• Title/Summary/Keyword: two-time testing

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Arthroscoic Anterior Cruciate Ligament Reconstruction with Autogenous Hamstring Gratt - Effect of the Additional Fixation after Fixation of the Graft with Intrafix - (자가 슬괵건을 이용한 관절경적 전방 십자 인대 재건술 - INTRAFIX system을 이용한 경골부 고정 후 부가적 고정의 효과 -)

  • Yoo, Jae-Doo;Roh, Kwon-Jae;Shin, Sang-Jin;Yoon, Jong-Suk;Yeo, Sung-Gu
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.1
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    • pp.51-55
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    • 2005
  • Purpose: To compare the stability and clinical result after anterior cruciate ligament reconstructed knee after graft fixation using Intrafix in tibial tunnel with or without additional tibial post fixation. Materials and Methods: We analyzed 37 cases which were treated with four-strand hamstring tendon autograft during the period from May 2002 to January 2003. The grafts were fixed with Rigidfix system (Mitek Product, Johnson and Johnson, USA) in femur tunnel and Intrafix system (Mitek Product, Johnson and Johnson, USA) in tibial tunnel. After tibial fixation, additional tibial post fixation was done, which was determined by the serial case number prospectively. Patients were followed for average of fourteen months(range, thirteen to twenty-five months) At the time of final follow-up, patients were evaluated in terms of Lachman test, pivot shift test, Lysholm scores, IKDC (International Knee Documentation Committee) assessment, side-to-side KT-1000 maximum-manual arthrometer differences. Results: At last follow-up, Lysholm score was average 93.1(range: 65 to 98), IKDC assessment revealed that 26 cases had score of A, 10 cases had score of B and 1 case had score of C. The average maximum-manual KT-1000 arthrometer side ?to-side difference was 2.5 mm$(0{\sim}6mm)$. There was one case in which the Lachman test was graded as 2+ and four cases in which the Lachman test was graded as 1+ and the remaining thirty-two cases were normal by Lachman test. One case had a 2+ pivot-shift, and 2 cases had a 11 pivot-shift. The remaining 34 knees were normal on pivot -shift testing. The average maximum-manual KT-1000 arthrometer side-to-side difference was average 2.8 mm$(0{\sim}6mm)$ in Intrafix only group and average 2.2 mm$(0{\sim}4mm)$ in additional fixation group (P>0.05). Conclusion: Without additional tibial fixation, the stability of the anterior cruciate reconstructed knee with hamstring graft which was fixed with Intrafix was restored.

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Control of Bakanae Disease of Rice by Seed Soaking into the Mixed Solution of Procholraz and Fludioxnil (Prochlornz와 fludioxonil 혼용침지소독에 의한 벼 키다리병 방제)

  • Park, Woo-Sik;Choi, Hyo-Won;Han, Seong-Suk;Shin, Dong-Beum;Shim, Hyeong-Kwon;Jung, En-Seon;Lee, Se-Weon;Lim, Chun-Keun;Lee, Yong-Hwan
    • Research in Plant Disease
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    • v.15 no.2
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    • pp.94-100
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    • 2009
  • These experiments were conducted to improve the effect of seed disinfection on rice seed severely infected Bakanae disease by seed soaking into mixed solution of prochloraz EC and fludioxonil FS. We investigated the effects of various concentrations of two fungicides mixed solution on spore germination and mycelial growth of Fusarium fujikuroi. Mycelial growth was inhibited 100% at $10{\mu}g$/ml of prochloraz and 33.3% at $80{\mu}g$/ml of fludioxonil. Spore germination was inhibited 81.4% at $40{\mu}g$/ml of prochloraz. Interestingly, mixed solution of $5{\mu}g$/ml or $10{\mu}g$/ml of each fungicide inhibitied 100% of mycelial growoth and 99.2% of spore germination, respectively. Severely infected rice seeds soaked into mixed solution composed of $125{\mu}l$/ml of prochloraz and $50{\mu}l$/ml of fludioxonil showed 2.1% of disease symptoms compared to 20.4% of prochloraz $125{\mu}l$/ml, but higher concentrations of prochloraz decreased the seedling stand rate. When the seed soaking time was longer and temperature was higher, control effect on Bakanae disease was improved, but seedling stand was lower about 80% over $35^{\circ}C$.

Synthetic Application of Seismic Piezo-cone Penetration Test for Evaluating Shear Wave Velocity in Korean Soil Deposits (국내 퇴적 지반의 전단파 속도 평가를 위한 탄성파 피에조콘 관입 시험의 종합적 활용)

  • Sun, Chang-Guk;Kim, Hong-Jong;Jung, Jong-Hong;Jung, Gyung-Ja
    • Geophysics and Geophysical Exploration
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    • v.9 no.3
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    • pp.207-224
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    • 2006
  • It has been widely known that the seismic piezo-cone penetration test (SCPTu) is one of the most useful techniques for investigating the geotechnical characteristics such as static and dynamic soil properties. As practical applications in Korea, SCPTu was carried out at two sites in Busan and four sites in Incheon, which are mainly composed of alluvial or marine soil deposits. From the SCPTu waveform data obtained from the testing sites, the first arrival times of shear waves and the corresponding time differences with depth were determined using the cross-over method, and the shear wave velocity $(V_S)$ profiles with depth were derived based on the refracted ray path method based on Snell's law. Comparing the determined $V_S$ profile with the cone tip resistance $(q_t)$ profile, both trends of profiles with depth were similar. For the application of the conventional CPTu to earthquake engineering practices, the correlations between $V_S$ and CPTu data were deduced based on the SCPTu results. For the empirical evaluation of $V_S$ for all soils together with clays and sands which are classified unambiguously in this study by the soil behavior type classification index $(I_C)$, the authors suggested the $V_S-CPTu$ data correlations expressed as a function of four parameters, $q_t,\;f_s,\;\sigma'_{v0}$ and $B_q$, determined by multiple statistical regression modeling. Despite the incompatible strain levels of the downhole seismic test during SCPTu and the conventional CPTu, it is shown that the $V_S-CPTu$ data correlations for all soils, clays and sands suggested in this study is applicable to the preliminary estimation of $V_S$ for the soil deposits at a part in Korea and is more reliable than the previous correlations proposed by other researchers.

Development of a Thermoplastic Oral Compensator for Improving Dose Uniformity in Radiation Therapy for Head and Neck Cancer (두경부암 방사선치료 시 선량 균일도 향상을 위한 Thermoplastic 구강 보상체의 개발)

  • Choi, Joon-Yong;Won, Young-Jin;Park, Ji-Yeon;Kim, Jong-Won;Moon, Bong-Ki;Yoon, Hyong-Geun;Moon, Soo-Ho;Jeon, Jong-Byeong;Suh, Tae-Suk
    • Progress in Medical Physics
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    • v.23 no.4
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    • pp.269-278
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    • 2012
  • Aquaplast Thermoplastic (AT) is a tissue-equivalent oral compensator that has been developed to improve dose uniformity at the common boundary and around the treated area during radiotherapy in patients with head and neck cancer. In order to assess the usefulness of AT, the degree of improvement in dose distribution and physical properties were compared to those of oral compensators made using paraffin, alginate, and putty, which are materials conventionally used in dental imprinting. To assess the physical properties, strength evaluations (compression and drop evaluations) and natural deformation evaluations (volume change over time) were performed; a Gafchromic EBT2 film and a glass dosimeter inserted into a developed phantom for dose verification were used to measure the common boundary dose and the beam profile to assess the dose delivery. When the natural deformation of the oral compensators was assessed over a two-month period, alginate exhibited a maximum of 80% change in volume from moisture evaporation, while the remaining tissue-equivalent properties, including those of AT, showed a change in volume that was less than 3%. In a free-fall test at a height of 1.5 m (repeated 5 times as a strength evaluation), paraffin was easily damaged by the impact, but AT exhibited no damage from the fall. In compressive strength testing, AT was not destroyed even at 8 times the force needed for paraffin. In dose verification using a glass dosimeter, the results showed that in a single test, the tissue-equivalent (about 80 Hounsfield Units [HU]) AT delivered about 4.9% lower surface dose in terms of delivery of an output coefficient (monitor unit), which was 4% lower than putty and exhibited a value of about 1,000 HU or higher during a dose delivery of the same formulation. In addition, when the incident direction of the beam was used as a reference, the uniformity of the dose, as assessed from the beam profile at the boundary after passing through the oral compensators, was 11.41, 3.98, and 4.30 for air, AT, and putty, respectively. The AT oral compensator had a higher strength and lower probability of material transformation than the oral compensators conventionally used as a tissue-equivalent material, and a uniform dose distribution was successfully formed at the boundary and surrounding area including the mouth. It was also possible to deliver a uniformly formulated dose and reduce the skin dose delivery.

Study on the Differences in the Results of Body Shape Test According to the Position of the Two Feet and the Usefulness of the Neck and Body Motion Image Test (두 발의 위치에 따른 체형검사 결과 차이와 체간신전 동작 이미지 검사의 유용성 연구)

  • Chang, Wan Song;Kim, Song Ja;Ryu, Seo Won;Lim, Duk Joon;Jung, Moon Young
    • Journal of Naturopathy
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    • v.9 no.1
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    • pp.22-26
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    • 2020
  • Purposes: The purposes of this study were to investigate the relationship between the standing position of the subject and the normal standing position(NSP) and the straight standing position(SSP) and to investigate the possibility of different body shape test results depending on the status of the image inspection apparatus. Methods: The images of the NSP and SSP were compared with each other by body line BLS system. Results: At the time of examination, the position of the camera was captured at a position 2.3 m vertically from the posterior position 45 cm behind the subject. This is a privacy protection method for covering the breast of the subject. Results: The physiological characteristics of the anatomical position of the body align image test are the living body. NSP and SSP tests showed different shapes of the pelvis AS(antero-supero) and pelvis rotation in the transverse plane. Shoulder and arm displacement was observed in the trunk extension image capture. Conclusions: In the body alignment test, the pelvis position test images of NSP and SSP are evaluated differently for pelvis rotation, AS, and PS. At the extension position of the trunk, a test of the maximal extension range showed that the left and right shortening of the shoulder anterior muscles could be observed. Inducing and testing the trunk extension is also useful.

Significance Evaluation of Lung Volume and Pulmonary Dysfunction (폐용적과 폐기능 환기장애에 대한 유의성 평가)

  • Ji-Yul Kim;Soo-Young Ye
    • Journal of the Korean Society of Radiology
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    • v.17 no.5
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    • pp.767-773
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    • 2023
  • To In this study, we sought to evaluate related factors affecting lung volume and their significance in pulmonary function and ventilation disorders. As experimental subjects, 206 normal adult men and women who underwent a low-dose chest CT scan and a spirometry test were selected at the same time. The experimental method was to measure lung volume using lung CT images obtained through a low-dose chest CT scan using deep learning-based AVIEW. Measurements were made using the LCS automatic diagnosis program. In addition, the results of measuring lung function were obtained using a spirometer, and gender and BMI were selected as related factors that affect lung volume, and significance was evaluated through an independent sample T-test with lung volume. As a result of the experiment, it was confirmed that in evaluating lung volume according to gender, all lung volumes of men were larger than all lung volumes of women. he result of an independent samples T-test using the respective average values for gender and lung volume showed that all lung volumes were larger in men than in women, which was significant (p<0.001). And in the evaluation of lung volume according to BMI index, it was confirmed that all lung volumes of adults with a BMI index of 24 or higher were larger than all lung volumes of adults with a BMI index of less than 24. However, the independent samples T-test using the respective average values for BMI index and lung volume did not show a significant result that all lung volumes were larger in BMI index 24 or higher than in BMI index less than 24 (p<0.055). In the evaluation of lung volume according to the presence or absence of pulmonary ventilation impairment, it was confirmed that all lung volumes of adults with normal pulmonary function ventilation were larger than all lung volumes of adults with pulmonary ventilation impairment. And as a result of the independent sample T-test using the respective average values for the presence or absence of pulmonary ventilation disorder and lung volume, the result was significant that all lung volumes were larger in adults with normal pulmonary function ventilation than in adults with pulmonary function ventilation disorder (p <0.001). Lung volume and spirometry test results are the most important indicators in evaluating lung health, and using these two indicators together to evaluate lung function is the most accurate evaluation method. Therefore, it is expected that this study will be used as basic data by presenting the average lung volume for adults with normal ventilation and adults with impaired lung function and ventilation in similar future studies on lung volume and vital capacity testing.

Colletotrichum Diversity within Different Species Complexes Associated with Fruit Anthracnose in South Korea and Their Fungicides In-Vitro Sensitivity (국내 과실 탄저병을 일으키는 종 복합체와 종 다양성 및 살균제 감수성)

  • Taehyun Chang;Oliul Hassan;Jong Yeob Jeon;Chi Hyun Kim;Dae Min Lee;Ju Sung Kim;Eun Chan Kang;Jaewon Kim
    • Research in Plant Disease
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    • v.29 no.4
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    • pp.345-362
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    • 2023
  • Anthracnose, caused by the Colletotrichum genus, comprises a significant number of plant pathogens and poses a major threat to fruit production worldwide, including South Korea. Colletotrichum species were identified associated with anthracnose in fruits such as apple, persimmon, plum, peach, jujube, walnut, and grape. A polyphasic approach, including morphology, multigene phylogenetics, and pathogenicity testing, was used. Additionally, the in-vitro sensitivity of identified Colletotrichum species to common fungicides was also evaluated. A total of nine Colletotrichum species within two complexes, namely gloeosporioides and acutatum, have been identified as the causal agents of anthracnose in common fruits in South Korea. In the gloeosporioides complex, we found Colletotrichumaenigma, C. fructicola, C. gloeosporioides, C. horii, C. siamense, and C. viniferum. Meanwhile, in the acutatum complex, C. fioriniae, C. nymphaeae, and C. orientalis were identified. Notably, C. fructicola, C. siamense, C. fioriniae, and C. nymphaeae were reported for the first time from apple, C. siamense, C. fioriniae and C. nymphaeae from plum, C. siamense, C. fructicola, and C. fioriniae frompeach, C. siamense and C. horii from persimmon, C. fioriniae from Omija (Schisandra), C. orientalis from walnut, C. nymphaeae from jujube, and C. aenigma, C. fructicola, and C. siamense fromgrape. Fungicide sensitivity tests revealed significant variation in the EC50 values among specific Colletotrichum species when exposed to different fungicides. Moreover, the same Colletotrichum species isolated from different host plants displayed varying sensitivity to the same fungicide.

Deep Learning-based Fracture Mode Determination in Composite Laminates (복합 적층판의 딥러닝 기반 파괴 모드 결정)

  • Muhammad Muzammil Azad;Atta Ur Rehman Shah;M.N. Prabhakar;Heung Soo Kim
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.37 no.4
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    • pp.225-232
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    • 2024
  • This study focuses on the determination of the fracture mode in composite laminates using deep learning. With the increase in the use of laminated composites in numerous engineering applications, the insurance of their integrity and performance is of paramount importance. However, owing to the complex nature of these materials, the identification of fracture modes is often a tedious and time-consuming task that requires critical domain knowledge. Therefore, to alleviate these issues, this study aims to utilize modern artificial intelligence technology to automate the fractographic analysis of laminated composites. To accomplish this goal, scanning electron microscopy (SEM) images of fractured tensile test specimens are obtained from laminated composites to showcase various fracture modes. These SEM images are then categorized based on numerous fracture modes, including fiber breakage, fiber pull-out, mix-mode fracture, matrix brittle fracture, and matrix ductile fracture. Next, the collective data for all classes are divided into train, test, and validation datasets. Two state-of-the-art, deep learning-based pre-trained models, namely, DenseNet and GoogleNet, are trained to learn the discriminative features for each fracture mode. The DenseNet models shows training and testing accuracies of 94.01% and 75.49%, respectively, whereas those of the GoogleNet model are 84.55% and 54.48%, respectively. The trained deep learning models are then validated on unseen validation datasets. This validation demonstrates that the DenseNet model, owing to its deeper architecture, can extract high-quality features, resulting in 84.44% validation accuracy. This value is 36.84% higher than that of the GoogleNet model. Hence, these results affirm that the DenseNet model is effective in performing fractographic analyses of laminated composites by predicting fracture modes with high precision.

A Study on Startups' Dependence on Business Incubation Centers (창업보육서비스에 따른 입주기업의 창업보육센터 의존도에 관한 연구)

  • Park, JaeSung;Lee, Chul;Kim, JaeJon
    • Korean small business review
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    • v.31 no.2
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    • pp.103-120
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    • 2009
  • As business incubation centers (BICs) have been operating for more than 10 years in Korea, many early stage startups tend to use the services provided by the incubating centers. BICs in Korea have accumulated the knowledge and experience in the past ten years and their services have been considerably improved. The business incubating service has three facets : (1) business infrastructure service, (2) direct service, and (3) indirect service. The mission of BICs is to provide the early stage entrepreneurs with the incubating service in a limited period time to help them grow strong enough to survive the fierce competition after graduating from the incubation. However, the incubating services sometimes fail to foster the independence of new startup companies, and raise the dependence of many companies on BICs. Thus, the dependence on BICs is a very important factor to understand the survival of the incubated startup companies after graduation from BICs. The purpose of this study is to identify the main factors that influence the firm's dependence on BICs and to characterize the relationships among the identified factors. The business incubating service is a core construct of this study. It includes various activities and resources, such as offering the physical facilities, legal service, and connecting them with outside organizations. These services are extensive and take various forms. They are provided by BICs directly or indirectly. Past studies have identified various incubating services and classify them in different ways. Based on the past studies, we classify the business incubating service into three categories as mentioned above : (1) business infrastructure support, (2) direct support, and (3) networking support. The business infrastructure support is to provide the essential resources to start the business, such as physical facilities. The direct support is to offer the business resources available in the BICs, such as human, technical, and administrational resources. Finally, the indirect service was to support the resource in the outside of business incubation center. Dependence is generally defined as the degree to which a client firm needs the resources provided by the service provider in order to achieve its goals. Dependence is generated when a firm recognizes the benefits of interacting with its counterpart. Hence, the more positive outcomes a firm derives from its relationship with the partner, the more dependent on the partner the firm must inevitably become. In business incubating, as a resident firm is incubated in longer period, we can predict that her dependence on BICs would be stronger. In order to foster the independence of the incubated firms, BICs have to be able to manipulate the provision of their services to control the firms' dependence on BICs. Based on the above discussion, the research model for relationships between dependence and its affecting factors was developed. We surveyed the companies residing in BICs to test our research model. The instrument of our study was modified, in part, on the basis of previous relevant studies. For the purposes of testing reliability and validity, preliminary testing was conducted with firms that were residing in BICs and incubated by the BICs in the region of Gwangju and Jeonnam. The questionnaire was modified in accordance with the pre-test feedback. We mailed to all of the firms that had been incubated by the BICs with the help of business incubating managers of each BIC. The survey was conducted over a three week period. Gifts (of approximately ₩10,000 value) were offered to all actively participating respondents. The incubating period was reported by the business incubating managers, and it was transformed using natural logarithms. A total of 180 firms participated in the survey. However, we excluded 4 cases due to a lack of consistency using reversed items in the answers of the companies, and 176 cases were used for the analysis. We acknowledge that 176 samples may not be sufficient to conduct regression analyses with 5 research variables in our study. Each variable was measured through multiple items. We conducted an exploratory factor analysis to assess their unidimensionality. In an effort to test the construct validity of the instruments, a principal component factor analysis was conducted with Varimax rotation. The items correspond well to each singular factor, demonstrating a high degree of convergent validity. As the factor loadings for a variable (or factor) are higher than the factor loadings for the other variables, the instrument's discriminant validity is shown to be clear. Each factor was extracted as expected, which explained 70.97, 66.321, and 52.97 percent, respectively, of the total variance each with eigen values greater than 1.000. The internal consistency reliability of the variables was evaluated by computing Cronbach's alphas. The Cronbach's alpha values of the variables, which ranged from 0.717 to 0.950, were all securely over 0.700, which is satisfactory. The reliability and validity of the research variables are all, therefore, considered acceptable. The effects of dependence were assessed using a regression analysis. The Pearson correlations were calculated for the variables, measured by interval or ratio scales. Potential multicollinearity among the antecedents was evaluated prior to the multiple regression analysis, as some of the variables were significantly correlated with others (e.g., direct service and indirect service). Although several variables show the evidence of significant correlations, their tolerance values range between 0.334 and 0.613, thereby demonstrating that multicollinearity is not a likely threat to the parameter estimates. Checking some basic assumptions for the regression analyses, we decided to conduct multiple regression analyses and moderated regression analyses to test the given hypotheses. The results of the regression analyses indicate that the regression model is significant at p < 0.001 (F = 44.260), and that the predictors of the research model explain 42.6 percent of the total variance. Hypotheses 1, 2, and 3 address the relationships between the dependence of the incubated firms and the business incubating services. Business infrastructure service, direct service, and indirect service are all significantly related with dependence (β = 0.300, p < 0.001; β = 0.230, p < 0.001; β = 0.226, p < 0.001), thus supporting Hypotheses 1, 2, and 3. When the incubating period is the moderator and dependence is the dependent variable, the addition of the interaction terms with the antecedents to the regression equation yielded a significant increase in R2 (F change = 2.789, p < 0.05). In particular, direct service and indirect service exert different effects on dependence. Hence, the results support Hypotheses 5 and 6. This study provides several strategies and specific calls to action for BICs, based on our empirical findings. Business infrastructure service has more effect on the firm's dependence than the other two services. The introduction of an additional high charge rate for a graduated but allowed to stay in the BIC is a basic and legitimate condition for the BIC to control the firm's dependence. We detected the differential effects of direct and indirect services on the firm's dependence. The firms with long incubating period are more sensitive to indirect service positively, and more sensitive to direct service negatively, when assessing their levels of dependence. This implies that BICs must develop a strategy on the basis of a firm's incubating period. Last but not least, it would be valuable to discover other important variables that influence the firm's dependence in the future studies. Moreover, future studies to explain the independence of startup companies in BICs would also be valuable.

Application and Expansion of the Harm Principle to the Restrictions of Liberty in the COVID-19 Public Health Crisis: Focusing on the Revised Bill of the March 2020 「Infectious Disease Control and Prevention Act」 (코로나19 공중보건 위기 상황에서의 자유권 제한에 대한 '해악의 원리'의 적용과 확장 - 2020년 3월 개정 「감염병의 예방 및 관리에 관한 법률」을 중심으로 -)

  • You, Kihoon;Kim, Dokyun;Kim, Ock-Joo
    • The Korean Society of Law and Medicine
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    • v.21 no.2
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    • pp.105-162
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    • 2020
  • In the pandemic of infectious disease, restrictions of individual liberty have been justified in the name of public health and public interest. In March 2020, the National Assembly of the Republic of Korea passed the revised bill of the 「Infectious Disease Control and Prevention Act.」 The revised bill newly established the legal basis for forced testing and disclosure of the information of confirmed cases, and also raised the penalties for violation of self-isolation and treatment refusal. This paper examines whether and how these individual liberty limiting clauses be justified, and if so on what ethical and philosophical grounds. The authors propose the theories of the philosophy of law related to the justifiability of liberty-limiting measures by the state and conceptualized the dual-aspect of applying the liberty-limiting principle to the infected patient. In COVID-19 pandemic crisis, the infected person became the 'Patient as Victim and Vector (PVV)' that posits itself on the overlapping area of 'harm to self' and 'harm to others.' In order to apply the liberty-limiting principle proposed by Joel Feinberg to a pandemic with uncertainties, it is necessary to extend the harm principle from 'harm' to 'risk'. Under the crisis with many uncertainties like COVID-19 pandemic, this shift from 'harm' to 'risk' justifies the state's preemptive limitation on individual liberty based on the precautionary principle. This, at the same time, raises concerns of overcriminalization, i.e., too much limitation of individual liberty without sufficient grounds. In this article, we aim to propose principles regarding how to balance between the precautionary principle for preemptive restrictions of liberty and the concerns of overcriminalization. Public health crisis such as the COVID-19 pandemic requires a population approach where the 'population' rather than an 'individual' works as a unit of analysis. We propose the second expansion of the harm principle to be applied to 'population' in order to deal with the public interest and public health. The new concept 'risk to population,' derived from the two arguments stated above, should be introduced to explain the public health crisis like COVID-19 pandemic. We theorize 'the extended harm principle' to include the 'risk to population' as a third liberty-limiting principle following 'harm to others' and 'harm to self.' Lastly, we examine whether the restriction of liberty of the revised 「Infectious Disease Control and Prevention Act」 can be justified under the extended harm principle. First, we conclude that forced isolation of the infected patient could be justified in a pandemic situation by satisfying the 'risk to the population.' Secondly, the forced examination of COVID-19 does not violate the extended harm principle either, based on the high infectivity of asymptomatic infected people to others. Thirdly, however, the provision of forced treatment can not be justified, not only under the traditional harm principle but also under the extended harm principle. Therefore it is necessary to include additional clauses in the provision in order to justify the punishment of treatment refusal even in a pandemic.