual performance test location, picture completion and performance, and the tests related with subcortical function such as arithmetic, digit span, attention, digit symbol test, digit symbol and trail making AB test were signigicantly corelated with delusional scale too. In psychiatric group there were significant difference of delusional score in the tests related with function of left hemisphere such as vocabulary, vocable IQ, comprehension and language, and in the tests related with subcortical function such as N 120 voltage, digit symbol and arithmetic. Conclusions: Delusion seems to be related with function of frontal lobe, left hemisphere and subcortex in both groups. Right hemisphere may be also partially related with delusion.

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Correlation among Ownership of Home Appliances Using Multivariate Probit Model (다변량 프로빗 모형을 이용한 가전제품 구매의 상관관계 분석)

  • Kim, Chang-Seob;Shin, Jung-Woo;Lee, Mi-Suk;Lee, Jong-Su
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.2
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    • pp.17-26
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    • 2009
  • As the lifestyle of consumers changes and the need for various products increases, new products are being developed in the market. Each household owns various home appliances which are purchased through the choice of a decision maker. These appliances include not only large-sized products such as TV, refrigerator, and washing machine, but also small-sized products such as microwave oven and air cleaner. There exists latent correlation among possession of home appliances, even though they are purchased independently. The purpose of this research is to analyze the effect of demographic factors on the purchase and possession of each home appliances, and to derive some relationships among various appliances. To achieve this purpose, the present status on the possession of each home appliances are investigated through consumer survey data on the electric and energy product. And a multivariate probit(MVP) model is applied for the empirical analysis. From the estimation results, some appliances show a substitutive or complementary pattern as expected, while others which look apparently unrelated have correlation by co-incidence. This research has several advantages compared to previous literatures on home appliances. First, this research focuses on the various products which are purchased by each household, while previous researches such as Matsukawa and Ito(1998) and Yoon(2007) focus just on a particular product. Second, the methodology of this research can consider a choice process of each product and correlation among products simultaneously. Lastly, this research can analyze not only a substitutive or complementary relationship in the same category, but also the correlation among products in the different categories. As the data on the possession of home appliances in each household has a characteristic of multiple choice, not a single choice, a MVP model are used for the empirical analysis. A MVP model is derived from a random utility model, and has an advantage compared to a multinomial logit model in that correlation among error terms can be derive(Manchanda et al., 1999; Edwards and Allenby, 2003). It is assumed that the error term has a normal distribution with zero mean and variance-covariance matrix ${\Omega}$. Hence, the sign and value of correlation coefficients means the relationship between two alternatives(Manchanda et al., 1999). This research uses the data of 'TEMEP Household ICT/Energy Survey (THIES) 2008' which is conducted by Technology Management, Economics and Policy Program in Seoul National University. The empirical analysis of this research is accomplished in two steps. First, a MVP model with demographic variables is estimated to analyze the effect of the characteristics of household on the purchase of each home appliances. In this research, some variables such as education level, region, size of family, average income, type of house are considered. Second, a MVP model excluding demographic variables is estimated to analyze the correlation among each home appliances. According to the estimation results of variance-covariance matrix, each households tend to own some appliances such as washing machine-refrigerator-cleaner-microwave oven, and air conditioner-dish washer-washing machine and so on. On the other hand, several products such as analog braun tube TV-digital braun tube TV and desktop PC-portable PC show a substitutive pattern. Lastly, the correlation map of home appliances are derived using multi-dimensional scaling(MDS) method based on the result of variance-covariance matrix. This research can provide significant implications for the firm's marketing strategies such as bundling, pricing, display and so on. In addition, this research can provide significant information for the development of convergence products and related technologies. A convergence product can decrease its market uncertainty, if two products which consumers tend to purchase together are integrated into it. The results of this research are more meaningful because it is based on the possession status of each household through the survey data.

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A Study On The Attitudes Toward Death -For Nursing Care of The Terminally Ill- (죽음의 태도에 관한 조사연구 -임종환자의 간호를 위하여-)

  • 유계주
    • Journal of Korean Academy of Nursing
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    • v.4 no.1
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    • pp.162-178
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    • 1974
  • The present study is purported to provide a basic information to be utilized by nurses to care and attend effectively for patients nearing the moment of death. Therefore, the primary purpose of the study has been placed upon grasping an understanding of the trends of death in general. For this purpose: 1. By utilizing the schneidman questionnaire, the trend of death has been categorized by 6 parts and analyzed. 2. A search has been conducted to find out dying patient's needs, nurse's attitudes viewed by the patient, and nurse attitudes to dying patient. The followings are itemized results of analysis: 1. Analysis by the schneidman questionnaire. (1) In general concepts of death. the first sighting of the occurrence of death was experienced upon strangers, grandfather and great grandfather. The death is openly discussed among people of all ages and sex. Ages in which the death is mostly feared were from 12 to well over 70 yews old that are evenly distributed regardless of difference in age. (2) As to the attitudes toward death the occurrence of death to most closely associated person influenced most upon the attitude of their own termination of lives. Among the reading materials, the maximum influence was effected by the Bible. In terms of religion, the thoughts of death were Influenced by religions education in case of the believers of the western religions (36%), and by their own health and physical conditions in case of the believers in the oriental religions (35%). In case of non-believer, their attitude toward death were largely determined through their own thinking meditation (45%). People aged 20 or thereunder revealed that they wished to know the day of their own death to be occurred (58%). However, the older the less thor wanted to know. (3) As to the choosing the time of death, 57% preferred senility, and 30% preferred the time in mediately following the prime period of their lives in general. In terms of religion, 85% of the believer in the oriental religion preferred senility, and 67% in the western religion, 58% in others, Therefore. the desiring of their lives to be terminated in earlier stage, not by the natural senility. sequenced as follows : Others, western religions and oriental religions. (4) Referring to the disposal of the corpse under the assumption that it had already occurred, majority desired the burial system. There has been seen a slight tendency to consider the importance of holding funeral services for the sake of survivors. Concerning the life insurance policy, it showed that the nurse had less belief in it than the patient (5) Upon the subject of life-after-death. religion wise, 72% of western religion believers preferred to have an existence of life-after-death: Among the believers of oriental regions, 35% desired this category, 30% did not mind either way. and 35% did not desire the existence of such a life-after-death. In others, 53% did not mind whether or not such a life existed. (6) In general, serious thoughts were not being attended to the commitment of suicide. 37% emphasized that such an act should be prevented. However, 30% insisted that such commitment should not be bothered, and that society possesses no right to prevented it. More male wished to commit suicide (13%) than females (9%). 2. Nurse's attitudes toward terminal patients and patient's needs. In the instance where the patient realized that their death is imminent, most of them showed desire to discuses mainly on the problems of life. When faced a situation of this nature, it is revealed that 40% of nurses could not furnish appropriate care for them.

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A Theory Construction on the Care Experience for Spouses of Patients with Chronic Illness (만성질환자 배우자의 돌봄 경험에 대한 이론 구축)

  • Choi, Kyung-Sook;Eun, Young
    • Journal of Korean Academy of Nursing
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    • v.30 no.1
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    • pp.122-136
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    • 2000
  • Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

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