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The Fiduciary Duties of Doctor in Clinical Trials (임상시험에서 의사의 선량한 관리자의 주의의무)

  • Lee, Jiyoun
    • The Korean Society of Law and Medicine
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    • v.21 no.2
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    • pp.163-207
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    • 2020
  • Korea has been positioned as the leading country in the industry of clinical trials as the clinical trail of Korea has developed for the recent 10 years. Clinical trial has plays a significant role in the development of medicine and the increase of curability. However, it has inevitable risk as the purpose of the clinical trial is to prove the safety and effectiveness of new drugs. Therefore, the clinical trial should be controlled properly to protect the health of the subjects of clinical trial and to ensure that they exercise a right of self-determination. In this context, the fiduciary duties of doctors who conduct clinical trials is especially important. The Pharmaceutical Affairs Act and the relevant regulations define several duties of doctors who conduct clinical trials. In particular, the duty to protection of subjects and the duty to provide information constitute the main fiduciary duties to the subjects. Those are essentially similar to the fiduciary duties of doctors in usual treatment from the perspective of the values promoted by the law and the content of the law. Nonetheless, clinical trials put more emphasis on the duties to provide explanation than in usual treatment. Further research and study are required to establish the concrete standard for the duty of care. However, if the blind pursuit of higher standards for the duty of care or to pass the burden of proof to doctors may result in disrupting the development of clinical trials, limiting the accessibility of patients to new treatment and even violating the principle of sharing damage equally and properly. In addition to these duties, the laws of clinical trials define several duties of doctors. Any decision on whether the violation of the law constitutes the violation of the fiduciary duty and justifies the demand for compensation of damages should be based on whether relevant law aims to protect the safety and benefit of subjects, even if in an incidental way, the degree to which such violation breaches the values promoted by the law and the concrete of violation of benefit of law, the detailed acts of such violation. The legal interests of the subjects can be protected effectively by guaranteeing compliance with those duties and establishing judicial and administrative controls to ensure that the benefit of subjects are protected properly in individual cases.

Ideological Impacts and Change in the Recognition of Korean Cultural Heritage during the 20th Century (20세기 한국 문화재 인식의 이데올로기적 영향과 변화)

  • Oh, Chunyoung
    • Korean Journal of Heritage: History & Science
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    • v.53 no.4
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    • pp.60-77
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    • 2020
  • An assumption can be made that, as a start point for the recognition and utilization of cultural heritage, the "choice" of such would reflect the cultural ideology of the ruling power at that time. This has finally been proved by the case of Korea in the 20th century. First, in the late Korean Empire (1901-1910), the prevailing cultural ideology had been inherited from the Joseon Dynasty. The main objects that the Joseon Dynasty tried to protect were royal tombs and archives. During this time, an investigation by the Japanese into Korean historic sites began in earnest. Stung by this, enlightened intellectuals attempted to recognize them as constituting independent cultural heritage, but these attempts failed to be institutionalized. During the 1910-1945 Japanese occupation, the Japanese led investigations to institutionalize Korean cultural heritage, which formed the beginning of the current cultural heritage management system. At that time, the historical investigation, designation, protection, and enhancement activities led by the Japanese Government-General of Korea not only rationalized their colonial occupation of Korea but also illustrated their colonial perspective. Korean nationalists processed the campaign for the love of historical remains on an enlightening level, but they had their limits in that the campaign had been based on the outcome of research planned by the Japanese. During the 1945-2000 period following liberation from Japan, cultural heritage restoration projects took places that were based on nationalist ideology. People intended to consolidate the regime's legitimacy through these projects, and the enactment of the 'Cultural Heritage Charter' in 1997 represented an ideology in itself that stretched beyond a means of promoting nationalist ideology. During the past 20 centuries, cultural heritage content changed depending on the whims of those with political power. Such choices reflected the cultural ideology that the powers at any given time held with regard to cultural heritage. In the background of this cultural heritage choice mechanism, there have been working trade-off relationships formed between terminology and society, as well as the ideological characteristics of collective memories. The ruling party has tried to implant their ideology on their subjects, and we could consider that it wanted to achieve this by being involved in collective memories related to traditional culture, so called-choice, and utilization of cultural heritage.

Informed Consent and Refusal of Treatment in Emergency Medical Situation (응급의료에서의 설명·동의 원칙과 응급의료거부죄)

  • Lee, Jung-eun
    • The Korean Society of Law and Medicine
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    • v.23 no.1
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    • pp.37-80
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    • 2022
  • By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

Studies on the Pulping Characteristics of Larchwood (Larix leptolepis Gordon) by Alkaline Process with Additives (첨가제(添加劑) 알칼리 법(法)에 의한 일본 잎갈 나무의 펄프화(化) 특성(特性)에 관(關)한 연구(硏究))

  • Lim, Kie-Pyo;Shin, Dong-Sho
    • Journal of the Korean Wood Science and Technology
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    • v.7 no.2
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    • pp.3-30
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    • 1979
  • Larch ($\underline{Larix}$ $\underline{leptolepis}$ GORDON), one of the major afforestation species in Korea in view of its growing stock and rate of growth, is not favored as a raw material for pulp due to its low yield of pulp and difficulties with bleaching arising from the high content of extractives in wood, and the high heartwood ratio and the active phenolics, respectively. The purpose of this study is to investigate the characteristics of firstly pulping with various additives of cellulose protector for the yield of pulp, and secondly bleaching with oxygen for chlotination-alkali extraction of five stage-sequence to reduce chlorine compounds in bleaching effluents. The kraft cooking liquor for five age groups of larchwood was 18 percent active alkali with 25 percent sulfidity and 5 : 1 liquor-to-wood ratio, and each soda liquor for sap-and heart-wood of the 15-year-old larchwood was 18 percent alkali having one of the following cellulose protectors as the additive; magnesium sulfate ($MgSO_4$, 2.5%), zinc sulfate ($ZnSO_4$, 2.5%), aluminium sulfate ($Al_2(SO_4)_3$, 2.5%), potasium iodide (KI, 2.5%), hydroquinone (HQ, 2.5%), anthraquinone (AQ, 0.1%) and ethylene diamine (EDA, 2.5%). Then each anthraquinone-soda liquor for the determination of suitable cooking condition was the active alkali level of 15, 17 and 19 percent with 1.0, 0.5 and 0.1 percent anthraquinone, respectively. The cooking procedure for the pulps was scheduled to heat to 170$^{\circ}C$ in 90 minutes and to cook 90 minutes at the maximum temperature. The anthraquinone-soda pulps from both heartwood and sapwood of 15-year-old larchwood prepared with 0.5 percent anthraquinone and 18 percent active alkali were bleached in a four-stage sequency of OCED. (O: oxygen bleaching, D: chlorine dioxide bleaching and E: alkali extraction). In the first stage oxygen in atmospheric pressure was applied to a 30 percent consistency of pulp with 0.1 percent magnesium oxide (MgO) and 3, 6, and 9 percent sodium hydroxide on oven dry base, and the bleached results were compared pulps bleached under the conventional CEDED (C: chlorination). The results in the study were summarized as follows: 1. The screened yield of larch kraft pulp did not differ from particular ages to age group, but heartwood ratio, basic density, fiber length and water-extractives contents of wood and the tear factor of the pulp increased with increasing the tree age. The total yield of the pulp decreased. 2. The yield of soda pulp with various chemicals for cellulose protection of the 15-year-old larchwood increased slightly more than that of pure soda pulp and was slightly lower than that of kraft pulp. The influence of cellulose protectors was similar to the yield of pulps from both sapwood and heartwood. The effective protectors among seven additives were KI, $MgSO_4$ and AQ, for which the yields of screened pulp was as high as that of kraft pulp. Considering the additive level of protector, the AQ was the most effective in improving the yield and the quality of pulp. 3. When the amount of AQ increased in soda cooking, the yield and the quality of the pulp increased but rejects in total yield increased with decreasing the amount of active alkali from 19 to 15 percent. The best proportion of the AQ seemed to be 0.5 percent at 17 percent active alkali in anthraquinone-soda pulping. 4. On the bleaching of the AQ-soda pulp at 30 percent consistency with oxygen of atomospheric pressure in the first stage of the ODED sequence, the more caustic soda added, the brighter bleached pulp was obtained, but more lignin-selective bleaching reagent in proportion to the oxygen was necessary to maintain the increased yield with the addition of anthraquinone. 5. In conclusion, the suitable pulping condition for larchwood to improve the yield and quality of the chemical pulp to the level for kraft pulp from conventional process seemed to be. A) the selection of young larchwood to prevent decreasing in yield and quality due to the accumulation extractives in old wood, B) the application of 0.5 percent anthraquinone to the conventional soda cooking of 18 percent active alkali, and followed, C) the bleaching of oxygen in atmospheric pressure on high consistency (30%) with 0.1 percent magnesium oxide in the first stage of the ODED sequence to reduce the content of chlorine compounds in effluent.

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Effects of Dietary Protein on the Progression of Early Chronic Renal Failure in Subtotally Nephrectomizid Rats (저단백식이의 투여가 만성신부전증의 진행에 미치는 영향에 관한 실험적 연구)

  • Kim, Kyo-Sun;Kim, Kee-Hyuk;Kim, Sang-Yun;Kang, Yong-Joo;Maeng, Won-Jae
    • Childhood Kidney Diseases
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    • v.3 no.1
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    • pp.64-71
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    • 1999
  • Purpose : The protective effects of dietary protein on the progression of renal failure were studied in subtotally nephrectomized rats. Methods : Treatment groups were as follows; 5/6 nephrectomy and a normal protein ($18.5\%$) diet (NP); 5/6 nephrectomy and a low protein ($6\%$) diet (LP): 5/6 nephrectomy, a normal protein diet and converting enzyme inhibitor, enalapril (NPE): 5/6 nephrectomy, a low protein diet and enalapril (LPE). Both diets were isocaloric and had the same phosphorus content. Proteinuria, remnant kidney weight, mesangial matrix expansion score and glomerular volume were assessed at 4, 12 and 16 weeks after renal ablation. Results : LP and NP developed progressive hypertension. Eight weeks after surgery, LPE and NPE controlled hypertension. LP, LPE, and NPE had significantly less proteinuria than NP at 16 weeks (P<0.05). Kidney weight in LP were markedly less enlarged than NP (P<0.05). There was no difference in kidney weight between LPE and NPE. At 12 and 16 weeks the mesangial matrix expansion score was significantly less in LP, LPE, and NPE compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume was significantly less in LP compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume in LPE was significantly less compared to NPE. Conclusion : Dietary protein restriction afforded considerable protection from renal injury in the rat remnant kidney model. During the enalapril treatment, there was no additional protective effect of dietary protein restriction against the development of renal lesions.

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Recognition and attitude to functional division between physicians and pharmacists of practising physicians and pharmacists in Taegu city (대구시 개원의사와 개국약사의 의약분업에 대한 인식과 태도)

  • Lee, Moo-Sik;Yoon, Nung-Ki;Suh, Suk-Kwon;Park, Jae-Yong
    • Journal of Preventive Medicine and Public Health
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    • v.26 no.1 s.41
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    • pp.1-19
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    • 1993
  • Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered faliure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is sucessful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical issurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician prefered pros and 17.7 percent cons, but 38 percent of practicing pharmacist prefered pros and 45.5 percent cons. And pharmacist knew better the content of functional division between physician and pharmacist than physician. As a reason for pros of enforcing functional division between physician and pharmacist, practicing physician emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist prefered generic name (44.0%, 89%) mostly, but physician prefered brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the govermental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached ; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the goverment should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.

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A Study on the Growth Diagnosis and Management Prescription for Population of Retusa Fringe Trees in Pyeongji-ri, Jinan(Natural Monument No. 214) (진안 평지리 이팝나무군(천연기념물 제214호)의 생육진단 및 관리방안)

  • Rho, Jae-Hyun;Oh, Hyun-Kyung;Han, Sang-Yub;Choi, Yung-Hyun;Son, Hee-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.36 no.3
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    • pp.115-127
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    • 2018
  • This study was attempted to find out the value of cultural assets through the clear diagnosis and prescription of the dead and weakness factors of the Population of Retusa Fringe Trees in Pyeongji-ri, Jinan(Natural Monument No. 214), The results are as follows. First, Since the designation of 13 natural monuments in 1968, since 1973, many years have passed since then. In particular, despite the removal of some of the buried soil during the maintenance process, such as retreating from the fence of the primary school after 2010, Second, The first and third surviving tree of the designated trees also have many branches that are dead, the leaves are dull, and the amount of leaves is small. vitality of tree is 'extremely bad', and the first branch has already been faded by a large number of branches, and the amount of leaves is considerably low this year, so that only two flowers are bloomed. The second is also in a 'bad'state, with small leaves, low leaf density, and deformed water. The largest number 1 in the world is added to the concern that the s coverd oil is assumed to be paddy soils. Third, It is found that the composition ratio of silt is high because it is known as '[silty loam(SiL)]'. In addition, the pH of the northern soil at pH 1 was 6.6, which was significantly different from that of the other soil. In addition, the organic matter content was higher than the appropriate range, which is considered to reflect the result of continuous application for protection management. Fourth, It is considered that the root cause of failure and growth of Jinan pyeongji-ri Population of Retusa Fringe Trees group is chronic syndrome of serious menstrual deterioration due to covered soil. This can also be attributed to the newly planted succession and to some of the deaths. Fifthly, It is urgent to gradually remove the subsoil part, which is estimated to be the cause of the initial damage. Above all, it is almost impossible to remove the coverd soil after grasping the details of the soil, such as clayey soil, which is buried in the rootstock. After removal of the coverd soil, a pestle is installed to improve the respiration of the roots and the ground with Masato. And the dead 4th dead wood and the 5th and 6th dead wood are the best, and the lower layer vegetation is mown. The viable neck should be removed from the upper surface, and the bark defect should undergo surgery and induce the development of blindness by vestibule below the growth point. Sixth, The underground roots should be identified to prepare a method to improve the decompression of the root and the respiration of the soil. It is induced by the shortening of rotten roots by tracing the first half of the rootstock to induce the generation of new roots. Seventh, We try mulching to suppress weed occurrence, trampling pressure, and soil moisturizing effect. In addition, consideration should be given to the fertilization of the foliar fertilizer, the injection of the nutrients, and the soil management of the inorganic fertilizer for the continuous nutrition supply. Future monitoring and forecasting plans should be developed to check for changes continuously.

Environmental Interpretation on soil mass movement spot and disaster dangerous site for precautionary measures -in Peong Chang Area- (산사태발생지(山沙汰發生地)와 피해위험지(被害危險地)의 환경학적(環境學的) 해석(解析)과 예방대책(豫防對策) -평창지구(平昌地區)를 중심(中心)으로-)

  • Ma, Sang Kyu
    • Journal of Korean Society of Forest Science
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    • v.45 no.1
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    • pp.11-25
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    • 1979
  • There was much mass movement at many different mountain side of Peong Chang area in Kwangwon province by the influence of heavy rainfall through August/4 5, 1979. This study have done with the fact observed through the field survey and the information of the former researchers. The results are as follows; 1. Heavy rainfall area with more than 200mm per day and more than 60mm per hour as maximum rainfall during past 6 years, are distributed in the western side of the connecting line through Hoeng Seong, Weonju, Yeongdong, Muju, Namweon and Suncheon, and of the southern sea side of KeongsangNam-do. The heavy rain fan reason in the above area seems to be influenced by the mouktam range and moving direction of depression. 2. Peak point of heavy rainfall distribution always happen during the night time and seems to cause directly mass movement and serious damage. 3. Soil mass movement in Peongchang break out from the course sandy loam soil of granite group and the clay soil of lime stone and shale. Earth have moved along the surface of both bedrock or also the hardpan in case of the lime stone area. 4. Infiltration seems to be rapid on the both bedrock soil, the former is by the soil texture and the latter is by the crumb structure, high humus content and dense root system in surface soil. 5. Topographic pattern of mass movement spot is mostly the concave slope at the valley head or at the upper part of middle slope which run-off can easily come together from the surrounding slope. Soil profile of mass movement spot has wet soil in the lime stone area and loose or deep soil in the granite area. 6. Dominant slope degree of the soil mass movement site has steep slope, mostly, more than 25 degree and slope position that start mass movement is mostly in the range of the middle slope line to ridge line. 7. Vegetation status of soil mass movement area are mostly fire field agriculture area, it's abandoned grass land, young plantation made on the fire field poor forest of the erosion control site and non forest land composed mainly grass and shrubs. Very rare earth sliding can be found in the big tree stands but mostly from the thin soil site on the un-weatherd bed rock. 8. Dangerous condition of soil mass movement and land sliding seems to be estimated by the several environmental factors, namely, vegetation cover, slope degree, slope shape and position, bed rock and soil profile characteristics etc. 9. House break down are mostly happen on the following site, namely, colluvial cone and fan, talus, foot area of concave slope and small terrace or colluvial soil between valley and at the small river side Dangerous house from mass movement could be interpreted by the aerial photo with reference of the surrounding site condition of house and village in the mountain area 10. As a counter plan for the prevention of mass movement damage the technics of it's risk diagnosis and the field survey should be done, and the mass movement control of prevention should be started with the goverment support as soon as possible. The precautionary measures of house and village protection from mass movement damage should be made and executed and considered the protecting forest making around the house and village. 11. Dangerous or safety of house and village from mass movement and flood damage will be indentified and informed to the village people of mountain area through the forest extension work. 12. Clear cutting activity on the steep granite site, fire field making on the steep slope, house or village construction on the dangerous site and fuel collection in the eroded forest or the steep forest land should be surely prohibited When making the management plan the mass movement, soil erosion and flood problem will be concidered and also included the prevention method of disaster.

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