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We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life.
The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea.
Retrospective cross-sectional study.
Demographic findings, clinical and epidemiological characteristics, statistics of microbiological tests, and microbial species isolated from patients within 2 weeks before death were collected in 2 tertiary-care referral hospitals from January to December 2018. We also reviewed the antimicrobial treatment that was given within 3 days of microbiological testing in patients on WLST.
Of the 1,187 hospitalized patients included, 905 patients (76.2%) had WLST. The number of tests per 1,000 patient days was higher after WLST than before WLST (242.0 vs 202.4). Among the category of microbiological tests, blood cultures were performed most frequently, and their numbers per 1,000 patient days before and after WLST were 95.9 and 99.0, respectively. The positive rates of blood culture before and after WLST were 17.2% and 18.0%, respectively. Candida spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and Acinetobacter spp. were the most common in blood culture (17.3%). After WLST determination, 70.5% of microbiological tests did not lead to a change in antibiotic use.
Many unnecessary microbiological tests are being performed in patients with WLST within 2 weeks of death. Microbiological testing should be performed carefully and in accordance with the patient’s treatment goals.
To evaluate the bidirectional relationship between blood pressure (BP) and depressive symptoms using a large prospective cohort study.
Prospective cohort study was performed in 276 244 adults who participated in a regular health check-up and were followed annually or biennially for up to 5.9 years. BP levels were categorised according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. Depressive symptoms were assessed using Centre for Epidemiologic Studies-Depression (CESD) questionnaire and a cut-off score of ≥25 was regarded as case-level depressive symptoms.
During 672 603.3 person-years of follow-up, 5222 participants developed case-level depressive symptoms. The multivariable-adjusted hazard ratios (HRs) [95% confidence interval (CI)] for incident case-level depressive symptoms comparing hypotension, elevated BP, hypertension stage 1 and hypertension stage 2 to normal BP were 1.07 (0.99–1.16), 0.93 (0.82–1.05), 0.89 (0.81–0.97) and 0.81 (0.62–1.06), respectively (p for trend <0.001). During 583 615.3 person-years of follow-up, 27 787 participants developed hypertension. The multivariable-adjusted HRs (95% CI) for incident hypertension comparing CESD 16–24 and ⩾25 to CESD < 16 were 1.05 (1.01–1.11) and 1.12 (1.03–1.20), respectively (p for trend <0.001) and in the time-dependent models, corresponding HRs (95% CI) were 1.12 (1.02–1.24) and 1.29 (1.10–1.50), respectively (p for trend <0.001).
In this large cohort study of young and middle-aged individuals, higher BP levels were independently associated with a decreased risk for developing case-level depressive symptoms and depressive symptoms were also associated with incident hypertension. Further studies are required to elucidate the mechanisms underlying the bidirectional association between BP levels and incident depression.
To propose a new anthropometric index that can be employed to better predict percent body fat (PBF) among young adults and to compare with current anthropometric indices.
All measurements were taken in a controlled laboratory setting in Seoul (South Korea), between 1 December 2015 and 30 June 2016.
Eighty-seven young adults (18–35 years) who underwent dual-energy x-ray absorptiometry (DXA) were used for analysis. Multiple regression analyses were conducted to develop a body fat index (BFI) using simple demographic and anthropometric information. Correlations of DXA measured PBF (DXA_PBF) with previously developed anthropometric indices and the BFI were analysed. Receiver operating characteristic curve analyses were conducted to compare the ability of anthropometric indices to identify obese individuals.
BFI showed a strong correlation with DXA_PBF (r = 0·84), which was higher than the correlations of DXA_PBF with the traditional (waist circumference, r = 0·49; waist to height ratio, r = 0·68; BMI, r = 0·36) and alternate anthropometric indices (a body shape index, r = 0·47; body roundness index, r = 0·68; body adiposity index, r = 0·70). Moreover, the BFI showed higher accuracy at identifying obese individuals (area under the curve (AUC) = 0·91), compared with the other anthropometric indices (AUC = 0·71–0·86).
The BFI can accurately predict DXA_PBF in young adults, using simple demographic and anthropometric information that are commonly available in research and clinical settings. However, larger representative studies are required to build on our findings.
To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS).
Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M).
Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline.
Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.
Feasibility of multiwavelength Raman spectroscopy was studied as a potential
in-line monitoring technique for grain size distribution in channel poly-Si used
in three dimensional stacked NAND (3D NAND) Flash memory devices. Various
channel poly-Si materials in 3D-NAND Flash memory devices, converted from
chemical vapor deposition (CVD) grown a-Si, were characterized using
non-contact, multiwavelength Raman spectroscopy and high resolution
cross-sectional transmission electron microscopy (HRXTEM). The Raman
characterization results were compared with HRXTEM images. The correlation
between the grain size distribution characterized by multiwavelength Raman
spectroscopy and “on current” (ION) of 3D NAND
Flash memory devices was investigated. Good correlation between these techniques
was seen. Multiwavelength Raman spectroscopy is very promising as a
non-destructive in-line monitoring technique for grain size distribution in
channel poly-Si used in 3D NAND Flash memory devices.
This study aimed to investigate the influences of age, education, and gender on the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological assessment battery (CERAD-NP) and to provide normative information based on an analysis for a large number of elderly persons with a wide range of educational levels.
In the study, 1,987 community-dwelling healthy volunteers (620 males and 1,367 females; 50–90 years of age; and zero to 25 years of education) were included. People with serious neurological, medical, and psychiatric disorders (including dementia) were excluded. All participants underwent the CERAD-NP assessment. TS-I was generated by summing raw scores from the CERAD-NP subtests, excluding Mini-Mental State Examination and Constructional Praxis (CP) recall subtests. TS-II was calculated by adding CP recall score to TS-I.
Both TS-I and TS-II were significantly influenced by demographic variables. Education accounted for the greatest proportion of score variance. Interaction effect between age and gender was found. Based on the results obtained, normative data of the CERAD-NP total scores were stratified by age (six overlapping tables), education (four strata), and gender.
The normative information will be very useful for better interpretation of the CERAD-NP total scores in various clinical and research settings and for comparing individuals’ performance of the battery across countries.
Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports.
We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis.
Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden.
In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
Pathological gambling (PG) is a severe and persistent pattern of problem gambling that has been aligned with obsessive-compulsive disorder (OCD). However, no study has compared the neurocognitive profiles of individuals with PG and OCD.
We compared neurocognitive functioning, including executive function, verbal learning and memory, and visual–spatial organization and memory among 16 pathological gamblers, 31 drug-naïve OCD subjects, and 52 healthy controls.
The only neurocognitive marker common to both groups was increased fragmentation errors on the Rey–Osterrieth Complex Figure Test (ROCF). The PG subjects showed increased nonperseverative error on the Wisconsin Card Sorting Test and organization difficulties in the ROCF, whereas the OCD subjects revealed longer response times on the Stroop test and retention difficulties on the immediate recall scale of the ROCF.
A more careful approach is required in considering whether PG is a part of the OCD spectrum, as little evidence of neurocognitive overlap between PG and OCD has been reported.
The objective of the present study was to determine whether angiotensinogen G(–6)A polymorphism is associated with the elevation of blood pressure (BP) in the hypertensive disorders of pregnancy in Korean population. The subjects included 201 cases with the hypertensive disorders of pregnancy and 160 healthy controls. The medical records of subjects were reviewed. Cases were classified into the four subtypes (transient hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension) by the diagnostic criteria suggested by the National High Blood Pressure Education Program Working Group. Cases were also divided into the high and low BP group by the elevation of BP (diastolic BP greater than or equal to 110 mmHg). Maternal angiotensinogen G(–6)A polymorphism was determined by restriction fragment length polymorphism. Frequencies of AA genotype were significantly higher in the high than in the low BP group in the preeclampsia, superimposed preeclampsia, and the combined group (N = 201), suggesting that the angiotensinogen G(–6)A allele was significantly associated with the elevation of BP in the hypertensive disorders of pregnancy among South Korean women. The present findings imply that the elevation of BP can serve as an endophenotype for a spectrum of hypertensive conditions in pregnancy.
Background: The influences of demographics, culture, language, and environmental changes on Mini-Mental State Examination (MMSE) scores are considerable.
Methods: Using a sample of 7452 healthy, community-dwelling elderly Koreans, aged 55 to 94 years, who participated in the four ongoing geriatric cohorts in Korea, we investigated demographic influences on MMSE scores and derived normative data for this population. Geropsychiatrists strictly excluded subjects with cognitive disorders according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Clinical Assessment Battery (CERAD-K-C).
Results: Education (standardized β = 0.463), age (standardized β = −0.303), and gender (standardized β = −0.057) had significant effects on MMSE scores (p < 0.001). The score of MMSE increase 0.379 point per 1-year education, decrease 0.188 per 1-year older, and decrease 0.491 in women compared to men. Education explained 30.4% of the scores’ total variance, which was much larger than the variances explained by age (8.4%) or gender (0.3%). Accordingly, we present normative data for the MMSE stratified by education (0, 1–3, 4–6, 7–9, 10–12, and ≥ 13 years), age (60–69, 70–79, and 80–89 years), and gender.
Conclusions: We provide contemporary education-, age-, and gender-stratified norms for the MMSE, derived from a large, community-dwelling elderly Korean population sample, which could be useful in evaluating individual MMSE scores.
Both luminous efficiency and lifetime in blue fluorescence organic light
emitting devices (OLEDs) have been improved by modified HTMs with higher
LUMO energy levels. The LUMO energy levels of HTM were increased by
modifying substituent in HTM molecules. Two HTMs containing ortho and meta
biphenyl substituent and one HTM containing thiophene substituent were
synthesized via palladium catalyzed amine coupling reactions to compare with
a para biphenyl substituent HTM-1 as a standard molecule. According to TDDFT
calculations, these three modified HTMs showed 0.05-0.15 eV higher LUMO
energy levels compared to the para biphenyl substituent HTM-1. The luminous
efficiency and the lifetime (LT90) of OLEDs using HTM-2 at 500
cd/m2 have been enhanced up to 20 % and 52 %, respectively,
compared to the standard device using HTM-1.
This study aimed to investigate whether aquaporin 3 (Aqp3) mRNAs are expressed in immature oocytes and altered during in vitro maturation process. Five- to 6-week-old female ICR mice were primed by gonadotropin for 24 and 48 h. Immature oocytes obtained 48 h after priming were also matured in vitro for 17 to 18 h. In vivo matured oocytes were obtained after 48 h priming followed by hCG injection. Total RNAs were extracted from 80 to 150 oocytes in each experimental group, and the levels of Aqp3 mRNA were quantified by real-time reverse transcriptase polymerase chain reaction. The experiments were repeated twice using different oocytes. The Aqp3 mRNA was expressed in immature oocytes, as well as in in vitro and in vivo matured oocytes. The expression level was higher in immature oocytes obtained 48 h after priming (17.2 ± 8.6, mean ± SD) than those with no priming (5.7 ± 0.8) or obtained 24 h after priming (2.5 ± 0.8). The expression of Aqp3 mRNA decreased after in vitro maturation (1.2 ± 0.5), which was similar to in vivo matured oocytes (1.0 ± 0.0). Our work demonstrated that Aqp3 mRNA expression increased during the development of immature oocyte but decreased after completion of in vitro maturation. The results indicate that AQP3 is certainly needed for the acquisition of immature oocytes’ full growing potential within antral follicles.
The absence of a low dielectric constant layer at the barium strontium titanate (BST)/Pt interface and a decreased roughness are critical issues in the production of (Ba0.5Sr0.5)TiO3 thin films with high tunabilities and low losses. An improvement in dielectric properties was achieved by the insertion of seed layers at the BST/Pt interface by pulsed laser deposition. The higher tunability can be attributed to (100) texturing of the BST films, which is independent of grain size and grain morphologies, thus leading to a variation in seed layer thicknesses. The tunability and dielectric constant of 1600-Å-thick BST films showed a maximum of 53% and 720, respectively, at a seed layer thickness of 100 Å. Dielectric loss is dependent on the roughness of BST films and reached a minimum of 0.8% at a root mean square roughness of 28 Å. The maximum figures of merit, defined as the ratio of tunability to dielectric loss, of approximately 58 at 100 kHz and 198 kV/cm were obtained at a seed layer thickness of 70 Å. The optimized seed layer thickness for BST deposition onto Pt/Ti/SiO2/Si substrates plays an important role in maintaining the high tunabilities and low loss, which are suitable for microwave device applications.
The YSTAR program is a general sky survey looking for variability. The main equipments are three 0.5-m telescopes. These telescopes have fast F/2 optics covering nearly 3.5 square degree field onto a 2K CCD. They also have very fast slew capability, which exceeds 10 degrees per second. These two factors make them most suitable for rapid target acquisition and wide-field surveys of various kinds. Our primary objective is to identify and monitor variable stars down to 18th R-magnitude, and our observing mode allows the same data set to be also useful in identifying asteroids. Our first telescope has just begun regular automated operation, and the second telescope will be installed in South Africa within this year to provide coverage of the southern sky.
A systematic study of photoluminescence (PL) and time-resolved PL spectra from In0.15Ga0.85N/In0.015Ga0.985N quantum wells (QWs) with different Si doping concentration in the barriers has been carried out. As the Si doping concentration increases, the PL emission intensity was increased and the PL peak energy was blueshifted. The energy separation between the spontaneous emission (SPE) and stimulated emission (SE) peaks decrease with increasing Si doping concentration. We also observed that the slow decay time τ2 in the QWs decreases with increasing Si doping concentration, from ∼ 130 ns for [Si] = 2 × 1018 cm−3 to ∼ 30 ns for [Si] = 1 × 1019 cm−3. The PL emission peak shifts to lower energies with delay time after a pulsed excitation and this shift decreases with increasing Si doping concentration. The increased recombination rate, the decrease of peak shift with delay time, and the reduced separation between the SPE and SE peaks with increasing Si doping concentration are attributed to the screening of piezoelectric field by carriers originated from Si doped barriers.
In Korea Depleted Uranium(DU) is used in manufacturing a metallic nuclear fuel for the Korean Multi-Purpose Research Reactor(KMRR). In the manufacturing processes it produces DU chips and scraps as a waste material which composed of U-Ti, U-Zr, U-Mo and U-Si intermetallic compound. In this study Air Controlled Oxidizer(ACO) has been developed which facilitates DU to be converted into U308, the most stable form of uranium. Since DU chips oxidize rapidly and their heat of oxidation is very high(4.199kJ/g, U3O8), the inside temperature of the oxidizer is likely going up rapidly. Therefore the oxidizer must be able to be cooled properly or temperature increasement of the oxidizer must be under control. Kang et al. reported for the oxidation of U-0.75wt%/o Ti chips in air that U308 was detected at the temperature above 350°C. And they also reported that the maximum heat generation per unit time during oxidation was as follows:
where Q was the maximum heat generation per unit time
WDU was the weight of DU loaded in ACO
dw/dt was the reaction rate
Vair was the flow rate of input air
R was the universal gas constant
and T was the absolute temperature.
From eq.(1) the maximum heat generation per unit time during oxidation is only function of the weight of DU loaded in ACO and the oxidation rate which is dependent on the oxidation temperature or the flow rate of input air.
The ACO consists of an air flow meter, an air heater, an oxidation chamber with inner heater(capacity 7.5kW), an ash collection tank, a fly ash collector, a pressure gauge, a safety valve, and a soaking tank. The air flow meter is used to control the flow rate of input air below theoretical air requirement limit for the complete oxidation of DU. The inner heater is used to heat the inside of the oxidizer to an optimum oxidation temperature. The ash collection tank is used to collect uranium oxide powder after completion of oxidation. The fly ash collector is used both to collect flying ashes and to condense vaporized uranium oxide. Also, in ACO, DU chips are not ignited directly in order to prevent rapid temperature increasement. The oxidation environment only is achieved by heating the inside of oxidizer.
To find effect of the oxidation temperature on the temperature of the oxidation chamber during treatment of DU, we conduct the experiment by changing heating rates of inner heater, 3, 4, 5 and 6kW, respectively. We conduct experiments for 120 minute with 2/min input air. However, it turned out that the complete oxidation is reached within 60 minute. After complete oxidation the weight gains of the DU chips is from 4.5 to 5.0 wt0/o and the DU chips are pulverized and they are converted to U 08 and 979 Mat. Res. Soc. Symp. Proc. Vol. 506 1998 Materials Research Society During the oxidation, maximum temperature increases to 470, 497.5, 572.5 and 6771C for heating rates 3, 4, 5 and 6kW, respectively. As the temperatures of the oxidation chamber outside surface are not exceed 1501C, however, DU chips are treated safely. In each experiment, weight before and after oxidation, the oxide forms of the product and the maximum temperature in the oxidation chamber during oxidation are shown in table 1. The maximum temperature profiles of the chamber inside and surface for time and heating rates are shown in Fig. I and 2, respectively.
We have constructed an apparatus for in situ measurement of stress of the film prepared by sputtering using an optical non-contact displacement detector. A change of the gap distance between the detector and the substrate, caused by stress of a deposited film, was detected by a corresponding change of the reflectivity. The sensitivity of the displacement detector was 5.9 µV/Å and thus, it was turned out to be good enough to detect stress caused by deposition of a monoatomic layer. The apparatus was applied to in situ stress measurements of Co/X(X=Pd or Pt) multilayer thin films prepared on the glass substrates by dc magnetron sputtering. At the very beginning of the deposition, both Co and X sublayers have subjected to their own intrinsic stresses. However, when the film was thicker than about 100 Å, constant tensile stress in the Co sublayer and compressive stress in the X sublayer were observed, which is believed to be related to a lattice mismatch between the matching planes of Co and X.
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