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In this paper, we recognize that technological trajectories can be modeled as a series of problem-solving activities, manifesting the cyclical pattern of divergence–convergence knowledge flow. This recognition is applied to study the technological development of the thermal inkjet print head, using main path analysis and an assignee cross-citation network. Our analysis shows that the thermal inkjet print head experienced three cycles of divergence–convergence knowledge flow. Each of the cycles was evidently characterized by a problem of most concern and a referred solution. Our research contributes to explaining why, when, and how trajectories diverge and converge cyclically.

Introduction: Reducing the delay in time to primary percutaneous coronary intervention (PCI) for acute coronary syndrome patients in the non-urban emergency department (ED) is of critical importance. Conventionally, physicians in a non-PCI-capable, non-urban local emergency department (LED) require approval from a tertiary university hospital emergency department (TUH-ED) prior to transferring eligible STEMI patients for PCI procedures. To reduce the ED delay time, this study developed a direct connection between the LED and the cardiac catheterisation laboratory in the TUH (TUH cath lab). Methods: ST-elevation myocardial infarction (STEMI) patients' medical records for 2014 to 2017, from a non-PCI regional hospital located in one of the rural counties in central Taiwan and a TUH-ED in a metropolitan area in the centre of Taiwan, were retrospectively collected and classified into two categories: the LED referral (group A) and the TUH-non-referral (group B). This study compared the ED delay time between TUH non-referral patients in the TUH and LED referral patients in the LED, to determine whether a direct connection reduces current LED delay time. Results: A total of 214 patients (group A, n=62; group B, n=152) who underwent PCI procedures at the TUH were enrolled in the study. ED delay times in the LED were significantly less than the TUH-ED (45.0 v 66.0 min, p

Background Those taking proton pump inhibitors (PPIs) might have a higher risk of acute kidney injury. The long-term safety, especially the PPI-associated chronic kidney disease (CKD) is the subsequent concern. Objective This study explores the potential relationship between using PPIs and CKD in Taiwan. Methods Using a database collated by the Taiwan National Health Insurance programme, we conducted a population-based case-controlled study to identify 16 704 cases of patients aged 20 years or older with newly diagnosed CKD between 2000 and 2013. 16 704 controls were randomly selected and were matched by sex, age and comorbidities. 'Use' of PPIs was defined as when subjects had received at least a prescription for PPIs before the index date. 'Non-use' was defined as subjects who had never received a prescription for PPIs before the index date. The odds ratio (OR) for CKD associated with the use of PPIs was estimated by a logistic regression model. Results The OR for CKD was 1.41 for subjects using PPIs [95% confidence interval (CI) 1.34, 1.48] compared with subjects who had never used PPIs. Almost all major types of PPIs present a weak association with increased odds of CKD in cumulative duration and dosage regression analysis. The OR in relation to cumulative duration (per month) of PPIs use was 1.02 (95% CI 1.01, 1.02) and the OR in relation to cumulative dosage (per microgram) of PPIs use was 1.23 (95% CI 1.18, 1.28). Conclusions Using PPIs presented 1.4-fold higher odds of CKD in Taiwan health insurance claims data analysis.

Mathews (Asia Pacific Journal of Management, 23(1): 5–27, 2006) argues for the importance of latecomer firms undertaking international expansion through the three pillars of resource linkage, leverage, and learning (LLL). We argue that these pillars can be discussed in terms of an institutional framework that explains how institutions shape resource access and economic actions. Despite their lack of capabilities vis-a-vis established multinationals, latecomers are not passive observers or recipients, but can be institutional entrepreneurs who are potentially reflexive enough to leverage their institutional linkages to acquire resources and develop learning activities for innovation, transformation, and internationalization. To illustrate our idea, we study the Taiwan-based dragon multinational, Acer, from 1976 to 2014. Three institutional blocks that underlie Acer’s engagement with institutional linkage, leverage, and learning are emphasized: the cultural system built around the norms of the Chinese family business; the political system defined by the distinct pattern of state-business relations in Taiwan; and a technological system constructed by multiple global players in the computer industry.

Background: It remains unknown whether hearing loss increases the risk of Alzheimer’s disease. This study aimed to examine the association between hearing loss and risk of Alzheimer’s disease in older people in Taiwan. Methods: Analyzing the database from Taiwan’s National Health Insurance Program, this case-control study enrolled 488 subjects ≥65 years old with newly diagnosed Alzheimer’s disease as a case group and 1952 subjects without Alzheimer’s disease as a control group from 1998–2011. Patients with Alzheimer’s disease and other comorbidities were identified by analyzing ICD-9 coding in claims data. The association of hearing loss, other comorbidities, and risk of Alzheimer’s disease were compared between groups. Results: After controlling for confounders, multivariable logistic regression showed an adjusted odds ratio of Alzheimer’s disease of 1.39 in people with hearing loss (95% CI, 1.05–1.84) versus those without. Parkinson’s disease (OR 4.44; 95% CI, 2.54–7.78), head injury (OR 2.31; 95% CI, 1.46–3.66), depression (OR 1.68; 95% CI, 1.19–2.39), hypertension (OR 1.40; 95% CI, 1.10–1.79), and age (each year, OR 1.03; 95% CI, 1.01–1.05) also showed strong links with Alzheimer’s. Conclusions: Hearing loss is associated with increased risk of Alzheimer’s disease in older people in Taiwan.

Background This population based study investigated the relationship between use of selective serotonin reuptake inhibitors (SSRIs) and hip fractures in the elderly in Taiwan. Methods Analysis of a random sample of 1 million insurance enrollees' data identified 4,891 patients with newly diagnosed hip fractures and 4,891 controls without hip fracture between 2000 and 2011. Both cases and controls were ≥65 years of age and were matched by sex, age, comorbidities, and index year of hip fracture diagnosis. Patients were considered current SSRI users if their last SSRI tablet was taken ≤7 days before the hip fracture diagnosis. Late use of SSRIs was defined as taking the last SSRI tablet ≥8 days before the hip fracture diagnosis. Non-SSRI users comprised individuals who never had an SSRI prescription. Odds ratios (ORs) and 95% confidence intervals (CIs) for hip fracture associated with SSRI use was estimated by multivariate unconditional logistic regression. Results After adjustment for covariants, multivariate regression analysis showed that the adjusted OR of hip fracture was 2.17 for current SSRI users (95% CI: 1.60–2.93) compared with those who never used SSRIs. The adjusted OR was 1.11 for individuals with late use of SSRIs (95% CI: 0.96–1.28) and was not significant. Conclusions Current use of SSRIs was associated with a 2.17-fold increase in the odds of hip fracture in the elderly in Taiwan. Clinicians should consider the possibility of SSRI-associated hip fracture among old people currently taking SSRIs.

This paper examines institutional entrepreneurship as a form of internal agency within national innovation systems. In particular, we consider the entrepreneurship of Taiwanese IT firms over 1980-2007 in creating a new professionalized organizational form markedly different from the traditional Taiwanese model of family business. We compare two successful sectors - personal computers and semiconductors - and one failure - hard disk drives. We emphasize how entrepreneurial firms used strategies of framing, aggregating and networking (F.A.N.) to build legitimacy, mobilize local resources and reach out beyond the limitations of their immediate contexts. We discuss how F.A.N. strategies may evolve from `introversion' to `extraversion' and develop implications for policy-makers and further research.

PurposeThis paper investigates how a firm's human resource capability can affect the deployment and effectiveness of corporate mergers and acquisitions strategy.Design/methodology/approachMergers and acquisitions (M&A) is treated as a long‐term strategic orientation based on human resource advantage rather than a tactic to pursue short‐term goals. Using a sample of 267 US banking firms, the main and interaction effects of M&A intensity, HR capability, and in‐state propensity on four firm performance measures were examined.FindingsThe findings confirm that banking M&A could be very effective when the firm had high HR capability. Evidence was also found that HR capability had a direct impact on firm performance. Although in‐state M&A strategy was in general superior to out‐of‐state M&A strategy, a firm with excellent HR capability might narrow the performance difference between in‐state and out‐of‐state M&A.Research limitations/implicationsAn obvious drawback of using this sample of banking firms is that it raises questions about the generalizability of these findings to smaller financial firms and firms in other industries. This study considers firms having at least one M&A over a three‐year period, so we should not generalize our findings to those firms preferring to use internal growth strategies or greenfield start‐ups.Practical implicationsThe main message of this paper is that human resource capability is critical for M&A strategy to be effective.Originality/valueBy extending previous investigations which showed that M&A strategy and HR capacity should be independently treated, this study highlights the critical role of internal HR capability in performance implications of M&A strategy.

The purpose of this paper is to study the strategic technology choices of Taiwan's high-technology-based firms and their impacts on performance. Cluster analyses were used to classify the firms into different groups based on four strategic tradeoffs, including the balance of product mix, the degree of research and development involvement, the breadth of technology scope, and the institutional sources of innovation. Six distinct technology strategies were then derived statistically; they were classified as opportunistic subcontractors, plural marketers, technological explorers, focused branders, hierarchical controllers, and professional subcontractors. Our study demonstrated that most of the firms remain in the same technology group over time. Yet, shifts in the firms' technology strategies are likely, notably the movement to the groups of opportunistic subcontractors and professional subcontractors. We also found that a relatively large group of firms shifted their strategies from groups of hierarchical controllers and professional subcontractors to the opportunistic subcontractors group, and from the plural marketers group to the focused branders group. In terms of profit differentials of technology groups, we found that, during an economic boom, technological explorers and focused branders had higher financial performance. In an economic recession, hierarchical controllers and professional subcontractors maintained higher profit margins. Conversely, throughout the period of study, opportunistic subcontractors had consistently poor financial performance.

Drawing on institutional analysis of politics, this paper proposes a concept of policy system that is then applied empirically to Taiwan's industrial context of 1986–95. Contemporary political sciences now identify the institutionalization of state-business relations. Accounts differ, but generally they retain a strong sense of conventional rules in the formulation and implementation of industry policy. While taking this idea of rules seriously, we extend institutional perspectives on politics from the familiar confines of structural constraints to the institutional context of resources. Thus, a policy system is socially constructed with a variety of rules and resources, appreciable in the Taiwanese context.

The 'new institutionalism' had led to increasing emphasis on the 'embed dedness' of organizations in local social systems. In this journal, Sorge (1991) and Whitley (1994) have shown, in particular, how the dominant forms of organization within countries or sectors are shaped by distinct national sys tems. The liability of these institutionalist approaches, however, is a focus on broad comparisons that gives little access to the diversity that is often observ able on the ground. Examining nine Taiwanese computer firms during the 1980s and early 1990s, this paper demonstrates that their strategies followed no singular system logic, displaying instead a wide scope for strategic divers ity. The paper argues that this kind of diversity can be explained not by rejecting institutionalism, but by recognizing the plural systems — business, technology and political — in which the dis-embedded actors of modernity now engage. Such a pluralistic approach has the potential to extend institu tionalist analysis beyond the broadly comparative to the strategies of individual firms.

Background Cholelithiasis has become a major health problem in Taiwan. The predominant type of gallstone found in Asian populations differs from that in the West, indicating possible differences in the etiology and risk factors for cholelithiasis. The aim of this study is to investigate the risk factors for cholelithiasis using data representative of the general population. Methods We performed a population-based, case-control study in which we analyzed medical data for 3725 patients newly diagnosed with cholelithiasis and 11175 gender- and age-matched controls with no history of cholelithiasis, using information obtained from the 2005 Registry for Beneficiaries of the National Health Insurance Research Database. Coexisting medical conditions were included in the analysis. Relative risks were estimated by adjusted odds ratio (OR) and 95% confidence interval (CI) using a multivariate logistic regression analysis. Results After controlling for the other covariates, multivariate logistic regression analysis identified the following as risk factors for cholelithiasis (in descending order of contribution): Among all patients - hepatitis C (OR = 2.78), cirrhosis (OR = 2.47), hepatitis B (OR = 2.00), obesity (OR = 1.89), and hyperlipidemia (OR = 1.54); Among women - hepatitis C (OR = 3.05), cirrhosis (OR = 1.92), obesity (OR = 1.91), menopause (OR = 1.61), hepatitis B (OR = 1.54), and hyperlipidemia (OR = 1.49). Diabetes mellitus appeared to have a marked influence on the development of cholelithiasis but was not identified as a significant independent risk factor for cholelithiasis. Conclusions The risk factors for cholelithiasis were obesity, hyperlipidemia, hepatitis B infection, hepatitis C infection, and cirrhosis in both genders, and menopause in females. Despite differences in the predominate type of gallstone in Asian versus Western populations, we identified no unique risk factors among the population of Taiwan.

This study presents a prototype design of an ultra-miniature, wireless, battery-less, and implantable temperature-sensor, with applications to thermal medicine such as cryosurgery, hyperthermia, and thermal ablation. The design aims at a sensory device smaller than 1.5 mm in diameter and 3 mm in length, to enable minimally invasive deployment through a hypodermic needle. While the new device may be used for local temperature monitoring, simultaneous data collection from an array of such sensors can be used to reconstruct the 3D temperature field in the treated area, offering a unique capability in thermal medicine. The new sensory device consists of three major subsystems: a temperature-sensing core, a wireless data-communication unit, and a wireless power reception and management unit. Power is delivered wirelessly to the implant from an external source using an inductive link. To meet size requirements while enhancing reliability and minimizing cost, the implant is fully integrated in a regular foundry CMOS technology (0.15 μm in the current study), including the implant-side inductor of the power link. A temperature-sensing core that consists of a proportional-to-absolute-temperature (PTAT) circuit has been designed and characterized. It employs a microwatt chopper stabilized op-amp and dynamic element-matched current sources to achieve high absolute accuracy. A second order sigma-delta (Σ-Δ) analog-to-digital converter (ADC) is designed to convert the temperature reading to a digital code, which is transmitted by backscatter through the same antenna used for receiving power. A high-efficiency multi-stage differential CMOS rectifier has been designed to provide a DC supply to the sensing and communication subsystems. This paper focuses on the development of the all-CMOS temperature sensing core circuitry part of the device, and briefly reviews the wireless power delivery and communication subsystems.

Spleen-conserving management has been the trend for blunt splenic injury when hemodynamic conditions are unstable. Even though spleen-conserving management using splenorrhaphy is of great benefit, the pitfalls in operations remain. A 45-year-old male suffered a sudden attack of severe abdominal pain while with his colleagues. He had a history of spleen injury 2 years earlier and underwent splenorrhaphy for the injury. His colleague hit his abdomen softly at an exercise activity, and the attack of severe abdominal pain followed in a few minutes. After prompt aggressive fluid resuscitation, the emergent laparotomy was then arranged. Upon laparotomy, peritoneal adhesions and organs rearrangement were observed. The pancreas tail and the spleen were pulled forward to the anterior part of the left upper abdominal cavity using the dense adhesion bands (Fig. 1). Approximately 600 mL of blood was evacuated from the peritoneal cavity initially and active oozing and bleeding were still noted from the injured tissues. More attention was paid to mobilizing the spleen, due to the presence of extensive adhesion. To avoid