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Purpose: The aims of this study were to identify depression rates depending on the sex among elderly people living alone and to compare depression-related ecological system factors between two sex groups.Methods: A cross-sectional study was conducted using secondary data from the 7th Korean Longitudinal Study of Aging survey in 2018. A total of 893 elders living alone were included (152 men and 741 women). Hierarchical logistic regression was used to identify depression-related ecological system factors depending on the sex.Results: Men had significantly higher rates of depression (28.6%) than women (24.0%, p

To describe the research protocol for an ecological momentary assessment (EMA) designed to examine patterns of suicidal ideation and relevant psychosocial stress indicators in adults at risk for suicide.This observational and longitudinal study will collect data for 28 consecutive days.A total of 150 adults at risk for suicide will be recruited from a single suicide prevention centre and an outpatient clinic in Korea. Self-report questionnaires will be administrated during weeks 0, 1, 3 and 5. Participants will receive text messages three times a day for 4 weeks prompting them to access an online survey link for daily mood survey including depression, anxiety, stress and suicidal ideation. In addition, for the first 2 weeks, they will wear an actigraphy device designed to collect actigraphic data in terms of sleep patterns and physical activity. Data analyses such as descriptive statistics, independent t-tests, one-way ANOVA, chi-squared statistics and time-series and correlation analyses will be performed using IBM SPSS 26.0 and SAS version 9.3. The study received funding from National Research Foundation of Korea in February 2020. Institutional Review Board approval for our study was obtained in April 2021.This study will yield fundamental information about daily patterns of suicide ideation and psychosocial stress indicators to develop preventive interventions for adults at risk for suicide.Our study will contribute to the development of EMAs and interventions for adults at risk for suicide aimed at providing timely and individualized mental health services in a community setting.The trial is registered with the Clinical Research Information Service (CRIS). CRIS Registration Number: KCT0006165.

Traditional IT projects have rolled out newly developed software or systems after iterating manual tests based on the scenarios and cases that are considered sufficient. However, due to the time and budget limitation of IT projects, these traditional tests almost always fail to include all the possible scenarios and cases of the real world. Thus, we cannot eliminate all potential defects before go-live and unexpected failures might occur as a result, which can lead to severe damage to both customers and IT project contractors. This paper demonstrates a real transaction-based automated testing approach named ‘PerfecTwin’ with several real-world examples. PerfecTwin overcomes the above limitations of the traditional testing by running the new and old systems side-by-side, automatically validating the new system against the old system's actual transactions, in real time, which can eliminate almost all potential defects before go-live.

Purpose: The purpose of this study was to investigate the effect of attentional focus instructions on movement patterns in a ballet pirouette task. We were also interested on how the effects will apply in different skill levels: professionals and amateurs. Methods: Four amateur dancers (1-3 years of experience) and four professional dancers (more than 9 years of training) participated in this experiment. All were asked to perform a single pirouette turn on the non-dominant(left) side. Each dancers had 5 trials for each of the following three instructions: non-focus instruction (turn as you usually do), internal focus instruction (stretch your standing leg vertically, making a consistent turn-out with the working leg, make your head remain to the front as long as possible), and external focus instruction (push against the ground with your standing leg” and “imagine that your body spirals up to the ceiling”, and “try to keep gazing at a spot until you have to turn your head”). Data were collected with motion analysis systems having 10 cameras. We analyzed the qualitative change in individual movement patterns on each three conditions. Results: Professional dancers did not show any difference from the contrasting instructions. However, the amateur dancers showed varieties according to different focus instructions. For amateur dancers, it was possible that internal focus instructions as well as external focus gave positive effects. Conclusion: In order to apply these research findings, further research is needed with more challenging task in professional dancers. Moreover, individual tendencies on using attentional focus when learning and enhancing dance techniques should be clarified.

[Purpose] The purpose of this study is to investigate postural stability in such group of taekwondo athletes by measuring the center-of-pressure variables in both the injured limb and uninjured limb during a single-leg stance with eyes closed. [Subjects and Methods] The study includes eleven taekwondo athletes with repetitive ankle sprains (RASs) and eleven healthy taekwondo athletes (the controls) at the college level participating in taekwondo training sessions. For the controls, the “injured” limb was taken to be the left limb. [Results] The postural stability measured in both the anteroposterior and mediolateral directions using center-of-pressure variables was lower in the uninjured limb of the RAS group than in the control group during a single-leg stance with eyes closed. However, for the injured limb, there were no significant differences between the two groups. Furthermore, compared to the RAS group, the control group had higher stability in the injured limb than in the uninjured limb. [Conclusion] Individuals with RASs should ensure improvements in their proprioceptive and neuromuscular functions, as well as muscle strength, through an adequate period of rehabilitation to reduce the risk of re-injury.

The purpose of this study was to investigate the club characteristics and vertical force distribution of pitch and lob shots of 20 and 30 m in female golfers from the Korean Ladies Professional Golf Association (age: 21.3 ± 1.7 years; height: 161.5 ± 4.4 cm; body weight: 60.3 ± 5.6 kg; career: 7.5 ± 1.7 years). Ten infrared cameras and two force plates were used to record the swing of each golfer. The test golf swings included a pitch and lob shot to target distances of 20 and 30 m. The carry distance for the 20 and 30 m shots was affected by club shaft angle, loft angle, projected ball angle, and club head speed. Pitch and lob shots were distinguished by ball position, club shaft angle, loft angle, vertical force distribution, projected ball angle, and club head speed. For the lob shot, the ball was positioned about 6 cm toward the left foot from the center of the heel marker, compared to the ball position in the pitch shot for the 20 and 30 m shots. In addition, the loft angle was 10° wider and the vertical force of the right foot was 4% greater than for the pitch shot. The projection angle of the ball for the 30 m lob shot was 57°, while that for the pitch shot was about 47°. Taken together, the within-player between-task design and the realistic well-practiced goal-directed experimental tasks provided an opportunity to determine how individual players modify their control strategies to regulate shot distance and ball trajectory when using the same club. These findings have practical implications for coaches and for golfers aiming to improve their short game ability.

[Purpose] The purpose of this study was to investigate the effects of chronic ankle instability and induced mediolateral muscular fatigue of the ankle on competitive Taekwondo athletes during single-leg drop landing. [Subjects and Methods] Fourteen competitive taekwondo athletes with chronic ankle instability and 14 healthy adults participated, and they performed three single-leg drop landings from a 40-cm height before and after induced fatigue. Ankle angular position, peak vertical ground reaction force, loading rate, eccentric work, and contribution were calculated and analyzed. [Results] Athletes had lower ankle eversion and abduction angle than the controls did at maximum knee flexion both pre- and post-fatigue. Furthermore, athletes had lower eccentric work of the hip than the controls did post-fatigue, and they had lower eccentric work of the knee than controls at both pre- and post-fatigue. The eccentric work of the knee increased while, peak vertical ground reaction force decreased in both, athletes as well as controls post-fatigue. [Conclusion] Taekwondo athletes with chronic ankle instability who participate in a high-intensity training program are continuously exposed to potential injuries of their ankle or knee joints. Therefore, competitive taekwondo athletes with chronic ankle instability should limit their participation in regular training until they complete the rehabilitation process.

Religion and spirituality (R/S) have been prominent aspects of most human cultures through the ages; however, scientific inquiry into this phenomenon has been limited. We conducted a systematic literature review of research on the neurobiological correlates of R/S, which resulted in 25 reports studying primarily R/S with electroencephalography, structural neuroimaging (MRI), and functional neuroimaging (fMRI, PET). These studies investigated a wide range of religions (e.g., Christianity, Buddhism, Islam) and R/S states and behaviors (e.g., resting state, prayer, judgments) and employed a wide range of methodologies, some of which (e.g., no control group, varying measures of religiosity, small sample sizes) raise concerns about the validity of the results. Despite these limitations, the findings of these studies collectively suggest that the experience of R/S has specific neurobiological correlates and that these correlates are distinct from non-R/S counterparts. The findings implicate several brain regions potentially associated with R/S development and behavior, including the medial frontal cortex, orbitofrontal cortex, precuneus, posterior cingulate cortex, default mode network, and caudate. This research may suggest future clinical applications and interventions related to R/S and various disorders, including mood, anxiety, psychotic, pain, and vertiginous disorders. Further studies with more rigorous study designs are warranted to elucidate the neurobiological mechanisms of R/S and their potential clinical applications.

Background: This study aimed to examine the effect of a 12-week progressive trunk resistance and stretching exercise program on fall-related factors in patients with Parkinson&rsquo, s disease (PD). Methods: A randomized study assessed a progressive trunk resistance and stretching exercise program over a 12-week period. A total of 17 patients with PD participated and wererandomly allocated into an exercise group (n = 10) or a control group (n = 7). Participants in the exercise group completed the exercise program in 60- to 90-min sessions for three days per week. Primary and secondary outcome measures included the trunk mobility scale, functional fitness test, standing balance, and sit-to-walk test. Results: The exercise group showed improvements in functional fitness, trunk mobility, standing balance, and dynamic stability compared with the control group (all p &lt, 0.05). The 2.44 m timed up and go test (odds ratio (OR): 0.125) and the 2 min step test (OR: 10.584) of the functional fitness test, and the first-step length (OR: 3.558) and first-toe clearance height (OR: 4.777) of the sit-to-walk test, were different between the groups following the exercise program. Conclusion: This 12-week exercise program improved fall-related factors in patients with PD and may lead to prevention of fall-related injuries.

This paper aims (1) to propose a novel bone adaptation model for age-related trabecular changes by adopting two implicit parameters in optimization, (2) to compare the simulated bone volume fraction (BV/TV) with the reported bone mineral density (BMD), and (3) to review the simulated trabecular architectures with the age-matched radiographs.The proposed model simulated the trabecular changes for an age span of 32-80 years. Quantitative comparison was conducted in terms of BMD and other morphometric indices. Then, two radiologists scored the simulated trabecular architectures using the age-matched radiographs. This protocol was approved by the hospital institutional review board.The simulated BV/TV was well correlated with BMD reported in the literature (R(2)=0.855; p0.05). In comparison with age-matched radiographs, the consensus scores of agreement of the trabeculae were higher in age groups over the 50s, and the means of the Ward's triangle areas were strongly correlated with those in the age-matched radiographs (R(2)=0.982; p0.05).The proposed model could reflect the targeted trabecular changes in proximal femur with age. With further follow-up measurements, this research would contribute to the development of patient-specific models that assist radiologists in predicting skeletal integrity with aging.

We introduce how to fit random effects models via a SRC-Stat statistical package. This package has been developed to fit double hierarchical generalized linear models where mean and dispersion parameters for the variance of random effects and residual variance (overdispersion) can be modeled as random-effect models. The estimates of fixed effects, random effects and variances are calculated by a hierarchical likelihood method. We illustrate the use of our package with practical data-sets.

Howard Lee,1,2,* Heechan Lee,1,2,* Jungmi Baik,3 Hyunjung Kim,3 Rachel Kim4 1Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, 2Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, 3Clinical Trials Center, Seoul National University Hospital, Seoul, Republic of Korea, 4Global Clinical Trial Execution, Pfizer Korea, Seoul, Republic of Korea *These authors contributed equally to this work Background: Failure mode and effects analysis (FMEA) is a risk management tool to proactively identify and assess the causes and effects of potential failures in a system, thereby preventing them from happening. The objective of this study was to evaluate effectiveness of FMEA applied to an academic clinical trial center in a tertiary care setting.Methods: A multidisciplinary FMEA focus group at the Seoul National University Hospital Clinical Trials Center selected 6 core clinical trial processes, for which potential failure modes were identified and their risk priority number (RPN) was assessed. Remedial action plans for high-risk failure modes (RPN >160) were devised and a follow-up RPN scoring was conducted a year later.Results: A total of 114 failure modes were identified with an RPN score ranging 3–378, which was mainly driven by the severity score. Fourteen failure modes were of high risk, 11 of which were addressed by remedial actions. Rescoring showed a dramatic improvement attributed to reduction in the occurrence and detection scores by >3 and >2 points, respectively.Conclusions: FMEA is a powerful tool to improve quality in clinical trials. The Seoul National University Hospital Clinical Trials Center is expanding its FMEA capability to other core clinical trial processes. Keywords: clinical trial, failure modes and effects analysis, quality improvement, quality management, quality risks

Freezing of gait (FOG) is a major risk factor for falls and fall-related injuries in patients with Parkinson’s disease (PD). The characteristics of gait in PD patients with FOG have been studied but remain controversial. To investigate gait characteristics of FOG in PD, this study analyzed the forward and backward walking of patients with PD. Twenty-six patients with PD were recruited [age: 71.0 ± 6.2 years, Hoehn and Yahr stage: 2–3 (median 2.5)]. Based on responses to the New Freezing of Gait Questionnaire, we classified patients into either the “freezer” or “non-freezer” group. Spatiotemporal and kinematic analyses of forward and backward walking were completed using a three-dimensional motion analysis system over an 8 m walkway in the defined “off” state. There was no difference in demographic and clinical characteristics between the freezers (n = 10) and non-freezers (n = 16). Analysis of forward walking revealed no between-group differences, except for faster walking speed among the non-freezers. During backward walking, the freezers exhibited slower walking speed, shorter stride length, and increased asymmetry of step length. Kinematic analysis of backward walking revealed smaller range of motion in hip and ankle joints and lower step height in freezers. Further investigations of backward walking might expand our understanding of the pathophysiology of FOG in patients with PD.

Background Depression is an important non-motor symptom of Parkinson’s disease (PD) that significantly impacts the daily activities of affected patients. Furthermore, the stooped posture that characterizes patients with PD has also been associated with depression. The purpose of this study was to investigate the relationship between the presence of depressive symptoms and body posture in patients with PD. Methods Forty-six patients with mild-to-moderate PD were recruited. The patients were divided into depression and no depression groups based on Beck Depression Inventory scores. All patients underwent kinematic analysis conducted in the upright standing posture with a motion capture system. Results There were no differences in clinical characteristics between the depression (n = 22) and no depression groups (n = 24). In the standing position, patients with depression showed anterior tilting of the head from the pelvis and an increased distance between head and pelvis. The severity of depression was correlated with the degree of flexion at the lower trunk level and the degree of anterior tilting of the head, neck, and trunk from the pelvis and base of support. Conclusions Patients with PD and depression showed increased flexion at pelvis level, which caused the trunk to tilt anteriorly. In addition, the severity of depression was correlated with the degree of anterior tilting of the head and trunk. These findings suggest that stooped posture, especially from the pelvis level, could be a marker of depression in patients with PD.

In this study, thermochromic photonic gels were fabricated using 2-hydroxyethyl methacrylate (HEMA) as a hydrogel building block, and 4-Acryloyl morpholine (ACMO) and N-isopropylacrylamide (NIPAAM) as thermoresponsive monomers with different critical solution temperature behaviors. Rapid photopolymerization of opal-templated monomer mixtures of varying ACMO contents formed five individual thermochromic inverse opal photonic gels integrated on a single substrate. With temperature variation from 10 degrees C to 80 degrees C, the changes in reflective colors and reflectance spectra of the respective thermochromic gels were noted, and lambda(peak) changes were plotted. Because NIPAAM exhibits a lower critical solution temperature (LCST) at 33 degrees C, the NIPAAM-only gel showed a steep slope for lambda(peak)/dT below 40 degrees C, whereas the slope became flatter at high temperatures. As the ACMO content increased in the thermochromic gel, the curve of lambda(peak)/dT turned out to be gradual within the investigated temperature range, exhibiting the entire visible range of colors. The incorporation of ACMO in NIPAAM-based thermochromic gels therefore enabled a better control of color changes at a relatively high-temperature regime compared to a NIPAAM-only gel. In addition, ACMO-containing thermochromic gels exhibited a smaller hysteresis of lambda(peak) for the heating and cooling cycle.

Patients with Parkinson disease (PD) experience problems such as falls and freezing of gait during walking and turning in daily activities. However, few studies have examined the relationship between simultaneous turning tasks and the severity of PD. To investigate turning characteristics in patients with PD using three-dimensional (3D) analysis during the timed up and go (TUG) test. Thirty individuals performed the TUG test under 3D motion analysis: 10 patients with Hoehn and Yahr (H&Y) stages 2.5 and 3.0 PD (group I), 10 patients with H&Y stage 2.0 PD (group II), and 10 healthy older adult controls. Spatiotemporal and kinematic variables were analyzed during the TUG test with a Vicon 3-D motion analysis system. The walking speed, step length, step length asymmetry index, range of motion of the hip, knee, and shoulder joints, and foot clearance height significantly differed between patients with PD and the controls. The step length and foot clearance height were significantly different between groups I and II. The step length and foot clearance are different between the severity levels of PD, and the TUG test may be useful for identifying turning characteristics in patients with PD. Patients with PD exhibited significant differences in all variables of interest compared to the controls. The step length and foot clearance height as well as the TUG test during the turning phase may be helpful for measuring turning in patients with different severity levels of PD.

Sporting situations include instances of continuous and/or integrated movements. However, the effect of fatigue on the performance of these movements remains unclear.To investigate the effect of knee flexor and extensor fatigue on the shock absorption strategy of the lower limb during cutting movements performed after jump landings.Twenty-four healthy participants performed cutting movements following jump landings from two heights - 30cm and 40cm - and under three levels of lower limb fatigue: pre-fatigue (100% peak knee extension torque), and post-fatigue 50% (post-50%) and 30% (post-30%) peak knee extension torque. Fatigue was induced by repeated isokinetic flexion/extension of the knee (60°/s).Compared to the pre-fatigue condition, power and work at the knee joint decreased under both post-50% and post-30% conditions (P0.001), while the work performed by the ankle (P0.001) increased significantly. An increase in height from 30cm to 40cm was associated with an increase in the range of motion of the ankle (P0.001) and knee (P=0.022), peak vertical ground reaction force (P0.001), rate of loading (P0.001), knee stiffness (P=0.026) and peak power of the knee (P0.001), as well as the work performed by the knee (P0.001) and hip (P0.001) joints.Under substantial muscle fatigue the proportion of shock absorption contributed by the knee for cutting movements performed after jump landings from a height of 40cm decreased; there was an adaptive increase in the contribution by the ankle.

Computational bone remodeling simulations have recently received significant attention with the aid of state-of-the-art high-resolution imaging modalities. They have been performed using localized finite element (FE) models rather than full FE models due to the excessive computational costs of full FE models. However, these localized bone remodeling simulations remain to be investigated in more depth. In particular, applying simplified loading conditions (e.g., uniform and unidirectional loads) to localized FE models have a severe limitation in a reliable subject-specific assessment. In order to effectively determine the physiological local bone loads for the volume of interest (VOI), this paper proposes a novel method of estimating the local loads when the global musculoskeletal loads are given. The proposed method is verified for the three VOI in a proximal femur in terms of force equilibrium, displacement field, and strain energy density (SED) distribution. The effect of the global load deviation on the local load estimation is also investigated by perturbing a hip joint contact force (HCF) in the femoral head. Deviation in force magnitude exhibits the greatest absolute changes in a SED distribution due to its own greatest deviation, whereas angular deviation perpendicular to a HCF provides the greatest relative change. With further in vivo force measurements and high-resolution clinical imaging modalities, the proposed method will contribute to the development of reliable patient-specific localized FE models, which can provide enhanced computational efficiency for iterative computing processes such as bone remodeling simulations.

In this paper, a new concept for an anion sensor is demonstrated. We synthesized anion-responsive N-allyl-N′-ethylurea (AEU) that can form hydrogen-bonded complexes with various anions. An allyl functional group enables AEU to participate in copolymerization with hydroxyethyl methacrylate (HEMA) and a crosslinker to form a crosslinked gel. Photopolymerization of the mixed monomer was conducted in the presence of a polymeric opal template, and the subsequent removal of the template resulted in a blue-colored photonic gel in organic solvents owing to light reflection by an inverse opal (IO) structure. After immersing the photonic gel into an acetonitrile (MeCN) solution containing an anion sample with tetrabutylammonium counterion, the reflective color of the gel red-shifted from swelling. For anions such as acetate and dihydrogen phosphate, the photonic gel exhibited color changes within the entire visible spectrum for anion concentration ranges of 10−5 to 10−2 M. Assuming that the charge increase by anion binding is mainly responsible for the longitudinal swelling of a photonic gel sensor, we proposed a mathematical relationship between the swelling factor α and the equilibrium constant K for hydrogen bonding (H-bonding) of an anion with AEU. For five different anion samples, variations in the normalized reflectance peak were plotted as a function of anion concentration, and the equilibrium constant K was calculated by fitting the experimental data to a mathematical function. The sequence of anion sensitivity for five samples was found to be in good accordance with previous investigations on urea–anion complexation, while the lower K values obtained in our system were presumably from the weak electron donating substituent in AEU and the hindered diffusion of the analyte within the gel. However, a photonic gel anion sensor has advantages from the standpoint of simplicity. For instance, a detection apparatus is not required, and the sensor can be used multiple times. With further modification of the urea receptor, the photonic gel will find useful applicability, such as in reusable probe sensors and for the in situ monitoring of ionic species in a continuous process.