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This chapter reviews the properties that contribute to the stability of microencapsulated ingredients and their effect on sensory properties. Special focus is given to factors that affect the wall and/or encapsulated core ingredients and how these factors can be measured to assess stability of the microcapsule. Additionally, basic physiology and methodologies in sensory science are reviewed. How these sensory basics are applied to microencapsulation research is shown through a variety of literature.

Background Cefaclor, a second-generation oral cephalosporin, is widely prescribed to treat infectious diseases. Immediate hypersensitivity (HS) reactions to cefaclor have continuously been reported and are expected to increase with its greater use. This study aimed to investigate the clinical characteristics and risk factors of immediate HS to cefaclor over the most recent 5 years. Methods This retrospective study investigated 521 adverse drug reactions (ADRs) to cefaclor at pharmacovigilance centers at two tertiary hospitals from January 2014 to December 2018. In total, 459 patients with immediate HS to cefaclor were reviewed. Results A total of 459 cases of cefaclor immediate HS were included among 521 cefaclor ADRs, and anaphylaxis was recorded in 61.2%. Female sex (odds ratio 2.917, 95% confidence interval 2.397–3.550, P P P P = 0.010), asthma (8.075, 5.301–12.302, P P Conclusions Cefaclor was found to elicit high proportions of immediate HS and anaphylaxis. Physicians ought to be cautious with prescribing cefaclor to females, individuals with hypertension, liver diseases, or asthma, and patients taking nonsteroidal anti-inflammatory drugs. Trial registration This study was retrospectively registered.

Although younger patients with allergic rhinitis (AR) have been successfully treated with pharmacotherapy, there are no definitive data on treatment outcomes in older patients with AR. We performed a prospective study of 51 older adults with AR (aged over 65 years) and 101 younger AR patients (aged from 19 to 40 years) to compare clinical outcomes between the 2 groups and to evaluate the impact of depressed mood on treatment outcomes in older AR patients. Changes in total symptom scores (TSS), rhinitis-specific quality of life questionnaire (RQLQ) results, rhinitis control assessment test (RCAT) results and visual analog scale (VAS) scores were evaluated after 4-week treatment according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guideline, and the severity of depressed mood was assessed by using the geriatric depression scale. After 4-week treatment, younger AR patients had greater improvements in clinical scores compared with older adults; differences in least squares mean changes from baseline in older patients vs. younger patients were 1.71 (P = 0.004) for TSS, 10.84 (P < 0.001) for RQLQ, 0.80 (P = 0.275) for RCAT, and 8.60 for VAS score (P = 0.061). Multiple logistic regression analysis showed that the severity of depressed mood was independently associated with severe chronic upper airway disease (adjusted odds ratio, 1.385; P = 0.004). Our results suggest that older AR patients are less responsive to standard treatment compared with younger AR patients and that depressed mood is strongly associated with the increased risk of uncontrolled AR in older AR patients.

PURPOSE Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics. METHODS We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups. RESULTS A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, p < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, p < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups. CONCLUSION These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.

Background Evaluation of interstitial lung disease (ILD) at CT is a challenging task that requires experience and is subject to substantial interreader variability. Purpose To investigate whether a proposed content-based image retrieval (CBIR) of similar chest CT images by using deep learning can aid in the diagnosis of ILD by readers with different levels of experience. Materials and Methods This retrospective study included patients with confirmed ILD after multidisciplinary discussion and available CT images identified between January 2000 and December 2015. Database was composed of four disease classes: usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia, and chronic hypersensitivity pneumonitis. Eighty patients were selected as queries from the database. The proposed CBIR retrieved the top three similar CT images with diagnosis from the database by comparing the extent and distribution of different regional disease patterns quantified by a deep learning algorithm. Eight readers with varying experience interpreted the query CT images and provided their most probable diagnosis in two reading sessions 2 weeks apart, before and after applying CBIR. Diagnostic accuracy was analyzed by using McNemar test and generalized estimating equation, and interreader agreement was analyzed by using Fleiss κ. Results A total of 288 patients were included (mean age, 58 years ± 11 [standard deviation]; 145 women). After applying CBIR, the overall diagnostic accuracy improved in all readers (before CBIR, 46.1% [95% CI: 37.1, 55.3]; after CBIR, 60.9% [95% CI: 51.8, 69.3]

PURPOSE OF REVIEW The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. RECENT FINDINGS Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. SUMMARY New insights into neutrophils in the pathogenesis of occupational asthma may provide a novel approach to the individual patient with occupational asthma.

Microfluidics has been studied as a rapid detection tool for food safety related applications for a long time. Recently, more and more interests have been attracted to use microfluidics as microreactors to assemble biopolymers to achieve desirable functionalities. Attributed to the accurate flow control and unique bottom-up mechanism, the properties of the assembled biopolymer structures could be well-controlled. To date, several food-grade biopolymers, including proteins and carbohydrates, have been found suitable for the microfluidic process. However, challenges remain, notably the scale-up of the process. In this chapter, the fundamental principles of microfluidics and their feasibility to process food materials and design food structures are thoroughly covered and discussed.

PURPOSE Dupilumab is recommended to be administered biweekly to treat adult patients with moderate-to-severe atopic dermatitis (AD). Real clinical practice data on the clinical efficacy of monthly dupilumab therapy are limited. We analyzed real clinical practice data on the clinical efficacy of monthly dupilumab therapy and predictive markers for favorable clinical responses to the therapy. METHODS Medical records of 57 adult patients with moderate-to-severe AD who received dupilumab therapy every 4 weeks for 16 weeks were analyzed retrospectively. Eczema Area and Severity Index (EASI) were recorded at baseline and week 16. Clinical responses to monthly dupilumab therapy were defined as the proportion of patients with decreased EASI scores of at least 50% or 75% from baseline at week 16 (EASI-50 or EASI-75). Blood eosinophil counts and serum lactate dehydrogenase (LDH) levels were measured at baseline and week 16. RESULTS Monthly dupilumab therapy showed EASI-50 and EASI-75 clinical responses in 48 (84.2%) and 27 (47.4%) of 57 patients at week 16, respectively. The percentage decrease in EASI scores from baseline at week 16 was significantly inversely correlated with baseline blood eosinophil count (correlation coefficient [r] = -0.405, P = 0.002) and baseline serum LDH level (r = -0.466, P < 0.001). The EASI-75 response rate was higher in patients with low (< 500/µL, 73.3%) than in those with high (≥ 500/µL, 37.5%) baseline blood eosinophil counts (P = 0.032), and was higher in patients with low (< 400 U/L, 55.6%) than those with high (≥ 400 U/L, 10.0%) baseline serum LDH levels (P = 0.013). CONCLUSIONS Monthly dupilumab therapy was clinically effective in adult patients with moderate-to-severe AD in real clinical practice. Baseline blood eosinophil count and serum LDH level could be predictive markers for clinical response to dupilumab therapy.

Background Aging populations are often accompanied by comorbidity and polypharmacy, leading to increases in adverse drug reactions (ADRs). We sought to evaluate the causes and characteristics of ADRs in older Korean adults (≥65 years) in comparison to younger individuals ( Methods Of 37,523 cases reported at a Korean pharmacovigilance center from 2011 to 2018, we reviewed 18,842 ADRs of certain or probable causality on the basis of WHO-UMC criteria. We estimated the number of ADRs per 1000 patients exposed to the major culprit drugs, and incidence rate ratios were obtained to assess high- and low-risk medications in older adults. Results In total, 4152 (22.0%) ADRs were reported for 3437 older adults (mean age, 74.6 years and 57.3% female). Tramadol (rate ratio, 1.32; 95% confidence interval [CI], 1.21–1.44; P P = 0.002) posed higher risks of ADRs in the older adults, whereas nonsteroidal anti-inflammatory drugs (NSAIDs) (0.35, 0.30–0.40, P P P P = 0.001) were higher in the older adults than in the younger patients. Analgesics primarily elicited cutaneous ADRs in the younger patients and gastrointestinal reactions in the older adults. ICM more commonly led to anaphylaxis in the older adults than the younger patients (3.0% vs. 1.6%, P = 0.019). Conclusion For early detection of ADRs in older adults, better understanding of differences in the causes and characteristics thereof in comparison to the general population is needed.

The rise of machine learning (ML) has created an explosion in the potential strategies for using data to make scientific predictions. For physical scientists wishing to apply ML strategies to a particular domain, it can be difficult to assess in advance what strategy to adopt within a vast space of possibilities. Here we outline the results of an online community-powered effort to swarm search the space of ML strategies and develop algorithms for predicting atomic-pairwise nuclear magnetic resonance (NMR) properties in molecules. Using an open-source dataset, we worked with Kaggle to design and host a 3-month competition which received 47,800 ML model predictions from 2,700 teams in 84 countries. Within 3 weeks, the Kaggle community produced models with comparable accuracy to our best previously published ‘in-house’ efforts. A meta-ensemble model constructed as a linear combination of the top predictions has a prediction accuracy which exceeds that of any individual model, 7-19x better than our previous state-of-the-art. The results highlight the potential of transformer architectures for predicting quantum mechanical (QM) molecular properties.

There have been few studies assessing long-term outcomes of asthma based on regular follow-up data.We aimed to demonstrate clinical outcomes of asthma by multidimensional analyses of a long-term real-world database and a prediction model of severe asthma using machine learning.The database included 567 severe and 1337 nonsevere adult asthmatics, who had been monitored during a follow-up of up to 10 years. We evaluated longitudinal changes in eosinophilic inflammation, lung function, and the annual number of asthma exacerbations (AEs) using a linear mixed effects model. Least absolute shrinkage and selection operator logistic regression was used to develop a prediction model for severe asthma. Model performance was evaluated and validated.Severe asthmatics had higher blood eosinophil (P = .02) and neutrophil (P.001) counts at baseline than nonsevere asthmatics; blood eosinophil counts showed significantly slower declines in severe asthmatics than nonsevere asthmatics throughout the follow-up (P = .009). Severe asthmatics had a lower level of forced expiratory volume in 1 second (P.001), which declined faster than nonsevere asthmatics (P = .033). Severe asthmatics showed a higher annual number of severe AEs than nonsevere asthmatics. The prediction model for severe asthma consisted of 17 variables, including novel biomarkers.Severe asthma is a distinct phenotype of asthma with persistent eosinophilia, progressive lung function decline, and frequent severe AEs even on regular asthma medication. We suggest a useful prediction model of severe asthma for research and clinical purposes.

Cefaclor, a second-generation oral cephalosporin, is the most frequently prescribed cephalosporin in Korea. Studies, however, have yet to analyze the incidence of cefaclor-associated adverse drug reactions (ADRs), including hypersensitivity (HS), according to total national usage rates. This study aimed to investigate the incidence rates and clinical features of cefaclor ADRs reported to the Korean Adverse Event Reporting System (KAERS) and Health Insurance Review and Assessment Service (HIRA) database for the most recent 5 years. Reviewing the HIRA database, which contains information on all insurance claims, including prescribed medications and patient demographics, we identified the total number of individuals who had been prescribed cefaclor and other cephalosporins including 2nd generation without cefaclor and 3rd generation antibiotics from January 2014 to December 2018. Additionally, we retrospectively analyzed all ADRs reported to the KAERS for these drugs over the same study period. Incidence rates for ADRs, HS, and anaphylaxis to cefaclor were 1.92/10,000 persons, 1.17/10,000 persons, and 0.38/10,000 persons, respectively, lower than those to other 2nd and 3rd cephalosporins. Among all ADRs, HS (60.9% vs. 43.6% vs. 44.8%, P P nd and 3rd cephalosporins. Females, individuals under 65 years of age, concomitant use of drugs, and serious ADRs were more strongly associated with HS to cefaclor than with HS to other 2nd and 3rd cephalosporins. In a nationwide database for the Korean population, the incidence of cefaclor-induced ADRs, particularly HS and anaphylaxis, was high. Female sex, age younger than 65 years, and concomitant use of drugs may be associated with HS to cefaclor.

Background It has been known that a high serum total immunoglobulin E (IgE) level is a predisposing factor of allergic asthma; however, there are considerable limitations to apply it in clinical practice. Objective To determine the clinical significance of the serum-free IgE level in patients with adult asthma. Methods We measured free IgE levels using our homemade enzyme-linked immunosorbent assay by applying a novel IgE TRAP protein (GI innovation, Seoul, Republic of Korea) in sera of adults with asthma (n = 116) compared with healthy controls (n = 32); enzyme-linked immunosorbent assay inhibition test was performed to validate its binding specificity. Associations between asthma-related clinical and laboratory parameters were analyzed. The diagnostic value and cutoff point for detecting atopy and type 2 asthma were determined using receiver operating characteristic curve analysis. Results The serum-free IgE levels were significantly higher in adults with asthma than in healthy controls and were significantly associated with atopic status and type 2 asthma (all P Conclusion It is suggested that a higher serum-free IgE level may be a useful biomarker of atopy and type 2 asthma in adults with asthma.

Among unconventional gas reservoirs, shale gas has become an increasingly important source of natural gas supply in North America and around the world. Horizontal drilling and multi-stage hydraulic fracturing are the two key technologies for the economic development of shale gas reservoirs. Generally, natural gas in shale reservoirs is stored as free gas state in both larger mineral pores and natural fractures, as well as adsorbed gas state within organic matter and clay minerals. Since a considerable fraction of the gas in place (GIP) is in the adsorbed state, investigation of gas adsorption can provide critical insights into the evaluation of resources volume in shale. In this study, several experiments are carried out on fourteen shale core samples obtained in a vertical well drilled in Horn River Basin, Canada. The total organic carbon (TOC) content, specific surface area (SSA), and CH4 adsorption isotherm are measured for the samples. In order to measure the volume of adsorbed gas at reservoir pressure, the high pressure Belsorp-HP equipment applying volumetric method is used. As results, it is observed that adsorption capacity is a function of not only the TOC but also the SSA. When the samples have similar TOC, adsorption capacity becomes higher as SSA increases and Langmuir volume increases too. We also consider the relationship between SSA and adsorption capacity for each kerogen quality that it shows a linear trend. Also, we attempt to find a correlation of TOC and SSA to the adsorption capacity by categorizing experimental results. Finally, gas in place calculation is carried out for the free gas and adsorbed gas in Horn River shale, respectively.

Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms.Owing to the heterogeneity of the disease, a new concept for the classification of NSAID hypersensitivity has recently been proposed to diagnose and manage NSAID hypersensitivity for personalized treatment. Acute and delayed reactions were distinguished in this classification, and identification of symptoms and speculation of putative mechanisms help physicians make the right diagnosis. NSAID-exacerbated respiratory disease is a noticeable phenotype of NSAID hypersensitivity that involves upper airway comorbidities (chronic rhinosinusitis with nasal polyps) as well as asthmatic features. The cutaneous phenotypes of NSAID hypersensitivity occur, and cross-reactivity with other types of NSAID should be considered in establishing a proper diagnosis. Hypersensitivity to a single NSAID can present urticaria/angioedema and anaphylaxis, in which an IgE-mediated immune response is suggested to be a prime mechanism. Management of NSAID hypersensitivity reactions includes avoidance, pharmacological treatment following standard guidelines, and aspirin desensitization.The classification, diagnosis, and management of NSAID hypersensitivity should be individually reached by identifying its phenotype.

PURPOSE Eosinophilic inflammation is a key component of severe asthma (SA). However, there has been no reliable serum biomarker for the eosinophilic inflammation of SA. We hypothesized that serum eosinophil-derived neurotoxin (EDN) could predict the eosinophilic inflammation of SA in adult asthmatics. METHODS Severe asthmatics (n = 235), nonsevere asthmatics (n = 898), and healthy controls (n = 125) were enrolled from Ajou University Hospital, South Korea. The serum levels of EDN and periostin were measured by enzyme-linked immunosorbent assay and compared between severe and nonsevere asthmatics. Their associations with total eosinophil count (TEC) and clinical parameters were evaluated; clinical validation of the K-EDN kit for the measurement of serum EDN was evaluated. RESULTS Severe asthmatics were older and had longer disease duration with significantly lower levels of forced expiratory volume in 1 second and methacholine PC20 than nonsevere asthmatics. Significant differences were found in TEC or sputum eosinophil count (%) between the groups. The serum levels of EDN and periostin were significantly higher in severe asthmatics than in nonsevere asthmatics and in healthy controls (all P < 0.05). Although significant correlations were found between serum EDN levels measured by the 2 kits (ρ = 0.545, P < 0.0001), higher correlation coefficients between serum EDN levels measured by the K-EDN kit and TEC were higher (ρ = 0.358, P < 0.0001) than those between serum EDN levels measured by the MBL kit and TEC (ρ = 0.319, P < 0.0001) or serum periostin level (ρ = 0.222, P < 0.0001). Multivariate regression analysis demonstrated that serum EDN levels measured by the K-EDN kit predicted the phenotype of SA (P = 0.003), while 2 other biomarkers did not. CONCLUSIONS The serum EDN level may be a useful biomarker for assessing asthma severity in adult asthmatics.

Patients with severe eosinophilic asthma (SEA) suffer from frequent asthma exacerbations, where eosinophils are major effector cells in airway inflammation, and anti-interleukin (IL)-5 becomes an effective treatment modality to control eosinophilic inflammation of SEA. Fifteen patients with SEA who had been treated with anti-IL5 (reslizumab, 100 mg monthly intravenously) for 6 months at Ajou University Hospital (Suwon, Korea) were enrolled in this study. Clinical parameters, including total blood eosinophil count (TEC), FEV1%, fractional exhaled nitric oxide (FeNO) levels, and serum biomarkers such as eosinophil-derived neurotoxin (EDN), periostin (PON), and transforming growth factor-β1 (TGF-β1), were analyzed. EDN levels and TEC decreased significantly after 1 month of treatment (P < 0.05 for both), while no changes were noted in FeNO/PON/TGF-β1 levels. FEV1% increased after 2 months of treatment (P < 0.05). A positive correlation was observed between TEC and EDN levels (r = 0.60, P = 0.02). Significant negative correlations were noted between age and TEC/EDN levels (r = −0.57, P = 0.02 and r = −0.56, P = 0.03, respectively). Baseline TEC was higher in the EDN-responder group (≥75% decrease) than in the non-responder group (P = 0.06) with a positive correlation between %reduction in EDN and TEC (r = 0.67, P = 0.01). The onset age was younger and asthma duration was longer in the FEV1%-non-responder group (

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in China. The mutated coronavirus spread worldwide, and some patients infected with SARS-CoV-2 developed coronavirus disease 2019 (CO VID-19) manifested with upper respiratory infection, pneumonia, or respiratory distress. Since the SARS-CoV-2 pandemic was de clared with surging confirmed cases and mortality of COVID-19 worldwide, it has reshaped our way of living and how to manage patients with allergic diseases. The medical staff, including allergy specialists, has been at the forefront of fighting against the SARS-CoV-2 pandemic and is struggling to guarantee safety to themselves and their patients. Thanks to vigorous research into the rela tionship between SARS-CoV-2 and allergic diseases, we have become able to treat allergic patients with the best of evidence to date. The clinician should make a careful decision on each clinical situation with regard to patient characteristics, local and national circumstances as well as the knowledge we have, since it is still limited. We hope further efforts to identify the nature of SARS-CoV-2 and COVID-19 clearer and effective SARS-CoV-2 vaccination will soon remove the grim picture of the worldwide pandemic and bring us back to normal. (Allergy Asthma Respir Dis 2021;9:115-123)

Severe asthma (SA) is a heterogeneous disease characterized by uncontrolled symptoms, frequent exacerbations, and lung function decline. The discovery of phenotypes and endotypes of SA significantly improves our understanding of its pathophysiology and allows the advent of biologics blocking multiple molecular targets. The advances have mainly been made in type 2-high asthma associated with elevated type 2 inflammatory biomarkers such as immunoglobulin E (IgE), interleukins (IL)-4, IL-5, and IL-13. Previous clinical trials have demonstrated that type 2 biomarkers, including blood/sputum eosinophils and the fraction of exhaled nitric oxide (FeNO), were correlated to severe airway inflammation, persistent symptoms, frequent exacerbations, and the clinical efficacy of these biomarkers in predicting treatment outcomes of type 2-targeting biologics. However, it is well known that type 2 inflammation is partially attributable to the pathogenesis of SA. Although some recent studies have suggested that type 2-low and mixed phenotypes of asthma are important contributors to the heterogeneity of SA, many questions about these non-type 2 asthma phenotypes remain to be solved. Consequently, many efforts to investigate and find novel biomarkers for SA have also made in their methods. Many cross-sectional experimental studies in large-scale cohorts and randomized clinical trials have proved their value in understanding SA. More recently, real-world cohort studies have been in the limelight for SA research, which is unbiased and expected to give us an answer to the unmet needs of the heterogeneity of SA.

PURPOSE Little is known about the clinical course of chronic urticaria (CU) and predictors of its prognosis. We evaluated CU patient clusters based on medication scores during the initial 3 months of treatment in an attempt to investigate time to remission and relapse rates for CU and to identify predictors for CU remission. METHODS In total, 4,552 patients (57.9% female; mean age of 38.6 years) with CU were included in this retrospective cohort study. The K-medoids algorithm was used for clustering CU patients. Kaplan-Meier survival analysis with Cox regression was applied to identify predictors of CU remission. RESULTS Four distinct clusters were identified: patients with consistently low disease activity (cluster 1, n = 1,786), with medium-to-low disease activity (cluster 2, n = 1,031), with consistently medium disease activity (cluster 3, n = 1,332), or with consistently high disease activity (cluster 4, n = 403). Mean age, treatment duration, peripheral neutrophil counts, total immunoglobulin E, and complements levels were significantly higher for cluster 4 than the other 3 clusters. Median times to remission were also different among the 4 clusters (2.1 vs. 3.3 vs. 6.4 vs. 9.4 years, respectively, P < 0.001). Sensitization to house dust mites (HDMs; at least class 3) and female sex were identified as significant predictors of CU remission. Around 20% of patients who achieved CU remission experienced relapse. CONCLUSIONS In this study, we identified 4 CU patient clusters by analyzing medication scores during the first 3 months of treatment and found that sensitization to HDMs and female sex can affect CU prognosis. The use of immunomodulators was implicated in the risk for CU relapse.

To plan a persuasive environmental campaign, it is important to tell consumers environmental messages in an engaging manner, to encourage user participation. To explore the effective approaches to storytelling for environmental innovation, this study analyzes how varying interaction modes based on the interactivity levels of user participation framework influence people&rsquo, s response to an environmental mission such as planting trees. This research has developed and employed various forms of interactive contents, such as problem-solving, mission-driven games to increase consumer awareness and induce pro-environmental actions. This research first reviews previous studies on game approaches and storytelling for environmental issues. It then explores how the different levels of interactive storytelling with the game content types induce consumer responses to a green product purchase or environmental protection campaign donation. Practical implications of environmental storytelling approaches and the use of interactive game content are also discussed.

Severe asthma (SA) presents in about 3%-5% of adult asthmatics and is responsible for over 60% of asthma-related medical expenses, posing a heavy socioeconomic burden. However, to date, a precise definition of or clear diagnostic criteria for SA have not been established, and therefore, it has been challenging for clinicians to diagnose and treat this disease. Currently, novel biologics targeting several molecules, such as immunoglobulin E, interleukin (IL)5, and IL4/IL13, have emerged, and many new drugs are under development. These have brought a paradigm shift in understanding the mechanism of SA and have also provided new treatment options. However, we need to agree on a precise definition of and its diagnostic criteria for SA. Additionally, it is necessary to explain the diagnostic criteria and to summarize current standard and additional treatment options. This review is an experts' opinion on SA from the Korean Academy of Asthma, Allergy, and Clinical Immunology, the Working Group on Severe Asthma, and aims to provide a definition of and diagnostic criteria for SA, and propose future direction for SA diagnosis and management in Korea.

Purpose Anaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults. Methods A total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated. Results PTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis. Conclusions In patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.

Although a viral infection is a major triggering factor of asthma and allergic diseases, asthma is suggested to be not a predisposing condition for coronavirus disease 2019 (COVID-19) infection. However, patients with severe asthma/allergic disease requiring systemic corticosteroids or immunosuppressive agents may be at higher risk of more severe clinical course of this infectious disease. For allergic patients who have been followed up at an allergy clinic in our region, it is recommended that they (patients with asthma, rhinitis, atopic dermatitis or chronic urticaria) continue to receive maintenance therapy and be in a well-controlled status. Patients who have used biologics (currently available for targeting type 2 inflammation) and allergen immunotherapy should continue the treatment while minimizing hospital and face-to-face visits. It is essential to wear protective equipment for the protection of health care workers as well as patients. We report this consensus to support allergists and clinical immunologists to make optimal decisions under the urgent situation in Asia.

Targeting both sodium and fat reduction in processed foods while maintaining consumer acceptance is a challenge in the food industry due to the innate liking by humans toward both ingredients. Canned soup is one of the leading processed food categories containing high quantities of sodium. Efforts to reduce both sodium and fat content in canned soup products have been problematic due to resulting decreased consumer acceptance. The objective of this study was to characterize the changes in the drivers of liking when sodium, fat, and herb levels are varied in a model retorted soup system. A creamy tomato soup system was developed containing four fat levels (free, low, reduced, regular), three sodium levels (low, reduced, regular), and two herb levels (with, without). Ninety-six consumers rated the soups for overall liking on a 9-point hedonic scale. A descriptive analysis panel composed of 10 trained panelists profiled the sensory attributes among the soups. Higher sodium level was found to be a driver of liking when fat content was reduced. Soups were significantly different in saltiness (taste) and tomato (aroma-by-mouth), based on varying fat and sodium levels. Herb content increased overall liking of lower sodium and fat soups and impacted attribute characterization of soups. Future steps would include approaches to increase overall liking of lower fat and sodium soups. Formulation modifications that would decrease intensities of attributes that characterize lower fat and sodium soups, such as sour (taste and aftertaste), grainy (texture), and darkness (appearance), will aid in higher consumer acceptance of these soups. PRACTICAL APPLICATION: With hypertensive individuals requiring reductions of both dietary sodium and fat, food products lower in fat and sodium while maintaining sensory acceptability are needed. Identifying drivers of liking when sodium and fat levels are reduced in processed food systems can assist in product reformulation to increase overall liking. Additionally, understanding the impact of herbs in consumer acceptance of lower sodium and fat food products will also contribute to further advances in product development.

Rationale Anaphylaxis is a serious allergic reaction which could be life-threatening. To date, it could be diagnosed by causality between clinical manifestations and triggers. But it is not always easy to find out the clue. Chlorpheniramine maleate (peniramin) is known to safe and it is an antihistamine commonly used to treat almost the whole allergic disease, including urticaria and allergic rhinitis. We recently experienced 2 cases of chlorpheniramine induced anaphylaxis. To document suspected cases of chlorpheniramine-induced adverse reactions, we analyzed a database spontaneously reported adverse drug reactions in the Ajou Regional Pharmacovigilance Center from 2011 to 2017. Patient concerns Two female patients presented urticaria and abdominal pain right after chlorpheniramine injection. Diagnoses Both patients were diagnosed with symptoms. One patient confirmed by assistance with tryptase level and another one confirmed cross-reactivity by skin tests. Interventions One patient was instructed to avoid future administration of chlorpheniramine. The other patient was advised not to take chlorpheniramine, and piperazine derivatives including cetirizine/levocetirizine, but piperidine derivatives such as fexofenadine, loratadine, and ebastine can be available. Outcomes The patients fully recovered after prompt treatment for anaphylaxis. After that, no recurrences were observed at the following. Among 54 patients with chlorpheniramine-induced adverse drug reactions from the Pharmacovigilance Center database, 17 (31.5%) were reported as anaphylaxis. Lessons Physicians should be aware chlorpheniramine could be a cause for allergic reaction. In addition, we suggest that serum tryptase level, skin prick test, and intradermal test could be considered as a supplementary test for diagnosing chlorpheniramine anaphylaxis and cross-reactivity should also be considered.

Service is often explained as a “staged experience.” However, the holistic structure that allows the audience to actively participate in experience co-creation is often more important in an aesthetic experience. We propose “storytelling” as a way to organize human experience. As a verb, storytelling is an ongoing, collaborative, and interactive conversation between the author and the audience. In this paper, we will explore how to apply storytelling to the design of the structural service experience by exploring the representative models of storytelling in the context of the service design process.

Experience design often emphasizes pleasurable emotion. In this paper, however, we seek to explore the role of negative emotion in experience with the case of storytelling applied to “mixed reality” technology in service situations. While mixed reality is a technological term focused on media, we propose the concept of “serviced reality,” which refocuses design on the needs and fulfillment of people who experience services across an organically unified virtual and real world. We introduce theories of storytelling to examine how stories connect negative and positive emotions in an overall flow that creates a sense of serviced reality. We discuss the role of negative emotion in the structure of autonomous experience based on Joseph Campbell’s model of the Hero’s Journey, with examples of student projects that applied this model to prototype service experiences.

The increase in physical (PHY) layer transmission rates in IEEE WLAN does not necessarily give the corresponding increase of MAC layer throughput because of MAC overhead such as PHY headers and contention time. To improve MAC layer efficiency, we propose the Transmission Order Deducing MAC (TOD-MAC) protocol, which controls packet length in such a way that the transmission duration is adjusted to implicitly provide necessary information for a node to determine its transmission order among all the nodes in a network. Each node transmits frames of different duration, and thus the other nodes can determine the time when they can transmit, which has the same effect as announcing the transmission order, without using a control message. Each node transmits a frame in a round robin manner, which minimizes the idle time between two consecutive transmissions without collisions, and significantly improves the MAC efficiency in very high speed CSMA/CA wireless networks. Extensive simulation results indicate that TOD-MAC achieves high throughput performance, short/long-term air-time fairness in multi-rate networks and excellent transient behavior in dynamic environments.

UNLABELLED Although herbs have been reported as one of the most common saltiness enhancers, few studies have focused on the effect of herbs on reducing added sodium as well as the impact of herbs on consumers' overall liking of foods. Therefore, the objectives of this study were to determine the effect of varying levels of herbs on reducing added sodium and consumers' overall liking of soups and identify the impact of salt levels on consumers' overall liking of soups. Overall liking of freshly prepared and retorted canned soups with varying levels of herbs was evaluated before and after adding salt by consumers ad libitum until the saltiness of the soup was just about right for them. The results of the study demonstrated that when the perceived herb flavor increased, the amount of salt consumers added to fresh soups decreased (P ≤ 0.006); however, consumers' overall liking decreased (P ≤ 0.013) as well for the highest level of herb tested in the study. Although overall liking of all canned soups was not significantly decreased by herbs, the amount of salt consumers added was also not significantly decreased when herbs were used. Overall liking of all soups significantly increased after more salt was added (P ≤ 0.001), which indicates that salt level was a dominant factor in affecting consumers' overall liking of soups with varying levels of herbs. These findings imply the role of herbs in decreasing salt intake, and the adequate amount of herbs to be added in soup systems. PRACTICAL APPLICATION It is challenging for the food industry to reduce sodium in foods without fully understanding the impact of sodium reduction on sensory properties of foods. Herbs are recommended to use in reducing sodium; however, little has been reported regarding the effect of herbs on sodium reduction and how herbs influence consumers’ acceptance of foods. This study provides findings that herbs may aid in decreasing the amount of salt consumers need to add for freshly prepared soups. It was also found that high levels of herbs may decrease consumers’ overall liking of soups.

Enhancing sodium release from the food matrix, thus increasing saltiness perception, is a promising strategy to reduce the amount of salt needed in foods. However, the complex nature of the effect of the food matrix on saltiness perception makes it difficult to control saltiness perception when designing food products. The aim of this review is to provide an overview of the food matrix effects on saltiness perception of sodium chloride. The effects are discussed in the order of 3 stages in saltiness perception: release of sodium from food matrix into oral cavity (1st stage), delivery of sodium within oral cavity (2nd stage), and detection of sodium by the taste receptor cells (TRCs) (3rd stage). In the 1st stage, the food matrix affects the initial availability of sodium to be released, and also affects the spontaneous and facilitated migration of sodium from the matrix into the oral cavity. In the 2nd stage, the food matrix affects the availability of sodium and the mixing efficiency of sodium with saliva. The relationship between food matrix and oral processing of food that may affect the sodium release (1st stage) and the delivery (2nd stage) is also discussed. In the 3rd stage, the food matrix affects the physical availability of sodium for the TRCs, the physiological activity of TRCs, and the central activities involved in the perception process. Based on the understanding of complex nature of the matrix effects on saltiness perception discussed in this review, the properties of food matrix may be controlled effectively to enhance saltiness perception and achieve sodium reduction.

This thesis deals with improvements plans of living space in a domestic juvenile reformatory. Juvenile reformatory is not only just facilities for detention, but also curing, protecting and educating facilities. Through analyzing the problem of domestic juvenile reformatory and case study of advanced country, The purpose of this thesis intends to suggest the planning direction and improvement direction of architecture in domestic juvenile reformatory. It will also help to show valid architectural types and facilities standard when it build, build an extension and remodel.

Coalbed methane (CBM) content is generally estimated using the isotherm theory between pressure and adsorbed amounts of methane. It usually determines the maximum content of adsorbed methane or storage capacity. However, CBM content obtained via laboratory experiment is not consistent with that in the in-situ state because samples are usually ground, which changes the specific surface area. In this study, the effect of the specific surface area relative to CBM content was investigated, and diffusion coefficients were estimated using equilibrium time analysis. The differences in adsorbed content with sample particle size allowed the determination of a specific surface area where gases can adsorb. Also, there was an equilibrium time difference between fine and lump coal, because more time is needed for the gas to diffuse through the coal matrix and adsorb onto the surface in lump coal. Based on this, we constructed a laboratory-scale simulation model, which matched with experimental results. Consequently, the diffusion coefficient, which is usually calculated through canister testing, can be easily obtained. These results stress that lump coal experiments and associated simulations are necessary for more reliable CBM production analysis.

Eosinophils have long been recognized as a central effector cell in the lungs of asthmatic patients. They contribute to airway inflammation and remodeling through releasing several molecules such as cytokines, granule proteins, lipid mediators and extracellular traps/vesicles. Repeated evidence reveals that intense eosinophil infiltration in upper and lower airway mucosae contributes to the pathogenesis of aspirin-exacerbated respiratory disease (AERD). Persistent eosinophilia is found to be associated with type 2 immune responses, cysteinyl leukotriene overproduction and eosinophil-epithelium interactions. This review highlights recent findings about key mechanisms of eosinophil activation in the airway inflammation of AERD. In addition, current biologics (targeting type 2 immune responses) were suggested to control eosinophilic inflammation for AERD patients.

We propose a novel media access control (MAC) protocol, referred to assignaling-free max-min airtime fair(SMAF) MAC, to improve fairness and channel utilization in ad hoc networks based on IEEE 802.11 wireless local area networks (WLANs). We introducebusy time ratio(BTR) as a measure for max-min airtime fairness. Each node estimates its BTR and adjusts the transmission duration by means of frame aggregation and fragmentation, so that it can implicitly announce the BTR to neighbor nodes. Based on the announced BTR, each of the neighbor nodes controls its contention window. In this way, the SMAF MAC works in a distributed manner without the need to know the max-min fair share of airtime, and it does not require exchanging explicit control messages among nodes to attain fairness. Moreover, we successfully incorporate the hidden node detection and resolution mechanisms into the SMAF MAC to deal with the hidden node problem in ad hoc networks. The simulation results confirm that the SMAF MAC enhances airtime fairness without degrading channel utilization, and it effectively resolves several serious problems in ad hoc networks such as the starvation, performance anomaly, and hidden node problems.

We investigated the morphological and optical properties of InAs quantum dots (QDs) grown by using periodic arsine interruption (PAI) and compared them with QDs grown conventionally. In the conventional growth, the formation of large islands was observed, which suppresses the nucleation and growth of QDs. Furthermore, the growth of capping layers was significantly degraded by these large islands. On the other hand, in the PAI growth, the formation of large islands was completely suppressed, resulting in the increase of the density and aspect ratio of QDs and the uniform growth of capping layers. As a result of photoluminescence (PL) measurements, we found that the emission efficiency was enhanced and the full-width-half-maximum was reduced to 32 meV. The temperature dependence of these optical properties also revealed the enhancement of the uniformity of QDs grown by the PAI method.

Purpose To assess the feasibility of performing central molecular analyses of fresh medulloblastomas obtained from multiple institutions and using these data to identify prognostic markers for contemporaneously treated patients. Materials and Methods Ninety-seven samples of medulloblastoma were collected. Tumor content in samples was judged by frozen section review. Tumor ERBB2 protein and MYCC, MYCN, and TRKC mRNA levels were measured blind to clinical details using Western blotting and real-time polymerase chain reaction, respectively. Histopathologic and clinical review of each case was also performed. All data were subjected to independent statistical analysis. Results Sample acquisition and analysis times ranged from 3 to 6 days. Eighty-six samples contained sufficient tumor for analysis, including 38 classic, 30 nodular desmoplastic, and 18 large-cell anaplastic (LCA) medulloblastomas. Protein and mRNA were extracted from 81 and 49 tumors, respectively. ERBB2 was detected in 40% (n = 32 of 81) of tumors, most frequently in LCA disease (P = .005), and was independently associated with a poor prognosis (P = .031). A combination of clinical characteristics and ERBB2 expression provided a highly accurate means of discriminating disease risk. One hundred percent (n = 26) of children with clinical average-risk, ERBB2-negative disease were alive at 5 years, with a median follow-up of 5.6 years, compared with only 54% for children with average-risk, ERBB2-positive tumors (n = 13; P = .0001). TRKC, MYCC, and MYCN expression and histopathologic subtype were not associated with prognosis in this study. Conclusion Central and rapid molecular analysis of frozen medulloblastomas collected from multiple institutions is feasible. ERBB2 expression and clinical risk factors together constitute a highly accurate disease risk stratification tool.

Recently, Health Impact Assessment has gained great attention in Korea. First, the Ministry of Environment introduced HIA within existing Environment Impact Assessment. Second, the Korea Institute for Health and Social Affairs began an HIA program in 2008 in alliance with Healthy Cities. In this short report, these two different efforts are introduced and their opportunities and challenges discussed. We believe these two approaches complement each other and both need to be strengthened. We also believe that both can contribute to the development of health in policy and project development and ultimately to improvements in the Korean population's health.

The Korea Advanced Manufacturing System (KAMS) is one of the Highly Advanced National (HAN) Projects planned to achieve significant technological advances in Korea. The aim of this project is to create new processes and technologies for managing and integrating manufacturing systems. The key to sustaining economic growth and surviving global competition is to develop advanced manufacturing systems technology. The Korea Institute of Industrial Technology (KITECH) began this project in 1992 with support from the Ministry of Trade, Industry and Energy and the Ministry of Science and Technology. The project is divided into three phases, each phase consisting of project groups which include several research projects. The main project groups are `next-generation machining system' and `assembly and inspection system for electronic products'. The names of research projects are listed, and brief explanations are also introduced in this paper. The KAMS Project is expected to result in many benefits for manufacturing industry. The increase in productivity and system accuracy, and reduction in lead-time, will give renewed vitality to Korean manufacturing industry.

Increasing the amount of protein in snack foods can add to their satiating ability, which aligns with many health-based trends currently seen in the food industry. Understanding the effect of adding high levels of protein in a food matrix is essential for product development. The objective for this research was to determine the effects of varying protein type and level on the sensory-related aspects of a model extruded snack food. Independent variables in the design of the snacks were the level of total protein and the protein type in the formulation. The level of protein ranged from 28% to 43% (w/w) in 5% increments. The protein type varied in the ratio of whey to soy protein ranging from 0: 100 to 100: 0, in 25% increments. Descriptive analysis was conducted on the samples to profile their sensory characteristics. Protein type was found to be the predominant variable in differentiating the sensory characteristics of the samples. Soy protein imparted nutty, grainy aromas-by-mouth, and increased expansion during processing, resulting in a lighter, crispier texture. Whey protein imparted dairy related aromas-by-mouth and inhibited expansion during processing, resulting in a more dense, crunchy texture. Separately, 100 consumers rated their acceptance of the samples using the 9-point hedonic scale. It was found that protein type was also the predominant variable in affecting acceptance, with some clusters of consumers preferring samples comprised of soy protein, and others preferring samples with whey. Food product developers can use these findings to predict changes in a similar food product by varying protein level or protein type. Practical Application: This work shows how the perceivable appearance, aroma, and texture characteristics of puffed snack foods change when adding protein or changing the protein type. The type of protein incorporated was shown to have major effects on the characteristics of the snacks, partially because of their impact on how much the snacks puffed during processing. The findings from this research can help develop acceptable products that incorporate high levels of protein to be aligned with current health trends in the market.

Although IEEE 802.11e Enhanced Distributed Channel Access (EDCA) provides service differentiation, it leaves much to be desired in terms of aggregate throughput and quality of Service (QoS) differentiation among priority classes. Furthermore, EDCA does not provide airtime fairness for nodes with different transmission rates. Therefore, the throughput of a node transmitting at a high transmission rate is heavily degraded when some nodes transmit at a low transmission rate, which is known as performance anomaly. In this paper, we propose a new medium access scheme, AS-MAC, which provides excellent absolute priority service, the successful transmission time (ST-time) fairness and optimal throughput performance in 802.11 WLANs.

As a major food ingredient, soybean provides numerous health benefits, for example, individuals who consume soybean-rich diets exhibit lower incidence of high plasma cholesterol, cancer (including bowel and kidney), diabetes mellitus, and obesity (Carroll and Kurowska, 1995; Friedman and Brandon, 2001; Duranti et al., 2004; Ali et al., 2004; Omini and Aluko, 2005; Kim et al., 2006). However, soybean is also among the “big 8” most allergenic foods, and the only possible solution currently to prevent allergenic reactions is total avoidance of the allergen-containing foods. Because soybean is ubiquitous in vegetarian and many meat based food products, avoidance has become increasingly difficult, and its prevalence will inevitably continue to rise. Due to the innumerable health benefits and economic importance of soy commercial products, there is a mounting need to remove the allergenic components contained in soybean proteins to a threshold deemed to be safe. The estimated threshold level for common food allergy is usually low and a small amount of the allergen may be enough to trigger an allergenic reaction (Poms et al., 2004). The threshold for soybean allergen is estimated to range from 88 mg to several grams of soy protein (Bindslev-Jensen et al., 2002; Fiocchi et al., 2003). Soybean allergy is of particular importance because soybean is widely used in processed foods and represents a particularly insidious source of hidden allergens. Since finding foods that do not contain soy is difficult and total elimination of food allergens is practically impossible to attain, investigations on the hypoallergenization of soy ingredients and products are imperative. Current requirements by the labeling regulations also make it imperative to identify a processing technology that is capable of reducing or eliminating the allergens from soy containing products. Elimination or reduction of allergens in allergenic foods has been attempted for years by various investigators, which has included, among various strategies, the use of genetic engineering, thermal processing, enzyme treatment, ultrafiltration, chemical agents, microwave, irradiation, high pressure processing, pulsed ultraviolet light, power ultrasound and pulsed electric field. The reduction or elimination of allergens from soybean proteins by different processing technologies offers unique insight to the structure and biological interaction of the antigenic proteins. With allergens reduced, the industry can further profit from the economical attributes of soybean and promote the