• Korea Journal of Hospital Management
• /
• v.2 no.1
• /
• pp.1-21
• /
• 1997

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study: 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums: however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11%; furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization showed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after t~e beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33billion Won while the net profits from MRI increased by 815.7million Won. Overall, these two together showed a net profit decrease of 1.51billion Won. The shifts in utilization showed a functional substitutionary relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.30 no.2
• /
• pp.272-285
• /
• 2003

This study was conducted to observe the microscopic structures of cavities formed after ablation of primary teeth, permanent teeth, enamel and dentin in using a bur and cavities formed after ablation using laser and the following results were obtained after comparing the effects of ablation. Using a #330 bur and Er:YAG laser irradiated at 150 mJ, 200 mJ, 250 mJ and 300 mJ all at the frequency of 5 Hz, 1 mm enamel and dentin samples were ablated and the ablation time was measured. In order to measure the surfaces ablated, 5 each of primary teeth and permanent teeth were ablated using a #330 bur and Er:YAG laser at 150 mJ, 200 mJ, 250 mJ and 300 mJ for 1 sec and the cross section and vertical section were observed. The following results were obtained : 1. Cutting time of Er:YAG laser was longer than that of conventinal high-speed bur regardless of teeth type. 2. Cutting on enamel, Cutting time of conventional high-speed bur in deciduous teeth was longer than in permanent teeth(P<0.05). But Er:YAG laser was not showed any difference between the deciduous and permanent teeth(P>0.05). 3. Cutting on dentin, Cutting time of conventional high-speed bur in permanent teeth was longer than deciduous teeth. Er:YAG laser of 150 mJ, 5 Hz in permanent teeth was longer than in deciduous teeth(p<0.05). But laser of other power did not showed mean difference. 4. The cavity surface treated with the convetional high-speed bur revealed a relatively flat appearance, almost covered with a debris-like smear layer. Cavity wall showed striped appearance because of blade of bur. 5. The cavity surface treated by the Er:YAG laser system was irregular or rough surface with the absence charring, carbonization, or cracking of the dentin. In addition, there was an absence of a smear layer. Cavity floor was round and relatively smooth. According to these results, cutting time of Er:YAG laser was almostly same in permanent and deciduous teeth, but more effective in dentin than enamel. Cutting the sample, Er:YAG laser was needed more time than conventional bur. But SEM findings suggested that laser device produced favorable surface characteristic(i.e, no smear layer, irregular surface, cracking).

• Journal of Aquaculture
• /
• v.4 no.1
• /
• pp.31-66
• /
• 1991

This paper deals with the reproductive ecology e.g., number of the pre-spawning moults, morphological characteristics of the pre-spawning moult the common moult, daily ration druing a molting cycle mating behavior, structures of spermatozoa and spermatophore, structure of vas deferens, mechanisms of the oviposition and brooding into the egg-chambers, a suitable time for the artificial mating and fertilization, time sequence of the oviposition and brooding into egg-chambers from the copulation, responses to temperature and chlorinity on the egg development and hatching, effect of temperatures on duration of egg development, physical mechanism of the egg hatching, to make an attempt for the artificial spawning and brooding to establish a suitable system of the artificial seedling-production for the aquaculture. 1. Females molted commonly $8{\~}10$ times at an interval of $17{\~}18$ days at $28^{\circ}C,\;3.26\~4.35\%_{\circ}$ while the prespawning moltings were $4{\~}5$ times at an interval of $13{\~}14$ days. The suitable state for artificial copulation was within 14 hours elapsed from the prespawning moltings (most suitable state was within 8 hours). Males discharged a gelatinous spermatophore and placed it on the females sternum during copulation. Oviposition was seen $6{\~}17$ hours after copulation. External fertilization was considered to take place at oviposition. Fertilized eggs held in egg-chambers forming between pleopods were about $5000{\~}6000$ in females those sizes about 6.5 cm in body length. 2. Eggs immediately after oviposition were elliptic shape, measuring $0.58{\times}0.48$ mm up to hatching. Their sizes increased with egg development and finally reached $0.85{\times}0.54$ mm up to hatching. The relationship between the long axis of the egg(Y in U) and days elapsed(X) was expressed as Y= 5.60194 + 0.007358X. The eggs performed superficial cleavage and their cleavage furrows became visible at the 4-daughter-nucleus stage. The eggs showed normal development up to hatching at water temperature range of $22{\~}30^{\circ}C$ (optimum temperature : $26{\~}28^{\circ}C$) and at chlorinity range of $0.00\~6.64\%_{\circ}$ (optimun chlorinity : $2.21{\%}_{\circ}$). The relationship between incubation period (Y in days) and water temperature(X in $^{\circ}C$) could be expressed as Y= 50.803-1.3555X. The eggs hatched $12{\~}13$ days after oviposition at $28.0{\~}28.6^{\circ}C$ 3. The pre-spawning moltings were appreciably different in the morphologic structure from those of common moltings. Breeding setae and dresses were formed on the thoracic regions, abdominal epimerae and the bases of the first to fourth pleopods in order to prepare and support oviposition, transfering and supporting eggs in egg-chambers up to hatching. These supplementary breeding organs were observed only at reproductive seasons.

• Journal of Distribution Research
• /
• v.15 no.1
• /
• pp.25-47
• /
• 2010

CS is one of the major concerns of managers in the world because it is well known to be a key medium construct for firms' superior outcome. One of the major agents for CS management is retailers. Firms try to manage not only employees but also retailers to promote CS behaviors. And so diverse incentives are used to promote their CS behaviors under diverse channel setting such as multi-channel. However in spite of the rising needs there has been scarce studies on the optimal incentive structure for a manufacturer to offer competing retailers at the multi-channel. In this paper, we try to find better way for a manufacturer to promote the competing retailers' CS behaviors. We investigated how to promote the retailers' CS behavior via game-theoretic modeling. Especially, we focus on the possible incentive, CS bonus type reward introduced in the studies of Hauser, Simester, and Wernerfelt(1994) and Chu and Desai(1995). We build up a multi stage complete information game and derive a subgame perfect equilibrium using backward induction. Stages of the game are as following. (Stage 1) Manufacturer sets wholesale price(w) and CS bonus($\eta$). (Stage 2) Both retailers in competition set CS effort level($e_i$) and retail price($p_i$) simultaneously. (Stage 3) Consumers make purchasing decisions based on the manufacturer's initial reputation and retailers' CS efforts.

• Journal of Korean Society for Atmospheric Environment
• /
• v.10 no.E
• /
• pp.371-386
• /
• 1994

Ecological examinations of the radial growth Patterns of pine trees(Pinus densiflora Sieb. et Zucc) growing on Mt. Namsan in central Seoul were made to test a Proposition that the pine trees decline due to the influence of air pollution and acid rain, which was proposed by some researchers in Korea, and the potential effects of current level of air pollutants to the growth of the Pine trees in central Seoul have been speculated. Tree-rings of 40 trees sampled at 3 sites of Mt. Namsan were prepared and examined using a Computer-aided Tree-Ring Measuring System at Kookmin University, Korea. Air Pollutant data collected by the Ministry of Environment( MOE ) and the Forestry Research Institute(FRI) were used to infer the general conditions of the environment. Correlation analysis was applied to the data set of tree growth and the other environmental factors. General information derived from the close examination of the tree-rings and the data on air pollution, drought and the other biological conditions suggested that the growth of the pine trees was severely affected by the occurrence of drought(climatic variation), the prevalence of the pine leaf gall midges(insects), and the suppression by the black locust trees(Robinia pseudo-acacia L.) (competition among trees). While the current condition of air pollution in Seoul cannot be categorized as good, the concentrations of air pollutants are not so high as to cause acute damages to the trees. In addition, while the data of rain acidity showed episodic low PHs of under 4.0, the average of them is far less acidic than those which were observed in either northeastern United States or central Europe, where the decline of trees were not solely attributed to any of the air pollutants. Considering the sequential facts that one of the most important environmental factors that affect the growth of trees is weather condition of the forest that the proposition of the decline of the pine trees was made without careful examination of the growth patterns and past growth history of them as well as the complex influences of many other factors including the weather conditions to the growth of trees, and that no objective explanation has been made on the causal relationships between the current condition of air pollution and the growth of the trees, such a proposition should be evaluated as invalid for the explanation of tree growth on Mt. Namsan in central Seoul, Korea. The author evaluates the factors of air pollution (including acid rain) as the predisposing factors, which may have the Potentials to chronically affect the tree growth at the forest ecosystem on Mt. Namsan for a long period of time. Ecosystem ecological studies should be further carried out to carefully explain both the functional and the structural aspects of the ecosystem processes, which include the biogeochemistry and the long-term changes of soil conditions as well as the growth of the other tree species on the mountain.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.27 no.3
• /
• pp.214-220
• /
• 2001

The clinical application of the three-dimensional radiographic technique had been limited to standard Broadbent-Bolton cephalometer with biplanar stereoradiography. We developed a new method for compensating the error of head position in ordinary non-biplanar cephalostat. It became to possible to use the three dimensional cephalogram commonly in clinical bases. 1. The method of methemetical compensation of head positioning error in non-biplanar condition was evaluated with dry skull. The error of the method of first and the second trial was $0.46{\pm}1.21$, $0.33{\pm}0.90mm$, which means the error of the head positioning correction in conventional cephalogram was within clinical acceptance. 2. The reproducibility of this system for clinical application was 0.54 mm ($-2.99{\sim}2.26mm$) which defines the absolute mean difference of the first and second trial. Compare to the The landmark identification error $1.2{\pm}1.6mm$, the error of the measurement was within the range of landmark identification error. The result indicates the adequate clinical accuracy of the computation of three-dimensional coordinates by compensation of the error of the head position in ordinary non-biplanar cephalostat.

• Journal of the Korean Institute of Landscape Architecture
• /
• v.42 no.5
• /
• pp.52-63
• /
• 2014

This is the study on users' perception gap about the effects of leisure space development of the Han River Citizen Park according to leisure constraints and was to identify leisure constraints expressed when using Han River Citizen Park and identify perception on positive and negative impacts according to use behavior characteristics of Han River Citizen Park and leisure space development. In order to compare and analyze the perception gap about the leisure space development of Han River Citizen Park users according to leisure constraints, we classified information and resources, economic affordability, free time on leisure activities in Han River Citizen Park into high influence group and low influence group and did an in-depth analysis. The results are as follows. First, Han River Citizen Park has the nature of neighborhood use with little influence on leisure constraints such as jogging and marathon, biking etc. including walking and relaxation and was a place to visit for simple exercises. Second, in the effects according to leisure space development of Han River Citizen Park, affordable leisure activity costs and ease of access were evaluated the most highly and congestion due to increasing users, increase in administrative operating budget and management personnel were concerned the most. Third, the leisure constraints in Han River Citizen Park were affected in the order of free time, economic affordability, information and resources. There were also perception gaps in congestion due to an increase in administrative operating budget and management personnel, increase in users including improvement of various leisure opportunities and leisure levels, encouragement of pride and attachment for Han river, affordable leisure activity costs depending on the degree of the influence of leisure constraints. Therefore, this study can be said to have the meaning in that we could identify leisure constraints affecting Han River Citizen Park users and resulting perception in leisure space development and revealed that the degree of the influence of leisure constraints varies in the use behavior of leisure space development of Han River Citizen Park and perception of positive and negative development impact. In addition, in order to resolve leisure complaints according to leisure constraints, we studied the need of accompaniment of leisure space operation and management system, development of various customized programs, introduction of recreational space and facilities prioritizing public interest rather than private interest with public relations and information delivery about leisure space of Han River Citizen Park.

• Journal of Bio-Environment Control
• /
• v.21 no.2
• /
• pp.79-87
• /
• 2012

This research was conducted to obtain basic data with regard to the heating performance that would be produced by installing an aluminum hot water pipe inside the greenhouse with the goal of reducing the heating energy in greenhouse. The research results are summarized as follows. The degree of difference in relation to the temperature by height within the greenhouse during the entire experiment was significant - within the range of 4.0~$7.0^{\circ}C$. The temperature difference between incoming and outgoing water was about $3.3^{\circ}C$ greater when FCU was activated compared to when it was not activated. Meanwhile, the amount of energy consumed increased about 36.2~40.1%. The amount of pyrexia per hour also increased by 44.6~52.0%. During the experiment period, circulated flux was within the range of 0.48~$0.49L{\cdot}s^{-1}$ while average fluid speed was 1.53~$1.56m{\cdot}s^{-1}$. The average temperature difference between incoming and outgoing water was 6.24~$11.50^{\circ}C$. The amount of heating value by each set temperature within the minimum outdoor temperature range of -14.0~$-0.6^{\circ}C$ was 135,930~307,150 kcal, and the range was within the 9,610~$19,630kcal{\cdot}h^{-1}$ per hour. This demonstrated that about 23~53% heating energy of the maximum heating load could be supplied. Total radiating value and amount of energy consumed were 2,548,306 kcal and 3,075.7 kWh, respectively. When heating takes place using oil, which is a fossil fuel, the total amount of light oil consumed was 281.6 L while the cost was 321,000 won. When the electricity cost for farms is applied, the total cost was about 110,730 won, which is about 33.5% of the cost required compared to oil consumption. The temperature at in the experiment area was about 8.3~$14.6^{\circ}C$ higher compared to that of the control area.

• Progress in Medical Physics
• /
• v.21 no.2
• /
• pp.192-200
• /
• 2010

Cyberknife with small field size is more difficult and complex for dosimetry compared with conventional radiotherapy due to electronic disequilibrium, steep dose gradients and spectrum change of photons and electrons. The purpose of this study demonstrate the usefulness of Geant4 as verification tool of measurement dose for delivering accurate dose by comparing measurement data using the diode detector with results by Geant4 simulation. The development of Monte Carlo Model for Cyberknife was done through the two-step process. In the first step, the treatment head was simulated and Bremsstrahlung spectrum was calculated. Secondly, percent depth dose (PDD) was calculated for six cones with different size, i.e., 5 mm, 10 mm, 20 mm, 30 mm, 50 mm and 60 mm in the model of water phantom. The relative output factor was calculated about 12 fields from 5 mm to 60 mm and then it compared with measurement data by the diode detector. The beam profiles and depth profiles were calculated about different six cones and about each depth of 1.5 cm, 10 cm and 20 cm, respectively. The results about PDD were shown the error the less than 2% which means acceptable in clinical setting. For comparison of relative output factors, the difference was less than 3% in the cones lager than 7.5 mm. However, there was the difference of 6.91% in the 5 mm cone. Although beam profiles were shown the difference less than 2% in the cones larger than 20 mm, there was the error less than 3.5% in the cones smaller than 20 mm. From results, we could demonstrate the usefulness of Geant4 as dose verification tool.

• Restorative Dentistry and Endodontics
• /
• v.35 no.3
• /
• pp.164-172
• /
• 2010

During a composite resin restoration, an anticipating contraction gap is usually tried to seal with low-viscosity resin after successive polishing, etching, rinsing and drying steps, which as a whole is called rebonding procedure. However, the gap might already have been filled with water or debris before applying the sealing resin. We hypothesized that microleakage would decrease if the rebonding agent was applied before the polishing step, i.e., immediately after curing composite resin. On the buccal and lingual surfaces of 35 extracted human molar teeth, class V cavities were prepared with the occlusal margin in enamel and the gingival margin in dentin. They were restored with a hybrid composite resin Z250 (3M ESPE, USA) using an adhesive AdperTM Single Bond 2 (3M ESPE). As rebonding agents, BisCover LV (Bisco, USA), ScotchBond Multi-Purpose adhesive (3M ESPE) and an experimental adhesive were applied on the restoration margins before polishing step or after successive polishing and etching steps. The infiltration depth of 2% methylene blue into the margin was measured using an optical stereomicroscope. The correlation between viscosity of rebonding agents and mciroleakage was also evaluated. There were no statistically significant differences in the microleakage within the rebonding procedures, within the rebonding agents, and within the margins. However, when the restorations were not rebonded, the microleakage at gingival margin was significantly higher than those groups rebonded with 3 agents (p < 0.05). The difference was not observed at the occlusal margin. No significant correlation was found between viscosity of rebonding agents and microleakage, except very weak correlation in case of rebonding after polishing and etching at gingival margin.