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Objectives. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients.Methods. Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated.Results. In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms.Conclusion. Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

Objective : Cerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC.Methods : For this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6–0 was used as the dura suture material, while black silk 5–0 was used as the dura suture material in the late group.Results : The overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p

Introduction: Young drivers are the most vulnerable road users and most likely to use a smartphone illegally while driving. Although when compared with drink-driving, attitudes to illegal smartphone risk are nearly identical, smartphone use among young drivers continues to increase. Method: Four in-depth focus groups were conducted with 13 young (18–25 years) drivers to gain insight into their perceptions of the risks associated with the behavior. Our aim was to determine how drivers navigate that risk and if their behavior shapes and informs perceptions of norms. Results: Three key themes emerged: (a) participants perceived illegal smartphone use as commonplace, easy, and benign; (b) self-regulatory behaviors that compensate for risk are pervasive among illegal smartphone users; and (c) risk-compensation strategies rationalize risks and perceived norms, reducing the seriousness of transgression when compared with drink-driving. Young drivers rationalized their own use by comparing their selfregulatory smartphone and driving skills with those of “bad drivers,” not law abiders. Practical Applications: These findings suggest that smartphone behaviors shape attitudes to risk, highlighting the importance for any countermeasure aimed at reducing illegal use to acknowledge how a young person’s continued engagement in illegal smartphone use is justified by the dynamic composition of use, risk assessment and the perceived norms.

BACKGRUOUND This study is an analysis of evaluator factors affecting physician-patient interaction (PPI) scores in clinical performance examination (CPX). The purpose of this study was to investigate possible ways to increase the reliability of the CPX evaluation. METHODS The six-item Yeungnam University Scale (YUS), four-item analytic global rating scale (AGRS), and one-item holistic rating scale (HRS) were used to evaluate student performance in PPI. A total of 72 fourth-year students from Yeungnam University College of Medicine in Korea participated in the evaluation with 32 faculty and 16 standardized patient (SP) raters. The study then examined the differences in scores between types of scale, raters (SP vs. faculty), faculty specialty, evaluation experience, and level of fatigue as time passes. RESULTS There were significant differences between faculty and SP scores in all three scales and a significant correlation among raters' scores. Scores given by raters on items related to their specialty were lower than those given by raters on items out of their specialty. On the YUS and AGRS, there were significant differences based on the faculty's evaluation experience; scores by raters who had three to ten previous evaluation experiences were lower than others' scores. There were also significant differences among SP raters on all scales. The correlation between the YUS and AGRS/HRS declined significantly according to the length of evaluation time. CONCLUSION In CPX, PPI score reliability was found to be significantly affected by the evaluator factors as well as the type of scale.

Objective To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data.Methods This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted.Results No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003).Conclusion The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.

Growth hormone (GH) treatment preference and adherence are affected by delivery device convenience, injection-site pain, confidence in correct dose administration, and device satisfaction. This survey investigated if switching device to NordiFlex® improved treatment experience in pediatric patients in South Korea.Patients aged 4-≤18 years were surveyed. Participants were NordiFlex® users who previously used NordiLet®/other devices. Participants compared preference, self-reported adherence, satisfaction, perceived ease of use, and device subjective benefits (across four domains:Ninety-four patients were enrolled, of which 91.5% previously used NordiLet®. Significantly more patients preferred, and were more satisfied with NordiFlex® vs. previous device; mean score: 0.65 (95% confidence interval [CI]:0.41;0.88) and 0.61 (95% CI:0.36;0.85), respectively. Participants reported greater perceived ease of use (0.49 [95% CI:0.26;0.72]) and fewer missed injections (0.20 [95% CI:0.06;0.34], with NordiFlex® vs. previous device. Bivariate analysis showed significant associations between preference for NordiFlex® and higher scores onThese results suggest that improvements in device features could be associated with improved treatment experience.

Objective Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation. Methods We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/cm2), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment. Results Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score. Conclusion The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

Pedestrian distraction from smartphone use is a concern from a road safety perspective. This research examined the effectiveness of current and future potential countermeasures from an end-user perspective by means of interviews and a focus group with smartphone users. Four broad countermeasure categories were identified from a countermeasures review: behavioural; legislation/regulation; infrastructure initiatives and technology advances. Overall it was found that no single countermeasure category was perceived by end-users to be fully effective in removing the road safety risk of smartphone use by pedestrians, but rather an integrated approach that combines elements such as pedestrian infrastructure separation, publicity, legislation and a shared responsibility for safety amongst all road users, was deemed to be the most promising solution. Future work in this area, particularly focusing on countermeasure prioritisation and subsequent deployment, is then outlined.

Background: Dermatophytes are the most common cause of fungal infections worldwide, having an estimated prevalence of 20% by the World Health Organization. Recent advances of sequencing and annotation of fungi explain the biodiversity evaluation and genomic identification of dermatophytes. Objective: This study's objective is to assess the mycobiome and microbiome in different dermatomycoses and identify their pathogenic organisms using fungal genomic analyses. Besides, we wanted to see the topographical biodiversity in dermatomycoses. Methods: Patients with dermatophyte infections confirmed by positive potassium peroxide examination were enrolled. Bacterial and fungal DNA were extracted from the skin sample. The internal transcribed spacer regions of rRNA gene and multiple variable regions in 16S rRNA gene were assessed to determine the fungal and bacterial community compositions. Results: We profiled both bacterial and fungal communities in the fungal-infected skin. Dermatophyte infection resulted in modified bacterial microbiome. The alpha diversity showed that the bacterial diversity was relatively low in tinea cruris patients compared to other dermatomycoses patients. Nonetheless, fungal diversity was not impacted by the body site but by the causative fungal organisms. Tinea pedis, tinea corporis, and tinea cruris due to Trichophyton species were similar as seen in principle component analysis. Alpha diversity demonstrates the tinea corporis on the leg had the most diverse fungal mycobiome and the scalp is the least diverse area. Conclusion: Sequencing and annotation of dermatophyte genomes of superficial skin infections will give sources that will help explain the virulence mechanisms of the dermatophyte. Understanding the pathogenesis of dermatophyte infections can help in generating effective therapeutics in the future.

In the 21st-century postmodernism era, which represents diversity and relativity, one of the most essential elements in the field of education is to strengthen individual human values. Accordingly, we must focus on developing capacity in order to adapt to change. It is clear that the medical field maximizes the need for new judgments to solve life-related problems constantly, and this problem-solving capacity is an essential skill for a physician. Problem-solving capacity can be achieved simultaneously with creativity to apply them in an appropriate manner based on stan dardized expertise and well-trained skills. Creativity is also a key element that medical education is currently pursuing. Many studies on creativity have resulted in confusion and misunderstand ings on the concept of creativity due to similar terms and varied definitions, such as creation, in novation, etc. In this study, we attempt to identify the importance of creativity in medical educa tion by comparing and organizing concepts related to creative capacity.

본 연구의 목적은 만 5세 유아의 디지털매체 이용 지도지침을 구성하기 위한 기초연구로서 교사의 요구도를 알아보는데 있다. 본 연구는 서울, 경기, 인천에 소재하고 있는 유아교육기관(어린이집 175개소, 유치원 143개소)에 근무하고 있는 만 5세반 담임교사 318명을 대상으로 하였다. 유아교육기관에서 유아의 디지털매체 이용 지도지침에 대한 교사의 요구도 분석은 Borich 요구도 공식과 The Locus for Focus Model을 이용해 최우선순위를 도출하였다. 교사가 우선적으로 고려해야 한다고 생각하는 지도지침은 유아의 디지털매체 이용 시 필요한 규칙을 스스로 정할 수 있도록 돕기, 활동 및 놀이에 적합한 매체를 제공하며 이를 위해 구체적인 계획 세우기, 적절한 물리적·정서적 환경 제공하기, 디지털매체를 이용하는 유아를 주의 깊게 관찰하고 다양한 방법으로 평가하기, 유해한 정보 구별할 수 있도록 지원하기로 나타났다. 즉, 유아의 올바른 디지털매체 이용을 위해 태도적인 부분이 우선시 되어야 함을 알 수 있다. 결론적으로 다수의 교사들은 유아의 디지털매체 이용을 위한 교사 역할을 중요하게 생각하고 있으며, 이를 위해 명확하고 현실적인 지도지침이 필요하다는 것을 시사한다.

This study investigated the effectiveness of radiation safety rules in animal hospital and the awareness and behavior of veterinary radiation workers. With the questionnaires, the data was collected from randomly selected veterinarians in animal hospitals and animal medical imaging centers. Collected data were about radiation device, shielding device, regulations, safety management, education, knowledge, behavior and awareness. Frequency, correlation and multiple regression analysis were performed. The medical devices related with radiation in animal hospital were X-ray (59%), CT (15%), fluoroscopy (12%), mobile X-ray (12%) and others (2%). The number of people using radiation shielding device is high. The answers were low on knowing radiation related regulation and receiving radiation protection education. The group with higher knowledge and awareness shows positive correlation with safety behavior. The increase of use of the radiation related medical devices in veterinary hospital causes the increase of radiation exposure risk. This study suggests that radiation safety management system and policies need to be developed to protect radiation workers and give them correct information and consciousness.

Cloud datacenters are important for the digital society, serving stakeholders across industry, government, and academia. Simulation is a critical part of exploring datacenter technologies, enabling scalable experimentation with millions of jobs and hundreds of thousands of machines, and what-if analysis in a matter of minutes to hours. Although the community has already developed powerful simulators, emerging technologies and applications in modern datacenters require new approaches. Addressing this requirement, in this work we propose OpenDC, a new platform for datacenter simulation. OpenDC includes novel models for emerging cloud-datacenter technologies and applications, such as serverless computing with FaaS deployment and TensorFlow-based machine learning. Our design also focuses on convenience, with a web-based interface for interactive experimentation, support for experiment automation, a library of prefabs for constructing and sharing datacenter designs, and support for diverse input formats and output metrics. We implement, validate, and open-source OpenDC 2.0, a significant redesign and release after a multi-year research and development process. We demonstrate the benefits of OpenDC for the field through a set of representative use-cases: serverless, machine learning, procurement of HPC-as-a-Service infrastructure, educational practices, and reproducibility studies. Overall, OpenDC helps understand how datacenters work, design datacenter infrastructure, and train the next generation of experts.

The COVID-19 pandemic has focused renewed attention on the ways in which building HVAC systems may be operated to mitigate the risk of airborne disease transmission. The most common suggestion is to increase outdoor-air ventilation rates so as to dilute the concentrations of infectious aerosol particles indoors. Although this strategy does reduce the likelihood of disease spread, it is often much more costly than other strategies that provide equivalent particle removal or deactivation. To address this tradeoff and arrive at practical recommendations, we explain how different mitigation strategies can be expressed in terms of equivalent outdoor air (EOA) to provide a common basis for energy analysis. We then show the effects of each strategy on EOA delivery and energy cost in simulations of realistic buildings in a variety of climates. Key findings are that in-duct filtration is often the most efficient mitigation strategy, while significant risk reduction generally requires increasing total airflow to the system, either through adjusted HVAC setpoints or standalone disinfection devices.

The COVID-19 pandemic has renewed interest in assessing how the operation of HVAC systems influences the risk of airborne disease transmission in buildings. Various processes, such as ventilation and filtration, have been shown to reduce the probability of disease spread by removing or deactivating exhaled aerosols that potentially contain infectious material. However, such qualitative recommendations fail to specify how much of these or other disinfection techniques are needed to achieve acceptable risk levels in a particular space. An additional complication is that application of these techniques inevitably increases energy costs, the magnitude of which can vary significantly based on local weather. Moreover, the operational flexibility available to the HVAC system may be inherently limited by equipment capacities and occupant comfort requirements. Given this knowledge gap, we propose a set of dynamical models that can be used to estimate airborne transmission risk and energy consumption for building HVAC systems based on controller setpoints and a forecast of weather conditions. By combining physics-based material balances with phenomenological models of the HVAC control system, it is possible to predict time-varying airflows and other HVAC variables, which are then used to calculate key metrics. Through a variety of examples involving real and simulated commercial buildings, we show that our models can be used for monitoring purposes by applying them directly to transient building data as operated, or they may be embedded within a multi-objective optimization framework to evaluate the tradeoff between infection risk and energy consumption. By combining these applications, building managers can determine which spaces are in need of infection risk reduction and how to provide that reduction at the lowest energy cost. The key finding is that both the baseline infection risk and the most energy-efficient disinfection strategy can vary significantly from space to space and depend sensitively on the weather, thus underscoring the importance of the quantitative predictions provided by the models.

Since the advent of the COVID-19 pandemic, there has been renewed interest in determining how the operation of building HVAC systems influences the risk of airborne transmission of disease. It has been established that combinations of increased ventilation, improved filtration, and other disinfection techniques can reduce the likelihood of transmission by removing or deactivating the airborne particles that potentially contain infectious material. However, when such guidance is general and qualitative in nature, it is extremely difficult for building managers to make informed decisions, as there is no quantitative information about how much risk reduction is provided. Furthermore, the actions that could be taken almost always require additional energy consumption by the HVAC system, and so in the absence of building-specific analysis, it is possible that chosen strategies might simply be wasting energy without providing meaningful reduction in transmission risk. To address this knowledge gap, we propose simplified steady-state models that can be used to quantify both the expected infection rate and the associated HVAC energy consumption that result from baseline operation and hypothetical changes. The transmission rate is modeled by considering the airborne concentration of infectious particles that would result from the activity-dependent respiration of an infector in the space, the physical dimensions of the space, and operation of the HVAC system. By formulating all disinfection mechanisms in terms of “equivalent outdoor air”, a common basis is established for comparing and combining different strategies. Energy consumption can then be estimated by considering the change in HVAC variables (e.g., flow rates and temperatures) and applying standard models. To illustrate the insights provided by these models, we present examples of how the proposed analysis can be applied to specific spaces, highlighting the fact that underlying transmission risk (and thus also the energy-optimal disinfection strategies) can vary significantly from building to building and even from space to space within the same building. The overall goal is to empower building managers to fully assess the tradeoff between energy consumption and infection risk so that they can more effectively target their disinfection efforts and take actions that are consistent with current health and sustainability priorities.

Purpose: The purpose of this study was to investigate factors related to use of restraints for older adults with dementia in long-term care settings. Methods: This study analyzed secondary data from the Nationwide Survey on Dementia Care in Korea (NaSDeCK). Demographic characteristics, disease characteristics, and functional characteristics were analyzed. Data were analyzed with x2 test, t-test, ANOVA, and logistic regression analysis. Results: Among participants, 8.2% experienced use of restraints. ‘Strap’ (78.3%) was the most commonly used restraint and ‘Behavioral problem’ (51.3%) was a major reason for the restraint. Persons who have low levels of daily activity and cognition deficits, higher levels of dependence, histories of falls within the past 3 months, and living in long-term hospitals have greater probability of restraint experience. Conclusion: Developing interventions for older adults who have a high risk of being restrained is essential to minimize unnecessary restraint use among older adults with dementia in long-term care settings. Further study exploring the interacting roles of organizational and staff factors related to use of physical restraints would provide more comprehensive perspectives in understanding this phenomenon.