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Flipped classrooms have been shown to be an effective teaching mode that fosters students' self-learning, stimulates learning motivation, and improves academic performance. However, preparation work and after-class assignments take up a large portion of students' and teachers' time outside the classroom, putting enormous strain on both parties. This study explores the time spent by teachers and students under the current flipped classroom mode and its impact on them from the perspective of junior high school English teachers and then proposes a full-flipped classroom mode to solve these problems. To this end, eight junior high school English teachers who had implemented flipped classroom teaching in a specific district in China were interviewed. The collected data were processed using thematic analysis. The results showed that the current flipped classroom mode does increase the outside-classroom burden for both students and teachers. The learning burden leaves students lacking in exercise and opportunities to develop interests, which is detrimental to their physical, mental, and overall development. The out-of-class burden hinders teachers from achieving work-life balance and is detrimental to their physical and mental health, as well as their professional growth. Based on the views of the interviewees and existing in-class flipped mode, this study provides a full-flipped classroom mode that is in line with Chinese students' actual language learning to concretize the in-class flipped pattern and present its specific steps in language teaching, which integrates all preclass preparation, postclass assignments, and assignment evaluation into one class, including four teaching sessions: preview and lecture, preview tasks, consolidation assignments, and evaluation and feedback.

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Teacher education students, as an important reserve in the field of education, their growth and development are related to the future of science, economy, sustainable development of education. Through participation in the educational practice of STEAM, which integrates science, technology, engineering, art, and mathematics is more beneficial for them to acquire 21st century skills like communication, collaboration, learning innovation and critical thinking. However, little has been seen about the use and effectiveness of short videos in STEAM education activities and how they can be used to support and promote teacher education students STEAM learning performance and sustainable inquiry behaviors. Therefore, this study combines the framework of triadic reciprocity determinism theory and technology acceptance theory to propose six research hypotheses and develop a research model to explore the relationship between collaborative self-efficacy (CS-E), perceived usefulness (PU) of short videos, perceived ease of use (PEOU), STEAM learning performance and teacher education students' sustainable inquiry behavior. To achieve the purpose of this study, this study used purposive sampling and invited teacher education students from five classes of preschool education at a university in Guangxi Zhuang Autonomous Region (GZAR), China, to participate in this study. A total of 8 h of instructional guidance was provided over a four-week period, in which participants used short videos for collaborative group learning and independent inquiry and applied STEAM concepts to kindergarten science activities. Participants' STEAM performance was measured and surveyed during the fourth week. The results of the study validation showed that (1) teacher education students CS-E had a positive effect on the PU and PEOU of short videos; (2) Teacher's education students PEOU of short videos had a positive effect on usefulness; (3) Teacher's education students PU and PEOU of short videos had a positive effect on STEAM learning performance; (4) Teacher's education students' STEAM learning performance had a positive effect on sustainable inquiry behavior.

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UN Sustainable Development Goal 3 states that "Ensuring healthy lives and promoting well-being at all ages is essential to sustainable development." The sustainable well-being of college teachers deserves attention. Currently, college teachers in China are facing enormous challenges and pressures, which may increase their emotional exhaustion (EE) and hinder the sustainable development of their well-being (WB). Therefore, this study examined Chinese college teachers' well-being in relation to their work-life balance (WLB) and EE. An online survey was conducted. The valid subjects included 586 college teachers (367 females, 62.6%). We assessed their WLB, EE, and WB. The results revealed that among the Chinese college teachers, (1) WLB was negatively correlated with EE, but positively correlated with WB; EE was negatively correlated with WB; (2) EE partially mediated the relationship between WLB and WB; and (3) College teachers who are male, class tutors, and in public colleges scored higher on EE and lower on WLB and WB than those who are female, non-class tutors, and in private colleges, respectively. The findings indicated that WLB is an important factor for the sustainable development of the well-being of college teachers, and special attention should be paid to college teachers who are male, class tutors, and in public colleges in China.

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The preschool education profession often faces many challenges and preschool teachers, as important members of the preschool education profession must respond to a variety of emergencies with young children, which also leads to high levels of job stress and can have a negative impact on their ongoing well-being. Past research has pointed out that a healthy lifestyle is one of the key factors in enhancing sustainable well-being in high-stress work situations and many studies have found that good leisure activity engagement as a healthy lifestyle is associated with higher levels of well-being. However, the relationship between preschool teachers' leisure engagement and sustainable well-being has been less explored. Therefore, this study proposed seven research hypotheses based on the engagement theory proposed by Fredricks et al. (2004) and developed a research model to explore the relationship between three types of leisure engagement, including behavioral, affective and cognitive, and preschool teachers' job stress and sustainable well-being, using age as a control variable. This study used a cross-sectional web-based questionnaire with a convenience sample of 500 preschool teachers in China. The collected data were analyzed for reliability and validity, model fit testing and structural equation modeling for model validation after removing invalid data and incomplete responses. The results of the study showed that (a) behavioral engagement was not related with either the job stress or sustainable well-being of preschool teachers; (b) Emotional and cognitive engagement were negatively related to job stress but positively related to the sustainable well-being of preschool teachers; and (c) Job stress was negatively related to the sustainable well-being of preschool teachers; (d) Age is an effective control variable. From the above results, it is clear that not all three types of leisure engagement are effective in terms of reducing the work stress of preschool teachers. As well as being related to the sustainable well-being of preschool teachers emotional and cognitive engagement contributed more to sustainable well-being acquisition.

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The academic performance of teacher education students predicts their future career development and it is also a significant factor related to their future students' academic performance. However, little is known about the associations between perceived classroom climate, student engagement and academic performance, especially for English-major teacher education students. This study was to examine English-major teacher education students' academic performance in relation to perceived classroom climate, student engagement. The questionnaire consisted of the Emotional Classroom Climate Scale, the Utrecht Work Engagement Scale - Student Form-3 Item (UWES-SF-3), and the 5-item Academic Performance Scale. This study investigated 307 English-major teacher education students in Guangxi, China. Among them, 280 (91.2%) were females, and 27 (8.8%) were males, aged between 18 and 24 (M = 20.34, SD = 1.26). Results indicated that perceived classroom climate was positively associated with student engagement and academic performance among English-major teacher education students; their student engagement was positively associated with their academic performance, and student engagement partially mediated the relationship between perceived classroom climate and academic performance. The findings supported the motivational process of study demands-resources (SD-R) model and revealed that perceived classroom climate and student engagement were significant factors linked to academic performance, and practical suggestions were discussed.

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The post-COVID-19 era means that the COVID-19 is basically under control; however, the risk of the pandemic still affects people's work, study, and life, physically and psychologically. In this era, due to the more challenges first-year college students face, more attention should be paid to their mental health. An emerging study demands-resources (SD-R) model can explain the influencing mechanism of college students' mental health. This model suggests that study demands increase the risk of student burnout, which results in mental health problems; meanwhile, study resources reduce student burnout and increase student engagement, thus improving mental health. Based on the SD-R model, this study explores the impacts of time pressure, emotional exhaustion, perceived social support, and student engagement on mental health and provides adequate measures to reduce the risk of mental health problems among first-year students. Time pressure, perceived social support, emotional exhaustion, student engagement, and mental health scales were used to investigate 537 first-year students at three universities in Guangxi, China, of whom 290 (54%) were female, and 247 (46%) were male, and the average age was 18.97 ± 1.01. Results indicated that: (1) Moderate scores on time pressure and emotional exhaustion and slightly-above-the-median scores on perceived social support, student engagement, and mental health were found among first-year students in the post-COVID-19 era. (2) Time pressure had a positive relationship with emotional exhaustion and a negative relationship with mental health. (3) Perceived social support was negatively correlated with emotional exhaustion but positively correlated with student engagement, and thus improved mental health. Results of this study with a sample of first-year college students in China support the hypotheses based on the SD-R model. These findings suggest that increasing perceived social support and student engagement while decreasing time pressure and emotional exhaustion may promote mental health among first-year college students.

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This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT).Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan-Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis.The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC.As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.

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BACKGROUND: To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. METHODS: A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. RESULTS: The average duration of follow-up care was 33.7 (12-71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. CONCLUSIONS: Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.

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STUDY DESIGN: Systematic review and meta-analysis. BACKGROUND: Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM). METHODS: Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate. RESULTS: Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR = 1.75, 95% CI (1.31, 2.35), P <.05], lower postoperative JOA scores [SMD = -0.38, 95% CI (-0.62, -0.15), P <.05], lower postoperative CCI [SMD = -0.64, 95% CI (-0.94, -0.33), P <.05], lower postoperative ROM [SMD = -1.11, 95% CI (-2.18, -0.04), P <.05], smaller lamina open angle [SMD = -1.98, 95% CI (-3.71, -0.24), P <.05], shorter operation time [SMD = -0.33, 95% CI (-0.59, -0.07), P <.05]. CONCLUSIONS: Compared with anchor screw fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, future well-designed, randomized controlled trials are still needed to further confirm our results.

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BACKGROUND: Currently, there are no known reports on the aetiology of local giant cell tumour (GCT) recurrence in the proximal fibula following en bloc resection. We analysed 21 cases of proximal fibular GCT, focusing on the presence of residual bone in the tibiofibular joint, its causes and its impact on postoperative recurrence. METHODS: We retrospectively analysed 21 cases with proximal fibular GCT occurring between 2000 and 2017. RESULTS: There were 14 males and 7 females. The average patient age was 25.0 years. Seventeen patients were diagnosed and treated at our facility, while 4 were referred after local recurrence. Six patients presented with residual bone fragments in the tibiofibular joint during their first month of follow-up. Patients with residual bone fragments had a higher local recurrence rate (83.3%) than those without (0%, p = 0.0003). Upon further analysis, patients with a preoperative Campanacci grade III tumour (p = 0.0055) and pathological fractures (p = 0.0109) were at a higher risk of exhibiting postoperative residual bone fragments. CONCLUSIONS: The presence of residual bone fragments in the tibiofibular joint was the main cause of postoperative local recurrence. The presence of residual bone fragments may be related to the preoperative Campanacci grade and pathological fractures. Therefore, close attention should be paid to postoperative follow-up examinations, and if recurrence is suspected, surgical resection should be planned.

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