The First Attempt to Apply an Online Mindfulness Program to Nursing Staff in a Traditional Korean Medicine Clinic in COVID-19 Era: A Case Series.

The importance of medical personnel's mental health is emphasized in the COVID-19 era. The characteristics of traditional Korean medicine (KM) may affect the mental health of nursing staff working at KM clinics. In this case series, we report the first attempt to apply an online mindfulness program to the nursing staff in a KM clinic in Korea. For three female nursing assistants, an online mindfulness program consisting of five sessions was offered for two months. After the program, a decrease in emotional labor was observed in two participants, and a decrease in the level of burnout was observed in all participants. One participant showed an increase in their emotional labor level, which was associated with an increase in deep acting. The participants expressed a high level of satisfaction with this program in terms of recommendations for peers and willingness to participate again. As this report is a case series, larger studies are needed to fully evaluate the benefits of the program on emotional labor and burnout of KM clinic nursing staff. However, the potential benefits of emotional labor and burnout, high satisfaction, and some challenges identified in this case series can be considered in future extensions and modifications of the program.

Impacts of the COVID-19 lockdown in China on new particle formation and particle number size distribution in three regional background sites in Asian continental outflow.

Despite the curtailment of atmospheric condensing precursor gases during the Coronavirus disease 2019 (COVID-19) lockdown (LD) period, unexpected haze events via the formation of new particles and their subsequent growth have been identified. This study investigated the impact of emission reduction during the Chinese LD period on the new particle formation (NPF) frequency and corresponding particle number size distribution (PNSD) at three regional background atmospheric monitoring sites in the western coastal areas of the Korean Peninsula. During this duration, the number concentrations of the nucleation- (<25 nm) and accumulation-mode (>90 nm) particles significantly decreased in Baengryeong (BRY), showing decreases of 34% and 29%, respectively. Unlike BRY, the PNSD in Anmyeon (AMY), which is influenced by nearby industrial emissions, remained nearly unchanged during the LD period, possibly because the reduction in industrial emissions was not significant during the social distancing period enforced by Korea. Bongseong (BOS) showed a similar variation to that of BRY; however, the magnitude of the reduction was weaker because of its higher altitude compared to other sites. The cyclostationary empirical orthogonal function technique was applied to the measured PNSDs at the three sites to objectively classify NPF events. Because mode 1 of cyclostationary loading vectors commonly represented the typical diurnal variation of PNSD during regional NPF events at three sites, mode 1 of the corresponding principal component time series was used for NPF classification. The NPF frequency decreased by 7%, 1%, and 7% in BRY, AMY, and BOS, respectively, despite favorable meteorological conditions, such as increased temperature and insolation during the LD period. The diurnal variation in the sulfuric acid (H2SO4) proxy implied that the H2SO4 proxy acted as a determining factor for NPF events during the NPF occurrence time (8-12 local hours) in AMY and BOS; however, NPF occurrence in BRY was not connected to the H2SO4 proxy level. This suggests that BRY was more likely to be influenced by the reduction in organic species in the continental upwind regions, while the occurrence of NPF events in AMY and BOS can be suppressed in association with the distinct reduction in inorganic compounds represented by the H2SO4 proxy during the LD period.

How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea.

Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, and the coronavirus disease 2019 (COVID-19) pandemic currently continues. In response to this unprecedented pandemic, several researchers and medical staff have struggled to find appropriate treatments for COVID-19. Patients with mild symptoms can recuperate with symptomatic care, however establishing treatment for severe to critically ill patients who can have a high mortality has been essential. Accordingly, the guidelines for COVID-19 treatment have evolved through numerous trials and errors and have been relatively well established to date. In the Republic of Korea, several evidence-based guidelines for COVID-19 treatment were released and revised, reflecting various research and regional medical conditions. To date, approximately 3 years after the beginning of the COVID-19 pandemic, we are reflecting on the changes in the guidelines thus far and have summarized the treatment experience of severe to critically ill patients with COVID-19. The Korean guidelines for COVID-19 treatment have been updated continuously as the National Institutes of Health (NIH) guidelines have changed. Dexamethasone is currently used as the backbone for the treatment of severe to critically ill patients with COVID-19, and remdesivir, baricitinib, and tocilizumab can be added depending on a patient's situation. In addition, venous thromboembolism prophylaxis is one of the important adjunctive therapies for patients with severe COVID-19. In the clinical field, treatment of severely ill patients with COVID-19 based on guidelines is widely practiced by medical staff and established currently.

Clinical Impact of Empirical Antibiotic Therapy in Patients With Coronavirus Disease 2019 Requiring Oxygen Therapy.

Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19.

BACKGROUND: The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19). METHODS: An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated. RESULTS: The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score. CONCLUSION: Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Light-absorption enhancement of black carbon in the Asian outflow inferred from airborne SP2 and in-situ measurements during KORUS-AQ.

We investigated the changes in the size distribution, coating thickness, and mass absorption cross-section (MAC) of black carbon (BC) with aging and estimated the light absorption enhancement (Eabs) in the Asian outflow from airborne in-situ measurements during 2016 KORUS-AQ campaign. The BC number concentration decreased, but mass mean diameter increased with increasing altitude in the West Coast (WC) and Seoul Metropolitan Area (SMA), reflecting the contrast between freshly emitted BC-containing particles at the surface and more aged aerosol associated with aggregation during vertical mixing and transport. Contradistinctively, BC number and mass size distributions were relatively invariant with altitude over the Yellow Sea (YS) because sufficiently aged BC from eastern China were horizontally transported to all altitudes over the YS, and there are no significant sources at the surface. The averaged inferred MAC of refractory BC in three regions reflecting differences in their size distributions increased to 9.8 ± 1.0 m2 g-1 (YS), 9.3 ± 0.9 m2 g-1 (WC), and 8.2 ± 0.9 m2 g-1 (SMA) as BC coating thickness increased from 20 nm to 120 nm. The absorption coefficient of BC calculated from the coating thickness and MAC were highly correlated with the filter-based absorption measurements with the slope of 1.16 and R2 of 0.96 at 550 nm, revealing that the thickly coated BC had a large MAC and absorption coefficient. The Eabs due to the inferred coatings was estimated as 1.0-1.6, which was about 30% lower than those from climate models and laboratory experiments, suggesting that the increase in the BC absorption by the coatings in the Asian outflow is not as large as calculated in the previous studies. Organics contributed to the largest Eabs accounting for 69% (YS), 61% (WC), and 64% (SMA). This implies that organics are largely responsible for the lensing effect of BC rather than sulfates in the Asian outflow.

Impacts of local versus long-range transported aerosols on PM10 concentrations in Seoul, Korea: An estimate based on 11-year PM10 and lidar observations.

Extreme haze episodes have frequently occurred in Seoul since mid-2010s by the combined contributions of transboundary transported aerosols as well as locally emitted pollutants. In this study, we developed a novel method to estimate the contribution of long-range transport (LRT, aerosols are transported from any regions except local area near Seoul) and local pollution (LP, aerosols are originated from local area near Seoul) cases to the PM10 concentration in Seoul, Korea, using the PM10 concentration ratio between surface (PM10S) and mountaintop (PM10M) sites and the lidar-derived mixing layer height. The overall contributions of LRT and LP events to nighttime high-PM10 episodes (PM10 > 50 µg m-3) during the period of May 2008-April 2019 were estimated to be approximately 32% and 47%, respectively. The monthly contribution of LRT events to the PM10 concentration varied from approximately 18% (July) to 43% (January), whereas the contribution of LP events was estimated between 39% (March) and 69% (July); this pattern was associated with seasonal synoptic circulations. The similar PM10S values between the LRT (71 ± 22 µg m-3) and LP (73 ± 26 µg m-3) cases during the nighttime suggest that a reduction in local PM10 emissions is crucial to decrease the PM10 concentration during high-PM10 events. The high PM10S for daytime LRT cases can be explained by the combined effects of increased local emissions and LRT aerosols.

A Direct Rapid Phenotypic Antimicrobial Susceptibility Test Enables Early Selection of Optimal Antibiotics to Treat Bacteremia in COVID-19 Patients.

BACKGROUND: Co-infection with bacteria and severe acute respiratory syndrome coronavirus 2 may result in greater use of healthcare resources and a poor prognosis. Therefore, early selection and use of optimal antibiotics are essential. The direct rapid antibiotic susceptibility test (dRAST) can detect antibiotic resistance within 6 h of a Gram smear result. This study aimed to assess the effectiveness of dRAST for improving early selection of appropriate antibiotics for coronavirus disease 2019 (COVID-19) patients with bacteremia. MATERIALS AND METHODS: This retrospective study included 96 blood culture-positive COVID-19 patients. Bacterial isolates and antimicrobial resistance profiles of each case were evaluated. Cases were divided into two groups based on whether they underwent conventional antibiotic susceptibility test (AST) or dRAST. The time to optimal targeted treatment for the two groups was investigated and compared. In addition, we examined the proportion of cases for which appropriate antibiotics were selected and broad spectrum antibiotics were administered at 72 h from blood sample collection. RESULTS: The mean time to optimal targeted antibiotic treatment was shorter for the dRAST group [55.7; standard deviation (SD), 28.7 vs. 92.3; SD, 51.1 h; P = 0.041]. The proportion of cases receiving optimal targeted antibiotics 72 h after blood collection for culture was higher [6/10 (60.0%) vs. 10/25 (40.0%)] and the percentage receiving broad spectrum antibiotics at 72 h was lower [6/10 (60.0%) vs. 19/25 (76.0%)] in the dRAST group than in the conventional AST group. In terms of microbiology profile, the contamination rate was high (35.5%) and multidrug-resistant strains were common (63.2%) in COVID-19 patients with bacteremia. CONCLUSION: Application of dRAST for selection of antibiotics to treat bacteremia in COVID-19 patients may enable earlier and optimal treatment. The high incidence of contamination and resistant organisms in blood cultures from COVID-19 patients suggest that dRAST may speed up appropriate targeted treatment.

Boundary layer versus free tropospheric submicron particle formation: A case study from NASA DC-8 observations in the Asian continental outflow during the KORUS-AQ campaign.

In this study, we contrasted major secondary inorganic species and processes responsible for submicron particle formation (SPF) events in the boundary layer (BL) and free troposphere (FT) over the Korean Peninsula during Korea-United States Air Quality (KORUS-AQ) campaign (May-June, 2016) using aircraft observations. The number concentration of ultrafine particles with diameters between 3 nm and 10 nm (NCN3-10) during the entire KORUS-AQ period reached a peak (7,606 ± 12,003 cm -3) at below 1 km altitude, implying that the particle formation around the Korean Peninsula primarily occurred in the daytime BL. During the BL SPF case (7 May, 2016), the SPF over Seoul metropolitan area was more attributable to oxidation of NO2 rather than SO2-to-sulfate conversion. From the analysis of the relationship between nitrogen oxidation ratio (NOR) and temperature or relative humidity (RH), NOR showed a positive correlation only with temperature. This suggests that homogeneous gas-phase reactions of NO2 with OH or O3 contributed to nitrate formation. From the relationship between NCN3-10 (> 10,000 cm-3) and the NOR (or sulfur oxidation ratio) at Olympic Park in Seoul during the entire KORUS-AQ period, it was regarded that the relative importance of nitrogen oxidation was grown as the NCN3-10 increased. During the FT SPF case (31 May, 2016) over the yellow sea, the SO2-to-sulfate conversion seemed to influence SPF highly. The sulfate/CO ratio had a positive correlation with both the temperature and RH, suggesting that aqueous-phase pathways as well as gas-phase reactions might be attributable to sulfate formation in the FT. In particular, FT SPF event on 31 May was possibly caused by the direct transport of SO2 precursors from the continent above the shallow marine boundary layer under favorable conditions for FT SPF events, such as decreased aerosol surface area and increased solar radiation.

Exploring the feasibility of Salmonella Typhimurium-specific phage as a novel bio-receptor.

The purpose of this study was aimed to isolate a Salmonella Typhimurium-specific phage (KFS-ST) from washing water in a poultry processing facility and to investigate the feasibility of the KFS-ST as a novel bio-receptor for the magnetoelastic (ME) biosensor method. KFS-ST against S. Typhimurium was isolated, propagated, and purified using a CsCl-gradient ultracentrifugation. Morphological characteristics of KFS-ST were analyzed using transmission electron microscopy (TEM). Its specificity and efficiency of plating analysis were conducted against 39 foodborne pathogens. The temperature and pH stabilities of KFS-ST were investigated by the exposure of the phage to various temperatures (-70°C-70°C) and pHs (1-12) for 1 h. A one-step growth curve analysis was performed to determine the eclipse time, latent time and burst size of phage. The storage stability of KFS-ST was studied by exposing KFS-ST to various storage temperatures (-70°C, -20°C, 4°C, and 22°C) for 12 weeks. KFS-ST was isolated and purified with a high concentration of (11.47 ± 0.25) Log PFU/mL. It had an icosahedral head (56.91 ± 2.90 nm) and a non-contractile tail (225.49 ± 2.67 nm), which was classified into the family of Siphoviridae in the order of Caudovirales. KFS-ST exhibited an excellent specificity against only S. Typhimurium and S. Enteritidis, which are considered two of the most problematic Salmonella strains in the meat and poultry. However, KFS-ST did not exhibit any specificity against six other Salmonella and 27 non-Salmonella strains. KFS-ST was stable at temperature of 4°C to 50°C and at pH of 4 to 12. The eclipse time, latent time, and burst size of KFS-ST were determined to be 10 min, 25 min and 26 PFU/ infected cell, respectively. KFS-ST was relatively stable during the 12-week storage period at all tested temperatures. Therefore, this study demonstrated the feasibility of KFS-ST as a novel bio-receptor for the detection of S. Typhimurium and S. Enteritidis in meat and poultry products using the ME biosensor method.

Isolation and characterization of a novel Escherichia coli O157:H7-specific phage as a biocontrol agent.

PURPOSE: Escherichia coli O157:H7 is one of the major foodborne pathogens of global public concern. Bacteriophages (phages) have emerged as a promising alternative to antibiotics for controlling pathogenic bacteria. Here, a lytic E. coli O157:H7-specific phage (KFS-EC) was isolated, identified, and characterized to evaluate its potential as a biocontrol agent for E. coli O157:H7. METHODS: KFS-EC was isolated from slaughterhouse in Korea. Morphological analysis, genomic analysis and several physiological tests were performed to identify and characterize the KFS-EC. RESULTS: A specificity test indicated KFS-EC was strictly specific to E. coli O157:H7 strains among 60 bacterial strains tested. Morphological and phylogenetic analyses confirmed that KFS-EC belongs to the Rb49virus genus, Tevenvirinae subfamily, and the Myoviridae family of phages. KFS-EC genome consists of 164,725 bp and a total of 270 coding sequence features, of which 114 open reading frames (ORFs) were identified as phage functional genes. KFS-EC does not contain genes encoding lysogenic property and pathogenicity, which ensure its safe application. KFS-EC was relatively stable (~1 log decrease) under stressed conditions such as temperatures (20 °C-50 °C), pHs (3-11), organic solvents (ethanol and chloroform), and biocides (0.1% citric acid, 1% citric acid, and 0.1% peracetic acid). KFS-EC was able to inhibit E. coli O157:H7 efficiently at a multiplicity of infection (MOI) of 0.01 for 8 h with greater inhibitory effect and durability and was stable at 4 °C and 22 °C over a 12-week storage period. CONCLUSIONS: Our results suggest that KFS-EC could be used as a biocontrol agent to E. coli O157:H7.

An Analysis of Infectious Disease Research Trends in Medical Journals From North Korea.

OBJECTIVES: This study aimed to investigate the current status of infectious disease research in North Korea by analyzing recent trends in medical journals from North Korea in comparison with research from South Korea. METHODS: Three medical journals (Preventive Medicine, Basic Medicine, and Chosun Medicine) were analyzed from 2012 to 2016. Articles on tuberculosis (TB), malaria, and parasitic diseases were selected and classified by their subtopics and study areas. Two medical journals published in the South Korea were selected for a comparative analysis of research trends. RESULTS: Of the 2792 articles that were reviewed, 93 were extracted from North Korea journals. TB research in North Korea was largely focused on multi-drug resistant TB and extrapulmonary TB, whereas research in South Korea more frequently investigated non-tuberculous mycobacteria. Research on parasitic diseases in North Korea was focused on protozoan and intestinal nematodes, while the corresponding South Korea research investigated various species of parasites. Additionally, the studies conducted in North Korea were more likely to investigate the application of traditional medicine to diagnosis and treatment than those conducted in South Korea. CONCLUSIONS: This study presents an analysis of research trends in preventive medicine in North Korea focusing on infectious diseases, in which clear differences were observed between South and North Korea. Trends in research topics suggest a high prevalence of certain parasitic diseases in North Korea that are no longer widespread in South Korea. The large proportion of studies examining traditional medicine implies a lack of affordable medicine in North Korea.