Radiation dose estimation with multiple artificial neural networks in dicentric chromosome assay.

PURPOSE: The dicentric chromosome assay (DCA), often referred to as the 'gold standard' in radiation dose estimation, exhibits significant challenges as a consequence of its labor-intensive nature and dependency on expert knowledge. Existing automated technologies face limitations in accurately identifying dicentric chromosomes (DCs), resulting in decreased precision for radiation dose estimation. Furthermore, in the process of identifying DCs through automatic or semi-automatic methods, the resulting distribution could demonstrate under-dispersion or over-dispersion, which results in significant deviations from the Poisson distribution. In response to these issues, we developed an algorithm that employs deep learning to automatically identify chromosomes and perform fully automatic and accurate estimation of diverse radiation doses, adhering to a Poisson distribution. MATERIALS AND METHODS: The dataset utilized for the dose estimation algorithm was generated from 30 healthy donors, with samples created across seven doses, ranging from 0 to 4 Gy. The procedure encompasses several steps: extracting images for dose estimation, counting chromosomes, and detecting DC and fragments. To accomplish these tasks, we utilize a diverse array of artificial neural networks (ANNs). The identification of DCs was accomplished using a detection mechanism that integrates both deep learning-based object detection and classification methods. Based on these detection results, dose-response curves were constructed. A dose estimation was carried out by combining a regression-based ANN with the Monte-Carlo method. RESULTS: In the process of extracting images for dose analysis and identifying DCs, an under-dispersion tendency was observed. To rectify the discrepancy, classification ANN was employed to identify the results of DC detection. This approach led to satisfaction of Poisson distribution criteria by 32 out of the initial pool of 35 data points. In the subsequent stage, dose-response curves were constructed using data from 25 donors. Data provided by the remaining five donors served in performing dose estimations, which were subsequently calibrated by incorporating a regression-based ANN. Of the 23 points, 22 fell within their respective confidence intervals at p < .05 (95%), except for those associated with doses at levels below 0.5 Gy, where accurate calculation was obstructed by numerical issues. The accuracy of dose estimation has been improved for all radiation levels, with the exception of 1 Gy. CONCLUSIONS: This study successfully demonstrates a high-precision dose estimation method across a general range up to 4 Gy through fully automated detection of DCs, adhering strictly to Poisson distribution. Incorporating multiple ANNs confirms the ability to perform fully automated radiation dose estimation. This approach is particularly advantageous in scenarios such as large-scale radiological incidents, improving operational efficiency and speeding up procedures while maintaining consistency in assessments. Moreover, it reduces potential human error and enhances the reliability of results.

The effects of mobile technology-based support on young women with depressive symptoms: A block randomized controlled trial.

BACKGROUND: The current body of knowledge highlights the potential role of mobile technology as a medium to deliver support for psychological and physical health. This study evaluated the influence of mobile technology support on depressive symptoms and physical activity in female university students. METHODS: A block randomized controlled trial design with a single site was used. Ninety-nine participants were block-randomized into 3 arms: Experimental Group 1 (emotional and informational support group), Experimental Group 2 (informational support group), and the control group. Interventions were delivered via mobile technology for 2 weeks. Data on depressive symptoms and physical activity were collected from 84 participants at baseline and on Days 8 and 15. Data analyses included descriptive statistics, t tests, one-way analysis of variance, and repeated-measures analysis of variance. RESULTS: This study showed no interaction effect of time and group on depressive symptom scores and physical activity, considering the emotional and informational support from mobile technology. However, Experimental Group 1 exhibited a significant reduction in depressive symptoms during the first week of the study compared to Experimental Group 2 and the control group. While physical activity in Experimental Group 2 and control group increased only during the first week of the study and subsequently decreased, Experimental Group 1 showed an initial increase during the first week that was sustained into the second week. CONCLUSIONS: Since informational and emotional support showed a strong effect over a short period of time, mobile technology offering emotional support could be used to provide crisis interventions for depression among young women when a short-term impact is required.

ß-arrestin 2 negatively regulates lung cancer progression by inhibiting the TRAF6 signaling axis for NF-κB activation and autophagy induced by TLR3 and TLR4.

ß-arrestin 2 (ARRB2) is functionally implicated in cancer progression via various signaling pathways. However, its role in lung cancer remains unclear. To obtain clinical insight on its function in lung cancer, microarray data from lung tumor tissues (LTTs) and matched lung normal tissues (mLNTs) of primary non-small cell lung cancer (NSCLC) patients (n = 37) were utilized. ARRB2 expression levels were markedly decreased in all 37 LTTs compared to those in matched LNTs of NSCLC patients. They were significantly co-related to enrichment gene sets associated with oncogenic and cancer genes. Importantly, Gene Set Enrichment Analysis (GSEA) between three LTTs with highly down-regulated ARRB2 and three LTTs with lowly down-regulated ARRB2 revealed significant enrichments related to toll-like receptor (TLR) signaling and autophagy genes in three LTTs with highly down-regulated ARRB2, suggesting that ARRB2 was negatively involved in TLR-mediated signals for autophagy induction in lung cancer. Biochemical studies for elucidating the molecular mechanism revealed that ARRB2 interacted with TNF receptor-associated factor 6 (TRAF6) and Beclin 1 (BECN1), thereby inhibiting the ubiquitination of TRAF6-TAB2 to activate NF-κB and TRAF6-BECN1 for autophagy stimulated by TLR3 and TLR4, suggesting that ARRB2 could inhibit the TRAF6-TAB2 signaling axis for NF-κB activation and TRAF6-BECN1 signaling axis for autophagy in response to TLR3 and TLR4. Notably, ARRB2-knockout (ARRB2KO) lung cancer cells exhibited marked enhancements of cancer migration, invasion, colony formation, and proliferation in response to TLR3 and TLR4 stimulation. Altogether, our current data suggest that ARRB2 can negatively regulate lung cancer progression by inhibiting TLR3- and TLR4-induced autophagy.

FFAR2 antagonizes TLR2- and TLR3-induced lung cancer progression via the inhibition of AMPK-TAK1 signaling axis for the activation of NF-κB.

BACKGROUND: Free fatty acid receptors (FFARs) and toll-like receptors (TLRs) recognize microbial metabolites and conserved microbial products, respectively, and are functionally implicated in inflammation and cancer. However, whether the crosstalk between FFARs and TLRs affects lung cancer progression has never been addressed. METHODS: We analyzed the association between FFARs and TLRs using The Cancer Genome Atlas (TCGA) lung cancer data and our cohort of non-small cell lung cancer (NSCLC) patient data (n = 42), and gene set enrichment analysis (GSEA) was performed. For the functional analysis, we generated FFAR2-knockout (FFAR2KO) A549 and FFAR2KO H1299 human lung cancer cells and performed biochemical mechanistic studies and cancer progression assays, including migration, invasion, and colony-formation assays, in response to TLR stimulation. RESULTS: The clinical TCGA data showed a significant down-regulation of FFAR2, but not FFAR1, FFAR3, and FFAR4, in lung cancer, and a negative correlation with TLR2 and TLR3. Notably, GSEA showed significant enrichment in gene sets related to the cancer module, the innate signaling pathway, and the cytokine-chemokine signaling pathway in FFAR2DownTLR2UpTLR3Up lung tumor tissues (LTTs) vs. FFAR2upTLR2DownTLR3Down LTTs. Functionally, treatment with propionate (an agonist of FFAR2) significantly inhibited human A549 or H1299 lung cancer migration, invasion, and colony formation induced by TLR2 or TLR3 through the attenuation of the cAMP-AMPK-TAK1 signaling axis for the activation of NF-κB. Moreover, FFAR2KO A549 and FFAR2KO H1299 human lung cancer cells showed marked increases in cell migration, invasion, and colony formation in response to TLR2 or TLR3 stimulation, accompanied by elevations in NF-κB activation, cAMP levels, and the production of C-C motif chemokine ligand (CCL)2, interleukin (IL)-6, and matrix metalloproteinase (MMP) 2 cytokines. CONCLUSION: Our results suggest that FFAR2 signaling antagonized TLR2- and TLR3-induced lung cancer progression via the suppression of the cAMP-AMPK-TAK1 signaling axis for the activation of NF-κB, and its agonist might be a potential therapeutic agent for the treatment of lung cancer.

The Relationship between the Frequency of Breakfast Consumption, Conversation with Parents, and Somatic Symptoms in Children: A Three-Wave Latent Growth Model.

Breakfast consumption is essential for children to generate energy for the day. Parents play an important role in children's breakfast habits and spending time with parents during breakfast greatly influences children's emotional development. Therefore, this study investigated the relationship between the frequency of children's breakfast consumption, time spent in conversation with parents, and children's somatic symptoms. Data were obtained from the Korea Children and Youth Panel Survey 2018 and were initially collected from fourth-grade elementary school students and followed up for three years. SPSS 21.0 and AMOS 21.0 software were used for data analysis. Multivariate latent growth modeling was applied to analyze the effect of the breakfast consumption frequency on children's somatic symptoms and the mediating effect of parent-child conversation time on this relationship. Consequently, as children's frequency of breakfast consumption increased, their somatic symptoms decreased. Furthermore, parent-child conversation time mediated the relationship between these two variables. Therefore, students, parents, and teachers should be educated about the importance of having breakfast and communicating with parents for students' emotional health.

The Relationship between Korean Parents' Smartphone Addiction and That of Their Children: The Mediating Effects of Children's Depression and Social Withdrawal.

With the number of smartphone users growing around the world, children are using smartphones from an increasingly early age. Consequently, a significant number of children are being exposed to the risk of smartphone addiction, which is emerging as a serious social problem. Smartphone addiction can negatively impact children's physical, cognitive, and social development. Previous studies have demonstrated that parental smartphone addiction influences that of their children. Therefore, this study explores the relationship between parental smartphone addiction and children's smartphone addiction and the mediating effects of children's depression and social withdrawal. Data are drawn from National Youth Policy Institute's 2018 Korean Children and Youth Panel Survey. Respondents comprise 2011 fourth-grade elementary school students and their parents. Data were analyzed using SPSS version 21.0 and AMOS 21.0 software. Results show that the relationship between parental smartphone addiction and that of their children has a significantly positive mediating effect on children's social withdrawal, but no such effect on children's depression and there were no serial effects of children's depression and social withdrawal. Consequently, educational programs that control parents' smartphone usage, improve the parent-child relationship, and engender social sensitivity should be developed to reduce and prevent smartphone addiction among children.

Nursing simulation practicum for delivery care: A scoping review.

OBJECTIVES: The purpose of this scoping review was to explore the state of the current body of knowledge on the use of nursing simulation for maternal nursing practicum with a focus on content and measured outcomes. DESIGN: This is a scoping review. DATA SOURCES: The literature search was performed using five databases (CINAHL, Cochrane, EMBASE, PubMed, and Web of Science). REVIEW METHOD: The review was conducted on quantitative and reflection/review studies that evaluated or described nursing simulation for delivery care, published between 2000 and 2020 in English and Korean. Two authors independently reviewed the studies and their references for additional literature search. Selected studies were charted to describe the study characteristics, and content and outcome of nursing simulation for delivery care. RESULTS: Fifteen articles were included in the review, of which twelve were intervention studies and three were reflection/review studies. The duration of the nursing simulations for delivery care ranged from 20 min to 4 h, with two to eight students in each simulation group. All nursing simulations focused on the normal, uncomplicated delivery process, with nine studies engaging in debriefing, but without pre- and/or post-assessments. The most frequently measured outcomes were knowledge, satisfaction, and clinical practice competency. CONCLUSIONS: Studies investigating nursing simulation pedagogy for delivery care were scarce, with limitations in the study designs and large variations in nursing simulation time across studies. Scenarios for nursing simulation for delivery care were rudimentary, and they usually focused on normal uncomplicated deliveries. The development of scenarios for high-risk deliveries and integration of pre-and/or post-assessments and debriefing into the nursing simulation are recommended to improve learning outcomes.

USP15 negatively regulates lung cancer progression through the TRAF6-BECN1 signaling axis for autophagy induction.

TNF receptor-associated factor 6 (TRAF6)-BECN1 signaling axis plays a pivotal role in autophagy induction through ubiquitination of BECN1, thereby inducing lung cancer migration and invasion in response to toll-like receptor 4 (TLR4) stimulation. Herein, we provide novel molecular and cellular mechanisms involved in the negative effect of ubiquitin-specific peptidase 15 (USP15) on lung cancer progression. Clinical data of the TCGA and primary non-small cell lung cancer (NSCLC) patients (n = 41) revealed that the expression of USP15 was significantly downregulated in lung cancer patients. Importantly, USP15-knockout (USP15KO) A549 and USP15KO H1299 lung cancer cells generated with CRISPR-Cas9 gene-editing technology showed increases in cancer migration and invasion with enhanced autophagy induction in response to TLR4 stimulation. In addition, biochemical studies revealed that USP15 interacted with BECN1, but not with TRAF6, and induced deubiquitination of BECN1, thereby attenuating autophagy induction. Notably, in primary NSCLC patients (n = 4) with low expression of USP15, 10 genes (CCNE1, MMP9, SFN, UBE2C, CCR2, FAM83A, ETV4, MYO7A, MMP11, and GSDMB) known to promote lung cancer progression were significantly upregulated, whereas 10 tumor suppressor genes (FMO2, ZBTB16, FCN3, TCF21, SFTPA1B, HPGD, SOSTDC1, TMEM100, GDF10, and WIF1) were downregulated, providing clinical relevance of the functional role of USP15 in lung cancer progression. Taken together, our data demonstrate that USP15 can negatively regulate the TRAF6-BECN1 signaling axis for autophagy induction. Thus, USP15 is implicated in lung cancer progression.

COVID-19 Subunit Vaccine with a Combination of TLR1/2 and TLR3 Agonists Induces Robust and Protective Immunity.

The development of COVID-19 vaccines is critical in controlling global health issues under the COVID-19 pandemic. The subunit vaccines are the safest and most widely used vaccine platform and highly effective against a multitude of infectious diseases. An adjuvant is essential for subunit vaccines to enhance the magnitude and durability of immune responses. In this study, we determined whether a combination of toll-like receptor (TLR)1/2 and TLR3 agonists (L-pampo) can be a potent adjuvant for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) subunit vaccine. We measured a neutralizing antibody (nAb) and an angiotensin-converting enzyme 2 (ACE2) receptor-blocking antibody against SARS-CoV-2 receptor-binding domain (RBD). We also detected interferon-gamma (IFN-γ) production by using ELISPOT and ELISA assays. By employing a ferret model, we detected nAbs and IFN-γ producing cells and measured viral load in nasal wash after the challenge of SARS-CoV-2. We found that SARS-CoV-2 antigens with L-pampo stimulated robust humoral and cellular immune responses. The efficacy of L-pampo was higher than the other adjuvants. Furthermore, in the ferret model, SARS-CoV-2 antigens with L-pampo elicited nAb response and antigen-specific cellular immune response against SARS-CoV-2, resulting in substantially decreased viral load in their nasal wash. Our study suggests that SARS-CoV-2 antigens formulated with TLR agonists, L-pampo, can be a potent subunit vaccine to promote sufficient protective immunity against SARS-CoV-2.

Analyzing Gender Differences in Factors Affecting Depression among Multicultural Adolescents in South Korea: A Cross-Sectional Study.

Suicide is the topmost cause of death among adolescents in South Korea and is deeply related to depression. This study aimed to identify gender differences in the factors affecting depression among multicultural adolescents. This study is a secondary analysis using data from a national survey, the Multicultural Adolescents Panel Study (MAPS) conducted in 2017. The participants were 1160 multicultural adolescents ranging from 15 to 18 years, living in Korea, and whose fathers were Koreans and mothers were foreigners. The results showed that depression scores were higher for females (18.35) than males (16.38, t = 6.42, p < 0.001). In total, seven factors affected depression among male multicultural adolescents' and the model explained 50.5% of the total variance (F = 77.99, p < 0.001), while four factors affected female multicultural adolescents' depression, and the model explained 51.4% of the total variance (F = 100.02, p < 0.001). Significant gender differences were found in factors that influence depression among multicultural adolescents. Therefore, depression prevention programs for multicultural adolescents need to vary according to gender. Additionally, these programs should target families and teachers of multicultural adolescents as well.

Feasibility Study on Automatic Interpretation of Radiation Dose Using Deep Learning Technique for Dicentric Chromosome Assay.

The interpretation of radiation dose is an important procedure for both radiological operators and persons who are exposed to background or artificial radiations. Dicentric chromosome assay (DCA) is one of the representative methods of dose estimation that discriminates the aberration in chromosomes modified by radiation. Despite the DCA-based automated radiation dose estimation methods proposed in previous studies, there are still limitations to the accuracy of dose estimation. In this study, a DCA-based automated dose estimation system using deep learning methods is proposed. The system is comprised of three stages. In the first stage, a classifier based on a deep learning technique is used for filtering the chromosome images that are not appropriate for use in distinguishing the chromosome; 99% filtering accuracy was achieved with 2,040 test images. In the second stage, the dicentric rate is evaluated by counting and identifying chromosomes based on the Feature Pyramid Network, which is one of the object detection algorithms based on deep learning architecture. The accuracies of the neural networks for counting and identifying chromosomes were estimated at over 97% and 90%, respectively. In the third stage, dose estimation is conducted using the dicentric rate and the dose-response curve. The accuracies of the system were estimated using two independent samples; absorbed doses ranging from 1- 4 Gy agreed well within a 99% confidential interval showing highest accuracy compared to those in previous studies. The goal of this study was to provide insights towards achieving complete automation of the radiation dose estimation, especially in the event of a large-scale radiation exposure incident.

Nursing students' experiences of a global outreach program: A mixed-method study.

Global health competency is an essential capacity for nursing students. This study evaluated the effect of a global outreach program on global health competency and cultural self-efficacy in nursing students and examined the students' experiences with the program. Participants included thirty-one undergraduate nursing students at a university in Seoul, Republic of Korea, who participated in a global outreach program in 2015 and 2016. Quantitative data were collected before and after program participation using questionnaires evaluating global health competency and cultural self-efficacy, and were analyzed using descriptive statistics and paired t-tests. Both global health competency and cultural self-efficacy increased significantly after the global outreach program. Qualitative data were collected via focus group interviews and reflective journals, and were analyzed using conventional content analysis and thematic analysis, respectively. The results of the content and thematic analyses were compared, and two themes and eight-sub-themes were finally extracted through the data analysis. The program was effective in improving nursing students' global health competency and cultural self-efficacy.

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia.

BACKGROUND: An adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees. OBJECTIVES: To assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia. DESIGN: Mixed methods. SETTING: Educational institutes in Phnom Penh, Cambodia. PARTICIPANTS: A total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers. METHODS: We conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program. RESULTS: Quantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required. CONCLUSIONS: This study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies.

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

Health beliefs and behaviours in relation to sexually transmitted infections among South Korean juvenile offenders: A focused ethnography study.

AIM: This study explored health beliefs and behaviours related to sexually transmitted infections (STIs) from the perspective of juvenile offenders with STIs in three urban cities. METHODS: Data were collected using observations and in-depth interviews between July and November, 2014. Under the supervision of probation officers, 24 juvenile offenders with STIs were interviewed. Leininger's four-step method guided the data analysis. FINDINGS: From participants' perspectives, poor hygiene and a promiscuous lifestyle caused the STIs. The diseases were considered an adult disease with distinct symptoms and deformities, no cure, and therefore fatal. STIs were shameful for juveniles because their presence revealed sexually active behaviours. The juveniles' health-related behaviours included neglecting their STI symptoms because they did not know they were infected, mistaking STIs for other health conditions, choosing to suffer rather than revealing their diagnosis, and keeping their genitals clean. CONCLUSION: A large gap emerged between juveniles' beliefs and behaviours related to STIs. Policies and education are needed to provide accurate STI information for this population.

Prevalence of and Risk Factors for Sexually Transmitted Infections among Korean Adolescents under Probation.

There is limited research on sexually transmitted infections (STIs) among adolescents in Korea. The objective of this study was to explore the prevalence of and risk factors for STIs among Korean adolescents under probation. A cross-sectional analysis was conducted in one juvenile-delinquent center and five probation offices in Korea to determine the prevalence of STIs caused by the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus (HSV), human immunodeficiency virus (HIV), Treponema pallidum, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum. Of the 237 (208 male and 29 female) participating adolescents, 152 (64.1%) had a history of coitus. Overall, 133 (56.1%) subjects tested positive for at least one microorganism in their genitourinary tract. The most prevalent pathogen was U. urealyticum (24.7%, n = 65), followed by U. parvum (24.1%, n = 57), M. hominis (17.3%, n = 41), C. trachomatis (13.9%, n = 33), N. gonorrhoeae (1.7%, n = 4), T. vaginalis (0.8%, n = 2), and HSV (0.8%, n = 2). The prevalence of syphilis was 0.8% (n = 2). There were no reported cases of HIV infection. Fifty-four participants (35.5%) were positive with more than two pathogens. We did not find any significant difference between STIs and socioeconomic factors, behavioral factors or sexual practices. In conclusion, the prevalence of STIs among adolescents under probation was high. Systematic screening programs, more practical sexual education, and adequate provision of treatment are essential for the prevention and management of STIs among adolescents, especially those under probation.