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This study aims to compare auditory temporal processing and phonological processing across locations and age levels and to test the direct and indirect effects of auditory temporal and phonological processing on proficiency in Chinese character reading. We recruited 108 typically developing children -- 25 and 24 kindergarteners from Taiwan and Hong Kong, respectively, and 34 and 25 primary school students from Taiwan and Hong Kong, respectively. Our findings showed that, before learning PCS, the languages' phonological complexity did not affect the importance of ATP in Chinese reading. Also, we found the use of PCS could lead to a direct effect from students' ATP to Chinese character reading as well as through phonological awareness. Our findings indicated that ways of learning to read influence children's patterns of cognitive and linguistic abilities, which should be considered in teaching designs for reading. [Translation from English by Mercè Rius.]

Background: With the remarkable effect of controlling the increase in drug costs by the first batch of National Key Monitoring and Rational Use Drugs (first NKMRUDs), the National Health Commission of the People's Republic of China releases the second NKMRUDs to further strengthen the reasonable use of drugs. Unfortunately, the second NKMRUDs include some drugs of National Volume-based Procurement and National Essential Medicines, which challenges the management of pharmaceutical affairs on the three kinds of drugs. Objective: The main objective of this study was to investigate the prevalence of the second NKMRUDs and explore their monitoring indicators. Methods: An adapted WHO methodology for point prevalence surveys was conducted for the second NKMRUDs. For the monitoring indicators, we sought to explore whether the defined daily dose (DDD) and days of therapy (DOT) can be suitable for the second NKMRUDs through comparing differences between DDD and DOT with the prescribed daily dose (PDD). Results: Among the 935 included patients, 29.20% of the patients received at least one of the second NKMRUDs. A total of 273 patients were administered with 487 times of the second NKMRUDs. Among them, 162, 62, and 49 patients were receiving one, two, and three or more agents, respectively. The most commonly prescribed second NKMRUDs were compound amino acids, budesonide, and ceftazidime. The total DDDs and DOTs of the second NKMRUDs were 3360.68 and 1819.80, respectively, with the PDDs of 1865.26. The deviations (80.17%) of DDDs from PDDs were significantly greater than those (-2.44%) of DOTs. Conclusion: The prevalence of the second NKMRUDs was obtained by using the adapted PPS methodology at a tertiary university hospital. The DOT indicator is found to more accurately reflect actual consumption than the DDD indicator for second NKMRUDs. It is recommended to use the DOT indicator to monitor second NKMRUDs. [ABSTRACT FROM AUTHOR]

Objective: Schools should design holistic sex education programmes to improve sex knowledge and enhance positive sexual attitudes among adolescents. A school-based social marketing sex education programme named "Starting from love -- Go! Go! Go!" was designed. This study determined the effectiveness of the intervention to promote adolescent sexual health in junior high schools in Southern Taiwan. Method: A one-group pretest-posttest design was utilised. Cluster random sampling was used to select participants (seventh-grade students aged 13-14 years) from 24 junior high schools. Results: A total of 1,407 seventh-grade participants completed the survey. Among the 1,407 participants, 714 were boys and 693 were girls. The results revealed that the total average sexual knowledge score of the participants was 1.55 points higher after the interventions, indicating significantly increased sexual knowledge (p < 0.001). The sexual attitudes of participants after the interventions significantly improved compared with those beforehand (p < 0.001). Moreover, the sexual knowledge and attitudes of participants exhibited a positive correlation (r = 0.357, p< 0.001). Conclusion: The proposed school-based social marketing sex education programme holds the potential to improve sexual knowledge and enhance positive sexual attitudes of the junior high school students and the educational efficacy of sex education with respect to sex-related concerns.

This study aims to understand how an indigenous teacher passed on Paiwanese culture during music teaching at an elementary school located in one of Paiwan tribes in southern Taiwan. A qualitative case study was adopted to portray the teaching context and phenomena. The study participants were an indigenous teacher and 18 sixth-grade indigenous students. The results found that the indigenous teacher had passed on Paiwanese culture through teaching Paiwanese songs in oral tradition, incorporating dancing in singing, and employing Paiwanese improvisational characteristic in different aspects. The original singing improvisation in adding ornamentations to main melodies and creating a contrapuntal part had been transformed into recorder playing by the indigenous students. Furthermore, the improvisational characteristic was also applied to free combination of contrapuntal singing. Furthermore, the free combinations of languages and melodies vertically and horizontally marked unique features for new culture. The indigenous students alternated between written culture and oral culture to learn textbook music and ancient Paiwanese songs, and they were cultivated their musicianship in two cultures. It may inspire music educators to include oral culture as a transmission process to teach indigenous music, and eventually expand students' variety of learning styles.

Acute hepatic porphyrias (AHP) are rare genetic disorders associated with acute neurovisceral attacks and chronic symptoms. This analysis was conducted to examine the long-term efficacy and safety of givosiran in Taiwanese participants in the ENVISION study (NCT03338816). Patients (age ≥12 years) with AHP and recurrent attacks were randomized to receive givosiran 2.5 mg/kg or placebo for 6 months during the double-blind period. Patients then switched from placebo to givosiran (placebo crossover group) or continued taking givosiran (continuous givosiran group) during a 30-month open-label extension period. The total study duration was 36 months. An analysis was conducted that included patients enrolled in Taiwan (N = 7). During the double-blind period and open-label extension period, the median annualized attack rates were 0.0 and 0.0, respectively, in the continuous givosiran group (n = 5) and 15.1 and 4.6, respectively, in the placebo crossover group (n = 2; 70 % decrease). Median annualized days of hemin use in the double-blind period and open-label extension period were 0.0 and 0.0, respectively, in the continuous givosiran group, and 23.8 and 5.0, respectively, in the placebo crossover group (79 % decrease). EQ-5D VAS scores remained relatively stable in both groups, and PPEQ responses indicated improved functioning and satisfaction in both groups. Delta-aminolevulinic acid and porphobilinogen levels remained low with long-term givosiran treatment. Serious adverse events were reported by 3 patients (43 %). Long-term efficacy and safety results in the Taiwan cohort are consistent with those in the global cohort. [ABSTRACT FROM AUTHOR]

Importance: Establishing empirical evidence on the psychometric properties of the Test of Visual–Motor Skills (3rd ed.; TVMS–3) is helpful for guiding its use as an assessment of visual–motor integration (VMI) skills in kindergarten children with developmental coordination disorder (DCD). Objective: To investigate the test–retest reliability, criterion-related validity, and ecological validity of the TVMS–3 in Taiwanese kindergarten children with DCD. Design: A nonexperimental, descriptive, correlational design. Setting: A hospital in Central Taiwan. Participants: Fifty-seven kindergarten children with DCD were recruited in the study. Outcomes and Measures: Intraclass correlation coefficient, percentage of minimal detectable change, and paired t test (Wilcoxon signed rank test) were used to investigate the test–retest reliability of the TVMS–3. The correlations (Pearson's r) between the TVMS–3 accuracy score and the scores of each of the four domains and the adaptive behavior composite score of the Vineland Adaptive Behavior Scales (3rd ed.; Vineland–3) were calculated, respectively, to examine criterion-related validity and ecological validity. Results: The accuracy score of the TVMS–3 had excellent test–retest reliability and acceptable random measurement error. Moreover, it showed good criterion-related validity and sufficient ecological validity with the Vineland–3 in Taiwanese kindergarten children with DCD. Conclusions and Relevance: The accuracy score of the TVMS–3 is applicable to Taiwanese kindergarten children with DCD in clinical and research settings. Plain-Language Summary: The accuracy score of the Test of Visual–Motor Skills (3rd ed.; TVMS–3) is a useful assessment tool to detect deficits in visual–motor integration for Taiwanese kindergarten children with developmental coordination disorder. The TVMS–3 has excellent test–retest reliability, good criterion-related validity, and sufficient ecological validity. The Test of Visual–Motor Skills is a useful assessment tool to detect deficits in visual–motor integration for Taiwanese kindergarten children with developmental coordination disorder. [ABSTRACT FROM AUTHOR]

Objectives: In previous reports, proton pump inhibitor (PPI) use increased the risk of gout. However, there is no epidemiological study investigating this association. We aimed to examine the potential impact of PPI treatment on the risk of developing gout. Methods: A population‐based case–control study was performed using a Longitudinal Health Insurance Database 2000 from Taiwan (population 23 million). We identified gout cases and non‐gout controls through propensity score matching at 1:1, which was matched by sex and age. We used a conditional logistic regression model to estimate an odds ratio and 95% confidence intervals (CI) for gout population versus controls. Results: Esomeprazole increased the risk of gout after adjusting confounding variables (adjusted odds ratio [aOR] 1.3; 95% CI 1.0–1.6). The risk of gout was highest within 30 days of PPI treatment (aOR 1.7; 95% CI 1.4–1.9) and attenuated thereafter. The risk of gout was increased among female users of PPI compared with male users (aOR 2.2; 95% CI 1.7–2.8). The aOR of gout in people with PPI use was higher in middle‐aged individuals (41–60 years: aOR 2.1; 95% CI 1.7–2.7) than in the older group (≥60 years: aOR 1.8; 95% CI 1.5–2.2). Conclusions: Our findings provide population‐level evidence for the hypothesis that PPI treatment is positively associated with the risk of developing gout. Further research on the mechanism underlying this association is warranted. [ABSTRACT FROM AUTHOR]

This study attempts to enhance the understanding of a music curriculum that represents holistic and meaningful learning for young children at a developmentally appropriate practice (DAP) classroom in Taiwan. The study participant implementing DAP was selected through purposive sampling by the Classroom Practice Inventory and pilot study. A qualitative case study method was employed to understand the phenomenon and context. The result found that music curriculum activities included group teaching and free music play, and the music curriculum structure was built on duration and pitch learning. In group teaching, the activities were designed by the teacher and partially extracted from music behaviour at free play to provide children with music experiences and facilitate children's learning interests. Free music play provided children with opportunities to practice newly acquired skills, extend their learning from group teaching and spontaneously connect with other domains and personal experiences. Group teaching and free music play were reciprocally affected to make music learning holistic and meaningful. (Contains 3 figures and 3 notes.)

This longitudinal study investigated self-invented notation systems created by young children aged four to six. The researcher showed the children how to feel various pitches and rhythms through singing, eurhythmy, instrumental playing, rhymes and music appreciation. The children were then provided with opportunities to create music notations and share them with peers, all without showing any conventional musical notations by the researcher. A method of qualitative study was employed, and the data from the children's notations and interviews were collected and analysed. The results found that children employed quantitative sizing, graphic patterns and literal symbols as notational strategies to create systems to notate pitches or rhythms. When children simultaneously notated pitches and rhythms, they created two modes for writing music. First, they employed one notation system, as mentioned above, to write pitches and added indications such as dots, underlines or circles to refer to different timing. Secondly, the children combined two systems to write pitches and rhythms such as combining two graphic patterns, combining a graphic pattern and literal symbols, combining a graphic pattern and conventional rhythmic notations or combining conventional rhythmic notations and literal symbols. These self-invented notation systems document how young children's musical thinking becomes more complex through exploring notational strategies.

Background: This study aimed to explore trends, in 3 periods, in the intake of energy and macronutrients among Taiwanese older adults. Methods: Study subjects were those aged ≥65 years in the Nutrition and Health Survey in Taiwan 1999–2000 as well as the surveys in 2005–2008 and 2013–2016. Twenty-four-hour dietary recall data were obtained. This study used the 3 nutrition survey datasets for 1999–2000, 2005–2008, and 2013–2016, including data on the questionnaire, physical examination, and dietary intakes. Each nutrition survey involved the face-to-face household interview, and individual's dietary intake of carbohydrate, fat, and protein (% of energy) was estimated. Subsequently, intake statuses of the three macronutrients were classified into below, meeting, and above intake categories. Results: In the 2013–2016 survey, approximately 40% of the older adults had a low intake of energy. The prevalence of older adults with a meeting intake of carbohydrate, fat, and protein have increased from the 1999–2000 to 2013–2016 periods. The prevalence of people having a low intake of carbohydrate declined from the 1999–2000 period to the 2013–2016 period. The prevalence of high fat intake in 2013–2016 was approximately 5% higher than that in 1999–2000. In the 2013–2016 period, the prevalence of low intake of carbohydrate, fat, and protein were 25.9, 24.5, and 4.9%, respectively; moreover, the prevalence of high intake of the aforementioned macronutrients were 38.7, 36.2, and 17.6%, respectively. Conclusions: Our study provides important evidence on the dietary patterns, as well as their changes over time among Taiwanese older adults. Such information would be useful for health policy makers about the burden of unbalanced diet and for nutrition educators on planning nutrition promotion interventions about well-balanced dietary for the older persons. [ABSTRACT FROM AUTHOR]

Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME. [ABSTRACT FROM AUTHOR]

Aims: Diabetic nephropathy (DN) is a major healthcare challenge. We developed and internally and externally validated a risk prediction model of DN by integrating clinical factors and SNPs from genes of multiple CKD-related pathways in the Han Chinese population. Materials and methods: A total of 1526 patients with type 2 diabetes were randomly allocated into derivation (n = 1019) or validation (n = 507) sets. External validation was performed with 3899 participants from the Taiwan Biobank. We selected 66 SNPs identified from literature review for building our weighted genetic risk score (wGRS). The steps for prediction model development integrating clinical and genetic information were based on the Framingham Heart Study. Results: The AUROC (95% CI) for this DN prediction model with combined clinical factors and wGRS was 0.81 (0.78, 0.84) in the derivation set. Furthermore, by directly using the information of these 66 SNPs, our final prediction model had AUROC values of 0.85 (0.82, 0.87), 0.89 (0.86, 0.91), and 0.77 (0.74, 0.80) in the derivation, internal validation, and external validation sets, respectively. Under the combined model, the results with a cutoff point of 30% showed 70.91% sensitivity, 67.84% specificity, 51.54% positive predictive value, and 82.86% negative predictive value. Conclusions: We developed and internally and externally validated a model with clinical factors and SNPs from genes of multiple CKD-related pathways to predict DN in Taiwan. This model can be used in clinical risk management practice as a screening tool to identify persons who are genetically predisposed to DN for early intervention and prevention. [ABSTRACT FROM AUTHOR]

Drawing upon social learning theory, this study explores turnover intention from learning perspectives by taking into account psychological safety as a mediator and inclusive leadership as a moderator. In the proposed model of this study, job self-efficacy, appreciation learning climate, and learning goal orientation have direct and positive relationships with psychological safety which in turn reduces turnover intention. At the same time, the relationships are hypothetically moderated by inclusive leadership. Empirical analyses are performed using the data of workers across a wide variety of industries in Taiwan. Research findings and implications about training and education based on this study's statistical analyses are provided. [ABSTRACT FROM AUTHOR]

Purpose: Chronic viral hepatitis is a major global public health problem. The guidelines suggest the long-term performance of regular ongoing liver examinations to monitor liver inflammation and screen for hepatocellular carcinoma. However, the effects of regular liver examinations on health-related quality of life (HRQoL) have not been adequately evaluated. Therefore, this study evaluated the effects of regular ongoing examinations on the quality of life of patients with hepatitis.Methods: A cross-sectional study was conducted from October to December 2016 in four hospitals in northern Taiwan. A hepatitis pay-for-performance (P4P) program was launched in 2010 to ensure that hepatitis patients have regular ongoing liver examinations. The study group consisted of patients who joined and stayed in the program for more than one year. The study assessed HRQoL utilizing the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) and the EuroQoL visual analog scale (EQ-VAS). The responses for the EQ-5D-5L in hepatitis patients were transformed into the EQ-5D index according to the Taiwanese population's value set. Sociodemographic and clinical characteristics were collected by questionnaire, and descriptive statistics were presented. A two-part model and generalized linear model with a Poisson distribution and a log link function, respectively, were used to examine the associations of the EQ-5D index and EQ-VAS score with participation in the hepatitis P4P program. We applied propensity score weighting with inverse probability weighting to control for selection bias.Results: In all, 508 patients (aged 57.6 ± 11.6 years; 60.8% male) were enrolled in this study. The mean (standard deviation, SD) reported EQ-5D index and EQ-VAS scores were 0.93 (0.12) and 75.1 (13.8), and the median (interquartile range, IQR) values were 1 (0.108) and 80 (15), respectively. The study group had a moderately significantly higher EQ-VAS score (mean ratio = 1.029, P < 0.001). However, the differences in the EQ-5D index scores between the study and control groups were not significant.Conclusion: Patients with hepatitis partially benefited from receiving hepatitis P4P in Taiwan, which featured regular ongoing liver examinations, in that their EQ-VAS scores were enhanced but not their EQ-5D index scores. [ABSTRACT FROM AUTHOR]

Electroencephalography (EEG) can reveal the abnormalities of dopaminergic subcortico-cortical circuits in patients with Parkinson's disease (PD). However, conventional time-frequency analysis of EEG signals cannot fully reveal the non-linear processes of neural activities and interactions. A novel Holo-Hilbert Spectral Analysis (HHSA) was applied to reveal non-linear features of resting state EEG in 99 PD patients and 59 healthy controls (HCs). PD patients demonstrated a reduction of β bands in frontal and central regions, and reduction of γ bands in central, parietal, and temporal regions. Compared with early-stage PD patients, late-stage PD patients demonstrated reduction of β bands in the posterior central region, and increased θ and δ2 bands in the left parietal region. θ and β bands in all brain regions were positively correlated with Hamilton depression rating scale scores. Machine learning algorithms using three prioritized HHSA features demonstrated "Bag" with the best accuracy of 0.90, followed by "LogitBoost" with an accuracy of 0.89. Our findings strengthen the application of HHSA to reveal high-dimensional frequency features in EEG signals of PD patients. The EEG characteristics extracted by HHSA are important markers for the identification of depression severity and diagnosis of PD. [ABSTRACT FROM AUTHOR]

Background: This study explored the effect of a continuous mitigation and containment strategy for coronavirus disease 2019 (COVID-19) on five vector-borne diseases (VBDs) in China from 2020 to 2021. Methods: Data on VBDs from 2015 to 2021 were obtained from the National Health Commission of the People's Republic of China, and the actual trend in disease activity in 2020–2021 was compared with that in 2015–2019 using a two-ratio Z-test and two proportional tests. Similarly, the estimated trend in disease activity was compared with the actual trend in disease activity in 2020. Results: There were 13,456 and 3684 average yearly cases of VBDs in 2015–2019 and 2020, respectively. This represents a decrease in the average yearly incidence of total VBDs of 72.95% in 2020, from 0.9753 per 100,000 population in 2015–2019 to 0.2638 per 100,000 population in 2020 (t = 75.17, P < 0.001). The observed morbidity rates of the overall VBDs were significantly lower than the predicted rates (47.04% reduction; t = 31.72, P < 0.001). The greatest decline was found in dengue, with a 77.13% reduction (observed rate vs predicted rate: 0.0574 vs. 0.2510 per 100,000; t = 41.42, P < 0.001). Similarly, the average yearly mortality rate of total VBDs decreased by 77.60%, from 0.0064 per 100,000 population in 2015–2019 to 0.0014 per 100,000 population in 2020 (t = 6.58, P < 0.001). A decreasing trend was also seen in the monthly incidence of total VBDs in 2021 compared to 2020 by 43.14% (t = 5.48, P < 0.001). Conclusions: The results of this study verify that the mobility and mortality rates of VBDs significantly decreased from 2015–2019 to 2020–2021, and that they are possibly associated to the continuous COVID-19 mitigation and contamination strategy implemented in China in 2020–2021. [ABSTRACT FROM AUTHOR]

Background: We externally validated Fujimoto's post‐transplant lymphoproliferative disorder (PTLD) scoring system for risk prediction by using the Taiwan Blood and Marrow Transplant Registry Database (TBMTRD) and aimed to create a superior scoring system using machine learning methods. Materials and Methods: Consecutive allogeneic hematopoietic cell transplant (HCT) recipients registered in the TBMTRD from 2009 to 2018 were included in this study. The Fujimoto PTLD score was calculated for each patient. The machine learning algorithm, least absolute shrinkage and selection operator (LASSO), was used to construct a new score system, which was validated using the fivefold cross‐validation method. Results: We identified 2,148 allogeneic HCT recipients, of which 57 (2.65%) developed PTLD in the TBMTRD. In this population, the probabilities for PTLD development by Fujimoto score at 5 years for patients in the low‐, intermediate‐, high‐, and very‐high–risk groups were 1.15%, 3.06%, 4.09%, and 8.97%, respectively. The score model had acceptable discrimination with a C‐statistic of 0.65 and a near‐perfect moderate calibration curve (HL test p =.81). Using LASSO regression analysis, a four–risk group model was constructed, and the new model showed better discrimination in the validation cohort when compared with The Fujimoto PTLD score (C‐statistic: 0.75 vs. 0.65). Conclusion: Our study demonstrated a more comprehensive model when compared with Fujimoto's PTLD scoring system, which included additional predictors identified through machine learning that may have enhanced discrimination. The widespread use of this promising tool for risk stratification of patients receiving HCT allows identification of high‐risk patients that may benefit from preemptive treatment for PTLD. Implications for Practice: This study validated the Fujimoto score for the prediction of post‐transplant lymphoproliferative disorder (PTLD) development following hematopoietic cell transplant (HCT) in an external, independent, and nationally representative population. This study also developed a more comprehensive model with enhanced discrimination for better risk stratification of patients receiving HCT, potentially changing clinical managements in certain risk groups. Previously unreported risk factors associated with the development of PTLD after HCT were identified using the machine learning algorithm, least absolute shrinkage and selection operator, including pre‐HCT medical history of mechanical ventilation and the chemotherapy agents used in conditioning regimen. Post‐transplant lymphoproliferative disorder (PTLD) refers to lymphoid and/or plasmacytic proliferations that develop after solid organ or allogeneic hematopoietic cell transplantation (HCT). This article reports a promising tool for risk stratification of patients receiving HCT that would allow for the identification of high‐risk patients who may benefit from preemptive treatment for PTLD. [ABSTRACT FROM AUTHOR]

Short-term load forecast (STLF) plays an important role in power system operations. This paper proposes a spline bases-assisted Recurrent Neural Network (RNN) for STLF with a semi-parametric model being adopted to determine the suitable spline bases for constructing the RNN model. To reduce the exposure to real-time uncertainties, interpolation is achieved by an adapted mean adjustment and exponentially weighted moving average (EWMA) scheme for finer time interval forecast adjustment. To circumvent the effects of forecasted apparent temperature bias, the forecasted temperatures issued by the weather bureau are adjusted using the average of the forecast errors over the preceding 28 days. The proposed RNN model is trained using 15-min interval load data from the Taiwan Power Company (TPC) and has been used by system operators since 2019. Forecast results show that the spline bases-assisted RNN-STLF method accurately predicts the short-term variations in power demand over the studied time period. The proposed real-time short-term load calibration scheme can help accommodate unexpected changes in load patterns and shows great potential for real-time applications. [ABSTRACT FROM AUTHOR]

Background: Pharmaceutical care provided by well‐educated clinical pharmacists improves the safety and effectiveness of health care, especially regarding medication use, and can thus save costs. Aims: The aim of this study is to illustrate the implementation of the reimbursement policy of National Health Insurance for pharmaceutical care in Taiwan, to determine its influences on current health care practices, and to evaluate the quantity of pharmacy interventions. Materials & Methods: The inclusion criteria for this study were qualified pharmacists working in intensive care units (ICUs) at medical centers and regional hospitals or in clinics at district hospitals who provided pharmaceutical care services. Details of the pharmaceutical care they provided—including pharmacy notes (in the subjective, objective, assessment, and plan sequence), intervention type, and acceptance by physicians—were uploaded and documented via an online virtual private network platform, from which data were later collected and analyzed. Results: During the first quarter of 2019, a total of 260 pharmacists were included in the analysis, 109 of whom were from medical centers, 94 from regional hospitals, and 57 from district hospitals. The total person‐days of pharmaceutical care during the study period was 12 158 for medical centers, 7090 for regional hospitals, and 757 for district hospitals. The acceptance rates of the doctors were 98.3%, 89.5%, and 90.5% for medical centers, regional hospitals, and district hospitals, respectively. Discussion: The cost savings of pharmaceutical care was estimated by adverse drug events (ADEs) avoidance based on an average prolonged ICU stay of 2 days per ADE. Pharmaceutical care in ICUs resulted in a savings of 57 931 710 New Taiwan Dollars during the study period, with a cost‐benefit ratio of 13.7. Conculsion: Based on the cost effectiveness of pharmaceutical care in early 2019, the program should be reserved and expanded to different settings, and it will hopefully become an essential service provided by pharmacists in Taiwan. [ABSTRACT FROM AUTHOR]

Objective: The primary goals of managing incontinence-associated dermatitis (IAD) are to control the incontinence and to stop the progress of dermatitis. This study evaluated the effectiveness of using a combination of topical antibiotic and topical antifungal medication to manage IAD. Method: Patients with grade 2 IAD treated with a combination of topical antibiotic Biomycin (CBC Biotechnological and Pharmaceutical, Taiwan) and antifungal clotrimazole (Sinphar Group, Taiwan) between January 2017 and January 2019 were included in this retrospective study. Data collected included patients' age, sex, diagnosis, body mass index, comorbidities and surface area involved. Patients were reviewed fortnightly until the wounds had healed, the patient was discharged or had died. Results: A total of 76 patients were included. There were 39 men and 37 women with a mean age of 74 years. In 58 (76%) patients, the surface area involved was >50cm2, in 13 (17%) patients the involved area was 20–50cm2 and in five (7%) patients the area involved was <20cm2. The mean number of days treated was 10.3 (range: 1–53). A total of 46 (61%) patients showed total healing of their IAD, 17 (22%) patients showed improvement of >50% of the involved area, seven (9%) patients showed improvement of 0–50%, five (7%) patients showed no improvement and one (1%) patient showed an increase in the area involved. Conclusion: This combination of treatment was effective in the management of IAD. It was cheap, easy to apply, easy to remove and easily accessible. It could be used efficiently by the hospital staff and the patient's family. [ABSTRACT FROM AUTHOR]

Background: Long-term deficits in the nursing labor force and high turnover rates are common in the Taiwanese medical industry. Little research has investigated the psychological factors associated with the retention of nursing staff. However, in practice, religious hospitals often provide nursing staff with education in medicine or the medical humanities to enhance their psychological satisfaction. The objective of this study was to explore factors influencing nursing staff retention in their work in relation to different levels of needs. A further objective was to investigate whether medical humanities education was associated with the retention of nursing staff. Methods: This study used self-administrated questionnaires to survey nurses working in northern areas of Taiwan. The questionnaire design was based on the six levels of Maslow's hierarchy of needs. Participation was voluntary, and the participants signed informed consent documents. Self-administrated questionnaires were distributed to a total of 759 participants, and 729 questionnaires were returned (response rate 96.04%). Logistic regression analysis was used to estimate the impact of seniority on nurses' reported intention to stay after adjustment for nurse characteristics (gender and age). Results: In the Pearson correlation analysis, nurses' willingness to stay was moderately correlated with "physical needs", "safety needs", "love and belonging needs", and "esteem needs" (r = 0.559, P < 0.001; r = 0.533, P < 0.001; r = 0.393, P < 0.001; and r = 0.476, P < 0.001, respectively). Furthermore, nurses' willingness to stay was highly correlated with "self-actualization needs", "beyond self-actualization needs" and "medical humanities education-relevant needs" (r = 0.707, P < 0.001; r = 0.728, P < 0.001; and r = 0.678, P < 0.001, respectively). We found that the odds ratios (ORs) of retention of nursing staff with less than 1 year (OR = 4.511, P = 0.002) or 1–3 years (OR = 3.248, P = 0.003) of work experience were significantly higher than that of those with 5–10 years of work experience. Conclusions: With regard to medical humanities education, we recommend adjusting training, as the compulsory activities included in the official programs are inadequate, and adjusting the number of required hours of medical humanities education. Tailoring different educational programs to different groups (especially nurses who have worked 3–5 years or 5–10 years in the case study hospital) might improve acceptance by nursing staff. [ABSTRACT FROM AUTHOR]

The origin and colonization history of Kurixalus , a genus of small arboreal tree frogs breeding exclusively in shallow swamps, is under disputed. On the basis of comprehensive sampling program, the evolutionary history of Kurixalus is investigated based on 3 mitochondrial genes. Our results indicate that the genus Kurixalus originated in the Asian mainland and subsequently arrived at its current distribution in Borneo, Taiwan, Ryukyu, and Hainan islands by a series of dispersal events. Moreover, the colonization of Taiwan from mainland Asia has occurred 2 times. The initial colonization of Taiwan occurred at 3.46–8.68 Mya (95% highest posterior density), which rejects the hypothesis that Kurixalus probably originated from Taiwan during the early Oligocene and favors the model of Neogene-origin rather than the model of Quaternary-origin for Taiwanese Kurixalus. Kurixalus eiffingeri has dispersed from Taiwan to the Ryukyus once or 2 times pending more data. Both transoceanic dispersal and landbridge dispersal have played a role in the colonization process; the former resulted in the colonization of Taiwan and the Ryukyus and the latter led to the colonization of Borneo and Hainan. [ABSTRACT FROM AUTHOR]

Cancer is the leading cause of death in Taiwan, and the overall incidence rate has gradually increased. The four most common cancers in Taiwan are colorectal, lung, breast and liver cancers. With the rise in incidence, the clinical use and costs of all anticancer drugs have steadily increased. The costs of novel therapeutics, such as targeted therapies and immunotherapy were accounted almost two-third of all antineoplastic agents in Taiwan. Moving forward, it will be necessary to discuss the economic impacts to clinical use of new therapeutics, while continuing to monitor and improve the quality of cancer therapy. In this review, we describe the epidemiology, disease screening policies and medication treatment policies for colorectal, lung, breast and liver cancer. We focus on the recent developments in cancer therapeutics, discuss the use of biomarkers, and finally consider the costs and the recent advances of anticancer medications in Taiwan. [ABSTRACT FROM AUTHOR]

By using US and Western databases, Hirschi and Gottfredson (HG) projected that the age distribution of crime always and everywhere has (a) a spiked adolescent peak and (b) a continuous decline thereafter into old age. In the study described here, we investigated these two core postulates of the age-crime invariance thesis by comparing age-crime distributions in South Korea (SK) with the inverted J-shaped norm proposed by HG. Our analysis considered age-crime schedules for a number of offense types (e.g. homicide) and indexes (e.g. total, violent, and property) and across a variety of measures or statistical tests. The findings revealed considerable divergence in South Korea's age-crime patterns compared with the HG invariance norm. Instead, SK age-crime patterns parallel those for Taiwan (also a collectivist Asian country) as reported recently by Steffensmeier and colleagues (2017). Implications for research and theory on the age-crime relation more broadly are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Glioblastoma (GBM) has the highest fatality rate among primary malignant brain tumors. GBMs with synchronous multiple foci (multiple GBMs) is rarely diagnosed in the clinical scenario. This study aims to compare the clinical characteristics between multiple and single GBMs and to identify factors associated with the survival of GBM and evaluate their effects.Methods: We retrospectively reviewed the medical records of patients with primary GBM in a referral medical center in Taiwan who were diagnosed between 2005 and 2016. They were identified from the cancer registry database of the center and followed from the date of diagnosis to october 2018. The primary endpoint of this study was overall survival (OS), and the independent factors for survival were identified through Cox regressions.Results: A total of 48 patients were identified, of whom 44 GBM (92%) and 4 gliosarcoma (GSM) (8%). Preoperative images showed five (10%) patients had multiple brain lesions. GSM showed a high ratio of multiple lesions (50%) than patients with GBM (5%) (p = 0.05). Those with multiple lesions had significantly worse median OS of 8.2 months compared to patients with a single lesion (16 months, p = 0.03). We found that multiple GBMs was a predictor of worse survival (hazard ratio [HR] = 3.57, 95% confidence interval [95%CI]: 1.26-10.13) after adjusting for other significant predictor of radiotherapy (HR = 0.47, 95%CI: 0.23-0.96).Conclusion: Patients with multiple GBMs had worse survival compared to those with single GBM. GBM patients without post-operative radiotherapy were also a predictor of worse survival. [ABSTRACT FROM AUTHOR]

This research develops a team-level model based on transactive memory theory to analyze how teams achieve excellent performance by managing innovative climate and politics. In the model, team performance relates to innovative climate positively and politics negatively through the full mediation of transactive memory systems (TMS). Meanwhile, the effects of innovative climate and politics on TMS are moderated by perceived meaningfulness. Its empirical results reveal that team performance indirectly relates to innovative climate and politics via the full mediation of TMS. Besides, the positive relationship between innovative climate and TMS is moderated by perceived meaningfulness, such that the relationship is stronger when perceived meaningfulness is higher. Empirical testing of our model using the data collected from team personnel in Taiwan confirmed the applicability of the transactive memory theory among work teams. Last, managerial implications and research limitations are provided. [ABSTRACT FROM AUTHOR]

Background There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact. Methods We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection. Results These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (−0.05‰, −0.63 to 0.53‰, P = 0.87), deep infection (−0.003‰, −0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, −0.21 to 0.25‰, P = 0.88). Conclusion The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes. [ABSTRACT FROM AUTHOR]

Abbott RealTi m e Genotype II assay can effectively identify hepatitis C virus (HCV) genotypes (GTs), but some GT 6 subtypes might not be differentiated from GT 1. Abbott RealTi m e Genotype II PLUS and sequencing might be needed to resolve these ambiguous results. Unlike the high prevalence of GT 6 in Southeast Asia, GT 6 had rarely been reported in Taiwan except in intravenous drug abusers (IDU). But the prevalence of GT 6 in Taiwan might be underestimated. We conducted this study to determine the GTs in a HCV endemic area in Southern Taiwan. A total of 1147 patients with hepatitis C viremia for direct acting antivirals (DAA) treatment at the Chi Mei medical system in Tainan were enrolled. Genotype was determined using a working flow consisted of Abbott GT II, PLUS assays and 5′ untranslated region (5′ UTR)/core sequencing. Among the 1147 patients, 883 (77.0%) obtained GT results by GT II, 264 (23.0%) samples with ambiguous results by GT II assay received further tests, including 194 (73.5%) with PLUS assay and 70 (26.5%) with 5′UTR/core sequencing. Nearly three-quarters (73.5%) of ambiguous results by GT II assay were GT 6. Overall, 18.3% of samples were GT 6. Phylogenetic study of 11 samples of GT 6 subtypes showed 7 (63.6%) were 6 g. GT 6 is the major factor for high ambiguous rate by GT II. Unexpected high prevalence of GT 6 (18.3%) in Southern Taiwan, especially subtype 6 g, closely related to Indonesian strains, is first reported. [ABSTRACT FROM AUTHOR]

Background/purpose: Little remains known regarding whether newer FQ with less anti-mycobacterial activity (gemifloxacin) would reduce treatment delay.Methods: We identified one hospital-based cohort (HBC) and one population-based cohort (PBC) including patients receiving amoxicillin/clavulanate acid (Beta-lactam), gemifloxacin (Gemi), and fluoroquinolones other than gemifloxacin (Non-Gemi FQ) prior to TB treatment.Results: A total of 201 patients in the HBC and 3544 patients in the PBC were recruited. After 1:1 propensity score matching, TB treatment delay was statistically insignificant between Beta-lactam, Gemi group, and Non-Gemi FQ group in HBC (Beta-lactam vs Gemi: 22.3 ± 21.4 d vs 28.6 ± 27.9 d, p = 0.292; Beta-lactam vs Non-Gemi FQ: 33.3 ± 26.5 d vs 50.3 ± 47.3 d, p = 0.135) and PBC (Beta-lactam vs Gemi: 26.4 ± 29.1 vs 25.0 ± 28.1, p = 0.638; Beta-lactam vs Non-Gemi FQ: 29.4 ± 36.0 d vs 32.7 ± 35.0 d, p = 0.124, Non-Gemi FQ vs Gemi: 28.4 ± 33.0 d vs 25.0 ± 28.1 d, p = 0.29).Conclusion: While limited by relatively low case number, our study showed that use of gemifloxacin neither results in nor reduces delay in TB treatment. The issue of FQ use on TB treatment delay was also not observed in our study. Early survey and maintaining high clinical alertness remains the key to reducing TB treatment delay. [ABSTRACT FROM AUTHOR]

Background: The incidence of cefepime-induced neurotoxicity (CIN) has been previously underestimated, and there have only been sporadic reports from critical neurological settings. The present study aimed to investigate the potential factors associated with disease development, electroencephalography (EEG) sub-classification, and outcome measures.Methods: The 10-year medical records of patients who underwent EEG between 2007 and 2016 at a tertiary medical center in Taiwan, and developed encephalopathy after cefepime therapy were retrospectively reviewed. Age- and sex-matched controls were included for further analysis. Demographic data, the occurrence of clinical seizures, non-convulsive status epilepticus (NCSE), use of antiepileptic drugs (AEDs), receiving maintenance or urgent hemodialysis, EEG findings, and functional outcomes were analyzed. The Chi-square test and a logistic regression model were applied to survey significant prognostic factors relating to mortality.Results: A total of 42 CIN patients were identified, including 25 patients from wards and 17 from intensive care units; their mean age was 75.8 ± 11.8 years. Twenty-one patients (50%) had chronic kidney disease, and 18 (43%) had acute kidney injury. Among these patients, 32 (76%) received appropriate cefepime dose adjustment. Three patients had a normal renal function at the time of CIN onset. The logistic regression model suggested that maintenance hemodialysis and longer duration of cefepime use were independently associated with the development of CIN, with odds ratios of 3.8 and 1.2, respectively. NCSE was frequently noted in the CIN patients (64%). Generalized periodic discharge with or without triphasic morphology was the most common EEG pattern (38%), followed by generalized rhythmic delta activity and generalized spike-and-waves. AEDs were administered to 86% of the patients. A total of 17 patients (40%) did not survive to hospital discharge. Adequate cefepime dose adjustment and early cefepime discontinuation led to a better prognosis.Conclusions: CIN was associated with high mortality and morbidity rates. Neurotoxic symptoms could still occur when the cefepime dose was adjusted, or in patients with normal renal function. Patients with maintenance hemodialysis or a longer duration of cefepime therapy tended to develop CIN. Early recognition of abnormal EEG findings allowed for the withdrawal of the offending agent, resulting in clinical improvements and a better prognosis at discharge. [ABSTRACT FROM AUTHOR]

Background/purpose: Although cerebral emboli are a frequent cause of cardiogenic stroke, the possibility of a reduction in cerebral perfusion consequent to arrhythmia or impaired cardiac function should be considered in patients with atrial fibrillation (AF).Methods: We reviewed sonographic studies and clinical features of patients with acute ischemic stroke. A total of 144 patients with AF and 144 age- and sex-matched patients with small vessel occlusion but without AF were included.Results: Patients with AF had significantly lower peak systolic velocity (PSV), mean velocity, flow volume (p < 0.001), and end-diastolic velocity (p = 0.035) of the internal carotid artery (ICA); significantly lower cerebral blood flow (p < 0.001); and lower flow velocities of the middle cerebral artery (p < 0.01) than patients with small vessel occlusion but without AF. In patients with AF, there was an inverse linear correlation between ICA end-diastolic velocity, mean velocity (p < 0.001), flow volume (p = 0.025), middle cerebral artery flow velocities (p < 0.05), and age. Cardiac ejection fraction had a positive linear correlation with ICA PSV (p = 0.016) but an inverse correlation with the heart rate (p = 0.009). There was a significant decline in PSV (p = 0.002), resistance index (p < 0.001), and flow volume (p = 0.0121) of the ICA as well as cerebral blood flow (p = 0.009) as the heart rate increased.Conclusion: Cerebral blood flow is markedly reduced in ischemic stroke patients with AF as compared with that in patients with small vessel disease but without AF. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to develop and test a model of team performance by applying social exchange and social capital perspectives in a single model setting. It hypothesizes that team performance is indirectly affected by politics through leader–member capitalization (LMC) and by ethical leadership through leader–member exchange (LMX). Meanwhile, team identification is hypothesized to moderate the relationships between politics and LMC and between ethical leadership and LMX. Design/methodology/approach: The hypotheses of this study were empirically tested using a survey of work teams from the banking and insurance industry in Taipei, Taiwan. Findings: The relationship between team performance and ethical leadership is fully mediated by LMX, while the indirect relationship between team performance and politics is mediated via both LMC and LMX. Team identification positively moderates the relationship between ethical leadership and LMX. Originality/value: This study is one of the few to examine the mediating roles of LMC and LMX simultaneously in team performance development. This study provides several key findings that complement the existing literature by evaluating fresh associations among LMC, LMX and their determinants and moderator. [ABSTRACT FROM AUTHOR]

Since its ratification of the United Nations' Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) in 1988, China has enacted many laws and rules in order to prohibit torture. But torture still happens, and tortured confessions continue to influence trials, as numerous wrongful convictions demonstrate. This study aims to examine why there are persistent practices of forced confession in China and to identify the roots of torture in China's current criminal justice system in order to mend the remaining flaws. Currently, the definition of torture used in China is too limited in scope, and not all illegally obtained evidence can be excluded even by law. In practice, courts focus on remedying wrongful convictions caused by torture in a narrow sense and are not totally in line with international standards. Even defence lawyers are charged with separate crimes and tortured to confess sometimes, seriously detrimental to fairness and justice. So, more institutional restraints on banning police torture are necessary, in spite of many reform measures that have already been taken. Legislative revisions on the scope of torture and institutional reforms on supervising police interrogations are needed at the very least. All lawyers should be immune from criminal investigations relating to their work during their defence against tortured confession in all cases. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis on Chen Yingzhen’s “Wo de didi Kangxiong” (“My brother Kangxiong”) and Wang Shangyi’s “Ye gezi de huanghun” (“Wild pigeon’s dusk”) in the cultural-historical context of Taiwan in 1960s, in the aim of exploring the origin of “nihilism” which had been prevailed among Taiwan youth from 1950s to 1960s. Furthermore, the paper reexamines the hidden but intimate relationship between modernism and left-wing intellectuals. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a mite-borne febrile disease caused by O. tsutsugamushi infection. Recently, emergence of scrub typhus has attracted considerable attention in several endemic countries in Asia and the western Pacific. In addition, the antigenic diversity of the intracellular pathogen has been a serious obstacle for developing effective diagnostics and vaccine. Methodology/Principal findings: To understand the evolutionary pathway of genotypic diversification of O. tsutsugamushi and the environmental factors associated with the epidemiological features of scrub typhus, we analyzed sequence data, including spatiotemporal information, of the tsa56 gene encoding a major outer membrane protein responsible for antigenic variation. A total of 324 tsa56 sequences covering more than 85% of its open reading frame were analyzed and classified into 17 genotypes based on phylogenetic relationship. Extensive sequence analysis of tsa56 genes using diverse informatics tools revealed multiple intragenic recombination events, as well as a substantially higher mutation rate than other house-keeping genes. This suggests that genetic diversification occurred via frequent point mutations and subsequent genetic recombination. Interestingly, more diverse bacterial genotypes and dominant vector species prevail in Taiwan compared to other endemic regions. Furthermore, the co-presence of identical and sub-identical clones of tsa56 gene in geographically distant areas implies potential spread of O. tsutsugamushi genotypes. Conclusions/Significance: Fluctuation and diversification of vector species harboring O. tsutsugamushi in local endemic areas may facilitate genetic recombination among diverse genotypes. Therefore, careful monitoring of dominant vector species, as well as the prevalence of O. tsutsugamushi genotypes may be advisable to enable proper anticipation of epidemiological changes of scrub typhus. [ABSTRACT FROM AUTHOR]

Background This study evaluated a medication therapy management service using the Taiwan National Health Insurance Administration's PharmaCloud system in a medical center in Taiwan. The new PharmaCloud System, launched in 2013, links a complete list of prescribed and dispensed medication from different hospitals, clinics, and pharmacies for all insured patients. Method The study included patients with polypharmacy (≥5 drugs) at a medication therapy management service from March 2013 to March 2014. A structured questionnaire was designed to collect patients' baseline data and record patients' knowledge, attitudes, and practice scores before and after the service intervention. Phone follow-ups for practice and adherence scores on medication use were performed after 3 months. Results There were 152 patients recruited in the study. Scores for medication use attitudes and practice significantly increased after the service (attitudes: 40.06 ± 0.26 to 43.07 ± 0.19, p  <   0.001; practice: 33.42 ± 0.30 to 40.37 ± 0.30, p  <   0.001). The scores for medication adherence also increased from 3.02 ± 0.07 to 3.92 ± 0.02 ( p  <   0.001). Conclusions The PharmaCloud system facilitates accurate and efficient medication reconciliation for pharmacists in the medication therapy management service. The model improved patients' attitudes and practice of the rational use of medications and adherence with medications. Further studies are warranted to evaluate human resources, executing costs, and the cost-benefit ratio of this medication therapy management service with the PharmaCloud system. [ABSTRACT FROM AUTHOR]

This study aimed to determine the possibility of using the Mini-Nutritional Assessment (MNA) to evaluate the quality of life and functional status in patients with hepatocellular carcinoma (HCC). The study recruited 300 outpatients with HCC from a teaching hospital in Central Taiwan to serve as subjects. All subjects were interviewed with a structured questionnaire for rating the nutritional status with the MNA (long-form and short-form), and for evaluating quality of life and functional status with Global Quality of Life (GQL) and Global Functional Status (GFS), respectively, of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version-3. Cancer staging and liver cirrhosis indicators, blood biochemical indicators, and self-rated health status and mobility were used as reference standards. Results showed that based on the strength of the correlation and association with the reference standards, both the long-form and short-form of the MNA performed better than GQL and GFS in predicting quality of life and functional status of patients with HCC. These results suggest that the MNA is suitable for identifying the risk of deteriorating quality of life or functional status, in addition to identifying the risk of malnutrition, in patients with HCC. [ABSTRACT FROM PUBLISHER]

The flathead grey mullet, Mugil cephalus (Mugilidae), is one of the most commercially important fish species in Taiwan since mullet roe is considered as a delicacy with a high economic value. Farmed, wild-caught, and imported mullet roes are often not properly labelled in retail stores and merchants can make unethical profits from selling mislabeled products. Therefore, there is an urgent need to identify the provenance and production method of the mullet roes. In this study, we conducted a molecular phylogenetic analysis so as to identify the species and geographical origin of the mullet roes and we used stable isotopic values as a tool to differentiate between the wild-caught and farmed mullet roes. DNA sequence variations of a mitochondrial COI gene from the sampled mullets and mullet roes of wild-caught and farmed individuals, as well as the roe products sold in retail stores in Taiwan, were analyzed within the phylogenetic framework. The results showed that the samples were from four M. cephalus lineages (or putative Mugil species B, C, I, and H) occurring in the Caribbean Sea, Northwestern Pacific, and Southeastern Australia, and the M. liza in the Western Atlantic, respectively. The M. liza samples were from the salted roe products purchased from two retail stores, in which one claimed that the roes were imported from Brazil, whereas the other claimed that the roes were from locally reared flathead grey mullets. The farmed mullet roes had significantly lower δ13C values and less variation in δ15N values when compared with the wild-caught and imported mullet roes. Quadratic discriminant analysis based on the δ13C and δ15N values successfully discriminated the farmed mullet roes from the wild-caught and imported roes with an approximate error rate of 2%. Our study demonstrated that the combined approach of genetic and stable isotopic analyses can effectively authenticate the mullet roe origin and production methods. • Mullet roe is considered as a delicacy with a high economic value. • Wrong labelling can make unethical profits from selling those roe products. • Molecular phylogenetics identifies species and geographic origin of mullet roes. • Stable isotope analysis discriminates farmed mullet roes from wild-caught ones. • Combined approach accurately authenticates mullet roe products. [ABSTRACT FROM AUTHOR]

Aims: The exact world-wide prevalence of Brugada electrocardiogram (ECG) pattern is still unclear, especially in adults aged 55 years and older.Methods and Results: The study was conducted as part of the Healthy Aging Longitudinal Study in Taiwan (HALST). Using a stratified random sampled method, a sample of community-dwelling subjects was recruited from seven community-based regions across Taiwan. All enrolled subjects were follow-up annually and cause of death was documented by citizen death records. A total of 5214 subjects were enrolled (male/female: 2530/2684) with a mean age of 69 ± 8 years. The overall prevalence of Brugada ECG patterns was 3.32%. Four subjects carried spontaneous Type 1 Brugada ECG pattern, 68 carried Type 2, and 101 carried Type 3. Compared with the world-wide average prevalence of Brugada ECG patterns, the prevalence of spontaneous Type 1 Brugada ECG pattern in subjects from the HALST cohort was similar (0.077 vs. 0.07%) and the combined prevalence of Types 2 and 3 Brugada ECG pattern was 10 times higher (3.24 vs. 0.28%) even the mean age of study subjects was significantly higher (69 ± 8 vs. 35 ± 8, P < 0.001). However, all-cause mortality and cardiac mortality rates were not significantly different between subjects with and without Brugada ECG patterns during the 4-year follow-up (log-rank test, P = 0.21, 0.32, respectively).Conclusion: The prevalence of Brugada ECG pattern in adults aged 55 years and older in Taiwan was higher than the average world-wide prevalence but was not associated with increased mortality. [ABSTRACT FROM AUTHOR]

This study aims to compare auditory temporal processing and phonological processing across locations and age levels and to test the direct and indirect effects of auditory temporal and phonological processing on proficiency in Chinese character reading. We recruited 108 typically developing children — 25 and 24 kindergarteners from Taiwan and Hong Kong, respectively, and 34 and 25 primary school students from Taiwan and Hong Kong, respectively. Our findings showed that, before learning PCS, the languages' phonological complexity did not affect the importance of ATP in Chinese reading. Also, we found the use of PCS could lead to a direct effect from students' ATP to Chinese character reading as well as through phonological awareness. Our findings indicated that ways of learning to read influence children's patterns of cognitive and linguistic abilities, which should be considered in teaching designs for reading. [ABSTRACT FROM AUTHOR]

Background: Whether HbA1c is a predictor of end-stage renal disease (ESRD) in type 2 diabetes patients remains unclear. This study evaluated relationship between HbA1c and ESRD in Chinese patients with type 2 diabetes. Methods: Patients aged ≥ 30 years who were free of ESRD (n = 51 681) were included from National Diabetes Care Management Program from 2002–2003. Extended Cox proportional hazard model with competing risk of death served to evaluate association between HbA1c level and ESRD. Results: A total of 2613 (5.06%) people developed ESRD during a follow-up period of 8.1 years. Overall incidence rate of ESRD was 6.26 per 1000 person-years. Patients with high levels of HbA1c had a high incidence rate of ESRD, from 4.29 for HbA1c of  6.0%–6.9% to 10.33 for HbA1c ≥ 10.0% per 1000 person-years. Patients with HbA1c < 6.0% particularly had a slightly higher ESRD incidence (4.34 per 1000 person-years) than those with HbA1c  of 6.0%–6.9%. A J-shaped relationship between HbA1c level and ESRD risk was observed. After adjustment, patients with HbA1c < 6.0% and ≥ 10.0% exhibited an increased risk of ESRD (HR: 1.99, 95% CI: 1.62–2.44; HR: 4.42, 95% CI: 3.80–5.14, respectively) compared with those with HbA1c of 6.0%–6.9%. Conclusions: Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia. Our study revealed that HbA1c level ≥ 7.0% was linked with increased ESRD risk in type 2 diabetes patients, and that HbA1c < 6.0% also had the potential to increase ESRD risk. Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population. Clinicians need to pay attention to HbA1c results on diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Background: Nursing is a caring profession involving commitment and dedication to meeting the satisfaction of human needs. Current research, conducted mainly with a quantitative design, highlights the caring experienced by nurses. Therefore, it is vital to explore nurses' caring perceptions with a qualitative method and its implementation in a clinical context. Aim: This study presents caring behavior exhibited by Taiwanese nurses. Methodology: A qualitative study was adopted. Using a semi-structured interview guide, we asked participants to describe their perceptions of caring behaviors in clinical situations. Total of 58 participants were recruited in this study. Twelve focus groups were conducted in the study. Thematic analysis was used to analyze the data. Results: Nurses' perceptions of caring behaviors were classified into five themes: inspiring hope in patients; providing physical comfort; having skillful techniques and possess professional knowledge; having patience; and respecting patients' culture. Conclusions: The findings of this study contribute to the discourse on the caring behaviors of Taiwanese nurses and indicate that the nursing curriculum should incorporate the concepts of caring behaviors that embrace diverse cultures to achieve holistic patient care. [ABSTRACT FROM AUTHOR]

The growing literature on corporate responsibility (CR) has drawn attention to how different CR practices complement each other and interact in the form of configurations. This study investigated CR patterns associated with high financial performance for 466 firms in Mainland China, Hong Kong, and Taiwan. We applied a set-theoretic approach using qualitative comparative analysis to identify similarities and differences across these three societies in configurations of CR practices relating to customer, employee, investor, community, and environmental stakeholder groups. The extent to which the financial benefits of various configurations of CR practices are attributable to institutional factors is examined. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous injection is a common clinical procedure. According to U.S. Centers for Disease Control guidelines, there is no need to replace peripheral catheters routinely every three days. However, local evidence-based research is needed to determine whether these guidelines are appropriate for Taiwan's island climate. Purpose: This study explores the effects of routine replacement of peripheral intravenous catheters every 96 hours versus every 72 hours, attempting to provide evidence-based information on optimal timing for replacing peripheral intravenous catheters. Methods: A randomized controlled trial design was adopted. Using convenience sampling, surgical otolaryngology inpatients of a medical center in southern Taiwan were recruited. A randomized block design assigned 71 participants to the 96-hour group and to the 72-hour group, respectively. A chi-square test and independent t test were used to compare the differences in the incidence of phlebitis, injection site infections, bloodstream infections, and catheter occlusion as well as the materials costs and nursing hours per patient day between the two groups. Results: There were no significant differences between the groups with respect to the incidence of phlebitis, injection site infections, bloodstream infections, or catheter occlusion (p > .05). The 96-hour group had a significant NT$ 152.72/person reduction in medical material costs (p < .0001) and a significant 174.23 seconds/person reduction in nursing hours per patient day (p < .0001). Conclusions / Implications for Practice: The results of this study suggest that for cases in which no infection signs at the intravenous injection sites are detected by routine assessment for more than three shifts during one day, the optimal replacement interval for peripheral intravenous catheters is 96 hours. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In addition to physical health benefits, being physically active or exercising can also have psychological benefits. We explored the psychological effects of an exercise intervention in this quasi-experiment. Materials and Methods: Residents in Ma-Yuan village in Wan Rung township in Hualien county, Taiwan were recruited to participate in a fitness program (n = 31). Residents from the same village but geographically segregated areas served as a control group (n = 44). Participants from both groups filled out a pretest questionnaire at the beginning of the intervention, and a post-test questionnaire 1 week after the conclusion of the intervention. Results: Analysis of the pre- and post-test survey data showed that after the intervention, participants in the intervention group, but not those in the control group, experienced less negative affect. In addition, participants in the intervention group had more positive attitudes toward some aspects of exercising. Conclusion: Future intervention promoting exercise or physical activity targeting indigenous people could stress the emotional benefits of exercising, as it may be more congruent with indigenous cultural values. [Copyright &y& Elsevier]

To examine the effectiveness of a Humanoid Diagram Teaching Strategy (HDTS) on care capabilities and retention of novice nurses. Guiding novice nurses in clinical practice is a matter of concern and the use of diagrams in assisting the learning process and to promote learning efficiency has been acknowledged. This is a quasi-experimental study with asynchronous repeated measurements for the experimental and control groups. The study was conducted in a medical centre in southern Taiwan with 24 novice nurses. The intervention, Humanoid Diagrams Teaching Strategy, contained three parts: the head and neck; trunk; and limbs. The HDTS was applied three time weekly. Each session lasted approximately 30 min and the training lasted 4 weeks. The effectiveness of HDTS was measured using Mini-CEX, CbD and retention rates in the 3rd and 6th months of novice nurses' experience. After the HDTS, although increases in mini-CEX and CbD scores in the experimental group were greater than the control group, these differences were not statistically significant after considering the time interaction. But the 3rd month and 6th month novice nurses' retention rates were statistically significantly different by comparing the differences under the time interaction effects in both groups. The Humanoid Diagram Teaching Strategy is an effective tool for preceptors to use in assisting novice nurses in learning, improving their nursing care knowledge and technical skills and to increase their retention rate. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined. Methods: Patients admitted between May 2008 and September 2009 were recruited. The type and class of medication discrepancies reported by pharmacists, the medication discrepancy rate, physician acceptance rate, and time taken for the intervention were studied. The degree of harm that could have resulted from the discrepancies was independently evaluated by four pharmacists. The association between selected variables and the occurrence of drug discrepancies was analyzed. Results: Among 3013 patients interviewed, the pharmacists identified 243 patients (8%) with at least one medication discrepancy between the patient's medication history and admission orders. There were 576 discrepancies identified. About 19% of the errors prevented could have potentially caused moderate to severe harm. The average time for one intervention was 18±9.8min. The number of preadmission medications, age, frequency of outpatient visits within 3 months prior to this hospital admission, and the number of specialist outpatient clinics the patient had visited within 3 months before the admission were determined to be risk factors for drug discrepancies. Conclusions: This medication reconciliation program, conducted by pharmacists, was made more efficient by medication usage data from the Taiwan NHI. Pharmacists can reconcile medications more effectively by selecting patients at high risk for unintentional drug discrepancies. [Copyright &y& Elsevier]

Background: An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear. Methods: We selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB. Results: Among 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205-2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral β-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral β-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios. Conclusion: Keeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice. [ABSTRACT FROM AUTHOR]

This meta-analysis aimed to evaluate the effectiveness of acupuncture or acupressure at the Sanyinjiao (SP6) acupoint in relieving pain associated with primary dysmenorrhea. We searched the scientific literature databases to identify randomized controlled trials. The primary outcome was visual analogue scale (VAS) pain score. Three acupuncture and four acupressure trials were included in the meta-analyses. For the acupuncture analysis, there was no difference in the mean VAS score reduction between the SP6 acupoint and control (GB39 acupoint) groups (-4.935; lower limit = -15.757, upper limit = 5.887; P = 0.371). For the acupressure analysis, there was a significant difference in the mean VAS score after intervention between the SP6 acupoint and control (rest/light touch at SP6/nonacupoint acupressure) groups, favoring the SP6 acupoint group (-1.011; lower limit = -1.622, upper limit = -0.400; P = 0.001). Sensitivity analyses demonstrated good reliability of the meta-analyses findings. These findings suggest that acupuncture at SP6 is not more effective than acupuncture at an unrelated acupoint in the relief from primary dysmenorrhea. Acupressure at SP6 may be effective in the relief from primary dysmenorrhea. High-quality randomized controlled trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]