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STEM literacy is a desired principal outcome of STEM (Science, technology, engineering, and mathematics) education. With the increasing popularity of Early STEM learning, it is believed that STEM literacy could be developed in the early years. However, relatively few studies have examined STEM literacy in young children. This study utilized the Delphi method and the analytic hierarchy process (AHP) to elicit the opinions of a panel of experts with diverse backgrounds and to construct a framework of STEM literacy for kindergarten children. The findings of the study illustrate what young children could achieve from high-quality early STEM experiences. This would help to promote curriculum development, performance assessment, and best practices in early STEM education.

Abstract Background Breast cancer is the most prevalent cancer among women globally, and surgical procedures continue to be the primary treatment. However, over 50% of patients experience preoperative anxiety due to the unknown and fear associated with surgery. Although drug therapy is commonly used to address this anxiety, its side effects have led to a heated debate regarding its effectiveness. Consequently, non-pharmacological therapies, such as preoperative education, have emerged as an alternative approach to alleviate anxiety. WeChat, a widely popular social media platform, offers a public platform that can potentially be utilized for effective preoperative education. This study aims to evaluate the use of WeChat public platform as a tool for preoperative education in patients undergoing breast surgery. Methods This is a prospective, randomized, and controlled trial will involve 392 adult women scheduled for breast cancer resection. Participants will be randomly assigned to either the WeChat education group or the regular group. In addition to regular preoperative visits, the WeChat education group will also watch science videos through the WeChat public platform. The regular group will only receive education from ward nurses during preoperative visits. The primary outcome measure will be the incidence of preoperative anxiety, defined by scores of the State Anxiety Inventory (SAI) exceeding 40 points. Secondary outcome measures include the incidence of severe anxiety (SAI > 44) on the day before surgery, incidence of anxiety 72 h after surgery, incidence of severe anxiety 72 h after surgery, NRS scores for pain at rest and during activity 24, 48, and 72 h after surgery, incidence of nausea and vomiting within 24 h after surgery, subjective sleep score at 1 week postoperatively, quality of life QoR-15 scores at 1 and 3 months postoperatively, incidence of chronic pain at 3 months postoperatively, bowel function recovery, length of hospital stay, and hospitalization expenses. Discussion This is the first clinical trial to investigate the use of WeChat public platform for delivering preoperative education on perioperative anxiety in breast cancer patients. By utilizing the renowned WeChat public platform, our study aims to improve patient outcomes by providing video education that explains the disease, surgery, and anesthesia in a more accessible manner, thereby reducing the incidence of perioperative anxiety. If our hypothesis is confirmed, this non-pharmacological approach can be universally acknowledged as a cost-effective and practical method in clinical care. Its application can also be extended to other medical fields beyond breast cancer. Trial registration ClinicalTrials.gov, NCT05291494. Registered on 29 December 2021.

Azathioprine (AZA) is commonly used for many autoimmune disorders; however, the limitation of its clinical use is due to potential toxicities, including severe leukopenia. Recent studies have identified genetic NUDT15 variants strongly associated with AZA-induced leukopenia in Asian patients. This study aimed to investigate the strength of above genetic association and evaluate the usefulness of prospective screening of the NUDT15 variants to prevent AZA-induced leukopenia in Chinese patients. AZA-induced leukopenia in patients with autoimmune disorders were enrolled from multiple medical centers in Taiwan/China between 2012 and 2017 to determine the strength of genetic association of NUDT15 or TPMT variants by whole exome sequencing (WES). Furthermore, a prospective study was conducted between 2018 and 2021 to investigate the incidence of AZA-induced leukopenia with and without genetic screening. The WES result showed the genetic variants of NUDT15 R139C (rs116855232) (P = 3.7 × 10-25 , odds ratio (OR) = 21.7, 95% confidence interval (95% CI) = 12.1-38.8) and NUDT15 rs746071566 (P = 4.2 × 10-9 , OR = 7.1, 95% CI = 3.7-13.7), but not TPMT, were associated with AZA-induced leukopenia and NUDT15 R139C variant shows the highest sensitivity with 92.5%. Furthermore, the targeted screening of 1,013 participants for NUDT15 R139C enabled those identified as carriers to use alternative immunosuppressants. This strategy resulted in a significant decrease in the incidence of AZA-induced leukopenia compared with historical incidence (incidence rate = from 7.6% decreased to 0.4%; P = 9.3 × 10-20 ). In conclusion, the NUDT15 R139C variant was strongly associated with AZA-induced leukopenia in Chinese patients. The genetic screening of NUDT15 R139C followed by use of alternative immunosuppressants in identified carriers effectively decreased the incidence of AZA leukopenia for patients with autoimmune disorders.

Transcutaneous spinal cord stimulation (tSCS) is an emerging therapeutic strategy to target spinal autonomic circuitry to normalize and stabilize blood pressure (BP) in hypotensive persons living with chronic spinal cord injury (SCI). Our aim is to describe our current methodological approach to identify individual tSCS parameters that result in the maintenance of seated systolic blood pressure (SBP) within a pre-defined target range. The parent study is a prospective, randomized clinical trial in which eligible participants will undergo multiple mapping sessions to optimize tSCS parameter settings to promote stable SBP within a target range of 110?120?mm Hg for males and 100?120?mm Hg for females. Parameter mapping includes cathode electrode placement site (T7/8, T9/10, T11/12, and L1/2), stimulation frequency (30, 60?Hz), current amplitudes (0?120?mA), waveform (mono- and biphasic), pulse width (1000??s), and use of carrier frequency (0, 10?kHz). Each participant will undergo up to 10 mapping sessions involving different electrode placement sites and parameter settings. BP will be continuously monitored throughout each mapping session. Stimulation amplitude (mA) will be increased at intervals of between 2 and 10?mA until one of the following occurs: 1) seated SBP reaches the target range; 2) tSCS intensity reaches 120?mA; or 3) the participant requests to stop. Secondary outcomes recorded include 1) symptoms related to autonomic dysreflexia and orthostatic hypotension, 2) Likert pain scale, and 3) skin appearance after removal of the tSCS electrode. Clinical Trials Registration: NCT05180227

Abstract Background Microcirculatory dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to investigate the association between preoperative retinal microcirculation evaluated using optical coherence tomography angiography (OCTA) and perioperative outcomes in patients with congenital heart disease (CHD). Methods This prospective, observational study was performed from May 2017 to January 2021. OCTA was used to automatically quantify the vessel density (VD) of the superficial capillary plexus, deep capillary plexus (DCP), and radial peripapillary capillary (RPC) preoperatively. The primary outcome was excessive postoperative bleeding, defined as bleeding volume > 75th percentile for 24-hour postoperative chest tube output. The secondary outcome was composite adverse outcomes, including one or more operative mortalities, early postoperative complications, and prolonged length of stay. The association between retinal VD and outcomes was assessed using Poisson regression. Results In total, 173 CHD patients who underwent cardiac surgery were included (mean age, 26 years). Among them, 43 (24.9%) and 46 (26.6%) developed excessive postoperative bleeding and composite adverse outcomes, respectively. A lower VD of DCP (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.08–1.43; P = 0.003) was independently associated with excessive postoperative bleeding, and a lower VD of RPC (OR, 1.97; 95% CI, 1.08–3.57; P = 0.027), and DCP (OR, 2.17; 95% CI, 1.08–4.37; P = 0.029) were independently associated with the postoperative composite adverse outcomes. Conclusion Preoperative retinal hypoperfusion was independently associated with an increased risk of perioperative adverse outcomes in patients with CHD, suggesting that retinal microcirculation evaluation could provide valuable information about the outcomes of cardiac surgery, thereby aiding physicians in tailoring individualized treatment.

In order to reflect on the lack of developing content knowledge of technology education in Taiwan's primary teacher education, the main aim of this study was to develop a STEM-based game-design project for helping preservice primary teachers acquire computational thinking concepts in a teacher education course and to evaluate its effectiveness. Preservice teachers were asked to develop a two-player educational game for primary students, using Scratch and Arduino microcontroller boards. All the finished games needed to be played by primary students and they were revised, in accordance with their feedback. To assess the learning effectiveness of the project, this study conducted pre-tests and post-tests to evaluate the improvement of the participants' knowledge and attitudes. The research results indicate that this project not only helped preservice primary teachers develop workable educational games and Arduino-based game controllers, but that it also enabled them to improve their performance in computational thinking concepts, energy knowledge, and programming attitude. Most of the preservice primary teachers involved in the study were satisfied with this project activity.

Abstract Phase extraction from single interferogram is of high significance and increasingly interest in optical metrology. In this contribute we propose an advanced Pixel-level Lissajous Ellipse Fitting (APLEF) method to extract the phase from single interferogram without carrier. At each pixel, a Lissajous figure is created by plotting N against D, where N and D are subtractions and additions of intensities of adjacent pixels in a small window. The so created Lissajous figure is already in phase quadrature because of the subtraction and addition process, and the Lissajous Figure is forced to be closed by taking the opposite values of N and D, i.e. –N and -D into account. The closed and in phase quadrature Lissajous Figure is the key point for APLEF to demodulate the single inteferogram without carrier in theoretically. The simulation shows its higher accuracy than existed SPT and Garbusi’s method and the experiments finally corroborate its effectiveness.

Integrated science, technology, engineering, and mathematics (STEM) curricula have taken center stage in the recent education reforms. However, the challenge in teaching STEM curricula lies in finding ways to develop students' content knowledge and plan suitable learning activities and instructional strategies. This paper is focused on the implementation of STEM curricula by secondary technology and engineering teachers and presents a framework for implementing a STEM curriculum centered on engineering design while illuminating its components, such as curriculum theme, content knowledge, learning activities, and teaching strategies. As an effective STEM teaching strategy relies on content integration, the focal point of this framework is the use of learning activities, such as "inquiry and experiment" and "design and making," to integrate STEM content into lessons and help students develop core competencies through engineering design processes. This paper is meant to serve as a reference for technology and engineering educators to use when designing and implementing engineering-oriented STEM curricula, thereby providing a deeper learning experience of engineering design and STEM integration in secondary-school classrooms.

Abstract Fibroblast-like synoviocytes (FLSs), play a key role in perpetuating synovial inflammation and bone erosion in rheumatoid arthritis (RA), however, the underlying mechanism(s) of RA FLSs activation and aggression remain unclear. Identifying endogenous proteins that selectively target FLSs is urgently needed. Here, we systematically identified that secreted modular calcium-binding protein 2 (SMOC2), was significantly increased in RA FLSs and synovial tissues. SMOC2 knockdown specifically regulated cytoskeleton remodeling and decreased the migration and invasion of RA FLSs. Mechanistically, cytoskeleton-related genes were significantly downregulated in RA FLSs with reduced SMOC2 expression, especially the motor protein myosin1c (MYO1C). SMOC2 controlled MYO1C expression by SRY-related high-mobility group box 4 (SOX4) and AlkB homolog 5 (ALKHB5) mediated-m6A modification through transcriptional and post-transcriptional regulation. Furthermore, intra-articular Ad-shRNA-SMOC2 treatment attenuated synovial inflammation as well as bone and cartilage erosion in rats with collagen-induced arthritis (CIA). Our findings suggest that increased SMOC2 expression in FLSs may contribute to synovial aggression and joint destruction in RA. SMOC2 may serve as a potential target against RA. SMOC2-mediated regulation of the synovial migration and invasion in RA FLSs. In RA FLSs, SMOC2 is significantly increased, leading to the increased level of MYO1C via SOX4-mediated transcriptional regulation and ALKBH5-mediated m6A modification, thereby causing cytoskeleton remodeling and promoting RA FLSs migration and invasion. The Figure was drawn by Figdraw.

Calf intestines are colonized by rich and complex microbial communities, playing a crucial role in animal physiology, metabolism, nutrition, and immune function. In this study, we provide insight into the composition of fecal microbial bacteria and fungi, respectively, as well as the cross-kingdom interactions. We investigated the intestinal microbiota of different breeds of calves by characterizing the bacterial and fungal communities in the rectal feces of Holstein calves and German Simmental × Holstein cross F1 generation (GXH) using 16S rRNA and ITS amplicon sequencing techniques. PICRUSt2 (version 2.2.0) were used to determine microbial diversity and function and explore the reasons why Holstein calves are more susceptible to diarrhea. The results revealed no significant difference in the diversity of fecal microbiota among the groups (p > 0.05). We identified Firmicutes, Bacteroidetes, and Proteobacteria as the dominant bacterial phyla in the fecal bacterial communities of the two breeds of calves. Ascomycota and Basidiomycota play important roles in the fungal community but differ in relative abundance. Bacteroides was the dominant genus at the group level for calf fecal microbiota in both breeds. The relative abundance of Prevotella, Escherichia-Shigella, Peptostreptococcus, and Butyricicoccus was higher in Holstein calves, and the relative abundance of Faecalibacterium, Megamonas, Butyricicoccus, and Alloprevotella was lower than GXH group. Aspergillus and Cladosporium were the dominating genera of fecal fungi in both groups of calves. LEfSe analysis revealed 33 different bacteria and 23 different fungi between the two groups, with more differential strains found in GXH. In addition, the feces fungi-bacteria interkingdom interactions varied among breeds. Thus, the composition and structure of bacterial and fungal communities in calf feces varied by breed, indicating a potential association between breed and microbial communities. We also found differences in the network between bacterial–fungal kingdoms. We explain the reasons for Holstein calves being more prone to diarrhea. This indicated that breed makes differences in calf diarrhea rates by influencing gut microbial composition and interactions.

In hypersonic flight control, characterized by challenges posed by input saturation, model parameter uncertainties, and external disturbances, this paper introduces a pioneering anti-input saturation control method based on RBFNN adaptivity. We have developed adaptive laws to enhance control system adaptability and robustness by integrating mission profiles, actuator saturation failure modes, and self-evolving neural network design. Furthermore, our approach introduces a novel anti-input saturation auxiliary system, effectively addressing input saturation constraints. This innovation ensures system stability and precise tracking, even in severe input saturation constraints. The results reveal that the system’s steady-state tracking error remains under 2% under input saturation constraints, and the convergence speed demonstrates an impressive 20% improvement. These findings underscore this research’s substantial advancement in hypersonic flight control. It may significantly enhance the controllability and performance of hypersonic vehicles in real-world scenarios.

SARS-CoV Spike (S) protein shares considerable homology with SARS-CoV-2 S, especially in the conserved S2 subunit (S2). S protein mediates coronavirus receptor binding and membrane fusion, and the latter activity can greatly influence coronavirus infection. We observed that SARS-CoV S is less effective in inducing membrane fusion compared with SARS-CoV-2 S. We identify that S813T mutation is sufficient in S2 interfering with the cleavage of SARS-CoV-2 S by TMPRSS2, reducing spike fusogenicity and pseudoparticle entry. Conversely, the mutation of T813S in SARS-CoV S increased fusion ability and viral replication. Our data suggested that residue 813 in the S was critical for the proteolytic activation, and the change from threonine to serine at 813 position might be an evolutionary feature adopted by SARS-2-related viruses. This finding deepened the understanding of Spike fusogenicity and could provide a new perspective for exploring Sarbecovirus' evolution.

Background: Teaching engineering at a high school level has been a subject of substantial concern during recent curriculum reforms. Many countries are increasingly including engineering-focused subjects in their technology curriculum guidelines. However, technology teachers face challenges regarding the optimal implementation of an engineering-focused curriculum. It is essential to understand technology teachers' perceptions of and behavior in classroom practices when teaching an engineering-focused curriculum. To explore the factors influencing the effective implementation of the curriculum, this study aimed to explore the association between technology teachers' perceptions regarding curriculum guidelines (i.e., perceived ease of use, perceived usefulness, and beliefs) and their behavioral intentions. In addition, this study explored how these perceptions change for teachers who participated in a professional development program (PDP) for teaching an engineering-focused curriculum compared with those who did not participate in the program (NoPDP). Results In this study, structural equation modeling was used to investigate factors potentially influencing teachers' behavioral intentions, including subjective norms and perceived behavioral control. The results showed that technology teachers' behavioral intentions were influenced by their perceptions of the curriculum's usefulness. Subjective norms and perceived behavioral control were also significant determinants of behavioral intentions. Moreover, the results differed between the two groups. Perceived usefulness had direct and indirect effects on the behavioral intentions of the PDP and NoPDP groups, respectively. Conclusions: We constructed a model of technology teachers' behavioral intentions to implement an engineering-focused curriculum and identified factors influencing technology teachers' behavioral intentions to implement an engineering-focused curriculum. Our conclusions are as follows: (1) the model was adequate for determining the factors influencing technology teachers' behavioral intentions; (2) in the PDP group, perceived usefulness, subjective norms, and perceived behavioral control were significantly associated with behavioral intentions; and (3) in the NoPDP group, perceived usefulness and perceived ease of use were associated with behavioral intentions and self-reported behavior only via the mediating factor of beliefs. The above influencing factors should be taken into account when planning professional development programs for pre- and in-service teachers, as these programs will have implications regarding the successful implementation of an engineering-focused curriculum.