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Critical-thinking skills are a desired higher education outcome and a primary goal in education. This research focuses on fostering college students' critical thinking through reflective writing. During an 18-week study, a total of 60 English majors were recruited. Both quantitative and qualitative data was collected, including 1) the pre- and post-tests of the 5-point Likert scale Reflection Questionnaire, and 2) nine students' reflective essays. The results showed that students significantly improved their critical thinking and revealed four prevalent changes. More specifically, self-worth and volunteerism (two major conceptual changes), as well as patience and gratefulness (two key behavioral changes) stood out among these changes. The implications of using reflective writing to promote students' critical thinking are discussed.

Previous research has addressed the effects of digital storytelling (DST) on verbal English competence and demonstrated that students engage more and learn more effectively. However, the relationship between learner engagement and speaking competence needs a further analysis of the methods wherein a specific DST tool facilitates learner engagement in the learning process and how it influences their speaking skills. Therefore, this study employed Toontastic--an app with the principles of scaffolding embedded to assist learners in producing DST. Results indicated that learners made significant progress in speaking competence as regards fluency and language use; but no significant correlations were observed between learner engagement and fluency as well as between engagement and language use; and topic familiarity and scaffolding embedded within DST were the two major methods in which the app, Toontastic, supported learners in improving speaking competence and learning engagement. The study concluded that using DST helps learners successfully communicate. Implications are disscussed.

Intracultural learning, building knowledge of one's native culture, is fundamental in developing learners into intercultural communicators. Integrating intracultural learning into the English curriculum could be a key to preparing English as a Foreign Language (EFL) students as cross-cultural communicators to people in non-English-speaking countries. The aim of this study was to investigate how assuming the role of local cultural material developers by making promotional YouTube videos helped EFL learners prepare to become socio-cultural agents to introduce themselves and their local culture to the world. Seventy-one participants were recruited from Multimedia English. Data included the students' concept-mapping worksheets, YouTube videos and final reflective oral presentations. Thematic analysis was used for data analysis. The results revealed that making YouTube videos helped EFL students to communicate aspects of their own culture, thereby enhancing their intracultural understanding and empowering them to take ownership of their learning. Practical implications and other issues were also discussed.

Although videos are now used pervasively in English as a Foreign Language settings, most existing literature centers on learners as knowledge receivers or passive video viewers (Lialikhova, 2014; Fisher & Frey, 2015; Bakar et al., 2019). Rarely do studies involving videos engaged learners as knowledge generators or active, self-directed learners. To fill this research gap, the current study examined the effects of the online-video pronunciation dictionary YouGlish, which employs a lexical approach on learners' speaking skills, including pronunciation, intonation, word usage, and strategies that learners applied while using YouGlish as well as their reactions to it. The results revealed that YouGlish can help learners make progress in their oral skills, especially in terms of word usage, by providing meaningful context that helps them comprehend how oral English is used in real life. The findings revealed the process of using YouGlish generated students to become more active and self-directed learners, rather than remained as passive receivers of knowledge.

Previous studies have indicated that computers and the internet play very important roles in students' acceptance and use of new information technology. In recent years, with the rapid development of mobile technology, mobile learning (m-learning) has becoming another popular topic. However, little is known about the students' attitudes and self-efficacy with the use of a mobile device in language learning. The purpose of this study was to investigate the attitudes and self-efficacy of using mobile learning devices for college students in a language class by employing task-based instruction. The sample group of the study comprised 58 second-year students at a technical university in central Taiwan who used mobile devices for m-learning in an English class to complete assigned tasks under the guidance of the instructor. Results showed that most students agreed that their motivation for English learning was enhanced and most of them had positive attitudes towards m-learning. Implications for future research and the practice of m-learning are discussed. (Contains 6 tables.)

Due to its complex nature and inherent unobservable features, teacher change within a specific context has rarely been investigated despite its importance as an issue in teacher professional development. To meet this challenge, the present study explored how teacher change was nurtured with the support of a web-based writing platform featuring such functions as "teacher action logs," "student learning logs and writing records," and "discussion forums." The data included (a) the writing teachers' written commentary on students' texts, (b) the writing teachers' discussion transcripts, and (c) focus group interview transcripts. Results showed that teacher change in pedagogical beliefs was manifested through two cycles of written commentary that included preconceptions, evaluations, and re-conceptualisations of their commentary in terms of local and global feedback. The writing teachers' perceptions of the web-based writing platform were also addressed in this study.

Previous studies have evaluated reading comprehension as the general understanding of reading texts. However, this broad and generic assessment of reading comprehension overlooks the specific aspects and processes that students need to develop. This study adopted Kintsch's Construction-Integration model to tap into reading comprehension at different levels and investigated how English as a foreign language (EFL) students benefit from online annotations to scaffold reading comprehension. Fifty EFL students participated in this study and the data collected included (1) the pre- and post-test assessments in reading comprehension levels, (2) the students' online annotations on reading texts, and (3) the discussion transcripts from an online discussion forum. The results from the first two data sources (1 and 2) were the data-sets used to investigate the influence of the annotation types on reading comprehension levels. The third data source was the data-set used to probe into the process of how students benefited from annotation types to reach different levels of reading comprehension. Four types of online annotations were frequently used by the students while reading online, including (1) marking vocabulary, (2) adding Chinese explanatory notes to unknown vocabulary, (3) marking text information, and (4) adding summary notes to each paragraph. Different frequencies of using the four types of online annotations resulted in three different comprehension levels: surface-based, text-based, and situation-based levels. Marking vocabulary and adding Chinese explanatory notes helped scaffold the students' learning to achieve surface comprehension levels to facilitate recognition and meaning of unknown vocabulary. Marking text information and in particular, the adding of summary notes to each paragraph were the core annotations that helped students comprehend the online text in text-based and situation-based levels. EFL teachers can guide students to use online annotations to different extents in order to deepen their reading comprehension.

Using the theories of critical reflection and community of practice, the aim of this paper was to explore the use of blogs as a reflective platform in the training processes of English as a Foreign Language (EFL) student teachers, who were learning to teach English for future employment in Taiwan. They made use of blogs as a platform to critically reflect on their learning processes as well as to gauge the impact of blogs on their own professional growth. Forty-three student teachers in two teacher-education programs at two science and technology institutions in central Taiwan participated in this study. Two instructors created a blog for use as a discussion forum so that the student teachers could engage in and examine their own reflection process. The data collected was qualitative in nature, consisting of student teachers' posting messages and comments on the blog, surveys on the student teachers' reflective experiences using blogs as reflection tools, and group reflective dialogues recorded by instructors in class meetings over the implementation of blogs during the course. The results showed that the student teachers actively discussed teaching theories and their implications through blogs. All of the 43 teachers who took part in this study were reflective, and some critically reflected on their thoughts and made significant comments; and the participants considered technology a useful platform for reflecting and communicating with each other. The positive implications for the use of blogs as a medium to provide and promote critical reflection for EFL teachers are discussed. (Contains 2 tables.)

• Exploring an adjustable urban road sustainable rating system from materials and energy aspects. • Introducing an adaptive approach, including top-down and bottom-up methods. • Developing five materials and energy-related indicators (MEIs) and corresponding requirements. • Applying the analytical hierarchy process to assign a weighting system to MEI and requirements. • Using the weighted sum model and sensitivity analysis to identify important barriers to MEI adoptions. Materials and energy consumption contribute significantly to the carbon footprint of roadway construction and operation. Although material and energy-related indicators (MEIs) have been incorporated into existing sustainability rating systems in developed countries, their application to other countries/regions, especially developing countries, might be hindered because of varying local contexts. Given that no rating system is specified for urban roadway projects, this study aims to develop MEIs and their weighting system as a part of an adjustable urban road sustainable rating system (AUR-SRS) and investigate the important barriers to MEI adoption. To this end, the adaptive approach integrating top-down and bottom-up methods was employed. The top-down approach used the comprehensive literature review to derive potential MEIs and barriers. The bottom-up approach referred to expert opinions in a three-country context (i.e., Taiwan, Indonesia, and Vietnam) to finalize the five most suitable MEIs and 26 corresponding requirements. The study then applied the Analytical Hierarchy Process (AHP) and Weighted Sum Model (WSM) methods to assign a weighting system to proposed indicators/ requirements and investigate the three critical barriers. The proposed research framework would serve as a baseline for developing adaptable indicators for other categories and examining barriers to indicator implementation. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan. Methods: The study of 23,781 people who were diagnosed with DM by using population—based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient’s job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors. Results: The 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81–1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04–3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups. Conclusion: DM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES. [ABSTRACT FROM AUTHOR]

Background: Stroke is a major risk factor for osteoporosis and fractures. No study has evaluated the association between diuretic use and risk of vertebral fracture in stroke patients, although a considerable proportion of stroke patients are prescribed diuretics for hypertension. Our study aimed to investigate whether treatment with thiazides or loop diuretics affects the risk of vertebral fracture after stroke., Methods: A population-based propensity score-matched retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients with a new diagnosis of stroke between 2000 and 2011 were included. After propensity score matching, 9468 patients were included in the analysis of the effect of thiazides, of who 4734 received thiazides within 2 years after stroke. To analyze the loop diuretic effect, 4728 patients were included, of who 2364 received loop diuretics. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) of vertebral fractures among patients according to thiazide or loop diuretic use within 2 years following stroke. Sensitivity analyses based on the duration of thiazide or loop diuretic use were further conducted., Results: There was no significant difference in vertebral fracture risk between thiazide users and non-users (adjusted HR [aHR] = 1.14, 95% confidence interval [CI] = 0.88-1.47, p = 0.316). Loop diuretic users had a significantly higher vertebral fracture risk than non-users (aHR = 1.45, 95% CI = 1.06-1.98, p = 0.019). However, the sensitivity analysis revealed that short-term thiazide use (exposure duration < 90 days within 2 years after stroke) significantly increased the risk of vertebral fracture versus non-use (aHR = 1.38, 95% CI = 1.02-1.88, p = 0.039). Only short-term loop diuretic users had significantly higher risk of vertebral fracture (aHR = 1.56, 95% CI = 1.11-2.20, p = 0.011). The other two subgroups with longer exposure duration in analyses for both thiazides and loop diuretics revealed no significant effect., Conclusions: Short-term thiazide or loop diuretic use was associated with an increased risk of vertebral fracture after stroke. Further prospective clinical trials are required to confirm this finding.

Objectives: To investigate the association between benzodiazepine (BZD) use and the risk of chronic-onset poststroke pneumonia., Design: Population-based propensity-matched retrospective cohort study., Setting: Taiwan's National Health Insurance Research Database., Participants: Patients newly diagnosed with stroke between 2000 and 2012 were identified and, after propensity score matching, 7516 patients were enrolled. Among these, 3758 patients received BZDs after stroke while 3758 did not., Outcome Measures: HRs for developing pneumonia over 1 month after stroke according to BZD use were assessed using Cox proportional hazards regression models. Analyses according to cumulative defined daily doses (cDDDs) of BZDs and stratification for age and sex were also performed., Results: During a mean follow-up time of 4.4 years, 1027 patients in the BZD cohort and 478 patients in the non-BZD cohort developed pneumonia over 1 month after stroke. Patients using BZDs after stroke had a higher pneumonia risk than did those not using BZDs (52.2vs32.6 per 1000 person-years, adjusted HR (aHR)=2.21, 95% CI (CI)=1.97 to 2.48, p<0.001). Analyses based on cumulative BZD dose revealed that all BZD user subgroups were associated with a higher risk of pneumonia. The aHRs for patients taking 1-90, 91-365 and >365 cDDDs of BZDs were 2.28 (95% CI=2.01 to 2.58; p<0.001), 2.09 (95% CI=1.77 to 2.47; p<0.001) and 2.08 (95% CI=1.72 to 2.52; p<0.001), respectively. The significant association between BZD use and increased pneumonia risk persisted even after stratifying subgroups by age and sex., Conclusions: BZD use is associated with an increased risk of chronic-onset poststroke pneumonia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Increasing evidence suggests that chronic, low-grade inflammation may be a common soil involving the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease. We examined the association between C-reactive protein (CRP) concentration, an extensively studied biomarker of low-grade inflammation, and the MetS in a representative sample of Chinese adults in Taiwan. We performed a cross-sectional analysis of data from 4234 subjects [mean (±SD) age, 47.1 (±18.2) years; 46.4 % males] who participated in a population-based survey on prevalences of hypertension, hyperglycemia, and hyperlipidemia in Taiwan. CRP levels were measured by the immunoturbidimetric CRP-latex high-sensitivity assay. The MetS was defined by an unified criteria set by several major organizations. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated with logistic regression model. Overall, there were 938 subjects with MetS among 4,234 participants, resulting in a prevalence rate of 22.1 %. A significantly progressive increase in the prevalence of MetS across quartiles of CRP was observed (p for trend <0.001). Participants in the second, third, and upper quartiles of CRP had significantly higher risk of having MetS when compared with those in the lowest quartile [adjusted ORs (95 % CIs) were 2.18 (1.62-2.94), 4.39 (3.31-5.81), and 7.11 (5.39-9.38), respectively; p for trend <0.001]. Furthermore, there was a strong stepwise increase in CRP levels as the number of components of the MetS increased. The prevalence of MetS showed a graded increase according to CRP concentrations. The possible utility of CRP concentration as a marker for MetS risk awaits further evaluation in prospective studies.

Background: Scabies is a global problem. Transmission of scabies is usually due to direct or indirect contact. Delay in diagnosis may result in the spread of the scabies mite. Prompt diagnosis and treatment are important., Methods: In this study, we collected data from 52 scabies patients and analyzed the risk factors for scabies with the case-control method., Results: Our study has revealed that the patients who were bedridden [odds ratio (OR) 6.72, p < 0.0001], living in a nursing home (OR 9.89, p < 0.0001), had a higher clinical severity status before admission (OR 1.25, p < 0.0001), and a catheter inserted (including nasogastric tube, Foley catheter, Port-A, or Hickman catheter) (OR 9.05, p < 0.0001) were significantly more likely to acquire scabies infection., Conclusion: To prevent scabies, proper management of the nursing home setting, including adequate cleaning of the contaminated clothing, bedding and equipment, in combination with treating all suspected scabies patients, and contact isolation are important and necessary., (Copyright © 2012. Published by Elsevier B.V.)