• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 대한간호학회지
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• 제26권2호
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• pp.257-270
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• 1996

Studies on menstruation have focused only on menstruation itself and menstrual disorders. The menstruating girls or women have been neglected. So, the purpose of this study was to understand menstrual experience of adolescent girls in their perspective and build a theory on it, The specific purpose of this study were to find initial reaction of the girls, their strategies to adapt to menstruation. consequences of their efforts, influencing factor, and patterns of experience. The subjects of this study were eleven adolescent girls who experienced menarche three months to twenty-six months before the interview time. They were selected purposively. Their ages were in range of twelve and sixteen. One of them was a elementary school girl, three high school girls, and seven middle school girls. Two girls were handicapped because of cerebral palsy. All of them had some knowledge about menstrual physiology and hygiene during menstruation. Data were collected from September, 1994 to July, 1995. Data collection ＆ analysis were done according to the grounded theory methodology by Strauss ＆ Corbin(1990). Data collecting method was the long interviews and observation. Each interview took from 1 hour to 2 hours. Interview were tape-recorded and transcribed later by author. Data were analyzed immediately after interviews. Based on the results of previous interview, next interview were planned until gathered data reached the saturation point. Results were as follows. One hundred and six concepts were found. Those concepts were grouped into twenty eight categories and then fourteen higher categories. Twenty eight categories were as follows. “want to hide”, “bewildered”, “sense of burden”, “sense of heterogeneity”. “gladness”. “sense of superiority”, “negative empathy”, “positive empathy”, “limited hygenic control”, “sense of timing”, “lack of knowledge”, “lack of support”, “advance knowledge”, “informational support”, “emotional support”, “endurance”, “prayer”, “disclosing”, “avoidance”, “diversion”, “sense of powerlessness”, “discovery of sex identity”, “sense of maturation”, “sense of stability”, “acceptance of menstruation ”. fourteen higher categories were as follows. “negative feeling”, “posive feeling”, “exchange of feeling”, “limited hygenic control”, “sense of timing”, “accumulated experience”, “dysmenorrhea”, “level of knowledge”, “need for support”, “perceived support”, “sharing of feeling”, “self-control”, “passive acceptance”, “active acceptance”. The core category was “emotional shaking”, which consisted of “positive feeling” and “negative feeling”. “Emotional shaking”comes up to every adolescent girls experiencing menarche, independently of any contextual conditions, and its dimension has two directions : positive one and negative one. Its influencing factors were time of menarche, advance knowledge, support from the significant persons, expression and self-regulation. Even if they showed different process of adaptation to menstruation, general process of adaptation were as follows : 1. stage of emotional shaking 2. stage of acceptance 3. stage of internalization of the menstrual experience. Seven patterns existed on the process of adaptation to menstruation after menarche. Those are as follows. 1. If girls thought their menarche came too early and they had not much knowledge on menstruation, they had a kind of negative feeling. If they did not get enough support and dysmenorrhea superimposed, they came to accept menstruation passively. 2. If girls had menarche too early. they had negative feeling, even though they had enough advance knowledge. But support helped them accept menstruation easily. 3. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. But by experiencing subsequent menstruations and disclosing feeling, they began to accept menstruation. 4. If girls had menarche too lately and they had enough advance knowledge on menstruation. they had positive feeling. If dysmenorrhea superimposed later, their feeling turned in to negative one. But they came to accept menstruation positively by disclosing feeling and getting support. 5. If girls had menarche too early, they had negative feeling, even though they had enough advance knowledge on menstruation. In addition to this. if dysmenorrhes superimposed while they did not get enough support, they felt powerless and came to accept menstruation passively. 6. If girls had menarche too early and did not get enough advance knowledge, they had negative feeling. But disclosing feeling and support made them get sense of homogeneity and began to accept menstruation. 7. If girls had handicap, they had negative feeling, even though they had enough advance knowledge and menarche was late. But Menarche made them get feel sexual identity. Their limited hygenic control and negative empathy from their mothers made them accept menstruation passively. To let adolescent girls take their menstrual experience as a part of their lives forming a positive sense of feminine identity, it needs qualified teaching and, support and deep concern of the significant others. Nurses including school nurses should try to develop an educational program, which include menstrual physiology. hygiene during menstrual period, meaning of menstruation and impact of menstruation on the development of female sexual identity.

• 한국환경과학회지
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• 제23권3호
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• pp.433-445
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• 2014

The objective of study was to analyze seasonal and inter-annual patterns of water chemistry of Miho Stream watershed during 2004 - 2007 along with some influences of tributaries and summer monsoon on the stream water quality. For the study, eight physico-chemical parameters such as nitrogen, phosphorus, BOD, COD and chlorophyll-a (CHL) etc. were analyzed in relation to spatial and temporal variability of seven sampling sites of the mainstream and some tributaries in the watershed. In the upstream reach, Mean of BOD, COD and TP averaged 3.2 mg/L, 6.5 mg/L and $186{\mu}g/L$, respectively, indicating an eutrophic conditions as a III-rank in the stream water quality criteria from the Ministry of Environment, Korea(MEK). The eutrophic water was due to a combined effect of Chiljang tributary with high nutrients ($TP=844{\mu}g/L$, TN=8.087 mg/L) and the point sources from some wastewater treatment plants. In the meantime, BOD, TN, and TP in the downstream reach were about > 1.2-1.5 folds than the values of the midstream reaches. This was mainly attributed to effluents of nutrient rich-water (mean TN: 11.980 mg/L) from two tributaries of Musim Stream and Suknam Stream, which is directly influenced by nearby wastewater disposal plants. Seasonal analysis of water chemistry showed that summer monsoon rainfall was one of the important factors influencing the water quality, and water quality had a large spatial heterogeneity during the rainfall period. In the premonsoon, BOD in the downstream averaged $6.0{\pm}2.47mg/L$, which was 1.4-fold greater than the mean of upstream reach. Mean of CHL-a as an indicator of primary productivity in the water body, was > 2.2 - 2.9 fold in the downstream than in the upstream, and this was a result of the high phosphorus loading from the watershed. Overall, our data suggest that some nutrient controls in point-source tributary streams are required for efficient water quality management of Miho Stream.

• 대한토목학회논문집
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• 제33권6호
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• pp.2437-2445
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• 2013

이 연구는 확률적 모수를 고려한 음이항회귀분석을 이용하여 고속도로에서의 사고와 기하구조와의 관계를 파악하는데 목적이 있다. 고속도로에서의 기하구조는 모든 구간에 동일한 설계요소가 적용되기에는 현실적으로 불가능함에도 불구하고, 지금까지의 연구에서는 모형을 통해 도출되는 계수값이 구간에 설치된 기하구조의 특성에 관계없이 항상 고정된 값으로 추정되어왔다. 고정된 값을 이용한 일반적인 음이항모형은 시간적 변화 또는 각 대상구간이 가지고 있는 고유한 특성에 따른 변화를 통합하여 설명하지 못한다는 단점이 있으며, 이로 인해 추정된 계수의 표준오차가 과소추정되어 t-값이 부풀려지게 되며, 그 결과 모형의 설명력이 떨어지게 된다. 따라서, 이 연구에서는 워싱턴 주에 위치하고 있는 7개의 고속도로에서 발생한 9년동안의 사고자료 및 기하구조자료를 이용하여 구간별로 상이한 기하구조가 사고에 미치는 영향을 알아보고자 한다. 총 16개의 기하구조 관련 변수가 모형 도출에 이용되었으며, 기존의 음이항모형과의 비교를 통해 이 연구에서 제시하는 모형이 교통사고와 기하구조와의 관계파악에 더욱 적합함을 보이고자 한다. 그리고, 각 변수의 한계효용 및 탄력성 분석을 통해 이질성을 가지는 기하구조가 사고에 미치는 영향을 제시하고자 한다. 이는 향후 기하구조 관련 정책수립에 도움이 될 것으로 판단된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.6863-6870
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• 2015

Background: Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Although breast cancer is the most prevalent cancer in India, there is no organised national breast cancer screening programme. Local studies on the burden of breast cancer are essential to develop effective context-specific strategies for an early detection breast cancer programme, considering the cultural and ethnic heterogeneity in India. This study examined the knowledge, attitudes, and practices about breast cancer in rural women in Central India. Materials and Methods: This community-based cross sectional study was conducted in Wardha district, located in Maharashtra state in Central India in 2013. The sample included 1000 women (609 rural, 391 urban) aged 13-50 years, selected as representative from each of the eight development blocks in the district, using stratified cluster sampling. Trained social workers interviewed women and collected demographic and socio-economic data. The instrument also assessed respondents' knowledge about breast cancer and its symptoms, risks, methods of screening, diagnosis and treatment, as well as their attitudes towards breast cancer and selfreported practices of breast cancer screening. Chi-square and t-test were applied to assess differences in the levels of knowledge, attitude, and practice (the outcome variables) between urban and rural respondents. Multivariable linear regression was conducted to analyse the relationship between socio-demographic factors and the outcome variables. Results: While about two-thirds of rural and urban women were aware of breast cancer, less than 7% in rural and urban areas had heard about breast self-examination. Knowledge about breast cancer, its symptoms, risk factors, diagnostic modalities, and treatment was similarly poor in both rural and urban women. Urban women demonstrated more positive attitudes towards breast cancer screening practices than their rural counterparts. Better knowledge of breast cancer symptoms, risk factors, diagnosis, and treatment correlated significantly with older age, higher levels of education, and being office workers or in business. Conclusions: Women in rural Central India have poor knowledge about breast cancer, its symptoms and risk factors. Breast self-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screening provide an opportunity to promote breast self-examination.

• Asian Pacific Journal of Cancer Prevention
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• 제13권11호
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• pp.5427-5432
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• 2012

Background and Purpose: Ovarian cancer is the leading cause of death among gynecologic cancers because of the lack of effective early detection methods. Accuracies of the human epididymis protein 4 (HE4) and mesothelin in detecting ovarian cancer have never been systematically assessed. The current systematic review aimed to tackle this issue. Methods: MEDLINE, EMBASE, and Cochrane databases were searched (September 1995-November 2011) for studies on the diagnostic performances of HE4 and mesothelin in differentiating ovarian cancer from other benign gynecologic diseases. QUADAS items were used to evaluate the qualities of the studies. Meta-DiSc software was used to handle data from the included studies and to examine heterogeneity. All included studies for diagnostic performance were combined with sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratios (DORs) with 95% confidence intervals (CIs), summary receiver operating characteristic (SROC) curves, and areas under the SROC curves (AUC). Results: A total of 18 studies and 3,865 patients were eligible for the final analysis. The pooled sensitivity estimates for HE4 (74.4%) were significantly higher than those for mesothelin (49.3%). The pooled specificity estimates for mesothelin (94.5%) were higher than those for HE4 (85.8%). The pooled DOR estimates for HE4 (26.22) were higher than those for mesothelin (24.01). The SROC curve for HE4 showed better diagnostic accuracy than that for mesothelin. The PLR and NLR of HE4 were 6.33 (95% CI: 3.58 to 11.18) and 0.27 (95% CI: 0.21 to 0.34), respectively. The PLR and NLR for mesothelin were 11.0 (95% CI: 6.21 to 19.59) and 0.51 (95% CI: 0.42 to 0.62), respectively. The combination of the two tumor markers or their combination with CA-125 increased sensitivity and specificity to different extents. Conclusion: The diagnostic accuracy of HE4 in differentiating ovarian cancer from other benign gynecologic diseases is better than that of soluble mesothelin-related protein. Combinations of two or more tumor markers show more sensitivity and specificity.

• 환경정책연구
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• 제10권4호
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• pp.3-37
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• 2011

한국과 중국, 일본 세 국가의 1971년부터 2006년까지의 시계열 자료를 바탕으로 이산화탄소 배출량과 경제성장 그리고 경제개방도의 인과관계를 파악하고, 환경 쿠즈네츠 곡선(Envirionmental Kuznets Curve, EKC)의 존재여부에 대해 분석하였다. 경제개방도나 경제성장에 따른 이산화탄소 배출량은 국가별로 상이한 형태를 보였다. 추정된 EKC는 국가별로 다른 패턴을 보이는데, 경제성장과 $CO_2$ 배출량의 경우 한국은 U자 곡선, 중국은 상승추세, 일본은 역 N자 형태를 보였다. 일본은 약 30,000달러의 경제성장을 달성하면서 이산화탄소 배출 감소구간을 보이고 있다. 이와 같은 결과를 통해, EKC의 최고점에 이르지 않고도 선진국의 경험과 기술을 이용하여 터널을 거쳐 환경이 개선될 수 있다는 가능성을 확인할 수 있었다. 경제개방도와 $CO_2$ 배출량의 관계를 보면 한국은 역 U자 곡선, 중국의 경우 U자곡선, 일본은 증가추세를 보였다. 또한 벡터자기회귀모형(vector auto regression, VAR)과 벡터오차수정모형(vector error correction model, VECM)을 사용하여 변수들 간의 동태적 관계를 분석하였다. 각 국가의 경제성장, 개방화 정도에 따른 이산화탄소 배출과의 관계를 보다 가시적으로 접근했다는 데 의의가 있다.

• 한국수자원학회논문집
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• 제41권11호
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• pp.1135-1142
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• 2008

하천제방의 붕괴 요인중 구조물(배수통문) 주변 제방의 붕괴는 전체 요인의 l0% 이상을 차지하고 있으며, 특히 2002년 홍수시 낙동강에서 발생한 제방 유실 지점은 거의 배수통문 주위에서 발생하였다. 이러한 제방 파괴는 이질 재료인 통문 구조물과 제체 접합부 사이에 공극이나 공동이 형성된 후 홍수시 내부 침식으로 인해 공동이 확대되어 발생하는 파괴구조를 가지고 있다. 이러한 상황에서 하천제방의 안전관리를 위해 배수통문 주변의 공동발생 여부 혹은 공동내의 흐름 인지 등을 목적으로 한 연구가 진행되고 있으며, 본 연구에서는 Flex센서와 Fiber bragg grating 센서의 변이 계측에 대한 실험을 통해 두 센서의 특징을 파악하고, 하천제방의 안전관리를 위해 보다 적합한 센서의 결정이 가능하도록 하였다. 실험결과 현 시점에서 변이 계측과 관련하여 계측치의 일관성, 미소변이 계측 등 Flex센서의 단점을 보완할 수 있는 FBG센서의 여러 특징을 확인할 수 있었다.

• 한국광물학회지
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• 제28권2호
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• pp.109-126
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• 2015

단층비지는 단층의 중심부에 분포하면서 연약대를 형성하므로 단층비지의 광물학적 특성과 물성은 암반의 안정성에 크게 영향을 미친다. 본 연구에서는 단열구조도를 참고하여 중, 대규모의 주요 단층을 선정하였으며, 총 16지역의 단층 코어부분에서 51종류의 시료를 채취하였다. XRD, SEM을 이용한 광물학적 분석과 단위중량, 마찰각, 점착력을 측정하였다. 점토광물은 대표적으로 카올리나이트, 일라이트, 스멕타이트로 나눠질 수 있으며, 화산암에는 일라이트 > 스멕타이트 > 카올리나이트와 녹니석의 순으로 함유된다. 퇴적암에는 카올리나이트와 녹니석 > 일라이트 > 스멕타이트의 순으로 풍부하다. 화강암에는 일라이트 > 스멕타이트 > 카올리나이트와 녹니석 순으로 함유된다. 마찰각은 점토함량이 높을수록 감소하며, 점착력은 분산이 심하게 나타났다. 점토광물의 함량이 45% 이하에서는 점토광물의 함량이 증가할수록 점착력이 높아지나 45% 이상에서는 점착력이 낮아지는 추세를 보인다. 이는 단층비지가 불균질하며, 점토광물의 종류와 함량에서도 넓은 범위를 가지기 때문인 것으로 보인다.

• 한국항해항만학회지
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• 제37권3호
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• pp.275-281
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• 2013

선박표준 네트워크는 2005년 IMO MSC 제 81차 회의에서 e-navigation을 공동 의제로 제출되었다. 2006년 MSC 81의 WG 프로그램으로 승인된 후 2008년까지 e-navigation 구현전략을 수립하기로 결정됨으로써 선박 네트워크의 표준화 작업은 본격화되었다. 이는 선박의 안전 항해 뿐 아니라 400여종의 이기종 항해통신장비 및 기관 장비를 탑재하는 선박에서의 효율적인 정보 교환을 지원하기 위한 것이기도 하다. 그 가운데 4S 네트워크는 육상과 선박, 선박과 선박사이의 무선통신을 말하며 선박과 육상 간 통신채널을 항상 연결하도록 해주는 기본이 된다. 4S 네트워크는 이를 기반으로 다양한 서비스를 제공할 수 있는 많은 활용 분야가 존재하기 때문에 향후 e-navigation이 적용되면 다양한 시장 창출이 가능할 것으로 보이나 현재 이에 대한 구체적인 기반 기술 연구나 시제품 개발은 전무한 상태이다. 본 논문에서는 육해상간 효율적이고 저렴한 통신환경을 제공하도록 하는 4S 다중매체 스위칭 서버와 육해상 정보교환 시스템을 개발하고, 구현한 시스템의 성능을 TTA(Telecommunications Technology Association) V&V(Verification and Validation) 인증을 통해 확인하였다.