• Journal of Oral Medicine and Pain
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• v.34 no.4
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• pp.341-351
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• 2009

There is tremendous variability in the ways patients present with taste problems. Because of complex and multifactorial etiological background, it is not simple to evaluate patients with taste disorders. Accurate assessment of patients' status by prudent, thorough history taking and symptom analysis is the most essential for exact diagnosis of taste disorders. The aim of this study was to investigate the clinical characteristics of patients with taste problems as a primary complaint. Consecutive series of 50 patients (12 males and 38 females, mean age $53.6\;{\pm}\;14.7$ years) were included for the present study. All subjects were requested to complete a comprehensive questionnaire. Clinical evaluation procedures included oral examination, interview, questionnaire analysis, panoramic radiography, blood test and measurement of salivary flow rate. The obtained results were as follows: 1. Among the patients, 36 patients (72%) complained of oral mucosal pain or burning sensation. Of these patients, 18 patients (36%) were diagnosed as burning mouth syndrome. 2. Nineteen patients (38%) complained of subjective oral dryness. The flow rate of unstimulated whole saliva was less than 0.1 mL/min in 14 patients (28%) and 17 (34%) had a stimulated whole salivary flow rate of less than 0.5 mL/min. 3. Among the types of taste disorders, hypogeusia, the most frequently reported, was found in 25 patients (50%), dysgeusia in 18 patients (36%), phantogeusia in 15 patients (30%), hypergeusia in 10 patients (20%), and ageusia in 5 patients (10%). Nineteen patients (38%) reported more than one type of taste disorder and the most frequent combination was dysgeusia + hypogeusia (n=6, 12%). 4. Based on data from the medical and dental histories and examinations, the patients were assigned to 12 probable causal categories. Taste disorders due to oral mucosal diseases and idiopathic taste disorder were the most frequent (n=9; 18%, each), followed by psychogenic taste disorder (n=8; 16%), drug-induced taste disorder (n=7; 14%), and taste disorder due to dry mouth (n=6; 12%). These 5 categories of taste disorder accounted for 78% of all cases in this study.

• Journal of Korean Academy of Nursing
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• v.11 no.1
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• pp.65-87
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• 1981

The study is aimed at exploring concept held by clinical nurses of nursing. The data were collected from 225 nurses conviniently selected from the population of nurses working in Kang Won province. Findings include. 1) Nurse's Qualification. The respondents view that specialized knowledge is more important qualification of the nurse. Than warm personality. Specifically, 92.9% of the respondents indicated specialized knowledge as the most important qualification while only 43.1％ indicated warm personality. 2) On Nursing Profession. The respondents view that nursing profession as health service oriented rather than independent profession specifically. This suggests that nursing profession is not consistentic present health care delivery system nor support nurses working independently. 3) On Clients of Nursing Care The respondents include patients, family and the community residents in the category of nursing care. Specifically, 92.0％ of the respondents view that patient is the client, while only 67.1％ of nursing student and 74.7％ of herself. This indicates the lack of the nurse's recognition toward their clients. 4) On the Priority of Nursing care. Most of the respondents view the clients physical psychological respects as important component of nursing care but not the spiritual ones. Specially, 96.0% of the respondents indicated the physical respects, 93% psychological ones, while 64.1% indicated the spiritual ones. This means the lack of comprehensive conception on nursing aimension. 5) On Nursing Care. 91.6% of the respondents indicated that nursing care is the activity decreasing pain or helping to recover illness, while only 66.2% indicated earring out the physicians medical orders. 6) On Purpose of Nursing Care. 89.8% of the respondents indicated preventing illness and than 76.6% of them decreasing 1;ai of clients. On the other hand, maintaining health has the lowest selection at the degree of 13.8%. This means the lack of nurses' recognition for maintaining health as the most important point. 7) On Knowledge Needed in Nursing Care. Most of the respondents view that the knowledge faced with the spot of nursing care is needed. Specially, 81.3% of the respondents indicated simple curing method and 75.1%, 73.3%, 71.6% each indicated child nursing, maternal nursing and controlling for the communicable disease. On the other hand, knowledge w hick has been neglected in the specialized courses of nursing education, that is, thinking line among com-w unity members, overcoming style against between stress and personal relation in each home, and administration, management have a low selection at the depree of 48.9%,41.875 and 41.3%. 8) On Nursing Idea. The highest degree of selection is that they know themselves rightly, (The mean score measuring distribution was 4.205/5) In the lowest degree,3.016/5 is that devotion is the essential element of nursing, 2.860/5 the religious problems that human beings can not settle, such as a fatal ones, 2,810/5 the nursing profession is worth trying in one's life. This means that the peculiarly essential ideas on the professional sense of value. 9) On Nursing Services. The mean score measuring distribution for the nursing services showed that the inserting of machine air way is 2.132/5, the technique and knowledge for surviving heart-lung resuscitating is 2.892/s, and the preventing air pollution 3.021/5. Specially, 41.1% of the respondents indicated the lack of the replied ratio. 10) On Nurses' Qualifications. The respondents were selected five items as the most important qualifications. Specially, 17.4% of the respondents indicated specialized knowledge, 15.3% the nurses' health, 10.6％ satisfaction for nursing profession, 9.8% the experience need, 9.2% comprehension and cooperation, while warm personality as nursing qualifications have a tendency of being lighted. 11) On the Priority of Nursing Care The respondents were selected three items as the most important component. Most of the respondents view the client's physical, spiritual: economic points as important components of nursing care. They showed each 36.8%, 27.6%, 13.8% while educational ones showed 1.8%. 12) On Purpose of Nursing Care. The respondents were selected four items as the most important purpose. Specially,29.3% of the respondents indicated curing illness for clients, 21.3% preventing illness for client 17.4% decreasing pain, 15.3% surviving. 13) On the Analysis of Important Nursing Care Ranging from 5 point to 25 point, the nurses' qualification are concentrated at the degree of 95.1%. Ranging from 3 point to 25, the priorities of nursing care are concentrated at the degree of 96.4%. Ranging from 4 point to 16, the purpose of nursing care is concentrated at the degree of 84.0%. 14) The Analysis, of General Characteristics and Facts of Nursing Concept. The correlation between the educational high level and nursing care showed significance. (P < 0.0262). The correction between the educational low level and purpose of nursing care showed significance. (P < 0.002) The correlation between nurses' working yeras and the degree of importance for the purpose of nursing care showed significance (P < 0.0155) Specially, the most affirmative answers were showed from two years to four ones. 15) On Nunes' qualification and its Degree of Importance The correlation between nurses' qualification and its degree of importance showed significance. (r = 0.2172, p< 0.001) 0.005) B. General characteristics of the subjects The mean age of the subject was 39 ; with 38.6% with in the age range of 20-29 ; 52.6% were male; 57.9％ were Schizophrenia; 35.1% were graduated from high school or high school dropouts; 56.l％ were not have any religion; 52.6% were unmarried； 47.4% were first admission; 91.2% were involuntary admission patients. C. Measurement of anxiety variables. 1. Measurement tools of affective anxiety in this study demonstrated high reliability (.854). 2. Measurement tools of somatic anxiety in this study demonstrated high reliability (.920). D. Relationship between the anxiety variables and the general characteristics. 1. Relationship between affective anxiety and general characteristics. 1) The level of female patients were higher than that of the male patient (t = 5.41, p < 0.05). 2) Frequencies of admission were related to affective anxiety, so in the first admission the anxiety level was the highest. (F = 5.50, p < 0.005). 2, Relationship between somatic anxiety and general characteristics. 1) The age range of 30-39 was found to have the highest level of the somatic anxiety. (F = 3.95, p < 0.005). 2) Frequencies of admission were related to the somatic anxiety, so .in first admission the anxiety level was the highest. (F = 9.12, p ＜ 0.005) 0. Analysis of significant anxiety symptoms for nursing intervention. 1. Seven items such as dizziness, mental integration, sweating, restlessness, anxiousness, urinary frequency and insomnia, init. accounted for 96％ of the variation within the first 24 hours after admission. 2. Seven items such as fear, paresthesias, restlessness, sweating insomnia, init., tremors and body aches and pains accounted for 84% of the variation on the 10th day after admission.

• Journal of Acupuncture Research
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• v.17 no.1
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• pp.27-41
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• 2000

The meridian system is the most essential and basic connecting structure that maintains the vital activities of viscera and bowels by connecting them with each part of body's surface. Doctors can understand the healthy condition, and the region and deficiency-excessiveness of disease by observing the condition of Qi flowing. Deficiency and excessiveness could be differentiated by various symptoms expressed in meridian system. Especially there could be several clues like pain, heat-cold, protuberance-depression, change of color and shine in the line of channel leads to the judgment of deficiency-excessiveness The diagnosis of deficiency and excessiveness can be generalized by quantification of elastic status in skin surface along the meridian system. By comparing data from measurement of elastic condition with those from traditional deficiency and excessiveness, it could be utilized for the development of oriental medicine. All biological activities in the human body are based on meridian system according to the oriental medicine. Also the meridian system is viewed as basic and essential structure connecting internal viscera and each part of body. The areas of expressed channel phenomena are muscle to bone, muscle to muscle and bone to bone. These areas are called depression where meridian system is present and any changing state on those points can be measured. It could be difficult in diagnosing the reaction of meridian system because doctor can depend on his own judgment. Therefore, it is necessary to quantify and indexate channel reactions. To quantify the channel reactions, specially manufactured instrument was used to quantify the protuberance and depression to differentiate the deficiency and excessiveness. The results follow as below; 1. The elastic index measurement by the equipment proved a pattern of agreement showing the values that ranged within standard deviation 0.05kgf/cm throughout the experiment except few cases' measurement in CV-17. 2. To evaluate the state of deficiency & excessiveness of elastic index measurements in frontal point, elastic index measurements in the front paint were compared to the elastic index measured surrounding the point within 2.5 cm. Such result of indexing procedure was closely matched to the concept of palpitation. 3. If the elastic index values in the surrounding front point closely located to the elastic index values in the front point, the judgement on the state of deficiency and excessiveness was delayed. Otherwise, it was judged as deficiency or excessiveness. 4. Out of total 12 cases of comparing the elastic index values to the elastic index values in the surrounding front point, Three to nine front points were judged as either in the state of deficiency or excessiveness. 5. Among the nine front points judged as either in the state of deficiency or excessiveness, Four cases were matched to the electric index measured by EAV that evaluating the internal organs by five different phases. If more clinical cases are accumulated, it is expected to systematically theorize and improve the concept of deficiency and excessiveness in the internal organs using the front point.

• Journal of Korean Academy of Nursing Administration
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• v.6 no.3
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• pp.389-404
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• 2000

This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.421-429
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• 2007

Some researchers suggested that tactile sensor system would be useful in evaluating masticatory muscles of TMD patients, but there were few studies on the effects of chewing with time. The aim of this study was to investigate the change of elasticity and stiffness for masseter and temporal muscles of normal subjects before, during and after gum chewing and to obtain the baseline data for further researches on the elasticity and stiffness for masticatory muscles of TMD patients. Stiffness and elasticity of their anterior temporalis and inferior masseter muscle were measured bilaterally by a tactile sensor system. Each subject was instructed to sit on a chair for evaluation of masticatory muscles. Before operating the sensor, the thickest skin area over anterior temporalis and inferior masseter muscles were selected as the points to be pressed by a tactile sensor, and marked with a pen. While the teeth of subjects were lightly contacted, the probe of the tactile sensor was placed perpendicularly over the marked point over the skin, followed by computer-controlled movement including gently pressing straight down on the muscle for a second and retracting. All subjects were instructed to chew gum (Excellent Breath, Taiyo Co., Japan) bilaterally with a velocity of 2 times per second for 40 minutes after the first measurement had been performed for the baseline data of all subjects. The measurements had been repeated during chewing with 10 minutes of interval and continued for 40 minutes with same interval after chewing. Resultantly, the decrease of elasticity and the increase of stiffness in masticatory muscles can be seen significantly within 10 minutes after chewing and those were maintained during chewing without significant change with chewing time. The elasticity of muscles was recovered within 10 minutes after stopping chewing, but the stiffness was recovered more lately than elasticity by about 10 minutes. Based on these results, it can be concluded that elasticity and stiffness of muscles would be good indicators to evaluate the masticatory muscles objectively, when more supported by further researches.

• Journal of Hospice and Palliative Care
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• v.3 no.1
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• pp.18-27
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• 2000

Purpose : This study aims to find out the quality of life of patients admitted to the hospice unit at Kangnam St. Mary's Hospital, at admission and after weeks hospice service and to assess the effects of hospice service on the quality of life of terminal cancer patients. Methods : This study subjects were 100 patients admitted to the hospice unit at Kangnam St. Mary's Hospital, Catholic University between October 1999 and March 2000, and their primary caregivers. Quality of life data were collected using a questionnaire revised by the authors and were analyzed by means of repeated measures ANOVA. Results : 1) Patient's quality of life as perceived by the primary caregiver was significantly improved and the mean score was 3.31, 3.68, 3.56, 3.73, 3.75 at admission and week 1, 2, 3, 4. With the detailed item analysis, the following items were shown to be significantly improved: "clean bodies"(F=6.50, P=0.0001) "pain control"(F=18.01, P=0.0001) constipate"(F=2.96, P=0.0237) "sleep"(F=3.99, P=0.0048) "nausea/vomiting"(F=4.50, P=0.0022) "medical team's comfortable care" (F=3.95, P=0.0051) "family's care"(F=2.76, P=0.0317) "anxiety" (F=3.14, P=0.0177) "comfort"(F=3.63, P=0.0085) "treat with dignity"(F=3.32, P=0.0136). The item of "death is not the end of life rather the beginning" was significantly decreased(F=2.54, P=0.0450). 2) Patient's quality of life as perceived by the patient showed an improvement but statistically insignificant and the mean score was 3.63 and 3.83 at admission and week 1. With the detailed item analysis, the item of "pain control" was shown to be significantly improved(F=9.19, P=0.0251). 3) The quality of score in the last week of life of patient were 3.48, 3.51, 3.44, 3.46, 3.50, respectively, from 5 week prior to 1 week prior to death and these changes were insignificant. Conclusion : The findings of this study showed a positive effect of hospice service on quality of life of the terminal cancer patients admitted to the hospice unit. To improve the quality of life, we need first of all to develop hospice interventions with a particular emphasis on the spiritual aspect of patient. Secondly, measurement instruments need to be developed to collect the quality of life of the hospice patients who become weakened especially in the last weeks of their life and with this effort more representative data of hospice patients may be collected.

• Journal of Oral Medicine and Pain
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• v.32 no.3
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• pp.283-292
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• 2007

In several treatment modalities for snoring and obstructive sleep apnea (OSA), oral appliances mainly including mandibular advancement appliance (MAA) and tongue retaining device (TRD) are recognized as a non-invasive, reversible alternative with favorable results. Tongue bulb is a major component of TRD which prevents the tongue from approaching the posterior wall of the pharynx and can be combined with MAA. Determination of tongue bulb size for the patient is important for therapeutic effect, but frequently needs time-consuming work. For effective fabrication and standardization of tongue bulbs, this study aimed to categorize tongue bulb size for healthy young men and to examine its relation with maximum retention force and with physical parameters including tongue-related variables. 36 non-snoring, asymptomatic young men with normal occlusion were voluntarily participated in this study (mean age: $24.47{\pm}2.58$ years). Experimental procedures consisted of prefabrication of tongue bulb set (20 types with a width of 27-36mm and thickness of 8 and 10 mm), determination of tongue bulb size and the maximum retention force for each subject, and measurement of physical parameters including body mass index (BMI), neck circumference and width, thickness and length of tongue. This study showed that there was significant difference of retention force among the bulb size-related groups both in upright and supine position (p<0.05) and that retention force increased with bulb size. Correlation of tongue bulb size with physical parameters was not clearly verified and there was no significant difference in retention force between upright and supine positions. Based on our results, it can be suggested that retention force relates with tongue bulb size, ultimately with tongue volume. A further study needs to be performed in the patients with snoring and OSA.

• Journal of the Korean Society of Radiology
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• v.10 no.6
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• pp.395-401
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• 2016

Upper gastrointestinal series is a diagnostic test that X-ray passes through the stomach after administering contrast media such as barium or gastrografin. Upper gastrointestinal series with an advantage of no side effect except temporary constipation or abdominal pain has been widely used to diagnose diseases of the gastrointestinal system. However, image degradation and diagnostic accuracy frequently occurred when improper movement and breath control were carried out by lack of understanding the overall inspection process for the upper gastrointestinal series. The movie of the upper gastrointestinal series was made for improving inspection accuracy and image quality. The examinees encouraged to see the movie for waiting time before doing upper gastrointestinal series. In this study, image quality and diagnostic accuracy was examined for the effect of the movie about upper gastrointestinal series. 60 patients composed of each 10 people from 30s to 80s were selected randomly among both 2,940 examinees in 2014 and 3,076 examinees in 2015. Image quality was evaluated by the full width at half maximum of profile for each image using the Image J. The measurement of the full width at half maximum showed 0.208 mm and 0.133 mm for after and before seeing the movie. Thus it was verified that the movie education could improve the image quality and diagnostic accuracy for upper gastrointestinal series.

• Journal of Periodontal and Implant Science
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• v.29 no.1
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• pp.51-63
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• 1999

Exposure of the root surface due to gingival recession after periodontal surgery, elicit pain response when exposed to mechanical, heat, chemical or osmotic irritation. Especially patients treated with periodontal surgery, show high frequency. There have been reports that the 1 out of 7 patients complains of dentinal hypersensitivity. There have been many studies on the clinical effects of various materials on the treatment of dentinal hypersensitivity. The purposes of this study were to evaluate the effect of sodium chloride and potassium oxalate and to observe the relationship between the dentinal hypersensitivity and surface characteristics such as dentinal tubule size and number. This study included 20 teeth which were scheduled for extraction and had no pulpal disease. These teeth were divided into Root planing group, EDTA group, NaCl group and Oxalate group. Dentinal hypersensitivity is measured by tactile, pressured air and cold water using NRS (Numerical Rating Scales). Teeth were extracted under local anesthesia and each specimen was sectioned to a size about 3 X 5 mm and was examined under the scanning electron microscope (X2,000) The results were as follows, 1. The EDTA group exhibited significantly increased dentinal hypersensitivity comparing with the other groups. 2. The NaCl and Oxalate groups showed significantly reduced dentinal hypersensitivity comparing with the EDTA group. 3. As a method for dentinal hypersensitivity measurement, it was presumed thet tactile sensitivity test was not sensitive method but air blast test and cold water test were adequate method. 4. In a SEM study, the root planing group exhibited amorphous smear layer and showed no dentinal tubule orifice, but the EDTA group showed the large number of dentinal tubules. On the other hand, the NaCl and Oxalate groups did not show exposed dentinal tubules. The NaCl group showed more rough root surface than the EDTA group, and the Oxalate group showed many participates to be presumed as calcium oxalate particle. As the results from this study, root planing couldn't expose the dentinal tubule and NaCl and potassium oxalate occluded exposed dentinal tubule effectively. Dentinal hypersensitivity has close relationship with the exposure of dentinal tubules, especially with it's size and number.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.93-99
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• 1998

We measured the glenohumeral and scapulothoracic movements during abduction of the arm in the coronal plane with radiologic analysis in the 30 shoulders of normal male adults who were without pain, limitation of motion, and history of trauma. In the resting position, the glenoid cavity of the scapula faced somewhat superiorly in over 80 percents of the individuals, the mean superior tilting was 5.7 degrees. The mean total scapulothoracic movement was 65.8 degrees and the mean total glenohumeral movement was 106.8 degrees during abduction of arm in the coronal plane. The mean ratio of the glenohumeral movement to the scapulothoracic movement was 1.6 and this GH/ST ratio was decreased toward the extreme abduction. When the arm was abducted, external rotation of the humeral head occurred and this external rotation was increased smoothly during 0 degree through 90 degrees, but steeply above 90 degrees. The acromiohumeral interval was 10.9 mm at the resting positon, and this interval decreased during the arm abduction. The superior migration of the humeral head was 3.1 mm while abducting the arm. Our measurement of the relationships of glenohumeral and scapulothoracic movements at the coronal plane would be useful in the understandings of the biomechanics of shoulder, but further study would be required for the analysis of the three dimensional relationship because of the limitation of our two dimensional analysis.