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An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • 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.

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Application of Science for Interpreting Archaeological Materials(III) Characterization of Some Western Asia Glass Vessels from South Mound of Hwangnamdaechong (고고자료의 자연과학 응용(III) 황남대총(남분)의 일부 서역계 유리제품에 대한 과학적 특성 분류)

  • Kang, Hyung Tae;Cho, Nam Chul
    • Korean Journal of Heritage: History & Science
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    • v.41 no.1
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    • pp.5-19
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    • 2008
  • Thirty six samples of Western asia glass vessel shards which were excavated from South Mound of Hwangnamdaechong were each measured for thickness, pore size and specific gravity and analyzed for ten major compositions and thirteen trace elements. The glass samples with colorless, greenish blue and dark purple blue were well classified by principal component analysis(PCA). All glass shards of Hwangnamdaechong belonged to Soda glass system ($Na_2O-CaO-SiO_2$) which have the range of 14~17% $Na_2O$ and 5~6% CaO. The corelation coefficients of (MgO, $K_2O$) and (MnO, CuO) showed above 0.90. The concentrations of thirteen trace elements apparently differentiated from colorless, greenish blue and dark blue glasses. We found that thirteen trace elements were very important indices for studying raw material of glass and the origin of glass making. Colorless glass : The specific gravity is $1.50{\pm}0.04$. Circle or oval circle pores are observed with regular direction in internal zone and the longest one is about 0.35 mm. The raw material of sodium must be the plant ash because sodium glasses contain HCLA(High CaO, Low $Al_2O_3$) and HMK(high MgO, high $K_2O$) and suggested to Sasanian glass. The total amount of coloring agent of colorless glass is below 1 % which is too small to attribute to the color. Greenish blue glass : The specific gravity is $1.58{\pm}0.04$. The fine pores which are 0.1~0.2mm are dispersed in internal zone. Sodium glasses are distributed to HCLA and HMK. Therefore the greenish blue glass also have used plant ash for raw material of sodium with the same as colorless glass. It was also suggested to the glass of Sasanian. The total amount of coloring agent of greenish blue glass is about 4% under the influence of working MnO, $Fe_2O_3$ and CuO. Dark purple blue glass : The specific gravity is $1.48{\pm}0.19$. There are rarely pores in internal zone. They are distributed to HCLA and LMK(Low MgO, Low $K_2O$) and suggested to Roman glass. The raw material of sodium is estimated to natron. The total amount of coloring agents of greenish blue is about 3% by $Fe_2O_3$ and CuO. These studies for western asia glass shards from South Mound of Hwangnamdaechong could be used in the future as the standard data which could be compared with those of other several graves in Korea and dispersed in foreign areas.

Business Application of Convolutional Neural Networks for Apparel Classification Using Runway Image (합성곱 신경망의 비지니스 응용: 런웨이 이미지를 사용한 의류 분류를 중심으로)

  • Seo, Yian;Shin, Kyung-shik
    • Journal of Intelligence and Information Systems
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    • v.24 no.3
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    • pp.1-19
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    • 2018
  • Large amount of data is now available for research and business sectors to extract knowledge from it. This data can be in the form of unstructured data such as audio, text, and image data and can be analyzed by deep learning methodology. Deep learning is now widely used for various estimation, classification, and prediction problems. Especially, fashion business adopts deep learning techniques for apparel recognition, apparel search and retrieval engine, and automatic product recommendation. The core model of these applications is the image classification using Convolutional Neural Networks (CNN). CNN is made up of neurons which learn parameters such as weights while inputs come through and reach outputs. CNN has layer structure which is best suited for image classification as it is comprised of convolutional layer for generating feature maps, pooling layer for reducing the dimensionality of feature maps, and fully-connected layer for classifying the extracted features. However, most of the classification models have been trained using online product image, which is taken under controlled situation such as apparel image itself or professional model wearing apparel. This image may not be an effective way to train the classification model considering the situation when one might want to classify street fashion image or walking image, which is taken in uncontrolled situation and involves people's movement and unexpected pose. Therefore, we propose to train the model with runway apparel image dataset which captures mobility. This will allow the classification model to be trained with far more variable data and enhance the adaptation with diverse query image. To achieve both convergence and generalization of the model, we apply Transfer Learning on our training network. As Transfer Learning in CNN is composed of pre-training and fine-tuning stages, we divide the training step into two. First, we pre-train our architecture with large-scale dataset, ImageNet dataset, which consists of 1.2 million images with 1000 categories including animals, plants, activities, materials, instrumentations, scenes, and foods. We use GoogLeNet for our main architecture as it has achieved great accuracy with efficiency in ImageNet Large Scale Visual Recognition Challenge (ILSVRC). Second, we fine-tune the network with our own runway image dataset. For the runway image dataset, we could not find any previously and publicly made dataset, so we collect the dataset from Google Image Search attaining 2426 images of 32 major fashion brands including Anna Molinari, Balenciaga, Balmain, Brioni, Burberry, Celine, Chanel, Chloe, Christian Dior, Cividini, Dolce and Gabbana, Emilio Pucci, Ermenegildo, Fendi, Giuliana Teso, Gucci, Issey Miyake, Kenzo, Leonard, Louis Vuitton, Marc Jacobs, Marni, Max Mara, Missoni, Moschino, Ralph Lauren, Roberto Cavalli, Sonia Rykiel, Stella McCartney, Valentino, Versace, and Yve Saint Laurent. We perform 10-folded experiments to consider the random generation of training data, and our proposed model has achieved accuracy of 67.2% on final test. Our research suggests several advantages over previous related studies as to our best knowledge, there haven't been any previous studies which trained the network for apparel image classification based on runway image dataset. We suggest the idea of training model with image capturing all the possible postures, which is denoted as mobility, by using our own runway apparel image dataset. Moreover, by applying Transfer Learning and using checkpoint and parameters provided by Tensorflow Slim, we could save time spent on training the classification model as taking 6 minutes per experiment to train the classifier. This model can be used in many business applications where the query image can be runway image, product image, or street fashion image. To be specific, runway query image can be used for mobile application service during fashion week to facilitate brand search, street style query image can be classified during fashion editorial task to classify and label the brand or style, and website query image can be processed by e-commerce multi-complex service providing item information or recommending similar item.

Computed Tomography-guided Localization with a Hook-wire Followed by Video-assisted Thoracic Surgery for Small Intrapulmonary and Ground Glass Opacity Lesions (폐실질 내에 위치한 소결질 및 간유리 병변에서 흉부컴퓨터단층촬영 유도하에 Hook Wire를 이용한 위치 선정 후 시행한 흉강경 폐절제술의 유용성)

  • Kang, Pil-Je;Kim, Yong-Hee;Park, Seung-Il;Kim, Dong-Kwan;Song, Jae-Woo;Do, Kyoung-Hyun
    • Journal of Chest Surgery
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    • v.42 no.5
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    • pp.624-629
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    • 2009
  • Background: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative. resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. Material and Method: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. Result: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy, The median diameter of lesions was 8 mm (range: $3{\sim}15\;mm$). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: $1{\sim}30\;mm$). The median interval between preoperative CT-guided with a hook-wire and VATS was 34.5 min (range: ($10{\sim}226$ min). The median operative time was 43.5.min (range: $26{\sim}83$ min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. Conclusion: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.

Statistical Analysis of Operating Efficiency and Failures of a Medical Linear Accelerator for Ten Years (선형가속기의 10년간 가동률과 고장률에 관한 통계분석)

  • Ju Sang Gyu;Huh Seung Jae;Han Youngyih;Seo Jeong Min;Kim Won Kyou;Kim Tae Jong;Shin Eun Hyuk;Park Ju Young;Yeo Inhwan J.;Choi David R.;Ahn Yong Chan;Park Won;Lim Do Hoon
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.186-193
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    • 2005
  • Purpose: To improve the management of a medical linear accelerator, the records of operational failures of a Varian CL2l00C over a ten year period were retrospectively analyzed. Materials and Methods: The failures were classified according to the involved functional subunits, with each class rated Into one of three levels depending on the operational conditions. The relationships between the failure rate and working ratio and between the failure rate and outside temperature were investigated. In addition, the average life time of the main part and the operating efficiency over the last 4 years were analyzed. Results: Among the recorded failures (total 587 failures), the most frequent failure was observed in the parts related with the collimation system, including the monitor chamber, which accounted for $20\%$ of all failures. With regard to the operational conditions, 2nd level of failures, which temporally interrupted treatments, were the most frequent. Third level of failures, which interrupted treatment for more than several hours, were mostly caused by the accelerating subunit. The number of failures was increased with number of treatments and operating time. The average life-times of the Klystron and Thyratron became shorter as the working ratio increased, and were 42 and $83\%$ of the expected values, respectively. The operating efficiency was maintained at $95\%$ or higher, but this value slightly decreased. There was no significant correlation between the number of failures and the outside temperature. Conclusion: The maintenance of detailed equipment problems and failures records over a long period of time can provide good knowledge of equipment function as well as the capability of predicting future failure. Wore rigorous equipment maintenance Is required for old medical linear accelerators for the advanced avoidance of serious failure and to improve the qualify of patient treatment.

A study on the Greeting's Types of Ganchal in Joseon Dynasty (간찰(簡札)의 안부인사(安否人事)에 대한 유형(類型) 연구(硏究))

  • Jeon, Byeong-yong
    • (The)Study of the Eastern Classic
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    • no.57
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    • pp.467-505
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    • 2014
  • I am working on a series of Korean linguistic studies targeting Ganchal(old typed letters in Korea) for many years and this study is for the typology of the [Safety Expression] as the part. For this purpose, [Safety Expression] were divided into a formal types and semantic types, targeting the Chinese Ganchal and Hangul Ganchal of modern Korean Language time(16th century-19th century). Formal types can be divided based on whether Normal position or not, whether Omission or not, whether the Sending letter or not, whether the relationship of the high and the low or not. Normal position form and completion were made the first type which reveal well the typicality of the [Safety Expression]. Original position while [Own Safety] omitted as the second type, while Original position while [Opposite Safety] omitted as the third type, Original position while [Safety Expression] omitted as the fourth type. Inversion type were made as the fifth type which is the most severe solecism in [Safety Expression]. The first type is refers to Original position type that [Opposite Safety] precede the [Own Safety] and the completion type that is full of semantic element. This type can be referred to most typical and normative in that it equipped all components of [Safety Expression]. A second type is that [Safety Expression] is composed of only the [Opposite Safety]. This type is inferior to the first type in terms of set pattern, it is never outdone when it comes to the appearance frequency. Because asking [Opposite Safety] faithfully, omitting [Own Safety] dose not greatly deviate politeness and easy to write Ganchal, it is utilized. The third type is the Original position type showing the configuration of the [Opposite Safety]+Own Safety], but [Opposite Safety] is omitted. The fourth type is a Original position type showing configuration of the [Opposite Safety+Own Safety], but [Safety Expression] is omitted. This type is divided into A ; [Safety Expression] is entirely omitted and B ; such as 'saving trouble', the conventional expression, replace [Safety Expression]. The fifth type is inversion type that shown to structure of the [Own Safety+Opposite Safety], unlike the Original position type. This type is the most severe solecism type and real example is very rare. It is because let leading [Own Safety] and ask later [Opposite Safety] for face save is offend against common decency. In addition, it can be divided into the direct type that [Opposite Safety] and [Own Safety] is directly connected and indirect type that separate into the [story]. The semantic types of [Safety Expression] can be classified based on whether Sending letter or not, fast or slow, whether intimate or not, and isolation or not. For Sending letter, [Safety Expression] consists [Opposite Safety(Climate+Inquiry after health+Mental state)+Own safety(status+Inquiry after health+Mental state)]. At [Opposite safety], [Climate] could be subdivided as [Season] information and [Climate(weather)] information. Also, [Mental state] is divided as receiver's [Family Safety Mental state] and [Individual Safety Mental state]. In [Own Safety], [Status] is divided as receiver's traditional situation; [Recent condition] and receiver's ongoing situation; [Present condition]. [Inquiry after health] is also subdivided as receiver's [Family Safety] and [Individual Safety], [Safety] is as [Family Safety] and [Individual Safety]. Likewise, [Inquiry after health] or [Safety] is usually used as pairs, in dimension of [Family] and [Individual]. This phenomenon seems to have occurred from a big family system, which is defined as taking care of one's parents or grand parents. As for the Written Reply, [Safety Expression] consists [Opposite Safety (Reception+Inquiry after health+Mental state)+Own safety(status+Inquiry after health+Mental state)], and only in [Opposite safety], a difference in semantic structure happens with Sending letter. In [Opposite Safety], [Reception] is divided as [Letter] which is Ganchal that is directly received and [Message], which is news that is received indirectly from people. [Safety] is as [Family Safety] and [Individual Safety], [Mental state] also as [Family Safety Mental state] and [Individual Safety Mental state].

Territorial Expansion the King Võ (Võ Vương, 1738-1765) in the Mekong Delta: Variation of Tám Thực Chi Kế (strategy of silkworm nibbling) and Dĩ Man Công Man (to strike barbarians by barbarians) in the Way to Build a New World Order (무왕(武王, 1738-1765) 시기 메콩 델타에서의 영토 확장 추이: 제국으로 가는 길, '잠식지계(蠶食之計)'와 '이만공만(以蠻攻蠻)'의 변주)

  • CHOI, Byung Wook
    • The Southeast Asian review
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    • v.27 no.2
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    • pp.37-76
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    • 2017
  • $Nguy{\tilde{\hat{e}}}n$ Cư Trinh has two faces in the history of territorial expansion of Vietnam into the Mekong delta. One is his heroic contribution to the $Nguy{\tilde{\hat{e}}}n$ family gaining control over the large part of the Mekong delta. The other is his role to make the eyes of readers of Vietnamese history be fixed only to the present territory of Vietnam. To the readers, $Nguy{\tilde{\hat{e}}}n$ Cư Trinh's achievement of territorial expansion was the final stage of the nam $ti{\acute{\hat{e}}n$ of Vietnam. In fact, however, his achievement was partial. This study pays attention to the King $V{\tilde{o}}$ instead of $Nguy{\tilde{\hat{e}}}n$ Cư Trinh in the history of the territorial expansion in the Mekong delta. King's goal was more ambitious. And the ambition was propelled by his dream to build a new world, and its order, in which his new capital, $Ph{\acute{u}}$ $Xu{\hat{a}}n$ was to be the center with his status as an emperor. To improve my assertion, three elements were examined in this article. First is the nature of $V{\tilde{o}}$ Vương's new kingship. Second is the preparation and the background of the military operation in the Mekong Delta. The nature of the new territory is the third element of the discussion. In 1744, six years after this ascending to the throne, $V{\tilde{o}}$ Vương declared he was a king. Author points out this event as the departure of the southern kingdom from the traditional dynasties based on the Red River delta. Besides, the government system, northern custom and way of dressings were abandoned and new southern modes were adopted. $V{\tilde{o}}$ Vương had enough tributary kingdoms such as Cambodia, Champa, Thủy $X{\tilde{a}}$, Hoả $X{\tilde{a}}$, Vạn Tượng, and Nam Chưởng. Compared with the $L{\hat{e}}$ empire, the number of the tributary kingdoms was higher and the number was equivalent to that of the Đại Nam empire of the 19th century. In reality, author claims, the King $V{\tilde{o}}^{\prime}s$ real intention was to become an emperor. Though he failed in using the title of emperor, he distinguished himself by claiming himself as the Heaven King, $Thi{\hat{e}}n$ Vương. Cambodian king's attack on the thousands of Cham ethnics in Cambodian territory was an enough reason to the King $V{\tilde{o}}^{\prime}s$ military intervention. He considered these Cham men and women as his amicable subjects, and he saw them a branch of the Cham communities in his realm. He declared war against Cambodia in 1750. At the same time he sent a lengthy letter to the Siamese king claiming that the Cambodia was his exclusive tributary kingdom. Before he launched a fatal strike on the Mekong delta which had been the southern part of Cambodia, $V{\tilde{o}}$ Vương renovated his capital $Ph{\acute{u}}$ $Xu{\hat{a}}n$ to the level of the new center of power equivalent to that of empire for his sake. Inflation, famine, economic distortion were also the features of this time. But this study pays attention more to the active policy of the King $V{\tilde{o}}$ as an empire builder than to the economic situation that has been told as the main reason for King $V{\tilde{o}}^{\prime}s$ annexation of the large part of the Mekong delta. From the year of 1754, by the initiative of $Nguy{\tilde{\hat{e}}}n$ Cư Trinh, almost whole region of the Mekong delta within the current border line was incorporated into the territory of $V{\tilde{o}}$ Vương within three years, though the intention of the king was to extend his land to the right side of the Mekong Basin beyond the current border such as Kampong Cham, Prey Vieng, and Svai Rieng. The main reason was $V{\tilde{o}}$ Vương's need to expand his territory to be matched with that of his potential empire with the large number of the tributary kingdoms. King $V{\tilde{o}}^{\prime}s$ strategy was the variation of 'silkworm nibbling' and 'to strike barbarians by barbarians.' He ate the land of Lower Cambodia, the region of the Mekong delta step by step as silkworm nibbles mulberry leave(general meaning of $t{\acute{a}}m$ thực), but his final goal was to eat all(another meaning of $t{\acute{a}}m$ thực) the part of the Mekong delta including the three provinces of Cambodia mentioned above. He used Cham to strike Cambodian in the process of getting land from Long An area to $Ch{\hat{a}}u$ Đốc. This is a faithful application of the Dĩ Man $C{\hat{o}}ng$ Man (to strike barbarians by barbarians). In addition he used Chinese refugees led by the Mạc family or their quasi kingdom to gain land in the region of $H{\grave{a}}$ $Ti{\hat{e}}n$ and its environs from the hand of Cambodian king. This is another application of Dĩ Man $C{\hat{o}}ng$ Man. In sum, author claims a new way of looking at the origin of the imperial world order which emerged during the first half of the 19th century. It was not the result of the long history of Đại Việt empires based on the Red River delta, but the succession of the King $V{\tilde{o}}^{\prime}s$ new world based on $Ph{\acute{u}}$ $Xu{\hat{a}}n$. The same ways of Dĩ Man $C{\hat{o}}ng$ Man and $T{\acute{a}}m$ Thực Chi $K{\acute{\hat{e}}}$ were still used by $V{\tilde{o}}^{\prime}s$ descendents. His grandson Gia Long used man such as Thai, Khmer, Lao, Chinese, and European to win another man the '$T{\hat{a}}y$ Sơn bandits' that included many of Chinese pirates, Cham, and other mountain peoples. His great grand son Minh Mạng constructed a splendid empire. At the same time, however, Minh Mạng kept expanding the size of his empire by eating all the part of Cambodia and Cham territories.