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To assess a quality improvement project using alternating pressure air mattresses' impact on reducing full‐thickness pressure injuries by enhancing setting accuracy and device utilization. We retrospectively evaluated adult acute care unit patients with inclusion criteria (Braden scores ≤12 or existing full‐thickness pressure injuries) between May 2020 and August 2023. A wound team attempted to enhance the accuracy, utilization and effectiveness of alternating pressure air mattress implementation. The implementation outcomes were setting accuracy and accurate utilization rates. The clinical outcome was the full‐thickness pressure injury proportion. Utilization and allocation gaps were also calculated. The setting accuracy and accurate utilization rates increased (0.59 to 0.88 and 0.15 to 0.37, respectively). The full‐thickness pressure injury proportion decreased (0.17 to 0.06), with a strong negative correlation coefficient (−0.789) (p < 0.001) with accurate utilization rates. The full‐thickness pressure injury proportion declined faster during the project's complete phase than the partial phase (−0.0046 vs. −0.0016; p < 0.05). The utilization gap narrowed (99 to 60); however, the allocation gap increased (1 to 13), suggesting increased alternating pressure air mattress usage among ineligible patients. Targeting high‐risk patients for alternating pressure air mattress utilization and ensuring correct settings, both performed by a dedicated team, substantially reduces the full‐thickness pressure injury incidence. [ABSTRACT FROM AUTHOR]

Higher education expansion is not a new development in the world. Different countries have faced various contexts and factors that push the expansion to occur. Since 1996, the Taiwanese government has allowed the private sector to open new higher education institutions or be upgraded for open more access at the higher education level to correspond to the general public's educational expectations. This article starts by describing the expansion of higher education from the elite to universal stage both globally and locally. The article then specifically introduces the case of the doctoral manpower structure in Taiwan and lists three specific scenarios regarding local PhDs' reality in the current competitive job market, highlighting the further talent fault crisis in society today. In addition to discussing the consequences and challenges at the doctoral level of talent cultivation, the article further identifies the main issues facing the current manpower planning in Taiwan. The article calls for all stakeholders of the agenda to rethink the purpose of doctoral manpower cultivation in Taiwan over the long run.

The development of the modern global economy and the national competition in trade and commerce has intensified. Thus, overseas study as a major form of human capital formation in the Asian region tends to be regarded as an economic measure for enhancing workforce quality and national competitiveness. Mainstream discourses on international students at the national level have been instrumental in ignoring the social and cultural dimensions pursued by transnational interaction and understanding. However, in addition to the rapid advancement of internationalisation, international student mobility has become significantly diversified in terms of scenarios, patterns and motivations. In this paper, two short-term study-abroad programmes in Taiwan and Los Angeles were selected to investigate their influence on participants' perception and awareness of intercultural literacy. Results indicate that many participants have been highly motivated to engage in 'local culture, people and tradition'. The international outlook and perspectives of participants have broadened substantially due to these short-term but focused activities. In contrast to the economic purpose of student mobility, the result from this research provides promising information on further raising the young generation's social and culture understanding of other societies and countries by attending such short-term study programme.

The coronavirus disease 2019 (COVID-19) pandemic had a great impact on healthcare system and patients. This study aimed to evaluate the effect of the COVID-19 pandemic on the perceptions of patients with inflammatory bowel disease (IBD). This prospective multicenter study was conducted between July 2021 and December 2021. Patients with IBD answered a structured questionnaire, and their degree of anxiety was assessed using a visual analogue scale (VAS) before and after reading educational materials. A total of 225 (47.67%) patients with Crohn's disease, 244 (51.69%) with ulcerative colitis and 3 (0.64%) with indeterminate colitis were enrolled. Common concerns were adverse events from vaccination (20.34%), and higher risks of developing severe COVID-19 (19.28%) and COVID-19 infection (16.31%) than the general population. Medications deemed by the patients to increase the risk of COVID-19 were immunomodulators (16.10%), anti-tumor necrosis factor-α antagonists (9.96%), and corticosteroids (9.32%). Thirty-five (7.42%) patients self-discontinued IBD medication, of whom 12 (34.28%) had worse symptoms. Older age (>50 years) (OR 1.10, 95% CI 1.01–1.19, p = 0.03), IBD-related complications (OR 1.16, 95% CI 1.04–1.28, p = 0.01), education status below senior high school (OR 1.22, 95% CI 1.08–1.37, p = 0.001), and residing in north–central Taiwan (OR 1.21, 95% CI 1.10–1.34, p < 0.001) were associated with more anxiety. None of the enrolled patients contracted COVID-19. The anxiety VAS score (mean ± SD) improved after reading the educational materials (3.84 ± 2.33 vs. 2.81 ± 1.96, p < 0.001). The medical behavior of IBD patients was influenced by the COVID-19 pandemic, and their anxiety could be mitigated after education. [ABSTRACT FROM AUTHOR]

Low-carbohydrate (LC) diets are popular among general and athletic populations attempting to lose body mass. This study investigated the effect of a 7-day LC or moderate-carbohydrate (MC) calorie–restricted diet followed by 18-h recovery on body composition and taekwondo-specific performance. In this randomised cross-over study, 12 male taekwondo athletes consumed an LC (10% of carbohydrate, 41% of protein, 49% of fat, and 15.8 ± 0.4 kcal/kg/day) or an isocaloric MC diet (60% of carbohydrate, 30% of protein, and 10% of fat) for 7 days. The participants then consumed a carbohydrate-rich recovery dinner (39.2 ± 3.1 kcal/kg) followed by breakfast (6.2 ± 0.4 kcal/kg) in both the trials. Three repeated sprint ability (RSA) tests were conducted after breakfast. The taekwondo-specific reaction battery was administered before the first RSA test and after each RSA test. The participants experienced similar magnitudes of significant loss of body mass in the LC (−2.4 ± 1.7%) and MC (−2.3 ± 1.7%) trials. Fat mass and fat percentage significantly decreased in the MC trial but remained unchanged in the LC trial after body mass loss. Fat free mass was maintained in both the trials. The average and peak power in the RSA tests and the premotor reaction time were similar between the trials. The participants experienced significantly higher fatigue in the LC trial. In conclusion, both the diets can help athletes rapidly lose body mass while maintaining performance as long as an adequate amount of carbohydrate is consumed during the recovery period. [ABSTRACT FROM AUTHOR]

We investigated the relationship among cognitive level, autistic severity and adaptive function in a Taiwanese sample of 94 high-functioning children with autism spectrum disorders (ASD) (mean full scale intelligent quotients FSIQ = 84.8). Parents and teachers both completed the Adaptive Behavior Assessment System-II and the Social Responsiveness Scale. Correlational and regression analyses were used to explore the relationships among the constructs of cognitive, symptomatic and adaptive domains. Results revealed that average General Adaptive Composites of these children (home: 74.0; school: 74.6) was below average FSIQ. Profile analysis revealed that Social domain was the weakness among the adaptive abilities assessed at school and home. Cognitive abilities had positive relationship with adaptive function, while autistic severity had a weak negative relationship with adaptive function. Also, the younger the age the child got diagnosed, the less severe the current symptoms of autism were. The implication for emphasizing adaptive skills intervention was discussed.

This study investigates the influences of gender and work experiences on career maturity, as well as the relationship between advisory mentoring and career maturity. Analytical results from 528 full-time MBA students are summarized as follows: (a) gender exerts significant differences in advisory mentoring functions (instrumental and career-related functions) but not in career maturity, (b) work experience is significantly related to planfulness, (c) psychosocial function is a strong predictor of planfulness and independence, whereas career-related function is a strong predictor of both information gathering and involvement. The results are interpreted and implications discussed in terms of advisory mentoring behavior and career counseling of MBA education. (Contains 2 tables.)

Context: An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts. Purpose: This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District. Methods: Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents. Findings: After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP. Conclusions: The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.

Background/Purpose: Recurrent obscure gastrointestinal bleeding (OGIB) in patients with chronic kidney disease is a challenge often faced by physicians, given the need for repeated hospitalizations, multiple extensive examinations, limited treatment options, and high medical costs. The purpose of this study was to identify the clinical characteristics of uremic patients undergoing deep enteroscopy for OGIB and analyze the risk factors for rebleeding in these patients after undergoing single-balloon enteroscopy (SBE). Methods: Out of 765 patients with OGIB who underwent 1004 procedures of SBE in four teaching hospitals, 78 uremic patients with OGIB were enrolled. Clinical characteristics and endoscopic findings were collected, and multiple variables were analyzed to determine the risk of rebleeding after SBE. Results: The diagnostic yield was 75.6%, and the rebleeding rate was 29.5% in the enrolled uremic patients. The most common etiology was angiodysplasia (74.6%) and the most common site was the jejunum (50.8%). The endoscopic intervention rate was 62.8% and most patients were treated with argon plasma coagulation (75.6%). Among the eight patients with valvular heart disease (VHD), four (50%) had severe aortic stenosis, and the remaining had non-aortic stenosis-VHD. VHD (p < 0.05) and angiodysplasia (p < 0.05) were both associated with a higher rebleeding rate. Conclusion: VHD may be an independent risk factor associated with rebleeding after SBE in uremic patients with OGIB. Moreover, uremic patients with angiodysplasia-related bleeding appear to have a higher rebleeding rate than those with alternative causes of bleeding. [ABSTRACT FROM AUTHOR]

Background: Roadside trees play an important role in urban landscaping. They are not only related to urban scenes, traffic safety, quality of life, and health, but also closely related to ecology and cultural development. Thus, effective, intelligent management of an area of urban roadside trees will become an important topic. Methods: This paper evaluates survey technologies and management techniques utilized in many cities of Taiwan, including surveys of roadside trees, risk assessment, and precious protected trees. A roadside tree management database was built using a geographic information system (GIS). Results: The number of urban forest trees exceeded 100,000 in our surveys, and many types of intelligent survey instruments were used to survey the trees, including real-time kinematic (RTK) and non-destructive detection instruments, radio frequency identification (RFID), in-vehicle light detection and ranging (LiDAR), and panoramic streetscape systems. A tree management system can be constructed by introducing the digitized information, which is based on a basic survey of trees. The survey stage primarily relies on manual surveys, in-vehicle LiDAR, and RFID, and then a visualized database retrieval system will be proposed using GIS. This system can be utilized for the health and foundation management of trees and the whole spatial planning of urban forests, among others. Conclusion: This research attempts to summarize the trends in intelligent management of urban forests using our practical experiences with the goal that it will be a reference for the future intelligent construction of urban forests. [ABSTRACT FROM AUTHOR]

Background and Aims. Patients with Meckel's diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan. Methods. We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed. Results. A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn's disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE—100%, capsule endoscopy—40%, Meckel's scan—35.7%, computed tomography—14.6%, small bowel series—12.5%, and angiography—11.1%; regarding endoscopic features of MD: a large ostium—89.1%, a small ostium—7.3%, and a polypoid mass—3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%). Conclusions. The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities. [ABSTRACT FROM AUTHOR]

Huang, J-H, Chiu, Y-C, and Chang, C-K. The influence of hot environment on pitching and hitting performance in professional baseball. J Strength Cond Res 35(11): 3251–3255, 2021—Baseball is usually played outdoors during the warmest months of the year. The long exposure to a hot environment may lead to hyperthermia and subsequent impaired cognitive function, which is crucial for hitting and pitching performance in baseball. The purpose of this study was to investigate the effect of apparent temperature on pitching and hitting performance in Chinese Professional Baseball League games in Taiwan. Each pitched and batted ball from a total of 480 regular season games in 2018 and 2019 was analyzed. Each game was categorized into one of the 4 groups on the basis of the average apparent temperature at which it was played: cold (below 21° C), warm (21–28° C), hot (28–34° C), or extremely hot (above 34° C). Differences in pitching and hitting variables were compared across the 4 groups. In the extremely hot environment, slugging percentage, isolated power, base on balls per 9 innings, home runs per 9 innings, and walks plus hits per inning were all significantly higher than those in the other 3 environments. The results suggest that offensive production was significantly increased in extremely hot environments in the Chinese Professional Baseball League. It is recommended that pitchers could adopt cooling interventions to alleviate the decline in performance in an extremely hot environment. [ABSTRACT FROM AUTHOR]

Objectives: To explore the mechanisms mediating the different levels of gentamicin resistance in enterococci.Methods: Susceptibility testing with gentamicin and PCR of resistance determinants were performed in 149 enterococcal isolates. Genetic relatedness was characterized by MLST and PFGE analysis. Sequences of the aac(6')-Ie-aph(2'')-Ia gene and its surrounding environment were determined by Illumina sequencing. Stability assays of gentamicin resistance were carried out to evaluate the probability of loss of the high-level gentamicin resistance (HLGR) phenotype.Results: A total of 17 (11.4%) aac(6')-Ie-aph(2'')-Ia-positive enterococcal isolates (2 Enterococcus faecalis and 15 Enterococcus faecium) with non-HLGR phenotype were found. MLST analysis revealed that the 2 E. faecalis belonged to ST116 and ST618, while all the 15 E. faecium belonged to clonal complex 17. Sequence analysis demonstrated that IS1216V was inserted into the 5'-end of aac(6')-Ie-aph(2'')-Ia, leading to loss of HLGR phenotype. Three IS1216V insertion types were found, and type II and III were frequently found in E. faecium. Interestingly, a total of 38 aac(6')-Ie-aph(2'')-Ia-positive E. faecium with HLGR phenotype also had type II or type III IS1216V insertion. Sequencing of the aac(6')-Ie-aph(2'')-Ia-positive HLGR E. faecium E37 revealed that an intact aac(6')-Ie-aph(2'')-Ia was located adjacent to IS1216V-disrupted aac(6')-Ie-aph(2'')-Ia. In a non-antibiotic environment, E37 tended to lose HLGR phenotype with a probability of 1.57 × 10-4, which was largely attributed to homologous recombination between the intact and disrupted aac(6')-Ie-aph(2'')-Ia.Conclusions: This is first study to elucidate that the E. faecium is capable of changing its HLGR phenotype, which may contribute to adaptation to hospital environments with decreased usage of gentamicin. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of hotel employee's thriving at work (including learning and vitality) on their service performance, and explores how leader-member exchange (LMX) moderates this influence. The sampling object of the questionnaire is the employees of 5-star hotels in the north, central, and south of Taiwan who are willing to answer the questionnaires. Purposive sampling is employed. In total, 900 surveys were disseminated throughout Taiwan., including 300 each in the north, central, and south. Out of these, 657 acceptable surveys were collected, resulting in a 73% response rate. The research findings show that: (1) learning positively affect service performance; (2) vitality positively affect service performance; (3) LMX negatively moderates the influence of learning on service performance; (4) LMX negatively moderates the influence of vitality on service performance. At last, the paper proposes managerial implications and subsequent recommendations derived from the research findings. • leader-member exchange = LMX. • Hotel employees' learning has a positive influence on their service performance. • Hotel employees' vitality has a positive influence on their service performance. • LMX moderates the influence of hotel employees' learning on service performance. • LMX moderates the influence of hotel employees' vitality on service performance. [ABSTRACT FROM AUTHOR]

Traveling in a Hakka village, the tourist can feel the culture of the Hakka in Taiwan and see traditional drama, artwork, handicrafts, and foods. The current trend in tourism planning is to incorporate online word of mouth into route design. This paper aims to examine common characteristics of Hakka village tourism development, identifying the need for planning and offering a model of the directions planning might take. It begins with big data collection of the online service and combines that with social network analysis. The results indicated that tourism planning with user's online search strategy will provide a better and more precise tour service. It is suggested that the government should set up the tour service center at the location identified as being in the structural hole of the tourism network. As cultural tourism continues to expand, big data applications will offer new opportunities and challenges to tourism planning. [ABSTRACT FROM AUTHOR]

Background/purpose: Inflammatory bowel disease (IBD) is a chronic gastrointestinal (GI) disorder that causes relapsing inflammation and severe mucosal damage in the intestine. Crohn's disease (CD)-related stricturing complications are a major cause of surgery, disability, and reduced quality of life. Endoscopic balloon dilation (EBD) has been shown to reliably delay or prevent surgery in patients with stricturing CD. However, cases of EBD performed for stricture in CD in Taiwan are rare. In this study, we want to evaluate the experiences regarding EBD for stricturing CD in Taiwan.Methods: We conducted a retrospective analysis of 9 medical centers in Taiwan. Patients with CD-related strictures who were treated with EBD were included and analyzed.Results: In nine medical centers, a total of 26 CD patients (19 male, 7 female, mean disease duration 75.4 ± 65.2 months) underwent 42 EBD procedures during the study period. Among the subjects, an 83.3% (35/42) EBD success rate was seen, but 26.9% (7/26) patients underwent surgery after ineffective EBD. In the surgery group, the the small bowel strictures was high compared with the non-surgery group (p = 0.01). There were no significant differences in disease phenotype, disease duration or history of fistulizing disease. In the surgery group, immunosuppressant use was high, and 5-aminosalicylic acid (5-ASA) use was low compared with the non-surgery group. After EBD, the physicians tended to change the drugs, especially increasing the use of biologic agents.Conclusion: EBD is a safe and effective procedure for CD-related stricture, with a 83.3% success rate in Taiwan. [ABSTRACT FROM AUTHOR]

For this study, dust storm data was collected on 24 - 25 March, 2012. This dust storm impacted the northern area of Taiwan for about two days, so our study was confined to the northern air quality region of Taiwan using indicator kriging for assessing the probability of exceeding the threhold concentration of PM2.5. Results showed that the highest levels of dust storm pollution in the study area were in the Zhongzheng District of Taipei City, with a concentration of 39.86 µg m-1. The lowest levels were 21.88 µg m-1, in Xinzhuang District, New Taipei City. Among the four administrative regions, variation was greatest in Taipei City, with concentrations between 22.74 and 39.86 µg m-1, and lowest in Keelung City, with concentrations between 23.97 and 27.56 µg m-1. We categorized pollution concentrations with probabilities greater than 0.7 into three categories to represent health risk hazards. Eighty-seven percent of areas were low risk, with PM2.5concentrations above 25 µg m-1. Areas with PM 2.5concentrations greater than 30 µg m-1 were considered moderate risk areas, and comprised 1.2% of all area; this category appeared in the Zhongshan, Songshan, Datong, and Daan Districts of Taipei City and the Zhongli District of Taoyuan City. Concentrations greater than 35 µg m-1, labeled high risk areas, accounted for only 0.4% and were concentrated in the Zhongshan, Songshan, and Zhongli Districts of Taipei City. The methods used in this study and its results can be key references for future early warning and prevention of dust pollution by relevant authorities. [ABSTRACT FROM AUTHOR]

Objects: The aim of our study was to investigate whether major depressive disorder (MDD) increased the risk of hypertension using propensity score matching (PSM) in patients with MDD in Taiwan. Methods: In this study, we recruited all samples from a random sample sub-dataset of one million insured individuals from 2005. A total of 743,114 outpatients were included in our study. We used PSM (nearest neighbor matching) stratified by age, hospital level, insurance amount, and Charlson Comorbidity Index score. Results: The hazard ratio (HR) of hypertension was significantly greater in the male MDD outpatients (HR = 1.116, P = 0.004) than in the female MDD outpatients (HR = 0.93, P = 0.02). Using PSM, we selected 27,988 outpatients with hypertension and 27,988 outpatients without hypertension for a nested case–control study. In this analysis, female outpatients with MDD (relative risk = 0.852) had lower risks of hypertension. Male outpatients without/with MDD (relative risk = 1.987/3.018) showed a synergistic interaction with gender in which male patients had a higher risk of hypertension in a multiplicative model. Furthermore, MDD appeared to have an interaction effect with gender (HR = 1.82, P < 0.001) in the proportional hazards model analysis. Antidepressant use also increased the risk of hypertension (HR = 1.16, P < 0.001). Conclusions: There was gender disparity in the risk of hypertension in subjects with MDD. MDD outpatients who used antidepressants had a higher risk of suffering from hypertension. A large-scale, population-based study is warranted to generalize these results in the future. [ABSTRACT FROM AUTHOR]

Aplastic anemia (AA) is a rare disease characterized by pancytopenia and bone marrow failure. The incidence of AA tends to be higher in Asia than in the West, but real-world data about AA in Asia remain limited. We aimed to describe the basic data, treatment, and outcome of AA patients from our institute and evaluate the incidence of AA in Taiwan with a nationwide population-based cohort from National Health Insurance Research Database (NHIRD). We identified patients older than 2 years with AA in the Registry of Catastrophic Illness of NHIRD between 2001 and 2010 and excluded patients with any diagnosis suggestive of congenital or secondary bone marrow failure. With a total of 1270 patients, the overall incidence was 5.67 per million people per year, and there was a biphasic age distribution of incidence rate, highest in ≥ 70 years (19.83 per million people per year) and another peak at age 2-9 years (5.26 per million people per year). Overall, the 5-year survival was 60.0%. Hematopoietic stem cell transplantation (HSCT) and anti-thymocyte globulin-based immunosuppressive therapy (IST) were the major first-line treatments in patients younger than 40 years and were linked with good survival. In contrast, the majority of patients older than 60 years were treated with androgen, and the survival was poor. In multivariate analysis, "severe AA," "very severe AA," and "treatment other than HSCT, IST, or androgen" were independent risk factors for inferior survival. In conclusion, the incidence of AA in Taiwan is consistent with nearby Asian countries and is higher than in the West. Advanced age is associated with higher incidence and poorer outcome. [ABSTRACT FROM AUTHOR]

Background/purpose: Small bowel (SB) accounts for the majority of gastrointestinal tract but its tumors are rare and always overlooked. In this study, we aimed to evaluate the epidemiology of SB tumors.Methods: This multicenter retrospective study utilized endoscopy database from 2006/11 to 2016/07. Baseline demographic characteristics, clinical, radiologic and endoscopic findings were collected.Results: Totally 103 (34 benign, 69 malignant lesions) patients with SB tumors in 1070 enteroscopic examinations were enrolled. There were male preponderance (56.3% males, 43.7% females), both in benign (52.9%, 49.1%) and malignant (58.0%, 42.0%) lesions, except for subtype gastrointestinal stromal tumors (GISTs) (31.6%, 68.4%). The age (mean ± SD) at diagnosis in malignant SB tumors (62.2 ± 15.6) was older than those with benign tumors (50.7 ± 21.4) (p < 0.01). Bleeding (43.7%), abdominal pain (40.8%) and ileus (10.7%) were the most common clinical presentations. Hamartoma (32.4%) and adenoma (14.7%) were the most common benign histology. Four major malignant histological subtypes were lymphomas (29.0%), GISTs (27.5%), adenocarcinomas (26.1%) and metastatic cancers (14.5%). SB adenocarcinoma patients (>60-year-old, 77.8%) were older than lymphomas (60%) and GISTs (50%). Proximally location rates of lymphomas, GISTs, adenocarcinomas were 25.0% (5/20), 84.2% (16/19), and 88.9% (16/18), respectively.Conclusion: This endoscopy-based study revealed the most common histology of benign SB tumors were hamartoma and adenoma, and malignant ones were lymphomas, GISTs, adenocarcinomas and metastatic cancers. Most of them were male gender, except for GISTs, and with proximal location, except for lymphomas. Further large-scale investigation efforts are warranted to elucidate the epidemiology of SB tumors. [ABSTRACT FROM AUTHOR]

The increasing elderly population puts significant health, economic, and social burdens on society. Physical activity is one of the most cost-effective ways to maintain the health of the elderly. This study adopts a treatment effects model to investigate the causal relationship between environment attributes and physical activity among the elderly, while taking endogeneity into account. The data were collected from 274 participants by face-to-face interviews in Taichung, Taiwan. Performing physical activity regularly in parks is the most important measure of the amount of physical activity by the elderly. Providing sufficient and accessible parks in metropolitan residential neighborhoods could be one of the most cost-effective ways to promote physical activity for the elderly living in midsize Asian cities. [ABSTRACT FROM PUBLISHER]

Background: The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown.Objectives: To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance.Methods: This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance.Results: A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990).Conclusions: The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L. [ABSTRACT FROM AUTHOR]

Background: Lilium callosum is native to Taiwan, but little is known about it since it has been considered extinct since 1915. After the rediscovery of this rare species after a fire in 2011 in Tunghsiao Township, intensive work has been conducted to count the number in the wild population, to develop a conservation strategy, and to understand its reproductive characteristics and even economic potential. Results: To conserve the germplasm of this population, three scales from a wild L. callosum plant were collected to establish a mass propagation system. Flowers from two regenerated plants were crossed by hand-pollination, the ovules were rescued and cultured in vitro, and 10 offspring were obtained. The karyotype was determined to be 2n = 2x = 24 = 2m + 2m(sat) + 2sm + 8st + 10t. The phylogenetic analysis using ITS sequences revealed that the sample of L. callosum from Taiwan was not grouped with the other accessions of L. callosum from other regions. The native habitat is classified as grass-dominated vegetation at the early successional stage and a subtropical monsoon-type climate. To clarify the causes of population scarcity in the native environment, reproductive characteristics of regenerated plants were investigated. Conclusions: Based on the information from this study, it is possible that factors intrinsic to L. callosum could combine to limit pollination and seed formation. The L. callosum pollen only germinated at a temperature that was higher than the native environment, the plants are self-incompatibile, there was a and scarce population, scattered flowering time and dichogamy. Through the culture of these wild harvested parts, the diversity of the germplasm has been broadened and is now available to preserve this rare and valuable species for the future. [ABSTRACT FROM AUTHOR]

Background/purpose: Serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) are found in some erosive oral lichen planus (EOLP) patients. This study assessed whether serum GPCA, TGA and TMA and EOLP itself played significant roles in causing anemia and hematinic deficiencies in TGA/TMA-positive EOLP patients with GPCA positivity (GPCA+/TGA/TMA/EOLP patients) or negativity (GPCA-/TGA/TMA/EOLP patients).Methods: The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of the four groups of 29 GPCA+/TGA/TMA/EOLP patients, 80 GPCA-/TGA/TMA/EOLP patients, 198 all antibodies-negative EOLP patients (Abs-/EOLP patients), and 218 healthy control individuals.Results: GPCA+/TGA/TMA/EOLP patients had significantly lower mean Hb and vitamin B12 levels as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy controls. GPCA+/TGA/TMA/EOLP patients had significantly lower serum vitamin B12 level and higher MCV as well as a significantly greater frequency of vitamin B12 deficiency than GPCA-/TGA/TMA/EOLP patients. Furthermore, both GPCA-/TGA/TMA/EOLP and Abs-/EOLP patients did have significantly lower mean Hb, MCV, and iron (for women only) levels, as well as significantly greater frequencies of Hb and iron deficiencies than healthy controls. However, there were no significant differences in measured blood data between GPCA-/TGA/TMA/EOLP and Abs-/EOLP patients.Conclusion: We conclude that serum GPCA is the major factor causing vitamin B12 deficiency, macrocytosis and pernicious anemia in GPCA+/TGA/TMA/EOLP patients. ELOP itself but not TGA/TMA positivity plays a significant role in causing anemia and hematinic deficiencies in GPCA-/TGA/TMA/EOLP patients. [ABSTRACT FROM AUTHOR]

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy. [ABSTRACT FROM AUTHOR]

Background With the growing number of transnational marriages in Taiwan, oral health disparities have become a public health issue. This study assessed immigrant-native differences in oral health behaviors of urban mothers and their children. Methods We used the baseline data of an oral health promotion program to examine the immigrant-native differences in caries-related knowledge, attitude, and oral health behaviors. A cross-sectional study was conducted to collect data from mothers in urban area, Taiwan. A total of 150 immigrant and 440 native mothers completed the self-report questionnaires. Logistic regression models analyzed the racial differences in oral health behaviors. Results Approximately 37% of immigrant mothers used dental floss, 25% used fluoride toothpaste, and only 13.5% of them regularly visited a dentist. Less that 40% of immigrant mothers brush their children's teeth before aged one year, 45% replaced child's toothbrush within 3 months, and only half of the mothers regularly took their child to the dentist. Immigrant mothers had lower level of caries-related knowledge and attitudes than native mothers (p < .001). Compared to native group, the immigrant mothers were less likely to use of dental floss ([Adjusted odds ratio (aOR) =0.35], fluoride toothpaste (aOR = 0.29), visit a dentist in the past 2 years (aOR = 0.26), and take their children to regular dental check-up (aOR = 0.38); whereas, they were more likely to not consume sweeten beverages (aOR = 3.13). Conclusions The level of caries-related knowledge, attitudes and oral health behaviors were found lower in immigrant mothers than native ones. The findings suggested cross-cultural caries prevention programs aimed at reducing immigrant-native disparities in child oral health care must be developed for these immigrant minorities. [ABSTRACT FROM AUTHOR]

Background/Purpose: Taiwan is only now beginning to offer palliative care to patients who do not have cancer. This study aimed to document the polysymptomatic presentation of illness in Taiwanese patients with late-stage nonmalignant disease and to evaluate the potential benefits of palliative care for these patients. The results may help to educate healthcare personnel regarding the need for and importance of palliative treatment as comprehensive, appropriate end-of-life care for patients with nonmalignant disease. Methods: We retrospectively analyzed 115 patients without cancer hospitalized in a community hospital in Taiwan: 61 had organic brain disease, 31 had chronic obstructive pulmonary disease, 17 had chronic renal failure, 14 had congestive heart failure, 12 had liver cirrhosis, and 20 had multiple illnesses. The median age was 81 years (interquartile range 69–86 years), and 51% of patients were enrolled from intensive care. Symptoms and their severity were analyzed. Patients' and their families' understanding of the diagnosis and prognosis and “Do Not Resuscitate” (DNR) consent were evaluated pre- and post-palliative care. Results: The four leading symptoms were fatigue (96%), fever (86%), cough (81%), and dyspnea (79%). No significant differences in symptom prevalence were found between different sexes, ages, performance statuses, ward locations, or underlying diseases, except for fewer episodes of dizziness, more frequent episodes of cough in patients older than 80 years, and more episodes of jaundice in ward service subjects. Only the presence of abdominal distension differed significantly between surviving and deceased patients (22.9% vs. 40.3%; p =0.004). After the start of palliative care, patients' DNR consent increased (105/115 before, 114/115 after). Patients' recognition of the diagnosis and prognosis increased from 13 to 64, respectively, with a simultaneous increase in family members' recognition (66 before, 114 after). Conclusion: Hospice care with good symptom control is warranted for patients with late-stage nonmalignant disease who need appropriate end-of-life care. Medical personnel need education in the importance of palliative care and the identification of patients who could benefit from it. In addition, patients should be informed of its availability. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have examined the association between heavy metal contamination (including arsenic [As], cadmium [Cd], chromium [Cr], copper [Cu], mercury [Hg], nickel [Ni], lead [Pb], and zinc [Zn]) and lung cancer. However, data from previous studies on pathological cell types are limited, particularly regarding exposure to low-dose soil heavy metal contamination. The purpose of this study was to explore the association between soil heavy metal contamination and lung cancer incidence by specific cell type in Taiwan. Methods: We conducted an ecological study and calculated the annual averages of eight soil heavy metals (i.e., As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) by using data from the Taiwan Environmental Protection Administration from 1982 to 1986. The age-standardized incidence rates of lung cancer according to two major pathological types (adenocarcinoma [AC] and squamous cell carcinoma [SCC]) were obtained from the National Cancer Registry Program conducted in Taiwan from 2001 to 2005. A geographical information system was used to plot the maps of soil heavy metal concentration and lung cancer incidence rates. Poisson regression models were used to obtain the adjusted relative ratios (RR) and 95% confidence intervals (CI) for the lung cancer incidence associated with soil heavy metals. Results: For males, the trend test for lung SCC incidence caused by exposure to Cr, Cu, Hg, Ni, and Zn showed a statistically significant dose-response relationship. However, for lung AC, only Cu and Ni had a significant dose-response relationship. As for females, those achieving a statistically significant dose-response relationship for the trend test were Cr (P = 0.02), Ni (P = 0.02), and Zn (P= 0.02) for lung SCC, and Cu (P < 0.01) and Zn (P = 0.02) for lung AC. Conclusion: The current study suggests that a dose-response relationship exists between low-dose soil heavy metal concentration and lung cancer occurrence by specific cell-type; however, the relevant mechanism should be explored further. [ABSTRACT FROM AUTHOR]

Background: Many studies have examined the risk factors for HCC (including hepatitis B virus, hepatitis C virus, aflatoxin, retinol, cigarette smoking, and alcohol consumption). However, data from previous studies on the association between iron exposure, land subsidence, and HCC mortality/incidence were limited, especially in Taiwanese population. We aimed to explore the geographical distribution of HCC mortality rates by township-specific data and to evaluate the association between HCC mortality, land subsidence, and iron levels in groundwater in Taiwan. Methods: We conducted an ecological study and calculated the HCC age-standardized mortality/incidence rates according to death certificates issued in Taiwan from 1992 to 2001 and incidence data from 1995-1998. The land subsidence dataset before 2005 and iron concentrations in groundwater in 1989 are also involved in this study. Both geographical information systems and Pearson correlation coefficients were used to analyze the relationship between HCC mortality rates, land subsidence, and iron concentrations in groundwater. Results: Township-specific HCC mortality rates are higher in southwestern coastal townships where serious land subsidence and higher township-specific concentrations of iron in groundwater are present. The Pearson correlation coefficients of iron concentrations in groundwater and ASRs of HCC were 0.286 (P = 0.004) in males and 0.192 (P = 0.058) in females for mortality data; the coefficients were 0.375 (P < 0.001) in males and 0.210 (P = 0.038) in females for incidence data. Conclusions: This study showed that HCC mortality is clustered in southwestern Taiwan and the association with the iron levels in groundwater in Taiwanese population warrant further investigation. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the efficacy of sequential treatment for 10 and 14 days and 14 days triple therapy in treating Helicobacter pylori infection. The study included patients with Helicobacter pylori infection from six centers in Taiwan, who were randomized to receive either sequential treatment for 10 to 14 days or 14 days of triple therapy. Study authors concluded in support of sequential treatment as the standard first-line treatment for Helicobacter pylori infection.

Background: To examine the association of anthropometry indices with gout and to compare the performance of indices to predict gout in Taiwanese men. Methods: There were 1443 male subjects aged more than 20 years who participated in the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996). Anthropometric evaluation consisted of weight, height, hip and waist circumference (WC) with later body mass index (BMI), waist to height (WHtR) and waist to hip (WHR) estimations. We conducted 4 logistic models to determine the relationships between anthropometric indices and gout. Receiver operating characteristic (ROC) curve were used to compare the predictive performance and to identify the optimal cut-off points, sensitivity and specificity of these indices for gout in men. Results: After controlling for other covariables, the adjusted odds ratios for the mid and top tertiles of WHtR were 2.55 (95% CI: 1.16, 5.59) and 3.01 (95% CI: 1.13, 7.99), respectively, but no linear association was found for BMI, WHR and WC. In ROC curve, the greatest area under curve was 0.684 for WHtR and the cut-off point of WHtR was 0.57. Conclusions: WHtR had a significant linear association with gout in Taiwanese men and was superior to BMI, WHR and WC. [ABSTRACT FROM AUTHOR]

Background: Positive results between caseloads and outcomes have been validated in several procedures and cancer treatments. However, there is limited information available on the combined effects of surgeon and hospital caseloads. We used nationwide population-based data to explore the association between surgeon and hospital caseloads and survival rates for major cancers. Methodology: A total of 11677 patients with incident cancer diagnosed in 2002 were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity scores were used to assess the relationship between 5-year survival rates and different caseload combinations. Results: Based on the Cox proportional hazard model, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer survival rates, and hazard ratios ranged from 1.3 in head and neck cancer to 1.8 in lung cancer after adjusting for patients' demographic variables, co-morbidities, and treatment modality. When analyzed using the propensity scores, the adjusted 5-year survival rates were poorer for patients treated by low-volume surgeons in low-volume hospitals, compared to those treated by high-volume surgeons in high-volume hospitals (P<0.005). Conclusions: After adjusting for differences in the case mix, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer 5-year survival rates. Payers may implement quality care improvement in low-volume surgeons. [ABSTRACT FROM AUTHOR]

The article outlines the progress of the chemical industry as well as its growth in its sectors in Taiwan. It notes that the industry contains complete supply chain that provides the necessary products. It mentions its challenges such as mergers and alliances, economic growth of competitive Asian countries, and trade barriers. It also suggests for the consolidation and globalization of the country's sales and production systems to enter into new business opportunities.

Acute myocardial infarction is a highly prevalent cardiovascular disease in Taiwan. Among several etiological risk factors, obesity and inflammation are strongly associated with the frequency of hypertension, cardiovascular disease, diabetes, and myocardial infarction. To discriminate obesity- and inflammation-related genes and the onset of acute myocardial infarction (AMI), a case-control study was conducted to investigate the association of the -308G/A polymorphisms of tumor necrosis factor (TNF)-α and the C825T polymorphism of guanidine nucleotide binding protein 3 (GNB3) with the onset of AMI among Taiwanese cohorts. A total of 103 AMI patients and 163 matched normal control samples were enrolled in the present study. The genomic DNA was extracted and subjected into polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) analysis. An association between the A homozygosity of the TNF-α-308G/A polymorphism and the onset of AMI was observed among the male subjects (p = 0.026; Spearman index = 0.200, p = 0.008). An association between the T homozygosity of GNB3 C825T polymorphism and obesity was also observed (Fisher's exact, p = 0.009). The TT genotype has a protective effect against acquiring AMI among the obese female population in Taiwan (Fisher's exact, p = 0.032). In conclusion, TNF-α-308G/A and the GNB3 C825T polymorphisms are associated with obesity and AMI in the Taiwanese population. [ABSTRACT FROM AUTHOR]

Liao C-H, Chang C-S, Chang S-N, Lane H-Y, Lyu S-Y, Morisky DE, Sung F-C. The risk of temporomandibular disorder in patients with depression: a population-based cohort study. Community Dent Oral Epidemiol 2011; 39: 525-531. © 2011 John Wiley & Sons A/S Abstract - Objectives: This study used a population-based retrospective cohort design to examine whether depression is a risk factor of temporomandibular disorder (TMD) Methods: From a universal insurance database, we identified 7587 patients who are newly diagnosed individuals with depression in 2000 and 2001. A total of 30 197 comparison subjects were randomly selected from a nondepression cohort. Both groups were followed until the end of 2008 to measure the incidence of TMD. Results: The incidence of TMD was 2.65 times higher in the depression cohort than in the nondepression cohort (6.16 versus 2.32 per 1000 person-years). The hazard ratio (HR) measured by multivariate Cox's proportional hazard regression analysis of TMD for the depression cohort was 2.21 (95% confidence interval (CI) 1.83-2.66), after controlling for socio-demographic factors and other psychiatric comorbidities. Women had higher risk to develop TMD than men (HR 1.61, 95% CI 1.36-1.92 for women without depression; HR 3.54, 95% CI 2.81-4.45 for women with depression). Conclusions: This study demonstrates that patients with depression are at an elevated risk of developing TMD. [ABSTRACT FROM AUTHOR]

Abstract: In 1995 a government-supported Universal National Health care system was implemented in Taiwan, which in 2008 was available to 98% of the population. This system offers affordable, rapid medical attention. A multi-center retrospective study was conducted to assess the prognosis of malignant glioma patients under this system. In 2005 and 2006, patients at 14 independent neuro-oncology centers with newly diagnosed malignant glioma were enrolled. The patient profile, pathology, treatment modalities, and prognosis were collected by questionnaire at each center. The Taiwan Neuro-Oncology Society was responsible for the data analysis. The overall median survival period, 1-year survival rate, and 2-year survival rate for patients with World Health Organization grade III glioma were 33.8 months, 81.4%, and 58.2%, respectively, and 15 months, 57.3%, and 33.9% in patients with grade IV glioma. The median survival period, 1-year survival rate, and 2-year-survival rate in patients receiving temozolomide adjuvant therapy was 36 months, 84.2%, and 61.8%, respectively, for patients with grade III glioma and 19.8 months, 73.1%, and 43.7%, for patients with grade IV glioma. The universal health care system in Taiwan offers a comparable prognosis with an affordable premium relative to other large series in developed countries. [Copyright &y& Elsevier]

Background: Falls are very common among the older people. Nearly one-third older people living in a community fall each year. However, few studies have examined factors associated with falls in a community-dwelling population of older Taiwanese adults. Objectives: To identify the associated factors for falls during the previous 12 months among the community-dwelling Taiwanese older people receiving annual geriatric health examinations. Participants: People aged sixty-five years or older, living in the community, assessed by annual geriatric health examinations Methods: 1377 community-dwellers aged $65 years who received annual geriatric health examinations at one hospital in northern Taiwan between March and November of 2008. They were asked about their history of falls during the year prior to their most recent health examination. Results: The average age of the 1377 participants was 74.9±6.8 years, 48.9% of which were women. Three-hundred and thirteen of the participants (22.7%) had at least one fall during the previous year. Multivariate analysis showed that odds ratio for the risk of falling was 1.94 (95% CI 1.36-2.76) when the female gender group is compared with the male gender group. The adjusted odds ratios of age and waist circumference were 1.03 (95% CI 1.00-1.06) and 1.03 (95% CI 1.01-1.05) respectively. The adjusted odds ratios of visual acuity, Karnofsky scale, and serum albumin level were 0.34 (95% CI 0.15- 0.76), 0.94 (95% CI 0.89-0.98), and 0.37 (95% CI 0.18-0.76) respectively. Larger waist circumference, older age, female gender, poorer visual acuity, lower score on the Karnofsky Performance Scale, and lower serum albumin level were the independent associated factors for falls. Conclusion: In addition to other associated factors, waist circumference should be included as a novel risk factor for falls. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the variables related to the effectiveness and adherence to treatment with risperidone long-acting injection (RLAI) in patients with schizophrenia. We performed a retrospective medical chart review of 137 patients with schizophrenia who were prescribed RLAI between July 2004 and December 2006. Cox regression analysis showed that the effectiveness of treatment in patients treated with RLAI was affected significantly by the provision of home care and the use of illicit drugs. The adherence of patients to treatment with RLAI was affected most by the provision of home care. Bayesian analysis showed that patients who received the provision of home care or who had no history of illicit drug use continued treatment for, on average, 15.27 and 17.14days longer, respectively, than those who did not receive such care or take illicit drugs. Patients who received the provision of home care adhered to treatment for 343.98 more days than those who did not. Even though patients taking RLAI show better adherence than those taking oral risperidone, home care services can have a significant additional effect on adherence. Randomized clinical follow-up trial studies are necessary to explore the risk factors for nonadherence in more detail. [Copyright &y& Elsevier]

Aims. (1) To understand nurses’ subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses’ workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses’ characteristics and the scores on workforce perception. Background. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. Design. A cross-sectional questionnaire survey. Method. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-wayanova. Results. The mean score of workforce perception was 6·28 points (total = 10 points). Both overtime ( p = 0·02) and number of callbacks on days off ( p = 0·01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience ( r = 0·37; p = 0·01) and those with more emergency department experience tended to have vacation accumulation ( r = 0·09; p = 0·04), overtime ( r = 0·10; p = 0·03) and better perception of their emergency department’s current workforce ( r = 0·09; p = 0·05). Conclusions. Although nurses’ perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. Relevance to clinical practice. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses’ work environment. [ABSTRACT FROM AUTHOR]

Typhoon passages across Taiwan can generate sudden surface warming in downslope regions. Special characteristics and mechanisms for 54 such warming events that were identified during the 1961–2007 period are examined. Preferred warming regions were identified in northwest Taiwan, where warming is generated by downslope flow from east or northeast winds in westward-moving typhoons, and in southeast Taiwan, where it is generated by downslope flow from west or northwest winds in northwestward-moving typhoons. In addition to the orographic effect, warmings occurred exclusively within nonprecipitation zones of typhoons. Most northwest (southeast) warmings occur during the day (night) with an average lifetime of 4 (5) h, which roughly corresponds to the average time a nonprecipitation zone remains over a station. During the period examined, three typhoons generated warming events in both northwest and southeast Taiwan, and only Typhoon Haitang (2005) generated warmings with comparable magnitudes (∼12-K increase) in both regions. For Typhoon Haitang as an example, diagnostic analyses with two different approaches reveal that the majority of the warming is contributed by downslope adiabatic warming, but the warming associated with the passage of a nonprecipitation zone is not negligible. Similar results were found when these two diagnostic approaches were applied to the other warming events. The diurnal mode of the atmospheric divergent circulation over East Asia–western North Pacific undergoes a clockwise rotation. The vorticity tendency generated by this diurnal divergent circulation through vortex stretching may modulate the arrival time of typhoons to cause daily (nighttime) warming in the northwest (southeast). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to several research studies on the clinical presentation and prognosis of ulcerative colitis in elderly adults, and it mentions proctitis, inflammatory bowel disease, and the risk of death in older people.

Abstract: Background: According to Hochschild''s (1983. The Managed Heart. Berkeley: University of California Press) classification of emotional labour, nursing staff express high emotional labour. This paper investigates how nursing staff influence job satisfaction and organizational commitment when they perform emotional labour. Objectives: This paper examines the relationship between emotional labour, job satisfaction, and organizational commitment from the perspective of nursing staff. Design: A questionnaire survey was carried out to explore these interrelationships. Setting: Teaching hospital in Taiwan. Participants: Questionnaires were distributed to 500 nursing staff; 295 valid questionnaires were collected and analysed—a 59% response rate. Methods: The questionnaires contained items on emotional labour, job satisfaction, and organizational commitment as well as some basic socio-demographics. In addition, descriptive statistics, correlation and linear structure relation (LISREL) were computed. Results: Emotional display rule (EDR) was significantly and negatively related to job satisfaction. Surface acting (SA) was not significantly related to job satisfaction but demonstrated a significantly negative relationship with organizational commitment. Deep acting (DA) significantly and positively correlated with job satisfaction but demonstrated no significance with organizational commitment. The variety of emotions required (VER) was not significantly related to job satisfaction; frequency and duration of interaction (FDI) and negatively related to job satisfaction; and job satisfaction significantly and positively correlated with organizational commitment. Conclusions: We found that some dimensions of emotional labour significantly relate to job satisfaction. Job satisfaction positively affects organizational commitment and has an intervening effect on DA and organizational commitment. [Copyright &y& Elsevier]

Given the increase in demands on water resources, optimal management policy has been sought for minimum resource utilities and maximum environmental benefits. Since the water resource system is complicated and has many uncertainties, artificial intelligence techniques, like fuzzy set theory or a genetic algorithm (GA), enable us to identify optimal decision variables more efficiently and incorporate uncertainty considerations. In this study, multiobjective programming was developed for a realistic application in Kinmen Island, Taiwan, against the scarce water resource. Three alternatives, including a desalination facility, additional activated carbon equipment for the current wastewater treatment plant (WTP), and constructed wetlands were designed to improve water quality and to ensure sufficient water supply. The GA technology is employed to search for the best solutions from the three alternatives. In addition, the fuzzy goal of cost and water quantity represented is utilized to determine the optimal control policy by the degree of satisfaction. In the optimal management of this case study, the desalination facility receives 17.8% of the treatment water, and 20.7 and 61.5% of the treatment water allocated to the current WTP and constructed wetland, respectively. The GA and fuzzy multiobjective programming are proven to facilitate the determination of the optimal solution for Kinmen’s water resource management. [ABSTRACT FROM AUTHOR]

This article discusses a method of determining the optimum number and spatial distribution of rain gauge stations in catchments in Taiwan. According to the authors, both topography and weather information is required for the optimum rain gauge stations. They used kriging and entropy information to prioritize the stations and then the saturation of the rainfall information to add or delete stations. They demonstrated this method on the Shimen Reservoir to determine the minimum number of rain gauge stations required.