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Online learning has been widely discussed in education research, and open educational resources have become an increasingly popular way to help learners acquire knowledge. However, these resources contain massive amounts of information, making it difficult for learners to identify Web articles that refer to computer science knowledge. This study developed an Internet articles retrieval agent combined with dynamic associative concept maps (DACMs). The system used text mining technology to analyze keywords to filter computer science articles. In previous research, concept maps were manually constructed; in this study, such maps can be automatically and dynamically generated in real time. In a case study of a fundamental course of artificial intelligence, this study designed two experiments to compare students' learning behaviors while using this system and the Google search engine. The results of the first experiment showed that the experimental group searched for more knowledge articles on computer science using this agent, compared to the control group using the Google search engine. The learning performance of the experimental group was significantly better than that of the control group, while the cognitive load of the experimental group was significantly lower than that of the control group. Furthermore, the results of the second experiment showed that the learning progress of students using the agent was significantly greater than that of students who used the Google search engine. This illustrates that the agent effectively filtered computer science articles, and DACMs helped students gain a deeper understanding of academic concepts and knowledge related to artificial intelligence.

This research focuses on the approach adopted by a university of science and technology in Taiwan (hereinafter the university) to develop students' employability indices and to explore the questionnaire analyses. The university developed the "Employability Map; E-Map" by weighting the learning hours, which was used to evaluate students' various employability items over the course of their schooling. Considering it not so appropriate to use students' credits on courses to be the standard of judgment, the Department of Computer Science & Information Engineering (hereinafter the department) proposed an innovative method to convert the E-Map of weighting by learning achievement to conduct assessments that is more reflection students' employability indices for graduate, and analyzed the questionnaires of alumni and their employers' various core employability indices. From those questionnaires, finding the graduating students and alumni are lack of self-confidence. The statistical data shall serve as a reference for guiding students at course selection, as well as improving department courses and planning.

The present study aims to incorporate a group leadership promotion approach into collaborative learning tasks in the hope of developing students' creativity, problem-solving, and critical thinking. In order to evaluate the effectiveness of the proposed approach, we recruited 59 cross-professional students from a university in northern Taiwan, and divided them into an experimental group (6 sub-groups) and a control group (6 sub-groups). The experimental group students learned with the group leadership promotion approach, while the control group learned with conventional blended learning approach. The results show that the students could better develop their creativity, problem-solving, critical thinking, and learning achievement via the group leadership promotion approach. Lastly, sequential analysis of their behaviors indicated that students' interaction with group leadership in online collaborative learning can promote many more creative ideas and comments, enhance reaching a consensus and making conclusions, and finally, facilitate completion of the group learning tasks.

Objective: Communication skills are important, but the evaluation of these skills in the medical curriculum remains inconsistent. The aim of this study was to explore the relationship between the communication skills scores of junior medical students following curricula with different module evaluations and the clinical interview performance of the same students in a psychiatry department in their fifth year. Design: Prospective evaluation of communication and clinical interview skills. Setting: Medical school and psychiatry department inpatient setting. Method: The communication skills scores of 208 medical students in their second year (between 2009 and 2011) and their performance in interviews with patients in a psychiatry department in their fifth year (between 2012 and 2014) were assessed. Initial assessment was undertaken on the basis of problem-based learning (PBL) performance, evaluation of performance during conversation with patients, a related oral presentation and written report, students' self-rating and a peer rating. Extra marks were given if students completed an optional special report inspired by the curriculum. To assess the interview performance of fifth-year medical students, the mini-Clinical Evaluation Exercise (mini-CEX) was used, together with weekly case-based discussions and the observation of a clinical interview with a real patient. Results: Tutors' evaluations of the junior medical students' performance during role-play (? = 0.22, p = 0.001), its related reciprocal assessment (? = 0.18, p = 0.010) and an extra-effort task (? = 0.18, p = 0.009) as part of the communication skills curriculum were significantly correlated with the students' later performance in a clinical interview with a patient. Conclusion: Observation of student interactions and motivations along with reciprocal peer evaluations offer better measures of communication skills in medical education than are oral presentations, self-ratings and conversations with real patients.

Researchers have conducted numerous empirical studies on evaluation capacity (EC) and evaluation capacity building (ECB) in Western cultural settings. However, little is known about these practices in non-Western contexts. To that end, this study identified the major dimensions of EC and feasible ECB approaches in Taiwanese elementary and junior high schools. Using a Delphi technique with 23 experts, the research sought consensus on the components of EC organized in three categories (evaluation culture, evaluation infrastructure, and human resources) and on approaches to building it in Taiwanese schools. The study also identified school-driven and government-driven approaches to ECB in this context. Although the findings support the major dimensions and approaches identified in the Western literature, unique differences emerged in the Taiwanese context. The article concludes with implications for theory and practice.

Purpose: The purpose of this paper is to discuss how principals in Taiwan lead student and teacher learning at a time of leadership and learning paradigm shifts and the imminent implementation of the curriculum guideline for 12-year basic education. Design/methodology/approach: This study interviewed 32 elementary and junior high school principals purposively sampled based on reputation and recommendation from senior principals and government officials. Findings: As a society which values credentialism, principals in Taiwan face challenges in executing the vision of educating student as a whole person. The authors discuss how principals are solidifying whole person education as the espoused value, how they are enforcing school-based curriculum and effective instruction, and encouraging teacher professional learning. Principals are sharing power by recruiting stakeholders' participation in guiding school development and enacting distributed leadership, while also building relationship as social capital and soliciting support from the community to establish the conditions to improve teaching and learning. Research limitations/implications: This paper highlights how principal practices are evolving in a time of changing conception of learning from academic achievement to multiple competencies and the shifting paradigm of power from participatory decision making to distributed leadership. This paper ends with a discussion on how leadership for learning (LfL) as a community engagement has emerged. Practical implications: With the shifting of the concept and paradigm of learning, principals in a high power distance society like Taiwan are now facing opportunities as well as challenges to lead teachers to engaging students in inquiry and collaboration. Originality/value: This paper highlights the indigenous practices of principal LfL in a high-performing East Asian education system in a time of changing notions of learning and leadership.

Some music has been proved effectively to mitigate anxiety, beneficial to reading. However, little was known on its influence of reading behaviors and outcomes. Thanks to the advance of e-book technology, it becomes possible to track reading rate and outcomes in a real-time manner by the underlying mobile devices. This study intends to examine the effects of the Mozart piece K.448 (sonata for two pianos in D major) on the learning anxiety, reading rates and reading comprehension of students for reading e-books. The quasi-experimental design was applied, and 62 senior grade elementary school students participated in this experiment. The results showed that when compared with a silent task (reading without the music), this piece of Mozart's music had positive effect in reducing learning anxiety, and improving the students' reading rates, reading comprehension and direct process performance. However, we found that the music had a negative effect on the students' attention for their interpretation process. We inferred that this Mozart's music might take part of attention resource. This was supported by the increase of students' extraneous load while listening to Mozart music, which led to the insufficient concentration in the interpretation and the evaluation of content. Overall, the findings reveal that the use of certain music, such as Mozart K.488, can be a potential tool to enhance reading outcomes when using e-books.

In recent years, Taiwan has actively pursued the development of renewable energy, with offshore wind power assessments indicating that 80% of the world's best wind fields are located in the western seas of Taiwan. The aim of this study is to maximize offshore wind power generation and develop a method for predicting offshore wind power, thereby exploring the potential of offshore wind power in Taiwan. The research employs machine learning techniques to establish a wind speed prediction model and formulates a real-time wind power potential assessment method. The study utilizes long short-term memory networks (LSTM), gated recurrent units, and stacked recurrent neural networks with LSTM units as the architecture for the wind speed prediction model. Furthermore, the prediction models are categorized into annual and seasonal patterns based on the seasonal characteristics of the wind. The research evaluates the optimal model by analyzing the results of the two patterns to predict the power generation conditions for 1 to 12 h. The study region includes offshore areas near Hsinchu and Kaohsiung in Taiwan. The novelty of the study lies in the systematic analysis using multiple sets of wind turbines, covering aspects such as wind power potential assessment, wind speed prediction, and fixed and floating wind turbine considerations. The research comprehensively considers the impact of different offshore locations, turbine hub heights, rotor-swept areas, and wind field energy on power generation. Ultimately, based on the research findings, it is recommended to choose the SG 8.0-167 DD wind turbine system for the Hsinchu offshore area and the SG 6.0-154 wind turbine system for the Kaohsiung offshore area, serving as reference cases for wind turbine selection. [ABSTRACT FROM AUTHOR]

This study examined technical characteristics of slopes produced from two general outcome measures (GOMs)--the Naming Spelling and the Dictating Spelling tests. A total of 305 first-graders in Taiwan participated in the study and underwent weekly assessments for 6 weeks. Six alternate forms were developed for each of the two measures to monitor young students' learning progress of Zhu Yin Fu Hao (ZYFH). Technical characteristics of the two measures were examined in terms of reliability, sensitivity, and criterion validity for assessing student growth. Results showed that the alternate-form reliability coefficients ranged from 0.88 to 0.94 (mean = 0.92) for the Naming Spelling test, and from 0.77 to 0.83 (mean = 0.80) for the Dictating Spelling test. Both tests demonstrated to be sensitive for monitoring student's learning progress by revealing a quadratic growth pattern and inter-individual differences in growth rates. The growth rates estimated from repeated Naming and Dictating Spelling tests were found to correlate with students' performance on the final exam of ZYFH for lower-performing students. Results support the use of these two GOMs tests as reliable, sensitive, and valid measures for monitoring first-graders' learning progress of ZYFH.

A cooperative education experience (or internship placement) is an essential component of the curricula of vocational higher education. The efficacy of internship placements has become one of the major concerns facing those who develop education curricula. The purpose of this longitudinal study was to explore the relationships among the multi-faceted predictors of intern commitment as a reflection of internship efficacy. Participants were drawn from third-year undergraduate students. A structural equation model applied to the final sample of 357 usable questionnaires demonstrated that individual goal orientation and mentoring positively affected both person-job and person-organization fit, leading to intern job satisfaction and commitment to the profession. A non-significant predictor, student learning goal orientation, is also comprehensively discussed. The findings imply that incorporating an internship (i.e., workplace learning experience) and professional mentoring into vocational higher education curricula would advance students' personal growth and future careers. (Contains 1 table and 2 figures.)

This paper explores the search effectiveness of social tagging which allows the public to freely tag resources, denoted as keywords, with any words as well as to share personal opinions on those resources. Social tagging potentially helps users to organize, manage, and retrieve resources. Efficient retrieval can help users put more of their focus on studying the resources rather than the retrieval process. This study was an investigation into the relations between social tags and user queries. Our findings were summarized into 4 main points: (1) 85% of the surveyed users agreed that social tags assisted them in searching for resources; (2) Over 40% of user queries searches, found their resources via the matching of social tags; (3) Social tags matched over 70% of user queries; and (4) 14% of the social tags for a resource did not appear in the context of the resource. The experimental results demonstrated that social tags can improve users' efficiency in searching for resources. (Contains 1 table and 7 figures.)

This study developed a Mobile Plant Learning System (MPLS) that provides instructors with the ways and means to facilitate student learning in an elementary-school-level botany course. The MPLS represented in this study was implemented to address problems that arise with the use of a didactic approach to teaching and learning botany, as is typically used in elementary schools in Taiwan. To extend opportunities for learning beyond the classroom, this study used personal digital assistants (PDAs) equipped with the MPLS, which provided both teachers and students access to plant information while in the field. A quasi-experimental research design was used to investigate the effectiveness of using the MPLS to support student learning. The responses to questionnaires and interviews indicate that students valued the outdoor learning activities made possible by use of the PDA and its functions. Pre- and post-test results demonstrated that students also benefitted academically from the use of the MPLS and the PDA. (Contains 6 tables and 7 figures.)

Due to the rise of e-Learning, more and more useful learning materials are open to public access. Therefore, an appropriate learning suggestion mechanism is an important tool to enable learners to work more efficiently. A smoother learning process increases the learning effect, avoiding unnecessarily difficult concepts and disorientation during learning. However, many suggestion demands come from different abstraction levels, and traditional single level frequent pattern mining is not sufficient. This paper proposes a methodology for mining frequent patterns of learners' behavior which connote a hierarchical scheme to provide cross-level learning suggestions for the next learning course. With this system, a learner can get multiple levels of abstract suggestions instead of merely single level frequent pattern mining results. Our study shows that the algorithms can mine considerable quantities of frequent patterns from real life learning data. The experimental data are collected from a Web learning system originating from National Cheng Kung University in Taiwan. The proposed methodology gives learners many suggestions to help them learn more effectively and efficiently. Finally, we collect some representative cases to realize different requirements which are extracted from a learners' access database. These cases are classified into three types; notably, type three generalized four meaningful external factors which are inferred by our observations from these cross-level frequent patterns. (Contains 6 tables and 11 figures.)

Previous studies had showed that indigenous clones of Salmonella Typhi and S. Paratyphi were originally imported from other countries in Taiwan. We presented the clinical manifestations and laboratory findings of indigenous and imported enteric fever cases in Taiwan in the current decade. We retrospectively reviewed typhoid and paratyphoid fever cases in two medical centers of Chang Gung Memorial Hospitals in 2010-2020. A total of 37 enteric fever cases including 24 typhoid fever and 13 paratyphoid fever were recorded. There were 20 indigenous cases, 16 imported cases, and one indetermined case. Splenomegaly and hepatitis were more frequent in typhoid fever than in paratyphoid fever (P < 0.05). Imported cases had more ciprofloxacin non-susceptibility rate (8/16, 50.0%) than indigenous cases (2/20, 10%). Indigenous ciprofloxacin non-susceptible S. Typhi isolates were found in 2018. One indigenous S. Paratyphi B isolate was multi-drug resistant (MDR) to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for cardiovascular diseases, which contributes to the worldwide mortality rate. Successful blood pressure control requires adherence to medications and lifestyle modifications. However, motivating patients with primary hypertension to change and sustain behaviors long‐term is challenging. A web‐based self‐care program centered on self‐efficacy theory could provide feedback for effective control of blood pressure. Purpose: To examine the effect of a web‐based self‐care program for patients with primary hypertension on cardiovascular risk‐factors (pulse pressure and lipids), self‐efficacy, and self‐care behaviors (medication adherence and lifestyle). Design A two‐armed randomized controlled trial with 3‐month and 6‐month follow‐ups. Setting and Participants: A total of 222 patients with primary hypertension were recruited between February 2017 and August 2018 at a cardiology clinic of a medical center in Taipei, Taiwan. Methods: Eligible patients were randomized by permuted block randomization into the intervention group (n = 111) and control group (n = 111). Patients in the intervention group received a 6‐month web‐based self‐care program, based on the theory of self‐efficacy, while patients in the control group received usual care. Baseline and outcome measures (3 and 6 months) included self‐efficacy, evaluated with the Chinese version of the 6‐item Self‐Efficacy for Managing Chronic Diseases (SEMC6), self‐care, using subscales of the Hypertension Self‐Care Activity Level Effects Scale (H‐SCALE) for lifestyle and medication adherence, and blood pressure and serum lipid data, collected through web‐based self‐reports and chart review. Generalized estimating equations evaluated the effects of the intervention. Findings At baseline, the control group had higher scores on the SEMC6, and lower cholesterol (HDL) compared with the intervention group (t = −2.70, p < 0.05; and t = 1.76, p < 0.05, respectively). Pulse pressure decreased significantly (β = −20.30, 95% CI −23.76, −16.83), and serum triglycerides and low‐density lipoprotein cholesterol levels were significantly lower compared with controls at 6 months (all p < 0.001). At 6 months, the intervention group had significantly higher mean scores for the SEMC6 compared with the control group (β = 21.84, 95% confidence interval [CI] 19.25, 24.42) and H‐SCALE subscale for medication adherence, diet, weight management, and physical activity compared with controls at 6 months (all, p < 0.001). Conclusions and clinical relevance: The greatest benefit of this program was allowing participants to immediately consult with the researchers about self‐care issues via the website. Lifestyles vary from person to person; therefore, the individuality of each participant was considered when providing feedback. We provided devising interventions for participants that would increase their confidence in self‐care for hypertension and ultimately achieve home blood pressure control. We encourage incorporating this program into standard clinical care for patients with hypertension. [ABSTRACT FROM AUTHOR]

Dermatophytes are the group of keratinophilic fungi that cause superficial cutaneous infection, which traditionally belong to the genera Trichophyton, Microsporum, and Epidermophyton. Dermatophyte infection is not only a threat to the health of small animals, but also an important zoonotic and public health issue because of the potential transmission from animals to humans. Rabbit dermatophytosis is often clinically identified; however, limited information was found in Asia. The aims of this study are to investigate the prevalence and to evaluate the risk factors of dermatophytosis in pet rabbits in Northern Taiwan. Between March 2016 and October 2018, dander samples of pet rabbits were collected for fungal infection examination by Wood's lamp, microscopic examination (KOH preparation), fungal culture, and PCR assay (molecular identification). Z test and Fisher's exact test were performed to evaluate the potential risk factors, and logistic regression analysis was then performed to build the model of risk factors related to dermatophyte infection. Of the collected 250 dander samples of pet rabbits, 29 (11.6%) samples were positive for dermatophytes by molecular identification. In those samples, 28 samples were identified as the T. mentagrophytes complex and 1 sample was identified as M. canis. Based on the results of the Firth's bias reduction logistic analyses, animal source (rabbits purchased from pet shops) and number of rearing rabbits (three rabbits or more) were shown as the main risks for dermatophyte infection in the pet rabbits in Taiwan. The results of the present study elucidate the prevalence of rabbit dermatophyte infection, pathogens, and risk factors in Taiwan, and provide an important reference for the prevention and control of rabbit dermatophytosis. [ABSTRACT FROM AUTHOR]

Rapid development and deployment of vaccines is crucial to control the continuously evolving COVID-19 pandemic. The placebo-controlled phase 3 efficacy trial is still the standard for authorizing vaccines in the majority of the world. However, due to a lack of eligible participants in parts of the world, this has not always been feasible. Recently, the Taiwan Food and Drug Administration, following the consensus of the International Coalition of Medicines Regulatory Authorities (ICMRA), adopted the use of immunobridging studies as acceptable for authorizing COVID-19 vaccines in lieu of efficacy data. Here, we describe a study in which our candidate vaccine, MVC-COV1901, an adjuvanted protein subunit vaccine, has been granted emergency use authorization (EUA) in Taiwan based on a noninferiority immunobridging study. Immunogenicity results from the per protocol immunogenicity (PPI) subset (n = 903) from the MVC-COV1901 phase 2 trial were compared with results from 200 subjects who had received an adenovirus vector vaccine, AstraZeneca ChAdOx nCOV-19 (AZD1222), in a separate study. The lower bound of the 95% confidence interval (CI) of the geometric mean titer (GMT) ratio comparing MVC-COV1901 to AZD1222 was 3.4. The lower bound of the 95% CI of the sero-response rate was 95.5%. Both the GMT ratio and sero-response rate exceeded the criteria established by the Taiwan regulatory authority, leading to EUA approval of MVC-COV1901 in Taiwan. [ABSTRACT FROM AUTHOR]

Objectives: The choice of optimal antithrombotic therapy in atrial fibrillation (AF) patients with acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains controversial. The aim of this longitudinal cohort study is to investigate the prescribing pattern of antithrombotic regimen in different cohorts and its subsequent impact. Setting and design: Longitudinal data from the Tri-Service General Hospital-Coronary Heart Disease (TSGH-CHD) registry, between January 2016 and August 2018 was screened. Participants and method: Patients with prior history of nonvalvular AF, who had ACS presentation or underwent PCI were selected, and these patients were divided into cohort 1 and cohort 2, according to the index date of antithrombotic prescription before and after the PIONEER AF-PCI study. Primary and secondary outcomes: The primary safety endpoints were composites of major bleeding and/or clinically relevant non-major bleeding. The secondary efficacy endpoints included the occurrence of all-cause mortality, stroke/systemic embolization, nonfatal myocardial infarction (MI), and >30-days coronary revascularization. Results: A total of 121 patients were included into analysis (cohort 1=35; cohort 2=86). Comparing with cohort 1, the prescription rate of triple antithrombotic therapy (TAT) increased from 17.1 to 38.4%, especially the regimen with dual antiplatelet therapy (DAPT) plus low-dose non-vitamin-K dependent oral anticoagulation (NOAC). However, the prescription rate of dual antithrombotic therapy (DAT) decreased (14.3–10.5%), as well as the prescription rate of DAPT (68.6–51.2%). These changes of antithrombotic prescription across different cohorts were not associated with risk of adverse safety (HR= 0.87; 95% CI, 0.42-1.80, p=0.710) and efficacy outcomes (HR=0.96; 95% CI, 0.40-2.32, p=0.930). Conclusions: Entering the NOAC era, the prescription of TAT increased alongside the decrease in DAT. As the prescription rate of DAPT without anticoagulation remained high, future efforts are mandatory to improve the implementation of guidelines and clinical practice. [ABSTRACT FROM AUTHOR]

MVC-COV1901, a recombinant protein vaccine containing pre-fusion-stabilised spike protein S-2P adjuvanted with CpG 1018 and aluminium hydroxide, has been shown to be well tolerated with a good safety profile in healthy adults aged 20–49 years in a phase 1 trial, and provided a good cellular and humoral immune responses. We present the interim safety, tolerability, and immunogenicity results of a phase 2 clinical trial of the MVC-COV1901 vaccine in Taiwan. This is a large-scale, double-blind, randomised, placebo-controlled phase 2 trial done at ten medical centres and one regional hospital in Taiwan. Individuals aged 20 years or older who were generally healthy or had stable pre-existing medical conditions were eligible for enrolment. Exclusion criteria included (but were not limited to) travel overseas within 14 days of screening, intention to travel overseas within 6 months of the screening visit, and the absence of prespecified medical conditions, including immunosuppressive illness, a history of autoimmune disease, malignancy with risk to recur, a bleeding disorder, uncontrolled HIV infection, uncontrolled hepatitis B and C virus infections, SARS-CoV-1 or SARS-CoV-2 infections, an allergy to any vaccine, or a serious medical condition that could interfere with the study. Study participants were randomly assigned (6:1) to receive two doses of either MVC-COV1901 or placebo, administered via intramuscular injection on day 1 and day 29. MVC-COV1901 contained 15 μg of S-2P protein adjuvanted with 750 μg CpG 1018 and 375 μg aluminium hydroxide in a 0·5 mL aqueous solution, and the placebo contained the same volume of saline. Randomisation was done centrally by use of an interactive web response system, stratified by age (≥20 to <65 years and ≥65 years). Participants and investigators were masked to group assignment. The primary outcomes were to evaluate the safety, tolerability, and immunogenicity of MVC-COV1901 from day 1 (the day of the first dose) to day 57 (28 days after the second dose). Safety was assessed in all participants who received at least one dose. Immunogenicity was assessed by measuring geometric mean titres (GMTs) and seroconversion rates of neutralising antibody and antigen-specific IgG in the per-protocol population. This study is registered with ClinicalTrials.gov , NCT04695652. Of 4173 individuals screened between Dec 30, 2020, and April 2, 2021, 3854 were enrolled and randomly assigned: 3304 to the MVC-COV1901 group and 550 to the placebo group. A total of 3844 participants (3295 in the MVC-COV1901 group and 549 in the placebo group) were included in the safety analysis set, and 1053 participants (903 and 150) had received both doses and were included in the per-protocol immunogenicity analysis set. From the start of this phase 2 trial to the time of interim analysis, no vaccine-related serious adverse events were recorded. The most common solicited adverse events in all study participants were pain at the injection site (2346 [71·2%] of 3295 in the MVC-COV1901 group and 128 [23·3%] of 549 in the placebo group), and malaise or fatigue (1186 [36·0%] and 163 [29·7%]). Fever was rarely reported (23 [0·7%] and two [0·4%]). At 28 days after the second dose of MVC-COV1901, the wild-type SARS-CoV-2 neutralising antibody GMT was 662·3 (95% CI 628·7–697·8; 408·5 IU/mL), the GMT ratio (geometric mean fold increase in titres at day 57 vs baseline) was 163·2 (155·0–171·9), and the seroconversion rate was 99·8% (95% CI 99·2–100·0). MVC-COV1901 has a good safety profile and elicits promising immunogenicity responses. These data support MVC-COV1901 to enter phase 3 efficacy trials. Medigen Vaccine Biologics and Taiwan Centres for Disease Control, Ministry of Health and Welfare. [ABSTRACT FROM AUTHOR]

Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (p < 0.001), and medications(steroids [p < 0.001], antibiotics [ p < 0.001], and antacids [ p = 0.001]) were associated with esophageal stricture. Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade ≥ 3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study. [ABSTRACT FROM AUTHOR]

Purpose: Secondary prevention of coronary artery disease, self‐management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self‐efficacy theory–based health information technology intervention implemented through blood control and patient self‐management. Design: A clinical randomized waitlist‐controlled trial. Methods: The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self‐management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations. Results: Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self‐management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective. Conclusion: The use of a theory‐based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self‐management behavior, and QOL in patients with coronary artery disease. Clinical Relevance: This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self‐management. It also may help guide further digital health care strategies during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: While coformulated ledipasvir (90 mg)/sofosbuvir (400 mg) (LDV/SOF) is approved for the treatment of hepatitis C virus (HCV) genotype 2 (GT2) infection in Taiwan, Japan, and New Zealand, data regarding its use for HIV (Human Immunodeficiency Virus)-positive patients infected with HCV GT2 are sparse. We aimed to assess the effectiveness and tolerability of LDV/SOF for HIV-positive patients with HCV GT2 coinfection. Methods: From January 2019 to July 2020, consecutive HIV-positive Taiwanese patients infected with HCV GT2 who received LDV/SOF were retrospectively included for analysis. The effectiveness was determined by sustained virologic response 12 weeks off-therapy (SVR12). Results: Of the 114 patients (mean age, 38.6 years) initiating LDV/SOF during the study period, 0.9% had liver cirrhosis and 4.4% were HCV treatment-experienced. All patients had estimated glomerular filtration rate (eGFR) > 30 ml/min/1.73 m2 and were receiving antiretroviral therapy with 98.2% having CD4 counts ≥ 200 cells/mm3 and 93.9% plasma HIV RNA load < 50 copies/ml. Antiretrovirals prescribed included tenofovir alafenamide/emtricitabine in 42.1%, tenofovir disoproxil fumarate (TDF)/emtricitabine 18.4%, other nucleoside reverse transcriptase inhibitors (NRTIs) 39.5%, non-NRTIs 12.3%, protease inhibitors 13.2%, and integrase inhibitors 74.6%. All patients had undetectable plasma HCV RNA load at the end of treatment, and 96.5% achieved SVR12 in intention-to-treat analysis. The on-treatment eGFR decline was more pronounced in those receiving TDF-containing antiretroviral therapy (mean change, − 8.33 ml/min/1.73 m2), which was reversible after discontinuation of LDV/SOF. None of the patients interrupted LDV/SOF during the 12-week treatment course. Conclusion: Similar to the response observed among HIV-negative patients, LDV/SOF is effective for HIV-positive patients coinfected with HCV GT2. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluated the efficacy of hydroxychloroquine (HCQ) against coronavirus disease 2019 (COVID-19) via a randomized controlled trial (RCT) and a retrospective study. Methods: Subjects admitted to 11 designated public hospitals in Taiwan between April 1 and May 31, 2020, with COVID-19 diagnosis confirmed by pharyngeal real-time RT-PCR for SARS-CoV-2, were randomized at a 2:1 ratio and stratified by mild or moderate illness. HCQ (400 mg twice for 1 d or HCQ 200 mg twice daily for 6 days) was administered. Both the study and control group received standard of care (SOC). Pharyngeal swabs and sputum were collected every other day. The proportion and time to negative viral PCR were assessed on day 14. In the retrospective study, medical records were reviewed for patients admitted before March 31, 2020. Results: There were 33 and 37 cases in the RCT and retrospective study, respectively. In the RCT, the median times to negative rRT-PCR from randomization to hospital day 14 were 5 days (95% CI; 1, 9 days) and 10 days (95% CI; 2, 12 days) for the HCQ and SOC groups, respectively (p = 0.40). On day 14, 81.0% (17/21) and 75.0% (9/12) of the subjects in the HCQ and SOC groups, respectively, had undetected virus (p = 0.36). In the retrospective study, 12 (42.9%) in the HCQ group and 5 (55.6%) in the control group had negative rRT-PCR results on hospital day 14 (p = 0.70). Conclusions: Neither study demonstrated that HCQ shortened viral shedding in mild to moderate COVID-19 subjects. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the association between ischaemic stroke (IS) and heart failure (HF) in the absence of atrial fibrillation (AF) or atrial flutter (AFL) using a population-based nation-wide cohort database.Method: Newly diagnosed patients with HF without previous stroke and acute myocardial infarction (AMI) were enrolled. Based on the propensity scores matching age, sex and all comorbidities, our studies comprised 12 179 patients with HF and 12 179 patients without HF. Cox proportion hazard regression models and competing-risk regression models were used to evaluate the risk of IS among patients with HF without AF or AFL.Results: In the multivariable analysis, older age (adjusted HR (95% CI)=1.05 (1.04 to 1.05)), male sex (adjusted HR (95% CI)=1.36 (1.24 to 1.50)), diabetes (adjusted HR (95% CI)=2.22 (1.97 to 2.49)) and hypertension (adjusted HR (95% CI)=1.60 (1.41 to 1.82)) were markedly associated with IS in patients with HF. The HF group had a markedly higher risk of IS than did the non-HF group (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66) and AMI (SHR=3.40, 95% CI: 2.71 to 4.28). Additionally, according to the Kaplan-Meier analysis, patients with HF were at a significantly higher risk of cumulative incidence of IS and AMI than did patients with non-HF (p value of log-rank test <0.001).Conclusion: This study indicated that HF is a strong independent risk factor for IS, even in the absence of AF or AFL. Clinical physicians should investigate IS through routine screening and careful monitoring of patients with HF. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) is rapidly increasing in developed countries. In Taiwan, the incidence rate of CRC has increased during the past decade, but the 5-year survival has remained at approximately 63%. In this study, we sought to determine the 5-year survival rate of patients diagnosed with colon and rectum cancer and to determine factors affecting survival.Material and Methods: All patients from the Taiwan Cancer Database of the medical center hospital in North Taiwan between 2007 and 2013 were identified. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable.Results: A total of 869 patients were included: 554 (63.8%) patients had colon cancer and 315 (36.2%) had rectum cancer. The mean survival time was 71.27 ±1.27 months (colon group: 71.90 ±1.58 months; rectum group: 67.88 ±1.95 months). There was no significant difference (p = 0.493) between patients who had colon or rectum cancer. The forward stepwise Cox regression analysis results indicated that perineural invasion, distant metastasis, age, pathological differentiation grade, and obstruction were statistically significant for patients who had CRC, colon cancer or rectum cancer.Conclusions: The long-term survival from CRC, colon cancer and rectum cancer remains promising, as 68.66%, 69.11% and 67.90% of patients are alive 5 years after being diagnosed, respectively. Perineural invasion was found to be an important factor related to the survival of patients who have CRC. Thus, early detection of CRC may help improve survival. [ABSTRACT FROM AUTHOR]

Purpose: Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs.Objectives: We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments.Methods: Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months.Results: Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments.Conclusions: Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage.Clinical trial registration number: NCT02101411. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to describe the seroprevalence of hepatitis A virus (HAV) in HIV-positive adult patients in Taiwan between 2012 and 2016 and to examine the evolution of HAV seroprevalence between 2004–2007 and 2012–2016. Methods: Clinical information and data of anti-HAV antibody results were collected from 2,860 antiretroviral-naïve HIV-positive Taiwanese aged 18 years or older who initiated combination antiretroviral therapy at 11 hospitals around Taiwan between 2012 and 2016 (2012–2016 cohort). A multivariate logistic regression model was applied to identify independent variables associated with HAV seropositivity. Comparisons of HAV seroprevalences and associated clinical characteristics were made between this 2012–2016 cohort and a previous cohort of 1580 HIV-positive patients in 2004–2007 (2004–2007 cohort). Results: Of the 2,860 HIV-positive patients between 2012 and 2016, the overall HAV seropositivity rate was 21.2% (605/2860), which was independently associated with an older age (adjusted odds ratio [AOR], per 1-year increase, 1.13; 95% confidence interval [95% CI], 1.11–1.15) and co-infection with hepatitis B virus (AOR 1.44; 95% CI, 1.08–1.93). Residence in southern Taiwan (AOR 0.49; 95% CI, 0.34–0.72) was inversely associated with HAV seropositivity. The overall HAV seroprevalence in the 2012–2016 cohort was significantly lower than that in the 2004–2007 cohort (21.2% vs 60.9%, p<0.01). The decreases of HAV seropositivity rate were observed in nearly every age-matched group, which suggested the cohort effect on HAV seroepidemiology. However, among individuals aged 25 years or younger, the HAV seropositivity rate increased from 3.8% (2/52) in the 2004–2007 cohort to 8.5% (50/587) in the 2012–2016 cohort, with 95.4% (560/587) being MSM in this age group of the latter cohort. Conclusions: HAV seroprevalence has decreased with time among HIV-positive adults in Taiwan. The cohort effect has increased the number of young HIV-positive patients that are susceptible to HAV infection in a country without nationwide childhood vaccination program against HAV. [ABSTRACT FROM AUTHOR]

Objectives: Two nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) plus 1 non-NRTI (nNRTI) remain the preferred or alternative combination antiretroviral therapy (cART) for antiretroviral-naive HIV-positive patients in Taiwan. The three most commonly used nNRTIs are nevirapine (NVP), efavirenz (EFV) and rilpivirine (RPV). This study aimed to determine the incidences of hepatotoxicity and skin rashes within 4 weeks of initiation of cART containing 1 nNRTI plus 2 NRTIs. Methods: Between June, 2012 and November, 2015, all antiretroviral-naive HIV-positive adult patients initiating nNRTI-containing cART at 8 designated hospitals for HIV care were included in this retrospective observational study. According to the national HIV treatment guidelines, patients were assessed at baseline, 2 and 4 weeks of cART initiation, and subsequently every 8 to 12 weeks. Plasma HIV RNA load, CD4 cell count and aminotransferases were determined. The toxicity grading scale of the Division of AIDS (DAIDS) 2014 was used for reporting clinical and laboratory adverse events. Results: During the 3.5-year study period, 2,341 patients initiated nNRTI-containing cART: NVP in 629 patients, EFV 1,363 patients, and RPV 349 patients. Rash of any grade occurred in 14.1% (n = 331) of the patients. In multiple logistic regression analysis, baseline CD4 cell counts (per 100-cell/μl increase, adjusted odds ratio [AOR], 1.125; 95% confidence interval [95% CI], 1.031–1.228) and use of NVP (AOR, 2.443; 95% CI, 1.816–3.286) (compared with efavirenz) were independently associated with the development of skin rashes. Among the 1,455 patients (62.2%) with aminotransferase data both at baseline and week 4, 72 (4.9%) developed grade 2 or greater hepatotoxicity. In multiple logistic regression analysis, presence of antibody for hepatitis C virus (HCV) (AOR, 2.865; 95% CI, 1.439–5.704) or hepatitis B surface antigen (AOR, 2.397; 95% CI, 1.150–4.997), and development of skin rashes (AOR, 2.811; 95% CI, 1.051–7.521) were independently associated with the development of hepatotoxicity. Conclusions: The baseline CD4 cell counts and use of NVP were associated with increased risk of skin rashes, while hepatotoxicity was independently associated with HCV or hepatitis B virus coinfection, and development of skin rashes in antiretroviral-naïve HIV-positive Taiwanese patients within 4 weeks of initiation of nNRTI-containing regimens. [ABSTRACT FROM AUTHOR]

Purpose: The population-based National Health Insurance database was used to investigate the trends, correlates, and disease patterns for elderly people in Taiwan who use antidepressants.Methods: The National Health Research Institute provided a database of 1000,000 random subjects for study. We created a sample of subjects who were older than 65 years from 1997 to 2005. Trends, prevalence, and associated factors of antidepressant use were detected. We also examined the proportion of antidepressant use for psychiatric and medical disorders.Results: The one-year prevalence of antidepressant use in elderly persons increased from 5.8 % in 1997 to 9.8 % in 2005. The one-year prevalence rates of tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), serotonin modulator, and other antidepressant use in 2005 were 5.3, 2.6, 0.4, 2.9, and 0.6 %, respectively. Overall antidepressant use was higher for those in the 75- to 84-year-old age group, females, and those with higher Charlson Comorbidity Index scores. Among subjects using TCAs, 77.6 % users did not have a psychiatric diagnosis. Psychiatric disorders were commonly found in most SSRI and SNRI users (85.1 and 90.1 %, respectively). Subjects using SSRIs and SNRIs had higher proportions of psychiatric disorders such as neurotic depression, major depression, senile and presenile organic psychotic conditions, and anxiety.Conclusion: The prevalence of antidepressant use among elderly persons increased greatly from 1997 to 2005. SSRIs, SNRIs, and other antidepressants were used mostly by subjects with psychiatric disorders, whereas TCAs were used mostly by subjects with nonpsychiatric disorders. [ABSTRACT FROM AUTHOR]

Objectives: To explore the relationships between traditional Chinese medicine (TCM) syndromes and disease severity and prognoses after ischemic stroke, such as neurologic deficits and decline in activities of daily living (ADLs). Methods: The study included 211 patients who met the inclusion criteria of acute ischemic stroke based on clinical manifestations, computed tomography or magnetic resonance imaging findings, and onset of ischemic stroke within 72 hours with clear consciousness. To assess neurologic function and ADLs in patients with different TCM syndromes, the TCM Syndrome Differentiation Diagnostic Criteria for Apoplexy scale (containing assessments of wind, phlegm, blood stasis, fire-heat, qi deficiency, and yin deficiency with yang hyperactivity syndromes) was used within 72 hours of stroke onset, and Western medicine-based National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) assessments were performed at both admission and discharge. Results: The most frequent TCM syndromes associated with acute ischemic stroke were wind syndrome, phlegm syndrome, and blood stasis syndrome. Improvement according to the BI at discharge and days of admission were significantly different between patients with and those without fire-heat syndrome. Patients with qi deficiency syndrome had longer hospital stays and worse NIHSS and BI assessments at discharge than patients without qi deficiency syndrome. All the reported differences reached statistical significance. Conclusions: These results provide evidence that fire-heat syndrome and qi deficiency syndrome are essential elements that can predict short-term prognosis of acute ischemic stroke. [ABSTRACT FROM AUTHOR]

The authors used a population-based database to investigate antidepressant use among children and adolescents in Taiwan. The National Health Research Institutes provided a database of 1 000 000 random subjects for study. The authors adopted this sample of subjects who were younger than 18 years during 1997 to 2005. Subjects with at least 1 antidepressant prescription were identified. Trends, prevalence, associated factors, and disease patterns of antidepressant use were detected. The 1-year prevalence of pediatric antidepressant use increased from 0.27% in 1997 to 0.47% in 2005. The 1-year prevalence of tricyclic antidepressant, selective serotonin reuptake inhibitor, and other antidepressant use among pediatric population was 0.23%, 0.20%, and 0.08%, respectively, in 2005. The prevalence of pediatric antidepressant use increased from 1997 to 2005. Among pediatric subjects with antidepressant use, selective serotonin reuptake inhibitors, and other antidepressants were used the most for psychiatric disorders, whereas tricyclic antidepressant was used the most for nonpsychiatric disorders. [ABSTRACT FROM AUTHOR]

There are reports of increased sexual risk behaviors in the HIV-positive population since the introduction of highly active antiretroviral therapy (HAART). Little is known about the effects of the case management (CM) program and HAART on sexually transmitted diseases (STDs) in Taiwan. HIV-positive subjects, who visited the outpatient clinics of Taoyuan General Hospital between 2007 and 2010, were enrolled. A total of 574 subjects and 14,462 person-months were reviewed. Incident STDs occurred in 104 (18.1%) subjects, and the incidence rate was 8.6 (95% confidence interval [CI], 7.1-10.5) per 100 person-years (PY). For men who have sex with men (MSM), heterosexual men and women, and injection drug users (IDU), 19.4 per 100 PY(95% CI, 15.7-24.0), 3.5 per 100 PY (95% CI, 1.4-7.3), and 1.1 per 100 PY (95% CI, 0.4-2.4) of STDs were noted, respectively; (MSM versus IDU and MSM versus heterosexual subjects, p<0.000001; heterosexual subjects versus IDU, p=0.061). Syphilis (59.6%) was the most common STD. Regular CM and no HAART (hazard ratio, 2.58; 95% CI, 1.14-5.84; p=0.02) was significantly associated with STDs in MSM. Though this retrospective study might underestimate the incidence of STDs and not draw the conclusion of causality, we concluded that the CM program and HAART are associated with lower acquisition of STDs in the Taiwanese HIV-positive population. [ABSTRACT FROM AUTHOR]

Background: In April 2009, confirmed cases of influenza A (H1N1) infections were reported worldwide, spreading from Mexico and southern California. In order to determine the clinical features of patients infected with this virus before vaccine implementation and evaluate the response of antiviral treatment in Taiwan, we reviewed medical charts and collected clinical data from outpatients and inpatients at the Tao-Yuan General Hospital. Methods: From May 19, 2009, to October 31, 2009, clinical data from patients confirmed by the rapid antigen-screening test for influenza A virus and/or reverse transcriptase–polymerase chain reaction analysis at the Tao-Yuan General Hospital were reviewed retrospectively. Results: A total of 1158 patients (94.6%) received outpatient management, 66 patients (5.4%) were hospitalized, and no patients died. More than two-thirds of patients were younger than 16 years old. The most common symptoms were fever (99.8%), cough (91.4%), sore throat (63.7%), and rhinorrhea (53.8%). Ninety patients (13.3%) had complications, including lower respiratory tract infections (11.1%). Among the 677 patients receiving follow-ups, none needed mechanical ventilation due to lower respiratory tract infection. Most of the patients (87.2%) began antiviral therapy within 2 days after the onset of symptoms. Ninety percent of patients became afebrile within 2 days after the initiation of antiviral therapy. The number of screening specimens and the positivity rate of the rapid influenza A antigen test were dramatically decreased 4 weeks later, after universal implementation of the pandemic influenza A (H1N1) 2009 vaccine to infants and school-age children. Conclusion: The clinical spectrum of pandemic influenza A (H1N1) 2009 infection was broad and the severity of disease was mild. Early antiviral treatment was effective in decreasing mortality and morbidity. Early and universal implementation of a novel influenza A vaccine is an effective approach for preventing pandemic community influenza outbreaks, particularly among infants and school-age children. [Copyright &y& Elsevier]

Aims. To assess safety and efficacy of valsartan/amlodipine combination in hypertensive Taiwanese patients. Methods. This 12-week, multi-center, prospective, observational, post-marketing study enrolled 1029 patients to receive valsartan/amlodipine combination alone or as add-on to other antihypertensives. Efficacy was evaluated by blood pressure (BP) control rate (in mmHg; non-diabetics, < 140/90; diabetics, < 130/80) at Week 12 and BP-lowering ability at Weeks 4 and 12. Additionally, responder rate (sitting-SBP < 140 for baseline SBP ≥ 140 or sitting-DBP < 90 for baseline DBP ≥ 90, or SBP reduction > 20 or DBP reduction > 10 from baseline) was determined. Major findings. Adverse events (AEs) were reported in 12.15% patients; dizziness, cough, and peripheral edema were the most commonly reported AEs. Overall BP control rate was 48.27%. Greater BP reduction was noted at Week 12 than at Week 4 between all groups and subgroups. Greater SBP/DBP reduction was observed in patients with stage 2 hypertension than stage 1 hypertension at baseline. The overall responder rate was 78.52%. Subgroup analysis showed greater BP reduction in non-diabetics than diabetics; only SBP reduction reached statistical significance (− 13.7 [18.3] vs. − 10.7 [17.4] mmHg; p < 0.0093). Principal conclusion. Valsartan/amlodipine combination was well tolerated, with no safety concerns identified and an effective treatment option for hypertensive Taiwanese patients. [ABSTRACT FROM AUTHOR]

Abstract: This study explored the important influential factors of Food and Beverage employees’ career success in international tourist hotels and identified relationships among these factors from contextual perspectives. Data was obtained from a sample of 481 respondents drawn from 22 international tourist hotels in Taiwan and analyzed with the AMOS program. The structural equation modeling results showed that multiple contexts influenced the career success of F&B employees in international tourist hotels, such as the Micro-System, the Meso-System, including organizational psychological factors, the Exo-System, and the Macro System contexts. In particular, the Exo-System context was the most direct influential factor for career success. [Copyright &y& Elsevier]

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For electrokinetics remediation, the acid produced at the anode due to the water electrolysis will cause the soil acidification and destroy the soil constituents. Especially, the contaminated soils in Taiwan are usually agricultural lands; it is necessary to improve the performance of EK system to maintain the soils nature after remediation. In this study, a circulation-enhanced EK system (CEEK) was designed to neutralize the pH of the working solution and soils. Experiments were conducted by the control of different electrolyte species (sodium and potassium salts) and concentrations (10−3 to 5×10−2 M), respectively. Experimental results show the operational characteristics include: the CEEK system can effectively stabilize the pH of processing solution at neutral range and the current can be maintained at stable status with carbonate salts; the pH buffering range of working solution in the CEEK system depends on the electrolyte species and their concentration significantly; the water content remains roughly as their original nature in the CEEK system. For consideration of electrochemical reactions, the water electrolysis is the predominating electrochemical reaction in the CEEK system, which not only influences the pH but also the conductivity of the working solution. In the application of practical engineering, there exist linear relationships between the pH, conductivity, current and the electrolyte concentration, respectively, which can serve as a means to assist engineers to select operational parameters of CEEK. [Copyright &y& Elsevier]

This article seeks to provide information about the situation of Filipina domestics and their female employers in Taiwan. It examines the competing meanings of domesticity, womanhood, and motherhood implicit in the global restructuring of care, focusing on the tension between Taiwanese female employers and Filipina domestics. The author explores the narratives of both groups of women to reveal their competing meanings of domesticity, womanhood, and motherhood and tries to provide in-depth background information for each subject. Hence, this article demonstrates that the identity struggles between Taiwanese female employers and Filipina domestics, while progressive in some aspects, serve to further entrench the hegemony of gender and sexual ideologies and perpetuate gender inequality in society. It is noted that Taiwanese male employers benefit not only from the labor of foreign domestics, but also from the continual designation of care work as women's natural calling.

Background: Hypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life.Objective: Our primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life.Methods: This was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention.Results: We included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (-21.4 mm Hg and -5.4 mm Hg, respectively; P<.001) and 6 months (-27.8 mm Hg and -9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (-0.202, P=.003) and 6 (-0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001).Conclusions: A Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension.Trial Registration: ClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974. [ABSTRACT FROM AUTHOR]

• It is the first real-world data of same-day ART initiation in a developed country. • Ninety-five percent of people with HIV started ART within 14 days of HIV diagnosis in 2021-2022. • SDART and rapid ART initiation lead to similar rates of engagement and outcomes. • PWH aged 30 or older and GBMSM were less likely to have unfavorable outcomes. WHO has recommended same-day antiretroviral therapy (SDART) initiation since 2017; however, higher attrition rates were noted in developing countries. We included newly diagnosed people with HIV (PWH) from 2018 to 2022 at 18 hospitals around Taiwan. SDART initiation was defined as starting ART on the same day of HIV diagnosis and rapid initiation as starting ART within 14 days of diagnosis. A composite unfavorable outcome was defined as death after 30 days of diagnosis, loss to follow-up (LTFU), or virologic failure or rebound at 12 months. At 12 months, PWH on SDART initiation and those on rapid ART initiation showed similar rates of engagement in care with plasma HIV-1 RNA <50 copies/mL (87.5% vs 87.7%) and composite unfavorable outcome (7.7% vs 7.7%). PWH aged >30 years were less likely to have LTFU (aHR 0.44, 95% CI 0.28-0.70). PWH aged >30 years (aHR 0.59, 95% CI 0.41-0.85) and gay, bisexual, and men who have sex with men (GBMSM) (aHR 0.50, 95% CI 0.32-0.79) were less likely to have composite unfavorable outcomes. SDART and rapid ART initiation resulted in comparable clinical outcomes and viral suppression rates. PWH aged >30 years and GBMSM were less likely to have unfavorable outcomes. [ABSTRACT FROM AUTHOR]

The study aims to discover risk factors significantly correlated with insulin resistance among adolescents in Taiwan. A total of 339 study subjects were recruited in this cross-sectional study. A self-administered questionnaire and physical examinations including anthropometrics and biochemistry profiles were collected. Insulin resistance was assessed using homeostasis model assessment for insulin resistance (HOMA-IR). Study subjects had a significantly increased risk of IR for those with abnormal level of body mass index (odds ratio [OR] = 3.54; 95% confidence interval [CI] = 1.81-6.91), body fat (OR = 2.71; 95% CI = 1.25-5.88), and waist circumference (OR = 25.04; 95% CI = 2.93-214.14) when compared with those who have normal values. Furthermore, a significantly joint effect of 10.86-fold risk for HOMA-IR abnormality among body fat, body mass index, and systolic blood pressure was observed. The identification of risk factors significantly correlated with IR will be important to prevent metabolic syndrome–related diseases and complications for adolescents in their future life. [ABSTRACT FROM PUBLISHER]

Background Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan. Objectives To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure. Design randomised controlled trial. Participants and setting Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group ( n = 43) or the control group ( n = 41). Methods Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression. Results The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week ( p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme ( p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality ( β = −2.22, p < .001), daytime sleepiness ( β = −4.23, p < .001), anxiety ( β = −1.94, p < .001), and depression ( β = −3.05, p < .001) after 12 weeks of the intervention. Conclusion This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing. [ABSTRACT FROM AUTHOR]

This study marked a preliminary attempt to standardize the Chinese Edition of the Communication and Symbolic Behavior Scales Developmental Profile ( Wetherby & Prizant, 2002 ; CSBS DP ) to assist in the early identification of young children with special needs in Taiwan. The study was conducted among 171 infants and toddlers aged 1–2. It also included a follow-up study one year after the initial test. Three domestically developed standardized child development inventories were used to measure the concurrent validity and predictive validity. The Chinese Edition of the CSBS DP demonstrated overall good test–retest and inter-rater reliability. It also showed good concurrent and predictive validity. The current study yields preliminary evidence that the Chinese Edition of the CSBS DP could be a valuable assessment tool worthy of wider distribution. Future research should employ random sampling to establish a true national norm. Additionally, the follow-up study needs to include atypical groups and to expand to children aged 6–12 months to strengthen the applicability of the instrument in Taiwan. [ABSTRACT FROM AUTHOR]

• Dolutegravir + boosted protease inhibitor is recommended as salvage therapy for highly experienced HIV-positive patients. • Evidence for the two-drug regimen of DTG + bPI is limited. • DTG + bPI demonstrated high efficacy and genetic barrier to resistance for patients with multiple resistance. • The two-drug regimen had metabolic impact on increased level of total cholesterol and low-density lipoprotein cholesterol. • Weight gain of 1.3 kg and 2.8 kg was noted after switching to the two-drug regimen at Weeks 24 and 48, respectively. Real-world experience with dolutegravir (DTG) plus boosted protease inhibitor (bPI) as a two-drug regimen is limited for highly experienced HIV-positive patients with virological failure or intolerance to antiretroviral therapy. Patients receiving DTG plus bPI between September 2016 and June 2019 at 15 designated hospitals for HIV care in Taiwan were retrospectively included in this study. A standardised case record form was used to collect clinical data. The primary endpoint was virological response, defined as achieving or maintaining plasma HIV-RNA <50 copies/mL at Week 48. A total of 77 patients were included; 58 (75.3%) had documented genotypic resistance to 1–4 antiretroviral classes. The most commonly used PI was darunavir (87.0%; 67/77). Seven patients (9.1%) had no virological data at Week 48, including three with loss to follow-up, one severe hyperlipidaemia, one renal failure and cardiovascular disease, one superimposed HBV infection and one death from anal cancer. The virological response rate increased from 59.7% at baseline to 90.9% at Week 24 and 85.7% at Week 48. The only patient (1.3%) with virological failure at Week 48 had poor adherence and baseline low-level resistance to darunavir with resistance-associated mutations at M46L, I50V and V82A. Compared with baseline, mean total cholesterol increased by 20.1 mg/dL and weight by 2.8 kg at Week 48, while the estimated glomerular filtration rate decreased by 14.4 mL/min/1.73m2 (both P < 0.05). We conclude that a two-drug regimen containing DTG plus bPI was effective in highly-experienced HIV-positive patients, but metabolic impact and weight gain should be closely monitored. [ABSTRACT FROM AUTHOR]

• Multicentre surveillance of antimicrobial susceptibility among clinically important Gram-negative bacteria (GNB) in Taiwan. • Increasing carbapenem resistance among clinically important GNB, especially among nosocomial isolates. • bla KPC , especially the bla KPC-2 variant, was detected in 48.4% of carbapenem-resistant Klebsiella pneumoniae isolates. • Low prevalence of the mcr-1 gene. • mcr-1 was detected in different Enterobacteriaceae species, raising concern of potential dissemination. Multicentre surveillance of antimicrobial susceptibility of clinically important Gram-negative bacteria (GNB) from 16 Taiwanese hospitals was performed. Escherichia coli (n = 398), Klebsiella pneumoniae (n = 346), Pseudomonas aeruginosa (n = 252) and Acinetobacter baumannii complex (ABC) (n = 188) bloodstream isolates, non-typhoidal Salmonella (n = 230) and Shigella flexneri (n = 18) from various sources were collected. Antimicrobial MICs were determined using broth microdilution. Genes encoding K. pneumoniae carbapenemases (KPCs), New Delhi metallo-β-lactamases (NDMs), Verona integron-encoded metallo-β-lactamase (VIM), OXA-48-like carbapenemase (OXA-48) as well as mcr-1–5 genes were detected by molecular methods. Rates of carbapenem non-susceptibility were 2.8%, 9.0%, 0.4%, 0%, 10.3% and 48.8% for E. coli, K. pneumoniae, Salmonella, Shigella, P. aeruginosa and ABC, respectively. For carbapenemases, one (0.3%) E. coli harboured bla NDM-1. Fifteen (4.3%), two (0.6%) and two (0.6%) K. pneumoniae contained bla KPC , bla OXA-48 and bla VIM , respectively. Two (0.5%) E. coli and fourteen (4.0%) K. pneumoniae were non-wild-type according to the colistin MIC. Among Enterobacteriaceae with a colistin MIC ≥ 2 mg/L, mcr-1 was detected in one E. coli , two K. pneumoniae and three Salmonella spp. All three mcr-1 -positive Salmonella isolates were collected from community-acquired infections; none of the six mcr-1 -positive Enterobacteriaceae were carbapenem-resistant. Carbapenem resistance has increased among clinically important GNB, especially among hospital-acquired infections. bla KPC , especially the bla KPC-2 variant, was detected in approximately one-half of the carbapenem-resistant K. pneumoniae isolates in this study. Although resistance rates to colistin remained low among Enterobacteriaceae, the finding of mcr-1 from different species raises concern of potential dissemination. [ABSTRACT FROM AUTHOR]

Previous research with parents and children with developmental disabilities indicated that the relationship between mothers' responsive style of interaction and children's rate of development was mediated by the simultaneous relationship between mothers' responsiveness and children's social engagement, or pivotal behavior. In this study, we attempted to determine whether children's pivotal behavior might also mediate the relationship between responsiveness and child development in a sample of 165 typically developing toddlers and their Taiwanese parents. Child development was assessed with a parent report measure of children's symbolic behavior. Parental responsiveness and children's pivotal behavior were assessed from observations of parent-child play. Results indicated that parental responsiveness was correlated with children's pivotal behavior, and that both of these variables were correlated with children's symbolic behavior. Structural equation models indicated that the relationship between responsiveness and children's symbolic behavior was fully mediated by children's pivotal behavior. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2012; 18: E373-E376 Abstract The clinical characteristics and risk factors for 28-day mortality in 120 patients with solid tumours with Acinetobacter nosocomialis bacteraemia were retrospectively analysed. Eighty-one patients (67.5%) had advanced-stage cancer. Most of the bacteraemia (37.5%) did not have an identified source. The bacteraemia episodes developed at a median of 15 days after hospitalization, and most during a non-neutropenic period (97.5%). Although only half of the patients received appropriate antimicrobial therapy, the mortality was relatively low (11.7%). High Pitt bacteraemia score and receipt of chemotherapy within the month before bacteraemia onset were independently associated with 28-day mortality. [ABSTRACT FROM AUTHOR]