• Journal of the Korean Society of Radiology
• /
• v.17 no.6
• /
• pp.903-909
• /
• 2023

The purpose of this study is to compare and analyze the effect of changes in the patient's central position on the exposure dose and image quality of surrounding organs during a chest lateral examination using an Auto Exposure Control(AEC). The experiment was conducted on a human body phantom. A needle was attached to the lower part of the center of the coronal plane of the phantom, and a lead ruler was attached to the lower part of the detector so that the 50 cm point was located at the lower center of the AEC ion chamber. The exposure conditions were 125 kVp, 320 mA, the distance between the source and the image receptor was 180 cm, and the exposure field size was 14 × 17 inches. Only one AEC ion chamber was used at the bottom center, and the density was set to '0' and sensitivity to 'Middle', and the central X-ray was incident vertically toward the 6th thoracic vertebra. With AEC mode applied, the 50 cm point of the needle and lead ruler were aligned and the phantom was moved 5 cm toward the stomach (F5) and 5 cm toward the back (B5), and the dose factor was analyzed by measuring ESD. The ESD of the thyroid gland according to the change in patient center position was 232.60±2.20 μGy for Center, 231.22±1.53 μGy for F5, and 184.37±1.19 μGy for B5, and the ESD of the breast was 288.54±3.03 μGy for Center, F5 was 260.97±1.93 μGy, B5 was 229.80±1.62 μGy, and the ESD of the center of the lung was 337.02±3.25 μGy for Center, F5 was 336.09±2.29 μGy, and B5 was 261.76±1.68 μGy. As a result of comparing the average values of dose factors between each group, the difference in average values was statistically significant (p<0.01), and each group appeared to be independent. As a result of the study, there was no significant difference in the dose to the thyroid, breast, and center of the lung according to the change in the patient's central position, except for the breast (10%) when the patient moved forward about 5 cm. However, movement of about 5 cm posteriorly resulted in an average dose reduction of 23.7%. Additionally, when the patient's central position was moved to the rear, image quality deteriorated.

• Health Policy and Management
• /
• v.34 no.1
• /
• pp.78-86
• /
• 2024

Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use of inpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021-2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. The dependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable was whether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type, surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number of orthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospital showed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital, indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. In our study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the cost-effectiveness of specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals in metropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designating specialty hospitals in non-metropolitan areas, such as introducing "semi-specialty hospitals (tentative name)," will lead to a reduction in health disparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals' medical staff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriately allocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.

• The Transactions of the Korea Information Processing Society
• /
• v.13 no.4
• /
• pp.189-198
• /
• 2024

Lipreading is one of the important parts of speech recognition, and several studies have been conducted to improve the performance of lipreading in lipreading systems for speech recognition. Recent studies have used method to modify the model architecture of lipreading system to improve recognition performance. Unlike previous research that improve recognition performance by modifying model architecture, we aim to improve recognition performance without any change in model architecture. In order to improve the recognition performance without modifying the model architecture, we refer to the cues used in human lipreading and set other regions such as chin and cheeks as regions of interest along with the lip region, which is the existing region of interest of lipreading systems, and compare the recognition rate of each region of interest to propose the highest performing region of interest In addition, assuming that the difference in normalization results caused by the difference in interpolation method during the process of normalizing the size of the region of interest affects the recognition performance, we interpolate the same region of interest using nearest neighbor interpolation, bilinear interpolation, and bicubic interpolation, and compare the recognition rate of each interpolation method to propose the best performing interpolation method. Each region of interest was detected by training an object detection neural network, and dynamic time warping templates were generated by normalizing each region of interest, extracting and combining features, and mapping the dimensionality reduction of the combined features into a low-dimensional space. The recognition rate was evaluated by comparing the distance between the generated dynamic time warping templates and the data mapped to the low-dimensional space. In the comparison of regions of interest, the result of the region of interest containing only the lip region showed an average recognition rate of 97.36%, which is 3.44% higher than the average recognition rate of 93.92% in the previous study, and in the comparison of interpolation methods, the bilinear interpolation method performed 97.36%, which is 14.65% higher than the nearest neighbor interpolation method and 5.55% higher than the bicubic interpolation method. The code used in this study can be found a https://github.com/haraisi2/Lipreading-Systems.

• Radiation Oncology Journal
• /
• v.23 no.3
• /
• pp.143-156
• /
• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• KDI Journal of Economic Policy
• /
• v.12 no.3
• /
• pp.27-45
• /
• 1990

Two opposing views prevail regarding the economic impact of rural out-migration on the rural areas of origin. The optimistic neoclassical view argues that rapid rural out-migration is not detrimental to the income and welfare of the rural areas of origin, whereas Lipton (1980) argues the opposite. We developed our own alternative model for rural to urban migration, appropriate for rapidly developing economies such as Korea's. This model, which adopts international trade theories of nontraded goods and Dutch Disease to rural to urban migration issues, argues that rural to urban migration is caused mainly by two factors: first, the unprofitability of farming, and second, the decrease in demand for rural nontraded goods and the increase in demand for urban nontraded goods. The unprofitability of farming is caused by the increase in rural wages, which is induced by increasing urban wages in booming urban manufacturing sectors, and by the fact that the cost increases in farming cannot be shifted to consumers, because farm prices are fixed worldwide and because the income demand elasticity for farm products is very low. The demand for nontraded goods decreases in rural and increases in urban areas because population density and income in urban areas increase sharply, while those in rural areas decrease sharply, due to rapid rural to urban migration. Given that the market structure for nontraded goods-namely, service sectors including educational and health facilities-is mostly in monopolistically competitive, and that the demand for nontraded goods comes only from local sources, the urban service sector enjoys economies of scale, and can thus offer services at cheaper prices and in greater variety, whereas the rural service sector cannot enjoy the advantages offered by scale economies. Our view concerning the economic impact of rural to urban migration on rural areas of origin agrees with Lipton's pessimistic view that rural out-migration is detrimental to the income and welfare of rural areas. However, our reasons for the reduction of rural income are different from those in Lipton's model. Lipton argued that rural income and welfare deteriorate mainly because of a shortage of human capital, younger workers and talent resulting from selective rural out-migration. Instead, we believe that rural income declines, first, because a rapid rural-urban migration creates a further shortage of farm labor supplies and increases rural wages, and thus reduces further the profitability of farming and, second, because a rapid rural-urban migration causes a further decline of the rural service sectors. Empirical tests of our major hypotheses using Korean census data from 1966, 1970, 1975, 1980 and 1985 support our own model much more than the neoclassical or Lipton's models. A kun (county) with a large out-migration had a smaller proportion of younger working aged people in the population, and a smaller proportion of highly educated workers. But the productivity of farm workers, measured in terms of fall crops (rice) purchased by the government per farmer or per hectare of irrigated land, did not decline despite the loss of these youths and of human capital. The kun having had a large out-migration had a larger proportion of the population in the farm sector and a smaller proportion in the service sector. The kun having had a large out-migration also had a lower income measured in terms of the proportion of households receiving welfare payments or the amount of provincial taxes paid per household. The lower incomes of these kuns might explain why the kuns that experienced a large out-migration had difficulty in mechanizing farming. Our policy suggestions based on the tests of the currently prevailing hypotheses are as follows: 1) The main cause of farming difficulties is not a lack of human capital, but the in­crease in production costs due to rural wage increases combined with depressed farm output prices. Therefore, a more effective way of helping farm economies is by increasing farm output prices. However, we are not sure whether an increase in farm output prices is desirable in terms of efficiency. 2) It might be worthwhile to attempt to increase the size of farmland holdings per farm household so that the mechanization of farming can be achieved more easily. 3) A kun with large out-migration suffers a deterioration in income and welfare. Therefore, the government should provide a form of subsidization similar to the adjustment assistance provided for international trade. This assistance should not be related to the level of farm output. Otherwise, there is a possibility that we might encourage farm production which would not be profitable in the absence of subsidies. 4) Government intervention in agricultural research and its dissemination, and large-scale social overhead projects in rural areas, carried out by the Korean government, might be desirable from both efficiency and equity points of view. Government interventions in research are justified because of the problems associated with the appropriation of knowledge, and government actions on large-scale projects are justified because they required collective action.

• The Journal of the Petrological Society of Korea
• /
• v.21 no.3
• /
• pp.287-307
• /
• 2012

The study area, which is located in the southeastern part of the Jirisan province of the Yeongnam massif, Korea, consists mainly of the Precambrian Hadong northern anorthosite complex (HNAC) and the Jirisan metamorphic rock complex (JMRC) and the Mesozoic granitoids which intrude them. Its tectonic frame is built into NS trend, unlike the general NE-trending tectonic frame of Korean Peninsula. This paper researched the structural characteristics at each deformation phase to clarify the geological structures associated with the NS-trending tectonic frame which was built in the HNAC and JMRC. The result indicates that the geological structures of this area were formed at least through three phases of deformation. (1) The $D_1$ deformation formed the $F_1$ sheath or "A"-type folds in the HNAC and JMRC, and the $S_{0-1}$ composite foliation and the $S_1$ foliation and the $D_1$ ductile shear zone which are (sub)parallel to the axial plane of $F_1$ fold, and the $L_1$ stretching lineation which is parallel to the $F_1$ fold axis owing to the large-scale top-to-the SE shearing on the $S_0$ foliation. (2) The $D_2$ deformation (re)folded the $D_1$ structural elements under the EW-trending tectonic compression environment, and formed the NS-trending $F_2$ open, tight, isoclinal, intrafolial folds with the $S_{0-1-2}$ composite foliation and the $S_2$ foliation and the $D_2$ ductile shear zone with S-C-C' structure and the $L_2$ stretching lineation which is (sub)parallel to the axial plane of $F_2$ fold. The extensive $D_2$ ductile shear zone (Hadong shear zone) of NS trend was persistently developed along the eastern boundary of HNAC and JMRC which would be to the limb of $F_2$ fold on a geological map scale. The Hadong shear zone is no less than 1.4 km width, and was formed in the mylonitization process which produced the mylonitic structure and the stretching lineation with the reduction of grain size during the $F_2$ passive folding. (3) The $D_3$ deformation formed the EW-trending $F_3$ kink or open fold under the NS-trending tectonic compression environment and partially rearranged the NS-trending pre-$D_3$ structural elements into (E)NE or (W)NW direction. The regional trend of $D_1$ tectonic frame before the $D_2$ deformation would be NE-SW unlike the present, and the NS-trending tectonic frame in the HNAC and JMRC like the present was formed by the rearrangement of the $D_1$ tectonic frame owing to the $F_2$ active and passive folding. Based on the main intrusion age of (N)NE-trending basic dyke in the study area, these three deformation events are interpreted to have occurred before the Late Paleozoic.

• Journal of Radiation Protection and Research
• /
• v.27 no.1
• /
• pp.1-10
• /
• 2002

High energy photon beams from medical linear accelerators produce large scattered radiation by various components of the treatment head, collimator and walls or objects in the treatment room including the patient. These scattered radiation do not provide therapeutic dose and are considered a hazard from the radiation safety perspective. Scattered dose of therapeutic high energy radiation beams are contributed significant unwanted dose to the patient. ICRP take the position that a dose of 500mGy may cause abortion at any stage of pregnancy and that radiation detriment to the fetus includes risk of mental retardation with a possible threshold in the dose response relationship around 100 mGy for the gestational period. The ICRP principle of as low as reasonably achievable (ALARA) was recommended for protection of occupation upon the linear no-threshold dose response hypothesis for cancer induction. We suggest this ALARA principle be applied to the fetus and testicle in therapeutic treatment. Radiation dose outside a photon treatment filed is mostly due to scattered photons. This scattered dose is a function of the distance from the beam edge, treatment geometry, primary photon energy, and depth in the patient. The need for effective shielding of the fetus and testicle is reinforced when young patients ate treated with external beam radiation therapy and then shielding designed to reduce the scattered photon dose to normal organs have to considered. Irradiation was performed in phantom using high energy photon beams produced by a Varian 2100C/D medical linear accelerator (Varian Oncology Systems, Palo Alto, CA) located at the Yonsei Cancer Center. The composite phantom used was comprised of a commercially available anthropomorphic Rando phantom (Phantom Laboratory Inc., Salem, YN) and a rectangular solid polystyrene phantom of dimensions $30cm{\times}30cm{\times}20cm$. the anthropomorphic Rando phantom represents an average man made from tissue equivalent materials that is transected into transverse 36 slices of 2.5cm thickness. Photon dose was measured using a Capintec PR-06C ionization chamber with Capintec 192 electrometer (Capintec Inc., Ramsey, NJ), TLD( VICTOREEN 5000. LiF) and film dosimetry V-Omat, Kodak). In case of fetus, the dosimeter was placed at a depth of loom in this phantom at 100cm source to axis distance and located centrally 15cm from the inferior edge of the $30cm{\times}30cm^2$ x-ray beam irradiating the Rando phantom chest wall. A acryl bridge of size $40cm{\times}40cm^2$ and a clear space of about 20 cm was fabricated and placed on top of the rectangular polystyrene phantom representing the abdomen of the patient. The leaf pot for testicle shielding was made as various shape, sizes, thickness and supporting stand. The scattered photon with and without shielding were measured at the representative position of the fetus and testicle. Measurement of radiation scattered dose outside fields and critical organs, like fetus position and testicle region, from chest or pelvic irradiation by large fie]d of high energy radiation beam was performed using an ionization chamber and film dosimetry. The scattered doses outside field were measured 5 - 10% of maximum doses in fields and exponentially decrease from field margins. The scattered photon dose received the fetus and testicle from thorax field irradiation was measured about 1 mGy/Gy of photon treatment dose. Shielding construction to reduce this scattered dose was investigated using lead sheet and blocks. Lead pot shield for testicle reduced the scatter dose under 10 mGy when photon beam of 60 Gy was irradiated in abdomen region. The scattered photon dose is reduced when the lead shield was used while the no significant reduction of scattered photon dose was observed and 2-3 mm lead sheets refuted the skin dose under 80% and almost electron contamination. The results indicate that it was possible to improve shielding to reduce scattered photon for fetus and testicle when a young patients were treated with a high energy photon beam.

• Journal of Chest Surgery
• /
• v.37 no.10
• /
• pp.845-855
• /
• 2004

Background: No general consensus has been available regarding the necessity of postoperative radiation therapy (PORT) and its optimal techniques in the patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We did retrospective analyses on the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. And we compared them with the pT3cwN0 NSCLC patients who did not received PORT during the same period. Material and Method: From Aug. of 1994 till June of 2002, 22 pT3cwN0 NSCLC patients received PORT-PORT (＋) group- and 16 pT3cwN0 NSCLC patients had no PORT-PORT (-) group. The radiation target volume for PORT (＋) group was confined to the tumor bed plus the immediate adjacent tissue only, and no regional lymphatics were included. The prognostic factors for all patients were analyzed and survival rates, failure patterns were compared with two groups. Result: Age, tumor size, depth of chest wall invasion, postoperative mobidities were greater in PORT (-) group than PORT (＋) group. In PORT (-) group, four patients who were consulted for PORT did not receive the PORT because of self refusal (3 patients) and delay in the wound repair (1 patient). For all patients, overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) rates at 5 years were 35.3%, 30.3%, 80.9%, 36.3%. In univariate and multivariate analysis, only PORT significantly affect the survival. The 5 year as rates were 43.3% in the PORT (＋) group and 25.0% in PORT (-) group (p=0.03). DFS, LRFS, DMFS rates were 36.9%, 84.9%, 43.1 % in PORT (＋) group and 18.8%, 79.4%, 21.9% in PORT(-) group respectively. Three patients in PORT (-) group died of intercurrent disease without the evidence of recurrence. Few suffered from acute and late radiation side effects, all of which were RTOG grade 2 or lower. Conclusion: The strategy of adding PORT to surgery to improve the probability not only of local control but also of survival could be justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. Authors were successful in the marked reduction of the incidence as well as the severity of the acute and late side effects of PORT, without taking too high risk of the regional failures by eliminating the regional lymphatics from the radiation target volume.

• Journal of Intelligence and Information Systems
• /
• v.27 no.1
• /
• pp.191-207
• /
• 2021

Up to this day, mobile communications have evolved rapidly over the decades, mainly focusing on speed-up to meet the growing data demands of 2G to 5G. And with the start of the 5G era, efforts are being made to provide such various services to customers, as IoT, V2X, robots, artificial intelligence, augmented virtual reality, and smart cities, which are expected to change the environment of our lives and industries as a whole. In a bid to provide those services, on top of high speed data, reduced latency and reliability are critical for real-time services. Thus, 5G has paved the way for service delivery through maximum speed of 20Gbps, a delay of 1ms, and a connecting device of 106/㎢ In particular, in intelligent traffic control systems and services using various vehicle-based Vehicle to X (V2X), such as traffic control, in addition to high-speed data speed, reduction of delay and reliability for real-time services are very important. 5G communication uses high frequencies of 3.5Ghz and 28Ghz. These high-frequency waves can go with high-speed thanks to their straightness while their short wavelength and small diffraction angle limit their reach to distance and prevent them from penetrating walls, causing restrictions on their use indoors. Therefore, under existing networks it's difficult to overcome these constraints. The underlying centralized SDN also has a limited capability in offering delay-sensitive services because communication with many nodes creates overload in its processing. Basically, SDN, which means a structure that separates signals from the control plane from packets in the data plane, requires control of the delay-related tree structure available in the event of an emergency during autonomous driving. In these scenarios, the network architecture that handles in-vehicle information is a major variable of delay. Since SDNs in general centralized structures are difficult to meet the desired delay level, studies on the optimal size of SDNs for information processing should be conducted. Thus, SDNs need to be separated on a certain scale and construct a new type of network, which can efficiently respond to dynamically changing traffic and provide high-quality, flexible services. Moreover, the structure of these networks is closely related to ultra-low latency, high confidence, and hyper-connectivity and should be based on a new form of split SDN rather than an existing centralized SDN structure, even in the case of the worst condition. And in these SDN structural networks, where automobiles pass through small 5G cells very quickly, the information change cycle, round trip delay (RTD), and the data processing time of SDN are highly correlated with the delay. Of these, RDT is not a significant factor because it has sufficient speed and less than 1 ms of delay, but the information change cycle and data processing time of SDN are factors that greatly affect the delay. Especially, in an emergency of self-driving environment linked to an ITS(Intelligent Traffic System) that requires low latency and high reliability, information should be transmitted and processed very quickly. That is a case in point where delay plays a very sensitive role. In this paper, we study the SDN architecture in emergencies during autonomous driving and conduct analysis through simulation of the correlation with the cell layer in which the vehicle should request relevant information according to the information flow. For simulation: As the Data Rate of 5G is high enough, we can assume the information for neighbor vehicle support to the car without errors. Furthermore, we assumed 5G small cells within 50 ~ 250 m in cell radius, and the maximum speed of the vehicle was considered as a 30km ~ 200 km/hour in order to examine the network architecture to minimize the delay.

• Journal of Global Scholars of Marketing Science
• /
• v.19 no.4
• /
• pp.32-43
• /
• 2009

Trust has been studied extensively in psychology, economics, and sociology, and its importance has been emphasized not only in marketing, but also in business disciplines in general. Unlike past relationships between suppliers and buyers, which take considerable advantage of private networks and may involve unethical business practices, partnerships between suppliers and buyers are at the core of success for industrial marketing amid intense global competition in the 21st century. A high level of mutual cooperation occurs through an exchange relationship based on trust, which brings long-term benefits, competitive enhancements, and transaction cost reductions, among other benefits, for both buyers and suppliers. In spite of the important role of trust, existing studies in buy-supply situations overlook the role of trust and do not systematically analyze the effect of trust on relational performance. Consequently, an in-depth study that determines the relation of trust to the relational performance between buyers and suppliers of business services is absolutely needed. Business services in this study, which include those supporting the manufacturing industry, are drawing attention as the economic growth engine for the next generation. The Korean government has selected business services as a strategic area for the development of manufacturing sectors. Since the demands for opening business services markets are becoming fiercer, the competitiveness of the business service industry must be promoted now more than ever. The purpose of this study is to investigate the effect of the mutual trust between buyers and suppliers on relational performance. Specifically, this study proposed a theoretical model of trust-relational performance in the transactions of business services and empirically tested the hypotheses delineated from the framework. The study suggests strategic implications based on research findings. Empirical data were collected via multiple methods, including via telephone, mail, and in-person interviews. Sample companies were knowledge-based companies supplying and purchasing business services in Korea. The present study collected data on a dyadic basis. Each pair of sample companies includes a buying company and its corresponding supplying company. Mutual trust was traced for each pair of companies. This study proposes a model of trust-relational performance of buying-supplying for business services. The model consists of trust and its antecedents and consequences. The trust of buyers is classified into trust toward the supplying company and trust toward salespersons. Viewing trust both at the individual level and the organizational level is based on the research of Doney and Cannon (1997). Normally, buyers are the subject of trust, but this study supposes that suppliers are the subjects. Hence, it uniquely focused on the bilateral perspective of perceived risk. In other words, suppliers, like buyers, are the subject of trust since transactions are normally bilateral. From this point of view, suppliers' trust in buyers is as important as buyers' trust in suppliers. The suppliers' trust is influenced by the extent to which it trusts the buying companies and the buyers. This classification of trust using an individual level and an organization level is based on the suggestion of Doney and Cannon (1997). Trust affects the process of supplier selection, which works in a bilateral manner. Suppliers are actively involved in the supplier selection process, working very closely with buyers. In addition, the process is affected by the extent to which each party trusts its partners. The selection process consists of certain steps: recognition, information search, supplier selection, and performance evaluation. As a result of the process, both buyers and suppliers evaluate the performance and take corrective actions on the basis of such outcomes as tangible, intangible, and/or side effects. The measurement of trust used for the present study was developed on the basis of the studies of Mayer, Davis and Schoorman (1995) and Mayer and Davis (1999). Based on their recommendations, the three dimensions of trust used for the study include ability, benevolence, and integrity. The original questions were adjusted to the context of the transactions of business services. For example, a question such as "He/she has professional capabilities" has been changed to "The salesperson showed professional capabilities while we talked about our products." The measurement used for this study differs from those used in previous studies (Rotter 1967; Sullivan and Peterson 1982; Dwyer and Oh 1987). The measurements of the antecedents and consequences of trust used for this study were developed on the basis of Doney and Cannon (1997). The original questions were adjusted to the context of transactions in business services. In particular, questions were developed for both buyers and suppliers to address the following factors: reputation (integrity, customer care, good-will), market standing (company size, market share, positioning in the industry), willingness to customize (product, process, delivery), information sharing (proprietary information, private information), willingness to maintain relationships, perceived professionalism, authority empowerment, buyer-seller similarity, and contact frequency. As a consequential variable of trust, relational performance was measured. Relational performance is classified into tangible effects, intangible effects, and side effects. Tangible effects include financial performance; intangible effects include improvements in relations, network developing, and internal employee satisfaction; side effects include those not included either in the tangible or intangible effects. Three hundred fifty pairs of companies were contacted, and one hundred five pairs of companies responded. After deleting five company pairs because of incomplete responses, one hundred five pairs of companies were used for data analysis. The response ratio of the companies used for data analysis is 30% (105/350), which is above the average response ratio in industrial marketing research. As for the characteristics of the respondent companies, the majority of the companies operate service businesses for both buyers (85.4%) and suppliers (81.8%). The majority of buyers (76%) deal with consumer goods, while the majority of suppliers (70%) deal with industrial goods. This may imply that buyers process the incoming material, parts, and components to produce the finished consumer goods. As indicated by their report of the length of acquaintance with their partners, suppliers appear to have longer business relationships than do buyers. Hypothesis 1 tested the effects of buyer-supplier characteristics on trust. The salesperson's professionalism (t=2.070, p<0.05) and authority empowerment (t=2.328, p<0.05) positively affected buyers' trust toward suppliers. On the other hand, authority empowerment (t=2.192, p<0.05) positively affected supplier trust toward buyers. For both buyers and suppliers, the degree of authority empowerment plays a crucial role in the maintenance of their trust in each other. Hypothesis 2 tested the effects of buyerseller relational characteristics on trust. Buyers tend to trust suppliers, as suppliers make every effort to contact buyers (t=2.212, p<0.05). This tendency has also been shown to be much stronger for suppliers (t=2.591, p<0.01). On the other hand suppliers trust buyers because suppliers perceive buyers as being similar to themselves (t=2.702, p<0.01). This finding confirmed the results of Crosby, Evans, and Cowles (1990), which reported that suppliers and buyers build relationships through regular meetings, either for business or personal matters. Hypothesis 3 tested the effects of trust on perceived risk. It has been found that for both suppliers and buyers the lower is the trust, the higher is the perceived risk (t=-6.621, p<0.01 for buyers; t=-2.437, p<0.05). Interestingly, this tendency has been shown to be much stronger for buyers than for suppliers. One possible explanation for this higher level of perceived risk is that buyers normally perceive higher risks than do suppliers in transactions involving business services. For this reason, it is necessary for suppliers to implement risk reduction strategies for buyers. Hypothesis 4 tested the effects of trust on information searching. It has been found that for both suppliers and buyers, contrary to expectation, trust depends on their partner's reputation (t=2.929, p<0.01 for buyers; t=2.711, p<0.05 for suppliers). This finding shows that suppliers with good reputations tend to be trusted. Prior experience did not show any significant relationship with trust for either buyers or suppliers. Hypothesis 5 tested the effects of trust on supplier/buyer selection. Unlike buyers, suppliers tend to trust buyers when they think that previous transactions with buyers were important (t=2.913 p<0.01). However, this study did not show any significant relationship between source loyalty and the trust of buyers in suppliers. Hypothesis 6 tested the effects of trust on relational performances. For buyers and suppliers, financial performance reportedly improved when they trusted their partners (t=2.301, p<0.05 for buyers; t=3.692, p<0.01 for suppliers). It is interesting that this tendency was much stronger for suppliers than it was for buyers. Similarly, competitiveness was reported to improve when buyers and suppliers trusted their partners (t=3.563, p<0.01 for buyers; t=3.042, p<0.01 for suppliers). For suppliers, efficiency and productivity were reportedly improved when they trusted buyers (t=2.673, p<0.01). Other performance indices showed insignificant relationships with trust. The findings of this study have some strategic implications. First and most importantly, trust-based transactions are beneficial for both suppliers and buyers. As verified in the study, financial performance can be improved through efforts to build and maintain mutual trust. Similarly, competitiveness can be increased through the same kinds of effort. Second, trust-based transactions can facilitate the reduction of perceived risks inherent in the purchasing situation. This finding has implications for both suppliers and buyers. It is generally believed that buyers perceive higher risks in a highly involved purchasing situation. To reduce risks, previous studies have recommended that suppliers devise risk-reducing tactics. Moving beyond these recommendations, the present study uniquely focused on the bilateral perspective of perceived risk. In other words, suppliers are also susceptible to perceived risks, especially when they supply services that require very technical and sophisticated manipulations and maintenance. Consequently, buyers and suppliers must solve problems together in close collaboration. Hence, mutual trust plays a crucial role in the problem-solving process. Third, as found in this study, the more authority a salesperson has, the more he or she can be trusted. This finding is very important with regard to tactics. Building trust is a long-term assignment; however, when mutual trust has not been developed, suppliers can overcome the problems they encounter by empowering a salesperson with the authority to make certain decisions. This finding applies to suppliers as well.