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Aim: To test the diagnostic performance of a deep learning-based system for the detection of clinically significant pulmonary nodules/masses on chest radiographs.Materials and Methods: Using a retrospective study of 100 patients (47 with clinically significant pulmonary nodules/masses and 53 control subjects without pulmonary nodules), two radiologists verified clinically significantly pulmonary nodules/masses according to chest computed tomography (CT) findings. A computer-aided diagnosis (CAD) software using a deep-learning approach was used to detect pulmonary nodules/masses to determine the diagnostic performance in four algorithms (heat map, abnormal probability, nodule probability, and mass probability).Results: A total of 100 cases were included in the analysis. Among the four algorithms, mass algorithm could achieve a 76.6% sensitivity (36/47, 11 false negative) and 88.68% specificity (47/53, six false-positive) in the detection of pulmonary nodules/masses at the optimal probability score cut-off of 0.2884. Compared to the other three algorithms, mass probability algorithm had best predictive ability for pulmonary nodule/mass detection at the optimal probability score cut-off of 0.2884 (AUCMass: 0.916 versus AUCHeat map: 0.682, p<0.001; AUCMass: 0.916 versus AUCAbnormal: 0.810, p=0.002; AUCMass: 0.916 versus AUCNodule: 0.813, p=0.014).Conclusion: In conclusion, the deep-learning based computer-aided diagnosis system will likely play a vital role in the early detection and diagnosis of pulmonary nodules/masses on chest radiographs. In future applications, these algorithms could support triage workflow via double reading to improve sensitivity and specificity during the diagnostic process. [ABSTRACT FROM AUTHOR]

Background Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. Aim To investigate the gender difference of BrS in Han Chinese. Design We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. Methods Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. Results The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P  =   0.15). Females exhibited longer QTc (457.8 ± 33.0 vs. 429.5 ± 42.1 ms, P  <   0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P  =   0.049), which was mainly attributed to syncope (P  <   0.01). Males with SCD exhibited longer QRS duration (114.2 ± 26.8 vs. 104.8 ± 15.3 ms, P  =   0.02) and QTc (442.5 ± 57.4 vs. 422.9 ± 28.8 ms, P  =   0.02). Males with syncope exhibited longer PR interval (181.2 ± 33.7 vs. 165.7 ± 27.1 ms, P  =   0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 ± 9.6 vs. 82.2 ± 16.3 bpm, P  =   0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. Conclusion Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females. [ABSTRACT FROM AUTHOR]

An afforestation project was initiated in the western plain of Taiwan to convert abandoned farming lands into forests to improve the ecological and environmental conditions. This study was conducted to understand the potential impacts of this land cover change on evapotranspiration (ET) and other land surface processes and the differences in the impacts under clear and rainy weather conditions. Numerical simulations with the land surface covered with crops and forests were conducted using an atmosphere-land coupled model during a summer monsoon season. Sensitivity experiments were conducted to understand the possible impacts of the convection and atmospheric planetary boundary layer parameterization schemes used in this study on the simulation results. The results of the entire simulation period indicate that, although the maximum solar radiation is increased by 30 W m-2 from about 800 W m-2 due to smaller albedo after afforestation, the maximum ET near noon time is decreased by about 3 mm h-1 from about 17 mm h-1 on clear days, mainly due to increased stem area index and reduced wind speed within the forest canopies. Meanwhile, the maximum sensible heat flux is increased by about 100 W m-2 from 200 W m-2 due to larger total vegetation area (the sum of leaf and stem area index) in forests. Similar responses in ET and other land surface processes to the afforestation are obtained for clear weather conditions. In contrast, ET is increased and sensible heat flux is decreased under rainy conditions. The changes in ET are more important on clear days than on rainy days in determining the responses over the entire simulation period. The sensitivity experiments confirmed the simulated responses of ET and other land surface processes. The results suggest that afforestation would modulate hydrological cycles by reducing ET on clear days and elevating ET on rainy days, thereby reducing the risks of hydrological extremes. [ABSTRACT FROM AUTHOR]

Summary: We investigated the cardiovascular disease risk and mortality in end-stage renal disease (ESRD) patients. A total of 12,535 patients with ESRD undergoing incident dialysis were enrolled, 4,153 (33.13 %) of whom had osteoporosis. The osteoporosis group was associated with a significantly higher risk of coronary artery disease, congestive heart failure, stroke, and mortality. Introduction: In this study, we aimed to investigate the risk of cardiovascular disease and mortality in a sample of end-stage renal disease patients with osteoporosis. Methods: We conducted this retrospective cohort study of incident dialysis patients with and without osteoporosis to evaluate the risk of overall mortality and cardiovascular complications including stroke, coronary heart disease, and congestive heart failure between the two groups. A total of 12,535 patients with ESRD undergoing incident dialysis were enrolled, 4,153 (33.13 %) of whom had osteoporosis, from the National Health Insurance Research Database of Taiwan for the years 1998 through 2011. The osteoporosis group had more comorbidities than the group without osteoporosis including hypertension, hyperlipidemia, mental disorders, and hepatitis C infection. Results: After adjusting for age, gender, and related comorbidities, the osteoporosis group was associated with a significantly higher risk of coronary artery disease (hazard ratio (HR) = 1.32, 95 % confidence interval (CI) = 1.20-1.45) which was significant in both genders (women, HR = 1.35, 95 % CI = 1.20-1.50; men HR = 1.27, 95 % CI = 1.06-1.52) and all age groups (≤49 years HR = 1.41, 95 % CI = 1.16-1.70; >49 years HR = 1.30, 95 % CI = 1.16-1.45). Similar results were observed for the outcomes of congestive heart failure, stroke, and mortality. Conclusions: The results showed that osteoporosis was significantly associated with the subsequent risk of cardiovascular events in patients with ESRD. When encountering patients with ESRD and osteoporosis, physicians should be alert to the subsequent cardiovascular risk in incident dialysis patients to prevent the subsequent occurrence of these adverse events. [ABSTRACT FROM AUTHOR]

This study investigated the in vitro susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) to nine antimicrobial agents in Taiwan. A total of 1,725 isolates were obtained from 20 hospitals throughout Taiwan from 2006 to 2010. The minimum inhibitory concentrations (MICs) of the nine agents were determined by the agar dilution method. The MICs of mupirocin and tyrothricin were determined for 223 MRSA isolates collected from 2009 to 2010. For vancomycin, 99.7 % were susceptible; however, 30.0 % ( n = 517) exhibited MICs of 2 μg/ml and 0.3 % ( n = 6) demonstrated intermediate susceptibility (MICs of 4 μg/ml). Nearly all isolates (≥99.9 %) were susceptible to teicoplanin, linezolid, and daptomycin. The MIC values were 2 μg/ml for ceftobiprole and 1 μg/ml for nemonoxacin. The MIC values of mupirocin and tyrothricin were 0.12 and 4 μg/ml, respectively. MIC creep was noted for daptomycin during this period, but not for vancomycin, teicoplanin, linezolid, or tigecycline. For isolates with vancomycin MICs of 2 μg/ml, the MIC values were 2 μg/ml for teicoplanin, 0.5 μg/ml for daptomycin, and 0.5 μg/ml for tigecycline. Those values were four- to eight-fold higher than those among isolates with vancomycin MICs of 0.5 μg/ml (2, 0.06, and 0.12 μg/ml, respectively). Of the nine MRSA isolates exhibiting non-susceptibility to vancomycin ( n = 6), teicoplanin ( n = 1), daptomycin ( n = 2), or tigecycline ( n = 1), all had different pulsotypes, indicating the absence of intra-hospital or inter-hospital spread. The presence of a high proportion of MRSA isolates with elevated MICs (2 μg/ml) and MIC creep of daptomycin might alert clinicians on the therapy for serious MRSA infections in Taiwan. [ABSTRACT FROM AUTHOR]

Aim To examine the relationships between depressive symptoms, menopausal status, and menopausal symptoms in middle-aged women. Material and methods This cross-sectional, population-based study involved patients in the Taiwanese community. Data were retrieved from the nationwide 2002 Health Promotion Knowledge, Attitude, and Performance Survey in Taiwan. We assessed depressive symptoms using the Taiwanese Depression Questionnaire with a cut-off point of 18 of 19. Self-reported perception of menopausal status, frequency of menstrual periods in the preceding 12 months, and a history of oophorectomy surgery were used to categorize the women's menopausal status into premenopause, perimenopause, postmenopause, and surgical menopause. Results A total of 3359 women aged 40-55 years were selected. Among these patients, 145 women (4.7%) experienced higher levels of concurrent depressive symptoms. The increase in depressive symptoms was significantly associated with menopausal status and most of the menopausal symptoms. After controlling for age, marital status, education, income, smoking, hormone therapy, and menopause symptoms, multivariate logistic regression showed that perimenopause was still significantly associated with depression in midlife women (odds ratio 1.97; 95% confidence interval 1.24-3.14). Conclusion Independent of menopausal symptoms, perimenopausal status increases the risk of depression. [ABSTRACT FROM AUTHOR]

The septum magnet bends the injection beam before the kicker magnet. The septum magnet is located near the storage ring in the Taiwan Photon Source (TPS). As the space from the magnet wall to the vacuum chamber of the ring is less than 3 mm, the leakage field of the septum magnet thus influences the stability of the electron beam in the storage ring. The main field and the leakage field of a septum of the direct-drive type are compared to one of the eddy-current type. The effects of the vacuum chamber and \mu-metal are simulated with full-sine and half-sine current pulses with the OPERA-2D TR analysis module; measurement results are presented in this paper. [ABSTRACT FROM PUBLISHER]

Oral Diseases (2010) , 53-59 The chromosome 3q26 locus is a hotspot region carrying oncogenes that frequently altered in neoplasms. ZASC1 is a zinc finger protein transcription factor localized on 3q26. Our previous study showed the frequent amplification of 3q26, including the ZASC1 gene, in oral squamous cell carcinoma (OSCC). This study investigated the copy number changes of ZASC1 gene from primary to recurrent OSCC and the functions of ZASC1 in OSCC cells. A total of 27 OSCC patients with primary and recurrent tumors were examined for ZASC1 and TERC copy number changes using Quantitative PCR analysis. Exogenous expression and knockdown of ZASC1 were carried out to specify the oncogenic potential of ZASC1 in OSCC cells. A ZASC1 copy number that has increased from primary to recurrent tumor counterparts in tissue pairs suggested the importance of ZASC1 in tumor progression. The increase of ZASC1 gene copy number in recurrent tumors was associated with the consumption of betel quid in patients. OSCC cells expressing ZASC1-FLAG fusion protein showed increased proliferation. After the knockdown of endogenous ZASC1 expression using small interference RNA, the growth and colony formation of SAS OSCC cells decreased. The findings support the hypothesis that ZASC1 localized on 3q26 contributes to the recurrence of OSCC. [ABSTRACT FROM AUTHOR]

Here, we report anticipatory behaviors of sea snakes and provide the first evidence for a sensory mechanism by which they survive a catastrophic cyclone. Sea kraits ( Laticauda spp.) are normally abundant in littoral habitats at Lanyu (Orchid Island), Taiwan but disappeared coincident with falling barometric pressure prior to typhoon Morakot, which impacted the island severely during 7-9 August 2009. The abundance of sea kraits that are visible within the littoral zone correlates with barometric pressure, but not with precipitation or wind speed, which drives the surf. We found very little evidence of direct mortality caused by the storm, and the visible abundance of sea kraits following the storm returned to pre-storm levels. Data suggest that survival of sea kraits depends on the sensory perception of low pressures preceding a tropical cyclone, followed by behaviors which avoid the lethal storm energies potentially affecting this coastal population. Sea kraits likely find refuge in cavernous spaces beneath volcanic rocks of the seacoast. [ABSTRACT FROM AUTHOR]

CHANG P.M.-H., LIU Y.-Y.L., CHAO T.-C., LIN H.-L., CHEN M.-B., CHEN P.-M. & CHIOU T.-J. (2010) European Journal of Cancer Care 19, 267–272 A new hospice consulting system for terminal cancer patients in transferring to post-acute care options in Taiwan The terminal cancer patients increase needs for hospice care day by day. A new hospice consulting system has been developed in Taiwan to provide options for terminal cancer patients in choosing a suitable post-acute hospice care while a combined hospice care system is also given by the consulting team in the acute wards. Hereinafter is our report. From March 2005 to January 2006, 313 terminal cancer patients were analysed. These patients had signed consent forms for palliative treatment and had received consultations from the new hospice consulting system. Multivariate analysis showed that the home care patients had better performance status ( P = 0.012), less shortness of breath ( P = 0.006), less limbs swelling ( P = 0.043), less flatulency ( P = 0.000) and less constipation ( P = 0.018). Among the 162 patients with regular follow-up, the symptoms/signs were significantly improved after intervention of consulting team in pain ( P = 0.000), shortness of breath ( P = 0.000), difficulty in sleeping ( P = 0.002), nausea ( P = 0.004), constipation ( P = 0.008), changes in skin ( P = 0.024) and adoption ( P = 0.000). This new system had significant improvement in the terminal cancer patients' symptoms/signs control in acute wards and could contribute to the care quality of home care patients. [ABSTRACT FROM AUTHOR]

A nationwide susceptibility surveillance of Streptococcus pneumoniae and Haemophilus influenzae isolates collected from patients treated at the intensive care units (ICUs) of ten Taiwanese major teaching hospitals was conducted from September 2005 through November 2005. High rates of resistance (intermediate/resistant) of S. pneumoniae to penicillin (85% resistance), ceftriaxone (46%/20%), and cefepime (43%/15%) by meningitis criteria, and in contrast, non-susceptibilities (intermediate/resistant) to penicillin (0%/0%), ceftriaxone (20%/0%) and cefepime (15%/0%) by non-meningitis criteria were noted ( p values < 0.05) by the Clinical and Laboratory Standards Institute 2008. Resistant rate of S. pneumoniae to azithromycin was also high (63%). S. pneumoniae isolates were significantly more susceptible to ertapenem (87%) than to imipenem (39%) and meropenem (44%) ( p values < 0.05). Rates of non-susceptibilities of H. influenzae isolates to ampicillin and cefaclor were high (55% and 45%, respectively). No β-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae isolates were found. Imipenem has a notably higher MIC90 value (8 μg/ml) for H. influenzae than that of the other two carbapenems. Tigecycline showed good in vitro activities against these two respiratory pathogens. High rates of resistance among isolates of S. pneumoniae and H. influenzae continue to exist in the ICUs of Taiwan. [ABSTRACT FROM AUTHOR]

To determine the antimicrobial resistance profiles among clinical isolates of Enterobacteriaceae in Taiwanese intensive care units (ICUs), a national surveillance of antibiotic resistance among important Enterobacteriaceae was conducted from September 2005 through November 2005 at the ICUs of ten major teaching hospitals in Taiwan. A total of 574 Enterobacteriaceae isolates recovered from various clinical samples of our ICU patients were submitted for in vitro test. Minimum inhibitory concentrations (MICs) of these isolates to 18 antimicrobial agents were determined by the broth microdilution method. The prevalences of Enterobacteriaceae isolates with phenotypic extended-spectrum β-lactamase (ESBL) production were 26% in Klebsiella pneumoniae, 16% in Serratia marcescens, 14% in Escherichia coli, and 13% in Proteus mirabilis, in which a significantly rising prevalence of ESBL production among K. pneumoniae was noted ( p = 0.002) when compared with a previous Taiwanese survey in 2000. Heterogeneous resistance to various fluoroquinolones was found among our Enterobacteriaceae isolates, except for Entetrobacter cloacae. Emergence of ertapenem-resistant isolates of E. coli, K. pneumoniae, E. cloacae, and S. marcescens was noted. Gradually increasing rates of drug-resistant Enterobacteriaceae were noted in Taiwanese ICUs. Periodic surveillance of the evolutionary trend of antimicrobial resistance among ICU isolates is crucial for starting appropriately empirical antimicrobial therapy in the future. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to describe Taiwanese women's experiences of prenatal depression. Background. Despite its long-term adverse effects for both mother and child, prenatal depression has received less scholarly attention than postpartum depression. Studies to date have proposed structured measures for quantifying prenatal depression, but the characteristics of this phenomenon have not been qualitatively analysed. Method. A convenience sample of 12 Taiwanese pregnant women scoring above 15 on the Edinburgh Perinatal Depression Scale participated in in-depth interviews during 2005. The interviews were transcribed verbatim and analysed using content analysis. Findings. Unbalanced commitment to motherhood was the primary theme of the life experiences of prenatal depression in these Taiwanese women, which summarized their feelings of engagement and ambivalence towards their experiences of transition to motherhood. Five recurring sub-themes were identified: multiple conflicting roles, lack of social support, dissatisfaction with body image, future uncertainty and emotional instability. Conclusion. Prenatal depression is a painful growth experience represented by silent and unbalanced commitment during the maternal role transition. Our findings may help healthcare professionals to understand the vulnerable experiences of pregnant women and devise preventive intervention strategies, such as prenatal education for both parents and comprehensive screening for prenatal depression in at-risk pregnant women, so that they are better prepared for the transition to motherhood. [ABSTRACT FROM AUTHOR]

Aims and Objectives. The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between-group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses' intention to leave. Background. Nurses' intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region. Methods. A cross-sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher-designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this. Results. The overall response rate was 100%; 63 (48·9%) revealed that they intended to leave their jobs. The findings were that their self-rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave ( p = 0·05-0·001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses' intention to leave their job. Conclusions. The findings suggest that there is a need to take steps to improve nurses' health-related quality of life and to develop effective strategies to improve nurse retention. Relevance to clinical practice. A succinct validated instrument would help identify the important factors that predict ICU nurses' intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs. [ABSTRACT FROM AUTHOR]

Calcineurin is a calcium/calmodulin-dependent protein phosphatase composed of two subunits, a regulatory subunit of calcineurin B (CNB) and a catalytic subunit of calcineurin A (CNA). PPP3CC is the γ isoform of CNA located at the chromosome 8p21.3 region. To evaluate the association between PPP3CC and schizophrenia in the Taiwanese population, 10 single nucleotide polymorphism (SNP) markers across the gene were genotyped by the method of MALDI-TOF in 218 schizophrenia families with at least two affected siblings. One SNP (rs2272080) located around the exon 1 untranslated region was nominally associated with schizophrenia (P=0.024) and significantly associated with the expression of PPP3CC in lymphoblast cell line; the TT and TG genotype had significantly higher relative expression levels than the GG genotype (P=0.0012 and 0.015, respectively). In further endophenotype stratification, the single locus of rs2272080 and the haplotypes of both two-SNP haplotype (rs7833266–rs2272080) and seven-SNP haplotype (rs2461491–rs2469758–rs2461489–rs2469770–rs2449340–rs1482337–rs2252471) showed significant associations with the subgroup of schizophrenia with deficits of the sustained attention as tested by the continuous performance test (CPT, P<0.05) and the executive functioning as tested by the Wisconsin Card Sorting Test (WCST, P<0.05). The results suggest that PPP3CC gene may be a true susceptibility gene for schizophrenia.Molecular Psychiatry (2007) 12, 966–974; doi:10.1038/sj.mp.4001977; published online 6 March 2007 [ABSTRACT FROM AUTHOR]

Inflammatory events may contribute to the pathogenesis of Parkinson’s disease (PD) and interleukin 1 (IL-1) may exert both neurotoxic and neuroprotective effects. We conducted a case-control study in a cohort of 493 PD cases and 388 ethnically matched controls to investigate the association of IL-1α C-889T and IL-1β C-511T polymorphisms with the risk of PD. No significant difference in the genotype distribution of the analyzed polymorphisms was found between PD and controls. However, after stratification by age, individuals over 70 years of age carrying IL-1α-889 C/T genotype demonstrated a significant decrease in risk of developing PD (OR = 0.44; 95% CI = 0.22–0.88, p = 0.021) and the decrease is strengthened by IL-1β-511 T-carrying genotype (OR = 0.28; 95% CI = 0.11–0.71, p = 0.008). Our data suggest that IL-1α, acting synergistically with IL-1β, plays role in PD susceptibility among Taiwanese people older than 70 years of age. [ABSTRACT FROM AUTHOR]

Background: Fever of unknown origin (FUO) is a challenging problem worldwide. There was no prospective study of FUO in the past two decades in Taiwan. A prospective study was conducted. Materials and Methods: The prospective study was undertaken from March 2001 to May 2002. All patients fulfilling the modified criteria for FUO, either admitted, referred or consulted in a medical center in southern Taiwan, were enrolled for analysis. Results: A total of 94 cases met the criteria of FUO. The final diagnoses of FUO consisted of 54 infectious diseases (57.4%), 8 hematologic/neoplastic (8.5%), 7 noninfectious inflammatory (7.4%), 8 miscellaneous (8.5%) and 17 undiagnosed (18.1%) cases. The single most common cause of FUO was tuberculosis. Some infectious diseases, such as rickettsiosis and melioidosis, were rarely reported in western countries. Three patients with hemophagocytotic syndrome without ascertainable etiologies were present with FUO in this study. Between the patients with and those without a final diagnosis, the short-term survival (3 months) was compared by the Kaplan-Meier analysis, which revealed no difference. Conclusions: Mycobacteriosis is still the leading cause of FUO in Taiwan and it is important to identify this treatable disease from all causes of FUO. This study has showed geographical variation among the studies of FUO. [ABSTRACT FROM AUTHOR]

Heading for possible use for clinical trial, THOR (Tsing Hua Open-pool Reactor) at Taiwan was shutdown for renovation of a new epithermal neutron beam in January 2003. In November 2003, concrete cutting was finished for closer distance from core and larger treatment room. This article presents the design base that the construction of the new beam is based on. The filter/moderator design along the beam is Cd(0.1 cm)+Al(10 cm)+FLUENTAL™(16 cm)+Al(10 cm)+FLUENTAL(24 cm)+Void(18 cm)+Cd(0.1 cm)+Bi(10 cm) with 6 cm Pb as reflector. Following the filter/moderator is an 88 cm long, 6 cm thick Bi-lined collimator with Li2CO3-PE at the end. The collimator is surrounded by Li2CO3-PE and Pb. The calculated beam parameters under 2 MW at the beam exit is φepi=3.4×109 n/cm2/s, Df/φepi=2.8×10-11 cGy cm2/n, Dγ/φepi=1.3×10-11 cGy cm2/n, and J+/φ= 0.8. For a phantom placed 10 cm from beam exit, MCNP calculation shows that the advantage depth is 8.9 cm, and advantage ratio is 5.6 if boron concentration in tumor and normal tissue are assumed to be 65 and 18 ppm. The maximum dose rate for normal tissue is 50 cGy/min. The maximum therapeutic ratio is 6. The construction of the beam is scheduled to be finished by the end of April 2004. [Copyright &y& Elsevier]

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the cost and determinants of morbidity from work related disabilities.Methods: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work.Results: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990.Conclusion: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments. [ABSTRACT FROM AUTHOR]

Japanese encephalitis (JE) is an endemic disease in Taiwan. Acute JE virus infection characterized by acute flaccid paralysis in an adult has never been reported in Taiwan. We report a young adult man who received four doses of JEV (Nakayama strain) vaccination in childhood, but still developed acute JE virus infection, characterized with acute flaccid paralysis. He presented with fever, headache, progressive muscle weakness, and respiratory paralysis requiring mechanical ventilator. Deep tendon reflexes were decreased except for the Achilles reflex. After supportive care, he was weaned from the mechanical ventilator and at discharge 1 month later, his muscle power level and deep tendon reflexes recovered partially. The diagnosis of JE was based on the presence of anti-JE virus IgM in the CSF and seroconversion of IgM and IgG by the ELISA method. Electrophysiological findings were described. From the experience of this case, we caution that a history of vaccination for JE with the Nakayama strain may not provide a complete protection against natural infection in the community; and in Taiwan or any area where JE remains an endemic disease, Japanese virus encephalitis infection should be considered as a differential diagnosis in any adult presenting with acute flaccid paralysis. [ABSTRACT FROM AUTHOR]

Background: Incisional recurrence after thoracoscopic surgery has been reported infrequently. In recent years, several reports of port-site recurrence after laparoscopic oncologic procedures have been published. This study evaluates the incidence of incisional recurrence among patients with intrathoracic malignancy after diagnostic and therapeutic thoracoscopy.Methods: The medical records of all patients with intrathoracic malignancies who underwent thoracoscopic procedures between 1992 and 1998 at Chang Gung Memorial Hospital Linkou Medical Center were reviewed. Information includes preoperative tumor status, thoracoscopic findings, primary tumor location, tumor pathology, procedures performed, and perioperative complications were recorded.Results: A total of 1,069 patients with known intrathoracic malignancies underwent thoracoscopy. The mean follow-up time was 17.1 months (range, 1-68 months). Two recurrences at the incision were identified (0.19%). Both patients with incision-site recurrence had advanced intrathoracic disease at the time of thoracoscopy. The one patient had a malignant pleural effusion (T4), and the other had diffuse pleural metastasis.Conclusion: The incidence of incisional recurrence after thoracoscopic oncologic surgery is very low. When recurrence occurs at the incision, it is associated most commonly with advanced intrathoracic disease. Additional patients and a longer follow-up evaluation are required, however, to confirm this observation. [ABSTRACT FROM AUTHOR]

Abstract: THORplan is a treatment planning system developed at Tsing Hua University, Taiwan, for boron neutron capture therapy (BNCT) purpose. It is recently developed with user-friendly interface using Interactive Data Language. In this article the accuracy of THORplan is verified by comparing results of Snyder phantom calculation with the analytical model results of MCNP. Neutron source from THOR epithermal neutron beam is used as the source for the calculation. The thermal neutron flux calculated by THORplan is very close to the reference results. SERA overestimates thermal neutron flux by 2–5%. NCTPlan underestimates thermal neutron flux by 4–9% in most locations. The total weighted dose calculated by THORplan is accurate to within 3% except at the tissue interface. SERA overestimates the total weighted dose at depth by 2–5%. NCTPlan underestimates the total weighted dose by ∼10% at depth . [Copyright &y& Elsevier]

Deleterious health sequelae caused by licit and illicit substance use is a serious problem in our society. Adolescent students and particularly those who are prone to substance use are of special concern in the prevention of drug abuse. The purpose of this study was to investigate the prevalence of alcohol consumption, tobacco smoking and illicit drug use and to identify the risk factors related to these habits among adolescent students. A total of 1358 adolescent students aged 16–18 y old were recruited into this study via stratified random sampling from a vocational school in Kaohsiung city. Students were asked to complete a structured questionnaire anonymously and a 96.7% response rate was achieved. Prevalence of substances use was estimated as follows: alcohol drinking, 70.7% (boys 75.1%, girls 51.4%); tobacco smoking, 56% (boys 61.8%, girls 30.2%); illicit drug use 6.4% (boys 6.6%, girls 5.6%). Significant risk factors that emerged as common correlates with substances use were behaviour problems, non-negative attitude toward parent’s substance use, and peer influence. A dose–response relationship was found between the prevalence of drinking, smoking, illicit drug use and the number of risk factors adolescents were exposed to. Prevention of adolescent substance abuse should be attempted and risk factors should be reduced. An educational approach is essential not only to gain/impart knowledge of substance abuse, but also to develop an effective program for health and social development. [ABSTRACT FROM AUTHOR]

Background: The proportion of intense tropical cyclones is expected to increase in a changing climate. However, there is currently no consistent and comprehensive assessment of infectious disease risk following tropical cyclone exposure across countries and over decades. We aimed to explore the tropical cyclone-associated hospitalisation risks and burden for cause-specific infectious diseases on a multi-country scale., Methods: Hospitalisation records for infectious diseases were collected from six countries and territories (Canada, South Korea, New Zealand, Taiwan, Thailand, and Viet Nam) during various periods between 2000 and 2019. The days with tropical cyclone-associated maximum sustained windspeeds of 34 knots or higher derived from a parametric wind field model were considered as tropical cyclone exposure days. The association of monthly infectious diseases hospitalisations and tropical cyclone exposure days was first examined at location level using a distributed lag non-linear quasi-Poisson regression model, and then pooled using a random-effects meta-analysis. The tropical cyclone-attributable number and fraction of infectious disease hospitalisations were also calculated., Findings: Overall, 2·2 million people who were hospitalised for infectious diseases in 179 locations that had at least one tropical cyclone exposure day in the six countries and territories were included in the analysis. The elevated hospitalisation risks for infectious diseases associated with tropical cyclones tended to dissipate 2 months after the tropical cyclone exposure. Overall, each additional tropical cyclone day was associated with a 9% (cumulative relative risk 1·09 [95% CI 1·05-1·14]) increase in hospitalisations for all-cause infectious diseases, 13% (1·13 [1·05-1·21]) for intestinal infectious diseases, 14% (1·14 [1·05-1·23]) for sepsis, and 22% (1·22 [1·03-1·46]) for dengue during the 2 months after a tropical cyclone. Associations of tropical cyclones with hospitalisations for tuberculosis and malaria were not significant. In total, 0·72% (95% CI 0·40-1·01) of the hospitalisations for all-cause infectious diseases, 0·33% (0·15-0·49) for intestinal infectious diseases, 1·31% (0·57-1·95) for sepsis, and 0·63% (0·10-1·04) for dengue were attributable to tropical cyclone exposures. The attributable burdens were higher among young populations (aged ≤19 years) and male individuals compared with their counterparts, especially for intestinal infectious diseases. The heterogeneous spatiotemporal pattern was further revealed at the country and territory level-tropical cyclone-attributable fractions showed a decreasing trend in South Korea during the study period but an increasing trend in Viet Nam, Taiwan, and New Zealand., Interpretation: Tropical cyclones were associated with persistent elevated hospitalisation risks of infectious diseases (particularly sepsis and intestinal infectious diseases). Targeted interventions should be formulated for different populations, regions, and causes of infectious diseases based on evidence on tropical cyclone epidemiology to respond to the increasing risk and burden., Funding: Australian Research Council, Australian National Health, and Medical Research Council., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories., Research Design and Methods: We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000-2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared., Results: Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011-1.022), 1.023 (1.011-1.035), 1.023 (1.015-1.032), 0.962 (0.823-1.032), 1.033 (1.001-1.066), and 1.013 (1.004-1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16-1.18%) and 1.02% (0.20-1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations., Conclusions: We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil., (© 2024 by the American Diabetes Association.)

We conducted a retrospective population-based, matched cohort study using the National Health Insurance Research Database to estimate healthcare resource utilisation (HRU) and costs in patients with newly diagnosed AL amyloidosis in Taiwan. Cases were matched 10:1 by age, sex, and area of residence to patients without AL amyloidosis (comparators) randomly selected from the database during the same time period. Annual all-cause HRU and costs for 3 years were quantified. AL amyloidosis-attributable costs were obtained by subtracting all-cause HRU costs incurred by comparators from cases. The mean age of all patients was 60.78 years and 59.07% were male. Co-morbidities were more frequent in cases than comparators. By 6 months after diagnosis, 12.1% of cases had died versus 0.9% of comparators. In the first year, cases had 103% more outpatient visits, 177% more emergency room visits, were hospitalised 4-times more frequently, and spent 5.5-times more days in hospital than comparators, and total healthcare costs were > sixfold higher. Costs incurred during the first year after diagnosis accounted for 55% of the 3-year cumulative cost. High HRU costs associated with delayed diagnosis and end-organ damage indicate a need for earlier diagnosis and more effective treatments for AL amyloidosis., (© 2024. The Author(s).)

Background: Hypertensive heart disease (HHD) is a common cause of cardiovascular disease and mortality worldwide, and its burden is increasing with aging populations., Objectives: This study aimed to estimate the prevalence and mortality rates of HHD in mainland China and Taiwan Province using data from the Global Burden of Disease Study 2019 (GBD 2019), and forecast the development trend of HHD from 2020 to 2024., Methods: We obtained data on number of cases, deaths, crude prevalence rate, crude death rate, age-standardized prevalence rate (ASPR), and age-standardized death rate (ASDR) for mainland China and Taiwan Province from 1990 to 2019 from the GBD 2019. Joinpoint software was used to estimate average annual percentage change (AAPC) with 95% confidence intervals, and the number of HHD cases in China from 2022 to 2024 was predicted by the exponential smoothing method., Results: Between 1990 and 2019, HHD cases and deaths increased in mainland China, but the ASPR and ASDR decreased by 5.96% and 48.72%, respectively. In Taiwan Province, ASPR and ASDR decreased by 7.66% and 52.14%, respectively. The number of HHD cases and death rates varied by region, age, and sex, with a higher number of cases in mainland China than in Taiwan Province. By 2024, the number of HHD cases in mainland China was projected to be over 9.6 million cases, and in Taiwan Province, it was projected to surpass 120,000 cases., Conclusion: The differences in HHD cases between mainland China and Taiwan Province in terms of age and sex indicated the need for effective prevention and control measures, especially targeting the elderly population. These findings can inform policymakers and health professionals in the development of targeted prevention and treatment strategies and resource allocation for HHD in China., (© 2024 John Wiley & Sons Ltd.)

Background: Thrombosis with thrombocytopenia syndrome (TTS) is a very rare prothrombotic disorder that is a safety concern for some COVID-19 vaccines. We aimed to devise a case definition to estimate the incidence of thrombosis with thrombocytopenia as a proxy for TTS in a national insurance claims database., Methods: We conducted a retrospective observational study using the National Health Insurance Research Database (NHIRD) in Taiwan over the three-year period prior to the SARS-COV-2 pandemic (2017-2019). Our case definition was all patients with newly diagnosed thrombosis co-occurring with a diagnosis of thrombocytopenia within seven days before or after the thrombosis diagnosis. Cases were identified using International Classification of Disease-10 codes., Findings: We identified 2010 patients with newly diagnosed thrombosis co-occurring with thrombocytopenia during the study period. The mean age was 64.71 years; female:male ratio 1:1.45. The most frequent thrombotic events were coronary artery disease (18.81%), cerebral infarction (16.87%), and disseminated intravascular coagulation (13.13%). Cerebral venous sinus thrombosis was rare (<0.1%). The average annual incidence rate of co-occurring new diagnoses of thrombosis and thrombocytopenia was 2.84 per 100 000 population. Incidence rates were higher in men than women, except in 20-39 year-olds (higher in females). 20.6% of patients died within the first month after diagnosis., Interpretation: We observed that the demographic and clinical characteristics of thrombosis with co-occurring thrombocytopenia using our case definition is different from that of TTS. Further research is needed to refine the case definition of TTS in the post-COVID-19 vaccination period., Competing Interests: The authors have read the journal’s policy and have the following competing interests: CHG, KCH, and HQ are employees of Johnson & Johnson, Office of the Chief Medical Officer. ML and ZC are employees of Janssen China Research & Development. YL is an employee of Janssen Pharmaceuticals LLC, United States. HQ, YL, ML and ZC hold stock in Johnson & Johnson. CHT and DS declare no conflicts of interest. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population., Methods: We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires., Results: The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program., Conclusion: This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: To systematically assess the prevalence of decreased intrinsic capacity in older adults, stratified by relevant factors such as country, sex, sample source, and region., Methods: We conducted a comprehensive search of PubMed, Web of Science, EMBASE, The Cochrane Library, PsychINFO, CINAHL, China Knowledge Resource Integrated Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database to collect studies published on the decline of intrinsic capacity in older adults before February 24, 2023. The results of the study were analyzed using the Stata 15.0 software package, using a random-effects model to estimate the pooled detection rate of decreased intrinsic capacity in older adults. The Joanna Briggs Institute Critical Appraisal Tool was used to assess the quality of all included studies., Results: A total of 16 studies (67,881 older adults in 4 countries) were included. The results showed that the pooled detection rate of decreased intrinsic capacity in older adults was 76.1% (95% CI: 68.0%-84.2%). The 16 studies had obvious heterogeneity, and further subgroup analysis showed that the detection rate of decreased intrinsic capacity in older adults was higher in developed countries, females, and hospitals. Thirteen studies found that the pooled detection rate was 73.7% (95%: CI 64.5%-82.8%) for decreased intrinsic capacity in Chinese older adults, with higher rates in mainland China and Hong Kong than in Taiwan., Conclusions: Our study suggests that intrinsic capacity declines more rapidly in older adults. Understanding the degree of decline in the intrinsic capacity of older adults will help to provide an important basis for the formulation and development of care policies for older adults., Trial Registration Number: PROSPERO (CRD42023402680)., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The incidence rate of AL (light-chain) amyloidosis is not known in Asia. We conducted a retrospective cohort study using the Taiwan National Healthcare Insurance Research database and Death Registry to estimate incidence and all-cause case fatality rates, and characteristics of patients with AL amyloidosis in Taiwan. All patients with confirmed, newly diagnosed AL amyloidosis from 01-Jan-2016 until 31-Dec-2019 were enrolled and followed up until dis-enrolment, death or study end (31-Dec-2019). There were 841 patients with newly diagnosed AL amyloidosis with median age of 61.4 years and 58.7% were men. At diagnosis, cardiac, renal and liver-related diseases were present in 28.54%, 23.19% and 2.14% of patients, respectively. AL amyloidosis age-adjusted annual incidence was 5.73 per million population in 2016 and 5.26 per million population in 2019. All-cause case fatality ranged from 1.7 to 2.9% over the study period and was highest (~10%) in patients ≥ 80 years. Survival was significantly lower in patients with co-morbid cardiac, renal, or liver-related diseases which could indicate organ involvement. The incidence of AL amyloidosis in Taiwan appears to be similar to Western countries. The poor prognosis in patients with co-morbid diseases highlights the need for earlier diagnosis., (© 2022. The Author(s).)

Background: Long-acting injectable (LAI) antipsychotics improve medication adherence in patients with schizophrenia and extend the duration of therapeutic drug levels but with administration of an increased dose. Real-world mortality data in patients prescribed LAIs are lacking. We conducted a population-based cohort study to estimate and compare the incidence rates of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder exposed to LAIs and oral antipsychotics., Methods: Patients with a diagnosis of schizophrenia/schizoaffective disorder between January 1, 2015 and November 30, 2019 were enrolled from the Taiwan National Health Insurance Research Database and linked to Death Registry records. Eligible patients were new antipsychotic users. Relative risks of death for each antipsychotic compared with oral paliperidone were evaluated using a Cox proportional hazard model adjusted for age, sex, Charlson Comorbidity Index, index year, bipolar or major depressive or other mood disorders, mental disorders due to drug use, and baseline hospitalization frequency., Results: There were 228,791.08 person-years of follow-up (mean 2.48 years). The incidence rates of all-cause death in users of LAI paliperidone administered monthly (PP1M) and every 3 months (PP3M) were 7.40/1,000 person-years (95% confidence interval 5.94-9.11) and 9.93 (5.88-15.79), respectively. The incidences of completed suicide were 2.03/1,000 person-years (1.32-2.99) and 3.10 (1.14-6.88), respectively. No significant associations were observed between PP1M and PP3M compared to oral paliperidone in incidences of all-cause death or for completed suicide., Discussion: No increased risk of all-cause death or completed suicide was observed in users of antipsychotic LAIs, including PP1M and PP3M.

Thirty-two surface sediment samples, collected from the Taiwan Strait (TWS), were investigated for the occurrence, composition profile, and spatial distribution of polycyclic aromatic hydrocarbons (PAHs) and oxygenated PAHs (OPAHs). PAHs were ubiquity in the TWS with a total concentration (∑PAHs, excluding naphthalene due to its high volatility) ranging from 17.8-213 ng g -1 . Benzo[b] fluoranthene, fluoranthene, phenanthrene, and pyrene were the predominant PAHs. Also, eight OPAHs were detected, having a cumulative concentration range (∑OPAHs) of 10.5-118 ng g -1 , predominated by anthraquinone and 6H-Benzo[c,d]Pyren-6-one. Higher concentrations of ∑PAHs and ∑OPAHs were detected at sampling sites adjacent to the mainland and in the northwest part of the TWS. The results suggested important continental input, and particle sedimentation under the specific hydrodynamic conditions of the region. Based on the measured concentrations and sediment quality guidelines, PAHs had a limited ecological impact on the area., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The optical design and performance of the recently opened 13A biological small-angle X-ray scattering (SAXS) beamline at the 3.0 GeV Taiwan Photon Source of the National Synchrotron Radiation Research Center are reported. The beamline is designed for studies of biological structures and kinetics in a wide range of length and time scales, from angstrom to micrometre and from microsecond to minutes. A 4 m IU24 undulator of the beamline provides high-flux X-rays in the energy range 4.0-23.0 keV. MoB 4 C double-multilayer and Si(111) double-crystal monochromators (DMM/DCM) are combined on the same rotating platform for a smooth rotation transition from a high-flux beam of ∼4 × 10 14  photons s -1 to a high-energy-resolution beam of ΔE/E ≃ 1.5 × 10 -4 ; both modes share a constant beam exit. With a set of Kirkpatrick-Baez (KB) mirrors, the X-ray beam is focused to the farthest SAXS detector position, 52 m from the source. A downstream four-bounce crystal collimator, comprising two sets of Si(311) double crystals arranged in a dispersive configuration, optionally collimate the DCM (vertically diffracted) beam in the horizontal direction for ultra-SAXS with a minimum scattering vector q down to 0.0004 Å -1 , which allows resolving ordered d-spacing up to 1 µm. A microbeam, of 10-50 µm beam size, is tailored by a combined set of high-heat-load slits followed by micrometre-precision slits situated at the front-end 15.5 m position. The second set of KB mirrors then focus the beam to the 40 m sample position, with a demagnification ratio of ∼1.5. A detecting system comprising two in-vacuum X-ray pixel detectors is installed to perform synchronized small- and wide-angle X-ray scattering data collections. The observed beamline performance proves the feasibility of having compound features of high flux, microbeam and ultra-SAXS in one beamline., (open access.)

Despite evidence that breast cancer screening effectively diagnoses and treats cancer through early detection, mammography use remains low in Taiwan. We applied the health belief model (HBM) and the knowledge-attitude-behavior (KAB) model as theoretical frameworks to examine factors associated with mammography uptake among women aged 45-69 years in Taiwan. A cross-sectional survey January-July 2018 was conducted of women aged 45-69 years in five southern Taiwan health institutions. Survey questionnaires included demographics, HBM constructs, and health knowledge regarding breast cancer and screening. Multivariable logistic regression models explored the mediation effects of HBM constructs between health knowledge and mammography use. The final analytical sample included 621 women; 67 did not receive mammography and 554 received mammography. When the regression model was adjusted only for demographic factors, women with adequate health knowledge were more likely to undergo mammography (AOR = 2.321, 95%CI = 1.141-3.809); in regression models including health knowledge and HBM constructs, the likelihood effect of health knowledge declined and became insignificant (AOR = 1.711, 95%CI = 0.985-2.972), indicating potential mediation effects between health knowledge and up-to-date mammography use. Overall, based on the HBM and the KAB theoretical framework, our data support that health belief played a substantial mediating role in the association between health knowledge and mammography uptake, in particular perceived barriers and cues to action in the HBM, which were modifying factors of health beliefs. Therefore, to improve mammography uptake, it may be helpful to design educational model-based interventions through tackling those modifiable perceived barriers and enhancing the intensity of external cues to action., (© 2020. American Association for Cancer Education.)

Objective: To analyze the regional inequality of height among Chinese Han students aged 7 to 18 years from 1985 to 2014. Methods: The Chinese Han students aged 7 to 18 years with complete basic information and height data from 30 mainland provinces (excluding Hong Kong, Macao, Taiwan and Tibet in China) were extracted as participants from 6 successive cross-sectional surveys of the Chinese National Survey on Student's Constitution and Health (CNSSCH). After excluding extreme and illogical cases, a total of 1 495 182 students were included in the analysis. The data of gross domestic product (GDP) per capita of each province at each survey year were collected from the website of National Bureau of statistics of China. Mann-Kendall trend test was used to analyze the trend of mean height across years. Weighted linear regression model was used to analyze the association between mean height of students aged 7 to18 years and GDP per capita at provincial level. Height difference, height ratio, slope index of inequality (SII) and relative index of inequality (RII) were used to measure the height inequality by gender and age groups. Results: The mean height of Chinese Han students aged 7 to 18 years increased from 144.9 cm in 1985 to 151.8 cm in 2014 ( P <0.05). The height difference between urban and rural students in all age groups was reducing ( P <0.05). The height difference between urban and rural boys aged 13 to 15 years decreased from 5.3 cm in 1985 to 2.5 cm in 2014, and the difference between urban and rural girls aged 7 to 12 years decreased from 4.6 cm in 1985 to 2.4 cm in 2014. The mean height of students aged 7 to 18 years was positively associated with GDP per capita in all survey years for both genders ( P <0.001). Taking Shanghai and Guizhou as the representatives of economically developed and underdeveloped provinces, from 1985 to 2014, the height differences between two provinces were 6.8-9.2 cm, 8.0-12.4 cm and 6.3-8.8 cm for boys aged 7 to 12 years, 13 to 15 years and 16 to 18 years, respectively, and the height ratios were stable at 1.05-1.07, 1.05-1.08 and 1.04-1.05 respectively. From 1985 to 2014, the SII of mean height for boys in three age groups were 4.4-6.2, 4.9-6.7 and 2.5-4.7, respectively. The RII of mean height of boys in three age groups were 1.03-1.05, 1.03-1.04 and 1.01-1.03, respectively. In the same period, the SII of mean height for girls in three age groups were 4.2-6.2, 2.8-4.5 and 2.5-3.9, and the RII were 1.03-1.05, 1.02-1.03 and 1.02, respectively. Conclusion: From 1985 to 2014, the urban-rural inequality of height development among Chinese Han students aged 7 to 18 years was narrowing, but the socio-economic inequality of height persisted and remained at a relatively stable level.

Complete disease journey and risk factors for poor outcomes are needed to facilitate effectiveness evaluations of new therapies and clinical decision-making in B-cell Non-Hodgkin lymphoma (B-NHL), particularly in Asia where such data are lacking. This retrospective cohort study used electronic medical records from a regional medical centre in southern Taiwan to follow-up 441 patients newly diagnosed with common B-NHL subtypes: Diffuse Large B-cell Lymphoma (DLBCL), Follicular Lymphoma (FL), Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma (CLL/SLL), Marginal Zone Lymphoma (MZL), Mantle Cell Lymphoma (MCL), and Waldenström macroglobulinemia (WM), between 01-Jan-2008 and 31-Dec-2013, until 31-Dec-2017. Treatment pathways were modelled using a Markov approach. Stage III/IV disease at diagnosis was frequent for patients with DLBCL, FL, MCL and WM. Hepatitis B surface antigen/hepatitis C virus seropositivity was 18.6%/12.3%. Clinical responses to 1st-line treatment were observed in 76.0% (DLBCL), 87.3% (FL), 86.0% (MZL), 60.0% (MCL), and 42.9% (WM) of patients. For DLBCL, disease control was achieved by ~ 50% after 1st-line, ~ 24% after 2nd-line, ~ 17% after 3rd-line. Patients with Stage III/IV DLBCL or age > 65 years at diagnosis had lower rates of active treatment, poorer disease control and higher mortality than patients with early stage disease or age ≤ 65 years. Disease flare < 6 months after 1st-line treatment was significantly associated with mortality. Despite good clinical response rates for some sub-types, survival remains poor. New treatments are needed to improve the outcome of B-NHL.

The quarantine and treatment plays an important role in prevention and control of respiratory infectious diseases. It has been nearly 200 years since sanatorium model was adopted to isolate and treat patients with tuberculosis(TB). The era of the Republic of China was an important period for the model to sprout and expand. TB sanatorium was established in the early 20th century in China, and flourished in the 1930s. Establishment and changes of TB sanatoriums in Peking, Shanghai and Hangzhou during the era of the Republic of China, has great significance for sorting out the clues of China's anti-TB history, exploring historical trends of TB in China, and most important of all, summing up valuable lessons.

This study aimed to identify knowledge gaps regarding coronavirus disease 2019 (COVID-19) and develop an integrated educational program for healthcare workers. First, we designed and validated ten multiple-choice questions to identify knowledge gaps among healthcare workers. Within one month of the online test and curriculum offering, 5533 staff had completed the test, with a completion rate of 84.97%. There were 2618 healthcare workers who answered the pre-test 100% correctly. Those who did not answer the pre-test 100% correctly took multiple tests after learning through the online teaching materials. Eventually, 5214 staff passed the test (pre-test or post-test with 100% correct answers). The result showed that all staff had a low correct rate for personal protective equipment (PPE) use recommendations. The Infection Control Center conducted training sessions for hospital staff on how to wear protective clothing. Information on the selection and use of PPE for infection prevention was provided, and participants were allowed time to practice and familiarize themselves with the correct way to wear PPE. Moreover, the Department of Education and Research continued updating the online learning materials based on the most important updated peer-reviewed published articles. The attending teaching physicians helped to search, translate, and take notes on articles in the local language (traditional Chinese) for other colleagues to read easily. We expect to increase learning opportunities for healthcare workers, even during uncertain times such as the current coronavirus pandemic through (1) the hospital-wide course announcements, (2) the continuous placement of test questions and learning files on the digital learning platform, (3) the placement of journal highlights in cloud folders, and (4) the use of the digital learning platform on mobile phones accessible outside the hospital.

Limited real-world data are available regarding treatment practices and outcomes of multiple myeloma (MM) in Asia. We conducted a retrospective cohort study using the Taiwan National Healthcare Insurance Research database and Taiwan Death Registry and used a Markov model to describe disease progression and outcomes in 4092 patients newly diagnosed with MM from 01-Jan-2007 to 31-Dec-2015. We observed marked differences in the characteristics, length and outcome of the clinical journey between patients who did/did not receive autologous stem cell transplant, and between patients initiated on novel agents versus other treatment regimens. In transplant recipients, initiation with combined thalidomide + bortezomib increased over time (12.2-77.5%). Progression-free survival after first-line treatment improved and a lower percentage of patients died. Lenalidomide in second and third-line regimens increased (15.5-31.5%). In non-transplanted patients, initiation with novel agents increased (17.5-54.6%), but death rates remained high (60.3%). The treatment landscape of MM in Taiwan has evolved, with increased use of combined bortezomib + thalidomide for first-line and lenalidomide for second/third-line but many patients die before receiving second-line treatment. Novel agents with different modes of action should be used as early as possible to maximize their benefits. Improved MM treatments remains a critical medical need.

Purpose: The impact of gastrointestinal bleeding (GIB) on outcomes of patients with bloodstream infection (BSI) has not been studied. We aim to evaluate the risk factors and survival impact of GIB on the outcome of BSI., Materials and Methods: This study was conducted prospectively at National Taiwan University Hospital Yunlin Branch between January 1, 2015, and December 31, 2016. Patients aged ≥18 years for who BSI was confirmed by blood cultures were enrolled and followed for 90 days. Risk factors of GIB were identified by univariable and multivariable logistic regression models. The survival impact of GIB on BSI was evaluated with the Cox proportional hazards model with inverse probability of treatment weighting., Results: Of the 1034 patients with BSI, 79 (7.64%) developed acute GIB. We identified 5 independent predictors of GIB. Patients with BSI complicated with GIB had an increased 90-day mortality compared to patients without GIB (hazard ratio 1.74, 95% confidence interval: 1.14, 2.65)., Conclusions: Gastrointestinal bleeding had an adverse impact on the short-term survival in patients with BSI. The clinical predictors may help identify patients who may benefit from active prevention and treatment of GIB.

Competing Interests: The authors have no conflicts of interest relevant to this article.

Longer survival in patients with multiple myeloma (MM) after treatment with novel agents (NA) such as thalidomide, bortezomib, and lenalidomide may be associated with increased risks of developing second primary malignancies (SPM). Few data describe the risk of SPM in patients with MM in Asia. This population-based retrospective cohort study assessed the risk of SPM in MM using the Taiwan National Cancer Registry and National Health Insurance Research databases from 2000 to 2014. Among 4,327 patients with newly diagnosed MM initiated with either novel agents alone (NA), chemotherapy combined with novel agents (CCNA), or chemotherapy alone (CA), the cumulative incidence of SPM overall was 1.33% at year 3. The SPM incidence per 100 person-years (95% confidence interval [CI]) was 0.914 (0.745-1.123) overall, 0.762 (0.609-1.766) for solid tumours, and 0.149 (0.090-0.247) for haematological malignancies. We compared risks of SPM using a cause-specific Cox regression model considering death as a competing risk for developing SPM. After controlling for age, gender, Charlson Co-morbidity Index, and time-period, the risk of developing any SPM or any haematological malignancy was significantly reduced in patients initiated on NA (2010-2014 period) compared to chemotherapy alone (adjusted hazard ratio 0.24, 95% CI 0.07-0.85, and 0.10, 95% CI 0.02-0.62, respectively). Contemporary treatment regiments using NA (mainly bortezomib) were associated with a lower risk for a SPM in comparison with CA.

Background: Workplace bullying is commonly experienced by nurses worldwide., Purpose: This study was conducted to examine the determinants of different types of workplace bullying and their relationship to depression in female nurses., Methods: A cross-sectional correlational study was employed, and 484 female nurses from a large medical center in southern Taiwan completed the questionnaire. Data were analyzed using logistic regression analysis., Results: Being unmarried and working in medical/surgical units were found to be the major determinants of work-related bullying, whereas being unmarried was found to be the single determinant of person-related and physical-intimidation bullying. Moreover, work-related and person-related bullying were both found to be significant determinants of depression., Conclusions/implications for Practice: Nursing administrators should establish workplace-bullying prevention and management strategies by setting reasonable and equal workloads for nurses, assigning tasks equitably, and building depression-related support and consultation groups.

Heart failure (HF) is a chronic, progressive disease that substantially decreases patients' quality of life. Few studies have compared quality of life and its related factors across genders in patients with HF. To explore gender differences in quality of life and related factors among adult patients with HF. A comparative study was conducted with 245 HF patients recruited from a medical center and a regional teaching hospital in Taiwan from February 2009 to February 2011. Descriptive and inferential statistics were used, including stepwise multiple regressions. The mean quality of life scores of males were significantly higher than those of females (87.78 ± 13.99 vs. 84.49 ± 11.85). The factors significantly related to quality of life for the male HF patients, in descending order of strength of association were depressive symptoms, physical symptoms, and monthly family income-less than USD 1,000; for the females, the significantly related factors were physical symptoms, depressive symptoms, and monthly family income-less than USD 1,000. The amount variance for which quality of life accounted for male and female HF patients was similar (60% vs. 64%). The results could be used for health professionals to provide more appropriate assessments and care according to gender in the future.

We evaluated whether previously reported latent profiles of burnout among health-care workers (Leiter & Maslach, 2016) would generalize to a new sample of research and development (R&D) workers. We also extended recent reviews (e.g., Harari, Swider, Steed, & Breidenthal, 2018) by using a multilevel approach to the study of perfectionism and burnout in R&D teams in Taiwanese companies. Following a stress-generation model, we examined the association between perfectionistic strivings, perfectionistic concerns, and burnout based on data collected from 760 R&D employees and their 195 team leaders. The latent profiles that emerged differed more by level than kind; therefore, we implemented more parsimonious latent-variable modeling to test worker-level models involving perfectionistic strivings, concerns, and their interaction in predicting 3 dimensions of worker burnout. The latent interaction was significant only in the prediction of cynicism and revealed a general buffering effect of strivings on the negative effects of concerns. However, multilevel analyses that included leader perfectionism as a cross-level predictor revealed only conditional effects and no significant interactions. Overall, perfectionistic strivings had positive effects in association with lower levels of burnout, and perfectionistic concerns had negative effects and seemed to be a strong risk factor for burnout. High levels of perfectionistic concerns from leaders further increased the risk for 2 of the 3 dimensions of worker burnout. The results are discussed in light of theoretical and practical implications and future research into work-related contextual considerations, including culture and work environment, that might increase or decrease the effects of perfectionism on important outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).