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This study aimed to identify the roles of community pharmacists (CPs) during the coronavirus disease 2019 (COVID-19) pandemic, the differences in their role performance compared with their perceived importance, and limiting factors.
Methods:
A cross-sectional online survey of CPs was conducted. The CPs self-measured the importance and performance of each role during the pandemic using a 5-point Likert scale. A paired t-test was used to compare each role’s importance and performance scores. A logistic regression analysis of the roles with low performance scores, despite their level of importance, was conducted to determine the factors affecting performance. The limiting factors were also surveyed.
Results:
The 436 responses to the questionnaire were analyzed. The performance scores were significantly lower than the perceived importance scores for 15 of the 17 roles. The source and update frequency of COVID-19 information and participation in outreach pharmaceutical services were associated with low performance scores. Insufficient economic compensation, the lack of communication channels, and legal limitations were the limiting factors in performing the CPs’ roles.
Conclusions:
The participation in outreach pharmaceutical services, economic compensation, and communication channel should be improved to motivate the CPs in performing their roles.
The aim of this study was to evaluate the impact of coronavirus disease 2019 (COVID-19) on treatment outcomes in critically ill patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). This single-centre, retrospective cohort study was conducted in a 1,048-bed university-affiliated tertiary hospital in the Republic of Korea from January 2021 to March 2022. The study participants included consecutive hospitalised adult patients (aged ≥18 years) in the intensive care unit with CRAB monomicrobial BSI. During the study period, a total of 70 patients were included in our study, and 24 (34.3%) were diagnosed with COVID-19. The 28-day mortality rate was 64.3%. In the multivariate Cox proportional hazard regression analysis, diagnosis of COVID-19 (hazard ratio (HR), 2.91; 95% confidence interval (CI): 1.45–5.87), neutropenia (HR, 2.76; 95% CI: 1.04–7.29), Pitt bacteraemia score (per point; HR, 1.30; 95% CI: 1.19–1.41), and appropriate definite antibiotic therapy (HR, 0.31; 95% CI: 0.15–0.62) were independent predictors of 28-day mortality in patients with CRAB BSI. In conclusion, our findings suggested that COVID-19 has a negative prognostic impact on patients with CRAB BSI. Further study is needed to investigate the specific mechanisms of how COVID-19 worsens the prognosis of CRAB infection.
Globally, an aging population is increasing, and aging is a natural physiological process and a major risk factor for all age-related diseases. It seriously threatens personal health and imposes a great economic burden. Therefore, there is a growing scientific interest in strategies for well-aging with prevention and treatment of age-related diseases. The seed, root, stem or leaves of Cassia tora Linn. are useful for anti-bacteria, anti-hyperlipidemia and anti-obesity due to its pharmacological activities such as anti-inflammation and anti-oxidant both in vitro and in vivo. Nevertheless, no clinical trials have been attempted so far, therefore here we would like to understand the current preclinical activities for aging-related disease models including cataract, metabolic dysfunction and neurodegeneration, then discuss their preparation for clinical trials and perspectives.
Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with <400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with <400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,’ the prescription was considered ‘optimal.’ If only the route was ‘optimal,’ and the dose and/or class was ‘suboptimal,’ but not ‘inappropriate,’ it was considered ‘suboptimal.’ If even 1 aspect was ‘inappropriate,’ it was classified as ‘inappropriate.’ Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.
The dissipation of ion-acoustic surface waves propagating in a semi-bounded and collisional plasma which has a boundary with vacuum is theoretically investigated and this result is used for the analysis of edge-relevant plasma simulated by Divertor Plasma Simulator-2 (DiPS-2). The collisional damping of the surface wave is investigated for weakly ionized plasmas by comparing the collisionless Landau damping with the collisional damping as follows: (1) the ratio of ion temperature $({T_i})$ to electron temperature $({T_e})$ should be very small for the weak collisionality $({T_i}/{T_e} \ll 1)$; (2) the effect of collisionless Landau damping is dominant for the small parallel wavenumber, and the decay constant is given as $\gamma \approx{-} \sqrt {\mathrm{\pi }/2} {k_\parallel }{\lambda _{De}}\omega _{pi}^2/{\omega _{pe}}$; and (3) the collisional damping dominates for the large parallel wavenumber, and the decay constant is given as $\gamma \approx{-} {\nu _{in}}/16$, where ${\nu _{in}}$ is the ion–neutral collisional frequency. An experimental simulation of the above theoretical prediction has been done in the argon plasma of DiPS-2, which has the following parameters: plasma density ${n_e} = (\textrm{2--9)} \times \textrm{1}{\textrm{0}^{11}}\;\textrm{c}{\textrm{m}^{ - 3}}$, ${T_e} = 3.7- 3.8\;\textrm{eV}$, ${T_i} = 0.2- 0.3\;\textrm{eV}$ and collision frequency ${\nu _{in}} = 23- 127\;\textrm{kHz}$. Although the wavelength should be specified with the given parameters of DiPS-2, the collisional damping is found to be $\gamma = ( - 0.9\;\textrm{to}\; - 5) \times {10^4}\;\textrm{rad}\;{\textrm{s}^{ - 1}}$ for ${k_\parallel }{\lambda _{De}} = 10$, while the Landau damping is found to be $\gamma = ( - 4\;\textrm{to}\; - 9) \times {10^4}\;\textrm{rad}\;{\textrm{s}^{ - 1}}$ for ${k_\parallel }{\lambda _{De}} = 0.1$.
Litter-dwelling arthropods play an important role in maintaining forest ecosystem function. This study was designed to understand seasonal variations and diversity of litter-dwelling adult beetles, one of the most diverse groups of arthropods. Sampling was conducted in mixed-wood forests of South Korea between March and December 2019, covering all seasons, including winter. We used a sifting method and a Berlese funnel to collect arthropods living in leaf litter and soil. We collected a total of 5820 invertebrates representing six orders, of which 1422 were beetles representing 24 families and minimum 141 species. Beetle species richness was highest in spring and lowest in summer based on rarefaction and extrapolation. However, beetle abundance was lowest in spring, but abundance was similar among the other seasons. Beetle assemblage composition was correlated significantly with soil surface and atmospheric temperature. The assemblage composition differed among seasons, except between spring and winter, which overlapped slightly. The combined sifting–Berlese funnel method showed great advantages for investigating the diversity of overwintering arthropods. Continued study of the relationship between arthropods and the leaf-litter environment is essential to understand this microecosystem and will increase the chance of discovering new beetle species.
Prognostic heterogeneity in early psychosis patients yields significant difficulties in determining the degree and duration of early intervention; this heterogeneity highlights the need for prognostic biomarkers. Although mismatch negativity (MMN) has been widely studied across early phases of psychotic disorders, its potential as a common prognostic biomarker in early periods, such as clinical high risk (CHR) for psychosis and first-episode psychosis (FEP), has not been fully studied.
Methods
A total of 104 FEP patients, 102 CHR individuals, and 107 healthy controls (HCs) participated in baseline MMN recording. Clinical outcomes were assessed; 17 FEP patients were treatment resistant, 73 FEP patients were nonresistant, 56 CHR individuals were nonremitters (15 transitioned to a psychotic disorder), and 22 CHR subjects were remitters. Baseline MMN amplitudes were compared across clinical outcome groups and tested for utility prognostic biomarkers using binary logistic regression.
Results
MMN amplitudes were greatest in HCs, intermediate in CHR subjects, and smallest in FEP patients. In the clinical outcome groups, MMN amplitudes were reduced from the baseline in both FEP and CHR patients with poor prognostic trajectories. Reduced baseline MMN amplitudes were a significant predictor of later treatment resistance in FEP patients [Exp(β) = 2.100, 95% confidence interval (CI) 1.104–3.993, p = 0.024] and nonremission in CHR individuals [Exp(β) = 1.898, 95% CI 1.065–3.374, p = 0.030].
Conclusions
These findings suggest that MMN could be used as a common prognostic biomarker across early psychosis periods, which will aid clinical decisions for early intervention.
To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting.
Design:
A quasi-experimental before-and-after study.
Setting:
A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.
Methods:
Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis.
Results:
After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%).
Conclusions:
The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.
The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.
Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years.
Methods
Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis.
Results
The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels.
Conclusions
Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.
Radiocarbon (14C) dating has been widely used to determine the age of deposits, but there have been frequent reports of inconsistencies in age among different dating materials. In this study, we performed radiocarbon dating on a total of 33 samples from 8-m-long sediment cores recovered from the wetland of the Muljangori volcanic cone on Jeju Island, South Korea. Ten pairs of humic acid (HA) and plant fragments (PF) samples, and three pairs of HA and humin samples, from the same depths were compared in terms of age. The PF were consistently younger than the HA. Interestingly, the age difference between HA and PF samples showed a long-term change during the past 8000 years. To test whether there was an association between this long-term age difference and climate change, we compared with the carbon/nitrogen (C/N) ratios and total organic carbon isotope (δ13CTOC) values of the sediments, as indicators of the relative abundance of terrestrial and aquatic plants; these parameters showed similar long-term trends. This suggests that the increasing (decreasing) trend in age difference was influenced by long-term dry (wet) climate change.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
Methods:
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
Results:
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Conclusions:
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.
Aim:
The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.
Methods:
Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.
Results:
A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.
Discussion:
Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.
Periodontitis, or conventionally “Gum Disease,” is the infection and inflammation of gingival tissue, and is currently the leading cause of tooth loss in the United States. One of the most effective treatments of periodontitis is guided bone regeneration (GBR); however, current GBR barrier membranes lack high biocompatibility and cell impermeability. The authors of this study evaluated the in vitro viability of previously synthesized Gelatin-Pluronic® F127 hybrid hydrogels as potential GBR barrier membranes through a novel three-partition test involving migration of fluorescent-dyed human dermal fibroblasts. Results showed that cells were unable to migrate across the Gelatin-Pluronic® F127 hybrid hydrogel barrier, whereas control setups with gelatin hydrogel barriers showed cell permeability. In addition, cytotoxicity tests were conducted with fibroblasts plated in both cell mediums that had been incubated while in contact hybrid gels and cell mediums suspended on the surface of hybrid gels during swelling procedures. Fluorescence cell plate readings showed similar cell viability across data from both tests, indicating that Gelatin-Pluronic® F127 hybrid hydrogels are not toxic to cells, and thus biocompatible.
Firefighters are routinely exposed to various traumatic events and often experience a range of trauma-related symptoms. Although these repeated traumatic exposures rarely progress to the development of post-traumatic stress disorder, firefighters are still considered to be a vulnerable population with regard to trauma.
Aims
To investigate how the human brain responds to or compensates for the repeated experience of traumatic stress.
Method
We included 98 healthy firefighters with repeated traumatic experiences but without any diagnosis of mental illness and 98 non-firefighter healthy individuals without any history of trauma. Functional connectivity within the fear circuitry, which consists of the dorsal anterior cingulate cortex, insula, amygdala, hippocampus and ventromedial prefrontal cortex (vmPFC), was examined using resting-state functional magnetic resonance imaging. Trauma-related symptoms were evaluated using the Impact of Event Scale – Revised.
Results
The firefighter group had greater functional connectivity between the insula and several regions of the fear circuitry including the bilateral amygdalae, bilateral hippocampi and vmPFC as compared with healthy individuals. In the firefighter group, stronger insula–amygdala connectivity was associated with greater severity of trauma-related symptoms (β = 0.36, P = 0.005), whereas higher insula–vmPFC connectivity was related to milder symptoms in response to repeated trauma (β = −0.28, P = 0.01).
Conclusions
The current findings suggest an active involvement of insular functional connectivity in response to repeated traumatic stress. Functional connectivity of the insula in relation to the amygdala and vmPFC may be potential pathways that underlie the risk for and resilience to repeated traumatic stress, respectively.
The study of extremely metal-poor (EMP; [Fe/H] <−3.0) and ultra metal-poor (UMP; [Fe/H] <−4.0) stars is crucial for better understanding first-star nucleosynthesis and constraining the initial mass function in the early Universe. However, UMP stars discovered in the past 25 years only number ~25. A few recent theoretical studies have pointed out that there is likely to exist large numbers of EMP and UMP stars in the periphery of the Galactic halo, at distances exceeding 30-50 kpc. We present identifications of several new EMP/UMP stars and introduce a survey to expedite discovering hundreds to thousands of EMP/UMP stars in the outermost halo (as well as in the local volume) over the next few years, which could revolutionize chemical-evolution studies of the Galaxy.
There is growing evidence that, among the various subclasses of carbon-enhanced metal-poor (CEMP) stars, the outer halo of the Milky Way exhibits a higher frequency of CEMP-no stars (those having no over-abundances of heavy neutron-capture elements) compared with the CEMP-s stars (those with over-enhancements of the s-process elements), while the inner halo shows a higher frequency of CEMP-s stars. We map out fractions of CEMP-no and CEMP-s stars in the inner- and outer-halo populations, separated by their spatial distribution of carbonicity ([C/Fe]), a so-called “carbonicity map”, based on a sample of over 100,000 main-sequence turnoff stars with available spectroscopy from the Sloan Digital Sky Survey. The CEMP-no and CEMP-s objects are classified by different levels of absolute carbon abundances for our sample, A(C). We also present kinematic and orbital characteristics of these subclasses for each population. The contrast appearing in these characteristics provides critical constraints on the assembly history of the two primary stellar components of the Galactic halo.
We present the derived kinematic characteristics of low-α thin-disk and high-α thick-disk stars in the Milky Way, investigated with a sample of about 32,000 G- and K-type dwarfs from the Sloan Extension for Galactic Understanding and Exploration (SEGUE). Based on the level of α-element enhancement as a function of [Fe/H], we separate our sample into thin- and thick-disk stars and then derive mean velocities, velocity dispersions, and velocity gradients for the U, V, and W velocity components, respectively, as well as the orbital eccentricity distribution. There are notable gradients in the V velocity over [Fe/H] in both populations: −23 km s−1 dex−1 for the thin disk and +44 km s−1 dex−1 for the thick disk. The velocity dispersion of the thick disk decreases with increasing [Fe/H], while the velocity dispersion gradient over [Fe/H] for the thin disk is almost flat for all velocity components, except for the W velocity dispersion of the metal-poor thin-disk stars. The eccentricity distribution exhibits a peak at a higher value, and is more symmetric as [α/Fe] increases, implying that complex formation mechanisms may be involved. Our results can be used to constrain several proposed disk-formation scenarios of the Milky Way and other large spirals.
To trace the surficial responses of lowlands to past climate change, we investigated δ13C in total organic carbon (TOC), C/N ratios, magnetic susceptibility (MS), and silicon (Si) intensity (directly proportional to concentration) in wetland sediments collected from the Gimpo area of central Korea, covering 6600–4600 cal yr BP. Two organic layers with high TOC%, negatively depleted δ13CTOC values (− 27 to − 29‰), low MS values, and low Si intensities were found at 6200–5900 and 5200–4800 cal yr BP, respectively. These middle Holocene wet periods corresponded to relatively intensified summer monsoon and solar activity periods. The intervening dry period (5900–5200 cal yr BP) with high MS, high Si, and low TOC% corresponded to an intensified dust-activity interval and stronger winter monsoon. This multi-centennial climatic fluctuation of wet periods (6200–5900 cal yr BP and 5200–4800 cal yr BP) and an intervening dry period (5900–5200 cal yr BP) in central Korea was more synchronous with climate change in the arid inner part of China than with that in South China, suggesting possible strong high-latitude-driven climatic influences (e.g., North Atlantic cooling events) during the middle Holocene.
Late Pleistocene carbon isotope (δ13C) records from a paleolithic sedimentary sequence collected from Baeki, Hongcheon, central Korea, show long-term changes with superimposed short-term isotopic excursions. The δ13C value of the sedimentary organic matter, a proxy for past vegetation change, varied from − 26‰ to − 23‰ for the period between 30 and 90 ka, with a long-term variation similar to insolation changes. High-amplitude (− 1‰ to approximately − 1.5‰) fluctuations superimposed on the long-term changes in the δ13C values decreased during stronger summer monsoon intervals but increased during the weakened summer monsoon. This millennial-scale pattern is generally similar to Greenland Dansgaard–Oeschger (D–O) cycles. The possible connection between the Hongcheon area, Korea and high latitudes may be explained by atmospheric circulation changing in response to the D–O oscillations in the Northern Hemisphere.