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This study proposed reflective learning in an online course design to maximise the effectiveness of online courses. A quasi-experimental design was employed, and 62 Taiwanese adults participated in...

Purpose The aim of this study is to identify sources of distress among cancer patients attending rehabilitation in the community. Methods Participants were 430 patients recruited from a cancer rehabilitation center in Singapore between 2017 and 2018, who had rated their distress using the distress thermometer (DT) and indicated associated problems on the problem list. Chi-square tests were used to detect differences in the reported symptoms among three age groups. Exploratory factor analysis was used to identify symptom clusters. Partial correlational analysis was then performed to examine the relationship between distress, symptom clusters, and age controlling for gender and cancer type. Results About 30% of the participants reported distress ≥ 5 on the DT (mean 3.3 ± 2.5), and the mean number of problems endorsed was 8 ± 6. A higher total number of reported problems (r = .63) and younger age (r = − .21) were associated with increased distress. The younger age group also reported more problems surrounding emotions, finance, work/school, children-related issues, and physical symptoms such as sleep and nausea. Of the 12 factors identified, 9 psychosocial and physical symptom clusters correlated with distress (r ranging from .12 to .41). All results were statistically significant after adjustment (p ≤ 0.05). Conclusion Younger survivors are more at risk of distress and report greater role functioning concerns related to childcare, partner relationship, and work participation. Age-tailored and multimodal interventions may be necessary to adequately address age-related differences and help coordinate management of multiple symptom clusters across physical and psychosocial concerns.

Visual impairment (VI) was associated with cognitive impairment. However, different visual trajectories might contribute to different risks of cognitive decline in the elderly.This study aimed to evaluate the association between visual trajectories and cognitive impairment.Four thousand two hundred eight community-dwelling elder adults were identified from Waves IV-VII (1999-2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive function was determined using the Short Portable Mental Status Questionnaire (SPMSQ) scores. Visual impairment was self-reported and visual trajectories were assessed in at least two waves of the survey. Ordinal logistic regression was performed to estimate adjusted odds ratios (adjORs) and 95% confidence intervals (CIs).Participants with visual trajectory from no VI to VI had significantly higher risk of cognitive impairment with an adjOR of 1.69 (95% CI 1.12-2.57) than participants without VI. Compared to participants without VI, participants with persistent VI (adjOR 1.32; 95% CI 0.89-1.96) and with visual trajectory from VI to no VI (adjOR 1.25; 95% CI 0.83-1.88) were not associated with cognitive impairment. A protective association between eyeglasses use and cognitive impairment (adjOR 0.69; 95% CI 0.55-0.87) was found in this study. Importantly, cataract was associated with higher risk of cognitive impairment (adjOR 1.34; 95% CI 1.10-1.62). However, nonsurgical cataract treatment did not show protective effect on cognitive impairment in patients with cataract.Visual trajectory from no VI to VI is a significant risk factor for cognitive impairment that physicians should pay special attention during community screening.

This letter proposes a new organic trench structure which can enhance the endurance of polycrystalline silicon thin film transistors (TFTs) under mechanical bending stress. It compares conventional structure TFTs to devices with an organic trench to examine reliability after undergoing 100,000 iterations of channel width-axis (100,000’WC) compression at R = 2mm. Due to the low Young’s modulus of organic materials, stress while undergoing bending strain is desorbed to the buffer layer, which can lower the overall stress in TFTs. Furthermore, an optimal location and ideal length for such an organic trench is evaluated by mechanical bending simulation.

In this study, a novel structural device, named as a wing-shaped TFT, is proposed and is demonstrated to prevent fast deterioration under mechanical bending in foldable devices. After long-term mechanical bending, standard low-temperature polysilicon TFTs exhibit instability behaviors such as sub-channel formation, serious threshold voltage shifts, an on-current (ION) increase, and an off-current (IOFF) decrease. These phenomena are believed to be due to additional oxide traps along the channel-width edges of the gate insulator after bending. In order to suppress this degradation, a wing-shaped structure is proposed. By extending the active layer, degradation regions are shifted away from the main channel. Therefore, the reliability of the devices is enhanced. The transfer characteristics show enhanced electrical behavior after being held for 48 hours in a static bent condition, with an 88% drop in threshold voltage shift as well as a 55% decrease in subthreshold swing degradation, proving better durability of the foldable TFT to bending stress for devices with these wings. Time-dependent transfer characteristics, a COMSOL simulation, and device geometry are discussed to support our findings.

We investigate the abnormal current-voltage (C-V) hump effect of p-type low-temperature polysilicon (LTPS) thin-film transistors (TFTs) which have undergone high current operations. Experimental results indicate localized electron trapping in the gate insulator (GI), which is carried out near the drain. The ON-current ( ${I}_{ \mathrm{\scriptscriptstyle ON}}$ ) enhancement is due to the reduction of effective length, and the OFF-current ( ${I}_{ \mathrm{\scriptscriptstyle OFF}}$ ) decrease as the electron tunneling path distance increases. These can be observed after hot carrier stress in current characteristics. The C-V measurements demonstrate that the threshold voltage ( ${V}_{\text {th}}$ ) shift is associated with the gate length. In addition, capacitance-voltage measurements also show that this localized trapping region remains the same in length, regardless of channel length. Hence, a model is proposed to explain how the electric field, which is gate length-dependent, affects the source side of the device, and then lowers the source barrier height. This leads to bulk leakage, which causes the subthreshold swing degradation at device scale down.

This letter investigates variations in polycrystalline silicon thin film transistor (TFT) performance under illumination and negative bias temperature instability (NBTI) tests due to different dehydrogenation annealing temperatures during the fabrication process. The depth of the density of state (DOS) in polysilicon can be indirectly determined by the TFT response to light illumination, since dangling bonds act as recombination centers. The electrical characteristics of TFTs after undergoing NBTI can also be indicative of the bonding type of silicon atoms. By analyzing the results of these reliability tests, the type of DOS can be clarified, which is beneficial for realizing the relationship between performance and reliability.

This paper clarifies the correct transmission mechanism, misattributed in the previous research, of a hydrogenated amorphous silicon thin-film transistor (a-Si:H TFT) device. Complete drain current–gate voltage ( ${I}_{\text {D}}$ – ${V}_{\text {G}}$ ) transfer characteristics including the forward and backward gate sweeps (gate voltage carried out in the OFF-state $\to $ on-state and the ON-state $\to $ OFF-state) are performed, and the physics models of an energy-band schematic are clearly explained. This paper reveals that the ${I}_{\text {D}}$ – ${V}_{\text {G}}$ curve stretch-out behavior of the subthreshold region is due to the leakage of the Poole–Frenkel region. At the Poole–Frenkel regions, electrons transfer to the drain terminal, and holes remain in the valance band of the a-Si:H bulk. The remaining holes represent the positive voltage and cause the electron barrier height lowering. This causes an increase in subthreshold current of the subthreshold region. Finally, three experiments are performed to prove the correctness of these models, and the a-Si TFTs device improvement methods will be proposed to enhance the stability and performance of product of the a-Si TFTs.

SummaryMammalian SWI/SNF (BAF) chromatin remodelers play dosage-sensitive roles in many human malignancies and neurologic disorders. The gene encoding the BAF subunit, ACTL6A, is amplified at an early stage in the development of squamous cell carcinomas (SCCs), but its oncogenic role remains unclear. Here we demonstrate that ACTL6A overexpression leads to its stoichiometric assembly into BAF complexes and drives its interaction and engagement with specific regulatory regions in the genome. In normal epithelial cells, ACTL6A was sub-stoichiometric to other BAF subunits. However, increased ACTL6A levels by ectopic expression or in SCC cells led to near-saturation of ACTL6A within BAF complexes. Increased ACTL6A occupancy enhanced polycomb opposition over the genome activating SCC genes and also enhanced the recruitment of transcription factor TEAD with its co-activator YAP, promoting their chromatin binding and enhancer accessibility. Both of these mechanisms appeared to be critical and function as a molecular AND gate for SCC initiation and maintenance, thereby explaining the specificity of the role of ACTL6A amplification in SCCs.HighlightsACTL6A occupancy within BAF complexes is sub-stoichiometric in normal epithelial cells.SCC cells upregulate ACTL6A thus increasing ACTL6A assembly with BAF complexes.Genome-wide chromatin profiling identifies ACTL6A-dependent regulatory regions.Increasing ACTL6A incorporation enhances TEAD-YAP binding to BAF complexes.ACTL6A overexpression counteracts polycomb-mediated repression at SCC signature genes.

Mammalian SWI/SNF (BAF) chromatin remodelers play dosage-sensitive roles in many human malignancies and neurologic disorders. The gene encoding the BAF subunit actin-like 6a (ACTL6A) is amplified early in the development of many squamous cell carcinomas (SCCs), but its oncogenic role remains unclear. Here we demonstrate that ACTL6A overexpression leads to its stoichiometric assembly into BAF complexes and drives their interaction and engagement with specific regulatory regions in the genome. In normal epithelial cells, ACTL6A was substoichiometric to other BAF subunits. However, increased ACTL6A levels by ectopic expression or in SCC cells led to near saturation of ACTL6A within BAF complexes. Increased ACTL6A occupancy enhanced polycomb opposition genome-wide to activate SCC genes and facilitated the co-dependent loading of BAF and TEAD-YAP complexes on chromatin. Both mechanisms appeared to be critical and function as a molecular AND gate for SCC initiation and maintenance, thereby explaining the specificity of the role of ACTL6A amplification in SCCs.

Research Objectives To describe older adults’ ability to bear weight post hip surgery using a wearable pressure insole sensor. It was hypothesized that the pressure insole sensor would detect a decrease in weightbearing ability as pain increased. Design This descriptive study detailed the weight-bearing ability of older adults for up to 14 postoperative days. Setting The study was conducted at a hip fracture unit located in an inpatient hospital setting. Participants Ten older adults who had sustained either neck of femur or intertrochanteric fracture and had undergone hemiarthroplasty or proximal femoral nail antirotation surgery participated in this study. All participants had a premorbid score of 100 on the Modified Barthel Index and had no cognitive impairment. Interventions The older adults were asked to wear a pair of pressure insole sensors once a day during their daily therapy session for up to 14 postoperative days. The maximum and mean weight-bearing load were measured during standing and walking. Main Outcome Measures Weight-bearing ability was measured by wearing a wireless device system consisting of (a) an air-filled sensor pad worn as a sandal, (b) a logger unit connected to the sensor pad via an air tube and secured to the calf using Velcro, and (c) a computer software that processed data transmitted wirelessly from the logger unit and recorded the weight-bearing load graphically in weight units across each step during ambulation. Results Three older adults, who had undergone a hemiarthroplasty, tolerated a maximum load close to 100% of their body weight, and was able to progress from walking with a walking frame to a quad stick. Although a high maximum load was achieved, older adults’ mean weight-bearing load on their injured limb remained lower compared to their non-injured limb especially in those who had reported more pain. Conclusions Early weight-bearing recovery of older adults can be monitored using pressure insole sensor and facilitated through better pain control and enhanced therapy intervention. Author(s) Disclosures The author declares no conflict of interest.

Research Objectives To examine the validity of the Brief Fatigue Inventory (BFI) and its relationship to distress in cancer survivors. Design This is a cross-sectional study. Setting The study was conducted in an outpatient community setting that specialized in cancer rehabilitation. Participants Two hundred and twenty-two cancer survivors who were predominantly female, diagnosed with breast cancer and aged between 30 to 88 years old participated in this study. Interventions Participants completed the BFI and the Distress Thermometer (DT) during admission to the cancer rehabilitation program. Main Outcome Measures Fatigue was measured by the BFI and distress rating was assessed using the DT. An overall fatigue score and 2 subscales (intensity and interference) were calculated. Results Two distinct factors (intensity and interference) were identified using exploratory factor analysis. Mean overall fatigue level was 3.42 ± 1.92, mean intensity level was 4.30 ± 1.99, and mean interference level was 5.97 ± 4.15. Both overall fatigue and Interference subscale correlated more with distress (r = .33) compared to intensity subscale (r = .26). Among the BFI items, enjoyment of life had the strongest correlation with distress (r =.34) followed by mood (r =.33), relations with other people (r = .30) and fatigue right now (r = .29). Conclusions Rather than treating fatigue as mostly a physical symptom, assessment and intervention should aim at addressing the interference of fatigue on psychosocial well-being especially among distressed cancer survivors. Author(s) Disclosures The author declares no conflict of interest.

Background Previous studies have reported associations between hearing impairment (HI) and cognitive impairment, but the evidence is not conclusive while considering concurrent geriatric syndromes. Especially, evidence from previous studies rarely came from Asian studies. This study aimed to evaluate the independent effects of HI and hearing aid use on the incidence of cognitive impairment while considering most geriatric confounders. Methods This population-based, propensity-score matched cohort study used cohort from Waves IV–VII (1999–2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive impairment was identified based on Short Portable Mental Status Questionnaire (SPMSQ) scores. The hazard ratio (HR) was calculated using the Cox proportional hazard regression adjusting for age, sex, comorbidities, socioeconomic status, Center for Epidemiologic Studies Depression (CES-D) scores, the instrumental activities of daily living scale, mobility condition and quality of life. In addition, social support and participation were also considered as confounders in the analysis. To assess the robustness of our findings, we conducted a sensitivity analysis designed to access unmeasured confounding factors by calculating E-values. Results After 1:1 propensity-score matching, we included 709 participants in both the HI and non-HI groups with a mean age of 73.4 years and 39.4% of participants were female. The mean follow-up was 8.9 ± 3.9 years. The HI group had a higher incidence of cognitive impairment than the non-HI group (74.5% vs. 69.1%, respectively), with an adjusted HR of 1.16 (95% confidence interval [CI], 1.03–1.32) based on a 12-year follow up. The E-value was 1.45 for the estimate, which provided evidence for this study’s robustness. Although, a subgroup analysis showed that hearing aid use was associated with lower incidences of cognitive impairment (66.3% vs. 75.6%) when compared to non-users in the HI group, the adjusted HR of 0.82 (95% CI, 0.61–1.09) revealed no significant differences. Conclusions HI was an independent risk factor of incident cognitive impairment on top of concurrent geriatric syndromes. Early HI detection may thus be effective for preventing cognitive decline. Further studies are needed to evaluate the effect of hearing aid use on the prevention of cognitive decline.

This paper systematically studies high-current-induced effects, hot-carrier effects, and self-heating effects in flexible low-temperature polycrystalline-silicon thin-film transistors fabricated on polyimide. By utilizing ${I}$ – ${V}$ and various-frequency ${C}$ – ${V}$ measurements, the exact location of defects generated by the self-heating effects can be clarified. The degradation mechanism is found to originate from asymmetric negative-bias temperature instability. After clarifying this mechanism, the self-heating effects were shown to be alleviated by manipulating the fabrication of the buffer layer, thereby improving heat dissipation capabilities.

Bulk heterojunction organic solar cells have been fabricated by inserting a high-resistivity sol-gel ITO buffer layer between an ITO anode and a PEDOT:PSS hole injection layer. The performance of the devices with the sol-gel ITO atop the ITO anodes treated by conventional annealing at 500 °C for 1 h and rapid thermal process (RTP) at 800 °C for 20 and 30 s was compared. The best power conversion efficiency of 3.5% was achieved for the device with the 15-nm-thick sol-gel ITO treated with RTP at 800 °C for 30 s, as compared with 2.7% of the standard device under an illumination of AM 1.5. In addition, the short circuit current of the device was significantly increased by 42.7%. The observed enhancement of the short circuit current can be attributed an interfacial energy step created by the high-resistivity sol-gel ITO between the ITO anode and the PEDOT:PSS.

This letter investigates flexible polycrystalline silicon thin film transistor performance variation due to different buffer layer thicknesses. In flexible electronics, thermal expansion stress during device fabrication is inevitable. A thicker SiO2 buffer demonstrates better endurance to thermal expansion stress from the polyimide substrate during device annealing. However, if the SiO2 buffer thickness is above a critical point, its weak heat dissipation capability causes the optimal ELA crystallization condition to shift. A thermal expansion stress simulation and TEM photos were utilized to verify performance variation. Furthermore, a similar trend was observed in electrical characteristics after negative bias temperature instability.

Lateral optical coupling using angled-fiber array and MT ferrule for quick plug-and-unplug interconnect to a PIC is proposed. The excess coupling loss of the technique to conventional vertical fiber coupling is 2.4dB/end with 0.4dB uniformity.

In this work, for the first time, to the best of our knowledge, an anomalous dispersion CMOS-compatible Ta

This letter investigates the effect of repeated uniaxial mechanical stress on bias-induced degradation behavior in polycrystalline thin-film transistors (TFTs). After 100 000 iterations of channel-width-direction mechanical compression, serious threshold voltage degradation and an abnormal hump are observed. Simulation indicates that the strongest mechanical stress occurs at both sides of the channel edge, between the polycrystalline silicon and gate insulator. Since these stress points produce oxide traps in the gate insulator, the degradation of threshold voltage shift and parasitic current path can be attributed to electron trapping at these intense mechanical stress points. In addition, the degradation becomes serious with diminishing TFT size.

The degree of degradation between the amorphous-indium–gallium–zinc oxide (a-IGZO) thin film transistor (TFT) using the top-gate only or bottom-gate only is compared. Under negative gate bias illumination stress (NBIS), the threshold voltage (V T ) after bottom-gate NBIS monotonically shifts in the negative direction, whereas top-gate NBIS operation exhibits on-state current increases without V T shift. Such anomalous degradation behavior of NBIS under top-gate operation is due to hole-trapping in the etch stop layer above the central portion of the channel. These phenomena can be ascribed to the screening of the electric field by redundant source/drain electrodes. In addition, the device degradation of dual gate a-IGZO TFT stressed with different top gate pulse waveforms is investigated. It is observed that the degradation is dependent on the frequency of the top gate pulses. The V T shift increases with decreasing frequency, indicating the hole mobility of IGZO is low.