Clinical implications of PNA­sequencing as a complementary test for EGFR mutation analysis in human lung cancer.

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the first-line regimen for the treatment of non-small cell lung cancer (NSCLC) patients with EGFR mutations. However, false-negative results are occasionally observed, even with FDA-approved molecular tests. Such examples in have been reported in our pilot study showing a slightly upward-shifted amplification curve using commercial reverse transcription-quantitative (RT-q)PCR. Verification using peptide nucleic acid (PNA) clamping-sequencing, which has a sensitivity of ~0.1%, may allow better prediction of which patients will benefit from EGFR-TKI therapy. To confirm this hypothesis, samples were prospectively collected from 1,783 lung cancer cases diagnosed in National Cheng Kung University Hospital between 2012-2018. An independent lung cancer cohort of 1,944 cases was also recruited from other hospitals. The clinical significance of mutant-enriched PCR with PNA-sequencing was analyzed and patient outcomes were followed. A total of 17 of 34 cases (50%) were found to harbor EGFR mutations by PNA-sequencing. A total of 22 cases were discovered in the independent lung cancer cohort, and 14 of these (63.6%) cases had EGFR mutations. TKIs were administered to 14 of the 17 mutation-positive patients, and a partial response was observed in 4 cases and stable disease in 10 cases. Patients with EGFR mutations receiving a TKI regimen had a longer overall survival (OS) (median: 40.0 vs. 10.0 months) compared with those without treatment. The difference in OS was not significant. Based on the results of the present study, combining RT-qPCR with PNA-sequencing may be a practical supplementary technology in a clinical molecular laboratory for a subset of lung cancer patients in selection of EGFR TKI therapy.

Taiwanese parents' perspectives on young children's use of information communication technology.

Introduction: How parents think and feel about their children's use of technology can influence how their kids behave online. The family's socioeconomic status (SES) may also affect this influence. In light of this, this research emphasizes the need for more investigation into parental attitudes and the role of SES in shaping how children consume media. Methods: This study surveyed 629 Taiwanese parents to explore their attitudes toward their young children's use of information communication technology (ICT), usage patterns, and the interplay with socioeconomic status. Results: The findings revealed a significant disconnect: although approximately 50% of parents considered above six years old to be a suitable age for children to start ICT, over 80% of children had already engaged with ICT before that age, indicating a large disparity between parental expectations and actual initiation. Furthermore, parents highlighted "learning interest" and "various content" as the most positive impacts of children's ICT use, while "addiction and overreliance" emerged as their primary concern. Notably, parents, as a whole, tended to perceive their child's ICT use more negative than positively, with fathers displaying greater acceptance of negative viewpoints than mothers. Parental attitudes toward children's ICT use were categorized into five clusters, ranging from balanced and optimistic views to value emphasis, conservatism, and negative doubts. This classification underscores the intricate and multifaceted nature of parental perspectives, encompassing both positive and negative outlooks on children's ICT utilization. Discussion: The findings underscore the nuanced character of parents' attitudes toward technology, shaped by the intricacies and challenges posed by the digital era. These insights emphasize that parental attitudes go beyond a simplistic positive-negative divide, reflecting a comprehensive response to the opportunities and complexities inherent in the digital age.

Gender Differences in Subclinical Coronary Atherosclerosis in the Asian Population With a Coronary Artery Calcium Score of Zero.

There is little evidence on whether gender difference influences the incidence of subclinical coronary atherosclerosis in Asian populations with a 0 score. In this study, we investigated the influence of age and gender on the extent of subclinical coronary atherosclerotic burden within a healthy Asian population with a 0 coronary artery calcium (CAC) score. A total of 934 participants (320 women and 614 men) from Taiwan's Han Chinese population with an initial CAC score of 0 were included in this study. They underwent 2 consecutive cardiac computed tomography scans over a clinical follow-up period of 4.35 ± 2.37 years. Clinical information and laboratory measurements were collected for analysis. Compared with the female group, the male group demonstrated significantly higher rates of subclinical CAC progression (27.4% vs 13.8%, p <0.001). Across the age group deciles (≤40, 41 to 50, 51 to 60, ≥61 years), the male group had a higher prevalence of subclinical CAC progression than the female group. For the subclinical CAC progression, the logistic regression model demonstrated that age, gender (male gender), cholesterol level, and follow-up period were statistically significant parameters. In conclusion, these findings support that a gender difference impacts the long-term natural course of subclinical coronary calcification conversion in women compared with men, suggesting that the gender-based effect on coronary CAC conversion plays an important role in subclinical coronary atherosclerosis risk stratification in personalized preventive medicine.

The relationships among Taiwanese youth's polychronicity, multitasking behavior and perceived learning performance in online learning.

Background: The advancement of digital technology implies the importance of polychronic learning. Since polychronicity is not equivalent to multitasking behavior, they need to be considered separately. However, less research has been explored on how polychronicity is related to multitasking behavior in the educational field. Objective: To explore the relationships among polychronicity, multitasking behavior and learning performance (including knowledge acquisition and learning satisfaction) in an online learning environment. Methods: The relationship among variables was analyzed from 865 responses obtained from a questionnaire survey, and independent sample t tests and SEM analysis were used to examine the research hypotheses. Results: College students showed a higher frequency of multitasking behavior, time tangibility and scheduling preference, and learning satisfaction in multitasking online learning environments than high school students. Additionally, college students were different from high school students on the paths of involvement with people to multitasking behavior (Δ χ 2= 5.42, p = 0.02) and scheduling preference to learning satisfaction (Δχ 2 = 9.54, p = 0.002). Conclusion: The relationship among polychronicity, multitasking behavior and perceived learning performance in an online learning environment varies by student educational stage.

High concordance rate of capillary electrophoresis workflow for microsatellite instability analysis and mismatch repair (MMR) immunostaining in colorectal carcinoma.

Microsatellite instability (MSI) is the primary predictive biomarker for therapeutic efficacies of cancer immunotherapies. Establishment of the MSI detection methods with high sensitivity and accessibility is important. Because MSI is mainly caused by defects in DNA mismatch repair (MMR), immunohistochemical (IHC) staining for the MMR proteins has been widely employed to predict the responses to immunotherapies. Thus, due to the high sensitivity of PCR, the MSI-PCR analysis has also been recommended as the primary approach as MMR IHC. This study aimed to develop a sensitive and convenient platform for daily MSI-PCR services. The routine workflow used a non-labeling QIAxcel capillary electrophoresis system which did not need the fluorescence labeling of the DNA products or usage of a multi-color fluorescence reader. Furthermore, the 15 and 1000 bp size alignment markers were used to precisely detect the size of the DNA product. A cohort of 336 CRC cases was examined by MSI-PCR on the five mononucleotide MSI markers recommended by ESMO. The PCR products were analyzed in the screening gels, followed by high-resolution gel electrophoresis for confirmation if needed. In the MSI-PCR tests, 90.1% (303/336) cases showed clear major shift patterns in the screening gels, and only 33 cases had to be re-examined using the high-resolution gels. The cohort was also analyzed by MMR IHC is, which revealed 98.5% (331/336) concordance with MSI-PCR. In the five discordant cases, 4 (3 MSI-L and 1 MSS) showed MSH6 loss. Besides, one case exhibited MSI-H but no loss in the MMR IHC. Further NGS analysis, in this case, found that missense and frameshift mutations in the PMS2 and MSH6 genes occurred, respectively. In conclusion, the non-labeling MSI-PCR capillary electrophoresis revealed high concordance with the MMR IHC analysis and is cost- and time-effective. Therefore, it shall be highly applicable in clinical laboratories.

Exploring the Impacts of Preventative Health Behaviors with Respect to COVID-19: An Altruistic Perspective.

This study aims to explore the impact of gender and anxiety on various preventative health behaviors, and the relationships among these preventative health behaviors, individual well-being and depression, from the perspective of altruism. This study employed an online questionnaire survey, and 136 males and 204 females participated in the survey. The results of this study showed that females exhibited better preventative health behaviors than males, including hygiene habits, social distancing and behaviors intended to help others mitigate the epidemic. Anxiety regarding COVID-19 infection encouraged individuals to adopt hygienic habits and social distancing measures rather than to help others mitigate the epidemic. Hygiene habits improved the individual's psychological well-being. Helping others mitigate the epidemic improved the individual's psychological well-being and social well-being and contributed to reducing individual depression. However, the preventative health behavior involved in social distancing was not conducive to emotional well-being or social well-being. Affective elements are related to individual behaviors. Therefore, the use of prosocial, altruistic language may play an important role with respect to encouraging people to comply with preventative health behaviors in the context of COVID-19. In addition, it is worth noting that different preventative health behaviors may have different effects on people's mental health, especially when implementing social distancing-related epidemic mitigation behaviors. The question of how to prevent negative psychological effects in restricted actors must be answered, and the degree of life satisfaction experienced by those actors must also be taken into account.

The Associations among Gender, Age, eHealth Literacy, Beliefs about Medicines and Medication Adherence among Elementary and Secondary School Teachers.

Background: A lack of health literacy may negatively impact patient adherence behavior in health care delivery, leading to a major threat to individual health and wellbeing and an increasing financial burden on national healthcare systems. Therefore, how to cultivate citizens' health literacy, especially electronic health (eHealth) literacy that is closely related to the Internet, may be seen as a way to reduce the financial burden of the national healthcare systems, which is the responsibility of every citizen. However, previous studies on medication adherence have mostly been conducted with chronic disease patient samples rather than normal samples. Teachers are not only the main body of school health efforts, but also role models for students' healthy behavior. Therefore, understanding differences in eHealth literacy beliefs among schoolteachers would be helpful for improving the existing health promoting programs and merit specific research. Aims: The present study identified the relationships among gender, age, electronic health (eHealth) literacy, beliefs about medicines, and medication adherence among elementary and secondary school teachers. Methods: A total of 485 teachers aged 22−51 years completed a pen-and-paper questionnaire. The instruments included an eHealth literacy scale, a belief about medicines scale and a medication adherence scale. Results: The results showed a significant difference between genders in necessity beliefs about medication (t = 2.00, p < 0.05), and a significant difference between ages in functional eHealth literacy (F = 3.18, p < 0.05) and in necessity beliefs about medication (Welch = 7.63, p < 0.01). Moreover, age (ß = 0.09), functional eHealth literacy (ß = 0.12), and necessity beliefs about medication (ß = 0.11) positively predicted medication adherence, while concerns about medication (ß = −0.23) negatively predicted medication adherence. Conclusions: The results showed that male teachers had stronger concerns about medication than female teachers. Teachers aged 42−51 years had lower functional eHealth literacy and stronger necessity beliefs about medication than teachers aged 22−31 years. In addition, teachers who were older, had higher functional eHealth literacy, had stronger necessity beliefs about medication, and had fewer concerns about medication tended to take their medications as prescribed. These findings revealed that helping teachers develop high eHealth literacy and positive beliefs about medicines is an effective strategy for improving medication adherence.

Radiomics in Early Lung Cancer Diagnosis: From Diagnosis to Clinical Decision Support and Education.

Lung cancer is the most frequent cause of cancer-related death around the world. With the recent introduction of low-dose lung computed tomography for lung cancer screening, there has been an increasing number of smoking- and non-smoking-related lung cancer cases worldwide that are manifesting with subsolid nodules, especially in Asian populations. However, the pros and cons of lung cancer screening also follow the implementation of lung cancer screening programs. Here, we review the literature related to radiomics for early lung cancer diagnosis. There are four main radiomics applications: the classification of lung nodules as being malignant/benign; determining the degree of invasiveness of the lung adenocarcinoma; histopathologic subtyping; and prognostication in lung cancer prediction models. In conclusion, radiomics offers great potential to improve diagnosis and personalized risk stratification in early lung cancer diagnosis through patient-doctor cooperation and shared decision making.

Exploration of Students' Perception of Academic Misconduct: Do Individual Factors, Moral Philosophy, Behavioral Intention, and Judgment Matter?

Using Reidenbach and Robin's Multidimensional Ethics Scale, this study designs three scenarios related to academic dishonesty (AD) dilemmas to explore students' moral philosophies, behavioral intentions, and ethical judgments and further examines whether students with different individual factors (i.e., culture of place, gender, and educational level) have differences in the above variables. A total of 605 students from two areas, Taiwan and Mainland China, participated in this study. The results indicated that Taiwanese students had stricter moral equity, relativism, and contractualism philosophies in the duplicate submission scenario than Mainland China students. They also had stricter moral equity and relativism philosophies in the incomplete citation scenario. Similarly, relatively harsh relativism and contractualism philosophies accompanied by a low level of willingness to be a perpetrator in the failure to cite research published in other countries scenario were found. In addition, females applied relatively harsh moral equity and utilitarianism to all scenarios, reporting that they and their peers were less likely to engage in all AD activities. Graduates had a stricter egoism attitude toward duplicate submission and had stricter moral equity, relativism, and contractualism philosophies toward the behavior of incomplete citation. Graduate students also had strict moral equity, relativism, egoism, and contractualism beliefs in the failure to cite the foreign research scenario. Finally, regression analysis showed that moral equity, contractualism, and self-behavioral intention are significant predictors of students' ethical evaluations in the three scenarios.

Knowledge, Attitude, and Practice (KAP) toward COVID-19 Pandemic among the Public in Taiwan: A Cross-Sectional Study.

Purpose: Knowledge, attitude, and practice (KAP) models are often used by researchers in the field of public health to explore people's healthy behaviors. Therefore, this study mainly explored the relationships among participants' sociodemographic status, COVID-19 knowledge, affective attitudes, and preventive behaviors. Method: This study adopted an online survey, involving a total of 136 males and 204 females, and used a cross-sectional study to investigate the relationships between variables including gender, age, COVID-19 knowledge, positive affective attitudes (emotional wellbeing, psychological wellbeing, and social wellbeing), negative affective attitudes (negative self-perception and negative perceptions of life), and preventive behaviors (hygiene habits, reducing public activities, and helping others to prevent the epidemic). Results: The majority of participants in the study were knowledgeable about COVID-19. The mean COVID-19 knowledge score was 12.86 (SD = 1.34, range: 7−15 with a full score of 15), indicating a high level of knowledge. However, the key to decide whether participants adopt COVID-19 preventive behaviors was mainly their affective attitudes, especially positive affective attitudes (ß = 0.18−0.25, p< 0.01), rather than COVID-19 disease knowledge (ß = −0.01−0.08, p > 0.05). In addition, the sociodemographic status of the participants revealed obvious differences in the preventive behaviors; females had better preventive behaviors than males such as cooperating with the epidemic prevention hygiene habits (t = −5.08, p< 0.01), reducing public activities (t = −3.00, p< 0.01), and helping others to prevent the epidemic (t = −1.97, p< 0.05), while the older participants were more inclined to adopt preventive behaviors including epidemic prevention hygiene habits (ß = 0.18, p = 0.001, R2 = 0.03), reducing public activities (ß = 0.35, p< 0.001, R2 = 0.13), and helping others to prevent the epidemic (ß = 0.27, p< 0.001, R2 = 0.07). Conclusions: Having adequate COVID-19 knowledge was not linked to higher involvement in precautionary behaviors. Attitudes toward COVID-19 may play a more critical function in prompting individuals to undertake preventive behaviors, and different positive affective attitudes had different predictive relationships with preventive behaviors.

Impact of Smoking Status on Lung Cancer Characteristics and Mortality Rates between Screened and Non-Screened Lung Cancer Cohorts: Real-World Knowledge Translation and Education.

This was a retrospective hospital-based cohort study of participants diagnosed with lung cancer in the lung cancer register database, and our goal was to evaluate the impact of smoking and screening status on lung cancer characteristics and clinical outcomes. According to the hospital-based lung cancer register database, a total of 2883 lung cancers were diagnosed in 2883 patients between January 2007 and September 2017, which were divided into four groups according to smoking and screening status. A comparison was performed in terms of clinical characteristics and outcomes of lung cancer between the four groups. For non-smokers, age, gender, screened status, tumor size, targeted therapy, and curative surgery were independent prognostic factors of overall survival for lung cancer subjects. However, screened status and gender were not significant prognostic factors for lung cancer survival in smokers with lung cancer. For the non-smoker group, about 4.9% of lung cancer subjects (N = 81) were detected by screening. However, only 0.97% of lung cancer subjects (N = 12) were detected by screening in smokers. This could be attributed to smokers' negative attitudes and low socioeconomic status preventing LDCT lung cancer screening. In summary, our real-world data suggest that effectively encouraging smokers to be more willing to participate in lung cancer screening programs with screening allowance and educational training in the future is an important issue.

eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study.

BACKGROUND: Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students' eHealth literacy and beliefs about medicines, as well as gender differences. OBJECTIVE: This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students. METHODS: We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses. RESULTS: The t test (t473=3.73; P<.001; t473=-2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed. CONCLUSIONS: These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines.

The Relationships among Anxiety, Subjective Well-Being, Media Consumption, and Safety-Seeking Behaviors during the COVID-19 Epidemic.

The COVID-19 epidemic has been confirmed as the largest scale outbreak of atypical pneumonia since the outbreak of severe acute respiratory syndrome (SARS) in 2003 and it has become a public health emergency of international concern. It exacerbated public confusion and anxiety, and the impact of COVID-19 on people needs to be better understood. Indeed, prior studies that conducted meta-analysis of longitudinal cohort research compared mental health before versus during the COVID-19 pandemic and proved that public health polices (e.g., city lockdowns, quarantines, avoiding gatherings, etc.) and COVID-19-related information that circulates on new media platforms directly affected citizen's mental health and well-being. Hence, this research aims to explore Taiwanese people's health status, anxiety, media sources for obtaining COVID-19 information, subjective well-being, and safety-seeking behavior during the COVID-19 epidemic and how they are associated. Online surveys were conducted through new media platforms, and 342 responses were included in the analysis. The research results indicate that the participants experienced different aspects of COVID-19 anxiety, including COVID-19 worry and perceived COVID-19 risk. Among the given media sources, the more participants searched for COVID-19 information on new media, the greater they worried about COVID-19. Furthermore, COVID-19 worry was positively related to safety-seeking behavior, while perceived COVID-19 risk was negatively related to subjective well-being. This paper concludes by offering some suggestions for future studies and pointing out limitations of the present study.

New Media Literacy, Health Status, Anxiety, and Preventative Behaviors Related to COVID-19: A Cross-Sectional Study in Taiwan.

Internet media may exacerbate public confusion and anxiety about COVID-19. New media health literacy (NMHL) is considered to play a protective role against health-related misinformation from the media for individuals to maintain their health. The current study aims to examine the relationship among Taiwanese adults' NMHL, health status, anxiety, and prevention behaviors during the COVID-19 pandemic. This cross-sectional study was conducted through an online survey, and 342 responses were included in the analysis. The survey tools include Health Status, COVID-19-Related New Media Health Literacy, COVID-19 Anxiety, and COVID-19 Preventive Behaviors. The research showed that both functional and critical prosuming literacy had positive relationships with health status. Functional consumption literacy had a weak negative correlation with COVID-19 anxiety. Furthermore, critical consumption literacy had a positive relationship with COVID-19 preventive behaviors. Therefore, individuals' health, anxiety, and prevention behaviors are affected by different aspects of COVID-19-related new media health literacy. Compared to their consuming media literacy, Taiwanese adults have insufficient prosuming media literacy in regard to COVID-19 health issues.

Development of a novel ALK rearrangement screening test for non-small cell lung cancers.

Approximately 5-7% of non-small cell lung cancer (NSCLC) cases harbor an anaplastic lymphoma kinase (ALK) fusion gene and may benefit from ALK inhibitor therapy. To detect ALK fusion genes, we developed a novel test using reverse transcription polymerase chain reaction (RT-PCR) for the ALK kinase domain (KD). Since ALK expression is mostly silenced in the adult with the exception of neuronal tissue, the normal lung tissue, mesothelial lining, and inflammatory cells are devoid of ALK transcript, making ALK KD RT-PCR an ideal surrogate test for ALK fusion transcripts in lung or pleural effusion. The test was designed with a short PCR product (197 bp) to work for both malignant pleural effusion (MPE) and formalin-fixed, paraffin-embedded (FFPE) NSCLC samples. Using ALK IHC as a reference, the sensitivity of the test was 100% for both MPE and FFPE. The specificity was 97.6% for MPE and 97.4% for FFPE. Two false positive cases were found. One was a metastatic brain lesion which should be avoided in the future due to intrinsic ALK expression in the neuronal tissue. The other one resulted from ALK gene amplification. Due to potential false positivity, subsequent confirmation tests such as fluorescence in situ hybridization or multiplex PCR would be preferable. Nevertheless, the test is simple and inexpensive with no false negativity, making it a desirable screening test. It also offers an advantage over multiplex RT-PCR with the capability to detect novel ALK fusions. Indeed through the screening test, we found a novel ALK fusion partner (sperm antigen with calponin homology and coiled-coil domains 1 like gene, SPECC1L) with increased sensitivity to crizotinib in vitro. In summary, a novel RNA-based ALK KD analysis was developed for ALK rearrangement screening in MPE and FFPE specimens of NSCLC. This simple inexpensive test can be implemented as routine diagnostics.

The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study.

BACKGROUND: The mass media have been condemned for encouraging young people to take dietary supplements (DS). Media literacy, which includes authors and audiences (AA), messages and meanings (MM), and representation and reality (RR) domains, is a new approach to teaching young adults to make better informed health decisions. However, it is not clear which domains are the most important for media literacy education. OBJECTIVE: The purpose of this study is to investigate the associations among individual factors, media literacy, and DS use. METHODS: The survey instrument included demographic items, the DS Media Literacy Scale (DSMLS), and DS use items (users or nonusers, types of DS, current use of DS, and intention to use DS in the future). The DSMLS is an 11-item instrument designed to assess college students' AA, MM, and RR media literacy in relation to DS. A total of 467 Taiwanese college students participated in the study. Descriptive statistical analysis, logistic regression analysis, and multiple regression analysis were conducted. RESULTS: A total of 338/467 (72.4%) participants reported using DS, and 176/467 (37.7%) consumed 3 or more supplements. Moreover, the MM media literacy domain was associated with having been a DS user (odds ratio 0.63, P=.002), current DS use (ß=-.10, P=.02), and intention to use DS in the future (ß=-.12, P=.011). Finally, perceived importance of health was positively related to current DS use (ß=.18, P=.001) and intention to use DS in the future (ß=.18, P=.001). CONCLUSIONS: This study showed that the majority of Taiwanese college students were DS users and used multiple types of supplements. Moreover, students with lower MM media literacy were more likely to be DS users, to take DS more frequently, and to have higher intentions for future frequent DS use. Finally, those who placed extreme importance on health were more likely to take DS frequently and have higher intentions for future frequent DS use.

The Associations between Individual Factors, eHealth Literacy, and Health Behaviors among College Students.

BACKGROUND: This study aimed to investigate the associations between individual factors, electronic health (eHealth) literacy, dietary behaviors, and exercise habits in college students, as well as the moderating effect of gender on the above target behaviors. METHODS: A pen-and-paper questionnaire with a stratified sampling method was used to collect data, and at least 100 students from each stratum were determined to be used for the official sample in this study. Finally, 674 students completed the survey. RESULTS AND CONCLUSIONS: Chi-square test results demonstrated that genders had dissimilar dietary supplement use and subjective health status. Further analyses indicated females had a higher likelihood of taking dietary supplements and poorer subjective health statuses. The t-test results indicated that the functional eHealth literacy, dietary behaviors, and exercise habits of genders were different, and the mean scores showed that males had higher functional eHealth literacy, healthier dietary behaviors, and higher exercise involvement than females. Regression analyses showed that students who were male, took dietary supplements, placed the utmost importance on health, and had high critical eHealth literacy tended to possess healthy dietary behaviors. Students who were male and had good subjective health statuses tended to have higher exercise involvement. Specifically, the critical eHealth literacy changed dietary behaviors less effectively for women than for men, and the subjective health status changed exercise habits less effectively for women than for men. Therefore, when designing the diet and exercise intervention programs, gender-specific programs rather than generic programs should be given priority to develop.

Electronic Health Literacy and Dietary Behaviors in Taiwanese College Students: Cross-Sectional Study.

BACKGROUND: Given the recognized importance of preventing poor dietary behaviors during adolescence, we need a better understanding of college students' dietary behaviors. Studies have found that individual factors and electronic health (eHealth) literacy may affect one's dietary behaviors. However, few studies have fully investigated the effect of the three levels of eHealth literacy (functional, interactive, and critical) and the interactive effect of individual factors (eg, gender, monthly expenses, and frequency of cooking) and the three levels of eHealth literacy on the four aspects of dietary behaviors (consumer health, balanced diet, regular eating habits, and unhealthy food intake). OBJECTIVE: This study aimed to investigate whether individual differences and higher eHealth literacy are associated with more positive dietary behaviors and less unhealthy dietary intake. METHODS: The eHealth Literacy Scale is a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy. The Dietary Behaviors Scale is a 14-item instrument developed to measure four aspects of dietary behaviors of college students. A questionnaire was administered to collect background information about participants' gender, monthly expenses, and frequency of cooking. A national sample of college students was surveyed, and 813 responses were obtained. We conducted a multiple regression analysis to examine the association among individual factors, eHealth literacy, and dietary behaviors. RESULTS: This study found that functional eHealth literacy was negatively related to unhealthy food intake (beta=-.11; P=.01), and interactive eHealth literacy was positively related to balanced diet (beta=.25; P<.001) and consumer health (beta=.15; P=.02). Moreover, critical eHealth literacy was positively related to consumer health (beta=.30; P<.001) and regular eating habits (beta=.20; P=.002). Finally, the interactive effect between gender and interactive eHealth literacy was negatively related to balanced diet (beta=-.22; P<.001). The interactive effect between monthly expenses and functional eHealth literacy was positively related to balanced diet (beta=.07; P=.03), although the interactive effect between monthly expenses and critical eHealth literacy was negatively related to balanced diet (beta=-.10; P=.047). CONCLUSIONS: This study showed that Taiwanese college students with higher functional eHealth literacy were more likely to engage in fewer unhealthy food consumption practices. Those who had higher interactive and critical eHealth literacy were more likely to engage in positive dietary behaviors than those with functional eHealth literacy. Surprisingly, females with high interactive eHealth literacy were more likely to have a poor balanced diet. In contrast, students with higher monthly expenses and higher functional eHealth literacy were more likely to have a balanced diet. However, students with higher monthly expenses and higher critical eHealth literacy were less likely to maintain a balanced diet.

Five Technologies for Detecting the EGFR T790M Mutation in the Circulating Cell-Free DNA of Patients With Non-small Cell Lung Cancer: A Comparison.

Third-generation tyrosine kinase inhibitors (TKIs) were developed to overcome T790M-mediated resistance to earlier generations of epidermal growth factor receptor (EGFR)-targeted TKIs. We compared four well-established and one in-house method for the analysis of the EGFR T790M mutation in plasma cell-free DNA (cfDNA), in hope to find a better way to select non-small cell lung cancer (NSCLC) patients appropriate for 3rd-generation TKI therapy. For sensitivity levels of each method, plasmid DNA with EGFR T790M mutations was serially diluted with cfDNA from healthy controls with wild type EGFR. The clinical performance was analyzed in a clinical cohort of EGFR mutation-positive NSCLC patients with acquired EGFR TKI resistance (n = 40). All methods except the therascreen kit (Qiagen) had a sensitivity level of 10 copies of T790M plasmid DNA in the spiked specimen. The detection rates of the EGFR T790M mutation in plasma cfDNA from the clinical cohort were 42.5, 35, 32.5, 22.5, and 17.5% for the in-house ARMS method, Bio-Rad droplet digital PCR, PANAMutyper, Therascreen EGFR Plasma RGQ PCR Kit and Cobas EGFR Mutation kit (with suboptimal template amounts), respectively. Osimertinib was given to 17 of 20 patients with EGFR T790M mutations. The best treatment responses, based on the RECIST criteria, included 6 partial responses (PR) and 7 stable diseases (SD). The PANAMutyper and the Bio-Rad droplet digital PCR were comparable, the Cobas EGFR Mutation kit required significantly more template for testing. The best combination would be the in-house ARMS method plus the PANAMutyper or Bio-Rad droplet digital PCR, which would have a detection rate of 50% (20/40) and a disease control rate of 76% (13/17).