• Journal of the Korean Society of Radiology
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• v.11 no.7
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• pp.547-553
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• 2017

In the current medical field, lead is widely used as a radiation shield. However, the lead weight is very heavy, so wearing protective clothing such as apron is difficult to wear for long periods of time and there is a problem with the danger of lethal toxicity in humans. Recently, many studies have been conducted to develop substitute materials of lead to resolve these problems. As a substitute materials for lead, barium(Ba) and iodine(I) have excellent shielding ability. But, It has characteristics emitting characteristic X-rays from the energy area near 30 keV. For patients or radiation workers, shielding materials is often made into contact with the human body. Therefore, the characteristic X-rays generated by the shielding material are directly exposured in the human body, which increases the risk of increasing radiation absorbed dose. In this study, we have developed the FLUKA transport code, one of the most suitable elements of radiation transport codes, to remove the characteristic X-rays generated by barium or iodine. We have verified the reliability of the shielding fraction of the structure of the structure shielding by comparing with the MCPDX simulations conducted as a prior study. Using the MCNPX and FLUKA, the double layer shielding structures with the various thickness combination consisting of barium sulphate ($BaSO_4$) and bismuth oxide($Bi_2O_3$) are designed. The accuracy of the type shown in IEC 61331-1 was geometrically identical to the simulation. In addition, the transmission spectrum and absorbed dose of the shielding material for the successive x-rays of 120 kVp spectra were compared with lead. In results, $0.3mm-BaSO_4/0.3mm-Bi_2O_3$ and $0.1mm-BaSO_4/0.5mm-Bi_2O_3$ structures have been absorbed in both 33 keV and 37 keV characteristic X-rays. In addition, for high-energy X-rays greater than 90 keV, the shielding efficiency was shown close to lead. Also, the transport code of the FLUKA's photon transport code was showed cut-off on low-energy X-rays(below 33keV) and is limited to computerized X-rays of the low-energy X-rays. But, In high-energy areas above 40 keV, the relative error with MCNPX was found to be highly reliable within 6 %.

• Pediatric Infection and Vaccine
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• v.20 no.1
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• pp.17-27
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• 2013

Purpose: Recently, two tests are commercially available for the identification of latent tuberculosis infection (LTBI): tuberculin skin test (TST) and interferon-${\gamma}$ release assay (IGRA). Due to its false positiveness, TST tends to be preferred by IGRA until now. In our study, we simultaneously performed both TST and QuantiFERON$^{(R)}$-TB Gold In-Tube (QFT-GIT) and compared their results. Methods: TST and QFT-GIT were done for the diagnosis of LTBI among children who visited pediatric out-patient clinic at St. Vincent's Hospital, The Catholic University of Korea from February of 2007 to May of 2008. The study group was stratified into two groups in terms of whether there was intrafamilial contact or not. Results: Out of total 35 children, 29 were tuberculosis (TB)-exposed cases and the remainders were diagnosed as clinical pulmonary TB. Among these 29 children, TST was positive 38.9% (7/18) for the intrafamilial and 45.5% (5/11) for the nonintrafamilial, and at the same time, the result for QFT-GIT was positive 5.6% (1/18) and 9.1% (1/11), respectively which implies that TST was more sensitive than QFT-GIT. Among 29 TB-exposed cases, 26 initially went through TST and QFTGIT together on their first visit to out-patient clinic, and 15 continued the follow-up tests. Out of total 41 cases collected, the agreement (known as kappa value) was 0.063 which was relatively low. Including 6 cases with pulmonary TB who were all positive for TST and only 5 being positive for QFT-GIT, the final kappa value was 0.334. Conclusion: In our study, the agreement for TST and QFT-GIT was low, and the majorities were almost the cases of positive TST. In current situation with lacking a gold standard test and limited data on children to adolescents, this result is quite alarming that the recent trend tends to replace TST by QFT-GIT when diagnosing LTBI.

• Journal of Arbitration Studies
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• v.19 no.2
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• pp.95-126
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• 2009

One of the controversial issues in investor-state investment arbitration is the interpretation of "umbrella clause" that is found in most BIT and FTAs. This treaty clause requires on Contracting State of treaty to observe all investment obligations entered into with foreign investors from the other Contracting State. This clause did not receive in-depth attention until SGS v. Pakistan and SGS v. Philippines cases produced starkly different conclusions on the relations about treaty-based jurisdiction and contract-based jurisdiction. More recent decisions by other arbitral tribunals continue to show different approaches in their interpretation of umbrella clauses. Following the SGS v. Philippines decision, some recent decisions understand that all contracts are covered by umbrella clause, for example, in Siemens A.G. v. Argentina, LG&E Energy Corp. v. Argentina, Sempra Energy Int'l v. Argentina and Enron Corp. V. Argentina. However, other recent decisions have found a different approach that only certain kinds of public contracts are covered by umbrella clauses, for example, in El Paso Energy Int'l Co. v. Argentina, Pan American Energy LLC v. Argentina and CMS Gas Transmission Co. v. Argentina. With relation to the exhaustion of domestic remedies, most of tribunals have the position that the contractual remedy should not affect the jurisdiction of BIT tribunal. Even some tribunals considered that there is no need to exhaust contract remedies before bringing BIT arbitration, provoking suspicion of the validity of sanctity of contract in front of treaty obligation. The decision of the Annulment Committee In CMS case in 2007 was an extraordinarily surprising one and poured oil on the debate. The Committee composed of the three respected international lawyers, Gilbert Guillaume and Nabil Elaraby, both from the ICJ, and professor James Crawford, the Rapportuer of the International Law Commission on the Draft Articles on the Responsibility of States for Internationally Wrongful Acts, observed that the arbitral tribunal made critical errors of law, however, noting that it has limited power to review and overturn the award. The position of the Committee was a direct attack on ICSID system showing as an internal recognition of ICSID itself that the current system of investor-state arbitration is problematic. States are coming to limit the scope of umbrella clauses. For example, the 2004 U.S. Model BIT detailed definition of the type of contracts for which breach of contract claims may be submitted to arbitration, to increase certainty and predictability. Latin American countries, in particular, Argentina, are feeling collectively victims of these pro-investor interpretations of the ICSID tribunals. In fact, BIT between developed and developing countries are negotiated to protect foreign investment from developing countries. This general characteristic of BIT reflects naturally on the provisions making them extremely protective for foreign investors. Naturally, developing countries seek to interpret restrictively BIT provisions, whereas developed countries try to interpret more expansively. As most of cases arising out of alleged violation of BIT are administered in the ICSID, a forum under the auspices of the World Bank, these Latin American countries have been raising the legitimacy deficit of the ICSID. The Argentine cases have been provoking many legal issues of international law, predicting crisis almost coming in actual investor-state arbitration system. Some Latin American countries, such as Bolivia, Venezuela, Ecuador, Argentina, already showed their dissatisfaction with the ICSID system considering withdrawing from it to minimize the eventual investor-state dispute. Thus the disagreement over umbrella clauses in their interpretation is becoming interpreted as an historical reflection on the continued tension between developing and developed countries on foreign investment. There is an academic and political discussion on the possible return of the Calvo Doctrine in Latin America. The paper will comment on these problems related to the interpretation of umbrella clause. The paper analyses ICSID cases involving principally Latin American countries to identify the critical legal issues arising between developing and developed countries. And the paper discusses alternatives in improving actual investor-State investment arbitration; inter alia, the introduction of an appellate system and treaty interpretation rules.

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

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

• Journal of Korean Clinical Health Science
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• v.2 no.1
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• pp.1-16
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• 2014

Purpose. For a more efficient hospital management, this study aims to provide basic data so that the hospital management and staff in charge of hospital administration may systematically classify and collect hospital information, by analyzing the ordinary characters of an upper-level general hospital system and its common-type balance sheet, common-type profit and loss statement and financial ratio. Methods. By using information about an upper-level general hospital in C Province, provided by Alio(www.alio.go.kr), a public organization information provision site, Health Insurance Review & Assessment Service(www.hira.or.kr) and Ministry of Health and Welfare(www.mw.go.kr), this study analyzed 3 year's data from 2010 to 2012 and provided basic data by analyzing the ordinary characters of an upper-level general hospital system, and its common-type balance sheet, common-type profit and loss statement and financial ratio. Results. After analyzing the ordinary characters, common-type balance sheet, common-type proft and loss statement and financial ration of this general hospital, based on the 2010 to 2012 data, this study came to the following conclusions. Firstly, out of all the 1,069 hospital staff, there were 272 doctors working for 24 medical departments, out of whom the majority was 33 physicians. Most of the nurses were third-class ones, and about 2,000 outpatients and 600 inpatients on average were treated per day. Secondly, as a result of analyzing the common-type balance sheet, this study discovered that intangible assets out of fixed assets accounted for 41%, the majority, out of which usable and profitable donation asset buildings were of great importance, and the liquid assets increased more in 2012 than 2011. In the financial structure, the ratio of liquid liabilities was over 50% out of all the liabilities in 2012, and the ratio of purchase payables was high as well. The ratio of fixed liabilities reached up to 40%, out of which the retirement benefit appropriation fund was quite high. The capital was over 80%, but the surplus was in a deficit state. Compared to the capital, the ratio of total liabilities was about 90%, which indicates the financial structure of this general hospital was vulnerable. Thirdly, as a result of analyzing the common-type profit and loss statement, this study found out that the medical profits from inpatients were higher than profits from outpatients. The material cost was related to the medical quality of this general hospital, and it was as high as 30% out of the total costs and was about 45% of the labor cost. This general hospital showed 10% in the ratio of non-medical profits, and it seemed because of government subsidies. The ratios of medical profits and current net income were gradually changing for the better in 2012, compared to 2011. Lastly, as a result of analyzing the financial ratio, it was found that the liquidity ratio kept decreasing, from 110.7% in 2010 and 102.0% in 2011 to 77.2% in 2012. Besides, it was analyzed that the liquidity ratio and the net working capital ratio greatly decreased, while the quick ratio and the liquid ratio kept decreasing. Conclusions. 1. It is necessary to take the risk management into more consideration, and particularly, it is needed to differentiate and manage the levels of risk in detail. 2. By considering the fact that investments into hospital infrastructures were mostly based on liabilities, it is needed to deal with the scale of losses when evaluating risks. 3. By reflecting the character that investments into hospital infrastructures were based on liabilities, it is necessary to consider the ratio of ordinary profits as well as the ratio of operating profits to sales, and it is also important to consider sales productivity factors, such as the sales amount per a sickbed, by comparing them with other hospitals. As for limitations of this study, there may be some problems in terms of data interpretation because of the lack of information about the number of inpatients and the number of outpatients per year, which are needed for the break-even point analysis. Besides, to suggest a direction for the improvement of hospital management through analyses, non-financial factors should be reflected, such as the trend of economy, medical policies, and politic backgrounds. However, this study only focused on the common-type balance sheet, common-type profit and loss statement and financial ratio, so this study is actually limited to generalizing all the factors by analyzing public data only.

• Neonatal Medicine
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• v.18 no.1
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• pp.59-69
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• 2011

Purpose: Current studies have demonstrated the neuroprotective effects of 6-cyano-7-nitroquinoxalin-2,3-dione (CNQX) in many animal models of brain injury, including hypoxic-ischemic (HI) encephlopathy, trauma and excitotoxicity, but limited data are available for those during the neonatal periods. Here we investigated whether CNQX can protect the developing rat brain from HI injury via mediation of nitric oxide synthase. Methods: In an in vivo model, left carotid artery ligation was done in 7-day-old Sprague-Dawley (SD) rat pups. The animals were divided into six groups; normoxia (N), hypoxia (H), hypoxia with sham-operation (HS), hypoxia with operation (HO), HO treated with vehicle (HV), and HO treated with CNQX at a dose of 10 mg/kg (HC). Hypoxia was made by exposure to a 2 hr period in the hypoxic chamber (92% $N_2$, 8% $O_2$). In an in vitro model, embryonic cortical neuronal cell culture of SD rats at 18-day gestation was done. The cultured cells were divided into three groups: normoxia (N), hypoxia (H), and hypoxia treated with CNQX (HC). The N group was prepared in 5% $CO_2$ incubators and the other groups were placed in 1% $O_2$) incubators (94% $N_2$, 5% $CO_2$) for 16 hr. Results: In the in vitvo and in vivo models, the expressions of iNOS and eNOS were reduced in the hypoxia group when compared to the normoxia group, whereas they were increased in the CNQX-treated group compared to the hypoxia group. In contrast, the expression of nNOS was showed reversely. Conclusion: CNQX has neuroprotective property over perinatal HI brain injury via mediation of nitric oxide synthase.

• Journal of Broadcast Engineering
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• v.16 no.2
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• pp.216-225
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• 2011

Following the proliferation of three-dimensional video contents and displays, many terrestrial broadcasting companies have been preparing for stereoscopic 3DTV service. In terrestrial stereoscopic broadcast, it is a difficult task to code and transmit two video sequences while sustaining as high quality as 2DTV broadcast due to the limited bandwidth defined by the existing digital TV standards such as ATSC. Thus, a terrestrial 3DTV broadcasting with a heterogeneous video codec system, where the left image and right images are based on MPEG-2 and H.264/AVC, respectively, is considered in order to achieve both high quality broadcasting service and compatibility for the existing 2DTV viewers. Without significant change in the current terrestrial broadcasting systems, we propose a joint rate control scheme for stereoscopic 3DTV service based on the heterogeneous dual codec systems. The proposed joint rate control scheme applies to the MPEG-2 encoder a quadratic rate-quantization model which is adopted in the H.264/AVC. Then the controller is designed for the sum of the left and right bitstreams to meet the bandwidth requirement of broadcasting standards while the sum of image distortions is minimized by adjusting quantization parameter obtained from the proposed optimization scheme. Besides, we consider a condition on maintaining quality difference between the left and right images around a desired level in the optimization in order to mitigate negative effects on human visual system. Experimental results demonstrate that the proposed bit rate control scheme outperforms the rate control method where each video coding standard uses its own bit rate control algorithm independently in terms of the increase in PSNR by 2.02%, the decrease in the average absolute quality difference by 77.6% and the reduction in the variance of the quality difference by 74.38%.

• Development and Reproduction
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• v.13 no.4
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• pp.207-215
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• 2009

Numerous factors can affect the activities of hypothalamus-pituitary-gonad (HPG) hormonal axis, resulting in alteration of reproductive capacity or status such as onset of puberty and menopause. Soon after the finding of leptin, a multifunctional hormone secreted from adipocytes, a close relationship between reproduction and body energy balance have been manifested. Ghrelin, another multifunctional hormone from gastrointestinal tract, is an endogenous ligand of growth hormone secretagogue receptor (GHSR), and is thought to be a counterpart of leptin in the regulation of energy homeostasis. As expected, ghrelin can also modulate the reproductive capacity through the modulation of activities of HPG axis. This paper summarizes the current knowledge on the discovery, gene structures, tissue distribution and roles of ghrelin and GHSRs in mammalian reproduction in particular modulation of reproductive hormone secretion in HPG axis. Like POMC gene expression in pituitary gland, preproghrelin gene can generate a complex repertoire of transcripts which further undergo alternative splicing and posttranslational modifications. Concerning the roles of preproghrelin gene products in the control of body physiology except energy homeostasis, limited knowledge is available so far. Several lines of evidence, however, show the interplay of ghrelin between metabolism and reproduction. In rat and human, the distribution of ghrelin receptor GHSRs (GHSR1a and GHSR1b) has been confirmed not only in the hypothalamus and pituitary which were originally postulated as target of ghrelin but also in the testis and ovary. Expression of the preproghrelin gene in the brain and gonads was also verified, suggesting the local role (s) of ghrelin in HPG axis. Ghrelin might play a negative modulator in the secretions of hypothalamic GnRH, pituitary gonadotropins and gonadal steroids though the action on pituitary is still questionable. Recent studies suggest the involvement of ghrelin in regulation of puberty onset and possibly of menopause entry. It is now evident that ghrelin is a crucial hormomal component in 'brain-gut' axis, and is a strong candidate links between metabolism and reproduction. Opposite to that for leptin, ghrelin signaling is likely representing the 'hunger' state of body energy balance and is necessary to avoid the energy investment into reproduction which has not a top priority in maintaining homeostasis. Further researches are needed to gain a deep insight into the more precise action mechanism and role of ghrelin in reproduction, and to guarantee the successful biomedical applications.

• Cartoon and Animation Studies
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• s.43
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• pp.285-320
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• 2016

Cartoons and Animation are convergent arts created with a composite application of language arts described in the form of literary texts and sounds, plastic arts visualized in the form of artistic paintings, and film arts produced in the form of moving pictures. An academic university major in cartoons and animation studies established in late 20th century however, did not satisfactorily meet the needs in academic research and development and the free expression of artistic creation was limited. In order to systematize the major in cartoons and animation studies, an convergent approach to establish and clarify following are in demand : the terms and definitions, the historical developments, the research areas and methods, the major education and related jobs and start-ups. New culture and arts industries including cartoons, animation, moving images, and games contents are not yet listed in the industries listing service jointly provided online by the portal site Naver.com and Hyung-Seol publishing company. Above all, cartoons and animation are inseparably related to each other that even if one uses the term separately and independently, the meaning may not be complete. So a new combined term "Animatoon" can be established for the major in cartoons and animation studies and also used for its degree with concentrations of cartoons, animation, moving images, games, and etc. In the Introduction, a new combined term Animatoon is defined and explained the use of this term as the name of the major and degree in cartoons and animation studies. In the body, first, the Historical Developments classified Animatoon in the ancient times, the medieval times, and the modern times and they are analyzed with the help of esthetics and arts using examples of mural frescos, animal painting, religion cartoons, caricatures, cartoons, satire cartoons, comics, animation, 2 or 3 dimensional webtoons, and K-toons. Second, the Research Areas of Animatoon reviewed the theories, genres, artworks, and artists and the Research Methods of Animatoon presented the curriculum that integrated the courses in humanities, science technologies, culture and arts, and etc. Third, the Major Education considered Animatoon education in children, young adults, students of the major and the Related Jobs and Start-Ups explored various jobs relating to personal creation of artwork and collective production of business-oriented artwork. In the Conclusion, the current challenges of Animatoon considered personalization of the artists, specialization of the contents, diversification of the types, and liberalization of the art creation. And the direction of improvement advocated Animatoon to be an academic field of study, to be an art, to be a culture, and to be an industry. The importance of cartoons and animation along with videos and games rose in the 21st century. In order for cartoons and animation to take a leading role, make efforts in studying Animatoon academically and also in developing Animatoon as good contents in the cultural industries.

• Cartoon and Animation Studies
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• s.49
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• pp.359-382
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• 2017

Content is the complex of art and technology of trend, so it is important to experience different technologies for content education. Today, many non-profit organizations plan and operate numbers of programs for disabilities, low-income, and minority families to enhance the quality of life and the realization of social integration. These programs are limited to museums and galleries, not so pro-actively in progressing. Various contend education is necessary to the expansion of cultural exchange for the culturally alienated area. Naver is running an outreach program named . It is an experience-based outreach program where current cartoon / webtoon writers come directly to the school to inform students about the basic story of comics and comic techniques. However, the fact that the is not centered on the marginalized area but is centered on the Seoul Gyeonggi area, has the limitation that they can not benefit from a wide range of programs because they have a space limit of 'school', and, has a spatial limitation that the experience of the work is excluded. 'Outreach programs in marginalized areas' must be reorganized into a fluid dimension, not a fixed, single-system program. You should be able to experience and experience your work by directly using various professional equipment of comics based on your capacity and experience, local culture, religion, and society. These program participants will gain the effect of attractive and effective learning with empathy with their comic experience. Meanings of Comics content outreach program are following: First, the rich cultural archive can be used efficiently by providing various contents to existing outreach programs with the educational limitation of museums and galleries. Second, Comics contents can be enjoyed as a part of our life by understanding diversity and technology of contents. Third, because it is the program of expertise' participation, it can remodel, and restructure the severed experience in remote areas for the continuous growth and development, and furthermore, it can enhance the understanding of society.