Facing an Aging Society: Taiwan’s Universities in crisis

ABSTRACT

As a result of the phenomenon of a rapidly aging population and low birth rates, Taiwanese universities face a shortage of traditionally aged students and as a result must respond to older learners’ needs. In response to this demand, the Ministry of Education issued the Lifelong Learning Act in 2002 and White Paper for implementing education for older persons in an aging society in 2006. Universities now face unprecedented challenges as they play a leading role in facilitating these programs. The purpose of this article is to explore the challenges Taiwanese universities face in educating an aging society and to provide some suggestions. First, this article notes current challenges. Second, the development of the status quo of senior education is presented. Third, the changing landscape of universities is discussed. Finally, some suggestions are presented for both university administration and program developers. In conclusion, universities should grasp this opportunity to modify strategies for involving older adults.     

User-designed information tools to support communication and care coordination in a trauma hospital

BackgroundIn response to inherent inadequacies in health information technologies, clinicians create their own tools for managing their information needs. Little is known about these clinician-designed information tools. With greater appreciation for why clinicians resort to these tools, health information technology designers can develop systems that better meet clinicians’ needs and that can also support clinicians in design and use of their own information tools.ObjectiveTo describe the design characteristics and use of a clinician-designed information tool in supporting information transfer and care coordinationDesignObservations, semi-structured interviews, and photographing were used to collect data. Participants were six nurse coordinators in a high-volume trauma hospital. Content analysis was carried out and interactions with information tools were analyzed.ResultsNurse coordinators used a paper-based information tool (a nurse coordinator’s clipboard) that consisted of the compilation of essential data from disparate information sources. The tool was assembled twice daily through (1) selecting and formatting key data from multiple information systems (such as the unit census and the EHR), (2) data reduction (e.g., by cutting and whitening out non-essential items from the print-outs of computerized information systems), (3) bundling (e.g., organizing pieces of information and taping them to each other), and (4) annotating (e.g., through the use of colored highlighters and shorthand symbols). It took nurse coordinators an average of 41 min to assemble the clipboard. The design goals articulated by nurse coordinators to fit the tool into their tasks included (1) making information compatible with the mobile nature of their work, (2) enabling rapid information access and note-taking under time pressure, and (3) supporting rapid information processing and attention management through the effective use of layout design, shorthand symbols, and color-coding.ConclusionsClinicians design their own information tools based on the existing health information technologies to meet their information needs. The characteristics of these clinician-designed tools provide insights into the “realities” of how clinicians work with health information technologies. The findings suggest an often overlooked role for health information technologies: facilitating user creation of information tools that will best meet their needs.     

Tid1 functions as a tumour suppressor in head and neck squamous cell carcinoma

Human tumourous imaginal disc (Tid1), a human homologue of the Drosophila tumour suppressor protein Tid56, is involved in multiple intracellular signalling pathways such as apoptosis, cell proliferation, and cell survival. Here, we investigated the anti‐tumourigenic activity of Tid1 in head and neck squamous cell carcinoma (HNSCC) in vitro and in vivo. Firstly, the clinical association between Tid1 expression and progression of HNSCC was explored. It was found that expression of Tid1 was negatively associated with tumour status, recurrence, and survival prognosis using immunohistochemical analysis of primary HNSCC patient tumour tissue. Secondly, ectopic expression of Tid1 in HNSCC cells was shown to significantly inhibit cell proliferation, migration, invasion, anchorage‐independent growth, and xenotransplantation tumourigenicity. Thirdly, we showed that overexpression of Tid1 attenuated EGFR activity and blocked the activation of AKT in HNSCC cells, which are known to be involved in the regulation of survival in HNSCC cells. On the other hand, ectopic expression of constitutively active AKT greatly reduced apoptosis induced by Tid1 overexpression. Together, these findings suggest that Tid1 functions as a tumour suppressor in HNSCC tumourigenesis. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Operando unraveling photothermal-promoted dynamic active-sites generation in NiFe2O4 for markedly enhanced oxygen evolution

The ability to develop highly active and low-cost electrocatalysts represents an important endeavor toward accelerating sluggish water-oxidation kinetics. Herein, we report the implementation and unraveling of the photothermal effect of spinel nanoparticles (NPs) on promoting dynamic active-sites generation to markedly enhance their oxygen evolution reaction (OER) activity via an integrated operando Raman and density functional theory (DFT) study. Specifically, NiFe₂O₄ (NFO) NPs are first synthesized by capitalizing on amphiphilic star-like diblock copolymers as nanoreactors. Upon the near-infrared light irradiation, the photothermal heating of the NFO-based electrode progressively raises the temperature, accompanied by a marked decrease of overpotential. Accordingly, only an overpotential of 309 mV is required to yield a high current density of 100 mA cm⁻², greatly lower than recently reported earth-abundant electrocatalysts. More importantly, the photothermal effect of NFO NPs facilitates surface reconstruction into high-active oxyhydroxides at lower potential (1.36 V) under OER conditions, as revealed by operando Raman spectroelectrochemistry. The DFT calculation corroborates that these reconstructed (Ni,Fe)oxyhydroxides are electrocatalytically active sites as the kinetics barrier is largely reduced over pure NFO without surface reconstruction. Given the diversity of materials (metal oxides, sulfides, phosphides, etc.) possessing the photo-to-thermal conversion, this effect may thus provide a unique and robust platform to boost highly active surface species in nanomaterials for a fundamental understanding of enhanced performance that may underpin future advances in electrocatalysis, photocatalysis, solar-energy conversion, and renewable-energy production.

Motivated by the need for accelerating sluggish reaction kinetics at the anode (1, 2), the focus of water electrolysis has been centered heavily on oxygen evolution reaction (OER) toward sustainable hydrogen fuel production. To date, there has been much effort in developing low-cost yet high-performance earth-abundant transition-metal alternatives to commonly used noble metals for OER. Intriguingly, many Ni-, Co-, Fe-, and Mn-based oxides experience a dynamic surface-reconstruction process to form more active oxyhydroxides, which are recognized as true catalytically active species for OER in alkaline media (3, 4). Among various transition metal-based OER catalysts, bimetal spinel-structured oxides in the form of AB₂O₄ (A and B are different metal ions) have garnered much attention due to their rich compositions, electron configurations, and valence states (5). Interestingly, inverse spinel NiFe₂O₄ (NFO), in principle, exhibits enhanced catalytic activity toward OER because of the presence of multivalent elements (i.e., Ni³⁺/Ni²⁺ and Fe³⁺/Fe²⁺) (6). It is important to note that studies on facilitating the surface reconstruction of NFO to achieve high-performance OER are relatively few, and a fundamental understanding as to what makes the derived OER catalysts perform well remains elusive.Recently, introducing thermal energy to promote electrocatalytic conversion has attracted significant interest (7–10). The thermal energy could accelerate the motion of reactant molecules, promote their effective collisions during the reaction, and thus make it easier to overcome the activation barrier (11, 12). Moreover, the use of thermal energy could also promote the surface reconstruction of catalysts into highly active species and accelerate the electrocatalytic kinetics, thereby leading to improved efficiency (13). Electrocatalysts with photothermal effect (referred to as photothermal electrocatalysts) enable in situ heating due to photo-to-thermal conversion under illumination with visible or near-infrared (NIR) light, thereby dispensing with the need for extra devices required to provide thermal energy. More importantly, in sharp contrast to common approaches where the entire solution is heated (14), the photothermal effect is localized on electrocatalysts themselves (15), thus effectively enabling heat modulation to a defined region (i.e., the working electrode). Despite recent impressive advances in transition metal oxides (e.g., Fe₃O₄ and Co₃O₄) as photothermal agents for cancer therapy (15), their implementations for photothermal-assisted OER, in particular spinel oxides, are comparatively few and limited in scope. Moreover, it has been reported that Ni- and Co-based OER catalysts are prone to surface reconstruction into highly active oxyhydroxides (16, 17). Surprisingly, the photothermal effect on promoting surface reconstruction in spinel oxide catalysts has yet to be explored.Herein, we report an integrated operando Raman and density functional theory (DFT) plus Hubbard U (DFT + U) study to exercise and unveil the photo-to-thermal conversion of inverse spinel oxide nanoparticles (NPs) in promoting the generation of dynamic active sites via surface reconstruction into oxyhydroxides and thus greatly enhancing their OER activity. First, a series of amphiphilic star-like poly(acrylic acid)-block-poly(styrene-co-acrylonitrile) (denoted PAA-b-PSAN) diblock copolymers with a well-defined molecular weight (MW) and low polydispersity index (PDI) are exploited as nanoreactors to synthesize a set of PSAN-ligated NFO NPs with different sizes and PSAN chain lengths. The effects of the NFO NP sizes and the outer PSAN chain lengths on catalytic activity of NFO NPs are then scrutinized. Interestingly, NFO NPs of the largest size (∼12 nm) ligated with the shortest PSAN chains (M_n = 7K) display the best OER reactivity on a glassy carbon (GC) electrode in alkaline media as a result of the high fraction of the exposed electrochemically active surface area and the fastest electrocatalytic kinetics. Subsequently, the photothermal effect of PSAN-ligated NFO NPs is exploited to promote their surface reconstruction and thus boost OER. More importantly, an operando Raman spectroelectrochemistry study is performed to unveil the mechanism of photothermal-assisted enhancement in OER reaction, revealing the emergence of electrocatalytically active γ-NiOOH at a lower potential (1.36 V) during the surface-reconstruction process with a photothermal effect. Finally, the first-principle calculations substantiate that the reconstructed surface, i.e., (Ni,Fe)oxyhydroxides, plays a pivotal role as the active site for electrocatalytic reaction. As such, photothermal electrocatalysts (e.g., metal oxides, sulfides, phosphides, etc.) may render significantly low overpotential and fast OER kinetics, representing an array of important materials that couple the localized heating with electrochemistry for effective renewable-energy production.     

支气管哮喘患者外周白细胞糖皮质激素的受体变化

用放射配基结合分析法测定了外源性及内源性哮喘患者外周白细胞糖皮质激素受体（ＧＣＲ）水平，同时测定其血浆皮质醇水平。结果发现哮喘患者ＧＣＲ水平较正常对照组明显降低（Ｐ＜０．０１），其降低程度与疾病初发年龄、病程密切相关，而哮喘患者血浆皮质醇水平与正常对照组无显著差异性。提示哮喘患者肾上腺皮质功能尚未受到明显损害，但其ＧＣＲ功能存在异常。关于哮喘患者ＧＣＲ功能异常原因，我们推测与哮喘患者遗传倾向有关，同时与环境因素反复刺激、疾病反复发作有关。     

In vitro hematopoietic and endothelial potential of flk-1(-/-) embryonic stem cells and embryos

Mice deficient in the Flk-1 receptor tyrosine kinase are known to die in utero because of defective vascular and hematopoietic development. Here, we show that flk-1(-/-) embryonic stem cells are nevertheless able to differentiate into hematopoietic and endothelial cells in vitro, although they give rise to a greatly reduced number of blast colonies, a measure of hemangioblast potential. Furthermore, normal numbers of hematopoietic progenitors are found in 7.5-day postcoitum flk-1(-/-) embryos, even though 8. 5-day postcoitum flk-1(-/-) embryos are known to be deficient in such cells. Our results suggest that hematopoietic/endothelial progenitors arise independently of Flk-1, but that their subsequent migration and expansion require a Flk-1-mediated signal.     

Long-term follow-up of nonmyeloablative allogeneic stem cell transplantation for renal cell carcinoma: The University of Chicago Experience

Nonmyeloablative allogeneic stem cell transplantation (NST) has considerable activity in patients with metastatic renal cell carcinoma (RCC), although there are limited long-term follow-up data. Between February 1999 and May 2003, 18 patients with metastatic RCC underwent 19 matched-sibling NSTs after conditioning with fludarabine and cyclophosphamide with tacrolimus and mycophenolate mofetil as post-transplant immunosuppression. Among the four objective responses, all were partial and have relapsed with a median response duration of 609 days (range, 107-926). All responders are alive at a median of 41 months. Median overall survival for the entire cohort was 14 months. There were four early treatment-related deaths and one late treatment-related death. Eight patients died from progressive disease and five (28%) from treatment-related mortality. Stratifying transplant outcome as early death, intermediate (no response, no early death), or response, the combination of pre-treatment anemia and decreased performance status, was associated with adverse outcome (P = 0.015) and reduced survival (HR 5.4, 95% confidence interval of 1.4 to 21, P = 0.007). Responders demonstrated prolonged survival compared to nonresponders (P = 0.002). NST leads to durable responses in a minority of metastatic RCC patients. Appropriate patient selection is paramount. Anemia and decreased performance status may enable risk stratification.     

静脉复合丙泊酚联合三通喉罩在行无痛纤维支气管镜检查的应用

目的探讨静脉复合丙泊酚联合三通喉罩在行无痛纤维支气管镜检查的应用及效果。方法选取行纤维支气管镜检查的患者共50例分为对照组和观察组,每组25例。对照组给予静脉复合丙泊酚,观察组给予!静脉复合丙泊酚联合三通喉罩。比较两组患者麻醉前(T0)、纤支镜探查/活检时(T1)、术毕5 min(T2)3个时间点的SpO 2、收缩压及HR;观察患者呛咳发生率及纤维支气管镜检查操作耗时。结果观察组各时间点SpO 2、收缩压及HR变化波动显著小于对照组,两组比较差异具有统计学意义(P<0.05)。观察组呛咳发生率及操作耗时均显著少于对照组,两组比较差异具有统计学意义(P<0.05)。结论静脉复合丙泊酚联合三通喉罩在行无痛纤维支气管镜检查,安全性高、舒适性佳,值得临床推广应用。