• Health Policy and Management
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• v.33 no.1
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• Journal of the Korean institute of surface engineering
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• v.56 no.6
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• pp.393-400
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• 2023

Acetone, a metabolite detected from the exhaled breath of people doing a diet, can be used for non-invasive monitoring of diet efficiency. Thus, gas sensors with rapid response and recovery characteristics to acetone need to be developed. Herein, we report ultrafast acetone sensors using Ce-doped In₂O₃ nanoparticles prepared by the one-pot microwave-assisted hydrothermal method. The pure In₂O₃ sensor shows a high response and fast response time (τ_res = 6 s) upon exposure to 2 ppm acetone at 300 ℃, while exhibiting a relatively sluggish recovery speed (τ_recov = 1129 s). When 20 wt% Ce is doped, the τ_recov of the sensor significantly decreased to 45 s withholding the fast-responding characteristic (τ_res = 6 s). In addition, the acetone response (resistance ratio, S) of the sensor is as high as 5.8, sufficiently high to detect breath acetone. Moreover, the sensor shows similar acetone sensing characteristics even under a highly humid condition (relative humidity of 60%) in terms of τ_res (6 s), τ_recov (47 s), and S (4.7), demonstrating its high potential in real applications. The excellent acetone sensing characteristics of Ce-doped In₂O₃ nanoparticles are discussed in terms of their size, composition, phase, and oxygen adsorption on the sensing surface.

• Journal of Korean Society of Forest Science
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• v.106 no.3
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• pp.288-299
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• 2017

This study was conducted to find out the influence of drought stress on physiological responses of Synurus deltoides. Drought stress was induced by withholding water for 25 days. Leaf water potentials were decreased of both predawn (${\Psi}_{pd}$) and mid-day (${\Psi}_{mid}$) with increasing drought stress, but water saturation dificit (WSD) was 7 times increased. ${\Psi}_{pd}-{\Psi}_{mid}$ showed the significant difference of 0.22~0.18 MPa in stressed before 10 days, and nonsignificant as treatment time became longer. A strong reduction of stomatal conductance ($gH_2O$) and stomatal transpiration rate (E) were observed after 15 days of drought stress Significant reductions of net apparent quantum yield (${\Phi}$) and maximum photosynthesis rate ($Pn_{max}$) were observed after 20 days of drought stress; However, water use efficiency (WUE) was shown the opposite trend. This implies that decrease of photosynthesis rate may be due to an inability to regulate water and $CO_2$ exchanged through the stomata. From JIP analysis, flux ratios (${\Psi}_O$ and ${\Phi}_{EO}$) and performance index on absorption basis ($PI_{ABS}$) were dramatically decreased withholding water after 15 days, which reflects the relative reduction of photosystem II activity. The leaf of S. deltoides showed osmotic adjustment of -0.35 MPa at full turgor and -0.40 MPa at zero turgor, and also cell-wall elastic adjustment of 9.4 MPa, indicating that S. deltoides tolerate drought stress through osmotic adjustment and cell-wall elastic adjustment. The degree of change in water relations parameters such as Vo/DW, Vt/DW decreased with increasing drought stress. This result showed that S. deltoides was exhibited a strong reduction of photosynthetic activity to approximately -0.93 MPa of predawn leaf water potential, and both of osmotic adjustment and cell-wall elastic adjustment in drought stress condition appears to be an important adaptation for restoration in this species.

• Journal of Hospice and Palliative Care
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• v.11 no.3
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• pp.140-146
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• 2008

Purpose: Sooner of later, end-of-life care decision-making will unfold and be settled during the professional lives of medical students. However, there is prevalent ambiguity and uncertainty between the palliative treatment and euthanasia. We conducted this survey to investigate attitudes of medical students towards end-of-life making decisions, and to find out which factors primarily influenced the attitudes. Methods: A study was conducted among medical students at one university, the Republic of Korea. A written questionnaire was sent to all the 1st, 2nd, and 3rd-year medical students. It presented 5 statements on end-of-life decision-making. Students were asked whether they agreed or disagreed with each statement. Results: The response rate was 74.4%, and 267 questionnaires were analyzed. Percentages of agreement with each statements on Voluntary active euthanasia (VAE), Physician assisted suicide (PAS), Withholding life-sustaining management, Withdrawing life-sustaining management, and Terminal sedation (TS) was 37.1%, 21.7%, 58.4%, 60.3%, and 41.6%, respectively. The grade of students, religious activity, and educational experience were determinant factors. Agreement on each statements was higher in the low religious activity group than in the high religious activity group. Agreement on TS was higher among 3rd year students during their clerkship than among 1st and 2nd year students. Age of students and the experience of dying-people care had no significant influence. Conclusion: In end-of-life decision-making, religious and educational factors influenced medical students' attitudes. Especially, the experience of education during clerkship had significant influence on the attitude. Proper teaching on end-of-life decisions should further be considered during medical students' clerkship.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.59 no.1
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• pp.54-58
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• 2014

Climate change may result in greater risk of yield reduction of waxy corn due to drought stress and maize is one of the sensitive crops to the soil moisture shortage. While irrigation is the most effective practice to reduce the drought damage, farmers are unable to apply water due to limited water resource and irrigating facilities. The study was conducted to investigate the application effect of salicylic acid and abscisic acid on reducing drought stress of waxy corn (Zea mays L.). Drought stress was imposed by withholding irrigation from 9 days before anthesis to 14 days after anthesis. Salicylic acid or abscisic acid was applied on tasseling date at concentration of 0.5 mM and 0.1 mM, respectively. Drought stress increased anthesis-silking interval (ASI) by 3.0~3.3 days and decreased plant height, ear length, ear diameter, number of rows in ear, and yield by 47~51 cm, 4.6~5.0 cm, 4.4~5.3 mm, 1.5~2.0, and 2.4~2.5 Mg/ha, respectively. Application of salicylic acid and abscisic acid did not significantly reduced the drought injuries of waxy corn. Pretreatment of the plant growth regulators before water deficit stress or divided application at low concentration may be required to obtain the reduction effect on drought stress of waxy corn.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.48 no.6
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• pp.506-515
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• 2003

Six barley varieties that showed different degree of drought tolerance were grown with and without drought stress treatment (control), and investigated for the temporal changes in growth and several physiological traits after drought treatment. Soil water potential was -0.05 ㎫ at the initial stage of drought treatment and dropped to -0.29 ㎫ at 19 days after withholding irrigation. Soil water potential (SWP) maintained at -0.05 ㎫ in the control. The dry weight (DW) under the drought treatment were reduced compared to the control as follows: Dicktoo-S (short awn), 69% ; Dicktoo-L (long awn), 70%; Dicktoo-T (tetra), 86%; Dongbori-1, 69%; Suwonssalbori-365, 55% and Tapgolbori, ,37%. Dicktoo lines and Dongbori-1 were more tolerant than Suwonssalbori-365 and Tapgolbori. Leaf relative water contents (RWC) and leaf water potential (LWP) decreased obviously under the drought condition, the decrease being greater especially in the less drought-tolerant barley genotypes. Dongbori-1 and Dicktoo-L in drought treatment showed net photosynthesis of 38% and 17% compared to the control, respectively, and the other four genotypes much lower photosynthesis of 1.1% to 7.0%. Stomatal conductance, mesophyll conductance, and the photochemical efficiency (Fv/Fm) of PS II were reduced by drought treatment, the reduction being greater in drought-sensitive genotypes. The drought-tolerant genotypes had greater osmotic adjustment (OA) capacity under water stress. Thus, the decrease of RWC and LWP was lower and the turgor pressure conservation capacity was higher under water stress in drought-tolerant genotypes. Drought-tolerant genotypes showed less decrease of photosynthesis because stomatal conductance, mesophyll conductance and the ratio (Fv/Fm) of the variable to maximal fluorescence of drought-resistant genotype was decreased less in the drought stress condition. In conclusion, the drought-tolerant genotypes had better water conservation capacity through efficient OA, and this led to the lower decrease of photosynthesis and growth in water stress condition.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.48 no.6
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• pp.516-526
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• 2003

Thirty-six barley varieties including Korean modern and local varieties were tested for drought-tolerance in the field of plastic rain shelter, Drought treatment was initiated at initial tillering stage (March 27, 2002) by withholding irrigation and lasted until harvest. Soil water potential maintained at around -0.05㎫ in the control plot and varied from -0.05㎫ (at the initial stage of drought treatment) to -0.29㎫ in the drought treatment plot. At forty days after drought treatment, relative water content (RWC), osmotic potential (OP), osmotic adjustment (OA), and $^{13}\textrm{C}$ discrimination ($\Delta$) were measured and then plants were sampled for leaf area index (LAI) and dry weight (DW). Barley was harvested at maturity for determining DW, grain yield, 1000 grains weight and number of spikelet. The tested varieties revealed wide spectrum of drought tolerance. Dongbori-1, Chalbori, Changyeongjaerae, Samdobori and Weolseong 87-31 showed strong drought-tolerance while Songhagbori and Suwonmaeg360 showed weak drought-tolerance. The drought injury indexes (drought/control ratio) of DW and yield revealed significant positive correlation with leaf RWC in drought treatment plot and $\Delta$ in the control plot, but obvious negative correlation with leaf OP and OA under drought condition. In addition, all the drought indexes of OP, $\Delta$ and RWC showed obvious positive correlation with the drought injury indexes of DW, 1000 grain weight and yield. Thus, OP and RWC under drought condition and $\Delta$ under well-watered condition would be used as the evaluation criteria for drought- tolerance of barley genotypes. However, further investigation is needed for the relationship between $\Delta$ and drought-tolerance as the other reports were not consistent with our result.

• Clinical and Experimental Reproductive Medicine
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• v.46 no.4
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• pp.173-177
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• 2019

Objective: We investigated the clinical characteristics of men with testosterone replacement therapy (TRT)-induced hypogonadism and its effect on assisted reproductive technology (ART) in infertile couples. Methods: This study examined the records of 20 consecutive male patients diagnosed with azoospermia or severe oligozoospermia (< 5 × 10⁶/mL) who visited a single infertility center from January 2008 to July 2018. All patients were treated at a primary clinic for erectile dysfunction or androgen deficiency symptoms combined with low serum testosterone. All men received a phosphodiesterase 5 inhibitor and TRT with testosterone undecanoate (Nebido^®) or testosterone enanthate (Jenasteron^®). Patients older than 50 years or with a chronic medical disease such as diabetes were excluded. Results: The mean age of patients was 37 years and the mean duration of infertility was 16.3 ± 11.6 months. At the initial presentation, eight patients had azoospermia, nine had cryptozoospermia, and three had severe oligozoospermia. Serum follicle-stimulating hormone levels were below 1.0 mIU/mL in most patients. Three ongoing ART programs with female factor infertility were cancelled due to male spermatogenic dysfunction; two of these men had normal semen parameters in the previous cycle. After withholding TRT, serum hormone levels and sperm concentrations returned to normal range after a median duration of 8 months. Conclusion: TRT with high-dose testosterone can cause spermatogenic dysfunction due to suppression of the hypothalamic-pituitary-testicular axis, with adverse effects on infertility treatment programs. TRT is therefore contraindicated for infertile couples attempting to conceive, and the patient's desire for fertility must be considered before initiation of TRT in a hypogonadal man.

• The Korean Journal of Ecology
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• v.17 no.1
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• pp.69-78
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• 1994

The acidic deposition (wet) was collected at three different locations; representative industrial (Kun-Jang industrial areas), semiindustrial (Kunsan City) and nonindustrial (Daeya areas) region between March, 1991 and June, 1993. Samples were analyzed for major chemical components along with pH. Also the responses of Hypnum filunzaeforme to the acidic deposition adjusted to pH 4.6, 3.6 and 2.6 with 1:4 molar ratio of nitric to sulfuric acid were investigated. Seasonal variation of pH showed the lowest in early spring and the highest in summer. The annual mean concentrations of $S0_4^{2-},\;NO_3^{-}\;and\;NH_4^{+}$ were 2.94 (81.0%), 0.48 (13.2%) and 0.21 (5.78%) mg/l in industrial region and 0.61 (64.21%), 0.25 (26.3%) and 0.9 (9.5%) mg /I in nonindustrial region, respectively. $S0_4^{2-}$ contents of industrial region was 4 times higher than those of nonindustrial region. The ratio of $S0_4^{2-}\;to\;NO_3^{-}$ was 4.75~7.35 in industrial region and 0.69-6.36 in nonindustrial region. The acidic deposition near industrial region was associated with excess ions, expecially $S0_4^{2-}$. Nitrate reductase activity(NRA) of mosses was inhibited by acidic deposition in both regions. The time required for the maximum NRA induction by 2mM $KNO_3$ was shortened in mosses collected from industrial region. Photosynthesis of H. plumaejorme began to decrease with acidic deposition by pH below 4.6, and was completely inhibited at pH 2.6 in both regions. Water potential of mosses treated with acidic deposition was almost constant during 18 days, however after withholding the supply of acidic deposition, it was rapidly decreased.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.105-138
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• 2017

This is case comments of several representative legal cases regarding self- determination right of patient. In a case in which an intoxicated patient attempted suicide refusing treatment, the Supreme Court ruled that the medical team's respect for the patient's decision was an act of malpractice, and that in particular medical situations (medical emergencies) the physician's duty to preserve life supersedes the patient's rights to autonomy. Afterwards, at the request of the patient's family, and considering the patient's condition (irrecoverable death stage, etc.) consistent with a persistent vegetative state, the Supreme Court deduced the patient's intention and decide to withdraw life-sustaining treatment. More recently, regarding patients who refuse blood transfusions or other necessary treatment due to religious beliefs, the Supreme Court established a standard of judgment that can be seen as conferring equal value to the physician's duty to respect patient autonomy and to preserve life. An empirical study of legal precedent with regard to cases in which the physician's duty to preserve life conflicts with the patient's autonomy, grounded in respect for human dignity, can reveal how the Court's perspective has reflected the role of the patient as a decision-making subject and ways of respecting autonomy in Korean society, and how the Court's stance has changed alongside changing societal beliefs. The Court has shifted from judging the right to life as the foremost value and prioritizing this over the patient's autonomy, to beginning to at least consider the patient's formally stated or deducible wishes when withholding or withdrawing treatment, and to considering exercises of self determination right based on religious belief or certain other justifications with informed refusal. This will have a substantial impact on medical community going forward, and provide implicit and explicit guidance for physicians who are practicing medicine within this environment.