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BACKGROUND: To apply non-invasive Automatic Tongue Diagnosis System (ATDS) in analyzing tongue features in patients with chronic kidney disease (CKD). METHODS: This was a cross-sectional, case-controlled observational study. Patients with CKD who met the inclusion and exclusion criteria were enrolled and divided into the following groups according to renal function and dialysis status: non-dialysis CKD group; end-stage renal disease (ESRD) group; and control group. Tongue images were captured and eight tongue features—shape, color, fur thickness, saliva, fissure, ecchymosis, teeth marks, and red dots—were imaged and analyzed by ATDS. RESULTS: 117 participants (57 men, 60 women) were enrolled in the study, which included 16 in control group, 38 in non-dialysis CKD group, and 63 in ESRD group. We demonstrated significant differences in the fur thickness (p = 0.045), color (p = 0.005), amounts of ecchymosis (p = 0.010), teeth marks (p = 0.016), and red dot (p

Objective: While radix Salvia miltiorrhiza (Danshen; RSM) is commonly used in Chinese herbal medicine, its current usage has not yet been analyzed in a large-scale survey. This study aimed to investigate the conditions for which RSM is prescribed and the utilization of RSM in Taiwan. Methods: 1 million beneficiaries enrolled in the Taiwan National Health Insurance Research Database were sampled to identify patients who were prescribed RSM. Next, the diagnoses of these patients based on the International Classification of Diseases 9th Revision Clinical Modification code were analyzed. Logistic regression analysis was employed to estimate the odds ratio (OR) for RSM utilization. Results: Patients with disorders of menstruation and abnormal bleeding from the female genital tract due to other causes were the diagnostic group most commonly treated with RSM (9.48%), followed by those with general (9.46%) and cardiovascular symptoms (4.18%). Subjects treated with RSM were mostly aged 35–49 years (30.1%). The most common combination of diseases for which RSM was prescribed (0.17%) included menopausal disorders and general symptoms. Women were more likely to receive RSM than men (OR = 1.75, 95% confidence interval = 1.73–1.78). RSM was frequently combined with Yan-Hu-Suo and Jia-Wei-Xiao-Yao-San for clinical use. Conclusion: To date, this is the first study to identify the most common conditions for which RSM is used in modern Taiwan. The results indicate RSM as a key medicinal herb for the treatment of gynecological diseases, including menstrual disorders, female genital pain, menopausal disorders, etc. The most common combination for which RSM is prescribed is menopausal disorders and general symptoms. Further research is needed to elucidate the optimal dosage, efficacy, and safety of RSM.

Drug lag, also known as drug innovation lag, can be categorized into marketing lag and reimbursement lag. This study investigates the trend and factors influencing drug innovation lag in Taiwan, and makes a comparison with major countries like USA, Canada, Japan, and Europe on marketing lag. The reimbursement lag in the National Health Insurance (NHI) of Taiwan is also explored. This is a retrospective study covering a total of 347 new drugs that were reimbursed by the Bureau of National Health Insurance (BNHI) from 1996 to 2002. Data collection includes time of regulatory approval, type of innovation, country of origin, and time and price of reimbursement by BNHI. The time of new drug approvals in study countries was obtained from relevant websites for comparison. The drug lag index between Taiwan and study countries was also analyzed. Data were analyzed by SPSS software for frequency distribution and multiple regressions. We found that new drugs are predominantly imported, and predominantly imported, and the average marketing lag was up to 30.5 months in Taiwan. Most of the new drugs were of me-too nature; only very few could be classified as breakthrough new drugs. In terms of marketing lag, USA was the shortest (5.6 months), followed by European countries (8.2 months), Canada (18.0 months), and Taiwan (30.5 months). The reimbursement lag was 11.7 months on average after product license granted by DOH, yet it was not affected by the NHI reimbursement price. The drug lag index from smallest to largest was: the USA (0.14), Europe (0.21), Canada (0.45), and Taiwan (0.76). Drug marketing lag is a serious issue in Taiwan. The average marketing lag of 30.5 months could be attributed to the fact that nearly all new drugs were of foreign origins. The average time after DOH's regulatory approval to NHI reimbursement was as long as 11.7 months. The government should reexamine the current function of the regulatory and reimbursement systems. More specifically, the health authorities should focus on faster regulatory process for breakthrough medicines instead of approving only ”me-too new drugs”.

Background: The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE). Methods: Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test. Results: Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed. Conclusion: Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.

The purpose of this article is that discuss the reasons of European debt crisis. Every European country adopts austerity policy, which cannot solve government debt problems and further lead to economic exacerbation and continuous recession, based on the neoclassical economic theory. In order to realize the root of European debt crisis, this article adopts the reaseach method of fiscal sociology. In this study, we think that the government debt problem is the result of economic profits conflict based on the Fiscal Sociology. The economic profits conflict of investment, consumption, international business and labor market will have influence on the government’s revenue and expenditure. Furthermore, the root of the European debt crisis is the uneven income distribution by financialization and neoliberalism.

In this work, we explore the interplay between manganese oxide (MnOx) nanomaterials and a glassy carbon (GC) support in catalyzing the oxygen reduction reaction (ORR) in an alkaline environment. Initially, we characterize the ORR activity of bare GC electrodes as a function of heat treatments in air, and find that ORR activity increases with increasing temperature up to 500 °C. Modification of GC with size-selected 1 nm MnOx nanoparticles prior to the 500 °C heat treatment yields a highly porous GC (pGC) structure, devoid of MnOx. This pGC sample exhibits the highest ORR performance of the bare carbon electrodes reaching an onset potential of 0.75 V vs the reversible hydrogen electrode (RHE) and a complete 2-electron reduction of oxygen to peroxide. Having established ORR activity of bare GC electrodes, we deposit size-selected 14 nm MnO nanoparticles onto the GC and pGC electrodes and then incite phase changes in MnO through heat treatments in air. Electrochemical characterization of the resulting electr...

LANGUAGE NOTE | Document text in English; abstract also in Chinese. The present randomized and double-blinded study investigated whether β-hydroxy-β-methylbutyrate (HMB) supplementation on low intensity training subjects had an effect on body composition and blood biochemistry. Fourteen recreational untrained college students participated in an eight-week low intensity resistant training. They were divided into two groups either an HMB group or a placebo group at the 5th week. Prior to beginning of the study a 1 RM max was performed at 1st week and again at the 4th week. 80% of 1 RM max was used as the training weight. The HMB group received 3g of HMB supplements per day from the 5th week to the 8th week. The body composition, blood biochemistry, and strength at 0 week and 8th week were measured. There were no significant differences (P

A layer-by-layer method is used to coat titania on spherical polystyrene (PS) powders in an aqueous solution. To increase surface charge density, a negatively charged PS powder is sequentially adsorbed by a cationic polyethylenimine (PEI)/ anionic ammonium salt of poly(acrylic acid)/cationic PEI polyelectrolytes. A precursor of a negatively charged titanium bis-ammonium lactate dihydroxide (TALH) is then precipitated onto the above positively charged PS. Repeating the coating processes of TALH/PEI in an aqueous solution, a uniform, multilayer TALH/PEI coating on PS powder is formed. A crystalline, spherical, hollow titania powder is then obtained by hydrothermal treatment of the above powder in an aqueous solution at temperatures higher than 350°C.

The colloidal stability of titania powder in electronic ink, which contains an organic solvent of octane and a dispersant of phosphate ester, has been investigated. The concentration of phosphate ester required to stabilize the nonaqueous titania suspension agrees with that needed for monolayer adsorption. Theoretical calculations of potential energies show that the colloidal stability of organic titania suspension is caused by the steric repulsion mechanism. The results of optical properties including reflectivity and response time show that the resulting nonpolar titania suspension meets the requirements of an electronic ink for electrophoretic display.

Magnesium and Mg-based material systems are attractive candidates for hydrogen storage but limited by unsuitable thermodynamic and kinetic properties. In particular, the kinetics are too slow at room temperature and atmospheric pressure. To study the hydride formation kinetics in a controlled way, we have designed a unique 'nanoportal' structure of Pd nanoparticles deposited on epitaxial Mg thin films, through which the hydride will nucleate only under Pd nanoparticles. We propose a growth mechanism for the hydrogenation reaction in the nanoportal structure, which is supported by scanning electron microscopy (SEM) images of hydrogenated samples exhibiting consistent results. Interestingly, the grain boundaries of Mg films play an important role in hydride nucleation and growth processes. Kinetic modeling based on the Johnson-Mehl-Avrami-Kolmogorov (JMAK) formalism seems to agree with the two-dimensional nucleation and growth mechanism hypothesized and the overall reaction rate is limited by hydrogen flux through the interface between the Pd nanoparticle and the underlying Mg film. The fact that in our structure Mg can be transformed completely into MgH2 with only a small percentage of Pd nanoparticles offers possibilities for future on-board storage applications.

There are many factors that influence technology integration in the classroom such as teacher willingness, availability of hardware, and professional development of staff. Taking into account these elements, this paper describes research on technology integration with a focus on principals’ attitudes. The role of the principal in classroom practice was found to be substantial. The purpose of this research was to assess the current attitudes concerning technology integration in schools from the school principal’s perspective. This research investigated the value principals place on using technology in student learning, what principals believe prevents teachers from succeeding in technology integration, what can best facilitate teacher development, and if principals perceive peer coaching or mentoring to be a viable option. The research herein consisted of a survey and an interview to help assess principals’ attitudes regarding the importance of technology integration, the perceived challenges and whether or not teacher coaches are a viable option for the future. This examination concluded that most principals in this research study value technology in education, perceive teacher willingness and professional development to be the strongest obstacles, and think teacher coaches would be a viable option for success. This study sheds light on a couple of paths for future research.

The purpose of this study was to determine how to integrate technology into mathematics classes using clickers in the high school setting. The ability to integrate technology into instruction is a current requirement for mathematics teachers in the United States; however, students have been traditionally taught to solve equations using pencils and paper. In addition to leveraging an understanding of the impact that using interactive Student Response System (SRS) have in helping students learn mathematics, this study also aimed to examine its effect on Special Education and English Language Learner (ELL) student learning outcome. 47 high school students who were enrolled in Geometry class were selected to participate in this study. Pre-tests and post-tests were conducted with both the trial and contrast groups of the study. The trial group contained all of the students in one period of Geometry class in which clickers were integrated into the classroom instruction. The contrast group contained all of the students in the same subject as the trial group but did not use clickers. The key elements of the study included having the technology available to the trial group throughout the entire learning process, having consistent participant groups, and having equal access to the materials presented to both groups. Based on the summative and informal assessment test scores, completion rates of class work and the teacher’s observations, the research team concluded that for the students in the trial group, the use of clickers did improve the student learning outcome and class participation in mathematics compared to the contrast group. The test scores of Special Education and ELL students in both groups were also assessed for the clickers’ impact on these students’ learning. The results showed that the use of clickers had a positive impact as these students gained better test scores. These results align with the current research regarding technology integration in mathematics. Factors affecting the effective integration of technology such as teachers’ use of clickers, types of questions teachers should ask and depth of technology integration will be discussed.

cited By 4; International audience; One frequently encountered obstacle during both ambient fabrication and the use of metal nanoclusters is spontaneous oxidation, which hampers many technological applications. In this work, we studied the influence of packaging material on the surface oxidation and magnetic properties of Co nanocrystals. We demonstrate that 'epoxy-electronic-varnish' capping (60-80 nm) effectively preserves the magnetic properties of pristine Co nanocrystals (∼14 nm); without showing any exchange bias coupling over a period of >720 h, slower temperature variation of coercivity reminiscent of a Co single crystal and intercluster interaction dominated high blocking temperatures >300 K. Packaging by a silver (Ag) capping layer of similar thickness facilitates pronounced exchange bias compared to the even air exposed Co nanocrystals. Numerical fits M(H) = M(∞)[1 - (H*/H)1/2] to the high field part (10-50 kOe) of M-H loops yield a sharp rise in H* values at cryogenic temperatures (5-25 K) only in Ag capped Co nanocrystals, indicating a large induced anisotropy due to altered Co/Ag interfacial spin structures.

The purpose of this research study was to explore with what impact evening media use interfered with either schoolwork and/or sufficient healthy sleep. In addition, the study examined with what impact there may be a compromise in students’ ability or aptitude for positive academic success, related to either lack of sleep or electronic media use. The participants were 89 high school and college students, ages 16 through 25, with median age of 18. Research was conducted using a secured online survey tool. Electronic habits, internet and social networking usage, sleep and rise times, daily sleepiness and perceptions were examined. College students were randomly sampled and participated in an in-depth, one-time survey. High school students participated in a weeklong nightly electronic sleep & evening media use survey and journal. Data was obtained from anonymous and coded student responses and student and teacher surveys. The results of the study suggested that healthful adolescent sleep is indeed greatly compromised, during a time when the reverse is vitally important. Of students randomly sampled, all but one student owned a cell phone. In the total study group, a majority were smart phone owner-users (84%). Many high school participants slept with a cell phone or tablet in their bed (72%), and among college participants who regularly slept with cell phone, tablet, or laptop, this rose to 86%. Over half of these students continued to access and use their devices in bed for significant amounts of time prior to sleeping. Many of these even awakened after falling asleep to access or respond to electronic messaging. The research indicated that unhealthy sleep habits may be creating a generation of sleep-deprived individuals who may not be functioning at top capacity. Findings regarding a correlation between lack of sleep and quantified academic success are inconclusive, however, student perceptions indicate that they believe there is a relationship. Findings also suggest that all instructors of late adolescent students aged 16-25 may count on the fact of their student clientele owning and using mobile devices to access internet for social purposes. Students allow their social digital world to impede and compete with their academic time and biological sleep cycle. Instructors would be wise to appropriately channel the digital skills of this new generation of no longer-wired, but now “wi-fied” students. Therefore it is strongly suggested that teachers, parents, and medical personnel adopt and provide healthy guidelines for parents to use with pre-teens and teens, to facilitate and develop in the next generation of students some structure and means of protecting their health in the realms of electronics and sleep.

Recently, a large increase in the equilibrium hydrogen pressure has been reported for MG thin films capped with a Pd layer. We show that this increase is due to intermixing of Mg and Pd, as opposed to a strain effect as previously claimed. Transmission electron microscopy and depth profiling x-ray photoemission spectroscopy are used to directly measure interfacial intermixing between Mg and Pd, and we find that intermixing and equilibrium hydrogen pressure both increase with annealing. We present a thermodynamic model of the effect of alloying on equilibrium pressure, and find that the observed equilibrium pressure increase is consistent with the observed thickness of the intermixed region, which is of the order of a few nm. We also show that stress measured during hydrogenation corresponds to a negligible increase in equilibrium pressure.

This study investigated the effects of BCAA, arginine and carbohydrate combined beverage (BCAA Drink) on biochemical responses and psychological conditions during recovery after a single bout of exhaustive exercise. Fourteen healthy males were assigned to drink either BCAA Drink (BA trial) or placebo (PL trial) on two sessions separated by 2 weeks. Blood samples of each subject were collected before exercise, 0, 10, 20, 40, 60, 120 min and 24 h after exercise. No significant differences in the levels of lactate, ammonia, creatine kinase and glycerol between the two groups were observed at any of the time points. However, the levels of glucose and insulin were significantly higher in the BA trial as compared to those in the PL trial at the 40 and 60 min recovery points. Furthermore, the testosterone-to-cortisol ratio at the 120 min recovery point was significantly higher in the BA trial as compared to that in the PL trial. The results indicate the occurrence of anabolic response during the recovery period. The benefit of BCAA Drink was also performed by Profile of Mood States to assess the psychological condition. Fatigue score increased immediately at exhaustion in both groups, but the decrease in the fatigue score at 120 min recovery point was significant only in BA trial. These data indicate that a single bout of exhaustive exercise enhanced the feeling of fatigue. The detrimental consequence was reduced by an ingestion of BCAA Drink.

The flipped classroom is an instructional method that can provide additional face-to-face interaction time with students in the classroom by minimizing the amount of direct instruction used in a traditional classroom setting. In this study, students in a high school Algebra 2 class who experienced a flipped classroom environment were surveyed to examine their attitudes, perceptions, and engagement of the flipped classroom and the elements that contribute to learning mathematics. The survey also addressed how the flipped classroom could be a motivating factor in learning mathematics. The survey used both quantitative and qualitative research measures to provide a broader understanding of how students perceive the attributes of flipping the classroom. In addition, student interviews helped gain insight into participants’ feelings, attitudes, motivation, and engagement about mathematics due to the flipped classroom. Researcher observations and notes provided information as to student engagement within the classroom as a byproduct of using the inverted classroom instructional strategy. The results revealed that the perceptions and attitudes of the participants were generally positive in the flipped classroom environment. The students were motivated to use the web-based instructional videos to prepare for their expected learning outcomes.

As the gate size continues to decrease in nanoscale transistors, having metal gates with amorphous or near amorphous structures can potentially reduce grain-induced work function variation. Furthermore, amorphous materials are known to have superior diffusion barrier properties, which can help prevent work function change due to the diffusion of metals in contact with the gate. In this work we show that with the addition of cobalt, thin films of polycrystalline TiN become more amorphous with a smaller grain size. Cox(TiN)1-x films, where x = 60–80%, appear to consist of nanocrystals embedded in an amorphous matrix, and are thermally stable with no significant crystallization up to an annealing temperature of at least 600 °C. Reducing the nitrogen gas flow ratio during sputter deposition from 9% to 2.5% further decreases the films' crystallinity, which is apparent by more sparse and even smaller nanocrystals. In addition to being partially amorphous, these CoTiN films also exhibit good thermal stability, l...

The hydrogenation and dehydrogenation of a thin film of Mg with a Pd cap layer was measured using neutron reflectometry. Upon hydrogenation, (at 373 K and 0.2 MPa H2), the Mg film swelled in the surface normal direction by an amount roughly equal to the difference in volume between MgH2 and Mg. After dehydrogenation (at 343–423 K), the Mg film returned to a composition of Mg but retained the swelled thickness by incorporating voids. The presence of the voids is confirmed by SEM micrographs. The voids may explain some of the changes in absorption kinetics after full cycling of Mg films.