• Title/Summary/Keyword: Mental change

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THE EFFICACY AND SAFETY OF RISPERIDONE IN CHILD & ADOLESCENT PSYCHIATRIC INPATIENT (소아 청소년 정신과 입원 환자에서 Risperidone의 효과 및 안정성에 관한 연구)

  • Park Jeong-Hyun;Kim Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.16 no.2
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    • pp.239-250
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    • 2005
  • Objective : The purpose of this study was obtaining data on the efficacy and safety of risperidone in child and adolescent psychiatric patients. Method : Thirty one children and adolescents (males n=18, females n=13, age ranged from 5.4 to 17.3 years) treated with risperidone were selected among child and adolescent psychiatric inpatients of Seoul National University Hospital from January, 2001 to June, 2002, and charts for them were reviewed retrospectively. Results : The primary psychiatric disorders treated with risperidone were schizophrenia and other psychosis, bipolar I disorder with psychotic features, Tourette's disorder, autism spectrum disorders, mixed receptive and expressive language disorder, attention deficit-hyperactivity disorder, conduct disorder and obsessive-compulsive disorder. twelve of these had comorbid mental retardation. Primary target symptoms of risperidone were psychotic symptoms (n=13 or $41.9\%$), behavioral symptoms (n=10 or $32.3\%$) including aggression, impulsivity, hyperactivity, stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics (n=8, $25.8\%$). The efficacy of risperidone was measured by clinical global improvement (CGI) for target symptoms, $67.7\%$ of subjects showed moderate or marked improvements and its therapeutic effect appeared to be maintained during at least 7.5 months. Mean daily dosage of risperidone was $0.05{\pm}0.01mg/kg$, the group with psychotic symptoms had significantly higher mean daily dosage (0.07mg/kg) compared with other two groups (0.04mg/kg) with behavioral symptoms or tics. A variety of adverse events were reported in this study : weight gain (n=23) most commonly reported, extrapyramidal symptoms (n=15), autonomic symptoms (n=6), sedation (n=5) and symptoms related to hyperprolactinemia (n=2) etc. Although there was no drug change related to the adverse events of risperidone, and $90\%$ of subjects at their last visits were maintained on it, thus its tolerability appeared good. Conclusions Results suggest that risperidone may be relatively safe and effective drug in managing a wide variety of child and adolescent psychopathologies such as psychotic symptoms, behavioral symptoms including aggression, impulsivity, hyperactivity and stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics. Controlled and long-term studies of efficacy and safety of risperidone treatment for children and adolescents are recommended in the future.

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Efficacy of Statins on BMB or Fracture Risk in Postmenopausal Women (스타틴이 폐경기 여성의 골밀도 혹은 골절위험에 미치는 효과 -보고된 임상연구결과 분석을 중심으로-)

  • Bang, Joon-Seok
    • Korean Journal of Clinical Pharmacy
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    • v.16 no.2
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    • pp.86-91
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    • 2006
  • There are 3 different hypotheses on how statins may affect bones, through promoting bone formation, inhibiting bone resorption or through anti-inflammatory effect. In the 3 cross-sectional studies above, one showed increase BMD at hip and spine, one showed increase BMD only at mid-forearm and one showed that the risk reduction in fractures is not explained by the changes in BMD however, all 3 studies showed a decrease in risk of fracture associated with statins. In the 2 prospective cohort studies, one showed the use of statins was not associated with BMD at any skeletal site or decreasing the risk of fracture, and the other showed statins except pravastatin decreased in risk of vertebrate fracture but not affecting lumbar spine BMD. All of case-control studies indicated reduction in fracture risk but did not provide any data regarding BMD. 2 of the randomized, controlled studies showed no significant reduction in fracture risk as well as statins' effects on BMD. Finally, one longitudinal study showed statin use reduced fracture risk and increased BMD. Among the conflicting results shown above, even when statin use was shown to increase BMD, it does not seem to account for the reduction in fracture risk. There may be different ways that statins affect bone other than those hypotheses proposed above. Many studies seem to agree that pravastatin does not have any effect on bone. Some studies suggested that the reason statins did not achieve clinically significant increases in BMD in some studies, is due to the low affinity of statins on bone; statins are designed to act in the liver therefore their effective concentration in extrahepatic tissue is low. The limitations to those studies discussed above. Many studies did not account for the change of lifestyle while subjects' were on statins. Increases in weight bearing exercise and changes in diet might affect BMD and thus reduce risk of fractures. Mental alertness and vision acuity might prevent falls from occurring; many statin-users in the studies were young so the risk of fractures from falls would be decreased. Almost all of the studies failed exclude patients with neurological problems. During study periods, many subjects may have been started on drugs for diseases that usually occur with aging which could cause drowsiness and lead to falls. The sample sizes used in some of the trials were small and the duration of treatment and follow up might not have been long enough to see clinically relevant results.

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A Study on the Product Design Case Study of Differential Design Concept (차별화 된 디자인 개념의 제품디자인 사례 연구)

  • 이덕상;한세준;김홍규;조철희
    • Archives of design research
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    • v.17 no.2
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    • pp.335-350
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    • 2004
  • Design takes concrete form from the things which are not yet exist to the molded reality. Creation of value which is accompanied by the rational value could be possible only through the searching examination of the basic concept. All designs are under circumstances because the results and the character of the problems are different under the given conditions and circumstances which are the characteristic of the design. The aim of this study is searching for the differential design conce- pt which is the most appropriate and reasonable in the basic design process in which the phase of the analysis, synthesis and evaluation of the problem. First of all the pursuit value of the times and the change of the view point of value of the product design. How the pursuit value of times were searched and analyzed. Analyze the successful product design realization of the typical trend of the modern design which are 3-2. function-focused design, 3-3. emotion-centered design, 3-4. image communicative design through the metaphor, 3-5. environmental affinity design. On the base of the case analysis how to apply the differential design concept which is coming as a trend in the future society which are sustainable developing society was examined closely. The outcome through the analysis of the success cases are as follows, \circled1 the value of the spirit of the times should be emphasized as the design image, \circled2 environmental appropriateness should be taken into consideration as the first primary factor, \circled3 the realization of value of the fulfillment of differential consumer's needs, \circled4 lead to prolong the life cycle of the product, \circled5 promote the sustaining growth of enterprise, \circled6 user-centered product value should be the first consideration. \circled7 It is necessary to overcome the cultural andinguistic barriers and to reflect the metaphor which people remember well. \circled8 The application of human's true character should be decided beforehand. It is the commonness of values of times and customs. \circled9 The differentiated design concept which meets our mental satisfaction, not material one, will be required. In addition to this the creative and differentiated design concepts which are accompanied by the good design factor under the base of product could achieve the emotional consensus from the consumers. That is, the value of all designs should be estimated by the base of the humanism ' The human beings are the barometer of all things".ngs".uot;.

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Alexithymia in Patients with Ulcerative Colitis and Irritable Bowel Syndrome (궤양성대장염 환자와 과민성대장증후군 환자의 감정표현불능증 비교 연구)

  • Lee, Sang-Bin;Lee, Seong-Yong;Kim, Sang-Heon;Rim, Hyo-Deog
    • Korean Journal of Psychosomatic Medicine
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    • v.11 no.1
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    • pp.69-76
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    • 2003
  • Objectives: Many researches have been done to compare psychopathology of functional gastrointestinal disorder and inflammatory bowel disease which involves structural change. Recently, many studies focused on the topic of alexithymia. The results from these studies were questionable for lack of valid measures of alexithymia and valid diagnostic criteria of functional gastrointestinal disorders. Therefore, we tried to overcome these two problems and to assess alexithymia, personality characteristics, and other psychopathology. Methods: The subjects consisted of ulcerative colitis group(N=28) who were diagnosed by colonoscopy and biopsy, irritable bowel syndrome group(N=27) who were diagnosed by Rome II criteria and normal control group(N=22). All patients were diagnosed at outpatient department of Kyungpook National University Hospital. All these groups completed three psychological tests, including MMPI, Rorschach test, and well validated TAS-20K(The Korean Version of the 20-Item Toronto Alexithymia Scale). Results: Twenty-five percent of the ulcerative colitis group and 22% of the irritable bowel syndrome group scored in the alexithymia range, compared with 0% of the normal group. In Rorschach test, irritable bowel syndrome group showed high levels of weighted Sum C and EA. Most of clinical scales of MMPI were higher in two gastrointestinal groups than the normal control group. And two gastrointestinal groups showed low ego strength level, but there was no statistical significant difference between them. Conclusion: Two gastrointestinal groups showed high rate of alexithymia, other psychopathological profiles, and low ego strength but there was no significant difference between two groups.

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Clinical observation for the Geriatric C.V.A. (노인(老人) 뇌졸중(腦卒中)에 대(對)한 임상적(臨床的) 고찰(考察))

  • Seo, Un-Kyo;Jeong, Ji-Cheon;Lee, Won-Chul
    • The Journal of Internal Korean Medicine
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    • v.14 no.2
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    • pp.50-70
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    • 1993
  • Clinical observation was done on 92 cases of Occlusive CVD, Cerebral hemorrhage (Subarachnoid hemorrhage) which were confirmed by Brain CT scan and observed for over 4 weeks, among the 121 cases which were more than 65 years of age. they admitted to the Dept. of Internal Medicine, Oriental Medical Hospital in Dong Guk Univ. from July 1992 to June 1993. The result were as follows; 1. In this study, Occlusive CVD was 74 cases, Cerebral hemorrhage (Subarachnoid hemorrhage was 2 cases) was 18 cases. 2. The ratio of male to female was 1.09:1. The age distribution showed the large number in the 65-69 year group(52.2%), 7th decade was 44.5% over 8th decade was 3.3% in ratio. 3. The site of Occlusive CVD was most common at MCA. the site of Cb-hemorrhage was most common at Basal ganglia. 4. The most common preceding disease was hypertension(47.8%) and the next were diabetes mellitus(14.1%), heart desease(14.1%). 5. Recurrence rate was 33.7% and 2nd attack was 20.7%, 3rd attack was 8.7%, 4th attack was 4.3% 6. Predisposing factors in Occlusive CVD were initiated usually during resting and sleeping, and that in Cb-hemorrhage were represented chiefly exercising(66.6%). 7. The smoker was 52.2%, the drinker was 32.6% in whole group. the drinker was 61.1% by the Cb-hemorrhage. 8. The ratio of the season distribution was as follow, fall 35.8%, winter 29.3%, spring 19.6%, summer 15.3%, that of the month distribution was november 15.2%. 9. Duration from on set in Occlusive CVD, 60.8% was within 5 days, that in Cb-hemorrhage, 77.8% was within 5 days. 10. Level of consciousness on attack was clear 42.2%, lethargy and mental change(dull, stupid etc.) 41.3%. The common symptoms were motor disturbance(90.2%), verbal disturbance(65.2%), headache(43.5%). 11. The physical theraphy of Occlusive CVD has been performed 75.7% in whole group and the average beginning time was 6.4 days, and that of Cb-hemorrhage has been performed 61.1% in whole group and the average beginning time was 13 days. 12. Duration of hospitalization was noted 11-20 days was 31.5%, over 21 days was 46.8%, and the average admission was 22.7 day(Occlusive CVD), 32days (Cb-hemorrhage). 13. The main complication were observed in the studies; urinary tract infection and pneumonia were noted in 6.5%, bed sore in 5.4%. 14. The ratio of systolic blood pressures in admission and discharge decreased from 58.7% to 28.3% in over 160 mmHg, that of diastolic blood pressures in admission and discharge decreased from 72.8% to 51.1% in over 90 mmHg. In 31(33.7%) of the 92 cases it showed the glucose levels of more than normal. 15. The patients have done family history of hypertension and C.V.A were 32.6% of all 16. Occlusive CVD In 83.8% and Cb-hernorrhage in 72.2% were improved 17. The herb medications were various Sunghyanggeonggisan, Sopungtang, CHunmagudeungeum were used most frequently and Gamidaebotang, Boyangwhanotang, Gagamyunjotang, Mangeumtang etc. were used as discharge.

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A Study of Design Education for the Public and its Development Direction (대중의 디자인교육문제와 발전방향에 관한 연구)

  • Cho, Kyu-Myung;Kim, Tae-Chul;Kim, Kyung-Sook
    • Archives of design research
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    • v.18 no.1 s.59
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    • pp.91-104
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    • 2005
  • In the past, the design education focused on the technique and skill to satisfy the production and consumption activities of a corporation based on beauty and practicality in the industrial age. Now, it's time to switchover to a life-quality enhancing education by harmonizing and meeting the public's physical and mental needs because design education is a character education which enhances the quality of life by uplifting people's aesthetic sense. This paper has emphasized on the importance of public education of design through the theoretical investigation on social environmental changes caused by the emergence of information society,,education problems, public education, and the necessity of design education. The reason why this study should be done has been suggested by investigating the necessity of this research and bringing up the issue. Furthermore, the current status and problems of public education on design have been analyzed. Then, based on the result, the development direction of design education has been suggested. This study can be concluded as follows: First, the design education should change from its vertical structure to a horizontal one. It should be widely spread to the public, getting off from its privatization for a certain group. Second, designers and the public should correct their way of thinking about design. The ordinary people as well as the designers should cultivate their capability to find and take care of design related issues in their everyday lives. Third, all people should be the subject of design education for the public. As a part of cultural education on the public's aesthetic sense, design education should be reborn as a field of study in which a sound public culture can be developed by the integration of human life and culture, exceeding the limit of school curriculum.

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A Study on the Development of Aerobic Exercise Equipment Design for User-Centered -Focusing on Elliptical Cross Trainer- (사용자 중심의 유산소 운동기구 디자인 개발에 관한 연구 -Elliptical Cross Trainer를 중심으로-)

  • Chung, Kyung-Ryul;Song, Bok-Hee;Yoon, Se-Kyun;Park, Il-Woo
    • Archives of design research
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    • v.19 no.5 s.67
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    • pp.129-138
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    • 2006
  • It is expected that the typical lifestyle of the future will be transformed into an opulent and comfortable existence as the quality of life improves due to the increase in household income and reduction in working hours. In the meantime, as the standard of living becomes increasingly more comfortable and plentiful, the toll on physical health becomes magnified as a result of obesity and insufficient exercise caused by super nutrition and change in labor conditions (from physical labor to mental labor). This has instigated a deep awareness in fitness on the part of many people, forcing them to recognize the significance of daily exercise and physical activity. The high annual growth rate in the fitness and athletic apparatus market, which is more than 20%, is attributed to this phenomenon. The Elliptical Cross Trainer(ECT), which has drawn wide attention recently, is a non-impact athletic apparatus that not only promotes exercise of the upper body parts in such sports as skiing but also the exercise of lower parts of the body on a treadmill. It is a type of cross training athletic gear that has been developed for aerobic exercise throughout the entire body. It has already formed a market as big as that of the treadmill in Europe, America, etc. Recently, its demand is growing sharply in the Korean markets as well as those in Northeast Asian countries, Despite such demand increase and expansion, since most of the expensive ECTs are exclusively supplied by suppliers in only a few advanced countries, localization of the ECT is urgently required in order to enhance competitiveness of Korean manufacturers and to expand the market. This paper introduces the process and results of a design-engineering cooperative study that was peformed for the development of the ECT.

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The Role of Radiotherapy in Patients with Brain Metastasis (고형암의 뇌전이시 방사선치료 효과)

  • Lee Soon Nam;Choo Mi-Soon;Lee Kyung-Ja;Nam Eunmi
    • Radiation Oncology Journal
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    • v.17 no.4
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    • pp.281-286
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    • 1999
  • Purpose : Brain metastases are the most frequent metastatic neurologic complication of systemic cancer. Even if the prognosis of brain metastases is grave, with available treatments, most patients experience effective palliation of neurologic symptoms and meaningful extension of life. We evaluated the clinical features and prognostic factors of the patients who were diagnosed as solid tumors with brain metastasis and received radiotherapy for brain metastases. Materials and Methods: Between January 1987 and January 1998, 71 patients with brain metastases from solid malignancy were included. We reviewed neurologic symptoms and signs of patients and evaluated improvememt of neurologic symptoms and signs. Survival durations after brain metastasis were ana lysed according to several factors such as age, performance status, primary malignancies, the pre-sence of brain metastasis at initial diagnosis of primary tumor, multiplicity of brain metastass, the presence of metastases other than brain, and treatment method. Results: Frequent symptoms associated with brain metastasis were headache (47.9$\%$), motor weakness (40.8$\%$), nausea and vomiting (19.7$\%$) and mental change (19.7%). Palliation of these symptoms was accomplished in 64.9$\%$ of cases. The overall median survival time was 16 weeks and 1- and 2-year survival rates were 15.0$\%$ and 5.1$\%$ respectively. Patients without extracranial metastases (n=27) had longer median survival than patients with extracranial metastases (33 weeks vs 10 weeks, p=0.0018). In patients with single brain metastasis (n=37), the median survival time was longer in patients treated with surgery plus radiotherapy than in patients treated with radiotherapy alone (40 weeks vs 16 weeks, p=0.0438). Conclusion: Patients who has brain metastases only constitute a prognostically favorable group and they may be benefited from radiotherapy and surgery if indicated.

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The Effects of Price Salience on Consumer Perception and Purchase Intentions (개격현저대소비자감지화구매의도적영향(价格显著对消费者感知和购买意图的影响))

  • Martin-Consuegea, David;Millan, Angel;Diaz, Estrella;Ko, Eun-Ju
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.2
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    • pp.149-163
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    • 2010
  • Previous studies have shown that retail price promotion change consumers' purchase behavior and that retailers use price promotion more frequently. Keeping constant the benefits received by consumers, there are several ways for retailers to communicate a price promotion. For example, retailers can present a price reduction in absolute terms ($, ${\euro}$), percentage terms (%), or some combinations of these two methods (Della Bitta et al. 1981). Communicating a price promotion in different ways is similar to the framing of purchase decisions (Monroe 1990). Framing effects refers to the finding that subjects respond differently to different descriptions of the same decision question (Frisch 1993). Thus, the presentation of the promotion has an impact on consumer deal evaluation and hence retail sales. In fact, much research in marketing attests to the effects of price presentation on deal perception (Lichtenstein and Bearden 1989; Urbany et al. 1988; Yadav and Monroe 1993). In this sense, a number of marketing researches have argued that deal perceptions are also determined by the degree to which consumers are able to calculate the discounts and final purchase prices accurately (Estelami 2003a; Morwitz et al. 1998), which suggests that marketers may be able to enhance responses to discounts by improving calculation accuracy. Consequently, since calculation inaccuracies in the aggregate lead to the underestimation of discounts (Kim and Kramer 2006), consumers are more likely to appreciate a discounted offer following deeper processing of price information that enables them to evaluate a price discount more accurately. The purpose of this research is to examine the effect of different presentations of discount prices on consumer price perceptions. To be more precise, the purpose of this study is to investigate how different implementations of the same price promotion (semantic and visual salience) affect consumers' perceptions of the promotion and their purchase decisions. Specifically, the analysis will focus on the effect of price presentation on evaluation, purchase intentions and perception of savings. In order to verify the hypotheses proposed in the research, this paper will present an experimental analysis dealing with several discount presentations. In this sense, a2 (Numerical salience presentation: absolute and relative) x2 (Worded salience presentation: novel and traditional) x2 (Visual salience: red and blue) design was employed to investigate the effects of discount presentation on three dependent variables: evaluation, purchase intentions and perception of savings. Respondents were exposed to a hypothetical advertisement that they had to evaluate and were informed of the offer conditions. Once the sample finished evaluating the advertisement, they answered a questionnaire related to price salience and dependent dimensions. Then, manipulation checks were conducted to ensure that respondents remembered their treatment conditions. Next, a $2{\times}2{\times}2$ MANOVA and follow-up univariate tests were conducted to verify the research hypotheses suggested and to examine the effects of the individual factors (price salience) on evaluation, purchase intentions and perceived savings. The results of this research show that semantic and visual salience presentations have significant main effects and interactions on evaluation, purchase intentions and perception of savings. Significant numerical salience interactions affected evaluation and purchase intentions. Additionally, a significant worded salience main effect on perception of savings and interactions on evaluation and purchase intentions were found. Finally, visual salience interactions have significant effects on evaluation. The main findings of this research suggest practical implications that firms should consider when planning promotion-based discounts to attract consumer attention. Consequently, because price presentation has important effects on consumer perception, retailers should consider which effect is wanted in order to design an effective discount presentaion. Specifically, retailers should present discounts with a traditional style that facilitates final price calculation. It is thus important to investigate ways in which marketers can enhance the accuracy of consumers' mental arithmetic to improve responses to price discounts. This preliminary study on the effect of price presentation on consumer perception and purchase intentions opens the line of research for further research. The results obtained in this research may have been determined by a number of limiting conceptual and methodological factors. In this sense, the research deals with a variety of discount presentations as well as with their effects; however, the analysis could include additional salience dimensions and effects on consumers. Furthermore, a similar study could be carried out including a larger, more inclusive and heterogeneous sample of consumers. In addition, the experiment did not require sample individuals to actually buy the product, so it is advisable to compare the effects obtained in the research with real consumer behavior and perception.

Spatial Structure of Hinterlands and Forelands of Pusan Container Export Port: the Cases of 3 National Flag Carriers (부산 컨테이너 수출항의 배후지와 지향지의 공간구조)

  • Cho, Su-Kyung
    • Journal of the Korean Geographical Society
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    • v.28 no.3
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    • pp.247-267
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    • 1993
  • According to developing international economy since the World War II, the increase and competition of the national business is so empha-sized tht both the interest and the necessity about marine transportation playing the impor-thant role of international transportation are increased. Today, the container transportation, as called the innovation of marine transport has been prevailed since the 1970's. The purpose of this paper is to grasp the spatial structure of the hinterlands and forelands, its object is export container cargo at Pusan Export Port, as known for the transportation node of modern containerlization. In this study, for the purpose of grasping the relation between hinterlands and forelands of Korean export container cargo, first, I researched the transition of carloading about container cargo, the bistribution channel of cargo, the change of the items of container and the carlo-adings about transport route, secondly, I used the cluster analysis so as to group hinterlands according to the items of goods and forelands. The object of the analysis is container cargo of Choyang Line, Hanjin Shipping and Hyundai Merchant Marine of National Frag Carriers. The source materials used in this study are Trucking Data of Hanjin Co., Container Ren-tal Data of Samik Transport Co. and Transpor-ting Present Condition Tables of Hyundai Mer-chant Marine. 1. There are two kinds of the transport classi-fied by its form: FCL and LCL. In Pusan Con-tainer Export, a lot of textile goods, clothings and furniture, compound, electric goods, and so on are dealed with but the rate of occupation of the transport is getting lower while that of occupation of equipment, papers and agricultu-ral, mineral and livestock industry higher. 2. In 1990, the transports of container cargo in Korea consist of 7 services and round-the world lines. We can list North America lines, East-South Asian lines, Japan lines and Inter European lines, in order of the quantity of tran-sport form the largest to the smaller. We can have another list that Japan lines, North Ame-rica lines and East-South lines in order of the rate participation of national flag carriers, be-cacuse Korean foreign trade lay disproportionate emphasis on East-South Asian lines. Japan lines among them is the biggest import-export market. Since the rationlization policy of marine tran-sport in 1984, each of national flag carriers have its own lines. Hanjin Shipping predominates over North America lines, Choyang Line over New Zealand, Inter European and Austria lines and Hyundai Merchant Marine over Center-South America lines, in terms of the volume of transport. And small-to-medium sized shippers are prevailing in lines which are adjacent to Korea, Such as Japan lines and East-South Asian lines. 3. In relation to hinterlands and forelands of Choyang Line, the light industry goods, electric goods and machinary produced in Seoul and Pusan are exported to the major ports in Europe and Japan, the same produces in Suwon, Ulsan, Kumi are exported to European Ports, and those in Incheon and Kwangju Austrian and Japanese ports, and those in the rest regions to the major port in Japan. 4. In relation to hinterlands and forelands of Hanjin Shipping, the light industry goods pro-ducing in Seoul and Pusan, the electric goods and machinary in Incheon and Pyeongteck, are exported to New York and Los Angeles. Electric goods and machinary Masan, Anyang, Cheona, Cheongju and Incheon, Electric goods machinary and light industry goods in Kwangju and non mental goods in Pohang, are exported New York, Los Angeles and Oakland. 5. In relation to hinterlands and forelands of Hyundai Merchant Marine, the region of Seoul, Pusan and Incheon closely related with the main ports in U.S.A. The rest regions with Montreal. The hinterlands of export container cargo can be classified by its export items into three kinds: the large city, industrial city and the rest city. Choyang Line's forelands are European lines, Japan lines and Austria lines, and Hanjin Shipping's forelands are North America lines, and Hyundai Merchant Marine's forelands are North America lines and Japan line. 3 National flag carriers' major forelands are determined by the size of port and the shipper's convenient use of the port terminal.

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