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A Geographical Study on the Behavior Changes of Telemedicine Participants in Terms of Time and Space (시공간 관점에서 본 원격진료 이용자 행태 변화에 관한 연구)

  • Park, Sookyung;Hanashima, Yuki
    • Journal of the Economic Geographical Society of Korea
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    • v.16 no.2
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    • pp.198-217
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    • 2013
  • This research aims to examine the behavior changes of telemedicine participants with regard to time-space reconfiguration and to address the implications of telemedicine in terms of extensibility and restrictions (ambilaterality). According to the results of this research, telemedicine can lead to behavior changes in telemedicine participants, particularly patients. However, it is difficult to anticipate the time-space reconfiguration of telemedicine participants drastically. In other words, although telemedicine minimizes patients' burden of accessibility to and utilization of medical institutions, it requires the patients to visit medical institutions at least once due to the restricted application of telemedicine related to technological problems, the characteristics of medical practice and mutual stakes among the medical institutions involved in telemedicine. And physicians (telemedicine providers as mediators between medical specialists and patients) and medical specialists (as the ultimate telemedicine providers) do not evidence considerable changes in their behaviors, except for offline meetings for information sharing and medical training. Because the present telemedicine system does not require simultaneity between physicians, patients and medical specialists. Furthermore, present telemedicine operation is absorbed into existing medical activities as a health care delivery method. These phenomena are due to 1) the interests among medical institutions and the limitation or generalization of telemedicine technologies to stimulate regional-based telemedicine operation and 2) the goal of face-to-face interactions between patients and doctors, which is to avoid misdiagnosis and side effects. Finally, medical activities related to telemedicine do not differ from general medical activities. The ambilaterality of telemedicine in terms of extensibility and the restriction of time-space reconfiguration is an unsettled problem in the ICT technologies of medical services.

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Search of Characteristic for Dose Distribution Presented by Multi­isocentric Stereotactic Radiosurgical Plan Using Linear Accelerator (선형 가속기를 이용한 정위적 방사선 수술시 병소내 선량분포의 특성조사)

  • 최경식;오승종;이형구;최보영;전흥재;서태석
    • Progress in Medical Physics
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    • v.14 no.4
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    • pp.225-233
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    • 2003
  • The goal of a radiation treatment plan is to deliver a homogeneous dose to a target with minimal irradiation of the adjacent normal tissues. Dose uniformity is especially important for stereotactic radiosurgery using a linear accelerator. The dose uniformity and high dose delivery of a single spherical dose distribution exceed 70%. This also results with a similar stereotactic radiosurgical plan using a Gamma Knife. The dose distribution produced in a stereotactic radiosurgical plan using a Gamma Knife and Linear accelerator is spherical, and the application of the sphere packing arrangement in a real radiosurgical plan requires much time and skill. In this study, we found a characteristic of dose distribution with transformation of beam parameters that must be considered in a radiosurgical plan for effective radiosurgery. First, we assumed a cylinder type tumor model and a cube type tumor model. Secondly, the results of the tumor models were compared and analyzed with dose profiles and DVH_(Dose Volume Histogram) representative dose distribution. We found the optimal composition of beam parameters_(i.e. collimator size, number of isocenter, gap of isocenters etc.), which allowed the tumor models to be involved in the isodose curve at a high level. In conclusion, the characteristics found in this study are helpful for improving the effectiveness and speed of a radiosurgical plan for stereotactic radiosurgery.

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Beta Dosimetry for Applying $^{166}Ho$-chitosan Complex to Cystic Brain Tumor Treatment : Monte Carlo Simulations Using a Spherical Model ($^{166}Ho$-chitosan 복합체를 이용한 낭성뇌종양 치료를 위한 베타선의 흡수선량 평가 : 구형 모델을 이용한 Monte Cairo 모사계산)

  • Kim, Eun-Hee;Rhee, Chang-Hun;Lim, Sang-Moo;Park, Kyung-Bae
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.4
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    • pp.433-439
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    • 1997
  • $^{166}Ho$-chitosan complex, or $^{166}Ho$-CHICO, is a candidate pharmaceutical for intracavitary radiation therapy of cystic brain tumors because of the desirable nuclear characteristics of $^{166}Ho$ for therapeutic use and the suitable biological and chemical characteristics of chitosan, not to mention its ready producibility The amount of $^{166}Ho$-CHICO to be administered to obtain the goal therapeutic effect can be suggested by predicting the dose to the cyst wall for a varying pharmaceutical dose. When $^{166}Ho$-CHICO is infused into the cyst, the major part of the energy delivery by beta particles emitted from $^{166}Ho$ occurs in the cyst wall within 4mm in depth from the cyst wall surface. Also, realizing the attachment of $^{166}Ho$-CHICO to the cyst wall surface would change the predictions of dose to the cyst wall.

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Optomizing Transfection Efficiency of Cervical Cancer Cells Transfected by Cationic Liposomes LipofectamineTM2000

  • Huang, Fei;Zhao, Feng;Liang, Li-Ping;Zhou, Mei;Qu, Zhi-Ling;Cao, Yan-Zhen;Lin, Chen
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7749-7754
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    • 2015
  • Background: Currently, cationic liposome has become the commonly used vehicles for gene transfection. Furthermore, one of the most significant steps in microRNAs expression studies is transferring microRNAs into cell cultures successfully. In this study we aim to approach the feasibility of transfection of cervical cancer cell lines mediated by liposome and to obtain the optimized transfection condition for cervical cancer cell lines. Materials and Methods: $Lipofectamine^{TM}2000$ as the carrier, miR-101 mimic was transfected into Hela cells and Siha cells. Using green fluorescent protein as reporter gene, to set different groups according to cell seeding density, the amount of miRNA, miRNA and the proportion of Liposomes, Whether to add serum into medium to study their impact on the liposomal transfection efficiency. Finally, MTT assay was used to analyze the relative minimal cell toxicity of liposome reagents. Results: The seeding density of Hela cell line and Siha are $1.5{\times}10^4$ (per well of 24 well plates), miRNA amount is 1ul of both, the ratio of miRNA and liposome is 1:0.5 of Hela cell line; 1:0.7 of Siha cell line respectively, after 24 hours we can get the highest transfection efficiency. Compared with serum medium, only Siha cells cultured with serum-free medium obtained higher transfection efficiency before transfection (P<0.01). MTT assay showed that according to the above conditions which has the lowest cytotoxicity. Conclusions: The method of Liposome to transfected is a suitable way and it can be an efficient reagent for miRNA delivery for Hela cells and Siha cells in vitro. It may serve as a reference for the further research or application.

Production and Breeding of Transgenic Cloned Pigs Expressing Human CD73

  • Lee, Seung-Chan;Lee, Haesun;Oh, Keon Bong;Hwang, In-Sul;Yang, Hyeon;Park, Mi-Ryung;Ock, Sun-A;Woo, Jae-Seok;Im, Gi-Sun;Hwang, Seongsoo
    • Development and Reproduction
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    • v.21 no.2
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    • pp.157-165
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    • 2017
  • One of the reasons to causing blood coagulation in the tissue of xenografted organs was known to incompatibility of the blood coagulation and anti-coagulation regulatory system between TG pigs and primates. Thus, overexpression of human CD73 (hCD73) in the pig endothelial cells is considered as a method to reduce coagulopathy after pig-to-non-human-primate xenotransplantation. This study was performed to produce and breed transgenic pigs expressing hCD73 for the studies immune rejection responses and could provide a successful application of xenotransplantation. The transgenic cells were constructed an hCD73 expression vector under control porcine Icam2 promoter (pIcam2-hCD73) and established donor cell lines expressing hCD73. The numbers of transferred reconstructed embryos were $127{\pm}18.9$. The pregnancy and delivery rate of surrogates were 8/18 (44%) and 3/18 (16%). The total number of delivered cloned pigs were 10 (2 alive, 7 mummy, and 1 died after birth). Among them, three live hCD73-pigs were successfully delivered by Caesarean section, but one was dead after birth. The two hCD73 TG cloned pigs had normal reproductive ability. They mated with wild type (WT) MGH (Massachusetts General Hospital) female sows and produced totally 16 piglets. Among them, 5 piglets were identified as hCD73 TG pigs. In conclusion, we successfully generated the hCD73 transgenic cloned pigs and produced their litters by natural mating. It can be possible to use a mate for the production of multiple transgenic pigs such as ${\alpha}-1,3-galactosyltransferase$ knock-out /hCD46 for xenotransplantation.

On Feasibility of Ambulatory KDRGs for the Classification of Health Insurance Claims (KDRG를 이용한 건강보험 외래 진료비 분류 타당성)

  • 박하영;박기동;신영수
    • Health Policy and Management
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    • v.13 no.1
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    • pp.98-115
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    • 2003
  • Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4% of KDRGs had a CV of charges from tertiary care hospitals less than 100% and 95.43% of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80% for non-outlier claims from tertiary care hospitals, 51.98% for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.

A Study on Effects of the Non-Deposited Arbitral Award with the Competent Court (관할법원에 송부${\cdot}$보관되지 않은 중재판정의 효력)

  • Oh Chang-Seog
    • Journal of Arbitration Studies
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    • v.15 no.3
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    • pp.55-84
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    • 2005
  • The arbitral award is the decision of the arbitrators on the dispute that had been submitted to them by the parties, either under the arbitration clause providing for the determination of future disputes or under submission of an existing controversy. The arbitral award has the same effect between the parties as a final and binding court judgment. The arbitration award shall acquire, as soon as it is given and delivered to each parties, the authority of res judicata in respect of the dispute it settles. The validity of an award is a condition precent for its recognition or enforcement. The validity of an award depends on the provisions of the arbitration agreement including any arbitration rules incorporated in it, and the law which is applicable to the arbitration proceedings. Such provisions usually address both the form and the content of the award. As the 'form', requires article 32 of Arbitration Act of Korea that an arbitral award should, at least, (1) be made in writing and be signed by all arbitrators. (2) state the reasons upon which it is based unless the parties have agreed that it should not, (3) state its date and place of arbitration. There are some further requirement which may have to be observed before an award which has been made by a tribunal can be enforced. (4) The duly authenticated award signed by the arbitrators shall be delivered to each of the parties and the original award shall be sent to and deposited with the competent court, accompanied by a document verifying such delivery. This rule can be interpreted as if the deposit of an arbitral award with the competent court is always required as a condition for its validity or as a preliminary to its enforcement in Korea. However, we must regard this rule which requires the deposit of an arbitral award with court, as rule of order, but not as condition of its validity. Because that the date on which the award is delivered to each party is important as it will generally determine the commencement of time limits for the making of any appeal which may be available. Furthermore, the party applying for recognition or enforcement merely has to supply the appropriate court with the duly authenticated original award or a duly certified copy thereof, not any document which proves that an the arbitral award is sent to and deposited with the competent court. In order to avoid some confusion which can be caused by its interpretation and application, the Article 32 (4) of Arbitration Act of Korea needs to be abolished or at least modified.

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The effect of a pulsed-Nd:YAG laser irradiation on microstructure of human gingiva (파동형 Nd:YAG 레이저조사가 인체 치은조직의 미세구조에 미치는 영향)

  • Han, Kyung-Yoon;Shin, Kwang-Yong;Kim, Chun-Seok;Kim, Hyung-Soo;Yum, Chang-Yup;Kim, Byung-Ock
    • Journal of Periodontal and Implant Science
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    • v.27 no.2
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    • pp.317-328
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    • 1997
  • Since laser therapy has been applied to dentistry, many dental practitioners are very interested in laser therapy on various intraoral soft tissue lesions including gingival hyperplasia and aphthous ulcer. The purpose of the present study was to determine the therapeutic effect and the harmful effect of a pulsed-Nd:YAG laser irradiation on human gingival tissue. In twenty periodontal patients with gingival enlargement, the facial gingival surface of maxillary anterior teeth was randomly irradiated at various power of 1.0W(100mJ, 10Hz), 3.0W(100mJ, 30Hz) and 6.0W(l50mJ, 40Hz) for 60 seconds by contact delivery of a pulsed-Nd:YAG laser(EN.EL.EN060, Italy). Immediately after laser irradiation, the gingival tissues were surgically excised and prepared in size of 1mm3. Subsequently the specimens were processed for prefixation and postfixation, embedded with epon mixture, sectioned in $1{\mu}$ thickness, stained with uranyl acetate and lead citrate, and observed under transmission electron microscope(JEM 100 CXII). Following findings were observed; l. In the gingival specimens irradiated with l.OW power, widening of intercelluar space and minute vesicle formation along the widened intercellular space were noted at the epithelial cells adjacent to irradiated area. 2. In the gingival specimens irradiated with 3.0W power, the disruption of cellular membrane, aggregation of cytoplasm, and loss of intercellular space were observed at the epithelial cells adjacent to irradiated area. 3. In the gingival specimens irradiated with 6.0W power, the disruption of nuclear and cellular membrane was observed at the epithelial cells adjacent to irradiated area. The ultrastructural findings of this study suggest that surgical application of a pulsed-Nd:YAG laser on human gingival tissue may lead somewhat delayed wound healing due to damage of epithelial cells adjacent to irradiated area.

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Measurement of Skin Dose for Rectal Cancer Patients in Radiotherapy using Optically Stimulated Luminescence Detectors (OSLDs) (광자극발광선량계(OLSDs)를 이용한 직장암 방사선치료 환자의 피부선량 측정)

  • Im, In-Chul;Yu, Yun-Sik;Lee, Jae-Seung
    • Journal of Radiation Protection and Research
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    • v.36 no.2
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    • pp.86-92
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    • 2011
  • This study used the optically stimulated luminescence dosimeters (OSLDs), recently, received the revaluation of usefulness in vivo dosimetry, and the diode detecters to measure the skin dose of patient with the rectal cancer. The measurements of dose delivered were compared with the planned dose from the treatment planning system (TPS). We evaluated the clinical application of OSDs in radiotherapy. We measured the calibration factor of OSLDs and used the percent depth dose to verified, also, we created the three point of surface by ten patients of rectal cancer to measured. The calibration factors of OSLD was 1.17 for 6 MV X-ray and 1.28 for 10 MV X-ray, demonstrating the energy dependency of X-ray beams. Comparison of surface dose measurement using the OSLDs and diode detectors with the planned dose from the TPS, The skin dose of patient was increased 1.16 ~ 2.83% for diode detectors, 1.36 ~ 2.17% for OSLDs. Especially, the difference between planned dose and the delivery dose was increased in the perineum, a skin of intense flexure region, and the OSLDs as a result of close spacing of measuring a variate showed a steady dose verification than the diode detecters. Therefore, on behalf of the ionization chamber and diode detecters, OSLDs could be applied clinically in the verification of radiation dose error and in vivo dosimety. The research on the dose verification of the rectal cancer in the around perineal, a surface of intense flexure region, suggest continue to be.

The Lived Experience of Mothers about Rearing of School Children With Cerebral palsy (뇌성마비 취학아동 어머니의 양육체험)

  • Baek Kyoung-Seon
    • Child Health Nursing Research
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    • v.7 no.4
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    • pp.434-450
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    • 2001
  • This study is designed to understand the meaning and nature of raising children with cerebral palsy. It researches the experience of mothers of schoolchildren with cerebral palsy by the research method of hermeneutic phenomenology. The study was conducted from November 10, 1999 to December 20, 2000. When children with cerebral palsy usually show symptoms in the early stage of cerebral palsy, mothers do not take children to a doctor for diagnosis. And, most of mothers have a difficult time to accept the reality; they usually respond to the initial diagnosis with shock, reproach, and deny. When mothers start recognizing the reality, they consider that their children have cerebral palsy due to the their mismanagement during pregnancy, delivery, nursing, and initial treatment. They shelter their children from view and feel guilty that they cannot afford to try folk remedies for their children. As time passes, mothers face conflicts between families in diverse ways. Families put the blame on genetic effects. Mothers-in-law give their daughters-in-law a hard time, husbands shift the responsibility of raising children onto their wives, and trouble arises between families-in-law and mothers native families. When children grow up, it is physically difficult for mothers to take care their children. In addition, they suffer from all the troubles in family due to childrens handicap. Mothers try the diverse methods of bringing up children. However, they start getting tired of raising children as they experience failures and financial difficulties. Mothers feel collapsed recalling the ways of raising children. They feel anxiety, miserable, lonely, and worrying when they think how children would attend school, make friends, and live in the future. In this stage, mothers do their best to raise their children with hope. They tend to compare their children with others without handicap and spend money and time in attempting all the treatments. When mothers and children join the society at school, they find that the society does not understand disabled people, teachers show inconsiderate attitude, friends avoid them, and children hardly follow classes. Such experiences make mothers feel angry and frustrated. However, when children adapt to school, mothers see the possibility that children could accomplish schoolwork. They appreciate teachers help and others consideration. Mothers place appropriate expectations on their children and help them to prepare for the future. I would make following suggestions based on the results. 1. As a primary basic course of rehabilitation nursing intervention, solution-centered nursing intervention system should be developed. The intervention needs to be based on the understanding of mothers, who raise children with cerebral palsy, through in-depth interview. 2. Advance researches on the development of individual nursing intervention should be conducted. Individual nursing intervention needs to prevent and release actual pain focusing on mothers raising children with cerebral palsy. 3. Integrated curriculum that help children with cerebral palsy lead a normal school life with ordinary children should be developed. 4. Basic research on using of facilities and effective application of service volunteer to help children with cerebral palsy in school needs to be conducted.

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