Search

This study proposes a home-assembled, low-cost blue light-emitting diode (LED) photometer that uses simple and low-cost hardware and software, costing about US $150. This 425-nm wavelength photometer is controlled by an 89C51 microcontroller chip. Glucose concentration detection experiments involving enzyme coupling reactions were carried out to verify the performance of the proposed system. Measurement errors for the system were between 3% and 4%, which can be further improved to less than 2%. The proposed LED photometer can be used by students in electronics classes to conduct biotechnological tests as part of their electrical and electronics vocational high school education. This can help them to explore the basic applications of biosensors and enhance their professional abilities in executing fundamental bioelectronics processes. Pretest and post-test assessments of students' knowledge of bioelectronics were conducted to determine the efficacy of the proposed system in enhancing students' knowledge. The LED photometer can be modified to test various samples in biochemistry and analytical chemistry, and it can also be applied to various fields such as electronics, chemical engineering, and biochemistry.

Background and Objectives: Treatment for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) must deal with immunosuppression, as well as infections associated with a compromised immune system, such as tuberculosis (TB). Our aim was to examine the risk of incidental TB after diagnosis of AAV. Materials and Methods: This retrospective population-based cohort study was based on the data from the National Health Insurance Research Database in Taiwan. Patients with newly diagnosed granulomatous polyangiitis or microscopic polyangiitis were identified between 1 January 2000 and 31 December 2012. The primary outcome was risk of incidental TB. Cox proportional hazard models were used to evaluate the association between AAV and incidental TB. Results: A total of 2257 patients with AAV and a propensity-score matched cohort of 9028 patients were studied. Overall, patients with AAV were at a 1.48× higher risk of contracting incidental TB than the patients in the matched cohort (adjusted HR 1.48; 95% confidence interval [CI], 1.02–2.15). Note that the highest risk of contracting incidental TB was in the first two years following a diagnosis of AAV, with a nearly 1-fold increase in risk (adjusted HR, 1.91; 95% CI, 1.01–3.60). Female AAV patients were 3.24× more likely than females without AAV to develop TB (adjusted HR 3.24; 95% CI, 1.85–5.67). Conclusions: Patients with AAV exhibit a 48% elevated TB risk, notably, a 91% increase within the first two years postdiagnosis. Female AAV patients face a 3.24 times higher TB risk compared to females without AAV. This study is limited by potential misclassification and overestimation of AAV cases. Clinicians should closely monitor TB risk in AAV patients, especially in females and the initial two years following diagnosis. [ABSTRACT FROM AUTHOR]

This study delves into the offshore fishing industry in Taiwan, emphasizing the significance of the aquatic product market, supply chain development, and the maturity of cold chain technology. Taiwan's geographical advantage of being surrounded by the sea provides a thriving environment for marine resources and migratory fish. This study is motivated by the increasing demand for diverse fish products, driven by the growing need for high-quality protein. Recognizing the importance of meeting this demand, this study aims to investigate the capacity of logistics systems and cold storage in the offshore fishery industry, particularly under conditions of uncertainty. To tackle the optimization challenges prevalent in the offshore fishery supply chain, this study employs the bat algorithm (BA), a metaheuristic algorithm inspired by the remarkable echolocation behavior of bats. Additionally, a systematic literature review methodology is utilized to gather relevant articles and establish a comprehensive understanding of the study domain. This study culminates in proposing an optimized fishing model for the offshore fishery supply chain, highlighting the significance of evaluating supply chain value from a management perspective and identifying existing deficiencies and bottlenecks in current research. By focusing on optimizing the offshore fishery supply chain, this study aims to enhance the industry's efficiency and effectiveness, providing valuable insights and recommendations to improve the capacity of logistics systems and cold storage. Furthermore, this study presents the results of the BA, showcasing its effectiveness in approaching optimization challenges, thereby validating its utility for the offshore fishery industry. Sensitivity analysis reveals the potential for higher profits by raising the inventory limit of the manufacturer, enabling the supplier to provide materials to more profitable trading partners. While this study is based on a revenue and cost model, it acknowledges that the objectives and constraints would become more complex in varying logistic system circumstances. The future study aims to expand the scale of the model and incorporate practical cases to further enhance its applicability. [ABSTRACT FROM AUTHOR]

Background: This phase IIIb, open-label study enrolled patients from nine Asian and Middle Eastern countries to evaluate the safety and efficacy of the combination therapy in underrepresented patient populations from the Breast Cancer Trials of Oral Everolimus-2 (BOLERO-2). Here, we report the Taiwanese subset data. Materials and Methods: The primary objective was to evaluate the safety and tolerability of everolimus and exemestane (EVE + EXE); the secondary endpoints included progression-free survival (PFS), response rates, and clinical benefit rate. Postmenopausal patients who had metastatic, recurrent, or locally advanced hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC) refractory to nonsteroidal aromatase inhibitor (NSAI) and had received EVE + EXE were recruited. Results: From March 2013 to October 2014, 235 postmenopausal women were enrolled in EVEREXES. Taiwanese patients (n = 22) had similar baseline characteristics compared with BOLERO-2 cohort; most (17/22) had discontinued due to disease progression. Only two patients dropped out due to unacceptable adverse events (AEs) despite worse stomatitis (any 77.3%; grade 3/4, 18.2%). Other common AEs included pneumonitis (45.5%), rash (27.3%), and hyperglycemia (9.1%). PFS and safety in EVEREXES compared favorably with BOLERO-2, especially among Taiwanese patients (median: 49 weeks; 95% confidence interval = 19.3-82.0). Conclusion: Although EVEREXES had a small Taiwanese population, the encouraging outcomes compared with BOLERO-2 showed that EVE + EXE is safe for Taiwanese patients with HR+ HER2- ABC who progressed on NSAIs. Large-scale verification is warranted. [ABSTRACT FROM AUTHOR]

This study investigates dynamic retirement patterns in Taiwan using longitudinal data. We identify two forms of transitional behaviors referred to as "phased retirement": (1) the arrangement of work reduction before retiring from a job, and (2) the presence of "bridge employment" after a declared retirement. The determinants of these transitional behaviors are estimated with logistic models. Earned income and occupational attributes are found to be persistently relevant in predicting both behaviors, while gender does not seem relevant. Health and spousal attributes have significant effects on the behavior of bridge employment but not on pre-retirement work reduction. We further explore the association between phased retirement behaviors and the duration of working life using the Cox proportional hazard model, and bridge employment appears to be an effective means to extend working life. However, we did not find a positive association between within-job phased retirement and the length of working life. [ABSTRACT FROM AUTHOR]

Aim: Global warming and deforestation are pushing species closer to their physiological limit, especially for species with habitat‐restricted life stages because sunlit areas have higher maximum temperatures. Here, we examined the critical thermal maximum (CTmax), and maximum environmental water temperature (Tmax) of larvae from 29 anuran species across a latitudinal gradient (22–43° N) to test how latitude and habitat type (open or closed‐forest ponds) affected warming tolerance, an index of vulnerability to climate change. Location: Taiwan, Korea, Japan. Time period: Present. Major taxa studied: Anurans. Results: We showed that open ponds lowered warming tolerance, regardless of latitude and phylogenetic clustering, contrasting the established literature that warming tolerance is lower at tropical latitudes, which only applied to species in forest ponds in this study. Importantly, biophysical models at the local scale suggest that increasing deforestation will exacerbate the effects of climate warming on warming tolerance. Main conclusions: Local effects of accelerated warming and habitat modification mean that species with range‐restricted life stages will become more vulnerable to anthropogenic change. [ABSTRACT FROM AUTHOR]

To determine phenotype-related dupilumab response in adult patients with atopic dermatitis (AD), this multicenter, retrospective study included 111 adults with moderate-to-severe AD in Taiwan, with median age of 31.5 years (18–87) and 71 (64.0%) males. Patients received dupilumab 300 mg per two to three weeks up to 12 months. We found a significant improvement after 4 and 16 weeks of treatment in all patients for all the assessed scores, including eczema area and severity index (EASI) improvement ≥50% (EASI-50) and 75% (EASI-75), EASI reaching minimal clinically important difference (MCID), and Investigator's Global Assessment (IGA) improvement ≥2. Importantly, prior to asthma, early AD onset and 3-week drug intervals were significantly associated with a high proportion of EASI-75 at month 12, while prurigo and lichenoid phenotypes were associated with a lower proportion of EASI-75 at month 12. However, the majority of adverse events were mild in severity. In conclusion, our study results identify phenotype-related dupilumab response at month 12 in adults with moderate-to-severe AD, and we suggest that treatment should not be discontinued until reaching a satisfactory clinical response. [ABSTRACT FROM AUTHOR]

The progress of industrial development naturally leads to the demand for more electrical power. Unfortunately, due to the fear of the safety of nuclear power plants, many countries have relied on thermal power plants, which will cause more air pollutants during the process of coal burning. This phenomenon as well as increased vehicle emissions around us, have constituted the primary factors of serious air pollution. Inhaling too much particulate air pollution may lead to respiratory diseases and even death, especially PM $_{2.5}$ 2. 5 . By predicting the air pollutant concentration, people can take precautions to avoid overexposure to air pollutants. Consequently, accurate PM $_{2.5}$ 2. 5 prediction becomes more important. In this study, we propose a PM $_{2.5}$ 2. 5 prediction system, which utilizes the dataset from EdiGreen Airbox and Taiwan EPA. Autoencoder and Linear interpolation are adopted for solving the missing value problem. Spearman’s correlation coefficient is used to identify the most relevant features for PM $_{2.5}$ 2. 5 . Two prediction models (i.e., LSTM and LSTM based on K-means) are implemented which predict PM $_{2.5}$ 2. 5 value for each Airbox device. To assess the performance of the model prediction, the daily average error and the hourly average accuracy for the duration of a week are calculated. The experimental results show that LSTM based on K-means has the best performance among all methods. Therefore, LSTM based on K-means is chosen to provide real-time PM $_{2.5}$ 2. 5 prediction through the Linebot. [ABSTRACT FROM AUTHOR]

Knowledge of biodiversity before species become extinct is paramount to conservation, especially when the relevant species are far from their expected distribution and, thus, likely overlooked. Here, we describe a new Kurixalus species corresponding to a range extension of Kurixalus on the Asian mainland, with the closest population in Taiwan. The species diverged from its closest relative during the Late Pliocene to Pleistocene, ca. 3.06 Mya (HPD 95%: 5.82-0.01), based on calibrations with a relaxed clock species tree of unlinked mtDNA 12S rRNA and nuclear DNA TYR. The status of the newly-described species is also supported by a divergence in call properties and morphometrics. We named the species described here as Kurixalus inexpectatus sp. nov. due to the nature of the discovery, as well as the adjunct distribution of the species relative to its closest congeners. The species was found in Zhejiang Province and it represents a range extension of 663 km for the Kurixalus genus. [ABSTRACT FROM AUTHOR]

Global warming is the main cause for the rise of both global temperatures and sea-level, both major variables threatening biodiversity. Rising temperatures threaten to breach the thermal limits of organisms while rising sea-level threatens the osmotic balance of coastal animals through habitat salinization. However, variations in thermal tolerance under different salinity stresses have not yet been thoroughly studied. In this study, we assessed the critical thermal maxima (CTmax) of amphibian tadpoles in different salinity conditions. We collected tadpoles of Duttaphrynus melanostictus, Fejervarya limnocharis and Microhyla fissipes from coastal areas and housed them in freshwater, low, and high salinity treatments for 7 days of acclimation. The CTmax, survival rate, and development rate of tadpoles in high salinity treatments were significantly lower than that of the two other treatments. Our results indicate that physiological performances and heat tolerances of tadpoles are negatively affected by salinization. Maximum entropy models showed that CTmax and sea-level rise are predicted to negatively affect the distribution of the three focal species. The present results suggest that global warming can lead to negative dual-impacts on coastal animals because of reduced thermal tolerances at elevated salinity. The impacts of global warming on anurans in coastal areas and other habitats impacted by salinization may be more severe than predicted and it is likely to cause similar dual-impacts on other ectotherms. [ABSTRACT FROM AUTHOR]

Background Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices. Methods Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined. Results Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively. Conclusions Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased. [ABSTRACT FROM AUTHOR]

Manual titration of positive airway pressure (PAP) is a gold standard to provide an optimal pressure for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAS). Since manual titration studies were costly and time-consuming, many statistical models for predicting effective PAPs were reported. However, the prediction accuracies of the models associated with nocturnal parameters still remain low. This study proposes a fuzzy neural prediction network (FNPN) with input candidate variables, selected among easily available measurements (e.g., body mass index (BMI), waist circumstance (WC), and body composition) and OSAS related questionnaires, to rapidly predict an optimal PAP. The FNPN comprises fuzzy rules and is characterized with the ability of automatic rule growing and pruning from training data. A total of 147 participants from April 2018 to April 2019 were enrolled in Taichung Veterans General Hospital, Taiwan. After two selection processes for feature extraction, WC and BMI were the significant variables for entering the FNPN to predict optimal PAP. Experimental results showed that the average successful prediction rate of the proposed method was 71.8%. This study also found that Epworth sleepiness scales (ESS) and body composition, such as visceral fat area and percent body fat, were excluded in the final prediction model. Compared with existing models, the proposed prediction approach provided a rapid prediction of optimal PAP with higher accuracy. [ABSTRACT FROM AUTHOR]

Background: The trend of women suffering from early-onset breast cancer is increasing in Taiwan. The association of early-onset breast cancer with body mass index (BMI), menarche, and menopausal status has focused interest on the field of cancer epidemiology; however, few studies have explored the interaction of these factors on early-onset risk. This study aimed to estimate the interaction effects of BMI, menarche, and menopausal status on 40-year-old early-onset breast cancer.Methods: Breast cancer patients were recruited from Kaohsiung Medical University Chung-Ho Memorial Hospital from 2013 to 2020. Multivariable logistic regression was used to estimate odds ratios (ORs) for early-onset breast cancer risk associated with menarcheal age stratified by sociodemographic factors and for the interaction between BMI and menopausal status on early-onset risk.Results: A total of 775 participants were divided into 131 early-onset cases (≤ 40 years) and 644 late-onset cases (> 40 years). Compared to the age of 13 years at menarche, the age ≤ 11 years was significantly positively associated (OR: 2.62, 95% CI: 1.38-4.97) and ≥ 16 years was negatively associated (OR: 0.13, 95% CI: 0.03-0.53) with 40-year-old early-onset breast cancer respectively. In an adjusted model, the status of BMI < 24 and premenopause had 1.76- and 4.59-fold risk of early-onset breast cancer respectively. Especially in BMI < 24 status, premenopause also had a 6.47-fold early-onset risk and the early-onset risk increased by a significant amount per one year younger at menarche (aOR: 1.26, 95% CI: 1.03-1.55). There was also a positive interaction effect on an additive scale between BMI and menopausal status on early-onset breast cancer (RERIOR = 4.62, Pinteraction = 0.057). Compared to both BMI ≥ 24 and peri-/postmenopausal status, both the status of BMI < 24 and premenopause were associated with early-onset breast cancer (aOR: 7.16, 95% CI: 3.87-13.25).Conclusions: This study suggests that the status of BMI < 24 and premenopause were associated with an increased risk of early-onset breast cancer and there was a positive interaction on an additive scale. Understanding how obesity and menopausal status affect early-onset breast cancer is important for drafting preventive measures for early-onset breast cancer in Taiwan. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effectiveness of neoadjuvant chemotherapy in patients with breast cancer in different age groups and evaluate the impact of age group on survival outcome according to different treatment responses. Data were retrospectively collected from the cancer registry database of Kaohsiung Medical University Hospital in Taiwan under an approved protocol. Overall, 96 elder patients (aged >50 years) and 96 younger controls (aged ≤50 years) who received neoadjuvant chemotherapy and breast surgical treatment were examined after 1:1 matching. Logistic regression analysis was used to investigate the effectiveness of treatment response in patients of different age groups. Additionally, the Kaplan–Meier estimator and log‐rank test were performed to evaluate the effect of age group and treatment response on disease‐free and overall survival (OS). Although no direct significant association was found between age group and treatment response, several significant results were found in treatment response stratification analysis. Among 16 pathological complete response (pCR) patients, elder patients showed significantly greater 5‐year disease‐free survival (DFS) than younger patients (DFS rate, 85.7% vs. 0%, p = 0.041). However, in 176 non‐pCR patients, elder patients showed poor DFS compared to younger patients (DFS rate, 16.6% vs. 32.3%; log‐rank test, p = 0.031). With limited sample size and study design, our study results demonstrate that patients aged >50 years who achieved pCR after neoadjuvant chemotherapy could obtain better survival outcome than younger patients. However, the younger patients showed no survival benefits regardless of pCR status. [ABSTRACT FROM AUTHOR]

Background: Neuromuscular ultrasound is a complementary technology that aids in the diagnosis of peripheral neuropathy. The interpretation of neuromuscular ultrasound results requires the use of accurate normative cross-sectional area (CSA) reference values. This study aims to provide CSA reference values specific to Taiwanese adults for Sonography of peripheral nerves in the upper and lower extremities. Methods: The study cohort included 66 healthy subjects (36 women; 30 men). A linear probe was used to measure the CSA of the median, ulnar, radial, tibial, sural, and peroneal nerves at multiple sites. These data were analyzed to determine standard ranges for the CSA at each site (reference range = mean ± 2 × SD) and identify correlations between the CSA and patient characteristics. Results: Normative CSA ranges were determined for all the assessed nerve sites, revealing that the nerve sizes in this Taiwanese population were smaller than Caucasian populations but comparable to those reported for other Asian cohorts. Men tended to have larger nerves than women, even after adjusting for height and weight. The size of ulnar nerve in the cubital tunnel and the peroneal nerve in the popliteal fossa correlated negatively with increasing age. The nerve size correlated positively with increasing weight and BMI at several sites, correlation of median nerve in the forearm with weight and BMI was significant after multiple testing. Significant correlation was also found between size of ulnar nerve in cubital tunnel and decreasing height. Conclusion: We provide reference ranges for neuromuscular ultrasound CSA values for the upper and lower extremities that are specific to the Taiwanese population. These reference values may be useful for evaluating peripheral neuropathy in Taiwanese subjects. [ABSTRACT FROM AUTHOR]

In Western countries, breast cancer tends to occur in older postmenopausal women. However, in Asian countries, the proportion of younger premenopausal breast cancer patients is increasing. Increasing evidence suggests that the gut microbiota plays a critical role in breast cancer. However, studies on the gut microbiota in the context of breast cancer have mainly focused on postmenopausal breast cancer. Little is known about the gut microbiota in the context of premenopausal breast cancer. This study aimed to comprehensively explore the gut microbial profiles, diagnostic value, and functional pathways in premenopausal breast cancer patients. Here, we analyzed 267 breast cancer patients with different menopausal statuses and age-matched female controls. The α-diversity was significantly reduced in premenopausal breast cancer patients, and the β-diversity differed significantly between breast cancer patients and controls. By performing multiple analyses and classification, 14 microbial markers were identified in the different menopausal statuses of breast cancer. Bacteroides fragilis was specifically found in young women of premenopausal statuses and Klebsiella pneumoniae in older women of postmenopausal statuses. In addition, menopausal-specific microbial markers could exhibit excellent discriminatory ability in distinguishing breast cancer patients from controls. Finally, the functional pathways differed between breast cancer patients and controls. Our findings provide the first evidence that the gut microbiota in premenopausal breast cancer patients differs from that in postmenopausal breast cancer patients and shed light on menopausal-specific microbial markers for diagnosis and investigation, ultimately providing a noninvasive approach for breast cancer detection and a novel strategy for preventing premenopausal breast cancer. Breast cancer: gut microbes before and after menopause Women developing breast cancer before the menopause have less diverse gut microbe populations than their healthy peers, and significantly different gut microbial profiles than postmenopausal breast cancer patients. There is increasing evidence of a link between gut microbes and breast cancer, but most studies have focused on women after the menopause. The incidence of breast cancer in premenopausal women is increasing, especially in Asia. Researchers in Taiwan led by Chih-Po Chiang at Kaohsiung Medical University Hospital compared gut microbial populations in 267 breast cancer patients at different menopausal stages to matched controls. The results suggest that gut microbe profiling might offer a novel and noninvasive method for diagnosing and monitoring breast cancer. It may also lead to new strategies for prevention and treatment, as evidence emerges of a link between gut microbes and cancer. [ABSTRACT FROM AUTHOR]

Whole-genome doubling (WGD) is an early macro-evolutionary event in tumorigenesis, involving the doubling of an entire chromosome complement. However, its impact on breast cancer subtypes remains unclear. Here, we performed a comprehensive and quantitative analysis of WGD and its influence on breast cancer subtypes in patients from Taiwan and consequently highlight the genomic association between WGD and homologous recombination deficiency (HRD). A higher manifestation of WGD was reported in triple-negative breast cancer, conferring high chromosomal instability (CIN), while HER2 + tumors exhibited early WGD events, with widely varied CIN levels, compared to luminal-type tumors. An association of higher activity of de novo indel signature 2 with WGD and HRD in Taiwanese breast cancer patients was reported. A control test between WGD and pseudo non-WGD samples was further employed to support this finding. The study provides a better comprehension of tumorigenesis in breast cancer subtypes, thus assisting in personalized treatment. Wu, Hsieh et al. analyze Taiwanese breast cancer patient samples using whole-exome sequencing to examine the heterogeneity and homogeneity in the timing and dependencies of somatic aberrations across disease subtypes. The authors focus on somatic alterations and related features that correlate with whole genome doubling, including homologous recombination deficiencies. [ABSTRACT FROM AUTHOR]

Background: The undertreatment of cancer pain is a global issue although many international guidelines and various studies bloom to explore the approaches in pain management. However, there is no standard care for cancer pain in routine practices. To set up a standardized procedure for improving cancer pain management in Taiwan, the Good Pain Management (GPM) program is explored to provide treatments following the US National Cancer Care Network (NCCN) Adult Cancer Pain Guideline.Method: Patients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Pain control, adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses based on the pain medication category were also conducted.Result: Fifty-one patients were enrolled, with 26 and 25 assigned to the GPM and control arms, respectively. Significant differences among the GPM and control arms were found including a greater decrease in the mean numerical rating scale (NRS) score in the GPM arm (- 4.6 vs. - 2.8), a lower proportion of moderate-to-severe pain in the GPM arm (23.2% vs. 39.8%), and a higher pain management index (PMI) score in the GPM arm (0.64 points vs. 0.33 points) (all p < 0.05). Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm.Conclusion: In summary, our study demonstrated that the implementation of a standardized pain assessment and management approach (GPM ward program) showed significant improvements on pain relief, decreased the portion of moderate-to-severe cancer pain, and increased patient satisfaction in the 1st 48 h after admission. The implementation of the GPM approach in the cancer ward may provide sooner and better improvement of cancer pain management for patients who suffered moderate-to-severe cancer pain.Trial Registration: ClinicalTrials.gov (Identifier: NCT03155516). [ABSTRACT FROM AUTHOR]

Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Malignancies after myositis were diagnosed in 61 (5.55%) patients with DM and 38 (3.26%) patients with PM. The cumulative incidence of malignancies in patients with DM were significantly higher than patients with PM (hazard ratio = 1.78, log-rank p = 0.004). Patients with DM had a greater risk of developing malignancy than those with PM at 40–59 years old (p = 0.01). Most malignancies occurred within 1 year after the initial diagnosis of DM (n = 35; 57.38%). Nasopharyngeal cancer (NPC) was the most common type of malignancy in patients with DM (22.95%), followed by lung, and breast cancers. In patients with PM, colorectal, lung and hepatic malignancies were the top three types of malignancy. The risk factors for malignancy included old age (≥ 45 years old) and low serum levels of creatine phosphokinase (CPK) for patients with DM and male sex and low serum levels of CPK for patients with PM. Low serum levels of CPK in patients with myositis with malignancy represented a low degree of muscle destruction/inflammation, which might be attributed to activation of the PD-L1 pathway by tumor cells, thus inducing T-cell dysfunction mediating immune responses in myofibers. A treatment and follow-up algorithm should explore the occurrence of malignancy in different tissues and organs and suggested annual follow-ups for at least 5.5 years to cover the 80% cumulative incidence of malignancy in patients with DM and PM. [ABSTRACT FROM AUTHOR]

Existing literature based in Western society generally supports that people who have high public service motivation (PSM) prefer a public service career, and public organizations are likely to recruit high-PSM individuals. This proposition may not hold in cultures where the public service exam is notoriously competitive. The present study, based in Taiwan, provides evidence showing that a competitive, standardized public service exam, along with its unique social symbolism, can deter high-PSM people from entering the public sector. We then discuss the theoretical and practical implications in the conclusion. [ABSTRACT FROM AUTHOR]

The World Health Organization announced the coronavirus disease 2019 (COVID‐19) outbreak a pandemic on 12 March 2020. Although being in proximity to China, the original epicenter of the COVID‐19 outbreak, Taiwan has maintained a low number of COVID‐19 cases despite its close social ties and heavy traffic between Taiwan and China. Containment strategies executed by the Taiwanese government have attracted global attention. Similarly, in‐hospital settings, high alertness and swift responses to the changing outbreak situation are necessary to ensure hospital staff members' safety so they can continue to save patients' lives. Herein, we present infection control measures that can be adopted in hospital settings that were executed in a Taiwanese hospital to confront the COVID‐19 pandemic, including emergency preparedness and responses from the hospital administration, education, surveillance, patient flow arrangement, the partition of hospital zones, and the prevention of a systemic shutdown by using the "divided cabin, divided flow" strategy. The measures implemented by a Taiwan hospital during the COVID‐19 pandemic may not be universally applicable in every hospital. Nonetheless, the presented infection control methods have been practically executed and can be referenced or modified to fit each hospital's unique condition. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence shows that advance care planning is effective in improving outcomes. However, its applicability and acceptability outside Western cultures remain unknown. Examination of relevant cultural adaptations is required prior to wider adoption. Aim: To examine the feasibility and acceptability of a culturally adapted advance care planning intervention in a Taiwanese inpatient hospital for advanced cancer patients, family members and healthcare professionals. Methods: A single-group, non-controlled, mixed methods feasibility study guided by a previously developed logic model. The culturally adapted advance care planning intervention represented a one-time intervention, comprising pre-advance care planning preparation and follow-up consultation. Qualitative interviews explored participants' view on their involvement in the study. Patients' medical records were examined to assess intervention fidelity. Findings from both data sets were integrated following analysis. Results: N = 29 participants (n = 10 patients; n = 10 family members and n = 9 healthcare professionals) participated in the intervention, of who 28 completed follow-up interviews. Of the 10 advance care planning interventions delivered, most components (n = 10/13) were met. Key contextual moderators influencing the intervention feasibility included: (1) resource constraints resulting in increased workload; (2) care decisions informed by relatives' experiences of care; (3) the requirement for financial and policy support; and (4) a presumption for end-of-life care provision and surrogate decision-making. Six areas of intervention refinement were identified for future research. Conclusion: Implementing a culturally adapted advance care planning intervention in an inpatient hospital setting in Taiwan is possible. The participants reported the intervention to be acceptable. However, careful attention to the conceptual underpinning using local primary data is imperative for its success. [ABSTRACT FROM AUTHOR]

Background: The study's purpose was to examine the effectiveness of different reminder strategies on first-time free mammography screening among middle-aged women in Taiwan.Methods: A quasi-experimental design with random assignment was adopted to divide the participants into three Reminder Strategies groups (mail reminder, telephone reminder, and combined mail and telephone reminders) and one control group. This study recruited 240 eligible middle-aged women, and 205 of them completed the study. Upon the completion of data collection, mail reminders were provided to women of the first group; telephone reminders were provided to the second group; mail followed by telephone reminders were provided to the third group, and the usual postcards were provided to the control group 1 month after the interventions. Two follow-up assessments were conducted 1 and 3 months after the intervention to collect mammography-screening behaviors from all groups.Results: The findings showed that, compared to the control group, more participants in the intervention groups underwent mammography screening after receiving reminder interventions. Telephone contact as reminder was found to have the most significant influence among the interventions (OR = 5.0556; 95% CI = 2.0422-13.5722).Conclusions: Government and healthcare providers are recommended to consider adopting the telephone reminder strategy to encourage women to undergo their first-time mammography screening. [ABSTRACT FROM AUTHOR]

This article empirically compares four electricity-pricing programs—increasing-block pricing (IBP); floating increasing-block pricing (FIBP); free market pricing (FMP); and a price-cum-trade incentive system (PTS)—in terms of efficiency, cost recovery, and income distribution by using the residential electricity data of Taiwan. The research results show that IBP and FIBP suffer from the same problem: It is hard to be cost-neutral. Further, FMP is economically efficient while favoring the electric utility over the households. PTS—which is a pricing program that satisfies the second fundamental theorem of welfare economics—shows a better ability to consider economic efficiency and equity simultaneously. [ABSTRACT FROM AUTHOR]

Background: The disease course and early signs specific to ATTR Ala97Ser, the most common endemic mutation in Taiwan, have not been well described. Since new medications can slow down the rate of disease progression, the early diagnosis of this heterogeneous and fatal disease becomes critical.Methods: We retrospectively reviewed the characteristics of genetically confirmed ATTR Ala97Ser patients at a tertiary referral medical center.Results: Eight patients from 7 different families were enrolled (61.7 ± 5.5 years). Gastrointestinal symptoms, dyspnea or chest tightness, rather than sensory symptoms, were the initial symptoms in two patients (2/7 = 29%). Body weight loss (3/7 = 43%), muscle wasting (4/7 = 57%), or dysphagia (3/7 = 43%) were the consecutive symptoms. Orthostatic symptoms including orthostatic hypotension (7/7 = 100%), dizziness (6/7 = 86%) and syncope (5/7 = 71%) tended to develop in the late phase of the disease. Autonomic dysfunction was conspicuous. Cardiographic findings included a combination of ventricular wall thickening and pericardial effusion (7/7 = 100%), a granular sparkling appearance of the ventricular myocardium (4/7 = 57%), or conduction abnormalities (5/7 = 71%).Conclusions: This study broadens the recognition of the initial signs and symptoms, including cardiographic findings and longitudinal manifestations in Taiwanese individuals with ATTR Ala97Ser mutation. These manifestations should prompt doctors to perform further studies and make an early diagnosis. [ABSTRACT FROM AUTHOR]

Of all the Proteus spp., Proteus mirabilis is the most common species identified in clinical specimens and is a leading agent of complicated urinary tract infection. This study was undertaken to understand the antimicrobial susceptibility, prevalence of antibiotic resistance genes, and molecular typing of P. mirabilis isolates collected from three hospitals in northern Taiwan. The results showed that the collected isolates of P. mirabilis were susceptible to most antibiotics except cefazolin and tigecycline. Many resistance genes were detected in the collected isolates, of which TEM genes were the most common. Resistance to third- or fourth-generation cephalosporins was related to the presence of at least one of the tested extended-spectrum β-lactamase (ESBL) or AmpC genes. The presence of the VEB-1 gene seemed to be a good predictor for both cefepime and ceftazidime resistance, which was further supported by quantitative polymerase chain reaction results. Of the four imipenem-resistant P. mirabilis isolates, three isolates could hydrolyze imipenem by mass spectrometry analysis. Molecular typing by pulsed-field gel electrophoresis showed that the pulsotyping of the selected P. mirabilis isolates was heterogeneous. By analyzing the relationship of antimicrobial resistance and the presence of resistance genes, revision of the Clinical and Laboratory Standards Institute cefepime and ceftazidime MIC breakpoints for Enterobacteriaceae to predict ESBL producers might possibly be needed. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common female‐specific malignancy in Taiwan and developed countries worldwide, and its incidence continues to grow. 14‐3‐3ε (YWHAE), which belong to 14‐3‐3 family, it has been reported up‐regulated in breast cancer tissues. However, the clinical implication and function of YWHAE in breast cancer remains unclear. In this study, we investigated the prognostic value of the YWHAE in human breast cancer. Immunohistochemistry was used to analyze YWHAE expression in breast cancer tissues. Cell model was applied to examine the functions of YWHAE. The chemotherapeutic agents were used to evaluate the effect of YWHAE in breast cancer cell lines. YWHAE expression was associated with tumor size, lymph node metastasis, and poor patient survival in patients with breast cancer. YWHAE overexpression significantly increased the proliferation, migration, and invasion abilities of breast cancer cells. Knockdown of YWHAE expression reduced the expression of Snail and Twist in breast cancer cells. We also found that YWHAE was responsible for the resistance of breast cancer cells to chemotherapeutic agents, and knockdown of YWHAE enhanced sensitivity to multiple chemotherapeutic agents in breast cancer cells. Taken together, our findings indicated that YWHAE promoted cancer progression and chemoresistance in breast cancer cells and can be a potential therapeutic target for breast cancer. [ABSTRACT FROM AUTHOR]

Background: In this multi-center study, we report the patient selection criteria for and preliminary oncologic outcomes associated with intraoperative radiotherapy (IORT) delivered by the Xoft Axxent® eBx® system for early-stage breast cancer in Taiwan. Methods: Patients with early breast cancer in Taiwan received breast conserving surgery and received IORT with Xoft Axxent® eBx® System during 2013–2015 was search from database of Taiwan IORT study cooperative group (T-IORTSCG). Patients’ clinicopathologic characteristics and early post-operative results were collected and reported. Results: During the study period, 26 hospitals in Taiwan performed a total of 261 Xoft IORT procedures for breast cancer. The mean age of them was 52.9 ± 9.8 years (37–72), and tumor size was 1.5 ± 0.8 cm (0.1–4.2 cm) for invasive cancer and 1.2 ± 0.8 cm (range, 0.2–3.0 cm) for ductal carcinoma in situ (DCIS) lesions. Lymph node metastasis was found in 6 (2.3%) patients. The patients received IORT in Taiwan differed markedly from those used in the ELIOT and TARGIT-A studies. Specifically, patients selected for IORT in Taiwan tended to be younger, their tumors tended to be larger and the prevalence of lymph node metastasis tended to be lower. Among these 261 patients, 8 (3.1%) patients required whole breast radiotherapy. During a mean follow up of 15.6 months, locoregional recurrence was observed in 2 (0.8%) patients. Conclusion: In real world experience, patients received IORT differed quite significantly with criteria formulated by trials. The preliminary results of IORT in Taiwan showed it is well acceptable by patients and clinicians. [ABSTRACT FROM AUTHOR]

In recent years, challenges in terms of both man-made and natural disasters as well as the lack of resources to deal with such challenges have become increasingly critical to local government. This article adopts an alternative view of strategy-based approach to examine how different strategic styles affect organizational capability in a crisis response. The results of a survey of middle managers in Taiwan’s local government highlighted the relations between strategic styles and crisis response capability. Such results provide public managers with a better understanding of what strategic styles they should adopt to improve their organizational capability in responding to crises. [ABSTRACT FROM AUTHOR]

Residential water demand has long been an important topic of empirical research. How to estimate water waste, however, has rarely been touched. Using the stochastic frontier approach, this article jointly estimates the residential demand for water and water waste in Taiwan, where water resources are scarce and unevenly distributed throughout the island and across seasons. The empirical results confirm that residential water demand is closely related to household characteristics and the overuse of water is affected by environmental variables. The estimated price and income elasticities are below 0.1 in absolute value. The estimated amount of wasted water is around 83 L per capita per day, which is roughly 1/3 of the actual water consumption. It is also shown that overlooking the waste of water use results in an over-estimation of the subsistence water requirement. [ABSTRACT FROM AUTHOR]

• Question: H1-antihistamines (AHs) may exert protective effects against cancer. Does any protective effect of AHs on hepatocellular carcinoma (HCC) risk in type 2 diabetes mellitus (T2DM) patients without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection? • Findings: The adjusted hazard ratios for AH users with diabetes (compared with AH nonusers with diabetes) were significantly associated with decreased HCC incidence, regardless of age, sex, comorbidities, medications, diabetes medications, and diabetes severity. • Meaning: AH use may reduce HCC in patients with T2DM in a dose-dependent manner. H1-antihistamines (AHs) may exert protective effects against cancer. We investigated the association of AH use with hepatocellular carcinoma (HCC) risk in type 2 diabetes mellitus (T2DM) patients without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The data of patients with T2DM enrolled from Taiwan's National Health Insurance Research Database were examined for the period of January 1, 2008, to December 31, 2018. We used the Kaplan–Meier method and Cox proportional hazards regression to evaluate the AH use–HCC risk association. After 1:1 propensity score matching was performed, the two cohorts were each divided into AH users (n = 47,990) and nonusers (n = 47,990). The risk of HCC was significantly lower in AH users than in AH nonusers (adjusted hazard ratio [aHR]: 0.55 95% confidence interval [95% CI], 0.46 to 0.67; IRR: 0.70; 95% CI, 0.60 to 0.84), respectively. The dose–response relationship between AH use and HCC risk was also observed (aHRs: 0.58, 0.56, 0.50, and 0.41 for 28–35, 36–49, 50–77, and >77 cumulative defined daily doses of AH, respectively). AH use can reduce HCC risk in T2DM patients without HBV or HCV infection in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Acute radiation dermatitis is a frequent adverse effect in patients with breast cancer undergoing radiotherapy, but there are only a small number of studies providing evidence-based interventions for this clinical condition. Adlay is a cereal crop that has been previously shown to have anti-inflammatory and antioxidant properties. In this study, we seek to evaluate the effectiveness of oral prophylactic treatment with adlay bran extract in reducing the risk of severe acute radiation dermatitis. A total of 110 patients with breast cancer undergoing radiotherapy were analyzed. Using a prospective, randomized, double-blind design, 73 patients received oral treatment with adlay bran extract and 37 patients received olive oil (placebo). Treatment was started at the beginning of radiation therapy and continued until the termination of radiation treatment. Our results showed that the occurrence of severe acute radiation dermatitis (RTOG grade 2 or higher) was significantly lower in patients treated with oral adlay bran extract compared to placebo (45.2% versus 75.7%, adjusted odds ratio 0.24). No serious adverse effects from adlay bran treatment were noted. In conclusion, prophylactic oral treatment with adlay bran extract reduces the risk of severe acute radiation dermatitis and may have potential use in patients with breast cancer undergoing radiotherapy. [ABSTRACT FROM AUTHOR]

In the recent years, great importance has been shown toward the cultural creativity in Taiwan. Cultural identification and determining how best to apply it to commercial products require investigating and compiling a vast amount of cultural information, along with the individual ideas of designers, to develop new cultural products. During the product development and design process, the color scheme is the final and most important element. It not only represents the first image of the product but also elicits the important first-sight impression of consumers. Consequently, color ranks first in cultural commodity development. By understanding the Taiwanese culture, as well as assessing, verifying, and internalizing it into the materials that can be used by the designers, this study uses an artificial neural network system and simplifies the collected pictures that are representative of the Taiwanese culture into groups of different matching colors to assist designers in developing cultural commodities with different features and according to different cultural styles. © 2014 Wiley Periodicals, Inc. Col Res Appl, 40, 341-351, 2015 [ABSTRACT FROM AUTHOR]

Background: Despite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment. Methodology/Principal Findings: The analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996–2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share. Conclusions/Significance: In addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments. [ABSTRACT FROM AUTHOR]

Background The acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported. Methods We conducted a case-control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed. Results TB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acidsuppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended Conclusions Recent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the influence of shareholding stability of institutional investors on firm performance. We analyze 647 sample companies listed in the Taiwan Stock Exchange from 2005 to 2009 using the coefficient of variance of institutional holding proportion as the measure for ownership stability. The empirical results show that increasing stability of institutional holdings is related to better firm performance. The low-risk and younger firms with higher CEO incentive compensation, larger insider holdings, and higher growth usually have better performance. Furthermore, when the long-term institutional shareholdings, particularly of foreign institutions, are higher, the firm performance is better. [ABSTRACT FROM AUTHOR]

Rivers flow downstream and unidirectionally. However, this fact has not yet been utilized in the institutional design for water trading. By utilizing this characteristic, we first designed a water trading system of "locational water rights." This new system is able to mitigate the return flow-related and instream flow-related third-party effects of volumetric reliability from water transfers. We provided mathematical proof of its economic efficiency. We then applied this water trading system to the case of the Choushui River basin in Taiwan. In this area, agriculture is highly developed while domestic and industrial water demands have increased rapidly. Using an agent-based model simulation, we estimated the potential economic benefits of implementing the system of locational water rights in the Choushui River basin. [ABSTRACT FROM AUTHOR]

In practice, water pricing is the main economic instrument used to discourage the wasteful use of residential water. Owing to considerations of affordability, residential water is systematically underpriced because water is essential for life. Such a low price results in water being used inefficiently. This paper proposes a system that supplements the existing price system with a cap-and-trade measure to reconcile conflicts among the goals of residential water use. It forces all people (independent of income) to be faced with reasonable price signals and to use water efficiently. The poor could, however, gain from trade and afford water. By taking advantage of the agent-based model, a simulation of this system applied to Taipei, Taiwan shows that those with lower income per capita are better off under this system even though the equilibrium price of residential water is higher. The simulated average price elasticity of market demand is −0.449. [ABSTRACT FROM AUTHOR]

Background: The opportunistic enterobacterium, Morganella morganii, which can cause bacteraemia, is the ninth most prevalent cause of clinical infections in patients at Changhua Christian Hospital, Taiwan. The KT strain of M. morganii was isolated during postoperative care of a cancer patient with a gallbladder stone who developed sepsis caused by bacteraemia. M. morganii is sometimes encountered in nosocomial settings and has been causally linked to catheter-associated bacteriuria, complex infections of the urinary and/or hepatobiliary tracts, wound infection, and septicaemia. M. morganii infection is associated with a high mortality rate, although most patients respond well to appropriate antibiotic therapy. To obtain insights into the genome biology of M. morganii and the mechanisms underlying its pathogenicity, we used Illumina technology to sequence the genome of the KT strain and compared its sequence with the genome sequences of related bacteria. Results: The 3,826,919-bp sequence contained in 58 contigs has a GC content of 51.15% and includes 3,565 protein-coding sequences, 72 tRNA genes, and 10 rRNA genes. The pathogenicity-related genes encode determinants of drug resistance, fimbrial adhesins, an IgA protease, haemolysins, ureases, and insecticidal and apoptotic toxins as well as proteins found in flagellae, the iron acquisition system, a type-3 secretion system (T3SS), and several two-component systems. Comparison with 14 genome sequences from other members of Enterobacteriaceae revealed different degrees of similarity to several systems found in M. morganii. The most striking similarities were found in the IS4 family of transposases, insecticidal toxins, T3SS components, and proteins required for ethanolamine use (eut operon) and cobalamin (vitamin B12) biosynthesis. The eut operon and the gene cluster for cobalamin biosynthesis are not present in the other Proteeae genomes analysed. Moreover, organisation of the 19 genes of the eut operon differs from that found in the other non-Proteeae enterobacterial genomes. Conclusions: This is the first genome sequence of M. morganii, which is a clinically relevant pathogen. Comparative genome analysis revealed several pathogenicity-related genes and novel genes not found in the genomes of other members of Proteeae. Thus, the genome sequence of M. morganii provides important information concerning virulence and determinants of fitness in this pathogen. [ABSTRACT FROM AUTHOR]

This paper adopts the context-dependent DEA model to analyze the operating efficiency of 49 international tourism hotels (ITHs) in Taiwan from 2004 through 2006. This model is able to evaluate the attractiveness of ITHs with better relative efficiency and the progress of ITHs with relative poorer efficiency. It is also able to rank the values of attractiveness and progress of ITHs. Among the 49 ITHs, 17 have been operating at the same levels for over three years. In terms of the ranking of these 49 ITHs, 25 have similar rankings in all levels of attractiveness values and 11 have the same progress values in all levels. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this study is to analyse factors influencing subscribers' usage of 3G mobile services in Taiwan. Design/methodology/approach - The research model, based on a technology acceptance model (TAM) and added perceived enjoyment, was tested by means of a two-stage structure equation modelling approach. Data were collected from 532 respondents via a web questionnaire survey. Findings - The findings indicate that perceived usefulness, perceived ease of use and perceived enjoyment are positively related to attitude, and perceived enjoyment has a positive influence on perceived usefulness. Practical implications - The findings suggest users of 3G mobile services need to be provided with more diverse and entertaining ways of communicating, which are at the same time easily accessible and convenient to use. Originality/value - A new correlation from perceived enjoyment to perceived usefulness was found to have a significant effect. This finding indicates enjoyment as a key factor influences customers' adoption of 3G services. [ABSTRACT FROM AUTHOR]

Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995–1998); (2) a programme of mass screening (1999–2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002–2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies. [ABSTRACT FROM AUTHOR]

Abstract: Somatic mutation of BRCA2 has been thought to be rare in breast cancers, though common allelic deletions in the BRCA2 locus (13q12-q13) imply an important role of somatic mutation in these tumors. Reasons of the reported rare incidence could be related to very few studies focusing on the mutational analysis of BRCA2 in sporadic tumors. The mutational status of the BRCA2 gene in exon11, the largest exon harboring the RAD51 interacting BRC domains which are critical for BRCA2 function, was screened by polymerase chain reaction/single strand conformation polymorphism (PCR-SSCP) analysis followed by direct sequencing. Tumor and paired normal tissue sample from 175 patients unselected for family history or age were taken after mastectomy for breast cancer and evaluated. There were 20 mutations of BRCA2 gene in exon 11 in 15 cases (15/175, 8.6%). Most mutations we identified were point mutation (19/20, 95%), except for one nucleotide insertion. Furthermore, among these mutations, missense mutations comprised 80% (16/20) of the BRCA2 mutations. All mutations we found were novel mutation after searched in the BIC database. There were three recurrent mutations at codon 1904; and two recurrent mutations at 1907, 1936, 1937 and 1968, respectively. The mutations were associated with ductal carcinoma in situ (P=0.038) and borderline with low histological grade (P=0.072). Besides, there were three cases possessing multiple mutations in the region we studied and one of them demonstrated aggressive lymph node metastasis. These findings implicated that somatic mutations of BRCA2 genes may play a significant role in the pathogenesis of breast carcinoma in Taiwan. In addition, those events were associated with some early clinicopathological features. [Copyright &y& Elsevier]

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

p53 gene mutation is a very frequent event in many human cancers and is associated with a poor clinical outcome in breast cancer patients. Analysis of p53 gene mutations can also provide clues to the etiology of tumor formation. The present study was conducted to investigate the p53 mutations in patients with breast cancer from Taiwan. Tumor samples from 119 patients undergoing mastectomy for breast cancer were evaluated. The mutational status of the p53 gene (exons 5–8) was screened by polymerase chain reaction-single strand conformation polymorphism analysis followed by direct sequencing. Of all 119 cases of breast carcinoma, 26 mutations of the p53 gene were found in 22 cases (18.5%). Among these mutations, 78% (20/26) were point mutations with the majority of those being missense mutations (75%, 15 of 20 mutations) and the other 22% (6/26) were frameshift mutations. No significant correlation between p53 mutations and clinicopathological features was found, including HER2 status. Moreover, our results disclosed distinct mutation spectra in excess transversions to transitions (15/21, 71.4% vs. 6/21, 28.6%) with GC to CG dominant (6/15, 40%). Mutation hot spots we identified at codons 167, 185, 186, 210, 265 and 295 have rarely been documented in the literature. These findings showed that p53 gene mutation might contribute to the pathogenesis of breast carcinoma. Furthermore, the different mutation spectrum with high transversions in G:C to C:G may imply that the exogenous mutagens outweigh the endogenous processes in breast cancer in patients in Taiwan. [Copyright &y& Elsevier]

Compares the four existing programs for air pollution control in Taiwan in terms of both economic and public choice theories. Features of the Air Pollution Control Act; Key indicators of economic performance and environmental load; Factors affecting the outcomes of policy instruments.

Simple Summary: This study provided an analysis of machine-learning algorithms and the ability to predict 10-year survival after breast cancer surgery. The univariate analyses and the global sensitivity analysis provided in this study are especially helpful. This represents a novel opportunity for understanding the significance of a preoperative SF-36 PCS score, a preoperative SF-36 MCS score, postoperative recurrence, and tumor stage in predicting 10-year survival after breast cancer surgery and could lead to clinicians being better informed about the precision and efficacy of management for these patients. These results encourage a broader international validation of language models in clinical practice and emphasize that preoperative physical and mental functioning should always be an integral part of cancer care. Future studies may investigate further refinements of the machine-learning algorithms applied in this study and their potential for integration with other clinical decision-making tools. Machine learning algorithms have proven to be effective for predicting survival after surgery, but their use for predicting 10-year survival after breast cancer surgery has not yet been discussed. This study compares the accuracy of predicting 10-year survival after breast cancer surgery in the following five models: a deep neural network (DNN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC) and Cox regression (COX), and to optimize the weighting of significant predictors. The subjects recruited for this study were breast cancer patients who had received breast cancer surgery (ICD-9 cm 174–174.9) at one of three southern Taiwan medical centers during the 3-year period from June 2007, to June 2010. The registry data for the patients were randomly allocated to three datasets, one for training (n = 824), one for testing (n = 177), and one for validation (n = 177). Prediction performance comparisons revealed that all performance indices for the DNN model were significantly (p < 0.001) higher than in the other forecasting models. Notably, the best predictor of 10-year survival after breast cancer surgery was the preoperative Physical Component Summary score on the SF-36. The next best predictors were the preoperative Mental Component Summary score on the SF-36, postoperative recurrence, and tumor stage. The deep-learning DNN model is the most clinically useful method to predict and to identify risk factors for 10-year survival after breast cancer surgery. Future research should explore designs for two-level or multi-level models that provide information on the contextual effects of the risk factors on breast cancer survival. [ABSTRACT FROM AUTHOR]

Study Objectives: This retrospective study investigated prognostic factors and recovery time in patients with Bell's palsy after different doses and durations of oral glucocorticoid treatments. Subjects and Methods: A total of 396 patients initially diagnosed with Bell's palsy that had visited the Department of Neurology of Chang Gung Memorial Hospital, Taoyuan, a tertiary referral medical center in Taiwan, between January 2014 and December 2018 were included. Medical records, facial electroneurography (fENoG), and blink reflex (BR) tests were reviewed and analyzed. A favorable outcome was defined as patients who improved to grade ≤ II, and an unfavorable outcome was defined as patients who improved to grade ≥ III in 6 months according to the House–Brackmann (HB) grading system. Results: The rate of favorable outcomes was 89.4% (354 of 396 patients) at the 6-month follow-up. A favorable outcome (HB less than grade II) was associated with a delayed BR (odds ratio, OR, 5.38; 95% CI, 1.82 to 15.90) and fENoG values (the lesion side/the healthy side) over 33% (OR, 6.67; 95% CI, 3.02 to 14.71). The recovery time was significantly shorter for those with a delayed BR than for those with an absent BR and shorter for those with good fENoG values (>33%) than for those with poor values (≤33%). However, treatment without or with different doses and durations of oral glucocorticoid did not influence the final outcome or recovery time in this study. Conclusions: The fENoG and BR tests were significant and highly valuable examinations for predicting the final outcome. Moreover, age younger than 60 years, a delayed BR, and fENoG values > 33% were associated with shorter recovery times. [ABSTRACT FROM AUTHOR]

Simple Summary: Three distinct lineages of Duttaphrynus melanostictus, the Asian black-spined toad, are present in Southeast Asia. However, divergence times, dispersion mechanisms and colonisation processes are still unknown. In the present study, molecular dating based on mitochondrial DNA sequences demonstrated that D. melanostictus expanded into Eastern Indomalaya following the Quaternary glaciation and colonised new landscapes during the Last Glacial Maximum. Subsequent to natural colonisation of landscapes, we found human-induced dispersal into regions such as in Taiwan, Southern Sundaic and Wallacea, temporally matching with prehistoric human settlements. We provide comprehensive dispersal pathways and mechanisms of D. melanostictus to the Eastern Indomalayan realm, thus solving the climate-driven question relevant to the species distribution in the Southeast Asia. Divergence-time estimation critically improves the understanding of biogeography processes underlying the distribution of species, especially when fossil data is not available. We hypothesise that the Asian black-spined toad, Duttaphrynus melanostictus, expanded into the Eastern Indomalaya following the Quaternary glaciations with the subsequent colonisation of new landscapes during the Last Glacial Maximum. Divergence dating inferred from 364 sequences of mitochondrial tRNAGly ND3 supported the emergence of a common ancestor to the three D. melanostictus clades around 1.85 (±0.77) Ma, matching with the Lower to Mid-Pleistocene transition. Duttaphrynus melanostictus then dispersed into Southeast Asia from the central Indo-Pacific and became isolated in the Southern Sundaic and Wallacea regions 1.43 (±0.10) Ma through vicariance as a result of sea level oscillations. The clade on the Southeast Asian mainland then colonised the peninsula from Myanmar to Vietnam and expanded towards Southeastern China at the end of the Mid-Pleistocene Revolution 0.84 (±0.32) Ma. Population dynamics further highlight an expansion of the Southeast Asian mainland population towards Taiwan, the Northeastern edge of the species' range after the last interglacial, and during the emergence of the Holocene human settlements around 7000 BP. Thus, the current divergence of D. melanostictus into three segregated clades was mostly shaped by Quaternary glaciations, followed by natural dispersion events over land bridges and accelerated by anthropogenic activities. [ABSTRACT FROM AUTHOR]

This study intends to examine if traditional local factors (seasonal weather conditions) and/or green awareness spillovers contribute to the spatial dependency of farmland allocated to organic farming after its uptake in Taiwan. To investigate the push and pull factors to improve the policy targeting on environmentally-friendly farming practices, we assess spatial autocorrelation of the adoption intensity of organic farming with exploratory analysis, and expand that by exploring how explanatory factors affect the adoption intensity using a spatial Tobit regression analysis, taking into consideration that the adoption intensity is a typical example of censored data. Based on township-level data of 323 townships constructed from 213,534 rice farm households drawn from the 2015 Agriculture Census, we find high-high clusters (hot spots) are mostly in the northern and the eastern parts of Taiwan, whereas the majority of low-low clusters (cold spots) locate in central and southern Taiwan. Such spatial aspects of organic adoption intensity suggest that a spatially targeted program in promoting environmental awareness is pertinent to fostering the development of organic agriculture. The results from the spatial lag Tobit regression estimation provide empirical evidence supporting the role of local weather conditions and green awareness spillovers in explaining the spatial patterns of organic agriculture in Taiwan. In light of the stylized fact that the majority of the rice farm households in Taiwan are small with 84% having farmland areas less than 1 ha, the findings provide practical references to policy practitioners in tailoring farm programs or policies in line with the notion of inclusive and sustainable development. • Sources of spatial dependency for organic adoption intensity are examined. • Growers' green awareness spillovers contribute to the spatial agglomeration. • Local weather conditions are key determinants of green rice farming in Taiwan. • Agricultural census data provide insights into resilient agricultural practices. • Spatially targeted program is pertinent to developing organic agriculture. [ABSTRACT FROM AUTHOR]