산업재해보상보험의 청구 절차 미비로 인한 건강보험의 재정 손실 규모와 개선 방안

좌혜경(Jwa, Hey-Kyoung),임준(Yim Jun),정원(Cheong Won) 비판과 대안을 위한 사회복지학회 2013 비판사회정책 Vol.- No.39

산업재해보상보험(이하 산재보험)으로 치료를 받지 못하고 건강보험을 이용하여 치료를 받는 직업성 손상 및 질병에 이환된 환자가 많은 것으로 알려져 있다. 본 연구는 산재보험으로 치료를 받지 못하여 발생하는 건강보험의 재정손실 규모를 추정하고 그 이유를 분석하여 개선 방안을 도출하고자 수행되었다. 손상 및 근골격계질환에 국한하여 직업 기여율을 먼저 구하고 직장가입자중 손상 및 근골격계질환으로 치료를 받은 환자의 공단부담금을 구한 후 직업 기여율을 곱하여 산재보험으로 치료를 받지 못하고 건강보험으로 치료를 받아 발생한 건강보험 재정손실 규모를 추정하였다. 또한 임금노동자 전체로 확대할 경우 산재를 산재보험에서 처리하는 방향으로 제도 변화를 가정했을때의 건강보험 재정 절감액을 추계하였다. 직업성 손상만을 모두 산재보험으로 처리한다고 가정할 때에 2014년부터 2018년까지의 5년 간 누적 재정 절감액은 최소 8,312억 원이고, 최대 1조 7,463억 원인 것으로 나타났다. 직업성 손상과 직업성 근골격계 질환자를 합쳐서 모두 산재보험으로 처리한다고 가정할 때에 5년 간 누적 재정 절감액은 최소 1조 6,812억 원이고, 최대 3조 5,746억 원인 것으로 나타났다. 현재의 산재보험은 직업성 손상 및 질병에 이환된 환자에게 직업관련성의 입증을 요구하고, 근로복지공단에 의한 사전승인 절차를 거치도록 하며, 그 기준마저 엄격하게 제한하고 있다는 점에서 노동자의 권리를 보장해주지 못하는 제도라고 할 수 있다. 산재 요양을 위해 직업성 손상 및 질병에 이환된 환자가 근로복지공단에 청구하고 사전을 받아야 하는 사전승인제도를 없애고 요양 시점부터 의료기관의 분류에 의하여 치료를 받을 수 있도록 청구절차를 개선하고 사후 평가 방식으로 제도운영을 보완한다면 보다 근본적인 제도 개선이 가능할 것이다. In Korea, many people suffering from occupational injuries or diseases are compensated by the national health insurance (NHI) instead of the national workers" compensation insurance (NWCI). We identified the occupational contribution for injuries and musculoskeletal disorders compensated by NHI and analyzed the total benefit amount for those and then estimated the financial losses to the NHI due to substitution for the NWCI. Finally, we estimated the financial savings of the NHI supposing that the NWCI would be reformed and all occupational injuries and musculoskeletal disorders were compensated by the NWCI. If it could be assumed that all occupational injuries were compensated by the NWCI, the cumulative financial savings for 5 years (2014~2018) ranged from 831.2 billion won to 1.746 trillion won. If it could be assumed that all occupational injuries and musculoskeletal disorders were compensated by the NWCI, the cumulative financial savings for 5 years(2014~2018) ranged from 1.684 trillion won to 3.575 trillion won. Nowadays, those people who want to be compensated by the NWCI, have to demonstrate the causality between work and disease, and then be approved before getting the medical care benefits. As a result, the NWCI has not protected the workers" rights but in fact has infringed the worker"s rights. In order to solve these problems, it needs to improve claims procedures for classifying occupational injuries and diseases at the point of medical care.

급성 백혈병 환자에서 감염증의 양상 및 예후인자에 관한 연구 : 1988년∼1995년까지

정희진,김병수,신상원,김열홍,김우주,김민자,김준석,박승철,김권범 대한감염학회 1998 감염 Vol.30 No.3

목적 : 급성 백혈병의 경우 골수기능이 억제되고 항암화학요법에 따른 골수기능 저하로 감염의 위험이 증가하며 감염의 치료가 환자의 생존에 큰 영향을 미치게 된다. 이에 저자들은 1988년부터 1995년까지 고대 구로병원에 급성 백혈병으로 입원했던 환자들 중 입원 기간 내 감염이 있었던 경우를 대상으로 하여 감염의 위험인자 및 감염증의 예후를 후향적으로 분석함으로써 향후 급성 백혈병환자의 감염의 치료에 대한 지침을 얻고자 하였다. 방법 : 급성 백혈병으로 확진된 환자들 중 감염병에 이환된 경우를 대상으로 하여 각각을 미생물학적 확인감염, 임상적 확인감염, 그리고 설명 불가열로 구분하였다. 각각의 경우에서 감염 당시의 호중구 수, 호중구 감소 기간, 항암화학요법과의 연관성, 감염 병소, 배양된 검체 및 원인균, 선택적 소화관 살균법의 사용여부 및 골수회복 여부 등을 조사한 후 환자의 예후와 어떤 관계가 있는 지 조사하였다. 결과 : 연구 대상은 총 113예로 남녀비는 46:67 이었고 평균연령은 34±13세, 진단은 급성 골수성 백혈병 (AML)이 84예, 급성 림프구성 백혈병(ALL)이 29예였으며, 감염시 평균 호중구수는 663±1678/㎣이었고, 호중구 감소 기간은 평균 18±13일이었다. 감염양상은 항암화학요법과 연관된 감염이 84예로 대부분이었고 미생물학적 확인 감염이 40예로서 35%였으며, 폐렴과 원발성 패혈증이 각각 20예와 19예로 가장 많았고, 카테터 연관 감염이 7예로 나타났다. 배양된 균주는 E. coli가 10예(25%)로서 가장 많았으며, 전체적으로 E. coli, P. aeruginosa, K. pneumoniae 등의 그람음성균이 63%로 대부분을 차지하였으나 최근 그람양성구군 및 진균의 분리율이 증가하는 양상을 보였다. 감염증의 예후를 분석한 결과 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으며 그 중에서도 골수 기능이 회복 여부가 환자들의 생존과 통계적으로 유의한 연관이 있었다.(P=0.01). 결론 : 급성 백혈병 환자들에서의 감염은 관해유도화학요법 후 초래되는 호중구 감소와 유의한 관계가 있으며, 폐렴 및 패혈증의 임상양상을 보이는 경우가 흔하고, 원인균별로는 그람 음성균이 주류를 이루나 최근 그람 양성균 감염이 증가하는 추세를 보였다. 감염의 예후 인자로는 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으나 골수 기능의 회복여부가 결정적인 역할을 하는 것으로 나타나, 향후 급성 백혈병 환자의 치료에 있어 감염 빈도의 감소와 감염에서의 조속한 회복을 위해서는 골수 기능의 회복에 중점을 두어야 할 것으로 사료된다. Background : Infection is one of the most important and fatal complications in patients with acute leukemia. The characteristics of infection in acute leukemic patients are different from those in other diseases by the lack of normal inflammatory responses or distinct clinical evidence except fever. To improve the outcome of acute leukemia, it is very important to recognize the risk factors, patterns and prognostic factors of acute leukemia. Methods : We analyzed retrospectively the patterns of infection from 113 febrile patients with acute leukemia from January, 1988 to December, 1995. To determine the prognostic factors and the outcome of infection, the following variables were analyzed: the presence of neutropenia, use of chemotherapeutic agents, type and site of infections, isolated organisms, gastrointestinal decontamination, duration of neutropenia, and bone marrow recovery. Results : Out of 113 febrile patients with acute leukemia, 84 infection episodes(74%) occurred after chemotherapy. The mean duration of neutropenia was 18±13 days. The incidence of microbiologically-documented infection(MDI) was 35%(40/113). Pneumonia was the most common infection(26%), followed by primary sepsis(24%), catheter-related infection(9%). In cases of MDI, 63% were caused by gram-negative bacteria, followed by gram-positive bacteria(28%), and fungi(10%). Escherichia coli(25%) was the most common isolated in MDI. Regarding the prognostic factors in cases with infections, the recovery of bone marrow function was the only statistically significant factor(P=0.01). Conclusion : Infection has been a major cause of morbidity and mortality in acute in acute leukemic patients. To prevent infection and thereby improve the prognosis of acute leukemia, restoration of bone marrow function at early stage is important.

Incorporation of amorphous TiO₂ into one-dimensional SnO₂ nanostructures as superior anodes for lithium-ion batteries

Cheong, Jun Young,Kim, Chanhoon,Jung, Ji-Won,Yun, Tae-Gwang,Youn, Doo Young,Cho, Su-Ho,Yoon, Ki Ro,Jang, Hye-Yeon,Song, Seok Won,Kim, Il-Doo Elsevier 2018 Journal of Power Sources Vol.400 No.-

<P><B>Abstract</B></P> <P>Lithium-ion batteries (LIBs) with higher energy density are necessary to meet the increasing demands of energy storage system (ESS) in near future. Tin (IV) oxide, SnO<SUB>2</SUB>, is one of highly promising anode candidates due to its high theoretical capacity (782 mAh g<SUP>−1</SUP>), abundance, environmental friendliness, and safety with organic electrolytes. However, a rapid capacity fading and poor rate capabilities arising from the large volume expansion and subsequent agglomeration of Sn nanoparticles have been major issues of SnO<SUB>2</SUB>. Here, we have synthesized one-dimensional (1D) SnO<SUB>2</SUB>-amorphous titanium (IV) oxide NTs (SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs), which allow both facile ionic and electron transport as well as easy penetration of electrolytes. The resultant SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs not only alleviate volume expansion by maintaining their structural integrity but also possess minimal charge transfer resistance even after a number of cycles. SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs exhibit both excellent cycle retention characteristics (1050.2 mAh g<SUP>−1</SUP> after 250 cycles) and outstanding rate capability (522.3 mAh g<SUP>−1</SUP> at a current density of 5000 mA g<SUP>−1</SUP>), which is attributed to the introduction of amorphous TiO<SUB>2</SUB> that not only acts as buffer agent for volume changes of SnO<SUB>2</SUB> but also allows fast surface-controlled diffusion process due to its pseudocapacitive charge storage mechanisms.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Introduction of amorphous TiO<SUB>2</SUB> into SnO<SUB>2</SUB> nanotubes (SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs). </LI> <LI> SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs fabricated by one-step electrospinning and calcination. </LI> <LI> Incorporation of amorphous TiO<SUB>2</SUB> leads to higher Li diffusivity. </LI> <LI> SnO<SUB>2</SUB>-a-TiO<SUB>2</SUB> NTs exhibit excellent cycle retention and rate capabilities. </LI> <LI> Amorphous TiO<SUB>2</SUB> effectively alleviates the volume changes of SnO<SUB>2</SUB>. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Feasible Defect Engineering by Employing Metal Organic Framework Templates into One-Dimensional Metal Oxides for Battery Applications

Cheong, Jun Young,Koo, Won-Tae,Kim, Chanhoon,Jung, Ji-Won,Kim, Il-Doo American Chemical Society 2018 ACS APPLIED MATERIALS & INTERFACES Vol.10 No.24

<P>Facile synthesis of rationally designed nanostructured electrode materials with high reversible capacity is highly critical to meet ever-increasing demands for lithium-ion batteries. In this work, we employed defect engineering by incorporating metal organic framework (MOF) templates into one-dimensional nanostructures by simple electrospinning and subsequent calcination. The introduction of Co-based zeolite imidazole frameworks (ZIF-67) resulted in abundant oxygen vacancies, which induce not only more active sites for Li storage but also enhanced electrical conductivity. Moreover, abundant mesoporous sites are formed by the decomposition of ZIF-67, which are present both inside and outside the resultant SnO<SUB>2</SUB>-Co<SUB>3</SUB>O<SUB>4</SUB> nanofibers (NFs). Attributed to the creation of vacancy sites along with the synergistic effects of SnO<SUB>2</SUB> and Co<SUB>3</SUB>O<SUB>4</SUB>, SnO<SUB>2</SUB>-Co<SUB>3</SUB>O<SUB>4</SUB> NFs exhibit an excellent reversible capacity for 300 cycles (1287 mA h g<SUP>-1</SUP> at a current density of 500 mA g<SUP>-1</SUP>) along with superior rate capabilities and improved initial Coulombic efficiency compared with pristine SnO<SUB>2</SUB> NFs. This is an early report on utilizing MOF structures as the defect formation platform into one-dimensional nanostructures, which is expected to result in superior electrochemical performances required for advanced electrodes.</P> [FIG OMISSION]</BR>

Design of BLDC Motor Controller for Electric Power Wheelchair

Jun-Uk Chu,In-Hyuk Moon,Gi-Won Choi,Jei-Cheong Ryu,Mu-Seong Mun 제어로봇시스템학회 2003 제어로봇시스템학회 국제학술대회 논문집 Vol.2003 No.10

Porous SnO₂-CuO nanotubes for highly reversible lithium storage

Cheong, Jun Young,Kim, Chanhoon,Jung, Ji-Won,Yoon, Ki Ro,Kim, Il-Doo Elsevier 2018 Journal of Power Sources Vol.373 No.-

<P><B>Abstract</B></P> <P>Facile synthesis of rationally designed structures is critical to realize a high performance electrode for lithium-ion batteries (LIBs). Among different candidates, tin(IV) oxide (SnO<SUB>2</SUB>) is one of the most actively researched electrode materials due to its high theoretical capacity (1493 mAh g<SUP>−1</SUP>), abundance, inexpensive costs, and environmental friendliness. However, severe capacity decay from the volume expansion and low conductivity of SnO<SUB>2</SUB> have hampered its use as a feasible electrode for LIBs. Rationally designed SnO<SUB>2</SUB>-based nanostructures with conductive materials can be an ideal solution to resolve such limitations. In this work, we have successfully fabricated porous SnO<SUB>2</SUB>-CuO composite nanotubes (SnO<SUB>2</SUB>-CuO p-NTs) by electrospinning and subsequent calcination step. The porous nanotubular structure is expected to mitigate the volume expansion of SnO<SUB>2</SUB>, while the as-formed Cu from CuO upon lithiation allows faster electron transport by improving the low conductivity of SnO<SUB>2</SUB>. With a synergistic effect of both Sn and Cu-based oxides, SnO<SUB>2</SUB>-CuO p-NTs deliver stable cycling performance (91.3% of capacity retention, ∼538 mAh g<SUP>−1</SUP>) even after 350 cycles at a current density of 500 mA g<SUP>−1</SUP>, along with enhanced rate capabilities compared with SnO<SUB>2</SUB>.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Porous SnO<SUB>2</SUB>-CuO nanotubes (SnO<SUB>2</SUB>-CuO p-NTs) by electrospinning & calcination. </LI> <LI> SnO<SUB>2</SUB>-CuO p-NTs exhibited superior ionic transport and penetration of electrolytes. </LI> <LI> The structure of SnO<SUB>2</SUB>-CuO p-NTs was maintained without pulverization. </LI> <LI> Introduction CuO into SnO<SUB>2</SUB> results in more reversible reaction with Li. </LI> <LI> SnO<SUB>2</SUB>-CuO p-NTs exhibited highly stable cycle retention up to 350 cycles. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Revisiting on the effect and role of TiO₂ layer thickness on SnO₂ for enhanced electrochemical performance for lithium-ion batteries

Cheong, Jun Young,Chang, Joon Ha,Kim, Chanhoon,Mweta, Frank Jaksoni,Jung, Ji-Won,Lee, Jeong Yong,Kim, Il-Doo Elsevier 2017 ELECTROCHIMICA ACTA Vol.258 No.-

<P><B>Abstract</B></P> <P>Careful modulation of surficial and interfacial properties of electrode materials is a critical factor for determining overall electrochemical characteristics. Recent studies have indicated that metal oxide nanocoating layer (such as titanium (IV) oxide (TiO<SUB>2</SUB>)) on metal oxide anodes (such as tin (IV) oxide (SnO<SUB>2</SUB>)) exhibited superior electrochemical properties, but fundamental research on the effect and role of TiO<SUB>2</SUB> layer thickness has been limited. Here we have successfully conducted in-depth study on how the thickness of TiO<SUB>2</SUB> overlayer on SnO<SUB>2</SUB> can have significant influence in the overall parameters of electrochemistry. It is revealed that TiO<SUB>2</SUB> overlayer with 12 nm shows good cycle retention (75.8%) even after 80 cycles and retains capacity of 438.3 mAh g<SUP>−1</SUP> even at high current density (5000 mA g<SUP>−1</SUP>). Surprisingly, it was further discovered that TiO<SUB>2</SUB> layer not only alleviates the volume expansion but also helps to facilitate Li ion transport compared with SnO<SUB>2</SUB>. The improvements in both ionic and electrical conductivity of TiO<SUB>2</SUB> layer are main factors in better cycle retention and rate capabilities. Finally, <I>in situ</I> transmission electron microscopy analysis was adopted to observe the growth dynamics of solid electrolyte interphase layer on TiO<SUB>2</SUB>@SnO<SUB>2</SUB>, which demonstrates that TiO<SUB>2</SUB> overlayer results in homogeneous and thinner interphase layer compared with SnO<SUB>2</SUB> NTs.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Study on the effect and role about the thickness of TiO<SUB>2</SUB> coated layer on SnO<SUB>2</SUB>. </LI> <LI> Optimal thickness of TiO<SUB>2</SUB> layer was 12 nm. </LI> <LI> TiO<SUB>2</SUB> layer with 12 nm has better cycle retention and excellent rate capability. </LI> <LI> New insights on the ionic and electronic properties of TiO<SUB>2</SUB> layer on SnO<SUB>2</SUB>. </LI> <LI> <I>In situ</I> TEM analysis of solid electrolyte interphase (SEI) layer on electrodes. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>In-depth study on the role and effect about the thickness of TiO<SUB>2</SUB> layer on SnO<SUB>2</SUB> was conducted, where its optimal thickness results in not only enhanced cycle retention but also excellent rate capability. Both ionic and electric along with interfacial properties of TiO<SUB>2</SUB> coated SnO<SUB>2</SUB> were examined in detail.</P> <P>[DISPLAY OMISSION]</P>

Design of Brushless DC Motor Controller for an Electric Wheelchair

Jun-Uk Chu,In-Hyuk Moon,Gi-Won Choi,Jei-Cheong Ryu,Mu-Seong Mun 한국과학기술원 인간친화 복지 로봇 시스템 연구센터 2004 International Journal of Assistive Robotics and Me Vol.5 No.3

  We introduce a design and implementation of brushless DC (BLOC) motor controller for an electric wheelchair. The control architecture consists of two layers of feedback control, namely the wheelchair posture control and the wheel velocity control. In the higher level of control architecture, the posture controller works as a reference velocity generator for the two wheels. We realize the joystick interface and the posture controller in an 8-bit microcontroller. It is on the lower layer that the velocity controller performs four quadrant operations. For the driving system, a DSP-based BLDC motor controller with three-phase inverter module is especially designed using only three Hall-effect sensors and a single dc-link current sensor. The functions of this motor controller include wheel velocity control and torque control. The performance of the control system has been verified experimentally.

Selection of precore mutants during lamivudine treatment in patients with chronic hepatitis B.

Cheong, Jae Youn,Cho, Sung Won,Yoo, Jun Hwan,Hong, Sun Pyo,Kim, Soo-Ok,Yoo, Wang Don,Kim, Jin Hong G. Thieme 2008 Hepato-gastroenterology Vol.55 No.84

<P>BACKGROUND/AIMS: Evolution of precore genes can occur during lamivudine therapy in HBV infection. This study investigated the changes in precore regions in patients treated with lamivudine and the pattern during relapse. METHODOLOGY: The sequences of codon 28 in precore region in serial samples of 16 patients with HBV (11 HBeAg-positive and 5 HBeAg-negative) treated with lamivudine were analyzed by restriction fragment mass polymorphism. RESULTS: Among 9 patients who had wild-type virus, the wild-type virus was replaced by A1896 during relapse after initial treatment in 2 patients, and a pure population with A1896 selected during relapse in all 4 patients with mixed infection. In 5 patients with A1896 during relapse, 3 patients initially reverted to wild-type and later selected A1896, and 2 patients maintained A1896 during lamivudine retreatment. In 8 patients showing HBeAg negative reactivation, 3 patients showed A1896 and 5 patients showed wildtype virus. CONCLUSIONS: Lamivudine therapy induced initial reversion from precore mutants to wild-type virus, but precore mutants reappeared in patients infected with precore mutants. In some patients infected by wildtype HBV, wild-type HBV was replaced by precore mutants, resulting in a flare-up of hepatitis after cessation of lamivudine administration, and HBeAg negativity did not always correspond to the presence of precore mutants.</P>

Ag-coated one-dimensional orthorhombic Nb₂O₅ fibers as high performance electrodes for lithium storage

Cheong, Jun Young,Youn, Doo Young,Kim, Chanhoon,Jung, Ji-Won,Ogata, Alana F.,Bae, Jin Gook,Kim, Il-Doo Elsevier 2018 ELECTROCHIMICA ACTA Vol.269 No.-

<P><B>Abstract</B></P> <P>In the recent times, pseudocapacitive electrode materials have received great attention due to their considerable capability in storing ions at relatively fast charging rates. Among various candidates, niobium (V) pentoxide (Nb<SUB>2</SUB>O<SUB>5</SUB>) has gained much attraction for lithium-ion batteries (LIBs) due to its insertion/extraction reaction with Li, safe redox potential, and considerably good capacity (about 200 mAhg<SUP>−1</SUP>). Nevertheless, low conductivity of Nb<SUB>2</SUB>O<SUB>5</SUB> has so far prevented its use as a viable electrode material for LIBs. In this study, we have successfully coated silver (Ag) nanoparticles (NPs) on the surface of one-dimensional orthorhombic Nb<SUB>2</SUB>O<SUB>5</SUB> fiber (1D T-Nb<SUB>2</SUB>O<SUB>5</SUB>) using simple electrospinning processing. Ag NPs coated Nb<SUB>2</SUB>O<SUB>5</SUB> fibers (Ag-1D T-Nb<SUB>2</SUB>O<SUB>5</SUB>) provided faster electron pathways, resulting in much improved capacity at a given current density with superior rate capabilities compared with pristine 1D T-Nb<SUB>2</SUB>O<SUB>5</SUB>. In addition, 1D T-Nb<SUB>2</SUB>O<SUB>5</SUB> was more suitable for coating Ag NPs compared with T-Nb<SUB>2</SUB>O<SUB>5</SUB> NPs, where its structural integrity was maintained even after cycling. As a result, effective coating of conductive Ag NPs on the 1D T-Nb<SUB>2</SUB>O<SUB>5</SUB> resulted in excellent cycle retention characteristics (179.7 mAhg<SUP>−1</SUP> after 500 cycles at 500 mA g<SUP>−1</SUP>) as well as superior rate capabilities (103.6 mAhg<SUP>−1</SUP> at a current density of 5000 mA g<SUP>−1</SUP>).</P> <P><B>Highlights</B></P> <P> <UL> <LI> Ag NPs were decorated on 1D T-Nb<SUB>2</SUB>O<SUB>5</SUB>. </LI> <LI> Decoration of Ag NPs resulted in enhanced reversible capacity. </LI> <LI> Ag-1D T-Nb<SUB>2</SUB>O<SUB>5</SUB> exhibited excellent rate capabilities. </LI> <LI> 1D T-Nb<SUB>2</SUB>O<SUB>5</SUB> served as effective platforms for decoration of Ag NPs. </LI> <LI> The structural integrity of Ag-1D T-Nb<SUB>2</SUB>O<SUB>5</SUB> was maintained after cycles. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>