• Journal of Korean Public Health Nursing
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• v.10 no.1
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• pp.118-138
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• 1996

Because of accelerated urbanization public body visiting nursing project that started according as matter of health on urban class in the lower brackets of income was concentrated on Social interests has a unsatisfied points to propel project efficiently from the lack of rating materials. Therefore centering around written contents in documentary literature of citizen health by household in five years from starting year of project to now. visiting frequency by medical manpower was evaluated quantitatively and qualitatively in aspect of management hereupon. for the sake of giving a basic materials for public health project of this field. This research presents documentary literature of citizen health which become materials is that as one person's charged region of nurse in duty scale. district is Kang-Buck Gu. the object is resident in the lower brackets of income grounded livelihood protection law and who is admitted by the head of organ~chief of health care). and the number of material centering around the head of a household is 415 copy. The result of research is summarized. as follow. 1. Average visiting frequency examinated by medical manpower show difference according to valuables of supervision characteristics namely average visiting. Frequency of nurse has long term residence in case registration season is early and supervision season is the first year and is high incase a kind of house is unlicdnsed mountain town. Average visiting frequency with doctor is high incase supervision season is the first year and the medical insurance system is admitted by chief of health care. That shows that a man of discomfort behavior left alone are yet many in local society. The meaning of this result shows that the continuity of official relation about class in the lowest brackets of income of long term residence goes well between househole who is a user of visiting nursing service of the object according to midway income under management influences a given duty of nurse s and so causes quantitative decrease. 2. In case behavier and condition of health that nurse diagnoses are bad. as the type matter is a lack of health and the number of patient is large. the average visiting frequency of nurse is high. because average visiting frequency with doctor is high as the condition of health is bad and the number of patient is large. That is similar with that of nurse. CD Average visiting frequency of nurse s seen by matter of disease is very high only in apoplexy by 39.50 and is confined within limits from 7.63 to 11.36 in other disease. But average visiting frequency with doctor is double as many as that of nurse but defined in apoplexy hypertension and articulate. (1) Average visiting frequency of nurse by existence in inoculation of hepatitis is low by 6.73 in unidentified group and very high by 26.89 in group of non-inoculation and the case of the antigenic positive man of B type hepatitis or epileptic who can't be inoculated shows 13.00 and that even family nursing service is needed to them. That result shows that though one person nurse of local charge has a large scale of duty. as visting nursing service is given a class who has a large demand preferentially by respectively accurate nursing diagnosis. the number of diagnosis service is similar with it. 3. During five years. average visiting frequency of nurse is 10.84 and average visiting frequency with doctor is 76.50 seeing from the official scale of nurse. visiting by household is performed two more per year to the average. Seeing this by type of service. average visiting frequency of nurse is higher in indirectly nursing than in directly nursing and that suggests that at the time of visiting household nurse performs education of protection lively save patient but at the time of contrastedly visiting with doctor. directly nursing is more contents of service show no difference by man power and medication dressing by demand is 14.3 and 18.6 the aid of hardship term of doctor and nurse is high by 18.7 and 17.00 in the request of hospitalization when seeing by demands. 4. Action by turns exemplified 1994 is well in sequence of 2/4 turn. 3/4 turn. 1/4 turn. 4/4 turn. When seen by average visiting frequency of nurse but gradually is even. Without difference by turns. average visiting frequency of doctor is much higher in 1/4 turn than other turns. Type of service by turns is all even but directly nursing is inactive in 4/4 and indirectly nursing. Very increases in 4/4 and so. Nurse's quantity of duty is plentiful that shows that by evaluation of last turn and plan of project. Contents of service follows that medication and dressing is the highest by' 5.57 in 1/4turn. goes down gradually by turn. becomes 3.57 in 3/4 turn. and increases again by 4.83 in 4/4 turn. the rest service is higher in 2/4 turn than other turns. 5. Total visiting frequency of nurse is explained to total $37.5\%$ by six valuables of visiting frequency of doctor. nursing demand. demand of diagnosis. condition of behavior. year. Special terms and magnitude of influential power is the same as sequence of enumerated valuables. Namely. the higher the visiting frequency of doctor. the bigger nursing and demand of diagnosis is. the worse the condition of behavior is. the older the object is and the more the household of special terms is. the high total visiting frequency of nurse is.

• Journal of agricultural medicine and community health
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• v.37 no.2
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• pp.67-75
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• 2012

Objectives: While there have recently been efforts to improve public health service at a governmental level, there is actually insufficient research on awareness of the roles related to public health service among hospital employees. This study examined role perception and function performance related to public health service among the medical staff in a national hospital. Methods: 15% were randomly sampled from each type of occupation among the medical staff in a national university hospital, a survey was conducted in 323 persons, and there were a total of 265 participants (80.2%): 103 doctors(38.9%), 98 nurses (37.0%), and 64 others (24.1%). Results: The hospital employees had insufficient awareness of their roles as public health service providers in terms of six required items for public health service: 1) services for supporting establishment, implementation, and assessment of public health service policies, 2) participation in the health service activities and support services by central or local governments, 3) technological support and educational services for private health service institutions, 4) health service for unprivileged brackets, 5) health service that requires association with other areas dealing with geriatric, disabled, and mentally-disordered people, and 6) health service for children and mothers. Conclusions: In general, since the hospital employees had insufficient awareness of their roles and responsibilities as public health service providers, it is necessary to secure manpower exclusively in charge of public health service and provide education about strategic public health service.

• Korean Journal of Health Education and Promotion
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• v.1 no.1
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• pp.83-97
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• 1983

The present study is to provide information for the improvement of school health services through research on the current condition of its organization and practice in universities, colleges and junior colleges. The scope of this study is consisted of four components including health organizations/units, school health services, environmental sanitation and health education for the 30 universities, the 20 colleges and the 32 junior colleges in Korea. The major findings are summarized as follows: (1) Among the sampled schools, around 73% of them have the health service organization/unit. When we break down health service organization/unit into the types by the level of school, around 73% of the universities have formal organization called "health center" and 20.0% of them have an informal organization called "health room". For the colleges level, 30.0% of them have the "health center" and 40.0% of them have the "health room". The figure of junior colleges is a quite different from universities and colleges, 56.3% of junior colleges have the "health room" only but the other have no service organization at all. (2) It was found that only 22.0% of 82 schools have the health committee for the school health services. It might be necessary to have a kind of expert committee to establish an annual health service program, budget and health policy in the school. (3) Approximately 29% of those schools having formal health organizations/units appointed directors as a medical persons. 13.4% of the sampled schools are appointed doctors (including the dentists) at health service organization/unit, 9.8% are appointed pharmacist and 65.9% are appointed nurses. Therefore, the data imply that the school health services are depending mainly on nurses. (4) The major activities of school health services are covering primary medical care (84.1%), health counseling (72.0%), physical examination (68.3%), vaccination (58.5%), tuberculosis control (54.9%), parasite control (29.3%) and dental health case(9.8%). Also 69.5% of the schools have the program on the environmental sanitation and the health education program. (5) In regard to health budget taking account of 34 schools, approximately 92% of them have less than 5,000 won per students and only 8.8% of them have more 10,000 won per students. At the average health budget per students is 4089.8 won in universities, 1617.1 won in colleges and 475.0 won in junior colleges. (6) The students enjoy the benifit of medical insurance at 11.0% of 82 schools surveyed. They are all universities. (7) The study found that 56 universities, colleges and junior colleges provide the annual physical examination. Only 21.4% of them have provided it for all students and school employees. (8) 64.3% of the 56 schools surveyed keep a record of the regular physical examinations. Records must be utilized as the basic data for the evaluation of the student's health condition and so the individual student is encouraged to take care of his own health. (9) At the 59 schools which practice health counseling, the main concerns of the counsellees are venereal disease, tuberculosis and psychoneurosis. This shows the need to practice health education in the area of preventive medicine. (10) 69.5% of the 82 universities, colleges and junior colleges surveyed are concerned with supervision of the environmental sanitation in their school, but non-professionals are in charge at 70.1% of them. This indicates negligence in environmental sanitation. (11) 53.7% of the 82 schools responded that they have no special instructive measure for the students' health and 54.9% are found to be negative in the use of a health education method. This reveals a problem. They are not positive to the recognition of their function as the initiative organization for the students' health. (12) The supplementary education for the faculty of the school health services is executed only at 8.5% of all the schools surveyed.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.528-531
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• 2004

Purpose: PET has some disadvantage in the imaging of small animal due to poor resolution. With the advent of microPET scanner, it is possible to image small animals. However, the image quality was not good enough as human image. Due to larger brain, cat brain imaging was superior to mouse or rat. In this study, we established the cat brain infarction model and evaluate it and its temporal charge using microPET scanner. Materials and Methods: Two adult male cats were used. Anesthesia was done with xylazine and ketamine HCl. A burr hole was made at 1cm right lateral to the bregma. Collagenase type IV 10 ${\mu}l$ was injected using 30 G needle for 5 minutes to establish the infarction model. $^{18}F$-FDG microPET (Concorde Microsystems Inc., Knoxville, TN) scans were performed 1, 11 and 32 days after the infarction. In addition, $^{18}F$-FDG PET scans were performed using human PET scanner (Gemini, Philips medical systems, CA, USA) 13 and 47 days after the infarction. Results: Two cat brain infarction models were established. The glucose metabolism of an infarction lesion improved with time. An infarction lesion was also distinguishable in the human PET scan. Conclusion: We successfully established the cat brain infarction model and evaluated the infarcted lesion and its temporal change using $^{18}F$-FDG microPET scanner.

• Journal of Intelligence and Information Systems
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• v.16 no.2
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• pp.73-94
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• 2010

The attending system is a medical system that allows doctors in clinics to use the extra equipment in hospitals-beds, laboratory, operating room, etc-for their patient's care under a contract between the doctors and hospitals. Therefore, the system is very beneficial in terms of the efficiency of the usage of medical resources. However, it is necessary to develop a strong support system to strengthen its weaknesses and supplement its merits. If doctors use hospital beds under the attending system of hospitals, they would be able to check a patient's condition often and provide them with nursing care services. However, the current attending system lacks delivery and assistance support. Thus, for the successful performance of the attending system, a networking system should be developed to facilitate communication between the doctors and nurses. In particular, the nursing records in the attending system could help doctors monitor the patient's condition and provision of nursing care services. A nursing record is the formal documentation associated with nursing care. It is merely a data repository that helps nurses to track their activities; nursing records thus represent a resource of primary information that can be reused. In order to maximize their usefulness, nursing records have been introduced as part of computerized patient records. However, nursing records are internal data that are not disclosed by hospitals. Moreover, the lack of standardization of the record list makes it difficult to share nursing records. Under the attending system, nurses would want to minimize the amount of effort they have to put in for the maintenance of additional records. Hence, they would try to maintain the current level of nursing records in the form of record lists and record attributes, while doctors would require more detailed and real-time information about their patients in order to monitor their condition. Therefore, this study developed a system for assisting in the maintenance and sharing of the nursing records under the attending system. In contrast to previous research on the functionality of computer-based nursing records, we have emphasized the practical usefulness of nursing records from the viewpoint of the actual implementation of the attending system. We suggested that nurses could design a nursing record dictionary for their convenience, and that doctors and nurses could confirm the definitions that they looked up in the dictionary through negotiations with intelligent agents. Such an agent-based system could facilitate networking among medical institutes. Multi-agent systems are a widely accepted paradigm for the distribution and sharing of computation workloads in the scientific community. Agent-based systems have been developed with differences in functional cooperation, coordination, and negotiation. To increase such communication, a framework for a multi-agent based system is proposed in this study. The agent-based approach is useful for developing a system that promotes trade-offs between transactions involving multiple attributes. A brief summary of our contributions follows. First, we propose an efficient and accurate utility representation and acquisition mechanism based on a preference scale while minimizing user interactions with the agent. Trade-offs between various transaction attributes can also be easily computed. Second, by providing a multi-attribute negotiation framework based on the attribute utility evaluation mechanism, we allow both the doctors in charge and nurses to negotiate over various transaction attributes in the nursing record lists that are defined by the latter. Third, we have designed the architecture of the nursing record management server and a system of agents that provides support to the doctors and nurses with regard to the framework and mechanisms proposed above. A formal protocol has also been developed to create and control the communication required for negotiations. We verified the realization of the system by developing a web-based prototype. The system was implemented using ASP and IIS5.1.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.6
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• pp.469-477
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• 2008

Purpose: The goal of this paper is to present the design and performance of a position encoding circuit for $16{\times}16$ array of position sensitive multi-anode photomultiplier tube for small animal PET scanners. This circuit which reduces the number of readout channels from 256 to 4 channels is based on a charge division method utilizing a resistor array. Materials and Methods: The position encoding circuit was simulated with PSpice before fabrication. The position encoding circuit reads out the signals from H9500 flat panel PMTs (Hamamatsu Photonics K.K., Japan) on which $1.5{\times}1.5{\times}7.0\;mm^3$ $L_{0.9}GSO$ ($Lu_{1.8}Gd_{0.2}SiO_{5}:Ce$) crystals were mounted. For coincidence detection, two different PET modules were used. One PET module consisted of a $29{\times}29\;L_{0.9}GSO$ crystal layer, and the other PET module two $28{\times}28$ and $29{\times}29\;L_{0.9}GSO$ crystal layers which have relative offsets by half a crystal pitch in x- and y-directions. The crystal mapping algorithm was also developed to identify crystals. Results: Each crystal was clearly visible in flood images. The crystal identification capability was enhanced further by changing the values of resistors near the edge of the resistor array. Energy resolutions of individual crystal were about 11.6%(SD 1.6). The flood images were segmented well with the proposed crystal mapping algorithm. Conclusion: The position encoding circuit resulted in a clear separation of crystals and sufficient energy resolutions with H9500 flat-panel PMT and $L_{0.9}GSO$ crystals. This circuit is good enough for use in small animal PET scanners.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.253-273
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• 2007

Objective: This study was to find ways to let a manager or superintendent rationally and consistently inspect as well as let a embryologist precisely record [The Book of Supernumerary Embryo Preservation] and [The Book of Supernumerary Embryo Donation]. Methods: Based on the data collected between 1994 and 2004 in Clinic 44 (Maria Fertility Hospital), [The Present State about Production and Use of Embryos], [The Preservation of Supernumerary Embryos and Their Thaw State], [The Present State about Thaw and Use of Frozen Embryos], [The Present State about Donation and Charge of Frozen Embryos], [The Book about Frozen Embryo Discard], and [The Summarization Book about Management and Use of Frozen Embryos] were designed and recorded. Results: The production, use, preservation, discard and donation quantity of human embryos, the use and discard quantity of thawed embryos, and the cumulative embryo preservation quantity could be totalized in [The Present State about Production and Use of Embryos in Clinic 44]. Also, [The Preservation of Supernumerary Embryos and Their Thaw State in Clinic 44] supported "the supernumerary embryo preservation quantity" etc. In addition, [The Present State about Thaw and Use of Frozen Embryos in Clinic 44] or [The Book about Frozen Embryo Discard in Clinic 44] supported "the use and discard quantity of thawed embryos" etc. Moreover, "The embryo donation quantity" could be totalized in [The Present State about Donation and Charge of Frozen Embryos in Clinic 44]. Finally, [The Summarization Book about Management and Use of Frozen Embryos in Clinic 44] could be used for rational and consistent management or inspection. Conclusion: The present results suggest that the documents not only be standard data to record [The Book about Supernumerary Embryo Preservation in Clinic] and [The Book about Supernumerary Embryo Donation in Clinic] but can also be preserved as treatment references.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.10
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• pp.6158-6167
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• 2014

The aim of this study was to perform comparative analysis of the duties of 7 new roles of HIMs in Malaysian and Korean hospitals of a similar scale. A Malaysian general hospital with a scale of 272 hospital beds was chosen. The researcher visited a Malaysian hospital in person and interviewed the staff in charge over a 2 week period from July 22nd 2013 to August 2nd 2013. For domestic hospitals, 13 general hospitals with 270 hospital beds, similar to the Malaysian general hospital, were chosen. Phone interviews with the department recorded the duty recording work. Regarding 7 new roles of Health Information Manager (HIM), although the role as a Health information manager and Security Officer in Malaysian general hospital was not defined, 30.8% performed their role in Korean general hospitals. The classification of disease & procedure within the role of Clinical data specialist was performed by both countries, and while the tumor registry was done in a Malaysian general hospital, only 15.4% of Korean general hospitals were operating. The statistics of the discharged patients were not measured in the Malaysian general hospital but 76.9% of Korean general hospitals recorded these statistics. Although 22.1% of Korean general hospitals operated registration work of special disease, Malaysian general hospital not only had a total legal contagious disease registration, but also took charge of information registration of hospital births and deceased ones. Other than these, the Patient Information Coordinator, Data Quality Manager, Document and Repository Manager, Research and Decision Support Analyst roles were not done by either country. The new role of HIM is operated in a low percentage in Korean middle and small hospitals. Therefore, to clearly establish the role of HIM in Korea, and have middle and small hospitals to operate such a role, it is essential for the related association to give continuous education and provide support to clarify the role within the hospital working environment. It is desirable to benchmark Malaysian general hospital's registration work on special diseases and others, and expand the work to improve overall.

• Journal of Korean Medical classics
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• v.10
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• pp.450-493
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• 1997

Three-yum and three-yang(三陰三陽) is the change state of yum-yang(陰陽) which is caused by six gi(六氣). They mean the flow of six gi(六氣) which exist throughout the viscera, the channel(經絡), and the skin. But it is not easy to understand the meaning because the contents of the attribute of three-yum and three-yang(三陰三陽), the bolt-leaf-hanges(關闔樞) theory and large or small of gi-blood(氣血多少) which is the main clue that explain it in ${\ll}$Somun(素問)${\gg}$ and ${\ll}$Yeongchu(靈樞)${\gg}$ don't coincide with each other. I, the writer, tried to understand the uncertain meaning and the contents which are written about three points above differently in each of the books that are ${\ll}$Somun(素問)${\gg}$ and ${\ll}$Yeongchu(靈樞)${\gg}$. So, from that the course that the book, ${\ll}$Huangjenegeong(黃帝內經)${\gg}$ is handed down is so relatively simple in a wood block-printed book, that the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ has less wong-words than the Somun(素問) and the Yeongchu(靈樞), and from that Yangshangsun(楊上善) wrote the note in the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ by royal order about 100 years former than Wangbing(王氷), as making projects of Yangshangsun(楊上善)'s note and the original of the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ which has relation to the yum-yang(陰陽) attribute of three-yum and three-yang(三陰三陽), the bolt-leaf-hanges(關闔樞) theory, and the large or small of gi-blood(氣血多少) and researching the Yangshangsun(楊上善)'s theory. The result is summarized like this. First, wherease the order of the change of three-yum and three-yang(三陰三陽) which is explained by Yangshangsun(楊上善) consider the change of yangi(陽氣) in body most important, the order of the change gaeggi(客氣)'s three-yum and three-yang(三陰三陽) considers chungi(天氣) most important, and the order of jugi(主氣)'s three-yum and three-yang(三陰三陽) considers jigi(地氣)'s change of ohaeng(五行) most important. If the order of change three-yum and three-yang(三陰三陽) in the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ is considered, each of taeyang(太陽) and soyum(少陰) are expressed as the base of yum-yang(陰陽) and yangmeong(陽明) and taeyum(太陰) are expressed as the palmy days of yum-yang(陰陽), soyang(少陽) and gyolyum(厥陰) are expressed as pacemaker(樞杻) which controls the change of yum-yang(陰陽). Thus, each has something in common that is fettered by the inside and outside. In the flow of channel(經絡), taeyang(太陽) and soyum(少陰) take charge of the behind of body, yangmeong(陽明) and taeyum(太陰) take charge of the front of body and soyang(少陽) and gyolyum(厥陰) take of the side of body. Second, in Yangshangsun(楊上善)'s bolt-leaf-hanges(關闔樞) theory, three-yum(三陰) is regarded as inside, three-yang(三陽) as outside, so when bolt, leaf and hanges fulfil their duties in inside and outside, the life(life force) is thought to be revealed normally. It is impossible to understand the bolt-leaf-hanges with the conception of the inside and outside which divide three-yum and three-yang(三陰三陽) into taeyang-soyum(太陽-少陰), yangmeong-taeyum(陽明-太陰), soyang-gyolyum(少陽-厥陰) according to yum-yang(陰陽) attribute, hence it need the special conception that is taeyang(太陽)-taeyum(太陰), yangmeong(陽明)-gyolyum(厥陰), soyang(少陽)-soyum(少陰) which center on their duties in inside and outside. In the denunciation of the word open(開) and bolt(關), because Yangshangsun(楊上善) said that the duities of taeyang(太陽) and taeyum(太陰) are shutter(閉禁), bolt(關) is coincided with that significance. Third, with explaining the large or small of gi-blood(氣血多少) of three-yum and three-yang(三陰三陽), Yangshangsun(楊上善) expressed the inside and outside either in the same way or differently. Because the inside and outside is interior of body and exterior of body, it is the explanation that is noticed by the fact that the property of large or small of gi-blood(氣血多少) is either able to be same or different. In this viewpoint, if we unite the contents about large or small of gi-blood(氣血多少) of ${\ll}$Somun(素問)${\gg}$, ${\ll}$Yeongchu(靈樞)${\gg}$, we will find that the descriptions of large or small of gi-blood(氣血多少) of three-yang(三陽) in ${\ll}$Somun(素問)${\gg}$ ${\ll}$Yeongchu(靈樞)${\gg}$ correspond with the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$, but in three-yum(三陰), the contrary presentations exit. The reason is that large or small of gi-blood(氣血多少) of three-yum(三陰) isn't only expressed as che(體) in the point of che-yong(體用), but as a point of yong(用) that is a phenomenon. As researching the original of ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ and Yangshangsun(楊上善)'s notes as a center about three problems that are yum-yang(陰陽) attribute, the bolt-leaf-hanges(關闔樞) and large or small of gi-blood(氣血多少) of three-yum and three-yang(三陰三陽), I, the writer, tried to explain the part which is written differently or has uncertain conception in the book ${\ll}$Somun(素問)${\gg}$ and the book ${\ll}$Yeongchu(靈樞)${\gg}$, but the concrete result of the work like this will be judged according to the question how many theories are correspondent with real presence at a sickbed. Hence, the work to veryfy the theories in the future will be left as assignment.

• Journal of Environmental Health Sciences
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• v.25 no.3
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• pp.94-102
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• 1999

To estimate the effects of environmental noise on inhabitants' life in an apartment area at Taejon, noise levels and traffic volume of major roads were measured. 203 housewives were surveyed by questionaires including general factors, noise related factors and three items of life effects: subjective evaluations on the general environment, annoyance, and life disturbance due to environmental noise. At the boundary adjacent to the road with more traffic volume, noise level was higher; according to the time, the amount of noise level was in the morning, in the evening, at noon, and at night in order. Most of boundary noise levels were higher than those of recommended standard environmental noise levels in a residential area. The boundary noise level showed a very significant linear relationship with traffic volume of near roads. Noise level difference in the apartments adjacent to three roads was ranged 2.4~6.7dB between in windows open and close state. The apartments adjacent to 9 lane or 6 lane-road, which were protected by noise prevention wall and 20m or more distance from the roads, showed higher noise level at middle floors and high floors than those of low floors; but the buildings adjacent to 4 lane-road, with no protection, showed higher noise level at low and middle floors than those of high floors. Among 203 housewives, 120(59.1%) participated in this study, and 86(73.2%) of them answered that the most serious environmental noise was traffic noise from near roads. Comparing traffic noise levels with those of before-migration, 67.0% participants found the environmental noise became louder. Fifty eight(49.5%) of the participants wanted noise protection wall and 15(25.9%) of them were willing to charge the fee. Less perception on the present noise comparing to those before-migration, less traffic volume, and lower noise levels in the apartments were related to higher scores of self-evaluation on the environment. Higher susceptibility on the present noise, areas with more traffic volume, higher boundary noise levels, and higher noise levels showed higher scores of annoyance on environmental noise and life disturbance. Considering above all things, it was suggested that traffic noise in this area was the major problem of environmental noise, and its' effect was so serious that inhabitants needed some preventive measures for better life quality.