Managing perceived distress to COVID-19 infection on post-COVID-19 condition

Aims: COVID-19 leaves diverse sequalae beyond the acute illness, referred to as 'long COVID'. However, the aetiology, characteristics and risk factors of Long-COVID is still lacking. COVID-19 patients experience various stressful events and suffer emotional distress which causes post-traumatic stress disorders. This study aimed to investigate association between of perceived distress to COVID-19 infection and long COVID. Method(s): Data from 56 patients who visited the psychiatric department of our post-COVID clinic between March and June 2022 were analysed. All patients completed a subjective symptom checklist [32 symptoms in eight categories], selected cognitive function tests [digit span test, trail making test (TMT), and Stroop word colour interference test], and validated neuropsychological scales [Hospital Anxiety and Depression Scale (HAS and HDS), Pittsburgh sleep quality index (PSQI) and Impact of event scale-revised (IES-R)]. We classified patients into two groups, 'High distress group'(N = 37) and 'Low distress group (N = 19) through IES-R score (cut-off = 25). The frequency and severity of long COVID-symptoms between the two groups were compared with Mann-whitney and chi-square test. Result(s): The average age of the patients was 53.34 years, and 70.53 days had passed from the SARS-CoV-2 confirmation using RTPCR. 'High distress group' showed higher HAS (284 vs. 455, p = .01), HDS (197 vs. 387, p = .032), and PSQI (238 vs. 428, p = .05) scores and suffered shortness of breath, palpitation, tingling, subjective memory deficit more frequently. Regarding neurocognitive functioning, there was no difference between two groups. Conclusion(s): Managing perceived distress due to COVID-19 could alleviate the long-covid sequalae especially in neuropsychiatric area.

COVID-associated pernio: Mechanistic insights to an abortive, seronegative SARS-CoV-2 infection

Introduction: SARS-CoV-2 replicates primarily in the airways but generates a systemic immune response mediated by Type I interferons (IFN-I). Pernio is a rare skin manifestation of disorders characterized by excessive IFN-I signalling. Although pernio increased in incidence during the pandemic, the relationship to SARS-CoV-2 remains controversial. Because of the pivotal nature of interferons in COVID-19 outcomes, pernio offers a window to investigate the biology underlying host resiliency to SARS-CoV-2 infection. Method(s): To further assess COVID-associated pernio, we characterized clinical samples from affected patients across 4 waves of the pandemic and investigated mechanistic feasibility in a rodent model. Patients were followed longitudinally with banking of blood and tissue. Golden hamsters were mock-treated or intra-nasally infected with SARS-CoV-2 and harvested at 3-and 30-days post-infection. Result(s): In affected tissue, immunophenotyping utilizing multiplex immunohistochemistry profiled a robust IFN-1 signature characterized by plasmacytoid dendritic cell activation. Viral RNA was detectable in a subset of cases using in situ hybridization for the SARS-CoV-2 S gene transcript. Profiling of the systemic immune response did not reveal a durable type 1 interferon signature. Consistent with previous literature, antibody and T-cell specific responses to SARS-CoV-2 were not detected. Nasopharyngeal SARS-CoV-2 inoculation in hamsters resulted in rapid dissemination of viral RNA and the generation of an IFN-I response that were both detectable in the paws of infected animals. Conclusion(s): Our data support a durable local IFN signature, with direct evidence of viral SARS-CoV-2 RNA in acral skin and suggest that COVID-associated pernio results from an abortive, seronegative SARS-CoV-2 infection.

Clinical characteristics and associated factors of qualitative olfactory dysfunction.

BACKGROUND: Although interest in qualitative olfactory dysfunction (OD), including parosmia and phantosmia, has been increasing since the COVID-19 pandemic, little is known about the clinical characteristics and associated factors of qualitative OD. METHODS: Adult patients with subjective smell disturbance who underwent both the olfactory questionnaire and psychophysical olfactory function test were retrospectively enrolled. Demographic and clinical characteristics were analysed according to the presence or absence of parosmia or phantosmia. RESULTS: Among a total of 753 patients with self-reported OD, 60 (8%) and 167 (22.2%) patients reported parosmia and phantosmia, respectively. Younger age and female sex were related to both parosmia and phantosmia. The frequency of parosmia was significantly higher in patients with post-viral OD (17.9%) than in patients with the sinonasal disease (5.5%), whereas that of phantosmia was not different according to aetiologies of OD. Patients with COVID-19 had significantly younger ages and higher TDI scores than those with other viral infections. Remarkably, patients with parosmia or phantosmia had significantly higher TDI scores than those without but experienced more disruption in daily life. In the multivariate analysis, younger age and higher TDI score were identified as independent factors associated with both parosmia and phantosmia, while the viral infection was associated with parosmia but not with phantosmia. CONCLUSIONS: Patients with OD who have parosmia or phantosmia have higher odour sensitivity than those who do not, but experience more deterioration in the quality of life. Viral infection is a risk factor for parosmia but not for phantosmia.

The Evolution of International Health: Lessons to Be Learned

Despite the United States' unique delivery of healthcare and status as a place of discovery and cutting-edge science, overall life expectancy is actually lower than that of other countries with similar per capita income. In comparison, developing countries around the world are utilizing innovative tactics to provide care to large amounts of people in a cost-effective way. The coronavirus disease of 2019 (COVID-19) pandemic, if anything, has proven the interconnectedness of the world, showing how certain health diseases can directly affect those in other countries, bringing the need to understand global health to the forefront of medicine. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Bouncing Back: Unpacking the Influence of Sport Media on Consumer Resilience

This study aims to empirically investigate how sport media consumption influences the relationships among the spatially explicit risks of COVID-19, resilience, and positive and negative affect, considering social class. To achieve this, we employed an integrated approach using spatial and aspatial analyses. The findings indicated that the negative effects of the spatially explicit risks of COVID-19 on resilience are mitigated by sport media consumption. In turn, an increased level of resilience enhances positive affect and reduces negative affect. Moreover, consumers in the upper class showed a more pronounced resilience process through sport media consumption than those in the lower class. This study contributes to the knowledge regarding the sport -resilience association by identifying the moderating effect of sport media consumption within social classes and addressing the spatially explicit risks of COVID-19. The present findings provide a basis for sport-based resilience strategies in times of adversity.

A New Approach to Improving Hedging Performance in the OLS Model

The sensitivity of VIX futures to market movements changes over time with changes in market risk. Accordingly, in the case of using the OLS (ordinary least squares) model to hedge S&P 500 exposure with VIX futures, hedge ratios are affected by changes in risk appetite, which in turn contributes to the overall hedging performance as well as the asymmetry of the performance distribution. The conventional OLS approach does not effectively reflect this phenomenon in the model. In this study, the authors explore a new approach to improving hedging performance in the OLS model. They introduce an interaction term between the VIX and VIX futures returns into the OLS model. They find that the hedge ratios derived by the new approach provide better hedging results compared to the univariate OLS model in terms of mean return and downside risk protection, and also improve the asymmetry of the performance distribution. They extend their research to compare it with the performance of the dynamic conditional correlation (DCC)-generalized autoregressive conditional heteroskedasticity (GARCH) model. The new approach also shows better results than the DCC-GARCH approach. They obtain the same results in case studies of the Global Financial Crisis and the COVID-19 pandemic, and also in applying a trading strategy to each hedging methodology.

Monitored Anesthesia Care in Uterine Artery Embolization for Leiomyomas and Adenomyosis

Background: Patients undergoing an interventional radiology procedure report some degree of anxiety. Therefore, procedure-related anxiety needs to be managed. The aim of our study was to investigate patient satisfaction with monitored anesthesia care (MAC) for uterine artery embolization (UAE)-related procedural anxiety in symptomatic uterine fibroids or adenomyosis. Method(s): Between May 2021 and June 2022, 36 patients with symptomatic fibroids or adenomyosis underwent UAE with MAC. Follow-up evaluations consisted of clinical symptoms, degree of satisfaction with MAC in UAE, and complications. Result(s): MAC in UAE was successfully performed in all patients. UAE significantly reduced patients' complaints such as bleeding and pain: the scores for bleeding and pain were significantly reduced after 3 months of UAE compared with those before UAE, indicating the effectiveness of UAE. The mean score of satisfaction with MAC in UAE was 4.3 points, meaning that 94.4% of women were satisfied or very satisfied. No major complications were observed. Conclusion(s): MAC in UAE for symptomatic uterine fibroids or adenomyosis can be emotionally effective and safe for patients who are anxious about the procedure.Copyright © 2023 The Author(s).

Social media in the election during the COVID-19 pandemic in South Korea: Candidates' use of social media when offline gatherings are prohibited

Objective: : This study investigated the utilization of social media during the 2020 South Korean general election, which took place during the COVID-19 pandemic, using the equalization versus normalization framework. Methods: : This study estimated the associations between the characteristics of candidates and their respective constituencies and the use of various social media platforms by the candidates. Results: : Dominant political actors were more active social media users, supporting the normalization hypothesis. However, when considering the candidates' chances of winning the election, social media's normalizing effect was weakened. Conclusion: : This study provides new insights into the equalization versus normalization debate by analyzing social media use in a context where offline campaigning was restricted. © 2023 by the Southwestern Social Science Association.

SARS-CoV-2 spike protein-mediated cardiomyocyte fusion may contribute to increased arrhythmic risk in COVID-19.

BACKGROUND: SARS-CoV-2-mediated COVID-19 may cause sudden cardiac death (SCD). Factors contributing to this increased risk of potentially fatal arrhythmias include thrombosis, exaggerated immune response, and treatment with QT-prolonging drugs. However, the intrinsic arrhythmic potential of direct SARS-CoV-2 infection of the heart remains unknown. OBJECTIVE: To assess the cellular and electrophysiological effects of direct SARS-CoV-2 infection of the heart using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). METHODS: hiPSC-CMs were transfected with recombinant SARS-CoV-2 spike protein (CoV-2 S) or CoV-2 S fused to a modified Emerald fluorescence protein (CoV-2 S-mEm). Cell morphology was visualized using immunofluorescence microscopy. Action potential duration (APD) and cellular arrhythmias were measured by whole cell patch-clamp. Calcium handling was assessed using the Fluo-4 Ca2+ indicator. RESULTS: Transfection of hiPSC-CMs with CoV-2 S-mEm produced multinucleated giant cells (syncytia) displaying increased cellular capacitance (75±7 pF, n = 10 vs. 26±3 pF, n = 10; P<0.0001) consistent with increased cell size. The APD90 was prolonged significantly from 419±26 ms (n = 10) in untransfected hiPSC-CMs to 590±67 ms (n = 10; P<0.05) in CoV-2 S-mEm-transfected hiPSC-CMs. CoV-2 S-induced syncytia displayed delayed afterdepolarizations, erratic beating frequency, and calcium handling abnormalities including calcium sparks, large "tsunami"-like waves, and increased calcium transient amplitude. After furin protease inhibitor treatment or mutating the CoV-2 S furin cleavage site, cell-cell fusion was no longer evident and Ca2+ handling returned to normal. CONCLUSION: The SARS-CoV-2 spike protein can directly perturb both the cardiomyocyte's repolarization reserve and intracellular calcium handling that may confer the intrinsic, mechanistic substrate for the increased risk of SCD observed during this COVID-19 pandemic.

Immunogenicity of an additional mRNA-1273 SARS-CoV-2 vaccination in people with HIV with hyporesponse after primary vaccination.

BACKGROUND: The COVIH-study is a prospective SARS-CoV-2 vaccination study in 1154 people with HIV (PWH), of whom 14% showed a reduced or absent antibody response after primary vaccination. We evaluated whether an additional vaccination boosts immune responses in these hyporesponders. METHODS: Consenting hyporesponders received an additional 100µg mRNA-1273 vaccination. The primary endpoint was the increase in antibodies 28 days thereafter. Secondary endpoints were the correlation between participant characteristics and antibody response, levels of neutralizing antibodies, S-specific T-cell and B-cell responses, and reactogenicity. RESULTS: Of the 66 participants, 40 previously received two doses ChAdOx1-S, 22 two doses BNT162b2, and four a single dose Ad26.COV2.S. The median age was 63[IQR:60-66], 86% were male, pre-vaccination CD4+ T-cell count was median 650/µL[IQR:423-941] and 96% had HIV-RNA < 50 copies/mL. The mean S1-specific antibody level increased from 35 BAU/mL (95%CI:24-46) to 4317 BAU/mL (95%CI:3275-5360) post-vaccination (p < 0.0001). Of all participants, 97% showed an adequate response (>300 BAU/mL) and the 45 antibody negative participants all seroconverted (>33.8 BAU/mL). A significant increase in the proportion of PWH with detectable ancestral S-specific CD4+ T-cells (p = 0.04) and S-specific B-cells (p = 0.02) was observed. CONCLUSION: An additional mRNA-1273 vaccination induced a robust serological response in 97% of PWH with a hyporesponse after primary vaccination.

Hate-motivated Crime/Incidents Against Asians in the United States of America: A Systematic Review

Although hate-motivated incidents and crimes against Asians are not a new phenomenon, there has been a lack of scholarly attention on the topic. Using a systematic review, we examine, assess, and analyze 23 published peer-reviewed articles that have explored hate-motivated crime/incidents against Asians in the United States of America between 2000 and 2020. We found all studies included in this systematic review examined microaggressions and/or discrimination, and tended to lump all different Asian subgroups into "Asians.” In addition, most studies focused on the consequences of hate-motivated incidents, such as mental and physical health. We suggest a future research agenda and direction that fills the gap in scholarly journal articles on Asian hate-motivated incidents in the United States. © The Author(s) 2022.

Correction: Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in people living with HIV in the Netherlands: A nationwide prospective cohort study.

[This corrects the article DOI: 10.1371/journal.pmed.1003979.].

Massive Subchorionic Thrombohematoma and Maternal Cardiac Dysfunction: A Case Series

Background. Massive subchorionic thrombohematoma (MST), also known as Breus' mole, is a rare and poorly understood entity defined as a substantial collection of clotted blood in the intervillous space, immediately beneath the chorionic plate, measuring >1 cm in thickness with >50% involvement of the fetal surface of the placenta. The presumed pathophysiology is an aberrant collection of maternal blood, although this data is limited. MST has previously been associated with maternal thrombophilia and following thrombolytic therapy. Method(s): Four cases of MST diagnosed by pathological examination at our institution from 1/1/2021-7/1/2022 were identified using our laboratory information system. Maternal medical history, prenatal imaging, antenatal complications, gestation at delivery, and pregnancy outcome were extracted from the medical record. Result(s): We report a novel association of MST and maternal cardiac dysfunction, illustrated by four cases at a highrisk obstetric reference center covering a large portion of the southeastern United States. Two of these mothers had surgically repaired complex congenital heart disease, one had heart failure secondary to SARS-CoV-2 myocarditis, and one had longstanding high output heart failure due to severe sickle cell disease with resulting severe anemia. All of these pregnancies were complicated by intrauterine growth restriction (IUGR). Grossly, all four placentas had extensive fetal surface involvement by thrombohematoma (90-100%), but with variable degrees of placental volume replacement (range: 10-80%). Two of the four mothers had documented enoxaparin administration during pregnancy;however, there were no common medications given to all four mothers None had recognized thrombophilic disorders. Only one of four lesions was definitively identified on prenatal ultrasound. Of these four cases, three were live births, though only one infant survived past fifteen days of life. This surviving child had the least affected placenta grossly, was delivered at term, and was born to the only mother who did not require admission to the intensive care unit. Conclusion(s): We posit abnormal maternal hemodynamics are the final common pathway in the development of MST. Previous studies have shown blood within the thrombohematoma to be of maternal origin;furthermore, there is correlation within our case series between the largest lesions and the mothers with the most hemodynamic instability. IUGR is likely secondary to decreased placental reserve capacity from these space-occupying lesions. High fetal/neonatal morbidity and mortality rates underscore the need to further characterize this pathophysiologic process. That only one of four cases was detected on prenatal ultrasound illustrates the importance of both ante- and postnatal clinical and pathologic recognition.

Introduction: New Frontiers for Tax in the Digital Age

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book reviews revenue authority responses to the challenges of the digital economy together with cutting-edge tax administrative initiatives in service delivery and compliance, including such concepts as the use of big data, "tap and go” developments, the impact of artificial intelligence, and the use of algorithms. It discusses ideas involved in identifying relevant features of digital markets and business models, as well as the implications of the development of macro databases in the digital economy. The book explores viable solutions to the setback created by the COVID-19 pandemic and envisions future security for digital markets. It provides a perspective of cooperative compliance as a solution for tackling issues of tax evasion in developing economies. The book presents a case study of the reforms that have been implemented in India, focusing on the challenges brought about by digital taxation. © 2023 selection and editorial matter, Asian Development Bank Institute;individual chapters, the contributors

Taxation in the Digital Economy: New Models in Asia and the Pacific

A robust and efficient tax administration in a modern tax system requires effective tax policies and legislation. Policy frameworks should cover all aspects of tax administration and include the essential processes of capturing, processing, analyzing, and responding to information provided by taxpayers and others concerning taxpayers' affairs. By far the greatest challenges facing tax administrations in all countries are those posed by the continuing developments in the digital economy. Whereas societies are grappling to come to terms with the transitions from the third industrial or digital revolutions, revenue authorities grapple with the consequences for the sustainability of their tax bases and the efficient administration and collection of taxes. This book presents a critical review of the status of tax systems in Asia and the Pacific in the era of the digital economy. The book suggests how countries can maximize their domestic resource mobilization when confronted by the challenges that digitalization inevitably produces, as well as how they can best harness or take advantage of aspects of digitalization to serve their own needs. The full implications of the COVID-19 crisis are still too uncertain to predict, but it is clear that the crisis will accelerate the trend towards digitalization and also increase pressures on public finances. This, in turn, may shape the preference for, and the nature of, both multilateral and unilateral responses to the tax challenges posed by digitalization and the need to address them. This book will be a timely reference for those researching on taxation in digital economy and for policy makers. 　 The Open Access version of this book, available at www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non-Commercial-No Derivatives 4.0 license. © 2023 selection and editorial matter, Asian Development Bank Institute;individual chapters, the contributors

Using an Ecological Approach to Explore Teacher Agency during the Implementation of a Citizen Science Education Program Using Arduino

Citizen science education is a new approach in science education for promoting scientific inquiry related to localized problems and for engaging in social action based on inquiry results. Using agency as a lens for understanding teachers' practices when using this approach is important. In this ethnographic case study, a teacher implementing a citizen science education program using Arduino was investigated from an ecological approach using temporal and relational dimensions of agency. In the iterational dimension, the teacher's own experiences and traits from life and professional histories were identified. His identity as a teacher and his religious values formed the projective dimension. Encouraging administrators, the financial difficulties of the school, and the COVID-19 pandemic were major elements of the practical-evaluative dimension. Findings reveal the complex array of the teacher's agency in the context of implementing citizen science education with Arduino with students, which contributes new understandings about science teacher agency. © 2022 by Na et al.

An outbreak of carbapenem-resistant Acinetobacter baumannii in an isolation ward for COVID-19 and successful outbreak control with infection control measures

Background. The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenemresistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving. Methods. This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021. Results. During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified (Figure 1). Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the enhanced environmental cleaning using sodium hypochlorite(NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. Conclusion. Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning.

Clinical accuracy and utility of plasma microbial cell free DNA NGS for the diagnosis of invasive aspergillosis in patients with hematologic malignancy and COVID-19

Background. Invasive aspergillosis (IA) is a great threat to the severely immunocompromised and patients with coronavirus disease (COVID-19). However, diagnosis of IA is often difficult due to need for invasive biopsy and low sensitivity of other diagnostic tests. Next-generation sequencing (NGS) of plasma cell free DNA (cfDNA) can be a novel non-invasive diagnostic modality. We evaluated the clinical accuracy and utility of microbial cfDNA NGS for the diagnosis of IA in patients with hematologic malignancy (HM) and COVID-19. Methods. A single-center prospective study of plasma microbial cfDNA NGS was conducted in a tertiary-care hospital in South Korea. We enrolled adult patients with HM and COVID-19, who suspected IA and performed conventional diagnostic tests for IA. The results of NGS were compared with the diagnosis of IA through conventional methods. IA cases were diagnosed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with COVID-19. (Figure 1). Figure 1. Flow chart for the participant selection method used in this study Results. Between March 2021 and January 2022, a total of 33 participants (22 [64.7%] male, median age 66.0 [50.5, 72.0]) were enrolled;19 participants with HM and 15 with COVID-19 were analyzed (Figure1 and Table1). In participants with HM, aspergillus cfDNA was detected in 100% of both proven (1/1) and probable (12/12) IA cases, and 33.3% of both possible (1/3) and no IA (1/3) cases. In participants with COVID-19, 46.2% of probable IA (6/13) showed positive aspergillus cfDNA. Detection rate of aspergillus cfDNA was significantly higher in proven/probable IA cases in participants with HM compared to participants with COVID-19. (100% vs 46.2%, p=0.005) (Figure 2). As shown in Table 2, among proven/probable IA cases, participants with positive aspergillus cfDNA showed significantly higher rate of having uncontrolled hematologic disease, receiving stem cell transplantation and recent chemotherapy. In three participants with HM, non-aspergillus strains confirmed by cfDNA NGS were in accordance with pathogens identified through conventional culture methods. Conclusion. Detection of aspergillus cfDNA showed high concordance in the results of conventional diagnostic methods in proven/probable IA of patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations.

Risk factors for COVID-19 associated pulmonary aspergillosis (CAPA) in severe COVID-19 and impact of airborne fungal contamination within negative pressure isolation room

Background. COVID-19 increase the risk of invasive pulmonary aspergillosis. However, the risk factors and fungal origin of COVID-19 associated pulmonary aspergillosis (CAPA) is not fully defined yet. We aim to identify the risk factors for CAPA in severe COVID-19 and evaluate association between fungal contamination within the air of negative pressure rooms and diagnosis of CAPAs. Methods. We performed a retrospective case-control study to identify risk factors for CAPA with 420 severe COVID-19 patients from March 2020 to January 2022 who admitted to a tertiary care hospital in South Korea. CAPA was defined with modified AspICU criteria. Control, matched by admission date and severity of COVID-19 at admission, was selected for each case. Air sampling and fungal culture was done on Jan 2022 with a microbial air sampler (MAS-100NT) at 11 spaces in the COVID-19 designated isolation ward including 9 negative pressure isolation rooms (IRs). A cross-sectional comparison between rooms with and without airborne fungal contamination was performed. Results. A total of 420 COVID-19 patients were hospitalized during the study period, and 51 patients were diagnosed with CAPA (prevalence 12.14%, incidence 6.26 per 1000 patient.day). Multivariate analysis showed that older age (odds ratio [OR] 1.051, 95% confidence intervals [CI] 1.006-1.009, p=0.025), mechanical ventilator use (OR 2.692, 95% CI 1.049-6.911, p=0.04), and lymphopenia (OR 4.353, 95% CI 1.727-10.975, p=0.02) were independent risk factors for CAPA. (Table 1, 2) Aspergillus spp. was identified within the air from 7 out of 11 spaces including 6 IRs and 1 doctors' room. (Figure 1). All 6 IRs with positive aspergillus culture were being occupied by patients at least 8 days. Among 6 patients, 3 had already been diagnosed with CAPA whereas the other 3 were not diagnosed with CAPA through the observation period. Among 4 patients in isolation rooms without airborne aspergillus contamination, one patient had been diagnosed as CAPA before air sampling. (Table 3). Conclusion. Association between CAPA and airborne aspergillus contamination within the negative pressure room could not be demonstrated in this study. Rather than environmental factors, patient factors such as older age, ventilator care, and lymphopenia were found to be associated with CAPA diagnosis.