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The wrapping layer's foaming process of the car steering wheel industry usually relies on the manual parameter setting by experienced engineers, but the reliability and validity are usually hard to control due to many foaming factors that affect the hardness of steering wheel wrapping layer (e.g., vulcanization time, mold temperature, material liquid temperature, material discharge pressure, humidity). This paper first proposes an intelligent process parameter recommendation system architecture, then develops a neural network-based hardness prediction (NNHP) model to predict the car steering wheel's wrapping hardness. Consequently, we combine NNHP and genetic algorithm (GA) to develop a foaming process parameter recommendation model (NNHP-GA) to effectively recommend the most suitable combinations of process parameters for achieving the desired wrapping hardness in an IoT-based intelligent manufacturing environment. An empirical study is applied in Taiwan's world-leading car steering wheel company. By analyzing the 16 important process sensor data installed in each casting machine, the five experimental results show that the NNHP-GA recommendation system can successfully predict the hardness of the steering wheel's wrapping layer and recommend appropriate process parameters (e.g., sensors S1-vulcanization time, S2-mold temperature, S5-A.P. pressure, S6-B.I. pressure, and "pressurization time") under a specific hardness target. The manufacturing company may employ the NNHP-GA model to build a process parameter recommendation system and increase the quality of process parameter setting. [ABSTRACT FROM AUTHOR]

• EU-23 panel data links circular economy to ecological footprint (2010–2020). • Stronger policies needed; recycling has limited impact on footprints. • Boosting secondary raw material markets reduces ecological footprints. • Invest in eco-innovation and sustainable food for broad impact. • Targeted policies like zero deforestation for municipal waste. In this era of global ecological overshoot, understanding the interplay between the circular economy and ecological footprint is vital. This study examines data from the EU-23 from 2010 to 2020 using panel regression methods. It explores the long-term relationships between ecological footprint types and circular economy indicators, such as per capita municipal waste generation, the municipal waste recycling rate, investment, circularity rate, and trade in recyclable materials. This study revealed four key findings. 1) All ecological footprints showed negative or minimal growth, except for forest footprints. Positive yet weak elasticities were found in forest ecological footprint factors, such as municipal waste generation, investment, and recycling rate. 2) The municipal waste recycling rate displayed negligible negative elasticities in total and carbon footprints. 3) Investment elasticities all footprint categories except carbon footprint were generally positive, but slight, indicating an ecological footprint. 4) The circularity rate showed negative elasticities in total and carbon footprints, particularly for the latter. These insights suggest that targeted investments in waste management and zero-waste technologies can reduce the ecological footprint. The EU should also diversify investments beyond energy efficiency, including protecting, restoring, and enhancing forests as well as eco-friendly food systems. Encouraging secondary raw material markets can significantly reduce ecological footprints. The policy implications emphasize investing in zero-waste technologies and diversifying investments for ecological balance. [ABSTRACT FROM AUTHOR]

• Mayfly nymphs were exposed to salt contaminated water. • Ionoregulatory homeostasis was disturbed. • Significant changes in ion transport occurred in the tracheal gills. • Expression and activities of ionomotive enzymes were unaltered in the tracheal gills. • The morphology of septate junctions in the tracheal gills is altered such that these junctions would be leakier. The impact of freshwater (FW) salinization on osmoregulation as well as tracheal gill morphology and function was examined in nymphs of the mayfly Hexagenia rigida following exposure to salt contaminated water (SCW, 7.25 g/l NaCl) for a 7-day period. Ionoregulatory homeostasis was perturbed in SCW exposed H. rigida nymphs as indicated by increased hemolymph Na+, K+ and Cl− levels as well as hemolymph pH and water content. Despite this, SCW did not alter gill Na+-K+-ATPase (NKA) or V-type H+-ATPase (VA) activity. In addition, NKA and VA immunolocalization in gill ionocytes did not show alterations in enzyme location or changes in ionocyte abundance. The latter observation was confirmed using scanning electron microscopy (SEM) to examine exposed tracheal gill ionocyte numbers. Ionocyte surface morphometrics also revealed that SCW did not change individual ionocyte surface area or ionocyte fractional surface area. Nevertheless, analysis of Na+ movement across the tracheal gill of mayfly nymphs using scanning ion-selective electrode technique indicated that FW nymphs acquired Na+ from surrounding water, while tracheal gills of SCW nymphs had the capacity to secrete Na+. Because Na+ secretion across the gill of SCW-exposed animals occurred in the absence of any change in (1) NKA and VA activity or (2) ionocyte numbers/surface exposure, it was reasoned that Na+ movement across the gill of SCW animals may be occurring, at least in part, through the paracellular pathway. The ultrastructure of tracheal gill septate junctions (SJs) supported this idea as they exhibited morphological alterations indicative of a leakier pathway. Data provide a first look at alterations in osmoregulatory mechanisms that allow H. rigida nymphs to tolerate sub-lethal salinization of their surroundings. [ABSTRACT FROM AUTHOR]

Abstract This study uses the Group of Twenty (G20) as a representative sample of global economic development. Within a panel Emissions–Energy–Output (EEO) framework over the period 1991–2016, to estimate the Carbon Kuznets Curve (CKC), the clean/fossil fuels energy consumption (CE/FF) elasticity of demand for carbon emissions, the causalities between emissions, energy, and economy, and thus to propose strategy for decoupling environmental pressure from economic growth (EG). The results of the descriptive statistical analysis suggest an absolute decoupling effect seems to have occurred with the drop in related environmental pressure and the continuation of economic growth. The panel cointegration test results show that there is a long-run equilibrium relationship between carbon emissions, FF, real GDP, and different types of CE [i.e., new renewable (Ren)/hydropower (Hydro)/nuclear (Nuc)]. The estimation results show that the CKC exists, and emissions are positively elastic to FF and negatively inelastic to Ren/Hydro/Nuc, although Ren's average per capita compound annual growth rate reached 14%. The results of panel vector error correction models reveal that 1) the use of nuclear energy is a key means for dealing with carbon emissions; 2) the substitutability/symbiosis exists between Ren/Hydro and FF; 3) the feedback hypothesis between EG and FF/Ren and the Hydro/Nuc-led growth hypothesis are confirmed. Therefore, energy-saving policies may hurt EG. A broad strategy for emissions, energy consumption, and economy decoupling are to support diversified, sustainable energy consumption mix (including SHP, Ren, and Nuc) and maintain stable economic growth, thereby improving energy efficiency and safety, reducing carbon dioxide intensity, and thus leading the world to absolute decoupling. Absolute decoupling is the only way to achieve a truly sustainable future. Highlights • The absolute decoupling effect of the G20 panel seems likely to occur. • The CKC/EKC hypothesis and the feedback hypothesis for FF/Ren–income are confirmed. • Substitutability exists for Ren–FF, and symbiosis exists for Hydro–FF. • Nuclear power is a key means for dealing with carbon emissions. • Complementary strategies of Ren and Nuc can lead the world to absolute decoupling. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between the stock market and the neurotic disorder doctor visits. We use aggregate data, partition the population by age and gender and examine the impact of changes in the stock market on neurotic disorders. Using doctor visits as a proxy measure of morbidity, we find evidence of some relationship between neurotic disorder morbidity and stock market variations. A stock market falling in a single day and the accumulation of daily stock market drops are both associated with more neurotic disorder doctor visits. We also observe more neurotic disorder doctor visits during periods of a low stock index for the elderly, regardless of gender. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

To consider the idea that a dietary botanical supplement could act as an adaptogen in a teleost fish, the effect of a liquorice root derivative (18β-glycyrrhetinic acid, 18βGA) on rainbow trout following an acute ionoregulatory stressor was examined. Freshwater (FW) trout were fed a control or 18βGA supplemented diet (0, 5, or 50 μg 18βGA/g diet) for 2 weeks, then abruptly exposed to ion-poor water (IPW) for 24 h. Following IPW exposure, muscle moisture content and serum cortisol levels elevated and serum [Na + ] and/or [Cl − ] reduced in control and 50 μg/g 18βGA-fed fish. However, these endpoints were unaltered in 5 μg/g 18βGA-fed fish. Gill tissue was investigated for potential mechanisms of 18βGA action by examining mRNA abundance of genes encoding corticosteroid receptors (CRs), 11β-hydroxysteroid dehydrogenase 2 ( 11β-hsd2 ), and tight junction (TJ) proteins, as well as Na + -K + -ATPase and H + -ATPase activity, and mitochondrion-rich cell (MRC) morphometrics. Following IPW exposure, CR and 11β-hsd2 mRNA, MRC fractional surface, Na + -K + -ATPase and H + -ATPase activity were unaltered or decreased in 50 μg 18βGA fish, as was mRNA encoding select TJ proteins. In contrast, 5 μg 18βGA-fed fish exhibited elevated 11β-hsd2 and CR mRNA abundance versus 50 μg 18βGA-fed, and reduced MRC apical area as well as some differences in TJ protein mRNA abundance versus control fish. Data suggest that 18βGA, at low levels, may be adaptogenic in trout and might help to ameliorate ionoregulatory perturbation following IPW exposure. This seems to occur, in part, through 18βGA-induced alterations in the biochemistry and physiology of the gill. [ABSTRACT FROM AUTHOR]

The effect of liquorice root derivatives (LRDs) glycyrrhizic acid (GL) and glycyrrhetinic acid (18βGA) on salt and water balance and end points of gill ion transport in a freshwater teleost, (rainbow trout) was examined after feeding fish diets containing GL or 18βGA (0, 5, 50 or 500 µg/g diet) for a two week period. Serum cortisol levels and gill 11β-hydroxysteroid dehydrogenase type 2 mRNA abundance decreased in fish fed GL but increased (at select doses) in fish fed 18βGA. At higher doses of GL, gill Na + -K + -ATPase and H + -ATPase activity increased, while cystic fibrosis transmembrane conductance regulator type II mRNA abundance significantly decreased at the lowest dose of GL. End points of gill transcellular ion transport were not significantly altered in fish fed 18βGA, except for a reduction in Na + -K + -ATPase activity at a 50 µg/g dose. In contrast, high doses of GL and 18βGA increased gill transcript abundance of the tight junction protein claudin-31 ( cldn-31 ). Other end points of gill paracellular transport differed in fishes fed LRDs. Tricellulin mRNA abundance was increased by high dose GL and decreased by high dose 18βGA, and cldn-23a and cldn-27b mRNA abundance significantly decreased in response to GL irrespective of dose. Despite the above observations, systemic end points of salt and water balance (i.e. serum [Na + ] and [Cl − ] as well as muscle moisture) were unaffected by LRDs. Therefore data suggest that LRDs can alter end points of ion transport in fishes but that overall salt and water balance need not be perturbed. [ABSTRACT FROM AUTHOR]

Abstract: This paper investigates the impact of stock market movement on incidences of stroke utilizing population-based aggregate data in Taiwan. Using the daily data from the Taiwan Stock Exchange Capitalization Weighted Stock Index and from the National Health Insurance Research Database during 2001/1/1–2007/12/31, which consist of 2556 observations, we examine the effects of stock market on stroke incidence – the level effect and the daily change effects. In general, we find that both a low stock index level and a daily fall in the stock index are associated with greater incidences of stroke. We further partition the data on sex and age. The level effect is found to be significant for either gender, in the 45–64 and 65≥ age groups. In addition, two daily change effects are found to be significant for males and the elderly. Although stockholdings can increase wealth, they can also increase stroke incidence, thereby representing a cost to health. [Copyright &y& Elsevier]

Background and Aim: The traditional management of open/laparoscopic choledochotomy after common bile duct (CBD) exploration is accomplished by placement of a T-tube, a procedure historically associated with complications and discomfort. In this study, we share in humble our laparoscopic experience of the use of primary closure of CBD, primary closure over pigtail J, and endonasobiliary drainage (ENBD) tubes as easy and effective alternatives to T-tubes. Methods: From April 2006 to March 2009, 27 (16 women) patients with CBD stones underwent laparoscopic choledochotomy at our institute and were engaged in this study by means of T-tube-free approach after bile duct exploration: primary closure, pigtail J tube, and ENBD tube groups. On admission, routine laboratory and imaging workups were performed to confirm choledocholithiasis diagnosis. Results: The mean operative time for primary closure, pigtail J tube, and ENBD tube groups were 95, 100, and 97.5 minutes, respectively. There was no conversion to open surgery nor was intraoperative complication experienced in all the groups. No major biliary complications such as bile leakage or bile peritonitis were seen; however, 1 patient from the pigtail J group experienced premature tube dislodgement and 1 patient from the ENBD tube group was found with a singular CBD retained stone. Conclusions: Laparoscopic primary closure of the CBD and over pigtail J and ENBD tubes are easy and effective alternatives to T-tube placements; these procedures are safe and with great feasibility, they offer faster recovery time for patients and early discharge with lower hospital charge. [ABSTRACT FROM AUTHOR]

Abstract: The daily oral activities may severely influence oral health of children with disabilities. In this survey, we analyzed the impact of dietary and tooth-brushing habits to dental caries in special school children with disabilities. This cross-sectional survey investigated 535 special school children with disabilities aged 6–12 years, 60.93% males, 39.07% females from 10 special schools in Taiwan. Oral examinations were carried out by dentists with a Kappa score of their inter-examiner agreement exceeding 0.8. Data on demographics, diet, and tooth-brushing habits of children with disabilities were collected using a standardized questionnaire completed by parents/caregivers. More than three quarters of the participants were combined with severe or profound disability. Children with profound severity in disability had a higher percentage (67.37%) in teeth-brushing by parents/caregivers compared to those children with mild/moderate severity in disability which had a higher percentage (81.60%) in teeth-brushing by themselves. Children whose teeth were brushed by parents/caregivers had a better dental health, and lower caries prevalence. The main risk factors related to decayed teeth of children with disabilities are frequency of sweets intake, ability to brush teeth and with plaque or not. The dental health education, prevention program and periodical oral check-up to children with disabilities and their parents/caregivers should be reinforced. Brushing skill should be taught to children according to their type, severity and individual characteristics of disability. [ABSTRACT FROM AUTHOR]

The barrier properties and intracellular responses of a primary cultured trout gill epithelium (containing both mitochondria-rich and pavement cells) were examined over 24 h of copper (Cu) exposure (0, 200 and 1000 μg/L) in apical fresh water. Transepithelial resistance (TER) and mRNA abundance of tight junction proteins zonula occludens-1, occludin, cingulin, claudin-8d and -28b were examined as endpoints of barrier function and the paracellular pathway. Intracellular endpoints analyzed were Cu accumulation, Na+ content, carbonic anhydrase activity and mRNA abundance of carbonic anhydrase (ca-II) and Na+/K+ ATPase (nka α1a and nka α1b isoforms). After a brief initial drop in TER in the 1000 μg Cu/L treatment, Cu at both levels increased TER over the first 6 h of exposure but there were no differences among groups from 12 h onwards. After 24 h of Cu exposure, there were no differences in mRNA abundance of any of the tight junction proteins examined. Cu accumulation occurred at 1000 μg Cu/L (5.5-fold increase), but no depletion of Na+ content. Carbonic anhydrase activity decreased significantly (by 76%), however Cu exposure did not alter the transcript abundance of ca-II, nka α1a, or nka α1b. This study provides a first report of carbonic anhydrase sensitivity to Cu exposure in a cultured model gill epithelium. We conclude that Cu impacts the permeability of this model during the early stages of exposure and that the use of carbonic anhydrase inhibition as an endpoint of metal toxicity in this model preparation may be useful for future mechanistic investigations and environmental monitoring. Unlabelled Image • Cu exposure did not change gene expression of paracellular proteins in reconstituted gill epithelia of rainbow trout. • After Cu exposure, DSI gill epithelia accumulated copper (5.5 fold) and decreased carbonic anhydrase activity significantly. • The sensitivity of CA activity to Cu has been demonstrated in vitro in the fish branchial epithelium using the DSI system. [ABSTRACT FROM AUTHOR]

The method allows access to a broad spectrum of the required diarylmethylamine synthons with excellent enantioselectivities. [ABSTRACT FROM AUTHOR]

Purpose: Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. Patients and methods: This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists' judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication. Results: Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed. Conclusion: Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation. [ABSTRACT FROM AUTHOR]

Objective Out-of-hospital cardiac arrest ( OHCA) studies are usually conducted at metropolitan medical centres. Because rural studies are rare, our study aimed to assess non-traumatic OHCA prevalence and resuscitation outcomes in rural Taiwan. Design A retrospective observational study. Setting All seven designated community hospital emergency departments ( ED) in Nantou County, Taiwan. Participants All OHCA patients from May 2011 to March 2013. Main outcome measures Any return of spontaneous circulation ( ROSC) and survival for ED discharge. Results In the 23-month period, 850 OHCA cases were reported; 741 (87.2%) were non-traumatic. The overall ROSC achievement rate was 19.7%, with 16.4% case survival for ED discharge. Logistic regression identified that arrest in public ( OR: 2.62, 95% CI: 1.19-5.78), witness when collapsed ( OR: 2.14, 95% CI: 1.28-3.60), and cardiopulmonary resuscitation ( CPR) by bystander ( OR: 2.09, 95% CI: 1.02-4.26) might increase the likelihood of any ROSC; arrest in public ( OR: 2.68, 95% CI: 1.10-6.50), witnessed collapse ( OR: 2.26, 95% CI: 1.24-4.09) and CPR by bystander ( OR: 2.79, 95% CI: 1.28-6.05) might also increase the likelihood of survival. For non-traumatic OHCA patients conveyed to EDs via emergency medical service system ( EMS), a shorter response time ( OR: 1.09, 95% CI: 1.01-1.18) and travelling time ( OR: 1.04, 95% CI: 1.00-1.09) might also increase the chance of survival. Conclusion Compared to previous data from metropolitan areas, ROSC achievement rate was lower in rural Taiwan. Witness presence, response and travelling times affect ROSC achievement in non-traumatic OHCA patients in rural Taiwan. [ABSTRACT FROM AUTHOR]

Highlights: [•] Establishing an oral prevention program for children with disabilities is critical. [•] We evaluated the effectiveness of caries reduction by long term fluoride ingestion. [•] Fluoride tablet ingestion with 1.0mg fluoride daily and persisted for 24 months. [•] Fluoride tablets were found to be effective in arresting dental caries by 36.84% in permanent dentition. [•] Fluoride tablets should be considered as one of the preventive measures in caries prevention programs in fluoride deficient areas. [ABSTRACT FROM AUTHOR]

Purpose: To compare the short-term outcomes of single-incision and conventional three-incision laparoscopic appendectomy (LA) at a single surgical unit. Methods: We conducted a retrospective study comparing the operative outcomes of two LA techniques between January 2009 and November 2010. Results: LA was performed successfully in 44 patients: through a single incision in 27 patients and through three incisions in 17 patients. The time taken to resume oral intake was slightly less in the single-incision group than in the three-incision group, at 1.1 versus 1.5 days, respectively ( P = 0.0419). However, blood loss and hospital stay were not significantly different, at 7.2 versus 6.4 ml ( P = 0.6244) and 3.7 versus 3.8 days ( P = 0.8565), respectively. The cosmetic result was better in the single-incision group, because of the well-concealed scar. Conclusion: Both single-incision and conventional LA are effective and minimally invasive, and should be performed according to the experience of the surgeon. Single-incision LA results in faster recovery, but larger studies are required to confirm this and to determine if these techniques can be used safely for all indications of appendectomy. [ABSTRACT FROM AUTHOR]

Background/aim: Optimization of quality of life is an important goal in the management of patients with unresectable peri-ampullary cancer. Herein, we share our two cases to demonstrate the feasibility of scarless transumbilical single-incision laparoscopic cholecystojejunostomy using conventional instruments in the management of unresectable peri-ampullary cancer.Cases and Methods: Two 58-year-old patients (one male) underwent transumbilical single-incision laparoscopic cholecystojejunostomies: The male and female patients were diagnosed with duodenal papillary carcinoma and pancreatic cancer, respectively. The hepatocystic junction was confirmed patent preoperatively in both patients. A 2-cm periumbilical incision was made for the placement of three trocars. Conventional rigid laparoscopic instruments were solely used throughout the procedure, and operative techniques were carried out in the same fashion as for conventional laparoscopic cholecystojejunostomy.Results: The procedures were completed uneventfully in 190 and 155 min, respectively, with no complications, and the blood loss was estimated at 80 and 20 ml, respectively. Postoperative pain scores on postoperative day 1 were 4/10 and 3/10. The patients were discharged from the hospital on postoperative days 3 and 5 with resolving jaundice.Conclusions: Transumbilical single-incision laparoscopic cholecystojejunostomy appears to be a technically feasible alternative to standard laparoscopic procedure and can be performed using conventional laparoscopic instruments. [ABSTRACT FROM AUTHOR]

Antipsychotics are the keystone in schizophrenia treatment. Although the benefits of the new generation of antipsychotics has been demonstrated over the last decade, the issues of patient compliance and higher purchasing price of atypical antipsychotics remain unresolved. Risperidone is the only atypical antipsychotic agent with long-acting formulation. Long-acting risperidone is a water-based injection and it has been associated with a low level of pain. The aim of the present study was to test whether an improvement in compliance with the use of a long-acting risperidone, compared with olanzapine and depot haloperidol, can increase the effectiveness and the cost-effectiveness indexes. An economic comparison model with decision tree, rather than a prospective design with real clinical drug trial, was applied. The unit cost for each medical procedure was obtained from the claimed-database of the Bureau of National Health Insurance in Taiwan. An executive committee simulated the incidence of extrapyramidal side-effects and proposed a therapeutic model for each strategy based on a literature review. The probabilities of treatment response of different agents and those of different mental health states were estimated by the executive committee and 10 senior psychiatrists who were randomly selected. Sensitivity analysis was performed for drug cost-effectiveness and compliance improvement for using long-acting risperidone. The results showed that long-acting risperidone is more cost-effective than either olanzapine or depot haloperidol for treating schizophrenia patients whose conditions are stable and whose illness duration ranges from 1 to 5 years. The comparison model with the Kaplan–Meier decision tree may serve as an alternative to prospectively designed studies for cost-effectiveness of atypical antipsychotics. [ABSTRACT FROM AUTHOR]

Large array devices are often used for big current driving capabilities in power electronic integrated circuit (IC) applications. Since these structures have big sizes, typical electrostatic discharge protection methodologies cannot be applied in such kind of IC. Otherwise, IC will become too huge to marketing. In this paper, a novel signal control switching architecture for adding large array devices' ESD performances is proposed. Only a little layout area is increased, but a huge electrostatic discharge robustness improvement can be obtained. Moreover, electrical safe operation area characteristics of large array devices are also improved very much with this new scheme. This study is processed in 0.15 μm Bipolar CMOS DMOS (BCD) with silicide technologies. • This is a very big study which can provide a good solution for pure 5 V power IC applications. • The research is based on our previous paper, published in 2018 MR. • Finally, it can be applied very well in the industry. [ABSTRACT FROM AUTHOR]