• Title/Summary/Keyword: second order effects

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Analyses on the Mean Length of Stay of and the Income Effects due to Early Discharge of Car Accident Patients at General Hospital (3차 병원에 입원한 교통사고환자의 평균 재원기간과 조기퇴원시의 수입증대효과 분석연구)

  • Ryu, Ho-Sihn
    • Research in Community and Public Health Nursing
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    • v.10 no.1
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    • pp.70-79
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    • 1999
  • This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

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A FEM study on stress distribution of tooth-supported and implant-supported overdentures retained by telescopic crowns (텔레스코픽 크라운 임플란트 지지 피개의치와 치아 지지 피개의치의 하악골내 응력분포에 관한 유한요소분석)

  • Paek, Jang-Hyun;Lee, Chang-Gyu;Kim, Tae-Hun;Kim, Min-Jung;Kim, Hyeong-Seob;Kwon, Kung-Rock;Woo, Yi-Hyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.50 no.1
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    • pp.10-20
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    • 2012
  • Purpose: The purpose of this study was to investigate the stress distribution in mandibular implant-supported overdentures and tooth-supported overdentures with telescopic crowns. Materials and methods: The assumption of this study was that there were 2, 3, 4 natural teeth and implants which are located in the second premolar and canine regions in various distributed conditions. The mandible, teeth (or implants and abutments), and connectors are modeled, and analyzed with the commercial software, ANSYS Version 10.1. Stress distribution was evaluated under 150 N vertical load bilaterally on 3 experimental conditions - between canine areas, canine and $2^{nd}$ premolars, 10 mm posterior to $2^{nd}$ premolars. Results: Overall, the case of the implant group showed more stress than the case of the teeth group in stress distribution to bone. In stress distribution to superstructures of tooth and implants, there was no significant difference between TH group and IM group and the highest stress appeared in TH-IV and IM-IV. The stress caused from bar was much higher than those of implant and tooth. TH group showed less stress than IM group in stress distribution to abutment teeth and implant. Conclusion: The results shows that it is crucial to make sure that distance between impact loading point and abutment tooth does not get too far apart, and if it does, it is at best to set abutment tooth on premolar tooth region. It will be necessary to conduct more experiments on effects on implants, natural teeth and bone, in order to apply these results to a clinical treatment.

Development and Application of the Explicit and Reflective Learning Strategy for Enhancement of the Elementary School Students' Basic Inquiry Skills -Based on Observation and Classification- (초등학생의 과학탐구기능 향상을 위한 명시적이고 반성적인 교수.학습전략 개발 및 적용 -관찰과 분류를 중심으로-)

  • Lee, Hye-Won;Min, Byeong-Mee;Son, Yeon-A
    • Journal of The Korean Association For Science Education
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    • v.32 no.1
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    • pp.95-112
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    • 2012
  • The research evaluated the effects of the improvements in scientific inquiry for elementary school students and focused on the development and application of the explicit and reflective learning strategy through observation and classification. The explicit and reflective learning strategy was modified and completed with the review of the experts after the development of the draft based on the theoretical approach. The students were evaluated for their academic achievements in scientific inquiry skills before and after taking the course. The results were as follows: First, the steps of the developed learning strategy (1) to motivate, (2) to explore reflectively, (3) to guide explicitly, (4) to inquire explicitly, and (5) to verify reflectively were set to reflect the verification. Second, the results of applying the developed model to the lessons based on the quantitative analysis was effective for observation and classification skills in the quest for improved performance of the whole (the sum of observation and classification, inquiry skills) and the observed features, but there was no effect on classification. Also, the lessons applied the developed teaching strategy and showed effectiveness in improving academic achievement. Particularly in analyzing the relationship between the academic achievement and exploration capabilities, in order to improve academic achievement, the importance of improving inquiry skills was found. Third, the qualitative analysis of teaching and learning strategy developed by applying the lessons of this teacher guide and small group activities through the explicit and reflective observation and classification of the student learning activities showed the significant improvement of ability of the scientific inquiry skills. In addition to the improvement in the abilities of the classification showed after the formation of the most basic observation skills of the scientific inquiry.

A Study on the Effects of Risk Factors and Protection Factors of Care givers on Job Change Intention: Focused on the Mediation Effect of Occupational Adaptation (요양보호사의 위험요인과 보호요인이 이직의도에 미치는 영향 연구: 직업적응의 매개효과 중심으로)

  • Park, Su Jan;Kim, Youn Jae
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.13 no.2
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    • pp.159-175
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    • 2018
  • The purpose of this study was to identify the factors that could overcome the crisis and adversity of the nursing care provider through understanding the effect of job adaptation on the turnover intention of the nursing care provider and to contribute to the various problems of the nursing care provider in the long term. In order to confirm this as an empirical research task, risk factors and protection factors, general characteristics of the survey subjects, job adaptation and turnover intention were selected, and the risk factors and protective factors of caregivers' As a mediator. So Seoul. The results of the questionnaire survey were as follows: 291 caregivers in the elderly medical welfare facilities in Gyeonggi area. First, as the relationship between the risk factors and protective factors of occupational caregivers and occupational adaptation were more severe, the higher the maladjustment of the workplace culture, the more the job satisfaction and organizational commitment were adversely affected. The emotional support, The higher the information support, the more satisfied and satisfied the job. Second, the relationship between the risk factors of the caregiver and the protective factors and the turnover intention, the higher the conflict of caregivers, the more unstable the workplace, the more difficult it is to adapt to work culture, Respectively. Finally, as a result of verifying the mediating effect of occupational adaptation on the relationship between risk factors and protective factors and turnover intention of caregivers, job satisfaction, which is a sub-factor of job adaptation, It is shown that they play mediating roles only in the relationship between stress and turnover intention, and do not play a mediating role in the relationship between protective factor self - efficacy and social support and turnover intention. In other words, if caregivers feel satisfaction about their job, they can be less stressed on their jobs, improve their self-efficacy, and have a positive attitude toward social support. Also, it was found that the more the caregiver 's immersion into the organization, the less job stress and turnover intention decreased, but the self - efficacy and social support perception were not influenced. Based on this, the director of the facility should strive to stabilize the operation of the facility and provide high-quality services by seeking ways to improve conflict resolution and adaptation to the workplace culture so that nursing care workers can adapt to their work. And it is required to develop active management strategies and institutional support for improving job satisfaction and organizational commitment of caregivers.

A Preliminary Epidemiologic Study on Korean Veterans Exposed to Herbicides in Vietnam War (파월국군장병의 고엽제 위해에 관한 예비적 역학조사)

  • Kim, Joung-Soon;Lee, Hyun-Sul;Lee, Hong-Bok;Lee, Won-Young;Park, Young-Joo;Kim, Sung-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.27 no.4 s.48
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    • pp.711-734
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    • 1994
  • Among chemical agents in herbicides, dioxin (2, 3, 7, 8-tetrachloro dibenzo-$\rho$-dioxin : TCDD), a chemical contaminant in herbicides sprayed during the Vietnam War has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the Vietnam War from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U.S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the Korean Veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993, This study was carried out with two major objectives : the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to October 1993. The results obtained are as followings: 1. The literature review of 107 papers revealed that 1) Dioxin is teratogenic, carcinogenic and affects almost all organs including nervous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to Vietnam during the period from $1965{\sim}1970$ around one year. 2) Most frequently complained symptoms in medical examination were motor weakness (32%), sensory abnormalities in extremities (23%), skin diseases (22%), and pain in extremities (20%) whereas in Interview they were more frequent in order of skin problem (44%), motor weakness (38%), sensory abnormalities and pain in extremities(17% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies: in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent 4) When dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis (anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only Indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.

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Comparative Study about Academic Thoughts of Xu Lingtai and Yoshimasu Todo (I) - Focus on their Major Books - (서영태(徐靈胎)와 길익동동(吉益東洞)의 학술사상 비교 연구 (I) - 각자의 주요 저서를 중심으로 -)

  • Yoon, Cheol-Ho;Huang, Huang
    • The Journal of Internal Korean Medicine
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    • v.31 no.4
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    • pp.792-812
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    • 2010
  • In the 18th century, Xu Lingtai (徐靈胎) and Yoshimasu Todo (吉益東洞) were famous doctors advocating ancient medicine, though they lived in different countries, China and Japan. We compared their major books, analyzed their academic thoughts and then took conclusions as below. 1. The first, for instance "Classified Prescriptions of Treatise on Cold Damage Diseases, 傷寒論類方" and "Classified Assemblage of Prescriptions, 類聚方". Based on essential thought that a prescription and a syndrome should correspond, these books arranged and classified the Zhang Zhongjing (張仲景)'s texts."Classified Prescriptions of Treatise on Cold Damage Diseases", based on the thought that principles, methods, formulas and medicinals (理法方藥) were integrated in prescriptions, tried to find out the implicit treatment rules in prescriptions and syndromes through analyzing "Treatise on Cold Damage Diseases, 傷寒論". On the other hand, because Classified Assemblage of Prescriptions focused on the syndromes of ancient prescriptions (古方), it classified and collected the related texts of Treatise on Cold Damage Diseases and "Synopsis of Prescriptions of the Golden Chamber, 금궤요략", and then suggested only simple instructions on how to prescribe medicine. So in this book, the trend of experience was clear. 2. The second, there is "100 Kinds Records from Shennong's Classic of Materia Medica, 神農本草經百種錄" and "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences, 藥徵". Though both of these books are professional oriental pharmacology publications that advocate reactionism, there were remarkable differences in writing style between them. "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences" was based on "Treat on Cold Damage Diseases" and "Synopsis of Prescriptions of the Golden Chamber", just explained the effects of medications and discussed 'matter of course (所當然)', but not discussed 'the reason why (所以然)'. In explaining style of syndromes, it confirmed through research, and emphasized the inductive method. On the other hand, "100 Kinds Records from Shennong's Classic of Materia Medica based on "Shennong's Classic of Materia Medica, 神農本草經", explained the nature of medications and discussed 'the reason why (所以然)'. In explaining style of syndromes, it annotated and explained, and emphasized the process of reasoning. 3. The third, there is "Discuss the Headwaters of Medicine, 醫學源流論" and Severance of Medical evils, 醫斷". Aiming the then medical theories fallen in confused state, these books brought order out of chaos, clarified the categories of medical research, and emphasized the scientific method that could put theories into practice and verify them. The difference is that "Severance of Medical Evils" researched only macroscopic viewable clinical phenomena, and even denied the existence of names of diseases and etiological causes. Thus, it emphasized the accumulation of experiences, laid emphasis on "watching and realizing (目認)", and "understand and taking in (解悟)". Discuss the Headwaters of Medicine extremely emphasized the research of 'something not occuring (未然)', that is to say, induced notions of a disease from observing clinical phenomena, furthermore based on these, predicted the 'something not occuring (未然)' and emphasized researching 'the reason why (所以然)'. As regards how they deal with the traditional theories and post-Zhang Zhongjing's medicines, "Severance of Medical evils" took completely denying attitudes. In case of "Discuss the Headwaters of Medicine", it could be used reasonably through specific situation and detailed analysis. Collectively speaking, there were some differences between medical theories of Xu Lingtai and Yoshimasu Todo. Actually, these differences were whether he tried to research the essence of disease, whether he tried to consider it rationally, and how he treated various opinions occurring in the theories of traditional medicine and clinical experience.

Establishment of a Buddhist Arboretum through a Survey of Temple Managers and Laypersons (사찰림 관리자와 일반인의 인식조사를 통한 불교수목원 조성방안)

  • Yi, Young-Kyoung;Yi, Pyong-In
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.1
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    • pp.104-114
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    • 2014
  • Nowadays, forests have been recognized as valuable resources for biological diversity and tourism/recreation. Temple forests occupy 1.3% of all the Korean forest and are under weak management although their ecological states are very good. Currently in the Buddhist society, the concern for the Buddhist arboretum has been raised as a good alternative for the practical use of temple forests to secure the sustainability of the temple forests as well as to actively meet the demand of the times for forests. This study aims to suggest establishment measures of Buddhist arboretum. This survey was performed on 105 temple forest managers and 130 laypersons. To summarize the results, the two groups differ in opinion. The temple forest managers more concerned for advertizing Buddhist culture and enhancing the image of the temple, while the laypersons had higher expectations for relaxation and education. However, they are similar in putting more emphasis on the conserving the heritage value of the temple and managing the temple forest. Above all, both groups evaluated the needs higher than the urgency and perceived managing temple forest as the most crucial function of a Buddhist arboretum. They also thought that a Buddhist arboretum should be planned to respond to the ecological characteristics of the temple area as well as to be non-exclusive to its users. Based on the important findings, five suggestions for a Buddhist arboretum were proposed. First, a Buddhist arboretum should be carried forward from a long-term point of view, developing a bond of sympathy between members of Buddhist society as well as conducting promotion and education to the general public. Second, the most significant function of a Buddhist arboretum should be preserving the temple forest, with the emphasis on relaxation and education. Third, in order to provide nonexclusive use, a Buddhist arboretum should provide mixed programs applicable to diverse user groups for high user satisfaction and educational effects. Fourth, the Buddhistic identification could be obtained through variety of plants closely associated with Buddhist culture. Lastly, in the process of collecting plants, it is also crucial to reflect the image of the temple and resource property so as to contribute itself in conservation and management of original temple forests. Thereby all Buddhist Arboretum can be classified into two types; preservation/collection and display/education/rest.

A Study on the Impact of Competency of Technology: Based Startups on Performance Using ETRI Technology (ETRI 기술을 활용한 기술창업기업의 역량이 경영성과에 미치는 영향에 관한 연구)

  • Bae, Hongbeom;Song, Minkyung;Kim, Seokyun
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.13 no.1
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    • pp.61-72
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    • 2018
  • In a rapidly changing environment, such as globalization, technology-based startups are attracting attention as a new growth engine that creates jobs and added value and promotes national competitiveness. At present, countries around the world recognize the development of technology-based start-up companies as a major policy task and strive to make policy efforts to revitalize start-ups and strengthen innovation capabilities of companies. Especially, in order to secure superiority in the fierce market competition, it is becoming more and more important for the growth and development of technological start-up companies that pioneer new markets and energize the economy based on original and innovative technologies. Therefore, it is necessary to study systematically and plan for survival and growth of technology start-up companies. The purpose of this study is to investigate the entrepreneurial spirit of Innovation, Entrepreneurship, Risk Sensibility and Technology Innovation Capacity, R&D ability, Technology Accumulation Capacity, Technology Innovation System, The results of this study are as follows. the effects of marketing ability on technical performance and financial performance are examined. First, the CEO 's entrepreneurial spirit has an effect on the technical performance and financial performance of the management performance. Second, the technology accumulation ability and the R & D capability have a positive effect on the technical performance. Finally, it was found that the ability to commercialize the technology commercialization capacity affects both technical performance and financial performance. The policy implications that can be gained through this are as follows. First, by strengthening cooperation between universities and research institutes, related technology entrepreneurship education programs should be upgraded so that technology entrepreneurs or preliminary entrepreneurs can capture business opportunities and secure market price competitiveness. Secondly, R & D for the purpose of start-up should be developed and marketable technology should be developed and linked to direct start-up. Third, it is necessary to activate the program to match the company with the honorary retirement manpower of large enterprises and SMEs, which have more experience in field experience than the founders.

The Effects of 'Climbing learning Method' in the Learning of Mathematics in Elementary School (학습구조차트를 활용하는 등산학습법의 초등수학 적용과 효과에 관한 연구)

  • Baik, Min-Ho;Kim, Pan-Soo
    • Journal of Elementary Mathematics Education in Korea
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    • v.11 no.2
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    • pp.177-197
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    • 2007
  • This study discussed the climbing learning method which studied and practiced by Professor Saito Noboru. This is the learning method which is devised to know not only the relationship of the learning factors but the systemic or structural connection of whole studying contents- affects children's math learning ability through practical class to both the lower and the higher grades. To achieve the purpose of this study, these following issues were set; A. Develop the teaching and learning course of mathematics by applying the climbing learning method. B. Execute the mathematics lesson according to the climbing learning method and analyze the learning achievement. C. Analyze the difference between application of the climbing learning method and that of the learning method by student's level in mathematics. D. Analyze what the climbing learning method gives a shift of the recognition of learning mathematics. In order to accomplish these study issues, we analyzed the text book of math not only for children but also for teachers and developed the teaching and learning course applied the climbing learning method with advice of experts. It was chosen two different homogeneous groups each, third year for lower grade group and fifth year for higher grade group. It was done the experimental group lesson applying the climbing learning method and general lesson for the control group. After then, t-test against independent samples was done depending on the result of the student's assessment(T1, T2). These two groups' students were divided into smaller groups based on result of achievement level regardless of gender. These subgroups were confirmed the difference of learning ability between upper and lower level group. As regarding the result making out grades of faith and attitude for math, t-test was used on independent sample. At the same time, experimental groups were tested using learning attitude with the learning structure chart. Through this study the following results are obtained and the conclusion was drawn. Firstly, although applying the climbing learning method to the lesson does not have significant effect to the lower grade of elementary school student's achievement it has significant influence on the higher grade student's achievement. Second, as a result of analyzing the difference between the climbing learning method and the learning method by student's level in mathematics, it is of no beneficial effect to the lower grade both upper level and lower level. However, it has appreciable effect to the higher grade classes both upper level and low level. Especially, upper level students have higher effect than low level students. Third, climbing learning method does not affect to the faith and attitude of the lower grade students positively, but it has affirmative effect to the higher grade students'. As a result of the survey of the experimental groups which were applied to the climbing loaming method, the lesson by using the learning structure chart proved to be helpful to the both the lower and higher grade. The best advantage of using the learning structure chart, children say, is easily understood whole contents of studying and is useful for review. Furthermore, using the learning structure chart is more efficient compared with previous learning method and is given the successful result to self-directed learning. In conclusion, keeping up with the current of the thought of education, we suggest a scheme as a new teaching method from the constructive learning method which emphasize the self-directed learning.

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Development and Effects of Instruction Model for Using Digital Textbook in Elementary Science Classes (초등 과학 수업에서 디지털 교과서 활용 수업모형 개발 및 효과)

  • Song, Jin-Yeo;Son, Jun-Ho;Jeong, Ji-Hyun;Kim, Jong-Hee
    • Journal of the Korean Society of Earth Science Education
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    • v.10 no.3
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    • pp.262-277
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    • 2017
  • Digital textbooks enable learning that is appropriate to the characteristics and level of learners through various interactions. The purpose of this study was to develop an instruction model that can more effectively use digital textbooks in elementary science classes and to verify its effectiveness. The results were as follows. The instruction model for helping learners complete their learning by using digital textbooks needs to receive diagnostic assessment and feedback on entry behavior, to build a self-directed learning environment, and to interact with teachers, students, and digital textbooks as scaffolding. In this study, we developed an instruction model using digital textbooks reflecting these characteristic. The instructional model consists of preparation, practice and solidity step. In the preparation step, the learner performs a diagnostic evaluation using digital textbooks. Based on the results, feedback provided at each level can complement the entry behavior and maintain interest in learning activities. In the practice step, self-directed learning is implemented using diverse functions of digital textbooks and various types of data. In the solidity step, learners can internalize the learning contents by reviewing video clips which are provided by teachers, performing problem-solving activities, and accessing outcomes accumulated by learners in the community online. In order to verify the effectiveness of this model, we selected the "Weather and our Life" unit. This experiment was conducted using 101 students in the 5th grade in B Elementary School in Gwangju Metropolitan City. In the experimental group, 50 students learned using a smart device that embodies digital textbooks applied with the instruction model. In the comparative group, 51 students were taught using the paper textbooks. The results were as follows. First, there was a significant effect on the improvement of the learning achievement in the experimental group with low academic ability compared with the comparative group with low academic ability. Second, there was a significant effect on self-directed learning attitude in the experimental group. Third, in the experimental group, the number of interactions with the learner, teacher, and digital textbook was higher than the comparative group. In conclusion, the digital textbooks based on the instruction model in elementary science classes developed in this study helped to improve learners' learning achievement and self-directed learning attitudes.