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Seo DG, Choi J, Kim J. Comparison of real data and simulated data analysis of a stopping rule based on the standard error of measurement in computerized adaptive testing for medical examinations in Korea: a psychometric study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2024; 21:18. [PMID: 38977033 DOI: 10.3352/jeehp.2024.21.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study aimed to compare and evaluate the efficiency and accuracy of computerized adaptive testing (CAT) under 2 stopping rules (standard error of measurement [SEM]=0.3 and 0.25) using both real and simulated data in medical examinations in Korea. METHODS This study employed post-hoc simulation and real data analysis to explore the optimal stopping rule for CAT in medical examinations. The real data were obtained from the responses of 3rd-year medical students during examinations in 2020 at Hallym University College of Medicine. Simulated data were generated using estimated parameters from a real item bank in R. Outcome variables included the number of examinees’ passing or failing with SEM values of 0.25 and 0.30, the number of items administered, and the correlation. The consistency of real CAT result was evaluated by examining consistency of pass or fail based on a cut score of 0.0. The efficiency of all CAT designs was assessed by comparing the average number of items administered under both stopping rules. RESULTS Both SEM 0.25 and SEM 0.30 provided a good balance between accuracy and efficiency in CAT. The real data showed minimal differences in pass/ fail outcomes between the 2 SEM conditions, with a high correlation (r=0.99) between ability estimates. The simulation results confirmed these findings, indicating similar average item numbers between real and simulated data. CONCLUSION The findings suggest that both SEM 0.25 and 0.30 are effective termination criteria in the context of the Rasch model, balancing accuracy and efficiency in CAT.
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Affiliation(s)
- Dong Gi Seo
- Department of Psychology, Hallym Applied Psychology Institute, College of Social Science, Hallym University, Chuncheon, Korea
- The CAT Korea Company, Chuncheon, Korea
| | - Jeongwook Choi
- Department of Psychology, Hallym Applied Psychology Institute, College of Social Science, Hallym University, Chuncheon, Korea
- The CAT Korea Company, Chuncheon, Korea
| | - Jinha Kim
- Department of Psychology, Hallym Applied Psychology Institute, College of Social Science, Hallym University, Chuncheon, Korea
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Di Sandro A, Moore TM, Zoupou E, Kennedy KP, Lopez KC, Ruparel K, Njokweni LJ, Rush S, Daryoush T, Franco O, Gorgone A, Savino A, Didier P, Wolf DH, Calkins ME, Cobb Scott J, Gur RE, Gur RC. Validation of the cognitive section of the Penn computerized adaptive test for neurocognitive and clinical psychopathology assessment (CAT-CCNB). Brain Cogn 2024; 174:106117. [PMID: 38128447 PMCID: PMC10799332 DOI: 10.1016/j.bandc.2023.106117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The Penn Computerized Neurocognitive Battery is an efficient tool for assessing brain-behavior domains, and its efficiency was augmented via computerized adaptive testing (CAT). This battery requires validation in a separate sample to establish psychometric properties. METHODS In a mixed community/clinical sample of N = 307 18-to-35-year-olds, we tested the relationships of the CAT tests with the full-form tests. We compared discriminability among recruitment groups (psychosis, mood, control) and examined how their scores relate to demographics. CAT-Full relationships were evaluated based on a minimum inter-test correlation of 0.70 or an inter-test correlation within at least 0.10 of the full-form correlation with a previous administration of the full battery. Differences in criterion relationships were tested via mixed models. RESULTS Most tests (15/17) met the minimum criteria for replacing the full-form with the updated CAT version (mean r = 0.67; range = 0.53-0.80) when compared to relationships of the full-forms with previous administrations of the full-forms (mean r = 0.68; range = 0.50-0.85). Most (16/17) CAT-based relationships with diagnostics and other validity criteria were indistinguishable (interaction p > 0.05) from their full-form counterparts. CONCLUSIONS The updated CNB shows psychometric properties acceptable for research. The full-forms of some tests should be retained due to insufficient time savings to justify the loss in precision.
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Affiliation(s)
- Akira Di Sandro
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tyler M Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA.
| | - Eirini Zoupou
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Kelly P Kennedy
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Katherine C Lopez
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Lucky J Njokweni
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sage Rush
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Tarlan Daryoush
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Olivia Franco
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Alesandra Gorgone
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Andrew Savino
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Paige Didier
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - J Cobb Scott
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
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Gupta P, Czerwonka N, Desai SS, deMeireles AJ, Trofa DP, Neuwirth AL. The current utilization of the patient-reported outcome measurement information system (PROMIS) in isolated or combined total knee arthroplasty populations. Knee Surg Relat Res 2023; 35:3. [PMID: 36658666 PMCID: PMC9850535 DOI: 10.1186/s43019-023-00177-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Patient reported outcome measures (PROMs) are essential for clinical research and patient-centric care because they allow us to capture patient perspectives on their health condition. In knee arthroplasty, PROMs are frequently used to assess the risks and benefits of new interventions, surgical approaches, and other management strategies. A few examples of PROMs used in total knee arthroplasty (TKA) include the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Forgotten Joint Score (FJS) (collectively referred to as "legacy" PROMs). More recently, attention has been brought to another PROM called the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS was developed by the National Institute of Health (NIH) and has over 300 domains assessing various aspects of patient health, including pain, physical function, and mental health. With the use of PROMIS increasing in TKA literature, there is a need to review the advancements being made in understanding and applying PROMIS for this population. Thus, the purpose of this study is to provide insight on the utilization, advantages, and disadvantages of PROMIS within the field of knee arthroplasty and to provide a comparison to legacy PROMs.
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Affiliation(s)
- Puneet Gupta
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
| | - Natalia Czerwonka
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
| | - Sohil S. Desai
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
| | - Alirio J. deMeireles
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
| | - David P. Trofa
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
| | - Alexander L. Neuwirth
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032 USA
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Schurter T, Escher M, Gachoud D, Bednarski P, Hug B, Kropf R, Meng-Hentschel J, König B, Beyeler C, Guttormsen S, Huwendiek S. Essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss federal licensing examination for human medicine. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc43. [PMID: 36310888 PMCID: PMC9585413 DOI: 10.3205/zma001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011. METHODS Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report. RESULTS The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process. CONCLUSION Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.
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Affiliation(s)
- Tina Schurter
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Monica Escher
- University of Geneva, Medical Faculty, Geneva, Switzerland
| | - David Gachoud
- University of Lausanne, Medical Faculty, Lausanne, Switzerland
| | - Piotr Bednarski
- University of Fribourg, Medical Faculty, Fribourg, Switzerland
- University of Bern, Medical Faculty, Bern, Switzerland
| | - Balthasar Hug
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Lucerne, Medical Faculty, Lucerne, Switzerland
| | - Roger Kropf
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - Juliane Meng-Hentschel
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Benjamin König
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Christine Beyeler
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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Tsaousis I, Sideridis GD, AlGhamdi HM. Evaluating a Computerized Adaptive Testing Version of a Cognitive Ability Test Using a Simulation Study. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2021. [DOI: 10.1177/07342829211027753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the psychometric quality of a computerized adaptive testing (CAT) version of the general cognitive ability test (GCAT), using a simulation study protocol put forth by Han, K. T. (2018a). For the needs of the analysis, three different sets of items were generated, providing an item pool of 165 items. Before evaluating the efficiency of the GCAT, all items in the final item pool were linked (equated), following a sequential approach. Data were generated using a standard normal for 10,000 virtual individuals ( M = 0 and SD = 1). Using the measure’s 165-item bank, the ability value (θ) for each participant was estimated. maximum Fisher information (MFI) and maximum likelihood estimation with fences (MLEF) were used as item selection and score estimation methods, respectively. For item exposure control, the fade away method (FAM) was preferred. The termination criterion involved a minimum SE ≤ 0.33. The study revealed that the average number of items administered for 10,000 participants was 15. Moreover, the precision level in estimating the participant’s ability score was very high, as demonstrated by the CBIAS, CMAE, and CRMSE). It is concluded that the CAT version of the test is a promising alternative to administering the corresponding full-length measure since it reduces the number of administered items, prevents high rates of item exposure, and provides accurate scores with minimum measurement error.
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Affiliation(s)
| | - Georgios D. Sideridis
- Harvard Medical School, Boston, Massachusetts, USA
- National and Kapodistrian University of Athens, Athens, Greece
| | - Hannan M. AlGhamdi
- Educational Testing and Evaluation Committee (ETEC), Riyadh, Saudi Arabia
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Seo DG, Choi J. Introduction to the LIVECAT web-based computerized adaptive testing platform. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2020; 17:27. [PMID: 33401349 PMCID: PMC7657939 DOI: 10.3352/jeehp.2020.17.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/23/2020] [Indexed: 06/12/2023]
Abstract
This study introduces LIVECAT, a web-based computerized adaptive testing platform. This platform provides many functions, including writing item content, managing an item bank, creating and administering a test, reporting test results, and providing information about a test and examinees. The LIVECAT provides examination administrators with an easy and flexible environment for composing and managing examinations. It is available at http://www.thecatkorea.com/. Several tools were used to program LIVECAT, as follows: operating system, Amazon Linux; web server, nginx 1.18; WAS, Apache Tomcat 8.5; database, Amazon RDMS-Maria DB; and languages, JAVA8, HTML5/CSS, Javascript, and jQuery. The LIVECAT platform can be used to implement several item response theory (IRT) models such as the Rasch and 1-, 2-, 3-parameter logistic models. The administrator can choose a specific model of test construction in LIVECAT. Multimedia data such as images, audio files, and movies can be uploaded to items in LIVECAT. Two scoring methods (maximum likelihood estimation and expected a posteriori) are available in LIVECAT and the maximum Fisher information item selection method is applied to every IRT model in LIVECAT. The LIVECAT platform showed equal or better performance compared with a conventional test platform. The LIVECAT platform enables users without psychometric expertise to easily implement and perform computerized adaptive testing at their institutions. The most recent LIVECAT version only provides a dichotomous item response model and the basic components of CAT. Shortly, LIVECAT will include advanced functions, such as polytomous item response models, weighted likelihood estimation method, and content balancing method.
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Affiliation(s)
- Dong Gi Seo
- Department of Psychology, College of Social Sciences & Hallym Applied Psychology Institute, Hallym University, Chuncheon, Korea
- The CAT Korea Company, Seoul, Korea
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Computerised adaptive testing accurately predicts CLEFT-Q scores by selecting fewer, more patient-focused questions. J Plast Reconstr Aesthet Surg 2019; 72:1819-1824. [DOI: 10.1016/j.bjps.2019.05.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
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Huh S. Updates from 2018: Being indexed in EMBASE, becoming an affiliated journal of the World Federation for Medical Education, implementing an optional open data policy, adopting principles of transparency and best practice in scholarly publishing, and appreciation to reviewers. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2018; 15:36. [PMID: 30590913 PMCID: PMC6340838 DOI: 10.3352/jeehp.2018.15.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 06/01/2023]
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Seo DG, Kim MG, Kim NH, Shin HS, Kim HJ. Liner programming method to construct equated item sets for implementation of periodical computer-based testing of Korean medical licensing examination. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2018; 15:26. [PMID: 30336541 PMCID: PMC6318553 DOI: 10.3352/jeehp.2018.15.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study aimed to find the best way of developing equivalent item sets and to propose a stable and effective management plan for the periodical licensing examinations. METHODS Five pre-equated item sets were developed based on the predicted correct answer rate of each item by using linear programming. These pre-equated item sets were compared to the ones that were developed with random item selection method based on the actual answer rate and difficulty from item response theory (IRT). Also, the results with and without common items were compared in the same way. ACAR and the IRT difficulty was used to determine whether there is a significant difference between pre-equating conditions. RESULTS There was a statistically significant difference in IRT difficulty among the results from different pre-equated conditions. As predicted correct answer rate was divided into 2 or 3 difficulty boundaries, the actual answer rate and IRT difficulty parameters of the 5 item sets were equally constructed. Comparing item sets conditions with common items and without common items, including common items did not contribute much for the equating of 5 item sets. CONCLUSION This study suggested the linear programming method is applicable to construct equated-item sets that reflect each content area. The best method to construct equated item sets suggested is to divide the predicted correct answer rate into 2 or 3 difficulty boundaries regardless of common items. If pre-equated item sets are required to construct a test based on the actual data, several optimal methods should be considered by simulation studies before administrating a real test.
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Affiliation(s)
- Dong Gi Seo
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Myeong Gi Kim
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Na Hui Kim
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Hye Sook Shin
- Department of Education, College of Education, Kangwon National University, Chuncheon, Korea
| | - Hyun Jung Kim
- Division of Nursing, Hallym University, Chuncheon, Korea
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Kim CH. Presidential address: Preparing for permanent test centers and computerized adaptive testing. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2018; 15:1. [PMID: 29298476 PMCID: PMC5847839 DOI: 10.3352/jeehp.2018.15.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 06/01/2023]
Affiliation(s)
- Chang Hwi Kim
- President, Korea Health Personnel Licensing Examination institute, Seoul, Korea
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