Context
The flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology‐enhanced pre‐class learning to transmit knowledge, ...incorporating in‐class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture‐based (LB) learning by meta‐analysis.
Methods
We systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random‐effects model when appropriate.
Results
Forty‐six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi‐experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta‐analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post‐intervention and pre–post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non‐USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta‐regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.
Conclusions
The FC method is associated with greater academic achievement than the LB approach for higher‐level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.
The authors’ meta‐analysis (46 studies, >9000 participants, health and non‐health science education) found flipped classrooms generally have significantly better learning outcomes than lecture learning, with a tendency for better outcomes for more recent studies.
Mesothelial cells are specific epithelial cells lining the serosal cavity and internal organs. Nonetheless, few studies have explored the possibility to culture mesothelial cells in a nanostructure ...scaffold for tissue engineering applications. Therefore, this study aims to fabricate nanofibers from a polycaprolactone (PCL) and PCL/chitosan (CS) blend by electrospinning, and to elucidate the effect of CS on the cellular response of mesothelial cells. The results demonstrate that a PCL and PCL/CS nanofiber membrane scaffold could be prepared with a comparable fiber diameter (~300 nm) and porosity for cell culture. Blending CS with PCL influenced the mechanical properties of the scaffold due to interference of PCL crystallinity in the nanofibers. However, CS substantially improves scaffold hydrophilicity and results in a ~6-times-higher cell attachment rate in PCL/CS. The mesothelial cells maintain high viability in both nanofiber membranes, but PCL/CS provides better maintenance of cobblestone-like mesothelial morphology. From gene expression analysis and immunofluorescence staining, the incorporation of CS also results in the upregulated expression of mesothelial marker genes and the enhanced production of key mesothelial maker proteins, endorsing PCL/CS to better maintain the mesothelial phenotype. The PCL/CS scaffold was therefore chosen for the in vivo studies, which involved transplanting a cell/scaffold construct containing allograft mesothelial cells for mesothelium reconstruction in rats. In the absence of mesothelial cells, the mesothelium wound covered with PCL/CS showed an inflammatory response. In contrast, a mesothelium layer similar to native mesothelium tissue could be obtained by implanting the cell/scaffold construct, based on hematoxylin and eosin (H&E) and immunohistochemical staining.
Mesothelial cells are specific epithelial cells that are lined in the serosal cavity and internal organs. Nonetheless, few studies have explored the possibility to culture mesothelial cells in a ...three-dimensional (3D) scaffold for tissue engineering applications. Towards this end, we fabricated macroporous scaffolds from gelatin and gelatin/hyaluronic acid (HA) by cryogelation, and elucidated the influence of HA on cryogel properties and the cellular phenotype of mesothelial cells cultured within the 3D scaffolds. The incorporation of HA was found not to significantly change the pore size, porosity, water uptake kinetics, and swelling ratios of the cryogel scaffolds, but led to a faster scaffold degradation in the collagenase solution. Adding 5% HA in the composite cryogels also decreased the ultimate compressive stress (strain) and toughness of the scaffold, but enhanced the elastic modulus. From the in vitro cell culture, rat mesothelial cells showed quantitative cell viability in gelatin (G) and gelatin/HA (GH) cryogels. Nonetheless, mesothelial cells cultured in GH cryogels showed a change in the cell morphology and cytoskeleton arrangement, reduced cell proliferation rate, and downregulation of the mesothelium specific maker gene expression. The production of key mesothelium proteins E-cadherin and calretinin were also reduced in the GH cryogels. Choosing the best G cryogels for in vivo studies, the cell/cryogel construct was used for the transplantation of allograft mesothelial cells for mesothelium reconstruction in rats. A mesothelium layer similar to the native mesothelium tissue could be obtained 21 days post-implantation, based on hematoxylin and eosin (H&E) and immunohistochemical staining.
To analyze the status of binocular visual functions, the relationship between binocular visual function and computer vision-related symptoms in the high-tech industry group. The study sample was ...comprised of 33 participants aged between 20 and 40 years of age. After completing basic information and the Computer Vision Symptom Scale (CVSS-17) questionnaire, the participants underwent a comprehensive examination of binocular visual function. All data were statistically analyzed with SPSS V26.0 software. The value of the binocular vision function of the Taiwan high-tech industry group was significantly different compared with the Scheiman and Morgan standard value. Study subjects were generally found to exhibit larger exophoric at distance, which in turn might lead to a lower ability to maintain binocular fusion to a single image, or recover from fusional disruption at distance. Subjects also experienced accommodation and convergence problems at near at the same time. Age, gender, and refractive errors had no significant impact on CVSS-17 scores, only the duration of computer usage showed a significant effect, particularly for internal symptom factor (ISF) dimensions. In addition, the interaction between the ISF and external symptom factor resulted in more severe visual symptoms. Long-term use of electronic devices may lead to an imbalance in binocular vision function, thereby increasing or exacerbating visual symptoms. If the use of electronic devices is an unchangeable trend, interventions in prescription, visual training or the visual design of electronic products become worthwhile topics for development.
For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge ...can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence.
Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions.
We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction.
Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.
Morgan and Scheiman's Optometric Extension Program (OEP) expected binocular vision findings have longstanding use in optometry. With technological advances, the demands and standards of binocular ...function have changed. This study aimed to investigate which binocular visual functions can effectively predict visual behavior performance.
Participants aged 15-24 years were recruited from two colleges and two universities. After completing the CSMU-Visual Behavioral Performance questionnaire (CSMU-VBP, with four components: near work, visual perception, visual comfort, and whole-body balance), participants were divided into symptomatic and asymptomatic groups based on questionnaire findings (cutoff: < 12 vs. ≥ 12 symptoms). Then a 24-step binocular visual examination was undertaken. Data were analyzed with one-sample, Student's, and paired t-tests. Additionally, receiver operating characteristic analysis was used to determine the predictors of binocular visual function required for near work, visual perception, visual comfort, and body balance dimensions.
Among 308 participants, 43 (14%) and 265 (86%) were symptomatic and asymptomatic, respectively. Among the 46 participants with abnormal binocular vision, 36 (78%) reported that they had no obvious symptoms. The commonest dysfunctions were accommodative excess and convergence excess. Most of the binocular visual findings significantly diverged from traditional normal values: amplitude of accommodation, as well as base-in prism to break and recovery points at distance were higher than traditional normal values, whereas others were lower than traditional normal values. Total CSMU-VBP scores indicated that the asymptomatic and symptomatic groups had significant differences in DBO recovery (t = 2.334, p = 0.020) and BAF (t = 1.984, p = 0.048). Receiver operating characteristic curve analysis yielded the following binocular visual functional cutoff points: near work (DBO blur < 7, DBO recovery < 5.5), visual perception (MAF < 10.5, BAF < 10.25), visual comfort (DLP < - 2.25, DBI break > 11.5, NBI blur > 15, NBI break > 17.5, NBI recovery > 13, NPC < 5.75), and body balance (NFD_H > - 0.5, gradient AC/A minus > 2.25, NPC < 4.75).
The mean values of binocular visual function among young Taiwanese adults were statistically different from traditional normative values. Further research is required to confirm whether these findings reflect impaired binocular vision or stringent criteria. Assessments of binocular visual function, especially binocular accommodation sensitivity, are crucial in routine optometric examination.
The prevalence of chronic kidney disease (CKD) is estimated to be 13.4% worldwide and 15% in the United States. CKD has been recognized as a leading public health problem worldwide. Unfortunately, as ...many as 90% of CKD patients do not know that they already have CKD. Ultrasonography is usually the first and the most commonly used imaging diagnostic tool for patients at risk of CKD. To provide a consistent assessment of the stage classifications of CKD, this study proposes an auxiliary diagnosis system based on deep learning approaches for renal ultrasound images. The system uses the ACWGAN-GP model and MobileNetV2 pre-training model. The images generated by the ACWGAN-GP generation model and the original images are simultaneously input into the pre-training model MobileNetV2 for training. This classification system achieved an accuracy of 81.9% in the four stages of CKD classification. If the prediction results allowed a higher stage tolerance, the accuracy could be improved by up to 90.1%. The proposed deep learning method solves the problem of imbalance and insufficient data samples during training processes for an automatic classification system and also improves the prediction accuracy of CKD stage diagnosis.
The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we ...explored the correlation between health literacy and depression in diabetic women.
In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses.
One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=−2.05, p=0.042).
A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.
Background The ideal method for catheter placement in patients undergoing peritoneal dialysis remains debatable. This prospective study intends to clarify whether laparoscopic assisted percutaneous ...puncture is superior to open surgery. Materials and Methods From 2002 to 2006, 77 patients receiving first catheter placement were enrolled and randomized to either an open group of 40 patients or a laparoscopic group of 37 patients. Patient characteristics, operation-related data, procedural complications, and clinical outcome were compared by using the statistical software SPSS ver. 11.5 (SPSS, Chicago, IL). Results Laparoscopy had a longer operative time (68.32 ± 31.90 versus 46.68 ± 15.99 min; P < 0.001), shorter wound length (1.69 ± 0.46 versus 2.34 ± 0.84 cm; P < 0.001), and higher costs ( P < 0.001) compared with open surgery. Laparoscopy tended to have a higher incidence of pericannular bleeding (21.6% versus 7.5%) and a lower rate of early catheter migration (2.7% versus 15.0%), but its early/late/overall complication rate did not statistically differ. No surgical mortality occurred. Rate and cause of overall mortality or catheter dropout did not statistically differ. Catheter longevity was equivalent in both groups. Conclusions Laparoscopic assisted percutaneous puncture exhibited no superiority to open surgery. As a matter of fact, open surgery's shorter operative time and reduced equipment requirement can increase cost-effectiveness. Therefore, conventional open surgery is recommended for most patients with primary catheter placement.
Sorghum (Sorghum bicolor) exhibits drought resistance and environmental adaptability, making it a crucial cereal crop for semi-arid regions. It has a wide range of uses, including as food, feed, ...brooms, alcohol production, and bioethanol. In particular, Taiwan imports nearly 50,000 tons of sorghum annually, primarily for the production of sorghum liquor. However, the ideal raw material for high-quality sorghum liquor is waxy sorghum, and not all sorghum varieties imported or promoted in Taiwan are of this waxy type. Consequently, there is a shortage of sufficient waxy sorghum raw materials to meet the demands of the Taiwan market. The occurrence of waxy sorghum (wx) is caused by the mutation of granule-bound starch synthase I (GBBS I), and there are currently several known types of mutants, carrying different wxa, wxb, and wxc waxy alleles. Among them, wxc is a novel mutation type, and in native sorghum in Taiwan, individuals with the waxy allele wxc have been found. The three-line method is a commonly used breeding strategy, which simplifies the process of emasculation to obtain hybrid F1 offspring. In this study, imported sorghum variety Liangnuo No.1 (with male sterility), native glutinous sorghum variety SB6 from Taiwan (carrying the wxc waxy allele), and sorghum reference genome variety BTx623 were used as research materials. The goal was to use the three-line method to produce waxy sorghums, including the male sterile line (A-line), male sterile maintenance line (B-line), and fertility-restoring line (R-line). The breeding results showed that by using backcross breeding, molecular-assisted selection, and traditional field selection methods, high-quality three-line materials (A-, B-, R-lines, named CNA1, CNB1 CNR1, respectively) and F1 hybrid (CNH1) with favorable agronomic traits and yield quality were successfully obtained.
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