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Abstract Background Empathy and communication are critical abilities for nursing students, and in recent years, scenario-based teaching has played a crucial role in fostering empathy and professional skill development. However, novice nursing students in basic nursing education often lack prior experience in patient communication, making it challenging for them to prepare adequately for scenarios and effectively handle difficulties in real-life situations. This deficiency also hampers participants’ or observers’ ability to engage in deep reflection, feedback, and learning. Consequently, students frequently experience anxiety in patient communication, and the effectiveness of empathy building remains limited. The aim of the study was to use empathy mapping and mini-simulation in learning to enhance nursing students’ empathy and self-confidence in communication. Methods A prospective quasi-experimental research design was employed, targeting second-year students in the four-year nursing program at our institution, specifically in the Basic Nursing and Experimentation II class. The students were randomly divided into two groups: an experimental group and a control group, with a total of 98 students (52 in the experimental group and 46 in the control group). The experimental group received instruction using empathic communication digital materials and engaged in empathy mapping exercises, while the control group underwent conventional scenario-based teaching. Pre-test and post-test data were collected from both groups. Results A total of 98 students participated in the study, with 46 students in the control group and 52 students in the experimental group. The average age of the participants was 19.19 ± 0.53 years, with a predominance of females (82.7%). At the end of the semester, there was no significant difference in the average empathy levels between the two groups. However, the communication confidence levels of students in the control group (40.20 ± 6.54) were significantly lower than those in the experimental group (43.88 ± 6.35) (P = 0.006). Conclusions This teaching approach facilitated deeper and broader student learning, enhancing both empathy and communication confidence. The teaching materials developed in this study can be employed in future courses to teach empathy and patient communication effectively.

Via microstructural characterization analysis and mechanical properties tests, the present study primarily focused on exploring the effect of hot deformation strain on the phase transformation behavior in Ti–Mo precipitation hardening stainless steels (PHSSs). Interestingly, under the fixed ageing condition, it was found that more reverted austenite formed when the Ti–Mo PHSSs were subjected to a large amount of hot deformation strain, which could be attributed to the more retained austenite achieved during deep cryogenic treatment. In other words, a positive correlation between retained austenite and reverted austenite prevailed in Ti–Mo PHSS. Furthermore, when the ageing temperature was increased from 520 °C to 640 °C, the KAM distribution lines shifted to higher angles under the lower strain, i.e. ε = 35 %, whereas under large strain (ε = 70 %), the positions of the KAM distribution lines remained at similar sites. This finding implies that higher thermal stability of reverted austenite was achieved when the Ti–Mo PHSS was subjected to large hot deformation strains. The above metallurgical phenomenon was further verified by Vickers hardness measurement. For example, under the fixed ageing temperature of 520 °C, the distributions of HV0.1 values were 480–680 and 370–660, respectively, for Ti–Mo PHSSs subjected to hot deformation strains of 35 % and 70 %, respectively. These results also corroborate the formation of more soft reverted austenite under the larger hot deformation strain.

Abstract Background Undetected atrial fibrillation (AF) poses a significant risk of stroke and cardiovascular mortality. However, diagnosing AF in real-time can be challenging as the arrhythmia is often not captured instantly. To address this issue, a deep-learning model was developed to diagnose AF even during periods of arrhythmia-free windows. Methods The proposed method introduces a novel approach that integrates clinical data and electrocardiograms (ECGs) using a colorization technique. This technique recolors ECG images based on patients' demographic information while preserving their original characteristics and incorporating color correlations from statistical data features. Our primary objective is to enhance atrial fibrillation (AF) detection by fusing ECG images with demographic data for colorization. To ensure the reliability of our dataset for training, validation, and testing, we rigorously maintained separation to prevent cross-contamination among these sets. We designed a Dual-input Mixed Neural Network (DMNN) that effectively handles different types of inputs, including demographic and image data, leveraging their mixed characteristics to optimize prediction performance. Unlike previous approaches, this method introduces demographic data through color transformation within ECG images, enriching the diversity of features for improved learning outcomes. Results The proposed approach yielded promising results on the independent test set, achieving an impressive AUC of 83.4%. This outperformed the AUC of 75.8% obtained when using only the original signal values as input for the CNN. The evaluation of performance improvement revealed significant enhancements, including a 7.6% increase in AUC, an 11.3% boost in accuracy, a 9.4% improvement in sensitivity, an 11.6% enhancement in specificity, and a substantial 25.1% increase in the F1 score. Notably, AI diagnosis of AF was associated with future cardiovascular mortality. For clinical application, over a median follow-up of 71.6 ± 29.1 months, high-risk AI-predicted AF patients exhibited significantly higher cardiovascular mortality (AF vs. non-AF; 47 [18.7%] vs. 34 [4.8%]) and all-cause mortality (176 [52.9%] vs. 216 [26.3%]) compared to non-AF patients. In the low-risk group, AI-predicted AF patients showed slightly elevated cardiovascular (7 [0.7%] vs. 1 [0.3%]) and all-cause mortality (103 [9.0%] vs. 26 [6.4%]) than AI-predicted non-AF patients during six-year follow-up. These findings underscore the potential clinical utility of the AI model in predicting AF-related outcomes. Conclusions This study introduces an ECG colorization approach to enhance atrial fibrillation (AF) detection using deep learning and demographic data, improving performance compared to ECG-only methods. This method is effective in identifying high-risk and low-risk populations, providing valuable features for future AF research and clinical applications, as well as benefiting ECG-based classification studies.

Abstract Background Previous research has demonstrated that atrial fibrillation (AF) ablation improves heart function variably among patients. We proposed that the ANTWERP score, which was validated in a European group of patients with low left ventricular ejection fraction (LVEF) who had AF ablation, would be valid in an Asian group as well. The purpose of the study is to examine how well a new scoring system (the ANTWERP score) can predict heart function improvement after atrial fibrillation ablation in Asian patients with heart failure. Methods A retrospective review was conducted on patients (n = 84) undergoing AF ablation between January 2019 and June 2022. Initial diagnoses for impaired LV systolic function were confirmed by echocardiography. Patients meeting the “2021 Universal Definition of HF” criteria for LVEF recovery were classified as “responders.” Results Similarities were observed between responders and nonresponders regarding comorbidities, AF type, and LVEF, except for the left ventricular internal diameter in diastole. A higher percentage of responders had an ANTWERP score ≤2 (87.8%) compared to those with a score >2 (55.6%). LVEF improvement was notably higher in the former group (+14.8% vs. +9.4%, p = .043). Atrial reverse remodeling and recurrent atrial arrhythmia rates were similar across groups. Conclusion The conclusion of the study was that the ANTWERP score effectively predicted LVEF improvement after atrial fibrillation ablation in the Asian population and that this scoring system could be used to guide clinical decisions and prognosis prediction.

Although the ageing process is the most important metallurgical process influencing the austenite reversion reaction, the role of retained austenite existing after cryogenic treatment on austenite reversion transformation is still not fully explored. Therefore, via different cooling modes, i.e. water quenching (WQ), air cooling (AC), and furnace cooling (FC), applied after austenitization treatment, different amounts of retained austenite, namely 0.3 % (WQ), 0.5 % (AC), and 1.2 % (FC), were formed in the martensite matrix of Ti–Mo precipitation hardening stainless steels (PHSSs). Interestingly, even under the same ageing treatment condition, i.e. 520 °C for 4 h, the amount of reverted austenite that formed in Ti–Mo PHSSs strongly depended on the cooling rate used. For instance, according to EBSD phase maps, the reverted austenite contents were 24.7 %, 15.0 %, and 9.4 % in the steel specimens cooled by FC, AC and WQ, respectively. Therefore, a positive correlation was found between retained austenite and reverted austenite after comparison of the overall EBSD analysis results. In addition, it was found that the strength and ductility trade-off relationship was improved in steel samples subjected to the slow cooling treatment, as numerous η-Ni3Ti precipitates and larger amounts of reverted austenite formed simultaneously during the ageing treatment.

Background: Oxaliplatin is commonly used to treat gastrointestinal malignancies. However, its applications are limited due to potential adverse drug reactions (ADRs), particularly severe anaphylactic shock. There is no method to predict or prevent ADRs caused by oxaliplatin. Therefore, we aimed to investigate the genetic HLA predisposition and immune mechanism of oxaliplatin-induced ADRs. Methods: A retrospective review was performed for 154 patients with ADRs induced by oxaliplatin during 2016–2021 recorded in our ADR notification system. HLA genotyping was conducted for 47 patients with oxaliplatin-induced ADRs, 1100 general population controls, and 34 oxaliplatin-tolerant controls in 2019–2023. The in vitro basophil activation test (BAT) was performed and oxaliplatin-specific IgE levels were determined. Results: The incidence of oxaliplatin-induced ADRs and anaphylactic shock in our cohort was 7.1% and 0.15%, respectively. Of the 154 patients, 67.5% suffered rash/eruption; 26.0% of the patients who could not undergo oxaliplatin rechallenge were considered to show oxaliplatin-induced immune-mediated hypersensitivity reactions (HRs). The genetic study found that the HLA-DRB∗12:01 allele was associated with oxaliplatin-induced HRs compared to the general population controls (sensitivity = 42.9%; odds ratio [OR] = 3.4; 95% CI = 1.4–8.2; P = 0.008) and tolerant controls (OR = 12; 95% CI = 2.3–63.7; P = 0.001). The in vitro BAT showed higher activation of CD63+ basophils in patients with oxaliplatin-induced HRs compared to the tolerant controls (P

Background: Superabsorbent polymers (SAPs) have a remarkable ability to absorb significant quantities of water. However, their absorption capacity is significantly reduced when exposed to saline solutions, such as urine, due to the polyelectrolyte effect and charge screening. Methods: In this study, we demonstrate a zwitterionic superabsorbent polymer (ZSAP) with excellent salt-water absorption and retention capacities. ZSAP was synthesized by grafting a copolymer of p(sulfobetaine methacrylate-co-2-hydroxyethyl methacrylate) (p(SBMA-co-HEMA)) onto an acrylic acid (AA)-based hydrogel via free-radical polymerization. The introduction of zwitterionic SBMA significantly enhances the hydrophilicity of the polymer, particularly in a saline solution due to the anti-polyelectrolyte effect, thereby accelerating the rate of salt absorption. Additionally, the hydroxyl groups from HEMA facilitate the formation of covalent bonds with the AA network membrane through esterification, effectively mitigating polymer leaching. The hydration/dehydration behaviors of linear polymers were measured using the dynamic vapor sorption (DVS) method. Moreover, the salt-water absorption capacity, centrifuge retention capacity (CRC), and absorbency under load (AUL) of ZSAP with various SBMA moieties and copolymer dosages were comprehensively evaluated in a 0.9 wt% sodium chloride solution. Additionally, the water retention under different temperatures and polymer leaching of ZSAP were investigated. Significant Findings: The copolymer p(SBMA-co-HEMA) not only demonstrates a high salt-water absorption rate at 90% RH in a 0.9 wt% NaCl solution but also exhibits superior water retention at 0% RH compared to the AA polymer. Moreover, the ZSAP exhibits superior salt-water absorption capacity and AUL in a 0.9 wt% NaCl solution compared to conventional AA-based SAP. Additionally, the introduction of the hydroxyl moiety from the p(SBMA-co-HEMA) copolymer reduces free polymer leaching from ZSAP. This work presents an approach for the development of new SAP with high salt-water absorption and retention.

Introduction: Obesity has arisen as a prominent risk factor for COVID-19 severity and long COVID, potentially owed in part to the obesity-induced proinflammatory state. This study aimed to examine relationships among circulating inflammatory biomarkers and body mass index in nonhospitalized adults recently diagnosed with COVID-19. Methods: This analysis included participants who completed a randomized placebo-controlled trial conducted in October 2020–March 2021. Participants (19–53 years) were unvaccinated and enrolled following COVID-19 diagnosis as allowed by CDC return-to-work guidance. Anthropometrics and biomarkers were assessed at study baseline and week four. We examined the associations between body mass index (BMI) and inflammatory biomarkers via multiple regression models. Results: At study baseline (i.e., the point of enrollment following COVID-19 diagnosis) across all participants (N = 60), a higher BMI was associated with elevations in several inflammatory biomarkers including IL-6 (β = 7.63, 95% CI = 3.54, 11.89, p = 0.0004), ferritin (β = 6.31, 95% CI = 1.97, 10.83, p = 0.0047), high sensitivity C-reactive protein (β = 13.1, 95% CI = 8.03, 18.42, p = < 0.0001), tumor necrosis factor-α (β = 3.23, 95% CI = 0.91, 5.60, p = 0.0069), IL-12p40 (β = 3.69, 95% CI = 0.93, 6.52, p = 0.0094), IL-13 (β = 5.11, 95% CI = 1.00, 9.40, p = 0.0154), and IL-1Ra (β = 7.57, 95% CI = 3.61, 11.70, p = 0.0003). In control group participants (n = 30) after 4 weeks, a higher BMI was associated with elevations in IL-4 (β = 17.8, 95% CI = 0.84, 37.6, p = 0.0397) and sP-selectin (β = 1.16, 95% CI = 0.22, 2.11, p = 0.0182), controlling for baseline and covariates. Conclusions: Here, BMI was positively associated with circulating biomarkers of platelet activation and inflammation in adults recently diagnosed with COVID-19 after 4 weeks. The shift in post-acute COVID-19 inflammatory biomarkers associated with an increasing BMI noted here shares similarities to biomarkers of LC reported in the literature.

Based on the microstructure analysis, the present research investigated the influence of various austenitizing conditions on the transformation behavior of intermetallic compound particles, i.e. η-Ni3Ti, and the reversed austenite during ageing treatment in Ti–Mo maraging stainless steel, as well as the related mechanical properties. The results revealed numerous tiny rod-like intermetallic compound particles, i.e. η-Ni3Ti, having a Burgers orientation relationship, i.e., {101}α′//{0001}η ; α′//η, with the martensite matrix, as well as blocky, lath, and granular reversed austenite of various sizes distributed within the tempered martensite matrix. Regardless of the austenitizing treatment condition, more reversed austenite was found in the samples aged at 520 °C than in those aged at 640 °C. Although this finding was not consistent with the Thermo-Calc predictions, it should be associated with the thermal stability of reversed austenite at different ageing temperatures. In other words, the greater amount of reversed austenite that formed at 640 °C did not remain at room temperature due to secondary martensite transformation during cooling, as was verified by EBSD analysis.

Abstract The performance of superconducting qubits is degraded by a poorly characterized set of energy sources breaking the Cooper pairs responsible for superconductivity, creating a condition often called “quasiparticle poisoning”. Both superconducting qubits and low threshold dark matter calorimeters have observed excess bursts of quasiparticles or phonons that decrease in rate with time. Here, we show that a silicon crystal glued to its holder exhibits a rate of low-energy phonon events that is more than two orders of magnitude larger than in a functionally identical crystal suspended from its holder in a low-stress state. The excess phonon event rate in the glued crystal decreases with time since cooldown, consistent with a source of phonon bursts which contributes to quasiparticle poisoning in quantum circuits and the low-energy events observed in cryogenic calorimeters. We argue that relaxation of thermally induced stress between the glue and crystal is the source of these events.

Abstract Accurately predicting the power conversion efficiency (PCE) in dye‐sensitized solar cells (DSSCs) represents a crucial challenge, one that is pivotal for the high throughput rational design and screening of promising dye sensitizers. This study presents precise, predictive, and interpretable machine learning (ML) models specifically designed for Zn‐porphyrin‐sensitized solar cells. The model leverages theoretically computable, effective, and reusable molecular descriptors (MDs) to address this challenge. The models achieve excellent performance on a “blind test” of 17 newly designed cells, with a mean absolute error (MAE) of 1.02%. Notably, 10 dyes are predicted within a 1% error margin. These results validate the ML models and their importance in exploring uncharted chemical spaces of Zn‐porphyrins. SHAP analysis identifies crucial MDs that align well with experimental observations, providing valuable chemical guidelines for the rational design of dyes in DSSCs. These predictive ML models enable efficient in silico screening, significantly reducing analysis time for photovoltaic cells. Promising Zn‐porphyrin‐based dyes with exceptional PCE are identified, facilitating high‐throughput virtual screening. The prediction tool is publicly accessible at https://ai‐meta.chem.ncu.edu.tw/dsc‐meta.

Abstract Recent progress in additive manufacturing has enabled the application of stereolithography (SLA) in bioprinting to produce 3D biomimetic structures. Bioinks for SLA often require synthetic polymers as supplements to ensure the structural integrity of the printed cell‐laden constructs. High molecular weight (MW) poly(ethylene‐glycol)‐diacrylate (PEGDA) (MW ≥ 3400 Da) is commonly used to enhance the mechanical property of crosslinked hydrogels. However, the production of bioink with high MW PEGDA requires in‐house polymer synthesis or the acquisition of costly reagents, which may not be readily available in all laboratory settings. As an alternative to high MW PEGDA, this research investigated the use of poly(ethylene‐glycol)‐dimethacrylate (PEGDMA) (MW = 1000 Da) as a supplement of a bioink to enhance the mechanical properties of the SLA‐printed constructs. The successful demonstration showcases 1) the fabrication of 3D constructs with overhang and complex architecture, and 2) the cytocompatibility, with high cell viability of 71–87% over 6 days of culture, of the GelMA‐PEGDMA bioink to enable cell‐laden bioprinting. This study suggests PEGDMA as a viable supplement in the formulation of SLA bioink. The accessibility to PEGDMA will facilitate the advance in 3D bioprinting to fabricate complex bioinspired structures and tissue surrogates for biomedical applications.

Two kinds of Cr–Mo–V hot work tool steels with different nitrogen contents, i.e. High-N steel and Low-N steel, were heat treated to investigate phase transformation phenomena in the present study. Microstructure characterization revealed the existence of numerous particles within both steels, which could be further categorized as the following three types: large- (>150 nm), medium- (50–100 nm), and tiny-sized (

Background / Aims: Effects of anti-hepatitis C virus (HCV) therapeutic regimens and mixed cryoglobulinemia on long-term renal function of HCV-infected patients with viral clearance have not been determined. Methods/Materials: A prospective 10-year cohort study of 1212 HCV-infected patients (interferon-based therapy, n = 615; direct-acting antiviral (DAA) therapy, n = 434) was conducted. Results: At baseline, age, body mass index (BMI), hemoglobin (Hb) and uric acid (UA) levels, and fibrosis-4 score were associated with estimated glomerular filtration rates (eGFRs) in HCV-infected patients. At 24 weeks posttherapy, age, BMI, and Hb and UA levels were associated with eGFRs in patients with a sustained virological response (SVR) (n = 930). Compared with those at baseline, the eGFRs were lower in SVR patients at 24 weeks posttherapy, regardless of the therapeutic regimen. The eGFRs reverted to baseline levels in interferon-treated SVR patients up to 10 years posttherapy but remained decreased in DAA-treated SVR patients up to 4 years posttherapy. Longitudinally, repeated measures analyses with generalized estimating equations showed that the interactions between DAA-based therapy and mixed cryoglobulinemia (OR: 3.291) and Hb levels (1.778) were positively, while DAA-based therapy (0.442), age (0.956), UA levels (0.698), homeostasis model assessment-insulin resistance index (0.961) and complement 4 levels (0.9395) were negatively associated with the eGFR. Among DAA-treated SVR patients, the baseline eGFR (OR: 1.014; 95%CI OR: 1.004–1.023) and high-sensitivity C-reactive protein (HR: 1.082; 95%CI HR: 1.018–1.15) were associated with eGFR reduction at 24 weeks and 4 years posttherapy, respectively. Conclusions: Hepatic fibrosis was an HCV-related factor for renal function. Longitudinally, DAA therapy was negatively, while the interaction between DAA therapy and mixed cryoglobulinemia was positively associated with renal function in SVR patients; deteriorated renal function was recovered in interferon-treated SVR patients. Particularly in DAA-treated SVR patients, baseline renal function and systemic inflammation were associated with short- and long-term reductions in renal function, respectively.

Diabetic retinopathy is characterized by hyperglycemic retinal pigment epithelial cells that secrete excessive pro-inflammatory cytokines and VEGF, leading to retinal damage and vision loss. Cobalt protoporphyrin (CoPP) is a compound that can reduce inflammatory responses by inducing high levels of HO-1. In the present study, the therapeutic effects of CoPP were examined in ARPE-19 cells under hyperglycemia. ARPE-19 cells were incubated in culture media containing either 5.5 mM (NG) or 25 mM (HG) glucose, with or without the addition of 0.1 µM CoPP. Protein expressions in samples were determined by either Western blotting or immunostaining. A Seahorse metabolic analyzer was used to assess the impact of CoPP treatment on mitochondrial respiration in ARPE-19 cells in NG or HG media. ARPE-19 cells cultured in NG media displayed different cell morphology than those cultured in HG media. CoPP treatment induced high HO-1 expressions and significantly enhanced the viability of ARPE-19 cells under hyperglycemia. Moreover, CoPP significantly downregulated expressions of inflammatory and apoptotic markers and significantly upregulated mitochondrial respiration in APRPE-19 cells under hyperglycemia. CoPP treatment significantly enhanced cell viability in ARPE-19 cells under hyperglycemia. The treatment also downregulated the expressions of pro-inflammatory and upregulated mitochondrial respiration in the hyperglycemic cells.

An international randomized phase II trial of Globo H (GH) vaccine, adagloxad simolenin/OBI-821 in 349 patients with metastatic breast cancer showed longer progression-free survival (PFS) in vaccinated patients who developed anti-Globo H (anti-GH) IgG than those who did not and the placebo group. The impacts of anti-GH IgM and GH expression on peak anti-GH IgG and clinical outcome were further evaluated. The titers of anti-GH IgG and IgM were determined by ELISA. GH expression in tumor was examined by immunohistochemical staining. Immunophenotyping was conducted by flow cytometry. Adagloxad simolenin elicited anti-GH IgM which peaked at titers ≥1:80 between weeks 5 and 13. The mean anti-GH IgG titer peaked at week 41 and decreased thereafter on the completion of vaccination. One log increase in peak IgM was associated with 10.6% decrease in the HR of disease progression (HR: 0.894, 95% CI: 0.833 to 0.960, p=0.0019). Patients with anti-GH IgM ≥1:320 within first 4 weeks after vaccination had significantly higher maximum anti-GH IgM (p

Abstract Background Taiwan’s warm and humid climate and dense population provide a suitable environment for the breeding of pests. The three major urban insects in Taiwan are house flies, cockroaches, and mosquitoes. In cases where a disease outbreak or high pest density necessitates chemical control, selecting the most effective insecticide is crucial. The resistance of pests to the selected environmental insecticide must be rapidly assessed to achieve effective chemical control and reduce environmental pollution. Methods In this study, we evaluated the resistance of various pests, namely, house flies (Musca domestica L.), cockroaches (Blattella germanica L. and Periplaneta americana), and mosquitoes (Aedes aegypti and Ae. albopictus) against 10 commonly used insecticides. Rapid insecticide resistance bioassays were performed using discriminating doses or concentrations of the active ingredients of insecticides. Results Five field strains of M. domestica (L.) are resistant to all 10 commonly used insecticides and exhibit cross- and multiple resistance to four types of pyrethroids and three types of organophosphates, propoxur, fipronil, and imidacloprid. None of the five field strains of P. americana are resistant to any of the tested insecticides, and only one strain of B. germanica (L.) is resistant to permethrin. One strain of Ae. albopictus is resistant to pirimiphos-methyl, whereas five strains of Ae. aegypti exhibit multiple resistance to pyrethroids, organophosphates, and other insecticides. Conclusions In the event of a disease outbreak or high pest density, rapid insecticide resistance bioassays may be performed using discriminating doses or concentrations to achieve precise and effective chemical control, reduce environmental pollution, and increase control efficacy. Graphical Abstract