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Critical factors that influence the value of digital game-based learning (DGBL) for enhancing learning effectiveness remain debatable. Based on the self-determination theory (SDT), people can be autonomously motivated to adopt DGBL to enhance learning effectiveness if their basic psychological needs are satisfied. Additionally, studies that simultaneously examine the effects of two critical factors of information feedback and game quality on students' autonomous motivation and learning effectiveness in DGBL contexts are missing in the literature. This study integrates information feedback, game quality, and SDT to develop a research model for comprehending the effectiveness of DGBL systems. Data collected from 383 respondents was analyzed to validate our research model. The results showed that information feedback, game quality, and autonomous motivation significantly influenced students' learning effectiveness and their continuance intention to use DGBL systems. Additionally, autonomous motivation indirectly influenced continuance intention via learning effectiveness. Implications for theory and for practice are discussed accordingly.

Simple Summary: Colorectal cancer is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all cases. Robotic-assisted surgery has emerged as a promising minimally invasive technique for resection. This study evaluates and compares the outcomes of robotic-assisted surgery and laparoscopic-assisted surgery for stage I to III colon cancer, using data collected between 2018 and 2024. By analyzing matched patient groups, the findings demonstrate that robotic-assisted surgery leads to faster recovery, fewer cases of bowel obstruction in left-sided colectomies, greater lymph node retrieval in right-sided colectomies, and reduced postoperative pain compared to laparoscopic-assisted surgery. These results underscore the potential of robotic-assisted surgery to enhance recovery and improve surgical precision. The study provides valuable evidence that may influence surgical practices and promote the broader adoption of robotic technology, particularly in the treatment of colon cancer. Background and Objective: Colorectal cancer (CRC) is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all CRC cases. Surgery remains the primary and most effective treatment. Robotic-assisted surgery (RAS) has emerged as a promising approach for colon cancer resection. This retrospective study compares RAS and laparoscopic-assisted surgery (LSS) for stage I–III colon cancer resections at a single medical center in East Asia. Methods: Between 1 January 2018, and 29 February 2024, patients undergoing colectomy were classified into right-side and left-side colectomies. Propensity score matching was conducted based on age group, gender, ASA score, and BMI to ensure comparability between groups. After matching, there were 50 RAS and 200 LSS cases for right colectomy (RC), and 129 RAS and 258 LSS cases for left colectomy (LC). Perioperative outcomes were compared between the two surgical approaches. The primary outcomes were recovery milestones, while secondary outcomes included complications and postoperative pain scores. Results: RAS demonstrated faster recovery milestones compared to LSS (hospital stay: 6.5 vs. 10.2 days, p = 0.005 for RC; 5.5 vs. 8.2 days, p < 0.001 for LC). RAS also resulted in lower rates of ileus (14% vs. 26%, p = 0.064 for RC; 6.2% vs. 15.9%, p = 0.007 for LC) and higher lymph node yields (31.4 vs. 26.8, p = 0.028 for RC; 25.8 vs. 23.9, p = 0.066 for LC). Major complication rates showed no significant difference between RAS and LSS (4.0% vs. 7.0%, p = 0.746 for RC; 4.7% vs. 3.1%, p = 0.563 for LC). Patients in the RAS group experienced earlier diuretic phases and reported significantly lower postoperative pain scores (3.0 vs. 4.1, p = 0.011 for RC; 2.9 vs. 4.1, p < 0.001 for LC). Conclusions: Robotic-assisted surgery is associated with faster recovery, lower rates of ileus (LC), higher lymph node yield (RC) and reduced postoperative pain compared to laparoscopic-assisted surgery for colon cancer resection. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database. Study Design: Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022. Methods: Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall‐up tympanomastoidectomy (TM‐CWU), and tympanoplasty with canal wall‐down tympanomastoidectomy (TM‐CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids. Results: A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM‐CWU (49.4%), and 825 underwent TM‐CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM‐CWU group compared to TM‐CWD (−0.34, 95% confidence interval [CI] −0.406,−0.279, P <.0001) and the TM group (9.352, 95% CI 0.315, 0.390, P <.0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM‐CWU and TM‐CWD groups (1.2%, P <.03, 1.9% vs 2.7%, P =.13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM‐CWU or TM‐CWU and TM‐CWD (3.5%vs 4.4% P =.07, 4.4% vs 5.2%., P =.38). Conclusion: TM and TM‐CWD had lower total surgical procedures than the TM‐CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM‐CWD was chosen as more definitive treatment in aggressive cases. TM‐CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures. [ABSTRACT FROM AUTHOR]

Studies investigating the use of mobile technologies when other options are available are still relatively rare in the literature, with the majority of studies requiring that learners use a particular technology, either using their own devices or devices provided by the institution. One exception to this was a study by Stockwell (2010) that examined how learners in Japan perceived the use of mobile phones for language learning and how willing they were to engage in the activities. This study, however, was conducted prior to the spread of smart phones and it focused exclusively on learners in Japan. Thus, the purpose of the current study was to replicate this study, but differed in two ways. First, although it was run in essentially the same environment as the original study, in the current study the majority of learners owned smart phones. Second, the same system was used not only in Japan but also with learners studying at a university in Taiwan. Data were collected through server logs, post-treatment surveys and semi-structured interviews. The results are discussed in terms of the ways in which learners engaged in the activities on their mobile phones, and the effect of the mobile platform on the time taken to complete the activities over the course of the semester. These results were correlated with those from the original 2010 study to identify the potential effect of the smart phone.

The teaching of translation has received considerable attention in recent years. Research on translation in collaborative learning contexts, however, has been less studied. In this study, we use a tool of synchronous collaboration to assist students in experiencing a peer translation process. Afterward, the unified theory of acceptance and use of technology (UTAUT) and a partial least squares regression approach are used to explore students' perspectives on the synchronous collaboration. Specifically, the study is constructed in a technical university in Tainan, Taiwan. A total of 27 participants enrolled in the study. The results show that most of the hypotheses we had developed before the study were supported by the data we collected, and further reveal that the construct of facilitating conditions is the most important determinant of students' intention to use the synchronous collaboration, followed by social influence and effort expectancy. The results indicate that the construct of facilitation conditions, such as the usage of new technology or problem solution, plays a significant role when integrating new technology since students will be more familiar with the new technology. Finally, both the implications and limitations of this study are discussed, and further research directions are proposed.

Background/Objectives: The potential and limitations of chatbots in medical education and clinical decision support, particularly in specialized fields like psychiatry, remain unknown. By using the Rasch model, our study aimed to evaluate the performance of various state-of-the-art chatbots on psychiatry licensing exam questions to explore their strengths and weaknesses. Methods: We assessed the performance of 22 leading chatbots, selected based on LMArena benchmark rankings, using 100 multiple-choice questions from the 2024 Taiwan psychiatry licensing examination, a nationally standardized test required for psychiatric licensure in Taiwan. Chatbot responses were scored for correctness, and we used the Rasch model to evaluate chatbot ability. Results: Chatbots released after February 2024 passed the exam, with ChatGPT-o1-preview achieving the highest score of 85. ChatGPT-o1-preview showed a statistically significant superiority in ability (p < 0.001), with a 1.92 logits improvement compared to the passing threshold. It demonstrated strengths in complex psychiatric problems and ethical understanding, yet it presented limitations in up-to-date legal updates and specialized psychiatry knowledge, such as recent amendments to the Mental Health Act, psychopharmacology, and advanced neuroimaging. Conclusions: Chatbot technology could be a valuable tool for medical education and clinical decision support in psychiatry, and as technology continues to advance, these models are likely to play an increasingly integral role in psychiatric practice. [ABSTRACT FROM AUTHOR]

Objective: To determine whether balloon dilation of Eustachian tube (BDET) improves postoperative audiology and quality of life scores in children with chronic Eustachian tube dysfunction. Study Design: Retrospective study. Setting: Tertiary care pediatric center. Methods: Eligible participants were patients 8 years or older, with a history of 2 prior tubes placement. Group 1—patients completed pre‐and post‐Eustachian Tube Dysfunction Quality of Life Survey (ETDQ‐7) survey scores, Group 2—patients had available pre‐ and postdilation tympanogram data (TD), and Group 3—patients had both ETDQ‐7 survey and TD. The average time for the first and subsequent follow‐ups was 3.8 and 12.9 months, respectively. Results: A total of 43 patients (85 ears) underwent BDET. The mean age was 13.3 years (8‐18 years). Twenty‐four patients were male (55.8%) and over 80% were Caucasian. The average mean ETDQ‐7 score before and after dilation was 3.9 and 2.5, respectively. Ninety‐three percent experienced improvement of their postoperative ETDQ‐7 scores and 53% had normal postdilation ETDQ‐7 score (P <.0001). Thirty‐seven ears in Group 2 (60.7%) had improvement in postdilation TD. A greater proportion of ears showed improvement of 62.3% with a 95% confidence interval (CI) [50.1%‐74.5%] compared to 37.7% without improvement, 95% CI [25.5%‐49.87%]. Ears with type A or B TD were more likely to show improvement than ears with type C, perforated, or with tubes (P <.0001). Eighteen out of 30 ears in Group 3 (60%) experienced an improvement in both ETDQ‐7 and tympanogram. Conclusion: BDET is a safe, efficacious alternative to tubes in selected pediatric patients. [ABSTRACT FROM AUTHOR]

Listeria monocytogenes causes listeriosis, a serious foodborne illness with a high mortality rate, especially in vulnerable populations. It accounts for 19% of foodborne deaths, with invasive cases having a mortality rate of up to 44%, leading to conditions like meningitis, bacteremia, and meningoencephalitis. However, the prognostic factors remain unclear. This study examines the hospital outcomes of invasive listeriosis and identifies risk factors for in-hospital and one-year mortality. We analyzed the electronic medical records of 118 hospitalized patients with non-perinatal, culture-proven invasive listeriosis collected over a 21-year period. The in-hospital mortality rate was 36.4%, with only 33.1% surviving one year and 22.0% surviving two years. The key findings indicate that a quick Sequential Organ Failure Assessment (qSOFA) score of ≥2 (OR 106.59, p < 0.001), respiratory failure (OR 7.58, p = 0.031), and shorter ampicillin duration (OR 0.53, p = 0.012) independently predicted poorer in-hospital outcomes. Additionally, a qSOFA score of ≥2 (OR 8.46, p < 0.001) and shorter ampicillin duration (OR 0.65, p < 0.001) were linked to higher one-year mortality. This study is the first to identify a qSOFA score of ≥2 as a significant marker for high-risk invasive listeriosis patients, with poorer outcomes linked to a qSOFA score of ≥2, respiratory failure, and shorter ampicillin use. [ABSTRACT FROM AUTHOR]

Background/Objectives: The complex association between attention-deficit/hyperactivity disorder (ADHD) and methylphenidate (MPH) with precocious puberty (PP) is still unclear. This study aims to investigate the association between ADHD, MPH, and PP. Methods: This is a nationwide cohort study including a total of 3,342,077 individuals, 186,681 with ADHD and 3,155,396 without. First, we compared the risk of PP between ADHD cases and non-ADHD cases. Second, we compared the risk of PP between MPH users and non-MPH users in patients with ADHD. Results: Patients with ADHD were at a greater risk of PP (adjusted hazard ratio [aHR], 2.01 [95% CI, 1.91–2.11]). In our moderation analyses, the female gender was a positive additive effect modifier of the association between ADHD and PP, whereas tics and intellectual disability were negative effect modifiers. In patients with ADHD, MPH users had a significantly lower risk of PP (aHR, 0.63 [95% CI 0.57–0.70]), and females had a negative effect modification on the association between MPH and PP. Conclusions: Our study found that children with ADHD were at a greater risk of PP. Girls with ADHD were a group particularly vulnerable to PP. Comorbid tics or intellectual disability was associated with a lower risk of PP. Among patients with ADHD, MPH was protective against PP, especially in girls. However, these preliminary results need further validation due to the nature of them being from an electronic database study. Unmeasured confounding factors might affect the association between MPH and PP. [ABSTRACT FROM AUTHOR]