Prevalence and molecular characteristics of carbapenem-resistant Escherichia coli isolated from dogs in South Korea.

IMPORTANCE: Carbapenem-resistant Enterobacteriaceae are emerging as a global public health risk. Therefore, assessing the prevalence of carbapenem-resistant Escherichia coli (CRE) in both humans and animals is important. OBJECTIVE: We aimed to ascertain the occurrence and characteristics of CRE isolated from companion animals, dogs and cats. METHODS: E. coli strains were tested for antimicrobial susceptibility using the broth microdilution technique. Antimicrobial resistance genes were detected by polymerase chain reaction and sequencing analysis. The molecular characteristics of CRE were determined using multi-locus sequence typing, replicon typing, and pulsed-field gel electrophoresis (PFGE). RESULTS: In total, 13 CRE isolates (0.13%) were identified from dogs possessing blaNDM-5 along with ß-lactamase genes, mostly blaCMY-2 (92.2%) and blaTEM-1 (53.8%). The commonly observed mutations were S83L and D87N in gyrA, S80I in parC, and S458A in parE. CRE carried non-beta-lactam resistance genes, with the majority being tet(B) (100%), sul (84.6%), and aac(3)-II (53.8%). Nine different PFGE patterns (P1-P9), IncX3-type plasmids (69.2%), and ST410 (84.6%) were predominantly detected. CONCLUSIONS AND RELEVANCE: This investigation provides significant insight into the prevalence and molecular characteristics of blaNDM-5-carrying E. coli in dogs. The co-existence of blaNDM-5 and other antimicrobial resistance genes in E. coli potentially poses severe health hazards to humans.

Survival of lung cancer patients according to screening eligibility using Korean Lung Cancer Registry 2014-2016.

This study assessed survival for lung cancer patients meeting criteria for the National Lung Cancer Screening Program in Korea launched in 2019 and updated guideline reported by the US Preventive Service Task Force (USPSTF). We assessed all-cause mortality based on the Korean Lung Cancer Registry (KLCR), including lung cancer patients diagnosed in 2014-2016. We compared survival among lung cancer patients eligible for extended USPSTF criteria (age 50-80 years and ≥ 20 pack-years) and those meeting current criteria (age 54-74 years and ≥ 30 pack-years, current or within the past 15 years). The nearest neighbour propensity-score matching was performed to generate a matched set. Kaplan-Meier curves were generated to compare survival among groups; differences in survival were analyzed using the stratified log-rank test. The mortality risk was estimated based on a Cox proportional hazards regression model and the robust standard error was calculated. Of 8110 patients, 37.4% and 24.3% met the extended USPSTF eligibility criteria and National Lung Cancer Screening Program (NLCSP) criteria, respectively. Overall mortality risk was not significantly different between the extended younger age group and the NLCSP group (hazard ratio [HR] [95% confidence interval (CI)]: 0.78 [0.59-1.02]). The extended older age group had a significantly higher mortality risk (HR [95% CI]: 1.41 [1.26-1.58]). Mortality risk was not significantly different between patients who smoked 20-29 pack-years and those who smoked ≥ 30 pack-years (HR [95% CI]: 0.90 [0.79-1.03]). Lung cancer patients aged 50-53 years and those with a 20-29 pack-years smoking history exhibited similar mortality risk to individuals meeting current criteria, while patients aged 75-80 years were at a higher risk of death. Although we verified similar or higher mortality risks in extended subgroups, a careful assessment of the benefits and harms of the screening tests is necessary when contemplating the extension of criteria.

Understanding medical students' transition to and development in clerkship education: a qualitative study using grounded theory.

BACKGROUND: Medical students perceive the transition to clerkship education as stressful and challenging and view themselves as novices during their rotation in clerkship education. The developmental perspective is thus important because the transition to clerkship supports rather than hinders growth. Accordingly, this study examines medical students' transition to clerkship and their developmental features. METHODS: In-depth interviews were conducted with 18 medical students or graduates who had completed clerkships as medical students. Based on Straussian grounded theory, the collected data were analyzed in terms of the differences between pre- and post-clerkship education. RESULTS: Our data analysis revealed five stages of the transition process: "anticipation and anxiety," "reality check," "seeking solutions," "practical application," and "transition and stability." The core category, that is, "growing up from being students to being student doctors," was driven by patients who perceived the participants as student doctors. Meanwhile, the participants recognized that having a solution that is agreed upon by colleagues was more important than knowing the correct answer. The participants undergoing the transition to clerkship showed developmental features divided into three categories: personal, social, and professional. Specifically, they attempted to balance clerkship and life through personal development, learned to navigate around the hospital and reduced tension through social development, and developed clinical competencies focused on efficiency through professional development. CONCLUSIONS: This study explores the process of students' transition to clerkship education and the developmental features that emerge during this period. The students were motivated by patients who perceived them as student doctors. Through the transition, they maintained a work-life balance and adapted to hospitals but developed an overly doctor-centered attitude by cultivating clinical competencies with a focus on efficiency. To develop them into medical professionals, it is essential to assist their transition and cultivate a patient-centered attitude.

Analysis of the current status of interview evaluations in Korean medical schools and professors' perceptions of the interview evaluations process.

PURPOSE: This study aimed to investigate the overall operational status of medical school admission interview evaluations in South Korea and explore the operational experience of universities conducting interview evaluations. METHODS: This study used a mixed-methods approach, combining quantitative and qualitative methods. Through a nationwide survey and data collection from 39 medical schools, the quantitative analysis explored interview evaluations procedures, the purpose of the interview evaluations, and the competencies expected of medical school freshmen. Concurrently, qualitative data were obtained through focus group discussions with 12 professors from 10 medical schools, providing in-depth insights into the operational experiences and challenges faced during interview evaluations. RESULTS: In the quantitative data, interview evaluations were most prevalent in the "comprehensive school records screening" for rolling admissions (85.5%), but less common in regular admissions (18.6%). Private schools (64.2%) showed a statistically significant higher proportion of interview admissions than public schools (11.1%) in the "high school grades focused admission" (p<0.01). Metropolitan areas (50.0%) conducted interview evaluations more frequently than non-metropolitan areas (11.1%) in the "College Scholastic Ability Test-focused admissions" (p<0.05). In the qualitative data, professors recognize the dominant role of "negative selection" in filtering out unsuitable candidates. Challenges in maintaining a consistent evaluator pool and team-based question development were acknowledged. Strategies, such as seeking student feedback for question improvement and conducting study meetings for interviewer preparation are essential. CONCLUSION: This study illuminates the operation of admissions interview evaluations in South Korea, revealing variations across regions and admissions types. These findings offer insights for enhancing medical school admission processes, guiding future research and policy.

Exploring effective video-review strategies of patient encounters for medical students: precepted review versus peer discussion.

BACKGROUND: Video-recordings review of patient encounters is reported to improve the clinical performance of medical students. However, evidence on specific remediation strategies or outcomes are lacking. We aimed to implement videorecording-based remediation of standardized patient encounters among medical students, combined with preceptor one-on-one feedback or peer group discussion, and evaluate the effectiveness of the two remediation methods using objective structured clinical examination (OSCE). METHODS: Following standardized patient encounters, 107 final-year medical students were divided into two groups based on different remediation methods of video review: (1) precepted video review with preceptor feedback (N = 55) and (2) private video review and subsequent peer group discussion under supervision (N = 52). All students underwent twelve-stations of OSCE both before and after the video review. Students' pre- and post-remediation OSCE scores, self-efficacy level in patient encounters, and level of educational satisfaction with each method were assessed and compared between different video-based remediation methods to evaluate their respective effects. RESULTS: After remediation, the total and subcomponent OSCE scores, such as history taking, physical examination, and patient - physician interaction (PPI), among all students increased significantly. Post-remediation OSCE scores showed no significant difference between two remediation methods (preceptor module, 79.6 ± 4.3 vs. peer module, 79.4 ± 3.8 in the total OSCE score). Students' self-efficacy levels increased after remediation in both modules (both p-value <0.001), with no difference between the two modules. However, students' satisfaction level was higher in the preceptor module than in the peer module (80.1 ± 17.7 vs. 59.2 ± 25.1, p-value <0.001). Among students with poor baseline OSCE performance, a prominent increase in PPI scores was observed in the preceptor-based module. CONCLUSION: Video-based remediation of patient encounters, either through preceptor review with one-on-one feedback or through private review with peer discussion, was equally effective in improving the OSCE scores and self-efficacy levels of medical students. Underperforming students can benefit from precepted video reviews for building PPI.

Prediction of disease-free survival using strain elastography and diffuse optical tomography in patients with T1 breast cancer: a 10-year follow-up study.

BACKGROUND: Early-stage breast cancer (BC) presents a certain risk of recurrence, leading to variable prognoses and complicating individualized management. Yet, preoperative noninvasive tools for accurate prediction of disease-free survival (DFS) are lacking. This study assessed the potential of strain elastography (SE) and diffuse optical tomography (DOT) for non-invasive preoperative prediction of recurrence in T1 BC and developed a prediction model for estimating the probability of DFS. METHODS: A total of 565 eligible patients with T1 invasive BC were enrolled prospectively and followed to investigate the recurrence. The associations between imaging features and DFS were evaluated and a best-prediction model for DFS was developed and validated. RESULTS: During the median follow-up period of 10.8 years, 77 patients (13.6%) developed recurrences. The fully adjusted Cox proportional hazards model showed a significant trend between an increasing strain ratio (SR) (P < 0.001 for trend) and the total hemoglobin concentration (TTHC) (P = 0.001 for trend) and DFS. In the subgroup analysis, an intensified association between SR and DFS was observed among women who were progesterone receptor (PR)-positive, lower Ki-67 expression, HER2 negative, and without adjuvant chemotherapy and without Herceptin treatment (all P < 0.05 for interaction). Significant interactions between TTHC status and the lymphovascular invasion, estrogen receptor (ER) status, PR status, HER2 status, and Herceptin treatment were found for DFS(P < 0.05).The imaging-clinical combined model (TTHC + SR + clinicopathological variables) proved to be the best prediction model (AUC = 0.829, 95% CI = 0.786-0.872) and was identified as a potential risk stratification tool to discriminate the risk probability of recurrence. CONCLUSION: The combined imaging-clinical model we developed outperformed traditional clinical prognostic indicators, providing a non-invasive, reliable tool for preoperative DFS risk stratification and personalized therapeutic strategies in T1 BC. These findings underscore the importance of integrating advanced imaging techniques into clinical practice and offer support for future research to validate and expand on these predictive methodologies.

The Cancer Clinical Library Database (CCLD) from the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) Project.

The common data model (CDM) has found widespread application in healthcare studies, but its utilization in cancer research has been limited. This article describes the development and implementation strategy for Cancer Clinical Library Databases (CCLDs), which are standardized cancer-specific databases established under the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) project by the Korean Ministry of Health and Welfare. Fifteen leading hospitals and fourteen academic associations in Korea are engaged in constructing CCLDs for 10 primary cancer types. For each cancer type-specific CCLD, cancer data experts determine key clinical data items essential for cancer research, standardize these items across cancer types, and create a standardized schema. Comprehensive clinical records covering diagnosis, treatment, and outcomes, with annual updates, are collected for each cancer patient in the target population, and quality control is based on six-sigma standards. To protect patient privacy, CCLDs follow stringent data security guidelines by pseudonymizing personal identification information and operating within a closed analysis environment. Researchers can apply for access to CCLD data through the K-CURE portal, which is subject to Institutional Review Board and Data Review Board approval. The CCLD is considered a pioneering standardized cancer-specific database, significantly representing Korea's cancer data. It is expected to overcome limitations of previous CDMs and provide a valuable resource for multicenter cancer research in Korea.

Presenting a Multispectral Image Sensor for Quantification of Total Polyphenols in Low-Temperature Stressed Tomato Seedlings Using Hyperspectral Imaging.

Hyperspectral imaging was used to predict the total polyphenol content in low-temperature stressed tomato seedlings for the development of a multispectral image sensor. The spectral data with a full width at half maximum (FWHM) of 5 nm were merged to obtain FWHMs of 10 nm, 25 nm, and 50 nm using a commercialized bandpass filter. Using the permutation importance method and regression coefficients, we developed the least absolute shrinkage and selection operator (Lasso) regression models by setting the band number to ≥11, ≤10, and ≤5 for each FWHM. The regression model using 56 bands with an FWHM of 5 nm resulted in an R2 of 0.71, an RMSE of 3.99 mg/g, and an RE of 9.04%, whereas the model developed using the spectral data of only 5 bands with a FWHM of 25 nm (at 519.5 nm, 620.1 nm, 660.3 nm, 719.8 nm, and 980.3 nm) provided an R2 of 0.62, an RMSE of 4.54 mg/g, and an RE of 10.3%. These results show that a multispectral image sensor can be developed to predict the total polyphenol content of tomato seedlings subjected to low-temperature stress, paving the way for energy saving and low-temperature stress damage prevention in vegetable seedling production.

Unraveling motives: identifying the impact of university attendance motives on learning behaviors among dental students.

PURPOSE: Students report various motives for attending university (MAU) grouped under five categories, namely, personal-intellectual development (PER), humanitarian (HUM), careerist-materialist (CAR), expectation-driven (EXP), and uncertain motives. Although the literature demonstrates that these motives exert an influence on learning and achievement, relatively less attention is given to this issue in the context of dental students. This study aimed to examine the relationship among the mindsets, MAU, academic engagement (AE), and DAL of dental students and to test the mediating effect of AE on the relationship between MAU and deep approach to learning (DAL). METHODS: The study recruited 226 dental students at various levels of the curriculum, who responded to four questionnaires for measuring MAU, DAL, mindsets, and AE. The study employed structural equation modeling to analyze the mediation effects of AE on the relationship between MAU and DAL and to determine the influence of mindsets on MAU. RESULTS: This model reveals the significant relationships of a growth mindset with CAR, PER, and HUM. Moreover, the study finds that a fixed mindset was associated with CAR, EXP, and uncertain motives. Furthermore, AE only fully mediated the significant positive relationship between PER and DAL, whereas CAR negatively predicted DAL without a mediator. CONCLUSIONS: These findings suggest that administering the inventories in a dental school setting can facilitate a more comprehensive understanding of students' mindsets toward learning and effective processes related to learning. This understanding can inform instructors' pedagogical practices, enabling them to provide more effective guidance to students navigating the complexities of academic coursework.