Risk prediction model for gastric cancer within 5 years in healthy Korean adults.

BACKGROUND: Although endoscopy is commonly used for gastric cancer screening in South Korea, predictive models that integrate endoscopy results are scarce. We aimed to develop a 5-year gastric cancer risk prediction model using endoscopy results as a predictor. METHODS: We developed a predictive model using the cohort data of the Kangbuk Samsung Health Study from 2011 to 2019. Among the 260,407 participants aged ≥20 years who did not have any previous history of cancer, 435 cases of gastric cancer were observed. A Cox proportional hazard regression model was used to evaluate the predictors and calculate the 5-year risk of gastric cancer. Harrell's C-statistics and Nam-D'Agostino χ2 test were used to measure the quality of discrimination and calibration ability, respectively. RESULTS: We included age, sex, smoking status, alcohol consumption, family history of cancer, and previous results for endoscopy in the risk prediction model. This model showed sufficient discrimination ability [development cohort: C-Statistics: 0.800, 95% confidence interval (CI) 0.770-0.829; validation cohort: C-Statistics: 0.799, 95% CI 0.743-0.856]. It also performed well with effective calibration (development cohort: χ2 = 13.65, P = 0.135; validation cohort: χ2 = 15.57, P = 0.056). CONCLUSION: Our prediction model, including young adults, showed good discrimination and calibration. Furthermore, this model considered a fixed time interval of 5 years to predict the risk of developing gastric cancer, considering endoscopic results. Thus, it could be clinically useful, especially for adults with endoscopic results.

Immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination among nursing home residents-Georgia, October 2020-July 2022.

BACKGROUND: Understanding the immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination is important in nursing home (NH) residents, a high-risk population. METHODS: An observational longitudinal evaluation of 37 consenting vaccinated NH residents with/without SARS-CoV-2 infection from October 2020 to July 2022 was conducted to characterize the immune response to spike protein due to infection and/or mRNA COVID-19 vaccine. Antibodies (IgG) to SARS-CoV-2 full-length spike, nucleocapsid, and receptor binding domain protein antigens were measured, and surrogate virus neutralization capacity was assessed using Meso Scale Discovery immunoassays. The participant's spike exposure status varied depending on the acquisition of infection or receipt of a vaccine dose. Longitudinal linear mixed effects modeling was used to describe trajectories based on the participant's last infection or vaccination; the primary series mRNA COVID-19 vaccine was considered two spike exposures. Mean antibody titer values from participants who developed an infection post receipt of mRNA COVID-19 vaccine were compared with those who did not. In a subset of participants (n = 15), memory B cell (MBC) S-specific IgG (%S IgG) responses were assessed using an ELISPOT assay. RESULTS: The median age of the 37 participants at enrollment was 70.5 years; 30 (81%) had prior SARS-CoV-2 infection, and 76% received Pfizer-BioNTech and 24% Moderna homologous vaccines. After an observed augmented effect with each spike exposure, a decline in the immune response, including %S IgG MBCs, was observed over time; the percent decline decreased with increasing spike exposures. Participants who developed an infection at least two weeks post-receipt of a vaccine were observed to have lower humoral antibody levels than those who did not develop an infection post-receipt. CONCLUSIONS: These findings suggest that understanding the durability of immune responses in this vulnerable NH population can help inform public health policy regarding the timing of booster vaccinations as new variants display immune escape.

Continuous Glucose Monitoring-Guided Insulin Administration in Long-Term Care Facilities: A Randomized Clinical Trial.

OBJECTIVES: To evaluate the efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF). DESIGN: Prospective randomized clinical trial. SETTINGS AND PARTICIPANTS: Insulin-treated patients with type 2 diabetes (T2D) admitted to LTCF. METHODS: Participants in the standard of care wore a blinded CGM with treatment adjusted based on point-of-care capillary glucose results before meals and bedtime (POC group). Participants in the intervention (CGM group) wore a Dexcom G6 CGM with treatment adjusted based on daily CGM profile. Treatment adjustment was performed by the LTCF medical team, with a duration of intervention up to 60 days. The primary endpoint was difference in time in range (TIR 70-180 mg/dL) between treatment groups. RESULTS: Among 100 participants (age 74.73 ± 11 years, 80% admitted for subacute rehabilitation and 20% for nursing home care), there were no significant differences in baseline clinical characteristics between groups, and CGM data were compared for a median of 17 days. There were no differences in TIR (53.38% ± 30.16% vs 48.81% ± 28.03%, P = .40), mean daily mean CGM glucose (184.10 ± 43.4 mg/dL vs 190.0 ± 45.82 mg/dL, P = .71), or the percentage of time below range (TBR) <70 mg/dL (0.83% ± 2.59% vs 1.18% ± 3.54%, P = .51), or TBR <54 mg/dL (0.23% ± 0.85% vs 0.56% ± 2.24%, P = .88) between rt-CGM and POC groups. CONCLUSIONS AND IMPLICATIONS: The use of rtCGM is safe and effective in guiding insulin therapy in patients with T2D in LTCF resulting in a similar improvement in glycemic control compared to POC-guided insulin adjustment.

Driver behavior and mental workload for takeover safety in automated driving: ACT-R prediction modeling approach.

OBJECTIVE: Conditional automated driving (SAE level 3) requires the driver to take over the vehicle if the automated system fails. The mental workload that can occur in these takeover situations is an important human factor that can directly affect driver behavior and safety, so it is important to predict it. Therefore, this study introduces a method to predict mental workload during takeover situations in automated driving, using the ACT-R (Adaptive Control of Thought-Rational) cognitive architecture. The mental workload prediction model proposed in this study is a computational model that can become the basis for emerging crash avoidance technologies in future autonomous driving situations. METHODS: The methodology incorporates the ACT-R cognitive architecture, known for its robustness in modeling cognitive processes and predicting performance. The proposed takeover cognitive model includes the symbolic structure for repeatedly checking the driving situation and performing decision-making for takeover as well as Non-Driving-Related Tasks (NDRT). We employed the ACT-R cognitive model to predict mental workload during takeover in automated driving scenarios. The model's predictions are validated against physiological data and performance data from the validation test. RESULTS: The model demonstrated high accuracy, with an r-square value of 0.97, indicating a strong correlation between the predicted and actual mental workload. It successfully captured the nuances of multitasking in driving scenarios, showcasing the model's adaptability in representing diverse cognitive demands during takeover. CONCLUSIONS: The study confirms the efficacy of the ACT-R model in predicting mental workload for takeover scenarios in automated driving. It underscores the model's potential in improving driver-assistance systems, enhancing vehicle safety, and ensuring the efficient integration of human-machine roles. The research contributes significantly to the field of cognitive modeling, providing robust predictions and insights into human behavior in automated driving tasks.

Prostate cancer risk prediction based on clinical factors and prostate-specific antigen.

INTRODUCTION: The incidence rate of prostate cancer (PCa) has continued to rise in Korea. This study aimed to construct and evaluate a 5-year PCa risk prediction model using a cohort with PSA < 10 ng/mL by incorporating PSA levels and individual factors. METHODS: The PCa risk prediction model including PSA levels and individual risk factors was constructed using a cohort of 69,319 participants from the Kangbuk Samsung Health Study. 201 registered PCa incidences were observed. A Cox proportional hazards regression model was used to generate the 5-year risk of PCa. The performance of the model was assessed using standards of discrimination and calibration. RESULTS: The risk prediction model included age, smoking status, alcohol consumption, family history of PCa, past medical history of dyslipidemia, cholesterol levels, and PSA level. Especially, an elevated PSA level was a significant risk factor of PCa (hazard ratio [HR]: 1.77, 95% confidence interval [CI]: [1.67-1.88]). This model performed well with sufficient discrimination ability and satisfactory calibration (C-statistic: 0.911, 0.874; Nam-D'Agostino test statistic:19.76, 4.21 in the development and validation cohort, respectively). CONCLUSIONS: Our risk prediction model was effective in predicting PCa in a population according to PSA levels. When PSA levels are inconclusive, an assessment of both PSA and specific individual risk factors (e.g., age, total cholesterol, and family history of PCa) could provide further information in predicting PCa.

Persistence or regression of prediabetes and coronary artery calcification among adults without diabetes.

OBJECTIVE: The effect of changes in glycemic status on subclinical atherosclerosis is uncertain. We assessed the association of persistence, regression, or progression of prediabetes with coronary artery calcium score (CACS) as a measure of subclinical atherosclerosis. DESIGN: A cross-sectional study, comprising 126 765 adults, and longitudinal sub-study, comprising 40 622 adults (with baseline and at least 1 follow-up computed tomography scan to assess changes in CACS), were undertaken. METHODS: Changes in glycemic status over 1.5 years (interquartile range, 1.0-2.0) before the first CACS assessment were categorized according to 6 groups: persistent normoglycemia (reference), normoglycemia to prediabetes, normoglycemia to diabetes, prediabetes to normoglycemia, persistent prediabetes, and prediabetes to diabetes. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs for prevalent coronary artery calcification (CAC). Mixed models with random intercepts and random slopes were used to estimate 5-year CAC progression rates. RESULTS: Mean (SD) age was 41.3 (7.0) years (74.7% male) (n = 126 765). Multivariable-adjusted OR for prevalent CAC was 1.13 (95% CI, 1.08-1.18) for persistent prediabetes, 1.05 (0.98-1.12) for regression to normoglycemia, and 1.46 (95% CI, 1.27-1.67) for progression from prediabetes to diabetes, compared with persistent normoglycemia. Coronary artery calcification progression increased significantly in all prediabetes groups. Multivariable-adjusted ratio of 5-year CAC progression rates was 1.19 (95% CI, 1.16-1.22) (persistent prediabetes), 1.11 (1.07-1.14) (regression to normoglycemia), and 1.63 (95% CI, 1.26-2.10) (progression from prediabetes to diabetes). CONCLUSIONS: Unfavorable changes in glycemic status, including persistence of prediabetes or progression to diabetes from prediabetes, were associated with increased risk of CAC.

Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex.

The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (n = 151,017) were followed up for a median of 3.7 years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis-4 index (FIB-4) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex-specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56-3.99) for men and 11.69 (10.46-13.06) for women (p-interaction by sex < 0.001). For incident NAFLD with intermediate/high FIB-4, aHRs were 2.83 (2.19-3.64) for men and 7.96 (3.85-16.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time-varying covariates. These associations were also more pronounced in nonobese than obese participants (p-interaction < 0.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity. Conclusion: Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.

Fatty liver disease and changes in dense breasts in pre- and postmenopausal women: the Kangbuk Samsung Health Study.

PURPOSE: While increased breast density is a risk factor for breast cancer, the effect of fatty liver disease on breast density is unknown. We investigated whether fatty liver is a risk factor for changes in breast density over ~ 4 years of follow-up in pre- and postmenopausal women. METHODS: This study included 74,781 middle-aged Korean women with mammographically determined dense breasts at baseline. Changes in dense breasts were identified by more screening mammograms during follow-up. Hepatic steatosis (HS) was measured using ultrasonography. Flexible parametric proportional hazards models were used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), and a Weibull accelerated failure time model (AFT) was used to determine the time ratios (TRs) and 95% CIs. RESULTS: During a median follow-up of 4.1 years, 4022 women experienced resolution of the dense breasts. The association between HS and dense breast resolution differed by the menopause status (P for interaction < 0.001). After adjusting for body mass index and other covariates, the aHRs (95% CI) for dense breast resolution comparing HS to non-HS were 0.81 (0.70-0.93) in postmenopausal women, while the association was converse in premenopausal women with the corresponding HRs of 1.30 (1.18-1.43). As an alternative approach, the multivariable-adjusted TR (95% CI) for dense breast survival comparing HS to non-HS were 0.81 (0.75-0.87) and 1.19 (1.06-1.33) in premenopausal and postmenopausal women, respectively. CONCLUSION: The association between HS and changes in dense breasts differed with the menopause status. HS increased persistent dense breast survival in postmenopausal women but decreased it in premenopausal women.

Elucidation of the bacterial communities associated with the harmful microalgae Alexandrium tamarense and Cochlodinium polykrikoides using nanopore sequencing.

Interactions between microalgae and bacteria are often obligatory for harmful algal blooms (HABs). Here, we investigated the specific bacterial communities associated with Alexandrium tamarense and Cochlodinium polykrikoides, which cause ecological and economic damage during their blooms. To this end, the bacterial metagenome was selectively isolated from the two dinoflagellates and subsequently used for 16S rRNA analysis via the Nanopore MinION and Illumina sequencing platforms. Although the full-length 16S rRNA reads from the MinION platform showed high correlation in higher taxonomic ranks to the partial-length 16S rRNA reads from the Illumina platform, there was less correlation at the genus and species levels. MinION reads that are similar in the V3-V4 hypervariable regions with Illumina reads are classified to different taxonomies due to the extra information encoded in the full-length 16S rRNA reads. This indicates that bias arising from the short length Illumina reads can be supplemented by MinION reads. Furthermore, integrated analysis of the Illumina and MinION data showed that A. tamarense was predominantly enriched in the Roseobacter clade and C. polykrikoides was enriched in Gammaproteobacteria and Alphaproteobacteria. These results suggest that the association of different bacterial communities with A. tamarense and C. polykrikoides may be required for HABs.

Periphyton effects on bacterial assemblages and harmful cyanobacterial blooms in a eutrophic freshwater lake: a mesocosm study.

Periphyton comprises a broad range of autotrophic and heterotrophic organisms that grow on submerged surfaces in aquatic environments. To investigate the ecological roles of periphyton and their symbiotic bacterial assemblages related to the control of cyanobacterial blooms, mesocosm experiments were performed in a eutrophic lake that is usually infested with harmful cyanobacterial blooms. Our results showed that periphyton, together with their symbionts, reduced Chl-a concentrations (up to 94%), improved water clarity and effectively controlled cyanobacterial blooms in the treatment mesocosm. Planktonic bacterial compositions varied greatly in the pre-bloom/bloom/post-bloom periods in both mesocosms and were mainly influenced by total dissolved nitrogen (TDN) concentrations. The phylum Cyanobacteria was the major component in the water samples until bloom peak, but it was replaced by Actinobacteria in the post-bloom period. However, periphyton niches were dominated by Alphaproteobacteria throughout the experiments, Cyanobacteria proportion being lower. Overall, the results indicated that periphyton and their unique bacterial partners could effectively compete with cyanobacteria and improve water quality. Their underlying interaction mechanism was also suggested to explain how periphyton and their symbionts can reduce cyanobacterial blooms in eutrophic water.

Effects of Environmental Factors on Cyanobacterial Production of Odorous Compounds: Geosmin and 2-Methylisoborneol.

Geosmin and 2-methylisoborneol (2-MIB), responsible for earthy or musty smell, are a major concern for safe drinking water supplies. This study investigated the effects of environmental factors on odorous compound production and cell growth in cyanobacterial strains. Anabaena sp. FACHB-1384, a 2-MIB producer, was sensitive to low temperature (<20°C). However, geosmin producers, Anabaena sp. Chusori and Anabaena sp. NIER, were sensitive to high light intensity (>100 µmol/m2/sec), but not to low temperature. Geosmin concentrations increased under higher nitrate concentrations, being linearly proportional to cell density. A P-limited chemostat showed that P-stress decreased the geosmin productivity and extracellular geosmin amount per cell in Anabaena sp. NIER. However, only 2-MIB productivity was reduced in Planktothrix sp. FACHB-1374 under P-limitation. The extracellular 2-MIB amount per cell remained constant at all dilution rates. In conclusion, high light intensity and P-stress can contribute to the lower incidence of geosmin, whereas 2-MIB reduction could be attainable at a lower temperature.

Two-phase photoperiodic cultivation of algal-bacterial consortia for high biomass production and efficient nutrient removal from municipal wastewater.

This study investigated the photoperiodic effects on the biomass production and nutrient removal in the algal-bacterial wastewater treatment, under the following three conditions: (1) a natural 12h:12h LD cycle, (2) a dark-elongated 12h:60h LD cycle, and (3) a two-phase photoperiodic 12h:60h LD, followed by 12h:12h LD cycles. The two-phase photoperiodic operation showed the highest dry cell weight and lipid productivity (282.6mgL(-1)day(-1), 71.4mgL(-1)day(-1)) and most efficient nutrient removals (92.3% COD, 95.8% TN, 98.1% TP). The genetic markers and sequencing analyses indicated rapid increments of bacteria, subsequent growths of Scenedesmus, and stabilized population balances between algae and bacteria. In addition, the two-phase photoperiod provided a higher potential for the algal-bacterial consortia to utilize various organic carbon substrates.

Effects of Titanium Doping Concentration on the Structural and Electrical Properties of Sputtered Indium Oxide Films.

The surface structure and electrical properties of titanium-doped indium oxide (ITiO) films prepared by RF magnetron sputtering were investigated. The doping concentration of TiO2 in the In2O3 target was changed from 1.0 wt.% to 10.0 wt.% with increments of 1.0 wt.%. At a Ti content of 5.0 wt.%, the optimum growth conditions were achieved. The finest value of hall mobility, carrier concentration, and resistivity of the deposited film reached 47.03 cm2Ns, 1.148 x 10(21) cm-3 and 1.14 x 10(-4) Ωcm, respectively. Then the transmittance was achieved up to 82% at 570 nm. The peaks of the XRD spectra became more intense and sharp as the Ti concentration increased up to 2.5 wt.% but a higher Ti content of 10.0 wt.% retarded a growth of In2O3 grains. The surface roughness of the films by examination of surface morphology using AFM also rose with increase of Ti doping concentration.

Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey.

BACKGROUND: The relationship between economics and health has been of great interest throughout the years. The accumulated data is not sufficient enough to carry out long-term studies from the viewpoint of morbidity, although Korea National Health and Nutrition Examination Survey (KNHANES) was carried out yearly since 1998 in Korea. Thus, we investigated the effect of the 2008 global economic crisis on health indicators of Korea. METHODS: Health indicators were selected by paired t-test based on 2007 and 2009 KNHANES data. Age, gender, body mass index (BMI), smoking, drinking, exercise, education, income, working status, and stress were used as confounding factors, which were analyzed with logistic and probit analyses. Validation was done by comparing gross domestic product (GDP) growth rates and probit analyses results of 2007-2012 KNHANES data. RESULTS: Among several health indicators, the prevalence of hypertension and stress perception was higher after the economic crisis. Factors related with higher hypertension prevalence include older age, male gender, higher BMI, no current tobacco use, recent drinking, lower education levels, and stress perception. Factors related with more stress perception were younger age, female gender, current smoking, lower education levels, and lower income. GDP growth rates, a macroeconomic indicator, are inversely associated with hypertension prevalence with a one-year lag, and also inversely associated with stress perception without time lag. CONCLUSION: The economic crisis increased the prevalence of hypertension and stress perception. In the case of GDP growth rate change, hypertension was an inversely lagging indicator and stress perception was an inversely-related coincident indicator.

Do People Have Healthier Lifestyles in Greener Environments? An Analysis of the Association between Green Environments and Physical Activity in Seven Large Korean Cities.

BACKGROUND: Recent studies suggest that neighborhood environments influence levels of health and disease in individuals. Evidence suggests that green environments have positive effects on physical and psychological health. In this study, we examined the association between public park per person (PPP) and physical activity in 7 large Korean cities with a population of over 1 million. METHODS: We obtained data from the third Korea National Health and Nutritional Survey and data on the area of PPP from the Korean national statistics office. RESULTS: Physical activity and adjusted mean of physical activity increased significantly with PPP. When stratified by family income, physical activity increased significantly in all groups in a PPP-dependent manner. Physical activity significantly increased as PPP increased (coefficient, 16.025; 95% confidence interval, 12.392 to 19.658) before and after adjustment for age, sex, and family income. Physical activity increased in all income groups including the low income group. CONCLUSION: These results show that green park spaces independently promote physical activity and influence healthy lifestyles. Therefore, the importance of PPP for physical activity and health should be emphasized in urban planning.