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No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

  • Yun Seok Suh;Jae Won Choi;Jeong Hee Yoon;Dong Ho Lee;Yoon Jun Kim;Jeong Hoon Lee;Su Jong Yu;Eun Ju Cho;Jung Hwan Yoon;Jeong Min Lee
    • Korean Journal of Radiology
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    • v.22 no.12
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    • pp.1974-1984
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    • 2021
  • Objective: This study aimed to compare the efficacy between no-touch (NT) radiofrequency ablation (RFA) and conventional RFA using twin internally cooled wet (TICW) electrodes in the bipolar mode for the treatment of small hepatocellular carcinomas (HCC). Materials and Methods: In this single-center, two-arm, parallel-group, prospective randomized controlled study, we performed a 1:1 random allocation of eligible patients with HCCs to receive NT-RFA or conventional RFA between October 2016 and September 2018. The primary endpoint was the cumulative local tumor progression (LTP) rate after RFA. Secondary endpoints included technical conversion rates of NT-RFA, intrahepatic distance recurrence, extrahepatic metastasis, technical parameters, technical efficacy, and rates of complications. Cumulative LTP rates were analyzed using Kaplan-Meier analysis and the Cox proportional hazard regression model. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat and as-treated analyses were performed. Results: Enrolled patients were randomly assigned to the NT-RFA group (37 patients with 38 HCCs) or the conventional RFA group (36 patients with 38 HCCs). Among the NT-RFA group patients, conversion to conventional RFA occurred in four patients (10.8%, 4/37). According to intention-to-treat analysis, both 1- and 3-year cumulative LTP rates were 5.6%, in the NT-RFA group, and they were 11.8% and 21.3%, respectively, in the conventional RFA group (p = 0.073, log-rank). In the as-treated analysis, LTP rates at 1 year and 3 years were 0% and 0%, respectively, in the NT-RFA group sand 15.6% and 24.5%, respectively, in the conventional RFA group (p = 0.004, log-rank). In as-treated analysis using multivariable Cox regression analysis, RFA type was the only significant predictive factor for LTP (hazard ratio = 0.061 with conventional RFA as the reference, 95% confidence interval = 0.000-0.497; p = 0.004). There were no significant differences in the procedure characteristics between the two groups. No procedure-related deaths or major complications were observed. Conclusion: NT-RFA using TICW electrodes in bipolar mode demonstrated significantly lower cumulative LTP rates than conventional RFA for small HCCs, which warrants a larger study for further confirmation.

Diagnostic Yield of Diffusion-Weighted Brain Magnetic Resonance Imaging in Patients with Transient Global Amnesia: A Systematic Review and Meta-Analysis

  • Su Jin Lim;Minjae Kim;Chong Hyun Suh;Sang Yeong Kim;Woo Hyun Shim;Sang Joon Kim
    • Korean Journal of Radiology
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    • v.22 no.10
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    • pp.1680-1689
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    • 2021
  • Objective: To investigate the diagnostic yield of diffusion-weighted imaging (DWI) in patients with transient global amnesia (TGA) and identify significant parameters affecting diagnostic yield. Materials and Methods: A systematic literature search of the MEDLINE and EMBASE databases was conducted to identify studies that assessed the diagnostic yield of DWI in patients with TGA. The pooled diagnostic yield of DWI in patients with TGA was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses were also performed of slice thickness, magnetic field strength, and interval between symptom onset and DWI. Results: Twenty-two original articles (1732 patients) were included. The pooled incidence of right, left, and bilateral hippocampal lesions was 37% (95% confidence interval [CI], 30-44%), 42% (95% CI, 39-46%), and 25% (95% CI, 20-30%) of all lesions, respectively. The pooled diagnostic yield of DWI in patients with TGA was 39% (95% CI, 27-52%). The Higgins I2 statistic showed significant heterogeneity (I2 = 95%). DWI with a slice thickness ≤ 3 mm showed a higher diagnostic yield than DWI with a slice thickness > 3 mm (pooled diagnostic yield: 63% [95% CI, 53-72%] vs. 26% [95% CI, 16-40%], p < 0.01). DWI performed at an interval between 24 and 96 hours after symptom onset showed a higher diagnostic yield (68% [95% CI, 57-78%], p < 0.01) than DWI performed within 24 hours (16% [95% CI, 7-34%]) or later than 96 hours (15% [95% CI, 8-26%]). There was no difference in the diagnostic yield between DWI performed using 3T vs. 1.5T (pooled diagnostic yield, 31% [95% CI, 25-38%] vs. 24% [95% CI, 14-37%], p = 0.31). Conclusion: The pooled diagnostic yield of DWI in TGA patients was 39%. DWI obtained with a slice thickness ≤ 3 mm or an interval between symptom onset and DWI of > 24 to 96 hours could increase the diagnostic yield.

Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis

  • Min Jung Ko;Dong A Park;Sung Hyun Kim;Eun Sook Ko;Kyung Hwan Shin;Woosung Lim;Beom Seok Kwak;Jung Min Chang
    • Korean Journal of Radiology
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    • v.22 no.8
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    • pp.1240-1252
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    • 2021
  • Objective: To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. Materials and Methods: Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. Results: Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86-0.93) and 0.90 (95% CI 0.84-0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68-0.83) and 0.83 (95% CI 0.73-0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93-0.97) for DBT and 0.86 (95% CI 0.82-0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. Conclusion: Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

Diagnostic Accuracy of CT for Evaluating Circumferential Resection Margin Status in Resectable or Borderline Resectable Pancreatic Head Cancer: A Prospective Study Using Axially Sliced Surgical Pathologic Correlation

  • Ji Hoon Park;Yoo-Seok Yoon;Seungjae Lee;Hae Young Kim;Ho-Seong Han;Jun Suh Lee;Won Chang;Haeryoung Kim;Hee Young Na;Seungyeob Han;Kyoung Ho Lee
    • Korean Journal of Radiology
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    • v.23 no.3
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    • pp.322-332
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    • 2022
  • Objective: CT plays a central role in determining the resectability of pancreatic cancer, which directs the use of neoadjuvant therapy. This study aimed to assess the diagnostic accuracy of CT in predicting circumferential resection margin (CRM) involvement in patients with resectable or borderline resectable pancreatic head cancer. Materials and Methods: Seventy-seven patients who were scheduled for upfront surgery for resectable or borderline resectable pancreatic head cancer were prospectively enrolled, and 75 patients (38 male and 37 female; mean age ± standard deviation, 68 ± 11 years) were finally analyzed. The CRM status was evaluated separately for the superior mesenteric artery (SMA) and posterior and superior mesenteric vein/portal vein (SMV/PV) margins. Three independent radiologists reviewed the preoperative CT images and evaluated the resection margin status. The reference standard for CRM status was pathologic examination of pancreaticoduodenectomy specimens in an axial plane perpendicular to the axis of the second portion of the duodenum. The diagnostic accuracy of CT was assessed for overall CRM involvement, defined as involvement of the SMA or posterior margins (per-patient analysis), and involvement of each of the three resection margins (per-margin analysis). The data were pooled using a crossed random effects model. Results: Forty patients had pathologically confirmed overall CRM involvement in pancreatic cancer, while CRM involvement was not seen in 35 patients. For overall CRM involvement, the pooled sensitivity and specificity were 15% (95% confidence interval: 7%-49%) and 99% (96%-100%), respectively. For each of the resection margins, the pooled sensitivity and specificity were 14% (9%-54%) and 99% (38%-100%) for the SMA margin, 12% (8%-46%) and 99% (97%-100%) for the posterior margin; and 37% (29%-53%) and 96% (31%-100%) for the SMV/PV margin, respectively. Conclusion: CT showed very high specificity but low sensitivity in predicting pathological CRM involvement in pancreatic cancer.

A Study on Setting Expected Targets for Satisfaction with the Frequency of Use of Construction Technology Information (건설기술정보의 활용 빈도 만족도에 대한 기대 목표치 설정에 관한 연구)

  • Seong-Yun Jeong
    • Journal of the Korean Society for Library and Information Science
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    • v.58 no.2
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    • pp.251-268
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    • 2024
  • Recently, with the implementation of the "e-Government Performance Management Guidelines," there is a growing demand for setting performance indicators for information systems. For systems that provide information services to the public, such as CODIL, it is not easy to set performance indicators. This study presented a research model that applies Monte Carlo simulation to set expected performance targets that can be achieved through CODIL based on objective evidence. Among the survey contents conducted from 2015 to 2023, the statistical characteristics of user satisfaction regarding the frequency of use of construction technology information provided by CODIL were designated as input variables. Future expected targets and confidence intervals from 2024 to 2026 were designated as outcome variables. The expected target value was measured by generating 5 simulation alternatives and 1,000 random numbers for each alternative. Next, the measured expected goals were interpreted and compared with the results of time series regression analysis measured in previous studies. Although, as in previous studies, the expected target value could not be predicted based on time series regression analysis that considers the correlation between years. However, compared to previous studies, this study can be considered a more accurate analysis result because it predicted the expected target value based on 5,000 input variables.

Meta-Analysis of ESD Program Studies in Home Economics Classes (가정과수업에서 ESD 프로그램 연구의 메타분석)

  • Yu, Nan Sook;Park, Mi Jeong
    • Journal of Korean Home Economics Education Association
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    • v.35 no.3
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    • pp.97-116
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    • 2023
  • This study conducted a meta-analysis on the effectiveness of education for sustainable development (ESD) programs within home economics classes. Articles spanning from 2000 to April 2023 were sourced from the Korean Citation Index (KCI) using search terms such as 'environment', 'sustainable', 'ESD', 'green', 'ecology', and 'home economics' in conjunction with 'development', 'application', and 'effectiveness'. Out of the gathered articles, 41 were chosen for analysis. Using a random effects model, the overall effect size was measured at 0.51 (SE=.08), suggesting that ESD programs significantly enhance student achievement in home economics. Further analysis of the 62 effect sizes, categorized by research design, ESD area (society, environment, economy), content area, school level, and school location, revealed that the research design, content area, and school location functioned as moderating variables. The findings of this meta-analysis underscore the efficacy of ESD in home economics education. Additionally, this study paves the way for future research, highlighting the importance of integrating economic perspectives in ESD, such as sustainable production and consumption, corporate sustainability, and market economy within home economics classes.

Discussion on Detection of Sediment Moisture Content at Different Altitudes Employing UAV Hyperspectral Images (무인항공 초분광 영상을 기반으로 한 고도에 따른 퇴적물 함수율 탐지 고찰)

  • Kyoungeun Lee;Jaehyung Yu;Chanhyeok Park;Trung Hieu Pham
    • Economic and Environmental Geology
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    • v.57 no.4
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    • pp.353-362
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    • 2024
  • This study examined the spectral characteristics of sediments according to moisture content using an unmanned aerial vehicle (UAV)-based hyperspectral sensor and evaluated the efficiency of moisture content detection at different flight altitudes. For this purpose, hyperspectral images in the 400-1000nm wavelength range were acquired and analyzed at altitudes of 40m and 80m for sediment samples with various moisture contents. The reflectance of the sediments generally showed a decreasing trend as the moisture content increased. Correlation analysis between moisture content and reflectance showed a strong negative correlation (r < -0.8) across the entire 400-900nm range. The moisture content detection model constructed using the Random Forest technique showed detection accuracies of RMSE 2.6%, R2 0.92 at 40m altitude and RMSE 2.2%, R2 0.95 at 80m altitude, confirming that the difference in accuracy between altitudes was minimal. Variable importance analysis revealed that the 600-700nm band played a crucial role in moisture content detection. This study is expected to be utilized in efficient sediment moisture management and natural disaster prediction in the field of environmental monitoring in the future.

A Time Series Graph based Convolutional Neural Network Model for Effective Input Variable Pattern Learning : Application to the Prediction of Stock Market (효과적인 입력변수 패턴 학습을 위한 시계열 그래프 기반 합성곱 신경망 모형: 주식시장 예측에의 응용)

  • Lee, Mo-Se;Ahn, Hyunchul
    • Journal of Intelligence and Information Systems
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    • v.24 no.1
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    • pp.167-181
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    • 2018
  • Over the past decade, deep learning has been in spotlight among various machine learning algorithms. In particular, CNN(Convolutional Neural Network), which is known as the effective solution for recognizing and classifying images or voices, has been popularly applied to classification and prediction problems. In this study, we investigate the way to apply CNN in business problem solving. Specifically, this study propose to apply CNN to stock market prediction, one of the most challenging tasks in the machine learning research. As mentioned, CNN has strength in interpreting images. Thus, the model proposed in this study adopts CNN as the binary classifier that predicts stock market direction (upward or downward) by using time series graphs as its inputs. That is, our proposal is to build a machine learning algorithm that mimics an experts called 'technical analysts' who examine the graph of past price movement, and predict future financial price movements. Our proposed model named 'CNN-FG(Convolutional Neural Network using Fluctuation Graph)' consists of five steps. In the first step, it divides the dataset into the intervals of 5 days. And then, it creates time series graphs for the divided dataset in step 2. The size of the image in which the graph is drawn is $40(pixels){\times}40(pixels)$, and the graph of each independent variable was drawn using different colors. In step 3, the model converts the images into the matrices. Each image is converted into the combination of three matrices in order to express the value of the color using R(red), G(green), and B(blue) scale. In the next step, it splits the dataset of the graph images into training and validation datasets. We used 80% of the total dataset as the training dataset, and the remaining 20% as the validation dataset. And then, CNN classifiers are trained using the images of training dataset in the final step. Regarding the parameters of CNN-FG, we adopted two convolution filters ($5{\times}5{\times}6$ and $5{\times}5{\times}9$) in the convolution layer. In the pooling layer, $2{\times}2$ max pooling filter was used. The numbers of the nodes in two hidden layers were set to, respectively, 900 and 32, and the number of the nodes in the output layer was set to 2(one is for the prediction of upward trend, and the other one is for downward trend). Activation functions for the convolution layer and the hidden layer were set to ReLU(Rectified Linear Unit), and one for the output layer set to Softmax function. To validate our model - CNN-FG, we applied it to the prediction of KOSPI200 for 2,026 days in eight years (from 2009 to 2016). To match the proportions of the two groups in the independent variable (i.e. tomorrow's stock market movement), we selected 1,950 samples by applying random sampling. Finally, we built the training dataset using 80% of the total dataset (1,560 samples), and the validation dataset using 20% (390 samples). The dependent variables of the experimental dataset included twelve technical indicators popularly been used in the previous studies. They include Stochastic %K, Stochastic %D, Momentum, ROC(rate of change), LW %R(Larry William's %R), A/D oscillator(accumulation/distribution oscillator), OSCP(price oscillator), CCI(commodity channel index), and so on. To confirm the superiority of CNN-FG, we compared its prediction accuracy with the ones of other classification models. Experimental results showed that CNN-FG outperforms LOGIT(logistic regression), ANN(artificial neural network), and SVM(support vector machine) with the statistical significance. These empirical results imply that converting time series business data into graphs and building CNN-based classification models using these graphs can be effective from the perspective of prediction accuracy. Thus, this paper sheds a light on how to apply deep learning techniques to the domain of business problem solving.

The Relations between Financial Constraints and Dividend Smoothing of Innovative Small and Medium Sized Enterprises (혁신형 중소기업의 재무적 제약과 배당스무딩간의 관계)

  • Shin, Min-Shik;Kim, Soo-Eun
    • Korean small business review
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    • v.31 no.4
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    • pp.67-93
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    • 2009
  • The purpose of this paper is to explore the relations between financial constraints and dividend smoothing of innovative small and medium sized enterprises(SMEs) listed on Korea Securities Market and Kosdaq Market of Korea Exchange. The innovative SMEs is defined as the firms with high level of R&D intensity which is measured by (R&D investment/total sales) ratio, according to Chauvin and Hirschey (1993). The R&D investment plays an important role as the innovative driver that can increase the future growth opportunity and profitability of the firms. Therefore, the R&D investment have large, positive, and consistent influences on the market value of the firm. In this point of view, we expect that the innovative SMEs can adjust dividend payment faster than the noninnovative SMEs, on the ground of their future growth opportunity and profitability. And also, we expect that the financial unconstrained firms can adjust dividend payment faster than the financial constrained firms, on the ground of their financing ability of investment funds through the market accessibility. Aivazian et al.(2006) exert that the financial unconstrained firms with the high accessibility to capital market can adjust dividend payment faster than the financial constrained firms. We collect the sample firms among the total SMEs listed on Korea Securities Market and Kosdaq Market of Korea Exchange during the periods from January 1999 to December 2007 from the KIS Value Library database. The total number of firm-year observations of the total sample firms throughout the entire period is 5,544, the number of firm-year observations of the dividend firms is 2,919, and the number of firm-year observations of the non-dividend firms is 2,625. About 53%(or 2,919) of these total 5,544 observations involve firms that make a dividend payment. The dividend firms are divided into two groups according to the R&D intensity, such as the innovative SMEs with larger than median of R&D intensity and the noninnovative SMEs with smaller than median of R&D intensity. The number of firm-year observations of the innovative SMEs is 1,506, and the number of firm-year observations of the noninnovative SMEs is 1,413. Furthermore, the innovative SMEs are divided into two groups according to level of financial constraints, such as the financial unconstrained firms and the financial constrained firms. The number of firm-year observations of the former is 894, and the number of firm-year observations of the latter is 612. Although all available firm-year observations of the dividend firms are collected, deletions are made in the case of financial industries such as banks, securities company, insurance company, and other financial services company, because their capital structure and business style are widely different from the general manufacturing firms. The stock repurchase was involved in dividend payment because Grullon and Michaely (2002) examined the substitution hypothesis between dividends and stock repurchases. However, our data structure is an unbalanced panel data since there is no requirement that the firm-year observations data are all available for each firms during the entire periods from January 1999 to December 2007 from the KIS Value Library database. We firstly estimate the classic Lintner(1956) dividend adjustment model, where the decision to smooth dividend or to adopt a residual dividend policy depends on financial constraints measured by market accessibility. Lintner model indicates that firms maintain stable and long run target payout ratio, and that firms adjust partially the gap between current payout rato and target payout ratio each year. In the Lintner model, dependent variable is the current dividend per share(DPSt), and independent variables are the past dividend per share(DPSt-1) and the current earnings per share(EPSt). We hypothesized that firms adjust partially the gap between the current dividend per share(DPSt) and the target payout ratio(Ω) each year, when the past dividend per share(DPSt-1) deviate from the target payout ratio(Ω). We secondly estimate the expansion model that extend the Lintner model by including the determinants suggested by the major theories of dividend, namely, residual dividend theory, dividend signaling theory, agency theory, catering theory, and transactions cost theory. In the expansion model, dependent variable is the current dividend per share(DPSt), explanatory variables are the past dividend per share(DPSt-1) and the current earnings per share(EPSt), and control variables are the current capital expenditure ratio(CEAt), the current leverage ratio(LEVt), the current operating return on assets(ROAt), the current business risk(RISKt), the current trading volume turnover ratio(TURNt), and the current dividend premium(DPREMt). In these control variables, CEAt, LEVt, and ROAt are the determinants suggested by the residual dividend theory and the agency theory, ROAt and RISKt are the determinants suggested by the dividend signaling theory, TURNt is the determinant suggested by the transactions cost theory, and DPREMt is the determinant suggested by the catering theory. Furthermore, we thirdly estimate the Lintner model and the expansion model by using the panel data of the financial unconstrained firms and the financial constrained firms, that are divided into two groups according to level of financial constraints. We expect that the financial unconstrained firms can adjust dividend payment faster than the financial constrained firms, because the former can finance more easily the investment funds through the market accessibility than the latter. We analyzed descriptive statistics such as mean, standard deviation, and median to delete the outliers from the panel data, conducted one way analysis of variance to check up the industry-specfic effects, and conducted difference test of firms characteristic variables between innovative SMEs and noninnovative SMEs as well as difference test of firms characteristic variables between financial unconstrained firms and financial constrained firms. We also conducted the correlation analysis and the variance inflation factors analysis to detect any multicollinearity among the independent variables. Both of the correlation coefficients and the variance inflation factors are roughly low to the extent that may be ignored the multicollinearity among the independent variables. Furthermore, we estimate both of the Lintner model and the expansion model using the panel regression analysis. We firstly test the time-specific effects and the firm-specific effects may be involved in our panel data through the Lagrange multiplier test that was proposed by Breusch and Pagan(1980), and secondly conduct Hausman test to prove that fixed effect model is fitter with our panel data than the random effect model. The main results of this study can be summarized as follows. The determinants suggested by the major theories of dividend, namely, residual dividend theory, dividend signaling theory, agency theory, catering theory, and transactions cost theory explain significantly the dividend policy of the innovative SMEs. Lintner model indicates that firms maintain stable and long run target payout ratio, and that firms adjust partially the gap between the current payout ratio and the target payout ratio each year. In the core variables of Lintner model, the past dividend per share has more effects to dividend smoothing than the current earnings per share. These results suggest that the innovative SMEs maintain stable and long run dividend policy which sustains the past dividend per share level without corporate special reasons. The main results show that dividend adjustment speed of the innovative SMEs is faster than that of the noninnovative SMEs. This means that the innovative SMEs with high level of R&D intensity can adjust dividend payment faster than the noninnovative SMEs, on the ground of their future growth opportunity and profitability. The other main results show that dividend adjustment speed of the financial unconstrained SMEs is faster than that of the financial constrained SMEs. This means that the financial unconstrained firms with high accessibility to capital market can adjust dividend payment faster than the financial constrained firms, on the ground of their financing ability of investment funds through the market accessibility. Futhermore, the other additional results show that dividend adjustment speed of the innovative SMEs classified by the Small and Medium Business Administration is faster than that of the unclassified SMEs. They are linked with various financial policies and services such as credit guaranteed service, policy fund for SMEs, venture investment fund, insurance program, and so on. In conclusion, the past dividend per share and the current earnings per share suggested by the Lintner model explain mainly dividend adjustment speed of the innovative SMEs, and also the financial constraints explain partially. Therefore, if managers can properly understand of the relations between financial constraints and dividend smoothing of innovative SMEs, they can maintain stable and long run dividend policy of the innovative SMEs through dividend smoothing. These are encouraging results for Korea government, that is, the Small and Medium Business Administration as it has implemented many policies to commit to the innovative SMEs. This paper may have a few limitations because it may be only early study about the relations between financial constraints and dividend smoothing of the innovative SMEs. Specifically, this paper may not adequately capture all of the subtle features of the innovative SMEs and the financial unconstrained SMEs. Therefore, we think that it is necessary to expand sample firms and control variables, and use more elaborate analysis methods in the future studies.

Service Quality, Customer Satisfaction and Customer Loyalty of Mobile Communication Industry in China (중국이동통신산업중적복무질량(中国移动通信产业中的服务质量), 고객만의도화고객충성도(顾客满意度和顾客忠诚度))

  • Zhang, Ruijin;Li, Xiangyang;Zhang, Yunchang
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.3
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    • pp.269-277
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    • 2010
  • Previous studies have shown that the most important factor affecting customer loyalty in the service industry is service quality. However, on the subject of whether service quality has a direct or indirect effect on customer loyalty, scholars' views apparently vary. Some studies suggest that service quality has a direct and fundamental influence on customer loyalty (Bai and Liu, 2002). However, others have shown that service quality not only directly affects customer loyalty, it also has an indirect impact on customer loyalty by influencing customer satisfaction and perceived value (Cronin, Brady, and Hult, 2000). Currently, there are few domestic articles that specifically address the relationship between service quality and customer loyalty in the mobile communication industry. Moreover, research has studied customer loyalty as a whole variable, rather than breaking it down further into multiple dimensions. Based on this analysis, this paper summarizes previous study results, establishes an effect mechanism model among service quality, customer satisfaction, and customer loyalty in the mobile communication industry, and presents a statistical test on model assumptions by using customer investigation data from Heilongjiang Mobile Company. It provides theoretical guidance for mobile service management based on the discussion of the hypothesis test results. For data collection, the sample comprised mobile users in Harbin city, and the survey was taken by random sampling. Out of a total of 300 questionnaires, 276 (92.9%) were recovered. After excluding invalid questionnaires, 249 remained, for an effective rate of 82.6 percent for the study. Cronbach's ${\alpha}$ coefficient was adapted to assess the scale reliability, and validity testing was conducted on the questionnaire from three aspects: content validity, construct validity. and convergent validity. The study tested for goodness of fit mainly from the absolute and relative fit indexes. From the hypothesis testing results, overall, four assumptions have not been supported. The ultimate affective relationship of service quality, customer satisfaction, and customer loyalty is demonstrated in Figure 2. On the whole, the service quality of the communication industry not only has a direct positive significant effect on customer loyalty, it also has an indirect positive significant effect on customer loyalty through service quality; the affective mechanism and extent of customer loyalty are different, and are influenced by each dimension of service quality. This study used the questionnaires of existing literature from home and abroad and tested them in empirical research, with all questions adapted to seven-point Likert scales. With the SERVQUAL scale of Parasuraman, Zeithaml, and Berry (1988), or PZB, as a reference point, service quality was divided into five dimensions-tangibility, reliability, responsiveness, assurance, and empathy-and the questions were simplified down to nineteen. The measurement of customer satisfaction was based mainly on Fornell (1992) and Wang and Han (2003), ending up with four questions. Based on the study’s three indicators of price tolerance, first choice, and complaint reaction were used to measure attitudinal loyalty, while repurchase intention, recommendation, and reputation measured behavioral loyalty. The collection and collation of literature data produced a model of the relationship among service quality, customer satisfaction, and customer loyalty in mobile communications, and China Mobile in the city of Harbin in Heilongjiang province was used for conducting an empirical test of the model and obtaining some useful conclusions. First, service quality in mobile communication is formed by the five factors mentioned earlier: tangibility, reliability, responsiveness, assurance, and empathy. On the basis of PZB SERVQUAL, the study designed a measurement scale of service quality for the mobile communications industry, and obtained these five factors through exploratory factor analysis. The factors fit basically with the five elements, indicating the concept of five elements of service quality for the mobile communications industry. Second, service quality in mobile communications has both direct and indirect positive effects on attitudinal loyalty, with the indirect effect being produced through the intermediary variable, customer satisfaction. There are also both direct and indirect positive effects on behavioral loyalty, with the indirect effect produced through two intermediary variables: customer satisfaction and attitudinal loyalty. This shows that better service quality and higher customer satisfaction will activate the attitudinal to service providers more active and show loyalty to service providers much easier. In addition, the effect mechanism of all dimensions of service quality on all dimensions of customer loyalty is different. Third, customer satisfaction plays a significant intermediary role among service quality and attitudinal and behavioral loyalty, indicating that improving service quality can boost customer satisfaction and make it easier for satisfied customers to become loyal customers. Moreover, attitudinal loyalty plays a significant intermediary role between service quality and behavioral loyalty, indicating that only attitudinally and behaviorally loyal customers are truly loyal customers. The research conclusions have some indications for Chinese telecom operators and others to upgrade their service quality. Two limitations to the study are also mentioned. First, all data were collected in the Heilongjiang area, so there might be a common method bias that skews the results. Second, the discussion addresses the relationship between service quality and customer loyalty, setting customer satisfaction as mediator, but does not consider other factors, like customer value and consumer features, This research will be continued in the future.