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Compounding hazards are becoming more common due to global environmental change. To build societal resilience, there is a need to focus on how people are made vulnerable by our social, political, and economic systems that turn hazards into disasters. Incremental adaptation, often piecemeal and hazard-specific actions, will be insufficient for keeping pace with the rapid global environmental changes already underway. Instead, transformative adaptation is necessary for meeting this need, although the pathways for how to create transformative as opposed to incremental change through individual action and social systems are challenging. These challenges for climate adaptation are on display in rural American Indian Tribal Nations, including the Tule River Indian Reservation, the site of this co-produced research. The Reservation is rural and isolated, and many of the 2000 members manage chronic health conditions like diabetes alongside increasing wildfire and wildfire smoke, extreme heat, drought, and flooding hazards. We ask: how do emergency managers and health practitioners on the Reservation characterize hazards and the vulnerabilities of the people they serve, and how do these understandings determine viable pathways for adaptation to support community health? We interviewed 16 practitioners with expertise in emergency management and health care services on the Tule River Indian Reservation. Using a grounded theory approach to analyze practitioner interviews, our article makes two major contributions. First, we identify a conceptual framework by which practitioners connect people to each other and to place, from place to compounding hazards, and from vulnerabilities to hazard management strategies. Second, our conceptual framework illustrates the incremental-transformative adaptation tension. Most adaptation strategies under consideration or implemented are incremental in nature and hazard-specific. Yet, we demonstrate how action at earlier points in the framework could promise transformative adaptation, addressing the disconnection between people, place, and infrastructure in ways that incremental adaptation actions cannot.

Abstract Background Preoperative (chemo)radiotherapy has been widely used as an effective treatment for locally advanced rectal cancer (LARC), leading to a significant reduction in pelvic recurrence rates. Because early administration of intensive chemotherapy for LARC has more advantages than adjuvant chemotherapy, total neoadjuvant therapy (TNT) has been introduced and evaluated to determine whether it can improve tumor response or treatment outcomes. This study aims to investigate whether short-course radiotherapy (SCRT) followed by intensive chemotherapy improves oncologic outcomes compared with traditional preoperative long-course chemoradiotherapy (CRT). Methods A multicenter randomized phase II trial involving 364 patients with LARC (cT3–4, cN+, or presence of extramural vascular invasion) will be conducted. Patients will be randomly assigned to the experimental or control arm at a ratio of 1:1. Participants in the experimental arm will receive SCRT (25 Gy in 5 fractions, daily) followed by four cycles of FOLFOX (oxaliplatin, 5-fluorouracil, and folinic acid) as a neoadjuvant treatment, and those in the control arm will receive conventional radiotherapy (45–50.4 Gy in 25–28 fractions, 5 times a week) concurrently with capecitabine or 5-fluorouracil. As a mandatory surgical procedure, total mesorectal excision will be performed 2–5 weeks from the last cycle of chemotherapy in the experimental arm and 6–8 weeks after the last day of radiotherapy in the control arm. The primary endpoint is 3-year disease-free survival, and the secondary endpoints are tumor response, overall survival, toxicities, quality of life, and cost-effectiveness. Discussion This is the first Korean randomized controlled study comparing SCRT-based TNT with traditional preoperative LC-CRT for LARC. The involvement of experienced colorectal surgeons ensures high-quality surgical resection. SCRT followed by FOLFOX chemotherapy is expected to improve disease-free survival compared with CRT, with potential advantages in tumor response, quality of life, and cost-effectiveness. Trial registration This trial is registered at Clinical Research Information under the identifier Service KCT0004874 on April 02, 2020, and at Clinicaltrial.gov under the identifier NCT05673772 on January 06, 2023.

In this study, we have developed an amplifier waveguide module suitable for broadband communication in the sub-THz band. To achieve a waveguide module with excellent gain flatness characteristics, the effects of errors during the packaging procedures of the waveguide module and the space occupied by the bondwire were analyzed through an electromagnetic simulation. Furthermore, a photonics-based sub-THz wireless link with a carrier frequency of 288 GHz was established using a packaged amplifier module. The amplifier module was placed at the output of the sub-THz transmitter based on a uni-traveling-carrier photodiode and at the input of the sub-THz receiver. The maximum gain and 3 dB bandwidth of the amplifier module are 17.3 dB and 39 GHz, respectively. With this setup, we successfully transmitted a 100-Gbps 16-QAM modulated signal, employing a carrier frequency of 288 GHz, across a wireless distance of 100 m.

Purpose To investigate whether CT-based tumor regression grade (ctTRG) can be used to predict the response to neoadjuvant chemotherapy (NAC) in colon cancer. Materials and Methods A total of 53 patients were enrolled. Two radiologists independently assessed the ctTRG using the length, thickness, layer pattern, and luminal and extraluminal appearance of the tumor. Changes in tumor volume were also analyzed using the 3D Slicer software. We evaluated the association between pathologic TRG (pTRG) and ctTRG. Patients with Rödel’s TRG of 2, 3, or 4 were classified as responders. In terms of predicting responder and pathologic complete remission (pCR), receiver operating characteristic was compared between ctTRG and tumor volume change. Results There was a moderate correlation between ctTRG and pTRG (ρ = -0.540, p < 0.001), and the interobserver agreement was substantial (weighted к = 0.672). In the prediction of responder, there was no significant difference between ctTRG and volumetry (Az = 0.749, criterion: ctTRG ≤ 3 for ct- TRG, Az = 0.794, criterion: ≤ -27.1% for volume, p = 0.53). Moreover, there was no significant difference between the two methods in predicting pCR (p = 0.447). Conclusion ctTRG might predict the response to NAC in colon cancer. The diagnostic performance of ctTRG was comparable to that of CT volumetry.

We demonstrate the transmission of uncompressed 4K videos over the photonics-based terahertz (THz) wireless link using a directly modulated distributed feedback laser diode (DFB-LD). For optical heterodyne mixing and data modulation, a DFB-LD was employed and directly modulated with a 5.94-Gb/s non-return-to-zero signal, which is related to a 6G-serial digital interface standard to support ultra-high-definition video resolution. We derived the optimal frequency of the THz carrier by varying the wavelength difference between DFB-LD output and Tunable LD output in the THz signal transmitter to obtain the best transmission performances of the uncompressed 4K video signals. Furthermore, we exploited the negative laser-to-filter detuning for the adiabatic chirp management of the DFB-LD by the intentional discrepancy between the center wavelength of the optical band-pass filter and the output wavelength of the DFB-LD. With the help of the abovementioned methods, we successfully transmitted uncompressed 4K video signals over the 2.3-m wireless transmission distance without black frames induced by time synchronization error.

Purpose We compared the radiation dose and image quality between the 2nd generation and the 3rd generation dual-source single-energy (DSSE) and dual-source dual-energy (DSDE) CT of the abdomen. Materials and Methods We included patients undergoing follow-up abdominal CT after partial or radical nephrectomy in the first 10 months of 2019 (2nd generation DS CT) and the first 10 months of 2020 (3rd generation DS CT). We divided the 320 patients into 4 groups (A, 2nd generation DSSE CT; B, 2nd generation DSDE CT; C, 3rd generation DSSE CT; and D, 3rd generation DSDE CT) (n = 80 each) matched by sex and body mass index. Radiation dose and image quality (objective and subjective qualities) were compared between the groups. Results The mean size-specific dose estimation of 3rd generation DSDE CT group was significantly lower than that of the 2nd generation DSSE CT (42.5%, p = 0.013) and 2nd generation DSDE CT (46.9%, p = 0.015) groups. Interobserver agreement was excellent for the overall image quality (intraclass correlation coefficient [ICC]: 0.8867) and image artifacts (ICC: 0.9423). Conclusion Our results showed a considerable reduction in the radiation dose while maintaining high image quality with 3rd generation DSDE CT as compared to the 2nd generation DSDE CT and 2nd generation DSSE CT.

The kidney is a rare site of ectopic adrenal adenoma. To the best of our knowledge, some cases of ectopic adrenal adenoma have been found in the kidney, but few of these cases explain the CT and MRI findings of the lesion. We reported a case of ectopic adrenal adenoma in the left renal sinus. A 47-year-old male patient underwent abdominal CT for routine health check-ups, which revealed a 1.2 cm enhancing mass in the left renal sinus. The MRI showed a signal drop of the mass in T1 weighted in- and opposed-phase, which indicates fat components. The mass was confirmed as an ectopic adrenal adenoma after surgery.

Purpose: This study aimed to investigate the impact of FDG PET/CT timing for biopsy site selection in patients with stage IV lung cancer regarding complications and diagnostic yield. Methods: This retrospective analysis was performed on 1297 patients (924 men and 373 women with a mean age of 71.4 ± 10.2 years) who underwent percutaneous needle biopsy (PNB) for stage IV lung cancer diagnosis in two hospitals. Data collected included the patient’s characteristics, order date of the biopsy and PET/CT exams, biopsy target site (lung or non-lung), guidance modality, complications, sample adequacy, and diagnostic success. Based on the order date of the PNB and PET/CT exams, patients were categorized into upfront and delayed PET/CT groups. Results: PNB for non-lung targets resulted in significantly lower rates of minor (8.1% vs. 16.2%), major (0.2% vs. 3.4%), and overall complications (8.3% vs. 19.6%) compared to PNB for lung targets (p < 0.001 for all types of complications). Compared to the delayed PET/CT group, the upfront PET/CT group exhibited a lower probability of lung target selection of PNB (53.9% vs. 67.1%, p < 0.001), including a reduced incidence of major complications (1.0% vs. 2.9%, p = 0.031). Moreover, there was no significant difference in the occurrence of minor and total complications between the two groups. Upfront PET/CT and delayed PET/CT groups showed no significant difference regarding sample adequacy and diagnostic success. Conclusions: Upfront PET/CT may have an impact on the selection of the biopsy site for patients with advanced lung cancer, which could result in a lower rate of major complications with no change in the diagnostic yield. Upfront PET/CT demonstrates potential clinical implications for enhancing the safety of lung cancer diagnosis in clinical practice.

Grout voids in the tendons of a post-tensioning bridge reduce their strength. Grout voids are also severe flaws causing corrosion of the steel strands in the tendons. Detecting voids during construction and operation of the tendons is essential to prevent tendon failure, which is critical to bridge safety. This study presents a method for inspecting external tendons for voids in the grout below the protective duct pipe using terahertz electromagnetic waves. Due to low attenuation in the high-density polyethylene duct and the large reflectivity difference between the duct/grout and the duct/void interfaces, terahertz waves are suitable for detecting voids in the grout inside tendons. For this study, we developed a mobile frequency-domain terahertz A-scanner that can be used to measure terahertz A-scan data in real time. It is shown that the mobile terahertz A-scanner can be used to assess the area of the grout void in external bridge tendons.

The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

Abstract Background Demographic, work environmental, and psychosocial features are associated with mental health of healthcare professionals at pandemic frontline. The current study aimed to find predictors of mental health for public health doctors from working experiences at frontline of COVID-19 pandemic. Methods With first-come and first-served manner, 350 public health doctors with experiences of work at COVID-19 frontline participated online survey on August 2020. Mental health was defined using the total scores of the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Perceived Stress Scale, and the Stanford Presenteeism Scale-6. Multivariate logistic regression models of mental health with lowest Akaike Information Criterion were determined among all combinations of working environments, perceived threats and satisfaction at frontline, and demographics that were significant (P

Purpose The purpose of this study was to investigate the effect of midsole hardness on gait mechanisms by wearing a backpack. Methods Ten healthy adult males(age:23.20±1.33yrs, heights: 1.72±0.03cm, weights: 67.60±5.95kg) participated in this study. Subjects walked at a speed of 1.5m/s in an 8m section wearing randomly selected midsole hardness (Soft, Medium, Hard) shoes and backpack (30% of body weight). For measurement of body movement, 10 infrared cameras (Vicon motion capture system, UK) and force plate (AMTI, ORG-6, US) were used. Results First, in the shock phenomenon change, the ground contact time was longer when wearing a backpack. Second, in the shock absorption strategy, the pack plantarflexion velocity at the ankle joint was faster in Hard than Soft, and the pack dorsiflexion moment decreased when wearing a backpack (p

Background To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. Methods Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results There were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0–35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p

PURPOSEWe prospectively determined whether the quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are useful for predicting pelvic lymph node (LN) status in cervical cancer through node-by-node pathologic validation of images.METHODSOverall, 182 LNs harvested from 200 consecutive patients with 2018 FIGO stage IB-IIA cervical cancer (82 metastatic and 100 nonmetastatic) were used for node-by-node assessment. Each LN was quantitatively assessed using Ktrans, Ve, and Kep values. The short-axis diameter, ratio of the long-axis to short-axis diameter, and long-axis diameter were also assessed. Data on metastatic LNs were divided into four groups according to the FIGO staging system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate statistically significant parameters derived from DCE-MRI for the differentiation of metastatic LNs from nonmetastatic LNs.RESULTSThe mean short-axis diameter of metastatic LNs was significantly larger than that of nonmetastatic LNs (all P < 0.05) despite several overlaps. In comparison with nonmetastatic LNs, metastatic LNs showed a significantly lower Ktrans (all P < 0.05); however, Kep and Ve were not significantly different (all P > 0.05). For IB3 and IIA2 cervical cancer, Ktrans had moderate diagnostic ability for differentiating metastatic LNs from nonmetastatic LNs (for IB3: area under the curve [AUC] 0.740, 95% CI 0.657–0.838, 61.7% sensitivity, 80.2% specificity, P = 0.007; for IIA2: AUC 0.786, 95% CI 0.650–0.846, 60.2% sensitivity, 81.8% specificity, P = 0.008).CONCLUSIONKtrans appears to be a useful parameter for detecting metastatic LNs, especially for IB3 and IIA2 cervical cancer.

Exposure to climate hazards is increasing, and the experiences of frontline communities warrant meaningful and urgent attention towards how to mitigate, manage, and adapt to hazards. We report results from a community-engaged pilot (November 2021–June 2022) of N = 30 participants in four frontline communities of the San Francisco Bay Area, California, USA. The study region is an area where low-income, non-English-speaking residents are inequitably exposed and vulnerable to wildfire smoke, extreme heat, and other climate hazards. Building from a yearslong partnership of researchers, community organizations, and community members, we report the feasibility of a project piloting (1) instruments to monitor indoor air quality, temperature, and participant sleep health, and (2) interventions to improve indoor air quality and support protective behaviors. Data collection included experience-based survey data (via in-person administered surveys and a smartphone application) and interviews about heat and air quality, as well as data from an air monitoring protocol. Results cover the prevalence of hazard exposure and protective actions among participants. We discuss throughout methods for conducting and evaluating a community-engaged pilot, particularly by using a community ambassador program. Implications include the feasibility of community-engaged research projects, including discussion of resources required to accomplish this work.

Modern management of rectal cancer highly depends on the interpretation of high-spatial-resolution MRI, which determines the benefits from preoperative chemoradiotherapy or surgery alone. Accordingly, the baseline MRI report plays a pivotal role in planning the treatment. Although several structured reporting templates for rectal cancer staging on MRI are available, many radiologists still use the free-text format. In this review, we discuss the essential items for reporting rectal cancer on MRI before treatment to guide general radiologists in preparing a qualified report.

OmpA, a protein commonly found in the outer membrane of Gram-negative bacteria, has served as a paradigm for the study of β-barrel proteins for several decades. In Escherichia coli, OmpA was previously reported to form complexes with RcsF, a surface-exposed lipoprotein that triggers the Rcs stress response when damage occurs in the outer membrane and the peptidoglycan. How OmpA interacts with RcsF and whether this interaction allows RcsF to reach the surface has remained unclear. Here, we integrated in vivo and in vitro approaches to establish that RcsF interacts with the C-terminal, periplasmic domain of OmpA, not with the N-terminal β-barrel, thus implying that RcsF does not reach the bacterial surface via OmpA. Our results suggest a novel function for OmpA in the cell envelope: OmpA competes with the inner membrane protein IgaA, the downstream Rcs component, for RcsF binding across the periplasm, thereby regulating the Rcs response.

Abstract Background Although the role of axillary imaging has been redirected for predicting high nodal burden rather than predicting nodal metastases since ACOSOG Z1011 trial, it remains unclear whether and how axillary lymph node (ALN) characteristics predicts high nodal burden. Our study was aimed to evaluate the predictive value of imaging characteristics of ALNs at ultrasound and magnetic resonance imaging (MRI) for prediction of high nodal burden (≥3 metastatic ALNs) in clinically node-negative breast cancer patients. Methods Clinicopathological and imaging characteristics were evaluated in patients with ultrasound (n = 312) and MRI (n = 256). Imaging characteristics include number of suspicious ALNs and cortical morphologic changes (grade 1, cortical thickness

This inter-lab study aimed to evaluate the comparability of heavy metal concentrations in the same samples using three X-ray fluorescence spectrometers (XRFs) in three different global re-search institutions, namely a collaboration lab between Soonchunhyang University (Asan, Korea). and PAN (a branch of Malvern PANalytical, Seoul, Korea), RTI (Research Triangle Institute, NC, U.S.A), and Aerosol laboratory in Harvard University, Boston, U.S.A. Indoor air filter samples were collected from 8 homes using 3 filters in each household (n = 24) of individuals with asthma, and the same filter samples were sequentially analyzed separately in the collaboration lab Soonchunhyang-PAN, Harvard University, and RTI. Results showed the detection rates of most heavy metals (n = 25 metals) across the three institutions to be approximately 90%. Of the 25 metals, 16 showed coefficient of determination (R²) 0.7 or higher (10 components had 0.9 or higher) implying high correlation among institutions. Therefore, this study demonstrated XRF as a useful device, ensuring reproducibility and compatibility in the measurement of heavy metals in PM2.5, collected from indoor air filters of asthmatics’ residents.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract (GIT). In fewer than 5% of cases, GIST originates primarily from outside the GIT. The occurrence of GIST originating from the pancreas is rare. Sometimes, neuroendocrine tumors should be differentiated from GISTs because of their hyperenhancing nature in radiologic images. We report a case of GIST arising in the pancreas that was confirmed by surgical resection.

Purpose: To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer. Materials and Methods: A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard. Results: The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination. Conclusion: CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.

Purpose: To assess the usefulness of an ultrasound (US)-guided peritoneal biopsy for the solitary peritoneal thickening visualized as only infiltrated fat on a computed tomography (CT) scan. Materials and Methods: This retrospective study included 36 patients (16 males, 20 females; mean age, 51.7 years) who underwent a US-guided biopsy for the solitary peritoneal thickening of unknown cause visualized as only infiltrated fat without an apparent mass formation on a CT scan. The rate of the specific histopathological diagnosis and accuracy for the diagnosis of malignant disease was assessed. Results: The procedure was technically successful with the acquisition of an adequate amount of the specimen for microscopic examination from all patients. A specific histopathological diagnosis was made in 31/36 patients (86.1%): peritoneal carcinomatosis in 15/31 (48.4%), tuberculous peritonitis in 15/31 (48.4%) and panniculitis in 1/31 (3.2%). A non-specific histopathological diagnosis was made in 5/36 (13.9%): chronic inflammation in 4/5 (80%) and mesothelial hyperplasia in 1/5 (20%). The procedure showed sensitivity of 83.3%, with a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 85.7%, and an accuracy rate of 86.1% for the diagnosis of malignant diseases. Conclusion: The US-guided peritoneal biopsy is a fairly accurate diagnostic procedure for the peritoneal thickening visualized as only infiltrated fat on a CT scan, and it can be used before performing laparoscopic or an open biopsy.

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.