Automatic speech recognition (ASR) for the diagnosis of pronunciation of speech sound disorders in Korean children.

This study presents a model of automatic speech recognition (ASR) that is designed to diagnose pronunciation issues in children with speech sound disorders (SSDs) to replace manual transcriptions in clinical procedures. Because ASR models trained for general purposes mainly predict input speech into standard spelling words, well-known high-performance ASR models are not suitable for evaluating pronunciation in children with SSDs. We fine-tuned the wav2vec2.0 XLS-R model to recognise words as they are pronounced by children, rather than converting the speech into their standard spelling words. The model was fine-tuned with a speech dataset of 137 children with SSDs pronouncing 73 Korean words that are selected for actual clinical diagnosis. The model's Phoneme Error Rate (PER) was only 10% when its predictions of children's pronunciations were compared to human annotations of pronunciations as heard. In contrast, despite its robust performance on general tasks, the state-of-the-art ASR model Whisper showed limitations in recognising the speech of children with SSDs, with a PER of approximately 50%. While the model still requires improvement in terms of the recognition of unclear pronunciation, this study demonstrates that ASR models can streamline complex pronunciation error diagnostic procedures in clinical fields.

Remarkable enantioselectivity enhancement of the extractors with nonaxial chirality in liquid-liquid extraction of underivatized amino acids by introducing t-butyl group.

A class of carbonyl extractors, (R)-3, (R)-4, and (R)-5, with nonaxial chirality containing asymmetric carbons has been synthesized and studied for their efficiencies in enantioselective liquid-liquid extraction for underivatized amino acids. The bulky t-butyl ketone extractors, (R)-4 and (R)-5, showed the stereoselectivities ranging 5.4-9.4 of l/d ratio much better than those of the aldehyde extractor, (R)-3, ranging 2.4-5.2. The imine formation rates and yields of the t-butyl ketones were not significantly affected by their bulkiness and even in the absence of resonance-assisted hydrogen bond. This work confirms that a bulky t-butyl ketone can be a good choice in the development of an extractor not only with axial chirality but also with nonaxial chirality for the enantioselective extraction of unprotected amino acids.

Handheld Microflow Cytometer Based on a Motorized Smart Pipette, a Microfluidic Cell Concentrator, and a Miniaturized Fluorescence Microscope.

Miniaturizing flow cytometry requires a comprehensive approach to redesigning the conventional fluidic and optical systems to have a small footprint and simple usage and to enable rapid cell analysis. Microfluidic methods have addressed some challenges in limiting the realization of microflow cytometry, but most microfluidics-based flow cytometry techniques still rely on bulky equipment (e.g., high-precision syringe pumps and bench-top microscopes). Here, we describe a comprehensive approach that achieves high-throughput white blood cell (WBC) counting in a portable and handheld manner, thereby allowing the complete miniaturization of flow cytometry. Our approach integrates three major components: a motorized smart pipette for accurate volume metering and controllable liquid pumping, a microfluidic cell concentrator for target cell enrichment, and a miniaturized fluorescence microscope for portable flow cytometric analysis. We first validated the capability of each component by precisely metering various fluid samples and controlling flow rates in a range from 219.5 to 840.5 µL/min, achieving high sample-volume reduction via on-chip WBC enrichment, and successfully counting single WBCs flowing through a region of interrogation. We synergistically combined the three major components to create a handheld, integrated microflow cytometer and operated it with a simple protocol of drawing up a blood sample via pipetting and injecting the sample into the microfluidic concentrator by powering the motorized smart pipette. We then demonstrated the utility of the microflow cytometer as a quality control means for leukoreduced blood products, quantitatively analyzing residual WBCs (rWBCs) in blood samples present at concentrations as low as 0.1 rWBCs/µL. These portable, controllable, high-throughput, and quantitative microflow cytometric technologies provide promising ways of miniaturizing flow cytometry.

Three-Dimensional Polymeric Mechanical Metamaterials Fabricated by Multibeam Interference Lithography with the Assistance of Plasma Etching.

The pentamode structure is a type of mechanical metamaterial that displays dramatically different bulk and shear modulus responses. In this study, a face-centered cubic (FCC) polymeric microstructure was fabricated by using SU8 negative-type photoresists and multibeam interference exposure. Isotropic plasma etching is used to control the solid-volume fraction; for the first time, we obtained a structure with the minimum solid-volume fraction as low as 15% that still exhibited high structural integrity. Using this method, we reduced the width of atom-to-atom connections by up to 40 nm. We characterize the effect of the connection area on the anisotropy of the mechanical properties using simulations. Nanoindentation measurements were also conducted to evaluate the energy dissipation by varying the connection area. The Young's/shear modulus ratio is 5 times higher for the etched microstructure than that of the bulk SU8 materials. The use of interference lithography may enable the properties of microscale materials to be engineered for various applications, such as MEMS.

Is There a Difference in Stability After Intraoral Vertical Ramus Osteotomy Between Vertically High-Angle and Normal-Angle Patients?

PURPOSE: Few studies have evaluated the relapse pattern of intraoral vertical ramus osteotomy (IVRO) for the correction of mandibular prognathism with a high angle. The aim of this study was to measure the association between vertical facial types (high and normal mandibular plane angle) and relapse after IVRO for the management of mandibular prognathism. MATERIALS AND METHODS: The retrospective cohort study sample (skeletal Class III patients) was divided into 2 groups according to the angle of the sella-nasion plane relative to the mandibular plane (SN-MP) at the initial examination. Lateral cephalograms were analyzed for the predictor (facial type) and outcome (cephalometric changes over time) variables before surgery, 7 days after surgery, and 12 months after surgery. The 2 groups were matched for sample size (n = 20 in each). Data were analyzed using repeated-measures analysis of variance with Bonferroni correction. RESULTS: The normal-angle group (group N, SN-MP from 27° to 37°) and high-angle group (group H, SN-MP >37°) were not significantly different in terms of gender and age at the initial examination. Seven days after surgery, the mandibles in group H moved 2.5 mm more superiorly than those in group N (P = .013); consequently, the amount of overbite correction in group H was approximately 2 mm greater than that in group N (P = .002). Nevertheless, 12 months after surgery, there was no statistically significant difference in relapse of the maxilla and mandible between the 2 groups. In the 2 groups, the mandible moved approximately 0.7 mm superiorly during retention. CONCLUSIONS: These findings suggest that IVRO is a clinically acceptable and stable treatment modality for mandibular prognathism with a high angle.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability.

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.

Adult patient with hemifacial microsomia treated with combined orthodontics and distraction osteogenesis.

Distraction osteogenesis is an alternative treatment option for patients with facial asymmetry and mandibular hypoplasia. New bone is formed between bone segment surfaces that are gradually separated by incremental traction. The purpose of this article is to report the treatment of a 22-year-old man with hemifacial microsomia, facial asymmetry, and a skeletal Class II profile. The patient's left mandibular ramus was lengthened with distraction osteogenesis, and miniscrew-assisted rapid palatal expansion was used to correct the maxillary transverse deficiency. Postoperative orthodontic treatment achieved tooth alignment and closure of the posterior open bite. The total treatment period was 27 months. These therapeutic treatments improved the patient's facial appearance.

Severe skeletal Class III malocclusion treated with 2-stage orthognathic surgery with a mandibular step osteotomy.

To reduce a large amount of mandibular setback and to prevent pharyngeal airway space narrowing when correcting a severe anteroposterior skeletal discrepancy, a mandibular step osteotomy is often combined with 2-stage orthognathic surgery. This case report describes a successful 2-stage orthognathic treatment combined with a mandibular step osteotomy. A 20-year-old man had severe mandibular protrusion, facial asymmetry, and macroglossia. Phase 1 surgery included the mandibular step osteotomy and a partial glossectomy; then we performed phase 2 surgery with a 2-piece LeFort I segmental osteotomy and a bilateral intraoral vertical ramus osteotomy to correct the patient's mandibular protrusion and facial asymmetry. The total treatment period was 30 months, and the final result was improvement of the patient's facial appearance.

Particulate inverse opal carbon electrodes for lithium-ion batteries.

Inverse opal carbon materials were used as anodes for lithium ion batteries. We applied particulate inverse opal structures and their dispersion in the formation of anode electrodes via solution casting. We prepared aminophenyl-grafted inverse opal carbons (a-IOC), inverse opal carbons with mesopores (mIOC), and bare inverse opal carbons (IOC) and investigated the electrochemical behavior of these samples as anode materials. Surface modification by aminophenyl groups was confirmed by XPS measurements. TEM images showed mesopores, and the specific area of mIOC was compared with that of IOC using BET analysis. A half-cell test was performed to compare a-IOC with IOC and mIOC with IOC. In the case of the a-IOC structure, the cell test revealed no improvement in the reversible specific capacity or the cycle performance. The mIOC cell showed a reversible specific capacity of 432 mAh/g, and the capacity was maintained at 88%-approximately 380 mAh/g-over 20 cycles.

CcpA and CodY Regulate CRISPR-Cas System of Streptococcus mutans.

Clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated (Cas) genes are widely recognized as bacterial adaptive immune systems against invading viruses and bacteriophages. The oral pathogen Streptococcus mutans encodes two CRISPR-Cas loci (CRISPR1-Cas and CRISPR2-Cas), and their expression under environmental conditions is still under investigation. In this study, we investigated the transcriptional regulation of cas operons by CcpA and CodY, two global regulators that contribute to carbohydrate and (p)ppGpp metabolism. The possible promoter regions for cas operons and the binding sites for CcpA and CodY in the promoter regions of both CRISPR-Cas loci were predicted using computational algorithms. We found that CcpA could directly bind to the upstream region of both cas operons, and detected an allosteric interaction of CodY within the same region. The binding sequences of the two regulators were identified through footprinting analysis. Our results showed that the promoter activity of CRISPR1-Cas was enhanced under fructose-rich conditions, while deletion of the ccpA gene led to reduced activity of the CRISPR2-Cas promoter under the same conditions. Additionally, deletion of the CRISPR systems resulted in a significant decrease in fructose uptake ability compared to the parental strain. Interestingly, the accumulation of guanosine tetraphosphate (ppGpp) was reduced in the presence of mupirocin, which induces a stringent response, in the CRISPR1-Cas-deleted (ΔCR1cas) and both CRISPR-Cas-deleted (ΔCRDcas) mutant strains. Furthermore, the promoter activity of both CRISPRs was enhanced in response to oxidative or membrane stress, while the CRISPR1 promoter activity was reduced under low-pH conditions. Collectively, our findings demonstrate that the transcription of the CRISPR-Cas system is directly regulated by the binding of CcpA and CodY. These regulatory actions play a crucial role in modulating glycolytic processes and exerting effective CRISPR-mediated immunity in response to nutrient availability and environmental cues. IMPORTANCE An effective immune system has evolved not only in eukaryotic organisms but also in microorganisms, enabling them to rapidly detect and neutralize foreign invaders in the environment. Specifically, the CRISPR-Cas system in bacterial cells is established through a complex and sophisticated regulatory mechanism involving specific factors. In this study, we demonstrate that the expression of two CRISPR systems in S. mutans can be controlled by two global regulators, CcpA and CodY, which play critical roles in carbohydrate metabolism and amino acid biosynthesis. Importantly, our results show that the expression of the CRISPR-Cas system in S. mutans influences (p)ppGpp production during the stringent response, which is a gene expression regulatory response that aids in environmental stress adaptation. This transcriptional regulation by these regulators enables a CRISPR-mediated immune response in a host environment with limited availability of carbon sources or amino acids, while ensuring efficient carbon flux and energy expenditure to support multiple metabolic processes.

The Auxiliary Role of Virtual Reality in Enhancing the Effects of Disaster News on Empathy and Fear: The Mediating Role of Presence.

This study conducted a two-condition between-subjects laboratory experiment (N = 147) to examine the effects of textual disaster news combined with a 360° video in different modes (virtual reality [VR] vs. two dimensional screen) on cognitive/affective empathy and fear. Additionally, the mediating role of presence (social and spatial presence) was considered. Results indicated that the news article presented through an immersive VR mode directly led to greater levels of presence and cognitive empathy but not affective empathy and fear. The effects on social presence further resulted in greater cognitive and affective empathy, not fear. Meanwhile, spatial presence enhanced by VR led to greater levels of emotions (affective empathy and fear) but not cognitive empathy. These findings suggest the dynamic mechanisms of how an immersive VR modality can function as a complementary tool for traditional news to improve audience engagement, which centers on emotion-related outcomes in tandem with cognitive responses.

Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients.

This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting ß2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165-1.241) and MI (HR, 1.244; 95% CI, 1.182-1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.

Inverse opal carbons for counter electrode of dye-sensitized solar cells.

We investigated the fabrication of inverse opal carbon counter electrodes using a colloidal templating method for DSSCs. Specifically, bare inverse opal carbon, mesopore-incoporated inverse opal carbon, and graphitized inverse opal carbon were synthesized and stably dispersed in ethanol solution for spray coating on a FTO substrate. The thickness of the electrode was controlled by the number of coatings, and the average relative thickness was evaluated by measuring the transmittance spectrum. The effect of the counter electrode thickness on the photovoltaic performance of the DSSCs was investigated and analyzed by interfacial charge transfer resistance (R(CT)) under EIS measurement. The effect of the surface area and conductivity of the inverse opal was also investigated by considering the increase in surface area due to the mesopore in the inverse opal carbon and conductivity by graphitization of the carbon matrix. The results showed that the FF and thereby the efficiency of DSSCs were increased as the electrode thickness increased. Consequently, the larger FF and thereby the greater efficiency of the DSSCs were achieved for mIOC and gIOC compared to IOC, which was attributed to the lower R(CT). Finally, compared to a conventional Pt counter electrode, the inverse opal-based carbon showed a comparable efficiency upon application to DSSCs.

Surgical-orthodontic treatment for skeletal class II malocclusion with vertical maxillary excess, anterior open bite, and transverse maxillary deficiency.

Nongrowing adult patients with skeletal open bite have been considered among the most difficult to treat. This case report describes the surgical-orthodontic treatment of a blind 20-year-old woman who presented with skeletal class II malocclusion with vertical maxillary excess, anterior open bite, and transverse maxillary deficiency.After the transverse maxillary deficiency was corrected with miniscrew-assisted rapid palatal expansion, Le Fort I osteotomy with anterior segmental osteotomy and bilateral sagittal split ramus osteotomy with advancement genioplasty were used to correct the vertical maxillary excess and the anterior open bite. The patient's facial appearance was markedly improved, and she achieved a functional and stable occlusion after these treatments.This case report demonstrates the efficiency of miniscrew-assisted rapid palatal expansion for a patient with transverse maxillary deficiency and the benefit of a team approach using effective orthodontic mechanics in orthognathic surgery to correct a severe dentofacial deformity.

Inverse Identification of a Constitutive Model for High-Speed Forming Simulation: An Application to Electromagnetic Metal Forming.

Forming simulation requires a constitutive model whose parameters are typically determined with tensile tests assumed static. However, this conventional approach is impractical for high-speed forming simulation characterized by high strain rates inducing transient effects. To identify constitutive parameters in relation to high-speed forming simulation, we formulated the problem of constitutive modeling as inverse parameter estimation addressed by regularized nonlinear least squares. Regarding the proposed inverse constitutive modeling, we adopted the L-curve method for proper regularization and model order reduction for rapid simulation. For demonstration, we corroborated the proposed strategy by identifying the modified Johnson-Cook model in the context of a free bulge test with electromagnetic metal forming simulation. The L-curve method allowed us to systematically choose a regularization parameter, and model order reduction brought enormous computational savings. After identifying constitutive parameters, we successfully verified and validated the reduced and original simulation models, respectively, with a manufactured workpiece. In addition, we validated the numerically identified constitutive model with a dynamic material test using a split Hopkinson pressure bar. Overall, we showed that inverse constitutive modeling for high-speed forming simulation can be effectively tackled by regularized nonlinear least squares with the help of an L-curve and a reduced-order model.

Multifunctional Injectable Hydrogel for In Vivo Diagnostic and Therapeutic Applications.

Injectable hydrogels show high potential for in vivo biomedical applications owing to their distinctive mode of administration into the human body. In this study, we propose a material design strategy for developing a multifunctional injectable hydrogel with good adhesiveness, stretchability, and bioresorbability. Its multifunctionality, whereupon multiple reactions occur simultaneously during its injection into the body without requiring energy stimuli and/or additives, was realized through meticulous engineering of bioresorbable precursors based on hydrogel chemistry. The multifunctional injectable hydrogel can be administered through a minimally invasive procedure, form a conformal adhesive interface with the target tissue, dynamically stretch along with the organ motions with minimal mechanical constraints, and be resorbed in vivo after a specific period. Further, the incorporation of functional nanomaterials into the hydrogel allows for various in vivo diagnostic and therapeutic applications, without compromising the original multifunctionality of the hydrogel. These features are verified through theranostic case studies on representative organs, including the skin, liver, heart, and bladder.

Performance Evaluation of the Newly Developed In Vitro Rapid Diagnostic Test for Detecting OXA-48-Like, KPC-, NDM-, VIM- and IMP-Type Carbapenemases: The RESIST-5 O.K.N.V.I. Multiplex Lateral Flow Assay.

The objective of this study was to evaluate the performance of the RESIST-5 O.K.N.V.I. assay for identifying these five common domestic carbapenemases among a large number of clinical isolates in South Korea. A total of 268 non-duplicated clinical isolates of gram-negative bacilli were included in this study as follows: 258 carbapenemase-producing (CP) strains (OXA-48-like, KPC, NDM, VIM, IMP, GES, OXA-23 and two or more carbapenemase producers) and 10 non-CP carbapenem-resistant Enterobacterales (non-CP CREs). Overall sensitivity and specificity were 98.4% and 100%, respectively. In addition, all non-targeted carbapenemase producers including GES and OXA-23 producers and non-CP CREs were correctly identified as negative results. There were only four discrepant cases in which three VIM carbapenemase producers and one NDM carbapenemase producer were not detected. The RESIST-5 O.K.N.V.I. assay as an in vitro diagnostic test for detecting five common carbapenemases provided rapid and accurate results in a short time, indicating that this method could provide an innovative solution for early detection, resulting in appropriate antimicrobial treatment in the clinical field.

Deep-learning model for screening sepsis using electrocardiography.

BACKGROUND: Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). METHODS: This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. RESULTS: During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882-0.920) and 0.863 (0.846-0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877-0.936) and 0.899 (95% CI, 0.872-0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845-0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793-0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). CONCLUSIONS: The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.

Enantioselective extraction of unprotected amino acids coupled with racemization.

Scalable and economical methods for the production of optically pure amino acids, both natural and unnatural, are essential for their use as synthetic building blocks. Currently, enzymatic dynamic kinetic resolution (DKR) underpins some of the most effective processes. Here we report the development of enantioselective extraction coupled with racemization (EECR) for the chirality conversion of underivatized amino acids. In this process, the catalytic racemization of amino acids in a basic aqueous solution is coupled with the selective extraction of one enantiomer into an organic layer. Back-extraction from the organic layer to an acidic aqueous solution then completes the deracemization of the amino acid. The automation of the EECR process in a recycling flow reactor is also demonstrated. Continuous EECR is made possible by the sterically hindered chiral ketone extractant 5, which prevents the coextraction of the copper racemization catalyst because of its nonplanar geometry. Furthermore, the extractant 5 unexpectedly forms imines with amino acids faster and with greater enantioselectivity than less bulky derivatives, even though 5 cannot participate in intramolecular resonance-assisted hydrogen bonding. These features may allow EECR to challenge the preponderance of enzymatic DKR in the production of enantiomerically enriched amino acids.

A Biodegradable Secondary Battery and its Biodegradation Mechanism for Eco-Friendly Energy-Storage Systems.

The production of rechargeable batteries is rapidly expanding, and there are going to be new challenges in the near future about how the potential environmental impact caused by the disposal of the large volume of the used batteries can be minimized. Herein, a novel strategy is proposed to address these concerns by applying biodegradable device technology. An eco-friendly and biodegradable sodium-ion secondary battery (SIB) is developed through extensive material screening followed by the synthesis of biodegradable electrodes and their seamless assembly with an unconventional biodegradable separator, electrolyte, and package. Each battery component decomposes in nature into non-toxic compounds or elements via hydrolysis and/or fungal degradation, with all of the biodegradation products naturally abundant and eco-friendly. Detailed biodegradation mechanisms and toxicity influence of each component on living organisms are determined. In addition, this new SIB delivers performance comparable to that of conventional non-degradable SIBs. The strategy and findings suggest a novel eco-friendly biodegradable paradigm for large-scale rechargeable battery systems.