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Owing to the development of Information and Communication Technology (ICT) and the inevitability of telecommuting in the COVID-19 environment, the boundary between working and non-working hours has become blurred. mWork, that is, ICT-based off-hour work, which has increased through the pandemic, affects employees’ work attitudes, such as presenteeism. Hence, we designed a study to investigate the antecedents and mechanisms of employee presenteeism from the perspective of the conservation of resources theory. We supported our hypothesis using a sample of 325 Korean office workers obtained through three rounds of time-delay surveys. The results show that presenteeism is higher among employees with high mWork. In addition, employees’ mWork increases sleep deprivation and presenteeism, and the exchange ideology of employees reinforces the positive effect of sleep deprivation on presenteeism. Additionally, the higher the level of exchange ideology, the stronger the mediating effect of mWork on presenteeism through sleep deprivation. This study verified the conservation of resources theory by identifying the mechanism by which mWork affects an employee’s life, which in turn affects their work, and provides practical implications for managing productivity loss due to presenteeism.

Enhancing corporate accountability in areas such as environment, social, and governance (ESG) has solidified its role in the discussion on improving corporate resilience and growth. ESG management activities not only augment corporate sustainability and risk control but also influence the professional roles and personal lives of members through their perceived ESG. Historically, most ESG research has centered on the interrelation of corporate ESG endeavors and outcomes, while studies focusing on the influence of perceived ESG on members have been sparse. In this light, our investigation, rooted in the conservation of resources theory, aimed to delineate the mechanistic link between perceived ESG and members’ psychological well-being. This study employed a stratified random sampling technique and collected data across three waves, each spaced four weeks apart. Our sample comprised 325 Korean employees working in administrative, technical, service, and sales roles. This study recruited 325 Korean employees across three time-lagged phases and found that ESG comprehension enhances job meaningfulness, subsequently amplifying psychological wellness. Intriguingly, as pay satisfaction escalates, the mediating role of job meaningfulness between perceived ESG and well-being intensifies. Our study underscores that for organizations to harness perceived ESG to boost psychological well-being via job meaningfulness, managing pay satisfaction is imperative. These findings highlight a crucial policy implication: policymakers must actively promote ESG awareness and incorporate it into employee compensation strategies. This integration is essential to cultivating a healthier, more engaged workforce and driving long-term organizational success.

Mass-impregnated (MI) cables have been used for many years as cables in high-voltage direct current (HVDC) systems. In line commutated converter (LCC) HVDC systems, polarity reversal for power flow control can induce significant electrical stress on MI cables. Furthermore, the mass oil and kraft paper comprising the impregnated insulation have significantly different coefficients of thermal expansion. Load fluctuations in the cable lead to expansion and contraction of the mass, creating pressure within the insulation and causing redistribution of the impregnant. During this process, shrinkage cavities can form within the butt gaps. Since the dielectric strength of the cavities is lower than that of the surrounding impregnation, cavitation phenomena in impregnated paper insulation are considered a factor in degrading insulation performance. Consequently, this study analyzes the electrical conductivity of thermally aged materials and investigates the transient electric field characteristics within the cable. Additionally, it closely analyzes the formation and dissolution of cavities in MI cables during polarity reversal based on a numerical model of pressure behavior in porous media. The conductivity of the impregnated paper indicates that it has excellent resistance to thermal degradation. Simulation results for various load conditions highlight that the interval of load-off time and the magnitude of internal pressure significantly influence the cavitation phenomenon. Lastly, the study proposes stable system operation methods to prevent cavitation in MI cables.

Background: Compared with normal people, stroke patients have decreased voluntary craniocervical motion, which affects their balance. Objects: This study was conducted in order to examine the effects of active craniocervical movement training using a cognitive game on stroke patient’s cervical movement control ability, balance, and functional mobility. Methods: The subject of this study were 29chronic stroke patients who were randomly allocated to either an experimental, cognitive game group (n = 15), or control group (n = 14), to which only neuro-developmental treatment (NDT) was applied. The intervention was conducted 5 times per week, 30 minutes per each time, for a total of 4 weeks. Active angle reproduction test, static stability test, limits of stability test, and Time up and Go (TUG) test, respectively, were carried out in order to evaluate cervical movement control ability, static balance, dynamic balance, and functional mobility. Paired t-test was used in order to compare differences between prior to after the intervention, along with an independent-test in order to compare prior to and after-intervention differences between the two groups. Results: After the craniocervical training with a body-driven cognitive game, the experimental group showed significant differences in flexion, extension, and lateral flexion on the affected side, and rotation on the affected side in the active angle reproduction test. The experimental group indicated significant differences in sway length both with eyes-open and with eyesclosed in the static stability test and in limits of stability test and TUG test. The control group to which NDT was applied had significant differences in flexion in the active angle reproduction test and in limits of stability test and TUG test. Conclusion: The above results mean that craniocervical training using a body-driven cognitive game positively influences stroke patient’s cervical movement control ability and as a result their balance and functional mobility.

A brain–computer interface (BCI) is a promising technology that can analyze brain signals and control a robot or computer according to a user’s intention. This paper introduces our studies to overcome the challenges of using BCIs in daily life. There are several methods to implement BCIs, such as sensorimotor rhythms (SMR), P300, and steady-state visually evoked potential (SSVEP). These methods have different pros and cons according to the BCI type. However, all these methods are limited in choice. Controlling the robot arm according to the intention enables BCI users can do various things. We introduced the study predicting three-dimensional arm movement using a non-invasive method. Moreover, the study was described compensating the prediction using an external camera for high accuracy. For daily use, BCI users should be able to turn on or off the BCI system because of the prediction error. The users should also be able to change the BCI mode to the efficient BCI type. The BCI mode can be transformed based on the user state. Our study was explained estimating a user state based on a brain’s functional connectivity and a convolutional neural network (CNN). Additionally, BCI users should be able to do various tasks, such as carrying an object, walking, or talking simultaneously. A multi-function BCI study was described to predict multiple intentions simultaneously through a single classification model. Finally, we suggest our view for the future direction of BCI study. Although there are still many limitations when using BCI in daily life, we hope that our studies will be a foundation for developing a practical BCI system.

Recently, most organizations, from for-profit organizations to nonprofit organizations, are facing a rapidly changing environment and increased uncertainty. Organizational performance now depends on quickly responding and overcoming change through employees’ innovative behavior. As the importance of innovative behavior has been highlighted, many organizations are looking for effective ways to encourage employees to adopt innovative behavior. From the resource perspective, innovative behavior can be regarded as high-intensity job demand, and organizations should support innovative behavior by providing and managing employees’ resources. Based on the conservation of resource perspective, this study attempted to empirically explore how self-efficacy and perceived organizational support affect the relationship between leader–member exchange (LMX) and innovative behavior. Using two-wave, time-lagged survey data from 337 employees in South Korea, we found that leader–member exchange enhances innovative behavior via the mediation of self-efficacy. Additionally, perceived organizational support positively moderates the relationship between leader–member exchange and self-efficacy. Our findings demonstrate that self-efficacy is a mediating mechanism in the relationship between leader–member exchange and innovative behavior. Furthermore, this study suggests that the higher the level of perceived organizational support, the greater the effect of leader–member exchange on innovative behavior affected by self-efficacy.

Abstract Background Total knee arthroplasty (TKA) is a treatment option for osteoarthritis of the knee. After undergoing TKA, patients can be treated with continuous passive motion (CPM); however, inconsistent results have been reported on the effectiveness of CPM as part of a rehabilitation strategy. This discrepancy may be due to the difference between the set-arc of CPM and real arcs of knee motion. In this randomized controlled trial, we compared the efficacy of the sitting-type CPM, which can apply a more fitted arc of motion, to that of the conventional CPM. Methods We performed a prospective, multicenter, single-blind, three-arm, randomized controlled trial. Patients who underwent unilateral TKA were recruited and randomly allocated to three groups (151 participants; Group 1, conventional type; Group 2, mixed; and Group 3, sitting type). All participants underwent 10 days of CPM management. Passive and active ranges of motion (ROMs), pain, lower-extremity edema, patient-reported outcomes, and functional assessments were evaluated at four time points. Results Passive and active ROMs and pain significantly improved during and after the intervention in all groups; however, no significant differences were noted between the groups. Compared with the conventional type, the sitting-type CPM devices were rated higher in participant’s satisfaction questionnaires. Conclusion The sitting-type CPM had equivalent efficacy to that of the conventional-type CPM but provided higher satisfaction to patients after TKA. Therefore, the sitting-type CPM may be a useful tool in post-TKA rehabilitation. Clinical trial registration This clincial trial was registed with the Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, date of first enrollment at 10/11/2020 https://cris.nih.go.kr/cris/search/detailSearch.do/21750 .

Purpose Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation. Methods This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared. Results The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P

Purpose This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma. Methods This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images. Results When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P

Purpose The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic. Methods This study is based on the data of patients who presented with injuries at 23 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and

Purpose We aimed to investigate the changing trends in intentional drug poisoning among pediatric and adolescent patients over the past 10 years. Methods A retrospective study was conducted on patients younger than 20 years who visited an academic hospital emergency department (ED) in Incheon, Korea, from January 2011 through December 2020. The study focused on patients who responded with “self-harm or suicide” in the ED-based Injury In-depth Surveillance, and whose injury mechanism was drug poisoning. Exclusion criteria were unintentional injuries and the ingestion of substances other than drugs. To describe the trend over the decade, we used the number of events/100,000 ED annual visits of the database. Results A total of 3,388 cases with a median age of 17 years (interquartile range, 15-18 years) were included. The most frequently ingested drugs were acetaminophen (27.8%), followed by benzodiazepines (15.2%), antidepressants (14.1%), other sedatives and hypnotics (13.4%), and antipsychotics (8.3%). As for the events/100,000 ED annual visits, benzodiazepines showed the biggest increase, from 7.6 to 80.2 cases. Similarly, antidepressants increased from 10.2 to 71.1 cases, and antipsychotics from 3.6 to 53.7 cases. Conclusion Intentional drug poisoning has increased over the past 10 years, particularly in benzodiazepines, antidepressants, and antipsychotics. It is advisable to establish injury prevention strategies according to patients’ characteristics and ingested drugs.

Purpose This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity. Methods The Emergency Department-based Injury In-depth Surveillance (EDIIS) data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and

Purpose Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years. Methods Patients (15–64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011–2015) and group 2 (2016–2020). General characteristics and the factors associated with severity were investigated. Results Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004–1.013), and overnight/morning (00:00–12:00; OR, 1.243; 95% CI, 1.091–1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410–9.424) and torso injury (OR, 4.122; 95% CI, 3.610–4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318–1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120–3.170). Conclusions Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.

Purpose This study aimed to identify the characteristics of patients injured by high-rotation cutting tools and the factors related to the severity of their injuries. Methods Adult patients (≥18 years), who presented to the emergency department (ED) after a high-rotation cutting tool injury and who were registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2018) database, were included. Patients’ demographic characteristics, injury-related factors, and Injury Severity Scores were collected. All included cases were categorized into two groups according to the tool that caused the injury: grinder versus nongrinder. The characteristics of the two groups were compared, and the factors associated with the severity of injuries were investigated. Results Among 8,697 ED visits, 4,603 patients had been using a grinder and 4,094 had been using a nongrinder tool. The most frequently injured body part while using a grinder was the hand (46.4%), followed by the head (23.0%). While using a nongrinder tool, the most frequently injured body part was also the hand (64.0%), followed by the lower leg (11.4%). The odds of a severe injury were affected by patient age (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.020–1.028) and using a grinder (OR, 2.073; 95% CI, 1.877–2.290). The odds of a severe injury using a grinder were higher in arm injuries (OR, 1.60; 95% CI, 1.40–1.83) and multiple-part injuries (OR, 1.998; 95% CI, 1.639–2.437). The odds of a severe injury using a grinder were lower for head injuries (OR, 0.481; 95% CI, 0.297–0.781). Conclusions Injuries from grinders were more likely to affect the head and neck than nongrinder injuries, despite the lower severity. The current lack of regulations on grinders in occupational safety and health standards warrants relevant legislation and the development of applicable safety equipment.

Purpose Studies on the relationship between obesity and injuries, especially those sustained in pedestrian traffic accidents, are lacking. We aimed to assess the effects of obesity on the severity of injury at the time of admission to the emergency room in patients who experienced pedestrian traffic accidents. Methods This study included trauma patients registered in the Korean Trauma Database from July 1, 2018 to December 31, 2020, whose mechanism of injury was pedestrian traffic accidents and who were treated at a single institution. Those aged below 15 years were excluded. Patients were assigned to nonobese and obese groups based on a body mass index of 25 kg/m2. An Injury Severity Score of 25 or greater was considered to indicate a critical injury. Results In total, 679 cases of pedestrian traffic accidents were registered during the study period, and 543 patients were included in the final analysis. Of them, 360 patients (66.3%) and 183 patients (33.7%) were categorized as nonobese and obese, respectively. The median age was significantly higher in the nonobese group than in the obese group (60 vs. 58 years). Multivariate analysis demonstrated that the odds ratio for critical injury in obese patients was 1.59 (95% confidence interval, 1.01–2.48) compared with nonobese patients. Conclusions Obesity affected the likelihood of sustaining severe injuries in pedestrian traffic accidents. Future studies should analyze the effects of body mass index on the pattern and severity of injuries in patients with more diverse injury mechanisms using large-scale data.

Purpose The aim of this study was to investigate the epidemiologic features of pediatric dental injury according to age groups using Korean national data. Methods We reviewed the data from 2015 to 2019 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. We included children aged 18 years or younger with the International Classification of Disease, 10th Revision codes related to dental injury. Other or combined codes were excluded. The children were classified by age groups: infants (< 1 year), preschoolers (2-6), schoolers (7-12), and adolescents (13-18). As per the age groups, we compared the clinical characteristics, injury event profiles, and outcomes. Results The study population (n = 33,020) consisted of 8,900 infants (27.0%), 15,705 preschoolers (47.6%), 5,295 schoolers (16.0%), and 3,120 adolescents (9.4%). Their median age was 3 years (interquartile range, 1-7), and boys accounted for 64.2%. The most common mechanism, type of activity, and place were slip down (14,274 [43.2%]), daily activity (23,777 [72.0%]), and home (19,980 [60.5%]), respectively. Among the injury types, soft tissue injury was most common (24,357 [73.8%]). As for the outcomes, 32,841 (99.5%) children were discharged, and 332 (1.0%) children had severe injury. As the age increased, the frequencies changed as follows. As for the place and type, household injury and soft tissue injury decreased while outdoor injury, such as road traffic injury, and tooth fracture increased (P < 0.001). As for the type of activity, injuries related to exercise/sports and education increased (P < 0.001). Of the sports activity, ball sports increased while kickboard/cycle decreased (P < 0.001). Conclusion Using the epidemiologic features of pediatric dental injury, it is advisable to establish injury prevention strategies according to the age groups.

Purpose The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea. Methods In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study. Results VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3–5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0–2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3–5) for VTE was 1.891 (95% confidence interval, 1.043–3.430). Conclusions Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.

Purpose The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients. Methods We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0–18 years), adults (19–59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections. Results Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16–48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279–12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488–10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167–10.494; P

Abstract Background Total knee arthroplasty (TKA) is an important management strategy for patients with knee osteoarthritis (OA) refractory to conservative management. Postoperative range of motion (ROM) exercise is important to recover patients’ activities of daily living. Continuous passive motion (CPM) is a machine that provides passive ROM exercises of the knee joint in a pre-defined arc of motion. The short- and long-term effects of CPM exercise are controversial. We hypothesized that the inconsistent results of the CPM exercise are due to poor fitting of CPM machines and measurement errors. This study aims to present a protocol for investigating a new type of CPM machine that could be applied in a sitting position in comparison with the conventional type of CPM machine for patients with unilateral TKAs. Methods This study presents the protocol of a prospective, multicenter, single-blinded, three-armed randomized controlled trial (RCT). One hundred and twenty-six patients receiving unilateral TKAs will be recruited at the physical medicine and rehabilitation clinics of two urban tertiary medical hospitals. The patients were randomly divided into three groups with a 1:1:1 allocation. The intervention group will receive two weeks of post-operative rehabilitation using a new type of CPM machine. The control group will receive 2 weeks of post-operative rehabilitation using conventional CPM machines. The third group will receive post-operative rehabilitation with both types of CPM machines. The primary outcome will be the change in the passive ROM of the affected knee joint from baseline to 2 weeks after baseline assessment. The secondary outcomes will be pain and functional measurements, and will include patient-reported outcomes and performance tests surveyed at multiple time points up to 3 months after TKA. Discussion This is the first RCT to investigate the effect of a new type of CPM machine. The results of this RCT will determine whether the position of the patients during CPM exercise is important in post-operative rehabilitation protocols after TKAs and will provide evidence for the development of proper rehabilitation guidelines after TKAs. Trial registration Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/21750

Objective To examine the features of powered mobility device-related injuries and identify the predictors of injury severity in such settings. Methods Emergency Department-based Injury In-depth Surveillance data from 2011 to 2018 were used in this retrospective study. Participants were assigned to the mild/moderate and severe groups based on their excess mortality ratio–adjusted injury severity score and their general injury-related factors and injury outcome-related factors were compared. Results Of 407 patients, 298 (79.2%) were assigned to the mild/moderate group and 109 (26.8%) to the severe group. The severe group included a higher percentage of patients aged 70 years or older (43.0% vs. 59.6%, P=0.003), injuries incurred in the daytime (72.6% vs. 82.4%, P=0.044), injuries from traffic accidents and falls (P=0.042), head injuries (38.6% vs. 80.7%, P

Purpose Methods for suicide attempt are largely divided into poisoning and non-poisoning, which differ in clinical features and severity. We aimed to investigate the clinical features of adolescents with suicide attempt and factors associated with poor outcomes from the 2 methods. Methods A retrospective study was conducted on adolescents (10-18 years) who visited the emergency department after suicide attempt from 2011 through 2018. The adolescents were divided into the poisoning and non-poisoning groups. We analyzed the differences of clinical features and outcomes between the 2 groups. Poor outcomes were defined as hospitalization to the intensive care unit or death. Factors associated with poor outcomes were investigated using multivariable logistic regression. Results Of 4,335 adolescents in total, 2,134 (49.2%) were categorized as the poisoning group. In this group, the adolescents with poor outcomes used acetaminophen most frequently (26.5%), followed by sedative or antipsychotics (22.3%). In the non-poisoning group, those with the outcomes used fall from height (73.2%) most commonly, followed by hanging (21.0%). The factors associated with the outcomes were age (for increment of 1 year; odds ratio, 1.11; 95% confidence interval, 1.02-1.22) in the poisoning group, and being boys (1.34; 1.03-1.73) and non-use of alcohols (2.87; 1.73-4.74) in the non-poisoning group. Conclusion In adolescents who used poisoning for suicide attempt, increasing age is associated with poor outcomes. The outcomes are associated with being boys and non-use of alcohols in those who used non-poisoning methods.

Purpose The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. Methods We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. Results Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [interquartile range, 6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). Conclusion In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.

Objective No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED. Methods This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance. Results This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667–0.791] vs. 0.681 [0.613–0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613–0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762–0.867) and 0.806 (0.754–0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00–1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02–1.11; P=0.002). Conclusion Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/ septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

Objective Alcohol consumption is associated with an increased risk of injuries. However, its effects on injury severity and mortality remain unclear. Specifically, the effects of alcohol intake on the severity of slip injuries have not been thoroughly investigated. Therefore, our study aimed to investigate the effects of alcohol intake on injury patterns and severity in patients experiencing slip injuries. Methods Emergency department surveillance data collected from 2011 to 2016 were analyzed for this study. Among patients aged 15 and older who were admitted for slip injuries, we compared the type and severity of injuries between the alcohol-intake group and the no-alcohol-intake group. Injury severity was classified as non-severe and severe based on the excess mortality ratio-adjusted injury severity score. Results In total, 227,548 (alcohol-intake, n=48,581; no-alcohol-intake, n=178,967) patients were included. After adjusting for age, time of injury, use of public ambulance, and season, multivariate logistic regression analysis showed that injuries were more likely to be severe in the alcohol-intake group than in the no-alcohol-intake group (odds ratio, 1.60; 95% confidence interval, 1.47–1.75). In addition, male gender and alcohol consumption had a greater synergistic effect on injury severity than the mere sum of each effect of these factors (odds ratio, 2.65; 95% confidence interval, 2.53–2.78). Conclusion Assessment of the patients influenced by alcohol was a challenge in the emergency department due to altered mental status. We suggest a considerate approach in testing and assessing male patients who slipped after alcohol-intake in the emergency department.

Purpose The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed. Results 425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024–8.647), and the severe group showed an OR of 5.073 (CI, 2.442–10.539). Conclusions Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

Background: There has been increased concern about the suitability of CO2 as a method for euthanasia of laboratory mice and rats, including the potential discomfort, pain or distress that animals may experience prior to loss of consciousness; time to loss of consciousness; best methods for use of CO2; and the availability of better alternatives. These discussions have been useful in providing new information, but have resulted in significant confusion regarding the acceptability of CO2 for rodent euthanasia. In some cases, researchers and veterinarians have become uncertain as to which techniques to recommend or use for euthanasia of laboratory mice and rats.Methods: The International Association of Colleges of Laboratory Animal Medicine (IACLAM) convened a taskforce to examine the evidence for adverse welfare indicators in laboratory rats and mice undergoing CO2 euthanasia using a SYRCLE-registered systematic review protocol. Of 3,772 papers identified through a database search (PubMed, Web of Science, CAB Direct, Agricola, and grey literature) from 1900 to 2017, 37 studies were identified for detailed review (some including more than one species or age group), including 15 in adult mice, 21 in adult rats, and 5 in neonates of both species. Experiments or reports were excluded if they only assessed parameters other than those directly affecting animal welfare during CO2 induction and/or euthanasia.Results: Study design and outcome measures were highly variable and there was an unclear to high risk of bias in many of the published studies. Changes in the outcome measures evaluated were inconsistent or poorly differentiated. It is likely that repeated exposures to carbon dioxide inhalation are aversive to adult rats and mice, based on avoidance behavior studies; however, this effect is largely indistinguishable from aversion induced by repeated exposures to other inhalant anesthetic gasses.Conclusion: There is insufficient evidence to permit an unbiased assessment of the effect of CO2 inhalation during euthanasia on welfare indicators in laboratory mice and rats. Additional well-designed, unbiased, and adequately powered studies are needed to accurately assess the welfare of laboratory mice and rats undergoing euthanasia via CO2 gas.

Abstract Nonporous silica nanoparticles (SiNPs) have potential as promising carriers for ophthalmic drugs. However, the in vivo safety of ocular topical SiNPs remains unclear. This study investigated the in vivo safety of oral and ocular topical applications of 100 nm-sized SiNPs in Sprague-Dawley rats. The rats were divided into the following four groups: low-dose oral administration (total 100 mg/kg of SiNPs mixed with food for one week), high-dose oral administration (total 1000 mg/kg of SiNPs mixed with food for one week), ocular topical administration (10 mg/ml concentration, one drop, applied to the right eyes four times a day for one month), or a negative control (no SiNP treatment). The rats were observed for 12 weeks to investigate any signs of general or ocular toxicity. During the observation period, no differences were observed in the body weights, food and water intakes, behaviors and abnormal symptoms of the four groups. No animal deaths occurred. After 12 weeks, hematologic, blood biochemical parameters and ophthalmic examinations revealed no abnormal findings in any of the animals. The lack of toxicity of the SiNPs was further verified in autopsy findings of brain, liver, lung, spleen, heart, kidneys, intestine, eyeballs, and ovaries or testes.

A helmet is critical for preventing head injuries during motorcycle accidents. However, South Korean motorcyclists have a lower prevalence of wearing a helmet, compared to developed countries. Therefore, we aimed to evaluate whether helmet wearing was associated with the clinical outcomes in Korean motorcycle accidents. Data were obtained from the Emergency Department-based Injury In-depth Surveillance database 2011-2015. We considered the patients had experienced a motorcycle accident and were only diagnosed with a craniocerebral trauma (CCT). The primary outcome was mortality and the secondary outcomes were the severity and hospitalization duration. The patients were separated whether they were wearing a helmet and the outcomes were compared using multivariate logistic regression after propensity score matching (PSM). Among 1,254,250 patients in the database, 2,549 patients were included. After PSM, 1,016 patients in each group were matched. The univariate analyses revealed that helmet wearing was associated with lesser severity (P < 0.001) and shorter hospitalization (P < 0.001). The regression analysis revealed that mortality was also lower in a helmet-wearing group (odds ratio: 0.34, 95% confidence interval: 0.21-0.56). In conclusion, wearing a helmet may reduce the mortality from a CCT after a motorcycle accident and associated with lesser severity and shorter hospitalization.

Background The aim of this study was to retrospectively evaluate and analyze the brain magnetic resonance imaging (B-MRI) findings of patients with a favorable neurological outcome following cerebral performance category (CPC) after out-of-hospital cardiac arrest (OHCA) at single university hospital emergency center. Methods Patients with return of spontaneous circulation (> 24 h) after OHCA who were older than 16 years of age and who had been admitted to the emergency intensive care unit (EICU) for over a 57-month period between July 2007 and March 2012 and survived with a favorable neurological outcome were enrolled. B-MRI was taken after recovery of their mental status. Results Fifty-two patients among the 305 admitted patients had a good CPC, and 33 patients’ B-MRI were analyzed (CPC 1: 26 patients, CPC 2: 7 patients). Among these, 18 (54.5%) patients had a normal finding on B-MRI. On the other hand, ischemia/infarction/microangiopathy compatible with hypoxic-ischemic encephalopathy (HIE) were found on various brain areas including subcortical white matter (7/13), cerebral cortex, central semiovlae, basal ganglia, putamen, periventricular white matter, and cerebellum. Conclusions Survivors with a favorable neurological outcome from OHCA showed HIE on B-MRI, especially all of the patients with a CPC 2. More detail neurologic category including brain imaging would be needed to categorize patients with favorable outcome after OHCA.