• Journal of Trauma and Injury
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• v.19 no.2
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• pp.164-172
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• 2006

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.

• Journal of Applied Tourism Food and Beverage Management and Research
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• v.7
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• pp.231-266
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• 1997

TQM is a whole process of systemizing, documenting and measuring of service quality scientifically to achieve zero defects in product quality and to continue to improve the body of the product quality by itself. To have this process be improved continuously, first of all it needs to prepare an ideal environment to understand and to conform to its internal and external customers', that is every guests' and employees' expectations and demands. Then it has to be followed by the next step removing some negative aspects that could be derived from the first mentioned process The third step is to cut the cost be suitable compensation rather than an attitude trying to solve the problems in an easy way. The last essential factor for setting up TQM system is to make good use of the outstanding feature or process as it is reviewed against the superior benchmark. The purpose of this study is meet the customers' expectations and to maximize the hotel's profits by searching TQM(total quality management) strategy in hotels. To attain this research's objective, it follows these three details. Firstly, it defines TQM and its contents. Secondly, it provides the standard of hotel TQM throughout some case studies. Thirdly, it suggests TQM strategic plan in tourism hotel as one of professional management strategies. Two useful methods are used together to achieve the goal of this study. To confirm its theoretical consideration, descriptive studies by the research documents its theoretical consideration, descriptive studies by the research documents published in and out of the country is used. The other is case studies of TQM execution in real hospitality industry, which present the cases of the airline, Jefferson Memorial and the hotel. This research is targeting to demonstrate the successful TQM's exercise in a hotel industry by completing the theoretical studies and case studies on service product quality with an understanding of its importance. As it is said earlier, to lead to the successful TQM's practice, it is necessary to maintain a constant training of the employees. Secondly, it also must identify where it has to focus on to deliver a professional quality management. Thirdly, effective quality management organization needs to be build up. The manager's strong will to accomplish and the employee' active participations are the last condition to be succeed. Once again this study places an emphasis on the fact that TQM is critical to maximize the customers' satisfaction and the hotel's profitability. It is also very worthwhile to have every people working on front line recognize why the TQM is important and further more how they can contribute to improve their service quality by a positive participation and a careful observation of TQM's operating in their property.

• Journal of Convergence for Information Technology
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• v.8 no.1
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• pp.105-114
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• 2018

The purpose of this study is to reconsider whether Temple in William Faulkner's Requiem for a Nun has grown morally. Temple in Sanctuary, the previous work was raped with a corn cob by Popeye and perjured in the court, resulting in Lee Goodwin's brutal death. Now she is now a mother of two children and a wife of Gowan Stevens, but she cannot get out of the past and tries to run away with Pete, Red's brother, but she was resisted by Nancy Mannigoe, a nanny. Nancy tries to stop Temple sacrificing herself and Temple's baby. When confronting Nancy who accepted her death sentence without hesitation, Temple realized her past guilt which never fades out. A lapse of 20 years between Sanctuary and Requiem provides Temple and author himself opportunities for spiritual and moral growth in spite of painful realization that the past is never past. On the other hand, Faulkner tells the history and the past of Jefferson elaborating the description of the courthouse and the jail. Both are correlated in thematic perspective, the former representing humanity's need for security, the latter the opposite impulse toward aggression and destruction. but together represent the presentness of the past and the fluidity of time.

• Asian Spine Journal
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• v.12 no.6
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• pp.973-980
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• 2018

Study Design: Retrospective review. Purpose: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery. Overview of Literature: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion. Methods: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were performed using logistic regression analysis, chi-square test, and odds ratio (OR) analysis. Results: Approximately 19% of the patients (495/2,613) received external stimulators following ALIF surgery. There was a slight increase in stimulator use from 2008 to 2014 (multi-level $R^2=0.08$, single-level $R^2=0.05$). Patients who underwent multi-level procedures were more likely to receive stimulators than patients who underwent single-level procedures (p<0.05; OR, 3.72; 95% confidence interval, 3.02-4.57). Grafting options associated with most frequent stimulator use were bone marrow aspirates (BMA) plus autograft or allograft for single-level and allograft alone for multi-level procedures. In both cohorts, patients treated with bone morphogenetic proteins were least likely to receive electrical stimulators (p<0.05). Patients who received stimulation generally had higher reimbursements. Concurrent posterior lumbar fusion (PLF) (ALIF+PLF) increased the likelihood of receiving stimulators (p<0.05). Patients who received electrical stimulators had similar revision rates as those who did not receive stimulation (p>0.05), except those in the multilevel ALIF+PLF cohort, wherein the patients who underwent stimulation had higher rates of revision surgery. Conclusions: Concurrent PLF or multi-level procedures increased patients' likelihood of receiving stimulators, however, the presence of comorbidities did not. Patients who received BMA plus autograft or allograft were more likely to receive stimulation. Patients with and without bone stimulators had similar rates of revision surgery.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.1
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• pp.49-57
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• 2021

Objectives : This study evaluated the medical communication skills of trainee doctors and analyzed the relationship between medical communication skills, self-efficacy on clinical performance (SECP) and empathy. Methods : A total of 106 trainee doctors from a university hospital participated. The questionnaire comprised self-evaluated medical communication skills, modified SECP and the Korean version of the Jefferson Scale of Empathy-Health Professionals version. The mean difference in medical communication skills scores according to gender, age, division (intern, internal medicine group or surgery group) and position (intern, first-/second- and third-/fourth-year residents) were analyzed. Pearson correlation coefficients were determined between medical communication skills, modified SECP and empathy. The effects of each variable on medical communication skills were verified using the structural equation model. Results : There were no statistically significant mean differences in self-evaluated medical communication skills according to gender, age, division or position. Medical communication skills had a significant positive correlation with modified SECP (r=0.782, p<0.001) and empathy (r=0.210, p=0.038). Empathy had a direct effect on modified SECP (β=0.30, p<0.01) and modified SECP had a direct effect on medical communication skills (β=0.80, p<0.001). Empathy indirectly influenced medical communication skills, mediating modified SECP (β=0.26, p<0.05). Conclusions : Medical communication skills are an important core curriculum of residency programs, as they have a direct correlation with SECP, which is needed for successful treatment. Moreover, the medical communication needs a new understanding that is out of empathy.