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OBJECTIVES: This study investigated caregivers' job image, abilities, and educational needs, which are rapidly increasing owing to an aging society. DESIGN: A self-administered written survey was conducted at 12 general hospitals in Korea from February 1, 2022 to March 15, 2023. SAMPLE: A total of 451 caregivers participated in the survey as subjects of analysis, and 560 nurses participated as external observers. MEASUREMENTS: The caregivers' self-assessment results regarding job performance, educational needs, and retraining needs were compared with those of external observers. RESULTS: Caregivers evaluated themselves significantly higher in all areas of job performance compared to the evaluations of external observers. In particular, the caregivers' self-evaluation of their abilities in "Recording and Reporting," "Basic Resuscitation," "Safety and Infection Control," and "Understanding Major Illnesses" was different from the evaluation of nurses. Both the caregivers and external observers agreed on the need for caregiver retraining, with 1-2 hours of supplementary training every 12 months being the most preferred amount of retraining. CONCLUSIONS: There was a significant difference between caregivers' self-evaluations of their capabilities and the external observers' evaluations. Therefore, systematic professional caregiver retraining is necessary.
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A vessel sails above the ocean against sea resistance, such as waves, wind, and currents on the ocean surface. Concerning the energy efficiency issue in the marine ecosystem, assigning the right magnitude of shaft power to the propeller system that is needed to move the ship during its operations can be a contributive study. To provide both desired maneuverability and economic factors related to the vessel's functionality, this research studied the shaft power utilization of a factual vessel operational data of a general cargo ship recorded during 16 months of voyage. A machine learning-based prediction model that is developed using Random Forest Regressor achieved a 0.95 coefficient of determination considering the oceanographic factors and additional maneuver settings from the noon report data as the model's predictors. To better understand the learning process of the prediction model, this study specifically implemented the SHapley Additive exPlanations (SHAP) method to disclose the contribution of each predictor to the prediction results. The individualized attributions of each important feature affecting the prediction results are presented.
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This systematic review aimed to synthesize and quantify the results of the studies investigating the changes in fibroblast growth factor-21 (FGF-21) induced by exercise. We searched for studies that did not differentiate between patients and healthy adults but compared them before and after exercise and with and without exercise. For quality assessment, the risk-of-bias assessment tool for nonrandomized studies and the Cochrane risk-of-bias tool were used. A quantitative analysis was performed using the standardized mean difference (SMD) and random-effects model in RevMan 5.4. A total of 94 studies were searched in international electronic databases, and after screening, 10 studies with 376 participants were analyzed. Compared with no exercise, there was a significant increase in the FGF-21 levels from before to after exercise (SMD = 1.05, 95% confidence interval (CI), 0.21 to 1.89). The changes in FGF-21 levels in the exercise group showed a significant difference from the levels in the controls. The results of the random-effects model were as follows: SMD = 1.12; 95% CI, -0.13 to 2.37. While the data on acute exercise were not synthesized in this study, FGF-21 levels generally increased after chronic exercise compared with no exercise.
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Terapia por Exercício , Exercício Físico , Adulto , Humanos , Terapia por Exercício/métodos , Fatores de Crescimento de FibroblastosRESUMO
Background and Objectives: Abdominal muscle exercises with limb movements are more effective for trunk stabilization than traditional exercises involving trunk flexion alone. This study examined the effects of abdominal exercises incorporating sprinter pattern and crunch exercises on changes in the lordotic curve and abdominal muscle activation in individuals with low back pain caused by hyperlordosis resulting from weak abdominal muscles. Materials and Methods: In this single-blind, randomized controlled trial, a total of 40 participants with hyperlordosis were recruited and randomly assigned to perform either sprinter-pattern abdominal exercises or crunch exercises. The participants assigned to each group performed three sets of ten abdominal exercises. The lumbar lordotic angle (LLA) and sacrohorizontal angle (SHA) were assessed prior to and following the intervention, whereas abdominal muscle activity was gauged throughout the intervention period. Changes in the LLA and SHA were measured by radiography. Abdominal muscle activity was measured using electromyography. Results: The LLA and SHA decreased significantly in both groups (p < 0.001), while the sprinter-pattern exercise group showed a statistically significant decrease compared to the crunch exercise group (p < 0.001). In the activity of the abdominal muscles, there was no significant difference in the rectus abdominis muscle between the two groups (p > 0.005). However, a significant difference between the external and internal oblique muscles was observed, and the activities of both muscles were significantly higher in the sprinter-pattern exercise group than in the crunch exercise group (p < 0.005). Conclusions: Abdominal exercise using a sprinter pattern may be effective in reducing lumbar lordosis by strengthening the abdominal muscles in patients with hyperlordosis.
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Lordose , Humanos , Método Simples-Cego , Músculos Abdominais/fisiologia , Exercício Físico/fisiologia , Reto do Abdome/fisiologiaRESUMO
In this study, we proposed a data-driven approach to the condition monitoring of the marine engine. Although several unsupervised methods in the maritime industry have existed, the common limitation was the interpretation of the anomaly; they do not explain why the model classifies specific data instances as an anomaly. This study combines explainable AI techniques with anomaly detection algorithm to overcome the limitation above. As an explainable AI method, this study adopts Shapley Additive exPlanations (SHAP), which is theoretically solid and compatible with any kind of machine learning algorithm. SHAP enables us to measure the marginal contribution of each sensor variable to an anomaly. Thus, one can easily specify which sensor is responsible for the specific anomaly. To illustrate our framework, the actual sensor stream obtained from the cargo vessel collected over 10 months was analyzed. In this analysis, we performed hierarchical clustering analysis with transformed SHAP values to interpret and group common anomaly patterns. We showed that anomaly interpretation and segmentation using SHAP value provides more useful interpretation compared to the case without using SHAP value.
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Algoritmos , Aprendizado de Máquina , RiosRESUMO
A graphene/In2O3 bilayer (termed as GI-bilayer) is proposed as a transparent conducting electrode with remarkably improved areal-uniformity. To fabricate this new structure, an In2O3 layer with a thickness of less than 50 nm was grown by atomic layer deposition and then a graphene layer was grown by chemical vapor deposition and subsequently transferred onto the as-grown In2O3 layer. Electrical and optical properties of the GI-bilayer were systematically studied to verify effects of the underlying In2O3 layer. Hall measurements and following analysis showed a conductance enhancement of the GI-bilayer owing to p-type doping of graphene. Specifically, Raman analysis and ultraviolet photoelectron spectroscopy were performed to prove p-type doping of the graphene in the GI-bilayer. In addition, the GI-bilayer exhibited the significantly improved uniformity of the sheet resistance compared to that of a conventional monolayer of graphene. There was a duality on the role of the In2O3 underlayer in the GI-bilayer. It acted as a dopant layer to the graphene and lowered the sheet resistance from 863 to 510 Ω/sq as well as compensated microscale defects on graphene. More importantly, the In2O3 underlayer resulted in the extremely reduced standard deviation of sheet resistance from 150 to 7.5 Ω/sq over the area of 49 cm2.
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This study proposes an unsupervised anomaly detection method using sensor streams from the marine engine to detect the anomalous system behavior, which may be a possible sign of system failure. Previous works on marine engine anomaly detection proposed a clustering-based or statistical control chart-based approach that is unstable according to the choice of hyperparameters, or cannot fit well to the high-dimensional dataset. As a remedy to this limitation, this study adopts an ensemble-based approach to anomaly detection. The idea is to train several anomaly detectors with varying hyperparameters in parallel and then combine its result in the anomaly detection phase. Because the anomaly is detected by the combination of different detectors, it is robust to the choice of hyperparameters without loss of accuracy. To demonstrate our methodology, an actual dataset obtained from a 200,000-ton cargo vessel from a Korean shipping company that uses two-stroke diesel engine is analyzed. As a result, anomalies were successfully detected from the high-dimensional and large-scale dataset. After detecting the anomaly, clustering analysis was conducted to the anomalous observation to examine anomaly patterns. By investigating each cluster's feature distribution, several common patterns of abnormal behavior were successfully visualized. Although we analyzed the data from two-stroke diesel engine, our method can be applied to various types of marine engine.
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The fluctuation of the oil price and the growing requirement to reduce greenhouse gas emissions have forced ship builders and shipping companies to improve the energy efficiency of the vessels. The accurate prediction of the required propulsion power at various operating condition is essential to evaluate the energy-saving potential of a vessel. Currently, a new ship is expected to use the ISO15016 method in estimating added resistance induced by external environmental factors in power prediction. However, since ISO15016 usually assumes static water conditions, it may result in low accuracy when it is applied to various operating conditions. Moreover, it is time consuming to apply the ISO15016 method because it is computationally expensive and requires many input data. To overcome this limitation, we propose a data-driven approach to predict the propulsion power of a vessel. In this study, support vector regression (SVR) is used to learn from big data obtained from onboard measurement and the National Oceanic and Atmospheric Administration (NOAA) database. As a result, we show that our data-driven approach shows superior performance compared to the ISO15016 method if the big data of the solid line are secured.
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PAL-XFEL utilizes a three-chicane bunch compression (3-BC) scheme (the very first of its kind in operation) for free-electron laser (FEL) operation. The addition of a third bunch compressor allows for more effective mitigation of coherent synchrotron radiation during bunch compression and an increased flexibility of system configuration. Start-to-end simulations of the effects of radiofrequency jitter on the electron beam performance show that using the 3-BC scheme leads to better performance compared with the two-chicane bunch compression scheme. Together with the high performance of the linac radiofrequency system, it enables reliable operation of PAL-XFEL with unprecedented stability in terms of arrival timing, pointing and intensity; an arrival timing jitter of better than 15â fs, a transverse position jitter of smaller than 10% of the photon beam size, and an FEL intensity jitter of smaller than 5% are consistently achieved.
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A fused pyrrolopyridine core having substituents on the nitrogen atom instead of the carbon atom of the indoloindole unit is developed as a new donor unit for organic electronics. The new donor-acceptor copolymers, PDHPHBT, PDHPFBT, and PDHP2FBT, are synthesized using the new donor unit, well-known benzothiadiazole derivatives containing fluorine atoms as the acceptor. The thermal, optical, and electrochemical properties of these novel copolymers are reported. A solar cell using PDHPFBT with diphenyl ether has an open-circuit voltage, short-circuit current, fill factor, and power conversion efficiency of 0.86 V, 11.32 mA cm-2 , 0.59%, and 5.68%, respectively, under AM 1.5G illumination (100 mW cm-2 ) in the absence of annealing.
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Fontes de Energia Elétrica , Polímeros/química , Pirimidinas/química , Pirróis/química , Energia Solar , Estrutura Molecular , Polímeros/síntese químicaRESUMO
Climate changes and continuous population growth increase water demands that will not be met by traditional water resources, like surface and ground water. To handle increased water demand, treated municipal wastewater is offered to farmers for agricultural irrigation. This study aimed to enhance the effluent quality from worn-out sewage treatment facilities in rural villages, retreat effluent to meet water quality criteria for irrigation, and assess any health-related and environmental impacts from using retreated wastewater irrigation on crops and in soil. We developed the compact wastewater retreatment and reuse system (WRRS), equipped with filters, ultraviolet light, and bubble elements. A pilot greenhouse experiment was conducted to evaluate lettuce growth patterns and quantify the heavy metal concentration and pathogenic microorganisms on lettuce and in soil after irrigating with tap water, treated wastewater, and WRRS retreated wastewater. The purification performance of each WRRS component was also assessed. The study findings revealed that existing worn-out sewage treatment facilities in rural villages could meet the water quality criteria for treated effluent and also reuse retreated wastewater for crop growth and other miscellaneous agricultural purposes.
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Irrigação Agrícola , Purificação da Água/métodos , Agricultura , Mudança Climática , Produtos Agrícolas , Água Subterrânea , Lactuca/química , Metais Pesados/análise , Esgotos , Solo/química , Eliminação de Resíduos Líquidos , Águas Residuárias/análise , Qualidade da ÁguaRESUMO
Background: Pharyngeal infection is more difficult to diagnose and treat than genital or rectal infection and can act as a reservoir for gonococcal infection. We determined the prevalence of pharyngeal gonorrhea in Korean men with urethritis and analyzed the molecular characteristics and antimicrobial susceptibility of the isolates. Methods: Seventy-two male patients with symptoms of urethritis who visited a urology clinic in Wonju, Korea, between September 2016 and March 2018 were included. Urethral and pharyngeal gonococcal cultures, antimicrobial susceptibility testing, Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST), and multiplex real-time PCR (mRT-PCR) were performed. Results: Among the 72 patients, 59 tested positive for gonococcus by mRT-PCR. Of these 59 patients, 18 (30.5%) tested positive in both the pharynx and urethra, whereas 41 tested positive only in the urethra. NG-MAST was feasible in 16 out of 18 patients and revealed that 14 patients had the same sequence types in both urethral and pharyngeal specimens, whereas two patients exhibited different sequence types between the urethra and pharynx. Of the 72 patients, 33 tested culture-positive. All patients tested positive only in urethral specimens, except for one patient who tested positive in both. All culture-positive specimens also tested positive by mRT-PCR. All isolates were susceptible to azithromycin and spectinomycin, but resistance rates to ceftriaxone and cefixime were 2.9% and 14.7%, respectively. Conclusions: The prevalence of pharyngeal gonorrhea in Korean men with gonococcal urethritis is as high as 30.5%, highlighting the need for pharyngeal screening in high-risk groups. Ceftriaxone is the recommended treatment for pharyngeal gonorrhea.
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This study aimed to determine the effectiveness of radial extracorporeal shockwave therapy (rESWT) in enhancing ankle function in patients with Achilles tendon injuries. The choice of rESWT was based on previous success in the treatment of musculoskeletal conditions. The study involved an intervention group that received rESWT, and a control group that received sham therapy. The results revealed that rESWT led to significant improvements in single-leg vertical jump (d = 0.55, p < 0.05), indicating enhanced power generation and ankle functionality that were not observed in the control group. Additionally, the therapy resulted in increased ankle mobility, as observed by improvements in plantar flexion and heel-rise tests. Interestingly, these functional gains were not accompanied by changes in the Achilles tendon stiffness, suggesting that the benefits of rESWT may be more functional than structural. This study highlights rESWT as a promising tool for rehabilitation, particularly following Achilles tendon injuries. The study concluded that, although rESWT appears to improve certain aspects of ankle function, further studies with a larger and more diverse population over a longer period are necessary to confirm these findings and establish comprehensive treatment protocols.
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OBJECTIVES: Biological aspect and clinical research demonstrated that dual-frequency ultrasound (local dynamic micro-massage, LDM) waves of very high frequency can significantly modify cellular signaling providing anti-inflammatory and anti-fibrotic effects. During the recent past, these waves were successfully applied for the treatment of various inflammatory skin conditions, hypertrophic scars, and chronical wounds. Since the main complications after rhinoseptoplasty are caused by excessive inflammatory reactions and development of fibrosis along nasal implants which can lead to a revision rhinoseptoplasty, in this retrospective multicenter blinded study we have evaluated the efficacy of LDM ultrasound for the treatment of the postoperative perilesional ecchymosis and edema in patients after rhinoseptoplasty. METHODS: Twenty-four patients received daily LDM treatment (study group) for 5 days starting from the first day postoperative, whereas 24 patients (control group) were treated with conventional ice packs. Dynamic reduction of the postoperative perilesional ecchymosis and edema was followed up, and the total duration of these side effects was determined within specific paranasal anatomical areas. RESULTS: Post-rhinoseptoplasty ecchymosis and edema were observed in the areas of anterior cheek, lower eyelids, and upper eyelids. Duration of the postoperative perilesional edema was significantly reduced in the group treated with LDM (1.9 ± 0.9 days) compared with control group (4.5 ± 2.1 days). Duration of the ecchymosis was also significantly reduced in LDM group (2.8 ± 1.4 days) compared with controls (7.4 ± 2.8 days). Postoperative patient satisfaction in LDM-treated and control groups was 3.1 ± 1.3 and 1.5 ± 0.7, respectively, demonstrating significantly higher satisfaction in LDM-treated group. CONCLUSIONS: This study proved that the post-rhinoseptoplasty group treated with LDM ultrasound showed a significantly shorter duration of the postsurgical perilesional ecchymosis and edema, with no substantial adverse effects other than those observed in the control group. It can be suggested that ultrasound treatment can serve as an alternative option for the noninvasive management of postoperative perilesional ecchymosis and edema.
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Equimose , Rinoplastia , Humanos , Equimose/etiologia , Equimose/terapia , Edema/terapia , Edema/tratamento farmacológico , Nariz/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Rinoplastia/métodosRESUMO
The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative 'Reverse Technique,' involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the 'Cross Technique using volumizing thread' is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety.
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[This corrects the article DOI: 10.1371/journal.pone.0248810.].
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BACKGROUND: In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE). METHODS: We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs. RESULTS: The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage. CONCLUSIONS: In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.
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Rotator cuff tear is a common cause of shoulder pain and disability. Arthroscopic rotator cuff repair (ARCR) is performed to treat a torn tendon. Postoperative joint immobilization is essential, but it is a problem that needs to be addressed in the rehabilitation process. This study aimed to evaluate the effects of radial extracorporeal shock wave therapy (rESWT) in patients who underwent ARCR and required active movement after the immobilization period. This study was an open-label, prospective, single-arm trial of 30 inpatients aged >18 years who underwent ARCR. A total of 6 rESWT sessions, along with the conventional rehabilitation program for ARCR patients, were provided at the hospital's sports rehabilitation center for 2 weeks. The application sites of rESWT are periscapular muscles (supraspinatus, infraspinatus, teres minor, and rhomboid). Evaluations were conducted 3 time points-baseline, immediately after the first session of rESWT, and after 2 weeks of intervention. The outcome measures were the numeric pain rating scale for pain, and shoulder flexion, scaption flexion, abduction, horizontal adduction, external rotation, and internal rotation for shoulder range of motion. For shoulder function, disabilities of the arm, shoulder and hand, shoulder pain and disability index, and simple shoulder test were used, and muscle strength was expressed by grip strength. supraspinatus and infraspinatus evaluated thickness, tone, and stiffness. The muscle strength (95% CI, -3.554 to -0.073) and supraspinatus tone (P = .017) showed significant changes immediately after the first session of rESWT. Further, there was significant improvement in ROM (P < .01); shoulder function (P < .01); and muscle strength (95% CI, -3.561 to -0.625), supraspinatus stiffness (95% CI, -67.455 to -26.345), and infraspinatus stiffness (P = .045) after 2 weeks of intervention. However, muscle thickness and tone were significantly improved only in supraspinatus (P = .044, P = .040). Rehabilitation with radial extracorporeal shock wave therapy additionally applied to the periscapular muscles in patients who started active movement in rehabilitation after arthroscopic rotator cuff repair is effective for shoulder function and muscle properties (muscle strength, thickness, tone, and stiffness). However, a randomized controlled trial is needed to further assess the effects of radial extracorporeal shock wave therapy alone.
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Tratamento por Ondas de Choque Extracorpóreas , Lesões do Manguito Rotador , Humanos , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Dor de Ombro/terapiaRESUMO
The purpose of this study was to quantify the effect of repetitive transcranial magnetic stimulation (rTMS), which is recommended for the improvement of some pain-related symptoms and for antidepressant treatment, on the primary motor cortex (M1) in patients with fibromyalgia (FM). We searched for studies comparing rTMS and sham rTMS in the M1 of FM patients. Pain intensity, quality of life, health status, and depression were compared with or without rTMS for at least 10 sessions. We searched four databases. Quality assessment and quantitative analysis were performed using RevMan 5.4. After screening, five randomized controlled trials of 170 patients with FM were included in the analysis. As a result of the meta-analysis of rTMS on the M1 of individuals with FM, high-frequency rTMS resulted in a significant improvement on quality of life (MD = -2.50; 95% CI: -3.99 to -1.01) compared with sham rTMS. On the other hand, low-frequency rTMS resulted in a significant improvement on health status (MD = 15.02; 95% CI: 5.59 to 24.45). The application of rTMS to the M1 is proposed as an adjunctive measure in the treatment of individuals with FM. Because rTMS has various effects depending on each application site, it is necessary to classify sites or set frequencies as variables.
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A reliable method for preparing a conformal amorphous carbon (a-C) layer with a thickness of 1-nm-level, is tested as a possible Cu diffusion barrier layer for next-generation ultrahigh-density semiconductor device miniaturization. A polystyrene brush of uniform thickness is grafted onto 4-inch SiO2 /Si wafer substrates with "self-limiting" chemistry favoring such a uniform layer. UV crosslinking and subsequent carbonization transforms this polymer film into an ultrathin a-C layer without pinholes or hillocks. The uniform coating of nonplanar regions or surfaces is also possible. The Cu diffusion "blocking ability" is evaluated by time-dependent dielectric breakdown (TDDB) tests using a metal-oxide-semiconductor (MOS) capacitor structure. A 0.82 nm-thick a-C barrier gives TDDB lifetimes 3.3× longer than that obtained using the conventional 1.0 nm-thick TaNx diffusion barrier. In addition, this exceptionally uniform ultrathin polymer and a-C film layers hold promise for selective ion permeable membranes, electrically and thermally insulating films in electronics, slits of angstrom-scale thickness, and, when appropriately functionalized, as a robust ultrathin coating with many other potential applications.