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Picture book reading is essential in the early stages of learning and development. The current study aimed to incorporate picture books to improve first graders' scientific thinking, including scientific reasoning and creativity. The study adopted a quasi-experimental research design. There were 24 students in the experimental group and 23 in the control group. The chi-square test was used to analyze the difference between the two groups. The teacher innovatively employed the 5E model strategies to aid students in the experimental group focus on the scientific knowledge and methods proposed in the picture books. The results revealed that students in the experimental group outperformed their counterparts in scientific thinking with small to large effect sizes. Besides, according to students' attitudes and the types of books borrowed, picture book teaching with the 5E model was appropriate for first graders to improve their scientific thinking.

This research sought to improve students' science reading comprehension ability and marine ecological conservation learning interest through the implementation of an inquiry-based learning course. A Triggered situational interest-Reading-Inquiry-Presentation (TRIP) model was proposed to guide the course design. The quasi-experimental design was adopted in this research. Experimental teaching activities were conducted with two classes of second graders (50 students in total) in southern Taiwan. One class served as the experimental group, and the other served as the comparison group. The Science Reading Comprehension Test (SRCT) and Marine Ecology Conservation Learning Interest Scale (MECLIS) were used as instruments. Data were analyzed using the Johnson-Neyman Technique, analysis of covariance, and qualitative analysis. The results showed that the students with lower pre-test scores on the SRCT in the experimental group had better scores on the post-test than those in the comparison group, while the students in both groups with higher pre-test scores on the SRCT had no difference in their post-test scores. Furthermore, the experimental group students had better MECLIS scores than the comparison group students, and the difference had a moderate effect size. Overall, this research suggests that the TRIP model may assist science teachers in designing science reading courses.

The purpose of this research was to design a course based on the design-based learning (DBL) model to improve undergraduates' web design skills, and to explore the differences in learning effectiveness of students with different levels of knowledge integration. The quasi-experimental design was adopted in this study. Ninety-two participants studying general education courses in a university in southern Taiwan were selected to participate in this study. The instruments included the Web Design Skills Test and the Knowledge Integration Scale. The study found that the use of the DBL strategy in teaching could improve the web design skills of the experimental group students, especially those students with insufficient web design skills in the initial stage. In addition, students with a high level of knowledge integration had better improvement in their web design skills. The implication of this research is that DBL is a suitable web design skills training strategy for students with insufficient web design skills. If students could be reminded to integrate knowledge while studying, their learning outcomes may be better.

Objective The objective of this study was to assess the incidence and risk factors of major adverse cardiovascular events (MACEs) in patients with systemic sclerosis (SSc). Methods We conducted a nationwide, population-based, cohort study using Taiwan's National Health Insurance Research Database. We performed propensity score matching (PSM) using a 1:2 ratio, resulting in inclusion of 1379 patients with SSc and 2758 non-SSc individuals in the analysis. We assessed the association between SSc and MACEs, using the multivariable Cox proportional hazard regression model with adjustment of time-dependent covariates, and investigated risk factors for MACEs in patients with SSc, shown as adjusted hazard ratios (aHRs) with 95% CIs. Results SSc was not significantly associated with the risk of MACEs (aHR 1.04; 95% CI 0.77–1.42). Nevertheless, SSc was associated with increased risk of myocardial infarction [incidence rate ratio (IRR) 1.76; 95% CI 1.08–2.86] and peripheral arterial occlusion disease (IRR 3.67; 95% CI 2.84–4.74) but not of ischaemic stroke (IRR 0.89; 95% CI 0.61–1.29). Factors independently associated with MACEs in SSc patients included age (aHR 1.02), male gender (aHR 2.01), living in a suburban area (aHR 2.09), living in a rural area (aHR 3.00), valvular heart disease (aHR 4.26), RA (aHR 2.14), use of clopidogrel (aHR 26.65), and use of aspirin (aHR 5.31). Conclusions The risk of MACEs was not significantly increased in Taiwanese patients with SSc, and our investigation effectively identified the factors independently associated with MACEs in SSc patients. Additionally, patients with SSc exhibited higher risks of myocardial infarction and peripheral arterial occlusion disease but not of ischaemic stroke. [ABSTRACT FROM AUTHOR]

Aims: The effectiveness of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) on incident dementia in patients with diabetes and atrial fibrillation (AF) remains unknown. This study aimed to investigate the association between SGLT2i and the risk of incident dementia in diabetic patients with AF, and to explore the interactions with oral anticoagulants or dipeptidyl peptidase‐4 inhibitors (DPP4i). Materials and Methods: We conducted a cohort study using Taiwan's National Health Insurance Research Database. Patients with diabetes and AFwithout a prior history of established cardiovascular diseases, were identified. Using propensity score matching, 810 patients receiving SGLT2i were matched with 1620 patients not receiving SGLT2i. The primary outcome was incident dementia, and secondary outcomes included composite cardiovascular events and mortality. Results: After up to 5 years of follow‐up, SGLT2i use was associated with a significantly lower risk of incident dementia (hazard: 0.71, 95% confidence interval: 0.51–0.98), particularly vascular dementia (HR: 0.44, 95% CI: 0.24–0.82). SGLT2i was related to reduced risks of AF‐related hospitalisation (HR: 0.72, 95% CI: 0.56–0.93), stroke (HR: 0.75, 95% CI: 0.60–0.94), and all‐cause death (HR: 0.33, 95% CI: 0.24–0.44). The protective effects were consistent irrespective of the concurrent use of non‐vitamin K antagonist oral anticoagulants (NOACs) or DPP4i. Conclusions: In diabetic patients with AF, SGLT2i was associated with reduced risks of incident dementia, AF‐related hospitalisation, stroke, and all‐cause death. The protective effects were independent of either concurrent use of NOACs or DPP4i. [ABSTRACT FROM AUTHOR]

Background The Taiwanese government made a concerted effort to contain a coronavirus disease 2019 (COVID-19) nosocomial outbreak of variant B.1.429, shortly before universal vaccination program implementation. This study aimed to investigate seroprevalence in the highest-risk regions. Methods Between January and February 2021, we retrieved 10 000 repository serum samples from blood donors to examine for antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) and spike (S) antigens. A positive result was confirmed if anti-N and anti-S antibodies were positive. Overall, 2000 donors residing in the highest-risk district and donating blood in January 2021 were further examined for SARS-CoV-2 RNA. We estimated seroprevalence and compared the epidemic curve between confirmed COVID-19 cases and blood donors with positive antibodies or viral RNA. Results Twenty-one cases with COVID-19 were confirmed in the nosocomial cluster, with an incidence of 1.27/100 000 in the COVID-affected districts. Among 4888 close contacts of the nosocomial cases, 20 (0.4%) became confirmed cases during isolation. Anti-SARS-CoV-2 was detected in 2 of the 10000 blood donors, showing a seroprevalence of 2/10000 (95% CI, 0.55–7.29). None of the 2000 donors who underwent tests for SARS-CoV-2 RNA were positive. The SARS-CoV-2 infection epidemic curve was observed sporadically in blood donors compared with the nosocomial cluster. Conclusions In early 2021, an extremely low anti-SARS-CoV-2 seroprevalence among blood donors was observed. Epidemic control measures through precise close contact tracing, testing, and isolation effectively contained SARS-CoV-2 transmission before universal vaccination program implementation. [ABSTRACT FROM AUTHOR]

For a 50G passive optical network (PON) low-density parity-check (LDPC) decoder, decoding performance and area efficiency must be balanced. This paper adopts a layered decoder method to improve the area efficiency of the decoder. By parallel processing of three submatrices and storage reuse of node information, optimizing the matrix partitioning and processing order of the 50G-PON standard, the throughput of 1235 bps was reached under 100 MHz circuit frequency in field-programmable gate array (FPGA) implementation, and 9.864 Gbps was achieved based on Taiwan semiconductor manufacturing company (TSMC) 65 nm synthesis with 800 MHz circuit frequency in an area of 2.61 mm 2 by proposing a mechanism of spare decision storage to avoid errors caused by quantization overflow of the decoder and using full verification to terminate decoding in advance to improve performance. Finally, at an input bit error rate (BER) of 2.3 × 10 − 2 (signal-to-noise ratio (SNR) of about 3.72 dB), the output BER was lower than 10 − 12 , and the throughput area rate (TAR) also increased by 2 to 4 times compared with other papers. In conclusion, an area-efficient LDPC decoder without sacrificing decoding performance is made. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to examine the relationships between smoking status and health-related physical fitness and balance ability in older males residing in Taiwan. This investigation adopted a cross-sectional design, utilizing data from 7688 older males who took part in the 2014–2015 wave of the National Physical Fitness Survey of Taiwan. Various data sources, including a standardized structured questionnaire, anthropometric measurements, health-related physical fitness assessments, and balance ability tests, were analyzed. The participants were divided into three categories based on their smoking habits: never smokers, former smokers, and current smokers. Multiple regression analyses were performed to evaluate the linear association between cigarette smoking status and health-related physical fitness and balance ability performance. Health-related physical fitness and balance performance were significantly greater (p < 0.05) in the never smoker group than in the current smoker group. Current smoking status was significantly negatively (p < 0.05) associated with cardiopulmonary function, muscular endurance, flexibility, and balance performance. A history of smoking (former smoker) was significantly negatively (p < 0.05) associated with the 2-min step test, 30-s arm curl and chair stand, as well as the 8-foot up-and-go test; however, the association was not significant for the back scratch, chair sit-and-reach, and one-leg stance with eyes open performance. These results suggest that current cigarette smoking is detrimental to health-related physical fitness and balance performance in older males. Quitting smoking may reverse the effects of smoking on overall body flexibility and static balance performance in Taiwanese older adults, thereby reducing the risk of falls and incapacity. [ABSTRACT FROM AUTHOR]

Because the senior population comes from various backgrounds, how to meet their needs and to cater to their different levels poses a great challenge for aging-education instructors when designing effective projects. The goal of this paper was to present the implementation of an innovative and effective project in aging education titled The K-shape Learning Project for Senior Citizens. The project was implemented in Taitung University and lasted for five months with 140 seniors in five sessions in total. An action research approach was adopted for the course implementation and content modification throughout this project. Meanwhile, data was collected through questionnaires and interviews. The findings then emphasized four elements for other aging education professionals' references: the philosophy and goal of the project, the implementation process of the project, the perception and response of participants, and the reflection of the educators. (Contains 2 figures.)

Employee assistance programs (EAPs) provide work, living, and health services to help employees overcome personal and organizational obstacles that affect their productivity. Most businesses in Taiwan are small or medium-sized, and their scale, stage of development, and resources affect their implementation of EAPs. This study explored EAPs and related measures that organizations can implement in each stage of their development. The results may serve as a reference for human resources personnel in planning EAPs, specifically in identifying appropriate measures to implement for each developmental stage of their organizations. The modified Delphi method and fuzzy analytic hierarchy process were used to organize and analyze key EAP measures and their weights during the creation, guidance, authorization, coordination, and collaboration stages of organizational development. Data analysis revealed that in all five stages of organizational development, work-related EAP measures are the most crucial. As an organization transitions from the creation to collaboration stages, the work dimension is neglected in favor of the health dimension. In the authorization stage, the organization begins to provide a wider range of services in the living dimension. The results and other information regarding EAP service models indicate that in each developmental stage, an organization should adopt a different EAP service model that suits its resources, organizational structure, implementation of EAP measures, and other factors. [ABSTRACT FROM AUTHOR]

An Infrared (IR)-passive microwave (PMW) blended technique is developed to derive precipitation estimates over the Asia-Pacific domain through calibrating the temperature of brightness blackbody from the Japanese Himawari-8 satellite to precipitation derived from the combined PMW retrievals (currently MWCOMB2x) based on the probability density function (PDF)-matching concept. Called IRQPE, the technique is modified and fine-tuned to better represent the spatially rapidly changing cloud–precipitation relationship over the target region with PDF-matching tables established over a refined spatial resolution of 0.5° lat/lon grid. The evaluation of the IRQPE shows broadly comparable performance to that of the CMORPH2 in detecting rainfall systems of large and medium-scales at a resolution of 1.0° degree. Rainfall variations from the two datasets over El Niño-Southern Oscillation and the Madden Julian Oscillation active convective centers show well consistency of each other, suggesting usefulness of the IRQPE in climate applications. Two approaches for regional improvements are explored by establishing the PDF tables for a further refined spatial resolution and by replacing the PMW-based precipitation 'truth' fields with the surface gauge data to overcome the shortcoming of PMW-based retrievals in capturing orographic rainfall over the Taiwan area. The results show significant improvements. The rainfall patterns of revised the IRQPE at a resolution of 0.1° degree on above the 5-day timescale correlate well with the Taiwan official surface ground truth called the QPESUMS, which is a gridded set of gauge-corrected Radar quantitative precipitation estimations. The root mean square error of the revised IRQPE on estimating the Taiwan overall land rainfall is close to Radar-derived rainfall accumulations on a 30-day time-scale. [ABSTRACT FROM AUTHOR]

We aim to investigate the alteration in disease activity of ankylosing spondylitis (AS) individuals before, during, and after the COVID-19 wave in Taiwan by using electronic medical-record management system (EMRMS). We identified 126 AS individuals from the single center, and gathered data of the three disease activities (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate [ASDAS-ESR], and Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein [ASDAS-CRP]) by using EMRMS before (7 February to 1 May, 2021), during (2 May to 24 July, 2021), and after the COVID-19 wave (25 July to 16 October, 2021). We compared the disease activity measures of the three phases through a paired t test. Among the 126 individuals, CRP was significantly higher during the COVID-19 wave (0.2 (0.1, 0.5) mg/dl, p = 0.001) than before the wave (0.2 (0.1, 0.4) mg/dl), ESR (8.0 (4.0, 15.0) mm/h, p = 0.003) and ASDAS-ESR (1.4 (1.0, 1.9), p = 0.032) were significantly higher after the wave than during the wave (6.0 (3.0, 12.0) mm/h and 1.2 (0.9, 1.8) mm/h) e. ESR, CRP, ASDAS-ESR and ASDAS-CRP were all significant higher after COVID-19 wave than before. The disease activities of AS individuals in Taiwan worsened after 2021 COVID-19 wave in Taiwan. [ABSTRACT FROM AUTHOR]

Background and Objectives: Health-related physical fitness reduces the risk of chronic disease, promotes quality of life, and has enormous economic benefits considering the global health care costs resulting from obesity. However, relatively limited information is available regarding the dose–response relationship between scientific physical fitness and obesity risk. This study aimed to determine the associations of scientific physical fitness with body mass index (BMI) distribution and overweight/obesity risk among adults aged 23–64 years in Taiwan. Materials and Methods: We conducted a cross-sectional study and reviewed data derived from the Scientific Physical Fitness Testing Program, Sports Administration, Ministry of Education, Taiwan. Responses from 16,939 participants from the database (7761 men and 9178 women, aged 23–64 years) were collected in this study. Each participant completed a series of scientific physical fitness measurements, including cardiorespiratory fitness (3 min progressive knee-up and step [3MPKS] test), muscular fitness (hand grip strength), and flexibility (sit-and-reach test). Anthropometric measurements included body height, weight, and BMI. The quartiles of scientific physical fitness results were identified as the dependent variable in the multiple linear and multiple logistic regression analysis to determine the associations of the scientific physical fitness measurements with BMI distribution and overweight/obesity risk, as well as the dose–response relationship. Results: The 3MPKS test was significantly associated with BMI (quartile 1 (Q1): β = 1.900; quartile 2 (Q2): β = 1.594; quartile 3 (Q3): β = 1.079 for men, and Q1: β = 1.454; Q2: β = 0.882; Q3: β = 0.555 for women), overweight (Q1: odds ratio (OR) = 2.117; Q2: OR = 2.056; Q3: OR = 2.063 for men, and Q1: OR = 3.036; Q2: OR = 2.542; Q3: OR = 1.959 for women), and obesity (Q1: OR = 6.530; Q2: OR = 5.747; Q3: OR = 3.557 for men, and Q1: OR = 3.238; Q2: OR = 1.431 for women) risk compared with quartile 4 (Q4) as the reference group with a dose–response relationship. In addition, relative hand grip strength was significantly associated with BMI (Q2: β = −0.922; Q3: β = −1.865; Q4: β = −3.108 for men, and Q2: β = −1.309; Q3: β = −2.161; Q4: β = −2.759 for women), overweight (Q2: OR = 0.806; Q3: OR = 0.697; Q4: OR = 0.278 for men, and Q2: OR = 0.667; Q3: OR = 0.398; Q4: OR = 0.228 for women), and obesity (Q1: OR = 0.528; Q2: OR = 0.206; Q3: OR = 0.049 for men, and Q1: OR = 0.351; Q2: OR = 0.129; Q3: OR = 0.051 for women) risk compared with Q1 as the reference group with a dose–response relationship. Conclusions: Higher levels of performance of the 3MPKS and relative grip strength tests were associated with lower BMI and overweight/obesity risk in both sexes. However, the sit-and-reach test was only partially related to BMI and overweight/obesity risk in both sexes. Cardiorespiratory fitness and muscular fitness were effective predictors of BMI distribution and overweight/obesity risk in Taiwanese adults. [ABSTRACT FROM AUTHOR]

From July 19 to 21, 2021, Henan, a province in northern China (NC), was affected by severe flooding (referred to hereafter as "21·7") caused by a prolonged record-breaking extreme precipitation (EP) event. Understanding the extremes of the large-scale circulation pattern during "21·7" is essential for predicting EP events and preventing future disasters. In this study, daily atmospheric large-scale circulations over NC in the summers from 1979 to 2021 were investigated using the circulation classification method of an obliquely rotated principal component analysis in T-mode (PCT). The geopotential height at 500 hPa and 925 hPa were applied successively in classification. Among the nine summer circulation patterns at 500 hPa were found, the 3 days of "21·7" belonged to the Type 8 pattern, which had the second highest probability of EP days among all patterns. It was characterized by a southeasterly wind toward North China Plain driven by a dipole geopotential height field, with the West Pacific subtropical high (WPSH) extending far north to 30°N and low to the south near NC. Tropical cyclones (TCs) occurred on 72.5% of EP days, in which larger amounts of precipitation and a longer duration of EP days were found along the mountains in NC, as compared with other patterns. The distribution of EP events under this pattern was mainly influenced by the location of the low at 925 hPa in the dipole. The subtype 8−3 circulation, with lows in the east of Taiwan Island, included "21·7" and accounted for 1.6% of all summer days. Typhoon In-fa, together with the WPSH, gave rise to intense column integrated moisture flux convergence (IMFC) via the southeasterly wind to Henan, which occurred continuously during the 3 days of "21·7", resulting in the largest (second largest) mean IMFC among 3 consecutive EP days under type 8 (all types) during the past 43 summers in NC. Further analysis revealed that the large-scale dynamic process could not completely explain the record-breaking EP during "21·7", indicating possible contributions of other dynamic processed related to meso-scale convective storms. [ABSTRACT FROM AUTHOR]

aimed evaluated the effectiveness of a hospital-based huddle at a general medical ward in Taiwan. Methods: A Continuous Integration team was conducted by combining multidisciplinary frontline staff to huddle at a 74-bed general medical ward. Team Huddles started twice a week. A physical huddle run board was created, which contained four parts, including idea submitted, idea approved, working on an idea and standardizing. Problems were submitted to the board to be identified, and the solutions were evaluated through huddle discussion. We divided the problems into two groups: quick hits (resolved within 24– 48hrs) and complex issues (resolved > 48hrs). An anonymous questionnaire was designed to evaluate the huddle response. Results: A total of 44 huddles occurred from September 9th, 2020, to September 30th, 2021, and 81 issues were identified and resolved. The majority issues were policy documentation (n=23; 28.4%). Sixty-seven (82.7%) issues were defined as quick hits, and the other fourteen (17.3%) issues were complex. The mean hours to the resolution of quick hits was 5.17 hours, median 3.5 hours, and range from 0.01– 15.4 hours. The mean days to resolve completion issues were 19.73 days, median 7.5 days, and range 3.57– 26.14 days. An overwhelming 92.9% of staff responded that huddles help to expedite the process to reach treatment goals, reduce clinical mistakes, near misses, reduce patient incidences, and help teamwork enhancement, with rating of 4.52 (on a 5-point Likert scale). Conclusion: Implementing of multidisciplinary team huddle improved the accountability of issue identification, problem-solving and teamwork enhancement. [ABSTRACT FROM AUTHOR]

Date Presented 03/21/24 The study provides a reliable and valid Chinese version of the Occupational Balance Questionnaire (OBQ11–C) for people with depression in the clinical and research field of OT. Primary Author and Speaker: Yun-Ling Chen Contributing Authors: Wei-Ting Ko, Pei-Chi Su, Ming-Hong Hsieh, Yin-To Liao, Po-Chung Ju, Yung-Teng Chan, Petra Wagman, Carita Håkansson [ABSTRACT FROM AUTHOR]

Objective: Appropriate triage in patients presenting to the emergency department (ED) is often challenging. Little is known about the role of physician gestalt in ED triage. We aimed to compare the accuracy of emergency physician gestalt against the currently used computerized triage process. Methods: We conducted a prospective observational study in the ED at an academic medical center. Adult patients aged ≥20 years were included and underwent a standard triage protocol. The patients underwent system‐based triage using the computerized software the Taiwan Triage and Acuity Scale. The entire triage process was recorded, and triage data were collected. Five physician raters provided triage levels (physician‐based) according to their perceived urgency after reviewing videos. The primary outcome was hospital admission. The secondary outcomes were ED length of stay (EDLOS) and charges. Results: In total, 656 patients were recruited (mean age 52 years, 50% male). The median system‐based triage level was 3. By contrast, the median physician‐based triage level was 4. The physician raters tended to provide lower triage levels than the system, with an average difference of 1. There was modest concordance between the two triage methods (correlation coefficient 0.30), with a weighted kappa coefficient of 0.18. The area under the receiver operating curve for the system‐ and physician‐based triage in predicting hospital admission were similar (0.635 vs. 0.631, p = 0.896). Attending physicians appeared to have better performance than residents in predicting admission. The variation explained (R2) in EDLOS and charges were similar between the two triage methods (R2 = 3% for EDLOS, 7%–9% for charges). Conclusions: Emergency physician gestalt for triage showed similar performance to a computerized system; however, physicians redistributed patients to lower triage levels. Physician gestalt has advantages for identifying low‐risk patients. This approach may avoid undue time pressure for health care providers and promote rapid discharge. [ABSTRACT FROM AUTHOR]

Due to excessive clinical blood usage and a rapidly aging population, an impending blood shortage in Taiwan is inevitable. This study aimed to determine the potential blood deficit in Taiwan in 2030. The numbers of units of whole blood (WB) donated and red blood cells (RBC) transfused will increase from 1,182,973 to 1,115,803 in 2018 to 1,230,500 and 1,250,760 in 2030, respectively. Considering the gap between donation and transfusion, we estimate a deficit of 97,633 units of WB in 2030. Blood collection will increasingly rely on donors over the age of 40. Moreover, we observed a large decline in units of WB donated among people less than 25 years old. A growing demand for RBC is attributed to the aging population and limited decreases in age-specific units of RBC transfused per capita. Scrutinizing and forecasting changes in blood collection and transfusion are necessary for generating strategies to mitigate blood shortages. [ABSTRACT FROM AUTHOR]

In this study, we aimed to determine the associations among health-related physical fitness measurements, waist circumference (WC), and abdominal obesity risk in Taiwanese adults. We conducted a cross-sectional study based on data from the 2017 Taiwan Scientific Physical Fitness Survey (the TSPFS). We collected the responses from 17,973 participants (7907 men and 10,066 women) aged 23–64 years for this study. The participants completed the study protocol with a standardized structural questionnaire and a series of health-related physical fitness measurements. The fitness measurements included cardiorespiratory fitness (measured by a 3-min progressive knee-up and step test), muscular fitness (measured by a hand grip strength test), and flexibility (measured by a sit-and-reach test). Our anthropometric measurements included height, weight, WC, hip circumference (HC), body mass index (BMI), and waist-to-hip ratio (WHR). We identified the quartiles of the health-related physical fitness results as the dependent variable in the multiple linear and multiple logistic regression analysis to determine the associations of the physical fitness measurements with WC distribution and abdominal obesity risk. We also considered the dose–response relationship. We found that cardiorespiratory fitness, relative grip strength, and flexibility were each significantly negatively associated with WC, but absolute grip strength was significantly positively associated with WC. We also found that higher levels of cardiorespiratory fitness, relative grip strength, and flexibility were each associated with a lower risk of abdominal obesity. Moreover, our secondary finding was of a dose–response relationship between physical fitness performance, WC, and abdominal obesity risk. In short, health-related physical fitness was an effective predictor of waist circumference for both sexes of Taiwanese adults, and higher levels of health-related physical fitness were associated with lower risks of abdominal obesity in Taiwanese adults. [ABSTRACT FROM AUTHOR]

To present the natural course of keratoconus (KC) and compare pediatric and adult patients. Design A retrospective cohort study. Setting Hospital-based. Patient Population In total, 152 patients (288 eyes) diagnosed with KC at Chang Gung Memorial Hospital, Taiwan, were included. Previously managed patients and those with missing optical data were excluded. Observation Procedures Patients were divided into pediatric (≤ 18 years) and adult (> 18 years) groups. Demographics, clinical data, and optical variables were collected, including corrected distance visual acuity (CDVA), refractive error, and keratometric readings (K). Main Outcome Measure Optical variables at the final follow-up before aggressive treatment. Results In total, 20 pediatric (37 eyes) and 132 adults (251 eyes) patients were eligible for this study. The mean follow-up time was 2.98 years. Male predominance was observed in both groups. Both groups had similar clinical characteristics and optical variables at the initial diagnosis. Pediatric patients progressed significantly more rapidly in refractive errors, including spheres and cylinders, spherical equivalence, steep K, and flat K during the follow-up. However, significant change between the two study groups was only seen in sphere refractive error spherical equivalence. Conclusion Pediatric patients had more rapidly progressive KC than adult patients, so early detection and frequent follow-up for prompt interventions are necessary for these patients. [ABSTRACT FROM AUTHOR]

Background: Evidence for mitigation of transfusion-transmitted dengue informed by surveillance data is lacking. In this study, we evaluated the risk of positive dengue viral (DENV) ribonucleic acid (RNA) from blood transfusions during a large outbreak in Taiwan.Methods: Serum collected from blood donors living in districts experiencing the dengue epidemic were tested for DENV RNA using a qualitative transcription-mediated nucleic acid amplification assay (TMA). The TMA-reactive specimens were further tested for immunoglobulin (Ig)M and IgG antibodies, nonstructural protein 1 (NS1) antigen, and viral RNA by reverse-transcription polymerase chain reaction. We estimated DENV RNA prevalence and the number of DENV infections among blood donors.Results: A total of 4976 specimens were tested for DENV RNA, and 21 were TMA-reactive. The detection rate was 0.84 (95% confidence interval [CI], 0.15-4.73), 3.36 (95% CI, 1.31-8.60), and 6.19 (95% CI, 3.14-12.17) per 1000 donors in districts where the weekly dengue incidence was 5-50, 50-200, and 200 or more per 100 000 residents, respectively. Alanine aminotransferase screening only detected 4.4% of TMA-reactive donations. A total of 143 transfusion-transmitted DENV infections probably occurred during this outbreak, accounting for 9.2 in 10 000 dengue infections.Conclusions: Approximately 0.5%-1% of blood donations were DENV RNA positive in epidemic districts. The correlation of DENV RNA rates with dengue incidence may inform the design of effective control measures. [ABSTRACT FROM AUTHOR]

Regular hepatocellular carcinoma (HCC) surveillance by ultrasonography in combination with the α-fetoprotein (AFP) examination is unsatisfactory in diagnostic sensitivity for early-stage HCC especially in cirrhotic patients. We conducted a prospective study in a tertiary medical center in Taiwan and consecutively collected serum samples from patients with chronic hepatitis, liver cirrhosis (LC), or HCC for new biomarker discovery. Overall, 166 patients were enrolled, including 40 hepatitis, 30 LC, and 96 HCC. Four acute-phase serum amyloid A (A-SAA) derived biomarkers including total A-SAA, A-SAA monomer and oligomer, and protein misfolding cyclic amplification (PMCA) signal were measured and compared between patients with and without HCC. A-SAA biomarkers significantly increased in the HCC group when compared to the hepatitis and LC groups, and generally increased in more advanced tumor stages. Among A-SAA biomarkers, the area under the receiver operator characteristic curves (AUROCs) for PMCA signal in discrimination of all-stage and early-stage HCC were 0.86 and 0.9 in cirrhotic patients, which is comparable to AFP. For cirrhotic patients with low AFP (< 7 ng/mL), PMCA signal maintained good capacity in prediction of early-stage HCC (AUROC: 0.94). Serum A-SAA and its prion-like property showed a potential to complement AFP in detection of early-stage HCC. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility of implementation of an extremity exercise program and to examine its preliminary effects in breast cancer survivors suffering from chemotherapy-induced peripheral neuropathy (CIPN). Sample & Setting: Thirteen breast cancer survivors from one hospital in northern Taiwan. Methods and Variables: A single group with repeated measures, and a quasi-experimental design. The intervention program was a four week, home-based extremity exercise program that was comprised of 10 skilled hand exercises and Buerger-Allen exercises. The Total Neuropathy Scale (clinical version), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group, Neurotoxicity (13-Item Version), Identification Pain Questionnaire, and pain Visual Analogue Scale were used to measure CIPN before exercise (T1), during (T2~T4), and after exercise (T5). Qualitative data were also collected at each time point. Data were analyzed by using descriptive statistics, generalized estimating equations, and directed content analysis. Results: None of the participants reported adverse events during the study period. The extremity exercise program significantly improved patient-reported CIPN after intervention at T4 or T5 but was insignificant on clinician-assessed CIPN. The qualitative data of participant experience indicated that this program is feasible and easy to follow. Conclusion: The extremity exercise program is feasible but needs to increase the sample size and prolong the intervention period for confirmation. [ABSTRACT FROM AUTHOR]

The purpose of this research was to design a course based on the design-based learning (DBL) model to improve undergraduates' web design skills, and to explore the differences in learning effectiveness of students with different levels of knowledge integration. The quasi-experimental design was adopted in this study. Ninety-two participants studying general education courses in a university in southern Taiwan were selected to participate in this study. The instruments included the Web Design Skills Test and the Knowledge Integration Scale. The study found that the use of the DBL strategy in teaching could improve the web design skills of the experimental group students, especially those students with insufficient web design skills in the initial stage. In addition, students with a high level of knowledge integration had better improvement in their web design skills. The implication of this research is that DBL is a suitable web design skills training strategy for students with insufficient web design skills. If students could be reminded to integrate knowledge while studying, their learning outcomes may be better. [ABSTRACT FROM AUTHOR]

This study is aimed at evaluating a deep transfer learning-based model for identifying diabetic retinopathy (DR) that was trained using a dataset with high variability and predominant type 2 diabetes (T2D) and comparing model performance with that in patients with type 1 diabetes (T1D). The Kaggle dataset, which is a publicly available dataset, was divided into training and testing Kaggle datasets. In the comparison dataset, we collected retinal fundus images of T1D patients at Chang Gung Memorial Hospital in Taiwan from 2013 to 2020, and the images were divided into training and testing T1D datasets. The model was developed using 4 different convolutional neural networks (Inception-V3, DenseNet-121, VGG1, and Xception). The model performance in predicting DR was evaluated using testing images from each dataset, and area under the curve (AUC), sensitivity, and specificity were calculated. The model trained using the Kaggle dataset had an average (range) AUC of 0.74 (0.03) and 0.87 (0.01) in the testing Kaggle and T1D datasets, respectively. The model trained using the T1D dataset had an AUC of 0.88 (0.03), which decreased to 0.57 (0.02) in the testing Kaggle dataset. Heatmaps showed that the model focused on retinal hemorrhage, vessels, and exudation to predict DR. In wrong prediction images, artifacts and low-image quality affected model performance. The model developed with the high variability and T2D predominant dataset could be applied to T1D patients. Dataset homogeneity could affect the performance, trainability, and generalization of the model. [ABSTRACT FROM AUTHOR]

Dravet syndrome is a severe developmental and epileptic encephalopathy characterized by the onset of prolonged febrile and afebrile seizures in infancy and SCN1A gene mutations. In some cases, non- SCN1A gene mutations can present with a phenotype very similar to that of Dravet syndrome. The aim of this study was to compare phenotypes of patients with SCN1A and non- SCN1A gene mutation-related Dravet syndrome. Thirty-six patients with Dravet syndrome-like phenotypes were followed from July 2017 to December 2019. We retrospectively analyzed their clinical profiles and genetic surveys. Of the 36 enrolled patients, 15 (41.7%) had SCN1A mutations, one (2.8%) had an SCN8A mutation, one (2.8%) had an STX1B mutation, and five females (13.9%) had PCDH 19 mutations. The median age at first seizure onset was 7 months in those with SCN1A mutations, 1.3 years in those with PCDH19 mutations, and 10 months for the remaining patients. The majority of the patients with SCN1A mutations had status epilepticus (80% vs. 20%) and fever-sensitive seizures (76% vs. 31%) compared to those with PCDH19 mutations. The patients with SCN1A -related seizures had a higher rate of focal seizures as first seizure type than those without SCN1A mutations. Three of five (60%) patients with PCDH19 mutations had brain magnetic resonance imaging abnormalities. The three most commonly used antiseizure medications were sodium valproate, levetiracetam, and clobazam. Seven of the 15 patients with SCN1A mutations used stiripentol. The median time from seizure onset to genetic diagnosis was 6.6 years (range 4 months–22.3 years). The patients with SCN1A mutations in this study had high rates of fever-sensitive seizures, status epilepticus, seizure onset with focal seizure type, and relatively young age at seizure onset. The patients with PCDH19 mutations had a relatively high rate of abnormal brain magnetic resonance imaging findings. [ABSTRACT FROM AUTHOR]

Purpose. The present study investigated the risk factors for high myopia in adulthood, with a focus on the age at which children wore their first spectacles. Methods. Adults aged between 20 and 45 years were invited to complete a questionnaire about age, sex, current refractive error, high myopia in parents, early onset of myopia presented by the age of the first myopic spectacle prescription, refractive power of the first spectacles, and life habits at different educational stages. The associations between these factors and high myopia in adulthood were then evaluated and analyzed. Results. In total, 331 participants were enrolled. Their average refractive error was −4.03 diopters, and high myopia was noted in 27.5% of the study participants. Only 3.3% of participants had fathers with high myopia, while 6.0% had mothers with high myopia. The participants received their first myopic spectacle prescription at a mean age of 13.35 years, with a mean refractive error of −1.63 diopters. The significant risk factors for developing high myopia in adult life were earlier age of the first spectacles prescribed (p < 0.001), higher refractive power of the first spectacles (p < 0.001), mother with high myopia (p = 0.015), and after-school class attendance in senior high school (p = 0.018). Those who wore their first spectacles at <9 years of age were more predisposed to high myopia than those who did so at ≧13 years, with an odds ratio of 24.9. Conclusion. The present study shows that earlier onset of myopia, which is presented by the age of the first myopic spectacle prescription, higher myopic refraction of the first spectacles, mothers with high myopia, and after-school class attendance in senior high school are risk factors for high myopia in adulthood. It suggests that delaying the onset of myopia in children is important for the prevention of high myopia in later life. [ABSTRACT FROM AUTHOR]

Background: The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. Objective: To determine whether medical legislation reform helps reduce the risk of medical litigation. Design, Setting, and Participants: This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. Interventions: After legislation reform vs before legislation reform. Measurements: The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1,  000,  000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. Results: With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727– 0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205– 0.288; p< 0.001). Conclusion: Medical legislation reform has reduced the risk of malpractice litigation over time. [ABSTRACT FROM AUTHOR]

Summary: A simple synthetic method without organic template is proposed for the synthesis of Ni‐silicate. The resulting Ni‐phyllosilicates are reconstructed by hydrothermal treatment to a porous structure with a high surface area (552 m2 g−1). Notably, the residual filtrate has a Ni2+ ion content of less than 0.1 ppm, and therefore satisfies the effluent standard in Taiwan (<1.0 ppm). As a result, it can be disposed of directly without the need for additional treatment. The effects of the pH value and hydrothermal treatment time on the structure, morphology, and surface area of the Ni‐silicate composites have been investigated. When applied to hydrogen production, the mesoporous Ni‐silicate shows a high catalytic capability (>99%) toward ammonia decomposition at a temperature of 400°C. Overall, the proposed synthetic method is facile and easily extendable to the production of other metal‐silicate materials for hydrogen generation. [ABSTRACT FROM AUTHOR]

The prevalence of hepatitis C virus (HCV) infection in Taiwan was approximately 4% a decade ago, much higher than the worldwide average. This study aimed to assess the HCV burden among 4 million voluntary blood donors after 2 decades of prevention and treatment policies. We retrieved screening results for anti‐HCV and HCV RNA from the Database for Evaluating Voluntary Taiwanese Eligible Donors. First‐time blood donors who donated blood after 1999 and repeat donors who donated blood more than once between 2013 and 2017 were included to estimate HCV prevalence and incidence, respectively. The Cox proportional hazards model was used to estimate hazard ratios. Geographic variation in HCV prevalence and incidence in 364 townships was also analyzed. The prevalence study included 3,656,598 first‐time donors. The overall crude prevalence of anti‐HCV decreased from 15.5 to 4.5 per 1,000 donors between 1999 and 2017. Younger birth cohorts had a significantly lower prevalence of anti‐HCV. The majority of townships (64.3%) in Taiwan showed a significantly decreased prevalence. The incidence study included 1,393,014 repeat donors followed for 3,436,607 person‐years. Ninety‐eight donors seroconverted to HCV RNA positivity, resulting in an HCV incidence of 2.9 per 100,000 person‐years. Donors living in townships where HCV RNA prevalence was greater than 2 per 1,000 had at least 2.5‐fold greater risk of new HCV infection. Conclusion: HCV prevalence in Taiwanese first‐time blood donors decreased by 71% in the last 2 decades. However, townships with higher HCV prevalence also showed higher HCV incidence and require more active intervention. [ABSTRACT FROM AUTHOR]

Background: De novo lipogenesis (DNL) is the primary metabolic pathway synthesizing fatty acids from carbohydrates, protein, or alcohol. Our aim was to examine associations of in vivo levels of selected fatty acids (16:0, 16:1n7, 18:0, 18:1n9) in DNL with incidence of type 2 diabetes (T2D). Methods and findings: Seventeen cohorts from 12 countries (7 from Europe, 7 from the United States, 1 from Australia, 1 from Taiwan; baseline years = 1970–1973 to 2006–2010) conducted harmonized individual-level analyses of associations of DNL-related fatty acids with incident T2D. In total, we evaluated 65,225 participants (mean ages = 52.3–75.5 years; % women = 20.4%–62.3% in 12 cohorts recruiting both sexes) and 15,383 incident cases of T2D over the 9-year follow-up on average. Cohort-specific association of each of 16:0, 16:1n7, 18:0, and 18:1n9 with incident T2D was estimated, adjusted for demographic factors, socioeconomic characteristics, alcohol, smoking, physical activity, dyslipidemia, hypertension, menopausal status, and adiposity. Cohort-specific associations were meta-analyzed with an inverse-variance-weighted approach. Each of the 4 fatty acids positively related to incident T2D. Relative risks (RRs) per cohort-specific range between midpoints of the top and bottom quintiles of fatty acid concentrations were 1.53 (1.41–1.66; p < 0.001) for 16:0, 1.40 (1.33–1.48; p < 0.001) for 16:1n-7, 1.14 (1.05–1.22; p = 0.001) for 18:0, and 1.16 (1.07–1.25; p < 0.001) for 18:1n9. Heterogeneity was seen across cohorts (I2 = 51.1%–73.1% for each fatty acid) but not explained by lipid fractions and global geographical regions. Further adjusted for triglycerides (and 16:0 when appropriate) to evaluate associations independent of overall DNL, the associations remained significant for 16:0, 16:1n7, and 18:0 but were attenuated for 18:1n9 (RR = 1.03, 95% confidence interval (CI) = 0.94–1.13). These findings had limitations in potential reverse causation and residual confounding by imprecisely measured or unmeasured factors. Conclusions: Concentrations of fatty acids in the DNL were positively associated with T2D incidence. Our findings support further work to investigate a possible role of DNL and individual fatty acids in the development of T2D. Fumiaki Imamura and colleagues investigate the association between concentrations of fatty acid involved in de-novo lipogensis and incidence of Type 2 diabetes. Author summary: Why was this study done?: De novo lipogenesis (DNL) is a metabolic pathway involved in the endogenous synthesis of specific fatty acids, such as 16:0, 16:1n7, 18:0, and 18:1n9, and it is linked to the pathophysiology of cardiometabolic diseases, including type 2 diabetes (T2D). Circulating or tissue concentrations of these fatty acids have been investigated for the associations with T2D incidence in epidemiological research. However, published studies reported inconsistent associations inconsistently and were subject to publication bias. Summary evidence is not available to date for the associations between these fatty acids and T2D incidence. An integration of available cohort studies would increase statistical power and allow assessment of generalizability, standardization of analytical strategies, and evidence synthesis with the potential publication bias minimized. What did the researchers do and find?: As a part of the Fatty Acids and Outcomes Research Consortium (FORCE), we conducted new individual-participant data analyses of 17 cohort studies of a total of 65,225 adults free of T2D at baseline, among whom 15,383 developed incident T2D over up to 20 years of follow-up. The cohort studies analyzed the associations between fatty acids (16:0, 16:1n7, 18:0, and 18:1n9) and the risk of developing T2D with standardized analytic strategy. In pooled analyses, each of the fatty acids was positively associated with a higher risk of developing T2D. The associations were independent of major risk factors for T2D, such as age, sex, race/ethnicity, socioeconomic characteristics, smoking status, physical activity, and obesity. What do these findings mean?: The findings provide the first summary evidence to date for the positive relationships of concentrations of the DNL-related fatty acids with a risk of T2D, indicating the strong relevance of DNL and its determinants to the development of T2D. These fatty acids potentially reflect the status of DNL activity, which may be stimulated or suppressed by a combination of carbohydrate intake, alcohol intake, polyunsaturated fatty acid intake, and other lifestyle and clinical factors. Therefore, the current findings indicate the need for investigation into determinants and consequences of elevated concentrations of these fatty acids. Despite several advantages of our individual-level data analysis in this pooling project, the results cannot establish whether elevated concentrations of these fatty acids caused the development of T2D or whether underlying peripheral or hepatic insulin resistance, for example, may elevate both the fatty acid concentrations and the risk of T2D independently. [ABSTRACT FROM AUTHOR]

Bauhinia championii (Benth.) is one of the commonly used herbs in Taiwan. The stem of this plant has been used to treat epigastria pain and rheumatoid arthritis. However, the antitumor activities of this herb have never been reported. This study aims to investigate the mechanism of anticancer activity of the extracts from B. championii (BC). BC was fractionated with a series of organic solvents, including n-hexane (H), ethyl acetate (EA), 1-butanol (B), and water (W). We first investigated the effects of BC-H, BC-EA, BC-B and BC-W partitioned fraction on cell viability. In HCT 116 colon cancer cell lines, BC-EA showed the highest inhibition of cell viability and changed the morphology of cells. With dose- and time-dependent manners, BC-EA inhibited the proliferation of HCT 116 cells by inducing apoptosis and G0/G1 phase arrest of cell cycle. To determine the underlying mechanisms, down-regulated CDK2, Cyclin D, and Cyclin E and up-regulated p16, p21, and p53 may account for the cell cycle arrest, while the apoptotic effect of BC-EA may attribute to increased intracellular Ca 2 + , loss of mitochondria membrane potential (Δ Ψ m ), increase of Bax, Bak, puma, and AIF, and decrease of Bcl-2. Furthermore, the inactivation of Ras signaling pathway by BC-EA also contributed to its apoptotic effect on HCT 116. Our study demonstrates that BC-EA not only inhibits cell growth but also induces apoptosis through inhibiting Ras signal pathway and increasing p53 expression levels. We suggest that BC-EA may be a new dietary supplement and a useful tool to search for therapeutic candidates against colon cancer. [ABSTRACT FROM AUTHOR]

This study investigates the subjective experiences of terminal cancer patients who expedite their corneal donation decisions. The percentage of cancer patients who donate their corneas postmortem is low in Taiwan. The reasons are complex and needs further exploration. A qualitative design using content analysis was used. A semistructured interview approach was adopted to interview cancer patients recruited from a cancer ward in northern Taiwan. The study findings show that the factors contributing to an aversive preference of cancer patients included the necessity to consider the emotions of family members, traditional perceptions, religious reasons, disease, and no reason at all. Most cancer patients maintain a negative stance toward corneal donation. The results obtained in the present study can be used as a reference for future in-service education and promotional efforts regarding corneal donation. Discussing cornea donation needs to become a routine end-of-life care discussion. [ABSTRACT FROM AUTHOR]

Environmental reward (ER) is an established mechanism contributing to depression. Given the high prevalence of depression in China and Taiwan, it is important to develop measures that facilitate the examination of cultural similarities and differences in ER. The reward probability index (RPI) assesses ER through items measuring individual access to rewarding (Reward Probability) and aversive (Environmental Suppressor) events. The purpose of the current study is to translate the RPI into Chinese (C-RPI) and to study cultural difference in ER by examining structural- and item-level differences in RPI functioning. A total of 930 college students were recruited from China (n = 300), Taiwan (n = 300), and the United States (n = 330). Confirmatory factor analysis was used to study the configural invariance of the RPI and C-RPI. Item response theory-based differential item functioning (DIF) testing was used to study item level differences in functioning between the RPI and C-RPI. Results overall support the established RPI structure in all three regions. Most Reward Probability items exhibit no DIF across cultures, while most Environmental Suppressor items exhibit DIF across cultures. Findings highlight cultural difference in ER constructs and cultural factors contributing to the observed DIF. The assessment and clinical implications of the findings are also discussed. [ABSTRACT FROM AUTHOR]

Recent blood distribution profiles for transfusions in Taiwan have not been comprehensively documented. This study aimed to analyze trends in red blood cell (RBC), platelet, and plasma distribution rates, and compares these profiles with those in other countries. The distribution rates of RBC, platelets, and plasma in Taiwan during 2015 were 47.6, 11.1, and 26.8 units per 1000 population, respectively. At least 1.5 and 2.5-fold higher platelet and plasma distribution rates were observed than other selected countries. During 2007-2015, there was no significant change in RBC distribution. However, we observed a significant increase of 0.20 (95% CI: 0.11-0.30) adult doses of platelets, and a significant decrease of 1.69 (95% CI: 1.45-1.93) units of plasma per 1000 population per annum. Seven other countries showed a general significant decreasing trend of RBC distributions. Higher blood distribution rates were observed in Taiwan. Therefore, the adoption of patient blood management is essential. [ABSTRACT FROM AUTHOR]

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an anti-neuronal antibody-mediated inflammatory brain disease that causes severe psychiatric and neurological deficits in previously healthy patients. The aims of this study were to demonstrate the clinical characteristics of patients diagnosed with anti-NMDA receptor encephalitis and to compare the different treatment strategies among these patients. Patients presenting with newly acquired psychiatric and/or neurological deficits were studied retrospectively from 2009 to 2017. Patients with evidence of anti-NMDA receptor antibodies in serum and/or cerebrospinal fluid were enrolled. The modified Rankin scale was used to assess the initial status and outcomes of the enrolled patients. Details of the clinical presentations and results of investigations were analyzed. All (n = 24) of the patients received first-line immunotherapy (steroids, and/or intravenous immunoglobulin, and/or plasma exchange), and 14 patients received second-line immunotherapy (rituximab and/or cyclophosphamide). The mean time between the first- and second-line treatment was 13 days. During the first 6 months, 20 patients (20/24, 83%) achieved a good outcome (modified Rankin Scale score ≤2) and 15 patients (15/24, 62.5%) completely recovered. Four patients (17.7%) relapsed, and three patients (12.5%) had associated tumors. Immunotherapy is an effective treatment for anti-NMDA receptor encephalitis. Rituximab and/or cyclophosphamide are treatment options for those who cannot tolerate or do not respond to first-line immunotherapy. Prospective studies are necessary to investigate the role of rituximab and cyclophosphamide in anti-NMDA receptor encephalitis. [ABSTRACT FROM AUTHOR]

High compliance with methadone maintenance therapy (MMT) is crucial to successful opioid abstinence in addicts. However, MMT has numerous side effects, including reductions in quality of life and quality of sleep. Many studies have demonstrated that electroacupuncture relieves withdrawal symptoms in opioid addicts. The present study was a case-control study. From January 2015 to September 2016, 106 patients undergoing MMT at a medical center in central Taiwan were recruited and separated into an electroacupuncture treatment group and a control group. Electroacupuncture was performed for 15 minutes twice weekly for 4 weeks. The electroacupuncture treatment group was discovered to have improved quality of life, especially in terms of vitality and mental health. Although electroacupuncture did not significantly improve sleep quality, we found that sleep quality was significantly improved once methadone dosage had been reduced. Electroacupuncture can improve quality of life in patients undergoing MMT. If methadone dosage can be reduced and electroacupuncture can be employed, both sleep and life quality can be improved. [ABSTRACT FROM AUTHOR]

In this study, mesoporous Cu Fe/silicate catalysts were obtained from a simultaneously mixing the NaOH and metal-ion solution to sodium silicate solution and a hydrothermal treatment under alkaline condition without using any organic template. During hydrothermally reaction, the amorphous metal-silicate would reconstruct and formation of the mesostructured Cu Fe/silicate. At appropriate pH values, the silicate species can strongly bind with the Cu2+ ions to form the stable Cu Fe/silicate, and the [Cu2+] in the final filtrated solution is lower than the effluent standard in Taiwan (1.0 ppm). To find the appropriate synthetic parameters, the effects of the pH value, metal to silicate ratio, and the hydrothermal treatment time on the surface areas and mesostructure of the resulted Cu Fe/silicates were discussed in detail. In practice, the mesoporous Cu Fe/silicate catalyst with high surface area of 547 m2g-1 demonstrated a high methanol conversion within 1 h up to >99% at 180 °C to be used as high-performance catalysts for steam reformer of methanol. • Mesoporous Cu Fe/silicate catalysts with high surface area of 547 m2g-1 were obtained. • The [Cu2+] in the final filtrated solution is lower than 1.0 ppm. • The Cu Fe/silicate catalysts demonstrate high methanol conversion up to >99% at 180 °C. [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]

Taiwanofungus camphoratus is a precious medicinal fungus endemic to Taiwan and has been used as traditional medicine for a long time. Many pharmacological studies have revealed that T. camphoratus possessed various biological activities, such as immunomodulatory effects, anticancer activity and liver protective function. The aim of this study is to investigate the non-specific and antigen (ovalbumin [OVA])-specific immunomodulation effects of solid-state cultivated powder of T. camphoratus (Leader Antrodia cinnamomea [LAC]) in BABL/c male mice. In non-specific and antigen-specific immune function studies, 8-week-old mice were orally administered with LAC for 6 and 8 weeks, respectively. The results have shown that the proliferation of splenic immune cells, phagocytic activity of macrophages and cytolytic activity of natural killer cells were enhanced by LAC. Additionally, LAC increased the levels of IL-2, TNF-α, INF-γ, GM-CSF and serum OVA-IgG and OVA-IgM. These findings provided evidences that LAC had the immunomodulation effects on both antigen-specific and non-specific immune responses in mice. [ABSTRACT FROM AUTHOR]

Background: Previous prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD). Methods: Between 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance. Results: A total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH. Conclusions: After 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients. [ABSTRACT FROM AUTHOR]

Background/purpose The Taita symptom checklist (TSCL) is a standardized self-rating psychiatric symptom scale for outpatients with mental illness in Taiwan. This study aimed to examine the validity and reliability of the TSCL using Rasch analysis. Methods The TSCL was given to 583 healthy people and 479 people with mental illness. Rasch analysis was used to examine the appropriateness of the rating scale, the unidimensionality of the scale, the differential item functioning across sex and diagnosis, and the Rasch cut-off score of the scale. Results Rasch analysis confirmed that the revised 37 items with a three-point rating scale of the TSCL demonstrated good internal consistency and met criteria for unidimensionality. The person and item reliability indices were high. The TSCL could reliably measure healthy participants and patients with mental illness. Differential item functioning due to sex or psychiatric diagnosis was evident for three items. A Rasch cut-off score for TSCL was produced for detecting participants' psychiatric symptoms based on an eight-level classification. Conclusion The TSCL is a reliable and valid assessment to evaluate the participants' perceived disturbance of psychiatric symptoms based on Rasch analysis. [ABSTRACT FROM AUTHOR]

Substrate Modification in Persistent Atrial Fibrillation Introduction The optimal substrate ablation approach in patients with persistent atrial fibrillation (Per AF) remains unclear. This was a prospective randomized study comparing the efficacy of limited (continuous complex fractionated atrial electrogram, CFAE: <60 milliseconds) versus extensive (continuous CFAE plus variable CFAE: <120 milliseconds) atrial substrate modification in Per AF patients. Methods and Results We enrolled 120 Per AF patients in the study, and 30 patients with AF termination after pulmonary vein isolation (PVI) were excluded. In the remaining 90 patients, 45 were treated with limited approach (Group 1) and 45 with an extensive approach (Group 2). The end point of the study was the incidence of an atrial arrhythmia recurrence postblanking period. The patients were followed up for 15 months with 3-month clinical reviews, electrograms (ECGs), Holter recordings, and echocardiographic monitoring. Procedural AF termination and the single procedural efficacy were statistically comparable between the 2 groups (48.9% vs. 63.4% in Groups 1 and 2, respectively, P = 0.289). During the follow-up, patients who received limited ablation had a lower incidence of recurrent AFL (P = 0.04), and better reverse remodeling of the left atrium (LA, P = 0.04). After 2 procedures, the freedom from any atrial arrhythmia was better in Group 2 (62.2% vs. 87.8%, P = 0.009). Those with longstanding AF and a larger baseline LA size responded better to the extensive ablation. Conclusions In the Per AF patients who failed to achieve AF termination after PVI alone, a specific atrial substrate modification approach targeting only continuous CFAEs could be considered as an initial ablation strategy. [ABSTRACT FROM AUTHOR]

Highlights: [•] The HLA-DQ β1∗06:02 allele is strongly associated with narcolepsy with cataplexy in patients from Taiwan. [•] The association is less prominent in narcolepsy patients without cataplexy in our sample. [•] HLA-DQ β1∗03:01 is another risk allele associated with cataplexy patients in our sample. [•] HLA-DQ β1∗06:01 is another risk allele associated with cataplexy negative patients in our sample. [ABSTRACT FROM AUTHOR]

Aims: This study examines the reliability and validity of the Mastery Scale-Chinese version (MS-C) when applied to three groups diagnosed with major depression, schizophrenia, or HIV/AIDS. Methods: The individuals participating in the study were recruited from outpatient units of a medical center and a municipal hospital in northern Taiwan. The study sample ( n = 2009) included 237 patients with depressive disorders, 160 with schizophrenia, and 1612 with HIV/AIDS. The reliability and construct validity of the MS-C was evaluated by confirmatory factor analysis (CFA) and Rasch analysis. Results: The results of the CFA showed that the MS-C has adequate construct validity with all indices meeting the criteria, except for chi-square values. The Rasch analysis supported the four-point rating scale structure and a unidimensional construct of the MS-C. The DIF analysis showed that all items demonstrated stable measurement properties among the different diagnosis groups (major depression, schizophrenia, HIV/AIDS). Conclusion: This study found that MS-C has acceptable psychometric qualities in terms of reliability, construct validity, rating scale performance, and item characteristics when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan. [ABSTRACT FROM AUTHOR]

Abstract: The aggressiveness of end-of-life (EOL) cancer care has often been analysed by the occurrence of several indicators, separately or aggregately. Whether aggressive EOL cancer care has different subtypes is unknown. This study sought to identify distinct subtypes of aggressive EOL care based on usage patterns of aggressive EOL-care indicators and to explore demographic, disease and treatment factors associated with the identified subtypes. This retrospective study linked data from 2001 to 2006 from three Taiwanese databases: National Registration of Death Database, Cancer Registration System and National Health Insurance claims database. Adult cancer patients (N =203,642) who died in 2001–2006 were selected. For these cancer patients’ last month of life, we analysed eight indicators of aggressive EOL care: receiving chemotherapy, >1 emergency room visit, >1 hospitalisation, hospitalisation for >14days, intensive care unit admission, received cardiopulmonary resuscitation, received intubation and received mechanical ventilation. Subtypes of aggressive EOL care were identified by latent class analysis. Among the study population, only 22.3% were treated by medical oncologists. Based on their profiles of EOL care, deceased cancer patients were classified into three subgroups: ‘not aggressive’ (45%), ‘intent to sustain life’ (33%) and ‘symptom crisis’ group (22%). Patients assigned to the ‘intent to sustain life’ group were less likely to have metastatic disease and to receive hospice care in the last year of life, but more likely to be cared for by non-medical oncologists, to die within 2months after diagnosis and to die in hospital. EOL cancer care may be improved by understanding factors related to different subtypes of aggressive EOL care. [Copyright &y& Elsevier]

Climate change has exerted a significant global impact in recent years, and extreme weather-related hazards and incidents have become the new normal. For Taiwan in particular, the corresponding increase in disaster risk threatens not only the environment but also the lives, safety, and property of people. This highlights the need to develop a methodology for mapping disaster risk under climate change and delineating those regions that are potentially high-risk areas requiring adaptation to a changing climate in the future. This study provides a framework of flood risk map assessment under the RCP8.5 scenario by using different spatial scales to integrate the projection climate data of high resolution, inundation potential maps, and indicator-based approach at the end of the 21st century in Taiwan. The reference period was 1979–2003, and the future projection period was 2075–2099. High-resolution climate data developed by dynamic downscaling of the MRI-JMA-AGCM model was used to assess extreme rainfall events. The flood risk maps were constructed using two different spatial scales: the township level and the 5 km × 5 km grid. As to hazard-vulnerability(H-V) maps, users can overlay maps of their choice—such as those for land use distribution, district planning, agricultural crop distribution, or industrial distribution. Mapping flood risk under climate change can support better informed decision-making and policy-making processes in planning and preparing to intervene and control flood risks. The elderly population distribution is applied as an exposure indicator in order to guide advance preparation of evacuation plans for high-risk areas. This study found that higher risk areas are distributed mainly in northern and southern parts of Taiwan and the hazard indicators significantly increase in the northern, north-eastern, and southern regions under the RCP8.5 scenario. Moreover, the near-riparian and coastal townships of central and southern Taiwan have higher vulnerability levels. Approximately 14% of townships have a higher risk level of flooding disaster and another 3% of townships will become higher risk. For higher-risk townships, adaptation measures or strategies are suggested to prioritize improving flood preparation and protecting people and property. Such a flood risk map can be a communication tool to effectively inform decision- makers, citizens, and stakeholders about the variability of flood risk under climate change. Such maps enable decision-makers and national spatial planners to compare the relative flood risk of individual townships countrywide in order to determine and prioritize risk adaptation areas for planning spatial development policies. [ABSTRACT FROM AUTHOR]