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The main goal of this article is to analyze the conditions under which South Korea would decide to go nuclear. It seeks to examine the key factors that would trigger Seoul's decision for nuclear‐arming. The article contends that South Korea is likely to go nuclear under the following conditions: where South Koreans' demands for nuclear weapons continue to rise despite US security assurances; where Pyongyang's threats of its nuclear weapons attacks are increasingly directed towards Seoul as opposed to Washington; where US security assurances for South Korea become highly questionable; and where potential nearby proliferators (Japan and Taiwan, in particular) go nuclear. Any single one of these conditions might not be enough for Seoul's decision to nuclearize, but when at least any two of them are fulfilled at the same time, South Korea is highly likely to go nuclear. [ABSTRACT FROM AUTHOR]

Background: Organising pneumonia (OP) is reported in patients with haematologic malignancy suspected of having invasive mould disease, yet little is known about this relationship. Objective: To investigate molecular evidence of invasive mould pneumonia in paraffin‐embedded lung tissues from histologically diagnosed OP patients with suspected invasive mould pneumonia. Patients/Methods: Patients with haematologic malignancy suspected to have invasive pulmonary mould disease who underwent lung biopsy at a tertiary hospital, Seoul, South Korea, between 2008 and 2020, were retrospectively reviewed. To find molecular evidence of fungal infection, PCR assay was used to detect Aspergillus‐ and Mucorales‐specific DNA within OP lung tissue sections. Results: Forty‐seven patients with suspected invasive mould pneumonia underwent lung biopsy and 15 (32%) were histologically diagnosed as OP without any evidence of fungal hyphae. Of these 15 patients, 3 (20%) received allogenic haematopoietic stem cell transplantation prior to developing OP. Before biopsy, 2 and 13 patients had probably and possible invasive mould disease, respectively. The median antifungal treatment length was 81 [8–114] days, and the median steroid treatment dosage was 0.35 mg/kg/day for 36 days (methylprednisolone equivalent doses), respectively. After biopsy, three patients with possible invasive mould infection revealed probable invasive pulmonary aspergillosis. From the 15 paraffin‐embedded lung tissues, 6 (40%) exhibited positive PCR assay results for detecting Aspergillus‐ and Mucorales‐specific DNA. Conclusions: More than one third of OP cases in patients with suspected invasive mould pneumonia exhibited molecular evidence of invasive mould infection by fungus‐specific PCR in lung tissues, likely associated with concurrent or prior fungal infection. [ABSTRACT FROM AUTHOR]

Background: Invasive fusariosis mainly affects immunocompromised patients including haematopoietic stem cell transplant recipients and those with haematologic malignancy. There are limited studies on invasive fusariosis in the Asia‐Pacific region. Objective: To describe the clinical characteristics and outcomes of invasive and non‐invasive fusariosis in South Korea. Patients/Methods: From 2005 to 2020, patients with fusariosis who met the revised European Organisation for Research and Treatment of Cancer and the Mycoses Study Group criteria for the definition of proven or probable invasive fusariosis, and those with non‐invasive fusariosis were retrospectively reviewed in a tertiary medical centre in Seoul, South Korea. Results: Overall, 26 and 75 patients had invasive and non‐invasive fusariosis, respectively. Patients with invasive fusariosis commonly had haematologic malignancy (62%), were solid organ transplant recipients (23%), and had a history of immunosuppressant usage (81%). In non‐invasive fusariosis, diabetes mellitus (27%) and solid cancer (20%) were common underlying conditions. Disseminated fusariosis (54%) and invasive pulmonary disease (23%) were the most common clinical manifestations of invasive fusariosis; skin infection (48%) and keratitis (27%) were the most common manifestations of non‐invasive fusariosis. Twenty‐eight‐day and in‐hospital mortalities were high in invasive fusariosis (40% and 52%, respectively). In multivariate analysis, invasive fusariosis (adjusted odds ratio, 9.6; 95% confidence interval 1.3–70.8; p =.03) was an independent risk factor for 28‐day mortality. Conclusions: Patients with invasive fusariosis were frequently immunocompromised, and more than half had disseminated fusariosis. Invasive fusariosis was associated with poor prognosis. [ABSTRACT FROM AUTHOR]

Data analysis and collection techniques now allow for detailed inventory‐building of urban rooftops for the purposes of identifying solar energy potential within geographically defined boundaries, including those of cities. The complexity and inherent diversity of a city's building stock has propelled the introduction of many so‐called "solar city" assessment methods that, with varying levels of accuracy, scalability, and ease of use, seek to characterize the citywide solar photovoltaic (PV) resource potential. A review of the landscape of available methods supports a fundamental distinction across two classes of methods. First, "solar city" assessment methods can principally rely on inference to identify and characterize rooftop solar potential. Such inferential methods can establish estimates of citywide solar potential without needing direct insight into rooftop conditions or morphology, Second, measurement‐based methods estimate rooftop solar opportunities based on the direct measurement of rooftop conditions, often conducted through remote sensing. Comparative performance testing of several inferential‐ and measurement‐based methods using case study analysis underscores the importance of measurement‐based methods. In particular, measurement‐based methods are likely better positioned to support the needs of policy‐makers and investors interested in transforming a city or metropolitan area into a sustainable city whose buildings serve as the host of a new solar PV‐powered distributed electricity service system. This article is categorized under:Sustainable Energy > Solar EnergyEnergy and Power Systems > Energy InfrastructureCities and Transportation > Smart Cities [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the diagnostic usefulness of real‐time (RT) polymerase chain reaction (PCR) on blood samples for diagnosis of invasive aspergillosis and mucormycosis in patients with suspected invasive mould infection. Methods: Adult patients with suspected invasive mould infection were prospectively enrolled at a tertiary referral hospital in Seoul, South Korea between 2017 and 2020. Standard tests for diagnosis of invasive mould infection and RT‐PCR for Aspergillus, Mucor and Rhizopus using blood samples were performed. We evaluated the diagnostic performance of RT‐PCR tests in patients diagnosed with proven and probable invasive aspergillosis or mucormycosis infection, according to the modified definitions of the EORTC/MSG 2019. Results: A total of 102 patients with suspected invasive mould infection were enrolled. Of these patients, 46 (45%) were classified as having proven (n = 13) or probable (n = 33) invasive aspergillosis, 21 (21%) as proven (n = 17) or probable (n = 4) invasive mucormycosis and 18 (18%) as possible invasive mould infection. The remaining 13 (13%) were classified as not having invasive mould infection. Patients with possible invasive mould infection (n = 18) and coinfection of aspergillosis and mucormycosis (n = 4) were excluded from the final analysis. The sensitivity and specificity of the Aspergillus PCR were 54.3% ([25/46], 95% confidence interval [CI]: 40.2–67.9%) and 94.1% ([32/34], 95% CI: 80.9–98.4%), respectively. The sensitivity and specificity of the Mucor or Rhizopus PCR were 57.1% ([12/21], 95% CI: 36.6–75.5%) and 76.3% ([45/59], 95% CI: 64.0–85.3), respectively. Conclusions: Our study suggests that blood PCR can be a useful adjunct test for diagnosing patients with suspected invasive mould infection. [ABSTRACT FROM AUTHOR]

Background and objectives: There are limited data in real clinical practice on the diagnostic value of a bronchoalveolar lavage (BAL) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Thus, we investigated the diagnostic performance of a BAL GM assay in patients with negative serum GM assay results who were suspected to have IPA. Methods: This retrospective study was performed between May 2008 and April 2019 at a tertiary‐care hospital in Seoul, South Korea. All patients with suspected IPA whose serum GM assays revealed negative results who sequentially underwent BAL were enrolled in this study. Results: A total of 341 patients with suspected IPA including four cases of proven IPA, 38 cases of probable IPA, 107 cases of possible IPA and 192 patients without IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven and probable IPA who had initial negative serum GM results, 24 (57%) had positive BAL GM results (n = 24) or BAL fungal culture results (n = 8). In addition, BAL revealed evidence of other opportunistic infections including Pneumocystis jirovecii pneumonia (14% [26/190]), cytomegalovirus (CMV) pneumonia (5% [9/188]) and respiratory viral pneumonia (6% [12/193]). Conclusion: Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in approximately half of patients with evidence of another co‐infection. [ABSTRACT FROM AUTHOR]

Background: Pulmonary mucormycosis (PM) represents a serious burden in terms of morbidity and mortality in immunocompromised patients. Studies of prognostic factors in patients with PM are limited and have involved small numbers of patients. Methods: Adult patients diagnosed with proven and probable PM according to the modified definitions of the EORTC/MSG 2008 in a tertiary hospital in Seoul, South Korea, between 2008 and 2019 were retrospectively enrolled. Results: A total of 49 patients including 31 (63%) with proven PM and 18 (37%) with probable PM were enrolled. The 90‐day mortality rate was 49% (24/49). Neutropenia, thrombocytopenia, use of voriconazole at clinical suspicion, positivity of non‐sterile culture, use of steroid and treatment without surgery were more common in fatal cases than non‐fatal cases. Voriconazole use at clinical suspicion for invasive mould pneumonia (OR 6.91, P =.01) and prolonged neutropenia (OR 4.86, P =.03) were independent risk factors for mortality. Voriconazole use at clinical suspicion was associated with positive galactomannan (GM) assay (OR 5.93, P =.02) and history of invasive pulmonary aspergillosis (OR, 6.88, P =.05). Conclusion: About half of the patients with PM died within 90 days of diagnosis, and fatal outcomes were common in patients with prolonged neutropenia and empirical voriconazole use. Caution is needed in using voriconazole even in patients with positive GM results and prior histories of invasive pulmonary aspergillosis in whom PM cannot be ruled out by differential diagnosis. [ABSTRACT FROM AUTHOR]