Assessing the Effectiveness of Simulation-Based Education in Emerging Infectious Disease Management: A Systematic Review and Meta-analysis.

SUMMARY STATEMENT: This systematic review and meta-analysis aimed to thoroughly examine the effectiveness of simulation-based education in the management of emerging infectious diseases, focusing on educational content and methods. Studies published between 2000 and 2022 were identified, and a meta-analysis was conducted using a random-effects model. The findings revealed that simulation-based education significantly enhances various competencies related to managing emerging infectious diseases, encompassing cognitive, negative-affective, positive-affective, and psychomotor outcomes. Subgroup analysis indicated that methods effective in improving competencies include the use of equipment with limited or full patient interaction, simulated or in situ settings, and scenarios involving some interruptions by educators or independent participation of trainees. This review underscores the importance of appropriate methodological considerations in simulation-based education, including equipment, settings, and scenario designs, to optimize educational outcomes in the management of emerging infectious diseases.

Monolayer, open-mesh, pristine PEDOT:PSS-based conformal brain implants for fully MRI-compatible neural interfaces.

Understanding brain function is essential for advancing our comprehension of human cognition, behavior, and neurological disorders. Magnetic resonance imaging (MRI) stands out as a powerful tool for exploring brain function, providing detailed insights into its structure and physiology. Combining MRI technology with electrophysiological recording system can enhance the comprehension of brain functionality through synergistic effects. However, the integration of neural implants with MRI technology presents challenges because of its strong electromagnetic (EM) energy during MRI scans. Therefore, MRI-compatible neural implants should facilitate detailed investigation of neural activities and brain functions in real-time in high resolution, without compromising patient safety and imaging quality. Here, we introduce the fully MRI-compatible monolayer open-mesh pristine PEDOT:PSS neural interface. This approach addresses the challenges encountered while using traditional metal-based electrodes in the MRI environment such as induced heat or imaging artifacts. PEDOT:PSS has a diamagnetic property with low electrical conductivity and negative magnetic susceptibility similar to human tissues. Furthermore, by adopting the optimized open-mesh structure, the induced currents generated by EM energy are significantly diminished, leading to optimized MRI compatibility. Through simulations and experiments, our PEDOT:PSS-based open-mesh electrodes showed improved performance in reducing heat generation and eliminating imaging artifacts in an MRI environment. The electrophysiological recording capability was also validated by measuring the local field potential (LFP) from the somatosensory cortex with an in vivo experiment. The development of neural implants with maximized MRI compatibility indicates the possibility of potential tools for future neural diagnostics.

Development and classification of autonomous vehicle's ambiguous driving scenario.

Human drivers are gradually being replaced by highly automated driving systems, and this trend is expected to persist. The response of autonomous vehicles to Ambiguous Driving Scenarios (ADS) is crucial for legal and safety reasons. Our research focuses on establishing a robust framework for developing ADS in autonomous vehicles and classifying them based on AV user perceptions. To achieve this, we conducted extensive literature reviews, in-depth interviews with industry experts, a comprehensive questionnaire survey, and factor analysis. We created 28 diverse ambiguous driving scenarios and examined 548 AV users' perspectives on moral, ethical, legal, utility, and safety aspects. Based on the results, we grouped ADS, with all of them having the highest user perception of safety. We classified these scenarios where autonomous vehicles yield to others as moral, bottleneck scenarios as ethical, cross-over scenarios as legal, and scenarios where vehicles come to a halt as utility-related. Additionally, this study is expected to make a valuable contribution to the field of self-driving cars by presenting new perspectives on policy and algorithm development, aiming to improve the safety and convenience of autonomous driving.

Emerging Roles of Using Small Extracellular Vesicles as an Anti-Cancer Drug.

Small extracellular vesicles (sEVs) are emerging as a novel therapeutic strategy for cancer therapy. Tumor-cell-derived sEVs contain biomolecules that can be utilized for cancer diagnosis. sEVs can directly exert tumor-killing effects or modulate the tumor microenvironment, leading to anti-cancer effects. In this review, the application of sEVs as a diagnostic tool, drug delivery system, and active pharmaceutical ingredient for cancer therapy will be highlighted. The therapeutic efficacies of sEVs will be compared to conventional immune checkpoint inhibitors. Additionally, this review will provide strategies for sEV engineering to enhance the therapeutic efficacies of sEVs. As a bench-to-bedside application, we will discuss approaches to encourage good-manufacturing-practice-compliant industrial-scale manufacturing and purification of sEVs.

Multi-modulation of immune-inflammatory response using bioactive molecule-integrated PLGA composite for spinal fusion.

Despite current developments in bone substitute technology for spinal fusion, there is a lack of adequate materials for bone regeneration in clinical applications. Recombinant human bone morphogenetic protein-2 (rhBMP-2) is commercially available, but a severe inflammatory response is a known side effect. Bone graft substitutes that enhance osteogenesis without adverse effects are needed. We developed a bioactive molecule-laden PLGA composite with multi-modulation for bone fusion. This bioresorbable composite scaffold was considered for bone tissue engineering. Among the main components, magnesium hydroxide (MH) aids in reduction of acute inflammation affecting disruption of new bone formation. Decellularized bone extracellular matrix (bECM) and demineralized bone matrix (DBM) composites were used for osteoconductive and osteoinductive activities. A bioactive molecule, polydeoxyribonucleotide (PDRN, PN), derived from trout was used for angiogenesis during bone regeneration. A nano-emulsion method that included Span 80 was used to fabricate bioactive PLGA-MH-bECM/DBM-PDRN (PME2/PN) composite to obtain a highly effective and safe scaffold. The synergistic effect provided by PME2/PN improved not only osteogenic and angiogenic gene expression for bone fusion but also improved immunosuppression and polarization of macrophages that were important for bone tissue repair, using a rat model of posterolateral spinal fusion (PLF). It thus had sufficient biocompatibility and bioactivity for spinal fusion.

Safety, high-performing and effects of the N/P ratio of a solid lithium ion battery using PEGDME based polymer electrolytes.

In this study, we report on the electrochemical properties of a solid state lithium ion battery (LIB) using a poly (ethylene glycol) dimethyl ether (PEGDME)-based solid polymer electrolyte (P-SPE). The LIB is prepared using a LiFePO4 (LFP) cathode and graphite anode material with P-SPE, and the kinetic properties of the lithium ions in the P-SPE are investigated. The synthesized P-SPE is shown to be suitable solid polymer electrolyte candidate for LIB applications. LFP and graphite are selected as electrode materials to validate their effectiveness in different battery cells with respect to their high energy density and inherent safety. The five-layer stacked 5 × 6 cm2 pouch-type LIB demonstrates a high capacity of 90 mAh (0.6 mAh/cm2) or more in the initial cycle, and it shows cycle stability with a capacity decrease of 20% over 500 cycles. We test the manufactured pouch-type full cells under extreme conditions (e. g., cutting, crushing and exposure of the battery cell to the atmosphere). LIBs using the developed P-SPE are promising solid polymer electrolyte candidates for wearable LIB as well as high energy LIB applications.

COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort.

INTRODUCTION: There is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea. METHODS AND ANALYSIS: A multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published. TRIAL REGISTRATION NUMBER: KCT0006270.

Modeling takeover time based on non-driving-related task attributes in highly automated driving.

This study aims to investigate the effects of non-driving-related tasks (NDRTs) on the transition of control in highly automated driving (HAD) by investigating the effects of NDRT physical, visual, and cognitive attributes during transition of control. A conceptual model of the takeover process is proposed by dividing this process into motor and mental reactions. A laboratory experiment was conducted to evaluate the effects of each NDRT attribute on the corresponding stage of the process of taking over control. A prediction model was developed using the results of multiple linear regression analysis. Additionally, a validation experiment with nine NDRTs and a baseline condition was conducted to determine the extent to which the developed model explains the takeover time for each NDRT condition. The results showed that the timing aspects of the transition of control in HAD largely consist of participant motor reactions that are affected by the physical attributes of NDRTs.

Risk factors for postoperative urinary retention among women who underwent laparoscopic cholecystectomy.

OBJECTIVES: The aim of this study was to investigate the risk factors for postoperative urinary retention (POUR) among female patients by evaluating its occurrence in women who underwent laparoscopic cholecystectomy in Gyeongsang National University Hospital. METHODS: The medical records of female patients who had undergone laparoscopic cholecystectomy for gallbladder stones between March 2014 and February 2018 were reviewed. Information was collected regarding patient age, body mass index (BMI), creatinine, absolute neutrophil count, duration of the operation and anesthesia, the amount of fluid infused, American Society of Anesthesiologists (ASA) classification, and medical comorbidities, such as hypertension, diabetes, and lung, liver, heart, renal, and neurologic disease. Comparisons were made between the POUR and non-POUR groups, and both univariate and multivariate analyses were conducted. RESULTS: Seventeen of 591 patients (2.9%) developed POUR. There as a positive correlation between age and POUR (P = 0.040), and a negative correlation between BMI and POUR (P = 0.037). In addition, a history of neurologic disease was greater in the POUR group (P = 0.033), which also had a higher ASA class than the non-POUR group (P < 0.001). Multivariate analysis showed that a high ASA class was a risk factor for POUR (hazard ratio 3.01; 95% confidence interval 1.13-7.99; P = 0.027). CONCLUSIONS: Medical care providers need to be aware of the risk factors for POUR, which is likely to prolong hospital stay for Foley catheter placement. A high ASA class is an important risk factor for POUR among female patients, so medical staff need to provide proper preoperative management strategies for patients with a high ASA class.

Frailty and Disability in Diabetes.

Diabetes is an important health problem with the population aging. Previously, it is well established that diabetes is associated with microvascular and macrovascular complications, but recently, several data suggest that diabetes is accompanied with frailty as well as disability among the older adults. Considering the clinical significance of frailty and disability, it is important to understand the pathway from diabetes to frailty and/or disability. Additionally, it is strongly recommended to find a new therapeutic intervention are required to meet the increasing demand of managing older diabetic patients with the population aging.

The effects of takeover request modalities on highly automated car control transitions.

This study investigated the influences of takeover request (TOR) modalities on a drivers' takeover performance after they engaged in non-driving related (NDR) tasks in highly automated driving (HAD). Visual, vibrotactile, and auditory modalities were varied in the design of the experiment under four conditions: no-task, phone conversation, smartphone interaction, and video watching tasks. Driving simulator experiments were conducted to analyze the drivers' take-over performance by collecting data during the transition time of re-engaging control of the vehicle, the time taken to be on the loop, and time taken to be physically ready to drive. Data were gathered on the perceived usefulness, safety, satisfaction, and effectiveness for each TOR based on a self-reported questionnaire. Takeover and hands-on times varied considerably, as shown by high standard deviation values between modalities, especially for phone conversations and smartphone interaction tasks. Moreover, it was found that participants failed to take over control of the vehicle when they were given visual TORs for phone conversation and smartphone interaction tasks. The perceived safety and satisfaction varied for the NDR task. Results from the statistical analysis showed that the NDR task significantly influenced the takeover time, but there was no significant interaction effect between the TOR modalities and the NDR task. The results could potentially be applied to the design of safe and efficient transitions of highly controlled, automated driving, where drivers are enabled to engage in NDR tasks.

Metabolic Syndrome Is an Independent Risk Factor for Acquired Premature Ejaculation.

PURPOSE: To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis. MATERIALS AND METHODS: From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivariate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p<0.001), NIH-CPSI pain score (OR=1.07, p=0.035), NIH-CPSI voiding score (OR=1.17, p=0.032), and presence of MetS (OR=2.20, p=0.022) were significantly correlated with the prevalence of acquired PE. In addition, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores and ejaculation anxiety scores progressively decreased as the number of components of MetS increased. CONCLUSIONS: MetS may be an independent predisposing factor for the development of acquired PE. Effective prevention and treatment of MetS could also be important for the prevention and treatment of acquired PE.

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia.

PURPOSE: Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients. PATIENTS AND METHODS: This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups. RESULTS: Among the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI. CONCLUSION: We identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients.

The double-sidedness of cough in the elderly.

Cough is a physiological reflex to protect airways against aspiration, but also it is one of the most frequent problems that lead patients to seek medical care. Chronic cough is more prevalent in the elderly than younger subjects, and more challenging to manage due to frequent comorbidities and possible side effects from drug treatment. Meanwhile, cough reflex does not decrease with natural aging but is often impaired by pathologic conditions like stroke. The impairment in cough reflex may lead to fatal complication like aspiration pneumonia. In this paper, we reviewed epidemiology and clinical considerations for chronic cough in the elderly, and summarized aging-related changes in cough reflex and also possible ways to normalize cough reflex and prevent aspiration pneumonia.

Simple Method of Screening for Frailty in Older Adults Using a Chronometer and Tape Measure in Clinic.

OBJECTIVES: Detecting frailty in older adults scheduled for surgery is important to predict the occurrence of adverse outcomes, but because of its complexity, frailty screening is not commonly performed. The objective of the current study was to assess whether frailty can be screened for using automatically measured usual gait speed (UGS) and mid-arm circumference (MAC) in the outpatient clinic. DESIGN: Prospective, cross-sectional study. SETTING: Geriatric center of a tertiary hospital. PARTICIPANTS: Outpatients aged 65 and older (N = 113). MEASUREMENTS: Frailty status was evaluated according to a multidimensional frailty score (MFS) using a comprehensive geriatric assessment, and participants were classified into 5 categories. UGS was evaluated by having participants walk through the clinic using an automated laser-gated chronometer. MAC was recorded using a tape measure on a blood pressure cuff. Correlations between these two physical measurements and MFS were assessed. RESULTS: The mean age of the 93 participants who successfully underwent UGS evaluation was 75.8 ± 4.7; 35 were male. In this population, the mean Charlson Comorbidity Index was 2.2 ± 1.4, mean MFS was 4.1 ± 2.0, and 20 participants were considered to be at high risk of experiencing adverse outcomes. Mean UGS was 0.75 ± 0.16 m/s, and mean MAC was 31.2 ± 1.9 cm); both physical parameters were correlated with MFS (UGS: standardized beta = -0.420, P < .001; MAC: standardized beta = -0.457, P < .001). Using UGS and MFS, the area under curve of receiver operating curve for determining which participants were at high risk of experiencing adverse outcomes was 0.809 (P < .001). CONCLUSION: UGS and MAC are viable methods of clinically screening for frailty.

The Correlation between Body Mass Index and Routine Parameters in Men Over Fifty.

PURPOSE: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV). MATERIALS AND METHODS: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient. RESULTS: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m², the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p<0.001). In the correlation analysis, BMI showed a statistically significant correlation (p<0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p<0.001), with a meaningful Pearson correlation coefficient of 0.124. CONCLUSIONS: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.

Association between Frailty and Hypertension Prevalence, Treatment, and Control in the Elderly Korean Population.

Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P < 0.001). Among hypertensive patients, frail elderly were more likely to be treated than pre-frail or robust elderly (P < 0.001), but the proportion of patients whose blood pressure was under control ( < 150/90 mmHg) was lower in frail elderly (P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.

Prediction of Mortality and Postoperative Complications using the Hip-Multidimensional Frailty Score in Elderly Patients with Hip Fracture.

High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4-3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210-1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115-1.377), 1.156 (95% CI: 1.031-1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466-8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively).

Clinical implication of frailty assessment in older patients with atrial fibrillation.

BACKGROUND: We aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA2DS2-VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AF patients. METHODS: We retrospectively evaluated 365 patients (≥65years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA2DS2-VASc and HAS-BLED scores were calculated based on the electronic medical records and the frailty index was computed from the CGA data. The primary outcomes were cardiovascular and all-cause mortality. RESULTS: Frailty status was positively associated with the CHA2DS2-VASc score (P<0.001) and the HAS-BLED score (P=0.01). Patients with high CHA2DS2-VASc and HAS-BLED scores were more likely to be treated with anticoagulants rather than antiplatelet agents. However, frailty status was not associated with antithrombotic therapy. During the follow-up period (median [interquartile range], 22.9 [8.4-42.2] months), 141 patients (38.6%) died, of which 48 were due to cardiovascular events. CHA2DS2-VASc score could predict cardiovascular mortality, but not all-cause mortality. In contrast, frailty status was the independent predictor for both cardiovascular and all-cause mortality after adjusting for possible confounders (hazard ratio for all-cause mortality, 4.549; 95% CI, 2.756-7.509; P<0.001). CONCLUSION: Frailty assessment can be used to predict mortality in older AF patients, and provides additional prognostic value, along with the CHA2DS2-VASc and HAS-BLED scores.

Preliminary Effectiveness and Sustainability of Group Aerobic Exercise Program in Patients with Schizophrenia.

The objective of this study was to examine the feasibility and sustained effect of a group aerobic exercise program in patients with schizophrenia. Twenty-four schizophrenic patients participated in a group-based individually tailored 90-minute outdoor cycling session per week for 3 months with intervention to enhance motivation. Physical health was evaluated by anthropometric measures, cardiorespiratory (CR) fitness, and blood tests. Mental health was assessed on self-esteem, interpersonal relationship, quality of life, and global function. Attrition rate for the exercise program was 8.3%. Exercise program significantly increased participant's self-esteem, positive relationship, global function, and quality of life. CR fitness significantly improved after 3 months. At the 9-month follow-up, 6 months after program completion, only in interpersonal relationship change the improved effects were maintained. These findings support the feasibility of group aerobic exercise program with high level of adherence and its long-term benefits in positive relationship change.