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The study investigated American and Taiwan undergraduate students' attitudes toward biodiversity. The survey questionnaire consisted of statements prompted by the question "To what extent do you agree with the following statements about problems with the biodiversity issues." Students indicated strongly disagree, disagree, agree, strongly agree, or no opinion. The questionnaire inquired students' awareness of biodiversity and the impact of human activity on biodiversity. The students' attitudes were analyzed by frequency of response and average value of response. The t-test was conducted to examine the difference among students of different backgrounds. The results showed that both American and Taiwan undergraduate students had consensus that they expressed lower level of confidence in the ability of science and technology to solve biodiversity problems, and they did not agree that people worry too much about the problem of biodiversity issue. There were also significant differences between different groups (gender, with or without experience of conservation activities). Understanding students' attitudes is important for educators to plan curriculum and instruction.

Tropical cyclone (TC) activity around Taiwan is analysed via typhoon datasets compiled by the Central Weather Administration (CWA) for the pre‐satellite era of 1900–1945 (IE1) and the satellite era of 1970–2015 (IE2). Modulating processes imposed by El Niño years on active and inactive TC activity around Taiwan in the July–September season are examined and compared between IE1 and IE2. Analyses reveal coherent dynamic relationships between TC variability in Taiwan and large‐scale modulating processes; furthermore, modulating processes exhibit similar features between IE1 and IE2. El Niño years tend to have more (less) TC formation in the eastern (western) sector of the western North Pacific (WNP). In both IE1 and IE2, intensified TC activity around Taiwan is associated with northwestward TC tracks from the eastern WNP toward Taiwan assisted by a westward‐elongating cyclonic anomaly across the WNP and South China Sea. When a WNP cyclonic anomaly stretches northwestward toward oceans north of Taiwan, TCs from the tropical eastern WNP generally move northward toward oceans east of Taiwan to result in suppressed TC activity around Taiwan. The westward‐elongating anomalous cyclone is associated with an anomalous divergent centre over the Indian Ocean and an anomalous convergent centre in the tropical eastern Pacific over the 150°–130°W region. The northwestward‐extending anomalous cyclone connects with an anomalous divergent centre over the Maritime Continent and an anomalous convergent centre over the 130°–110°W region. Anomalous divergent and convergent centres displace westward (eastward) for active (inactive) TC types that are related to a more westward (eastward) maximum centre of anomalous warm waters in the tropical eastern Pacific. The above coherent dynamic relationships justify the reliability of TC records compiled by the CWA during IE1 and IE2. [ABSTRACT FROM AUTHOR]

Background: Dengue virus serotype 2 (DENV-2) was the major serotype in the 2015 dengue outbreak in Taiwan, while DENV-1 and DENV-3 were dominant between 2005 and 2014. We aimed to investigate whether DENV-2 contributed to disease severity and mortality in the outbreak in Kaohsiung city, Taiwan. Methods: We collected serum samples from dengue patients to detect the presence of DENV and determine the serotypes by using quantitative reverse transcription-polymerase chain reaction. Our cohorts comprised 105 DENV-1-infected cases and 1,550 DENV-2-infected cases. Demographic data, DENV serotype, and comorbidities were covariates for univariate and multivariate analyses to explore the association with severity and mortality. Results: The results suggested that DENV-1 persisted and circulated, while DENV-2 was dominant during the dengue outbreak that occurred between September and December 2015. However, DENV-2 did not directly contribute to either severity or mortality. Aged patients and patients with diabetes mellitus (DM) or moderate to severe chronic kidney disease (CKD) had a higher risk of developing severe dengue. The mortality of dengue patients was related to a higher Charlson comorbidity index score and severe dengue. Among DENV-2-infected patients and older patients, preexisting anti-dengue IgG, DM, and moderate to severe CKD were associated with severe dengue. Moreover, female sex and severe dengue were associated with a significantly higher risk of death. Conclusions: Our findings highlight the importance of timely serological testing in elderly patients to identify potential secondary infections and focus on the meticulous management of elderly patients with DM or moderate to severe CKD to reduce dengue-related death. [ABSTRACT FROM AUTHOR]

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in October 2021, possessed many mutations compared to previous variants. We aimed to identify and analyze SARS-CoV-2 Omicron subvariants among coronavirus disease 2019 (COVID-19) patients between January 2022 and September 2022 in Taiwan. The results revealed that BA.2.3.7, featuring K97E and G1251V in the spike protein compared with BA.2, emerged in March 2022 and persistently dominated between April 2022 and August 2022, resulting in the largest COVID-19 outbreak since 2020. The accumulation of amino acid (AA) variations, mainly AA substitution, in the spike protein was accompanied by increasing severity in Omicron-related COVID-19 between April 2022 and January 2023. Older patients were more likely to have severe COVID-19, and comorbidity was a risk factor for COVID-19-related mortality. The accumulated case fatality rate (CFR) dropped drastically after Omicron variants, mainly BA.2.3.7, entered Taiwan after April 2022, and the CFR was 0.16% in Taiwan, which was lower than that worldwide (0.31%) between April 2021 and January 2023. The relatively low CFR in Omicron-related COVID-19 patients can be attributed to adjustments to public health policies, promotion of vaccination programs, effective antiviral drugs, and the lower severity of the Omicron variant. [ABSTRACT FROM AUTHOR]

This article is aimed at the problems encountered by the fishing ground of set nets in Taiwan when the set net operators need to work when the weather is bad at sea. We developed a velocimeter that can be placed in the ocean for a long time and change sensing directions with the flow direction. The self-designed velocimeter has advantages, such as simple operation, low cost, and easy maintenance. With wireless monitoring and an early warning system, it can monitor current velocity, flow direction, sea temperature, and displacement. The data is transmitted back to the operator through the radio transmission module as a basis for dispatching personnel to go out to sea for fishing. To prevent the set net from drifting into the open sea due to bad weather, a GPS module is used to monitor the current location of the set net. If the waves wash away the set net, the warning signal can be received the first time to prevent the floating set net from endangering the safety of ship navigation and the survival of marine life. This innovative technology aligns with SDG 14, which aims to "conserve and sustainably use the oceans, seas, and marine resources for sustainable development". [ABSTRACT FROM AUTHOR]

In Taiwan, coronavirus disease 2019 (COVID‐19) involving the delta variant occurred after that involving the alpha variant in 2021. In this study, we aimed to analyze the Delta variant. A total of 318 patients in Taiwan infected with delta variants were identified. The case fatality rate (CFR) of patients infected with delta variants was 0.94% in Taiwan compared with that of those infected with alpha variants (5.95%). The possible reasons for the low CFR might be hybrid immunity due to infection and rapid promotion of the COVID‐19 vaccination program during the alpha variant outbreak. We identified three 21J delta variants. Two long gene deletions were detected in these severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) isolates: ORF7aΔ91 in KMUH‐8 and SpikeΔ30 in KMUH‐9. Protein structure prediction indicates that ORF7aΔ91 results in malfunction of NS7a as an interferon antagonist and that SpikeΔ30 results in a truncated spike protein (N679–A688del), resulting in a lower infection rate compared with the delta variant without these deletions. The impact of these two deletions on SARS‐CoV‐2‐associated pathogenesis deserves further investigation. Delta variants still exist in many regions in the omicron era, and the backbone of the delta variant genome possibly spread worldwide in the form of delta‐omicron hybrids (deltacron; e.g., XBC.1 and XAY.2), which casts a potential threat to public health. Our study further highlighted the importance of more understanding of the delta variants. [ABSTRACT FROM AUTHOR]

This study investigated whether the level of practice interacts with the initial conditions (here manipulated as preparatory movements) and task difficulty (ball angular velocity and friction) in determining the stability of movement coordination for a roller ball motor task. Practice level and task difficulty were manipulated as two control parameters that theoretically were hypothesized to change the threshold for the transition between task success and failure. The findings showed bi-stability and hysteresis in the coordination mode as a manifestation of dependence on the initial conditions. The transition from failure to success in the roller ball task as a function of practice time can be modeled as a saddle-node bifurcation corresponding to a first order phase transition. It is proposed that task difficulty acts as a control parameter that is a dual to skill level and that also effectively compensates for practice time. (Contains 1 table and 11 figures.)

The old existing reinforced concrete (RC) structures in Taiwan are susceptible to severe damage under earthquakes because of the soft-story mechanism. Moreover, the effects of near-fault ground motions often contain a long period of velocity pulse and permanent ground displacement. This study is based on the tri-axial shaking table test conducted at the National Center for Research on Earthquake Engineering in Taiwan and a series of seismic performance evaluations of a non-ductile RC structure in Taiwan. Finite element analysis (FEA) will be conducted to simulate the linear and nonlinear behavior of the seven-story building. This accommodates the damage plasticity model for concrete and the elastic-perfectly plastic model for reinforcement. Comparison of the results between the experimental test and numerical model showed that the similarity of the vibration period has a great influence on the simulation results. The findings showed that the data of acceleration and displacement behavior corresponded with the experimental results in a satisfactory margin. Also, the damage mode is very similar to the shaking table test results. The study found that using FEA can satisfactorily simulate the seismic performance of mid-rise buildings under a near-fault earthquake. [ABSTRACT FROM AUTHOR]

Background: Human respiratory syncytial virus (RSV) is a leading pathogen of acute respiratory tract disease among infants and young children. Compared with previous seasons, RSV outbreaks in Taiwan during the 2020–2021 season were delayed because of COVID‐19 mitigation measures. We conducted this study to determine the association of viral factors with clinical characteristics of preschool children with RSV infection. Methods: We performed a molecular epidemiology analysis of RSV among inpatient preschool children in Taiwan. In 80 nasopharyngeal samples positive for RSV, we sequenced and analyzed viral genotypes according to patient data. Patients' clinical data were obtained from medical files, and their clinical profiles were compared with those of RSV cases recorded during the 2014–2017 seasons. Results: Phylogenetic analysis revealed that among the RSV‐positive samples, all RSV strains identified during the 2020–2021 season belonged to the ON1 genotype. Most of the Taiwan ON1 strains were categorized into two well‐supported clusters with distinct G protein amino acid substitution patterns that had never been demonstrated previously. Furthermore, the proportion of cases among children aged >24 months increased (P < 0.001). Compared with patients infected during the 2014–2017 seasons, patients infected during the 2020–2021 season were hospitalized for shorter days from hospital admission to dereference (P = 0.004) and had a greater need for oxygen supplements (P = 0.021) and systemic steroid therapy (P = 0.026). Conclusion: The delayed 2020–2021 RSV outbreak in Taiwan was caused by two novel RSV ON1.1 variants. How the change in RSV epidemiology affects future RSV outbreaks warrants exploration. [ABSTRACT FROM AUTHOR]

Urinary Na excretion is a potential risk factor for CVD. However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterise the relative contribution of biological factors to the Na–CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour Na excretion was estimated using a single overnight urine sample. Hypertension, the metabolic syndrome and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary Na excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (sd) of the 2112 participants was 54·5 (sd 12·2) years, and they were followed up for a mean of 14·1 (sd 8·1) years. Compared with those in the lowest quartile, the highest baseline urinary Na excretion (>4·2 g/24 h) was associated with a 43 % higher CVD risk (hazard ratio, 1·43; 95 % CI 1·02, 1·99). Participants with high urinary Na excretion, hypertension or the metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35 % of the Na–CVD association), followed by systolic blood pressure (BP) (33 %), left ventricular mass (28 %) and diastolic BP (14 %). Higher urinary Na excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic BP. [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) infection results mostly from the bites of virus‐carrying Aedes mosquitoes, which results in dengue fever (DF) with or without warning signs, severe dengue, or asymptomatic infections in humans. For point‐of care identification of DENV‐infected patients, a rapid diagnostic test (RDT) for DENV nonstructural protein 1 (NS1) has been developed to achieve early diagnosis and timely clinical management. We evaluated the performance of a new commercially available dengue NS1 RDT AsiaGen Dengue NS1 Antigen Rapid Diagnosis Test using real‐time qRT‐PCR as a reference method and compared the results with SD BIOLINE Dengue NS1 Ag using a single acute‐phase serum panel collected during the largest dengue outbreak in the history of Taiwan in 2015. The results suggested that the sensitivity and specificity of AsiaGen Dengue NS1 Antigen RDT (96.9% and 100%) were similar to those of SD BIOLINE Dengue NS1 RDT (100% and 100%) for detection in the acute phase of DENV‐2 infection. The results suggested that the sensitivity of both RDTs was similar (95.4% ~ 100%) for the sera collected at less than or equal to three days postsymptom onset (PSO). Our results suggested that the two DENV NS1 RDTs used in this study were promising for the timely diagnosis of DENV infection during dengue outbreaks, at least for DENV‐2 in areas where authorized medical laboratories are not available or medical resources are limited. However, the performance of AsiaGen DENV NS1 RDTs in the detection of primary/secondary infections and infection by serotypes of DENV other than DENV‐2 requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Previous studies indicate significant gaps exist in current practices and perceptions of oncofertility care. Objectives: We aim to understand the clinical experience regarding oncofertility care among health providers in a multidisciplinary breast care team. Methods: A qualitative, descriptive study was conducted. Data were collected through in-depth interviews with 16 health care providers who worked in a hospital in Taipei. Verbatim transcriptions were analyzed using constant analysis methods. Results: Health care providers’ experiences regarding fertility care for reproductive-age women with breast cancer were divided into two themes: personal perspectives and barriers. Personal perspectives consisted of six subthemes including empathizing with the patient’s suffering during the diagnosis and treatment, safety as a prerequisite, satisfying the women’s needs, respecting the women’s choice, questioning women’s ability to raise children, and returning to family life. There were also six subthemes under barriers. These subthemes were poor communication among the multidisciplinary team, lack of initial screening, insufficient support in the women’s families, treatment considerations, lack of evidence-based information regarding oncofertility, and non-follow-up protocol. Conclusion: Nurses should evaluate the fertility needs of women with cancer and identify potential gaps during oncofertility care. Education strategies and tactics should be improved in order to overcome difficulties arising from health care providers’ personal perspectives and barriers to the provision of optimal fertility care in women with cancer. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes infectious symptoms including fever, cough, respiratory and gastrointestinal symptoms, and even loss of smell/taste and to date had caused 489 000 people to be infected with 32 000 deaths. This article aims to develop some strategies in dealing with the COVID-19 epidemic to prevent nosocomial infection and ensure the safety of healthcare workforce and employees. Methods: This is a prospectively registered and retrospective descriptive study investigating the clinical characteristics, results of diagnostic tests, and patients' disposition from February 1, 2020, to April 30, 2020, at a tertiary medical center in Northern Taiwan. Results: There is no nosocomial spreading of SARS-CoV-2 in our facility. The following strategies were followed: information transparency; epidemic prevention resources planning by authorities; multidisciplinary cooperation; informative technologies; immigration quarantine policies; travel restrictions; management of diversion/subdivision; self-health monitoring; social distancing; screening of travel, occupation, contact, and cluster (TOCC) history; traffic control bundling (TCB); training of using personal protective equipment; real-name visiting management; and employee care. The patients' basic characteristics and diagnostic results were gathered. Of the 3832 cases, about 25.9% had travel history. Most of them were traveling to Asia (419 people/time, 10.9%) and from China (256 people/time, 6.7%). Meanwhile, healthcare personnel accounted for 316 people/time (8.3%) and cleaning personnel, 6 people/time (0.16%). The 36 cases who care or have contact with confirmed cases have negative results from the COVID-19 test. The most frequent symptoms were fever and upper respiratory infection followed by gastrointestinal symptoms. Conclusion: The above strategies were followed. Patients were stratified based on the risk of TOCC history assessment to ensure the safety of healthcare personnel and patients' appropriate and timely medical services. [ABSTRACT FROM AUTHOR]

Background/Aim: Acral melanomas (AM) represent a rare subgroup of melanomas with poor clinical outcomes and are enriched in Asian populations. Recent advances in next generation sequencing have provided opportunities to apply precision medicine to AM. Patients and Methods: Here, we present a series of 13 patients with melanomas from Taiwan and Singapore, including 8 patients with AM profiled using whole exome sequencing and summarize the recent studies on the genomic landscape of AM. Results: We identified mutually exclusive mutations in BRAF, NRAS, HRAS, NF1 and KIT in 6 AM cases. In addition, recurrent copy number gains in CCND1 and CDK4, as well as recurrent deletions in CDKN2A/CDKN2B, ATM and RAD51 were observed, supporting the potential use of CDK4/6 or PARP inhibitors in the treatment of these patients. Conclusion: The genomic landscape of AM provides an important resource for applying novel targeted therapies in this rare disease. [ABSTRACT FROM AUTHOR]

Background & Aims: Thrombocytosis is associated with more aggressive tumour biology in many malignancies. There are limited data in patients with hepatocellular carcinoma (HCC), which often occurs in patients with cirrhosis and portal hypertension. We aimed to explore the prognostic value of thrombocytosis in two cohorts of patients with HCC. Methods: We included 3561 patients from Taiwan and 1145 patients from the USA. Thrombocytopenia was defined as platelet count < 150×109/L and thrombocytosis as ≥ 300 × 109/L at HCC diagnosis. We used multivariable Cox proportional hazard models to identify independent predictors of survival. Results: Thrombocytosis was present in 9.0% and 6.9% of Taiwan and USA patients respectively. Compared to patients with normal platelet counts and those with thrombocytopenia, patients with thrombocytosis had larger tumours, increased vascular invasion and a higher proportion had extrahepatic metastases in both cohorts. In multivariable analysis, thrombocytosis (aHR 1.40, 95% CI 1.23‐1.60) and thrombocytopenia (aHR 1.13, 95% CI 1.04‐1.23) were both associated with worse survival after adjusting for age, gender, liver disease aetiology, Child‐Pugh score, maximal tumour size, tumour nodularity, vascular invasion, lymph node or distant metastasis, performance status and alpha‐fetoprotein level. Patients with thrombocytosis had a median survival of 6 and 4 months in the Taiwan and USA cohorts, compared to 32 and 14 months for those with normal platelet counts and 38 and 16 months for thrombocytopenic patients. Conclusion: Thrombocytosis is independently associated with increased tumour burden and worse overall survival among HCC patients. [ABSTRACT FROM AUTHOR]

Early diagnosis is important for the clinical management of diseases caused by dengue virus (DENV) infections. We investigated the performance of three commercially available DENV nonstructural protein 1 (NS1) rapid diagnostic tests (RDTs) using 173 acute-phase sera collected from dengue fever-suspected patients during the 2012–2013 DENV outbreak in Taiwan. The results of the NS1 RDTs were compared with those of qRT-PCR to calculate the sensitivity and specificity of the NS1 RDTs. The anti-DENV IgM and IgG RDT results were included to increase the probability of detecting acute DENV infection. The anti-DENV IgM/IgG RDT results were also compared with those of IgM/IgG captured ELISA. The sera from DENV qRT-PCR-positive patients were subjected to NS1 RDTs, as well as IgM/IgG captured ELISA. These results suggested that there was no significant difference in the sensitivities of the three commercially available DNEV NS1 RDTs; the SD NS1 RDT results showed the highest agreement with the qRT-PCR reference results, followed in order by the Bio-Rad and CTK NS1 RDT results when the specificity was considered. Inclusion of the IgM or IgG RDT results increased the likelihood of diagnosing either a primary or secondary DENV infection. NS1 RDTs were more sensitive for the detection of primary infections than secondary infections, related to DENV viremia levels determined by qRT-PCR. These results suggested that anti-DENV antibodies reduced the sensitivity of NS1 rapid tests. We also analyzed the sensitivity for the detection of different DENV serotypes, and the results suggested that the NS1 RDTs used in this study were valuable for rapid screening of acute DENV infection with DENV-1, DENV-2 and DENV-3. Our results suggest that the NS1 RDT is a good alternative to qRT-PCR analysis for timely dengue disease management and prevention in dengue-endemic regions where medical resources are lacking or during large dengue outbreaks. However, the relatively low sensitivity for DENV-4 might miss the detection of DENV-4-infected cases. [ABSTRACT FROM AUTHOR]

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18–2.76]) and 1.45 (95% CI [0.67–3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment. [ABSTRACT FROM AUTHOR]

Background/purpose: Whether esophagogastric varices (EGV) can determine the outcome of patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) remains unknown. This study aimed to assess the impact of EGV on the prognosis of HCC patients after TACE.Methods: From 2007 to 2012, we retrospectively enrolled 251 treatment-naïve HCC patients who underwent TACE and received esophagogastroduodenoscopy when HCC was diagnosed. The prognostic factors were analyzed using a Cox proportional hazards model and propensity score-matching analysis.Results: There were 120 (47.8%) patients with EGV. Compared to those without EGV, patients with EGV had worse liver functional reserve. After a median follow-up of 14.7 months (25th-75th percentiles, 6.4-35.6 months), 152 patients died. The cumulative 5-year overall survival (OS) rates were 11.2% and 38.8% in patients with and without EGV, respectively (p < 0.001). Multivariate analysis showed that presence of EGV, presence of ascites, tumor size >5 cm, serum alpha-fetoprotein >20 ng/mL, progressive disease by modified Response Evaluation Criteria in Solid Tumors, Assessment for Retreatment with TACE score ≥2.5, and higher albumin-bilirubin grades were the independent predictors of poor OS. Subgroup analysis also demonstrated that EGV was associated with poor OS in most of the subgroups. After propensity score matching, the EGV group still had a lower OS rate than their counterparts (p = 0.004).Conclusion: HCC patients with EGV had worse liver functional reserve compared to those without EGV. Moreover, EGV was an independent risk factor to predict poor prognosis in patients with HCC after TACE. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis , kills over 1 million people worldwide annually. Development of drug resistance (DR) in the pathogen is a major challenge for TB control. We conducted whole-genome analysis of seven Taiwan M. tuberculosis isolates: One drug susceptible (DS) and five DR Beijing lineage isolates and one DR Euro-American lineage isolate. Developing a new method for DR mutation identification and applying it to the next-generation sequencing (NGS) data from the 6 Beijing lineage isolates, we identified 13 known and 6 candidate DR mutations and provided experimental support for 4 of them. We assembled the genomes of one DS and two DR Beijing lineage isolates and the Euro-American lineage isolate using NGS data. Moreover, using both PacBio and NGS sequencing data, we obtained a high-quality assembly of an extensive DR Beijing lineage isolate. Comparative analysis of these five newly assembled genomes and two published complete genomes revealed a large number of genetic changes, including gene gains and losses, indels and translocations, suggesting rapid evolution of M. tuberculosis. We found the MazEF toxin–antitoxin system in all the seven isolates studied and several interesting mutations in MazEF proteins. Finally, we used the four assembled Beijing lineage genomes to construct a high-quality Beijing lineage reference genome that is DS and contains all the genes in the four genomes. It contains 212 genes not found in the standard reference H37Rv, which is Euro-American. It is therefore a better reference than H37Rv for the Beijing lineage, the predominant lineage in Asia. [ABSTRACT FROM AUTHOR]

Although the lung function test has played an important role in respiratory care for a long time, valid spirometry reference values in the Chinese population in Taiwan remain to be elucidated. 2963 healthy Taiwanese subjects aged 21 to 88 years (1765 males, 59.6%) from February 2015 to February 2017 were enrolled. The subjects attempted to meet the 2005 American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines when performing forced expiratory spirograms. We would like to establish the spirometry predictive equations for forced expiratory volume (FEV 1), forced vital capacity (FVC), FEV 1 /FVC, and lower limit of normal (LLN) in Taiwan and compare with other Asian populations. We established the spirometry predictive equations using a linear model for the entire population, using age and height as independent variables, which best predicted all spirometry parameters for sea level and highland subjects. We found that the values of FEV 1 and FVC for the Taiwanese subjects in our study were systematically lower than those reported in South Korea, Japan, and China, but higher than the values in Yang's 1993 and Pan's 1997 Taiwan study. This study addressed the up-to-date spirometry reference equations and values for a healthy adult Chinese population in Taiwan. [ABSTRACT FROM AUTHOR]

Background/purpose: The risk of recurrence after resection of hepatocellular carcinoma (HCC) is high. Apart from nucleos(t)ide analogues therapy, population-based studies suggest statin, nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin have chemopreventive effect on recurrence. The role of those drugs on HCC recurrence should be delineated.Methods: Consecutive 430 hepatitis B surface antigen (HBsAg)-positive patients undergoing curative resection of HCC were enrolled. The detailed medical records including the use of statin, NSAID and aspirin were reviewed. All the patients had regular image study surveillance after the surgery. Predictors associated with recurrence were analyzed by Cox's proportional hazards models.Results: There were 58.8% patients in Barcelona Clinic Liver Cancer (BCLC) stage A, and 37.6% had severe liver fibrosis or cirrhosis. Of them, 47 (10.9%) patients had received potential chemoprophylactic agents either at the time of HCC diagnosis or before their HCC recurrence. During a median 50.3 months of follow-up, 54.7% patients experienced recurrence. The median time to recurrence was 15.4 months. In the univariate analysis, aspirin and statins use were significantly associated a low risk of recurrence (hazard ratio [HR]: 0.18; p = 0.016, and HR: 0.50; p = 0.031, respectively). After adjusting competing factors, large tumor size, severe liver fibrosis, and high alpha-fetoprotein (AFP) level were significantly associated with recurrence. Importantly, aspirin use was found to significantly decrease the risk for HCC recurrence with the adjusted HRs of 0.22-0.24 based on the models.Conclusion: Aspirin use may have chemo-preventive effect on recurrence of hepatitis B virus-related HCC after curative resection. [ABSTRACT FROM AUTHOR]

Very-low-birth-weight (VLBW) infants have a high risk of postdischarge growth retardation (GR). Continued GR might exert negative long-term effects on their health. This study examined the prevalence and the risk factors for postdischarge GR among VLBW infants in Taiwan. Nationwide data from the Taiwan Premature Infant Follow-up Network between 2007 and 2011 were analyzed. Infants with a gestational age (GA) < 37 weeks and birth body weight (BBW) < 1500 g were enrolled. They were followed up after discharge at the corrected ages of 6, 12, and 24 months. Associations between postdischarge GR at the follow-ups and possible risk factors were analyzed. The prevalence of postdischarge GR among 2124 VLBW infants was 17.3%, 19.4%, and 13.8% at the corrected age (CA) of 6, 12, and 24 months, respectively. The significant perinatal factors of postdischarge GR were being small for gestational age (SGA) and extremely low birth weight (ELBW). ELBW infant with extra-uterine growth retardation (EUGR) at discharge or longer length of hospital stay (LOS) had poorer growth outcomes. Among non-ELBW infants, EUGR at discharge and surgical necrotizing enterocolitis (NEC) were the main influencing factors of unfavorable growth outcomes. RDS with surfactant therapy had a positive effect of postdischarge growth outcomes in ELBW infants. Postdischarge GR is still a serious problem in Taiwan. Being SGA and ELBW and EUGR were significant risk factors for postdischarge GR throughout the first two years of life in VLBW infants. An integrated and organized team for postdischarge care as well as scheduled follow-ups, detailed nutritional education, and thorough inspection are necessary. [ABSTRACT FROM AUTHOR]

Background: The insulated isothermal PCR (iiPCR) technology enables consistent PCR amplification and detection in a simple heating device. A pan-dengue virus (DENV) RT-iiPCR, targeting the 5’ untranslated region, was validated previously on the semi-automated POCKIT combo system (involving separate devices for nucleic acid extraction and PCR amplification/detection) to offer performance comparable to a laboratory real-time PCR. Working on the same technologies, a compact automated sample-in-answer-out system (POCKIT Central Nucleic Acid Analyser) has been available commercially for iiPCR, minimizing human error risks and allowing easy molecular bio-detection near points of need. Here, we evaluated the analytical and clinical performance of the pan-DENV RT-iiPCR on the fully automated system by comparison to those on the semi-automated system. Methodology/Principal findings: Testing sera containing serial diluted DENV-1, -2, -3, or -4 cell culture stock, the pan-DENV RT-iiPCR system had similar 100% detection endpoints on the two systems; i.e. at 1, 10, 1 and 10 PFU/ml, respectively, on the fully automated system, and at 10, 1, 10 and 10 PFU/ml, respectively, on the semi-automated system. Furthermore, both fully automated and semi-automated PCR system can detect all four DENV serotypes in mosquitos. Clinical performance of the reagent on the two systems was evaluated by testing 60 human serum samples. Both systems detected the same 40 samples (ten DENV-1, -2, -3, and -4 positive each) and did not detect the other 20; 100% agreement (κ = 1) was found between the two systems. Conclusions/Significance: With performance comparable to a previously validated system, the fully-automated PCR system allows applications of the pan-DENV reagent as a useful tool near points of need to facilitate easy, fast and effective detection of dengue virus and help mitigate versatile public health challenges in the control and management of dengue disease. [ABSTRACT FROM AUTHOR]

Suppose learners use their free time to go online to review course materials, and they do so by taking optional tests that consist of multiple‐choice questions (MCQs). What will happen if, for every practice question, there is always a choice (out of four possible choices) that is marked as "the (current) hot choice?" Will this make any difference in learning effects? To answer this question, an educational experiment was conducted. It was found that "hot designations" helped the experimental group perform significantly better in both the immediate post‐test exam and a delayed post‐test exam and that learners with higher levels of initial knowledge benefited more from this review strategy. From the results of a follow‐up questionnaire and one‐on‐one interviews, it was found that the proposed review strategy promoted a more thorough thinking style in subjects of the experimental group. Lay Description: What is already known about the subject matter: There are good reasons why multiple‐choice questions (MCQs) are a popular choice for tests.E‐learning such as game‐based/mobile learning often uses MCQs for formative assessment.The main "problem" with MCQs is that MCQ tests tend to encourage rote learning.It is desirable to use MCQ tests to promote meaningful learning.What this paper adds to the subject matter: An HMCQ is an MCQ with one of its four choices being marked as "the (current) hot choice."The proposed review strategy requires learners to use their free time to do online tests.Learners taking HMCQ tests better retained knowledge than learners taking MCQ tests.Learners with higher levels of initial knowledge benefited most from the HMCQ review strategy.Implications of study findings for practitioners: It should be worthwhile to use HMCQ tests to help learners review course materials.The effect of "hot" designations (in MCQs) on learning still needs to be clearly delineated.Are there other approaches that also go well with "hot" designations (in MCQs)? [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) is the leading cause of arboviral diseases in humans worldwide. In this study, we investigated the seroprevalence of DENV infection in two districts of Kaohsiung City, a metropolis in southern Taiwan, where major dengue outbreaks have occurred in the past three decades. We enrolled 1,088 participants from the Sanmin and Nanzih districts after the dengue outbreak of 2015, the largest in Taiwan since World War II, and found an overall DENV seroprevalence of 12.4% (95% confidence interval: 10.5–13.4%) based on the InBios DENV IgG ELISA kit. The ratios of clinically inapparent to symptomatic infections were 2.86 and 4.76 in Sanmin and Nanzih districts, respectively. Consistent with higher case numbers during recent outbreaks, the DENV seroprevalence was higher in Sanmin district (16.4%) than in Nanzih district (6.9%), suggesting district differences in seroprevalence and highlighting the importance of screening the DENV immune status of each individual before using the currently available DENV vaccine, Dengvaxia. In the two districts, the seroprevalence rates increased from 2.1% (in the 30–39-year age group) to 17.1% (60–69) and 50% (70–79). The pattern of a sharp and significant increase in seroprevalence in the 70–79-year age group correlated with a dramatic increase in the proportion of clinically severe DENV infections among total dengue cases in that age group. This differed from observations in the Americas and Southeast Asia and suggested that a large proportion of monotypically immune individuals together with other risk factors may contribute to clinically severe dengue among the elderly in Taiwan. [ABSTRACT FROM AUTHOR]

To determine the prevalence of asymptomatic dengue virus-infected blood donors during the largest dengue outbreak in Taiwan history occurred in 2015, we examined the evidence of dengue virus (DENV) infection by the detection of DENV RNA genome using real-time reverse transcription-polymerase chain reaction (real-time RT-PCR), DENV NS1 antigen using rapid diagnosis test (RDT) and anti-dengue antibody using IgM/IgG capture enzyme-linked immunosorbent assay (capture ELISA) and RDT in eight thousand serum samples from blood donations to the blood centers of the Taiwan Blood Services Foundation (TBSF) in Kaohsiung City and Tainan City during the largest dengue outbreak in Taiwan history occurred in 2015. Only one serum sample was positive for DENV RNA detection by using dengue-specific real-time RT-PCR, the virus was DENV-2 determined by serotype-specific real-time RT-PCR and sequencing, and the DENVs in the serum were confirmed as being infectious by a plaque assay. The recipient of this blood did not develop any dengue fever symptom on follow-up. None of the samples was NS1 RDT-reactive. Seventeen IgM-positive samples were identified. There was a low prevalence of asymptomatic confirmed or probable DENV-infected blood donors in our study (0.013% and 0.21%, respectively), and no symptomatic transfusion-transmitted dengue (TT dengue) was developed during the largest dengue outbreak in Taiwan history in highly endemic areas and periods. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the development of knowledge sharing from the perspectives of broaden-and-build theory and expectancy theory. Its research purpose is to understand how knowledge sharing is driven by such predictors as optimism, pessimism, and positive affect through their complex interactions with collectivism or power distance. In the proposed model of this study, knowledge sharing relates to optimism and pessimism via the partial mediation of positive affect. At the same time, the influence of optimism, pessimism, and positive affect on knowledge sharing are moderated by the national culture of collectivism and power distance, respectively.Design/methodology/approach This study’s hypotheses were empirically tested using data from high-tech firms across Taiwan and Malaysia. Of the 550 questionnaires provided to the research participants, 397 usable questionnaires were collected (total response rate of 72.18 percent), with 237 usable questionnaires from Taiwanese employees and 160 usable questionnaires from Malaysian employees. The data from Taiwan and Malaysia were pooled and analyzed using: confirmatory factor analysis for verifying data validity, independent sample t-tests for verifying the consistency with previous literature regarding cultural differences, and hierarchical regression analysis for testing relational and moderating effects.Findings This study demonstrates the integrated application of the broaden-and-build theory and expectancy theory for understanding optimism, pessimism, and positive affect in the development of knowledge sharing. The test results confirm that positive affect partially mediates the relationship between optimism and knowledge sharing and fully mediates the relationship between pessimism and knowledge sharing. Moreover, collectivism and power distance have significant moderating effects on most of the model paths between knowledge sharing and its predictors except for the relationship between pessimism and knowledge sharing.Originality/value This study extends the expectancy theory to justify how optimistic and pessimistic expectations are stable traits that dominate the way employees share their knowledge sharing. This study shows how collectivism and power distance of Hofstede’s cultural framework can be blended with the broaden-and-build theory and expectancy theory to jointly explain knowledge sharing. Besides, this study provides additional support to the adaptation theory of well-being that suggests psychosocial interventions, which manage to enhance well-being by leveraging positive affect, hold the promise of reducing stressful symptoms and boosting psychological resources among employees. [ABSTRACT FROM AUTHOR]

Since the 1950s, Taiwan and China have utilized foreign aid as an instrument of foreign policy. After Taiwan's forced withdrawal from the United Nations in 1971, diplomatic and aid-giving competition with China became more intense. As a result, Taiwan's and China's struggles to gain supporters have been reflected in foreign aid strategies. Taiwan's bid for the UN and the WHO, and the issue of diplomatic recognition empirically demonstrate the utilization of aid to obtain diplomatic support from recipient countries, and, frequently, any decisions are heavily influenced by the competition it experiences with China. Theoretically, this highlights an important relational framework for analyzing foreign aid decisions – particularly the management of foreign relations of small states or middle powers simultaneously influenced by greater powers and aid recipient states.Using data from ICDF and related reports, we observe geographically concentrated patterns in the distribution of Taiwan's aid recipients from 1988 to 1997 – mostly in Latin America and Southeast Asia. In contrast to China's foreign aid which emphasizes infrastructural development, the spirit of Taiwan's economic development aid programs often took the form of technical cooperation. However, a high percentage of aid went to countries with diplomatic ties to Taiwan. With civil society development and increased international activities of Taiwanese NGOs in humanitarian relief and development projects after 2000, we find a new emerging set of geographical aid distribution patterns that expand beyond countries that recognize Taiwan. In addition, while the process of incorporating civil society into foreign aid work was initiated by the ICDF the following decade, Taiwanese NGOs have increasingly demonstrated autonomous international agendas, funding, and direction, as well as the formation of civil society alliances that work on common international development issues. [ABSTRACT FROM PUBLISHER]

Aims: Evidence of a role for type 2 diabetes in overall cancer risk and risk for specific types of cancer is limited in ethnic Chinese populations. We therefore investigated whether there is an association between diabetes and cancer incidence in Taiwan. Methods: This study recruited a total of 3602 adults aged 35 years or over (average 54.9 ± 12.3 years, 52.8% women). Participants with fasting glucose ≥126 mg/dL, or taking hypoglycemic medications, were classed as having type 2 diabetes. Cancer incidence was established through regular follow-up interviews and medical records. Cox proportional hazard regression models were used to examine associations for diabetes with risk of all-cause and site-specific cancers. Results: During a median of follow-up of 10.5 years, 275 individuals developed cancer, including 157 digestive cancers and 31 urinary cancers. Younger participants (aged < 55 years) with diabetes had a greater risk of all cancers [adjusted relative risk (RR) 3.42; 95% confidence interval (CI), 1.78-6.57], digestive cancers (adjusted RR 2.88; 95% CI 1.15-6.94) and urinary cancers (adjusted RR 13.4; 95% CI 2.70-66.3) compared with individuals in the same age group without diabetes. Conclusions: Our results clearly demonstrate that middle-aged individuals of Chinese ethnicity with diabetes have a greater risk of all-cause cancer and specific subtypes of cancer. [ABSTRACT FROM AUTHOR]

We read with interest the paper "Changing epidemiology of hepatocellular carcinoma in Asia" published in a recent issue of Liver International.1 It is an interesting review of the past and current status in aetiology, clinical presentation, management and prognosis of hepatocellular carcinoma (HCC) in Asia. Taiwan is an endemic area of hepatitis B and is the world's first one to deploy nationwide hepatitis B immunization programme for newborns. [Extracted from the article]

Introduction: To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals.Patients and Methods: All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates.Results and Discussion: Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05).Conclusion: The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes. [ABSTRACT FROM AUTHOR]

Understanding the role of biodiversity (B) in maintaining ecosystem function (EF) is a foundational scientific goal with applications for resource management and conservation. Two main hypotheses have emerged that address B-EF relationships: niche complementarity (NC) and the mass-ratio (MR) effect. We tested the relative importance of these hypotheses in a subtropical old-growth forest on the island nation of Taiwan for two EFs: aboveground biomass (ABG) and coarse woody productivity (CWP). Functional dispersion (FDis) of eight plant functional traits was used to evaluate complementarity of resource use. Under the NC hypothesis, EF will be positively correlated with FDis. Under the MR hypothesis, EF will be negatively correlated with FDis and will be significantly influenced by community-weighted mean (CWM) trait values. We used path analysis to assess how these two processes (NC and MR) directly influence EF and may contribute indirectly to EF via their influence on canopy packing (stem density). Our results indicate that decreasing functional diversity and a significant influence of CWM traits were linked to increasing AGB for all eight traits in this forest supporting the MR hypothesis. Interestingly, CWP was primarily influenced by NC and MR indirectly via their influence on canopy packing. Maximum height explained more of the variation in both AGB and CWP than any of the other plant functional traits. Together, our results suggest that multiple mechanisms operate simultaneously to influence EF, and understanding their relative importance will help to elucidate the role of biodiversity in maintaining ecosystem function. [ABSTRACT FROM AUTHOR]

Background: Prognostic assessment in patients with hepatocellular carcinoma (HCC) remains controversial. Using the Italian Liver Cancer (ITA.LI.CA) database as a training set, we sought to develop and validate a new prognostic system for patients with HCC.Methods and Findings: Prospective collected databases from Italy (training cohort, n = 3,628; internal validation cohort, n = 1,555) and Taiwan (external validation cohort, n = 2,651) were used to develop the ITA.LI.CA prognostic system. We first defined ITA.LI.CA stages (0, A, B1, B2, B3, C) using only tumor characteristics (largest tumor diameter, number of nodules, intra- and extrahepatic macroscopic vascular invasion, extrahepatic metastases). A parametric multivariable survival model was then used to calculate the relative prognostic value of ITA.LI.CA tumor stage, Eastern Cooperative Oncology Group (ECOG) performance status, Child-Pugh score (CPS), and alpha-fetoprotein (AFP) in predicting individual survival. Based on the model results, an ITA.LI.CA integrated prognostic score (from 0 to 13 points) was constructed, and its prognostic power compared with that of other integrated systems (BCLC, HKLC, MESIAH, CLIP, JIS). Median follow-up was 58 mo for Italian patients (interquartile range, 26-106 mo) and 39 mo for Taiwanese patients (interquartile range, 12-61 mo). The ITA.LI.CA integrated prognostic score showed optimal discrimination and calibration abilities in Italian patients. Observed median survival in the training and internal validation sets was 57 and 61 mo, respectively, in quartile 1 (ITA.LI.CA score ≤ 1), 43 and 38 mo in quartile 2 (ITA.LI.CA score 2-3), 23 and 23 mo in quartile 3 (ITA.LI.CA score 4-5), and 9 and 8 mo in quartile 4 (ITA.LI.CA score > 5). Observed and predicted median survival in the training and internal validation sets largely coincided. Although observed and predicted survival estimations were significantly lower (log-rank test, p < 0.001) in Italian than in Taiwanese patients, the ITA.LI.CA score maintained very high discrimination and calibration features also in the external validation cohort. The concordance index (C index) of the ITA.LI.CA score in the internal and external validation cohorts was 0.71 and 0.78, respectively. The ITA.LI.CA score's prognostic ability was significantly better (p < 0.001) than that of BCLC stage (respective C indexes of 0.64 and 0.73), CLIP score (0.68 and 0.75), JIS stage (0.67 and 0.70), MESIAH score (0.69 and 0.77), and HKLC stage (0.68 and 0.75). The main limitations of this study are its retrospective nature and the intrinsically significant differences between the Taiwanese and Italian groups.Conclusions: The ITA.LI.CA prognostic system includes both a tumor staging-stratifying patients with HCC into six main stages (0, A, B1, B2, B3, and C)-and a prognostic score-integrating ITA.LI.CA tumor staging, CPS, ECOG performance status, and AFP. The ITA.LI.CA prognostic system shows a strong ability to predict individual survival in European and Asian populations. [ABSTRACT FROM AUTHOR]

Background Steady increase in computed tomography (CT) utilisation in the ED was observed in countries such as the USA, Canada, China and Korea; however, limited empirical data are available regarding Taiwan. Objective The objective of the present study is to quantify and compare trends in CT utilisation in the ED over a 5 year period in a medical centre in Taiwan. Methods Electronic chart review was performed in a medical centre with an annual ED census of 80 000 patients. Subjects >20 years of age who underwent CT scans during ED visits from 1 January 2005 to 31 December 2009 were identified. Results Among the 333 673 adult ED visits, 43 635 received CT scans, with a utilisation rate of 131 per 1000. Within the 5 year span, patient volume increased by 7.7%, whereas CT utilisation increased by 42.7%. The rates of increase in patient volume and CT utilisation were 5.0% and 32.4% in non-trauma; 19.7% and 97.8% in trauma. CT scans were mostly performed on the head (47%), abdomen (36%), followed by chest (10%) and miscellaneous (7%). An increase of 168% in spinal CTs for trauma patients was observed. An increase in CT utilisation was found in all age groups with a proportionate increase with increasing age in both trauma and non-trauma. Conclusion ED CT utilisation has increased at a rate far exceeding the growth in ED patient volume. This may be attributed to the improved utility of CT in diagnosing serious pathology, more diagnostic indications for CT, ready availability and the necessity for diagnostic certainty in the ED. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between changes in patient attributes and hospital attributes over time and to explore predictors of medical utilization and mortality rates in mechanical ventilation (MV) patients in Taiwan. Background: Providing effective medical care for MV patients is challenging and requires good planning and effective clinical decision making policies. Most studies of MV, however, have only analyzed a single regional ventilator weaning center or respiratory care unit, high-quality population-based studies of MV trends and outcomes are scarce. Methods: This population-based cohort study retrospectively analyzed 213,945 MV patients treated during 2004-2009. Results: During the study period, the percentages of MV patients with the following characteristics significantly increased: age ≦ 65 years, treatment at a medical center, and treatment by a high-volume physician. In contrast, the percentages of MV patients treated at local hospitals and by low-volume physicians significantly decreased (P<0.001). Age, gender, Deyo-Charlson co-morbidity index, teaching hospital, hospital level, hospital volume, and physician volume were significantly associated with MV outcome (P<0.001). Over the 6-year period analyzed in this study, the estimated mean hospital treatment cost increased 48.8% whereas mean length of stay decreased 13.9%. The estimated mean overall survival time for MV patients was 16.4 months (SD 0.4 months), and the overall in-hospital 1-, 3-, and 5-year survival rates were 61.0%, 36.7%, 17.3%, and 9.6%, respectively. Conclusions: These population-based data revealed increases in the percentages of MV patients treated at medical centers and by high-volume physicians, especially in younger patients. Notably, although LOS for MV patients decreased, hospital treatment costs increased. Healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: The fatty liver index (FLI) is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects. Methods: We enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve. Results: Among the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044–1.047, p< 0.001). Moreover, FLI had the best discriminative ability to identify patients with ultrasonographic fatty liver (AUROC: 0.827, 95% confidence interval, 0.822–0.831). An FLI < 25 (negative likelihood ratio (LR−) 0.32) for males and <10 (LR− 0.26) for females rule out ultrasonographic fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+) 3.12) for males and ≥ 20 (LR+ 4.43) for females rule in ultrasonographic fatty liver. Conclusions: FLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males. [ABSTRACT FROM AUTHOR]

Background On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). Methods An annual sample of about 13 000-14 000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. Results The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. Conclusions The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: Despite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment. Methodology/Principal Findings: The analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996–2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share. Conclusions/Significance: In addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments. [ABSTRACT FROM AUTHOR]

Taiwan is particularly sensitive to changes in monsoonal precipitation and to the frequency of typhoon-induced heavy precipitation events. Many parts of this mountainous subtropical island have high erosion rates that produce high sedimentation rates in lakes and offshore ocean basins, and evidence suggests that these rates have varied in the past. A high-resolution 2ky record of changes in sediment delivery to Dahu, a floodplain lake in northeastern Taiwan, that suggests changes in precipitation has been inferred from organic matter, pollen, and spores in a 12m sediment core and from the organic matter compositions of soil, catchment plants, and fluvial suspended sediment. From 0 to 1400AD, the lake experienced repeated flood events, principally resulting from overflows of the "old" Ilan River, one of tributaries of the Lanyang River, that were briefly interrupted ~1000AD by decreased precipitation and/or only localized rainfall. The record of heavy precipitation can be linked to the northward shift of the ITCZ. During the early Little Ice Age, 1400-1600AD, local erosion fluctuated in association with deforestation and farming, during which the ITCZ shifting varied as well. A decrease in precipitation since 1600AD is linked with the southward migration of the ITCZ. [ABSTRACT FROM AUTHOR]

To study the Holocene paleomagnetic field in Taiwan area, we performed a series of magnetic experiments to a marine sediment core OR1-715-21 obtained from the offshore of eastern Taiwan during the OR1-715 cruise. Analyzed magnetic properties show that the remanent magnetization carriers of the core are uniformly dominated by single-domain and pseudo-single-domain magnetite, revealing a suitable material for relative paleointensity (RPI) estimation. The stable and well defined characteristic remanent magnetization (ChRM) provides the reliable determination of the inclination and declination. Dipole moments were further calculated by using the RPI and inclination data. The variation of the dipole moments compares well to the CALS10k.1b model (a continuous model of archaeomagnetic and lake sediment data for the past 10000 years), implying the dominance of the dipole field in Taiwan area. Though the real declination is unavailable because of lacking core orientation during coring, we could correct the values based on some critical conditions. If the paleosecular variation (PSV) is considered, the virtual geomagnetic pole (VGP) is generally suggested to vary between 80°N and 90°N instead of coinciding with the geography North Pole. To fit the condition considering the PSV effect, the ChRM declination had to be rotated 180° to get the corrected declination. As a result, variation patterns of the paleo-inclination, -declination, and paleointensity could be suitably determined in the study. Outcomes of these analyses reveal that the paleomagnetic field in Taiwan region should be dominantly driven from the dipole field under the PSV effect for the last 7500 years. [ABSTRACT FROM AUTHOR]

Background Head injury has been suggested to correlate with meningioma. However, results of studies investigating the relationship between head injury and meningioma were inconsistent. Therefore, we conducted this study to assess the association between head injury and meningioma, and to determine the possible risk factors. Methods Head injury patients aged 18 years and older, without antecedent diagnosis of brain tumor, and who were followed up for more than 30 days between January 1, 2001, and December 31, 2010, were recruited from the Taiwan National Health Insurance Research Database. Hazard ratios (HRs) of meningioma risk for head injury patients compared with an age- and sex-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative incidence between head injury patients and the matched cohort was analyzed using the Kaplan–Meier method and tested with the log-rank test. Results Each cohort (i.e., the head injury cohort and the matched cohort) consisted of 75,292 individuals with a mean age of 44.7 years, and 52.3% of these patients were male. The incidence rates of meningioma were 3.99/10 5 person-years and 3.23/10 5 person-years in the head injury cohort and the comparison cohort, respectively, with a Charlson Comorbidity Index score-adjusted HR of 1.27 ( p = 0.514). There were no associations between head injury and risk of meningioma, neither overall nor in stratified analyses according to severity of head injury, age, and sex of patients. Conclusion Head injury, regardless of severity, patient sex, or age, is unlikely to be a cause of meningioma. [ABSTRACT FROM AUTHOR]

Highlights: [•] Vivianite occurs below a sulfidization zone in cold-seep sediments off SW Taiwan. [•] Sulfide scavenging in overlying sediments favored the mineralization of vivianite. [•] Precipitations of vivianite and AVS could take place by turns in the transition. [•] A significant but varied Mg content is characteristic of the nodular vivianite. [•] Vivianite influences P burial in iron-rich sediments with high sedimentation rates. [ABSTRACT FROM AUTHOR]

Aim To evaluate the association of cognitive impairment, depressive mood and sarcopenia among older men living in the veterans retirement community in southern Taiwan Methods This cross-sectional study recruited 353 men aged 65 years and older. In addition to demographic characteristics, all participants were measured for gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis ( BIA). The diagnosis of sarcopenia was made according to the European Working Group on Sarcopenia in Older People criteria. Slow walking speed was defined as ≤0.8 meter/second. Low muscle strength was defined as the handgrip strength less than 22.5 kg which was adjusted according to Taiwanese norms. A height-adjusted muscle mass of 8.87 kg/m2 from a previous Taiwanese study was defined as low muscle mass. Cognitive function was evaluated by the Mini- Mental State Examination ( MMSE), and the Geriatric Depression Scale-15 ( GDS-15) was used for screening of depressive symptoms. Results Among the 353 participants (mean age 82.7 ± 5.3 years), 30.9% (109/353) were classified as sarcopenic. Multivariate logistic regression showed that sarcopenia was independently associated with cognitive impairment (adjusted OR 3.03, 95% CI 1.63-5.65, P < 0.001) and depressive symptoms (adjusted OR 2.25, 95% CI 1.03-4.89, P = 0.04). Conclusions Sarcopenia was significantly associated with cognitive impairment and depressive symptoms among otherwise healthy older men living in the veterans retirement community. Further outcome study is required to explore the interrelationship of cognition, depressive symptoms and sarcopenia in older adults. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 102-108. [ABSTRACT FROM AUTHOR]

Background: Few studies have used pooled data for more than 2 years and few have analyzed data for patients receiving mechanical ventilation in Taiwan. Objective: To validate the use of an artificial neural network model for predicting in-hospital mortality in patients receiving mechanical ventilation in Taiwan and to compare the predictive accuracy of the artificial neural network model with that of a logistic regression model. Methods: Retrospective comparison of 1000 pairs of data sets processed by logistic regression and artificial neural network models based on initial clinical data for 213 945 patients receiving mechanical ventilation. For each pair of artificial neural network and logistic regression models, the area under the receiver operating characteristic curves, Hosmer-Lemeshow statistics, and accuracy rate were calculated and compared by using t tests. Global sensitivity analysis and sensitivity score approach were also used to assess the relative significance of input parameters in the system model and the relative importance of variables. Results: Compared with the logistic regression model, the artificial neural network model had a better accuracy rate in 96.3% of cases, better Hosmer-Lemeshow statistics in 41.2% of cases, and a better area under the curve in 97.6% of cases. Hospital volume was the most influential (sensitive) variable affecting in-hospital mortality, followed by Charlson comorbidity index, length of stay, and hospital type. Conclusions: Compared with the conventional logistic regression model, the artificial neural network model was more accurate in predicting in-hospital mortality and had higher overall performance indices. [ABSTRACT FROM AUTHOR]

Background: The volume-outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC. Methods: This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1-29, 30-84, ≥85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1-10, 11-24, ≥25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost. Results: The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47 % lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001). Conclusions: Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost. [ABSTRACT FROM AUTHOR]

By examining the price and liquidity effects around announcements of switching exchanges by firms within structurally similar markets in Taiwan, the authors uncover that while switching firms experience only a trivial effect around the application announcement days, there is a pronounced price rise during the prelisting period. Subsequently, they find only a partial reversal of this prelisting increase over the listing days and the postlisting period. However, they observe that stock liquidity improves following the application announcements, peaks around the listing days, and remains at high levels after listing. Further results suggest that firms' announcements that they are switching exchanges are not followed by improved earnings relative to performance-matched control firms. Collectively, these results reveal that transfer stocks in Taiwan convey information about permanent improvements in liquidity rather than better earnings prospects, which is consistent with the stock marketability implications of managerial exchange-switching decisions. [ABSTRACT FROM AUTHOR]