Prenatal cocaine exposure and self-reported behavioral adjustments from ages 12 to 21: environmental pathways.

BACKGROUND: In a birth-cohort study, we followed offspring with prenatal cocaine exposure (PCE) to investigate longitudinal associations of PCE with self-reported behavioral adjustment from early adolescence to emerging adulthood (EA). Environmental pathways (family functioning, non-kinship care, maltreatment) were specified as potential mediators of PCE. METHODS: Participants were 372 (190 PCE; 47% male), primarily Black, low socioeconomic status, enrolled at birth. Internalizing and externalizing behaviors were assessed using Youth Self-Report at ages 12 and 15 and Adult Self-Report at age 21. Extended random-intercept cross-lagged panel modeling was used to account for potential bidirectional relationships between internalizing and externalizing behaviors over time, examining potential mediators. RESULTS: Adjusting for covariates, significant indirect effects were found for each mediator at different ages. For family functioning, these were both internalizing (ß = 0.83, p = 0.04) and externalizing behaviors (ß = 1.58, p = 0.02) at age 12 and externalizing behaviors at age 15 (ß = 0.51, p = 0.03); for non-kinship care, externalizing behaviors at ages 12 (ß = 0.63, p = 0.02) and 15 (ß = 0.20, p = 0.03); and for maltreatment, both internalizing and externalizing behaviors at ages 15 (ß = 0.64, p = 0.02 for internalizing; ß = 0.50, p = 0.03 for externalizing) and 21 (ß = 1.39, p = 0.01 for internalizing; ß = 1.11, p = 0.01 for externalizing). Direct associations of PCE with internalizing and externalizing behaviors were not observed, nor cross-lagged relationships between internalizing and externalizing behaviors. CONCLUSIONS: Negative associations of PCE with behavioral adjustment persist into EA via environmental pathways, specifying intervention points to disrupt adverse pathways toward healthy development.

Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study.

PURPOSE: Virtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students. METHODS: A quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions. RESULTS: The self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = -2.62, p = 0.011), violence risk management (t = -3.42, p = 0.001), and nurse-patient interaction (t = -3.12, p = 0.003). CONCLUSIONS: The findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

Erratum: Correction of Funding in the Article "Rates of COVID-19 Infection Among Healthcare Workers in Designated COVID-19 Wards and General Wards".

This corrects the article on p. e308 in vol. 37, PMID: 36345254.

Full-Color Solar-Heat-Resistant Films Based on Nanometer Optical Coatings.

Nanometer optical coatings with absorbing materials allow the tuning of structured absorption spectra, thus developing ultrathin color devices. However, these coatings are limited by the narrow bandwidth and tunability of wavelength that restrict the chroma and hue characteristics of colors, respectively, apart from imposing adverse thermal problems under sunlight exposure. Here, we demonstrate that inversely designed TiN/ZnS/Ag coatings attain a wide color gamut in the trilayer configuration and efficiently dissipate heat through thermal radiation when transfer-printed on high-emissivity polymers. Daytime experiments reveal that fabricated optical films yield an almost color-independent heat dissipation rate against solar heating. Moreover, they outperform commercial paints of the same color when applied to three-dimensional miniature houses. All magenta, green, cyan, and yellow optical films lower the roof temperature by 10, 6, 8, and 2 °C below one sun irradiance, respectively, compared to their paint counterparts; the temperature gradient increases directly with the level of sunlight.

Constructing a Mixed Simulation With 360° Virtual Reality and a High-Fidelity Simulator: Usability and Feasibility Assessment.

Virtual reality technology has been adopted to overcome barriers of conventional simulation. This study was conducted to determine the impact of mixed simulation (a 360° virtual reality and a high-fidelity simulator) on learning how to provide nursing care for patients with arrhythmia. A total of 49 students were randomly assigned to intervention (n = 25) and control (n = 23) groups. They were given four arrhythmia cases with a 360° virtual reality system first followed by a manikin-based simulation. The mixed simulation group showed greater improvement in knowledge, higher decision-making competency in "knowing and acting" ( P = .025) and "seeking information from instructors" ( P = .049), and lower anxiety in "using resources to gather information" ( P = .031). Study participants achieved a good level of empathy (3.28 ± 0.72) and liked the program (4.56 ± 0.60). They were satisfied with the program (4.48 ± 0.65). These findings provide new insight into learning through blending of new technology. When the 360° virtual reality was used with existing manikin-based simulation, they effectively reinforced one another. The 360° virtual reality can be an effective strategy to ensure active participation to gain a comprehensive understanding of and empathy for patients.

Distinct intramolecular interactions regulate autoinhibition of vinculin binding in αT-catenin and αE-catenin.

α-Catenin binds directly to ß-catenin and connects the cadherin-catenin complex to the actin cytoskeleton. Tension regulates α-catenin conformation. Actomyosin-generated force stretches the middle (M)-region to relieve autoinhibition and reveal a binding site for the actin-binding protein vinculin. It is not known whether the intramolecular interactions that regulate epithelial (αE)-catenin binding are conserved across the α-catenin family. Here, we describe the biochemical properties of testes (αT)-catenin, an α-catenin isoform critical for cardiac function and how intramolecular interactions regulate vinculin-binding autoinhibition. Isothermal titration calorimetry showed that αT-catenin binds the ß-catenin-N-cadherin complex with a similar low nanomolar affinity to that of αE-catenin. Limited proteolysis revealed that the αT-catenin M-region adopts a more open conformation than αE-catenin. The αT-catenin M-region binds the vinculin N-terminus with low nanomolar affinity, indicating that the isolated αT-catenin M-region is not autoinhibited and thereby distinct from αE-catenin. However, the αT-catenin head (N- and M-regions) binds vinculin 1000-fold more weakly (low micromolar affinity), indicating that the N-terminus regulates the M-region binding to vinculin. In cells, αT-catenin recruitment of vinculin to cell-cell contacts requires the actin-binding domain and actomyosin-generated tension, indicating that force regulates vinculin binding. Together, our results show that the αT-catenin N-terminus is required to maintain M-region autoinhibition and modulate vinculin binding. We postulate that the unique molecular properties of αT-catenin allow it to function as a scaffold for building specific adhesion complexes.

Synergistically designed antireflective cover for improving wide-angle photovoltaic efficiencies.

We demonstrated that a well-designed nanopatterned cover improves photovoltaic efficiency across a wide range of incident angles (θ). A nanopatterned cover was created using an integrated ray-wave optics simulation to maximize the light absorption of the surface-textured Si photovoltaic device. A hexagonally arranged nanocone array with a 300 nm pitch was formed into a polymer using nanoimprinting, and the nanostructured polymer was then attached to a glass cover with an index-matching adhesive. Angle-resolved current density-voltage measurements on Si photovoltaic devices showed that the nanopatterned glass cover yielded a 2-13% enhancement in power conversion efficiency at θ = 0-60°, which accounted for its broadband antireflective feature. We performed all-season-perspective simulations based on the results of the integrated ray-wave optics simulations and solar altitude database of South Korea, which validated the sustainability of the developed nanopatterned cover during significant seasonal fluctuations.

Effects of App-Based Mobile Interventions for Dementia Family Caregivers: A Systematic Review and Meta-Analysis.

BACKGROUND: Dementia was caregivers experience tremendous difficulties both physically and psychologically, leading to high levels of depression and caregiver burden. The advantage of mobile interventions has been recognized due to its freedom from time and space restrictions. OBJECTIVES: A systematic review and meta-analysis was conducted to evaluate effectiveness of app-based mobile interventions for dementia caregivers. METHOD: We searched nine different databases including CINAHL, the Cochrane Library, Embase, MEDLINE, PsycINFO, the ACM digital library, IEEE Xplore, KoreaMed, and RISS for publications on app-based mobile interventions targeting dementia caregivers published in English or Korean. Meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) version 3.0. Standard mean difference (SMD) was used to estimate the effectiveness of the intervention on caregiver-related outcomes of caregiver burden, depression, stress, caregiving competency, and quality of life (QoL). RESULTS: Five studies (three randomized controlled trials and two quasi-experimental studies) with a total of 230 participants were included. Using a mobile device, interventions were used to provide information and feedback, perform monitoring, and conduct skill training. Pooled analysis showed favorable effects of app-based mobile interventions for caregivers on caregiver burden (SMD = -0.315, 95% CI: -0.681 to 0.052), depression (SMD = -0.236, 95% CI: -0.517 to 0.046), stress (SMD = -0.295, 95% CI: -0.708 to 0.118), competency (SMD = 0.434, 95% CI: 0.093-0.775), and QoL (SMD = 0.794, 95% CI: 0.310-1.278). CONCLUSION: Types of mobile devices, lengths, and contents of interventions varied between included studies. Given that only five studies were included, the current meta-analysis could not confirm the effectiveness of app-based mobile interventions. However, this study suggests that app-based mobile interventions for dementia caregivers might have positive effects on diverse caregiving-related issues such as caregiver burden, depression, stress, competency, and QoL.

Rates of COVID-19 Infection Among Healthcare Workers in Designated COVID-19 Wards and General Wards.

BACKGROUND: To evaluate the effects of isolating coronavirus disease 2019 (COVID-19) patients in general wards, we compared the rates of COVID-19 infection in nurses and nursing assistants working in COVID-19 designated wards and in general wards of our hospital from 1 October 2021 to 21 April 2022. METHODS: This study was conducted in a 2,700-bed tertiary care hospital in Seoul, Korea. Designated wards comprised single, negative pressure rooms and a 100% outdoor air system. RESULTS: During the study period, a total of 2,698 nurses and nursing assistants were employed at our hospital, of whom 310 (11%) were working in the designated wards, and the remaining 2,388 (89%) in the general wards, and among whom 1,158 (43%) were diagnosed with COVID-19. The healthcare workers (HCWs) in the designated wards were less frequently diagnosed with COVID-19 than those in the general wards (31% vs. 45%, P < 0.001). During the period before patients with COVID-19 were isolated in general wards, and during the period after these cases were isolated in general ward, HCWs in designated wards were less frequently infected with the virus than those in general wards (7% vs. 11%, P = 0.039; and 23% vs. 33%, P < 0.001, respectively). CONCLUSION: HCWs in designated wards have a lower rate of contracting COVID-19 than those in general wards. A lack of exposure to undiagnosed cases and their caregivers, greater care with social distancing outside the hospital, higher rates of 3-dose vaccinations, and the use of isolation rooms with negative pressure may be associated with this finding.

Evaluation of In-Hospital Cluster of COVID-19 Associated With a Patient With Prolonged Viral Shedding Using Whole-Genome Sequencing.

BACKGROUND: Patients with hematologic malignancies may produce replication-competent virus beyond 20 days of SARS-CoV-2 infection. However, data regarding the transmission of SARS-CoV-2 from patients with prolonged viral shedding is limited. METHODS: In May 2022, four additional cases of COVID-19 were reported in a hematologic ward at a tertiary care hospital in South Korea, after an 8-week isolation of a patient with prolonged viral shedding. We performed whole-genome sequencing (WGS) of SARS-CoV-2 to evaluate the possibility of post-isolation transmission from this prolonged viral shedding. RESULTS: A patient (case 1) with acute myeloid leukemia was released from isolation 54 days after the diagnosis of COVID-19 based on rising Ct value of up to 29.3, and moved to a six-patient room. On days 10 and 11 post-isolation, his doctor (case 2) and 2 patients who were his roommates (case 3, 4) had positive SARS-CoV-2 PCR results. Additionally, 16 days post-isolation, another patient (case 5) in a remote room had positive SARS-CoV-2 PCR result. All the three patients were hospitalized for ≥ 14 days when they were diagnosed with SARS-CoV-2 infection. Except for case 3, the remaining 4 cases were available for WGS, which revealed that case 1 exhibited a 7 nucleotides difference in comparison to cases 4 and 5 and case 2 displayed a 20 nucleotides difference compared with case 1, while sequences of cases 4 and 5 were identical. CONCLUSIONS: Despite the possibility of transmission from the patient with prolonged viral shedding, no evidence of the transmission of SARS-CoV-2 from the patient with prolonged positive RT-PCR using WGS was found.

Substance use and individual assets in urban adolescents: Subgroups and correlates in emerging adulthood.

INTRODUCTION: To investigate patterns of divergence in adolescent adjustment, this study examined the co-occurring patterns of adolescents' individual assets (e.g., school engagement, values) and substance use, and whether the co-occurring patterns were associated with later functioning in emerging adulthood. METHODS: Participants were 358 (54% females), predominantly African American, urban adolescents, recruited at birth for a prospective study on the effects of prenatal substance exposure in the Midwest United States. Individual assets, using the Developmental Assets Profile, substance use (alcohol, tobacco, marijuana), via biologic assays and self-report, and substance use-related problems were assessed at age 15 years. High-school completion, substance use disorder, mental health symptoms, and legal problems were assessed at age 21 years. RESULTS: Latent class analysis identified five classes as follows: high assets with low substance use (C1, 10.2%); moderate assets with low substance use (C2, 28.7%); low assets with low substance use (C3, 32%); moderate assets with high substance use (C4, 9.4%); and low assets with high substance use (C5, 19.2%). Despite similar levels of assets, adolescents in C5 reported more life adversities (suboptimal caregiving environment, daily hassles, non-birth parents' care) than those in C3. C4 and C5 reported more substance use disorder at age 21 years than the three low substance use classes; adolescents in C5 were less likely to complete high school than those in C2. More females in C5 reported greater mental health symptoms than those in C1 and C3, and criminal justice involvement than those in C1. CONCLUSIONS: The current findings underscore the significance of substance use in adolescence in disrupting healthy transition to adulthood, especially among females in the context of low individual assets.

Cooling Metals via Gap Plasmon Resonance.

We report highly emissive and radiatively cooled metallic surfaces that sustain multiple and high-amplitude gap plasmon cavity modes within the principal thermal radiation spectrum at room temperature (i.e., 8-13 µm). A square-lattice array of Cu/ZnS/Cu gap plasmon cavities with five different widths was designed to avoid the near-field coupling between adjacent cavities and the anticrossing of a cavity mode and the first diffraction mode. The gap plasmon cavities fabricated on a Si substrate exhibited an effective emissivity of >0.62, up to an incidence of 60°. Outdoor solar heating experiments showed that the Cu/ZnS/Cu multicavity array lowered the Si substrate temperature by 4 °C at a maximum solar irradiance of 800 W/m2, which is equivalent to a near-one-sun intensity, relative to a planar Cu/ZnS/Cu multilayer. Such mid-infrared spectrum management of metals enables heat dissipation via radiation, which will be further utilized for designing electrodes that cool optoelectronic devices with the same metal/dielectric/metal configuration.

Nanometer-optical-coating-based visibly tinted films with 24-hour sub-atmospheric passive cooling.

Colored films absorb solar radiation at specific visible wavelengths, and they consequently heat up above atmospheric temperatures when exposed to sunlight. In this Letter, we report nanometer-thick TiN-based multilayers of light cyan, magenta, and yellow colors that can provide 24 h sub-atmospheric cooling when covered with high-emissivity polymers. Outdoor experiments have demonstrated that these visibly tinted films retain sub-atmospheric temperatures during daytime and nighttime. All fabricated films generated almost color-independent cooling powers and even surpassed commercial white paint at TiN thicknesses <5nm. Our work thus highlights the potential of multispectral selective absorbers as esthetic passive coolers.

Adaptation of Extended Reality Smart Glasses for Core Nursing Skill Training Among Undergraduate Nursing Students: Usability and Feasibility Study.

BACKGROUND: Skill training in nursing education has been highly dependent on self-training because of Korea's high student-faculty ratio. Students tend to have a passive attitude in self-practice, and it is hard to expect effective learning outcomes with traditional checklist-dependent self-practice. Smart glasses have a high potential to assist nursing students with timely information, and a hands-free device does not interrupt performance. OBJECTIVE: This study aimed to develop a smart glass-based nursing skill training program and evaluate its usability and feasibility for the implementation of self-practice. METHODS: We conducted a usability and feasibility study with 30 undergraduate nursing students during a 2-hour open lab for self-practice of core nursing skills, wearing smart glasses for visualized guidance. The usability test was conducted using a 16-item self-reporting questionnaire and 7 open-ended questions. Learning satisfaction was assessed using a 7-item questionnaire. The number of practice sessions was recorded, and perceived competency in core nursing skills was measured before and after the intervention. At the final evaluation, performance accuracy and time consumed for completion were recorded. RESULTS: Smart glass-assisted self-practice of nursing skills was perceived as helpful, convenient, and interesting. Participants reported improved recollection of sequences of skills, and perceived competency was significantly improved. Several issues were raised by participants regarding smart glasses, including small screen size, touch sensors, fogged lenses with masks, heaviness, and heat after a period of time. CONCLUSIONS: Smart glasses have the potential to assist self-practice, providing timely information at students' own paces. Having both hands free from holding a device, participants reported the convenience of learning as they could practice and view the information simultaneously. Further revision correcting reported issues would improve the applicability of smart glasses in other areas of nursing education.

Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea.

BACKGROUND: We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. METHODS: HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. RESULTS: A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%]; BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. CONCLUSION: In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.

Atomic-resolution structures from fragmented protein crystals with the cryoEM method MicroED.

Traditionally, crystallographic analysis of macromolecules has depended on large, well-ordered crystals, which often require significant effort to obtain. Even sizable crystals sometimes suffer from pathologies that render them inappropriate for high-resolution structure determination. Here we show that fragmentation of large, imperfect crystals into microcrystals or nanocrystals can provide a simple path for high-resolution structure determination by the cryoEM method MicroED and potentially by serial femtosecond crystallography.

Tuning of polarized room-temperature thermal radiation based on nanogap plasmon resonance.

When a one-dimensional (1D) metal array is coupled to a planar metal mirror with a dielectric gap, localized plasmon resonance is excited inside the gap at a specific polarization of light in free space. Herein, we report on the completely polarized, mid-infrared thermal radiation that is released from gap plasmon resonators with a nanometer-thick dielectric. We fabricated nanogap plasmon resonators with 1D Au or Ni array of various widths (w) using laser interference lithography. An atomic layer deposition process was used to introduce a 10 nm-thick alumina gap between a 1D metal array and a planar metal mirror. It was observed that only for the Au nanogap plasmon resonators, high-amplitude absorption peaks that were attributed to gap plasmon modes with different orders appeared at discrete wavelengths in a polarization-resolved spectrum. In addition, all the pronounced peaks were gradually redshifted with increasing w. At w = 1.2-1.6 µm, the fundamental gap plasmon mode was tuned to the main wavelengths (8-9 µm) of thermal radiation at room temperature (e.g., ∼300 K), which led to polarization-selective camouflage against standard infrared thermal imaging. The results of electromagnetic simulations quantitatively agreed with the measured absorbance spectra in both peak wavelength and amplitude. We believe that these experimental efforts towards achieving radiation/absorption spectra tailored at mid-infrared wavelengths will be further exploited in thermal-radiation harnessed energy devices, spectroscopic sensors, and radiative coolers.

Universal Screening of Severe Acute Respiratory Syndrome Coronavirus 2 with Polymerase Chain Reaction Testing after Rally of Trainee Doctors.

There were two rallies of medical students and trainee doctors, where 9,000 participants gathered. We performed polymerase chain reaction (PCR)-based universal screening for the participants using pooling at a tertiary care hospital. Around 609 (94%) of 646 participants underwent PCR tests for severe acute respiratory syndrome coronavirus 2; all of them tested negative. Our data suggested low transmission rates in open air mass gatherings when appropriate personal protective practices were followed.

Optical Tunneling Mediated Sub-Skin-Depth High Emissivity Tungsten Radiators.

Tailoring the spectrum of thermal radiation at high temperatures is a central issue in the study of thermal radiation harnessed energy resources. Although bulk metals with periodic cavities incorporated into their surfaces provide high emissivity, they require a complicated micron metal etch, thereby precluding reliable, continuous operation. Here, we report thermally stable, highly emissive, ultrathin (<20 nm) tungsten (W) radiators that were prepared in a scalable and cost-effective route. Alumina/W/alumina multiwalled, submicron cavity arrays were fabricated sequentially using nanoimprinting lithography, thin film deposition, and calcination processes. To highlight the practical importance of high-temperature radiators, we developed a thermophotovoltaic (TPV) system equipped with fabricated W radiators and low-bandgap GaSb photovoltaic cells. The TPV system produced electric power reliably during repeated temperature cycling between 500 and 1200 K; the power density at 1200 K was fixed to be approximately 1.0 W/cm2. The temperature-dependent electric power was quantitatively reproduced using a one-dimensional energy conversion model. The symmetric configuration of alumina/W/alumina multiwall together with the presence of a void inside each cavity alleviated thermal stress, which was responsible for the stable TPV performance. The short-current-density (JSC) of developed TPV system was augmented significantly by decreasing the W thickness below its skin depth. A 17 nm thick W radiator yielded a 32% enhancement in JSC compared to a 123 nm thick W radiator. Electromagnetic analysis indicated that subskin-depth W cavity arrays led to suppressed surface reflection due to the mitigated screening effect of free electrons, thereby enhancing the absorption of light within each W wall. Such optical tunneling-mediated absorption or radiation was valid for any metal material and morphology (e.g., planar or patterned).

Integrated ray-wave optics modeling for macroscopic diffractive lighting devices.

We studied a high-accuracy hybrid optics modeling for macroscopic lighting devices containing highly diffractive elements. For a two-dimensional (2D) grating, we achieved forward and backward diffraction distributions at omnidirectional incidence by conducting rigorous coupled-wave analysis and then assigned the diffuse information to a virtual, planar surface in a ray-optics model. By using the integrated ray-wave optics simulation, we obtained extraction efficiencies and far-field distributions of millimeter-scale (0.5 × 0.5 × 0.1 mm3) flip-chip GaN-based light-emitting diodes (LEDs) with embedded 2D gratings. The increased index contrast of 2D gratings progressively improved the extraction of light via the top face of the substrates, thus inducing a vertical beaming effect that strongly supported measured data. The outcoupling features related to the index contrast of gratings were understood by performing Fourier analysis; a high-index-contrast grating preferred to excite high-order diffraction modes, thereby effectively converting tightly bound waveguide modes into leaky light through the top escape route. The simulation strategy developed herein will be essential for designing directional illuminations and micro-LED displays.