In-depth correlation analysis between tear glucose and blood glucose using a wireless smart contact lens.

Tears have emerged as a promising alternative to blood for diagnosing diabetes. Despite increasing attempts to measure tear glucose using smart contact lenses, the controversy surrounding the correlation between tear glucose and blood glucose still limits the clinical usage of tears. Herein, we present an in-depth investigation of the correlation between tear glucose and blood glucose using a wireless and soft smart contact lens for continuous monitoring of tear glucose. This smart contact lens is capable of quantitatively monitoring the tear glucose levels in basal tears excluding the effect of reflex tears which might weaken the relationship with blood glucose. Furthermore, this smart contact lens can provide an unprecedented level of continuous tear glucose data acquisition at sub-minute intervals. These advantages allow the precise estimation of lag time, enabling the establishment of the concept called 'personalized lag time'. This demonstration considers individual differences and is successfully applied to both non-diabetic and diabetic humans, as well as in animal models, resulting in a high correlation.

The Effect of a Table Tennis Exercise Program With a Task-Oriented Approach on Visual Perception and Motor Performance of Adolescents With Developmental Coordination Disorder.

In this study we investigated the effects of an 8-week table tennis exercise program with a task-oriented approach on visual perception and motor performance of 31 adolescents with developmental coordination disorder (DCD). The participants were identified by their teachers as having greater difficulty than their peers (450 students from three Korean middle schools) in physical education (PE) classes. On the Bruininks-Oseretsky Test of Motor Proficiency-2, these adolescents scored below the 15th percentile and showed difficulties in performing daily life activities due to motor performance problems; they did not have physical defects, intellectual or neurological impairments, or Attention Deficit Hyperactivity Disorder. Of 98 prospective adolescents with PE difficulties, we obtained personal assent and parents' informed consent from 54, and 31 of these met screening criteria for DCD through the Developmental Coordination Disorder Questionnaire-Korean. This final group was divided in non-random fashion (based on the proximal geographic grouping of the children's schools) between an experimental group (n = 16) and a control group (n = 15). The experimental group participated in the 8-week task-oriented table tennis training program with three 90-minute sessions per week, while the control group only participated in regular PE classes twice per week. We measured participants' visual perception and motor performance in the same environment before and after the intervention program. Participants' visual perception was significantly more improved in the experimental group than the control group, with specific improved skills in visual-motor search, visual-motor speed, figure-ground, and visual closure; copying and perceptual constancy skills did not improve significantly. In addition, total motor performance and motor sub-skills, including fine manual control, manual coordination, body coordination, strength, and agility were significantly more improved in the experimental group than in the control group. Thus, our task-oriented table tennis exercise program was of greater assistance than general PE classes for improving visual perception and motor performance in adolescents at risk of DCD.

A self-powered and supercapacitive microneedle continuous glucose monitoring system with a wide range of glucose detection capabilities.

Continuous detection of sudden changes in blood glucose is essential for individuals with diabetes who have difficulty in maintaining optimal control of their blood glucose levels. Hypoglycemic shock or a hyperglycemic crisis are likely to occurs in patients with diabetes and poses a significant threat to their lives. Currently, commercial continuous glucose monitoring (CGM) has limits in the glucose concentration detection range, which is 40-500 mg/dL, making it difficult to prevent the risk of hyperglycemic shock. In addition, current CGMs are invasive, cause pain and irritation during usage, and expensive. In this research, we overcome these limitations by introducing a novel mechanism to detect glucose concentration using supercapacitors. The developed CGM, which is self-powered and minimally invasive due to the use of microneedles, can detect a wider range of glucose concentrations than commercial sensors. In addition, efficacy and stability were proven through in vitro and in vivo experiments. Thus, this self-powered, microneedle and supercapacitive-type CGM can potentially prevent both hypoglycemic and complications of hyperglycemia without pain and with less power consumption than current commercial sensors.

Measurement of Empathy in Virtual Reality with Head-Mounted Displays: A Systematic Review.

We present a systematic review of 111 papers that measure the impact of virtual experiences created through head-mounted displays (HMDs) on empathy. Our goal was to analyze the conditions and the extent to which virtual reality (VR) enhances empathy. To achieve this, we categorized the relevant literature according to measurement methods, correlated human factors, viewing experiences, topics, and participants. Meta-analysis was performed based on categorized themes, and under specified conditions, we found that VR can improve empathy. Emotional empathy increased temporarily after the VR experience and returned to its original level over time, whereas cognitive empathy remained enhanced. Furthermore, while VR did not surpass 2D video in improving emotional empathy, it did enhance cognitive empathy, which is associated with embodiment. Our results are consistent with existing research suggesting differentiation between cognitive empathy (influenced by environmental factors and learnable) and emotional empathy (highly heritable and less variable). Interactivity, target of empathy, and point of view were not found to significantly affect empathy, but participants' age and nationality were found to influence empathy levels. It can be concluded that VR enhances cognitive empathy by immersing individuals in the perspective of others and that storytelling and personal characteristics are more important than the composition of the VR scene. Our findings provide guiding information for creating empathy content in VR and designing experiments to measure empathy.

Association Between Flexible Work Arrangement and Sleep Problems Among Paid Workers: Using 6th Korean Working Conditions Survey.

Background: As social distancing persists and interest in work-life balance grows, more companies are adopting flexible work policies. While there have been studies on sleep disorders associated with different types of work, such as shift work, research exploring the relationship between flexible work schedules and sleep disorders is still limited, particularly among Korean workers. Methods: We performed a secondary analysis of the 6th Korean Working Conditions Survey, focusing on 31,243 paid workers out of a total of 50,538 participants. We defined flexible workers as those who set their own working hours. Sleep disorders were divided into three categories: 'difficulty falling asleep,' 'frequent waking during sleep,' and 'waking up feeling exhausted and fatigued.' Using scores derived from three specific symptoms, the Minimal Insomnia Symptoms Scale (MISS) was calculated to assess the prevalence of insomnia. We used chi-square tests to analyze demographic and job-related differences. A multivariate logistic regression analysis was employed to identify any relationship between flexible work schedules and sleep disorders. Results: Significant differences were found between flexible and non-flexible workers regarding age, income level, education level, and job type. Flexible workers reported sleep-related symptoms significantly more often. The odds ratio for insomnia was 1.40 (95% CI 1.21-1.61). For males, the odds ratio was 1.68 (1.36-2.08). Conclusion: This study establishes a correlation between flexible work schedules and sleep disorders among Korean salaried workers. Potential causes could include changes in circadian rhythm, increased work demands, and extended working hours. To precisely determine causality and associated diseases, further research is required.

Evaluating the delivery of physical activity for people with developmental disabilities using an online knowledge translation approach: part 1 - web accessibility.

Background: Knowledge-to-action gap exists in delivering physical activity (PA) to people with developmental disabilities via online platforms. Although web-based platforms have great potential in facilitating the delivery of PA for this target group, the lack of knowledge regarding web accessibility poses a challenge in accessing PA-related information online.Objective: This study evaluates the delivery of PA in terms of web accessibility. It also aims to identify barriers and facilitators in delivering PA knowledge to people with developmental disabilities online to improve web accessibility for the target user group.Methods: The study employs a concurrent nested design incorporating both quantitative (web usability questionnaire) and qualitative data (in-depth interviews). Fifteen pairs of individuals consisting of a person with developmental disabilities and a primary caregiver participated in the study, and three web-based platforms were selected for web accessibility tests and in-depth interviews.Results: The nested analysis provides a quantitative comparison of web accessibility and identifies barriers and facilitators of delivering PA for the target user group from the web accessibility perspective. Conclusion: The study findings could inform the development of accessible online platforms that distribute health-related knowledge to populations with developmental disabilities. Additionally, they could help enhance the design of other platforms intended for these populations.

Online platforms have significant potential to improve the delivery of physical activity information to individuals with developmental disabilities.Barriers to accessing online platforms due to poor web usability impede the process of online knowledge translation to end-users.Web usability can be enhanced by implementing appropriate interventions, such as restructuring navigation and redesigning the user interface.Improving web usability will enhance the accessibility of physical activity knowledge for individuals with developmental disabilities, which consequently will positively impact their health.

A 28 GHz GaN 6-Bit Phase Shifter MMIC with Continuous Tuning Calibration Technique.

A 28 GHz digitally controlled 6-bit phase shifter with a precision calibration technique in GaN high-electron mobility transistor (HEMT) technology is presented for Ka-band phased-array systems and applications. It comprises six stages, in which stages 1 and 2 for 5.625° and 11.25° are designed in the form of a switched-line circuit, and stages 3, 4, and 5 for 22.5°, 45°, and 90° are designed in the form of a switched-filter circuit. The final stage 6 for 180° is designed in a single-to-differential balun followed by a single-pole double-throw (SPDT) switch for achieving an efficient phase inversion. A novel continuous tuning calibration technique is proposed to improve the phase accuracy. It controls the gate bias voltage of off-state HEMTs at the stage 6 SPDT switch for fine calibration of the output phase. Fabricated in a 0.15 µm GaN HEMT process using a die size of 1.75 mm2, the circuit produces 64 phase states at 28 GHz with a 5.625° step. The experimental results show that the Root-Mean-Square (RMS) phase error is significantly improved from 8.56° before calibration to 1.08° after calibration. It is also found that the calibration does not induce significant changes for other performances such as the insertion loss, RMS amplitude error, and input-referred P1dB. This work successfully demonstrates that the GaN technology can be applied to millimeter-wave high-power phased-array transceiver systems.

Mortality in metabolic dysfunction-associated steatotic liver disease: A nationwide population-based cohort study.

BACKGROUND: A new fatty liver disease nomenclature, steatotic liver disease (SLD) has been proposed; however, there are no data on clinical outcomes. We investigated the impact of SLD with metabolic dysfunction (MD; SLD-MD) on all-cause mortality. METHODS: We evaluated nationally representative participants aged ≥19 years using data from the Korea National Health and Nutrition Examination Survey 2007-2015 and their linked death data through 2019. The presence of fatty liver disease was assessed by liver fat score, fatty liver index and significant liver fibrosis was evaluated by the Fibrosis-4 Index, and fibrosis score. SLD-MD was categorized into three groups: metabolic dysfunction-associated steatotic liver disease (MASLD); metabolic alcoholic liver disease (MetALD); and SLD with other combination etiologies. RESULTS: Among 26734 individuals (11561 men and 15173 women, mean age 48.8 years), 1833 (6.9 %) died during a mean follow-up period of 110.6 ± 33.9 months. Mortality risk was significantly higher in individuals with SLD-MD (hazard ratio [HR] = 1.35) than in those without (P < 0.001). Among the three groups, MASLD (HR = 1.32) and SLD with other combination etiologies (HR = 2.06) independently increased mortality risk (all P < 0.001). When individuals with SLD-MD had significant liver fibrosis or diabetes, mortality risk increased further (HR = 1.68 and 1.85, respectively; all P < 0.001). SLD-MD with both significant liver fibrosis and diabetes showed the highest mortality risk (HR = 2.29, P < 0.001). When applied fatty liver index and fibrosis score, similar results were observed. CONCLUSIONS: SLD-MD is associated with a higher mortality risk. When SLD-MD was combined with significant liver fibrosis or diabetes, the mortality risk became much higher. Treatment strategies to reduce fibrotic burden and improve glycemic control in individuals with MASLD are needed.

Alanine to glycine ratio is a novel predictive biomarker for type 2 diabetes mellitus.

AIM: We aimed to evaluate the metabolite ratios that could predict the clinical incidence or remission of type 2 diabetes mellitus (T2D). METHODS: The Cox proportional hazards regression model was used to assess 1813 individuals without T2D to test the predictive value of metabolite ratios for T2D incidence and 451 newly diagnosed T2D for remission. The receiver operating characteristic curve analysis was performed to determine the best cut-off values for the metabolite ratios. Survival analyses were performed to compare the four subgroups defined by baseline metabolite ratios and clinical status of obesity. RESULTS: The alanine/glycine was the most significant marker for T2D incidence (hazard ratio per SD: 1.24; p < .001). On the other hand, metabolite hydroxy sphingomyelin C22:2 was most specific for T2D remission (hazard ratio per SD: 1.32; p = .029). Survival analysis of T2D incidence among the subgroups defined by the combination of alanine/glycine and obesity showed the group with a high alanine/glycine and obesity had the highest risk of T2D incidence (p < .001). The alanine/glycine as a T2D risk marker was also validated in the independent external data. CONCLUSIONS: The combination of obesity and the alanine/glycine ratio can be used to evaluate the diabetes risk.

Moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome and atherosclerotic cardiovascular disease: A post-hoc analysis of the RACING trial.

AIM: This study evaluated the safety and efficacy of a moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome (MetS) and atherosclerotic cardiovascular disease. MATERIALS AND METHODS: In this post-hoc subgroup analysis of the RACING trial, patients were analysed based on the presence of MetS. MetS was defined as meeting at least three of the five following criteria: (a) elevated waist circumference; (b) elevated triglycerides; (c) reduced high-density lipoprotein cholesterol; (d) elevated blood pressure; and (e) elevated fasting glucose. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. RESULTS: Of the 3780 patients enrolled in the RACING trial, 1703 (45.1%) had MetS at baseline. The primary outcome rate was 10.1% and 10.3% in patients with MetS receiving ezetimibe combination therapy versus high-intensity statin monotherapy (hazard ratio = 0.97; 95% confidence interval = 0.72-1.32; p = .868). Lower rates of intolerance-related drug discontinuation or dose reduction (3.9% vs. 8.0%; p < .001) and lower low-density lipoprotein cholesterol levels (57 vs. 65 mg/dl; p < .001) were observed with ezetimibe combination therapy versus high-intensity statin monotherapy. Furthermore, the rate of new-onset diabetes was 18.5% and 19.1% in each group (p = .822). There were no significant interactions between MetS and therapy regarding study outcomes in the total population. CONCLUSIONS: In patients with MetS and atherosclerotic cardiovascular disease, a moderate-intensity statin with ezetimibe combination therapy had comparable cardiovascular benefits with those of high-intensity statin monotherapy. Meanwhile, ezetimibe combination therapy was associated with lower drug intolerance and low-density lipoprotein cholesterol levels, but there was no apparent between-group difference in new-onset diabetes.

Appendicular Skeletal Muscle Mass to Visceral Fat Area Ratio Predicts Hepatic Morbidities.

Background/Aims: : Reports on the association between sarcopenic visceral obesity and non-alcoholic fatty liver disease (NAFLD)-associated morbidities remain scarce. We investigated the association between sarcopenia and visceral obesity, and the influence of this association on hepatic and coronary comorbidities. Methods: : The appendicular skeletal muscle mass to visceral fat area ratio (SV ratio) was evaluated using bioelectric impedance analysis. NAFLD and significant liver fibrosis were assessed using transient elastography, and high atherosclerotic cardiovascular disease (ASCVD) risk was defined as a 10-year ASCVD risk score >10%. Sarcopenia was defined as appendicular skeletal muscle mass adjusted by body mass index (<0.789 for men and <0.512 for women). Results: : In total, 82.0% (n=1,205) of the entire study population had NAFLD, and 14.6% of these individuals (n=176) exhibited significant liver fibrosis. Individuals with the lowest SV ratio had a significantly increased risk of NAFLD, significant liver fibrosis, and high ASCVD risk (all p<0.05). Individuals with both the lowest SV ratio and sarcopenia had the highest risk of developing NAFLD (odds ratio [OR]=3.11), significant liver fibrosis (OR=2.03), and high ASCVD risk (OR=4.15), compared with those with a higher SV ratio and without sarcopenia (all p<0.05). Conclusions: : Low SV ratio combined with sarcopenia was significantly associated with an increased risk of NAFLD, significant liver fibrosis, and high ASCVD risk among individuals with a high risk of NAFLD.

The relationship between exposure to environmental noise and risk of atopic dermatitis, asthma, and allergic rhinitis.

BACKGROUND: Noise is defined as unwanted sound. It may induce negative emotions and mental health problems and may even lead to increased suicide risk. However, the impact of noise exposure on environmental diseases and disease severity is not well understood. This study aimed to elucidate the association between night-time noise exposure and the prevalence of environmental diseases in South Korea. METHODS: We conducted an analysis of the Environmental Disease Database provide by the National Health Insurance Service (NHIS) from 2013 to 2017. After spatially interpolating the noise data provided by the National Noise Information System (NNIS), night-time noise values in the district level were obtained by calculating the mean noise values at the administrative district level. The linear regression analyses were performed to test the association between the age-standardized prevalence ratio (SPR) and the night-time noise exposure in the district level. RESULTS: In areas with high night-time noise exposure (≥55 dB), the SPR for atopic dermatitis and allergic rhinitis were 1.0515 (95 % confidence interval [CI]:1.0508-1.0521) and 1.0202 (95 % CI:1.0201-1.0204), respectively, which were higher than those in the general population. The SPR for environmental diseases, including atopic dermatitis, asthma, and allergic rhinitis, was 1.0104 (95 % CI:1.0103-1.0105). Additionally, a significant linear association was observed between the level of nocturnal noise exposure and the total hospitalization period for atopic dermatitis (ß = 399.3, p < 0.01). CONCLUSION: We provide evidence of a significant association between night-time environmental noise and environmental diseases, particularly atopic dermatitis and allergic rhinitis. Furthermore, we observed a significant linear association between night-time noise exposure and the severity of atopic dermatitis.

SGLT2 and DPP4 inhibitors improve Alzheimer's disease-like pathology and cognitive function through distinct mechanisms in a T2D-AD mouse model.

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2D) share common features, including insulin resistance. Brain insulin resistance has been implicated as a key factor in the pathogenesis of AD. Recent studies have demonstrated that anti-diabetic drugs sodium-glucose cotransporter-2 inhibitor (SGLT2-i) and dipeptidyl peptidase-4 inhibitor (DPP4-i) improve insulin sensitivity and provide neuroprotection. However, the effects of these two inhibitors on the brain metabolism and insulin resistance remain uninvestigated. We developed a T2D-AD mouse model using a high-fat diet (HFD) for 19 weeks along with a single dose of streptozotocin (100 mg/kg, intraperitoneally) at the fourth week of HFD initiation. Subsequently, the animals were treated with SGLT2-i (empagliflozin, 25 mg/kg/day orally [p.o.]) and DPP4-i (sitagliptin, 100 mg/kg/day p.o.) for 7 weeks. Subsequently, behavioral tests were performed, and the expression of insulin signaling, AD-related, and other signaling pathway proteins in the brain were examined. T2D-AD mice not only showed increased blood glucose levels and body weight but also insulin resistance. SGLT2-i and DPP4-i effectively ameliorated insulin sensitivity and reduced body weight in these mice. Furthermore, SGLT2-i and DPP4-i significantly improved hippocampal-dependent learning, memory, and cognitive functions in the T2D-AD mouse model. Interestingly, SGLT2-i and DPP4-i reduced the hyperphosphorylated tau (pTau) levels and amyloid ß (Aß) accumulation and enhanced brain insulin signaling. SGLT2-i reduced pTau accumulation through the angiotensin converting enzyme-2/angiotensin (1-7)/ mitochondrial assembly receptor axis, whereas DPP4-i reduced Aß accumulation by increasing insulin-degrading enzyme levels. These findings suggest that SGLT2-i and DPP4-i prevent AD-like pathology and cognitive dysfunction in T2D mice potentially through affecting brain insulin signaling via different mechanisms.

Association between lone work and self-rated health status: using the 5th Korean Working Conditions Survey.

Background: Lone workers are generally defined as individuals who work alone without supervision, including self-employed people. While lone workers are considered a vulnerable group in some countries, there is a lack of research on their health status in domestic studies. Globally, the number of lone workers has been increasing, and this trend has been further accelerated since the coronavirus disease 2019 (COVID-19) pandemic with the rise of remote work. Methods: The study analyzed data from 44,281 participants, excluding unpaid family workers, soldiers, and those with missing data. Lone workers were defined as individuals who reported having no colleagues with the same job at their current workplace. Self-rated health status was categorized as "good" or "poor." Results: This study found a statistically significant higher number of lone workers among women compare to men. The largest occupational category for lone workers was service and sales workers, followed by agriculture and fisheries workers. A majority of non-lone workers reported working 40 hours or less per week, while the majority of lone workers reported working 53 hours or more per week. In addition, lone workers had significantly poorer health status evaluations compared to non-lone workers (odds ratio: 1.297; 95% confidence interval: 1.165-1.444). Conclusions: Further research is needed to investigate the causal relationship between lone work and health, using data collected after the COVID-19 pandemic.

Comparisons of the prediction models for undiagnosed diabetes between machine learning versus traditional statistical methods.

We compared the prediction performance of machine learning-based undiagnosed diabetes prediction models with that of traditional statistics-based prediction models. We used the 2014-2020 Korean National Health and Nutrition Examination Survey (KNHANES) (N = 32,827). The KNHANES 2014-2018 data were used as training and internal validation sets and the 2019-2020 data as external validation sets. The receiver operating characteristic curve area under the curve (AUC) was used to compare the prediction performance of the machine learning-based and the traditional statistics-based prediction models. Using sex, age, resting heart rate, and waist circumference as features, the machine learning-based model showed a higher AUC (0.788 vs. 0.740) than that of the traditional statistical-based prediction model. Using sex, age, waist circumference, family history of diabetes, hypertension, alcohol consumption, and smoking status as features, the machine learning-based prediction model showed a higher AUC (0.802 vs. 0.759) than the traditional statistical-based prediction model. The machine learning-based prediction model using features for maximum prediction performance showed a higher AUC (0.819 vs. 0.765) than the traditional statistical-based prediction model. Machine learning-based prediction models using anthropometric and lifestyle measurements may outperform the traditional statistics-based prediction models in predicting undiagnosed diabetes.

Ablation of the deubiquitinase USP15 ameliorates nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) occurs due to the accumulation of fat in the liver, leading to fatal liver diseases such as nonalcoholic steatohepatitis (NASH) and cirrhosis. Elucidation of the molecular mechanisms underlying NAFLD is critical for its prevention and therapy. Here, we observed that deubiquitinase USP15 expression was upregulated in the livers of mice fed a high-fat diet (HFD) and liver biopsies of patients with NAFLD or NASH. USP15 interacts with lipid-accumulating proteins such as FABPs and perilipins to reduce ubiquitination and increase their protein stability. Furthermore, the severity of NAFLD induced by an HFD and NASH induced by a fructose/palmitate/cholesterol/trans-fat (FPC) diet was significantly ameliorated in hepatocyte-specific USP15 knockout mice. Thus, our findings reveal an unrecognized function of USP15 in the lipid accumulation of livers, which exacerbates NAFLD to NASH by overriding nutrients and inducing inflammation. Therefore, targeting USP15 can be used in the prevention and treatment of NAFLD and NASH.