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Abstract Background We conducted a comparative study to examine the differences in the use of complementary therapies (CT) among patients who attended diabetic clinics for follow-up treatment between 2007 and 2023 in Taiwan. Methods This study employed a cross-sectional survey design to recruit individuals with diabetes from two regions (northern and southern) of Taiwan. A total of 183 and 307 participants were included in the surveys of 2007 and 2023, respectively. The data were analyzed using IBM SPSS Statistics version 28.0 to compare the survey results between the two time periods. Results Among the various CTs, nutritional supplements remained the most prevalent, with a significant increase in usage from 68.3% in 2007 to 89.9% in 2023. Conversely, other therapies, such as Chinese herbal medicines, manipulative-based therapies, supernatural healings, and bioelectromagnetic-based therapies, demonstrated a significant decrease in usage between the two time periods. Furthermore, the disclosure rate of CT use to healthcare professionals remained persistently low, with only 24.6% in 2007 and a slight increase to 30.3% in 2023. Conclusion The significant rise in the use of nutritional supplements in conjunction with conventional medicine, without adequate monitoring and guidance from healthcare professionals, poses a substantial risk of unregulated blood sugar control, compromised diabetes management, and potential harm to health outcomes.

The advent of the digital era has catalyzed transformative shifts in educational paradigms, seamlessly integrating sustainable education with innovative pedagogical approaches that cater to a broader spectrum of learners and educators. As the academic landscape evolves into an information-dense environment, traditional models of one-on-one feedback often fall short, resulting in delays and a lack of diverse intellectual engagement. This shift underscores the growing importance of peer feedback and asynchronous post-lesson feedback mechanisms, which have emerged as vital, process-oriented educational activities. Such mechanisms not only address the immediacy and diversity of feedback but also foster a sustainable, collaborative, and engaging learning environment that bolsters student autonomy and interaction. This study conducts a mapping review and synthesis of the literature on peer interaction, assessment, and participatory innovations in online and mobile learning within higher education, covering the period from 1993 to 2022. By employing topic modeling techniques to analyze a corpus of 485 articles, the literature was initially segmented into 19 distinct issues. These were subsequently consolidated into three major thematic models, thereby highlighting significant themes, research focal points, and prospective trends. This analytical process not only enriches the understanding of peer dynamics in digital learning settings but also integrates sustainable educational practices by promoting resource efficiency and inclusivity. The findings serve as a robust reference for future researchers aiming to explore the intersections of technology, peer interaction, and sustainability in educational settings.

For vegetarians or vegan athletes, improving the utilization of plant-based protein and the absorption of amino acids is crucial. This study explored the impact of combining pea protein with Lactiplantibacillus plantarum TWK10 and resistance training on amino acid absorption and exercise performance. Sixteen male and sixteen female participants were randomly assigned to either a control group (20 g of pea protein without TWK10) or a TWK10 group (20 g of pea protein combined with 1 × 1010 colony-forming units of TWK10). After 28 days of supplementation combined with resistance exercise training three times per week. All subjects underwent body composition and muscle strength performance, plasma and fecal samples were collected for microbiota analysis and blood amino acid concentrations. The TWK10 group showed a significant increase in muscle thickness and improvements were observed in 1 repetition maximum bench press, explosive, anaerobic power output compared to before the intervention, and were significantly higher than those in the control group (p

Abstract In this study, Kinesio tape (KT) was applied in two different directions to the gastrocnemius muscle, the most important muscle in stance stability, to investigate the effect of different taping directions on overall balance and sensation systems before versus after muscle fatigue. The participants, comprising 45 healthy athletes, were randomly divided into three groups: the placebo taping group (PTG), the facilitation KT group (FKTG), and the inhibition KT group (IKTG). The tests involved in this study were a balance test, a superficial sensory function test, and a combined cortical sensation test. The data from these tests were collected before taping, after taping and a 10-min rest, and immediately after continuous heel raises were performed to fatigue. The results of the balance tests showed no significant group × time interaction, whether subjects stood barefoot on one foot or stood on a soft mat with eyes open or closed (p > 0.05). Only the sway distance and sway velocity of the center of pressure (COP) when subjects stood barefoot on one foot with eyes open were significantly higher in the inhibition taping group than in the placebo taping group (p

Abundance indices play a crucial role in monitoring and assessing fish population dynamics. Fishery-independent surveys are commonly favored for deriving abundance indices because they follow standardized or randomized designs, ensuring spatiotemporal consistency in representative and unbiased sampling. However, modifications to the survey protocol may be necessary to accommodate changes in survey goals and logistic difficulty. When the survey undergoes changes, calibration is often needed to remove variability that is unrelated to changes in abundance. We evaluated a long-term monitoring program, the Long River Survey (LRS) in the Hudson River Estuary (HRE), to illustrate the process of calibrating survey data to account for the effects of changing sampling protocol. The LRS provided valuable ichthyoplankton data from 1974 to 2017, but inconsistencies in sampling timing, location, and gears resulted in challenges in interpreting and comparing the fish abundance data in the HRE. Generalized Additive Models were developed for five species at various life stages, aiming to mitigate the impact of sampling protocol changes. Model validation results suggest the consistent performance of the developed models with varying lengths of time series. This study indicates that changes in the sampling protocol can introduce biases in the estimates of abundance indices and that the model-based estimates can improve the reliability and accuracy of the survey abundance indices. The model-estimated sampling effects for each species and life stage provide critical information and valuable insights for designing future sampling protocols.

Climate change is known to have significant impacts on coastal marine ecosystems. However, a good understanding of the exact impacts requires consistent long-term monitoring programs, which are not available for many coastal marine ecosystems. The Hudson River Estuary (HRE) provides critical habitats for many estuarine, freshwater, and diadromous species. The Longitudinal River Ichthyoplankton Survey and Water Quality Survey in the Hudson River Biological Monitoring Program provided a long-term time series (1974-2017) for examining the changes in salinity and other environmental variables and identifying the temporal variability of fish diversity. In this study, we examined the environmental data and found a 2-phase pattern in the salinity time series data with a change point of 1984. We calculated a Margalef index and a Simpson index to examine species richness and evenness for early and older life stages in the upper and lower HRE, and explored the potential effects of rising sea level and salinity on fish biodiversity. This study reveals that sea level and salinity may play an important part in explaining increased species richness and evenness. The increased occurrence, establishment and range expansion of marine species as well as possible displacement of freshwater species may be associated with sea level-induced salinity change observed in the HRE. This study highlights a need for a long-term consistent monitoring program and a better understanding of climate change effects on the biota in coastal estuary ecosystems such as the HRE in order to enhance management, conservation, and restoration plans.

Introduction Patients require prolonged mechanical ventilation to overcome respiratory failure in the chronic respiratory care ward; however, how to facilitate ventilator weaning using a nurse-led strategy is limited. Objectives This study aimed to examine the impact of adjusting ventilator trigger sensitivity as inspiratory muscle training on weaning parameters in patients with prolonged ventilator dependence. Methods Multiple pre-test–post-test with a non-equivalent control group design was conducted at a chronic respiratory care ward in southern Taiwan. A convenience sampling method was used to recruit patients who received prolonged mechanical ventilation for more than 21 days into control ( n = 20) and intervention groups ( n = 22). Adjustment of ventilator trigger sensitivity started from 10% of the initial maximum inspiratory pressure and increased to 40% after a training period of six weeks. The weaning parameters were collected for pre-test and multiple post-tests, and statistical analysis of treatment effects was performed using the generalized estimating equation. Results Magnitude of weaning parameters was significantly higher in the intervention group after the six-week training, including maximum inspiratory pressure, rapid shallow breathing index, tidal volume, and ratio of arterial-to-inspired oxygen. Conclusion Adjustment of ventilator trigger sensitivity as inspiratory muscle training can help prolonged ventilator-dependent patients improve their respiratory muscle strength, breathing patterns, and oxygenation.

The northern shrimp (Pandalus borealis) once supported a significant winter fishery in the Gulf of Maine (GOM). However, the population collapsed in 2012 and a fishery moratorium has been in effect since 2014 due to record low levels of spawning stock biomass and persistent recruitment failure. An important parameter in determining population dynamics, fecundity, has not been evaluated for more than 30 years, during which time the GOM has warmed significantly. In this study, we quantified three reproductive characteristics related to fecundity: potential fecundity (PF, number of viable eggs), relative fecundity (RF, number of viable eggs per gram of body weight), and egg size (ES) for GOM northern shrimp. The results showed that PF was strongly related to body size, while RF was independent of body size. Egg size declined with increasing body size for larger females. Egg size is related to size at larval hatch, suggesting that although larger females produced more eggs, those eggs may produce smaller larvae. In contrast with previous studies, PF and RF were positively correlated with bottom temperature in the relatively warm years of our study. We hypothesize that the positive temperature-fecundity relationship we observed may not reflect a direct effect, but possibly a compensatory response relating to decreased population density during the time period of our study. In addition, the environmental effects we observed may to some extent reflect progression of the inshore migration of females. The information derived in this study can help us have a better understanding of environmental effects on reproductive potential for climatically vulnerable species such as the GOM northern shrimp.

The purpose of this study was to clarify the role of saturated fats from cocoa butter (plant source) compared with lard (animal source) on alcoholic liver damage in rats. Male Wistar rats were fed either a control diet (C) or an ethanol diet (E), and the dietary fats (corn oil, olive oil, and safflower oil) of these two diets were further replaced by lard (CL, EL) or cocoa butter (CC, EC). After 8-week feeding, plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, hepatic triglyceride (TG) levels, plasma intercellular adhesion molecular (ICAM)-1 levels, hepatic cytochrome P450 2E1 (CYP2E1) protein expression, and hepatic interleukin (IL)-1β significantly increased in the E group compared to the C group. In addition, hepatic histopathological scores of fatty changes, inflammatory cell infiltration, and degeneration and necrosis in the E group were significantly higher compared to those in the C group. However, fatty changes were significantly inhibited only in the EC group as well as hepatic inflammatory cell infiltration, degeneration, and necrosis being significantly lower in the EL and EC groups. Plasma ICAM-1 and hepatic tumor necrosis factor (TNF)-α, IL-1β, IL-6, and IL-10 levels were significantly lower in the EL and EC groups than those in the E group. Moreover, a correlation analysis showed that hepatic histopathological scores of degeneration and necrosis were significantly positively correlated with erythrocytic oleic acid (C18:1) and were negatively correlated with linoleic acid (C18:2). In conclusion, cocoa butter protected the liver against lipid accumulation and inflammation in rats chronically fed ethanol.

Abstract Objectives This study aimed to develop and validate scales to assess attitudes towards patient’ s use of TCM (APUTCM) and to measure a communicative competence in TCM (CCTCM) among nurses. Methods The instrument development process was conducted from Sep 2013 to Jul 2014, using the following steps: 1) item development; 2) internal review and refinement; 3) face and content validation; 4) instrument administration to a development sample; and 5) evaluation of validity and reliability. A convenience sample was used to recruit registered and advanced practice nurses who worked in different regions throughout Taiwan. A total of 755 respondents completed the online questionnaire. Statistical analyses were performed using the software of SPSS Version 21.0 and Analysis of Moment Structures (AMOS) version 24.0. Results The scale-level indexes (S-CVI) of content validity for both scales were over 80%. The reliabilities for the 13-item APUTCM scale and for the five-item CCTCM scale were 0.88 and 0.84, respectively. The model suitability for both scales was assessed, and the findings revealed suitable parameters for all indicators: GFI = 0.954, AGFI = 0.932, CFI = 0.959, RMSEA = 0.62, and chi-square/df = 3.891 for APUTCM; and GFI = 0.992, AGFI = 0.969, CFI = 0.992, RMSEA = 0.63, and chi-square/df = 4.04 for CCTCM. The convergent and divergent validity of scores on both scales provided evidence in the expected direction. Conclusion This scale development study provides preliminary evidence that suggests that the 13-item APUTCM and the five-item CCTCM are reliable and valid scales for assessing attitudes toward patient’s TCM use and communicative competence in TCM.

There have been no reports on the association of hyperthyroidism with hyperlipidemia in patients undergoing treatment especially in Asia. To determine the association between hyperthyroidism and the risk of hyperlipidemia in patients, we conducted a retrospective cohort study using Longitudinal Health Insurance Database (LHID) from Taiwan, R.O.C. We also evaluate the influence of 6-n-propyl-2-thiouracil (PTU) and methimazole (MMI) on hepatic genes to explain changes in blood lipid levels in a hepatic cell line model. The cohort study involved 13,667 patients with hyperthyroidism, and the corresponding comparison cohort had four times as many patients. Using Kaplan-Meier analysis method, the results showed that, compared to patients without hyperthyroidism, the overall incidence of hyperlipidemia was significantly higher in the hyperthyroidism patients (18.7 vs. 11.8 cases/1,000 persons-years; adjusted HR 1.5; 95% CI, 1.41–1.59). With only PTU or MMI/carbimazole (CBM) treatment, patients with hyperthyroidism showed a 1.78-fold (95% CI, 1.50–2.11) and 1.43-fold (95% CI, 1.27–1.60) higher risk of hyperlipidemia than those without hyperthyroidism, respectively. Additionally, hyperthyroidism patients that received surgery only or surgery with I131 therapy tended to have a higher risk of hyperlipidemia. Although PTU and MMI treatment decreased the expression levels of genes responsible for circulating remnant lipoproteins, they increased the levels of lipogenic gene expression in hepatic cells. Thus, treatment of hyperthyroid patients with anti-thyroid drugs (ATDs), I131, or surgery is likely to induce hyperlipidemia. ATDs downregulate the expression of genes involved in lipoproteins clearance; increases lipogenic genes expression, which may partly contribute to abnormal blood lipid profiles.

Supplementing chicken feed with antibiotics can improve survival and prevent disease outbreaks. However, overuse of antibiotics may promote the development of antibiotic-resistant bacteria. Recently, antimicrobial peptides have been proposed as alternatives to antibiotics in animal husbandry. Here, we evaluate the effects of antimicrobial peptide, Epinephelus lanceolatus piscidin (EP), in Gallus gallus domesticus. The gene encoding EP was isolated, sequenced, codon-optimized and cloned into a Pichia pastoris recombinant protein expression system. The expressed recombinant EP (rEP) was then used as a dietary supplement for G. g. domesticus; overall health, growth performance and immunity were assessed. Supernatant from rEP-expressing yeast showed in vitro antimicrobial activity against Gram-positive and Gram-negative bacteria, according to an inhibition-zone diameter (mm) assay. Moreover, the antimicrobial peptide function of rEP was temperature independent. The fermentation broth yielded a spray-dried powder formulation containing 262.9 μg EP/g powder, and LC-MS/MS (tandem MS) analysis confirmed that rEP had a molecular weight of 4279 Da, as expected for the 34-amino acid peptide; the DNA sequence of the expression vector was also validated. We then evaluated rEP as a feed additive for G. g. domesticus. Treatment groups included control, basal diet and rEP at different doses (0.75, 1.5, 3.0, 6.0 and 12%). Compared to control, rEP supplementation increased G. g. domesticus weight gain, feed efficiency, IL-10 and IFN-γ production. Our results suggest that crude rEP could provide an alternative to traditional antibiotic feed additives for G. g. domesticus, serving to enhance growth and health of the animals.

This study investigated the effects of rowing with different seat cushion and cadence conditions on oxyhemoglobin (O2Hb) and total hemoglobin (tHb) levels of the erector spinae (ES) as well as the effects on heart rate (HR) and ratings of perceived exertion (RPE). Thirty healthy adults completed tests under three unstable air seat cushion pressure levels (0, 80, and 140 mmHg) and three rowing cadences (slow: 18 bpm, medium: 30 bpm, and fast: 36 bpm) on a rowing machine, for a total of nine test conditions. During the exercise period, rowing on cushions set to 80 mmHg resulted in greater O2Hb and tHb changes than did rowing at 0 mmHg (p < 0.05). When rowing cadence increased, the O2Hb and tHb decreased during the exercise period, whereas HR and RPE increased (p < 0.05). During the recovery period, O2Hb and tHb on cushions set to 140 mmHg during slow rowing were higher than those at 0 mmHg during slow rowing and 140 mmHg during fast rowing (p < 0.05). Rowing on an appropriate pressure of seat cushion and using a slow cadence contribute to increasing muscle oxygenation of low back during exercise.

This research investigated how children aged five to six performed in social interactions and participation by learning American English through music technology activities in an inclusive class. The purposes of this research were to analyze, through music technology activities, the social interactions and participation of children in the inclusive class. Therefore, the research question was as follows: can music technology activities significantly improve children’s social interactions and participation in an inclusive class? There were two themes for the research teaching, each of which included seven weeks of instruction. The teaching content involved three stages, which were pre-test, implementation, and post-test. The research teaching was given 40 min per session twice a week and continued for 14 weeks with 28 teaching times. The methodology primarily consisted of a qualitative assessment of participation, observations, and interviews. In addition to collecting and analyzing qualitative data, quantitative data were also employed in the study. Data sources were semi-structured observation forms, anecdote records, language test scales and interview records, and feedback forms. The results indicated that all children had positive performance in social interactions and participating motivation, as supported by statistical results of social validity. Furthermore, the children’s cooperation and communication effectively improved through music technology activities. Nevertheless, the limitation of the study is the insufficient number of participants involved in the evaluation. For future research, utilizing more than 30 samples would be more appropriate and would supplement the social network analysis to carry out more in-depth investigations and discussions.

Background and objectives: Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Materials and Methods: Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. Results: The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program (p < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmH2O to 131.09 ± 28.20 cm H2O in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Conclusions: Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants’ inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.

Background and Objectives: Sleeper stretching (SS) can improve the shoulder’s range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD. Materials and Methods: Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT. Results: The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space. Conclusions: KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.

This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls.Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV.Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls.Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.

The aim of this study was to investigate the ameliorative effects of fish oil on hepatic injury in ethanol-fed rats based on the intestinal permeability and microbiota. Rats were assigned to 6 groups and fed either a control diet or an ethanol diet such as C (control), CF25 (control with 25% fish oil), CF57 (control with 57% fish oil), E (ethanol), EF25 (ethanol with 25% fish oil), and EF57 (ethanol with 57% fish oil) groups. Rats were sacrificed at the end of 8 weeks. Plasma aspartate aminotransferase (AST) and aminotransferase (ALT) activities, hepatic cytokines, and plasma endotoxin levels were significantly higher in the E group. In addition, hepatic histopathological analysis scores in the E group were significantly elevated. Rats in the E group also showed increased intestinal permeability and decreased numbers of fecal Bifidobacterium. However, plasma AST and ALT activities and hepatic cytokine levels were significantly lower in the EF25 and EF57 groups. Histological changes and intestinal permeability were also improved in the EF25 and EF57 groups. The fecal Escherichia coli numbers were significantly lower, but fecal Bifidobacterium numbers were significantly higher in the EF25 and EF57 groups.

Background and objectives: Faced with the serious problem of an aging population, exercise is one of the most effective ways to maintain the health of the elderly. In recent years, with the popularization of smartphones, the elderly have increasingly accepted technological products that incorporate artificial intelligence (AI). However, there is not much research on using artificial intelligence bracelets to enhance elders’ motivation and participation in exercise. Therefore, the purpose of this study is to evaluate the effectiveness of the combination of sports smart bracelets and multi-sport training programs on the motivation of the elderly in Macau. Materials and Methods: The study was conducted with a randomized trial design in a 12 week multi-sport exercise training intervention. According to the evaluation, a total of sixty elders’ pre- and post-test data were included in this study. Results: After 12 weeks of multi-sport exercise training, the evaluation scores on the exercise motivation scale (EMS) increased significantly in the group wearing exercise bracelets and those taking part in the multi-component exercise program, and the degree of progress reached a statistically significant level, but the control group did not show any statistically significant difference. The influence of the combination of sports smart bracelets and multi-sport training programs on elders’ motivation is clearer. Conclusions: The use of sports smart bracelets by elderly people in conjunction with diverse exercise training can effectively enhance elders’ motivation and increase their participation in regular exercise. The combination of sports smart bracelets and multi-sport training programs is worth promoting in the elderly population.