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Although the utilization of mobile technologies has recently emerged in various educational settings, limited research has focused on cognitive load detection in the pen-based learning process. This research conducted two experimental studies to investigate what and how multimodal data can be used to measure and classify learners' real-time cognitive load. The results found that it was a promising method to predict learners' cognitive load by analysing their handwriting, touch gestural and eye-tracking data individually and conjunctively. The machine learning approach used in this research achieved a prediction accuracy of 0.86 area under the receiver operating characteristic curve (AUC) and 0.85/0.86 sensitivity/specificity by only using handwriting data, 0.93 AUC and 0.93/0.94 sensitivity/specificity by only using touch gestural data, and 0.94 AUC and 0.94/0.95 sensitivity/specificity by using both the touch gestural and eye-tracking data. The results can contribute to the optimization of cognitive load and the development of adaptive learning systems for pen-based mobile learning.

BACKGROUND: The number of breast cancer survivors is increasing, yet evidence to inform dietary and lifestyle guidelines is limited. METHODS: This analysis included 3,658 participants from the Pathways Study, a prospective cohort of women diagnosed with invasive breast cancer. A healthy plant-based dietary index score (hPDI), an American Cancer Society (ACS) nutrition guidelines score, a 2015 Healthy Eating Index score (HEI), hours per week of moderate to vigorous physical activity (PA), and lifetime cumulative pack-years of cigarette smoking (SM) were each measured at diagnosis, 6, 24, and 72 months. Using g-computation, 5- and 10-year risk ratios (RR), risk differences, and 95% confidence intervals (CI) for all-cause mortality under hypothetical interventions on diet quality, PA, and SM, compared with the natural course (no intervention) were calculated. RESULTS: Hypothetical moderate to extreme interventions on hPDI, ACS, and HEI, each in combination with PA and SM, showed 11% to 56%, 9% to 38%, and 9% to 49% decreases in 5-year risks of all-cause mortality compared with no intervention, respectively [(hPDI: RRmoderate = 0.89, 95% CI: 0.82-0.94; RRextreme = 0.44, 95% CI: 0.26-0.67), (ACS: RRmoderate = 0.91, 95% CI: 0.85-0.96; RRextreme = 0.62, 95% CI: 0.43-0.82), (HEI: RRmoderate = 0.91, 95% CI: 0.84-0.95; RRextreme = 0.51, 95% CI: 0.33-0.72)]. While 10-year relative risks were slightly attenuated, absolute risk reductions were more pronounced. CONCLUSIONS: Interventions to improve diet quality, increase PA, or reduce SM at the time of diagnosis may improve survival among breast cancer survivors. IMPACT: We estimate that over 10% of deaths could be delayed by even moderate adoption of these behaviors.

Microbial communities have been demonstrated to be essential for healthy and productive soil ecosystems. However, an understanding of the relationship between soil microbial community and soil productivity levels is remarkably limited. In this study, bulk soil (BS), rhizosphere soil (RS), and root (R) samples from the historical high-productive (H) and low-productive (L) soil types of wheat in Hebei province of China were collected and analyzed by high-throughput sequencing. The study highlighted the richness, diversity, and structure of bacterial communities, along with the correlation networks among different bacterial genera. Significant differences in the bacterial community structure between samples of different soil types were observed. Compared with the low-productive soil type, the bacterial communities of samples from the high-productive soil type possessed high species richness, low species diversity, complex and stable networks, and a higher relative abundance of beneficial microbes, such as Pseudoxanthomonas, unclassified Vicinamibacteraceae, Lysobacter, Massilia, Pseudomonas, and Bacillus. Further analysis indicated that the differences were mainly driven by soil organic matter (SOM), available nitrogen (AN), and electrical conductivity (EC). Overall, the soil bacterial community is an important factor affecting soil health and crop production, which provides a theoretical basis for the targeted regulation of microbes in low-productivity soil types.

Aggressive breast cancers portend a poor prognosis, but current polygenic risk scores (PRSs) for breast cancer do not reliably predict aggressive cancers. Aggressiveness can be effectively recapitulated using tumor gene expression profiling. Thus, we sought to develop a PRS for the risk of recurrence score weighted on proliferation (ROR-P), an established prognostic signature. Using 2363 breast cancers with tumor gene expression data and single nucleotide polymorphism (SNP) genotypes, we examined the associations between ROR-P and known breast cancer susceptibility SNPs using linear regression models. We constructed PRSs based on varying p-value thresholds and selected the optimal PRS based on model r2 in 5-fold cross-validation. We then used Cox proportional hazards regression to test the ROR-P PRS's association with breast cancer-specific survival in two independent cohorts totaling 10,196 breast cancers and 785 events. In meta-analysis of these cohorts, higher ROR-P PRS was associated with worse survival, HR per SD = 1.13 (95% CI 1.06-1.21, p = 4.0 × 10-4). The ROR-P PRS had a similar magnitude of effect on survival as a comparator PRS for estrogen receptor (ER)-negative versus positive cancer risk (PRSER-/ER+). Furthermore, its effect was minimally attenuated when adjusted for PRSER-/ER+, suggesting that the ROR-P PRS provides additional prognostic information beyond ER status. In summary, we used integrated analysis of germline SNP and tumor gene expression data to construct a PRS associated with aggressive tumor biology and worse survival. These findings could potentially enhance risk stratification for breast cancer screening and prevention.

AbstractObjective Increasing number of depression cases, drug tolerability and compliance issues have triggered researchers to actively seek potential alternative treatment modalities. Integrating traditional Chinese medicine (TCM) and Western medicine (integrative medicine) has demonstrated favourable treatment outcomes for depression. However, most studies have focused on single-modality of TCM therapy, and its sustainability has rarely been evaluated. This protocol aims to describe a trial investigating the multi-modality integrative medicine effectiveness while measuring the post-intervention effect sustainability in treating liver stagnation and spleen deficiency in major depressive disorder (MDD).Methods/design A total of 318 eligible patients meeting the International Statistical Classification of Disease 10th Edition criteria for MDD and diagnosed with liver stagnation and spleen deficiency will be randomly allocated to receive Western medicine (Group A), Western medicine plus single-modality non-invasive TCM (Group B) or Western medicine plus comprehensive TCM (Group C). Each patient will receive a 6-week treatment; primary outcomes measured will be the overall response rate, changes in both Hamilton Depression Rating Scale 24 and Treatment Emergent Symptom Scale scores 18 weeks after randomisation. The secondary outcomes will include scores on the Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Health-related Quality of Life scale and Family Burden Scale 0, 3, 6, 10 and 18 weeks post-randomisation. Intention-to-treat analysis will be conducted using repeated-measures analysis of variance and covariance.Discussion Because there are various manifestations of MDD from the perspective of TCM, this trial may recommend a customised evidence-based regimen with longer potency for treating liver stagnation and spleen deficiency in MDD.

Abstract Tumor‐infiltrating CD4+ T cells orchestrate the adaptive immune response through remarkable plasticity, and the expression patterns of exhaustion‐related inhibitory receptors in these cells differ significantly from those of CD8+ T cells. Thus, a better understanding of the molecular basis of CD4+ T cell exhaustion and their responses to immune checkpoint blockade (ICB) is required. Here, we integrated multiomics approaches to define the phenotypic and molecular profiles of exhausted CD4+ T cells in oropharyngeal squamous cell carcinoma (OPSCC). Two distinct immune‐promoting (Module 1) and immunosuppressive (Module 2) functional modules in tumor‐infiltrating CD4+ T cells were identified, and both the immune‐promoting function of Module 1 cells and immunosuppressive function of Module 2 cells were positively associated with their corresponding exhaustion states. Furthermore, the application of ICBs targeting effector CD4+ T cells in Module 1 (αPD‐1) and Treg cells in Module 2 (αCTLA‐4) in mouse models could help reinvigorate the effector function of Module 1‐exhausted CD4+ T cells and reduce the immunosuppressive function of Module 2‐exhausted CD4+ T cells, ultimately promoting OPSCC tumor regression. Taken together, our study provides a crucial cellular basis for the selection of optimal ICB in treating OPSCC.

IntroductionThis study explores the emotional impact of religion-related films through a “cinematherapy” lens. It aims to analyze the emotional patterns in a curated selection of religion-related films compared to a broader sample of acclaimed movies using facial recognition with YOLOv5 object detection. The study aims to uncover the potential therapeutic application of religion-related films.MethodsFacial recognition with YOLOv5 object detection was utilized in this study to analyze the emotional patterns in religion-related films. A curated selection of these films was compared to a broader sample of acclaimed movies to identify any distinct emotional trajectories.ResultsThe analysis of the emotional patterns revealed that religion-related films exhibited a subtler range of emotions compared to the broader film spectrum. This finding suggests that these films potentially create a safe space for contemplation, aligning with the profound themes often explored in religion-related films. Interestingly, the emotional arc observed in the films mirrored the spiritual journeys depicted in them. The films started with a low point of separation, transitioned through challenges, and culminated in a peak representing spiritual transformation.DiscussionThese findings suggest promise for the therapeutic application of religion-related films. The muted emotional expression in these films creates a safe space for self-reflection, enabling viewers to connect with the struggles of the characters and explore their own values when faced with complex religious ideas. This emotional engagement may contribute to therapeutic goals such as introspection and personal growth. The study unveils the unique emotional power of religion-related films and paves the way for further research on their potential as therapeutic tools. It emphasizes the need for continued exploration of the emotional impact of these films and their capacity to aid in therapeutic goals.

Summary: Exhausted CD8+ T cells (Texs) are characterized by the expression of various inhibitory receptors (IRs), whereas the functional attributes of these co-expressed IRs remain limited. Here, we systematically characterized the diversity of IR co-expression patterns in Texs from both human oropharyngeal squamous cell carcinoma (OPSCC) tissues and syngeneic OPSCC model. Nearly 60% of the Texs population co-expressed two or more IRs, and the number of co-expressed IRs was positively associated with superior exhaustion and cytotoxicity phenotypes. In OPSCC patients, programmed cell death-1 (PD-1) blockade significantly enhanced PDCD1-based co-expression with other IR genes, whereas dual blockades of PD-1 and cytotoxic T lymphocyte-associated protein 4 (CTLA-4) significantly upregulated CTLA4-based co-expression with other IR genes. Collectively, our findings demonstrate that highly diverse IR co-expression is a leading feature of Texs and represents their functional states, which might provide essential clues for the rational selection of immune checkpoint inhibitors in treating OPSCC.

With the rapid growth of the number and scale of smart grid users, traditional data encryption transmission methods can no longer meet the performance requirements of data aggregation. In response, a power consumption information collection and management system based on SGX software protection extension is proposed. The system mainly consists of three parts: user electricity data acquisition terminal, SGX data security processing and distributed storage module on the chain, and data monitoring management display platform. The user electricity data collection terminal collects electricity data from various buildings, residences, rooms, and other smart meters, analyzes and uploads it. After calling the trusted function of SGX technology, it enters the security zone provided by SGX for data processing. Finally, the data security processing results and data are uploaded to the blockchain for storage. In order to visually display user electricity usage data, an intelligent monitoring platform for user electricity collection and management has been established. This system can reduce the workload of user electricity data collection, ensure the accuracy of data collection, and provide an efficient and highly reliable system platform for user electricity data management.

Background: The prognostic effects of different treatment modalities on patients with hypopharyngeal squamous cell carcinoma (HPSCC) remain unclear. Methods: HPSCC patients diagnosed and treated at either West China Hospital or Sichuan Cancer Hospital between January 1, 2009, and December 31, 2019, were enrolled in this retrospective, real-world study. Survival rates were presented using Kaplan–Meier curves and compared using log-rank tests. Univariable and multivariable Cox proportional hazards regression models were used to identify the predictors of overall survival (OS). Subgroup analyses were conducted for patients with advanced-stage HPSCC (stages III and IV and category T4). Results: A total of 527 patients with HPSCC were included. Patients receiving SRC (surgery, radiotherapy [RT], and chemotherapy) showed the best OS (p

Abstract Background Immense attention has been given to the outcome of COVID-19 infection. However, comprehensive studies based on large populational cohort with long-term follow-up are still lacking. This study aimed to investigate the risk of various short-term comorbidities (within one month) and long-term sequelae (above one month) after COVID-19 infection. Methods In this large prospective cohort study with 14 months follow-up information based on UK biobank, we included 16,776 COVID-19-positive participants and 58,281 COVID-19-negative participants matched for comparison. The risk of each comorbidity and sequela was evaluated by multivariable logistic regression analysis and presented as hazard ratio (HR) and 95% confidence interval (95% CI). Results COVID-19-positive individuals had a higher risk of 47 types of comorbidities within one month following COVID-19 infection, especially those who were older, male, overweight/obese, ever-smoked, with more pre-existing comorbidities and hospitalized. About 70.37% of COVID-19 patients with comorbidities had more than one co-occurring comorbidities. Additionally, only 6 high-risk sequelae were observed after one month of COVID-19 infection, and the incidence was relatively low (