• Title/Summary/Keyword: Withholding

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Legislative Approaches to Terminal Care Issue in the U.S.A. - Acts on Terminal Health-Care Decision (말기의료에 관한 미국 법제의 연구 - 말기의료결정 제도를 중심으로)

  • Suk, HeeTae
    • The Korean Society of Law and Medicine
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    • v.14 no.1
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    • pp.355-401
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    • 2013
  • The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

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A Comparative Study on the Buyer's Right to Withhold Performance for the Seller's Delivery of Defective Goods and Documents in International Sales within the CISG, English law and Korean law

  • Lee, Byung-Mun
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.17
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    • pp.251-293
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    • 2002
  • The study is a comparative and analytical study which comprises of the analysis of the rules of the buyer's right to withhold performance where the seller delivers defective goods or documents of three legal systems; the CISG, English law and Korean law. The purposes underlying this study are twofold. The first is to clarify the current position as to the right of withholding performance in the event of the seller's tender of defective goods or documents in Korean law, CISG and English law so that it may assist the parties in drafting the buyer's right to withhold performance in their own contract. The second is to compare the rules of one jurisdiction with those of other jurisdictions and to evaluate the rules in light of the practical functions and benefits of the right to withhold performance and the discipline of comparative law the basic question of which is whether a solution from one jurisdiction may facilitate the systematic development and reform of another jurisdiction. It shows that each jurisdiction does not have any provision or case law specifically dealing with the buyer's right to withhold performance where the seller delivers the goods which are defective in terms of quality or quantity. The absence of such provision or case in each jurisdiction has resulted in either disputes or uncertainty. However, the study executed in light of the primary functions and benefits of the right in practice and the discipline of comparative law reveals that, first, the view in English law which is against recognizing the right may not be justified when one considers the practical importance of having the right and the position taken by the CISG as a well developed and modernized law, second, the view in Korean law which argues that the principle of specific goods dogma on which it is based is extended even to substitutable or repairable goods cannot be also justified on the ground of one's ordinary expectation and the position under the CISG and English law which imposes a contractual duty to deliver non-defective goods on the seller insofar as the buyer's payment is deemed to be made in exchange for the seller's delivery of non-defective goods and they are substitutable or repairable. Regarding the right to withhold performance in the event of the seller's tender of defective documents, the study shows that the relatively detailed rules in English law may be utilized as a guideline to fill the gap in the CISG and Korean law in terms of the practicability and appropriateness to govern documentary sales. Furthermore, it is found that the position in English law which confers on the buyer the right to withhold performance for a trivial defect in documents may be unreasonable in terms of one's need to enable justice to be done in individual cases.

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Awareness and Attitude Change after End-of-Life Care Education for Medical Students (말기환자 돌봄 교육 후 의과대학생의 인식과 태도 변화)

  • Kim, Hyun-Kyung;Nam, Eun-Mi;Lee, Kyoung-Eun;Lee, Soon-Nam
    • Journal of Hospice and Palliative Care
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    • v.15 no.1
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    • pp.30-35
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    • 2012
  • Purposes: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. Methods: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. Results: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. Conclusion: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.

Studies on the Drought-Resistance of Major Food Crops II. Effect of Water Stress on the Activity of Nitrate Reductase and Protease, and the Accumulation of Free Proline in Barley and Wheat at Seedling Stage (주요작물의 한발저항성에 관한 연구 제2보 맥류 유묘기의 수분부족이 질산환원효소 및 단백질 분해효소의 활성변화와 유리 Proline의 축적에 미치는 영향)

  • 최원열;민경수
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.27 no.1
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    • pp.60-65
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    • 1982
  • In order to observe the degree and response of drought-resistance and its physiological mechanism in barley and wheat seedling stage, 5 species (16 cultivars) were tested for the changes of nitrate reductase and protease activity and the accumulation of free proline, by being subjected to water stress by withholding watering for 8 days at 10 days (at the 3rd leaf stage) after emergence and by imposing water stress to the excised first leaf by polyethyleneglycol solution (osmotic potential, -20 bars) for 48 hours. The average rate of decrease of all cultivars was 42% in nitrate reductase activity and 73% in protease activity. But proline content in water stress was increased 10 folds more than that of control. The decrease4 rate of nitrate reductase activity in 5 species was in the order of wheat < rye < covered barley < naked barley < two-row barley: wheat being the lowest. The decreased rate of protease activity in 5 species was in the order of wheat > rye > two-row barley > covered barley > naked barley: wheat being the" heighest. The accumulated amount of free proline in 5 species by water stress was in the order of wheat > covered barley > rye > naked barley > two-row barley. And the increased ratio (folds) of free proline of water stress to control was in the order of rye(13) > wheat. covered barley(11) > naked barley(99) > two-row barley(7): rye being the highest. In terms of the enzymatic activity and the physiotically adaptive metabolism during the processing leading to drought-resistance, the degree of drought-resistance of 5 species to water stress at seedling stage was shown to be in the order of wheat > rye > covered barley > naked barley > two-row barley.

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Effect of Soil Water Potential on Stomatal Conductance and Photosynthesis of Wasabia japonica Matsum (토양수분(土壤水分)포텐셜이 고추냉이의 기공전도도(氣孔傳導度)와 광합성(光合成)에 미치는 영향(影響))

  • Choi, Sun-Young;Lee, Kang-Soo
    • Korean Journal of Medicinal Crop Science
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    • v.4 no.4
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    • pp.288-293
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    • 1996
  • This study was investigated to obtain basic information for the development of irrigation plans in upland cultivation of Wasabi. Changes of stomatal conductivity and photosynthetic rate of Wasabi, and of the soil water potential during withholding watering were analysed. The stomatal conductivity of Wasabi at $1000{\mu}Em^{-2}s^{-1}$ light intensity was $70mmolem^{-2}s^{-1}$, which was about 49% lower than that of Chinese cabbage, $138mmolem^{-2}s^{-1}$. The temporal changes of light intensity during the daytime did not influence the stomatal conductivity. The soil water potential that decreased stomatal conductivity in Wasabi was about - 50kPa at 10 AM, and about - 30kPa at 3 PM. The photosynthetic rate of Wasabi at$1000{\mu}Em^{-2}s^{-1}$ light intensity was $7.6mgdm^{-2}hr^{-1}$, which was about 50% lower than that of Chinese cabbage, $15.3mgdm^{-2}hr^{-1}$. The duration required for a stable photosynthetic rate was longer in Wasabi than in Chinese cabbage. The soil water potential that decreased photosynthetic rate in Wasabi was about - 50kPa at 10 AM, and about - 30kPa at 3 PM. The stomatal conductivity and photosynthetic rate showed significant positive correlation at various soil water potential. The results indicated that irrigation in wasabi could be done during the daytime when the soil water potential is above - 30kPa, which does not decrease stomatal conductivity and photosynthesis in Wasabi.

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A Study of Korea Tasks through Standard Contents of Special Teacher Training in Germany (독일의 특수교사 표준양성내용으로 본 한국의 과제 탐색)

  • Nam, Suk
    • Korean Journal of Comparative Education
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    • v.28 no.6
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    • pp.53-84
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    • 2018
  • With the change of society and the rapid development of science and technology, the direction of future education and the functions of schools have changed. Also the roles and tasks of teachers are changing rapidly. As Germany entered into the 21st century, many discussions let to a consensus on the direction of future education and schooling withholding a sense of responsibility and solidarity for the education of all members of the society. As a result, standards for the training of general teachers and teachers for special education were presented. The purpose of this study is to compare the standard contents of teacher training for special education in Germany with the qualification criteria for special school, teachers in Korea, focusing on evaluation and giving as well detailed information on the examination of teachers for special school, as on basic subjects for the qualification of special school teachers for special education in Korea will be explored. As a result, the content of this study can be summarized by four items. The first one is dealing with the creation of a consciousness of solidarity and a sense of responsibility among the members of the society for the future education and the role of schools and teachers. The second item ist about including the capacity and competence of teachers in the restructuring of the school and in the minimum standards of teacher training for special education. Third, the specificity of each state (provincial and local) is considered in the content of standards for teacher training. Fourth, standards for teacher training are linked to each other, previous teacher education, trainee teacher education, and current teacher education.

Effects of Water Stress on Nitrate Reductase Activity and Abscisic Acid Content in Soybean Plants (수분부족이 콩의 질산환원효소 활성과 Abscisic acid 함량에 미치는 영향)

  • Ryu, Jeom-Ho;Doo, Hong-Soo;Ko, Gyong-Nam;Choo, Byong-Gil;Lee, Kang-Soo
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.39 no.3
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    • pp.223-231
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    • 1994
  • To investigate effects of water stress on leaf water potential, nitrate reductase activity and abscisic acid content, Paldalkong, Saealkong and Danyeobkong were subjected to water stress by polyethyene glycol(PEG, MW=6,000) in the water culture and withholding irrigation in soil culture. Leaf water potential and nitrate reductase activity decreased with increaseing of PEG concentration in the water culture. These were higher at 3rd and 5th leaf stage than at 1st leaf stage. Leaf water potential showed no significant differance among the varieties, but nitrate redutase activity was higher in Paldalkong than in Saealkong and Danyeobkong. Leaf water potential and nitrate reductase activity decreased approximately 2.2 times (-1.67 MPa/-0.75MPa) and 47%(3.1${\mu}$ mole nitrite/g.DW/hour/15.9${\mu}$ mole nitrite/g.DW/hour) to control, respectively, after 3 days from water stress treatment in the soil culture. According to increasing PEG concentration, abscisic acid content increased in the water culture and was higher at 5th leaf stage than at 1st and 3rd leaf stage. Paldalkong showed the highest abscisic acid content. Abscisic acid content increased approximately 1.7 times (9.9nmole/g.DW/5.7nmole/g.DW) compared to the control after 3 days from water stress treatment in the soil culture.

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Path Algorithm for Maximum Tax-Relief in Maximum Profit Tax Problem of Multinational Corporation (다국적기업 최대이익 세금트리 문제의 최대 세금경감 경로 알고리즘)

  • Sang-Un Lee
    • The Journal of the Institute of Internet, Broadcasting and Communication
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    • v.23 no.4
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    • pp.157-164
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    • 2023
  • This paper suggests O(n2) polynomial time heuristic algorithm for corporate tax structure optimization problem that has been classified as NP-complete problem. The proposed algorithm constructs tax tree levels that the target holding company is located at root node of Level 1, and the tax code categories(Te) 1,4,3,2 are located in each level 2,3,4,5 sequentially. To find the maximum tax-relief path from source(S) to target(T), firstly we connect the minimum witholding tax rate minrw(u, v) arc of node u point of view for transfer the profit from u to v node. As a result we construct the spanning tree from all of the source nodes to a target node, and find the initial feasible solution. Nextly, we find the alternate path with minimum foreign tax rate minrfi(u, v) of v point of view. Finally we choose the minimum tax-relief path from of this two paths. The proposed heuristic algorithm performs better optimal results than linear programming and Tabu search method that is a kind of metaheuristic method.

Customer Intangible Value in a Social Network (사회적 네트워크에서의 고객무형가치에 대한 연구)

  • Han, Sangman;Lee, Jieun
    • Asia Marketing Journal
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    • v.10 no.4
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    • pp.99-121
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    • 2009
  • Social networks can be a powerful force in marketing because they provide new ways to market to young generation. Though many studies on evaluation of customer lifetime value have been conducted, it is not clear how to assess the value of members within social networks. The purpose of this study is to evaluate members based on customer intangible value as well as customer lifetime value. Customer network value in terms of the power and influence within a network is analyzed through network structure analysis. Using Cyworld log file data, this study have shown that high percentage of members are very influential in terms of spreading or withholding information even though their CLV is low. It is expected that the findings of this research contribute to understand the interactive behaviors of members within networks and to provide valuable implications on new product launching and customer management strategies to marketers.

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DNR (Do-Not-Resuscitate) Order for Terminal Cancer Patients at Hospice Ward (호스피스 병동에서 시행되는 말기 암 환자의 DNR (Do-Not-Resuscitate) 동의)

  • Shim, Byoung-Yong;Hong, Seok-In;Park, Jin-Min;Cho, Hong-Joo;Ok, Jong-Sun;Kim, Seon-Young;Han, Sun-Ae;Lee, Ok-Kyung;Kim, Hoon-Kyo
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.232-237
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    • 2004
  • Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

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