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Abstract In the biological nervous system, the integration and cooperation of parallel system of receptors, neurons, and synapses allow efficient detection and processing of intricate and disordered external information. Such systems acquire and process environmental data in real‐time, efficiently handling complex tasks with minimal energy consumption. Memristors can mimic typical biological receptors, neurons, and synapses by implementing key features of neuronal signal‐processing functions such as selective adaption in receptors, leaky integrate‐and‐fire in neurons, and synaptic plasticity in synapses. External stimuli are sensitively detected and filtered by “artificial receptors,” encoded into spike signals via “artificial neurons,” and integrated and stored through “artificial synapses.” The high operational speed, low power consumption, and superior scalability of memristive devices make their integration with high‐performance sensors a promising approach for creating integrated artificial sensory systems. These integrated systems can extract useful data from a large volume of raw data, facilitating real‐time detection and processing of environmental information. This review explores the recent advances in memristor‐based artificial sensory systems. The authors begin with the requirements of artificial sensory elements and then present an in‐depth review of such elements demonstrated by memristive devices. Finally, the major challenges and opportunities in the development of memristor‐based artificial sensory systems are discussed.

We report a long-term (4.5 year) time-series with weekly resolution of iodide and iodate measurements made at 4 depths within the Bedford Basin: a 70 m deep, seasonally stratified, coastal fjord located near Halifax, Nova Scotia, Canada. The subsurface data (60 m) reveal strong inverse correlations of both iodide and total dissolved iodine (TDI) with dissolved oxygen and indicate that there is in-situ reduction of iodate in subsurface waters (in the presence of oxygen) as well as an additional external source of iodide from the remineralization of sinking organic matter, a flux from sediments, or both. Surface water (

IntroductionChronic exposure to arsenic through drinking water has been linked to several cancers. The metabolism of arsenic is thought to play a key role in arsenic-related carcinogenesis as metabolites of varying toxicity are produced and either stored in or excreted from the body. Atlantic Canada has the highest age-standardized incidence rates of all cancers in the country. This may be due to its high levels of environmental arsenic and the prevalence of unregulated private wells for water consumption. Here, we aimed to characterize the profiles of arsenic species and metallome in the toenails of four cancer groups, compare them to healthy participants (N = 338), and assess potential associations between the profiles with cancer prevalence.MethodsThis study employed a case–control design. Toenail samples and questionnaire data from cases (breast, cervical, prostate, and skin cancers) and controls were sourced from the Atlantic Partnership for Tomorrow’s Health (PATH) cohort study. The levels of arsenic species were measured using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) paired with High Performance Liquid Chromatography (HPLC) and total concentrations of metallome (23 metals) were determined by ICP-MS separately. Multivariate analyses were conducted to compare cases with controls within each cancer group.ResultsArsenic speciation profiles varied by cancer type and were significantly different between cases and controls in the breast (p = 0.0330), cervical (p = 0.0228), and skin (p = 0.0228) cancer groups. In addition, the profiles of metallome (nine metals) were significantly differentiated in the prostate (p = 0.0244) and skin (p = 0.0321) cancer groups, with higher zinc concentrations among cases compared to controls.ConclusionHistory of cancer diagnosis was associated with specific profiles of arsenic species and metallome. Our results indicate that arsenic methylation and zinc levels, as measured in toenails, may be an important biomarker for cancer prevalence. Further research is needed to use toenails as a prognostic measure of arsenic-and other metal-induced cancer.

Chronic exposure to inorganic arsenic and trace metals has been linked to prostate cancer, and altered arsenic methylation capacity may have an important role in arsenic carcinogenesis. Biomarkers may be able to elucidate this role. Our objectives were to characterize profiles of arsenic species and metallome in toenails and urine samples, compare profiles between prostate cancer cases and controls, and determine the discriminant ability of toenail and urine biomarkers. Toenail samples (n = 576), urine samples (n = 152), and questionnaire data were sourced from the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. Healthy controls were matched to prostate cancer cases (3:1 ratio) on sex, age, smoking status, and the province of residence. Metallome profiles and proportions of arsenic species were measured in toenail and urine samples. Analysis of covariance (ANCOVA) was used to compare the mean percent monomethylarsonic acid (%MMA), dimethylarsonic acid (%DMA), inorganic arsenic (%iAs), primary methylation index (PMI, MMA/iAs), and secondary methylation index (SMI, DMA/MMA). Multivariate analysis of covariance (MANCOVA) was used to compare selected metal concentrations. Mean %MMA was significantly lower and SMI was significantly higher in toenails from prostate cancer cases compared to controls in unadjusted and adjusted models. Proportions of arsenic species were correlated with total arsenic in toenails. Arsenic speciation in urine was not different between cases and controls, nor were metallome profiles in toenails and urine. Our results indicate that toenails are a viable biomarker for altered arsenic speciation in prostate cancer cases and may have greater utility than urine in this context.

Abstract Background The present study examined the relationship between body mass index (BMI) and the risk for fragility fractures in postmenopausal Korean women. Methods Among subjects who participated in the 4th Korea National Health and Nutrition Examination Survey (2008–2009), 2114 women ≥ 40 years of age were included. BMI was based on standards set by the Korean Society for the Study of Obesity, as follows:

Abstract Globally consistent measurements of airborne metal concentrations in fine particulate matter (PM2.5) are important for understanding potential health impacts, prioritizing air pollution mitigation strategies, and enabling global chemical transport model development. PM2.5 filter samples (N ~ 800 from 19 locations) collected from a globally distributed surface particulate matter sampling network (SPARTAN) between January 2013 and April 2019 were analyzed for particulate mass and trace metals content. Metal concentrations exhibited pronounced spatial variation, primarily driven by anthropogenic activities. PM2.5 levels of lead, arsenic, chromium, and zinc were significantly enriched at some locations by factors of 100–3000 compared to crustal concentrations. Levels of metals in PM2.5 and PM10 exceeded health guidelines at multiple sites. For example, Dhaka and Kanpur sites exceeded the US National Ambient Air 3-month Quality Standard for lead (150 ng m−3). Kanpur, Hanoi, Beijing and Dhaka sites had annual mean arsenic concentrations that approached or exceeded the World Health Organization’s risk level for arsenic (6.6 ng m−3). The high concentrations of several potentially harmful metals in densely populated cites worldwide motivates expanded measurements and analyses.

BackgroundResearch assessing lipid levels in individuals diagnosed with post-traumatic stress disorder (PTSD) has yielded mixed results. This study aimed to employ meta-analytic techniques to characterize the relationship between the levels of lipid profiles and PTSD.MethodsWe performed meta-analyses of studies comparing profiles and levels of lipids between PTSD patients and healthy individuals by searching Embase, Ovid Medline, Scopus, PsycINFO, and Cochrane databases for the studies until March 2021. Meta-analyses were performed using random-effects models with the restricted maximum-likelihood estimator to synthesize the effect size assessed by standardized mean difference (SMD) across studies.FindingsA total of 8,657 abstracts were identified, and 17 studies were included. Levels of total cholesterol (TC) (SMD = 0.57 95% CI, 0.27–0.87, p = 0.003), low-density lipoprotein (LDL) (SMD = 0.48, 95% CI, 0.19–0.76, p = 0.004), and triglyceride (TG) (SMD = 0.46, 95% CI, 0.22–0.70, p = 0.001) were found to be higher, while levels of high-density lipoprotein (HDL) (SMD = –0.47, –0.88 to –0.07, p = 0.026) were found to be lower in PTSD patients compared to healthy controls. Subgroup analysis showed that TG levels were higher in PTSD patients who were on or off of psychotropic medications, both < 40 and ≥ 40 years of age, and having body mass index of < 30 and ≥ 30 compared to healthy controls.InterpretationThis work suggested dysregulation of lipids in PTSD that may serve as biomarker to predict the risk. The study will be useful for physicians considering lipid profiles in PTSD patients to reduce cardiovascular morbidity and mortality.

Long-term exposure to environmental arsenic has been associated with many chronic diseases, including several cancers, and diabetes. Urinary studies have implicated arsenic speciation as an important risk factor, however, such associations have not been replicated using toenail samples: a relatively new biosample for estimating long-term internal dose-exposure to arsenic. Despite having several advantages over conventional biosamples such as ease of collection and storage, standard methods for arsenic speciation analysis in toenails have not yet been established. The primary objectives of this study were to 1) establish an analytical method for arsenic speciation analysis in toenails, 2) describe preliminary arsenic speciation profiles of toenail samples from individuals with skin, lung, bladder, and kidney cancer, type II diabetes, and no known disease, and 3) determine if these speciation patterns differ between disease groups to inform the feasibility of subsequent research. A small cross-sectional feasibility study was carried out using 60 toenail samples and baseline questionnaire data from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) study. Arsenic speciation profiles were determined using high performance liquid chromatography (HPLC) paired with inductively coupled plasma-mass spectrometry (ICP-MS). While no differences in total arsenic were found, arsenic speciation profiles were significantly different between certain cancer groups and the reference group with no known disease. Specifically, the percentage of monomethylarsonic acid (%MMA) was found to be significantly higher in the toenails of individuals with lung cancer and kidney cancer, compared to healthy individuals with similar total arsenic exposure. To the best of our knowledge, this is the first study to describe arsenic speciation patterns in individuals with several arsenic-related diseases using toenails: a convenient, non-invasive, biobankable sample capable of longer-term exposure estimation than conventional biosamples. These preliminary data provide evidence that toenail arsenic speciation patterns differ between groups with arsenic-related disease, and those with no known disease. Toenail arsenic speciation analysis is feasible and could potentially have important implications for research on arsenic-related diseases. Further investigation is warranted and would benefit from including detailed arsenic exposure data to explore the observed heterogeneity in arsenic speciation profiles.

Though liquid sensing platforms are highly sought after for emerging biomedical applications, current technology is limited in its capacity to directly sense and store information. Here, the authors report a sensing memory platform that senses, monitors, and stores information on various liquids.

Purpose: Penile resurfacing with various scrotal flaps is a simple, effective, and reliable reconstructive armamentarium to treat penile paraffinoma. However, scrotal flaps often result in heavy hair-bearing penile skin causing dyspareunia or shortening of penile length. We introduce a new penile skin preservation technique for reconstruction surgery of penile paraffinoma. Materials and Methods: From March 2007 to April 2018, 23 patients underwent excision of paraffinoma with the penile skin preservation technique. Complete removal of the subcutaneous tissue was done, including paraffinoma. No. 10 surgical blades were used to peel off the skin as thin as possible in order to get paraffinoma-free skin. The preserved penile skin was given an end to end anastomosis to the circumferential incision site. Multiple anchoring fixation sutures of the penile skin were made on the underlying tissue. Dressing of chopped gauze soaked with antibiotic saline solution was done on the skin to help preserve it and keep it fixed on the penis. Results: The skin survived completely without necrosis in 19 patients (82.6%), with the mean duration of healing being 21.9 days. The penis after the operation looked natural in color and shape. Partial necrosis after the operation was shown on 4 patients (17.4%), whom were all later treated with the scrotal skin free graft. The final results were successful without any cosmetic or functional complications, such as skin contracture. Conclusions: Penile resurfacing with the penile skin preservation technique is a new effective reliable method for skin-intact paraffinoma which produces good functional and cosmetic results.

Abstract This study investigated the trend in emaciation infection outbreak in olive flounder (Paralichthys olivaceus) of Jeju island, South Korea, during 2014−2015. A total of 900 fish were systematically examined by PCR method using the EM-F/EM-R primer set in April, May, September, November, and December 2014, and the infection rate was recorded. In 2015, the same examination was conducted in March, May, July, and October but with 660 fish. It was found that the infection rate was 18.3~71.6% in 2014, which increased to 16.3~90.3% in 2015. Furthermore, September and December in 2014 and March, July, and October in 2015 showed a relatively higher infection rate. According to the infection trend analysis, which depended on the sample size, the infection occurred in all of fish sizes in this study and 11~30 cm fish group showed the highest infection rate. Histological examination confirmed that the kidney areas of the emaciating infected olive flounder contained several spores of 4~9 μm, and in severe cases, the elimination and destruction of tissue were confirmed by PCR. Thus, an important portion of farmed olive flounders in the Jeju region suffers from emaciation disease. This epidemiological survey serves as a useful reference on the emaciation disease of cultured olive flounders in Jeju.

Background : This study aimed to evaluate the association between abdominal obesity and lumbar bone mineral density (BMD) according to the postmenopausal period of Korean women. Methods : This was a cross-sectional study. Among the 1,923 women enrolled, 1,138 were included in the study; 785 women were excluded based on conditions that might have affected their bone density. Subjects were divided into short postmenopausal period (SPP, 0–5 years after menopause) and long postmenopausal period (LPP, 6–10 years after menopause). The association between abdominal obesity (waist circumference ≥85 cm) and lumbar BMD according to postmenopausal period in Korean women was assessed. Results : After adjusting for age, exercise amount, alcohol consumption, skeletal muscle mass, and body fat mass, the adjusted odds ratio (OR) for osteoporosis in the group with abdominal obesity compared to the group without abdominal obesity was 0.38 (95% confidence interval [CI], 0.16–0.88; P=0.023) in the SPP group. However, in the LPP and total groups, the adjusted ORs were not significant. The adjusted ORs for low bone mass showed no significance in the SPP, LPP, and total groups. Conclusion : In the SPP group, the risk of osteoporosis was lower in the group with abdominal obesity than in the group without abdominal obesity. However, in the LPP group, no significant difference was found. Therefore, the effect of abdominal obesity on lumbar BMD may be just for a short period after menopause (0–5 years).

Abstract In addition to the demand for stimuli‐responsive sensors that can detect various vital signals in epidermal skin, the development of electronic skin displays that quantitatively detect and visualize various epidermal stimuli such as the temperature, sweat gland activity, and conductance simultaneously are of significant interest for emerging human‐interactive electronics used in health monitoring. Herein, a novel interactive skin display with epidermal stimuli electrode (ISDEE) allowing for the simultaneous sensing and display of multiple epidermal stimuli on a single device is presented. It is based on a simple two‐layer architecture on a topographically patterned elastomeric polymer composite with light‐emitting inorganic phosphors, upon which two electrodes are placed with a certain parallel gap. The ISDEE is directly mounted on human skin, which by itself serves as a field‐responsive floating electrode of the display operating under an alternating current (AC). The AC field exerted on the epidermal skin layer depends on the conductance of the skin, which can be modulated based on a variety of physiological skin factors, such as the temperature, sweat gland activity, and pressure. Conductance‐dependent field‐induced electroluminescence is achieved, giving rise to an on‐hand sensing display platform where a variety of human information can be directly sensed and visualized.

Medical congresses often held in highlands. We reviewed several medical issues associated with altitude stress especially while physicians have participated medical congress held in high altitude. Altitude stress, also known as an acute mountain sickness (AMS), is caused by acute exposure to low oxygen level at high altitude which is defined as elevations at or above 1,200 m and AMS commonly occurs above 2,500 m. Altitude stress with various symptoms including insomnia can also be experienced in airplane. AMS and drunken state share many common features in symptoms, neurologic manifestations and even show multiple microbleeds in corpus callosum and white matter on MRI. Children are more susceptible to altitude stress than adults. Gradual ascent is the best method for the prevention of altitude stress. Adequate nutrition (mainly carbohydrates) and hydration are recommended. Consumption of alcohol can exacerbate the altitude-induced impairments in judgment and the visual senses and promote psychomotor dysfunction. For prevention or treatment of altitude stress, acetazolamide, phosphodiesterase inhibitors, dexamethasone and erythropoietin are helpful. Altitude stress can be experienced relatively often during participation of medical congress. It is necessary to remind the harmful effect of AMS because it can cause serious permanent organ damage even though the symptoms are negligible in most cases.

Multi-walled carbon nanotubes (MWCNTs) have variable metal impurities, but little is known about the impact of soluble metal impurities on the toxicity of MWCNTs. Here, we evaluated the role of soluble metal impurities to the acute inflammogenic potential of MWCNTs, using five types of high purity MWCNTs (>95%). MWCNTs and their soluble fractions collected at 24 h after incubation in phosphate-buffered saline showed diverse metal impurities with variable concentrations. The fiber-free soluble fractions produced variable levels of reactive oxygen species (ROS), and the iron level was the key determinant for ROS production. The acute inflammation at 24 h after intratracheal instillation of MWCNTs to rats at 0.19, 0.63, and 1.91 mg MWCNT/kg body weight (bw) or fiber-free supernatants from MWCNT suspensions at 1.91 and 7.64 mg MWCNT/kg bw showed that the number of granulocytes, a marker for acute inflammation, was significantly increased with a good dose-dependency. The correlation study showed that neither the levels of iron nor the ROS generation potential of the soluble fractions showed any correlations with the inflammogenic potential. However, the total concentration of transition metals in the soluble fractions showed a good correlation with the acute lung inflammogenic potential. These results implied that metal impurities, especially transitional metals, can contribute to the acute inflammogenic potential of MWCNTs, although the major parameter for the toxicity of MWCNTs is size and shape.

The hypothalamus is an important structure that regulates sleep via hypocretin neurotransmission. Central nervous system disorders such as tumors and vascular legions involving the hypothalamus can cause secondary narcolepsy. In addition, brain trauma can contribute to post-traumatic narcolepsy despite lack of any definite brain lesion. Here, we present a case of a 37-year-old man suffering from a hypothalamus-to-thalamus hemorrhage after a traffic accident. After this trauma, he suffered from excessive daytime sleepiness and was diagnosed with post-traumatic narcolepsy by polysomnography and multiple sleep latency tests. He was positive for human leukocyte antigen (HLA)-DQB1*03:01 and HLA-DQB1*06:01 antigens.

PurposeSmoking is a well known risk factor for stroke. The cerebral arteries may be uniquely susceptible to the atherosclerotic effects of smoking, such that it has a different risk profile for stroke compared with other atherosclerosis risk factors. It remains uncertain whether smoking is associated specifically with intracranial (IC) or extracranial (EC) atherosclerotic cerebrovascular disease. The aim of this study design will be to evaluate the association between smoking and severe IC stenosis, adjusting for other atherosclerosis risk factors, particularly age distribution.Study designThis is a retrospective cohort study design. Participants are patients (n=1714) with severe atherosclerotic stenosis undergoing cerebral catheter angiography because of stroke or transient ischaemic attack. All atherosclerotic steno-occlusive lesions are described in terms of location (anterior versus posterior circulation, IC versus EC, or intradural versus extradural). The atherosclerotic or stroke risk factors for analysis include age, gender, smoking history, number of lesions (single versus multiple), cardiac disease, diabetes mellitus, hypertension, family history, dyslipidemia, history of previous stroke, alcohol intake, metabolic syndrome and body mass index. Statistical analysis includes univariate analysis followed by multivariate logistic regression. The relationship between IC atherosclerotic stenosis and smoking will be assessed. Differences in risk factor distribution is analysed according to age at intervals of 10 years. Significant risk factors associated with IC atherosclerotic stenosis will also be assessed by multivariate logistic regression analysis.SummaryThis is an analytical study design that intends to measure the association between IC or EC atherosclerotic stenosis and smoking and other risk factors. We anticipate that it will have the power to detect any relationship between smoking and IC atherosclerotic lesions especially in younger patients.

PurposeSince we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery.Materials and MethodsAmong 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting.ResultsThe procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route.ConclusionIf a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.

PurposeComputational flow dynamic (CFD) study has not been widely applied in intracranial artery stenosis due to requirement of high resolution in identifying the small intracranial artery. We described a process in CFD study applied to symptomatic severe intracranial (M1) stenosis before and after stenting.Materials and MethodsReconstructed 3D angiography in STL format was transferred to Magics (Materialise NV, Leuven, Belgium) for smoothing of vessel surface and trimming of branch vessels and to HyperMesh (Altair Engineering Inc., Auckland, New Zealand) for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5 (ADINA R & D, Inc., Lebanon, MA). The distribution of wall shear stress (WSS), peak velocity and pressure in a patient was analyzed before and after intracranial stenting.ResultsComputer simulation of wall shear stress, flow velocity and wall pressure before and after stenting could be demonstrated three dimensionally by video mode according to flow vs. time dimension. Such flow model was well correlated with angiographic finding related to maximum degree of stenosis. Change of WSS, peak velocity and pressure at the severe stenosis was demonstrated before and after stenting. There was no WSS after stenting in case without residual stenosis.ConclusionOur study revealed that CFD analysis before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.

Background: In clinical practice, primary healthcare physicians commonly encounter patients with alcohol- related problems. This review article introduces the concept of an alcohol clinic for treating patients with these issues at primary healthcare clinics. Current Concepts: Alcohol-related problems often give rise to health problems, which prompts primary healthcare physicians to be required to develop screening, treatment, and counseling skills. Primary healthcare clinics should actively screen for alcohol-related problems. Screening involves questions regarding the frequency, quantity, and maximum consumption of alcohol to determine risk levels. For Koreans, moderate alcohol consumption is defined as ≤8 drinks per week (1 drink=14 g of alcohol) for men aged up to 65 years, and ≤4 drinks per week for men over 65 years; consumption for women is set at half of the amount defined for men. Individuals experiencing facial flushing after alcohol consumption are advised to limit their alcohol intake to half the amount consumed by those who do not experience flushing. Discussion and Conclusion: The focus for these patients should be on their environment, particularly when implementing a family-oriented approach. The decision to initiate drug treatment should be based on the symptoms of the patient, with follow-up evaluations performed at appropriate time points. The "FRAMES Motivational Enhancement Interview" and "Insight Enhancement Counseling" are recommended for an effective counseling of patients. [ABSTRACT FROM AUTHOR]

This research aims to employ the focus group interview methodology to extract important insights and policy recommendations for the revitalization of tourism in island regions during the era of significant digital transformation. To achieve this objective, the current study focuses on Jebudo Island, located in Hwaseong-city, Gyeonggi province, as a representative case area and utilizes the findings obtained to identify practical and effcacious viewpoints. The ensuing report highlights the paramount importance and policy recommendations extracted via a focus group interview technique. Initially, considering the prospect of being established as a tourism hub, Jebudo Island has persistently engaged in development and business promotions. However, the island continues to be characterized by an aging tourist destination, emphasizing private facilities, which does not align with the current tourism trend. In light of the ongoing digital transformation, it is imperative that Jebudo Island utilizes its local resources effciently while adhering to contemporary tourism trends by implementing relevant technologies appropriately. Another noteworthy policy recommendation pertains to the underdevelopment of Jebudo Island, given its remarkable geographical conditions and regional resources. Conventionally, tourism activities were confined to sightseeing, primarily highlighting hardware and natural landscapes. However, recently, such activities have shifted towards experiences and emotions, emphasizing content and engagement. Consequently, the need to develop content using cutting-edge technologies such as artificial intelligence, metaverse, and ChatGPT is essential to enhance national awareness. Finally, concerning the island's placeness strategy in conjunction with digital transformation, islands face a daunting challenge of regional extinction, with a more severe decline in population than that of mainland areas. Despite various policy measures to address this issue, no effective exit strategy has emerged thus far. Therefore, it is imperative to devise a strategy centered on the sense of place that aligns with regional characteristics. In particular, engaging the MZ generation, which values novel social values and actively utilizes social media and the internet, could lead to broader engagement across other generations. Moreover, in the process of revitalizing island tourism during the digital transformation era, various stakeholders are intricately interconnected. Hence, it is crucial to utilize different platforms and establish cooperative governance. Furthermore, to create a functional ecosystem, it is crucial to institute policies such as island business schools, forums, and full-time operating organizations to enhance expertise and commercial viability, while fostering sustainable strategic discussions. Notwithstanding, considering that the present study solely examined the case of Jebudo Island in Hwaseong through the focus group interviews in the era of significant digital transformation, it remains uncertain whether the findings can be uniformly applied and extrapolated to other islands. Consequently, further studies are essential to enhance objectivity and empirical validity by broadening the scope of case areas and incorporating stakeholder surveys. [ABSTRACT FROM AUTHOR]