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Objective North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs’ particular circumstances.Methods A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention.Results We developed a multi-part gatekeeper training program, “Suicide CARE for NKDs.” In the “Introduction,” trainees learn about the need for the program and its importance. In “Careful observation,” trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In “Active listening,” trainees learn how to ask about suicidal thoughts and to listen empathetically. In “Risk evaluation and expert referral,” trainees learn to evaluate suicide risk and to connect NKDs with institutes or services.Conclusion We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.

Purpose: Despite promising preclinical studies, toxicities have precluded combinations of chemotherapy and DNA damage response (DDR) inhibitors. We hypothesized that tumor-targeted chemotherapy delivery might enable clinical translation of such combinations. Patients and Methods: In a phase I trial, we combined sacituzumab govitecan, antibody–drug conjugate (ADC) that delivers topoisomerase-1 inhibitor SN-38 to tumors expressing Trop-2, with ataxia telangiectasia and Rad3-related (ATR) inhibitor berzosertib. Twelve patients were enrolled across three dose levels. Results: Treatment was well tolerated, with improved safety over conventional chemotherapy-based combinations, allowing escalation to the highest dose. No dose-limiting toxicities or clinically relevant ≥grade 4 adverse events occurred. Tumor regressions were observed in 2 patients with neuroendocrine prostate cancer, and a patient with small cell lung cancer transformed from EGFR-mutant non–small cell lung cancer. Conclusions: ADC-based delivery of cytotoxic payloads represents a new paradigm to increase efficacy of DDR inhibitors.

Throughout an individual’s lifetime, genomic alterations accumulate in somatic cells1–11. However, the mutational landscape induced by retrotransposition of long interspersed nuclear element-1 (L1), a widespread mobile element in the human genome12–14, is poorly understood in normal cells. Here we explored the whole-genome sequences of 899 single-cell clones established from three different cell types collected from 28 individuals. We identified 1,708 somatic L1 retrotransposition events that were enriched in colorectal epithelium and showed a positive relationship with age. Fingerprinting of source elements showed 34 retrotransposition-competent L1s. Multidimensional analysis demonstrated that (1) somatic L1 retrotranspositions occur from early embryogenesis at a substantial rate, (2) epigenetic on/off of a source element is preferentially determined in the early organogenesis stage, (3) retrotransposition-competent L1s with a lower population allele frequency have higher retrotransposition activity and (4) only a small fraction of L1 transcripts in the cytoplasm are finally retrotransposed in somatic cells. Analysis of matched cancers further suggested that somatic L1 retrotransposition rate is substantially increased during colorectal tumourigenesis. In summary, this study illustrates L1 retrotransposition-induced somatic mosaicism in normal cells and provides insights into the genomic and epigenomic regulation of transposable elements over the human lifetime.

Bank deregulation in the form of the repeal of the Glass-Steagall Act facilitated the entry of non-bank lenders into the market for syndicated loans during the pre-2008 credit boom. Institutional investors disproportionately purchase tranches of loans originated by universal banks able to cross-sell loans and underwriting services to firms (as permitted by the repeal). A shock to cross-selling intensity increases loan liquidity at origination and over time. The mechanism is that non-loan exposures ensure monitoring even when banks retain small loan shares. Our findings complement the conventional view that regulatory arbitrage caused the rise of non-bank lenders.

Purpose: We investigated the current status of imaging studies for pediatric blunt cervical spine injury, and applied 3 clinical decision rules to children with blunt trauma of the head or neck in a pediatric emergency center in Korea. The rules included National Emergency X-Radiography Utilization Study (NEXUS) criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors.Methods: This was a retrospective study conducted on 399 children aged 15 years or younger who visited the center after the blunt trauma, and underwent cervical spine radiographs from January 2020 through December 2021. We examined the clinical characteristics per age groups (0-1, 2-5, 6-12, and 13-15 years). Using the 3 rules, we selected children with a potential need for imaging studies (PNI). For this purpose, we analyzed the absence of low-risk variables and the presence of high-risk variables. Predictive performances of the rules were measured for the imaging-confirmed cervical spine injury.Results: The study population (n = 399) had a median age of 5.0 years (interquartile range, 2.0-9.0) and a 64.2% boys’ proportion. Fall (36.6%) was the most common injury mechanism. Two children had the cervical spine injuries. As per NEXUS criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors, 72 (18.0%), 289 (72.4%), and 74 children (18.5%) were classified as those with PNI, respectively. Resultantly, 291 children (72.9%) were classified as having PNI whereas the other 108 (27.1%) were deemed to undergo unnecessary imaging. The 3 rules had nearly 100% sensitivity and negative predictive value, except a 50% sensitivity of NEXUS criteria.Conclusion: Imaging studies can be minimized for children with blunt trauma of the head or neck who are deemed without PNI per the 3 current clinical decision rules. More elaborate criteria are needed to make a timely diagnosis.

Background and Objectives Invasive fungal sinusitis is extremely rare. Yet the consequences of this infection may be fatal if not diagnosed correctly at an early stage. We discuss three cases of Aspergillosis sphenoid sinusitis that were misdiagnosed and have led to fatal consequences.Subjects and Method This is a retrospective analysis of cases diagnosed as invasive fungal sinusitis of sphenoid sinus.Results All three cases were of men who had immunocompromised medical histories that included leukemia and diabetes mellitus. The patients presented symptoms that included fever, chronic headache, weakness on one side, and facial edema. In the first case, CT showed no suspicious lesions that indicated fungal infection. However, five days after being prescribed antibiotics, the patient suffered obstruction of the right internal carotid artery (ICA) and right cavernous sinus. In the second case, CT showed total obstruction in the left ICA and a soft tissue mass in the left sphenoid sinus that extended and involved the left cavernous sinus. In the last case, CT showed soft density progression in the right sphenoid sinus with bone erosion when compared to images taken eight days earlier. In each of these cases, we performed emergency endoscopic sinus surgery. One case was confirmed to be invasive aspergillosis by histology whereas the other two cases were suspected to be invasive aspergillosis based on their past medical histories, clinical findings and image studies.Conclusion Clinicians must take great care to rule out invasive aspergillosis in immunocompromised patients with sinusitis.

In Ju Yoon,1 Su Jung Lee2 1Graduate School of Nursing Science, Hallym University, Hallym University Sacred Heart Hospital, Anyang, South Korea; 2School of Nursing, Research Institute of Nursing Science, Hallym University, Chuncheon, South KoreaCorrespondence: Su Jung Lee, Tel +82-33-248-2722, Fax +82-33-248-2734, Email sujunglee.95@gmail.comBackground and Purpose: The COVID-19 pandemic can cause psychological distress, and hemodialysis patients with chronic kidney disease may be particularly vulnerable. The aim of this study is to investigate anxiety levels among patients undergoing hemodialysis during the COVID-19 pandemic and to explore the relationship between health literacy and anxiety.Methods: This study recruited 149 hemodialysis patients from two hospitals between July 16th and July 31st, 2021. Patient data were collected using questionnaires on general characteristics, health literacy, generalized anxiety, and coronavirus disease-related anxiety. We used the Coronavirus Anxiety Scale (CAS) and the Korean version of the Generalized Anxiety Disorder (GAD) scale to evaluate the anxiety symptoms of the patients. Statistical analyses were performed using descriptive statistics, t-test, Mann–Whitney U-test, one-way ANOVA, Kruskal-Walli’s test and Spearman’s rank correlation.Results: The results showed that health literacy increased with decreasing age and increasing educational level among patients who source health information from the internet and among patients without comorbidities. Patients with comorbidities showed high levels of general anxiety. Patients who search for health information for ≥ 1 hour had high levels of coronavirus disease-related anxiety. Both CAS and GAD showed a significant negative correlation with the sub-domains of health literacy, except for critical health literacy.Conclusion: The results of this study highlight the need for a follow-up study on whether health literacy programs will reduce the anxiety levels of patients undergoing hemodialysis during infectious disease outbreaks. In addition, provision of social support for patients with comorbidity is essential for reducing their anxiety levels during disease outbreaks.Keywords: end-stage kidney disease, anxiety, health literacy, coronavirus disease-19, pandemics

Purpose: The purpose of our study was to evaluate the usefulness of the BiofireFilmArray Meningitis/Encephalitis (FA ME) panel and identify factors associated with positive FA ME panel results. Methods: We retrospectively analyzed the medical records of 129 patients (45 children, 84 adults) with central nervous system infections and FA ME panel test results. We compared the results of the FA ME panel and the diagnostic yield between pediatric and adult patients with positive and negative FA ME panel results. Positive FA ME panel results were compared with conventional microbiological testing. Results: Forty-three patients (33.3%) had positive results on the FA ME panel. The detected pathogens were enterovirus (n=17, 39.5%), varicella zoster virus (n=10, 23.3%), herpes simplex virus-2 (n=2, 16.3%), herpes simplex virus-1 (n=2, 4.7%), human parechoviruses (n=2), Cryptococcus neoformans/gattii (n=2), Streptococcus agalactiae (n=1, 2.3%), Streptococcus pneumoniae (n=1), and Haemophilus influenzae (n=1). The time to detection of the FA ME panel (4.9±6.6 hours) was significantly shorter than that of conventional culture (77.4±48.2 hours) (P=0.005). Fever was more common in the positive FA ME group than in the negative FA ME group (81.4% vs. 41.9%) and in pediatric patients than in the adult patients (93.3% vs. 34.5%) (P

For people with visual impairments, many studies have been conducted to improve the accessibility of various types of images on the web. However, the majority of the work focused on photos or graphs. In this study, we propose AccessComics, an accessible digital comic book reader for people with visual impairments. To understand the accessibility of existing platforms, we first conducted a formative online survey with 68 participants who are blind or have low vision asking about their prior experiences with audiobooks and eBooks. Then, to learn the implications of designing an accessible comic book reader for people with visual impairments, we conducted an interview study with eight participants and collected feedback about our system. Considering our findings that a brief description of the scene and sound effects are desired when listening to comic books, we conducted a follow-up study with 16 participants (8 blind, 8 sighted) to explore how to effectively provide scene descriptions and sound effects, generated based on the onomatopoeia and mimetic words that appear in comics. Then we assessed the impact of the overall reading experience and if it differs depending on the user group. The results show that the presence of scene descriptions was perceived to be useful for concentration and understanding the situation, while the sound effects were perceived to make the book-reading experience more immersive and realistic. Based on the findings, we suggest design implications specifying features that future accessible comic book readers should support.

Supervisory mentoring represents a type of social dilemma called a delayed social fence. This study adopts a social dilemma perspective to examine how the three types of psychological contracts (balanced, relational, and transactional) perceived by supervisors differently influence their mentoring. Drawn on social dilemma perspective, we proposed that supervisory mentoring would be more likely to occur when supervisors perceived benefit return from their mentoring provision in a timely manner. The results obtained from a sample of 596 supervisor–subordinate matched data from the self-reported questionnaires completed by 225 sales agent teams in the insurance industry in Taiwan support our predictions. Consistent with the social dilemma perspective, supervisory mentoring is more likely among subordinates whose supervisors perceived balanced psychological contract, while supervisory mentoring is less likely among subordinates whose supervisors perceived transactional psychological contract. Furthermore, we found that supervisory mentoring is positively related to subordinate performance. Our mentor-centric multilevel framework helps identify the social dilemma nature underlying mentoring provision, and verify the positive influence of mentoring on protégé performance.