• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.8 no.2
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• pp.161-174
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• 2013

The purpose of this study was to examine the efficiency of senior welfare centers and the cause of differences among senior welfare centers in that regard, and to investigate influential factors for the differences in efficiency and the size of the influence of the factors. What methods would be effective at assessing the efficiency of senior welfare centers by taking into account their circumstances was reviewed, and post-hoc analyses were made by using data envelopment analysis(DEA) and Tobit analysis, which were useful tools to evaluate relative efficiency. After 24 senior welfare centers located in Seoul were selected, their yearly operating data of 2011 were utilized. In this study, we set limits to the medical welfare of the elderly welfare services business, and divided into model 2 including the elderly population in the region and model 1, input factors for only internal factors, such as full-time workers. We calculated a valid result by proceeding a BCC analysis and analysis of CCR respectively. As this study has some limitations, follow-up research should be implemented. Yet this study is of significance in that it attempted to present general norms for the efficiency analysis of senior welfare centers by using a DEA model and made various post-hoc analyses based on the efficiency data to give significant suggestions on the service of senior welfare centers.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.86-91
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• 2010

Purpose: To introduce mini-open rotator cuff repair using the anterolateral approach and evaluate its clinical outcomes and effectiveness. Materials and Methods: 59 consecutive cases of rotator cuff tearing which were treated with mini-open repair utilizing the anterolateral approach were evaluated. The population comprised 39 men and 20 women, with an average age of 56.6 years. An average follow-up time period was 26 months. Clinical outcomes were analyzed based on VAS, ADL, and ASES scores. Results: The average respective VAS, ADL, and ASES scores improved from 7.04, 12.37, and 35.32 preoperatively to 1.02, 27.20, and 90.08 postoperatively (p=0.000). There were 41 excellent, 11 good, 2 fair, and 5 poor results. There were satisfactory results in 52 cases (88.1%). There were no statistically significant differences between the final ASES scores and age, sex, duration of symptoms, tear size, and preoperative stiffness (p>0.05). Conclusion: Mini-open rotator cuff repair using the anterolateral approach effective in providing better visualization.

• The Bulletin of The Korean Astronomical Society
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• v.42 no.1
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• pp.30.2-31
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• 2017

Compact elliptical (cE) galaxies are in a rare class of stellar systems characterized by high stellar densities, small sizes, high velocity dispersion, and high metallicity corresponding to elliptical galaxies. cE galaxies have been observed around massive galaxies, so they could be formed under strong influences of tidal stripping and truncation. However, the recent discovery of isolated cE galaxies requires the need of new formation scenarios. We aim at finding cE galaxies in various environments using SDSS DR12, and studying stellar population of cEs as function of environments. Based on the typical properties of cE galaxies, we selected cE candidates by restricting that low-luminosity Mg > 19.5 mag, small sizes Re < 700 pc, and high velocity dispersions ${\sigma}$ > $60kms^{-1}$. Since effect radii of cE candidates are mostly smaller than the seeing size of SDSS photometry, we calculated the effective radius by fitting a Sersic profile. In addition, we assumed that host galaxies have brightness with Mr < -21 mag, and an environmental parameter is computed as distances between cE galaxies and host-galaxies. We found 112 cE galaxies at z < 0.05, which have high sersic indices (mean value is 5.2) similar to the typical massive elliptical galaxies. Mgb values of cE galaxies increase as the distances from the host galaxies decrease. Especially, for cEs close to the host galaxies (NcE; $D_{host}$ < 300 pc), the Mgb values are similar to those of massive elliptical galaxies, which is consistent with the previous studies. On the other hand, cE galaxies distant from the host galaxies (DcE; Dhost >300 pc) have lower Mgb values than the conventional cE. The Mgb values follow the ${\sigma}$-Mgb relation of elliptical galaxies, and are connected to its faint end. This can be explained as a result of different merger histories for differing environments. For example, NcE galaxies are formed by tidal stripping by massive galaxies as suggested by previous studies, but DcE galaxies could be linked with high-redshift spheroids (e.g. red nuggets) which have not evolved into present-day elliptical galaxies because of the environmental influences.

• Asian-Australasian Journal of Animal Sciences
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• v.26 no.6
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• pp.755-765
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• 2013

The accumulation of inbreeding and the loss of genetic diversity is a potential problem in the modern swine breeds in China. Therefore, the purpose of this study was to analyze the pedigrees of Chinese Duroc (CD), Landrace (CL) and Yorkshire (CY) swine to estimate the past and current rates of inbreeding, and to identify the main causes of genetic diversity loss. Pedigree files from CD, CL and CY containing, 4529, 16,776 and 22,600 records, respectively, were analyzed. Pedigree completeness indexes of the three breeds, accounting for one generation back, were 83.72, 93.93 and 93.59%, respectively. The estimated average annual inbreeding rates for CD, CL and CY in recent three years were 0.21, 0.19 and 0.13%, respectively. The estimated average percentage of genetic diversity loss within each breed in recent three years was about 8.92, 2.19, and 3.36%, respectively. The average relative proportion of genetic diversity loss due to unequal contributions of founders in CD, CL and CY was 69.09, 57.95 and 60.57%, and due to random genetic drift was 30.91, 42.05 and 39.43%, respectively. The estimated current effective population size for CD, CL and CY was 76, 117 and 202, respectively. Therefore, CD has been found to have lost considerable genetic diversity, demanding priority for optimizing the selection and mating to control future coancestry and inbreeding. Unequal contribution of founders was a major cause of genetic diversity loss in Chinese swine breeds and random genetic drift also showed substantial impact on the loss of diversity.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.5075-5079
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• 2015

Background: Adverse effects of treatment prolongation beyond 8 weeks with radiotherapy for cervical cancer have been established. Clinical data also show that cisplatin increases the biologically effective dose of radiotherapy. However, there are no data on the effect of overall treatment time in patients with locally advanced cervical cancer treated with concomitant chemo-radiotherapy (CCRT) in an Indian population. The present study concerned the feasibility of concurrent chemotherapy and interspacing brachytherapy during the course of external radiotherapy to reduce the overall treatment time and compare the normal tissue toxicity and loco-regional control with a conventional schedule. Materials and Methods: Between January 2009 and March 2012 fifty patients registered in the Gynaecologic Oncology Clinic of Institute Rotary Cancer Hospital with locally advanced cervical cancer (FIGO stage IIB-IIIB) were enrolled. The patients were randomly allocated to treatment arms based on a computer generated random number. Arm I (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions, and weekly cisplatin $40mg/m^2$. High dose rate intra-cavitary brachytherapy (HDR-ICBT) was performed after one week of completion of external beam radiotherapy (EBRT). The prescribed dose for each session was 7Gy to point A for three insertions at one week intervals. Arm II (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions. Mention HDR-ICBT ICRT was performed after 40Gy and 7Gy was delivered to point A for three insertions (days 23, 30, 37) at one week intervals. Cisplatin $20mg/m^2/day$ was administered from D1-5 and D24-28. Overall treatment time was taken from first day of EBRT to last day of HDR brachytherapy. The overall loco-regional response rate (ORR) was determined at 3 and 6 months. Results: A total of 46 patients completed the planned treatment. The overall treatment times in arm I and arm II were $65{\pm}12$ and $48{\pm}4$ days, respectively (p=0.001). At three and six months of follow-up the ORR for arm I was 96% while that for arm II was 88%. No statistically significant difference was apparent between the two arms. The overall rate of grade ${\geq}3$ toxicity was numerically higher in arm I (n=7) than in arm II (n=4) though statistical significance was not reached. None of the predefined prognostic factors like age, performance status, baseline haemoglobin level, tumour size, lymph node involvement, stage or histopathological subtype showed any impact on outcome. Conclusions: In the setting of concurrent chemoradiotherapy a shorter treatment schedule of 48 days may be feasible by interspacing brachytherapy during external irradiation. The response rates and toxicities were comparable.

• Korean Journal of Ecology and Environment
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• v.51 no.3
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• pp.234-244
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• 2018

The roadkill that animals die after bumping by vehicles on the roads is acting as a factor to decrease the size of various animal populations. It has also been known to be the biggest artificial causations of Vertebrata deaths not only in urban areas but also protected areas such as national parks. Nevertheless, in the national park areas which are major protected national areas for conservation of national biodiversity and ecological diversity, snake roadkills occur frequently. Up to date, related studies are rare. Therefore, in this study, we described snake roadkill patterns on the roads in six national parks between 2006 and 2015. We identified total 736 snake roadkills compromising 10 different species. Five species, Rhabdophis lateralis, Elaphe dione, Gloydius ussuriensis, Lycodon rufozonatus, Gloydius brevicaudus occupied more than 91.7% of total roadkill cases. Active forager snakes were killed by roadkills more than ambush foragers, and the snake roadkill frequency was the highest in September, a migration period and in August when the young individuals dispersed at between 100 and 799 m altitude areas. Roads where roadkills were frequent lie between forest and hydrosphere or between forest and crop field road sides. Our results could be used to identify the trend of snake roadkills on the roads in national parks, and to establish effective roadkill mitigation measures and policies.

• International Journal of Knowledge Content Development & Technology
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• v.10 no.3
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• pp.33-50
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• 2020

Knowledge recipes are packages of knowledge which arise from the process of combining the knowledge assets in the organization in distinctive ways. This involves converting them into useful outputs which are the ideal core competitive advantage enablers for companies. The major objective of this study was to propose a knowledge recipe for financial-sector state corporations in Kenya. The study adopted a convergent parallel mixed methods research design. Quantitative and qualitative data were collected using questionnaires and key informant interviews. The target population of the study was 1574 respondents drawn from all financial state corporations. A multistage sampling technique was used for the study. The first phase involved purposive sampling of the organizations to be studied whereby the four state corporations namely: Capital Markets Authority, Competition Authority of Kenya, Kenya Investment Authority, and Kenya Revenue Authority were identified. The second phase entailed stratified sampling of the respondents in three strata namely senior management team, knowledge management team, and general staff. The authors used a census of all senior management team and knowledge management staff while a simple random sampling technique was used for the general staff. By use of the Krejcie and Morgan table, the actual sample size was 358 respondents from all the four organizations. Data were collected using questionnaires and interview schedules. The qualitative data were analyzed using content analysis while the quantitative data were analyzed by the use of Ms. Excel and VOSviewer and presented using pie charts, bar graphs, and tables. The response rate for this study was 257 (72%). The study revealed that while most employees in the financial sector organizations understand their knowledge needs, knowledge types, knowledge uses and knowledge gaps, they do not have a universal knowledge recipe to facilitate effective knowledge management in their organizations. Consequently, the authors propose a universal knowledge recipe for the state corporations in the financial sector in Kenya. The ingredients of the recipe are legal-knowledge (18%), financial knowledge (15%), administrative knowledge (11%), best practice (10%), lessons learnt (8%), human resource knowledge (8%), research and statistics knowledge (7%), product knowledge (6%), policy and procedure knowledge (5%), ICT knowledge (4%), investor knowledge (3%), markets knowledge (2%), general knowledge (2%) and regulatory framework knowledge (1%).

• Journal of Digital Convergence
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• v.16 no.12
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• pp.153-162
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• 2018

This paper analyzed the current level of the middle school academic achievement in Changwon City and explored the ways for improving academic achievement of the middle school in Changwon City. The data used in the analysis were the results of National Assessment of Educational Achievement of middle school students from 2013 to 2016 which was released on the school's information website(www.schoolinfo.go.kr) First, the analysis found that the academic achievement level of the middle school in Changwon City was not higher than those of Gwangju, Daejeon, and Ulsan, where the population size is similar. Second, the level of academic achievement among middle schools in Changwon City differed by year. Third, the level of academic achievement of middle school in Changwon City differed by district. Fourth, the educational achievement gap among middle schools in Changwon City existed by public and private school, as well as by male school, female school, and male and female Middle School. The paper suggested that schools with low ratio of proficient and above achievement levels should look for ways to raise the percentage of proficient and above achievement levels, and schools with higher rates of below basic achievement should make efforts to solve the problem.

• Journal of Radiation Protection and Research
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• v.38 no.4
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• pp.214-227
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• 2013

Computed tomographic scan as a screening procedures in asymptomatic individuals has seen a steady increase with the introduction of multiple-raw detector CT scanners. This report provides a brief review of the current controversy surrounding CT cancer screening, with a focus on the radiation induced cancer risks and clinical efficacy. 1. A large study of patients at high risk of lung cancer(the National Lung Screening Trial[NLST]) showed that CT screening reduced cancer deaths by 20%(1.33% in those screened compared with 1.67% in those not screened). The rate of positive screening tests was 24.2% and 96.4% of the positive screening results in the low-dose CT group were false-positive. Radiation induced lung cancer risk was estimated the most important in screening population because ERR of radiation induced lung cancer does not show the decrease with increasing age and synergistic connection between smoking and radiation risk. Therefore, the radiation risk may be on the same order of magnitude as the benefit observed in the NLST. Optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation. 2. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but significantly less sensitive and specific for smaller lesions and disadvantageous for subsequent therapeutic optical colonoscopy if polyps are detected. The average effective dose from CT colonography was estimated 8-10 $mS{\nu}$, which could be a significant dose if administered routinely within the population over many years. CT colonography should a) achieve at least 90% sensitivity and specificity in the size category from 6 and 10 mm, b) offer non-cathartic bowl preparation and c) be optimized and standardized CT parameters if it is to be used for mass screening. 3. There is little evidence that demonstrates, for whole-body scanning, the benefit outweighs the detriment. This test found large portion of patient(86~90.8%) had at least one abnormal finding, whereas only 2% were estimated to have clinically significant disease. Annual scans from ages 45 to 75 years would accrue an estimated lifetime cancer mortality risk of 1.9%. There is no group within the medical community that recommends whole-body CT. No good studies indicate the accuracy of screening CT, at this time. The benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established. These areas need further research. Therefore wild screening should be avoided.