• Journal of Global Scholars of Marketing Science
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• v.18 no.2
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• pp.189-222
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• 2008

This study developed a model to empirically investigate the effects of market orientation and relationship orientation with suppliers on business performance and examine the moderating effects of entrepreneur's characteristics (working tenure) and clinic's location. The data was collected from 200 animal clinics which belong to Korean Animal Hospital Association (KAHA)'s national conference in April, 2007. Descriptive statistic, factor analysis, reliability analysis, and regression analysis were conducted to analyze the data using SPSS/PC+ 12.0. The findings are as follows. First, the market orientation of animal clinics influences significantly both financial and non-financial performance. When the moderating effect of entrepreneur's working tenure is considered, market orientation has significant effect on animal clinic's financial and non-financial performance. However, when the moderating effect of animal clinic's location is considered, market orientation has not significant effect on animal clinic's financial and non-financial performance. Second, animal clinic's relationship orientation with suppliers mostly affects the financial and non-financial performance significantly. When entrepreneur's working tenure in the clinic is longer (above 4 years group), relationship orientation with suppliers significantly affects both financial and non-financial performance. Meanwhile, when the entrepreneur's working tenure in the clinic is shorter (less than 3 years group), relationship orientation with suppliers doesn't affect clinic's financial performance but affect non-financial performance partially. In other words, when entrepreneur's working tenure is shorter (less than 3 years group), market orientation more influences on clinic's financial and non-financial performance while relationship orientation with suppliers does less. It is thought that their relation with suppliers and relationship orientation activities with suppliers are less strongly established and maintained yet. So, they primarily focus on market orientation strategy when entrepreneur's working tenure is shorter. Third, when animal clinics are located in non-metropolitan area, relationship orientation with suppliers significantly affects financial and non-financial performance. However, when animal clinics are located in metropolitan area, it doesn't affect financial and non-financial performance either. It is thought that animal clinics which are located in non-metropolitan area need stronger relationship with suppliers and need support more from them as most of suppliers actively work in metropolitan area not in the non-metropolitan area and animal clinics in metropolitan area can easily get better market information than animal clinics in non-metropolitan area. Lastly, while the effect of the market orientation significantly influences animal clinic's business performance continuously, the effect of the relationship orientation differently influences business performance as it is moderated by entrepreneur's working tenure and animal clinic's location. So, relationship orientation with suppliers can be selectively applied to improve the clinic's financial and no-financial performance. In summary, both of animal clinic's marketing orientation and animal clinic's relationship orientation with suppliers positively influence their business performance. However, entrepreneur's working tenure and animal clinic location moderate the relationship between market orientation and relationship orientation and their business performance differently. This study is quite meaningful to empirically investigate the effects of both of market orientation and relationship orientation with suppliers on business performance and examine the moderating effects of entrepreneur's characteristics (working tenure) and clinic's location. And, as this kind of study has been very few in the context of animal clinic industry, it helps practically understand the effects of market orientation and relationship orientation with suppliers on the financial and non-financial performance in animal clinic industry. Furthermore, as the market conditions in animal clinic industry have been in difficulty for a few years, this study can help improve animal clinic's financial and non-financial business performance together with their suppliers as business partners. Lastly, this study can help find mid-term and long-term cooperation between animal clinics and their suppliers. This study has some limitations. So, care should be taken when generalizing the results of the study. First, our samples were collected from only the animal clinics industry. However, a comparison of the results presented here with those form other marketing contexts (e.g., general hospitals) would be worthwhile. Future comparative research will enhance the generality of our contingency theory cross industry context. Second, this study found that market orientation and relationship orientation affect business performance. However, there may be other antecedents, such as internal market orientation and relationship orientation with customers. Also, this research did not consider other moderators, such as overall market conditions, competitive situations, and power/conflict between suppliers and buyers in the relationship between market and relationship orientation and business performance.

• Journal of Nutrition and Health
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• v.49 no.3
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• pp.165-178
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• 2016

Purpose: This study was performed to examine associations of intakes of milk and dairy products, pulses, and soy foods with bone health in Koreans aged 50 yr and older. Methods: A total of 3,201 men and 3,581 women aged 50 yr and older who participated in the 2008~2011 Korea National Health and Nutrition Examination Survey were grouped by sex and age groups of 50~64 yr and 65 yr and older. Subjects within each sex and age group were divided into three bone health groups: normal, osteopenia, and osteoporosis groups based on bone mineral density. Intakes of nutrients and foods derived from 24-hour recall data were compared among three bone health groups. Associations between intake frequencies of foods, including milk, yogurt, tofu, or soy milk, and osteoporosis risk were evaluated based on confounding risk factor-adjusted logistic regression. Results: Calcium intake was in the order of normal, osteopenia, and osteoporosis in men (p < 0.01) and women (p < 0.05) aged 50~64 yr as well as in men aged 65 yr and older (p < 0.001). In women aged 50~64 yr, intake of milk and dairy products was lower in the osteoporosis group (p < 0.01) as compared with the osteopenia group. Intake of pulses or tofu was not significantly different among bone health groups. Odds ratio (OR) for milk intake frequency (${\geq}2$ times/week) compared to intake frequency less than 1 time/month was 0.45 (95% CI 0.24~0.85, p for trend = 0.022) in men aged 65 yr and older. The OR for yogurt intake frequency (1 time/month~1 time/week) was 0.47 (95% CI 0.30~0.73, p for trend = 0.019) in women aged 50~64 yr. Intake frequency of tofu or soy milk was not associated with reduced risk of osteoporosis in all groups. Conclusion: Dairy food intake was significantly associated with bone health, and its effect was sex- and age group-specific, whereas soy food intake was not. Dietary intervention to prevent osteoporosis would be effective for women aged 50~64 yr old and for men aged 65 yr and older.

• Journal of Nutrition and Health
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• v.48 no.6
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• pp.558-570
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• 2015

Purpose: The objective of this study is to investigate the work performances and the factors contributing to the work performance of nutrition teachers and school dieticians according to employment status in Daejeon and Chungcheongnamdo. Methods: A survey was conducted among 415 school dieticians from selected elementary, middle, and high schools in the area. This survey was used for analysis of the general characteristics and the status of working and foodservice environments. The frequency of occurrence was measured using the ${\chi}^2$-test while analysis of differences in work performance of 57 variables grouped according to 12 categories by mean ${\pm}$ SD was performed using student t-test. In addition, a regression analysis was performed to assess the influence of occupational (working and foodservice) environment on work performances. Results: All 14 environmental factors including general characteristics were different between nutrition teachers and school dieticians. In 12 of 57 variables there were significant differences in work performance between the two groups. When compared using average work performance, 5 domains showed significant difference in work performance between the two groups. These 5 domains were other works (T = 6.050), dietary habit guide (T = 4.789), menu (nutrition) management (T = 3.524), foodservice administration and evaluation (T = 2.757), and production and service management (T = 2.588). Overall, the work performances of nutrition teachers were comparably higher than those of school dietitians. A correlation analysis between occupational (working or foodservice) environments and work performances of the two groups showed that the work performances of nutrition teachers were influenced by the number of employees, number of students, meal frequency a day, annual salary, age, foodservice years of school, and school type. Conclusion: Meanwhile, the work performances of school dieticians were influenced by the number of students, number of employees, meal frequency a day, work hour, education level, age, school type, and service years as a dietitian.

• Radiation Oncology Journal
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• v.15 no.2
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• pp.137-143
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• 1997

Purpose : Radiation pneumonitis is one of the complications caused by radiation therapy that includes a Portion of the lung tissue. The severity of radiation induced pulmonary dysfunction depends on the irradiated lung volume, total dose, dose rate and underlying Pulmonary function. It also depends on whether chemotherapy is done or not. The irradiated lung volume is the most important factor to predict the pulmonary dysfunction in breast cancer Patients following radiation therapy. There are some data that show the irradiated lung volume measured from CT scans as a part of treatment Planning with the tangential beams. But such data have not been reported in Korea. We planned to evaluate the irradiated lung volume quantitatively using CT scans for the breast tangential field and search for useful factors that could Predict the irradiated lung volume Materials and Methods : The lung volume was measured for 25 patients with breast cancer irradiated with tangential field from Jan.1995 to Aug.1996. Parameters that can predict the irradiated lung volume included; (1) the peruendicular distance from the Posterior tangential edge to the posterior part of the anterior chest wall at the center of the field (CLD) ; (2) the maximum perpendicular distance from the posterior tangential field edge to the posterior Part of the anterior chest wall (MLD) ; (3) the greatest perpendicular distance from the Posterior tangential edge to the posterior part of anterior chest wall on CT image at the center of the longitudinal field (GPD) ; (4) the length of the longitudinal field (L). The irradiated lung volume(RV), the entire both lung volume(EV) and the ipsilateral lung volume(IV) were measured using dose volume histogram. The relationship between the irradiated lung volume and predictors was evaluated by regression analysis. Results :The RV is 61-279cc (mean 170cc), the RV/EV is $2.9-13.0\%\;(mean\;5.8\%)$ and the RV/IV is $4.9-29.0\%\;(mean\;12.2\%)$. The CLD, the MLD and the GPD ave 1.9-3.3cm, 1.9-3.3cm and 1.4-3.1cm respectively. The significant relations between the irradiated lung volume such as RV. RV/EV, RV/IV and parameters such as CLD, MLD, GPO, L. $CLD\timesL,\;MLD\timesL\;and\;GPD\timesL$ are not found with little variances in parameters. The RV/IV of the left breast irradiation is significantly larger than that of the right but the RV/EVS do not show the differences. There is no symptomatic radiation pneumonitis at least during 6 months follow up. Conclusion : The significant relationship between the irradiated lung volume and predictors is not found with little variation on parameters. The irradiated lung volume in the tangential held is liss than $10\%$ of entire lung volume when CLO is less than 3cm. The RV/IV of the left tangential field is larger than that of the right but there was no significant differences in RV/EVS. Symptomatic radiation pneumonitis has not occurred during minimum 6 months follow up.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.126-132
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• 2009

Purpose: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8~2 Gy. Results: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage ($\geq$T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size ($\geq$5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage ($\geq$T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. Conclusion: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

• Korean Journal of Ecology and Environment
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• v.45 no.2
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• pp.158-173
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• 2012

The objectives of this study were to analyze the longitudinal gradient and temporal variations of water quality in Daecheong Reservoir in relation to the major inflowing streams from the watershed, during 2001~2010. For the study, we selected 7 main-stream sites of the reservoir along the main axis of the reservoir, from the headwater to the dam and 8 tributary streams. In-reservoir nutrients of TN and TP showed longitudinal declines from the headwater to the dam, which results in a distinct zonation of the riverine ($R_z$, M1~M3), transition ($T_z$, M4~M6), and lacustrine zone ($L_z$, M7) in water quality, as shown in other foreign reservoirs. Chlorophyll-a (CHL) and BOD as an indicator of organic matter, were maximum in the $T_z$. Concentration of total phosphorus (TP) was the highest (8.52 $mg\;L^{-1}$) on March in the $R_z$, and was the highest (165 ${\mu}g\;L^{-1}$) in the $L_z$ on July. Values of TN was the maximum (377 ${\mu}g\;L^{-1}$) on August in the $R_z$, and was the highest (3.76 $mg\;L^{-1}$) in the $L_z$ on August. Ionic dilution was evident during September~October, after the monsoon rain. The mean ratios of TN : TP, as an indicator of limiting factor, were 88, which indicates that nitrogen is a surplus for phytoplankton growth in this system. Nutrient analysis of inflowing streams showed that major nutrient sources were headwater streams of T1~T2 and Ockcheon-Stream of T5, and the most influential inflowing stream to the reservoir was T5, which is located in the mid-reservoir, and is directly influenced by the waste-water treatment plants. The key parameters, influenced by the monsoon rain, were TP and suspended solids (SS). Empirical models of trophic variables indicated that variations of CHL in the $R_z$ ($R^2$=0.044, p=0.264) and $T_z$ ($R^2$=0.126, p=0.054) were not accounted by TN, but were significant (p=0.032) in the $L_z$. The variation of the log-transformed $I_r$-CHL was not accounted ($R^2$=0.258, p=0.110) by $I_w$-TN of inflowing streams, but was determined ($R^2$=0.567, p=0.005) by $I_w$-TP of inflowing streams. In other words, TP inputs from the inflowing streams were the major determinants on the in-reservoir phytoplankton growth. Regression analysis of TN : TP suggested that the ratio was determined by P, rather than N. Overall, our data suggest that TP and suspended solids, during the summer flood period, should be reduced from the eutrophication control and P-input from Ockcheon-Stream should be controlled for water quality improvement.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.426-436
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• 2001

Background : Chronic obstructive pulmonary disease(COPD) is one of the major contributors to morbidity and mortality among the adult population. Cigarette smoking(CS) is undoubtedly the single most important factor in the pathogenesis of COPD. However, its mechanism is unclear. The current hypothesis regarding the pathogenesis of COPD postulates that an imbalance between proteases and antiproteases leads to the destructive changes in the lung parenchyma. This study had two aims. First, to evaluate the effect of CS exposure on histologic changes of the lung parenchyme, and second, to evaluate the effect of CS exposure on the expression of the gelatinolytic enzymes in BAL fluid cells in guinea pigs. Methods : Two groups of five guinea pigs were exposed to the whole smoke of 20 commercial cigarettes per day, 5 hours/day, 5 days/week, for 6weeks, and 12 weeks, respectively, using a smoking apparatus. Five age-matched guinea pigs exposed to room air were used as controls. Five or more sections were microscopically extamined(${\times}400$) and the number of cellular infiltration of the alveolar wall was measured in order to evaluate the effect of CS exposure on the histologic changes of lung parenchyme. The statistical significance was analyzed by a linear regression method. To evaluate the expression of the gelatinolytic enzymes in intraalveolar cells, BAL fluid was obtained and the intraalveolar cells were separated by centrifugation (500 g for 10 min at $4^{\circ}C$). Two sets of culture plates were loaded with $1{\times}10^6$ intraalveolar cells. One plate, contained O.1mM EDTA, a inhibitor of matrix metalloproteases(MMPs), and the other plate had no EDTA. Both plates were incubated for 48 hours at $37^{\circ}C$. After incubation, gelatinolytic protease expression in the supernatants was analyzed by gelatin zymography. Results : At the end of CS exposure, the level of blood carboxy Hb had increased significantly(4.1g/dl in control group, 24g/dl immediately after CS exposure, 18g/dl 30 min after CS exposure, 15g/dl 1 hour after CS exposure). Alveolar inflammatory cells were identified in the CS exposed guinea pigs. The number of alveolar cellular cells observed in a microscopic field ($400{\times}$) was $121.4{\pm}7.2$, $158.0{\pm}20.2$, $196.8{\pm}32.8$, in the control, the 6 weeks, and the 12 weeks group, respectively. The increased extent of inflammatory cellular infiltration of the lung parenchema showed a statistically significant linear relationship with the duration of CS exposure(p=0.001, $r^2=0.675$). Several types of gelatinolytic enzymes in the intraalveolar cells of CS exposed guinea pigs were expressed, of which some were inhibited by EDT A. However, the gelatinolytic enzymes were not expressed in the control groups. Conclusion : CS exposure increases inflammatory cellular infiltration of the alveolar wall and the expression of gelatinolytic proteases in guinea pigs. EDTA inhibits some of the gelatinolytic proteases. These findings suggest a possibility that CS exposure may increase MMP expression in the lungs of guinea pigs.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.601-613
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• 2000

Background : Idiopathic pulmonary fibrosis (IPF) is a fatal progressive fibrous disease of the lung of unknown etiology. Recently it has been classified into several distinct entities on the basis of pathologic and clinical characteristics, ie : usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), acute interstitial pneumonia (AIP), bronchiolitis obliterans with organizing pneumonia (BOOP), and nonspecific interstitial pneumonia (NSIP). IPF is now applied only for UIP, which has the worst prognosis. The previous reports of 3-5 year median survival appears to be overoptimistic because other types with better prognosis like NSIP or BOOP might have been included. Therefore, this study was performed to determine the clinical course and the prognostic factors of UIP as diagnosed by surgical lung biopsy. Methods : The subjects were 72 UIP patients (age $58.2{\pm}11.6$ years, M : F=45 : 27, median follow up period : 18.1 months (0.7-103.6) diagnosed by surgical lung biopsy at the Asan Medical Center (68 patients) and the Paik Hospital in Seoul (4 patients). Clinical scores (level of dyspnea : 1-20 points), radiologic score (honeycombing : HC score 0-5 points, ground glass : GG score 0-5 points), and physiologic scores (FVC : 1-12 points, $FEV_1$ : 0-3 points, TLC : 0-10 points, $D_{LCO)$ : 0-5 points, $AaDO_2$ : 0-10 points) were summed into a total CRP score. Results : 1) The one year survival rate was 78.3%, while the rate for three year survival was 58.1%, and the median survival period was 42.5months. 2) Short term (1 year) prognosis : The patients who died within one year of diagnosis (14 patients) had the higher initial total CRP score ($28.6{\pm}8.3$ vs. $16.6{\pm}9.7$) than those who lived longer than one year (46 patients). The difference in the total CRP score was attributed to the symptom score ($8.4{\pm}2.1$ vs. $5.7{\pm}3.9$) and the physiologic score ($15.7{\pm}7.1$ vs. $6.7{\pm}5.7$) including FVC, $D_{LCO)$ and $AaDO_2$. 3) Long-term (3year) prognosis : The total CRP score ($12.2{\pm}6.7$ vs. $28.7{\pm}7.9$ : including symptom score, FVC, $D_{LCO)$ and $AaDO_2$) at the time of diagnosis were also different for the long-term survivors and those who lived less than 3 years. 4) Cox regression analysis showed $D_{LCO)$ (${\geq}$60%) (Hazard ratio : 4.56, 95% CI : 2.30-16.04) was the independent prognostic factors of UIP (P<0.05). Conclusion : These results suggest that $D_{LCO)$ at the time of diagnosis seem to be a prognostic markers of biopsy-proven UIP.

• Journal of Intelligence and Information Systems
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• v.18 no.3
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• pp.153-169
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• 2012

Exhibitions have played a key role of effective marketing activity which directly informs services and products to current and potential customers. Through participating in exhibitions, exhibitors have got the opportunity to make face-to-face contact so that they can secure the market share and improve their corporate images. According to this economic importance of exhibitions, show organizers try to adopt a new IT technology for improving their performance, and researchers have also studied services which can improve the satisfaction of visitors through analyzing visit patterns of visitors. Especially, as smart technologies make them monitor activities of visitors in real-time, they have considered booth recommender systems which infer preference of visitors and recommender proper service to them like on-line environment. However, while there are many studies which can improve their performance in the side of new technological development, they have not considered the choice factor of visitors for booth recommender systems. That is, studies for factors which can influence the development direction and effective diffusion of these systems are insufficient. Most of prior studies for the acceptance of new technologies and the continuous intention of use have adopted Technology Acceptance Model (TAM) and Extended Technology Acceptance Model (ETAM). Booth recommender systems may not be new technology because they are similar with commercial recommender systems such as book recommender systems, in the smart exhibition environment, they can be considered new technology. However, for considering the smart exhibition environment beyond TAM, measurements for the intention of reuse should focus on how booth recommender systems can provide correct information to visitors. In this study, through literature reviews, we draw factors which can influence the satisfaction and reuse intention of visitors for booth recommender systems, and design a model to forecast adaptation of visitors for booth recommendation in the exhibition environment. For these purposes, we conduct a survey for visitors who attended DMC Culture Open in November 2011 and experienced booth recommender systems using own smart phone, and examine hypothesis by regression analysis. As a result, factors which can influence the satisfaction of visitors for booth recommender systems are the effectiveness, perceived ease of use, argument quality, serendipity, and so on. Moreover, the satisfaction for booth recommender systems has a positive relationship with the development of reuse intention. For these results, we have some insights for booth recommender systems in the smart exhibition environment. First, this study gives shape to important factors which are considered when they establish strategies which induce visitors to consistently use booth recommender systems. Recently, although show organizers try to improve their performances using new IT technologies, their visitors have not felt the satisfaction from these efforts. At this point, this study can help them to provide services which can improve the satisfaction of visitors and make them last relationship with visitors. On the other hands, this study suggests that they managers along the using time of booth recommender systems. For example, in the early stage of the adoption, they should focus on the argument quality, perceived ease of use, and serendipity, so that improve the acceptance of booth recommender systems. After these stages, they should bridge the differences between expectation and perception for booth recommender systems, and lead continuous uses of visitors. However, this study has some limitations. We only use four factors which can influence the satisfaction of visitors. Therefore, we should development our model to consider important additional factors. And the exhibition in our experiments has small number of booths so that visitors may not need to booth recommender systems. In the future study, we will conduct experiments in the exhibition environment which has a larger scale.

• Journal of Preventive Medicine and Public Health
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• v.30 no.3 s.58
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• pp.630-642
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• 1997

The purpose of this study was to examine the mortality risk associated with cognitive impairment among the rural elderly. The subjective of study was 558 of 'A Study on the Depression and Cognitive Impairment in the Rural Elderly' of Jung Ae Rhee and Hyang Gyun Jung's study(1993). Cognitive impairment and other social and health factors were assessed in 558 elderly rural community residents. For this study, a Korean version of the Mini-Mental State Examination(MMSEK) was used as a global indicator of cognitive functioning. And mortality risk factors for each cognitive impairment subgroup were identified by univariate and multivariate Cox regression analysis. At baseline 22.6% of the sample were mildly impaired and 14.2% were severely impaired. As the age increased, the cognitive function was more impaired. Sexual difference was existed in the cognitive function level. Also the variables such as smoking habits, physical disorders had the significant relationship with cognitive function impairment. Across a 3-year observation period the mortality rate was 8.5% for the cognitively unimpaired, 11.1% for the mildly impaired, and 16.5% for the severly impaired respendents. And the survival probability was .92 for the cognitively unimpaired, .90 for the mildly impaired, and .86 for the severly impaired respondents. Compared to survival curve for the cognitively unimpaired group, each survival curve for the mildly and the severely impaired group was not significantly different. When adjustments models were not made for the effects of other health and social covariates, each hazard ratio of death of mildly and severely impaired persons was not significantly different as compared with the cognitively unimpaired. But, as MMSEK score increased, significantly hazard ratio of death decreased. Employing Cox univariate proportional hazards model, statistically other significant variables were age, monthly income, smoking habits, physical disorders. Also when adjustments were made for the effects of other health and social covariates, there was no difference in hazard ratio of death between those with severe or mild impairment and unimpaired persons. And as MMSEK score increased, significantly hazard ratio of death did not decrease. Employing Cox multivariate proportional hazards model, statistically other significant variables were age, monthly income, physical disorders. Employing Cox multivariate proportional hazards model by sex, at men and women statistically significant variable was only age. For both men and women, also cognitive impairment was not a significant risk factor. Other investigators have found that cognitive impairment is a significant predictor of mortality. But we didn't find that it is a significant predictor of mortality. Even though the conclusions of our study were not related to cognitive impairment and mortality, early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.