Providence University

Introduction The efficacy and safety of patent foramen ovale closure (PFOC) in cryptogenic stroke (CS) patients aged ⩾ 60 remain controversial. This study evaluates the efficacy and safety of PFOC in elderly (aged ⩾ 60) versus non-elderly (aged < 60) patients and examines potential age-related benefit. Patients and methods A hospital-based cohort study (January 2013–June 2023) compared the efficacy and safety between PFOC and non-PFOC groups in patient with CS or cryptogenic TIA. The primary efficacy outcome was recurrent ischemic stroke, and safety outcomes included procedure-related adverse events and periprocedural atrial fibrillation (AF). Subgroup analyses, including various age ranges, were performed for the elderly group. Results Among 239 patients (mean age 57.2 years), 120 were elderly. During a mean follow-up of 3.1 years, the PFOC group had significantly fewer recurrent ischemic stroke than the non-PFOC group (adjusted hazard ratio (AHR): 0.10, 95% CI: 0.03–0.29, p = 0.001). The risk reduction was similar in elderly (AHR: 0.11, p = 0.004) and non-elderly (AHR: 0.10, p = 0.005) patients ( p for interaction = 0.337). Safety outcomes were comparable across age groups, including younger elderly (60–70) and older elderly (⩾70). No life-threatening complications occurred; one patient required additional intervention. Subgroup analysis indicated significant risk reduction for patients aged ⩾ 65 (AHR: 0.01, p = 0.012) but not for those aged 60–65 (AHR: 0.24, p = 0.071). Discussion and conclusion PFO closure is safe and effective in elderly patients with CS. Advanced age should not be a contraindication for PFOC, as older patients may potentially derive more significant benefits from the procedure.

Background The treatment of large arteriovenous malformations (AVMs), in particular those unruptured, remains a topic of debate. Stereotactic radiosurgery has favorable outcomes for small to medium-sized AVMs. However, for large AVMs, the goal is to maximize obliteration rates and at the same time, to minimize radiation-induced complications. This study assessed outcomes of large symptomatic AVMs treated with Gamma Knife radiosurgery (GKRS) focusing on cases presenting with rupture or seizures. The study followed the guidelines of Taiwan Neurosurgical Consensus, a government-funded committee under the Central Bureau of Health Insurance that determines whether radiosurgery is an appropriate treatment. Materials and methods This retrospective study included 75 cases of large AVMs (> 10 cc) treated with GKRS during the period from June 2003 to January 2020. Inclusion criteria were as follows: a history of intracerebral hemorrhage (ICH) or seizures, no prior embolization, and periodic MRI examinations with clinical assessments post-GKRS. Treatment procedures were adapted based on the Taiwan Neurosurgical Consensus guidelines. Results The average patient age was 36.4 ± 16.1 years, with a median follow-up duration of 104 (range 82–150) months. Forty-six patients (61.3%) underwent single-stage treatment, while 29 patients (38.7%) received two-stage treatment. The mean AVM volume was 20.5 ± 11.7 cc, with an average peripheral radiation dose of 17.7 ± 1.2 Gy. Among the 32 cases with AVM volumes between 10 and 15 cc, 25 (78.1%) achieved total obliteration. For the 17 cases with volumes between 15 and 20 cc, 7 (41.2%) achieved total obliteration, while 8 out of 26 (30.8%) cases with volumes > 20 cc achieved total obliteration. Severe brain edema developed in 16 patients (21.3%) after an average follow-up of 105.4 ± 56.2 months, but 11 patients (14.6%) experienced symptoms. Only one patient (1.3%) suffered neurological disability. Seizure control in Engel classification I was achieved in 21 of 42 patients (50%). Eight patients (10.6%) experienced new hemorrhages, with 4 (12.1%) occurring in those with a prior history of hemorrhage (annual bleeding rate: 1.2%) and 4 (9.5%) in those patients with a history of seizures (annual bleeding rate: 1.1%). Univariate analyses showed that total obliteration was significantly associated with smaller nidus volumes (< 15 cc), single-stage radiosurgery, Radiosurgery-Based Grading Scale, first-stage volume, maximum dose, 12 Gy volume, and nidus coverage percentages at 16 Gy and 18 Gy. Multivariate analyses revealed that post-GKRS symptoms and severe brain edema were significantly correlated with the following: Virginia Radiosurgery AVM Score, Charlson Comorbidity Index, and mean radiation dose. Conclusion The obliteration rate of large AVMs is strongly correlated with their size. This approach appears to achieve the goals of obliteration and minimizing the risks of radiation-induced complications and hemorrhage. Further investigation is needed for adjuvant treatments in residual or refractory cases after GKRS.

In this paper, we address the multi-objective task scheduling problem in cloud computing environments for IoT-generated tasks, focusing on minimizing makespan, load imbalance, energy consumption, and CO2 emissions. We propose a novel load imbalance metric tailored for this specific context and introduce an enhanced Equilibrium Optimizer (EO) algorithm, termed CEEO. The CEEO integrates a Coulomb operator inspired by Coulomb’s law to improve exploration and escape local optima in multimodal optimization problems. The algorithm’s performance is evaluated using standard benchmark functions from CEC2017, where it demonstrates significant improvements over existing optimization algorithms in terms of convergence speed and solution quality. In addition, the CEEO is applied to a simulated cloud computing task scheduling environment, considering varying numbers of tasks and virtual machines. The results reveal that CEEO consistently outperforms other scheduling algorithms, reducing makespan and improving load balancing, energy consumption, and CO2 emissions. Statistical analysis using the Friedman test confirms the statistical significance of these improvements. This research provides an efficient and robust solution for multi-objective task scheduling in cloud computing, offering substantial improvements in operational costs, execution time, and overall service quality.

Accidental falls among the elderly present serious health risks and are a significant concern, particularly for individuals living alone. Annually, approximately 2.8 million seniors require emergency medical attention due to fall-related injuries, highlighting the urgent need for effective fall detection and response mechanisms. While video-based fall detection systems tend to be more expensive than wearable solutions, their ability to integrate with smart home technologies enhances their practicality and real-time monitoring capabilities. This review systematically examines video-based fall detection methodologies, assessing their effectiveness, challenges, and constraints across different processing stages. Furthermore, we provide a comparative analysis of state-of-the-art techniques, identifying key advancements and potential areas for future research to improve reliability and accuracy.

Light-emitting electrochemical cells (LECs) provide a cost-effective solution for lighting applications and are well-suited for large-area and industrial-scale manufacturing. However, enhancing the efficiency of LECs remains a significant challenge. To address this issue, this study presents a series of blue-green iridium complexes with promising phosphorescent emission properties. Among these, di­[1-(2,4-difluorophenyl)-pyrazolyl]-5,5′-difluoro-2,2′-bipyridyl iridium­(III) hexafluorophosphate stands out, demonstrating exceptional performance. Following optimizing the device with varying thicknesses, an EQE of 16.8% and a current efficiency of 47.2 cd A–1 were attained. Further enhancements through the integration of a diffusive layer resulted in a 270% increase in efficiency, reaching an EQE of 39.3% and current efficiency of 109.6 cd A–1. This efficient technology demonstrates significant potential and lays the groundwork for future high-performance light-emitting devices.

The internet of medical things (IoMT) integrates various sensors, smart devices, and fully utilizes medical data to provide high-quality medical services through the Internet of Things (IoT). Smart medical devices can be cross-domain shared in IoMT to provide health monitoring, disease diagnosis, rehabilitation training, etc. In IoMT, conventional authentication schemes struggle to meet cross-domain medical service sharing requirements due to resource constraints (computational/communication), confidentiality challenges, and strict latency demands. To address these issues, we propose a cross-domain authentication scheme based on dynamic accumulators and two-layer blockchains. First, a blockchain-based collaborative authentication framework is designed to realize secure and reliable intradomain and cross-domain authentication. Second, certificateless cryptography and dynamic accumulators are combined to guarantee both the confidentiality and efficiency of cross-domain authentication. Furthermore, we analyze the potential security threats that threaten the system’s stability and formally demonstrate the security of the proposed scheme using Burrows–Abadi–Needham logic. The formal and informal security analyses indicate that the proposed scheme is secure and can resist against known security threats. Finally, we evaluate the performance of the proposed authentication protocols in terms of computational and communication overhead. The corresponding performance analysis shows that compared with related protocols, it can reduce the computational and communication costs by more than 42.3% and 21.4%, respectively.

Detection of weld proximity defects aims to recognize and classify different proximity defects in industrial welding. It presents some characteristics such as the small-target, localized diffusion, and dense distribution, which is difficult in steel-sheet welding engineering. Due to small-target size, localized diffusion, the similar and dense distribution, and imbalanced sample numbers, the existing detection models with the fixed receptive field are weak in detecting weld proximity defects. To solve the problem, we propose an expansive you-only-look-once detection model, called DRB-YOLOv5. It integrates a novel dilation causal convolution cross-stage partial network and the improved Focal Loss function. First, we provide a dilation causal transposed-convolution residual block cross-stage partial network to amplify and extract features of weld proximity defects effectively. Further, we reduce the block number of two middle Resblock Bodies in the Backbone of DRB-YOLOv5 to avoid network overfitting. Second, we design a Prediction Head via the Bias Focal Loss to balance positive and negative samples and improve the detection accuracy of various number-imbalanced weld defects. Finally, we compare the proposed model with some related existing models via the real weld proximity defects dataset. Experimental results show that the proposed DRB-YOLOv5 can present superior effects, mainly including mAP: 89.21%, F1: 83.50%, and recall: 80.73%.

This study aimed to investigate changes in the physicochemical properties and kinetics of xylooligosaccharides (XOS) during non-enzymatic browning reactions. This study indicated that the initial caramelization rate of XSO heat-treated at 140–190 °C was 3.97× 10⁻⁴– 8.50× 10⁻³ h⁻¹) and the activation energy (Ea) was 94.4 kJ/mol. The initial MR rates for XSO with amino acids exhibited an upward trend with increasing temperature, whereas the Ea for this process fell within the range of 27–113 kJ/mol. In addition, the MR products had a maximum thermogravimetric loss of approximately 36–56 % at pH 11, which occurred above 400 °C, compared to the caramelized products, and the MR products showed higher heat resistance. Overall, this study provides essential information on XOS in thermo-processed applications, which facilitates the potential explosion of XOS as a substitute sugar addition in thermally processed foods, namely, into a portion of functional food.

This study, grounded in the work-home resources model, examines how perceived insecurity due to COVID- 19 (including both job and financial insecurity) influences subsequent resource depletion and vigor through the mediating roles of work-family conflict (WFC) and family-work conflict (FWC). Additionally, this study explores the moderating effects of employee assistance programs and telework. Longitudinal data were gathered from 310 participants employed in the general industry sector in China over three distinct time points. Hypotheses were empirically examined utilizing multilevel path analysis within the Mplus 8 framework. The study results indicate that perceived insecurity due to COVID- 19 exacerbates resource depletion and reduces vigor through the mediating mechanisms of WFC and FWC. Furthermore, employee assistance programs and telework effectively moderate the relationship between perceived insecurity due to COVID- 19 and WFC and FWC, thereby mitigating the subsequent negative impacts on resource depletion and vigor.

English proficiency and motivation are critical determinants of learning outcomes in English medium instruction (EMI) courses. This study investigates the impact of students' English proficiency and academic motivation on EMI learning outcomes in Taiwanese management courses. A total of 97 questionnaires were collected from six management courses and analyzed using SPSS and partial least squares structural path modeling software SmartPLS 4. The measurement model results indicated that as a multidimensional construct, academic motivation can predict EMI learning outcomes. Among the three core facets of academic motivation, extrinsic motivation emerged as the strongest positive predictor of EMI learning outcomes, whereas amotivation showed significant negative effects on shaping EMI learning outcomes. Additionally, English proficiency was found to predict both EMI learning outcomes and amotivation levels. Students with CEFR ≤ B1 English proficiency exhibited higher amotivation, lower course grades, and worse self-reported learning outcomes, including content comprehension, confidence in undertaking future EMI courses, advancement in professional competence, and enhanced international mobility, than their ≥ B2 peers. Similar disparities in English proficiency, academic motivation, and learning outcomes were observed between domestic and international students. As a pedagogical implication, targeted support for domestic and less proficient students is recommended to mitigate these disparities.

Importance Aspirin (acetylsalicylic acid) and intravenous immunoglobulin (IVIG) are standard treatments for Kawasaki disease (KD) to reduce coronary artery lesions (CALs). However, the optimal duration and dosage of aspirin remain inconsistent across hospitals. The absence of large-scale, multicenter randomized clinical trials hinders a clear understanding of the effectiveness of high-dose aspirin. Objective To evaluate the effectiveness of IVIG alone compared with IVIG combined with high-dose aspirin as the active interventional therapy for KD and to compare treatment effectiveness across various KD subgroups. Design, Setting, and Participants In this prospective, evaluator-blinded, multicenter noninferiority randomized clinical trial, children (aged <6 years) who had been diagnosed with KD according to American Heart Association criteria were recruited from 5 medical centers in Taiwan and were enrolled between September 1, 2016, and August 31, 2018, with follow-up assessments at 6 weeks and 6 months after treatment. Data were analyzed between January 23, 2023, and January 29, 2024. Intervention The standard group received IVIG (2 g/kg) plus high-dose aspirin (80-100 mg/kg per day) until fever subsided for 48 hours. The intervention group received IVIG (2 g/kg) alone. Main Outcomes and Measures The primary outcome was the occurrence of CALs at 6 weeks. The noninferiority margin was set at 10%. Data analysis was performed using χ ² tests for categorical variables; independent t tests for continuous, normally distributed variables; generalized estimating equations for variables without specific distributions at multiple time points; and repeated-measures analysis of variance for continuous variables at multiple time points. Results The final cohort consisted of 134 patients with KD (mean [SD] age, 1.8 [1.3] years; 82 males [61.2%]), with matched age, weight, height, and sex distributions in 2 groups. Overall, in the IVIG plus aspirin group, among 69 patients, CAL occurrence decreased from 9 (13.0%) at baseline to 2 (2.9%) at 6 weeks and to 1 (1.4%) at 6 months. In the IVIG-only group, among 65 patients, CAL occurrence decreased from 7 (10.8%) at diagnosis to 1 (1.5%) at 6 weeks and to 2 (3.1%) at 6 months. No statistically significant differences in CAL frequency were observed between the 2 groups (0.7 percentage points [95% CI, −4.5 to 5.8 percentage points]; P = .65). There were also no significant differences in the treatment or prophylactic effect. Conclusions and Relevance This randomized clinical trial demonstrated the noninferiority of IVIG alone compared with IVIG plus aspirin, with a noninferiority margin set at 10%. The findings suggest that addition of high-dose aspirin during initial IVIG treatment is not clinically meaningful for CAL reduction in children with KD. Future studies on IVIG treatment alone for CAL reduction in KD across diverse racial and ethnic groups, beyond the Asian population, may be necessary to confirm minimal racial and ethnic variability and the broad applicability of these findings. Trial Registration ClinicalTrials.gov Identifier: NCT02951234

Introduction The impact of medial unicompartmental knee arthroplasty (MUKA) on ankle alignment is not well-studied. This study aims to investigate the changes in ankle alignment following MUKA and identify the influencing factors. Materials and Methods A retrospective analysis included 175 patients undergoing MUKA between 2018 and 2020. Patients were categorized into varus (n = 113) or valgus (n = 62) ankle groups based on preoperative ankle deformities. Preoperative and postoperative full-length standing radiographs were used for radiographic measurements. Results Following MUKA, significant differences in the change in tibial plafond-talus angle (PTA) were observed between the groups, with the varus ankle group showing a change of -0.71 ± 0.82° and the valgus ankle group showing a change of 0.08 ± 0.94° (p < 0.001). In the varus ankle group, the tibial plafond-ground angle (PGA) increased from -3.65 ± 4.22° preoperatively to -0.51 ± 4.52° postoperatively (p < 0.001), talus-ground angle (TGA) increased from -5.28 ± 4.32° to -1.32 ± 4.74° (p < 0.001), and PTA decreased from 1.52 ± 1.04° to 0.81 ± 1.12° (p < 0.001). In the valgus ankle group, PGA increased from -5.44 ± 4.39° to -1.43 ± 4.63° (p < 0.001) and TGA increased from -4.55 ± 4.24° to -0.59 ± 4.47° (p < 0.001), but PTA did not show a significant change. Ankle alignment change significantly correlated with preoperative joint line convergence angle (JLCA), preoperative medial proximal tibial angle (MPTA), preoperative PGA, preoperative TGA, preoperative PTA, hip-knee-ankle angle (HKA) changes, and bearing thickness. Conclusions MUKA significantly corrects the majority of ankle alignment towards a more neutral position. The extent of ankle alignment correction is influenced by preoperative knee and ankle joint deformities, as well as the degree of knee alignment correction.

The functionality of probiotics is highly influenced by culture and processing conditions, making batch stability validation through human or mouse trials impractical. Here, we employed a comprehensive approach using Caenorhabditis elegans, mouse and human models to elucidate the beneficial effects of Lactiplantibacillus plantarum TWK10 (TWK10). In C. elegans, TWK10 administration significantly prolonged lifespan by 26.1 ± 11.9 % (p < 0.05), enhanced locomotion (p < 0.01) and muscle mass (p < 0.001), elevated glycogen storage (p < 0.05), and reduced lipid accumulation (p < 0.001), outperforming Lacticaseibacillus rhamnosus GG and L. plantarum type strain ATCC 14917T. We also confirmed the equivalence of laboratory-prepared and mass-produced TWK10 in ergogenic efficacy using C. elegans assay. In mice, oral administration of mass-produced TWK10 significantly enhanced exercise performance and glycogen storage in muscle and liver in a dose-dependent manner. In a clinical study involving healthy male adults, significant improvements in grip strength (1.1-fold, p < 0.01) and exhaustion time (1.27-fold, p < 0.01), and significant reductions in circulating lactate and ammonia levels were observed in the TWK10 group (1 × 10¹⁰ colony-forming unit/day) compared to the control group. Both humans and mice receiving mass-produced TWK10 showed improved body composition with increased muscle mass and reduced fat mass. In conclusion, TWK10 demonstrates superior longevous and ergogenic effects in C. elegans compared to reference strains. The consistent ergogenic efficacy of mass-produced TWK10 across C. elegans, mice, and humans, highlights the utility of C. elegans as a reliable model for probiotic research and industrial application.

Speech with gender opposition on the internet have been causing antagonism, gamophobia, and pregnancy phobia among young groups. Recognizing gender opposition speech contributes to maintaining a healthy online environment and security in cyberspace. Traditional recognition model ignores the Chinese-owned features and emojis, which inevitably affects the recognition accuracy of gender opposition. To tackle this issue, a gender opposition recognition method fusing emojis and multi-features in Chinese speech(GOR-CS) is proposed. Firstly, the exBERT method is employed to expand the encoding of emojis into the BERT vocabulary, which can ensure BERT to extract the basis vectors containing characters and emojis information. Then, the feature vectors containing Wubi, Zhengma, and Pinyin information are extracted by Word2Vec to obtain the Chinese-owned features of gender opposition text. Further, the proposed basis vector and feature vectors are fused and then fed into the Bi-GRU network to extract deeper semantics from input sentences. Finally, to determine whether the speech are related to gender opposition, the sentiment polarities are calculated with the fully connected layer and SoftMax function. Experimental results show that the proposed method can effectively improve the accuracy of gender opposition recognition.

Activation of Sirtuin 1 (SIRT-1) is vital for axonogenesis and nerve regeneration. Caloric restriction (CR) has health benefits and protects against neurodegenerative disorders, largely through SIRT-1 regulation. This study investigates how diet control impacts peripheral nerve injury, focusing on SIRT-1 expression. We prepared nerve tissue cultures for a pharmacological analysis of SIRT-1's effects on nerve degeneration. After two weeks of 70% caloric restriction, we crushed the left sciatic nerve of Sprague–Dawley rats with a vessel clamp. We then administered SIRT-1 agonists or antagonists intraperitoneally. Nerve explant cultures showed increased SIRT-1 expression with SRT-1720, which was reduced by EX527, indicating enhanced regeneration. In the animal study, diet control led to notable SIRT-1 expression in plasma. This expression increased with SIRT-1 agonists and decreased with antagonists. SIRT-1 levels in paw skin were strongly correlated with PGP 9.5 and collagen deposition, while nerve fiber size and regeneration markers (S-100 and NF) also correlated with SIRT-1 expression. Inflammatory markers showed an inverse relationship with SIRT-1. TNF-α and NGF in the dorsal root ganglion responded reciprocally to SIRT-1 expression. Increased acetylcholine receptors and desmin in denervated muscle were parallel to SIRT-1 levels, with similar trends observed in muscle weight and diameter. Neurobehavioral and electrophysiological results aligned with these measurements. Caloric restriction has a preventative effect on nerve damage, mainly through SIRT-1 modulation. From a health perspective, promoting caloric restriction is important for mitigating nerve injury severity.

Research question: Migration studies have confirmed that migrants are associated with higher lifetime gains and social mobility than non-migrants. As hard-to-reach population, although Taiwan indigenous peoples (TIPs) are much more migratory than the ordinary people, it is contradictory to see that poverty and inequality remain persistent and prevalent among TIPs. Data and methodology: The research utilizes record linkage and geocoding methods to build anonymized population dynamics data, based on household register from 2013 to 2018. Using this longitudinally linked data, the research unveils the entangled features of population dynamics in TIPs. With a focus on the effects of income inequality in the context of systemic barriers and structural factors, the research explores migration dynamics in primary, return, and onward migrations in the context of regional inequality. Main research findings: (1) migration of TIPs is characterized by migration between areas of high income-high inequality and areas of low income-low inequality; (2) TIPs are much more migratory in areas of high income-high inequality than in areas of low income-low inequality; inequality in wealthy areas outweighs income in triggering migration, but migration in areas with high poverty and low inequality is triggered by low income gain; (3) repeat migration, particularly the return type, is characterized by a net gain of migrants moving from low poverty but high inequality areas into areas with high poverty but low inequality; (4) Onward migration of TIPs counters existing findings. The main reason why migration is less likely to promote TIPs social mobility is due to weak ethnic and socioeconomic connections and systemic barriers between TIPs and non-TIPs population.

Chenopodium formosanum (djulis), well known for its vivid color variation during diverse senescence stages, has attracted attention for its perceived health benefits and antioxidant capacity. Djulis leaves, often discarded as biowaste after harvesting, were evaluated for their potential as a source of antioxidant compounds. The current study analyzes the physicochemical and antioxidant activities of red, green, and yellow djulis leaf extracts across various senescence stages to probe their prospective utility in cosmeceuticals. Various plant compounds including total carbohydrates, phenolics and flavonoids, chlorophyll a and b, and betaxanthins and betacyanins were measured using spectrophotometric techniques. Antioxidant potential was assessed using DPPH, FRAP, CUPRAC, TEAC, and DMPD assays. Green djulis leaves displayed elevated total carbohydrate and chlorophyll levels, whereas red djulis leaves exhibited heightened phenolic, flavonoid, betaxanthin, and betacyanin content, indicating its suitability for cosmeceutical applications. Antioxidant evaluations revealed substantial disparities among the extracts, with red djulis leaf extract demonstrating superior antioxidant activity in most assays. These findings revealed the distinct antioxidant profiles of djulis leaf extracts influenced by color and senescence stage. These findings advance our understanding of the bioactive attributes of djulis leaves and their potential for incorporation into functional products.

In 2017, Taiwan launched a dedicated long-term care plan for Indigenous peoples, enhancing tribal cultural health stations. By 2018, the Indigenous Council introduced a cultural safety mentoring program for caregivers, aiming to improve their cultural sensitivity in providing elder care. This article reviews practical experiences documented in the Indigenous culture care curriculum, examining examples of culturally sensitive care and proposing an elder care model suitable for Indigenous communities based on the findings. The development of social safety policies for Indigenous peoples underscores the critical role of cultural health stations in their welfare. Insights from these stations highlight their adaptation to meet local elders’ needs while respecting diverse tribal cultures. Challenges include aligning with policies, training caregivers effectively and ensuring operational efficiency. Addressing these issues requires stable caregiver salaries, proficiency in ethnic languages, and training programs to enhance professionalism and preserve elders’ traditional knowledge. Integrating this wisdom into future policies, along with collaboration with cultural experts, will build a robust foundation for future generations.