• Title/Summary/Keyword: Management Factors

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Beak Trimming Methods - Review -

  • Glatz, P.C.
    • Asian-Australasian Journal of Animal Sciences
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    • v.13 no.11
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    • pp.1619-1637
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    • 2000
  • A review was undertaken to obtain information on the range of beak-trimming methods available or under development. Beak-trimming of commercial layer replacement pullets is a common yet critical management tool that can affect the performance for the life of the flock. The most obvious advantage of beak-trimming is a reduction in cannibalism although the extent of the reduction in cannibalism depends on the strain, season, and type of housing, flock health and other factors. Beak-trimming also improves feed conversion by reducing food wastage. A further advantage of beak-trimming is a reduction in the chronic stress associated with dominance interactions in the flock. Beak-trimming of birds at 7-10 days is favoured by Industry but research over last 10 years has shown that beak-trimming at day-old causes the least stress on birds and efforts are needed to encourage Industry to adopt the practice of beak-trimming birds at day-old. Proper beak-trimming can result in greatly improved layer performance but improper beak-trimming can ruin an other wise good flock of hens. Re-trimming is practiced in most flocks, although there are some flocks that only need one trimming. Given the continuing welfare scrutiny of using a hot blade to cut the beak, attempts have been made to develop more welfare friendly methods of beak-trimming. Despite the developments in design of hot blade beak-trimmers the process has remained largely unchanged. That is, a red-hot blade cuts and cauterises the beak. The variables in the process are blade temperature, cauterisation time, operator ability, severity of trimming, age of trimming, strain of bird and beak length. This method of beak-trimming is still overwhelmingly favoured in Industry and there appears to be no other alternative procedures that are more effective. Sharp secateurs have been used trim the upper beak of both layers and turkeys. Bleeding from the upper mandible ceases shortly after the operation, and despite the regrowth of the beak a reduction of cannibalism has been reported. Very few differences have been noted between behaviour and production of the hot blade and cold blade cut chickens. This method has not been used on a large scale in Industry. There are anecdotal reports of cannibalism outbreaks in birds with regrown beaks. A robotic beak-trimming machine was developed in France, which permitted simultaneous, automated beak-trimming and vaccination of day-old chicks of up to 4,500 chickens per hour. Use of the machine was not successful because if the chicks were not loaded correctly they could drop off the line, receive excessive beak-trimming or very light trimming. Robotic beak-trimming was not effective if there was a variation in the weight or size of chickens. Capsaicin can cause degeneration of sensory nerves in mammals and decreases the rate of beak regrowth by its action on the sensory nerves. Capsaicin is a cheap, non-toxic substance that can be readily applied at the time of less severe beak-trimming. It suffers the disadvantage of causing an extreme burning sensation in operators who come in contact with the substance during its application to the bird. Methods of applying the substance to minimise the risk to operators of coming in contact with capsaicin need to be explored. A method was reported which cuts the beaks with a laser beam in day-old chickens. No details were provided on the type of laser used, or the severity of beak-trimming, but by 16 weeks the beaks of laser trimmed birds resembled the untrimmed beaks, but without the bill tip. Feather pecking and cannibalism during the laying period were highest among the laser trimmed hens. Currently laser machines are available that are transportable and research to investigate the effectiveness of beak-trimming using ablasive and coagulative lasers used in human medicine should be explored. Liquid nitrogen was used to declaw emu toes but was not effective. There was regrowth of the claws and the time and cost involved in the procedure limit the potential of using this process to beak-trim birds.

A survey on sex life behavior and factors of low back pain (요통환자들의 성생활 행태와 영향 요인 조사)

  • Nam, Chul-Hyun;Woo, Kwang-Seog
    • Journal of Korean Physical Therapy Science
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    • v.9 no.3
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    • pp.31-49
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    • 2002
  • The purpose of this study was to investigate discomforts and sexual life and to identify the relation between the discomforts and sexual life with low back pain. The data were collected from March 2 through July 31, 2001. Four hundred forty-two questionnaires were returned (response rate=88.0%). Analysis of the data was done with SPSS PC+ and use descriptive statistics, $x^2$-test, t-test, ANOVA. regression. The statistics shows that over than 80% of the adults experienced lumbago at least one time in their life, and Back pain is known as one of the most common complaints made by the patients of all ages in the general hospital or local medical clinics throughout. However, in certain case it leads to a chronic condition which can cause a great deal of problems in management and in financial burden to individuals and society. The result of this study was summarized as follows: 1) It appeared that regarding the distribution of gender, male was the higher(63.6%) then that of female, the portion of forties was 28.5%. Sitting for long time was 23.1% in men and 21.7% in women. Unknown reason including sexual behaviour was 12.9% in men and 15.5% in women. Patients treated medicine and physical therapy were 36.4%. In level of educational background, the rate of high school was 31.0%, technical college was 28.5%. The highest proportion by occupation was 18.3% of office workers, occupation posture was 41.9% of sitting. 2) Men(26.0%) and most of women(34.8%) were not satisfied in the explanation satisfaction rate of sex life concerned disease. 23.8% in men and 23.6% in women considered flexibility of waist good. Man(33.3%) and most of woman(35.0%) considered that Health education is necessary. 32.7% in men and 27.3% in women did't mind educator is whoever. Preventing of lower back pain(LBP) and proper Health education of sex life are demanded in daily life. 3) 58.0% of man and 64.0% of woman mostly had a posture which is man over woman. 28.5% in men and 27.8% in women considered that proper information finding of LBP and sex life was very few and few. 37.7% in men and 42.7% in women have acquired information about sex life flung their friends. 4) The number of sex life was decreased from 2.96 0.98 to 2.61 1.63 and also the time of sex life was decreased from 3.65 1.89 to 226 1.64. The satisfaction rate of sex life changed from 3.60 0.86 to 2.77 1.10. In the number of sex life, The non correct group was 2.62 1.91 and the correct group was higher in 2.68 1.65. In the time of sex life, The non correct group was 2.02 1.47 and the correct group was higher in 229 1.65. The satisfaction rate of sex life was 2.76 0.86 in non correct group and 2.88 1.10 in correct group. So there was a difference. 5) In the satisfaction rate of sex life, Men who have a lower back pain were higher than women and no attack group was higher than attack group. As they had many sex life, the satisfaction rate was higher significantly in statistics. As the time of sex life was short, the satisfaction rate was lower significantly in statistics. As the age was low, the demand rate of Health education was high and as means of patient who had a lower back pain was high, the demand rate of Health education was high. As the patient who had a lower back pain had a long married life, the demand rate of Health education was high and as education level was high, the demand rate of Health education was high. It is necessary to provide patients with conservative treatment, educational teaching, and training to prevent further injuries in the future. In general, it is important to educate the public how to prevent back injuries and how to treat themselves in an onset period to prevent further injuries sliding into a chronic state. Sexuality is an integral part of normal and healthy relationships, but patients are unable to enjoy sex because they are riot able to get into a comfortable position due to back pain. Many conditions of the spine can make certain positions uncomfortable. Health educator should make the education program of the discomforts and the sexual pattern for low back pain in workplace and/or hospital. Further study Is needed on how to integrate the educational program on sexuality into the total rehabilitation program.

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Impact of fetal diagnosis of congenital heart disease on parents (선천성 심질환의 산전 진단이 보호자의 임신 유지 결정에 미치는 영향)

  • Choi, Eun Young;Lee, Chang Hoon;Yoon, Myung Ja;Han, Eun Sook;Hong, Joon Suk;Jung, Yun Sook;Choi, Jung Yun
    • Clinical and Experimental Pediatrics
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    • v.49 no.10
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    • pp.1073-1078
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    • 2006
  • Purpose : This study was performed to assess how a fetal diagnosis of congenital heart disease affects parents, as regards pregnancy management and care of infants after birth. Methods : Database search to find out abnormal fetal echocardiography performed at Seoul National University Children's Hospital from July 1988 to June 2003 revealed 370 examinations. After excluding both arrhythmias without structural cardiac disease and multiple pregnancies, 299 pregnancies remained and this data formed the basis of this analysis. We retrospectively reviewed the medical records with special attention to pregnancy outcomes and also tried to find out factors influencing parental decisions on whether to continue or terminate pregnancy. Results : In this study, the mean gestation age at diagnosis was $28{\pm}6.0weeks$. The mean age of mothers was $30{\pm}3.9$ years old. Younger gestational ages at diagnosis(P=0.000), more severe grades of fetal heart disease(P=0.002) and younger mothers(P=0.014) correlated with terminations of pregnanies. But the grades of fetal status, the grades of associated anomaly, whether in-vitro-fertilization was carried out or not and numbers of previous children were not significant. Conclusion : This study found that the earlier gestational ages at diagnosis, younger maternal age and higher grades of fetal heart disease tended to lead parent to select abortions. Fetal echocardiographies were performed too late. Moreover Koreans have a biased view that malformation is a something incurable and a tragedy not only to oneself, but also to a family. So parents select terminations of pregnancy, even in curable cases. This is very unethical.

Drinking Pattern and Nonfatal Injuries of Adults in Korea (성인에서 AUDIT와 손상의 연관성)

  • Yoo, In-Sook;Choi, Eun-Mi;Kwon, Ho-Jang;Lee, Sang-Gyu
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.13 no.4
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    • pp.1690-1698
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    • 2012
  • As alcohol use is one of the most important risk factors for injuries, this study was intended to clarify and evaluate any relationship between drinking patterns and the incidence rates/specific characteristics of injuries in adult populations, using a widely accepted tool, the Alcohol Use Disorders Identification Test (chronic alcohol drinking behaviors measurement, hereinafter the AUDIT) developed by the World Health Organization to help to assess the behaviors in a more accurate and reliable manner. This study used the data collected from the 2009 Korea National Health and Nutrition Examination Survey (KNHANES), in which 7,511 of 7,893 adult participants aged ${\geq}19$ years answered the questions about injuries, and excluding 104 non-respondents, 6,258 of participants in the questionnaire survey of drinking patterns were finally analyzed. The incidence rates and specific characteristics of injuries as classified by the AUDIT categories (i.e., body regions, types and mechanisms) were assessed and estimated in terms of their relative risk using t-test, ANOVA, and logistic regression. SPSS 19.0 statistical package software was employed for statistical analyses. These analyses indicate that the incidence rates of overall injuries were significantly higher in male respondents than in female respondents. The risks of alcohol use related injuries were 8.3 times higher in male respondents than in female ones. Regarding educational background, high school graduates showed the highest rates in the AUDIT with significant difference from the other groups. The married group and the group of respondents having monthly income estimated at KRW 2.01 to 3 million also showed the highest rates in the AUDIT compared to the other groups, indicating statistically significant difference. Significantly increased in problematic drinkers and those with alcohol dependence, the incidence rate of injuries body regions was 0.0371 in the head/neck, and with respect to the AUDIT and the mechanisms of external causes of injuries, transport accidents ranked first, followed by slippage, others, crash and fall. In regard to the classified types of injuries, it was statistically significant in others (e.g., laceration, contusion, addiction, or penetrating wound). In conclusion, the mechanisms of external causes of injuries as well as injuries attributed to alcohol use are very important, and a strategy is required to reduce such the injuries in the manner of decreasing the frequency of drinking after motivation by professional counsellors.

A Study on the Current Fire Insurance Subscription and Solutions for Ensuring the Safety of the Traditional Market (전통시장 안전성 확보를 위한 개선방안: 화재보험 가입실태를 중심으로)

  • Kim, Yoo-Oh;Byun, Chung-Gyu;Ryu, Tae-Chang
    • Journal of Distribution Science
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    • v.9 no.4
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    • pp.43-50
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    • 2011
  • Concerning the risk factors of the outbreak of a fire in a traditional market, most of those markets are located in downtown areas or residential areas; thus, although their location may be favorable in terms of marketability, they face a potential risk in that a fire may develop into a large blaze owing to poor environment or the absence of facilities prepared for disaster during a fire. Moreover, as many people are densely poised in the markets, it is very probable that a fire may occur owing to the excessive use of heaters in the winter as well as the reckless use of electric and gas facilities. It seems that traditional markets encounter difficulty being insured against fire, because of their vulnerability and that the vast majority of small-scale sellers are likely to suffer mental anguish and tremendous physical injury in case of a fire. However, most of those sellers in the traditional markets are hand-to-mouth sellers, and they lack awareness of safety concerns and have insufficient experience in safe facility management. As small-scale sellers constitute the majority in the traditional market, the subscription rate of fire insurance in most of the traditional markets is low for the reasons of their needy circumstances and their financial burden. Statistically, the subscription by street vendors is non-existent; therefore, these vendors have a fairly limited access to indemnification after fire damage. Because of these problems, this study's purpose is to identify the current level of insurance subscription by these markets, which are exposed to poor facilities and vulnerability to fire. In order to fix this, it appears that shop owners and consumers will have to band together. For this study, we executed a fire policyholder fact-finding mission at traditional markets with approximately 108 and 981 stores. The research method was executed by an investigation using one-on-one individual interviews using a questionnaire. The contents investigated current insurance subscriptions. The method of analysis looked at the difference of insured amount according to volume size through cross-tabulation of the difference of insured amount by possession form, difference of insured amount by market form, difference of insured amount by category of business, difference of insured amount by market size, etc. Furthermore, the study should be used to propose solutions for problems through theoretical review with the use of a literature research, because the field case study was through interviews with the persons concerned, and the survey of the current insurance subscriptions by traditional market shopkeepers. The traditional market would generally have difficulty affording fire insurance. Fire insurance subscription rates of most of the market proved to be inactive, because of the economic burden of payment. Lack of funds is thought to be the main factor that causes a lack of realization about the necessity of fire insurance. In addition to expensive insurance premiums, sometimes, the companies' valuation of the businesses is lower than their actual valuations, and they do not pay out enough during a claim. The research presents an improvement plan that, when presented at the traditional markets, may strengthen their ability to procure fire insurance through the help of the central government. Researchers connected with the traditional market mainly accomplish the initial research. However, although this research has its limitations, it offers considerable benefits. For future researchers, I would suggest looking at several regions for comparison.

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A Study on the Emotional Labor of Sales Workers at Department Stores (백화점 판매사원의 감정노동에 관한 연구)

  • Bae, Jun-Chul;Kim, Pan-Jin
    • Journal of Distribution Science
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    • v.9 no.4
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    • pp.75-82
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    • 2011
  • Along with economic development, the service industry is growing as days go by. Therefore, companies should maximize customer satisfaction through continuous changes by providing services which are suitable for customer needs. The general service industry has a decisive effect on the rate of growth and profitability of a superior business. Therefore, many companies try to provide the best customer service to increase profitability. Because service to a customer is delivered through interactions with the employee, the employee's attitude has a strong influence on the customer's satisfaction level. For these, most service industries are required to provide new types of labor. It is often referred to 'Emotional Labor', and that is different from physical and mental labor. Service providers always provide a service for the customers with a smile, even though they conceal their emotions. The Purpose of this study is to identify theologically the fact of that Sales Workers at Department Stores emotional labor, according to the economization of service, has become to decide the predominance of competition among companies and represents the quality of service ; to confirm that their emotion management is a crucial part of the work; to identify the correlation among job stress and job satisfaction which are experienced in the process of performing display rules required by organization. To practice them, this study deals with the theological consideration of the emotional labor, job stress and job satisfaction. This study proceeded to evaluate how the emotional labor of sales workers at department stores effected on their job stress and satisfaction. The result of this study will be summarized below. First of all, the frequency of emotional display and attentiveness required to display emotions both have a similar effect on the level of job stress. In the case of the emotional dissonance, there isn't a great amount of proof that it effects the job stress. That shows us that the aspect of the latter, they express the feelings on their daily lives less than the former by the public awareness and gaze. so, once they could accept the latter, the effect on the job stress would be vanished. Second, a study was performed to figure out the effect of emotional labor on job stress. As a result, none of them make negative effects on the job satisfaction but the attentiveness to required display rules even have positive effects on it. that means the emotional labor has an indirect effect on the job satisfaction through some intermediation stuff. Third, the role conflict of job stress factors has a negative effect on job satisfaction, Although role ambiguity has a negative effect on that as well, I couldn't find appropriate proof for that. As far as I figured out, job stress can only increase job dissatisfaction. In other hands, the sales workers would have tendencies to have more motivation to work hard rather than reveal their job stress and complain about work. Finally, emotional laborers always work close to job stress. This can maximize service for the customers, but it increases stress of the laborers providing services at the same time. Then, they can not provide high quality service. It is no doubt that we need to begin managing it systematically. In conclusion, the work satisfaction of the sales workers is connected to the service quality for the customers directly.

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Social Network Analysis for the Effective Adoption of Recommender Systems (추천시스템의 효과적 도입을 위한 소셜네트워크 분석)

  • Park, Jong-Hak;Cho, Yoon-Ho
    • Journal of Intelligence and Information Systems
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    • v.17 no.4
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    • pp.305-316
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    • 2011
  • Recommender system is the system which, by using automated information filtering technology, recommends products or services to the customers who are likely to be interested in. Those systems are widely used in many different Web retailers such as Amazon.com, Netfix.com, and CDNow.com. Various recommender systems have been developed. Among them, Collaborative Filtering (CF) has been known as the most successful and commonly used approach. CF identifies customers whose tastes are similar to those of a given customer, and recommends items those customers have liked in the past. Numerous CF algorithms have been developed to increase the performance of recommender systems. However, the relative performances of CF algorithms are known to be domain and data dependent. It is very time-consuming and expensive to implement and launce a CF recommender system, and also the system unsuited for the given domain provides customers with poor quality recommendations that make them easily annoyed. Therefore, predicting in advance whether the performance of CF recommender system is acceptable or not is practically important and needed. In this study, we propose a decision making guideline which helps decide whether CF is adoptable for a given application with certain transaction data characteristics. Several previous studies reported that sparsity, gray sheep, cold-start, coverage, and serendipity could affect the performance of CF, but the theoretical and empirical justification of such factors is lacking. Recently there are many studies paying attention to Social Network Analysis (SNA) as a method to analyze social relationships among people. SNA is a method to measure and visualize the linkage structure and status focusing on interaction among objects within communication group. CF analyzes the similarity among previous ratings or purchases of each customer, finds the relationships among the customers who have similarities, and then uses the relationships for recommendations. Thus CF can be modeled as a social network in which customers are nodes and purchase relationships between customers are links. Under the assumption that SNA could facilitate an exploration of the topological properties of the network structure that are implicit in transaction data for CF recommendations, we focus on density, clustering coefficient, and centralization which are ones of the most commonly used measures to capture topological properties of the social network structure. While network density, expressed as a proportion of the maximum possible number of links, captures the density of the whole network, the clustering coefficient captures the degree to which the overall network contains localized pockets of dense connectivity. Centralization reflects the extent to which connections are concentrated in a small number of nodes rather than distributed equally among all nodes. We explore how these SNA measures affect the performance of CF performance and how they interact to each other. Our experiments used sales transaction data from H department store, one of the well?known department stores in Korea. Total 396 data set were sampled to construct various types of social networks. The dependant variable measuring process consists of three steps; analysis of customer similarities, construction of a social network, and analysis of social network patterns. We used UCINET 6.0 for SNA. The experiments conducted the 3-way ANOVA which employs three SNA measures as dependant variables, and the recommendation accuracy measured by F1-measure as an independent variable. The experiments report that 1) each of three SNA measures affects the recommendation accuracy, 2) the density's effect to the performance overrides those of clustering coefficient and centralization (i.e., CF adoption is not a good decision if the density is low), and 3) however though the density is low, the performance of CF is comparatively good when the clustering coefficient is low. We expect that these experiment results help firms decide whether CF recommender system is adoptable for their business domain with certain transaction data characteristics.

Extracting Beginning Boundaries for Efficient Management of Movie Storytelling Contents (스토리텔링 콘텐츠의 효과적인 관리를 위한 영화 스토리 발단부의 자동 경계 추출)

  • Park, Seung-Bo;You, Eun-Soon;Jung, Jason J.
    • Journal of Intelligence and Information Systems
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    • v.17 no.4
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    • pp.279-292
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    • 2011
  • Movie is a representative media that can transmit stories to audiences. Basically, a story is described by characters in the movie. Different from other simple videos, movies deploy narrative structures for explaining various conflicts or collaborations between characters. These narrative structures consist of 3 main acts, which are beginning, middle, and ending. The beginning act includes 1) introduction to main characters and backgrounds, and 2) conflicts implication and clues for incidents. The middle act describes the events developed by both inside and outside factors and the story dramatic tension heighten. Finally, in the end act, the events are developed are resolved, and the topic of story and message of writer are transmitted. When story information is extracted from movie, it is needed to consider that it has different weights by narrative structure. Namely, when some information is extracted, it has a different influence to story deployment depending on where it locates at the beginning, middle and end acts. The beginning act is the part that exposes to audiences for story set-up various information such as setting of characters and depiction of backgrounds. And thus, it is necessary to extract much kind information from the beginning act in order to abstract a movie or retrieve character information. Thereby, this paper proposes a novel method for extracting the beginning boundaries. It is the method that detects a boundary scene between the beginning act and middle using the accumulation graph of characters. The beginning act consists of the scenes that introduce important characters, imply the conflict relationship between them, and suggest clues to resolve troubles. First, a scene that the new important characters don't appear any more should be detected in order to extract a scene completed the introduction of them. The important characters mean the major and minor characters, which can be dealt as important characters since they lead story progression. Extra should be excluded in order to extract a scene completed the introduction of important characters in the accumulation graph of characters. Extra means the characters that appear only several scenes. Second, the inflection point is detected in the accumulation graph of characters. It is the point that the increasing line changes to horizontal line. Namely, when the slope of line keeps zero during long scenes, starting point of this line with zero slope becomes the inflection point. Inflection point will be detected in the accumulation graph of characters without extra. Third, several scenes are considered as additional story progression such as conflicts implication and clues suggestion. Actually, movie story can arrive at a scene located between beginning act and middle when additional several scenes are elapsed after the introduction of important characters. We will decide the ratio of additional scenes for total scenes by experiment in order to detect this scene. The ratio of additional scenes is gained as 7.67% by experiment. It is the story inflection point to change from beginning to middle act when this ratio is added to the inflection point of graph. Our proposed method consists of these three steps. We selected 10 movies for experiment and evaluation. These movies consisted of various genres. By measuring the accuracy of boundary detection experiment, we have shown that the proposed method is more efficient.

High-Dose-Rate Intraluminal Brachytherapy for Biliary Obstruction by Secondary Malignant Biliary Tumors (속발성 담도부 종양에 의한 담도 폐쇄에서 고선량률 관내 근접치료)

  • Yoon Won-Sup;Kim Tae-Hyun;Yang Dae-Sik;Choi Myung-Sun;Kim Chul-Yong
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.35-43
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    • 2003
  • Purpose :To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic billary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor Methods and Materials : A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter Insertion, be)ween December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-lLB, while slx were treated with HDR-lLB only. The 4otal external beam, and brachytherapy radiations dose were 30$\~$61.2 and 9$\~$30 Gy, with median doses of 50 and 15 Gy, respectively. Results : Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8$\%$ (5 patients), respectively. The median survivals for stomach and gailbladder cancers were 7.8 and 10.2 months, respectively, According to the unlvariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (o=0.0200), with all )he patients surviving more than one year had been Irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangltis due to the radiation therapy Conclusion :An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of 4hose patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-lLB, which is a prognostic factor In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and It could be regarded as a safe treatment.

Radiotherapy for Nasopharyngeal Carcinoma (비인강암의 방사선치료 성적)

  • Lee, Myung-Za;Chun, Ha-Chung
    • Radiation Oncology Journal
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    • v.21 no.4
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    • pp.269-275
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    • 2003
  • Purpose: To evaluate the results of radiation management on recurrence, survival and prognostic factors of patients with nasopharyngeal cancer Materials and Methods: Forty-nine patients, treated for nasopharyngeal cancer by radiotherapy between January 1984 and June 2000, were retrospectively studied. All patients were followed up for at least 2.5 years. Their median age was 52 years (range 17$\~$78). The histological types were 21 squamous cell carcinoma, 25 undifferentiated carcinoma, and 3 adenoid cystic carcinoma. The tumor stages were as follows: T1 in 14 patients, T2 in 24, T3 in 3, and T4 in 8, and N0 in 17 patients, Nl in 15, N2 in 4 and N3 in 13. Stages I, IIa, IIb ,III, IV and IVb were 4, 7, 12, 5, 8, and 13 patients respectively. Radiation doses of 58$\~$70 Gy (median 68.7 Gy) were given to the nasopahryngeal and involved lymphatic areas and of 46 $\~$ 50 Gy to the uninvolved neck areas. Results: The overall 5 and 10-year actuarial and disease free survival rates were 54.53$\%$ and 47$\%$ and 55.7$\%$ and 45.3$\%$, respectively The overall five-year survival rates were 100$\%$ in stage I , 80$\%$ in stage IIa, 59.5$\%$ in stage IIIb, 40$\%$ in stage III, and 42.2$\%$ in stage IV tumors. Twenty-three patients fatted either loco-regionally or distantly. Incidences of local failure, regional failure and distant metastasis for the first failure were 20.4$\%$, 8.2$\%$ and 20.4$\%$, respectively. Local recurrences were 4.3$\%$ in T1, 12.5$\%$ in T2, 0$\%$ in T3, and 62.5$\%$ in T4 lesions. Distant metastasis was seen in 41.2$\%$ of N2-3 lesions. Fifty percent of local recurrence appeared within 2 years of treatment at the primary lesion, whereas 70$\%$ of distant metastasis appeared within 2 years following treatment. Young age, female, early T stage, N0 stage; and poorly differentiated carcinoma were all related with good survival. However only stage showed statistically significance. Conclusionn: Based on the results of this study, radiation therapy to nasopharyngeal cancer showed high local recurrence in T4 and increased metastasis in N2-3 lesions. To improve local failure, further radiation doses, such as stereotactic radiation or IMRT radiation, are necessary especially in T4 lesions. The high incidence of distant metastasis in positive lymph node patients, indicates that combined radiation and effective chemotherapeutic agents with appropriated schedule are necessary.