• Korean Journal of Health Education and Promotion
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• v.6 no.2
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• pp.23-39
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• 1989

There have been a lot of considerable. discussion and debate surrounding the management model in the health insurance management system and opinions regarding the management operating cost. It is a well known fact that there have always been dissenting opinions and debates surrounding the issue. The management operating cost varies according to the scale of the management organization and component members characteristics of the insurance carrier. Therefore, it is necessary to examine and compare the management operating cost to the simulated management models developed to cover those eligible for the health insurance scheme in this country. Since the management operating cost can vary according to the different models of management, four alternative management models have been established based on the critical evaluation of existing theories concerned, as well as on the basis of the survey results and simulation attempts. The first alternative model is the Unique Insurance Carrier Model(Ⅰ) ; desigened to cover all of the people with no classification of insurance qualifications and finances from the source of contribution of the insured, nationwide. The second is the Management Model of Large-scale District Insurance Carrier(Ⅱ) ; this means the Korean society would be divided into 21 large districts; each having its own insurance carrier that would cover the people in that particular district with no classification of insurance qualifications arid finances as in Model I. The third is the Management Model of Insurance Carrier Divided by Area and Classified with Occupation if Largescale (Ⅲ) ; to serve the self-employed in the 21 districts divided as in Model Ⅱ. It would serve the employees and their dependents by separate insurance carriers in large-scale similar to the area of the district-scale for the self-employed, so that the insurance qualifications and finances would be classified with each of the insurance carriers: The last is the Management Model of the Multi - insurance Carrier (Ⅳ) based on the Si. Gun. Gu area which will cover their own self- employed people in the area with more than 150 additional insurance carriers covering the employees and their dependents. The manpower necessary to provide services to all of the people according to the four models is calculated through simulation trials. It indicates that the Management Model of Large-scale District Insurance Carrier requires the most manpower among the four alternative models. The unit management operating costs per the insured individuals and covered persons are leveled with several intervals based on the insurance recipients. in their characteristics. The interval levels derived from the regression analysis reveal that the larger the scale of the insurance carriers is in the number of those insured and covered. the more the unit management operating cost decreases. significantly. Moreover. the result of the quadratic functional formula also shows the U-shape significantly. The management operating costs derived from the simulated calculation. on the basis of the average salary and related cost per staff- member of the Health Insurance Societies for Occupational Labours and Korean Medical Insurance Corporation for the Official Servants and Private School Teachers in 1987 fiscal year. show that the Model of Multi-insurance Carrier warrants the highest management operating cost. Meanwhile the least expensive management operating cost is the Management Model of Unique Insurance Carrier. Insurance Carrier Divided by Area and Classified with Occupation in Large-scale. and Large-scale District Insurance Carrier. in order. Therefore. it is feasible to select the Unique Insurance Carrier Model among the four alternatives from the viewpoint of the management operating cost and in the sense of the flexibility in promoting the productivity of manpower in the human services field. However. the choice of the management model for health insurance systems and its application should be examined further utilizing the operation research analysis for such areas as the administrative efficiency and factors related to computer cost etc.

• Radiation Oncology Journal
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• v.18 no.2
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• pp.101-106
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• 2000

Purpose : This study was peformed to evaluate the effectiveness and tolerance of craniospinal irradiation for patients with modulloblastoma and to define the optimal radiotherapeutic regimen. Materials and Methods : We retrospectively analyzed the records of 43 patients with modulloblastoma who were treated with external beam craniospinal radiotherapy at our institution between May, 1984 and April, 1998. Median follow up period was 47 months with range of 18 to U months. Twenty seven patients were male and sixteen patients were female, a male to female ratio of 1.7:1. Surgery consisted of biopsy alone in 5 patients, subtotal excision in 24 patients, and gross total excision in 14 patients. All of the patients were treated with craniospinal irradiation. All of the patients except four received at least 5,000 cGy to the posterior fossa and forty patients received more than 3,000 cGy to the spinal cord. Results : The overall survival rates at 5 and 7 years for entire group of patients were 57$\%$ and 56$\%$, respectively. Corresponding disease free survival rates were 60$\%$ and 51$\%$, respectively, The rates of disease control in the posterior fossa were 77$\%$ and 67$\%$ at 5 and 7 years. Gross total excision and subtotal excision resulted in 5 year overall survival rates of 76$\%$ and 66$\%$, respectively, In contrast, those patients who had biopsy alone had a 5 year survival rate of only 40$\%$. Posterior fossa was a component of failure in 11 of the 18 recurrences. Seven recurrences were isolated to the posterior fossa. Four patients had neuraxis recurrences, three had distant metastasis alone and four had multiple sites of failure, all involving the primary site. Conclusion : Craniospinal irradiation for patients with moduiloblastoma is an effective adjuvant treatment without significant treatment related toxicitles. There is room for Improvement in terms of posterior fossa control, especially in biopsy alone patients. The advances in radiotherapy including hypefractionation, stereotactic radiosurgery and 3D conformal radiotherapy would be evolved to improve the tumor control rate at primary site.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.145-151
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• 1996

Pathways both mediated by and independent of transferrin(Tf) and the TfR have been described for the accumulation of iron. Although it is not clear whether the same systems take up iron and gallium, these pathways may suggest the contention that uptake of Ga-67 can, in fact, occur by both Tf-independent and Tf-dependent systems and may share with Fe-59 in part the same mechanism for uptake. The predominant system by which uptake of both radiometals occurs may be different in the degree of the transformation of tumor. Transformed(MMSV/3T3) and untransformed(BALB/3T3) cells were incubated with luM of Ga-67-citrate of Fe-59-chloride for 15 min. at $37^{\circ}C$ in either the presence or absence of Tf. After then, the monolayers were washed with HBSS or PBS, and the cells were solubilized in 1% SDS for gamma well counting and protein determinations. There were similarities, as well as differences, in the pattern of uptake of Fe-59 and Ga-67 presented both in ionic from and as bound to Tf. Both radiometals appeared gain to cells in either ionic or Tf-bound forms. Transformed cells appeared to accumulate more radiometal, either Ga-67 or Fe-59 in the presence of Tf than do the their untransforemd counterparts. Conversly the presentation of either radiometal in ionic form resulted in significantly greater accumulation of metal by the untransformed cells than those transformed. The efficiency for uptake of Ga-67 or Fe-59 in the absence of Tf was greater than for uptake of the Ga-Tf or Fe-Tf. However, the magnitude of difference in efficiency of uptake was greater for Fe-59(10-fold) than for Ga-67 (3-fold). Our results Supports the theory that both Tf-independent and Tf-dependent systems for the uptake of Ga-67 both systems operate oppositely between transformed cells and those untransformed, with uptake by the predominating in transformed cells by the Tf-mediated system and in untransformed cells by the Tf-independent. The uptake of Ga-67 by tumor may share with Fe-59 in part the same mechanism.

• Proceedings of the Korean Society of Fisheries Technology Conference
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• 2000.05a
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• pp.71-73
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• 2000

Campylobacter jejuni is most frequently identified cause of cause of acute diarrhoeal infections in developeed countries, exceeding rates of illness caused by both salmonella and shigilla(Skirrow, 1990 ; Lior 1994). Previous studies on campylobacter jejuni contamination of commercial broiler carcasses in u.s.(Stern, 1992). Most cases of the disease result from indirect transmission of Campylobactor from animals via milk, water and meat. In addition to Campylobactor jejuni. the closely relates species Campylobactor coli and Campylobactor lari have also been implicated as agents of gastroenteritis in humans. Campylobactor coli represented only approximately 3% of the Campylobactor isolates from patients with Campylobactor enteritis(Griffiths and Park, 1990) whereas Campylobactor coli is mainly isolated from pork(Lmmerding et al., 1988). Campylobactor jejuni has also been isolated from cases of bacteremia, appendicitis and, recently, has been associated with Guillai-Barre syndrome(Allos and Blaser, 1994; von Wulffen et al., 1994; Phillips, 1995). Studies in volunteers indicated that the infectious dose for Campylobactor jejuni is low(about 500 organisms)(Robinson, 1981). The methods traditionally used to detect Campylobactor ssp. in food require at least two days of incubation in an enrichment broth followed by plating and two days of incubation on complex culture media containing many antibiotics(Goossens and Butzler, 1992). Finnaly, several biochemical tests must be done to confirm the indentification at the species level. Therfore, sensitive and specific methods for the detection of small numbers of Campylobactor cells in food are needed. Polymerase chain reaction(PCR) assays targeting specific DNA sequences have been developed for the detection of Campylobactor(Giesendorf and Quint, 1995; Hemandex et al., 1995; Winter and Slavidk, 1995). In most cases, a short enrichment step is needed to enhance the sensitivity of the assay prior to detection by PCR as the number of bacteria in the food products is low in comparison with those found in dinical samples, and because the complex composition of food matrices can hinder the PCR and lower its sensitivity. However, these PCR systems are technically demanding to carry out and cumbersome when processing a large number of samples simutaneously. In this paper, an immunomagnetic method to concentrate Campylobactor cells present in food or clinical samples after an enrichment step is described. To detect specifically the thermophilic Campylobactor. a monoclonal antibody was adsorbed on the surface of the magnetic beads which react against a major porin of 45kDa present on the surface of the cells(Huyer et al., 1986). After this partial purification and concentration step, detection of bound cells was achieved using a simple, inexpensive microtitre plate-based hybridization system. We examined two alternative detection systems, one specific for thermophilic Campylobactor based on the detection of 23S rRNA using an immobilized DNA probe. The second system is less specific but more sensitive because of the high copy number of the rRNA present in bacterial cell($10^3-10^4$). By using specific immunomagnetic beads against thermophilic Campylobactor, it was possible to concentrate these cells from a heterogeneous media and obtain highly specific hybridization reactions with good sensitivity. There are several advantages in using microtitre plates instead of filter membranes or other matrices for hybridization techniques. Microtitre plates are much easier to handle than filter membranes during the adsorption, washing, hybridization and detection steps, and their use faciilitates the simultanuous analysis of multiple sample. Here we report on the use of a very simple detection procedure based on a monoclonal anti-RNA-DNA hybrid antibody(Fliss et al., 1999) for detection of the RNA-DNA hybrids formed in the wells.

• The Journal of the Petrological Society of Korea
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• v.20 no.2
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• pp.77-98
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• 2011

The igneous complex consisting of mangerite and gabbro in the Odaesan area, the eastem part of the Gyeonggi Massif, South Korea, intruded early Paleo-proterozoic migmatitic gneiss. The mangerite is composed of orthopyroxene, clinopyroxene, amphibole, biotite, plagioclase, pethitic K-feldspar, quartz. The gabbro has similar mineral assemblage but gabbro has minor amounts of amphibole and no perthitic K-feldspar. The gabbro occurs as enclave and irregular shaped body within the mangerite, and the boundary between the mangerite and gabbro is irregular. Leucocratic lenses with perthitic K-feldspar are included in the gabbro enclaves. These textures represent mixing of two different magmas in liquid state. SHRIMP U-Pb zircon age dating gave $234{\pm}1.2$ Ma and $231{\pm}1.3$ Ma for mangerite and gabbro, respectively. These ages are similar with the intrusion ages of post collision granitoids in the Hongseong (226~233 Ma) and Yangpyeong (227~231 Ma) areas in the Gyeonggi Massif. The mangerite and gabbro are high Ba-Sr granites, shoshonitic and formed in post collision tectonic setting. These rocks also show the characters of subduction-related igneous rock such as enrichment in LREE, LILE and negative Nb-Ta-P-Ti anomalies. These data represent that the mangerite and gabbro formed in the post collision tectonic setting by the partial melting of an enriched lithospheric mantle during subduction which occurred before collision. The heat for the partial melting was supplied by asthenospheric upwelling through the gab between continental and oceanic slabs formed by slab break-off after continental collision. The distribution of post-collisional igneous rocks (ca. 230 Ma) in the Gyeonggi Massif including Odaesan mangerite and gabbro strongly suggests that the tectonic boundary between the North and South China blocks in Korean peninsula passes the Hongseong area and futher exteneds into the area between the Yangpyeong-Odaesan line and Ogcheon metamorphic belt.

• The Journal of Korean Institute of Electromagnetic Engineering and Science
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• v.11 no.5
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• pp.813-821
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• 2000

The engineering of satellite communication systems at frequencies above 10GHz requires a method for estimating rain-caused outage probabilities on the earth-satellite path. A procedure for predicting a rain attenuation distribution from a point rainfall rate distribution is, therefore, needed. In order to predict rain attenuation on the satellite link, several prediction models such as ITU-R, Global, SAM, DAH model, have been developed and used at a particular propagation condition, they may not be appropriate to a propagation condition in Korean territory. In this paper, a new rain attenuation prediction method appropriate to a propagation condition in Korea is introduced. Based on the results from ETRI measurements, a new method has been derived for an empirical approach with an identification on the horizontal correction factor as in current ITU-R method, and the vertical correction factor has been suggested with decreasing power law as a function of rainfall rate. This proposed model uses the entire rainfall rate distribution as input to the model, while the ITU-R and DAH model approaches only use a single 0.01% annual rainfall rate and assume that the attenuation at other probability levels can be determined from that single point distribution. This new model was compared with several world-wide prediction models. Based on the analysis, we can easily know the importance of the model choice to predict rain attenuation for a particular location in the radio communication system design.

• Proceedings of the Korean Institute of Intelligent Systems Conference
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• 1993.06a
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• pp.975-976
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• 1993

This talk presents the overview of the author's research and development activities on fuzzy inference hardware. We involved it with two distinct approaches. The first approach is to use application specific integrated circuits (ASIC) technology. The fuzzy inference method is directly implemented in silicon. The second approach, which is in its preliminary stage, is to use more conventional microprocessor architecture. Here, we use a quantitative technique used by designer of reduced instruction set computer (RISC) to modify an architecture of a microprocessor. In the ASIC approach, we implemented the most widely used fuzzy inference mechanism directly on silicon. The mechanism is beaded on a max-min compositional rule of inference, and Mandami's method of fuzzy implication. The two VLSI fuzzy inference chips are designed, fabricated, and fully tested. Both used a full-custom CMOS technology. The second and more claborate chip was designed at the University of North Carolina(U C) in cooperation with MCNC. Both VLSI chips had muliple datapaths for rule digital fuzzy inference chips had multiple datapaths for rule evaluation, and they executed multiple fuzzy if-then rules in parallel. The AT & T chip is the first digital fuzzy inference chip in the world. It ran with a 20 MHz clock cycle and achieved an approximately 80.000 Fuzzy Logical inferences Per Second (FLIPS). It stored and executed 16 fuzzy if-then rules. Since it was designed as a proof of concept prototype chip, it had minimal amount of peripheral logic for system integration. UNC/MCNC chip consists of 688,131 transistors of which 476,160 are used for RAM memory. It ran with a 10 MHz clock cycle. The chip has a 3-staged pipeline and initiates a computation of new inference every 64 cycle. This chip achieved an approximately 160,000 FLIPS. The new architecture have the following important improvements from the AT & T chip: Programmable rule set memory (RAM). On-chip fuzzification operation by a table lookup method. On-chip defuzzification operation by a centroid method. Reconfigurable architecture for processing two rule formats. RAM/datapath redundancy for higher yield It can store and execute 51 if-then rule of the following format: IF A and B and C and D Then Do E, and Then Do F. With this format, the chip takes four inputs and produces two outputs. By software reconfiguration, it can store and execute 102 if-then rules of the following simpler format using the same datapath: IF A and B Then Do E. With this format the chip takes two inputs and produces one outputs. We have built two VME-bus board systems based on this chip for Oak Ridge National Laboratory (ORNL). The board is now installed in a robot at ORNL. Researchers uses this board for experiment in autonomous robot navigation. The Fuzzy Logic system board places the Fuzzy chip into a VMEbus environment. High level C language functions hide the operational details of the board from the applications programme . The programmer treats rule memories and fuzzification function memories as local structures passed as parameters to the C functions. ASIC fuzzy inference hardware is extremely fast, but they are limited in generality. Many aspects of the design are limited or fixed. We have proposed to designing a are limited or fixed. We have proposed to designing a fuzzy information processor as an application specific processor using a quantitative approach. The quantitative approach was developed by RISC designers. In effect, we are interested in evaluating the effectiveness of a specialized RISC processor for fuzzy information processing. As the first step, we measured the possible speed-up of a fuzzy inference program based on if-then rules by an introduction of specialized instructions, i.e., min and max instructions. The minimum and maximum operations are heavily used in fuzzy logic applications as fuzzy intersection and union. We performed measurements using a MIPS R3000 as a base micropro essor. The initial result is encouraging. We can achieve as high as a 2.5 increase in inference speed if the R3000 had min and max instructions. Also, they are useful for speeding up other fuzzy operations such as bounded product and bounded sum. The embedded processor's main task is to control some device or process. It usually runs a single or a embedded processer to create an embedded processor for fuzzy control is very effective. Table I shows the measured speed of the inference by a MIPS R3000 microprocessor, a fictitious MIPS R3000 microprocessor with min and max instructions, and a UNC/MCNC ASIC fuzzy inference chip. The software that used on microprocessors is a simulator of the ASIC chip. The first row is the computation time in seconds of 6000 inferences using 51 rules where each fuzzy set is represented by an array of 64 elements. The second row is the time required to perform a single inference. The last row is the fuzzy logical inferences per second (FLIPS) measured for ach device. There is a large gap in run time between the ASIC and software approaches even if we resort to a specialized fuzzy microprocessor. As for design time and cost, these two approaches represent two extremes. An ASIC approach is extremely expensive. It is, therefore, an important research topic to design a specialized computing architecture for fuzzy applications that falls between these two extremes both in run time and design time/cost. TABLEI INFERENCE TIME BY 51 RULES {{{{Time }}{{MIPS R3000 }}{{ASIC }}{{Regular }}{{With min/mix }}{{6000 inference 1 inference FLIPS }}{{125s 20.8ms 48 }}{{49s 8.2ms 122 }}{{0.0038s 6.4㎲ 156,250 }} }}

• Journal of radiological science and technology
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• v.29 no.1
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• pp.1-6
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• 2006

Purpose: Renal stones are common and typically arise within the collecting system. The renal sinus are contains the collection system, the renal vessels, lymphatcs, fat, and fibrous tissue. Because of the compression of all the large echoes in signal processing, the echo from the renal stone generally cannot be distinguished from large echoes emanating from normal structures of the renal sinus. Use of ultrasonography has been difficult for detecting small renal stone without posterior shadowing and chemical composition of stone. The aim of study was measuring for posterior acoustic shadowing to a stone for various scan parameter and it examines a help in renal stone diagnosis. Material & Methods: The stone was place on sponge examined in a water bath with a 3.5MHz or 7.5MHz transducer(LOGIQ 400, USA). First, tested a variety of gain. Second, tested a variety of dynamic range. Third, tested a variety of focal zone. Fourth, measuring of the echo level for low and high frequency for depth. Results: 1) Average echo level was 98 for low total gain(10 dB) and was 142 for high total gain(40 dB). Posterior acoustic shadowing of renal stone was clear for low gain. 2) Average echo level was 129 for low dynamic range(42 dB) and was 101 for high dynamic range(72 dB). Posterior acoustic shadowing of renal stone was clear for high dynamic range. 3) When stone is in focal zone of transducer, definite posterior acoustic shadow is identified. 4) Stone was clear appeared for high frequency(7.5 MHz) than low frequency(3.5 MHz) and it is not distorted. Conclusion: The demonstration of an posterior acoustic shadow of renal stone dependents on several technical factors such as gain, dynamic range, focus, and frequency. This various factors are a help in renal stone diagnosis.

• Restorative Dentistry and Endodontics
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• v.32 no.1
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• pp.37-46
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• 2007

The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. The main anatomical feature of C-shaped canals is the presence of fins or web connecting the individual root canals. The complexity of C-shaped canals prevents these canals from being cleaned, shaped, and obturated effectively during root canal therapy, and sometimes it leads to an iatrogenic perforation from the extravagant preparation. The purpose of this study was to provide further knowledge of the anatomical configuration and the minimal thickness of dentinal wall according to the level of the root. Thirty extracted mandibular second molars with fused roots and longitudinal grooves on lingual or buccal surface of the root were collected from a native Korean population. The photo images and radiographs from buccal, lingual, apical direction were taken. After access cavity was prepared, teeth were placed in 5.25% sodium hypochlorite solution for 2 hours to dissolve the organic tissue of the root surface and from the root canal system. After bench dried and all the teeth were embedded in a self-curing resin. Each block was sectioned using a microtome (Accutom-50, Struers, Denmark) at interval of 1 mm. The sectioned surface photograph was taken using a digital camera (Coolpix 995, Nikon, Japan) connected to the microscope. 197 images were evaluated for canal configurations and the minimal thickness of dentinal wall between canal and external wall using 'Root Thickness Gauge Program' designed with Visual Basic. The results were as follows : 1. At the orifice level of all teeth, the most frequent observed configuration was Melton's Type C I (73%), however the patterns were changed to type C II and C III when the sections were observed at the apical third. On the other hand, the type C III was observed at the orifice level of only 2 teeth but this type could be seen at apical region of the rest of the teeth. 2. The C-shaped canal showed continuous and semi-colon shape at the orifice level, but at the apical portion of the canal there was high possibility of having 2 or 3 canals 3. Lingual wall was thinner than buccal wall at coronal, middle, apical thirds of root but there was no statistical differences.