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효율적인 교통수요관리를 위한 교통유발부담금 제도 개선방안 연구
신성일 ( Seong Il Shin ),윤혁렬 ( Huyk Ryul Yun ),전병은 ( Byeong Eun Jeon ) 서울시정개발연구원 2008 연구보고서 Vol.2008 No.26
Rapid growth and development in Seoul Metropolis Area has placed increased pressure on the transportation system and it has stressed the importance of travel demand management (TDM). Seoul Metropolitan Government (SMG) has placed TDM as one of crucial elements of transportation policies and deployed various TDM strategies. However it is judged that Seoul is still experiencing severe traffic congestion, undermining the urban competitiveness and quality of life. Transportation Impact Fee(TIF) has been implemented in order to ensure that urban facilities pay a proportionate share of the cost to internalize the externalities since 1990 with a basic charge of 350 won per 1,000 . SMG revised TIF system that total amount of fees could be refund according to participation rates of TDM program in 2006. In spite of this effort, the participation rates of TDM program is no more than 19.8% in 2007. With the right incentives (or disincentives) travelers may be influenced to use transportation systems in a way that contributes less to congestion. So it`s time to evolve into the more flexible TIP systems in terms of equality of charging and effectiveness of TDM. Impact fees are authorized under the Urban Transportation Maintenance Act. TIF for the building owners are probably the most commonly imposed of all types of impact fees. The purpose of impact fees is not just revenue for transportation system but traffic reduction. Impact fees for transportation facilities is calculated based on average trip, gross area, parking area, main land use of the facilities, and other factors, One of the variables that is used in the vast majorities of impact fee systems is trip generation. Trip generation data is used in transportation impact fees to measure the demand that different land uses create for roadway capacity. TIF systems limit the number of land use categories to a few in each of the following general categories: residential, commercial, industrial, institutional, office, recreational and services. But a number of difficulties have been encountered in using TIF trip generation data. It`s because of a lack of trip generation data and because of the administrative difficulties involved in maintaining a system that contains a long list of land use categories. So we are seeing increased scrutiny and questions about the accuracy of the trip rates we use, Use of Index of Trip Generation ruled by the Urban Transportation Maintenance Act has a number of shortcoming when it is applied to metropolis areas, In seoul, revision of national standards may produce a more equitable trip rates in a given area, With the concerns the nation standards, however, Seoul Metropolitan Government still has no reliable trip generation data. This study aims to review current TDM strategies in Seoul and identify policy direction toward the successful achievement of TDM strategies, Thus this study focuses on two TIF strategies: gradual raising of impact fees and making a area-based impact fees standard, These TIF measures are being deployed as a way to reduce vehicle use, while increase the ridership of public transportation. Based on the reviewing the TIF system, this study makes following suggestions: to heighten the impact fees level so that actively encourage the owners of trip generating building to participate in the TDM program for corporation. It`s possible to raise the basic unit charge and index of trip generation following land use categories. It is necessary to concert with developing appropriate incentives. to amend TIF system allowing the congestion charging area to raise impact fees so that such area experiencing heavy traffic congestion as the entire CBD and Gangnam areas would be included. At this time, two traffic impact fee areas should be considered, and this study suggest a new standards based on the parking cap areas in Seoul. It is anticipated that improve the equality of impact fee charging and the expansion of participation for company TDM program. In the present level of traffic impact fees, the vehicle trip reduction effect of TDM was limited. This study suggests the TIF system has the largest potential to improve the effectiveness of TDM measures in reduction vehicle trip. The purpose of this study is to suggest the effectiveness of a new non- regulatory company transportation demand management programs in Seoul, which allows building owners to get discounts of Traffic Impact Fee (TIF), when implementing a certain level of TDM programs. Since it is verified that trip generation varies by TDM program types, TIF should vary, as the ordinance intended, according to program content. In order to induce more building owners (employers) to implement TDM programs, it is recommended that TIF be increased to the level where employers feel it to be burden-some, and that the number of firms exempted from TIF be reduced.
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신성수(Seong Soo Shin),안용찬(Yong Chan Ahn),전호경(Ho Kyung Chun,이우용(WooYong Lee),강원기(Won Ki Kang),박영석(Young Suk Park),박준오(Joon Oh Park),송상용(Sang Yong Song),임도훈(Do Hoon Lim, 박원(Won Park),이정은(Jung Eun Lee),강민규 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.2
목 적: 수술 전 동시병용 방사선-항암 화학 요법의 초기 치료성적과 급성 부작용에 대해 알아보고자 하였다. 대상 및 방법: 1999년 6월부터 2002년 4월까지 T3 또는 T4 병기의 직장암으로 진단 받고 완전절제가 어렵거나, 종양이 하부직장에 위치하여 수술 시 항문 괄약근의 보존이 불가능하리라고 예견된 40명의 환자에게 수술 전 동시병용 방사선-항암 화학요법을 적용하여 37명의 환자가 수술전 치료방침을 완료하였다.방사선치료는 전 골반부에 일일 1.8 Gy씩 5주간에45 Gy를 엎드린 자세로 조사하였다. 항암 화학요법은 경구 UFT와 Leucovorin(LV)(12명),정주 5-fluorouracil(FU)와 LV (10명), 정주 5-FU 단독요법(일시 정주 10명, 지속 정주5명)을 각각 시행하였다. 수술은 수술 전 치료 종료후 4˜6주경에 예정하였으며 35명에 대해서 수술을 시도하였다. 결 과: 본 연구의 수술 전 방사선-항암 화학요법에 대한 순응도는 매우 높았다(92.5%, 37/40). 수술 전에 간과폐에 새로운 원격전이가 확인된 2명을 제외한 35명의 환자에서 절제수술을 시도하였고, 22명(62.9%)에서 항문괄약근의 보존이 가능하였으나, 2명(5.7%)은 개복 후 절제수술을 포기하였다. 절제수술을 시행한 33명 중 30명은 육안적 완전절제를, 1명은 육안적 불완전절제를 시행하였으며 2명은 병리소견에 관한 정보를 얻을 수 없었다. 수술 및 병리소견에 근거한 병기하강률은 45.5% (15/33), 절제연 음성 완전절제율은 78.8% (26/33)였다.수술전 방사선치료 도중 급성부작용으로 Grade 3˜4 호중구 감소가 4명(10.8%)에서 발생하였다.절제수술 후 국소재발이 12.1%(4/33), 수술 전 치료방침 완료 후 원격전이는 21.6% (8/37)에서 각각 나타났으며, 3년 생존율은 87%였다. 결 론: 직장암에 대한 수술전 동시병용 방사선-항암 화학요법은 낮은 부작용으로 높은 수술절제율,병기하강률,완전절제율, 항문 괄약근 보존율 등을 얻을 수 있는 효과적인 방법으로 판단되며 앞으로 장기간에 걸친 추적관찰을 요한다. Purpose: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer. Materials and Methods: From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery receivedpreoperative CRCT. Thirty-sevenpatients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4˜6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients. Results: The compliance to the current preoperative CRCT protocol was excellent, where 92.5% (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9%), while resection was abandoned during laparotomy in twopatients (5.7%). Gross complete resection was performed in 30 patients, gross incomplete resection was performed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5% (15/33), and the complete resection rate with the negative resection margin 78.8% (26/33). During the CRCT course, grade 3˜4 neutropenia developed in four patients (10.8%). Local recurrence after surgical resection developed in 12.1% (4/33), and distant metastases after the preoperative CRCT start developed in 21.6% (8/37). The overall 3-years survival rate was 87%. Conclusion: Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.
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직장암 3문조사와 자궁경부암 4문조사 방사선 치료 시 유리선량계를 이용한 피부선량 측정에 관한 연구
신성수(Seong-Soo Shin),최원식(Won-Sik Choi),박철수(Cheol-Soo Park),이선엽(Sun-Yeb Lee),조재환(Jae-Hwan Cho),서정민(Jeong-Min Seo),심재구(Jae-Koo Shim),김찬형(Chan-Hyeong Kim),구은회(Eun-Hoe Goo),김응찬(Eng-Chan Kim) 대한방사선과학회 2011 방사선기술과학 Vol.34 No.2
현재의 방사선 치료의학은 고도로 발전하여 다양한 기술의 방사선 치료기술(IMRT, SRS, 3D-RT, 등)이 행하여지고 있다. 자궁경부암의 방사선 치료나 직장암의 방사선 치료에서는 아직까지 보편화된 치료법인 3문조사법이나 4문조사법을 실시하고 있다. 2차원 치료 시 치료부위 피부에 방사선에 의한 화상이 생기게 된다. 이러한 피부 부작용은 방사선 치료의 대표적인 부작용이라 할 수 있다. 지금까지는 피부선량 측정에 있어서 1회 측정으로 총 치료기간을 환산하여 피부선량을 기술하였다. 본 연구에서는 환자의 매회 치료 시 마다 피부선량을 측정하였다. 피부선량 측정에는 누적선량 측정에 적합한 유리선량계를 사용하였다. 피부선량 측정 후 치료계획 장치에서 측정한 피부선량과 비교 분석하였다. 치료기간 동안 매번 측정한 피부선량과 치료 계획 장치에서 계산한 선량을 서로 유의성 분석을 실시한 결과 유의하다는 결과를 없었다. 환자치료 시 움직임에 의한 오차가 있음에도 치료 계획 장치의 계산 선량과 비교하여도 오차범위에 합당하였다. Recently a variety of high technologies for radiation therapy (IMRT, SRS,. 3D-RT, etc.) has been developed. For the cervical and rectal cancer, 3field or 4field radiotherapy have been applied to the patients. In the case of two-dimensional treatment, one of the most typical side-effects is skin burn due to the radiation irradiation. In general the skin dose is evaluated by only a single measurement during the whole treatment period. In this study, however, skin dose was measured in each radiation treatment and the total skin dose was accumulated in a glass dosimeter through all the cases. After simulating the skin dose from treatment planning system, the results were compared with the actual skin doses. The results showed a good agreement between two data sets. Even though there are certain amount of errors caused by the patient movement along the treatment, the difference between actual dose and simulated dose was within the accepted range of error.
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방사선치료로 인한 통증 및 암성통증에 대한 듀로제식의 효과
신성수(Seong Soo Shin),허승재(Seung Jae Huh),최은경(Eun Kyung Choi),김종훈(Jong Hoon Kim),안승도(Seung Do Ahn),이상욱(Sang-Wook Lee),김연실(Yeun Sil Kim),이규찬(Kyu Chan Lee),이창걸(Chang Geol Lee),노준규(John JK Loh),전미선(Mison Ch 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.4
목 적: 방사선치료로 인해 발생하는 점막염, 식도염 등의 통증과 암성 통증을 가진 환자에 대한 듀로제식의 통증 완화 및 일상생활 개선 효과를 알아보고자 하였다. 대상 및 방법: 다기관 전향적 4상 임상시험으로 방사선치료로 인한 통증을 호소하거나(A군) 암성통증으로 방사선치료를 시행 받고 있는 환자(B군) 중에 진통제를 복용 중임에도 숫자등급평가(Numeric rating scale, NRS)가 4 이상이거나 진통제 복용 없이 NRS가 6 이상인 환자를 대상으로 듀로제식 25 ug/hr을 처방한 후에 1주일과 2주일 후에 통증횟수와 강도변화, 통증이 일상생활에 미치는 영향평가, 피험자와 임상의 만족도 평가, 그리고 이상반응 평가를시행하였다. 결 과: 2005년 3월 28일부터 6월 15일까지 26개 기관에서 총 312명의 피험자를 등록하였고 그 중 249명이 임상시험을 완료하였는데 A군은 185명, B군은 64명이였다. 평균 연령은 60세였고, 남자가 189명, 여자가 60명이였다. 2주후 가장 심한 통증의 강도 변화를 보면 A군에서 6.9에서 3.9로 B군에서는 7.1에서 3.9로 통계적으로 유의하게(p=0.003) 감소하였고 일상생활의 미치는 영향을 보기 위한 수면방해 정도와 일상적인 일의 저하 그리고 삶의 질의저하는 투여 2주 후에 모두 호전되었다. 연하통증의 변화는 A군에서만 유의하게 투여 후 호전되었으며 피험자의 만족도는 매우 만족이 A에서 47%, B군에서 41%로 좋았고 만족 이유는 진통효과 우수, 전반적 만족, 편리성 순이었다. 임상의 만족도는 매우만족이 50% 정도로 좋았다. 이상반응은 A군에서 40% B군에서 34%로 총 38%에서 나 타났고 오심이 30%로 가장 많았고 소양증 16%, 어지러움 14%, 변비 10% 순이었다. 중대한 이상반응은 없었다.결 론: 듀로제식의 통증완화 효과 일상생활 개선효과는 우수하였고 피험자와 임상의의 만족도도 좋았고 중대한 이상반응도 없었다. Purpose: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. Materials and Methods: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. Results: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. Conclusion: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
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신성재 ( Sung Jae Shin ),이석호 ( Suck Ho Lee ),박동일 ( Dong Il Park ),홍성노 ( Sung Noh Hong ),김성은 ( Seong Eun Kim ),양동훈 ( Dong Hoon Yang ),홍성필 ( Sung Pil Hong ),이보인 ( Bo In Lee ),김현수 ( Hyun Soo Kim ),김영호 ( You 대한장연구학회 2011 Intestinal Research Vol.9 No.3
Background/Aims: There are no evidence-based, procedural guidelines to appropriately perform a colon polypectomy. Thus, we investigated the treatment modality for colon polypectomy in Korea, using a web-based e-mail survey. Methods: A questionnaire of preferred treatment modality for colon polypectomy was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who performed colonoscopies as a screening or surveillance program nationwide. Among 425 colonoscopists who were sent the e-mail, 263 replied. We analysed data from 252 colonoscopists who had performed colon polypectomies. Results: The stopping time for antiplatelet and anticoagulation therapy before a colon polypectomy had a tendency to increase and the restarting time for these drugs was delayed as polyp size increased. Colonoscopists preferred cold biopsy removal for polyps <5 mm in size and a hot snare polypectomy after injecting normal saline and epinephrine mixture for polyps ≥5 mm in size. More than half of colonoscopists preferred observation rather than additional procedures for adenomas with incomplete resection. In contrast, most colonoscopists recommended additional procedures, such as endoscopic mucosal resection, endoscopic submucosal dissection or surgery for an advanced adenoma with incomplete resection. The most preferred prophylactic treatment for immediate postpolypectomy bleeding was hemoclipping. Conclusions: Various treatment modalities were used for a colon polypectomy because there are few guidelines for performing a colon polypectomy based on a critical review of the available data. Further well-designed, prospective studies are needed to develop evidence-based guidelines for colon polypectomy. (Intest Res 2011;9:196-205)
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