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Abstract In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of Google teachable machine, a deep neural network-based image classification tool, to develop algorithm for predicting TB probability of CXRs. The training dataset included 348 TB CXRs and 3806 normal CXRs for training TB detection. We also collected 1150 abnormal CXRs and 627 normal CXRs for training abnormality detection. For external validation, we collected 250 CXRs from our hospital. We also compared the accuracy of the algorithm to five pulmonologists and radiological reports. In external validation, the AI algorithm showed areas under the curve (AUC) of 0.951 and 0.975 in validation dataset 1 and 2. The accuracy of the pulmonologists on validation dataset 2 showed AUC range of 0.936–0.995. When abnormal CXRs other than TB were added, AUC decreased in both human readers (0.843–0.888) and AI algorithm (0.828). When combine human readers with AI algorithm, the AUC further increased to 0.862–0.885. The TB CXR AI algorithm developed by using Google teachable machine in this study is effective, with the accuracy close to experienced clinical physicians, and may be helpful for detecting tuberculosis by CXR.

As the basis of firm innovation, employee creativity engagement plays an important role in this process. According to strategic human resources management, high-performance work systems (HPWS) (organizational level) and mindfulness (individual level) trigger employee creativity in improving several work-related outcomes like work well-being and employee creativity. However, existing studies that have considered the relationships between HPWS and the underlying/boundary mechanism (organization-to-employee) are scarce. A cross-level influence of the hierarchical linear model based on 44 enterprises and 382 employees in Taiwan indicated: Based on the findings of the study, HPWS and mindfulness have significant positive effects on employee creativity. While HPWS enhanced employee creative engagement by increasing employee work well-being, at the same time, employee mindfulness could improve employee creative engagement by increasing employee work well-being. We also find strong evidence that the system is an important organizational factor that modifies work well-being and employee creative engagement relationship; furthermore, employees’ work well-being may affect mood disturbances and stress reduction in association with creative engagement and mindfulness. The findings of our study shed light on a blueprint for future research into HPWS, mindfulness, and employee creativity is presented. Taking these findings into account, we discussed them both theoretically and practically.

This study developed a quasi-monoenergetic neutron source (QMN) for the semiconductor device's soft error rate test (SER). Quasi-monoenergetic neutrons are generated by Be(p,n)B99 nuclear reaction with a 1 mm beryllium target and 30 MeV protons from a cyclotron. An 8 mm water in the back of the beryllium target is used for avoiding proton penetration. The neutron spectra simulated by MCNP showed that the peak energy was around 26.5 MeV. The heat flow and mechanical properties are numerically analyzed, and the safe operating conditions are therefore determined.

Abstract Background Restless legs syndrome is a highly prevalent comorbidity of migraine; however, its genetic contributions remain unclear. Objectives To identify the genetic variants of restless legs syndrome in migraineurs and to investigate their potential pathogenic roles. Methods We conducted a two-stage genome-wide association study (GWAS) to identify susceptible genes for restless legs syndrome in 1,647 patients with migraine, including 264 with and 1,383 without restless legs syndrome, and also validated the association of lead variants in normal controls unaffected with restless legs syndrome (n = 1,053). We used morpholino translational knockdown (morphants), CRISPR/dCas9 transcriptional knockdown, transient CRISPR/Cas9 knockout (crispants) and gene rescue in one-cell stage embryos of zebrafish to study the function of the identified genes. Results We identified two novel susceptibility loci rs6021854 (in VSTM2L) and rs79823654 (in CCDC141) to be associated with restless legs syndrome in migraineurs, which remained significant when compared to normal controls. Two different morpholinos targeting vstm2l and ccdc141 in zebrafish demonstrated behavioural and cytochemical phenotypes relevant to restless legs syndrome, including hyperkinetic movements of pectoral fins and decreased number in dopaminergic amacrine cells. These phenotypes could be partially reversed with gene rescue, suggesting the specificity of translational knockdown. Transcriptional CRISPR/dCas9 knockdown and transient CRISPR/Cas9 knockout of vstm2l and ccdc141 replicated the findings observed in translationally knocked-down morphants. Conclusions Our GWAS and functional analysis suggest VSTM2L and CCDC141 are highly relevant to the pathogenesis of restless legs syndrome in migraineurs.

Chronic obstructive pulmonary disease (COPD) has significant contributions to morbidity and mortality world-wide. Early symptoms of COPD are not readily distinguishable, resulting in a low rate of diagnosis and intervention. Different guidelines and recommendatations for the diagnosis and treatment of COPD exist globally. The first edition of clinical practice guidelines for COPD was published in 2016 by the Ministry of Health and Welfare in Taiwan in collaboration with the Taiwan evidence-based medicine association and Cochrane Taiwan, and was revised in 2019 in order to update recent diagnostic and therapeutic modalities for COPD and its acute exacerbation. This revised guideline covered a range of topics highlighted in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, including strategies for the diagnosis, assessment, monitoring, and management of stable COPD and exacerbations, with particular focus on evidence from Taiwan. The recommendations included in the revised guideline were formed based on a comprehensive systematic review or meta-analysis of specific clinical issues identified by an expert panel that surveyed relevant scientific evidence in the literature and guidelines published by the clinical communities and organizations nationally and internationally.The guidelines and recommendations are applicable to the clinical settings in Taiwan. We expect this revised guideline to facilitate the diagnosis, treatment and management of patients with COPD by physicians and health care professionals in Taiwan. Adaptations of the materials included herein for educational and training purposes is encouraged.

BackgroundWe conducted a five-year prospective follow-up study to track the real-world quality of life of patients with narcolepsy after medication and analyzed predictors.MethodsThe study ultimately included 157 participants who completed 5-year follow-up, 111 had type 1 narcolepsy (NT1) and 46 had type 2 narcolepsy (NT2). Polysomnography, multiple sleep latency test, actigraphy and HLA-typing were conducted. The Short Form 36 Health Survey Questionnaire (SF-36), the Stanford Center for Narcolepsy Sleep Inventory, the Epworth Sleepiness Scale (ESS), the visual analog for hypersomnolence (VAS), and Conners' Continuous Performance Test were used. Descriptive statistics, repeated measures, and hierarchical linear models were applied for analysis.ResultsMost demographic and clinical data did not significantly differ between groups, but the NT1 group had significantly more overweight, more severe narcoleptic symptoms, more positive HLA typing, shorter mean sleep latency, and more sleep onset rapid eye movement periods. No significant change to the physical domains of SF-36 was found in the total group, but we observed significant changes in emotional role functioning and social function. The NT1 group showed significant improvements in physical role functioning, emotional role functioning, and social function. The NT2 group demonstrated significant improvements in emotional role functioning. At the baseline, the NT2 group had significantly better scores, but there was no significant group difference after treatment, except for physical and social function. ESS and VAS were significantly improved during follow-up. At the baseline, the NT1 group had significantly higher ESS and VAS scores, and continuously significantly higher ESS scores during follow-up. Narcolepsy types, HLA typing, age of onset, symptom severity, attention and vigilance were significantly correlated with SF-36.ConclusionSymptom control greatly associates with the quality of life in narcoleptic patients, and medication can play the most important role. Management targeting narcoleptic symptoms, attention impairment, and drug adherence should be provided.

Abstract Home blood pressure (BP) monitoring is a useful tool for hypertension management. BP variability (BPV) has been associated with an increased risk of cardiovascular events. However, little is known about the correlation between BPV and different measurement patterns of long‐term home BP monitoring. This longitudinal cohort study aimed to assess the associations between dynamic BP measurement patterns and BPV. A total of 1128 participants (mean age, 77.4 ± 9.3 years; male, 51%) with 23 269 behavior measuring units were included. We used sliding window sampling to classify the home BP data with a regular 6‐month interval into units in a sliding manner until the data are not continuous. Three measurement patterns (stable frequent [SF], stable infrequent [SI], and unstable [US]) were assessed based on the home BP data obtained within the first 3 months of the study, and the data in the subsequent 3 months were used to assess the BPV of that unit. We used linear mixed‐effects model to assess the association between BP measurement patterns and BPV with adjustment for possible confounding factors including average BP. Average real variability and coefficient variability were used as measures of the BPV. No significant differences were observed in average BP between the SF, SI, and US patterns. However, BPV in the SF group was significantly lower than that in the US and SI groups (all p‐values

Although understandings of scientific inquiry (as opposed to conducting inquiry) are included in science education reform documents around the world, little is known about what students have learned about inquiry during their elementary school years. This is partially due to the lack of any assessment instrument to measure understandings about scientific inquiry. However, a valid and reliable assessment has recently been developed and published, Views About Scientific Inquiry (VASI; Lederman et al. [2014], Journal of Research in Science Teaching, 51, 65-83). The purpose of this large-scale international project was to collect the first baseline data on what beginning middle school students have learned about scientific inquiry during their elementary school years. Eighteen countries/regions spanning six continents including 2,634 students participated in the study. The participating countries/regions were: Australia, Brazil, Chile, Egypt, England, Finland, France, Germany, Israel, Mainland China, New Zealand, Nigeria, South Africa, Spain, Sweden, Taiwan, Turkey, and the United States. In many countries, science is not formally taught until middle school, which is the rationale for choosing seventh grade students for this investigation. This baseline data will simultaneously provide information on what, if anything, students learn about inquiry in elementary school, as well as their beginning knowledge as they enter secondary school. It is important to note that collecting data from all of the approximately 200 countries globally was not humanly possible, and it was also not possible to collect data from every region of each country. The results overwhelmingly show that students around the world at the beginning of grade seven have very little understandings about scientific inquiry. Some countries do show reasonable understandings in certain aspects but the overall picture of understandings of scientific inquiry is not what is hoped for after completing 6 years of elementary education in any country.

Pulmonary fibrosis (PF) is a progressive, non-reversible illness with various etiologies. Currently, effective treatments for fibrotic lungs are still lacking. Here, we compared the effectiveness of transplantation of human mesenchymal stem cells from umbilical cord Wharton’s jelly (HUMSCs) versus those from adipose tissue (ADMSCs) in reversing pulmonary fibrosis in rats. Bleomycin 5 mg was intratracheally injected to establish a severe, stable, single left lung animal model with PF. On Day 21 post-BLM administration, one single transplantation of 2.5 × 107 HUMSCs or ADMSCs was performed. Lung function examination of Injury and Injury+ADMSCs rats displayed significantly decreased blood oxygen saturation and increased respiratory rates, while Injury+HUMSCs rats showed statistical amelioration in blood oxygen saturation and significant alleviation in respiratory rates. Reduced cell number in the bronchoalveolar lavage and lower myofibroblast activation appeared in the rats transplanted with either ADMSCs or HUMSCS than that in the Injury group. However, ADMSC transplantation stimulated more adipogenesis. Furthermore, matrix-metallopeptidase-9 over-expression for collagen degradation, and the elevation of Toll-like receptor-4 expression for alveolar regeneration were observed only in the Injury+HUMSCs. In comparison with the transplantation of ADMSCs, transplantation of HUMSCs exhibited a much more effective therapeutic effect on PF, with significantly better results in alveolar volume and lung function.

The biphenyl scaffold represents a prominent privileged structure within the realms of organic chemistry and drug development. Biphenyl derivatives have demonstrated notable biological activities, including antimicrobial, anti‐inflammatory, anti‐HIV, and the treatment of neuropathic pain. Importantly, their anticancer abilities should not be underestimated. In this context, the present study involves the design and synthesis of a series of biphenyl derivatives featuring an additional privileged structure, namely the quinoline core. We have also diversified the substituents attached to the benzyloxy group at either the meta or para position of the biphenyl ring categorized into two distinct groups: [4,3′]biphenylaminoquinoline‐substituted and [3,3′]biphenylaminoquinoline‐substituted compounds. We embarked on an assessment of the cytotoxic activities of these derivatives in colorectal cancer cell line SW480 and prostate cancer cell line DU145 for exploring the structure–activity relationship. Furthermore, we determined the IC50 values of selected compounds that exhibited superior inhibitory effects on cell viability against SW480, DU145 cells, as well as MDA‐MB‐231 and MiaPaCa‐2 cells. Notably, [3,3′]biphenylaminoquinoline derivative 7j displayed the most potent cytotoxicity against these four cancer cell lines, SW480, DU145, MDA‐MB‐231, and MiaPaCa‐2, with IC50 values of 1.05 μM, 0.98 μM, 0.38 μM, and 0.17 μM, respectively. This highly promising outcome underscores the potential of [3,3′]biphenylaminoquinoline 7j for further investigation as a prospective anticancer agent in future research endeavors. [ABSTRACT FROM AUTHOR]

Abstract Background The present study compared the effects of antifibrotic medications, pirfenidone, and nintedanib, with transplantation of human umbilical mesenchymal stem cells (HUMSCs) in restoring rat pulmonary fibrosis (PF). Methods A stable animal model was established via an intratracheal injection of 5 mg bleomycin (BLM). One single transplantation of 2.5× 107 HUMSCs or initiation of daily oral nintedanib/pirfenidone administration was performed on day 21 following BLM damage. Results Pulmonary function examination revealed that BLM rats exhibited a significant decrease in blood oxygen saturation and an increase in respiratory rates. While no significant improvements were found in BLM rats receiving nintedanib or pirfenidone, those who transplanted with HUMSCs showed a statistical amelioration in blood oxygen saturation and significant alleviation in respiratory rates. Quantification results revealed that a significant reduction in alveolar space and marked increases in substantial cell infiltration and collagen deposition in the left lungs of BLM rats. No significant alteration was observed in BLM rats administered nintedanib or pirfenidone. However, BLM rats transplanted with HUMSCs had a significant recovery in alveolar space and noticeable decreases in cell infiltration and collagen deposition. The inflammatory cell numbers in the bronchoalveolar lavage was increased in the BLM group. While the rats treated with nintedanib or pirfenidone had a lower cell number than the BLM group, a higher cell number was found as compared with the Normal group. In rats transplanted with HUMSCs, the cell number did not differ from the Normal group. Conclusions Transplantation of HUMSCs could effectively treat PF as opposed to the administration of anti-fibrotic drugs with nintedanib or pirfenidone with a significant better result in lung volume, pathological changes, lung function, and blood oxygen saturation.

BackgroundInfections may play a role in the development of systemic lupus erythematosus (SLE).ObjectiveTo assess the link between Mycoplasma pneumonia (M. pneumonia) infection and the incidence of SLE.MethodWe conducted a retrospective cohort study, which identified 116,043 hospitalized patients with M. pneumoniae between 2000 and 2012 from the Taiwan National Health Insurance Research Database and compared them with 447,839 matched inpatients who had never been diagnosed with M. pneumonia infection (at a 1:4 ratio, matched by age, gender, and index year). Their comparative risk of developing SLE was evaluated. The follow-up period was defined as the time from the initial diagnosis of M. pneumonia infection to the date of SLE diagnosis, or December 31, 2013. The incidence rates of SLE were assessed in people with and without M. pneumoniae infection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), with the uninfected group used as the reference.ResultsThe adjusted HR of SLE for the M. pneumoniae group was 2.97 with 95% CI = 2.18–4.05 compared with the uninfected group. The risk was most significantly higher within 0.5 years after the M. pneumoniae infection with an adjusted HR of 6.18 (95% CI = 3.82–9.97, p < 0.01). The adjusted HR for SLE from 0.5 to 2 years and from 2 to 5 years after M. pneumoniae infection was 1.59 (95% CI = 0.70–3.59, p = 0.27) and 2.42 (95% CI = 1.22–4.81, p = 0.01), respectively.ConclusionThe incidence of SLE was significantly higher in subjects infected with M. pneumoniae.

Teleosts live in aquatic habitats, where they encounter ionic and acid-base fluctuations as well as infectious pathogens. To protect from these external challenges, the teleost epidermis is composed of living cells, including keratinocytes and ionocytes that maintain body fluid ionic homeostasis, and mucous cells that secret mucus. While ionocyte progenitors are known to be specified by Delta-Notch-mediated lateral inhibition during late gastrulation and early segmentation, it remains unclear how epidermal mucous cells (EMCs) are differentiated and maintained. Here, we show that Delta/Jagged-mediated activation of Notch signaling induces the differentiation of agr2-positive (agr2+) EMCs in zebrafish embryos during segmentation. We demonstrated that agr2+ EMCs contain cytoplasmic secretory granules and express muc5.1 and muc5.2. Reductions in agr2+ EMC number were observed in mib mutants and notch3 MOs-injected notch1a mutants, while increases in agr2+ cell number were detected in notch1a- and X-Su(H)/ANK-overexpressing embryos. Treatment with γ-secretase inhibitors further revealed that Notch signaling is required during bud to 15 hpf for the differentiation of agr2+ EMCs. Increased agr2+ EMC numbers were also observed in jag1a-, jag1b-, jag2a- and dlc-overexpressing, but not jag2b-overexpressing embryos. Meanwhile, reductions in agr2+ EMC numbers were detected in jag1a morphants, jag1b mutants, jag2a mutants and dlc morphants, but not jag2b mutants. Reduced numbers of pvalb8-positive epidermal cells were also observed in mib or jag2a mutants and jag1a or jag1b morphants, while increased pvalb8-positive epidermal cell numbers were detected in notch1a-overexpressing, but not dlc-overexpressing embryos. BrdU labeling further revealed that the agr2+ EMC population is maintained by proliferation. Cell lineage experiments showed that agr2+ EMCs are derived from the same ectodermal precursors as keratinocytes or ionocytes. Together, our results indicate that specification of agr2+ EMCs in zebrafish embryos is induced by DeltaC/Jagged-dependent activation of Notch1a/3 signaling, and the cell population is maintained by proliferation.

Patients at risk of chronic kidney disease (CKD) must be identified early and precisely in order to prevent complications, save lives, and limit expenditures for patients and health systems. This study aimed to develop a simple, high-precision machine learning model to identify individuals at risk of developing CKD in the near future, using a novel metabolic index with or without creatinine. This retrospective cohort study used data from the MJ medical record database collected between 2001 and 2015 in Taiwan. We used Cox hazard regression to identify potential predictors, including the novel metabolic index, for use as variables in the models. To develop a machine learning-based CKD risk model with fewer variables, we performed several experimental analyses to combine interacting variables into subsets. Those subsets were used to train three models, random forest, logistic regression, and XGBoost, with or without adding creatinine. The study included 12,189 participants, 20% with and 80% without CKD. The most important conventional predictors of CKD are age and gender. The novel metabolic index, TyG-Index, TG/HDL-ratio and VAI, had stronger predictive power than the conventional risk factors. Without including creatinine data, the XGBoost provided the best predictive performance. After adding creatinine, the performance of all the models was excellent, outperforming both conventional indicators and existing clinical algorithms for CKD. Using novel metabolic index in machine learning-based CKD risk prediction can accurately identify individuals at risk of diagnosis with CKD in the next year, with or without including creatinine.

This study optimized the field plate (FP) design (i.e., the number and positions of FP layers) of p-GaN power high-electron-mobility transistors (HEMTs) on the basic of simulations conducted using the technology computer-aided design software of Silvaco. Devices with zero, two, and three FP layers were designed. The FP layers of the HEMTs dispersed the electric field between the gate and drain regions. The device with two FP layers exhibited a high off-state breakdown voltage of 1549 V because of the long distance between its first FP layer and the channel. The devices were subjected to high-temperature reverse bias and high-temperature gate bias measurements to examine their characteristics, which satisfied the reliability specifications of JEDEC.

Peer-assessment and video comment-sharing are effective learning strategies for students to receive feedback on their learning. Researchers have emphasized the need for well-designed peer involvement in order to improve students' abilities in the cognitive and affective domains. Although student perceptions of peer-assessment have been studied extensively in higher education, few studies have focused on the effects of the peer-assessment strategy on students' performance from the affective perspective, especially in Physical Education courses. Therefore, in this study, a peer-assessment mobile physical education approach is proposed for developing a mobile learning system for a Kung Fu Tai-Chi physical education course. To evaluate the effectiveness of the proposed approach, an experiment was conducted by assigning 42 college students to participate in this learning activity. The experimental results show that the proposed approach not only promoted the students' learning interest and motivation, but also improved their learning self-efficacy and socialization.

We examined the effect of cultural familiarity and question-preview types on the listening comprehension of L2 learners. The results showed that the participants who received the full question-preview format scored higher than those receiving either the answer-option preview or question-stem preview, despite a statistically nonsignificant difference across the three previewing activities. In addition, the participants exposed to diverse cultural texts did not perform differently in their comprehension score. The findings suggest that the use of visual cues and key-vocabulary instruction in both texts may have compromised the positive psychological value of question previewing in enhancing comprehension of the unfamiliar text.

In this study, we investigated the characteristic difference between the two different configurations of the three-dimensional shell–core nanorod LED. We achieve a degree of polarization of 0.545 for tip-free core–shell nanorod LED and 0.188 for tip core–shell nanorod LED by combining the three-dimensional (3D) structure LED with photonic crystal. The ability of low symmetric modes generated by photonic crystals to enhance degree of polarization has been demonstrated through simulations of photonic crystals. In addition, light confinement in GaN-based nanorod structures is induced by total internal reflection at the GaN/air interface. The combination of 3D core–shell nanorod LED and photonic crystals cannot only produce a light source with a high degree of polarization, but also a narrow divergence angle up to 56°. These 3D LEDs may pave the way for future novel optoelectronic components.

Owing to the superior properties of silicon carbide (SiC), such as higher breakdown voltage, higher thermal conductivity, higher operating frequency, higher operating temperature, and higher saturation drift velocity, SiC has attracted much attention from researchers and the industry for decades. With the advances in material science and processing technology, many power applications such as new smart energy vehicles, power converters, inverters, and power supplies are being realized using SiC power devices. In particular, SiC MOSFETs are generally chosen to be used as a power device due to their ability to achieve lower on-resistance, reduced switching losses, and high switching speeds than the silicon counterpart and have been commercialized extensively in recent years. A general review of the critical processing steps for manufacturing SiC MOSFETs, types of SiC MOSFETs, and power applications based on SiC power devices are covered in this paper. Additionally, the reliability issues of SiC power MOSFET are also briefly summarized.