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With the wide application of the OSCE in the field of pharmacy, the development of e-assessment in OSCE is a predictable trend. However, the feasibility of its practical application and the acceptance of examiners who are accustomed to using traditional paper-based methods are worthy of being discussed. The e-assessment system (EAS) was constructed in this study and used in the examination process. Examiner satisfaction and changes in acceptance of EAS were evaluated. Examiners showed high recognition for the advantages of EAS in data processing, but EAS obviously made the examiner more nervous than the paper-based method. After repeated use of the e-OSCE system, the examiner's satisfaction and acceptance significantly improved, which showed that there was a certain correlation between examiner's familiarity with the assessment method and their acceptance. Besides, EAS has great advantages over traditional paper-based methods, and it is feasible in clinical practice examination of pharmacy education.

This study explores Taiwanese college students' awareness and action on UN's Sustainable Development Goals (SDGs) launched in 2015. These goals define key dimensions wherein youth's recognition, appreciation, and implementations ignite global citizenship, therefore enhancing both employability and mobility. The SDGs have set a strong presence in higher education, but perhaps not enough as most studies have not assessed a holistic view of undergraduates' SDGs perception. In a well-globalized Chinese society where undergraduate degrees are as widespread as in Taiwan, this study aims to uncover whether higher education institutions (HEIs) in Taiwan have served as enabling environments for the growth of global citizens. Building on the government's educational reforms and individual policies, it asks: on which aspects have Taiwan excelled or receded, why, and what can our example offer the global community in sowing global citizens? The Importance--Performance Analysis (IPA) grid was conducted to assess college students' recognition and implementation of each goal. A list of 17 goals and 68 items were identified from literature reviews and each item was rated using a five-point Likert scale. On the scale, the online survey enables the 1238 college students from HEIs, ranging from research to non-research ones, to rate the relative importance of the items, followed by another performance rating. We aspire analysis of the responses to allow reflection on the implementation of professional and general education, as results indicate the factors contributing to students' cognition of the SDGs. Echoing current policy in Taiwan, we intend to offer insights and recommendations to extend students' SDGs vision, ultimately enhancing youth's international understanding and mobility.

The purpose of this study was to examine the relationships among homework time, homework frequency, and learning achievements of Taiwanese students. Applying a 2-level hierarchical linear modeling on the TIMSS 2007 and 2011 data, our findings were as follows: (1) Within the context of TIMSS 2007 and 2011 students, the frequency of mathematics homework positively predicted mathematics learning achievements; (2) Within the context of TIMSS 2007 students, the amount of time spent doing mathematics homework positively predicted mathematics learning achievements. (3) Among TIMSS 2011 students, homework time in mathematics of 1 to 15 minutes, 16 to 30 minutes, 31 to 60 minutes, and 61 to 90 minutes all could positively predict mathematics learning achievements of Taiwanese 8th-grade students, except for homework time more than 90 minutes. It revealed that in relation to mathematics homework time, too much homework might be as bad as not enough.

Providing teachers with innovative teaching approaches that combine simulation-based learning systems with entrepreneurship education helps create and recognize entrepreneurial opportunities. In this study, key antecedents are identified as critical drivers of flow experience and the impact of flow experience on learning performance and entrepreneurial self-efficacy is examined in order to propose a behavior model based on flow theory. Virtual Business Retailing (VBR) software, a business simulation system for convenience store operations, is used in this study to investigate the learning behavior of students and to collect data for analysis. The results reveal that challenge-skill balance and playability play a critical role in enhancing flow experience and, consequently, in improving learning performance and entrepreneurial self-efficacy. The findings contribute to existing flow theory, the literature on simulation and game-based learning, and the literature on entrepreneurship education. Furthermore, the findings provide VBR education-system educators and developers with a better understanding of students' expectations and needs when interacting with retail business simulation-based learning environments as well as with guidelines to effectively design VBR educational systems that are conducive to flow experience, which may help improve entrepreneurial self-efficacy in students.

This study aims to explore relationship between teacher self-efficacy and teacher teaching practice in junior high schools at Taiwan. TALIS (2018) survey database is adopted, and 3106 teachers were analyzed in this research. Through literature review and exploratory factor analysis (EFA), the research model is assumed to include two constructs (classroom management efficacy and instruction efficacy) in teacher self-efficacy, and three constructs (clarity of instruction practice, cognitive activation practice, and classroom management practice) in teacher teaching practice. Through the analysis of Structural Equation Modeling (SEM), the main findings are as follows. (1) For clarity of instruction practice, instruction efficacy has more positive influences than classroom management efficacy. (2) For classroom management practice, classroom management efficacy as more positive influences than instruction efficacy. (3) For cognitive activation practice, instruction efficacy has positive influences but classroom management efficacy has negative influences.

With the proliferation of paid mobile learning applications (m-learning apps), understanding how to assess their success has become an important issue for academics and practitioners. Based on the information systems (IS) success models and the value-based adoption model, this study developed and validated a multidimensional model for assessing paid m-learning app success. The proposed model describes the interrelationships among seven paid m-learning app success variables: system quality, information quality, perceived enjoyment, perceived fee, user satisfaction, intention to reuse, and learning effectiveness. Data collected from 160 paid m-learning app users were tested against the research model using structural equation modeling (SEM). The empirical findings provide evidence that learning effectiveness is affected by user satisfaction and intention to reuse, which, in turn, are determined by system quality, information quality, perceived enjoyment, and perceived fee. The findings of this study provide several important theoretical and practical implications for the development, implementation, and promotion of paid m-learning apps.

In response to the growing demand for high-resolution rainfall data to support disaster prevention in Taiwan, this study presents an innovative approach for downscaling precipitation data. We employed a hierarchical architecture of Multi-Scale Residual Networks (MSRN) to downscale rainfall from a coarse 0.25-degree resolution to a fine 0.0125-degree resolution, representing a substantial challenge due to a resolution increase of over 20 times. Our results demonstrate that the hierarchical MSRN outperforms both the one-step MSRN and linear interpolation methods when reconstructing high-resolution daily rainfall. It surpasses the linear interpolation method by 15.1 and 9.1% in terms of mean absolute error and root mean square error, respectively. Furthermore, the hierarchical MSRN excels in accurately reproducing high-resolution rainfall for various rainfall thresholds, displaying minimal biases. The threat score (TS) highlights the hierarchical MSRN's capability to replicate extreme rainfall events, achieving TS scores exceeding 0.54 and 0.46 at rainfall thresholds of 350 and 500 mm per day, outperforming alternative methods. This method is also applied to an operational global model, the ECMWF's daily rainfall forecasts over Taiwan. The evaluation results indicate that our approach is effective at improving rainfall forecasts for thresholds greater than 100 mm per day, with more significant improvement for the 1- to 3-day lead forecast. This approach also offers a realistic visual representation of fine-grained rainfall distribution, showing promise for making significant contributions to disaster preparedness and weather forecasting in Taiwan. [ABSTRACT FROM AUTHOR]

Objective: Age-related macular degeneration (AMD), particularly its exudative form, is a primary cause of vision impairment in older adults. As diabetes becomes increasingly prevalent in aging, it is crucial to explore the potential relationship between diabetic retinopathy (DR) and AMD. This study aimed to assess the risk of developing overall, non-exudative, and exudative AMD in individuals with DR compared to those without retinopathy (non-DR) based on a nationwide population study in Taiwan. Methods: A retrospective cohort study was conducted using the Taiwan National Health Insurance Database (NHIRD) (2000–2013). A total of 3413 patients were placed in the study group (DR) and 13,652 in the control group (non-DR) for analysis. Kaplan–Meier analysis and the Cox proportional hazards model were used to calculate the hazard ratios (HRs) and adjusted hazard ratios (aHRs) for the development of AMD, adjusting for confounding factors, such as age, sex, and comorbid conditions. Results: Kaplan–Meier survival analysis indicated a significantly higher cumulative incidence of AMD in the DR group compared to the non-DR group (log-rank test, p < 0.001). Adjusted analyses revealed that individuals with DR faced a greater risk of overall AMD, with an aHR of 3.50 (95% CI = 3.10–3.95). For senile (unspecified) AMD, the aHR was 3.45 (95% CI = 3.04–3.92); for non-exudative senile AMD, it was 2.92 (95% CI = 2.08–4.09); and for exudative AMD, the aHR was 3.92 (95% CI = 2.51–6.14). Conclusion: DR is a significant risk factor for both overall, senile, exudative, and non-exudative AMD, even after adjusting for demographic and comorbid conditions. DR patients tend to have a higher prevalence of vascular comorbidities; however, our findings indicate that the ocular pathologies inherent to DR might have a more significant impact on the progression to AMD. Early detection and appropriate treatment of AMD is critically important among DR patients. [ABSTRACT FROM AUTHOR]

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

Purpose: Continuous advancements in medical diagnostic technology and the growing availability of resources suggest a potential for fluctuations in the incidence rate of retinoblastoma (Rb). This study aimed to analyze incidence data of Rb patients in Taiwan from 1999 to 2018, utilizing the nationwide Taiwan Cancer Registry (TCR) database. Additionally, we investigated the treatment modalities used for these Rb patients and compared them with those observed in other countries. Patients and Methods: We conducted a retrospective cohort study utilizing data from the TCR database. The study cohort comprised individuals who were newly diagnosed with Rb between 1999 and 2018. The incidence of Rb was calculated as the number of patients with Rb per million live births, both for the entire population and for different gender groups and time periods. The trends in Rb incidence from 1999 to 2018 across various age groups and sexes were presented with the linear trend test. Results: From 1999 to 2018, a total of 248 cases of Rb were identified. The overall incidence rate over this 20-year period was 60.20 cases per million live births, corresponding to 1 case per 16,611 live births. Incidence rates for each 5-year period between 1999 and 2018 exhibited no significant differences. The study cohort was predominantly male, with 134 cases (54.03%) being males and 114 cases (45.97%) being females, resulting in an overall male-to-female sex ratio of 1.18. Females had lower relative risk than males (RR: 0.92, 95% CI: 0.72– 1.19). Primary surgical intervention was the preferred treatment modality for over 75% of the cases. Conclusion: This retrospective epidemiology study, using TCR from 1999 to 2018, indicated that no discernible trend of retinoblastoma incidence in Taiwan. Nevertheless, continuous monitoring of incidence rates and exploration of treatment strategies for retinoblastoma within the Taiwanese population are important to address potential changes in developing medical practices. [ABSTRACT FROM AUTHOR]

Tea is an integral part of Taiwanese culture and is a popular drink as it contains many beneficial compounds. However, during the processing of tea, polycyclic aromatic hydrocarbons (PAHs) may form. This study investigated the concentrations of PAH4 in different black tea leaves and tea infusions based on the origin of the tea. The samples were extracted using QuEChERS, while the content of PAH4 was analyzed by high performance liquid chromatography coupled to a fluorescence detector (HPLC-FLD). The content of PAH4 in the tea leaves ranged from 2.88 µg/kg to 218.2 µg/kg (dry weight), with the highest concentration being found in teas from Vietnam. The concentration of BaP ranged from ND to 47.92 µg/kg. The release of PAH4 from tea leaves to tea infusions was significantly low, with the highest transfer being 25.8%. In this study, all PAH4 compounds in commercial black tea leaves can be detected by QuEChERS extraction with a simple HPLC method. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs) are organic compounds found in many foods and drinks, and there have been some concerns over these compounds due to their carcinogenic nature. This study evaluated the concentrations of PAH4 (BaP, BaA, BbF, and CHR) in different black tea infusions and drinks based on the origin of the tea. The release of PAH4 from tea leaves to tea infusions was significantly low, with the highest transfer being 25.81%. The mean concentrations of BaP and PAH4 in tea infusions were used to conduct a risk assessment for the Taiwanese population, which showed that the 19–65 age group had the highest estimated intake of PAH4 and BaP among all age groups. These results, however, also showed margin of exposure (MOE) values well above the benchmark of 10,000. This indicated that PAH exposure from black tea consumption for the Taiwanese population constitutes a low-level health concern. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) and functional fitness (FF) are crucial for promoting independent living and healthy aging in older adults. However, there is a lack of normative values for the Senior Fitness Test (SFT) among older adults (aged 55–90) living in southern rural Taiwan, particularly in the Chiayi region, which has been relatively underserved in terms of health-related resources compared to northern Taiwan. Purpose: This study aimed to determine the age- and gender-specific normative fitness scores for a large representative population of community-dwelling older adults in southern rural Taiwan. Methods: A cross-sectional descriptive study was conducted to obtain normative FF scores for 3332 community-dwelling elderly people (1057 men and 2275 women) in Chiayi, through the implementation of functional fitness tests across 72 Chiayi communities. The developed normative data served as a reference for exercise prescription for the elderly in southern Taiwan. Results: The study showed that the average normative values of all functional fitness tests declined significantly with increasing age (p < 0.05). Sex differences were also found in all measures of FF tests, with elderly women scoring significantly better than men on flexibility (scratch back: −1.34 ± 9.03 vs. −6.54 ± 11.07; chair sit and reach: 6.56 ± 9.44 vs. 0.56 ± 10.40) (p < 0.05), while men scored significantly higher than women on strength (grip strength: 30.83 ± 8.06 vs. 21.82 ± 5.32; bicep curl: 19.25 ± 5.44 vs. 17.64 ± 4.98) (p < 0.05). Furthermore, four FF normative scores in southern rural Taiwan were found to be significantly higher than their counterparts living in northern Taiwan. Conclusion: These findings contribute positively to the evaluation of fitness levels among older adults in southern rural Taiwan and provide a concrete reference for developing sound PA programs for this population. The results suggest that strategies aimed at promoting increased participation in PA among older adults need to consider age-, sex-, and region-specific factors. [ABSTRACT FROM AUTHOR]

The main purpose of this study is to develop and validate a multidimensional instrument for measuring mobile learning systems success (MLSS) based on the previous research. This study defines the construct of MLSS, develops a generic MLSS instrument with desirable psychometric properties, and explores the instrument's theoretical and practical applications. By analyzing data from a calibration sample (n = 241) and a validation sample (n = 209), this study proposes a 6-factor, 25-item MLSS instrument. This empirically validated instrument will be useful to researchers in developing and testing mobile learning theories, as well as to educators in understanding MLSS from students' perspective and promoting the use of mobile learning systems.

Red blood cell (RBC) storage solution is used for suspending and preserving RBCs for later use in in vitro immunohematology testing. Proper RBC preservation is crucial for obtaining accurate results in RBC phenotyping and pretransfusion antibody screening tests. Haemolysis or RBC antigen degradation during storage can result in inaccurate RBC phenotyping, thereby decreasing the sensitivity of pretransfusion antibody screening and identification assays. The conventional RBC storage solutions usually contain adenosine, adenine, and antibiotics. We designed an RBC storage solution and determined whether it could preserve RBC integrity for 70 days. The new storage solution has a different formula from that of the conventional solution—in particular, it is strengthened with polyethylene glycol (PEG). The extent of haemolysis and hemagglutination reactivity of the RBC antigen systems, Rh, Duffy, Kidd, Lewis, MNS, P1, and the rare antigen Mia (which has a low prevalence antigen in most parts of the world but a higher prevalence in Taiwan), in the new RBC storage solution was compared with that of the conventionally preserved RBC storage solution. The RBCs preserved in the new solution for 70 days retained a similar haemolysis grade as those preserved in the control solution for 28 days. Although both solutions largely preserved RBC antigenicity, the decline in RBC hemagglutination scores in new solution often occurred later than that in the control solution in most antigen phenotyping assays, especially labile antigens such as D, P1, and M. The new solution reduces haemolysis more effectively and preserves antigenicity throughout the 70-day storage period. Moreover, Mia antigen is more stable in the experimental group. [ABSTRACT FROM AUTHOR]

Pioglitazone is an insulin resistance inhibitor widely used as monotherapy or combined with metformin or insulin in treating type 2 diabetes mellitus (T2DM). This study further investigated the relationship between pioglitazone use and the risk of developing Alzheimer's disease (AD) in patients newly diagnosed with T2DM, and examined the potential impact of insulin use on this association. Data were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Our data exhibited that the risk of developing AD in the pioglitazone group was 1.584-fold (aHR = 1.584, 95% CI 1.203–1.967, p < 0.05) higher than that in the non-pioglitazone controls. Compared to patients without both insulin and pioglitazone, higher cumulative risk of developing AD was found in patients receiving both insulin and pioglitazone (aHR = 2.004, 95% CI = 1.702–2.498), pioglitazone alone (aHR = 1.596, 95% CI = 1.398–1.803), and insulin alone (aHR = 1.365, 95% CI = 1.125–1.572), respectively (all p < 0.05). A similar observation also found in the evaluation the use of diabetic drugs with a cumulative defined daily dose (cDDD). No interaction between pioglitazone and major risk factors (comorbidities) of AD was observed. In conclusion, alternative drug therapies may be an effective strategy for reducing risk of developing AD in T2DM patients. [ABSTRACT FROM AUTHOR]

Background: Maintaining cognitive and physical function is essential to healthy aging. Aim: This study aims to investigate the effect of an exercise–cognitive dual-task program in Chinese language on cognitive function and functional fitness in older adults. Methods: Seventy adults aged 60–84 years were conveniently assigned to one of the three groups: exercise–cognitive dual-task (EC) group (n = 28), exercise group (n = 22), and control group (n = 20). The EC group received a 90-min class including multicomponent exercise–cognitive dual-task twice a week. The exercise group received a 90-min class including multicomponent exercise twice a week. The control group maintained their regular level of physical activity and general lifestyle. Cognitive functions and functional fitness were measured before and after the 12-week intervention. Results: The participants in the EC and exercise group significantly improved scores in Taiwanese Frontal Assessment Battery, the Chang Gung University Orthographical Fluency Test, and the Mini-Mental State Examination; however, those in the control group did not. The participants in the EC and exercise group showed significant increases in almost all functional fitness tests. The participants in the EC group showed significantly higher improvements in Chang Gung University Orthographical Fluency Test score and aerobic endurance than the exercise group and in Chang Gung University Orthographical Fluency Test score and lower body strength than the control group. In addition, the changes in Taiwanese Frontal Assessment Battery and Mini-Mental State Examination scores were significantly correlated with the changes in functional fitness. Conclusion: The dual-task intervention resulted in greater improvements in verbal fluency, endurance, and muscular strength than exercise alone and control. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis infection is one of the most widespread sexually transmitted infections in the world. There are approximately 276 million cases worldwide. Most men remain undiagnosed and untreated because they are asymptomatic. The chronic inflammation induced by persistent infection may increase the risk of developing genitourinary cancers. In this study, we aimed to investigate the association between trichomoniasis and benign prostate hyperplasia (BPH), prostate cancer (PCa), and bladder cancer (BC) in Taiwan. We designed a case–control study by using the database of the National Health Insurance program in Taiwan. We used the International Classification of Diseases, 9th Revision classifications to classify all the medical conditions in the case and control groups. All odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed using multivariable logistic regression to adjust for all comorbidities and variables. From 2000 to 2015, we enrolled a total of 62,544 individuals as the case group and 187,632 as the control group. Trichomoniasis exposure had a significant association with BPH and PCa (adjusted OR: BPH = 2.685, 95% CI = 1.233–4.286, P = 0.013; PCa = 5.801, 95% CI = 1.296–26.035, P = 0.016). The relative risk was much higher if patients had both trichomoniasis and depression (adjusted OR = 7.682, 95% CI = 5.730–9.451, P < 0.001). Men with trichomoniasis had a significantly higher risk of developing BPH and PCa than those without. Healthcare professionals should not only pay more attention to disease treatment, but also to public health education. [ABSTRACT FROM AUTHOR]

Trichomoniasis is the most prevalent sexually transmitted infection worldwide, and is associated with adverse pregnancy outcomes. However, Trichomonas vaginalis (TV) has received little public health attention, and only limited data are available on prevalence of TV and other Trichomonas-associated syndromes in pregnant women. This study aimed to determine associations between pregnancy and incident trichomoniasis-related diseases. Data of pregnant women were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. The pregnant cohort included 113,781 women, and cases were randomly matched by age, and index year with those of non-pregnant women (n = 113,781). Risk of incident trichomoniasis-related diseases was also not significantly different between pregnant and non-pregnant women. However, after stratifying by age or level of care, the younger subgroup among pregnant women had a higher risk of incident trichomoniasis-related diseases than did the younger subgroup in non-pregnant women, while the elder subgroup among pregnant women had a lower risk of incident trichomoniasis-related diseases than did the same subgroup in non-pregnant women (all p < 0.05). The higher level of care (medical center) subgroup among pregnant women had a lower risk of incident trichomoniasis-related diseases than did the same subgroup in non-pregnant women. In conclusions, although pregnancy is not significantly associated with risk of trichomoniasis-related diseases, data of the present study support an enhanced high level of medical care for pregnant women, emphasizing the potential of high medical care in reduced incidence of trichomoniasis-related diseases. This may be an effective strategy for reducing various pregnancy complications associated with trichomoniasis-related diseases. [ABSTRACT FROM AUTHOR]

Purpose: It is commonly recommended that tooth extraction should be performed prior to radiotherapy (RT) in patients with head neck cancer to prevent osteoradionecrosis (ORN). However, doctors still occasionally encounter patients who require tooth extraction during RT. This study aimed to determine the risk of ORN in patients who undergo tooth extraction during RT. Methods: Data were collected from Taiwan's National Health Insurance Research Database. We retrospectively enrolled 24,412 patients with head and neck cancer treated with radiotherapy between 2011 and 2017. The associations between ORN and demographic characteristics, timing of tooth extraction, and treatments were examined using univariate and multivariable Cox proportional hazards regression models. Results: A total of 24,412 head and neck cancer patients were enrolled; 133 patients underwent tooth extraction during RT and 24,279 patients did not undergo tooth extraction during RT. Tooth extraction during RT was not associated with a significantly higher risk of ORN (hazard ratio [HR] = 1.303, P = 0.4862). Tumor site, RT dose ≥ 60 Gy, age < 55 y/o, mandibulectomy, chronic periodontitis, and chemotherapy were significantly associated with a higher risk of ORN. Conclusion: The risk of ORN in head and neck cancer is not significantly different between patients who undergo tooth extraction during RT and patients who do not undergo tooth extraction during RT. [ABSTRACT FROM AUTHOR]

This paper explores applications of the coordinated multi-point (CoMP) architecture operation of enhanced node B (eNB) in wireless communication networks featuring device-to-device (D2D) signaling. This is applied to cellular phone coverage for rapid mass transit systems, such as the Taiwan high speed rail transport system, and indoor public environments. The paper is based on formulas pertaining to the link between budget design and guidelines, as well as principles and theories of engineering practice, allowing designers to analyze and fully control the uplink and downlink signals and output power of fiber repeaters linking cellular phones to base stations. Finally, we employ easily installed cellular-over-fiber optic solutions for a small cell enhancement (SCE) system with novel architecture based on a leakage coaxial cable system using LTE-A technology. As a result, we successfully applied enhanced coverage designs for distributed antenna systems. These can be used to create self-organizing networks (SoN) for an Internet of Things. [ABSTRACT FROM AUTHOR]

Juvenile and trash fish excluder devices (JTEDs) are used to mitigate the ecological impact of trawling. Trawling has a large ecological footprint in Taiwan. Thus, this study designed three JTEDs, which differed only in grid interval, for single boat bottom otter trawls that are commonly used in Taiwan. The designed JTEDs were tested in the waters off of Kaohsiung on a Kaohsiung-based bottom trawler, and the results were as follows. (1) At least 300 species were caught, and 189 of these species had little commercial value; their weight accounted for 52.5% of the total catch. (2) The three JTEDs had good exclusion performance. (3) The ratios of the weight of bycatch excluded to the weight of total catch were 7.9%, 29.1%, and 36.2%, for grid intervals of 10, 15, and 20 mm, respectively. (4) JTEDs with grid intervals of 10, 15, and 20 mm were associated with a 0.4%, 11.5%, and 19.0% loss in revenue, respectively. (5) Mature (and thus commercially valuable) Loliginidae tended to be excluded when the grid interval was 20 or (especially) 15 mm. In general, the designed JTEDs should be used at a grid size of 15 mm because this strikes the best balance between profitability and sustainability. [ABSTRACT FROM AUTHOR]

[Display omitted] • 50.8% of packaging waste and 59.8 % CO 2 reduced in the reuse strategies proposed. • Waste reduction is affected by consumers' adoption willingness of reuse strategies. • Ambitious goals are suggested for fruits, eggs, and bottled water for retailers. • Consumers' adoption willingness is proportional to regulations or the accessibility. Consumption of single-use packaging has been increasing globally and the waste produced causes negative impacts on both human and the environment. Retailers, such as supermarkets, developed quickly in recent years to provide for the modern lifestyle, using a lot of packaging in the process of distribution and sales. This research evaluates the packaging waste and CO 2 reduction potential of 10 different products sold in supermarkets in Taiwan when adopting different reuse strategies of Reduce, Return and Refill. In the suggested reuse strategies, a total of 8 kilotons of packaging waste and 30 kilotons of packaging CO 2 can be reduced, accounting for 50.8% and 59.8% reduction of the current situation, respectively. Retailers are suggested to provide different reuse strategies and experiential activities to increase consumers familiarity with new consumption methods. Significant impacts are made with a slight change in the small proportion investigated, which suggests considerable benefits if the scope is expanded. [ABSTRACT FROM AUTHOR]

With the proliferation of weblogs (blogs) used in educational contexts, gaining a better understanding of why students are willing to blog has become an important topic for practitioners and academics. The main purpose of this study is to explore the individual difference antecedents of perceived enjoyment and examine how they influence blogging intention through the mediation of perceived enjoyment. Based on previous literature, the Big Five personality traits (ie, extraversion, agreeableness, conscientiousness, neuroticism and openness to experience), as well as computer self-efficacy and personal innovation in information technology, are hypothesised as potential antecedents of perceived enjoyment in the acceptance of blogging. Data collected from a sample of 358 students at seven universities in Taiwan were tested against the research model using the structural equation modelling approach. The results indicate that extraversion, agreeableness, conscientiousness and personal innovation in information technology have a significant influence on perceived enjoyment, which in turn significantly influences blogging intention. The findings of this study provide several theoretical and practical implications for educational uses of blogging.

Introduction: The management of pediatric bipolar disorder (PBD) requires pharmacotherapy to control acute symptoms, reduce relapse, prevent suicide, and improve psychosocial functioning. The purpose of this study was to investigate prescribing patterns among PBD patients discharged from two public mental hospitals in Taiwan, from 2006 to 2019. Methods: PBD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 420), were included in the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second‐ and first‐generation antipsychotics, SGAs and FGAs), and antidepressants, were explored. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Time trends of each prescribing pattern were analyzed using the Cochran‐Armitage Trend test. Results: The most commonly prescribed psychotropic agents were SGAs (76.0%), followed by valproate (65.7%) and FGAs (24.8%). The prescription rates of SGAs, antidepressants, antidepressant plus antipsychotic, and antidepressant without mood stabilizer significantly increased over time, whereas the prescription rates of mood stabilizers, lithium, and FGAs significantly decreased. Discussions: Prescribing patterns changed greatly for PBD patients over time. However, much more evidence supporting the effectiveness of psychotropic agents in PBD patients is required. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate factors associated with concomitant laxative use among elderly patients with schizophrenia, discharged on second‐generation antipsychotics (SGAs), from two large public psychiatric hospitals in Taiwan. Methods: Elderly patients with schizophrenia who were discharged between 2006 and 2019 and received SGA monotherapy at discharge were included in the analysis. Multivariate logistic regression was used to identify factors associated with regular laxative use at discharge. The Cochrane‐Armitage trend test was used to evaluate whether significant time trends existed for rates of laxative use at discharge. Results: A total of 2591 elderly patients with schizophrenia were discharged during the study period, and 1727 of 2591 patients who met the inclusion criteria were included for analysis. Of these 1727 patients, 732 (42.4%) also received concomitant laxatives. Female gender, mood stabiliser use and concomitant diabetes mellitus were found to be associated with increased laxative use. Among SGAs, clozapine was associated with the highest rate of laxative use, followed by zotepine, quetiapine, olanzapine and risperidone. Additionally, risperidone, amisulpride, aripiprazole, paliperidone and sulpiride were associated with comparable rates of laxative use. Laxative use rates grew over time from 30.8% in 2006 to 46.6% in 2019 (z = 4.83, P < 0.001). Conclusions: Laxative use is common in elderly schizophrenia patients treated with SGAs. In cases of clinically significant constipation, switching to an SGA with a lower risk for constipation, or discontinuing the use of mood stabilisers should be considered, if clinically feasible. [ABSTRACT FROM AUTHOR]

Sweet potato (Ipomoea batatas L.) is one of the most important food crops worldwide, with leaves of different varieties showing purple, green and yellow, and these leaves provide a dietary source of nutrients and various bioactive compounds. The objective of this study was to identify the active constituents of chlorogenic acids (CGAs) in different methanolic extract of leaves of three varieties of sweet potato (purple CYY 98-59, green Taoyuan 2, and yellow CN 1927-16) using liquid chromatography–tandem mass spectrometry. Genotype-specific metabolite variations were observed; CGAs and three isomeric peaks were detected in sweet potato leaf extracts (SPLEs). Among them, the yellow SPLE contained the highest contents of 3,5-dicaffeoylquinic acid (3,5-di-CQA) and 3,4-dicaffeoylquinic acid (3,4-di-CQA), followed by the green SPLE, whereas the purple SPLE retained lower 3,5-di-CQA content compared to yellow and green SPLEs. All three SPLEs contained lower 4,5-dicaffeoylquinic acid (4,5-di-CQA) and CGA contents compared to 3,5-di-CQA and 3,4-di-CQA, although CGA constituents were not significantly different in genotypes, whereas purple SPLE contained higher 4,5-di-CQA content compared to yellow and green SPLEs. This study indicates that SPLs marketed in Taiwan vary widely in their biological potentials and may impart different health benefits to consumers. [ABSTRACT FROM AUTHOR]

Accurate hourly real-time flood forecasting is necessary for early flood warning systems, especially during typhoon periods. Artificial intelligence methods have been increasingly used for real-time flood forecasting. This study developed a real-time flood forecasting model by using back-propagation networks (BPNs) with a self-organizing map (SOM) to create ensemble forecasts. Random weights and biases were set for the BPNs to learn the characteristics of a catchment system. An unsupervised SOM network with a classification function was then used to cluster representative BPN weights and biases; clusters of BPNs with high accuracy were selected to act as experts for the ensemble models to forecast flow rates. The model was applied to flood events in the Wu River Basin of Taiwan. Most observed values were within the forecasting intervals of the BPN clusters in the calibration and validation phases, indicating that the models had acceptable accuracy. For the large flood events of typhoons Saola in the calibration phase and Soulik in the validation phase, the mean average error of the ensemble mean model for the cluster A was 143.1 and 327.4 m3/s, respectively; these values were lower than those for the best individual model within the cluster (194.3 and 917.9 m3/s). The ensemble model thus outperformed the individual models and can accurately forecast flood values and intervals. Therefore, the model can be used to accurately forecast floods. [ABSTRACT FROM AUTHOR]

Promoting dementia‐friendly communities is an important strategy for improving quality of life for people with dementia and dementia‐family caregivers. The process of building dementia‐friendly communities should include all people living in the community. The objective of this study was to compare perceived dementia friendliness in the community among people with dementia, family caregivers, service providers, and the general public. In Taiwan, we surveyed 60 people with dementia, 140 family caregivers, and 200 members of the general public face to face, with 200 service providers surveyed by mail. Participants completed the Perceived Community Dementia Friendliness measure, consisting of seven subscales: care services, community members, community environment, community interactions, transportation, hospitals, and stores and organisations. This measure has acceptable convergent validity, construct validity, and internal consistency reliability for use in Taiwan. Differences in perceived dementia friendliness were examined by chi‐square tests/analysis of variance. Among the seven subscales, hospitals were rated with good dementia friendliness by 70% of people with dementia (n = 42); however, care services were rated poor by 23.3% of people with dementia (n = 14). Hospitals were also rated with good dementia friendliness by 39.2% of family caregivers (n = 54). Care services were rated as having good dementia friendliness by 43.5% of service providers (n = 87) and 47% of the general public (n = 86). Furthermore, community interactions were rated as good by small percentages of family caregivers (11.4%, n = 16), service providers (22.2%, n = 44), and the general public (30.9%, n = 58). Family caregivers, service providers, and the general public rated hospitals with the highest mean dementia‐friendliness score and community interactions with the lowest. Perceived community‐dementia friendliness among participants with dementia differed from that of participants without. People with dementia prioritised improving care services, while people without dementia rated facilitating community interactions as more vital. These differences provide vital insights into understanding the policies and administration of dementia‐friendly communities. [ABSTRACT FROM AUTHOR]

Modern governments strive to enhance their emergency management capacity and establish multiple policy tools that can help reduce damage caused by natural and human hazards. Among these institutional mechanisms, the constitution in Taiwan entrusts presidents with the authority to act immediately in response to an emergency based on the principle of necessity. The objective of this paper is to gain insight into the following questions: (1) How does the Taiwanese government respond to a pandemic and to what extent does this situation affect the Taiwanese governmental emergency response powers? (2) Do the Taiwanese governmental interventions contradict democratic values and civil liberties? By analyzing the boundaries and limitations of the presidential emergency power, demonstrating practical examples of the different views of Taiwanese presidents regarding their use of the emergency power to address catastrophic disasters, and exploring preemptive actions in response to the COVID-19 pandemic, the authors argue two points: (1) Taiwan's administrative response to COVID-19 reveals a tendency toward having authority vastly centralized at the legislative level through blank-check authorization, and this represents the presumptive allocation of power embodied in the Republic of China Constitution, which has gradually expanded. (2) The vague and unfettered legal authorization by the CDC and the COVID-19 Special Act may diminish the substantial rule of law in the long run. This article demonstrates, by applying the assessment from a variety of key principles of constitutionalism, Taiwan exhibited how it has integrated institutional memories and past lessons. However, there continues to be in Taiwan an overdependent reliance on statutory authorization with the inherent risk of a slippery slope in exploiting legal authorization, coupled with administrative blind spots, that can generate disproportionate public measures. This leverage, we argue, supersedes the president's discretionary emergency power, enabling emergency legislation without proper oversight, prevailing over ordinary constitutional order, and possibly producing a corrosive effect on civil liberties and the rule of law in the long term. [ABSTRACT FROM AUTHOR]

This retrospective study assessed the effect of the co-administration of clomiphene citrate (CC) and letrozole in mild ovarian stimulation, compared to conventional regimens, among Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Group 4 patients. There were 114 POSEIDON Group 4 patients undergoing in vitro fertilization treatments with 216 stimulation cycles recruited from a Taiwan's reproductive center during 2016-2020. Main outcomes were the numbers, quality of retrieved oocytes and embryo development. Pregnancy outcomes were assessed after embryo transfers. Per stimulation cycle, patients receiving mild stimulation with a combination of CC and letrozole (study group) versus those with COS (control group) had lower numbers of pre-ovulatory follicles (2.00 ± 1.23 vs. 2.37 ± 1.23, p =0.0066) and oocytes retrieved (1.83 ± 1.17 vs. 2.37 ± 1.23, p =0.0017), and lower follicular output rate (58.6% vs. 68.38%, p =0.0093) and mature oocyte output rate (44.29% vs. 52.88%, p =0.0386) but a higher top-quality metaphase II oocyte ratio (66.7% vs. 54.59%, p =0.0444) and a similar fertilization rate (91.67% vs. 89.04%, p =0.4660). With adjustment for significant between-group baseline differences using multivariable logistic generalized estimating equation model analyses, there was no statistical difference in oocytes retrieved and embryo development between the study and control groups, and insignificant increases in successful pregnancies in the study group were found compared to the control group (i.e., odds ratios [95% CIs]: 1.13 [0.55, 232] and 1.50 [0.65, 3.49] for ongoing pregnancy and live birth, respectively). For POSEIDON Group 4 patients, cotreatment of CC and letrozole in mild stimulation may increase the high-quality oocyte ratio and yield comparable fertilization rate and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Although previous studies have investigated the relationship between fracture risk and type 2 diabetes (T2D), cohort studies that estimate composite osteoporosis risk are lacking. This retrospective cohort study sought to determine the risk of osteoporosis in Taiwanese patients with T2D. Patients diagnosed with T2D between 2002 and 2015 identified through the 2002 Taiwan Survey of Hypertension, Hyperglycemia, and Hyperlipidemia were included. A total of 1690 men and 1641 women aged ≥40 years linked to the National Health Insurance Research Database (NHIRD) were followed up to the end of 2015 to identify the incidences of osteoporosis through ICD9-CM codes for osteoporosis or osteoporotic fractures or usage of anti-osteoporotic agents according to Anatomical Therapeutic Chemical codes determined from NHIRD. The person year approach and Kaplan–Meier analysis were then used to estimate the incidences and cumulative event rates, whereas the Cox proportional hazard model was used to calculate adjusted hazard ratios (HR) for osteoporosis events. A total of 792 new osteoporosis events were documented over a median follow-up duration of 13.6 years. Participants with T2D had higher osteoporosis risk [adjusted HR: 1.37, 95% confidence interval (CI): 1.11–1.69] compared with those without T2D. Subgroup analyses revealed that age had a marginally significant effect, indicating that T2D had a more pronounced effect on osteoporosis risk in younger population (<65 years old). No difference was found between patients stratified according to sex. In conclusion, T2D was significantly associated with increased osteoporosis risk, especially in younger participants. [ABSTRACT FROM AUTHOR]

Aedes aegypti , the primary vector responsible for transmitting dengue fever in southern Taiwan, has developed a relatively high resistance to synthetic pyrethroids. It has evolved four amino acid substitutions in the voltage-gated sodium channel (VGSC), namely S996 P , V1023 G , F1565 C , and D1794 Y. To unveil the distribution and correlation of VGSC mutations and pyrethroid resistance among different field populations, Ae. aegypti collected from various districts in Kaohsiung and Tainan Cities underwent tests for resistance development against different pyrethroids and frequency of S996 P , V1023 G , F1565 C , and D1794 Y substitutions. The adult knockdown assay revealed a relatively high knockdown resistance in the Ae. aegypti populations from Kaohsiung and Tainan against permethrin, cypermethrin, and fenvalerate (averaging >50-fold). Conversely, less resistance was observed against α-cypermethrin, deltamethrin, λ-cyhalothrin, cyfluthrin, and etofenprox (averaging <35-fold). Using Polymerase Chain Reaction/restriction fragment length polymorphism analysis, four mutant haplotypes were identified in these field populations. Notably, the S IA VFD and S IB VFD wild haplotypes were absent. Analysis utilizing IBM SPSS Statistics 20.0 and Spearman's rank correlation coefficient indicated that Haplotype C (P IA G FD), especially P allele, frequency displayed a significant positive correlation with five Type II pyrethroid resistance, while 1023G and 1023G/G exhibited a significant association with permethrin and fevalerate resistance. Conversely, Haplotype E (S IB V C D) negatively correlated with pyrethroid resistance, particularly fenvalerate resistance (−0.776). Haplotype C and E were the most prevalent and widely distributed among the investigated field populations. This prevalence of haplotype C is likely tied to the extensive and excessive use of Type II pyrethroids for dengue control over the past three decades. Given the significant positive correlation, the best-fit lines and R2 values were established to facilitate the swift prediction of knockdown resistance levels to various pyrethroids based on VGSC mutation frequency. This predictive approach aims to guide insecticide usage and the management of pyrethroid resistance in the field populations of Ae. aegypti in Taiwan. [Display omitted] • Four VGSC mutations were detected in Aedes aegypti of southern Taiwan. • Only mutant haplotypes and diplotypes of these mutations were detected in the field populations. • Haplotype C (P IA G FD) had strong correlation with most Type II pyrethroid resistance. • 1023 G and 1023 G / G exhibited a significant correlation with permethrin and fevalerate resistance. • A molecular detection tool was developed to predict knockdown resistance levels in the field populations. [ABSTRACT FROM AUTHOR]

Background: Burkholderia cepacia, an opportunistic pathogen mainly affecting patients with cystic fibrosis or immunocompromised, has rarely been documented as a cause of corneal infection. The clinical and microbiological profiles of B. cepacia keratitis are reported herein. Methods: We retrospectively reviewed the medical record of 17 patients with culture-proven B. cepacia keratitis, treated between 2000 and 2019 at Chang Gung Memorial Hospital, Taiwan. Our data included predisposing factors, clinical presentations, treatments, and visual outcomes of B. cepacia keratitis as well as the drug susceptibility of the causative agent. Results: The most common predisposing factor for B. cepacia keratitis was preexisting ocular disease (seven, 41.2%), particularly herpetic keratitis (five). Polymicrobial infection was detected in seven (41.2%) eyes. All B. cepacia isolates were susceptible to ceftazidime. Main medical treatments included levofloxacin or ceftazidime. Surgical treatment was required in five (29.4%) patients. Only four (23.5%) patients exhibited final visual acuity better than 20/200. Conclusions: B. cepacia keratitis primarily affects patients with preexisting ocular disease, particularly herpetic keratitis, and responds well to ceftazidime or fluoroquinolones. However, the visual outcomes are generally poor. [ABSTRACT FROM AUTHOR]

Background/purpose: The FUT2 gene is a histo-blood group antigen (HBGA) that determines the susceptibility to Norovirus (NoV) infection. This study investigated the clinical significance of the FUT2 gene profile and HBGA expression in NoV infection.Methods: Fecal specimens were collected from children in Chang-Gung Children's Hospital with acute gastroenteritis (AGE). The medical records were reviewed for clinical data. The viral etiology of gastroenteritis was validated using molecular methods. Genomic DNA was isolated from saliva or whole blood with the Puregene B Kit, according to the manufacturers' instructions. Single-nucleotide polymorphisms (SNPs) were determined by real-time PCR assays.Results: FUT2 gene DNA was examined in 98 children with AGE. NoV was detected by RT-PCR in 44 patients (44.8%), while 54 (55.2%) had non-NoV AGE. Of the 44 NoV patients, 38 (86.3%) were secretors (no G428A mutation) and six (13.7%) were non-secretors (G428A mutation). Of the 54 non-NoV AGE patients, 28 (51.9%) were secretors and 20 (48.1%) were non-secretors. NoV-infected patients who were secretors had more frequent vomiting (P < 0.001), longer duration of diarrhea (P < 0.001), and greater overall disease severity score (P < 0.001) compared with non-secretors. Non-NoV infection secretor AGE patients had a longer duration of diarrhea (P < 0.001) than non-secretors.Conclusion: FUT2 secretor status affects NoV AGE in children. Secretor patients have prolonged diarrhea, more frequent vomiting, more severe disease, and greater infection transmissibility than non-secretors. [ABSTRACT FROM AUTHOR]

The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan. We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed. Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery. The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets. [ABSTRACT FROM AUTHOR]

Background: The prevalence of gallstone disease (GSD) increases with age, and the elderly have a much higher mortality risk and incidence of surgical comorbidities. The aim of this study was to explore the relationship between GSD and cardiometabolic risk factors in elderly people with non-alcoholic fatty liver disease (NAFLD). Methods: In this cross-sectional study, we analyzed the data of elderly people who underwent annual health check-ups at a Northern Taiwan health examination center. These data were collected from physical examination, blood tests, abdominal ultrasonography, and medical histories. We excluded those with hepatitis B or C infections, heavy alcohol consumption, or cholecystectomy. Results: The analysis included 3,037 participants with a mean age of 73.6± 6.0 years. Over 70% were overweight or obese, and the overall prevalence of GSD was 17.7%. In our univariate analysis, GSD was positively correlated with age, body mass index, metabolic syndrome, diabetes mellitus (DM), hypertension (HTN), and various metabolic factors (fasting plasma glucose [FPG], triglyceride, uric acid, and high-density lipoprotein cholesterol [HDL-C] levels). After adjustment for age, gender, and body mass index, metabolic syndrome showed a positive association with GSD (odds ratio [OR] 1.31 [95% confidence interval [CI], 1.05– 1.64]; P=0.020). Specific components of metabolic syndrome that increased the risk for GSD in NAFLD elderly include lower levels of HDL-C (OR 1.35 [95% CI, 1.10– 1.66]; P< 0.001) and elevated FPG (OR 1.36 [95% CI, 1.10– 1.69]; P< 0.001). Conclusion: Our study concluded that GSD is significantly associated with metabolic syndrome in elderly people with NAFLD. Reduced HDL-C and elevated FPG both heighten the risk of developing GSD. Therefore, to lower the risk of GSD in NAFLD patients, their FPG levels and HDL-C levels must be regularly followed-up, and these patients should be educated about the symptoms of GSD if they meet the criteria for metabolic syndrome. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis is the most common nonviral sexually transmitted infection. According to the 2019 WHO cancer report, cervical cancer is the fourth most frequent cancer in women. However, previous research, which has not included a large-scale study to date, has revealed that Trichomonas vaginalis increases cervical cancer risk. In this study, we investigated a group of Asian females in Taiwan to determine the association between trichomoniasis and the risk of developing cervical lesions, including cancer, neoplasm, and dysplasia. We conducted a nested case-control study by using the National Health Insurance (NHI) program database in Taiwan. The International Classification of Diseases, 9th Revision classifications (ICD-9-CM) was used to categorize all of the medical conditions for each patient in the case and control groups. The adjusted odds ratio (AOR) and 95% confidence interval (CI) for the association between trichomoniasis and cervical lesions were estimated using multivariable conditional logistic regression to adjust for all comorbidities and variables. In total, 54,003 individuals were enrolled in the case group and 216,012 were enrolled in the control group. Trichomonas vaginalis exposure had a significant association with cervical lesions (AOR 2.656, 95% CI = 1.411–5.353, p = 0.003), especially cervical cancer (AOR 3.684, 95% CI = 1.622–6.094, p = 0.001). In patients with both trichomoniasis and depression, the relative risk increased 7.480-fold compared to those without trichomoniasis or depression. In conclusion, female patients with Trichomonas vaginalis exposure had a significantly higher risk of developing cervical lesions (especially cervical cancer) than those without exposure. [ABSTRACT FROM AUTHOR]

The dual legitimacy of an international non‐governmental organisation (INGO) affiliate is critical to the INGO's sustainable development, but few studies are found in the extant literature. Based on Kostova and Zaheer's theoretical concept elaborating on organisational legitimacy under conditions of complexity, we conducted this study through the extended case method and used the grounded theory approach to examine the case study of the child organisation (CO) in Taiwan and its affiliate in Kyrgyzstan (CKO). Utilising an integrated framework elaborating on the INGO affiliate's dual legitimacy (IADL), we examined the impact generated from the institutional environments in a multidimensional construct at the macro‐, meso‐, and microlevels. This study also explored the complexity of and interactions with the institutional environment that INGO affiliates might encounter. The findings of this study could serve as a guideline for INGO workers, policy makers and academicians. Key Practitioner Message: • The first article applying the institutional theory and theory of organisational legitimacy on checking dual legitimacy of INGO affiliates through the case study of CO and CKO; • We examined the impact generating from the institutional environments with a multidimensional construct at the macro‐, meso‐, and microlevels through an integrated framework of INGO legitimacy from the perspective of the dual legitimacy that INGO affiliates face; • The findings of this study could be the resources of guideline for INGO workers, policy makers and academicians. [ABSTRACT FROM AUTHOR]

This descriptive study aimed to explore the physiological factors that determine tolerance to exertion during high-intensity interval effort. Forty-seven young women (15–28 years old) were enrolled: 23 athletes from Taiwan national or national reserve teams and 24 moderately active females. Each participant underwent a maximal incremental INC (modified Bruce protocol) cardiopulmonary exercise test on the first day and high-intensity interval testing (HIIT) on the second day, both performed on a treadmill. The HIIT protocol involved alternation between 1-min effort at 120% of the maximal speed, at the same slope reached at the end of the INC, and 1-min rest until volitional exhaustion. Gas exchange, heart rate (HR), and muscle oxygenation at the right vastus lateralis, measured by near-infrared spectroscopy, were continuously recorded. The number of repetitions completed (Rlim) by each participant was considered the HIIT tolerance index. The results showed a large difference in the Rlim (range, 2.6–12.0 repetitions) among the participants. Stepwise linear regression revealed that the variance in the Rlim within the cohort was related to the recovery rates of oxygen consumption (V˙O2), HR at the second minute after INC, and muscle tissue saturation index at exhaustion (R = 0.644). In addition, age was linearly correlated with Rlim (adjusted R = −0.518, p < 0.0001). In conclusion, the recovery rates for V˙O2 and HR after the incremental test, and muscle saturation index at exhaustion, were the major physiological factors related to HIIT performance. These findings provide insights into the role of the recovery phase after maximal INC exercise testing. Future research investigating a combination of INC and HIIT testing to determine training-induced performance improvement is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The paper aims to compare two general team identification processes of consumers' in-group-favor and out-group-animosity responses to sports sponsorship. Design/methodology/approach: The paper draws on two studies and four samples of professional baseball fans in Taiwan (N = 1,294). In Study 1, data from the fans of three teams were analyzed by using multi-group structural equation modeling to account for team effects and to consider parallel in-group-favor and out-group-animosity processes. In Study 2, the fans of one team were sampled and randomly assigned to assess the sponsors of one of three specific competitor teams to account for differences in team competition and rivalry. In both studies, these two processes were compared using patterns of significant relationships and differences in the indirect identification-attitude-outcome relationships. Findings: Positive outcomes of in-group-favor processes were broader in scope and were more pronounced in absolute magnitude than the negative outcomes of out-group-animosity processes across all outcomes and studies. Research limitations/implications: The research was conducted in one country and considered the sponsorship of one sport. It is possible that the results could differ for leagues within different countries, more global leagues and different fan bases. Practical implications: The results suggest that managers should carefully consider whether the negative out-group-animosity outcomes are actually present, broad enough or strong enough to warrant costly or compromising intervention, because they might not always be present or meaningful. Originality/value: The paper demonstrates the comparatively greater breadth and strength of in-group-favor processes when compared directly to out-group-animosity processes. [ABSTRACT FROM AUTHOR]

• Workplace fun has a significant positive effect on psychological capital in the tourism and hospitality industry. • Psychological capital plays a partial mediating role between workplace fun and work engagement. • Psychological capital has a significant moderating effect between workplace fun and work engagement. Although previous literature has examined the relationship between workplace fun and work engagement, the construct of psychological capital is introduced in the context of tourism and hospitality to investigate the mediating and moderating roles in this relationship. This research aimed to discuss the effect of workplace fun on psychological capital and further examine psychological capital's mediating and moderating effects between workplace fun and work engagement. The survey data were taken from 331 front-line employees in customer service-oriented tourism and hospitality enterprises in Taiwan. The results showed that workplace fun has a significant positive effect on psychological capital. In addition, psychological capital plays a partial mediating role between workplace fun and work engagement. Moreover, psychological capital has a significant moderating effect between workplace fun and work engagement, namely, psychological capital can help to strengthen the relationship between workplace fun and work engagement. The implications and suggestions are discussed for tourism and hospitality operators. [ABSTRACT FROM AUTHOR]

• Local pre-processing can reduce the treatment cost of e-waste for remote area. • Characteristics of e-waste affects the cost reduction of local pre-processing. • Labor cost and transportation distance are main factors for cost effectiveness. An optimum treatment system for the waste electronic home appliance in remote area by local pre-processing and outsourcing post-processing is proposed. The cost reduction potential of the proposed treatment system is presented for main four types of electronic home appliances by the case study of Kinmen, Taiwan. Implementation of local pre-processing in Kinmen, Taiwan can provide 42, 54, 32, and 41 TWD unit cost reduction for television, washing machine, refrigerator, and air conditioner, respectively, comparing to the current treatment system. The different treatment characteristics according to the type of the appliances are the major factors for the applicability and cost reduction potential of the local pre-processing system. The application of this system to other cases is presented by sensitivity analysis with relative labor cost and transportation distance as the parameters. The results and the analysis process can be applied to the domestic systems with regions without recycling facilities, and also the international systems under the extended producer responsibility concept to take back the products for recycling. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and present the demography, clinical behavior, especially the risk factors of tumor hemorrhage and management of sporadic angiomyolipoma (SAML), tuberous sclerosis complex associated angiomyolipoma (TSCAML) and epithelioid angiomyolipoma (EAML) in our institution.Methods: A retrospective study of 587 patients who were diagnosed with renal angiomyolipoma in our institution between January 2000 and May 2015 was done. The AMLs were diagnosed by ultrasonography, CT, or MRI. EAML was confirmed by histopathology. Medical records and follow-up results were analyzed using the SPSS version 22 software.Results: Out of 587 cases of renal AMLs, 87.4% were SAMLs, 8.7% were TSCAMLs and 3.9% were EAMLs. Most of the AML patients were asymptomatic. The most common presenting symptoms included flank pain and abdominal pain. The median tumor size of SAML, TSCAML, EAML were 4.7, 2.7, 10.5 cm respectively. Approximately half of SAMLs were conservatively treated, almost all TSCAMLs were treated conservatively, while all EAMLs were surgically treated. The median tumor size of hemorrhagic SAML cases was 8 cm versus non-hemorrhagic cases of 4.1 cm. The optimal cut-off point on the ROC curve for predicting SAML tumor hemorrhage was 7.35 cm.Conclusion: A larger tumor size, younger patient's age and higher BMI value correlated with a higher risk of tumor hemorrhage. For tumor sizes less than 7.35 cm, we recommend active surveillance or TAE for hemorrhage prevention. We also suggest that surgical management should be considered for patients with tumors larger than 7.35 cm, symptomatic and progressive AML, or suspicious EAML. [ABSTRACT FROM AUTHOR]

This study investigates the effects of a solution-focused brief counseling training program on telephone-counseling volunteers in Taiwan, with an emphasis on promoting their counseling self-efficacy. There were 14 hotline volunteers recruited from Taipei Lifeline, they received 24 hours of solution-focused brief counseling training over 3 days. All participants were required to fill in an open-ended course feedback form after the solution-focused brief counseling training program and 1 month later. We used open coding to analyze the verbal data from the course-feedback forms. There were 6 features contributing to the effect of this solution-focused brief counseling training program that were found: helpful solutionfocused brief counseling skills, the usefulness of solutionfocused brief counseling's stages, the establishment of basic knowledge of solution-focused brief counseling, enhancing the confidence and stability of telephone-counseling volunteers, the positive influence on volunteers' personal life, and effective ways to learn and master solution-focused brief counseling. Using the research results, this study discusses solutionfocused brief counseling training as it relates to telephonecounseling volunteers and suggests further research directions in relevant fields. [ABSTRACT FROM AUTHOR]

Marine debris is an international environmental issue, and the growing amount of abandoned, lost, or otherwise discarded fishing gear (ALDFG) is a particular concern. Despite Taiwan's substantial fishing industry, there is a lack of comprehensive understanding of fishing gear. This work conducted a static material flow analysis to estimate the flows and the stocks of fishing gear in Taiwan in 2020, based on government statistics and interviews with fishing gears producing companies, fishermen, and recycling companies. Our findings reveal that the inflow, outflow, and stock of the fishing gears are 8,846 t/a, 4,271 t/a, and 4,575 t/a, respectively. Only 36 % of end-of-life fishing gear is recycled, while the rest is incinerated or landfilled. Additionally, the stock comprises 27 % in use, 23 % in ports, and 50 % entering the ocean. These results underscore the need to increase recycling capacity, prevent loss in oceans, and promote repairs to extend the lifespan of fishing gear. [Display omitted] • Fishing gear flow analysis in Taiwan shows low recycling and high ocean loss. • Only 17 % of end-of-life fishing gear is recycled, rest is incinerated in Taiwan. • Fishing gear stock in Taiwan: 27 % in use, 23 % in ports, 50 % enters ocean • Need to increase recycling, prevent loss, and extend fishing gear lifespan • Collaboration is crucial for sustainable fishing and reducing impact. [ABSTRACT FROM AUTHOR]

Microplastics are ubiquitous and affect all environments, including rivers. In recent years the number of studies about microplastics in rivers has strongly increased. But still many questions exist regarding sources, pathways, and the role of land use patterns. In this study the relationship between microplastics abundance and anthropogenic factors (population density, urbanization, land use types), as well as the potential role of storm sewers as pathways in tributaries of the Wu River in Taichung, central Taiwan, were studied. Two river catchments of the Dali River were studied in greater detail to investigate the influence of land use on microplastics abundance along an urban-rural gradient, and to observe the change of microplastics abundance in the transition from rural to urban areas. Samples were taken from 41 different locations in urban and rural areas using a manta net with a mesh size of 0.3 mm. Results show abundances ranging from 0 pcs/m³ in unpopulated rural areas up to 230 pcs/m³ in densely populated urban centers, and are positively correlated with population density. Remarkably, a sharp increase in microplastics abundance was observed at the transition from rural to urban areas, which coincides with the appearance of storm sewers. Land use analysis revealed that microplastics abundance positively correlates with the size of industrial, residential and traffic areas in the catchment areas, and negatively correlates with the size of forest areas. Source areas for microplastics in the studied rivers are likely residential and commercial areas. Furthermore, the results of this study show that correlations between microplastics abundances and population density or land use patterns along urban-rural gradients are not trivial. Strength of correlations can depend on local factors or how well urban-rural gradients are developed. Absence of correlations need to be considered carefully, as existing correlations might be masked by the above-mentioned factors. [Display omitted] • Microplastics pollution suddenly rises at the transition from rural to urban areas. • The majority of microplastics are generated in residential and industrial areas. • Storm sewers are important pathways of microplastics from land into urban rivers. • Strength of correlations depend on development of urban-rural gradients. [ABSTRACT FROM AUTHOR]

Internationally, news on patent infringement is often seen, and patent infringement law-suits affect stock prices. However, fewer studies have discussed how market reflects corporate value and impact of patent infringement lawsuit on investment returns when a patent infringement lawsuit occurs and the news is released. This study applied event study to discuss changes in information value of plaintiffs and defendants, and information value difference of different patent lawsuit sources in competitive environment. The empirical results showed that patent infringement lawsuits may cause negative perception of investors or insider shareholders. This event may become an arbitrage opportunity. Through five forces analysis, the lawsuits from various sources are bad news. Reverse correction is conducted after the event, and makes stock price rational. Thus, in Taiwan market, patent infringement lawsuit is negative news for plaintiff and defendant. [ABSTRACT FROM AUTHOR]