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Korea operates exclusive bus lanes (XBLs) on many of its expressways. As XBLs convert one lane of regular-use traffic into bus-only traffic, they have a large impact on traffic flow, so careful judgment is required to determine if the operation is effective. However, XBLs have been operated based on only political judgment due to the lack of standards for the operation of expressway XBLs. Therefore, we sought to establish standards for the operation of expressway XBLs using the micro-traffic simulation program VISSIM and the multi-criteria value function methodology. Various scenarios were established based on traffic volume changes of passenger vehicles and bus traffic of four- and five-lane expressway networks. Through an expert survey, the average speed and speed-deviation values, which are the criteria for evaluating operational efficiency and safety, were determined. Also, value points were converted using average speed and speed deviation extracted from the simulation. In addition, quantitative operation standards were established using the converted value scores. Using the results of this study, we established standards for the operation of the XBLs and presented guidelines for related agencies such as police, bus groups, and corporations. The National Police have prepared guidelines for the operation of the XBLs. Citing the results of this study, the new guidelines were implemented in February 2021, and sections of some XBLs have been abolished. Through this study, quantitative standards for the operation of XBLs, one of the management lane techniques necessary for sustainable highway operation, were prepared and applied to actual highways. By properly applying the newly applied guidelines according to quantitative standards, there will be effects of reducing traffic congestion, improving travel time, and enhancing environmental characteristics such as exhaust gas emission. It is also expected to have a positive effect on safety.

Abstract We investigated the polarity dependence of a capacitive energy management circuit in a triboelectric nanogenerator (TENG) power system. In a half-wave rectifying circuit, the Simulation Program with Integrated Circuit Emphasis and analytical models show that the charge dump to the load varied depending on the polarity of the rectifying circuit even with the same charge output from TENG. Depending on the polarity of the rectifying circuit, a fast saturation of the direct current (DC) output voltage or a high DC output voltage was obtained. Experiments with a half-wave rectifier and Bennet doubler confirmed our simulation and theoretical results. The charge dump from the minimum capacitance of the separated TENG to the load capacitance and the charge dump from the maximum capacitance of the contacted TENG to the load resulted in asymmetric charging behavior. We concluded that it is necessary to analyze the TENG and the capacitive energy management circuit as a single system rather than considering them as independent units in the rectifying circuit of the TENG. This work can provide insights for the design of triboelectric energy harvesting systems.

Abstract HIV-1 persistence during ART is due to the establishment of long-lived viral reservoirs in resting immune cells. Using an NHP model of barcoded SIVmac239 intravenous infection and therapeutic dosing of anti-TGFBR1 inhibitor galunisertib (LY2157299), we confirm the latency reversal properties of in vivo TGF-β blockade, decrease viral reservoirs and stimulate immune responses. Treatment of eight female, SIV-infected macaques on ART with four 2-weeks cycles of galunisertib leads to viral reactivation as indicated by plasma viral load and immunoPET/CT with a 64Cu-DOTA-F(ab’)2-p7D3-probe. Post-galunisertib, lymph nodes, gut and PBMC exhibit lower cell-associated (CA-)SIV DNA and lower intact pro-virus (PBMC). Galunisertib does not lead to systemic increase in inflammatory cytokines. High-dimensional cytometry, bulk, and single-cell (sc)RNAseq reveal a galunisertib-driven shift toward an effector phenotype in T and NK cells characterized by a progressive downregulation in TCF1. In summary, we demonstrate that galunisertib, a clinical stage TGF-β inhibitor, reverses SIV latency and decreases SIV reservoirs by driving T cells toward an effector phenotype, enhancing immune responses in vivo in absence of toxicity.

Abstract Previous studies on Alzheimer’s disease-type cognitive impairment (ADCI) and subcortical vascular cognitive impairment (SVCI) has rarely explored spatiotemporal heterogeneity. This study aims to identify distinct spatiotemporal cortical atrophy patterns in ADCI and SVCI. 1,338 participants (713 ADCI, 208 SVCI, and 417 cognitively unimpaired elders) underwent brain magnetic resonance imaging (MRI), amyloid positron emission tomography, and neuropsychological tests. Using MRI, this study measures cortical thickness in five brain regions (medial temporal, inferior temporal, posterior medial parietal, lateral parietal, and frontal areas) and utilizes the Subtype and Stage Inference (SuStaIn) model to predict the most probable subtype and stage for each participant. SuStaIn identifies two distinct cortical thinning patterns in ADCI (medial temporal: 65.8%, diffuse: 34.2%) and SVCI (frontotemporal: 47.1%, parietal: 52.9%) patients. The medial temporal subtype of ADCI shows a faster decline in attention, visuospatial, visual memory, and frontal/executive domains than the diffuse subtype (p-value

PurposeThe aim of this study was to investigate the mediating effects of health literacy on the relationship between frailty and health-related quality of life (HRQOL) among community-dwelling older adults.MethodsThis study used the Korean Frailty and Aging Cohort Database (KFACD) for secondary data analysis. We selected data from 1,631 people without missing main variable values for analysis. Frailty was determined based on the modified Fried's phenotype [MFP], and HRQOL was measured using the Korean version of the 5-level EuroQol questionnaire (EQ-5D-5L). Health literacy was assessed using the questions on the Behavioral Risk Factor Surveillance System (BRFSS) used by the U.S. Center for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and HRQOL, Baron & Kenny's three-step mediating effect verification method was utilized.ResultsThe participants had a mean frailty score of 1.37±1.02, health literacy score of 8.56±2.59, and HRQOL score of 0.84±0.10. Frailty was negatively correlated with health literacy (r = -0.27, p < .001) and HRQOL (r = -0.32, p < .001), while health literacy was positively correlated with HRQOL (r = 0.34, p < .001). We observed that health literacy played a partial mediating role in the relationship between frailty and HRQOL.ConclusionTo increase older adults' HRQOL, measures that directly prevent and manage frailty as well as interventions that target the enhancement of health literacy are needed.

Abstract Approximately 300,000 anterior cruciate ligament (ACL) tears occur annually in the United States, half of which lead to the onset of knee osteoarthritis within 10 years of injury. Repetitive loading is known to result in fatigue damage of both ligament and tendon in the form of collagen unravelling, which can lead to structural failure. However, the relationship between tissue’s structural, compositional, and mechanical changes are poorly understood. Herein we show that repetitive submaximal loading of cadaver knees causes an increase in co-localised induction of collagen unravelling and tissue compliance, especially in regions of greater mineralisation at the ACL femoral enthesis. Upon 100 cycles of 4× bodyweight knee loading, the ACL exhibited greater unravelled collagen in highly mineralized regions across varying levels of stiffness domains as compared to unloaded controls. A decrease in the total area of the most rigid domain, and an increase in the total area of the most compliant domain was also found. The results highlight fatigue-driven changes in both protein structure and mechanics in the more mineralized regions of the ACL enthesis, a known site of clinical ACL failure. The results provide a starting point for designing studies to limit ligament overuse injury.

Abstract Aim The study aimed to assess the validity and reliability of the short‐form Nurse Professional Competence Scale–Korean version (NPC‐K) among Korean nursing students at the point of graduation. Design This was a cross‐sectional survey. Methods The Nurse Professional Competence scale was translated into Korean using the World Health Organization (WHO) translation method. A total of 195 graduating nursing students participated. Exploratory factor analysis for validity and Cronbach's alpha coefficients for reliability were examined. Results Factor analysis showed that five NPC‐K factors accounted for 68.38% of the total variance. Cronbach's alpha for the total scale was 0.97. The NPC‐K has high internal reliability and acceptable construct validity. The content of the scale reflected nursing students' confidence in formal competence requirements based on Korean cultural and educational backgrounds. An accurate assessment of nurse professional competence using the NPC‐K may help nursing academics enhance the quality of education and training.

In 2021, the incidence of newly notified tuberculosis in Jeju Province decreased by 23.0% compared to that in the previous year. This was the largest decline among the 18 municipalities studied. This study aimed to examine trends in the incidence of tuberculosis among different age and sex groups in Jeju Province between 2017 and 2021. This study observed the number of new cases in the annual report from 2017 to 2021, published by the Jeju Center for Infectious Diseases Control and Prevention. The average annual percentage change (AAPC; %) was calculated to determine the trend in crude incidence rates over the past 5 years by sex and age. While a P-value of

Drought is a significant climatic factor that significantly affects the production of Chinese cabbage, a crop that is highly susceptible to drought stress. The development and cultivation of drought-tolerant varieties could be a viable strategy to minimize the damage caused by climate change and ensure stable production of Chinese cabbage. This requires the implementation of technologies for early evaluation and selection of a plethora of resources. In this study, we screened 100 varieties and breeding resources for drought tolerance under a water deficit treatment at the seedling stage. We also evaluated the growth response of Chinese cabbage varieties and breeding resources under water deficit treatment and selected drought-tolerant Chinese cabbage genotypes. We confirmed that the visual score for wilting, which evaluates the wilting response during the recovery process of Chinese cabbage seedlings through water deficit treatment and re-watering, can be used as an indicator for evaluating tolerance to drought stress. The visual score for wilting showed a high correlation with major traits representing drought tolerance. Our findings highlight the need for an integrated approach that considers various environmental conditions, varieties, and lines to select and develop drought-tolerant varieties. We selected ‘18-FH112-1’ and ‘18-FH112-1-2’ among others, and these germplasms will be useful resources for drought tolerance breeding. This study provides a foundation for future efforts to develop drought-tolerant Chinese cabbage varieties, thereby contributing to the stable production of this crucial crop.

Ogura male sterile cytoplasm is widely used for radish breeding. In this study, high-resolution melting (HRM) markers associated with Rft and Rfo, major restorer-of-fertility genes in Ogura cytoplasmic male sterility (CMS) in radish, were developed. Genetic mapping was carried out using F2 populations derived from crosses between male-sterile Ogura CMS lines and male-fertile lines. Identification of the Rft and Rfo loci was achieved through SNP-based genotyping and linkage grouping. HRM markers were subsequently developed based on flanking sequences of SNPs linked to these loci. For the Rft gene, a set of 117 SNPs was selected within a candidate region on chromosome 5, and 14 HRM markers were successfully developed. Genotyping of F2 showed high correlation between three markers and the phenotype. Regarding the Rfo gene, a set of 27 HRM markers was designed based on flanking sequences of SNPs located on chromosomes 9 and 0. Genotyping in the Rfo segregating population identified a single marker, RSRF27, that accurately distinguished the male sterility phenotype. Validation of the developed markers was performed in populations containing both Rft and Rfo genes, confirming their utility for genotyping and demonstrating that these two genes independently contribute to male sterility recovery. Overall, this study provides HRM markers that can be used for genotyping Rft and Rfo and contributes to a deeper understanding of male sterility restoration mechanisms in Ogura CMS.

The objective of this study was to investigate the effect of low-molecular-weight fish collagen (valine-glycine-proline-hydroxyproline-glycine-proline-alanine-glycine; LMWCP) on H2O2- or LPS-treated primary chondrocytes and monoiodoacetate (MIA)-induced osteoarthritis rat models. Our findings indicated that LMWCP treatment exhibited protective effects by preventing chondrocyte death and reducing matrix degradation in both H2O2-treated primary chondrocytes and cartilage tissue from MIA-induced osteoarthritis rats. This was achieved by increasing the levels of aggrecan, collagen type I, collagen type II, TIMP-1, and TIMP-3, while simultaneously decreasing catabolic factors such as phosphorylation of Smad, MMP-3, and MMP-13. Additionally, LMWCP treatment effectively suppressed the activation of inflammation and apoptosis pathways in both LPS-treated primary chondrocytes and cartilage tissue from MIA-induced osteoarthritis rats. These results suggest that LMWCP supplementation ameliorates the progression of osteoarthritis through its direct impact on inflammation and apoptosis in chondrocytes.

Plant structures exhibit complex behaviors through unique shape changes and movements closely related to moisture factors. When the plants absorb moisture, their inside has a higher tension than their outside, so the entire structure is folded to closure or opened. The principle and property could be applied to bio-inspired technology, which is the process of fusion mimicking the structure, function, metabolism, mechanism, and ecological system of those creatures adapted to their environments. In this study, we analyzed the functions and physical characteristics of environment-sensing plants to demonstrate the principles of plants with opening-and-closing and curling-and-uncurling mechanisms and to better understand these behavior principles. From a biological and ecological viewpoint, the target sensory and cognitive plants that respond to external humidity and vibration were found to undergo structural changes in the size of the xylem and the degree of adhesion of the leaf and stem, as well as the opening, closing, and curling of the external shapes of the plants. The phenomenon of external form changes based on the microstructural characteristics of plants showed a promising direction for addressing issues in existing technology, such as non-powered operation. Therefore, in this study, we presented a biomimetic humidification model that was biocompatible and reversible. Pinecone samples with the applied opening-and-closing mechanism were to apply these biological properties to biomimetics. The results provide biomimetic knowledge for understanding the functions of biological and ecological features underlying the morphological changes in humidity-sensing plants and plant bioacoustics. These bio-inspired plant resources could provide sustainable new-growth power and valuable scientific information for advancing the research and technological development of biomimetics.

Summary: Here, we describe detailed steps to constitute an in vitro assay for monitoring papain-like protease of coronavirus and a cell-based immunofluorescence infection assay. These assays can be adapted for high-throughput screening to determine the efficacy of novel protease inhibitors of coronaviruses and other viruses. In addition, cell-based immunofluorescence infection assay can be used to visually analyze antiviral efficacy of any novel compounds.For complete details on the use and execution of this protocol, please refer to Jeong et al. (2022).1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Background Human papillomavirus (HPV) infection is a major cause of cervical cancer and associated precursor lesions. Multiple HPV genotype infections have been reported. However, their clinicopathological characteristics still remain elusive. Methods For this study, 814 consecutive patients who had undergone colposcopy and HPV genotyping test using BD Onclarity HPV assay were retrospectively selected. Clinicopathological parameters of multiple HPV infections were compared with those of single HPV infection. Results Multiple HPV infections were found in 110 out of 814 cases (13.5%). Multiple HPV infections were associated with a significantly higher incidence of high-grade intraepithelial lesions (HSILs) compared with single HPV infection. Other high-risk HPV genotypes, in addition to HPV 16, were found more frequently in the multiple HPV infections group; these included HPV 51, 52, 33/58, 56/59/66, and 35/39/68. No specific coinfection pattern was not identified. Additionally, the number of HPV genotypes in multiple HPV infections was not associated with the progression to HSIL or squamous cell carcinoma. Conclusions Multiple HPV infections have distinct clinicopathological characteristics (compared with single HPV infection). As their biological behavior is uncertain, close and frequent follow-up is warranted.

Abstract Prior experiences of successful and failed treatments are known to influence the efficacy of a newly applied treatment. However, whether that carry-over effect applies to non-pharmacological treatments is unknown. This study investigated how a failed treatment history with placebo analgesic cream affected the therapeutic outcomes of cold-pack treatment. The neural correlates underlying those effects were also explored using functional magnetic resonance imaging. The effect of the placebo analgesic cream was induced using placebo conditioning with small (44.5 °C to 43.7 °C, negative experience) and large (44.5 °C to 40.0 °C, positive experience) thermal stimuli changes. After the placebo conditioning, brain responses and self-reported evaluations of the effect of subsequent treatment with a cold-pack were contrasted between the two groups. The negative experience group reported less pain and lower anxiety scores in the cold-pack condition than the positive experience group and exhibited significantly greater activation in the right inferior parietal lobule (IPL), which is known to be involved in pain relief. These findings suggest that an unsatisfying experience with an initial pain-relief treatment could increase the expectations for the complementary treatment outcome and improve the analgesic effect of the subsequent treatment. The IPL could be associated with this expectation-induced pain relief process.

Abstract Background This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among community-dwelling Korean older adults. Methods We used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried’s physical frailty phenotype was used to identify frailty. Results After adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8–40.78 vs. OR=9.89, 95% CI=4.28–22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67–19.56 vs. OR=3.19, 95% CI=1.17–8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93–3.98 vs. OR=2.49, 95% CI=1.66–3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28–7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in ‘using transportation’. Among men, pre-frailty was significantly associated with disability in “going out” and “shopping”. In women, frailty was significantly associated with disability in “doing laundry,” “performing household chores,” “shopping,” and “managing money”. Conclusions Physical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail.

Purpose To demonstrate that curriculum expertise required of prospective Korean teachers based on design thinking is needed for both the development and implementation of programs relevant to student needs. Methods The concepts and characteristics of design thinking, followed by its relevance to teacher education were explored. Then concepts and elements within the theory informing curriculum literacy were reviewed before articulating its value in professional development of Korean language teachers’ curriculum literacy. Results Based on theoretical considerations, a program that can enhance Korean language curriculum literacy according to the stages of design thinking was developed. Conclusion The results of this study suggest that preliminary Korean language teachers will be able to systematically develop the curriculum expertise required of teachers by participating in the Korean language curriculum literacy program of teacher training institutes.

Abstract For two-dimensional electron gas device applications, it is important to understand how electrical-transport properties are controlled by gate voltage. Here, we report gate voltage-controllable hysteresis in the resistance–temperature characteristics of two-dimensional electron gas at LaAlO3/SrTiO3 heterointerface. Electron channels made of the LaAlO3/SrTiO3 heterointerface showed hysteretic resistance–temperature behavior: the measured resistance was significantly higher during upward temperature sweeps in thermal cycling tests. Such hysteretic behavior was observed only after application of positive back-gate voltages below 50 K in the thermal cycle, and the magnitude of hysteresis increased with the applied back-gate voltage. To explain this gate-controlled resistance hysteresis, we propose a mechanism based on electron trapping at impurity sites, in conjunction with the strong temperature-dependent dielectric constant of the SrTiO3 substrate. Our model explains well the observed gate-controlled hysteresis of the resistance–temperature characteristics, and the mechanism should be also applicable to other SrTiO3-based oxide systems, paving the way to applications of oxide heterostructures to electronic devices.

Introduction: Understanding how different countries have responded to mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) transmission in dental offices is important. This article describes the different approaches taken towards optimal fallow periods in Canadian jurisdictions. Methods: We searched publicly available information from dentist and dental hygiene regulator websites across the 10 provinces and 3 territories in Canada. We also searched for guidance documents on dental associations’ websites or through personal communication with government officials. We extracted and tabulated information on fallow period recommendations or guidance, when available. Results: Nine jurisdictions (6 provinces and all 3 territories) acknowledge or provide guidance on fallow periods following aerosol-generating procedures. Among those who have provided guidance regarding a fallow period, recommendations follow the Centers for Disease Control and Prevention guidance if the air changes per hour (ACH) in the dental operatory is known. Conclusion: The evidence for deciding on optimal fallow period is limited and still being explored, resulting in substantial variation across Canadian jurisdictions. A focus on developing scientific evidence relevant to dentistry and assimilating existing science is crucial to establishing consistency and uniformity in information to deliver safe oral health care services.

The growing mental health concerns during COVID-19, particularly among rural residents, is a public health emergency. Rural residents are at an elevated risk, as rurality has been associated with various disparities, including lower accessibility to mental health services. Maryland Rural Opioid Technical Assistance (ROTA; Maryland Extension) aimed to address this issue by delivering evidence-based programs on opioid misuse and mental health to rural community members and practitioners throughout Maryland when the COVID-19 pandemic hit the U.S. and all research activities had to transition to the virtual setting. The current study provides an overview of the implementation process of the Mental Health First Aid (MHFA) program and reports the findings from the evaluation efforts. Participants (N = 398) completed a one-time online survey and answered open-ended questions, reporting high satisfaction rates and positive experiences with the virtual delivery of the program. Results suggested that the virtual format was still effective in program content delivery and that virtual delivery of evidence-based programs may be an opportune strategy to reach more rural residents. Recommendations for future research and practice efforts include building sustainable partnerships with local community organizations and considering rurality and prolonged-pandemic factors for effective program implementation.

Background Long‐term exposure to outdoor fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM2.5 increases individuals' mortality risk can clarify the PM2.5–mortality relationship and identify possible points of interventions. Recent evidence has linked PM2.5 to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM2.5 on mortality remains poorly understood. Methods and Results We conducted a population‐based cohort study to investigate how the effect of PM2.5 on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population‐based health surveys in Ontario, Canada, from 1996 to 2014. Follow‐up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM2.5 on mortality into a direct effect and several path‐specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual‐ and neighborhood‐level covariates, we estimated that for every 1000 adults, each 10 μg/m3 increase in PM2.5 was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM2.5‐related deaths, 31.7% (95% CI, 17.2%–53.2%) were attributable to diabetes and major cardiovascular events in relation to PM2.5. Specifically, 4.5% were explained by PM2.5‐induced diabetes, 22.8% by PM2.5‐induced major cardiovascular events, and 4.5% through their interaction. Conclusions This study suggests that a significant portion of the estimated effect of long‐term exposure to PM2.5 on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM2.5 on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.

Objective Mindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management. However, it is currently used to alleviate sleep disturbances. Therefore, this contemporary systematic review aimed to elucidate the clinical effects of MBSR on sleep quality and sleep-related daytime impairment in adults with sleep disturbances, including chronic insomnia disorders.Design Systematic review and meta-analysis of randomised controlled trials (RCTs).Methods A comprehensive search was conducted using the following databases: Ovid MEDLINE, AMED, Ovidembase, PsycINFO, Cochrane Library, CINAHL, and four domestic databases: KoreaMed, KISS, KMbase and NDSL. The final search update was performed in June 2022. Two researchers independently selected relevant studies, assessed the risk of bias and extracted the data.Results Of the 7516 records searched, 20 RCTs and 21 reports were included. In the subgroup analysis, MBSR did not improve objective or subjective sleep quality in chronic insomnia and cancers. However, MBSR versus waitlist control might have been effective in improving subjective sleep quality, but with substantial heterogeneity (standardised mean difference=−0.32; 95% CI: −0.56 to –0.08; I2=71%). In addition, MBSR compared with active control did not improve the sleep-related daytime impairments including depression, anxiety, stress, fatigue and quality of life. The overall risk of bias included in this review was a concern because of performance and detection bias.Conclusions MBSR might be ineffective for improving sleep quality in patients with chronic insomnia and cancers. In addition, more than half of the RCTs included in this review had small sample sizes and were vulnerable to performance and detection biases. Therefore, well-designed RCTs with larger sample sizes are required to confirm the clinical effects of MBSR in adults with sleep disturbances.PROSPERO registration number CRD42015027963.

Abstract Background Social and hospital environmental factors that may be associated with hospital-acquired pneumonia (HAP) have not been evaluated. Comprehensive risk assessment for the incidence of HAP including sociodemographic, clinical, and hospital environmental factors was conducted using national health insurance claims data. Methods This is a population-based retrospective cohort study of adult patients who were hospitalized for more than 3 days from the Health Insurance Review and Assessment Service-National Inpatient Sample data between January 1, 2016 and December 31, 2018 in South Korea. Multivariable logistic regression analyses were conducted to identify the factors associated with the incidence of HAP. Results Among the 512,278 hospitalizations, we identified 25,369 (5.0%) HAP cases. In multivariable analysis, well-known risk factors associated with HAP such as older age (over 70 vs. 20–29; adjusted odds ratio [aOR], 3.66; 95% confidence interval [CI] 3.36–3.99), male sex (aOR, 1.35; 95% CI 1.32–1.39), pre-existing lung diseases (asthma [aOR, 1.73; 95% CI 1.66–1.80]; chronic obstructive pulmonary disease [aOR, 1.62; 95% CI 1.53–1.71]; chronic lower airway disease [aOR, 1.79; 95% CI 1.73–1.85]), tube feeding (aOR, 3.32; 95% CI 3.16–3.50), suctioning (aOR, 2.34; 95% CI 2.23–2.47), positioning (aOR, 1.63; 95% CI 1.55–1.72), use of mechanical ventilation (aOR, 2.31; 95% CI 2.15–2.47), and intensive care unit admission (aOR, 1.29; 95% CI 1.22–1.36) were associated with the incidence of HAP. In addition, poverty (aOR, 1.08; 95% CI 1.04–1.13), general hospitals (aOR, 1.54; 95% CI 1.39–1.70), higher bed-to-nurse ratio (Grade ≥ 5; aOR, 1.45; 95% CI 1.32–1.59), higher number of beds per hospital room (6 beds; aOR, 3.08; 95% CI 2.77–3.42), and ward with caregiver (aOR, 1.19; 95% CI 1.12–1.26) were related to the incidence of HAP. Conclusions The incidence of HAP was associated with various sociodemographic, clinical, and hospital environmental factors. Thus, taking a comprehensive approach to prevent and treat HAP is important.

Objective The aim of this study was to assess the effects of dancing (using the Feldenkrais method) on motor and non-motor symptoms, quality of life (QoL), and objective parameters of gait at the time of intervention and at the end of the 1-year study period. Methods This was a single-arm study in which 12 subjects with Parkinson’s disease (PD) received dance intervention during a 6-month period. Objective motor scales, gait analysis, and questionnaires on non-motor symptoms were evaluated at baseline and at 3, 6, and 12 months. Results Dance intervention decreased motor scale (Unified Parkinson’s Disease Rating Scale and Tinetti scale) scores and improved gait disturbance (gait velocity and step length) without increasing levodopa equivalent dose. Furthermore, dancing decreased non-motor scale (Non-Motor Symptoms Scale and Montgomery-Asberg Depression Rating Scale) scores and improved QoL. Conclusion Our findings suggest that dance intervention can be a complementary management method for PD patients.

Abstract Background Urban health is a field of research and practice that has attracted the interest of various disciplines. While it is encouraged for diverse disciplines to contribute to a multidisciplinary field of study such as urban health, this often results in tensions, conflicts or competition between the different traditions that stem from different epistemological backgrounds. This meta-narrative review aims to identify and describe the multiple paradigms and articulate the underlying epistemological, ontological, methodological, and aetiological differences in their approaches. Articulating the paradigms not only contributes to the advancement of research, but also provides a framework for understanding the different policy beliefs and ideas policy actors hold and apply in the policy process. Methods We apply the meta-narrative method to systematic literature review which includes the following six iterative phases. The planning phase includes the finalisation of the review protocol and assembly of review team. The search phase includes a comprehensive literature search in key databases and a double-sided systematic snowballing method. We will search multidisciplinary databases including Web of Science, Scopus and ProQuest, and topic-specific databases including Urban Studies Abstracts (EBSCO), MEDLINE, and EMBASE from their inception onwards. Bibliometric analyses of this literature will be used to triangulate the mapping of the paradigms. The mapping phase includes identifying the dominant paradigms and landmark publications through agreement with the review team. In the appraisal phase, the literature will be assessed by their respective quality standards, followed by data extraction to identify the individual narratives in the conceptual, theoretical, methodological, and instrumental dimensions of each paradigm. The synthesis phase will review the data to compare and contrast and identify the overarching meta-narratives. The recommendation phase will include dissemination of the findings from the review. Discussion The meta-narrative review will reveal the how the different paradigms conceptualise, frame and prioritise urban health issues, their preferred methodologies to study the phenomenon, and the nature of the solutions to improve human health. This review will assist researchers and practitioners in understanding and interpreting evidence produced by other traditions that study urban health. Through this, urban health researchers and practitioners will be able to seek coherence in understanding, explaining, and exploring the urban health phenomenon. Systematic review registration Open Science Framework ( https://osf/io/tn8vk )

Abstract Alterations in time-varying functional connectivity (FC) have been found in Parkinson’s disease (PD) patients. To date, very little is known about the influence of sex on brain FC in PD patients and how this could be related to disease severity. The first objective was to evaluate the influence of sex on dynamic FC characteristics in PD patients and healthy controls (HC), while the second aim was to investigate the temporal patterns of dynamic connectivity related to PD motor and non-motor symptoms. Ninety-nine PD patients and sixty-two HC underwent a neuropsychological and clinical assessment. Rs-fMRI and T1-weighted MRI were also acquired. Dynamic FC analyses were performed in the GIFT toolbox. Dynamic FC analyses identified two States: State I, characterized by within-network positive coupling; and State II that showed between-network connectivity, mostly involving somatomotor and visual networks. Sex differences were found in dynamic indexes in HC but these differences were not observed in PD. Hierarchical clustering analysis identified three phenotypically distinct PD subgroups: (1) Subgroup A was characterized by mild motor symptoms; (2) Subgroup B was characterized by depressive and motor symptoms; (3) Subgroup C was characterized by cognitive and motor symptoms. Results revealed that changes in the temporal properties of connectivity were related to the motor/non-motor outcomes of PD severity. Findings suggest that while in HC sex differences may play a certain role in dynamic connectivity patterns, in PD patients, these effects may be overcome by the neurodegenerative process. Changes in the temporal properties of connectivity in PD were mainly related to the clinical markers of PD severity.

Background Despite the increasing number of older adults as the population ages, there is a lack of frailty prevention guidelines for community-dwelling older adults. The Korean Frailty and Aging Cohort Study conducted systematic review on contributors to frailty and developed guidelines on the primary prevention of frailty in community-dwelling older adults. Methods This study updated a previous systematic review of contributors to frailty by adding the most recent articles. Based on this updated systematic review, experts in geriatrics and gerontology developed guidelines for preventing frailty using the Delphi method. Results These guidelines categorized the recommendations into physical activity, resilience, oral health, management of non-communicable diseases, involvement in society, smoking cessation, and eating various kinds of food. Conclusion Unlike previous frailty-related guidelines, this study developed evidence-based frailty prevention guidelines based on a systematic review. The guidelines are expected to contribute to the healthy aging of community-dwelling older adults by the primary prevention of frailty.

Abstract Catastrophic earthquakes stimulate information-seeking behaviors beyond the affected geographical boundaries; however, our understanding of the dynamics of global public interest in earthquakes remains limited. Herein, we harness Big Data to examine the dynamic patterns of global public interest, concerning 17 significant worldwide earthquakes over 2004–2019. We find that the global community shows a higher level of interest when an earthquake occurs in developed countries than in developing countries; however, they lose their interest in the former more rapidly than the latter. Regardless of the affected nation, there is a one- to two-week “golden” time window when attention can be leveraged for fundraising and humanitarian aid. Our findings suggest that European citizens who are highly interested in earthquakes emerge as a potential key community to achieve great inclusiveness in policy interventions to solicit international aid. The findings of this study hint at how Big Data can be utilized to identify “time windows of opportunities” for international humanitarian organizations to efficiently raise donations, charities, and aid resources around the world.

Objective The Four Square Step Test (FSST) is a tool that assesses dynamic balance during obstacle step-over. To date, few studies have used the FSST to measure balance in patients with Parkinson’s disease (PD). This study aimed to verify that patients with PD, even at the de novo early stage, take more time to perform the FSST and identify which factors, cognitive status or cardinal motor symptoms, are related most to FSST scores. Methods Thirty-five newly diagnosed drug-naïve patients with PD and 17 controls completed the FSST. The Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) stage, spatiotemporal gait parameters, and neuropsychological test battery were also assessed in the PD group. Results Mean FSST performance time was 8.20 ± 1.61 seconds in patients with PD, which was significantly more than the control group (7.13 ± 1.10 seconds, p = 0.018). UPDRS part III total score and H&Y stage were not significantly associated with FSST, but among the UPDRS subscores, only the postural instability/gait disturbance subscore showed a significant association. Regarding the association between FSST and cognition, the Trail Making Test-B and the Color Word Stroop Test showed strongly inverse correlations with FSST (rho = -0.598 and -0.590, respectively). With respect to gait parameters, double support time was significantly associated with FSST score (rho = 0.342, p = 0.044); however, other parameters, including velocity and step length, were not associated with the FSST. Conclusion The FSST can be used in the clinic to assess dynamic balance with cognitive demands even in the early stages of PD.

Summary: The papain-like protease (PLpro) of coronaviruses is an attractive antiviral target to inhibit both viral replication and interference of the host immune response. We have identified and characterized three novel classes of small molecules, thiophene, cyanofuran, and triazoloquinazoline, as PLpro inhibitors. Thiophene inhibited the PLpro of two major coronaviruses, Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) including SARS-CoV-2, while cyanofuran and triazoloquinazoline more selectively inhibited MERS-CoV PLpro. Unlike GRL0617, a known PLpro inhibitor, all three compounds contain no naphthyl group but like GRL0617 were predicted to fit on the cleft near the BL2 loop. Docking studies further revealed that the location and direction of the binding determined their specificity to different coronaviruses. Together, our work demonstrates that the BL2 loop and nearby regions are outstanding druggable targets, and our three inhibitors can be applicable to the development of therapeutics for coronavirus infection.

Cognitive impairment may be commonly accompanied by gait disturbance in patients with Parkinson’s disease (PD). However, it is still controversial whether gait disturbance is associated with mild cognitive impairment (MCI) and which cognitive function has a more important effect on specific gait parameter. Our objective was to investigate the association of gait parameters with MCI and the correlation between performance on comprehensive neuropsychological tests and gait parameters in PD patients. We enrolled 257 patients with de novo PD (111 PD-normal cognition and 146 PD-MCI). All patients underwent comprehensive neuropsychological tests and gait evaluation using the GAITRite system. We used logistic regression analysis and partial correlation to identify the association between gait parameters and MCI and correlations between neuropsychological performance and gait parameters. Gait velocity (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.97−0.99) and stride length (OR = 0.98; 95% CI = 0.97−0.99) were associated with MCI in patients with PD. Specifically, gait velocity, stride length, and double support ratio were only associated with attention and frontal-executive function performance in patients with PD. Our findings provide insight into the relationship between gait disturbance and MCI in patients with PD. Furthermore, the evaluation of gait disturbance is necessary for PD patients with cognitive impairment.

Background Locoregional stem cell delivery is very important for increasing the efficiency of cell therapy. Amnisite BA (Amnisite) is a freeze-dried amniotic membrane harvested from bovine placenta. The objective of this study was to investigate the retention of cells of the stromal vascular fraction (SVF) on Amnisite and to determine the effects of cell-loaded Amnisite in a porcine radiation-induced chronic wound model. Methods Initially, experiments were conducted to find the most suitable hydration and incubation conditions for the attachment of SVF cells extracted from pig fat to Amnisite. Before seeding, SVFs were labeled with PKH67. The SVF cell-loaded Amnisite (group S), Amnisite only (group A), and polyurethane foam (group C) were applied to treat radiation-induced chronic wounds in a porcine model. Biopsy was performed at 10, 14, and 21 days post-operation for histological analysis. Results Retaining the SVF on Amnisite required 30 minutes for hydration and 1 hour for incubation. A PKH67 fluorescence study showed that Amnisite successfully delivered the SVF to the wounds. In histological analysis, group S showed increased re-epithelialization and revascularization with decreased inflammation at 10 days post-operation. Conclusions SVFs had acceptable adherence on hydrated Amnisite, with successful cell delivery to a radiation-induced chronic wound model.

Abstract Background Lactobacillus rhamnosus GG (LGG) is the most widely used probiotic, but the mechanisms underlying its beneficial effects remain unresolved. Previous studies typically inoculated LGG in hosts with established gut microbiota, limiting the understanding of specific impacts of LGG on host due to numerous interactions among LGG, commensal microbes, and the host. There has been a scarcity of studies that used gnotobiotic animals to elucidate LGG-host interaction, in particular for gaining specific insights about how it modifies the metabolome. To evaluate whether LGG affects the metabolite output of pathobionts, we inoculated with LGG gnotobiotic mice containing Propionibacterium acnes, Turicibacter sanguinis, and Staphylococcus aureus (PTS). Results 16S rRNA sequencing of fecal samples by Ion Torrent and MinION platforms showed colonization of germ-free mice by PTS or by PTS plus LGG (LTS). Although the body weights and feeding rates of mice remained similar between PTS and LTS groups, co-associating LGG with PTS led to a pronounced reduction in abundance of P. acnes in the gut. Addition of LGG or its secretome inhibited P. acnes growth in culture. After optimizing procedures for fecal metabolite extraction and metabolomic liquid chromatography-mass spectrometry analysis, unsupervised and supervised multivariate analyses revealed a distinct separation among fecal metabolites of PTS, LTS, and germ-free groups. Variables-important-in-projection scores showed that LGG colonization robustly diminished guanine, ornitihine, and sorbitol while significantly elevating acetylated amino acids, ribitol, indolelactic acid, and histamine. In addition, carnitine, betaine, and glutamate increased while thymidine, quinic acid and biotin were reduced in both PTS and LTS groups. Furthermore, LGG association reduced intestinal mucosal expression levels of inflammatory cytokines, such as IL-1α, IL-1β and TNF-α. Conclusions LGG co-association had a negative impact on colonization of P. acnes, and markedly altered the metabolic output and inflammatory response elicited by pathobionts.

Purpose The purpose of this study is to investigate gender perception of eSports gamers. Methods 8 male gamers in the professional team were selected purposeful and snowball sampling. Data were collected through face-to-face and online interviews, and analyzed by content analysis and classification analysis. Results Esport gamers explained their indirect experiences with female gamers. The results are as follows. First, it was confirmed that the number of female gamers was small and they had a negative stigma image, and this consistently reproduced the gender role stereotype of female gamers in digital games. Second, in the game world, men are swearing, verbal abuse, and sexual harassment against female gamers, which suggests that female gamers are viewed as targets of sexual play from the perspective of the strongest. Third, eSports male gamers are characterized by being conservative or open to gender perceptions by age. We discussed what to need in eSports which is male dominated area should give to opportunity for equality education. Conclusions In-depth understanding of gender perception in e-sports players should be prioritized in order to change gender perception. Therefore, it would be an important research topic bring to discuss. This paper is expected to be a beneficial material for eSports gender studies and stimulate to discuss gender imbalance.

Background: Preclinical evidence suggests that increasing levels of the major endocannabinoid anandamide decreases anxiety and fear responses potentially through its effects in the amygdala. Here we used neuroimaging to test the hypothesis that lower fatty acid amide hydrolase (FAAH), the main catabolic enzyme for anandamide, is associated with a blunted amygdala response to threat. Methods: Twenty-eight healthy participants completed a positron emission tomography (PET) scan with the radiotracer for FAAH, [11C]CURB, as well as a block-design functional magnetic resonance imaging session during which angry and fearful faces meant to activate the amygdala were presented. Results: [11C]CURB binding in the amygdala as well as in the medial prefrontal cortex, cingulate and hippocampus correlated positively with blood-oxygen-level-dependent (BOLD) signal during processing of angry and fearful faces (pFWE < 0.05). Conclusion: Our finding that lower levels of FAAH in amygdala, medial prefrontal cortex, cingulate and hippocampus was associated with a dampened amygdala response to a threatening social cue aligns with preclinical and neuroimaging studies in humans and suggests the involvement of FAAH in modulating stress and anxiety in humans. The current neuroimaging study also lends support for the potential use of FAAH inhibitors to control amygdala hyperactivity, which is known to be involved in the pathophysiology of anxiety and trauma-related disorders.

Magnetic anisotropy strongly influences the performance of the magnetocaloric effect. We investigated the magnetocaloric properties of the NdAlGe single crystal with I41md structure. The temperature-dependent magnetization revealed significant anisotropic properties; stable antiferromagnetic transition at TN = 6 K for H//a and meta-magnetic spin reorientation at low temperature (T ≤ 5 K) within an intermediate field (H = 2 T) for H//c. During the metamagnetic spin reorientation, the abrupt change of the magnetic entropy leads to a significant magnetocaloric effect with negative magnetic entropy change (∆SM) by −13.80 J kg−1 K−1 at TC = 5.5 K for H = 5 T along the H//c axis. In addition, the antiferromagnetic state for H//a shows the inverse magnetocaloric effect(I-MCE) by positive entropy change ∆SM = 2.64 J kg−1 K−1 at TN = 6 K for H = 5 T. This giant MCE accompanied by the metamagnetic transition resulted in a significantly large relative cooling power (158 J/kg at H = 5 T) for H//c. The giant MCE and I-MCE can be applied to the rotational magnetocaloric effect (R-MCE) depending on the crystal orientations. NdAlGe exhibits rotational entropy change ∆Sc−a = −12.85 J kg−1 K at Tpeak = 7.5 K, H = 5 T. With comparison to conventional MCE materials, NdAlGe is suggested as promising candidate of R-MCE, which is a novel type of magnetic refrigeration system.

Background and objectives: Telomerase reverse transcriptase (TERT) promoter mutation, found in a subset of patients with thyroid cancer, is strongly associated with aggressive biologic behavior. Predicting TERT promoter mutation is thus necessary for the prognostic stratification of thyroid cancer patients. Materials and Methods: In this study, we evaluate TERT promoter mutation status in thyroid cancer through the deep learning approach using histologic images. Our analysis included 13 consecutive surgically resected thyroid cancers with TERT promoter mutations (either C228T or C250T) and 12 randomly selected surgically resected thyroid cancers with a wild-type TERT promoter. Our deep learning model was created using a two-step cascade approach. First, tumor areas were identified using convolutional neural networks (CNNs), and then TERT promoter mutations within tumor areas were predicted using the CNN–recurrent neural network (CRNN) model. Results: Using the hue–saturation–value (HSV)-strong color transformation scheme, the overall experiment results show 99.9% sensitivity and 60% specificity (improvements of approximately 25% and 37%, respectively, compared to image normalization as a baseline model) in predicting TERT mutations. Conclusions: Highly sensitive screening for TERT promoter mutations is possible using histologic image analysis based on deep learning. This approach will help improve the classification of thyroid cancer patients according to the biologic behavior of tumors.

Abstract The advancement of artificial intelligence (AI) has facilitated its application in medical fields. However, there has been little research for AI-assisted endoscopy, despite the clinical significance of the efficiency and safety of cannulation in the endoscopic retrograde cholangiopancreatography (ERCP). In this study, we aim to assist endoscopists performing ERCP through automatic detection of the ampulla and the identification of cannulation difficulty. We developed a novel AI-assisted system based on convolutional neural networks that predict the location of the ampulla and the difficulty of cannulation to the ampulla. ERCP data of 531 and 451 patients were utilized in the evaluation of our model for each task. Our model detected the ampulla with mean intersection-over-union 64.1%, precision 76.2%, recall 78.4%, and centroid distance 0.021. In classifying the cannulation difficulty, it achieved the recall of 71.9% for the class of easy cases and that of 61.1% for that of difficult cases. Remarkably, our model accurately detected AOV with varying morphological shape, size, and texture on par with the level of a human expert and showed promising results for recognizing cannulation difficulty. It demonstrated its potential to improve the quality of ERCP by assisting endoscopists.

Moving beyond the direct support all alone by a human teacher or an Artificial Intelligence (AI) system, optimizing the complementary strengths of the two has aroused great expectations and educational innovation potential. Yet, the conceptual guidance of how best to structure and implement teacher-AI collaboration (TAC) while ensuring teachers' instructional roles to support students learning remains limited. This study, therefore, aims what (1) curriculum, (2) teacher-AI interaction, (3) learning environment would be required as well as how TAC would evolve by reflecting teachers' views. Through in-depth interviews with 20 Chinese leading teachers in AI in Education (AIED), the study found that teachers aimed to improve students' subject-matter knowledge and build their capacity as the desired goals for TAC and these can be carried out by data-driven problem-based learning and case-based reasoning in tandem with growth-focused and reflective assessment. While teachers highlighted that developing teachers' data literacy and collegiality with AI are essential, they expected AI to be equipped with Technological Pedagogical and Content Knowledge (TPACK) knowledge and conflict resolution skills. In addition, teachers expressed that Internet of Things (IoT)-based classrooms, systematic AIED curriculum, school-based continuing professional development, research-practice-policy partnerships as well as creating a continuous learning and AI-ready culture are significant. Furthermore, teachers envision TAC would develop into three stages: (1) teachers as passive AI recipients, (2) teachers as active AI users (3) teachers-AI as constructive partners. These findings build a more holistic and in-depth understanding of the AIED and offer implications for the educational AI design and teachers' education.

Infectious diseases and stroke are common and a great health problem worldwide. However, relatively few studies have focused on direct infectious causes of acute stroke, and the exact mechanisms of acute stroke associated with infections are poorly understood. Herein, we present several infectious organisms that are probable causes of stroke. Different pathomechanisms of stroke and neuroimaging features of infection by these organisms are discussed. Specifically, the distribution of cerebral infarction suggests that infections could be a direct cause of acute stroke. These include cerebral convexity probably due to vasculitis in bacterial meningitis, deep infarcts due to endarteritis and inflammation in neurocysticercosis, and exudates in tuberculous meningitis, as well as hemodynamic borderzone infarct due to large vessel vasculitis by direct invasion of fungal infection. We suggest that prompt and appropriate control of these organisms could prevent ischemic stroke.

Automated driving technologies have advanced remarkably and are expected to be a part of our lives soon. Because automated driving technology does not require a driver, a significant change in future mobility services is expected. Automated driving technology is closely related to the development of public transit services as it can significantly reduce driver labor costs and provide a more comfortable in-vehicle environment. In particular, the preference for automated mobility-on-demand services that can respond in real time to the dynamic demand through automated driving technology is growing. Previous studies have compared passengers’ preferences for automated mobility-on-demand services and other transportation modes and proposed a way to enable more passengers to use automated mobility-on-demand services. However, as the number of pilot operations increases, future research will focus on ways to improve competitiveness among automated mobility-on-demand services. This study conducts a passenger preference survey based on the characteristics of automated mobility-on-demand services. In particular, changes in the in-vehicle environment and seat selection system, which differ from existing mobility-on-demand services due to automated driving technology, are investigated. The latent class modeling approach is used to classify passengers based on stated preference data collected from the survey. The estimation results show that vehicle type and seat choice system have a significant impact on passengers’ preference for automated mobility-on-demand services. In addition, considering that a high percentage of passengers do not prefer to improve autonomy in seat reservation and the in-vehicle environment, this study suggests that cost-consuming service improvement strategies are not always appropriate.

Deep learning approaches are widely employed for forecasting short-term travel demand to respond to real-time demand. Although it is critical for demand forecasting to be evenly distributed in the spatial and temporal views to support real-time mobility service operations, in related studies, the predictive performance of models has been evaluated only in terms of aggregated errors. Therefore, the present study was conducted to investigate the distribution of errors to explore spatiotemporal correlations. Six deep learning models with the same architecture, except for the base module, consisting of three stacked layers, were constructed. These models were used to forecast demands for a station-based bike-sharing service in Seoul, South Korea. To attain our goals, global and local Moran’s I of the errors was introduced to evaluate the spatial and temporal performances of the deep learning approaches. The results showed that the model with convolutional long short-term memory layers, which are effective at predicting spatiotemporal data, outperformed the other models in terms of aggregated performance. However, the global Moran’s I of the errors in the model reflects spatial dependency over the regions. This suggests that the best predictive performance of the model does not necessarily imply that it performs well in demand forecasting in all regions. Furthermore, cluster and outlier analyses of the errors indicated that excessive or insufficient predictions were clustered or dispersed throughout the regions. These results can be used to enhance the model by introducing the spatial correlation index into the loss function or by incorporating additional features for handling spatial correlations.

Abstract Purpose Certain types of repetitive sub‐maximal knee loading cause microfatigue damage in the human anterior cruciate ligament (ACL) that can accumulate to produce macroscopic tissue failure. However, monitoring the progression of that ACL microfatigue damage as a function of loading cycles has not been reported. To explore the fatigue process, a confocal laser endomicroscope (CLEM) was employed to capture sub‐micron resolution fluorescence images of the tissue in situ. The goal of this study was to quantify the in situ changes in ACL autofluorescence (AF) signal intensity and collagen microstructure as a function of the number of loading cycles. Methods Three paired and four single cadaveric knees were subjected to a repeated 4 times bodyweight landing maneuver known to strain the ACL. The paired knees were used to compare the development of ACL microfatigue damage on the loaded knee after 100 consecutive loading cycles, relative to the contralateral unloaded control knee, through second harmonic generation (SHG) and AF imaging using confocal microscopy (CM). The four single knees were used for monitoring progressive ACL microfatigue damage development by AF imaging using CLEM. Results The loaded knees from each pair exhibited a statistically significant increase in AF signal intensity and decrease in SHG signal intensity as compared to the contralateral control knees. Additionally, the anisotropy of the collagen fibers in the loaded knees increased as indicated by the reduced coherency coefficient. Two out of the four single knee ACLs failed during fatigue loading, and they exhibited an order of magnitude higher increase in autofluorescence intensity per loading cycle as compared to the intact knees. Of the three regions of the ACL ‐ proximal, midsubstance and distal ‐ the proximal region of ACL fibers exhibited the highest AF intensity change and anisotropy of fibers. Conclusions CLEM can capture changes in ACL AF and collagen microstructures in situ during and after microfatigue damage development. Results suggest a large increase in AF may occur in the final few cycles immediately prior to or at failure, representing a greater plastic deformation of the tissue. This reinforces the argument that existing microfatigue damage can accumulate to induce bulk mechanical failure in ACL injuries. The variation in fiber organization changes in the ACL regions with application of load is consistent with the known differences in loading distribution at the ACL femoral enthesis.

Purpose It is necessary to identify factors that influence nurses’ intention to care for coronavirus disease 2019 (COVID-19) patients to improve the quality of care during the pandemic. This study identifies factors that influence nurses’ intention to care for COVID-19 patients, focusing on positive psychological capital and nursing professionalism. Methods This study adopted a descriptive correlational design. Data were collected between August 16 and August 30, 2020, through self-administered questionnaires from 148 bedside nurses caring for COVID-19 patients, from four hospitals designated for COVID-19 treatment. Modified versions of the Nursing Intention Questionnaire for SARS Patient Care, Psychological Capital Questionnaire, and Hall’s Professional Inventory were used. The collected data were analyzed using stepwise multiple regression. Results In total, 165 questionnaires were distributed, and 148 questionnaires (89.7%) were included in the final analysis. Factors influencing nurses’ intention to care were: age (30Conclusions Strategies to increase nurses’ positive psychological capital are necessary to improve nursing care quality by increasing intention to care when facing novel infectious diseases such as COVID-19. Furthermore, adequate education and training on managing novel infectious diseases should be implemented to provide nurses with relevant experience and skills regarding caring for patients infected with these diseases. Through various studies, strategies for improving nurses’ positive psychological capital need to be suggested to improve the quality of care by increasing the nurses’ intention to care during the emergence of a novel infectious disease, such as COVID-19. Additionally, adequate education and training on managing the novel infectious diseases, sufficient for the nurses to believe they have the experience and skills for caring for the infected patients, will be needed.

Presently, human papillomavirus (HPV)-based cervical cancer screening is commonly used and is replacing conventional cytology screening tests. The HPV genotyping assay is useful for triage in cervical cancer screening and the evaluation of HPV vaccination effects. In this study, we evaluated the clinical performance of two HPV genotyping assays, BD Onclarity HPV (Onclarity) and Seegene Anyplex II HPV28 (Anyplex) in the detection of relevant cervical lesions and for HPV genotyping concordance. Anyplex and Onclarity assays were performed on 920 consecutive liquid-based specimens. Anyplex, sensitivity, specificity, and genotyping concordance with Onclarity were optimal when restricted to ≥2+ (medium) viral loads. HPV genotyping agreement between the two assays ranged between 0.75 and 0.9 (excellent), except for HPV 33/58, which was 0.73 (good). With Onclarity as a reference, the relative sensitivity of Anyplex for the detection of ≥CIN 2 was 1.05 (95% CI: 0.99-1.1) and the relative specificity for detection of negative for intraepithelial lesion and malignancy (NILM) was 0.89 (95% CI: 0.85-0.93). For most ≥CIN 2 lesions, high-risk HPV was detected by Onclarity (66/72) and Anyplex (69/72) assays. For high-risk HPV negative ≥CIN 2 lesions, possible high-risk HPV genotypes were detected by Anyplex. In conclusion, the genotyping agreement between the tests was good to excellent. Full genotyping with Anyplex might confer additional benefits to patients with ≥CIN 2, although the difference is small. We also suggest an optimal cutoff value when reporting HPV infections using the Anyplex assay (≥2+; medium viral loads).

Abstract Background Quantifying the potential cancer cases associated with environmental carcinogen exposure can help inform efforts to improve population health. This study developed an approach to estimate the environmental burden of cancer and applied it to Ontario, Canada. The purpose was to identify environmental carcinogens with the greatest impact on cancer burden to support evidence-based decision making. Methods We conducted a probabilistic assessment of the environmental burden of cancer in Ontario. We selected 23 carcinogens that we defined as “environmental” (e.g., pollutants) and were relevant to the province, based on select classifications provided by the International Agency for Research on Cancer. We evaluated population exposure to the carcinogens through inhalation of indoor/outdoor air; ingestion of food, water, and dust; and exposure to radiation. We obtained or calculated concentration-response functions relating carcinogen exposure and the risk of developing cancer. Using both human health risk assessment and population attributable fraction models in a Monte Carlo simulation, we estimated the annual cancer cases associated with each environmental carcinogen, reporting the simulation summary (e.g., mean and percentiles). Results We estimated between 3540 and 6510 annual cancer cases attributable to exposure to 23 environmental carcinogens in Ontario. Three carcinogens were responsible for over 90% of the environmental burden of cancer: solar ultraviolet (UV) radiation, radon in homes, and fine particulate matter (PM2.5) in outdoor air. Eight other carcinogens had an estimated mean burden of at least 10 annual cancer cases: acrylamide, arsenic, asbestos, chromium, diesel engine exhaust particulate matter, dioxins, formaldehyde, and second-hand smoke. The remaining 12 carcinogens had an estimated mean burden of less than 10 annual cancer cases in Ontario. Conclusions We found the environmental burden of cancer in Ontario to fall between previously estimated burdens of alcohol and tobacco use. These results allow for a comparative assessment across carcinogens and offer insights into strategies to reduce the environmental burden of cancer. Our analysis could be adopted by other jurisdictions and repeated in the future for Ontario to track progress in reducing cancer burden, assess newly classified environmental carcinogens, and identify top burden contributors.

Purpose Highly popular these days, eSport is inviting increasing scholarly attention and research. Scholarly work on eSport, however, remains focused on whether eSport is a “real” sport, that is, its sporting qualities and status, excluding ethical issues. This paper analyzes ethical issues about cognitive enhancement drugs often associated with eSport in order to suggest guidelines for resolving these issues. Methods First, environmental features of eSport are examined to find out types of cheating in eSport, as well as the ways eSport athletes are exposed to drugs. Next, ethical issues of cognitive enhancement drug use and why they are important are discussed, drawing upon multiple scholars. Last, this paper argues that the ban on drug use conventionally implemented in sport is not appropriate to eSport due to the characteristics of eSport. The paper concludes with possible future approaches to this issue. Results The ban lists administered by ESIC and WADA would not work for the need of eSport athletes and even run a risk of stunting the growth of eSport industries. It is thus important to think up an appropriate drug-related policy for eSport. Preemptive education for eSport athletes is also required to promote the ethical consciousness and judgment regarding drug use. Conclusions Insofar as eSport’s huge popularity leads to the increased status of eSport athletes, thereby exerting much influence on young people, ethical questions about eSport, drug use in particular, need to be urgently discussed for the sake of eSport’s wholesome development.

Objectives This study aimed to evaluate the association between dental implants and cognitive function in community-dwelling older adults. Methods Data were collected from the baseline survey (2016-2017) of the Korean Frailty and Aging Cohort Study. The study sample comprised 1115 community-dwelling people aged 70 years to 84 years who had 0-19 natural teeth. Dental implants and natural teeth were identified by panoramic radiography, while the cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The association between dental implants and cognitive function was analyzed by multiple linear regression. Sensitivity analysis was performed to test for potential bias. Results The mean number of natural teeth in the study population was 9.50 (standard deviation [SD], 6.42), and the mean MMSE-KC score was 24.93 (SD, 3.55). In the simple univariate analysis, tooth replacement, age, sex, smoking status, alcohol consumption, body mass index, osteoporosis, number of natural teeth, periodontitis, chewing discomfort, tooth-brushing frequency, education level, monthly household income, participation in economic activity, living alone, and marital status had a significant impact on the association. After adjusting for confounders, the association between dental implants and cognitive function remained significant (B, 0.85; standard error, 0.40; p

Strawberry is an allo-octoploid crop with high genome heterozygosity and complexity, which hinders the sequencing and the assembly of the genome. However, in the present study, we have generated a chromosome level assembly of octoploid strawberry sourced from a highly homozygous inbred line ‘Wongyo 3115’, using long- and short-read sequencing technologies. The assembly of ‘Wongyo 3115’ produced 805.6 Mb of the genome with 323 contigs scaffolded into 208 scaffolds with an N50 of 27.3 Mb after further gap filling. The whole genome annotation resulted in 151,892 genes with a gene density of 188.52 (genes/Mb) and validation of a genome, using BUSCO analysis resulted in 94.10% complete BUSCOs. Firmness is one of the vital traits in strawberry, which facilitate the postharvest shelf-life qualities. The molecular and genetic mechanisms that contribute the firmness in strawberry remain unclear. We have constructed a high-density genetic map based on the ‘Wongyo 3115’ reference genome to identify loci associated with firmness in the present study. For the quantitative trait locus (QTL) identification, the ‘BS F2’ populations developed from two inbred lines were genotyped, using an Axiom 35K strawberry chip, and marker positions were analyzed based on the ‘Wongyo 3115’ genome. Genetic maps were constructed with 1,049 bin markers, spanning the 3,861 cM. Using firmness data of ‘BS F2’ obtained from 2 consecutive years, five QTLs were identified on chromosomes 3-3, 5-1, 6-1, and 6-4. Furthermore, we predicted the candidate genes associated with firmness in strawberries by utilizing transcriptome data and QTL information. Overall, we present the chromosome-level assembly and annotation of a homozygous octoploid strawberry inbred line and a linkage map constructed to identify QTLs associated with fruit firmness.