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Background Endometriosis is a common gynaecological disease characterized by growth of uterine endometrial tissue, outside the uterine cavity, on the ovaries, oviduct and pelvic peritoneum. Isoliquiritigenin (ISL) is a natural flavonoid isolated from the root of licorice (Glycyrrhiza uralensis) and shallot (Allium cepa). ISL has previously shown antioxidant, anti-inflammatory, anti-proliferation and anti-tumor activities. Purpose This study aimed to investigate the effects of ISL on endometriosis in vivo and in vitro. Methods End1/E6E7 endometriosis cells were treated with ISL and β-estradiol. The MTT assay was used to detect cell viability. Cell migration was evaluated by the wound-healing assay. The expression of epithelial-to-mesenchymal transition (EMT)-related proteins were detected by western blot. Female Balb/c mice, surgically induced to have endometriosis by transplanting uterine tissue into the abdominal cavity, were treated with ISL or vehicle for 4 weeks. Lesion growth was subsequently analyzed by high-resolution ultrasound imaging. Serum and lesion inflammatory cytokines were measured by ELISA. EMT-related proteins and apoptosis-related proteins of endometriotic lesions were detected by western blot. Results It was observed that ISL treatment inhibited the viability and migration of End1/E6E7. ISL treatment increased the expression of E-cadherin, and decreased the expression of N-cadherin, Slug and Snail. In the animal model, ISL treatment reduced the volume and weight of endometriotic lesions, decreased serum and lesion inflammatory cytokines, inhibited EMT, and induced apoptosis of the lesions. Conclusion ISL inhibited the viability, migration and EMT-related proteins of End1/E6E7 cells, reduced the volume and weight of endometriotic lesions, inhibited inflammatory cytokines and EMT, and induced apoptosis of the lesions to improve endometriosis.

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator&ndash, student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.

Colorectal cancer (CRC) remains the third most commonly diagnosed cancer globally, and its incidence and mortality rates have been on the rise in Asia. In this paper, we summarize the recent trends and screening challenges of CRC in this region. In 2018, Asia had the highest proportions of both incident (51.8%) and mortality (52.4%) CRC cases (all genders and ages) per 100,000 population in the world. In addition, there has been a rising trend of this disease across Asia with some regional geographic variations. This rise in CRC can be attributed to westernized dietary lifestyle, increasing population aging, smoking, physical inactivity, and other risk factors. In curbing the rising trend, Japan, South Korea, Singapore, and Taiwan have launched nationwide population-based screening programs. CRC screening across this region has been found to be effective and cost-effective compared with no screening at all. The emergence of new therapies has caused a reduction in case fatality; however, these new options have had a limited impact on cure rates and long-term survival due to the great disparity in treatment capacity/resources and screening infrastructures among Asian countries with different degrees of economic development. CRC is still rising in Asia, and implementation of screening is necessary for moderate- to high-incidence countries and construction of treatment capacity is the priority task in low-incidence and low-income countries. Unless countries in Asia implement CRC screening, the incidence and mortality rates of this disease will continue to rise especially with the rapidly rising population growth, economic development, westernized lifestyle, and increasing aging.

One TiZrNbTaFe and five (TiZrNbTaFe)N high entropy alloy coatings were deposited onto three different substrates using a high power impulse magnetron sputtering (HiPIMS) at different nitrogen gas flow ratios (RN2). The peak current and peak power density values of HiPIMS increased with increasing RN2. The crystalline nitride (TiZrNbTaFe)N coatings were obtained as grown using equal and higher than 10.0% RN2. The higher RN2 can promote a phase transformation from an amorphous state to face-centered cubic (fcc) structure. The fcc structured coatings exhibited a fine columnar microstructure and enhanced crystallinity. The highest hardness and reduced elastic modulus reached 36.2 GPa and 265 GPa, respectively, were found for the 32.0 at.% nitrogen contained (TiZrNbTaFe)N coating primarily due to its high residual stress and secondarily because of the formation of metal-nitride phase and the solid solution strengthening of various elements. The electrochemical properties of coatings in 3.5 wt.% NaCl aqueous solution at room temperature was studied using the potentiodynamic polarization and electrochemical impedance spectroscopy methods. We discovered that the highest corrosion polarization resistance of 3.08 × 106 Ω·cm2 was also obtained for 32.0 at.% nitrogen contained (TiZrNbTaFe)N coatings grown at RN2 of 10.0%. Based on these excellent properties, (TiZrNbTaFe)N high-entropy alloy nitride coating with 32.0 at.% nitrogen content can be used as a promising protective hard coating.

Background Cold snare polypectomy (CSP) was considered as effective in reducing the risk of delayed post-polypectomy bleeding. However, previous randomized controlled trials (RCTs) are mainly conducted in high-risk subjects using anticoagulants rather than in average-risk population. Herein we conducted a multicenter RCT to investigate the risk of delayed bleeding after CSP and hot snare polypectomy (HSP) in six Taiwanese centers (TAiwan COld Snare trial). Method A minimal of 4258 subjects were considered as necessary using delayed bleeding as the primary outcome based on previous meta-analyses. Subjects having colorectal neoplasm sized 4 to 10 mm were randomly assigned to either CSP or HSP arm. Lesions exceeding this size range were managed as per the preference of individual endoscopist. The primary measurement was the risk of delayed bleeding. Secondary measurement included event of emergency service (ES) visit, procedure time, tissue retrieval rate, and en-bloc resection rate. All enrolled subjects were interviewed by telephone on day 2 and day 14 after colonoscopy to access delayed bleeding. Result During the period of August 2018 to August 2020, a total of 7,596 subjects were assessed for eligibility, and 4,270 were successfully randomized and finished two telephone interviews. Totally 2,133 and 2,137 subjects were randomized into HSP and CSP arms, respectively. The risk of delayed bleeding was significantly higher in HSP than in CSP [31(1.5%) vs. 8(0.4%), p Conclusion CSP significantly reduced the risk of delayed post-polypectomy bleeding, including both severe and mild events. We concluded that CSP is safer than HSP in resecting colorectal polyps sized 4 to 10 mm. Download : Download high-res image (324KB) Download : Download full-size image Table 1 . Demographics of study population Download : Download high-res image (297KB) Download : Download full-size image Table 2 . Comparison of primary and secondary measurements between subjects with hot and cold snare polypectomy

Bowel preparation is burdensome, and less-demanding preparation procedures are needed. Few studies have investigated the effects of low-residue diet and prepackaged low-residue diet in combination with low-volume polyethylene glycol-electrolyte lavage solution during colonoscopy preparation.We compared self-prepared low-residue diets with prepackaged low-residue diets in combination with low-volume polyethylene glycol.This was a single-blinded, 3-arm, multicenter, randomized controlled trial.Colonoscopies were conducted in outpatient settings at 3 centers in Taiwan.The study included 180 patients (age range, 20-75 years) who were scheduled for colonoscopy.Three groups were compared: group A included self-prepared, 1-day, low-residue diets with a same-day 2.0-L single-dose of polyethylene glycol; group B included prepackaged low-residue diets plus 2.0 L of polyethylene glycol; and group C included prepackaged low-residue diets plus 1.5 L of polyethylene glycol.The outcome measures were adherence, bowel-cleansing level, and patient satisfaction.One third of the subjects in group A, but none in the prepackaged low-residue diets groups, violated the dietary restrictions. The proportion of right-segment preparation failure was 15.0%, 1.7%, and 6.7% (p = 0.025). Accordingly, treatment B was superior to A (p = 0.008). Among subjects violating the low-residue diets guideline, the right-segment preparation failure rate was 25%. According to a multivariate analysis, low-residue diet compliance (adjusted OR = 6.55 (95% CI, 1.83-23.43)) and BMI were predictors of right-sided preparation adequacy, but the volume of polyethylene glycol ingested was not a predictor. Compared with group A, a greater proportion of subjects in groups B and C reported satisfaction.Patients with high BMI and severe constipation were excluded from this study. This study included only an Asian population.The prepackaged low-residue diet provides excellent adherence, better bowel cleansing, and a better experience than a self-prepared low-residue diet. With good dietary compliance, 1.5 L of polyethylene glycol provides effective preparation.

Statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (HMGR) inhibitors decreasing serum cholesterol and have shown promise in cancer prevention. In this study, we demonstrated the oncogenic role of HMGR in colorectal cancer (CRC) by disclosing increased HMGR activity in CRC patients and its enhancement of anti-apoptosis and stemness. Our previous studies showed that statins containing carboxylic acid chains possessed activity against histone deacetylases (HDACs), and strengthened their anti-HDAC activity through designing HMGR-HDAC dual inhibitors, JMF compounds. These compounds exerted anti-cancer effect in CRC cells as well as in AOM-DSS and ApcMin/+ CRC mouse models. JMF mostly regulated the genes related to apoptosis and inflammation through genome-wide ChIP-on-chip analysis, and Ingenuity Pathways Analysis (IPA) predicted their respective regulation by NR3C1 and NF-κB. Furthermore, JMF inhibited metastasis, angiogenesis and cancer stemness, and potentiated the effect of oxaliplatin in CRC mouse models. Dual HMGR-HDAC inhibitor could be a potential treatment for CRC.

Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising.

Characteristics of chemically-synthesized (CS) gold nanoparticle (Au-NP) nonvolatile memories (NVMs) with low-damage NH 3 plasma treatment on a tunneling oxide (TO) layer have been investigated. Although the dot density of CS Au-NPs is decreased, the programming efficiency of memories with optimized NH 3 plasma treatment condition is enhanced due to the formation of a trapezoid-like energy band diagram of the TO layer by nitrogen incorporation. With the extraction of relative permittivity and electron affinity of the TO layer, the capacitance-voltage ( C - V ) and programming behaviors of CS Au-NP memories with low-damage NH 3 plasma treatment on the TO layer are well-fitted by the TCAD (Technology Computer-Aided-Design) simulation. Further, the built-in electric field induced by the trapezoid-like energy band diagram of the TO layer can suppress the leakage current of the TO layer, thereby improving the data retention properties. The low-damage NH 3 plasma treatment that results in no plasma damage to the TO layer has been proposed to be the probable candidate for future NVM applications.

This paper presents the fabrication of an inkjet-printed multilayer bandpass filter using the liquid crystal polymer (LCP) system-on-package (SOP) technology. The LCP-SOP technology adopted by lamination bonding process reduces the occupied area of a device and is suitable for radio frequency (RF) package applications. The surface morphologies and RF performance of the inkjet-printed silver film on an LCP substrate after the lamination bonding process, which entails applying high temperatures and pressures, were observed and analyzed. Acceptable performance of the inkjet-printed silver film of an optimal lamination bonding condition was 0.69 MPa at 270 °C. Using the inkjet-printing and LCP-SOP technologies, a miniature bandpass filter was created with a minimal $S_{21}$ value and a maximal $S_{11}$ value of −1.5 and −17.4 dB at 10.6–14.5-GHz passband, respectively. A strain effect of silver line and bandpass filter was also analyzed. The results demonstrated the effectiveness of the proposed design methodology and the fabrication technique.

In this study, Ta Al multilayer films were cosputtered on Inconel 617 through cyclical gradient concentration deposition. The oxidation behavior of the Ta Al films and the interdiffusion between the Ta Al films and Inconel 617 were evaluated through thermogravimetric analysis, X-ray diffraction, transmission electron microscopy, and Auger electron spectroscopy after the films were annealed in air at 400–800 °C. The results indicated that the Ta0.79Al0.21 multilayer films had a low O content even though O diffused inward through the entire film thickness after 8 h of annealing at 800 °C, which was attributed to the formation of an Al oxide scale due to the outward diffusion of Al in the initial oxidation stage. This under-stoichiometric Al2O3/Ta2O5 structure caused the produced films to exhibit a high hardness of 23.2 GPa and a high Young's modulus of 316 GPa. Moreover, the outward diffusion of Inconel 617 elements, namely Ni and Cr, was restricted by the oxidized films. However, the high Ta content in the Ta Al films deteriorated the film adherence to the substrates due to a high volume ratio of Ta2O5/Ta. Furthermore, laminated Ta0.79Al0.21/Ta0.34Al0.66/Ti films were fabricated to improve the film–substrate adhesion. These films exhibited a high hardness of 17.1 GPa after annealing at 800 °C for 24 h.

The reactive gas flow ratio and substrate bias voltage are crucial sputtering parameters for fabricating transition metal nitride films. In this study, W&ndash, N films were prepared using sputtering with nitrogen flow ratios (f) of 0.1&ndash, 0.5. W&ndash, N and W&ndash, Si&ndash, N films were then prepared using an f level of 0.4 and substrate bias varying from 0 to &minus, 150 V by using sputtering and co-sputtering, respectively. The variations in phase structures, bonding characteristics, mechanical properties, and wear resistance of the W&ndash, N films were investigated. The W&ndash, N films prepared with nitrogen flow ratios of 0.1&ndash, 0.2, 0.3, and 0.4&ndash, 0.5 displayed crystalline W, amorphous W&ndash, N, and crystalline W2N, respectively. The W&ndash, N films prepared using a nitrogen flow ratio of 0.4 and substrate bias voltages of &minus, 50 and &minus, 100 V exhibited favorable mechanical properties and high wear resistance. The mechanical properties of the amorphous W&ndash, N films were not related to the magnitude of the substrate bias.

Recently, the refractory high entropy alloy coatings have drawn lots of attention due to their high temperature strength and stable thermal properties. In this study, the VNbMoTaW and three Al contained VNbMoTaWAl refractory high entropy alloy coatings were fabricated using a pulsed direct current magnetron co-sputtering system. Al addition into the VNbMoTaW coatings was chosen for this study since Al is an important material known for its lightweight. The BCC phase of the VNbMoTaWAl coating was kept as 8.54 at.% Al was added. The surface roughness, grain size and density of VNbMoTaW and VNbMoTaWAl coatings decreased with increasing Al content. The addition of Al element into VNbMoTaW coating can increase its hardness up to 18.1 GPa due to the solution hardening effect. The corrosion resistance of the 304 stainless steel substrate in 0.5 M H2SO4 solution was improved by the refractory VNbMoTaW and VNbMoTaWAl coatings. Furthermore, the best corrosion resistance of VNbMoTaWAl coatings was obtained by the addition of 2.37 at.% Al. The equivalent circuit of the VNbMoTaWAl coatings in 0.5 M H2SO4 solution was also proposed. However, the oxygen contamination in excess of 3 at.% in the VNbMoTaWAl coatings had detrimental effects on the mechanical properties and corrosion resistance of the coatings due to formation of oxide phases.

Significance This study set out to illustrate the trajectories of myopia control in time sequence and explore orthokeratology compliance for parents with myopic children in the first fitting within one year. Profiling these results is crucial to improving myopia control and orthokeratology care. Purpose To obtain a better understanding of myopia control and orthokeratology care that could promote compliance with orthokeratology (ortho-K) lenses for parents with myopic children. Methods We conducted semi-structured qualitative interviews and pre-interview questionnaire surveys of the parent who is mainly responsible for complying to ortho-K lens care for their myopic children aged 7–12 years, including 16 mothers and 4 fathers. A framework analytical approach that involved gaining familiarity with the data to identify a thematic framework was used for data analysis. It was written in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results Five themes and twelve subthemes depicted the parents’ trajectory during myopia diagnosis, treatment, and compliance with ortho- K for their children in the first fitting within one year. Myopia control and the convenience of outdoor activities were important reasons for parents to actively ask for ortho-K lenses for their children. Parents have non-compliance behaviors after the children wore the lenses for three months, including not scheduling follow-up visits, simplifying cleaning procedures, not replacing accessories. The degree of parents’ non-compliance differed based on the uncomfortable feelings of their child’s eyes. In general, clear, unaided vision (visual acuity > 0.9) during the day was an indicator of ortho-K’s effectiveness, according to parents. Conclusions Although parents play a passive role when a child is diagnosed with myopia, they take on a proactive role when deciding on ortho-K treatment. Myopia treatment for children is a long-term process. Understanding the course of treatment and non-compliance helps eye care professionals provide parents with the necessary assistance and resources, and enables myopia treatment to yield maximum effects.

Glass molding is widely used for manufacturing high-precision optical elements. Nitride coatings are recommended as protective coatings on glass molding dies. In a die-fixed glass molding system, the molding dies undergo rapid thermal shocks. In this study, near-amorphous Cr–Si–N, Ta–Si–N, and Zr–Si–N coatings with a Si concentration of >14 at.% were prepared. The feasibility of these coatings in the glass molding process was evaluated through rapid thermal cycling annealing in a 15-ppm O2–N2 atmosphere. The cycling annealing test was performed at 270 °C and 580 °C or 600 °C. The heating, holding, and cooling times in the annealing process were 1 min each. The results indicated that Zr–Si–N coatings exhibited superior anti-sticking against SiO2–B2O3–BaO-based glass. The reactions between the nitride coatings and glass were investigated.

Background: Depressed colorectal neoplasms exhibit a high malignant potential and may become invasive rapidly but their genomic alterations remain unknown. We investigated the genomic alterations of depressed neoplasms and potential implications on long-term survival. Methods: We examined 20 depressed neoplasms and 15 polypoid neoplasms by genome-wide copy number analysis. Subsequently, we validated the identified copy number alterations in an independent sample of 37 depressed and 42 polypoid neoplasms. Specific copy number alterations were tested in 530 colorectal cancers in order to clarify the clinical outcome of depressed colorectal neoplasms. Findings: Copy number alterations in MYC, CCNA1, and BIRC7 were significantly enriched in depressed neoplasms and designated as the D-marker panel. In the validation set, the panel presented a positive predictive value, sensitivity and accuracy of 80·0%, 75·7% and 79·7% respectively for discriminating the depressed neoplasms. colorectal cancers developing from depressed neoplasms account for 22·1% of all colorectal cancers and have a significantly more unfavorable progression-free survival compared with colorectal cancer without those biomarkers, especially in stage I, T1+2, and proximal cancers. Interpretation: In this article, we characterize the genome-wide landscape in the depressed neoplasm and its specific biosignature. The D-marker panel may help to optimize the treatment of depressed neoplasms and surveillance strategies, and develop more effective molecular screening tests in the future. Funding Statement: Funding by the National Taiwan University Hospital (Grand Number: NTUH 107-M3990, NTUH 108-M4209), Ministry of Science and Technology, Taiwan (Grant Number: MOST-105-2314-B-002-047, MOST106-2319-B-002-002, MOST107-2319-B-002-002), and as well as the “Center of Precision Medicine” from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Before initiation, this study received approval (No. 201712033RINC) from the Institutional Review Board and Ethical Committee of National Taiwan University Hospital.

Background The increasingly complex medical environment highlights the importance of milestones and entrustable professional activities (EPAs) to realize the ideals of competency-based medical education (CBME). However, if enormous amounts of assessment results need to be compiled, the development of a digital system to manage, integrate, and synthesize learning and assessment data will be necessary. Furthermore, this system should be able to facilitate real-time assessment with feedback and therefore enhance users’ learning through coaching in the moment in the clinical workplace. Objective The main purpose of this study was to develop a competency-based electronic platform system to provide resident physicians with clinical assessments and learning in order to enhance the learning of trainees and reduce the burden of assessments. Methods A competency-based learning and assessment system (CBLAS) for residency training was designed, developed, and evaluated in this study. Opinion interviews and a focus group consensus meeting of key users, including trainees, clinical teachers, and administrative staff, were conducted as needs assessments. The structure of the CBLAS was designed according to the thematic analysis of needs assessments. Clinical teachers’ acceptance of using CBME assessments, according to the constructs of attitude, perceived usefulness, and perceived ease of use, was surveyed in the beginning and half a year after implementation of the CBLAS. Additionally, the satisfaction of using the CBLAS, according to information, system, and service qualities, was surveyed after implementation. Results The main functions of the CBLAS, including milestones, EPAs, learning portfolios, teacher/student feedback, e-books, learning materials, assessment progress tracking, and statistical analysis of assessment results, were designed and developed for responding to nine themes, which emerged from the needs assessments of the three user groups. Twenty clinical teachers responded to the CBME assessment acceptance surveys before and after CBLAS implementation, which revealed a significant improvement in the factor of “attitude” (P=.02) but no significant differences in the two factors of “usefulness” (P=.09) and “ease of use” (P=.58) for CBME assessments. Furthermore, satisfaction surveys were performed in 117 users, and 87.2% (102/117) were satisfied with the CBLAS in terms of information, system, and service qualities. There was no significant difference in satisfaction among different user groups. Conclusions The CBLAS is a user-centered platform that supports clinical teachers’ assessment exercises and residents’ learning, as well as administrative work for staff according to users’ needs assessments and operationalized features of CBME assessments. With the system, clinical teachers had a more positive attitude to conduct the assessment activities of milestones and EPAs and learners could arrange their study schedules to enhance their learning effectiveness. The CBLAS sheds light on how to effectively design and develop a digital system to execute milestone- and EPA-based assessments for enhancing competency-based education among residents, according to our experiences in Taiwan.

Monolithic Hf&ndash, Si&ndash, N coatings and multilayered Hf&ndash, N coatings with cyclical gradient concentration were fabricated using reactive direct current magnetron cosputtering. The structure of the Hf&ndash, N coatings varied from a crystalline HfN phase, to a mixture of HfN and amorphous phases and to an amorphous phase with continuously increasing the Si content. The multilayered Hf48Si3N49 coatings exhibited a mixture of face-centered cubic and near-amorphous phases with a maximal hardness of 22.5 GPa, a Young&rsquo, s modulus of 244 GPa and a residual stress of &minus, 1.5 GPa. The crystalline phase-dominant coatings exhibited a linear relationship between the hardness and compressive residual stress, whereas the amorphous phase-dominant coatings exhibited a low hardness level of 15&ndash, 16 GPa, this hardness is close to that of Si3N4. Various oxides were formed after annealing of the Hf&ndash, N coatings at 600 &deg, C in a 1% O2&ndash, 99% Ar atmosphere. Monoclinic HfO2 formed after Hf54N46 annealing and amorphous oxide formed for the oxidation-resistant Hf32Si19N49 coatings. The oxidation behavior with respect to the Si content was investigated by using transmission electron microscopy and X-ray photoelectron spectroscopy.

The implementation of evidence-based practice (EBP) in health care has been focused mainly on hospital settings and there is little research on EBP adoption and implementation among school nurses in Taiwan. This study aimed to determine primary school nurses&rsquo, perceptions regarding EBP and to explore the factors that influence EBP in Taiwan. A cross-sectional design was used and the School Nurse Evidence-Based Practice Questionnaire was developed to collect data. A total of 2679 elementary school nurses in Taiwan were invited to participate in this study, and 1200 completed questionnaires were returned, with a 45% response rate. Participants&rsquo, mean age was 37.5 (range: 31&ndash, 62) years and the mean duration of employment as a school nurse was 8.4 (range: 1&ndash, 20) years. The majority of participants had a Bachelor&rsquo, s degree (56%). The results revealed that participants had insufficient EBP knowledge and skills. However, they had a positive attitude toward and moderate self-efficacy in EBP. The demographic data positively correlated with knowledge, attitudes, skills, self-efficacy, and influencing factors. Certain influencing factors were highlighted. As school nurses play a crucial role in promoting children&rsquo, s health, they ought to embrace EBP so as to provide more effective services. School organization should play a supportive role with regard to EBP implementation.

Background Cultural competency has been identified as an essential curricular element in undergraduate and graduate nursing programmes. Supporting successful transition to practice is essential for retaining graduate nurses in the workforce and meeting the demand for cultural diversity in health care services. Objectives This study aimed to explore the teaching and learning interactions of transition cultural competence from the perspective of mentors of newly graduated nurses in a Taiwanese postgraduate nursing programme. Design A qualitative design that utilised focus group interviews was adopted for this study. A framework approach—a content and thematic analysis strategy—was used to analyse the interviews. Setting The study setting consisted of two hospitals in northern Taiwan. Participants The study participants consisted of 24 new graduate nurse mentors. Methods Three focus group sessions were conducted (two at a medical centre and one at a district hospital), where the participants were interviewed. Results Four themes were derived from the data—transition process, teaching strategies according to the transition stage, learning after overcoming clinical stress, and awareness of cultural diversity among new graduate nurses. The clinical routine and physical stress of caring for patients did not allow the newly graduated nurses to appropriately demonstrate cultural competence in the first three months. Mentors were only able to provide resources for new graduate nurses when they first started to care for patients in cultural groups. The point of catalysis was when learners finally gained awareness of cultural differences, and, consequently, they could encounter the teaching and learning process. Conclusion The different learning stages and teaching strategies illustrated the interactive process between new nurses and educators. Facilitating the cultural awareness of learners is a challenge for teachers who provide cultural competence training. This model could serve as a reference for curriculum and clinical training programmes.

Zr&ndash, Si&ndash, N films were fabricated through the co-deposition of high-power impulse magnetron sputtering (HiPIMS) and radio-frequency magnetron sputtering (RFMS). The mechanical properties of the films fabricated using various nitrogen flow rates and radio-frequency powers were investigated. The HiPIMS/RFMS co-sputtered Zr&ndash, N films were under-stoichiometric. These films with Si content of less than 9 at.%, and N content of less than 43 at.% displayed a face-centered cubic structure. The films&rsquo, hardness and Young&rsquo, s modulus exhibited an evident relationship to their compressive residual stresses. The films with 2&ndash, 6 at.% Si exhibited high hardness of 33&ndash, 34 GPa and high Young&rsquo, s moduli of 346&ndash, 373 GPa, which was accompanied with compressive residual stresses from &minus, 4.4 to &minus, 5.0 GPa.

Objectives This study explored whether there is an association between medical trainees’ future specialty choices and the 360-degree feedback they receive. We hypothesised that the higher the scores that teachers, trainees and/or nurses give to postgraduate year 1s (PGY1s) in any given specialty, the more likely that they will choose that specialty for their residency. Setting The study was conducted in a large regional teaching hospital in Taiwan. Participants The participants of this study were n=66 PGY1s who had completed their medical studies domestically or internationally and had received their PGY1 training in a single teaching hospital in southern Taiwan. Data from 990 assessments were included. Primary and secondary outcome measures Logistic regression analyses for teachers’, nursing staff and peers’ authentic assessments of trainees were undertaken for (1) desired specialty, (2) applied specialty, (3) enrolled specialty, (4) consistency between desired and applied specialties, (5) consistency between applied and enrolled specialties and (6) consistency between desired and enrolled specialties. Alpha was set at p Results Nursing staff scores were significantly associated with all six dependent variables. Furthermore, teachers’ scores were significantly associated with trainees’ desired specialty and the consistency between desired and enrolled specialty. Peers’ scores were not significantly associated with any dependent variable. Conclusions Trainees’ specialty choices are associated with scores given by nursing staff and clinical teachers. We suggest that qualitative research methods should further explore this association to ascertain whether PGY1s are consciously influenced by these scores and if so, in what way.

There is an increasing trend of colorectal cancer incidence in Asia and nearly 45% of CRC cases worldwide occur in Asia therefore screening for CRC becomes an urgent task. Stool-based tests, including guaiac fecal occult blood test (gFOBT) and fecal immunochemical test (FIT), can select subjects at risk of significant colorectal neoplasms from the large target population thus are currently the most commonly used non-invasive screening tool in large population screening programs. FIT has the advantage over gFOBT in terms of higher sensitivity for early neoplasms, the ability to provide high-throughput automatic analysis, and better public acceptance thus greater effectiveness on reducing CRC mortality and incidence is expected. Owing to the large target population and constrained endoscopic capacity and manpower, FIT is nowadays the most popular CRC screening test in Asia. Some Asian countries have launched nationwide screening program in the past one or two decades but also encountered some challenges such as low screening participation rate, low verification rate after positive stool tests, low public awareness, and insufficient manpower. In addition, some controversial or potential future research issues are also addressed in this review.

This study explores the internal oxidation of laminated Hf–Ta coatings with a cyclically gradient chemical concentration distribution along the growth direction. The oxidation behavior was examined by annealing the coatings at 400–600 °C in a 15 ppm O 2 –N 2 atmosphere for 30 min. The variations in crystalline structure, nanohardness, chemical states, and chemical composition profiles in depth after various annealing conditions were investigated. The results indicate that all the Hf–Ta coatings maintain a laminated structure after annealing at 400–600 °C. Internal oxidation conducts during 500 and 600 °C annealing, but part of the outmost layers exhibits complex oxides after annealing at 600 °C. The nanohardness of annealed Hf–Ta coatings related to the formation of HfO 2 , Hf 6 Ta 2 O 17 , and amorphous Ta-oxide were studied.

Ta1 − xZrxNy coatings were fabricated using reactive direct-current magnetron cosputtering on silicon and cemented carbide substrates. The oxidation resistance of the Ta1 − xZrxNy coatings was evaluated by annealing the samples in a 15-ppm O2–N2 atmosphere at 600 °C. The variations in crystalline structure, mechanical properties, and surface roughness values after annealing were investigated. One commercial moldable glass material, a SiO2–B2O3–BaO-based glass, was used to evaluate the chemical inertness of Ta1 − xZrxNy coatings, applied as protective coatings in glass molding processes. Thermal cycling annealing at 270 and 600 °C, with the temperature strictly maintained at 600 ± 10 °C for 1 min/cycle, was conducted in a quartz tube furnace to simulate a glass molding process in a continuous flow of 15 ppm O2–N2. Up to 500 thermal cycling annealing tests were conducted for the glass and coating assemblies.

Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11–12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students ( N = 373) was –.10, which increased to –.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention ( t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition’s efforts, which reinforces the usefulness of co-operatively implementing the HPS program.

Glass molding can be employed to fabricate high-quality lenses with a lower cost and higher process rate than those of the traditional glass lens production method. Glass molding is widely employed in manufacturing precision optical elements with aspheric surfaces. In this study, amorphous Ta–Si–N coatings with a Ti interlayer were sputtered on cemented carbide substrates to evaluate their potential as protective coatings on glass molding dies. Commercial moldable SiO2–B2O3–BaO-based and B2O3–ZnO–La2O3-based glasses were used to evaluate the chemical inertness of Ta–Si–N coatings in glass molding. Thermal cycle annealing, which involves annealing at 270 °C and 600 °C and maintaining the glasses at 600 °C ± 10 °C for 1 min/cycle, was conducted in a quartz tube furnace to simulate glass molding in a continuous flow of a 15-ppm O2–N2 atmosphere. The glass and coating assemblies were subjected to up to 1000 thermal cycles. The variations in the crystalline structure and surface roughness after various annealing durations were investigated.

In this study, the mechanical properties of silver film are studied using a nanoindentation test, dynamic bending test, and lamination bonding pressure test. The hardness and elastic modulus of silver film were approximately 1.08 and 88.5 GPa, respectively, which corresponds to those of bulk silver. Acceptable fatigue properties were obtained after 10 4 dynamic bending cycles. A lamination bonding pressure of 0.69 MPa and temperature of 270 °C were used to achieve multilayer liquid crystal polymer (LCP) technology. A miniature bandpass filter using inkjet printing technology on multilayer LCP was realized with a minimal S 21 value of − 1.4 dB at 25 GHz. The results demonstrated the proposed design methodology and fabrication technique.

Carrier injection and charge loss characteristics of nonvolatile memories with chemically-synthesized (CS) and vacuum-deposited (VD) gold nanoparticles (Au-NPs) have been investigated. Compared to CS counterparts, the memories with VD Au-NPs exhibit a higher dot density of 3.77 × 1011 cm−2, leading to a larger memory window. Further, the energy from valence-band edge to vacuum level (EVB_vac) of tunneling oxide for the samples with CS and VD Au-NPs is found to be 9.04 and 9.85 eV respectively. The small EVB_vac value of the memories with CS Au-NPs is resulted from the formation of a thin chemical oxide (SiOx) on thermally-grown SiO2 tunneling layer during the chemically synthesized process, contributing to a slow erasing behavior. Besides, the programming of the memories with VD Au-NPs is saturated at high gate bias, which has been well-explained by the electrons induced potential coupling between Au-NPs. Superior data retention property and high temperature dependence of charge loss are observed for the memories with CS Au-NPs, which can be ascribed to the thick tunneling oxide layer by the additional SiOx film.

The purpose of this study was to explore the reading behavior of young proficient Chinese readers at preschool age. Especially, the roles of phonetic skill and Chinese Character recognition in reading comprehension were explored. 10 kindergartens were recruited to participate in the study. Subjects were 72-98 kindergarten children. Instruments include 5 measures of language assessments. Pearson product-moment correlation, ANOVA and stepwise regression were used to analyze quantitative data. Reading miscue analysis was employed to analyze children's reading style and error patterns. The results found: (1) Word recognition was a better predictor in reading fluency when comparing with Chinese phonic spelling ability. (2) Reading fluency was positively correlated with reading comprehension. (3) There were 4 types of young readers. (4) Balanced readers had the best reading comprehension abilities.(5) Young children used mostly syntax and semantics clues in miscue analysis. (6) Reading fluency and PPVT were the two best early predictors for later reading comprehension abilities.

Spilanthol has been reported to possess antioxidant, anti‑inflammatory, antimicrobial and antinociceptive properties. At present, the literature has reported the beneficial role of spilanthol on tumor necrosis factor‑α (TNF‑α)‑stimulated HaCaT cells. The present study investigated the effects of spilanthol on the expression of TNF‑α‑induced intercellular adhesion molecule 1 (ICAM‑1) and cyclooxygenase (COX)‑2 in the human keratinocyte cell line HaCaT. Cells were pretreated with various concentrations of spilanthol (10‑150 µM) followed by TNF‑α to induce inflammation. Pretreatment with spilanthol decreased TNF‑α‑induced COX‑2 expression by western blotting and suppressed the expression of pro‑inflammatory mediators, including interleukin (IL)‑6, IL‑8 and monocyte chemotactic protein 1 using ELISA. Spilanthol also decreased the expression of TNF‑α‑induced ICAM‑1 protein and mRNA assay by western blotting and RT‑qPCR, respectively, in addition to the monocyte adhesiveness of HaCaT cells. Furthermore, spilanthol significantly suppressed the phosphorylation of c‑Jun N‑terminal kinase (JNK), while pretreatment with spilanthol enhanced heme oxygenase (HO)‑1 protein expression by western blotting. These results demonstrated that spilanthol may exert its anti‑inflammatory activity by suppressing the TNF‑α‑induced expression of ICAM‑1, COX‑2 and pro‑inflammatory mediators by enhancing that of HO‑1, and inhibiting the activation of the phosphorylated JNK signaling pathway. It is hypothesized that spilanthol may be a natural anti‑inflammatory drug to attenuate skin inflammatory disease.

Background Colorectal cancer remains a considerable challenge in healthcare nowadays. Most patients’ disease develops via the adenoma–carcinoma sequence; colonoscopy with polypectomy effectively reduces both mortality and incidence by removing precancerous adenomas. Previous studies showed that polypectomy without electrocautery (cold snaring polypectomy) is a safe and time-saving procedure to manage polyps

To investigate the relationships among social support, health literacy, and self-management, and the factors influencing self-management of chronic kidney disease (CKD).Cross-sectional study.A random sample of 410 patients was recruited from nephrology clinics. Data were collected using structured questionnaires and chart reviews from January 2013 to February 2014. Hierarchical regression analysis was used to determine the predictive factors of self-management behaviors and ∆RHealth literacy and social support were positively correlated with self-management behaviors. Furthermore, social support, health literacy, and marital status were significant predictors of self-management behaviors. Social support had a relatively greater explanatory power for self-management behaviors than did health literacy. Particularly, healthcare provider support had the greatest influence on patients' self-management behaviors.Health literacy and social support play independent positive roles in self-management behaviors of patients with CKD, with social support having a particularly dominant role. Further research using a systems approach to improving self-management behaviors is necessary to clarify the role of social support.Health literacy and social support are independently and positively related to self-management. Social support, which is a system-level factor, is a relatively stronger and crucial predictor than is health literacy. Nurses have to refine self-management programs to focus on families and adopt a systems approach to help CKD patients improve their self-management behaviors.

Ta–Zr–N thin films were fabricated through co-deposition of radio-frequency magnetron sputtering and high-power impulse magnetron sputtering (HIPIMS/RFMS co-sputtering). The oxidation resistance of the fabricated films was evaluated by annealing the samples in a 15-ppm O2-N2 atmosphere at 600 °C for 4 and 8 h. The mechanical properties and surface roughness of the as-deposited and annealed thin films were evaluated. The results indicated that the HIPIMS/RFMS co-sputtered Ta–Zr–N thin films exhibited superior mechanical properties and lower surface roughness than did the conventional direct current-sputtered Ta–Zr–N thin films and HIPIMS-fabricated ZrNx thin films in both the as-deposited and annealed states.

Colorectal cancer (CRC) is increasing in Asia, especially in regions with higher levels of economic development. Several Asian countries have launched population CRC screening programs to combat this devastating disease because previous studies have demonstrated that either fecal occult blood test or lower gastrointestinal endoscopy can effectively reduce CRC mortality. Screening includes engaging the population, testing, administering a confirmation examination, and treating screening-detected neoplasms; thus, monitoring the whole process using measurable indicators over time is of utmost importance. Only when the quality of every step is secured can the effectiveness of CRC screening be maximized. Screening and verification examination rates remain low in Asian countries, and important infrastructure, including cancer or death registry systems, colonoscopy capacity, and reasonable subsidization for screening, is lacking or insufficient. Future research should identify potential local barriers to screening. Good communication and dialog among screening organizers, clinicians, professional societies, and public health workers are indispensible for successful screening programs.

The incidence and disease burden of colorectal cancer (CRC) in young adults were increasing. However, there was a dearth of advice on how to identify young population at risk for neoplastic colonic polyps (NCPs) and CRC. We aimed to identify risk factors for NCPs and CRC in young adults presenting with bloody stool.A total of 1496 subjects younger than 40 years old who underwent colonoscopy due to bloody stool from 2005 to 2014 were enrolled in this retrospective study as the study group, and 1481 age-matched and gender-matched asymptomatic subjects who underwent colonoscopy for health checkup from 2011 to 2016 were enrolled as the control group at a tertiary center hospital.Multivariate analysis results showed that increasing age (odds ratio [OR] = 1.11, 95% confidence interval [CI]: 1.07-1.15, P 0.001), higher body mass index (BMI) (OR = 1.07, 95%CI: 1.03-1.12, P = 0.001), diabetes mellitus (OR = 2.80, 95%CI: 1.06-7.42, P = 0.038), and positive family history of CRC (OR = 13.28, 95%CI: 5.70-30.97, P 0.001) were identified as independent risk factors for NCPs in study group. The best cut-off values by receiver operating characteristic curve for age and BMI were 32 years old and 24.8 kg/mAdults aged ≤ 40 years with bloody stool who had increasing age ( 32 years old), higher BMI ( 24.8 kg/m

Endoscopic diagnosis of sessile serrated adenoma/polyp (SSA/P) is challenging because of their subtle appearance. Narrow-band imaging (NBI) is useful for diagnosis, but its utility with concurrent chromoendoscopy (CE), especially to detect small SSA/P, is unproven.This prospective study enrolled 367 consecutive patients who underwent screening colonoscopy with the finding of serrated polyps. Patients were divided into derivation and validation cohorts: Diagnostic criteria using different endoscopic modalities were generated by regression analysis in the derivation cohort and were validated in the validation cohort for sensitivity, specificity, and accuracy.There were 180 patients with 119 SSA/P and 147 hyperplastic polyps (HP) in the derivation cohort and 187 patients with 177 SSA/P and 125 HP in the validation cohort. With white-light endoscopy plus NBI, mucus cap, surface grooves, and expanded crypt were most associated with SSA/P. With white-light endoscopy plus CE, II-O pit pattern, mucus cap, and superficial telangiectasia were most associated with SSA/P. With the combined use of these three modalities, II-O pit pattern, mucus cap, and surface grooves were most associated with SSA/P. For large serrated polyp, NBI in combination with CE had a better accuracy than NBI alone (91% vs 86%, P = 0.025) to distinguish SSA/P from HP. CE alone had a better accuracy than NBI alone for distinguishing small SSA/P from small HP (85% vs 72%, P 0.0001).Compared with NBI alone, adjunctive use of CE can improve the diagnostic accuracy for distinguishing SSA/P from HP, especially for small SSA/P.

This paper presents a series-fed two-dipole antenna, fabricated on a liquid crystal polymer (LCP) substrate using inkjet-printing technology. The radio frequency characteristics of inkjet-printing silver film onto an LCP substrate are studied using the microstrip line. The proposed antenna consists of two modified dipole elements of distinct lengths: a modified ground plane and a balun filter yielding a wide bandwidth with bandpass responses. The proposed antenna can be used at frequency band of 26-33 GHz. The bending behaviors of the microstrip line and antenna are also measured. Inkjet printing on LCP substrates provides a low-cost, compact, and flexible packaging solution that can be used in future communication technology.

Background Gender, smoking, and metabolic syndrome (MetS) are important risk factors of colorectal neoplasm. Whether presence of these factors may warrant earlier screening remains unclear. Objective To compare age- and gender-specific risk of colorectal neoplasms in association with smoking and MetS under endoscopic or stool-based screening. Design Cross-sectional observational study. Setting Screening center in a university hospital in Taiwan. Patients A cohort of 10,884 average-risk individuals who received concurrent screening colonoscopy and fecal immunochemical testing (FIT). Main Outcome Measurements First, the prevalence of colorectal neoplasms and positive predictive value of FIT relative to age, gender, smoking, and MetS. Second, the number of colonoscopies needed to detect 1 advanced neoplasm with different strategies. Results Male smokers aged 40 to 49 years had a significantly higher prevalence of advanced neoplasms and positive predictive value of stool tests than nonsmoking counterparts. The prevalence of advanced neoplasms in concurrent MetS and smoking (6.2%) or smoking alone (3.8%) men aged 40 to 49 years was higher than that of average-risk women aged 50 to 59 years (2.1%) ( P = .03 and .04, respectively). The number of colonoscopies needed to detect 1 advanced neoplasm in men aged 40 to 49 years with concurrent MetS and smoking, smoking, MetS, and women aged 50 to 59 years was, respectively, 14.6, 24.8, 39.8, and 47.4 in the colonoscopy scenario and 1.7, 4.6, 5.7, and 8.3 in the FIT scenario. Limitation Self-selective bias may exist for subjects voluntarily submitted to health check-ups. Conclusions MetS and smoking significantly impact both the prevalence of colorectal neoplasms and the diagnostic yields of screening tests in men aged 40 to 49 years. Whether our findings justify earlier screening in this subgroup requires further study.