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This study uses female migrants' 'transnational daughterhood' within the context of transnational Taiwanese families as a case to examine how culturally constructed ideals of eldercare and information and communication technologies (ICTs) are interwoven in the context of transnational families. Filial piety is the traditional cultural norm in Confucian societies, which form parent–child relationships and eldercare practices in Taiwanese families. Through this research on transnational eldercare, the results will demonstrate how adult daughters construct their 'transnational daughterhood' by evoking filial norms, guiding their use of ICTs in polymedia environments. Through in-depth interviews with single migrant daughters from Taiwan to Australia, this research identifies ICTs that are stratified into three levels of filial piety, based on the principle that the more 'social cues' a particular media technology affords, the more filial it is. The findings in this study fill in the gaps in the existing literature by illustrating 'transnational daughterhood' and demonstrating that ICT-based filial practices are not only exercised by ICT-based co-presence, but also allow women, through virtual absence, to avoid unnecessary conflicts and worries with their aging parents at home. Therefore, daughters utilize different levels of filial ICTs to successfully manage their emotional relationship with their parents and fulfill their sense of filial responsibilities. [ABSTRACT FROM AUTHOR]

This article examines Zhang Wojun (1902–1955) and the memory of his 'collaboration' with Japan during the Second World War. A Taiwanese-born writer and educator who lived in Beijing for 25 years, his drifting identity was full of ambiguities. Although he was one of the key intellectuals behind Taiwan's New-Old Literatures Debate and responsible for introducing many May Fourth ideas to Taiwan, he also played an important role in bringing Japanese literature and thought into Chinese discourse during the 1920s, 1930s, and 1940s. During the war, he continued to teach in Beijing and travelled to Japan to attend the Greater East Asia Writers' conferences. Some of his works from this period call for the Chinese people to support the empire and eradicate Western culture and literature from Asia, but many of his writings also indicate a strong sense of Chinese nationalism. This article considers the memories of Zhang, his various intellectual contributions, and his oeuvre, arguing that his collaboration must be understood and contextualized within his intellectual landscape through a research methodology that examines continuities and change across decades of his life and work. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Research in Education Sciences is the property of National Taiwan Normal University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this study, XAD-8 resins were used to extract the natural organic matter (NOM) from samples collected at the intake of Feng Yuan Water Treatment Plant (in central Taiwan) into five groups: humic acids, fulvic acids, hydrophobic neutrals, hydrophobic bases, and hydrophilic fractions. Quantitative results show that hydrophobic and hydrophilic fractions contribute 44.2% and 55.5% of NOM, individually. Ozonation processes will significantly reduce both disinfection by-products formation potential (DBPFP) and average molecular weight of the humic acid sample. Additionally, double carbon bonds are broken up so that hydrophobic fractions were converted to hydrophilic fractions by ozonation leading to the reduction of DBPFP. [ABSTRACT FROM AUTHOR]

Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the acute effects of 3 warm-up protocols on knee flexor and extensor muscles performance in elite female collegiate handball players. Ten female handball players with poor hamstring flexibility completed 3 randomly sequenced experimental visits. During each visit, a different warm-up protocol (general running warm-up [GW], dynamic stretching [DS], or DS combined with vibration foam rolling [DS + VR]) was delivered before the subsequent tests: quadriceps and hamstring muscle stiffness, knee extension and flexion range of motion (ROM), knee joint position sense, knee extension and flexion isokinetic strength with hamstring-quadriceps strength ratio, and muscle endurance during fatiguing exercise. Relative to the GW, the DS + VR protocol resulted in significantly greater knee flexion ROM (mean ± SD: DS + VR = 79.4° ± 7.7°; GW = 69.3° ± 9.6°) and lower hamstring muscle stiffness (DS + VR = 253.33 ± 36.20 N·m-1; GW = 292.89 ± 24.28 N·m-1). In addition, the DS + VR protocol also yielded greater hamstring muscle endurance than the other 2 protocols did (fatigue percentage: DS + VR = 30.24% ± 10.84%; GW = 41.40% ± 8.98%; DS = 42.22% ± 9.42%). Therefore, the results of this experiment suggest that it can be more beneficial for the female handball players to warm-up with the DS + VR, rather than the GW and DS protocols. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Journal of East Asian Studies is the property of National Taiwan Normal University, College of International Studies & Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The “tablelands” in Taiwan are sedimentary terraces occurring in the foreland basin west of the Neogene mountain ranges. The Miaoli Tableland consists of elevated Late Quaternary sedimentary successions, representing a change from tidal to coastal and fluvial to eolian depositional environments. The present-day morphology is a result of combined processes, including differential tectonic uplift, ongoing fluvial aggradation, and incision. Selected deposits in 10 outcrops were sampled and studied by optical dating. The deposition of fluvial sediments started after the last interglacial (<100 ka) in the southeast of the tablelands. Uplift and sea-level lowering caused a base-level fall, resulting in a stepwise redeposition of the fluvial sediments. Additionally, enhanced remobilization of fluvial sediments occurred during the cold/dry climate during Marine Oxygen Isotope Stages (MIS) 4 and 2. The depositional ages of the coastal sediments enabled the estimation of long-term uplift rates of ca. 0.5 to 3.5 mm/yr. The eolian cover sediments yielded MIS 3 (east) to Holocene ages (west). Our results provide new insight into the interplay of climate, sea-level changes, remobilization of sediments, and tectonism leading to tableland formation during the Late Quaternary. [ABSTRACT FROM AUTHOR]

The field of queer/sexuality studies in Taiwan was pioneered in the 1990s by a group of mainly second‐generation descendants of Chinese civil war migrants (waishengren) who have problematised and disparaged the post‐martial law Taiwanisation of identity and politics. Despite the seminal nature of their 'sex positive' work that challenged many cultural orthodoxies, subsequent sociopolitical developments strengthening civil society, visibility of and human rights protections for tongzhi (LGBTQ) citizens, the consolidation of Taiwanese identity, and the Chinese Communist Party's (CCP) acceleration of revanchist hostility towards Taiwan over the past two decades have coalesced to forge unequivocal rifts between them and a new generation of Taiwanese sexuality scholars and activists. This rupture highlights how "Taiwan's sex/gender/sexualities knowledge production and reproduction have long been intertwined with the [contentious] politics of nationhood, nation‐building, and nationalism" (Kao, 2019). In probing these interstices, this article proposes a decolonial approach to tongzhi identity politics in Taiwan. [ABSTRACT FROM AUTHOR]

Abstract: In the face of world-wide energy price fluctuation, energy supply security, and the energy crisis, it becomes an urgent issue to search for alternative methods for energy generation and to close the gap between the supply and demand of global energy. The current method of energy supply in Taiwan is through a centralized electronic power system, which is generated by a few large electronic power plants. Hydrogen fuel cell (HFC) has a characteristic of de-centralized electronic power supply system, which provides electronic power more reliably, efficiently and economically. Based on the output of Taiwan’s sewage, sludge, kitchen waste and biohydrogen technology, the preliminary market for biohydrogen fuel cell (BHFC) is positioning itself toward the supply of public electronic power within the housing communities. Based on the patent analysis of BHFC, this study finds that Taiwan pays more attention to the front-end manufacturing of raw materials and emphasizes the development of biohydrogen technology, while America and Japan mainly pay more attentions to rear-end product application and emphasize the application of hydrogen and fuel cells by integrating industrial opinions. Based on the market analysis of BHFC, this study finds that the product attributes, consumers’ characteristics and external variables strongly influence consumer’s purchase intention of biohydrogen technology products. [Copyright &y& Elsevier]

Giardia and Cryptosporidium have emerged as waterborne pathogens of concern. Thirty-one water samples were collected from nine potable water treatment plants in Taiwan and investigated for the presence of Giardia cysts and Cryptosporidium oocysts. The immunofluorescence assay was used for the simultaneous detection of cysts and oocysts. The frequency of occurrence of cysts was 77.8% for Giardia and 72.2% for Cryptosporidium in 18 raw water samples. Ten out of 13 samples collected from treated water samples showed the presence of cysts, while in 5 out of 13 treated water samples oocysts were detected. The risk assessment for adverse human effects arising from the presence of cysts and oocysts indicates the possibility of waterborne transmission of Giardia and Cryptosporidium infection in Taiwan if water is not adequately treated. [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]

Though there has been much research into green performance, few studies have analyzed whether a green market orientation (GMO) is important. In this study, we propose and test a model that links three subconstructs of GMO (i.e., green customer orientation, green interfunctional orientation, and green competitor orientation) and green performance. The mediating role of green innovation and if there is a missing link between these relationships is also tested. By decomposing the components of GMO and introducing green innovation as a mediator, the results contribute to a more nuanced understanding of how and why green innovation is important in the linkage between GMO and green innovation. Using a survey of 248 high‐tech firms in Taiwan, the results highlight three subconstructs of GMO in facilitating green innovation and green performance. Green innovation fully mediates the association between green interfunctional orientation and green performance. However, green innovation only partially mediates the effects of green customer orientation and green competitor orientation on green performance. [ABSTRACT FROM AUTHOR]

Introduction: The risk factors for systemic autoimmune diseases (SAD) in gastric disease patients with proton pump inhibitor (PPI) use are still unclear. This study discussed this relationship in an Asian population. Methods: Patients without a prior history of SAD were identified from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2010. Cox regression models were applied to estimate the hazard ratio (HR) with 95% confidence interval [CI] of SAD. The cumulative PPI dosage was stratified by quartiles of defined daily doses and adjusted for baseline disease risk score which served as the primary variables compared against no PPI use. Results: We analyzed the data of 51,291 participants aged 18 years or older and free of SAD at baseline. PPI users (n = 17,938) had a significantly increased risk of SAD over non-PPI users. There was a significantly higher risk of developing SAD in older age groups. A significant dose-dependent association was observed between cumulative PPI use and the risk of SAD. Female PPI users had significantly higher risk of developing SAD. In patients who received PPI, the autoimmune disease with significantly higher incidence was Sjögren syndrome (SjS) (adjusted HR [aHR] 1.82, 95% CI, 1.02–3.27) and rheumatoid arthritis (RA) (aHR, 2.19, 95% CI, 1.19–4.01). Conclusion: This study found PPI users to be associated with an increased risk of SAD. Older age or cumulative PPI use was significantly associated with SAD, and the highest incidence was SjS and RA among gastric disease patients who received PPI. Key Points • This nationwide long-term cohort study found PPI users to be associated with an increased risk of rheumatoid arthritis and Sjögren syndrome in Taiwan. • This finding may help with clinical risk evaluation and will inform further investigation of the pathogenesis between autoimmune diseases and PPI use. [ABSTRACT FROM AUTHOR]

When organizations face paradoxical tensions, such as when they must simultaneously meet scientific and commercial objectives, individuals within the organization also experience tensions. How individuals' responses to these tensions inform the collective organizational response remains a theoretical and empirical challenge. We address this challenge by introducing a social network perspective. In a two-stage mixed-method study of a research institute in Taiwan, we examined how individuals' social networks facilitated the organization's response to a science-commerce paradox. Our results demonstrated that the level of heterogeneity in each individual's social network influenced how each individual contributed to the organization's collective response. Specifically, individuals with heterogeneous instrumental networks were more likely to contribute to the organization-wide consensus response, whereas individuals with homogeneous expressive networks were more likely to contribute to a polarized subgroup response. Our findings suggest that individuals' roles in shaping a collective organizational response to paradoxes depends on who they seek advice from and who they befriend. [ABSTRACT FROM AUTHOR]

In this paper the author will utilize both anthropological and historical approaches to illustrate how religion and the State intersect in the Dajia Mazu pilgrimage. Moreover, she will critique the conventional binary model of sacred versus profane by demonstrating how these two concepts are intricately intertwined in the course of the Dajia pilgrimage. The article aims to: provide a brief introduction and background to the Dajia pilgrimage; explore how the pilgrimage route is determined; discuss the protagonists involved in the choice of the pilgrimage route – temple committee leaders and members, as well as local politicians; and examine how temple committee members exploit the pilgrimage to express dissent against the central government of Taiwan. [ABSTRACT FROM PUBLISHER]

This paper analyses the relationship between entrepreneurship and an industrial cluster in general, by particularly examining one of Taiwan's industrial clusters, Houli's saxophone cluster. Our purpose is threefold. First, instead of investigating high-profile and chiefly government-directed clusters, such as science parks, we focus on a small and medium enterprise (SME) cluster. Second, unlike most studies that usually show how clusters foster entrepreneurship, we emphasize the role of entrepreneurship in the formation of the cluster industry. We discuss how a skilled artisan turns into an entrepreneur and how an apprentice-based cluster is formed. Third, we show that what used to be the competitive advantages of Houli's saxophone cluster – a peculiar apprentice-based cluster and the supportive precision machine agglomeration in central Taiwan – turn into its weaknesses when globalization surged in the 1980s. A three-year stint in government support, attempting to revitalize Houli's saxophone cluster by organizing a functional network and improving the technology, was unable to overturn the challenges from globalization. Although entrepreneurs learn to adapt to the changing environment, the current lackluster performance of Houli's saxophone industry demonstrates that regardless of how much glory there was in the past, it is inevitable in a “living” economy that a cluster cannot avoid its own ebb and flow. [ABSTRACT FROM PUBLISHER]

Survivors of the 921 Earthquake in the Tung Shih areas were the target population for this study. The researchers used purposive sampling strategies to select information-rich participants for study in depth. A total of 15 interviewees and 8 focus group members participated in this study. Qualitative data analysis software, ATLAS.ti 5.5, was used for cross-case and content analyses. The results indicate that acceptance, preparedness, self-reliance, spirituality, Hakka spirit, resource availability, social support networks, and serving others have positive impacts on disaster resilience. Participants from the in-depth interviews group affirm the importance of government involvement. Participants from the focus group pay special attentions on re-establishing social support networks. Furthermore, they reinforce the importance of understanding culture and meanings for the local people. [ABSTRACT FROM AUTHOR]

Summary Apolipoprotein E (APOE) polymorphism plays an important role in lipid metabolism. Preliminary evidence suggests that APOE genotype appears to be a risk factor for not only cardiovascular disease, but also Alzheimers disease and cancer. We screened the APOE genotype in 290 breast cancer patients and 232 non-cancer controls and determined the relationship between APOE gene polymorphism and breast cancer in Taiwan. We found risk for breast cancer was associated with the APOE genotype (?2 = 8.652, p = 0.013). Carriers of the e4 allele were more common in breast cancer cases than carriers of e3 allele (p = 0.004, OR = 1.786, 95% CI: 1.1972.664). In addition, the e4 allele is also associated with HER2/neu negative status in breast cancer patients (p = 0.006, OR = 0.277, 95% CI: 0.1110.693). No significant associations between APOE genotype and tumor grade, TN classification, progesterone receptor, estrogen receptor, lymphatic invasion, or recurrence of breast cancer were in evidence. These results suggest that the APOE e4 allele may be a risk factor for breast cancer and correlates with HER2/neu negative status. [ABSTRACT FROM AUTHOR]

In Taiwan, surfactants are frequently used in the flotation process to aid in solid/liquid separation. Their effect on the dewatering of alum sludge was investigated. Various amounts of cationic and anionic surfactants were added to sludge samples, and the dewatering characteristics of the sludge and the water content of sludge cakes were evaluated. Both surfactants improved the dewatering of the sludge by lowering the specific resistance to filtration, decreasing the bound water content, and increasing the dewatering rate of the sludge. Different combinations of anionic and cationic surfactants and polyelectrolytes were also experimented on to study the effect of surfactant addition on the dewatering characteristics of polyelectrolyte-conditioned sludge. Experimental results indicated that both cationic and anionic surfactants adversely affected the dewatering of the conditioned sludge. The addition of surfactant to the oppositely charged polyelectrolyte proved to be most detrimental to sludge dewatering due to the precipitation between surfactant and polyelectrolyte. The addition of cationic surfactant to the cationic polyelectrolyte-conditioned sludge had the least effect. [ABSTRACT FROM AUTHOR]

In order to understand the impact of the massive earthquake on disease activity, 60 patients with systemic lupus erythematosus (SLE) living in the earthquake area (group 1) and 31 patients living away from the area (group 2) were enrolled in this study. A questionnaire was used to record demographic data and clinical manifestations before and 6 months after the earthquake. Laboratory tests, including serum C3, C4, creatinine, anti-DNA antibody, CBC and 24h urine protein were taken. The results showed that nine patients in group 1 had obvious disease flare-up as evidenced by fever, arthralgia, malar rash and photosensitivity, increased protein loss or edema, and other symptoms. However, there were no significant changes in either group 1 or 2 patients. In contrast, the comparison of laboratory parameters in group 1 patients before and after the earthquake showed a significant decrease of C4 from 17.3±15.3 to 14.1±7.33 and a significant increase of creatinine from 1.20± 1.54 to 1.27±1.70 (P<0.05), respectively. No significant difference for either C4 or creatinine was found in group 2 patients. In conclusion, there was no striking change in the clinical aspects for lupus patients. However, some laboratory results became abnormal in group 1 patients after the earthquake, indicating that their lupus status may have worsened. [ABSTRACT FROM AUTHOR]

Discusses ethnographical data gathered in Ta-chia, Central Taiwan, which suggest that kinship organizations have not been an important functional, social mechanism there. Reconstruction of the historical process of Chinese settlement in the area; Origin, growth and change of societal groups based on regional identities of various sorts.

Airborne particulate matter 2.5 (PM2.5) can have a profound effect on the health of the population. Many researchers have been reporting highly accurate numerical predictions based on raw PM2.5 data imported directly into deep learning models; however, there is still considerable room for improvement in terms of implementation costs due to heavy computational overhead. From the perspective of environmental science, PM2.5 values in a given location can be attributed to local sources as well as external sources. Local sources tend to have a dramatic short-term impact on PM2.5 values, whereas external sources tend to have more subtle but longer-lasting effects. In the presence of PM2.5 from both sources at the same time, this combination of effects can undermine the predictive accuracy of the model. This paper presents a novel combinational Hammerstein recurrent neural network (CHRNN) to enhance predictive accuracy and overcome the heavy computational and monetary burden imposed by deep learning models. The CHRNN comprises a based-neural network tasked with learning gradual (long-term) fluctuations in conjunction with add-on neural networks to deal with dramatic (short-term) fluctuations. The CHRNN can be coupled with a random forest model to determine the degree to which short-term effects influence long-term outcomes. We also developed novel feature selection and normalization methods to enhance prediction accuracy. Using real-world measurement data of air quality and PM2.5 datasets from Taiwan, the precision of the proposed system in the numerical prediction of PM2.5 levels was comparable to that of state-of-the-art deep learning models, such as deep recurrent neural networks and long short-term memory, despite far lower implementation costs and computational overhead. [ABSTRACT FROM AUTHOR]

Background: The use of matrix-assisted laser desorption/ionisation-time-of-flight mass spectra (MALDI-TOF MS) with machine learning (ML) has been explored for predicting antimicrobial resistance. This study evaluates the effectiveness of MALDI-TOF MS paired with various ML classifiers and establishes optimal models for predicting antimicrobial resistance and the presence of mecA gene among Staphylococcus aureus., Materials and Methods: Antimicrobial resistance against tier 1 antibiotics and MALDI-TOF MS of S. aureus were analysed using data from the Database of Resistance against Antimicrobials with MALDI-TOF Mass Spectrometry (DRIAMS) and one medical centre (CS database). Five ML classifiers were used to analyse performance metrics. The Shapley value quantified the predictive contribution of individual features., Results: The LightGBM demonstrated superior performance in predicting antimicrobial resistance for most tier 1 antibiotics among oxacillin-resistant S. aureus (ORSA) compared with all S. aureus and oxacillin-susceptible S. aureus (OSSA) in both databases. In DRIAMS, Multilayer Perceptron (MLP) was associated with excellent predictive performance, expressed as accuracy/AUROC/AUPR, for clindamycin (0.74/0.81/0.90), tetracycline (0.86/0.87/0.94), and trimethoprim-sulfamethoxazole (0.95/0.72/0.97). In the CS database, Ada and Light Gradient Boosting Machine (LightGBM) showed excellent performance for erythromycin (0.97/0.92/0.86) and tetracycline (0.68/0.79/0.86). Mass-to-charge ratio (m/z) features of 2411-2414 and 2429-2432 correlated with clindamycin resistance, whereas 5033-5036 was linked to erythromycin resistance in DRIAMS. In the CS database, overlapping features of 2423-2426, 4496-4499, and 3764-3767 simultaneously predicted the presence of mecA and oxacillin resistance., Conclusion: The predictive performance of antimicrobial resistance against S. aureus using MALDI-TOF MS depends on database characteristics and the ML algorithm selected. Specific and overlapping mass spectra features are excellent predictive markers for mecA and specific antimicrobial resistance., Competing Interests: Declarations Funding: This project was supported by Chung Shan Medical University (grant number: CSMUH No:CS1-23228). This funding source played no role in study design or conduct, data collection, analysis or interpretation, writing of the manuscript, or the decision to submit the manuscript for publication. Competing interests: The authors declare no conflicts of interest in relation to this study. Ethical approval: CSMUH No. CS1-23228 of Chung Shan Medical University and REC112-51 of Taichung Tzu Chi Hospital). Sequence information: Not applicable., (Copyright © 2024 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.)

Objective: This study compared Taiwanese public health insurance outpatient reimbursements for interstitial cystitis (IC)/bladder pain syndrome (BPS) and rheumatoid arthritis (RA) treatment. Methods: This observational study used data from the Taiwan Longitudinal Health Insurance Database between 2002 and 2013. Patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes for IC/BPS and RA were selected and matched in a ratio of 1 : 5 based on index year. After adjustment for possible confounders, including age, sex, income, hospital levels of care, and reimbursements for 24 comorbidities, yearly and per‐visit pharmacy, non‐pharmacy, and total claims were determined. Results: In all, 1438 IC/BPS and 7190 RA patients were identified in the database. IC/BPS patients were significantly younger, and the proportion of females in this group was higher. Income levels were lower in the IC/BPS cohort, but not significantly. There were no significant differences between cohorts in terms of reimbursements for treatment for comorbidities, with the exception of end‐stage renal disease, for which reimbursement was higher in the RA cohort. After adjusting for confounders, the regression coefficient for IC/BPS to RA was significantly lower for yearly total pharmacy claims, yearly total claims, per‐visit pharmacy claims, and total claims per visit. Conclusions: Outpatient reimbursement was significantly lower for IC/BPS than for RA treatment, primarily with regard to pharmacy costs. This indicates less medical utilization for IC/BPS, possibly due to poor treatment outcomes and copayment polices. Further advances in the treatment of IC/BPS and health budget reallocation are encouraged. [ABSTRACT FROM AUTHOR]

Background: Second-generation antipsychotics (SGA) augmentation treatment has showed better efficacy in patients with major depressive disorder (MDD). However, the association between SGA and diabetes mellitus (DM) in MDD patients deserves further investigation. The study aimed to examine the risk of new onset type II DM in MDD patients receiving SGA treatment.Methods: From the Psychiatric Inpatient Medical Claim Dataset, MDD patients treated with SGA continuously for more than 8 weeks were analyzed in a 1:1 propensity score matched pair sample to 1,049 patients that had never been treated with SGA. Patients were followed up to 5 years based on ICD-9 CM codes indicating incident type II DM. Cumulative incidences of type II DM were calculated and the Cox proportional hazards model with competing risk was applied to determine the risk factors for type II DM onset.Results: Cumulative incidences of new-onset type II DM between the two groups were similar. Use of SGA showed no significant increase in risk for new-onset type II DM (hazard ratio [HR] = 0.898; 95% confidence interval [CI], 0.605-1.334; P-value = 0.596). Increased risk for type II DM was shown to be associated with aging (per year) (HR = 1.039; 95% CI, 1.026-1.053; P-value < 0.001) and history of hyperlipidemia (HR = 2.323; 95% CI, 1.469-3.675; P-value < 0.001).Conclusions: This study indicated that there is no significant difference in the risk of developing type II DM between MDD patients with and without SGA exposure. More studies focused on the benefit-risk assessment of SGA treatment in patients with MDD are warranted. [ABSTRACT FROM AUTHOR]

Viral- and host-targeted traditional Chinese medicine (TCM) formulae NRICM101 and NRICM102 were administered to hospitalized patients with COVID-19 during the mid-2021 outbreak in Taiwan. We report the outcomes by measuring the risks of intubation or admission to intensive care unit (ICU) for patients requiring no oxygen support, and death for those requiring oxygen therapy. This multicenter retrospective study retrieved data of 840 patients admitted to 9 hospitals between May 1 and July 26, 2021. After propensity score matching, 302 patients (151 received NRICM101 and 151 did not) and 246 patients (123 received NRICM102 and 123 did not) were included in the analysis to assess relative risks. During the 30-day observation period, no endpoint occurred in the patients receiving NRICM101 plus usual care while 14 (9.27%) in the group receiving only usual care were intubated or admitted to ICU. The numbers of deceased patients were 7 (5.69%) in the group receiving NRICM102 plus usual care and 27 (21.95%) in the usual care group. No patients receiving NRICM101 transitioned to a more severe status; NRICM102 users were 74.07% less likely to die than non-users (relative risk= 25.93%, 95% confidence interval 11.73%-57.29%). NRICM101 and NRICM102 were significantly associated with a lower risk of intubation/ICU admission or death among patients with mild-to-severe COVID-19. This study provides real-world evidence of adopting broad-spectrum oral therapeutics and shortening the gap between outbreak and effective response. It offers a new vision in our preparation for future pandemics. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Patients with invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA), especially those with an elevated minimal inhibitory concentration (MIC) of vancomycin (VA), are likely to have treatment failure and poor outcomes. The aim of this study was to delineate and correlate the genotypes and phenotypes of clinical VA-intermediate S. aureus (VISA) from invasive infections in Taiwan., Methods: Between 2006 and 2010, a total of 670 non-duplicate MRSA isolates were collected from patients with invasive infections, mostly from blood, as part of a nationwide antimicrobial surveillance program named Tigecycline in vitro Surveillance in Taiwan. Among them, 10 (1.5%) VISA (VA MIC = 4 mg/L) isolates were identified. Molecular typing with staphylococcal cassette chromosome mec (SCCmec), multilocus sequence typing, staphylococcal protein A (spa), mec-associated hypervariable region (dru), accessory gene regulator (agr), and pulse-field gel electrophoresis, and phenotypic analysis including antibiotic susceptibility testing, gene encoding Panton-Valentine leukocidin (pvl), and superantigenic toxin profiles, were analyzed., Results: All but one isolate was defined as molecular health-care-associated MRSA: 6 as SCCmecIII-ST239-spa t037-agrI-dru7 (1 isolate) and dru14 (5 isolates), 2 as SCCmecII-ST5-spa t586-agrII-dru4, and one as SCCmecII-ST89-spa t3520-agrIII-dru7. One isolate was defined as SCCmecIV-ST59-spa t437-agrI-dru8, which was categorized as molecular community-associated MRSA. Five pulsotypes were identified; only one had a positive D-test and 3 were insusceptible to daptomycin (MIC ≧1 mg/L). Five isolates possessed sea-selk-selq, among them 4 belonged to SCCmecIII-ST239-spa t037-agrI., Conclusion: In this study, VISA was rarely isolated from invasive MRSA infections, and most cases harbored limited genotypes and corresponding phenotypes., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021. Published by Elsevier B.V.)

Abstract: The main aim of this study was to investigate the risk factors and consequence of LTCFs-acquired infections in Taiwan through a 16-month follow-up. This prospective cohort study invited residents of 10 private LTCFs in Taipei for study. For each participant, Karnofsky Performance Scale (KPS), use of feeding tube and/or urinary catheters, serum levels of albumin, total cholesterol, complete blood count, occurrence of LTCF-acquired infections, all-cause mortality were recorded. Overall, a total of 198 LTCF residents entered the study for a total of 67,395 resident-days, and 156 participants (79.8±9.7 years, 51.3% males) complete the follow-up with a total of 67,395 resident-days. During the study period, 360 LTCF-acquired infections occurred, and the incidence was estimated to be 5.34 episodes per 1000 resident-days. Subjects with LTCF-acquired infections were more likely to die than those without infections. Besides, subjects with lymphopenia and long-term use of feeding tube and/or urinary catheters were significant risk factors for LTCF-acquired infections. However, poorer functional status and occurrence of lower respiratory tract infections were significant predictive factors for all-cause mortality. In conclusion, the period prevalence of LTCF-acquired infections was higher in Taiwan than previous reports, but the incidence was similar. In addition to traditional risk factors, lymphopenia, a surrogate indicator for immunosenescence, was a significant risk factor for LTCF-acquired infections. [Copyright &y& Elsevier]

This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.

Using the claims data of one million insured residents in Taiwan from 1996-2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25-0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03-2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.

In clinical practice, some atrial fibrillation (AF) patients were classified as having low and moderate stroke risk by the CHADS 2 score (≤ 1) in 2001 but in 2012 they were not truly classified as low risk of stroke according to the CHA 2 DS 2 -VASc score (≥ 2) (defined gray zone). Therefore, a treatment gap exists in gray zone AF patients. This study aimed to evaluate whether gray zone AF patients could benefit from reduced all-cause mortality under antithrombotic treatment. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance from January 2000 to December 2011. The new-onset AF patients consisted of a gray zone cohort with a total of 1237 patients being enrolled. The primary outcome was all-cause mortality between 2001 and 2011. Patients in the gray zone receiving antithrombotic treatment had a significant reduction in all-cause mortality [hazard ratio (HR): 0.21; 95% confidence interval (CI): 0.16-0.28] compared with the no treatment group [warfarin only: HR, 0.28 (95% CI, 0.15-0.52); warfarin + Aspirin: HR, 0.21 (95% CI, 0.15-0.30); and Aspirin only: HR, 0.22 (95% CI, 0.16-0.29) ]. All-cause mortality was notably increased when any of the following risk factors were present: age 65-74 years, age ≥ 75 years, chronic kidney disease, and vascular disease. We concluded that AF patients in the gray zone must receive either anticoagulant and/or antiplatelet treatment and there is a lower mortality in these groups during long-term follow-up. Further investigation is needed to observe whether the antithrombotic drugs have benefits for patients with AF with a CHA 2 DS 2 -VASc score < 2.

Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan., Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies., Results: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA 2 DS 2 -VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality., Conclusion: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

As the world's population ages, the number of people receiving total knee arthroplasty (TKA) has been on the rise. Although patients with diabetes mellitus are known to face greater risks of TKA postoperative infection and revision TKA owing to diabetic complications, studies on whether such patients' participation in pay for performance (P4P) programs influences the incidence rates of TKA postoperative infection or revision TKA are still lacking. This study examined the 2002-2012 data of Taiwan's National Health Insurance Research Database to conduct a retrospective cohort analysis of diabetic patients over 50 years old who have received TKA. To reduce any selection bias between patients joining and not joining the P4P program, propensity score matching was applied. The Cox proportional hazards model was used to examine the influence of the P4P program on TKA postoperative infection and revision TKA, and the results indicate that joining P4P lowered the risk of postoperative infection (HR = 0.91, 95% CI: 0.77-1.08), however, which was not statistically significant, and significantly lowered the risk of revision TKA (HR = 0.53, 95% CI: 0.39-0.72). Being younger and male, having multiple comorbid conditions or greater diabetic severity, receiving care at regional or public hospitals, and not having a diagnosis of degenerative or rheumatoid arthritis were identified as factors for higher risk of TKA postoperative infection for patients with diabetes. As for the risk of revision TKA, postoperative infection and being younger were identified as factors for a significantly higher risk (p < 0.05)., Competing Interests: The authors have declared that no competing interests exist.

Background: Studies on second-generation antipsychotics (SGA) augmentation treatment for older adults with major depressive disorder (MDD) remain limited. We aimed to investigate the effectiveness of SGA augmentation for overall and older patients with MDD inpatient history by assessing the change in 1-year hospitalization before and after SGA augmentation using the latest National Health Insurance Research Database (NHIRD) in Taiwan., Methods: The samples were MDD patients (ICD-9 CM code: 296.2 and 296.3) who had psychiatric inpatient history. A total of 2602 MDD patients including 430 elderly subjects (age ≥ 60 years) who received SGA augmentation for 8 weeks between January 1998 and December 2012 were included in this 1-year mirror-image study. Outcome measures included number and length of psychiatric and all-cause hospitalizations., Results: After 8-week continuous SGA augmentation in the study subjects, the total number and days of psychiatric hospitalizations among overall patients reduced by 33.57% (p < .0001) and 18.24% (p < .0001), respectively; the total number and days of psychiatric hospitalizations among older patients (age ≥ 60) reduced by 44.52% (p < .0001) and 27.95% (p < .0001), respectively. Similarly, the total number and days of all-cause hospitalizations were significantly reduced., Limitations: MDD patients without inpatient history were not included due to data limitation; hence, the results may not be generalized to all patients., Conclusions: The results support that SGA may be effective in reducing psychiatric and all-cause hospitalization among overall and elderly MDD patients. More studies focusing on the safety of SGA among older MDD patients is warranted., (Copyright © 2018 Elsevier B.V. All rights reserved.)

We investigated whether colonic diverticulosis (CD) is associated with an increased risk of the subsequent development of erectile dysfunction (ED).We identified 2879 patients, diagnosed with CD between 1998 and 2011 from the Taiwan National Health Insurance Research Database as the study cohort. Patients in a comparison cohort were frequency-matched with those in the CD cohort at a ratio of 1:4, frequency matched according to age (in 5-year bands) and year of CD diagnosis. The patients were followed-up until ED development, withdrawal from the National Health Insurance system, or the end of 2011. For both cohorts, the overall and age-specific incidence density rates of ED (per 1000 person-years) were calculated. The effects of age, CD, and other comorbidities on the risk of ED development were examined using Cox proportional hazards regression models.The average follow-up durations were 4.76 years and 4.97 years for the CD patients and comparison cohorts, respectively. The overall incidence of ED was 1.70-fold higher in the CD cohort than in the comparison cohort (2.92 and 1.71 per 1000 person-years, respectively). Colonic diverticulosis was an independent risk factor for subsequent ED development (adjusted HR [aHR] = 1.56, 95% confidence interval = 1.07-2.28) in a multivariate Cox proportional hazards regression model.In this large retrospective cohort study, CD was associated with future ED development. Additional studies are required for validating our results., Competing Interests: The authors have no conflicts of interest to disclose.

Objective: Few studies have examined the relationship between gout and erectile dysfunction (ED). We investigated whether patients with gout exhibited an increased risk of ED., Methods: This longitudinal nationwide cohort study investigated the incidence and risk of ED in 19,368 men with gout who were newly diagnosed between January 2002 and December 2008. A total of 77,472 controls without gout were randomly selected from the general population and frequency-matched according to age and sex. The patients were followed up from the date on which they were included in the study cohort to the date of an ED event, censoring, or December 31, 2010. We conducted the Cox proportional hazard model to estimate the effects of gout on ED risk including age and comorbidities., Results: The gout cohort exhibited a 1.21-fold adjusted HR of subsequent ED development compared with the non-gout cohort (95% CI 1.03-1.44). The incidence of ED increased with age in both cohorts and was higher among the patients in the gout cohort than among those in the non-gout cohort. Compared to the patients without gout and comorbidities, the patients with both gout and any type of comorbidity exhibited a 2.04-fold risk of developing ED (95% CI 1.63-2.57). Further, the patients with gout who had numerous comorbidities exhibited the dose-response effect in developing ED., Conclusion: This nationwide cohort study revealed that ED risk is significantly higher in patients with gout than in the general population.

The association between type 1 diabetes mellitus (T1DM) and asthma remains controversial and has led to new interest in these 2 disorders. The purpose of this study was to examine the associations among young people with T1DM and asthma and offer a clinical demonstration of the balance between Th1 and Th2 responses.We conducted a retrospective cohort study by using data from the National Health Insurance (NHI) system of Taiwan. The cohort consisted of 3545 T1DM cases and 14,180 controls established during the 1998 to 2011 period. Of the 3545 T1DM patients, 55.1% were girls and 26.5% were in the age group <8 years.The overall incidence of asthma was 47% higher in the T1DM cohort than in the control cohort (6.49 vs 4.42 per 1000 person-y), with an adjusted hazard ratio (HR) of 1.34 (95% confidence interval [CI] = 1.11-1.62). Moreover, T1DM patients who visited the emergency room (ER) more than twice for diabetes had a higher adjusted HR of 17.4 (95% CI = 12.9-23.6) of developing asthma. The adjusted HR of asthma was 38.6 (95% CI = 28.5-52.2) in T1DM patients who had been hospitalized more than twice for diabetes.We observed a significantly higher incidence of asthma in young patients with T1DM than in the general population. Among young people of T1DM with more ER visits or frequent hospitalization because of diabetes mellitus were associated with risk of asthma, may indicate that poor glycemic control significantly contributes to asthma risk.