• Journal of the Daesoon Academy of Sciences
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• v.25_1
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• pp.121-155
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• 2015

The purpose of this article is to study on the comparative relationship between mutual cooperation of the Dae-soon thought of Dae-soon jinrihoe and Shinnyo thought of Shinjo Ito. Dae-soon thought focuses on outspreading virtues and enlightenment teaching based on the saying of Jeong-san Sang Jae's Mutual cooperation without any grudge. According to the Buddha's nature thought of Shinjo Ito, 'Dharma kāya resident' is the source of touching upon buddhahood. The Shinyo-en is an outward manifestation of their deep resolve to help others by cultivating spiritual faculty and mind session. First, we can find the virtue action theory in the mutual cooperation of Dae-soon thought and the virtue nature theory in the Shinnyo thought of Shinjo Ito. From the perspective of comparative relationship, it was Jeong-san Sang Jae who laid foundation for the Posterior Grand Renewal. His idea is that the universe should be completed through the mutual communication between the earth and men following the Posterior Grand Renewal. It was Kyodoin-sama who laid the foundation for identifying the place Shinchoji was established. It was at the time that the power we call bakku-daiju as transversality and Shinnyo spiritual faculty were perfected through Shindoin-sama's passing. Second, based on Jeon-kyungn or Dae-soon Ji Chim, outspreading virtue is to awaken mutual cooperation without any grudge and the enlightenment teaching to practice according to mutual cooperation principle without any deceit toward one's own self. No deceit toward one's own self is to be sincere, to be respectful and to be faithful in Jeong-san Sang Jae. In the different context of Mahayana Buddhism, we can be aware that the immortal resident immortal of Dharma kāya is the source of permanent bliss in the Mahāyāna Mahāparinirvāṇa Sūtra' From the perspective of comparative relationship to pray toward Jeong-san Sang Jae and to participate in the Posterior Grand Renewal is to take part in Cheonji-Gongsa. It is a similar phenomena to be reflected suchness reality before the three personifications of buddhahood and the Shinnyo Stupa is the same meaning as meeting the ever present Buddha. Both of them, they focus to find religious altruism from real possibilities of mutual support. They argue that to dispense with altruism is to dispense with Sang Jae or Dharma for the divine transformation of human possibilities Third, Everybody possesses unique and wonderful abilities to be unified with Jeong-san Sang Jae. If we seek happiness by trying to get by without making much of an effort to take part in CheonjiGongsa, it will be difficult to attain the harmony and peace of mankind with outspreading virtues and enlightenment teaching. In the 'Mahāyāna Mahāparinirvāṇa Sūtra' tells us 'all sentient beings have Buddha nature' that could be the possibility to the fulfillment of buddhahood in the spiritual practice. From the comparative relationship, we can strive with open hearts and minds, in efforts that benefit others, and in ways we can work together to build a word of joy in which everyone can have an opportunity to cultivate spiritual faculty. This is based on mutually beneficial voluntary focused our principles into practice the spirit to build a mind session of Shinnyo as the civic clean precepts of 'Mahāyāna Mahāparinirvāṇa Sūtra'. Fourth, the disciples of Jeong-san Sang Jae are encouraged to acquire the Mutual cooperation manner of being considerate. It is important to accumulate virtue action by daily effort. It is the contrast to awaken virtue nature by daily practice. The Buddha's nature thought of Shinjo Ito is based on the thought of Mahāyāna Mahāparinirvāṇa Sūtra. It can be supported by the Shinnyo parents and the two Dojis to build a world of joy as the light dharma descending and the emphasis of Tathatā spiritual faculty. It's not that we can't do something we haven't attained a higher spiritual level. What counts is our continuos effort, act so we can cultivate our spiritual faculty through the way of mind session.

• The Journal of KAIRB
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• v.2 no.2
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• pp.37-48
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• 2020

Purpose: The purpose of this study is to assess the operational status and level of understanding among IRB and HRPP staffs at a hospital or a research institute to the HRPP guideline set by the Ministry of Food and Drug Safety (MFDS) and to provide recommendations. Methods: Online survey was distributed among members of Korean Association of IRB (KAIRB) through each IRB office. The result was separated according to topic and descriptive statistics was used for analysis. Result: Survey notification was sent out to 176 institutions and 65 (37.1%) institutions answered the survey by online. Of 65 institutions that answered the survey; 83.1% was hospital, 12.3% was university, 3.1% was medical college, 1.5% was research institution. 23 institutions (25.4%) established independent HRPP offices and 39 institutions (60.0%) did not. 12 institutions (18.5%) had separate IRB and HRPP heads, 21 (32.3%) institutions separated business reporting procedure and person in charge, 12 institutions separated the responsibility of IRB and HRPP among staff, and 45 institutions (69.2%) had audit & non-compliance managers. When asked about the most important basic task for HRPP, 23% answered self-audit. And according to 43.52%, self-audit was also the most by both institutions that operated HRPP and institutions that did not. When basic task performance status was analyzed, on average, the institutions that operated HRPP was 14% higher than institutions that only operated IRB. 9 (13.8%) institutions were evaluated and obtained HRPP accreditation from MFDS and the most common reason for obtaining the accreditation was to be selected as Institution for the education of persons conducting clinical trial (6 institutions). The most common reason for not obtaining HRPP accreditation was because of insufficient staff and limited capacity of the institution (28%). Institutions with and without a plan to be HRPP accredited by MFDS were 20 (37.7%) each. 34 institutions (52.3%) answered HRPP evaluation method and accreditation by MFDS was appropriate while 31 institutions (47.7%) answered otherwise. 36 institutions answered that HRPP evaluation and accreditation by MFDS was credible while 29 institutions (44.5%) answered that HRPP evaluation method and accreditation by MFDS was not credible. Conclusion: 1. MFDS's HRPP accreditation program can facilitate the main objective of HRPP and MFDS's HRPP accreditation program should be encouraged to non-tertiary hospitals by taking small staff size into consideration and issuing accreditation by segregating accreditation. 2. While issuing Institution for the education of persons conducting clinical trial status as a benefit of MFDS's HRPP accreditation program, it can also hinder access to MFDS's HRPP accreditation program. It should also be considered that the non-contact culture during COVID-19 pandemic eliminated time and space limitation for education. 3. For clinical research conducted internally by an institution, internal audit is the most effective and sole method of protecting safety and right of the test subjects and integrity for research in Korea. For this reason, regardless of the size of the institution, an internal audit should be enforced. 4. It is necessary for KAIRB and MFDSto improve HRPP awareness by advocating and educating the concept and necessity of HRPP in clinical research. 5. A new HRPP accreditation system should be setup for all clinical research with human subjects, including Investigational New Drug (IND) application in near future.

• Journal of the Korea Knowledge Information Technology Society
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• v.13 no.1
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• pp.11-23
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• 2018

This paper empirically investigates the factors that influence the consumer choice of an app market based on the rational choice theory. The app market is the only channel where a consumer can buy smartphone apps, which give various functional convenience and are considered to be a major contributor to the proliferation of smartphones. Analyses of 281 questionnaires show that usability and structural guarantees as benefit factors significantly influence the app market choice. From the cost perspectives, both monetary and non-monetary conversion costs are found to significantly influence the app market choice. On the other hand, customer trust, information quality, and market image were found to have no significant effect on app market selection. In particular, Korean app market platform providers (KT, LG U +) seem to be superior in terms of structural guarantees, such as customer center operation and damage compensation regulations, compared to overseas app market platform operators (Google). However, in the case of the Google App Market, it is pre-installed on all Android phones, so it is not inconvenient to install additional apps to use other app market. This is disadvantageous to domestic app market platform operators, and it is necessary to establish a policy solution point. In terms of operator costs, both monetary and non-monetary conversion costs have a significant impact on app market choice. In particular, non-monetary conversion costs have a negative impact on Korean app market platform operators. It can be explained that the service expectation level of the domestic app market is low and it is recognized that the time cost factor such as membership is large for new users to use. It seems to be necessary to improve the domestic app market business. Meanwhile, extant research on smartphone apps focuses on the purchase of apps themselves, but not on the selection of the app market itself. In order to fill in this gap, this study focuses on the determinants of app market selection, including the characteristics of an app market and the switching costs.

• Journal of Practical Agriculture & Fisheries Research
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• v.25 no.4
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• pp.118-126
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• 2024

Recently, the alternative meat (food) market is growing rapidly due to the increase in meat consumption due to global population growth and income improvement, as well as issues such as equal welfare, carbon neutrality, and sustainability. The government is also developing a green bio convergence new industry development plan to foster alternative foods, but there are difficulties in commercialization due to the lack of technology and insufficient production facilities among domestic small and medium-sized enterprises, so it is necessary to build joint utilization facilities and equipment to resolve the difficulties faced by companies. am. In addition, small and medium-sized enterprises are having difficulty developing and commercializing plant-based meat substitutes due to a lack of technical skills, and related equipment is expensive, making it difficult to build equipment on their own. Accordingly, Jeollabuk-do is pursuing a strategy to secure the source technology for development, processing, and industrialization of plant-based substitute meat at the level of developed countries by establishing a plant-based alternative meat industrialization center. In this study, an economic feasibility analysis study was conducted when a plant-based alternative meat industrialization center is built in Jeollabuk-do. As a result of the analysis, B/C=1.32, NPV=374 million won, and IRR=4.8%, showing that there is economic feasibility in establishing an alternative meat industrialization center. In addition, as a result of analyzing the regional economic ripple effect resulting from the establishment of an industrialization center, if 38 billion won is invested in Jeollabuk-do, the nationwide production inducement effect is 74 billion won, the added value inducement effect is 29.8 billion won, and the employment inducement effect is 672 people

• Journal of Global Scholars of Marketing Science
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• v.17 no.4
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• pp.247-269
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• 2007

In recent years, one of the major reasons for the fierce competition amongst firms is that they strive to increase their own market shares and customer acquisition rate in the same market with similar and apparently undifferentiated products in terms of quality and perceived benefit. Because of this change in recent marketing environment, the differentiated after-sales service and diversified promotion strategies have become more important to gain competitive advantage. Price promotion is the favorite strategy that most retailers use to achieve short-term sales increase, induce consumer's brand switch, in troduce new product into market, and so forth. However, if marketers apply or copy an identical price promotion strategy without considering the characteristic differences in product and consumer preference, it will cause serious problems because discounted price itself could make people skeptical about product quality, and the changes of perceived value might appear differently depending on other factors such as consumer involvement or brand attitude. Previous studies showed that price promotion would certainly increase sales, and the discounted price compared to regular price would enhance the consumer's perceived values. On the other hand, discounted price itself could make people depreciate or skeptical about product quality, and reduce the consumers' positivity bias because consumers might be unsure whether the current price promotion is the retailer's best price offer. Moreover, we cannot say that discounted price absolutely enhances the consumer's perceived values regardless of product category and purchase situations. That is, the factors that affect consumers' value perceptions and buying behavior are so diverse in reality that the results of studies on the same dependent variable come out differently depending on what variable was used or how experiment conditions were designed. Majority of previous researches on the effect of price-comparison advertising have used consumers' buying behavior as dependent variable. In order to figure out consumers' buying behavior theoretically, analysis of value perceptions which influence buying intentions is needed. In addition, they did not combined the independent variables such as brand loyalty and price discount rate together. For this reason, this paper tried to examine the moderating effect of brand loyalty on relationship between the different levels of discounting rate and buyers' value perception. And we provided with theoretical and managerial implications that marketers need to consider such variables as product attributes, brand loyalty, and consumer involvement at the same time, and then establish a differentiated pricing strategy case by case in order to enhance consumer's perceived values properl. Three research concepts were used in our study and each concept based on past researches was defined. The perceived acquisition value in this study was defined as the perceived net gains associated with the products or services acquired. That is, the perceived acquisition value of the product will be positively influenced by the benefits buyers believe they are getting by acquiring and using the product, and negatively influenced by the money given up to acquire the product. And the perceived transaction value was defined as the perception of psychological satisfaction or pleasure obtained from taking advantage of the financial terms of the price deal. Lastly, the brand loyalty was defined as favorable attitude towards a purchased product. Thus, a consumer loyal to a brand has an emotional attachment to the brand or firm. Repeat purchasers continue to buy the same brand even though they do not have an emotional attachment to it. We assumed that if the degree of brand loyalty is high, the perceived acquisition value and the perceived transaction value will increase when higher discount rate is provided. But we found that there are no significant differences in values between two different discount rates as a result of empirical analysis. It means that price reduction did not affect consumer's brand choice significantly because the perceived sacrifice decreased only a little, and customers are satisfied with product's benefits when brand loyalty is high. From the result, we confirmed that consumers with high degree of brand loyalty to a specific product are less sensitive to price change. Thus, using price promotion strategy to merely expect sale increase is not recommendable. Instead of discounting price, marketers need to strengthen consumers' brand loyalty and maintain the skimming strategy. On the contrary, when the degree of brand loyalty is low, the perceived acquisition value and the perceived transaction value decreased significantly when higher discount rate is provided. Generally brands that are considered inferior might be able to draw attention away from the quality of the product by making consumers focus more on the sacrifice component of price. But considering the fact that consumers with low degree of brand loyalty are known to be unsatisfied with product's benefits and have relatively negative brand attitude, bigger price reduction offered in experiment condition of this paper made consumers depreciate product's quality and benefit more and more, and consumer's psychological perceived sacrifice increased while perceived values decreased accordingly. We infer that, in the case of inferior brand, a drastic price-cut or frequent price promotion may increase consumers' uncertainty about overall components of product. Therefore, it appears that reinforcing the augmented product such as after-sale service, delivery and giving credit which is one of the levels consisting of product would be more effective in reality. This will be better rather than competing with product that holds high brand loyalty by reducing sale price. Although this study tried to examine the moderating effect of brand loyalty on relationship between the different levels of discounting rate and buyers' value perception, there are several limitations. This study was conducted in controlled conditions where the high involvement product and two different levels of discount rate were applied. Given the presence of low involvement product, when both pieces of information are available, it is likely that the results we have reported here may have been different. Thus, this research results explain only the specific situation. Second, the sample selected in this study was university students in their twenties, so we cannot say that the results are firmly effective to all generations. Future research that manipulates the level of discount along with the consumer involvement might lead to a more robust understanding of the effects various discount rate. And, we used a cellular phone as a product stimulus, so it would be very interesting to analyze the result when the product stimulus is an intangible product such as service. It could be also valuable to analyze whether the change of perceived value affects consumers' final buying behavior positively or negatively.

• The Korean Journal of Air & Space Law and Policy
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• v.35 no.2
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• pp.313-374
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• 2020

The idea of creating a new International Space Agency (ISA) is only my academic and practical opinion. It is necessary for us to establish ISA as an international organization for the efficient and rapid exploitation of natural resources in the moon, Mars and other celestial bodies. The establishment of ISA as a new international regime is based on the Article 11, 5 and Article 18 of the 1979 Moon Agreement. In order to establish as a preliminary procedure, it needs to make a "Draft for the Convention on the Establishment of an International Space Agency" among the space-faring countries. In this paper, I was examined the domestic space legislation in the United States, Luxembourg, European Space Agency, China, Japan, the Republic of Korea as well as space exploration and planning of the moons, Mars, Asteroids, Venus, Jupiter, Saturn, Titan and Other Celestial Bodies. The creation of an ISA would lead to a strengthening of the cooperation needed essentially by the developed countries towards joint and cooperative undertakings in space and would act as a catalyst for the space exploration and exploitation of the moon, Mars and other celestial bodies. It will be managed effectively and centrally the exploitation and exploitation of space the natural resources, technology, manpower and finances as an independent organization in order to get the benefit of the space developed countries by ISA. It is desirable and necessary for us to establish ISA in order to promote cooperation in space policy, law, science technology and industry among the space developed countries in the near future. The establishment of the ISA will be promoted the international cooperation among the space-faring countries in exploration and exploitations of the natural resources in the moon and other celestial bodies. I would propose the "Draft for the Convention for the Establishment of an International Space Agency." in refering the "Convention for the Establishment of a European Space Agency." This "Draft for the Convention Convention for the Establishment of an ISA" must pass the abovementioned "Draft for the Convention" by two-third majority of Diplomatic Conference in the UNCOPUOS. Finally, a very important point is need that a political drive at the highest level and a solemn statement by heads of state of the space devloped countries including the United Nations for the space exploitation of the medium and long term. It should be noted that this political drive will be necessary not only to set up the organization, but also during a subsequent period. It is desirable and necessary for us to establish the ISA in order to develop the space industry, to strengthen friendly relations and to promote research cooperation among the space-faring countries based on the new ideology and creative ideas. If the heads of the superpowers including the United Nations will be agreed to establish ISA at a summit conference, 1 am sure that it is possible to establish an ISA in the near future.

• Tuberculosis and Respiratory Diseases
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• v.40 no.1
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• pp.6-15
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• 1993

Background: Positive end, expiratory pressure (PEEP) has become one of the standard therapies for adult respiratory distress syndrome (ARDS). Total static compliance has been proposed as a guide to determine the size of PEEP ('best PEEP') which is of unproven clinical benefit and remains controversial. Besides increasing functional residual capacity and thus improving oxygenation, PEEP stimulate prostacyclin secretion and was proposed for the treatment of acute pulmonary embolism. But little is known about the effect of PEEP on hemodynamic and gas exchange disturbances in acute pulmonary embolism. Methods: To study the validity of total static compliance as a predictor of 'best PEEP' in ARDS and acute pulmonary embolism, experimental ARDS was induced in mongrel dog with oleic acid and acute pulmonary embolism with autologous blood clot. Then hemodynamic and gas exchange parameters were measured with serial increment of PEEP. Results:In ARDS group, total static compliance and oxygen transport were maximal at 5 cm$H_2O$, and decreased thereafter (p<0.05). With increment of PEEP, arterial oxygen tension ($PaO_2$) and arterial carbon dioxide tension ($PaCO_2$) increased and cardiac output and physiological shunt decreased. In pulmonary embolism group, total static compliance, oxygen transport, physiological shunt and cardiac output decreased and $PaO_2$ and $PaCO_2$ increased with increment of PEEP (p<0.05). Comparing the change induced by increment of PEEP by 1 cm$H_2O$ in ARDS group with that in pulmonary embolism group, there was no significant difference between two groups except cardiac output which decreased more in pulmonary embolism group (p<0.05). In ARDS group, oxygen transport and total static compliance increased after PEEP application, and total static compliance was maximal at the PEEP level where oxygen transport was maximal. However in pulmonary embolism group, oxygen transport and total static compliance decreased after application of PEEP. There was significant correlation between change of total static compliance and change of oxygen transport in both groups. Conclusion: In both ARDS and acute pulmonary embolism, it can be concluded that total static compliance is useful as a predictor of 'best PEEP'.

• Horticultural Science & Technology
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• v.30 no.5
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• pp.534-542
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• 2012

This study was conducted to investigate the effect of 1-methylcyclopropene (1-MCP) on fruit quality and incidence of physiological disorders for keeping freshness during marketing period in Asian pear (Pyrus pyrifolia Nakai) 'Wonhwang' and 'Whasan'. Fruits were treated with $1{\mu}L{\cdot}L^{-1}$ 1-MCP for 12 hours at $25^{\circ}C$, at two or three stages of ripeness as determined by days after full bloom (DAFB). Fruits were harvested at 130 and 140 DAFB in early season cultivar 'Wonhwang' and 135, 145, and 150 DAFB in mid-season cultivar 'Whasan', respectively. Fruits were stored at $25^{\circ}C$ for 21 days and measured the flesh firmness, weight loss, soluble solids, acidity, ethylene, respiration and severity of physiological disorders at week interval. 1-MCP treatment to 'Wonhwang' pears harvested at 130 and 140 DAFB effectively delayed firmness loss during storage at $25^{\circ}C$. Untreated fruits of 'Wonhwang' pears harvested at 130 DAFB showed 32.3 and 10.1N of firmness after 14 and 21 days of shelf-life at $25^{\circ}C$, respectively, while those of the 1-MCP treated fruits showed 39.4 and 33.1N during same period. In the fruits harvested at 140 DAFB, the firmness of untreated fruit was lowered to 14.8 and 6.6N after 14 and 21 days, respectively, but those of 1-MCP treated fruit were 35.0 and 33.3N, respectively. Whereas, 1-MCP treatment delayed firmness loss only in the fruit harvested late (150 DAFB) in 'Whasan' pears. Higher soluble solids content and acidity during extended shelf-life were apparent in 1-MCP treated 'Wonhwang' pears, while those of 'Whasan' pears were little changed. 'Wonhwang' pears showed a relatively high ethylene production (maximum $0.58{\mu}l{\cdot}L^{-1}$) in the fruits harvested late than early harvested one. 'Whasan' pears showed little amount of ethylene production regardless of extended shelf-life. 1-MCP treatment to 'Wonhwang' pears decreased respiration rate following shelf-life, 42 and 50% reduction were observed at 14 days of shelf-life when compared with those of untreated ones harvested at 130 and 140 DAFB, respectively. No reduction of respiration rate by the treatment of 1-MCP was detected in 'Whasan' pears which showed considerably low respiration rate compared with 'Wonhwang' pears. Harvest time influenced the level of physiological disorders together with extension of shelf-life in both the cultivars. 1-MCP treatment completely blocked the incidence of internal browning of 'Wonhwang' pears harvested at 130 DAFB, and reduced the incidences of pithiness and core browning, while it promoted the flesh spot decay disorder regardless of harvest time. 1-MCP treatment was of little benefit for the prevention of physiological disorders in 'Whasan' pears compared with those of 'Wonhwang'.

• Journal of Distribution Research
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• v.17 no.3
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• pp.1-24
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• 2012

Franchises have recently emerged as the most rapidly expanding industry positioned to create a large impact in the domestic economic. The Chinese franchise industry developed rapidly in the period prior and subsequent to WTO accession with more than 50% of new franchises brands emerging since 2000. M&A transactions in the Chinese franchise industry have progressed actively. In the period from 2005-2007, due to the wholesale and retail market opening in accordance with the guidelines laid forth within the MOU by the WTO the Chinese franchise market is now the largest market in the world all despite a short history of only 20 years. The amount of franchise market research on China is disproportional to its current size and development potential. Beginning in the 1990s, market research conducted by the International Franchise Association focused on emerging markets in Eastern Europe and China. While the research dealt with the Chinese investment environment, it insufficiently explained the market region and cultural environment. The purpose of this research is (i) to investigate the determinants of the performance of franchise systems in China and (ii) new contract renewals based on performance factors. This study will complement existing research in terms of the franchisee perspective. This study may also prove of the benefit to the franchise companies entering the Chinese franchise market enabling them to develop an effective strategy. This study shows that support, incentives, and system standardization by franchisor yielded a positive effect on management performance. This is consistent with previous studies by Shin (2000) and Kim (2008) targeting Korean franchises. Therefore, in the Chinese market, the franchisor must focus on support, incentives, and system standardization rather than concentrate only on the recruitment of franchisees in order to improve revenue. Hypotheses regarding franchisor control have been dismissed in existing research, in the opinion of this study, due to their complexity and inability to control the merchant as a one-kind-assessment-standard. Our findings show that the franchisees' financial condition, management ability and entrepreneurial spirit, among franchisee's characteristics, have a positive effect on franchisor's business performance and satisfaction for the franchisee. This is consistent with previous studies on headquarters' management performance of Lussier (1996), Heo and Jang (2008), and franchisees' financial condition, management ability and entrepreneurial spirit effect on franchisor's satisfaction of Weaven and Franzer (2007), Kim (2009), Han (2009), and Yoon etc. (2008). Therefore, when permitting a franchisee, financial condition, management ability, entrepreneurship of the franchisee should be carefully considered. Among relational factors between franchisor and franchisee, trust has the positive influence on the management performance of the franchisor while conflict has a negative effect. However, trust, commitment and conflict factors have been shown not to have any impact on the satisfaction of the franchise headquarters. This result is consistent with the previous studies of Pavlou and Ba (2000), Morrison (1999), Weaven and Frazer (2007), Kim and Park (1994), Sohn (2007) which show that trust between franchisor and the franchisees have a positive effect and that conflict has a negative impact on franchisor's management performance. Other factors causing a negative effective on the franchisor's management performance are a rapid environmental changes and uncertainty in the business. This is consistent with Campbell et al (2007), Kim and Kim (2009), Han and Baek (2008). Finally, the high management performance and satisfaction of the franchise headquarters has a positive effect on the intention of franchise renewal. In the case of large markets such as China, the franchisor's strategy and the role is very important. In this study, we also investigated the characteristics of franchisor and franchisee, relationship, and environmental uncertainty affecting on the management performance and satisfaction of franchisor. Recently, Korean franchises are attempting to enter foreign markets through the rise in popularity of Korean culture and entertainment commonly referred to as the Korean wave. This study provides recommendations for Korean franchises intending on entering the Chinese market. First, in order to achieve stable profits, the franchise corporation needs to support the operation of the individual franchisee through incentives and standardization of services. Second, because trust between the franchisor and franchisee has a positive effect on management performance, on-going discussion and cooperation is necessary to reduce the level of conflict.

• 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.