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Abstract Background Empathy and communication are critical abilities for nursing students, and in recent years, scenario-based teaching has played a crucial role in fostering empathy and professional skill development. However, novice nursing students in basic nursing education often lack prior experience in patient communication, making it challenging for them to prepare adequately for scenarios and effectively handle difficulties in real-life situations. This deficiency also hampers participants’ or observers’ ability to engage in deep reflection, feedback, and learning. Consequently, students frequently experience anxiety in patient communication, and the effectiveness of empathy building remains limited. The aim of the study was to use empathy mapping and mini-simulation in learning to enhance nursing students’ empathy and self-confidence in communication. Methods A prospective quasi-experimental research design was employed, targeting second-year students in the four-year nursing program at our institution, specifically in the Basic Nursing and Experimentation II class. The students were randomly divided into two groups: an experimental group and a control group, with a total of 98 students (52 in the experimental group and 46 in the control group). The experimental group received instruction using empathic communication digital materials and engaged in empathy mapping exercises, while the control group underwent conventional scenario-based teaching. Pre-test and post-test data were collected from both groups. Results A total of 98 students participated in the study, with 46 students in the control group and 52 students in the experimental group. The average age of the participants was 19.19 ± 0.53 years, with a predominance of females (82.7%). At the end of the semester, there was no significant difference in the average empathy levels between the two groups. However, the communication confidence levels of students in the control group (40.20 ± 6.54) were significantly lower than those in the experimental group (43.88 ± 6.35) (P = 0.006). Conclusions This teaching approach facilitated deeper and broader student learning, enhancing both empathy and communication confidence. The teaching materials developed in this study can be employed in future courses to teach empathy and patient communication effectively.

Via microstructural characterization analysis and mechanical properties tests, the present study primarily focused on exploring the effect of hot deformation strain on the phase transformation behavior in Ti–Mo precipitation hardening stainless steels (PHSSs). Interestingly, under the fixed ageing condition, it was found that more reverted austenite formed when the Ti–Mo PHSSs were subjected to a large amount of hot deformation strain, which could be attributed to the more retained austenite achieved during deep cryogenic treatment. In other words, a positive correlation between retained austenite and reverted austenite prevailed in Ti–Mo PHSS. Furthermore, when the ageing temperature was increased from 520 °C to 640 °C, the KAM distribution lines shifted to higher angles under the lower strain, i.e. ε = 35 %, whereas under large strain (ε = 70 %), the positions of the KAM distribution lines remained at similar sites. This finding implies that higher thermal stability of reverted austenite was achieved when the Ti–Mo PHSS was subjected to large hot deformation strains. The above metallurgical phenomenon was further verified by Vickers hardness measurement. For example, under the fixed ageing temperature of 520 °C, the distributions of HV0.1 values were 480–680 and 370–660, respectively, for Ti–Mo PHSSs subjected to hot deformation strains of 35 % and 70 %, respectively. These results also corroborate the formation of more soft reverted austenite under the larger hot deformation strain.

Abstract Background Undetected atrial fibrillation (AF) poses a significant risk of stroke and cardiovascular mortality. However, diagnosing AF in real-time can be challenging as the arrhythmia is often not captured instantly. To address this issue, a deep-learning model was developed to diagnose AF even during periods of arrhythmia-free windows. Methods The proposed method introduces a novel approach that integrates clinical data and electrocardiograms (ECGs) using a colorization technique. This technique recolors ECG images based on patients' demographic information while preserving their original characteristics and incorporating color correlations from statistical data features. Our primary objective is to enhance atrial fibrillation (AF) detection by fusing ECG images with demographic data for colorization. To ensure the reliability of our dataset for training, validation, and testing, we rigorously maintained separation to prevent cross-contamination among these sets. We designed a Dual-input Mixed Neural Network (DMNN) that effectively handles different types of inputs, including demographic and image data, leveraging their mixed characteristics to optimize prediction performance. Unlike previous approaches, this method introduces demographic data through color transformation within ECG images, enriching the diversity of features for improved learning outcomes. Results The proposed approach yielded promising results on the independent test set, achieving an impressive AUC of 83.4%. This outperformed the AUC of 75.8% obtained when using only the original signal values as input for the CNN. The evaluation of performance improvement revealed significant enhancements, including a 7.6% increase in AUC, an 11.3% boost in accuracy, a 9.4% improvement in sensitivity, an 11.6% enhancement in specificity, and a substantial 25.1% increase in the F1 score. Notably, AI diagnosis of AF was associated with future cardiovascular mortality. For clinical application, over a median follow-up of 71.6 ± 29.1 months, high-risk AI-predicted AF patients exhibited significantly higher cardiovascular mortality (AF vs. non-AF; 47 [18.7%] vs. 34 [4.8%]) and all-cause mortality (176 [52.9%] vs. 216 [26.3%]) compared to non-AF patients. In the low-risk group, AI-predicted AF patients showed slightly elevated cardiovascular (7 [0.7%] vs. 1 [0.3%]) and all-cause mortality (103 [9.0%] vs. 26 [6.4%]) than AI-predicted non-AF patients during six-year follow-up. These findings underscore the potential clinical utility of the AI model in predicting AF-related outcomes. Conclusions This study introduces an ECG colorization approach to enhance atrial fibrillation (AF) detection using deep learning and demographic data, improving performance compared to ECG-only methods. This method is effective in identifying high-risk and low-risk populations, providing valuable features for future AF research and clinical applications, as well as benefiting ECG-based classification studies.

Abstract Background Previous research has demonstrated that atrial fibrillation (AF) ablation improves heart function variably among patients. We proposed that the ANTWERP score, which was validated in a European group of patients with low left ventricular ejection fraction (LVEF) who had AF ablation, would be valid in an Asian group as well. The purpose of the study is to examine how well a new scoring system (the ANTWERP score) can predict heart function improvement after atrial fibrillation ablation in Asian patients with heart failure. Methods A retrospective review was conducted on patients (n = 84) undergoing AF ablation between January 2019 and June 2022. Initial diagnoses for impaired LV systolic function were confirmed by echocardiography. Patients meeting the “2021 Universal Definition of HF” criteria for LVEF recovery were classified as “responders.” Results Similarities were observed between responders and nonresponders regarding comorbidities, AF type, and LVEF, except for the left ventricular internal diameter in diastole. A higher percentage of responders had an ANTWERP score ≤2 (87.8%) compared to those with a score >2 (55.6%). LVEF improvement was notably higher in the former group (+14.8% vs. +9.4%, p = .043). Atrial reverse remodeling and recurrent atrial arrhythmia rates were similar across groups. Conclusion The conclusion of the study was that the ANTWERP score effectively predicted LVEF improvement after atrial fibrillation ablation in the Asian population and that this scoring system could be used to guide clinical decisions and prognosis prediction.

Although the ageing process is the most important metallurgical process influencing the austenite reversion reaction, the role of retained austenite existing after cryogenic treatment on austenite reversion transformation is still not fully explored. Therefore, via different cooling modes, i.e. water quenching (WQ), air cooling (AC), and furnace cooling (FC), applied after austenitization treatment, different amounts of retained austenite, namely 0.3 % (WQ), 0.5 % (AC), and 1.2 % (FC), were formed in the martensite matrix of Ti–Mo precipitation hardening stainless steels (PHSSs). Interestingly, even under the same ageing treatment condition, i.e. 520 °C for 4 h, the amount of reverted austenite that formed in Ti–Mo PHSSs strongly depended on the cooling rate used. For instance, according to EBSD phase maps, the reverted austenite contents were 24.7 %, 15.0 %, and 9.4 % in the steel specimens cooled by FC, AC and WQ, respectively. Therefore, a positive correlation was found between retained austenite and reverted austenite after comparison of the overall EBSD analysis results. In addition, it was found that the strength and ductility trade-off relationship was improved in steel samples subjected to the slow cooling treatment, as numerous η-Ni3Ti precipitates and larger amounts of reverted austenite formed simultaneously during the ageing treatment.

Background: Oxaliplatin is commonly used to treat gastrointestinal malignancies. However, its applications are limited due to potential adverse drug reactions (ADRs), particularly severe anaphylactic shock. There is no method to predict or prevent ADRs caused by oxaliplatin. Therefore, we aimed to investigate the genetic HLA predisposition and immune mechanism of oxaliplatin-induced ADRs. Methods: A retrospective review was performed for 154 patients with ADRs induced by oxaliplatin during 2016–2021 recorded in our ADR notification system. HLA genotyping was conducted for 47 patients with oxaliplatin-induced ADRs, 1100 general population controls, and 34 oxaliplatin-tolerant controls in 2019–2023. The in vitro basophil activation test (BAT) was performed and oxaliplatin-specific IgE levels were determined. Results: The incidence of oxaliplatin-induced ADRs and anaphylactic shock in our cohort was 7.1% and 0.15%, respectively. Of the 154 patients, 67.5% suffered rash/eruption; 26.0% of the patients who could not undergo oxaliplatin rechallenge were considered to show oxaliplatin-induced immune-mediated hypersensitivity reactions (HRs). The genetic study found that the HLA-DRB∗12:01 allele was associated with oxaliplatin-induced HRs compared to the general population controls (sensitivity = 42.9%; odds ratio [OR] = 3.4; 95% CI = 1.4–8.2; P = 0.008) and tolerant controls (OR = 12; 95% CI = 2.3–63.7; P = 0.001). The in vitro BAT showed higher activation of CD63+ basophils in patients with oxaliplatin-induced HRs compared to the tolerant controls (P

Background: Superabsorbent polymers (SAPs) have a remarkable ability to absorb significant quantities of water. However, their absorption capacity is significantly reduced when exposed to saline solutions, such as urine, due to the polyelectrolyte effect and charge screening. Methods: In this study, we demonstrate a zwitterionic superabsorbent polymer (ZSAP) with excellent salt-water absorption and retention capacities. ZSAP was synthesized by grafting a copolymer of p(sulfobetaine methacrylate-co-2-hydroxyethyl methacrylate) (p(SBMA-co-HEMA)) onto an acrylic acid (AA)-based hydrogel via free-radical polymerization. The introduction of zwitterionic SBMA significantly enhances the hydrophilicity of the polymer, particularly in a saline solution due to the anti-polyelectrolyte effect, thereby accelerating the rate of salt absorption. Additionally, the hydroxyl groups from HEMA facilitate the formation of covalent bonds with the AA network membrane through esterification, effectively mitigating polymer leaching. The hydration/dehydration behaviors of linear polymers were measured using the dynamic vapor sorption (DVS) method. Moreover, the salt-water absorption capacity, centrifuge retention capacity (CRC), and absorbency under load (AUL) of ZSAP with various SBMA moieties and copolymer dosages were comprehensively evaluated in a 0.9 wt% sodium chloride solution. Additionally, the water retention under different temperatures and polymer leaching of ZSAP were investigated. Significant Findings: The copolymer p(SBMA-co-HEMA) not only demonstrates a high salt-water absorption rate at 90% RH in a 0.9 wt% NaCl solution but also exhibits superior water retention at 0% RH compared to the AA polymer. Moreover, the ZSAP exhibits superior salt-water absorption capacity and AUL in a 0.9 wt% NaCl solution compared to conventional AA-based SAP. Additionally, the introduction of the hydroxyl moiety from the p(SBMA-co-HEMA) copolymer reduces free polymer leaching from ZSAP. This work presents an approach for the development of new SAP with high salt-water absorption and retention.

Introduction: Obesity has arisen as a prominent risk factor for COVID-19 severity and long COVID, potentially owed in part to the obesity-induced proinflammatory state. This study aimed to examine relationships among circulating inflammatory biomarkers and body mass index in nonhospitalized adults recently diagnosed with COVID-19. Methods: This analysis included participants who completed a randomized placebo-controlled trial conducted in October 2020–March 2021. Participants (19–53 years) were unvaccinated and enrolled following COVID-19 diagnosis as allowed by CDC return-to-work guidance. Anthropometrics and biomarkers were assessed at study baseline and week four. We examined the associations between body mass index (BMI) and inflammatory biomarkers via multiple regression models. Results: At study baseline (i.e., the point of enrollment following COVID-19 diagnosis) across all participants (N = 60), a higher BMI was associated with elevations in several inflammatory biomarkers including IL-6 (β = 7.63, 95% CI = 3.54, 11.89, p = 0.0004), ferritin (β = 6.31, 95% CI = 1.97, 10.83, p = 0.0047), high sensitivity C-reactive protein (β = 13.1, 95% CI = 8.03, 18.42, p = < 0.0001), tumor necrosis factor-α (β = 3.23, 95% CI = 0.91, 5.60, p = 0.0069), IL-12p40 (β = 3.69, 95% CI = 0.93, 6.52, p = 0.0094), IL-13 (β = 5.11, 95% CI = 1.00, 9.40, p = 0.0154), and IL-1Ra (β = 7.57, 95% CI = 3.61, 11.70, p = 0.0003). In control group participants (n = 30) after 4 weeks, a higher BMI was associated with elevations in IL-4 (β = 17.8, 95% CI = 0.84, 37.6, p = 0.0397) and sP-selectin (β = 1.16, 95% CI = 0.22, 2.11, p = 0.0182), controlling for baseline and covariates. Conclusions: Here, BMI was positively associated with circulating biomarkers of platelet activation and inflammation in adults recently diagnosed with COVID-19 after 4 weeks. The shift in post-acute COVID-19 inflammatory biomarkers associated with an increasing BMI noted here shares similarities to biomarkers of LC reported in the literature.

Based on the microstructure analysis, the present research investigated the influence of various austenitizing conditions on the transformation behavior of intermetallic compound particles, i.e. η-Ni3Ti, and the reversed austenite during ageing treatment in Ti–Mo maraging stainless steel, as well as the related mechanical properties. The results revealed numerous tiny rod-like intermetallic compound particles, i.e. η-Ni3Ti, having a Burgers orientation relationship, i.e., {101}α′//{0001}η ; α′//η, with the martensite matrix, as well as blocky, lath, and granular reversed austenite of various sizes distributed within the tempered martensite matrix. Regardless of the austenitizing treatment condition, more reversed austenite was found in the samples aged at 520 °C than in those aged at 640 °C. Although this finding was not consistent with the Thermo-Calc predictions, it should be associated with the thermal stability of reversed austenite at different ageing temperatures. In other words, the greater amount of reversed austenite that formed at 640 °C did not remain at room temperature due to secondary martensite transformation during cooling, as was verified by EBSD analysis.

Abstract The performance of superconducting qubits is degraded by a poorly characterized set of energy sources breaking the Cooper pairs responsible for superconductivity, creating a condition often called “quasiparticle poisoning”. Both superconducting qubits and low threshold dark matter calorimeters have observed excess bursts of quasiparticles or phonons that decrease in rate with time. Here, we show that a silicon crystal glued to its holder exhibits a rate of low-energy phonon events that is more than two orders of magnitude larger than in a functionally identical crystal suspended from its holder in a low-stress state. The excess phonon event rate in the glued crystal decreases with time since cooldown, consistent with a source of phonon bursts which contributes to quasiparticle poisoning in quantum circuits and the low-energy events observed in cryogenic calorimeters. We argue that relaxation of thermally induced stress between the glue and crystal is the source of these events.

Abstract Accurately predicting the power conversion efficiency (PCE) in dye‐sensitized solar cells (DSSCs) represents a crucial challenge, one that is pivotal for the high throughput rational design and screening of promising dye sensitizers. This study presents precise, predictive, and interpretable machine learning (ML) models specifically designed for Zn‐porphyrin‐sensitized solar cells. The model leverages theoretically computable, effective, and reusable molecular descriptors (MDs) to address this challenge. The models achieve excellent performance on a “blind test” of 17 newly designed cells, with a mean absolute error (MAE) of 1.02%. Notably, 10 dyes are predicted within a 1% error margin. These results validate the ML models and their importance in exploring uncharted chemical spaces of Zn‐porphyrins. SHAP analysis identifies crucial MDs that align well with experimental observations, providing valuable chemical guidelines for the rational design of dyes in DSSCs. These predictive ML models enable efficient in silico screening, significantly reducing analysis time for photovoltaic cells. Promising Zn‐porphyrin‐based dyes with exceptional PCE are identified, facilitating high‐throughput virtual screening. The prediction tool is publicly accessible at https://ai‐meta.chem.ncu.edu.tw/dsc‐meta.

Abstract Recent progress in additive manufacturing has enabled the application of stereolithography (SLA) in bioprinting to produce 3D biomimetic structures. Bioinks for SLA often require synthetic polymers as supplements to ensure the structural integrity of the printed cell‐laden constructs. High molecular weight (MW) poly(ethylene‐glycol)‐diacrylate (PEGDA) (MW ≥ 3400 Da) is commonly used to enhance the mechanical property of crosslinked hydrogels. However, the production of bioink with high MW PEGDA requires in‐house polymer synthesis or the acquisition of costly reagents, which may not be readily available in all laboratory settings. As an alternative to high MW PEGDA, this research investigated the use of poly(ethylene‐glycol)‐dimethacrylate (PEGDMA) (MW = 1000 Da) as a supplement of a bioink to enhance the mechanical properties of the SLA‐printed constructs. The successful demonstration showcases 1) the fabrication of 3D constructs with overhang and complex architecture, and 2) the cytocompatibility, with high cell viability of 71–87% over 6 days of culture, of the GelMA‐PEGDMA bioink to enable cell‐laden bioprinting. This study suggests PEGDMA as a viable supplement in the formulation of SLA bioink. The accessibility to PEGDMA will facilitate the advance in 3D bioprinting to fabricate complex bioinspired structures and tissue surrogates for biomedical applications.

Two kinds of Cr–Mo–V hot work tool steels with different nitrogen contents, i.e. High-N steel and Low-N steel, were heat treated to investigate phase transformation phenomena in the present study. Microstructure characterization revealed the existence of numerous particles within both steels, which could be further categorized as the following three types: large- (>150 nm), medium- (50–100 nm), and tiny-sized (

Background / Aims: Effects of anti-hepatitis C virus (HCV) therapeutic regimens and mixed cryoglobulinemia on long-term renal function of HCV-infected patients with viral clearance have not been determined. Methods/Materials: A prospective 10-year cohort study of 1212 HCV-infected patients (interferon-based therapy, n = 615; direct-acting antiviral (DAA) therapy, n = 434) was conducted. Results: At baseline, age, body mass index (BMI), hemoglobin (Hb) and uric acid (UA) levels, and fibrosis-4 score were associated with estimated glomerular filtration rates (eGFRs) in HCV-infected patients. At 24 weeks posttherapy, age, BMI, and Hb and UA levels were associated with eGFRs in patients with a sustained virological response (SVR) (n = 930). Compared with those at baseline, the eGFRs were lower in SVR patients at 24 weeks posttherapy, regardless of the therapeutic regimen. The eGFRs reverted to baseline levels in interferon-treated SVR patients up to 10 years posttherapy but remained decreased in DAA-treated SVR patients up to 4 years posttherapy. Longitudinally, repeated measures analyses with generalized estimating equations showed that the interactions between DAA-based therapy and mixed cryoglobulinemia (OR: 3.291) and Hb levels (1.778) were positively, while DAA-based therapy (0.442), age (0.956), UA levels (0.698), homeostasis model assessment-insulin resistance index (0.961) and complement 4 levels (0.9395) were negatively associated with the eGFR. Among DAA-treated SVR patients, the baseline eGFR (OR: 1.014; 95%CI OR: 1.004–1.023) and high-sensitivity C-reactive protein (HR: 1.082; 95%CI HR: 1.018–1.15) were associated with eGFR reduction at 24 weeks and 4 years posttherapy, respectively. Conclusions: Hepatic fibrosis was an HCV-related factor for renal function. Longitudinally, DAA therapy was negatively, while the interaction between DAA therapy and mixed cryoglobulinemia was positively associated with renal function in SVR patients; deteriorated renal function was recovered in interferon-treated SVR patients. Particularly in DAA-treated SVR patients, baseline renal function and systemic inflammation were associated with short- and long-term reductions in renal function, respectively.

Diabetic retinopathy is characterized by hyperglycemic retinal pigment epithelial cells that secrete excessive pro-inflammatory cytokines and VEGF, leading to retinal damage and vision loss. Cobalt protoporphyrin (CoPP) is a compound that can reduce inflammatory responses by inducing high levels of HO-1. In the present study, the therapeutic effects of CoPP were examined in ARPE-19 cells under hyperglycemia. ARPE-19 cells were incubated in culture media containing either 5.5 mM (NG) or 25 mM (HG) glucose, with or without the addition of 0.1 µM CoPP. Protein expressions in samples were determined by either Western blotting or immunostaining. A Seahorse metabolic analyzer was used to assess the impact of CoPP treatment on mitochondrial respiration in ARPE-19 cells in NG or HG media. ARPE-19 cells cultured in NG media displayed different cell morphology than those cultured in HG media. CoPP treatment induced high HO-1 expressions and significantly enhanced the viability of ARPE-19 cells under hyperglycemia. Moreover, CoPP significantly downregulated expressions of inflammatory and apoptotic markers and significantly upregulated mitochondrial respiration in APRPE-19 cells under hyperglycemia. CoPP treatment significantly enhanced cell viability in ARPE-19 cells under hyperglycemia. The treatment also downregulated the expressions of pro-inflammatory and upregulated mitochondrial respiration in the hyperglycemic cells.

An international randomized phase II trial of Globo H (GH) vaccine, adagloxad simolenin/OBI-821 in 349 patients with metastatic breast cancer showed longer progression-free survival (PFS) in vaccinated patients who developed anti-Globo H (anti-GH) IgG than those who did not and the placebo group. The impacts of anti-GH IgM and GH expression on peak anti-GH IgG and clinical outcome were further evaluated. The titers of anti-GH IgG and IgM were determined by ELISA. GH expression in tumor was examined by immunohistochemical staining. Immunophenotyping was conducted by flow cytometry. Adagloxad simolenin elicited anti-GH IgM which peaked at titers ≥1:80 between weeks 5 and 13. The mean anti-GH IgG titer peaked at week 41 and decreased thereafter on the completion of vaccination. One log increase in peak IgM was associated with 10.6% decrease in the HR of disease progression (HR: 0.894, 95% CI: 0.833 to 0.960, p=0.0019). Patients with anti-GH IgM ≥1:320 within first 4 weeks after vaccination had significantly higher maximum anti-GH IgM (p

Abstract Background Taiwan’s warm and humid climate and dense population provide a suitable environment for the breeding of pests. The three major urban insects in Taiwan are house flies, cockroaches, and mosquitoes. In cases where a disease outbreak or high pest density necessitates chemical control, selecting the most effective insecticide is crucial. The resistance of pests to the selected environmental insecticide must be rapidly assessed to achieve effective chemical control and reduce environmental pollution. Methods In this study, we evaluated the resistance of various pests, namely, house flies (Musca domestica L.), cockroaches (Blattella germanica L. and Periplaneta americana), and mosquitoes (Aedes aegypti and Ae. albopictus) against 10 commonly used insecticides. Rapid insecticide resistance bioassays were performed using discriminating doses or concentrations of the active ingredients of insecticides. Results Five field strains of M. domestica (L.) are resistant to all 10 commonly used insecticides and exhibit cross- and multiple resistance to four types of pyrethroids and three types of organophosphates, propoxur, fipronil, and imidacloprid. None of the five field strains of P. americana are resistant to any of the tested insecticides, and only one strain of B. germanica (L.) is resistant to permethrin. One strain of Ae. albopictus is resistant to pirimiphos-methyl, whereas five strains of Ae. aegypti exhibit multiple resistance to pyrethroids, organophosphates, and other insecticides. Conclusions In the event of a disease outbreak or high pest density, rapid insecticide resistance bioassays may be performed using discriminating doses or concentrations to achieve precise and effective chemical control, reduce environmental pollution, and increase control efficacy. Graphical Abstract

Edible sweet potato leaf can be exploited in the management and treatment of insulin resistance. This study investigated the effects of three sweet potato leaf extracts (SPLEs) and chlorogenic acid (CGA) on glucose uptake (2-NBDG uptake and GLUT4 abundance) and expression of their related regulatory factors (such as IR, IRS-1, p-Akt1, and p-AMPKα1 abundances) using Western blot analysis in insulin-treated insulin-resistant C2C12 cells. The results show that both purple and green SPLEs improved glucose (2-NBDG) uptake efficacy with insulin treatments, and both SPLEs also increased GLUT4 and IR abundances via activation of p-Akt in the PI3K/Akt pathway, whereas the IR abundance efficacy influence was the same as in the insulin-treated group. The yellow SPLE and CGA have higher protein abundances of IR and IRS-1, while CGA (20 μg/mL) exhibits the highest abundance of p-Akt1 and p-AMPKα1. These results suggest potential benefits of purple and green SPLEs in promoting glucose uptake, possibly through modulation of insulin signaling pathways.

Listeria monocytogenes causes listeriosis, a serious foodborne illness with a high mortality rate, especially in vulnerable populations. It accounts for 19% of foodborne deaths, with invasive cases having a mortality rate of up to 44%, leading to conditions like meningitis, bacteremia, and meningoencephalitis. However, the prognostic factors remain unclear. This study examines the hospital outcomes of invasive listeriosis and identifies risk factors for in-hospital and one-year mortality. We analyzed the electronic medical records of 118 hospitalized patients with non-perinatal, culture-proven invasive listeriosis collected over a 21-year period. The in-hospital mortality rate was 36.4%, with only 33.1% surviving one year and 22.0% surviving two years. The key findings indicate that a quick Sequential Organ Failure Assessment (qSOFA) score of ≥2 (OR 106.59, p < 0.001), respiratory failure (OR 7.58, p = 0.031), and shorter ampicillin duration (OR 0.53, p = 0.012) independently predicted poorer in-hospital outcomes. Additionally, a qSOFA score of ≥2 (OR 8.46, p < 0.001) and shorter ampicillin duration (OR 0.65, p < 0.001) were linked to higher one-year mortality. This study is the first to identify a qSOFA score of ≥2 as a significant marker for high-risk invasive listeriosis patients, with poorer outcomes linked to a qSOFA score of ≥2, respiratory failure, and shorter ampicillin use.

Background/Objective: This study aims to utilize advanced artificial intelligence (AI) image recog-nition technologies to establish a robust system for identifying features in lung computed tomog-raphy (CT) scans, thereby detecting respiratory infections such as SARS-CoV-2 pneumonia. Spe-cifically, the research focuses on developing a new model called Residual-Dense-Attention Gates U-Net (RDAG U-Net) to improve accuracy and efficiency in identification. Methods: This study employed Attention U-Net, Attention Res U-Net, and the newly developed RDAG U-Net model. RDAG U-Net extends the U-Net architecture by incorporating ResBlock and DenseBlock modules in the encoder to retain training parameters and reduce computation time. The training dataset in-cludes 3,520 CT scans from an open database, augmented to 10,560 samples through data en-hancement techniques. The research also focused on optimizing convolutional architectures, image preprocessing, interpolation methods, data management, and extensive fine-tuning of training parameters and neural network modules. Result: The RDAG U-Net model achieved an outstanding accuracy of 93.29% in identifying pulmonary lesions, with a 45% reduction in computation time compared to other models. The study demonstrated that RDAG U-Net performed stably during training and exhibited good generalization capability by evaluating loss values, model-predicted lesion annotations, and validation-epoch curves. Furthermore, using ITK-Snap to convert 2D pre-dictions into 3D lung and lesion segmentation models, the results delineated lesion contours, en-hancing interpretability. Conclusion: The RDAG U-Net model showed significant improvements in accuracy and efficiency in the analysis of CT images for SARS-CoV-2 pneumonia, achieving a 93.29% recognition accuracy and reducing computation time by 45% compared to other models. These results indicate the potential of the RDAG U-Net model in clinical applications, as it can accelerate the detection of pulmonary lesions and effectively enhance diagnostic accuracy. Additionally, the 2D and 3D visualization results allow physicians to understand lesions' morphology and distribution better, strengthening decision support capabilities and providing valuable medical diagnosis and treatment planning tools.

Abstract Thermal indices, such as Predicted Mean Vote, Outdoor Standard Effective Temperature, Physiologically Equivalent Temperature, and Universal Thermal Climate Index, are essential for the evaluation of thermal perception, the design of climate sensitive buildings or urban area, and tourism. These thermal indices are built on complicated numeric models. RayMan was developed to calculate thermal indices based on Delphi program language on the Windows 7 operating system. RayMan is not currently under active maintenance or development. Thus, this report describes the development of an innovative Python library named biometeo that includes an innovative thermal index (modified Physiologically Equivalent Temperature) as a next generation program to calculate thermal indices and human biometeorological variables.

Abstract With ageing populations, new elderly end-stage kidney disease (ESKD) cases rise. Unlike younger patients, elderly ESKD patients are less likely to undergo kidney transplant, and therefore the decision of receiving peritoneal dialysis (PD) and hemodialysis (HD) is more crucial. A total of 36,852 patients, aged more than 65, who were newly diagnosed with ESKD and initiated renal replacement therapy between 2013 and 2019 were identified. These patients were categorized into two groups: the PD group and the HD group according to their long-term renal replacement treatment. After propensity score matching, the PD group (n = 1628) displayed a lower incidence of major adverse cardiac and cerebrovascular events (MACCE) (10.09% vs. 13.03%, hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.66–0.83), malignancy (1.23% vs. 2.14%, HR: 0.55, 95% CI: 0.40–0.76), and MACCE-associated mortality (1.35% vs. 2.25%, HR: 0.62, 95% CI: 0.46–0.84) compared to the HD group (n = 6512). However, the PD group demonstrated a higher rate of infection (34.09% vs. 24.14%, HR: 1.28, 95% CI: 1.20–1.37). The risks of all-cause mortality and infection-associated mortality were not different. This study may provide valuable clinical information to assist elderly ESKD patients to choose HD or PD as their renal replacement therapy.

Abstract Development and understanding of highly mechanically robust and electronically conducting hydrogels are extremely important for ever‐increasing energy‐based applications. Conventional mixing/blending of conductive additives with hydrophilic polymer network prevents both high mechanical strength and electronic conductivity to be presented in polymer hydrogels. Here, we proposed a double‐network (DN) engineering strategy to fabricate PVA/PPy DN hydrogels, consisting of a conductive PPy‐PA network via in‐situ ultrafast gelation and a tough PVA network via a subsequent freezing/thawing process. The resultant PVA/PPy hydrogels exhibited superior mechanical and electrochemical properties, including electrical conductivity of ~6.8 S/m, mechanical strength of ~0.39 MPa, and elastic moduli of ~0.1 MPa. Upon further transformation of PVA/PPy hydrogels into supercapacitors, they demonstrated a high capacitance of ~280.7 F/g and a cycle life of 2000 galvanostatic charge/discharge cycles with over 94.3% capacity retention at the current density of 2 mA/cm2 and even subzero temperatures of −20 °C. Such enhanced mechanical performance and electronic conductivity of hydrogels are mainly stemmed from a synergistic combination of continuous electrically conductive PPy‐PA network and the two interpenetrating DN structure. This in‐situ gelation strategy is applicable to the integration of ionic‐/electrical‐conductive materials into DN hydrogels for smart‐soft electronics, beyond the most commonly used PEDOT:PSS‐based hydrogels.

IntroductionSignal-averaged electrocardiography (SAECG) provides diagnostic and prognostic information regarding cardiac diseases. However, its value in other nonischemic cardiomyopathies (NICMs) remains unclear. This study aimed to investigate the role of SAECG in patients with NICM.Methods and resultsThis retrospective study included consecutive patients with NICM who underwent SAECG, biventricular substrate mapping, and ablation for ventricular arrhythmia (VA). Patients with baseline ventricular conduction disturbances were excluded. Patients who fulfilled at least one SAECG criterion were categorized into Group 1, and the other patients were categorized into Group 2. Baseline and ventricular substrate characteristics were compared between the two groups. The study included 58 patients (39 men, mean age 50.4 ± 15.5 years), with 34 and 24 patients in Groups 1 and 2, respectively. Epicardial mapping was performed in eight (23.5%) and six patients (25.0%) in Groups 1 and 2 (p = 0.897), respectively. Patients in Group 1 had a more extensive right ventricular (RV) low-voltage zone (LVZ) and scar area than those in Group 2. Group 1 had a larger epicardial LVZ than Group 2. Epicardial late potentials were more frequent in Group 1 than in Group 2. There were more arrhythmogenic foci within the RV outflow tract in Group 1 than in Group 2. There was no significant difference in long-term VA recurrence.ConclusionIn our NICM population, a positive SAECG was associated with a larger RV endocardial scar, epicardial scar/late potentials, and a higher incidence of arrhythmogenic foci in the RV outflow tract.

This study evaluates the post-fire performance of steel connections under a column-loss scenario. A series of fire tests, coupon tests and cyclic loading tests were carried out on 5 sets of 1/3-scaled SN400YB steel H-beam-to-H-column connections. After exposure to temperatures reaching 800 °C, the connections do not indicate any beam residual deformations or column drifts, and the steel properties, such as yield strength, tensile strength, and elongation, still meet the design requirements for room temperature. Under cyclic loading testing, fracture occurs in the base metal of beam flanges near the column faces of the connections subjected to high temperature and room temperature. Moreover, all the connections developed a moment strength greater than the 80% of nominal plastic moment strength of the beam after the first loading cycle with a drift angle of 0.04 rad. Finite element analyses were also conducted to simulate the test results, showing the severity of a column-loss scenario and the minor effect of initial heating rates. The results obtained from this work show the structural robustness of steel connections against earthquake shaking following a fire accident.

Abstract Background Treatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF. Methods A one-group pretest–posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients’ recognition of SDM, and a 5-point scoring method was used, where “very much” was scored as 5 points, and “totally not” was scored as 1 point. Results Fifty-two patients with AF were enrolled. In terms of patients’ recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of “very much.” The patients’ anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p

關於探討教師專業能力發展對於教學效能之影響，以往研究較少同時整合外在因素與內在因素；本研究採取行銷導向的觀點，將教師視為學校組織的內部顧客，整合內部行銷策略為外在因素、教學信念為內在因素，以探討內部行銷、教學信念、教師專業發展與教學效能之關係。本研究以國民中學332位教師為研究對象進行實證問卷調查，資料分析方法為結構方程模式。研究結論發現：內部行銷與教學信念對於教師專業發展有顯著正向的影響；教師專業發展對教學效能有顯著正向的影響；並且更進一步驗證教師專業發展的中介效果，內部行銷與教學信念能夠經由教師專業發展的中介轉化機制，進而有助於提升教學效能。最後提出供學校組織參考之實務建議及未來研究建議。 Little research explores the effects of external and internal factors on teacher professional development and teaching effectiveness. Based on the marketing-oriented perspective, this study regards teachers as internal customers in school organizations. This study integrates internal marketing strategies as external factors and teaching beliefs as internal factors to explore the relationships between internal marketing, teaching belief, teachers' professional development, and teaching effectiveness. This study employs a quantitative survey method to collect data from 332 teachers in junior high schools. The data analysis method is structural equation modelling. The results indicate that internal marketing and teaching belief have significantly positive influences on teaching effectiveness. Professional development has a significantly positive influence on teaching effectiveness. The mediating role of professional development is further demonstrated in the relationships between internal marketing, teaching belief, and teaching effectiveness. This study provides specific suggestions to educational organizations and future research.

Background: High-power short-duration (HPSD) and cryoballoon ablation (CBA) has been used for pulmonary vein isolation (PVI). Objective: We aimed to compare the efficacy of PVI between CBA and HPSD ablation in patients with paroxysmal atrial fibrillation (PAF). Methods: We retrospectively analyzed 251 consecutive PAF patients from January 2018 to July 2020. Of them, 124 patients (mean age 57.2 ± 10.1 year) received HPSD and 127 patients (mean age 59.6 ± 9.4 year) received CBA. In HPSD group, the radiofrequency energy was set as 50 W/10 s at anterior wall and 40 W/10 s at posterior wall. In CBA group, 28 mm s generation cryoballoon was used for PVI according the guidelines. Results: There was no significant difference in baseline characteristics between these 2 groups. The time to achieve PVI was significantly shorter in cryoballoon ablation group than in HPSD group (20.6 ± 1.7 min vs 51.8 ± 36.3, P = 0.001). The 6-month overall recurrence for atrial tachyarrhythmias was not significantly different between the two groups (HPSD:14.50% vs CBA:11.0%, P = 0.40). There were different types of recurrent atrial tachyarrhythmia between these 2 groups. Recurrence as atrial flutter was significantly more common in CBA group compared to HPSD group (57.1% vs 12.5%, P = 0.04). Conclusion: In PAF patients, CBA and HPSD had a favourable and comparable outcome. The recurrence pattern was different between CBA and HPSD groups.

Abstract Excessive inflammation is a postulated cause of severe disease and death in respiratory virus infections. In response to severe influenza virus infection, adoptively transferred naïve hemagglutinin-specific CD4+ T cells from CD4+ TCR-transgenic 6.5 mice drive an IFN-γ-producing Th1 response in wild-type mice. It helps in virus clearance but also causes collateral damage and disease aggravation. The donor 6.5 mice have all the CD4+ T cells with TCR specificity toward influenza hemagglutinin. Still, the infected 6.5 mice do not suffer from robust inflammation and grave outcome. The initial Th1 response wanes with time, and a prominent Th17 response of recent thymic emigrants alleviates inflammation and bestows protection in 6.5 mice. Our results suggest that viral neuraminidase-activated TGF-β of the Th1 cells guides the Th17 evolution, and IL-17 signaling through the non-canonical IL-17 receptor EGFR activates the scaffold protein TRAF4 more than TRAF6 during alleviation of lung inflammation in severe influenza.

IntroductionHypertriglyceridemia is the most prevalent dyslipidemia in patients with chronic kidney disease (CKD). However, research about fibrate treatment in CKD patients is limited, and assessing its benefits becomes challenging due to the frequent concurrent use of statins. Thus, this study is aimed to investigate the role of fibrate in CKD stage 3 patients with hypertriglyceridemia who did not receive other lipid-lowering agents.MethodsThis study enrolled patients newly diagnosed CKD3 with LDL-C200mg/dL but not receiving fibrate treatment). The inverse probability of treatment weighting was performed to balance baseline characteristics.ResultsCompared with the non-fibrate group (n=2020), the fibrate group (n=705) exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (MACCEs) (10.4% vs. 12.8%, hazard ratios [HRs]: 0.69, 95% confidence interval [CI]: 0.50 to 0.95), AMI (2.3% vs. 3.9%, HR: 0.52, 95% CI: 0.37 to 0.73), and ischemic stroke (6.3% vs. 8.0%, HR: 0.67, 95% CI: 0.52 to 0.85). The risk of all-cause mortality (5.1% vs. 4.5%, HR: 1.09, 95% CI: 0.67 to 1.79) and death from CV (2.8% vs. 2.3%, HR: 1.07, 95% CI: 0.29 to 2.33) did not significantly differ between the 2 groups.ConclusionThis study suggests that, in moderate CKD patients with hypertriglyceridemia but LDL-C < 100mg/dL who did not take other lipid-lowering agents, fibrates may be beneficial in reducing cardiovascular events.

IntroductionCatheter ablation is an effective and safe strategy for treating atrial fibrillation patients. Nevertheless, studies on the long-term outcomes of catheter ablation in patients with dilated cardiomyopathy are limited. This study aimed to assess the electrophysiological characteristics of atrial fibrillation patients with dilated cardiomyopathy and compare the long-term clinical outcomes between patients undergoing catheter ablation and medical therapy.MethodPatient baseline characteristics and electrophysiological parameters were examined to identify the predictors of atrial fibrillation recurrence following catheter ablation. The clinical outcomes of catheter ablation and medical therapy were compared using the propensity score matched method.ResultsA total of 343 patients were enrolled, with 46 in the catheter ablation group and 297 in the medical therapy group. Among the catheter ablation group, 58.7% (n = 27) had persistent atrial fibrillation. The recurrence rate of atrial arrhythmia was 30.4% (n = 14) after an average follow-up duration of 7.7 years following catheter ablation. The only predictive factor for atrial fibrillation recurrence after catheter ablation was the left atrial diameter. When compared to medical therapy, catheter ablation demonstrated significantly better outcomes in terms of overall survival, freedom from heart failure hospitalization, improvement in left ventricular ejection fraction, and a greater reduction in left ventricular diameter and left atrial diameter after propensity score matching.ConclusionsTherefore, catheter ablation proves to be effective in providing long-term control of atrial fibrillation in patients with dilated cardiomyopathy. In addition to standard heart failure care, catheter ablation significantly enhanced both morbidity and mortality outcomes and reversed structural remodeling when compared to heart failure medication alone.

BackgroundStudies have confirmed that osteoporosis has been considered as one of the complications of diabetes, and the health hazards to patients are more obvious. This study is mainly based on the Taiwan National Health Insurance Database (TNHID). Through the analysis of TNHID, it is shown that the combined treatment of traditional Chinese medicine (TCM) medicine in patients of diabetes with osteoporosis (T2DOP) with lower related risks.MethodsAccording to the study design, 3131 patients selected from TNHID who received TCM treatment were matched by 1-fold propensity score according to gender, age, and inclusion date as the control group. Cox proportional hazards analyzes were performed to compare fracture surgery, hospitalization, and all-cause mortality during a mean follow-up from 2000 to 2015.ResultsA total of 1055/1469/715 subjects (16.85%/23.46%/11.42%) had fracture surgery/inpatient/all-cause mortality of which 433/624/318 (13.83%/19.93%/10.16%) were in the TCM group) and 622/845/397 (19.87%/26.99%/12.68%) in the control group. Cox proportional hazards regression analysis showed that subjects in the TCM group had lower rates of fracture surgery, inpatient and all-cause mortality (adjusted HR = 0.467; 95% CI = 0.225-0.680, PConclusionThis study provides longitudinal evidence through a cohort study of the value of integrated TCM for T2DOP. More research is needed to fully understand the clinical significance of these results.

This study explores the development of a thermostable and bio-inert PVDF membrane by grafting poly(acrylamide-r-N-vinylpyrrolidone) (P(AA-r-NVP)) onto a styrene-co-maleic anhydride (SMA)-functionalized PVDF substrate. The fabrication process involved blending SMA into the PVDF matrix followed by vapor-induced phase separation process to form the porous membrane. P(AA-r-NVP) was then grafted onto the membrane through the ring-opening of maleic anhydride groups. Characterization through ATR-FTIR and XPS confirmed successful surface modification. Antifouling performance of the membranes were assessed through bacterial adhesion tests before and after steam sterilization. Before sterilization, SMA3_A3V7 effectively resisted up to 97 % of E. coli adhesion. After steam sterilization, SMA3_A3V7 demonstrated excellent thermal stability, with a minimal 1.25 % increase in bacterial adhesion, compared to a 250 % increase in the unmodified PVDF membrane. These findings feature the effectiveness of utilizing SMA in simplifying the grafting process and the contribution of the thermostable and bio-inert polymer in imparting high-temperature resistance and antifouling resistance to the membrane, enabling versatile applications.