When do we use the Recycling Autograft in Limb Salvage Surgery? (사지구제술에서 언제 재활용 자가골 이식술이 유용한가?)
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- The Journal of the Korean bone and joint tumor society
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- v.14 no.2
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- pp.95-105
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- 2008
Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.
Recent improvements in living standard and development in medical care led to an increased interest in life expectancy and personal health, and also led to a more demand for higher quality of life. Thus, the problem of women's health draw a fresh interest nowadays. Since late-middle aged women experience various physical and socio-psychological changes and tend to have chronic illnesses, these women have to take initiatives for their health control by realizing their own responsibility. The basic elements for a healthy life of these women are understanding of their physical and psychological changes and acceptance of these changes. Health promoting behaviors of an individual or a group are actions toward increasing the level of well-being and self-actualization, and are affected by various variables. In Pender's health promoting model, variables are categorized into cognitive factors(individual perceptions), modifying factors, and variables affecting the likelihood for actions, and the model assumes the health promoting behaviors are affected by cognitive factors which are again affected by demographic factors. Since Pender's model was proposed based on a tool broad conceptual frame, many studies done afterwards have included only a limited number of variables of Pender's model. Furthermore, Pender's model did not precisely explain the possibilities of direct and indirect paths effects. The objectives of this study are to evaluate Pender's model and thus propose a model that explains health promoting behaviors among late-middle aged women in order to facilitate nursing intervention for this group of population. The hypothetical model was developed based on the Pender's health promoting model and the findings from past studies on women's health. Data were collected by self-reported questionnaires from 417 women living in Seoul, between July and November 1994. Questionnaires were developed based on instruments of Walker and others' health promotion lifestyle profile, Wallston and others' multidimensional health locus of control, Maoz's menopausal symptom check list and Speake and others' health self-rating scale. IN addition, items measuring self-efficacy were made by the present author based on past studies. In a pretest, the questionnaire items were reliable with Cronbach's alpha ranging from .786 to .934. The models for health promoting behaviors were tested by using structural equation modelling technique with LISREL 7.20. The results were summarized as follows : 1. The overall fit of the hypothetical model to the data was good (chi-square=4.42, df=5, p=.490, GFI=.995, AGFI=.962, RMSR=.024). 2. Paths of the model were modified by considering both its theoretical implication and statistical significance of the parameter estimates. Compared to the hypothetical model, the revised model has become parsimonious and had a better fit to the data (chi-square =4.55, df=6, p=.602, GFI=.995, AGFI=.967, RMSR=.024). 3. The results of statistical testing were as follows : 1) Family function internal health locus of control, self-efficacy, and education level exerted significant effects on health promoting behaviors(
Corporate social responsibility has become a very important issue for researchers (Greenfield, 2004; Maignan & Ralston, 2002; McWilliams et al., 2006; Pearce & Doh 2005), and many consider it necessary for businesses to define their role in society and apply social and ethical standards to their businesses (Lichtenstein et al., 2004). As a result, a significant number of retailers have adopted CSR as a strategic tool to promote their businesses. To this end, this study sought to discover U.S. consumers' attitudes and behavior in ethical purchasing and consumption based on their subjective perception and evaluation of a retailer. The objectives of this study include: 1) determine the participants awareness of retailers corporate social responsibility; 2) assess how participants evaluate retailers corporate social responsibility; 3) examine whether participants evaluation process of retailers CSR influence their attitude toward the retailer; and 4) assess if participants attitude toward the retailers CSR influence their purchase behavior. This study does not focus on actual retailers' CSR performance because a consumer's decision making process is based on an individual assessment not an actual fact. This study examines US college students' awareness and evaluations of retailers' corporate social responsibility (CSR). Fifty six college students at a major Southeastern university participated in the study. The age of the participants ranged from 18 to 26 years old. Content analysis was conducted with open coding and focused coding. Over 100 single-spaced pages of written responses were collected and analyzed. Two steps of coding (i.e., open coding and focused coding) were conducted (Esterberg, 2002). Coding results and analytic memos were used to understand participants' awareness of CSR and their ethical purchasing behavior supported through the selection and inclusion of direct quotes that were extracted from the written responses. Names used here are pseudonyms to protect confidentiality of participants. Participants were asked to write about retailers, their aware-ness of CSR issues, and to evaluate a retailer's CSR performance. A majority (n = 28) of respondents indicated their awareness of CSR but have not felt the need to act on this issue. Few (n=8) indicated that they are aware of this issue but not greatly concerned. Findings suggest that when college students evaluate retailers' CSR performance, they use three dimensions of CSR: employee support, community support, and environmental support. Employee treatment and support were found as an important criterion in evaluation of retailers' CSR. Respondents indicated that their good experience with a retailer as an employee made them have a positive perception and attitude toward the retailer. Regarding employee support four themes emerged: employee rewards and incentives based on performance, working environment, employee education and training program, and employee and family discounts. Well organized rewards and incentives were mentioned as an important attribute. The factors related to the working environment included: how well retailers follow the rules related to working hours, lunch time and breaks was also one of the most mentioned attributes. Regarding community support, three themes emerged: contributing a percentage of sales to the local community, financial contribution to charity organizations, and events for community support. Regarding environments, two themes emerged: recycling and selling organic or green products. It was mentioned in the responses that retailers are trying to do what they can to be environmentally friendly. One respondent mentioned that the company is creating stores that have an environmentally friendly design. Information about what the company does to help the environment can easily be found on the company’s website as well. Respondents have also noticed that the stores are starting to offer products that are organic and environmentally friendly. A retailer was also mentioned by a respondent in this category in reference to how the company uses eco-friendly cups and how they are helping to rebuild homes in New Orleans. The respondents noticed that a retailer offers reusable bags for their consumers to purchase. One respondent stated that a retailer uses its products to help the environment, through offering organic cotton. After thorough analysis of responses, we found that a participant's evaluation of a retailers' CSR influenced their attitudes towards retailers. However, there was a significant gap between attitudes and purchasing behavior. Although the participants had positive attitudes toward retailers CSR, the lack of funds and time influenced their purchase behavior. Overall, half (n=28) of the respondents mentioned that CSR performance affects their purchasing decisions making when shopping. Findings from this study provide support for retailers to consider their corporate social responsibility when developing their image with the consumer. This study implied that consumers evaluate retailers based on employee, community and environmental support. The evaluation, attitude and purchase behavior of consumers seem to be intertwined. That is, evaluation is based on the knowledge the consumer has of the retailers CSR. That knowledge may influence their attitude toward the retailer and thus influence their purchase behavior. Participants also indicated that having CSR makes them think highly of the retailer, but it does not influence their purchase behavior. Price and convenience seem to surpass the importance of CSR among the participants. Implications, recommendations for future research, and limitations of the study are also discussed.
The supply chain management (SCM) systems have emerged as strong managerial tools for manufacturing firms in enhancing competitive strength. Despite of large investments in the SCM systems, many companies are not fully realizing the promised benefits from the systems. A review of literature on adoption, implementation and success factor of IOS (inter-organization systems), EDI (electronic data interchange) systems, shows that this issue has been examined from multiple theoretic perspectives. And many researchers have attempted to identify the factors which influence the success of system implementation. However, the existing studies have two drawbacks in revealing the determinants of systems implementation success. First, previous researches raise questions as to the appropriateness of research subjects selected. Most SCM systems are operating in the form of private industrial networks, where the participants of the systems consist of two distinct groups: focus companies and vendors. The focus companies are the primary actors in developing and operating the systems, while vendors are passive participants which are connected to the system in order to supply raw materials and parts to the focus companies. Under the circumstance, there are three ways in selecting the research subjects; focus companies only, vendors only, or two parties grouped together. It is hard to find researches that use the focus companies exclusively as the subjects probably due to the insufficient sample size for statistic analysis. Most researches have been conducted using the data collected from both groups. We argue that the SCM success factors cannot be correctly indentified in this case. The focus companies and the vendors are in different positions in many areas regarding the system implementation: firm size, managerial resources, bargaining power, organizational maturity, and etc. There are no obvious reasons to believe that the success factors of the two groups are identical. Grouping the two groups also raises questions on measuring the system success. The benefits from utilizing the systems may not be commonly distributed to the two groups. One group's benefits might be realized at the expenses of the other group considering the situation where vendors participating in SCM systems are under continuous pressures from the focus companies with respect to prices, quality, and delivery time. Therefore, by combining the system outcomes of both groups we cannot measure the system benefits obtained by each group correctly. Second, the measures of system success adopted in the previous researches have shortcoming in measuring the SCM success. User satisfaction, system utilization, and user attitudes toward the systems are most commonly used success measures in the existing studies. These measures have been developed as proxy variables in the studies of decision support systems (DSS) where the contribution of the systems to the organization performance is very difficult to measure. Unlike the DSS, the SCM systems have more specific goals, such as cost saving, inventory reduction, quality improvement, rapid time, and higher customer service. We maintain that more specific measures can be developed instead of proxy variables in order to measure the system benefits correctly. The purpose of this study is to find the determinants of SCM systems success in the perspective of vendor companies. In developing the research model, we have focused on selecting the success factors appropriate for the vendors through reviewing past researches and on developing more accurate success measures. The variables can be classified into following: technological, organizational, and environmental factors on the basis of TOE (Technology-Organization-Environment) framework. The model consists of three independent variables (competition intensity, top management support, and information system maturity), one mediating variable (collaboration), one moderating variable (government support), and a dependent variable (system success). The systems success measures have been developed to reflect the operational benefits of the SCM systems; improvement in planning and analysis capabilities, faster throughput, cost reduction, task integration, and improved product and customer service. The model has been validated using the survey data collected from 122 vendors participating in the SCM systems in Korea. To test for mediation, one should estimate the hierarchical regression analysis on the collaboration. And moderating effect analysis should estimate the moderated multiple regression, examines the effect of the government support. The result shows that information system maturity and top management support are the most important determinants of SCM system success. Supply chain technologies that standardize data formats and enhance information sharing may be adopted by supply chain leader organization because of the influence of focal company in the private industrial networks in order to streamline transactions and improve inter-organization communication. Specially, the need to develop and sustain an information system maturity will provide the focus and purpose to successfully overcome information system obstacles and resistance to innovation diffusion within the supply chain network organization. The support of top management will help focus efforts toward the realization of inter-organizational benefits and lend credibility to functional managers responsible for its implementation. The active involvement, vision, and direction of high level executives provide the impetus needed to sustain the implementation of SCM. The quality of collaboration relationships also is positively related to outcome variable. Collaboration variable is found to have a mediation effect between on influencing factors and implementation success. Higher levels of inter-organizational collaboration behaviors such as shared planning and flexibility in coordinating activities were found to be strongly linked to the vendors trust in the supply chain network. Government support moderates the effect of the IS maturity, competitive intensity, top management support on collaboration and implementation success of SCM. In general, the vendor companies face substantially greater risks in SCM implementation than the larger companies do because of severe constraints on financial and human resources and limited education on SCM systems. Besides resources, Vendors generally lack computer experience and do not have sufficient internal SCM expertise. For these reasons, government supports may establish requirements for firms doing business with the government or provide incentives to adopt, implementation SCM or practices. Government support provides significant improvements in implementation success of SCM when IS maturity, competitive intensity, top management support and collaboration are low. The environmental characteristic of competition intensity has no direct effect on vendor perspective of SCM system success. But, vendors facing above average competition intensity will have a greater need for changing technology. This suggests that companies trying to implement SCM systems should set up compatible supply chain networks and a high-quality collaboration relationship for implementation and performance.
1. Introduction: Contrast to the offline purchasing environment, online store cannot offer the sense of touch or direct visual information of its product to the consumers. So the builder of the online shopping mall should provide more concrete and detailed product information(Kim 2008), and Alba (1997) also predicted that the quality of the offered information is determined by the post-purchase consumer satisfaction. In practice, many fashion and apparel online shopping malls offer the picture information with the product on the real person model to enhance the usefulness of product information. On the other virtual product experience has been suggested to the ways of overcoming the online consumers' limited perceptual capability (Jiang & Benbasat 2005). However, the adoption and the facilitation of the virtual reality tools requires high investment and technical specialty compared to the text/picture product information offerings (Shaffer 2006). This could make the entry barrier to the online shopping to the small retailers and sometimes it could be demanding high level of consumers' perceptual efforts. So the expensive technological solution could affects negatively to the consumer decision making processes. Nevertheless, most of the previous research on the online product information provision suggests the VR be the more effective tools. 2. Research Model and Hypothesis: Presented in
The outline and characteristics of the important doctors of the 'Zhe Zhong Pai'(折衷派) are as follows. Part 1. In the late Edo(江戶) period The 'Zhe Zhong Pai', which tried to take the theory and clinical treatment of the 'Hou Shi Pai (後世派)' and the 'Gu Fang Pai(古方派)' and get their strong points to make treatments perfect, appeared. Their point was 'The main part is the art of the ancients, The latter prescriptions are to be used'(以古法爲主, 後世方爲用) and the "Shang Han Lun(傷寒論)" was revered for its treatments but in actual use it was not kept at that. As mentioned above The 'Zhe Zhong Pai' viewed treatments as the base, which was the view of most doctors in the Edo period. However, the reason the 'Zhe Zhong Pai' is not valued as much as the 'Gu Fang Pai' by medical history books in Japan is because the 'Zhe Zhong Pai' does not have the substantiation or uniqueness of the 'Gu Fang Pai', and also because the view of 'gather as well as store up'(兼收並蓄) was the same as the 'Kao Zheng Pai'. Moreover, the 'compromise'(折衷) point of view was from taking in both Chinese and western medical knowledge systems(漢蘭折衷). Generally the pioneer of the 'Zhe Zhong Pai' is seen as Mochizuki Rokumon(望月鹿門) and after that was Fukui Futei(福井楓亭), Wadato Kaku(和田東郭), Yamada Seichin(山田正珍) and Taki Motohiro(多紀元簡). Part 2. The lives of Wada Tokaku(和田東郭), Nakagame Kinkei(中神琴溪), Nei Teng Xi Zhe(內藤希哲), the important doctors of the 'Zhe Zhong Pai', are as follows. First Wada Tokaku(和田東郭, 1743-1803) was born when the 'Hou Shi Pai' was already declining and the 'Gu Fang Pai' was flourishing and learned medicine from a 'Hou Shi Pai' doctor, Hu Tian Xu Shan(戶田旭山) and a 'Gu Fang Pai' doctor, Yoshimasu Todo(吉益東洞). He was not hindered by 'the old ways(古方)' and did not lean towards 'the new ways(後世方)' and formed a way of compromise that 'looked at hardness and softness as the same'(剛柔相摩) by setting 'the cure of the disease' as the base, and said that to cure diseases 'the old way' must be used, but 'the new way' was necessary to supplement its shortcomings. His works include "Dao Shui Suo Yan(導水瑣言)", "Jiao Chiang Fang Yi Je(蕉窗方意解)" and "Yi Xue Sho(醫學說)". Second. Nakagame Kinkei(中神琴溪, 1744-1833) was famous for leaving Yoshimasu Todo(吉益東洞) and changing to the 'Zhe Zhong Pai', and in his early years used qing fen(輕粉) to cure geisha(妓女) of syphilis. His argument was "the "Shang Han Lun" must be revered but needs to be adapted", "Zhong Jing can be made into a follower but I cannot become his follower", "the later medical texts such as "Ru Men Shi Qin(儒門事親)" should only be used for its prescriptions and not its theories". His works include "Shang Han Lun Yue Yan(傷寒論約言)". Third, Nei Teng Xi Zhe(內藤希哲, 1701-1735) learned medicine from Qing Shui Xian Sheng(淸水先生) and went out to Edo. In his book "Yi Jing Jie Huo Lun(醫經解惑論)" he tells of how he went from 'learning'(學) to 'skepticism'(惑) and how skepticism made him learn in 'the six skepticisms'(六惑). In the latter years Xi Zhe(希哲) combines the "Shen Nong Ben Cao Jing(神農本草經)", the main text for herbal medicine, "Ming Tang Jing(明堂經)" of accupuncture, basic theory texts "Huang Dui Nei Jing(皇帝內經)" and "Nan Jing(難經)" with the "Shang Han Za Bing Lun", a book that the 'Gu Fang Pai' saw as opposing to the rest, and became 'an expert of five scriptures'(五經一貫). Part 3. Asada Showhaku(淺田宗伯, 1815-1894) started medicine at Zhong Cun Zhong Zong(中村中倧) and learned 'the old way'(古方) from Yoshimasu Todo and got experience through Ouan Yue(川越) and Fu Jing(福井) and received teachings in texts, history and Wang Yangmin's principles(陽明學) fmm famous teachers. Showhaku(倧伯) meets a medical official of the makufu(幕府), Ben Kang Zong Yuan(本康宗圓), and receives help from the 3 great doctors of the Edo period, Taki Motokato(多紀元堅), Xiao Dao Xue Gu(小島學古) and Xi Duo Cun Kao(喜多村栲窻) and further develops his arts. At 47 he diagnoses the general Jia Mao(家茂) with 'heart failure from beriberi'(脚氣衡心) and becomes a Zheng Shi(徵土), at 51 he cures a minister from France and received a present from Napoleon, at 65 he becomes the court physician and saves Ming Gong(明宮) Jia Ren Qn Wang(嘉仁親王, later the 大正天皇) from bodily convulsions and becomes 'the vassal of merit who saved the national polity(國體)' At the 7th year of the Meiji(明治) he becomes the 2nd owner of Wen Zhi She(溫知社) and takes part in the 'kampo continuation movement'. In his latter years he saw 14000 patients a year, so we can estimate the qualjty and quantity of his clinical skills. Showhaku(宗伯) wrote over 80 books including the "Ju Chuang Shu Ying(橘窻書影)", "Wu Wu Yao Shi Fang Han(勿誤藥室方函)", "Shang Han Biang Shu(傷寒辨術)", "Jing Qi Shen Lun(精氣神論)", "Hunag Guo Ming Yi Chuan(皇國名醫傳)" and the "Xian Jhe Yi Hua(先哲醫話)". Especially in the "Ju Chuang Shu Ying(橘窻書影) he says "the old theories are the main, and the new prescriptions are to be used"(以古法爲主, 後世方爲用), stating the 'Zhe Zhong Pai' way of thinking, In the first volume of "Shang Han Biang Shu(傷寒辨術)" and "Za Bing Lun Shi(雜病論識)", 'Zong Ping'(總評), He discerns the parts that are not Zhang Zhong Jing's writings and emphasizes his theories and practical uses.
Up to the present the scholastic achievements in the history of the medical system have been rather scare despite its importance in the Korean History. Hence, this dissertation attempts to examine the significance of the institute in the Korean History, covering the period from the ancient times through the early Chosun-Dynasty. In the ancient times, the medical practice relied primarily upon human instincts and experiences at the same time, shaman's incantations were widely believed to cure diseases, the workings of evil spirits supposedly. For the period from the Old Chosun through Samhan(巫堂), Chinese refugees brought a long medical knowledge and skills of the continent. New Chinese medicine, traditional practices and incantations were generally used at this time. Medicine and the medical system were arranged by the period of the Three Countries(三國時代). No definite record concerning Koguryo remains now. As for Paekje, however, history shows that they set up the system under the Chinese influence, assigning medical posts such as Euibaksa(medical doctor), Chaeyaksa(pharmacist), and Jukeumsa(medicine man) within Yakbu(department of medicine). Scientifically advanced, they sent experts to Japan, giving a tremendous influence on the development of the science on ancient Japan. After the unification of the three countries, Shilla had their own system after the model of Dang(唐). This system of the Unified Shilla was continued down to Koryo and became the backbone of the future ones. In the ancient time religion and medicine were closely related. The curative function of the shaman was absolute. Buddhism played a notable part in medical practice, too, producing numerous medical monks. The medical system of Koryo followed the model of Dang with some borrowings from Song(宋). Sangyakkuk(尙藥局) was to deal exclusively with the diseases of the monarch whereas Taeeuigam(太醫監) was the central office to handle the national medical administration and the qualification test and education for doctors. In addition, Dongsodaebiwon(東西大悲院), Jewibo(濟危寶), and Hyeminkuk(惠民局) were public hospitals for the people, and a few aristocrats practiced medicine privately. In 987, the 6th year of Songjong(成宗), local medical operations were installed for curing the sick and educating medical students. Later Hyonjong(顯宗), established Yakjom(clinics, 藥店) throughout the country and officials were sent there to see patients. Foreign experts, mainly from Song, were invited frequently to deliver their advanced technology, and contributed to the great progress of the science in Korea. Medical officials were equipped with better land and salary than others, enjoying appropriate social respect. Koryo exchanged doctors, medicine and books mainly with Song, but also had substantial interrelations with Yuan(元), Ming(明), Kitan(契丹), Yojin(女眞), and Japan. Among them, however, Song was most influential to the development of medicine in Koryo. During Koryo Dynasty Buddhism, the national religion at the time, exercised bigger effect on medicine than in any other period. By conducting national ceremonies and public rituals to cure diseases, Taoism also affected the way people regarded illness. Curative shamanism was still in practice as well. These religious practices, however, were now engaged only when medication was already in use or when medicine could not held not help any more. The advanced medical system of Koryo were handed down to Chosun and served the basis for further progress. Hence, then played well the role to connect the ancient medicine and the modern one. The early Chosun followed and systemized the scientific and technical achievement in medicine during the Koryo Dynasty, and furthermore, founded the basis of the future developments. Especially the 70 years approximately from the reign of Sejong(世宗) to that of Songjong(成宗) withnessed a termendous progress in the field with the reestablishment of the medical system. The functions of the three medical institute Naeeuiwon(內醫院), Joneuigam(典醫監), Hyeminkuk(惠民局) were expanded. The second, particualy, not only systemized all the medical practices of the whole nation, but also grew and distributed domestic medicaments which had been continually developed since the late Koryo period. In addition, Hyeminso(惠民局, Hwarinwon(活人院)) and Jesaenwon(濟生院)(later merged to the first) played certain parts in the curing illness. Despite the active medical education in the capital and the country, the results were not substantial, for the aristocracy avoided the profession due to the social prejudice against technicians including medical docotors. During the early Chosun-Dynasty, the science was divided into Chimgueui (acupuncturist), Naryogeui(specialist in scrofula) and Chijongeui (specialist in boil). For the textbooks, those for the qualification exam were used, including several written by the natives. With the introduction on Neoconfucianism(性理學) which reinforced sexual segregation, female doctors appeared for the female patients who refused to be seen by male doctors. This system first appeared in 1406, the sixth year of Taejong(太宗), but finally set up during the reign of Sejong. As slaves to the offices, the lowest class, female doctors drew no respect. However, this is still significant in the aspect of women's participation in society. They were precedents of midwives. Medical officials were selected through the civil exam and a special test. Those who passed exams were given temporary jobs and took permanent posts later. At that time the test score, the work experience and the performance record of the prospective doctor were all taken into consideration, for it was a specialized office. Most doctors were given posts that changed every six months, and therefore had fewer chances for a goverment office than the aristocracy. At the beginning the social status of those in medicine was not that low, but with the prejudice gradully rising among the aristocracy, it became generally agreed to belong to the upper-middle technician class. Dealing with life, however, they received social respect and courtesy from the public. Sometimes they collected wealth with their skills. They kept improving techniques and finally came to take an important share in modernization process during the late Chosun-Dynasty.
We are living in more comfortable circumstances with the social developments and the improvement of the standard of living, but, on the other hand, we are exposed to an increase of the occurrences of tires on account of large-sized, higher stories, deeper underground building and the use of various energy resources. The materials of the floor in a residence modern society have been going through various alterations in accordance with the uses of a residence and are now used as final goods in interioring the bottom of apartments, houses and shops. There are so many kinds of materials you usually come in contact with, but in the first place, we need to make an experiment on the spread of the fire with the hypocaust used as the floors of apartments, etc. and the floor covers you usually can get easily. We, scientific investigators, can get in contact with the accidents caused by incendiarism or an accidental fire closely connected with petroleum stuffs on the floor materials that give rise to lots of problems. on this account, I'd like to propose that we conduct an experiment on fire shapes by each petroleum stuff and that discriminate an accidental tire from incendiarism. In an investigation, it seems that finding a live coal could be an essential part of clearing up the cause of a tire but it could not be the cause of a fire itself. And besides, all sorts of tire cases or fire accidents have some kind of legislation and standard to minimize and at an early stage cope with the damage by tires. That is to say, we are supposed to install each kind of electric apparatus, automatic alarm equipment, automatic fire extinguisher in order to protect ourselves from the danger of fires and check them at any time and also escape urgently in case of fire-outbreaking or build a tire-proof construction to prevent flames from proliferating to the neighboring areas. Namely, you should take several factors into consideration to investigate a cause of a case or an accident related to fire. That means it's not in reason for one investigator or one investigative team to make clear of the starting part and the cause of a tire. accordingly, in this thesis, explanations would be given set limits to the judgement and verification on the cause of a fire and the concrete tire-spreading part through investigation on the very spot that a fire broke out. The fire-discernment would also be focused on the early stage fire-spreading part fire-outbreaking resources, and I think the realities of police tire investigations and the problems are still a matter of debate. The cause of a fire must be examined into by logical judgement on the basis of abundant scientific knowledge and experience covering the whole of fire phenomena. The judgement of the cause should be made with fire-spreading situation at the spot as the central figure and in case of verifying, you are supposed to prove by the situational proof from the traces of the tire-spreading to the fire-outbreaking sources. The causal relation on a fire-outbreak should not be proved by arbitrary opinion far from concrete facts, and also there is much chance of making mistakes if you draw deduction from a coincidence. It is absolutely necessary you observe in an objective attitude and grasp the situation of a tire in the investigation of the cause. Having a look at the spot with a prejudice is not allowed. The source of tire-outbreak itself is likely to be considered as the cause of a tire and that makes us doubt about the results according to interests of the independent investigators. So to speak, they set about investigations, the police investigation in the hope of it not being incendiarism, the fire department in the hope of it not being problems in installments or equipments, insurance companies in the hope of it being any incendiarism, electric fields in the hope of it not being electric defects, the gas-related in the hope of it not being gas problems. You could not look forward to more fair investigation and break off their misgivings. It is because the firing source itself is known as the cause of a fire and civil or criminal responsibilities are respected to the firing source itself. On this occasion, investigating the cause of a fire should be conducted with research, investigation, emotion independent, and finally you should clear up the cause with the results put together.
Purpose : The purpose of this study was to evaluate the present status of patients' satisfaction and the reasons for any satisfaction or dissatisfaction in cancer pain management Methods : A cross-sectional survey was used to obtain the feedback about pain management. The results of the survey were collected from 59 in- or out-patient who had cancer treatment at two of the teaching hospitals in Seoul from July, 2002 to November, 2002. The data was obtained by a structured questionnaire based on the American Cancer Society Patient Outcome Questionnaire(APS-POQ) and other previous research. The clinical information for all patients were compiled by reviewing their medical records. Resuts : 1) The subjects' mean score of the worst pain was 6.77, the average pain score was 3.80, and the pain score after management was 2.93 for the past 24 hours. The mean score of total pain interference was
The outline and characteristics of the important doctors of the 'Zhe Zhong Pai'(折衷派) are as follows. Part 1. In the late Edo(江戶) period The 'Zhe Zhong Pai', which tried to take the theory and clinical treatment of the 'Hou Shi Pai (後世派)' and the 'Gu Fang Pai (古方派)' and get their strong points to make treatments perfect, appeared. Their point was 'The main part is the art of the ancients, The latter prescriptions are to be used'(以古法爲主, 後世方爲用) and the "Shang Han Lun(傷寒論)" was revered for its treatments but in actual use it was not kept at that. As mentioned above The 'Zhe Zhong Pai ' viewed treatments as the base, which was the view of most doctors in the Edo period, However, the reason the 'Zhe Zhong Pai' is not valued as much as the 'Gu Fang Pai' by medical history books in Japan is because the 'Zhe Zhong Pai' does not have the substantiation or uniqueness of the 'Gu Fang Pai', and also because the view of 'gather as well as store up' was the same as the 'Kao Zheng Pai', Moreover, the 'compromise'(折衷) point of view was from taking in both Chinese and western medical knowledge systems(漢蘭折衷), Generally the pioneer of the 'Zhe Zhong Pai' is seen as Mochizuki Rokumon(望月鹿門) and after that was Fukui Futei(福井楓亭), Wadato Kaku(和田東郭), Yamada Seichin(山田正珍) and Taki Motohiro(多紀元簡), Part 2. The lives of Wada Tokaku(和田東郭), Nakagame Kinkei(中神琴溪), Nei Teng Xi Zhe(內藤希哲), the important doctors of the 'Zhe Zhong Pai', are as follows First. Wada Tokaku(和田東郭, 1743-1803) was born when the 'Hou Shi Pai' was already declining and the 'Gu Fang Pai' was flourishing and learned medicine from a 'Hou Shi Pai' doctor, Hu Tian Xu Shan(戶田旭山) and a 'Gu Fang Pai' doctor, Yoshimasu Todo(吉益東洞). He was not hindered by 'the old ways(古方), and did not lean towards 'the new ways(後世方)' and formed a way of compromise that 'looked at hardness and softness as the same'(剛柔相摩) by setting 'the cure of the disease' as the base, and said that to cure diseases 'the old way' must be used, but 'the new way' was necessary to supplement its shortcomings. His works include "Dao Shui Suo Yan", "Jiao Chiang Fang Yi Je" and "Yi Xue Sho(醫學說)" Second. Nakagame Kinkei(中神琴溪, 1744-1833) was famous for leaving Yoshirnasu Todo(吉益東洞) and changing to the 'Zhe Zhong Pai', and in his early years used qing fen(輕粉) to cure geisha(妓女) of syphilis. His argument was "the "Shang Han Lun" must be revered but needs to be adapted", "Zhong jing can be made into a follower but I cannot become his follower", "the later medical texts such as "Ru Men Shi Qin(儒門事親)" should only be used for its prescriptions and not its theories". His works include "Shang Han Lun Yue Yan(傷寒論約言) Third. Nei Teng Xi Zhe(內藤希哲, 1701-1735) learned medicine from Qing Shui Xian Sheng(淸水先生) and went out to Edo. In his book "Yi Jing Jie Huo Lun(醫經解惑論)" he tells of how he went from 'learning'(學) to 'skepticism'(惑) and how skepticism made him learn in 'the six skepticisms'(六惑). In the latter years Xi Zhe(希哲) combines the "Shen Nong Ben Cao jing(神農本草經)", the main text for herbal medicine, "Ming Tang jing(明堂經)" of accupuncture, basic theory texts "Huang Dui Nei jing(黃帝內徑)" and "Nan jing(難經)" with the "Shang Han Za Bing Lun", a book that the 'Gu Fang Pai' saw as opposing to the rest, and became 'an expert of five scriptures'(五經一貫). Part 3. Asada Showhaku(淺田宗伯, 1815-1894) started medicine at Zhong Cun Zhong(中村中倧) and learned 'the old way'(古方) from Yoshirnasu Todo and got experience through Chuan Yue(川越) and Fu jing(福井) and received teachings in texts, history and Wang Yangmin's principles(陽明學) from famous teachers. Showhaku(宗伯) meets a medical official of the makufu(幕府), Ben Kang Zong Yuan(本康宗圓), and recieves help from the 3 great doctors of the Edo period, Taki Motokato(多紀元堅), Xiao Dao Xue GU(小島學古) and Xi Duo Cun Kao Chuang and further develops his arts. At 47 he diagnoses the general Jia Mao(家茂) with 'heart failure from beriberi'(脚氣衝心) and becomes a Zheng Shi(徵I), at 51 he cures a minister from France and received a present from Napoleon, at 65 he becomes the court physician and saves Ming Gong(明宮) jia Ren Qn Wang(嘉仁親王, later the 大正犬皇) from bodily convulsions and becomes 'the vassal of merit who saved the national polity(國體)' At the 7th year of the Meiji(明治) he becomes the 2nd owner of Wen Zhi She(溫知社) and takes part in the 'kampo continuation movement'. In his latter years he saw 14000 patients a year, so we can estimate the quality and quantity of his clinical skills Showhaku(宗伯) wrote over 80 books including the "Ju Chuang Shu Ying(橘窓書影)", "WU Wu Yao Shi Fang Han(勿誤藥室方函)", "Shang Han Biang Shu(傷寒辨術)", "jing Qi Shen Lun(精氣神論)", "Hunag Guo Ming Yi Chuan(皇國名醫傳)" and the "Xian Jhe Yi Hua(先哲醫話)". Especially in the "Ju Chuang Shu Ying(橘窓書影)" he says "the old theories are the main, and the new prescriptions are to be used"(以古法爲主, 後世方爲用), stating the 'Zhe Zhong Pai' way of thinking. In the first volume of "Shung Han Biang Shu(傷寒辨術) and "Za Bing Lun Shi(雜病論識)", 'Zong Ping'(總評), He discerns the parts that are not Zhang Zhong Jing's writings and emphasizes his theories and practical uses.
, research model suggests VR effect could be moderated by the product types by the usage situations. Product types could be defined as the portable product and installed product, and the information offering type as still picture of the product, picture of the product with the real-person model and VR. 3. Methods and Results: 3.1. Experimental design and measured variables We designed the 2(product types) X 3(product information types) experimental setting and measured dependent variables such as information usefulness, attitude toward the shopping mall, overall product quality, purchase intention and the revisiting intention. In the case of information usefulness and attitude toward the shopping mall were measured by multi-item scale. As a result of reliability test, Cronbach's Alpha value of each variable shows more than 0.6. Thus, we ensured that the internal consistency of items. 3.2. Manipulation check The main concern of this study is to verify the moderate effect by the product type of usage situation. indicates that our experimental manipulation of the moderate effect of the product type was successful. 3.3. Results As
indicates, there was a significant main effect on the only one dependent variable(attitude toward the shopping mall) by the information types. As predicted, VR has highest mean value compared to other information types. Thus, H1 was partially supported. However, main effect by the product types was not found. To evaluate H2 and H3, a two-way ANOVA was conducted. As
indicates, there exist the interaction effects on the three dependent variables(information usefulness, overall product quality and purchase intention) by the information types and the product types. As predicted, picture of the product with the real-person model has highest mean among the information types in the case of portable product. On the other hand, VR has highest mean among the information types in the case of installed product. Thus, H2 and H3 was supported. 4. Implications: The present study found the moderate effect by the product type of usage situation. Based on the findings the following managerial implications are asserted. First, it was found that information types are affect only the attitude toward the shopping mall. The meaning of this finding is that VR effects are not enough to understand the product itself. Therefore, we must consider when and how to use this VR tools. Second, it was found that there exist the interaction effects on the information usefulness, overall product quality and purchase intention. This finding suggests that consideration of usage situation helps consumer's understanding of product and promotes their purchase intention. In conclusion, not only product attributes but also product usage situations must be fully considered by the online retailers when they want to meet the needs of consumers.
A Study on the ' Zhe Zhong Pai'(折衷派) of the Traditional Medicine of Japan
(일본(日本) 의학(醫學)의 '절충파(折衷派)'에 관(關)한 연구(硏究))
A study of the Medical System in the Early Chosun-Dynasty
(조선시대(朝鮮時代) 전기(前期)의 의료제도(醫療制度)에 대한 연구(硏究))
A Study on the Improvement Plans of Police Fire Investigation
(경찰화재조사의 개선방안에 관한 연구)
Patient Satisfaction with Cancer Pain Management
(암성통증관리 만족도)
A Study on the 'Zhe Zhong Pai'(折衷派) of the Traditional Medicine of Japan
(일본(日本) 의학醫學의 '절충파(折衷派)'에 관(關)한 연구(硏究))
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