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Taiwan has implemented a Medical Home Healthcare (MHHC) policy to provide home healthcare services to residents in need. First was the Ordinary Medical Home Healthcare (OMHHC) program in 1997 and then expanded to Integrated Medical Home Healthcare (IMHHC) in 2016. The OMHHC is provided care for residents with tubes at home or in institutions by physicians and nurses, and the IMHHC include additional professions, such as pharmacists and dentists. This study analyzed the longitudinal data from 2013 to 2020 with respect to overall home health services utilizations, and the type of services, and compared the differences between areas with and without healthcare shortages. Our results showed that the IMHHC program enhanced the accessibility of home healthcare to those in needs, especially those in healthcare shortage areas. However, some services in the IMHHC program may still have low utilization rates. It is necessary to investigate the potential barriers for residents to access those services.

Abstract Translation initiation in bacteria is frequently regulated by various structures in the 5′ untranslated region (5′UTR). Previously, we demonstrated that G-quadruplex (G4) formation in non-template DNA enhances transcription. In this study, we aim to explore how G4 formation in mRNA (RG4) at 5′UTR impacts translation using a T7-based in vitro translation system and in E. coli. We show that RG4 strongly promotes translation efficiency in a size-dependent manner. Additionally, inserting a hairpin upstream of the RG4 further enhances translation efficiency, reaching up to a 12-fold increase. We find that the RG4-dependent effect is not due to increased ribosome affinity, ribosome binding site accessibility, or mRNA stability. We propose a physical barrier model in which bulky structures in 5′UTR biases ribosome movement toward the downstream start codon, thereby increasing the translation output. This study provides biophysical insights into the regulatory role of 5′UTR structures in in vitro and bacterial translation, highlighting their potential applications in tuning gene expression.

Abstract The objective of this study is to investigate the relationship between metabolic syndrome (MetS), and bone density in a 30- to 50-year-old Taiwanese population, and to explore the combined effects of BMI and health behaviors on this association. A total of 52,912 individuals aged 30–50 years from the Taiwan Biobank were included in this cross-sectional study. Bone density status was assessed using quantitative ultrasound (QUS). The joint effect was assessed by including an interaction term in the multi-logistic regression models to test the association between MetS, BMI, and bone density while controlling for potential confounders. MetS was associated with reduced bone density, with the risk of severe low bone density (SLBD) higher among BMI

Background: The effectiveness of hyperbaric oxygen (HBO) therapy for chronic osteomyelitis remains inconclusive. In particular, recent studies have shown that chronic osteomyelitis is a crucial risk factor for cardiovascular diseases. However, the preventive effect of HBO on cardiovascular events has not been reported in patients with chronic osteomyelitis. Methods: We conducted a population-based cohort study to evaluate the impact of HBO on patients with chronic osteomyelitis. Overall, 5312 patients with chronic osteomyelitis were selected from the Taiwan National Health Insurance Database to evaluate the impact of HBO in patients with chronic osteomyelitis. Propensity-score (PS) matching and inverse probability weighting (IPTW) were employed to balance covariates between the HBO and non-HBO groups. The primary outcome was all-cause mortality. The secondary outcomes were myocardial infarction (MI) and stroke hospitalisation. Furthermore, we evaluated the appropriate timing for HBO intervention by the restricted cubic spline (RCS) functions. Results: After 1:4 PS-matching, the HBO group (n = 265) was associated with lower 1-year mortality (hazard ratio [HR], 0.49; 95 % confidence interval [CI], 0.25–0.95) than the non-HBO group (n = 994); this was consistent with the IPTW weighting results (HR, 0.25; 95 % CI, 0.20–0.33). The risk of stroke was lower in the HBO group (HR, 0.46; 95 % CI, 0.34–0.63) than that in the non-HBO group. However, HBO therapy failed to reduce the risk of MI. Using the RCS model, patients with intervals within 90 days (HR, 1.38; 95 % CI, 1.04–1.84) presented a significant risk of 1-year mortality. After 90 days, as the length of interval increased, the risk gradually decreased and became insignificant. Conclusion: The present study revealed that adjunctive HBO could benefit the 1-year mortality and stroke hospitalisation in patients with chronic osteomyelitis. HBO was recommended to be initiated within 90 days of chronic osteomyelitis hospitalisation.

Abstract Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30–60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (− 0.55 kg, p = 0.02) and change of body weight percentage (− 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future. Clinical Trial Registration: ISRCTN16082909.

PCR is an essential method for the amplification and manipulation of nucleic acids, but the requirement for a thermocycler limits access. Here, authors engineer a helicase to replace the heating step of PCR with enzymatic unwinding, allowing the isothermal amplification of fragments up to 6 kb.

In this study, the corrosion-wear behavior of a Fe-based amorphous alloy coating was analyzed using a pin-on-ring corrosion abrasion system. The Fe-based amorphous alloy coating was prepared by the high velocity oxygen fuel (HVOF) method. The purpose of this article is to study the corrosion-wear behavior of this Fe-based amorphous alloy coating in sea water. The dynamic potential polarization curve and friction coefficient measurement were used to explore the influence of different polarization potentials on the corrosion-wear of the Fe-based amorphous alloy coating. The corrosion behavior of the coating was also analyzed using SEM, TEM and XPS. The experimental results show that under low polarization potential, after the iron oxide is dissolved, the chromium element in the Fe-based amorphous alloy coating will form chromium trioxide to produce a passivation protective layer. However, when the polarization potential is increased, the chromium trioxide will begin to dissolve. Subsequently, the molybdate formed by the passivation layer of molybdenum dioxide and molybdenum trioxide will provide more effective corrosion resistance of this Fe-based amorphous alloy coating. In terms of corrosion-wear behavior, owing to high hardness of the Fe-based amorphous alloy, the wear rate under low polarization potential is very small. When the polarization potential increases, a softer passivation layer will be formed on the surface of the coating, which will cause the wear rate to increase. As the polarization potential is +200 mVSCE, the wear mechanism of the coating is mainly a plowing type. While at high polarization potential (+600 mVSCE), it changes to a corrosive wear type.

(1) Background: Non-alcoholic fatty liver disease (NAFLD) is a major global health concern. The increasing prevalence of NAFLD has been related to type 2 diabetes mellitus (T2D). However, the relationship between short-chain fatty acids (SCFAs) and NAFLD severity is ambiguous in T2D subjects. This study aimed to explore the association of SCFAs with the severity of NAFLD in T2D patients. (2) Methods: We employed echography to examine the severity of hepatic steatosis. The serum levels of nine SCFAs, namely, formate, acetate, propionate, butyrate, isobutyrate, methylbutyrate, valerate, isovalerate, and methylvalerate, were measured using gas chromatography mass spectrometry. (3) Results: A total of 259 T2D patients was enrolled in this cross-sectional study. Of these participants, 117 with moderate to severe NAFLD had lower levels of formate, isobutyrate, and methylbutyrate than the 142 without NAFLD or with mild NAFLD. Lower circulating levels of isobutyrate and methylbutyrate were associated with an increased severity of NAFLD. A relationship between NAFLD severity and circulating isobutyrate and methylbutyrate levels was found independently of a glycated hemoglobin (HbA1C) level of 7.0%. (4) Conclusion: Circulating levels of isobutyrate and methylbutyrate were significantly and negatively correlated with NAFLD severity in the enrolled T2D patients. SCFAs may be related to NAFLD severity in T2D patients.

Negative and positive emotions are the risk and protective factors for the cause and prognosis of hypertension. This study aimed to use five photoplethysmography (PPG) waveform indices and affective computing (AC) to discriminate the emotional states in patients with hypertension. Forty-three patients with essential hypertension were measured for blood pressure and PPG signals under baseline and four emotional conditions (neutral, anger, happiness, and sadness), and the PPG signals were transformed into the mean standard deviation of five PPG waveform indices. A support vector machine was used as a classifier. The performance of the classifier was verified by using resubstitution and six-fold cross-validation (CV) methods. Feature selectors, including full search and genetic algorithm (GA), were used to select effective feature combinations. Traditional statistical analyses only differentiated between the emotional states and baseline, whereas AC achieved 100% accuracy in distinguishing between the emotional states and baseline by using the resubstitution method. AC showed high accuracy rates when used with 10 waveform features in distinguishing the records into two, three, and four classes by applying a six-fold CV. The GA feature selector further boosted the accuracy to 78.97%, 74.22%, and 67.35% in two-, three-, and four-class differentiation, respectively. The proposed AC achieved high accuracy in categorizing PPG records into distinct emotional states with features extracted from only five waveform indices. The results demonstrated the effectiveness of the five indices and the proposed AC in patients with hypertension.

The performance improvement of advanced electronic packaging material is an important topic to meet the stringent demands of modern semiconductor devices. This paper studies the incorporation of nano-alumina powder and thermoplastic elastomer (TPE) into thermoplastic polystyrene matrix to tune the thermal and mechanical properties after injection molding process. In the sample preparation, acetone was employed as a solvent to avoid the powder escape into surrounding during the mechanical mixing in a twin-screw mixer. The pressure and shear force were able to mix the composite with good uniformity in compositions. The samples with different compositions were fabricated using injection molding. The measured results showed that adding 5 wt.% of TPE into the simple polystyrene was able to raise the melt flow index from 12.3 to 13.4 g/10 min while the thermal decomposition temperature remained nearly unchanged. Moreover, the addition of small amount of nano-alumina powder could quickly improve the mechanical property by raising its storage modulus. For example, the addition of 3 wt.% of nano-alumina powder had an increase of 7.3% in storage modulus. Over doping of nano-alumina powder in the composite, such as 10 wt.%, on the other hand, lowered the storage modulus from 2404 MPa to 2069 MPa. The experimental study demonstrated that the tuning in the polystyrene’s thermal and mechanical properties is feasible by composition modification with nano-alumina powder and TPE. The better concentration of the additives should be determined according to the specific applications.

Adolescents with comparable personal risk factors may have different lipid profiles because of the school’s context. Lipid determinants in adolescents should be considered using a multilevel perspective. This multilevel study investigated the effects of individual-level and school-level factors on lipid profiles in adolescents and evaluated the cross-level influence of lipid determinants. A representative adolescent cohort (n = 2727) was randomly selected from 36 schools in three diverse economic areas in Taiwan and assessed for their personal dietary patterns, physical parameters, and lipid profiles. For individual-level factors, both low physical activity and high body mass index (BMI) were associated with elevated triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) levels, and a sugar-sweetened beverage intake of >500 mL/day was associated with increases of 5.97 and 6.12 mg/dL in LDL-C and TC levels, respectively, compared with abstinence. Regarding school-level factors, students in schools with ≥2 health promotion programs per year had a 5.27 mg/dL lower level of LDL-C than those in schools with 0–1 program, and students in schools with ≥46 food outlets within 600 m of the school had 6.90 and 13.3 mg/dL higher levels of TG and TC, respectively, than those in schools with p-value for the random-slope effect was 0.003). In conclusion, individual-level and school-level factors exert a multilevel effect on adolescent lipid profiles. The food environment near the school has a stronger cross-level impact on individual TG levels in adolescents with a high BMI than in those with a normal BMI.

Underlying pathophysiological mechanisms drive excessive clustering of cardiometabolic risk factors, causing metabolic syndrome (MetS). MetS status may transform as adolescents transition to young adulthood. This study investigated the latent clustering structure and its stability for MetS during adolescence, and assessed the anthropometric and clinical metabolic determinants for MetS transformation. A community-based representative adolescent cohort (n = 1516) was evaluated for MetS using four diagnostic criteria, and was followed for 2.2 years to identify new-onset MetS. The clustering structure underlying cardiometabolic parameters was stable across adolescence; both comprised a fat—blood pressure (BP)—glucose three-factor structure (total variance explained: 68.8% and 69.7% at baseline and follow-up, respectively). Among adolescents with MetS-negative at baseline, 3.2–4.4% had incident MetS after 2.2 years. Among adolescents with MetS-positive at baseline, 52.0–61.9% experienced MetS remission, and 38.1–48.0% experienced MetS persistence. Increased systolic BP (SBP) was associated with a high MetS incidence risk, while decreased levels of SBP and glucose were associated with MetS remission. Compared with adolescents with a normal metabolic status at baseline, those with an initial abdominal obesity and increased triglycerides level had a 15.0- and 5.7-fold greater risk for persistent abnormality, respectively. Abdominal obesity and low high-density lipoprotein cholesterol are two abnormal MetS components that highly persist during adolescence, and are the intervention targets for reducing the future risk of cardiometabolic disorders.

In this study, Fe40Cr19Mo18C15B8 amorphous coatings were prepared using high velocity oxygen fuel (HVOF) technology. Different temperatures were used in the heat treatment (600 °C, 650 °C, and 700 °C) and the annealed coatings were analyzed by DSC, SEM, TEM, and XRD. XRD and DSC results showed that the coating started to form a crystalline structure after annealing at 650 °C. From the SEM observation, it can be found that when the annealing temperature of the Fe-based amorphous alloy coating reached 700 °C, the surface morphology of the coating became relatively flat. TEM observation showed that when the annealing temperature of the Fe-based amorphous alloy coating was 700 °C, crystal grains in the coating recrystallized with a grain size of 5–20 nm. SAED analysis showed that the precipitated carbide phase was M23C6 phase with different crystal orientations (M = Fe, Cr, Mo). Finally, the corrosion polarization curve showed that the corrosion current density of the coating after annealing only increased by 9.13 μA/cm2, which indicated that the coating after annealing treatment still had excellent corrosion resistance. It also proved that the Fe-based amorphous alloy coating can be used in high-temperature environments. XPS analysis showed that after annealing FeO and Fe2O3 oxide components increased, and the formation of a large number of crystals in the coating resulted in a decrease in corrosion resistance.

Bearings are common components used in the transmission system of tool machinery and linear drive equipment. With increasing demand for higher efficiency and faster production under the required accuracy, the control of bearing temperature rise under high operational speed becomes a critical issue. The improper control of temperature rise can lead to the thermal deformation and life reduction of the machinery. Conventionally, a circulating oil lubrication system is utilized with journal bearings. In this study, a similar lubrication system was adopted for the ball bearing with a retrofit design. Three control factors, i.e., rotational speed, bearing preload, and the viscosity of the lubricant used, were chosen to study their effects on the temperature performance of the proposed lubrication system. Experimental measurements showed that the lubrication system was able to lower the temperature rise of the bearing considerably compared with its unlubricated counterpart, especially at high rotational speeds. Even with the enhanced cooling from the oil circulation system, temperature rise still increased with rotational speed. However, with increased preload, the temperature rise first dropped and then increased owing to the different contact characteristics of the balls and rings of the bearing. A fitted function for the temperature rise of the bearing under different operational conditions was demonstrated to have a prediction accuracy within 3%. Therefore, the retrofitted bearing oil cooling system should be applicable in the design of high-speed machinery for industry. [ABSTRACT FROM AUTHOR]