• Journal of Chest Surgery
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• 제40권4호
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• pp.280-287
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• 2007

Background: We retrospectively evaluated the clinical results of surgically managing patients with Ebstein's anomaly. Material and Method: Between Feb. f 984 and June 2006, 50 patients who underwent surgical treatment for Ebstein's anomaly at Yonsei Cardiovascular Center were retrospectively reviewed. The mean age of the patients was 26.9 years and 19 patients were male, Associated anomalies included atrial septal defect (33), patent ductus arteriosus (2), ventricular septal defect (1), and pulmonary stenosis (4), and 90%, (45/50) of the patients had more than a moderate degree of tricuspid regurgitation. Carpentier type A was present in 6 patients, type B in 26, type C in 14 and type D in 4. Ten patients were associated with WPW syndrome. Conservative surgery was possible in 31 patients (tricuspid annuloplasty, plication of the atrialized RV), Fontan's operation was peformed in 4 patients, tricuspid valve replacement was done in 12 and palliative surgery was done in 2 patients. Thirteen patients were associated with hi-directional cavopulmonary shunt (BCPS: one and a half ventricular repairs): 10 patients with WPW syndrome and 4 patients with atrial fibrillation underwent concomitant ablation. Result: The postoperative median NYHA functional class $(3{\rightarrow}1)$ and the mean cardio-thoracic ratio $(0.65{\rightarrow}0.59)$ were decreased significantly (p<0.001, p=0.014). The mean oxygen saturation $(86.6{\rightarrow}94.1%)$, and median TR grade $(4{\rightarrow}1)$ were also significantly improved (p=0.004, p<0.001). For comparison of BCPS and conservative surgery, the preoperative right ventricular pressure (33.0 vs. 41.3 mmHg), the ICU stay (2.80 vs. 1.89 days), the hospital say (10.6 vs. 16.8 days), and the left ventricular ejection fraction (64.3 vs. 72.8%) were statistically different. Postoperative mortality occurred in 3 patients (6%) due to biventricular failure in 2 patients and sepsis in the other patient. The mean follow up duration was 101.5 months, and one patient died of Fontan failure and 6 patients required reoperation (bioprosthetic degenerative change (2) and Fontan conversion (4)). The overall survival rate at 10 years was 90.2%, the freedom from reoperation rate and rate of cardiac related events were 78.9% and 49.2%, respectively. Conclusion: Surgical management of Ebstein's anomaly can be performed safely, and the associated BCPS may be helpful for high-risk patients. Adequate application of surgical management may increase the long-term survival with a reduced rate of reoperation.

• Journal of Korean Society of Forest Science
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• 제84권3호
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• pp.286-298
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• 1995

This study was carried out to investigate the effect of forest soil acidification on the distribution of exchangeable cations($Ca^{2+}$, $Mg^{2+}$, $Al^{3+}$) and heavy metals(Cu, Zn, Mn, Pb, Cd) in soil, and to understand the relation of the soil chemical properties and the distribution of nutrients and hear metals in fine root and foliage. The results through survey on the long - term change of soil pH and the contents of nutrient and heavy metal in soil, fine root and foliage by 2 sites near Ulsan - Onsan industrial estate and 2 sites in limited development district are summarized as follows : 1. The average forest soil pH(A horizon) in Ulsan had been proceeded down to 3.73 in deciduous forest and 3.86 in coniferous forest in 1994 from 4.45 and 4.78 in 1987, respectively, which indicated serious soil acidification. As comparing soil pH among sites, Dongcheon coniferous forest(pH 4.57) in limited development district showed the highest values and Dangwol deciduous forest(pH 3.19) near Onsan industrial estate showed the lowest values in 1994. 2. Contents of exchangeable calcium in forest soils of limited development district where showed much higher soil pH than industrial estate were 3.5 times more in deciduous forest soil and 11 times more in coniferous forest soil than in industrial estate, and contents of exchangeable magnesium were also 4.5 and 5 times more in limited development district than in industrial estate, respectively. However contents of exchangeable aluminium which had been supposed more in forest soil of industrial estate were more in limited development district. 3. Contents of calcium and magnesium in fine root of deciduous trees(A hirsuta. Q. acutissima) were 3.6 and 1.7 times more in limited development district than in industrial estate, respectively, and those of coniferous trees(P. rigida, P. thunbergii) were 4.6 and 1.5 times more in Limited development district than in industrial estate, respectively. Also contents of calcium and magnesium in foliage of deciduous trees were 1.1 and 2.2 times more in limited development district than in industrial estate, respectively, and those of coniferous trees were 1.8 and 3.3 times more in limited development district, respectively. And contents of aluminium in fine root and foliage were nearly as same as in soil. 4. Ca/Al molar ratios in soil and fine root, which could be related with the dgree of soil acidification and Al toxicity on trees, were Less than 1 in all sites except Dongcheon, suggesting that the soil and fine root in the sites have high sensitivity to soil acidification and the decrease in nutrient uptake and root enlargement. The Ca/Al molar ratios in soil and fine root in coniferous forest were highly correlated with the soil pH one another. 5. Contents of Cu, Zn and Pb in soil, fine root and foliage were more in industrial estate than in limited development district in both deciduous and coniferous forests, however, oppositely contents of Mn and Cd in soil were more in limited development district than in industrial estate.

• Tuberculosis and Respiratory Diseases
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• 제47권6호
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• pp.824-835
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• 1999

Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• 제19권1호
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• pp.75-91
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• 2024

Recently, global business environment is changing dramatically along with the acceleration of technological innovation amid the war, climatic change, and geopolitical instability. Accordingly, it is difficult to predict or plan for the future as the volatility, complexity, ambiguity, and uncertainty of the industrial ecosystem continue to increase. Therefore, organizations are undergoing inevitable restructuring in accordance with their survival strategy, for instance, removing marginal businesses or firing. Accordingly, office workers are seeking a startup as an alternative for their continuous economic activity amid rising anxiety factors that make them think they would lose their jobs unintentionally. Here, this study is aimed to verify through what paths office workers' self-determination influences the process of converting to a startup. For this study, an online survey was carried out, and 310 respondents' valid data were analyzed through SPSS and AMOS. To sum up the results, first, office workers' self-determination did not have significant effects on entrepreneurial intention. However, it was confirmed that self-determination had positive (+) effects on innovativeness and perception of the startup support system. This result shows that their psychology works to prepare step by step by accumulating innovative experiences and increasing perception of the startup support system from a long-term life path perspective rather than challenging startups right way. Second, innovativeness is found to have positive (+) effects on entrepreneurial intention. Also, perception of the startup support system had positive (+) effects on entrepreneurial intention. This implies that when considering startups, they are highly aware of the government's various startup support systems. Third, innovativeness is found to have positive (+) effects on perception of the startup support system. It is judged that perception of the startup support system is valid for prospective founders to exhibit their innovativeness and realize new ideas. Fourth, it was confirmed that innovativeness and perception of the startup support system mediated correlation between self-determination and entrepreneurial intention, and perception of the startup support system mediated correlation between innovativeness and entrepreneurial intention, which shows that it is a crucial factor in entrepreneurial intention. Although previous studies related to startups deal with students mostly, this study targets office workers who form a great part in economic activities, which makes it academically valuable in terms of being differentiated from others and extending the scope of research. Also, when we consider the fact that the motivation for self-determination alone fails to stimulate entrepreneurial intention and the complete mediation of innovativeness and the startup support system, it has great implications in practical aspects such as the government's human and material support systems. In the selection and analysis of samples, this study exhibits a limitation that the problem of common method bias is not completely resolved. Also, additional definitive research is needed on whether entrepreneurial intention is formed and converted into startup behavior. Academically and practically, this study deals with the relationship between humans' psychological motives and startups which has not been handled sufficiently in previous studies. The conversion of office workers to startups is expected to have effects on individuals' economic stability and the state's job creation; therefore, it needs to be investigated continuously for its great value.

• Journal of Distribution Research
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• 제15권1호
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• pp.49-71
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• 2010

Franchise businesses in South Korea have contributed to economic growth and job creation, and its growth potential remains very high. However, despite such virtues, domestic franchise businesses face many problems such as the instability of franchisor's business structure and weak financial conditions. To solve these problems, the government enacted legislation and strengthened franchise related laws. However, the strengthening of laws regulating franchisors had many side effects that interrupted the development of the franchise business. For example, legal regulations regarding franchisors have had the effect of suppressing the franchisor's leadership activities (e.g. activities such as the ability to advocate the franchisor's policies and strategies to the franchisees, in order to facilitate change and innovation). One of the main goals of the franchise business is to build cooperation between the franchisor and the franchisee for their combined success. However, franchisees can refuse to follow the franchisor's strategies because of the current state of franchise-related law and government policy. The purpose of this study to explore the effects of franchisor's leadership style on franchisee's commitment in a franchise system. We classified leadership styles according to the path-goal theory (House & Mitchell, 1974), and it was hypothesized and tested that the four leadership styles proposed by the path-goal theory (i.e. directive, supportive, participative and achievement-oriented leadership) have different effects on franchisee's commitment. Another purpose of this study to explore the how the level of franchisee's self-efficacy influences both the franchisor's leadership style and franchisee's commitment in a franchise system. Results of the present study are expected to provide important theoretical and practical implications as to the role of franchisor's leadership style, as restricted by government regulations and the franchisee's self-efficacy, which could be needed to improve the quality of the long-term relationship between the franchisor and franchisee. Quoted by Northouse(2007), one problem regarding the investigation of leadership is that there are almost as many different definitions of leadership as there are people who have tried to define it. But despite the multitude of ways in which leadership has been conceptualized, the following components can be identified as central to the phenomenon: (a) leadership is a process, (b) leadership involves influence, (c) leadership occurs in a group context, and (d) leadership involves goal attainment. Based on these components, in this study leadership is defined as a process whereby franchisor's influences a group of franchisee' to achieve a common goal. Focusing on this definition, the path-goal theory is about how leaders motivate subordinates to accomplish designated goals. Drawing heavily from research on what motivates employees, path-goal theory first appeared in the leadership literature in the early 1970s in the works of Evans (1970), House (1971), House and Dessler (1974), and House and Mitchell (1974). The stated goal of this leadership theory is to enhance employee performance and employee satisfaction by focusing on employee motivation. In brief, path-goal theory is designed to explain how leaders can help subordinates along the path to their goals by selecting specific behaviors that are best suited to subordinates' needs and to the situation in which subordinates are working (Northouse, 2007). House & Mitchell(1974) predicted that although many different leadership behaviors could have been selected to be a part of path-goal theory, this approach has so far examined directive, supportive, participative, and achievement-oriented leadership behaviors. And they suggested that leaders may exhibit any or all of these four styles with various subordinates and in different situations. However, due to restrictive government regulations, franchisors are not in a position to change their leadership style to suit their circumstances. In addition, quoted by Northouse(2007), ssubordinate characteristics determine how a leader's behavior is interpreted by subordinates in a given work context. Many researchers have focused on subordinates' needs for affiliation, preferences for structure, desires for control, and self-perceived level of task ability. In this study, we have focused on the self-perceived level of task ability, namely, the franchisee's self-efficacy. According to Bandura (1977), self-efficacy is chiefly defined as the personal attitude of one's ability to accomplish concrete tasks. Therefore, it is not an indicator of one's actual abilities, but an opinion of the extent of how one can use that ability. Thus, the judgment of maintain franchisee's commitment depends on the situation (e.g., government regulation and policy and leadership style of franchisor) and how it affects one's ability to mobilize resources to deal with the task, so even if people possess the same ability, there may be differences in self-efficacy. Figure 1 illustrates the model investigated in this study. In this model, it was hypothesized that leadership styles would affect the franchisee's commitment, and self-efficacy would moderate the relationship between leadership style and franchisee's commitment. Theoretically, quoted by Northouse(2007), the path-goal approach suggests that leaders need to choose a leadership style that best fits the needs of subordinates and the work they are doing. According to House & Mitchell (1974), the theory predicts that a directive style of leadership is best in situations in which subordinates are dogmatic and authoritarian, the task demands are ambiguous, and the organizational rule and procedures are unclear. In these situations, franchisor's directive leadership complements the work by providing guidance and psychological structure for franchisees. For work that is structured, unsatisfying, or frustrating, path-goal theory suggests that leaders should use a supportive style. Franchisor's Supportive leadership offers a sense of human touch for franchisees engaged in mundane, mechanized activity. Franchisor's participative leadership is considered best when a task is ambiguous because participation gives greater clarity to how certain paths lead to certain goals; it helps subordinates learn what actions leads to what outcome. Furthermore, House & Mitchell(1974) predicts that achievement-oriented leadership is most effective in settings in which subordinates are required to perform ambiguous tasks. Marsh and O'Neill (1984) tested the idea that organizational members' anger and decline in performance is caused by deficiencies in their level of effort and found that self-efficacy promotes accomplishment, decreases stress and negative consequences like depression and emotional instability. Based on the extant empirical findings and theoretical reasoning, we posit positive and strong relationships between the franchisor's leadership styles and the franchisee's commitment. Furthermore, the level of franchisee's self-efficacy was thought to maintain their commitment. The questionnaires sent to participants consisted of the following measures; leadership style was assessed using a 20 item 7-point likert scale developed by Indvik (1985), self-efficacy was assessed using a 24 item 6-point likert scale developed by Bandura (1977), and commitment was assessed using a 6 item 5-point likert scale developed by Morgan & Hunt (1994). Questionnaires were distributed to Korean optical franchisees in Seoul. It took about 20 days to complete the data collection. A total number of 140 questionnaires were returned and complete data were available from 137 respondents. Results of multiple regression analyses testing the relationships between the each of the four styles of leadership shown by the franchisor as independent variables and franchisee's commitment as the dependent variable showed that the relationship between supportive leadership style and commitment ($\beta$=.13, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.07, p<.001)were significant. However, when participants divided into high and low self-efficacy groups, results of multiple regression analyses showed that only the relationship between achievement-oriented leadership style and commitment ($\beta$=.14, p<.001) was significant in the high self-efficacy group. In the low self-efficacy group, the relationship between supportive leadership style and commitment ($\beta$=.17, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.10, p<.001) were significant. The study focused on the franchisee's self-efficacy in order to explore the possibility that regulation, originally intended to protect the franchisee, may not be the most effective method to maintain the relationships in a franchise business. The key results of the data analysis regarding the moderating role of self-efficacy between leadership behavior style as proposed by path-goal and commitment theory were as follows. First, this study proposed that franchisor should apply the appropriate type of leadership behavior to strengthen the franchisees commitment because the results demonstrated that supportive and participative leadership styles by the franchisors have a positive influence on the franchisee's level of commitment. Second, it is desirable for franchisor to validate the franchisee's efforts, since the franchisee's characteristics such as self-efficacy had a substantial, positive effect on the franchisee's commitment as well as being a meaningful moderator between leadership and commitment. Third, the results as a whole imply that the government should provide institutional support, namely to put the franchisor in a position to clearly identify the characteristics of their franchisees and provide reasonable means to administer the franchisees to achieve the company's goal.

• Journal of Distribution Research
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• 제16권4호
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• pp.65-93
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• 2011

As relationship between buyer and seller has been brought closer and long-term relationship has been more important in B2B markets, the importance of service and service convenience increases as well as product. In homogeneous markets, where service offerings are similar and therefore not key competitive differentiator, providing greater convenience may enable a competitive advantage. Service convenience, as conceptualized by Berry et al. (2002), is defined as the consumers' time and effort perceptions related to buying or using a service. For this reason, B2B customers are interested in how fast the service is provided and how much save non-monetary cost like time or effort by the service convenience along with service quality. Therefore, this study attempts to investigate the impact of service convenience on relationship factors such as relationship satisfaction, relationship commitment, and relationship performance. The purpose of this study is to find out whether service convenience can be a new antecedent of relationship quality and relationship performance. In addition, this study tries to examine how five-dimensional service convenience constructs (decision convenience, access convenience, transaction convenience, benefit convenience, post-benefit convenience) affect customers' relationship satisfaction, relationship commitment, and relationship performance. The service convenience comprises five fundamental components - decision convenience (the perceived time and effort costs associated with service purchase or use decisions), access convenience(the perceived time and effort costs associated with initiating service delivery), transaction convenience(the perceived time and effort costs associated with finalizing the transaction), benefit convenience(the perceived time and effort costs associated with experiencing the core benefits of the offering) and post-benefit convenience (the perceived time and effort costs associated with reestablishing subsequent contact with the firm). Earlier studies of perceived service convenience in the industrial market are none. The conventional studies that have dealt with service convenience have usually been made in the consumer market, or they have dealt with convenience aspects in the service process. This service convenience measure for consumer market can be useful tool to estimate service quality in B2B market. The conceptualization developed by Berry et al. (2002) reflects a multistage, experiential consumption process in which evaluations of convenience vary at each stage. For this reason, the service convenience measure is good for B2B service environment which has complex processes and various types. Especially when categorizing B2B service as sequential stage of service delivery like Kumar and Kumar (2004), the Berry's service convenience measure which reflect sequential flow of service deliveries suitable to establish B2B service convenience. For this study, data were gathered from respondents who often buy business service and analyzed by structural equation modeling. The sample size in the present study is 119. Composite reliability values and average variance extracted values were examined for each variable to have reliability. We determine whether the measurement model supports the convergent validity by CFA, and discriminant validity was assessed by examining the correlation matrix of the constructs. For each pair of constructs, the square root of the average variance extracted exceeded their correlations, thus supporting the discriminant validity of the constructs. Hypotheses were tested using the Smart PLS 2.0 and we calculated the PLS path values and followed with a bootstrap re-sampling method to test the hypotheses. Among the five dimensional service convenience constructs, four constructs (decision convenience, transaction convenience, benefit convenience, post-benefit convenience) affected customers' positive relationship satisfaction, relationship commitment, and relationship performance. This result means that service convenience is important cue to improve relationship between buyer and seller. One of the five service convenience dimensions, access convenience, does not affect relationship quality and performance, which implies that the dimension of service convenience is not important factor of cumulative satisfaction. The Cumulative satisfaction can be distinguished from transaction-specific customer satisfaction, which is an immediate post-purchase evaluative judgment or an affective reaction to the most recent transactional experience with the firm. Because access convenience minimizes the physical effort associated with initiating an exchange, the effect on relationship satisfaction similar to cumulative satisfaction may be relatively low in terms of importance than transaction-specific customer satisfaction. Also, B2B firms focus on service quality, price, benefit, follow-up service and so on than convenience of time or place in service because it is relatively difficult to change existing transaction partners in B2B market compared to consumer market. In addition, this study using partial least squares methods reveals that customers' satisfaction and commitment toward relationship has mediating role between the service convenience and relationship performance. The result shows that management and investment to improve service convenience make customers' positive relationship satisfaction, and then the positive relationship satisfaction can enhance the relationship commitment and relationship performance. And to conclude, service convenience management is an important part of successful relationship performance management, and the service convenience is an important antecedent of relationship between buyer and seller such as the relationship commitment and relationship performance. Therefore, it has more important to improve relationship performance that service providers enhance service convenience although competitive service development or service quality improvement is important. Given the pressure to provide increased convenience, it is not surprising that organizations have made significant investments in enhancing the convenience aspect of their product and service offering.

• Advances in pediatric surgery
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• 제8권2호
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• pp.143-155
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• 2002

A survey on biliary atresia was made among 26 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and a case registration form for each patient during the twentyone-year period of 1980-2000. Three hundred and eighty patients were registered from 18 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:1.3. The age of patients on diagnosis with biliary atresia was on average $65.4{\pm} 36.2$ days old. The national distribution was 32.8% in Seoul, 25.3% in Gyoungki-Do, 21.6% in Gyoungsang-Do, 9.27% in Choongchung-Do, etc. in order. The most common clinical presentation was jaundice (98.4%) and change of stool color (86.2%) was second. Two hundred eighty (74.7%) of 375 patients were operated by 80 days of age. Three hundred thirty six (9 1.9%) of 366 patients were operated on by the original Kasai procedure, and 305 (84.3%) of 362 patients were observed by bile-drainage postoperatively. The overall postoperative complication rate was 18.5% and the overall postoperative mortality rate was 6.8%. The associated anomalies were observed in 72 cases (22.5%). One hundred ninty five (64.7%) of 302 patients have been alive in follow-up and 49 (25.1%) have survived over 5 years without problem after operation. Ascending cholangitis, varices and ascites affected survival significantly, and the important long-term prognostic factor was the occurrence of complications.