We sought to confirm an independent factor about in-stent restenosis (ISR) in the patients who underwent drug-eluting stent (DES) and know a possibility as a predictor of measured coronary artery calcium score by MDCT. A total of 178 patients (159 men,
Virtual communities (VCs) have developed rapidly, with more and more people participating in them to exchange information and opinions. A virtual community is a group of people who may or may not meet one another face to face, and who exchange words and ideas through the mediation of computer bulletin boards and networks. A business-to-consumer virtual community (B2CVC) is a commercial group that creates a trustworthy environment intended to motivate consumers to be more willing to buy from an online store. B2CVCs create a social atmosphere through information contribution such as recommendations, reviews, and ratings of buyers and sellers. Although the importance of B2CVCs has been recognized, few studies have been conducted to examine members' word-of-mouth behavior within these communities. This study proposes a model of involvement, statistics, trust, "stickiness," and word-of-mouth in a B2CVC and explores the relationships among these elements based on empirical data. The objectives are threefold: (i) to empirically test a B2CVC model that integrates measures of beliefs, attitudes, and behaviors; (ii) to better understand the nature of these relationships, specifically through word-of-mouth as a measure of revenue generation; and (iii) to better understand the role of stickiness of B2CVC in CRM marketing. The model incorporates three key elements concerning community members: (i) their beliefs, measured in terms of their involvement assessment; (ii) their attitudes, measured in terms of their satisfaction and trust; and, (iii) their behavior, measured in terms of site stickiness and their word-of-mouth. Involvement is considered the motivation for consumers to participate in a virtual community. For B2CVC members, information searching and posting have been proposed as the main purpose for their involvement. Satisfaction has been reviewed as an important indicator of a member's overall community evaluation, and conceptualized by different levels of member interactions with their VC. The formation and expansion of a VC depends on the willingness of members to share information and services. Researchers have found that trust is a core component facilitating the anonymous interaction in VCs and e-commerce, and therefore trust-building in VCs has been a common research topic. It is clear that the success of a B2CVC depends on the stickiness of its members to enhance purchasing potential. Opinions communicated and information exchanged between members may represent a type of written word-of-mouth. Therefore, word-of-mouth is one of the primary factors driving the diffusion of B2CVCs across the Internet. Figure 1 presents the research model and hypotheses. The model was tested through the implementation of an online survey of CTrip Travel VC members. A total of 243 collected questionnaires was reduced to 204 usable questionnaires through an empirical process of data cleaning. The study's hypotheses examined the extent to which involvement, satisfaction, and trust influence B2CVC stickiness and members' word-of-mouth. Structural Equation Modeling tested the hypotheses in the analysis, and the structural model fit indices were within accepted thresholds:
In Smart Education, the roles of digital textbook is very important as face-to-face media to learners. The standardization of digital textbook will promote the industrialization of digital textbook for contents providers and distributers as well as learner and instructors. In this study, the following three objectives-oriented digital textbooks are looking for ways to standardize. (1) digital textbooks should undertake the role of the media for blended learning which supports on-off classes, should be operating on common EPUB viewer without special dedicated viewer, should utilize the existing framework of the e-learning learning contents and learning management. The reason to consider the EPUB as the standard for digital textbooks is that digital textbooks don't need to specify antoher standard for the form of books, and can take advantage od industrial base with EPUB standards-rich content and distribution structure (2) digital textbooks should provide a low-cost open market service that are currently available as the standard open software (3) To provide appropriate learning feedback information to students, digital textbooks should provide a foundation which accumulates and manages all the learning activity information according to standard infrastructure for educational Big Data processing. In this study, the digital textbook in a smart education environment was referred to open digital textbook. The components of open digital textbooks service framework are (1) digital textbook terminals such as smart pad, smart TVs, smart phones, PC, etc., (2) digital textbooks platform to show and perform digital contents on digital textbook terminals, (3) learning contents repository, which exist on the cloud, maintains accredited learning, (4) App Store providing and distributing secondary learning contents and learning tools by learning contents developing companies, and (5) LMS as a learning support/management tool which on-site class teacher use for creating classroom instruction materials. In addition, locating all of the hardware and software implement a smart education service within the cloud must have take advantage of the cloud computing for efficient management and reducing expense. The open digital textbooks of smart education is consdered as providing e-book style interface of LMS to learners. In open digital textbooks, the representation of text, image, audio, video, equations, etc. is basic function. But painting, writing, problem solving, etc are beyond the capabilities of a simple e-book. The Communication of teacher-to-student, learner-to-learnert, tems-to-team is required by using the open digital textbook. To represent student demographics, portfolio information, and class information, the standard used in e-learning is desirable. To process learner tracking information about the activities of the learner for LMS(Learning Management System), open digital textbook must have the recording function and the commnincating function with LMS. DRM is a function for protecting various copyright. Currently DRMs of e-boook are controlled by the corresponding book viewer. If open digital textbook admitt DRM that is used in a variety of different DRM standards of various e-book viewer, the implementation of redundant features can be avoided. Security/privacy functions are required to protect information about the study or instruction from a third party UDL (Universal Design for Learning) is learning support function for those with disabilities have difficulty in learning courses. The open digital textbook, which is based on E-book standard EPUB 3.0, must (1) record the learning activity log information, and (2) communicate with the server to support the learning activity. While the recording function and the communication function, which is not determined on current standards, is implemented as a JavaScript and is utilized in the current EPUB 3.0 viewer, ths strategy of proposing such recording and communication functions as the next generation of e-book standard, or special standard (EPUB 3.0 for education) is needed. Future research in this study will implement open source program with the proposed open digital textbook standard and present a new educational services including Big Data analysis.
Information technology is a critical resource necessary for any company hoping to support and realize its strategic goals, which contribute to growth promotion and sustainable development. The selection of information technology and its strategic use are imperative for the enhanced performance of every aspect of company management, leading a wide range of companies to have invested continuously in information technology. Despite researchers, managers, and policy makers' keen interest in how information technology contributes to organizational performance, there is uncertainty and debate about the result of information technology investment. In other words, researchers and managers cannot easily identify the independent factors that can impact the investment performance of information technology. This is mainly owing to the fact that many factors, ranging from the internal components of a company, strategies, and external customers, are interconnected with the investment performance of information technology. Using an agent-based simulation technique, this research extracts factors expected to affect investment performance on information technology, simplifies the analyses of their relationship with economic modeling, and examines the performance dependent on changes in the factors. In terms of economic modeling, I expand the model that highlights the way in which product quality moderates the relationship between information technology investments and economic performance (Thatcher and Pingry, 2004) by considering the cost of information technology investment and the demand creation resulting from product quality enhancement. For quality enhancement and its consequences for demand creation, I apply the concept of information quality and decision-maker quality (Raghunathan, 1999). This concept implies that the investment on information technology improves the quality of information, which, in turn, improves decision quality and performance, thus enhancing the level of product or service quality. Additionally, I consider the effect of word of mouth among consumers, which creates new demand for a product or service through the information diffusion effect. This demand creation is analyzed with an agent-based simulation model that is widely used for network analyses. Results show that the investment on information technology enhances the quality of a company's product or service, which indirectly affects the economic performance of that company, particularly with regard to factors such as consumer surplus, company profit, and company productivity. Specifically, when a company makes its initial investment in information technology, the resultant increase in the quality of a company's product or service immediately has a positive effect on consumer surplus, but the investment cost has a negative effect on company productivity and profit. As time goes by, the enhancement of the quality of that company's product or service creates new consumer demand through the information diffusion effect. Finally, the new demand positively affects the company's profit and productivity. In terms of the investment strategy for information technology, this study's results also reveal that the selection of information technology needs to be based on analysis of service and the network effect of customers, and demonstrate that information technology implementation should fit into the company's business strategy. Specifically, if a company seeks the short-term enhancement of company performance, it needs to have a one-shot strategy (making a large investment at one time). On the other hand, if a company seeks a long-term sustainable profit structure, it needs to have a split strategy (making several small investments at different times). The findings from this study make several contributions to the literature. In terms of methodology, the study integrates both economic modeling and simulation technique in order to overcome the limitations of each methodology. It also indicates the mediating effect of product quality on the relationship between information technology and the performance of a company. Finally, it analyzes the effect of information technology investment strategies and information diffusion among consumers on the investment performance of information technology.
Documentation strategy has been experimented in various subject areas and local regions since late 1980's when it was proposed as archival appraisal and selection methods by archival communities in the United States. Though it was criticized to be too ideal, it needs to shed new light on the potentialities of the strategy for documenting local regions in digital environment. The purpose of this study is to analyse the implementation issues of documentation strategy and to suggest the directions for documenting local regions of Korea through the application of the strategy. The documentation strategy which was developed more than twenty years ago in mostly western countries gives us some implications for documenting local regions even in current digital environments. They are as follows; Firstly, documentation strategy can enhance the value of archivists as well as archives in local regions because archivist should be active shaper of history rather than passive receiver of archives according to the strategy. It can also be a solution for overcoming poor conditions of local archives management in Korea. Secondly, the strategy can encourage cooperation between collecting institutions including museums, libraries, archives, cultural centers, history institutions, etc. in each local region. In the networked environment the cooperation can be achieved more effectively than in traditional environment where the heavy workload of cooperative institutions is needed. Thirdly, the strategy can facilitate solidarity of various groups in local region. According to the analysis of the strategy projects, it is essential to collect their knowledge, passion, and enthusiasm of related groups to effectively implement the strategy. It can also provide a methodology for minor groups of society to document their memories. This study suggests the directions of documenting local regions in consideration of current archival infrastructure of Korean as follows; Firstly, very selective and intensive documentation should be pursued rather than comprehensive one for documenting local regions. Though it is a very political problem to decide what subject has priority for documentation, interests of local community members as well as professional groups should be considered in the decision-making process seriously. Secondly, it is effective to plan integrated representation of local history in the distributed custody of local archives. It would be desirable to implement archival gateway for integrated search and representation of local archives regardless of the location of archives. Thirdly, it is necessary to try digital documentation using Web 2.0 technologies. Documentation strategy as the methodology of selecting and acquiring archives can not avoid subjectivity and prejudices of appraiser completely. To mitigate the problems, open documentation system should be prepared for reflecting different interests of different groups. Fourth, it is desirable to apply a conspectus model used in cooperative collection management of libraries to document local regions digitally. Conspectus can show existing documentation strength and future documentation intensity for each participating institution. Using this, documentation level of each subject area can be set up cooperatively and effectively in the local regions.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
Hemodialysis is essential treatment for the chronic renal failure patient's long-term cure and for the patient management before and after kidney transplantation. It sustains the endstage renal failure patient's life which didn't get well despite strict regimen and furthermore it becomes an essential treatment to maintain civil life. Bursing implementation in hemodialysis may affect the significant effect on patient's life. The purpose of this study was to obtain the basic data to solve the hypotension problem encountable to patient and the blood loss problem affecting hemodialysis patient'a anemic states by incomplete rinsing of blood in coil through all process of hemodialysis. The subjects for this study were 44 patients treated hemodialysis 691 times in the hemodialysis unit, The .data was collected at Gang Nam 51. Mary's Hospital from January 1, 1981 to April 30, 1981 by using the direct observation method and the clinical laboratory test for laboratory data and body weight and was analysed by the use of analysis of Chi-square, t-test and anlysis of varience. The results obtained an follows; A. On clinical laboratory data and other data by dialysis Procedure. The average initial body weight was 2.37 ± 0.97kg, and average body weight after every dialysis was 2.33 ± 0.9kg. The subject's average hemoglobin was 7.05±1.93gm/dl and average hematocrit was 20.84± 3.82%. Average initial blood pressure was 174.03±23,75mmHg and after dialysis was 158.45±25.08mmHg. The subject's average blood ion due to blood sample for laboratory data was 32.78±13.49cc/ month. The subject's average blood replacement for blood complementation was 1.31 ±0.88 pint/ month for every patient. B. On the hypotensive state and the coping approaches occurrence rate of hypotension was 28.08%. It was 194 cases among 691 times. 1. In degrees of initial blood pressure, the most 36.6% was in the group of 150-179mmHg, and in degrees of hypotension during dialysis, the most 28.9% in the group of 40-50mmHg, especially if the initial blood pressure was under 180mmHg, 59.8% clinical symptoms appeared in the group of“above 20mmHg of hypotension”. If initial blood pressure was above 180mmHg, 34.2% of clinical symptoms were appeared in the group of“above 40mmHg of hypotension”. These tendencies showed the higher initial blood pressure and the stronger degree of hypotension, these results showed statistically singificant differences. (P=0.0000) 2. Of the occuring times of hypotension,“after 3 hrs”were 29.4%, the longer the dialyzing procedure, the stronger degree of hypotension ann these showed statistically significant differences. (P=0.0142). 3. Of the dispersion of symptoms observed, sweat and flush were 43.3%, and Yawning, and dizziness 37.6%. These were the important symptoms implying hypotension during hemodialysis accordingly. Strages of procedures in coping with hypotension were as follows ; 45.9% were recovered by reducing the blood flow rate from 200cc/min to 1 00cc/min, and by reducing venous pressure to 0-30mmHg. 33.51% were recovered by controling (adjusting) blood flow rate and by infusion of 300cc of 0,9% Normal saline. 4.1% were recovered by infusion of over 300cc of 0.9% normal saline. 3.6% by substituting Nor-epinephiine, 5.7% by substituting blood transfusion, and 7,2% by substituting Albumin were recovered. And the stronger the degree of symptoms observed in hypotention, the more the treatments required for recovery and these showed statistically significant differences (P=0.0000). C. On the effects of the changes of blood pressure and osmolality by albumin and hemofiltration. 1. Changes of blood pressure in the group which didn't required treatment in hypotension and the group required treatment, were averaged 21.5mmHg and 44.82mmHg. So the difference in the latter was bigger than the former and these showed statistically significant difference (P=0.002). On the changes of osmolality, average mean were 12.65mOsm, and 17.57mOsm. So the difference was bigger in the latter than in the former but these not showed statistically significance (P=0.323). 2. Changes of blood pressure in the group infused albumin and in the group didn't required treatment in hypotension, were averaged 30mmHg and 21.5mmHg. So there was no significant differences and it showed no statistical significance (P=0.503). Changes of osmolality were averaged 5.63mOsm and 12.65mOsm. So the difference was smaller in the former but these was no stitistical significance (P=0.287). Changes of blood pressure in the group infused Albumin and in the group required treatment in hypotension were averaged 30mmHg and 44.82mmHg. So the difference was smaller in the former but there is no significant difference (P=0.061). Changes of osmolality were averaged 8.63mOsm, and 17.59mOsm. So the difference were smaller in the former but these not showed statistically significance (P=0.093). 3. Changes of blood pressure in the group iutplemented hemofiltration and in the Uoup didn't required treatment in hypotension were averaged 22mmHg and 21.5mmHg. So there was no significant differences and also these showed no statistical significance (P=0.320). Changes of osmolality were averaged 0.4mOsm and 12.65mOsm. So the difference was smaller in the former but these not showed statistical significance（P=0.199). Changes of blood pressure in the group implemented hemofiltration and in the group required treatment in hypotension were averaged 22mmHg and 44.82mmHg. So the difference was smatter in the former and these showed statistically significant differences (P=0.035). Changes of osmolality were averaged 0.4mOsm and 17.59mOsm. So the difference was smaller in the former but these not showed statistical significance (P=0.086). D. On the changes of body weight, and blood pressure, between the group of hemofiltration and hemodialysis. 1, Changes of body weight in the group implemented hemofiltration and hemodialysis were averaged 3.340 and 3.320. So there was no significant differences and these showed no statistically significant difference, (P=0.185) but standard deviation of body weight averaged in comparison with standard difference of body weight was statistically significant difference (P=0.0000). Change of blood Pressure in the group implemented hemofiltration and hemodialysis were averaged 17.81mmHg and 19.47mmHg. So there was no significant differences and these showed no statistically significant difference (P=0.119), But in comparison with standard deviation about difference of blood pressure was statistically significant difference. (P=0.0000). E. On the blood infusion method in coil after hemodialysis and residual blood losing method in coil. 1, On comparing and analysing Hct of residual blood in coil by factors influencing blood infusion method. Infusion method of saline 200cc reduced residual blood in coil after the quantitative comparison of Saline Occ, 50cc, 100cc, 200cc and the differences showed statistical significance (p < 0.001). Shaking Coil method reduced residual blood in Coil in comparison of Shaking Coil method and Non-Shaking Coil method this showed statistically significant difference (P < 0.05). Adjusting pressure in Coil at OmmHg method reduced residual blood in Coil in comparison of adjusting pressure in Coil at OmmHg and 200mmHg, and this showed statistically significant difference (P < 0.001). 2. Comparing blood infusion method divided into 10 methods in Coil with every factor respectively, there was seldom difference in group of choosing Saline 100cc infusion between Coil at OmmHg. The measured quantity of blood loss was averaged 13.49cc. Shaking Coil method in case of choosing saline 50cc infusion while adjusting pressure in coil at OmmHg was the most effective to reduce residual blood. The measured quantity of blood loss was averaged 15.18cc.
The purpose of this study was to develop and evaluate pre-parenthood education program(PPEP) based on Home Economics(HE) subject for high school students. The development and evaluation of PPEP based on HE subject in this study followed ADDIE model except implementation through 4 processes such as analysis, design, development, and evaluation. First, program development directions were set in three aspects such as 'general development', 'contents', and 'teaching and learning methods'. Themes of the program are 11 in total such as '1. Parenting, what is being a parent', '2. Choosing your spouse, happy marital relationship, the best gift to your children', '3. Pregnancy and birth, a moving meeting with a new life', '4. Taking care of a new born infant for 24 hours', '5. Taking care of infants, relationship with my lovely baby, attachment', '6. Taking care of young children, my child from another planet', '7. Parents and children in healthy family', '8. Parent-child relationship, wise parents to make effective interaction with their children', '9. Parents safety manager at home,', '10. Practice to take care of infants', and '11. Practice of community nurturing support service development'. In particular, learning activities of the program have major characteristics such as 1) utilization of cases including practice problems related to parenting, 2) community exchange activities utilizing learned knowledge and techniques, 3) actual life project activities utilizing learning contents related with parenting, 4) activities inducing positive changes in current life of high school students, and 5) practice activities for the necessities of life such as food, clothing and shelter supporting development of children. Second, the program was developed according to the design. Teaching-learning plans and materials for 17 classes were developed according to 11 themes. The developed plans include class flow and teacher's reference. It starts with receiving a class-related message from a virtual child at the introduction stage and ended with replying to the message by summarizing contents of the class and making a promise as a parent-to-be. That is the basic frame of class flow. Learning materials included various plans and reports necessary for learning activities and they are prepared in details so that they can be play the role of textbooks in regular curriculum. Third, evaluation of developed program was executed by a 5 point Likert scale survey on 13 HE experts on two aspects of program development process and program development results. In the evaluation of development process, mean value was 4.61 and index of content validity was 97.4%. For development results, mean value was 4.37 and index of content validity was 86.9%. These values showed that validity in the development process and results in this study was highly secured and confirmed that PPEP based on HE was appropriate and valid to enhance parent qualifications of high school learners.
To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.