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Abstract Background Weight control behaviors are commonly observed among adolescents and emerging adults. However, the high prevalence of overweight and obesity in both these age groups remains an imperative health concern. Adolescents and emerging adults represent the most vulnerable groups facing the health burden of obesity. Methods This study was designed to articulate the underlying beliefs concerning weight control behaviors among adolescents and emerging adults living with obesity by an elicitation qualitative study based on the integrated behavioral model (IBM). Semi-structured and individual interviewing was utilized. Eligible participants were recruited during September and November 2020. All interviews were audio-recorded, transcribed verbatim, and analyzed using a hybrid inductive and deductive content analysis approach. Results Twenty-seven participants, comprising 12 adolescents and 15 emerging adults living with obesity, were interviewed to explore their beliefs and strategies regarding weight control behaviors. Emerging adults were more likely to engage in extreme weight control methods. Three overarching themes emerged across both age groups: eating-centered concerns, focus on physical appearance, and social interference. Significant differences were noted while adolescents and emerging adults shared some common beliefs. Emerging adults expressed more economic concerns about weight control, whereas adolescents identified food restriction as the primary barrier to their weight management efforts. These findings highlight the nuanced differences in beliefs about the weight control practice of these two developmental groups. Conclusion More beliefs-tailored and theoretically driven interventions are needed for these two unique age groups. Healthcare providers should address dietary and economic concerns while engaging adolescents and emerging adults in weight management. Future obesity interventions should incorporate shared and unique beliefs identified in each group to promote healthy weight management effectively.

Abstract Background The aim of this study was to determine whether and how Zn proteinate with moderate chelation strength (Zn-Prot M) can alleviate heat stress (HS)-induced intestinal barrier function damage of broilers. A completely randomized design was used for comparatively testing the effects of Zn proteinate on HS and non-HS broilers. Under high temperature (HT), a 1 (Control, HT-CON) + 2 (Zn source) × 2 (added Zn level) factorial arrangement of treatments was used. The 2 added Zn sources were Zn-Prot M and Zn sulfate (ZnS), and the 2 added Zn levels were 30 and 60 mg/kg. Under normal temperature (NT), a CON group (NT-CON) and pair-fed group (NT-PF) were included. Results The results showed that HS significantly reduced mRNA and protein expression levels of claudin-1, occludin, junctional adhesion molecule-A (JAMA), zonula occludens-1 (ZO-1) and zinc finger protein A20 (A20) in the jejunum, and HS also remarkably increased serum fluorescein isothiocyanate dextran (FITC-D), endotoxin and interleukin (IL)-1β contents, serum diamine oxidase (DAO) and matrix metalloproteinase (MMP)-2 activities, nuclear factor kappa-B (NF-κB) p65 mRNA expression level, and protein expression levels of NF-κB p65 and MMP-2 in the jejunum. However, dietary supplementation with Zn, especially organic Zn as Zn-Prot M at 60 mg/kg, significantly decreased serum FITC-D, endotoxin and IL-1β contents, serum DAO and MMP-2 activities, NF-κB p65 mRNA expression level, and protein expression levels of NF-κB p65 and MMP-2 in the jejunum of HS broilers, and notably promoted mRNA and protein expression levels of claudin-1, ZO-1 and A20. Conclusions Our results suggest that dietary Zn, especially 60 mg Zn/kg as Zn-Prot M, can alleviate HS-induced intestinal barrier function damage by promoting the expression of TJ proteins possibly via induction of A20-mediated suppression of the NF-κB p65/MMP-2 pathway in the jejunum of HS broilers.

Abstract Osteoarthritis (OA) is one of the most prevalent musculoskeletal diseases in Taiwan, posing a significant public health challenge. In recent years, outdoor air pollution has become an increasingly critical global health issue. Asian Dust Storms (ADS) are known to exacerbate various health conditions due to elevated levels of particulate matter and other pollutants. However, the relationship between ADS and knee OA remains insufficiently explored. This study investigates the association between ADS occurrences and knee OA outpatient visits from January 2006 to December 2012, aiming to understand the potential health impacts of dust storms on OA patients. Using data from the National Health Insurance Research Database (NHIRD), the Taiwan Environmental Protection Agency (TEPA), and the Taiwan Central Weather Bureau, we conducted a time-series analysis employing the autoregressive moving average with exogenous variables (ARMAX) model. This approach accounted for daily outpatient visits related to knee OA, ADS events, and various environmental and meteorological factors. The results revealed a significant increase in knee OA outpatient visits on days immediately following ADS events, with peaks observed one to two days after the event. This increase was most pronounced among females, individuals aged 61 and above, and residents in the western regions. The study demonstrates an association between ADS and increased knee OA outpatient visits, highlighting the need for public health strategies to mitigate the health impacts of dust storms.

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.

Abstract Phosphorus pentamers (cyclo-P5) are unstable in nature but can be synthesized at the Ag(111) surface. Unlike monolayer black phosphorous, little is known about their electronic properties when in contact with metal electrodes, although this is crucial for future applications. Here, we characterize the atomic structure of cyclo-P5 assembled on Ag(111) using atomic force microscopy with functionalized tips and density functional theory. Combining force and tunneling spectroscopy, we find that a strong charge transfer induces an inward dipole moment at the cyclo-P5/Ag interface as well as the formation of an interface state. We probe the image potential states by field-effect resonant tunneling and quantify the increase of the local change of work function of 0.46 eV at the cyclo-P5 assembly. Our experimental approach suggest that the cyclo-P5/Ag interface has the characteristic ingredients of a p-type semiconductor-metal Schottky junction with potential applications in field-effect transistors, diodes, or solar cells.

Abstract Pulmonary vascular remodeling is a key pathological process of pulmonary arterial hypertension (PAH), characterized by uncontrolled proliferation and migration of pulmonary arterial smooth muscle cells (PASMCs). Bortezomib (BTZ) is the first Food and Drug Administration (FDA)‐approved proteasome inhibitor for multiple myeloma treatment. Recently, there is emerging evidence showing its effect on reversing PAH, although its mechanisms are not well understood. In this study, anti‐proliferative and anti‐migratory effects of BTZ on PASMCs were first examined by different inducers such as fetal bovine serum (FBS), angiotensin II (Ang II) and platelet‐derived growth factor (PDGF)‐BB, while potential mechanisms including cellular reactive oxygen species (ROS) and mitochondrial ROS were then investigated; finally, signal transduction of ERK and Akt was examined. Our results showed that BTZ attenuated FBS‐, Ang II‐ and PDGF‐BB‐induced proliferation and migration, with associated decreased cellular ROS production and mitochondrial ROS production. In addition, the phosphorylation of ERK and Akt induced by Ang II and PDGF‐BB was also inhibited by BTZ treatment. This study indicates that BTZ can prevent proliferation and migration of PASMCs, which are possibly mediated by decreased ROS production and down‐regulation of ERK and Akt. Thus, proteasome inhibition can be a novel pharmacological target in the management of PAH.

ObjectiveCarpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS.MethodThis was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR).ResultsBoth the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65–3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22–1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33.ConclusionThis study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude.Clinical Trial Registrationhttps://doi.org/10.1186/ISRCTN82192319, ISRCTNregistry (No. ISRCTN82192319).

ABSTRACT: Zinc (Zn) could alleviate the adverse effect of high temperature (HT) on intestinal integrity and barrier function of broilers, but the underlying mechanisms remain unclear. We aimed to investigate the possible protective mechanisms of Zn on primary cultured broiler jejunal epithelial cells exposed to thermal stress (TS). In Exp.1, jejunal epithelial cells were exposed to 40℃ (normal temperature, NT) and 44℃ (HT) for 1, 2, 4, 6, or 8 h. Cells incubated for 8 h had the lowest transepithelial resistance (TEER) and the highest phenol red permeability under HT. In Exp.2, the cells were preincubated with different Zn sources (Zn sulfate as iZn and Zn proteinate with the moderate chelation strength as oZn) and Zn supplemental levels (50 and 100 µmol/L) under NT for 24 h, and then continuously incubated under HT for another 8 h. TS increased phenol red permeability, lactate dehydrogenase (LDH) activity and p-PKC/PKC level, and decreased TEER, cell proliferation, mRNA levels of claudin-1, occludin, zona occludens-1 (ZO-1), PI3K, AKT and mTOR, protein levels of claudin-1, ZO-1 and junctional adhesion molecule-A (JAM-A), and the levels of p-ERK/ERK, p-PI3K/PI3K and p-AKT/AKT. Under HT, oZn was more effective than iZn in increasing TEER, occludin, ZO-1, PI3K, and AKT mRNA levels, ZO-1 protein level, and p-AKT/AKT level; supplementation with 50 μmol Zn/L was more effective than 100 μmol Zn/L in increasing cell proliferation, JAM-A, PI3K, AKT, and PKC mRNA levels, JAM-A protein level, and the levels of p-ERK/ERK and p-PI3K/PI3K; furthermore, supplementation with 50 μmol Zn/L as oZn had the lowest LDH activity, and the highest ERK, JNK-1, and mTOR mRNA levels. Therefore, supplemental Zn, especially 50 μmol Zn/L as oZn, could alleviate the TS-induced integrity and barrier function damage of broiler jejunal epithelial cells possibly by promoting cell proliferation and tight junction protein expression via the MAPK and PI3K/AKT/mTOR signaling pathways.

The fast-paced growth in digitization of smart grid components enhances system observability and remote-control capabilities through efficient communication. However, enhanced connectivity results in heightened system vulnerability towards cybersecurity risks in the cyber-physical power system. Coordinated cyber-attacks (CCA), when undetected, lead to system-wide impact in terms of large disturbances or widespread outages. Detecting CCA in the cyber layer is critical to thwart cyber-attacks in real-time before the attack impacts the physical system. The challenge of locating CCA stems from the complex grid dynamics, making it difficult to distinguish between normal operational variations and cyber-attack impact. CCA often employs multiple attack vectors targeting geographically distributed components, further complicating CCA identification. Existing research in intrusion detection is primarily focused on the transmission network and limited to detecting individual attacks. In this paper, a novel proactive DCA strategy is proposed for early detection of CCA by establishing correlations among distinct attack events through model-based reinforcement learning that utilizes abductive reasoning to conclude the attacker goal. The solution includes understanding the system model, learning the system dynamics, and correlating individual cyber-attacks to extract the attacker’s objective. The developed learning algorithm identifies the most probable attack path to reach the attacker’s objective by predicting the next attack steps. A DNP3-based cyber-physical co-simulation testbed is developed to test the proposed algorithm using the IEEE 13-node test feeder.

Our study is the first to illuminate a previously underexplored dimension in the intricate interplay between environmental factors, specifically dust storms (DSs), and rheumatoid arthritis (RA) outcomes. An Auto Regressive Moving Average (ARMA) time-series estimation model was employed to analyze rheumatoid arthritis outpatient visits, dust storms, air pollution, and meteorology data in Taiwan from 2006 to 2012. The results show that females are three times more likely to experience RA-related issues and seek medical attention. Percentage analysis revealed a 10–15% increase in daily RA outpatient visits on post-event days 1 and 2 compared to non-DS days. However, the time-series estimation indicated a delayed and statistically significant (p < 0.05) increase in RA outpatient visits on post-event day 1 for males but not females. Additionally, a significant increase in RA outpatient visits (p < 0.05) was observed on post-event day 1 among individuals aged 61 and above. Environmental factors such as temperature and SO2 showed strong significance across all genders and age groups (p < 0.001). The findings highlight distinct gender and age disparities regarding the impacts of DS on RA outpatient visits, emphasizing the heightened sensitivity of males to environmental pollutants and the vulnerability of the elderly population.

Bacterial infections and cancers are important issues in public health around the world. Currently, Western medicine is the most suitable approach when dealing with these issues. “Antibiotics” and “Corticosteroids” are the Western medicines used for bacterial infection. “Chemotherapy drugs”, “surgery”, and “radiotherapy” are common techniques used to treat cancer. These are conventional treatments with many side effects. PDT is a non-invasive and effective therapy for bacterial infection and cancer diseases. Methods: Nine electronic databases, namely WanFang Data, PubMed, Science Direct, Scopus, Web of Science, Springer Link, SciFinder, and China National Knowledge Infrastructure (CNKI), were searched to conduct this literature review, without any regard to language constraints. Studies focusing on the photodynamic actions of hydrogel and Resveratrol were included that evaluated the effect of PDT against bacteria and cancer. All eligible studies were analyzed and summarized in this review. Results: Resveratrol has antibacterial and anticancer effects. It can also act as PS in PDT or adjuvant but has some limitations. This is much better when combined with a hydrogel to enhance the effectiveness of PDT in the fight against bacteria and cancer. Conclusions: Resveratrol combined with hydrogel is possible for PDT treatment in bacteria and cancer. They are compatible and reinforce each other to increase the effectiveness of PDT. However, much more work is required, such as cytotoxicity safety assessments of the human body and further enhancing the effectiveness of PDT in different environments for future investigations.

Background: Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT. Methods: We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed. Results: 60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR = 21.9, P = 0.04) Conclusion: AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes.

Abstract Objectives The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented. Material and Methods A narrative review was conducted to fulfill the aim. Results The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial. Conclusions A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.

Abstract Electron-vibration coupling is of critical importance for the development of molecular electronics, spintronics, and quantum technologies, as it affects transport properties and spin dynamics. The control over charge-state transitions and subsequent molecular vibrations using scanning tunneling microscopy typically requires the use of a decoupling layer. Here we show the vibronic excitations of tetrabromotetraazapyrene (TBTAP) molecules directly adsorbed on Ag(111) into an orientational glassy phase. The electron-deficient TBTAP is singly-occupied by an electron donated from the substrate, resulting in a spin 1/2 state, which is confirmed by a Kondo resonance. The TBTAP•− discharge is controlled by tip-gating and leads to a series of peaks in scanning tunneling spectroscopy. These occurrences are explained by combining a double-barrier tunneling junction with a Franck-Condon model including molecular vibrational modes. This work demonstrates that suitable precursor design enables gate-dependent vibrational excitations of molecules on a metal, thereby providing a method to investigate electron-vibration coupling in molecular assemblies without a decoupling layer.

Abstract Background Robot-assisted gait training is incorporated into guidelines for stroke rehabilitation. It is a promising tool combined with conventional therapy for low ambulatory patients. The heavy weight and bulky appearance of a robotic exoskeleton limits its practicality. On the other hand, soft robotic exosuit (SRE) based on its light weight and inconspicuous property, is better tolerated by patients in daily life. The aim of this study is to review the efficacy of the SRE with regard to walking ability and biomechanical properties in stroke patients. Methods Electronic searches were carried out in PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database. Clinical trials that investigated the effectiveness of SREs on ambulation ability in patients with post-stroke hemiparesis were eligible. Qualitative data synthesis was subsequently performed. Results Nine studies were identified as relevant, involving a total of 83 patients. For the assessment of SRE efficacy, outcome measures were walking ability and biomechanical properties. In terms of both immediate effect and training effect, SREs improved the walking speed, walking distance, peak ankle dorsiflexion angle during swing phase, peak paretic propulsion, stride length and compensated gait in stroke patients. Conclusions SRE improved the ambulation ability of stroke patients in terms of walking ability and biomechanical properties. The small number of studies limits the generalizability of interpretation. More controlled studies with better quality are required to reach a more solid conclusion on this issue.

Abstract 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 Background The short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents. Methods The Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated. Results The Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83. Conclusions The Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.

Summary: When Saccharomyces cerevisiae grows on mixtures of glucose and galactose, galactose utilization is repressed by glucose, and induction of the GAL gene network only occurs when glucose is exhausted. Contrary to reference GAL alleles, alternative alleles support faster growth on galactose, thus enabling distinct galactose utilization strategies maintained by balancing selection. Here, we report on new wild populations of Saccharomyces cerevisiae harboring alternative GAL versions and, for the first time, of Saccharomyces paradoxus alternative alleles. We also show that the non-functional GAL version found earlier in Saccharomyces kudriavzevii is phylogenetically related to the alternative versions, which constitutes a case of trans-specific maintenance of highly divergent alleles. Strains harboring the different GAL network variants show different levels of alleviation of glucose repression and growth proficiency on galactose. We propose that domestication involved specialization toward thriving in milk from a generalist ancestor partially adapted to galactose consumption in the plant niche.

Abstract Objectives To attain a collective expert opinion on the use of air powder waterjet technology (APWT) with erythritol and glycine powders in the prophylaxis and therapy of periodontal and peri‐implant diseases. Material and Methods In the first step, a modified one‐round online Delphi survey including 44 five‐point Likert scale questions was conducted among a group of 10 expert clinicians and researchers with thorough knowledge and experience in this topic. In the second step, the single questions and the survey results were discussed during a meeting, and consensus statements were formulated, respectively. Results An agreement was reached on most items, especially opinions supporting glycine and erythritol powders as favorable with respect to efficiency, safety, and comfort. More scientific evidence is needed to support the improvement in clinical attachment on teeth and implants, especially when APWT with erythritol is used. In addition, APWT needs more long‐term evaluation and studies in terms of microbiome/microbiological effects as well as effects on the inflammatory response on natural teeth and implants, also in light of a guided biofilm therapy concept. Conclusions In line with the expert opinions and supported by the evidence, it was concluded that the use of APWT with erythritol and glycine powders in nonsurgical periodontal and peri‐implant therapy and prophylaxis is patient compliant and efficient.

Vaccination is the most effective strategy for preventing infectious diseases such as COVID-19. College students are important targets for COVID-19 vaccines given this population's lower intentions to be vaccinated; however, limited research has focused on international college students' vaccination status. This study explored how psychosocial factors from the Theory of Planned Behavior (TPB; attitudes, perceived behavioral control, subjective norms, and behavioral intentions) related to students' receipt of the full course of COVID-19 vaccines and their plans to receive a booster. Students were recruited via Amazon mTurk and the Office of the Registrar at a U.S. state university. We used binary logistic regression to examine associations between students' psychosocial factors and full COVID-19 vaccination status. Hierarchical multiple regression was employed to evaluate relationships between these factors and students' intentions to receive a booster. The majority of students in our sample (81% of international students and 55% of domestic students) received the complete vaccination series. Attitudes were significantly associated with all students' full vaccination status, while perceived behavioral control was significantly associated with domestic students' status. Students' intentions to receive COVID-19 vaccines were significantly correlated with their intentions to receive a booster, with international students scoring higher on booster intentions. Among the combined college student population, attitudes, intentions to receive COVID-19 vaccines, and subjective norms were significantly related to students' intentions to receive a booster. Findings support the TPB's potential utility in evidence-based interventions to enhance college students' COVID-19 vaccination rates. Implications for stakeholders and future research directions are discussed.

Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.

Abstract Patients with dementia are at increased risks of adverse consequences associated with motor vehicle crash injury (MVCI). However, studies of the association for patients with young-onset dementia (YOD) are limited. Therefore, we aim to investigate whether YOD was associated with adverse outcomes after hospitalization for MVCI. In this retrospective cohort study, we identified 2052 MVCI patients with YOD (aged 40–64 years) between 2006 and 2015 and included 10 260 matched MVCI patients without YOD (matching ratio: 1:5) from Taiwan’s National Health Insurance Research Database and the Taiwan Police-Reported Traffic Accident Registry. We evaluated the intensive care unit (ICU) admission, organ failure, in-hospital and 30-day mortalities, length of hospital stay, and hospital costs. Compared with participants without dementia, patients with YOD had higher rates of ICU admission (34.31% vs. 20.89%) and respiratory failure (6.04% vs. 2.94%), with a covariate-adjusted odds ratio of 1.50 (95% CI 1.33–1.70) and 1.63 (95% CI 1.24–2.13), respectively. The patients also exhibited higher in-hospital mortality (4.73% vs. 3.12%) and 30-day mortality (5.12% vs. 3.34%) than their non-YOD counterparts, but the risk ratio was not significant after adjusting for transport mode. Moreover, the log means of hospital stay and cost were higher among patients with YOD (0.09 days; 95% CI 0.04–0.14 and NT$0.17; 95% CI 0.11–0.23, respectively). This cohort study determined that YOD may be adversely associated with hospital outcomes among MVCI patients. However, the association between YOD and mortality risk may depend on transport mode.

For power grids with high penetration of distributed energy resources (DERs), microgrids can provide operation and control capabilities for clusters of DERs and load. Furthermore, microgrids enhance resilience of the hosting bulk power grid if they are enabled to serve critical load beyond the jurisdiction of the microgrids. For widespread deployment of microgrids, a modular and standardized Microgrid Building Block (MBB) is essential to help reduce the cost and increase reliability. This paper proposes the conceptual design of an MBB with integrated features of power conversion, control, and communications, resulting in a systemwide controller for the entire microgrid. The results of a feasibility study indicate that, in a utility-connected mode, MBB-based microgrids can exchange power with the hosting power grid while serving regulation and optimal dispatch functions. In a resiliency (islanded) mode when the microgrid is disconnected from the utility system, the MBB control system acts to stabilize the system frequency and voltage under small or large disturbances. The microgrid controller is supported by a communication system that meets the latency requirements imposed by the microgrid dynamics as well as data acquisition time. The extended IEEE 13-node system is used as a microgrid model to validate the proposed MBB design and functionality.

Cyber-physical system security for electric distribution systems is critical. In direct switching attacks, often coordinated, attackers seek to toggle remote-controlled switches in the distribution network. Due to the typically radial operation, certain configurations may lead to outages and/or voltage violations. Existing optimization methods that model the interactions between the attacker and the power system operator (defender) assume knowledge of the attacker’s parameters. This reduces their usability. Furthermore, the trend with coordinated cyberattack detection has been the use of centralized mechanisms, correlating data from dispersed security systems. This can be prone to single point failures. In this paper, novel mathematical models are presented for the attacker and the defender. The models do not assume any knowledge of the attacker’s parameters by the defender. Instead, a machine learning (ML) technique implemented by a multi-agent system correlates detected attacks in a decentralized manner, predicting the targets of the attacker. Furthermore, agents learn optimal mitigation of the communication level through Q-learning. The learned attacker motive is also used by the defender to determine a new configuration of the distribution network. Simulations of the technique have been performed using the IEEE 123-Node Test Feeder. The simulation results validate the capability and performance of the algorithm.

Abstract Purpose To assess the dimensional establishment of a bony envelope after alveolar ridge preservation (ARP) with deproteinized bovine bone mineral (DBBM) in order to estimate the surgical feasibility of standard diameter implants placement without any additional augmentation methods. Methods PubMed, Embase and CENTRAL databases were searched for suitable titles and abstracts using PICO elements. Inclusion criteria were as follows: randomized controlled trials (RCTs) comprising at least ten systemically healthy patients; test groups comprised placement of (collagenated) DBBM w/o membrane and control groups of no grafting, respectively. Selected abstracts were checked regarding their suitability, followed by full-text screening and subsequent statistical data analysis. Probabilities and number needed to treat (NNT) for implant placement without any further need of bone graft were calculated. Results The initial database search identified 2583 studies. Finally, nine studies with a total of 177 implants placed after ARP with DBBM and 130 implants after SH were included for the quantitative and qualitative evaluation. A mean difference of 1.13 mm in ridge width in favour of ARP with DBBM could be calculated throughout all included studies (95% CI 0.28–1.98, t2 = 1–1063, I2 = 68.0%, p

Background: Data on self-harm (SH) repetition in non-Western adolescents are limited; this study is to survey the predictors. Methods: A total of 5879 adolescents (mean age 16.02 years) in Northern Taiwan were recruited. The participants filled in online questionnaires about their sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use at baseline (T1) and at the 1 year follow-up (T2). We used logistic regression analysis to examine the predictors of SH continuation. Generalized structural equation modeling (GSEM) was then estimated to analyze the treatable variables for both years and to investigate their relationships and mediating effects. Results: A total of 125 students were identified as being in the SH continuation group; while 470 students were identified as being in the SH stop group. The SH continuation rate was 21%; no significant gender difference was found. Logistic regression analysis showed that the predictors of SH continuation were low school ranking, poor quality of listening from relatives, use of the cutting method for SH, and a suicide plan in the past year at T1, and more depressed mood, use of the cutting method for SH, more suicide ideation and plans at T2. Similar predictors were found by GSEM; self-esteem at T1 and depressed mood at T2 were found to be mediators in the pathways. Conclusion: The continuation rate of SH was similar to that reported in Western countries. These predictors should be included in the treatment plan to prevent SH continuation.

Background: Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk. Methods: We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009–2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009–2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs). Results: The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55–2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35–2.59). Conclusions: This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.

Abstract Endogenous signals, namely nitric oxide (NO) and electrons, play a crucial role in regulating cell fate as well as the vascular and neuronal systems. Unfortunately, utilizing NO and electrical stimulation in clinical settings can be challenging due to NO's short half‐life and the invasive electrodes required for electrical stimulation. Additionally, there is a lack of tools to spatiotemporally control gas release and electrical stimulation. To address these issues, an “electromagnetic messenger” approach that employs on‐demand high‐frequency magnetic field (HFMF) to trigger NO release and electrical stimulation for restoring brain function in cases of traumatic brain injury is introduced. The system comprises a NO donor (poly(S‐nitrosoglutathione), pGSNO)‐conjugated on a gold yarn‐dynamos (GY) and embedded in an implantable silk in a microneedle. When subjected to HFMF, conductive GY induces eddy currents that stimulate the release of NO from pGSNO. This process significantly enhances neural stem cell (NSC) synapses' differentiation and growth. The combined strategy of using NO and electrical stimulation to inhibit inflammation, angiogenesis, and neuronal interrogation in traumatic brain injury is demonstrated in vivo.

This study investigates the impact of various instrumentation techniques on material removal and surface changes in titanium (Ti)- and zirconia (Zr) implant discs. Ti- and Zr discs were subjected to standardized experiments using various instruments including airflow, ultrasound, carbide, and diamond burs. Instrumentation was performed for 60 s with continuous automatic motion. Abrasion and changes in surface roughness were assessed using profilometry, while scanning electron microscopy was used to examine morphological changes and particle size. Carbide burs predominantly caused abrasion on Ti discs, while diamond burs caused more abrasion on Zr discs. The Ti discs were more susceptible to surface changes. However, among the materials tested, machined Zr discs treated with diamond burs produced the largest particle. In certain cases, a statistical significance (p < 0.05) was observed between the groups, while in others, there was no considerable difference among the means (p > 0.05). These results highlighted the statistical significance of our findings. These results found diverse alterations in surface characteristics of Ti- and Zr discs due to different instruments, with carbide and diamond burs causing notable effects. The findings highlight the need for a careful balance between promoting healing and minimizing harm during implantoplasty.

Background: Screening or diagnosis for the elderly with dementia in rural regions might be delayed and underestimated due to limited utilization of healthcare resources. This study aimed to evaluate the disparities of prevalence and risk factors of mild cognitive impairment (MCI) and dementia between urban and rural residence. Methods: In this nationwide door-to-door survey, 10,432 participants aged 65 years and more were selected through computerized random sampling from all administrative districts in Taiwan and were assessed using an in-person interview. We calculated the prevalence of MCI and dementia, with their risk factors examined using multivariable logistic regression. Results: The prevalence of dementia in rural, suburban, and urban areas among the elderly was 8.69% (95% CI, 8.68–8.69), 6.63% (95% CI, 6.62–6.63), and 4.46% (95% CI, 4.46–4.47), respectively. A similar rural-suburban-urban gradient relationship on the dementia prevalence was observed in any age and sex group. The rural:urban ratio was higher in women than in men for both MCI and dementia. Urbanization remained to be an independent factor for both MCI and dementia after adjustment for age, gender, education, lifestyle, and health status. The beneficial effects of exercise on dementia were more evident in rural areas than in urban ones. Conclusion: Significantly higher prevalence of MCI and dementia were found in rural areas than in urban ones, especially for women. The odds of risk factors for MCI and dementia varied by urbanization status. Focus on the rural-urban inequality and the modification of associated factors specifically for different urbanization levels are needed.

As most erb‐b2 receptor tyrosine kinase 2 (HER2)‐positive breast cancer (BC) patients currently receive dual HER2‐targeting added to neoadjuvant chemotherapy, improved methods for identifying individual response, and assisting postsurgical salvage therapy, are needed. Herein, we evaluated the 41‐gene classifier trastuzumab advantage risk model (TRAR) as a predictive marker for patients enrolled in the NeoSphere trial. TRAR scores were computed from RNA of 350 pre‐ and 166 post‐treatment tumor specimens. Overall, TRAR score was significantly associated with pathological complete response (pCR) rate independently of other predictive clinico‐pathological variables. Separate analyses according to estrogen receptor (ER) status showed a significant association between TRAR score and pCR in ER‐positive specimens but not in ER‐negative counterparts. Among ER‐positive BC patients not achieving a pCR, those with TRAR‐low scores in surgical specimens showed a trend for lower distant event‐free survival. In conclusion, in HER2‐positive/ER‐positive BC, TRAR is an independent predictor of pCR and represents a promising tool to select patients responsive to anti‐HER2‐based neoadjuvant therapy and to assist treatment escalation and de‐escalation strategies in this setting.

Antimicrobial drug resistance is one of the major threats to global health. It has made common infections increasingly difficult or impossible to treat, and leads to higher medical costs, prolonged hospital stays and increased mortality. Infection rates due to multidrug-resistant organisms (MDRO) are increasing globally. Active agents against MDRO are limited despite an increased in the availability of novel antibiotics in recent years. This guideline aims to assist clinicians in the management of infections due to MDRO. The 2019 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group, comprising of infectious disease specialists from 14 medical centers in Taiwan, reviewed current evidences and drafted recommendations for the treatment of infections due to MDRO. A nationwide expert panel reviewed the recommendations during a consensus meeting in Aug 2020, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes recommendations for selecting antimicrobial therapy for infections caused by carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, and vancomycin-resistant Enterococcus. The guideline takes into consideration the local epidemiology, and includes antimicrobial agents that may not yet be available in Taiwan. It is intended to serve as a clinical guide and not to supersede the clinical judgment of physicians in the management of individual patients.

Background/Purpose: Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement. Methods: We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined. Results: Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p

Background: Human metapneumovirus (hMPV), classified in the Pneumoviridae family, is primarily known for causing lower respiratory tract infections in children, the elderly, and immunocompromised individuals. However, rare instances have shown that hMPV can also affect other systems, such as the cardiovascular system, leading to conditions like myocarditis. Case Report: We describe a 68-year-old man with a medical history of diabetes, hypertension, and liver cirrhosis who presented to the Emergency Department (ED) exhibiting symptoms of fever, cough, and dyspnea. His condition deteriorated rapidly, progressing to septic shock and requiring increased oxygen support, which led to his transfer to the medical intensive care unit (MICU). Diagnostic evaluations, including cardiac echocardiography and coronary angiography (CAG), confirmed the presence of myocarditis while excluding acute myocardial infarction. Despite aggressive interventions, including extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) therapy, the patient's condition worsened, and he died 3 days after admission. Polymerase chain reaction (PCR) testing of a throat swab confirmed hMPV infection, with Klebsiella pneumoniae simultaneously identified via sputum culture. The bacterial susceptibility report indicated that the bacteria were sensitive to piperacillin/tazobactam, which had been administered since the patient arrived at our ED, which suggests that the bacterial infection alone cannot fully explain the patient's condition. Conclusions: Compared to previously reported cases of hMPV-related myocarditis, this case is the first to demonstrate notably adverse outcomes associated with the concurrent presence of bacterial infection. The rapid progression and poor outcome despite aggressive treatment emphasize the need for early diagnosis and management of such co-infections. [ABSTRACT FROM AUTHOR]

Summary: Purpose: This study aimed to evaluate the effectiveness of an interactive virtual reality (VR) play intervention including instructional play and emotional catharsis play sessions in reducing children's pain and fear during intravenous placement. Methods: A randomized controlled trial with parallel groups was conducted. The sample consisted of 134 hospitalized children aged 6–12 years (intervention group: n = 69; comparison group: n = 65). The intervention involved one immersive intravenous scene in VR before the actual intravenous placement and one emotional catharsis VR play after injection. The comparison group received an educational photo book about intravenous placement before receiving intravenous placement. The children and their caregivers rated their pain and fear by using the Wong–Baker FACES Pain Rating Scale and the Children's Fear Scale. The time required for successful intravenous insertion was also compared between the two groups. Results: Children's pain (p = .028) and fear scores (p = .004) were significantly lower in the intervention group than in the comparison group. Their caregivers' pain and fear scores (both p

Background/purpose: The bond strength and durability of highly translucent zirconia ceramics to dentin is still unclear. The purpose of this study was to investigate the effect of various surface treatments on the bond strength of self-adhesive resin cements to high-translucent zirconia crowns and dentin. Materials and methods: A high-transparent zirconia and three self-adhesive resin cements (G-CEM LinkAce (GCL), RelyX U200 (RXU) and TotalCem (TTC)) were used. The zirconia surface was sandblasted with 50 μm alumina particles or coated with an SR Link primer, while a dentin primer (Tetric N-Bond Universal, TBU) was applied to the surface of the dentin. By using three self-adhesive resin cements, zirconia samples were bonded to the dentin surfaces of human teeth. The shear strength of the specimens was measured before and after 10,000-cycle thermocycling or 90-day aging. Results: When using GCL to bond with the untreated dentin and various zirconia surfaces, the shear bond strength of the sandblasted (ZSB) and RS Link primer-coated (ZLK) groups was significantly higher than that of the untreated control group (Zc). However, in the case of TBU-treated dentin, the shear strength of the ZSB + LK + DTBU group was significantly higher than that of the other groups. After thermocycling and aging, the shear strength of the ZSB + LK + DTBU group using GCL and RXU cements decreased slightly, while the TTC showed no impact. Conclusion: The zirconia surface pretreated by sandblasting and bonding agent, which was sequentially bonded with a primer-treated dentin by using resin cements, can provide excellent shear bond strength and anti-aging performance.

ABSTRACT: The preovulatory hormonal surge (PS) consists of elevated circulating luteinizing hormone (LH) and progesterone levels and serves as the primary trigger for ovarian follicle ovulation. Increased LH and progesterone, produced by the pituitary and the granulosa layer of the largest ovarian follicle (F1), respectively, result from hypothalamic stimulation and steroid hormone feedback on the hypothalamo-pituitary-gonadal (HPG) axis. The hypothalamus, pituitary, F1 granulosa, and granulosa layer of the fifth largest follicle (F5) were isolated from converter turkey hens outside and during the PS and subjected to RNA sequencing (n = 6 per tissue). Differentially expressed genes were subjected to functional annotation using DAVID and IPA. A total of 12, 250, 1235, and 1938 DEGs were identified in the hypothalamus, pituitary, F1 granulosa, and F5 granulosa respectively (q1.5, FPKM>1). Gene Ontology (GO) analysis revealed key roles for metabolic processes, steroid hormone feedback, and hypoxia induced gene expression changes. Upstream analysis identified a total of 4, 42, 126, and 393 potential regulators of downstream gene expression in the hypothalamus, pituitary, F1G, and F5G respectively, with a total of 63 potential regulators exhibiting differential expression between samples collected outside and during the PS (|z-score|>2). The results from this study serve to increase the current knowledge base surrounding the regulation of the PS in turkey hens. Through GO analysis, downstream processes and functions associated with the PS were linked to identified DEGs, and through upstream analysis, potential regulators of DEGs were identified for further analysis. Linking upstream regulators to the downstream PS and ovulation events could allow for genetic selection or manipulation of ovulation frequencies in turkey hens.

Background/purpose: The efficient rapid sintering technique has employed to dental zirconia ceramics for shortening the fabrication time of zirconia restorations. The purpose was to compare the optical properties of two generations of rapid sintered translucent zirconia using two dental colorimeters. Materials and methods: Two generations of translucent zirconia ceramics, 3 mol% yttria-tetragonal zirconia polycrystal (3Y-TZP): Copran Zr-i Ultra-T (UT) and Cercon HT (HT), and 5 mol% yttria-tetragonal zirconia polycrystal (5Y-TZP): Cercon xt (XT), of different thicknesses (0.5, 0.8, and 1.2 mm; n = 5) underwent rapid sintering (RS) or conventional sintering (CS). The CIELAB values were measured on the white and black backgrounds, respectively, by digital colorimeters, shadepilot, DeguDent (DD) and Easyshade V, Vita (Vita). Translucency parameter (TP), color difference (ΔE), surface morphology, and surface roughness were evaluated. Results: RS resulted in reduced lightness, except in the XT group. The chromaticity increased slightly after RS. Translucency decreased with increasing material thickness. ΔE values differed between both sintering processes but were clinically acceptable (ΔE

Topological superconductivity emerging in one- or two-dimensional hybrid materials is predicted as a key ingredient for quantum computing. However, not only the design of complex heterostructures is primordial for future applications but also the characterization of their electronic and structural properties at the atomic scale using the most advanced scanning probe microscopy techniques with functionalized tips. We report on the topographic signatures observed by scanning tunneling microscopy (STM) of carbon monoxide (CO) molecules, iron (Fe) atoms and sodium chloride (NaCl) islands deposited on superconducting Pb(111). For the CO adsorption a comparison with the Pb(110) substrate is demonstrated. We show a general propensity of these adsorbates to diffuse at low temperature under gentle scanning conditions. Our findings provide new insights into high-resolution probe microscopy imaging with terminated tips, decoupling atoms and molecules by NaCl islands or tip-induced lateral manipulation of iron atoms on top of the prototypical Pb(111) superconducting surface.

Abstract An islanded microgrid is cyber‐physical system, and the control relies on the communication system significantly. Improper parameters of the cyber system can result in instability of a microgrid system. To evaluate the impact of a networked control system on control performance, a cyber model is developed to represent data acquisition periods and communication delays. Simplification of the networked control system model is proposed to enhance the computational performance, making the analytical method applicable for large‐scale systems. Based on the analysis, a two‐dimensional stability region of a microgrid in the space of cyber parameters can be obtained. To validate the proposed method, a microgrid control scheme is proposed for power dispatch and regulation based on the droop and proportional‐integral (PI) feedback control. The analytical method is compared to the time‐domain simulation, and it is shown that the stability regions are nearly identical. The critical values of cyber parameters are determined based on the analytical results. The proposed control strategy with the given cyber parameters is validated for transient stability following dynamic events. Simulation results indicate that the design of a microgrid as a cyber‐physical system needs to be guided by critical values for cyber parameters to prevent system instability.

During embryonic life, chicks mainly derive energy from hepatic oxidation of yolk lipids. After hatch, chicks must rely on carbohydrate-rich feed to obtain energy. This requires an abrupt and intensive switch of metabolic processes, particularly in the liver. We recently identified a number of transcriptional and post-transcriptional regulatory networks that work concordantly to tune metabolic processes during the metabolic switch. Here, we used delayed feeding post-hatch (48 h) to impede the metabolic switch in broilers. We used RNA-seq to identify hepatic transcriptome differences between late stage embryos (E18) and two-day-old chicks (D2), which were either fed-from-hatch (FED) or not fed (DLY). Between FED and E18, 2,430 genes were differentially expressed (fold-change≥ 2; FDR p-value 0.05), of these 1,237 were downregulated in FED birds and 1,193 were upregulated. Between DLY and E18, 1979 genes were differentially expressed, of these 1,043 were downregulated and 936 were upregulated in DLY birds. Between DLY and FED, 880 genes were differentially expressed, of these 543 were downregulated and 337 were upregulated in DLY birds. We found that in addition to disturbances in a number of metabolic pathways, unfed chicks had a widespread suppression of gene networks associated with cell proliferation, cell cycle progression and mitosis. Expression patterns suggest that hepatocytes of delayed-fed birds have abnormal mitosis and increased polyploidization. This suggests that post-hatch feed consumption maintains the rate and integrity of liver growth immediately, which in turn, likely helps facilitate the appropriate programming of hepatic metabolic networks.

The Baima igneous complex (BIC) consists of a cumulate layered gabbroic unit, an Fe-Ti oxide ore zone, and an isotropic quartz syenite. The formation of the BIC is attributed to a variety of petrological processes including: silicate immiscibility, fractional crystallization, and fluxing of fO2 by either internal or external factors. This study attempts to determine if a parental magma similar to high-Ti Emeishan basalt can produce the syenitic rocks of the BIC. The experimental results at atmospheric pressure show that the liquidus temperature and solidus temperature of the basaltic melt are estimated to be 1303 and 1120°C. The crystallization sequence is: titanomagnetite, clinopyroxene (Wo43-47En32-45Fs11-23), and plagioclase (An65-31). The residual liquid composition, represented by quenched glass, evolves from lower SiO2 (~45 wt%) values to higher values (~60 wt%) with corresponding decreases in Ti, Fe, Mg, Ca and increases of Na and K. The results show that a starting composition of high-Ti basalt from the Emeishan large igneous province can produce evolved silicic liquids that resemble the compositions of microgranular enclaves from the Baima syenitic unit.

Multicentric Castleman disease (MCD) is a systemic lymphoproliferative disorder that can lead to mass lesions in various body parts, including the lungs, kidneys, and extranodal sites. Meanwhile, orbital Castleman disease is extremely rare. Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized fibroinflammatory disorder and is characterized by the formation of tumor-like lesions with lymphoplasmacytic infiltrates, which are enriched in IgG4-positive plasma cells and may present with a characteristic storiform pattern of fibrosis to variable degrees. In this study, we report a case of a 67-year-old Taiwanese man with a 7-year history of bilateral eyelid swelling and proptosis. Orbital magnetic resonance imaging revealed soft tissue lesions in the bilateral intraconal region, demonstrating strong enhancement in the lacrimal glands, and extension into the bilateral infraorbital foramen, suggesting an orbital lymphoproliferative disease. The histopathological results of the intraorbital tumor excision were suggestive of a plasma-cell-predominant mixed-cell variant of MCD. However, the patient also showed definitive signs of IgG4-RD, including lacrimal gland enlargement and histopathological results of plasmacytosis, fibrosis, and germinal centers, with an increased ratio of IgG4 cells and elevated serum IgG4 levels. This case suggests a potential interacting pathway between these two disease entities that needs further studies.

Abstract Background Proteus mirabilis is the second most common pathogen that causes urinary tract infections after Escherichia coli. In rare cases, it is associated with vertebral osteomyelitis. The underlying mechanism of this relationship may be related to the retrograde dissemination of bacteria through the paravertebral venous plexus. Case presentation We report a case of an 80-year-old Taiwanese woman who had recurrent episodes of fever and chronic back pain for 1 year. All blood cultures were positive for P. mirabilis. Inflammation scans and magnetic resonance imaging revealed a previously undetected vertebral lesion between the seventh and eighth thoracic vertebra. She responded well to treatment with antibiotics, reporting considerable relief of back pain and no fever recurrence at the 4-month follow-up. Conclusions Chronic back pain is a common but often dismissed symptom among the older population; osteomyelitis should be considered in patients with recurrent fever or neurological symptoms. Old age, chronic renal failure, and diabetes mellitus are possible predisposing factors for osteomyelitis. Our findings suggest that long-term treatment with antibiotics is effective for osteomyelitis caused by P. mirabilis,, although surgery is required for abscess formation or serious vertebral destruction.

Abstract Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

Congenital coronary artery fistulas (CAFs) are an uncommon congenital anomaly. While most patients are asymptomatic, life-threatening events including sudden death, myocardial ischemia, heart failure, infective endocarditis, and rupture of aneurysm may occur. Surgical ligation was once the standard choice of management of CAFs in the past. However, transcatheter closure of CAFs has become an emerging alternative to surgery in patients with suitable anatomy. We reported a 7-month-old infant with a giant and tortuous CAF that originated from the distal right coronary artery and drained into the right ventricle, and was successfully treated by transcatheter closure with an Amplatzer ductus occluder.

BackgroundPreschool-aged children with acute lymphoblastic leukemia (ALL) receive long-term treatment according to the Taiwan Pediatric Oncology Group (TPOG)–ALL 2013 protocol. Severe anxiety and noncompliance ahead of frequent invasive therapies leads to an increase in health care costs. Previous studies have shown that therapeutic video games (TVGs) can decrease the anxiety experienced by children who are ill. To our knowledge, no existing TVG has been designed specifically for preschool-aged children with ALL in Taiwan. ObjectiveThe purpose of this study was to develop a TVG using the popular Mechanics, Dynamics, and Aesthetics (MDA) framework for game design and to investigate the effect of this TVG on the reduction of therapy-related anxiety among preschool-aged children with ALL. MethodsThis study used a mixed methods approach over three phases: (1) develop a TVG using the MDA framework, (2) test the reliability of the TVG among three certified children’s art therapists, and (3) evaluate the reduction of therapy-related anxiety among participants after using the TVG for 6 weeks, using a two-group, stratified randomized controlled trial at a medical center in northern Taiwan. Eligible preschool-aged children with ALL were randomly assigned 1:1 into an experimental group or a control group. The two groups of subjects received the same usual care, and only the experimental group had access to and used the TVG. The children’s anxiety responses were reported by their family caregivers using the face rating scale (FRS). Descriptive analyses, the Fisher exact test, the Pearson chi-square test, and the Mann-Whitney U test were used to statistically analyze the variables. ResultsSix mechanics rules supported the dynamics of the TVG using four main features—character, nursery, tasks, and market—in order to complete all of the therapy-related anxiety reduction scenarios and to achieve eight aesthetics goals. The results of reliability test showed that participants found the TVG to be useful and trustworthy for preschool-aged children with ALL (Cronbach α=.98). A total of 15 participants were enrolled and randomly allocated to the experimental group (n=7) or the control group (n=8). The average number of TVG log-ins was 37.9 (SD 15.30, range 14-62) in the experimental group. The demographic data showed homogeneity across the two groups regarding age (3 to 5 years), sex (male), risk classification (standard risk), and treatment status (continuation therapy). The mean FRS score was 6.16 (SD 3.31) for the experimental group as compared to 7.45 (SD 2.71) for the control group (P=.04), which represented a significant difference between the groups at the 6-week follow-up. ConclusionsThis research provides evidence that using a TVG can decrease anxiety in preschool-aged children with ALL in Taiwan. The TVG could be used to support clinical professionals before they perform invasive therapies. However, it is recommended to increase the statistical power for inference. Trial RegistrationClinicalTrials.gov NCT04199637; https://www.clinicaltrials.gov/ct2/show/NCT04199637

Abstract Patients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Six cytokines were subsequently validated by enzyme-linked immunosorbent assays (ELISAs). We then used ELISA to further evaluate the diagnostic values and cutoff values of these cytokines as potential biomarkers in an expanded group that included 200 patients with uncomplicated parapneumonic effusion (UPPE), CPPE, empyema, transudates, other exudates, and malignant pleural effusion (MPE). The pleural levels of four cytokines (MIF, MIP-3α, IL-1β, ENA-78) were highest and significantly increased in CPPE/empyema compared with those in other etiologies. According to receiver operating characteristic curve analysis, the four cytokines (MIF, MIP-3α, IL-1β, and ENA-78) had areas under the curve (AUCs) greater than 0.710 for discriminating parapneumonic pleural effusion from noninfectious pleural effusions. In a comparison of nonpurulent CPPE with UPPE, logistic regression analysis revealed that pleural fluid MIF ≥ 12 ng/ml and MIP-3α ≥ 4.3 ng/ml had the best diagnostic value; MIF also displayed the highest odds ratio of 663 for nonpurulent CPPE, with 97.5% specificity, 94.44% sensitivity, and an AUC of 0.950. In conclusion, our results show that elevated MIF and MIP-3α may be used as novel biomarkers for PPE diagnosis, particularly in patients with CPPE/empyema; the findings indicate that dysregulated cytokine expression may provide clues about the pathogenesis of pleural infection.