• Journal of Korean Academy of Nursing
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• v.41 no.4
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• pp.500-509
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• 2011

Purpose: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Methods: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. Results: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. Conclusion: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

• Magazine of the Korean Society of Agricultural Engineers
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• v.45 no.5
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• pp.160-170
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• 2003

A pilot study was performed to examine the feasibility of intermittent slow sand filtration for agricultural reuse of reclaimed water. The effluent of biofilter for 16-unit apartment was used as influent to the slow sand filtration system at 0.6 $m^3$/day loading rate using 15 seconds spray in every 10 minutes on the about 1 $m^2$ surface area and 0.5 m depth. The influent concentrations of total coliform (TC), fecal coliform (FC) and E. coli were in the range of 10.000 MPN/100 mL. and they were reduced to less than 1,000 MPN/100 mL after filtration with average of 320, 270, and 154 MPN/100 mL, respectively, showing over 95 % removal. Turbidity and SS were improved effectively and their average concentration was reduced to 0.8 NTU and 1.7 mg/L, respectively, and removal rate was about 50 %. Average BOD and COD concentrations were also reduced substantially to 2.6 and 25.8 mg/L with about 55 and 21 % removal rate, respectively. Nutrients removal was relatively low and removal rate for T-N and T-P was low however, remaining nutrients might be beneficial and less concerned in case of agricultural reuse. The concentration of biofilter effluent used in this experiment was in the range of secondary treatment effluent but slightly stronger than the one from existing wastewater treatment plants (WWTPs). Therefore, intermittent slow sand filtration might be also applicable to the effluent from WWTPs as long as its agricultural reuse is available. Considering stable performance and effective removal of bacterial indicators as well as other water quality parameters, low maintenance, and cost-effectiveness, the intermittent slow sand filtration was thought to be an effective and feasible alternative for agricultural reuse of reclaimed water. This paper is a preliminary result from pilot study and further investigations are recommended on the optimum design parameters before full scale application.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.84-93
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• 2024

Objective : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.

• Health Policy and Management
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• v.7 no.1
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• pp.100-124
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• 1997

In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

• Asian-Australasian Journal of Animal Sciences
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• v.30 no.2
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• pp.187-191
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• 2017

Objective: An experiment was conducted to examine the effect of dietary supplementation of dried and ground foliage of black gram (Vigna mungo L.) on feed intake and utilization, and production performance of crossbred lactating cows. Methods: Eighteen lactating crossbred (Bos taurus${\times}$Bos indicus) cows (body weight $330.93{\pm}10.82kg$) at their second and mid lactation (milk yield $6.77{\pm}0.54kg/d$) were randomly divided into three groups of six each in a completely randomized block design. Three supplements were formulated by quantitatively replacing 0, 50, and 100 per cent of dietary wheat bran of concentrate mixture with dried and ground foliage of black gram. The designated supplement was fed to each group with basal diet of rice straw (ad libitum) to meet the requirements for maintenance and milk production. Daily feed intake and milk yield was recorded. A digestion trial was conducted to determine the total tract digestibility of various nutrients. Results: The daily feed intake was increased (p<0.05) with the supplementation of black gram foliage. Although the digestibility of dry matter, organic matter, crude protein, and ether extract did not vary (p>0.05), the fibre digestibility was increased (p<0.05), which ultimately improved (p<0.05) the total digestible nutrients content of composite diet. Although, the average milk yield (kg/animal/d) and composition did not differ (p>0.05) among the groups, milk yield was increased by 10 per cent with total replacement of wheat bran in concentrate mixture with of black gram foliage. The economics of milk production calculated as feed cost per kg milk yield (INR 10.61 vs 7.98) was reduced by complete replacement of wheat bran with black gram foliage. Conclusion: Black gram foliage could be used as complete replacement for wheat bran in concentrate mixture of dairy cows in formulating least cost ration for economic milk production in small holders' animal production.

• Korean Journal of Community Nutrition
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• v.16 no.2
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• pp.195-205
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• 2011

This study was conducted to investigate the time spent, activity coefficient and energy expenditure on 7 different types of activity. Total of 386 5th and 6th grade primary school boys and girls in Seoul participated in this study. The participants spent 8 hrs for rest, 4 hrs for out of school study, 3 hrs for leisure, 1 hr 45 mins. for hygiene, 1 hr for commute, and 15 mins. for house choir activity in the day of 6 class hours. The average activity coefficient of 1 day for boys and girls were 1.69 and 1.64, respectively. The TEEs were 2,382 kcal and 2,050 kcal for boys and girls, respectively. The energy cost for study related activity (in school and study activities) was 40% of the TEE, and for rest 20%, for commute 9%, and for hygiene 10% of the TEE. The energy cost for house choir was only about 2% of TEE. The 91.2% participant's EER was higher than the EER shown in the table of 2010 DRI for Koreans. When the participant's EER was compared with the energy allowance calculated by the method in 2000 RDA for Korean, 81.6% was in the range of ${\pm}5%$, and the correlation coefficients between the 2 values were 0.981 for boys and 0.978 for girls, which means high agreements.

• Health Policy and Management
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• v.22 no.3
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• Journal of Preventive Medicine and Public Health
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• v.36 no.4
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• pp.339-348
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• 2003

Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

• Journal of The Korean Society of Grassland and Forage Science
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• v.38 no.3
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• pp.180-189
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• 2018

The present study was conducted to evaluate the effects of high levels of nutrients on the growth performance, blood metabolites and carcass characteristics of Hanwoo cattle. Eighteen Hanwoo steers were fed two types of diets: 1) Nine animals were fed the conventional diet including typical levels of crude protein (CP) and total digestive nutrients (TDN), and 2) Nine animals were fed the treatment diet including high levels of CP and TDN. The average body weight (BW) and dry matter intake (DMI) were greater (P < 0.05) in the treatment group than in the conventional group at early and late fattening stages. Also, in the treatment group, the average daily gain (ADG) was greater (P < 0.05) at the late fattening stage. The serum total lipid and cholesterol levels were higher (P < 0.05) in the late fattening stage of treatment group. The carcass weight, total fat weight, longissimus muscle area and the grade of meat quality were also greater (P < 0.05) in the treatment group than the conventional diet group. This study demonstrates that high levels of CP and TDN exhibit a positive effect on the growth performance and carcass characteristics, indicating that high levels of CP and TDN can be used as a cost-effective feeding program for Hanwoo cattle by shortening the feeding period.

• Asian-Australasian Journal of Animal Sciences
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• v.11 no.5
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• pp.586-596
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• 1998

The relevance and importance of buffalo production under coconut plantations in the North Westen Province of Sri Lanka was studied in three districts (Bingiriya, Pannala, Kuliyapitiya). The objective of the study was to collect baseline information on socioeconomic and cultural aspects of buffalo production, with a view to promote and disseminate new technologies. The survey technique used consisted of a formal survey using a structured questionnaire (71 households) and rapid appraisal (55 households). The results indicate the existence of a wide stratification of dariy farmers which ranged from skilled dairy operators with high levels of production and management of efficiency to marginal subsistence farmers with low levels of productivity. The most frequent family size of households ranged from 4-5 members (58%), and the average family size was 4.7. The actual average land ownership accounts to 2.4 ha of upland and 0.5 ha of lowland, but when their accessibility to common property resources are taken into account, the land availability was assessed at 13 ha and 0.7 ha of upland and lowland, respectively. The highest average monthly income (Rs. 13,590) was received by farmers with off-farm employment (primary) who are also engaged in livestock production (secondary), and livestock contributed 43% of the total income. Livestock farmers who practised integrated crop farming as a secondary source of income received a monthly income of Rs. 10,843, and those involved in crop production as the primary source received the lowest average income (Rs. 7,295). The survey revealed a high investment cost on concentrate feeds (47%) for milk production. However some farmers obtained higher milk yields (11 litres/cow/day) at lower ration costs, and this could be attributed to the entrepreneurship skills and management efficiency. The study area had a well developed market infrastructure for fresh milk, principally due to the existence of the Nestle's company and the Coconut Triangle Milk Union. On an average the producer collected Rs. 10 per litre of milk marketed.