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Risk Factors and Preoperative Risk Scoring System for Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

  • Kim, Joo Hyun;Kim, Jae Hoon;Kang, Hee In;Kim, Deok Ryeong;Moon, Byung Gwan;Kim, Joo Seung
    • Journal of Korean Neurosurgical Society
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    • v.62 no.6
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    • pp.643-648
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    • 2019
  • Objective : Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration. Methods : We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge. Results : In the multivariate analysis, acute HCP (bicaudate index of ${\geq}0.2$) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843-16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044-16.169; p=0.043), and an age of ${\geq}50years$ (OR, 3.938; 95% CI, 1.375-11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0-3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750-0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847-0.943). Conclusion : Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.

Usefulness of the SAFARI score for predicting convulsive seizure in patients with aneurysmal subarachnoid hemorrhage (비외상성 동맥류성지주막하출혈 환자에서 SAFARI 점수를 이용한 경련 발생 예측의 유용성)

  • Baik, Seung Jun;Hong, Dae Young;Kim, Sin Young;Kim, Jong Won;Park, Sang O;Lee, Kyeong Ryong;Baek, Kwang Je
    • Journal of The Korean Society of Emergency Medicine
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    • v.29 no.5
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    • pp.449-454
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    • 2018
  • Objective: The SAFARI score was introduced to assess the risk of convulsive seizure during admission for aneurysmal subarachnoid hemorrhage in 2017. This study was conducted to determine whether the SAFARI score derived from the afore-mentioned study could be applied to patients with aneurysmal subarachnoid hemorrhage in Korea. Methods: We conducted a retrospective study of patients who were diagnosed with aneurysmal subarachnoid hemorrhage from March 2013 to October 2017. Patients' age, sex, blood pressure, pulse rate, body temperature, Glasgow-Coma Scale, Hunt-Hess scale, modified Fisher grade, size of ruptured aneurysm, surgery type, transfusion, and SAFARI score were compared between the seizure and non-seizure groups. The area under the receiver operator characteristic curves was calculated to evaluate the predictive ability for seizure during admission. Logistic regression analysis was used to analyze predictive factors for seizure during admission. Results: A total of 220 patients were included. Ninety-seven (44.1%) were male and 123 (55.9%) were female. The mean age of the patients was 65.8 years old (range, 56-75). The area under the curve of the SAFARI score for predicting seizure was 0.813. The SAFARI score was the only significant predictor of seizure during admission, while other factors were not statistically significant upon logistic regression analysis. Conclusion: The SAFARI score could be used for predicting seizure during admission in patients with aneurysmal subarachnoid hemorrhage.

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

  • Kang, Jongsoo;Kang, Chul-Hoo;Roh, Jieun;Yeom, Jeong A;Shim, Dong-Hyun;Kim, Young Soo;Lee, Sang Won;Kim, Young-Soo;Park, Kee Hong;Kim, Chang-Hun;Kim, Soo-Kyoung;Choi, Nack-Cheon;Kwon, Oh-Young;Kang, Heeyoung;Baik, Seung Kug
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.93-101
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    • 2018
  • Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

A Study on the Development of Board Games in 'Nonsan, Finding Lost Treasure' ('논산, 잃어버린 보물을 찾아서' 보드게임 개발 연구)

  • Lim, Ji-Won;Hwang Bo, Hyung-Ho;Lee, Gi-Yeon;Song, A-Reum;Kim, Kyu-Rim;Kim, Byung-Kuk
    • Journal of Korea Entertainment Industry Association
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    • v.15 no.8
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    • pp.457-464
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    • 2021
  • This study is a study on the development of board games using local cultural contents. As a prior study related to this study, basic research on board game development, research on cultural products based on cultural heritage, and storytelling development research using local cultural and tourism resources were considered. Among them, for the main purpose of board games and development process, discussions were conducted on the research methodology of Lee Dae-woong and Oh Seung-taek (2004). As a result, it was possible to successfully proceed with planning meetings, proposal preparation, board game design, board game 3D graphic production process, and prototype development. What is peculiar is that characters (dried persimmons, strawberries, jujube, and salted seafood) containing Nonsan's unique regional characteristics were searched and utilized. In addition, major cultural heritages such as Donamseowon Confucian Academy and Gwanchoksa Temple, designated as Nonsan-si cultural properties, were combined with important treasure hunt contents of board games to enhance interest and education at the same time. The theme of this paper, Nonsan, Finding Lost Treasure, is a new educational alternative that can solve the problems of computer games, and has the advantage of having the nature of community leisure play, not individual play. Based on this board game development research in the future, we intend to expect the results of game production using cultural elements from other regions.

Development of computer program for the Growth Function in plant Growth Analysis: Effect of Seed Weight and Resources on Growth of Wild Radish (Raphanus raphanistrum) (植物의 成長과 成長解析에 對한 Computer Program 開發에 關한 硏究 - 種子의 무게, 資源이 植物의 成長에 미치는 影響)

  • Choe, Hyun Sup
    • The Korean Journal of Ecology
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    • v.13 no.3
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    • pp.225-236
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    • 1990
  • We studied that seeds of wild radish with different size of weight can be obtained for the purpose of differentiation and growth of these seeds by total growth periods. This study is practised a view of plant eco-physiological side and dry-matter production. Through whole growth periods, we knowthat seed weight of L plots was higher than that of M and S plots. In the 33th day after day after germination, growth values of L, M and S plots were 13.93, 7.77, and 4.61 g/plant, respectively. Growth of shoot (cotyledon and leaf) area and shoot weight were shown the similar trends with individual plant dry-amtter weight. In the 33th day after germination, shoot area of L, M and S plots were 21.55, 11.81 and 8.75 $cm^3$/plant and shoot dry weight of L, M and S plots were 10.83, 6.03, 3.50 g/plant, respectively. In the early stage of growth (the 10-14th day after germination), the values of RGR of seed weight of L, M, S plots were 0.2887, 0.2807 and 0.2365 g/g/day, in the late stage of growth, those values of RGR of L, M, S plote were 0.2721, 0.1716, 0.1727 g/g/day, respectively. In the early stage of growth (the 14th day after germination), the values of NAR or L, M and S plots were 0.1513, 0.1373, and 0.1094 g/$cm^2$/day, respectively. It is thought that seed weights were influenced seriously effect in the early stage of growth. The NAR value, in the late stage of growth (the-28-33th day after germination), of L, M and S plots were not large different as 0.1086, 0.1097 and 0.112 g/$cm^2$/day, respectively. The LAR values of M and S (2.0396, 2.1520 $m^2$/g) plots, in the early stage of growth, were higher than L (1.9037 $m^2$/g) plots. In the late stage of growth, the value of LAR of L plots were nearly same as M plots, but the value of S plots were higher than that of L and M plots (0.0458 $m^2$/g). And, in the early stage of growth, the values of SLA of L, M and S plots were 2.2123, 2.2107 and 2.8448 $m^2$/g, respectively. We measured the photosynthetic rates and the respiratory rates as the physiological characteristics of wild radish. In the early stage of growth, the photosynthetic rates of L, M and S plots were 12.4, 14.4, 9.8 $\mu$mol /$m^2$/sec and 9.4, 11.4, 9.8 $\mu$mol/$m^2$ /sec in the late stage of growth, respectively. In this result, it could be informed that photosynthetic rates in the late stage of growth were lower than the early stage. In the middle stage of growth, the respiratory rates were 0.793, $\mu$mol/$m^2$/min in shoot, and 3.28 $\mu$mol/$m^2$/min in root without relation to seed weight. The growth analysis of plants was used by Hunt & Parson s computer program (1974, 1981) and its results used this program were good. Therefore, in this sense, it could be expected that the computer program used and developed largely in researches of plant growth.

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Ecological Characteristics of Termite(Reticulitermes speratus kyushuensis) for Preservation of Wooden Cultural Heritage (목조문화재의 보존을 위한 한국산 흰개미의 생태적 특성 연구)

  • Lee, Kyu-Shik;Jeong, So-Young
    • Korean Journal of Heritage: History & Science
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    • v.37
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    • pp.327-348
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    • 2004
  • In this study, after analyzing several local climate characteristics of South Korea, I validated distribution, invasion, foraging, underground activities, attack season as ecological characteristics and also temperature, relative humidity, and tree species as preference characteristics of Korean termites (Reticulitermes speratus kyushuensis Morimoto). Especially, southern part of the Korean peninsula is a suitable area for inhabitation and motion of termites holding same ecological characteristic like R. speratus kyushuensis. Busan is a neighboring district at field distribution north limiting temperature of Coptotermes formosanus Shiraki and Chuncheon is a passing area through the Korean Peninsula of field distribution north limiting temperature of Reticulitermes speratus Kolbe. The termite attack of wood devices was about 34.5% for 3 years in the forest of Jongmyo. Although the attack rate of termite increased each year, the detection rate decreased and the missing rate was high by degrees. I confirmed a foraging habits which is a part of termite colony was a role of continuous decomposition and another was a role of new food hunt as experimental results. The foraging termites were found under ground at Jongmyo in Seoul from April to November in the 2001 and the most active period was on July and August. The termite invasion rate of bait station increased in every monitoring. Through the increasing attack rate of bait station during 2nd monitoring (November, 2000) and 3rd monitoring(March, 2001), I confirmed that termites moved into the deep underground in winter, and were working continuously to forage. R. speratus kyushuensis inhabiting at the Korean Peninsula is a species which has food consumption rate with higher temperature. The termite revealed the greatest amount of food(filter paper) at $30^{\circ}C$(90% RH), but showed increasing death rate at over $32^{\circ}C$. Also, survival rate of this termite was 97% at 84% RH($30^{\circ}C$), but killed 100% at 52% RH($30^{\circ}C$) and 70% RH($30^{\circ}C$). For wood feeding, this was observed the preference in a pine tree(Pinus densiflora) above all others. Survival of termites was high(87%) at a pine tree, but low(13.5%) at a paulownia tree(Paulownia coreana). In this study, I presented the biological characteristic of termite(R. speratus kyushuensis Morimoto) and confirmed the deterioration degree of termite on wooden cultural heritage in Korea. Depending on climate and soil temperature, each area in the southern part of the Korea Peninsula, has some different active period and different distribution of R. speratus kyushensis. With these results, I expect that this report helps to prepare the integrated pest management(IPM) of the termite on wooden cultural heritage in Korea, and it may help to reduce the economical loss from termite damage in Korea.

The Crisis of AIDS and responses of South African Churches in the task of new national building (새로운 민주주의 국가건설의 과제 속에 직면한 AIDS와 이에 대한 교회의 반응과 과제: 남아프리카 공화국을 중심으로)

  • Kim, Dae-Yoong
    • Journal of the Korean Association of African Studies
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    • v.29
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    • pp.27-53
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    • 2009
  • At the start of the new century, South Africa probably had the largest number of HIV-infected people of any country in the world. The only nation that comes close is India with a population of one billion people compared to South Africa's figure of 57 million. The tragedy is that this did not have to happen. South Africa was aware of the dangers posed by AIDS as early as 1985. In 1991, the national survey of women attending antenatal clinics found that only 0.8percent were infected. In 1994, when the new government took power, the figure was still comparatively low at 7.6 %. The 2004 figure which has been published is 26.5%. This article tracks the epidemic globally, in the region and in South Africa. I explain some of the basic concepts around the disease and look at what may happen with respect to numbers. The situation is bad, and the number of people falling ill, dying and leaving families will rise over next few years. This will impact on South Africa in a number of important ways. This article assesses the demographic, economic and social consequences of the epidemic. It disposes of a number of myths and present the real facts. The AIDS in South Africa is not related to individuals only. It warns that AIDS in Africa is becoming a community and systemic problem. The acuteness of the problem does not stem merely from the fact that communities are affected, or could even be wipe out by the end of this decade, but from the fact that AIDS will place incredible burdens and obligations upon medical services, health care and religious communities such as churches. The facts confront churches' mission with the important question: who is going to take care of all the patients and where? The reality is that people dying of AIDS will have to be cared for at home by relatives and friends. A further question that arises is whether our people are prepared for this. AIDS was considered to be a homo-plague and the hunt was on for a scapegoat in the light of the fatal implication of the disease. At present we are in the strategic phase where we all realize that it will be of no avail to scare people with the ominous threat of AIDS AIDS destroys the optimism of our achievement ethics. This exposure of the culture of optimism is also an exposure of the so-called 'human basic fear which accuses Christianity that their concept of sin is a damper on man's search for liberation and basic need to be freed from all Imitation. AIDS is also a test for our ecclesiastical genuineness and the sincerity of our mission sensibility. It poses the question: How unconditional is Christian love? Is there room for the AIDS sufferer in the community of believers, despite the fact he is an acknowledged homosexual? The question to put to the church is whether the community of believers is an exclusive to put to the koinonia which excludes homosexuals. They may be welcome on principle, but in actual fact are not acceptable to the church community. As South Africa enters the new century, it is clear that the epidemic is not having a measurable impact. However, the impact of AIDS is gradual, subtle and incremental. The author's proposal of what is currently most needed in South Africa is that the little things will make a difference. It's about doing lots of little things better at grassroots level, with the emphasis on doing. There are so many community, churches and NGOs initiatives worth building on and intensifying. One must not underestimate the therapeutic value of working together in small groups to overcome a problem

The Determination of Trust in Franchisor-Franchisee Relationships in China (중국 프랜차이즈 시스템에서의 본부와 가맹점간 신뢰의 영향요인)

  • Shin, Geon-Cheol;Ma, Yaokun
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.2
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    • pp.65-88
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    • 2008
  • Since the implementation of economic reforms in 1978, the Chinese economy grows rapidly at an average annul growth rate of 9% over the post two decades. Franchising has been widely recognized as an important source of entrepreneurial activity. Trust is important in that it facilitates relational exchanges by permits partners to transcend short-run inequities or risks to concentrate on long-term profits or gains. In the relationship between the franchisors and franchisees, trust has been described as an important source of competitive advantage. However, little research has been done on the factors affecting trust in Chinese franchisor-franchisee relationships. The purpose of this study is to investigate what factors affect the trust in the franchise system in China, and to provide guidelines and insights to franchisors which enter Chinese market. In this study, according to Morgan and Hunt (1994), trust is defined as the extending when one party has confidence in an exchange partner's reliability and integrity. We offered a conceptual model of the empirical study. The model shows that the factors affecting the trust include franchisor's supports, communication, satisfaction with previous outcome and conflict. We also suggested the franchisor's supports and communication like to enhance the franchisee's satisfaction with previous outcome, and the franchisor's supports, communication and he franchisee's satisfaction with previous outcome tend to decrease conflict. Before the formal study, a pretest involving exploratory interviews with owners from three franchisees was conducted to make sure the questionnaire was relevant and clear to the respondents. The data were collected using trained interviewers to carry out personal interviews with the aid of an unidentified, muti-page, structured questionnaire. The respondents comprised of owners, managers, and owner managers of franchisee-owned food service franchises located in Beijing, China. Even though a total of 256 potential franchises were initially contacted, the finally usable sample consisted of 125 respondents. As expected, the sampling method was successful in soliciting respondents with waried personal and firm characteristics. Self-administrated questionnaires were used for all measures. And established scales were used to measure the latent constructs in this study. The measures tapped the franchisees' perceptions of the relationship with the referent franchisor. Five-point Likert-type scales ranging from "strongly disagree" (=1) to "strongly agree" (=7) were used throughout the constructs (trust, eight items; support, five items; communication, four items; satisfaction, six items; conflict, three items). The reliability measurements traditionally employed, such as the Cronbach's alpha, were used. All the reliabilities were greater than.80. The proposed measurement model was estimated using SPSS 12.0 and AMOS 5.0 analysis package. We conducted A series of exploratory factor analyses and confirmatory factor analyses to assess the convergent validity, discriminant validity, and reliability. The results indicate reasonable overall fits between the model and the observed data. The overall fit of measurement model were $X^2$= 159.699, p=0.004, d.f. = 116, GFI =.879, NFI =.898, CFI =.969, IFI =.970, TLI =.959, RMR =.058. The results demonstrated that the data reasonably fitted the model. We also examined construct reliability and reliability and average variance extracted (AVE). The construct reliability of each construct was greater than.80 and the AVE of each construct was greater than.50. According to the analysis of Structure Equation Modeling (SEM), the results of path model indicated an adequate fit of the model: $X^2$= 142.126, p = 0.044, d.f. = 115, GFI =.892, NFI =.909, CFI =.981, IFI =.981, TLI =.974, RMR =.057. As hypothesized, the results showed that it is strategically important to establish trust in a franchise system, and the franchisor's supports, communication and satisfaction with previous outcome tend to reinforce franchisee's trust. The results also showed trust seems to decrease as the experience of conflict episodes increases. And we also noticed that franchisor's supports and communication tend to enhance the franchisee's satisfaction with previous outcome, and communication tend to decrease conflict. If the trust between the franchisor and franchisee can be established in a franchise system, franchising offers many benefits and reduces many costs. To manage a mutual trust of relationship with their franchisees, franchisor's should provide support effectively to their franchisees. Effective assistant services have direct effect on franchisees' satisfaction with previous outcome and trust in franchisor. Especially, franchise sales process, orientation, and training in the start-up period are key elements for success of the franchise system. Franchisor's support is an accumulated separate satisfaction evaluation with different kind of service provided by the franchisor. And providing support definitely can improve the trustworthy image of the franchisor. In the franchise system, conflicts of interests and exertions of different power sources are very common. The experience of conflict episodes seems to negatively relate to trust. Therefore, it is important to reduce the negative side of the relationship conflicts. Communication actually plays a broader role in reducing conflict and establish mutual trust in franchisor-franchisee relationship. And effective communication between franchisors and franchisees can improve franchisees' satisfaction toward the franchise system. As the diversification of Chinese markets, both franchisors and franchisees must keep the relevant, timely, and reliable communication. And it is very important to improve the quality of communication. Satisfaction with precious outcomes seems to positively relate to trust. Franchisors and franchisees that are highly satisfied with the previous outcomes that flow from their relationship will perceive their partner as advancing their goal achievement. Therefore, it is necessary for both franchisor and their franchisees to make the welfare of partner with effort. Little literature has focused on what factors affect the trust between franchisors and their franchisees in China. This study developed the hypotheses regarding the factors affecting trust in the transaction relationship. The results of data analysis supported the hypotheses strongly. There are certain limitations in this study. First, we may point out that some other factors missed in this study could be significantly important. Second, the context of this study, food service industry, limits its potential generalizability for all franchise systems. More studies in different categories of franchise system are needed to broaden its generalizability. Third, the model was tested empirically in a sample in Beijing, more empirical tests of the proposed model in other Chinese areas are needed. Finally, the analysis in this study was solely based on the perception of franchisees and the opinions of franchisors were not included.

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An Empirical Study in Relationship between Franchisor's Leadership Behavior Style and Commitment by Focusing Moderating Effect of Franchisee's Self-efficacy (가맹본부의 리더십 행동유형과 가맹사업자의 관계결속에 관한 실증적 연구 - 가맹사업자의 자기효능감의 조절효과를 중심으로 -)

  • Yang, Hoe-Chang;Lee, Young-Chul
    • Journal of Distribution Research
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    • v.15 no.1
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    • pp.49-71
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    • 2010
  • Franchise businesses in South Korea have contributed to economic growth and job creation, and its growth potential remains very high. However, despite such virtues, domestic franchise businesses face many problems such as the instability of franchisor's business structure and weak financial conditions. To solve these problems, the government enacted legislation and strengthened franchise related laws. However, the strengthening of laws regulating franchisors had many side effects that interrupted the development of the franchise business. For example, legal regulations regarding franchisors have had the effect of suppressing the franchisor's leadership activities (e.g. activities such as the ability to advocate the franchisor's policies and strategies to the franchisees, in order to facilitate change and innovation). One of the main goals of the franchise business is to build cooperation between the franchisor and the franchisee for their combined success. However, franchisees can refuse to follow the franchisor's strategies because of the current state of franchise-related law and government policy. The purpose of this study to explore the effects of franchisor's leadership style on franchisee's commitment in a franchise system. We classified leadership styles according to the path-goal theory (House & Mitchell, 1974), and it was hypothesized and tested that the four leadership styles proposed by the path-goal theory (i.e. directive, supportive, participative and achievement-oriented leadership) have different effects on franchisee's commitment. Another purpose of this study to explore the how the level of franchisee's self-efficacy influences both the franchisor's leadership style and franchisee's commitment in a franchise system. Results of the present study are expected to provide important theoretical and practical implications as to the role of franchisor's leadership style, as restricted by government regulations and the franchisee's self-efficacy, which could be needed to improve the quality of the long-term relationship between the franchisor and franchisee. Quoted by Northouse(2007), one problem regarding the investigation of leadership is that there are almost as many different definitions of leadership as there are people who have tried to define it. But despite the multitude of ways in which leadership has been conceptualized, the following components can be identified as central to the phenomenon: (a) leadership is a process, (b) leadership involves influence, (c) leadership occurs in a group context, and (d) leadership involves goal attainment. Based on these components, in this study leadership is defined as a process whereby franchisor's influences a group of franchisee' to achieve a common goal. Focusing on this definition, the path-goal theory is about how leaders motivate subordinates to accomplish designated goals. Drawing heavily from research on what motivates employees, path-goal theory first appeared in the leadership literature in the early 1970s in the works of Evans (1970), House (1971), House and Dessler (1974), and House and Mitchell (1974). The stated goal of this leadership theory is to enhance employee performance and employee satisfaction by focusing on employee motivation. In brief, path-goal theory is designed to explain how leaders can help subordinates along the path to their goals by selecting specific behaviors that are best suited to subordinates' needs and to the situation in which subordinates are working (Northouse, 2007). House & Mitchell(1974) predicted that although many different leadership behaviors could have been selected to be a part of path-goal theory, this approach has so far examined directive, supportive, participative, and achievement-oriented leadership behaviors. And they suggested that leaders may exhibit any or all of these four styles with various subordinates and in different situations. However, due to restrictive government regulations, franchisors are not in a position to change their leadership style to suit their circumstances. In addition, quoted by Northouse(2007), ssubordinate characteristics determine how a leader's behavior is interpreted by subordinates in a given work context. Many researchers have focused on subordinates' needs for affiliation, preferences for structure, desires for control, and self-perceived level of task ability. In this study, we have focused on the self-perceived level of task ability, namely, the franchisee's self-efficacy. According to Bandura (1977), self-efficacy is chiefly defined as the personal attitude of one's ability to accomplish concrete tasks. Therefore, it is not an indicator of one's actual abilities, but an opinion of the extent of how one can use that ability. Thus, the judgment of maintain franchisee's commitment depends on the situation (e.g., government regulation and policy and leadership style of franchisor) and how it affects one's ability to mobilize resources to deal with the task, so even if people possess the same ability, there may be differences in self-efficacy. Figure 1 illustrates the model investigated in this study. In this model, it was hypothesized that leadership styles would affect the franchisee's commitment, and self-efficacy would moderate the relationship between leadership style and franchisee's commitment. Theoretically, quoted by Northouse(2007), the path-goal approach suggests that leaders need to choose a leadership style that best fits the needs of subordinates and the work they are doing. According to House & Mitchell (1974), the theory predicts that a directive style of leadership is best in situations in which subordinates are dogmatic and authoritarian, the task demands are ambiguous, and the organizational rule and procedures are unclear. In these situations, franchisor's directive leadership complements the work by providing guidance and psychological structure for franchisees. For work that is structured, unsatisfying, or frustrating, path-goal theory suggests that leaders should use a supportive style. Franchisor's Supportive leadership offers a sense of human touch for franchisees engaged in mundane, mechanized activity. Franchisor's participative leadership is considered best when a task is ambiguous because participation gives greater clarity to how certain paths lead to certain goals; it helps subordinates learn what actions leads to what outcome. Furthermore, House & Mitchell(1974) predicts that achievement-oriented leadership is most effective in settings in which subordinates are required to perform ambiguous tasks. Marsh and O'Neill (1984) tested the idea that organizational members' anger and decline in performance is caused by deficiencies in their level of effort and found that self-efficacy promotes accomplishment, decreases stress and negative consequences like depression and emotional instability. Based on the extant empirical findings and theoretical reasoning, we posit positive and strong relationships between the franchisor's leadership styles and the franchisee's commitment. Furthermore, the level of franchisee's self-efficacy was thought to maintain their commitment. The questionnaires sent to participants consisted of the following measures; leadership style was assessed using a 20 item 7-point likert scale developed by Indvik (1985), self-efficacy was assessed using a 24 item 6-point likert scale developed by Bandura (1977), and commitment was assessed using a 6 item 5-point likert scale developed by Morgan & Hunt (1994). Questionnaires were distributed to Korean optical franchisees in Seoul. It took about 20 days to complete the data collection. A total number of 140 questionnaires were returned and complete data were available from 137 respondents. Results of multiple regression analyses testing the relationships between the each of the four styles of leadership shown by the franchisor as independent variables and franchisee's commitment as the dependent variable showed that the relationship between supportive leadership style and commitment ($\beta$=.13, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.07, p<.001)were significant. However, when participants divided into high and low self-efficacy groups, results of multiple regression analyses showed that only the relationship between achievement-oriented leadership style and commitment ($\beta$=.14, p<.001) was significant in the high self-efficacy group. In the low self-efficacy group, the relationship between supportive leadership style and commitment ($\beta$=.17, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.10, p<.001) were significant. The study focused on the franchisee's self-efficacy in order to explore the possibility that regulation, originally intended to protect the franchisee, may not be the most effective method to maintain the relationships in a franchise business. The key results of the data analysis regarding the moderating role of self-efficacy between leadership behavior style as proposed by path-goal and commitment theory were as follows. First, this study proposed that franchisor should apply the appropriate type of leadership behavior to strengthen the franchisees commitment because the results demonstrated that supportive and participative leadership styles by the franchisors have a positive influence on the franchisee's level of commitment. Second, it is desirable for franchisor to validate the franchisee's efforts, since the franchisee's characteristics such as self-efficacy had a substantial, positive effect on the franchisee's commitment as well as being a meaningful moderator between leadership and commitment. Third, the results as a whole imply that the government should provide institutional support, namely to put the franchisor in a position to clearly identify the characteristics of their franchisees and provide reasonable means to administer the franchisees to achieve the company's goal.

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