AI in evaluating ambulation of stroke patients: severity classification with video and functional ambulation category scale.

BACKGROUND: The evaluation of gait function and severity classification of stroke patients are important to determine the rehabilitation goal and the level of exercise. Physicians often qualitatively evaluate patients' walking ability through visual gait analysis using naked eye, video images, or standardized assessment tools. Gait evaluation through observation relies on the doctor's empirical judgment, potentially introducing subjective opinions. Therefore, conducting research to establish a basis for more objective judgment is crucial. OBJECTIVE: To verify a deep learning model that classifies gait image data of stroke patients according to Functional Ambulation Category (FAC) scale. METHODS: Gait vision data from 203 stroke patients and 182 healthy individuals recruited from six medical institutions were collected to train a deep learning model for classifying gait severity in stroke patients. The recorded videos were processed using OpenPose. The dataset was randomly split into 80% for training and 20% for testing. RESULTS: The deep learning model attained a training accuracy of 0.981 and test accuracy of 0.903. Area Under the Curve(AUC) values of 0.93, 0.95, and 0.96 for discriminating among the mild, moderate, and severe stroke groups, respectively. CONCLUSION: This confirms the potential of utilizing human posture estimation based on vision data not only to develop gait parameter models but also to develop models to classify severity according to the FAC criteria used by physicians. To develop an AI-based severity classification model, a large amount and variety of data is necessary and data collected in non-standardized real environments, not in laboratories, can also be used meaningfully.

Feasibility of Computerized Visuomotor Integration System for Visual Field Defects and Spatial Neglect in Poststroke Patients.

OBJECTIVE: To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. METHODS: The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert's test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland-Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. RESULTS: Ten patients with acute stroke completed the study. Bland-Altman plots revealed good agreements for Albert's test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. CONCLUSION: The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

Deep learning model for classifying shoulder pain rehabilitation exercises using IMU sensor.

BACKGROUND: Artificial intelligence is being used for rehabilitation, including monitoring exercise compliance through sensor technology. AI classification of shoulder exercise wearing an IMU sensor has only been reported in normal (i.e. painless) subjects. To prove the feasibility of monitoring exercise compliance, we aimed to classify 11 types of shoulder rehabilitation exercises using an AI (artificial intelligence) algorithm in patients with shoulder pain. We had the patients wear an IMU-based sensor, collected data during exercise, and determined the accuracy of exercise classification. METHODS: Data were collected from 58 patients (27 males, 31 females, age range 37-82 years) diagnosed with shoulder diseases such as adhesive capsulitis and rotator cuff disease. 11 types of shoulder pain rehabilitation exercise programs were developed and repeated each exercise ten times per session while wearing an IMU sensor. The study applied the Rectified Linear Unit (ReLU) and the SoftMax as the activation function for hidden layers, the output layer. RESULTS: The acquired data was used to train a DNN model using the multilayer perceptron algorithm. The trained model was used to classify 11 types of shoulder pain rehabilitation exercises. The training accuracy was 0.975 and the test accuracy was 0.925. CONCLUSION: The study demonstrates that IMU sensor data can effectively classify shoulder pain rehabilitation exercises, providing more appropriate feedback for patients. The model can be utilized to establish a system for remotely monitoring patients' exercise performance. The use of deep learning in patient monitoring and rehabilitation has significant potential to bring innovative changes to healthcare service delivery.

Development research on an AI English learning support system to facilitate learner-generated-context-based learning.

For decades, AI applications in education (AIEd) have shown how AI can contribute to education. However, a challenge remains: how AIEd, guided by educational knowledge, can be made to meet specific needs in education, specifically in supporting learners' autonomous learning. To address this challenge, we demonstrate the process of developing an AI-applied system that can assist learners in studying autonomously. Guided by a Learner-Generated Context (LGC) framework and development research methodology (Richey and Klein in J Comput High Educ 16(2):23-38, https://doi.org/10.1007/BF02961473, 2005), we define a form of learning called "LGC-based learning," setting specific study objectives in the design, development, and testing of an AI-based system that can facilitate Korean students' LGC-based English language learning experience. The new system is developed based on three design principles derived from the literature review. We then recruit three Korean secondary-school students with different educational backgrounds and illustrate and analyze their English learning experiences using the system. Following this analysis, we discuss how the AI-based system facilitates LGC-based learning and further issues to be considered for future research.

Laparoscopic systemic restaging surgery for women with unexpected uterine malignancy.

OBJECTIVE: We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer. METHODS: This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy. RESULTS: The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/m2 (range, 20.75- 31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence. CONCLUSION: Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.

Reliability and Validity of the Korean Version of Disruptive Behavior Disorders Rating Scale, DSM-5 Version-Parent Form.

OBJECTIVE: Disruptive behavior disorder (DBD) adversely impacts children and adolescents. However, a comprehensive and cost-effective scale to assess DBD is lacking in Korea. Therefore, this study translated the Disruptive Behavior Disorders Rating Scale (DBDRS) into Korean and analyzed its psychometric properties. METHODS: Parents and primary caregivers of non-clinical (n=429) and clinical (n=28) children and adolescents aged 6-15 years were included in the analysis. Confirmatory factor analysis was conducted; further, concurrent validity and internal consistency were investigated using correlation analysis and Cronbach's alpha, respectively. Furthermore, discriminative capacity was estimated using receiver operating characteristic curve analysis. RESULTS: The four-factor model of K-DBDRS showed good model fit indices and factor loadings, which supported the construct validity of the scale. Strong correlations between K-DBDRS and related measurements were observed, and a robust level of Cronbach's alpha was confirmed (0.891-0.933). The discriminative capacity of the scale was good, based on the area under the curve values (0.933-0.953). CONCLUSION: This study indicated that the K-DBDRS is an appropriate screening tool for Korean children and adolescents. Thus, this scale can be applied in clinical and community settings to identify children and adolescents with disruptive behavior disorders.

A machine learning approach for predicting suicidal ideation in post stroke patients.

Currently, the identification of stroke patients with an increased suicide risk is mainly based on self-report questionnaires, and this method suffers from a lack of objectivity. This study developed and validated a suicide ideation (SI) prediction model using clinical data and identified SI predictors. Significant variables were selected through traditional statistical analysis based on retrospective data of 385 stroke patients; the data were collected from October 2012 to March 2014. The data were then applied to three boosting models (Xgboost, CatBoost, and LGBM) to identify the comparative and best performing models. Demographic variables that showed significant differences between the two groups were age, onset, type, socioeconomic, and education level. Additionally, functional variables also showed a significant difference with regard to ADL and emotion (p < 0.05). The CatBoost model (0.900) showed higher performance than the other two models; and depression, anxiety, self-efficacy, and rehabilitation motivation were found to have high importance. Negative emotions such as depression and anxiety showed a positive relationship with SI and rehabilitation motivation and self-efficacy displayed an inverse relationship with SI. Machine learning-based SI models could augment SI prevention by helping rehabilitation and medical professionals identify high-risk stroke patients in need of SI prevention intervention.

Psychometric Properties of the Korean Version of the Mental Health Professionals Stress Scale.

Background: Job stress of mental health professionals can have a negative impact on them, particularly their psychological health and mortality, and may also affect organizations' and institutions' ability to provide quality mental health services to patients. Aim: This study aimed to: (1) investigate the validity and reliability of the Korean Mental Health Professionals Stress Scale (K-MHPSS), (2) develop K-MHPSS cut-off points to measure clinical depression and anxiety, and (3) examine whether specific stressors vary by area of expertise. Methodology: Data were collected via an online survey over 3 months, from August to October 2020. An online survey using a survey website was administered to volunteers who accessed the link and consented to participate. Data from 558 participants (200 clinical psychologists, 157 nurses, and 201 social workers) were included in the final analysis. Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the K-MHPSS; concurrent validity of the scale was determined by analyzing correlation; internal consistency was determined by Cronbach's alpha coefficient. In addition, ROC curve analysis and Youden's index were used to estimate optimal cut-off points for K-MHPSS; one-way ANOVA was performed to investigate the difference among the three groups. Results: The seven-factor model of the original scale did not be replicated by Korean mental health professionals. The K-MHPSS had the best fit with the six-factor model, which consists of 34 items. Concurrent validity was confirmed, and overall reliability was found to be good. The K-MHPSS cut-off points for depression and anxiety appeared to slightly different by professional groups. Furthermore, nurses and social workers showed significantly higher total scores compared to clinical psychologists, and there are significant differences in subscale scores among professionals. Conclusion: The Korean version of the MHPSS has appropriate psychometric properties and can be used to assess the occupational stress of mental health professionals. It can also serve as a reference point for screening clinical level of depression and anxiety in mental health professionals.

Correction: Improving the quality of sexual history disclosure on sex offenders: Emphasis on a polygraph examination.

[This corrects the article DOI: 10.1371/journal.pone.0239046.].

A factorial randomized controlled trial to examine separate and combined effects of a simulation-based empathy enhancement program and a lecture-based education program on family caregivers of people with dementia.

OBJECTIVES: The present study was a 2 × 2 factorial randomized controlled trial that examined if a simulation-based empathy enhancement program and a lecture-based education program, together or separately, improved outcomes of family caregivers of people with dementia. METHOD: A total of 101 participants were randomly assigned to simulation-based education only, lecture-based education only, simulation-based education plus lecture-based education, or treatment as usual. Data were analyzed using a two-way analysis of covariance while controlling for pretest results, kinship, and gender. RESULTS: Statistically significant interaction effects between the simulation program and the lecture program were found in the levels of well-being and helplessness. The lecture program accompanied by the simulation program led to higher level of well-being in terms of happiness and lower level of helplessness than the lecture program alone. Caregivers with the lecture program provided led to less frequent use of dysfunctional coping strategies than those with no lecture program provided. Caregivers with the simulation program provided led to more frequent use of emotion-focused coping strategies than those with no simulation program provided. CONCLUSIONS: Findings of the present study support benefits of combined of and separate simulation-based and lecture-based programs on family caregivers of people with dementia in important outcomes affecting quality of care and quality of lives in families of people with dementia. Further studies are needed to identify intervention components that can improve empathy of family caregivers of people with dementia and be embedded into a multicomponent program tailored better to families in different needs.

Improving the quality of sexual history disclosure on sex offenders: Emphasis on a polygraph examination.

The increasing recidivism rate of sex offenders indicates potential problems in existing recidivism programs. The present study was conducted to determine whether the polygraph examination is a useful technique to obtain a sex offender's concealed past sexual history. We collected fifty-two sex offenders' data and analyzed it. Among the 52 participants, the court ordered 26 sex offenders to take the psychiatric evaluation and the polygraph test. The other half were prisoners at the hospital who were currently undergoing treatment. The participants in the polygraph group disclosed more deviant sexual behaviors and paraphilia interests/behaviors than the comparison group. Thus, the polygraph examination is a powerful tool that can encourage sex offenders to disclose hidden information to help create suitable psychological therapy programs for preventing recidivism in the future.

Potential for short-term migration of mineral oil hydrocarbons from coated and uncoated food contact paper and board into a fatty food simulant.

Mineral oil hydrocarbons (MOH) are widely used in the food industry for applications such as printing inks, additives, adhesives, and processing aids for food additives. Recently, the migration of MOH from food contact paper and board into foods has raised public health concerns. In this study, a total of 110 food contact paper and board samples, including baking and cooking paper (23), baking cups (28), food packaging bags (22), lunch boxes (8), party plates (26), and straws (3) were evaluated to quantify the content and short-term migration levels of MOH. The MOH were separated into mineral oil saturated hydrocarbons (MOSH)/polyolefin oligomeric saturated hydrocarbons (POSH) and mineral oil aromatic hydrocarbons (MOAH) via a validated on-line liquid chromatography-gas chromatography-flame ionisation detection (LC-GC-FID) technique. The coating materials of the sample products comprised polyethylene, polypropylene, polyethylene terephthalate, and silicone. The effects of the coating materials on the content and migration of MOH/POSH were evaluated. Quantitative analysis of the MOH in the samples showed that the MOSH/POSH and MOAH content varied widely, ranging from 16 to 5626 mg kg-1 for MOH, regardless of the coating materials. Short-term migration of MOSH/POSH was observed only in samples with polyolefinic coatings, such as polyethylene and polypropylene, in experiments conducted at 25 °C for 10 min, although the extent of MOAH migration for all samples was at the trace level. The migration of MOSH/POSH was detected within the range of 0.93 to 62.3 µg L-1 in 22 samples, and the migration of MOAH was detected within the range of 0.80 to 2.6 µg L-1 in only 4 samples. These results demonstrate that although the short-term migration potential of MOH is generally negligible, the migration of MOSH/POSH into wet fatty foods can be accelerated by polyolefinic coatings, even within a very short time.

The use of motivational interviewing during an interdisciplinary Service-Learning activity for older adults at risk for dementia.

This study aimed to develop a service-learning program based on motivational interviewing for older adults living alone and at risk for dementia. This paper focused on description and implementation of the developed program and students' preliminary outcomes as a mixed-methods pilot study. Participants were nine students in occupational therapy, physical therapy, and social work and three older adults matched to each of the three interdisciplinary student groups. Students' attitudes about community service improved. Also, participation in the program was regarded as a new useful experience that helped in realizing the importance of interprofessional collaboration, expanding knowledge about other disciplines, contributing to the community and professional development, and understanding older adults living alone. Future study should include a larger sample size and measure the program's effectiveness for both the students and older adults.

Experiences of caregivers of people with dementia in a Korean dementia simulation program.

OBJECTIVES: Experiencing dementia-related challenges in a dementia simulation program can be useful for caregivers to understand perspectives of people with dementia possibly leading to improvement in the quality of care and positive outcomes in caregivers and people with dementia. Previous studies about dementia simulation programs have been conducted in Western countries and no research has been conducted in Asian countries. The purpose of this qualitative study was to explore experiences of caregivers of people with dementia who participated in a Korean dementia simulation program. METHODS: A descriptive phenomenological study using thematic analysis with ATLAS.ti 8 software was used. A total of 28 Korean caregivers were interviewed about two weeks after participating in the Korean dementia simulation program that was modified from a program developed in USA by considering Korean cultures. RESULTS: Three key themes with seven subthemes emerged. The present study demonstrated that participation in the program helped caregivers have more empathy, affected their care strategies positively leading to emotional and social benefits on the care dyads, and increased awareness in possible changes due to aging and the risk of dementia. CONCLUSIONS: The present study was the first study that demonstrated caregivers' positive experiences in and benefits from participation in a dementia simulation program in an Asian country. Caregivers in the other Asian countries may have similar benefits from participation in dementia simulation programs.

Cluster analysis of child homicide in South Korea.

BACKGROUND: There has been an insufficient in-depth analysis of the nature and prevalence of the typologies of child homicide in Asia, particularly in South Korea. OBJECTIVE: In the current study, we sought to determine the prevalence and identify the heterogeneity of the child homicide phenomenon in South Korea. PARTICIPANT AND SETTINGS: All 341 original case files (i.e., hospital, police, and autopsy reports) of homicide incidents involving children aged 0-18 in 2016 were obtained from the forensic autopsy archives of the National Forensic Service (NFS), which handles 100 % of the medico-legal autopsies in South Korea. These were examined and reclassified based on our definition. METHOD: A cluster analysis using Gower's distance was applied, which has rarely been utilized in this field of research. By performing a qualitative analysis, we first extracted 70 (numerical, logical, categorical) crime, victim, perpetrator, and household relevant variables, which were later utilized in the cluster analysis. RESULTS: Among the 341 cases from 2016, 95 were judged to be at least suspicious child homicide cases. When applying the cluster analysis, eight sub-clusters were extracted: child torture, maternal filicide, neonaticide, death not related to previous abuse, paternal filicide, paternal infanticide, maternal infanticide, and psychotic killings. CONCLUSIONS: The commonality and the unique aspect of the child homicide phenomenon in South Korea, in comparison with the results from previous research from other countries, are discussed.

Arginase II activity regulates cytosolic Ca2+ level in a p32-dependent manner that contributes to Ca2+-dependent vasoconstriction in native low-density lipoprotein-stimulated vascular smooth muscle cells.

Although arginase II (ArgII) is abundant in mitochondria, Ca2+-accumulating organelles, the relationship between ArgII activity and Ca2+ translocation into mitochondria and the regulation of cytosolic Ca2+ signaling are completely unknown. We investigated the effects of ArgII activity on mitochondrial Ca2+ uptake through mitochondrial p32 protein (p32m) and on CaMKII-dependent vascular smooth muscle cell (VSMC) contraction. Native low-density lipoprotein stimulation induced an increase in [Ca2+]m as measured by CoCl2-quenched calcein-AM fluorescence, which was prevented by Arg inhibition in hAoSMCs and reduced in mAoSMCs from ArgII-/- mice. Conversely, [Ca2+]c analyzed with Fluo-4 AM was increased by Arg inhibition and ArgII gene knockout. The increased [Ca2+]c resulted in CaMKII and MLC 20 phosphorylation, which was associated with enhanced vasoconstriction activity to phenylephrine (PE) in the vascular tension assay. Cy5-tagged siRNA against mitochondrial p32 mRNA (sip32m) abolished mitochondrial Ca2+ uptake and induced activation of CaMKII. Spermine, a polyamine, induced mitochondrial Ca2+ uptake and dephosphorylation of CaMKII and was completely inhibited by sip32m incubation. In mAoSMCs from ApoE-null mice fed a high-cholesterol diet (ApoE-/- +HCD), Arg activity was increased, and spermine concentration was higher than that of wild-type mice. Furthermore, [Ca2+]m and p32m levels were elevated, and CaMKII phosphorylation was reduced in mAoSMCs from ApoE-/- +HCD. In vascular tension experiments, an attenuated response to vasoconstrictors in de-endothelialized aorta from ApoE-/- +HCD was recovered by incubation of sip32m. ArgII activity-dependent production of spermine augments Ca2+ transition from the cytosol to the mitochondria in a p32m-dependent manner and regulates CaMKII-dependent constriction in VSMCs.

Risk assessment of toxicants on WHO TobReg priority list in mainstream cigarette smoke using human-smoked yields of Korean smokers.

Recently, the World Health Organization Study Group on Tobacco Product Regulation (WHO TobReg) announced a priority list of 38 toxicants among the more than 7000 chemicals found in cigarette smoke, building upon previous lists of toxicants in cigarette smoke. Here, we conducted a comprehensive study on the quantitative exposure and risk characterization of these priority toxicants in mainstream cigarette smoke listed by the WHO TobReg. The human-smoked toxicant yields estimated from spent cigarette butts of a total of 361 smokers using the part-filter method (PFM) were applied to current exposure and risk estimation for the first time. The PFM can estimate human-smoked yields of toxicants using smokers' maximum mouth-level exposure. The human-smoked yield of each toxicant was converted to systemic uptake by considering bioavailability. Risk indicators-including the incremental lifetime cancer risk (ILCR), cumulative ILCR, hazard quotient (HQ), hazard indices (HIs), and margin of exposure (MOE)-were estimated from the systemic uptake of toxicants combined with Korean exposure factors by gender and age group as well as for total smokers. It was demonstrated that cigarette smoking results in significant cancer and non-cancer health risks. A sensitivity analysis showed that the human-smoked toxicant yield is one of the most important contributors to risk level variations. Our risk estimation suggested that previous risk assessments might have ignored or underestimated the uncertainty of risk assessment. In conclusion, we assessed the risk level of the 38 toxicants on the priority list developed by the WHO TobReg and provided a Korean-specific priority list for the regulations on the emission of cigarette smoke.

Psychophysiological Responses of People with Psychopathic Tendencies to the Concealed Information Test.

This study was designed to investigate differences in psychophysiological responses among individuals with psychopathic tendencies. A total 40 students were participated and were divided into two groups based on Levenson Self-Report Psychopathy Scale (LSRP) scores: a high psychopathic tendency group selected from the top 5% of LSRP scores, and a low psychopathic tendency group selected from the bottom 5% of LSRP scores. All participants were instructed to perform a mock crime and complete the concealed information test (CIT). Results indicate that significant differences between crime-relevant questions and irrelevant questions were observed for respiration line length and skin conductance response in both groups, but heart rate did not significantly differ between groups. There were no differences in psychophysiological responses between the groups. In conclusion, CIT was found to be an effective method for detecting crime-relevant information in individuals with psychopathic tendencies.

The effects of the academic performance of college students whose major is sports on body composition and abdominal fat rates.

The subjects of this research are 30 students of Dong-Eui Institute of Technology in Busan city, who were grouped into two categories after applying the curriculum of the second semester of the freshman year to their classes: those whose academic performance was at the top 20% (15 students) and those whose academic performance was at the bottom 20% (15 students). For the measurement items, we measured their weight, body fat mass, body fat rates, body mass index, and abdominal fat rates by using a body composition testing machine. We then analyzed the t-test results by using the IBM SPSS ver. 18.0 program. Through this research, we found that there was a significant difference among those in the group of students whose academic performance was at the top 20% in terms of body fat mass and body fat rates, which means that academic performance has relatively little effect on body composition and abdominal fat rates.

The effects of strenuous exercises on resting heart rate, blood pressure, and maximal oxygen uptake.

The purpose of this study is to investigate the effects of strenuous exercises on resting heart rate, blood pressure, and maximal oxygen uptake. To achieve the purpose of the study, a total of 30 subjects were selected, including 15 people who performed continued regular exercises and 15 people as the control group. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation. The difference of mean change between groups was verified through an independent t-test. As a result, there were significant differences in resting heart rate, maximal heart rate, maximal systolic blood pressure, and maximal oxygen uptake. However, the maximal systolic blood pressure was found to be an exercise-induced high blood pressure. Thus, it is thought that a risk diagnosis for it through a regular exercise stress test is necessary.