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Anticoagulation Management after Mitral Valve Replacement with the St. Jude Medical Prosthesis (승모판치환 환자의 항응혈제 치료)

  • 김종환;김영태
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1172-1182
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    • 1998
  • Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

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Antioxidant activity of extracts from soybean and small black bean (대두와 쥐눈이콩 추출물의 항산화 활성에 관한 연구)

  • Hong, Ju-Yeon;Shin, Seung-Ryeul;Kong, Hyun-Joo;Choi, Eun-Mi;Woo, Sang-Chul;Lee, Myoung-Hee;Yang, Kyung-Mi
    • Food Science and Preservation
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    • v.21 no.3
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    • pp.404-411
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    • 2014
  • This study was carries out to analyzed the antioxidant activities of extracts extrated from soybean and small black bean for the development of functional materials. Yields of hot-water and ethanol extracts were higher in the soybean than small black bea, and yields of hot-water extracts were higher than ethanol extracts. Total phenol contents were 26.22 mg/g in the ethanol extracts from small black bean, and were higher than those in the soybean extracts. Total flavonoid contents were 30.52 mg/g of hot-water extracts from small black bean. The EDA values were increased by the increase of extract concentrations and were high in the hot-water and ethanol extracts from bean and small black bean The EDA values was high in the extracts of small black bean from low concentrations. The SOD-like activity of hot-water and ethanol extracts from small black bean was higher than those of soybean extracts. The SOD-like activity was 73%, 62% of the hot-water and ethanol extracts from small black bean in 10 ml/mL extract concentration, respectably. The nitrite scavenging ability was high extracts from soybean was 47.60% in pH 1.2, Those of hot-water extracts were higher than in ethanol extracts in 10 ml/mL extract concentration. The xanthine oxidase inhibitory activities were increased by the increase of extract concentrations and were high in ethanol extracts from small black bean of low concentration. The xanthine oxidase inhibitory activities was hot-water extracts from soybean were higher than 5 ml/mL extract concentration than those of other extracts. The inhibitory activities of tyrosinase were increased by increase of extract concentrations and were high each other 42.05%, 45.67% of hot-water and ethanol extracts from small black bean in 10 ml/mL extract concentration. Reducing power was increased by increase of extract concentrations in extracts of small black bean, and were high more than double in hot-water and ethanol from small black bean than extracts of soybean.

Characterization of Nitric Oxide (NO)-Induced Cell Death in Lung Epithelial Cells (폐상피세포에서 Nitric Oxide (NO)에 의한 세포사에 관한 연구)

  • Yong, Wha Shim;Kim, Youn Seup;Park, Jae Seuk;Jee, Young Koo;Lee, Kye Young
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.2
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    • pp.187-197
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    • 2004
  • Background : Nitric Oxide (NO) is a multi-faceted molecule with dichotomous regulatory roles in many areas of biology. NO can promote apoptosis in some cells, whereas it inhibits apoptosis in other cell types. This study was performed to characterize NO-induced cell death in lung epithelial cells and to investigate the roles of cell death regulators including iron, bcl-2 and p53. Methods : A549 cells were used for lung epithelial cells. SNP (sodium nitroprusside) and SNAP (S-nitroso-N-acetyl- penicillamine) were used for NO donor. Cytoxicity assay was done by MTT assay and crystal violet assay. Apoptotic assay was done by fluorescent microscopy after double staining with propidium iodide and hoecst 33342. Iron inhibition study was done with RBCs and FeSO4. For bcl-2 study, bcl-2 overexpressing cells (A549-bcl-2) were used and for p53 study, Western blot analysis and p53 functionally knock-out cells (A549-E6) were used. Results : SNP and SNAP induced dose-dependent cell death in A549 cells and fluorescent microscopy revealed that SNAP induced apoptosis in low doses but necrosis in high doses while SNP induced exclusively necrotic cell death. Iron inhibition study using RBCs and FeSO4 significantly blocked SNAP-induced cell death. And also SNAP-induced cell death was blocked by bcl-2 overexpression. Finally, we found that SNAP activate p53 by Western blot analysis and that SNAP-induced cell death was decreased in the abscence of p53. Conclusion : In lung epithelial cells, NO can induce cell death, more precisely apoptosis in low doses and necrosis in high doses. And iron, bcl-2, and p53 play important roles in NO-induced cell death.

A Proposal on a Management Model Applicable to Visiting Nursing Program for a Low-income Group (저소득층 방문간호 관리를 위한 제안 - 강북구 방문간호 대상자를 중심으로-)

  • Ko Mee-Ja
    • Journal of Korean Public Health Nursing
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    • v.10 no.1
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    • pp.118-138
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    • 1996
  • Because of accelerated urbanization public body visiting nursing project that started according as matter of health on urban class in the lower brackets of income was concentrated on Social interests has a unsatisfied points to propel project efficiently from the lack of rating materials. Therefore centering around written contents in documentary literature of citizen health by household in five years from starting year of project to now. visiting frequency by medical manpower was evaluated quantitatively and qualitatively in aspect of management hereupon. for the sake of giving a basic materials for public health project of this field. This research presents documentary literature of citizen health which become materials is that as one person's charged region of nurse in duty scale. district is Kang-Buck Gu. the object is resident in the lower brackets of income grounded livelihood protection law and who is admitted by the head of organ~chief of health care). and the number of material centering around the head of a household is 415 copy. The result of research is summarized. as follow. 1. Average visiting frequency examinated by medical manpower show difference according to valuables of supervision characteristics namely average visiting. Frequency of nurse has long term residence in case registration season is early and supervision season is the first year and is high incase a kind of house is unlicdnsed mountain town. Average visiting frequency with doctor is high incase supervision season is the first year and the medical insurance system is admitted by chief of health care. That shows that a man of discomfort behavior left alone are yet many in local society. The meaning of this result shows that the continuity of official relation about class in the lowest brackets of income of long term residence goes well between househole who is a user of visiting nursing service of the object according to midway income under management influences a given duty of nurse s and so causes quantitative decrease. 2. In case behavier and condition of health that nurse diagnoses are bad. as the type matter is a lack of health and the number of patient is large. the average visiting frequency of nurse is high. because average visiting frequency with doctor is high as the condition of health is bad and the number of patient is large. That is similar with that of nurse. CD Average visiting frequency of nurse s seen by matter of disease is very high only in apoplexy by 39.50 and is confined within limits from 7.63 to 11.36 in other disease. But average visiting frequency with doctor is double as many as that of nurse but defined in apoplexy hypertension and articulate. (1) Average visiting frequency of nurse by existence in inoculation of hepatitis is low by 6.73 in unidentified group and very high by 26.89 in group of non-inoculation and the case of the antigenic positive man of B type hepatitis or epileptic who can't be inoculated shows 13.00 and that even family nursing service is needed to them. That result shows that though one person nurse of local charge has a large scale of duty. as visting nursing service is given a class who has a large demand preferentially by respectively accurate nursing diagnosis. the number of diagnosis service is similar with it. 3. During five years. average visiting frequency of nurse is 10.84 and average visiting frequency with doctor is 76.50 seeing from the official scale of nurse. visiting by household is performed two more per year to the average. Seeing this by type of service. average visiting frequency of nurse is higher in indirectly nursing than in directly nursing and that suggests that at the time of visiting household nurse performs education of protection lively save patient but at the time of contrastedly visiting with doctor. directly nursing is more contents of service show no difference by man power and medication dressing by demand is 14.3 and 18.6 the aid of hardship term of doctor and nurse is high by 18.7 and 17.00 in the request of hospitalization when seeing by demands. 4. Action by turns exemplified 1994 is well in sequence of 2/4 turn. 3/4 turn. 1/4 turn. 4/4 turn. When seen by average visiting frequency of nurse but gradually is even. Without difference by turns. average visiting frequency of doctor is much higher in 1/4 turn than other turns. Type of service by turns is all even but directly nursing is inactive in 4/4 and indirectly nursing. Very increases in 4/4 and so. Nurse's quantity of duty is plentiful that shows that by evaluation of last turn and plan of project. Contents of service follows that medication and dressing is the highest by' 5.57 in 1/4turn. goes down gradually by turn. becomes 3.57 in 3/4 turn. and increases again by 4.83 in 4/4 turn. the rest service is higher in 2/4 turn than other turns. 5. Total visiting frequency of nurse is explained to total $37.5\%$ by six valuables of visiting frequency of doctor. nursing demand. demand of diagnosis. condition of behavior. year. Special terms and magnitude of influential power is the same as sequence of enumerated valuables. Namely. the higher the visiting frequency of doctor. the bigger nursing and demand of diagnosis is. the worse the condition of behavior is. the older the object is and the more the household of special terms is. the high total visiting frequency of nurse is.

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Detection of IgY Specific to Salmonella enteritidris and S. typhimurium in the Yolk of Commercial Brand Eggs using ELISA (ELISA 방법으로 계란의 난황에 존재하는 Salmonella enteritidis와 S. typhimurium에 대한 IgY 측정)

  • 이승배
    • Food Science of Animal Resources
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    • v.23 no.2
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    • pp.161-167
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    • 2003
  • Identification of salmonellosis-infected commercial poultry flocks has become a pivotal component of efforts to reduce incidence of egg-associated transmission of S. enteritidis and S. typhimurium to humans. As a basic study for sanitary control of S. enteritidis and S. typhimurium, main food-borne pathogenic bacteria in eggs produced by domestic hens, commercial egg samples were tested for specific antibodies to whole cells of S. enteritidis and S. typhimurium and outer membrane protein(OMP) of S. typhimurium by ELISA to detect infection of S. enteritidis and S. typhimurium in various groups of hens. When the antibody titers of yolks from three commercial brand eggs were tested after diluting in the ratio from 1:100 to 1:1,600 with double dilution method, ELISA values of the specific antibodies could be shown as differences in dilution patterns by comparing with negative control egg. When the antibody titers of the yolks from two commercial brand eggs were tested after diluting in the ratio of 1:200 and 1:1,000, ELISA values of specific antibodies were different among same brand eggs. When the antibody titers of yolks from five eggs sampled randomly from twenty one commercial brand eggs were tested after diluting in the ratio of 1:1,000, ELISA value of the specific antibodies were shown generally high. ELISA values of 28.5, 30, and 28.5% of yolks from 21 brand eggs were shown low and similar to negative control egg in antibody titers to whole cells of S. enteritidis and S. typhimurium and OMP of S. typhimurium, respectively. The results demonstrated that ELISA test of egg yolk antibody could provide a highly sensitive indicator to detect contamination of S. typhimurium and S. enteritidis in poultry, and could be used effectively to reduce incidence of S. typhimurium and S. enteritidis infection in poultry.

The Intelligent Determination Model of Audience Emotion for Implementing Personalized Exhibition (개인화 전시 서비스 구현을 위한 지능형 관객 감정 판단 모형)

  • Jung, Min-Kyu;Kim, Jae-Kyeong
    • Journal of Intelligence and Information Systems
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    • v.18 no.1
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    • pp.39-57
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    • 2012
  • Recently, due to the introduction of high-tech equipment in interactive exhibits, many people's attention has been concentrated on Interactive exhibits that can double the exhibition effect through the interaction with the audience. In addition, it is also possible to measure a variety of audience reaction in the interactive exhibition. Among various audience reactions, this research uses the change of the facial features that can be collected in an interactive exhibition space. This research develops an artificial neural network-based prediction model to predict the response of the audience by measuring the change of the facial features when the audience is given stimulation from the non-excited state. To present the emotion state of the audience, this research uses a Valence-Arousal model. So, this research suggests an overall framework composed of the following six steps. The first step is a step of collecting data for modeling. The data was collected from people participated in the 2012 Seoul DMC Culture Open, and the collected data was used for the experiments. The second step extracts 64 facial features from the collected data and compensates the facial feature values. The third step generates independent and dependent variables of an artificial neural network model. The fourth step extracts the independent variable that affects the dependent variable using the statistical technique. The fifth step builds an artificial neural network model and performs a learning process using train set and test set. Finally the last sixth step is to validate the prediction performance of artificial neural network model using the validation data set. The proposed model is compared with statistical predictive model to see whether it had better performance or not. As a result, although the data set in this experiment had much noise, the proposed model showed better results when the model was compared with multiple regression analysis model. If the prediction model of audience reaction was used in the real exhibition, it will be able to provide countermeasures and services appropriate to the audience's reaction viewing the exhibits. Specifically, if the arousal of audience about Exhibits is low, Action to increase arousal of the audience will be taken. For instance, we recommend the audience another preferred contents or using a light or sound to focus on these exhibits. In other words, when planning future exhibitions, planning the exhibition to satisfy various audience preferences would be possible. And it is expected to foster a personalized environment to concentrate on the exhibits. But, the proposed model in this research still shows the low prediction accuracy. The cause is in some parts as follows : First, the data covers diverse visitors of real exhibitions, so it was difficult to control the optimized experimental environment. So, the collected data has much noise, and it would results a lower accuracy. In further research, the data collection will be conducted in a more optimized experimental environment. The further research to increase the accuracy of the predictions of the model will be conducted. Second, using changes of facial expression only is thought to be not enough to extract audience emotions. If facial expression is combined with other responses, such as the sound, audience behavior, it would result a better result.

The Survey on Actual Condition Depending on Type of Degraded area and Suggestion for Restoration Species Based on Vegetation Information in the Mt. Jirisan Section of Baekdudaegan (식생정보에 기초한 백두대간 지리산권역 내 훼손지 유형별 실태조사)

  • Lee, Hye-Jeong;Kim, Ju-Young;Nam, Kyeong-Bae;An, Ji-Hong
    • Korean Journal of Environment and Ecology
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    • v.34 no.6
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    • pp.558-572
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    • 2020
  • The purpose of this study was to classify the types of degraded areas of Mt. Jirisan section in Baekdudaegan and survey the actual condition of each damage type to use it as basic data for the direction of the restoration of damaged areas according to damage type based on the vegetation information of reference ecosystem. The analysis of the Mt. Jirisan section's actual degraded conditions showed that the total number of patches of degraded areas was 57, and the number of patches and size of degraded areas was higher at the low average altitude and gentle slope. Grasslands (deserted lands) and cultivated areas accounted for a high portion of the damage types, indicating that agricultural land use was a major damage factor. The survey on the conditions of 14 degraded areas showed that the types of damage were classified into the grassland, cultivated area, restoration area, logged-off land, and bare ground. The analysis of the degree of disturbance (the ratio of annual and biennial herb, urbanized index, and disturbance index) by each type showed that the simple single-layer vegetation structure mostly composed of the herbaceous and the degree of disturbance were high in the grassland and cultivated land. The double-layer vegetation structure appeared in the restoration area where the pine seedlings were planted, and the inflow of naturalized plants was especially high compared to other degraded areas due to disturbances caused by the restoration project and the nearby hiking trails. Although the inflow of naturalized plants was low because of high altitude in bare ground, the proportion of annual and biennial herb was high, indicating that all surveyed degraded areas were in early succession stages. The stand ordination by type of damage showed the restoration area on the I-axis, cultivated area, grassland, logged-off land, and bare ground in that order, indicating the arrangement by the damage type. Moreover, the stand ordination of the degraded areas and reference ecosystem based on floristic variation showed a clear difference in species composition. This study diagnosed the status of each damage type based on the reference ecosystem information according to the ecological restoration procedure and confirmed the difference in species composition between the diagnosis result and the reference ecosystem. These findings can be useful basic data for establishing the restoration goal and direction in the future.

A study of poverty experiences among Korean elderly women in the United States (재미 한인 여성노인의 빈곤경험에 관한 연구)

  • Yeom, Jihye
    • 한국노년학
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    • v.40 no.4
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    • pp.801-821
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    • 2020
  • There are a number of prior studies on the poverty experience of Korean women, but little is known about the poverty experience of Korean elderly women in the U.S. The purpose of this study is to examine the poverty experiences of Korean elderly women who immigrated to the U. S. Qualitative case study methods were used to achieve these research objectives. Three Korean elderly women living in Oakland of California who received Supplemental Security Income (SSI) from the U.S. federal government were included in the study. The data were collected by conducting a total of six meetings per participant, and the researcher read the consent form directly to the participants and obtained a hand-written signature. The analysis and interpretation began by repeating the interview transcript several times, and the repeated keywords were to be understood in the context, focusing on time, space, and relationships with other people. The contextual understanding of Korean elderly women's experiences in poverty was interpreted in three dimensions: extending poverty in their mother country, double torture as female immigrants, and limiting labor due to aging and diseases. Before moving to the U.S., they had a difficult livelihood by farming and one of them had to live in poverty due to the bereavement to her husband. But even after moving to the U.S., they have continued to live in poverty. As female immigrants with low education and no special skills, they were incorporated into the periphery of the labor market in the industrialized U.S. and were forced to make a living with low wages. Korean elderly women were unable to return to the labor market in the surrounding areas due to aging and diseases, and were continuing their impoverished lives relying on SSI. From the findings, we discussed the role of the Korean immigrants community as a way to improve the quality of life for Korean elderly women in the U.S.

Ecological Renewal Plan of Urban Parks for the Revitalization of Urban Green Axis in Gangdong-Gu (강동구 도시 녹지축 기능 활성화를 위한 도시공원의 생태적 리뉴얼 방안 연구)

  • Park, Jeong-Ah;Han, Bong-Ho;Kwak, Jeong-In
    • Journal of the Korean Institute of Landscape Architecture
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    • v.51 no.2
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    • pp.12-27
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    • 2023
  • In this study, among the construction-type parks in Gangdong-gu, targeting parks with high environmental and ecological value located on the urban green axis, a plan was prepared for the ecological renewal of urban parks, and a design that applied to them was proposed. The renewal target site was selected by analyzing the general condition of Gangdong-gu and urban parks, the land use and green area ratio, park green area, and the green axis of Gangdong-gu. Gangdong-gu has 54 parks, including 2 neighborhood parks and 52 children's parks. In the first stage of the current status review, 17 parks were extracted through locational value analysis, such as location and adjacency to the natural axis and green axis. In the second stage, eight parks were selected among the first-stage extraction parks based on the ratio of green spaces and open spaces within each park service area. In the third stage, two of the second stage extraction parks were selected based on whether the legal standard of the park area was met, and in the fourth stage, one of the third stage extraction parks was selected through an aging survey of the park. As for the urban ecological status of the renewal target site, the status of land use in the aspect of entropy reduction, the status of soil cover in the aspect of water circulation, and the status of planting structure in the aspect of biodiversity were investigated. As for the status of the three renewal sites, the green area was insufficient at 18.3-45.3%, and the facility area was 54.7%-81.7%, which was judged to have low urban temperature reduction effects. The impervious pavement area accounted for 34.5% to 48.9% of the park area, accounting for most of the facility area, and it was judged that the water circulation function was insufficient. The planting structure consisted of a single layer and a double layer structure, and although the tree layer was good, the lower vegetation was poor, and there was no planting site of edible plants or large hardwood trees, so the biodiversity was low. After the ecological renewal design of Seonrin Children's Park, Dangmal Children's Park, and Saemmul Children's Park, which were selected as the renewal targets in this study, the ecological area ratio of each park increased by 1.4 to 3 times than before the renewal. If the urban parks located on the urban green axis are examined from the perspective of the urban ecosystem and renewed ecologically, it is judged that the expected effect will be high in reducing entropy, improving water circulation, and laying the foundation for biodiversity in terms of the urban ecosystem.

The Effect of Service Failure on the Desire for Betrayal and Retaliatory Behavior - Based on the Moderating Role of the Customer-Service Firm Relationship Quality (서비스 실패요인이 보복행위에 미치는 영향과 관계품질의 조절효과)

  • Kim, Mo Ran;Ahn, Kwang Ho
    • Asia Marketing Journal
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    • v.14 no.1
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    • pp.99-130
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    • 2012
  • Service failure and a poor service recovery may lead loyal customers to try to aggressively punish the service firm. We use perceived betrayal and desire for vengeance as the key constructs to understand customer retaliation. Perceived betrayal is defined as a customer's belief that a firm has intentionally violated what is normative in the context of their relationship. And the desire for vengeance is defined as the retaliatory feelings that consumers feel toward a firm, such as the desire to exert harm on the firm. The perceived betrayal and the desire for vengeance are key antecedents of retaliatory behaviors such as vindictive complaining, negative WOM and third-party complaining for publicity. The empirical results suggest that betrayal is a key motivational factor that lead customers to restore fairness by making use of all means, including retaliation. We also find that relationship quality has effect on a customer's response to a failure in service recovery. As the levels of relationship increases, a violation of the proper fairness has a stronger effect on the sense of betrayal experienced by customers. Considerable research has investigated consumer responses to dissatisfaction. But our study examine the response of outraged and highly frustrated consumers. We focus on emotional and behavioral processes that have not been covered by previous dissatisfaction researches and which are unique to outraged consumers caused by extremely dissatisfied purchase experience. It has recently been pointed out by various mass media that the customers not only have positive effects on the company performance but also put the company in crisis. It has often been reported that one customer's dissatisfaction, for example, never ends as it is, and it tends to grow for retaliating upon the company, depending on the level of seriousness of the dissatisfaction. This sometimes leads to a lawsuit against the company. Our study focuses on the customers' emotional and behavioral responses induced by their extreme dissatisfactions. We divided the customer groups into the customers with high relationship quality and the customers with low relationship quality, and the difference between two groups is examined. The objective of this study is to comprehend the causal relationship between the feeling of betrayal caused by the service failure and the retaliatory behavior triggered by the desire of revenge. Our study is divided into three parts. First, a causal relationship between perceived unfairness and the perceived betrayal and desire for revenge. Second, the effect of the perceived betrayal and desire for revenge on the retaliatory behavior is investigated. Finally, the moderating role of relationship quality in the causal relationship between the unfairness in service recovery and the perceived betrayal is analyzed. This study finds the following empirical results. The distributive unfairness, procedural unfairness and interactional unfairness had significant effects on the perceived betrayal. Especially, the perceived distributive unfairness results in the highest perceived betrayal. When the service company does not provide customers proper and sufficient compensation for the failure, they feel the strong sense of betrayal. And in the causal relationship between the perceived betrayal, desire for revenge and retaliatory behavior, the perceived betrayal has significant effects on e desire for revenge. In addition desire for revenge has significant effects on negative word of mouth, retaliatory complaining behavior and publicity of complaints through third group. Therefore the perceived unfairness has effects on retaliatory behavior through the mediation of the perceived betrayal and desire for revenge. Finally the moderating role of relationship quality was examined in the relationship between the unfairness and perceived betrayal. If the customers experienced the perceived unfairness in the process of service recovery, the customers with high relationship quality feel the stronger perceived betrayal than the customers with low relationship quality do. When they experience the double service failure, the customer group with high relationship quality accumulating the sense of trust feel the more perceived betrayal than the customer with low relationship quality who do not have strong trust. The contribution of this study is to find the effect of the service failure on the retaliatory behavior with the moderating roles of relationship quality. The dimensions of unfairness in service recovery is found to have differential effects on the perceived betrayal, desire for revenge. And these differential effect is moderated by the level of relationship quality.

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