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This article presents a narrative inquiry of a Chinese heritage mother to theorize and explicate how historical, relational, and spatial processes impacted her negotiation with power and agency in relation to her own heritage language (HL) identity development. A narrative approach enables us to draw on participant counter-stories against master narratives that erase experiences of marginalization of Asians in Asian language education in the United States. We do this through a model of HL identity development (Zhou & Liu, 2022) supplemented by an AsianCrit lens (Iftikar & Museus, 2018). We show the importance of normalizing Chinese as a HL outside of the home in terms of language maintenance as well as the impact such normalization has on the development of an affirmative Chinese HL identity. We add that spaces for such identity development are deeply associated with language programs like dual language bilingual education (DLBE), especially as the number of DLBE opportunities grow in number and in popularity. Thus, language programs, including DLBE, have a responsibility to ensure that the language education they provide address the interests and investments of families with respect to their HL in order to decenter a primary focus on the interests of ethnolinguistic majoritized families.

The rise of precision education has encouraged teachers to use intelligent diagnostic systems to understand students' learning processes and provide immediate guidance to prevent students from giving up when facing learning difficulties. However, current research on precision education rarely employs multimodal learning analytics approaches to understand students' learning behaviors. Therefore, this study aims to investigate the impact of teachers intervene based on different modalities of learning analytics diagnosing systems on students' learning behaviors, learning performance, and motivation in STEM collaborative learning activities. We conducted a quasi-experiment with three groups: a control group without any learning analytics system assistance, experimental group 1 with a unimodal learning analytics approach based on image data, and experimental group 2 with a multimodal learning analytics approach based on both image and voice data. We collected students' image or voice data according to the experimental design and employed artificial intelligence techniques for facial expression recognition, eye gaze tracking, and speech recognition to identify students' learning behaviors. The results of this research indicate that teacher interventions, augmented by learning analytics systems, have a significant positive impact on student learning outcomes and motivation. In experimental group 2, the acquisition of multimodal data facilitated a more precise identification and addressing of student learning challenges. Relative to the control group, students in the experimental groups exhibited heightened self-efficacy and were more motivated learners. Moreover, students in experimental group 2 demonstrated a deeper level of engagement in collaborative processes and the behavior associated with constructing knowledge.

Background: Virtual reality (VR) offers significant potential for hands-on learning environments by providing immersive and visually stimulating experiences. Interacting with such environments can bring numerous benefits to learning, including enhanced engagement, knowledge construction, and higher-order thinking. However, many current VR studies in hands-on learning tend to utilise one-way learning materials, limiting participants' ability to interact with and reflect on their actions and learning experiences. Moreover, these studies often neglect to assess learners' capacity to transfer their skills from VR learning to real-world scenarios. Therefore, this study aims to investigate participants' engagement, learning outcomes, higher-order thinking, and their ability to apply acquired skills in real-world contexts. Method and Objective: Participants were immersed in a hands-on learning environment in VR, where they received feedback and engaged in reflection during the learning process. This study recruited 68 university students to participate in the experiment, employing a quasi-experimental design. Participants experienced learning units both with and without reflection on the feedback. The theme of these learning units was related to embedded systems, encompassing topics such as the assembly of embedded components and Python programming. The investigation aimed to assess whether reflection in VR could enhance cognitive levels, engagement, real-world hands-on tasks abilities, and higher-order thinking. Results: The research results indicate that in the VR hands-on learning environment, participants engage in reflection through the provided feedback, effectively enhancing their engagement, cognitive levels, and hands-on task abilities. Simultaneously, it also successfully assists participants in developing problem-solving skills and critical thinking in higher-order thinking. Conclusions: Participants actively engaged in reflection on their own learning tasks and actions within the hands-on learning environment, enabling them to develop a deeper understanding of the learning material and enhance their real-world hands-on tasks abilities, we encourage the integration of reflection strategies in VR learning environments for hands-on learning, as they can yield positive benefits for learners.

Abstract Background The evidence for adjuvant chemoradiotherapy (CRT) of oral cavity squamous cell carcinoma (OCSCC) with extra-nodal extension (ENE) in National Comprehensive Cancer Network (NCCN) guidelines is derived from patients with head and neck cancer. The guidelines further suggest a radiation dose ranging from 6000 to 6600 cGy. In this nationwide study, we sought to evaluate the prognostic significance of adjuvant therapy and the specific radiation dosage in Taiwanese patients with pure OCSCC and ENE. Methods A retrospective analysis of 1577 OCSCC patients with ENE who underwent resection and received adjuvant CRT or radiotherapy (RT) between January 2011 and December 2020 was conducted. Results Multivariable analysis revealed that adjuvant RT, more than four pathologically positive nodes, and radiation dosage below 6000 cGy were independent risk factors for unfavorable 5-year disease-specific survival (DSS) and overall survival (OS). Comparing patients who received CRT (n = 1453) to those treated with RT (n = 124) before and after propensity score (PS) matching, the 5-year outcomes were as follows: before PS matching, DSS (54% versus 30%, p

While research has shown that students' epistemic beliefs can be a strong predictor of their academic performance, cognitive abilities, or self-efficacy, studies of this topic in computer education are rare. The purpose of this study was twofold. First, it aimed to validate a newly developed questionnaire for measuring students' epistemic beliefs about computer programming at middle school level. Second, the study aimed to understand how students' epistemic beliefs predict their computational thinking disposition and computer programming self-efficacy. A total of 406 middle school students completed a survey consisting of three research instruments: the Computer Programming Epistemic Belief Inventory (CPEBI), the Computational Thinking Scale (CTS), and the Computer Programming Self-Efficacy Scale (CPSES). The results indicated that the epistemic belief of "uncertainty" was a significant and positive predictor of the "abstraction" and "generalization" dimensions of computational thinking dispositions. In addition, the belief of "complexity" was an antecedent to three dimensions of computational thinking, namely, "algorithmic thinking," "evaluation," and "generalization." Only the "evaluation" dimension of CT disposition had significant and positive relationships with "programming self-efficacy." The roles of "uncertainty" and "complexity" of computer programming epistemic beliefs are discussed. Implications and suggestions for future computer programming education, especially for young students, are provided.

Research purposes and design: This study aimed to compare the effects of different explicit approaches used in modeling-based instruction on students' understanding of scientific models and modeling (USMM). In Study 1, a self-study approach was compared to a preliminary explicit approach. In Study 2, preliminary explicit approach and embedded explicit approach were compared. Methods: For the data analysis, t tests and analysis of covariance (ANCOVA) were used to compare students' USMM under the conditions of using different explicit approaches. Findings: Results showed that in the first study, no statistically significant difference was found between self-study approach and the preliminary explicit approach in any of the USMM subscales. In the second study, students who learned with the embedded explicit approach had better understandings in all subscales of USMM, but not in the "changing nature of scientific models" (CNM) subscale, than those who learned with the preliminary explicit approach. Through qualitative analysis of the data, categories and examples of the teacher's embedded epistemic guidance were illustrated. Suggestions for future professional development and research instrument design are provided. changing nature of scientific models

Science, Technology, Engineering, and Mathematics (STEM) education is essential for developing future-ready learners in both secondary and higher education levels. However, as students transition to higher education, many encounter challenges with independent learning and research. This can negatively impact their Higher-Order Thinking Skills (HOTS), engagement, and practical expertise. This study introduces a solution: Computational Thinking Scaffolding (CTS) in the Jupyter Notebook environment, designed to enhance STEM education at the tertiary level. CTS incorporates five phases: Decomposition, Pattern Recognition, Abstraction, Algorithm Design, and Evaluation. Utilizing a quasi-experimental method, we assessed the impact of CTS on the HOTS, engagement, and practical skills of undergraduate and postgraduate students. Our findings hold substantial relevance for university educators, academic advisors, and curriculum designers aiming to enhance students' HOTS and hands-on capabilities in STEM disciplines. The results validate the effectiveness of CTS in elevating tertiary STEM learning outcomes, and they spotlight the adaptability of the Jupyter Notebook as a valuable tool in higher education. In conclusion, our research underscores the merits of CTS for improving outcomes in higher STEM education and sets a benchmark for future endeavors in this domain.

In the evolving landscape of higher education, challenges such as the COVID-19 pandemic have underscored the necessity for innovative teaching methodologies. These challenges have catalyzed the integration of technology into education, particularly in blended learning environments, to bolster self-regulated learning (SRL) and higher-order thinking skills (HOTS). However, increased autonomy in blended learning can lead to learning disruptions if issues are not promptly addressed. In this context, OpenAI's ChatGPT, known for its extensive knowledge base and immediate feedback capability, emerges as a significant educational resource. Nonetheless, there are concerns that students might become excessively dependent on such tools, potentially hindering their development of HOTS. To address these concerns, this study introduces the Guidance-based ChatGPT-assisted Learning Aid (GCLA). This approach modifies the use of ChatGPT in educational settings by encouraging students to attempt problem-solving independently before seeking ChatGPT assistance. When engaged, the GCLA provides guidance through hints rather than direct answers, fostering an environment conducive to the development of SRL and HOTS. A randomized controlled trial (RCT) was employed to examine the impact of the GCLA compared to traditional ChatGPT use in a foundational chemistry course within a blended learning setting. This study involved 61 undergraduate students from a university in Taiwan. The findings reveal that the GCLA enhances SRL, HOTS, and knowledge construction compared to traditional ChatGPT use. These results directly align with the research objective to improve learning outcomes through providing guidance rather than answers by ChatGPT. In conclusion, the introduction of the GCLA has not only facilitated more effective learning experiences in blended learning environments but also ensured that students engage more actively in their educational journey. The implications of this study highlight the potential of ChatGPT-based tools in enhancing the quality of higher education, particularly in fostering essential skills such as self-regulation and HOTS. Furthermore, this research offers insights regarding the more effective use of ChatGPT in education.

Building on the long-standing tradition of challenging oppression and questioning whose interests are being served in the field of language education, we report on a study that involved a group of U.S.-based graduate students who collaborated with a ninth-grade English teacher in Nepal. The study comes out of a larger project that sought to internationalize the curriculum of a graduate educational linguistics course at a U.S. university. At the heart of this internationalizing curriculum endeavour was a commitment to expose graduate students in the U.S. to the issues of language teaching outside of the U.S. This was done through co-designing of a unit of lessons, with six graduate students meeting virtually with their teacher partner, Ditya, in Nepal over the course of a semester. The graduate students and Ditya constitute our research participants. The graduate student participants learned about the need to develop pedagogical materials that were relevant to the local context in Nepali classroom, and not attempt to transplant a Western-centric curriculum onto the Nepali classroom. In keeping with recent calls to decolonize higher education, we illustrate how critical theory in general and decolonizing pedagogy in particular can be infused into a U.S. graduate curriculum by drawing on the rich, indigenous knowledge and resources of a teacher collaborator from the Global South. We do this by reporting how this critical, decolonizing goal was realized through collaborative professionalism, which is characterized by the sharing of knowledge, skills, and experience to improve student achievement, reflection, dialogue and collective responsibility.

Abstract Background In recent years, artificial intelligence (AI) has made remarkable advancements and achieved significant accomplishments across the entire field of dentistry. Notably, efforts to apply AI in prosthodontics are continually progressing. This scoping review aims to present the applications and performance of AI in dental crown prostheses and related topics. Methods We conducted a literature search of PubMed, Scopus, Web of Science, Google Scholar, and IEEE Xplore databases from January 2010 to January 2024. The included articles addressed the application of AI in various aspects of dental crown treatment, including fabrication, assessment, and prognosis. Results The initial electronic literature search yielded 393 records, which were reduced to 315 after eliminating duplicate references. The application of inclusion criteria led to analysis of 12 eligible publications in the qualitative review. The AI-based applications included in this review were related to detection of dental crown finish line, evaluation of AI-based color matching, evaluation of crown preparation, evaluation of dental crown designed by AI, identification of a dental crown in an intraoral photo, and prediction of debonding probability. Conclusions AI has the potential to increase efficiency in processes such as fabricating and evaluating dental crowns, with a high level of accuracy reported in most of the analyzed studies. However, a significant number of studies focused on designing crowns using AI-based software, and these studies had a small number of patients and did not always present their algorithms. Standardized protocols for reporting and evaluating AI studies are needed to increase the evidence and effectiveness.

Abstract Background Patient safety (PS) is a core competency for registered nurses. However, there is a gap between the PS competence of nursing students and their clinical experience in PS. This study explored the effect of PS competence levels on the occurrence of adverse events (AEs) among nursing master’s students in China. Methods A sequential mixed methods design was used, with a purposive sample across seven colleges. A total of 327 graduate nursing students, aged 22 to 38, participated in the survey, and 15 participated in qualitative interviews. The Health Professional Education in Patient Safety Survey (H-PEPSS) assessed the students’ competence levels in PS. The respondents also reported any AEs that they had been involved in over the past year. Results A total of 78 AEs occurred in the past year, with 17.7% of the participants involved 1 to 3 AEs. The most common AEs were medication administration errors (30.77%) and improper use of medical equipment/supplies (28.20%). Students acquired more competencies from the clinical setting than from the classroom setting. Three competencies learned from classroom settings were associated with clinical AEs: low clinical safety skills [OR = 0.61], inappropriate identify, response to and disclosing AE and close calls [OR = 0.454], and low confidence in working in teams with other health professionals [OR = 2.168]. Qualitative data analysis revealed five themes: recognizing AEs, reducing harm by addressing immediate risks to patients and others involved, promoting safe medication and clinical practice, managing members’ authority and team dynamics, and dealing with inter-professional conflict. Conclusions The quantitative and qualitative data align, supporting the enhancement of students’ PS competence.

The MR transverse relaxation rate, R2*, has been widely used to detect iron and myelin content in tissue. However, it is also sensitive to macroscopic B0 inhomogeneities. One approach to correct for the B0 effect is to fit gradient-echo signals with the three-parameter model, a sinc function-weighted monoexponential decay. However, such three-parameter models are subject to increased noise sensitivity. To address this issue, this study presents a two-stage fitting procedure based on the three-parameter model to mitigate the B0 effect and reduce the noise sensitivity of R2* measurement in the mouse brain at 7T. MRI scans were performed on eight healthy mice. The gradient-echo signals were fitted with the two-stage fitting procedure to generate R2corr_t*. The signals were also fitted with the monoexponential and three-parameter models to generate R2nocorr* and R2corr*, respectively. Regions of interest (ROIs), including the corpus callosum, internal capsule, somatosensory cortex, caudo-putamen, thalamus, and lateral ventricle, were selected to evaluate the within-ROI mean and standard deviation (SD) of the R2* measurements. The results showed that the Akaike information criterion of the monoexponential model was significantly reduced by using the three-parameter model in the selected ROIs (p = 0.0039–0.0078). However, the within-ROI SD of R2corr* using the three-parameter model was significantly higher than that of the R2nocorr* in the internal capsule, caudo-putamen, and thalamus regions (p = 0.0039), a consequence partially due to the increased noise sensitivity of the three-parameter model. With the two-stage fitting procedure, the within-ROI SD of R2corr* was significantly reduced by 7.7–30.2% in all ROIs, except for the somatosensory cortex region with a fast in-plane variation of the B0 gradient field (p = 0.0039–0.0078). These results support the utilization of the two-stage fitting procedure to mitigate the B0 effect and reduce noise sensitivity for R2* measurement in the mouse brain.

The microstructure and uniformity of Cu metallization in the through glass via (TGV) structure were investigated through electron backscatter diffraction (EBSD) analysis system and finite element analysis (FEA) method. Two different direct current (DC) electroplating methods were employed for the TGV metallization, including single- and multiple-step electroplating methods. We found that the multiple-step electroplating process with appropriate current density (j)/plating time (t) can efficiently enhance the throwing power (TP) value (uniformity) of electroplated Cu in the TGV metallization. Moreover, the Cu electrodeposition via the multiple-step electroplating process possessed larger grain sizes and high fraction of high angle grain boundaries (HAGBs), including twin boundaries (TBs), which are very beneficial to the mechanical and electrical properties of Cu interconnects. Detailed analyses of the uniformity (i.e., TP), crystallographic microstructure (e.g., grain size), and mechanical characteristics (e.g., ductility) of electroplated Cu derived from single- and multiple-step electroplating process were discussed in this paper.

Abstract Diabetic corneal neuropathy (DCN) is a common diabetic ocular complication with limited treatment options. In this study, we investigated the effects of topical and oral fenofibrate, a peroxisome proliferator-activated receptor-α agonist, on the amelioration of DCN using diabetic mice (n = 120). Ocular surface assessments, corneal nerve and cell imaging analysis, tear proteomics and its associated biological pathways, immuno-histochemistry and western blot on PPARα expression, were studied before and 12 weeks after treatment. At 12 weeks, PPARα expression markedly restored after topical and oral fenofibrate. Topical fenofibrate significantly improved corneal nerve fibre density (CNFD) and tortuosity coefficient. Likewise, oral fenofibrate significantly improved CNFD. Both topical and oral forms significantly improved corneal sensitivity. Additionally, topical and oral fenofibrate significantly alleviated diabetic keratopathy, with fenofibrate eye drops demonstrating earlier therapeutic effects. Both topical and oral fenofibrate significantly increased corneal β-III tubulin expression. Topical fenofibrate reduced neuroinflammation by significantly increasing the levels of nerve growth factor and substance P. It also significantly increased β-III-tubulin and reduced CDC42 mRNA expression in trigeminal ganglions. Proteomic analysis showed that neurotrophin signalling and anti-inflammation reactions were significantly up-regulated after fenofibrate treatment, whether applied topically or orally. This study concluded that both topical and oral fenofibrate ameliorate DCN, while topical fenofibrate significantly reduces neuroinflammation.

Abstract Background The World Health Organization urged governments to prioritize the health and work well-being of nursing staff by promoting a positive working environment. A safe and healthy physical and psychosocial work environment is a basic human right for nurses. Job crafting is a necessary skill when facing challenging working conditions. Objectives This cross-sectional correlational research based on the Job Demands-Resources Model aimed to explore the correlation between psychosocial work environment and work well-being among nurses working in the intensive care unit (ICU) and determine whether personal perceived health could mediate the relationship and whether job crafting can moderate the mediating effect. The study hypothesized that: 1. The psychosocial work environment would impact nurses' work well-being; 2. Personal perceived health would play a role as a mediator in the relationship between psychosocial work environment and work well‐being; 3. Job crafting would moderate the relationship between personal perceived health and work well‐being. Methods A total of 655 registered nurses (RNs) from 7 ICUs in a teaching hospital in Beijing participated in this study. The RNs completed a battery questionnaire measuring their health, psychosocial work environment, well-being, and job crafting. PROCESS macros analysis was used to test mediating and moderating effects. Results Personal perceived health mediated the relationship between psychosocial work environment and work well-being (b = 0.012, 95% CI [0.008, 0.016]). The moderated mediated analysis revealed that job crafting moderated perceived health’s impact on work well-being (b = -0.007, 95% CI [− 0.010, − 0.003]). Conclusion A better psychosocial work environment with well-designed work organization and job content through job crafting could positively impact nurses’ health and work well-being.

Background With recent advancements in bronchoscopic procedures, data on the best modality to sample peripheral pulmonary lesions (PPLs) is lacking, especially comparing bronchoscopy with computed tomography-guided transthoracic biopsy or needle aspiration (CT-TBNA). Methods We performed a meta-analysis, pairwise meta-analysis and network meta-analysis on studies reporting diagnostic yield and complications with the use of CT-TBNA, radial endobronchial ultrasound (rEBUS), virtual bronchoscopy (VB), electromagnetic navigation (EMN) or robot-assisted bronchoscopy (RAB) to sample PPLs. The primary outcome was diagnostic yield and the secondary outcome was complications. We estimated the relative risk ratios using a random-effects model and used the frequentist approach for the network meta-analysis. We performed extensive analysis to assess the heterogeneity including reporting bias, publication bias, subgroup and meta-regressional analysis. We assessed the quality of the studies using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and QUADAS-Comparative (QUADAS-C). Results We included 363 studies. The overall pooled diagnostic yield was 78.1%, the highest with CT-TBNA (88.9%), followed by RAB (84.8%) and the least with rEBUS (72%). In the pairwise meta-analysis, only rEBUS showed inferiority to CT-TBNA. The network meta-analysis ranked CT-TBNA as likely the most effective approach followed by VB, EMN and RAB, while rEBUS was the least effective, with a low-GRADE certainty. CT-TBNA had the highest rate of complications. Conclusion Although CT-TBNA is the most effective approach to sample PPLs, RAB has a comparable diagnostic yield with a lesser complication rate. Further prospective studies are needed comparing CT-TBNA and RAB.

OBJECTIVE It is crucial that teaching faculties determine and remain informed of medical school learners’ clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability. METHODS This was a cross-sectional observational study of fourth-year medical students’ reasoning assessments from 2019 to 2022. Teams of four–five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student t -tests. RESULTS A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%–58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses ( P

Abstract Background Alzheimer’s disease (AD) is a devastating neurodegenerative disorder affecting 44 million people worldwide, leading to cognitive decline, memory loss, and significant impairment in daily functioning. The recent single-cell sequencing technology has revolutionized genetic and genomic resolution by enabling scientists to explore the diversity of gene expression patterns at the finest resolution. Most existing studies have solely focused on molecular perturbations within each cell, but cells live in microenvironments rather than in isolated entities. Here, we leveraged the large-scale and publicly available single-nucleus RNA sequencing in the human prefrontal cortex to investigate cell-to-cell communication in healthy brains and their perturbations in AD. We uniformly processed the snRNA-seq with strict QCs and labeled canonical cell types consistent with the definitions from the BRAIN Initiative Cell Census Network. From ligand and receptor gene expression, we built a high-confidence cell-to-cell communication network to investigate signaling differences between AD and healthy brains. Results Specifically, we first performed broad communication pattern analyses to highlight that biologically related cell types in normal brains rely on largely overlapping signaling networks and that the AD brain exhibits the irregular inter-mixing of cell types and signaling pathways. Secondly, we performed a more focused cell-type-centric analysis and found that excitatory neurons in AD have significantly increased their communications to inhibitory neurons, while inhibitory neurons and other non-neuronal cells globally decreased theirs to all cells. Then, we delved deeper with a signaling-centric view, showing that canonical signaling pathways CSF, TGFβ, and CX3C are significantly dysregulated in their signaling to the cell type microglia/PVM and from endothelial to neuronal cells for the WNT pathway. Finally, after extracting 23 known AD risk genes, our intracellular communication analysis revealed a strong connection of extracellular ligand genes APP, APOE, and PSEN1 to intracellular AD risk genes TREM2, ABCA1, and APP in the communication from astrocytes and microglia to neurons. Conclusions In summary, with the novel advances in single-cell sequencing technologies, we show that cellular signaling is regulated in a cell-type-specific manner and that improper regulation of extracellular signaling genes is linked to intracellular risk genes, giving the mechanistic intra- and inter-cellular picture of AD.

In this study, a combination of X-ray excited optical luminescence (XEOL), time-resolved XEOL (TR-XEOL) and the Hanbury-Brown and Twiss (HB-T) interferometer at the Taiwan Photon Source (TPS) 23A X-ray nanoprobe beamline for exploring quantum materials is demonstrated. On the basis of the excellent spatial resolution rendered using a nano-focused beam, emission distributions of artificial micro-diamonds can be obtained by XEOL maps, and featured emission peaks of a selected local area can be obtained by XEOL spectra. The hybrid bunch mode of the TPS not only provides a sufficiently high peak power density for experiments at each beamline but also permits high-quality temporal domain (∼200 ns) measurements for investigating luminescence dynamics. From TR-XEOL measurements, the decay lifetime of micro-diamonds is determined to be approximately 16 ns. Furthermore, the XEOL spectra of artificial micro-diamonds can be investigated by the HB-T interferometer to identify properties of single-photon sources. The unprecedented strategy of combining XEOL, TR-XEOL and the HB-T interferometer at the X-ray nanoprobe beamline will open new avenues with significant characterization abilities for unraveling the emission mechanisms of single-photon sources for quantum materials.

BackgroundSodium-glucose co-transporter-2 inhibitors (SGLT2i) have cardiovascular (CV) benefits, particularly in reducing the risk of heart failure (HF). Pioglitazone (Pio) has shown potential in decreasing the risks of recurrent stroke, non-fatal myocardial infarction (MI), and all-cause mortality but increasing risks of HF. Our study aimed to examine the synergistic effects on CV outcomes in patients with type 2 diabetes mellitus (T2DM) who received the combined treatment of SGLT2i and Pio.Materials and methodsA total of 117,850 patients with T2DM and without a history of HF were selected as the observational study cohort from the Chang Gung Research Database (CGRD) in Taiwan between January 1, 2016, and December 31, 2019. The primary composite outcome was 4-point major adverse CV events (4P-MACE), including CV death, non-fatal MI, non-fatal ischemic stroke, and hospitalization for HF. The study was divided into four groups: a combined treatment group in which SGLT2i and Pio were used, two individual groups in which SGLT2i or Pio was used separately, and a reference group (non-study drugs).ResultsCombined treatment of SGLT2i and Pio had the lowest risk of 4P-MACE (adjusted hazard ratio [aHR], 0.66; 95% confidence interval [CI], 0.54–0.80) compared with the reference group after a mean follow-up of 2.2 years. There was no significant difference in risks of hospitalization for HF (adjusted subdistribution hazard ratio, 0.73; 95% CI, 0.49–1.07) compared with the reference group.ConclusionsIn T2DM patients without HF, the combined treatment with SGLT2i and Pio may synergistically provide CV benefits without increasing risks of HF.

Abstract Background While surgery remains the primary treatment for oral squamous cell carcinoma (OCSCC), induction chemotherapy (IC) can be used as a bridging or neoadjuvant therapy. This nationwide study in Taiwan examines the survival outcomes of OCSCC patients who received IC before surgery. Methods We analyzed data from 29,891 patients with OCSCC. Of these, 29,058 initially underwent surgery (OP group), whereas 833 received IC before surgery (IC + OP group). A propensity score (PS)‐matched analysis (4, 1 ratio, 3260 vs. 815 patients) was performed considering tumor subsite, sex, age, Charlson comorbidity index, clinical T1–T4b tumors, clinical N0–3 disease, and clinical stage I–IV. Results In the PS‐matched cohort, the 5‐year disease‐specific survival (DSS) and overall survival (OS) rates were 65% and 57%, respectively. When comparing the OP and IC + OP groups, the 5‐year DSS rates were 66% and 62%, respectively (p = 0.1162). Additionally, the 5‐year OS rates were 57% and 56%, respectively (p = 0.9917). No significant intergroup differences in survival were observed for specific subgroups with cT4a tumors, cT4b tumors, cN3 disease, pT4b tumors, and pN3 disease. However, for patients with pT4a tumors, the OP group demonstrated superior 5‐year outcomes compared to the IC + OP group, with a DSS of 62% versus 52% (p = 0.0006) and an OS of 53% versus 44% (p = 0.0060). Notably, patients with cT2–3, cN1, and c‐Stage II disease in the IC + OP group were significantly more likely to achieve pT0–1 status (p

Halloysite nanotubes (HNTs) have a layered structure of clay silicate minerals and a tubular shape, which is suitable for the uniform loading of small substrates and drug molecules. The inner diameter of HNTs with an acidic solvent is selectively etched to increase the loading capacity of magnetic iron–platinum (FePt) nanoparticles. The FePt nanoparticles and etched HNTs (eHNT) are then composited by vacuum decompression. The resulting product is named FePt@eHNT and is used as a contrast agent for T2‐weighted magnetic resonance imaging. According to a comprehensive analysis of the material and its magnetic properties, by adding different proportions of HNTs before and after modification, the saturation magnetization can reach 23.769 emu g−1, which is higher than that of the composite materials studied in previous studies. This is because the tubular structure promotes the orderly displacement of the FePt nanoparticles under three‐dimensional space constraints and the uniform effect of the magnetic field. In addition, the magnetothermal effect of the composite material is observed and its potential as an imaging agent is investigated. In this study, the enhancement of its ferromagnetism and its potential to become a multifunctional composite material for applications in drug delivery, magnetic hyperthermia, and bioimaging is demonstrated.

With the evolution of advanced integrated circuit (IC) packaging technology, the use of experiments to identify package performance and life expectation will take a significant amount of time and cost to finish the job. To reduce the cost of research and testing, predictive analyses of reliability and performance using simulation tools have become a feasible approach for the IC assembly industry. Therefore, this study utilized Moldex3D molding simulation software to analyze very thin profile fine pitch ball grid array (VFBGA) packages and established a numerical analysis procedure from the molding and curing process, the post-mold cure (PMC) process, to a thermal cycling test (TCT) to predict the amount of package warpage during processing and reliability after TCT.The results showed that the warpage trends of both experiments and simulations during the same temperature ramping process were similar. In the thermal cycling analysis, potential failure locations were found to be at the copper pillars and redistribution layer (RDL), where the maximum Von Mises stress occurred at the lowest temperature (−65 °C). The fatigue life model, Coffin–Manson model, was used to calculate the potential fatigue life at the two locations, resulting in 1689 cycles (copper pillars) and 9706 cycles (RDL L1).

Objective To investigate the suicide risk factors among caregivers of individuals with depression who may develop suicidal ideation due to the ongoing challenges of managing the patient's mood fluctuations. Methods This cross-sectional study enrolled dyads of patients with depression and their caregivers from a medical centre. The assessment included a psychiatric diagnostic interview, the Hospital Anxiety and Depression Scale, the List of Threatening Experiences, Benefit Finding Scale, Numerical Pain Rating Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, Big Five Inventory-10, the Family APGAR Index and the Suicide Assessment Scale. Univariate and multivariate regression analysis were used to explore the interrelationship between the mental health of patients and caregivers. Results Among the 125 caregivers, 60.0% ( n = 75) were females. The most common psychiatric diagnoses were depressive disorders (33 of 125; 26.4%), followed by anxiety disorders (21 of 125; 16.8%) and insomnia disorder (19 of 125; 15.2%). There was a significant association between the stressful life events of depressive patients and the suicide risk of their caregivers. The severity of anxiety and depression in caregivers was significantly associated with the suicide risk among the caregivers. Conclusion A relationship may exist between the psychological well-being of patients with depression and their caregivers.

ObjectivesEarly smoking initiation has been associated with a higher risk of developing long-term smoking habit. There is a growing global consensus that demands raising the minimum legal age (MLA) for smoking as an approach to address this problem. Singapore successfully raised the MLA from 18 to 21 years in 2021. This study aimed to evaluate the awareness and attitude of multi-ethnic Asian youth (aged 15–24) on raising MLA to 21 and passive smoking.MethodsA cross-sectional survey comprising of 23 items was circulated via a secure internet-based platform, FORMSG between September and November 2022. Data were analyzed for descriptive statistics. Categorical variables were compared for association with receptivity toward change in MLA using Chi-Squared test and multivariable logistic regression analysis using Rstudio. Post-hoc Bonferroni correction were further utilized for pairwise comparison.ResultsMajority (80.3%) of the 608 participants expressed their support for MLA 21 implementation. Participants’ age was a significant variable as those aged 15–17 years old (OR = 2.1, 95%CI = 1.01–4.32, p = 0.048) showed a higher likelihood of supporting MLA implementation compared to those aged 21 and above. In addition, majority (89.8%) of them were also aware of the harmful effects of passive smoking. When it came to discouraging smoking among youth, family influence (64%) and school education (55.6%) emerged as the top strategies.ConclusionMost of the youth express strong support for raising the MLA to 21, with over 80% in favor of such change, reflects a significant harmony among youth in favor of tobacco-free environment.

Abstract Background Elective tracheotomy is commonly performed in resected oral squamous cell carcinoma (OCSCC) to maintain airway patency. However, the indications for this procedure vary among surgeons. This nationwide study evaluated the impact of tracheotomy on both the duration of in‐hospital stay and long‐term survival outcomes in patients with OCSCC. Methods A total of 18,416 patients with OCSCC were included in the analysis, comprising 7981 patients who underwent elective tracheotomy and 10,435 who did not. The primary outcomes assessed were 5‐year disease‐specific survival (DSS) and overall survival (OS). To minimize potential confounding factors, a propensity score (PS)‐matched analysis was performed on 4301 patients from each group. The duration of hospital stay was not included as a variable in the PS‐matched analysis. Results Prior to PS matching, patients with tracheotomy had significantly lower 5‐year DSS and OS rates compared to those without (71% vs. 82%, p

The cornea is an avascular tissue in the eye that has multiple functions in the eye to maintain clear vision which can significantly impair one’s vision when subjected to damage. Peroxisome proliferator-activated receptors (PPARs), a family of nuclear receptor proteins comprising three different peroxisome proliferator-activated receptor (PPAR) isoforms, namely, PPAR alpha (α), PPAR gamma (γ), and PPAR delta (δ), have emerged as potential therapeutic targets for treating corneal diseases. In this review, we summarised the current literature on the therapeutic effects of PPAR agents on corneal diseases. We discussed the role of PPARs in the modulation of corneal wound healing, suppression of corneal inflammation, neovascularisation, fibrosis, stimulation of corneal nerve regeneration, and amelioration of dry eye by inhibiting oxidative stress within the cornea. We also discussed the underlying mechanisms of these therapeutic effects. Future clinical trials are warranted to further attest to the clinical therapeutic efficacy.

Background: Exploring the epigenetic regulations, such as microRNA, in newborns holds significant promise for enhancing our ability to address and potentially prevent early-life developmental delays. Objectives: Hence, this research seeks to investigate if the expression of miRNA in the umbilical cord blood of infants can forecast their developmental outcomes as they grow older. Design and method: We enrolled 143 full-term newborns, delivered either via cesarean section (CS) or through natural spontaneous delivery (NSD). We then analyzed the profiles of specific miRNAs (miR-486-5p, miR-126-5p, miR-140-3p, miR-151a-3p, miR-142-5p, and miR-30e-5p) in the umbilical cord blood of these infants. Subsequently, we performed follow-up assessments using Bayley-III scores when the cohort reached 1 year of age. Furthermore, we conducted pathway-enrichment analyses on the target genes associated with these examined miRNAs. Results: When comparing newborns delivered via cesarean section (CS) to those born via natural spontaneous delivery (NSD), we observed notable differences. Specifically, newborns through NSD displayed significantly higher ΔCt values for miR-486-5p, alongside lower ΔCt values for miR-126-5p and miR-151a-3p in their cord blood. At 1 year of age, cognitive development was significantly linked to the ΔCt values of miR-140-3p and miR-142-5p, while language development showed a significant association with the ΔCt values of miR-140-3p. Moreover, our pathway enrichment analyses revealed that the target genes of these miRNAs were consistently involved in the pathways related to neurons, such as axon guidance and the neurotrophin signaling pathway. Conclusion: In summary, this study represents a pioneering effort in elucidating the potential connections between miRNA levels in cord blood and the health indicators and neurodevelopment of newborns at 1 year of age. Our findings underscore the significance of miRNA levels at birth in influencing mechanisms related to neurodevelopment.

Study region: The island of Taiwan. Study focus: This study presents long-term and high-resolution modeling of flood occurrence, interdecadal patterns of river-floodplain dynamics, and analysis of flooding during two typhoon events—Nari and Morakot over Taiwan. The modeling system combines a hydrological model (HiGW-MAT) and a river hydrodynamics model (CaMa-Flood), simulating hydrologic-hydrodynamic processes at ∼ 5 km resolution with flood occurrences downscaled to ∼ 90 m. New hydrological insights for the region: As the first investigation to conduct spatially comprehensive and temporally continuous modeling in Taiwan, this study presents important advances on the application of large-scale hydrological-hydrodynamic models in settings like that of Taiwan with important implications on flood prediction under climate change. The assessment of interdecadal changes in streamflow indicates no consistent trends over the past four decades; however, the variabilities in monthly-scale streamflow are significant and regionally diverse across Taiwan. Decadal changes in flood occurrence are also minimal at the island-scale, but the changes vary substantially across different regions and exhibit an increased variability over time. Furthermore, the simulated flood patterns in response to Typhoons Nari and Morakot suggest that the modeling framework can be used to reproduce the spatial dynamics and temporal progression of flooding under extreme events in relatively small regions like Taiwan.

Knee osteoarthritis (OA) involves articular cartilage degradation driven mainly by inflammation. Kaempferol (KM), known for its anti-inflammatory property, holds potential for OA treatment. This study investigated the potential of hyaluronic acid (HA)-coated gelatin nanoparticles loaded with KM (HA-KM GNP) for treating knee OA. KM was encapsulated into gelatin nanoparticles (KM GNP) and then coated with HA to form HA-KM GNPs. Physical properties were characterized, and biocompatibility and cellular uptake were assessed in rat chondrocytes. Anti-inflammatory and chondrogenic properties were evaluated using IL-1β-stimulated rat chondrocytes, compared with HA-coated nanoparticles without KM (HA GNP) and KM alone. Preclinical efficacy was tested in an anterior cruciate ligament transection (ACLT)-induced knee OA rat model treated with intra-articular injection of HA-KM GNP. Results show spherical HA-KM GNPs (88.62 ± 3.90 nm) with positive surface charge. Encapsulation efficiency was 98.34 % with a sustained release rate of 18 % over 48 h. Non-toxic KM concentration was 2.5 μg/mL. In IL-1β-stimulated OA rat chondrocytes, HA-KM GNP significantly down-regulated RNA expression of IL-1β, TNF-α, COX-2, MMP-9, and MMP-13, while up-regulating SOX9 compared to HA GNP, and KM. In vivo imaging demonstrated significantly higher fluorescence intensity within rat knee joints for 3 hours post HA-KM GNP injection compared with KM GNP (185.2% ± 34.1% vs. 45.0% ± 16.7%). HA-KM GNP demonstrated significant effectiveness in reducing subchondral sclerosis, attenuating inflammation, inhibiting matrix degradation, restoring cartilage thickness, and reducing the severity of OA in the ACLT rat model. In conclusion, HA-KM GNP holds promise for knee OA therapy.

Abstract Hepatitis C virus (HCV) infection is prevalent in patients with type 2 diabetes mellitus (DM). We aimed to investigate whether HCV antibody (Ab) seropositivity is associated with diabetic micro- and macro-vascular diseases. In this hospital-based cross-sectional study, we retrospectively collected data from patients who participated in the diabetes pay-for-performance program and underwent HCV Ab screening in the annual comprehensive assessment between January 2021 and March 2022. We examined the relationships of HCV Ab seropositivity with the spot urinary albumin-to-creatinine ratio (UACR) and ankle-brachial index (ABI) in patients aged ≥ 50 years with type 2 DM. A total of 1758 patients were enrolled, and 85 (4.83%) of the enrolled patients had HCV Ab seropositivity. Multivariable regression analyses revealed that albuminuria showed a dose-dependent association with HCV Ab seropositivity (UACR [30–299 mg/g]: odds ratio [OR] = 1.463, 95% confidence interval [CI] 0.872‒2.456); UACR [≥ 300 mg/g]: OR = 2.300, 95% CI 1.160‒4.562; P for trend = 0.015) when compared with normal albuminuria (UACR

School counselor educators train future professionals who will adopt a non-dual educator-counselor identity and deliver direct services to culturally diverse students and other education stakeholders. To capture select school counselor educators’ values and practices, the authors of the current study performed a descriptive phenomenological study using semi-structured interview questions to elicit the experiences of six school counselor educators who received federal funding to increase the diversity and quality of mental health services in public schools. Findings included the following five themes: 1) perspectives of professional identity; 2) equity, social justice, and inclusion; 3) pedagogical strategies in training program; 4) collaboration and partnerships; and 5) rewards and challenges in counseling education. Implications related to counselor education and future research are discussed.

For future or 6G international mobile communication (IMT) mobile services, the World Radiocommunication Conference 2023 (WRC-23) identified new frequency band 6.425-7.125 GHz and also recommended 7.125-8.4 GHz to be considered four years later in the WRC-27. It is thus envisioned that the wide frequency band 6.425-8.4 GHz (about 2 GHz bandwidth) in the upper mid-band is very promising to become the core frequency band for 6G mobile communication, which is expected to launch in 2030. This article presents the wideband low-profile (1 mm) small-size 4-port patch (4PP) antenna module covering 6.425-8.4 GHz and its application to form a compact 8-port two-module (8PTM) antenna for the mobile device. The fabricated 8PTM antenna is studied; moreover, it is applied as 8 receive antennas in the $8\times 4$ MIMO system field test with 4 spatial streams. The 8PTM antenna shows its capability for the $8\times 4$ device MIMO application with enhanced spectral efficiency (the extreme receive antennas-aided MIMO system). In this study, a measured spectral efficiency up to 37.3 bps/Hz or 9.33 bps/Hz per stream is obtained for the $8\times 4$ MIMO operation, which is larger than those that have been reported for the upper mid-band device MIMO application. Details of the 4PP antenna module, the 8PTM antenna, and the $8\times 4$ MIMO system field test in our campus indoor and outdoor public scenarios are presented.

Previous studies have reported a role of alterations in the brain’s inhibitory control mechanism in addiction. Mounting evidence from neuroimaging studies indicates that its key components can be evaluated with brain oscillations and connectivity during inhibitory control. In this study, we developed an internet-related stop-signal task with electroencephalography (EEG) signal recorded to investigate inhibitory control. Healthy controls and participants with Internet addiction were recruited to participate in the internet-related stop-signal task with 19-channel EEG signal recording, and the corresponding event-related potentials and spectral perturbations were analyzed. Brain effective connections were also evaluated using direct directed transfer function. The results showed that, relative to the healthy controls, participants with Internet addiction had increased Stop-P3 during inhibitory control, suggesting that they have an altered neural mechanism in impulsive control. Furthermore, participants with Internet addiction showed increased low-frequency synchronization and decreased alpha and beta desynchronization in the middle and right frontal regions compared to healthy controls. Aberrant brain effective connectivity was also observed, with increased occipital-parietal and intra-occipital connections, as well as decreased frontal-paracentral connection in participants with Internet addiction. These results suggest that physiological signals are essential in future implementations of cognitive assessment of Internet addiction to further investigate the underlying mechanisms and effective biomarkers.

Background: The immunoglobulin E (IgE) response to Angiostrongylus cantonensis infection increases in the host. This study analyzed the IgG and IgE responses detected in different body fluids of A. cantonensis-infected mice. Methods: BALB/c (high susceptibility), CBA (medium), and C57BL/6 and C57BL/10 (resistance) strain mice were used in this study. The levels of IgM, IgG, and IgE in the serum and cerebrospinal fluid (CSF) from infected mice were compared. A. cantonensis-reactive antigens from BALB/c and C57BL/6 mice CSF were also analyzed. Results: Antibodies against fifth-stage larvae (L5) antigens increased in mice CSF, particularly IgE, relate to worm rejection and the susceptibility of different mouse strains. The increased IgE level in BALB/c mice CSF is lower than that from others, suggesting IgE response in brain is more important than that in serum. Anti-L5 and anti-excretory/secretory (ES) antigen IgE and IgG responses in CSF were analyzed. In addition, the antibody-dependent eosinophil-mediated cytotoxicity induced by anti-excretory/secretory (ES) antigen antibodies may be the reason of severe brain inflammation in infected BALB/c mice. IgE and IgG antibodies against a 105 kDa protein of L5 antigen was detected at week 3 post-infection in C57BL/6 mice and week 5 post-infection in BALB/c mice. We suggest that 105 kDa protein is related with the antibody response of A. cantonensis-infected mice. Conclusion: We found that IgE antibodies in mice CSF against L5 antigens related to worm rejection in mice brains. This study may help to identify specific angiostrongyliasis markers that can be applied for clinical diagnosis and treatment in future.

Abstract Objectives This study aimed to investigate the association between salivary matrix metalloproteinase‐1 (MMP‐1) and clinicopathological parameters of oral cavity squamous cell carcinoma (OSCC) and compare the prognostic efficacy of salivary MMP‐1 and other established circulating markers for OSCC. Methods Saliva specimens from 479 OSCC subjects were examined using an enzyme‐linked immunosorbent assay. The area under the curve (AUC) values of salivary MMP‐1 and other markers were calculated, and survival analyses were conducted using Kaplan–Meier and multivariate regression methods. Results Salivary MMP‐1 showed good discrimination in predicting overall survival, with an AUC of 0.638, which was significantly higher than that of albumin (0.530, p = .021) and Charlson comorbidity index (0.568, p = .048) and comparable with neutrophil‐to‐lymphocyte ratio (0.620, p = .987), platelet‐to‐lymphocyte ratio (0.575, p = .125), and squamous cell carcinoma antigen (0.609, p = .605). Elevated levels of salivary MMP‐1 were significantly associated with higher pT classification, pN classification, overall pathological stage, positive extranodal extension, tumor differentiation, positive lymphovascular invasion, positive perineural invasion, and tumor depth (p all