We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
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 ${k_\parallel }{\lambda _{De}} = 0.1$.
Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs).
Method
This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival.
Results
We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively.
Significance of results
Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.
We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn.
Design:
Experimental study.
Setting:
A tertiary-care referral center in South Korea.
Participants:
In total, 10 infection control practitioners participated in the fit test.
Methods:
The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning.
Results:
For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours.
Conclusions:
High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.
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.
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.
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.
To trace past changes in flooding frequency, we investigated fluvial sediments in the middle reach of the Nakdong River, South Korea. Sediments with larger grain size, lower total organic carbon percentage, and depleted δ13C values in the recovered sediment cores were interpreted as periods of more frequent flooding. Patterns of decreased long-term flooding frequency and vegetation changes during the early to late Holocene were similar to the decreasing regional summer monsoon intensity. Multicentennial frequent flooding periods in the study area (2900–3400 cal yr BP, 3600–3900 cal yr BP, 4600–5300 cal yr BP, and 5800–6400 cal yr BP) corresponded to stronger El Niño–Southern Oscillation (ENSO) activity periods. Based on previous studies showing that high-frequency tropical typhoon-driven coastal inundation along the western coast of Japan during the middle to late Holocene was coupled with stronger ENSO activity, it is likely that the observed centennial-to-millennial-scale flood frequency change in South Korea was influenced mainly by changes in the genesis and tracks of tropical typhoons at centennial-to-millennial time scales. This suggests that the centennial-to-millennial-scale hydrologic changes in East Asia were linked to the remote atmospheric-oceanic circulation changes represented by an ENSO-like pattern.
Personality may predispose family caregivers to experience caregiving differently in similar situations and influence the outcomes of caregiving. A limited body of research has examined the role of some personality traits for health-related quality of life (HRQoL) among family caregivers of persons with dementia (PWD) in relation to burden and depression.
Methods:
Data from a large clinic-based national study in South Korea, the Caregivers of Alzheimer's Disease Research (CARE), were analyzed (N = 476). Path analysis was performed to explore the association between family caregivers’ personality traits and HRQoL. With depression and burden as mediating factors, direct and indirect associations between five personality traits and HRQoL of family caregivers were examined.
Results:
Results demonstrated the mediating role of caregiver burden and depression in linking two personality traits (neuroticism and extraversion) and HRQoL. Neuroticism and extraversion directly and indirectly influenced the mental HRQoL of caregivers. Neuroticism and extraversion only indirectly influenced their physical HRQoL. Neuroticism increased the caregiver's depression, whereas extraversion decreased it. Neuroticism only was mediated by burden to influence depression and mental and physical HRQoL.
Conclusions:
Personality traits can influence caregiving outcomes and be viewed as an individual resource of the caregiver. A family caregiver's personality characteristics need to be assessed for tailoring support programs to get the optimal benefits from caregiver interventions.
The HoDoo English game was developed to take advantage of the benefits attributed to on-line games while teaching English to native Korean speakers. We expected to see that the improvements in the subjects’ English language abilities after playing the HoDoo English game would be associated with increased brain functional connectivity in the areas of the brain involved in the language production (Broca’s area) and the understanding (Wernicke’s area) networks. Twelve children, aged nine and ten, were asked to play the on-line English education game for 50 minutes per day, five days per week for twelve weeks. At baseline, and again at the end of twelve weeks of game play, each child’s English language ability was assessed and a functional magnetic resonance imaging (fMRI) scan was conducted. The on-line English education game play effectively improved English language skills, especially in terms of non-verbal pragmatic skills. Following twelve weeks of on-line English education game play, the children showed positive connectivity between Broca’s area and the left frontal cortex as well as between Wernicke’s area and the left parahippocampal gyrus and the right medial frontal gyrus. Changes in pragmatic scores were positively correlated with average peak brain activity in the left parahippocampal gyrus. To the best of our knowledge, this is the first study to report an improvement in English ability and changes in brain activity within language areas after on-line language education game play.
During the past decade, carbapenemase-producing Enterobacteriaceae (CPE) has emerged and spread across the world.1 The major carbapenemase enzymes currently being reported are KPC, NDM-1, VIM, IMP, and OXA.2 Because carbapenemase can be effectively transmitted via mobile genetic elements, and current therapeutic options for CPE infections are extremely limited, CPE may be one of the most serious contemporary threats to public health. However, very little is known about the characteristics of CPE carriage during hospitalization. The aims of this study were to investigate the clearance rate of CPE carriage and determine the number of consecutive negative cultures required to confirm CPE clearance. We also examined CPE transmission among hospitalized patients.
Infect. Control Hosp. Epidemiol. 2015;36(11):1361–1362
The present study was performed to investigate whether breast-feeding is associated with early pubertal development among children 7–9 years old in Korea.
Design
Children were divided into those who did and did not receive breast-feeding for 6 months or longer in accordance with the recommendations of the WHO. Pubertal status was determined by clinical examination using Tanner staging.
Setting
Prospective observational study.
Subjects
We conducted a follow-up study of children aged 7–9 years in 2011 who had taken part in the Ewha Birth & Growth Cohort study.
Results
Fifty (22·8 %) of the total of 219 children were in early puberty, with the proportion being slightly higher for girls (24·1 %) than boys (21·4 %). Children who had entered early puberty were taller, weighed more and had a higher concentration of insulin-like growth factor 1. Moreover, the change in weight Z-score from birth to follow-up was significantly lower in children who were breast-fed than in those who were not (weight Z-score change: 0·32 (sd 1·59) v. 0·77 (sd 1·61), respectively, P=0·04). Comparison of breast-feeding by puberty status indicated a preventive association with early puberty in children who were breast-fed for 6 months or longer (OR=0·37; 95 % CI 0·18, 0·74). This association remained significant after adjustment for relevant covariates.
Conclusions
These results demonstrate a beneficial association between breast-feeding and early pubertal development, especially in those breast-fed for 6 months or longer. The study suggests that interventions would need to start early in life to prevent early pubertal development.
This book examines competition and collaboration among Western powers, the socialist bloc, and the Third World for control over humanitarian aid programs during the Cold War. Young-sun Hong's analysis reevaluates the established parameters of German history. On the one hand, global humanitarian efforts functioned as an arena for a three-way political power struggle. On the other, they gave rise to transnational spaces that allowed for multidimensional social and cultural encounters. Hong paints an unexpected view of the global humanitarian regime: Algerian insurgents flown to East Germany for medical care, barefoot Chinese doctors in Tanzania, and West and East German doctors working together in the Congo. She also provides a rich analysis of the experiences of African trainees and Asian nurses in the two Germanys. This book brings an urgently needed historical perspective to contemporary debates on global governance, which largely concern humanitarianism, global health, south-north relationships, and global migration.