노인장기요양보험제도 서비스 질 관리체계 개선에 관한 연구

최은희(Choe, Eunhee) 한국노년학회 2010 한국노년학 Vol.30 No.2

본 연구는 노인장기요양보험제도의 서비스 질 관리체계 개선을 위하여 장기요양기관 평가와 현지조사에 대한 실태를 조사하고 정책방안을 제언하는데 목적을 두고 있다. 문헌연구로 서비스 질, 장기요양서비스 질 관리, 해외 선진국의 장기요양보호서비스 질 관리체계 등을 검토하였으며, 실증조사를 실시하기 위하여 장기요양기관 평가, 현지조사 및 행정적 관리감독을 실시하는 국민건강보험공단, 보건복지부, 지방자치단체의 담당자와 장기요양서비스 제공기관장 등 7명을 대상으로 면접조사를 실시하였다. 연구조사 결과, 첫째, 장기요양기관 평가는 중장기적으로 제도의 운영기관이 아닌 독립된 평가전담 기구에서 수행해야할 필요성이 있으며, 이와 더불어 평가인력의 전문화, 단계적인 서비스 질 향상을 위한 평가방향, 기관의 정보 공개 등이 요구된다. 둘째, 지방자치단체 수준에서 장기요양기관을 관리감독 할 수 있도록 업무역량 강화 및 규제 신설이 요구된다. 셋째, 장기요양서비스가 돌봄의 사회화를 추구하기 위해 장기요양기관 시범 운영을 통한 서비스 표준화 및 지침개발과 기관 운영에 대한 컨설팅이 요구된다. 마지막으로 등급판정, 평가, 현지조사, 수급지원 등 업무의 균형과 견제를 위해 장기요양보험제도 관련 기관 간 역할조정이 요구된다. 이상 결과에 근거하여 다음과 같이 제언하였다. 장기요양서비스 질 관리를 위해서는 장기요양기관에 대한 총체적 질 관리를 위한 독립된 기관이 설립되어야 한다. 또한 장기요양서비스 확대에 따른 지방정부의 역할변화 및 장기요양기관에 대한 관리ㆍ감독권에 대한 법률적 개정이 요구된다. The aim of this study are to investigates LTC facilities in field with it's actual conditioning and to suggests a line of policy to improve service quality management system of LTC. To elucidates practical view, I interviewed 7 persons. They are government(Ministry of Health & Welfare: MHW) official, local officials and National Health Insurance Corporation(NHIC) official who are in charge of assessing, investigating in field and administrative supervising LTC facilities and director of LTC facility. The results reveals as follow. First, for efficiency, conduction of LTC Facilities Inspection should be carried by independent institution, not by competent institution under medium and long range plan. In addition, the specialization of personnel, improving the quality of service assessment for phased and information disclosure are required Second, to supervise LTC facilities, empowering service skills and new regulations are required. Third, to pursuit socialization of LTC service, service standardization, guideline development and operating advisory agency for institution by trial operation are required, too. Finally, to check and balance of roles of assessment, field investigation and financial support, adjustments role between LTC related agencies would be needed. Based on above results, I suggest following recommendations for improving of service quality system of LTC. To improve service quality of LTC, independent agency for managing total quality of LTC facilities would be instituted. And, due to decentraliztion and expansion of LTC demands, legislative amendment for changing role of local government and rights of management of LTC facilities is required.

Limiting Dilution Assay를 이용한 Long-term Culture-Initiating Cells의 정량

성기웅,유경하,고상혁,윤계진,장필상,강형진,이준아,한효정,최형수,유은선,구홍회,신희영,안효섭 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

연구배경: LTC-IC는 5주간의 장기액상배양 후에도 집락을 형성할 수 있는 세포를 말하며 조혈모세포의 이식능을 가장 잘 대변할 수 있는 세포이다. 본 연구에서는 Limiting Dilution Assay를 통해 LTC-IC를 정량하고자 하였다. 대상 및 방법: 제대혈, 가동화된 말초혈 및 골수형을 대상으로 일정수의 단핵구에 포함된 CD34^(+) 세포수, CD34^(+)/38- 세포수, 단기배양시 형성된 집락의 수 및 LTC-IC의 수를 구하였다. LTC-IC의 수는 96-well plate에서의 장기액상배양 및 Poisson 분포를 이용한 limiting dilution assay를 이용하였다. 결과: 10^(5)개의 단핵구에 포함된 CD34^(+) 세포, CD34^(+)/38^(-) 세포수는 제대혈에서 960±493, 43.0±20.0, 가동화된 말초혈에서 720±432, 42.5±18.8, 골수혈에서 2,505±805, 805±305였고, CFU-GM의 수는 제대혈에서 24.6±9.9, 가동화된 말초혈에서 20.7±13.0이었고, LTC-IC의 수는 제대혈에서 10.4±5.7, 가동화된 말초혈에서 5.8±5.3, 골수혈에서 13.9±4.2였다. 결론: 96-well plate에서의 장기액상배양 및 Poisson 분포를 이용한 limiting dilution assay를 이용하여 성공적으로 LTC-IC의 수를 정량하였고 이를 통해 이식후의 장기생착능에 대한 정보를 얻을수 있다. Background: Long-term culture-initiating cells(LTC-IC) are defined as those cells responsible for the presence of clonogenic progenitors in 5-week-old long-term culture. LTC-IC are the best available approximation of stem cells in human. we compared the number of LTC-IC in cord blood(CB), mobilized peripheral blood(PB), and bone marrow(BM) using limiting dilution assay(LDA). Methods: Samples were obtained from CB, mobilized PB, and BM. Mononuclear cells(MNC) and CD34^(+) cells were separated by ficoll-hypaque centrifugation and method using immunomagnetic beads, respectively. Flow cytometric analysis was done for determination of CD34^(+) and CD34^(+)/38 cells. Clonogenic progenitors were assayed in methylcellulose media. For LDA, MNCs or CD 34^(+) cells were seeded onto irradiated murine stromal feeder layer in 96-well plate at 3~5 different cell concentrations. Wells that did not contain cobblestone area after 5 weeks of culture were counted and the number of LTC-IC was determined using Poisson distribution. Results: The number of CD34^(+) and CD34^(+)/38^(+) cells per 10^(5) MNCs in CB, PB, and BM were 960±493, 43.0±20.0, 720±432, 42.5±18.8, and 2,505±805, 805±305, respectively. The number of CFU-GM per 10^(5) MNCs in CB and PB were 24.6±9.9 and 20.7±13.0, respectively. The number of LTC-IC per 10^(5) MNCs in CB, PB, and BM were 10.4±5.7, 5.8±5.3, and 13.9±4.2, respectively. Conclusion: In this report, we successfully determined LTC-IC frequencies using LDA with long-term culture system. Determination of LTC-IC frequencies is useful for measurement of long-term in vivo repopulating potential.

지역별 이용요인을 통한 노인장기요양보험 인프라 충족율 분석

이재완 ( Jae Wan Lee ),최인덕 ( In Duck Choi ),박순우 ( Soon Woo Park ) 한국사회복지정책학회 2013 사회복지정책 Vol.40 No.2

본 연구에서는 노인장기요양보험 서비스 이용행태를 시군구별로 정리, 분석하여 시군구별 이용요인을 회귀분석으로 도출하고, 요인별 계수값에 시군구별 변수값을 대입하여 개별 시군구의 적정 인프라 수요, 공급율을 파악하고자 하였다. 더불어, 실제 공급된 인프라 규모와 비교하여 재가 및 시설 서비스 기관의 과,소 공급 여부를 분석하고 시군구별 효과적인 인프라 관리방안을 제시하고자 하였다. 이를 위해 본 연구에서는 노인장기요양보험의 수요, 공급의 적정성에 대한 문헌 및 선행연구고찰과 함께 2008년부터 2011년 12월까지의 자료를 각 년도 12월자료 4개월 데이터를 시군구별로 구축하고, 회귀분석을 통해 이용요인 특성에 따른 회귀계수값을 도출하였으며, 이를 토대로 개별 시군구의 적정 인프라 수요, 공급율을 파악하고, 실제 공급된 인프라 양과 비교하여 수요, 공급 실충족율을 산출 하였다. 분석결과, 234개 시군구에 대한 수요, 공급 실충족율을 유형화하였으며 그 유형은 첫째, 수요와 공급 집중관리지역으로 수요와 공급이 과잉되어 과당경쟁을 단속하고, 서비스 질 및 등외자 관리 강화가 필요한 지역으로 관리방안을 제시하였다. 둘째, 수요와 공급모니터링 지역은 각각 수요와 공급이 과소로 나타나는 지역으로 수요와 공급을 적정선으로 유도하는 방법이 필요한 지역이다. 셋째, 초과잉 공급이 일어나는 지역으로 공급기관 허가 규제지역에서는 기관 인허가를 억제하고, 기준 미달 기관을 퇴출할 수 있는 방안을 모색할 필요가 있겠다. 넷째, 공급이 오히려 저조한 공급기관 유도 및 공공요양기관 확충지역은 인접시군의 수요분산이나 공공기관 확충으로 질적 서비스가 제고되도록 유도할 필요가 있는 지역이다. 본 연구를 통해 노인장기요양보험의 인프라에 대한 효율적 관리방안을 제시함으로써 향후 노인복지 분야에서 노인장기요양보험의 안정적 정착 및 발전방향을 제시할 수 있을 것으로 판단된다. This study is to explain the an efficient management system in LTC infrastructure with LTC In-home care and nursing home service`s affecting factors at regional(Si, Gun, Gu). To Analyse the Determinants of LTC infrastructure utilization Regression, we use the data of NHIC(National Health Insurance Corporation, LTC Corporation) from 2008 to 2011. A calculated LTC infrastructure`s demand and supply rate is used to compare the real infrastructure`s supply rate at region(Si, Gun, Gu). So, we find a real supply rate of LTC infrastructure in 234(Si, Gun, Gu) regional level. The major results of the quantitative analysis and management infrastructure in regional level: First, Management intensity area is very high supply rate and we propose that regulate the oversupply rate infrastructure of LTC. Second, Monitoring area of infrastructure LTC is to need induce supply of LTC services. Third, Intensive regulated area is excessive high supply rate, so we have to tightened controls on licensing the LTC service infrastructure. Fourth, Inducing and expansion of public in-home care or nursing home services area, these regions are have to strengthen the public services and permit licence of private services. Consequently, This study impact on the policy of LTC supply rate in regional level and seek the developmental approaches on LTC infrastructures.

교육현장 연계를 강화한 생명과학교사양성교육과정용 PBL(LTC-PBL) 모형의 설계 및 적용

강경희 한국교육과정평가원 2024 교육과정평가연구 Vol.27 No.3

이 연구의 목적은 중등 교육현장과의 연계를 강화한 생명과학교사양성교육과정용 LTC-PBL 모형(Life science teacher Training Curriculum-Problem Based Learning model)을 설계하고 적용하는 것이다. 교사양성교육과정에서 예비 생명과학교사들의 교수역량을 함양하는 데 도움을 제공하기 위해 실제 중등학교 현장에서 나타날 수 있는 다양한 문제 상황을 이용해 LTC-PBL 모형을 설계하였다. 현직 교사들은 자신들이 교수 활동에서 느꼈던 어려움을 토대로 PBL 문제 시나리오를 개발하였다. 예비 생명과학교사들은 모둠활동을 통해 이 PBL 문제를 해결하기 위한 수업을 설계하였고, 실제 수업실연을 통해 문제해결 방안을 실행하였다. 예비 생명과학교사들이 작성한 수업지도안과 수업실연 영상에 대해 현직 교사들이 피드백을 제공하였다. 또한 LTC-PBL 모형을 적용한 후 PBL 수업에 대한 예비 생명과학교사들의 인식을 조사하였다. 이들은 LTC-PBL 모형에서 제시된 문제들이 실제 학교 수업에서 일어날 수 있는 상황들이어서 교사의 활동을 이해하는 데 도움이 되었다고 응답했다. The purpose of this study was to design and apply a LTC-PBL model for the teacher training curriculum (Life science teacher Training Curriculum-Problem Based Learning Model) that strengthens the linkage with the secondary education field. In order to help pre-service life science teachers cultivate their teaching competencies in the teacher training curriculum, LTC-PBL model was designed using various problem situations that may appear in the actual secondary school field. In-service teachers developed PBL problems scenario based on the difficulties they felt in their teaching activities. Pre-service life science teachers designed a class to solve this PBL problem through group activities and implemented a problem solving method through actual class demonstrations. In-service teachers provided feedback on the lesson plans and class demonstrations prepared by pre-service life science teachers. In addition, after applying the LTC-PBL model, we investigated the perceptions of pre-service life science teachers about PBL classes. They responded that the problems presented in the LTC-PBL model were situations that could occur in actual school classes, which helped them understand the activities of teachers.

아스피린 유발성 천식환자에서 leukotriene C4 ( LTC4 ) 합성효소 유전자 다형에 관한 연구

조재연(Jae Youn Cho),이상엽(Sang Yeub Lee),한선애(Seon Ae Han),유세화(Se Hwa Yoo),김선신(Sun Sin Kim),박해심(Hae Sim Park),박중원(Jung Won Park),홍천수(Chein Soo Hong),인광호(Kwang Ho In) 대한천식알레르기학회 1999 천식 및 알레르기 Vol.19 No.4

Background: Aspirin/NSAIDs can release cysteinyl-leukotriene (cys-LTs) into airways and precipitate asthmatic symptoms in aspirin - induced asthma(AIA). It has been reported that there is profound overexpression of LTC4 synthase in their bronchial mucosa, compared to aspi- rin-tolerant asthma. Objective : We observed whether genetic polymorphism of LTC4 synthase may be predisposed to LTC4 synthase overexpression in AIA. Subject and method: Forty - four AIA patients having positive responses on lysin aspirin bron choprovocation tests and 47 non - aspirin induced asthma ( non - AIA ) patients having negative challenges and 32 healthy controls were enrolled. The genotypes of the promoter LTC4 synthase gene ( A,C transversion ) were determined by polymerase chain reaction and restriction frag- ment length polymorphism ( RFLP ) method. Results : LTC4 synthase promoter polymorphism ( A444C btransversion) was not significantly dif - ferent between non - AIA and AIA patients (p 〉0.05). Conclusion These findings suggest that genetic polymorphism of LTC4 synthase promoter may not be predisposed to LTC, synthase overexpression in AIA.

조혈모세포원 간의 Long-Term Culture-Initiating Cell의 비교

김정아,홍대식,김숙자,김동욱,이종욱,한치화,민우성,박희숙,김춘추 大韓血液學會 1999 大韓血液學會誌 Vol.34 No.1

Leukotriene C4 Synthase 유전자 Promoter 부위 유전적 다형과 아스피린 과민성 천식의 연관성

김상헌 ( Sang Heon Kim ),박흥우 ( Heung Woo Park ),손성욱 ( Seong Wook Sohn ),이상민 ( Sang Min Lee ),오선영 ( Sun Young Oh ),김선신 ( Sun Sin Kim ),박준우 ( Joon Woo Bahn ),장윤석 ( Yoon Seok Chang ),신은순 ( Eun Soon Shin ),이 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.2

Background: The 5-lipoxygenase, 5-lipoxygenase associated protein and leukotriene C4 (LTC4) synthase are enzymes involved in the synthesis of cysteinyl leukotrienes which are known to be important lipid mediators for the development of aspirin-intolerant asthma (AIA). Several studies have evaluated genetic association between polymorphisms of these enzymes and AIA, reporting inconsistent results. Objective: To evaluate the genetic effect of polymorphisms of promoter areas of ALOX5, ALOX5AP and LTC4S genes in the development of AIA. Method: Polymorphisms in promoter areas of ALOX5 (-1761G>A, -1708G>A), ALOX5AP (21A/18A repeat) and LTC4S (-444A>C) were genotyped in patients with AIA (n=44), aspirin-tolerant asthma (ATA, n=104), and healthy-normal controls (NC, n=107). Result: The frequency of LTC4S -444 AC or CC alleles was significantly lower in AIA patients than in ATA patients (19.0% vs. 36.5%, P=0.005, OR=0.23, 95%CI 0.08∼0.64). However, the frequency of these genotypes was not different between AIA and NC (19.0% vs. 24.8%, P=0.458). As to LOX5 -1761G>A, -1708G>A, and ALOX5AP 21A/18A repeat, the frequency of these genotypes was not different between AIA and ATA patients and between AIA and NC. Conclusion: A significant association was found between LTC4S -444A>C and the frequency of AIA. This finding suggests that LTC4 synthase may be involved in the development of AIA in the Korean population. (Korean J Asthma Allergy Clin Immunol 2006;26:115-121)

고 EGR 영역의 디젤연소에서 다단분사가 배기물질에 미치는 영향

이정우(Jeongwoo Lee),신승협(Seunghyup Shin),최승목(Seungmok Choi),민경덕(Kyungdoug Min) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.11

Recently one of the main issues in diesel engine is reduction of emissions. Especially, NOx and PM are important because Euro 6 regulation which demands 55.6% NOx reduction is enforced in 2014. One of the effective ways to reduce engine-out NOx and PM emissions is a LTC method. LTC is implemented by high EGR rate to reduce oxygen concentration. Low oxygen concentration makes combustion temperature low and ignition delay much longer. So it suggests the possibility of reduction NOx and PM simultaneously. But because of low oxygen concentration, combustion efficiency is bad and CO and HC emissions are increasing sharply. To reduce the CO and HC emissions, many researches have been performed, especially about swirl motion. However there are a few papers about injection strategies on LTC to improve emission problem. So this paper focused on the effects of multiple injections on emissions when high EGR rate is applied. Experiments were done by sweeping the second injection timing form BTDC 46 CA to ATDC 10 CA. The result shows CO emission decrease drastically at some points with other emissions same level. So it can aid to maintain the stable combustion of LTC.

The Triple Knot of Long-Term Care in the United States: Long-Term Care Financing, Delivery and Workforce Policy

Robyn Stone 세계섬학회 2016 World Environment and Island Studies Vol.6 No.2

The U.S. is currently in the midst of a serious debate about the future of immigration policy in the U.S. Any change has the potential to profoundly shape the circumstances of direct care workers and the demand for Long-Term Care LTC. Yet prior immigration reform debates and proposals have not considered workforce planning needs or contemplated immigration as a primary tool for managing labor markets. Historically, the U.S. has elected not to import lesser skilled workers for the purpose of employment because these workers compete directly with other vulnerable low-wage workers. Prediction of strong job growth in this sector, however, suggests a clear need to consider options that may include an immigration visa pathway to admission. Policies that limit the entry of low skilled workers may diminish the future labor pool of direct care workers in LTC. Options under exploration include 1) increasing pathways to legal status for undocumented immigrants; 2) increasing pathways for legal temporary workers with the option to offer extensions of stay or transitions to permanency; 3) pursuing an aggressive immigration strategy to permit an influx of low-wage workers to fill vacancies for direct care jobs; and 4) creating a new visa program for less-skilled, non-seasonal, non-agricultural workers. This latter option was proposed in Congress in 2013, but movement on any reforms has stalled.

EGR율 변화와 분사전략에 따른 저온 디젤 연소의 모드 전환 특성

한상욱(Sangwook Han),김기현(Kihyun Kim),배충식(Choongsik Bae) 한국자동차공학회 2010 한국자동차공학회 학술대회 및 전시회 Vol.2010 No.11

Combustion mode transition between low temperature diesel combustion (LTC) and conventional diesel combustion was carried out in a direct injection diesel engine by changing exhaust gas recirculation (EGR) rate with two throttles. The characteristics of combustion mode transition was analyzed based on the in-cylinder pressure and hydrocarbon (HC) emission of each cycle. In the case of mode transition from LTC to conventional diesel combustion, rapid decrease in indicated mean effective pressure (IMEP) and increase in HC emissions occurred right after throttle movement owing to air flow overshoot. On the other hand, IMEP was decreased very slowly and continuously during mode transition from conventional diesel combustion to LTC. As the EGR rate was changed slowly, IMEP fluctuation was reduced. Rapid IMEP fluctuation which occurred during mode transition by changing EGR rate was improved with application of injection strategy.