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Educational chatbots are gaining momentum due to their distinctive affordances of interactivity, immediacy, ease of use, and individualized experience. However, a fairly limited body of literature discusses how a chatbot can facilitate collaborative learning among peers in extensive reading contexts to encourage more vibrant interactions supporting further interest development. Therefore, this research aimed to analyze the affordances and limitations of a chatbot to facilitate human-human interactions by incorporating the refined Academically Productive Talk framework for nurturing a learning community, forming accurate knowledge, fostering rigorous thinking, and encouraging affective responses for elementary school learners. Specifically, the purpose of the research was to observe the situational interest of the learners, their interaction patterns, and their social learning behaviors. This research developed a chatbot stored with 64 children's storybooks to initiate and facilitate peer dialogues. A group of 30 learners were paired up to conduct two chatbot-facilitated dialogic reading activities. A total of 30 discourse logs and students' feedback on a survey of situational interest were analyzed. The discourse analysis of this research supports the affordances of the chatbot acting as an effective dialogue initiator and discussion facilitator to support both human-chatbot and human-human social learning. The chatbot encourages a diverse interactive dialogic climate, and four interaction patterns were identified. The situational interest of the initial encounter with the chatbot was boosted; however, their interest was unable to be sustained. The implications for the affordances and limitations of educational chatbots are discussed.

Reading requires appropriate strategies to spark initial interest and sustain engagement. One promising strategy is the pedagogical approach of learning-by-teaching, transforming learners into active participants. Integrating this approach into digitalized and individualized reading contexts has the potential to foster the development of young readers. Currently, AI techniques are primarily used in chatbots as tutors, with limited focus on tutee chatbots that employ the learning-by-teaching pedagogy. Therefore, this study adopted a teachable Q&A agent and probed into the effect of chatbot training, employing AI techniques and utilizing student-generated questions and answers, with the aim of enhancing students' reading interest and engagement. Ninety-five fifth graders participated in a 9-week reading program. A quasi-experimental design was conducted. The results proved that incorporating a learning-by-teaching approach into the chatbot training activity significantly enhanced their reading interest and engagement. However, the quantity of certain question types is negatively correlated with interest and engagement. This implies that asking diverse questions poses a certain level of challenge to young readers, which requires deliberate training and incubation. Additionally, the identification of four distinct student clusters exhibited the affordances and limitations of tutee chatbots for reading.

This study proposed and implemented a blended self-directed learning program for English-as-a-Foreign-Language (EFL) college students beyond the classroom. Adopting a case study-mixed methods design, the study aimed to investigate (1) learners' engagement in the program, (2) the effects of the program, and (3) learners' perceptions of the affective, resource, and capacity supports offered by the program. Thirty-six students voluntarily participated in a 12-week self-directed listening program, which offered both in-person and online learning resources along with mechanisms designed to support students' self-regulated learning outside of the classroom. Data collection included (1) TOEFL listening pre-and post-test scores, (2) Metacognitive Awareness Listening Questionnaire (MALQ) preand post-test scores, (3) an English learning motivation questionnaire, (4) learning diaries, (5) activity participation records, (6) an end-of-program questionnaire, and (7) end-of-program interviews. The findings showed that participants perceived learning flexibility within the program as both a pivotal strength and a notable weakness. The participants, who generally demonstrated reactive autonomy, actually depended on, and expected various forms of external regulation to sustain their learning motivation. Also, the highly engaged learners had more growth in metacognitive awareness of listening than did less engaged ones. By engaging in self-directed learning, learners actively exercised their agency to (re)construct their personal language learning ecologies, a process that was found to require teacher guidance.

Abstract The prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) and carbapenem-resistant Enterobacterales (CRE) has become a global public health problem. ESBL-E/CRE colonization can increase the risk of infection in patients and lead to poor disease prognosis. We conducted a systematic review and meta-analysis to evaluate current decolonization strategies regarding ESBL-E/CRE and their efficacy. A literature search was conducted until August 2023 on the five databases to review decolonization strategies associated with ESBL-E/CRE. A meta-analysis was conducted using RevMan 5.4 to compare differences in the decolonization strategy with placebo controls. The primary outcome was decolonization rates, with secondary outcomes of attributable death and adverse events. Quality of identified studies was determined using the Newcastle–Ottawa scale and cochrane risk assessment tool. Random and fixed effects meta-analyses were performed to calculate pooled value. A total of 25 studies were included. In five randomized controlled trial (RCT) studies, the decolonization effect of selective digestive decontamination(SDD) on ESBL-E/CRE at the end of treatment was significantly better in the experimental group than the controls [risk radio (RR): 3.30; 95% CI 1.78–6.14]. In three n-RCT studies, the decolonization effect in the experimental group was still better than the controls one month after SDD therapy [odds ratio (OR): 4.01; 95% CI 1.88–8.56]. The combined decolonization rates reported by six single-arm trial studies of SDD therapy ranged from 53.8 to 68.0%. Additionally, TSA analysis confirmed the effectiveness of SDD therapy. In studies on Faecal microbiota transplantation (FMT) therapy, the decolonization effect of the experimental group was significantly better than the controls 1 month after treatment (OR: 2.57; 95% CI 1.07–6.16). In studies without a control group and with varying follow-up times, the decolonization rates varied widely but indicated the effectiveness trend of FMT therapy (61.3–81.2%). Currently, research on the decolonization effect of probiotic therapy on ESBL-E/CRE is insufficient, and only a systematic review was conducted. SDD and FMT strategies have short-term benefits for ESBL-E/CRE decolonization, but long-term effects are unclear. The effect of probiotic therapy on ESBL-E/CRE decolonization is an interesting topic that still requires further investigation.

AIM:To test and compare the perceptual eye position and fixation stability of adolescents with emmetropia and adolescents with low myopia, investigating the characteristics of the perceptual eye position and fixation stability of adolescents with low myopia.METHODS: Cross-sectional study. A total of 132 adolescents(264 eyes)who visited in the ophthalmology clinic of our hospital from April to December 2023 were randomly selected as the research subjects. Participants were categorized into normal control group(n=45, 90 eyes), simple low myopia group(n=45, 90 eyes)and low myopia with anisometropia group(n=42, 84 eyes)according to their refractive status and were underwent assessments for perceptual eye position and fixation stability.RESULTS: Compared with the normal control group, the static and dynamic horizontal perceptual eye position deviation of the simple low myopia group and the low myopia with anisometropia group were significantly increased(P0.05); compared with the normal control group, the horizontal and vertical fixation stability of the simple low myopia group and the low myopia with anisometropia group were significantly worse(all P0.05).CONCLUSION: Abnormalities are observed in perceptual eye position and fixation stability function in adolescents with low myopia compared with those adolescents with emmetropia, even at best corrected visual acuity. The occurrence of anisometropia could lead to an increased degree of horizontal perceptual eye position displacement.

Computer-simulated experiments have been gaining popularity over hands-on experiments in science education, given the availability of technology and the trend of distance learning. Past studies have focused primarily on comparing the learning outcomes and user experiences of the two experiment modes. In this study, we used an eye tracker to investigate the learning processes involved in manipulating hands-on and computer-simulated experiments, and the effect of prior knowledge and experiment mode on eye movements. A total of 105 undergraduates completed either mode of experiment to learn about pulley mechanics. Participants were asked to read relevant concepts before conducting the experiments to ensure they had basic knowledge about the subject matter. Results showed that the learning outcome of experimentation was affected by prior knowledge but not experiment mode. As for eye movements, the two experiment workstations were divided into nine functional regions. The findings revealed that eye movements in most regions were affected by the experiment mode, but not prior knowledge. The simulation group had shorter total fixation durations and smaller pupil sizes than the hands-on group, implying a lower cognitive load in learning in computer-simulated experiments. Lag sequential analysis and entropy analysis were conducted on cross-regional fixation transitions. The results revealed that participants in hands-on experiments tended to make more diversified fixation transitions across regions, whereas those in simulated experiments showed a higher level of concentration in the spatial pattern of fixation transitions. While sequential analysis offers insights into important fixation transitions on a regional level, entropy analysis allows for a more macro perspective on the overall transition distribution and facilitates conventional statistical modeling that takes individual differences into account.

Cancer stem cells (CSCs) have emerged as key contributors to tumor initiation, growth, and metastasis. In addition, CSCs play a significant role in inducing immune evasion, thereby compromising the effectiveness of cancer treatments. The reciprocal communication between CSCs and the tumor microenvironment (TME) is observed, with the TME providing a supportive niche for CSC survival and self-renewal, while CSCs, in turn, influence the polarization and persistence of the TME, promoting an immunosuppressive state. Consequently, these interactions hinder the efficacy of current cancer therapies, necessitating the exploration of novel therapeutic approaches to modulate the TME and target CSCs. In this review, we highlight the intricate strategies employed by CSCs to evade immune surveillance and develop resistance to therapies. Furthermore, we examine the dynamic interplay between CSCs and the TME, shedding light on how this interaction impacts cancer progression. Moreover, we provide an overview of advanced therapeutic strategies that specifically target CSCs and the TME, which hold promise for future clinical and translational studies in cancer treatment.

Ovarian cancer (OC) is highly lethal due to late detection and frequent recurrence. Initial treatments, comprising surgery and chemotherapy, lead to disease remission but are invariably associated with subsequent relapse. The identification of novel therapies and an improved understanding of the molecular and cellular characteristics of OC are urgently needed. Here, we conducted a comprehensive analysis of primary tumor cells and their microenvironment from 16 chemonaive and 10 recurrent OC patient samples. Profiling OC tumor biomarkers allowed for the identification of potential molecular targets for developing immunotherapies, while profiling the microenvironment yielded insights into its cellular composition and property changes between chemonaive and recurrent samples. Notably, we identified CD1d as a biomarker of the OC microenvironment and demonstrated its targeting by invariant natural killer T (iNKT) cells. Overall, our study presents a comprehensive immuno-profiling of OC tumor and microenvironment during disease progression, guiding the development of immunotherapies for OC treatment, especially for recurrent disease.

Abstract To detect the contaminate of faucets in hospitals and the splash during hand washing, and to explore the reasonable layout of hand washing pools. Two faucets with roughly the same spatial layout in the ICU of a third-class first-class general hospital were selected, and the farthest splashing distance and specific splashing points were measured by color paper. Samples were detected by ATP detection technology and routine microbial detection method, and the contaminate of faucets was analyzed. After 72 h of daily hand-washing activities, the furthest distance to the splash point was about 100 cm around the faucet, and the place 40–110 cm around the faucet was contaminated seriously. The farthest distance that the splash point reached was about 80 cm around the faucet with the center of the circle, and the area 40–60 cm around the faucet was heavily contaminated. The distance from the water outlet of the long handle and the short handle faucet to the detection point had a high negative correlation (r = − 0.811, P

Abstract Background Neuronal guanine nucleotide exchange factor (NGEF) plays a key role in several cancers; however, its role in lung adenocarcinoma (LUAD) remains unclear. The aim of this study was to evaluate the efficacy of NGEF as a prognostic biomarker and potential therapeutic target for LUAD. Methods NGEF expression data for multiple cancers and LUAD were downloaded from multiple databases. The high- and low-NGEF expression groups were constructed based on median NGEF expression in LUAD samples, and then performed Kaplan–Meier survival analysis. Differentially expressed genes (DEGs) from the two NGEF expression groups were screened and applied to construct a protein-protein interaction network. The primary pathways were obtained using gene set enrichment analysis. The associations between NGEF expression and clinical characteristics, immune infiltration, immune checkpoint inhibitors (ICIs), sensitivity to chemotherapy, and tumor mutation burden (TMB) were investigated using R. Levels of NGEF expression in the lung tissue was validated using single-cell RNA sequencing, quantitative polymerase chain reaction (qPCR), immunohistochemical staining, and western blot analysis. Results The expression of NGEF mRNA was upregulated in multiple cancers. mRNA and protein expression levels of NGEF were higher in patients with LUAD than in controls, as validated using qPCR and western blot. High NGEF expression was an independent prognostic factor for LUAD and was associated with advanced tumor stage, large tumor size, more lymph node metastasis, and worse overall survival (OS). A total of 182 overlapping DEGs were screened between The Cancer Genome Atlas and GSE31210, among which the top 20 hub genes were identified. NGEF expression was mainly enriched in the pathways of apoptosis, cell cycle, and DNA replication. Moreover, elevated NGEF expression were associated with a high fraction of activated memory CD4+ T cells and M0 macrophages; elevated expression levels of the ICIs: programmed cell death 1 and programmed cell death 1 ligand 1 expression; higher TMB; and better sensitivity to bortezomib, docetaxel, paclitaxel, and parthenolide, but less sensitivity to axitinib and metformin. Conclusion NGEF expression is upregulated in LUAD and is significantly associated with tumor stages, OS probability, immune infiltration, immunotherapy response, and chemotherapy response. NGEF may be a potential diagnostic and prognostic biomarker and therapeutic target in LUAD.

Objective To provide an initial understanding of problems and potential solution strategies for part-time clinical pharmacist work in China, and provide references for the training of part-time clinical pharmacists.Methods The study was conducted in a tertiary teaching hospital in China, and the project lasted 6 months. Phenomenological methods were used to guide the research design. Research data were obtained by conducting one-to-one semistructured interviews with part-time clinical pharmacists, and interview data were coded and analysed through thematic analysis.Results A total of 21 pharmacists were interviewed in a semistructured manner, and the results showed that following problems exist in the work of part-time clinical pharmacists: the existing professional knowledge is not adequate to meet the demands of clinical service; the career orientation of part-time clinical pharmacists is not clear; lack of professional self-confidence in clinical pharmacy practice; there is no suitable entry point to carry out pharmacy service work; it is difficult to communicate effectively, and for in addition, 17 potential solution strategies are proposed for the current problems, which can provide reference for the development of part-time clinical pharmacists’ work.Conclusions The work performed by part-time clinical pharmacists is currently immature and the strategies derived from this study may serve as potential solutions to resolve the part-time clinical pharmacy practice challenges.

This paper describes a new automated disengagement tracking system (DTS) that detects learners' maladaptive behaviors, e.g. mind-wandering and impetuous responding, in an intelligent tutoring system (ITS), called AutoTutor. AutoTutor is a conversation-based intelligent tutoring system designed to help adult literacy learners improve their reading comprehension skills. Learners interact with two computer agents in natural language in 30 lessons focusing on word knowledge, sentence processing, text comprehension, and digital literacy. Each lesson has one to three dozen questions to assess and enhance learning. DTS automatically retrieves and aggregates a learner's response accuracies and time on the first three to five questions in a lesson, as a baseline performance for the lesson when they are presumably engaged, and then detects disengagement by observing if the learner's following performance significantly deviates from the baseline. DTS is computed with an unsupervised learning method and thus does not rely on any self-reports of disengagement. We analyzed the response time and accuracy of 252 adult literacy learners who completed lessons in AutoTutor. Our results show that items that the detector identified as the learner being disengaged had a performance accuracy of 18.5%, in contrast to 71.8% for engaged items. Moreover, the three post-test reading comprehension scores from Woodcock Johnson III, RISE, and RAPID had a significant association with the accuracy of engaged items, but not disengaged items.