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Background: Although prisoner health is a topic of significant importance, it has received limited attention in epidemiological studies, likely due to challenges in obtaining data. Therefore, this study aimed to investigate the prevalence of skin diseases among elderly prisoners in Taiwan. Methods: We examined the presence of skin diseases in 2215 elderly prisoners based on the International Classification of Diseases, 9th revision Clinical Modification (ICD-9-CM). Additionally, the most common types of skin diseases among elderly prisoners in Taiwan were identified. Results: The prevalence of skin diseases among prisoners was estimated to be 55.03%. Elderly men prisoners exhibited a higher prevalence of skin diseases than the women prisoners. The most common skin diseases observed were as follows: contact dermatitis and other forms of eczema; pruritus and related conditions; cellulitis and abscesses; and urticaria. Conclusion: Skin diseases were identified in more than half of the elderly prisoners. The overall quality of life of elderly prisoners can be improved by addressing their skin health, which would contribute to the fulfilment of their basic human rights. Clinical trials number: NA. [ABSTRACT FROM AUTHOR]

Many students who study English as a foreign language (EFL) have difficulty transferring linguistic features between languages while writing. This study aims to investigate how college students improve their EFL writing with text revisions by using a bilingual concordancer (Chinese and English). A sample of 32 college students consented to participate in a writing program. According to pre-test scores, they were grouped into an experimental (N = 15) group, which used the bilingual concordancer, and a control (N = 17) group, which used Yahoo's Chinese-English online dictionary. The results of the study indicate that the experimental group made greater improvement in text revision than those in the control group, as they raised metalinguistic awareness to evaluate word choice and sentence construction, by viewing authentic language examples retrieved from the bilingual concordancer. The bilingual concordancer also provided the experimental group with rich linguistic contexts to compare the differences between two languages and induce the rules of the target language (English), which lead to a reduction in errors due to the interference of the native language in EFL writing. In contrast, the control group relied mostly on limited sample sentences listed in the online dictionary, and lacking contexts resulted in little writing improvement.

Objectives: This retrospective case-controlled study aimed to evaluate the association between the severity of fall-related injuries and fall-risk-increasing drugs (FRIDs) in hospitalized patients. Methods: Data were collected from Changhua Christian Hospital, Taiwan, of all adult inpatients who experienced falls between January 2017 and December 2021, and were divided into two groups based on whether they sustained severe fall-related injuries. Retrospective data that may affect the severity of fall-related injuries and the use of FRIDs were investigated. Results: Among 1231 documented cases of falls, 26 patients sustained severe fall-related injuries. Older patients and those with osteoporosis were more susceptible to more severe injuries from a fall. The use of mobility aids and osteoporosis medications showed protective effects against fall injuries. No significant association was observed between fall-related injuries and comorbidities or FRIDs. Multivariate analysis confirmed the inverse correlation between the use of mobility aids, osteoporosis medications, and fall severity. Patients with osteoporosis exhibited significantly higher odds of sustaining more severe injuries with a fall (odds ratio = 3.02, 95% confidence interval: 1.21–7.53). Conclusions: This study highlights the importance of addressing risk factors associated with fall severity among hospitalized patients. Providing mobility aids to persons at greater risk. [ABSTRACT FROM AUTHOR]

Background Intradialytic hypotension (IDH) is a common hemodialysis complication causing adverse outcomes. Despite the well-documented associations of ambient temperatures with fluid removal and pre-dialysis blood pressure (BP), the relationship between ambient temperature and IDH has not been adequately studied. Methods We conducted a cohort study at a tertiary hospital in southern Taiwan between 1 January 2016 and 31 October 2021. The 24-h pre-hemodialysis mean ambient temperature was determined using hourly readings from the weather station closest to each patient's residence. IDH was defined using Fall40 [systolic BP (SBP) drop of ≥40 mmHg] or Nadir90/100 (SBP <100 if pre-dialysis SBP was ≥160, or SBP <90 mmHg). Multivariate logistic regression with generalizing estimating equations and mediation analysis were utilized. Results The study examined 110 400 hemodialysis sessions from 182 patients, finding an IDH prevalence of 11.8% and 10.4% as per the Fall40 and Nadir90/100 criteria, respectively. It revealed a reverse J-shaped relationship between ambient temperature and IDH, with a turning point around 27°C. For temperatures under 27°C, a 4°C drop significantly increased the odds ratio of IDH to 1.292 [95% confidence interval (CI) 1.228 to 1.358] and 1.207 (95% CI 1.149 to 1.268) under the Fall40 and Nadir90/100 definitions, respectively. Lower ambient temperatures correlated with higher ultrafiltration, accounting for about 23% of the increased IDH risk. Stratified seasonal analysis indicated that this relationship was consistent in spring, autumn and winter. Conclusion Lower ambient temperature is significantly associated with an increased risk of IDH below the threshold of 27°C, irrespective of the IDH definition. This study provides further insight into environmental risk factors for IDH in patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

This paper reports on an investigation of adult online learning for 91 Taiwanese in-service preschool teachers enrolled in online degree programs. By using an open-ended written essay to investigate what learners thought they were learning through online education (their conceptions) and how they engaged in online education (their approaches), qualitatively different categories of conceptions and approaches were identified through a phenomenographic analysis approach. The results found that their conceptions of online education ranged from "a way of diploma completion" to "a way of lifelong learning," while their approaches ranged from "interacting with people" to "getting involved in the community of sharing." In addition, the teacher-learners with fragmented conceptions ("a way of diploma completion") tended to have surface approaches ("interacting with people"), and those with cohesive conceptions ("a way of lifelong learning") tended to have deep approaches in online education ("getting involved in the community of sharing").

Many college students who study English as a Foreign Language (EFL) are less-proficient readers as they have few opportunities to negotiate their perspectives for creating meaning through peer questioning in onsite instruction. This study reports on using online peer questioning to enhance less-proficient college students' negotiation of meaning in comprehending texts. A sample of 50 college students was divided into two groups based on the pre-test, into a more-proficient group and a less-proficient group, with 25 students in each group. The results of this study reveal that the less-proficient students made greater progress in reading comprehension than the more-proficient students after using the strategy of online peer questioning. The less-proficient students were able to explicitly observe how the more-proficient peers used integration questions, agreed or disagreed with peer responses, and finally constructed new understandings of the hypertexts. Particularly, the less-proficient students learned from the more-proficient peers on how to engage in critical thinking to express and share multiple perspectives. Using online peer questioning, both the more-and the less-proficient students frequently engaged in negotiation of meaning, interaction, and teaching one another. Their reading progress was reflected in the post-test, the types of questions and responses, and their perceptions toward using online peer questioning.

An incorrect concept map may obstruct a student's comprehension when writing summaries if they are unable to grasp key concepts when reading texts. The purpose of this study was to investigate the effects of automatic scaffolding and measurement of three-layer concept maps on improving university students' writing summaries. The automatic three-layer concept maps presented in this study include: (1) the central idea of the title, (2) the main idea of each paragraph, and (3) the supporting ideas in each paragraph. A sample of 107 university students who studied English as a Foreign Language (EFL) was divided into experimental and control groups, comprised of 54 and 53 students respectively. The results of this study indicate that the students of the experimental group made more significant improvement in reading comprehension and summary writing than those of the control group as they were able to identify the main idea from each paragraph and clarify relations among paragraphs after requesting the three-layer concept maps. They then modified their prior knowledge structure by revising the first-draft summaries to final ones. The students' perceptions toward the automatic three-layer concept maps to improve summary writing are also described in this study.

Background: Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. Methods: This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. Results: All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). Conclusions: Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization. [ABSTRACT FROM AUTHOR]

Oftentimes, college students who learn English as a Foreign Language (EFL) provide their peers with incorrect and misleading feedback during text revision. To improve the effectiveness of peer feedback, this study examined the degree to which online feedback training impacted EFL college students' text revisions. A sample of 50 college students was grouped into the more- and less-proficient groups with 25 students in each. Results of this study reveal that the less-proficient students improved more during text revision than the more-proficient students did after the online feedback training on error correction. They were better able to detect and correct both local errors (i.e., grammatical) and global errors (i.e., text development, organization, and style) in their own and peers' texts. Their texts improved as a result of receiving immediate feedback and having the opportunity to explicitly observe how their more-proficient peers provided corrections and useful suggestions to peers and clarified writing problems for text improvement. The more-proficient students did not trust their peers' suggestions as much and made corrections mainly on local errors. These EFL college students' perceptions toward the effects of online feedback training on text revision were elaborated in this study.

Students seldom think about language unless they are instructed to do so or are made to do so during learning activities. To arouse students' awareness while learning English for Specific Purposes (ESP), this study formed a computer-supported collaborative learning (CSCL) community to engage teachers and students from different domains and countries in intercultural communication. Participating were 208 students, including 83 international students from one of the eight vocational and technological universities which composed the CSCL community. Organized according to activity theory, the results indicate that students' language awareness is stimulated when students monitor the accuracy of their language usage (process-oriented) and assess their language performance (product-oriented) during intercultural communication with their peers from different backgrounds (across majors, colleges, and universities) and countries (China, Denmark, Indonesia, Malaysia, Netherlands, Thailand, and Vietnam). The intercultural characteristics of the CSCL community fostered students' language awareness as they acquired expressions from different cultures and contexts on the levels of lexical, syntactic, and textual organization. As a result of such intercultural communication, students' improvement of language awareness was further revealed by nine assessments examined by means of a repeated one-way analysis of variance. This study lays a foundation for promoting online intercultural interaction.

Background. Archery exercise exerts a rehabilitative effect on patients with paraplegia and might potentially serve as complementary physiotherapy for patients with Parkinson's disease. Objective. This study aimed to examine the rehabilitative effects of an archery intervention. Methods. A randomized controlled trial of a 12-week intervention was performed in patients with idiopathic Parkinson's disease. Thirty-one of the 39 eligible patients recruited from a medical center in Taiwan participated in the trial, of whom 16 were in the experimental group practicing archery exercises and 15 were in the control group at the beginning; twenty-nine completed the whole process. The Purdue pegboard test (PPT), the Unified Parkinson's Disease Rating Scale I to III (UPDRS I to III), physical fitness test, and timed up and go test (TUG) were used to assess the intervention effects of archery exercise. Results. Compared to the control group, the outcome differences between the posthoc and baseline tests in PPT, UPDRS I to III, lower extremity muscular strength, and TUG in the experimental group (between-group difference in difference's mean: 2.07, 1.59, 1.36, −2.25, −3.81, −9.10, 3.57, and −1.51, respectively) did show positive changes and their effect sizes examined from Mann–Whitney U tests (η: 0.631, 0.544, 0.555, 0.372, 0.411, 0.470, 0.601, and 0.381, respectively; Ps < 0.05) were medium to large, indicating that the archery intervention exerted promising effects on improving hand flexibility and finger dexterity, activity functions in motor movement, lower extremity muscular strength, and gait and balance ability. Conclusions. Traditional archery exercise was suggested to have a rehabilitative effect for mild to moderate Parkinson's disease and could be a form of physiotherapy. Nevertheless, studies with larger sample sizes and extended intervention periods are needed to ascertain the long-term effects of archery exercise. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 had reported over 676 million cases by March 2023. The main aim of this study is to investigate whether the levels of anti-S and anti-N antibodies could precisely indicate the degree of protection against SARS-CoV-2 and affect the probability or time of contracting COVID-19. In this study, a serosurveillance study was conducted in healthcare workers (HCWs) at a regional hospital in Taiwan to evaluate their antibody levels based on infection and vaccination status. Of 245 HCWs enrolled, all have been vaccinated prior to infection. Of these, 85 participants were infected by SARS-CoV-2, while 160 participants were not infected at the time of blood sample collection. The level of anti-SARS-CoV-2 S antibody was significantly higher in the infected HCWs than in the non-infected participants (p < 0.001). It is worth noting that the mean duration between the administration of the last dose of the vaccine and the occurrence of SARS-CoV-2 infection was 5.61 ± 2.95 months. Our follow-up survey revealed that the non-infected group had significantly higher levels of antibodies compared to the infected group (all p < 0.001). In conclusion, this study suggests that the level of antibodies could serve as a reflection of the protective efficacy against SARS-CoV-2 infection. It has the implication for vaccine decision-making policies in the future. [ABSTRACT FROM AUTHOR]

Background and Objectives: In 2004, the Health Administration of Taiwan began to promote a hospital-based cancer screening quality improvement program, under the principle that "prevention is better than therapy". The aim of this study was to evaluate the effectiveness of colorectal cancer (CRC) screening in patients who received a fecal immunochemical test (FIT) at a hospital in central Taiwan. Materials and Methods: This was a retrospective study. Results: Fecal occult blood immunoassays for CRC screening were conducted in 58,891 participants, of whom 6533 were positive (positive detection rate 11.10%). The positive patients then underwent colonoscopy, and the detection rates of polyps and CRC accounted for 53.6% and 2.4% of all colonoscopy-confirmed diagnoses (3607), respectively. We further enrolled data from patients diagnosed with CRC at our hospital from 2010 to 2018. The patients with CRC were divided into two groups according to whether or not they had received fecal occult blood screening. Among the 88 patients with CRC by screening, 54 had detailed medical records including cancer stage. Of these 54 patients, 1 (1.8%) had pre-stage, 11 (20.4%) had stage I, 24 (44.4%) had stage II, 10 (18.5%) had stage III, and 8 (14.8%) had stage IV CRC. The early cancer detection rates of the screening and non-screening groups were 66.7% and 52.7%, respectively, and the difference was significant (p = 0.00130). Conclusions: In this study, screening with FIT significantly increased the early detection of CRC. The main advantage of FIT is the non-invasiveness and low cost. It is hoped that the further adoption of early screening can increase the detection rates of colorectal polyps or early cancer to improve survival, reduce the high cost of subsequent cancer treatment, and reduce the burden on the patient and healthcare system. [ABSTRACT FROM AUTHOR]

This qualitative study aims to understand how English learners interpret shared space in an online multilateral English blogging context and how their interpretations of shared space contribute to their multilateral exchange experience. Twenty-four Asian learners of English from two different universities--one in Japan and one in Taiwan--participated in this study. These learners worked on their individual blogs and interacted on both their own blogs and on those of their partners. Data sources include surveys, online interaction records, class assignments, reflective journals, and interviews. Guided by Kramsch's (2009c) analogy of the mindsets of the structuralist and post-structuralist approaches in culture and communication, this study reported that students in this multilateral English blogging project interpreted shared space from two perspectives (a) commonality, and (b) relativity. While students who interpreted shared space from the perspective of commonality valued pre-existing shared personal interests, mutual understanding, and similar personal experiences as a prerequisite for inter-class blogging, students who interpreted shared space from the perspective of relativity tended to draw relative positions from a dialogue between their and their inter-class peers' historicity or cultural memories through re-contextualization and re-positioning. This study suggests that although students who interpreted shared space from the commonality perspective were able to engage in inter-class blogging, they faced difficulties in exploring other possibilities in relating to the blog content, the blog discussions, and the bloggers, when commonality was absent. However, for students who interpreted shared space from the relativity perspective, they were able to form relationships of possibility in mediating encounters through uses of heterogeneous semiotic resources. Future research on what barriers can hinder students' development due to interpretation of shared space and how students develop uses of symbolic resources can contribute to understanding students' construction of shared space for communication. (Contains 3 tables and 3 notes.)

Many studies have reported the results of how students constructed texts, yet the cognitive process of how texts were constructed by sentences and how the constructive process was formulated and reformulated have rarely been addressed. This study aims to develop a computer-aided text construction system which supports 83 English as a Foreign Language (EFL) university students in inserting sentences to construct texts with the scaffoldings of lexical cohesion and sentence relations. The students' actions in text construction were recorded in a "recording module" which showed their metacognitive process during the task. Results of this study revealed that the engagement in metacognitive process was rarely found in the students who made little progress through three online texts. The students who demonstrated the developmental progress in three texts were actively engaged in the metacognitive process to monitor and evaluate their text constructive problems. They then frequently revised the text by reselecting the sentences with the assistance of lexical cohesion and sentence relations. It was further found that students' metacognition could be strengthened by the text construction task. The increased engagement in metacognition, especially reselecting the sentences (revising), led to higher scores being obtained in text construction. (Contains 15 figures and 9 tables.)

Learning happens through interaction with others. The purpose of this study is to investigate how online interaction patterns affect students' text revisions. As a sample, 25 undergraduate students were recruited to play multiple roles as writers, editors, and commentators in online text revisions. In playing different roles, they chose to read peer writers' texts, edit peer writers' errors, evaluate peer editors' suggestions and corrections, and finally rewrite their own texts. Students' choices of actions in the system to interact with their peers for the common goal of text improvement were identified as interaction patterns in this study. Results of this study revealed significant differences in students' interaction patterns and their final texts. The interaction pattern of students who made both local (grammatical corrections) and global (the development, organization, and style of texts) revisions was an extensive and reciprocal process. The interaction pattern of students who made only local revisions was almost a one-way process. Based on these interaction patterns, we suggest that teachers encourage low-participating students to engage in interactions with their peers by showing the benefits of peers' text revisions in the final drafts. Providing necessary assistance and guidance to low-participating students is essential, given their difficulties in writing texts, editing peer writers' texts, and evaluating peer editors' suggestions. (Contains 16 figures and 6 tables.)

This study aims at arousing college students' metacognition in detecting lexical cohesion during online text construction as WordNet served as a lexical resource. A total of 83 students were requested to construct texts through sequences of actions identified as interaction chains in this study. Interaction chains are grouped and categorized as a meaningful entity in order to investigate the students' thinking process and behavior in general and to understand the interaction between the computer and the students in particular. From the interaction chains, it was found that some students revised incorrect sentences to correct ones. In making correct revision, they needed to assess incoming information, interpret and organize textual information, engage in thinking what they know, monitor their own meaning construction process, and take remedial actions to reach comprehension. The rate of correct sentence selection increased from 34.04% to 55.02% in three sequential text construction tasks. The recognition of lexical cohesion was found to be a determining factor for successful construction of a text. (Contains 10 tables and 9 figures.)

The purpose of this study is to examine readers' comprehension as they develop their mental representation of reference in four sequential online texts. A total of 92 college students from three reading classes were recruited to complete the following steps in each text: (1) identify references, (2) draw the relationships between references, and (3) answer reading comprehension test items. Results of this study showed that the correlation between referential resolution and reading comprehension tests ranged from 0.68 to 0.90 in four online texts. This indicated that when readers' scores in referential resolution increased, their scores in reading comprehension tests were also raised. Among three groups of readers, the more-proficient readers were able to integrate the references in different parts of the text as a coherent network from text 1 to 4. In contrast, average and less-proficient readers initially did not integrate any reference when reading the first text. They eventually clustered different references and referred them to a correct subject in the final text. The keys to the development of college readers' mental representation of reference lay in whether they were actively engaged in comprehension monitoring and frequently asked for feedback tool as a scaffold. (Contains 4 tables and 10 figures.)

This study reports on our design of a computer system which supports the understanding of how students construct their mental representation of references and how the construction failures impede their reading comprehension. Three modules, "User interface", "Recording", and "Feedback" were implemented. The "recording module" traced all students' reading process when they tried to link sentences together by references. Results showed that more-proficient readers' mental process in resolving references was constructed to be a complete and coherent network. When they encountered reading difficulty, they usually engaged in comprehension monitoring to read and reread the related sentences to find out contextual clues. They also asked for a "feedback tool" for assistance. All these helped them grasp the main idea of a text and solve lexical ambiguities. In contrast, average and less-proficient readers often resolved the references separately or mismatched them to an incorrect subject which led to partial understanding of textual information. Their unsuccessful resolution of references in previous sentences often hindered their interpretation of subsequent sentences. This caused repeated reading failures in the comprehension of an online text. The mental maps and reading process shown in this study clearly explain students' reading success and failure. The discussion of these maps and processes between the teacher and students will be one of the ways to promote latter's awareness in employing comprehension monitoring and referring strategy. (Contains 4 tables and 20 figures.)

The major purpose of this study is to assist college students in constructing mental representation of referential resolution in a computer system. Ninety students were asked to draw mental maps indicating the relationships between references, take reading comprehension tests, and fill out open-ended questionnaire. Results showed that the correlation between referential resolution and reading comprehension ranged from 61% to 75% in three reading tasks. The more students practiced in referential resolution, the higher average score they obtained in the reading comprehension test. Students also requested fewer feedbacks when they progressed to better comprehend the final online text. That is, they became more independent and relied less on the system's feedback in their reading development. Although seventy-six students expressed that they learned from building connections of related words and made progressed in reading comprehension, fourteen students revealed that they still had difficulties after using the online system. This deserved more investigation in the future. (Contains 6 tables and 12 figures.)

Background: It is well known that the implementation of routine immunizations to prevent vaccine-preventable diseases has a significant impact on the health and well-being of infants, children, and pregnant women. We aimed to evaluate the influence of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine on the immunogenicity of SARS-CoV-2 vaccine among pregnant women, the priority population recommended for vaccination. Methods: We conducted a prospective study among pregnant women without previous SARS-CoV-2 infection in Taiwan. Maternal and umbilical cord blood samples at delivery were analyzed for the percentage of inhibition of neutralizing antibodies (NAbs) against the original strain, Delta, and Omicron variants of SARS-CoV-2 as well as the total antibody to the SARS-CoV-2 spike protein. We examined the association between different doses of SARS-CoV-2 vaccine in combination with influenza and Tdap vaccination, and two-dose SARS-CoV-2 vaccination with or without influenza and Tdap vaccines via a two-sample t-test. Results of p < 0.05 were considered to be statistically significant. Results: 98 pregnant women were enrolled in our study, with 32 receiving two doses of SARS-CoV-2 mRNA-1273 vaccine, 60 receiving three-dose of mRNA-1273, and 6 receiving one-dose of ChAdOx1 and two-dose of mRNA-1273. Twenty-one participants were immunized with SARS-CoV-2, influenza, and Tdap vaccines. Of these 21 individuals, there were no significant NAbs levels in maternal and cord blood samples against the Omicron variant, regardless of doses or type of SARS-CoV-2 vaccine. However, antibody responses against the wild-type and Delta variant were significantly lower in all maternal sera in the two-dose SARS-CoV-2 vaccine group. Among 32 women receiving two-dose mRNA-1273, significantly lower levels of NAbs in maternal sera were observed against the Delta variant and total antibody both in maternal sera and cord blood were observed in individuals receiving SARS-CoV-2 and influenza vaccine. Conclusion: This is the pilot study to demonstrate the effects of influenza and the Tdap vaccine on the immunogenicity of the SARS-CoV-2 vaccine among pregnant women. These results suggest that combination vaccination during pregnancy may result in immunogenic interactions. [ABSTRACT FROM AUTHOR]

Oral cancer is a fatal disease, and its incidence in Taiwan is increasing. Thyroid hormone as L-thyroxine (T4) stimulates cancer cell proliferation via a receptor on integrin αvβ3 of plasma membranes. It also induces the expression of programmed death-ligand 1 (PD-L1) and cell proliferation in cancer cells. Thyroid hormone also activates β-catenin-dependent cell proliferation in cancer cells. However, the relationship between PD-L1 and cancer proliferation is not fully understood. In the current study, we investigated the role of inducible thyroid hormone-induced PD-L1-regulated gene expression and proliferation in oral cancer cells. Thyroxine bound to integrin αvβ3 to induce PD-L1 expressions via activation of ERK1/2 and signal transducer and activator of transcription 3 (STAT3). Inactivated STAT3 inhibited PD-L1 expression and nuclear PD-L1 accumulation. Inhibition of PD-L1 expression reduced β-catenin accumulation. Furthermore, nuclear PD-L1 formed a complex with nuclear proteins such as p300. Suppression PD-L1 expression by shRNA blocked not only expression of PD-L1 and β-catenin but also signal transduction, proliferative gene expressions, and cancer cell growth. In summary, thyroxine via integrin αvβ3 activated ERK1/2 and STAT3 to stimulate the PD-L1-dependent and β-catenin-related growth in oral cancer cells. [ABSTRACT FROM AUTHOR]

Locating and calculating the number of asbestos-cement corrugated roofing tiles is the first step in the demolition process. In this work, archived image cubes of Taiwan served as the fundamental data source used via machine learning approach to identify the existence of asbestos-cement corrugated roofing tiles with more than 85% accuracy. An adequate quantity of ground-truth data covering all the types of roofs via aerial hyperspectral scan was the key to success for this study. Twenty randomly picked samples from the ground-truth group were examined by X-ray refraction detection to ensure correct identification of asbestos-cement corrugated roofing tiles with remote sensing. To improve the classifying accuracy ratio, two different machine learning algorithms were applied to gather the target layers individually using the same universal training model established from 400 ground-truth samples. The agreement portions within the overlapping layers of these two approaches were labeled as the potential targets, and the pixel growth technique was performed to detect the roofing boundary and create the polygon layer with size information. Exacting images from aerial photos within the chosen polygon were compared to up-to-date Sentinel-1 images to find the temporal disagreements and remove the mismatched buildings, identified as non-asbestos roofs, from the database to reflect the actual condition of present data. This automatic matching could be easily performed by machine learning to resolve the information lag while using archived data, which is an essential issue when detecting targets with non-simultaneous acquired images over a large area. To meet the 85% kappa accuracy requirement, the recurring processes were applied to find the optimal parameters of the machine learning model. Meanwhile, this study found that the support vector machine method was easier to handle, and the convolution neuro network method offered better accuracy in automatic classification with a universal training model for vast areas. This work demonstrated a feasible approach using low-cost and low-resolution archived images to automatically detect the existence of asbestos-cement corrugated roofing tiles over large regions. The entire work was completed within 16 months for an area of 36,000 km2, and the detected number of asbestos-cement corrugated roofing tiles was more than three times the initial estimation by statistics method from two small-area field surveys. [ABSTRACT FROM AUTHOR]

Acanthamoeba spp. are opportunistic human pathogens that cause granulomatous amoebic encephalitis and keratitis, and their accurate detection and enumeration in environmental samples is a challenge. In addition, information regarding the genotyping of Acanthamoeba spp. using various PCR methods is equally critical. Therefore, considering the diverse niches of habitats, it is necessary to develop an even more efficient genotyping method for Acanthamoeba spp. detection. This study improved the sensitivity of detection to avoid underestimation of Acanthamoeba spp. occurrence in aquatic environmental samples, and to accurately define the pathogenic risk by developing an efficient PCR method. In this study, a new nested genotyping method was established and compared with various PCR-based methods using in silico, lab, and empirical tests. The in silico test showed that many PCR-based methods could not successfully align specific genotypes of Acanthamoeba, except for the newly designed nested PCR and real-time PCR method. Furthermore, 52 water samples from rivers, reservoirs, and a river basin in Taiwan were analysed by six different PCR methods and compared for genotyping and detection efficiency of Acanthamoeba. The newly developed nested-PCR-based method of genotyping was found to be significantly sensitive as it could effectively detect the occurrence of Acanthamoeba spp., which was underestimated by the JDP-PCR method. Additionally, the present results are consistent with previous studies indicating that the high prevalence of Acanthamoeba in the aquatic environment of Taiwan is attributed to the commonly found T4 genotype. Ultimately, we report the development of a small volume procedure, which is a combination of recent genotyping PCR and conventional real-time PCR for enumeration of aquatic Acanthamoeba and acquirement of biologically meaningful genotyping information. We anticipate that the newly developed detection method will contribute to the precise estimation, evaluation, and reduction of the contamination risk of pathogenic Acanthamoeba spp., which is regularly found in the water resources utilised for domestic purposes. [ABSTRACT FROM AUTHOR]

Background The factors that predict the progression of Mycoplasma pneumoniae infection remain inconclusive. Therefore, we investigated macrolide resistance prevalence, M pneumoniae genotype, and clinical characteristics of childhood M pneumoniae respiratory tract infections in Taiwan. Methods A total of 295 children hospitalized with respiratory tract infections with positive serological M pneumoniae immunoglobulin M test results were enrolled in this 3-year prospective study. Oropharyngeal swabs were obtained for M pneumoniae cultures and polymerase chain reaction tests. All M pneumoniae specimens were further characterized by P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide resistance genotyping. The clinical characteristics and blood cytokine profiles were analyzed accordingly. Results Of 138 M pneumoniae specimens, type I P1 was the predominant (136 of 138, 98.6%). The MLVA type P (4-4-5-7-2) was the leading strain (42 of 138, 30.4%), followed by type J, U, A, and X. The overall macrolide-resistant rate was 38.4% (53 of 138); the resistance rate increased dramatically yearly: 10.6% in 2017, 47.5% in 2018, and 62.5% in 2019 (P  < .001). All macrolide-resistant M pneumoniae (MRMP) harbored the A2063G mutation and were MLVA type 4-5-7-2 (49 of 53, 92.5%), especially type U and X. No significant differences in clinical symptoms, duration of hospital stay, and radiographic findings were identified among patients between MRMP and macrolide-sensitive M pneumoniae (MSMP) groups. Patients with MRMP infection had more febrile days before and during hospitalization and higher interleukin (IL)-13 and IL-33 levels than patients with MSMP infection (P  < .05). Conclusions Macrolide-resistant M pneumoniae surged in Taiwan throughout the study period, but macrolide resistance was not a determinant factor of clinical severity. [ABSTRACT FROM AUTHOR]

Novel clade 2.3.4.4 H5 highly pathogenic avian influenza virus (HPAIV) outbreaks have occurred since early 2015 in Taiwan and impacted the island economically, like they have many countries. This research investigates the immunogenicity of two HPAIV-like particles to assess their promise as vaccine candidates. The haemagglutinin (HA) gene derived from clade 2.3.4.4 H5 HPAIV and matrix protein 1 (M1) gene were cloned into the pFastBac Dual baculovirus vector. The resulting recombinant viruses were expressed in Spodoptera frugiperda moth (Sf)21 cells and silkworm pupae to generate Sf21 virus-like particles (VLP) and silkworm pupa VLP. Two-week-old specific pathogen–free chickens were immunised and their humoral and cellular immune responses were analysed. The silkworm pupa VLP had higher haemagglutination competence. Both VLP types elicited haemagglutination inhibition antibodies, anti-HA antibodies, splenic interferon gamma (IFN-γ) and interleukin 4 (IL-4) mRNA expression, and CD4+/CD8+ ratio elevation. However, chickens receiving silkworm pupa VLP exhibited a significantly higher anti-HA antibody titre in ELISA after vaccination. Although Sf21 VLP recipients expressed more IFN-γ and IL-4, the increase in IFN-γ did not significantly raise the CD4+/CD8+ ratio and the increase in IL-4 did not promote anti-HA antibodies. Both VLP systems possess desirable immunogenicity in vivo. However, in respect of immunogenic efficacy and the production cost, pupa VLP may be the superior vaccine candidate against clade 2.3.4.4 H5 HPAIV infection. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the risk of osteoporosis or bone fractures (vertebrae, hip and others) in hysterectomized women in Taiwan. Materials and methods: This is a retrospective population-based cohort study from 2000 to 2013. Women aged ≥30 years who underwent hysterectomy between 2000 and 2012 were included in this study. The comparison group was randomly selected from the database with a 1:4 matching with age and index year. Incidence rate and hazard ratios of osteoporosis and bone fracture between hysterectomized women and the comparison group were calculated. Cox proportional hazard regressions were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We identified 9,189 hysterectomized women and 33,942 age-matched women without a hysterectomy. All women were followed for a median time of about 7 years. The adjusted hazard ratio (aHR) of subsequent osteoporosis or bone fracture was higher in the hysterectomy women (2.26, 95% confidence interval [CI] = 2.09–2.44) than in the comparison group. In the subgroup analysis, oophorectomy and estrogen therapy increase the risk of osteoporosis or fracture in both groups. Regarding the fracture site, the aHR of vertebral fracture (4.92, 95% CI = 3.78–6.40) was higher in the hysterectomized women than in the comparison group. As follow-up time increasing, the aHR of vertebral fracture in hysterectomized women were 4.33 (95% CI = 2.99–6.28), 3.89 (95% CI = 2.60–5.82) and 5.42 (95% CI = 2.66–11.01) for <5, 5–9 and ≥9 years of follow-up, respectively. Conclusions: In conclusion, we found that hysterectomized women might be associated with increased risks of developing osteoporosis or bone fracture. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a serious medical problem in Taiwan. New, effective therapeutic approaches are needed. The selection of promising anticancer drugs and the transition from pre-clinical investigations to clinical trials are often challenging. The deaminated thyroid hormone analog (tetraiodothyroacetic acid, tetrac) and its nanoparticulate analog (NDAT) have been shown to have anti-proliferative activity in vitro and in xenograft model of different neoplasms, including colorectal cancers. However, mechanisms involved in tetrac- and NDAT-induced anti-proliferation in colorectal cancers are incompletely understood. We have investigated possible mechanisms of tetrac and NDAT action in colorectal cancer cells, using a perfusion bellows cell culture system that allows efficient, large-scale screening for mechanisms of drug actions on tumor cells. Although integrin αvβ3 in K-RAS wild type colorectal cancer HT-29 cells was far less than that in K-RAS mutant HCT116 cells, HT-29 was more sensitive to both tetrac and NDAT. Results also indicate that both tetrac and NDAT bind to tumor cell surface integrin αvβ3, and the agents may have different mechanisms of anti-proliferation in colorectal cancer cells. K-RAS status appears to play an important role in drug resistance that may be encountered in treatment with this drug combination. [ABSTRACT FROM AUTHOR]

Background/purpose: Abnormal folliculogenesis is one of the cardinal presentations of polycystic ovarian syndrome (PCOS) and permeability of follicular wall has been proposed to be involved in the normal follicular growth. However, whether or not there is a change in intrafollicular permeability underlies PCOS is unknown.Methods: This was a tertiary center-based case-control study. From 2014 to 2015, thirteen patients with PCOS who underwent in vitro fertilization-embryo transfer (IVF-ET) were enrolled. Eleven normo-ovulatory patients who underwent IVF-ET due to male factor and/or tubal factor infertility were enrolled as the control group. The influence of ovarian follicular fluid (FF) on endothelial cell permeability was evaluated using a human umbilical vein endothelial cell monolayer permeability assay. The intrafollicular expression profiles of angiogenesis-related proteins were analyzed using a Human Angiogenesis Protein Array Kit.Results: The FF from PCOS patients caused significantly poorer endothelial cell permeability comparing with the effect of FF from the control group (46% ± 12% vs. 58% ± 9%, P = 0.023). Among the 55 angiogenesis-related proteins tested, there was a significantly higher level of intrafollicular platelet factor 4 (PF4) and PF4/IL-8 complex in the PCOS group (p = 0.004). The anti-permeability effect of PF4 was related to the decrease in the intercellular gaps and antagonistic binding with IL-8.Conclusion: Our study provides the first evidence of the pathophysiologic contribution of the well-known angiostatic protein, PF4, on human reproductive biology. The increase of the intrafollicular PF4 and its anti-permeability effect might affect the formation of FF and folliculogenesis in PCOS. [ABSTRACT FROM AUTHOR]

Background/purpose: The freeze-all strategy in high responders is considered to be a safe and effective strategy for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment; however, the cumulative pregnancy outcomes have not been established.Methods: A retrospective, single-center cohort study was conducted and 1311 high-responder patients (>20 oocytes retrieved and/or a serum estradiol level > 3000 pg/ml on the triggering day) were recruited from 2006 to 2015. The study group (n = 351) underwent the freeze-all strategy with subsequent thawed embryo transfer (ET), and the control group (n = 960) received fresh-cycle ET and subsequent thawed ET if needed. A case-control matching analysis was performed to match the two groups for the number of retrieved oocytes. The primary outcomes were the ongoing pregnancy rate (OPR) of the first ET cycle and the cumulative OPR.Results: After matching, there was a significantly higher OPR in the first ET cycle (49.5% vs. 32.2%, p < 0.0001; n = 301 in each group) and the cumulative OPR (69.4% vs. 55.1%, p < 0.0001) in the study group, with significantly fewer total transferred embryos and cycles. The advantages of the freeze-all strategy for the OPR in the first ET cycle (OR: 1.97, p < 0.0001) and the cumulative OPR (OR: 1.49, p = 0.032) remained statistically significant after adjusting for other possible confounding factors in multivariate logistic regression analysis.Conclusion: For high responders, the freeze-all strategy with thawed ET achieved a significantly higher OPR in the first ET cycle and a higher cumulative OPR than the fresh ET strategy. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study has been to evaluate the occupational heat exposure of 12 workers at 5 plants in a subtropical country.Material and Methods: The heat stresses and strain on workers in 5 plants were assessed by the International Organization for Standardization (ISO) 7243 index (wet bulb globe temperature - WBGT) and the ISO 7933 index (maximum allowable exposure time - Dlim).Results: Results indicated that 42% of the subjects (5 workers) surpassed the WBGT limits. According to the Dlim, 42% of the subjects could not continue working in the hot environments. The relationships between the various heat stress indices and the WBGT index were also correlated. However, further studies from different heat environments and more subjects should be performed.Conclusions: The sensitive dependence of skin temperature on meteorological and physiological indices for each subject was clearly observed. Obviously, the heart rate response to metabolic rate was much greater than that caused by environmental heat alone. The exponential relationship between workers' duration-limited exposure time, predicted by various estimated criteria, and WBGT were also found. Int J Occup Med Environ Health 2017;30(3):379-395. [ABSTRACT FROM AUTHOR]

Background Previous studies have demonstrated that multidisciplinary pre-dialysis education and team care may slow the decline in renal function for chronic kidney disease (CKD). Our study compared clinical outcomes of CKD patients between multidisciplinary care (MDC) and usual care in Taiwan. Methods In this 3-year prospective cohort study from 2008 to 2010, we recruited 1056 CKD subjects, aged 20–80 years, from five hospitals, who received either MDC or usual care, had an estimated glomerular filtration rate (eGFR) <60 mL/min, were matched one to one with the propensity score including gender, age, eGFR and co-morbidity diseases. The MDC team was under-cared based on NKF K/DOQI clinical practice guidelines and the Taiwanese pre-end-stage renal disease (ESRD) care program. The incidence of progression to ESRD (initiation of dialysis) and mortality was compared between two groups. We also monitored blood pressure control, the rate of renal function decline, lipid profile, hematocrit and mineral bone disease control. Results Participants were prone to be male (64.8%) with a mean age of 65.1 years and 33.1 months of mean follow-up. The MDC group had higher prescription rates of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), phosphate binder, vitamin D3, uric acid lower agents and erythropoietin-stimulating therapy and better control in secondary hyperparathyroidism. The decline of renal function in advanced stage CKD IV and V was also slower in the MDC group (−5.1 versus −7.3 mL/min, P = 0.01). The use of temporary dialysis catheter was higher in the usual care group, and CKD patients under MDC intervention exhibited a greater willingness to choose peritoneal dialysis modality. A Cox regression revealed that the MDC group was associated with a 40% reduction in the risk of hospitalization due to infection, and a 51% reduction in patient mortality, but a 68% increase in the risk of initiation dialysis when compared with the usual care group. Conclusions MDC patients were found to have more effective medication prescription according to K/DOQI guidelines and slower renal function declines in advanced/late-stage CKD. After MDC intervention, CKD patients had a better survival rate and were more likely to initiate renal replacement therapy (RRT) instead of mortality. [ABSTRACT FROM PUBLISHER]

Study question During controlled ovarian stimulation (COS), does the duration of premature serum progesterone (P) elevation before administration of hCG affect the outcomes of IVF/ICSI embryo transfer (-ET) cycles? Summary answer The duration of the premature serum P elevation is inversely related to the clinical pregnancy rate of IVF/ICSI-ET cycles. What is known and what this paper adds The majority of the previous studies only considered a single serum P measurement made on the day of hCG administration and the results of attempts to relate this to IVF/ICSI-ET outcomes were controversial. However, the effect of the duration of premature serum P elevation before the hCG administration on the outcomes of IVF/ICSI-ET cycles has not been studied well. Here we demonstrate that the duration of premature serum P elevation has a more significant inverse correlation than the absolute serum P concentration on the day of hCG administration with IVF/ICSI-ET outcomes. Design It is a retrospective, single-centre cohort study. A total of 1784 IVF and/or ICSI-ET cycles were included from October 2005 to June 2011. Participants and setting A total of 1784 patients underwent their IVF and/or ICSI-ET cycles in a university hospital IVF unit. The inclusion criteria include (i) age between 20 and 42 years and (ii) eligible indications for COS before IVF/ICSI. Main results and the role of chance The duration of premature serum P elevation to >1 ng/ml is significantly inversely associated with the probability of clinical pregnancy (odds ratio = 0.773, 95% confidence interval: 0.660–0.891, P < 0.001), after adjustment for possible confounders with multivariate logistic regression analysis. However, the significance of inverse correlation between the absolute serum P concentration on the day of hCG administration with clinical pregnancy rate decreased after adjustment. Bias, confounding and other reasons for caution The cutoff value we chose to define premature serum P elevation (P > 1.0 ng/ml) might not be able to be applied to different immunoassay kits and study population. The retrospective nature of this study inevitably might be influenced by some selection bias. Generalizability to other populations Older patients (>42 years) are excluded from our study. Study funding/competing interest(s) This study was supported in part by grants from the National Science Council (100-2314-B-002-022-MY3) and National Taiwan University Hospital (NTUH 100-S1555), Taipei, Taiwan. No competing interests are declared. Trial registration number nil. [ABSTRACT FROM AUTHOR]

Background/purpose: An increasing number of human immunodeficiency virus-1 (HIV-l)-discordant couples in Taiwan have been seeking fertility help. We conducted the first clinical trial in Taiwan of assisted reproductive technology (ART) using sperm washing and viral load measurement.Methods: From 2005 to 2009, we performed 22 ART cycles on 14 HIV-1-discordant couples. The sperm washing involved density gradient centrifugation followed by swim-up method. HIV-1 RNA was checked by real-time reverse transcription-polymerase chain reaction with a sensitivity of 40 copies/mL. In addition, we enrolled two other groups of ART recipients using frozen sperm to compare the clinical outcomes.Results: There were five pregnancies in the fresh cycles (23.8%) of HIV-1-discordant couples and the cumulative pregnancy per couple was 42.9% (6/14). The data were comparable with normal controls and testicular sperm extraction/microscopic epididymal sperm aspiration groups. The nine babies and the 14 women in this study showed no seroconversion.Conclusion: The preliminary data showed good ART results in HIV-1-discordant couples. Fertility services should not be withheld from individuals with HIV-1, although larger series are needed to reach conclusions about safety. [ABSTRACT FROM AUTHOR]

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

Endometriosis is a common systemic chronic inflammatory disease. Inflammation is the key mechanism responsible for the development of endothelial dysfunction and atherosclerosis. We aimed to investigate the risk of coronary artery disease (CAD) among Asian women with endometriosis. This retrospective population-based cohort study included patients with endometriosis diagnosed from 2000 to 2012 and registered in the Longitudinal Health Insurance Database, Taiwan. The comparison cohort (those without endometriosis) were selected (1:4) by matching the age frequency and the index year. We followed up the patients until the diagnosis of CAD (ICD-9-CM codes: 410–414, A270, and A279), withdrawal from the National Health Insurance system, death, or the end of the study. We used a multivariable-adjusted Cox proportional hazard model for evaluating the risk of CAD. We included 19,454 patients with endometriosis and 77,816 women as a comparison group. The mean age of the women at the diagnosis of endometriosis was 37.4 years. A total of 3245 women developed CAD in both groups during a median follow-up of 7 years. The incidence of CAD was higher in women with endometriosis than in those without (5.96 vs. 4.38 per 10,000 person-years; adjusted hazard ratio [95% confidence interval], 1.34 [1.22–1.47]). In conclusion, Asian women with endometriosis had a significantly higher risk of CAD. Further large-scale studies are needed to elucidate the cause-effect relationship between endometriosis and CAD. [ABSTRACT FROM AUTHOR]

Atmospheric polychlorinated-dibenzo-dioxins/dibenzo-furans (PCDD/Fs) remains an important environmental health concern. Although the total emission inventories of PCDD/Fs in Taiwan decreased from 320 to 52.1 g-I-TEQ/year during 2002–2016, the resulting concentrations of atmospheric PCDD/F and distributions in Taiwan are unknown. We, therefore, conducted a comprehensive investigation of spatial and seasonal variations and apportioned potential sources of ambient PCDD/F concentrations in Taiwan-based on 11-year observation data. A total of 1,008 atmospheric PCDD/F samples were collected from 25 air monitoring stations (from seven areas) and 1 background station for 2006–2016. Linear regression was used to model changes in PCDD/F concentrations. Principal component analysis (PCA) and positive matrix factorization (PMF) were used to identify potential contributors. PCDD/F concentrations in the ambient air gradually decreased during the study period, with a median concentration of 28.2 fg I-TEQ/m3 over 11 years. The highest median PCDD/F concentrations were found in the highly industrialized regions of western Taiwan (38.0–43.4 fg I-TEQ/m3). Lower concentrations were found in eastern Taiwan (∼10 fg I-TEQ/m3). Background stations reported the lowest concentrations of PCDD/Fs, with a median concentration of 1.47 fg I-TEQ/m3. Overall, the concentrations of atmospheric PCDD/Fs in Taiwan were higher in winter (13.4–86.7 fg I-TEQ/m3) than in summer (9.65–27.2 fg I-TEQ/m3). The PCA results indicated that PCDD/F profiles varied by both region (industrialized, urbanized, and background areas) and season. The PMF model for the overall data revealed that the major sources of PCDD/Fs were industrial activities (71.2%). However, in less industrialized areas, traffic activities, long-range transport, and open burning were dominant. • Atmospheric PCDD/Fs widely ranged from 0.97 to 255 fg I-TEQ/m3. • Annual median of ambient PCDD/Fs dropped from 43.9 to 18.2 fg I-TEQ/m3 in 11 years. • Highest level of PCDD/Fs were in western Taiwan spatially and in winter seasonally. • PMF showed major sources to be industry (71.2%), LRT (28.6%), and traffic (2.2%). [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) is a major threat to public health that causes infections in hospitals, communities, and animal husbandry. Livestock-associated MRSA (LA-MRSA) is defined as MRSA possessing staphylococcal cassette chromosome mec (SCCmec) IV or V, both of which lacks the Panton–Valentine leukocidin (PVL) gene but has variable combinations of antimicrobial susceptibility. This study focused on Taiwan's subtropical river basin and the Puzih River, which converges from tributaries flowing through downtown and animal husbandry areas. MRSA was detected at a rate of 7.8% in the tributaries, which was higher than downstream (2.1%). The ratio of multidrug-resistant (MDR) MRSA (n = 30) to total MRSA isolates (n = 39) was 0.769, and most of the MDR MRSA isolates (66.7%, 20/30) exhibited resistance to chloramphenicol, ciprofloxacin, clindamycin, erythromycin, sulfamethoxazole-trimethoprim, and tetracycline. The number of MDR MRSA isolates in the tributaries was also higher than the downstream regions of the Puzih River. The majority of MRSA isolates (64.1%) observed in this study possessed SCCmec type IV without PVL, which is typical for LA-MRSA. Enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) typing aided the discrimination of resistance patterns among SCCmec types. This study highlights the threat to human health posed by the waterborne transmission of MDR LA-MRSA. Image 1 • MRSA in the Puzih River basin is associated with the activities of the livestock industry. • MRSA in the Puzih River basin exhibited multidrug-resistance. • The dominant strain of MRSA in the Puzih River basin is LA-MRSA. • LA-MRSA successfully analysed by ERIC-PCR and SCCmec typing. • Livestock sewage discharge may be the source of LA-MRSA in the Puzih River basin. [ABSTRACT FROM AUTHOR]

In this study, we explored the willingness to pay (WTP) for broilers raised under the high welfare system. The interval data model and the ordered probit model were used to investigate the factors that affect consumers' WTP for broiler meat produced by farm animal welfare (FAW), practice. Our results from both methods suggest that socioeconomic characteristics such as education level, income level, gender, and age significantly affect consumers' WTP. The food safety concerns of consumers and perceived consumer effectiveness also influence consumers' WTP. Using the interval data method, we computed the mean and median of the estimated WTP from our survey sample. The mean was 46.7745 New Taiwanese dollar per kilogram. The marginal effects of the different variables are also presented. Simple Summary: In Taiwan, the development of farm animal welfare practice is in its beginning stage. Consumers' attitude toward farm animal welfare products is important for the development of this practice. The main goal of this research is to explore the consumers' willingness to pay for broilers' welfare improvement and to identify the factors that affect this willingness to pay. The results of this study showed that consumers' food safety concerns combined with farm animal welfare can influence consumers' willingness to pay. The more consumers believed that they could make a difference in the improvement of animal welfare, the more they were willing to pay. Consumers who felt that farm animal welfare was the producers' responsibility were less willing to pay. The results of this study can be used to evaluate whether or not farm animal welfare practice is market viable. Moreover, the results can be used to develop marketing strategies for high welfare broilers. [ABSTRACT FROM AUTHOR]

Highlights • The methicillin resistance rate of Staphylococcus aureus isolates was comparable in the new and old hospitals. • The molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) differed between the new and old hospitals. • The molecular epidemiology of MRSA in the hospitals changed over time. Abstract Objective To compare the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolates between an old, urban hospital and a new, rural hospital over the same time period. Methods The molecular characteristics of 398 MRSA bloodstream isolates collected between 2007 and 2013 from two hospitals in Taiwan were analyzed retrospectively; 202 isolates were from the old hospital and 196 from the new hospital (opened in 2007). Results The rate of resistance to multiple antibiotics was significantly higher in the old hospital (93%) than in the new hospital (81%) (p < 0.001). Genetic community-associated MRSA carrying staphylococcal cassette chromosome (SCC) type IV or V accounted for 58% of all MRSA isolates in the new hospital, significantly higher than the rate in the old hospital (p = 0.018). The rate of spa t037-SCC mec III MRSA was significantly lower in the new hospital than in the old hospital (p = 0.02). A significant decreasing trend in spa t002-SCC mec II MRSA isolates was observed in the old hospital (p = 0.006), while the proportion of spa t037-SCC mec III MRSA decreased significantly in the new hospital (41.7% to 26.1%, p = 0.022). Conclusions The rate of multiple antibiotic resistance and the molecular characteristics of MRSA differed significantly between the old and new hospitals and changed over time. [ABSTRACT FROM AUTHOR]

Abstract: Geotechnical reconnaissance of a recurrent liquefaction site at a Quaternary alluvial deposit in southern Taiwan was conducted to establish a comprehensive case history for liquefaction on silty fine sand with high fines content. The liquefaction occurred at a silty fine sand layer with D50 =0.09mm and fines content greater than 35% and was triggered by a Mw =6.4 earthquake on March 4, 2010, which induced maximum horizontal acceleration up to 0.189g at the site. In situ subsurface characterizations, including standard penetration test, cone penetration test, and shear wave velocity measurement, were performed as well as cyclic simple shear tests on undisturbed specimens retrieved by a modified hydraulic piston sampler. Comparisons of cyclic resistance ratios (CRRs) indicate that CPT sounding with standard penetration rate could overestimate the resistance ratio and drainage conditions during penetration should be considered for high fines content soil in the liquefaction analysis. Additionally, variations of CRRs from different in situ tests indicate that correlations among in situ tests and CRR could be soil specific and precautions should be taken when using these curves on silty fine sands. [Copyright &y& Elsevier]

Before the COVID-19 pandemic, Mycoplasma pneumoniae infections emerged during spring to summer yearly in Taiwan, but infections were few during the pandemic. M. pneumoniae macrolide resistance soared to 85.7% in 2020 but declined to 0% during 2022-2023. Continued molecular surveillance is necessary to monitor trends in macrolide-resistant M. pneumoniae.

From 2008 to 2020, the Taiwan National Notifiable Disease Surveillance System database demonstrated that the incidence of non-vaccine serotype 23A invasive pneumococcal disease (IPD) approximately doubled. In this study, 276 non-repetitive pneumococcal clinical isolates were collected from two medical centers in Taiwan between 2019 and 2021. Of these 267 pneumococci, 60 were serotype 23A. Among them, 50 (83%) of serotype 23A isolates belonged to the sequence type (ST) 166 variant of the Spain 9V -3 clone. Pneumococcal 23A-ST166 isolates were collected to assess their evolutionary relationships using whole-genome sequencing. All 23A-ST166 isolates were resistant to amoxicillin and meropenem, and 96% harbored a novel combination of penicillin-binding proteins (PBPs) (1a:2b:2x):15:11:299, the newly identified PBP2x-299 in Taiwan. Transformation of the pbp1a , pbp2b , and pbp2x alleles into the β-lactam-susceptible R6 strain revealed that PBP2x-299 and PBP2b-11 increased the MIC of ceftriaxone and meropenem by 16-fold, respectively. Prediction analysis of recombination sites in PMEN3 descendants (23A-ST166 in Taiwan, 35B-ST156 in the United States, and 11A-ST838/ST6521 in Europe) showed that adaptive evolution involved repeated, selectively favored convergent recombination in the capsular polysaccharide synthesis region, PBPs, murM , and folP genome sites. In the late 13-valent pneumococcal conjugate vaccine era, PMEN3 continuously displayed an evolutionary capacity for global dissemination and persistence, increasing IPD incidence, leading to an offset in the decrease of pneumococcal conjugate vaccine serotype-related diseases, and contributing to high antibiotic resistance. A clonal shift with a highly β-lactam-resistant non-vaccine serotype 23A, from ST338 to ST166, increased in Taiwan. ST166 is a single-locus variant of the Spain 9V -3 clone, which is also called the PMEN3 lineage. All 23A-ST166 isolates, in this study, were resistant to amoxicillin and meropenem, and 96% harbored a novel combination of penicillin-binding proteins (PBPs) (1a:2b:2x):15:11:299. PBP2x-299 and PBP2b-11 contributed to the increasing MIC of ceftriaxone and meropenem, respectively. Prediction analysis of recombination sites in PMEN3 descendants showed that adaptive evolution involved repeated, selectively favored convergent recombination in the capsular polysaccharide synthesis region, PBPs, murM , and folP genome sites. In the late 13-valent pneumococcal conjugate vaccine era, PMEN3 continuously displays the evolutionary capacity for dissemination, leading to an offset in the decrease of pneumococcal conjugate vaccine serotype-related diseases and contributing to high antibiotic resistance., Competing Interests: The authors declare no conflict of interest.

Background: The prevalence of oral diseases among Taiwanese prisoners has rarely been investigated. This study aimed to estimate the gender-specific prevalence of oral disease in a sample of Taiwanese prisoners., Methods: We included 83,048 participants from the National Health Insurance (NHI) Program. Outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision (ICD-9-CM). For prevalence, we provide absolute values and percentages. We also performed a χ2 test to assess sex and age group differences in the percentage of disease in the oral cavity, salivary glands, and jaw., Results: The prevalence rate of oral diseases was 25.90%, which was higher than that of the general population. The prevalence of oral diseases in female prisoners was higher than that in male prisoners (p < 0.001), and the prevalence of oral diseases in prisoners aged ≤ 40 was higher than that of prisoners aged > 40. Among all cases of diagnosed oral diseases, the top three diseases were dental hard tissue diseases (13.28%), other cellulitis and abscesses (9.79%), and pruritus and related conditions (2.88%), respectively. The prevalence of various oral diseases in female prisoners was significantly higher than that in male prisoners., Conclusion: Oral disease is common among Taiwanese prisoners. Female prisoners had a higher prevalence of oral, salivary gland, and jaw diseases than male prisoners. Therefore, early prevention and appropriate treatment are required and also a need for gender-specific oral disease products given the differences in the prevalence of oral disease among male and female prisoners., (© 2023. The Author(s).)

A key component of integrated vector management strategies is the efficient implementation of mosquito traps for surveillance and control. Numerous trap types have been created with distinct designs and capture mechanisms, but identification of the most effective trap type is critical for effective implementation. For dengue vector surveillance, previous studies have demonstrated that active traps utilizing CO 2 attractant are more effective than passive traps for capturing Aedes mosquitoes. However, maintaining CO 2 supply in traps is so labor intensive as to be likely unfeasible in crowded residential areas, and it is unclear how much more effective active traps lacking attractants are than purely passive traps. In this study, we analyzed Aedes capture data collected in 2019 from six urban areas in Kaohsiung City to compare Aedes mosquito catch rates between (passive) gravitraps and (active) fan-traps. The average gravitrap index (GI) and fan-trap index (FI) values were 0.68 and 3.39 respectively at peak catch times from June to August 2019, with consistently higher FI values calculated in all areas studied. We compared trap indices to reported cases of dengue fever and correlated them with weekly fluctuations in temperature and rainfall. We found that FI trends aligned more closely with case numbers and rainfall than GI values, supporting the use of fan-traps for Aedes mosquito surveillance and control as part of broader vector management strategies. Furthermore, combining fan-trap catch data with rapid testing for dengue infections may improve the early identification and prevention of future disease outbreaks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pan, Cheng, Liu, Su, Ho, Liao, Chang, Yang, Hsu, Huang and Chen.)

Chronic obstructive pulmonary disease (COPD) and age-related macular degeneration (AMD) are both common diseases of the elderly people. COPD induced systemic inflammation and hypoxia may have an impact on the development of AMD. This study investigated the possible association between COPD and subsequent risk of AMD. A retrospective cohort study was conducted based on the data from the National Health Insurance Research Database in Taiwan. The COPD cohort comprised 24,625 adult patients newly diagnosed during 2000-2012, whereas age-, gender-, and the year of diagnosis-matched non-COPD cohort comprised 49,250 individuals. Incident AMD was monitored to the end of 2013. A Cox proportional hazards model was applied to evaluate the risk of AMD. The COPD cohort showed 1.25 times higher AMD incidence than the non-COPD cohort (4.80 versus 3.83 per 1000 person-years, adjusted hazard ratio (HR) = 1.20 [95% confident interval (CI) = 1.10-1.32]). Stratified analyses for age, gender, and presence of comorbidity resulted in significant adjusted HRs in most subgroups. Further analysis revealed that the COPD group had an increased risk of both the exudative and non-exudative types of AMD (adjusted HRs = 1.49 [95% CI = 1.13-1.96] and 1.15 [95% CI = 1.05-1.26], respectively). COPD patients have an increased risk for AMD development. Clinicians should provide adequate care for the ocular health to these patients., (© 2021. The Author(s).)

Background: Air pollution is speculated to affect the reproductive health of women. However, a longitudinal association between exposure to air pollution and dysmenorrhea has not been identified, which this study aimed to examine this point. Methods: Two nationwide databases, namely the Taiwan Air Quality Monitoring database and the Taiwan National Health Research Institutes database were linked. Women with a history of dysmenorrhea (International Classification of Disease, Ninth Revision, Clinical Modification code 625.3) before 2000 were excluded. All participants were followed from January 1, 2000 until the diagnosis of dysmenorrhea, withdrawal from National Health Insurance, or December 31, 2013. Furthermore, air pollutants were categorized into quartiles with three cut-off points (25th, 50th, and 75th percentiles). The Cox regression model was used to calculate the hazard ratios of dysmenorrhea. Results: This study enrolled 296,078 women. The mean concentrations of yearly air pollutants were 28.2 (±12.6) ppb for nitric oxides (NO x ), 8.91 (±7.93) ppb for nitric oxide (NO), 19.3 (±5.49) ppb for nitrogen dioxide (NO 2 ), 0.54 (±0.18) ppm for carbon monoxide (CO), and 31.8 (±6.80) μg/m 3 for PM 2.5 . In total, 12,514 individuals developed dysmenorrhea during the 12-year follow-up. Relative to women exposed to Q1 concentrations of NO x , women exposed to Q4 concentrations exhibited a significantly higher dysmenorrhea risk [adjusted hazard ratio (aHR)= 27.9, 95% confidence interval (CI) = 21.6-31.3]; similarly higher risk was found for exposure to NO (aHR = 16.7, 95% CI = 15.4-18.4) and NO 2 (aHR = 33.1, 95% CI = 30.9-37.4). For CO, the relative dysmenorrhea risk in women with Q4 level exposure was 28.7 (95% CI = 25.4-33.6). For PM 2.5 , women at the Q4 exposure level were 27.6 times (95% CI = 23.1-29.1) more likely to develop dysmenorrhea than those at the Q1 exposure level. Conclusion: Our results showed that women would have higher dysmenorrhea incidences while exposure to high concentrations of NO, NO 2 , NO x , CO, and PM 2.5 ., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lin, Yang, Lin, Chang, Hsu, Wang, Lin, Hsu and Kao.)

Di-(2-ethylhexyl) phthalate (DEHP), a common plasticizer, has been detected in breast milk in many countries; however, whether phthalate metabolite concentration and the detection rate in breast milk change postpartum is still unknown. We measured phthalate metabolite concentrations in breast milk in the first 6 months postpartum in women enrolled in the E-Da hospital from January to July 2017. A total of 56 breastfeeding mothers and 66 samples were included in this study. We analyzed the samples' concentration of eight phthalate metabolites using liquid chromatography mass spectrometry. The concentration of mono-2-ethylhexyl phthalate (MEHP) was significantly higher in the first month, and then decreased over time. The detection rate of ono-isobutyl phthalate (MiBP) and mono-n-butyl phthalate (MBP) was low in the first month and then increased over time. Compared with a previous study published in 2011, the levels of MEHP and MiBP in breast milk were much lower in the present study, suggesting an increased awareness of the health risks of phthalate exposure after a food scandal occurred in Taiwan. This study provides information for evaluating newborns' exposure to different kinds of phthalate through human milk in the postpartum period.

Abstract: We investigate whether patients with chronic kidney disease (CKD) are at increased risk of retinal vascular disease (RVD). Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with CKD between 2000 and 2012. The endpoint of interest was a diagnosis of RVD. Follow-up data of 85,596 patients with CKD and 85,596 matched comparisons (non-CKD) from 2000 to 2012 were analyzed. Patients with CKD were found to have a significantly higher cumulative incidence of RVD (Kaplan-Meier analysis, log-rank test P < .0001). Through multivariate Cox regression analysis, the CKD group was found to have higher risk of developing RVD (adjusted hazard ratio (HR) [95% confidence interval (CI)]: 2.30 [2.16-2.44]) when compared to the control cohort. When comparison of CKD group and non-CKD group was stratified by gender, age and comorbidities (hypertension, diabetes, and hyperlipidemia), the higher risk of RVD in patients with CKD remained significant in all subgroups. Patients with CKD were found to have higher risk of developing RVD in this cohort study. In addition, CKD imposed the same risk for RVD development in all age groups and in patients with or without hypertension or diabetes. Thus, patients with CKD should be vigilant for symptoms of RVD. Understanding the link between CKD and RVD could lead to the development of new treatment and screening strategies for both diseases., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)