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Background: After the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the government newly established the additional reimbursement for infection prevention to encourage infection control activities in the hospitals. The new policy was announced in December 2015 and was implemented in September 2016. We evaluated how infection control activities improved in hospitals after the change of government policy in Korea. Methods: Three cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using multivariable linear regression model including hospital characteristics, we analyzed the changes in total HHSAF scores according to the survey time. Results: In total, 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In a multivariable linear regression model, the total HHSAF scores were significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% CI, 8.9–96.4; P = .018), bed size (β coefficient of 100-bed increase, 5.1; 95% CI, 0.3–9.8; P = .038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3–70.9; P = .001). Conclusions: After the national policy implementation, the number of infection control professionals increased, and the promotion of hand hygiene activities was strengthened in Korean hospitals.
A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital.
The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient’s characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method.
DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector.
For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients’ medical records, and to reorganize the DMAT dispatch system.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
Korea Microlensing Telescope Network (KMTNet) which consists of three identical 1.6 m wide-field telescopes with 18k × 18k CCDs, is the first optical survey system of its kind. The combination of fast optics and the mosaic CCD delivers seeing limited images over a 4 square degrees field of view. The main science goal of KMTNet is the discovery and characterization of exoplanets, yet it also offers various other science applications including DEep Ecliptic Patrol of SOUTHern sky (DEEP-South). The aim of DEEP-South is to discover and characterize asteroids and comets, including Near Earth Objects (NEOs). We started test runs last February after commissioning, and will return to normal operations in October 2015. A summary of early results from the test runs will be presented.
Korea Astronomy and Space Science Institute (KASI) successfully completed the development of Korea Microlensing Telescope Network (KMTNet, Park et al. 2012) in mid-2015, following which it conducted test runs for several months. ‘DEep Ecliptic Patrol of the Southern sky’ (DEEP-South, Moon et al. 2015), which will be used for asteroid and comet studies, will not only characterize targeted asteroids, carrying out blind surveys toward the sweet spots, but will also mine the data of such bodies using the KMTNet archive. We report preliminary lightcurves of four Potentially Hazardous Asteroids (PHAs) from test runs at KMTNet-CTIO in the February - May 2015 period.
We started ‘DEep Ecliptic Patrol of the Southern sky’ (DEEP-South, DS) (Moon et al. 2015) in late 2012, and conducted test runs with the first Korea Microlensing Telescope Network (KMTNet) (Park et al. 2012), a 1.6 m telescope with 18k x 18k CCD stationed at CTIO in early 2015. While the primary objective of DEEP-South is the physical characterization of small Solar System bodies, it is also expected to discover a large number of such bodies, many of them previously unknown. An automated observation scheduling, data reduction and analysis software subsystem called ‘DEEP-South Scheduling and Data reduction System’ (DS SDS) is thus being designed and implemented to enable observation planning, data reduction and analysis with minimal human intervention.
Octamer-binding transcription factor 4 (Oct4) is a critical molecule for the self-renewal and pluripotency of embryonic stem cells. Recent reports have shown that Oct4 also controls cell-cycle progression and enhances the proliferation of various types of cells. As the high proliferation of donor fibroblasts is critical to the production of transgenic pigs, using the somatic cell nuclear transfer technique, we analysed the effect of Oct4 overexpression on the proliferation of porcine fibroblasts and embryos. Porcine endogenous Oct4 cDNA was cloned, sequenced and inserted into an expression vector. The vector was transfected into porcine fibroblasts, and a stable Oct4-overexpressed cell line was established by antibiotic selection. Oct4 expression was validated by the immunostaining of Oct4. Cell morphology was changed to sharp, and both proliferation and migration abilities were enhanced in Oct4-overexpressed cells. Real-time RT-PCR results showed that p16, Bcl2 and Myc were upregulated in Oct4-overexpressed cells. Somatic cell nuclear transfer was performed using Oct4-overexpressed cells, and the development of Oct4 embryos was compared with that of wild-type cloned embryos. The cleavage and blastocyst formation rates were improved in the Oct4 embryos. Interestingly, blastocyst formation of the Oct4 embryos was observed as early as day 5 in culture, while blastocysts were observed from day 6 in wild-type cloned embryos. In conclusion, the overexpression of Oct4 enhanced the proliferation of both porcine fibroblasts and embryos.
A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.
This study quantitatively investigated the immediate effects of a photooxidative collagen cross-linking treatment with photosensitizer riboflavin (RF) and 370 nm UVA light in in vitro human corneoscleral collagen fibrils using histology, thickness, scanning electron microscopy, and atomic force microscopy analyses. Twenty 8 × 2 mm corneoscleral strips were dissected sagittally from donor tissue using a scalpel. Four parameters were investigated, including the density, thickness, adhesion force, and stiffness of corneoscleral tissues before and after the collagen cross-linking treatment. The RFUVA-catalyzed collagen cross-linking treatment led to an increase in the density of both corneal (8%) and scleral (23%) stromal collagens. However, there was no difference in corneoscleral thickness. Furthermore, RFUVA-catalyzed collagen cross-linking treatment led to an increased biomechanical response of corneosclera: 25 and 8% increases in corneoscleral stiffness, and 24 and 22% increases in corneoscleral adhesion force. The collagen cross-linking treatment through RF-sensitized photoreaction may cause structural and biomechanical changes in the collagen fibril network of the cornea and the sclera. This is due to narrowing of the interfibrillar spacing and the stromal edema.
This study investigated the inflammatory effect of intraoperative mitomycin C (MMC) on adhesion reformation in human rectus muscles. Ten consecutive patients who underwent medial rectus resection had their postoperative rectus muscles divided into two groups: control group (n = 10) and MMC group (n = 10). In the MMC group, the muscle was soaked for 2 min with MMC, prepared as a 0.2 mg/mL (0.02%) solution. The 0.02% MMC reactions were examined using histological analysis with hematoxylin-eosin (inflammatory response) and Masson's trichrome (collagen fibrils), immunoreactivities of cyclooxygenase-II (inflammatory response), and collagen type I and III, scanning electron microscopy analysis to quantify the diameter and D-periodicity of collagen fibrils, and atomic force microscopy analysis to quantify the diameter, D-periodicity, and adhesion force of collagen fibrils. The rectus muscles treated with 0.02% MMC showed a significantly increased inflammatory response (p < 0.05), increased collagen density (p < 0.0001), increased fibril diameter (p < 0.001 or p < 0.05), and decreased fibril adhesion force (p < 0.005) compared to the rectus muscles in the control group. MMC simultaneously caused an inflammatory response as well as nanostructural and biomechanical property changes in the collagen fibril network.
To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.
Retrospective cohort study.
Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).
From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.
SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were “severe” SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.
Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.
Nitrogen (N) and boron (B) codoped diamond-like carbon (DLC) films were prepared on silicon oxide substrates by RF magnetron sputtering to optimize the electrical conductivity and hardness of DLC film. The electrical conductivity and hardness of the N–B codoped DLC films were controlled simultaneously by varying N2 flow rate with fixed B target power and varying B target power with fixed N2flow rate. The electrical resistivity of the B-doped DLC films showed a cup-shaped relationship with B target power and a U-shaped relationship with the N–B codoped DLC film. However, hardness of the B-doped DLC films showed a decreasing behavior but it was maintained almost constant for the N–B codoped DLC film. These particular electrical and hardness behaviors of the N–B codoped DLC films could be explained by a neutralization effect of N and B codoping.
To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea.
A nationwide prospective multicenter study.
Twenty university-affiliated hospitals in Korea.
The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.
Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 (±12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09–2.58]), increased operation time (1.20 [1.07–1.34] per 1-hour increase), reoperation (7.27 [3.68–14.38]), combined multiple procedures (1.79 [1.13–2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09–8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26–5.64]) were independently associated with increased risk of SSI.
Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.
A combinatory approach of Step-and-Flash Imprint Lithography (SFIL) and Metal-Assisted Chemical Etching (MacEtch) was used to generate near perfectly-ordered, high aspect ratio silicon nanowires (SiNWs) on 4" silicon wafers. The ordering and shapes of SiNWs depends only on the SFIL nanoimprinting mould used, thereby enabling arbitary SiNW patterns not possible with nanosphere and interference lithography (IL) to be generated. Very densely packed SiNWs with periodicity finer than that permitted by conventional photolithography can be produced. The height of SiNWs is, in turn, controlled by the etching duration. However, it was found that very high aspect ratio SiNWs tend to be bent during processing. Hexagonal arrays of SiNW with circular and hexagonal cross-sections of dimensions 200nm and less were produced using pillar and pore patterned SFIL moulds. In summary, this approach allows highlyordered SiNWs to be fabricated on a wafer-level basis suitable for semiconductor device manufacturing.
Background: Low education and illiteracy are associated with an increased risk of dementia. This study aimed to develop a neuropsychological test battery applicable to both illiterate and literate elderly and to assess its reliability and validity for a diagnosis of dementia.
Methods: We developed the Literacy Independent Cognitive Assessment (LICA), which consists of 13 subtests assessing memory, language, visuoconstruction, executive function, attention and calculation. We investigated its reliability and validity on 152 patients with dementia, 66 with mild cognitive impairment and 639 normal controls.
Results: The subtests were found to be applicable to most of the illiterate normal controls (97.3%) and were found to have high inter-rater reliabilities (r = 0.85–1.00, p < 0.001) and moderate to high test-retest reliabilities (r = 0.50–0.86, p < 0.001). The LICA performed well in discriminating participants across Clinical Dementia Rating stages and showed excellent internal consistency and good concurrent validity with the Korean Mini-mental State Examination in both literate and illiterate participants. The area under the curve of the receiver operating characteristic was 0.985 in each of the two literacy groups. Sensitivity and specificity of the LICA to make a diagnosis of dementia was 91.9% and 91.8% at the cutoff point of 186.0 in the literate subjects and 96.2% and 91.1% at the cutoff point of 154.5 in the illiterate subjects. The battery was factored into two separate factors consisting of verbal memory tests and tests for other cognitive domains.
Conclusion: The LICA is a valid and reliable instrument for a diagnosis of dementia in both illiterate and literate elderly.
Structural parameters of periphytic ciliate communities on a modified substrate were studied in Korean coastal waters during the period August–November 2007. In order to reduce the strong disturbances from tidal current and circulation in marine ecosystems, a modified slide method, named the polyurethane foam enveloped slide (PFES) system, was used to host ciliate communities. A total of 37 ciliate species, about half of which belong to the orders Hypotrichida and Cyrtophorida, were identified using living observation and silver impregnation method with this system. The sessile ciliates belonged to the orders Peritrichida and Suctorida, while the motile forms were represented primarily by the species of the orders Hypotrichida, Cyrtophorida and Pleurostomatida. The species diversity and evenness were significantly higher in the PFES system than those on the conventional slides (paired t-test: t = 2.384, 2.415; P < 0.05). Multivariate analysis revealed that the ciliate communities from both sampling systems had similar species composition, but represented significant differences in species distribution and temporal dynamics mainly due to the most dominant peritrich Zoothaminium duplicatum, which overly colonized the conventional slides. Results suggest that the PFES system is more effective than the conventional slide method for periphytic ciliate colonization with high species diversity, evenness and sensitive temporal dynamics mainly due to the reduction of disturbances from tidal current and circulation in marine ecosystems.
The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains causing bloodstream infection (BSI) has not been studied in Korea.
We sought to determine the prevalence of CA-MRSA strains among isolates recovered from patients with MRSA BSIs and to explore epidemiological changes in Korea. We also sought to evaluate clinical characteristics relevant to the development of healthcare-associated BSIs.
We prospectively collected consecutive MRSA isolates from patients with BSI at 4 hospitals from July 1 through November 30, 2007, and we also included MRSA isolates recovered from culture of blood samples collected during a previous year (October 1, 2004 through September 30, 2005) at a different hospital. Molecular typing studies were performed, including pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, Staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. We compared the clinical characteristics and outcomes of patients with healthcare-associated BSI due to CA-MRSA strains with those of patients with healthcare-associated BSI due to healthcare-associated MRSA (HA-MRSA) strains.
There were 76 cases of MRSA BSI, of which 4 (5.3%) were community-associated and 72 (94.7%) were healthcare-associated. Among the 72 HA-MRSA BSIs, 18 (25%) were community onset, and 54 (75%) were hospital onset. PFGE type D-ST72–spa B-SCCmec type IVA MRSA, the predominant genotype of CA-MRSA in Korea, accounted for 19 (25%) of all 76 MRSA BSIs, including 17 (23.6%) of 72 HA-MRSA BSIs and 11 (20.8%) of 53 hospital-onset HA-MRSA BSIs. Patients with healthcare-associated BSIs due to CA-MRSA strains carrying SCCmec type IVA tended to have fewer healthcare-associated risk factors, compared with patients with healthcare-associated BSIs due to HA-MRSA strains carrying other SCCmec types. The presence of a central venous catheter or other invasive device was the only independent factor differentiating patients infected with hospital-associated genotype strains from patients infected with other strains. Clinical outcomes were similar between both groups.
CA-MRSA strains are emerging as a major cause of BSI in healthcare settings in Korea. This changing epidemiology of MRSA poses a challenge to public health and infection control in hospital settings.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
New biomolecular-inorganic nanohybrids with two different functions, one from inorganic moiety and the other from biological one were realized by soft chemical methods such as intercalation, coprecipitation and exfoliation-reassembling reactions. Recently we have been focusing on two-dimensional inorganic compounds like layered double hydroxides (LDHs), since they are biocompatible and can be used as gene or drug delivery inorganic nanovehicles. To the best of our knowledge, such inorganic drug delivery vectors are quite different from conventionally developed ones such as viral based vectors, naked DNA, biodegradable polymers,liposomes, and etc, those which are however limitedly used due to their toxicity, immunogenecity, poor integration, and etc. But we found that such disadvantages can be overcome by immobilizing genes or drug molecules into these new inorganic vectors, which consist of non-toxic metal ions with biological compatibility. Since LDHs are anion exchangeable, negatively charged functional biomolecules can be easily intercalated into hydroxide layers of LDHs by soft chemical reaction methods to form bio-LDHs nanohybrids. In such a way they can gain extra stabilization energy due to the electrostatic interaction between inorganic layers, whatever they are anionic or cationic, and counter-charged biomolecules or drugs. We also found that the hydroxide layers of LDHs could protect the intercalated molecules very efficiently. If necessary, inorganic materials, as reservoir and delivery carrier, can be intentionally removed by dissolving them in an acidic or basic media, which offer a way of recovering the encapsulated biomolecules or drugs. The possible roles of inorganic lattice as the gene and drug delivery carrier will be shown by demonstrating the cellular uptake experiments of FITC, fluorophore, with laser scanning confocal fluorescence microscopy as well as of radioactive isotope-labeled ATP-LDH hybrid. As the typical examples for gene and drug delivery systems, As-myc-LDH and MTX-LDH nanohybrids will be demonstrated along with their endocytic mechanism. In addition, nanotoxicity of LDH and other inorganic nanoparticles will be also discussed in detail.
The syntxhesis, photo-physics, and electroluminescence of new types of Iridium(III)-encapsulated dendrimers are described. Thus, four different iridium complexes [Ir(III)(C^N)2(LX), Blue-DCBP, Green-DCBP, Yellow-DCBP, and Red-DCBP] with ancillary ligand tethered to the CBP dendritic unit were synthesized and investigated for their photo-physical properties. A large enhancement in electroluminescence performance was observed by using these dendrimers as host/dopant hybrid materials in layered emitting diodes. In particular, host/dopant ratio can be systematically adjusted by varying dendritic generations. These results demonstrate that new Ir(III)-encapsulated dendrimers can be used as potential single-layer materials for organic light emitting diodes. Large difference in the intra-molecular charge transfer phosphorescence quantum yields and electroluminescence effiencies were observed among dendriritic generations.