Prevalence and Molecular Characterization of Vancomycin Variable Enterococcus faecium Isolated From Clinical Specimens.

Vancomycin variable Enterococcus (VVE) bacteria are phenotypically susceptible to vancomycin, but they harbor the vanA gene. We aimed to ascertain the prevalence of VVE among clinically isolated vancomycin-susceptible Enterococcus faecium (VSE) isolates, as well as elucidate the molecular characteristics of the vanA gene cluster within these isolates. Notably, we investigated the prevalence and structure of the vanA gene cluster of VVE. Between June 2021 and May 2022, we collected consecutive, non-duplicated vancomycin-susceptible Enterococcus faecium (VSE) samples. Real-time PCR was performed to detect the presence of vanA, vanB, and vanC. Overlapping PCR with sequencing and whole-genome sequencing were performed for structural analysis. Sequence types (STs) were determined by multilocus sequence typing. Exposure testing was performed to assess the ability of the isolates to acquire vancomycin resistance. Among 282 VSE isolates tested, 20 isolates (7.1%) were VVE. Among them, 17 isolates had partial deletions in the IS1216 or IS1542 sequences in vanS (N=10), vanR (N=5), or vanH (N=2). All VVE isolates belonged to the CC17 complex and comprised five STs, namely ST17 (40.0%), ST1421 (25.0%), ST80 (25.0%), ST787 (5.0%), and ST981 (5.0%). Most isolates were related to three hospital-associated clones (ST17, ST1421, and ST80). After vancomycin exposure, 18 of the 20 VVEs acquired vancomycin resistance. Considering the high reversion rate, detecting VVE by screening VSE for vanA is critical for appropriate treatment and infection control.

Influencing factors of early childhood teachers' disaster preparedness.

Background: The risk of disasters and infectious diseases continues to persist in modern times. Children are a vulnerable group in disaster prevention and management due to their limited ability to cope on their own. Hence, the role and disaster preparedness capacity of early childhood teachers (ECTs) is vital for children's protection. Objectives: This study aims to explore how ECTs can improve their personal resilience to adapt to and overcome disasters as part of early childhood education and care (ECEC). To this end, this study examined the effects of ECTs' self-efficacy, resilience, disaster awareness, COVID-19 stress, and work-related stress on their disaster preparedness. Results: According to the outcomes of disaster preparedness of ECTs based on their general and job characteristics, full-time employees and principals scored significantly higher in work-related disaster preparedness (WrDP) compared to part-time workers and general and assistant teachers, respectively. Resilience and WrDP were identified as influencing factors of general disaster preparedness (GdP), with an explanatory power of 26.4%. GdP and self-efficacy were identified as influencing factors of WrDP, with an explanatory power of 25.7%. Discussion: According to the findings, ECTs' self-efficacy and GdP must be improved, followed by developing strategies to strengthen their resilience and WrDP. Doing so would ensure the safety and disaster preparedness of ECTs and infants who have low self-care capacity.

Aortic aneurysms: current pathogenesis and therapeutic targets.

Aortic aneurysm is a chronic disease characterized by localized expansion of the aorta, including the ascending aorta, arch, descending aorta, and abdominal aorta. Although aortic aneurysms are generally asymptomatic, they can threaten human health by sudden death due to aortic rupture. Aortic aneurysms are estimated to lead to 150,000 ~ 200,000 deaths per year worldwide. Currently, there are no effective drugs to prevent the growth or rupture of aortic aneurysms; surgical repair or endovascular repair is the only option for treating this condition. The pathogenic mechanisms and therapeutic targets for aortic aneurysms have been examined over the past decade; however, there are unknown pathogenic mechanisms involved in cellular heterogeneity and plasticity, the complexity of the transforming growth factor-ß signaling pathway, inflammation, cell death, intramural neovascularization, and intercellular communication. This review summarizes the latest research findings and current pathogenic mechanisms of aortic aneurysms, which may enhance our understanding of aortic aneurysms.

Frequency of peripheral PD-1+regulatory T cells is associated with treatment responses to PARP inhibitor maintenance in patients with epithelial ovarian cancer.

BACKGROUND: Poly (adenosine diphosphate [ADP]-ribose) polymerase inhibitors (PARPis) are becoming the standard of care for epithelial ovarian cancer (EOC). Recently, clinical trials of triple maintenance therapy (PARPi+anti-angiogenic agent+anti-PD-1/L1) are actively ongoing. Here, we investigated the immunological effects of PARPi or triple maintenance therapy on T cells and their impact on clinical responses. METHODS: We collected serial blood from EOC patients receiving PARPi therapy (cohort 1: PARPi, n = 49; cohort 2: olaparib+bevacizumab+pembrolizumab, n = 31). Peripheral T cells were analyzed using flow cytometry and compared according to the PARPi response. Progression-free survival (PFS) was assessed according to prognostic biomarkers identified in a comparative analysis. RESULTS: Regulatory T cells (Tregs) were suppressed by PARPi therapy, whereas PD-1 was not significantly changed. Short PFS group exhibited a higher percentage of baseline PD-1+Tregs than long PFS group, and the patients with high percentage of PD-1+Tregs before treatment showed poor PFS in cohort 1. However, the expression of PD-1 on Tregs significantly decreased after receiving triple maintenance therapy, and the reduction in PD-1+Tregs was associated with superior PFS in cohort 2 (P = 0.0078). CONCLUSION: PARPi suppresses Tregs, but does not affect PD-1 expression. Adding anti-PD-1 to PARPi decreases PD-1+Tregs, which have negative prognostic value for PARPi monotherapy.

Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis.

Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate burnout interventions for clinical nurses. Seven English databases and two Korean databases were searched to retrieve intervention studies on burnout and its dimensions between 2011 and 2020.check Thirty articles were included in the systematic review, 24 of them for meta-analysis. Face-to-face mindfulness group intervention was the most common intervention approach. When burnout was measured as a single concept, interventions were found to alleviate burnout when measured by the ProQoL (n = 8, standardized mean difference [SMD] = - 0.654, confidence interval [CI] = - 1.584, 0.277, p < 0.01, I2 = 94.8%) and the MBI (n = 5, SMD = - 0.707, CI = - 1.829, 0.414, p < 0.01, I2 = 87.5%). The meta-analysis of 11 articles that viewed burnout as three dimensions revealed that interventions could reduce emotional exhaustion (SMD = - 0.752, CI = - 1.044, - 0.460, p < 0.01, I2 = 68.3%) and depersonalization (SMD = - 0.822, CI = - 1.088, - 0.557, p < 0.01, I2 = 60.0%) but could not improve low personal accomplishment. Clinical nurses' burnout can be alleviated through interventions. Evidence supported reducing emotional exhaustion and depersonalization but did not support low personal accomplishment.

Production of a New Biosurfactant by a New Yeast Species Isolated from Prunus mume Sieb. et Zucc.

Biosurfactants reduce surface and interfacial tension due to their amphiphilic properties and are an eco-friendly alternative for chemical surfactants. In this study, a new yeast strain JAF-11 that produces a biosurfactant was selected using drop collapse method, and the properties of the extracts were investigated. The nucleotide sequences of the strain were compared with closely related strains and identified based on the D1/D2 domain of the large subunit ribosomal DNA (LSU) and internal transcribed spacer (ITS) regions. Neodothiora populina CPC 39399T, the closest species with strain JAF-11, showed a sequence similarity of 97.75% for LSU and 94.27% for ITS, respectively. The result suggests that the strain JAF-11 represents a distinct species that cannot be assigned to any existing genus or species in the family Dothideaceae. Strain JAF-11 produced a biosurfactant reducing the surface tension of water from 72 mN/m to 34.5 mN/m on the sixth day of culture and the result of measuring the critical micelle concentration (CMC) by extracting the crude biosurfactant was found to be 24 mg/l. The molecular weight 502 of the purified biosurfactant was confirmed by measuring the fast atom bombardment mass spectrum. The chemical structure was analyzed by measuring 1H nuclear magnetic resonance (NMR), 13C NMR, and two-dimensional NMRs of the compound. The molecular formula was C26H46O9, and it was composed of one octanoyl group and two hexanoyl groups to myo-inositol moiety. The new biosurfactant is the first report of a compound produced by a new yeast strain, JAF-11.

DDM-HSA: Dual Deterministic Model-Based Heart Sound Analysis for Daily Life Monitoring.

A sudden cardiac event in patients with heart disease can lead to a heart attack in extreme cases. Therefore, prompt interventions for the particular heart situation and periodic monitoring are critical. This study focuses on a heart sound analysis method that can be monitored daily using multimodal signals acquired with wearable devices. The dual deterministic model-based heart sound analysis is designed in a parallel structure that uses two bio-signals (PCG and PPG signals) related to the heartbeat, enabling more accurate heart sound identification. The experimental results show promising performance of the proposed Model III (DDM-HSA with window and envelope filter), which had the highest performance, and S1 and S2 showed average accuracy (unit: %) of 95.39 (±2.14) and 92.55 (±3.74), respectively. The findings of this study are anticipated to provide improved technology to detect heart sounds and analyze cardiac activities using only bio-signals that can be measured using wearable devices in a mobile environment.

FOXA2 and STAT5A regulate oncogenic activity of KIF5B-RET fusion.

KIF5B-RET gene rearrangement occurs in ~1% of lung adenocarcinomas. Recently, targeted agents that inhibit RET phosphorylation have been evaluated in several clinical studies; however, little is known about the role of this gene fusion in driving lung cancer. Immunohistochemistry was used to evaluate the expression of the FOXA2 protein in tumor tissues of patients with lung adenocarcinoma. KIF5B-RET fusion cells proliferated in a cohesive form and grew tightly packed with variable-sized colonies. The expression of RET and its downstream signaling molecules, including p-BRAF, p-ERK, and p-AKT, increased. In KIF5B-RET fusion cells, the intracellular expression of p-ERK was higher in the cytoplasm than in the nucleus. Two transcription factors, STAT5A and FOXA2, exhibiting significantly different expressions at the mRNA level, were finally selected. p-STAT5A was highly expressed in the nucleus and cytoplasm, whereas the expression of the FOXA2 protein was lower; however, it was much higher in the nucleus than in the cytoplasm. Compared with the expression of FOXA2 in the RET rearrangement-wild NSCLC (45.0%), high expression (3+) were observed in most RET rearrangement NSCLCs (94.4%). Meanwhile, KIF5B-RET fusion cells began to increase belatedly from day 7 and only doubled on day 9 in 2D cell culture. However, tumors in mice injected with KIF5B-RET fusion cells began to rapidly increase from day 26. In cell cycle analyses, the KIF5B-RET fusion cells in G0/G1 were increased on day 4 (50.3 ± 2.6%) compared with the empty cells (39.3 ± 5.2%; P = 0.096). Cyclin D1 and E2 expressions were reduced, whereas CDK2 expression slightly increased. pRb and p21 expression was diminished compared with the empty cells, TGF-ß1 mRNA was highly expressed, and the proteins were accumulated mostly in the nucleus. Twist mRNA and protein expression was increased, whereas Snail mRNA and protein expression was decreased. Particularly, in KIF5B-RET fusion cells treated with FOXA2 siRNA, the expression of TGF-ß 1 mRNA was remarkably reduced but Twist1 and Snail mRNA were increased. Our data suggest that cell proliferation and invasiveness in KIF5B-RET fusion cells are regulated by the upregulation of STAT5A and FOXA2 through the continuous activation of multiple RET downstream signal cascades, including the ERK and AKT signaling pathways. We found that TGF-ß1 mRNA, where significant increments were observed in KIF5B-RET fusion cells, is regulated at the transcriptional level by FOXA2.

Effects of long-term tubular HIF-2α overexpression on progressive renal fibrosis in a chronic kidney disease model.

Renal fibrosis is the final manifestation of chronic kidney disease (CKD) regardless of etiology. Hypoxia-inducible factor-2 alpha (HIF-2α) is an important regulator of chronic hypoxia, and the late-stage renal tubular HIF-2α activation exerts protective effects against renal fibrosis. However, its specific role in progressive renal fibrosis remains unclear. Here, we investigated the effects of the long-term tubular activation of HIF-2α on renal function and fibrosis, using in vivo and in vitro models of renal fibrosis. Progressive renal fibrosis was induced in renal tubular epithelial cells (TECs) of tetracycline-controlled HIF-2α transgenic (Tg) mice and wild-type (WT) controls through a 6-week adenine diet. Tg mice were maintained on doxycycline (DOX) for the diet period to induce Tg HIF-2α expression. Primary TECs isolated from Tg mice were treated with DOX (5 µg/ml), transforming growth factor-ß1 (TGF-ß1) (10 ng/ml), and a combination of both for 24, 48, and 72 hr. Blood was collected to analyze creatinine (Cr) and blood urea nitrogen (BUN) levels. Pathological changes in the kidney tissues were observed using hematoxylin and eosin, Masson's trichrome, and Sirius Red staining. Meanwhile, the expression of fibronectin, E-cadherin and α-smooth muscle actin (α-SMA) and the phosphorylation of p38 mitogenactivated protein kinase (MAPK) was observed using western blotting. Our data showed that serum Cr and BUN levels were significantly lower in Tg mice than in WT mice following the adenine diet. Moreover, the protein levels of fibronectin and E-cadherin and the phosphorylation of p38 MAPK were markedly reduced in the kidneys of adenine-fed Tg mice. These results were accompanied by attenuated fibrosis in Tg mice following adenine administration. Consistent with these findings, HIF-2α overexpression significantly decreased the expression of fibronectin in TECs, whereas an increase in α-SMA protein levels was observed after TGF-ß1 stimulation for 72 hr. Taken together, these results indicate that long-term HIF-2α activation in CKD may inhibit the progression of renal fibrosis and improve renal function, suggesting that long-term renal HIF-2α activation may be used as a novel therapeutic strategy for the treatment of CKD. [BMB Reports 2023; 56(3): 196-201].

High-Risk Symptom Cluster Groups for Work-Life Quality and Turnover Intention among Nurses.

This cross-sectional study aims to identify high-risk symptom cluster groups for assessing the quality of nursing work life (QNWL) and turnover intention among Korean nurses who have experienced workplace violence. Nurses were recruited for an online survey in May 2021 (n = 203). The following four symptom clusters are extracted: (a) depression-anxiety, (b) shame-somatization, (c) nightmare-loss of appetite, and (d) anger-shock. Three symptom cluster groups were identified. Group 1 had the highest score for the anger-shock symptom cluster, as well as the highest symptom scores and turnover intention. Group 2 had the highest score for the nightmare-loss of appetite symptom cluster and the lowest QNWL. Group 3 had a similar symptom cluster pattern to Group 1 but lower scores for all symptom clusters. Symptom monitoring and programs tailored to symptom cluster groups at the institutional level could be useful for managing QNWL and turnover intention.

Neodothiora pruni sp. nov., a Biosurfactant-Producing Ascomycetous Yeast Species Isolated from Flower of Prunus mume.

A yeast strain, designated as JAF-11T, was isolated from flower of Prunus mume Sieb. et Zucc. in Gwangyang, Republic of Korea. Phylogenetic analysis showed that strain JAF-11T was closely related to Neodothiora populina CPC 39399T with 2.07 % sequence divergence (12 nucleotide substitutions and three gaps in 581 nucleotides) in the D1/D2 domain of the large subunit (LSU) rRNA gene, and Rhizosphaera macrospora CBS 208.79T with 4.66 % sequence divergence (25 nucleotide substitutions and five gaps in 535 nucleotides) in the internal transcribed spacer (ITS) region. Further analysis based on the concatenated sequences of the D1/D2 domain of the LSU rRNA gene and the ITS region confirmed that strain JAF-11T was well-separated from Neodothiora populina CPC 39399T. In addition to the phylogenetic differences, strain JAF-11T was distinguished from its closest species, Neodothiora populina CPC 39399T and Rhizosphaera macrospora CBS 208.79T belonging to the family Dothioraceae by its phenotypic characteristics, such as assimilation of carbon sources. Hence, the name Neodothiora pruni sp. nov. is proposed with type strain JAF-11T (KACC 48808T; MB 850034).

Identification of the rare yeast Cutaneotrichosporon (Trichosporon) debeurmannianum from diabetic foot infection.

BACKGROUND: Diabetic foot infection is the most common complications of diabetes mellitus. Although most of the diabetic foot infections has been known to be caused by aerobic and anaerobic bacteria, mycotic diabetic foot infection caused by Candida species has also been reported recently. Here, we present the first case of diabetic foot infection caused by Cutaneotrichosporon debeurmannianum (previously known as Trichosporon debeurmannianum). METHODS: A 68-year-old diabetic male patient was admitted for management of the necrosis of the big toe. Wound swab culture was performed three times, and each time after 5 days of incubation, beige-colored, wrinkled, and rough colonies were observed on chocolate agar plate. RESULTS: The isolate was identified as C. debeurmannianum with the matrix-assisted laser desorption ionization-time of flight mass spectrometry system (MicroIDSys, ASTA corp.). For confirmation, the sequencing for ITS1/ITS2 and D1/D2 ribosomal DNA was also performed, and the isolate was confirmed as C. debeurmannianum with 100% identity. The isolate exhibited low minimum inhibitory concentrations (MICs) for azoles and high MICs for all echinocandins. CONCLUSION: Considering that usual incubation time for bacterial culture of open wound specimens is only 48 h, it is important to include the request for fungus culture to detect pathogen in diabetic foot lesion.

Novel Design of a Multimodal Technology-Based Smart Stethoscope for Personal Cardiovascular Health Monitoring.

Heart sounds and heart rate (pulse) are the most common physiological signals used in the diagnosis of cardiovascular diseases. Measuring these signals using a device and analyzing their interrelationships simultaneously can improve the accuracy of existing methods and propose new approaches for the diagnosis of cardiovascular diseases. In this study, we have presented a novel smart stethoscope based on multimodal physiological signal measurement technology for personal cardiovascular health monitoring. The proposed device is designed in the shape of a compact personal computer mouse for easy grasping and attachment to the surface of the chest using only one hand. A digital microphone and photoplehysmogram sensor are installed on the bottom and top surfaces of the device, respectively, to measure heart sound and pulse from the user's chest and finger simultaneously. In addition, a high-performance Bluetooth Low Energy System-on-Chip ARM microprocessor is used for pre-processing of measured data and communication with the smartphone. The prototype is assembled on a manufactured printed circuit board and 3D-printed shell to conduct an in vivo experiment to test the performance of physiological signal measurement and usability by observing users' muscle fatigue variation.

A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-Year-Old Child.

Coronavirus disease 2019 (COVID-19) is usually less severe in children and adolescents than in adults. However, it can cause severe respiratory illness in a small proportion of children with risk factors. Here, we report a rare case of a 10-year-old boy with postinfectious bronchiolitis obliterans that developed after pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This patient was previously healthy apart from a high body mass index (BMI, 30.13; 99.6th percentile for the age bracket), history of preterm birth (35 weeks), and low birth weight (1,850 g). He had persistent exertional dyspnea after recovering from SARS-CoV-2-related pneumonia. Spirometry revealed obstructive lung disease with the following results: predicted forced vital capacity (FVC%pred), 71%; forced expiratory volume in 1 second (FEV1%pred), 63%; FEV1/FVC, 0.81; and forced expiratory flow25-75%pred, 55%. Chest computed tomography showed multifocal areas of parenchymal hyperlucency and mosaic attenuation in both lungs. This case suggests that careful observation of children with obesity and low birth weight is necessary after recovery from SARS-CoV-2-related pneumonia.

Validation Study of the Estimated Glycemic Load Model Using Commercially Available Fast Foods.

The recent popularization of low-glycemic foods has expanded interest in glycemic index (GI) not only among diabetic patients but also healthy people. The purpose of this study is to validate the estimated glycemic load model (eGL) developed in 2018. This study measured the glycemic load (GL) of 24 fast foods in the market in 20 subjects. Then, the transportability of the model was assessed, followed by an assessment of model calibration and discrimination based on model performance. The transportability assessment showed that the subjects at the time of model development are different from the subjects of this validation study. Therefore, the model can be described as transportable. As for the model's performance, the calibration assessment found an x 2 value of 11.607 and a p-value of 0.160, which indicates that the prediction model fits the observations. The discrimination assessment found a discrimination accuracy exceeding 0.5 (57.1%), which confirms that the performance and stability of the prediction model can be discriminated across all classifications. The correlation coefficient between GLs and eGLs measured from the 24 fast foods was statistically significant at 0.712 (p < 0.01), indicating a strong positive linear relationship. The explanatory powers of GL and eGL was high at 50.7%. The findings of this study suggest that this prediction model will greatly contribute to healthy food choices because it allows for predicting blood glucose responses solely based on the nutrient content labeled on the fast foods.

Postprandial Glucose Response after Consuming Low-Carbohydrate, Low-Calorie Rice Cooked in a Carbohydrate-Reducing Rice Cooker.

This study evaluates whether blood glucose response differs upon consuming rice cooked in a carbohydrate (carb)-reducing rice cooker. Rice cooked this way exhibited 19% reduced total carbohydrate (34.0 ± 0.3 vs. 27.6 ± 0.9 g/100 g rice) and 20% reduced total calorie (149.0 ± 1.0 vs. 120.8 ± 3.7 kcal/100 g rice) contents. We measured the blood glucose response (at 0, 15, 30, 45, 60, 90, and 120 min) in 13 healthy participants after consuming 6 different rice types: regular white rice (regular WR, 50 g of available carbohydrate (AC)), low-carb WR with equivalent weight as regular WR (low-carb WR (EW)), low-carb WR with equivalent carb as regular WR (low-carb WR (EC), regular mixed-grain rice (regular MR), low-carb MR (EW) as regular MR, and low-carb MR (EC) as regular MR. All rice samples were prepared in an electric carb-reducing rice cooker. Postprandial blood glucose, sensory, and appetite were assessed after each test meal. The incremental area under the curve of 15 and 30 min after rice consumption was significantly lower in low-carb WR (EW) than that in regular WR. These results suggest possible health benefits of low-carb WR in reducing early postprandial spikes in blood glucose level without significant differences in satiety and satisfaction.

Sexual Violence as a Key Predictor of Depressive Symptoms in Women: Korean Longitudinal Survey of Women and Families.

The purpose of this study was to identify the influence of violence on depressive symptoms in women. We analyzed panel data from the Korean Longitudinal Survey of Women and Families (n = 6,632). Exposure to sexual violence was a significant predictor of the onset of depressive symptoms. After adjusting for all covariates, other predictors included the perception of a poor or very poor health status than normal and participants in their 40s and 50s versus participants younger than 40 years. Assessing exposure to sexual violence might be beneficial for evaluating depressive symptoms in women who are newly diagnosed with depression.

Healing from sexual violence among young women in South Korea.

Reports of sexual violence against young women have been increasing. Due to limited support, young women who experience sexual violence have difficulties in healing, resulting in long-term consequences for individuals and society. We used grounded theory combined with a Photovoice approach to explore young women's experience of healing from sexual violence. From interviews and Photovoice activities of 29 participants, we identified a social process of healing that included internalizing anger, cutting off connections, reaching a turning point with support, restoring connections, struggling through individual internal processes, and transforming sexual violence into a stepping stone. The process of healing from sexual violence identified in this study shows commonalities as well as cultural and age-specific aspects from experiences of sexual violence among young women. In addition, this theory presented a new perspective on healing that contrasts with the past belief that disclosure is the key to healing.

Using lactate dehydrogenase to predict the severity of respiratory distress in term newborn infants with no perinatal asphyxia.

BACKGROUND: We aimed to establish whether knowledge of lactate dehydrogenase (LDH) levels on day 1, as well as the change in these levels in the first three days, could be of clinical benefit in the diagnosis and/or prediction of severity of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). METHODS: A retrospective study was conducted on 275 term infants (35 with RDS and 240 with TTN) admitted to the neonatal intensive care unit from January 2014 to June 2019. LDH levels were measured on admission and after three days. RESULTS: Both RDS and TTN groups had elevated LDH levels during admission. LDH levels were significantly higher in the RDS group than in the TTN group on both days. LDH levels in both groups significantly correlated with both the duration of respiratory support required, as well as the number of hospital days. We used these outcomes as a measure of severity of these conditions. CONCLUSIONS: In patients with respiratory distress, it may not be clinically useful to use LDH levels on day 1 to differentiate between RDS and TTN, despite the statistically significant differences, because of the overlapping values. However, LDH levels on day 1 and day 3 may predict the degree and duration of the required respiratory support for both RDS and TTN groups.

3D Facial Pain Expression for a Care Training Assistant Robot in an Elderly Care Education Environment.

As the elderly population increases, the importance of the caregiver's role in the quality of life of the elderly has increased. To achieve effective feedback in terms of care and nursing education, it is important to design a robot that can express emotions or feel pain like an actual human through visual-based feedback. This study proposes a care training assistant robot (CaTARo) system with 3D facial pain expression that simulates an elderly person for improving the skills of workers in elderly care. First, in order to develop an accurate and efficient system for elderly care training, this study introduces a fuzzy logic-based care training evaluation method that can calculate the pain level of a robot for giving the feedback. Elderly caregivers and trainees performed the range of motion exercise using the proposed CaTARo. We obtained quantitative data from CaTARo, and the pain level was calculated by combining four key parameters using the fuzzy logic method. Second, we developed a 3D facial avatar for use in CaTARo that is capable of expressing pain based on the UNBC-McMaster Pain Shoulder Archive, and we then generated four pain groups with respect to the pain level. To mimic the conditions for care training with actual humans, we designed the system to provide pain feedback based on the opinions of experts. The pain feedback was expressed in real time by using a projector and a 3D facial mask during care training. The results of the study confirmed the feasibility of utilizing a care training robot with pain expression for elderly care training, and it is concluded that the proposed approach may be used to improve caregiving and nursing skills upon further research.