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A Study of variables Related to Nursing Productivity (간호생산성에 관한 연구: 관련변수의 검증을 중심으로)

  • 박광옥
    • Journal of Korean Academy of Nursing
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    • v.24 no.4
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    • pp.584-596
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    • 1994
  • The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

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Stressful Life Events, Health Symptoms, Social Support and Coping/in Early Adolescents (스트레스생활사건, 건강문제, 대응, 사회적 지지의 관계 -청소년을 대상으로-)

  • 오가실;한정석
    • Journal of Korean Academy of Nursing
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    • v.20 no.3
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    • pp.414-429
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    • 1990
  • Numerous research reports have substantiated the role of stressful life events in relation to the onset of health changes. The relationship tends to hold across different age groups. Theoretically, adolescence has been considered a developmental crisis period of great stress, impoverished coping skills and high vulnerability to biological, social and psychological demands. The research problem addressed by this study was to examine the relationships between stressful life events and health symptom patterns, and the effect of two variables, coping and social, support, theoretically considered to mediate the relationship between stress and health symptoms in adolescents. The following five hypotheses were tested in this research : 1. Health symptoms are positively related to stressful life events in adolescents, 2. Health symptoms are negatively related to coping in adolescents, 3. Health symptoms are negatively related to social support in adolescents, 4. When coping is controlled, the relationship between health symptoms and stressful life events will decrease, and 5. When social support is controlled, the relationship between health symptoms and stressful life events will increase. The study subjects consisted of 1090 high school students of the metropolitan city of Seoul. The following sampling procedure was used : 1. Of the 169 high schools in nine school administrative districts in the city, a proportional sample of ten schools was selected. 2. One class from each of the freshman and sophomore was randomly selected and all the students who were in the sampled class were used as the study sample. The study was limited to freshman and sophomore adolescents, aged 15 to 18(mean=16.6). Of the 1090 subjects 688(63%) were boys and 402(37%) were girls. An Adolescent Inventory of Stressful Life Events, a Health Symptom Questionnaire and an Adolescent Coping Inventory were adapted for this study. The Norbeck Social Support questionnaire was utilized to collect the data on perceived social support. Five high school teachers in the areas of school health and counselling reviewed the items of each questionnaire for content validity. A pilot study was undertaken to ascertain reliability. Fifty three high school students responded to the questionnaires and gave their opinions on the items. For stressful life events, health symptoms, coping, and social support, the Cronbach's alpha's on the study were .70, .94, .77, and .76, respectively. Research assistants attended all the sampled classes with the school proctor to explain the purpose and procedures of the study to the students. The questionnaires along with a ballpoint pen were distributed to the students who were asked to complete each item. The research assistants left the ballpoint pen with the students as a gift for their cooperation. An average of 50 minutes was required to complete the questionnaires. Using an SPSS, the first, three hypotheses were tested using Gamma, a measure of association for ordinal variables. Partial gamma was used to test the fourth and fifth hypotheses. Patterns of elaboration described by Babbie were selected to interpret the relationship of the three variable analyses. The significance of gamma was determined by Chisquare at a .05 level of significance. There was a positive relationship between health symptoms and stressful life events(Gamma=.35, p=.000). Thus the first hypothesis was supported. Unexpectedly, coping was positively related with health symptoms(Gamma=.13, p=.000). That is, the higher the coping levels, the greater number of health problems. The third hypothesis, the higher the level of social support, the fewer the health symptoms, was not accepted in this adolescent study group. When coping was controlled, under the condition of low coping the association between health symptoms and stressful life events increased significantly to a partial gamma of .39, and under the condition of high coping it was .30. According to the elaboration model, when one partial relationship is the same or greater than the original and the other is smaller, the control variable should be considered to be specifying the conditions. When social support was controlled the relationship between stressful life events and health symptoms increased under the condition of low social support, but with high social support, the relationship decreased. Both partial gamma were statistically significant at .05 level(.43 and .26 relatively). It can be interpreted that stressful life events are strongly and positively related to health symptoms under the condition of low social support, however this relationship can not be expected with high social support. Thus, the last two hypotheses were conditionally sustained. In this study, the relationships between stressful life events and health symptoms, and the specified me diating roles of coping and social support were found to have statistical interaction. This finding supports the theoretical position of this study. It suggests that stressful life events would create high susceptability to biological social and psychological health symptoms and coping and social support buffering the relationship between stressful life events and health symptom. The findings of this study have implications for nursing practice. When adolescents are confronted with non-developmental life events that are perceived as stressful, nurses should recognize the evidence of the stress-buffering effect of coping and social support on health symptoms and utilize the diverse sources of social support that are readily available to adolescents.

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Evaluating the Impact of Attenuation Correction Difference According to the Lipiodol in PET/CT after TACE (간동맥 화학 색전술에 사용하는 Lipiodol에 의한 감쇠 오차가 PET/CT검사에서 영상에 미치는 영향 평가)

  • Cha, Eun Sun;Hong, Gun chul;Park, Hoon;Choi, Choon Ki;Seok, Jae Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.1
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    • pp.67-70
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    • 2013
  • Purpose: Surge in patients with hepatocellular carcinoma, hepatic artery chemical embolization is one of the effective interventional procedures. The PET/CT examination plays an important role in determining the presence of residual cancer cells and metastasis, and prognosis after embolization. The other hand, the hepatic artery chemical embolization of embolic material used lipiodol produced artifacts in the PET/CT examination, and these artifacts results in quantitative evaluation influence. This study, the radioactivity density and the percentage error was evaluated by the extent of the impact of lipiodol in the image of PET/CT. Materials and Methods: 1994 NEMA Phantom was acquired for 2 minutes and 30 seconds per bed after the Teflon, water and lipiodol filled, and these three inserts into the enough to mix the rest behind radioactive injection with $20{\pm}10MBq$. Phantom reconfigure with the iterative reconstruction method the number of iterations for two times by law, a subset of 20 errors. We set up region of interest at each area of the Teflon, water, lipiodol, insert artifact occurs between regions, and background and it was calculated and compared by the radioactivity density(kBq/ml) and the% Difference. Results: Radioactivity density of the each region of interest area with the teflon, water, lipiodol, insert artifact occurs between regions, background activity was $0.09{\pm}0.04$, $0.40{\pm}0.17$, $1.55{\pm}0.75$, $2.5{\pm}1.09$, $2.65{\pm}1.16 kBq/ml$ (P <0.05) and it was statistically significant results. Percentage error of lipiodol in each area was 118%, compared to the water compared with the background activity 52%, compared with a teflon was 180% of the difference. Conclusion: We found that the error due to under the influence of the attenuation correction when PET/CT scans after lipiodol injection performed, and the radioactivity density is higher than compared to other implants, lower than background. Applying the nonattenuation correction images, and after hepatic artery chemical embolization who underwent PET/CT imaging so that the test should be take the consideration to the extent of the impact of lipiodol be.

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Arthroscopic Decompression of Spinoglenoid Ganglion Cyst (견갑골 극관절와 결절종의 관절경하 감압술)

  • Hwang, Tae Hyok;Wang, Tae Hyun;Cho, Hyung Lae;Kim, Keun Young
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.2
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    • pp.92-98
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    • 2011
  • Purpose: We describe a all-arthroscopic technique for decompression of spinoglenoid ganglion cyst and present our clinical results for this procedure. Materials and Methods: From March 2006 to June 2009, eight patients (7 males, 1 female; mean age 40.6 years; range: 21~61) were included who underwent arthroscopic decompression of spinoglenoid ganglion cyst. The most common symptoms were vague shoulder pain and external rotation weakness, which lasted 6.4 months (range: 3~8) on average. Five of eight patients were noted abnormalities on electromyographic (EMG) examination to have suprascapular nerve neuropathy and magnetic resonance imaging (MRI) showed spinoglenoid ganglion cysts in all eight patients and the cyst size was 2.6 cm (range: 1.8~3.6). Labral pathology was identified intraoperatively in all patients and the cysts were decompressed by the posterosuperior capsulotomy under arthroscopic control and labral repair with suture anchors was performed in six patients. Results: The average clinical outcome scores including Constant and Murley, Simple shoulder test (SST) all improved significantly at the time of the final follow-up and there were no complications resulting from the procedures. All patients including the patients with abnormal EMG study recovered strength on isokinetic strength testing. Follow-up MRI scans were performed on all patients at a mean of 5.2 months postoperatively (range: 3~12) revealed complete resolution of the cysts and no evidence of recurrences were seen at an average of 18 months (range: 12~26) of follow-up. Conclusion: Arthroscopic decompression of spinoglenoid ganglion cyst effectively restores patient function and all patients in this study showed improvement in their postoperative MRI findings. Arthroscopic decompression is also useful in the appropriate treatment for labral pathology and may contribute to decreased risk of cyst recurrence.

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Comparison of Ultrasound-guided Suprapubic Aspiration with Urethral Catheterization in Infants (영유아에서 초음파 감시하 치골상부 방광천자와 도뇨관 채뇨의 비교)

  • Lee, Jung-Won;Lee, Seung-Joo
    • Childhood Kidney Diseases
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    • v.11 no.1
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    • pp.59-64
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    • 2007
  • Purpose : Suprapubic aspiration(SPA) has been considered the "gold standard" for obtaining urine in non-toilet trained infants. Ultrasound(US)-guided SPA improves the success rate of the procedure and reduces the complications. However, many physicians perceive SPA as invasive and prefer the use of urethral catheterization (Ucat). We compared the success rate, complications and accuracy of US-guided SPA and Ucat. Methods : 121 infants who visited Ewha Womans University Mokdong Hospital with suspected urinary tract infection(UTI) were investigated. For the first study, the study infants were randomly assigned to either the US-guided SPA(n=32) or Ucat(n=32) groups. The success rate and complications of both procedures were compared. For the second study, US-guided SPA and Ucat were performed simultaneously(n=57). The accuracy of urethral catheterization was subsequently analyzed. The criteria for success was defined as the collection of more than 0.5 mL of urine. UTI was diagnosed by the presence of uropathogens over 105 colony-forming units (CFU)/mL. Results : The overall success rate of the US-guided SPA was 96.9%(71.9% in first attempts, 25.0% in second attempts) which was not significantly different compared to 96.9%(90.6% in first attempts, 6.3% in second attempts) in the Ucat(P>0.05) group. The aspirated urine volume was $7.4{\pm}3.7mL$ in the US-guided SPA group, which was not significantly different to $4.5{\pm}2.6mL$ in the Ucat(P>0.05) group. The accuracy of Ucat in comparison to the US guided SPA was low with sensitivity 59.5%, specificity 86.6%, false-positive rate 13.3% and false-negative rate 40.5%. Conclusion : US-guided SPA should be encouraged as the best method to collect the urine in non-toilet trained infants with UTI.

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Evaluation of Incident Detection Algorithms focused on APID, DES, DELOS and McMaster (돌발상황 검지알고리즘의 실증적 평가 (APID, DES, DELOS, McMaster를 중심으로))

  • Nam, Doo-Hee;Baek, Seung-Kirl;Kim, Sang-Gu
    • Journal of Korean Society of Transportation
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    • v.22 no.7 s.78
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    • pp.119-129
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    • 2004
  • This paper is designed to report the results of development and validation procedures in relation to the Freeway Incident Management System (FIMS) prototype development as part of Intelligent Transportation Systems Research and Development program. The central core of the FIMS is an integration of the component parts and the modular, but the integrated system for freeway management. The whole approach has been component-orientated, with a secondary emphasis being placed on the traffic characteristics at the sites. The first action taken during the development process was the selection of the required data for each components within the existing infrastructure of Korean freeway system. After through review and analysis of vehicle detection data, the pilot site led to the utilization of different technologies in relation to the specific needs and character of the implementation. This meant that the existing system was tested in a different configuration at different sections of freeway, thereby increasing the validity and scope of the overall findings. The incident detection module has been performed according to predefined system validation specifications. The system validation specifications have identified two component data collection and analysis patterns which were outlined in the validation specifications; the on-line and off-line testing procedural frameworks. The off-line testing was achieved using asynchronous analysis, commonly in conjunction with simulation of device input data to take full advantage of the opportunity to test and calibrate the incident detection algorithms focused on APID, DES, DELOS and McMaster. The simulation was done with the use of synchronous analysis, thereby providing a means for testing the incident detection module.

A Review on Ultimate Lateral Capacity Prediction of Rigid Drilled Shafts Installed in Sand (사질토에 설치된 강성현장타설말뚝의 극한수평지지력 예측에 관한 재고)

  • Cho Nam Jun;Kulhawy F.H
    • Journal of the Korean Geotechnical Society
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    • v.21 no.2
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    • pp.113-120
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    • 2005
  • An understanding of soil-structure interaction is the key to rational and economical design for laterally loaded drilled shafts. It is very difficult to formulate the ultimate lateral capacity into a general equation because of the inherent soil nonlincarity, nonhomogeneity, and complexity enhanced by the three dimensional and asymmetric nature of the problem though extensive research works on the behavior of deep foundations subjected to lateral loads have been conducted for several decades. This study reviews the four most well known methods (i.e., Reese, Broms, Hansen, and Davidson) among many design methods according to the specific site conditions, the drilled shaft geometric characteristics (D/B ratios), and the loading conditions. And the hyperbolic lateral capacities (H$_h$) interpreted by the hyperbolic transformation of the load-displacement curves obtained from model tests carried out as a part of this research have been compared with the ultimate lateral capacities (Hu) predicted by the four methods. The H$_u$ / H$_h$ ratios from Reese's and Hansen's methods are 0.966 and 1.015, respectively, which shows both the two methods yield results very close to the test results. Whereas the H$_u$ predicted by Davidson's method is larger than H$_h$ by about $30\%$, the C.0.V. of the predicted lateral capacities by Davidson is the smallest among the four. Broms' method, the simplest among the few methods, gives H$_u$ / H$_h$ : 0.896, which estimates the ultimate lateral capacity smaller than the others because some other resisting sources against lateral loading are neglected in this method. But it results in one of the most reliable methods with the smallest S.D. in predicting the ultimate lateral capacity. Conclusively, none of the four can be superior to the others in a sense of the accuracy of predicting the ultimate lateral capacity. Also, regardless of how sophisticated or complicated the calculating procedures are, the reliability in the lateral capacity predictions seems to be a different issue.

Factors Influencing the Preference for German farm Tourism: A Path Model Approach

  • Sidali, Katia Laura;Spiller, A.
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.33-59
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    • 2008
  • This paper aims to analyse the preference for German farm tourism among the German population. For this reason, we conducted an empirical study in Germany during summer 2007 and we applieda structural equation model based on partial leasts quares(PLS) to analyse the data. In the following chapters we will introduce the literature review and our conceptual frame work. We will then outline the procedures we adopted and the results of the empirical analysis. In the final part so me conclusions will be presented and a discussion will follow in order to draw the future directions of our research. According to our hypotheses, the possibility that agri-tourism enters in the evoked set of an individual is higher: H1: The higher the information degree about it. H2: The lower the influence of the social stimuli. H3: The higher the physical exposure to it (experience). H4: The higher the wellness image of agri-tourism. H5: The higher the traditional image of agri-tourism. H6: The higher the exciting image of agri-tourism. H7: The higher the perceived value for money. Our further hypotheses affirm that the possibility that agri-tourism enters in the evoked set of an individual is higher: H8: The lower the perceived risk. H9: The higher the motive to enjoy a holiday in the nature. H10: The higher the motive to enjoy a sport holiday. H11: The lower the motive to have an organized holiday. H12: The lower the motive to have a holiday abroad. H13: The lower the motive of action and night life. H14: The higher the motive to spend a holiday with the family. H15: The lower the motive to spend a city holiday. Finally, our model has some socio-demographics data. As we mentioned before, German agri-tourism has traditionally been the travel destination of large-size families, with low-to-middle income. For that reason, our final hypothesises are the following: the possibility that agri-tourism enters in the evoked-set of an individual is higher: H16: The higher the number of family members. H17: The lower the family income. Since in this study we use a path model with a PLS approach, we are able to state some interrelations among the exogenous latent variables: H18: The motive of sport holiday has a positive influence towards nature motives. H19: The physical exposition to agri-tourism has a positive influence toward information. H20: The motive of family holiday has a negative influence toward the motive of action and night life. H21: Social stimuli have a positive influence towards individuals risk perceptions. H22: Social stimuli have negative influence towards experience. Data for this study were gathered via administrated questionnaires during the summer 2007 within the frame of an academic "marketing research" course. The corresponding t-values are assessed using the bootstrapping method with 500 re-samples. In our model 61% of the degree of appreciation of German agri-tourism (evoked set) is explained by five independent variables: value for money ($0.335^{{\ast}{\ast}{\ast}}$) (H7) experience ($0.267^{{\ast}{\ast}}$) (H3), exciting image ($0.204^{\ast}$) (H6) organisation ($-0.162^{\ast}$) (H11) and holiday abroad ($-0.156^{\ast}$) (H12). The variance explained ($R^2$) for the other endogenous variables are the following: nature 24.3%, information 14.1%, action holiday 13.8%, risk perception 5.8% and experience 2.4%. An overview can be inferred from table 5. The results also allow us to test each of the proposed hypotheses. With exception of organization and abroad, none of the others travel style factors (H9 to H15) seem to have any significant impact towards evoked set which leads to the rejection of the respective hypotheses. As expected, social stimuli have a significant influence on individuals' risk perception (H21 accepted), however neither the former nor the latter have a valuable impact on evoked set (rejection of H2 and H8). Besides, since the influence of social stimuli towards experience is not significant, also H22 has to be rejected. Experience influences information (H19 accepted) but the latter does not affect significantly the evoked set (H1 rejected). Both H4 as well as H5, referring respectively to the perceived images of German agri-tourism as a wellness destination and the traditional image of the German farm tourism have to be rejected. Finally, none of the demographic data included in the model explains significantly the variance of the factor evoked set. Therefore neither H16 nor H17 has been accepted. As far as the interrelation between sport and nature (H18) and family and action (H20) are concerned, the stated relationship among these variables has been statistically confirmed. Our path model based on partial least squares shows the factors influencing the preference for farm tourism in Germany. Among others value for money and experience are the most significant ones. Practical implications are discussed.

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Establishment of PCR Conditions for the Identification of Stenotrophomonas maltophilia Isolated from Boar Semen and Antimicrobial Susceptibility Patterns of the Isolates (돼지 정액에서 분리된 Stenotrophomonas maltophilia 확인을 위한 PCR 기법 개발 및 분리 균주의 항생제 감수성 양상)

  • Jung, Byeong-Yeal;Park, Bum-Soo;Kim, Ha-Young;Byun, Jae-Won;Kim, Ae-Ran;Jeon, Albert Byung-Yun;Kim, In-Cheul;Chung, Ki-Hwa
    • Journal of Life Science
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    • v.22 no.8
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    • pp.1114-1119
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    • 2012
  • Bacteria are frequently contaminated during the collection and processing procedures of boar semen. Of the contaminants, Stenotrophomonas (S.) maltophilia is a Gram-negative bacterium that is widely distributed in a variety of habitats. Although PCR assays have been developed for the detection of S. maltophilia, they cross-react with some species of Xanthomonas. In this study, we designed a primer set for the detection of S. maltophilia in order to target the chiA (GenBank accession no. NC_010943) gene. The specific PCR products were amplified from S. maltophilia only, not from other tested strains that are frequently found in semen. The detection limit of the PCR was $1.5{\times}10^3$ CFU/ml with pure-cultured S. maltophilia and $1.5{\times}10^4$ CFU/ml with S. maltophilia spiked in semen. Twenty-six (5.9%) S. maltophilia were isolated from 440 semen samples. The PCR results exhibited 98.9% agreement with a comparison of S. maltophilia isolation. Also, the sensitivity and specificity of the PCR were 100% and 98.7%, respectively. In the antimicrobial susceptibility test, S. maltophilia isolates were highly susceptible to enrofloxacin and florfenicol, while the majority of them were resistant to amoxicillin/clavulanic acid, apramycin, ceftiofur, penicillin, and spectinomycin. These results indicated that the PCR using the chiA gene was proven to be reliable and effective for the detection of S. maltophilia with high levels of sensitivity and specificity.

Establishment of Choline Analysis in Infant Formulas and Follow-up Formulas by Ion Chromatograph (이온크로마토그래프를 이용한 조제유류 및 영아용·성장기용 조제식 중 콜린 함량 분석법 연구)

  • Hwang, Kyung Mi;Ham, Hyeon Suk;Lee, Hwa Jung;Kang, Yoon Jung;Yoon, Hae Seong;Hong, Jin Hwan;Lee, Hyoun Young;Kim, Cheon Hoe;Oh, Keum Soon
    • Journal of Food Hygiene and Safety
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    • v.32 no.5
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    • pp.411-417
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    • 2017
  • This study was conducted to establish the analysis method for the contents of choline in infant formulas and follow-up formulas by ion chromatograph (IC). To optimize the method, we compared several conditions for extraction, purification and instrumental measurement using spiked samples and certified reference material (CRM; NIST SRM 1849a) as test materials. IC method for choline was established using Ion Pac CG column and 18 mM $H_2SO_4$ mobile phase. The parameters of validation were specificity, linearity, LOD, LOQ, recovery, accuracy, precision and repeatability. The specificity was confirmed by the retention time and the linearity, $R_2$ was over 0.999 in range of 0.5~10 mg/L. The detection limit and quantification limit were 0.14, 0.43 mg/L. The accuracy and precision of this method using CRM were 95%, 2.1% respectively. Optimized methods were applied in sample analysis to verify the reliability. All the tested products were acceptable contents of choline compared with component specification for nutrition labeling. The standard operating procedures were prepared for choline to provide experimental information and to strengthen the management of nutrient in infant formula and follow-up formula.