Institutional and individual factors associated with functional outcomes in nursing home residents under long-term care insurance in Korea: A multilevel analysis.

OBJECTIVE: The purpose of this study was to analyze the relationship between institutional and individual characteristics that influence changes in the functional outcomes of nursing home residents. METHODS: Long-term Care Insurance claims data with basic information of nursing home(n = 3,263) and long-term care needs assessment data of nursing home residents(n = 34,717) was used. The independent variable was classified into individual (level 1) and nursing home characteristics (level 2). Changes in physical function, cognitive function, and behavioral symptoms were used as dependent variables. RESULTS: The institutional factors of nursing homes contributed relatively little to substantial changes in function of nursing home residents. Ownership, size, and nursing home staff including care worker and physical/occupational therapist were important determinants of functional changes in nursing home residents. CONCLUSION: To improve the quality of nursing homes in Korea, regulations on staffing should be modified, and an disincentive policy should be introduced for low-quality institutions.

An Ultralow Power Mixed Dimensional Heterojunction Transistor Based on the Charge Plasma pn Junction.

Development of a reliable doping method for 2D materials is a key issue to adopt the materials in the future microelectronic circuits and to replace the silicon, keeping the Moore's law toward the sub-10 nm channel length. Especially hole doping is highly required, because most of the transition metal dichalcogenides (TMDC) among the 2D materials are electron-doped by sulfur vacancies in their atomic structures. Here, hole doping of a TMDC, tungsten disulfide (WS2 ) using the silicon substrate as the dopant medium is demonstrated. An ultralow-power current sourcing transistor or a gated WS2 pn diode is fabricated based on a charge plasma pn heterojunction formed between the WS2 thin-film and heavily doped bulk silicon. An ultralow switchable output current down to 0.01 nA µm-1 , an off-state current of ≈1 × 10-14 A µm-1 , a static power consumption range of 1 fW µm-1 -1 pW µm-1 , and an output current ratio of 103 at 0.1 V supply voltage are achieved. The charge plasma heterojunction allows a stable (less than 3% variation) output current regardless of the gate voltage once it is turned on.

Low-temperature n-type doping of insulating ultrathin amorphous indium oxide using H plasma-assisted annealing.

Low-temperature process compatibility is a key factor in successfully constructing additional functional circuits on top of pre-existing circuitry without corrupting characteristics thereof, a technique that typically requires die-to-die (wafer-to-wafer) stacking and interconnecting. And against thermal annealing, which is mandatory and is possible only globally for activating amorphous oxide semiconductors, the selective control of electrical characteristics of the oxide thin-films for integrated circuit applications is challenging. Here, a low-temperature process that enables n-type doping of the designed region of insulating In2O3thin-film is demonstrated. A short hydrogen plasma treatment followed by low-temperature annealing is used to increase interstitial and substitutional hydrogen associated bond states creating shallow donor levels in the insulating In2O3surface to transform the thin-film into an n-type semiconductor. As a result, an In2O3thin-film transistor with a high on/off current ratio (>108), a field-effect mobility of 3.8 cm2V-1s-1, and a threshold voltage of ∼3.0 V has been developed. Compared to performing just thermal annealing, the H-plasma assisted annealing process resulted in an n-type In2O3thin-film transistor showing similar characteristics, while the processing time was reduced by ∼1/3 and the plasma-untreated area still remained insulating. With further development, the hydrogen plasma doping process may make possible a monolithic planar process technology for amorphous oxide semiconductors.

Effect of 150 MeV protons on carbon nanotubes for fabrication of a radiation detector.

High energy and high flux protons are used in proton therapy and the impact of proton radiation is a major reliability concern for electronics and solar cells in low earth orbit as well as in the trapped belts. Carbon nanotubes (CNTs), due to their unique characteristics, have been considered for the construction of proton and other radiation sensors. Here, a single wall CNT based proton sensor was fabricated on FR4 substrate and its response to 150 MeV proton irradiation was studied. The change in the resistance of the nanotubes upon irradiation is exploited as the sensing mechanism and the sensor shows good sensitivity to proton radiation. Proton radiation induces dissociation of ambient oxygen, followed by the adsorption of oxygen species on the nanotube surface, which influences its electrical characteristics. Since the nanotube film is thin and the 150 MeV protons are expected to penetrate into and interact with the substrate, control experiments were conducted to study the impact on FR4 substrate without the nanotubes. The dielectric loss tangent or dissipation factor of FR4 increases after irradiation due to an increase in the cross-linking of the resin arising from the degradation of the polymer network.

Patch-Type Vibration Visualization (PVV) Sensor System Based on Triboelectric Effect.

Self-powered wireless sensor systems have emerged as an important topic for condition monitoring in nuclear power plants. However, commercial wireless sensor systems still cannot be fully self-sustainable due to the high power consumption caused by excessive signal processing in a mini-electronic computing system. In this sense, it is essential not only to integrate the sensor system with energy-harvesting devices but also to develop simple data processing methods for low power schemes. In this paper, we report a patch-type vibration visualization (PVV) sensor system based on the triboelectric effect and a visualization technique for self-sustainable operation. The PVV sensor system composed of a polyethylene terephthalate (PET)/Al/LCD screen directly converts the triboelectric signal into an informative black pattern on the LCD screen without excessive signal processing, enabling extremely low power operation. In addition, a proposed image processing method reconverts the black patterns to frequency and acceleration values through a remote-control camera. With these simple signal-to-pattern conversion and pattern-to-data reconversion techniques, a vibration visualization sensor network has successfully been demonstrated.

Tactile Interaction Sensor with Millimeter Sensing Acuity.

In this article we report on a 3 × 3 mm tactile interaction sensor that is able to simultaneously detect pressure level, pressure distribution, and shear force direction. The sensor consists of multiple mechanical switches under a conducting diaphragm. An external stimulus is measured by the deflection of the diaphragm and the arrangement of mechanical switches, resulting in low noise, high reliability, and high uniformity. Our sensor is able to detect tactile forces as small as ~50 mgf along with the direction of the shear force. It also distinguishes whether there is a normal pressure during slip motion. We also succeed in detecting the contact shape and the contact motion, demonstrating potential applications in robotics and remote input interfaces. Since our sensor has a simple structure and its function depends only on sensor dimensions, not on an active sensing material, in comparison with previous tactile sensors, our sensor shows high uniformity and reliability for an array-type integration.

Graphene surface contacts of tin disulfide transistors for switching performance improvement and contact resistance reduction.

We investigated the performance improvement of tin disulfide channel transistors by graphene contact configurations. From its two-dimensional nature, graphene can make electric contacts only at the outermost layers of the channel. For intralayer current flow, two graphene flakes are contacted at the channel's top or bottom layer. For interlayer current flow, one flake is contacted at the top and bottom of each layer. We compared the transistor performance in terms of current magnitude, mobility, and subthreshold swing between the configurations. From such observations, we deduced that device characteristics depend on resistivity or doping level of individual graphene flakes. We also found that interlayer flow excels in the on-current magnitude and the mobility, and that top-contact configuration excels in the subthreshold swing.

Layered deposition of SnS2 grown by atomic layer deposition and its transport properties.

In this work, we report on the layered deposition of few-layer tin disulfide (SnS2) using atomic layer deposition (ALD). By varying the ALD cycles it was possible to deposit poly-crystalline SnS2 with small variation in layer numbers. Based on the ALD technique, we developed the process technology growing few-layer crystalline SnS2 film (3-6 layers) and we investigated their electrical properties by fabricating bottom-gated thin film transistors using the ALD SnS2 as the transport channel. SnS2 devices showed typical n-type characteristic with on/off current ratio of ∼8.32 × 106, threshold voltage of ∼2 V, and a subthreshold swing value of 830 mV decade-1 for the 6 layers SnS2. The developed SnS2 ALD technique may aid the realization of two-dimensional SnS2 based flexible and wearable devices.

Highly Sensitive Tactile Shear Sensor Using Spatially Digitized Contact Electrodes.

In this article, we report on a highly sensitive tactile shear sensor that was able to detect minute levels of shear and surface slip. The sensor consists of a suspended elastomer diaphragm with a top ridge structure, a graphene layer underneath, and a bottom substrate with multiple spatially digitized contact electrodes. When shear is applied to the top ridge structure, it creates torque and deflects the elastomer downwards. Then, the graphene electrode makes contact with the bottom spatially digitized electrodes completing a circuit producing output currents depending on the number of electrodes making contact. The tactile shear sensor was able to detect shear forces as small as 6 µN, detect shear direction, and also distinguish surface friction and roughness differences of shearing objects. We also succeeded in detecting the contact slip motion of a single thread demonstrating possible applications in future robotic fingers and remote surgical tools.

Dynamic Bonds between Boronic Acid and Alginate: Hydrogels with Stretchable, Self-Healing, Stimuli-Responsive, Remoldable, and Adhesive Properties.

For the increasing demand of soft materials with wide ranges of applications, hydrogels have been developed exhibiting variety of functions (e.g., stretchable, self-healing, stimuli-responsive, and etc.). So far, add-in components such as inorganic nanoparticles, carbon materials, clays, and many others to main polymers have been used to achieve various unique functions of hydrogels. The multicomponent hydrogel systems often exhibit batch-dependent inconsistent results and problems in multicomponent mixings, require labors during preparations, and accompany unpredictable cross-talk between the added components. Here, we developed 'single polymeric component', alginate-boronic acid (alginate-BA) hydrogel to overcome the aforementioned problems. It exhibits unprecedented multifunctionalities simultaneously, such as high stretchability, self-healing, shear-thinning, pH- and glucose-sensitivities, adhesive properties, and reshaping properties. Multifunctionalities of alginate-BA hydrogel is resulted from the reversible inter- and intramolecular interactions by dynamic equilibrium of boronic acid-diol complexation and dissociation, which was proved by single molecule level Atomic Force Microscopy (AFM) pulling experiments. We also found that the alginate-BA gel showed enhanced in vivo retentions along gastrointestinal (GI) tract. Our findings suggest that rational polymer designs can result in minimizing the number of a participating component for multifunctional hydrogels, instead of increasing complexity by adding various additional components.

Precise Targeting of Liver Tumor Using Glycol Chitosan Nanoparticles: Mechanisms, Key Factors, and Their Implications.

Herein, we elucidated the mechanisms and key factors for the tumor-targeting ability of nanoparticles that presented high targeting efficiency for liver tumor. We used several different nanoparticles with sizes of 200-300 nm, including liposome nanoparticles (LNPs), polystyrene nanoparticles (PNPs) and glycol chitosan-5ß-cholanic acid nanoparticles (CNPs). Their sizes are suitable for the enhanced permeation and retention (EPR) effect in literature. Different in vitro characteristics, such as the particle structure, stability, and bioinertness, were carefully analyzed with and without serum proteins. Also, pH-dependent tumor cell uptakes of nanoparticles were studied using fluorescence microscopy. Importantly, CNPs had sufficient stability and bioinertness to maintain their nanoparticle structure in the bloodstream, and they also presented prolonged circulation time in the body (blood circulation half-life T1/2 = about 12.2 h), compared to the control nanoparticles. Finally, employing liver tumor bearing mice, we also observed that CNPs had excellent liver tumor targeting ability in vivo, while LNPs and PNPs demonstrated lower tumor-targeting efficiency due to the nonspecific accumulation in normal liver tissue. Liver tumor models were produced by laparotomy and direct injection of HT29 tumor cells into the left lobe of the liver of athymic nude mice. This study provides valuable information concerning the key factors for the tumor-targeting ability of nanoparticles such as stability, bioinertness, and rapid cellular uptake at targeted tumor tissues.

Nanomechanics of Poly(catecholamine) Coatings in Aqueous Solutions.

Mussel-inspired self-polymerized catecholamine coatings have been widely utilized as a versatile coating strategy that can be applied to a variety of substrates. For the first time, nanomechanical measurements and an evaluation of the contribution of primary amine groups to poly(catecholamine) coatings have been conducted using a surface-forces apparatus. The adhesive strength between the poly(catecholamine) layers is 30-times higher than that of a poly(catechol) coating. The origin of the strong attraction between the poly(catecholamine) layers is probably due to surface salt displacement by the primary amine, π-π stacking (the quadrupole-quadrupole interaction of indolic crosslinks), and cation-π interactions (the monopole-quadrupole interaction between positively charged amine groups and the indolic crosslinks). The contribution of the primary amine group to the catecholamine coating is vital for the design and development of mussel-inspired catechol-based coating materials.

The 21-gene recurrence score and locoregional recurrence in breast cancer patients.

PURPOSE: Although the 21-gene recurrence score (RS) assay has been validated to assess the risk of distant recurrence in hormone receptor-positive breast cancer patients, the relationship between RS and the risk of locoregional recurrence (LRR) remains unclear. The purpose of this study was to determine if RS is associated with LRR in breast cancer patients and whether this relationship varies based on the type of local treatment [mastectomy or breast-conserving therapy (BCT)]. METHODS: 163 consecutive estrogen receptor-positive breast cancer patients at our institution had an RS generated from the primary breast tumor between August 2006 and October 2009. Patients were treated with lumpectomy and radiation (BCT) (n = 110) or mastectomy alone (n = 53). Patients were stratified using a pre-determined RS of 25 and then grouped according to local therapy type. RESULTS: Median follow-up was 68.2 months. Patients who developed an LRR had stage I or IIA disease, >2 mm surgical margins, and received chemotherapy as directed by RS. While an RS > 25 did not predict for a higher rate of LRR, an RS > 24 was associated with LRR in our subjects. Among mastectomy patients, the 5-year LRR rate was 27.3 % in patients with an RS > 24 versus 10.7 % (p = 0.04) in those whose RS was ≤ 24. RS was not associated with LRR in patients who received BCT. CONCLUSIONS: Breast cancer patients treated with mastectomy for tumors that have an RS > 24 are at high risk of LRR and may benefit from post-mastectomy radiation.

PBI-05204, a supercritical CO2 extract of Nerium oleander, inhibits growth of human pancreatic cancer via targeting the PI3K/mTOR pathway.

Introduction Oleandrin, a cardiac glycoside, exerts strong anti-proliferative activity against various human malignancies in in vitro cells. Here, we report the antitumor efficacy of PBI-05204, a supercritical C02 extract of Nerium oleander containing oleandrin, in a human pancreatic cancer Panc-1 orthotopic model. Results While all the control mice exhibited tumors by the end of treatment, only 2 of 8 mice (25%) treated for 6 weeks with PBI-05204 (40 mg/kg) showed dissectible tumor at the end of the treatment period. The average tumor weight (222.9 ± 116.9 mg) in mice treated with PBI-05204 (20 mg/kg) was significantly reduced from that in controls (920.0 ± 430.0 mg) (p < 0.05). Histopathologic examination of serial sections from each pancreas with no dissectible tumor in the PBI-05204 (40 mg/kg) treated group showed that the pancreatic tissues of 5/6 mice were normal while the remaining mouse had a tumor the largest diameter of which was less than 2.3 mm. In contrast, while gemcitabine alone did not significantly reduce tumor growth, PBI-05204 markedly enhanced the antitumor efficacy of gemcitabine in this particular model. Ki-67 staining was reduced in pancreatic tumors from mice treated with PBI-05204 (20 mg/kg) compared to that of control, suggesting that PBI-05204 inhibited the proliferation of the Panc-1 tumor cells. PBI-05204 suppressed expression of pAkt, pS6, and p4EPB1 in a concentration-dependent manner in both Panc-1 tumor tissues and human pancreatic cancer cell lines, implying that this novel botanical drug exerts its potent antitumor activity, at least in part, through down-regulation of PI3k/Akt and mTOR pathways.

Epicardial adipose tissue predicts mortality in incident hemodialysis patients: a substudy of the Renagel in New Dialysis trial.

BACKGROUND: Epicardial adipose tissue (EAT) has been described in the general population as an independent risk marker for incident coronary artery disease. In hemodialysis patients, it correlates with other markers of cardiovascular disease, but it is unknown if it is associated with adverse events. METHODS: post hoc analysis of the Renagel in New Dialysis (RIND) patients study, a randomized trial of sevelamer versus calcium-based phosphate binders in 109 incident hemodialysis patients, followed for all-cause mortality for a median of 49.3 months. Patients underwent baseline cardiac computed tomography imaging within 120 days of dialysis initiation. RESULTS: Baseline EAT measurements were available in 95 patients; EAT was positively correlated with age, body mass index, triglycerides, C-reactive protein, coronary artery calcium and aortic calcium, and negatively correlated with systolic and diastolic blood pressure, serum high density lipoprotein (HPL) cholesterol and serum phosphate (all P < 0.05). During follow-up, a total of 27 (28.4%) patients expired [mortality per 1000 patients/year: 95% confidence interval (95% CI) = 77 (64-94)]. Five-year survival rate was 44. 6% (95% CI: 21.1-65.7) and 71.2% (95% CI: 45.95-86.25) in patients with EAT above or below the median, respectively. Each 10 cc increase in EAT volume was associated with a significant 6% increase in the risk of death during follow-up [hazard ratio (HR): 1.060; 95% CI: 1.013-1.109; P-value = 0.012]. CONCLUSIONS: In this subanalysis of a randomized trial, EAT was an independent predictor of mortality in incident hemodialysis patients after ~4 years of follow-up. These hypothesis-generating findings will need confirmatory evidence.

Chemical composition, antioxidant activity and larvicidal effects of essential oil from leaves of Apium graveolens.

The leaves of Apium graveolens were extracted and the essential oil composition, immunotoxicity effects, and antioxidant activity were studied. The analyses were conducted by gas chromatography and mass spectroscopy (GC-MS), which revealed the essential oils of A. graveolens leaves. Twenty-eight components, representing 73.72% of the total oil were identified from the leaves. The major components are 4-chloro-4,4-dimethyl-3-(1-imidazolyl)-valerophenone (19.90%), 1-dodecanol (16.55%), 9-octadecen-12-ynoic acid, methyl ester (4.93%), ethyl 4,4-D2-N-hexyl ether (4.11%), 3-(hydroxymethyl)-1-phenyl-1-heptadecyn-3-ol (3.28%), 1,4-methano-1H-indene, octahydro-4-methyl-8-methylene-7-(1-methylethyl)-, [1S-(1α,3αα,4α,7α,7αα)]- (2.99%), 3,4-dihydro-2H-1,5-(3″-t-butyl)benzodioxepine (2.56%), Z-10-tetradecen-1-ol acetate (2.53%), 9H-pyrrolo[3',4':3,4]pyrrolo[2,1-α]phthalazine-9, 11(10H)-dione, 10-ethyl-8-phenyl (2.07%). The leaf oil had significant toxic effects against the larvae of A. aegypti with an LC(50) value of 59.32 ppm and an LC(90) value of 127.69 ppm. The essential oil from the A. graveolens leaves was investigated for scavenging of the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical activity and the results demonstrate that the essential oil from the A. graveolens has potential as a natural antioxidant and thus inhibit unwanted oxidation process. The above data indicate that the major compounds may play an important role in the toxicity of essential oils and also as natural antioxidant.

Composition of the essential oil constituents from leaves and stems of Korean Coriandrum sativum and their immunotoxicity activity on the Aedes aegypti L.

The leaves and stems of Coriandrum sativum were extracted and the essential oil composition and immunotoxicity effects were studied. The analyses were conducted by gas chromatography-mass spectroscopy (GC-MS), which revealed the essential oils of C. sativum leaves and stems. Thirty-nine components representing 99.62% of the total oil were identified from the leaves. The major components are cyclododecanol (23.11%), tetradecanal (17.86%), 2-dodecenal (9.93%), 1-decanol (7.24%), 13-tetradecenal (6.85%), 1-dodecanol (6.54%), dodecanal (5.16%), 1-undecanol (2.28%), and decanal (2.33%). Thirty-eight components representing 98.46% of the total oil were identified from the stems of the coriander. The major components are phytol (61.86%), 15-methyltricyclo[6.5.2(13,14),0(7,15)]-pentadeca-1,3,5,7,9,11,13-heptene (7.01%), dodecanal (3.18%), and 1-dodecanol (2.47%). The leaf oil had significant toxic effects against the larvae of Aedes aegypti with an LC50 value of 26.93 ppm and an LC90 value of 37.69 ppm and the stem oil has toxic effects against the larvae of A. aegypti with an LC50 value of 29.39 ppm and an LC90 value of 39.95 ppm. Also, the above data indicate that the major compounds may play an important role in the toxicity of essential oils.

Evaluation of burnout in physician members of the American Brachytherapy Society.

PURPOSE: To evaluate the prevalence of burnout among brachytherapy specialists and to identify factors associated with burnout. METHODS AND MATERIALS: An anonymous, online, cross-sectional survey was administered to non-trainee physician members of the American Brachytherapy Society. Burnout was evaluated using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Demographic and practice-specific questions were collected from respondents. Univariate and multivariable analysis of outcomes were performed using probabilistic index models. RESULTS: Overall, 51 of 400 physicians responded (13% response rate). Fifty-seven percent of respondents demonstrated at least one symptom of professional burnout. However, only 6% of respondents met strict criteria for high burnout. Analysis of the individual MBI-HSS subdomains demonstrated higher subscale scores for emotional exhaustion and depersonalization, but also higher scores for personal accomplishment. On multivariable analysis after adjusting for increased feelings of burnout due to the COVID-19 pandemic or total hours of work per week, younger age was associated with both increased subscale scores for emotional exhaustion (p = 0.026) and lower personal accomplishment (p = 0.010). Lastly, nearly half of all respondents (47%) reported increased feelings of burnout due to the COVID-19 pandemic. Respondents from academic facilities were significantly more likely to report increased burnout due to COVID-19 compared to those from non-academic facilities (odds ratio, 7.04; 95% CI 1.60-31.0; p = 0.010). CONCLUSIONS: Nearly 60% of brachytherapists demonstrated symptoms of professional burnout, which is higher than other radiation oncology groups (academic chairs, program directors, residents). Managing stressors related to workload, COVID and support for junior physicians are potential areas for improving feelings of burnout.

Antiangiogenic kringles derived from human plasminogen and apolipoprotein(a) inhibit fibrinolysis through a mechanism that requires a functional lysine-binding site.

Many proteins in the fibrinolysis pathway contain antiangiogenic kringle domains. Owing to the high degree of homology between kringle domains, there has been a safety concern that antiangiogenic kringles could interact with common kringle proteins during fibrinolysis leading to adverse effects in vivo. To address this issue, we investigated the effects of several antiangiogenic kringle proteins including angiostatin, apolipoprotein(a) kringles IV(9)-IV(10)-V (LK68), apolipoprotein(a) kringle V (rhLK8) and a derivative of rhLK8 mutated to produce a functional lysine-binding site (Lys-rhLK8) on the entire fibrinolytic process in vitro and analyzed the role of lysine binding. Angiostatin, LK68 and Lys-rhLK8 increased clot lysis time in a dose-dependent manner, inhibited tissue-type plasminogen activator-mediated plasminogen activation on a thrombin-modified fibrinogen (TMF) surface, showed binding to TMF and significantly decreased the amount of plasminogen bound to TMF. The inhibition of fibrinolysis by these proteins appears to be dependent on their functional lysine-binding sites. However, rhLK8 had no effect on these processes owing to an inability to bind lysine. Collectively, these results indicate that antiangiogenic kringles without lysine binding sites might be safer with respect to physiological fibrinolysis than lysine-binding antiangiogenic kringles. However, the clinical significance of these findings will require further validation in vivo.

Anticomplement activity of polyacetylenes from leaves of Dendropanax morbifera Leveille.

The present study evaluated the anticomplement effect of polyacetylenes from Dendropanax morbifera (Araliaceae) in the classical pathway complement system. The leaves of D. morbifera were evaluated with regard to its anticomplement activity, and its active principles identified following activity-guided isolation. An aqueous CCl(4) fraction of the leaves of D. morbifera exhibited significant anticomplement activity on the classical pathway complement system, which was expressed as total hemolytic activity. Three polyacetylenes isolated from the leaves of D. morbifera, namely (3S)-falcarinol (1), (3S,8S)-falcarindiol (2) and (3S)-diynene (3). Compounds 1, 2 and 3 showed inhibitory activity against complement system with 50% inhibitory concentrations (IC(50)) values of 87.3 µM, 15.2 µM and 39.8 µM. Among the compounds tested, 2 showed the most potent anticomplement activity (IC(50), 15.2 µM).