• Journal of Korean Academy of Nursing
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• v.10 no.1
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• pp.41-55
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• 1980

The medical care insurance system, being put into practice nearly for three years, seem to have brought about some considerable problems as serious for the government as to consider a revision of that system. As one of the most serious problems of present system, the treatment cost of insurance patients is so remarkably low in comparison with than of non-insurance cases that normal operation of hospitals is threatened and care services of low quality are induced. The researcher carried out this survey to analyze and bring to light several aspects of treatment cost of non-insurance patients as a material for a re-assessment of the cost of insurance cases which shows a a considerable difference in amount at the standpoint of hospitals with than of non-insurance cases and further, hoping the significant blind spot of present insurance system(that is, the absence of regulations' for cost assessment by patterns or types of health care treatment) will be mended in near future. The survey was carried out with the treatment invoice sheets of total 902 in-hospital Patients of a general hospital in Seoul during the period of the 2 nd quarter of the year(1979). Among total 902 patients, 694 cases were used for analysis, because those disease or syndromes shared by less than 10% of the patients were put aside before procession. The data were analyzed by kinds or types of diseases, demographic characteristics of patients, hospitalization patterns, types of nursing treatment, etc. The result of analysis was as follows 1. Among all the non-insurance cases, those who received one or more kinds of nursing treatment mounted up to 96. 7 ％. The invoice issue frequency per person was 7.2 times, while that frequency per day for a person was 0.8, : the treatment cosr per person was ￦22,650 while its daily average was ￦2,430, due to the average 9.3 in-hospital days per person. 2. As to the nursing treatment types by the demographic characteristics of patients and hospitalization patterns. a. The unit cost female patients was generally more expensive them that of males, and independent nursing service was more given than other types of treatment. As to age, higher age groups received independent nursing service most, while the youngest group received instrumental and integrated nursing services. b. As to room grade, the unit cost of I.C.U. cases was the highest : and the cast of private room patients was higher than that of public room patients. By in-hospital days, the curve of function showed L. type : that is, the longer stay, the lower function. 3. State of treatment types by kinds of disease were ; a. Dependent nursing service showed comparatively high availability in surgical and neurologic disease and independent nursing service was most received by medical, obstetrical and urological patients, while instrumental and integrated services were most available for respiratory disease and obstetrical and neurologic diseases next. b. The invoice issue frequency per day for a patient was highest in obstetrical disease 3.8 times, and the unit cost(per one invoice sheet) was also highest in obstertrical disease(￦10,880) and next in neurologic cases(￦ 4,690 ). 4. As to the pertained departments. a. Cost amount per person was highest in department of Psychiatries daily cost was highest in obstetrical cases : while the invoice issue frequency was highest in obstetrics and next in pediatrics. b. In departments in need of surgical operation, dependent nursing care was highly availabl : while in internal medicine and obstetrics, independent service was higher. Psychiatrics showed the highest the of integrate nursing while pediatrics and obstetrics higher of instrumental services. The variation co-efficien of treatment cost came out to be relatively in high in special surgery, opthalmology and internal medicine. 5. State of treatment cost by types of nursing behavior was. a. The average frequency of invoice issue was 3.5 (times). Among the type four types of treatment, instrumetal service (4.3) and independent nursing behavior(3.9) showed higher frequency than average respectively. But as to unit cost (per invoice). dependent (￦5,200) and integrated (￦5,340) nursing care services were higher than average and considerably higher than the other two types. b. In repect patient distribution. independent nursing behavior(80.3% ) was the highest and depend ent nursing (31.7% ) the lowest. The variation co-efficient of treatment cost appeared highest in dependent nursing be havior as a whole, and among that, doctor's diagnosis showed the highest coefficient value (100.7). In conclusion, the variaty of treatment cost(treatment itself ) by various characteristics and treatment types pro- that treatment various sort of patients and treatment cost of various types of nursing behavior cannot be uniform. Therefore, to attain the equalization of health care service and its cost both for insurant and non-insurant patients, a more specific provision for assessment of cost should be added to the present medical care insurance system and, in addition, the cost of nursing treatment is desired to be inserted into the treatment invoice.

• The Korean Journal of Applied Statistics
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• v.29 no.7
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• pp.1459-1473
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• 2016

Both longitudinal data and survival data are collected simultaneously in longitudinal data which are observed throughout the passage of time. In this case, the effect of the independent variable becomes biased (provided that sole use of longitudinal data analysis does not consider the relation between both data used) if the missing that occurred in the longitudinal data is non-ignorable because it is caused by a correlation with the survival data. A joint model of longitudinal data and survival data was studied as a solution for such problem in order to obtain an unbiased result by considering the survival model for the cause of missing. In this paper, a joint model of the longitudinal zero-inflated count data and survival data is studied by replacing the longitudinal part with zero-inflated count data. A hurdle model and proportional hazards model were used for each longitudinal zero inflated count data and survival data; in addition, both sub-models were linked based on the assumption that the random effect of sub-models follow the multivariate normal distribution. We used the EM algorithm for the maximum likelihood estimator of parameters and estimated standard errors of parameters were calculated using the profile likelihood method. In simulation, we observed a better performance of the joint model in bias and coverage probability compared to the separate model.

• Journal of the Computational Structural Engineering Institute of Korea
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• v.27 no.5
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• pp.345-352
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• 2014

In this paper, the CAD data for the optimal shape design obtained by isogeometric shape optimization is directly used to fabricate the specimen by using 3D printer for the experimental validation. In a conventional finite element method, the geometric approximation inherent in the mesh leads to the accuracy issue in response analysis and design sensitivity analysis. Furthermore, in the finite element based shape optimization, subsequent communication with CAD description is required in the design optimization process, which results in the loss of optimal design information during the communication. Isogeometric analysis method employs the same NURBS basis functions and control points used in CAD systems, which enables to use exact geometrical properties like normal vector and curvature information in the response analysis and design sensitivity analysis procedure. Also, it vastly simplify the design modification of complex geometries without communicating with the CAD description of geometry during design optimization process. Therefore, the information of optimal design and material volume is exactly reflected to fabricate the specimen for experimental validation. Through the design optimization examples of elasticity problem, it is experimentally shown that the optimal design has higher stiffness than the initial design. Also, the experimental results match very well with the numerical results. Using a non-contact optical 3D deformation measuring system for strain distribution, it is shown that the stress concentration is significantly alleviated in the optimal design compared with the initial design.

• Journal of Korean Tunnelling and Underground Space Association
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• v.10 no.1
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• pp.69-79
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• 2008

Prediction of ground condition ahead of tunnel face might be the most important factor to prevent collapse during tunnel excavation. In this study, a non-destructive method to evaluate the phase velocity in model rock mass using wavelet transform of surface wave was proposed aiming at ground condition assessment ahead of tunnel face. Model tests using gypsum as a rocklike material composed of two layers were performed. A Piezoelectric actuator with frequencies ranging from 150 Hz to 5 kHz was selected as a harmonic source. The acceleration history was measured with two accelerometers. Wavelet transform analysis was used to obtain the dispersion curves from the measured data. The experimental results showed that the near-field effects can be neglected if the distance between two receivers is chosen to be three times the wavelength. A simple inversion method using weighted factor based on the normal distribution was proposed. The inversion results showed that the predicted phase velocity agreed reasonably well with the measured one when the wavelength influence factor was 0.2. The depth of propagation of surface wave was from 0.42 to 0.63 times the wavelength. The range of wavelength varying with phase velocity in dispersion curve matched well with that estimated by inversion technique.

• Korean Journal of Clinical Pharmacy
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• v.27 no.2
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• pp.92-98
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• 2017

Background: Nebulized colistimethate is increasingly used, because there are problems such as renal dysfunction and low distribution within the lungs when colistimethate is administered intravenously. This study was designed to compare and analyze the changes in renal function by of nebulized colistimethate treatment for its safe administration. Methods: This study retrospectively reviewed the electronic medical records of adult patients above 19 years old, receiving only the nebulized colistimethate at least 4 days in Yonsei university health system from Nov 2014 to Aug 2015. Acute kidney injury (AKI) was determined by using the RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease) according to serum creatinine (SCr) levels before and after use of nebulized colistimethate. Results: 48 patients were included our study and their SCr increased significantly after nebulized colistimethate treatment ($SCr_0$ vs. $SCr_1$; $0.85{\pm}0.80$ vs. $1.00{\pm}0.82mg/dL$, n=48, p<0.001), but the changes were in normal range according to the standards at Yonsei university health $system^a$. Among 48 patients, 38 patients were in the non-AKI group (79.2%), and 10 patients developed AKI (20.8%). Within the AKI group, 2 patients were in the Injury group (20%) and the other 8 in the Risk group (80%). Conclusion: There was no significant difference in age, dosage and duration of treatment between AKI group and non-AKI group (p>0.05). The study has a significance in that it reviewed the safety of nebulized colistimethate only treatment to national patients, analyzing its nephrotoxicity. It has confirmed that nebulized colistimethate is a safer method than intravenous injection, and requires to establish a guideline for the use of nebulized colistimethate in further studies with broader patient groups. $^a$ : SCr Male 0.68-1.19 mg/dL, Female 0.49-0.91 mg/dL.

• Journal of the Korean Geotechnical Society
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• v.31 no.6
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• pp.59-69
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• 2015

Recently, landslide and debris-flow disasters caused by severe rain storms have frequently occurred. Many researches related to landslide susceptibility analysis and debris-flow hazard analysis have been conducted, but there are not many researches related to mobilization analysis for landslides transforming into debris-flow in slope areas. In this study, statistical analyses such as discriminant analysis and logistic regression analysis were conducted to develop a mobilization criterion using geomorphological and geological factors. Ten parameters of geomorphological and geological factors were used as independent variables, and 466 cases (228 non-mobilization cases and 238 mobilization cases) were investigated for the statistical analyses. First of all, Fisher's discriminant function was used for the mobilization criterion. It showed 91.6 percent in the accuracy of actual mobilization cases, but homogeneity condition of variance and covariance between non-mobilization and mobilization groups was not satisfied, and independent variables did not follow normal distribution, either. Second, binomial logistic analysis was conducted for the mobilization criterion. The result showed 92.3 percent in the accuracy of actual mobilization cases, and all assumptions for the logistic analysis were satisfied. Therefore, it can be concluded that the mobilization criterion for debris-flow using binomial logistic regression analysis can be effectively applied for the prediction of debris-flow hazard analysis.

• Journal of Periodontal and Implant Science
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• v.28 no.4
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• pp.645-660
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• 1998

The purpose of this study was to make and ascertain a decision making process on the base of patient-oriented utilitarianism in the treatment of patients of chronic adult periodontitis. Fifty subjects were chosen in Yonsei Dental hospital and the other fifty were chosen in Severance dental hospital according to the selection criteria. Fifty four patients agreed in this study. NS group(N=32) was treated with scaling and root planing without any surgical intervention, the other S group(N=22) done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. A questionnaire composed of 6 kinds(hygienic easiness, hypersensitivity, post treatment comfort, complication, functional comfort, compliance) of questions was delivered to each patient to obtain the subjective evaluation regarding the results of therapy. The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient's ubjective evaluation. The optimal path was calculated by using the success rate of the results as the probability and utility according to relative value and the economic value in the insurance system. The success rate to achieve the diagnostic goal of periodontal treatment as the remaining pocket depth less than 3mm and without BOP was $0.83{\pm}0.12$ by non surgical treatment and $0.82{\pm}0.14$ by surgical treatment without any statistically significant difference. The moderate success rate of more than 4mm probing pocket depth were 0.17 together. The utilities of non-surgical treatment results were 100 for a result with less than 3mm probing pocket depth, 80 for the other results with more than 4mm probing pocket depth, 0 for the extraction. Those of surgical treatment results were the same except 75 for the results with more than 4mm. The pooling results of subjective evaluation by using a questionnaire were 60% for satisfaction level and 40% for no satisfaction level in the patient group receiving nonsurgical treatment and 33% and 67% in the other group receiving surgical treatment. The utilities for 4 satisfaction levels were 100, 75, 60, 50 on the base of that the patient would express the satisfaction level with normal distribution. The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the success rate, the distributed ratio of patient's satisfaction level. Both results of the calculation was non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal path for this decision tree of treatment protocol if the goal of the periodontal treatment is to achieve the remaining probing pocket depth of less than 3mm for adult chronic periodontitis and if the utilitarian philosophy to maximise the expected utility for the patients is advocated.

• Journal of Life Science
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• v.28 no.3
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• pp.314-319
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• 2018

We analyzed QTLs for alkali-related digestion by using 120 population crossed Cheongcheong and Nagdong derived from anther culture (CNDH). The DNA markers located in the QTLs gene were selected and applied to existing cultivars. As a result of the investigation of the alkali decay degree, brown rice of Cheongcheong and Nagdong was 1.9 and 1.6, respectively, and the CNDH was $3.79{\pm}2.01$, and the distribution of variance was distributed to 7.0-1.0. The milled rice of Cheongcheong and Nagdong was 5.6 and 4.1, respectively. The mean of the CNDH was $4.86{\pm}1.55$, and the distribution of variance was distributed to 7.0-2.0. Variation distribution curves showed continuous variation that was close to non-normal distribution. In the QTLs analysis, qBRA2, qBRA6, and qBRA11 were mapped in 1-2 replications of brown rice. QHRA2-1, qHRA2-2, qHRA2-3, qHRA3, and qHRA8 were mapped in the first replication. QHRA2-1, qHRA2-2, qHRA2-3 and qHRA3 were mapped in the second replicates. And mapped to qHRA5 in 4 replicates. These were found on chromosome 2, 3, 6, 8 and 11, respectively. The phenotypic variations of qBRA2, qBRA6, and qBRA11 on the chromosomes of brown and milled rice were 1-9%. The polymorphism was analyzed for 12 types of the japonica type and six types of the indica type, based on the nine markers found in the QTLs analysis of alkali digestion. Chromosome 11, RM27258, was selected to determine the segregation ratio, which shows the difference in size by the band pattern. The results of this study will be used as basic data for the development of high-quality rice cultivars.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.2
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• pp.105-112
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• 2006

Purpose: To demonstrate that water bolus in the patient surface can decrease the dose inhomogeneity by patient surface large tissue defect when the surface is in an electron-beam field. And We tried to find a easy way to water control. Methods and Materials: To demonstrate the use of water bolus in the irregular surface clinically, the case of a patient with myxofibrosarcoma of the chest wall who was treated with electrons. We obtained dose distribution using missing tissue option of PINACLE 6.2b (ADAC, USA). We fabricate a Mev-green for water bolus in patient with defect of tissue. Then put the water bolus which is vinyl packed water into the designed Mev-green. We peformed CT scan with CT-simulator. Three-dimensional (3D) dose distributions with and without water bolus in the large irregular chest wall were calculated for a representative patient. Resulting dose distributions and dose-volume histograms of water bolus were compared with missing tissue option and non bolus plans. We fabricate a new water control device. Results: Controlled Water bolus markedly decrease the dose heterogeneity, and minimizes normal tissue exposure caused by the surface irregularities of the chest wall mass. In the test case, The non bolus plan has a maximum target dose of 132%. After applying water bolus, the maximum target dose has been reduced substantially to 110.4%. The maximum target dose was reduced by 21.6% using this technique. Conclusion: The results showed that controlled water bolus could significantly improve the dose homogeneity in the PTV for patients treated with electron therapy using water control device. This technique may reduce the incidence of normal organ complications that occur after electron-beam therapy in irregular surface. And our new device shows handiness of water control.

• Journal of Nutrition and Health
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• v.7 no.3
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• pp.1-13
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• 1974

The relative state of human iron storage may be ascertained more reliably through determination of the serum iron, iron binding capacity, transferrin saturation and absorption of radioactive iron in conjunction with studies of red cell morphology than from the study of red cell morphology alone. Recent investigations have shown that there is an increase in red cell protoporphyrin concentration in iron deficiency anemia. The significance of the red cell protoporphyrin has been discussed greatly during the years since its discovery. Two of the main factors which appear to influence the amaunt of protoporphyrin are increased erythropoiesis and factors interfering with the utilization of iron in the synthesis of hemoglobin, and iron deficiency. Recently Heller et al. have described a simplified method for blood protoporphyrin assay and this technique could be used assess nutritional iron status, wherein even minor insufficiencies are detectable as increased protoporphyrin concentrations. Based on the evaluation of the relationship between nutritional iron status and red cell protoporphyrin as an index suitable for the detection of the iron deficiency is described in this paper. RESULTS 1. Hemoglobin Concentrations and Anthropometric Measurements. The mean and standard deviations of the various anthropometric measurements of different age and sex groups are shown in table 1. There measurements have been compared with the Korean Standard. In the absence of local standards for arm circumference and skin-fold thickness over triceps, they have been compared with the standard from Jelliffe. Table 2,3, and 4 give anthropometric measurements and frequency (%) of anemia in children surveyed. The mean height of the children studid was 10 to 20 percent; below the Korean Standard. The distribution of height below 80 percent of the Standard was 21.2 percent, however, among anemic group this percentage was 27.7 percent. In general, the mean weight of the children was 10 to 15 percent below the Korean Standard. The percentage of children with weight less than 80 percent of the Standard was about 35 percent. But in the anemic group of the children, this percentage was 44 percent. The mean arm circumference was about 15 percent lower than the Jelliffe's standard. 61.2 percent of the children had values of arm circumference below 80 percent of the standard. Children with low hemoglobin levels, this percentage was 80 percent. The mean skinfold thickness over the triceps of the children studied was about 25 Percent lower than the Jelliffe's standard and 61.2 percent of the children had the value less than 80 percent of the standard. Among anemic children, this percentage was 70.8%. As may be seen from table 5, the mean hemoglobin concentration of the total group was 11.3g/100ml. Hemoglobin concentration was less than 11.0g/100ml. in 65(36.5%) of the 178 children. The degree of anemia in most of these children was mild with a hemoglobin level of less than 8.0g/100ml. found in only one child. In general, the prevalence of anemia was high in female children than male and decreased its frequency with increasing age. Relatively close relationship was observed between hemoglobin level and anthrophometric measurements especially high between arm circumference and skinfold thickness and hemoglobin but very low in height and low in weight and hemoglobin level, estimated by chi-square value. II. Serum iron, Transferrin saturation (1) Serum iron, and transferrin saturation Serum iron, transferrin saturation and red cell protoporphyrin concentrations were estimated in sub-sample of 84 children from 1 to 6 years and 24 older children between 7 and 13 years of age. The findings are presented in table 6. The mean serum iron concentration of the total group was 59ug/100ml. However, the level incrased with age from 36.6ug/100ml. (1-3years) to 80.8ug/100ml. (7-13 years). 60 percent of these children had a serum iron level less than 50ug/10ml. in the 1-3 years age group and 31.4 percent for 4-6 years group. These contrast with the finding of 12.5 percent anemic children in the 7-13 years age group. The mean transferrin saturation for the total group was 18.1 percent and frequency of anemia by transferrin saturation was observed same pattern as serum iron concentration. (2) Red cell protoporphyrin concentrations. (a) Red cell protoporphrin levels of children: Red cell protoporphyrin and other biochemical data are shown in table 4. The mean concentration in red cell of all children was fround 46.3ug/100ml. RBC. and differences with age groups were observed; in the age group 1-3 years, the mean concentration was $59.5{\pm}32.14$ ug/100ml. RBC; 4-6 years $44.1{\pm}22.57$ ug/100ml. RBC. and 7-13 years, $39.0{\pm}13.56$ ug/100ml. RBC. (b) Normal protoporphyrin values in adults: It was observed that in 10 normal adult males studied here the level of protoporphyrin in red cell ranged from 18 to 54 ug/100ml. RBC. and the mean concentration was $47.5{\sim}14.47$ ug/100ml. RBC. Other biochemical determination made on the same subjects are presented in table 8. (c) Red tell protoporphyrin concentration of occupational blood donors: The results of analyses for red cell protoporphyrin as well as serum iron, transferrin saturation and hemoglobin in the 76 blood donors are presented in table 7 and 8. In this experiment, donors were selected at random, however, most of them bled repeatedly because of poor economic situation, I doubt. Table 9 shows the distribution of red cell protoporphyrin concentration and hemoglobin concentration of occupational donors. The mean hemoglobin value for the total was 11.9 g/100 ml. When iron deficiency anemia is defined as a transferrin saturation below 15%, prevalence of anemia was 47.4 percent and the mean serum iron was 27.1ug/100ml. and red cell protoporphyrin, 168.3ug/100ml. RBC. However, mean serum iron and protoporphyrin concentration of above 15% transferrin saturation were 11.6 ug/100 ml. and 58.8 ug/100 ml. RBC. respectively. The mean Protoporphyrin concentration of non-anemic (above 15% transferrin saturation) donors was slightly higher than the results of normal adult males.