Student engagement and learning outcomes:an empirical study applying a four-dimensional framework

Introduction: This study applies Reeve’s four-dimensional student engagement framework to a medical education context to elucidate the relationship between behavioral, emotional, cognitive, and agentic engagement and learning outcomes. Meanwhile, we categorize learning outcomes in knowledge and skills, and added taxonomies to the cognitive education objectives for the knowledge part, including memorization, comprehension, and application. Methods: We used the China Medical Student Survey to investigate student engagement, and combined it with the Clinical Medicine Proficiency Test for Medical Schools results as a standardized measurement of learning outcomes. We performed multivariate regression analyses to delve into the effectiveness of different types of student engagement. Moreover, we evaluated the moderating roles of gender and the National College Entrance Examination (NCEE) within the relationships between student engagement and learning outcomes. Results: We observed that emotional engagement is most effective in promoting learning outcomes in basic medical knowledge and basic clinical skills. Emotional engagement and cognitive engagement could effectively contribute to learning outcomes in all three aspects of basic medical knowledge. In contrast, behavioral and agentic engagement showed negative effects on learning outcomes. Besides, we found that the results of the NCEE played a positive moderating role. Conclusion: This study provides robust evidence for the effectiveness of emotional engagement and cognitive engagement in promoting learning outcomes. Whereas behavioral and agentic engagement may not be good predictors of learning outcomes in macro-level general competence tests. We suggest a combined effort by students and institutions to promote student engagement and bridge the distance between general competency tests and daily learning activities.</p

Janus Monolayer Transition Metal Dichalcogenides

A novel crystal configuration of sandwiched S-Mo-Se structure (Janus SMoSe) at the monolayer limit has been synthesized and carefully characterized in this work. By controlled sulfurization of monolayer MoSe2 the top layer of selenium atoms are substituted by sulfur atoms while the bottom selenium layer remains intact. The peculiar structure of this new material is systematically investigated by Raman, photoluminescence and X-ray photoelectron spectroscopy and confirmed by transmission-electron microscopy and time-of-flight secondary ion mass spectrometry. Density-functional theory calculations are performed to better understand the Raman vibration modes and electronic structures of the Janus SMoSe monolayer, which are found to correlate well with corresponding experimental results. Finally, high basal plane hydrogen evolution reaction (HER) activity is discovered for the Janus monolayer and DFT calculation implies that the activity originates from the synergistic effect of the intrinsic defects and structural strain inherent in the Janus structure.Comment: 22 pages, 12 figure

Forest effects on runoff under climate change in the Upper Dongjiang River Basin: insights from annual to intra-annual scales

Climate change and large-scale afforestation characterize the conditions in the Upper Dongjiang River Basin (UDRB), which is one of the most important headwater basins in southern China. It is important to understand whether, and to what extent, the observed runoff change can be attributed to forest and/or climate change. Using process- and relation-based methods, we found precipitation in spring (March–May) decreased notably, while precipitation in summer (June–August) showed an increase from the reference period (1961–1990) to the afforestation period (1991–2010). In comparison, annual averaged potential evapotranspiration did not change much. Both of the methods indicated forest had a positive effect while climate change exerted a negative impact on annual averaged runoff in the UDRB. As a result, the observed annual averaged runoff only showed a little decrease from the reference period to the afforestation period. The climate change impact on monthly averaged runoff basically followed the pattern of precipitation change. Except in July and August, climate change exerted negative or little impact on runoff in most of other months. In comparison, the forest effects on monthly averaged runoff change showed a totally different pattern. Except in May and June, forest exerted positive impact on runoff in other months. As a result, the observed monthly averaged runoff in May and June experienced notable reduction, while those in other months experienced increase or no change. The UDRB provides evidence that additional forest cover would not injure but even increase runoff, especially dry season runoff. The study has important implications for sustainable water management and afforestation in this subtropical region and for similar river basins

Cost-effectiveness analysis of nivolumab combination therapy in the first-line treatment for advanced esophageal squamous-cell carcinoma

ObjectiveWe aimed to investigate the cost-effectiveness of nivolumab plus chemotherapy and nivolumab plus ipilimumab versus chemotherapy in the first-line treatment for advanced esophageal squamous-cell carcinoma (ESCC) patients from a healthcare system perspective in China.MethodsOn the basis of the CheckMate 648 trial, a partitioned survival model was constructed to estimate economic costs and health outcomes among overall and PD-L1-positive advanced ESCC patients over a 10-year lifetime horizon. The health-related costs and utilities were obtained from the local charges and published literature. The lifetime costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were measured. One-way and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the model.ResultsIn the base-case analysis, in overall and PD-L1-positive advanced ESCC patients, the ICERs were $415,163.81/QALY and$216,628.00/QALY for nivolumab plus chemotherapy, and$430,704.11/QALY and$185,483.94/QALY for nivolumab plus ipilimumab, respectively, compared with chemotherapy. One-way sensitivity analyses revealed that patients’ weight was the most influential parameter on ICER. The PSA demonstrated that the probability of nivolumab combination therapy being cost-effective was 0% over chemotherapy at the current price and willingness-to-pay threshold ($38,351.20/QALY). When the price of nivolumab and ipilimumab decreased 80%, the cost-effective probability of nivolumab plus ipilimumab increased to 40.44% and 86.38% in overall and PD-L1-positive advanced ESCC patients, respectively.ConclusionNivolumab combination therapy could improve survival time and health benefits over chemotherapy for advanced ESCC patients, but it is unlikely to be a cost-effective treatment option in China

Autophagy regulates the maturation of hematopoietic precursors in the embryo

An understanding of the mechanisms regulating embryonic hematopoietic stem cell (HSC) development would facilitate their regeneration. The aorta-gonad-mesonephros region is the site for HSC production from hemogenic endothelial cells (HEC). While several distinct regulators are involved in this process, it is not yet known whether macroautophagy (autophagy) plays a role in hematopoiesis in the pre-liver stage. Here, we show that different states of autophagy exist in hematopoietic precursors and correlate with hematopoietic potential based on the LC3-RFP-EGFP mouse model. Deficiency of autophagy-related gene 5 (Atg5) specifically in endothelial cells disrupts endothelial to hematopoietic transition (EHT), by blocking the autophagic process. Using combined approaches, including single-cell RNA-sequencing (scRNA-seq), we have confirmed that Atg5 deletion interrupts developmental temporal order of EHT to further affect the pre-HSC I maturation, and that autophagy influences hemogenic potential of HEC and the formation of pre-HSC I likely via the nucleolin pathway. These findings demonstrate a role for autophagy in the formation/maturation of hematopoietic precursors.</p

Partitioning the contributions of glacier melt and precipitation to the 1971–2010 runoff increases in a headwater basin of the Tarim River

Glacier retreat and runoff increases in the last few decades characterize conditions in the Kumalak River Basin, which is a headwater basin of the Tarim River with a catchment area of 12,800 km2. To address the scientific question of whether, and to what extent, the observed runoff increase can be attributed to enhanced glacier melt and/or increased precipitation, a glacier evolution scheme and precipitation-runoff model are developed. Using the glacio-hydrological model, we find that both glacier cover area and glacier mass in the study area have decreased from 1971 to 2010. On average, the contribution to total runoff from rainfall, glacier melt and snowmelt are 60.6%, 28.2% and 11.2%, respectively. Despite covering only 21.3% of the basin area, glacier areas contributed 43.3% (including rainfall, snowmelt and glacier melt) to the total runoff from our model estimates. Furthermore, as primary causes of increased runoff in response to the warmer and wetter climate over the period 1971–2010, contribution from increases in rainfall and glacier melt are 56.7% and 50.6%, respectively. In comparison to rainfall and glacier melt, snowmelt has a minor influence on runoff increase, accounting for −7.3%. The research has important implications for water resources development in this arid region and for some similar river basins in which glacial melt forms an important part of the hydrological cycle

Autologous Skin Fibroblast-Based PLGA Nanoparticles for Treating Multiorgan Fibrosis

Fibrotic diseases remain a substantial health burden with few therapeutic approaches. A hallmark of fibrosis is the aberrant activation and accumulation of myofibroblasts, which is caused by excessive profibrotic cytokines. Conventional anticytokine therapies fail to undergo clinical trials, as simply blocking a single or several antifibrotic cytokines cannot abrogate the profibrotic microenvironment. Here, biomimetic nanoparticles based on autologous skin fibroblasts are customized as decoys to neutralize multiple fibroblast-targeted cytokines. By fusing the skin fibroblast membrane onto poly(lactic-co-glycolic) acid cores, these nanoparticles, termed fibroblast membrane-camouflaged nanoparticles (FNPs), are shown to effectively scavenge various profibrotic cytokines, including transforming growth factor-beta, interleukin (IL)-11, IL-13, and IL-17, thereby modulating the profibrotic microenvironment. FNPs are sequentially prepared into multiple formulations for different administration routines. As a proof-of-concept, in three independent animal models with various organ fibrosis (lung fibrosis, liver fibrosis, and heart fibrosis), FNPs effectively reduce the accumulation of myofibroblasts, and the formation of fibrotic tissue, concomitantly restoring organ function and indicating that FNPs are a potential broad-spectrum therapy for fibrosis management.Peer reviewe