Factors associated with Health-promoting Behaviors Among Nurses in South Korea: Systematic Review and Meta-analysis Based on Pender's Health Promotion Model

PURPOSE

Although the importance of health promotion for nurses is increasing, there is a lack of meta-analyses targeting nurses in the world. This study aimed to identify the effect sizes between the health-promoting behaviors and related variables of nurses working in Korea METHODS: Systematic review and meta-analysis were conducted according to the PRISMA and MOOSE guidelines. The literature included in this meta-analysis was published between 1994 and 2022 in core databases such as KMbase, KISS, KoreaMed, ScienceON, DBpia, NAL, RISS, CINAHL, Cochrane, WoS, Pudmed, and hand searched. In this study, the PICO were The participants were nurses working in Korea, and for a more comprehensive search, intervention and comparisons were not set. The outcomes were nurses' health-promoting behaviors, and the study design included observational studies. The Comprehensive Meta-Analysis and the R software program were used for meta-analysis RESULTS: In total, 50 articles were selected for the systematic review and meta-analysis. The total effect size of the 50 articles was moderate (correlation effect size [ESr] = 0.30). The individual variables presented in the 50 articles were classified into nine sub-categories according to Pender's Health Promotion Model (HPM). Among them, situational influences demonstrated the largest effect size (ESr = 0.44, number of studies [k] = 2), followed by perceived self-efficacy (ESr = 0.39, k = 10) and activity-related affect (ESr = 0.32, k = 12) CONCLUSIONS: To achieve the optimal health status of nurses through health promotion intervention programs, these effective variables - situational influences, perceived self-efficacy, and activity-related affect - should be considered when developing the intervention program for nurses REGISTRATION: CRD42022299907.

Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad

BACKGROUND

Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative.

RESULTS

Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU.

CONCLUSION

Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.

[National Petition Analysis Related to Nursing: Text Network Analysis and Topic Modeling]

PURPOSE

This study aimed to identify the main keyword, network structure, and main topics of the national petition related to "nursing" in South Korea.

METHODS

Data were gathered from petitions related to the national petition in Korea Blue House related to the topic "nursing" or "nurse" from August 17, 2017, to May 9, 2022. A total of 5,154 petitions were searched, and 995 were selected for the final analysis. Text network analysis and topic modeling were analyzed using the Netminer 4.5.0 program.

RESULTS

Regarding network characteristics, a density of 0.03, an average degree of 144.483, and an average distance of 1.943 were found. Compared to results of degree centrality and betweenness centrality, keywords such as "work environment," "nursing university," "license," and "education" appeared typically in the eigenvector centrality analysis. Topic modeling derived four topics: (1) "Improving the working environment and dealing with nursing professionals," (2) "requesting investigation and punishment related to medical accidents," (3) "requiring clear role regulation and legislation of medical and nonmedical professions," and (4) "demanding improvement of healthcare-related systems and services."

CONCLUSION

This is the first study to analyze Korea's national petitions in the field of nursing. This study's results confirmed both the internal needs and external demands for nurses in South Korea. Policies and laws that reflect these results should be developed.

Initial phase establishment of an in vitro method for developmental neurotoxicity test using Ki-67 in human neural progenitor cells

Building a precise alternative neurotoxicological test is of great importance to respond to societal and ethical requirements. In this study, a new developmental neurotoxicity test (DNT) was established with the human neural progenitor cell line. ReNcell CX cells were exposed to neurotoxic chemicals (aphidicolin, hydroxyurea, cytosine arabinoside, 5-fluorouracil, and ochratoxin A) or non-neurotoxic chemicals (sodium gluconate, sodium bicarbonate, penicillin G, and saccharin). Propidium iodide (PI) was used to evaluate cell viability. BrdU and Ki-76 were employed to determine cell proliferation. Based on the cell viability and proliferation, mathematical models were built by linear discriminant analysis. Furthermore, the neurotoxic-considered chemicals inhibited cell cycle progression at the protein level, supporting the biomolecular rationale for the predictive model. Overall, these results show that the new test method can be used to determine the potential developmental neurotoxicants or new drug candidates.

[Factors Affecting Radiation Protective Behaviors in Perioperative Nurses Applying the Theory of Planned Behavior: Path Analysis]

PURPOSE

The aim of this study was to identify the factors explaining protective behaviors against radiation exposure in perioperative nurses based on the theory of planned behavior.

METHODS

This was a cross-sectional study. A total of 229 perioperative nurses participated between October 3 and October 20, 2021. Data were analyzed using SPSS/WIN 23.0 and AMOS 23.0 software. The three exogenous variables (attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control) and two endogenous variables (radiation protective intention and radiation protective behaviors) were surveyed.

RESULTS

The hypothetical model fit the data (χ²/df = 1.18, SRMR = .02, TLI = .98, CFI = .99, RMSEA = .03). Radiation protective intention (β = .24, p = .001) and attitude toward radiation protective behaviors (β = .32, p = .002) had direct effects on radiation protective behaviors. Subjective norm (β = .43, p = .002) and perceived behavior control (β = .24, p = .003) had direct effects on radiation protective intention, which explained 38.0% of the variance. Subjective norm (β = .10, p = .001) and perceived behavior control (β = .06, p = .002) had indirect effects via radiation protective intention on radiation protective behaviors. Attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control were the significant factors explaining 49.0% of the variance in radiation protective behaviors.

CONCLUSION

This study shows that the theory of planned behavior can be used to effectively predict radiation protective behaviors in perioperative nurses. Radiation safety guidelines or education programs to enhance perioperative nurses' protective behaviors should focus on radiation protective intention, attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control.

[Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis]

PURPOSE

This study aimed to test a hypothetical model of Korean nurses' patient safety management activities using meta-analytic path analysis.

METHODS

A systematic review, meta-analysis, and meta-analytic path analysis were conducted following the PRISMA and MOOSE guidelines. Seventy-four studies for the meta-analysis and 92 for the meta-analytic path analysis were included. The R software program (Version 3.6.3) was used for data analysis.

RESULTS

Four variables out of 49 relevant variables were selected in the meta-analysis. These four variables showed large effect sizes (ESr = .54) or median effect sizes (ESr = .33~.40) with the highest k (number of studies) in the individual, job, and organizational categories. The hypothetical model for the meta-analytic path analysis was established using these variables and patient safety management activities. Twelve hypothetical paths were set and tested. Finally, the perception of the importance of patient safety management and patient safety competency directly affected patient safety management activities. In addition, self-efficacy, the perception of the importance of patient safety management, patient safety competency, and patient safety culture, indirectly affected patient safety management activities.

CONCLUSION

Self-efficacy, the perception of the importance of patient safety management, patient safety competency, and the organization's patient safety culture should be enhanced to improve nurses' patient safety management activities.

Nurses' ethical leadership and related outcome variables: Systematic Review and Meta-analysis

AIM

To investigate the outcomes and the effect sizes of ethical leadership in nursing practice BACKGROUND: Many meta-analysis of ethical leadership have conducted in other fields, but there are none of the effects of ethical leadership of nurse leaders and should be investigated EVALUATION: For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science, and Korean databases for studies published in Korean or English. We used CMA 2.0 and R 3.6.2 for the meta-analysis KEY ISSUES: We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviors (ES = 0.04), and job or organizational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them CONCLUSION: This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs, and organizations IMPLICATIONS FOR NURSING MANAGEMENT: Nursing organizations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organizational performance including individual nurses' perceptions about their leaders, their jobs, and organizations.

[Images of Nurses Appeared in Media Reports Before and After Outbreak of COVID-19: Text Network Analysis and Topic Modeling]

PURPOSE

The aims of study were to identify the main keywords, the network structure, and the main topics of press articles related to nurses that have appeared in media reports.

METHODS

Data were media articles related to the topic "nurse" reported in 16 central media within a one-year period spanning July 1, 2019 to June 30, 2020. Data were collected from the Big Kinds database. A total of 7,800 articles were searched, and 1,038 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4.

RESULTS

The number of media reports related to nurses increased by 3.86 times after the novel coronavirus (COVID-19) outbreak compared to prior. Pre- and post-COVID-19 network characteristics were density 0.002, 0.001; average degree 4.63, 4.92; and average distance 4.25, 4.01, respectively. Four topics were derived before and after the COVID-19 outbreak, respectively. Pre-COVID-19 example topics are "a nurse who committed suicide because she could not withstand the Taewoom at work" and "a nurse as a perpetrator of a newborn abuse case," while post-COVID-19 examples are "a nurse as a victim of COVID-19," "a nurse working with the support of the people," and "a nurse as a top contributor and a warrior to protect from COVID-19."

CONCLUSION

Topic modeling shows that topics become more positive after the COVID-19 outbreak. Individual nurses and nursing organizations should continuously monitor and conduct further research on nurses' image.

Academic Success of Online Learning in Undergraduate Nursing Education Programs in the COVID-19 Pandemic Era

BACKGROUND

This study aimed to investigate predictors for academic success, including satisfaction with online class and academic achievement, in the coronavirus disease 19 (COVID-19) pandemic era.

PURPOSE

To obtain basic data needed to improve the quality and outcomes of online learning in lectures for nursing students.

METHOD

A cross-sectional, descriptive, nationwide online survey in South Korea was performed using structured questionnaires. Participants were 200 nursing students taking online-based learning at universities in 2020. Data were analyzed using descriptive statistics and hierarchical multiple regression with SPSS WIN 26.0 program.

RESULTS

Cyber-class flow (β = 0.65, p < 0.001) was a significant predictor of satisfaction with online class. Self-directed learning (β = 0.18, p = 0.014) and satisfaction with online class (β = 0.19, p = 0.035) were significant predictors of academic achievement.

CONCLUSION

To achieve academic success from online learning, self-directed learning should be prioritized and satisfaction with online class needs to be managed by nursing educators. To improve satisfaction with online class, cyber-class flow should be considered when designing teaching and learning methods for undergraduate nursing education programs.

[Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors]

PURPOSE

This study was investigated the mediating effect of coping behaviors in the relationship between the second victim experiences after patient safety incidents and the nursing practice changes.

METHODS

A cross-sectional survey was performed using structured questionnaires. Participants were 218 clinical nurses in general tertiary hospitals in South Korea. Data were collected through an online survey and snowball sampling from August 11 to September 6 2020. Data were analyzed using SPSS 23.0 program. A mediation analysis was performed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval.

RESULTS

The mean scores of second victim experiences was 3.41/5. Approach coping (β = .55, p < .001) and the avoidant coping (β = - .23, p = .001) showed mediation effects in the relationship between second victim experiences and constructive change in nursing practice. Avoidant coping (β = .29, p < .001) showed a mediation effect in the relationship between second victim experiences and defensive change in nursing practice.

CONCLUSION

Coping behaviors has a mediating effect on the relationship between second victim experiences and nursing practice changes. To ensure that nurses do not experience second victim, medical institutions should have a culture of patient safety that employs a systematic approach rather than blame individuals. They also need to develop strategies that enhance approach coping and reducing avoidant coping to induce nurses' constructive practice changes in clinical nurses in experiencing second victims due to patient safety incidents.

[A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers' Transformational Leadership: Systemic Review and Meta-Analysis]

PURPOSE

The purpose of this study was to identify the outcome variables of nursing unit managers' transformational leadership and to test a hypothetical model using meta-analytic path analysis.

METHODS

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.

RESULTS

In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.

CONCLUSION

Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.

Effects of nursing power and organizational trust on nurse's responsiveness and orientation to patient needs

Aim

To assess the relationship among perceived nursing group power, organizational trust and patient orientation and identify patient orientation predictors.

Background

Nurses and nursing organizations should use all resources to give care.

Methods

Survey data were collected from 193 nurses at six acute care hospitals in South Korea. Characteristics of hospitals and nurses were analysed using t tests, one-way ANOVAs and regression models.

Results

The means for perceived nursing group power, organizational trust and patient orientation were 3.71 (SD± 0.58), 3.22 (SD± 0.83) and 3.94 (SD± 0.53), respectively. Multiple regression analysis revealed that 40% of the variance in patient orientation was explained by perceived nursing group power, organizational trust and work experience.

Conclusion

Hospitals should increase nursing group power and improve organizational trust to enhance patient orientation. Hospital executives and nurse managers should work to enhance nursing group power and positive perceptions of organizational trust, which could contribute to patient orientation.

Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

<sec> <title>BACKGROUND</title> Idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) share common risk factors. They could therefore be expressed in a single patient. However, the prevalence, clinical characteristics and prognosis of individuals with comorbid IPF and COPD are not known. </sec> <sec> <title>METHOD</title> From 2003 to 2007, the Korean Interstitial Lung Disease Study Group created a register for idiopathic interstitial pneumonia using 2002 ATS/ERS (American Thoracic Society/European Respiratory Society) criteria. Of the 1546 IPF patients assessed, 143 had decreased lung function consistent with COPD (IPF-COPD). COPD was diagnosed based on age (≥40 years) and pulmonary function (forced expiratory volume in 1 sec [FEV₁]/forced vital capacity [FVC] ratio < 0.7). </sec> <sec> <title>RESULTS</title> The median age of the IPF-COPD group was 71.0 years (interquartile range 66.0-76.0); most patients were male (88.1%). FVC (%) was significantly higher in the IPF-COPD group; however, FEV₁ (%) was significantly lower in the IPF-COPD group (P < 0.001). Diffusing capacity of the lung for carbon monoxide (DL_CO) was not significantly different between the two groups. In survival analysis, age and FVC (%), but not COPD, were significantly associated with prognosis (respectively P = 0.003, 0.001 and 0.401). COPD severity was also not related to prognosis (P = 0.935). </sec> <sec> <title>CONCLUSION</title> The prevalence of IPF-COPD was estimated to be ∼9.2% among all IPF patients; prognosis of patients with IPF-COPD was not worse than those with IPF alone. </sec>.

[Types of Perception toward Ethical Issues in Perioperative Nurses: Q-Methodological Approach]

PURPOSE

This study was aimed at identifying the types of perceptions of ethical issues among perioperative nurses.

METHODS

Q-methodology focusing on individual subjectivity was used with data collected in November 2016. Thirty-four Q-statements were selected and scored by the 35 participants on a 9-point scale with normal distribution. Participants were perioperative nurses working in advanced general hospitals and general hospitals. The data were analyzed using the PC-QUANL program.

RESULTS

total of 35 perioperative nurses were classified into 4 factors based on the following viewpoints: self-centered (type 1), onlooking and avoiding (type 2), patient-centered (type 3), and problem-centered (type 4). The 4 factors accounted for 57.84% of the total variance. Individual contributions of factors 1, 2, 3, and 4 were 41.80%, 7.18%, 5.20%, and 3.66%, respectively.

CONCLUSION

The major contribution of this study is the clarification of perioperative nurses' subjective perceptions of ethical issues. These findings can be used in formulating effective strategies for nursing educators, professional nurses, and nursing administrators to improve ethical decision-making abilities and to perform ethical nursing care by the appropriate management of ethical issues in everyday nursing practice.

Silver nanoparticles induce Egr-1-dependent psoriasin expression via the ERK and p38 pathways

BACKGROUND

Silver nanoparticles (Ag-NPs) can prevent bacterial infection and improve cutaneous wound healing owing to their antimicrobial activity. However, the mechanism of their antimicrobial activity is poorly understood.

AIM

To determine the mechanistic relationship between Ag-NP treatment and expression of psoriasin.

METHODS

Human epidermal keratinocytes, neonatal (HEKn) were used. Psoriasin mRNA expression was measured by reverse transcription PCR and real-time PCR. Western blotting was performed to verify expression of early growth response-1 (Egr-1) and psoriasin, and phosphorylation of mitogen-activated protein kinase (MAPK). Psoriasin promoter activity by Egr-1 was detected by a luciferase assay.

RESULTS

Treatment of HEKn with Ag-NPs induced psoriasin mRNA and protein expression. Upregulation of psoriasin promoter activity was also observed in the luciferase assay. Ag-NPs increased Egr-1 expression, promoter activity and nuclear translocation in HEKn. Psoriasin luciferase activity was increased in HEKn transfected with Egr-1 pcDNA 3.1. Ag-NPs activated MAPK pathways including the extracellular signal-regulated kinase (ERK), p38, and c-Jun-N-terminal kinase (JNK) pathways. The upregulation of Egr-1 expression by Ag-NP stimulation was inhibited by ERK and p38 inhibitors, but not by a JNK inhibitor. Psoriasin expression was reduced in Egr-1 small interfering RNA-transfected HEKn.

CONCLUSIONS

Ag-NP treatment induces upregulation of psoriasin expression through Egr-1 expression. We suggest that the ERK and p38 pathways are involved in Egr-1-dependent psoriasin expression.

Job autonomy, perceptions of organizational policy, and the safety performance of nurses

AIMS

This study aimed to identify the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance by identifying the safety performance predictors of nurses working in acute health care settings in South Korea.

METHODS

Using data from a structured questionnaire, this cross-sectional descriptive study assessed the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance. In 2016, of the 290 nurses from nine acute care hospitals in South Korea invited to participate in the survey, 254 successfully did. Using cross-sectional data, characteristics of hospitals and nurses were analysed with t tests, one-way analyses of variance, Pearson correlations, and regression models.

RESULTS

On a scale of one to five, the mean job autonomy was 3.37, mean perceptions of organizational policy was 3.09, and mean safety performance was 3.75. Statistically significant positive correlations were found among job autonomy, perceptions of organizational policy, and safety performance. Multiple regression results found 44% of the variation in safety performance explained by job autonomy, length of employment, and perceptions of organizational policy.

CONCLUSION

Job autonomy and perceptions of organizational policy were positively related to safety performance. Hospital executives and nurse managers should work to enhance job autonomy and positive perceptions of organizational policy, to contribute to improving patient safety.

[Life Experiences of Uninfected Women Living with HIV-Infected Husbands: A Phenomenological Study]

PURPOSE

This study aimed to understand the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands.

METHODS

This qualitative study adopted van Manen's hermeneutic phenomenological method. Study participants were 8 females whose husband had been diagnosed with HIV for longer than 6 months, who had known about their husband's infection for more than 6 months, who were in a legal or common-law marriage and were living with their husbands at the time of interview for this study, and whose HIV antibody test results were negative. Data were collected from in-depth individual interviews with the participants from May to August 2016, and from related idiomatic expressions, literature, artwork, and phenomenological references.

RESULTS

The following essential themes were identified regarding the life experiences of uninfected women living with HIV-infected husbands: 'experiencing an abrupt change that came out of the blue and caused confusion', 'accepting one's fate and making desperate efforts to maintain one's family', 'dealing with a heavy burden alone', 'experiencing the harsh reality and fearful future', and 'finding consolation in the ordeal'.

CONCLUSION

This study provided a holistic and in-depth understanding of the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. Thus, this study recognizes these unnoticed women as new nursing subjects. Further, the present findings can be used as important basic data for the development of nursing interventions and national policy guidelines for uninfected women living with HIV-infected husbands.

Long-term characteristics of soil respiration in a Korean cool-temperate deciduous forest in a monsoon climate

Analysis of relationship between soil respiration and environmental factors has become essential for understanding changes in ecosystem carbon cycles under global warming. However, rough predictions have been made that soil respiration will increase with increasing temperature, but long-term data to support this theory were scarce. We measured soil respiration and environmental factors continuously using an automatic open-closed chamber system in a Korean cool-temperate forest from 2004 to 2016 to ascertain the reliability of this prediction and to more accurately predict changes in carbon cycle. Average air and soil temperatures were 11.0°C and 10.2°C. The increase in temperature was greater in winter (the inactive period for soil respiration) than in summer (the active period). Additionally, precipitation decreased sharply because of patter changes in 2012, and through 2016, it was approximately 69% of the previous period. Effect of precipitation on soil respiration was expected to be larger than temperature because the change in precipitation appeared in summer. Soil respiration exhibited a significant decline in 2012 because of precipitation. From 2004 to 2011, it averaged 344.4 mgCO2 m-2 h-1 and from 2012 to 2016 the average was 205.3 mgCO2 m-2 h-1. This phenomenon hasn't been detected in short-term studies, suggesting that the prediction of previous studies is inaccurate. Additionally, to predict future ecosystem carbon cycle changes in a cool-temperate monsoon climate, changes in precipitation pattern should be regarded as equally important to temperature, and the prediction cannot be based solely on temperature. Therefore, long-term and continuous measurements are needed with consideration of the effects of both precipitation and temperature. Abbreviations: Rs: soil respiration; Ts: soil temperature; Ta: air temperature; AOCC: automatic open/closed chamber.

Acute endophthalmitis after cataract surgery: 164 consecutive cases treated at a referral center in South Korea

PurposeTo identify prognostic factors in patients referred with endophthalmitis after cataract surgery, and to evaluate the efficacy of primary vitrectomy as an initial management.MethodsOver an eight-year study period, we retrospectively reviewed the medical records of 164 patients who were referred with endophthalmitis following cataract surgery. Treatment generally conformed to standard guidelines, although primary vitrectomy was performed in several eyes with a visual acuity of hand motion or better, depending on the patient's status. Using multivariate analysis, we analyzed outcomes to determine the effect on final visual outcome.ResultsA final visual acuity of ≥20/40 was achieved in 92/164 (56.1%) cases after treatment. Bacterial cultures showed bacterial growth in 89/164 cases (54.3%). Among the various baseline characteristics, old age (P=0.028), poor visual acuity at presentation (P=0.004), gram-negative bacterial infection (P=0.030), and short time between cataract surgery and signs of endophthalmitis (P=0.021) were associated with poor visual outcome. The visual outcome showed no significant difference, in terms of initial treatment feature, between the primary vitrectomy with intraocular antibiotics injection (IOAI) and IOAI-only groups. However, reintervention was significantly less frequent in the primary vitrectomy group than in the IOAI group (12.5 and 32.7%, respectively; P=0.002).ConclusionOld age, poor visual acuity at presentation, type of cultured organism (gram-negative bacteria), and early onset of endophthalmitis after cataract surgery were significantly related to poor visual outcome after endophthalmitis treatment. Primary vitrectomy may decrease the need for reintervention to control infection, although the treatment showed no benefits with regard to visual outcome.

Health literacy and barriers to health information seeking: A nationwide survey in South Korea

OBJECTIVE

To identify the level of health literacy and barriers to information seeking and to explore the predictors of health literacy.

METHODS

A cross-sectional descriptive design was used. A total of 1000 Korean adults were recruited through proportional quota sampling. Health literacy, barriers to health information seeking, sociodemographics, and health-related characteristics were surveyed. Descriptive statistics and binary logistic regression were performed for data analysis.

RESULTS

About 61% of participants were classified as inadequately health literate. "No health fairs/activities near home" was the most frequently reported barrier. Older age, lower education, living in the capital city, barriers regarding how to get information and access to expensive books and magazines were predictors of inadequate health literacy.

CONCLUSION

Strategies for improving health literacy and reducing barriers to health information seeking should be designed. Education on how to access health-related information with easily accessible sources either free or inexpensive could be a way to help adults with limited health literacy.

PRACTICE IMPLICATIONS

Health care professionals should assess clients' health literacy levels, particularly amongst those who are older or have less education. They should provide clients with information on how to access credible and readily available sources of health-related information, considering their health literacy level.

A phase 3b study of sofosbuvir plus ribavirin in treatment-naive and treatment-experienced Korean patients chronically infected with genotype 2 hepatitis C virus

In Korea, patients with chronic hepatitis C virus (HCV) infection are typically treated with pegylated interferon-alpha plus ribavirin, but interferons are contraindicated in many patients and are often poorly tolerated, particularly by the elderly and those with advanced liver disease. No interferon-free treatment regimens are approved in Korea. Sofosbuvir is an oral nucleotide analog inhibitor of the HCV nonstructural 5B RNA polymerase. It is approved in the USA, European Union and Japan for treating a number of HCV genotypes, including genotype 2. Genotype 2 has a seroprevalence of 38-46% in Korea. This single-arm, phase 3b study (NCT02021643) examined the efficacy and safety of sofosbuvir plus ribavirin (12-week duration) in chronic genotype 2 HCV-infected treatment-naive and treatment-experienced Korean patients with and without cirrhosis. The proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12) was 97% (125/129), with 96% (101/105) of treatment-naive and 100% (24/24) of treatment-experienced patients achieving SVR12. Two patients experienced virologic failure (n = 1, on-treatment failure; n = 1, relapse). No patient discontinued study treatment due to an adverse event (AE). The most common treatment-emergent AEs were headache (18%, 23/129) and pruritus (15%, 19/129). Few patients had grade 3 AEs (5%, 6/129) or grade 3 laboratory abnormalities (12%, 15/129). No grade 4 AE was reported. These data suggest that 12 weeks of treatment with the all-oral, interferon-free regimen of sofosbuvir plus ribavirin is effective and well tolerated in Korean patients with chronic genotype 2 HCV infection.

[Effects of Nursing Interventions for Fall Prevention in Hospitalized Patients: A Meta-analysis]

PURPOSE

The purpose of this study was to identify which nursing interventions are the most effective in fall prevention for hospitalized patients.

METHODS

From 3,675 papers searched, 34 were selected for inclusion in the meta-analysis. Number of fallers, falls, falls per 1,000 hospital-days, and injurious falls, fall protection activity, knowledge related to falls, and self-efficacy about falls were evaluated as outcome variables. Data were analyzed using the Comprehensive Meta Analysis (CMA) 2.2 Version program and the effect sizes were shown as the Odd Ratio (OR) and Hedges's g.

RESULTS

Overall effect size of nursing interventions for fall prevention was OR=0.64 (95% CI: 0.57~0.73, p<.05) and Hedges's g=-0.24. The effect sizes (OR) of each intervention ranged from 0.34 to 0.93, and the most effective nursing intervention was the education & environment intervention (OR=0.34, 95% CI: 0.28~0.42, p<.001), followed by education intervention (OR=0.57, 95% CI: 0.50~0.67, p=.001). Subgroup analyses showed that multifaceted interventions (OR=0.76, 95% CI: 0.73~0.79, p<.001) were more effective than unifactorial interventions, and that activities for prevention of falls (OR=0.08, 95% CI: 0.05~0.15, p<.001) showed the largest effect size among outcome variables.

CONCLUSION

Falls in hospitalized patients can be effectively prevented using the nursing interventions identified in this study. These findings provide scientific evidence for developing and using effective nursing interventions to improve the safety of hospitalized patients.

Modification to the accelerator of the NBI-1B ion source for improving the injection efficiency

Minimizing power loss of a neutral beam imposes modification of the accelerator of the ion source for further improvement of the beam optics. The beam optics can be improved by focusing beamlets. The injection efficiencies by the steering of ion beamlets are investigated numerically to find the optimum modification of the accelerator design of the NBI-1B ion source. The beam power loss was reduced by aperture displacement of three edge beamlets arrays considering power loadings on the beamline components. Successful testing and operation of the ion source at 60 keV/84% of injection efficiency led to the possibility of enhancing the system capability to a 2.4 MW power level at 100 keV/1.9 μP.

Role of protein kinase C-η in cigarette smoke extract-induced apoptosis in MRC-5-cells

Cigarette smoke (CS) is a major risk factor for emphysema, which causes cell death in structural cells of the lung by mechanisms that are still not completely understood. We demonstrated previously that CS extract (CSE) induces caspase activation in MRC-5 human lung fibroblasts, activated protein kinase C-η (PKC-η), and translocated PKC-η from the cytosol to the membrane. The objective of this study was to investigate the involvement of PKC-η activation in a CSE-induced extrinsic apoptotic pathway. We determined that CSE increases expression of caspase 3 and 8 cleavage in MRC-5 cells and overexpression of PKC-η significantly increased expression of caspase 3 and 8 cleavage compared with control LacZ-infected cells. In contrast, dominant negative (dn) PKC-η inhibited apoptosis in MRC-5 cells exposed to CSE and decreased expression of caspase 3 and 8 compared with control cells. Exposure to 10% CSE for >8 h significantly increased lactate dehydrogenase release in PKC-η-infected cells compared with LacZ-infected cells. Additionally, PKC-η-infected cells had an increased number of Hoechst 33342 stained nuclei compared with LacZ-infected cells, while dn PKC-η-infected cells exhibited fewer morphological changes than LacZ-infected cells under phase-contrast microscopy. In conclusion, PKC-η activation plays a pro-apoptotic role in CSE-induced extrinsic apoptotic pathway in MRC-5 cells. These results suggest that modulation of PKC-η may be a useful tool for regulating the extrinsic apoptosis of MRC-5 cells by CSE and may have therapeutic potential in the treatment of CS-induced lung injury.

Analysis of RAS mutation and PAX8/PPARγ rearrangements in follicular-derived thyroid neoplasms in a Korean population: frequency and ultrasound findings

OBJECTIVE

To investigate the frequency and ultrasonography (US) findings of RAS mutations and PAX8/PPARγ rearrangements between follicular thyroid adenomas (FTAs) and follicular thyroid carcinomas (FTCs) in a Korean population.

METHODS

RAS mutations and PAX8/PPARγ rearrangements in 56 FTAs and 35 FTCs were analyzed. We also analyzed the US findings of FTCs and FTAs.

RESULTS

16 nodules of 35 FTCs (45.7 %) and 19 nodules of 56 FTAs (33.9 %) harbored RAS mutations. Three FTCs and three FTAs showed two point mutations simultaneously. K-RAS codon 12-13 (n = 6, 31.6 %), N-RAS codon 61 (n = 5, 26.3 %), H-RAS codon 61 (n = 4, 21.1 %), K-RAS codon 61 (n = 3, 15.8 %), and N-RAS codon 12-13 (n = 1, 5.3 %) were found in FTCs, and N-RAS codon 61 (n = 10, 45 %), K-RAS codon 12-13 (n = 5, 22.7 %), H-RAS codon 61 (n = 5, 22.7 %), K-RAS codon 61 (n = 1, 4.5 %), and N-RAS codon 12-13 (n = 1, 4.5 %) were observed in FTAs. 4 of 56 (7.1 %) FTAs and 1 of 35 (2.9 %) FTCs represented PAX8/PPARγ rearrangements, respectively (P = 0.645). The absence of a hypoechoic rim (P = 0.021) and presence of calcifications (P = 0.049) were significantly associated with FTCs compared with FTAs.

CONCLUSIONS

RAS mutation frequency targeting the Korean population showed a 45.7 % in FTCs and 35.7 % in FTAs, and PAX8/PPARγ rearrangements were more frequently showed in FTAs. K-RAS codon 12-13 was the most common RAS mutation in FTCs, whereas N-RAS codon 61 was more frequent in FTAs. The presence of calcifications and absence of a hypoechoic rim showed more frequently in FTCs.

[Effects of Blending Oil of Lavender and Thyme on Oxidative Stress, Immunity, and Skin Condition in Atopic Dermatitis Induced Mice]

PURPOSE

The purpose of this study was to evaluate the effects of essential oil on oxidative stress, immunity, and skin condition in atopic dermatitis (AD) induced mice.

METHODS

This study was a 3×3 factorial design. Factors were oil type (Lavender, Thyme, and 2:1 mixture of lavender and thyme oil [blending oil]) and treatment period (0 day, 7 days, and 21 days). The samples were 45 mice with AD and randomly assigned to nine groups of five mice per group. The dependent variables such as superoxide radical, IgE, degranulated mast cells, and epidermal thickness were measured. Data were collected from February to April in 2014. Descriptive statistics, One-way ANOVA, Two-way ANOVA, and Tukey's HSD test were performed using the SPSS WIN 20.0 program.

RESULTS

Dependent variables were not statistically significantly different by the three oil types (p>.05). Essential oils such as lavender, thyme, and blending oil were all effective in reducing AD symptoms and especially 2:1 blending oil were most effective. There were statistically significant differences by the three treatment periods in all dependent variables (p<.001). There were statistically significant interactions between oil types and treatment periods in all dependent variables (p<.01). For decreasing superoxide radical, degranulated mast cells, and epidermal thickness, 2:1 mixed oil should be applied for at least 21 days. Otherwise to reduce IgE, 2:1 mixed oil should be used for at least 7 days.

CONCLUSION

These findings provide bases for developing effective interventions for AD patients to manage their AD symptoms.

Factors associated with willingness to participate in clinical trials: a nationwide survey study

Background

This study was conducted to investigate awareness of clinical trials (CTs) including perceptions of favorable feelings about, necessity for, and safety of CTs, the ultimate beneficiary of CTs and the factors associated with willingness to participate in CTs among the general population in South Korea.

Methods

A cross sectional survey study was conducted in a randomly selected national sample of 1,515 Korean.

Results

Perception toward CTs was measured using a scale from 0 (strongly disagree) to 10 (strongly agree). Respondents readily understood the necessity for CTs (M = 7.27, SD = 2.15); had moderately favorable feelings (M = 5.32, SD = 2.31) toward CTs and felt that these CTs were moderately safe (M = 4.71, SD = 1.90). Twenty-five percent of the respondents answered that they would be willing to participate in a CT in the future. Perception of the ultimate benefits of CTs, awareness, favorable feelings, safety, and necessity regarding CTs were identified as significant predictors of willingness to participate in CTs.

Conclusion

An awareness of CTs and the perceptions toward CTs were associated with general public willingness to participate in a CT. Findings from this study can be used in planning outreach and recruitment strategies, and to understand the predictors of CT participation.

Does type D personality affect symptom control and quality of life in asthma patients?

AIMS AND OBJECTIVES

This study aims to identify the effects of type D personality on symptom control and quality of life and to explore factors influencing quality of life among asthma patients in Korea.

BACKGROUND

Psychological factors such as depression and stress are well known to be related to medical outcomes and quality of life in asthma patients. People with type D personality are vulnerable to stress, show poor prognosis in disease and experience low quality of life.

DESIGN

A descriptive cross-sectional design was used.

METHODS

A total of 144 patients with asthma participated in this study. Data were collected through face-to-face interviews using structured questionnaires: the Type D Personality Scale-14, Asthma Control Test and Asthma-Specific Quality of Life.

RESULTS

About 33% of participants were classified into the type D personality group. The type D personality group showed statistically significantly lower symptom control and asthma-specific quality of life compared to the non-type D personality group. Based on forward stepwise multiple regression, the most significant factor of quality of life was symptom control, followed by type D personality, hospitalisation within the previous one year, and lifetime hospitalisation experiences.

CONCLUSIONS

The prevalence of type D personality in asthma patients was high, and type D personality was significantly associated with poor symptom control and low quality of life. Psychosocial interventions might be beneficial to improve symptom control and quality of life in asthma patients with type D personality.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be aware of the high prevalence of type D personality and the effects on symptom control and quality of life in asthma patients. Nurses should also provide personality-specific interventions to improve quality of life in such patients.

[Identification of subgroups with lower level of stroke knowledge using decision-tree analysis]

PURPOSE

This study was performed to explore levels of stroke knowledge and identify subgroups with lower levels of stroke knowledge among adults in Korea.

METHODS

A cross-sectional survey was used and data were collected in 2012. A national sample of 990 Koreans aged 20 to 74 years participated in this study. Knowledge of risk factors, warning signs, and first action for stroke were surveyed using face-to-face interviews. Descriptive statistics and decision tree analysis were performed using SPSS WIN 20.0 and Answer Tree 3.1.

RESULTS

Mean score for stroke risk factor knowledge was 7.7 out of 10. The least recognized risk factor was diabetes and four subgroups with lower levels of knowledge were identified. Score for knowledge of stroke warning signs was 3.6 out of 6. The least recognized warning sign was sudden severe headache and six subgroups with lower levels of knowledge were identified. The first action for stroke was recognized by 65.7 percent of participants and four subgroups with lower levels of knowledge were identified.

CONCLUSION

Multi-faceted education should be designed to improve stroke knowledge among Korean adults, particularly focusing on subgroups with lower levels of knowledge and less recognition of items in this study.

Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods

BACKGROUND

Ischemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods.

METHODS

Patients were randomized to an NS group (n = 30) or a Plasmalyte group (n = 30). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis.

RESULTS

Compared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl(-)], free-water corrected Cl(-), BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups.

CONCLUSIONS

Both NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation. However, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period.

Development progresses of radio frequency ion source for neutral beam injector in fusion devices

A large-area RF (radio frequency)-driven ion source is being developed in Germany for the heating and current drive of an ITER device. Negative hydrogen ion sources are the major components of neutral beam injection systems in future large-scale fusion experiments such as ITER and DEMO. RF ion sources for the production of positive hydrogen (deuterium) ions have been successfully developed for the neutral beam heating systems at IPP (Max-Planck-Institute for Plasma Physics) in Germany. The first long-pulse ion source has been developed successfully with a magnetic bucket plasma generator including a filament heating structure for the first NBI system of the KSTAR tokamak. There is a development plan for an RF ion source at KAERI to extract the positive ions, which can be applied for the KSTAR NBI system and to extract the negative ions for future fusion devices such as the Fusion Neutron Source and Korea-DEMO. The characteristics of RF-driven plasmas and the uniformity of the plasma parameters in the test-RF ion source were investigated initially using an electrostatic probe.

Improvement of a plasma uniformity of the 2nd ion source of KSTAR neutral beam injector

The 2nd ion source of KSTAR (Korea Superconducting Tokamak Advanced Research) NBI (Neutral Beam Injector) had been developed and operated since last year. A calorimetric analysis revealed that the heat load of the back plate of the ion source is relatively higher than that of the 1st ion source of KSTAR NBI. The spatial plasma uniformity of the ion source is not good. Therefore, we intended to identify factors affecting the uniformity of a plasma density and improve it. We estimated the effects of a direction of filament current and a magnetic field configuration of the plasma generator on the plasma uniformity. We also verified that the operation conditions of an ion source could change a uniformity of the plasma density of an ion source.

Mitochondrial modulation decreases the bortezomib-resistance in multiple myeloma cells

Multiple myeloma (MM) is an incurable hematological malignancy that causes most patients to eventually relapse and die from their disease. The 20S proteasome inhibitor bortezomib has emerged as an effective drug for MM treatment; however, intrinsic and acquired resistance to bortezomib has already been observed in MM patients. We evaluated the involvement of mitochondria in resistance to bortezomib-induced cell death in two different MM cell lines (bortezomib-resistant KMS20 cells and bortezomib-sensitive KMS28BM cells). Indices of mitochondrial function, including membrane potential, oxygen consumption rate and adenosine-5'-triphosphate and mitochondrial Ca(2+) concentrations, were positively correlated with drug resistance of KMS cell lines. Mitochondrial genes including CYPD, SOD2 and MCU were differentially expressed in KMS cells. Thus, changes in the expression of these genes lead to changes in mitochondrial activity and in bortezomib susceptibility or resistance, and their combined effect contributes to differential sensitivity or resistance of MM cells to bortezomib. In support of this finding, coadministration of bortezomib and 2-methoxyestradiol, a SOD inhibitor, rendered KMS20 cells sensitive to apoptosis. Our results provide new insight into therapeutic modalities for MM patients. Studying mitochondrial activity and specific mitochondrial gene expression in fresh MM specimens might help predict resistance to proapoptotic chemotherapies and inform clinical decision-making.

Comparison of cystatin C- and creatinine-based estimation of glomerular filtration rate according to glycaemic status in Type 2 diabetes

AIMS

The influence of hyperglycaemia on the performance of glomerular filtration rate (GFR) estimating equations remains to be determined. We compared the performance of creatinine-based GFR with cystatin C-based GFR in patients with Type 2 diabetes according to glycaemic status.

METHODS

In a cross-sectional study of 210 patients with Type 2 diabetes, we staged glycaemic status by HbA(1c) tertiles [HbA(1c) ≤ 75 mmol/mol (9.0%) (n = 70), HbA(1c) 76-95 mmol/mol (9.1-10.8%) (n = 70), HbA(1c) >95 mmol/mol (10.8%) (n = 70)] and measured GFR. Isotopic GFR was measured using renal dynamic imaging with (99m) Tc-diethylene-triamine-penta-acetic acid. Estimated GFR (eGFR) was measured using creatinine-based formulae (Cockcroft-Gault-eGFR, the Modification of Diet in Renal Disease equation-eGFR and the Chronic Kidney Disease Epidemiology Collaboration formula-eGFR) and a cystatin C-based formula (cystatin C-eGFR).

RESULTS

The isotopic GFR of all patients was 93.1 ± 34.1 ml min(-1) 1.73 m(-2). All methods for estimating GFR underestimated isotopic GFR [Cockcroft-Gault-eGFR (68.8 ± 38.6 ml min(-1) 1.73 m(-2) ) (P < 0.05), Modification of Diet in Renal Disease-eGFR (74.8 ± 31.3 ml min(-1) 1.73 m(-2) ) (P < 0.05), Chronic Kidney Disease Epidemiology Collaboration-eGFR (72.9 ± 26.6 ml min(-1) 1.73 m(-2)) (P < 0.05) and cystatin C-eGFR (83.5 ± 33.2 ml min(-1) 1.73 m(-2)) (P < 0.05)]. In all patient groups, cystatin C-eGFR was less biased and more accurate than the creatinine-based formulae, especially in the group with HbA(1c) > 95 mmol/mol (10.8%) where there was no difference between cystatin C-eGFR and isotopic GFR.

CONCLUSIONS

Performance of cystatin C-eGFR was superior to creatinine-based GFR in patients with Type 2 diabetes with HbA(1c) >95 mmol/mol (10.8%).

Modification of fullerene nanocolumn structure by accelerated C60 ions

Crystalline C60 and amorphous graphite-like films of nanocolumn arrays fabricated by glancing angle deposition of C60 fullerene at substrate temperatures of -425 K were studied by transmission electron microscopy (TEM) and atomic-force microscopy (AFM). Characteristic dimension of columns is 200-400 nm. We used co-deposition of C60 molecules and accelerated C60 ions to modify the structure and properties of nanocolumn arrays. Influence of incidence angle for C60 ions on formation of film morphology was revealed. Raman spectrum analysis showed that amorphous carbon nanocolumns consist of nanographite areas with average size of -1.5 nm. The films have high conductivity (close to graphite) and have no mechanical stresses. The carbon films were applied in all-solid-state rechargeable thin-film battery as an anode layer. The nanocolumn amorphous carbon film as anode electrode showed the discharge capacity of about 50 microAh cm(-2)microm(-1) and good cycling ability over 100 times in full cell system.

Dissemination of ceftazidime-resistant Acinetobacter baumannii clonal complex 92 in Korea

AIMS

This study was performed to describe the epidemiological traits of ceftazidime-resistant Acinetobacter baumannii clinical isolates from Korea.

METHODS AND RESULTS

Antimicrobial susceptibilities were determined by disk diffusion assay. PCR experiments were performed to detect genes encoding extended-spectrum β-lactamases and metallo-β-lactamases. Detection of ISAba1 upstream of the bla(ADC) gene was also performed by PCR amplification. The genetic organization of the bla(PER-1) gene was investigated by PCR mapping and sequencing of the regions surrounding the gene. Multilocus sequence typing was performed using seven housekeeping genes. A. baumannii isolates of clonal complex (CC) 92 exhibited a higher resistance rate (286/289, 99%) against ceftazidime compared to A. baumannii isolates of non-CC92 (7/87, 8%). Amongst 286 ceftazidime-resistant isolates of CC92, 100 (35%) isolates carried the bla(PER-1) gene, while none of the 87 isolates of non-CC92 carried the gene. The bla(ADC) gene associated with an ISAba1 element was detected in 98% (281/286) of ceftazidime-resistant isolates of CC92 and in all seven ceftazidime-resistant isolates of non-CC92. The bla(PER-1) gene was located on a transposon, Tn1213 (ISPa12-bla(PER-1) -Δgst-ISPa13), in 95 isolates and on a complex class 1 integron (orf513-bla(PER-1) -putative ABC transporter gene) in five isolates. Southern blot experiments confirmed the chromosomal location of the bla(PER-1) gene.

CONCLUSIONS

Acinetobacter baumannii CC92 which has acquired ceftazidime resistance by the production of PER-1 extended-spectrum β-lactamases and/or the overproduction of Acinetobacter-derived cephalosporinase is widely disseminated in Korea.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study shows the mechanisms of acquiring ceftazidime resistance in A. baumannii and the epidemiological traits of ceftazidime-resistant A. baumannii isolates from Korea.

The views of patients and healthy volunteers on participation in clinical trials: an exploratory survey study

BACKGROUND AND AIMS

This study was conducted to investigate the views of patients and healthy volunteers on participation in clinical trials.

METHODS

A total of 291 clinical trial participants, including 140 patients and 151 healthy volunteers, were recruited from four university hospital-affiliated clinical trial centers among 15 Korean regional clinical trial centers in South Korea where the levels of information and care were sufficient to meet the global standard. Participants were recruited from phase I trials or bioequivalence tests, a short term hospitalization under close monitoring in the clinical trial centers, or from phase II, III or IV trials occurring in both wards and outpatient clinics. A structured questionnaire survey was performed to identify their perspectives on clinical trials.

RESULTS

Participants who were patients were significantly influenced by medical personnels regarding the decision making processes for participation in clinical trials when compared to healthy volunteers. However, no difference was found between the two groups in the level of willingness to participate in and satisfaction with clinical trials. More than 50% of patient subjects misunderstood and thought that their physicians could persuade them to participate in clinical trials or that all the participants would receive a new drug or treatment during trials.

CONCLUSIONS

Clinical researchers who are involved in clinical trials should make an extra effort to confirm the level of understanding of their patients regarding the clinical trial and to guarantee that each patient has sufficient time to make an informed decision before participating in a clinical trial.

First neutral beam injection experiments on KSTAR tokamak

The first neutral beam (NB) injection system of the Korea Superconducting Tokamak Advanced Research (KSTAR) tokamak was partially completed in 2010 with only 1∕3 of its full design capability, and NB heating experiments were carried out during the 2010 KSTAR operation campaign. The ion source is composed of a JAEA bucket plasma generator and a KAERI large multi-aperture accelerator assembly, which is designed to deliver a 1.5 MW, NB power of deuterium at 95 keV. Before the beam injection experiments, discharge, and beam extraction characteristics of the ion source were investigated. The ion source has good beam optics in a broad range of beam perveance. The optimum perveance is 1.1-1.3 μP, and the minimum beam divergence angle measured by the Doppler shift spectroscopy is 0.8°. The ion species ratio is D(+):D(2)(+):D(3)(+) = 75:20:5 at beam current density of 85 mA/cm(2). The arc efficiency is more than 1.0 A∕kW. In the 2010 KSTAR campaign, a deuterium NB power of 0.7-1.5 MW was successfully injected into the KSTAR plasma with a beam energy of 70-90 keV. L-H transitions were observed within a wide range of beam powers relative to a threshold value. The edge pedestal formation in the T(i) and T(e) profiles was verified through CES and electron cyclotron emission diagnostics. In every deuterium NB injection, a burst of D-D neutrons was recorded, and increases in the ion temperature and plasma stored energy were found.

Development of a plasma generator for a long pulse ion source for neutral beam injectors

A plasma generator for a long pulse H(+)/D(+) ion source has been developed. The plasma generator was designed to produce 65 A H(+)/D(+) beams at an energy of 120 keV from an ion extraction area of 12 cm in width and 45 cm in length. Configuration of the plasma generator is a multi-cusp bucket type with SmCo permanent magnets. Dimension of a plasma chamber is 25 cm in width, 59 cm in length, and 32.5 cm in depth. The plasma generator was designed and fabricated at Japan Atomic Energy Agency. Source plasma generation and beam extraction tests for hydrogen coupling with an accelerator of the KSTAR ion source have been performed at the KSTAR neutral beam test stand under the agreement of Japan-Korea collaborative experiment. Spatial uniformity of the source plasma at the extraction region was measured using Langmuir probes and ±7% of the deviation from an averaged ion saturation current density was obtained. A long pulse test of the plasma generation up to 200 s with an arc discharge power of 70 kW has been successfully demonstrated. The arc discharge power satisfies the requirement of the beam production for the KSTAR NBI. A 70 keV, 41 A, 5 s hydrogen ion beam has been extracted with a high arc efficiency of 0.9 -1.1 A/kW at a beam extraction experiment. A deuteron yield of 77% was measured even at a low beam current density of 73 mA/cm(2).

Relatively scaled ECE temperature profiles of KSTAR plasmas

A scheme to obtain relatively scaled profiles of electron cyclotron emission (ECE) temperature directly from uncalibrated raw radiometer data is proposed and has been tested for the 2009 campaign KSTAR plasmas. The proposed method utilizes a position controlled system to move the plasma adiabatically and compares ECE radiometer channels at the same relative radial positions assuming the profile consistency during the adiabatic change. This scaling method is an alternative solution when an absolute calibration is unreliable or too time consuming. The application to the two dimensional ECE imaging data, wherein calibration is extremely difficult, may also prove to be useful.

Calibration of electron cyclotron emission radiometer for KSTAR

We developed and installed an electron cyclotron emission radiometer for taking measurements of Korea Superconducting Tokamak Advanced Research (KSTAR) plasma. In order to precisely measure the absolute value of electron temperatures, a calibration measurement of the whole radiometer system was performed, which confirmed that the radiometer has an acceptably linear output signal for changes in input temperature. It was also found that the output power level predicted by a theoretical calculation agrees with that obtained by the calibration measurement. We also showed that the system displays acceptable noise-temperature performance around 0.23 eV.

Electron cyclotron emission diagnostics on KSTAR tokamak

A new electron cyclotron emission (ECE) diagnostics system was installed for the Second Korea Superconducting Tokamak Advanced Research (KSTAR) campaign. The new ECE system consists of an ECE collecting optics system, an overmode circular corrugated waveguide system, and 48 channel heterodyne radiometer with the frequency range of 110-162 GHz. During the 2 T operation of the KSTAR tokamak, the electron temperatures as well as its radial profiles at the high field side were measured and sawtooth phenomena were also observed. We also discuss the effect of a window on in situ calibration.

Diagnostics for first plasma and development plan on KSTAR

The first plasma with target values of the plasma current and the pulse duration was finally achieved on June 13, 2008 in the Korea Superconducting Tokamak Advanced Research (KSTAR). The diagnostic systems played an important role in achieving successful first plasma operation for the KSTAR tokamak. The employed plasma diagnostic systems for the KSTAR first plasma including the magnetic diagnostics, millimeter-wave interferometer, inspection illuminator, H(alpha), visible spectrometer, filterscope, and electron cyclotron emission (ECE) radiometer have provided the main plasma parameters, which are essential for the plasma generation, control, and physics understanding. Improvements to the first diagnostic systems and additional diagnostics including an x-ray imaging crystal spectrometer, reflectometer, ECE radiometer, resistive bolometer, and soft x-ray array are scheduled to be added for the next KSTAR experimental campaign in 2009.