Search

Immune checkpoint inhibitors (ICIs) are widely used for first-line cisplatin-ineligible patients with metastatic urothelial carcinoma (mUC). However, whether to use ICIs as monotherapy or in combination with chemotherapy is still uncertain. We retrospectively analyzed cisplatin-ineligible patients with mUC who underwent first-line ICI monotherapy or ICI plus chemotherapy at 2 medical centers in Taiwan from 2016 to 2021. We calculated the objective response rate, progression-free survival, and overall survival (OS) using the Kaplan-Meier method and Cox regression model for multivariable analysis. In total, 130 patients were enrolled and categorized into 2 groups: an ICI monotherapy group [immunotherapy (IO), n=101] and an ICI plus noncisplatin chemotherapy group [immunotherapy and chemotherapy (IC), n=29]. The median OS of patients in the IO and IC groups was 19.5 and 9.7 months ( P =0.33). Among patients with high programmed cell death ligand-1-expressing tumors, the median OS was significantly prolonged in the IO group compared with the IC group (not reached vs. 6.3 mo, P =0.02). First-line ICI monotherapy demonstrated robust antitumor activity in cisplatin-ineligible patients with mUC. Combining noncisplatin chemotherapy with ICI did not improve clinical outcomes.

Since learning environments have the support of innovational technology, blended learning environments could integrate the physical learning methods with multimedia learning materials, which combines the use of technology with the traditional teaching methods and offers a potential for teachers and students to meet the requirements of learning flexibility and innovation. This study aims to redesign a user-centered Activity System-Based Process Model (ASPM) and integrate the Augmented Reality (AR) into blended learning to implement the Augmented Reality-Based Blended Learning (ARBL) system. There were 57 participants who learned with the ARBL while the control group was made up of 52 students who learned with the Traditional Blended Learning (TBL) approach. Analytical results indicate that the learning outcomes and learning attitude of the ARBL group were better than those of the TBL group. The activity system-based process model could provide a helpful structure in the ARBL to guide course designers, teachers, and researchers for designing the AR learning activity.

Background: Minimally invasive techniques for inguinal herniorrhaphy have focused on developing the laparoendoscopic single-site (LESS) procedure to improve cosmesis. Outcomes of total extraperitoneal (TEP) herniorrhaphy vary considerably because of being performed by different surgeons. We aimed to evaluate the perioperative characteristics and outcomes of patients undergoing the LESS-TEP approach for inguinal herniorrhaphy and to determine its overall safety and effectiveness. Methods: Data of 233 patients who underwent 288 laparoendoscopic single-site total extraperitoneal approach (LESS-TEP) herniorrhaphies at Kaohsiung Chang Gung Memorial Hospital between January 2014 and July 2021 were reviewed retrospectively. We reviewed the experiences and results of LESS-TEP herniorrhaphy performed by a single surgeon (CHC) using homemade glove access and standard laparoscopic instruments with a 50 cm long 30° telescope. Results: Among 233 patients, 178 patients had unilateral hernias and 55 patients had bilateral hernias. About 32% (n = 57) of patients in the unilateral group and 29% (n = 16) of patients in the bilateral group were obese (body mass index ≥ 25). The mean operative time was 66 min for the unilateral group and 100 min for the bilateral group. Postoperative complications occurred in 27 (11%) cases, which were minor morbidities except for one mesh infection. Three (1.2%) cases were converted to open surgery. Comparison of the variables between obese and non-obese patients found no significant differences in operative times or postoperative complications. Conclusion: LESS-TEP herniorrhaphy is a safe and feasible operation with excellent cosmetic results and a low rate of complication, even in obese patients. Further large-scale prospective controlled studies and long-term analyses are needed to confirm these results.

Detrusor underactivity/underactive bladder (DU/UAB) is a disease with great unmet needs and no current approved drug treatment. Extracorporeal shock wave therapy (ESWT) has been shown to improve regeneration of tissue and increase detrusor contractility in preclinical studies of DU/UAB.To assess ESWT as a treatment of DU/UAB.Patients with DU/UAB were enrolled in this phase 2 randomized, double-blind, placebo-controlled, physician-initiated study.The patients were assigned to ESWT (N = 6, 2500 shocks, frequency of four pulses per second, and maximum total energy flow density of 0.25 mJ/mmThe primary endpoint was the average changes in postvoid residual urine (PVR) from baseline to 4 wk after treatment. Other endpoints included the average changes in 3-d voiding diary, global response assessment of patient satisfaction, Underactive Bladder Questionnaire (UAB-Q) score, and urodynamic evaluation.The difference in improvement in PVR was -157.8 ml (95% confidence interval [CI]: -380.1, 64.4) versus -6.6 ml (95% CI: -178.1, 164.9) and -77.5 ml (95% CI: -242.1, 87.1) versus 81.8 ml (95% CI: -137.2, 300.7) for ESWT versus placebo (p = 0.116 and 0.056) at 4 and 12 wk, respectively. The ESWT group exhibited a significant reduction in the UAB-Q score (-4.3; 95% CI: -9.1, 0.4) compared with the placebo group (-0.4; 95% CI: -1.8, 1.0) at 4 wk after treatment (p = 0.025), and the effects were decreased at 12 wk (p = 0.091). This study was limited by small sample size.ESWT was well tolerated with a statistically significant decrease of DU/UAB symptoms and a trend to decrease PVR versus placebo. These results indicate that ESWT may be a promising treatment for DU/UAB and multicenter studies are needed.Bladder shock wave therapy was studied in this randomized, double-blind, placebo-controlled study in patients with inadequate bladder emptying (underactive bladder). Bladder shock wave therapy was found to be well tolerated with an improvement in bladder emptying. These results indicate that bladder shock wave therapy may be a promising treatment for patients who cannot empty their bladder adequately.

BACKGROUND Image-based recognition has become a long-term topic in the field of artificial intelligence, and neuroimaging has gradually become a beneficial way to understand the course of Alzheimer’s disease (AD). OBJECTIVE The goal of this study is to compare the detection performance of convolutional neural networks (CNNs) on medical images to establish a classification model for epidemiological research. However, medical image analysis lacks large labeled training datasets, and thus many transfer learning-based methods have been proposed to solve few labels in the medical field. METHODS Owing to the scarcity of image data from single-photon emission computed tomography (SPECT), this study uses transfer learning to compare the performance of diagnostic methods based on five different CNNs (two lightweight and three deeper-weight CNN models) to determine the most suitable model. Brain scan image data were collected from 36 male and 63 female subjects. This study used 4711 images as the input data for the model. RESULTS The Cognitive Abilities Screening Instrument and Mini Mental State Exam scores of subjects with Clinical Dementia Rating (CDR) of 2 were significantly lower than those of subjects with CDR of 1 and 0.5. These results indicate that the ResNet model (the deeper-weight CNN model) exhibits the highest accuracy (70.79%) and can hence be used to improve the classification of mild cognitive impairment (MCI), mild AD, and moderate AD (CDRs of 0.5, 1, and 2, respectively). CONCLUSIONS This study successfully analyzes the classification performance of different CNN architectures for medical images and also proves the effectiveness of transfer learning in identifying the MCI, mild AD, and moderate AD scoring based on SPECT images.

The purpose of this article is to discuss how to improve the ways the Taiwanese Ground Forces use the common operational picture (COP) for training to improve the efficacy of tactical training and ...

Upper tract urothelial carcinoma (UTUC) is relatively rare in Western countries. The impact of programmed death-ligand 1 (PD-L1) expression on UTUC remains unclear because previous studies have focused on bladder UC. We investigated the association of PD-L1 expression with clinicopathological features and prognosis in patients with UTUC. We retrospectively reviewed the patients with UTUC that we treated at our institute from 2013 to 2018. In total, 105 patients with UTUC undergoing radical nephroureterectomy were analyzed to evaluate the PD-L1 expression on representative whole-tissue sections using the Combined Positive Score (CPS; Dako 22C3 pharmDx assay). A PD-L1 CPS ≥ 10 was considered positive. Among the 105 UTUC cases, 17.1% exhibited positive PD-L1 expression. A CPS ≥ 10 was significantly associated with higher tumor stage (≥ T2, p = 0.034) and lymph node invasion at diagnosis (p = 0.021). A multivariable analysis indicated that a CPS ≥ 10 was an independent prognostic predictor of shorter cancer-specific survival (hazard ratio [HR] = 4.59, 95% confidence interval [CI] = 1.66 − 12.7, p = 0.003) and overall survival (HR = 2.51, 95% CI = 1.19 − 5.27, p = 0.015). A PD-L1 CPS ≥ 10 in UTUC was associated with adverse pathological features and independently predicted worse cancer-specific and overall survival.

Image recognition and neuroimaging are increasingly being used to understand the progression of Alzheimer’s disease (AD). However, image data from single-photon emission computed tomography (SPECT) are limited. Medical image analysis requires large, labeled training datasets. Therefore, studies have focused on overcoming this problem. In this study, the detection performance of five convolutional neural network (CNN) models (MobileNet V2 and NASNetMobile (lightweight models); VGG16, Inception V3, and ResNet (heavier weight models)) on medical images was compared to establish a classification model for epidemiological research. Brain scan image data were collected from 99 subjects, and 4711 images were used. Demographic data were compared using the chi-squared test and one-way analysis of variance with Bonferroni’s post hoc test. Accuracy and loss functions were used to evaluate the performance of CNN models. The cognitive abilities screening instrument and mini mental state exam scores of subjects with a clinical dementia rating (CDR) of 2 were considerably lower than those of subjects with a CDR of 1 or 0.5. This study analyzed the classification performance of various CNN models for medical images and proved the effectiveness of transfer learning in identifying the mild cognitive impairment, mild AD, and moderate AD scoring based on SPECT images.

With the development of such technologies as embedded systems, cloud databases and hardware components, detection of cognitive in the elderly can be made more convenient and accurate. This work develops a novel cognitive assessment interactive embedded system, which consists of a micro-controller unit (MCU), organic light-emitting diode (OLED) modules and a client identification circuit. The reliability of the proposed system is demonstrated in visuospatial memory tests. With its combination of OLED modules and pressable components, the elderly can use the system to perform testing under a flashing light source sequence with tactile feedback. To identify the various pattern arrangements in the Corsi block tapping task (CBTT), the client identification circuit in the proposed system is implemented to compute the number of OLED lighting devices on each column of the wooden base. The data that are collected from each subject will be transferred to cloud servers through a smart phone APP via wireless networks to eliminate recording errors by the experimenter. The functionality of the spatial working memory is verified in experiments that involve the proposed OLED, a computerized version of the CBTT, and 24 participants. Experimental results reveal that the difference in memory span between young and elderly groups is significant, F(1, 92) = 214, p

As technology advanced, new e-health solutions are evolved to empower people to manage their care at home. This study explored the needs for disease management in activity tracking using photo diary through older adults' subjective perspective. It further aimed to suggest which lifestyle measures, symptoms and behaviours would be meaningful to include in such a digital diseases care management program for technology design. Both photo diary and focus group discussion were used, 11 older adults with multiple metabolism-related chronic diseases (Mean age, 72.5 ± 6.14 years) were recruited and asked to carry out the photo diary to trace their living situation and needs using a tablet camera. A focus group discussion was applied to identify the needs of chronic disease management, based on the results of living context tracing. Five themes, regular physical activity, smart management of healthy behaviors, healthy diet, regular daily routine and social connection, were identified by content analysis from photo diary and the focus group discussion. The results indicated that the photo diary program can raise awareness and promotes positive behavior changes. It is believed that the E-approach can be applied to the effectively enhance older adults' self-management by monitoring their health status and their daily routine activities.

High-efficiency electro-optic tuning of microresonators both for TE and TM polarizations is important for versatile advanced photonic applications. This work demonstrates a new device design to realize on-chip lithium niobate microresonators with excellent dual-polarized electro-optic tuning efficiency. The electrode structure is designed such that the produced axial electric field ( Ez ) has an obviously stronger intensity distribution in the guided-wave area of microdisk compared to the radial electric field ( Er ). Thus the large electro-optic coefficient r 13 and r 33 can be effectively utilized for the TE- and TM-polarized electro-optic tuning. The ultra-thin transparent conducting electrode, which is fully covered on the microdisk surface, is utilized with the air-bridge wiring for the production of strong Ez and maintaining a high quality factor of 3.0 × 104. The produced 20μm-diameter lithium niobate microresonators possess the electro-optic tuning efficiency as high as 30.2 pm/V for TE polarization and 24.3 pm/V for TM polarization, which show obvious enhancement compared to the previous works. The highly effective electro-optic tuning of microresonators for dual polarizations offers efficient photonic platforms with the flexible use of any polarization for various photonic applications.

BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Electro-optic tuning by using lithium niobate (LiNbO3) possesses the unique features of sub-picosecond response time, low power consumption, reduced thermal noise, and combination of nonlinear-optic applications. Here, we demonstrate a new device design and fabrication to realize on-chip electro-optically tunable LiNbO3 microresonators with high performance. This device design solves the problem of cancel-out of effective index variation induced by electro-optic effect in the microresonators made of anisotropic materials. Besides, it enables the device functions of high quality factor, polarization-selective electro-optic tuning, and large free spectral range simultaneously with few high-order modes. The microdisk structure with the air-bridge wiring produced by the standard semiconductor process facilitates the realization of integrated photonic circuits. The presented device achieves the electro-optic tuning rate up to 29.2 pm/V and the large free spectral range of 17.1 nm. The proposed device design offers highly-efficient platforms for nonlinear optics, cavity optomechanics, Kerr frequency comb generation, and cavity quantum electrodynamics.

Art is an expression of emotion; art exhibitions bring artists' creations and perceptions to the visitors. International art exhibitions present diverse and high-quality artistic creations through the curator's elaborate exhibition planning, and the connection between artworks and visitors is established to allow visitors to admire and understand; on the contrary, it also challenges the digital communication tools for curators and artists when conducting co-curation remotely. This study utilizes interviews and field study to collect pain points and ultimately provides guidelines and crucial functions for curators and artists to design a visual communication platform during international curation collaboration.

The application of robots will be in various situations soon, including the growing need for remote communication accelerated by the COVID-19 epidemic. The usage rate of instant messaging is higher than regular calling, including text, internet calls, and video calls. Since remote communication is now more convenient and more used than before, it is important to make the user experience in remote communication better and clearer. This research aims to design a robot for remote communication to enhance the social presence of remote objects through the interaction between humans and robots and propose a human-robot interaction model based on this purpose. They focus on people’s emotional expressions since one of the most important parts of communication between humans. In order to make it easier for users to accept the robot and have a nice interactive experience with it, the shape of the robot is designed as a beast-like. A bionic quadruped robot that can move flexibly is used as the design prototype, making it possible to adjust the video lens and screen simultaneously and make rich and diverse interactive actions. In this case, the robot would help its user communicate with others, making the user’s emotion expressed appropriately by the robot’s movement, sound, and facial expression. In order to accomplish these functions, the robot should also be able to recognize human facial expressions and body movements by using camera and image recognition; therefore, the robot can react to those inputs.

In recent years, with the continuous advancement of technology, modern people live in the context of the digital age, they are proficient in various digital technologies, good at using mobile phones, computers, and smart home appliances, some people call them "digital natives". However, despite their familiarity with digital media, few can independently create new projects to solve life's problems. It’s as if they can read but don’t have the ability to write. Gradually, people began to realize the importance of programming languages. Programming education has become an important part of basic education, and more and more people are beginning to attach importance to computer science, programming logic, and computational thinking. Most countries have cultivated students' programming concepts from an early age, but programming languages begin to become abstract and difficult to understand when they reach a certain level. In high school, programming language courses are a difficult subject for many students. Generally, teaching aids are considered to enhance teaching effectiveness, promote learners’ cognition and make it easier to understand. That can help teachers express the content of the course more clearly when teaching. But sometimes, poorly designed teaching aids can become a more troublesome factor for teachers, such as delays in teaching time, leading to student misunderstandings or more problems, etc. Not every teaching aid is suitable as a classroom-aided learning tool. Therefore, this research will take the programming language courses of high school as the background, focus on the difficulties encountered by students in the classroom and design a set of interactive teaching aids “Pixel Button” for teaching algorithmic thinking. It is hoped that through Pixel Button, students' learning motivation and understanding will be enhanced.

Because imbalanced power will cause the loss of the propulsion motor of the railway vehicle, and the increase in temperature will shorten the service life of the electric vehicle. Not only this, but also increase the cost of electricity and maintenance. In the past, the industry only focused on methods to improve power quality such as load capacity, relay setting, and harmonic resolution. Now, the consider of three-phase unbalance rate (TPUR) must be applied. I propose special transformers wiring (STW) to improve the three unbalance rates and provide different transformer wiring methods. According to the IEEE Committee, in the future, power companies will need to install balanced relay stations to improve three-phase unbalance rate. the internal regulations of Taipower must be less than 4.5% (voltage unbalance rate (NPSUR)of 2.5% and motor temperature rise of 12.5%). the derivation of the transformer "three-phase unbalance rate" model is the focus of the railway system. This research is based on the model derivation of different wiring methods to improve the hot problem caused by the three-phase imbalance and improve the service life of the train. And pointed out that Scott, Le-Blanc, Modified-Woodbridge three wiring methods can be applied to future railway system routes to improve the three-phase unbalance rate, in line with the IEEE standard of less than 2%.

We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF)

In this study, we prepared a p-type Ge thin film and then implanted Mn ions in it at room temperature. P-type Ge thin film was made by gallium ion implantation in to an n-type Ge substrate to provide additional hole carriers. Mn ions were implanted into the same layer with Ga ions. Helium ion beam induced epitaxial crystallization with 2 MeV was used to growth GeMn thin films. The results show the beam annealed GeMn sample has been regrowth and has magnetoresistance.

Indonesia, the world’s fourth most populous nation, is an aging country. The significant demographic changes force this middle-income developing country to prepare for the new society. We proposed chatbot usage as a new medium for the baby-boomers to interact. This cohort will or already enter their retirement age soon. We argue this technology suitable due to familiarity with the usage. This research uses quasi-experimental research in the form of within-subject measurement implemented to the people older than 55 years old and user of cross-platform messaging service with simple memory training. A chatbot prototype called Chatty Bot was developed to learn the participants’ ability to detect the features given. Chatty Bot has proven acceptable for its system’s usability and predicted to still be used by the majority of the participants for at least one month. The simple chatbot technology recommended enhances the effective communication channel, related but not limited only to healthy aging.

The rapid growth in the global elderly population and the declining number of the newborn brings about the burden of family caregiving for the elderly, resulting in the rising needs for the elderly to stay in a nursing home. Staying in the nursing home elevates the safety for the elderly. However, the caregivers in the nursing home are not able to pay full-time attention to every elderly due to the shortages of staff and their daily heavy work. It might lead to unexpected accidents happening to the elderly out of the caregivers’ sight and cause a delay for assistance. In addition, the family members of the elderly would like to be aware of the elderly’s health status to ensure the condition and living quality. In this paper, we present the design of The Guardian Slippers as an Internet connected slippers with pressure sensor and Bluetooth modules to estimate the elderly’s health status and report their current locations in the nursing home. We describe in detail how design is applied in relation to IoT, and how the Guardian Slippers support to construct a better caring environment between the elderly, caregivers, and family members. We discuss the subtleness of this design application, its practical usage in the indoor environment of the nursing home, and its challenges on the design aspect. Based on these discussions, we provide future designers a design direction on designing nursing home caring systems for the elderly.

In this study, a system that combines real 360° virtual reality based with a stationary bike. We use a 360° camera to record movies in the real world. The system was developed through Unity Engine and connected to a stationary bicycle through Bluetooth. We provide A) HTC-Vive head-mounted display, HMD, B) PC and C) Android versions for the elderly. In this test, we use HMD and screen as the viewing medium for the feelings of the elderly. The results show that the elderly has a very high willingness and preference for viewing on the screen, and they believe that this system is beneficial for lower limb exercises, but it is not suitable for HMD because it is prone to dizziness. In the future, we will continue to test the tablet and the screen, combined with the heart rate function. We expect that the system can be implemented in elderly life.

Somatosensory game-based rehabilitation has recently experienced rapid increases in demand and scale in the health promotion market. However, the existing research on this topic mostly focuses on treatment efficacy rather than game usability, experience feedback, and the needs of the elderly when experiencing the games. To fill this knowledge gap, we designed a somatosensory interactive game focusing on lower extremity rehabilitation, explored the intention and motivation of elderly patients, and documented the difficulties and needs of these patients in using the game. We enrolled 15 elderly subjects with lower extremity degeneration and collected data using a one-group pre-test and post-test experiment. For the pre-test, the subjects were treated with a traditional lower extremity rehabilitation program for 1 min, followed by a 5-min questionnaire survey. Next, the subjects were asked to play the somatosensory interactive game for 1 min, followed by 15 min of post-test questionnaire survey and interview. The results showed a significant difference between the two types of rehabilitation in the us-ability constructs of “fun”, “liking”, “self-expression”, “self-understanding”, “intention”, and “fatigue” in elderly subjects with no prior rehabilitation experience, indicating that, compared to the traditional ones, the rehabilitation game performed better in introducing rehabilitation to the elders, enhancing their motivation, intention, and increasing their self-confidence. The results also showed that the status of lower extremity disease in elderly users did not affect gameplay. Lastly, we provide suggestions for further improvements in the design of the operational interface, software, and hardware of lower extremity rehabilitation-dedicated somatosensory interactive games.

Training new employees is the most vital part of any vocational industry. Along with the development of digitization, new methods of employee qualification arise. Virtual Reality (VR) can create immersive situations, have great potential in terms of repetitive, high retention rate learning and multi-sensory interaction, and are gradually being applied to training in various fields. Chain coffee shop is an industry with a relatively high demand for manpower. New employee training requires a lot of human resources and costs. Furthermore, the coffee-making process is a more complex training project that requires professionals to guide details and a lot of time to practice. The study chooses Starbucks as a case and proposes a design combining virtual reality and coffee-making training. As an initial attempt to provide insight into utilizing a new technology for better coffee-making training of chain coffee shops’ new employees.

Parkinson’s disease (PD) has an average onset age of 55 years old. Its incidence increases with age. Due to an aging demographic, PD poses an increasing burden on patients and health care resources. PD causes tremors, rigidity, abnormal gait, postural instability, and freezing of gait. These symptoms diminish patients’ quality of life. Continuous rehabilitation of PD patients is more effective in the long term than either pharmacotherapy or surgical treatment. Nevertheless, a patient's motivation for rehabilitation suffers from the difficulties associated with the need for frequent visits to a rehabilitation center. The purpose of this study is to develop a serious game based on augmented reality for the rehabilitation of patients with PD. The game was designed to allow patients with PD to ambulate while following virtual visual cues in a real environment as well as incorporated levels with increasing difficulty. We assess improvements in gait and a sense of balance after 3 weeks of training. The results show that all patients have had improvements in these two outcomes. The results of this study provide references for future study and develop more or methods of playing rehabilitation games.

This work presents a fall detection system that is worn on the head, where the acceleration and posture are stable such that everyday movement can be identified without disturbing the wearer. Falling movements are recognized by comparing the acceleration and orientation of a wearer&rsquo, s head using prespecified thresholds. The proposed system consists of a triaxial accelerometer, gyroscope, and magnetometer, as such, a Madgwick&rsquo, s filter is adopted to improve the accuracy of the estimation of orientation. Moreover, with its integrated Wi-Fi module, the proposed system can notify an emergency contact in a timely manner to provide help for the falling person. Based on experimental results concerning falling movements and activities of daily living, the proposed system achieved a sensitivity of 96.67% in fall detection, with a specificity of 98.27%, and, therefore, is suitable for detecting falling movements in daily life.

The purpose of this study was to investigate methods by which to reduce the dizziness that people experience when watching virtual reality (VR) videos. VR technology is being used in increasing numbers of fields, but a phenomenon that causes dizziness is common. A head-mounted display (HMD) is the device generally worn for viewing virtual reality videos. HMDs put the screen close to the eyes, and users often feel pressure and also experience dizziness. The feeling of dizziness is a result of the unique constitution of each person. In this work, different subjects were selected based on their level of physical fitness. This research showed that haptic feedback caused by vibration during the viewing process can help reduce dizziness. We designed a vibration device, which was mounted on the HMD headband. Through sensing audio from the video, the vibrator is triggered, and the feeling of vibration is feed back to the haptic device. In the study, we used four vibration points, A1, A2, O1, and O2 near the areas of the brain affected by the detection points. The head is a highly sensitive organ that experiences a tactile sensation due to the vibration of the headband when an individual is watching a VR movie, thereby causing inconsistent visual and body perceptions. We found in the current research that the dizziness felt when watching VR video is caused by the inconsistency between visual and cognitive experiences. Typically, the tactile sensation can reduce such cognitive sensations and lower the degree of dizziness experienced by the wearer.

Upper tract urothelial carcinoma (UTUC) is relatively rare in Western countries. The impact of programmed death-ligand 1 (PD-L1) expression on UTUC remains unclear because previous studies have focused on bladder UC. We investigated the association of PD-L1 expression with clinicopathological features and prognosis in patients with UTUC.We retrospectively reviewed the patients with UTUC that we treated at our institute from 2013 to 2018. In total, 105 patients with UTUC undergoing radical nephroureterectomy were analyzed to evaluate the PD-L1 expression on representative whole-tissue sections using the Combined Positive Score (CPS; Dako 22C3 pharmDx assay). A PD-L1 CPS ≥ 10 was considered positive.Among the 105 UTUC cases, 17.1% exhibited positive PD-L1 expression. A CPS ≥ 10 was significantly associated with higher tumor stage (≥ T2, p = 0.034) and lymph node invasion at diagnosis (p = 0.021). A multivariable analysis indicated that a CPS ≥ 10 was an independent prognostic predictor of shorter cancer-specific survival (hazard ratio [HR] = 4.59, 95% confidence interval [CI] = 1.66 - 12.7, p = 0.003) and overall survival (HR = 2.51, 95% CI = 1.19 - 5.27, p = 0.015).A PD-L1 CPS ≥ 10 in UTUC was associated with adverse pathological features and independently predicted worse cancer-specific and overall survival.

In Augment Reality (AR) environment, human perception could help virtual object mixing with real environment to intensify its reality. Human’s sensory sometimes make a cross effect on each other, by controlling visual effects and interactive feedback on touch-screen, we could take advantage of cross-sensory interaction to create a tactile illusion called pseudo-haptic. This investigation would focus on this field, describe the theory and experiment plan of making virtual perception in AR-environment with touch screen interface; implement pseudo-haptic AR system on a Tablet PC, without additional device, generate a sense of touch by pushing and pressing operation, probing into physical property of augmented objects.

Aims Intravesical prostatic protrusion (IPP) is associated with the degree of benign prostatic obstruction. We evaluated the effects of Mirabegron, a selective β3 adrenoceptor agonist, on overactive bladder (OAB) in male patients with different degrees of IPP. Methods About 185 male patients ≥40 years with lower urinary tract symptoms were recruited from a tertiary referral center. OAB was defined by the overactive bladder symptom score (OABSS) urgency score of ≥2 and sum score of ≥3. IPP was measured in the midsagittal section using transrectal ultrasound and patients were divided into IPP ≤5 mm and IPP >5 mm groups. Outcomes were assessed at the baseline, 4, and 12 weeks. Results About 104 patients (56.2%) were diagnosed with OAB and received Mirabegron (50 mg) daily use. Both IPP groups (≤5 and >5 mm) had similar baseline OABSS and International Prostate Symptom Scores (IPSS). Four-week Mirabegron usage was associated with significant decreases in both symptom score measurements, OABSS: IPP ≤5 mm -27.4% and IPP >5 mm -19.7% (P = .419) and IPSS: -32% and -22.5% (P = .202), respectively. Urgency, urge incontinence, and nocturia sub-scores were decreased in both groups, -26.3% and -27.4% (P = .690), 53.3% and 46.2% (P = .916), and 20.8% and 15.4% (P = .958). Effects were maintained at 12 weeks. We found no significant improvement in the frequency sub-score in either group. One patient stopped medication because of intolerable hypertension. Most frequent adverse event was increased residual urine (≥50 mL higher than baseline), IPP ≤5 mm 9.2% and IPP >5 mm 5.1% (P = .707), but no case had acute urinary retention. Conclusions Mirabegron is an effective drug to treat male OAB regardless of IPP grade.

Disease of the lower limb musculoskeletal system is one of the most common diseases in elders. The use of interactive somatosensory games (ISGs) in rehabilitation has been widely used. Most relevant studies have focused on efficacy, while only a few have investigated the difficulties, willingness, and requirements of elderly people in playing the game. Therefore, this study is to design an ISG that is focused on lower-limb rehabilitation and to explore whether the designed ISG can enhance the willingness and motivation of elders to undergo rehabilitation. In this study, 15 elders (5 males and 10 females with average age of 78 years) with degenerative joint disease were recruited to participate in our pretest-posttest design experiments. First, the subjects completed a five-minute pre-test questionnaire after a one-minute traditional rehabilitation (TR). Second, they completed a five-minute post-test questionnaire after a one-minute interactive somatosensory game rehabilitation (ISGR). The average experiment time for each subject was 25 min. We used a t-test to analyze the data. According to the result, there are significant differences in four factors (i.e., interest (t=-6.89, p

An activity in a well-designed virtual environment can provide both a short-term emotional impression and an immersive experience related to personal and cultural experience. In this study, we dissect the “Coming-of-Sixteen” (COS) ritual, a local rite of passage that derives from the Tainan city of Taiwan, and meticulously select kayaking activity as the theme among other related activities. Next, we propose a virtual kayaking experience (VKE) system that includes the physical movement of users using virtual reality (VR) techniques. We adopt real scenes of tradition-based culture as the vision of VR to evoke the motivation of the elderly, and also engage bystanders in the experience through these familiar scenes. To evaluate the feasibility of applying the VKE system to the rehabilitation of elderly people, we conduct two formative user-studies. The results suggest that virtual reality technology provides an opportunity to leverage culturally relevant activities, which can enhance the engagement of the elderly rehabilitation.

Although intention to revisit is increasingly regarded as a key indicator of performance in tourism markets, there are clear gaps in knowledge pertaining to the factors which influence intention to...

Graphical abstract, A compact beam-position monitor was constructed using a linear contact image sensor attached to a plastic scintillator and tested using a 230 MeV proton beam. The results indicate that the beam position can be obtained in real-time, and the beam position with a precision of up to 0.03 mm. The compactness and high precision of the device hold considerable potential for it to be used as a beam-position monitor and offline, daily quality assurance monitor in hadron therapy. • The method can provide a high precision and high resolution beam position for flash irradiation in particle therapy in real-time. • The method using contact image sensor with scintillator does not require a long focal length for camera and it is free of image distortion. • The method can be integrated into medical particle accelerator for feedback control and daily quality assurance.

We report in this paper a new MRI contrast agent based on magnetic nanodiamonds fabricated by Fe ion implantation. The Fe atoms that are implanted into the nanodiamonds are not in direct contact with the outside world, enabling this new contrast agent to be free from cell toxicity. The image enhancement was shown clearly through T2 weighted images. The concentration dependence of the T2 relaxation time gives a relaxivity value that is about seven times that of the regular non-magnetic nanodiamonds. Cell viability study has also been performed. It was shown that they were nearly free from cytotoxicity independent of the particle concentration used. The imaging capability demonstrated here adds a new dimension to the medical application of nanodiamonds. In the future one will be able to combine this capability of magnetic nanodiamonds with other functions through surface modifications to perform drug delivery, targeted therapy, localized thermal treatment and diagnostic imaging at the same time.

Autism spectrum disorders (ASD) are characterized by a reduced ability to appropriately express social greetings. Studies have indicated that individuals with ASD might not recognize the crucial nonverbal cues that usually aid social interaction. Social reciprocity depends on the ability to empathize with others, to be aware of emotional and interpersonal cues, and to respond appropriately; it requires joint attention and nonverbal social skills. Fortunately, there is evidence-based research which shows that augmented reality (AR) attracts the attention of children with ASD and allows them to focus on social cues. AR has also been proved effective for teaching social skills. However, there is a lack of appropriate instructional scaffolds in AR applications to help students organize learning materials. Therefore, in this study, we use AR combined with concept map (CM) strategy as a training tool to focus on the standard nonverbal social cues to teach children with ASD how to appropriately reciprocate when they greet others. The learner can integrate the AR with CM strategy to visually conceptualize the social scenarios in a tabletop role-play training platform. Single-subject research with a multiple-baselines across-subject design was used in this study. Our results showed substantial increases in the children’s target responses during the intervention phases compared with the baseline phases. Generalization probes were administered during baseline (4–8 sessions for 0.5–1 month), intervention (10 sessions for 1.2 months), and maintenance phases (4–8 sessions for 0.5–1 month) to assess the generalization and maintenance of learned skills. The three-phase test data suggest that the AR with CM intervention was moderately effective in teaching the target greeting responses to children with ASD. The practical and developmental implications of the findings are discussed.

In this study, we used Mn ion implantation following with helium ion irradiation to prepare GaMnAs thin film. Extended X-ray absorption fine structure, and X- ray absorption spectrum were applied to analyze the crystalline of Mn implanted GaAs layer. And the results showed implanted Mn ions stand on the substitutional site of Ga ions of GaAs lattice. Also from X-ray absorption spectrum, we confirmed the electronic valence state of Mn ions in the implanted layer were 2+.

We retrospectively enrolled 102 patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy to examine the prognostic value of Ki-67 and programmed cell death ligand-1 (PD-L1). Then, we performed PD-L1 and Ki-67 immunohistochemical staining on whole tissue sections. The cut-off value of PD-L1 positivity was a combined positive score (CPS) ≥10 and the Ki-67 overexpression was 20%. Among the 102 patients, 16.7% and 48.0% showed positive PD-L1 expression and Ki-67 overexpression, respectively. A CPS ≥10 was significantly associated with a higher pathological T stage (p = 0.049). In addition, Ki-67 overexpression was significantly associated with a pathological T stage ≥ 2 (p = 0.027) and tumour necrosis (p = 0.016). In the multivariable analysis, a positive PD-L1 expression was significantly correlated with worse cancer-specific survival (HR = 3.66, 95% CI =1.37−9.77, p = 0.01). However, there was no predictive value using a combination of PD-L1 expression and Ki-67 overexpression as a prognostic predictor. Compared with Ki-67 overexpression, a positive PD-L1 expression with CPS ≥ 10 was a stronger independent prognostic factor for CSS in patients with UTUC.

The physical condition and cognitive ability of older adults tends to decline. This study focused on the development of an augmented reality (AR)-based rehabilitation training system to improve the spatial visualization and mental rotation abilities of elderly people. Using one’s imagination to manipulate objects is common in everyday life. However, training tasks for the elderly are still presented in two-dimension, which research indicates generates a cognitive load that reduces the participants’ interest and diminishes the effects of training. AR can effectively reduce cognitive load, improve one’s sense of spatial direction, and increase participants’ interest in training. Therefore, this study used AR technology, combined with a tangible user interface as a manual controller, to allow participants to directly manipulate a virtual three-dimensional model that used a cube to conduct mental rotation tasks (MRT) for the elderly to improve their mental rotation ability. After 6 weeks of intervention, we used an ABA (reversal) design and paired-sample t tests in SPSS to compare the learning effects on the experimental group’s pre- and posttests. The participants’ error rates significantly declined and their reaction times significantly improved during the MRT test.

In this study, an augmented reality-based multidimensional concept map (ARMCM) learning system is proposed for conducting mobile learning activities. The subjects consisted of 65 students with an average age of 11 years in an elementary school in Taiwan. They were divided into an ARMCM group and a multidimensional concept map (MCM) group. An experiment was conducted to evaluate the effectiveness of the proposed approach. The experimental results suggested that students in the ARMCM group performed significantly better than those in the MCM group. Moreover, this study also found that the students using the ARMCM learning approach showed significantly higher motivation than those using the MCM learning approach, because ARMCM learning is able to simulate the complex knowledge that they needed to learn. ARMCM learning was easier to understand and easy to use, as it could simplify the content of the learning knowledge. Pedagogical implications, conclusion, and some suggestions based on this study are provided.

We present electrical spin injection and detection in p-type Ge channels using Ni/Al2O3/Ge on glass tunneling contacts. The entire structure is integrated on a glass substrate. We investigate the temperature dependence of the Hanle effect in a composite p-type Ge on glass (GeOG), using three-terminal configuration Hanle measurements; from these measurements, we observe spin accumulation up to room temperature. A spin signal of 0.3 V and a spin lifetime of 34 ps are obtained at room temperature.

Post-travel experiences influence whether a tourist decides to revisit a destination. Tourists usually use souvenirs as triggers to connect with their past travel. We have created a cloud-based mobile augmented reality (AR) system (MARS) accessible via, for example, a theme park's entrance ticket. MARS can auto-grab information from the theme park's website's real-time information and broadcast special events displayed by AR mode. MARS makes recalling one's travel experience more vivid because it becomes both visualized and interactive. Moreover, MARS is intended to increase tourists' motivation to revisit. The system is intended to enhance a tourist's post-travel experience. This gives the post-travel experience new value, and increases motivation to revisit.