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Preclinical and clinical studies have suggested a neuroprotective effect of remote ischemic conditioning (RIC), which involves repeated occlusion/release cycles on bilateral upper limb arteries; however, robust evidence in patients with ischemic stroke is lacking.To assess the efficacy of RIC for acute moderate ischemic stroke.This multicenter, open-label, blinded-end point, randomized clinical trial including 1893 patients with acute moderate ischemic stroke was conducted at 55 hospitals in China from December 26, 2018, through January 19, 2021, and the date of final follow-up was April 19, 2021.Eligible patients were randomly assigned within 48 hours after symptom onset to receive treatment with RIC (using a pneumatic electronic device and consisting of 5 cycles of cuff inflation for 5 minutes and deflation for 5 minutes to the bilateral upper limbs to 200 mm Hg) for 10 to 14 days as an adjunct to guideline-based treatment (n = 922) or guideline-based treatment alone (n = 971).The primary end point was excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. All end points had blinded assessment and were analyzed on a full analysis set.Among 1893 eligible patients with acute moderate ischemic stroke who were randomized (mean [SD] age, 65 [10.3] years; 606 women [34.1%]), 1776 (93.8%) completed the trial. The number with excellent functional outcome at 90 days was 582 (67.4%) in the RIC group and 566 (62.0%) in the control group (risk difference, 5.4% [95% CI, 1.0%-9.9%]; odds ratio, 1.27 [95% CI, 1.05-1.54]; P = .02). The proportion of patients with any adverse events was 6.8% (59/863) in the RIC group and 5.6% (51/913) in the control group.Among adults with acute moderate ischemic stroke, treatment with remote ischemic conditioning compared with usual care significantly increased the likelihood of excellent neurologic function at 90 days. However, these findings require replication in another trial before concluding efficacy for this intervention.ClinicalTrials.gov Identifier: NCT03740971.

Recently, the evolution of Generative Adversarial Networks (GANs) has embarked on a journey of revolutionizing the field of artificial and computational intelligence. To improve the generating ability of GANs, various loss functions are introduced to measure the degree of similarity between the samples generated by the generator and the real data samples, and the effectiveness of the loss functions in improving the generating ability of GANs. In this paper, we present a detailed survey for the loss functions used in GANs, and provide a critical analysis on the pros and cons of these loss functions. First, the basic theory of GANs along with the training mechanism are introduced. Then, the most commonly used loss functions in GANs are introduced and analyzed. Third, the experimental analyses and comparison of these loss functions are presented in different GAN architectures. Finally, several suggestions on choosing suitable loss functions for image synthesis tasks are given.

Key message MADS-box genes family may play important roles in the flower sex determination in Excoecaria agallocha. A total of 73 MADS-box genes were identified in E. agallocha. De novo transcriptome assembly analysis suggested that AP1/FUL, AP3/PI, AGL104, and SOC1 plays potential roles in E. agallocha flower sex determination. Context Excoecaria agallocha is a dioecious species containing both male and female individuals producing unisexual flowers. The underlying mechanisms regulating inflorescence differentiation in these species remains poorly understood. Aims Flower development influences reproduction and breeding in E.agallocha, which contributes to ecological restoration in the intertidal zone. Methods We performed de novo transcriptome assembly analysis on male and female flowers and leaves from E. agallocha. Results We identified a total of 73 MADS-box genes in the E. agallocha genome, which we grouped into five distinct classes (MIKCc, Mα, Mβ, Mγ, MIKC*) after phylogenetic comparisons with J. curcas homologs. We analyzed expression profiles and suggested AP1/FUL, AP3/PI, AGL104, and SOC1 as candidate regulators of sex determination. In addition, several EaMADS genes were significantly upregulated in flowers compared to leaves. Conclusion Our study represents the first detailed, comprehensive evaluation of the regulation of MADS-box genes associated with sex determination in E. agallocha. The assembled transcriptomic profiles increase the genetic information available for this species and constitute an important contribution to functional studies of inflorescence genes. In turn, this will help exploring the molecular mechanisms underlying the evolution of E. agallocha.

自1966年《Coleman報告書》發表後，如何透過學校教育以弭平學生遭逢的經濟、文化乃至於學習條件不利，乃成為關注焦點。然而，聚焦於學校效能的同時，卻常忽略了學校所處脈絡所帶來的限制，學校如何根據自身處境發展其行動邏輯，至為關鍵。過去教育機會均等研究多關注偏遠學校或都會學校，本研究聚焦於常受忽略的都會邊陲學校，探討其學校處境、行動邏輯及教育機會均等挑戰。本研究從中央邊陲的理論觀點來檢視位處都會邊陲的三所個案高中學校，面對高中就學區的重疊劃分，當地優秀學生常被居優勢的都會學校吸收，致使都會邊陲高中有著高比例的弱勢學生，不但無法脫離都會主流價值的箝制，且相當程度地符應了依附的角色。本研究說明此類都會邊陲學校的經營困境與挑戰，以及因應學校條件與環境限制所產生的「學校行動邏輯」，並探討其對實踐教育機會均等的影響。根據訪談結果分析發現：都會邊陲高中雖然弱勢學生集中，卻因鄰近都會區而被忽略其困境，學校辦學挑戰大，因應此限制，學校必須追求學術拔尖以維持名聲，穩 定生源；經營辦學受都會（中央）辦學價值框限與自身條件限制，陷入進退兩難之境，在教育機會均等的促進上只能採取較為保守的策略。 Since the “Coleman Report” was released in 1966, great attention has been placed on how schools can alleviate the economic and cultural factors leading to unfavorable learning conditions for students. However, an emphasis on school effectiveness often neglects the restrictions imposed by school contexts. School contexts matter greatly, since schools react to contextual constraints in developing their own logics of action based on an analysis of opportunities and constraints. While past studies on equality of educational opportunity emphasized either remote or urban schools, this article focuses on oft-neglected urban peripheral schools, exploring their challenges in terms of school context, logics of action, and equality of educational opportunity. This study adopts center-periphery theory as a theoretical framework to investigate three high schools located in urban peripheral areas. Due to the overlap of school districts in urban peripheral areas, students with outstanding academic performance are often attracted to urban schools, resulting in a higher proportion of disadvantaged students in urban peripheral schools. Furthermore, such schools are unable to depart from mainstream urban values, despite their contextual constraints. The findings of this study describe the operational difficulties and challenges for urban peripheral schools in adapting their own logics of action to contextual and environmental constraints, and discuss the practical implications for equality of educational opportunity. Based on an analysis of interview data, the major findings of this study are as discussed as follows. Despite the high concentrations of disadvantaged students in urban peripheral high schools, their difficulties are often neglected, due to close proximity to urban schools. Urban peripheral high schools face great challenges and, in response, prioritize academic excellence in order to maintain their reputation and secure student enrollment. Constrained by the core values of the center (urban) areas and the schools’ own contextual constraints, urban peripheral schools can only adopt more conservative strategies in order to improve equality of educational opportunity.

To test the effect of Banxia Xiexin Decoction (半夏泻心汤, BXD) on the contraction and relaxation of gastric smooth muscle (SM) in diabetic gastroparesis (DGP) model rats, and to explore the mechanism of BXD in the prevention and treatment of DGP through experiments of signal pathway both in vivo and in vitro. Sixty Sprague-Dawley rats were divided into 6 groups according to a random number table: control group, model group, high-, medium- and low-dose BXD groups (9.2, 4.6 and 1.8 g/(kg·d), respectively), and domperidone group (10 mg/(kg·d)), 10 rats per group. DGP model was established initially by a single intraperitoneal injection of streptozotocin (STZ), and was confirmed by recording gastric emptying, intestinal transport velocity and gastric myoelectric activity of rats after 2 months. Each group was treated with a corresponding drug for 4 weeks. The mRNA and protein expressions of phospholipase C (PLC), inositol triphosphate (IP3), neuronal nitric oxide synthase (nNOS), and cyclic guanosine monophosphate (cGMP) dependent protein kinase G (PKG) were detected by reverse transcription-polymerase chain reaction and Western blot, respectively, while nitric oxide (NO) and cGMP expressions were detected by enzyme-linked immunosorbent assay. Gastric tissues were obtained from rats for primary cell culture preparation. Gastric SM cells were treated with 0.8 µmol/L of STZ or STZ plus 1,000, 500 and 200 µg/mL of BXD or STZ plus 2.5 µmol/mL of domperidone for 24, 48, 72 or 96 h, respectively. The length of gastric SM cells and intracellular Ca2+ concentration ([Ca2+]i) before and after BXD treatment was measured. Compared with the model group, high- and medium-dose BXD and domperidone significantly increased the expressions of PLC, IP3, NO, nNOS, cGMP and PKG in rat’s gastric tissue (P

The pathogenesis of inflammatory bowel disease (IBD) remains unclear, and it is currently believed that an imbalance in regulatory T (Treg) cells/T helper 17 cells (Th17 cells) is related to the occurrence and development of IBD. Recently, the JAK2 inhibitor AG490 has been used in animal models such as rheumatoid arthritis and bronchial asthma models and shown to exert immunoregulatory functions that improve disorder in the Treg/Th17 cell balance. This study aimed to evaluate the effect of AG490 on the intestinal inflammatory process in an IBD rat model. A dextran sulfate sodium (DSS)-induced IBD rat model was established, and disease activity index (DAI) scores were calculated. The histopathological damage score was determined by haematoxylin-eosin (H&E) staining. Treg/Th17 cells in the spleen were detected by flow cytometry. The levels of interleukin (IL)-10, IL-6 and IL-17A were detected by enzyme-linked immunosorbent assay (ELISA). AG490 attenuated DSS-induced IBD injury by regulating the Treg/Th17 balance and related cytokine secretion to reduce the DAI and colonic tissue damage. Thus, AG490 may be a new method for effective treatment of IBD.

The aim of this study was to investigate the harmful effects of acute hypoxia on mouse cerebral cortex and hippocampus and the underlying mechanism. Mouse model of acute hypoxia was constructed by using a sealed glass jar. Laser speckle contrast imaging was used to detect the changes of cerebral blood flow after different time duration of hypoxia. Total superoxide dismutase (T-SOD) and malondialdehyde (MDA) assay kits were used to detect oxidative stress in cerebral cortex and hippocampus. Immunofluorescent staining was used to detect neuroinflammatory response of microglia in the cerebral cortex and hippocampus. One-step TUNEL method was used to detect neuronal apoptosis. The results showed that, compared with non-hypoxia (0 min hypoxia) group, 30 min hypoxia group exhibited decreased cerebral blood flow, higher percentage of CD68

Secreted protein acidic and rich in cysteine-like 1 (SPARCL1) regulates synaptic stability with upregulation throughout axonal regeneration. Our study aims to determine the correlation of serum SPARCL1 concentrations with the severity and in-hospital mortality of severe traumatic brain injury (sTBI).A total of 102 consecutively recruited patients admitted for sTBI and 102 randomly selected healthy controls were included in this observational prospective study. Serum SPARCL1 concentrations were measured and correlated with Glasgow coma scale (GCS) scores and in-hospital mortality using multivariate analysis.Compared with controls (median, 0.22 ng/ml; interquartile range, 0.19-0.41 ng/ml), patients had significantly higher SPARCL1 concentrations (median, 3.29 ng/ml; interquartile range, 1.88-4.37; P 0.001). There was an independently correlation between SPARCL1 concentrations and GCS scores (t = -7.011, P 0.001). We found a high area under receiver operating curve (AUC) of serum SPARCL1 concentrations to predict in-hospital mortality (AUC, 0.822; 95% confidence interval, 0.734-0.891). In the multiple logistic regression analysis, serum SPARCL1 concentrations3.29 ng/ml was independently associated with in-hospital mortality (odds ratio = 10.052, 95% confidence interval = 1.918-52.686, P = 0.006).The novel findings of our study are that sTBI patients had an increase of serum SPARCL1 concentrations, and that there is an association between high serum SPARCL1 concentrations and sTBI mortality or trauma severity.

BackgroundChronic cough is a common complaint which affects a large number of patients worldwide. Increased cough sensitivity is a very important cause of chronic persistent cough. However, there are limited clinical diagnosis and treatment for increased cough sensitivity. Transient receptor potential vanilloid-1 (TRPVl) is a member of the transient receptor potential (TRP) family of channels which is very closely associated with respiratory diseases. However, the mechanism through which TRPV1 that influences downstream events is still poorly understood.ResultsCapsaicin induced increase in cough sensitivity by upregulating the protein level of TRPV1, leading to the secretions of Substance P and neurokinin A which stimulated neurogenic inflammation. However, sinomenine, a component of traditional Chinese medicine, significantly attenuated the capsaicin-induced cough by inhibiting the expression of TRPV1 in guinea pigs. In addition, capsaicin increased the expression of SOX5 which mediated the transcriptional upregulation of TRPV1. However, pretreatment with sinomenine reduced the expression of SOX5.ConclusionThese results indicate that capsaicin induced increase in cough sensitivity by activating neurogenic inflammation, while sinomenine attenuated the increase in cough sensitivity by inhibiting the expressions of SOX5 and TRPV1 in guinea pigs. This finding may provide a novel target for the treatment of aggravated cough sensitivity.

Mucopolysaccharidosis (MPS) is a lysosomal storage disease caused by genetic defects that result in deficiency of one specific enzyme activity, consequently impairing the stepwise degradation of glycosaminoglycans (GAGs). Except for MPS II, the other types of MPS have autosomal recessive inheritance in which two copies of an abnormal allele must be present in order for the disease to develop. In this study, we present the status of variant alleles and biochemistry results found in infants suspected of having MPS I, II, IVA, and VI. A total of 324 suspected infants, including 12 for MPS I, 223 for MPS II, 72 for MPS IVA, and 17 for MPS VI, who were referred for MPS confirmation from newborn screening centers in Taiwan, were enrolled. In all of these infants, one specific enzyme activity in dried blood spot filter paper was lower than the cut-off value in the first blood sample, as well asin a second follow-up sample. The confirmatory methods used in this study included Sanger sequencing, next-generation sequencing, leukocyte enzyme fluorometric assay, and GAG-derived disaccharides in urine using tandem mass spectrometry assays. The results showed that five, nine, and six infants had MPS I, II, and IVA, respectively, and all of them were asymptomatic. Thus, a laboratory diagnosis is extremely important to confirm the diagnosis of MPS. The other infants with identified nucleotide variations and reductions in leukocyte enzyme activities were categorized as being highly suspected cases requiring long-term and intensive follow-up examinations. In summary, the final confirmation of MPS depends on the most powerful biomarkers found in urine, i.e., the quantification of GAG-derived disaccharides including dermatan sulfate, heparan sulfate, and keratan sulfate, and analysis of genetic variants can help predict outcomes and guide treatment.

In this study we firstly reported the complete chloroplast genome of Torenia concolor, a species of Linderniaceae. The complete chloroplast genome of T. concolor is 153,853 bp in length with a typical quadripartite structure, consisting of a large single-copy region (LSC, 85,446 bp), a single-copy region (SSC, 18,837 bp), and a pair of inverted repeats (IRs, 24,785 bp). There are 114 genes annotated, including 80 unique protein-coding genes, 4 unique ribosomal RNA genes, and 30 transfer RNA genes. To investigate the evolution status of T. concolor, as well as Linderniaceae, we constructed a phylogenetic tree with T. concolor and other 16 species based on their complete chloroplast genomes. According to the phylogenetic topologies, T. concolor was closely related to Pedicularis hallaisanensis.

Torenia benthamiana Hance is an endemic plant species distributed in southern China. In this study, we report and characterize the complete plastid genome sequence of T. benthamiana in order to provide genomic resources helpful for promoting its conservation and garden utilization. The complete plastome is 153,526 bp in length and contains the typical quadripartite structure of angiosperm plastome, including two inverted repeat (IR) regions of 24,638 bp, a large single-copy (LSC) region of 85,417 bp, and a small single-copy (SSC) region of 18,833 bp. The plastome contains 114 genes, consisting of 80 unique protein-coding genes, 30 unique tRNA gene, and 4 unique rRNA genes. The overall A/T content in the plastome of T. benthamiana is 62.40%. The complete plastome sequence of T. benthamiana will provide a useful resource for the conservation and garden utilization of this species as well as for the phylogenetic studies of Linderniaceae.

A novel moderately halophilic bacterial strain, designated YIM 93176T, was isolated from a saltern in Korea and subjected to a polyphasic taxonomic study. This isolate YIM 93176T was observed to grow in the presence of 0–22% (w/v) NaCl and at pH 6.0–10.0 and 10–45 °C; optimum growth was observed with 5–10% (w/v) NaCl and at pH 7.0–9.0 and 28–37 °C. Based on 16S rRNA gene sequences analysis, the nearest relatives were Lentibacillus alimentarius M2024T (96.5% similarity), followed by Virgibacillus carmonensis LMG 20964T (96.0%) and the other type strains of the family Bacillaceae, but phylogenetic analysis indicated that strain YIM 93176T belonged to the cluster comprising type species of the genus Lentibacillus. Genome sequencing of strain YIM 93176T revealed a genome size of 3.2 Mb and a DNA G + C content of 40.5 mol%. The major fatty acids were anteiso-C15:0 (40.7%) and iso-C15:0 (26.4%), while the predominant respiratory quinone was menaquinone 7. The polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. These genotypic and chemotaxonomic characteristics supported affiliation of strain YIM 93176T to the genus Lentibacillus. In addition, phenotypic characteristics could distinguish strain YIM 93176T from its closely related species in genus Lentibacillus. Based on the cumulative evidences from the polyphasic taxonomic study, strain YIM 93176T represents a novel species of the genus Lentibacillus, for which name Lentibacillus saliphilus sp. nov. (type strain YIM 93176T = CCTCC AB 208139T = DSM 21375T) is proposed.

Background: Mucopolysaccharidosis II (MPS II) is an X-linked disorder resulting from a deficiency in lysosomal enzyme iduronate-2-sulfatase (IDS), which causes the accumulation of glycosaminoglycans (GAGs) in the lysosomes of many tissues and organs, leading to progressive cellular dysfunction. An MPS II newborn screening program has been available in Taiwan since 2015. The aim of the current study was to collect and analyze the long-term follow-up data of the screen-positive subjects in this program. Methods: From August 2015 to April 2022, 548,624 newborns were screened for MPS II by dried blood spots using tandem mass spectrometry, of which 202 suspected infants were referred to our hospital for confirmation. The diagnosis of MPS II was confirmed by IDS enzyme activity assay in leukocytes, quantitative determination of urinary GAGs by mass spectrometry, and identification of the IDS gene variant. Results: Among the 202 referred infants, 10 (5%) with seven IDS gene variants were diagnosed with confirmed MPS II (Group 1), 151 (75%) with nine IDS gene variants were classified as having suspected MPS II or pseudodeficiency (Group 2), and 41 (20%) with five IDS gene variants were classified as not having MPS II (Group 3). Long-term follow-up every 6 months was arranged for the infants in Group 1 and Group 2. Intravenous enzyme replacement therapy (ERT) was started in four patients at 1, 0.5, 0.4, and 0.5 years of age, respectively. Three patients also received hematopoietic stem cell transplantation (HSCT) at 1.5, 0.9, and 0.6 years of age, respectively. After ERT and/or HSCT, IDS enzyme activity and the quantity of urinary GAGs significantly improved in all of these patients compared with the baseline data. Conclusions: Because of the progressive nature of MPS II, early diagnosis via a newborn screening program and timely initiation of ERT and/or HSCT before the occurrence of irreversible organ damage may lead to better clinical outcomes. The findings of the current study could serve as baseline data for the analysis of the long-term effects of ERT and HSCT in these patients.

2014年高中課綱微調爭議成為全國焦點，法律與歷史攻防鬧得沸沸揚揚，對於課程內容、課程決定的程序、課程決定的權威，都有對立與激烈的討論。本文跳脫法律與歷史爭議，由政治面出發，討論教育政治歧見的處理方式。教育內容常位於政治十字路口，如何在嚴重歧見中繼續教育下一代，實為重要議題。本文以A. Gutmann的民主教育理論為架構，在有意識社會再製的前提下，根據不壓迫與不歧視原則，分析課程綱要歧見的處理方式。由程序面、內容面、決定權威面，討論課程綱要的決定原則。而回到教育面，更重要的是培育學生進行公共思辨與公共參與的能力，以踐行民主社會。 Resolving Political Disagreement: Reflecting on High School Curriculum Guideline In 2014, High School Curriculum Guideline Adjustment has become a national controversial issue with furious legal and historical debates. The issues that have emerged include the content of curriculum, procedures for curriculum decision-making, and the authority of curriculum decision-making. Rather than focusing on the legal and historical dimensions of the debates, this paper focuses on the political dimension of curriculum decision using Amy Gutmann’s Democratic Education Theory. Under the assumption of conscious social reproduction and following the rule of nondiscrimination and non-repression, this paper discusses how political disagreement about curriculum should be handled. Cultivating the ability of public deliberation and public participation is critical for a democratic society and should be included in education.

The aim of this study was to observe the effect of AG1478, an inhibitor of the epidermal growth factor receptor, on cell proliferation, cell cycle and apoptosis of human hepatoma HepG2 cells. Cell counting kit-8 assay was employed to examine the survival rates of cultured HepG2 cells after treatments with different concentrations of AG1478 for 24 h. Flow cytometry was performed to determine the effect of AG1478 on cell cycle and apoptosis. Immunohistochemistry was used to measure the expression of c-Myc protein. The survival rates of human hepatoma HepG2 cells after treatments with 5, 10, 20 and 40 μmol/L of AG1478 for 24 h were 76.0%, 59.6%, 51.2% and 42.1%, respectively. The apoptotic rates after treatments with 5, 10, 20 and 40 μmol/L of AG1478 were (12.88 ± 1.91)%, (23.16 ± 2.67)%, (35.36 ± 1.95)% and (47.16 ± 3.78)%, respectively. HepG2 cells were mainly arrested in the G0/G1 phase after treatment with 10, 20 and 40 μmol/L of AG1478. The c-Myc protein was highly expressed in HepG2 cells, whereas treatment with 20 μmol/L AG1478 substantially inhibited its expression. Overall, AG1478 inhibited the proliferation of human hepatoma cells in vitro, arrested the cells in G0/G1 phase, induced apoptosis and reduced the expression of c-Myc protein. These results also indicated that AG1478 blocked the proliferation and induced apoptosis of hepatoma cells in a dose-dependent manner.

Many female carriers of Fabry disease are likely to develop severe morbidity and mortality. However, by our own estimation, around 80% of female newborns are missed by our current enzyme-based screening approach. Our team’s aim was to develop an improved cost-effective screening method that is able to detect Fabry disease among female newborns. In Taiwan, based on a database of 916,000 newborns, ~98% of Fabry patients carry mutations out of a pool of only 21 pathogenic mutations. An Agena iPLEX platform was designed to detect these 21 pathogenic mutations using only a single-assay panel. A total of 54,791 female infants were screened and 136 female newborns with the IVS4 + 919G > A mutation and one female newborn with the c.656T > C mutation were identified. Using the current enzyme-based newborn screening approach as baseline, around 83% of female newborns are being missed. Through a family study of the IVS4 female newborns, 30 IVS4 adult family members were found to have left ventricular hypertrophy. Ten patients received endomyocardial biopsy and all were found to have significant globotriaosylceramide (Gb3) accumulation in their cardiomyocytes. All of these individuals now receive enzyme replacement therapy. We have demonstrated that the Agena iPLEX assay is a powerful tool for detecting females with Fabry disease. Furthermore, through this screening, we also have been able to identify many disease-onset adult family members who were originally undiagnosed for Fabry disease. This screening helps them to receive treatment in time before severe and irreversible cardiac damage has occurred.

Cyclin-dependent kinase 5 (Cdk5) is a regulator of axon growth and radial neuronal migration in the developing mouse brain, and it plays critical roles in cortical structure formation and brain function. However, the function of Cdk5 in cortico-cortical and cortico-sensorimotor networks in the adult remains largely unknown. In this study, we investigated the function of Cdk5 in the rostral secondary motor cortex (M2) in the male mouse using CRISPR/Cas9 gene editing and somatic brain transgenesis, to produce M2-specific knockdown of Cdk5 in neurons in the male mouse. Mouse deficient in Cdk5 in the M2 exhibited a reduction in both the number of functional synapses and the total basal dendritic length, as well as motor dysfunction. Furthermore, whole-cell patch-clamp recordings in layer V green fluorescent protein (GFP)-tag pyramidal neurons revealed a decrease in the frequency and amplitude of miniature EPSCs and miniature IPSCs, as well as a reduction in the population synaptic responses (fEPSPs) in these mice. Specifically, retrograde labeling showed that Cdk5 knockdown in the M2 caused a reduction in long-range projections to the M2 from the thalamus/prefrontal cortex and claustrum. Collectively, our findings show a new regulatory role of Cdk5 in neural circuit maintenance, and that the changes in neural transmission and circuits in the mice with Cdk5 knockdown in the M2 likely contribute to the motor dysfunction in these animals.

Homeless individuals have many negative experiences with inequality regarding access to and the use of primary healthcare services, so policies to eliminate the disparities in and barriers to primary care access for these people are needed. The aim of this study was to explore the use and determinants of free hospital outpatient services for homeless people, in order to describe the provision of free healthcare policies for this vulnerable population in Taipei. One cross-sectional survey was conducted to recruit homeless people aged 45 years old and over in Taipei in 2018. A structured questionnaire was used, and face-to-face interviews were conducted by three social workers to collect the data. Finally, 129 participants were recruited in the study. The results show that 81.4% of the homeless people had made free hospital outpatient care visits (mean = 5.9 visits) in the last three months. An unadjusted logistic regression analysis showed that those homeless people who reported having usual healthcare providers, with higher depressive symptom scores, who used medication and had been hospitalized within one year, and had more chronic diseases, were significantly more likely to make free hospital outpatient visits. The adjusted logistic regression model indicates that homeless people with severe depressive symptoms (odds ratio (OR) = 9.32, 95% CI = 1.15–56.07), who had received medication (OR = 3.93, 95% CI = 1.06–14.52), and who had more than five chronic diseases (OR = 1.06, 95% CI = 1.35–13.27), were significantly more likely to make free hospital outpatient visits than their counterparts. The findings highlight that homeless people have higher healthcare requirements than the general population, and the healthcare system should pay more attention to factors associated with higher outpatient service use, such as homelessness, severe depressive symptoms, the receipt of medication and chronic diseases.

擴散指一項創新從一地逐漸散布到其他地區的過程，在政府部門中代表決策受到別處創新的影響。目前臺灣在政策及方案擴散的模式及影響因素的研究相當有限，其理論仍待探究。在國外研究中，在地政府的鄰近縣市影響以及內在資源，被視為是重要的影響因素。本研究的目的在透過空間分析以及事件歷史分析的模式建構，探究臺灣學習共同體擴散的過程，分析其中的資源影響因素。研究 主要發現為：一、各縣市存在不同學習共同體採用時間及方式；二、學習共同體擴散在研習次數上具有鄰近效應；三、資源影響因素包括教師負擔、財政依賴度、平均教育水準、相關研習辦理。據此，本研究對中央財政及縣市教育實務提出相關建議。 Diffusion is the process of one innovation spreading to other areas. To the governments, diffusion means policy making affected by the innovations in other places. In Taiwan, the research on the factors affecting policy and program diffusion as well as its models is under development. In previous studies, the neighborhood effect of nearby local jurisdictions and their internal resources are seen as important factors of diffusion. In this research the process and the resources affecting the diffusion of school as learning community in Taiwan are analyzed via spatial analysis and event history analysis. The result shows that (1) there exist differences in terms of time and models among different counties; (2) neighborhood effect exists in the diffusion of activities for school as learning community; (3) internal factors included subsidy dependence, teacher-student ratio, the higher education students population ratio, and the impact of the hours of teacher training courses in the previous semester. Recommendations for central government and local educationauthorities are provided based on findings.