• 제목/요약/키워드: critical means

검색결과 978건 처리시간 0.028초

Manganese and Iron Interaction: a Mechanism of Manganese-Induced Parkinsonism

  • Zheng, Wei
    • 한국환경성돌연변이발암원학회:학술대회논문집
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    • 한국환경성돌연변이발암원학회 2003년도 추계학술대회
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    • pp.34-63
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    • 2003
  • Occupational and environmental exposure to manganese continue to represent a realistic public health problem in both developed and developing countries. Increased utility of MMT as a replacement for lead in gasoline creates a new source of environmental exposure to manganese. It is, therefore, imperative that further attention be directed at molecular neurotoxicology of manganese. A Need for a more complete understanding of manganese functions both in health and disease, and for a better defined role of manganese in iron metabolism is well substantiated. The in-depth studies in this area should provide novel information on the potential public health risk associated with manganese exposure. It will also explore novel mechanism(s) of manganese-induced neurotoxicity from the angle of Mn-Fe interaction at both systemic and cellular levels. More importantly, the result of these studies will offer clues to the etiology of IPD and its associated abnormal iron and energy metabolism. To achieve these goals, however, a number of outstanding questions remain to be resolved. First, one must understand what species of manganese in the biological matrices plays critical role in the induction of neurotoxicity, Mn(II) or Mn(III)? In our own studies with aconitase, Cpx-I, and Cpx-II, manganese was added to the buffers as the divalent salt, i.e., $MnCl_2$. While it is quite reasonable to suggest that the effect on aconitase and/or Cpx-I activites was associated with the divalent species of manganese, the experimental design does not preclude the possibility that a manganese species of higher oxidation state, such as Mn(III), is required for the induction of these effects. The ionic radius of Mn(III) is 65 ppm, which is similar to the ionic size to Fe(III) (65 ppm at the high spin state) in aconitase (Nieboer and Fletcher, 1996; Sneed et al., 1953). Thus it is plausible that the higher oxidation state of manganese optimally fits into the geometric space of aconitase, serving as the active species in this enzymatic reaction. In the current literature, most of the studies on manganese toxicity have used Mn(II) as $MnCl_2$ rather than Mn(III). The obvious advantage of Mn(II) is its good water solubility, which allows effortless preparation in either in vivo or in vitro investigation, whereas almost all of the Mn(III) salt products on the comparison between two valent manganese species nearly infeasible. Thus a more intimate collaboration with physiochemists to develop a better way to study Mn(III) species in biological matrices is pressingly needed. Second, In spite of the special affinity of manganese for mitochondria and its similar chemical properties to iron, there is a sound reason to postulate that manganese may act as an iron surrogate in certain iron-requiring enzymes. It is, therefore, imperative to design the physiochemical studies to determine whether manganese can indeed exchange with iron in proteins, and to understand how manganese interacts with tertiary structure of proteins. The studies on binding properties (such as affinity constant, dissociation parameter, etc.) of manganese and iron to key enzymes associated with iron and energy regulation would add additional information to our knowledge of Mn-Fe neurotoxicity. Third, manganese exposure, either in vivo or in vitro, promotes cellular overload of iron. It is still unclear, however, how exactly manganese interacts with cellular iron regulatory processes and what is the mechanism underlying this cellular iron overload. As discussed above, the binding of IRP-I to TfR mRNA leads to the expression of TfR, thereby increasing cellular iron uptake. The sequence encoding TfR mRNA, in particular IRE fragments, has been well-documented in literature. It is therefore possible to use molecular technique to elaborate whether manganese cytotoxicity influences the mRNA expression of iron regulatory proteins and how manganese exposure alters the binding activity of IPRs to TfR mRNA. Finally, the current manganese investigation has largely focused on the issues ranging from disposition/toxicity study to the characterization of clinical symptoms. Much less has been done regarding the risk assessment of environmenta/occupational exposure. One of the unsolved, pressing puzzles is the lack of reliable biomarker(s) for manganese-induced neurologic lesions in long-term, low-level exposure situation. Lack of such a diagnostic means renders it impossible to assess the human health risk and long-term social impact associated with potentially elevated manganese in environment. The biochemical interaction between manganese and iron, particularly the ensuing subtle changes of certain relevant proteins, provides the opportunity to identify and develop such a specific biomarker for manganese-induced neuronal damage. By learning the molecular mechanism of cytotoxicity, one will be able to find a better way for prediction and treatment of manganese-initiated neurodegenerative diseases.

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하작물의 기상재해와 그 대책 (Meteorological Constraints and Countermeasures in Major Summer Crop Production)

  • 권신한;이홍석;홍은희
    • 한국작물학회지
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    • 제27권4호
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    • pp.398-410
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    • 1982
  • 밭에서 재배되는 우리나라 하작물의 종류는 다양하며 년차 또는 지역에 따라 변이가 큰데 그 주요원인은 기상요인으로서 강우와 온도가 그 주요한 역할을 하고 있으며 바람과 일조량 등 각종 기상요인도 하작물의 생산에 영향을 미치게 될 것이다. 주요 재해원인이 되고 있는 기상요인을 인위적으로 조절하여 일반작물을 재배한다는 것을 매우 어렵기 때문에 농작물 자체나 재배 및 관리기술의 향상으로 재해를 최소화시켜야 될 것이다. 강우량은 하작물 생산에 가장 중요한 기상요인의 하나로 작용하며 이는 한발과 과습의 두 측면에서 생각할 수 있다. 우리나라는 계절풍대에 속하는 관계로 이 두 재해원인중 그 정도의 차이는 있을지라도 거의 매년 부닥치게 되므로 관개와 배수시설을 완비한다면 별로 문제가 없겠으나 현실적으로는 용역한 일이 아니다. 따라서 하작물 품종 육성에서는 반드시 내한, 내습, 내병 등의 요인을 고려하여야 할 것이며 한해나 습해상습지대에서는 이에 알맞는 작물종류 및 품종을 선택 이용해야 될 것이고 배수와 중경, 제초, 재식방법 등의 재배기술을 활용해야 할 것이다. 온도에 의한 장해로서는 주로 저온피해를 생각할 수 있으며 늦추위와 가을철 조기 저온이 그 주요인이 될 것이고 가끔 여름철의 저온도 하작물의 저수원인으로 작용하게 될 것이다. 또 작물에 따라서는 고온장해도 발생하나 내냉, 내서성 및 조숙성품종 육성 등으로 어느 정도 극복이 가능하며 파종기, 수확기 등의 조정도 피해회피의 좋은 방법이 될 수 있을 것이다. 하작물의 도복, 병해, 충해 등도 기상요인에 의한 직접 또는 간접의 피해가 되겠으나 이들 재해는 육종적인 방법으로 극복할 수 있는 형질들이며 또 적절한 방제나 구제방법도 알려져 있다. 기상요인에 의한 피해통계의 작성과 재해발생예보체계의 확립 및 보상제도를 도입하여 농업을 근대산업형태로 체질개선하는 정책적 뒷받침이 시급히 요구된다. 가지고 있음이 확인됐다. 7. 참깨 품종중에는 주당삭수 150개이상인 구례와 재래종 12003가 조사되었으며 삭당입수 75입이상인 해남, 우강품종, 등숙비율에서도 90%이상인 품종 수원 8호, 청송등이 있었다. 8. 참깨는 품종에 따라 만파적응력이 다르므로 맥후작재배용 품종육성은 반드시 맥후작 재배조건에 맞추어 별도의 육종계획으로 실시하는 것이 효과적이다.. 현재 품종들의 탈립성 분류기준으로 사용되고 있는 평균인장강도는 그 분산이 변이가 크고, 환경의 영향을 많이 받으며 이삭의 곡립들 중 수확작업시 실제로 탈립이 잘 되는 곡립은 인장강도가 98g이하이었으므로 품종의 탈립성 판정 및 포장손실의 추정을 위해서는 표본중 인장강도가 100g 이하인 곡립들의 전곡립수에 대한 비율을 기준으로 할 것을 제의한다. 6. MET계통은 생장속도가 수원 19호보다 훨씬 늦었으며 개화기도 2~3주나 늦었다. 7. 흑조위축병 : 수원 19호와 같이 MET계통도 흑조위축병에 대해 이병성이었다. 이병성은 늦게 파종하거나 밀식할수록 높아지는 경향이 있었다..7g로서 가장 무거워 많은 차이를 보이었다. 10a당 정조중은 대조구에 비하여 Dolomite처리구가 8.6%, 유황첨가구가 5.7~7.4% 증수되었음을 보이었다. 7. 식물체중의 조단백질 함량은 대조구, 5%, 10% 유황첨가구가 3.31~3.50%로서 비슷하였고 15% 유황첨가구는 3.94%, Dolomite첨가구는 5.38%였다. 아미노산도 15%유황첨가구와 Dolomite첨가구가 많이 함유되어 있었다. 현미중 조단백질은 15%유황첨가구가 10.14%로서 최고이었으며 10%유황첨가구와 Dolomite첨가구는 9.85%로서 다음이었다. 아미노산도 대조구의 현미에는 유황처리구보다 작았으며 유황처리구에서는 특히 Glutamic acid와 Lysine이 함유되여 있었다.ligraphy patterns were

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산화 스트레스에 의존한 식물 및 진핵세포 2-시스테인 퍼록시레독신의 기능 조절 (Oxidative Stress-dependent Structural and Functional Regulation of 2-cysteine Peroxiredoxins In Eukaryotes Including Plant Cells)

  • 장호희;김선영;이상열
    • Journal of Plant Biotechnology
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    • 제33권1호
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    • pp.1-9
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    • 2006
  • 도처에 분포하는 peroxiredoxins (Prxs)은 세포 내 방어신호전달 과정에서 다양한 기능을 하는 것으로 나타났다. Prxs는 크게 typical 2-Cys Prx, atypical 2-Cys Prx와 1-Cys Prx의 세 부류로 분류되는데, 이것들은 cysteine 잔기의 수와 촉매기전에 따라 구분된다. 세 종류의 단백질 중, N-말단에 peroxidatic cysteine 잔기를 포함하는 typical 2-Cys Prx는 $H_2O_2$ 분해과정 동안 과산화물-의존적인 sulfenic acid로의 산화와 thiol-의존적 환원과정이 순환되어 일어난다. Sulfenic acid는 고농도의 $H_2O_2$와 Trx, Trx reductase와 NADPH를 포함하는 촉매 요소의 존재하에 cysteine sulfenic acid로 과산화 될 수 있다 과산화된 2-Cys Prx는 ATP 의존성 효소인 sulfiredoxin의 작용에 의해 천천히 환원된다. 세포가 강력한 산화나 열 충격 스트레스에 노출되면, 2-Cys Prx는 LMW 단백질에서 HMW complex로 구조를 변화시켜 peroxidase에서 chaperone으로 기능의 전환을 일으킨다. 2-Cys Prx의 C-말단 부분 역시 이러한 구조적 전환에 중요한 역할을 한다. 따라서, C-말단이 잘려진 단백질은 과산화가 되지 않고 단백질의 구조와 기능이 조절될 수 없다. 이러한 반응들은 활성 자리인 peroxidatic cysteine 잔기에 의해 일차적으로 유도되며, 그것은 세포에서 '$H_2O_2$ sensor' 로서 작용하다. 2-Cys Prx의 가역적인 구조와 기능 변화는 세포가 외부자극에 적응하는 수단으로 작용하며, 아마도 세포내 방어신호체계를 활성화 시키는 것으로 생각된다. 특히, chloroplast에 존재하는 식물 2-Cys Prx는 촉매반응 동안 주된 구조적인 변화를 나타내는 역동적인 단백질 구조를 가지고 있어서, 산화-환원 의존적으로 super-complex를 형성하고 가역적으로 thylakoid membrane에 부착한다.

제주지역(濟州地域) 여중학생(女中學生)의 영양실태(營養實態)와 성장발육(成長發育)에 관한 연구(硏究) (A Study on the Nutrients Intake and Physical Growth and Development of Junior High School Girls in Cheju Is. Area)

  • 홍양자
    • Journal of Nutrition and Health
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    • 제8권4호
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    • pp.15-26
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    • 1975
  • 제주도내 중학교 2학년 여학생 418명에게 일반적인 환경실태, 영양섭취 실태를 조사하고 성장발육과의 관계를 요약해 보면 다음과 같다. A. 조사대상자의 일반 실태 1. 형제의 수는 대부분이 $5{\sim}6$명이었다. 2. 유아기에는 90%가 모유로 양육되었으며 이유는 $7{\sim}12$개월이 20.9%이고 $13{\sim}24$개월이 45%였다. 3. 식사시간이 불규칙한 학생은 45.7%이며 불규칙한 이유는 식욕부족과 시간부족이 각각 42.9%, 31.9%였다. 4. 1년을 기준해서 병으로 결석하는 일수는 $2{\sim}5$일이 52%였다. 5. 기호 실태에 있어서는 주식으로는 잡곡밥이 45%, 식빵이 30.6%, 국수는 26.3%가 즐기고 40.7%나 흰밥을 제일 싫어하고 있다. 부식으로는 계란, 쇠고기, 닭고기, 김치류를 좋아하고 버터, 돼지고기, 나물류를 싫어한다. 간식은 아이스크림, 우유, 과일, 과즙, 빵 등을 좋아하고 호콩 등을 좋아하지 않는 것으로 나타났다. B. 영양섭취 실태 1. 열량섭취 평균은 1,738Ca1, 총 섭취열량에 대한 탄수화물의 비율은 73%, 단백질이 15%, 지방이 12% 로 나타났다. 2. 열량 및 모든 영양소가 권장량에 미달이나 vitamin A. $B_{1}$. Niacin 등은 권장량에 달하고 있다. 3. 단백질이 1일(日) 평균 섭취량은 68g 으로서 권장량 75g에 가깝다. 총 단백질에 대한 동물성 단백질이 비율은 36%로 나타났다. 4. 총식품 섭취량에 있어서 동물성 식품이 평균섭취 비율은 14%, 곡류가 63%를 차지하고 있다. C. 영양 섭취실태, 성장발육, 지능과의 상호관계 1. 열량 섭취량과 성장발육은 상호 의의(意義)있는 결과가 나타났다. 2. 단백질 섭취량과 성장발육도 상호관계가 의의(意義)있는 결과가 나타났다. 3. 열량과 단백질 섭취와 지능과의 상호관계는 의미가 없는 것으로 나타났다. 4. 이같은 상호 관계의 결과를 보면 영양과 성장발육은 직접적인 관계가 있다고 지적되고 반면 영양과 지능과의 관계는 간접적인 영향이 있을 뿐이라고 결론을 내릴 수 있다.

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『애니메이툰』의 기사 분석 연구: 'Animatoon Report' 항목의 유형적 특성 및 통사적 경향을 중심으로 (The Article Type Analysis of Animatoon : Focusing on Characteristics and Tendency of 'Animatoon Report' Type Articles)

  • 권재웅
    • 만화애니메이션 연구
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    • 통권44호
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    • pp.85-116
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    • 2016
  • 본 연구는 애니메이션 분야의 유일한 전문잡지인 "애니메이툰"에 대한 심층적 연구로서 'Animatoon Report' 항목의 기사를 분석했다. 전문잡지가 내부에서 설정한 항목을 통해서 어떤 성격의 기사에 관심을 가지고 있는지를 도출하고, 통사적 흐름 속에서 관점의 변화를 살펴보고자 했다. 'Animatoon Report'는 "애니메이툰"의 항목 중 기사의 성격이 명칭에 나타나지 않지만, 기사의 건수가 많은 항목이기 때문에 분석 대상으로 선정되었다. 기사의 구성적 측면에서 나타난 결과로는 첫째, 초기 10년(1995-2005년)에 기사의 면수와 이미지 게재 수가 많은 것으로 나타났다. 기사 하나하나에 대한 집중도가 높고 기사 내용의 충실도를 높이려는 것으로 볼 수 있다. 둘째, 기사 작성자 분석을 통해서 나타난 것은 기자의 역할이 상대적으로 데스크보다 낮다는 점이다. 셋째는 기사의 건당 면수가 적고 주로 앞쪽에 배치됨으로써, 다양한 이슈에 초점을 맞춘다는 점과 이 항목이 "애니메이툰" 내에서 중요하게 고려된다는 점을 알 수 있다. 넷째로는 초기에는 기사 내용을 요약 형식으로 소개하는 것이 주된 방식이었으나, 후기로 갈수록 기사 구성의 완성도를 높이는 모습을 보여주었다. 마지막으로 기사의 대상 분야와 국가는 애니메이션과 한국에 집중하는 모습을 보였다. 한편 유형 분석을 통해서 드러난 결과는 다음과 같다. 6가지 유형 중에서 정책/산업 유형의 기사가 가장 많았고, 정책에 대한 기사와 산업에 대한 기사가 비슷한 수치로 제시되었다. 두 번째로는 행사 유형의 기사가 두 번째로 많다는 점이다. 세 번째로는 기타 유형이 의외로 높게 나타났는데, 이는 잡지 초기에 역사와 기술/기법에 대한 기사가 집중적으로 게재되었기 때문이다. 네 번째 시기적 변화를 살펴볼 때, 인물과 작품 유형은 전체시기에 걸쳐 꾸준한 관심을 드러내면서, 기관/기업/단체 및 정책/산업에 대한 관심과 행사에 대한 관심이 계속 증가했음을 알 수 있다. 즉, 'Animatoon Report' 항목의 기사들은 어느 정도 다양성을 가지고 있기는 하지만 정책과 산업에 대한 기사들에 집중됨으로써 "애니메이툰"은 이 항목을 통해 정책과 산업을 주로 다루고 싶어 했다는 점을 알 수 있다. 둘째, 전체적으로 볼 때 'Animatoon Report' 항목내의 유형들은 기사가 집중되는 시기가 각각 다른 편이었고, 정책/산업은 1995-2000년을 제외한 나머지 시기(2001-2015년)에 꾸준히 제시되었다는 것을 알 수 있다.

[결핵 및 호흡기질환] 게재 논문의 통계적 기법 활용에 대한 평가 (An Evaluation of the Use of Statistical Methods in the Journal of Tuberculosis and Respiratory Diseases)

  • 고원중;이승준;강민종;이훈재
    • Tuberculosis and Respiratory Diseases
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    • 제57권2호
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    • pp.168-179
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    • 2004
  • 배 경 : 의학연구에서는 표본자료로부터 의학적 의미를 찾아내고 그 결과를 일반화시키기 위하여 통계적 기법과 원리를 활용하게 된다. 현재까지 여러 국내 의학학술지를 대상으로 한 연구에서는 60-100%의 논문에서 통계적 오류가 있는 것으로 보고되었다. 본 연구는 [결핵 및 호흡기질환]에 게재된 논문에서의 통계적 기법의 활용 및 오류 실태를 파악하고자 하였다. 대상 및 방법 : 1999년에 발간된 총 12권의 [결핵 및 호흡기질환]에 게재된 논문 185편을 대상으로 하였다. 주요 평가영역은 연구유형, 통계적 기법의 활용현황 그리고 통계적기법 적용의 타당성 등이었으며, 국제의학학술지편집 위원회에서 제시한 통계적 서술 통일양식을 기초로 개발된 점검표를 활용하여 평가하였다. 평가는 연구자들간의 종합토의를 통해 합의를 도출하였다. 결 과 : 1) 논문을 연구유형에 따라 분류하면 원저 110편(59.5%), 증례보고 61편(33.0%), 종설 12편(6.5%), 기타 2편(1.1%) 순이었다. 증례보고와 종설을 제외한 112편의 논문 중 통계기법은 107편(95.5%)에서 활용되었으며 기술통계학적 기법만을 적용한 경우가 13편(11.6%), 그리고 추측통계학적 분석을 함께 활용한 경우가 94편(83.9%)이었다. 2) 추측통계학적 분석을 활용한 논문에서는 평균 2.0가지(범위 1-5개)의 통계기법을 적용하였으며, 집단간 평균값의 비교가 64편(68.1%), 비연속 변수의 분할표 분석이 43편(45.7%) 그리고 상관 및 회귀분석이 18편(19.1%)에서 사용되었다. 9편(9.6%)의 논문에서는 p-값을 제시했음에도 불구하고 어떤 분석기법을 이용했는지 제시하지 않았다. 3) 기술통계학적 기법을 적용하여 자료를 요약 제시한 107편의 논문 중 변수의 특성을 고려하지 않고 적절하지 못한 대표값 또는 산포도를 제시한 경우가 89편(83.2%)이었다. 4) 추측통계학적 기법을 활용한 94편의 논문 중 민감도와 특이도, 예측도 등 진단 통계만을 사용한 5편의 논문을 제외한 89편의 논문 중 79편(88.8%)에서 자료의 특성에 맞지 않는 분석기법을 적용하고 있었으며, 가장 흔한 오류는 정규성이 의심되는 변수에 모수적 검정기법을 적용한 경우였다(35편, 39.3%). 5) 전체적으로 통계적 기법이 활용된 107편의 논문 중 93편(86.9%)에서 중요한 통계적 오류가 관찰되었다. 결 론 : [결핵 및 호흡기질환] 게재논문 중 통계적 기법을 활용한 많은 논문에서 통계적 오류가 발견되고 있으며, 이는 대부분 기본적인 통계적 기법의 적용과 관련되어 있었다. 통계적 기법을 적용할 때 연구자의 보다 세심한 주의와 함께, 논문의 심사와 게재 과정에서 적절한 지침과 평가가 필요하리라 사료된다.

소비자의 라이프스타일에 따른 서비스품질 지각 차이에 관한 연구 (A Study on the Consumer's Service Quality Perception Based on the Types of Life-style)

  • 박윤서;이승인;최인
    • 마케팅과학연구
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    • 제19권2호
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    • pp.53-67
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    • 2009
  • For the last decades, service quality has been studied as one of the most important tools for a service company to compete with the other companies. Based on these past researches, it has been agreed that the service quality is a basic and powerful tool to create the competitive advantage. Due to similar reason, many service marketing practitioners have been also focused on the service quality to retain the existing consumers and collect the new consumers. However, service quality is subjectively perceived by individual consumers. Consumer evaluation of service quality can be different from each other. Especially consumers with one life-style may evaluate the service quality differently from the consumers with the other life-styles. Therefore we need to know whether there are differences in service quality perception on the categories of life-style. Life-style refers to a distinctive mode of living in its aggregate and broadest sense. It embodies the patterns that were developed and emerged from the dynamics of living in a society. Since the concept of life-style and its relationship to marketing was introduced in 1963 by William Lazer, methods of measuring the life-style and their application have been developed. Life-style has been usually used to segment the marketplace because it offers marketers a unique and important view of the market. When Life-style is combined with clustering methods, life-style segmentation can generate identifiable whole persons rather than isolated fragment. Life-style segmentation begins with people instead of products and classifies them into different life-style types, each characterized by a unique style of living based on a wide range of activities, interests, and opinions(Plummer, 1974). In this study we applies the life-style segmentation based on the AIO(Activities, Interests, and Opinions) to the consumers of the large discount stores. In Korea, the large discount store market has entered into maturity stage so that the market differentiation strategy is becoming a more critical issue to the marketing practitioners. One of the most important tools to differentiate from the competitors in large discount store market is continuously to provide service of better quality than competitors. This study tries to find answers about the following questions: 1) How can we categorize the consumer life-styles in the large discount store? 2) What are the characteristics of the categorized groups? 3) Are there any differences in service quality perception among the consumers with different life-styles 4) Are there any differences in consumer behavior among them in the large discount store? For the purpose, we collected survey data from consumers and analyzed the data with the SPSS package where we had $X^2$-test, factor analysis, ANOVA, MANOVA, and cluster analysis. The survey was made during one month in the April of 2008. Among the collected 306 copies of questionnaires, 281 copies were chosen as the effective samples for empirical analysis except 25 copies with wrong responses. To identify the life-style patterns, we used the measures employed by Kim and Kwon(1999), where 44 items on a seven-point scale were used to measure factors of the life-style patterns. The Principal Component Method was used for factor extraction, and the VARIMAX orthogonal factor rotation was employed. The 7 items showing low factor loading were eliminated. The results of the factor analysis suggested that nine factors of the life-style patterns were identified as follows: 1) the equality-of-sexes and pursuit-of-independence tendency 2) self-management tendency 3) sociable tendency 4) self-display tendency 5) degree of a dilettante life 6) pursuit-of-information tendency 7) bargain hunter tendency 8) TV preference tendency 9) pursuit-of-leisure tendency. Next, after the K-means cluster analysis was performed with nine factors of the life-style patterns, the life-styles of the respondents were classified into four groups which are named as the 'progressive practicality-oriented group', 'positive success-oriented group', 'sociable ostentation-oriented group', 'stable conservation-oriented group'. The analysis results for usage behavior between the market segments showed statistically significant differences in the frequency of usage, duration time in the store, consumer satisfaction, and loyalty. Also, we tried to investigate whether the large discount store consumers differently perceive the quality of service based upon the types of life-style. To measure the service quality of large discount store, we adapted several measurement models measuring the service quality such as SERVPERF, BCP, R-SERVPERF, R-BCP. MANOVA and One-Way ANOVA were performed to confirm the difference in service quality perception based on the market segments. The results have also shown significant differences between life-style types in service quality perception. These findings show that the large discount store marketers should consider consumer life-style as one of the most important market segments for marketing and understand the difference in service quality perception between life-style types. Our findings give important implications to marketers of large discount stores as well as life-style researchers. First, this study showed there were significant differences in consumer's service quality perception and usage behavior between the types of life-style. It provides evidence that the life-style approach can be a important basis in segmenting the large discount store market and will make consumers perceive the service quality high. Second, most previous researches on service quality have been in aggregate level. However, our results imply that the future research on service quality have to focus on segment level.

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병원중심 가정간호사업 관리대상범위 확대를 위한 기초연구 (A Preliminary Study for Expending of Hospital-Based Horne Health Care Coverage - Focused on Accident Inpatients Who has the Workers Compensation Insurance -)

  • 이숙자;이진경;유호신
    • 가정∙방문간호학회지
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    • 제6권
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    • pp.5-18
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    • 1999
  • This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

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무의미한 연명치료 중단 등의 기준에 관한 재고 - 대법원 2009.5.21 선고 2009다17417사건 판결을 중심으로 - (Review on the Justifiable Grounds for Withdrawal of Meaningless Life-sustaining Treatment -Based on a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009)-)

  • 문성제
    • 의료법학
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    • 제10권2호
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    • pp.309-341
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    • 2009
  • According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

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의료보험 관리체계에 대한 연구 - 관리비용을 중심으로 - (A Study on the Health Insurance Management System; With Emphasis on the Management Operating Cost)

  • 남광성
    • 보건교육건강증진학회지
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    • 제6권2호
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    • pp.23-39
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    • 1989
  • There have been a lot of considerable. discussion and debate surrounding the management model in the health insurance management system and opinions regarding the management operating cost. It is a well known fact that there have always been dissenting opinions and debates surrounding the issue. The management operating cost varies according to the scale of the management organization and component members characteristics of the insurance carrier. Therefore, it is necessary to examine and compare the management operating cost to the simulated management models developed to cover those eligible for the health insurance scheme in this country. Since the management operating cost can vary according to the different models of management, four alternative management models have been established based on the critical evaluation of existing theories concerned, as well as on the basis of the survey results and simulation attempts. The first alternative model is the Unique Insurance Carrier Model(Ⅰ) ; desigened to cover all of the people with no classification of insurance qualifications and finances from the source of contribution of the insured, nationwide. The second is the Management Model of Large-scale District Insurance Carrier(Ⅱ) ; this means the Korean society would be divided into 21 large districts; each having its own insurance carrier that would cover the people in that particular district with no classification of insurance qualifications arid finances as in Model I. The third is the Management Model of Insurance Carrier Divided by Area and Classified with Occupation if Largescale (Ⅲ) ; to serve the self-employed in the 21 districts divided as in Model Ⅱ. It would serve the employees and their dependents by separate insurance carriers in large-scale similar to the area of the district-scale for the self-employed, so that the insurance qualifications and finances would be classified with each of the insurance carriers: The last is the Management Model of the Multi - insurance Carrier (Ⅳ) based on the Si. Gun. Gu area which will cover their own self- employed people in the area with more than 150 additional insurance carriers covering the employees and their dependents. The manpower necessary to provide services to all of the people according to the four models is calculated through simulation trials. It indicates that the Management Model of Large-scale District Insurance Carrier requires the most manpower among the four alternative models. The unit management operating costs per the insured individuals and covered persons are leveled with several intervals based on the insurance recipients. in their characteristics. The interval levels derived from the regression analysis reveal that the larger the scale of the insurance carriers is in the number of those insured and covered. the more the unit management operating cost decreases. significantly. Moreover. the result of the quadratic functional formula also shows the U-shape significantly. The management operating costs derived from the simulated calculation. on the basis of the average salary and related cost per staff- member of the Health Insurance Societies for Occupational Labours and Korean Medical Insurance Corporation for the Official Servants and Private School Teachers in 1987 fiscal year. show that the Model of Multi-insurance Carrier warrants the highest management operating cost. Meanwhile the least expensive management operating cost is the Management Model of Unique Insurance Carrier. Insurance Carrier Divided by Area and Classified with Occupation in Large-scale. and Large-scale District Insurance Carrier. in order. Therefore. it is feasible to select the Unique Insurance Carrier Model among the four alternatives from the viewpoint of the management operating cost and in the sense of the flexibility in promoting the productivity of manpower in the human services field. However. the choice of the management model for health insurance systems and its application should be examined further utilizing the operation research analysis for such areas as the administrative efficiency and factors related to computer cost etc.

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