COVID-19-associated Pulmonary Aspergillosis: A New Entity

In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. This resulted in the discovery of a new clinical Aspergillus disease phenotype, COVID-19-associated pulmonary aspergillosis. This review aimed to collect and share clinical experiences from this new disease. Copyright © 2021 by The Korean Society for Medical Mycology. All right reserved.

A TECHNOLOGY-BASED BODY-MIND INTERVENTION FOR LOW-INCOME AMERICAN OLDER ADULTS

Research is limited on the use of technology to help individuals who have a mismatch between physiological fall risk (Body) and perceived fall risk (Mind) and are unable to access traditional fall interventions. We examined the feasibility and acceptability of a technology-based body-mind intervention in low-income older adults during the COVID-19 pandemic and explored barriers to access and adopting the technology. Data were collected using a survey, balance test, accelerometer-based physical activity (PA), and semi-structured interviews with twenty participants who engaged in an 8-week intervention at a low-income setting in Florida. We found that: 1) the technology-based intervention is feasible, 2) participants tend to accept technology to alter their perceptions of fall risk and balance capacity, 3) tailored activities to each component are not a one-size-fits-all approach. There were no statistically significant changes in sedentary time, light PA, and moderate to vigorous PA between pre and post-intervention.

Mediating Effect of Health Behavior between Meaning in Life and Happiness Related to Aging among Commuity-dwelling Older Adults During COVID-19: A Cross-Sectional Study

Purpose: The purpose of this study was to identify the mediating effect of health behavior between meaning in life and happiness related to aging among community-dwelling older adults during the COVID-19. Methods: The subjects of this study were 140 older adults in D city. Data were collected from July 21 to August 23 in 2020 using structured questionnaires and analyzed with IBM SPSS 25.0 program. Data were analyzed via independent t-test, one-way ANOVA, Pearson's correlation coefficients, and regression following the Baron and Kenny method and Sobel test for identifying mediating effect. Results: Happiness related to aging was positively correlated with meaning in life (r=.33, p<.001) and health behavior (r=.50, p<.001). The result of this study shows that health behavior completely mediated the relationship between meaning in life and happiness related to aging among older adults (Z=4.17, p<.001). Conclusion: It is necessary to promote health behavior to improve the happiness related to aging of older adults, especially during COVID-19. © 2022 Korean Gerontological Nursing Society.

The impact of the COVID-19 on the screening of breast and cervical cancer in Korea

Background: The COVID-19 pandemic has affected use of healthcare services, especially disrupting individual participation in cancer screening programs. The National Cancer Screening Program (NCSP) of Korea provides screening services for six common cancers - stomach, liver, colorectum, breast, cervix, and lung. As complete national lockdown measures were not implemented, the NCSP continued operation during the three major COVID-19 waves in Korea, which allowed us to assess the changes in health-seeking behavior. We examined the cancer screening rates for breast and cervical cancers among NCSP participants in different geographic regions and by age group, in association with the COVID-19 pandemic. Methods: From the National Health Insurance Service database, we obtained information on the number of eligible population and NCSP participants from January 2019 to December 2020. The target group for biennial mammography screening is women aged 40 years and over, and that for biennial pap smear is women aged 20 years and over. We compared monthly screening rates for breast and cervical cancer between 2020 vs 2019 and described them as a percentage change. Results: The overall cancer screening rate has decreased in both cancers in 2020 compared with that of 2019: breast (55.8% vs 63.8%), cervical (52.2% vs 57.8%). Screening rates for both cancers declined in all age groups in March and December of 2020, which corresponds to the first and third COVID-19 wave. The month of March 2020 had the sharpest drop in screening rates, by 57.9% for breast cancer and 43.7% for cervical cancer compared with March 2019. In June 2020, screening rates for both cancers rebounded compared with 2019 (breast, +29.2%;cervical, +26.3%), which remained higher compared with the same months in 2019 until November 2020. By December 2020, screening rates for both cancers have dropped, compared with December 2019 (breast, -19.5%;cervical, -21.0%). For breast cancer, the screening rate decreased in all age groups, and the largest decline was observed in women aged 80 years and over. Although the cervical cancer screening rate has been steadily increasing since 2010, it decreased in all age groups in 2020 compared with that of 2019, with the exception of the 20-29 age group. Considering social distancing measures that were implemented nationwide during each COVID-19 wave, we observed a similar pattern of cancer screening rates in major cities. Conclusions: It was observed that after the two major COVID-19 waves, mammography and pap smear rates declined compared with that of 2019. The largest decline in cancer screening rates was seen in elderly women. The pattern of screening rate changes was comparable according to geographic region. In contrast to reports showing a deficit in cancer screening in other countries, our results suggest a substantial recovery in cancer screening in Korea. Additional analyses are needed to assess the effect of the 6-month extension of NCSP.

Colorectal and gastric cancer screening rates in Korea during the COVID-19 pandemic

Background: The COVID-19 pandemic has disrupted healthcare delivery, which is widely discussed as the distraction effect. This study aimed to estimate the distraction effect of the COVID-19 pandemic in Korea by analyzing colorectal and gastric cancer screening rates in the years 2019 and 2020. Methods: Information of eligible population who had colorectal and gastric cancer screening provided by the National Cancer Screening Program in the years 2019 and 2020 was collected. Participation rates were analyzed by age group, sex, geographic region, and calendar month. Percentage change was calculated by dividing the percentage point difference by the screening rate of the reference period (2019). Results: Overall, the colorectal and gastric cancer screening rates had decreased in 2020, compared to the reference period. For colorectal cancer, the screening rate decreased from 68.3% in 2019 (5,886,319 participants/14,526,424 eligible population) to 54.6% in 2020 (5,135,218/9,410,525) For gastric cancer, the screening rates decreased from 61.9% in 2019 (7,194,489/11,625,627) to 54.6% in 2020 (6,244,491/11,439,246). In March, during the first wave, the screening rates declined sharply (percentage change: colorectal, 56.6%;gastric, 57.3%). Although the screening rates had rebounded aftermath, they declined again in December, during the third wave (percentage change: colorectal, 17.0%;gastric, 13.8%). According to specific-age group, we found a substantial decline in screening rates for older adults aged 80∼84, and those over 85 (percentage change: colorectal, 19.0% & 23.0%;gastric, 17.4% & 25.1% respectively). Conclusion: During the COVID-19 pandemic, the screening rates for both colorectal and gastric cancer decreased. There was a substantial decline during the first and the third waves of the epidemic, in March and in December. The older adults group showed the highest reduction in screening rates. However, comparing the screening rate by region and sex, we did not find a significant difference. Delayed cancer diagnosis or excess death due to distraction effect of the COVID-19 pandemic has not yet been detected in Korea, therefore, further studies are needed.

A vertical laminar airflow system to prevent aerosol transmission of SARS-CoV-2 in building space: Computational fluid dynamics (CFD) and experimental approach

Respiratory aerosol particles carrying the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) are a primary cause of the long-distance infection, and insufficient ventilation systems make building occupants highly prone to the coronavirus disease-2019 (COVID-19). As a preventive measure of the aerosolized viable SARS-CoV-2 suspension in building space, we seek to propose an optimal design of the upper-room/drop-ceiling aeration grid system generating vertical laminar airflow (VLAF) as an aerosol barrier. On a test plan (6.1 × 4.7 m) representing the standard hospital patient room in South Korea (a 2.7 m-height room of 77.4 m3 in volume), we investigated the air-terminal size, spacing and air speed that shape uniform downflow of fresh air, minimizing horizontal spread. Our simulation results using the Taguchi method and computational fluid dynamics (CFD) in presence of indoor human expiration indicated that a steady vertical air supply of 0.3 m/s through 0.04m-diameter air diffusers deployed by 0.5 m spacing is the most effective to form VLAF. Physical particle detection tests at the height of 1.5 m in mockup setting of the optimal system design, revealed that expiratory aerosols produced by a single person were almost entirely removable in 20 s. Investigations also confirmed that the proposed design could minimize stagnant airflow regions and would potentially satisfy the indoor air-speed condition for occupant thermal comfort.

Inspiratory leakage flow fraction for surgical masks with varying gaps and filter materials

Leakage flows due to a poor fit can greatly reduce the mask protection efficiency. However, accurate quantification of leakages is lacking due to the absence of standardized tests and difficulties in quantifying mask gaps. The objective of this study is to quantify the leakage flows around surgical masks with gaps of varying areas and locations. An integrated ambient-mask-face-airway model was developed with a pleated surgical mask covering an adult's face, nose, and chin. To study the gap effects, the mask edge along the facile interface was divided into different domains, which could be prescribed either as the mask media or air. A low Reynolds number k-omega turbulence model with porous media was used to simulate inspiratory flows. Experimentally measured resistances of two surgical masks were implemented in porous media zones. Results show that even a small gap of 1-cm(2) area could cause a 17% leakage. A gap area of 4.3 cm(2) at the nose bridge, the most frequent misfit when wearing a surgical mask, led to a leakage of 60%. For a given mask, the increase rate of leakage slowed down with the increasing gap area. For a given gap, the leakage fraction is 30-40% lower for a mask with a resistance of 48.5 Pa than a mask of 146.0 Pa. Even though the flow dynamics were very different among gaps at different locations, the leakage intensity appeared relatively insensitive to the gap location. Therefore, correlations for the leakage as a function of the gap area were developed for the two masks.

A phase 2 study evaluating the addition of ublituximab and umbralisib (U2) to ibrutinib in patients with chronic lymphocytic leukemia (CLL): A minimal residual disease (MRD)-driven, time-limited approach

Background: While time-limited novel agent combinations have demonstrated high overall response rates and durable responses for patients with chronic lymphocytic leukemia (CLL), they also have high rates of adverse events and possibly overtreat many favorable risk patients. Meanwhile, patients receiving indefinite ibrutinib monotherapy are at risk for cumulative toxicity and acquired resistance with continuous exposure. To address these challenges, we utilized an 'add-on' approach to combination therapy after a period of ibrutinib monotherapy exposure. We examined the addition of umbralisib (a selective PI3Kδ and casein kinase-1epsilon [CK1ϵ] inhibitor) and ublituximab (a novel anti-CD20 monoclonal antibody glycoengineered for enhanced antibody-dependent cellular cytotoxicity;U2) to ibrutinib in CLL patients with detectable minimal residual disease (MRD) after an initial period of treatment with ibrutinib monotherapy. With this strategy, we aimed to induce undetectable MRD (uMRD), minimize the risk of developing BTKi resistance mutations, stop all CLL-directed therapy, and achieve a durable treatment-free observation (TFO) period in CLL patients who would most benefit from combination therapy. Methods: This is a phase II, multicenter, open label clinical trial (NCT04016805). Eligible patients were receiving ongoing ibrutinib, in any line of therapy, for a minimum duration of 6 months and had detectable residual CLL in the peripheral blood via MRD assay (flow cytometry with a cutoff of 10

ASSOCIATION BETWEEN SYMPTOM DURATION AND CLINICAL OUTCOMES IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION

Background Although the number of patients presenting with non-ST elevation myocardial infarction (NSTEMI) has drastically reduced in the coronavirus-19 pandemic era, increased mortality was reported. A plausible explanation for increased mortality was suggested as the delay of arrival at the hospital due to patients’ reticence of their symptoms. However, evidence to support the suggested explanation is lacking. Methods From the nationwide prospective registry, we evaluated 6,544 patients with NSTEMI. Study patients were categorized into two groups according to their symptom-to-door (StD) time (<24 h or ≥24 h). The primary outcome was 3-year all-cause mortality, and the secondary outcome was 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure. Results Overall, 27.9% patients were classified into the StD time ≥24 h group. The StD time ≥24 h group had higher all-cause mortality (17.0% vs. 10.5%, p<0.001) and incidence of secondary outcome (23.3% vs. 15.7%, p<0.001) than the StD time <24 h group. In the multivariable analysis, independent predictors of delayed arrival at the hospital were the elderly, female, non-specific symptoms such as atypical chest pain or dyspnea, diabetes, and no use of emergency medical services. Conclusion Delayed arrival (StD time ≥24 h) is associated with an increased risk of 3-year all-cause mortality and composite outcomes in patients with NSTEMI. [Formula presented]

Scalable Lightweight Blockchain-Based Authentication Mechanism for Secure VoIP Communication

Currently, the world is experiencing a global pandemic due to the spread of coronavirus disease 2019 (COVID-19), a disease stemming from a novel coronavirus. The main measure used to contain the rapid spread and to control this virus’s contamination rate is social distancing. This method has dramatically affected citizens’ daily lives. To this end, replacing face-to-face meetings with virtual meetings using cloud videoconferencing application solutions has emerged. This approach has indeed solved this problem for millions of schools, companies, governments, and individuals worldwide. However, security and privacy concerns arise. The number of videoconferencing users has increased during the pandemic, yet some applications offer only unencrypted communication for unpaid users. Moreover, uninvited attendees can join virtual meetings, collect sensitive information about users and shared files, and participate in them using deepfake tools. To resolve this dilemma, we propose in this paper a lightweight, scalable blockchain-based authentication mechanism to secure cloud videoconferencing. Private blockchain, as a decentralized network, can handle user authentication and provide complete data privacy to shared information in a virtual meeting. Moreover, to reduce the latency and mining processing overhead and for scalability of the system, we use a time-based consensus algorithm. Our simulation shows very low latency results, perfect for a video system © 2022, Human-centric Computing and Information Sciences.All Rights Reserved.

The effects of COVID-19 on physician's burnout: A systematic review

Background: To suggest measures to prevent burnout of physicians during the coronavirus disease 2019 (COVID-19) pandemic, we conducted a systematic review of research on physician burnout due to COVID-19. Methods: Three foreign databases were used: MEDLINE, Embase, and the Cochrane Library. A search was performed using the following search terms: COVID-19, coronavirus, NCOV, physicians, doctors, residents, and burnout. Four rounds of review were performed to enhance the consistency of quality assessment. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to assess the quality of the eligible studies. Results: A total of 465 studies were identified, of which 32 were selected. The quality assessment determined that 19 studies met the Joanna Briggs Institute criteria and had a low risk of bias. The most common tool used to measure physician burnout in the 32 studies was the Maslach Burnout Inventory. Conclusion: This study systematically evaluated the literature on physician burnout. However, the generalizability of our findings to Korean physicians may be limited. The composition of the medical personnel in Korea, such as open doctors, volunteer doctors, medical professors, and public health doctors, differs significantly from that of other countries. Nevertheless, evaluating the current status of physician burnout due to COVID-19 globally may hold meaningful implications for policymaking.

Boba, milk, and toilet paper lessons from the pandemic

This article examines the disruptions in the boba, milk, and toilet paper supply chains during the COVID-19 pandemic, exposing characteristically different vulnerabilities in each supply chain. Although the three examples that we investigate in this article are just a few from many disruptions during the pandemic, we find that the underlying risks and insights gained from each instance apply to many other disruptions. © 2021 Pepperdine University.

Anti-SARS-CoV-2 Nucleoprotein Antibodies Derived from Pig Serum with a Controlled Specificity

Antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein (NP) were purified from pig serum through two steps: (1) isolation of anti-NP IgG antibodies using magnetic beads with immobilized human SARS-CoV-2 NP and (2) filtration of anti-spike protein (SP) IgG antibodies using magnetic beads with immobilized human SARS-CoV SP. The enhanced specificity of the purified antibodies to the NP of SARS-CoV-2 was demonstrated using an immunoassay with anti-NP IgG antibodies after the isolation and filtration steps. The binding constants (K-d) of the purified anti-NP IgG antibodies to the NP of SARS-CoV-2 and the SP of SARS-CoV were estimated using a surface plasmon resonance biosensor (SPR). A competitive assay using the two-step purified anti-NP IgG antibodies from pig serum demonstrated (a) the detection of SARS-CoV-2 in viral fluid and (b) the discrimination of SARS-CoV-2 from SARS-CoV, MERS-CoV, and CoV strain 229E in viral fluids.

Factors that affect the performance of covid-19 infection management administration in general hospitals

Background: This study aimed to provide basic data for the development of COVID-19 infection management educational programs by confirming the factors that affect the performance of COVID-19 infection management administration in general hospitals. Method: Data was collected from administrative staff at 192 general hospitals by means of a structuralized questionnaire, and SPSS Ver. 21.0 software was used for data analysis. Conclusion: The extent of knowledge and execution of COVID-19 infection management processes by administrative staff in general hospitals was positively correlated with the extent of educational demand for COVID-19 infection management, with explanatory power of 16.7%. It is necessary to include factors including COVID-19 transmission route, transmission prevention, and staff safety in COVID-19 infection management educational program administration. In addition, it is essential also to performance COVID-19 infection management education.

The impact of airport managerial type and airline market share on airport efficiency

This paper investigates the impact of airport managerial type and airline market structure on airport efficiency. It explores whether the market shares of the largest airlines differ depending on the managerial type of the airport. In this study, the efficiency scores for the sample airport are measured through DEA (Data Envelop Analysis), and the impacts of the airport managerial type and dominant carrier market share on airport efficiency are subsequently estimated through CEM (Coarsened Exact Matching). This paper concludes that group airports are more efficient than the standalone airports, and the market shares of the largest airlines have a positive impact on enhancing airport efficiency. In addition, the market shares of the largest airlines are found to be higher for group airports than for standalone airports. These findings can serve as practical guidelines for governments and airport authorities by suggesting that efficiency improves when multiple standalone airports are operated as a group through the M&A of airports or the establishment of airport operation agencies. While facing unprecedented challenges from the spread of COVID 19, this paper also suggests that an increase in airline market share through airport–airline cooperation has a positive impact on airport efficiency. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Financial loss of medical clinics resulted from the COVID-19 outbreak in Korea

As the world is facing an infectious disease pandemic caused by coronavirus disease 2019 (COVID-19), medical institutions are experiencing significant financial losses. we attempted to estimate such financial losses through a survey of clinics that reported temporary closure due to COVID-19 to the Korean Medical Association. As a result, the data of 56 clinics were obtained. The average closure period was 6.7 days, and the overall number of related health insurance claims and loss of sales reached 13,408,000 Korean won (KRW) and 20,911,000 KRW, respectively, while daily losses reached 1,343,000 and 2,202,000 KRW, respectively. In addition, the monthly average health insurance claims and sales were compared to those of the same month of the previous year. In January, they slightly increased by 4.4% and 7.8%, respectively, whereas in February, they slightly decreased by 10.2% and 12.4%, respectively. In March, they significantly decreased by 46.8% and 49.8%, respectively, as COVID-19 was at its peak. Considering the financial losses of clinics that played a pivotal role in quarantine at the forefront of infectious diseases, the government should prepare a reasonable compensation plan for such losses.

Blockchain-based secure digital twin framework for smart healthy city

Nowadays, Digital Twins (DTs) are being integrated into various sectors thanks to the continuous progress of computing power and data science. We are surrounded by a tremendous number of sensors and connected objects that produce data regularly. These data represent the fuel for a DT as they are used to represent the most accurate digital model of a system or an object and to predict and simulate all the possible scenarios. Recently, DT has been adapted into the healthcare sector as well for an accurate medical and surgery simulation and medical resources’ orchestration. However, DT technology is still a novice to the healthcare system and security threats urge immediate consideration. To this end, we propose in this paper a Blockchain-based secure Digital Twin framework for a smart healthy city. We discuss as a case study the current COVID-19 pandemic and argue on the help of DT to control the situation, prevent future cases, and personalize the treatment. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.