• Title/Summary/Keyword: 동반이탈

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The Effects of Relationship Quality on Customer Defection Following Salesperson Turnover: The Role of Relational Benefits and Switching Costs (영업사원-고객 간 관계의 질이 고객의 동반이탈에 미치는 영향: 관계혜택과 전환비용의 역할)

  • Lim, Si-Hyuk;Lim, Young-Kyun
    • Journal of Distribution Research
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    • v.16 no.1
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    • pp.179-222
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    • 2011
  • This research investigates the influence of relational characteristics on 'co-defection', customer defection following salesperson turnover, in the context of salesperson-customer relationship. Based on the social exchange theory, it was hypothesized that perceived relational benefits and switching costs affect directly the customer's intentions to defect. Key constructs in relationship marketing such as customer satisfaction, trust, and loyalty were hypothesized to affect the customer's intention to defect as well as perceived relational benefits and switching costs. The results of structural equation modeling using a survey sample of 503 insurance customers who purchased life insurance policies through salespersons unveiled that the customer satisfaction with salesperson and the customer trust in salesperson strongly influence the salesperson-owned customer loyalty. However, they did not have significant direct effects on co-defection intentions. All paths from salesperson-owned customer loyalty to perceived relational benefits and perceived switching costs were also significant. Salesperson-owned customer loyalty did not have significant direct effects on co-defection intentions, but it had significant indirect effects on co-defection intentions through relational benefits and switching costs. Three sub-dimensions of perceived relational benefits had significant positive effects on co-defection intentions while the perceived switching costs had significant negative effects on co-defection intentions. The significance of our research findings were verified by comparing the hypothesized model and the rival model in the past studies.

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한국고속철도의 개통과 운영준비

  • 강길현
    • Proceedings of the KSR Conference
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    • 2003.10a
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    • pp.45-72
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    • 2003
  • 2004년 4월 역사적인 한국의 고속철도 개통과 더불어 한국철도는 프랑스, 일본, 독일, 스페인, 이탈리아 등과 함께 300km/h의 초고속철도시대에 들어서게 된다. 고속철도의 개통은 물리적인 속도향상에 따른 시간단축으로 국민들의 삶의 변혁을 가져올 뿐만 아니라 경제적ㆍ사회적ㆍ문화적으로 큰 변화를 동반할 것이 틀림없다.(중략)

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The Early Childhood Caring Experience of North Korean Refugee Mothers (북한이탈 어머니의 영유아 자녀 양육 경험)

  • Kim, Yae-Young
    • Child Health Nursing Research
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    • v.19 no.2
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    • pp.102-110
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    • 2013
  • Purpose: This study was done to develop a theory on the early childhood caring experience of North Korean refugee mothers and how such caring affects how they deal with the socio-psychological problems they face as North Korean refugees. Methods: Data were gathered by indepth interviews, participant observation, and medical records, and were analyzed using the Grounded Theory methods of Strauss and Corbin (1998). Results: From open coding 62 concepts, 23 subcategories and 11 categories were derived, and the North Korean refugee mothers' caring experience was revealed to be 'hopeful upbringing'. A central theme common to the participants was 'coexistence of expectations and worries'. Conclusion: The results of this study provide theoretical grounds to understand North Korean refugee mothers' child care experiences and offer personalized nursing and a deeper understanding of their needs by looking at their experience. Findings may also be useful to help nurses who care for North Korean refugee mother-child dyads in the community and in clinical settings to gain insight on this special needs group, and facilitate the development of interventions based on better understanding of the mothers' experiences.

Relationship between Physical Illness and Depression in North Korean Defectors (북한이탈주민의 신체질환과 우울증상의 연관성에 관한 연구)

  • Kim, Seog-Ju;Kim, Hyo-Hyun;Kim, Jung-Eun;Cho, Seong-Jin;Lee, Yu-Jin
    • Korean Journal of Psychosomatic Medicine
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    • v.19 no.1
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    • pp.20-27
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    • 2011
  • Objectives: The present study aims to investigate the effects of physical illness on depression in North Korean Defectors. Methods: One hundred forty-four North Korean Defectors(20 males, 124 females) and 376 South Koreans 133 males, 243 females) in Incheon Metropolitan areas participated the present study. Face-to-face interview was conducted for demographic information including presence of physical illnesses. To investigate depressive symptoms, all participants were required to complete the Center for Epidemiologic Studies-Depression scale (CES-D). Results: After controlling gender, age, marital status, educational year, employment status and physical illness, North Korean Defectors showed higher CES-D score than South Koreans(${\beta}$=0.449, p<0.001). Within North Korean Defectors, the presence of physical illnesses independently was related to higher CES-D score(${\beta}$=0.243, p<0.001). However, within South Koreans, the presence of physical illnesses did not significantly predict CES-D score. North Korean Defectors with physical illness have higher CES-D score than North Korean Defectors without physical illness($26.8{\pm}13.8$ versus $19.7{\pm}12.7$). However, there was no significant differences of CES-D score between South Koreans with physical illness and South Koreans without physical illness($10.3{\pm}9.8$ versus $9.3{\pm}8.8$). Conclusion: Compared to South Koreans, North Korean Defector showed higher depressive symptoms independently from gender, age, education, employment, marriage. In addition, only North Korean Defectors showed the relationship between depression and physical illness. Our study suggests that depression should be assessed when North Korean Defectors have physical illness.

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A Study on the Effects of the Early Use of Nasal CPAP in the Weaning of Mechanical Ventilators (인공호흡기 이탈시 비강내 CPAP 조기 사용 효과에 관한 연구)

  • Kim, Yeoung Ju;Jung, Byun Kyung;Lee, Sang Geel
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1200-1206
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    • 2003
  • Purpose : This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). Methods : Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. Results : There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in $PaCO_2$. However, the control group showed a slight $CO_2$ retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. Conclusion : Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.

Surgical Experience of Open Heart Surgery in Neonates (신생아개심술의 외과적 경험)

  • 이용훈;조은희
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.828-835
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    • 1996
  • From January 1993 to April 1995, 27 neonates (under age of 30 days underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Center. Mean age and weight were 12.1 days(2days∼306ays) and 3.29 kg(2.6kg∼4.1 kg) respectively. Cardiac anomalies were simple complete transposition of great arteries(TGA) in 11 neonates, TGA with coarctation of aorta(COA) in 1 , total anomalous pulmonary venous connection(TAPVC) in 5, double inlet right ventricle with TAPVC in 1, interrupted aortic arch(IAA) with ventricular septal defect(VSD) in 3, pulmonary atresia(PA) with intact ventricular septum(IVS) in 3, pulmonary stenosis with IVS in 1, Taussig-Bing anomaly with IAA in 1, and hypoplastic left heart syndrome(HLHS) in 1 . Postoperative complications were myocardial and/or pulmonary edema which caused open sternum in 13 patients(54.2%), acute renal failure( RF) in 10(37.0%), Intractable low cardiac output syndrome (LCOS) including weaning failure from cardiopulmonary bypass in 7(25.9%), bronchopulmonary dysplasia in 1, wound infection in 1, and paroxysmal supraventricular tachycardia in 1. Nine of 13 patients with postoperative open sternum were recovered with delayed sternal closure, and seven of 10 patients survived postoperative ARF with peritoneal dialysis. There were 8 operative deaths(29.6%): 3 in the patients with simple complete TGA, 1 In TCA with COA, 1 in PA with IVS, 1 in Taussig-Bing anomaly with IAA, 1 in DIRV with TAPVC, and 1 in HLHS. One late death occurred after arterial switch operation in simple TGA. The mosts common cause of death was low cardiac output syndrome. Our initial experience of open heart surgery in neonates showed high operative mortality and morbidity, especially in complex anomalies.

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Humeral Head Decentralization of Preoperative Magnetic Resonance Images and the Treatment of Shoulder Dislocations in Large to Massive Rotator Cuff Tears in Elderly over 65 Years Old (65세 이상 고령의 회전근 개 대파열 및 광범위 파열에 동반된 견관절 탈구의 치료 및 술 전 자기공명영상의 상완골두 탈중심화)

  • Lee, Bong-Ju;Song, In-Soo;Cha, Kihun
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.5
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    • pp.418-426
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    • 2019
  • Purpose: This study analyzed the features of humeral head decentralization in large to massive rotator cuff tears with a shoulder dislocation in the elderly. Moreover, shoulder instability and treatment were reviewed. Materials and Methods: From May 2005 to February 2017, Group A containing 45 cases (45 patients) over 65 years old accompanied by a large or massive rotator cuff tear with a shoulder dislocation and Group B containing 45 cases (45 patients) without a shoulder dislocation were enrolled. The mean ages in Groups A and B were 73.2 and 72.1 years old, and the mean follow-up periods were 30.7 and 31.3 months, respectively. Twenty-one cases (46.7%) in Group A underwent rotator cuff repair, and 8 cases (17.8%) underwent concomitant rotator cuff repair with Bankart repair. Sixteen cases (35.6%) underwent reverse total shoulder arthroplasty for cuff tear arthropathy. 45 cases (100%) in Group B underwent rotator cuff repair. The off-the center and head elevation were measured in the preoperative magnetic resonance imaging (MRI) of Groups A and B. The preoperative and postoperative visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score in Groups A and B were compared. Results: In Groups A and B, the mean off-the centers were posterior 7.41 mm and posterior 2.02 mm (p=0.03), and the mean head elevations were superior 6.66 mm and superior 2.44 mm (p=0.02), respectively. The mean ASES scores of Groups A and B were 32.8 and 33.4 before surgery, and 77.1 (p=0.02) and 78.1 (p=0.02) after surgery (p=0.18), respectively. The mean UCLA scores of Groups A and B were 13.1 and 12.8 before surgery, and 28.9 (p=0.02) and 29.5 (p=0.01) after surgery (p=0.15), respectively. Conclusion: Patients over 65 years old with a shoulder dislocation in large to massive rotator cuff tears had higher off-the center and head elevation on the preoperative MRI than those without a shoulder dislocation. This measurement can help predict preceding shoulder instability. Early rotator cuff repairs should be performed and other treatments, such as Bankart repair and reverse total shoulder arthroplasty, should also be considered.

Factors Related to the Development of Myocardial Ischemia During Mechanical Ventilation (인공 호흡기 적용에 따른 심근 허혈의 발생에 관한 연구)

  • Kim, Tae-Hyung;Kim, You-Ho;Lim, Chae-Man;Kim, Won;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.645-653
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    • 1999
  • Introduction : Although myocardial ischemia tends to occur more frequently than can he documented in ventilated patients, it has not been well studied on the factors related to the occurrence of the ischemia. Methods : To investigate the related factors to ischemia development, a prospective study was done in 95 cases with consecutive 73 patients who had received mechanical ventilation(MV) in MICU. In addition to 24 h holter monitoring, echocardiogram, electrolytes, cardiac enzymes, hemodynamic, and gas exchange measurements were done within 24 h after initiation of MV in 69 cases. The measurements were repeated at weaning period in 26 cases. The ischemia was defined by the ST segment changes; up-sloping depression more than 1.5 mm or down-sloping or horizontal depression more than 1.0 mm from isoelectric baseline for 80 ms following J point. Results : Twelve patients(12.6% in 95 cases) developed ischemia in total. The incidence of ischemia development showed an increased tendency in the initial 24 hr after MV (15.9%) and in patients with left-sided heart failure found by echocardiogram (18.2%) compared with that of the weaning period (3.8%) and patients without heart failure (10.9%) (P=0.12, P=0.09, in each). There were no differences in APACHE III score, baseline ECG findings, electrolytes abnormalities, use of inotropics or bronchodilators, presence of sepsis or shock, mode of ventilation, and survival rate according to the development of ischemia. Maximal heart rates and mean arterial pressure also were not different between patients with ($137.2{\pm}30.9/min$, $82.5{\pm}15.9$ mm Hg) and without ischemia ($l29.5{\pm}29.7/min$, $83.8{\pm}17.6$ mm Hg). Conclusion : Although the incidence of myocardial ischemia was 12.6% in total, there were no clinically predictable factors to the development of ischemia during mechanical ventilation.

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Aggressive Surgical Treatment for Complex Cardiac Anomalies Associated with Right Atrial Isomerism (우심방 이성체를 동반한 복잡 심기형에 대한 적극적인 수술적 치료)

  • Hwang, Ui-Dong;Jung, Sung-Ho;Jhang, Won-Kyoung;Kim, Young-Hwue;Yun, Tae-Jin
    • Journal of Chest Surgery
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    • v.40 no.8
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    • pp.569-573
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    • 2007
  • A 3 month old female baby, who had been diagnosed with right atrial isomerism associated with total anomalous pulmonary venous return (TAPVR), a functional single ventricle and major aortopulmonary collateral arteries (MAPCA), underwent left MAPCA unifocalization and left Blalock-Taussig shunt (3.5 mm) at 3 months of age. The post-operative course was complicated by pulmonary venous congestion, and the drainage site of the TAPVR was found to be stenotic on echocardiography. We performed sutureless repair of the TAPVR along with unifocalization of the right MAPCA. She was put on an extracorporeal membrane oxygenator for 8 days after the 2nd operation, and she was able to come off the oxygenator with the placement of a central shunt (3 mm). She developed tracheal stenosis, which was presumably due to longstanding endotracheal intubation, and she then underwent tracheostomy. She was discharged to home on day 104 after the 1st operation, and she has been followed up for 2 months in a good clinical condition.

The Norwood Operation in Infants with Complex Congenital Heart Disease (복잡 선천성 심기형 환자에서의 Norwood 술식)

  • 박정준;김용진
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.263-269
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    • 1997
  • From April 1987 to May 1996, 13 infants underwent a Norwood operation for complex congenital heart diseases including hypoplastic left heart syndrome (n : 7), mitral stenosis with small VSD and subaortic stenosis (n : 1), mitral atresia with ventricular septal defect, coarctation of aorta, and subaortic stenosis (n = 1), interrupted aortic arch with ventricular septal defect and subaortic stenosis (n : 1), tricuspid atresia with transposition of the great arteries (n = 1), and complex double-inlet left ventricle (n : 2). All patients without hypoplastic left heart syndrome were associated wit hypoplasia of ascending aorta and arch. Age at operation ranged from 3 days to 8.7 months (mean 60.6 $\pm$ 71.6 days, median 39 days). The operative mortality( < 30 days) was 46% (6 patients). Late mortality was 15% (2 patients). All operative deaths occured during the Erst 24 hours after the operation as a result of cardiopulmonary bypass weaning failure (5 patients) and sudden hemodynamic instability postoperatively (1 patient). Late death was due to aspiration pneumonia in two cases. There are 5 long-term survivals (39%). Three of them have undergone a two-stage repair with a modified Fontan operation in two and total cavopulmonary shunt in one at 12, 17, 4.5 months after Norwood procedure with no mortality. Two patients have entered a three-stage repair strategy by undergoing a bidirectional cavopulmonary shunt at 3 and 5.5 months after initial operation with 1 operative death. The actuarial survival rate for all patients at the first-stage operation, including hospital deaths and ate death was 30.8% at 1 year. In conclusion, the operative mortality of Norwood operation was relatively high compared to other operation for major cardiac anomalies, continuing experience will lead to an improvement in result.

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