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Objectives: Home healthcare (HHC) is an important care choice for ageing people with disabilities; however, the risk factors for emergency department (ED) visits, a poor outcome index, remain unclear. Therefore, we conducted this study to clarify it. Methods: We conducted a case-control study from a medical center in Taiwan by identifying HHC patients between Aug 1, 2019, and July 31, 2021. Age, sex, iatrogenesis, underlying comorbidities, and ED visit data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of ED visits. Results: We identified 240 patients, including 133 patients with and 107 patients without ED visits, for this study. The mean ages were 83.9 and 83.3 years and females accounted for 71% and 60.9% of patients without and with ED visits, respectively. Multivariable logistic regression analyses showed that urinary catheters (adjusted odds ratio [aOR]: 5.84; 95% confidence interval [CI]: 1.48-23.01, p = 0.012) and peptic ulcer disease (PUD)/gastroesophageal reflux disease (GERD) (aOR: 2.27; 95%CI: 1.12-4.61, p = 0.023) were independent predictors of ED visits. Stratified analyses according to sex and age showed that PUD/GERD and dyslipidemia were significant predictors of ED visits in female patients. Conclusions and clinical implications: This study identified independent predictors of ED visits in HHC patients. Our results provide an important reference for the early prevention, recognition, and adjustment of care plans for at-risk patients. Further studies recruiting more patients and external validation are warranted. [ABSTRACT FROM AUTHOR]

This article discusses a new method for segmenting specific intervertebral discs in medical images using the MultiResUNet model. The article highlights the importance of accurately measuring intervertebral discs in clinical medicine and identifies the limitations of current deep learning methods. The proposed two-stage segmentation method shows lower error rates when measuring specific disc heights compared to other models. The article also provides an overview of the human spine and the role of intervertebral discs in diagnosing degenerative disc disease. The study was funded by the National Science and Technology Council, Taiwan, and suggests that future research should focus on improving segmentation accuracy. [Extracted from the article]

Background: Body fat mass (FM) is associated with multiple organ damage. However, data regarding the relationship between various organ damage and FM are rare in the elderly. Therefore, we aim to perform an analysis on the relationship between organ damage and FM in a geriatric cohort. Methods: 3331 participants were included in this analysis. Based on age, body height, body weight, waist circumference, and race, we calculated FM with the established formula. Organ damage, including arterial stiffening, lower extremity atherosclerosis, left ventricular hypertrophy (LVH), micro-albuminuria, and chronic kidney disease (CKD), were measured and calculated with standard methods. Results: All organ damage parameters were significantly related to FM (all p < 0.001). In univariate logistics regression, the highest quartile of FM was tied to the increased risk of arterial stiffening, lower extremity atherosclerosis, LVH, micro-albuminuria, and CKD (all p < 0.05). After adjustment, participants with higher quantiles of FM had a significantly increased odd ratio (OR) for arterial stiffening [OR = 1.51, 95% confidence interval (CI): 1.15–1.99, p = 0.002] and LVH (OR = 1.99, 95% CI: 1.48–2.67, p < 0.001). Moreover, FM was linearly associated with arterial stiffening and LVH in total population and gender subgroups. Independent of confounders, FM was significantly correlated with arterial stiffening, lower extremity atherosclerosis, LVH and CKD in female, while was only related to LVH in male. Conclusions: Among various organ damage, elevated FM is significantly and independently associated with arterial stiffening and LVH in the elderly. Compared with men, women with increased FM are more likely to have multiple organ damage. [ABSTRACT FROM AUTHOR]

Background: Postoperative nerve palsy is a major complication following resection of neck peripheral nerve sheath tumours (PNSTs). Accurate preoperative identification of the nerve origin (NO) can improve surgical outcomes and patient counselling. Material and methods: This study was a retrospective cohort and quantitative analysis of the literature. The authors introduced a parameter, the carotid-jugular angle (CJA), to differentiate the NO. A literature review of neck PNST cases from 2010 to 2022 was conducted. The CJA was measured from eligible imaging data, and quantitative analysis was performed to evaluate the ability of the CJA to predict the NO. External validation was performed using a single-centre cohort from 2008 to 2021. Results: In total, 17 patients from our single-centre cohort and 88 patients from the literature were analyzed. Among them, 53, 45, and 7 patients had sympathetic, vagus, and cervical nerve PNSTs, respectively. Vagus nerve tumours had the largest CJA, followed by sympathetic tumours, whereas cervical nerve tumours had the smallest CJA (P <0.001). Multivariate logistic regression identified a larger CJA as a predictor of vagus NO (P<0.001), and receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.907 (0.831-0.951) for the CJA to predict vagus NO (P< 0.001). External validation showed an AUC of 0.928 (0.727-0.988) (P<0.001). Compared with the AUC of the previously proposed qualitative method (AUC =0.764, 0.673-0.839), that of the CJA was greater (P=0.011). The cut-off value identified to predict vagus NO was greater than or equal to 100°. Receiver operating characteristic analysis showed an AUC of 0.909 (0.837-0.956) for the CJA to predict cervical NO (P< 0.001), with a cut-off value less than 38.5°. Conclusions: A CJA greater than or equal to 100° predicted a vagus NO and a CJA less than 100° predicted a non-vagus NO. Moreover, a CJA less than 38.5 was associated with an increased likelihood of cervical NO. [ABSTRACT FROM AUTHOR]

Inflammation closely correlates with atherosclerosis and cardiovascular disease (CVD). Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammation index that can be obtained by routine blood tests. We aimed to investigate the associations between MHR and atherosclerosis and arteriosclerosis. We enrolled 2451 participants from the Northern Shanghai Study. Atherosclerosis (carotid plaque (CP), lower extremity atherosclerotic (LEA) assessed by ankle-brachial index) and arteriosclerosis (arterial stiffness (AS) assessed by carotid-femoral pulse wave velocity) were measured using standard methods. In the univariable logistic regression model, higher MHR was significantly associated with increased AS, CP, and LEA risk. In the multivariable logistic regression model, after adjustment for age, sex, hypertension, diabetes mellitus, body mass index, smoking habit, low-density lipoprotein cholesterol, and family history of premature CVD, quartile 4 (Q4) of MHR was associated with an increased risk of AS (odds ratio (OR) = 1.41; 95% confidence interval (CI):1.05–1.88; P for trend = 0.036), CP (OR = 1.35; 95%CI:1.04–1.77; P for trend = 0.044), and LEA (OR = 2.23; 95%CI:1.49–3.35; P for trend < 0.001). Similar results were observed when MHR was analyzed as a continuous variable. The restricted cubic spline (RCS) curve showed that the association between MHR and AS was nonlinear (P nonlinear = 0.021), but not LEA (P nonlinear = 0.177) or CP (P nonlinear = 0.72). MHR presents a linear association with atherosclerosis and a nonlinear association with arteriosclerosis in the elderly Chinese population. These findings may indicate the need for early assessment and intervention for inflammation. The registration number for clinical trials: NCT02368938. • Monocyte to high-density lipoprotein ratio (MHR) is a novel inflammation index. • MHR presents a linear association with atherosclerosis and nonlinear association with arteriosclerosis. • MHR may a potential biomarker identified to anti-inflammatory therapy. [ABSTRACT FROM AUTHOR]

Originally broadcast on Taiwan's Public Television Service (PTS) in 2019, The World between Us is the first Taiwanese television drama that attempts to create public understanding of how the country's legal and judicial system is influenced by the UN's International Covenant on Civil and Political Rights (ICCPR). While The World between Us seems to imply that the world between the characters is created by a lack of knowledge about and understanding of legal and medical judgments, the plot, characters, and social events in the series point to another complexity that separated the world for Taiwanese people: the way in which language use in Taiwanese society combined with Western conceptions of knowledge to construct a new socioeconomic hierarchy. Thus, this essay examines how code-switching is used in the series to traverse and create social boundaries, analyzing how characters' code-switching reveals the social classifications produced by the practice of language and how languages signify and classify what belongs to the world of modern institutions, laws, and practices. [ABSTRACT FROM AUTHOR]

Epidermal growth factor receptor (EGFR) mutation is a positive prognostic factor for survival in patients with non–small-cell lung cancer (NSCLC). In such patients, brain metastasis signifies negative outcomes. Patients with NSCLC brain metastasis that may benefit from neurosurgery is under investigation. We aim to investigate the impact of different mutation loci in surgically treated NSCLC brain metastasis patients. This retrospective cohort study included patients with NSCLC brain metastasis who underwent brain lesionectomy, followed by radiotherapy and chemotherapy or targeted therapy. Demographics and tumor characteristics were compared between the EGFR mutant type and wild type groups. Postoperative survival and risk factors were analyzed using log rank and Cox regression methods. Overall, 101 patients were included, with 57 belonging to the EGFR mutant type group and 44 to the EGFR wild type group. The median postoperative survival was 17 months for the entire cohort, with the duration being 19 and 14 months for EGFR mutant type and wild type patients (p = 0.013), respectively. Multivariate analysis revealed that exon 19 del (p = 0.02) and a high Karnofsky Performance Scale score (p < 0.01) were independent positive prognostic factors to predict survival. The timing of development of the brain metastasis or the location of the intracranial metastasis was not associated with EGFR mutations. EGFR mutations are associated with better survival outcomes in patients with NSCLC brain metastasis suitable for surgical treatment. This advantage was attributed to patients having a specific mutation of exon 19 deletion. [ABSTRACT FROM AUTHOR]

A 24-year-old woman visited our emergency department due to intermittent dull pain in the right eye, blurred vision, foreign body sensation for 3 weeks, and progressive facial rash with pustules for 3 months. She had a history of recurring skin rash on her face and extremities since early adolescence. Peripheral ulcerative keratitis (PUK) was diagnosed based on slit-lamp examination and corneal topography and then granulomatous rosacea (GR) based on clinical manifestations and skin pathology. Topical prednisolone, artificial tears, oral doxycycline, oral prednisolone, and topical clindamycin were administered. After 1 month, PUK progressed to corneal perforation probably due to eye rubbing. The corneal lesion was repaired with a glycerol-preserved corneal graft. A dermatologist prescribed oral isotretinoin for 2 months in conjunction with topical betamethasone gradually tapered for 14 months. After 34 months of follow-up, no signs of skin and ocular recurrence were noted, and the cornea graft was intact. In conclusion, PUK may present with GR, and oral isotretinoin may be an effective therapy for PUK in the setting of GR. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that vitamin D might lower breast cancer mortality. There is also growing interest in vitamin D's potential association with health-related quality-of-life (HRQoL). Associations between circulating 25-hydroxyvitamin D (25OHD) concentrations and HRQoL were examined prospectively among breast cancer survivors at the time of diagnosis and 1 year later. Methods: 504 women with incident early-stage breast cancer at Roswell Park Comprehensive Cancer Center were included, and 372 patients provided assessments 1 year later. At each timepoint, participants provided blood samples and completed the SF-36 Health Survey, and surveys on perceived stress, depression, and fatigue. Season-adjusted serum 25OHD concentrations were analyzed in relation to HRQoL measures using multivariable logistic regression models. Results: Approximately 32% of participants had deficient vitamin D levels at diagnosis, which decreased to 25% at 1 year. Concurrently, although SF-36 physical health summary scores were lower at 1 year, mental health summary scores improved, and levels of depression and perceived stress were lower. In comparison with women with sufficient 25OHD levels (>30 ng/mL) at diagnosis, those who were deficient (<20 ng/mL) had significantly worse HRQoL at diagnosis and 1 year later. Vitamin D deficiency 1 year post-diagnosis was also associated with worse HRQoL, particularly among breast cancer survivors who took vitamin D supplements. Conclusions: Breast cancer survivors with vitamin D deficiency were more likely to report lower HRQoL than those with sufficient levels at the time of diagnosis and 1 year post-diagnosis. Impact: Our results indicate a potential benefit of vitamin D supplementation for improving breast cancer survivorship. [ABSTRACT FROM AUTHOR]

This study examined whether interventions through barrier-free home environment improvements could reduce family caregivers' care stress, improve their family functions, and increase their quality of life. This study recruited family caregivers of older people with disabilities from a long-term care management center in central Taiwan. These older people required improvements related to a barrier-free home environment. A pretest was conducted before and a post-test was conducted 2 months after the improvements. The content of the pretest and the posttest questionnaires included: demographic characteristics, Caregiver stress scale, Family functions scale, World Health Organization Quality of Life-BREF (WHOQOL-BREF) Questionnaire. This study recruited 72 family caregivers; the average age was 56.25 ± 12.99 years. The results indicated that interventions through barrier-free home environment improvements could significantly reduce the family caregivers' care stress, improve their family functions (e.g., reducing conflicts), and enhance their quality of life. Additionally, after intervention, the family cohesion of family caregivers caring for those with mild disability improved to a greater extent than did that of those caring for people with other disease severities. This study revealed that interventions involving barrier-free home environment improvements have positive effects on family caregivers. [ABSTRACT FROM AUTHOR]

Designated verifier signature (DVS) is a variant of digital signature which can designate a verifier to verify signatures. The key difference between message authentication code and DVS is that there is no initial and shared key in DVS. In this paper, we propose a new generic construction of DVS from standard cryptographic algorithms. Our DVS construction is very modular and composed of a few fundamentally cryptographic primitives (i.e., message authentication code, public key encryption and collision resistant hash). Based on the DVS construction, we can also obtain a generic construction of threshold designated verifier signature with only slight modification. [ABSTRACT FROM AUTHOR]

Background: Candidemia is a life-threatening condition; however, the predictive markers for candidemia and mortality are inadequate in cirrhotic patients. This study was conducted to propose candidate predictors for the occurrence of candidemia and 30-day mortality in hospitalized cirrhotic patients with bloodstream infection (BSI) and review the related literature. Methods: Cirrhotic patients with BSI between January 2011 and March 2020 were screened from the databank of a medical center and eligible patients were enrolled. Patients were separated into candidemia and bacteremia groups according to the results of blood cultures. Baseline characteristics, clinical presentation, and biochemistry data were collected at this time, as were microbiological data, medical management, use of antimicrobial agents, and outcome of the patients. The parameters and 30-day mortality were compared between candidemia and bacteremia groups. A combination of the MeSH terms and text terms related to candidemia and cirrhosis was searched in the electronic databases. Results: Four hundred and sixty cirrhotic patients with BSI were enrolled. Thirty-five patients with candidemia (7.6%) were identified. Nosocomial infection, intensive care unit (ICU) admission, antibiotics exposure ≥14 days, white cell count >10 K/mm³, and model for end-stage liver disease (MELD) score >24 were associated with candidemia. The 30-day mortality was 65.7% in the candidemia group and 37.9% in the bacteremia group (p = 0.001). Nosocomial infection, ICU admission, hepatoma, hepatic encephalopathy, international normalized ratio ≥1.2, platelet ≤150 K/mm³, estimated glomerular filtration rate <60 mL/min/1.73m², and MELD score >24 were associated with 30-day mortality. Six studies were identified. The results were consistent with our findings regarding low incidence of candidemia, and relevant risk factors are listed. Conclusion: Candidemia had low incidence but high mortality in hospitalized cirrhotic patients with BSI. New predictors were proposed for the occurrence of candidemia and 30-day mortality in these patients. [ABSTRACT FROM AUTHOR]

The NanoString GeoMx digital spatial profiling is a new multiplexed platform that quantifies the abundance of tumor‐ and immune‐related proteins in a spatially resolved manner. We performed DSP for the simultaneous assessment of 52 analytes within spatially resolved tissue compartments defined by pan‐cytokeratin expression. We compared protein targets between 94 African American/Black and 65 European American/White cases, tumor and stromal tissue compartments, estrogen receptor alpha (ER)‐positive and ER‐negative cases, and explored potential biomarkers of survival. Of 33 analytes with robust signal for analysis, results were highly replicable. For a subset of markers, correlative analyses between DSP analytes and traditional immunohistochemistry scores revealed moderate to very strong associations between the two platforms. Similarly, DSP analytes and gene expression scores were concordant for 21 of 25 markers with overlap between the two datasets. Several analytes varied by ER status, and across the 25 immune markers surveyed, 14 had a significant inverse association with ER expression. B7 homolog 3 (B7‐H3; encoded by CD276) was the only analyte to show a significant difference by race, being lower in both the tumor and stromal compartments in Black women. DSP markers that were associated with survival included CD8, CD25, CD56, CD127, EpCAM, ER, Ki‐67, and STING. We conclude that DSP is an efficient tool for screening tumor‐ and immune‐related markers in a simultaneous fashion and yields results that are concordant with established immune profiling assays. DSP immune analytes were inversely associated with ER expression, in agreement with a substantial body of previous work that documents higher immune infiltration in ER‐negative breast cancers. This technology revealed that scores of the B7‐H3 protein were significantly lower in breast cancers from Black women compared with White women, an intriguing finding that requires replication in independent and racially diverse female populations. [ABSTRACT FROM AUTHOR]

To register mobile mapping system (MMS) lidar points and panoramic-image sequences, a relative orientation model of panoramic images (PROM) is proposed. The PROM is suitable for cases in which attitude or orientation parameters are unknown in the panoramic-image sequence. First, feature points are extracted and matched from panoramic-image pairs using the SURF algorithm. Second, these matched feature points are used to solve the relative attitude parameters in the PROM. Then, combining the PROM with the absolute position and attitude parameters of the initial panoramic image, the MMS lidar points and panoramic-image sequence are registered. Finally, the registration accuracy of the PROM method is assessed using corresponding points manually selected from the MMS lidar points and panoramic-image sequence. The results show that three types of MMS data sources are registered accurately based on the proposed registration method. Our method transforms the registration of panoramic images and lidar points into image feature-point matching, which is suitable for diverse road scenes compared with existing methods. [ABSTRACT FROM AUTHOR]

Hotel Penaga is a heritage-listed boutique hotel in the Unesco World Heritage Site in Penang, Malaysia. It was built in the 1920s and renovated into a 45-room hotel in 2008. Hotel Penaga was the first heritage-listed renovated hotel to be awarded Gold by the Green Building Index. Currently, Hotel Penaga is managed by Vouk Hotel Management. Hotel Penaga is committed to environmental sustainability and emphasizes destination marketing in its hotel operations. Achieving a healthy occupancy rate for the hotel is one of the biggest challenges for Hotel Penaga, especially after the pandemic. [ABSTRACT FROM AUTHOR]

Background: The visceral adiposity index (VAI) is a newly developing indicator about visceral fat function and insulin resistance. This research aims to assess the association between organ damage and VAI in the community-dwelling elderly Chinese population. Methods: In total, 3363 elderly participants were recruited between June 2014 and August 2019. VAI was used to measure visceral adipose accumulation, and organ damage was measured with standardized methods, including arterial stiffness, lower extremity atherosclerosis, carotid hypertrophy, left ventricular hypertrophy, micro-albuminuria, and chronic kidney disease. Results: According to multivariable linear regression analysis, VAI was related to carotid-femoral pulse wave velocity (cf-PWV; β = 0.047, P = 0.024), urine albumin to creatinine ratio (UACR; β = 3.893, P = 0.008), estimated glomerular filtration rate (eGFR; β = − 0.526, P = 0.003) and loge(ankle-to-brachial index) (ABI; β = -0.003, P = 0.024). Using multivariable stepwise logistic regression model, higher VAI was found to be significantly related to cf-PWV > 10 m/s (OR 1.44, [95% CI 1.17–1.78]; Pfor trend < 0.001), and chronic kidney disease (CKD; OR 1.54, [95% CI 1.09–2.20]; Pfor trend = 0.015). Conclusions: Since higher VAI is related to increased risk of arterial stiffness and CKD, it may serve as a useful index for the assessment of arteriosclerosis and CKD in elderly population. Trial registration: NSS, NCT02368938. [ABSTRACT FROM AUTHOR]

The composition of the membrane-concentrated landfill leachate (MCLL) is complex with a high concentration of organic matter and inorganic ions. In this study, a chemical and an electro-Fenton system were constructed to treat MCLL from a mature landfill using granular activated carbon loaded with iron oxides as heterogeneous Fenton catalysts. In the chemical Fenton treatment optimized by orthogonal experiments, the COD and colour removal rates were 93.9% and 80.2%. For the electro-Fenton system, the best COD, colour, and TN removal rates of MCLL reached 95.7%, 99%, and 94.9% with an energy consumption (EC) of 0.098 kWh·(g COD)−1 under the condition of pH 6, applied voltage 8 V, the reaction time 4 h, and the catalyst dosage 16.67 g L−1. Various spectral analyses confirmed that refractory organic matter and toxic substances in the MCLL were effectively degraded. The synergistic effect study of the factors in chemical Fenton indicated that as far as the effect on COD removal is concerned, heterogeneous Fenton system > catalyst adsorption > activated carbon/H 2 O 2 system > activated carbon adsorption. The results of free radical quenching experiments illustrate that a large amount of · OH was produced in the chemical heterogeneous Fenton system, while both · OH and active chlorine play important roles in the removal of pollutants for the electro-Fenton system. MCLL can be disposed of costly and effectively by chemical and electrical Fenton processes with Iron-loaded granular activated carbon catalysts. [Display omitted] • An Iron-loaded heterogeneous GAC Fenton catalyst was used to treat MCLL. • Chemical Fenton with GAC-Fe 3 O 4 removed 93.9% and 80.2% of COD and colour. • Electro-Fenton removed 95.7% and 94.9% of COD and TN with EC of 0.098 kWh·(g COD)−1. • Most complex organic pollutants were converted into simple ones, or mineralized. [ABSTRACT FROM AUTHOR]