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Cases and Legal Issues For 119paramedics in Mental Emergency Situations (정신응급상황에서 119구급대원 대응사례와 법적쟁점)

  • Young Pyo Hong
    • The Korean Society of Law and Medicine
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    • v.25 no.1
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    • pp.87-115
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    • 2024
  • In Korea, exposure to stress has been accompanied by mental pain in the process of achieving many growth along with rapid development, various social problems, and the frequency of emergency hospitalization is increasing.. In the case of mentally ill patients, "unwanted hospitalization" is a problem, and police and 119 paramedics try to suppress the body of mentally ill patients, and many problems are exposed This is because the constituent requirements of the provisions of emergency hospitalization under the Mental Health and Welfare Act do not reflect reality, and each institution has a different position on one mentally ill person, and emergency hospitalization does not proceed smoothly or leads to friction between related organizations, and the safety of the mentally ill or others is not secured. Emergency hospitalization is defined as "a person who finds a person who is presumed to be mentally ill and is at high risk of harming his or her health or safety or others," and if the situation is so urgent that he or she cannot afford time to go through the hospitalization procedure to decide on his or her own hospitalization, he or she can request emergency hospitalization with the consent of a doctor and a police officer. In this case, 119 paramedics are escorted to a psychiatric institution. This provision of emergency hospitalization poses many problems in the process of transferring to psychiatric institutions. If a police officer or 119 paramedics in charge of practice use "physical force" during the emergency hospitalization process, side effects will inevitably occur, and professional negligence can be a problem. Specifically, when exercising physical force, the minimum necessary physical restraint based on laws and regulations and proportional principles is required, and the lack of the duty of care of 119 paramedics or police officers under the laws and regulations will eventually be resolved by applying other laws and regulations. Accordingly, it will be an opportunity for mentally ill patients to be transferred to psychiatric institutions in a safe environment by changing the subject of emergency hospitalization provisions under the Mental Health Welfare Act, defining and prescribing the use of physical protection guards as the enforcement regulations of the Mental Health Act, setting the duty of care for 119 paramedics and police officers, and creating an environment for transportation so that mentally ill patients can be treated safely.

Whitening activity of Ficus carica L. fruits extract through inhibition of tyrosinase and MITF expression (무화과(Ficus carica L.) 열매 추출물의 tyrosinase 및 MITF 발현 억제를 통한 미백 활성)

  • Min Ji Kim;Si Eun Park;Geun soo Lee;Jin Hwa Kim;Sunwoo Kwon;Hyung Seo Hwang
    • Journal of Applied Biological Chemistry
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    • v.66
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    • pp.204-212
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    • 2023
  • Whitening is inhibitory activity of the melanin synthesis of melanocytes. Recently, whitening materials have been developed on natural materials because of its side effects on skin. Figs (Ficus Carica L.) is a fruit belonging to the Moraceae family and whitening activity was reported in focusing on the fig's stem and leaf components, but whitening activity of the figs fruit was not known. Thus, in this study, we tried to observe its anti-melanogenesis as well as antioxidant and anti-inflammation. The radical scavenging activity of figs fruits extract (FFE) was observed as the level of 34.52±1.98%/60.71±1.26% compared to the control in the its maximum concentration in the DPPH/ABTS assay. Cytotoxicity of FFE was observed at 10% concentration by CCK8 assay, so the maximum concentration was set at 5% and applied to all experiments. FFE concentration dependently decreased NO production associated with inducible nitric oxide synthase, cyclooxygenase-2, interleukin-6 and tumor necrosis factor-α gene expression, these strongly suggesting anti-inflammatory activity. In melanin contents assay, FFE significantly down-regulated melanin production in α-MSH-stimulated B16F10 cell as well as tyrosinase inhibition in vitro. In addition, FFE decreased the Microphthalmia-associated transcription factor (MITF) mRNA expression about 94.34% compared to the α-MSH treatment group in RT-PCR. Finally, FFE significantly reduced the MITF, cAMP response element-binding protein and tyrosinase protein expression in the α-MSH stimulated B16F10 cell. Through these results, we found that FFE can not only directly inhibit tyrosinase enzyme activity but also suppress melanogenesis through regulation of MITF gene expression in α-MSH signal transduction.

A comparative study of the puberty suppression effect of gonadotropin-releasing hormone agonist in precocious or early puberty girls (중추성 성조숙증 및 조기 사춘기 여아에서 성선자극호르몬 방출호르몬작용제의 용량에 따른 사춘기 억제 효과 비교)

  • Shim, Kye-Shik;Bae, Chong-Woo;Yang, You-Jung
    • Clinical and Experimental Pediatrics
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    • v.51 no.6
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    • pp.634-639
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    • 2008
  • Purpose : There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods : Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and $110{\mu}g/kg/-month$, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results : There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion : It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height.

Development of Korean Version of Heparin-Coated Shunt (헤파린 표면처리된 국산화 혈관우회도관의 개발)

  • Sun, Kyung;Park, Ki-Dong;Baik, Kwang-Je;Lee, Hye-Won;Choi, Jong-Won;Kim, Seung-Chol;Kim, Taik-Jin;Lee, Seung-Yeol;Kim, Kwang-Taek;Kim, Hyoung-Mook;Lee, In-Sung
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.97-107
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    • 1999
  • Background: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. Material and Method: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. Result: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. Conclusion: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).

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Evaluation of the Fruit Quality Indices during Maturation and Ripening and the Influence of Short-term Temperature Management on Shelf-life during Simulated Exportation in 'Changjo' Pears (Pyrus pyrifolia Nakai) (배 신품종 '창조'의 성숙 중 품질 요인 변화 및 수송온도 환경에 따른 반응성)

  • Lee, Ug-Yong;Choi, Jin-Ho;Ahn, Young-Jik;Chun, Jong-Pil
    • Journal of Bio-Environment Control
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    • v.26 no.4
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    • pp.378-385
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    • 2017
  • In this study, we evaluated the changes of fruit quality indices during fruit development and ripening in Korean new pear cultivar 'Changjo', developed from a cross between 'Tama' and '81-1-27' ('Danbae' ${\times}$ 'Okusankichi') in 1995 and named in 2009, to determine appropriate harvest time and to enhance the market quality and broaden the cultivation area. The fruits of 'Changjo' pears harvested from 132 days after full bloom (DAFB) to 160 DAFB. Fruit growth and quality indices were monitored at 1 week interval by measuring fruit weight, length, diameter, firmness, and taste related quality indices. The calculated fruit fresh weight increased continuously with fruit development and reached to an average of 594g on Sep. 20 (160 DAFB). The ratio of length to diameter declines as fruit maturation progress, resulting in 0.898 for ripe fruit stage as a round oblate shape. Flesh firmness of 'Changjo' pears showed over 30N until 153 DAFB and then decreased abruptly with fruit ripening, reaching a final level of about 26.44N on 160 DAFB. Starch content of fruit sap was also decreased abruptly after 146 DAFB which decreased almost half of the fruits harvested at 139 DAFB. In parallel with the decrease of flesh firmness, ethanol insoluble solids (EIS) content decreased sharply with fruit ripens, only 50% of EIS was detected on the fruits harvested on 160 DAFB when compared to that of the fruits harvested on 139 DAFB (Aug. 30). The maximum value of soluble solids contents was observed in the fruits harvested on 153 DAFB, resulting in $14.2^{\circ}Brix$. The changes of skin color difference $a^*$ which means loss of green color occurred only after 139 DAFB, coincide with the decrease of SPAD value of the fruit skin. The sugars of the 80% ethanol soluble fraction consisted mainly of fructose, sorbitol, glucose and sucrose, also increased during maturation and ripening. Fructose and sucrose contents were larger than those of glucose and sorbitol in flesh tissues. These results were explained that stored starch is converted to soluble sugars during fruit maturation, mainly in fructose and sucrose increasing the sweetness of this cultivar. Total polyphenols were increased up to middle of fruit maturation (146 DAFB) and then decreased continuously until the end of fruit maturation. Consequently, our results suggested that the commercial harvest time of 'Changjo' pears should not be passed 153 DAFB and late harvest of this cultivar would not good for quality maintenance during shelf-life. As a result of the post-harvest low-temperature acclimation experiment during the short-term transportation period, fruits harvested at 146 DAFB tended to maintain higher firmness after 14 days of simulated marketing at $25^{\circ}C$ compared to fruits harvested at 153 DAFB regardless of temperature set. And, the slower the rate of decrease to the final transport temperature of $5^{\circ}C$, the higher the incidence of internal browning and ethylene production. Therefore, in order to suppress the physiological disorder and to maintain the fruit quality when exporting to Southeast Asia in the 'Chanjo' pears, it is desirable to lower the temperature of the fruits within a short time after harvest and to set the harvest time before 146 days after full bloom.

The Effect of Lidocaine Dose and Pretreated Diazepam on Cardiovascular System and Plasma Concentration of Lidocaine in Dogs Ansthetized with Halothane-Nitrous Oxide (Diazepam 전투여와 Lidocaine 투여용량이 혈중농도 및 심혈역학적 변화에 미치는 영향)

  • Lee, Kyeong-Sook;Kim, Sae-Yeon;Park, Dae-Pal;Kim, Jin-Mo;Chung, Chung-Gil
    • Journal of Yeungnam Medical Science
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    • v.10 no.2
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    • pp.451-474
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    • 1993
  • Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels ($3.97{\pm}0.22-4.48{\pm}0.36$ mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels ($7.50{\pm}0.66-11.83{\pm}0.59$ mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and increased pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was associated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVRI). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered, reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level ($7.64{\pm}0.79-13.79{\pm}0.82$ mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After $CaCl_2$ administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, CVP was rather increased than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.

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Effects of Different Types of Dietary Fat on Muscle Atrophy According to Muscle Fiber Types and PPAR${\delta}$ Expression in Hindlimb-Immobilized Rats (지방의 종류가 다른 식이의 섭취가 하지고정 흰 쥐의 근 섬유별 근 위축과 PPAR${\delta}$ 활성에 미치는 영향)

  • Lee, Ho-Uk;Park, Mi-Na;Lee, Yeon-Sook
    • Journal of Nutrition and Health
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    • v.44 no.5
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    • pp.355-365
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    • 2011
  • This study investigated how dietary fat affects muscle atrophy and lipid metabolism in various muscles during hindlimb immobilization in rats. Twenty-four male Sprague?Dawley rats had their left hindlimb immobilized and were divided into four groups by dietary fat content and composition. The contralateral hindlimb (control) was compared with the immobilized limb in all dietary groups. Rats (n = 6/group) were fed a 4% corn oil diet (CO), 2.6% corn oil + 1.4% fish oil diet (FO), 30% corn oil diet (HCO), or a 30% beef tallow diet (HBT)after their hind limbs were immobilized for 10 days. Data were collected for the gastrocnemius, plantaris and soleus muscles. Muscle atrophy was induced significantly after 10 days of hindlimb immobilization, resulting in significantly decreased muscle mass and total muscle protein content. The protein levels of peroxisome proliferator activated receptor ${\delta}$ (PPAR${\delta}$) in the plantaris, gastrocnemius, and soleus increased following hindlimb immobilization irrespective of dietary fat intake. Interestingly, the PPAR${\delta}$ mRNA level in the plantaris decreased significantly in all groups and that in the FO group was lower than that in the other groups. The soleus PPAR${\delta}$ mRNA level decreased significantly following hindlimb immobilization in the FO group only. Muscle carnitine palmitoyl transferase 1 (mCPT1) mRNA level was not affected by hindlimb immobilization. However, the mCPT1 mRNA level in the FO group was significantly lower in the plantaris but higher in the soleus than that in the other groups. The pyruvate dehydrogenase kinase 4 (PDK4) mRNA level in the plantaris decreased significantly, whereas that in the soleus increased significantly following hindlimb immobilization. The plantaris, but not soleus, PDK4 mRNA level was significantly higher in the FO group than that in the CO group. The increased PPAR${\delta}$ protein level following hindlimb immobilization may have suppressed triglyceride accumulation in muscles and different types of dietary fat may have differentially affected muscle atrophy according to muscle type. Our results suggest that ${\omega}$-3 polyunsaturated fatty acids may suppress muscle atrophy and lipid accumulation by positively affecting the expression level and activity of PPAR${\delta}$ and PPAR${\delta}$-related enzymes, which are supposed to play an important role in muscle lipid metabolism.

A Study on the Growth Diagnosis and Management Prescription for Population of Retusa Fringe Trees in Pyeongji-ri, Jinan(Natural Monument No. 214) (진안 평지리 이팝나무군(천연기념물 제214호)의 생육진단 및 관리방안)

  • Rho, Jae-Hyun;Oh, Hyun-Kyung;Han, Sang-Yub;Choi, Yung-Hyun;Son, Hee-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.36 no.3
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    • pp.115-127
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    • 2018
  • This study was attempted to find out the value of cultural assets through the clear diagnosis and prescription of the dead and weakness factors of the Population of Retusa Fringe Trees in Pyeongji-ri, Jinan(Natural Monument No. 214), The results are as follows. First, Since the designation of 13 natural monuments in 1968, since 1973, many years have passed since then. In particular, despite the removal of some of the buried soil during the maintenance process, such as retreating from the fence of the primary school after 2010, Second, The first and third surviving tree of the designated trees also have many branches that are dead, the leaves are dull, and the amount of leaves is small. vitality of tree is 'extremely bad', and the first branch has already been faded by a large number of branches, and the amount of leaves is considerably low this year, so that only two flowers are bloomed. The second is also in a 'bad'state, with small leaves, low leaf density, and deformed water. The largest number 1 in the world is added to the concern that the s coverd oil is assumed to be paddy soils. Third, It is found that the composition ratio of silt is high because it is known as '[silty loam(SiL)]'. In addition, the pH of the northern soil at pH 1 was 6.6, which was significantly different from that of the other soil. In addition, the organic matter content was higher than the appropriate range, which is considered to reflect the result of continuous application for protection management. Fourth, It is considered that the root cause of failure and growth of Jinan pyeongji-ri Population of Retusa Fringe Trees group is chronic syndrome of serious menstrual deterioration due to covered soil. This can also be attributed to the newly planted succession and to some of the deaths. Fifthly, It is urgent to gradually remove the subsoil part, which is estimated to be the cause of the initial damage. Above all, it is almost impossible to remove the coverd soil after grasping the details of the soil, such as clayey soil, which is buried in the rootstock. After removal of the coverd soil, a pestle is installed to improve the respiration of the roots and the ground with Masato. And the dead 4th dead wood and the 5th and 6th dead wood are the best, and the lower layer vegetation is mown. The viable neck should be removed from the upper surface, and the bark defect should undergo surgery and induce the development of blindness by vestibule below the growth point. Sixth, The underground roots should be identified to prepare a method to improve the decompression of the root and the respiration of the soil. It is induced by the shortening of rotten roots by tracing the first half of the rootstock to induce the generation of new roots. Seventh, We try mulching to suppress weed occurrence, trampling pressure, and soil moisturizing effect. In addition, consideration should be given to the fertilization of the foliar fertilizer, the injection of the nutrients, and the soil management of the inorganic fertilizer for the continuous nutrition supply. Future monitoring and forecasting plans should be developed to check for changes continuously.

The lesson From Korean War (한국전쟁의 교훈과 대비 -병력수(兵力數) 및 부대수(部隊數)를 중심으로-)

  • Yoon, Il-Young
    • Journal of National Security and Military Science
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    • s.8
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    • pp.49-168
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    • 2010
  • Just before the Korean War, the total number of the North Korean troops was 198,380, while that of the ROK(Republic of Korea) army troops 105,752. That is, the total number of the ROK army troops at that time was 53.3% of the total number of the North Korean army. As of December 2008, the total number of the North Korean troops is estimated to be 1,190,000, while that of the ROK troops is 655,000, so the ROK army maintains 55.04% of the total number of the North Korean troops. If the ROK army continues to reduce its troops according to [Military Reform Plan 2020], the total number of its troops will be 517,000 m 2020. If North Korea maintains the current status(l,190,000 troops), the number of the ROK troops will be 43.4% of the North Korean army. In terms of units, just before the Korean War, the number of the ROK army divisions and regiments was 80% and 44.8% of North Korean army. As of December 2008, North Korea maintains 86 divisions and 69 regiments. Compared to the North Korean army, the ROK army maintains 46 Divisions (53.4% of North Korean army) and 15 regiments (21.3% of North Korean army). If the ROK army continue to reduce the military units according to [Military Reform Plan 2020], the number of ROK army divisions will be 28(13 Active Division, 4 Mobilization Divisions and 11 Local Reserve Divisions), while that of the North Korean army will be 86 in 2020. In that case, the number of divisions of the ROK army will be 32.5% of North Korean army. During the Korean war, North Korea suddenly invaded the Republic of Korea and occupied its capital 3 days after the war began. At that time, the ROK army maintained 80% of army divisions, compared to the North Korean army. The lesson to be learned from this is that, if the ROK army is forced to disperse its divisions because of the simultaneous invasion of North Korea and attack of guerrillas in home front areas, the Republic of Korea can be in a serious military danger, even though it maintains 80% of military divisions of North Korea. If the ROK army promotes the plans in [Military Reform Plan 2020], the number of military units of the ROK army will be 32.5% of that of the North Korean army. This ratio is 2.4 times lower than that of the time when the Korean war began, and in this case, 90% of total military power should be placed in the DMZ area. If 90% of military power is placed in the DMZ area, few troops will be left for the defense of home front. In addition, if the ROK army continues to reduce the troops, it can allow North Korea to have asymmetrical superiority in military force and it will eventually exert negative influence on the stability and peace of the Korean peninsular. On the other hand, it should be reminded that, during the Korean War, the Republic of Korea was attacked by North Korea, though it kept 53.3% of troops, compared to North Korea. It should also be reminded that, as of 2008, the ROK army is defending its territory with the troops 55.04% of North Korea. Moreover, the national defense is assisted by 25,120 troops of the US Forces in Korea. In case the total number of the ROK troops falls below 43.4% of the North Korean army, it may cause social unrest about the national security and may lead North Korea's misjudgement. Besides, according to Lanchester strategy, the party with weaker military power (60% compared to the party with stronger military power) has the 4.1% of winning possibility. Therefore, if we consider the fact that the total number of the ROK army troops is 55.04% of that of the North Korean army, the winning possibility of the ROK army is not higher than 4.1%. If the total number of ROK troops is reduced to 43.4% of that of North Korea, the winning possibility will be lower and the military operations will be in critically difficult situation. [Military Reform Plan 2020] rums at the reduction of troops and units of the ground forces under the policy of 'select few'. However, the problem is that the financial support to achieve this goal is not secured. Therefore, the promotion of [Military Reform Plan 2020] may cause the weakening of military defence power in 2020. Some advanced countries such as Japan, UK, Germany, and France have promoted the policy of 'select few'. However, what is to be noted is that the national security situation of those countries is much different from that of Korea. With the collapse of the Soviet Unions and European communist countries, the military threat of those European advanced countries has almost disappeared. In addition, the threats those advanced countries are facing are not wars in national level, but terrorism in international level. To cope with the threats like terrorism, large scaled army trops would not be necessary. So those advanced European countries can promote the policy of 'select few'. In line with this, those European countries put their focuses on the development of military sections that deal with non-military operations and protection from unspecified enemies. That is, those countries are promoting the policy of 'select few', because they found that the policy is suitable for their national security environment. Moreover, since they are pursuing common interest under the European Union(EU) and they can form an allied force under NATO, it is natural that they are pursing the 'select few' policy. At present, NATO maintains the larger number of troops(2,446,000) than Russia(l,027,000) to prepare for the potential threat of Russia. The situation of japan is also much different from that of Korea. As a country composed of islands, its prime military focus is put on the maritime defense. Accordingly, the development of ground force is given secondary focus. The japanese government promotes the policy to develop technology-concentrated small size navy and air-forces, instead of maintaining large-scaled ground force. In addition, because of the 'Peace Constitution' that was enacted just after the end of World War II, japan cannot maintain troops more than 240,000. With the limited number of troops (240,000), japan has no choice but to promote the policy of 'select few'. However, the situation of Korea is much different from the situations of those countries. The Republic of Korea is facing the threat of the North Korean Army that aims at keeping a large-scale military force. In addition, the countries surrounding Korea are also super powers containing strong military forces. Therefore, to cope with the actual threat of present and unspecified threat of future, the importance of maintaining a carefully calculated large-scale military force cannot be denied. Furthermore, when considering the fact that Korea is in a peninsular, the Republic of Korea must take it into consideration the tradition of continental countries' to maintain large-scale military powers. Since the Korean War, the ROK army has developed the technology-force combined military system, maintaining proper number of troops and units and pursuing 'select few' policy at the same time. This has been promoted with the consideration of military situation in the Koran peninsular and the cooperation of ROK-US combined forces. This kind of unique military system that cannot be found in other countries can be said to be an insightful one for the preparation for the actual threat of North Korea and the conflicts between continental countries and maritime countries. In addition, this kind of technology-force combined military system has enabled us to keep peace in Korea. Therefore, it would be desirable to maintain this technology-force combined military system until the reunification of the Korean peninsular. Furthermore, it is to be pointed out that blindly following the 'select few' policy of advanced countries is not a good option, because it is ignoring the military strategic situation of the Korean peninsular. If the Republic of Korea pursues the reduction of troops and units radically without consideration of the threat of North Korea and surrounding countries, it could be a significant strategic mistake. In addition, the ROK army should keep an eye on the fact the European advanced countries and Japan that are not facing direct military threats are spending more defense expenditures than Korea. If the ROK army reduces military power without proper alternatives, it would exert a negative effect on the stable economic development of Korea and peaceful reunification of the Korean peninsular. Therefore, the desirable option would be to focus on the development of quality of forces, maintaining proper size and number of troops and units under the technology-force combined military system. The tableau above shows that the advanced countries like the UK, Germany, Italy, and Austria spend more defense expenditure per person than the Republic of Korea, although they do not face actual military threats, and that they keep achieving better economic progress than the countries that spend less defense expenditure. Therefore, it would be necessary to adopt the merits of the defense systems of those advanced countries. As we have examined, it would be desirable to maintain the current size and number of troops and units, to promote 'select few' policy with increased defense expenditure, and to strengthen the technology-force combined military system. On the basis of firm national security, the Republic of Korea can develop efficient policies for reunification and prosperity, and jump into the status of advanced countries. Therefore, the plans to reduce troops and units in [Military Reform Plan 2020] should be reexamined. If it is difficult for the ROK army to maintain its size of 655,000 troops because of low birth rate, the plans to establish the prompt mobilization force or to adopt drafting system should be considered for the maintenance of proper number of troops and units. From now on, the Republic of Korean government should develop plans to keep peace as well as to prepare unexpected changes in the Korean peninsular. For the achievement of these missions, some options can be considered. The first one is to maintain the same size of military troops and units as North Korea. The second one is to maintain the same level of military power as North Korea in terms of military force index. The third one is to maintain the same level of military power as North Korea, with the combination of the prompt mobilization force and the troops in active service under the system of technology-force combined military system. At present, it would be not possible for the ROK army to maintain such a large-size military force as North Korea (1,190,000 troops and 86 units). So it would be rational to maintain almost the same level of military force as North Korea with the combination of the troops on the active list and the prompt mobilization forces. In other words, with the combination of the troops in active service (60%) and the prompt mobilization force (40%), the ROK army should develop the strategies to harmonize technology and forces. The Korean government should also be prepared for the strategic flexibility of USFK, the possibility of American policy change about the location of foreign army, radical unexpected changes in North Korea, the emergence of potential threat, surrounding countries' demand for Korean force for the maintenance of regional stability, and demand for international cooperation against terrorism. For this, it is necessary to develop new approaches toward the proper number and size of troops and units. For instance, to prepare for radical unexpected political or military changes in North Korea, the Republic of Korea should have plans to protect a large number of refugees, to control arms and people, to maintain social security, and to keep orders in North Korea. From the experiences of other countries, it is estimated that 115,000 to 230,000 troops, plus ten thousands of police are required to stabilize the North Korean society, in the case radical unexpected military or political change happens in North Korea. In addition, if the Republic of Korea should perform the release of hostages, control of mass destruction weapons, and suppress the internal wars in North Korea, it should send 460,000 troops to North Korea. Moreover, if the Republic of Korea wants to stop the attack of North Korea and flow of refugees in DMZ area, at least 600,000 troops would be required. In sum, even if the ROK army maintains 600,000 troops, it may need additional 460,000 troops to prepare for unexpected radical changes in North Korea. For this, it is necessary to establish the prompt mobilization force whose size and number are almost the same as the troops in active service. In case the ROK army keeps 650,000 troops, the proper number of the prompt mobilization force would be 460,000 to 500,000.

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