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Intensity Modulated Radiation Therapy Commissioning and Quality Assurance: Implementation of AAPM TG119 (세기조절방사선치료(IMRT)의 Commissioning 및 정도관리: AAPM TG119 적용)

  • Ahn, Woo-Sang;Cho, Byung-Chul
    • Progress in Medical Physics
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    • v.22 no.2
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    • pp.99-105
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    • 2011
  • The purpose of this study is to evaluate the accuracy of IMRT in our clinic from based on TG119 procedure and establish action level. Five IMRT test cases were described in TG119: multi-target, head&neck, prostate, and two C-shapes (easy&hard). There were used and delivered to water-equivalent solid phantom for IMRT. Absolute dose for points in target and OAR was measured by using an ion chamber (CC13, IBA). EBT2 film was utilized to compare the measured two-dimensional dose distribution with the calculated one by treatment planning system. All collected data were analyzed using the TG119 specifications to determine the confidence limit. The mean of relative error (%) between measured and calculated value was $1.2{\pm}1.1%$ and $1.2{\pm}0.7%$ for target and OAR, respectively. The resulting confidence limits were 3.4% and 2.6%. In EBT2 film dosimetry, the average percentage of points passing the gamma criteria (3%/3 mm) was $97.7{\pm}0.8%$. Confidence limit values determined by EBT2 film analysis was 3.9%. This study has focused on IMRT commissioning and quality assurance based on TG119 guideline. It is concluded that action level were ${\pm}4%$ and ${\pm}3%$ for target and OAR and 97% for film measurement, respectively. It is expected that TG119-based procedure can be used as reference to evaluate the accuracy of IMRT for each institution.

An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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Study on Suggestions for the Nutritional and Hygienic Standards and Guidelines for Quality Certification in Children's Preferable Food (어린이 기호식품 품질인증을 위한 영양 및 위생기준 설정에 대한 연구)

  • Yun, Jee-Hye;Cho, Sun-Duk;Kim, Seo-Young;Lee, Eun-Ju;Park, Hye-Kyung;Kim, Myung-Chul;Kim, Gun-Hee
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.37 no.5
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    • pp.589-597
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    • 2008
  • The purpose of this study is to arrange for the systematic execution of safety control in children's foods through nutrition and hygiene standard suggestions and guidelines for quality certification system in children's preferable food. Aiming to achieve this objective, the study researched the present status of children’s preferable food sold near elementary schools, elicited the hazards and problems of those foods and selected nutritional and hygienic hazard components in those foods. To suggest the standards and guidelines for quality certification in children's preferable food, the study referred to sundry records, surveyed the practical cases of relevant policies and standards at home and abroad. We studied the standard of nutrition for the quality certification in those foods for sugar, fat, sodium, and additives (tar color: red No. 2 in a ban on use, caffeine), microorganism (aflatoxin $B_1$ (${\mu}g$/kg) and pathogenic bacteria (Staphylococcus aureus, Bacillus cereus, Salmonella spp.), which are the nutrients that may hamper health when taken in a large amount, and the standard for a diet restricted to under 200 kcal per one serving size. Results of distribution of processed foods (242 samples) by nutrition standards were as follows. In case of all ‘low’ level in total sugar, total fat and sodium, 0.4% of total samples was possible to be certified, In case of all ‘medium’ level in total sugar, total fat and sodium, maximumly 22.3% of total samples was possible to be certified. In case of all medium level in nutrients and $\leq$200 kcal/serving, 17.8% of total samples was possible to be certified. Certified food types was milk products and beverages.

A STUDY ON THE MAXIMUM BITE FORCE AND FACIAL MORPHOLOGY ACCORDING TO CHEWING SIDE PREFERENCE (저작습관에 따른 교합력과 안면골격형태의 비교연구)

  • Jeong, Mi-Ra;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.25 no.3 s.50
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    • pp.311-321
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    • 1995
  • This study was undertaken to investigate the distribution of the chewing side preference and variations in the maximum bite force and facial morphology according to chewing side preference since unilateral chewing may cause morphologic and functional anomalies. 50 dental students who had no signs or symptoms of masticatory system and Angle's Class I relationship in posterior segments were selected, and divided into two groups, that is, 25 in bilateral chewing group(19 male and 6 female) and 25 in unilateral chewing group(10 male and 15 female). Maximum bite force was estimated ana posteroanterior cephalogram were measured ana statistically analyzed. The results were as follows : 1. Their were more students with bilateral chewing side preference($68\%$) and unilateral chewing side group consisted of right side preference($68\%$) and left side preference($32\%$). 2. There was no significant difference in the strength of max. bite force between the right and left side in bilateral chewing group. The bite force of the chewing side nab greater in the unilateral chewing group but less in the non-chewing side compared to those of bilateral chewing group with Bo significant difference. Max. bite force of chewing side was greater than that of non-chewing side in the unilateral chewing group(Female p<0.05). Max. bite force of males was about twice in that of females in both groups(p<0.05). Max. bite force of chewing side of the unilateral chewing group was similar to that of the bilateral chewing group, but that of non-chewing side was less than that of the bilateral chewing group. 3. In comparison of the facial morphology, there was no statistically significant difference in the size between the right and left side of the bilateral chewing group and between chewing and non-chewing side of the unilateral chewing group.

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Associations between Characteristics of Green Spaces, Physical Activity and Health - Focusing on the Case Study of Changwon City - (공원녹지의 특성과 신체활동 및 건강의 상호관련성 - 창원시를 대상으로 -)

  • Baek, Su-Kyeongq;Park, Kyung-Hun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.3
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    • pp.1-12
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    • 2014
  • Urban Green space takes charge of the important role for the physical activity and promotion of health to the residents. Therefore, this study is trying to examine the relationship between the various characteristics of green space and green space usage for physical activity and health promotion. A questionnaire survey was conducted to obtain the information about patterns of green space usage and perceived neighborhood environments for the residents living in Changwon-si, Gyeongsangnam-do(n=541). Geographic Information System(GIS) was used to construct spatial data about green space accessibility and physical neighborhood environments. A Multiple Linear Regression model was used to examine the association between the characteristics of green space and physical activity, perceived health status and BMI(Body Mass Index). The study results revealed that the residents' physical activities are positively and directly influenced by the number of available public parks and green spaces in the vicinity(${\leq}200m$). The frequency at which residents witness others exercising nearby or the perceived abundance of low-cost gym facilities also factor as positive influences. The closer to the park, the higher the number of parks and area of green spaces, the more comfortable the walk thereto and the denser the neighboring residential area distribution, the perceived health level was found to be the more positively influenced. Further, it was verified that BMI is correlated with the number of public parks and green spaces within 400 m of the resident's home as well as the safety of walkways, the density of neighboring residential areas, the ratio of road, and the density of crosswalk. The significant multiple regression models between the characteristics of green spaces and physical activities and perceived health level were extracted within the significance level of 10%. This study will contribute to provide better understanding the ways in which green space and neighborhood characteristics are associated with physical activity and health. The result of this research will be available in the landscape architecture plan aimed at improving the use of green space for physical activity and reducing obesity.

A Study on Organizational Strategy and Operational Elements of Community-based Agricultural Management Bodies (마을단위 농업경영체 조직전략 및 운영요소 도출 연구)

  • Kim, Jong An;Kil, Cheong Soon;Kim, Gi Tae;Kim, Won Gyeong
    • Journal of Agricultural Extension & Community Development
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    • v.20 no.3
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    • pp.777-822
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    • 2013
  • This study attempts to elicit the organizational strategy and operational elements of community-based agricultural management bodies as new main farm management. We analyzed the newest discussion trend, cooperated community management, between Republic of Korea and Japan based on theory of organizing regional agriculture, and also researched on the organization management and business management about cooperated management of community. In this study, the main conclusion of the organizational strategy and operational elements of community-based agricultural management bodies are as following. i) The community-based agricultural management bodies is the cooperation managed individual agriculture resources as joint stock for purposing compound goal, an expansion agricultural income, maintenance farm productivity and rural societies. ii) The domain of cooperative management focus on secondary and tertiary industry like food process, farm produce distribution, rural experience more than farm produce production. The study suggest business promotion system of village unit farmers groups, element of organization management as executive decision organization, business management, operating factor for each steps and management element of cooperation farm working. iii) The policy direction for invigoration community-based agricultural management bodies is to make facilitation for each steps instead of standardized support.

A Baseline Survey on Development of Primary Health Care in the Rural Korea -Sanpuk Village, Kumsa-Myun, Yuju- Gun, Kyunggi-Do- (농촌지역의 일차보건사업 개발을 위한 기초조사 연구 - 경기도 여주군 금사면 산북부락을 중심으로 -)

  • Kim, Myung-Ho;Yun, Suk-Woo;Rhee, Hae-Soak
    • Journal of agricultural medicine and community health
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    • v.12 no.1
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    • pp.5-27
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    • 1987
  • It is widely recognized that primary health care in the community is one of the most important and effective health measures in these days. However, it is reality that unsatisfactory health care system, ineffective utilization of health care by the community people in the rural area are hampering better understanding for primary health care. Therefore promoting health for the rural people and increasing understanding about primary health care, the baseline survey in the community focused in examination for safe community water supply was carried out. The survey was conducted through August 25-31, 1986 in order to find out health problems and relevant factors and to define the demographic characteristics of $^*$Sanpuk village, Kumsa-Myun, Yuju-Gun, Kyunggi-Do, Korea. Household survey was carried out for every home by trained interviewers. The major results are found out as follows : 1) 84.2%(400 houses) of total households were surveyed because 15.8%(75 houses) were unable to survey due to either refusal against interview or absence of family. These 400 households were composed of 1,697 residents(male:830, female 867). Educational level of respondents showed 34.1% as elementary school graduated. Religion distribution showed Buddism(23.8%) as the most dominant. 50.7% of respondents married in the area. 2) Most households(91.5%) have lived in their own house in Sanpuk area. Average family size showed 4.3. More than half of residents(64.2%) have used public supplied water tap. Only 1.5% of the households had a flush toliet. The rest of households have still used primitive insanitary latrines. 3) 32.5% of residents have used gas burner for cooking and for heating in the house, and the coal briquet were used for boiler. Lack of convenient public transportation was the chief complaint for their day life. 4) Each household occupied 1,990 pyungs of rice paddy and 1,170 pyungs of ordinary field in average. Beside farming products, mushroom was the highest product. 5) Sixth percent of households in the survey area regularly participated in community meeting one hand and on the other hand 39.5% never participated. Most of respondents closely contacted with their neighbours and they seemed very friendly each other. 6) The prevalence rate of illness and injury during recent 15 days showed 48.3 per 1,000. The prevalence rate of chronic illnesses during the past one year showed 74 per 1,000. Injury and accident lead the higher portion(22.0%) in the former and in the latter pain(arthritis, back-pain) showed 27.0% as the dominant sickness. 87.8% of the ill residents in the former received medical treatment. As the most frequently utilized medical facility, the clinic or hospital were counted. Among the residents suffering from chronic illnesses, 77.3% in Sanpuk area get some kind of medical treatments and they rarely utilized the clinic or hospital. The reason why the patient did not receive any medical care was found out the fact that symptoms of illness was light or mild and economic problems was serious. 7) Average age of marriage showed 21.6 years old in the women and the average duration of marital period was shown for 15.1 years. The married woman in reproductive age in Sanpuk area had experienced pregnancies 4 times in the aver-age including 0.7 time of pregnancy in average were interrupted by induced abortion and 0.3 time by spontaneous abortion respectively. The practicing rate of the family planning of the married woman during reproductive ages showed 70.7% and the tuballigation was found out as the most frequently used contraceptives. 8) Among woman who has children under 2 years old, 70.0% had received the prenatal care for the last pregnancy. However, the average number of prenatal care visitis per woman showed 3.3 times. Fifty-two % of woman who received the postnatal care for the last delivery showed only 37.5%. 9) Immunization rate of the children under 2 years old showed relatively high and looked successful. The breast feeding for these children showed dominantly in the most. Most of the mothers in Sanpuk area had started the supplementary diet during weaning period of their infants of 6th and 7th month after birth. * : Sanpuk area is a demstration area for community development which has been supported by the Community Development Foundation during the part 10 years. The village is relatively closer to urban area such as Seoul, However, it has a similar characteristics shown as a remote village because of geographical location and inconvenient transportation at present.

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A Study of community diagnosis activity by Community Health Nurse Working in Health Centers (보건소 보건간호사의 지역사회 진단활동에 관한 조사연구)

  • Cho Won-Jung;Kim Young-Ran
    • Journal of Korean Public Health Nursing
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    • v.6 no.1
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    • pp.32-45
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    • 1992
  • An important role of community health nurses in health centers is to solve community health problems found through data collection methodology which has been used to identify the health needs of the community, diagnose the health problems and to plan health programs suitable for the health problems. Also community health nurses must be prepared to know the community health needs and to participate in the planning process. Since 1956 when the health center law was established, community health nurses have really implemented only the services which the government has asked them to do. This has kept them busy enough. But these days as society is in rapid change, community health nurses should have the flexibility to deal with the social change and demands that are unique to their community each which has different health needs and demands. So community health nurses need to identify what community health problems exist in their particular communities. The purposes of this study were as follows. 1) To explore the suitability of the health programs which the government has asked the community health nurses to do for their own communities and if these programs are not suitable, to explore the reasons why. 2) To explore the degree to which the community health nurses have the ability to identify health problems in their own communities and activate the community diagnostic process. 3) To identify the degree that the community health nurses have the ability to implement plans related to community diagnosis. 4) To find out how much data related to community health problems, the community health nurses have and how they are utilizing it. 5) To measure the community health nurses self-confidence concerning diagnostic activities for community health. The study subjects were 454 Community Health Nurses working in Health Centers in Seoul, Korea. The period of data collection was 6 days(Nov. 9th 1991-Nov. 15th 1991). A questionnaire used for data collection was composed of three different items; general characteristics, community health diagnostic activities and self-confidence in performing diagnostic activities. The results of the study are as follows. First, over one third of the respondents replied that the government required activities for their communities are not appropriate. Of these activities the most frequent reply $(51.2\%)$ indicated that many of the activities in the community were inappropriate to the actual situation. Further, $25\%$ of the replies indicated that many activities were only administratively oriented and as such not appropriate. Second, $49.8\%$ of the respondents replied that they had done general assessments and had a general idea of the health problems of their community. Effective solutions to health problems could be found with an increase in health personnel and management ability according to $41.5\%$ of the respondents. Third, to the question as to whether they had ever independently implemented a plan towards solving community diagnosed problems, $52\%$ of nurses replied 'never', $40\%$ 'occasionally' but only $7.5\%$ replied that they did it frequently. Actually there was very little done even in the basic work of collecting the necessary data. Fourth, when asked how much of basic information they had collected that might be used in community diagnosis activity, of 26 items in 5 areas, there was hardly one for which complete data had been collected. Fifteen percent did have data on the geographical aspects of their area, housing distribution and types of housing, while $17.8\%$ knew the frequency with which the health center was used. Concerning community resources, even with a list of community resources, only $12.3\%$ had data on any of these resources, and this data was incomplete. Further, information about social work institutions, and facilities was also incomplete, only $14.2\%$ of the respondents had any data and even it was incomplete; that is, in general, the nurses did not have this information. Fifth, concerning the confidence of the community health nurse in their ability to carry out community diagnoses activities, $60\%$ replied that they were very or at least nominally confident, indicating that although they were not doing community diagnostic activities they felt they could do so, as they were carrying out home visits and program planning as part of their official duties. The following recommendations are made based on the results of this study. First; since the community health nurses have a high perception of the need for community diagnostic activities and. high confidence in their ability to carry out this activity and high percentage of respondents replied that with a little training they could do this even better it is recommended that community diagnostic activity training be included in the continuing education program for community health nurses. Second, in order for the Community Health Nurses to successfully solve the health problems of their respective community they reported to a need to increase the number of health personnel, improve the facilities and the system of managing their work. Considering this, it is recommended that ways be sought to remedy these deficits.

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The Characteristics Asian Dust Observed in Japan Deflecting the Korean Peninsula (2010. 5. 22.-5. 25.) (한반도를 돌아 일본에서 관측된 황사의 특징 (2010년 5월 22일-5월 25일))

  • Ahn, Bo-Young;Chun, Young-Sin
    • Journal of the Korean earth science society
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    • v.32 no.4
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    • pp.388-401
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    • 2011
  • Asian dust was observed a total of 66 times in the springtime during the period from 2002 to 2010, with 26 cases in March, 23 cases in April and 17 cases in May. This study investigates a Asian dust episode that occurred during the period from 22 to 25 May 2010, based on synoptic weather patterns, wind vector at 850 hPa, relative humidity at 1000 hPa, Jet streams and wind vector at 300 hPa, PM10 concentration in Korea and satellite imagery. In this case, Asian dust originated on 22 May along the rear of a developing low pressure system in Mongolia. The Asian dust was then transported southeastward and bypassed the Korea peninsula from 23 to 24 May, before reaching Japan on 25 May. Jet streams on 24 May bypassed the Korean peninsula and induced the development of a surface low pressure centered over the peninsula. The resulting air flow was critical to the trajectory of the Asian dust, which likewise bypassed the Korean peninsula. 72-hour backward trajectory data reveal that the Shandong Peninsula and the East China Sea were the points of origin for the air flows that swept through the Japanese sites where Asian dust was observable to the naked eay. The Asian dust pathway is ascertained by horizontal distribution of the Asian dust of RGB imagery from MODIS satellites which captured the Asian dust moving over the Shandong Peninsula, the East China Sea, and northwest of the Kyushu region in Japan. Since the synoptic pattern and the transport way of the Asian dust case are far from typical ones, which Asian dust forecasting technique has long been based on, this study can be good example of exceptional Asian dust pattern and it will be used for more accurate Asian dust forecasting.

Morphologic Response of Gravel Beach to Typhoon Invasion - A Case Study of Gamji Beach Taejongdae in Busan (태풍 내습 시 자갈 해빈의 지형반응 - 부산 태종대 감지 해빈의 사례)

  • Lee, Young Yun;Chang, Tae Soo
    • Journal of the Korean earth science society
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    • v.41 no.1
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    • pp.19-30
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    • 2020
  • To understand the impact of typhoons on Gamji gravel beach Taejongdae in Busan, we carried out beach profiling using a VRS-GPS system and a Drone photogrammetry for the typhoons 'Kong-rey' invaded in October 2018 and 'Danas' in July 2019. In addition, grain sizes are analyzed to investigate the overall distribution pattern of gravels on the beach, and the beach topography is surveyed periodically to confirm the recovery rate of the beach. Grain-size analysis reveals that mean gravel sizes, in general, become finer from -6.2Φ to -5.4Φ towards the east in the seashore line direction. Variation in mean sizes is obviously observed in the cross-shore direction. Gravels in the swash zone are relatively fine about -4.5Φ in size and equant in shape, whereas the coarse and oblate gravels ranged from -5Φ to -6Φ are found in the berm. Gamji gravel beach particularly has two lines of berms: a lower berm situated facing beach and an upper berm about 10 m landward. After the typhoon Kong-rey passed by, about 1.4 m of severe erosion in upper berm occurred, and the berm eventually disappeared. On the backshore of the upper berm about 50 cm of erosion took place so that the elevation became lower. However, tangible erosion was not observed in the lower berm. When typhoon Danas hit, rated as mild storm, both upper and lower berm were eroded out. However, about 50 cm of deposition occurred only in the backshore. Only three days later, the new lower berm was formed, meaning that sedimentation rate must be high. This result indicates that Gamji gravel beach is recovered very fast from erosion caused by the typhoons when it is under the fair-weather condition even though beach morphology changes dramatically in a short period of time. Gravel beach is estimated to be or evaluated very resilient to typhoon erosion.