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Background: Congenital anomalies (CAs) with or without intellectual disability (ID)/developmental delay (DD) comprise a heterogeneous spectrum of diseases that affect approximately 3% of live births worldwide. Recently, whole‐exome sequencing (WES) demonstrated the highly heterogeneous genetic causes of CAs. The purpose of this study was to evaluate a referral system to increase the yield of WES for CAs. Methods: From August 2018 to July 2019, patients with CAs, with or without ID/DD, after excluding gross chromosomal aberrations, were referred to geneticists in two medical centers. Variant prioritization was conducted with an AI‐assisted tool for whole exomes or a CA‐related gene panel. Results: Forty patients (27 males and 13 females) with CAs were enrolled in the study with a mean age of 4.71 years (range, 0.01–18.2). Pathogenic variants in 14 genes were discovered in 16 patients (three patients with CHD7 and 13 patients with one gene each of ATP6V1B2, TAF6, COL4A3BP, ANKH, BMP2, SMARCA4, CUL4B, PGAP3, SOX11, FBN2, PTPN11, SOS1, or PROKR2), with a positive diagnostic rate of 40%. Among the 16 positive cases, 13 (81%) also had ID/DD. The inheritance was autosomal dominant in 13 (81%), autosomal recessive in two (13%), and X‐linked in one (6%). Only five patients received a correct clinical diagnosis before WES. The analyses of patients with a negative genetic diagnosis revealed a phenotype and gene mutation load similar to those of the positive‐finding patients but with a lower percentage of ID/DD. Conclusions: The careful selection of patients by experienced geneticists and the exclusion of chromosomal aberrations raises the positive rate of the molecular diagnosis for CAs to 40%. However, more than half of the patients with CAs still do not have a genetic diagnosis by current technologies. Whole‐exome sequencing demonstrated the highly heterogeneous genetic causes of congenital anomalies. The careful selection of patients by experienced geneticists and the exclusion of chromosomal aberrations raises the positive rate of the molecular diagnosis for congenital anomalies. [ABSTRACT FROM AUTHOR]

Based on the daily minimum temperature data from 199 meteorological stations in northeast China (NEC), the cold wave (CW) processes in winter from 1980 to 2020 are identified. Then, by using the reanalysis 500‐hPa geopotential height data provided by the European Centre for Medium‐Range Weather Forecasts (ECMWF), the CWs are objectively classified into two types (abbreviated as Type 1 and Type 2) according to the corresponding atmospheric circulation through the hierarchical cluster algorithm (HCA). The relationships of the CWs with the Arctic sea sic (SIC) and sea surface temperature (SST) are revealed. For Type 1, the SIC in the north of the Barents Sea–Kara Sea is relatively less in the previous autumn, and a wave train propagating from the polar regions to Northeast Asia is stimulated under the ice–atmosphere interaction. This wave train further cooperates with the positive SST anomaly in the southern Indian Ocean to excite the low‐vortex circulation under the negative phase of Arctic Oscillation (AO) in winter, which is conducive to the occurrence of Type 1. However, the relatively low SST in the western Pacific warm pool in previous autumn stimulates a northward propagating wave train along the meridian, which increases the degree of meridionality of the atmospheric circulation over East Asia and thus indirectly causes the polar‐vortex‐splitting circulation under the positive AO phase, which favours the formation of Type 2. The numerical simulations can well reproduce the observational facts, further confirming the possible impact of the SIC and SST in the previous autumn on the two types of CW over the NEC. [ABSTRACT FROM AUTHOR]

Pacific‐Panthalassa plate tectonics are the most challenging on Earth to reconstruct during the Mesozoic and Cenozoic eras due to extensive subduction, which has resulted in large (>9,000 km length) unconstrained gaps between the Pacific and Laurasia (now NE Asia) back to the Early Jurassic. We build four contrasted NW Pacific‐Panthalassa global plate reconstructions and assimilate their velocity fields into global geodynamic models. We compare our predicted present mantle structure, synthetic geoid and dynamic topography to Earth observations. P‐wave tomographic filtering of predicted mantle structures allows for more explicit comparisons to global tomography. Plate reconstructions that include intra‐oceanic subduction in NW Pacific‐Panthalassa fit better to the observed geoid and residual topography, challenging popular models of Andean‐style subduction along East Asia. Our geodynamic models predict significant SE‐ward lateral slab advections within the NW Pacific basin lower mantle (∼2,500 km from Mesozoic times to present) that would confound "vertical slab sinking"‐style restorations of imaged slabs and past subduction zone locations. Plain Language Summary: Our knowledge of Earth's past tectonic plate configurations becomes increasingly uncertain going back into geologic time. Northwest Pacific‐Panthalassa plate tectonics along East Asia and the northern Pacific margin are among the most uncertain place on Earth to reconstruct during the Mesozoic‐Cenozoic eras. Numerous hypotheses have been proposed: one popular hypothesis suggests a large oceanic plate subducted continuously and exclusively under the eastern margin of Asia throughout Jurassic and Cretaceous times (i.e., Andean‐type subduction); a second hypothesis assumes that a number of smaller plates existed within the Northwestern Pacific that subducted both under the Asian margin and at offshore subduction zones (i.e., intra‐oceanic subduction). Using numerical models of mantle convection, we computed where each hypothesis predicts the subducted lithospheric plates to be at present in the Earth's interior. We compared these predictions against tomographic images of the Earth's mantle. We also calculated the gravitational attraction caused by the predicted mass distributions and compared them against the observed geoid. The warping of the Earth's surface caused by mantle flow was also computed and compared against non‐hydrostatic topography measurements. Our results favor plate reconstructions featuring intra‐oceanic subduction within Northwestern Pacific‐Panthalassa, with implications for past global CO2 and reconstructing disappeared ocean basins. Key Points: Six fully kinematic, end‐member western Pacific plate tectonic reconstructions were assimilated into global geodynamic modelsIntra‐oceanic subduction in western Pacific produces synthetic geoid and dynamic topography best fit observed geoid and residual topographyGeodynamic models predict significant SE‐ward lateral slab advections within NW Pacific lower mantle (∼2,500 km from Jurassic to present) [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 surge in Taiwan, the Far East Memorial Hospital established a system including a centralized quarantine unit and triage admission protocol to facilitate acute care surgical inpatient services, prevent nosocomial COVID-19 infection and maintain the efficiency and quality of health care service during the pandemics. Materials and methods: This retrospective cohort study included patients undergoing acute care surgery. The triage admission protocol was based on rapid antigen tests, Liat® PCR and RT-PCT tests. Type of surgical procedure, patient characteristics, and efficacy indices of the centralized quarantine unit and emergency department (ED) were collected and analyzed before (Phase I: May 11 to July 2, 2021) and after (Phase II: July 3 to July 31, 2021) the system started. Results: A total of 287 patients (105 in Phase I and 182 in Phase II) were enrolled. Nosocomial COVID-19 infection occur in 27 patients in phase I but zero in phase II. More patients received traumatological, orthopedic, and neurologic surgeries in phase II than in phase I. The patients' surgical risk classification, median total hospital stay, intensive care unit (ICU) stay, intraoperative blood loss, operation time, and the number of patients requiring postoperative ICU care were similar in both groups. The duration of ED stay and waiting time for acute care surgery were longer in Phase II (397 vs. 532 minutes, p < 0.0001). The duration of ED stay was positively correlated with the number of surgical patients visiting the ED (median = 66 patients, Spearman's ρ = 0.207) and the occupancy ratio in the centralized quarantine unit on that day (median = 90.63%, Spearman's ρ = 0.191). Conclusions: The triage admission protocol provided resilient quarantine needs and sustainable acute care surgical services during the COVID-19 pandemic. The efficiency was related to the number of medical staff dedicated to the centralized quarantine unit and number of surgical patients visited in ED. [ABSTRACT FROM AUTHOR]

Background: Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems.Methods: We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death.Results: The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries.Conclusion: There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance. [ABSTRACT FROM AUTHOR]

Objectives: Buddhism, Taoism, and Confucianism have influenced societies and shaped cultures as they have spread across the span of history and ultimately across the world. However, to date, the interrelated nature of their impacts has yet to be examined largely due to the lack of a measure that comprehensively assesses their various tenets. Building on a conceptual integration of foundational texts on each ideology as well as on recent measure development work (much of which is unpublished), the current studies developed a comprehensive measure of these ideologies (the Three Teachings of East Asia Inventory; TTEA) and validated it across four languages. Methods: A combined sample of 2,091 online respondents (Study 1: 322 Chinese respondents, Study 2: 400 Japanese respondents, Study 3: 362 Taiwanese respondents, Study 4: 688 White Americans and 319 Asian Americans) completed 25–35 min online survey in their preferred language: English, Traditional Mandarin, Simplified Mandarin, or Japanese. Results: Exploratory Factor Analyses within a 122-item pool identified 18 stable dimensions across all samples. Measurement invariance analyses identified the final 61-items of the TTEA inventory (demonstrating reasonable invariance across all languages), confirming 18 individual tenet subscales that organize into four higher-order composites: Buddhism, Taoism, Restrictive Confucianism, and Empowering Confucianism. A shorter 36-item version of the TTEA inventory was also developed. The TTEA scales demonstrated (1) acceptable internal consistency, (2) discriminant validity, and (3) incremental predictive validity for current life satisfaction and vitality. Conclusions: The TTEA inventory offers one of the first comprehensive, multilingual measures that will allow cross-cultural researchers to examine the influence of three related Eastern ideologies on societies across the world. [ABSTRACT FROM AUTHOR]

This paper examines the role of the "Bluefin Tuna Cultural Festival" in developing and sustaining regional identities within the context of rural regeneration, sustainability, and the creation of closer relationships between production and consumption in the countryside. It focuses on Donggang, Southern Taiwan, an area with rural development issues, increasing tourism impacts, and contested issues of local identity, sustainability, and an aging society. This paper draws on public discourse and in-depth interviews with key stakeholders in Donggang to understand the conditions required for substantiating authenticity of the gastronomic products and experiences and the promotion of an appealing gastronomic image. This study traces the process of embedding bluefin tuna in Donggang through marketing, branding and provides a preliminary conceptualization of interrelations between gastronomic tourism and community development in East Asia. The paper draws attention to these particular issues issues: the commodification of local heritage and countryside capital, strategies and challenges of hosting culinary festivals and resolving the issue of return migration. • Local food is a marker of openness and balance between fine palate and sustainability. • Bluefin Tuna Cultural Festival connects consumers to perceived culture and heritage. • Bluefin Tuna Cultural Festival shows that local food can enhance visitor experience. • Social relationships with food are at odds with the ecosystem's health and longevity. [ABSTRACT FROM AUTHOR]

Using a sample of 86 East Asian international graduate students, this study examined Bandura’s perceived self-efficacy model (1986) in the domain of job search self-efficacy and tested the mediating effects of job search self-efficacy in the relationship between efficacy source variables and job search behaviors. Results show that both performance accomplishments and verbal persuasion are significant predictors of job search self-efficacy and that performance accomplishments is a stronger predictor of job search self-efficacy than verbal persuasion. Moreover, verbal persuasion has a significant indirect effect on the job search behaviors through the mediation of job search self-efficacy. Vocational interventions for enhancing East Asian international graduate students' job search self-efficacy are suggested. The authors also address the theoretical and practical implications of the findings for East Asian international students' career development. [ABSTRACT FROM PUBLISHER]

Background Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in East Asia. KPLA is usually caused by hypervirulent strains that are susceptible to all kinds of antibiotics except ampicillin. Patients with KPLA are commonly treated with β-lactams and need prolonged duration of intravenous therapy. Fluoroquinolone has high oral bioavailability and has the potential to shorten the duration of intravenous therapy, but studies regarding fluoroquinolone use in KPLA are limited. We aimed to compare the outcomes of patients with KPLA treated with β-lactams and fluoroquinolone. Methods Consecutive patients with KPLA in a tertiary medical center of Taiwan between 2011 and 2018 were enrolled retrospectively. Clinical characteristics and treatment outcomes were compared between cases treated with β-lactams and fluoroquinolones. Logistic regression was performed to identify risk factors of prolonged hospitalization (defined as > 30 days). Capsular genotypes and presence of rmpA or rmpA2 genes were analyzed among K. pneumoniae strains collected after July 2012. Hypervirulent strains were defined as those had rmpA or rmpA2 genes. Results A total of 330 KPLA patients identified, and the in-hospital mortality was 0.9% (n = 3). Nearly all K. pneumoniae strains were hypervirulent strains (97.1%). Capsular type K1 (n = 176) and K2 (n = 63) were the most common capsular types. Most patients received β-lactams (n = 296, 89.7%), and only 34 (10.3%) patients received fluoroquinolones as the main antibiotics (levofloxacin = 17; moxifloxacin = 10; ciprofloxacin = 7). The duration of intravenous antibiotics use in fluoroquinolones group was shorter than β-lactams group (20.12 ± 9.21 vs. 26.81 ± 16.10, P = 0.001). Prolonged hospitalization was more common in β-lactams group than fluoroquinolones group (32.1% vs. 11.8%, P = 0.014). The in-hospital mortality, duration of antibiotic use, and recurrence rate were similar between the two groups. Fluoroquinolones was independent protective factor for prolonged hospitalization (hazard ratio, 0.28; P = 0.026). Conclusion Fluoroquinolone is able to shorten the duration of intravenous antibiotic use and beneficial in prolonged hospitalization in patients with KPLA. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

• Fluoroquinolones had similar clinical efficacy to β-lactams in Klebsiella pneumoniae liver abscess (KPLA). • KPLA patients treated with fluoroquinolones had a shorter duration of intravenous antibiotics. • KPLA patients treated with fluoroquinolones had a shorter hospital length of stay. Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in East Asia. Patients with KPLA usually require prolonged intravenous (i.v.) β-lactam therapy and hospitalisation. Fluoroquinolones have high oral bioavailability and the potential to shorten the duration of i.v. therapy. The aim of this study was to investigate the feasibility of fluoroquinolones as an alternative treatment for KPLA in Taiwan. Consecutive patients with KPLA in a medical centre in Taiwan between July 2012 and August 2019 were retrospectively enrolled. Clinical characteristics and outcomes were compared between cases treated with β-lactams and fluoroquinolones. A multivariate logistic regression model and propensity-score adjusted analysis were performed to identify independent risk factors for prolonged hospitalisation. A total of 234 patients with KPLA were identified during the study period. Most patients received β-lactams (n = 199; 85.0%), whilst only 35 (15.0%) received fluoroquinolones as the major therapy. Fluoroquinolones had similar clinical efficacy to β-lactams even in critically ill patients. Patients treated with fluoroquinolones had a shorter i.v. antibiotics duration (18.9 ± 7.6 days vs. 28.5 ± 14.7 days; P < 0.001) and hospital length of stay (LOS) (20.9 ± 8.3 days vs. 29.5 ± 16.2 days; P < 0.001) than patients treated with β-lactams. Major therapy with fluoroquinolones was an independent protective factor for hospital LOS > 14 days in all patients and for hospital LOS > 21 days in critically ill patients. In conclusion, fluoroquinolones were an effective alternative treatment for KPLA that resulted in a shorter duration of i.v. therapy and hospital LOS. [ABSTRACT FROM AUTHOR]