The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.
Ham, Hyun Seok;Lee, Hae Young;Lee, Seung Jun;Cho, Yu Ji;Jeong, Yi Young;Kim, Ho Cheol;Ham, Jong Ryeal;Park, Chan Hoo;Lee, Jong Deok;Sohn, Hyun Joon;Youn, Hee Shang;Hwang, Young Sil
Tuberculosis and Respiratory Diseases
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v.61
no.4
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pp.330-338
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2006
Background: The main factors associated with weight loss in patients with COPD are not well known. Since chronic inflammation and oxidative stress play a major pathogenic role in COPD, these factors may be responsible for the patients' weight loss. Therefore, this study measured the body mass index (BMI) in COPD patients and evaluated the variables, such as systemic inflammatory marker, oxidative stress and lung function, that correlate with the BMI. Method: The stable COPD patients (M:F=49:4, mean age=$68.25{\pm}6.32$) were divided into the lower (<18.5), normal (18.5-25) and higher (>25) BMI group. The severity of the airway obstruction was evaluated by measuring the $FEV_1$. The serum IL-6 and TNF-$\alpha$ levels were measured to determine the degree of systemic inflammation, and the carbonyl protein and 8-iso-prostaglandin $F_2{\alpha}$ level was measured to determine the level of oxidative stress. Each value in the COPD patients and normal control was compared with the BMI. Results: 1) Serum 8-iso-prostaglandin $F_2{\alpha}$ in COPD patients was significantly higher ($456.08{\pm}574.12pg/ml$) than that in normal control ($264.74{\pm}143.15pg/ml$) (p<0.05). However, there were no significant differences in the serum IL-6, TNF-$\alpha$, carbonyl protein between the COPD patients and normal controls. 2). In the COPD patients, the $FEV_1$ of the lower BMI group was significantly lower ($0.93{\pm}0.25L$) than that of the normal BMI ($1.34{\pm}0.52L$) and higher BMI groups ($1.72{\pm}0.41L$) (p<0.05). The lower $FEV_1$ was significantly associated with a lower BMI in COPD patients (p=0.002, r=0.42). The BMI of very severe COPD patients was significantly lower ($19.8{\pm}2.57$) than that of the patients with moderate COPD ($22.6{\pm}3.14$) (p<0.05). 3). There were no significant differences in the serum IL-6, TNF-$\alpha$, carbonyl protein and 8-iso-prostaglandin $F_2{\alpha}$ according to the BMI in the COPD patients. Conclusion: The severity of the airway obstruction, not the systemic inflammatory markers and oxidative stress, might be associated with the BMI in stable COPD patients. Further study will be needed to determine the factors associated with the decrease in the BMI of COPD patients.
Purpose: The aim of this study was to determine an appropriate energy level of breakfast with less risk of chronic disease for Korean adults. Methods: Using data from the 2007~2009 Korean National Health & Nutrition Examination Survey, from a total of 12,238 adults aged 19~64, the final 7,769 subjects were analyzed except subjects who were undergoing treatment for cancer or metabolic disorder. According to the percent of breakfast energy intake versus their estimated energy requirement (EER), the subjects were divided into four groups: < 10% (very low, VL), 10~20% (low, L), 20~30% (moderate, M), ${\geq}30%$ (sufficient, S). All data were analyzed on the metabolic risk and nutritional state after application of weighted value and adjustment of sex, age, residential area, income, education, job or jobless, and energy intake using a general linear model or logistic regression. Results: The subjects of group S were 16.9% of total subjects, group M 39.2%, group L 37.6%, and group VL 6.3%. The VL group included more male subjects, younger-aged (19 to 40 years), urban residents, higher income, higher education, and fewer breakfasts eaters together with family members. Among the 4 groups, the VL group showed the highest waist circumference, while the S group showed the lowest waist circumference, body mass index, and serum total cholesterol. The groups of VL and L with lower intake of breakfast energy showed high percent of energy from protein and fat, and low percent of energy from carbohydrate. With the increase of breakfast energy level, intake of energy, most nutrients and food groups increased, and the percentage of subjects consuming nutrients below EAR decreased. The VL group showed relatively higher intake of snacks, sugar, meat and eggs, oil, and seasonings, and the lowest intake of vegetable. Risk of obesity by waist circumference was highest in the VL group by 1.90 times of the S group and the same trend was shown in obesity by BMI. Risk of dyslipidemia by serum total cholesterol was 1.84 times higher in the VL group compared to the S group. Risk of diabetes by Glu-FBS (fasting blood sugar) was 1.57 times higher in the VL group compared to the S group. Conclusion: The results indicate that higher breakfast energy level is positively related to lower metabolic risk and more desirable nutritional state in Korean adults. Therefore, breakfast energy intake more than 30% of their own EER would be highly recommended for Korean adults.
This study was carried out to identify the difference between nursing needs and levels of satisfaction of primiparae during the early postpartum period. The goal of the study was to obtain data needed to develope maternal education programs and to improve the nursing quality for primipara. The subjects were 111 primiparae who had normal delivery at 2 general hospitals in the Seoul area. The data was gathered using an 81 items questionnaire which was developed by the researcher from Nov. 30, 1995 to Feb. 5, 1996. Results found are as follows : 1. The characteristics of subjects : The majority of subjects were aged 26-30yrs(60.4%), high school graduated(49.5%), jobless(52.3%), had no religion(49.5%), no antenatal(74.5%), and postnatal education on self and infant care(55.9%). A large proportion of primiparae intended to feed breast milk(49.5%) but in fact only 7.2% fed breast milk while in the hospital. Many subjects perceived that they had reasonable self confidence about self care(46.8%), and infant care(36%). 2. The level of nursing needs of overall nursing care was relatively high(Mn 3.98) but the level of satisfaction was of average level(Mn 3.09). Therefore, difference between the level of nursing needs and satisfaction was significant(p=0.0001). 3. The nursing needs by category of nursing care the highest need was on the education of infant care(4.29), the lowest was on physical care(3.80). The level of satisfaction was higher on environmental care(3.40) and physical care(3.32). But the category that showed the lowest satisfaction was education of infant care(2.67). Hence, difference of categories between the level of nursing needs and satisfaction was significant(p=0.0001). 4. Among items of physical care, observation of primiparas' conditions(4.21), accurate medication and treatment(4.18), care of breast engorgement(4.07) and control of postpartal hemorrage(4.01) showed high nursing needs. On the other hand, only the level of satisfaction was higher on accurate medication and treatment(3.82). The rest of items revealed only average level of satisfactions. Difference of items between the level of nursing needs and satisfaction was significant(p=0.0001) except items of dietary care. 5. Among items of psychological care, 8 items of nursing needs were high(3.72-4.29), expecially detailed explanation on which mothers want to know(4.29), treatment and nursing care they receive(4.23), kind and faithful care(4.22), early contacts with their baby(4.20), and adequate draping during the care and treatment(4.18). Among items of psychological care higher satisfactions were shown on items of kind and faithful care(3.80), personal treatment(3.70), and detailed explanation to mothers, but the least satisfied items was early contact with baby(2.13). Difference between the level of nursing needs and satisfaction was significant(p=0.0001). 6. Among items of environmental care, the highest level of need and satisfaction was on the items of neat bedding and pajamas(3.54). The difference was significant (p=0.0001). 7. Among the items of educational needs on self care, all of 22 items revealed higher educational needs(3.50-4.33) but the levels of satisfaction varied with a range of 2.63-3.42. Among the items the satisfactions were high on items of breast care including massages(3.42), perineal care(3.36) and expression of breast milk(3.32). Less satisfied items were drugs not be taken by breast milk feeder(2.63), maintenance of breast figure(2.76) and postpartum exercise(2.80) and so on. The difference was significant(p=0.0001). maintain 8. Among the items of educational needs on infant care, 19 items revealed higher educational needs(3.28-4.54). And the highest need were on the 3 items of normal growth and development of infant, safety and emergency care, symptoms of sick(4.45) and the meaning of crying of the baby(4.52). The level of satisfaction among items of education of infant care ranged from 2.47 to 3.16. Most satisfied items were buriping(3.16), bathing(3.11) and diapering(3.09). The items of which the mother's needs were high revealed the lowest satisfaction level. The difference was significant (p=0.0001). 9. Relationship between nursing needs and levels of satisfaction among primiparae of different characteristics were as follows : 1) Nursing needs of physical and psychological areas were significantly different among different age levels but no relationship was found on other categories regardless of the level of satisfaction. 2) With regard to different levels of education, some relationship was found in nursing needs of psychological area(p=0.007), educational needs on infant care(p=0.04) and environmental care(p=0.01). Also, the difference of satisfaction level was significant. 3) Working mothers had higher nursing needs and were more satisfied on items of physical care(p=0.05), education on self care and infant care. Difference were significant between nursing needs and level of satisfaction. 4) With regards to different religion a moderate relation was found between nursing needs of environmental care infant care education but no relationship was found on levels of satisfaction. 5) With regards to antenatal education, the mothers who have had no antenatal education revealed higher nursing needs on physical care but those who had antenatal education were more satisfied with education on self care and infant care. The difference was significant. (p=0.0001). 6) With regards to postpartum education, the mothers who have had some sort of postpartum education revealed higher nursing needs on physical and self care. And they were more satisfied with nursing of every category except infant care than mothers who had not any postpartum education. Differences was significant between the nursing needs and levels of satisfaction.(p=0.0001). 7) With regards to breast feeding experience during the hospitalization, those who had no experience of breast feeding revealed higher nursing needs on physical care in contrast to breast feeders, who had higher educational needs on infant care. And breast feeder were more satisfied with all categories. Differences was significant(p=0.0001). 8) With regards to perception of self confidence on self care and infant care, no relationship was found on nursing needs and level of satisfaction in every category of nursing.
This study developed a model to empirically investigate the effects of market orientation and relationship orientation with suppliers on business performance and examine the moderating effects of entrepreneur's characteristics (working tenure) and clinic's location. The data was collected from 200 animal clinics which belong to Korean Animal Hospital Association (KAHA)'s national conference in April, 2007. Descriptive statistic, factor analysis, reliability analysis, and regression analysis were conducted to analyze the data using SPSS/PC+ 12.0. The findings are as follows. First, the market orientation of animal clinics influences significantly both financial and non-financial performance. When the moderating effect of entrepreneur's working tenure is considered, market orientation has significant effect on animal clinic's financial and non-financial performance. However, when the moderating effect of animal clinic's location is considered, market orientation has not significant effect on animal clinic's financial and non-financial performance. Second, animal clinic's relationship orientation with suppliers mostly affects the financial and non-financial performance significantly. When entrepreneur's working tenure in the clinic is longer (above 4 years group), relationship orientation with suppliers significantly affects both financial and non-financial performance. Meanwhile, when the entrepreneur's working tenure in the clinic is shorter (less than 3 years group), relationship orientation with suppliers doesn't affect clinic's financial performance but affect non-financial performance partially. In other words, when entrepreneur's working tenure is shorter (less than 3 years group), market orientation more influences on clinic's financial and non-financial performance while relationship orientation with suppliers does less. It is thought that their relation with suppliers and relationship orientation activities with suppliers are less strongly established and maintained yet. So, they primarily focus on market orientation strategy when entrepreneur's working tenure is shorter. Third, when animal clinics are located in non-metropolitan area, relationship orientation with suppliers significantly affects financial and non-financial performance. However, when animal clinics are located in metropolitan area, it doesn't affect financial and non-financial performance either. It is thought that animal clinics which are located in non-metropolitan area need stronger relationship with suppliers and need support more from them as most of suppliers actively work in metropolitan area not in the non-metropolitan area and animal clinics in metropolitan area can easily get better market information than animal clinics in non-metropolitan area. Lastly, while the effect of the market orientation significantly influences animal clinic's business performance continuously, the effect of the relationship orientation differently influences business performance as it is moderated by entrepreneur's working tenure and animal clinic's location. So, relationship orientation with suppliers can be selectively applied to improve the clinic's financial and no-financial performance. In summary, both of animal clinic's marketing orientation and animal clinic's relationship orientation with suppliers positively influence their business performance. However, entrepreneur's working tenure and animal clinic location moderate the relationship between market orientation and relationship orientation and their business performance differently. This study is quite meaningful to empirically investigate the effects of both of market orientation and relationship orientation with suppliers on business performance and examine the moderating effects of entrepreneur's characteristics (working tenure) and clinic's location. And, as this kind of study has been very few in the context of animal clinic industry, it helps practically understand the effects of market orientation and relationship orientation with suppliers on the financial and non-financial performance in animal clinic industry. Furthermore, as the market conditions in animal clinic industry have been in difficulty for a few years, this study can help improve animal clinic's financial and non-financial business performance together with their suppliers as business partners. Lastly, this study can help find mid-term and long-term cooperation between animal clinics and their suppliers. This study has some limitations. So, care should be taken when generalizing the results of the study. First, our samples were collected from only the animal clinics industry. However, a comparison of the results presented here with those form other marketing contexts (e.g., general hospitals) would be worthwhile. Future comparative research will enhance the generality of our contingency theory cross industry context. Second, this study found that market orientation and relationship orientation affect business performance. However, there may be other antecedents, such as internal market orientation and relationship orientation with customers. Also, this research did not consider other moderators, such as overall market conditions, competitive situations, and power/conflict between suppliers and buyers in the relationship between market and relationship orientation and business performance.
Yoon Yoo Sang;Park Jeong Jun;Yun Tae Jin;Kim Young Hwue;Ko Jae Kon;Park In Sook;Seo Dong Man
Journal of Chest Surgery
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v.39
no.1
s.258
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pp.18-27
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2006
Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, but is one of the most common causes of myocardial ischemia which would result in high mortality within the first year of life. This is our early result of the surgical management for these patients. Material and Method: From June 1989 to July 2003, 6 patients with ALCAPA and one patient with ARCAPA (Anomalous origin of the Right coronary artery from the pulmonary artery) underwent surgical repair. We have reviewed the all medical records, electrocardiogram, chest X-ray and echocardiography retrospectively. Result: Three of the patients were boys and four were girls. The median age at the operation was 5.4 months (Range: 3$\∼$33 months). The average body weight of at the operation was 6.7 kg (Range: 3.7$\∼$11.3 kg). A mean follow up period was 18 months. Only 3 patients were initially diagnosed as ALCAPA. And 3 patients had moderate mitral regurgitation. Immediate coronary artery reimplantation on diagnosis with the aim of restoring a two-coronary system circulation was done. The average bypass time was 114$\pm$37 minutes, and the average aortic cross clamping time was 55$\pm$22 minutes. The average stay of intensive care unit was 5$\pm$3 days, the mean mechanical ventilator time was 38$\pm$45 hours and the hospital stay after operation was 12$\pm$5 days. There were significant improvements in electrocardiogram and chest X-ray of the all patients except one late death patient. The ventricular function showed almost normal recovery after operation; the EF (Ejection Fraction) increased from 41.2$\pm$ 10.3$\%$ to 60.5$\pm$ 15.8$\%$ within 1 month and to 59.8$\pm$13.9$\%$ within 1 year after operation, the SF (Shortening Fraction) increased from 23.6$\pm$4.7$\%$ to 38.6$\pm$8.4$\%$ within 1 month and to 37.4$\pm$7.9$\%$ within 1 year after operation, LVEDDI (Left Ventricular End-diastolic Dimension Index) decreased from 100.8$\pm$25.6 mm/$m^{2}$ to 90.3$\pm$ 19.2 mm/$m^{2}$ within f month and to 79.3$\pm$ 15.8 mm/$m^{2}$ within 1 year after operation. Concomitant mitral repair was done in two patients with anterior mitral leaflet prolapse. In every patient, mitral valve showed less than mild regurgitation during follow up. One late death occurred in which patient Dor procedure was applied 10 months after initial operation due to the dilated cardiomyopathy Conclusion: In the management of this rare and could be fatal Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), early suspicion and correct diagnosis is of most important. But, after diagnosis, immediate restoration of 2 coronary systems could result in good outcome.
Journal of the Korean Society of Food Science and Nutrition
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v.36
no.9
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pp.1148-1160
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2007
This study was performed to document the association between eating behaviors and major risk factors for cardiovascular diseases. Those who stated that they ate a daily breakfast for male and female were 88.6% and 96.0%, $1{\sim}2$ times a week were 9.1% and 2.0%, $3{\sim}4$ times a week were 2.3% and 2.0%, respectively. Those who stated that they were overeating of $0{\sim}1$ time a week for man and female were 80.7% and 89.9%, overeating of $2{\sim}3$ times a week were 19.3% and 10.1%, respectively. Those who said that they were regular of meal time for man and female were 38.6%, and 37.4%, sometimes irregular of meal time were 14.8% and 19.2%, irregular of meal time were 46.6% and 43.4%, respectively. Those who said that they were light of eating volume for man and female were 20.5% and 25.3%, moderate of eating volume were 69.3% and 61.6%, heavy of eating volume were 10.2% and 13.1%, respectively. Those who said that they were very fast of eating speed for man and female were 15.9% and 8.1%, fast of eating speed were 51.1% and 34.3%, moderate of eating speed were 4.5% and 20.2%, slow of eating speed were 17.0% and 14.1%, and very slow of eating speed were 11.4% and 23.2%, respectively. Higher frequency of breakfast a week resulted in higher serum total cholesterol and blood sugar for the daily eating group for both genders with women having high LDL-cholesterol and HDL-cholesterol. Both group had high HDL-cholesterol and low blood sugar with less number of overeating, with men having low triglyceride and LDL-cholesterol. With regular meal, both group had low triglyceride, total-cholesterol, atherogenic index, and blood sugar with women having low LDL-cholesterol. For both groups, the triglyceride, total-cholesterol, LDL-cholesterol, atherogenic index, and blood sugar had higher figures for overeating, with men having low HDL-cholesterol and women having high HDL-cholesterol. This study revealed that less number of overeating, regular mealtime, and less volume of food intake are effective in preventing and treating for the cardiovascular diseases.
Purpose: This research aimed to investigate the actual condition and satisfaction of volunteer activity in Australian hospital. Methods: Data was collected by self reported questionnaire from 101 volunteers and analyzed by frequency and percentage, t-test, ANOVA and Sheffe and Pearson's correlation coefficients using SPSS 12.0. Results: 1. Years involved in volunteer work were $5{\sim}10$ years (32.7%), above 10 years (30.7%), $2{\sim}3$ years (11.9%) and $3{\sim}5$ years (10.9%). Types of volunteer work were physical care (32.7%), physical and emotional care (14.9%), and others (18.8%). Types of allocation of tasks were by volunteer coordination (55.7%), and by volunteer preference and consent between volunteer and coordinator (both respectively, 20.5%). Main reasons for volunteer work were to help sick people (61.4%) and to make good use of leisure time (22.8%). Routes to start volunteer work were from his (her) own inquiries (43.4%), from hearing from other volunteers (30.7%) and from mass media (13.1%). 80.2% of volunteers had received some kinds of training or preparation for volunteer work. Suitability of volunteer's skill and ability to voluntary work were 'very well' (74.0%) and 'mostly well' (18.0%). Reimbursements or benefits received for volunteer work were token or lunch or group outing (31.7%), and token and lunch or group outing (19.8%). Evaluation frequency for volunteer work was occasionally (372%), frequently (30.9%), always (17.0%) and never (14.9%). Relationship with volunteer work coordinator was very good (85.0%). The relationship with other volunteers was very good (81.2%). The relationship with hospital staffs was very good (69.7%) and mostly good (21.2%). Family and friend's support for volunteer work was very good (83.2%). 2 The mean score of satisfaction for the hospital volunteer activity was $3.09{\pm}0.49\;(range:\;1{\sim}4)$. The highest score domain was 'social contact', $3.48{\pm}0.61$, and the lowest was 'social exchange', $1.65{\pm}0.63$. An item of the highest score was 'I have an opportunity to help other people' ($3.83{\pm}0.40$), and the lowest score item was 'I will receive compensation for volunteer work I have done ($1.10{\pm}0.78$).' 3. The satisfaction from hospital volunteer activity was shown by significant difference according to sex (t=2.038, P=0.044), marital status (F=3.806, P=0.013), years involved in volunteer work (F=3.326), nam reason to do volunteer work (F=2.707, P=0.035), receive any training or preparation for volunteer work (t=-1.982, 0=0.050), frequency of evaluation for volunteer work (F=7.877, P=0.000), suitability of volunteer's skill and ability to voluntary work (t=2.712, P=0.049), relationship with volunteer work coordinators (F=-2.517, P=0.013), relation with hospital staffs (F=5.202, P=0.007), and support of their volunteer work by their family and friends (t=-3.394, P=0.001). Conclusion: The satisfaction of hospice volunteer activity was moderate. The satisfaction for hospice volunteer activity was shown by significant difference according to sex (t=2.038, P=0.044), marital status (F=3.806, P=0.013), years involved in volunteer work (F=3.326), main reason to do volunteer work (F=2.707, P=0.035), receive any training or preparation for volunteer work (t=-1.982, 0=0.050), frequency of evaluation for volunteer work (F=7.877, P=0.000), suitability of volunteer's skill and ability to voluntary work (t=2.712, P=0.049), relationship with volunteer work coordinator (F=-2.517, P=0.013), relation with hospital staffs (F=5.202, P=0.007), and family and friend's support for volunteer work (t=-3.394, P=0.001). Therefore, it is necessary to consider various factors to improve the satisfaction of voluntary work.
1. Introduction Today Internet is recognized as an important way for the transaction of products and services. According to the data surveyed by the National Statistical Office, the on-line transaction in 2007 for a year, 15.7656 trillion, shows a 17.1%(2.3060 trillion won) increase over last year, of these, the amount of B2C has been increased 12.0%(10.2258 trillion won). Like this, because the entry barrier of on-line market of Korea is low, many retailers could easily enter into the market. So the bigger its scale is, but on the other hand, the tougher its competition is. Particularly due to the Internet and innovation of IT, the existing market has been changed into the perfect competitive market(Srinivasan, Rolph & Kishore, 2002). In the early years of on-line business, they think that the main reason for success is a moderate price, they are awakened to its importance of on-line service quality with tough competition. If it's not sure whether customers can be provided with what they want, they can use the Web sites, perhaps they can trust their products that had been already bought or not, they have a doubt its viability(Parasuraman, Zeithaml & Malhotra, 2005). Customers can directly reserve and issue their air tickets irrespective of place and time at the Web sites of travel agencies or airlines, but its empirical studies about these Web sites for reserving and issuing air tickets are insufficient. Therefore this study goes on for following specific objects. First object is to measure service quality and service recovery of Web sites for reserving and issuing air tickets. Second is to look into whether above on-line service quality and on-line service recovery have an impact on overall service quality. Third is to seek for the relation with overall service quality and customer satisfaction, then this customer satisfaction and loyalty intention. 2. Theoretical Background 2.1 On-line Service Quality Barnes & Vidgen(2000; 2001a; 2001b; 2002) had invented the tool to measure Web sites' quality four times(called WebQual). The WebQual 1.0, Step one invented a measuring item for information quality based on QFD, and this had been verified by students of UK business school. The Web Qual 2.0, Step two invented for interaction quality, and had been judged by customers of on-line bookshop. The WebQual 3.0, Step three invented by consolidating the WebQual 1.0 for information quality and the WebQual2.0 for interactionquality. It includes 3-quality-dimension, information quality, interaction quality, site design, and had been assessed and confirmed by auction sites(e-bay, Amazon, QXL). Furtheron, through the former empirical studies, the authors changed sites quality into usability by judging that usability is a concept how customers interact with or perceive Web sites and It is used widely for accessing Web sites. By this process, WebQual 4.0 was invented, and is consist of 3-quality-dimension; information quality, interaction quality, usability, 22 items. However, because WebQual 4.0 is focusing on technical part, it's usable at the Website's design part, on the other hand, it's not usable at the Web site's pleasant experience part. Parasuraman, Zeithaml & Malhorta(2002; 2005) had invented the measure for measuring on-line service quality in 2002 and 2005. The study in 2002 divided on-line service quality into 5 dimensions. But these were not well-organized, so there needed to be studied again totally. So Parasuraman, Zeithaml & Malhorta(2005) re-worked out the study about on-line service quality measure base on 2002's study and invented E-S-QUAL. After they invented preliminary measure for on-line service quality, they made up a question for customers who had purchased at amazon.com and walmart.com and reassessed this measure. And they perfected an invention of E-S-QUAL consists of 4 dimensions, 22 items of efficiency, system availability, fulfillment, privacy. Efficiency measures assess to sites and usability and others, system availability measures accurate technical function of sites and others, fulfillment measures promptness of delivering products and sufficient goods and others and privacy measures the degree of protection of data about their customers and so on. 2.2 Service Recovery Service industries tend to minimize the losses by coping with service failure promptly. This responses of service providers to service failure mean service recovery(Kelly & Davis, 1994). Bitner(1990) went on his study from customers' view about service providers' behavior for customers to recognize their satisfaction/dissatisfaction at service point. According to them, to manage service failure successfully, exact recognition of service problem, an apology, sufficient description about service failure and some tangible compensation are important. Parasuraman, Zeithaml & Malhorta(2005) approached the service recovery from how to measure, rather than how to manage, and moved to on-line market not to off-line, then invented E-RecS-QUAL which is a measuring tool about on-line service recovery. 2.3 Customer Satisfaction The definition of customer satisfaction can be divided into two points of view. First, they approached customer satisfaction from outcome of comsumer. Howard & Sheth(1969) defined satisfaction as 'a cognitive condition feeling being rewarded properly or improperly for their sacrifice.' and Westbrook & Reilly(1983) also defined customer satisfaction/dissatisfaction as 'a psychological reaction to the behavior pattern of shopping and purchasing, the display condition of retail store, outcome of purchased goods and service as well as whole market.' Second, they approached customer satisfaction from process. Engel & Blackwell(1982) defined satisfaction as 'an assessment of a consistency in chosen alternative proposal and their belief they had with them.' Tse & Wilton(1988) defined customer satisfaction as 'a customers' reaction to discordance between advance expectation and ex post facto outcome.' That is, this point of view that customer satisfaction is process is the important factor that comparing and assessing process what they expect and outcome of consumer. Unlike outcome-oriented approach, process-oriented approach has many advantages. As process-oriented approach deals with customers' whole expenditure experience, it checks up main process by measuring one by one each factor which is essential role at each step. And this approach enables us to check perceptual/psychological process formed customer satisfaction. Because of these advantages, now many studies are adopting this process-oriented approach(Yi, 1995). 2.4 Loyalty Intention Loyalty has been studied by dividing into behavioral approaches, attitudinal approaches and complex approaches(Dekimpe et al., 1997). In the early years of study, they defined loyalty focusing on behavioral concept, behavioral approaches regard customer loyalty as "a tendency to purchase periodically within a certain period of time at specific retail store." But the loyalty of behavioral approaches focuses on only outcome of customer behavior, so there are someone to point the limits that customers' decision-making situation or process were neglected(Enis & Paul, 1970; Raj, 1982; Lee, 2002). So the attitudinal approaches were suggested. The attitudinal approaches consider loyalty contains all the cognitive, emotional, voluntary factors(Oliver, 1997), define the customer loyalty as "friendly behaviors for specific retail stores." However these attitudinal approaches can explain that how the customer loyalty form and change, but cannot say positively whether it is moved to real purchasing in the future or not. This is a kind of shortcoming(Oh, 1995). 3. Research Design 3.1 Research Model Based on the objects of this study, the research model derived is
. 3.2 Hypotheses 3.2.1 The Hypothesis of On-line Service Quality and Overall Service Quality The relation between on-line service quality and overall service quality I-1. Efficiency of on-line service quality may have a significant effect on overall service quality. I-2. System availability of on-line service quality may have a significant effect on overall service quality. I-3. Fulfillment of on-line service quality may have a significant effect on overall service quality. I-4. Privacy of on-line service quality may have a significant effect on overall service quality. 3.2.2 The Hypothesis of On-line Service Recovery and Overall Service Quality The relation between on-line service recovery and overall service quality II-1. Responsiveness of on-line service recovery may have a significant effect on overall service quality. II-2. Compensation of on-line service recovery may have a significant effect on overall service quality. II-3. Contact of on-line service recovery may have a significant effect on overall service quality. 3.2.3 The Hypothesis of Overall Service Quality and Customer Satisfaction The relation between overall service quality and customer satisfaction III-1. Overall service quality may have a significant effect on customer satisfaction. 3.2.4 The Hypothesis of Customer Satisfaction and Loyalty Intention The relation between customer satisfaction and loyalty intention IV-1. Customer satisfaction may have a significant effect on loyalty intention. 3.2.5 The Hypothesis of a Mediation Variable Wolfinbarger & Gilly(2003) and Parasuraman, Zeithaml & Malhotra(2005) had made clear that each dimension of service quality has a significant effect on overall service quality. Add to this, the authors analyzed empirically that each dimension of on-line service quality has a positive effect on customer satisfaction. With that viewpoint, this study would examine if overall service quality mediates between on-line service quality and each dimension of customer satisfaction, keeping on looking into the relation between on-line service quality and overall service quality, overall service quality and customer satisfaction. And as this study understands that each dimension of on-line service recovery also has an effect on overall service quality, this would examine if overall service quality also mediates between on-line service recovery and each dimension of customer satisfaction. Therefore these hypotheses followed are set up to examine if overall service quality plays its role as the mediation variable. The relation between on-line service quality and customer satisfaction V-1. Overall service quality may mediate the effects of efficiency of on-line service quality on customer satisfaction. V-2. Overall service quality may mediate the effects of system availability of on-line service quality on customer satisfaction. V-3. Overall service quality may mediate the effects of fulfillment of on-line service quality on customer satisfaction. V-4. Overall service quality may mediate the effects of privacy of on-line service quality on customer satisfaction. The relation between on-line service recovery and customer satisfaction VI-1. Overall service quality may mediate the effects of responsiveness of on-line service recovery on customer satisfaction. VI-2. Overall service quality may mediate the effects of compensation of on-line service recovery on customer satisfaction. VI-3. Overall service quality may mediate the effects of contact of on-line service recovery on customer satisfaction. 4. Empirical Analysis 4.1 Research design and the characters of data This empirical study aimed at customers who ever purchased air ticket at the Web sites for reservation and issue. Total 430 questionnaires were distributed, and 400 were collected. After surveying with the final questionnaire, the frequency test was performed about variables of sex, age which is demographic factors for analyzing general characters of sample data. Sex of data is consist of 146 of male(42.7%) and 196 of female(57.3%), so portion of female is a little higher. Age is composed of 11 of 10s(3.2%), 199 of 20s(58.2%), 105 of 30s(30.7%), 22 of 40s(6.4%), 5 of 50s(1.5%). The reason that portions of 20s and 30s are higher can be supposed that they use the Internet frequently and purchase air ticket directly. 4.2 Assessment of measuring scales This study used the internal consistency analysis to measure reliability, and then used the Cronbach'$\alpha$ to assess this. As a result of reliability test, Cronbach'$\alpha$ value of every component shows more than 0.6, it is found that reliance of the measured variables are ensured. After reliability test, the explorative factor analysis was performed. the factor sampling was performed by the Principal Component Analysis(PCA), the factor rotation was performed by the Varimax which is good for verifying mutual independence between factors. By the result of the initial factor analysis, items blocking construct validity were removed, and the result of the final factor analysis performed for verifying construct validity is followed above. 4.3 Hypothesis Testing 4.3.1 Hypothesis Testing by the Regression Analysis(SPSS) 4.3.2 Analysis of Mediation Effect To verify mediation effect of overall service quality of and , this study used the phased analysis method proposed by Baron & Kenny(1986) generally used. As
shows, Step 1 and Step 2 are significant, and mediation variable has a significant effect on dependent variables and so does independent variables at Step 3, too. And there needs to prove the partial mediation effect, independent variable's estimate ability at Step 3(Standardized coefficient $\beta$eta : efficiency=.164, system availability=.074, fulfillment=.108, privacy=.107) is smaller than its estimate ability at Step 2(Standardized coefficient $\beta$eta : efficiency=.409, system availability=.227, fulfillment=.386, privacy=.237), so it was proved that overall service quality played a role as the partial mediation between on-line service quality and satisfaction. As
shows, Step 1 and Step 2 are significant, and mediation variable has a significant effect on dependent variables and so does independent variables at Step 3, too. And there needs to prove the partial mediation effect, independent variable's estimate ability at Step 3(Standardized coefficient $\beta$eta : responsiveness=.164, compensation=.117, contact=.113) is smaller than its estimate ability at Step 2(Standardized coefficient $\beta$eta : responsiveness=.409, compensation=.386, contact=.237), so it was proved that overall service quality played a role as the partial mediation between on-line service recovery and satisfaction. Verified results on the basis of empirical analysis are followed. First, as the result of , it shows that all were chosen, so on-line service quality has a positive effect on overall service quality. Especially fulfillment of overall service quality has the most effect, and then efficiency, system availability, privacy in order. Second, as the result of , it shows that all were chosen, so on-line service recovery has a positive effect on overall service quality. Especially responsiveness of overall service quality has the most effect, and then contact, compensation in order. Third, as the result of and , it shows that and all were chosen, so overall service quality has a positive effect on customer satisfaction, customer satisfaction has a positive effect on loyalty intention. Fourth, as the result of and , it shows that and all were chosen, so overall service quality plays a role as the partial mediation between on-line service quality and customer satisfaction, on-line service recovery and customer satisfaction. 5. Conclusion This study measured and analyzed service quality and service recovery of the Web sites that customers made a reservation and issued their air tickets, and by improving customer satisfaction through the result, this study put its final goal to grope how to keep loyalty customers. On the basis of the result of empirical analysis, suggestion points of this study are followed. First, this study regarded E-S-QUAL that measures on-line service quality and E-RecS-QUAL that measures on-line service recovery as variables, so it overcame the limit of existing studies that used modified SERVQUAL to measure service quality of the Web sites. Second, it shows that fulfillment and efficiency of on-line service quality have the most significant effect on overall service quality. Therefore the Web sites of reserving and issuing air tickets should try harder to elevate efficiency and fulfillment. Third, privacy of on-line service quality has the least significant effect on overall service quality, but this may be caused by un-assurance of customers whether the Web sites protect safely their confidential information or not. So they need to notify customers of this fact clearly. Fourth, there are many cases that customers don't recognize the importance of on-line service recovery, but if they would think that On-line service recovery has an effect on customer satisfaction and loyalty intention, as its importance is very significant they should prepare for that. Fifth, because overall service quality has a positive effect on customer satisfaction and loyalty intention, they should try harder to elevate service quality and service recovery of the Web sites of reserving and issuing air tickets to maximize customer satisfaction and to secure loyalty customers. Sixth, it is found that overall service quality plays a role as the partial mediation, but now there are rarely existing studies about this, so there need to be more studies about this.
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