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Jieun Hwang,1,2 Kyunghee Lee3 1Department of Health Administration, College of Health Science, Dankook University, Cheonan City, Chungcheongnam-do, South Korea; 2Institute of Convergence Healthcare, Dankook University, Cheonan City, Chungcheongnam-do, South Korea; 3Department of Healthcare Management, Eulji University of Korea, Seongnam City, Kyeonggi-do, South KoreaCorrespondence: Kyunghee Lee, Department of Healthcare Management, Eulji University of Korea, 553 Sanseongdaero, Sujeong-Gu, Seongnam City, Kyeonggi-do, 13135, South Korea, Tel +821072428346, Email rose1294@hanmail.netPurpose: The aim of this study was to analyze hospital-discharged acute myocardial infarction (AMI) patients in Korea (2006– 2020) to understand how pre-existing conditions affect mortality rates.Participants and Methods: This study utilized the 2006– 2020 Korean National Hospital Discharge In-depth Injury Survey data. A weighted frequency analysis estimated discharged AMI patients and calculated age-standardized discharge and mortality rates, Charlson Comorbidity Index (CCI) score distribution, and general patient characteristics. Weighted logistic regression analysis examined influencing mortality factors.Results: There were 486,464 AMI patients (143,751 female), with AMI-related mortality rates at 7.5% (36,312): 5.7% for males (19,190) and 11.8% for females (17,122). The highest mortality rate was among individuals aged 70– 79 years (25%). Factors influencing mortality included sex, insurance type, admission route, hospital bed count, region, operation status, and CCI score. Mortality risk at discharge was 1.151 times higher in females than males (95% CI: 1.002– 1.322), 0.787 times lower among those with national health insurance than Medicaid recipients (95% CI 0.64– 0.967), 2.182 times higher among those admitted via the emergency department than the outpatient department (95% CI 1.747– 2.725), and 3.402 times higher in patients with a CCI score of 3 points than those with 0 points (95% CI 1.263– 9.162).Conclusion: The number of discharged AMI patients and related mortality rates increased, underscoring the need for proactive management of chronic diseases, particularly for those with higher CCI scores.Keywords: acute myocardial infarction, mortality, Charlson Comorbidity Index (CCI), chronic diseases, Korean National Hospital Discharge In-depth Injury Survey data

Jeongok Park,1 Kyoungjin Lee,2 Kayoung Lee3 1College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea; 2College of Nursing, Kyungbok University, Gyeonggi-do, South Korea; 3College of Nursing, Gachon University, Incheon, South KoreaCorrespondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-Gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email kayolee@gachon.ac.krPurpose: This study aimed to investigate the effectiveness of the simplified intervention, consisting of fluid and caffeine management alone in older women with overactive bladder symptoms.Patients and Methods: A quasi-experimental pretest-posttest design was used. Rural, community-dwelling older women were recruited at four senior centers in South Korea. Of the 63 participants initially enrolled, 34 met the inclusion criteria. One group (n = 15) used fluid and caffeine management alone (FM), and the other group (n = 12) used a combination of fluid and caffeine management and pelvic floor muscle training (FM+PFMT). Urinary symptom-specific health-related quality of life was measured using the Korean version of KHQ. Sleep quality was measured using the Pittsburgh Sleep Quality Index. After the intervention, participants were assessed 4 and 8 weeks. A linear mixed model was used for the analysis.Results: The mean age of the participants was 74.44 ± 5.67 years. Among the nine domains of KHQ, impact on life and physical limitations decreased significantly in both groups, without significant between-group differences. Sleep/energy increased in both groups, and the scores in the FM+PFMT group were significantly improved. The number of micturition episodes per day and the quality of sleep did not differ significantly between the two groups.Conclusion: A simplified intervention, consisting of fluid and caffeine management alone can be considered as the first-line intervention to improve health-related quality of life in rural, community-dwelling, older women with overactive bladder symptoms. Healthcare providers should consider providing a relatively simple, but equally effective intervention to maximize the adherence and effectiveness.Keywords: overactive urinary bladder, behavior therapy, quality of life, treatment adherence and compliance, nursing

Abstract Outdoor recreation is an essential way many people engage with nature. The provision of public spaces for recreation intersects with conservation practices motivated by intertwined social and ecological values, such as strict practices associated with the concept of ‘wilderness’. Debates persist about how such concepts and management practices influence people's recreation experiences. Many US public land management agencies facilitate opportunities for outdoor recreation, relying on management frameworks and tools intended to foster specific experiential qualities. But these frameworks and tools assume simplistic relationships between settings and people's experiences, and managers rarely assess these relationships. This study uses a data set of nearly 70,000 crowdsourced trip reports from a hiking website to understand the qualities of visitors' experiences on trails. We study the geographic distribution of experiential qualities commonly associated with US wilderness areas: aesthetics, awe, challenge, pristineness, quietness, solitude and timelessness. Using analytical methods that rely on machine learning and natural language processing, we identify these experiential qualities in trip reports from hundreds of routes, and use generalized linear models to analyse relationships between the frequency of each experiential quality and the route's administrative, built, biophysical, geographic and social settings. We find that four of the seven experiential qualities (aesthetics, awe, challenge and solitude) are commonly described in trip reports, each appearing in 15%–55% of manually coded reports. The extent to which setting characteristics explained variability in experiences differed, ranging from 34% of the variability in the proportion of trip reports describing aesthetics to 55% for awe. The setting characteristics associated with each experiential quality also differed, with characteristics such as trail mileage and summit destinations having stronger influences on experiential qualities than characteristics such as wilderness designation. Synthesis and applications. Our findings suggest the need to consider more diverse variables in experience–setting relationships, develop more robust models to characterize those relationships and create new data sources to represent understudied variables. These advances would help empirically inform and improve frameworks and tools used for recreation and wilderness planning and monitoring, and potentially promote more responsive management to evolving social–ecological values. Read the free Plain Language Summary for this article on the Journal blog.

Abstract A contractile sheath and rigid tube assembly is a widespread apparatus used by bacteriophages, tailocins, and the bacterial type VI secretion system to penetrate cell membranes. In this mechanism, contraction of an external sheath powers the motion of an inner tube through the membrane. The structure, energetics, and mechanism of the machinery imply rigidity and straightness. The contractile tail of Agrobacterium tumefaciens bacteriophage Milano is flexible and bent to varying degrees, which sets it apart from other contractile tail-like systems. Here, we report structures of the Milano tail including the sheath-tube complex, baseplate, and putative receptor-binding proteins. The flexible-to-rigid transformation of the Milano tail upon contraction can be explained by unique electrostatic properties of the tail tube and sheath. All components of the Milano tail, including sheath subunits, are crosslinked by disulfides, some of which must be reduced for contraction to occur. The putative receptor-binding complex of Milano contains a tailspike, a tail fiber, and at least two small proteins that form a garland around the distal ends of the tailspikes and tail fibers. Despite being flagellotropic, Milano lacks thread-like tail filaments that can wrap around the flagellum, and is thus likely to employ a different binding mechanism.

Sally Tran,1 Biyao Zou,1,2 Leslie Kam,1 KeeSeok Lee,1 Daniel Q Huang,3,4 Linda Henry,1 Ramsey Cheung,1,5 Mindie H Nguyen1,2 1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; 2Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA; 3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 4Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore; 5Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USACorrespondence: Mindie H Nguyen, Department of Medicine and Department of Epidemiology and Population Health (by courtesy), Stanford University Medical Center, 780 Welch Road, CJ250K, Palo Alto, CA, 94304, USA, Tel +1 650-498-5691, Fax +1 650-498-5692, Email mindiehn@stanford.eduBackground & Aim: Causes of hepatocellular carcinoma (HCC) may change as treatments become available for some liver diseases. We examined the distribution of HCC cause and survival of a nationwide cohort of insured patients.Methods: Optum’s de-identified Clinformatics® Data Mart Database (CDM), 2003– 2021.Results: A total of 34707 patients with HCC were included: mean age: 68.3± 11.6 years, 61% male, 62% Caucasian, 74% cirrhosis. Non-alcoholic fatty liver disease (NAFLD) was the most common etiology (38.9%), then hepatitis C virus (HCV) (25.3%), cryptogenic (18.0%), alcohol-associated liver disease (9.4%), other liver diseases (5.8%) and hepatitis B virus (HBV) at 2.6%. NAFLD patients were the oldest (mean age 71.1± 11.2) and had the highest Charlson Comorbidity Index (CCI) (mean 10.5± 3.9), while HCV were the youngest (mean age 64.2± 9.2 years) and HBV had the lowest CCI (mean 7.2± 4.4) (both P< 0.0001). The overall 5-year survival was 18.8% (95% CI 18.2– 19.3) but was lower in the recent 2014– 2021 period vs 2003– 2013 (18.1% vs 19.5%, P=0.003). The 2014– 2021 cohort (inclusive of HCV treatment advances) was significantly older, with more females, fewer Caucasians, more African Americans, more Hispanics, fewer Asians, more cirrhosis, more NAFLD, and higher CCI (all P< 0.001). On multivariable analysis, males (aHR: 1.13), Caucasians (aHR: 1.46), African Americans (aHR: 1.53) and Hispanics (aHR: 1.28) vs Asians, 2014– 2021 (vs 2003– 2013) cohort (aHR: 1.12), NAFLD (aHR: 1.14) or cryptogenic liver disease (aHR: 1.45) were associated with increased mortality (all P< 0.001).Conclusion: HCC patients in more recent time 2014– 2021 were more likely to be older, more likely to have nonviral etiology, and had worse survival compared to those from 2003 to 2013.Keywords: ethnic disparities, NAFLD, nonviral, epidemiology

Jeongmin Lee, Junho Choi, Juyoung Kim, Kayoung Lee College of Nursing, Gachon University, Incheon, South KoreaCorrespondence: Kayoung Lee, College of Nursing, Gachon University, Health Science Building, Room&num; 412, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, South Korea, Tel: +82-32-820-4227, Email kayolee@gachon.ac.krBackground: During COVID-19, nursing students experienced variations in on-site clinical practice, such as a combination of on-site and non-face-to-face clinical practice. Although on-site clinical practice is critical for increasing nurses’ clinical self-efficacy and developing professional nursing values, there is a lack of knowledge that reflects the current clinical practice environment.Aim: To examine the relationship between on-site clinical practice, nursing professional values, and nursing clinical self-efficacy during the COVID-19 pandemic.Methods: This study is a cross-sectional correlational study design. Demographic characteristics, on-site clinical practice, nursing professional values, and nursing clinical self-efficacy were assessed using an online survey from October 3, 2022, to November 6, 2022. Data were analyzed using descriptive statistics, ANOVA, t-test, Pearson’s correlation coefficient, and multiple regression.Results: Of the 86 participants, 18 (20.9%) were male and 68 (79.1%) were female. The duration of the participants’ average participation in on-site clinical practice was 39.67 days (61.04%). Nursing professional values significantly influenced clinical self-efficacy (β=0.379, p< 0.001). However, on-site clinical practice was not significantly related to clinical self-efficacy (β=0.051, p=0.611). In terms of nursing clinical self-efficacy, measuring blood glucose had the highest score. On the other hand, establishing and maintaining intravenous catheters had the lowest scores.Conclusion: Nursing students’ professional values were significantly associated with nursing clinical self-efficacy; however, the extent of involvement in on-site clinical practice during the pandemic did not have a significant impact on nursing clinical self-efficacy. Given that this study focused on a single university, it is imperative to replicate this research using diverse samples in the future. In addition, there is a need to establish a range of teaching and learning approaches for clinical practice, including simulation, online learning, and the use of state-of-the-art technology for faculty-student feedback strategies, in anticipation of the need for alternative practices.Keywords: clinical practice, COVID-19, self-efficacy, professionalism, nursing education, nursing students

Background:. Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. Methods:. We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Results:. Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. Conclusions:. In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.

Kyunghee Lee,1 Jieun Hwang,2 Chang Min Lee3 1Department of Healthcare Management, Eulji University of Korea, Seongnam, Republic of Korea; 2College of Health and Welfare, Department of Health Administration, Dankook University, Cheonan, Republic of Korea; 3Department of Gastroenterology, Changwon Hanmaeum Hospital, Changwon, Republic of KoreaCorrespondence: Jieun Hwang, College of Health and Welfare, Department of Health Administration, Dankook University, Cheonan, Republic of Korea, Email hwang0310@dankook.ac.krPurpose: Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality.Patients and Methods: We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS).Results: Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses.Conclusion: All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.Keywords: healthcare quality evaluation indicators, present on admission, POA, decubitus ulcers, delirium, hypokalemia

The falcine sinus is a normal embryonic structure that is situated between the 2 layers of the falx cerebri and drains the deep cerebral venous system into the superior sagittal sinus. It normally involutes after birth and is uncommon in adults. Although it is often an isolated and incidental finding, it can also be associated with a number of other conditions including but not limited to vein of Galen arterial malformations (VGAM), atretic parietal cephaloceles, acrocephalosyndactyly (Apert syndrome), absence of the corpus callosum, absence of the tentorium, osteogenesis imperfecta, or Chiari II malformations. We present a case series of 3 pediatric patients born with a persistent falcine sinus and an associated condition, including a VGAM, an APC, and a sinus thrombosis. The purpose of this article is to highlight the importance of understanding anatomic variations in the cerebral venous system to help aid in the proper diagnosis and treatment of associated pathologies.

ABSTRACT Corrosion inhibitors, including zinc orthophosphate, sodium orthophosphate, and sodium silicate, are commonly used to prevent the corrosion of drinking water infrastructure. Metals such as zinc are known stressors for antibiotic resistance selection, and phosphates can increase microbial growth in drinking water distribution systems (DWDS). Yet, the influence of corrosion inhibitor type on antimicrobial resistance in DWDS is unknown. Here, we show that sodium silicates can decrease antibiotic resistant bacteria (ARB) and antibiotic-resistance genes (ARGs), while zinc orthophosphate increases ARB and ARGs in source water microbial communities. Based on controlled bench-scale studies, zinc orthophosphate addition significantly increased the abundance of ARB resistant to ciprofloxacin, sulfonamides, trimethoprim, and vancomycin, as well as the genes sul1, qacEΔ1, an indication of resistance to quaternary ammonium compounds, and the integron-integrase gene intI1. In contrast, sodium silicate dosage at 10 mg/L resulted in decreased bacterial growth and antibiotic resistance selection compared to the other corrosion inhibitor additions. Source water collected from the drinking water treatment plant intake pipe resulted in less significant changes in ARB and ARG abundance due to corrosion inhibitor addition compared to source water collected from the pier at the recreational beach. In tandem with the antibiotic resistance shifts, significant microbial community composition changes also occurred. Overall, the corrosion inhibitor sodium silicate resulted in the least selection for antibiotic resistance, which suggests it is the preferred corrosion inhibitor option for minimizing antibiotic resistance proliferation in DWDS. However, the selection of an appropriate corrosion inhibitor must also be appropriate for the water chemistry of the system (e.g., pH, alkalinity) to minimize metal leaching first and foremost and to adhere to the lead and copper rule. IMPORTANCE Antibiotic resistance is a growing public health concern across the globe and was recently labeled the silent pandemic. Scientists aim to identify the source of antibiotic resistance and control points to mitigate the spread of antibiotic resistance. Drinking water is a direct exposure route to humans and contains antibiotic-resistant bacteria and associated resistance genes. Corrosion inhibitors are added to prevent metallic pipes in distribution systems from corroding, and the type of corrosion inhibitor selected could also have implications on antibiotic resistance. Indeed, we found that sodium silicate can minimize selection of antibiotic resistance while phosphate-based corrosion inhibitors can promote antibiotic resistance. These findings indicate that sodium silicate is a preferred corrosion inhibitor choice for mitigation of antibiotic resistance.

Soohee Lee,1 Ji Yeon Lee,2 Hyejin Kim,3 Kayoung Lee,1 Taewha Lee4 1College of Nursing, Gachon University, Incheon, South Korea; 2College of Nursing, Yonsei University, Seoul, South Korea; 3Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea; 4Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South KoreaCorrespondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-Gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email kayolee@gachon.ac.kr Taewha Lee, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea, Tel +82-2-2227-8303, Email twlee5@yuhs.acPurpose: Despite the increasing interest in patient safety, most research have been conducted in hospital settings, thereby demonstrating an overall lack of research regarding patient safety culture in home healthcare. South Korea has three types of home healthcare services based on hospitals, public health centers, and long-term care insurance. Home healthcare nurses in hospitals require a master’s degree and advanced nursing skills. They play important roles in ensuring patients’ safe transition into home health care. This study aimed to explore the experience of patient safety culture among South Korean advanced practice nurses in hospital-based home healthcare.Methods: This qualitative descriptive study was conducted through purposive sampling, whereby twenty advanced practice nurses involved in home healthcare were recruited from twelve hospitals located in three different cities throughout South Korea. Face-to-face semi-structured interviews were conducted, and the collected data were analyzed through inductive and deductive content analyses.Results: Three main categories were finally confirmed: (a) teamwork climate, (b) safety climate, and (c) working condition. The sub-categories of the teamwork climate included the collaboration between patients, caregivers, and nurses, collaboration within medical institutions, and collaboration among the individuals involved in community partnerships. The sub-categories of the safety climate included nurses’ commitment to patient safety, the associated institutions’ commitment to patient safety, and the government’s commitment to patient safety. The sub-categories of the working condition included the frontline working environments and the associated institutions’ support aimed at ensuring effective working environments.Conclusion: Cultivating patient safety culture is crucial for ensuring the safe transition of patients from acute care hospitals to home healthcare. This study revealed significant aspects of patient safety culture in hospital-based home healthcare, allowing for the continuum of care among the associated patients. Such aspects include communicating with caregivers, building community partnerships, understanding unexpected home environments, and enhancing the safety of nurses.Keywords: patient safety, home care services, hospital-based, qualitative research

Jeongok Park,1 Sang Bin You,2 Hyejin Kim,3 Cheolmin Park,4 Gi Wook Ryu,5 Seongae Kwon,2 Youngkyung Kim,6 Sejeong Lee,6 Kayoung Lee7 1Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea; 2Yonsei University College of Nursing, Seoul, South Korea; 3Severance Hospital, Yonsei University Health System, Seoul, South Korea; 4Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea; 5Department of Nursing, Hansei University, Gunpo-si, South Korea; 6College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea; 7Gachon University College of Nursing, Incheon, South KoreaCorrespondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email kayolee@gachon.ac.krPurpose: Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration.Patients and methods: This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist.Results: Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment.Conclusion: This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.Keywords: intravenous infusions, medication errors, medication systems, nurses, patient safety

Hwanjin Park,1 Kounseok Lee2 1Department of Occupational & Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of KoreaCorrespondence: Kounseok Lee, Tel +82-2-2290-8423, Fax +82-2-2298-2055, Email dual@hanyang.ac.krPurpose: It has been previously reported that skipping breakfast is positively associated with increased depression, anxiety, stress, and psychological distress. This study examined the effects of breakfast consumption on suicide attempts among adolescents.Patients and Methods: The Korean Youth Risk Behavior Web-based Survey (KYRBWS) is an anonymous self-report survey conducted with middle- and high-school students to understand the health behavior of Korean adolescents. Variables related to suicide risk such as suicide attempts, breakfast frequency, depression, anxiety, and violence were analyzed using multivariate logistic regression analysis. The class selected as the sample class was surveyed for all students and the number of youths selected as the sample in 2020 was 57,925 students from 800 schools (400 middle schools and 400 high schools) in 17 cities and provinces nationwide. Among them, the dataset for this study was 54,948 completed adolescent health behavior surveys.Results: Adolescents who attempted suicide often skipped breakfast and had high stress levels. In the regression analysis, those who ate breakfast less than once a week had a stronger association with suicide attempts than the group of six or seven times a week (OR = 2.186; 95% CI = 1.873– 2.552). In the group of feeling sadness or hopeless for more than two weeks in the past year, those who ate breakfast zero or once a week (OR = 1.269; 95% CI = 1.044– 1.542), or two or three times (OR = 1.300; 95% CI = 1.043– 1.619), showed a stronger correlation with suicide attempts than the group of six or seven times a week.Conclusion: Breakfast can affect adolescents’ emotions. Helping adolescents regularly eat breakfasts might be a suicide prevention strategy.Keywords: breakfast, suicide, depression, risk factors, adolescents

Tripartite motif (TRIM) proteins are involved in development, innate immunity, and viral restriction. TRIM gene repertoires vary between species, likely due to diversification caused by selective pressures from pathogens; however, this has not been explored in birds. We mined a de novo assembled transcriptome for the TRIM gene repertoire of the domestic mallard duck (Anas platyrhynchos), a reservoir host of influenza A viruses. We found 57 TRIM genes in the duck, which represent all 12 subfamilies based on their C-terminal domains. Members of the C-IV subfamily with C-terminal PRY-SPRY domains are known to augment immune responses in mammals. We compared C-IV TRIM proteins between reptiles, birds, and mammals and show that many C-IV subfamily members have arisen independently in these lineages. A comparison of the MHC-linked C-IV TRIM genes reveals expansions in birds and reptiles. The TRIM25 locus with related innate receptor modifiers is adjacent to the MHC in reptile and marsupial genomes, suggesting the ancestral organization. Within the avian lineage, both the MHC and TRIM25 loci have undergone significant TRIM gene reorganizations and divergence, both hallmarks of pathogen-driven selection. To assess the expression of TRIM genes, we aligned RNA-seq reads from duck tissues. C-IV TRIMs had high relative expression in immune relevant sites such as the lung, spleen, kidney, and intestine, and low expression in immune privileged sites such as in the brain or gonads. Gene loss and gain in the evolution of the TRIM repertoire in birds suggests candidate immune genes and potential targets of viral subversion.

In this work, we report the measurement of elastic and Coulomb break-up channels in 6He+208Pb collisions at Elab = 19.3 MeV, close to the Coulomb barrier of this system ∼ 19 MeV. In the context of the astrophysical r-process, the reaction 4He(2n,γ)6He has been proposed to be a key reaction in the path of synthesizing seed nuclei for the r-process, as 12C, in an environment composed mainly of alpha particles and neutrons. Based on a theoretical approach for treating three body reactions by means of which its reaction rate can be inferred, our experimental approach aims to obtain an indirect measurement of the reaction rate of 4He(2n,γ)6He by measuring the Coulomb breakup of 6He under the intense electric field produced by a 208Pb target nucleus. The experiment was carried out at the TriSol facility operated in the Nuclear Science Laboratory of the University of Notre Dame, USA, which delivered a 6He beam together with other contaminants. Particular care must be taken for the alpha particles produced in the production reaction.

In our systematic research on reactions with weakly bound nuclei at suband nearbarrier energies, we have studied the system 8B+natZr at the sub-barrier energy of 26.5 MeV. Our measurements, performed at the TriSol radioactive beam facility of the University of Notre Dame, include angular distributions of both elastic scattering and breakup, for the determination of the total reaction and breakup cross sections as well as the direct-to-total reaction cross section ratio. Preliminary results of the breakup analysis will be presented, supported by Continuum Discretized Coupling Channel calculations.

Introduction The patient journey for residents of New South Wales (NSW) Australia with ST-elevation myocardial infarction (STEMI) often involves transfer between hospitals and these can include stays in hospitals in other jurisdictions. Objective To estimate the change in enumeration of STEMI hospitalisations and time to subsequent cardiac procedures for NSW residents using cross-jurisdictional linkage of administrative health data. Methods Records for NSW residents aged 20 years and over admitted to hospitals in NSW and four adjacent jurisdictions (Australian Capital Territory, Queensland, South Australia, and Victoria) between 1 July 2013 and 30 June 2018 with a principal diagnosis of STEMI were linked with records of the Australian Government Medicare Benefits Schedule (MBS). The number of STEMI hospitalisations, and rates of angiography, percutaneous coronary intervention and coronary artery bypass graft were compared for residents of different local health districts within NSW with and without inclusion of cross-jurisdictional data. Results Inclusion of cross-jurisdictional hospital and MBS data increased the enumeration of STEMI hospitalisations for NSW residents by 8% (from 15,420 to 16,659) and procedure rates from 85.6% to 88.2%. For NSW residents who lived adjacent to a jurisdictional border, hospitalisation counts increased by up to 210% and procedure rates by up to 70 percentage points. Conclusions Cross-jurisdictional linked hospital data is essential to understand patient journeys of NSW residents who live in border areas and to evaluate adherence to treatment guidelines for STEMI. MBS data are useful where hospital data are not available and for procedures that may be conducted in out-patient settings.

Blood-brain barrier (BBB) dysfunction may be involved in the increased sensitivity of Alzheimer's disease (AD) patients to antipsychotics, including amisulpride. Studies indicate that antipsychotics interact with facilitated glucose transporters (GLUT), including GLUT1, and that GLUT1 BBB expression decreases in AD. We tested the hypotheses that amisulpride (charge: +1) interacts with GLUT1, and that BBB transport of amisulpride is compromised in AD. GLUT1 substrates, GLUT1 inhibitors and GLUT-interacting antipsychotics were identified by literature review and their physicochemical characteristics summarised. Interactions between amisulpride and GLUT1 were studied using in silico approaches and the human cerebral endothelial cell line, hCMEC/D3. Brain distribution of [3H]amisulpride was determined using in situ perfusion in wild type (WT) and 5xFamilial AD (5xFAD) mice. With transmission electron microscopy (TEM) we investigated brain capillary degeneration in WT mice, 5xFAD mice and human samples. Western blots determined BBB transporter expression in mouse and human. Literature review revealed that, although D-glucose has no charge, charged molecules can interact with GLUT1. GLUT1 substrates are smaller (184.95±6.45g/mol) than inhibitors (325.50±14.40g/mol) and GLUT-interacting antipsychotics (369.38±16.04). Molecular docking showed beta-D-glucose (free energy binding: -15.39kcal/mol) and amisulpride (-29.04kcal/mol) interact with GLUT1. Amisulpride did not affect [14C]D-glucose hCMEC/D3 accumulation. [3H]amisulpride uptake into the brain (except supernatant) of 5xFAD mice compared to WT remained unchanged. TEM revealed brain capillary degeneration in human AD. There was no difference in GLUT1 or P-glycoprotein BBB expression between WT and 5xFAD mice. In contrast, caudate P-glycoprotein, but not GLUT1, expression was decreased in human AD capillaries versus controls. This study provides new details about the BBB transport of amisulpride, evidence that amisulpride interacts with GLUT1 and that BBB transporter expression is altered in AD. This suggests that antipsychotics could potentially exacerbate the cerebral hypometabolism in AD. Further research into the mechanism of amisulpride transport by GLUT1 is important for improving antipsychotics safety.

Circadian rhythms play a vital role in maintaining an individual's well-being, and they have been shown to be the product of the master oscillator in the suprachiasmatic nuclei (SCN) located in the brain. The SCN however, is inaccessible for assessment, so existing standards for circadian phase estimation often focus on the use of indirect measurements as proxies for the circadian state. These methods often suffer from severe delays due to invasive methods of sample collection, making online estimation impossible. In this paper, we propose a linear state observer as an elegant solution for continuous phase estimation. This observer-based filter is used in isolating the frequency components of input biometric signals, which are then taken to be the circadian state. We start the design process by fixing the observer's oscillatory frequency at 24 hours, and then we tune its gains using an evolutionary optimization algorithm to extract the target components from individuals' data. The resulting filter was able to provide phase estimates with an average absolute error within 1.5 hours on all test subjects, given their minute-to-minute actigraphy data collected in ambulatory conditions.

Sunhae Kim, Kounseok Lee Department of Psychiatry, Hanyang University Medical Center, Seoul, KoreaCorrespondence: Kounseok Lee Tel +82 2 2290 8423Fax +82 2 2298 2055Email dual@hanyang.ac.krPurpose: Depression is a symptom commonly encountered in primary care; however, it is often not detected by doctors. Recently, disease diagnosis and treatment approaches have been attempted using smart devices. In this study, instrumental effectiveness was confirmed with the diagnostic meta-analysis of studies that demonstrated the diagnostic effectiveness of PHQ-9 for depression using mobile devices.Patients and Methods: We found all published and unpublished studies through EMBASE, MEDLINE, MEDLINE In-Process, and PsychINFO up to March 26, 2021. We performed a meta-analysis by including 1099 subjects in four studies. We performed a diagnostic meta-analysis according to the PHQ-9 cut-off score and machine learning algorithm techniques. Quality assessment was conducted using the QUADAS-2 tool. Data on the sensitivity and specificity of the studies included in the meta-analysis were extracted in a standardized format. Bivariate and summary receiver operating characteristic (SROC) curve were constructed using the metandi, midas, metabias, and metareg functions of the Stata algorithm meta-analysis words.Results: Using four studies out of the 5476 papers searched, a diagnostic meta-analysis of the PHQ-9 scores of 1099 people diagnosed with depression was performed. The pooled sensitivity and specificity were 0.797 (95% CI = 0.642– 0.895) and 0.85 (95% CI = 0.780– 0.900), respectively. The diagnostic odds ratio was 22.16 (95% CI = 7.273– 67.499). Overall, a good balance was maintained, and no heterogeneity or publication bias was presented.Conclusion: Through various machine learning algorithm techniques, it was possible to confirm that PHQ-9 depression screening in mobiles is an effective diagnostic tool when integrated into a diagnostic meta-analysis.Keywords: diagnostic meta-analysis, depression, Patient Health Questionnaire-9, machine learning, mobile, diagnosis

Lipoblastomas are rare benign mesenchymal tumors comprised primarily mature adipocytes, which are most commonly found in infants and children younger than 3 years. They are usually found in the extremities, trunk, head, neck, and retroperitoneum, although cases occurring in the scrotum have been reported. Due to its rarity, there is a relative paucity of literature describing its imaging and management. We present a rare case of a scrotal lipoblastoma, and discuss the current imaging strategies to differentiate this adipocytic tumor from other more common paratesticular masses, including aggressive neoplasms such as rhabdomyosarcomas. Knowledge of the radiological appearance of lipoblastoma can provide the correct diagnosis and prevent unnecessary orchiectomy.

Ji Hae Hwang,1,2,&ast; Kyeongmin Lee,1,&ast; Eunji Choi,1,3 Ha Na Cho,1 Boyoung Park,4 Yumie Rhee,5 Kui Son Choi1 1Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea; 2Center for Emergency Operations, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea; 3Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA; 4Department of Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea; 5Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Kui Son ChoiGraduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of KoreaTel +82-31-920-2912Fax +82-31-920-2189Email kschoi@ncc.re.krPurpose: Poor sleep quality is a common problem among middle-aged women. Few studies, however, have assessed differences in sleep quality among premenopausal, perimenopausal, and postmenopausal women and related risk factors in Korea women. The aim of this study was to assess sleep quality and factors associated therewith according to menopausal status in Korean women.Patients and Methods: This study was based on the 2016 Korean Study of Women’s Health Related Issues (K-Stori), a cross-sectional survey employing nationally representative random sampling. In total, 3000 Korean women aged 45 to 64 years completed the Pittsburgh Sleep Quality Index (PSQI). Comparison of demographic characteristics and sleep quality among pre-, peri-, and postmenopausal women was conducted.Results: Among the participants, 26% suffered from poor sleep quality based on the PSQI. The prevalence of poor sleep quality increased with later menopausal stage (from 18.8% in the premenopausal stage to 29.5% in the postmenopausal stage P < 0.001). Multivariate logistic regression analysis showed that peri- and postmenopausal women were 1.50 and 1.73 times more likely to have poor sleep quality in comparison to premenopausal women, respectively. Chronic disease, depression, at-risk drinking, taking dietary supplements, and single women were associated with a higher likelihood of having poor sleep quality. Health status, at-risk drinking, chronic illness, dietary supplementation, and depression were significantly associated with poor sleep quality.Conclusion: Poor sleep quality appears to be prevalent in peri- and postmenopausal women in Korea. The management of sleep quality during menopause transition is important, and further research on how sleep disturbances influence the health status of women in menopausal transition is required.Keywords: menopause, sleep quality, Pittsburgh sleep quality index

Jitendra Kumar Singh,1,* Dilaram Acharya,2,3,* Divya Rani,4,* Salila Gautam,5 Kalpana Thapa Bajgain,6 Bishnu Bahadur Bajgain,7 Ji-Hyuk Park,2 Seok-Ju Yoo,2 Thomas G Poder,8,9 Antoine Lewin,10,11 Kwan Lee2 1Department of Community Medicine and Public Health, Janaki Medical College, Tribhuvan University, Janakpur, Nepal; 2Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Republic of Korea; 3Department of Community Medicine, Kathmandu University, Devdaha Medical College and Research Institute, Rupandehi, Nepal; 4Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; 5Department of Public Health, Sanjeevani College of Medical Sciences, Purbanchal University, Rupandehi, Nepal; 6Aabka Research & Consultancy, Calgary, Alberta, Canada; 7Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 8School of Public Health, University of Montreal, Montreal, Canada; 9Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-L’île-de-Montréal, Montreal, Canada; 10Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada; 11Faculty of Medicine and Health Science, Sherbrooke University, Sherbrooke, Quebec, Canada*These authors contributed equally to this workCorrespondence: Seok-Ju YooDepartment of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-Ro, Gyeongju-si 38066, Republic of KoreaTel +82-10-8712-6730Fax +82-54-770-2825Email medhippo@dongguk.ac.krBackground and Purpose: Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.Materials and Methods: In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.Results: Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00– 4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12– 3.11), and number of people in the family > 4 (AOR=2.18, 95%CI: 1.18– 4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25– 3.92), and < 3 meals per day (AOR=2.36, 95%CI: 1.40– 3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01– 5.51) were more likely to be underweight than those from food-secure households.Conclusion: The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.Keywords: cross-sectional study, teenage girls, urban slums, undernutrition, underweight, India

The recently published reference genome of peanuts enables a detailed molecular description of the allergenic proteins of the seed. We used LC-MS/MS to investigate peanuts of different genotypes to assess variability and to better describe naturally occurring allergens and isoforms. Using relative quantification by mass spectrometry, minor variation of some allergenic proteins was observed, but total levels of Ara h 1, 2, 3, and 6 were relatively consistent among 20 genotypes. Previously published RP-HPLC methodology was used for comparison. The abundance of three Ara h 3 isoforms were variable among the genotypes and contributed to a large proportion of total Ara h 3 where present. Previously unpublished hydroxyproline sites were identified in Ara h 1 and 3. Hydroxylation did not vary significantly where sites were present. Peanut allergen composition was largely stable, with only some isoforms displaying differences between genotypes. The resulting differences in allergenicity are of unknown clinical significance but are likely to be minor. The data presented herein allow for the design of targeted MS methodology to allow the quantitation and therefore control of peanut allergens of clinical relevance and observed variability.

Dukyoo Jung,1 Jennie C De Gagne,2 Minkyung Lee,3 Hyesoon Lee,1 Kyuri Lee,1 Eunju Choi,1 Juyoun Chung4 1College of Nursing, Ewha Womans University, Seoul, South Korea; 2School of Nursing, Duke University, Durham, NC, USA; 3Weill Cornell Medicine, New York, NY, USA; 4Department of Comics and Animation Technology, Sejong University, Seoul, South KoreaCorrespondence: Minkyung LeeWeill Cornell Medicine, 1300 York Ave, New York, NY 10065, USATel +1 917-239-6475Fax + 82-2-3277-2850Email mkmk8888@naver.comPurpose: The purpose of this study was to assess the feasibility and examine the preliminary effectiveness of a mobile application-based meal assistant training program (APP) for use by direct care workers (CAs) assisting residents with dementia in long-term care facilities in South Korea.Methods: We adopted a mixed methods research design, which included a pre- and post-intervention study and focus group interviews for the feasibility assessment. Participants included 23 dyads of older adults with dementia and their CAs from a long-term care facility in South Korea. Upon completion of the APP intervention, focused group interviews were conducted with six CAs and five nurses.Results: The results of paired t-tests showed that the effects of the APP intervention on the older adults with dementia and their CAs were not significant; however, the results of the focused group interviews support the potential usefulness of the APP for CAs.Conclusion: The APP may be applicable to long-term care workers who need meal assistant skills education.Keywords: dementia, eating, mobile applications, nursing intervention

Abstract Background Aboriginal people are under-reported on administrative health data in Australia. Various approaches have been used or proposed to improve reporting of Aboriginal people using linked records. This cross-sectional study used self-reported Aboriginality from the NSW Patient Survey Program (PSP) as a reference standard to assess the accuracy of reporting of Aboriginal people on NSW Admitted Patient (APDC) and Emergency Department Data Collections (EDDC), and compare the accuracy of selected approaches to enhance reporting Aboriginality using linked data. Methods Ten PSP surveys were linked to five administrative health data collections, including APDC, EDDC, perinatal, and birth and death registration records. Accuracy of reporting of Aboriginality was assessed using sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) and F score for the EDDC and APDC as baseline and four enhancement approaches using linked records: “Most recent linked record”, “Ever reported as Aboriginal”, and two approaches using a weight of evidence, “Enhanced Reporting of Aboriginality (ERA) algorithm” and “Multi-stage median (MSM)”. Results There was substantial under-reporting of Aboriginality on APDC and EDDC records (sensitivities 84 and 77% respectively) with PPVs of 95% on both data collections. Overall, specificities and NPVs were above 98%. Of people who were reported as Aboriginal on the PSP, 16% were not reported as Aboriginal on any of their linked records. Record linkage approaches generally increased sensitivity, accompanied by decrease in PPV with little change in overall F score for the APDC and an increase in F score for the EDDC. The “ERA algorithm” and “MSM” approaches provided the best overall accuracy. Conclusions Weight of evidence approaches are preferred when record linkage is used to improve reporting of Aboriginality on administrative health data collections. However, as a substantial number of Aboriginal people are not reported as Aboriginal on any of their linked records, improvements in reporting are incomplete and should be taken into account when interpreting results of any analyses. Enhancement of reporting of Aboriginality using record linkage should not replace efforts to improve recording of Aboriginal people at the point of data collection and addressing barriers to self-identification for Aboriginal people.

Kyujin Lee,1 Duk Han Ko,2 Ji Young Lee3 1Institution of Sports Science, Seoul National University, Seoul, Republic of Korea; 2Department of Sports Science Convergence, Dongguk University, Seoul, Republic of Korea; 3Department of Physical Education, Gangneung-Wonju National University, Gangneung, Republic of KoreaCorrespondence: Duk Han Ko Tel +82 10-2763-0101Fax +82-2-2260-3741Email kodh119@hanmail.netJi Young Lee Tel +82 33-640-2556Fax +82-33-641-3659Email jylee@gwnu.ac.krPurpose: One cause of metabolic syndrome (MetS) is inactivity. This study analyzed the prevalence of MetS due to causes of activity limitation (AL) in adults over 40 years old.Paticipants and Methods: Participants included 2885 people aged 40– 79 (1198 men and 1687 women) who completed the Korean National Health and Nutrition Survey (KNHANES) conducted between 2013 and 2017. They were divided into two groups based on age: the middle age group (MA) included 1148 total participants, 515 men and 633 women from 40– 59 years old; the older age group (OA) included 1737 total participants, 683 men and 1054 women from 60– 79 years old. MetS was diagnosed according to the Third Report of the National Cholesterol Education Program and the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III). Logistic regression was conducted to calculate the odds ratio for MetS prevalence.Results: The prevalence of MetS in people with AL increased 1.432-fold in the MA men group, 1.511-fold in the OA men group, 1.546-fold in the MA women group, and 1.565-fold in the OA women group. There were several causes of AL; people with physical activity for diabetes mellitus and hypertension increased MetS prevalence in both sexes and all age groups: MA men group (OR=3.216, 95% CI= 1.852– 7.354, P=0.034), MA women group (OR=2.159, 95% CI= 1.854– 5.346, P=0.032), OA men group (OR=3.200, 95% CI= 1.235– 7.841, P=0.009), and OA women group (OR=3.444, 95% CI= 1.310– 6.627, P=0.008). Also, mental problems in the MA men group (OR=2.284, 95% CI= 1.591– 4.986, P=0.012) and OA men group (OR=1.149, 95% CI= 1.017– 2.941, P=0.012), and musculoskeletal problems in the MA women group (OR=1.784, 95% CI= 1.102– 2.902, P=0.021) and OA women group (OR=1.459, 95% CI= 1.054– 1.993, P=0.004) increased the prevalence.Conclusion: The prevalence of MetS due to activity limitation was increased in MA and OA groups. Activity limitation increased the MetS prevalence from 1.4- to 1.5-times, Therefore, to prevent metabolic syndrome, physical activity should be increased, and guidelines should be presented according to the activity limitation causes, age, and sex.Keywords: metabolic syndrome, physical activity limitation, prevalence

Abstract Background Timely restoration of bloodflow acute ST-segment elevation myocardial infarction (STEMI) reduces myocardial damage and improves prognosis. The objective of this study was describe the association of demographic factors with hospitalisation rates for STEMI and time to angiography, Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. Methods This was an observational cohort study using linked population health data. We used linked records of NSW and the ACT hospitalisations and the Australian Government Medicare Benefits Schedule (MBS) for persons aged 35 and over hospitalised with STEMI in the period 1 July 2010 to 30 June 2014. Survival analysis was used to determine the time between STEMI admission and angiography, PCI and CABG, with a competing risk of death without cardiac procedure. Results Of 13,117 STEMI hospitalisations, 71% were among males; 55% were 65-plus years; 64% lived in major cities, and 2.6% were Aboriginal people. STEMI hospitalisation occurred at a younger age in males than females. Angiography and PCI rates decreased with age: angiography 69% vs 42% and PCI 60% vs 34% on day 0 for ages 35-44 and 75-plus respectively. Lower angiography and PCI rates and higher CABG rates were observed outside major cities. Aboriginal people with STEMI were younger and more likely to live outside a major city. Angiography, PCI and CABG rates were similar for Aboriginal and non-Aboriginal people of the same age and remoteness area. Conclusions There is a need to improve access to definitive revascularisation for STEMI among appropriately selected older patients and in regional areas. Aboriginal people with STEMI, as a population, are disproportionately affected by access to definitive revascularisation outside major cities. Improving access to timely definitive revascularisation in regional areas may assist in closing the gap in cardiovascular outcomes between Aboriginal and non-Aboriginal people.

Juvenile idiopathic arthritis (JIA) is the most common cause of arthritis in children. It is characterized by inflammatory cell infiltration of synovial membranes leading to synovitis and synovial membrane thickening. Synovial chondromatosis is rare sequela of synovitis in which foci of cartilage develop within the synovial membrane of a joint capsule. We report a case of a 35-month old boy who developed tumefactive synovial hypertrophy and hyperplasia that mimicked synovial chondromatosis on MRI. The reactive synovium was arthroscopically excised and the patient's arthritis improved. Tumefactive synovial hypertrophy and hyperplasia mimicking synovial chondromatosis on MRI in the setting of JIA, has not been reported in this young of a patient in the literature to date. A discussion on imaging in oligoarticular JIA and synovial chondromatosis is presented herein. Keywords: Juvenile idiopathic arthritis, Synovial chondromatosis, Tumefactive synovium

Yuen Yee Cheng, 1, 2 Emma M Rath, 3 Anthony Linton, 1, 2, 4 Man Lee Yuen, 1 Ken Takahashi, 1 Kenneth Lee 1, 2, 4 1Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; 2Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; 3Garvan Institute of Medical Research, Sydney, New South Wales, Australia; 4Concord Repatriation General Hospital, Sydney, New South Wales, AustraliaCorrespondence: Yuen Yee ChengAsbestos Disease Research Institute, PO Box 3628, Rhodes, New South Wales 2139, AustraliaTel +61 2 9767 9800Fax +61 2 9767 9860Email yycheng@adri.org.auAbstract: Asbestos is a naturally occurring mineral consisting of extremely fine fibres that can become trapped in the lungs after inhalation. Occupational and environmental exposures to asbestos are linked to development of lung cancer and malignant mesothelioma, a cancer of the lining surrounding the lung. This review discusses the factors that are making asbestos-induced lung cancer a continuing problem, including the extensive historic use of asbestos and decades long latency between exposure and disease development. Genomic mutations of DNA nucleotides and gene rearrangements driving lung cancer are well-studied, with biomarkers and targeted therapies already in clinical use for some of these mutations. The genes involved in these mutation biomarkers and targeted therapies are also involved in epigenetic mechanisms and are discussed in this review as it is hoped that identification of epigenetic aberrations in these genes will enable the same gene biomarkers and targeted therapies to be used. Currently, understanding of how asbestos fibres trapped in the lungs leads to epigenetic changes and lung cancer is incomplete. It has been shown that oxidoreduction reactions on fibre surfaces generate reactive oxygen species (ROS) which in turn damage DNA, leading to genetic and epigenetic alterations that reduce the activity of tumour suppressor genes. Epigenetic DNA methylation changes associated with lung cancer are summarised in this review, and some of these changes will be due to asbestos exposure. So far, little research has been carried out to separate the asbestos driven epigenetic changes from those due to non-asbestos causes of lung cancer. Asbestos-associated lung cancers exhibit less methylation variability than lung cancers in general, and in a large proportion of samples variability has been found to be restricted to promoter regions. Epigenetic aberrations in cancer are proving to be promising biomarkers for diagnosing cancers. It is hoped that further understanding of epigenetic changes in lung cancer can result in useful asbestos-associated lung cancer biomarkers to guide treatment. Research is ongoing into the detection of lung cancer epigenetic alterations using non-invasive samples of blood and sputum. These efforts hold the promise of non-invasive cancer diagnosis in the future. Efforts to reverse epigenetic aberrations in lung cancer by epigenetic therapies are ongoing but have not yet yielded success.Keywords: lung cancer, epigenetic biomarkers, microRNA, DNA methylation, immunohistochemistry, IHC, fluorescence in situ hybridization, FISH

Ducks are the natural host and reservoir of influenza A virus (IAV), and as such are permissive to viral replication while being unharmed by most strains. It is not known which mechanisms of viral control are globally regulated during infection, and which are specific to tissues during infection. Here we compare transcript expression from tissues from Pekin ducks infected with a recombinant H5N1 strain A/Vietnam 1203/04 (VN1203) or an H5N2 strain A/British Columbia 500/05 using RNA-sequencing analysis and aligning reads to the NCBI assembly ZJU1.0 of the domestic duck (Anas platyrhynchos) genome. Highly pathogenic VN1203 replicated in lungs and showed systemic dissemination, while BC500, like most low pathogenic strains, replicated in the intestines. VN1203 infection induced robust differential expression of genes all three days post infection, while BC500 induced the greatest number of differentially expressed genes on day 2 post infection. While there were many genes globally upregulated in response to either VN1203 or BC500, tissue specific gene expression differences were observed. Lungs of ducks infected with VN1203 and intestines of birds infected with BC500, tissues important in influenza replication, showed highest upregulation of pattern recognition receptors and interferon stimulated genes early in the response. These tissues also appear to have specific downregulation of inflammatory components, with downregulation of distinct sets of proinflammatory cytokines in lung, and downregulation of key components of leukocyte recruitment and complement pathways in intestine. Our results suggest that global and tissue specific regulation patterns help the duck control viral replication as well as limit some inflammatory responses in tissues involved in replication to avoid damage.

Epidermoid cysts are benign cysts of ectodermal origin that are most commonly found on the face, trunk, and neck but have been infrequently described in the presacral region. Presacral epidermoid cysts are most commonly seen in middle-aged women and to our knowledge, only two previous cases have been reported in the pediatric population. In this case report, we present the case of a pediatric patient who underwent a total mass excision with formal coccygectomy for a presacral epidermoid cyst. We describe the differential diagnosis for a presacral mass in a pediatric patient and the clinical, radiographic, and histologic work up involved in obtaining the correct diagnosis. Finally, we discuss the surgical treatment options to remove the mass and to decrease the risk of local recurrence, infection, and other serious complications.

Michael Mileski,1 Kimberly Lee,1 Curtis Bourquard,1 Belinda Cavazos,1 Kristopher Dusek,1 Kristopher Kimbrough,1 Linda Sweeney,1 Rebecca McClay2 1School of Health Administration, Texas State University, San Marcos, TX, USA; 2School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, WV, USACorrespondence: Michael MileskiSchool of Health Administration, Texas State University, 601 University Drive, Encino Hall—250, San Marcos, TX 78666, USATel +1 (512) 245-3556Email mileski@txstate.eduPurpose: The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer’s disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse.Patients and methods: A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: Residents with dementia or Alzheimer’s disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting.Conclusion: The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.Keywords: exploitation, nursing facility, skilled nursing, nursing home

Abstract Objective: To provide insights into complexities of seeking access to state and federal cross‐jurisdictional data for linkage with the Australian Childhood Immunisation Register (ACIR). We provide recommendations for improving access and receipt of linked datasets involving Australian Government‐administered data. Methods: We describe requirements for linking eleven federal and state data sources to establish a national linked dataset for safety evaluation of vaccines. The required data linkage methodology for integrating cross‐jurisdictional data sources is also described. Results: Extensive negotiation was required with 18 different agencies for 21 separate authorisations and 12 ethics approvals. Three variations of the ‘best practice’ linkage model were implemented. Australian Government approval requests spanned nearly four years from initial request for data, with a further year before ACIR data transfer to the linkage agency. Conclusions: Integration of immunisation registers with other data collections is achievable in Australia but infeasible for routine and rapid identification of vaccine safety concerns. Lengthy authorisation requirements, convoluted disparate application processes and inconsistencies in data supplied all contribute to delayed data availability. Implications for public health: Delayed data access for safety surveillance prevents timely epidemiological reviews. Poor responsiveness to safety concerns may erode public confidence, compromising effectiveness of vaccination programs through reduced participation.

Wooil Kim,1,* Won Kon Kim,1,* Kyungmin Lee,1 Min Jeong Son,1 Minjeong Kwak,2 Won Seok Chang,3 Jeong-Ki Min,1 Nam Woong Song,2 Jangwook Lee,1 Kwang-Hee Bae1 1Division of Biomedical Research, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea; 2Center for Nano-Bio Measurement, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea; 3Department of Nanoprocess, Korea Institute of Machinery & Materials (KIMM), Daejeon 34103, Republic of Korea*These authors contributed equally to this workCorrespondence: Jangwook Lee;Kwang-Hee BaeDivision of Biomedical Research, Korea Research Institute of Bioscience and Biotechnology, 125 Gwahak-ro, Yusung-gu, Daejeon 34141, Republic of KoreaTel +82 42 860 4268Fax +82 42 860 4149Email jlee@kribb.re.kr; khbae@kribb.re.krBackground: The size of nanoparticles is considered to influence their toxicity, as smaller-sized nanoparticles should more easily penetrate the cell and exert toxic effects. However, conflicting results and unstandardized methodology have resulted in controversy of these size-dependent effects. Here, we introduce a unique approach to study such size-dependent effects of nanoparticles and present evidence that reliably supports this general assumption along with elucidation of the underlying cytotoxic mechanism.Methods: We prepared and physically characterized size-controlled (20–50 nm) monodispersed silica nanoparticles (SNPs) in aqueous suspensions. Then, a variety of biochemical assessments are used for evaluating the cytotoxic mechanisms.Results: SNP treatment in three cell lines decreased cell viability and migration ability, while ROS production increased in dose- and size-dependent manners, with SNPs

Kiyoung Lee,1,2 Ie Byung Park,1,2 Seung Hee Yu,2 Soo-Kyung Kim,3 So Hun Kim,4 Da Hea Seo,4 Seongbin Hong,4 Ja Young Jeon,5 Dae Jung Kim,5 Soo Wan Kim,6 Cheol Soo Choi,1,2 Dae Ho Lee1,21Department of Internal Medicine, Gachon University College of Medicine, Incheon, Republic of Korea; 2Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea; 3Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea; 4Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea; 5Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea; 6Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of KoreaAim: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology.Methods: This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies.Results: Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05–5.13 mmol/L and 1.02–15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L).Conclusions: Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA.Keywords: Diabetic ketoacidosis, ketone bodies, diagnosis, lactic acidosis, acid base imbalance

Objective: Lighting is a strong synchronizer for circadian rhythms, which in turn drives a wide range of biological functions. The objective of our work is a) to construct a clinical in-patient testbed with smartİ lighting, and b) evaluate its feasibility for use in future clinical studies. Methods: A feedback capable, variable spectrum lighting system was installed at the University of New Mexico Hospital. The system consists of variable spectrum lighting troffers, color sensors, occupancy sensors, and computing and communication infrastructure. We conducted a pilot study to demonstrate proof of principle, that 1) this new technology is capable of providing continuous lighting and sensing in an active clinical environment, 2) subject recruitment and retention is feasible for round-the-clock, multi-day studies, and 3) current techniques for circadian regulation can be deployed in this unique testbed. Unlike light box studies, only troffer-based lighting was used, and both lighting intensity and spectral content were varied. Results: The hardware and software functioned seamlessly to gather biometric data and provide the desired lighting. Salivary samples that measure dim-light melatonin onset showed phase advancement for all three subjects. Conclusion: We executed a five-day circadian rhythm study that varied intensity, spectrum, and timing of lighting as proof-of-concept or future clinical studies with troffer-based, variable spectrum lighting. Clinical Impact: The ability to perform circadian rhythm experiments in more realistic environments that do not overly constrain the subject is important for translating lighting research into practice, as well as for further research on the health impacts of lighting.

Under normal physiological conditions, the lung remains an oxygen rich environment. However, prominent regions of hypoxia are a common feature of infected and inflamed tissues and many chronic inflammatory respiratory diseases are associated with mucosal and systemic hypoxia. The airway epithelium represents a key interface with the external environment and is the first line of defense against potentially harmful agents including respiratory pathogens. The protective arsenal of the airway epithelium is provided in the form of physical barriers, and the production of an array of antimicrobial host defense molecules, proinflammatory cytokines and chemokines, in response to activation by receptors. Dysregulation of the airway epithelial innate immune response is associated with a compromised immunity and chronic inflammation of the lung. An increasing body of evidence indicates a distinct role for hypoxia in the dysfunction of the airway epithelium and in the responses of both innate immunity and of respiratory pathogens. Here we review the current evidence around the role of tissue hypoxia in modulating the host-pathogen interaction at the airway epithelium. Furthermore, we highlight the work needed to delineate the role of tissue hypoxia in the pathophysiology of chronic inflammatory lung diseases such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease in addition to novel respiratory diseases such as COVID-19. Elucidating the molecular mechanisms underlying the epithelial-pathogen interactions in the setting of hypoxia will enable better understanding of persistent infections and complex disease processes in chronic inflammatory lung diseases and may aid the identification of novel therapeutic targets and strategies.

Mallard ducks are a natural host and reservoir of avian Influenza A viruses. While most influenza strains can replicate in mallards, the virus typically does not cause substantial disease in this host. Mallards are often resistant to disease caused by highly pathogenic avian influenza viruses, while the same strains can cause severe infection in humans, chickens, and even other species of ducks, resulting in systemic spread of the virus and even death. The differences in influenza detection and antiviral effectors responsible for limiting damage in the mallards are largely unknown. Domestic mallards have an early and robust innate response to infection that seems to limit replication and clear highly pathogenic strains. The regulation and timing of the response to influenza also seems to circumvent damage done by a prolonged or dysregulated immune response. Rapid initiation of innate immune responses depends on viral recognition by pattern recognition receptors (PRRs) expressed in tissues where the virus replicates. RIG-like receptors (RLRs), Toll-like receptors (TLRs), and Nod-like receptors (NLRs) are all important influenza sensors in mammals during infection. Ducks utilize many of the same PRRs to detect influenza, namely RIG-I, TLR7, and TLR3 and their downstream adaptors. Ducks also express many of the same signal transduction proteins including TBK1, TRIF, and TRAF3. Some antiviral effectors expressed downstream of these signaling pathways inhibit influenza replication in ducks. In this review, we summarize the recent advances in our understanding of influenza recognition and response through duck PRRs and their adaptors. We compare basal tissue expression and regulation of these signaling components in birds, to better understand what contributes to influenza resistance in the duck.

Catheter-related sheaths, formerly known as “fibrin sheaths,” are the most common complications of central venous catheters. Although usually harmless, they can very rarely detach from the venous wall against which they were formed and embolize with effects ranging from subclinical embolisms to death. This rare occurrence has only been described a few times in the literature to date, and to our knowledge, the embolized sheath has never been directly visualized with CT. We report the case of catheter-related sheath embolization to the right pulmonary artery in a child, as confirmed on CT.

Jaeyoung Yang, Yusun Choi, Juyoung Park, Junhyug Jeong, Bousung Lee, Kwanghaeng Lee, Jaedo Lee, Rakmin Choi Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea Abstract: We successfully performed cervical spinal cord stimulator (SCS) surgery in a 27-year-old man with complex regional pain syndrome to control intractable pain. The SCS trial was performed twice to adjust the SCS coverage region. After permanent implantation surgery, the patient developed Horner’s syndrome when the region near the C4 spinal dorsal root was stimulated. However, Horner’s syndrome disappeared after changing the stimulation leads. This case report suggests that cervical SCS can be associated with superior cervical ganglion stimulation. Keywords: spinal cord stimulator, Horner’s syndrome, complex regional pain syndrome, superior cervical ganglion block

Chungmo Yang,1,* Hae Hyun Hwang,2,* Soohyun Jeong,1 Deokwon Seo,1 Yoon Jeong,1 Dong Yun Lee,2,3 Kangwon Lee1,4 1Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Republic of Korea; 2Department of Bioengineering, College of Engineering, and BK21 PLUS Future Biopharmaceutical Human Resources Training and Research Team, Hanyang University, Seoul 04763, Republic of Korea; 3Institute of Nano Science & Technology (INST), Hanyang University, Seoul 04763, Republic of Korea; 4Advanced Institutes of Convergence Technology, Gyeonggi-do 16229, Republic of Korea *These authors contributed equally to this work Purpose: Nitric oxide (NO) can be clinically applied at low concentrations to regulate angiogenesis. However, studies using small molecule NO donors (N-diazeniumdiolate, S-nitrosothiol, etc) have yet to meet clinical requirements due to the short half-life and initial burst-release profile of NO donors. In this study, we report the feasibility of methoxy poly(ethylene glycol)-b-poly(lactic-co-glycolic acid) (mPEG-PLGA) nanoparticles (NPs) as NO-releasing polymers (NO-NPs) for inducing angiogenesis.Materials and methods: The mPEG–PLGA copolymers were synthesized by typical ring-opening polymerization of lactide, glycolide and mPEG as macroinitiators. Double emulsion methods were used to prepare mPEG–PLGA NPs incorporating hydrophilic NONOate (diethylenetriamine NONOate).Results: This liposomal NP encapsulates hydrophilic diethylenetriamine NONOate (70%±4%) more effectively than other previously reported materials. The application of NO-NPs at different ratios resulted in varying NO-release profiles with no significant cytotoxicity in various cell types: normal cells (fibroblasts, human umbilical vein endothelial cells and epithelial cells) and cancer cells (C6, A549 and MCF-7). The angiogenic potential of NO-NPs was confirmed in vitro by tube formation and ex vivo through an aorta ring assay. Tubular formation increased 189.8% in NO-NP–treated groups compared with that in the control group. Rat aorta exhibited robust sprouting angiogenesis in response to NO-NPs, indicating that NO was produced by polymeric NPs in a sustained manner.Conclusion: These findings provide initial results for an angiogenesis-related drug development platform by a straightforward method with biocompatible polymers. Keywords: mPEG-PLGA nanoparticles, sprouting angiogenesis, low concentration of nitric oxide, liposomal nanoparticles, amphiphilic polymers

Hwa Yeon Park,1,2,* Sin Ae Seo,2,* Hyeyoung Yoo,2 Kiheon Lee1–3 1Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea; 3Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea *These authors contributed equally to this work Purpose: The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version.Participants and methods: This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general.Results: In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns), 49.7% were ambivalent (high necessity with high concerns), 1.9% were skeptical (low necessity with high concerns), and 11.4% were indifferent (low necessity and low concerns). In multivariable analysis, we found that adherence was related to patients’ beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, p=0.003; skeptical, p=0.001; ambivalent, p