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In this study, we proposed an augmented reality- (AR-) based mobile touring system for an authentic learning activity, which enables students to observe and learn key information regarding cultural heritage sites. To evaluate the effectiveness of the proposed system, we conducted an experiment in a cultural heritage course at a Taiwanese university. A total of 72 students were divided into two groups and randomly assigned to an experimental group who learned with the AR-based mobile touring system and a control group who learned with a conventional mobile touring system. The experimental results show that the AR-based mobile touring system significantly improved the students' memorising dimension of learning achievement, as compared with a conventional mobile touring system. Moreover, the positive impact of the proposed system on students' actualised interest and task-based interest factors provide a particularly encouraging result for outdoor experiences. These experimental results also suggest the potential of AR technology to increase students' learning interest and improve their learning achievements in outdoor settings. Therefore, we suggest that, when applying an AR-based mobile touring system in authentic learning activities, AR virtual objects should be designed appropriately, in order that the content recall performance and learning interest are enhanced.

This study developed a VR-based mobile learning system to simulate the natural environment of a geopark for university students to learn geological knowledge. This learning method used a Google cardboard equipped with smartphones, where students can watch stereoscopic scenes and experience virtual environments as if visiting the geopark. In order to evaluate the learning effectiveness of the proposed system, we collected the learning outcomes, learning motivation, and cognitive load of students before and after the learning activity. The results indicated that students had significantly better learning achievement in their comprehension ability and learning motivation after using the proposed system. Therefore, it can be inferred that the VR-based mobile learning system not only helps students restructure knowledge and improves their comprehension skills but also enhances their learning motivation tendencies. In addition, the results showed that the students did not have high intrinsic and extraneous cognitive loads but had a high germane cognitive load. This finding implies that the proposed system can promote students' learning without overloading their working memories. [ABSTRACT FROM AUTHOR]

Background: the objective of this study is to evaluate the predictive power of the survival model using deep learning of diffusion-weighted images (DWI) in patients with non-small-cell lung cancer (NSCLC). Methods: DWI at b-values of 0, 100, and 700 sec/mm2 (DWI0, DWI100, DWI700) were preoperatively obtained for 100 NSCLC patients who underwent curative surgery (57 men, 43 women; mean age, 62 years). The ADC0-100 (perfusion-sensitive ADC), ADC100-700 (perfusion-insensitive ADC), ADC0-100-700, and demographic features were collected as input data and 5-year survival was collected as output data. Our survival model adopted transfer learning from a pre-trained VGG-16 network, whereby the softmax layer was replaced with the binary classification layer for the prediction of 5-year survival. Three channels of input data were selected in combination out of DWIs and ADC images and their accuracies and AUCs were compared for the best performance during 10-fold cross validation. Results: 66 patients survived, and 34 patients died. The predictive performance was the best in the following combination: DWI0-ADC0-100-ADC0-100-700 (accuracy: 92%; AUC: 0.904). This was followed by DWI0-DWI700-ADC0-100-700, DWI0-DWI100-DWI700, and DWI0-DWI0-DWI0 (accuracy: 91%, 81%, 76%; AUC: 0.889, 0.763, 0.711, respectively). Survival prediction models trained with ADC performed significantly better than the one trained with DWI only (p-values < 0.05). The survival prediction was improved when demographic features were added to the model with only DWIs, but the benefit of clinical information was not prominent when added to the best performing model using both DWI and ADC. Conclusions: Deep learning may play a role in the survival prediction of lung cancer. The performance of learning can be enhanced by inputting precedented, proven functional parameters of the ADC instead of the original data of DWIs only.

In most cultural heritage courses, students physically visit several renowned heritage sites for educational purposes. However, because of time and manpower limitations, many teachers use traditional outdoor instruction methods to transmit vital information regarding these sites and buildings. This approach could result in students merely memorizing knowledge for test-taking purposes, rather than engaging in active thinking. Therefore, this study proposed using a ubiquitous guide-learning system to enhance students' performance and active participation in cultural heritage courses. To evaluate the effectiveness of the proposed system, a trial experiment was conducted to visit eight heritage sites featured in the cultural heritage course offered by a local university. In total, 62 students were randomly assigned to either an experimental group testing the proposed system or a control group using traditional outdoor instruction methods. The experimental results indicated that our ubiquitous guide-learning system significantly improved students' learning achievements. The outcome of the Instructional Materials Motivation Survey questionnaire indicated that the experimental group participants were motivated to learn and interested in using the proposed system. Moreover, the two groups had statistically significant results for the attention, confidence, and satisfaction factors. Therefore, implementing our proposed system in conjunction with cultural heritage education courses may yield a significant learning advantage for students by improving overall learning performance and motivation.

Abstract Objectives This research innovatively analyzed the marital transitions (i.e., divorce and widowhood) of older Taiwanese parents, their sleep problems and spousal specific characteristics (i.e., separate bedrooms for sleep and marital relationships) as well as their social and family connections, all of which were simultaneously reflected in emotional and social domains of loneliness. Methods Data are from 1645 older parents from Northern Taiwan. Loneliness was assessed by a De Jong-Gierveld short scale with emotional and social domains. We conducted multivariate logistic regression to examine the associations of marital transitions and family/social connections regarding sleep problems and psychological well-being with loneliness in social and emotional domains. Besides sleep problems and individual socioeconomic status, we included data on couples’ sleeping arrangements and marital relationships. Results Social loneliness was significantly associated with being divorced (AOR = 1.80, 95% CI 1.13–2.86) and living alone (AOR = 1.50, 95% CI 1.02–2.23). In contrast, strong family cohesion and frequent weekly contact with friends were associated with lower social loneliness. Married parents who slept in separate bedrooms were more likely than bed-sharing couples to feel emotional and social loneliness, despite adjusting for their sleep problems. Furthermore, satisfactory spousal relationships significantly decreased the magnitude of associations in the social domain. Discussion Our findings support significant associations between loneliness in later life and major marital transitions, family and social connections and sleep problems which differ in social and emotional domains. Independent of relationship satisfaction, separate bedrooms relate to higher risks of emotional loneliness in older adults.

Condyloma acuminatum is one of the most commonly occurring sexually transmitted diseases, caused by the human papillomavirus. We report the case of a male with intraurethral condyloma acuminata treated through electrocauterization. He presented to our genitourinary outpatient department with several days of painless gross hematuria. Patient history indicated 3 years of ongoing hemodialysis and a prior ureteroscopy. Multiple intraurethral tumors and bulbar urethral strictures were found by cystoscopy. Eventually, the patient underwent transurethral resection with electrocauterization. The patient recovered well, and there was no evidence of recurrence at the 1-year follow-up consultation. While there are many different methods for the treatment of intraurethral condyloma acuminata, panurethral condyloma acuminata are rare and difficult to treat. Here, we report a case of panurethral condyloma acuminata where urethroscopy with electrocauterization, without the use of the cutting mode, was performed with rapid, safe, and effective results.

Although Augmented Reality (AR) technology has already been adopted into mobile learning environments, additional effort must be put towards providing strong evidence that AR-based mobile systems are excellent educational tools that make a positive impact in or outside of the classroom. Our study utilized a similar AR-based mobile learning system developed to authentically teach a liberal arts course at a Taiwanese university. Under controlled study environments, we were able to design a system that could impart relevant concepts from the course to students outside of the traditional classroom setting. Experimental results demonstrated that students with the opportunity to learn through the proposed system demonstrated higher learning motivation, had better learning performance and comprehension abilities than those studying via the conventional outdoor instruction approach. Moreover, the questionnaire survey conducted after our study revealed that "confidence" was the most highly rated motivational factor among students who used the proposed system, suggesting that students were quite motivated to learn using the novel system supplemented with technological advances because they felt more sure of their knowledge and performance. Thus, we believe that using the proposed system can effectively improve the learning outcomes of students enrolled in the liberal arts course, with the particular benefit of boosting confidence in gaining new knowledge, which leads to an improvement of overall learning performance and motivation.

In this work, we improved the performance of germanium (Ge) channel Charge Trapping MemTransistors (CTMTs) as synaptic device by using Ti-doped HfO2 as charge trapping layer (CTL). We manipulated the amount of Ti dopant within the HfO2 CTL to perform the band engineering by varying the Hf/Ti cycle ratio in atomic layer deposition (ALD). The content of Ti was quantified and the energy band structures of the gate stack was constructed with the aid of transmission electron microscope (TEM) images and X-ray photoelectron spectroscopy (XPS) analysis. We then fabricated the charge trapping capacitors and characterized their memory characteristics such as memory windows. By the implementation of amphoteric trap model, thermal activated electron retention model and advanced charge decay model, the trap distribution of the CTL was extracted. Finally, we fabricated the CTMTs with Ti-doped HfO2 as the CTL and characterized their performance as synaptic device such as nonlinearity of depression and potentiation and also conductance on/off ratio. We used NeuroSim simulator with multilayer perceptron and convolutional neural network models to evaluate the pattern recognition accuracy of neural network hardware accelerator using CTMTs as synaptic devices and benchmarked the performance of our CTMT with those of other types of synaptic devices.

In this work, we investigated the effects of the crystal phase of ZrO2 on charge trapping memtransistors (CTMTs) as synaptic devices for neural network applications. The ZrO2 deposited through thermal (t-ZrO2) atomic layer deposition (ALD) and plasma (p-ZrO2) ALD were analyzed using an X-ray diffractometer, which indicated that the t-ZrO2 consisted of pure cubic phase, whereas p-ZrO2 consisted of both cubic and tetragonal phases. Through X-ray photoelectron spectroscopy analysis, we then constructed the energy band diagram of the gate stacks. The ΔEC of tand p-ZrO2 with respect to tunneling and blocking Al2O3 were 1.84 and 1.19 eV respectively. Because of the relatively large ΔEC of t-ZrO2, the window of the flat band voltage (VFB) shift extracted from charge trapping capacitors was enlarged by 591.9 mV more than the one using p-ZrO2 as the charge trapping layer. Retention was also improved by 10.4% after 105 s in the t-ZrO2 case. Finally, we fabricated the CTMTs with the gate stack of the t-ZrO2 case and demonstrated their characteristics as synaptic devices. With the optimization of pulse schemes, we reduced the nonlinear factors of depression (αd) and potentiation (αp) from -6.72 and 6.47 to 0.03 and 0.01 respectively, enlarged the ON/OFF ratio from 15.6 to 70.4 and increased the recognition accuracy from 27.6% to 86.5% simultaneously.

This paper proposes a novel interactive ubiquitous learning system (IULS) for authentically teaching a cultural heritage course and imparting relevant concepts to students. Experimental results demonstrated that learning performance was significantly improved after students used the IULS. This study also demonstrated that students using the IULS achieved superior results to those achieved using conventional teaching models. No gender bias affecting the performance of students in the experimental group was observed because each student consistently performed to a higher standard on the learning tasks compared with students in the control group, particularly in learning comprehension-related content. The IULS was more effective in enhancing the overall learning performance of students exhibiting different cognitive styles in liberal arts education courses. Furthermore, the results of a survey on Instructional Materials Motivation Survey revealed that Relevance was the most highly rated motivational factor among students who used the IULS, suggesting that students were motivated to use the IULS. Thus, we believe that a liberal arts education supplemented with the IULS yields a significant learning advantage for students by improving overall learning performance and motivation.

Abstract Background We aimed to examine the effect of ambient air pollution at the district level on adolescents’ happiness and their change in happiness over time in a cohort sample from Taiwan. Method A cohort from the Taiwan Youth Project was evaluated. The adolescents (n = 2571) were in the 7th grade (mean age = 14.3 years) when the study was initiated and resided in 40 districts in three cities and counties in northern Taiwan. We examined the effects of the concentration level of air pollution, including PM2.5, PM10, and NO2, at the district level on adolescents’ happiness and their change in happiness over time (7th to 9th grade). Due to the high correlations of the three pollutants, we examined each separately with similar covariates. The analyses were based on both multilevel modeling and latent growth curve modeling. Results Higher concentration levels of each of the three air pollutants measured were associated with adolescent happiness such that a higher level of concentration was related to lower levels of adolescents’ happiness. These results were observed after controlling for important individual- and district-level covariates. However, further analyses did not reveal that the concentration level of air pollution was associated with the change in happiness in the study period (after 3 years). Some sensitivity checks (e.g., adjusting district size) did not change the substantive results. Conclusion Many previous studies have shown the influence of air pollution on physical health and negative emotions, but only a few using adult samples have shown that air pollution is inversely related to positive wellbeing. This study may be the first to examine the effects of air pollution on adolescents’ positive affect. Our results echo recent research on the consequent health burden of air pollution. Given that positive affect has been linked to future adult health, the results of the current study provide empirical grounds for early intervention concerning environmental factors.

BACKGROUND:Sexually explicit media exposure during early adolescence has been found to be associated with risky sexual behavior. However, previous study suffered from methodological issue, such as selection bias. Furthermore, little is known about the effect of multi-modality sexually explicit media exposure on risky sexual behavior, and how this relationship can be applied to non-western societies. OBJECTIVES:This study aimed to improve upon previous studies by using instrumental variable estimation. In addition, this study also included multi-modality of sexually explicit media and three risky sexual behavior measure from a sample of Taiwanese adolescents. METHODS:Participants were recruited from a prospective longitudinal study (Taiwan Youth Project). All were in 7th grade (mean age = 13.3) when the study was initiated in 2000. Sexually explicit media exposure, including ever-exposure and number of modalities exposed to, was measured in wave 2 (8th grade). Risky sexual behavior was measured in waves 8 (mean age = 20.3) and 10 (mean age = 24.3). A two-stage least squares regression was employed, with pubertal timing as the instrumental variable. RESULTS:About 50% of participants had been exposed to sexual media content by 8th grade, from an average of one modality. Sexually explicit media exposure predicted early sexual debut, unsafe sex, and multiple sexual partners (all: p < .05). Furthermore, exposure to more media modalities increased the likelihood of risky sexual behaviors. However, only the effect on early sexual debut was gender invariant. CONCLUSIONS:Exposure to sexually explicit media in early adolescence had a substantive relationship with risky sexual behavior in the emerging adulthood. Knowledge of this causal like effect provides a basis for building better preventive programs in early adolescence. One prominent way is early education on media literacy, and physicians themselves may need to be familiar with such content to initiate it.

Using digital learning content to realize learning in games is a rapidly-developing direction of interest for teachers and researchers. This study has developed a digital role-playing gaming system to review Social Studies course content to a fifth Grade class at an elementary school. It allows students to experience the historical storyline of Tamsui, located in the north of Taiwan, by playing the role of Dr. Mackay. An experiment was conducted to evaluate the potential effects of the proposed system when applied to the reviewing activity of Humanities courses. The results of the post-test scores showed that the proposed system is not superior to the traditional teaching method which uses PowerPoint-based slides with the teacher's oral instruction, but it still enhances their overall learning performance after the reviewing activity. Moreover, the results of the questionnaire survey showed that the students who reviewed by using the proposed system showed a higher learning motivation than those reviewing with the traditional teaching method. It is therefore concluded that our role-playing digital gaming system can be used to assist the teachers' teaching activities, because it allows the students to complete their reviewing activity by themselves, and it effectively enhances their learning performances and motivation. [ABSTRACT FROM AUTHOR]

The addition of animated pedagogical agents (APAs) in computer-assisted learning (CAL) systems could successfully enhance students' learning motivation and engagement in learning activities. Conventionally, the APA incorporated multimedia materials are constructed through the cooperation of teachers and software programmers. However, the thinking and technical gap between two roles, a concept/content provider (teacher) and an implementer (software programmer), may lead to the concept distortion and loss in the final teaching material implementations. This often results in preventing a teacher from preparing his or her own APA-based multimedia learning systems. This study aims to develop a courseware to facilitate the CAL through the combination of the two roles into a single one and then teachers can use it freely by themselves. The courseware can help teachers to develop appropriate multimedia instructional materials incorporating APAs, which attracts students' attention and enhances their interest in learning. Furthermore, in this study two separate trial experiments were conducted to measure the teachers' satisfaction with the courseware and students' learning motivation after using APA-based multimedia learning systems. The results show that the participating teachers were satisfied with the courseware and would like to apply it in their instruction. Moreover, the participating students were strongly motivated by the customized APA-based multimedia learning systems. Therefore, the proposed courseware could give teachers a good opportunity to add pedagogical value to the curriculum, so that students' learning interest and motivation could be enhanced.

Abstract Recent studies have shown that overexpression of tonicity-responsive enhancer binding protein (TonEBP) is associated with many inflammatory diseases, including diabetes mellitus, which causes neuroinflammation in the hippocampus as well as hepatic steatosis. However, the exact mechanism in diabetic neuroinflammation is unknown. We report that haploinsufficiency of TonEBP inhibits hepatic and hippocampal high-mobility group box-1 (HMGB1) expression in diabetic mice. Here, mice were fed a high-fat diet (HFD) for 16 weeks and received an intraperitoneal injection of 100 mg/kg streptozotocin (STZ) and followed by continued HFD feeding for an additional 4 weeks to induce hyperglycemia and hepatic steatosis. Compared with wild-type diabetic mice, diabetic TonEBP+/− mice showed decreased body weight, fat mass, hepatic steatosis, and macrophage infiltration. We also found that adipogenesis and HMGB1 expression in the liver and hippocampus were lower in diabetic TonEBP+/− mice compared with the wild type. Furthermore, iba-1 immunoreactivity in the hippocampus was decreased in diabetic TonEBP+/− mice compared with that in the wild type. Our findings suggest that TonEBP haploinsufficiency suppresses diabetes-associated hepatic steatosis and neuroinflammation.

ObjectivesMost researchers have examined forms of loneliness as discrete and emotional distress. The approach proposed in this study captures the reality that many persons experience more than one dimension of loneliness-varying degrees coupled with their psychological well-being in a family context. This study explores the latent structure of loneliness during young adulthood and its association with psychological well-being, as well as how these are related to their family characteristics in adolescence.MethodsData are from 2,748 young people, a cohort sample from the Taiwan Youth Project (TYP). Loneliness was assessed by a 6-item de Jong-Gierveld short scale with emotional and social loneliness domains. We describe the clustering between loneliness domains and psychological well-being, namely depressive symptoms, self-esteem, suicidal thoughts, and alcohol use using latent class cluster analysis. In addition to incorporating the Taiwanese family context, multivariate multinomial logistic regression models included data on family cohesion and parental guan (parental control) in adolescence. This might be associated with choices in partnership and childbearing, and influence loneliness in young adulthood.ResultsOur results demonstrate a three-cluster model of loneliness involving emotional loners, serious emotional loners, and severe emotional/social loners. We also found that a feeling of serious emotional loneliness and severe emotional/social loneliness were significantly associated with psychological well-being, even adjusting for individual characteristics. Among young adults who had a partner, the married adults were significantly less likely to feel serious emotional loneliness than those who were living alone. Furthermore, young adults with stronger family cohesion during early adolescence were less likely to suffer from serious emotional loneliness (Relative risk ratios [RRR] 0.77, 95% CI 0.65-0.91) and severe emotional/social loneliness (RRR 0.54, 95% CI 0.34-0.85) in young adulthood.DiscussionThis measurement strategy provides a foundation for future research into how experts can address loneliness clusters in order to better understand psychological well-being during young adulthood and family context in adolescence. This is important because our results suggest that the various loneliness domains do not occur independently, but rather are embedded in patterns and are associated with family characteristics.

This study developed a QR-based U-Learning Material Production System (QR-ULMPS) that provides teachers with an education tool to motivate college level students enrolled in a liberal arts course. QR-ULMPS was specifically designed to support the development of u-learning materials and create an engaging context-aware u-learning environment for students. A quasi-experimental research design was used to evaluate the overall effectiveness of QR-ULMPS; the Unified Theory of Acceptance and Use of Technology (UTAUT) assessed the feasibility of using QR-ULMPS to implement teaching activities; while the Instructional Materials Motivation Survey (IMMS) was used to measure the students' learning motivation after using the proposed u-learning system. From the results of the UTAUT questionnaire, we found that teachers rated the system positively and were willing to accept and adopt QR-ULMPS into their course content. Teachers also agreed that QR-ULMPS was a useful tool to motivate students' learning during outdoor teaching activities. Moreover, results of the IMMS questionnaire indicated that students assigned to the proposed u-learning system achieved better results than participants learning via conventional methods. We believe that the proposed u-learning system is advantageous because it enhances student motivation and allows for higher levels of engagement, particularly during outdoor learning activities. Thus, we conclude that the proposed u-learning system can create a learning experience that both interests and engages students. Although QR-ULMPS is not mature enough to be used across a sundry of educational domains, it provides an innovative opportunity for teachers to integrate a novel teaching methodology that challenges traditional educational norms.