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Adopting a sequential mixed-methods approach, the current inquiry examined English major students’ perceptions of the role of teacher confirmation and teacher credibility in enhancing their academic engagement in the Chinese context. In doing so, through WeChat messenger, three scales were provided to 1168 English major students chosen from different English as a foreign language (EFL) classes. For the sake of triangulation, 40 participants were invited to take part in interview sessions as well. The inspection of the correlations between the constructs indicated a strong association between student academic engagement and teacher confirmation as well as a close connection between student academic engagement and teacher credibility. This showed that the academic engagement of Chinese EFL students is tied to these teacher interpersonal behaviors. The contribution of teacher confirmation and credibility to Chinese EFL students’ academic engagement was also examined using path analysis, which demonstrated that Chinese EFL students’ academic engagement was predicted by teacher credibility and confirmation. Additionally, the interview outcomes proved the integral role of these two communication behaviors in increasing Chinese students’ engagement. Findings may have some noteworthy implications for teacher educators and language instructors.

Although recent years have seen a growing interest in positive emotions in second or foreign language learning and teaching, negative emotions are always present in the classroom and they deserve to be investigated in their own right. The article focuses on boredom, a construct that has been explored in educational psychology but has received only scant attention from second language acquisition researchers. It reports a study which examined the changes in the levels of boredom experienced by 13 English majors in four EFL classes and the factors accounting for such changes. Using data obtained from a few different sources (i.e., boredom grids, narratives, interviews, class evaluations and lesson plans), it was found that although boredom can be attributed to different constellations of factors, it was mainly traced to repetitiveness, monotony and predictability of what transpired during a particular class.

Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) is a noninvasive application to evaluate the hemodynamic impact of coronary artery disease by simulating invasively measured FFR based on CT data. CT-FFR is based on the assumption of a normal coronary microvascular response. We assessed the diagnostic performance of a machine-learning based application for on-site computation of CT-FFR in patients with and without diabetes mellitus with suspected coronary artery disease. The study population included 75 diabetic and 276 nondiabetic patients who were enrolled in the MACHINE consortium. The overall diagnostic performance of coronary CT angiography alone and in combination with CT-FFR were analyzed with direct invasive FFR comparison in 110 coronary vessels of the diabetic group and in 415 coronary vessels of the nondiabetic group. Per-vessel discrimination of lesion-specific ischemia by CT-FFR was assessed by the area under the receiver operating characteristic curves. The overall diagnostic accuracy of CT-FFR in diabetic patients was 83% and in nondiabetic patients 75% (p = 0.088), showing improvement over the diagnostic accuracy of coronary CT angiography, which was 58% and 65% (p = 0.223), respectively. In addition, the diagnostic accuracy of CT-FFR was similar between diabetic and nondiabetic patients per stratified CT-FFR group (CT-FFR < 0.6, 0.6 to 0.69, 0.7 to 0.79, 0.8 to 0.89, ≥0.9). The area under the curves for diabetic and nondiabetic patients were also comparable, 0.88 and 0.82 (p = 0.113), respectively. In conclusion, on-site machine-learning CT-FFR analysis improved the diagnostic performance of coronary CT angiography and accurately discriminated lesion-specific ischemia in both diabetic and nondiabetic patients suspected of coronary artery disease.

The present paper reports the findings of a quasi-experimental study which investigated the effects of strategy-based instruction targeting grammar learning strategies (GLS) on the development of autonomy in learning English grammar. Participants were 55 Polish university students, English majors in the first year of a three-year BA program, divided into an intervention group (43 students) and a control group (12 students). The intervention focused on different types of GLS and was implemented in eight 30-minute segments during regularly scheduled classes over one academic semester. The data were collected on the pretest, posttest and delayed posttest by means of the Grammar Learning Autonomy Scale (GLAS), a research instrument specifically created for the purpose of the study. Analysis of variance failed to show statistically significant differences within and between the two groups, indicating that the intervention failed to impact autonomy in learning grammar among the participants. Item-level analysis provided evidence for a positive effect of the treatment with respect to the belief that progress in learning L2 grammar depends on the teacher. Limitations of the study are presented and directions for future research are outlined.

The present study employed an interpretive approach to investigate individual learners’ viewpoints on foreign language learning boredom (FLLB). To this aim, a Q method, which shares features of both qualitative and quantitative research approaches, was used to explore 37 Iranian English as a foreign language (EFL) learners’ perceptions of potential sources of boredom in the classroom. Nonprobability purposeful sampling was used to select participants from two private language institutes in Mashhad, Iran. A hybrid-type Q sampling was employed to produce 40 statements related to the sources of FLLB. Using PQ Method, an exclusive statistical package for Q methodology, the Q sorts were intercorrelated and factor-analyzed. Three factors were extracted and rotated using varimax rotation and hand adjustment. Factor arrays and qualitative analyses were utilized to find and interpret three different accounts of FLLB. The three factors showed that the students held three divergent prototypical points of view about the sources of boredom experienced in EFL learning in class: (a) teacher-induced boredom, (b) student-induced boredom, and (c) activity-induced boredom. The findings also showed that different learner prototypes experience FLLB distinctly. Thus teachers should consider using different strategies to prevent or reduce this negative emotion in the context of L2 learning since otherwise this process could be impeded.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in women worldwide. Its social impact in the case of premature CAD is particularly devastating. Many differences in the presentation of the disease in women as compared to men, including atypical symptoms, microvascular involvement, and differences in pathology of plaque formation or progression, make CAD diagnosis in women a challenge. The contribution of different risk factors, such as smoking, diabetes, hyperlipidemia, or obesity, may vary between women and men. Certain pathological pathways may have different sex-related magnitudes on CAD formation and progression. In spite of the already known differences, we lack sufficiently powered studies, both clinical and experimental, that assess the multipathogenic differences in CAD formation and progression related to sex in different age periods. A growing quantity of data that are presented in this article suggest that thrombosis with fibrinogen is of more concern in the case of premature CAD in women than are other coagulation factors, such as factors VII and VIII, tissue-type plasminogen activator, and plasminogen inhibitor-1. The rise in fibrinogen levels in inflammation is mainly affected by interleukin-6 (IL-6). The renin–angiotensin (RA) system affects the inflammatory process by increasing the IL-6 level. Unlike in men, in young women, the hypertensive arm of the RA system is naturally downregulated by estrogens. At the same time, estrogens promote the fibrinolytic path of the RA system. In young women, the promoted fibrinolytic process upregulates IL-6 release from leukocytes via fibrin degradation products. Moreover, fibrinogen, whose higher levels are observed in women, increases IL-6 synthesis and exacerbates inflammation, contributing to CAD. Therefore, the synergistic interplay between thrombosis, inflammation, and the RA system appears to have a more significant influence on the underlying CAD atherosclerotic plaque formation in young women than in men. This issue is further discussed in this review. Fibrinogen is the biomolecule that is central to these three pathways. In this review, fibrinogen is shown as the biomolecule that possesses a different impact on CAD formation, progression, and destabilization in women to that observed in men, being more pathogenic in women at the early stages of the disease than in men. Fibrinogen is a three-chain glycoprotein involved in thrombosis. Although the role of thrombosis is of great magnitude in acute coronary events, fibrinogen also induces atherosclerosis formation by accumulating in the arterial wall and enabling low-density lipoprotein cholesterol aggregation. Its level rises during inflammation and is associated with most cardiovascular risk factors, particularly smoking and diabetes. It was noted that fibrinogen levels were higher in women than in men as well as in the case of premature CAD in women. The causes of this phenomenon are not well understood. The higher fibrinogen levels were found to be associated with a greater extent of coronary atherosclerosis in women with CAD but not in men. Moreover, the lysability of a fibrin clot, which is dependent on fibrinogen properties, was reduced in women with subclinical CAD compared to men at the same stage of the disease, as well as in comparison to women without coronary artery atherosclerosis. These findings suggest that the magnitude of the pathological pathways contributing to premature CAD differs in women and men, and they are discussed in this review. While many gaps in both experimental and clinical studies on sex-related differences in premature CAD exist, further studies on pathological pathways are needed.

Although coronary computed tomographic angiography has the ability to depict potentially malignant features of anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), there are limited data on the significance of ACAOS in the computed tomography population. The aims of this study were to assess the prevalence of ACAOS and to correlate its anatomic features with patients' symptoms among 8,522 consecutive subjects who underwent coronary computed tomographic angiography from February 2008 to May 2012. The ACAOS proximal course was classified into anterior, interarterial, septal, and retroaortic subtypes. Malignant ACAOS was recorded if a slitlike ostium, an acute angle of takeoff, an intramural course, and significant compression between the aorta and pulmonary trunk were present simultaneously. The prevalence of ACAOS was 0.84% (72 of 8,522), including right-sided origins of the left main coronary artery (n = 11), left anterior descending coronary artery (n = 9), and left circumflex coronary artery (n = 33) and left-sided origin of the right coronary artery (n = 20). Of the 24 ACAOS (0.28%) with an interarterial course, 12 (0.14%) showed significant vessel compression, of which 6 (0.07%) were classified as malignant. The presence of significant interarterial compression and malignant ACAOS type were observed in left-sided right coronary arteries only, and interarterial compression correlated with patients' symptoms at a median of 15-month follow-up. In conclusion, the computed tomographic prevalence of ACAOS seems to be comparable with that of previous angiographic studies. The malignant features of ACAOS in the adult computed tomography population might be exclusively associated with left-sided right coronary arteries.

Due to the difficulties in retrieving both the time-dependent shapes of the vessels and the generation of numerical meshes for such cases, most of the simulations of blood flow in the cardiac arteries use static geometry. The article describes a methodology for generating a sequence of time-dependent 3D shapes based on images of different resolutions and qualities acquired from ECG-gated coronary artery CT angiography. The precision of the shape restoration method has been validated using an independent technique. The original proposed approach also generates for each of the retrieved vessel shapes a numerical mesh of the same topology (connectivity matrix), greatly simplifying the CFD blood flow simulations. This feature is of significant importance in practical CFD simulations, as it gives the possibility of using the mesh-morphing utility, minimizing the computation time and the need of interpolation between boundary meshes at subsequent time instants. The developed technique can be applied to generate numerical meshes in arteries and other organs whose shapes change over time. It is applicable to medical images produced by other than angio-CT modalities.

In the field of second and foreign language (L2) anxiety studies, which are predominantly group-based, the role of individual-level inner workings of L2 anxiety has been neglected. Emerging evidence in L2 learning underscores that while aggregating data from a large number of learners reveals general trends, this approach often overlooks the distinct characteristics inherent in each individual’s data. For this reason, specialists have emphasized the necessity of illuminating unique and individualized experiences of L2 anxiety, both in short- and long-term evaluations. The present study aimed to grasp person-specific variation in L2 anxiety in Sara, an adult female L2 learner. In a year-long ecological momentary assessment study design, Sara provided daily replies to an online questionnaire about L2 anxiety. Using the dynamic P-technique, this research explored how Sara’s L2 anxiety ratings on a given day impacted or predicted her rating on the following day and the consistency of her evaluations over time. Results revealed that a four-factor structure best represented her daily L2 anxiety, comprising lack of self-confidence (LSC), fear of negative evaluation (FNE), performance anxiety (PA), and negative attitude toward language learning (NA). It was observed that on days when Sara experienced higher-than-usual LSC and FNE, her return to equilibrium was slower compared to days with heightened PA or NA. Additionally, despite daily fluctuations in the four subfactors, these factors appeared immune to fluctuations in predictor levels and did not immediately affect other subfactors. Moreover, LSC, FNE, PA, and NA exhibited positive feedback loops, where each subfactor could potentially predict another in subsequent states.

In this paper, we present 2 patients with ST-elevation myocardial infarction in the course of Spontaneous Coronary Artery Dissection. The first patient, a female admitted with STEMI, was diagnosed with SCAD with intravascular imaging and treated with IVUS-guided PCI. In the second patient, a young male hospitalized due to angina and STEMI, SCAD was not identified initially, and the patient was treated conservatively. Based on these cases, we show different faces of the same disease that imply different diagnostics and management strategies. We draw attention to the fact that the disease affects not only young women without atherosclerotic risk factors and that it is not always possible to avoid generally not recommended invasive treatment and anticoagulant therapy. The paper also discusses the disease’s pathophysiology and its diagnosis methods.