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Abstract In the evolving landscape of higher education, challenges such as the COVID-19 pandemic have underscored the necessity for innovative teaching methodologies. These challenges have catalyzed the integration of technology into education, particularly in blended learning environments, to bolster self-regulated learning (SRL) and higher-order thinking skills (HOTS). However, increased autonomy in blended learning can lead to learning disruptions if issues are not promptly addressed. In this context, OpenAI's ChatGPT, known for its extensive knowledge base and immediate feedback capability, emerges as a significant educational resource. Nonetheless, there are concerns that students might become excessively dependent on such tools, potentially hindering their development of HOTS. To address these concerns, this study introduces the Guidance-based ChatGPT-assisted Learning Aid (GCLA). This approach modifies the use of ChatGPT in educational settings by encouraging students to attempt problem-solving independently before seeking ChatGPT assistance. When engaged, the GCLA provides guidance through hints rather than direct answers, fostering an environment conducive to the development of SRL and HOTS. A randomized controlled trial (RCT) was employed to examine the impact of the GCLA compared to traditional ChatGPT use in a foundational chemistry course within a blended learning setting. This study involved 61 undergraduate students from a university in Taiwan. The findings reveal that the GCLA enhances SRL, HOTS, and knowledge construction compared to traditional ChatGPT use. These results directly align with the research objective to improve learning outcomes through providing guidance rather than answers by ChatGPT. In conclusion, the introduction of the GCLA has not only facilitated more effective learning experiences in blended learning environments but also ensured that students engage more actively in their educational journey. The implications of this study highlight the potential of ChatGPT-based tools in enhancing the quality of higher education, particularly in fostering essential skills such as self-regulation and HOTS. Furthermore, this research offers insights regarding the more effective use of ChatGPT in education.

Abstract In the field of Science, Technology, Engineering, and Mathematics (STEM) education, which aims to cultivate problem-solving skills, accurately assessing learners' engagement remains a significant challenge. We present a solution to this issue with the Real-time Automated STEM Engagement Detection System (RASEDS). This innovative system capitalizes on the power of artificial intelligence, computer vision, and the Interactive, Constructive, Active, and Passive (ICAP) framework. RASEDS uses You Only Learn One Representation (YOLOR) to detect and map learners' interactions onto the four levels of engagement delineated in the ICAP framework. This process informs the system's recommendation of adaptive learning materials, designed to boost both engagement and self-efficacy in STEM activities. Our study affirms that RASEDS accurately gauges engagement, and that the subsequent use of these adaptive materials significantly enhances both engagement and self-efficacy. Importantly, our research suggests a connection between elevated self-efficacy and increased engagement. As learners become more engaged in their learning process, their confidence is bolstered, thereby augmenting self-efficacy. We underscore the transformative potential of AI in facilitating adaptive learning in STEM education, highlighting the symbiotic relationship between engagement and self-efficacy.

Abstract Background In the realm of Science, Technology, Engineering, and Mathematic (STEM) education, computer programming stands as a vital discipline, amalgamating cross-disciplinary knowledge and fostering the capacity to solve real-world problems via fundamental concepts and logical methodologies inherent to computer science. Recognizing the important of computer programming, numerous countries have mandated it as a compulsory course to augment the competitiveness of K-12 learners. Nevertheless, the inherent complexity of computer programming for K-12 learners often goes unacknowledged. Constraints imposed by the course format, coupled with a low instructor–learner ratio, frequently inhibit learners’ ability to resolve course-related issues promptly, thereby creating difficulties in the affective domain. While precision education tools do exist to ascertain learners’ needs, they are largely research-oriented, thereby constraining their suitability for deployment in pragmatic educational settings. Addressing this issue, our study introduces the precision education-based timely intervention system (PETIS), an innovative tool conceived to enhance both programming skills and affective learning in K-12 learners. Our research investigates the influence of PETIS on learners’ performance and evaluate its efficacy in facilitating computer programming education in K-12 environments. Results Quantitative results demonstrate that the application of the precision education-based timely intervention system (PETIS) proposed by this research significantly improves programming skills and affective-domain learning objectives for K-12 learners. Similarly, qualitative results indicate that PETIS is beneficial for both teaching and learning in K-12 computer programming courses. Conclusions These results not only confirm that timely intervention and feedback improve K-12 learners’ programming skills and affective-domain learning objectives in computer programming courses, but also yield implications as to the feasibility of applying precision education in real-world STEM scenarios.

ABSTRACTWe propose a semi-automatic staging area for efficiently building an accurate database of experimental physical properties of superconductors from literature, called SuperCon2, to enrich the existing manually-built superconductor database SuperCon. Here we report our curation interface (SuperCon2 Interface) and a workflow managing the state transitions of each examined record, to validate the dataset of superconductors from PDF documents collected using Grobid-superconductors in a previous work. This curation workflow allows both automatic and manual operations, the former contains ‘anomaly detection’ that scans new data identifying outliers, and a ‘training data collector’ mechanism that collects training data examples based on manual corrections. Such training data collection policy is effective in improving the machine-learning models with a reduced number of examples. For manual operations, the interface (SuperCon2 interface) is developed to increase efficiency during manual correction by providing a smart interface and an enhanced PDF document viewer. We show that our interface significantly improves the curation quality by boosting precision and recall as compared with the traditional ‘manual correction’. Our semi-automatic approach would provide a solution for achieving a reliable database with text-data mining of scientific documents.

Background and purpose: Basilar-artery occlusion (BAO) usually accounts for devastating neurologic sequelae, poor prognosis, and even death. While endovascular thrombectomy (EVT) is the most successful treatment for anterior circulation stroke with large vessel occlusion, its effectiveness in treating acute BAO is still debatable. Our aim is to compare the efficacy and safety between EVT and conservative medical treatment (CMT) in BAO. Methods: Up until May 2022, relevant literature was gathered using searches in Embase, PubMed, and the Cochrane Library. The primary outcomes were defined as good functional outcome (modified Rankin Scale 0–2) and favorable functional outcome (modified Rankin Scale 0–3) at 3 months between EVT and CMT groups. The secondary outcomes included mortality at 3 months, symptomatic intracerebral hemorrhage (ICH), and any ICH. Results: Eight studies involving 3733 patients with BAO were enrolled 2573 individuals underwent EVT, and the remaining 1160 patients received CMT. Compared with CMT, EVT achieved more favorable functional outcome (odds ratio (OR) 1.26, 95% CI 1.03–1.55, I2 = 54%, p = 0.05) in BAO. The good functional outcome showed a similar tendency (OR 1.23, 95% CI 0.97–1.57, I2 = 63%, p = 0.02) as well. EVT decreased mortality at 3 months (OR 0.81, 95% CI 0.70–0.93, I2 = 31 %, p = 0.19), although having a tendency to cause symptomatic ICH (OR 2.91, 95% CI 1.38–6.18, I2 = 22 %, p = 0.27). Conclusions: EVT in BAO provides superior functional outcomes and less mortality compared with CMT. Even though EVT has the propensity to cause symptomatic ICH, EVT nevertheless improved posterior circulation stroke.

BackgroundChorea is a movement disorder characterized by abrupt, rapid, and uncontrollable, random movements from one part of the body to another with motor impersistence. Sporadic chorea is rarely caused by either thyrotoxicosis or Moyamoya disease (MMD).Methods and resultsIn this case report, we describe a female patient with chorea with the rare coexistence of Graves' disease and Moyamoya disease. Tc-99m ethyl cysteinate dimer (ECD) brain perfusion single-photon emission computed tomography (SPECT) showed mild to moderate hypoperfusion in bilateral frontal and left temporal regions. After administering dexamethasone 20 mg for 5 days, her choreic movement symptoms recovered rapidly.ConclusionAlthough uncommon, thyrotoxicosis and Moyamoya disease can co-occur, especially in Asian female adults. Excessive thyroid hormones contribute to the dysregulation of neurotransmitters in basal ganglia-thalamocortical circuits. Moyamoya disease is responsible for ischemic changes affecting the excitatory–inhibitory circuits between the basal ganglia and the neocortex. Under a state of coexistence, thyrotoxicosis exaggerates cerebral metabolism, aggravating the impaired cerebral perfusion induced by Moyamoya disease. Moreover, inflammatory reactions caused by thyroid autoantibodies may also promote the progression of Moyamoya disease. In our experience, treatment with steroids may not only synergize the anti-thyroid effect but may also be a way to modulate the neurotransmitters within the basal ganglia or restore cerebral perfusion. We suggest that evaluation of the thyroid function status in Moyamoya disease is essential.

Virtual Reality (VR) has demonstrated significant advantages in various educational fields as it allows learners to actively learn in high interactivity and realism under their learning pace. However, for low-achieving students, VR learning environments may introduce some challenges, which are problems encountered during their learning process, which lead to difficulties in self-regulating their learning progress and becoming disoriented in the lack of guidance. This study aims to explore the improvement of self-regulated VR learning environment based on the Cognitive Theory of Multimedia Learning and enhance the performance of low-achieving students. We designed a VR course on electronic circuit hardware and programming, providing participants with a series of learning aids in the VR learning environment, including feedback, hints and guidance. Feedback aids provide correct or incorrect feedback after each task or test, guidance aids display progress following each task or test and hint aids offer guidance when inactivity is detected. A quasi-experiment was conducted by using questionnaires and practical tasks to assess the participants' cognitive levels, practical hands-on skills, self-regulated learning abilities and learning engagement after VR learning. The results demonstrated significant improvements in all learning indicators for low-achieving students.

The core purpose of integrating inquiry-based learning strategies into STEM activities is to create a challenging learning environment that stimulates students' active learning, thereby effectively enhancing their interest in learning, thinking skills, and practical application abilities. To achieve these goals, developing more technology-assisted tools and platforms to improve teaching efficiency and enrich the learning experience becomes crucial. Therefore, this research developed InquiryGPT, which guides students through the POEE inquiry process by imposing limitations, facilitating dialogue, and providing feedback, while avoiding over-reliance on ChatGPT. This promotes the cultivation of higher-order thinking skills through interactions with InquiryGPT, thereby enhancing students' knowledge construction and understanding. This study, based on the Technology Acceptance Model (TAM), examined the effectiveness of InquiryGPT. The results showed no significant difference between InquiryGPT and ChatGPT in terms of perceived usefulness and perceived ease of use. Additionally, through analysis of covariance (ANCOVA), the study further analyzed the impact of InquiryGPT on students' higher-order thinking skills and learning scores, proving that it significantly enhances students' creativity, problem-solving abilities, critical thinking, and knowledge construction.

Abstract Background The onset of chronic fatigue syndrome (CFS) has been shown to be associated with several immunological conditions such as infections or atopy. The aim of this study was to clarify the risk of chronic fatigue syndrome following the diagnosis of psoriasis, an immune-related dermatological disease, by analyzing the National Health Insurance Research Database of Taiwan. Method 2616 patients aged 20 years or older with newly diagnosed psoriasis during 2004–2008 and 10,464 participants without psoriasis were identified. Both groups were followed up until the diagnoses of CFS were made at the end of 2011. Results The relationship between psoriasis and the subsequent risk of CFS was estimated through Cox proportional hazards regression analysis, with the incidence density rates being 2.27 and 3.58 per 1000 person-years among the non-psoriasis and psoriasis populations, respectively (adjusted hazard ratio [HR] = 1.48, with 95% confidence interval [CI] 1.07–2.06). In the stratified analysis, the psoriasis group were consistently associated with a higher risk of CFS in male sex (HR = 2.05, 95% CI 1.31–3.20) and age group of ≥ 60 years old (HR = 2.32, 95% CI 1.33–4.06). In addition, we discovered that the significantly increased risk of CFS among psoriasis patients is attenuated after they receive phototherapy and/or immunomodulatory drugs. Conclusions The data from this population-based retrospective cohort study revealed that psoriasis is associated with an elevated risk of subsequent CFS, which is differentiated by sex and age.

The rise of precision education has encouraged teachers to use intelligent diagnostic systems to understand students' learning processes and provide immediate guidance to prevent students from giving up when facing learning difficulties. However, current research on precision education rarely employs multimodal learning analytics approaches to understand students' learning behaviors. Therefore, this study aims to investigate the impact of teachers intervene based on different modalities of learning analytics diagnosing systems on students' learning behaviors, learning performance, and motivation in STEM collaborative learning activities. We conducted a quasi-experiment with three groups: a control group without any learning analytics system assistance, experimental group 1 with a unimodal learning analytics approach based on image data, and experimental group 2 with a multimodal learning analytics approach based on both image and voice data. We collected students' image or voice data according to the experimental design and employed artificial intelligence techniques for facial expression recognition, eye gaze tracking, and speech recognition to identify students' learning behaviors. The results of this research indicate that teacher interventions, augmented by learning analytics systems, have a significant positive impact on student learning outcomes and motivation. In experimental group 2, the acquisition of multimodal data facilitated a more precise identification and addressing of student learning challenges. Relative to the control group, students in the experimental groups exhibited heightened self-efficacy and were more motivated learners. Moreover, students in experimental group 2 demonstrated a deeper level of engagement in collaborative processes and the behavior associated with constructing knowledge.

Background: Virtual reality (VR) offers significant potential for hands-on learning environments by providing immersive and visually stimulating experiences. Interacting with such environments can bring numerous benefits to learning, including enhanced engagement, knowledge construction, and higher-order thinking. However, many current VR studies in hands-on learning tend to utilise one-way learning materials, limiting participants' ability to interact with and reflect on their actions and learning experiences. Moreover, these studies often neglect to assess learners' capacity to transfer their skills from VR learning to real-world scenarios. Therefore, this study aims to investigate participants' engagement, learning outcomes, higher-order thinking, and their ability to apply acquired skills in real-world contexts. Method and Objective: Participants were immersed in a hands-on learning environment in VR, where they received feedback and engaged in reflection during the learning process. This study recruited 68 university students to participate in the experiment, employing a quasi-experimental design. Participants experienced learning units both with and without reflection on the feedback. The theme of these learning units was related to embedded systems, encompassing topics such as the assembly of embedded components and Python programming. The investigation aimed to assess whether reflection in VR could enhance cognitive levels, engagement, real-world hands-on tasks abilities, and higher-order thinking. Results: The research results indicate that in the VR hands-on learning environment, participants engage in reflection through the provided feedback, effectively enhancing their engagement, cognitive levels, and hands-on task abilities. Simultaneously, it also successfully assists participants in developing problem-solving skills and critical thinking in higher-order thinking. Conclusions: Participants actively engaged in reflection on their own learning tasks and actions within the hands-on learning environment, enabling them to develop a deeper understanding of the learning material and enhance their real-world hands-on tasks abilities, we encourage the integration of reflection strategies in VR learning environments for hands-on learning, as they can yield positive benefits for learners.

Virtual reality (VR) provides a unique platform for interactive learning experiences, enhancing learning, particularly in hands-on courses. However, the visual load of VR and the lack of guidance and interaction from physical teachers or peers can pose challenges for learners in self-regulated learning (SRL) and learning motivation. This study designed feedback in the VR learning environment based on the signaling principles of Cognitive Theory of Multimedia Learning (CTML) to investigate learners' SRL, learning motivation, cognitive levels, and their abilities to handle real-world scenarios. We developed a VR hands-on learning course on the Artificial Intelligence of Things (AIoT) and conducted two real-world AIoT hands-on tasks, implementing a quasi-experimental study with 71 university students. Participants were randomly assigned to either the experimental group or the control group. The experimental group received three types of feedback signals (gaze, progress, and decision) designed based on signaling principles, while the control group received no feedback. The results showed that the experimental group exhibited significantly higher levels of SRL and learning motivation compared to the control group after VR learning. The feedback group also performed better in terms of cognitive levels and real-world hands-on tasks.

Science, Technology, Engineering, and Mathematics (STEM) education is essential for developing future-ready learners in both secondary and higher education levels. However, as students transition to higher education, many encounter challenges with independent learning and research. This can negatively impact their Higher-Order Thinking Skills (HOTS), engagement, and practical expertise. This study introduces a solution: Computational Thinking Scaffolding (CTS) in the Jupyter Notebook environment, designed to enhance STEM education at the tertiary level. CTS incorporates five phases: Decomposition, Pattern Recognition, Abstraction, Algorithm Design, and Evaluation. Utilizing a quasi-experimental method, we assessed the impact of CTS on the HOTS, engagement, and practical skills of undergraduate and postgraduate students. Our findings hold substantial relevance for university educators, academic advisors, and curriculum designers aiming to enhance students' HOTS and hands-on capabilities in STEM disciplines. The results validate the effectiveness of CTS in elevating tertiary STEM learning outcomes, and they spotlight the adaptability of the Jupyter Notebook as a valuable tool in higher education. In conclusion, our research underscores the merits of CTS for improving outcomes in higher STEM education and sets a benchmark for future endeavors in this domain.

Background: To study the clinical presentation, diagnosis, treatment, and outcome of acute encephalitis. Methods: Records of 151 cases from January 1, 2004 to December 31, 2008 were reviewed retrospectively. Cases that met the definition of encephalitis were included and patients with bacterial meningoencephalitis or a post-operation infection were excluded. A total of 25 cases were enrolled after this screening; and age, sex, underlying diseases, brain computed tomography (CT) scan results, magnetic resonance imaging (MRI) results, and cerebrospinal fluid data were analyzed. Results: One patient positive for herpes simplex virus-I (HSV-I) by polymerase chain reaction (PCR) and one patient positive for HSV-II by PCR were detected among the 25 cases. Two positive Mycoplasma encephalitis cases by PCR were confirmed. One patient, who was human immunodeficiency virus positive, was diagnosed as having cerebral toxoplasmosis by brain MRI, serology results, and clinical response to treatment. All the patients’ brain CT scans showed no abnormalities. Among the 12 patients receiving brain MRI, six patients showed hyper-intense signs that were typical of HSV encephalitis. Acyclovir was given to four patients when the MRI results indicated a high suspicion of HSV encephalitis or when there was a clinical suspicion. Three of the 25 cases died. All of the patients who received acyclovir treatment survived. Conclusion: Brain MRI results have more clinical value than CT scans when diagnosing encephalitis. The administration of antibiotics should be discouraged when the clinical picture is consistent with HSV encephalitis. The timing of any administration of acyclovir should rely more on MRI than on the HSV PCR results because the sensitivity is low and the test is relatively unreliable. Early diagnosis and prompt management with acyclovir, especially when HSV is considered to be the cause of the encephalitis, are extremely crucial in order to obtain a better outcome.

Despite advances in medicine, early diagnosis of spinal epidural abscess remains a challenge to clinicians. The most common symptoms of spinal epidural abscess include back pain, fever, and neuralgic deficits. However, spinal epidural abscess can also present with vague and nonspecific symptoms. In this case, a 68-year-old male had abdominal pain in the right upper quadrant lasting 3 weeks and was diagnosed with a gastric ulcer. After treatment, his symptoms did not resolve. Fever and back pain became evident as his disease progressed, followed by right lower limb weakness and the inability to walk. He was taken to the emergency department of our hospital, and the weakness of his lower extremities worsened during hospitalization. His right leg became completely paralyzed despite the use of intravenous antibiotics. A spinal computed tomography scan was performed emergently (magnetic resonance imaging was unavailable) and revealed an epidural abscess involving T5–6 with adjacent osteomyelitis. The patient underwent posterior decompressive laminectomy with pus drainage in the T4–7 region. His neuralgic examinations improved soon after the operation, but ambulation remained limited. Early diagnosis is crucial to the prognosis of spinal epidural abscess, because delayed diagnosis usually results in complete paralysis even death. Thus, clinicians should be aware of atypical presentations of spinal epidural abscess.

BACKGROUND:Nasopharyngeal carcinoma (NPC) is known for its high metastatic potential and locoregional recurrence, although the molecular alterations that are driving NPC metastasis remain unclear at this time. This study aimed to examine the expression of fibulin-5 in NPC, correlate the results with clinicopathological variables and survival, and to investigate the role of fibulin-5 in human NPC cell lines. MATERIAL AND METHODS:Standard semi-quantitative-RT-PCR, quantitative-RT-PCR, immunoblotting, and immunohistochemistry were used to investigate the mRNA and protein expression profiles of fibulin-5 in normal and NPC tissues. Immunohistochemistry of fibulin-5 was correlated with clinicopathological characteristics by univariate analyses. NPC cells overexpressing fibulin-5 or fibulin-5-siRNA cells were generated by stable transfection to characterize the molecular mechanisms of fibulin-5-elicited cell growth and metastasis. RESULTS:Our results demonstrated that fibulin-5 overexpression in NPC specimens and significantly correlated with advanced tumor metastasis indicating a poor 5-year overall survival. Fibulin-5 was mainly expressed in the nucleus in human NPC specimens and cell lines. Functionally, fibulin-5 overexpression yielded fast growth in NPC cells. In addition, fibulin-5 promotes cell metastasis in NPC cells through increased FLJ10540 and phosphor-AKT activity. In contrast, siRNA depletion of fibulin-5 suppressed FLJ10540 expression and phosphor-AKT activity. Suppression of either fibulin-5 or FLJ10540 can cause significant inhibition with regards to cell motility in NPC cells. Finally, immunohistochemical analysis of human aggressive NPC specimens showed a significant and positive correlation between fibulin-5 and FLJ10540 expression. CONCLUSION:Higher fibulin-5 expression is not only an important indicator of poor survival, but also contributes to the development of new therapeutic strategies in the FLJ10540/AKT pathway for NPC treatment.