Crack Detection and Analysis of Concrete Structures Based on Neural Network and Clustering.

Concrete is extensively used in the construction of infrastructure such as houses and bridges. However, the appearance of cracks in concrete structures over time can diminish their sealing and load-bearing capability, potentially leading to structural failures and disasters. The timely detection of cracks allows for repairs without the need to replace the entire structure, resulting in cost savings. Currently, manual inspection remains the predominant method for identifying concrete cracks. However, in today's increasingly complex construction environments, subjective errors may arise due to human vision and perception. The purpose of this work is to investigate and design an autonomous convolutional neural network-based concrete detection system that can identify cracks automatically and use that information to calculate the crack proportion. The experiment's findings show that the trained model can classify concrete cracks with an accuracy of 99.9%. Moreover, the clustering technique applied to crack images enables the clear identification of the percentage of cracks, which facilitates the development of concrete damage level detection over time.

Networked Cluster Formation via Trigonal Lipid Modules for Augmented Ex Vivo NK Cell Priming.

Current cytokine-based natural killer (NK) cell priming techniques have exhibited limitations such as the deactivation of biological signaling molecules and subsequent insufficient maturation of the cell population during mass cultivation processes. In this study, we developed an amphiphilic trigonal 1,2-distearoyl-sn-glycero-3-phosphorylethanolamine (DSPE) lipid-polyethylene glycol (PEG) material to assemble NK cell clusters via multiple hydrophobic lipid insertions into cellular membranes. Our lipid conjugate-mediated ex vivo NK cell priming sufficiently augmented the structural modulation of clusters, facilitated diffusional signal exchanges, and finally activated NK cell population with the clusters. Without any inhibition in diffusional signal exchanges and intrinsic proliferative efficacy of NK cells, effectively prime NK cell clusters produced increased interferon-gamma, especially in the early culture periods. In conclusion, the present study demonstrates that our novel lipid conjugates could serve as a promising alternative for future NK cell mass production.

Optimized Design of Hyaluronic Acid-Lipid Conjugate Biomaterial for Augmenting CD44 Recognition of Surface-Engineered NK Cells.

Triple-negative breast cancer (TNBC) presents treatment challenges due to a lack of detectable surface receptors. Natural killer (NK) cell-based adaptive immunotherapy is a promising treatment because of the characteristic anticancer effects of killing malignant cells directly by secreting cytokines and lytic granules. To maximize the cancer recognition ability of NK cells, biomaterial-mediated ex vivo cell surface engineering has been developed for sufficient cell membrane immobilization of tumor-targeting ligands via hydrophobic anchoring. In this study, we optimized amphiphilic balances of NK cell coating materials composed of CD44-targeting hyaluronic acid (HA)-poly(ethylene glycol) (PEG)-lipid to improve TNBC recognition and the anticancer effect. Changes in the modular design of our material by differentiating hydrophilic PEG length and incorporating lipid amount into HA backbones precisely regulated the amphiphilic nature of HA-PEG-lipid conjugates. The optimized biomaterial demonstrated improved anchoring into NK cell membranes and facilitating the surface presentation level of HA onto NK cell surfaces. This led to enhanced cancer targeting via increasing the formation of immune synapse, thereby augmenting the anticancer capability of NK cells specifically toward CD44-positive TNBC cells. Our approach addresses targeting ability of NK cell to solid tumors with a deficiency of surface tumor-specific antigens while offering a valuable material design strategy using amphiphilic balance in immune cell surface engineering techniques.

Ex Vivo Surface Decoration of Phenylboronic Acid onto Natural Killer Cells for Sialic Acid-Mediated Versatile Cancer Cell Targeting.

Phenylboronic acid (PBA) has been highly acknowledged as a significant cancer recognition moiety in sialic acid-overexpressing cancer cells. In this investigation, lipid-mediated biomaterial integrated PBA molecules onto the surface of natural killer (NK) cells to make a receptor-mediated immune cell therapeutic module. Therefore, a 1,2-distearoyl-sn-glycero-3-phosphorylethanolamine (DSPE) lipid-conjugated di-PEG-PBA (DSPEPEG-di(PEG-PBA) biomaterial was synthesized. The DSPEPEG-di(PEG-PBA) biomaterial exhibited a high affinity for sialic acid (SA), confirmed by fluorescence spectroscopy at pH 6.5 and 7.4. DSPEPEG-di(PEG-PBA) was successfully anchored onto NK cell surfaces (PBA-NK), and this biomaterial maintains intrinsic properties such as viability, ligand availability (FasL & TRAIL), and cytokine secretion response to LPS. The anticancer efficacy of PBA-NK cells was evaluated against 2D cancer cells (MDA-MB-231, HepG2, and HCT-116) and 3D tumor spheroids of MDA-MB-231 cells. PBA-NK cells exhibited greatly enhanced anticancer effects against SA-overexpressing cancer cells. Thus, PBA-NK cells represent a new anticancer strategy for cancer immunotherapy.

Tailoring tumor-recognizable hyaluronic acid-lipid conjugates to enhance anticancer efficacies of surface-engineered natural killer cells.

Natural killer (NK) cells have clinical advantages in adoptive cell therapy owing to their inherent anticancer efficacy and their ability to identify and eliminate malignant tumors. However, insufficient cancer-targeting ligands on NK cell surfaces often inhibit their immunotherapeutic performance, especially in immunosuppressive tumor microenvironment. To facilitate tumor recognition and subsequent anticancer function of NK cells, we developed hyaluronic acid (HA, ligands to target CD44 overexpressed onto cancer cells)-poly(ethylene glycol) (PEG, cytoplasmic penetration blocker)-Lipid (molecular anchor for NK cell membrane decoration through hydrophobic interaction) conjugates for biomaterial-mediated ex vivo NK cell surface engineering. Among these major compartments (i.e., Lipid, PEG and HA), optimization of lipid anchors (in terms of chemical structure and intrinsic amphiphilicity) is the most important design parameter to modulate hydrophobic interaction with dynamic NK cell membranes. Here, three different lipid types including 1,2-dimyristoyl-sn-glycero-3-phosphati-dylethanolamine (C14:0), 1,2-distearoyl-sn-glycero-3-phosphatidylethanolamine (DSPE, C18:0), and cholesterol were evaluated to maximize membrane coating efficacy and associated anticancer performance of surface-engineered NK cells (HALipid-NK cells). Our results demonstrated that NK cells coated with HA-PEG-DSPE conjugates exhibited significantly enhanced anticancer efficacies toward MDA-MB-231 breast cancer cells without an off-target effect on human fibroblasts specifically via increased NK cell membrane coating efficacy and prolonged surface duration of HA onto NK cell surfaces, thereby improving HA-CD44 recognition. These results suggest that our HALipid-NK cells with tumor-recognizable HA-PEG-DSPE conjugates could be further utilized in various cancer immunotherapies.

Surface Engineering of Natural Killer Cells with CD44-targeting Ligands for Augmented Cancer Immunotherapy.

Adoptive immunotherapy utilizing natural killer (NK) cells has demonstrated remarkable efficacy in treating hematologic malignancies. However, its clinical intervention for solid tumors is hindered by the limited expression of tumor-specific antigens. Herein, lipid-PEG conjugated hyaluronic acid (HA) materials (HA-PEG-Lipid) for the simple ex-vivo surface coating of NK cells is developed for 1) lipid-mediated cellular membrane anchoring via hydrophobic interaction and thereby 2) sufficient presentation of the CD44 ligand (i.e., HA) onto NK cells for cancer targeting, without the need for genetic manipulation. Membrane-engineered NK cells can selectively recognize CD44-overexpressing cancer cells through HA-CD44 affinity and subsequently induce in situ activation of NK cells for cancer elimination. Therefore, the surface-engineered NK cells using HA-PEG-Lipid (HANK cells) establish an immune synapse with CD44-overexpressing MIA PaCa-2 pancreatic cancer cells, triggering the "recognition-activation" mechanism, and ultimately eliminating cancer cells. Moreover, in mouse xenograft tumor models, administrated HANK cells demonstrate significant infiltration into solid tumors, resulting in tumor apoptosis/necrosis and effective suppression of tumor progression and metastasis, as compared to NK cells and gemcitabine. Taken together, the HA-PEG-Lipid biomaterials expedite the treatment of solid tumors by facilitating a sequential recognition-activation mechanism of surface-engineered HANK cells, suggesting a promising approach for NK cell-mediated immunotherapy.

Comprehensive Physical Work Capacity Evaluations for Korean Farmers Assessed in Healthy Volunteers.

OBJECTIVE: To establish the lower limits of normative values of the physical work capacity for Korean farmers in healthy working individual. METHODS: We developed a comprehensive set of physical work capacity evaluation items that encompass common farming tasks. These items include measurements of trunk flexion/extension angles, strength (hand grip, trunk flexion/extension, leg/back lifting, and pushing/pulling), and positional tolerances. We calculated the normative values for the items and defined the normal range in 124 healthy volunteers aged 20-79 years. We calculated the intraclass correlation coefficient (ICC) to validate the test-retest reliability of the measurements protocol. RESULTS: The normal values for each measurement item were as follows: trunk flexion and extension angle (65.3°±11.6° and 29.6°±6.6°), dominant hand grip strength (32.2±10.5 kgf), trunk flexion and extension strength (288.4±119.0 N and 297.3±129.9 N), leg and back lifting strength (452.9±233.5 N and 349.2±166.7 N), pushing and pulling strength (214.7±75.1 N and 221.7±63.3 N), and positional tolerance time (squat: 76.8±9.0 seconds, front: 73.8±7.7 seconds, twist: 82.2±8.8 seconds, upward: 71.9±11.3 seconds). Regarding test-retest reliability, all strength measurements demonstrated excellent absolute agreement (ICC, 0.91-0.96). However, positional tolerance showed poor-to-moderate absolute agreement (ICC, 0.37-0.58). CONCLUSION: We conducted measurements of muscle strength and positional tolerance in healthy participants of various ages, focusing on tasks commonly performed by Korean farmers. The outcomes hold significant value as they offer a pertinent instrument for assessing the appropriateness of workers, thereby carrying implications for rehabilitation objectives, legal evaluations, and work capacity assessments within the agricultural domain.

Ex Vivo Peptide Decoration Strategies on Stem Cell Surfaces for Augmenting Endothelium Interaction.

Ischemic vascular diseases remain leading causes of disability and death. Although various clinical therapies have been tried, reperfusion injury is a major issue, occurring when blood recirculates at the damaged lesion. As an alternative approach, cell-based therapy has emerged. Mesenchymal stem cells (MSCs) are attractive cellular candidates due to their therapeutic capacities, including differentiation, safety, angiogenesis, and tissue repair. However, low levels of receptors/ligands limit targeted migration of stem cells. Thus, it is important to improve homing efficacy of transplanted MSCs toward damaged endothelium. Among various MSC modulations, ex vivo cell surface engineering could effectively augment homing efficiency by decorating MSC surfaces with alternative receptors/ligands, thereby facilitating intercellular interactions with the endothelium. Especially, exogenous decoration of peptides onto stem cell surfaces could provide appropriate functional signaling moieties to achieve sufficient MSC homing. Based on their protein-like functionalities, high modularity in molecular design, and high specific affinities and multivalency to target receptors, peptides could be representative surface-presentable moieties. Moreover, peptides feature a mild synthetic process, enabling precise control of amino acid composition and sequence. Such ex vivo stem cell surface engineering could be achieved primarily by hydrophobic interactions of the cellular bilayer with peptide-conjugated anchor modules and by covalent conjugation between peptides and available compartments in membranes. To this end, this review provides an overview of currently available peptide-mediated, ex vivo stem cell surface engineering strategies for enhancing MSC homing efficiency by facilitating interactions with endothelial cells. Stem cell surface engineering techniques using peptide-based bioconjugates have the potential to revolutionize current vascular disease treatments while addressing their technical limitations.

Back Extensor Strength as a Potential Marker of Frailty Using Propensity Score Matching and Machine Learning.

This study assessed the potential of back extensor strength as an alternative marker of frailty. A total of 560 farmers were included. Computed tomography scans measured fat and muscle mass volumes at the mid-L4 vertebral level. Back extensor strength was measured in a seated posture. Multivariate linear regression was used to analyze the associations between back extensor strength and trunk muscle/fat compositions. The participants were divided into two groups based on back extensor strength. Propensity score matching, multivariate logistic regression, and Extreme Gradient Boosting (XGBoost) were employed to evaluate the relationship between Fried's frailty criteria and back extensor strength. Back extensor strength exhibited positive associations with abdominal muscle volume (r = 1.12) as well as back muscle volume (r = 0.89) (p < 0.05). Back extensor strength was linked to more frail status, such as reduced grip strength, walking speed, and frequent self-reported exhaustion. Multivariate logistic regression indicated that back extensor strength was associated with higher frail status (OR = 0.990), and XGBoost analysis identified back extensor strength as the most important predictor (gain = 0.502) for frailty. The prediction models using grip strength produced similar results (OR = 0.869, gain = 0.482). These findings suggested the potential of back extensor strength as an alternative frailty marker.

Association Between Ergonomic Burden Assessed Using 20-Item Agricultural Work-Related Ergonomic Risk Questionnaire and Shoulder, Low Back, and Leg Pain in Korean Farmers.

OBJECTIVES: This study aimed to determine the agricultural ergonomic burden in Korean farmers and to analyze its correlation with musculoskeletal pain. METHODS: In total, 1001 farmers (525 females and 476 males; mean age, 59.6±7.5years) who owned or rented a farm and belonged to an agricultural cooperative unit were recruited. Ergonomic burdens were assessed using a 20-item Agricultural Work-related Ergonomic Risk Questionnaire (20 agricultural works). The presence of musculoskeletal pain (shoulder, low back, and leg/foot), Farm Stressor Inventory, subjective stress index, and agricultural workload (low, moderate, somewhat hard, or hard) were collected using structured questionnaires. RESULTS: Factor analysis of the Agricultural Work-related Ergonomic Risk Questionnaire revealed a four-factor solution: neck and upper limb, trunk and push - pull, machine and heavy lifting, and repetitive trauma. Cronbach's alpha was greater than 0.65. For 18 of the 20 items, there was a significant association with the Farm Stressor Inventory, subjective stress index, and agricultural workload. The most frequent ergonomic burdens were squatting (51.2%), highly repetitive wrist movements (53.5%), shoulder flexion at 45-90° (51.2%), and trunk flexion or twisting at≥45° (48.8%). Ergonomic burdens were significantly different in 13 items between sexes. The musculoskeletal pain was associated with increased agricultural burdens in 10 items in male farmers and 14 items in female farmers. CONCLUSION: Increased agricultural ergonomic burdens were associated with musculoskeletal pain. Ergonomic burden showed different patterns between male and female farmers, with female farmers appearing to be more affected by ergonomic burden than male farmers.

A Case of Hemophagocytic Lymphohistiocytosis following Second Dose of COVID-19 Vaccination.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, severe hyperinflammatory disease characterized by overproduction of cytokines and hemophagocytosis of hematopoietic cells, resulting in multiorgan failure. Prompt treatment initiation is essential for patient survival. The coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of several vaccines, including BNT162b2 by Pfizer-BioNTech. Few cases of immune-mediated complications of COVID-19 and its vaccines have been reported, characterized by persistent stimulation of the immune system, resembling HLH. We report the case of a 21-year-old man with secondary HLH following a second dose of the BNT162b2 vaccine. The patient did not have primary HLH or other contributors to secondary HLH and met the HLH-2004 diagnostic criteria. He was safely treated with steroid pulse therapy alone, without etoposide, cyclosporin, or immunoglobulins, which are recommended for pediatric patients. Physicians need to be aware of such severe complications following a second dose of the COVID-19 vaccine.

A non-traditional crystal-based compound screening method targeting the ATP binding site of Plasmodium falciparum GRP78 for identification of novel nucleoside analogues.

Drug resistance to front-line malarial treatments represents an ongoing threat to control malaria, a vector borne infectious disease. The malarial parasite, Plasmodium falciparum has developed genetic variants, conferring resistance to the current standard therapeutic artemisinin and its derivatives commonly referred to as artemisinin-combination therapies (ACTs). Emergence of multi-drug resistance parasite genotypes is a warning of potential treatment failure, reaffirming the urgent and critical need to find and validate alternate drug targets to prevent the spread of disease. An attractive and novel drug target includes glucose-regulated protein 78 kDa (GRP78, or BiP), an essential molecular chaperone protein involved in the unfolded protein response that is upregulated in ACT treated P. falciparum parasites. We have shown that both sequence and structure are closely related to human GRP78 (hGRP78), a chaperone belonging to the HSP70 class of ATPase proteins, which is often upregulated in cellular stress responses and cancer. By screening a library of nucleoside analogues, we identified eight 'hit' compounds binding at the active site of the ATP binding domain of P. falciparum GRP78 using a high-throughput ligand soaking screen using x-ray crystallography. These compounds were further evaluated using protein thermal shift assays to assess target binding activity. The nucleoside analogues identified from our screen provide a starting point for the development of more potent and selective antimalarial inhibitors. In addition, we have established a well-defined, high-throughput crystal-based screening approach that can be applied to many crystallizable P. falciparum proteins for generating anti-Plasmodium specific compounds.

Associations Between Trunk Muscle/Fat Composition, Narrowing Lumbar Disc Space, and Low Back Pain in Middle-Aged Farmers: A Cross-Sectional Study.

OBJECTIVE: To investigate the association of trunk fat and muscle composition, lumbar disc space narrowing, and low back pain in middle-aged farmers. METHODS: Fat and muscle areas were identified using standard Hounsfield unit ranges for adipose tissue and skeletal muscle with computed tomography images at the mid-L4 vertebral level. Trunk fat mass, muscle mass, and fat/muscle mass ratio were calculated. Low back pain was assessed using the Oswestry Disability Index (ODI). The L4/5-disc space and low back pain were also assessed. RESULTS: Male had a higher total trunk, back, psoas, and abdominal muscle mass, and visceral fat; female had a higher subcutaneous fat mass and fat/muscle ratio. Pearson correlation coefficients with ODI for waist circumference, total fat mass, visceral fat mass, and fat/muscle ratio were all significant in female; only the fat/muscle ratio was significant in male. Pearson correlation coefficients with L4/5-disc space narrowing grades for visceral fat mass, total, back, and psoas muscle mass, and fat/muscle ratio, were all significant in female; total and back muscle mass, and fat/muscle ratio in male. CONCLUSION: There were significant relationships between: fat indicators with low back pain; trunk muscle mass with lumbar disc degeneration; and fat/muscle ratio with both lumbar disc degeneration and low back pain. The fat/muscle ratio may be a useful index for low back pain.

The validity of the assignment book-based structured interview in predicting academic performance in medical schools: a retrospective cohort study.

PURPOSE: Structured interviews have become essential in the medical schools admission selection because structured interviews predict academic achievement after admission. The purpose of this study was to determine validity and fairness of the new structural interview technique, assignment book-based structured interview (ABSI), in predicting future academic achievement of the medical students. METHODS: The validity of this new interview technique and academic achievement was evaluated based on the data of all the applicants and successful applicants who applied for on-time admission between the year 2011 and 2014. RESULTS: The ABSI technique showed a significant correlation and predictive validity for academic achievement in the medical school. The retention group received significantly lower T-scores of ABSI compared with the superior student group. CONCLUSION: The results indicate that ABSI is a feasible, reliable, fair and valid admission selection tool. The ABSI may be meaningful and fair method for predicting academic achievements, and it could be incorporated as one of the contents in the multiple mini-interview.

The Association Between Sagittal Plane Alignment and Disc Space Narrowing of Lumbar Spine in Farmers.

OBJECTIVE: To investigate whether lumbar lordosis (LL) and lumbar segmental lordosis (LSL) are related to sex, age, low back pain (LBP), and lumbar disc space narrowing (DSN). METHODS: A total of 569 farmers were recruited. In lateral spine radiograph, LL (L1-L5) and LSL (L1, L2, L3, L4, and L5) were measured using Cobb's method. The differences in LSL values (ΔLSL) according to the presence or absence of a DSN were calculated as LSLDSN - LSLnoDSN for each DSN level. RESULTS: In male, the lateral spine radiograph showed significantly greater L4-LSL and L5-LSL and smaller L1-LSL and L2-LSL compared to female. LLs in the 50-59 and ≥60 years age groups were significantly smaller compared to those in the <50 years age group. In subjects with LBP, LL and L4-LSL were significantly smaller than in those without. The ΔLSLs at the disc level with DSN showed the greatest decrease: L1-ΔLSL (Δ-3.99°), L2-ΔLSL (Δ-3.31°), L3-ΔLSL (Δ-2.87°), L4-ΔLSL (Δ-3.31°), and L5-ΔLSL (Δ-4.44°) in L1/2, L2/3, L3/4, L4/5, and L5/S1 DSN, respectively. Conversely, distant ΔLSLs were inversely increased: L1-LSL (Δ0.75°) with L4/5 DSN and L2-LSL (Δ0.94°) with L5/S1 DSN. CONCLUSION: Sagittal plane alignment was significantly associated with sex, age, LBP, and DSN. LSLs around the levels of DSN were decreased, and there was compensational increase of LSL distant to the DSN to maintain the overall LL.

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia.

OBJECTIVE: To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS). METHODS: Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed. RESULTS: Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70-16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14-5.58), dysphagia (OR=3.82; 95% CI, 1.42-10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84-111.60) were factors significantly related with pneumonia. CONCLUSION: Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.

Accuracy of Wearable Devices for Measuring Heart Rate During Conventional and Nordic Walking.

INTRODUCTION: Nordic walking is being used increasingly as an exercise method in many clinical disorders. To apply Nordic walking in cases of fragile or deconditioned patients, monitoring of exercise intensity such as heart rate (HR) measurement is required. The accuracy of wearable HR monitors during Nordic walking has not yet been reported. OBJECTIVE: To compare the accuracy of an electrocardiography (ECG)-based HR monitor (Polar H7) and a photoplethysmography (PPG)-based HR monitor (Fitbit Charge 2) during conventional and Nordic walking. DESIGN: Accuracy was assessed by comparing the HR values obtained using the wearable devices with those obtained via 12-lead ECG as a reference. SETTING: Laboratory setting. PARTICIPANTS: Fifteen male volunteers age 23.7 ± 3.0 years. INTERVENTIONS: None. MAIN OUTCOMES MEASURES: HR was simultaneously recorded via 12-lead ECG, the Polar H7, and the Fitbit Charge 2 during conventional and Nordic walking. Agreement between the devices was assessed by calculating Lin's concordance correlation coefficient (rc ), the mean absolute difference, and the limit of agreement (LoA) from Bland-Altman plots. RESULTS: Regarding HR values including Nordic and conventional walking, there was a better agreement between the Polar H7 and the reference (rc = 0.96) than between the Fitbit Charge 2 and the reference (rc = 0.84). For the Polar H7, the mean absolute difference from the reference did not differ significantly between the walking methods; for the Fitbit Charge 2, the mean absolute difference was significantly higher during Nordic walking than during conventional walking (6.60 vs. 3.68 bpm, P < .001). The Fitbit Charge 2 had a wider LoA than did the Polar H7 during both walking methods. CONCLUSION: ECG-based wearable devices may be better than PPG-based devices for monitoring HR during Nordic walking. However, both types of devices may adequately monitor HR during conventional walking.

A mobile delivered self-exercise program for female farmers.

INTRODUCTION: Female farmers commonly experience musculoskeletal pain in the back, knee, and shoulder. Despite their obvious advantages in reducing musculoskeletal pain, face-to-face exercise programs are limited by geographical and physical barriers. Thus, we decided to introduce eHealth technology to farmers' musculoskeletal health care. Using a mobile application (app), we aim to provide a tailored self-exercise program for shoulder, knee, and back pain in female farmers in rural areas after a musculoskeletal health check-up. METHODS: This study is planned as 2 randomized control studies (MObile Delivered self-Exercise [MODE] phase I and phase II). We plan to recruit 200 female farmers aged 41 to 70 years. Initially, the shoulders, knees, and low back will be evaluated to provide individualized exercise programs. In MODE-I (single-blinded: evaluator), the subjects will be randomly allocated to experimental (n = 100) and control (n = 100) groups using a computer-generated sequence. Both groups will perform a 3-month self-exercise using a smartphone app or physical education data (booklets), respectively. Outcomes including exercise completion will be assessed at 3 months. In MODE-II, after subject random allocation, the experimental and control groups will perform exercise using a smartphone app with and without real-time feedback, respectively. Every 3 months, the level of the exercise program will be evaluated and the difficulty level will be adapted accordingly. After MODE-II is completed, all subjects will undergo close-out assessment. DISCUSSION: This will be the first attempt to compare methods using booklets and apps to identify effective ways of providing personalized self-exercise programs according to musculoskeletal health stages by evaluating female farmers (MODE-I). This will help clarify whether the mobile app is effective for self-exercise compared to a conventional booklet. The MODE-II study will help to assess the effect of providing feedback through the mobile app. Finally, we will evaluate musculoskeletal health according to the degree of participation over 12 months to confirm the effect of self-exercise. Our study should aid in managing musculoskeletal health for farmers living in rural areas and help promote health in the "untact" era. TRIAL REGISTRATION: Clinical Research Information Service of the Korean National Institutes of Health (KCT0005245). Registered July 17, 2020.

Community-Based Cardiac Rehabilitation Conducted in a Public Health Center in South Korea: A Preliminary Study.

OBJECTIVE: To evaluate the safety and effectiveness of the community-based cardiac rehabilitation (CBCR) program that we had developed. METHODS: Individuals aged >40 years with cardiovascular disease or its risk factors who were residing in a rural area were recruited as study subjects. The CBCR program, which consisted of 10 education sessions and 20 weeks of customized exercises (twice a week), was conducted in a public health center for 22 weeks. Comprehensive outcomes including body weight, blood glucose level, and 6-minute walk distance (6MWD) were measured at baseline, 11th week, and completion. Furthermore, the outcomes of young-old (65-74 years) and old-old (≥75 years) female subjects were compared. RESULTS: Of 31 subjects, 21 completed the program (completion rate, 67.7%). No adverse events were observed, and none of the subjects discontinued the exercise program because of chest pain, dyspnea, and increased blood pressure. Body weight and blood glucose level were significantly decreased, and 6MWD was significantly increased following program implementation (p<0.05). Both young-old and old-old women exhibited an improvement in blood glucose level and 6MWD test (p<0.05). CONCLUSION: We reported the results of the first attempted CBCR in South Korea that was implemented without adverse events during the entire program. Improved aerobic exercise ability and reduced risk factors in all participants were observed. These improvements were also achieved by older adults aged ≥75 years.