• Journal of the Korean Institute of Traditional Landscape Architecture
• /
• v.31 no.1
• /
• pp.28-37
• /
• 2013

As a symbolic landscape of Seoul, Namsan has undergone not only physical changes but also changes in its human use and characteristics. At this point, research on Namsan, which holds diverse stories that have accumulated over a long period, as a cultural landscape is necessary. In particular, a concrete understanding of the characteristics of the mountain's use in the period of its initiation as a modern park is an important task in research on the history of urban parks. Consequently, the purpose of the present study lies in grasping the use of Namsan at the time of the establishment of Kyongsungbu Namsan Park Design Proposal in 1917 and examining the characteristics per space. The research process was based on the status of the park design plan. The primary source of information came from the analysis of historical newspaper articles. Additional materials including documents, old maps, photographs, postcard materials were also used. The period of the study was 1883 to 1917. This time was the initial period of Namsan Park soon after the opening up of Korea's ports to the world. The major spaces in which Namsan was used as a park encompassed Hanyang Park, Waeseongdae Park, Noin-jeong, Jangchung-dan, and remaining parts of Namsan in a natural state. When the main ways in which each space is used are examined based on the data analyzed, Namsan has been used for purposes including public events, accidents, religious worship, track and field days, field trips, and strolls. When the nature of each of the spaces is determined in terms of the characteristics of their use, these spaces were characterized as community parks, outdoor community spaces, indoor community spaces, sports arenas, and natural parks, among other things. The present study is significant in terms of research on the history of parks for confirming that Namsan in the initial period already served as a modern park for urban activities and grasping the specific urban activities that were engaged in on Namsan.

• The Korean Society of Law and Medicine
• /
• v.16 no.1
• /
• pp.155-190
• /
• 2015

The court sentenced meaningful decisions related to the medical service in 2014. The court assumed the negligence of medical staff in the accident if being broken while using the medical equipment for not an original purpose at the time of surgery and ruled that the compensation for damage can be recognized in recognition of the causal relationship between the explanation duty violation and side effect's happening when unproven surgery on safety is implemented regarding the duty of explanation, that in the case of cosmetic surgery, the subject on the duty of explanation needs to be expanded compared to the general medical practice and that the duty of explanation cannot be accepted for the range that cannot be expectable. Also, the court has provided the requirement and limitation of self-determination exercise in case of the crash between patient's self-determination and doctor's duty of care and has ruled that as automobile insurance contract is a contract with the insurance company to pay regarding liability for car accidents, treating patients and taking the insurance money is not illegal activity even for the unlicensed hospital violating the medical law while established. The judgment stating the opinion that medical practitioners cannot be punished according to the medical law prohibiting the receiving of rebate in case that medical practitioners did not receive benefit while the medical institution itself gained an unfair economic benefit also stands out. And the court has ruled that even if the medical institution who received a business suspension is closed, the suspension is still effective in case that the same operator opens a new medical institution in the same place, ruled on the requirement to conduct a medical service outside of the medical institution that the doctor opened and ruled that the administrative penalty cannot be conducted prior to the conviction on charge of violating the medical law.

• The Korean Society of Law and Medicine
• /
• v.21 no.1
• /
• pp.107-152
• /
• 2020

During the main ruling in 2019, a number of rulings that were of interest or meaningful were handed down, such as just because the complication of medical practice has occurred, there is no presumption of negligence, a case involving a fall accident in which a lot of culpability has recently been made. the death of a well-known singer that caused a sensation, a case about damages caused by MERS in 2015, which is more meaningful in connection with damages caused by COVID-19, an infectious disease that has recently hit the world, including Korea. In preaching the principles of the law, just because there has been a complication caused by medical practice, there is no presumption of negligence, 'The scope of the complication without presumption of negligence' was determined differently by the court, the court was not able to specify the criteria. Specific circumstances were presented to limit the responsibility of the medical institution while acknowledging the malpractice of the medical institution in relation to the fall accident. In relation to the scope of damages, judgment was made on issues related to the calculation of lost profits of medical malpractice; criteria for determining celebrities' daily income, criteria for determining daily income in case of receiving survivor's pension due to medical accident, an incident in which the daily income is denied if the labor capacity is already lost at the time of a medical accident. But, it seems that judgments should be made based on clearer and more reasonable standards. Related to Medical Advertise, specific logic of judgment was presented as to whether it was interpreted as being in accordance with the specific prohibition listed in Article 27 paragraph 3 of the Medical Law, which is the criterion for violation of the Medical Law, or if it constitutes a significant harm to the order of the medical market. In response to the prohibition of operating the multiple medical institutions, the Constitutional Court decided that it was constitutional because it did not violate the regulations on excessive funding, and rationally limited the scope of the prohibited 'redundant operation'. The Supreme Court ruled for the first time that even a medical institution established and operated in violation of the Medical Service Act did not make it impossible to receive all medical care benefits implemented by a medical institution under the National Health Insurance Act. Significant rulings were finalized that recognized the existence of specific protection obligations for the people of the country in the management of infectious diseases.

• Fire Science and Engineering
• /
• v.17 no.1
• /
• pp.8-20
• /
• 2003

Natural gas has been supplied through underground pipelines and valve stations as a new city gas in Seoul. In contrast to its handiness the natural gas has very substantial hazards due to fires and explosions occurring from careless treatments or malfunctions of the transporting system. The main objectives of this study are to identify major hazards and to perform risk assessments after assessing reliabilities of the composing units in dealing with typical pipeline networks. there-fore two method, fault tree analysis ;1nd event tree analysis, are used here. Random valve stations are selected and considered its situation in location. The value of small leakage, large rupture, and no supply of liquefied natural gas is estimated as that of top event. By this calculation the values of small leakage are 3.29 in I)C valve station, 1.41 in DS valve station, those of large rup-lure are $1.90Times10_{-2}$ in DC valve station, $2.32$\times$10^{-2}$ in DS valve station, and those of no supply of LNG to civil gas company are $2.33$\times$10 ^{-2}$ , $2.89$\times$10^{-2}$ in each valve station. And through minimal cut set we can find the parts that is important and should be more important in overall system. In DC valve station one line must be added between basic event 26,27 because the potential hazard of these parts is the highest value. If it is added the failure rate of no supply of LNG is reduced to one fourth. In DS valve station the failure rate of basic event 4 is 92eye of no supply of LNG. Therefore if the portion of this part is reduced (one line added) the total failure rate can be decreased to one tenth. This analytical study on the risk assessment is very useful to prepare emergency actions or procedures in case of gas accidents around underground pipeline networks and to establish a resolute gas safety management system for loss prevention in Seoul metropolitan area.

• Korean Journal of Child Studies
• /
• v.1
• /
• pp.65-81
• /
• 1980

This study is aimed at investigating the compensatory education which was already implemented or is being implemented in the U.S.A. and Japan; and at studying the types of programs and their characteristics; and at sounding out the possibilities of the application of such programs in family and social conditions is Korea. In order to achieve the above mentioned objectives, the established items for the study are as follows: (1) Various types of early children's education (2) Programs of compensatory education for the disadvantaged Children (3) Head Start Program, Early Training Project and Montessori School (4) Integrated Preschool Programs (5) Day-Care Center for employed mothers We investigated the various compensatory education programs for the preschool children who are in economically, socially, culturally disadvantaged conditions. Head Start Programs were federally supported programs for preschool children and opened as summer programs in 1965 for the first time. The purpose of Head Start has been to give preschool children the kinds of experiences they need in preparation for school. The Head Start children were found to be significantly better prepared for school than the normal children. However, after six to eight months, their initial advantages had virtually. disappeared and then the simple problem with Head Start and other such programs was that little long-term good could be evidenced unless the high quality educational environment was maintained. Therefore, to solve this problem, three other programs were funded as part of the overall Head Start. These three programs are the Parent-Child Center, Home Start, and the Child and Family Resources Program. The Early Training Project for disadvantaged children was implemented by Klaus and Gray of Peabody College in 1962. The program was a field research study concerned with the development and testing over time of procedures for improving the educability of young children from low income homes. Its major concern was to study whether it was possible to offset the progressive retardation observed in the public schooling careers of children, living in deprived circumstances. Children, who were trained through the Early Training Project were superior to control groups in the test of IQ and vocabulary as well as linguistic abilities, and preparation for reading. This project showed the possibilities which could prevent preschool children from being disadvantaged socially, culturally and mentally. In 1907, Montessori School was established by Maria Montessori in Italy and her school program has been introduced at present to several countries in the world as one compensatory educations. She first began her experimental methods with retarded children, followed by disadvantaged children from the tenements of Rome. The Montessori approach futures a prepared environment and carefully designed, self-correcting materials. The Montessori curriculum presents tastes that feature sequence, order, and regularity, in addition to those that develop motor and sensory skills. She was interested in children's intellectual development and in developing good work habits. One of the latest developed programs for disadvantaged children is "Integrated Preschool Program" which has successfully integrated handicapped and nonhandicapped children. Several studies have showed that handicapped children in integrated school environments are accepted by and interact with their nonhandicapped peers. In fact, this program provides a number of potential, and perhaps opportunities for nonhandicapped children to serve as valuable resources in fostering the development of their handicapped peers. Next we turn to Japanese programs which are divided into two different types. One is Day-Care Center which was established by Child Welfare Law and the other is kindergarten organized by School Education Law. The kindergarten opened in 1876 and it has been part of school systems since 1947 by the implementation of education law, and the Day-Care Center which started in 1890 for the employed mothers. was changed into Day-Nursery by the enactment of child welfare law in 1947. The laws and operational regulations for the Day-Nursery were set up and were put in effect by the establishment standard acts of children welfare facilities, and the Day-Nursery has been operated in various types by the increasing demand, chiefly because of the socio-economical changes of family structures in both urban and suburban areas. Nursery education for physically and mentally disadvantaged children is for those who are blind, deaf and dumb, mentally retarded; physically disadvantaged by accidents or diseases. Montessori education in Japan was started in 1968 and many research groups for studying Montessori were organized. In 1977, Montessori remedial education society was also organized in which they started a number of studies; a study for developing materials; in-service training for the remedial education; and seminars and lectures, etc It is strongly suggested that we study the early educations that are being implemented in Japan and a variety of compensatory educations that were already implemented in the U.S.A. and modify them for the organization of our own model and properly accommodate them to our social needs.

• Journal of the Korean Association of Geographic Information Studies
• /
• v.20 no.4
• /
• pp.126-138
• /
• 2017

Recently, the national interest in environment is increasing and for dealing with water environment-related issues swiftly and accurately, the demand to facilitate the analysis of water environment data using a GIS is growing. To meet such growing demands, a spatial network data-based stream network analysis map(Korean Reach File; KRF) supporting spatial analysis of water environment data was developed and is being provided. However, there is a difficulty in delineating catchment areas, which are the basis of supplying spatial data including relevant information frequently required by the users such as establishing remediation measures against water pollution accidents. Therefore, in this study, the development of a computer program was made. The development process included steps such as designing a delineation method, and developing an algorithm and modules. DEM(Digital Elevation Model) and FDR(Flow Direction) were used as the major data to automatically delineate catchment areas. The algorithm for the delineation of catchment areas was developed through three stages; catchment area grid extraction, boundary point extraction, and boundary line division. Also, an add-in catchment area delineation module, based on ArcGIS from ESRI, was developed in the consideration of productivity and utility of the program. Using the developed program, the catchment areas were delineated and they were compared to the catchment areas currently used by the government. The results showed that the catchment areas were delineated efficiently using the digital elevation data. Especially, in the regions with clear topographical slopes, they were delineated accurately and swiftly. Although in some regions with flat fields of paddles and downtowns or well-organized drainage facilities, the catchment areas were not segmented accurately, the program definitely reduce the processing time to delineate existing catchment areas. In the future, more efforts should be made to enhance current algorithm to facilitate the use of the higher precision of digital elevation data, and furthermore reducing the calculation time for processing large data volume.

• Journal of Korean Academy of Nursing
• /
• v.24 no.1
• /
• pp.58-69
• /
• 1994

In order to see the development of Nursing related research activities in Korea over the last three decades, abstracts of almost all of the Master and Ph.D theses that appeared from 1961 up to August 1991 were collected. The number of theses was 2354, from which an index of key words has been constructed. Key words were defined as those terms in each thesis title that convey major objectives of the given thesis study and the important nursing concepts dealt with in the thesis. Although all the key words were picked from the thesis title only, full use was made of the abstracts in deciding the principal objectives and essential contents of the thesis studies and their important concepts as well. In total, 539 kinds of key words were identified from the 2354 titles, and the identified words were all found to be in the International Nursing Index. On an average each title has two key words. Which key words were most frequently used, how they have changed with time, what kind of concept is preferably dealt with by each graduate school, and the concepts to which a given key word is likely to be connected were examined. The results are summerized below : 1) For each decade the theses numbers were as follows : 54(2.3%) from the 60’s, 413(17.5%) from the 70’s, 1523(64.7%) from the 80’s, and 364(15.5%) from the 90’s. Master’s thesis contributed 96% (2252) of the papers and Ph. D’s theses filled the remaining 4%(102). 2) A total of 539 key words were used, averaging about 2 for each thesis. The most frequently used key words were ‘Nurse’, ‘Anxiety’, ‘Knowledge / Attitude /Practice’, ‘Stress /Stressor’, ‘Attitude’, ‘Job-Satisfaction’, ‘Mental Disorder’, ‘Operation’, ‘Elderly’, ‘Nursing Role’. 3) Each decades key words can be classified as : the 60’s : ‘Nursing Education’, ‘Pulmonary Tuberculosis’, ‘Mother-Child Health’, ‘Growth & Development’, ‘Public Facilities’, ‘Mental Disorder’ : the 70’s : ‘Nurse’, ‘Family Planning’, ‘Attitude’ / ‘Knowledge, Attitude / Practice’, ‘Curriculum in Nursing Education’, ‘Clinical Practice in Nursing’, ‘Analysis of the Work of the Nurse’, ‘Health Education of School’, : the 80’s : ‘Nurse’, ‘Anxiety’, ‘Stress /Stressor’, ‘Operation’, ‘Nursing Role’, ‘Job Satisfaction’ : the 90’s : ‘Nurse’, ‘Elderly’, ‘Family-Support’, ‘Stress /Stressor’, ‘Home Care’. Key word ‘Nurse’ appears continuously and most frequently through the years, which indicates that there has been active study of the characteristics of nurses and related fields. The concept ‘Anxiety’ has been studied steadly from the 80’s and it shows that interest in health and disease are increasing Which comes as a result of society changing to an industrial and informational community. 4) Looking into each graduate school’s study area key words ‘Anxiety’, ‘Nurse’, ‘Mental Disorder’, ‘Stress /Stressor’, ‘Operation’, ‘Attitude’, ‘Hemo-dialysis’, were studied in the regular graduate school : ‘Family Planning /Contraception’, ‘Knowledge / Attitude /Practice’, ‘Physical Health-State /Physical Health Examination’, ‘Nurse’, ‘Using Clinical Facilities’, ‘Health Education of School’, were studied in the Graduate School of Public Health’ ; ‘Nurse’, ‘Anxiety’, ‘Stress / Stressor’, ‘Job-Satisfaction’, ‘Clinical Practice Education’, ‘Nursing Education’, were studied in the Graduate School of Education : ‘Nurse’, ‘Job Satisfaction’, ‘Nursing Role’, ‘Administration - Employment /Employment Management’, ‘Leadership’, ‘Personnel Profile’, ‘Nursing Manpower / Changing Working Place’, were studied in the Graduate School of Public Administration. 5) The Connection between key words were : ‘Nurse Job Satisfaction’, ‘Stress / Stressor ⇔ Coping / Ajustment’, ‘Nurse ⇔ Nursing Role’, ‘Anxiety ⇔ Giving Information’, ‘Nurse ⇔ Stress / Stressor’, ‘Anxiety ⇔ Operation’, ‘Nurse ⇔ Burnout’, ‘Knowledge, Attitude, Practice ⇔ Family Planning’, ‘Nurse Administration ⇔ Employment’, ‘Anxiety Muscle ⇔ Relaxation Technic’, ‘Anxiety ⇔ Mental Disorder’. From the above it can be noted that many nursing concepts were handled in the thesis titles. But there were more than enough papers on the characteristics of the nurse. It is suggested that in depth research be made on ‘Nursing Accidents’, t-‘Ethics’, ‘Nurse - Patient Interactions’, ‘Spritual Care’, ‘Dying’, ‘Hospice’, ‘Resident Helper’ and that there should be in depth research relating to the physical and mental development of youth and in particular physical concepts like ‘Drug - Abuse’, ‘Child -Abuse and Teaching’.

• Journal of the Korean Institute of Landscape Architecture
• /
• v.40 no.2
• /
• pp.1-14
• /
• 2012

The purpose of this study is to derive a desirable riverfront construction plan to me for the activities of citizens through the evaluation and analysis of the urban riverfront space from the perspective of universal design. Therefore, previous studies were examined in order to induce evaluation tools that bhve been grafted from the universal design concept; in addition, a field survey was conducted in Shincheon, Daegu, which was selected as the study target, in order to induce problems and improvement directions from the perspective of universal design. The major results can be summarized as follows. (1) In the 'fairness' aspect, all the items such as installation of integrated functional signage, showing pictures, symbols, foreign language signs, and restroom entrances signage were determined to be 'All Unsuitable' for all sections; and therefore, it is necessary to improve the fairness of usage for everybody. (2) In the 'Functionality(Usability)' aspect, all items such as installation of bicycle paths beside access roads, installation of integrated functional signs, and night light signs were determined to be 'All Unsuitable' for all sections; therefore, it is necessary to improve the functionalities of these facilities. (3) In the 'Convenience' aspect, all items such as the installation of bicycle parking areas, continuous rest facilities, and back and ann support(handles) at resting facilities were determined to be 'All Unsuitable' for many sections; therefore, it is necessary to improve these facilities for the convenience of usage. (4) In the 'Information(Recognizability)' aspect, all items such as showing pictures, symbols, foreign languages and installation of night light signs, and restroom entrances signage were determined to be 'All Unsuitable' for all sections; therefore, it is necessary to improve the recognizability to minimize misunderstandings and confusion. (5) In the 'Safety' aspect, all items such as the installation of safe pedestrian paths in parking areas, using anti-slip and shock absorption materials on restroom floors, and the continuous installation of pedestrian paths that are separate from bicycle paths were determined to be 'All Unsuitable' for all sections; therefore, it is necessary to improve the safety to prevent accidents. (6) In the 'Amenity' aspect, access roads, parking areas, hygiene facilities, convenience facilities, and waterside facilities for many sections were determined to be 'All Unsuitable'; therefore, it is necessary to conduct more concentrated hygiene management. (7) In the 'Accessibility(Mobility)' aspect, all items such as the installation of safe pedestrian paths in parking areas, and continuous pedestrian paths that are separate from bicycle paths were determined to be 'All Unsuitable' for all sections; therefore, it is necessary to improve the accessibility to provide safety and convenience. (8) In the 'Durability' aspect, access roads, parking areas, rest facilities, convenience facilities, fitness facilities, and waterside facilities were determined to be 'All Unsuitable' for many sections, therefore, it is necessary to improve sunken or damaged areas by inspecting facilities by section.

• The Korean Society of Law and Medicine
• /
• v.13 no.1
• /
• pp.199-247
• /
• 2012

According to the review and analysis of medical cases that are assigned to the Supreme Court and all local High Court in 2011 and that are presented in the media, it was found that the following categories were taken seriously, medical and pharmaceutical product liability, the third principle of trust between medical institutions, negligence and causation estimation, responsibility limit, the meaning of medical records and related judgment of disturbed substantiation, Oriental doctors' duties to explain the procedures, IMS events, whether one can claim for each medical care operated by non-physician health care institutions to the nonmedical domain in the National Health Insurance Corporation, and the basis of norms for each claim. In the cases related to medical pharmaceutical product liability, Supreme Court alleviated burden of proof for accidents with medical and pharmaceutical products prior to the practice of Product Liability Law and onset the point of negative prescription as the time of damage strikes to condition feasibility of the specific situation. In the cases related to the 3rd principle of trust between medical institutions, the Supreme Court refused to sentence the doctor who has trusted the judgment of the same third-party doctors the violations of the care duty. With respect to proof of a causal relationship and damages in a medical negligence case, the Supreme Court decided that it is unjust to deny negligence by the materials of causal relationship rejecting the original verdict and clarified that the causal relationship shall not deny the reasons to limit doctors' responsibilities. In order not put burden on patients with disadvantages in which medical records and the description of the practice or the most fundamental and important evidence to prove negligence and causation are being neglected, the Supreme Court admitted in the hospital's responsibility for the case of the neonate death of suffocation without properly listed fetal heart rate and uterine contraction monitor. On the other hand, the Seoul Western District Court has admitted alimony for altering and forging medical records. With respect to doctors' obligations to description, the Supreme Court decided that it is necessary to explain the foreseen risks by the combination of oriental and western medicines emphasizing the right of patient's self-determination. However, questions have arisen whether it is realistically feasible or not. In a case of an unlicensed doctor performing intramuscular stimulation treatment (IMS), the Supreme Court put off its decision if it was an unlicensed medical practice as to put limitation of eastern and western medical practices, but it declared that IMS practice was an acupuncture treatment therefore the plaintiff's conduct being an illegal act. In the future, clear judgment on this matter should be made. With respect to the claim of bills from non-physical health care institutions, the Supreme Court decided to void it for the implementation of the arrangement is contrary to the commitments made in the medical law and therefore, it is invalid to claim. In addition, contrast to the private healthcare professionals, who are subject to redemption according to the National Healthcare Insurance Law, the Seoul High Court explicitly confirmed that the non-professionals who receive the tort operating profit must return the unjust enrichment and have the liability for damages. As mentioned above, a relatively wide range of topics were discussed in medical field of 2011. In Korea's health care environment undergoing complex changes day by day, it is expected to see more diverse and in-depth discussions striding out to the development in the field of health care.

• Journal of Preventive Medicine and Public Health
• /
• v.30 no.3 s.58
• /
• pp.585-598
• /
• 1997

Background : Although there are growing concerns about the adverse health effect of air pollution, not much evidence on health effect of current air pollution level had been accumulated yet in Korea. This study was designed to evaluate the chronic health effect of ai. pollution using Korean Medical Insurance Corporation (KMIC) data and air quality data. Medical insurance data in Korea have some drawback in accuracy, but they do have some strength especially in their national coverage, in having unified ID system and individual information which enables various data linkage and chronic health effect study. Method : This study utilized the data of Korean Environmental Surveillance System Study (Surveillance Study), which consist of asthma, acute bronchitis, chronic obstructive pulmonary diseases (COPD), cardiovascular diseases (congestive heart failure and ischemic heart disease), all cancers, accidents and congenital anomaly, i. e., mainly potential environmental diseases. We reconstructed a nested case-control study wit5h Surveillance Study data and air pollution data in Korea. Among 1,037,210 insured who completed? questionnaire and physical examination in 1992, disease free (for chronic respiratory disease and cancer) persons, between the age of 35-64 with smoking status information were selected to reconstruct cohort of 564,991 persons. The cohort was followed-up to 1995 (1992-5) and the subjects who had the diseases in Surveillance Study were selected. Finally, the patients, with address information and available air pollution data, left to be 'final subjects' Cases were defined to all lung cancer cases (424) and COPD admission cases (89), while control groups are determined to all other patients than two case groups among 'final subjects'. That is, cases are putative chronic environmental diseases, while controls are mainly acute environmental diseases. for exposure, Air quality data in 73 monitoring sites between 1991 - 1993 were analyzed to surrogate air pollution exposure level of located areas (58 areas). Five major air pollutants data, TSP, $O_3,\;SO_2$, CO, NOx was available and the area means were applied to the residents of the local area. 3-year arithmetic mean value, the counts of days violating both long-term and shot-term standards during the period were used as indices of exposure. Multiple logistic regression model was applied. All analyses were performed adjusting for current and past smoking history, age, gender. Results : Plain arithmetic means of pollutants level did not succeed in revealing any relation to the risk of lung cancer or COPD, while the cumulative counts of non-at-tainment days did. All pollutants indices failed to show significant positive findings with COPD excess. Lung cancer risks were significantly and consistently associated with the increase of $O_3$ and CO exceedance counts (to corrected error level -0.017) and less strongly and consistently with $SO_2$ and TSP. $SO_2$ and TSP showed weaker and less consistent relationship. $O_3$ and CO were estimated to increase the risks of lung cancer by 2.04 and 1.46 respectively, the maximal probable risks, derived from comparing more polluted area (95%) with cleaner area (5%). Conclusions : Although not decisive due to potential misclassication of exposure, these results wert drawn by relatively conservative interpretation, and could be used as an evidence of chronic health effect especially for lung cancer. $O_3$ might be a candidate for promoter of lung cancer, while CO should be considered as surrogated measure of motor vehicle emissions. The control selection in this study could have been less appropriate for COPD, and further evaluation with another setting might be necessary.