Students’ Use of Knowledge Resources in Environmental Interaction on an Outdoor Learning Trail

This study examined how students leveraged different types of knowledge resources on an outdoor learning trail. We positioned the learning trail as an integral part of the curriculum with a pre- and post-trail phase to scaffold and to support students’ meaning-making process. The study was conducted with two classes of secondary two students. We coded two groups’ discourse to examine the use of knowledge resource types in the meaning-making process in an outdoor learning setting: contextual resource, new conceptual resource, prior knowledge resource, as well as the relationship among these knowledge resource types. Next, we also examined environmental interaction and integration in the students’ use of these knowledge resource types. Analysis showed that contextual resources are chiefly instrumental in fostering students’ capacity to harness new conceptual resource and to activate prior knowledge resource in interacting with and integrating the outdoor learning environment in the meaning-making process.This research is supported by the FutureSchools@Singapore project under the Singapore National Research Foundation’s (NRF) Interactive and Digital Media (IDM) in Education Research and Development (R&D) Programme

ENHANCING EFL TEACHERS’ TECHNOLOGICAL PEDAGOGICAL CONTENT KNOWLEDGE (TPACK) COMPETENCE THROUGH REFLECTIVE PRACTICE

This study examines how reflective practices can be an effective strategy in enhancing in-service teachers’ Technological Pedagogical Content Knowledge (TPACK). The participants were two English teachers in high schools in Indonesia who designed and implemented technology-integrated lessons after participating in a professional development workshop. Data collected from their reflective journals and interviews were analyzed using thematic analysis. Findings from the interviews and teacher’s reflective journal revealed three reflective practices: reflection in, on, and for action. Reflective practices helped the teachers to describe and articulate their own experiences in teaching, learn from enacted experiences in the classroom, and apply learned practices in subsequent teaching. This virtuous cycle indicates that reflective practice is an essential mechanism for EFL teachers to become proficient in integrating technology in their teaching practices

Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia

Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner

Air-stable n-type operation of Gd-contacted carbon nanotube field effect transistors

We report air-stable n -type operations of the single-walled carbon nanotube field effect transistors (SWNT-FETs) fabricated with Gd electrodes. Unlike previously reported n -type SWNT-FETs, our devices maintained their n -type operation characteristics in ambient atmosphere for more than two months. The shallow Gd films with a thickness below 20 nm are corroded by environmental oxygen, whereas the well-contacted Gd-SWNT interfaces underneath the thick Gd layers are protected from contaminations by air molecules. Theoretical studies based on the first-principles electronic structure calculations confirm that Gd layers have an excellent binding affinity to the SWNTs.open8

Type and Severity of Migraine Determines Risk of Atrial Fibrillation in Women

OBJECTIVE: To evaluate sex differences in the risk of atrial fibrillation (AF) according to the type and severity of migraine. METHODS: We analyzed the nationwide health screening recipients in 2009 without previous AF diagnosis from the Korean National Health Insurance Service data. The diagnosis, type, and severity of migraine were determined using claims data. Newly developed AF was identified during a 10-year follow-up. Sex-difference in the effect of migraine on AF was evaluated. RESULTS: A total of 4,020,488 subjects were enrolled from January 1, to December 31, 2009 and followed-up through December 31, 2018; 4,986 subjects had migraine with aura (age 50.6 ± 14.0 years, men 29.3%); and 105,029 had migraine without aura (age 51.6 ± 14.3 years, men 30.9%). Risk of AF in a mild degree of migraine was similar to that in the control group, regardless of sex or the presence of aura. Severe migraine without aura modestly but significantly increased the risk of AF in both men and women compared to controls, with increase in AF risk being most prominent in women who had severe migraine with aura [incidence rate (IR) = 3.39, hazard ratio (HR)(adjust) = 1.48, 95% confidence intervals (CI) = 1.18–1.85]. No significant association according to aura was observed in men with severe migraines (p for interaction 0.011). CONCLUSION: Severe migraine with aura significantly increased the risk of incident AF in women, but not in men. Surveillance for incident AF and prompt lifestyle modification may be beneficial, particularly for young women suffering from severe migraine with aura

Cumulative burden of metabolic syndrome and its components on the risk of atrial fibrillation:a nationwide population-based study

BackgroundThe metabolic syndrome (MetS) and its components are associated with the development of atrial fibrillation (AF). However, the impact of time-burden of MetS on the risk of AF is unknown. We investigated the effect of the cumulative longitudinal burden of MetS on the development of AF.MethodsWe included 2 885 189 individuals without AF who underwent four annual health examinations during 2009-2013 from the database of the Korean national health insurance service. Metabolic burdens were evaluated in the following three ways: (1) cumulative number of MetS diagnosed at each health examination (0-4 times); (2) cumulative number of each MetS component diagnosed at each health examination (0-4 times per MetS component); and (3) cumulative number of total MetS components diagnosed at each health examination (0 to a maximum of 20). The risk of AF according to the metabolic burden was estimated using Cox proportional-hazards models.ResultsOf all individuals, 62.4%, 14.8%, 8.7%, 6.5%, and 7.6% met the MetS diagnostic criteria 0, 1, 2, 3, and 4 times, respectively. During a mean follow-up of 5.3 years, the risk of AF showed a positive association with the cumulative number of MetS diagnosed over four health examinations: adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of 1, 2, 3, and 4 times compared to 0 times were 1.18 (1.13-1.24), 1.31 (1.25-1.39), 1.46 (1.38-1.55), and 1.72 (1.63-1.82), respectively; P for trend ConclusionsGiven the positive correlations between the cumulative metabolic burdens and the risk of incident AF, maximal effort to detect and correct metabolic derangements even before MetS development might be important to prevent AF and related cardiovascular diseases

Associations between obesity parameters and the risk of incident atrial fibrillation and ischaemic stroke in the different age groups

OBJECTIVE: Obesity and aging are important predisposing factors to atrial fibrillation (AF) and ischaemic stroke (IS). However, limited data comprehensively evaluated the relationships between obesity measurements and AF and IS in different ages. METHODS: A total of 9,432,332 adults from the Korean National Health Insurance Service Database were included. The study population was categorized into the six age subgroups by an increase every decade from the twenties. We evaluated AF and IS risk according to body mass index (BMI) and waist circumference (WC) in the different age groups. RESULTS: During a mean follow-up of 8.2 ± 1.0 years, BMI-AF presented a J-shaped association across ages. The highest hazard ratio (HR) of the BMI ≥ 30 kg/m(2) group was observed in subjects aged 30–39 years [HR 1.80, 95% CI 1.63–1.98, p 60 years. Among the BMI ≥ 30 kg/m(2) groups, subjects aged 20–29 years presented the highest risk of IS [HR 3.00, 95% CI (2.34–3.84), p < 0.001]. Overall, WC-AF and WC-IS showed positive linear correlations, but the WC-IS association was weak in subjects aged ≥ 40 years. CONCLUSION: The higher risks of AF and IS according to an increment of BMI and WC were most apparent among the young ages. The association between obesity measurements and IS was not significantly above the midlife. Weight management in the young and integrated risk factor management in the elderly are warranted

Impact of components of metabolic syndrome on the risk of adverse renal outcomes in patients with atrial fibrillation: a nationwide cohort study

Background: The renal effect of metabolic syndrome components is unclear in patients with atrial fibrillation. This study aimed to investigate the association between metabolic syndrome components and incident end-stage renal disease among patients with atrial fibrillation. Methods: A total of 202,434 atrial fibrillation patients without prevalent end-stage renal disease were identified from the National Health Insurance Service database between 2009 and 2016. We defined the metabolic score range from 0 to 5 points such that a patient received every 1 point if the patient met each component listed in the diagnostic criteria of metabolic syndrome. The population was divided into 6 groups: MS 0–MS 5 for a metabolic score of 0–5, respectively. Multivariate Cox regression analysis was used to estimate the risks of end-stage renal disease. Results: There were 12,747, 31,059, 40,361, 48,068, 46,630, and 23,569 patients for MS 0–MS 5, respectively. Compared with MS 0, MS 5 had a higher CHA 2DS 2-VASc score (3.8 vs. 1.0) (P &lt;.001). During a median follow-up of 3.5 years, compared with MS 0, MS 1–MS 5 were associated with a gradually increasing incidence of end-stage renal disease, in relation to an increase in the metabolic score, (log-rank P &lt;.001). After multivariate adjustment, a higher metabolic score was associated with a greater risk of incident end-stage renal disease: adjusted hazard ratio [95% confidence interval] = 1.60 [0.78–3.48], 2.08 [1.01–4.31], 2.94 [1.43–6.06], 3.71 [1.80–7.66], and 4.82 [2.29–10.15], for MS 1–MS 5, respectively. Conclusions: Metabolic syndrome components additively impacts the risk of incident end-stage renal disease among patients with atrial fibrillation.</p

Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus:a nationwide population-based study

BACKGROUND: It is unclear whether mental disorders are an independent risk factor for atrial fibrillation (AF) in patients with diabetes. We aimed to investigate whether patients with diabetes who have mental disorders have an increased risk for AF. METHODS: Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with diabetes without AF between 2009 and 2012. We assessed five mental disorders: depression, insomnia, anxiety, bipolar disorder, and schizophrenia. Newly diagnosed AF was identified during the follow-up period, and multivariate Cox regression analysis was performed. RESULTS: Among the 2,512,690 patients (mean age 57.2 ± 12.3 years; 60.1% men), 828,929 (33.0%) had mental disorders. Among the five mental disorders, anxiety (68.1%) was the most common, followed by insomnia (40.0%). During a median follow-up duration of 7.1 years, new-onset AF was diagnosed in 79,525 patients (4.66 per 1,000 person-years). Patients with diabetes who had mental disorders showed a higher risk for AF (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.17–1.21; p-value < 0.001). Depression, insomnia, and anxiety were significantly associated with higher risk for AF (adjusted HR [95% CI]: 1.15 [1.12–1.17], 1.15 [1.13–1.18], and 1.19 [1.67–1.21], respectively; all p-values < 0.001), whereas bipolar disorder and schizophrenia were not. CONCLUSIONS: Mental disorders, especially depression, insomnia, and anxiety, were associated with an increased risk for AF in patients with diabetes. Greater awareness with a prompt diagnosis of AF should be considered for patients with both DM and mental disorders. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-022-01682-7

Neutrophil-to-lymphocyte ratio as a predictor of in-hospital complications and overall mortality in Takotsubo syndrome preceded by physical triggers

Background Takotsubo syndrome (TTS) with physical triggers has worse short- and long-term clinical courses than those with emotional triggers. However, predictive factors associated with poor outcomes of TTS with physical triggers are unknown. Methods We included 231 patients identified as TTS preceded by physical triggers at two tertiary referral hospitals from 2010 to 2019. In-hospital complications (IHC)—a composite of malignant arrhythmia, need for mechanical circulatory support or mechanical ventilation, and in-hospital death—and overall mortality were retrospectively reviewed. The associations with clinical features were evaluated by multivariable logistic and Cox regression analyses. Results The mean age was 69.3 ± 11.6years, and 85 (36.8%) were male. The in-hospital complications rate was 46.8%. During a median follow-up of 883days, 96 (41.6%) had died, and overall mortality was 13.6% per patient-year. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with a higher risk of IHC (area under the receiver operating characteristic curve = 0.73; positive and negative predictive value = 60.9% and 67.2% for NLR ≤ 12); odds ratio (OR) with 95% confidence interval (CI) was 1.03 (1.01–1.05), p = 0.010. Subsequently, higher NLR was also related to a greater risk of overall mortality; patients with high NLR (NLR > 12) exhibited poor long-term survival than those with low NLR (NLR ≤ 5): hazard ratio (95% CI), 3.70 (1.72–7.94) with p < 0.001. Conclusions A high NLR at initial presentation is associated with an increased risk of IHC and overall mortality in TTS preceded by physical triggers. Given that the treatment of TTS is mainly supportive, intensive monitoring with careful follow-up would be warranted in patients with high NLR.This study was funded by SNUBH Research Fund [Grant No. 14-2015-029]