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Minimally invasive surgery has become a worldwide trend to reduce the wound and mitigate pain. However, the role of robotic pancreaticoduodenectomy (RPD) has not been well established in the era of minimally invasive surgery. It would be nearly impossible to apply minimally invasive surgery in the tedious and complicated Whipple operation without an experienced and dedicated pancreas team. The pancreatic team led by Shyr YM and Wang SE at Taipei Veterans General Hospital have already been highly accredited with a Copper Award of Symbol of National Quality (SNQ award), entitled with “Minimally Invasive Robotic Pancreatic Surgery—Small Wound for Major Pancreatic Surgery” in Taiwan in 2019. RPD was claimed to be associated with less blood loss, less delayed gastric emptying, shorter length of postoperative stay, and lower wound infection rate, but longer operative time, as compared with the traditional open pancreaticoduodenectomy (OPD). More than 99% of the patients undergoing minimally invasive RPD are satisfied with the surgical outcomes and would like to recommend RPD to those with periampullary lesions. RPD could be recommended not only to surgeons but also to patients in terms of surgical outcomes and patient satisfaction. Moreover, our study showed a survival benefit for pancreatic head adenocarcinoma in RPD group, with 1-year, 3-year, and 5-year survival of 82.9%, 45.3%, and 26.8%, respectively, as compared with 63.8%, 26.2%, and 17.4% in OPD. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the relationship between multidimensional factors, such as environment, health status, behavior, social support, and the well-being of middle-aged and older adults. Methods: This study utilized data from 2 waves of the nationally representative Taiwan Longitudinal Study on Aging Survey Report (TLSA) conducted in 2015 and 2019. The TLSA assesses socioeconomic status, physical and health status, the 5-item World Health Organization Well-Being Index (WHO-5 index), and social support. Data regarding the degree of digital development were obtained from the 2020 Township Digital Development Report. We applied a generalized estimating equation (GEE) to analyze the influencing factors. Results: This study included 4796 participants. Residing in areas with a higher degree of digital development, having a higher socioeconomic status, and experiencing better physical and mental health were significantly associated with well-being. Furthermore, emotional and attentive support mediated the association between physical and mental status and well-being. Conclusion: People's awareness of searching for and receiving social support and medical resources is important for enhancing their well-being. It is also crucial to pay attention to the living environment and maintain one's health status to promote well-being. [ABSTRACT FROM AUTHOR]

Introduction: Following the introduction of incretin-based drugs to the market, instances of acute pancreatitis have been reported, leading the FDA to mandate a warning label. Incretin-based therapy has been linked to a rare yet significant adverse event known as acute pancreatitis. However, these concerns of use of incretin therapy remained an ongoing debate. Methods: This retrospective cohort study was extracted data from the National Health Insurance (NHI) program in Taiwan focused on those having prior hospitalization history of acute pancreatitis. We identified adult patients with type 2 diabetes, all patients who received new prescriptions one year after the diagnosis of hospitalization for acute pancreatitis for DPP-4 inhibitors (index date). Study participants were divided into two groups: those taking DPP-4 inhibitors (the DPP-4 inhibitors group, n=331) and those not taking DPP-4 inhibitors (the non-DPP-4 inhibitors group, n=918). The outcome of interest is the recurrence of hospitalization of acute pancreatitis. Results: The incidence density (per 1000 person-years) of acute pancreatitis was 23.16 for DPP-4 inhibitors group and 19.88 for non-DPP-4 inhibitor group. The relative risk is 0.86 (95% confidence interval (CI) 0.53-1.38). Results from the Cox proportional hazard model (HR) analysis, the DPP-4 inhibitor was associated with a neutral risk of acute pancreatitis HR 0.68; 95% CI: 0.42-1.09. Conclusions: In this extensive nationwide cohort study conducted in Taiwan, involving a substantial number of newly diagnosed cases, the utilization of DPP-4 inhibitors appears to show no significant correlation with an elevated risk of acute pancreatitis, even among diabetic patients deemed to be at a high risk. These results extend the safety reassurance of incretin-based therapy to individuals considered high-risk for such complications. [ABSTRACT FROM AUTHOR]

From 2001 to 2020, three typhoons with similar moving paths and intensities were found to trigger markedly different cooling off northeastern Taiwan. They were typhoons Utor (2001), Nuri (2008), and Hagupit (2008), which led to maximum sea surface temperature (SST) cooling temperatures of 8.8, 2.7, and 1.4 °C, respectively. The drastic cooling discrepancy implies that the existing understanding of the key mechanism leading to the cooling off northeastern Taiwan could be insufficient. For further exploring the key reason(s) contributing to the marked discrepancy, a regional oceanic modeling system (ROMS) was used to reconstruct the background oceanic environment corresponding to three typhoon passages. Results show that the wide radius of maximum winds of typhoon Utor contributes to the strongest SST cooling by enhancing the Kuroshio intrusion (KI) onto the shelf northeast of Taiwan. Heat budget diagnostics explain why including tidal forcing can substantially promote SST cooling. The process was associated mainly with a stronger vertical advection tied to the influence of de-stratification by tidal mixing. Finally, warmer Taiwan Strait currents, driven by wind forcing the typhoons to pass zonally through the north South China Sea, intruded clockwise into the Longdong coast and accelerated the recovery of sea surface cooling around Longdong. [ABSTRACT FROM AUTHOR]

Background: Medical records are a valuable source for understanding patient health conditions. Doctors often use these records to assess health without solely depending on time-consuming and complex examinations. However, these records may not always be directly relevant to a patient's current health issue. For instance, information about common colds may not be relevant to a more specific health condition. While experienced doctors can effectively navigate through unnecessary details in medical records, this excess information presents a challenge for machine learning models in predicting diseases electronically. To address this, we have developed 'al-BERT', a new disease prediction model that leverages the BERT framework. This model is designed to identify crucial information from medical records and use it to predict diseases. 'al-BERT' operates on the principle that the structure of sentences in diagnostic records is similar to regular linguistic patterns. However, just as stuttering in speech can introduce 'noise' or irrelevant information, similar issues can arise in written records, complicating model training. To overcome this, 'al-BERT' incorporates a semi-supervised layer that filters out irrelevant data from patient visitation records. This process aims to refine the data, resulting in more reliable indicators for disease correlations and enhancing the model's predictive accuracy and utility in medical diagnostics. Method: To discern noise diseases within patient records, especially those resembling influenza-like illnesses, our approach employs a customized semi-supervised learning algorithm equipped with a focused attention mechanism. This mechanism is specifically calibrated to enhance the model's sensitivity to chronic conditions while concurrently distilling salient features from patient records, thereby augmenting the predictive accuracy and utility of the model in clinical settings. We evaluate the performance of al-BERT using real-world health insurance data provided by Taiwan's National Health Insurance. Result: In our study, we evaluated our model against two others: one based on BERT that uses complete disease records, and another variant that includes extra filtering techniques. Our findings show that models incorporating filtering mechanisms typically perform better than those using the entire, unfiltered dataset. Our approach resulted in improved outcomes across several key measures: AUC-ROC (an indicator of a model's ability to distinguish between classes), precision (the accuracy of positive predictions), recall (the model's ability to find all relevant cases), and overall accuracy. Most notably, our model showed a 15% improvement in recall compared to the current best-performing method in the field of disease prediction. Conclusion: The conducted ablation study affirms the advantages of our attention mechanism and underscores the crucial role of the selection module within al-BERT. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of applying a fall-risk assessment to prevent falls in residents of long-term care facilities has not been investigated. Methods: This prospective study enrolled elderly residents in a long-term care facility in Taiwan. Caregivers were provided with a health-status assessment and fall-risk data to enhance their fall-prevention practices. A multivariate analysis was performed to identify the factors associated with falls. Results: A total of 123 subjects, including 68 and 55 for general and nursing-care models, respectively, were assessed. Their health status and risk of falls were provided to the care units to enhance their fall-prevention practices. Subjects in the nursing-care model had more dementia and more prescribed medications, worse physiologic conditions, and higher fall risk. Of them, 28 (23%) had subsequent falls. A univariate analysis showed that those with and without falls were similar in demographic characteristics, prescribed medications, physiologic function, and fall risk. There was a tendency for more falls in the nursing-care model residents (accounting for 61% of those who fell; p = 0.053). A regression analysis showed that gender (beta = 1.359; 95% confidence interval = 0.345–2.374; p = 0.010) and NPI score (beta = 0.101; 95% CI = 0.001–0.200; p = 0.047) were associated with the risk of falls. Conclusion: Residents at the long-term care facility had a significant risk of falls despite knowledge of their fall risk and the implementation of preventive measures. In this context of being aware of the risk, gender, and psychiatric symptoms were significantly associated with falls. Caregivers at long-term care facilities should implement further measures to prevent falls based on behavioral and psychological symptoms. [ABSTRACT FROM AUTHOR]

Over the past century, conscientiousness has become seen as the preeminent trait for predicting performance. This consensus is due in part to these employees' ability to work with traditional 20th-century technology. Such pairings balance the systematic nature of conscientious employees with the technology's need for user input and direction to perform tasks--resulting in a complementary match. However, the 21st century has seen the incorporation of intelligent machines (e.g., artificial intelligence, robots, and algorithms) into employees' jobs. Unlike traditional technology, these new machines are equipped with the capability to make decisions autonomously. Thus, their nature overlaps with the orderliness subdimension of conscientious employees--resulting in a non-complementary mismatch. This calls into question whether the consensus about conscientious employees' effectiveness with 20th-century technology applies to 21st-century jobs. Integrating complementarity and role theory, we refine this consensus. Across three studies using distinct samples (an experience sampling study, a field experiment, and an online experiment from working adults in Malaysia, Taiwan, and the United States), each focused on a different type of intelligent machine, we show not only that using intelligent machines has benefits and consequences, but, importantly, that conscientious (i.e., orderly) employees are less likely to benefit from working with them. [ABSTRACT FROM AUTHOR]

Background: Hepatitis is a serious global health issue. To reduce mortality, early screening for liver disease has been recommended in community health policies, particularly for asymptomatic individuals., Aim: This study explored the link between liver function biomarkers and how quickly people adopt a new multiple cancer screening program, using the diffusion of innovation (DOI) Theory., Methods: The study included 57,939 participants from a community-based screening program in Keelung, Taiwan, between January 1, 2001, and December 31, 2010. Data on demographics and lifestyle habits were collected through questionnaires, and blood samples were analyzed to measure biomarkers related to liver function., Results: On average, participants took 3.48 years to accept the new screening program. People with healthier lifestyles, such as those who drank alcohol less often, were more likely to adopt the screening early. Additionally, those with higher levels of liver-related biomarkers like albumin, total protein, and ALT joined even sooner. In conclusion, using DOI theory, the study found that personal lifestyle and liver function play a role in how quickly individuals adopt a new screening system., Conclusion: These insights can help healthcare providers improve early screening efforts, particularly for people at risk of hepatitis and liver cancer, potentially reducing related deaths., (© 2024 Wiley Periodicals LLC.)

Submarine volcanism makes up approximately 85 % of volcanism that occurs on Earth, and its eruptions have the potential to cause several hazards including ash dispersal, pumice rafts, pyroclastic density currents, sector collapses, and tsunamis. Recent examples include the eruptions in Japan and in the Kingdom of Tonga in 2021 and 2022 respectively, but there has been little to no study of submarine volcanism in Southeast Asia and surroundings. Here we provide a compilation of 466 seamounts from the region, from different published sources, through the SEATANI dataset (Southeast Asia, Taiwan, and the Andaman and Nicobar Islands). We use this newly compiled dataset to assess on a regional level the seamount hazard potential and exposure potential as a springboard for future more quantitative hazard studies of the region. The hazard potential was assessed through seamount morphological and structural analyses, to determine the seamount evolution stage and grade of maturity. The exposure potential was evaluated with two different approaches: an areal analysis of the number of assets within a 100 km radius of each seamount and the development of a hazard-weighted seamount density map to highlight potential areas of interest for future more-in-depth studies. Our results show that there are several potentially hazardous seamounts in this region. Taiwan has the highest hazard and exposure potential, for all assets considered, while the Philippines, Indonesia, and Vietnam have relatively high exposure potential for submarine communication cables and ship traffic density. The results from this work serve as a first step towards Southeast Asia and neighbouring countries becoming more resilient against and prepared for submarine volcanic eruptions in the region. [ABSTRACT FROM AUTHOR]

The current quasi-experimental study explored the effects of Baduanjin qigong on body mass index (BMI) and five metabolic indexes in people with schizophrenia. Inclusion criteria were body mass index >25 kg/m2 or metabolic syndrome. Twenty-two service users were recruited from a psychiatric center and were assigned to the experimental group (EG) or control group (CG) using blocked randomization. The EG performed Baduanjin qigong lasting 1 hour for 12 weeks three times per week, whereas the CG received routine care. Generalized estimating equations showed that the EG achieved a greater decrease in BMI and waist circumference (WC) than the CG post-intervention. Baduanjin qigong may provide an effective nonpharmacological approach to reducing BMI and WC in people with schizophrenia. This study showed that performing Baduanjin qigong for 12 weeks is a feasible and effective strategy for improving the body shape of individuals with chronic schizophrenia, thus providing results that can serve as a reference for health professionals working in psychiatry departments. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 41–48.] [ABSTRACT FROM AUTHOR]

Plants are associated with a large diversity of microbes, and these complex plantassociated microbial communities are critical for plant health. Welsh onion (Allium fistulosum L.) is one of the key and oldest vegetable crops cultivated in Taiwan. The leaf of the Welsh onion is one of the famous spices in Taiwanese cuisine, thus, it is crucial to control foliar diseases. In recent years, Welsh onion cultivation in Taiwan has been severely threatened by the occurrence of leaf blight disease, greatly affecting their yield and quality. However, the overall picture of microbiota associated with the Welsh onion plant is still not clear as most of the recent etiological investigations were heavily based on the isolation of microorganisms from diseased plants. Therefore, studying the diversity of fungal communities associated with the leaf blight symptoms of Welsh onion may provide information regarding key taxa possibly involved in the disease. Therefore, this investigation was mainly designed to understand the major fungal communities associated with leaf blight to identify key taxa potentially involved in the disease and further evaluate any shifts in both phyllosphere and rhizosphere mycobiome assembly due to foliar pathogen infection by amplicon sequencing targeting the Internal Transcribed Spacer (ITS) 1 region of the rRNA. The alpha and beta-diversity analyses were used to compare the fungal communities and significant fungal groups were recognized based on linear discriminant analyses. Based on the results of relative abundance data and co-occurrence networks in symptomatic plants we revealed that the leaf blight of Welsh onion in Sanxing, is a disease complex mainly involving Stemphylium and Colletotrichum taxa. In addition, genera such as Aspergillus, Athelia and Colletotrichum were abundantly found associated with the symptomatic rhizosphere. Alphadiversity in some fields indicated a significant increase in species richness in the symptomatic phyllosphere compared to the asymptomatic phyllosphere. These results will broaden our knowledge of pathogens of Welsh onion associated with leaf blight symptoms and will assist in developing effective disease management strategies to control the progress of the disease. [ABSTRACT FROM AUTHOR]

During the early months of life, infant formula plays a crucial role as a primary source of both food and essential nutrients for infants, serving as a replacement for or supplement to breast milk. However, nonessential metals in infant formulas are a concern because infants are highly vulnerable to chemical exposure. The aim of this study was to investigate infant exposure to nonessential metals in infant formula products in Taiwan and assess the associated health risks. In this study, concentrations of arsenic (As), barium (Ba), cadmium (Cd), manganese (Mn), lead (Pb), and vanadium (V) in 45 formula products for 0–1‐year‐old infants were determined by inductively coupled plasma mass spectrometry. The mean As, Ba, Cd, Mn, Pb, and V concentrations were 6.42, 280, 3.72, 1425, 20.4, and 21.9 µg/kg, respectively. According to our probabilistic simulation of the estimated daily intake of metals, the proportion of hazard quotients exceeding one was 7.69% for As and 3.29% for Mn, and that of hazard index (HI) values exceeding 1 was >17% for metals. Arsenic had the largest HI contribution (46.9%), followed by Mn (22.3%) and Pb (12.7%). The nonessential metals content in infant formula raises potential noncarcinogenic health concerns for infants in Taiwan. Therefore, regulations for nonessential metals must be imposed on related food products in Taiwan, with a particular focus on As and Mn. [ABSTRACT FROM AUTHOR]

Professional identities may influence a wide range of attitudes, ethical standards, professional commitments and patient safety. This study aimed to explore the important elements that comprise pediatricians' professional identities. A Q-methodology was used to identify the similarities and differences in professional identity. Forty pediatricians were recruited from two tertiary referral hospitals in Taiwan. A list of statements was developed by five attending physicians and three residents. R software was used to analyze the Q-sorts to load the viewpoints and formulate the viewpoint arrays. Additional qualitative data—one-to-one personal interviews—were analyzed. Twenty-eight of forty pediatricians, 11 males and 17 females, with an average age of 39.9 (27–62) years, were associated with four viewpoints. We labeled the four viewpoints identified for professional identity as (1) professional recognition, (2) patient communication, (3) empathy and (4) insight. The professional recognition viewpoint comprised of youngest participants—28–36 years—with the majority as residents (77.8%), while the empathy viewpoint comprised the oldest participants—38–62 years—with all as attending physicians. All participants in the empathy and insight viewpoints were married. This study found professional identity to be a multifaceted concept for pediatricians, especially in the areas of professional recognition, patient communication, empathy and insight into patient care. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of vancomycin-resistant Enterococcus faecium (VRE) infection at a medical center in Eastern Taiwan rose to 80.6%, exceeding the average prevalence of 55.6% among all medical centers nationwide during the same period. In recent years, the number of cases of VRE infection detected among hospitalized patients has increased annually. However, most of these patients in different wards are asymptomatic carriers. Therefore, restricting active screening to high-risk units will not improve the current situation, and it is necessary to review the risk factors for VRE colonization to provide a reference for future infection control policies. Materials and Methods: Between 2014 and 2019, there were 3188 VRE-positive cultures reported at our institution, as per the electronic medical records system. Results: In the medical and surgical wards, patients who received penicillin (odds ratios [ORs]: 2.84 and 4.16, respectively) and third-generation cephalosporins (ORs: 3.17 and 6.19, respectively) were at higher risk of VRE colonization. In intensive care units, the use of carbapenems (OR: 2.08) was the most significant variable. Conclusion: This study demonstrated that the risk factors for VRE colonization differed between wards. Thus, policies should be established according to the attributes of patients in each ward, and active screening tests should be performed according to individual risks, instead of a policy for comprehensive mass screening. [ABSTRACT FROM AUTHOR]

Developing offshore wind farms may impact cetaceans due to vessel collisions and underwater noise. Therefore, it is critical to protect cetaceans while developing offshore wind farms. We first studied the code of conduct/guidelines for whale watching and then interviewed members of the local whale-watching industry to learn about the interaction between cetaceans and vessels. After that, we compared current whale-watching guidelines in Taiwan with 69 published guidelines from other countries and locations, then developed guidelines for the offshore wind farm industry. The results show that rules related to approaching and interacting with cetaceans in Taiwan are similar to those in other countries. However, swimming with cetaceans and approaching calves are prohibited in Taiwan. From the survey of the whale-watching industry, most whale-watching guidelines in Taiwan were found to be feasible, and the guidelines should be described in the premise with different phenotypic traits of various cetaceans. Based on the whale-watching guidelines, we developed a code of conduct for protecting cetaceans from the impact of vessels, specifically in offshore wind farm operations in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated that patients with type 2 diabetes mellitus (T2DM) who receive metformin have a decreased risk of developing agerelated macular degeneration (AMD). However, other studies have also suggested that metformin may increase the risk of AMD development. Therefore, this study investigated the association between treatment with metformin and the risk of AMD in patients with T2DM by using Taiwan’ National Health Insurance Research Database. Methods: Patients who received a diagnosis of new-onset T2DM between 2002 and 2013 were enrolled in this study. The patients were divided into patients treated and not treated with metformin to evaluate the risk of AMD after 5 years of follow-up. The logistic regression was used to estimate the risk of AMD associated with the intensity of treatment with metformin. Result: A total of 7 517 patients (103.16 patients per 10,000 people) developed AMD in 5 years after DM diagnosis. After adjusting for the relevant variables, patients with T2DM treated with <5 defined daily dose (DDD)/month of metformin had a lower risk of AMD (odds ratios [OR]: 0.93; 95% confidence interval [CI]: 0.88 0.99). Patients treated with >25 DDD/month of metformin had a higher risk of AMD (OR: 1.39; 95% CI: 1.08-1.78). Conclusion: Metformin use may be associated with a risk of AMD among patients with T2DM in a dose-dependent association manner, with the greater benefit at lower DDD/month. However, higher DDD/month exhibited an increased risk of AMD. [ABSTRACT FROM AUTHOR]

Background: This study examined the long-term risks of heart failure (HF) and coronary heart disease (CHD) following traumatic brain injury (TBI), focusing on gender differences. Methods: Data from Taiwan's National Health Insurance Research Database included 29,570 TBI patients and 118,280 matched controls based on propensity scores. Results: The TBI cohort had higher incidences of CHD and HF (9.76 vs. 9.07 per 1000 person-years; 4.40 vs. 3.88 per 1000 person-years). Adjusted analyses showed a significantly higher risk of HF in the TBI group (adjusted hazard ratio = 1.08, 95% CI = 1.01–1.17, P = 0.031). The increased CHD risk in the TBI cohort became insignificant after adjustment. Subgroup analysis by gender revealed higher HF risk in men (aHR = 1.14, 95% CI = 1.03–1.25, P = 0.010) and higher CHD risk in women under 50 (aHR = 1.32, 95% CI = 1.15–1.52, P < 0.001). TBI patients without beta-blocker therapy may be at increased risk of HF. Conclusion: Our results suggest that TBI increases the risk of HF and CHD in this nationwide cohort of Taiwanese citizens. Gender influences the risks differently, with men at higher HF risk and younger women at higher CHD risk. Beta-blockers have a neutral effect on HF and CHD risk. [ABSTRACT FROM AUTHOR]

Soil liquefaction is one of the complex topics in geotechnical engineering, and a variety of liquefaction studies have been reported, including the hyperbolic function (HBF) method for calculating the liquefaction factor of safety. This research aims to assess its performance, quantitatively, in terms of accuracy, recall, precision, etc. To achieve the objective, a new soil liquefaction database with the data from published papers was also compiled. Based on a total of 796 soil liquefaction case histories, the study shows that the accuracy of the HBF method is about 92%. In addition, the findings from this research also include: (i) the accuracy of the HBF method is comparable with other well-known methods (also SPT-based) for computing the liquefaction factor of safety; and (ii) the HBF method mainly developed with the data from Taiwan is applicable to other regions, given its accuracy still above 90% based on the data outside Taiwan. [ABSTRACT FROM AUTHOR]

In Taiwan, the pesticides dimethomorph and imidacloprid are recommended for pest control in vineyards. Therefore, tank-mixing of these two pesticides is usually a routine practice before application. This study analyzed the influence of vineyard soil microbial flora under the recommended and high dosages (100 times the recommended dosage) of dimethomorph and imidacloprid. Individual and combined applications of pesticides were also tested through batches of soil incubation experiments. Four treatments--control (C), dimethomorph (DT), imidacloprid (IM), and mixed application of dimethomorph and imidacloprid (ID)-- were used in the experimental design. From the soil metabolism, no significant reaction was observed after 2 months in the recommended dosage group, regardless of whether the pesticides were being applied individually or combined. For the high dosage, imidacloprid showed a higher effect than the co-exposure treatments, showing a possible prolonged effect after its repetitive application. From PCoA analysis, pesticide treatments altered the soil ecology after 2 months, and the effect of imidacloprid can be explicitly observed at high dosages. At the phylum level, Acidobacteria can indicate pesticide application around the recommended dosage. It was inhibited by ID on day 7 and was augmented by all pesticides on day 63. The effect of the recommended dosage of pesticide mixtures after 2 months of incubation was revealed in the minor families Gemmataceae and Pirellulaceae, while the high dosage treatments affected both the core and the minor families. Our findings verified the changes in the composition of microbial communities upon pesticide application, which would affect carbon, nitrogen, sulfur, phosphorous cycles, and contaminant removal ability within the vineyard. [ABSTRACT FROM AUTHOR]

Storm‐flood‐dominated deltas are sedimentary systems in which a complex interplay of hydrodynamic processes occurs during storms (e.g. tropical cyclones) due to the coeval action of continental and oceanic processes. This paper reports on a superbly exposed, 135.5 m thick stratigraphic succession of the Pleistocene Cholan Formation exposed along the Da'an River, Taiwan. The sedimentary succession comprises alternating mudstone and sandstone, is mostly fine‐grained, and exhibits multiple event beds that record deposition during tropical cyclones and post‐depositional deformation features produced during earthquakes. Detailed facies analyses reveal that deposition towards the base of the succession occurred in the palaeo‐Taiwan Strait in storm‐flood‐dominated prodelta and delta‐front environments passing upwards into delta‐plain environments. Tropical cyclone beds are encountered throughout the subaqueous storm‐flood delta successions, and are identified by (i) trough cross‐stratified sandstone bedsets with erosive bases that contain both mud clasts and mudstone beds, (ii) sandstone with aggrading wave ripples and (iii) hummocky cross‐stratified sandstone with rare gutter casts filled with coal fragments and shell remains. Tropical cyclone deposits are either top‐down burrowed or capped by massive or laminated mudstone. Seismites are rare and are mainly recognised through soft‐sediment deformation of beds; they do not show evidence of slope failure. Compared to storm‐flood delta successions described elsewhere, the Cholan Formation shows significantly fewer oscillatory‐generated sedimentary structures and gutter casts. This difference is attributed to the Cholan Formation being deposited in and along the margin of a strait characterised by strong shore‐parallel currents and relatively small storm waves due to its position between Taiwan and mainland China. This study refines depositional process interpretations of the Cholan Formation, provides criteria for recognising storm‐flood delta deposits in tectonically active straits with multiple sediment sources fed by steep drainages and short river catchments, and provides additional criteria for recognising tropical cyclone deposits in shallow‐marine settings. [ABSTRACT FROM AUTHOR]

Our study aimed to determine whether mothers with bipolar disorder, major depressive disorder, schizophrenia, or schizoaffective disorder affected the risk of type 1 diabetes (T1D) in their offspring.Methods: We conducted a nationwide cohort study by using data from Taiwan's National Health Insurance Research Database and the Maternal and Child Health Database from 2004 to 2018. A total of 2,556,640 mother-child pairs were identified. Cox proportional hazards models were used to compare the risk of T1D between children born to mothers with mood disorders and schizophrenia and those without.Results: No significant difference in risk of T1D was observed between the offspring of mothers with major psychiatric disorders and those without (adjusted hazard ratio (aHR) of 0.86 with a 95% confidence interval (CI) of 0.58– 1.24). In subgroup analysis, we found an aHR of 1.81 with a 95% CI of 0.83– 3.82 in the maternal bipolar disorder on the risk of T1D in offspring and an aHR of 0.87 (95% CI: 0.59– 1.25) in maternal major depressive disorder. In the schizophrenia/schizoaffective disorder group, aHR cannot be obtained due to lesser than three events in the analysis.Conclusion: The risk of T1D in offspring of mothers with mood disorders and schizophrenia was not significant. However, children born to mothers with bipolar disorder may have a tendency to develop T1D. The relationship between maternal psychiatric disorders and the risk of T1D in offspring warrants further investigation in studies with longer follow-up periods. [ABSTRACT FROM AUTHOR]

Edwardsiella anguillarum, a highly virulent species within the Edwardsiella genus, causes significant mortality in milkfish farms in Taiwan. This study aimed to investigate the comparison of milkfish susceptibility, a newly identified host species in Taiwanese aquaculture, with other species Nile tilapia (Oreochromis niloticus) and Asian seabass (Lates calcarifer), to E. anguillarum, elucidating its pathogenicity across both seawater and freshwater aquaculture environments. The results showed milkfish exhibited the highest mortality rate of 85% within 48 h of infection, whereas Nile tilapia exhibited a mortality rate of 70% between the second- and tenth-day post challenge, and seabass exhibited a mortality rate of 25% between the second- and sixth-day post challenge. Gross lesions observed in milkfish included splenomegaly and haemorrhage, whereas Nile tilapia exhibited signs of ascites, exophthalmia and brain haemorrhage. Seabass displayed spleen granulomas and haemorrhage at the injection site. Histopathological analysis revealed common features across all three species, including multifocal necrosis, bacterial presence in the necrotic areas, serositis and oedema. Asian seabass also exhibited chronic lesions in the form of splenic granulomas. This study highlights the high susceptibility of milkfish and Nile tilapia to E. anguillarum, emphasizing the urgent need for further investigation into targeted vaccine development for these fish species. These results not only deepen our understanding of the differing levels of pathogenicity among the three species but also offer valuable insights for improving disease prevention and management strategies in aquaculture, including those applied within polyculture systems and for the maintenance of aquaculture water environments., (© 2024 John Wiley & Sons Ltd.)

Objective: This study was undertaken to examine the association between different patterns of antiseizure medication (ASM) use during pregnancy and adverse obstetric outcomes (preterm birth, low birth weight [LBW], and small for gestational age [SGA])., Methods: This retrospective cohort study used the Birth Certificate Application and National Health Insurance data in Taiwan (January 1, 2004 through December 31, 2018). We retrieved weekly ASM among pregnant women with epilepsy who were prepregnancy chronic users and used group-based trajectory modeling to identify distinct patterns of use. Logistic regressions were adopted to examine the association between patterns of ASM use and risk of preterm birth, LBW, and SGA. In addition, we revealed postnatal ASM utilization pattern among these prepregnancy chronic users as an exploratory study., Results: Of 2175 pregnant women with epilepsy, we identified four patterns of ASM use during pregnancy: frequent and continuous (64.87%), frequent but discontinuous (7.08%), intermittent (19.72%), and intermittent and discontinuous users (8.32%). Compared to frequent and continuous users, the adjusted odds ratios for preterm birth in frequent but discontinuous, intermittent, and intermittent and discontinuous users were .83 (95% confidence interval [CI] = .47-1.48), .71 (95% CI = .47-1.05), and .88 (95% CI = .52-1.49), respectively. Similar results were observed for LBW and SGA. In the exploratory study, we found that most of our study subjects maintained the same patterns before and after delivery., Significance: After considering duration and timing of exposure, our study did not find an association between four distinct patterns of ASM use and adverse obstetric outcomes among women with epilepsy. The findings suggested that optimal seizure control could be received for pregnant women with epilepsy after evaluating the risks and benefits., (© 2024 International League Against Epilepsy.)

The terrain, such as Taiwan Island, have been shown to have complex effects on typhoons and the associated typhoon waves. Terrain effects change with typhoon tracks. In this study, three types of typhoon tracks (northern, middle and southern) were defined according to the relationship between the typhoon tracks and Taiwan Island. Typhoons on these three tracks and typhoon waves were simulated using the Weather Research and Forecasting–Simulating Waves Nearshore model. In each type of typhoon, a control case without the Taiwan topography was simulated to compare with real cases. The results showed that typhoons on different tracks were affected by the terrain of Taiwan Island in different ways. Taiwan Island had weakening, decelerating and deflective effects on typhoons. The ranking for the weakening effect was middle track (81%) > southern track (69%) > northern track (3%). The decelerating effect was 7% in the northern track and 25% in the southern track. The deflective effect of the terrain makes typhoons on the northern (southern) track deflect toward the south (north). When a typhoon on a middle track passed over Taiwan Island, a new center of low pressure would replace the former center and make the track discontinuous. In addition, the influence of typhoons on regions near Taiwan Island changed with the typhoon's tracks. The influence ranking of typhoons in Taiwan Island was the middle track > southern track > northern track, which was consistent with that of typhoons in the Taiwan Strait and opposite to that of typhoons in Fujian Province. The influence ranking of typhoons on the Taiwan Strait was the opposite of the typhoon intensity ranking, which suggests that the intensities of wind and waves in the strait were more related to typhoon tracks than typhoon intensity. The variations in the significant wave height were similar to those of the wind speed, but there was a time lag (2 h) between them due to the wave growth process and swells. In addition, the significant wave height distribution sometimes differed from the wind speed distribution under the influence of swells and terrain. [ABSTRACT FROM AUTHOR]

The knowledge of English idioms is essential for advanced English learning and application, particularly for English-as-a-foreign-language (EFL) learners. While studies have shown the benefits of mobile-assisted language learning (MALL) to facilitate English learning, few studies have examined the factors that may influence MALL in light of motivation and anxiety, let alone the behavioral patterns of learners with different learning motivation and learning anxiety levels. Therefore, in this study, a mobile application named My English Idiom Learning Assistant (MEILA) rooted in the theory of Associative Fluency was developed to examine the relationships among learning outcomes, motivation, anxiety, and learning behaviors in English idiom learning. The participants were 59 students from two Freshman English classes in one private university in Central Taiwan. In this 5-week implementation, the students were engaged in 3-week self-study learning, where they were encouraged to watch 15 idiom-related animations and videos each week and make and record English sentences in MEILA. Multiple data sources were collected in this mixed-methods research, including pre- and post-test of English idiomatic understanding, two questionnaires (English learning motivation and English learning anxiety), and interviews. The results from the tests revealed the positive affordances of MEILA for facilitating English idiom learning among Taiwanese college students. The analysis of students' behavioral patterns showed that students with different levels of motivation and anxiety (high motivation/high anxiety, high motivation/low anxiety, low motivation/high anxiety, low motivation/low anxiety) exhibited distinctive learning behaviors. Most students were positive about the use of MEILA for English idiom learning. The current findings provide recommendations to instructional designers who wish to optimize MALL for benefiting learners with different needs. [ABSTRACT FROM AUTHOR]

China and Taiwan (so‐called Greater China) are representative of two of the fastest‐growing economies in the Pacific Rim region. This study uses Taiwanese high‐tech firms as sample and explores whether boards of directors attempt to avoid opportunistic reductions in research and development (R&D) investments by CEOs. This study considers a scenario in which high‐tech firms face a small earnings decline or a small loss but their CEOs could opportunistically cut R&D investments to improve financial results. The focus of this study is to examine how corporate control (whether or not a firm is controlled by a family) and market competition affect the relationship between R&D investments and CEO compensation schemes. Overall, we find that the stock‐based incentive compensation is more effective than the cash compensation in deterring managerial opportunism. In non‐family firms, we find there exists a positive significant relationship between changes in R&D expenditures and changes in CEO stock‐based compensation when a firm is faced with a small earnings decline or a small loss. Specifically, compared to family firms, the boards of directors of non‐family firms face more severe agency problems (as a result of the separation of ownership and control) and therefore tend to significantly adjust the incentive components in CEO compensation schemes to deter managerial opportunism. Regarding the effect of market competition, we find that incentives to adjust compensation plan to remove CEOs from opportunistically reducing discretionary R&D investments are greater in firms facing more intense market competition. [ABSTRACT FROM AUTHOR]

The concepts of culinary sustainability and avoiding the waste of surplus food have become important sustainability trends today. How the handling of surplus food can be integrated into the catering industry is a topic of concern in the industry. Kitchen staff are the vital soul of any restaurant, and we intend to discuss how kitchen staff actually behave and explore factors that influence their behaviors in order to develop an implementation model for food waste prevention. Therefore, this study explored a model of ethical sustainability, professional competence, self-efficacy, sustainable food preparation objectives, and sustainable food promotion and behavior focused on limiting food waste, using structural equation modeling (SEM) to understand the relationship between various constructs. This study used a questionnaire and surveyed employees who had been employed for more than 6 months in Taiwan. From May to August 2022, 500 questionnaires were distributed; 415 valid questionnaires were retrieved, yielding a 90.2% recovery rate. According to the structural equation modeling analysis between the dimensions, ethical sustainability should have a positive influence on professional competence in food waste prevention and self-efficacy. Professional competence in food waste prevention affected self-efficacy and behavioral intentions during food preparation; self-efficacy also significantly affected behavioral intentions towards sustainable food preparation. Similarly, behavioral intention had a positive influence on promoting sustainable behaviors. There is a significant relationship between all constructs in this study. Professional competence in food waste prevention was found to be the mediating factor between ethical sustainability and behavioral intentions toward sustainable food preparation, and self-efficacy was the mediating factor between professional competence in food waste prevention and behavioral intentions toward sustainable food preparation. [ABSTRACT FROM AUTHOR]

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Background: We aimed to describe the clinical features of Gram-negative bacillary (GNB) meningitis in neonates and investigate the risk factors associated with final adverse outcomes of neonatal GNB meningitis. Methods: From 2003 to 2020, all neonates (aged ≤ 90 days old) with bacterial meningitis who were hospitalized in four tertiary-level neonatal intensive care units (NICUs) of two medical centers in Taiwan were enrolled. Neonates with GNB meningitis were compared with those with Streptococcus agalactiae (group B streptococcus, GBS) meningitis. Results: During the study period, a total of 153 neonates with bacterial meningitis were identified and enrolled. GNB and GBS accounted for 40.5% (n = 62) and 35.3% (n = 54) of all neonatal bacterial meningitis, respectively. In neonates with GNB meningitis, the final mortality rate was 6.5% (4 neonates died); 48 (77.4%) had neurological complications, and 26 (44.8%) of 58 survivors had neurological sequelae at discharge. Although the final outcomes were comparable between neonates with GNB meningitis and those with GBS meningitis, neonates with GNB meningitis were more likely to have more severe clinical manifestations initially and have ventriculomegaly at follow-up. After multivariate logistic regression analysis, neonates with seizure at onset, early onset sepsis, and requirement of surgical intervention for neurological complications were independently associated with final adverse outcomes. Conclusions: GNB meningitis was associated with a high risk of neurological complications and sequelae, although it did not significantly increase the final mortality rate. Close monitoring of the occurrence of neurological complications and advanced therapeutic strategies to optimize the outcomes are urgently needed in the future. [ABSTRACT FROM AUTHOR]

Background: The prevalence of violence in acute psychiatric wards is a critical concern. According to a meta-analysis investigating violence in psychiatric inpatient units, researchers estimated that approximately 17% of inpatients commit one or more acts of violence during their stay. Inpatient violence negatively affects health-care providers and patients and may contribute to high staff turnover. Therefore, predicting which psychiatric inpatients will commit violence is of considerable clinical significance. Objective: The present study aimed to estimate the violence rate for psychiatric inpatients and establish a predictive model for violence in psychiatric inpatients. Methods: We collected the structured and unstructured data from Chinese nursing electronic medical records (EMRs) for the violence prediction. The data was obtained from the psychiatry department of a regional hospital in southern Taiwan, covering the period between January 2008 and December 2018. Several text mining and machine learning techniques were employed to analyze the data. Results: The results demonstrated that the rate of violence in psychiatric inpatients is 19.7%. The patients with violence in psychiatric wards were generally younger, had a more violent history, and were more likely to be unmarried. Furthermore, our study supported the feasibility of predicting aggressive incidents in psychiatric wards by using nursing EMRs and the proposed method can be incorporated into routine clinical practice to enable early prediction of inpatient violence. Conclusions: Our findings may provide clinicians with a new basis for judgment of the risk of violence in psychiatric wards. [ABSTRACT FROM AUTHOR]

Climate oscillations preserved in sedimentary archives tend to decrease in resolution further back in Earth's history. High‐frequency climate cycles (e.g., ∼20‐Kyr precession cycles) are especially prone to poor preservation due to sediment reworking. Recent studies have shown, however, that given sufficient basin accommodation space and sedimentation rate, shallow‐marine paleoclimate archives record precession‐driven hydroclimate change in mid‐low latitude regions. Our study evaluates how the evolution of a rapidly uplifting orogen influences the recording of astronomical climate forcing in shallow‐marine sedimentary strata in the Taiwan Western Foreland Basin (WFB). Time‐series analysis of gamma‐ray records through the late Miocene–Pliocene Kueichulin Formation shows that during early stages of Taiwan orogenesis (before 5.4 Ma), preservation of precession‐driven East Asian Summer Monsoon variability is low despite increasing monsoon intensities between 8 and 3 Ma. The Taiwan Strait had not formed, and the southeast margin of Eurasia was open to the Pacific Ocean. Consequently, depositional environments in the WFB were susceptible to reworking by large waves, resulting in the obscuration of higher‐frequency precession cycles. From 5.4 to 4.92 Ma, during early stages of emergence of Taiwan, basin subsidence increased while sedimentation rates remained low, resulting in poor preservation of orbital oscillations. After 4.92 Ma and up to 3.15 Ma, Taiwan became a major sediment source to the WFB, and sheltered the WFB from erosive waves with the development of Taiwan Strait. The elevated sediment influx, increased basin accommodation as the WFB developed, and formation of a semi‐sheltered strait, resulted in enhanced preservation of precession‐driven East Asian Summer Monsoon variability. Plain Language Summary: Rhythmic changes in the shape of Earth's orbit (eccentricity, ∼100‐Kyr cycles), tilt (obliquity, ∼41‐Kyr cycles), and axial rotation (precession, ∼20‐Kyr cycles) drive climate change that may be preserved in sedimentary records. Orbital climate cycles are recorded in clastic shallow‐marine strata where the amount of sediment transported from land to sea and space available for deposition in the basin are sufficiently high. Our study of the Kueichulin Formation in the Taiwan Western Foreland Basin (WFB) shows how a rapidly uplifting orogen influences the preservation of different climate cycles in the shallow‐marine realm. During early Taiwan orogenesis (before 5.4 Ma) when the Taiwan Strait did not exist, sediment in the WFB were susceptible to reworking by erosive waves generated in the Pacific Ocean, which obscured higher‐frequency precession cycles. From 5.4 to 4.92 Ma, Taiwan began to emerge from the Pacific Ocean and the WFB began to subside, but sedimentation rates were low, so climate cycles were poorly preserved. After 4.92 Ma, rapid uplift and erosion of Taiwan and WFB subsidence continued, resulting in increased sedimentation to the sea, increased sediment accumulation space, and the formation of a strait that sheltered the WFB from waves, which all served to enhance the preservation of precession. Key Points: Preservation of different climate cycles in shallow‐marine records is influenced by a rapidly uplifting orogenDuring early uplift of Taiwan (before 5.4 Ma), only eccentricity and obliquity were preserved due to low sedimentation/basin accommodationFormation of a sheltered strait and increased sediment flux/basin subsidence as Taiwan uplifted enhanced preservation of precession cycles [ABSTRACT FROM AUTHOR]

As a conservation and breeding institution for birds, Taipei Zoo plays an important role in restoring endangered species. As approximately half of all bird species are monomorphic, precisely confirming the sex of individuals is critical for the management of ex-situ conservation breeding populations, as well as for understanding the sex ratio of those in the wild. Generally, PCR is used more reliably for sex determination versus traditional methods such as plumage, behavior or hormone levels. Nevertheless, the various primer sets and annealing temperatures vary between species, and so inaccurate sexing can occasionally happen due to inadequate PCR conditions. To reduce the probability of misidentification, and to establish a PCR condition database for sex determination across the diverse range of avian taxa, we tested multiple primer sets and annealing temperatures for amplification of the bird sex-specific gene fragments (CHD1) for each captive or rescued avian species held at Taipei Zoo since 2014. A total of 162 species across 22 orders were tested using one or two primer sets. One hundred and fifty-five species were successfully sexed by the primer set 2550F/2718R and the success rate of sex typing reached over 90% of species tested in each order. Most species have suitable PCR annealing temperatures between 45°C and 55°C, and the species in the same avian taxa showed similar results in temperature. This indicates that it is possible to select the annealing temperature of other species in the same family when the species had not been tested before. We expect this study will improve the success rate of identifying sex by using applicable PCR conditions and reduce the time for searching references every time before attempts to PCR sex birds., (© 2024 Wiley Periodicals LLC.)

Objectives: The association of migraine with the risk of certain cancer has been reported. The aim of this pilot study was to examine the associations between migraine and the onset of head and neck cancers (HNC)., Materials and Methods: A total of 1755 individuals were identified through a nationwide population-based cohort registry in Taiwan between 2000 and 2013. The primary end point variable was new-onset head and neck cancers in patients with migraine versus non-migraine controls. Cox proportional hazard regression was used to derive the risk of HNC. Subgroup analyses were performed to determine subpopulations at risk of migraine-associated HNC. Sub-outcome analyses were carried out to provide the subtypes of migraine-associated HNC. Propensity score matching was utilized to validate the findings., Results: A total of four patients out of 351 patients with migraine and seven out of 1404 non-migraine controls developed HNC. The incidence of HNC was higher in patients with migraine than that in non-migraine controls (108.93 vs. 48.77 per 100,000 person-years) (adjusted hazard ratio, aHR = 2.908, 95% CI = 0.808-10.469; p = 0.102). The risk of HNC in patients with migraine with aura (aHR = 5.454, 95% CI = 0.948-26.875; p = 0.264) and without aura (aHR = 2.777, 95% CI = 0.755-8.473; p = 0.118) was revealed. The incidence of non-nasopharyngeal HNC secondary to migraine (112.79 per 100,000 person-years) was higher than that of nasopharyngeal cancer secondary to migraine (105.33 per 100,000 person-years)., Conclusion: A higher incidence of HNC was observed in a small sample of patients with migraine, especially in those with migraine with aura. Migraine-associated HNC included non-nasopharyngeal HNC. Studies with a larger sample are needed to confirm the finding of the high risk of HNC in people with migraine., (© 2023 Wiley Periodicals LLC.)

We analysed the attributes of online travel reviews that facilitate online travel purchasing decisions. In Study 1, we developed and validated a scale for measuring the perceived value of online travel reviews (PVOTR). The PVOTR scale has six dimentions and was based on a literature review and Fuzzy Delphi Method. It was validated with data from 69 undergraduate students and 485 travelers in Taiwan. In Study 2, we examined the impact of PVOTR on the online travel purchasing attitudes of another 469 travelers in Taiwan. PVOTR significantly affected online travel purchasing attitudes through the mediation of reduced perceived complexity. [ABSTRACT FROM AUTHOR]

Methylglyoxal (MG) is a highly reactive dicarbonyl aldehyde and a major precursor of advanced glycation end products that result in oxidative stress. Graptopetalum paraguayense E. Walther (WGP) is a herbal medicine of Taiwan with the hepatoprotective property. The aim of this study was to investigate the protective effects of the water extract of WGP on MG-induced liver damage in a rat model. The results showed that WGP lowered the total cholesterol level and the low-density lipoprotein cholesterol level. WGP could help normalize the MG level. The amelioration of inflammatory factors such as transformation growth factor-β1 was observed in the WGP treatment group. In another animal model, a high-fructose diet (HFD) was used to induce intestinal dysfunction in C57BL/6 mice. The results indicated that the HFD induction resulted in intestinal dysbiosis, including inflammation, microflora imbalances, and reductions in tight-junction proteins. However, both WGP and its active compound gallic acid could improve intestine function. According to the above, WGP can improve hyperlipidemia in the liver, inhibit inflammatory cytokine production, and regulate intestinal flora in mice, as well as enhance the intestinal barrier. These findings provide a basis for the development of health products. [ABSTRACT FROM AUTHOR]

Patients with viral infections are susceptible to osteoporosis. This cohort study investigated the correlation between human papillomavirus (HPV) infections and the risk of osteoporosis via 12,936 patients with new-onset HPV infections and propensity score-matched non-HPV controls enrolled in Taiwan. The primary endpoint was incident osteoporosis following HPV infections. Cox proportional hazards regression analysis and the Kaplan-Meier method was used to determine the effect of HPV infections on the risk of osteoporosis. Patients with HPV infections presented with a significantly high risk of osteoporosis (adjusted hazard ratio, aHR = 1.32, 95% CI = 1.06–1.65) after adjusting for sex, age, comorbidities and co-medications. Subgroup analysis provided that populations at risk of HPV-associated osteoporosis were females (aHR = 1.33; 95% CI = 1.04–1.71), those aged between 60 and 80 years (aHR = 1.45, 95% CI = 1.01–2.08 for patients aged 60–70; aHR = 1.51; 95% CI = 1.07–2.12 for patients aged 70–80), and patients with long-term use of glucocorticoids (aHR = 2.17; 95% CI = 1.11–4.22). HPV-infected patients who did not receive treatments for HPV infections were at a greater risk (aHR = 1.40; 95% CI = 1.09–1.80) of osteoporosis, while the risk of osteoporosis in those who received treatments for HPV infections did not reach statistical significance (aHR = 1.14; 95% CI = 0.78–1.66). Patients with HPV infections presented with a high risk of subsequent osteoporosis. Treatments for HPV infections attenuated the risk of HPV-associated osteoporosis. [ABSTRACT FROM AUTHOR]

Simple Summary: The population of Indo-Pacific humpback dolphin (Sousa chinensis) endemic to the inshore and estuarine waters of western Taiwan was identified as a subspecies (Sousa chinensis ssp. taiwanensis) and designated as "Critically Endangered" by the International Union for Conservation of Nature (IUCN). This population is at a high risk of extirpation, faces being impacted by some major anthropogenic threats, and numbers fewer than 65 individuals. Through a combination of long-term observations and photographic monitoring of identifiable individuals and stranding responses, accurate identification and classification of human-induced injuries and skin lesions is an effective approach and is particularly important to the management of the declining population. The results showed that the prevalence of skin marks is higher or comparable to the previous studies on the coastal cetacean populations across the globe. As the total population comprises dozens of individuals, radical measures to conserve the population and reduce environmental hazards are considered indispensable. As long-lived apex predators, Indo-Pacific humpback dolphins (Sousa chinensis) are key indicators of marine coastal environmental health. Skin marks can be observed on dorsal body surfaces that are visible during mark–recapture studies that rely on photo-identification (photo-ID) methods. Skin mark prevalence may be an indicator of environmental or anthropogenic stressors in the ecosystem, which may lead to individual and/or population-level health concerns. The prevalence of marks of anthropogenic origin was assessed in the Critically Endangered S. chinensis taiwanensis population along the coasts of central Taiwan. Fifty, twenty-eight, and thirty-four individuals were identified in 2018, 2019, and 2021, respectively. At least one category of injuries was observed in 47 of 57 distinctive individuals (82%), and adults showed a higher prevalence of deep injuries than the other coloration stages. At least one category of skin lesion was observed in 33 of 57 distinctive individuals (58%), and high prevalence of skin lesions was found in mature individuals. Given the difficulty in taking direct observations, skin mark prevalence is proposed as a proxy for estimating habitat health and anthropogenic stressors upon S. chinensis taiwanensis. The moderate-to-high prevalence of skin marks in this study was designated as a warning of risks. This study provides important updated information for the assessment of the health and survival of this population. More effective management measures are urgently needed to reverse the observed population decline. [ABSTRACT FROM AUTHOR]

Aim: The study examined whether occupational stress mediated the relationship between abusive supervision and well‐being of nursing staff. Design: A cross‐sectional questionnaire survey was administered. Methods: Data were collected at three‐time points between July 2020 and January 2021. A total of 313 valid responses were obtained from nurses working in a general hospital in Taiwan. The data were analysed using descriptive statistics, Pearson's correlation analysis and the bootstrap method. Results: Abusive supervision was positively associated with occupational stress (β = 0.288, SE = 0.069, 95% CI [0.152, 0.423]) and negatively associated with employee well‐being, including psychological (β = −0.350, SE = 0.084, 95% CI [−0.515, −0.186]), physical (β = −0.301, SE = 0.080, 95% CI [−0.459, −0.143]) and social well‐being (β = −0.422, SE = 0.121, 95% CI [−0.661, −0.183]). Occupational stress was negatively related to employee well‐being. A mediation analysis with bootstrapping revealed that occupational stress mediated the relationship between abusive supervision and employee well‐being, which included psychological (95% bootstrap CI [−0.183, −0.046]), physical (95% bootstrap CI [−0.212, −0.062]) and social well‐being (95% bootstrap CI [−0.178, −0.040]). Conclusion: Abusive supervision influences employee well‐being. Occupational stress mediates the relationship between abusive supervision and employee well‐being. To improve employee well‐being, hospital administrators should develop policies for effectively managing nursing supervisors' abusive behaviour and subordinates' stress management. Impact Abusive supervision increased the occupational stress of employees and influenced their well‐being. Thus, educational courses should be implemented to train supervisors to practice positive leadership and treat employees fairly. Promoting stress management among nursing staff may lead to the prompt reporting of abusive events and improved employee well‐being. No Patient or Public Contribution: This study investigated the relationship between the abusive supervision and employee well‐being of nursing employees. No patient or public contribution is involved in this study. [ABSTRACT FROM AUTHOR]

The prevalence of chronic diseases (such as diabetes, obesity, cancer, heart disease, and chronic obstructive pulmonary disease) continues to increase among patients with mental illness. This cross‐sectional study investigated the factors affecting nurses' views on the provision of physical healthcare to patients with comorbid mental illness and chronic disease. In total, 369 nurses working in mental health were assessed for the physical healthcare attitudes and practices using the Physical Health Attitude Scale for Mental Health Nurses. The results of generalized linear modelling indicated that nurses' involvement in physical healthcare was associated with psychiatric mental health nurse credentials (B = 1.560, 95% CI = 0.292–2.828, P = 0.016) and their confidence in delivering physical healthcare was associated with prior physical healthcare training (B = 0.639, 95% CI = 0.104–1.174, P = 0.019). In addition, the frequency with which the nurses engaged in physical healthcare practices was associated with working in a community unit (B = −7.416, 95% CI = −9.652 to −5.180, P < 0.001), involvement in physical healthcare (B = 0.349, 95% CI = 0.162–0.535, P < 0.001), and confidence in delivering physical healthcare (B = 1.148, 95% CI = 0.776–1.519, P < 0.001). Our findings suggest that interventions aiming to help nurses assess and improve their own physical healthcare practices should consider nurses' background and patients' physical health needs in various settings and focus on cultivating an organizational culture that gives nurses confidence in providing physical healthcare. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic that swept the world in 2020 has highlighted the dangers and challenges posed by infectious diseases and encouraged healthcare providers to further re-think the stigma of epidemic and pandemic diseases. HIV infection was reclassified as a chronic disease in Taiwan after highly active antiretroviral therapy was introduced in the country. Because HIV infection is related to behavior, people living with HIV are often affected by a negative social image that is influenced by multiple stereotypes and the general stigma toward AIDS. In Taiwan, this stigma is deeply influenced by Eastern philosophy and Confucian culture, making the context and effect of stigma different from Western countries. The current "U=U" concept of HIV treatment holds that someone under treatment for HIV with an undetectable HIV viral load cannot sexually transmit the virus to others. Therefore, in the post-pandemic era, HIV medical care personnel should apply evidence-based-care thinking. This article describes HIV stigma in the context of Confucianism, U=U as the leading concept of HIV treatment, and the recommended approach to care for HIV healthcare practitioners in the post-COVID-19 era. Reducing HIV stigma will enable Taiwan to achieve the 'Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Program on HIV/AIDS for ending the AIDS epidemic by 2030. [ABSTRACT FROM AUTHOR]

Since the first discovery of severe fever with thrombocytopenia syndrome virus (SFTSV) in China in 2009, SFTSV has rapidly spread through other Asian countries, including Japan, Korea, Vietnam and Pakistan, in chronological order. Taiwan reported its first discovery of SFTSV in sheep and humans in 2020. However, the prevalence of SFTSV in domestic and wildlife animals and the geographic distribution of the virus within the island remain unknown. A total of 1324 animal samples, including 803 domestic ruminants, 521 wildlife animals and 47 tick pools, were collected from March 2021 to December 2022 from 12 counties and one terrestrial island. The viral RNA was detected by a one-step real-time reverse transcription polymerase chain reaction (RT-PCR). Overall, 29.9% (240/803) of ruminants showed positive SFTSV RNA. Sheep had the highest viral RNA prevalence of 60% (30/50), followed by beef cattle at 28.4% (44/155), goats at 28.3% (47/166), and dairy cows at 27.5% (119/432). The bovine as a total of dairy cow and beef cattle was 27.8% (163/587). The viral RNA prevalence in ticks (predominantly Rhipicephalus microplus) was similar to those of ruminants at 27.7% (13/47), but wild animals exhibited a much lower prevalence at 1.3% (7/521). Geographically the distribution of positivity was quite even, being 33%, 29.1%, 27.5% and 37.5% for northern, central, southern and eastern Taiwan, respectively. Statistically, the positive rate of beef cattle in the central region (55.6%) and dairy cattle in the eastern region (40.6%) were significantly higher than the other regions; and the prevalence in Autumn (September–November) was significantly higher than in the other seasons (p < 0.001). The nationwide study herein revealed for the first time the wide distribution and high prevalence of SFTSV in both domestic animals and ticks in Taiwan. Considering the high mortality rate in humans, surveillance of other animal species, particularly those in close contact with humans, and instigation of protective measures for farmers, veterinarians, and especially older populations visiting or living near farms or rural areas should be prioritized. [ABSTRACT FROM AUTHOR]

Automated clinical decision support systems (CDSS) are knowledge-based systems that provide patient-specific information and data to clinicians at the proper time for enhancing the clinical workflow of hospital organizations. Nowadays, it is adopted by most of the health care professionals for clinical decision-making that helps to reduce the adverse clinical care events occurring during the treatment. In this article, we present a recent literature review on the adoption of computer-based CDSSs in the area of health care based on qualitative and quantitative techniques, published between 2007 and 2022. For this purpose, we searched Google Scholar and identified different adoption factors by using textual analysis from the included publications. We then ranked the different factors based on the total number of occurrences and represented them as a conceptual framework. A total of 14 different adoption factors were found from 13 studies, among them the usefulness of the system is the most prominent factor that influences the adoption of CDSS to a great extent. This literature review and the framework could be helpful to researchers and healthcare professionals working in the field of technology adoption, providing an overall idea of factors and techniques in this field of research. We have also mentioned the limitations and future research gaps of different studies, which will help the researchers to take an initiation towards these types of research. We also conducted a case study on adoption of fully automatic digital blood pressure monitor and identified that "usefulness" and "ease of use" could influence the adoption of fully automatic digital blood pressure monitor system. [ABSTRACT FROM AUTHOR]

The Chinese soft‐shelled turtle (Pelodiscus sinensis) is a freshwater softshell turtle native to East Asia. It is a choice of food and tonic in China, Taiwan and other Asian countries and is commonly cultured in ponds, lakes and canals. This study aimed to study the aetiology of a deadly disease outbreak among these turtles in Jiangxi Province of China in 2020 and 2021. By performing an aseptic dissection of symptomatic and moribund P. sinensis, a dominant strain (No.: ZF2) was isolated from livers, and studies were carried out to ascertain the biological status, pathogenicity and pathological characteristics of the isolate. For isolate identification, a morphological observation, physiological and biochemical analysis, 16S rRNA and gyrB gene sequencing, and phylogenetic analysis were performed. Other experiments were also carried out simultaneously, such as infection experiments, histopathological observation, virulence gene detection and drug sensitivity. Through traditional and molecular biological methods study with the pathogenic strain, ZF2 was identified as Aeromonas veronii. The results of the virulence gene test showed that ZF2 carried three virulence genes, aer, ast and act. Histopathological observation revealed that various internal organs were severely damaged after infection and manifested as liver ischemia and whitening, intestinal chorion shedding, glomerular congestion and splenic lymphocyte proliferation. After the drug sensitivity test results, the ZF2 strain was identified to be sensitive to nine drugs, including cefradine, neomycin, minocycline and enrofloxacin. It was intermediate or resistant to other drugs. [ABSTRACT FROM AUTHOR]

Simple Summary: In most areas, domestic geese are still raised in free-range, semi-intensive, or backyard farms owing to their high adaptability to various environments and excellent fiber digestion. In many Asian countries, waterfowl production is severely affected by ongoing avian influenza biosecurity concerns. Numerous intervention policies are being implemented in Taiwan to limit the use of free-range or outdoor-based poultry farming. In contrast to the free-range rearing system, indoor rearing involves higher housing construction costs and a more restrictive living environment. Among various facilities in goose houses, an open water source is a major factor affecting goose welfare. Because waterfowl are strongly water-oriented, they require water for dabbling, bathing, grooming, swimming, and certain reproductive behaviors. This study investigated the effects of swimming pool conditions and different floor types on the physical condition scores and behaviors of White Roman geese. Offering swimming pools and using perforated plastic floors improved physical condition scores and reduced feather damage in White Roman geese. Moreover, providing swimming pools decreased injurious pecking and diversified other behaviors. Biosecurity problems, including the continual risk of avian influenza spread by wild birds, have severely affected traditional free-range waterfowl production systems. Regulations and techniques for indoor goose production require more considerations for animal welfare. This study investigated the effects of swimming pool conditions and different floor types on the physical condition scores and behaviors of indoor-reared White Roman geese. A total of 48 male and 48 female White Roman geese reared from the age of 15 to 84 days were randomly allocated to pens with or without a swimming pool and with either mud or perforated plastic floors. Providing a swimming pool improved geese's eye and feather cleanliness and breast blister scores at the age of 84 days. Compared with geese reared on a mud floor, those reared on a perforated plastic floor had better feather cleanliness and higher breast blister scores at the age of 56 and 84 days. Providing a swimming pool to indoor-reared geese may reduce the proportion of abnormal behaviors, such as injurious feather pecking, by increasing water-related behaviors. This study suggests a more appropriate environment design for better balancing commercial goose production with animal welfare in an indoor rearing system. [ABSTRACT FROM AUTHOR]

Customer mistreatment is common in service interactions. Past research has demonstrated its detrimental effects on employee well-being and work outcomes. Using cognitive-motivational-relational theory as our theoretical lens, we proposed a dual moderated mediation model that examines employee deviant behaviours towards both the customer (service sabotage) and the organization (organizational deviance) in reaction to customer mistreatment through employee anger. We further examined the cognitive (self-accountability attribution) and affective (socio-affective sharing) moderators in this mediation process. Data were collected from 292 front-line service employee-co-worker dyads from Taiwan and analysed using structural equation modelling. Bootstrapping procedures were used in estimating the bias-corrected confidence intervals for the hypothesized moderated mediation. The results indicated that employee anger mediated the relationship between customer mistreatment and employee organizational deviant behaviour. Also, self-accountability attribution interacted with customer mistreatment in influencing employee anger. Additionally, socio-affective sharing interacted with employee anger in influencing service sabotage. The mediating effect of customer mistreatment on service sabotage via employee anger was only significant when socio-affective sharing was low. In contrast, the mediating effect on organizational deviance was nonsignificant when socio-affective sharing was low or when employee self-attribution of accountability was very high. We discuss the theoretical and practical implications of these findings. [ABSTRACT FROM AUTHOR]

Congenital stationary night blindness (CSNB) is an inherited retinal disease (IRD) that causes night blindness in childhood with heterogeneous genetic, electrophysical, and clinical characteristics. The development of sequencing technologies and gene therapy have increased the ease and urgency of diagnosing IRDs. This study describes seven Taiwanese patients from six unrelated families examined at a tertiary referral center, diagnosed with CSNB, and confirmed by genetic testing. Complete ophthalmic exams included best corrected visual acuity, retinal imaging, and an electroretinogram. The effects of identified novel variants were predicted using clinical details, protein prediction tools, and conservation scores. One patient had an autosomal dominant CSNB with a RHO variant; five patients had complete CSNB with variants in GRM6, TRPM1, and NYX; and one patient had incomplete CSNB with variants in CACNA1F. The patients had Riggs and Schubert–Bornschein types of CSNB with autosomal dominant, autosomal recessive, and X-linked inheritance patterns. This is the first report of CSNB patients in Taiwan with confirmed genetic testing, providing novel perspectives on molecular etiology and genotype–phenotype correlation of CSNB. Particularly, variants in TRPM1, NYX, and CACNA1F in our patient cohort have not previously been described, although their clinical significance needs further study. Additional study is needed for the genotype–phenotype correlation of different mutations causing CSNB. In addition to genetic etiology, the future of gene therapy for CSNB patients is reviewed and discussed. [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]

Main Conclusion: Taiwan oil millet has two types of epicuticular wax: platelet wax composed primarily of octacosanol and filament wax constituted essentially by the singular compound of octacosanoic acid. Taiwan oil millet (TOM-Eccoilopus formosanus) is an orphan crop cultivated by the Taiwan indigenous people. It has conspicuous white powder covering its leaf sheath indicating abundant epicuticular waxes, that may contribute to its resilience. Here, we characterized the epicuticular wax secretion in TOM leaf blade and leaf sheath using various microscopy techniques, as well as gas chromatography to determine its composition. Two kinds of waxes, platelet and filaments, were secreted in both the leaf blades and sheaths. The platelet wax is secreted ubiquitously by epidermal cells, whereas the filament wax is secreted by a specific cell called epidermal cork cells. The newly developed filament waxes were markedly re-synthesized by the epidermal cork cells through papillae protrusions on the external periclinal cell wall. Ultrastructural images of cork cell revealed the presence of cortical endoplasmic reticulum (ER) tubules along the periphery of plasma membrane (PM) and ER-PM contact sites (EPCS). The predominant wax component was a C 28 primary alcohol in leaf blade, and a C 28 free fatty acid in the leaf sheath, pseudopetiole and midrib. The wax morphology present in distinct plant organs corresponds to the specific chemical composition: platelet wax composed of alcohols exists mainly in the leaf blade, whereas filament wax constituted mainly by the singular compound C 28 free fatty acids is present abundantly in leaf sheath. Our study clarifies the filament wax composition in relation to a previous study in sorghum. Both platelet and filament waxes comprise a protection barrier for TOM., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Golden pompano (Trachinotus blochii) is a carnivorous teleost cultured in the Asia-Pacific region. Fish culture in high densities and numbers results in disease outbreaks, causing huge economic losses. Here, we collected cultured golden pompanos from 2021 to 2022 and identified the pathogens isolated from the diseased fish. Out of a total of 64 clinical cases observed in both sea cages and fish ponds, it was found that Nocardia seriolae was the predominant pathogen (26%), followed by Lactococcus garvieae (13%). Trichodina spp. was the most prevalent parasite in sea cages and earthen ponds (21%), while Neobenedenia spp. was the primary parasitic pathogen (16%) in sea cages. Given these findings, further investigations were conducted, including antibiotic susceptibility and pathogenicity tests specific to N. seriolae in golden pompanos. Antibiotic susceptibility tests of N. seriolae revealed that all strains were susceptible to doxycycline, oxytetracycline, florfenicol and erythromycin but resistant to amoxicillin and ampicillin. Additionally, a pathogenicity assessment was carried out by administering an intraperitoneal injection of 0.1 mL containing 10 7  CFU of N. seriolae per fish. The mortality rates observed varied between 40% and 90%, with the P2 strain exhibiting the highest level of virulence, resulting in a cumulative mortality of 90%. Therefore, disease outbreaks in fish can be minimized by developing effective treatments and prevention methods., (© 2023 John Wiley & Sons Ltd.)

Objective: Previous studies have revealed that coronary artery calcium is related to cardiovascular diseases and mortality. However, most studies have been conducted in Western countries and have excluded patients with pre-existing heart disease. We investigated the association between coronary artery calcium (CAC) and all-cause mortality in an Asian cohort and in subgroups stratified by age, sex, smoking, obesity, diabetes, cardiovascular disease, blood pressure, and biochemical parameters. Methods: We conducted a retrospective cohort study on 4529 health examinees who underwent multidetector computed tomography in a tertiary medical center in Taiwan between 2011 and 2016. The mean follow-up was 3.5 years. Cox regression was used to estimate the relative hazards of death. Stratified analyses were performed. Results: The all-cause mortality rates were 2.94, 4.88, 17.6, and 33.1 per 1000 person-years for CAC scores of 0, 1–100, 101–400, and >400, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CIs]) for all-cause mortality were 0.95 (0.53, 1.72), 1.87 (0.89, 3.90), and 3.05 (1.46, 6.39) for CAC scores of 1–100, 101–400, and >400, respectively, relative to a CAC score of 0. Compared with CAC ≤ 400, the HRs (95% CIs) for CAC > 400 were 6.46 (2.44, 17.15) and 1.94 (1.00, 3.76) in younger and older adults, respectively, indicating that age was a moderating variable (p = 0.02). Conclusion: High CAC scores were associated with increased all-cause mortality. Although older adult patients had higher risks of death, the relative risk of death for patients with CAC > 400 was more prominent in people younger than 65 years. [ABSTRACT FROM AUTHOR]