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Evaluation of the Usefulness of Restricted Respiratory Period at the Time of Radiotherapy for Non-Small Cell Lung Cancer Patient (비소세포성 폐암 환자의 방사선 치료 시 제한 호흡 주기의 유용성 평가)

  • Park, So-Yeon;Ahn, Jong-Ho;Suh, Jung-Min;Kim, Yung-Il;Kim, Jin-Man;Choi, Byung-Ki;Pyo, Hong-Ryul;Song, Ki-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.2
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    • pp.123-135
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    • 2012
  • Purpose: It is essential to minimize the movement of tumor due to respiratory movement at the time of respiration controlled radiotherapy of non-small cell lung cancer patient. Accordingly, this Study aims to evaluate the usefulness of restricted respiratory period by comparing and analyzing the treatment plans that apply free and restricted respiration period respectively. Materials and Methods: After having conducted training on 9 non-small cell lung cancer patients (tumor n=10) from April to December 2011 by using 'signal monitored-breathing (guided- breathing)' method for the 'free respiratory period' measured on the basis of the regular respiratory period of the patents and 'restricted respiratory period' that was intentionally reduced, total of 10 CT images for each of the respiration phases were acquired by carrying out 4D CT for treatment planning purpose by using RPM and 4-dimensional computed tomography simulator. Visual gross tumor volume (GTV) and internal target volume (ITV) that each of the observer 1 and observer 2 has set were measured and compared on the CT image of each respiratory interval. Moreover, the amplitude of movement of tumor was measured by measuring the center of mass (COM) at the phase of 0% which is the end-inspiration (EI) and at the phase of 50% which is the end-exhalation (EE). In addition, both observers established treatment plan that applied the 2 respiratory periods, and mean dose to normal lung (MDTNL) was compared and analyzed through dose-volume histogram (DVH). Moreover, normal tissue complication probability (NTCP) of the normal lung volume was compared by using dose-volume histogram analysis program (DVH analyzer v.1) and statistical analysis was performed in order to carry out quantitative evaluation of the measured data. Results: As the result of the analysis of the treatment plan that applied the 'restricted respiratory period' of the observer 1 and observer 2, there was reduction rate of 38.75% in the 3-dimensional direction movement of the tumor in comparison to the 'free respiratory period' in the case of the observer 1, while there reduction rate was 41.10% in the case of the observer 2. The results of measurement and comparison of the volumes, GTV and ITV, there was reduction rate of $14.96{\pm}9.44%$ for observer 1 and $19.86{\pm}10.62%$ for observer 2 in the case of GTV, while there was reduction rate of $8.91{\pm}5.91%$ for observer 1 and $15.52{\pm}9.01%$ for observer 2 in the case of ITV. The results of analysis and comparison of MDTNL and NTCP illustrated the reduction rate of MDTNL $3.98{\pm}5.62%$ for observer 1 and $7.62{\pm}10.29%$ for observer 2 in the case of MDTNL, while there was reduction rate of $21.70{\pm}28.27%$ for observer 1 and $37.83{\pm}49.93%$ for observer 2 in the case of NTCP. In addition, the results of analysis of correlation between the resultant values of the 2 observers, while there was significant difference between the observers for the 'free respiratory period', there was no significantly different reduction rates between the observers for 'restricted respiratory period. Conclusion: It was possible to verify the usefulness and appropriateness of 'restricted respiratory period' at the time of respiration controlled radiotherapy on non-small cell lung cancer patient as the treatment plan that applied 'restricted respiratory period' illustrated relative reduction in the evaluation factors in comparison to the 'free respiratory period.

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An Analysis on the Priority of Educational Needs of Teachers in Charge of Educational Contents of Invention Intellectual Property in Secondary Vocational Education (중등단계 직업교육에서의 발명·지식재산 교육내용에 대한 담당 교사의 교육요구도 우선 순위 분석)

  • Lee, Sang-hyun;Lee, Chan-joo;Lee, Byung-Wook
    • 대한공업교육학회지
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    • v.40 no.2
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    • pp.155-174
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    • 2015
  • The purposes of this study were to analyze the property of educational needs of teachers for educational contents of invention and intellectual property in secondary vocational education and provide fundamental data for the development of job training programs so as to develop the capabilities of teachers, the base for effective education of invention intellectual property in secondary vocational education. To achieve them, educational needs for the educational contents of invention intellectual property and the priority of the educational needs in secondary vocational education based on the recognition of the teachers were analyzed and suggested. Concrete results of this study can be suggested as follows. First, the average of educational needs of the teachers for the educational contents of invention intellectual property in secondary vocational education was 5.02. There were 23 items of the educational contents whose educational needs were higher than the average of the whole items and for those items and the average of each item, there were F4(The average of patent applications) 6.72, F5(Modification and supplementation of specification sheets) 6.46, F2(Writing of patent floor plans) 6.39, F3(Writing of patent specification sheets and abstraction) 6.31, A5(Invention method and activity) 6.27, E6(Invention design project) 6.15, H3(Invention commercialization) 5.97, F1(Patent information and application) 5.90, E5(Design obligation) 5.78, E3(Designing process of inventional design) 5.77, A4(Invention and problem solving) 5.57, G2(Patent investigation and classification) 5.47, C2(Thinking method of inventional problem solution) 5.45, E4(Production of inventional design product) 5.45, B5(Inventional patent project) 5.42, A2(Creativity development) 5.26, C4(Inventional problem solving project) 5.26, H4(Invention marketing) 5.26, H2(Analysis on invention commercialization) 5.20, D4(Invention and management) 5.16, C3(Problem solving activity) 5.14, E2(Inventional design devise and expression) 5.11, B3(Actuality of inventional method) 5.08 in order. Second, for the priority of educational needs of the teachers for the educational contents of invention intellectual property in secondary vocational education, there were 13 items of the educational contents for the first rank, 10 for the second rank and 17 for the third rank. The items of the educational contents for the first rank were A4(invention and problem solving), A5(inventional method and activity), B5(Invention patent project), C2(Thinking method of inventional problem solution), C4(Inventional problem solving project), E3(Inventional design process), E4(Production of inventional design product), E5(Design obligation), E6(Invention design project), F1(Patent information and application), F2(Writing of patent floor plan), F3(Writing of patent specification sheet and abstract), and H3(Invention commercialization. The items of the educational contents for the second rank were A2(Creativity development), B3(Actuality of inventional method), C3(Problem solving activity), D4(Invention and management), E2(Invention design devise and expression), F4(Range of patent demand), F5(Modification and supplementation of specification sheet), G2(Patent investigation and classification), H2(Analysis on invention commercialization), and H4(Invention marketing). The items for the third rank were the educational contents except the ones of the first rank and the second rank.

Awareness Activation of Dance Copyrights and Research of Effectiveness Plans (무용의 저작권 인식 활성화와 실효성 방안 연구)

  • LEE, Seoeun
    • Trans-
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    • v.2
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    • pp.1-38
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    • 2017
  • Dance, as an art which expresses thoughts and emotions by movement human, is included in work that its copyright has to be protected, choreographers who are creators and dancers who are performing can exercise their rights included in copyright laws. However, artists who work in the dancing scene have lack of awareness about copyrights and the application level is low. The purpose of this thesis is to look into the current status and issues about dance copyright and to discuss activation plans and effectiveness plans for dance copyrights. The main point is to check into the level of awareness for dance copyrights with choreographers, dancers and students majoring in dance who are in charge of the art of dancing, to present issues about the necessity of the dance copyrights protection plans by analyzing interviews-in-depth and to prepare the dance copyrights protection plans which are concretely realistic. For the research methods, first, I looked into ideas and contents about copyrights through a document research and then, wanted to prepare theoretical background by reviewing actual cases of performing art copyrights related to dance. Next, I carried out surveys about awareness of copyrights with students majoring in dance, choreographers and dancers then carried out analysis of actual proof. Also, I chose three famous dancers who are actively performing in the current dancing scene and did interviews-in-depth about dance copyrights then carried out a recording analysis. I tried to complement the analysis by discussing deeper which I couldn't deal with in the previous surveys and to contemplate awareness activation of dance copyrights and plans. As a result of the research, the level of the awareness about dance copyrights through age, major, education and career was very low. The level of awareness was almost same compared to the previous research 10 years ago. 'Music', which can be an element of copyright issue in dance, was the highest in rate, and dance was recognized as an art which is combined with various elements as a combination work. The way of protection for works of choreography and performance only used data preservation and contracts and didn't register copyrights or record in dace notation. Majority of responders answered that they couldn't have any education about copyrights while they were recognizing the necessity of education and management for copyrights. The analysis of interviews-in-depth was also matched to the result of the previous surveys and a deeper discussion about the status of dance copyrights and issues was carried out. The plans of effectiveness for dance copyrights through the result of previous research are as followings. First, an advanced education is necessary above all to increase the awareness and application of copyrights in dancing scene. Long-term education like study curriculums and short-term education like special courses and seminars should be combined, and education about copyrights for dance groups, choreographers, dancers and students majoring in dance should keep on going. Second, revision of performing art works is necessary for the activation of dance copyrights, and establishing a dance copyright association to manage copyrights systematically and training dance copyright experts are necessary as well. Third, as the way of copyright protection for choreographers and dancers, an establishment for relation gain and loss about copyrights is necessary when creating dance works and performing, and registration of dance works should be activated. Also, the dancing scene should sign contracts for choreography and performance and this contract culture should be activated, and it should systematically preserve and manage choreography and performance records through basic ways. Hereby, it is considered to prepare a foundation to foster the awareness of dance copyrights and activate dance copyrights.

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A Hybrid Recommender System based on Collaborative Filtering with Selective Use of Overall and Multicriteria Ratings (종합 평점과 다기준 평점을 선택적으로 활용하는 협업필터링 기반 하이브리드 추천 시스템)

  • Ku, Min Jung;Ahn, Hyunchul
    • Journal of Intelligence and Information Systems
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    • v.24 no.2
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    • pp.85-109
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    • 2018
  • Recommender system recommends the items expected to be purchased by a customer in the future according to his or her previous purchase behaviors. It has been served as a tool for realizing one-to-one personalization for an e-commerce service company. Traditional recommender systems, especially the recommender systems based on collaborative filtering (CF), which is the most popular recommendation algorithm in both academy and industry, are designed to generate the items list for recommendation by using 'overall rating' - a single criterion. However, it has critical limitations in understanding the customers' preferences in detail. Recently, to mitigate these limitations, some leading e-commerce companies have begun to get feedback from their customers in a form of 'multicritera ratings'. Multicriteria ratings enable the companies to understand their customers' preferences from the multidimensional viewpoints. Moreover, it is easy to handle and analyze the multidimensional ratings because they are quantitative. But, the recommendation using multicritera ratings also has limitation that it may omit detail information on a user's preference because it only considers three-to-five predetermined criteria in most cases. Under this background, this study proposes a novel hybrid recommendation system, which selectively uses the results from 'traditional CF' and 'CF using multicriteria ratings'. Our proposed system is based on the premise that some people have holistic preference scheme, whereas others have composite preference scheme. Thus, our system is designed to use traditional CF using overall rating for the users with holistic preference, and to use CF using multicriteria ratings for the users with composite preference. To validate the usefulness of the proposed system, we applied it to a real-world dataset regarding the recommendation for POI (point-of-interests). Providing personalized POI recommendation is getting more attentions as the popularity of the location-based services such as Yelp and Foursquare increases. The dataset was collected from university students via a Web-based online survey system. Using the survey system, we collected the overall ratings as well as the ratings for each criterion for 48 POIs that are located near K university in Seoul, South Korea. The criteria include 'food or taste', 'price' and 'service or mood'. As a result, we obtain 2,878 valid ratings from 112 users. Among 48 items, 38 items (80%) are used as training dataset, and the remaining 10 items (20%) are used as validation dataset. To examine the effectiveness of the proposed system (i.e. hybrid selective model), we compared its performance to the performances of two comparison models - the traditional CF and the CF with multicriteria ratings. The performances of recommender systems were evaluated by using two metrics - average MAE(mean absolute error) and precision-in-top-N. Precision-in-top-N represents the percentage of truly high overall ratings among those that the model predicted would be the N most relevant items for each user. The experimental system was developed using Microsoft Visual Basic for Applications (VBA). The experimental results showed that our proposed system (avg. MAE = 0.584) outperformed traditional CF (avg. MAE = 0.591) as well as multicriteria CF (avg. AVE = 0.608). We also found that multicriteria CF showed worse performance compared to traditional CF in our data set, which is contradictory to the results in the most previous studies. This result supports the premise of our study that people have two different types of preference schemes - holistic and composite. Besides MAE, the proposed system outperformed all the comparison models in precision-in-top-3, precision-in-top-5, and precision-in-top-7. The results from the paired samples t-test presented that our proposed system outperformed traditional CF with 10% statistical significance level, and multicriteria CF with 1% statistical significance level from the perspective of average MAE. The proposed system sheds light on how to understand and utilize user's preference schemes in recommender systems domain.

Improving Bidirectional LSTM-CRF model Of Sequence Tagging by using Ontology knowledge based feature (온톨로지 지식 기반 특성치를 활용한 Bidirectional LSTM-CRF 모델의 시퀀스 태깅 성능 향상에 관한 연구)

  • Jin, Seunghee;Jang, Heewon;Kim, Wooju
    • Journal of Intelligence and Information Systems
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    • v.24 no.1
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    • pp.253-266
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    • 2018
  • This paper proposes a methodology applying sequence tagging methodology to improve the performance of NER(Named Entity Recognition) used in QA system. In order to retrieve the correct answers stored in the database, it is necessary to switch the user's query into a language of the database such as SQL(Structured Query Language). Then, the computer can recognize the language of the user. This is the process of identifying the class or data name contained in the database. The method of retrieving the words contained in the query in the existing database and recognizing the object does not identify the homophone and the word phrases because it does not consider the context of the user's query. If there are multiple search results, all of them are returned as a result, so there can be many interpretations on the query and the time complexity for the calculation becomes large. To overcome these, this study aims to solve this problem by reflecting the contextual meaning of the query using Bidirectional LSTM-CRF. Also we tried to solve the disadvantages of the neural network model which can't identify the untrained words by using ontology knowledge based feature. Experiments were conducted on the ontology knowledge base of music domain and the performance was evaluated. In order to accurately evaluate the performance of the L-Bidirectional LSTM-CRF proposed in this study, we experimented with converting the words included in the learned query into untrained words in order to test whether the words were included in the database but correctly identified the untrained words. As a result, it was possible to recognize objects considering the context and can recognize the untrained words without re-training the L-Bidirectional LSTM-CRF mode, and it is confirmed that the performance of the object recognition as a whole is improved.

Caries Prevention Effect of Water Fluoridation in Gimhae, Korea (김해시 수돗물불소농도조정사업의 영구치 우식예방효과)

  • Kim, Han-Na;Cho, Hyun-Hee;Kim, Min-Ji;Jun, Eun-Joo;Han, Dong-Hun;Jeong, Seung-Hwa;Kim, Jin-Bom
    • Journal of dental hygiene science
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    • v.14 no.4
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    • pp.448-454
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    • 2014
  • The aim of this study was to evaluate the effect of a water fluoridation program (WFP) on prevention of dental caries in Gimhae City, Korea, with reference to the results of 2012 Korean National Oral Health Survey (KNOHS). In WFP population, 972 subjects including 8-, 10- and 12-year-old children in Gimhae City were examined in 2009. The WFP in Gimhae city has been implemented since 1999. 1872 subjects in non-fluoridated small and medium sized cities similar to Gimhae city were selected from 2012 KNOHS data as the control population. Two dentists who received training in KNOHS with an inter-examiner-agreement examined oral health status of all subjects. To assess the effects of WFP on dental caries, caries preventive fraction was estimated by assessing the differences of decayed, missing, and filled teeth (DMFT) index and decayed, missing, and filled surfaces (DMFS) index, DMFS in pit and fissures and smooth surfaces between WFP population and the control. Univariate analysis of variance adjusted for gender and number of fissure-sealed teeth or surfaces was conducted. DMFT of 12-year-old subjects (n=354) in WFP and control population (n=1,518) were 1.60 and 2.12, respectively, with an estimated prevention effect of 24.7%. Caries preventive fraction on pit and fissure, and smooth surfaces of WFP subjects was estimated 27.5% and 24.0%, among subjects aged 12 years, respectively. WFP in Gimhae City, Korea reduced the prevalence of dental caries and is recommended as a public oral health program where a fluoride-containing toothpastes are commonly used.

Measuring Attitudes and Satisfaction Level towards Military Foodservices (군 급식소의 이용실태 및 만족도 조사)

  • Kang, Bo-Kyoung;Lee, Young-Eun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.40 no.7
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    • pp.1032-1042
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    • 2011
  • The purpose of this study was to examine the attitudes and satisfaction level towards military foodservices as well as suggest effective ways to increase foodservice quality. A questionnaire survey was administered to 413 subjects, which included 400 soldiers and 13 foodservice managers. The survey period was from August 6 to August 25, 2008. The collected data were statistically treated using SPSS V12.0. Most of the investigated soldiers were 20~25 years old. The foodservice managers were male general officials and the majority of them had no prior food service training. None of the foodservice managers had a dietician certificate. Menu was planned through a local foodservice conference, and most food materials were delivered in the form of center-type and military unit-type. Deficiency and deterioration of food service facilities (28.6%) as well as deficiency in the number of cooking personnel (14.3%) increased the difficulty of operational management. Soldiers expressed a desire for increases in Western (25.7%) and Korean traditional foods (21.5%), which meant menu diversity. To increase the quality of military foodservices, taste of food (40.6%), increased portion size (30.4%), and improvement in hygienic conditions (13.6%) were demanded by the soldiers. Food taste (30.8%), improvement in hygienic conditions (23.1%), and better job management were all demanded by the foodservice managers. After factor analysis, quality attributes were rearranged into five dimensions, including facilities, food, menu, service, and sanitation most attributes were over 4 points out of 5 total in importance, but only 3 points in performance. The importance score was higher than the performance score. Soldiers' overall satisfaction level was on average 3.43 points out of 5 points.

A STUDY OF INSERTION DEPTH OF GUTTA PERCHA CONES AFTER SHAPING BY NI-TI ROTARY FILES IN SIMULATED CANALS (레진모형 근관에서 Ni-Ti 파일로 근관성형 후 거타퍼챠콘의 근관내 삽입깊이에 대한 연구)

  • Cho, Hyun-Gu;Hwang, Yun-Chan;Hwang, In-Nam;Oh, Won-Mann
    • Restorative Dentistry and Endodontics
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    • v.32 no.6
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    • pp.550-558
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    • 2007
  • The purpose of this study was to evaluate the insertion depth of several brands of master gutta percha cones after shaping by various Ni-Ti rotary files in simulated canals. Fifty resin simulated J-shape canals were instrumented with ProFile, ProTaper and HEROShaper. Simulated canals were prepared with ProFile .04 taper #25(n=10), .06 taper #25(n=10), ProTaper F2(n=10), HEROShaper .04 taper #25(n=10) and .06 taper #25(n=10). Size #25 gutta percha cones with a .04 & .06 taper from three different brands were used: DiaDent; META; Sure-endo. The gutta percha cones were selected and inserted into the prepared simulated canals. The distance from the apex of the prepared canal to the gutta percha cone tip was measured by image analysis program. Within limited data of this study, the results were as follows 1. When the simulated root canals were prepared with HEROShaper, gutta-percha cones were closely adapted to the root canal. 2. All brands of gutta percha cones fail to go to the prepared length in canal which was instrumented with ProFile, the cones extend beyond the prepared length in canal which was prepared with ProTaper. 3. In canal which was instrumented with HEROShaper .04 taper #25, Sure-endo .04 taper master gutta percha cone was well fitted(p < 0.05). 4. In canal which was instrumented with HEROShaper .06 taper #25, META .06 taper master gutta percha cone was well fitted(p < 0.05). As a result, we concluded that the insertion depth of all brands of master gutta percha cone do not match the rotary instrument, even though it was prepared by crown-down technique, as recommended by the manufacturer. Therefore, the master cone should be carefully selected to match the depth of the prepared canal for adequate obturation.

Estimation of Rice-Planted Area using Landsat TM Imagery in Dangjin-gun area (Landsat TM 화상을 이용한 당진군 일원의 논면적 추정)

  • 홍석영;임상규;이규성;조인상;김길웅
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.3 no.1
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    • pp.5-15
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    • 2001
  • For estimating paddy field area with Landsat TM images, two dates, May 31, 1991 (transplanting stage) and August 19, 1991 (heading stage) were selected by the data analysis of digital numbers considering rice cropping calendar. Four different estimating methods (1) rule-based classification method, (2) supervised classification(maximum likelihood), (3) unsupervised classification (ISODATA, No. of class:15), (4) unsupervised classification (ISODATA, No. of class:20) were examined. Paddy field area was estimated to 7291.19 ha by non-classification method. In comparison with topographical map (1:25,000), accuracy far paddy field area was 92%. A new image stacked by 10 layers, Landsat TM band 3,4,5, RVI, and wetness in May 31,1991 and August 19,1991 was made to estimate paddy field area by both supervised and unsupervised classification method. Paddy field was classified to 9100.98 ha by supervised classification. Error matrix showed 97.2% overall accuracy far training samples. Accuracy compared with topographical map was 95%. Unsupervised classifications by ISODATA using principal axis. Paddy field area by two different classification number of criteria were 6663.60 ha and 5704.56 ha and accuracy compared with topographical map was 87% and 82%. Irrespective of the estimating methods, paddy fields were discriminated very well by using two-date Landsat TM images in May 31,1991 (transplanting stage) and August 19,1991 (heading stage). Among estimation methods, rule-based classification method was the easiest to analyze and fast to process.

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Innovative approaches to the health problems of rural Korea (한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案))

  • Loh, In-Kyu
    • Journal of agricultural medicine and community health
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    • v.1 no.1
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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