Integrating mixed reality preparation into acute coronary syndrome simulation for nursing students: a single-group pretest-posttest study.

BACKGROUND: Timely and effective intervention within the 'golden hour'-the critical first 90 min after the symptom onset-is crucial for initiating life-saving treatment and reducing mortality in acute coronary syndrome (ACS). This highlights the need for nursing students to be proficient in ACS care, emphasizing the importance of preparatory training. This study enhanced traditional simulation methods by integrating a mixed reality (MR) preparation step, offering a more immersive learning experience. We aimed to evaluate the effectiveness of integrating MR preparation into ACS simulation education, focusing on enhancements in knowledge, self-confidence in learning, and self-efficacy in learning. Additionally, we examined performance, practice immersion, and satisfaction to comprehensively evaluate the MR application. METHODS: One-group pretest-posttest design was implemented in a convenience sample of thirty-nine senior nursing students from a university in South Korea in August 2022. We developed a simulation program integrating MR preparation into ACS simulation (IMRP-ACSS), which was validated through expert review for content validity. The students participated in the simulation program over six hours across two days, including a 40-minute individual session of MR-based simulation preparation using head-mounted displays (the HoloLens 2). Individual changes in knowledge, self-confidence in learning, and self-efficacy in learning evaluated by the survey were analyzed using paired t-tests. Additionally, group performance assessed using the checklist was analyzed. Immersion and satisfaction were measured with a tool and a 10-point Likert scale, respectively. RESULTS: Individually, participants demonstrated significantly increased knowledge (t = 11.87, p < .001), self-confidence in learning (t = 7.17, p < .001), and self-efficacy in learning (t = 4.70, p < .001) post-education. Group performance yielded a mean score of 56.43/70 ± 7.45. Groups scored higher in electrocardiogram interpretation, patient safety, and heparin administration. Participants reported a practice immersion level of 37.82/50 ± 9.13 and expressed satisfaction with the program, achieving an average score of 8.85/10 ± 1.35. CONCLUSION: Integrating MR preparation into ACS simulation enhanced nursing students' knowledge, self-confidence in learning, and self-efficacy in ACS care, providing a replicable and immersive learning experience. This method is an effective addition to nursing education, preparing students through comprehensive, technology-enhanced training.

How receiving welfare assistance could be linked to children's bullying victimization: Exploring the potential pathways.

The study proposes and tests the pathways from receiving welfare assistance to children's bullying victimization. Specifically, the study examines whether children's difficulty making friends and school disconnection mediate the association between welfare assistance receipt to children's bullying victimization. The 2019 National Survey of Children's Health dataset was used, and the sample consisted of 12,230 caregivers of adolescents, aged 12-17 years. A path model was utilized to explore the proposed pathways. Findings suggest that welfare assistance receipt was not significantly associated with children's bullying victimization. It was positively related to children's bullying victimization through the mediating roles of having difficulty making friends and school disconnection. Schools and communities need to create spaces where youth can connect with peers, which is an important part of their development.

Association between Secondhand Smoke and Allergic Diseases in Korean Adolescents: Cross-Sectional Analysis of the 2019 KYRBS.

This study aimed to determine whether secondhand smoking (SHS) in adolescents is associated with allergic diseases. Data from the 2019 Korea Youth Risk Behavior Survey were used (N = 37,848 Korean adolescents: 19,114 boys and 18,734 girls). This study assessed SHS exposure using questionnaire data, which included information, such as exposure to SHS and allergic diseases. Multiple logistic regression analysis was used to estimate the association between exposure to SHS and allergic diseases. The results showed that exposure to SHS in schools and public places, exposure for 1-3 days (OR = 1.158, 95% CI, 1.077-1.246), 4-6 days (OR = 1.308, 95% CI, 1.190-1.438), and everyday (OR = 1.306, 95% CI, 1.187-1.437), and exposure in one, two, or three places were significantly associated with allergic diseases (one OR = 1.226, 95% CI, 1.169-1.128, two OR = 1.289, 95% CI, 1.222-1.360 and three OR = 1.282, 95% CI, 1.177-1.395). The present results show that exposure to SHS occurs in various places and at various frequencies, and it is associated with allergic diseases in Korean adolescents.

Anti-obesity effects of Lactiplantibacillus plantarum SKO-001 in high-fat diet-induced obese mice.

PURPOSE: Previous reports showed that some probiotics provide beneficial effects on various diseases including metabolic disorders. This study aimed to investigate the anti-obesity effects of Lactiplantibacillus (L.) plantarum SKO-001 (SKO-001), a probiotic strain newly isolated from Angelica gigas. METHODS: C57BL/6J mice were fed with high-fat diet (HFD, 60% fat) for four weeks, and then different doses of SKO-001 (n = 10 each group) were orally given for 12 weeks. Following treatment, body weight, fat weight, serum parameters and adipose and liver tissues were analyzed. RESULTS: SKO-001 (2 × 1010 CFU/day, per os) reduced body weight gain after 10th week of administration, accompanied by a reduction in body fat mass of mice. In the SKO-001-fed group, increased serum adiponectin, decreased leptin, insulin, total cholesterol, low-density lipoprotein cholesterol, free fatty acids, and triglyceride levels were observed. Hematoxylin and eosin staining of various fat depots showed that increased adipocyte size caused by HFD intake was markedly reduced and correlated with reduced mRNA levels of lipogenesis genes, including sterol regulatory element-binding protein-1c, peroxisome proliferator-activated receptor gamma, and CCAAT/enhancer binding protein alpha, and increased uncoupling protein 1 levels. Similarly, SKO-001 reduced lipid accumulation, decreased the mRNA levels of lipogenic genes, and reduced α-smooth muscle actin and collagen type 1 alpha 1 levels in the liver. CONCLUSIONS: SKO-001 ameliorates obesity and related metabolic abnormalities in adipose and liver tissues, possibly via the regulation of lipid metabolism. Based on the results of the present study, SKO-001 may be applicable as an anti-obesity therapeutic or functional food.

Tranilast protects pancreatic ß-cells from palmitic acid-induced lipotoxicity via FoxO-1 inhibition.

Tranilast, an anti-allergic drug used in the treatment of bronchial asthma, was identified as an inhibitor of the transcription factor Forkhead box O-1 (FoxO-1) by high throughput chemical library screening in the present study. Based on FoxO-1's role in apoptotic cell death and differentiation, we examined the effect of tranilast on palmitic acid (PA)-induced cell damage in INS-1 cells. Tranilast substantially inhibited lipoapoptosis and restored glucose-stimulated insulin secretion under high PA exposure. Moreover, PA-mediated downregulation of PDX-1, MafA, and insulin expression was attenuated by tranilast. PA-induced oxidative and ER stress were also reduced in the presence of tranilast. These protective effects were accompanied by increased phosphorylation and decreased nuclear translocation of FoxO-1. Conversely, the effects of tranilast were diminished when treated in transfected cells with FoxO-1 phosphorylation mutant (S256A), suggesting that the tranilast-mediated effects are associated with inactivation of FoxO-1. Examination of the in vivo effects of tranilast using wild type and diabetic db/db mice showed improved glucose tolerance along with FoxO-1 inactivation in the pancreas of the tranilast-treated groups. Thus, we report here that tranilast has protective effects against PA-induced lipotoxic stress in INS-1 cells, at least partly, via FoxO-1 inactivation, which results in improved glucose tolerance in vivo.

Racial/ethnic differences in parenting behaviors as protective factors in adolescent internalizing problems.

The current study explores variations among racially/ethnically diverse adolescents regarding parents' role in mitigating internalizing problems. Adolescents with a higher level of parental awareness, ease of talking to parents, and parental support were less likely to show internalizing problems. Parental awareness was negatively associated with internalizing problems among Whites and Hispanics. The ease of talking to parents was significant for all groups except for American Indians/Alaska Natives. These findings can inform culturally relevant treatments.

Effects of school environment on depression among Black and White adolescents.

While the school environment is critical for adolescents' psychological development, how the school environment influences depression among different racial groups has not been fully explored. This study aims to identify the effects of the school environment (school connectedness, school climates, trouble with peers and teachers) on depressive symptoms among Black and White adolescents. It also compares how the effects of school environments differ between Black and White adolescents. This study analyzed wave 6 of the Fragile Families and Child Well-being Study, a longitudinal birth cohort study in 20 major cities across the United States. Almost three-fourth (73.39%) of the adolescents were Black, and 26.61% were White. About half (50.46%) of the adolescents were females, and the mean age of adolescents was 15.39. Multiple regression analysis showed that higher school connectedness and less frequent troubles with teachers were associated with lower depression among Black adolescents. In contrast, only school connectedness was associated with depression among White adolescents. Higher school connectedness was associated with lower depressive symptoms for both Black and White adolescents. However, the magnitude of the effects of school connectedness was found to be statistically weaker among Black adolescents. These findings suggest a need for creating a racially equitable school environment that makes every student feel more connected to their schools, especially Black students.

Maternal Pre-Pregnancy Obesity and Gestational Diabetes Mellitus Increase the Risk of Childhood Obesity.

Previous studies have shown inconsistent results regarding the effects of maternal gestational diabetes mellitus (GDM) and pre-pregnancy obesity (PPO) on childhood obesity. This study aimed to determine the risk for early childhood obesity based on maternal GDM and PPO. This nationwide study used data obtained from the National Health Information Database in South Korea. The participants were divided into four groups based on maternal GDM and PPO, and 1:1 matching was performed. Each group had 1319 participants. A generalized estimating equation model was used to analyze the changes in body mass index percentile of children with age, and simple and multiple conditional logistic regression models were used to compare the prevalence of childhood obesity at 5 years. Children whose mothers had both PPO and GDM, only PPO, or only GDM had a 4.46 (95% CI: 3.28−6.05, p < 0.001), 3.11 (95% CI: 2.27−4.26, p < 0.001), or 1.58 (95% CI: 1.12−2.23, p = 0.010) times higher risk, respectively, of developing childhood obesity than children whose mothers had neither PPO nor GDM. Maternal PPO increases the risk for childhood obesity to a higher degree than maternal GDM, and the presence of both increases the risk even further.

Sodium salicylate induces browning of white adipocytes via M2 macrophage polarization by HO-1 upregulation.

Browning, a white to brown-like (beige) adipocyte conversion, offers a promising therapeutic strategy for the treatment of human obesity. In the present study, the effects of sodium salicylate, a nonsteroidal anti-inflammatory drug, on adipocyte browning were investigated. We found sodium salicylate altered the macrophage phenotype to M2 in RAW264.7 cells, mediated by up-regulation of heme oxygenase-1 (HO-1), and sodium salicylate-treated conditioned medium from macrophages (Sal-M2 CM) induced browning of fully differentiated 3T3-L1 adipocytes. Conversely, the conditioned medium obtained from macrophages when treated with sodium salicylate in the presence of either ZnPP (a HO-1 inhibitor) or HO-1 siRNA did not induce browning. In association with macrophage HO-1 induction by sodium salicylate, iron production also increased, and deferoxamine (an iron chelator) blunted the browning effects of Sal-M2 CM, suggesting that iron may play a role in the Sal-M2 CM-induced browning. The in vivo browning effects of sodium salicylate were confirmed in ob/ob mice, whereas in vivo macrophage depletion by clodronate as well as HO-1 blockade by either ZnPP or adeno-associated virus carrying HO-1 shRNA (AAV-HO-1 shRNA) attenuated the browning effects of sodium salicylate. These results reveal sodium salicylate induces browning in vitro and in vivo by up-regulating HO-1 thus promoting M2 polarization.

Adapalene induces adipose browning through the RARß-p38 MAPK-ATF2 pathway.

Adipose browning has recently been reported to be a novel therapeutic strategy for obesity. Because the retinoic acid receptor (RAR) is a potential target involved in browning, adapalene (AD), an anti-acne agent with RAR agonism, was examined in detail for its effects on adipose browning and the underlying mechanisms in vitro and in vivo. AD upregulated the expression of adipose browning-related markers in a concentration-dependent manner, promoted mitochondrial biogenesis, increased oxygen consumption rates, and lowered lipid droplet sizes in differentiated 3T3/L1 white adipocytes. Among the three retinoic acid receptors (RARα, RARß, and RARγ), knockdown of the gene encoding RARß mitigated AD-induced adipose browning. Similarly, LE135 (a selective RARß antagonist) attenuated AD action, suggesting that AD promotes adipose browning through RARß. Sequential phosphorylation of p38 mitogen-activated protein kinase (MAPK) and activating transcription factor 2 (ATF2) was critical for AD-induced adipose browning, based on the observations that either SB203580 (a p38 MAPK inhibitor) or ATF2 siRNA reduced the effects of AD. In vivo browning effects of AD were confirmed in C57BL/6J mice and high-fat diet-induced obese (DIO) mice after oral administration of AD either acutely or chronically. This study identifies new actions of AD as an adipose browning agent and demonstrates that RARß activation followed by increased phosphorylation of p38 MAPK and ATF2 appears to be a key mechanism of AD action.

Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study.

BACKGROUND: There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies. METHODS: This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models. RESULTS: The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy. CONCLUSION: This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

Bioengineering of Halobacterium sp. NRC-1 gas vesicle nanoparticles with GvpC fusion protein produced in E. coli.

Gas vesicle nanoparticles (GVNPs) are hollow, buoyant prokaryotic organelles used for cell flotation. GVNPs are encoded by a large gas vesicle protein (gvp) gene cluster in the haloarchaeon, Halobacterium sp. NRC-1, including one gene, gvpC, specifying a protein bound to the surface of the nanoparticles. Genetically engineered GVNPs in the Halobacterium sp. have been produced by fusion of foreign sequences to gvpC. To improve the versatility of the GVNP platform, we developed a method for displaying exogenously produced GvpC fusion proteins on the haloarchaeal nanoparticles. The streptococcal IgG-binding protein domain was fused at or near the C-terminus of GvpC, expressed and purified from E. coli, and shown to bind to wild-type GVNPs. The two fusion proteins, GvpC3GB and GvpC4GB, without or with a highly acidic GvpC C-terminal region, were found to be able to bind nanoparticles equally well. The GVNP-bound GvpC-IgG-binding fusion protein was also capable of binding to an enzyme-linked IgG-HRP complex which retained enzyme activity, demonstrating the hybrid system capability for display and delivery of protein complexes. This is the first report demonstrating functional binding of exogenously produced GvpC fusion proteins to wild-type haloarchaeal GVNPs which significantly expands the capability of the platform to produce bioengineered nanoparticles for biomedical applications. KEY POINTS: • Haloarchaeal gas vesicle nanoparticles (GVNPs) constitute a versatile display system. • GvpC-streptococcal IgG-binding fusion proteins expressed in E. coli bind to GVNPs. • IgG-binding proteins displayed on floating GVNPs bind and display IgG-HRP complex.

Risk Factors for Obesity in Five-Year-Old Children: Based on Korean National Health Insurance Service (NHIS) Data.

This study aimed to identify the risk factors for obesity in five-year-old children using data from the database of the Korean National Health Insurance Service. We identified 26,047 children who underwent the sixth screening (at age 5) from the 2017 National Health Screening Program for Infant and Children and for whom data from the fourth screening (at age 3) database and the mothers' health screening and eligibility database were available. To identify the risk factors of obesity, odds ratios and 95% confidence intervals were calculated by a hierarchical multiple logistic regression. Female sex, a birth weight of over 4 kg, the "caution/refer" remark during developmental screening at ages three and five, maternal obesity, and a middle-level income were risk factors for obesity in the subjects. Good appetite, high consumption of milk, heavy intake of sweet food at age three, speedy eating, irregular meals and snack times, large single-meal quantities, heavy intake of oily and salty food, and not performing physical exercise at age five were also considered significant risk factors. For early intervention efforts to prevent childhood obesity, modifiable behavioral factors and other obesity risk factors identified in this study could be used to target high-risk children and dietary behaviors.

The Factors Associated with Health Promotion Behavior of International Students in South Korea.

BACKGROUND: We aimed to explore the factors associated with health promotion behavior of international students in South Korea. METHODS: The convenience sample of 263 participants was recruited from two universities in Gangwon-do and Jeollanam-do, South Korea. The data were collected by using structured questionnaires from Apr to Jun 2019. Demographic characteristics, health conception, acculturative stress, self-efficacy, interpersonal support, and health promotion behavior were assessed. T-test, ANOVA, and multiple regression analyses were used for statistical analyses. RESULTS: Participants from Vietnam (P=.040), with more health conception (P<.001), more acculturative stress (P<.001), more self-efficacy (P<.001), and greater interpersonal support (P<.001) were more likely to engage in more health promotion behaviors. CONCLUSION: This study is meaningful as it collected the data on which to design health promotion programs for international students. Future studies are needed to investigate further factors relating to international students' health promotion behavior, including internal and external environments.

Characterization of a C-Type Lectin Domain-Containing Protein with Antibacterial Activity from Pacific Abalone (Haliotis discus hannai).

Genes that influence the growth of Pacific abalone (Haliotis discus hannai) may improve the productivity of the aquaculture industry. Previous research demonstrated that the differential expression of a gene encoding a C-type lectin domain-containing protein (CTLD) was associated with a faster growth in Pacific abalone. We analyzed this gene and identified an open reading frame that consisted of 145 amino acids. The sequence showed a significant homology to other genes that encode CTLDs in the genus Haliotis. Expression profiling analysis at different developmental stages and from various tissues showed that the gene was first expressed at approximately 50 days after fertilization (shell length of 2.47 ± 0.13 mm). In adult Pacific abalone, the gene was strongly expressed in the epipodium, gill, and mantle. Recombinant Pacific abalone CTLD purified from Escherichia coli exhibited antimicrobial activity against several Gram-positive bacteria (Bacillus subtilis, Streptococcus iniae, and Lactococcus garvieae) and Gram-negative bacteria (Vibrio alginolyticus and Vibrio harveyi). We also performed bacterial agglutination assays in the presence of Ca2+, as well as bacterial binding assays in the presence of the detergent dodecyl maltoside. Incubation with E. coli and B. subtilis cells suggested that the CTLD stimulated Ca2+-dependent bacterial agglutination. Our results suggest that this novel Pacific abalone CTLD is important for the pathogen recognition in the gastropod host defense mechanism.

Heat shock protein 70 gene expression and stress response of red-spotted (Epinephelus akaara) and hybrid (E. akaara female × E. lanceolatus male) groupers to heat and cold shock exposure.

The importance of the temperature tolerance of fish is increasing due to climate change caused by global warming. This study examined the expression of the heat shock protein 70 (HSP70) gene, and plasma cortisol and glucose levels, as a stress response in red-spotted and hybrid groupers during exposure to heat and cold shock. Temperature in the tank where fishes acclimated at 20℃ was gradually increased or decreased, respectively, to examine the survival rate of fish. The result showed a higher survival rate of the hybrid than that of the red-spotted grouper upon exposure to a higher temperature. To further analyze the factors associated with temperature-associated stress, fishes were collected from different temperatures which changed from 20 to 30℃ or 10℃, respectively, and then back to 20℃. The expression levels of the gene encoding heat shock protein 70 (HSP70) were analyzed by qPCR using cDNA prepared from RNA extracted from the brain. A higher level of HSP70 transcript was detected in the hybrid during heat shock exposure. Analysis of cortisol and glucose from the blood of fish collected during the acclimation periods clearly indicated that the level of cortisol was increased upon temperature shift although a slight difference in the degrees of changes timing was slightly different between red-spotted grouper and hybrid. The results showed a correlation between the level of HSP70 and survival rate upon exposure to higher temperature shock. This study provides basic information regarding whether HSP70 expression increases the survival rate of fish subjected to rapid temperature changes.

Caregiver's difficulty paying child's healthcare bills and bullying victimization of adolescents with physical disabilities.

Guided by the ecological systems perspective, the objective of the study was to examine whether caregivers' difficulty paying their child's health-care bills is associated with bullying victimization directly and indirectly through the mediating mechanisms of caregivers' frustration, adolescents' internalizing problems, and social difficulty focusing on adolescents with physical disabilities. The 2019 National Survey of Children's Health dataset, which collected data on adolescents' and caregivers' demographic characteristics and health and well-being, was used. The study sample consisted of 368 caregivers of adolescents, 12-17 years of age with physical disabilities. No direct association between caregivers' difficulty paying their child's health-care bills and bullying victimization was found. However, caregivers' frustration and adolescents' internalizing problems were shown to have an indirect association with bullying victimization, which was mediated by difficulty making friends. In addition, adolescents' difficulty making friends was positively associated with bullying victimization. Practitioners working with adolescents with physical disabilities are encouraged to foster collaborative processes across various ecological systems of the adolescent and family to address caregivers' frustration and promote positive social and emotional development of the adolescent with physical disabilities, which can decrease their risk of bullying victimization.

Racial/ethnic disproportionality in reunification across U.S. child welfare systems.

BACKGROUND: Racial/ethnic disparities are persistent in referrals and removals of children into child welfare systems. Yet, less is known about disparities in reunification, and how system factors may contribute to more equitable outcomes for families of color. OBJECTIVE: This study examined racial/ethnic disparities in reunification rates across U.S. child welfare systems controlling for child- and system-factors. PARTICIPANTS AND SETTING: Data for this study came from the 2017 Adoption and Foster Care Analysis and Reporting System (AFCARS). We utilized a subsample of n = 284,382 children ages 0-5. METHODS: We used a bottom-up model building-approach to examine child- and system-factors associated with reunification. A series of multilevel models were run. RESULTS: Less than 3% of the variance in reunification occurred between state child welfare systems. Native American children had lower odds of reunification than White children (AOR = 0.87, p < .001), while Hispanic children had higher odds of reunification (AOR = 1.08, p < .001). Random effects were present for race/ethnicity and interaction terms between race/ethnicity and parental drug use were significant. CONCLUSIONS: Racial/ethnic disparities are present in reunification, though these may vary across child welfare systems. Thus, future research could examine state systems that have better outcomes for families of color and examine factors that might explain these relationships.

Use of a gene encoding zona pellucida 4 as a female-specific marker for early stage sexual differentiation and size dimorphism in the pacific abalone Haliotis discus hannai.

Growth rates of Pacific abalone Haliotis discus hannai are an important trait affecting the economic value in the abalone aquaculture industry. A reverse-transcription polymerase chain reaction (RT-PCR) analyses of tissues from H. discus hannai was conducted for sexually mature gonads to determine male- and female-specific target gene expression, including genes encoding zona pellucida domain 4 (zp4), sperm protein (sp) and lysin (lys), respectively. Sex-specific expression patterns of these gene expression, even in sexually immature abalone, indicate these genes can be used as sensitive and robust sex-specific molecular markers. The RT-PCR procedure was also performed to analyze tissues collected at various developmental stages (50-day intervals) beginning at fertilization to determine when sex differentiation and expression of sex-specific genes was initiated. Detection of zp4 transcript in tissues collected at 200 days post-fertilization (dpf) indicated egg-specific development starts at 150-200 dpf. To evaluate possible sex-specific differences in growth rate, there was conducting of a molecular marker-based sex identification of abalone from a population selected for rapid growth rate. In a group of large H. discus hannai, females were more prevalent than males. To assess the correlation between growth and sex, there was comparison of weights of 3-year-old Pacific abalone in specimens where there had been sex determinations by visual examination and molecular methods. The results indicated females weighed more (55.92 ± 9.38 g, n = 15) than males (43.64 ± 15.55 g, n = 6, P = 0.037), indicating females had a more rapid growth rate than males.