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Abstract Background Undergraduates’ workplace learning is an important part of health sciences education. Educational psychology research considers many different aspects of self-regulated learning at the workplace, including cognition, motivation, emotions, and context. Multivariate longitudinal and diary studies in this field require fewer items than alternatives or even a single item per construct and can reveal the sub-processes of workplace learning and contribute to a better understanding of students’ learning. Short instruments are necessary for application in workplace settings, especially stressful ones, to mitigate survey fatigue. The present study aimed to assess the psychometric properties of single items measuring various aspects of workplace learning. Methods Twenty-nine single items selected from the Workplace Learning Inventory in Health Sciences Education were analyzed for reliability, information reproduction, and relationships within the nomological network. The authors additionally analyzed four generally formulated single items’ relationships with the full Workplace Learning Inventory scales and external criteria within the nomological network. Participants were 214 ninth- or tenth-semester veterinary medicine students in Austria and Germany who were learning at varied workplaces during the winter semester of 2021/2022. Results Of the 29 single items selected from existing scales, 27 showed sufficient reliability, but mixed results were obtained regarding validity. Although the items’ relationships within the nomological network were similar to those of the full scales, information reproduction was insufficient for most items. The four general single items showed acceptable validity, but the reliability of these measures of states could not be assessed. Conclusions This paper reported findings on the psychometric properties of single items for undergraduates’ workplace learning in health science education. The findings are crucial for deciding whether to use scales versus single-item measures in future studies. By applying the findings, researchers can be more economical in their workplace learning data collection and can include more constructs.

Introduction Enfortumab vedotin is an antibody‐drug conjugate targeting Nectin‐4 for the treatment of advanced urothelial carcinoma in patients previously treated with platinum‐containing chemotherapy and immune checkpoint inhibitors. Common adverse events include rashes, peripheral neuropathy, and hyperglycemia. However, there are no reports on the development of myelodysplastic syndrome during enfortumab vedotin therapy in clinical settings. Case presentation A 72‐year‐old male patient experienced prolonged and severe thrombocytopenia 18 weeks after the start of enfortumab vedotin therapy for metastatic urothelial carcinoma, requiring daily platelet transfusions. Bone marrow examination and chromosomal analysis confirmed the diagnosis of myelodysplastic syndrome. Treatment with eltrombopag proved to be effective. Conclusion This is the first report of the development of myelodysplastic syndrome during enfortumab vedotin therapy in a clinical setting. Although rare, myelodysplastic syndrome can occur during enfortumab vedotin therapy.

Background: Low-dose oral food challenge (LD-OFC) is an approach to avoid complete elimination in high-risk patients with wheat allergy (WA). We examined the 3-year prognosis after LD-OFC among patients who passed and failed LD-OFC. Methods: Children with immediate-type WA aged ≤6 years with a history of reaction to ≤390 mg of wheat protein underwent their first LD-OFC with 52 mg (baseline LD-OFC). After passing the LD-OFC, children stepped up to 390, 1300, and 5200 mg step-by-step every 3–6 months. After failing LD-OFC, children repeated LD-OFC every 6–12 months. We assessed wheat tolerance defined as consuming 5200 mg without symptoms for 3 years after baseline LD-OFC. Results: The median age of 124 children was 2.4 years, and the wheat- and ω-5-gliadin-specific immunoglobulin E (IgE) levels (kUA/L) were 23.6 and 2.1, respectively. Upon baseline LD-OFC, 57% passed (LD-tolerant), whereas 43% failed (LD-reactive). Within 3 years, 38% of the LD-reactive group passed re-administered LD-OFC, and 70% of all participants avoided complete elimination. The percentage of the participants who became capable of consuming 390 mg (87% vs. 18%), 1300 mg (78% vs. 13%), and acquired tolerance (70% vs. 13%) was significantly higher in the LD-tolerant group than in the LD-reactive group (p

Abstract Background Biliary atresia (BA) is an intractable disease of unknown cause that develops in the neonatal period. It causes jaundice and liver damage due to the destruction of extrahepatic biliary tracts,. We have found that heterozygous knockout mice of the SRY related HMG-box 17 (Sox17) gene, a master regulator of stem/progenitor cells in the gallbladder wall, exhibit a condition like BA. However, the precise contribution of hypoplastic gallbladder wall to the pathogenesis of hepatobiliary disease in Sox17 heterozygous embryos and human BA remains unclear. Methods We employed cholangiography and histological analyses in the mouse BA model. Furthermore, we conducted a retrospective analysis of human BA. Results We show that gallbladder wall hypoplasia causes abnormal multiple connections between the hilar hepatic bile ducts and the gallbladder-cystic duct in Sox17 heterozygous embryos. These multiple hilar extrahepatic ducts fuse with the developing intrahepatic duct walls and pull them out of the liver parenchyma, resulting in abnormal intrahepatic duct network and severe cholestasis. In human BA with gallbladder wall hypoplasia (i.e., abnormally reduced expression of SOX17), we also identify a strong association between reduced gallbladder width (a morphometric parameter indicating gallbladder wall hypoplasia) and severe liver injury at the time of the Kasai surgery, like the Sox17-mutant mouse model. Conclusions Together with the close correlation between gallbladder wall hypoplasia and liver damage in both mouse and human cases, these findings provide an insight into the critical role of SOX17-positive gallbladder walls in establishing functional bile duct networks in the hepatic hilus of neonates.

The emotion of boredom has sparked considerable interest in research on teaching and learning, but boredom during tests and exams has not yet been examined. Based on the control-value theory of achievement emotions, we hypothesized that students may experience significant levels of boredom during testing ("test boredom"; Hypothesis 1) and that test boredom may be significantly related to theoretically hypothesized antecedents (control and value appraisals; Hypothesis 2) and outcomes (performance; Hypothesis 3). We further hypothesized that test boredom was more detrimental when students felt overchallenged during the test than when they felt underchallenged ("abundance hypothesis"; Hypothesis 4). We tested these hypotheses in two studies (Study 1: N = 208 eighth graders; 54% female; Study 2: N = 1,612 fifth to 10th graders, 47% female) using both trait and state measures of test boredom in mathematics and their proposed antecedents and outcomes. In support of Hypothesis 1, participants reported statistically significant levels of boredom during tests. Furthermore, the relations of test boredom with its control and value antecedents (i.e., being over- or underchallenged, facets of value) were in line with our assumptions (Hypothesis 2). In support of Hypothesis 3, test boredom was significantly negatively related to academic achievement (grades). In line with Hypothesis 4, test scores were negatively related to boredom due to being overchallenged but unrelated, or even positively related, to boredom due to being underchallenged. Directions for future research on test boredom as well as practical implications are outlined.

Background. Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients. Methods. We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020–October 2020; second wave November 2020–2021; third wave December 2021–September 2022) and compared these results. Results. Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality. Conclusions. Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.

Summary: Background: Meropenem (MEPM) holds significance in treating severe infections and drug-resistant bacteria. There are concerns that antimicrobial shortages may lead to the use of alternative antimicrobials that are less effective and safer. We have responded to the MEPM shortage with post-prescription monitoring and feedback (PPRF) with no restrictions on MEPM initiation. We aimed to assess the impact of the MEPM shortage and the PPRF on broad-spectrum antimicrobial use and mortality. Methods: This retrospective study was conducted in a single hospital in Japan. The period from October 2021 to August 2022 was defined as the period before the MEPM shortage, and the period from September 2022 to March 2023 was defined as the period during the MEPM shortage. To support the appropriate use of antimicrobials during MEPM shortages, the antimicrobial stewardship team (AST) developed a list of alternatives to MEPM. An interrupted time series analysis was used to assess changes in use and mortality among patients receiving broad-spectrum antimicrobials over the study period. Discussion: The shortage of MEPM and PPRF temporarily increased the use of alternative cefepime; however, the subsequent change in days of therapy and days of coverage of broad-spectrum antimicrobials suggests a decrease in the use of these antimicrobials. Despite these shifts, the mortality rates remained stable, suggesting that the response to the shortage did not adversely affect treatment outcomes. Conclusion: In the context of antimicrobial shortages, AST support plays an important role in enabling physicians to make optimal use of antimicrobials.

Both self-regulation and external regulation are key to understanding adolescents' learning and positive development at school. However, evidence on the joint development of self-regulated learning and externally regulated learning during adolescence is lacking. In addition, the current knowledge on interrelations between the development of adolescents' self-regulated learning, externally regulated learning, behaviors of teachers and parents in terms of autonomy support and achievement pressure, and academic achievement is very limited. The present multilevel longitudinal analysis focusing on the domain of mathematics (N = 1,542 German adolescents; annual assessments from Grades 5 to 9; mean age at Grade 5 = 11.79 years, SD = 0.71, 51.75% female) addressed these gaps. Results from multilevel latent basic growth curve models showed that self- and externally regulated learning decreased over the 5 years at both the individual student and the class level. Changes in self- and externally regulated learning were linked: Classes with higher levels of self-regulated learning at Grade 5 showed a stronger decrease in externally regulated learning over time. Initial levels of and changes in student-reported teacher and parental autonomy support and achievement pressure were associated with self- and externally regulated learning at the individual student level; student-reported teacher autonomy support and self-regulated learning were also linked at the class level. Self-regulated learning related positively to standardized achievement test scores but not to adolescents' grades. This study adds to the scarce evidence base on different regulatory forms of adolescents' learning and can inform future research on adolescents' positive development and educational practice.

Background: Bone assessment using the MRI DEAL-IQ sequence may have the potential to serve as a substitute for evaluating bone strength by quantifying the bone marrow hematopoietic region (R2*) and marrow adiposity (proton density fat fraction: PDFF). Higher body mass index (BMI) is associated with increased bone mineral density (BMD) in the proximal femur; however, the relationship between BMI and R2* or PDFF remains unclear. Herein, we investigated the correlation between BMI and MRI IDEAL-IQ based R2* or PDFF of the proximal femur. Methods: A retrospective single-cohort study was conducted on 217 patients diagnosed with non-metastatic prostate cancer between September 2019 and December 2022 who underwent MRI. The correlation between BMI and R2* or PDFF of the proximal femur was analyzed using Spearman’s rank correlation test. Results: Among 217 patients (median age, 74 years; median BMI, 23.8 kg/m2), there was a significant positive correlation between BMI and R2* at the right and left proximal femur (r = 0.2686, p < 0.0001; r = 0.2755, p < 0.0001, respectively). Furthermore, BMI and PDFF showed a significant negative correlation (r = −0.239, p = 0.0004; r = −0.2212, p = 0.001, respectively). Conclusion: In elderly men, the increased loading on the proximal femur due to elevated BMI was observed to promote a decrease in bone marrow adiposity in the proximal femur, causing a tendency for a transition from fatty marrow to red marrow with hematopoietic activity. These results indicate that the MRI IDEAL-IQ sequence may be valuable for assessing bone quality deterioration in the proximal femur.

Abstract Background Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump–uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump–round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods. Methods Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed. Results No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P

Abstract Autologous skin grafting is a standard treatment for skin defects such as burns. No artificial skin substitutes are functionally equivalent to autologous skin grafts. The cultured epidermis lacks the dermis and does not engraft deep wounds. Although reconstituted skin, which consists of cultured epidermal cells on a synthetic dermal substitute, can engraft deep wounds, it requires the wound bed to be well-vascularized and lacks skin appendages. In this study, we successfully generate complete skin grafts with pluripotent stem cell-derived epidermis with appendages on p63 knockout embryos’ dermis. Donor pluripotent stem cell-derived keratinocytes encroach the embryos’ dermis by eliminating p63 knockout keratinocytes based on cell-extracellular matrix adhesion mediated cell competition. Although the chimeric skin contains allogenic dermis, it is engraftable as long as autologous grafts. Furthermore, we could generate semi-humanized skin segments by human keratinocytes injection into the amnionic cavity of p63 knockout mice embryos. Niche encroachment opens the possibility of human skin graft production in livestock animals.

Objective: To investigate the impact of donor–recipient (DR) sex matches on survival after lung transplantation while controlling for size difference in the United Network of Organ Sharing (UNOS) database. Methods: We performed a retrospective study of 27,423 lung transplant recipients who were reported in the UNOS database (January 2005-March 2020). Patients were divided into groups based on their respective DR sex match: male to male (MM), male to female (MF), female to female, (FF), and female to male (FM). Kaplan–Meier curve and Cox regression with log-rank tests were used to assess 1-, 3-, 5-, and 10-year survival. We also modeled survival for each group after controlling for size-related variables via the Cox regression. Results: Kaplan–Meier curves showed overall significance at 1-, 3-, 5-, and 10-year end points (P

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which is associated with various neurological symptoms, including nausea, dizziness, headache, encephalitis, and epileptic seizures. SARS-CoV-2 is considered to affect the central nervous system (CNS) by interacting with the blood–brain barrier (BBB), which is defined by tight junctions that seal paracellular gaps between brain microvascular endothelial cells (BMECs). Although SARS-CoV-2 infection of BMECs has been reported, the detailed mechanism has not been fully elucidated. Methods Using the original strain of SARS-CoV-2, the infection in BMECs was confirmed by a detection of intracellular RNA copy number and localization of viral particles. BMEC functions were evaluated by measuring transendothelial electrical resistance (TEER), which evaluates the integrity of tight junction dynamics, and expression levels of proinflammatory genes. BMEC signaling pathway was examined by comprehensive RNA-seq analysis. Results We observed that iPSC derived brain microvascular endothelial like cells (iPSC-BMELCs) were infected with SARS-CoV-2. SARS-CoV-2 infection resulted in decreased TEER. In addition, SARS-CoV-2 infection decreased expression levels of tight junction markers CLDN3 and CLDN11. SARS-CoV-2 infection also increased expression levels of proinflammatory genes, which are known to be elevated in patients with COVID-19. Furthermore, RNA-seq analysis revealed that SARS-CoV-2 dysregulated the canonical Wnt signaling pathway in iPSC-BMELCs. Modulation of the Wnt signaling by CHIR99021 partially inhibited the infection and the subsequent inflammatory responses. Conclusion These findings suggest that SARS-CoV-2 infection causes BBB dysfunction via Wnt signaling. Thus, iPSC-BMELCs are a useful in vitro model for elucidating COVID-19 neuropathology and drug development.

Understanding the structure, antecedents, and outcomes of students' emotions has become a topic of major interest in research on mathematics education. Much of this work is based on the Achievement Emotions Questionnaire--Mathematics (AEQ-M), a self-report instrument assessing students' mathematics-related emotions. The AEQ-M measures seven emotions (enjoyment, pride, anger, anxiety, shame, hopelessness, boredom) across class, learning, and test contexts (internal structure). Based on control-value theory, it is assumed that these emotions are evoked by control and value appraisals, and that they influence students' motivation, learning strategies, and performance (external relations). Despite the popularity and frequent use of the AEQ-M, the research leading to its development has never been published, creating uncertainty about the validity of the proposed internal structure and external relations. We close this gap in Study 1 (N = 781 students, Grades 5-10, mean age 14.1 years, 53.5% female) by demonstrating that emotions are organized across contexts and linked to their proposed antecedents and outcomes. Study 2 (N = 699 students, Grade 7 and 9, mean age 14.0 years, 56.9% female) addresses another deficit in research on the AEQ-M, the lack of evidence regarding the assumption that emotions represent sets of interrelated affective, cognitive, motivational, and physiological/expressive components. We close this gap by evaluating extended AEQ-M scales, systematically assessing these components for five core mathematics emotions (enjoyment, anger, anxiety, hopelessness, boredom). Our work provides solid grounds for future research using the AEQ-M to assess emotions and their components in the domain of mathematics.

Fenugreek is often hidden in processed foods, where it is included in the generic term spice on food labels. Cross-reactivity of peanut and fenugreek should be considered in the management of peanut allergy.

Photoluminescence, scintillation, and thermoluminescence characteristics of the Tb3+-activated gallate glasses (20K2O–(11-x/2)La2O3–69Ga2O3–x/2Tb4O7, x = 0.1–1.0) were investigated. The Tb3+-activated gallate glasses exhibited photoluminescence with some peaks at approximately 490, 540, 595, and 625 nm that were attributable to the 4f→4f transition of Tb3+. These peaks also appeared under X-ray radiation, and the x = 1.0 gallate glass showed the highest intensity. Moreover, a broad thermoluminescence glow peak appeared at 90 °C, and the thermoluminescence peak intensity decreased with increasing the Tb concentration. A complimentary relation between the scintillation and thermoluminescence intensity was observed.

It is known that two heavy Majorana right-handed neutrinos are sufficient to generate the baryon asymmetry in the present universe. Thus, it is interesting to identify the third right-handed neutrino N with the dark matter. We impose a new discrete symmetry Z2 on this dark matter neutrino to stabilize it. However, the U(1)B−L gauge boson A′ couples to the right-handed neutrino N. If the B−L breaking scale VB−L is sufficiently low, the dark matter neutrino N can be in the thermal bath. We find that the thermal relic N can explain the dark matter abundance for the B−L breaking scale VB−L∼O(10) TeV. After considering all the constraints from the existing experiments, a narrow mass region of the thermal produced right-handed neutrino dark matter N is still surviving.