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Results of Radiation Therapy for Carcinoma of the Uterine Cervix (자궁경부암의 방사선치료 성적)

  • Lee Kyung-Ja
    • Radiation Oncology Journal
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    • v.13 no.4
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    • pp.359-368
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    • 1995
  • Purpose : This is a retrospective analysis for pattern of failure, survival rate and prognostic factors of 114 patients with histologically proven invasive cancer of the uterine cervix treated with definitive irradiation. Materials and Methods : One hundred fourteen patients with invasive carcinoma of the cervix were treated with a combination of intracavitary irradiation using Fletcher-Suit applicator and external beam irradiation by 6MV X-ray at the Ewha Womans University Hospital between March 1982 and Mar 1990. The median age was 53 years(range:30-77 years). FIGO stage distribution was 19 for IB, 23 for IIA, 42 for IIB, 12 for IIIA and 18 for IIIB. Summation dose of external beam and intracavitary irradiation to point A was 80-90 Gy(median:8580 cGy) in early stage(IB-IIA) and 85-100 Gy(median:8850 cGy) in advanced stage(IIB-IIIB). Kaplan-Meier method was used to estimate the survival rate and multivariate analysis for progrostic factors was performed using the Log likelihood for Weibull Results : The pelvic failure rates by stage were $10.5{\%}$ for IB. $8.7{\%}$ for IIA, $23.8{\%}$ for IIB, $50.0{\%}$ for IIIA and $38.9{\%}$ for IIIB. The rate of distant metastasis by stage were $0{\%}$ for IB, $8.7{\%}$ for IIA, $4.8{\%}$ for IIB. $0{\%}$ for IIIA and $11.1{\%}$ for IIIB. The time of failure was from 3 to 50 months and with median of 15 months after completion of radiation therapy. There was no significant coorelation between dose to point A($\leq$90 Gy vs >90 Gy) and pelvic tumor control(P>0.05). Incidence rates of grade 2 rectal and bladder complications were $3.5{\%}$(4/114) and $7{\%}$(8/114), respectively and 1 patient had sigmoid colon obstruction and 1 patient had severe cystitis. Overall 5-year survival rate was $70.5{\%}$ and disease-free survival rate was $53.6{\%}$. Overall 5-year survival rate by stage was $100{\%}$ for IB, $76.9{\%}$ for IIA, $77.6{\%}$ for IIB $87.5{\%}$ for IIIA and $69.1{\%}$ for IIIB. Five-rear disease-free survival rate by stage was $81.3{\%}$ for IB, $67.9{\%}$ for IIA, $46.8{\%}$ for IIB, $45.4{\%}$ for IIIA and $34.4{\%}$ for IIIB. The prognostic factors for disease-free survival rate by multivariate analysis was performance status(p= 0.0063) and response rate after completion of radiation therapy(p= 0.0026) but stage, age and radiation dose to point A were not siginificant. Conclusion : The result of radiation therapy for early stage of the uterine cervix cancer was relatively good but local control rate and survival rate in advanced stage were poor inspite of high dose irradiation to point A above 90 Gy. Prospective randomized studies are recommended to establish optimal tumor doses for various stages and volume of carcinoma of uterine cervix, And ajuvant chemotherapy or radiation-sensitizing agents must be considered to increase the pelvic control and survival rate in advanced cancer of uterine cervix.

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The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure (고식적 Damus-Kaye-Stansel 술식의 임상적 적용 및 결과)

  • Lim, Hong-Gook;Kim, Soo-Jin;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul;Shinn, Sung-Ho;Yie, Kil-Soo;Lee, Jae-Woong;Lee, Chang-Ha
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.1-11
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    • 2008
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

Clinical Differential Diagnosis of Usual Interstitial Pneumonia from Nonspecific Interstitial Pneumonia (통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상적 감별 진단)

  • An, Chang-Hyeok;Koh, Young-Min;Chung, Man-Pyo;Suh, Gee-Young;Kang, Soo-Jung;Kang, Kyeong-Woo;Ahn, Jong-Woon;Lim, Si-Young;Kim, Ho-Joong;Han, Jeung-Ho;Lee, Kyung-Soo;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.6
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    • pp.932-943
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    • 2000
  • Background : Nonspecific interstitial pneumonitis (NSIP) is most likely to be confused with usual interstitial pneumonitis (UIP). Unlike patients witþ UIP, the majority of patients with NSIP have a good prognosis, with most patients improving after treatment with corticosteroids. Therefore it is clinically important to differentiate NSIP from UIP. Up to now, the only means of differentiating these two diseases was by means of surgical lung biopsy. American Thoracic Society (ATS) proposed a clinical diagnostic criteria for UIP to provide assistance to clinicians in its diagnosis without surgical lung biopsy. This study is aimed to investigate whether there were clinical and radiological differences between NSIP and UIP, and the usefulness of ATS clinical diagnostic criteria for UIP in Korea. Methods : We studied 60 patients with UIP and NSIP confirmed by surgical lung biopsy. Clinical manifestations, pulmonary function test, arterial blood gas analysis, bronchoalveolar lavage (BAL), and high resolution computed tomography (HRCT) were evaluated and analyzed by Chi-square test or t-test. The clinical criteria for UIP proposed by ATS were applied to all patients with idiopathic interstitial pneumonia. Results : Forty-two patients with UIP and 18 with NSIP were pathologically identified. Among the 18 patients with NSIP (M : F=1 : 17), the mean age was 55.2$\pm$8.4 (44~73) yr. Among the 42 patients with UIP (M : F=33 : 9), the mean age was 59.5$\pm$7.1 (45~74) yr (p=0.046). Fever was more frequent in NSIP (39%) (p=0.034), but clubbing was frequently observed in UIP (33%) (p=0.023). BAL lymphocytosis was more frequent (23%) (p=0.0001) and CD4/CD8 ratio was lower in NSIP (p=0.045). On HRCT, UIP frequently showed honeycomb appearance (36 of 42 patients) though not in NSIP (p=0.0001). Six of 42 UIP patients (14.3%) met the ATS clinical criteria for IPF, and 3 of 16 NSIP patients (18.8%) met the diagnostic criteria. Conclusion : Being a relatively young female and having short duration of illness, fever, BAL lymphocytosis, low CD4/CD8 ratio with the absence of clubbing and honeycomb appearance in HRCT increase the likelihood of the illness being NSIP. The usefulness of ATS clinical diagnostic criteria for UIP may be low in Korea.

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The Effects of Evaluation Attributes of Cultural Tourism Festivals on Satisfaction and Behavioral Intention (문화관광축제 방문객의 평가속성 만족과 행동의도에 관한 연구 - 2006 광주김치대축제를 중심으로 -)

  • Kim, Jung-Hoon
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.2
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    • pp.55-73
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    • 2007
  • Festivals are an indispensable feature of cultural tourism(Formica & Uysal, 1998). Cultural tourism festivals are increasingly being used as instruments promoting tourism and boosting the regional economy. So much research related to festivals is undertaken from a variety of perspectives. Plans to revisit a particular festival have been viewed as an important research topic both in academia and the tourism industry. Therefore festivals have frequently been leveled as cultural events. Cultural tourism festivals have become a crucial component in constituting the attractiveness of tourism destinations(Prentice, 2001). As a result, a considerable number of tourist studies have been carried out in diverse cultural tourism festivals(Backman et al., 1995; Crompton & Mckay, 1997; Park, 1998; Clawson & Knetch, 1996). Much of previous literature empirically shows the close linkage between tourist satisfaction and behavioral intention in festivals. The main objective of this study is to investigate the effects of evaluation attributes of cultural tourism festivals on satisfaction and behavioral intention. accomplish the research objective, to find out evaluation items of cultural tourism festivals through the literature study an empirical study. Using a varimax rotation with Kaiser normalization, the research obtained four factors in the 18 evaluation attributes of cultural tourism festivals. Some empirical studies have examined the relationship between behavioral intention and actual behavior. To understand between tourist satisfaction and behavioral intention, this study suggests five hypotheses and hypothesized model. In this study, the analysis is based on primary data collected from visitors who participated in '2006 Gwangju Kimchi Festival'. In total, 700 self-administered questionnaires were distributed and 561 usable questionnaires were obtained. Respondents were presented with the 18 satisfactions item on a scale from 1(strongly disagree) to 7(strongly agree). Dimensionality and stability of the scale were evaluated by a factor analysis with varimax rotation. Four factors emerged with eigenvalues greater than 1, which explained 66.40% of the total variance and Cronbach' alpha raging from 0.876 to 0.774. And four factors named: advertisement and guides, programs, food and souvenirs, and convenient facilities. To test and estimate the hypothesized model, a two-step approach with an initial measurement model and a subsequent structural model for Structural Equation Modeling was used. The AMOS 4.0 analysis package was used to conduct the analysis. In estimating the model, the maximum likelihood procedure was used.In this study Chi-square test is used, which is the most common model goodness-of-fit test. In addition, considering the literature about the Structural Equation Modeling, this study used, besides Chi-square test, more model fit indexes to determine the tangibility of the suggested model: goodness-of-fit index(GFI) and root mean square error of approximation(RMSEA) as absolute fit indexes; normed-fit index(NFI) and non-normed-fit index(NNFI) as incremental fit indexes. The results of T-test and ANOVAs revealed significant differences(0.05 level), therefore H1(Tourist Satisfaction level should be different from Demographic traits) are supported. According to the multiple Regressions analysis and AMOS, H2(Tourist Satisfaction positively influences on revisit intention), H3(Tourist Satisfaction positively influences on word of mouth), H4(Evaluation Attributes of cultural tourism festivals influences on Tourist Satisfaction), and H5(Tourist Satisfaction positively influences on Behavioral Intention) are also supported. As the conclusion of this study are as following: First, there were differences in satisfaction levels in accordance with the demographic information of visitors. Not all visitors had the same degree of satisfaction with their cultural tourism festival experience. Therefore it is necessary to understand the satisfaction of tourists if the experiences that are provided are to meet their expectations. So, in making festival plans, the organizer should consider the demographic variables in explaining and segmenting visitors to cultural tourism festival. Second, satisfaction with attributes of evaluation cultural tourism festivals had a significant direct impact on visitors' intention to revisit such festivals and the word of mouth publicity they shared. The results indicated that visitor satisfaction is a significant antecedent of their intention to revisit such festivals. Festival organizers should strive to forge long-term relationships with the visitors. In addition, it is also necessary to understand how the intention to revisit a festival changes over time and identify the critical satisfaction factors. Third, it is confirmed that behavioral intention was enhanced by satisfaction. The strong link between satisfaction and behavioral intentions of visitors areensured by high quality advertisement and guides, programs, food and souvenirs, and convenient facilities. Thus, examining revisit intention from a time viewpoint may be of a great significance for both practical and theoretical reasons. Additionally, festival organizers should give special attention to visitor satisfaction, as satisfied visitors are more likely to return sooner. The findings of this research have several practical implications for the festivals managers. The promotion of cultural festivals should be based on the understanding of tourist satisfaction for the long- term success of tourism. And this study can help managers carry out this task in a more informed and strategic manner by examining the effects of demographic traits on the level of tourist satisfaction and the behavioral intention. In other words, differentiated marketing strategies should be stressed and executed by relevant parties. The limitations of this study are as follows; the results of this study cannot be generalized to other cultural tourism festivals because we have not explored the many different kinds of festivals. A future study should be a comparative analysis of other festivals of different visitor segments. Also, further efforts should be directed toward developing more comprehensive temporal models that can explain behavioral intentions of tourists.

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Development of Quantification Methods for the Myocardial Blood Flow Using Ensemble Independent Component Analysis for Dynamic $H_2^{15}O$ PET (동적 $H_2^{15}O$ PET에서 앙상블 독립성분분석법을 이용한 심근 혈류 정량화 방법 개발)

  • Lee, Byeong-Il;Lee, Jae-Sung;Lee, Dong-Soo;Kang, Won-Jun;Lee, Jong-Jin;Kim, Soo-Jin;Choi, Seung-Jin;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.6
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    • pp.486-491
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    • 2004
  • Purpose: factor analysis and independent component analysis (ICA) has been used for handling dynamic image sequences. Theoretical advantages of a newly suggested ICA method, ensemble ICA, leaded us to consider applying this method to the analysis of dynamic myocardial $H_2^{15}O$ PET data. In this study, we quantified patients' blood flow using the ensemble ICA method. Materials and Methods: Twenty subjects underwent $H_2^{15}O$ PET scans using ECAT EXACT 47 scanner and myocardial perfusion SPECT using Vertex scanner. After transmission scanning, dynamic emission scans were initiated simultaneously with the injection of $555{\sim}740$ MBq $H_2^{15}O$. Hidden independent components can be extracted from the observed mixed data (PET image) by means of ICA algorithms. Ensemble learning is a variational Bayesian method that provides an analytical approximation to the parameter posterior using a tractable distribution. Variational approximation forms a lower bound on the ensemble likelihood and the maximization of the lower bound is achieved through minimizing the Kullback-Leibler divergence between the true posterior and the variational posterior. In this study, posterior pdf was approximated by a rectified Gaussian distribution to incorporate non-negativity constraint, which is suitable to dynamic images in nuclear medicine. Blood flow was measured in 9 regions - apex, four areas in mid wall, and four areas in base wall. Myocardial perfusion SPECT score and angiography results were compared with the regional blood flow. Results: Major cardiac components were separated successfully by the ensemble ICA method and blood flow could be estimated in 15 among 20 patients. Mean myocardial blood flow was $1.2{\pm}0.40$ ml/min/g in rest, $1.85{\pm}1.12$ ml/min/g in stress state. Blood flow values obtained by an operator in two different occasion were highly correlated (r=0.99). In myocardium component image, the image contrast between left ventricle and myocardium was 1:2.7 in average. Perfusion reserve was significantly different between the regions with and without stenosis detected by the coronary angiography (P<0.01). In 66 segment with stenosis confirmed by angiography, the segments with reversible perfusion decrease in perfusion SPECT showed lower perfusion reserve values in $H_2^{15}O$ PET. Conclusions: Myocardial blood flow could be estimated using an ICA method with ensemble learning. We suggest that the ensemble ICA incorporating non-negative constraint is a feasible method to handle dynamic image sequence obtained by the nuclear medicine techniques.

Prediction of Salvaged Myocardium in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Angioplasty using early Thallium-201 Redistribution Myocardial Perfusion Imaging (급성심근경색증의 일차적 관동맥성형술 후 조기 Tl-201 재분포영상을 이용한 구조심근 예측)

  • Choi, Joon-Young;Yang, You-Jung;Choi, Seung-Jin;Yeo, Jeong-Seok;Park, Seong-Wook;Song, Jae-Kwan;Moon, Dae-Hyuk
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.4
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    • pp.219-228
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    • 2003
  • Purpose: The amount of salvaged myocardium is an important prognostic factor in patients with acute myocardial infarction (MI). We investigated if early Tl-201 SPECT imaging could be used to predict the salvaged myocardium and functional recovery in acute MI after primary PTCA. Materials and Methods: In 36 patients with first acute MI treated with primary PTCA, serial echocardiography and Tl-201 SPECT imaging ($5.8{\pm}2.1$ days after PTDA) were performed. Regional wall motion and perfusion were quantified with on 16-segment myocardial model with 5-point and 4-point scaling system, respectively. Results: Wall motion was improved in 78 of the 212 dyssynergic segments on 1 month follow-up echocardiography and 97 on 7 months follow-up echocardiography, which were proved to be salvaged myocardium. The areas under receiver operating characteristic curves of Tl-201 perfusion score for detecting salvaged myocardial segments were 0.79 for 1 month follow-up and 0.83 for 7 months follow-up. The sensitivity and specificity of Tl-201 redistribution images with optimum cutoff of 40% of peak thallium activity for detecting salvaged myocardium were 84.6% and 55.2% for 1 month follow-up, and 87.6% and 64.3% for 7 months follow-up, respectively. There was a linear relationship between the percentage of peak thallium activity on early redistribution imaging and the likelihood of segmental functional improvement 7 months after reperfusion. Conclusion: Tl-201 myocardial perfusion SPECT imaging performed early within 10 days after reperfusion can be used to predict the salvaged myocardium and functional recovery with high sensitivity during the 7 months following primary PTCA in patients with acute MI.

A Study on Developing a VKOSPI Forecasting Model via GARCH Class Models for Intelligent Volatility Trading Systems (지능형 변동성트레이딩시스템개발을 위한 GARCH 모형을 통한 VKOSPI 예측모형 개발에 관한 연구)

  • Kim, Sun-Woong
    • Journal of Intelligence and Information Systems
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    • v.16 no.2
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    • pp.19-32
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    • 2010
  • Volatility plays a central role in both academic and practical applications, especially in pricing financial derivative products and trading volatility strategies. This study presents a novel mechanism based on generalized autoregressive conditional heteroskedasticity (GARCH) models that is able to enhance the performance of intelligent volatility trading systems by predicting Korean stock market volatility more accurately. In particular, we embedded the concept of the volatility asymmetry documented widely in the literature into our model. The newly developed Korean stock market volatility index of KOSPI 200, VKOSPI, is used as a volatility proxy. It is the price of a linear portfolio of the KOSPI 200 index options and measures the effect of the expectations of dealers and option traders on stock market volatility for 30 calendar days. The KOSPI 200 index options market started in 1997 and has become the most actively traded market in the world. Its trading volume is more than 10 million contracts a day and records the highest of all the stock index option markets. Therefore, analyzing the VKOSPI has great importance in understanding volatility inherent in option prices and can afford some trading ideas for futures and option dealers. Use of the VKOSPI as volatility proxy avoids statistical estimation problems associated with other measures of volatility since the VKOSPI is model-free expected volatility of market participants calculated directly from the transacted option prices. This study estimates the symmetric and asymmetric GARCH models for the KOSPI 200 index from January 2003 to December 2006 by the maximum likelihood procedure. Asymmetric GARCH models include GJR-GARCH model of Glosten, Jagannathan and Runke, exponential GARCH model of Nelson and power autoregressive conditional heteroskedasticity (ARCH) of Ding, Granger and Engle. Symmetric GARCH model indicates basic GARCH (1, 1). Tomorrow's forecasted value and change direction of stock market volatility are obtained by recursive GARCH specifications from January 2007 to December 2009 and are compared with the VKOSPI. Empirical results indicate that negative unanticipated returns increase volatility more than positive return shocks of equal magnitude decrease volatility, indicating the existence of volatility asymmetry in the Korean stock market. The point value and change direction of tomorrow VKOSPI are estimated and forecasted by GARCH models. Volatility trading system is developed using the forecasted change direction of the VKOSPI, that is, if tomorrow VKOSPI is expected to rise, a long straddle or strangle position is established. A short straddle or strangle position is taken if VKOSPI is expected to fall tomorrow. Total profit is calculated as the cumulative sum of the VKOSPI percentage change. If forecasted direction is correct, the absolute value of the VKOSPI percentage changes is added to trading profit. It is subtracted from the trading profit if forecasted direction is not correct. For the in-sample period, the power ARCH model best fits in a statistical metric, Mean Squared Prediction Error (MSPE), and the exponential GARCH model shows the highest Mean Correct Prediction (MCP). The power ARCH model best fits also for the out-of-sample period and provides the highest probability for the VKOSPI change direction tomorrow. Generally, the power ARCH model shows the best fit for the VKOSPI. All the GARCH models provide trading profits for volatility trading system and the exponential GARCH model shows the best performance, annual profit of 197.56%, during the in-sample period. The GARCH models present trading profits during the out-of-sample period except for the exponential GARCH model. During the out-of-sample period, the power ARCH model shows the largest annual trading profit of 38%. The volatility clustering and asymmetry found in this research are the reflection of volatility non-linearity. This further suggests that combining the asymmetric GARCH models and artificial neural networks can significantly enhance the performance of the suggested volatility trading system, since artificial neural networks have been shown to effectively model nonlinear relationships.

A Study of Guidelines for Genetic Counseling in Preimplantation Genetic Diagnosis (PGD) (착상전 유전진단을 위한 유전상담 현황과 지침개발을 위한 기초 연구)

  • Kim, Min-Jee;Lee, Hyoung-Song;Kang, Inn-Soo;Jeong, Seon-Yong;Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.7 no.2
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    • pp.125-132
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    • 2010
  • Purpose: Preimplantation genetic diagnosis (PGD), also known as embryo screening, is a pre-pregnancy technique used to identify genetic defects in embryos created through in vitro fertilization. PGD is considered a means of prenatal diagnosis of genetic abnormalities. PGD is used when one or both genetic parents has a known genetic abnormality; testing is performed on an embryo to determine if it also carries the genetic abnormality. The main advantage of PGD is the avoidance of selective pregnancy termination as it imparts a high likelihood that the baby will be free of the disease under consideration. The application of PGD to genetic practices, reproductive medicine, and genetic counseling is becoming the key component of fertility practice because of the need to develop a custom PGD design for each couple. Materials and Methods: In this study, a survey on the contents of genetic counseling in PGD was carried out via direct contact or e-mail with the patients and specialists who had experienced PGD during the three months from February to April 2010. Results: A total of 91 persons including 60 patients, 49 of whom had a chromosomal disorder and 11 of whom had a single gene disorder, and 31 PGD specialists responded to the survey. Analysis of the survey results revealed that all respondents were well aware of the importance of genetic counseling in all steps of PGD including planning, operation, and follow-up. The patient group responded that the possibility of unexpected results (51.7%), genetic risk assessment and recurrence risk (46.7%), the reproduction options (46.7%), the procedure and limitation of PGD (43.3%) and the information of PGD technology (35.0%) should be included as a genetic counseling information. In detail, 51.7% of patients wanted to be counseled for the possibility of unexpected results and the recurrence risk, while 46.7% wanted to know their reproduction options (46.7%). Approximately 96.7% of specialists replied that a non-M.D. genetic counselor is necessary for effective and systematic genetic counseling in PGD because it is difficult for physicians to offer satisfying information to patients due to lack of counseling time and specific knowledge of the disorders. Conclusions: The information from the survey provides important insight into the overall present situation of genetic counseling for PGD in Korea. The survey results demonstrated that there is a general awareness that genetic counseling is essential for PGD, suggesting that appropriate genetic counseling may play a important role in the success of PGD. The establishment of genetic counseling guidelines for PGD may contribute to better planning and management strategies for PGD.

Effects of Nitrogen , Phosphorus and Potassium Application Rates on Oversown Hilly Pasture under Different Levels of Inclination II. Changes on the properties, chemical composition, uptake and recovery of mineral nutrients in mixed grass/clover sward (경사도별 3요소시용 수준이 겉뿌림 산지초지에 미치는 영향 II. 토양특성 , 목초의 무기양분함량 및 3요소 이용율의 변화)

  • 정연규;이종열
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.5 no.3
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    • pp.200-206
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    • 1985
  • This field experiment was undertaken to assess the effects of three levels of inclination ($10^{\circ},\;20^{\circ},\;and\;30^{\circ}$) and four rates of $N-P_2O_5-K_2O$ (0-0-0-, 14-10-10, 28-25-25, and 42-40-40kg/10a) on establishment, yield and quality, and botanical compositions of mixed grass-clover sward. This second part is concerned with the soil chemical properties, concentrations and uptake of mineral nutrients, and percent recovery and efficiency of NPK. The results obtained after a two-year experiment are summarized as follows: 1. The pH, exchangeable Mg and Na, and base saturation in the surface soils were decreased by increasing the grade of inclination, whereas organic matter and available $P_2O_5$ tended to be increased. However, the changes in the Ca content and equivalent ratio of $K\sqrt{Ca+Mg}$ were not significant. The pH, exchangeable Ca and Mg, and base saturation were reduced by increasing the NPK rate, whereas available $P_2O_5$, exchangeable K, and equivalent ratio of $K\sqrt{Ca+Mg}$ tended to be increased. 2. The concentrations of mineral nutrients in grasses and weeds were not significantly affected by increasing the grade of slope in hilly pasture, whereas the concentrations of N, K, and Mg in legume were the lowest with the steep slope, which seemed to be related to the low legume yield. The Mg concentrations of all forage species were below the critical level for good forage growth and likelihood of grass tetany. 3. The increase of NPK rate resulted in the increment of N, K and Na concentrations, and the decrease of Mg and Ca in grasses. The P concentration was increased with P application, but there were no differences in that among the P rates applied. It resulted also in a slight increase of K, and a decrease of Mg in legume, but the contents of N, Ca, and Na were not affected by that. On the other hand, it has not affected the mineral contents in weeds except a somewhat increase of N. The mixed forages showed a increase of N and K contents, a decrease of Ca and Mg, and a slight change in P and Na. 4. The percent recovery of N, P and K by mixed forages were greatly decreased by increasing the grade of inclination and NPK rate. They were high in the order; K>N>P. The efficiency of mixed NPK applications was decreased by that. The efficiency of mixed NPK fertilizers absorbed was slightly decreased by the increased rate of NPK, but it was not affected by the grade of inclination.

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Spatial effect on the diffusion of discount stores (대형할인점 확산에 대한 공간적 영향)

  • Joo, Young-Jin;Kim, Mi-Ae
    • Journal of Distribution Research
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    • v.15 no.4
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    • pp.61-85
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    • 2010
  • Introduction: Diffusion is process by which an innovation is communicated through certain channel overtime among the members of a social system(Rogers 1983). Bass(1969) suggested the Bass model describing diffusion process. The Bass model assumes potential adopters of innovation are influenced by mass-media and word-of-mouth from communication with previous adopters. Various expansions of the Bass model have been conducted. Some of them proposed a third factor affecting diffusion. Others proposed multinational diffusion model and it stressed interactive effect on diffusion among several countries. We add a spatial factor in the Bass model as a third communication factor. Because of situation where we can not control the interaction between markets, we need to consider that diffusion within certain market can be influenced by diffusion in contiguous market. The process that certain type of retail extends is a result that particular market can be described by the retail life cycle. Diffusion of retail has pattern following three phases of spatial diffusion: adoption of innovation happens in near the diffusion center first, spreads to the vicinity of the diffusing center and then adoption of innovation is completed in peripheral areas in saturation stage. So we expect spatial effect to be important to describe diffusion of domestic discount store. We define a spatial diffusion model using multinational diffusion model and apply it to the diffusion of discount store. Modeling: In this paper, we define a spatial diffusion model and apply it to the diffusion of discount store. To define a spatial diffusion model, we expand learning model(Kumar and Krishnan 2002) and separate diffusion process in diffusion center(market A) from diffusion process in the vicinity of the diffusing center(market B). The proposed spatial diffusion model is shown in equation (1a) and (1b). Equation (1a) is the diffusion process in diffusion center and equation (1b) is one in the vicinity of the diffusing center. $$\array{{S_{i,t}=(p_i+q_i{\frac{Y_{i,t-1}}{m_i}})(m_i-Y_{i,t-1})\;i{\in}\{1,{\cdots},I\}\;(1a)}\\{S_{j,t}=(p_j+q_j{\frac{Y_{j,t-1}}{m_i}}+{\sum\limits_{i=1}^I}{\gamma}_{ij}{\frac{Y_{i,t-1}}{m_i}})(m_j-Y_{j,t-1})\;i{\in}\{1,{\cdots},I\},\;j{\in}\{I+1,{\cdots},I+J\}\;(1b)}}$$ We rise two research questions. (1) The proposed spatial diffusion model is more effective than the Bass model to describe the diffusion of discount stores. (2) The more similar retail environment of diffusing center with that of the vicinity of the contiguous market is, the larger spatial effect of diffusing center on diffusion of the vicinity of the contiguous market is. To examine above two questions, we adopt the Bass model to estimate diffusion of discount store first. Next spatial diffusion model where spatial factor is added to the Bass model is used to estimate it. Finally by comparing Bass model with spatial diffusion model, we try to find out which model describes diffusion of discount store better. In addition, we investigate the relationship between similarity of retail environment(conceptual distance) and spatial factor impact with correlation analysis. Result and Implication: We suggest spatial diffusion model to describe diffusion of discount stores. To examine the proposed spatial diffusion model, 347 domestic discount stores are used and we divide nation into 5 districts, Seoul-Gyeongin(SG), Busan-Gyeongnam(BG), Daegu-Gyeongbuk(DG), Gwan- gju-Jeonla(GJ), Daejeon-Chungcheong(DC), and the result is shown

    . In a result of the Bass model(I), the estimates of innovation coefficient(p) and imitation coefficient(q) are 0.017 and 0.323 respectively. While the estimate of market potential is 384. A result of the Bass model(II) for each district shows the estimates of innovation coefficient(p) in SG is 0.019 and the lowest among 5 areas. This is because SG is the diffusion center. The estimates of imitation coefficient(q) in BG is 0.353 and the highest. The imitation coefficient in the vicinity of the diffusing center such as BG is higher than that in the diffusing center because much information flows through various paths more as diffusion is progressing. A result of the Bass model(II) shows the estimates of innovation coefficient(p) in SG is 0.019 and the lowest among 5 areas. This is because SG is the diffusion center. The estimates of imitation coefficient(q) in BG is 0.353 and the highest. The imitation coefficient in the vicinity of the diffusing center such as BG is higher than that in the diffusing center because much information flows through various paths more as diffusion is progressing. In a result of spatial diffusion model(IV), we can notice the changes between coefficients of the bass model and those of the spatial diffusion model. Except for GJ, the estimates of innovation and imitation coefficients in Model IV are lower than those in Model II. The changes of innovation and imitation coefficients are reflected to spatial coefficient(${\gamma}$). From spatial coefficient(${\gamma}$) we can infer that when the diffusion in the vicinity of the diffusing center occurs, the diffusion is influenced by one in the diffusing center. The difference between the Bass model(II) and the spatial diffusion model(IV) is statistically significant with the ${\chi}^2$-distributed likelihood ratio statistic is 16.598(p=0.0023). Which implies that the spatial diffusion model is more effective than the Bass model to describe diffusion of discount stores. So the research question (1) is supported. In addition, we found that there are statistically significant relationship between similarity of retail environment and spatial effect by using correlation analysis. So the research question (2) is also supported.

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