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Purpose: This study aims to evaluate the current situation of education for sustainable development, climate change education and environmental education in a nationwide context. Methodologically, this study calls for more research to go beyond case studies and take a similar approach to examine university curricula and facilitate cross-country comparisons. Design/methodology/approach: This paper examines the status of climate and sustainability curricula in Taiwan's higher education system. Using the course catalog for the 2020-2021 academic year, the authors constructed a unique data set that includes 1,827 courses at 29 major universities in Taiwan. In each institution, the authors search for course titles that include "climate," "sustainable/sustainability" and "environment/environmental" as keywords and code the courses according to their disciplines. Findings: The finding highlights the variations across institutional types and subject matters. Public universities have an average of 4.94 related courses per 1,000 students, whereas private universities have only 3.13. In general, the relevant courses are more concentrated in the STEM and bioscience fields. The curricula, however, are seriously constrained by the disciplinary structure and foster few transdisciplinary perspectives. Originality/value: The authors seek to go beyond case studies and offer one of the most comprehensive curricula samples at the national level. Taiwan adds an important data point, as the current literature focuses heavily on the USA and Europe.

Loosened by the laws and regulations, Taiwan's alternative educational policy has allowed public schools to conduct school-wide curriculum transformation experiments, which is a possible opportunity for Taiwanese aborigines who have been subjected to long-term oppression and assimilation to separate from the mainstream ideological educational framework. In this change process, the school principal-led curriculum transformation has become an important way to seek a new educational model. This paper qualitatively investigates two alternative schools for Taiwanese aborigines that have undergone successful transformation and collects the views of the principals, directors, team leaders, and teachers (eight persons in total) in two schools on the school principal-led curriculum transformation. Through summarizing and analyzing relevant data, this paper proposes that the principals of Taiwanese aboriginal schools effectively change the teachers' beliefs, curriculum structure, and school culture through the systematic practices of "belief change" and "structural innovation," and establish a curriculum paradigm different from mainstream education, which realizes a certain knowledge transfer effect. The transformative curriculum leadership process can be summarized into the conflict awakening and positioning stage, the experimental and interactive development stage, and the revision and transformation stage. This study intents to provide a reference for Taiwan's educational reform and encourage the principals of other alternative schools to picture the connotation and value of transformative curriculum leadership and establish more new curriculum models of alternative education.

The aim of this study was to determine the effects of different types of language tasks performed in Second Life (SL) on the oral performance of beginners of Chinese as a Second Language (CSL), focusing on oral accuracy. The 30 CSL beginners who participated in this study were randomly divided into two groups (n = 15 per group), required to perform two different types of language tasks: information-gap and reasoning-gap. During the study, both the Mandarin oral accuracy and the learning motivation of both groups were measured and analyzed to determine to what extent performing the two different task types could contribute to the two dependent variables (i.e., accuracy and motivation). All the learners improved significantly in oral communication competence, with those performing the reasoning-gap task improving significantly more than those performing the information-gap task. It was also found that almost all the learners exhibited positive learning motivation and appreciated the task-based learning activities designed in SL. Both groups made significant improvement in the affective dimension. Furthermore, the reasoning-gap group received significantly higher scores in the educational-context-related dimension (attitude toward SL as the Mandarin Chinese learning environment) than the information-gap group did.

The aims of this research were to develop guidelines for designing interaction tasks for learners of Chinese as a foreign language (CFL) and to investigate the attitudes of CFL learners toward a full CFL class in Second Life (SL). Three research questions were addressed in this research: (1) what are the attitudes of CFL learners toward the language learning tasks in SL? (2) what kinds of social interactions emerge from learning activities in a CFL class in SL? (3) how do those activities benefit CFL learners in the learning of Chinese in SL? Two studies were conducted to tackle these questions. The cognition, usage, and expansion (CUE) model was proposed based on the findings obtained from study 1 and then implemented and evaluated in study 2. The findings of study 2 indicated that the activities run in the CUE model were effective at motivating CFL beginners and improving their oral communication and social interactions. Based on the video data analysis, three criteria were proposed for designing learning activities. Suggestions are also made for future research on CFL teaching/learning in SL. (Contains 2 tables and 9 figures.)

Background: There is limited research on the development of newspaper analysis about the images of people with ID in Chinese newspapers. The purpose of this study was: (a) to understand the general image of persons with ID presented in printed newspapers in Taiwan, and (b) to classify the various images of persons with ID and to measure the relative proportions among these classifications. Method: Articles from 2008 from the media databank UDNDATA were analysed by content analysis. Results: Three main images were portrayed. The greatest number of articles revolved around the "dispirited" image (44.5%), followed by "needy" (32.7%), and "affirmative" (22.8%). Articles focused on families with a member with ID made up 20.8% of the total articles, and 81% of these stories had a negative theme. Conclusion: The pessimistic portrayal of people with ID is popular and newspapers may create stigma for people with ID in Taiwan. (Contains 1 table.)

This study develops a model to examine the key drivers of users' continuance intention of e-learning, based on negative critical incidents (NCIs) standpoints. The developed research model is tested empirically using a field survey of 230 users. This study finds that users' past service encounters (NCIs), belief (perceived ease of use and usefulness), satisfaction (quality attributes cumulative satisfaction and overall satisfaction) and attitude are key antecedents of continued usage intention. Four dimensions of both NCIs and quality attributes in e-learning (administration procedures, e-learning system functionality, instructional process and human interaction) are explored in this study. Results indicate that NCIs in teaching and administration are comparatively more important in determining user satisfaction and continuance intention. Further analysis finds that the recorded lecture content and the response time to users are the most critical problems in teaching and administration. In practice, this model can identify the key problems of satisfaction and continuance intention to help managers and teachers react promptly or make right decisions about how to better achieve higher user retention rates. (Contains 6 tables and 4 figures.)

This paper analyzes the effects of parenting practices on children's education. Our empirical analyses are based on household data from Taiwan. More specifically, we investigate the influence of parents' child-rearing practices (i.e., encouragement and punishment) on their children's education attainments and aspirations. We also explore the association between parents' socioeconomic background and their child-rearing practices. The empirical results help explain the relationship between family background and education attainments.

The purpose of this qualitative study is to present and shape successful indigenous school principal leadership in Taiwan. We focus particularly on a principal's attitudes to change, how this influences principal leadership practice and ultimately its contribution to improving school performance. The study captures and analyzes opinions of the stakeholders of an indigenous school on principal leadership to understand how the principal leads the school to successful transformation. The results show that indigenous principal leadership emphasizes harmonious collective relationships, equality of power, spiritual satisfaction and collectivism. The ancestral soul is especially rooted in the principal's philosophy and values, such that the principal makes good use of the blood ties between schools and tribes, and creates a community of a shared future, facing difficulties together. The findings contribute to the body of knowledge on shaping successful indigenous school principal leadership, which transforms the internal and external environmental factors into the forces for successful school change and benefits the stakeholders. [ABSTRACT FROM AUTHOR]

Background/purpose: Both prone positioning and extracorporeal membrane oxygenation (ECMO) are used as rescue therapies for severe hypoxemia in patients with acute respiratory distress syndrome (ARDS). This study compared outcomes between patients with severe influenza pneumonia-related ARDS who received prone positioning and those who received ECMO.Methods: This retrospective cohort study included eight tertiary referral centers in Taiwan. All patients who were diagnosed as having influenza pneumonia-related severe ARDS were enrolled between January and March 2016. We collected their demographic data and prone positioning and ECMO outcomes from medical records.Results: In total, 263 patients diagnosed as having ARDS were included, and 65 and 53 of them received prone positioning and ECMO, respectively. The baseline PaO2/FiO2 ratio, Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score did not significantly differ between the two groups. The 60-day mortality rate was significantly higher in the ECMO group than in the prone positioning group (60% vs. 28%, p = 0.001). A significantly higher mortality rate was still observed in the ECMO group after propensity score matching (59% vs. 36%, p = 0.033). In the multivariate Cox regression analysis, usage of prone positioning or ECMO was the single independent predictor for 60-day mortality (hazard ratio: 2.177, p = 0.034).Conclusion: While the patients receiving prone positioning had better outcome, the causality between prone positioning and the prognosis is unknown. However, the current data suggested that patients with influenza-related ARDS may receive prone positioning before ECMO support. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence linking low levels of vitamin D3 to an increased risk of many autoimmune diseases. Compared to the general population, hypovitaminosis D is more prevalent among children with systemic lupus erythematosus (SLE), which can be associated with sun exposure avoidance, long-term corticosteroid treatment, and renal disease. Therefore, we launched this study to assess the correlation between 25 (OH) D3 (VitD3) levels and the disease activity of children with SLE (cSLE) in Taiwan. Methods: From September to December 2018, we recruited 31 cSLE patients from the Pediatric Out-patient Department of Taichung Veterans General Hospital. Their basic data, including SLE disease index 2000 (SLEDAI-2K) score, laboratory values, prescribed drugs and VitD3 levels were collected and analyzed statistically. Results: The mean serum VitD3 concentration was 19.7 ± 7.9 ng/mL and SLEDAI-2K 6.2 ± 5.0. Those patients (N = 16) with an SLEDAI-2K≦4 had higher VitD3 levels when compared to those (N = 15) with an SLEDAI-2K>4 (22.9 ± 7.7 vs 16.3 ± 6.7 points, p = 0.020). Five patients not taking systemic corticosteroids (SCS) had significantly higher VitD3 levels and lower SLEDAI-2K than those who took SCS (N = 26). Additionally, we found VitD3 levels to be negatively correlated to SLEDAI-2K (rs = -0.55, p = 0.001) and daily SCS dosages (rs = -0.49, p = 0.005). Conclusion: This study shows that VitD3 deficiency is common in patients with cSLE. It was also noted that serum VitD3 levels negatively correlate to SLEDAI-2K, which can be partially explained by less usage of SCS. [ABSTRACT FROM AUTHOR]

Purpose: Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting gonadotropin-releasing hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes. Hereby, we compared the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer receiving either surgical castration or GnRH therapies. Materials and Methods: Using the Taiwan Cancer Registry and Taiwan's National Health Insurance Research Database, we identified 8,413 patients receiving GnRH therapies compared with 694 receiving surgical castration from 2008 to 2017. The median followup duration was 3 years. Results: The crude incidences of 3-year mortality and MACCEs were 19.90% vs 26.51% and 8.23% vs 8.65% in patients receiving GnRH therapies or surgical castration, respectively. After adjusting for age, cancer stage and comorbidities, despite no significant differences in MACCEs between groups there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared with those receiving GnRH therapies. The mortality adjusted hazard ratios of MACCEs and AMI among patients receiving surgical castration were 1.11- and 1.8-fold higher than those receiving GnRH therapies. Notably, in subgroup analysis regarding cancer stage, patients with cancer stage IV showed the most significantly increasing risk of AMI in those receiving surgical castration compared with GnRH therapies. Conclusions: Collectively, we indicated an increased risk of AMI in patients with prostate cancer, especially in patients receiving surgical castration rather than those receiving GnRH therapies. Our findings highlight concerns regarding the cardiac safety of surgical castration compared with GnRH therapies. [ABSTRACT FROM AUTHOR]

This study adopts the framework of transformative curriculum leadership theory, focused on one privatized school, the KIST (KIPP Inspired Schools in Taiwan) school, as a case study. The authors mainly utilize interview methods to explore the practices of principals' transformative curriculum leadership in the KIST school, and find that the case of school principal leadership successfully integrates the interactions from the school autonomy, the local educational authority, and the private foundation into a driving force to develop a new educational model. Such results not only restructure the subjectivity of school education, but also effectively provide the reference framework for policy correction and solutions to the contemporary problems of rural education. [ABSTRACT FROM AUTHOR]

Global charter flight demand remined relatively stable over the last decades, and international charter flight is an integrated product of the aviation and tourism industries. To better understand charter flight tourism in Asia, this study analyses key reasons affected Taiwan's charter flight demand from Japan, South Korea, Malaysia, and Singapore during the period 2009‒2018, with a consideration of aviation- and tourism-related variables. Empirical results show that the reduction in scheduled flight aircraft size stimulated new charter flight demand to Taiwan, offsetting the negative effects caused by scheduled seat increment to a certain degree. This study contributes to literature by exploring the impact of scheduled flight service availability on charter flight demand, and further enriches our understanding of the impact of scheduled flight services on international tourist arrivals in terms of aircraft size. Importantly, it has implications for policymakers and stakeholders involved in charter business, assisting them in facilitating aviation and tourism recovery during the post-COVID-19 era. • Estimates the effects of changes in scheduled flight service availability on charter flight demand. • First study to explore the effects of changes in aircraft size on charter tourism. • Highlights the role of tour operators and the impacts of tourism variables on charter tourism. • Findings contribute to the current debate on the aviation‒charter tourism nexus. [ABSTRACT FROM AUTHOR]

Background The outcomes of drug-eluting stent (DES) versus bare-metal stent (BMS) use in patients with diabetic mellitus (DM) and acute coronary syndrome (ACS) are rarely reported in Taiwan. This study aimed to investigate the 1-year cardiovascular outcomes of DESs versus BMSs implanted in Taiwanese patients with DM and ACS. Methods For this study, we collected and analyzed patient information from the database of the Taiwan ACS Full Spectrum registry regarding characteristics and cardiovascular events in participants with DM and ACS who received implantation of either BMS (BMS group) or DES (DES group) from October 2008 to January 2010. Results We found that several characteristics significantly varied between the groups. Compared with the BMS group ( n = 575), the DES group ( n = 199) had significantly lower rates of in-hospital cardiogenic shock (1.5% vs. 4.9%, p = 0.037) and acute renal failure (0.5% vs. 4.5%, p = 0.008), all-cause mortality (5.0% vs. 8.9%, p = 0.048), and major adverse cardiac events (MACEs) at 1 year (11.1% vs. 18.6%, p = 0.006) with an identical target vessel revascularization (TVR) rate (6.0% vs. 7.3%, p = 0.395). The BMS group had significantly higher risk-adjusted all-cause mortality [hazard ratio (HR) = 2.4, 95% confidence interval (CI) 1.0–5.7; p = 0.048] and MACE (HR = 2.2, 95% CI 1.2–3.9; p = 0.011) at 1 year with identical risks of TVR (HR = 1.3, 95% CI 0.6–2.9; p = 0.505) and nonfatal myocardial infarction (HR = 1.5, 95% CI 0.5–4.4; p = 0.478). Conclusion The results of this study support the use of DES over BMS in Taiwanese patients with DM and ACS, providing the clinical benefits of lower rates of total mortality and MACE, and without increased TVR at 1 year in a real-world setting. [ABSTRACT FROM AUTHOR]

Background A greater policy of emphasis on the early detection and treatment of breast cancer is prevalent among developed countries. To raise the screening performance with a potentially decreased mortality rate, it is crucial to evaluate and analyze the screening outcome after implementation. We report the clinical outcome of an 8-year nationwide mammography screening in Taiwan to help share our statistical information on breast screening worldwide, especially in Asia. Methods Taiwan has provided nationwide, free, biennial mammographic screening since 2004. A total of 2,392,789 consecutive screening mammography examinations were performed during this study period for women aged 50–69 years (2006–2009) and 45–69 years (from December 2009 onwards). The screening covers 33.2% of the target population in the most recent 2 years. The workload of every screening radiologist, the overall recall rate, positive predictive value (PPV1), cancer detection rate (CDR), cancer incidence rate (CIR) from the screening, 1-year interval cancer, sensitivity, and specificity of the screening mammography are calculated, and compared with the American College of Radiology (ACR) recommendation level and/or those of other screening mammographic series. Results The CDRs (%) and CIRs (%) increased from 3.94–4.08 and 4.80–5.04 to 4.71–5.04 and 5.71 after 2009, implying a high occurrence of breast cancer in the younger age group of 45–49 years. The recall rates (9.3–10.0%) in this review are within the ACR recommendation range (<10%) and the PPV1 has also reached the ACR recommended level (>5%) in the most recent 2 years. The improvement of the screening performance may be attributed to our peer auditing review and education program. The sensitivity of our screening mammography is slightly lower than that of the ACR recommended level (>85%), which is still comparable to the results of the Vermont area in the USA. Although the workload (screenees/screeners) for every radiologist each year has increased from 150 in 2004 to 1360 in 2012, it does not seem to worsen the quality outcome of this screening program. Conclusion From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN) cases. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study was conducted to investigate whether detectable missed breast cancers could be distinguished from truly false negative images in a mammographic screening by a regular peer auditing. Methods: Between 2004 and 2007, a total of 311,193 free nationwide biennial mammographic screenings were performed for 50- to 69-year-old women in Taiwan. Retrospectively comparing the records in Taiwan''s Cancer registry, 1283 cancers were detected (4.1 per 1000). Of the total, 176 (0.6 per 1000) initial mammographic negative assessments were reported to have cancers (128 traditional films and 48 laser-printed digital images). We selected 186 true negative films (138 traditional films and 48 laser-printed ones) as control group. These were seeded into 4815 films of 2008 images to be audited in 2009. Thirty-four auditors interpreted all the films in a single-blind, randomized, pair-control study. The performance of 34 auditors was analyzed by chi-square test. A p value of <0.05 was considered significant. Results: Eight (6 traditional and 2 digital films) of the 176 false negative films were not reported by the auditors (missing rate of 4.5%). Of this total, 87 false negatives were reassessed as positive, while 29 of the 186 true negatives were reassessed as positive, making the overall performance of the 34 auditors in interpreting the false negatives and true negatives a specificity of 84.4% and sensitivity of 51.8%. The specificity and sensitivity in traditional films and laser-printed films were 98.6% versus 43.8% and 41.8% versus 78.3%, respectively. Almost 42% of the traditional false negative films had positive reassessment by the auditors, showing a significant difference from the initial screeners (p < 0.001). The specificity of their reinterpretation of laser-printed films was obviously low. Conclusion: Almost 42% of the false negative traditional films were judged as missed cancers in this study. A peer auditing should reduce the probability of missed cancers. [Copyright &y& Elsevier]

Abstract: Background: Drug abuse is becoming more prevalent in Taiwan, as evidenced by increasing reports of drug trafficking and drug abuse-related criminal activity, and the wide use of more contemporary illicit drugs. Consequently, drug abuse-related accidents are also expected to occur with greater frequency. However, no study has yet specifically evaluated the prevalence, pattern, and outcomes of drug abuse-related accidents among patients visiting emergency departments (EDs) in Taiwan. Methods: We conducted an ambidirectional study with patients who visited the EDs of Taipei Veterans General Hospital (TVGH) and China Medical University Hospital (CMUH) due to drug abuse-related accidents from January 2007 through September 2009. Information on the patients’ baseline characteristics and clinical outcomes was collected and analyzed. Results: During the study period, a total of 166 patients visited the EDs of one of the two study hospitals due to drug abuse-related accidents. This yielded a prevalence of drug abuse of 0.1% among all patients visiting the ED due to accident and/or trauma. Fifty-six out of the 166 patients visited the ED at TVGH, most patients being between 21 and 40 years old. Opioids (41.1%) were the drugs most commonly abused by the patients, followed by benzodiazepines (32.1%). More than two-thirds of the patients (n =38, 67.9%) required hospitalization, and three patients died (5.4%). In contrast, 110 patients with drug abuse-related accidents visited the ED at CMUH during the study period. Most of these subjects had abused benzodiazepines (69.1%), were between 21 and 40 years old, and were female. Fewer than one-fifth of the patients (n =19, 17.3%) required hospitalization, with no deaths reported. There were significant between-hospital differences in terms of patient gender, drugs of choice, injury mechanisms, method and time of the ED visit, triage levels, and need for hospitalization. Conclusion: Although the prevalence of drug abuse-related accidents was low, and only three patient deaths were reported in this study, many patients presented to the EDs with severe effects and later required hospitalization. Better and timely management of such patients will help to minimize the adverse health impacts associated with drug abuse. Governmental agencies and all healthcare professionals should also work together to fight against the surging trend of drug abuse in Taiwan. [Copyright &y& Elsevier]

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

Background: We investigated the health effects of low-dose radiation on cardiologists exposed to scattered radiation while performing cardiac catheterization (CC) in a hospital setting from 2003 to 2006. Methods: We performed a 4-year retrospective study on 2, 292 medical doctors, using claims data from all contracted hospitals of the Bureau of National Health Insurance, Taiwan. We gathered statistical data regarding radiation-related diseases using the International Classification of Diseases, 9th Revision, Clinical Modification record numbers of each doctor. Results: Of the 2,292 doctors evaluated, 1,721 were aged 35–50 years and the remaining 571 were aged 51–65 years. There were 892 cardiologists who performed CC (experimental group), and the majority of these (733/892, 82.17%) were aged 35–50 years. There were 1,400 medical doctors who performed no CC from 2003 to 2006 (control group). A total of 988 of these belonged to the 35–50 years age group and 412 to the 51–65 years group. In the 35–50 years group, the controls had significantly more medical visits for hematological and thyroid cancer (p <0.05), skin disease (p <0.001), and acute upper respiratory tract infection (p <0.001) compared with the experimental group. In contrast, cardiologists who performed catheterization had more cataracts compared with the control group, but this difference was not significant. Conclusion: Doctors who did not perform CC had more visits for radiation-related diseases than those who performed catheterization. In the experimental group, cardiologists aged 35–50 years who were exposed to radiation during CC had more visits for cataracts than the control group. We recommend that radiation protection concepts be emphasized to cardiologists, and that hospital managers be obligated to upgrade angiography equipment because the newer models have less scattered radiation. [Copyright &y& Elsevier]

Crotaline snakebites (Protobothrops mucrosquamatus and Trimeresurus stejnegeri) are a common medical emergency in Taiwan that can be effectively treated by a bivalent F(ab'')2 antivenom. We investigated the differences in the clinical outcomes of patients who received different therapeutic regimens of antivenom in a medical center where clinical toxicologists followed the poison control center (PCC) guidelines (medical group) and surgeons did not (surgical group). The medical records of inpatients with crotaline snakebites between 1991 and 2005 were reviewed and information on demographics, treatments, adverse effects of antivenom, and complications was abstracted and analyzed. A total of 179 patients (90 medical, 89 surgical) were eligible for study. There was no significant intergroup difference in baseline characteristics except that the dose of antivenom and the probability of antibiotic use were both higher in the surgical group (5.9 ± 4.2 vials vs. 2.7 ± 1.6 vials; 93%vs. 60%). Multiple logistic regression adjusting for age, gender, calendar year of envenomation, severity of envenomation, and antibiotic use did not disclose evidence of any difference in various clinical outcomes between medical and surgical patients. The lower dose of antivenom recommended by the PCC may be as effective and safe as the higher dose used in the surgical group for the treatment of crotaline snakebites. [Copyright &y& Elsevier]