• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.35 no.2
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• pp.98-107
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• 2017

The Ministry of Agriculture, Food and Rural Affairs of Korea(MAFRA) has launched 'The Korea's Important Agricultural Heritage System(KIAHS)' in 2012 to conserve the regional heritages of agriculture and its significance. The effort has achieved in designation of seven KIAHS and two Globally Important Agricultural Heritage System(GIAHS). The policy environment has evolved a great deal since the launch of KIAHS. The study has evaluated the current policy condition of KIAHS and analyzed the shift on the KIAHS policy environment. The study has concluded the policy environmental changes as follows; insufficient Agricultural Heritage(AH) resource development, intensified interests in AH monitoring system, anticipated rural developments thru AH utilizations, under-budgeted AH conservation and management measures. The study has suggested the following based on the evaluation; establishment of AH Conservation and Management System as the conservation and management policy of AH, ease the designation standards for AH, obliged monitoring system for AH, developing AH brand, budget increase for AH conservation and management system. The suggest policy will successfully assist the further development and designation of AH. Farmers in AH area can maintain farm activities thru the conservation, management and utilization of AH, inheriting the important agricultural heritage for the future generation.

• Korean Security Journal
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• no.61
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• pp.9-38
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• 2019

As the scales & density of the Korean national infrastructures have been increased, they will be identified as rich and attractive potential targets for intensified North Korea's attack in the rear region and terrorism attack. In addition, due to changes in security environment such as drone threats and lack of security forces under the 52-hour workweek law, I think that it is the proper time point to reevaluate the effectiveness and appropriateness of the current physical protection system and its shift to a new system. In this study, the direction and improvement of the perimeter physical protection systems of the national infrastructures are to be studied from the viewpoints of its concepts of operations and design methodology, focusing on the nuclear power plant. The reason why we focus on nuclear power plants is because they cause wide-range and long-term damages caused by radioactive materials disperal and pollution, along with short-term damage caused by the interruption of electricity generation in the event of damage to nuclear power plants. With the aim of extracting improvement directions, as we will comprehensively review domestic research trends and domestic·overseas related laws, and consider Korea's specificity, we try to reframe the concept of operation - systematization, mobilization and flexibility -, and establish criteria on system change. In order to improve the technical performance of the new perimeter physical protection system, we study on high-fidelity·multi-methodology based integrated design methodology, breaking from individual silo-type design methods, and I suggest improvement of government procurement, its expansion to export business and other national infrastructure.

• Informatization Policy
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• v.24 no.3
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• pp.67-90
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• 2017

This study is conducted to find out problems in the implementation system of regional informatization policies in Korea and solutions to enhance the effectiveness in policy execution. The study uses research methodologies such as participant observation, interview and AHP for experts and employees of public organizations for regional informatization policies. Many implications were found in the analysis, including that policy relations, structure of the policy implementation system, and environment and contents of regional informatization policiesin Korea have to be innovated and re-organized. Especially, this paper emphasizes the horizontal and cooperative relationship between the central and local governments and redesigning of the legal system on the regional informatization. This paper also shows expectations on reshaping of the regional informatization policies with the paradigm shift of the government power toward decentralization. This paper also finds diverse views on the problems and solutions for the regional informatization policy implementation system based on different characteristics and interests of policy participants. This paper finds the possibility of applying the policy network model to regional informatization policy implementation, which can be supported by Rhodes & Marsh(1992)'s theory. Therefore, this paper shows the change of regional informatization policies can be expected through application of the policy network. Although the paper draws many academic and policy implications, they are limited to the implementation system of regional informatization policies only.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.99-106
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• 2007

Purpose: The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Materials and Methods: Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours and then the radiation therapist registered the MVCT images with the CT simulation images based on the bone based, rectal balloon based and GTV based respectively and registered image was compared with each others. The average and standard deviation of each X, Y, Z and rotation from the initial planning center was calculated for each patient. The image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours. Results: There was a significant difference in the mean variations of the rectal balloon among the methods. Statistical results based on the bone fusion shows that maximum x-direction shift was 8 mm and 4.2 mm to the y-direction. It was statistically significant (P=<0.0001) in balloon based fusion, maximum X and Y shift was 6 mm, 16mm respectively. One patient's result was more than 16 mm shift and that was derived from the rectal expansions due to the bowl gas and stool. GTV based fusion results ranging from 2.7 to 6.6 mm to the x-direction and 4.3$\sim$7.8 mm to the y-direction respectively. We have checked rotational error in this study but there are no significant differences among fusion methods and the result was 0.37$\pm$0.36 in bone based fusion and 0.34$\pm$0.38 in GTV based fusion.

• Research in Community and Public Health Nursing
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• v.14 no.2
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• pp.190-199
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• 2003

This study was conducted to determine the factors affecting job satisfaction in workers by using the Job Stress Model proposed by the National Institute for Occupational Safety and Health (NIOSH). Data were collected from December 1 to December 30, 1999. The subjects were 2,133 workers employed at 155 work sites, who were examined using NIOSH Job Stress questionnaire translated by the Korea Occupational Safety ${\pounds}|$ Health Academy and Occupational Safety ${\pounds}|$ Health Research Institute. SAS/PC program was used for statistical analysis using descriptive analysis. Pearson's correlation coefficient, ANOVA, and Stepwise multiple regression analysis. The results of this study were as follows. 1. According to general characteristics of the subjects, job satisfaction was high in those with less number of children. 2. By work condition, job satisfaction was higher in those who were working in a permanent job position, were working with regular time basis than with shift basis, were working in regular shift hours than in changing shift hours, were working for a short period, and were working less hours and overtime works per week. 3. In terms of physical work environment, job satisfaction was significantly related to 10 physical environmental factors. In other words, job satisfaction was high in workers who were working in an environment with no noise, bright light, temperature adjusted to an appropriate level during summer and winter, humidity adjusted to an appropriate level. well ventilation, clean air, no exposure to hazardous substance during work hour, overall pleasant work environment and not crowded work space. 4. By work-related factors, job satisfaction was high in those with less ambiguity about future job and role, high job control/autonomy, and less workload. On the other hand, job satisfaction was low in those with little utilization of competencies, and much role conflict at work and workload. 5. As for the relationships between job satisfaction and the non-work related factors, job satisfaction was high in workers who were volunteering at different organizations or active in religious activities for 5-10 hours per week. 6. In the relationships between job satisfaction and buffering factors, significantly positive correlations were found between job satisfaction and factors such as support by direct superior, support by peers, and support by spouse, friend and family. 7. There were nine factors that affected job satisfaction in the workers: age, number of children, work hours per week, noise, temperature at the work site during summer, uncomfortable physical environment, role ambiguity, role conflict, ambiguity in job future, work load, no utilization of competencies and social support from direct supervisor. These nine factors accounted for 26% of the total variance in the multiple regression analysis. In conclusion. the following are proposed based on the results of this study. 1. The most important physical environmental factors affecting job satisfaction in workers were noise, role ambiguity, and work load, suggesting a need to develop strategies or programs to manage these factors at work sites. 2. A support system that could promote job satisfaction is needed by emphasizing the roles of occupational health nurses who may be stationed at work sites and manage the factors that could generate job stress. 3. Job satisfaction is one of the three acute responses to stress proposed in NIOSH job stress model (job satisfaction. physical discomfort and industrial accidents). Therefore, further studies need to be conducted on the other two issues.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.1-6
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• 2008

Purpose: The purpose of this study is to compare the results of the arthroscopic reconstruction of ACL using autologous hamstring tendon and autologous bone-patellar tendon-bone. Materials and Methods: From January, 2000 to December, 2004, 120 patients underwent arthroscopic ACL reconstruction using autologous hamstring tendon(60 cases) and autologous bone-patellar tendon-bone(BPTB)(60 cases). The mean followed up period of hamstring tendon group was 42 months(range $24{\sim}69$ months) and patellar tendon group was 52 months(range $24{\sim}84$ months). At the time of the final follow up, sixty patients in each group were evaluated the results of physical examination, activity level, patients' satisfaction, functional status, and objective anteriror stability using KT-2000 arthrometer. Results: At the time of the final follow up we compared the two groups who had ACL reconstruction using either autologous hamstring tendon or BPTB, and the final results of the Lachman test showed negative, or mildly positive in 85%(51 cases) of the hamstring tendon group and 90%(54 cases) of the BPTB group. Pivot shift test indicated positive in both groups, 8%(5 cases) and 5%(3 cases) respectively and showed no statistically significant difference. The evaluation of the anterior laxity using the KT-2000 arthrometer revealed no significant difference in the hamstring and BPTB groups: differences less than 3 mm compared to the healthy side were 85%(51 cases) and 90%(54 cases)(p>0.05). The Lysholm score improved from a preoperative score of 51 to a postoperative score of 79.1 in the hamstring groups and from 52 to 82.2 in the BPTB groups. According to the IKDC rating system, 87%(52 cases) were normal or near normal in the hamstring group. In the BPTB group, 83%(50 cases) were normal or near normal. The Tegner score for the hamstring groups was 4.8 preoperatively and 7.1 at the final follow up, and the Tegner score for the BPTB groups was 4.5 preoperatively and 7.3 after the last follow-up. The anterior knee pain was found in 7%(4 cases) in the hamstring tendon group and 10%(6 cases) in the patellar tendon group. Conclusion: Arthroscopic ACL reconstruction using both the autologous hamstring tendon and the patellar tendon during their mid term follow up period demonstrated excellent results. However, the final results during their last follow up showed no statistically significant difference between the two groups.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.476-486
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• 2008

Background: TRAIL (TNF-related apoptosis inducing ligand) is a newly identified member of the TNF gene family which appears to have tumor-selective cytotoxicity due to the distinct decoy receptor system. TRAIL has direct access to caspase machinery and induces apoptosis regardless of p53 phenotype. Therefore, TRAIL has a therapeutic potential in lung cancer which frequently harbors p53 mutation in more than 50% of cases. However, it was shown that TRAIL also could activates $NF-{\kappa}B$ in some cell lines which might inhibit TRAIL-induced apoptosis. This study was designed to investigate whether TRAIL can activate $NF-{\kappa}B$ in lung cancer cell lines relatively resistant to TRAIL-induced apoptosis and inhibition of $NF-{\kappa}B$ activation using proteasome inhibitor MG132 which blocks $I{\kappa}B{\alpha}$ degradation can sensitize lung cancer cells to TRAIL-induced apoptosis. Methods: A549 (wt p53) and NCI-H1299 (null p53) lung cancer cells were used and cell viability test was done by MTT assay. Apoptosis was confirmed with Annexin V assay followed by FACS analysis. To study $NF-{\kappa}B$-dependent transcriptional activation, a luciferase reporter gene assay was used after making A549 and NCI-H1299 cells stably transfected with IgG ${\kappa}-NF-{\kappa}B$ luciferase construct. To investigate DNA binding of $NF-{\kappa}B$ activated by TRAIL, electromobility shift assay was used and supershift assay was done using anti-p65 antibody. Western blot was done for the study of $I{\kappa}B{\alpha}$ degradation. Results: A549 and NCI-H1299 cells were relatively resistant to TRAIL-induced apoptosis showing only 20~30% cell death even at the concentration 100 ng/ml, but MG132 ($3{\mu}M$) pre-treatment 1 hour prior to TRAIL addition greatly increased cell death more than 80%. Luciferase assay showed TRAIL-induced $NF-{\kappa}B$ transcriptional activity in both cell lines. Electromobility shift assay demonstrated DNA binding complex of $NF-{\kappa}B$ activated by TRAIL and supershift with p65 antibody. $I{\kappa}B{\alpha}$ degradation was proven by western blot. MG132 completely blocked both TRAIL-induced $NF-{\kappa}B$ dependent luciferase activity and DNA binding of $NF-{\kappa}B$. Conclusion: This results suggest that inhibition of $NF-{\kappa}B$ can be a potentially useful strategy to enhance TRAIL-induced tumor cell killing in lung cancer.

• Journal of Korean Academy of Nursing Administration
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• v.1 no.1
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• pp.132-146
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• 1995

Even though Korean medical law stipulates that number of patients attended by a nurse is 2.5 for hospitalization and 30 for ambulatory care, the number of patients cared by a nurse per day is much greater than the standard prescribed by the medical law. Current productivity of nurses is not desirable unless the quality of care is considered. And nursing manpower staffing based on neither current nurses' productivity nor standard of medical law cannot respond properly to dynamic situation of the medical services. Under this background, the necessity of more efficient management of nursing manpower occupying 1/3 of total hospital workers has been recognized by many nursing administrators. Many nursing researchers have studied to foretell the nursing manpower objectively on the basis of measured nursing workload according to patient classification as well. Most of These researches, however, have been conducted in the tertiary hospitals, so it is imperative to conduct other researches to predict necessary nursing manpower in the secondary and the primary hospitals. The study was performed to measure nursing workload and predict pertinent nursing manpower to a secondary hospital with 400beds. Nursing workload was surveyed using measuring tool for direct and indirect care hours in a surgical unit and a medical unit. Survey was conducted from Sep.10 to Sep.16 and from Oct.5 to Oct.11, 1994 respectively by two skilled nurses, Subjects were patients, patients' family members and nursing personnels. Results are follows : 1. Patient classification distributed as 22% of class I (mildly ill patient), 57% of class II (moderately ill patient), and 21% of class III (acutely ill patient) in the medical nursing unit, while 23% of class I, 29% of class II, 12% of class III, and 36% of classIV (critically ill patient) in the surgical nursing unit. There was no difference of inpatient number between weekday and weekend. Bed circulation rate was 89% in both units and average patients number per day was 37.4 (total 42beds) in the medical nursing unit, 32.9 (total 37beds) in the medical nursing unit. 2. Direct care hours per day measured as 2.8hrs for class I, 3.3hrs for class II, and 3.5hrs for class III in the medical nursing unit, while 3.1hrs for class I, 3hrs for class II, 2.7hrs for class III, and 2.2hrs for classIV in the surgical nursing unit. Meanwhile, hours for nursing assistant activities per patient by patients' family members were 11mins and 200mins respectively. Direct care hour rate by shift was day 36%, evening 25%, and night 39% in the medical nursing unit, while 40%, 29%, and and 31% respectively in the surgical nursing unit. 3. Measurement and observation activity held 44.2% of direct care activities of nurses and medication 36.7%, communication 11.7%, exercise 1.8%, treatment 1.3%, hygiene 1.3%, elimination and irrigation 1.1%, suction 1%, nutrition 0.5%, thermotherapy 0.3%, oxygen therapy 0.1% in order. 4. Indirect care hours per day were 294.2mins in the medical nursing unit, and 273.9mins in the surgical nursing unit. By shift, evening was the highest in both units. Indirect care hours for each patient were 44.5mins in the medical nursing unit and 46mins in the surgical nursing unit. 5. checking activities including doctor's order, medication, and delivering patients to the next shift occupied 39.7% of indirect care activities, and preparation 26%, recording 23.8%, communication and conference 6.7%, managing equipments 2.1%, messenger activity 1.7% in order. 6. On the ground of these results, nursing manpower needed in a secondary hospital was estimated ; 27 nursing personnels for the medical nursing unit of 37beds, and 20 nursing personnels for the surgical nursing unit of 33beds.

• The Journal of Korean Institute of Communications and Information Sciences
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• v.41 no.11
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• pp.1653-1660
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• 2016

The synthetic aperture rardar (SAR) is an active sensor using microwaves. It transmits a microwave signal, called a chirp pulse, and receives the reflected signal in a moving platform such as satellite and unmanned aerial vehicle. Since this sensor uses microwaves that can penetrate the atmosphere, SAR generates the images regardless of light and weather conditions. However SAR operates on the moving platform, the Doppler shift and the side-looking observation method should be considered. In addtion, a residual image or ghost image can be occurred according to selection of the pulse repetition frequency (PRF). In this paper, a range design of the PRF for the L-band spaceborne SAR system is studied for prevention of SAR image distortion. And the system is studied for prevention of SAR image distortion. And the system parameter and the PRF are calibrated iteratively according to the proposed system design procedure and design constraints. The MATLAB based on SAR system simulator has been developed to verify the validity of calculated PRF. The developed simulator assumes that SAR sensor is operated by the PRF calculated from the design. The results of the simulator show that the targets in image has a valid peak to side-lobe ratio (PSLR) so that the PRF can be used for the spaceborne SAR sensor.