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High school students experience considerable stress and anxiety. Meditative practices have been found to reduce stress and anxiety, but research has neglected the acceptability of these practices for adolescents. Bilingual guided meditation (BGM) has been shown to be both acceptable and effective in reducing stress and anxiety for second language (L2) learners in college, but its acceptability for culturally diverse high school students is unknown. The current study investigated acceptability of BGM and its components (music, positive suggestion) with L2 learners in a diverse and low-income high-school setting. Qualitative feedback and content analysis were used to investigate the acceptability of the intervention among 99 student and 5 teacher participants. Results indicate that both music and guided meditation were acceptable to the majority of the students and all of their teachers. Students particularly valued the perceived calming effects of the meditation music. Implications for future research and practice are discussed.

BackgroundIt has been a matter of much debate whether the co-administration of furosemide and albumin can achieve better diuresis and natriuresis than furosemide treatment alone. There is inconsistency in published trials regarding the effect of this combination therapy. We, therefore, conducted this meta-analysis to explore the efficacy of furosemide and albumin co-administration and the factors potentially influencing the diuretic effect of such co-administration.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Medline, and Cochrane databases. Prospective studies with adult populations which comparing the effect of furosemide and albumin co-administration with furosemide alone were included. The outcomes including diuretic effect and natriuresis effect measured by hourly urine output and hourly urine sodium excretion from both groups were extracted. Random effect model was applied for conducting meta-analysis. Subgroup analysis and sensitivity analysis were performed to explore potential sources of heterogeneity of treatment effects.ResultsBy including 13 studies with 422 participants, the meta-analysis revealed that furosemide with albumin co-administration increased urine output by 31.45 ml/hour and increased urine excretion by 1.76 mEq/hour in comparison to furosemide treatment alone. The diuretic effect of albumin and furosemide co-administration was better in participants with low baseline serum albumin levels (< 2.5 g/dL) and high prescribed albumin infusion doses (> 30 g), and the effect was more significant within 12 hours after administration. Diuretic effect of co-administration was better in those with baseline Cr > 1.2 mg/dL and natriuresis effect of co-administration was better in those with baseline eGFR < 60 ml/min/1.73m2.ConclusionCo-administration of furosemide with albumin might enhance diuresis and natriuresis effects than furosemide treatment alone but with high heterogeneity in treatment response. According to the present meta-analysis, combination therapy might provide advantages compared to the furosemide therapy alone in patients with baseline albumin levels lower than 2.5 g/dL or in patients receiving higher albumin infusion doses or in patients with impaired renal function. Owing to high heterogeneity and limited enrolled participants, further parallel randomized controlled trials are warranted to examine our outcome.RegistrationPROSEPRO ID: CRD42020211002; https://clinicaltrials.gov/.

Numerous studies have revealed an alarming prevalence of test anxiety among Chinese junior high school students. Prevention of test anxiety in this population has become crucial. Brief meditation intervention (BMI) has shown promising results for promoting students' well-being and reducing test anxiety, but its mechanism for reducing test anxiety remains unknown. This study examined the effects of BMI and the roles mindfulness and self-efficacy play in mediating between the intervention and test anxiety. The BMI was optimized in content and form and culturally tailored for Chinese eighth graders. It includes guided meditation with relaxation music, mindful breathing and body scanning, and positive suggestions that promote self-efficacy. Six eighth grade classes at an urban junior high school in Beijing (N = 202, M[subscript age] = 14.14, 102 males) were assigned to either a BMI group (3 classes, N = 103) or a control group (3 classes, N = 99). Test anxiety, mindfulness, and self-efficacy measures were administered before, in the middle of, immediately after, and one month after the intervention. Repeated measures ANOVA and mediation analysis indicated that BMI had a significant effect on reducing test anxiety and enhancing mindfulness and self-efficacy over time. The study also found that mindfulness and self-efficacy played a chain of mediating roles in the relationship between BMI and test anxiety. The mediation effect value accounted for 68.35% of the intervention effects.

To address the unmet need for treatment of social anxiety disorder in China, it is timely and relevant to identify more effective, accessible, economic, and easily disseminated interventions. The present study examined the effect of an eight-session program for cognitive bias modification for interpretation (CBM-I). Smartphones were used in the training of reducing interpretation bias and social anxiety of Chinese undergraduates with high social anxiety. In total, 38 participants were randomly assigned to either a CBM-I training group ( n = 19) or a control group ( n = 19). As a result, the CBM-I training group provided more positive interpretations in ambiguous situations and less social anxiety than the control group. Results indicate that CBM-I training via smartphones can effectively promote positive interpretations of ambiguous situations and relieve social anxiety. CBM-I via smartphones may have clinical utility when applied as a multisession intervention of social anxiety for Chinese undergraduates.

This study used bibliographic data from Web of Science and employed various bibliometric analysis tools to present a systematic review of ethical leadership research from a board perspective. Theoretical evolutions underpinning how ethical leaders influence their followers are also detailed. Results identify the key documents, frequent keywords, and the most used theories in the field of ethical leadership. Results show that not only are there few newcomers to the field, the knowledge on ethical leadership, dominated by a minority few, has not diffused to a broader community. Results also show that although the focus of ethical leadership research in recent years shifted to employee creativity and knowledge sharing, the theories applied in the investigations remain the dominant social exchange theory and social learning theory. The results provide useful references for future studies, avoiding repetitive research while identifying possible knowledge gaps.

Purpose: This study examined the impact of school leadership on teacher professional collaboration, with collective teacher innovativeness and teacher self-efficacy (TSE) playing the mediating role. Two most commonly used leadership styles, instructional leadership (IL) and distributed leadership (DL), were analyzed using a multilevel design, i.e. teachers are nested within schools. Design/methodology/approach: The proposed model was validated using data of Taiwan TALIS 2018 collected from both teachers and principals and analyzed using hierarchical linear modeling. Findings: Results showed that IL and DL influence teacher professional collaboration through different paths. IL had a significant direct impact on teacher professional collaboration alone, while DL had a significant direct impact on both teachers' collective innovativeness and their professional collaboration. While TSE had a direct effect on collective teacher innovativeness, TSE and collective teacher innovativeness had a direct effect on teacher professional collaboration. Originality/value: This study highlights the significant impact of principal leadership as both principals and teachers work in the same environment and culture co-shaped through the interaction and collaboration. Research evidence regarding the effects of IL and DL on teacher professional collaboration is limited; this is even less evidential when the indirect effects of variables mediating between school leadership and teacher outcomes, including teacher collective innovativeness and TSE, are added to the total effects. The present findings provide useful references for principals and teachers when promoting professional collaboration to achieve desired outcomes in school and student improvement.

This study aims to explore whether teachers' voice behavior is triggered by the leadership of the principal or the teachers themselves. Two conceptual frameworks are proposed to guide this research. In addition, the current study analyzes separately two dimensions of teachers' voice behavior, namely, promotive voice and prohibitive voice. Data collected from 884 teachers in Taiwan were analyzed to test the moderated mediation model. Results of the first conceptual framework revealed that under identity leadership, teacher agency moderated significantly the relationship of psychological empowerment with prohibitive voice, but not significantly with promotive voice. Findings of the second conceptual framework confirmed that under teacher agency, identity leadership did not significantly moderate the relationships of psychological empowerment with promotive voice and prohibitive voice. Most important, this study discovered that teacher agency is the main trigger for teachers exhibiting promotive and prohibitive voice behaviors. Finally, implications and limitations of this study are presented.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a promising therapy for diabetes and CKD patients. However, the pros and cons of SGLT2i in Type2 diabetes patients with CKD stage 5 remained largely unexplored. By using Taiwan's national health insurance research database (NHIRD), this observational cohort study enrolled T2DM patients with newly identified as having CKD5, and the index date defined as the date of CKD5 identification. The enrollees were divided into 2 groups depending on whether SGLT2 inhibitors were used for more than 3 months or not following the index date. A 1:4 propensity score matching was performed to balance characteristics between two groups. The SGLT2-inhibitor group exhibited significantly lower risks of new-onset ESRD (35.9% vs. 58.2%, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.59–0.74). For the risks of MACCEs (16.72% vs. 17.66%, HR 0.84, 95% CI: 0.62–1.15), infections related hospitalization (2.4% vs. 2.61%, HR:1.02, 95% CI:0.80–1.31), Infection-associated mortality (3.45% vs. 4.18% HR:0.80, 95% CI:0.41–1.56) and all-cause mortality (13.79% vs. 13.83%, HR:0.95, 95% CI:0.68–1.32), no significant differences were observed between two groups. In conclusion, we provide evidence suggesting that SGLT2 inhibitors may offer renal protection and did not increase infection risks for CKD5 patients with type2 diabetes. [ABSTRACT FROM AUTHOR]

Public libraries are an invaluable institution in the United States, and the digital revolution has posed many challenges for them. With the American Library Association's updated "Library Bill of Rights" and public library services increasingly moving online in response to the COVID-19 pandemic, the protection of patron privacy in public libraries is an important and timely topic of study. However, there is a lack of empirical data regarding privacy practices and the challenges that public libraries face. To fill this gap, we conducted an online survey that was sent to more than 12,500 public librarians across the country to study the state of patron privacy practices and challenges in public libraries. This study is the first of its kind on this topic. Our results show that patron privacy protections vary drastically depending on the library's size and service area. This study provides essential knowledge for administrators and policy makers in public libraries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic hepatitis B and C infections are major causes of morbidity and mortality in end-stage kidney disease (ESKD) patients on hemodialysis (HD). The Fibrosis-4 (FIB-4) score is a non-invasive method to evaluate chronic liver disease. However, it is unclear whether there is a connection between the FIB-4 score and major adverse cardiovascular events (MACEs) and mortality in patients on HD. This study investigates the relationship between FIB-4 scores, MACEs, and mortality in HD patients. METHODS: A 5-year retrospective study included 198 HD patients with chronic hepatitis B and C from Chang Gung Memorial Hospital. FIB-4 scores were categorized into high (>2.071), middle (1.030~2.071), and low (<1.030) tertiles for cross-sectional analyses. MACEs and mortality were tracked longitudinally. RESULTS: Patients with high FIB-4 scores had lower hemoglobin and albumin levels. Cox multivariate analysis showed that high FIB-4 scores (aHR: 1.589) and diabetes mellitus (aHR: 5.688) were significant factors for all-cause mortality. The optimal FIB-4 score for 5-year mortality was 2.942. FIB-4 scores were not significant for predicting 5-year MACEs. CONCLUSIONS: High FIB-4 scores are associated with increased 5-year all-cause mortality risk in HD patients with chronic hepatitis virus infection. [ABSTRACT FROM AUTHOR]

Background: Sodium-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 Methods: A 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). Results: Combined 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. Conclusions: In T2DM patients without HF, the combined treatment with SGLT2i and Pio may synergistically provide CV benefits without increasing risks of HF. [ABSTRACT FROM AUTHOR]

Past research often found that older adults searched less in terms of browsing and generating keywords; few studiesexamined the processes and underlying mechanism that caused the age-related reduction on search. In the current study, 20younger and older adults performed ill-defined search tasks with a search box we implemented. In addition to the age differencesin the quantities of search, results showed that there were qualitative age differences in allocating resources to exploration andexploitation across tasks varying in difficulties. Older adults were found to do more exploitation within one information clusteras defined by the keywords than younger adults. There was also age difference in the ways to reformulate keywords, that olderdoing more total changes in keywords and younger doing more partial changes in terms of narrowing or broadening the search.The links between search processes and the age differences in cognitive profiles were also discussed.

Selective laser melting (SLM) is a rapidly evolving technology that requires extensive knowledge and management for broader industrial adoption due to the complexity of phenomena involved. The selection of parameters and numerical analysis for the SLM process are both costly and time-consuming. In this paper, a three-dimensional radial basis function-finite difference (RBF-FD) meshless model is introduced to accurately and efficiently simulate the molten pool size and temperature distribution during the SLM process for austenitic stainless steel (AISI 316L). Two different volumetric moving heat source models were presented, namely the ray-tracing method heat source model and the double-ellipsoidal shape heat source model. The temperature-dependent material properties and phase change process were also considered, based on experiments and effective models. Results of the model for the molten pool size were validated with those of the literature. The proposed approach can be used to predict the effect of different laser power and scan speed on the molten pool size and temperature gradient along the depth direction. The result reveals that the depth of the molten pool is more sensitive to laser power than scan speed. Under the same scan speed, a 22% change in laser power (45 ± 10 W) affects the maximum temperature proportionally by about 9%. The developed algorithm is computationally efficient and suitable for industrial applications. [ABSTRACT FROM AUTHOR]