• Health Policy and Management
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• v.10 no.3
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• pp.19-49
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• 2000

This study was conducted to help staff members of health centers manage personnel by examining the staff members' recognition level of organization structure of health centers, their motivation, their job satisfaction level and its related factors. Data were collected from 471 staff members of 14 health centers from March 3, 1999 to April 30, 1999. The results of this study are summarized as follows. In recognition levels of organization structure of health centers, the recognition level of necessity of discretion right was highest(3.55 points on the base of 5 points), while the recognition level of the location of decision making right was lowest(2.77 points). The general recognition of organization structure of health centers was 3.06 points, the suitability of division of duties was 3.05 points, and the optimum of manpower and budget was 2.93 points. The staff members' general recognition level of the organization structure appeared significantly higher in case of the groups of small and medium sized cities, above fifties, below high school graduate, above the sixth grade, public service experience of above 20 years, service period of below 2 years at present post, and average monthly salary of one million, eight hundred and ten thousand won. In the recognition level of the location of decision making right, the groups of big cities, male, the married, above the sixth grade, health and administration posts, average monthly salary of one million, three hundred and ten thousand won to one million, and eight hundred thousand won were significantly higher than the other groups. The recognition level of necessity of discretion right was higher in case of the groups of the twenties, the unmarried, above college graduate, nursing post, public service experience of below 5 years, service period of below 2 years at present post, and average monthly salary of below eight hundred thousand won. In the recognition level of suitability of division of duties, the groups of small and medium sized cities, the married, medical technicians, public service experience of above 20 years, and service period of below 4 years at present post were significantly higher than the other groups. In the staff members' recognition levels of organization management, the recognition level of opinion response when making decision was highest(2.92 points). The recognition level of rationality of the target amount establishment method was 2.88 points and the recognition level of personnel management was 2.63 points. The recognition level of personnel management was significantly higher in case of the groups of small and medium sized cities, the forties, above the sixth grade, medical technicians, public service experience of above 20 years, service period of below 2 years at present post, and average monthly salary of above one million, eight hundred and ten thousand won. In the recognition level of opinion response when making decision, the groups of small and medium sized cities, female, the eighth grade, health and administration posts, and service period of below 2 years at present post were higher than the other groups. The recognition level of rationality of the target amount establishment method was significantly higher in case of the groups of above fifties, below high school graduate, above the sixth grade, medical service post, and public service experience of 15 to 20 years. The factors significantly influencing sanitation were sex, education level, the period of public service experience, general recognition of organization structure, recognition of necessity of discretion right, recognition of suitability of division of duties, and recognition of opinion response when making decision. The factors which significantly influenced motivation were marital status, grade, recognition of the location of decision making right, recognition of necessity of discretion right, recognition of division of duties, recognition of opinion response when making decision, and sanitation. Sex, education level, recognition of suitability of division of duties, recognition of the target amount establishment method, and motivation influenced job satisfaction significantly. The factors significantly influencing organization culture were age, the period of public service experience, service period at present post, recognition of optimum of manpower and budget, recognition of suitability of division of duties, recognition of opinion response when making decision, and recognition of rationality of the target amount establishment method. In the coming days, the staff members' job satisfaction level must be increased through motivation and efficient conduct of duty must be accomplished through rational organization structure and management. Moreover, change of the staff members' consciousness and administrative system which are suitable for local autonomy system have to be established with increase of local residents' consciousness level and education level. Forming organization culture by reformative idea which fits the new era, public health service by the Community Health Act and health education service by the Health Promotion Act must be carried out efficiently. In doing so, financial support of central government and active efforts and concerns of local governments have to be devoted in order to get public health service in which peculiarity of the community is considered to be pursued well.

• Journal of Intelligence and Information Systems
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• v.22 no.3
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• pp.143-163
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• 2016

The demographics of Internet users are the most basic and important sources for target marketing or personalized advertisements on the digital marketing channels which include email, mobile, and social media. However, it gradually has become difficult to collect the demographics of Internet users because their activities are anonymous in many cases. Although the marketing department is able to get the demographics using online or offline surveys, these approaches are very expensive, long processes, and likely to include false statements. Clickstream data is the recording an Internet user leaves behind while visiting websites. As the user clicks anywhere in the webpage, the activity is logged in semi-structured website log files. Such data allows us to see what pages users visited, how long they stayed there, how often they visited, when they usually visited, which site they prefer, what keywords they used to find the site, whether they purchased any, and so forth. For such a reason, some researchers tried to guess the demographics of Internet users by using their clickstream data. They derived various independent variables likely to be correlated to the demographics. The variables include search keyword, frequency and intensity for time, day and month, variety of websites visited, text information for web pages visited, etc. The demographic attributes to predict are also diverse according to the paper, and cover gender, age, job, location, income, education, marital status, presence of children. A variety of data mining methods, such as LSA, SVM, decision tree, neural network, logistic regression, and k-nearest neighbors, were used for prediction model building. However, this research has not yet identified which data mining method is appropriate to predict each demographic variable. Moreover, it is required to review independent variables studied so far and combine them as needed, and evaluate them for building the best prediction model. The objective of this study is to choose clickstream attributes mostly likely to be correlated to the demographics from the results of previous research, and then to identify which data mining method is fitting to predict each demographic attribute. Among the demographic attributes, this paper focus on predicting gender, age, marital status, residence, and job. And from the results of previous research, 64 clickstream attributes are applied to predict the demographic attributes. The overall process of predictive model building is compose of 4 steps. In the first step, we create user profiles which include 64 clickstream attributes and 5 demographic attributes. The second step performs the dimension reduction of clickstream variables to solve the curse of dimensionality and overfitting problem. We utilize three approaches which are based on decision tree, PCA, and cluster analysis. We build alternative predictive models for each demographic variable in the third step. SVM, neural network, and logistic regression are used for modeling. The last step evaluates the alternative models in view of model accuracy and selects the best model. For the experiments, we used clickstream data which represents 5 demographics and 16,962,705 online activities for 5,000 Internet users. IBM SPSS Modeler 17.0 was used for our prediction process, and the 5-fold cross validation was conducted to enhance the reliability of our experiments. As the experimental results, we can verify that there are a specific data mining method well-suited for each demographic variable. For example, age prediction is best performed when using the decision tree based dimension reduction and neural network whereas the prediction of gender and marital status is the most accurate by applying SVM without dimension reduction. We conclude that the online behaviors of the Internet users, captured from the clickstream data analysis, could be well used to predict their demographics, thereby being utilized to the digital marketing.

• Radiation Oncology Journal
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• v.28 no.1
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• pp.1-8
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• 2010

Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4：3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (${\geq}60$, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

• Korean Security Journal
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• no.1
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• pp.371-408
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• 1997

This article is the reserch on actual condition of crime of arson which occurs in Korea and its countermeasures. The the presented problem in this article are that (1) we have generally very low rate concern about the crime of arson contrary to realistic problems of rapid increase of crime of arson (2) as such criminal motives became so diverse as to the economic or criminal purpose unlike characteristic and mental deficiency of old days, and to countermeasure these problems effectively it presentation the necessity of systemantic research. Based on analysis of reality of arson, the tendency of this arson in Korea in the ratio of increase is said to be higher than those in violence crime or general fire rate. and further its rate is far more greater than those of the U.S.A. and Japan. Arson is considered to be a method of using fire as crime and in case of presently residence to be the abject, it is a public offense crime which aqccompany fatality in human life. This is the well It now fact to all of us. And further in order to presentation to the crime of arson, strictness of criminal law (criminal law No, 164 and 169, and fire protection law No. 110 and 111) and classification of arsonist as felony are institutionary reinforced to punish with certainty of possibility, Therefore, as tendency of arson has been increased compared to other nations, it is necessary to supplement strategical policy to bring out overall concerns of the seriousness of risk and damage of arson, which have been resulted from the lack of understanding. In characteristics analysis of crime of arson, (1) It is now reveald that, in the past such crime rate appeared far more within the boundary of town or city areas in the past, presently increased rate of arsons in rural areas are far more than in the town or small city areas, thereby showing characteristics of crime of arson extending nation wide. (2) general timetable of arson shows that night more than day time rate, and reveald that is trait behavior in secrecy.(3) arsonists are usually arrested at site or by victim or report of third person(82,9%).Investigation activities or self surrenders rate only 11.2%. The time span of arrest is normally the same day of arson and at times it takes more than one year to arrest. This reveals its necessity to prepare for long period of time for arrest, (4) age rate of arson is in their thirties mostly as compared to homicide, robbery and adultery, and considerable numbers of arsons are in old age of over fifties. It reveals age rate is increased (5) Over half of the arsonists are below the junior high school (6) the rate of convicts by thier records is based on first offenders primarily and secondly more than 4 time convicts. This apparently shows necessity of effective correctional education policy for their social assimilation together with re-investigation of human education at the primary and secondary education system in thier life. The examples of motivation for arosnits, such as personal animosity, fury, monetary swindle, luscious purpose and other aims of destroying of proof, and other social resistance, violence including ways of threatening, beside the motives of individual defects, are diverse and arsonic suicide and specifically suicidal accompany together keenly manifested. When we take this fact with the criminal theory, it really reveals arsons of crime are increasing and its casualities are serious and a point as a way of suicide is the anomie theory of Durkheim and comensurate with the theory of that of Merton, Specifically in the arson of industrial complex, it is revealed that one with revolutionary motive or revolting motive would do the arsonic act. For the policy of prevention of arsons, professional research work in organizational cooperation for preventive activities is conducted in municipal or city wise functions in the name of Parson Taskforces and beside a variety of research institutes in federal government have been operating effectively to countermeasure in many fields of research. Franch and Sweden beside the U.S. set up a overall operation of fire prevention research funtions and have obtained very successful result. Japan also put their research likewise for countermeasure. In this research as a way of preventive fire policy, first, it is necessary to accomodate the legal preventitive activities for fire prevention in judicial side and as an administrative side, (1) precise statistic management of crime of arson (2) establishment of professional research functions or a corporate (3) improvement of system for cooperative structural team for investigation of fires and menpower organization of professional members. Secondly, social mentality in individual prospect, recognition of fires by arson and youth education of such effect, educational program for development and practical promotion. Thirdly, in view of environmental side, the ways of actual performance by programming with the establishment of cooperative advancement in local social function elements with administrative office, habitants, school facilities and newspapers measures (2) establishment of personal protection where weak menpowers are displayed in special fire prevention measures. These measures are presented for prevention of crime of arson. The control of crime and prevention shall be prepared as a means of self defence by the principle of self responsibility Specifically arsonists usually aims at the comparatively weak control of fire prevention is prevalent and it is therefore necessary to prepare individual facilities with their spontaneous management of fire prevention instead of public municipal funtures of local geverment. As Clifford L. Karchmer asserted instead of concerns about who would commit arson, what portion of area would be the target of the arson. It is effective to minister spontaveously the fire prevention measure in his facility with the consideration of characteristics of arson. On the other hand, it is necessary for the concerned personnel of local goverment and groups to distribute to the local society in timely manner for new information about the fire prevention, thus contribute to effective result of fire prevention result. In consideration of these factors, it is inevitable to never let coincide with the phemonemon of arsons in similar or mimic features as recognized that these could prevail just an epedemic as a strong imitational attitude. In processing of policy to encounter these problems, it is necessary to place priority of city policy to enhancement of overall concerns toward the definitive essense of crime of arson.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.845-855
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• 2004

Background: No general consensus has been available regarding the necessity of postoperative radiation therapy (PORT) and its optimal techniques in the patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We did retrospective analyses on the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. And we compared them with the pT3cwN0 NSCLC patients who did not received PORT during the same period. Material and Method: From Aug. of 1994 till June of 2002, 22 pT3cwN0 NSCLC patients received PORT-PORT (＋) group- and 16 pT3cwN0 NSCLC patients had no PORT-PORT (-) group. The radiation target volume for PORT (＋) group was confined to the tumor bed plus the immediate adjacent tissue only, and no regional lymphatics were included. The prognostic factors for all patients were analyzed and survival rates, failure patterns were compared with two groups. Result: Age, tumor size, depth of chest wall invasion, postoperative mobidities were greater in PORT (-) group than PORT (＋) group. In PORT (-) group, four patients who were consulted for PORT did not receive the PORT because of self refusal (3 patients) and delay in the wound repair (1 patient). For all patients, overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) rates at 5 years were 35.3%, 30.3%, 80.9%, 36.3%. In univariate and multivariate analysis, only PORT significantly affect the survival. The 5 year as rates were 43.3% in the PORT (＋) group and 25.0% in PORT (-) group (p=0.03). DFS, LRFS, DMFS rates were 36.9%, 84.9%, 43.1 % in PORT (＋) group and 18.8%, 79.4%, 21.9% in PORT(-) group respectively. Three patients in PORT (-) group died of intercurrent disease without the evidence of recurrence. Few suffered from acute and late radiation side effects, all of which were RTOG grade 2 or lower. Conclusion: The strategy of adding PORT to surgery to improve the probability not only of local control but also of survival could be justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. Authors were successful in the marked reduction of the incidence as well as the severity of the acute and late side effects of PORT, without taking too high risk of the regional failures by eliminating the regional lymphatics from the radiation target volume.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.202-209
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• 2008

Background: The introduction of Drug Eluting Stents (DES) decreased the number of patients referred for coronary artery bypass grafting (CABG). The impact of DES on CABG (Step 1) was studied and compared with the 1-year outcome after CABG with DES (Step 2). Material and Method: Surgical results for patients who underwent off-pump CABG (OPCAB) before the introduction of DES(n=298) were compared with those who underwent OPCAB after the introduction of DES (n=288) (Step 1). Postoperative 30-day and 1-year results were also compared between the patients who underwent percutaneous coronary intervention (PCI) using DES (n=220) and those who underwent OPCAB (n=255) (Step 2). Result: Since the introduction of DES, the ratio of CABG versus PCI decreased. In the CABG group, the number of high risk patients such as elderly patients (age 62 vs. 64, p=0.023), those with chronic renal failure (4% vs. 9%, p=0.021), calcification of the ascending aorta (9% vs. 15%, p=0.043), or frequency of urgent or emergent operations (12% vs. 22%, p=0.002) increased. However, there were no differences in the cardiac death and graft patency rates between the two groups (step 1). During the one-year follow up period, the rate of target vessel revascularization (12.3% vs. 2.4%, p<0.001) and major adverse cardiac events (MACE: death, myocardial infarct, TVR) were higher in the DES than the CABG group (13.6% vs 4.3%) (stage 2). Conclusion: Introduction of DES decreased the number of patients referred for surgery, and increased the comorbidity in patients who underwent CABG. DES increased the rate of target vessel revascularization, and the occurrence of MACE during the 1-year follow-up. However, there was no difference in the incidence of myocardial infarction and cardiac death between the two groups.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.9-16
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• 2010

Purpose: With increasing medical use of radiation and radioactive isotopes, there is a need to better manage the risk of radiation exposure. This study aims to grasp and analyze the individual radiation exposure situations of radiation-related workers in a medical facility by specific job, in order to instill awareness of radiation danger and to assist in safety and radiation exposure management for such workers. Materials and Methods: 1 January 2007 to 31 December 2009 to work in medical institutions are classified as radiation workers Nuclear personal radiation dosimeter regularly, continuously administered survey of 40 workers in three years of occupation to target, Imaging Unit beautifully, age, dose sector, job function-related tasks to identify the average annual dose for a deep dose, respectively, were analyzed. The frequency analysis and ANOVA analysis was performed. Results: Imaging Unit beautifully three years the annual dose PET and PET/CT in the work room 11.06~12.62 mSv dose showed the highest, gamma camera injection room 11.72 mSv with a higher average annual dose of occupation by the clinical technicians 8.92 mSv the highest, radiological 7.50 mSv, a nurse 2.61 mSv, the researchers 0.69 mSv, received 0.48 mSv, 0.35 mSv doctors orderly, and detail work employed the average annual dose of the PET and PET/CT work is 12.09 mSv showed the highest radiation dose, gamma camera injection work the 11.72 mSv, gamma camera imaging work 4.92 mSv, treatment and safety management and 2.98 mSv, a nurse working 2.96 mSv, management of 1.72 mSv, work image analysis 0.92 mSv, reading task 0.54 mSv, with receiving 0.51 mSv, 0.29 mSv research work, respectively. Dose sector average annual dose of the study subjects, 15 people (37.5%) than the 1 mSv dose distribution and 5 people (12.5%) and 1.01~5.0 mSv with the dose distribution was less than, 5.01~10.0 mSv in the 14 people (35.0%), 10.01~20.0 mSv in the 6 people (15.0%) of the distribution were analyzed. The average annual dose according to age in occupations that radiological workers 25~34 years old have the highest average of 8.69 mSv dose showed the average annual dose of tenure of 5~9 years in jobs radiation workers in the 9.5 mSv The average was the highest dose. Conclusion: These results suggest that medical radiation workers working in Nuclear Medicine radiation safety management of the majority of the current were carried out in the effectiveness, depending on job characteristics has been found that many differences. However, this requires efforts to minimize radiation exposure, and systematic training for them and for reasonable radiation exposure management system is needed.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.457-462
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• 2003

Background: Surgical results of the Fontan procedures in patients with a single ventricle have improved. As the perioperative mortality continues to decline and late outcome is forthcoming, attention is now being directed toward late complications of the Fontan procedures. We retrospectively analyzed our experience with reoperations after Fontan procedures. Material and Method: Between January 1988 and December 2002, 24 patients underwent reoperations after Fontan procedures. The median age at Fontan procedures and reoperation was 3.3 years and 9.2 years, respectively. Types of initial Fontan procedures were atriopulmonary connection (n＝11), lateral tunnel Fontan (n＝11), and extracardiac conduit Fontan (n＝2). Indications for reoperation included atrioventricular valve regurgitation (n＝7), atrial arrhythmia (n＝8), Fontan pathway stenosis (n＝7), residual right-to-left shunt (n＝5), etc. Result: Procedures performed at reoperation included atrioventricular valve replacement (n＝6), conversion to lateral tunnel Fontan (n＝5), conversion to extracardiac conduit Fontan (n＝3), cryoablation of arrhythmia circuit (n＝7), etc. There was no operative mortality. There were 2 late deaths. Mean follow-up duration was 2.7$\pm$2.1 years. All patients except two were in NYHA class I at the latest follow-up. Among 8 patients with preoperative atrial arrhythmia, postoperative conversion to normal sinus rhythm was achieved in 7 patients. Conclusion: Reoperations after Fontan procedures could be achieved with low mortality and morbidity. Reoperation may lead to clinical improvement in patients with specific target conditions such as atrioventricular valve regurgitation, refractory atrial arrhythmia, or Fontan pathway stenosis, especially in patients with previous atriopulmonary connection.

• Journal of dental hygiene science
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• v.12 no.1
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• pp.63-70
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• 2012

The purpose of this study was to research sociodemographic characteristic, work-concerned characteristic, health behavior, life stress, psychosocial stress, job stress and self-esteem of dental hygienists and to find their effects on cortisol level in saliva. The target of this study is 219 dental hygienists registered in Daegu and Gyeongbuk Dental Hygienists Association as of February 2010. For life stress, there was significant difference depending on working years of current job(p<0.05), self health status and regular meal(p<0.01). For psychosocial stress, there was significant difference depending on age(p<0.05), daily working hours(p<0.01), self health status, sleeping hours, regular meal and hobby and leisure activity(p<0.01). For job stress, there was significant difference depending on academic background (p<0.05), job experience, position, man power appropriateness in department and working years of current job(p<0.05). For cortisol level in saliva, extra working days(p<0.05) and self health status(p<0.05) showed significant difference and job stress and cortisol level in saliva showed the negative correlation(p<0.01). Health behavior gave a significant effect to life stress by path coefficient -36.807(p<0.05) and that to psychosocial stress by path coefficient -5.209(p<0.001). And health behavior also gave a significant effect to self-esteem by path coefficient 0.561(p<0.05). Life stress gave a significant effect to psychosocial stress by 0.012(p<0.05) with self-esteem to psychosocial stress by -2.437(p<0.001) and psychosocial stress to job stress by 0.523(p<0.001). Job stress gave a significant effect to cortisol level in saliva by -0.060 (p<0.05). It was found that the most significant factor that affects cortisol level in saliva was job stress, but showed negative correlation. It can be assumed that chromic job stress cause shortage in cortisol excretion, and caused lower cortisol level in saliva.

• Journal of The Korean Association For Science Education
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• v.37 no.1
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• pp.87-101
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• 2017

The analysis was carried out with meta-analysis on master's and doctoral dissertations, and academic journals that analyzed the effects of STEAM education between 2012 and 2015. From the total number of 75 dissertations and articles analyzed, 183 different effect sizes were calculated. The analysis was done to find out the kinds of differences that would be created according to the effect size of creativity, problem-solving ability, and researcher, target area, student division research design type, and level of schools. The total effect size of creativity scored 0.776, and demonstrated satisfaction in symmetry of funnel plot, with no publication biases. The fail-safe N scored 780, and since the number is smaller than 8,945, the results of this research has credibility. Furthermore, problem-solving ability shows intermediate level of effect size with a score of 0.584. It also showed satisfaction in symmetry with funnel plot, with no publication bias. With the different research methods of the sub-factors of creativity, fluency scored the highest with 0.929, flexibility with 0.881, originality with 0.838, sophistication with 0.653, abstractness with title 0.705, and resistance to termination, 0.527. This study finds its significance in the demonstration of average effect size of STEAM education through meta-analysis. According to research results, the effects of inclusive education could be determined, yet the specific effect cause or learning principles were difficult to find. It was found that the effects of STEAM education do not rise or fall depending on school age, and demonstrated differences in creativity according to the research methods or the researchers.