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Impact of a 'Proactive Self-Audit Program of Fraudulent Claims' on Healthcare Providers' Claims Patterns: Intravenous Injections (KK020) (부당청구 예방형 자율점검제가 의료기관의 청구행태에 미치는 영향: 정맥 내 일시주사(KK020)를 중심으로)

  • Hee-Hwa Lee;Young-Joo Won;Kwang-Soo Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.163-177
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    • 2024
  • Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

Kinetic and Statistical Analysis of Adsorption and Photocatalysis on Sulfamethoxazole Degradation by UV/$TiO_2$/HAP System (UV/$TiO_2$/HAP 시스템에서 Sulfamethoxazole의 흡착과 광촉매반응에 대한 동역학적 및 통계적 해석)

  • Chun, Suk-Young;Chang, Soon-Woong
    • Journal of the Korean GEO-environmental Society
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    • v.13 no.5
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    • pp.5-12
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    • 2012
  • Antibiotics have been considered emerging compounds due to their continuous input and persistence in environment. Due to the limited biodegradability and widespread use of these antibiotics, an incomplete removal is attained in conventional wastewater treatment plants and relative large quantities are released into the environment. In this study, it was determined the adsorption and photocatalysis kinetics of antibiotics (Sulfamethoxazole, SMX) with various catalyst (Titanium dioxide; $TiO_2$, Hydroxyapatite; HAP) conditions under UV/$TiO_2$/HAP system. In addition, the statistical analysis of response surface methods (RSM) was used to determine the effects of operating parameters on UV/$TiO_2$/HAP system. $TiO_2$/HAP adsorbent were found to follow the pseudo second order reaction in the adsorption. In the result of applied intrapaticle diffusion model, the constants of reaction rate were $TiO_2$=$0.064min^{-1}$, HAP=$0.2866min^{-1}$ and $TiO_2$/HAP=$0.3708min^{-1}$, respectively.The result of RSM, term of regression analysis in analysis of variance (ANOVA) showed significantly p-value (p<0.05) and high coefficients for determination values($R^2$=96.2%, $R^2_{Adj}$=89.3%) that allowed satisfactory prediction of second order regression model. And the estimated optimal conditions for Y(Sulfamethoxazole removal efficiency, %) were $x_1$(initial concentration of Sulfamethoxazole)=-0.7828, $x_2$(amount of catalyst)=0.9974 and $x_3$(reation time)=0.5738 by coded parameters, respectively. According to the result of intraparticle diffusion model and photocatalysis experiments, it was shown that the $TiO_2$/HAP was more effective system than conventional AOPs(advanced oxidation processes, UV/$TiO_2$ system).

Mammary Performance of First Lactation Bali Cows (Bibos banteng) Fed Grass-Legume Based Diets in Relation to the Role of Glucose

  • Sukarini, I.A.M.;Sastradipradja, Djokowoerjo;Nusada, N.;Mahardika, I.G.;Kiranadi, B.
    • Asian-Australasian Journal of Animal Sciences
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    • v.14 no.5
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    • pp.615-623
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    • 2001
  • A study of mammary function in relation to glucose metabolism of first lactation Bali cows on grass-legume diets was carried out using 12 primiparous cows (initial BW $263.79{\pm}21.66kg$) for 16 weeks starting immediately post calving. The animals were randomly allocated into 4 dietary treatment groups R1, R2, R3 and R4, receiving from the last 2 months of pregnancy onwards, rations based on a mixture of locally available grass and legume feed ad libitum. On a DM basis R1 contained 70% elephant grass (PP, Penicetum purpureum) plus 30% Gliricidia sepia leaves (GS), R2 was 30% PP plus 25% GS supplemented with 55% Hibiscus tilliacius leaves (HT, defaunating effect), R3 and R4 were 22.5% PP+41.25% GS+11.25% HT+25% concentrate, with R4 supplemented with zinc-diacetate. TDN, CP and zinc contents of the diets were 58.2%, 12.05% and 18.3 mg/kg respectively for R1, 65.05%, 16.9% and 25.6 mg/kg respectively for R2, 66.03%, 16.71% and 29.02 mg/kg respectively for R3 and 66.03%, 16.71% and 60.47 mg/kg respectively for R4. Milk production and body weights were monitored, an energy and protein balance trial conducted, overall glucose kinetics parameters assessed, mammary blood flow (MBF) and metabolite arteriovenous differences (${\Delta}AVs$) measured to get uptake data and mammary performance relationships. Parameters of glucose kinetics at peak lactation or during dry condition were not affected by ration quality. Glucose pool size, space of distribution and flux increased by 61.77, 62.26 and 82.08%, respectively, during lactation compared to the dry period. Mean glucose flux of lactating Bali cows was $5.52mg/min.kgBW^{0.807}$ which resembles the range of values of temperate dairy cows. Calculation showed that glucose requirements for maintenance, milk lactose and fat-glycerol synthesis, and the formation of NADPH reached 461.69 g for a yield of 1 kg/d or equal to 320.62 mg/min, which was less than the average glucose flux of lactating Bali cows of 481.35 mg/min. Mammary blood flow (MBF) values ranged from 56 to 83 l/h for the different treatments and the ratio MBF per kg milk produced improved from av. 1540 l/kg for R1 to av. 967 l/kg for R4 treated cows. Mammary glucose uptake ranged from 6.27 to 12.03 g/h or 120 to 140 g/kg milk. Glucose uptake was mass-wise 2 to 4 times the amount secreted as lactose, which indicated values less than the calculated mammary glucose needs and that little lactose was synthesized. The excess glucose taken-up was used for other metabolic processes. Linear relationships between metabolite ${\Delta}AVs$ and arterial blood plasma concentration [A] showed that in Bali cows triglycerides (TG), phenylalanine (Phe) and tyrosine (Tyr) have high coefficients of determination, i.e. 0.77, 0.81 and 0.69, respectively. For glucose, the relationship is quadratic with an $R^2$ value of 0.49. It was concluded that lactose synthesis was inadequate, which led to a speculation that milk yield could be improved by increased lactose synthesis.

Study on Quality Characteristics of Korean Traditional Kukhwaju by Addition of Dried Chrysanthemum indicum L. Extract into Mash (건조된 감국 열수추출물의 첨가 방법에 따른 국화주의 특성 연구)

  • Bang, Byung-Ho;Paik, Jean Kyung;Choi, Jea Young;Jeong, Eun-Ja;Rhee, Moon-Soo;Yi, Dong-Heui
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.44 no.9
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    • pp.1333-1338
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    • 2015
  • This study investigated the effects of addition of Chrysanthemum indicum L. extracts on quality characteristics of Kukhwju during fermentation. Fermented liquors without C. indicum L. were used as the control group. For experimental groups, we added 1, 2, 5, and 10% C. indicum L. extracts and brewed according to the addition method written in Yorok. The pH level during fermentation phase, alcohol concentration, level of reducing sugars, and acidity were measured in each of the experimental groups. After fermentation, we measured total contents of phenols, antioxidant effects, free sugars, organic acids, and chromaticity. During fermentation, no significant difference was observed between the C. indicum L. group and control group. Regarding total phenol contents and antioxidant effects, only the 5% and 10% C. indicum L. groups showed higher contents of phenols than the non-addition group. In general, 5% and 10% C. indicum L. addition groups were positively evaluated. In conclusion, Kukhwaju with 10% C. indicum L. extract showed the best antioxidant effects. In the present study, we obtained different characteristics and determined the optimum addition amount of C. indicum L.

SURFACE ROUGHNESS OF EXPERIMENTAL COMPOSITE RESINS USING CONFOCAL LASER SCANNING MICROSCOPE (공초점 레이저 주사 현미경을 이용한 실험적 레진의 표면 조도에 대한 연구)

  • Bae, J.H.;Lee, M.A.;Cho, B.H.
    • Restorative Dentistry and Endodontics
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    • v.33 no.1
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    • pp.1-8
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    • 2008
  • The purpose of this study was to evaluate the effect of a new resin monomer, filler size and polishing technique on the surface roughness of composite resin restorations using confocal laser scanning microscopy. By adding new methoxylated Bis-GMA (Bis-M-GMA, 2,2-bis[4-(2-methoxy-3-methacryloyloxy propoxy) phenyl] propane) having low viscosity, the content of TEGDMA might be decreased. Three experimental composite resins were made: EX1 (Bis-M-GMA/TEGDMA = 95/5 wt%, 40 nm nanofillers); EX2 (Bis-M-GMA/TEGDMA = 95/5 wt%, 20 nm nanofillers); EX3 (Bis-GMA/TEGDMA = 70/30 wt%, 40 nm nanofillers). Filtek Z250 was used as a reference. Nine specimens (6 mm in diameter and 2 mm in thickness) for each experimental composite resin and Filtek Z250 were fabricated in a teflon mold and assigned to three groups. In Mylar strip group, specimens were left undisturbed. In Sof-lex group, specimens were ground with #1000 SiC paper and polished with Sof-lex discs. In DiaPolisher group, specimens were ground with #1000 SiC paper and polished with DiaPolisher polishing points. The Ra (Average roughness), Rq (Root mean square roughness), Rv (Valley roughness), Rp (Peak roughness), Rc (2D roughness) and Sc (3D roughness) values were determined using confocal laser scanning microscopy. The data were statistically analyzed by Two-way ANOVA and Tukey multiple comparisons test (p = 0.05). The type of composite resin and polishing technique significantly affected the surface roughness of the composite resin restorations (p < 0.001). EX3 showed the smoothest surface compared to the other composite resins (p < 0.05). Mylar strip resulted in smoother surface than other polishing techniques (p < 0.05). Bis-M-GMA. a new resin monomer having low viscosity, might reduce the amount of diluent, but showed adverse effect on the surface roughness of composite resin restorations.

Study on an Effective Decellularization Technique for Cardiac Valve, Arterial Wall and Pericardium Xenographs: Optimization of Decellularization (이종 심장 판막 및 대혈관 이식편과 심낭에서 효과적인 탈세포화 방법에 관한 연구: 탈세포화의 최적화)

  • Park, Chun-Soo;Kim, Yong-Jin;Sung, Si-Chan;Park, Ji-Eun;Choi, Sun-Young;Kim, Woong-Han;Kim, Kyung-Hwan
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.550-562
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    • 2008
  • Background: We attempted to reproduce a previously reported method that is known to be effective for decellularization, and we sought to find the optimal condition for decellularization by introducing some modifications to this method. Material and Method: Porcine semilunar valves, arterial walls and pericardium were processed for decellularization with using a variety of combinations and concentrations of decellularizing agents under different conditions of temperature, osmolarity and incubation time. The degree of decellularization and the preservation of the extracellular matrix were evaluated by staining with hematoxylin and eosin and with alpha-Gal and DAPI in some of the decellularized tissues. Result: Decellularization was achieved in the specimens that were treated with sodium deoxycholate, sodium dodesyl sulfate, Triton X-100 and sodium dodesyl sulfate with Triton X-100 as single-step methods, and this was also achieved in the specimens that were treated with hypotonic solution ${\rightarrow}$ Triton X-100 ${\rightarrow}$ sodium dodesyl sulfate, sodium deoxycholate ${\rightarrow}$ hypotonic solution ${\rightarrow}$ sodium dodesyl sulfate, and hypotonic solution sodium dodesyl sulfate as multi-step methods. Conclusion: Considering the number and the amount of the chemicals that were used, the incubation time and the degree of damage to the extracellular matrix, a single-step method with sodium dodesyl sulfate and Triton X-100 and a multi-step method with hypotonic solution followed by sodium dodesyl sulfate were both relatively optimal methods for decellularization in this study.

A Study Related to Adolescent Students' School Uniform Behavior and Attitude toward Appearance (청소년의 교복행동과 외모에 대한 태도와의 관련 연구)

  • Han, Mi-Hwa;Lee, Eun-Hee
    • Journal of Korean Home Economics Education Association
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    • v.21 no.2
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    • pp.23-43
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    • 2009
  • This study examined the relativity between school uniform behavior(especially attitude toward school uniform, school uniform satisfaction, school uniform alteration) and attitude toward appearance in the adolescence. From November to December in 2007, 898 middle school and high school students from four schools in Jeollabuk-do Province were analyzed and the influence of relevant variables was understood to gather basic information about the fashion life in the adolescence. This study used SPSS 11.5 for Windows Program to conduct frequency analysis, factor analysis, reliability analysis, ${\chi}^2$-test, t-test, One-way ANOVA, Duncan's multiple comparison test, and Pearson's correlation. The following summarizes the findings of this study: The results of analysing the factors to the response attitude toward uniforms and attitude toward appearance and clothing attitude emerged four dimensions(fashion, symbolism, cleanliness, alternation), three dimensions(needs value conformity toward appearance). In attitude toward uniform, female students were more actively altering their uniforms than male students and middle school students were more sensitive to trends than high school students. However, high school students were more aware of the cleanliness and alteration of uniforms. Overall, most students were not very satisfied with their uniforms (design, color, texture). When students' attitude toward appearance and demographical characteristics were examined, it was found that female students were more aware of desire, value, and conformity in appearances than male students. By age, it was found that high school students were more aware than middle school students. Also, students receiving KRW 30,000 or more for monthly allowance were more aware than others who receive a lower amount between KRW 10,000 and KRW 20,000. Therefore, most students(62.1%) have experiences in altering uniforms. Especially, more female students and more high school students had such experiences. Uniform alteration is more related to attitude to appearance. In other words, students who choose to alter their uniforms are highly aware of desire, value, and conformity toward appearance. Students who are satisfied with all factors regarding attitude toward uniform, except for alteration, did not alter their uniforms that much. In addition, when the relativity between students' attitude toward appearance with uniform was considered, students that are not very satisfied with their uniforms were more aware of desire, value, and conformity toward appearance. In conclusion, it was found that students' attitude toward appearance and school uniform behavior are closely related and their interests in appearance lead to alteration of uniforms, the clothing in which they spend most time of the day. From now on, students' opinions shall be considered when selecting or designing school uniforms.

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Immunomodulatory Effects of β-1,3/1,6-glucan and Lactobacillus plantarum LM1004 on Atopic Dermatitis Models (아토피 피부염 모델에 대한 β-1,3/1,6-glucan과 Lactobacillus plantarum LM1004의 면역 조절 효과)

  • Kim, In Sung;Kim, Sung Hak;Kim, Jeong A;Yu, Da Yoon;Kim, Gwang Il;Park, Dong-Chan;Lim, Jong Min;Lee, Sang Suk;Choi, In Soon;Cho, Kwang Keun
    • Journal of Life Science
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    • v.28 no.1
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    • pp.17-25
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    • 2018
  • In this study, we examined the efficacy of the immune regulation of ${\beta}$-1,3/1,6-glucan and Lactobacillus plantarum LM1004 on atopic dermatitis models. The oral administration of ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004 on mice significantly decreased the amount of scratching, leakage to evans blue, and concentrations of serum immunoglobulin E (IgE) and histamine compared with the atopic dermatitis - induced group. When atopic dermatitis was induced, the transcription factors (GATA-3, retinoic acid-related orphan receptor ${\gamma}$ T [$ROR{\gamma}T$]) and cytokines (interleukin-4 [IL-4], IL-17) of Th2 and Th17 cells were overexpressed at the transcriptional level, and they significantly decreased with oral administration of ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004. In addition, ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004 were shown to modulate the immune balance by increasing the expression of Th1 and Treg transcription (T-bet, forkhead box p3 [Foxp3]) and cytokines (interferon-${\gamma}$ [IFN-${\gamma}$], transforming growth factor-${\beta}$ [TGF-${\beta}$]). Galectin-9 and filaggrin were significantly lower in the atopic dermatitis - induced group and significantly higher in the ${\beta}$-1,3/1,6-glucan-treated group. In contrast, thymic stromal lymphopoietin (TSLP) was highest in the atopic dermatitis-induced group, while mice that were orally administered ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004 showed similar TSLP levels to the control group. These results indicate that ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004 have immunomodulatory effects and atopic dermatitis improvement effects in an animal model of atopic dermatitis. Therefore, it is expected that ${\beta}$-1,3/1,6-glucan and L. plantarum LM1004 can be used as natural materials in the treatment of atopic dermatitis.

The Effect of Calcium Supplementation on Soy Sauce Seasoning and Cooking Meat (액상칼슘을 첨가한 육류조리용 간장양념 및 그 제조방법)

  • Lee, Syng-Ook;Yu, Mi-Hee;Choi, Jun-Hyeok;Im, Hyo-Gwon;Lee, In-Seon
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.42 no.6
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    • pp.969-974
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    • 2013
  • In this study, liquid calcium was used to develop a calcium-fortified soy sauce-based seasoning for meat and the quality characteristics of the seasoning and cooked meat were investigated. All seasonings with different amount of liquid calcium (0, 2, 4, or 8%) showed no significant changes in pH and titratable acidity at $4^{\circ}C$ for 9 days; however, the control seasoning and seasoning with 2% liquid calcium (Ca-2%) showed significant decreases in pH and increases in titratable acidity during storage at $20^{\circ}C$ for 9 days, compared to the seasoning with 4% (Ca-4%) and 8% (Ca-8%) liquid calcium. We also observed that during storage at $20^{\circ}C$, the numbers of total aerobic bacteria, lactic acid bacteria, and yeast were significantly lower in Ca-4% and Ca-8% seasoning compared to the control or Ca-2%. The calcium contents in cooked meat seasoned with the control, Ca-2%, Ca-4%, or Ca-8% were 2.16, 33.47, 54.72, and 58.23 mg/100 g, respectively. Sensory evaluations demonstrated no significant differences in flavor, taste, juiciness, texture, and overall acceptability between the cooked meat samples. These results suggest that soy sauce seasoning supplemented with liquid calcium (2~8%) effectively increases the calcium content in cooked meat without adversely affecting its taste, flavor, and juiciness. Thus, this type of calcium-fortified seasoning may be helpful in combating the lack of calcium in modern diets.

Adaptation Strategy in Dry Matter and Seed Production of Rice and Weed Species (벼와 잡초(雜草)의 건물생산(乾物生産) 및 종자생산(鐘子生産) 특성(特性)에 따른 환경적응(環境適應) 전략(戰略))

  • Kim, Soon-Chul;Moody, Keith
    • Korean Journal of Weed Science
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    • v.9 no.3
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    • pp.183-200
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    • 1989
  • An experiment was conducted at the greenhouse of the International Rice Research Institute in 1987 to find out the character of dry matter production, the potential seed production ability and the ecological and physiological strategies to adaptation. For these, two rice cultivars, IR64(lowland rice) and UPLRi-5(upland rice), and seven weed species were used ; Echinochloa glabrescens Munro ex Hook. f., E. cress-galls ssp. hispidula (Retz.) Honda, E. colons (L.) Link, Monochoria vaginalis (Burin. f.), Ludwigia octovalvis Jacq.) Raven, Fimbristylis miliacea Vahl and Cyperus difformis L. Adaptation strategies of weed species varied by species. However, they had efficient seed production strategy through different ways. In general, sedge weed species (F. miliacea and C. difformis) produced great amount of seeds at the expense of seed size through greater ratooning ability and low relative dry weight for flowering. For broadleaved weed species, greater number of descendants were obtained through high plasticity and low relative dry weight for flowering (M. vaginalis) or greater growth ability through effective photosynthetic efficiency (L. octovalvis). Grass weed species, on the other hand, produced their seeds through effective growth (net assimilation rate and relative growth rate), high ratooning ability (except E. crus-galls ssp. hispidula) or low relative dry weight to maximum dry weight for flowering (E. glabrescens). The harvest indices of the weed species were considerably lower than those of rice. Fimbristylis miliacea had the greatest ratooning ability followed by C. difformis, E. colons and E. glabrescens. The greatest seed productivity was recorded by C. difformis (279, 000) and L. octovalvis (268,000) while rice produced the least number of seeds (1300-6100). Log seed weight had a negative linear relationship with log seed number (y=6.30-1.48X, $R=-0.965^{**}$). For all species plant plasticity response was not directly correlated with mortality response.

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