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BackgroundWeak nystagmus with fixation removed can be seen both in normal individuals and in recovery from a unilateral vestibular insult, thus its clinical significance is unclear in patients with dizziness. We thus sought to compare features of nystagmus at various stages following unilateral vestibular loss (UVL).MethodsWe enrolled thirty consecutive patients after acute UVL with impaired vestibulo-ocular reflex (VOR) gain. The patients were allocated into three groups according to time from onset of symptoms: acute (1–7 days), subacute (8–30 days), and chronic (>30 days). Patients underwent video-oculography (with and without fixation) and video head impulse testing (vHIT) to determine VOR gain. We examined the relationships amongst SPV, VOR gain, and time from symptom onset across groups.ResultsThere were 11, 10, and 9 patients in the acute, subacute, and chronic stages of UVL, respectively. With visual fixation, only 8 patients (26.7%) demonstrated nystagmus, all from the acute group. With fixation removed, 26 patients (86.7%) exhibited spontaneous nystagmus, including 90.9%, 90%, and 77.8% of the patients from the acute, subacute, and chronic groups, respectively. Horizontal nystagmus was paralytic (i.e., fast phase contralesional) in 25 (96.7%) cases. Horizontal SPV was negatively correlated with logarithm of time from onset to examination (r = −0.48, p = 0.007) and weakly negatively correlated with ipsilesional VOR gain (r = −0.325, p = 0.08).ConclusionIn the subacute or chronic stages of UVL, paralytic nystagmus with fixation removed persisted at a low intensity. Therefore, weak nystagmus in the dark may have diagnostic value in chronic dizziness.

This research examines whether Google search volume index (GSVI), a proxy of investor attention, can predict the excess returns and abnormal trading volumes of TPEx 50 index constituents. It also explores the motive underlying GSVI based on positive or negative shocks to stock prices. The empirical data include 48 companies from TPEx 50 index constituents and cover a period from 1 September 2016 to 31 August 2019. The empirical results present that (1) lagged GSVI negatively affects current excess returns, perhaps due to the characteristics of TPEx, in which there are a higher proportion of retail investors, smaller listed companies, and a higher information asymmetry problem. (2) Lagged GSVI can positively affect abnormal current trading volumes. (3) If GSVI is driven by positive shocks, then it can predict excess returns and abnormal trading volumes positively.

ObjectiveTo study the long-term treatment outcome of vestibular paroxysmia (VP).Study designRetrospective study.SettingTertiary referral hospital.MethodsWe analyzed records of 29 consecutive patients who were diagnosed with VP and who were treated with VP-specific anticonvulsants for at least 3 months. Patients were followed for a minimum of 6 months. We recorded and assessed starting and target dosage of medications, time to achieve adequate therapeutic response, adverse effects, and the rates of short-term and long-term remission without medication.ResultsAll 29 patients were started on oxcarbazepine as first-line treatment, and 93.1% and 100% of patients reported good-to-excellent therapeutic response within 2 and 4 weeks, respectively. Three patients switched to other anticonvulsants at 3 months. At long-term follow-up (8–56 months), most (84.6%) oxcarbazepine-treated patients maintained good therapeutic response at doses between 300 and 600 mg/day. Eleven (37.9%) patients experienced complete remission without medication for more than 1 month, of which six (20.7%) had long-term remission off medication for more than 12 months. Nineteen (65.5%) patients had neurovascular compression (NVC) of vestibulocochlear nerve on MRI, but its presence or absence did not predict treatment response or remission.ConclusionLow-dose oxcarbazepine monotherapy for VP is effective over the long term and is generally well-tolerated. About 20% of patients with VP in our study had long-term remission off medication.

BackgroundDiagnosis of acute vestibular syndrome (AVS) with hearing loss is challenging because the leading vascular cause—AICA territory stroke—can appear benign on head impulse testing. We evaluated the diagnostic utility of various bedside oculomotor tests to discriminate imaging-positive and imaging-negative cases of AVS plus hearing loss.MethodWe reviewed 13 consecutive inpatients with AVS and acute unilateral hearing loss. We compared neurologic findings, bedside and video head impulse testing (bHIT, vHIT), and other vestibular signs (including nystagmus, skew deviation, and positional testing) between MRI+ and MRI– cases.ResultsFive of thirteen patients had a lateral pontine lesion (i.e., MRI+); eight did not (i.e., MRI–). Horizontal-canal head impulse test showed ipsilateral vestibular loss in all five MRI+ patients but only in three MRI– patients. The ipsilesional VOR gains of horizontal-canal vHIT were significantly lower in the MRI+ than the MRI– group (0.56 ± 0.11 vs. 0.87 ± 0.24, p = 0.03). All 5 MRI+ patients had horizontal spontaneous nystagmus beating away from the lesion (5/5). One patient (1/5) had direction-changing nystagmus with gaze. Two had skew deviation (2/5). Among the 8 MRI– patients, one (1/8) presented as unilateral vestibulopathy, four (4/8) had positional nystagmus and three (3/8) had isolated posterior canal hypofunction.ConclusionThe horizontal-canal head impulse test poorly discriminates central and peripheral lesions when hearing loss accompanies AVS. Paradoxically, a lateral pontine lesion usually mimics unilateral peripheral vestibulopathy. By contrast, patients with peripheral lesions usually present with positional nystagmus or isolated posterior canal impairment, risking misdiagnosis as central vestibulopathy.

Objective: The objective is to investigate the test-retest reliability of subjective visual vertical (SVV) in the upright position and with lateral head tilts through a computerized SVV measuring system using virtual reality (VR) goggles. Materials and Methods: Thirty healthy controls underwent SVV test in upright position, with the head tilted to the right 30°, and with the head tilted to the left 30°. Subjects wore SVV VR goggles, which contained a gyroscope for monitoring the angle of head tilt. Each subject completed 10 adjustments in each head position. The mean value of SVV deviations and SVV imprecision (the intra-individual variability of SVV deviations from the 10 adjustments) were recorded and compared across different head positions. The participants then repeated the same SVV protocol at least 1 week later. The test-retest reliability of SVV deviation and SVV imprecision were analyzed. Results: The SVV deviation (mean ± standard deviation) was 0.22° ± 1.56° in upright position, −9.64° ± 5.91° in right head tilt, and 7.20° ± 6.36° in left head tilt. The test-retest reliability of SVV deviation was excellent in upright position (intra-class correlation coefficient [ICC] = 0.77, P < 0.001), right head tilt (ICC = 0.83, P < 0.001) and left head tilt (ICC = 0.84, P < 0.001). The SVV values from the 10 adjustments made during right and left head tilts were less precise than when measured at upright (P < 0.001). The test-retest reliability of SVV imprecision was poor at upright (ICC = 0.21, P = 0.26) but fair-to-good in right head tilt (ICC = 0.72, P < 0.001) and left head tilt (ICC = 0.44, P = 0.04). Conclusion: The test-retest reliability of SVV deviation during lateral head tilts via VR goggles is excellent, which supports further research into the diagnostic value of head-tilt SVV in various vestibular disorders. In addition, the degree of SVV imprecision during head tilt has fair-to-good test-retest reliability, which suggests SVV imprecision may have clinical applicability.

Abstract Background Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8 ± 4.1° and 0.7 ± 1.0°, respectively. The abnormal rate of SVV deviations (> 2.3°) in CVD was significantly higher than VM (p

This paper applies the context-dependent total-factor energy efficiency (CD-TFEE) to determine the multi-layer disaggregate energy efficiency frontiers of twenty administrative regions in Taiwan for the year of 2016. The CD-TFEE overcomes the shortcoming of conventional TFEE index that TFEE is not able to find the “closest target” for each inefficient region in the short run. Furthermore, the CD-TFEE scores here deal with four types of energy inputs (electricity for production, electricity for household and non-household lighting, diesel sales, and gasoline sales), illustrating that multi-layer TFEE frontiers for each energy input in the case of Taiwan can be computed. Empirical results indicate that there are three levels of TFEE frontiers for electricity for production and four levels for other types of energy inputs. In addition, New Taipei City, Taipei City, Keelung City, and Penghu County are at the top level of TFEE frontier for all four energy inputs. This paper also demonstrates that the CD-TFEE procedure generates results different from the CD-DEA introduced by Seiford and Zhu (2003).

Patients with vestibular migraine (VM) often report dizziness with changes in the head or body position. Such symptoms raise the possibility of dysfunction in neural mechanisms underlying spatial orientation in these patients. Here we addressed this issue by investigating the effect of static head tilts on errors of upright perception in a group of 27 VM patients in comparison with a group of 27 healthy controls. Perception of upright was measured in a dark room using a subjective visual vertical (SVV) paradigm at three head tilt positions (upright, ±20°). VM patients were also surveyed about the quality of their dizziness and spatial symptoms during daily activities. In the upright head position, SVV errors were within the normal range for VM patients and healthy controls (within 2° from true vertical). During the static head tilts of 20° to the right, VM patients showed larger SVV errors consistent with overestimation of the tilt magnitude (i.e., as if they felt further tilted toward the right side) (VM: −3.21° ± 0.93 vs. Control: 0.52° ± 0.70; p = 0.002). During the head tilt to the left, SVV errors in VM patients did not differ significantly from controls (VM: 0.77° ± 1.05 vs. Control: −0.04° ± 0.68; p = 0.52). There was no significant difference in SVV precision between the VM patients and healthy controls at any head tilt position. Consistent with the direction of the SVV errors in VM patients, they largely reported spatial symptoms toward the right side. These findings suggest an abnormal sensory integration for spatial orientation in vestibular migraine, related to daily dizziness in these patients.

Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation.Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls.In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27-2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39-2.26).Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.

Background: Diagnosis of acute vestibular syndrome (AVS) with hearing loss is challenging because the leading vascular cause--AICA territory stroke--can appear benign on head impulse testing. We evaluated the diagnostic utility of various bedside oculomotor tests to discriminate imaging-positive and imaging-negative cases of AVS plus hearing loss. Method: We reviewed 13 consecutive inpatients with AVS and acute unilateral hearing loss. We compared neurologic findings, bedside and video head impulse testing (bHIT, vHIT), and other vestibular signs (including nystagmus, skew deviation, and positional testing) between MRI+ and MRI-cases. Results: Five of thirteen patients had a lateral pontine lesion (i.e., MRI+); eight did not (i.e., MRI-). Horizontal-canal head impulse test showed ipsilateral vestibular loss in all five MRI+ patients but only in three MRI-patients. The ipsilesional VOR gains of horizontal-canal vHIT were significantly lower in the MRI+ than the MRI-group (0.56 ± 0.11 vs. 0.87 ± 0.24, p = 0.03). All 5 MRI+ patients had horizontal spontaneous nystagmus beating away from the lesion (5/5). One patient (1/5) had direction-changing nystagmus with gaze. Two had skew deviation (2/5). Among the 8 MRI- patients, one (1/8) presented as unilateral vestibulopathy, four (4/8) had positional nystagmus and three (3/8) had isolated posterior canal hypofunction. Conclusion: The horizontal-canal head impulse test poorly discriminates central and peripheral lesions when hearing loss accompanies AVS. Paradoxically, a lateral pontine lesion usually mimics unilateral peripheral vestibulopathy. By contrast, patients with peripheral lesions usually present with positional nystagmus or isolated posterior canal impairment, risking misdiagnosis as central vestibulopathy. [ABSTRACT FROM AUTHOR]

This study aims to examine the determinants of banking efficiency in the digital finance environment using data from 35 banks in Taiwan. We use a two-stage DEA model to measure service penetration efficiency and profit creation efficiency. Then, we adopt Tobit regression to evaluate how the key factors affect banking efficiency. Our results show that 13 banks (out of 20 high profit-creating banks) are profit creators but not service penetrators, suggesting that financial inclusion can generate profits, but it is not a necessity. Although IT infrastructure of ATMs and e-banking plays a crucial role in fostering financial inclusion, ATMs are still the backbone of efficient banking, while digital banking in Taiwan is merely a strategic necessity rather than strategic advantage. Further, although financial holding banks are more efficient than their nonfinancial holding counterparts, our research suggests that banks should still specialize in a few products rather than diversify too widely. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: A nationwide, population- based, retrospective cohort study. * OBJECTIVES: To investigate whether benign paroxysmal posit ional vertigo (BPPV) is associated with an increased risk of fracture. * BACKGROUND: Benign paroxysmal positional vertigo is a brief rotational vertigo induced by head posit ion change that may increase the risk of falls and, therefore, fracture. * METHODS: Data from the Taiwan National Health Insurance Research Database were used for this study. We selected a case cohort comprising 3796 patients aged over 20 years who were newly diagnosed with BPPV between 2000 and 2006. In addition, we randomly selected a control cohort of 15184 individuals without BPPV. Patients with BPPV were matched to individuals in the control group according to sex, age, and index year. A Cox proportional hazard regression was performed to compute the hazard ratio of fracture, after adjusting for demographic characteristics and comorbidities. * RESULTS: The prevalence of comorbidities was higher among patients with BPPV. After adjusting for age, sex, and comorbidities, patients with BPPV exhibited a 1.14-fold (95% confidence interval [Cl]: 1.04,1.25; P<.01) higher risk of fracture than those without BPPV. Trunk fracture (vertebra, rib, and pelvis) was the fracture type with the highest adjusted hazard ratio (1.24; 95% Cl: 1.06,1.45; P<01) in patients with BPPV relative to those without BPPV. An analysis stratified according to demographic factors revealed tha t men with BPPV exhibited a 1.43-fold (95% Cl; 1.22,1.66; P<.001) higher risk of fracture. Patients with BPPV aged over 65 years exhibited a significantly higher risk of fracture (adjusted hazard ratio = 1.17; 95% Cl: 1.03,1.33; P<.05) than did those without BPPV. * CONCLUSION: Patients with BPPV exhibited a higher risk of fracture than did those without BPPV. * LEVEL OF EVIDENCE: Prognosis, level 2b. J Orthop Sports Phys Ther 2015;45(5):406-412. Epub 26 Mar 2015. [ABSTRACT FROM AUTHOR]

Since 1998, the EPA (Environmental Protection Administration) of Taiwan has been promoting the four-in-one recycling system to reduce waste production and increase the collection of recyclable resources, but there has been no objective evaluation to assess the recycling performance of local governments. This paper introduces a useful indicator (recycling efficiency) for accurate and meaningful measures to achieve better recycling performance and efficiency, and analyses the recycling efficiency of 23 local governments in Taiwan during 1998-2004. The data envelopment analysis, with multiple inputs and outputs, is used in constructing a recycling efficiency indicator. This study takes up four input variables, including the budget for environmental protection per capita, waste-cleaning vehicles per capita, waste-cleaning persons per square kilometre, and participants in promoting activities per capita frequency, along with two outputs (recycling volume per capita and recycling rate). The local governments are divided into three groups, and four environmental variables are incorporated to analyse the effects. According to the results, Keelung City has the highest performance, and Kaohsiung City and Taipei County the least. The high- education population proportion, real mean household income, and urban population proportion all have a positive relation with recycling efficiency. These results may help the EPA and local governments form feasible and efficient recycling targets. [ABSTRACT FROM AUTHOR]

This article follows a three-stage data envelopment analysis (DEA) approach proposed by Fried et al. (2002) to decompose mutual fund underperformance, in order to obtain pure managerial performance. In the first stage, DEA is used to compute each fund's performance. In the second stage, a stochastic frontier regression decomposes fund underperformance into characteristics (including fund and management attributes), managerial inefficiency, and statistical noise. In the third stage, DEA with slack-adjusted data is used to find out the pure performance. It is found that a fund's performance significantly increases with its size, previous performance, manager's tenure and education, while it decreases with the age of the fund and number of managed funds. [ABSTRACT FROM AUTHOR]

We report a case of a tiny infarct on the left dorsolateral pons in a 50-year-old man who presented with prolonged and isolated vertigo. The clinical features mimic vestibular neuritis and can easily lead to misdiagnosis. Selective involvement of the left superior vestibular nucleus might explain the resemblance to acute peripheral vestibulopathy. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]