This study aims to offer detailed insights into the evolution of digital learning by exploring universal trends and shifts. To achieve this aim, we conducted a comprehensive investigation of academic literature from prominent journals on digital learning. The academic literature was categorized into two stages based on publication years. Stage 1 (pre-COVID-19) spans from July 2015 to December 2019, while Stage 2 (during and post-COVID-19) covers January 2020 to June 2024. The Term Frequency–Inverse Document Frequency (TF–IDF) method was then applied to rank the importance of keywords in each academic paper. For each paper, the five keywords with the highest TF–IDF values were extracted and treated as its subject topics. Subsequently, the five most frequently occurring subject topics were identified as representing trends in digital learning within leading five countries/regions. Results showed the USA’s consistent leadership in digital learning research, with China and Taiwan maintaining strong positions. Moreover, there were shifts in subject topics between the two aforementioned stages. In Stage 1, mobile learning and online assessment were dominant subject topics. In Stage 2, digital games and virtual reality emerged as key subject topics, indicating a trend towards immersive and interactive technologies. Additionally, the findings revealed country-specific and general changes across these two stages. This study not only advances academic knowledge of trends and shifts in digital learning, but also provides practical implications for researchers, instructors, and designers in digital learning, enabling such stakeholders to adapt strategies and develop innovative tools for modern educational settings.

Game-Based Learning (GBL) has the potential to provide immediate feedback while simultaneously enhancing learner engagement through entertainment. Building upon this potential, this research proposed a novel design strategy that seamlessly integrates GBL into English learning. More specifically, two entertaining English learning tools were developed: the Entertaining English Listening Learning (E2L2), which was developed for improving listening comprehension, and the Entertaining English Speaking Support (E2S2), which was designed to enhance speaking proficiency. Two empirical studies were conducted to examine learners' reactions to the E2L2 and E2S2 from a gender difference perspective. Findings revealed consistent gender differences in learning performance across both studies. Furthermore, male learners tended to employ integrative strategies by drawing on multiple cues and sources of voice input, whereas female learners demonstrated a preference for focused strategies centered on specific cues. Based on these findings, a framework is proposed to inform the design of inclusive and individualized digital learning environments that better address the distinct needs and preferences of both male and female learners.

Digital game-based learning (DGBL) and electronic books (E-books) can provide students with different benefits. Accordingly, one aim of this study was to incorporate an E-book into DGBL to develop a Digital Entertaining English Learning (DEEL). However, individual differences exist among learners, especially prior knowledge. To this end, the other aim of this study was to provide a complete understanding of the effects of prior knowledge on student learning in the context of DEEL. Hence, we conducted empirical investigation, where learners' reactions to the DEEL were analyzed with quantitative methods and the lag sequential analyses. An independent variable was prior knowledge while dependent variables were test performance, task performance and learning behavior. Regardless of test performance or task performance, results indicated that high prior knowledge learners (HPK) performed better than low prior knowledge learners (LPK). Regarding learning behavior, LPK more frequently used the grammar E-book than HPK, especially pictorial illustration. Additionally, LPK moved between the text description and pictorial illustration with a bidirectional approach while HPK viewed the text description and pictorial illustration with a unidirectional approach. Based on these findings, we developed a framework, which can be applied to personalize the DEEL so that learners' learning experience can be improved.

High-quality academic writing should be presented with clear logical connections. However, it may be too challenging for some students so they may be demotivated. On the other hand, serious games provide students with fun and engagement so their motivation can be enhanced. Thus, this study developed a serious game, which was named as a Digital Entertaining English Logic Learning (D-[EL]2). Students could learn how to present academic writing with clear logical connections in the D-[EL]2 context. Additionally, an empirical study was conducted to investigate students' reactions to the D-[EL]2 from a cognitive style perspective, in terms of test performance, task performance and task behavior. Regarding test performance, Holists significantly obtained better pre-test scores than Serialists but Serialists' gaining scores were significantly higher than those of Holists. Accordingly, no significant difference was found for their post-test scores. Regarding task performance, no significant difference existed between Serialists and Holists. Regarding task behavior, Serialists more frequently used the location hint and keyword hint than Holists. Additionally, Serialists used the notebook for multiple purposes whereas Holists used it for a single purpose. Based on these findings, we proposed a framework, which can be applied to personalize the D-[EL]2 in the future so that the preferences and requirements of diverse learners can be satisfied.

This study proposed a three-tier test (T3), where students were not only asked to give answers and reasons for their answers but also to engage in review questions. Furthermore, an individualized three-tier test (IT3) was implemented by incorporating customization and personalization into the T3. The T3 was utilized in Group A while the IT3 was used in Group B. Both tests were applied to help students learn English grammar. An empirical study was conducted to examine the varied reactions of these two groups, in terms of test performance, task performance, and learning behavior. Regarding test performance, Group B outperformed Group A. Regarding task performance, Group B obtained higher task scores than Group A. Regarding learning behavior, Group A tended to rely on a single scaffolding hint iteratively whereas Group B preferred utilizing various scaffolding hints concurrently. These results suggested that the IT3 was relatively beneficial to students. The aforementioned findings could provide guidance for the effective implementation of online tests.

Game-based learning, electronic books (e-books), and animations offer different advantages and serve distinct purposes. Consequently, this study aimed to propose an entertaining animated e-book by seamlessly integrating these three information technologies. Additionally, customization was incorporated into the entertaining animated e-book to accommodate learners' diverse preferences. In other words, a Customizable Entertaining Animated E-book (CEAE) was implemented in this study, which also aimed to investigate the influences of gender differences on their reactions to the CEAE. Results indicated that the CEAE could reduce gender differences, in terms of test performance and task performance. However, differences between males and females still existed in learning behavior and gaming behavior. More specifically, males and females preferred to use different scaffolding hints and choose different gaming modes. Based on these findings, we introduced a framework, which could work as a valuable reference for instructors to implement e-books, GBL, and animations in educational settings. This framework could also provide guidelines for designers to personalize entertaining animated e-books.

ABSTRACT Individual differences exist among learners. Among various individual differences, cognitive styles can strongly predict learners’ learning behavior. Therefore, cognitive styles are essential for the design of online learning. There are a variety of cognitive style dimensions and overlaps exist among these dimensions. In particular, Witkin’s field dependence/independence and Pask’s Holism/Serialism share some similarities. To this end, it is necessary to develop a framework to show overlapped behavior between these two cognitive style dimensions. To address this issue, this study used the Lag Sequential Analysis to examine the overlaps between these two cognitive style dimensions from the aspect of online learning behavior. The results from this study indicated that the overlaps mainly appear in comprehensive/local and dynamic/fixed approaches. Based on the findings of this study, we develop a framework that can support the improvement of instruction design so that the needs of different cognitive style groups can be accommodated. Accordingly, this study is an interdisciplinary work, which makes scientific contributions to three communities, i.e. human–computer interaction, digital learning and learning analytic.

Online tests offer many advantages but they still belong to assessment, which may make learners have anxiety. Thus, students may experience certain emotion. Academic emotion is a branch of emotion and has great effects on student learning. Such effects can be associated with individual differences, especially prior knowledge. To this end, this study examined the influences of academic emotion and prior knowledge in the context of an online test. The results indicated that the positive academic emotion of high prior knowledge learners (HPKs) and low prior knowledge learners (LPKs) was connected with their pre-test scores while no connection was found for their post-test scores. Additionally, HPKs had higher positive academic emotion and lower negative academic emotion than LPKs. On the other hand, HPKs got better pre-and post-test scores than LPKs whereas LPKs had higher gain scores. Furthermore, HPKs and LPKs exhibited different behavior sequences. More specifically, LPKs tended to acquire small-scaled information from the Chinese hint only while HPKs preferred to obtain both small-scaled information and large-scaled information from the Chinese hint and sentence hint, respectively. According to the findings of this study, we develop a framework, which can be applied to help understand the needs of HPKs and LPKs.

This study proposed a three-tier test to help students learn English grammar. To reduce students' anxiety, game-based learning was incorporated into the three-tier test, where personalization was also implemented to accommodate students' different needs. More specifically, we developed a Personalized Entertaining Three-Tier Test (PET3), which consisted of the three-tier test, game-based learning and personalization. On the other hand, diversities exist among learners, especially prior knowledge. To this end, this study aimed to provide the complete understandings of the effects of prior knowledge in the PET3 context, in terms of test performance, task performance, learning behavior and gaming behavior. Regarding test performance, high prior knowledge learners (HPK) performed better than low prior knowledge learners (LPK). Regarding task performance, HPK was superior to LPK in two aspects, i.e., the reasons of the main questions and advanced questions, while LPK performed better than HPK in the aspect of the review questions. Regarding learning behavior, HPK and LPK favored to use different hints. Regarding gaming behavior, HPK tended to be a winner while LPK had a tendency to be looser. Based on these findings, we developed a framework, which could help designers and instructors to know the preferences of diverse learners.

Virtual competition can address the problems of real competition, but there is a lack of sufficient interactive engagement. Furthermore, virtual competition still belongs to competition, which may let learners have high anxiety. To this end, we developed a Virtual Competitive Scaffolding Assistant (VCSA), which not only included mechanisms to enhance interactive engagement, but also provided scaffolding hints to reduce learners' anxiety. On the other hand, an empirical study was undertaken to examine how prior knowledge influenced learners' reactions to the VCSA, including learning achievement and learning behavior. Regarding learning achievement, high prior knowledge learners significantly performed better than low prior knowledge learners for Task 1, while they demonstrated similar performance for Task 2. Additionally, low prior knowledge learners and high prior knowledge learners obtained similar post-test scores, but the former significantly got higher gain scores than the latter. Regarding learning behavior, low prior knowledge learners tended to locate small-scaled information with the Chinese hint, while high prior knowledge learners tended to collect large-scaled information with the sentence hint. According to findings obtained from this study, a framework was provided for designers to develop virtual competitive games that can accommodate learners' individual differences, especially prior knowledge.

Abstract Funding Acknowledgements Type of funding sources: None. Backgrounds: Pulsed field ablation (PFA) represents a cardiac specific energy source for atrial fibrillation (AF) ablation. The correlation among this remarkable technique, the incidence of silent cerebral ischemic phenomena (SCIP), and the clinical impact on serum S100B release, a well-known neural injury relevant biomarker concomitant to denervation of the intrinsic cardiac autonomic nervous system during AF ablation, has been unclear. Aims This study thought to reveal the "triangle correlation" by investigating the serum S100B increase, incidence of SCIP on cerebral magnetic resonance imaging (MRI), and its interactive correlation in PFA using the FARAPULSE system. Methods and Results Pre- and postprocedural serum S100B was analyzed in a total of 85 patients who underwent AF ablation using the FARAPULSE PFA device. Cerebral MRI was performed subsequently 24-48 hours after procedure. All PVs (332 PVs) were successfully isolated solely with PFA. No additional left atrial mapping using other catheters was performed. The median overall serum S100B increase from the preprocedural value was 0.01μg/l (-0.02 – 0.04μg/l). Asymptomatic SCIP were detected on MRI in 10/53 patients (18.9 %). Of those, the patients with SCIP demonstrated a significantly higher S100B release (0.04, 0.02 – 0.16μg/l vs. without SCIP:0.01, -0.04 – 0.03μg/l, p = 0.0038). Receiver operating characteristic curve revealed a predictive cut-off point for SCIP of 0.04 μg/l (sensitivity:0.7, specificity: 0.49). Conclusions We revealed no clear detectable impact of PFA on S100B release, highlighting the cardioselectivity with limited concomitant denervation. SCIP was detected approximately in a one-fifth after procedures and was a potential confounder of the higher S100B increase.

In this paper, we present the development and characterization of a fully differential SiGe BiCMOS low noise amplifier (LNA) with active impedance matching for the readout of superconducting, quantum interference devices (SQUIDs). Impedance matching is particularly important when using the LNA over a broad frequency range and it is achieved using the Miller effect by adding a negative feedback loop. This approach avoids the degradation of the noise performance that is generated by simply using a parallel resistor at the LNA input. Furthermore, this impedance matching implementation preserves the signal to noise ratio (SNR) because both the signal and the noise are divided by 2 due to the negative feedback loop. This was verified by measuring a lower input voltage noise with the LNA input loaded with a 100  $$\Omega $$ resistor at 77 K compared to a short-circuit. In addition, we present simulations and measurements of the LNA frequency response, input impedance and input voltage noise. The obtained performances for the LNA show a flat gain of 173 V/V with a cut-off frequency of 26MHz and a referred input voltage white noise spectral density level of 0.34 nV/ $$\sqrt{\mathrm{Hz}}$$ with a corner frequency of 72 Hz in input matching condition. These values are in good agreement with the simulations. Finally, a discussion about the impact of the impedance matching on the SQUID biasing is also presented.

Task-based learning can be used to promote language learning. On the other hand, scaffolding instruction can help students without sufficient abilities to undertake tasks. Accordingly, we developed the Scaffolding Task-based English Logic Learning (S-TELL) by incorporating scaffolding instruction into Task-based Learning. The S-TELL was applied to facilitate research students to learn how to present clear logical relationships in academic writing. Additionally, an empirical study was conducted to investigate how different cognitive style groups (i.e., Serialists and Holists) reacted to the S-TELL, including learning performance, learning perception and learning behavior. Regarding learning performance, the findings showed that either Holists or Serialists made significant improvement via interacting with the S-TELL. Moreover, Holists significantly obtained higher post-scores than Serialists though they had similar task scores. Regarding learning perception, few perception differences existed between Serialists and Holists. Regarding learning behavior, Holists demonstrated more behavior sequences than Serialists. This was due to the fact that Holists often checked the current status and used the English hint while Serialists did not show such behavior. According to these findings, we proposed a framework, which can be employed to personalize the S-TELL in our future work so that the preferences of Holists and Serialists can be accommodated.

Abstract Funding Acknowledgements Type of funding sources: None. Objectives To evaluate the feasibility, procedural data, and lesion characteristics of anterior line (AL) and roof line (RL) ablation by using ablation index (AI) guided high-power(50W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI). Methods 35 consecutive patients with macro-reentrant left atrial tachycardia (LAT) or substrate at LA anterior wall or roof after previous PVI were enrolled. Ablation power was set to 50W, targeting AI 500 for AL and 400 for RL. First-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into 3(caudal, middle and cranial) segments to analyze the location of conduction gaps in non-FPB patients. Results A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them respectively. In non-FPB group, the most frequent gap location along the AL was the middle third. Final block of AL was achieved in 97%, and block of RL was achieved in 100%. The RF ablation time was short (2,9 ± 0,8 min for AL and 46,2 ± 15,6 sec for RL). For AL, female gender was significantly more frequent in FPB than in non-FPB patients(p 0,028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 sec vs 161 ± 41 sec; p = 0,02). No procedural complications occurred. Conclusion AI guided high-power(50W) ablation appears to be a feasible, effective and fast technique for AL and RL ablation.

Learning materials are integrated into digital games in digital game-based learning (DGBL). There are two types of contexts to present such integration, i.e., tightly coupling context (TCC) and loosely coupling context (LCC). These two types of contexts have different strengths and weaknesses. On the other hand, prior abilities have great effects on DGBL. Accordingly, this study aims to examine the effects of the TCC and LCC on DGBL from a prior ability aspect. Regarding the TCC, low-ability students and high-ability students obtained similar gain scores. On the other hand, the post-test scores of high-ability students were significantly better than their pre-test scores in the TCC while such a significant difference was not found for low-ability students. Regarding the LCC, high-ability students acquired significantly higher gain scores than low-ability students. Furthermore, students’ post-test scores were significantly higher than their pre-test scores in the LCC, regardless of low-ability students or high-ability students. Implications for system design are also discussed.

Personalized learning allows students to pursue individual learning goals at their own pace. Such a benefit is achieved by understanding each individual’s needs. Hence, it is important to implement personalized learning to accommodate students’ individual differences. Due to such importance, research into this issue has increased over the past decade. Accordingly, this paper presents a state-of-the art review of the current research that investigates relationships between individual differences and personalized learning. The main results from past research include that: (1) learning style is a major individual difference considered in works on personalized learning; (2) current works shift to address multiple individual differences, instead of a single difference; (3) learner models are widely applied to deal with multiple individual differences in the development of personalized learning; (4) learning styles, prior knowledge, preferences and ability levels are frequently considered together, and (5) it is a current trend to consider emotion recognition in the context of personalized learning. In addition to reviewing existing empirical studies, this paper also does an appraisal to identify directions for future research.

Digital game-based learning (DGBL) includes various features. On the other hand, diversities exist among learners. Accordingly, each learner may appreciate different game features. Thus, there is a need to examine how individual differences affect learners' reactions to DGBL. Among various individual differences, the levels of gaming experience, which are associated with playing skills, have important effects. Thus, this study developed a Massively Multiplayer Online Role-Playing Game (MMORPG)-based English learning environment and investigated how the levels of gaming experience affected learners' reactions to the developed MMORPG. A total of 45 sixth graders from an elementary school in northern Taiwan participated in this study and they were divided into high gaming-experience learners (HGEL) and low gaming-experience learners (LGEL) based on the participants' responses to a prior gaming experience questionnaire. A mixed method was employed to analyze both learners' quantitative log data and qualitative interview responses. The results from quantitative log data showed that the HGEL had better game achievement and higher game socialization than the LGEL, especially in terms of buying items, chatting, and teaming up with friends. Conversely, the LGEL needed more in-game assistance than the HGEL, especially for checking the task list and route map. The results from qualitative interview responses showed that the HGEL skipped most of the learning content while the LGEL paid full attention to the learning content. These findings demonstrate the understandings of the effects of individual differences, especially the levels of gaming experience, on learners’ reactions to DGBL. Based on such findings, we contribute to developing a framework and several design solutions, which can be used to implement personalized DGBL to accommodate the needs of learners with different levels of gaming experience.

Abstract Background The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported. Purpose To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB. Methods Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) >75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT). Results Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p<0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p<0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%). Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded. Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF. Conclusions Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF. Funding Acknowledgement Type of funding source: None

Drug abuse causes serious problems around the world. Thus, anti-drug material has been increasingly developed and used. However, conventional anti-drug material has until today shown insufficient effects on preventing drug abuse, especially for drug-addicted users. To this end, this study proposes a game-based anti-drug material and examines how drug-addicted people and non-drug-addicted people interact with the game-based anti-drug material. A lag sequential analysis approach was applied to analyze their different behavior patterns. The results revealed that the experience of drug addiction influenced the way individuals access drug information, complete tasks and reach goals during their gaming process. Based on the findings, some suggestions are proposed for the development of adaptive game-based anti-drug material that can accommodate the needs of drug-addicted and non-drug-addicted people to achieve the goal of universal access.