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The citizenship curriculum used in Taiwan during the authoritarian period from 1949 to 1987 sacrificed the individual for the national interest as a tool for political socialisation. In the wake of democratisation since 1987, the curriculum has gradually been stripped of its nationalist overtones which were designed to foster 'informed citizens' to facilitate those in power. The increased stress on the reflective and critical capabilities of the individual reminds pupils to examine their positions and roles in society instead of mechanistically accepting the existing social structure. This article sheds light on the intricate internal-external power relationships and differing views on critical pedagogy among curriculum designers. Interviewed curriculum designers hold that pluralistic ideologies should be presented in the curriculum and then room should be left for students to deliberate or judge for themselves. As the gatekeepers tasked with deciding which information to include and being faced with the intervention of numerous internal and external forces, the Curriculum Committee sided with the critical theory and aimed to break the unreflective social reproduction.

The new Taiwanese citizenship curriculum has converted its traditional bullet-point guidelines to hundreds of open-ended questions. Each question acts to initiate collective inquiry, to stimulate the sharing of lived experiences and to trigger within-class conversations. The previous pre-determined educational objectives and learning outcomes, in line with the Tyler Rationale, have been replaced by the process model. This Taiwanese case aims to prove that the process model, which emerged in the 1970s, remains relevant and applicable to current curriculum construction and this revived version may bring new perspectives to the scholarship on curriculum development. Based on interviews with fifteen curriculum developers, this article reveals the thinking behind the curriculum transformation and shows how the creation of such new guidelines is more attentive to students' personal experiences and diverse views, and facilitates mutual understanding, conversations and the possible reaching of consensus. This approach also attracts less controversy or opposition while still managing to touch upon sensitive social topics in the curriculum. Meanwhile, the 'Social Inquiry Method' has also been integrated into Taiwan's new curriculum to ensure question-based guidelines can bring about reforms to actual classroom practice, despite concerns regarding the required re-training of teachers and the ingrained exam-driven culture.

This study aimed to investigate the effect of flipped classrooms integrated with massive open online courses (MOOCs) and game-based learning on the learning motivation and learning outcomes of students from different backgrounds (in terms of gender, grade, self-confidence indicators in mathematics, and roles played in the game-based learning process). Surveys and a semi-structured open questionnaire were used for data collection, including a basic information questionnaire (to understand the participants' backgrounds), a questionnaire on learning motivation (the Motivated Strategies for Learning Questionnaire, MSLQ), a test of learning achievements in mathematics, and a semi-structured open-ended questionnaire (to understand the learners' feelings). Quantitative analysis results showed that flipped classrooms integrated with MOOCs and game-based learning can enhance students' learning motivation and outcomes. Specifically, compared with students with high self-confidence in learning mathematics, students with low and medium levels of self-confidence showed significantly greater improvement in overall learning motivation. Significantly more enhancements were found for the expectation component of "soldiers" (students with relatively lower learning achievements) than for "generals" (students with higher learning achievements). Furthermore, students in the eighth grade showed significantly greater progress in academic performance than did students in the seventh grade.

This article challenges the simplistic and reductive image of Taiwanese schoolteachers, and reveals their actions of resistance during the turmoil of the recent curriculum reform controversy. Despite the fact that teachers are not usually portrayed as progressive and revolutionary agents, in the face of the disputed curriculum revision in 2014, some Taiwanese teachers came forward to oppose its implementation through demonstrations, hunger strikes, and litigation. The wider public's attention to this issue and ensuing student movement can be attributed to these teachers' pioneering activism. By means of interviewing 12 teachers, this article explores activist teachers' political self-efficacy, the creation of their pressure groups, and their apprehension about fighting against the authorities. The recording of this teacher-initiated social movement demonstrates 'teachers as activists', and hopefully will inspire educators not to limit their influence solely to the classroom.

Osimertinib has demonstrated efficacy in patients with epidermal growth factor receptor (EGFR) T790M-positive non-small cell lung cancer (NSCLC) in clinical trials. However, real-world data on its effectiveness remain scarce. Taiwanese patients with T790M-positive locally advanced or metastatic NSCLC and progressive disease following treatment with at least one EGFR tyrosine kinase inhibitor (TKI) were enrolled from the osimertinib early access program. Of the 419 patients (mean age, 63 years; female, 67%), 53% were heavily pretreated (≥ third-line [3L]), making osimertinib a fourth-line (4L) intervention. The median progression-free survival (PFS) was 10.5 months (95% confidence interval [CI]: 8.95–11.41); the 18-month PFS rate was 26.5%. The median overall survival (OS) was 19.0 months (95% CI: 16.30–20.95); the 24-month OS rate was 40.9%. The objective response rate was 32.46%, and the disease control rate was 86.38%. The median time to treatment discontinuation of osimertinib monotherapy was 11.9 months (95% CI: 10.49–13.11). Subgroup analyses of median PFS and OS in the chemotherapy combination group vs. the osimertinib monotherapy group yielded no difference. Central nervous system (CNS) metastasis, number of prior lines of therapy, and types of initial EGFR-TKIs did not significantly impact outcomes. The median PFS values were 9.0 (95% CI: 5.18–11.34) and 10.9 (95% CI: 9.18–11.90) months with and without CNS metastasis, respectively, and 10.8 (95% CI: 8.59–12.69), 13.6 (95% CI: 10.89–16.3), and 9.2 (95% CI: 7.8–10.62) months for second-line (2L), 3L, and ≥4L therapy, respectively. In patients who received osimertinib as 2L therapy, the median PFS values in response to prior afatinib, erlotinib and gefitinib treatment were 11.2 (95% CI: 4.85–4.79), 10.5 (95% CI: 8.59–20.26) and 8.7 (95% CI: 7.21–16.79) months, respectively. Overall, real-world data from Taiwan support the clinical benefits of osimertinib in EGFR T790M -positive NSCLC. [ABSTRACT FROM AUTHOR]

In early 2014, a group of senior high school teachers initiated a series of campaigns to fight against the government's imposition of a revised history and citizenship education curriculum, an unprecedented display of opposition in the history of public schools in Taiwan. They rose above the traditional stereotype of the schoolteacher common across many societies in Asia and challenged the pro-reunification and Chinese ethnocentric setting underlying the new educational proposals. Drawing upon Giroux's writings on teachers as transformative intellectuals, this article looks into the social activism of 12 teachers from the campaign and the impact this movement had on their classroom practices. While "the language of critique" and "the language of possibility" are defined by Giroux as the two crucial components a critical educator should possess, these Taiwanese activist teachers appeared to demonstrate a more nuanced view by separating their activism from their professionalism in front of students and preventing themselves from incorporating the personal social movement experience into their classroom teaching. Moreover, our findings also suggest that elements of Confucianism--deeply rooted in Taiwanese society--have shaped these teachers' involvement in activism in important ways.

Aims: Sodium‐glucose cotransporter 2 inhibitors (SGLT‐2is) have been demonstrated to be associated with cancer cell mechanisms. However, whether they increase the risk of cancer remains unclear. Thus, this study aimed to determine the association between SGLT‐2i use and the incidence of cancer in patients with diabetes mellitus (DM) in Taiwan. Materials and Methods: This retrospective cohort study was based on the Taiwan National Health Insurance database. The study population comprised patients with DM, and those who first used SGLT‐2is during 2016–2018 were assigned to the study group. Greedy propensity score matching was performed to select patients who first used dipeptidyl peptidase 4 inhibitors (DPP‐4is), and these patients were assigned to the control group. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for cancer risk in the study and control groups; this model was adjusted for demographic characteristics, DM severity, comorbidities and concomitant medication use. Results: After controlling for relevant variables, the SGLT‐2i cohort (aHR = 0.90, 95% CI = 0.87–0.93) had a significantly lower risk of developing cancer than the DPP‐4i cohort, particularly when the SGLT‐2i was dapagliflozin (aHR = 0.91, 95% CI = 0.87–0.95) or empagliflozin (aHR = 0.90, 95% CI = 0.86–0.94). Regarding cancer type, the SGLT‐2i cohort's risk of cancer was significantly lower than that of the DPP‐4i cohort for leukaemia, oesophageal, colorectal, liver, pancreatic, lung, skin and bladder cancer. Conclusions: SGLT‐2i use was associated with a significantly lower risk of cancer than DPP‐4i use. [ABSTRACT FROM AUTHOR]

This study investigated two science teachers' meta-strategic knowledge (MSK) of argumentation teaching by applying the repertory grid technique (RGT). One teacher was a novice, while the other was experienced in teaching argumentation. Using the RGT, we elicited the objectives and strategies of the two teachers regarding their argumentation teaching involving two social scientific issue (SSI) scenarios. The results showed that the experienced teacher had more varied and organised MSK for teaching argumentation than the novice teacher. Meanwhile, the novice teacher indicated a belief that the learning of argumentation should occur in a more student-centred manner, rather than relying on a traditional lecture-based environment. Consequently, she spent a considerable amount of time engaging students with their peers' ideas through discussion and collaboration. On the other hand, the experienced teacher noticed that most of students had the ability to generate arguments, but that few knew how to argue based on evidence. Therefore, she helped students to collect data from various resources and suggested that they construct their own knowledge framework in order to improve students' ability to incorporate their understanding of scientific knowledge into scientific argumentation.

The national curriculum reformers, regarded as members of the social elites and intellectuals, projected their vision of identity onto the curriculum which they constructed and influenced the next generation's national consciousness. In the tangled relationship between politics and education, the selection of the reformers in a sense dictates the direction of the new curriculum. This article interviewed 18 reformers, members of the latest citizenship curriculum of 2010, to investigate their individual views on identities and the monolithically-promoted Chinese configuration in the old curriculum. Although the new citizenship curriculum, renamed "Curriculum Guidelines for Civics and Society," puts nothing in writing in favour of either a Chinese or Taiwanese national identity, according to the discovery in this research, the Curriculum Committee implicitly embedded a transformed inclusive and hyphenated Taiwanese national identity in the new curriculum in the hope of accentuating Taiwan's exclusive sovereignty. The inner thinking of the reformers is uncovered to reveal their reasoning that a broadly constructed national identity can concurrently accommodate diverse personal identities and suits the society better than the previously prescribed Chinese identity. This article also records the evolution of the curriculum from the previous China-centred narratives to Taiwan-centred narratives, something that happened in line with the changes in Taiwanese society.

Purpose: Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self‐care ability of patients undergoing peritoneal dialysis. Materials and Methods: We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1–5 score‐based questionnaire and the higher score indicated higher satisfaction. Results: There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p =.049 and.024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face‐to‐face education. Conclusion: The innovative Chatbot allowed delivering remote and digital information's to improve patients' self‐care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long‐term impact of Artificial Intelligence Chatbot in peritoneal dialysis care. [ABSTRACT FROM AUTHOR]

Background: Previous research has examined the use of augmented reality (AR) and virtual reality (VR) in English language teaching. However, to the best of our knowledge, none of the earlier studies that investigated integrating AR and VR "wearables" into teaching and learning English based on the attention, relevance, confidence, and satisfaction (ARCS) motivation model compared the differences in learning motivation and performance between traditional teaching methods and those using AR‐ and VR‐based using wearables. Objectives: To create a thematic learning environment based on learners' lived experiences and provide them with an immersive English course that extends textbook knowledge using a technology‐assisted real‐life learning context. Method: This study used a quasi‐experimental research design. A total of 119 participants were spilt into three learning groups based on teaching tools: traditional methods and AR‐ and VR‐based wearable devices. The performance of each group was evaluated through three stages using appropriate educational tools for traditional, AR‐, and VR‐based classrooms, followed by semistructured interviews. Multiple regression analysis was conducted to investigate the inference learning performance (remembering and analysing) of the four ARCS dimensions with the three teaching methods. Results: The results showed that confidence and relevance were positively correlated with learning performance in the VR‐based wearable group. In the context of the ARCS model, learners' confidence predicted learning performance and the remembering subdimension when VR‐based learning materials were used. Implications: These results suggest that, compared to traditional teaching methods, VR‐based wearables make it easier to create a highly immersive learning environment and are more likely to help learners find the correct words, improve their accuracy, and increase their confidence and sense of accomplishment in the entire learning process. Lay Description: Augmented reality (AR) and virtual reality (VR) allow learners to apply memorized subject knowledge to real‐life scenarios.The attention, relevance, confidence, and satisfaction (ARCS) motivation model enhances learning. What this paper adds: The study proposed the integration of AR and VR with "wearables" for teaching English.The study investigated the differences between how the teaching materials designed to incorporate different technological devices with the four ARCS dimensions predict their learning performance (remembering and analysing). Implications for practice and/or policy: The ARCS motivation model‐based design allows learners using VR‐based wearables to learn English through multiple interactions in real‐time.Integrating daily life experiences with course materials can attract learners' attention in the early stages of teaching.VR‐based learning creates a virtual learning environment relevant to the learners, allows them to learn English thematically in an immersive environment, and allows them to interact with the system. [ABSTRACT FROM AUTHOR]

This article aims to investigate how the discourse on national identity is approached in the new Taiwanese citizenship curriculum. The differing opinions on Taiwan's relationship with China and the constant threat from this rising superpower have deterred the explicit promotion of either a Taiwanese or Chinese identity. The new curriculum follows a strategy of "intentional ambiguity", where neither identity is mentioned. In this "polysemous" form, the curriculum has been criticized for staying silent on the question of cultivating a national identity. However, the curriculum developers interviewed for this paper suggested that parents and pupils who examine the new curriculum can find support for whichever national identity they favor since it is designed in such an inclusive manner. They can then simultaneously reflect on the multiple, divergent or competing meanings behind the "polysemous texts" and this "hermeneutic" process of reasoning can then facilitate the choice of national identity with maximum acceptance.

Advances in technology have led to continuous innovation in teaching and learning methods. For instance, the use of tablet PCs (TPCs) in classroom instruction has been shown to be effective in attracting and motivating students' interest and increasing their desire to participate in learning activities. In this paper, we used a TPCs game--an iPad app called "Motion Math: Hungry Fish"--to help young students learn to theoretically understand and practically implement the mathematical concepts of addition and subtraction. Based on findings from a pilot study, we categorized the game's 18 levels of difficulty into "challenging" (experimental group) and "matching" (control group) games. We aimed to investigate whether challenging games were more able than matching games to improve the students' motivation, flow experience, self-efficacy for technology, self-efficacy for science, feelings about the TPC game, and satisfaction with the learning approach. The findings showed that the students in the experimental group achieved better flow experience, learning performance, and satisfaction.

Confucianism, long regarded as the key philosophy on personal character-building and interpersonal relations in Chinese society, used to be pivotal to citizenship education in Taiwan, but that has changed in the last 20 years. In the wake of democratization in the late 1980s, growing liberalism and pluralism in Taiwanese society prompted the authorities to widen the scope of the school curriculum to include a diversity of cultures and thus the influence of this ancient Chinese philosophy began to fade away. The new citizenship curriculum, introduced in 2010, is no longer structured around Confucian moral guidance, but has instead embraced pluralism. Confucianism, from the perspective of those Taiwanese citizenship curriculum designers who were interviewed, hinders the formation of civil society due to its overly strong emphasis on familial kinship and "sovereign-subject" paternalism. Engulfed by Confucian moral principles, the critical and reflective competence of the individual often fails to develop. The new citizenship programme therefore attempts to counter the emphasis on fostering "obedient citizens" under monolithic Confucian doctrines and envisions a resilient civil society open to pluralistic voices.

This article examines and compares the hotly debated issue of national identity in the Taiwanese and English citizenship curricula and investigates the extent to which schoolteachers' perceptions fall in line with the written curriculum. The author describes the background to the evolution of national identity in each country. Following this preliminary understanding, the theory of civic-ethnic nationalism is used as the criterion to examine the nature of nationalism underlying the curriculum. The Taiwanese citizenship curriculum with its 60-year long history has transformed from being a tool for the promotion of an "imagined" Chinese national identity to a more Taiwan-oriented programme. With fewer disagreements, "British-ness", as a consensual identity constructed from a civic construct, creates an inclusive umbrella to accommodate citizens with different ethnic, cultural, and religious identities. However, English citizenship education teachers question whether it has a robust-enough and deep-enough magnet to engage every citizen with varying backgrounds and further enhance social consolidation. On the other hand, this umbrella-type national identity seems to provide a valid solution for the Taiwanese citizenship curriculum designers to heal the long-lasting tensions caused by the "Taiwanese-Chinese identity" divide. On closer examination, the Taiwanese curriculum chooses to sidestep this contentious issue and is therefore strongly criticised by the school teachers interviewed here. This research attempts to demonstrate the strengths and limitations of each curriculum's discourses of national identity and suggest what each may learn from each other.

This study, based on Taiwanese geographical concepts, develops a multi-touch interactive jigsaw puzzle (MIJP) to assist primary school students in solving geographical puzzles. The MIJP, which has multi-touch operating characteristics and provides two kinds of scaffolding tools, each with a different level of difficulty, can assist students in solving problems in the games and prevent them from feeling stuck and frustrated. In addition, it explores the influence of the interactive game approach (three levels of difficulty) on learning performance and satisfaction. The results indicated that the learning performance of each group, significantly improved after the experiment. In particular, moderate gaming difficulty led to the best learning performance for learners. A comparison of learners who did not use scaffolding to solve problems and those who did shows the level of the zone of proximal development (ZPD). Moreover, the analysis of satisfaction evaluations by learners with/without scaffolding showed there were statistically significant differences in the measures of learning satisfaction. Finally, this study revealed that the students tended to be over-reliant on the scaffolding tools during the game, which prevented them from internalizing knowledge through the interactive learning process.

This article compares the development of citizenship education (CE) in Taiwan and England, as well as teachers' perceptions about the liberal and communitarian constructs underpinning the curriculum in both countries. Due to distinct social and political environments, the Taiwanese and English CE curricula demonstrate an interesting contrast. Until 1987, the Taiwanese curriculum grew under an authoritarian regime which had implemented the citizenship curriculum in 1945; in England, however, CE was not added to the school timetable until 2002, after a long debate about the controversial and potential influence of the subject. This article first offers an overview of the development of CE in Taiwan and England. Following this preliminary understanding, interview accounts with 20 CE teachers are included to share insights based on actual practical experience. The English curriculum leans towards a communitarian type of "active citizenship", but teachers in England mention a gap between the theory and practice. In addition, reservations about the existence of the assumed "common values" underlying the communitarian construct are dealt with. In contrast, social and political participation is not perceived as a goal that is emphasised in the Taiwanese curriculum. Taiwanese CE sides with the "liberal construct", but is criticised by some in Taiwan for ignoring moral values and character-building. It is also observed that both curricula use a "deliberative democracy" approach to compensate for the shortcomings in curriculum construction. For a comparative study such as this, weaving both cases together demonstrates how each curriculum could derive inspiration from the other.

Simple Summary: Afatinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) used to treat patients with advanced EGFR-mutant lung cancer. In this study, we retrospectively enrolled patients with lung adenocarcinomas harboring susceptible EGFR mutations, who were diagnosed and treated with first-line afatinib in three Kaohsiung Medical University-affiliated hospitals. Patients who received local consolidative therapy (LCT) had a significantly longer PFS than those who did not. Patients who received LCT also had significantly longer OS. Multivariable analysis showed LCT was an independent prognostic factor for improved PFS and OS. The analyses using propensity score-weighting showed consistent results. We conclude that LCT may improve clinical outcomes, in terms of PFS and OS, in patients with advanced EGFR-mutant lung adenocarcinomas who are treated with first-line afatinib. Further large-scale prospective trials are warranted. Afatinib is an irreversible tyrosine kinase inhibitor (TKI) targeting the epidermal growth factor receptor (EGFR), which is utilized for the treatment of patients with advanced lung cancer that harbors EGFR mutations. No studies have evaluated the clinical efficacy of LCT in patients treated with first-line afatinib. In this study, we retrospectively enrolled patients with advanced lung adenocarcinomas harboring susceptible EGFR mutations who were diagnosed and treated with first-line afatinib in three hospitals. A total of 254 patients were enrolled, including 30 (12%) patients who received LCT (15 patients received definitive radiotherapy for the primary lung mass and 15 patients received curative surgery). Patients who received LCT had a significantly longer PFS than those who did not (median PFS: 32.8 vs. 14.5 months, p = 0.0008). Patients who received LCT had significantly longer OS than those who did not (median OS: 67.1 vs. 34.5 months, p = 0.0011). Multivariable analysis showed LCT was an independent prognostic factor for improved PFS (adjusted hazard ratio [aHR] [95% confidence interval (CI)]: 0.44 [0.26–0.73], p = 0.0016) and OS (aHR [95% CI]: 0.26 [0.12–0.54], p = 0.0004). The analyses using propensity score-weighting showed consistent results. We conclude that LCT may improve clinical outcomes, in terms of PFS and OS, in patients with advanced EGFR-mutant lung adenocarcinomas who are treated with first-line afatinib. [ABSTRACT FROM AUTHOR]

This article examines the relationship between writing and attention problems and hypothesizes that homophone spelling errors coincide with attention deficits. We analyze specific types of attention deficits, which may contribute to Attention Deficits Hyperactivity Disorder (ADHD); rather than studying ADHD, however, we focus on the inattention dimension of behavior. Our methodology was to develop a survey study for exploring the coincidence of homophone errors and attention problems in schoolchildren. Two sets of parent-questionnaires characterizing individually types of Chinese handwriting errors and behavioral problems in schoolchildren were developed by the research team. Our participants were 491 Taiwanese children from the first to fifth grades in an elementary school in Taipei; they all used traditional Chinese as their primary written language of communication. Based on the ratings of the parent-questionnaires, two groups with proficient and non-proficient homophonic writing were formed. One consisted of children known to have made heterographic homophone errors (words with correct pronunciation but different spellings). The other (control group) consisted of children known to be proficient in Chinese homophone spellings. In each group, there were 54 boy and girl pupils, matched by gender, age, school and grade. A significant correlation was found between attention deficits and homophone errors. This survey study confirms our hypothesis and strengthens a currently underdeveloped theory in the literature of handwriting that attention impairments play an important role in the production of homophone errors. (Contains 2 tables.)

Although the influence of workplace practices and employees' experiences with training effectiveness has received considerable attention, less is known of the influence of workplace practices on training evaluation methods. The purposes of this study were to: (1) explore and understand the training evaluation methods used by seven Taiwanese companies benchmarked for their excellence; and (2) compare Kirkpatrick's and Swanson's training evaluation models with practices used by the benchmarked Taiwanese organizations from a cross-cultural perspective. Five themes emerged from in-depth interviews, extending our understanding of training evaluation in the benchmarked Taiwanese organizations.

Background: Studies have reported mixed results on the importance of medial calcar support for the treatment of proximal humeral fractures. The purpose of this study was to compare radiographic and functional outcomes of patients who had displaced proximal humeral fractures with varying levels of medial support. Methods: We performed a retrospective comparative cohort study. The study was conducted at a Level III trauma center in Taiwan. Seventy patients with proximal humeral fractures were collected retrospectively from 2015 to 2019. Only patients with two-, three-, or four-part types (Neer type I, II, or III) of displaced proximal humeral fractures were included in this study. However, patients with head-split fracture patterns, shoulder dislocation, prior shoulder trauma, and poor fracture reduction present in postoperative films were excluded. We assessed the radiographic outcomes, including the reduction score and amount of impaction in the humeral head. The functional outcome was evaluated based on the Constant score. Results: Patients were grouped into the intact medial calcar group and the medial calcar deficiency group. In a subgroup analysis, the group with intact medial support had a significantly lower amount of impaction and a higher Constant score compared with the medial calcar deficiency group. Additionally, the groups with intact medial support had a nonsignificant difference in the Constant score between the affected side and the contralateral side. Conclusion: The amount of impaction and the reduction score in the humeral head at the 12-month radiographic follow-up were significantly higher in the group with medial support deficiency. However, the reduction score after surgery exhibited no difference. This implies that the inherent nature of medial comminution of proximal humeral fracture may lead to inferior radiographic outcomes. [ABSTRACT FROM AUTHOR]

Colistin is the last resort antimicrobial for treating multidrug-resistant gram-negative bacterial infections. The plasmid-mediated colistin resistance gene, mcr-1 , crucially influences colistin's resistance transmission. Human fecal carriages of mcr-1 -positive Escherichia coli (E. coli) were detected in many regions worldwide; however, only a few studies have focused on children. Therefore, we identified the prevalence and risk factors of mcr-1 -positive E. coli in fecal carriages among community children in Southern Taiwan. In this study, 510 stool samples were collected from April 2016 to August 2019 from the pediatric department at a medical center in Southern Taiwan. These samples were collected within 3 days after admission and were all screened for the presence of the mcr-1 gene. Diet habits, travel history, pet contact, and medical history were also obtained from participants to analyze the risk factors of their fecal carriages to mcr-1 -positive E. coli. Antimicrobial susceptibility testing was determined using the VITEK 2 system and the broth microdilution test. Twelve mcr-1 -positive E. coli. were isolated from 2.4% of the fecal samples. Through multivariate analysis, frequent chicken consumption (at least 3 times per week) had a significantly positive association with the presence of mcr-1 -positive E. coli in fecal carriages (adjust odds ratio 6.60, 95% confidence interval1.58– 27.62, p = 0.033). Additionally, multidrug resistance was more common in mcr-1 -positive E. coli. (75.0% vs. 39.5%, p = 0.031) than in non- mcr-1 -positive Escherichia coli. Furthermore, the percentage of extraintestinal pathogenic E. coli in mcr-1 -positive isolates was 83.3%. Some multi-locus sequence types in our mcr-1 -positive E. coli were also similar to those isolated from food animals in the literature. The prevalence of fecal carriages of mcr-1 -positive E. coli was low among community children in Southern Taiwan. Our data shows that chicken consumption with a higher frequency increases the risk of mcr-1 -positive E. coli. in fecal carriages. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of chronic kidney disease (CKD) is on the rise due to population aging and multimorbidity. Taiwan is particularly afflicted by this prevailing ailment. Although multidisciplinary pre‐dialysis care has been implemented to halt CKD progression and reduce health‐care utilization in Taiwan, more is needed to reduce the local burden of CKD. Methods: The Taiwan Joint Commission initiated a kidney‐care disease‐specific care (DSC) certification program since 2017, aiming to improve participating hospitals' quality of care for kidney disease and to synchronize the quality of kidney care across Taiwan. We analysed the trend of changes over time among the kidney DSC certification program participating institutes during the period before, during, and after DSC certification program implementation, using the Generalized Estimating Equation methods. Results: A total of 20 institutes participated in the DSC certification program focusing on kidney diseases between January 2018 and March 2020, among which 70% were medical centres. DSC certification program was shown to significantly reduce the annual incidence of arteriovenous fistula reconstruction while increase the levels of serum albumin and haemoglobin among patients with end‐stage renal disease (ESRD) under haemodialysis over time. For parameters related to peritoneal dialysis (PD), participating in the kidney‐care DSC certification program significantly increased serum albumin levels among these patients with ESRD over time. Conclusion: In this study, we discovered that a kidney‐care DSC certification program significantly improved multiple performance indicators of participating institutes including patients' haemoglobin, albumin, and shunt re‐creation probability among patients with end‐stage renal disease. SUMMARY AT A GLANCE: This study investigated the impact of the Kidney‐care Disease Specific Care (DSC) Certification Program in Taiwan on the performance indicators of facilities treating patients with chronic kidney disease, and found that the program significantly improved patients' haemoglobin, serum albumin, and reduced the probability of shunt re‐creation in patients with end‐stage renal disease. [ABSTRACT FROM AUTHOR]

Background: Afatinib has shown favorable response rates (RRs) and longer progression free survival (PFS) in lung cancer patients harboring EGFR mutations compared with standard platinum-based chemotherapy. However, serious adverse drug reactions (ADRs) limit the clinical application of afatinib.Methods: We designed a retrospective study, enrolling all patients with metastatic lung adenocarcinoma who were diagnosed and treated with 30 or 40 mg daily afatinib as their initial treatment in three Kaohsiung Medical University-affiliated hospitals in Taiwan.Results: A total of 179 patients were enrolled in the study, of which 102 (57%) and 77 (43%) received 30 mg and 40 mg afatinib daily as their initial treatment, respectively. The patients initially using 30 mg afatinib daily had a similar RR (75% vs. 83%, p = 0.1672), median PFS (14.5 vs. 14.8 months, log-rank p = 0.4649), and median OS (34.0 vs. 25.2 months, log-rank p = 0.5982) compared with those initially using 40 mg afatinib daily. Patients initially receiving 30 mg afatinib daily had fewer ADRs compared with those using 40 mg daily. The overall incidence of moderate and severe ADRs was significantly lower in patients receiving 30 mg afatinib daily compared with those using 40 mg daily (49% vs. 77%, p = 0.002); similar findings was observed in terms of severe ADRs (7% vs. 24%, p < 0.0001).Conclusion: Patients receiving 30 mg afatinib daily as their initial treatment had similar RR, PFS, OS, but significantly fewer serious ADRs, as compared with those using 40 mg as their starting dose. [ABSTRACT FROM AUTHOR]

Background/purpose: There is a lack of data on nivolumab treatment outcomes in Taiwanese patients with advanced or recurrent non-small cell lung cancer (NSCLC) ineligible for radical radiotherapy and resistant to platinum-based chemotherapy. We investigated the safety and efficacy of nivolumab in this population.Methods: In this ongoing, multicenter, open-label, single-arm, phase II study, patients aged ≥20 years with a performance status of 0-1 and stage IIIB/IV or recurrent NSCLC received nivolumab 3 mg/kg every 2 weeks in 6-week cycles. Interim data obtained between 27 January 2016 and 21 May 2017 were analyzed. Safety, based on adverse event (AE) reporting, was the primary endpoint. Efficacy assessment parameters included overall response rate (ORR), overall survival (OS), and progression-free survival (PFS).Results: Among 53 treated patients with advanced NSCLC (median age 61.0 years; 62.3% male), mean treatment duration was 99.7 days. AEs (any grade) and serious AEs were reported by 92.5% and 47.2% of patients, respectively. Adverse drug reactions (ADRs; any) occurred in 58.5% of patients; grade ≥3 ADRs occurred in 13.2% of patients. Five deaths occurred; two cases (neoplasm progression and septic shock) were considered treatment-emergent. Common ADRs were fatigue (17.0%) and rash (13.2%). Common immune-related treatment-emergent AEs were rash (17.0%) and pruritus (13.2%). The centrally assessed ORR was 9.4% (5/53). The median OS and median PFS were 11.5 months and 1.4 months, respectively.Conclusion: Nivolumab appeared to be safe and effective in Taiwanese patients. These interim results suggest that nivolumab is a suitable treatment option for this population.Clinical Trial Registration: NCT02582125. [ABSTRACT FROM AUTHOR]

The Lewisian concept of dualism was empirically relevant to Taiwan given its heavy population pressure on scarce land. Most of the literature, albeit based on little solid evidence, concluded that Taiwan reached the Lewisian turning point around the end of the 1960s. Others argued that the LTP was after 1979. This paper first follows three criteria proposed by Minami (1973). We observe the active reallocation of employment after the mid-1960s and the dramatic increases in real wages of the agricultural and unskilled workers at the end of the 1960s. Furthermore, we introduce a new empirical methodology on the agricultural production function by adding a year dummy variable to identify a potential LTP, which leads to the agricultural marginal product of labor being zero before the LTP and becoming positive thereafter. Our findings support the notion that the LTP in Taiwan occurred around the period 1969–1973, rather than after 1979. [ABSTRACT FROM AUTHOR]

Background: DNA copy number variations (CNVs) are a hallmark of cancer, and the current study aimed to demonstrate the profile of the CNVs for oral cavity squamous cell carcinoma (OSCC) and elucidate the clinicopathological associations and molecular mechanisms of a potential marker derived from CNVs, mixed‐lineage leukemia translocated to chromosome 3 protein (MLLT3), in OSCC carcinogenesis. Materials and Methods: CNVs in 37 OSCC tissue specimens were analyzed using a high‐resolution microarray, the OncoScan array. Gene expression was analyzed by real‐time polymerase chain reaction in 127 OSCC and normal tissue samples. Cell function assays included cell cycle, migration, invasion and chromatin immunoprecipitation assays. Results: We found a novel copy number amplified region, chromosome 9p, encompassing MLLT3 via the comparison of our data set with six other OSCC genome‐wide CNV data sets. MLLT3 overexpression was associated with poorer overall survival in patients with OSCC (p =.048). MLLT3 knockdown reduced cell migration and invasion. The reduced invasion ability in MLLT3‐knockdown cells was rescued with double knockdown of MLLT3 and CBP/p300‐interacting transactivator with ED rich carboxy‐terminal domain 4 (CITED4; 21.0% vs. 61.5%). Knockdown of MLLT3 impaired disruptor of telomeric silencing‐1‐like (Dot1L)‐associated hypermethylation in the promoter of the tumor suppressor, CITED4 (p <.001), and hence dysregulated HIF‐1α‐mediated genes (TWIST, MMP1, MMP2, VIM, and CDH1) in OSCC cells. Conclusion: We identified unique CNVs in tumors of Taiwanese patients with OSCC. Notably, MLLT3 overexpression is related to the poorer prognosis of patients with OSCC and is required for Dot1L‐mediated transcriptional repression of CITED4, leading to dysregulation of HIF‐1α‐mediated genes. Implications for Practice: This article reports unique copy number variations in oral cavity squamous cell carcinoma (OSCC) tumors of Taiwanese patients. Notably, MLLT3 overexpression is related to the poorer prognosis of patients with OSCC and is required for Dot1L‐mediated transcriptional repression of CITED4, leading to dysregulation of HIF‐1α‐mediated genes. DNA copy number variations are a hallmark of cancer. This article reports a potential biomarker derived from copy number variations, MLLT3, in oral cavity squamous cell carcinoma carcinogenesis. [ABSTRACT FROM AUTHOR]

This article challenges the simplistic and reductive image of Taiwanese schoolteachers, and reveals their actions of resistance during the turmoil of the recent curriculum reform controversy. Despite the fact that teachers are not usually portrayed as progressive and revolutionary agents, in the face of the disputed curriculum revision in 2014, some Taiwanese teachers came forward to oppose its implementation through demonstrations, hunger strikes, and litigation. The wider public's attention to this issue and ensuing student movement can be attributed to these teachers' pioneering activism. By means of interviewing 12 teachers, this article explores activist teachers' political self-efficacy, the creation of their pressure groups, and their apprehension about fighting against the authorities. The recording of this teacher-initiated social movement demonstrates 'teachers as activists', and hopefully will inspire educators not to limit their influence solely to the classroom. [ABSTRACT FROM AUTHOR]

The delay of home leaving and increasing parental support for young adults are issues of increasing concern. However, little is known about the family support for young adults' housing in non-Western societies. By using age cohort data, this paper examines housing arrangements among young adults in Taiwan as a case study to elucidate how parental resources are related. Unlike the leaving home phenomenon discovered in Western societies, young adults are more likely to stay in their parental homes in Taiwan. Age and gender are less related to home leaving, and young adults' economic capability is positively related to leaving the family nest. Parental resources, however, are negatively related to home leaving. Furthermore, the multinational analysis indicates that among the various forms of living, parental resources are prevalent in supporting young adults in gaining access to better housing consequences. [ABSTRACT FROM AUTHOR]

Background/purpose: Warfarin treatment benefits vary with the clinical skill of warfarin dosage adjustment. However, optimal dosage adjustment in response to the out-of-range international normalized ratio (INR) is not completely understood.Methods: Data for 2014-2016 from an integrated health care information system of a single hospital were analyzed. Based on their warfarin dosage fluctuation (WDF), defined as the standard deviation of all prescribed warfarin dosages divided by the mean dosage, the patients were classified into Groups 1 (0-0.10), 2 (0.10-0.20), and 3 (>0.20). Target and in-range INRs were 2.0-2.5 and 1.5-3.0, respectively. Based on time in therapeutic range (TTR), patients were also categorized into Groups 1 (<0.6), 2 (0.6-0.9), and 3 (>0.9). The primary outcome was emergency department visits for bleeding or thromboembolism (TE) events.Results: Eighty-three events were retrieved from 17,397 records (1834 patients). Annual incidence rates were 0.9%, 2.5%, and 4.5% for WDF Groups 1, 2, and 3, respectively (p < 0.05), and 2.3%, 1.7%, and 1.7% for TTR Groups 1, 2, and 3, respectively (p = 0.41). Area under the receiver operator characteristic curves for WDF and TTR were 0.686 and 0.519, respectively, indicating that WDF exhibited superior predictive performance than TTR.Conclusion: High WDF rather than low TTR was associated with increased bleeding and TE incidence rates. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the relationships of self‐care, symptoms, and a variety of demographic factors to quality of life (QOL), and to identify determinants of QOL in lung cancer patients undergoing chemotherapy. Design: A cross‐sectional, correlational study. Methods: 159 patients with lung cancer undergoing chemotherapy were recruited from three southern hospitals in Taiwan. Four instruments were used: the Quality of Life Questionnaire Core 30‐item (QLQ‐C30), M.D. Anderson Symptom Inventory (MDASI), Memorial Symptom Assessment Scale‐Short Form (MSAS‐SF), and Self‐Care Behavior Scale (SCBS). Findings: Lung cancer patients rated lower scores of self‐care behaviors on food choice and nutrition maintenance, regular exercise and sleep, and medical compliance. Being younger, having spouses as main caregivers, having food choice and nutrition maintenance, and getting regular exercise and sleep were associated with better QOL. Degree of interference with life, age, food choice and nutrition maintenance, and psychological symptoms were found to predict functional QOL and accounted for 43% of total variance. Conclusions: The findings identified factors influencing QOL and provided evidence for designing an intervention to enhance QOL in lung cancer patients undergoing chemotherapy. Clinical Relevance: The findings may be useful for guiding intervention development for early detection and management of symptom interference with daily living, and place greater focus on patient self‐care to promote food choice and nutrition maintenance, especially in older patients and those whose caregivers are not their spouses. [ABSTRACT FROM AUTHOR]

Background: Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients.Methods: Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009-2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity.Results: From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001).Conclusions: In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs. [ABSTRACT FROM AUTHOR]

Background: The Chinese version of the Continuity Assessment Record and Evaluation (CARE-C) item set was developed to facilitate the assessment of post-acute care (PAC) patients in Taiwan. Considering that the length of hospital stay (LOS) has a significant effect on the total healthcare cost, determining whether the CARE-C scores could predict the LOS of PAC patients is of great interest to the PAC providers. Methods: This prospective trial included PAC patients with stroke or central nervous system injuries. The demographic data and CARE-C scores were collected after admission and before discharge. A multivariable stepwise linear regression model was used to identify the predictors of the LOS using age, sex, tube placement status, CARE-C component scores at admission, and score differences between admission and discharge as independent variables. Results: This study included 178 patients (66 women and 112 men), with a mean age of 61.9 ± 15.6 years. Indwelling urinary catheter placement status at admission (β = 0.241, p = 0.002) was a positive predictor of the LOS, whereas age (β = −0.189, p = 0.010), core transfer subscale score at admission (β = −0.176, p = 0.020), and difference in continence subscale score (β = −0.203, p = 0.008) were negative predictors of the LOS. The model explained 14% of the total variance. Conclusions: Indwelling urinary catheter placement status at admission, age, core transfer subscale score at admission, and difference in the CARE-C continence subscale score were identified as predictors of the LOS. The explanatory power of these predictors might be limited due to the regulations of Taiwan’s National Health Insurance. [ABSTRACT FROM AUTHOR]

Background: Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management. Methods: A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital ( n = 111) and a rural hospital ( n = 48) in southern Taiwan from 2009 to 2012. Results: Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 ( p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations. Conclusions: The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural-urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance. [ABSTRACT FROM AUTHOR]

Background: The Taiwanese government increased financial subsidies for smoking cessation services in 2012. We aimed to evaluate the effects of this new policy on smoking cessation services from the physician's perspective.Methods: This was a cross-sectional nationwide survey. Physicians who provided smoking cessation services for more than ten patient encounters in the preceding year of the new policy (February 2011 to March 2012) were recruited. The questionnaire was developed by two experts and was validated by a committee consisting of 11 delegates.Results: We sent a total of 1,319 questionnaires. The response rate was 45.9 %. The majority of respondents were male (88.4 %), middle-aged (65.3 %), and worked as family physicians (56.1 %). Most physicians agreed that the new policy had increased the number of patients seeking smoking cessation, increased patients' willingness to adopt pharmacotherapy, helped physicians to prescribe medications, improved patients' adherence to medications, and improved quality of care. These changes were most prominent in medical centers. Changes in the practice of the 5As (ask, advise, assess, assist, arrange) were moderate. Among different medical settings, the most significant change was an increase in the expenditure on smoking cessation medications.Conclusions: The new subsidization policy in Taiwan has improved smoking cessation services. Overall, physicians reported positive effects of the new policy. Further study is warranted to evaluate the long-term influence of the policy. [ABSTRACT FROM AUTHOR]

Purpose: Wasabia japonica (wasabi) has been shown to exhibit properties of detoxification, anti-inflammation and the induction of apoptosis in cancer cells. This study aimed to investigate the molecular mechanism of the cytotoxicity of wasabi extract (WE) in colon cancer cells to evaluate the potential of wasabi as a functional food for chemoprevention. Methods: Colo 205 cells were treated with different doses of WE, and the cytotoxicity was analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide. Apoptosis and autophagy were detected by 4′,6-diamidino-2-phenylindole, 5,5′,6,6′-tetrachloro-1,1′,3,3′-tetraethyl-imidacarbo-yanine iodide and staining for acidic vascular organelles (AVOs), along with Western blotting. Results: The results demonstrated that WE induced the extrinsic pathway and mitochondrial death machinery through the activation of TNF-α, Fas-L, caspases, truncated Bid and cytochrome C. WE also induced autophagy by decreasing the phosphorylation of Akt and mTOR and promoting the expression of microtubule-associated protein 1 light chain 3-II and AVO formation. An in vivo xenograft model verified that tumor growth was delayed by WE treatment. Conclusion: Our studies revealed that WE exhibits anti-colon cancer properties through the induction of apoptosis and autophagy. These results provide support for the application of WE as a chemopreventive functional food and as a prospective treatment of colon cancer. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality. However, no previous studies have rigorously evaluated the relationship between incident acute kidney injury (AKI) and functional status of elderly patients.Methods: Elderly patients (≥ 65 years-old) were prospectively from the general medical wards of a single medical center in Taiwan between January, 2014 and August, 2014. These patients were divided into those with and without AKI at initial presentation, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Functional status was assessed by Barthel Index on admission. Multiple regression analyses were utilized to investigate the relationship between AKI and functional status.Results: One hundred and fifty-two elderly patients were recruited, 38.9 % of whom had AKI. Patients with AKI at admission had significantly higher mean Charlson Comorbidity Index score (p = 0.05) and borderline lower mean Barthel Index score (34.5 vs. 43.1; p = 0.08), and a significantly lower bladder continence subscale (5.4 vs. 7.0; p = 0.05). Multiple regression analyses indicated that the presence of AKI at admission was associated with a significantly lower Barthel Index score (p = 0.04). Increasing AKI severity (higher KDIGO stage) was also associated with significantly lower Barthel Index score (p < 0.01).Conclusions: This study documented a close relationship between AKI and functional status in the elderly. Interventions that aim to restore functional status might help to lower the risk of AKI in the elderly. [ABSTRACT FROM AUTHOR]

Confucianism, long regarded as the key philosophy on personal character-building and interpersonal relations in Chinese society, used to be pivotal to citizenship education in Taiwan, but that has changed in the last 20 years. In the wake of democratization in the late 1980s, growing liberalism and pluralism in Taiwanese society prompted the authorities to widen the scope of the school curriculum to include a diversity of cultures and thus the influence of this ancient Chinese philosophy began to fade away. The new citizenship curriculum, introduced in 2010, is no longer structured around Confucian moral guidance, but has instead embraced pluralism. Confucianism, from the perspective of those Taiwanese citizenship curriculum designers who were interviewed, hinders the formation of civil society due to its overly strong emphasis on familial kinship and “sovereign-subject” paternalism. Engulfed by Confucian moral principles, the critical and reflective competence of the individual often fails to develop. The new citizenship programme therefore attempts to counter the emphasis on fostering “obedient citizens” under monolithic Confucian doctrines and envisions a resilient civil society open to pluralistic voices. [ABSTRACT FROM PUBLISHER]

Background: Postoperative shoulder stiffness complicates functional recovery after arthroscopic rotator cuff repair. Purpose: To compare early passive range of motion (ROM) exercise with a delayed rehabilitation protocol with regard to the effectiveness of stiffness reduction and functional improvements and rates of improper healing in patients undergoing arthroscopic repair for torn rotator cuffs. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) comparing both rehabilitation approaches were identified in PubMed and Scopus. Between-group differences in shoulder function were transformed to effect sizes for comparisons, whereas the effectiveness against stiffness and the risk of tendon failure were reported using standardized mean differences of ROM degrees and odds ratios (ORs) of recurrent tears, respectively. Results: Six RCTs were included, consisting of 482 patients. No significant difference in shoulder function existed across both protocols. The early ROM group demonstrated more improvement in shoulder forward flexion than the delayed rehabilitation group, with a standardized mean difference of 7.45 (95% CI, 3.20-11.70) at 6 months and 3.51 (95% CI, 0.31-6.71) at 12 months. Early ROM exercise tended to cause a higher rate of recurrent tendon tears (OR, 1.43; 95% CI, 0.90-2.28), and the effect became statistically significant (OR, 1.93; 95% CI, 1.04-3.60) after excluding 2 RCTs that recruited only those patients with small to medium-sized tears. Conclusion: Early ROM exercise accelerated recovery from postoperative stiffness for patients after arthroscopic rotator cuff repair but was likely to result in improper tendon healing in shoulders with large-sized tears. The choice of either protocol should be based on an accommodation of the risks of recurrent tears and postoperative shoulder stiffness. [ABSTRACT FROM AUTHOR]

This article presents an international perspective of the proposed changes to the DSM-5 for learning disabilities (LD) and attention-deficit/hyperactivity disorders (ADHD) across ten countries: Australia, Germany, Greece, India, Israel, Italy, Spain, Taiwan, the United Kingdom, and the United States. We provide perspectives of the present situation for youth with LD and youth with ADHD and describe the legislation, prevalence rates, and educational systems that serve students with disabilities in the respective countries. We also present a discussion of the expected impact of the proposed changes for the diagnosis of LD and ADHD in each country. [ABSTRACT FROM PUBLISHER]

Background. Metabolic syndrome (MS) is thought to be a risk marker for cardiovascular diseases in the general population and in patients with chronic kidney disease. This study investigated whether the presence of MS also modifies cardiovascular (CV) outcomes among non-diabetic patients undergoing long-term peritoneal dialysis (PD).Methods. We enrolled 280 patients from a medical centre in North Taiwan who began PD between January 1999 and December 2005 and followed them until December 2009. MS was defined by the modified National Cholesterol Educational Programme (Adult Treatment Panel III) criteria. All parameters and biochemical data were collected by chart review. Patient outcomes (overall and CV death, fatal or non-fatal CV events) were recorded during the follow-up period. Survival was analysed by the Kaplan–Meier method, and the influence of MS and its components on outcomes were analysed by Cox regression models.Results. The average follow-up period was 49.2 months. Non-diabetic patients with MS had worse outcomes than those without MS or at risk for MS, but better than their diabetic counterparts. By multivariate analysis, MS was independently associated with increased risk for CV death (hazard ratio, HR = 13.27) and fatal or non-fatal CV events (HR = 10.50). Among five MS components, hypertriglyceridaemia, low high-density lipoprotein levels and hyperglycaemia were significant risk factors for adverse CV outcomes.Conclusions. MS is a potent risk marker for adverse CV outcomes in non-diabetic patients on PD. Timely interventions targeting specific component of this syndrome may be required in this subset of patients. [ABSTRACT FROM PUBLISHER]

Purpose: Taiwan is a highly endemic area for urothelial carcinoma (UC) and chronic kidney disease (CKD). We evaluate the gender effect on the relationship between renal outcome and clinical characteristics of CKD patients with UC. Methods: The clinical and pathologic records of 404 patients were retrospectively analyzed. We calculated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation, and staged CKD status according to K/DOQI guideline. Results: The female group had a significantly higher proportion (67.6% vs 29.0%, P < 0.001) of upper urinary tract urothelial carcinoma (UUT-UC). Pathologically, the frequency of high T stage UC (32.4% and 19.1%; P = 0.003), high-grade UC (89.4% and 75.6%; P = 0.001), and larger UC (51.4% and 37.8%; P = 0.009) in the female patients were significantly higher, when compared with the male group. Male gender, diabetes, anemia, poor preoperative renal function, UUT-UC, and low-grade tumor were independent risk factors of poor renal outcome by multivariate analysis in these UC patients. Diabetes was a risk factor of poor renal outcome in male UUT-UC patients, but not in the female patients ( P = 0.009). Conclusion: Female gender had a more aggressive histological urothelial carcinoma pattern than male patients did, but paradoxically had a more favorable renal outcome. [ABSTRACT FROM AUTHOR]

Background/purpose: Sevelamer hydrochloride is a recently developed phosphate binder, which is a quaternary amine anion exchanger without calcium or aluminum. Sevelamer is effective in controlling hyperphosphatemia without increasing the calcium load in chronic hemodialysis (HD) patients. We investigated whether sevelamer restored bone metabolism in chronic HD patients.Methods: An 8-week, prospective, open-label, randomized study was conducted after a 2-week washout period in chronic hyperphosphatemic HD patients. This study compared the effect of sevelamer on markers of bone turnover with that of calcium acetate, as stratified by baseline serum intact parathyroid hormone (iPTH) level.Results: There was no difference in the changes of serum phosphorus, calcium-phosphorus product and serum iPTH between the sevelamer and the calcium acetate groups. However, more hypercalcemic events (12%) were documented under calcium acetate treatment. In patients with hypoparathyroidism, calcium acetate treatment decreased serum iPTH at the end of the study, while sevelamer did not. Increased serum alkaline phosphatase levels were found among patients receiving sevelamer treatment compared with those who received calcium acetate treatment. In those patients receiving sevelamer, the serum alkaline phosphatase level was also positively correlated to the sevelamer dosage (r = 0.246, p = 0.013).Conclusion: Sevelamer effectively reduces serum phosphorus with a lower incidence of hypercalcemic effects in HD patients. Sevelamer is an effective means of treatment for chronic hyperphosphatemic HD patients, especially those with hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Background: Psychological depression and physical disability are closely correlated in hemodialysis patients. A retrospective cohort study was conducted to examine the independent association of physical and psychological functioning with mortality in a hemodialysis cohort in Taiwan. Methods: A total of 888 stable hemodialysis patients were included. Patients completed two questionnaires: the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0) and the Beck Depression Inventory (BDI, Chinese Version). Mortality outcomes were recorded for a seven-year follow-up period. Results: There were 303 deaths recorded. BDI scores were inversely related to all health-related quality of life (HRQoL) domains (p < 0.001). In the Cox-proportional hazard model, only poor physical dimension of HRQoL was independently associated with higher mortality. Conclusion: Poor physical dimension in HRQoL is a strong predictor of mortality among hemodialysis patients in Taiwan. Psychological depression is closely correlated with poor HRQoL but does not predict mortality. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose - This study aims to investigate the psychometric characteristics of a Chinese version of the Dimensions of Learning Organization Questionnaire (DLOQ©). Design/methodology/approach - The DLOQ©, developed by Watkins and Macsick in 1997, assessed the characteristics of a learning organization. This study employed a survey validate utility of the DLOQ© for the Taiwanese context. Findings - Psychometric analyses revealed that the Chinese DLOQ© has reasonable reliability, and that the seven-dimensional factor structure was appropriate for the Taiwanese context. Study results also revealed that the seven dimensions of a learning organization can classify different organization types successfully and demonstrate a statistically significant correlation between organization type and perceptual measures of organizational performance. Research limitations/implications - This study has implications for both research and practice in HRD. It offers preliminary evidence of reliability and validity for the Chinese DLOQ©. The positive evidence supporting the psychometric properties of the Chinese DLOQ© indicates the potential for particular cross-cultural applications. Experimental results also suggest that the Chinese DLOQ© can be utilized to determine cultural differences in building a learning organization. Further studies are required to investigate the relationships between the concept of a learning organization and its antecedent and outcomes variables, such as organizational structure, culture, and performance. Originality/value - This study confirms that the validity of applying the seven dimensions as determinants of a learning organization in the Taiwanese context and, in particular, supports the cross-validity of the DLOQ© in this context. This study also offers practical help to understand the concept of organizational learning and developing learning organizations. [ABSTRACT FROM AUTHOR]

This paper tests two competing hypotheses describing investors’ behavior: the efficient market hypothesis and the functional fixation hypothesis. In particular, this study examines how Taiwan's stock market interprets the nature of corporate income tax after the 1998 Tax Reform, which switches from the classical tax system to the integrated tax system. This Tax Reform changes the nature of corporate income tax from a pure operating expense to an individual shareholder's tax credit, but current GAAP still treats it as an operating expense in the income statement. The empirical results show that Taiwan's stock market perceives the change in nature of corporate income tax and responds accordingly. [ABSTRACT FROM AUTHOR]

A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3 , Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3 , 1-hydroxy vitD3 , and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 μg/L, and the mean (±SD) concentration was 705.8 (±128.23) μg/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 μg/L, and the mean (±SD) was 44.30 (±28.28) μg/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 μg/L, and the mean (±SD) was 3.32 (±1.49) μg/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4.6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (±SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (±233.25) μg/L, 7.45 (±3.95) μg/dL, and 3.17 (±25.56) μg/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 μg/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 ± 26.70 versus 41.15 ± 28.03 μg/L, p < 0.001) and hematocrit levels (29.61 ± 4.61 versus 27.81 ± 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contaminated plants such as rice. [ABSTRACT FROM AUTHOR]

A large petrochemical complex, dubbed Petro–complex, situated in a rather rural region of Taiwan, was used as a test bed to detect emissions from the Petro–complex to its surroundings. Hourly observations of speciated non–methane hydrocarbons (NMHCs) by the photochemical assessment monitoring stations (PAMSs), as well as the total amounts of NMHCs, SO2, and NOx provided by the air quality stations (AQSs), were utilized to find useful petro–emission indication methods. The analytical aspect of NMHCs either as a speciated form or as total amounts was demonstrated through field comparison to illustrate data quality. Using ethyne to offset traffic influence, the ratios of ethene to ethyne (acetylene) (E/A) and propene to ethyne (P/A) were proven to be effective indicators of petro–emissions owing to pronounced emissions of ethene and propene, revealed as tall spikes in PAMS measurements. SO2 and NOx were also explored as petro–emission indicators mainly for stack sources. By coordinating with three–dimensional modeling, SO2 from petro–emissions could be distinguished from other prominent sources, such as coal–fired power plants. An attempt was also made to use SO2 and NOx as indicators of broader petro–emissions with stringent criteria to minimize traffic interference and increase specificity. Similar findings were observed with the three indicators, that is, volatile organic compounds (VOCs) ratios, SO2 and NOx, to identify the southwest area of the Petro–region as the most affected area, as represented by Taisi station (F2). The percent affected time of a year at F2 was 10%–14%, owing to the dominant wind field of northeast monsoonal (NEM) in the region, as compared with other sites in the east and north of 1–5%. Using VOC ratios as petro–emission indicators is more effective than using other gases, owing to the compositional advantage to minimize traffic interference. [ABSTRACT FROM AUTHOR]