A Study on the Improvement of Customs Clearance System According to Increase of Overseas Direct Purchase

전자상거래를 이용한 해외직구는 가격과 품질을 우선시하고 합리적으로 물품을 구매하는 소비자의 인식변화, 모바일을 포함한 인터넷의 확산, 국제배송의 신속화, 온라인 쇼핑몰 운영자의 적극적인 마케팅과 결제방법의 편리성 등으로 인해 2010년 이후 매년 40% 이상 증가하고 있다. 본 연구는 전자상거래로 반입되는 물품(이하 “해외직구물품”이라 한다)의 통관제도를 연구하여 문제점을 도출하고, 개선방안을 제시하고자 하였다. 해외직구물품은 목록통관을 원칙으로 하나, 밀수방지․관세탈루 방지와 미화 150불 이상인 경우에 해당하는 경우 목록통관을 배제하고 일반통관절차를 적용하고 있다. 그러나 일반통관절차는 기업이 수입하는 물품에 적용되는 절차이므로 개인이 수입하는 해외직구물품에 적용하는 것은 적정하지 않다. 본 연구는 단기적으로 목록통관이 배제되는 해외직구물품에 대한 관세 등의 납세신고 방법 개선, 물품신고시 전자상거래에 적합하도록 신고항목 축소, 그리고 서류보관 의무 면제 등의 방안을 제시하였다. 장기적으로는 전자상거래 활성화를 위해 쇼핑몰사업자, 국제운송인 및 세관당국이 함께 싱글윈도우를 구축하는 한편, 전자상거래 분야에서도 블록체인에 기반한 업무프로세스 재설계를 통해 거래의 신뢰성과 가시성을 동시에 확보할 수 있는 방안을 제시하였다. WCO는 세계시장에 새로운 기회를 창출하고 있는 전자상거래의 활성화를 위해 세관당국의 협조가 필요함을 지적하고 있으나, 전자상거래를 위한 통관제도를 별도로 운영하고 있는 나라는 찾아볼 수 없었다. 따라서 본 연구가 전자상거래물품의 통관제도 개선에 도움이 되길 기대한다. Abstract ⅴ 1장 서 론 1 제1절 연구의 목적 1 제2절 연구의 범위 및 구성 2 제2장 해외직구물품에 대한 선행연구 4 제1절 해외직구의 개념과 유형 4 1. 해외직구의 개념 4 2. 해외직구의 유형 5 제2절 선행연구 7 1. 해외직구 관련 선행연구 7 2. 외국의 통관제도 9 제3장 해외직구 현황 및 문제점 12 제1절 해외직구 현황 12 1. 개요 12 2. 국가별 수입실적 13 3. 품목별 수입실적 14 제2절 해외직구물품의 통관절차 16 1. 통관절차 개요 16 2. 해외직구물품의 통관절차 19 제3절 통관제도상 문제점 21 1. 일반통관시 납세신고와의 관계 미정립 22 2. 일반통관 건에 대한 통관서류 보관의무 적정성 23 3. 일반통관 절차 적용시 문제점 25 제4장 통관제도 개선방안 28 제1절 해외직구물품의 통관제도 개선 28 1. 해외직구물품에 대한 납세신고 방법 개선 28 2. 해외직구물품에 대한 수입신고제도 개선 31 3. 서류보관 의무 폐지 33 제2절 해외직구물품의 통관제도에 대한 중장기 발전방향 34 제5장 결 론 36 제1절 연구결과의 요약 및 시사점 36 제2절 연구의 한계 및 향후 연구 과제 38 참고 문헌 39Maste

소현세자 병증과 치료에 대한 연구

약 8년간의 인질생활을 하고 청나라에서 귀국한 소현세자(1612∼1645)가 젊은 나이에 갑자기 사망한 사건에 대하여 그동안 독살설이 주류였다. 하지만 심양일기와 을유동궁일기에 나타난 세자의 병증과 치료과정을 분석해보면, 당시의 치료가 주로 『東醫寶鑑』(1613)에 근거하였으며, 세자는 산증(疝症)으로 계속 고생하는데, 이는 울화병이 있는 상태에서 한기(寒氣)에 접촉되어 생겨난 것으로 볼 수 있다. 또한 사상체질의학의 입장에서 분석해보면 세자는 소양인으로 볼 수 있으며, 소양인체질의 세자가 결흉증과 음허오열로 한열왕래하는 것을 학질로 잘못 이해하여 치료하는 바람에 사망하게 된 것으로 보인다

Long-term macrolide treatment for non-cystic fibrosis bronchiectasis in children: a meta-analysis

Recurrent bacterial infection causes frequent bronchiectasis (BE) exacerbations. The effectiveness and safety of long-term administration of macrolides in BE remain controversial, especially in children who require minimal treatment to prevent exacerbation. We conducted this meta-analysis to determine the usefulness of long-term macrolide use in pediatric BE. We searched PubMed, Cochrane Library databases, Embase, KoreaMed, Igaku Chuo Zasshi, and Chinese National Knowledge Infrastructure databases. We identified randomized controlled trials (RCTs) which elucidated long-term macrolide treatment (≥ 4 weeks) in non-cystic fibrosis BE in children aged < 18 years. The primary outcome was frequency of acute exacerbation; secondary outcomes included changes in pulmonary function, sputum scores, and adverse events including bacterial resistance. We included four RCTs. Long-term macrolide treatment showed a significant decrease in the frequency of exacerbation (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.10-0.87), mean number of exacerbations per patient (mean difference, - 1.40; 95% CI, - 2.26 to - 0.54), and sputum purulence score (mean difference, - 0.78; 95% CI, - 1.32 to - 0.24). However, long-term macrolide treatment was accompanied by an increased carriage of azithromycin-resistant bacteria (OR, 7.13). Long-term macrolide administration prevents exacerbation of BE in children; however, there are risks of increasing antibiotic resistance. Benefits and risks should be weighed and determined on a patient-by-patient basis.ope

Prescription Patterns and Burden of Pediatric Asthma in Korea

PURPOSE: This study aimed to estimate the prevalence, prescription pattern and burden of pediatric asthma in Korea by analyzing the National Health Insurance (NHI) claims data. METHODS: We retrospectively analyzed the insurance claim records from the Korean NHI claims database from January 2010 to December 2014. Asthmatic patients were defined as children younger than 18 years, with appropriate 10th Revision of the International Classification of Diseases codes (J45 or J46) and a prescription for 1 or more asthma maintenance medications at the same date. Hospitalization and emergency department visits for asthma were defined as use of short-acting beta₂-agonists during hospital visits among asthmatic patients. RESULTS: There were 1,172,807 asthmatic children in 2010, which increased steadily to 1,590,228 in 2014 in Korea. The prevalence showed an increasing trend annually for all ages. The mean prevalence by age in those older than 2 years decreased during the study period (from 39.4% in the 2-3 year age group to 2.6% in the 15-18 year age group). In an outpatient prescription, leukotriene receptor antagonists were the most commonly prescribed medication for all ages. Patients older than 6 years for whom inhaled corticosteroids were prescribed comprised less than 15% of asthmatic patients. The total direct medical cost for asthma between 2010 and 2014 ranged from $376 to$483 million. Asthma-related medical cost per person reached its peak in $366 in 2011 and decreased to$275 in 2014. CONCLUSIONS: The prevalence of pediatric asthma increased annually and decreased with age. Individual cost of asthma showed a decreasing trend in Korean children.ope

Reduction Rate of Specific IgE Level as a Predictor of Persistent Egg Allergy in Children

PURPOSE: Egg is the most common food allergen in infants. However, the natural course of egg allergy has not been fully elucidated. This study aimed to describe clinical characteristics and to identify prognostic factors associated with tolerance acquisition of immunoglobulin E (IgE)-mediated egg allergy in children. METHODS: Children who underwent more than 1 follow-up egg white-specific immunoglobulin E (EWsIgE) test between November 2005 and November 2015 at -Severance Children's Hospital were assessed. Children were diagnosed as having IgE-mediated egg allergy based on immediate allergic reaction after egg consumption and an EWsIgE level of > 0.35 kU/L. The children were divided into "tolerant" and "persistent" groups according to tolerance acquisition defined as egg consumption without adverse allergic reactions. RESULTS: Of 124 participants, egg allergy resolved in 101 (81.5%) children. The persistent group had more atopic dermatitis (P = 0.039), and more wheat (P = 0.009) and peanut (P = 0.012) allergies compared to the tolerant group. The EWsIgE levels at diagnosis (EWsIgEdiag) were higher in the persistent group than in the tolerant group (P = 0.001). The trend of the EWsIgE levels in the tolerant group decreased markedly over time compared to the persistent group (P < 0.001). In predicting egg allergy tolerance acquisition, the reduction rate of EWsIgE level after 12 months from diagnosis (ΔEWsIgE12mo) tended to be more accurate than EWsIgEdiag (area under the curve: 0.835 vs. 0.731). When ΔEWsIgE12mo was ≥ 30%, tolerance acquisition was more frequent than that of < 30% (91.9% vs. 57.9%; P < 0.001). CONCLUSIONS: ΔEWsIgE12mo can be used as an early independent predictor of tolerance acquisition of IgE-mediated egg allergy in children.ope

Lung Clearance Index and Quantitative Computed Tomography of Post-Infectious Bronchiolitis Obliterans in Infants

Post-infectious bronchiolitis obliterans (BO) could be diagnosed via spirometry and chest computed tomography (CT); however, these tests are limited in infants. We aimed to evaluate the utility of lung clearance index (LCI) and air-trapping lung volume from chest CT in infants. This prospective study included 20 infants (mean age, 10.9 ± 6.3 months) diagnosed with post-infectious BO between 2009 and 2016. All subjects underwent multiple breath washout tests. For quantitative analysis of chest CT, the mean lung area attenuation value was used as an individual cutoff to determine the air-trapping lung volume. The mean cutoff lung attenuation value was -659 Hounsfield units, the mean total lung volume was 265 ml, and the mean air-trapping lung volume percentage was 22.9%. Functional residual capacity correlated with total lung volume and normal attenuation lung volume (p < 0.02). LCI (p < 0.02) and moment ratio (MR) 1 (p < 0.05) correlated with the air-trapping lung volume percentage. The concordance indices of LCI (0.659, p = 0.025) and MR1 (0.642, p = 0.046) were significantly correlated with the air-trapping lung volume percentage from CT. LCI and quantitative air-trapping lung volume from chest CT are feasible, complimentary tools for assessing infants with post-infectious BO.ope

Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit

Background: Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU). Methods: Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded. Results: The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively. Conclusions: Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.ope

Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.ope