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In light of mixed findings in existing input enhancement research, Issa and Morgan-Short in a 2019 article urged researchers to compare the relative effects of input enhancement that taps into learners' attention to the external format of second language (L2) target forms (e.g. through capitalizing or boldfacing the forms) and input enhancement that taps into learners' attention to the internal attributes of L2 target forms (e.g. via increasing the frequency of the forms). In response to this call, the study described in this article drew on a pretest-treatment-posttest-experimental-design to explore whether working memory (WM) capacity modulates the extent to which L2 learners benefit from input enhancement engaged by internal and external attentional manipulations for partially-acquired L2 vocabulary. Analyses of these learners' lexical gains under different experimental conditions showed that although compound input enhancement engaged by internal attentional manipulations did indeed lead to better lexical gains, such manipulations did not unequivocally lead to greater gains than the external manipulations in all cases. Furthermore, simple input enhancement engaged by internal attentional manipulations (i.e. varying the contextual supports for the target words) could be as effective as compound input enhancement. Importantly, we found that the aforementioned pedagogical effects of internal and external manipulations were both modulated by differences in WM capacity, albeit to differing extents. Insights from this study provide important pedagogical implications for differentiated input enhancement theory and practice.

A purposive sampling was conducted with 109 students from Anding elementary school, Taiwan. First, we found perceived ease of learning, enjoyment, self-efficacy, social interaction and learning attitude have significant differences between integrated teaching approach and Spoon-feeding instruction in this study. Second, the research framework has been proven perceived ease of learning and enjoyment positively influence on self-efficacy and learning attitude. Furthermore, we have verified self-efficacy positively influence on social interaction. Moreover, social interaction positively influences on learning attitude. Two contributions are found in this study. First, we adopted the concept of open innovation to design digital orchid game and integrated teaching approach. Second, we verified the connections of the research model with great model fit.

This study investigates the effects of the text difficulty of extensive reading materials on the reading comprehension and reading motivation of English as a foreign language (EFL) vocational high school students in Taiwan. Two experimental groups were assigned, on an individual basis, to read graded readers at either one level below ('i-1') or one level beyond ('i+1') their current level, while a control group followed their regular curriculum. The results showed that after treatment, the 'i-1' group improved their overall comprehension and the subset of literal comprehension. They also outperformed the 'i+1' group on the same measures. For reading motivation, the 'i+1' group's overall motivation was promoted. Both groups enhanced their reading engagement, while only the 'i-1' group inhibited reading avoidance. Moreover, the 'i+1' group outperformed the 'i-1' group in the perception of self-efficacy. Overall, the 'i-1' level yielded better effects on reading comprehension; the 'i+1' level, on reading motivation.

With rising societal interest in the subject areas of science, technology, engineering, art and mathematics (STEAM), a micro:bit robotics course with an online group study (OGS) system was designed to foster student learning anytime and anywhere. OGS enables the development of a learning environment that combines real-world and digital-world resources, and can enhance the effectiveness of learning among students from a remote area. In this pre- and post-test experiment design, we studied 22 (8 males and 14 females) 5th grade students from a remote area of Taiwan. A t test performed before and after the robotics course showed a positive increase in students' proportional reasoning, probabilistic reasoning, and ability to analyze a problem. Results also revealed a gender difference in the association between students' logical reasoning and problem-solving ability.

Existing research has established captions as effective second-language (L2) or foreign language (FL) listening comprehension aids. However, due to the transient nature of captions, not all learners are capable of attending to captions in all cases. Previous work posited that to leverage the impact of technologies in learning and instruction, a better understanding of the interplay between technology and cognition is warranted. In this vein, the current study set out to investigate the effects of four different caption modes (full vs. partial vs. real-time vs. control) on the listening comprehension of 95 high-intermediate Taiwanese learners of English as a foreign language (EFL) with different caption reliance (i.e. more-caption-reliant vs. less-caption-reliant). The results showed no significant difference between the participants' listening comprehension outcomes under the four caption conditions when their caption reliance was not considered. However, when this was considered, the differences among the four caption conditions became salient, which was suggestive of the selective effect of captions on L2 learners with different caption reliance. While less-caption-reliant L2 learners had the best listening comprehension outcome under the partial-caption condition and the worst under the full-caption condition, more-caption-reliant L2 learners exhibited the best performance under the full-caption condition yet the worst under the partial-caption condition. The finding underscores the importance of considering L2 learners' processing profiles when utilizing captioned videos as multimodal instructional/learning materials and speaks to the need of utilizing differentiated video materials for optimal listening outcomes.

ADHD comorbidity has been associated with delayed diagnosis of ASD, but no study has investigated this association in an Asian country. Children with ASD were included and divided into three groups: ADHD before ASD, ADHD same/after ASD, and ASD only. Timing of ASD and ADHD diagnoses were assessed. The logistic regression model was performed to investigate the likelihood of being diagnosed with ASD after 6 years of age between three groups. ADHD before ASD (OR 10.93) group was more likely to being diagnosed with ASD after 6 years of age compared with ADHD same/after ASD (OR: 1.37) and ASD only groups. ADHD comorbidity would delay the diagnosis of ASD in the general clinical settings in Taiwan.

Research has shown that the effectiveness of written corrective feedback (WCF) on writing performance depends on learners' engagement with WCF and its associated motivational state. However, little research has examined the inner causal relationships between motivation, learner engagement with WCF, and writing performance. The current study fills the void in the existing literature by taking a structural equation modeling approach as the methodological framework. Two independent Chinese undergraduate samples partook in the pilot and formal phases of the study. The results showed that cultivation of an ideal self-image significantly promoted both intrinsic and extrinsic motivations and enhanced learners' engagement with WCF, but ought-to self-image was found to have no such effects. Furthermore, both intrinsic motivation and learner engagement with WCF could directly influence writing scores, with the latter being more explanatory than the former. The implications of the research findings are provided and discussed.

Background: To gain a comprehensive understanding of the altered sensory processing in patients with migraine, in this study, we developed an electroencephalography (EEG) protocol for examining brainstem and cortical responses to sensory stimulation. Furthermore, machine learning techniques were employed to identify neural signatures from evoked brainstem–cortex activation and their interactions, facilitating the identification of the presence and subtype of migraine. Methods: This study analysed 1,000-epoch-averaged somatosensory evoked responses from 342 participants, comprising 113 healthy controls (HCs), 106 patients with chronic migraine (CM), and 123 patients with episodic migraine (EM). Activation amplitude and effective connectivity were obtained using weighted minimum norm estimates with spectral Granger causality analysis. This study used support vector machine algorithms to develop classification models; multimodal data (amplitude, connectivity, and scores of psychometric assessments) were applied to assess the reliability and generalisability of the identification results from the classification models. Results: The findings revealed that patients with migraine exhibited reduced amplitudes for responses in both the brainstem and cortical regions and increased effective connectivity between these regions in the gamma and high-gamma frequency bands. The classification model with characteristic features performed well in distinguishing patients with CM from HCs, achieving an accuracy of 81.8% and an area under the curve (AUC) of 0.86 during training and an accuracy of 76.2% and an AUC of 0.89 during independent testing. Similarly, the model effectively identified patients with EM, with an accuracy of 77.5% and an AUC of 0.84 during training and an accuracy of 87% and an AUC of 0.88 during independent testing. Additionally, the model successfully differentiated patients with CM from patients with EM, with an accuracy of 70.5% and an AUC of 0.73 during training and an accuracy of 72.7% and an AUC of 0.74 during independent testing. Conclusion: Altered brainstem-cortex activation and interaction are characteristic of the abnormal sensory processing in migraine. Combining evoked activity analysis with machine learning offers a reliable and generalisable tool for identifying patients with migraine and for assessing the severity of their condition. Thus, this approach is an effective and rapid diagnostic tool for clinicians. [ABSTRACT FROM AUTHOR]

Background: Pre-cluster symptoms (PCSs) are symptoms preceding cluster bouts and might have implications for the treatment of cluster headache (CH). This study investigated the prevalence of PCSs, and their utility in predicting upcoming bouts as well as the associations with therapeutic efficacy. Methods: We prospectively collected data from patients with CH. Each patient received a structured interview and completed questionnaire surveys during CH bouts. In sub-study 1, we cross-sectionally analyzed the prevalence, symptomatology, and predictability of upcoming bouts. Overall, 34 PCSs, divided into seven categories, were queried, including head and neck pain, cranial autonomic symptoms, restlessness, fatigue or mood changes, sleep alterations, constitutional symptoms, and generalized pain. In sub-study 2, we recorded the weekly frequency of CH attacks after the initiation of verapamil concurrently with a 14-day transitional therapy based on the patients' headache diary. A responder to verapamil was defined as a patient who have a reduction from baseline of at least 50% in the weekly frequency of CH attacks 4 weeks after the initiation of verapamil. Results: A total of 168 CH patients (women/men: 39/129) completed the study. In sub-study 1, we found 149 (88.7%) experienced PCSs, with a median of 24 (IQR 18 to 72) hours before the bouts. Up to 57.7% of patients with PCS reported that they could predict upcoming bouts. Among the seven categories of PCSs, head and neck pain was the most common (81.0%) and was associated with a higher predictability of upcoming bouts (odds ratio [OR] = 4.0; 95% confidence interval [CI] 1.7–9.6). In sub-study 2, we found two categories of PCSs were associated with the response to verapamil: sleep alteration (OR = 2.5 [95% CI = 1.3–4.8], p = 0.004) and ≥ 1 cranial autonomic symptoms (OR = 2.7 [95% CI = 1.4–5.1], p = 0.003). Conclusion: PCSs were very common in CH and could be used to predict upcoming bouts. Different symptom categories of PCSs may have different clinical implications. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) are commonly used for acid reduction in patients with peptic ulcer disease or esophageal reflux. Previous studies have shown that acid-reducing agents (ARAs) might affect bevacizumab treatment. This study found that PPI use worsened the oncological outcomes in patients with metastatic colorectal cancer (mCRC) undergoing bevacizumab treatment. There was a negative dose–response relationship when compared to H2RA use. Physicians should consider the benefits and risks of long-term use of ARAs, especially PPIs, in mCRC patients treated with bevacizumab. Background: Approximately one-third of patients with advanced colorectal cancer (CRC) and treated with bevacizumab are prescribed proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs). However, there is limited data on the effects of PPIs and H2RAs in these patients. To investigate the oncological outcomes of PPI and H2RA use in CRC patients treated with bevacizumab, we performed a retrospective cohort study using the Taiwan National Health Insurance Research Database and Taiwan Cancer Registry Database from 2005 to 2020. Methods: In CRC patients treated with bevacizumab, the PPI users and H2RA users were matched with patients without acid-reducing agents (ARAs) by 1:4 propensity score matching. PPI users and H2RA users were matched with propensity scoring in a 1:1 ratio. We divided patients into 4 cumulative PPI dosage levels to assess the dose–response relationship. The primary endpoints were 5-year overall survival and cancer-specific survival. Results: Compared with ARA non-users, both H2RA users and PPI users were associated with reduced overall survival. PPI users were associated with more significant negative effects on overall survival. Compared with H2RA users, PPI users were associated with lower 5-year overall survival (aHR: 1.19, 95% CI: 1.09–1.31) and cancer-specific survival (aHR: 1.20, 95% CI: 1.09–1.31). A similar dose–response relationship was observed for PPI users in terms of 5-year overall survival and cancer-specific overall survival. Conclusions: Compared to H2AR use, PPI use was associated with dose-dependent poorer oncological outcomes in metastatic CRC patients treated with bevacizumab. [ABSTRACT FROM AUTHOR]

Given the widespread application of ChatGPT, we aim to evaluate its proficiency in the emergency medicine specialty written examination. Additionally, we compare the performance of GPT-3.5, GPT-4, GPTs, and GPT-4o. The research seeks to ascertain whether custom GPTs possess the essential capabilities and access to knowledge bases necessary for providing accurate information, and to explore the effectiveness and potential of personalized knowledge bases in supporting the education of medical residents. We evaluated the performance of ChatGPT-3.5, GPT-4, custom GPTs, and GPT-4o on the Emergency Medicine Specialist Examination in Taiwan. Two hundred single-choice exam questions were provided to these AI models, and their responses were recorded. Correct rates were compared among the four models, and the McNemar test was applied to paired model data to determine if there were significant changes in performance. Out of 200 questions, GPT-3.5, GPT-4, custom GPTs, and GPT-4o correctly answered 77, 105, 119, and 138 questions, respectively. GPT-4o demonstrated the highest performance, significantly better than GPT-4, which, in turn, outperformed GPT-3.5, while custom GPTs exhibited superior performance compared to GPT-4 but inferior performance compared to GPT-4o, with all p < 0.05. In the emergency medicine specialty written exam, our findings highlight the value and potential of large language models (LLMs), and highlight their strengths and limitations, especially in question types and image-inclusion capabilities. Not only do GPT-4o and custom GPTs facilitate exam preparation, but they also elevate the evidence level in responses and source accuracy, demonstrating significant potential to transform educational frameworks and clinical practices in medicine. [ABSTRACT FROM AUTHOR]

Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate‐to‐high physical activity levels and whether psychosocial correlates are associated with engagement in moderate‐to‐high physical activity among hemodialysis patients. A cross‐sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self‐efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate‐to‐high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self‐efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self‐efficacy of physical activity were significantly associated with moderate‐to‐high physical activity levels. Developing strategies to improve the self‐efficacy of physical activity, support employment, and enhance anti‐smoking campaigns in hemodialysis patients can help them engage in moderate‐to‐high levels of physical activity. [ABSTRACT FROM AUTHOR]

This study examined the mediating roles of two forms of willingness to communicate (WTC) in the relationship between teachers' attitudes toward classroom interaction and L2 classroom teaching behaviors. Classroom interaction is held to be pivotal in the acquisition of a second language, and the attitudes of L2 teachers toward it may play a critical role in determining their instructional willingness to integrate it into their teaching and the extent to which it features in their teaching behavior. However, few studies advance this line of research. To address the research gap on this issue, the purpose of this study is to establish an empirical model to examine the causal relationships between the attitudes of L2 teachers toward classroom interaction, their instructional willingness, and their teaching behavior. The empirical data consist of survey responses from 410 Taiwanese high school teachers of English. The structural equation modeling (SEM) results showed that both the general form and the instructional form of WTC significantly mediated the causal relationships between teachers' attitudes toward classroom interaction and teachers' L2 teaching behaviors. A multi-group analysis further showed that the two forms of WTC played a more salient mediating role in the practice of senior teachers, defined as those with more than 10 years of teaching experience, than in the practice of junior teachers, defined as those with 10 years or less teaching experience. The research and pedagogical implications are presented in light of the research findings.

This paper proposes an online multi-user real-time co-reading (OMURCOR) system to promote the performance of co-reading with collaborative learning. The OMURCOR system utilizes WebSocket to perform synchronization controls on co-reading to allow teachers and students to watch streaming videos together with less delay. Moreover, teachers utilize the system to synchronize control operations of videos on the student site, and the OMURCOR system can be integrated into a learning management system to strengthen students' interaction through co-reading. Unlike traditional platforms, the system supports grouping mechanisms during instruction. A survey was conducted with 104 participants. The bootstrapping square and partial least square approaches of the structural equation modeling (PLS-SEM) are employed via the SmartPLS tool to explore evidence of reliability and validity of the revised TAM. Experimental results reflected that six of the seven hypotheses were supported, and the proposed system has a significant impact on students' learning effectiveness during co-reading.

Background: Onychopapilloma is an uncommon benign tumor of the nail bed and the distal matrix. Objectives: We aimed to investigate the clinical and pathological features of onychopapilloma in Taiwan. Materials and methods: We conducted a retrospective analysis of 12 patients with histopathologically proven onychopapilloma in a medical center in southern Taiwan from 2017 to 2023. Results: This case series consisted of 5 men and 7 women aged 29 to 38, with a mean age of 41.25 years. The clinical features were as follows: distal subungual hyperkeratosis (100%), longitudinal erythronychia (50%), longitudinal leukonychia (50 %), distal onycholysis (41%), and distal nail plate fissuring (41%). The duration of the disease varied greatly, ranging from 1 month to several years. Most patients were asymptomatic (58%), while some presented tenderness (41%). Fingernail involvement was more prevalent than toe involvement, with the thumb being the most commonly affected site. Most of the patients presented with a solitary onychopapilloma. None of the seven patients who underwent surgery and were available for follow-up experienced recurrence. Conclusions: This study highlights that longitudinal erythronychia and leukonychia emerged as the predominant clinical presentations of onychopapilloma. Furthermore, our findings suggest that surgical excision appears to be an effective method for onychopapilloma. [ABSTRACT FROM AUTHOR]

Currently, education places a focus on teamwork, with empathy playing an important role in the coherence of teammates embark on project based learning (PBL). It is often difficult to persuade students to reach an agreement when they are working in groups. Enhancing empathy may reduce arguments and conflict during teamwork Creating interactive learning environments (ILEs) has been recognized as a major approach to improving students' ability to express the empathy necessary to enhance teamwork and acquire heterogeneous competencies. In this study, Taiwanese junior high school students were placed into teams to brainstorm and devise innovative ideas and complete team projects. Students were instructed to shoot a film on bullying. The project was intended to improve their abilities in perspective taking, affective response, emotional regulation, self/other awareness, empathy, and competence. Study results suggest that peer learning incorporating PBL and ILE can significantly increase students' empathy and functional competence acquisition. Results also show empathy is a key mediator between peer learning and competence acquisition.

Objectives: This study aimed to explore the relationship between multidimensional factors, such as environment, health status, behavior, social support, and the well-being of middle-aged and older adults. Methods: This study utilized data from 2 waves of the nationally representative Taiwan Longitudinal Study on Aging Survey Report (TLSA) conducted in 2015 and 2019. The TLSA assesses socioeconomic status, physical and health status, the 5-item World Health Organization Well-Being Index (WHO-5 index), and social support. Data regarding the degree of digital development were obtained from the 2020 Township Digital Development Report. We applied a generalized estimating equation (GEE) to analyze the influencing factors. Results: This study included 4796 participants. Residing in areas with a higher degree of digital development, having a higher socioeconomic status, and experiencing better physical and mental health were significantly associated with well-being. Furthermore, emotional and attentive support mediated the association between physical and mental status and well-being. Conclusion: People's awareness of searching for and receiving social support and medical resources is important for enhancing their well-being. It is also crucial to pay attention to the living environment and maintain one's health status to promote well-being. [ABSTRACT FROM AUTHOR]

Relative GNSS positioning, a longstanding measurement standard, often incurs high manpower and equipment costs. Online Precise Point Positioning (PPP) presents a cost-effective alternative by minimizing these expenses. However, transitioning from the ITRF2014 to the TWD97[2010] coordinate system presents unique challenges. This study evaluates the efficacy of five PPP services – AUSPOS, OPUS, CSRS-PPP, magicGNSS, and RTX-PP – using 2018 Continuously Operating Reference Stations (CORS) data. Following a seven-parameter transformation, we systematically compared these services to identify the optimal solution for Taiwan’s geodetic survey needs. Our analysis reveals that RTX-PP offers superior performance, achieving 1 cm accuracy over 24 h and 4 cm accuracy over 1 h. Most stations met these accuracy standards, even during short observation intervals from September 9, 2018. Nonetheless, there is a 24.1 % likelihood of exceeding the 6 cm accuracy threshold due to variations in GNSS data quality. To address this, we employed G-Nut software to analyze station data quality across regions, recommending station selection based on data ratio and cycle slips to improve PPP solution accuracy effectively. [ABSTRACT FROM AUTHOR]

Limited data exist on long-term renal outcomes in patients with hyperglycemic crisis (HC) as initial type 2 diabetes presentation. We evaluated the risk of chronic kidney disease (CKD) development in those with concurrent HC at diagnosis. Utilizing Taiwan's insurance claims from adults newly diagnosed with type 2 diabetes during 2006–2015, we created HC and matched non-HC cohorts. We assessed incident CKD/diabetic kidney disease (DKD) by 2018's end, calculating the hazard ratio (HR) with the Cox model. Each cohort comprised 13,242 patients. The combined CKD and DKD incidence was two-fold higher in the HC cohort than in the non-HC cohort (56.47 versus 28.49 per 1000 person-years) with an adjusted HR (aHR) of 2.00 (95% confidence interval [CI] 1.91–2.10]). Risk increased from diabetic ketoacidosis (DKA) (aHR:1.69 [95% CI 1.59–1.79]) to hyperglycemic hyperosmolar state (HHS) (aHR:2.47 [95% CI 2.33–2.63]) and further to combined DKA-HHS (aHR:2.60 [95% CI 2.29–2.95]). Subgroup analysis in individuals aged ≥ 40 years revealed a similar trend with slightly reduced incidences and HRs. Patients with HC as their initial type 2 diabetes presentation face a higher CKD risk than do those without HC. Enhanced medical attention and customized interventions are crucial to reduce this risk. [ABSTRACT FROM AUTHOR]

Background: Most gastrointestinal stromal tumors (GISTs) harbor c-KIT or PDGFRA mutations. Administration of tyrosine kinase inhibitors (TKIs) has significantly improved the survival of patients with GISTs. We aimed to evaluate the clinical outcome of advanced or recurrent GIST patients in Taiwan. Methods: Patients diagnosed between 2010 and 2020 were enrolled. The collected data included baseline characteristics, treatment pattern, treatment outcome, genetic aberrations and survival status. Progression-free survival (PFS) and overall survival (OS) were analyzed and plotted with the Kaplan–Meier method. Cox regression analysis was used to analyze the prognostic factors of survival. Results: A total of 224 patients with advanced or recurrent GISTs treated with TKIs were enrolled. All patients received imatinib treatment. Ninety-three and 42 patients received sunitinib and regorafenib treatment, respectively. The 48-month PFS and OS rates for patients treated with imatinib were 50.5% and 79.5%, respectively. c-KIT exon 9 and PDGFRA mutations were prognostic factors for a poor PFS and PDGFRA mutation was a prognostic factor for a poor OS in patients treated with imatinib in multivariate Cox regression analysis. The median PFS of patients who received sunitinib treatment was 12.76 months (95% confidence interval (CI), 11.01–14.52). Patients with c-KIT exon 9 mutations had a longer PFS than those with other genetic aberrations. The median PFS of patients treated with regorafenib was 7.14 months (95% CI, 3.39–10.89). Conclusions: We present real-world clinical outcomes for advanced GIST patients treated with TKIs and identify mutational status as an independent prognostic factor for patient survival. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is the treatment-resistant depression (TRD) phenotype transmitted within a family? Findings: This cohort study found that, compared with control individuals match for birth year, sex, and kinship, first-degree-relatives of individuals with TRD had an increased risk of developing TRD and increased suicide mortality. Meaning: The findings suggest that a family history of TRD might be a clinically significant risk factor for resistance to antidepressant treatment and increased suicide mortality, indicating that combining or altering therapies for depression might be considered instead of monotherapy at an earlier treatment stage. This cohort study evaluates susceptibility to treatment-resistant depression by family. Importance: Antidepressant responses and the phenotype of treatment-resistant depression (TRD) are believed to have a genetic basis. Genetic susceptibility between the TRD phenotype and other psychiatric disorders has also been established in previous genetic studies, but population-based cohort studies have not yet provided evidence to support these outcomes. Objective: To estimate the TRD susceptibility and the susceptibility between TRD and other psychiatric disorders within families in a nationwide insurance cohort with extremely high coverage and comprehensive health care data. Design, Setting, and Participants: This cohort study assessed data from the Taiwan national health insurance database across entire population (N = 26 554 001) between January 2003 and December 2017. Data analysis was performed from August 2021 to April 2023. TRD was defined as having experienced at least 3 distinct antidepressant treatments in the current episode, each with adequate dose and duration, based on the prescribing records. Then, we identified the first-degree relatives of individuals with TRD (n = 34 467). A 1:4 comparison group (n = 137 868) of first-degree relatives of individuals without TRD was arranged for the comparison group, matched by birth year, sex, and kinship. Main Outcomes and Measures: Modified Poisson regression analyses were performed and adjusted relative risks (aRRs) and 95% CIs were calculated for the risk of TRD, the risk of other major psychiatric disorders, and different causes of mortality. Results: This study included 172 335 participants (88 330 male and 84 005 female; mean [SD] age at beginning of follow-up, 22.9 [18.1] years). First-degree relatives of individuals with TRD had lower incomes, more physical comorbidities, higher suicide mortality, and increased risk of developing TRD (aRR, 9.16; 95% CI, 7.21-11.63) and higher risk of other psychiatric disorders than matched control individuals, including schizophrenia (aRR, 2.36; 95% CI, 2.10-2.65), bipolar disorder (aRR, 3.74; 95% CI, 3.39-4.13), major depressive disorder (aRR, 3.65; 95% CI, 3.44-3.87), attention-deficit/hyperactivity disorders (aRR, 2.38; 95% CI, 2.20-2.58), autism spectrum disorder (aRR, 2.26; 95% CI, 1.86-2.74), anxiety disorder (aRR, 2.71; 95% CI, 2.59-2.84), and obsessive-compulsive disorder (aRR, 3.14; 95% CI, 2.70-3.66). Sensitivity and subgroup analyses validated the robustness of the findings. Conclusions and Relevance: To our knowledge, this study is the largest and perhaps first nationwide cohort study to demonstrate TRD phenotype transmission across families and coaggregation with other major psychiatric disorders. Patients with a family history of TRD had an increased risk of suicide mortality and tendency toward antidepressant resistance; therefore, more intensive treatments for depressive symptoms might be considered earlier, rather than antidepressant monotherapy. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of preoperative chronic kidney disease (CKD) on the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent standard radical nephroureterectomy (RNU). A total of 1172 UTUC patients who received RNU at a single center in Taiwan between February 2005 and August 2019 were included. The patients were categorized into two groups based on their preoperative CKD stage: CKD stage ≤3 (811 patients) and CKD stage >3 (361 patients). The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. The study investigated the oncological outcomes, including intravesical recurrence, non-urothelial recurrence, and cancer-specific mortality, stratified by preoperative CKD status. The main findings indicated that UTUC patients with CKD stage >3 in Taiwan exhibited a higher proportion of females (p < 0.001), a greater history of concurrent bladder cancer (p = 0.003), more multifocal tumor behavior (p < 0.001), a higher incidence of carcinoma in situ (p = 0.008), increased rates of intravesical recurrence (p < 0.001), a lower prevalence of smoking history (p = 0.003), lower utilization of adjuvant chemotherapy (p < 0.001), reduced occurrence of non-urothelial recurrence (p < 0.001), and lower cancer-specific mortality (p = 0.006) compared to patients with CKD stage ≤3. Multivariate Cox regression analysis revealed significant differences in intravesical recurrence (p = 0.014) and non-urothelial recurrence (p = 0.006) between the CKD stage >3 and CKD stage ≤3 groups. The study also demonstrated that patients with concurrent bladder cancer and variant histology had higher rates of intravesical recurrence, non-urothelial recurrence, and cancer-specific mortality. The CKD stage >3 group exhibited lower rates of intravesical recurrence (p = 0.0014), higher rates of non-urothelial recurrence (p < 0.0001), and increased cancer-specific mortality (p = 0.0091) compared to the CKD stage ≤3 group in the 5-year free survival analysis. In Taiwan, UTUC patients with CKD stage >3 exhibit distinct characteristics compared to the general population with urothelial carcinoma. They are associated with a non-smoking status, a higher proportion of females, and less aggressive pathological features. Additionally, CKD stage >3 can serve as a clinical indicator for intravesical and non-urothelial recurrence. Further investigation into molecular aspects and treatment modifications for these patients is warranted. [ABSTRACT FROM AUTHOR]

Summary: The epidemiological data on osteogenesis imperfecta (OI) in Asia is limited. This study, representing the first comprehensive epidemiological investigation on OI in Taiwan, reveals high medical resource utilization and underscores the importance of early diagnosis to enhance care quality. Introduction: This study examines osteogenesis imperfecta, a hereditary connective tissue disorder causing pediatric fractures and limb deformities, using a nationwide database from Taiwan to analyze clinical features and medical burden. Methods: The study identified validated OI patients from the Catastrophic Illness Registry in the National Health Insurance Research Database from 2008 to 2019. Demographic data and medical resource utilization were analyzed. A multivariate Cox model assessed the influence of sex, validation age, and comorbidities. Results: 319 OI patients (M/F = 153/166) were identified, with 58% validated before age 20. Prevalence and incidence were 0.8–1.3/100,000 and 0.02–0.09/100,000, respectively, with higher rates in the pediatric demographic. In the study period, 69.6% of the patients had admission history, primarily to pediatric and orthopedic wards. The median admission number was 3, with a median length of stay of 12 days and a median inpatient cost of approximately 3,163 USD during the period. Lower limb fractures were the main reason for hospitalization. 57% of OI patients received bisphosphonate treatment. The leading causes of mortality were OI-related deaths, neurovascular disease, and cardiovascular disease. The median age of validation in the non-survival group was significantly higher compared to the survival group (33 vs. 14 years), and patients validated during childhood required more inpatient fracture surgeries than those validated during adulthood. Conclusion: This study provides comprehensive real-world evidence on the clinical characteristics and high medical resource utilization of OI patients in a low prevalence region like Taiwan. Early diagnosis is crucial for improving care quality and enhancing health outcomes. [ABSTRACT FROM AUTHOR]

Background: The literature for assessing online and offline shopping behaviours that are linked to intelligent robotic goods and services is inadequate. In this study, we applied the Theory of Planned Behaviour model for guidance regarding how consumer behaviour affects their purchase intentions for intelligent robotic goods and services. Methods: Data from 408 respondents were gathered through an online questionnaire binned into Online and Overall Shoppers, and analysed using SPSS, AMOS, and Covariance-Based Structural Equation Modelling software to evaluate the appropriateness of the measurements and to confirm data reliability, convergence, divergence, and validity. These tools were also used to track and test hypothesized relationships between the variables and model constructs used in this study. Results and conclusions: The overarching outcomes from the data analyses indicated the Ease of Usage, Brand Perception, and Product Pricing variables causally impacted the TPB model constructs, namely Attitude, Subjective Norms, and Perceived Behaviour Control for the two populations tested with respect to their intention to purchase intelligent robotic goods and services. The reliability measurements for Ease of Usage, Brand Perception, and Product Pricing are discussed. The results are important for companies and future investors because opportunities to study the complex relationships that ultimately drive consumer behaviour and their intention to purchase intelligent robotic goods and services are provided. [ABSTRACT FROM AUTHOR]

Background: Biallelic pathogenic variants in USH2A lead to Usher syndrome or non-syndromic retinitis pigmentosa, and shown to have geographical and ethnical distribution in previous studies. This study provided a deeper understanding of the detailed clinical features using multimodal imaging, genetic spectrum, and genotype–phenotype correlations of USH2A-related retinal dystrophies in Taiwan. Results: In our cohort, the mean age at first visit was 47.66 ± 13.54 years, and the mean age at symptom onset, which was referred to the onset of nyctalopia and/or visual field constriction, was 31.21 ± 15.24 years. Among the variants identified, 23 (50%) were missense, 10 (22%) were splicing variants, 8 (17%) were nonsense, and 5 (11%) were frameshift mutations. The most predominant variant was c.2802T>G, which accounted for 21% of patients, and was located in exon 13. Patients with truncated alleles had significantly earlier symptom onset and seemly poorer disease progression regarding visual acuity, ellipsoid zone line length, and hypofluorescent lesions in the macula than those who had the complete gene. However, the clinical presentation revealed similar progression between patients with and without the c.2802T>G variant. During long-term follow-up, the patients had different ellipsoid zone line progression rates and were almost evenly distributed in the fast, moderate, and slow progression subgroups. Although a younger onset age and a smaller baseline intact macular area was observed in the fast progression subgroup, the results showed no significant difference. Conclusions: This is the first cohort study to provide detailed genetic and longitudinal clinical analyses of patients with USH2A-related retinal dystrophies in Taiwan. The mutated allele frequency in exon 13 was high in Taiwan due to the predominant c.2802T>G variant. Moreover, truncated variants greatly impacted disease progression and determined the length of therapeutic windows. These findings provide insight into the characteristics of candidates for future gene therapies. [ABSTRACT FROM AUTHOR]

Background: Worldwide, more than 125 million people are infected with Shigella each year and develop shigellosis. In our previous study, we provided evidence that Shigella sonnei infection triggers activation of the NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome in macrophages. NLRP3 inflammasome is responsible for regulating the release of the proinflammatory cytokines interleukin (IL)-1β and IL-18 through the protease caspase-1. Researchers and biotech companies have shown great interest in developing inhibitors of the NLRP3 inflammasome, recognizing it as a promising therapeutic target for several diseases. The leaves of Cinnamomum osmophloeum kaneh, an indigenous tree species in Taiwan, are rich in cinnamaldehyde (CA), a compound present in significant amounts. Our aim is to investigate how CA affects the activation of the NLRP3 inflammasome in S. sonnei-infected macrophages. Methods: Macrophages were infected with S. sonnei, with or without CA. ELISA and Western blotting were employed to detect protein expression or phosphorylation levels. Flow cytometry was utilized to assess H2O2 production and mitochondrial damage. Fluorescent microscopy was used to detect cathepsin B activity and mitochondrial ROS production. Additionally, colony-forming units were employed to measure macrophage phagocytosis and bactericidal activity. Results: CA inhibited the NLRP3 inflammasome in S. sonnei-infected macrophages by suppressing caspase-1 activation and reducing IL-1β and IL-18 expression. CA also inhibited pyroptosis by decreasing caspase-11 and Gasdermin D activation. Mechanistically, CA reduced lysosomal damage and enhanced autophagy, while leaving mitochondrial damage, mitogen-activated protein kinase phosphorylation, and NF-κB activation unaffected. Furthermore, CA significantly boosted phagocytosis and the bactericidal activity of macrophages against S. sonnei, while reducing secretion of IL-6 and tumour necrosis factor following infection. Conclusion: CA shows promise as a nutraceutical for mitigating S. sonnei infection by diminishing inflammation and enhancing phagocytosis and the bactericidal activity of macrophages against S. sonnei. [ABSTRACT FROM AUTHOR]

Congenital nephrotic syndrome (CNS) is one of the important causes of end-stage kidney disease in children. Studies on the genotype, phenotype, and clinical outcome in infants with CNS caused by genetic mutations are scarce. We analyzed the genetic background, clinical manifestations, treatment response, and prognosis of pediatric patients with CNS in Taiwan. Fifteen infants with CNS were enrolled, and 11 patients of median age 21 (interquartile range 3∼44) days caused by genetic mutations from 10 unrelated families were included in the study. Of the eleven patients, 9 had extra-renal manifestations including microcephaly, facial dysmorphism, and skeletal anomalies. More than two-thirds of the patients had disease onset before 1 month of age. Diffuse meningeal sclerosis was the most common histological characteristic. Whole exome sequencing followed by direct Sanger sequence revealed mutations in OSGEP (R247Q), WT1 (R366H and R467Q), LAMB2 (Q1209∗ and c. 5432–5451 19 bp deletion), NUP93 (D302V), and LAGE3 (c.188+1G > A). Three of the variants were novel. Corticosteroids and/or immunosuppressants were administered in 2 patients, but both were refractory to treatment. During the mean 3.5 years of follow-up, all but two died of uremia and sepsis. The two survivors reached end-stage kidney disease and required peritoneal dialysis, and one of them underwent uneventful renal transplantation. The majority of patients with CNS in Taiwan were caused by OSGEP followed by WT1 mutation. R247Q is the hotspot mutation of OSGEP in Taiwan. CNS patients in Taiwan suffer from significant morbidity and mortality. [ABSTRACT FROM AUTHOR]

With the declining birth rate in Taiwan, the proportion of middle-aged and older women returning to the workplace has increased, and they have become an important human resource in the job market. The purpose of this study is to examine the experiences of middle-aged and older women from career disruption to re-employment. In this study, eighteen middle-aged and older women were interviewed in order to understand their re-employment process. The study found that the reasons for the career interruptions and re-employment of middle-aged and older women were all family related. Difficulties in restarting a career included age discrimination, lack of ability, and opposition from family members. By using selection, optimization, and compensation theory, people could successfully return to work in the face of these difficulties. The strategies used were as follows: knowing one’s own expertise and interests, having relevant certificates and professional experience, adjusting one’s attitude to start again, continuous learning and empowerment, and obtaining workplace support. The results of this study can serve as a reference for employment service centers in assisting middle-aged and older female job seekers and as a basis for the government and relevant units to formulate policies to promote the re-employment of middle-aged and older women. [ABSTRACT FROM AUTHOR]

The purpose of this study is to develop and evaluate the effects of multimodal presentation system (MPS), a multimodal presentation software integrated with interactive whiteboard (IWB), on student learning in the elementary English as second language (ESL) course. It focuses primarily on techniques and tools to enhance the students' ESL learning achievement and learning satisfaction in the classroom setting. This paper utilizes the MPS, based on Mayer's cognitive theory of multimedia learning (CTML), to present the multimedia instructional materials in auditory and visual modalities. This learner-centered instruction was compared with a traditional teacher-centered English teaching using blackboard. An experimental research design was employed and 134 fifth-graders were involved in this study. Evaluation of the instruction was based upon data from test scores and questionnaire related to students' learning satisfaction. In addition, semi-structured individual interviews were conducted with randomly selected participants from experimental group to express their perspectives on the merit of using the MPS. The results revealed that there were statistically significant differences between the students in experimental group and control group on measures of learning effectiveness. More details of the results and implications are also discussed in the study.

A rapid scene indexing method is proposed to improve retrieval performance for students accessing instructional videos. This indexing method is applied to anchor suitable indices to the instructional video so that students can obtain several small lesson units to gain learning mastery. The method also regulates online course progress. These anchored points not only provide students with fast access to specific material but also can link to certain quizzes or problems to show the interactive e-learning content that course developers deposited in the learning management system, which enhances the learning process. This allows students to click on the anchored point to repeat their lesson, or work through the quizzes or problems until they reach formative assessment. Hence, their learning can be guided by the formative assessment results. In order to quickly find the scene to index, some specific description of it was needed. Actually, most of the instructional videos were recorded by teachers and were part of their PowerPoint presentations. Based on the features of the PowerPoint slides in the instructional videos, such as the title or page number, the specified scene can be found. Since we used specific scene descriptions, it was easy to employ the rapid scene detection method using an image filter and Sobel mask. Finally, we applied an experimental design to check the precision of the scene detection and evaluate user satisfaction. The results showed that rapid scene indexing can definitely assist learners in their online learning; that is, it gives them better learning mastery and provides regulation for the online learning environment. (Contains 2 tables and 11 figures.)

In the "Digital Divide" research, adult women have generally been found to be the weakest group when compared with others. There is thus a need to provide this particular group with computer literacy training, and to give them opportunities to learn about using computers. In such training, women not only need to learn computer skills, but also a positive attitude. This study gathered qualitative and quantitative data from 175 women who attended computer literacy training, to analyze their attitudes towards computers and to identify differences in their attitudes. The data were collected from questionnaires, interviews and class observations. It was found that only women with lower educational levels had feelings of high anxiety prior to the training. However, other characteristics influenced their attitudes during the training, including age, education, nationality, and PC ownership. Factors influencing the differences in their attitudes were the difficulties of data input, physiological limitations, cultural differences, computer access and learning opportunities. Suggestions for future computer training programs for adult women are proposed. (Contains 6 tables.)

Purpose: The purpose of this paper is to investigate entrepreneurial competencies of students in practicums within departments of electrical engineering and computer sciences (EECS) in universities of technology. In total, 71 faculty members who advised in entrepreneurial competitions in universities of technology were participants in the questionnaire survey to find the entrepreneurial competencies during practicums of the EECS students. Design/methodology/approach: Analysis was carried out based on the literatures related to off-campus internship in universities of technology and entrepreneurship competency. Then, through the questionnaire survey, the authors can understand what the entrepreneurial abilities should have when they after off-campus internships. The entrepreneurship competency expected of off-campus internship students within EECS was analyzed to derive at the important conclusion in this study. Findings: As the results of this study, the authors found that entrepreneurial processes, entrepreneurial traits/behaviors, communications and interpersonal skills, and digital skills are the entrepreneurial competencies that are emphasized during practicums. Originality/value: The paper suggests that, first, the EECS students take up innovative entrepreneurship programs and take electives such as marketing management, financial management, and related business administration courses. Second, respective universities of technology and internship organizations may co-arrange the incorporation of project-based learning (PBL), PBL into the internship work content. Third, establishing a platform that bridges communication for off-campus internship students.

This study investigated how 223 mothers and 200 fathers of 3- to 6-year-old children from Taiwan saw their child-rearing strengths and shortcomings. The Mandarin version of the Parent as a Teacher Inventory (PAAT) was administered to each of the 423 subjects. This instrument is designed to examine five aspects of interaction between parent and child. Multivariate analyses of variance were applied to determine the significant effects of eight independent variables on the five PAAT subscales. The variables that significantly affected parent responses were (1) amount of time spent with a child, (2) household income, (3) parent education, and (4) gender of parent. The variable with the most impact was time spent with a child. Parents who spent 10 hours or more per week interacting with their child demonstrated greater strengths than peers who spent less time interacting with their child, as indicated on all subscales of the PAAT.

Urban heat islands will occur if city neighborhoods contain insufficient green spaces to create a comfortable environment, and residents' health will be adversely affected. Current satellite imagery can only effectively identify large-scale green spaces and cannot capture street trees or potted plants within three-dimensional building spaces. In this study, we used a deep convolutional neural network semantic segmentation model on Google Street View to extract environmental features at the neighborhood level in Taipei City, Taiwan, including the green vegetation index (GVI), building view factor, and sky view factor. Monthly temperature data from 2018 to 2021 with a 0.01° spatial resolution were used. We applied a linear mixed-effects model and geographically weighted regression to explore the association between pedestrian-level green spaces and ambient temperature, controlling for seasons, land use information, and traffic volume. Their results indicated that a higher GVI was significantly associated with lower ambient temperatures and temperature differences. Locations with higher traffic flows or specific land uses, such as religious or governmental, are associated with higher ambient temperatures. In conclusion, the GVI from street-view imagery at the community level can improve the understanding of urban green spaces and evaluate their effects in association with other social and environmental indicators. [ABSTRACT FROM AUTHOR]

Osimertinib has demonstrated efficacy in patients with epidermal growth factor receptor (EGFR) T790M-positive non-small cell lung cancer (NSCLC) in clinical trials. However, real-world data on its effectiveness remain scarce. Taiwanese patients with T790M-positive locally advanced or metastatic NSCLC and progressive disease following treatment with at least one EGFR tyrosine kinase inhibitor (TKI) were enrolled from the osimertinib early access program. Of the 419 patients (mean age, 63 years; female, 67%), 53% were heavily pretreated (≥ third-line [3L]), making osimertinib a fourth-line (4L) intervention. The median progression-free survival (PFS) was 10.5 months (95% confidence interval [CI]: 8.95–11.41); the 18-month PFS rate was 26.5%. The median overall survival (OS) was 19.0 months (95% CI: 16.30–20.95); the 24-month OS rate was 40.9%. The objective response rate was 32.46%, and the disease control rate was 86.38%. The median time to treatment discontinuation of osimertinib monotherapy was 11.9 months (95% CI: 10.49–13.11). Subgroup analyses of median PFS and OS in the chemotherapy combination group vs. the osimertinib monotherapy group yielded no difference. Central nervous system (CNS) metastasis, number of prior lines of therapy, and types of initial EGFR-TKIs did not significantly impact outcomes. The median PFS values were 9.0 (95% CI: 5.18–11.34) and 10.9 (95% CI: 9.18–11.90) months with and without CNS metastasis, respectively, and 10.8 (95% CI: 8.59–12.69), 13.6 (95% CI: 10.89–16.3), and 9.2 (95% CI: 7.8–10.62) months for second-line (2L), 3L, and ≥4L therapy, respectively. In patients who received osimertinib as 2L therapy, the median PFS values in response to prior afatinib, erlotinib and gefitinib treatment were 11.2 (95% CI: 4.85–4.79), 10.5 (95% CI: 8.59–20.26) and 8.7 (95% CI: 7.21–16.79) months, respectively. Overall, real-world data from Taiwan support the clinical benefits of osimertinib in EGFR T790M -positive NSCLC. [ABSTRACT FROM AUTHOR]

Background: Both the size of the older population and the use of complementary and alternative medicine are increasing worldwide. This study evaluated the long-term trend in utilization of traditional Chinese medicine (TCM) and associated factors among older people in Taiwan. Methods: Using the database of population-based interview surveys, we evaluated the one-month prevalence of TCM use among 13,945 older people aged over 65 years from 2001–2017. The sociodemographic status and medical comorbidities of older people who did and did not use TCM were compared by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multiple logistic regressions. Results: The one-month prevalence of TCM use increased from 5.5% in 2001 to 9.1% in 2017 among older people in Taiwan. Overall, 7.3% of older people had used TCM within the previous month. People with a history of heart disease (OR 1.62, 95% CI 1.24–2.12), use of folk therapy (OR 3.16, 95% CI 2.00–4.99), and purchase of non-prescribed Chinese herbal medicine (OR 2.08, 95% CI 1.48–2.91) were more likely to use TCM than the comparison group. However, age ≥80 years (OR 0.48, 95% CI 0.31–0.72) and previous hospitalization (OR 0.59, 95% CI 0.41–0.85) were associated with the reduced use of TCM. Conclusion: From 2001–2017, the use of TCM increased in the older population in Taiwan. The use of folk medicine and purchase of non-prescribed Chinese herbal medicine were significant predictors for the use of TCM. [ABSTRACT FROM AUTHOR]

Bisphosphonates have been associated with a decreased risk of revision surgery after total joint arthroplasty of the hip or knee (TJA) because of their effects on decreased periprosthetic bone loss and prosthetic migration. However, the results in the early literature are inconsistent, and the influence of bisphosphonates on associated complications and subsequent TJA remains unknown. This study investigated the association between the use of bisphosphonates and the risk of adverse outcomes after primary TJA. This matched cohort study utilized the National Health Insurance Research Database in Taiwan to identify patients who underwent primary TJA over a 15-year period (January 2000–December 2015 inclusive). Study participants were further categorized into two groups, bisphosphonate users and nonusers, using propensity score matching. The Kaplan–Meier curve analysis and adjusted hazard ratios (aHRs) of revision surgery, adverse outcomes of primary surgery and subsequent TJA were calculated using Cox regression analysis. This study analyzed data from 6485 patients who underwent total hip arthroplasty (THA) and 20,920 patients who underwent total knee arthroplasty (TKA). The risk of revision hip and knee arthroplasty was significantly lower in the bisphosphonate users than in the nonusers (aHR, 0.54 and 0.53, respectively). Furthermore, the risk of a subsequent total joint arthroplasty, adverse events and all-cause mortality were also significantly reduced in the bisphosphonate users. This study, involving a large cohort of patients who underwent primary arthroplasties, revealed that bisphosphonate treatment may potentially reduce the risk of revision surgery and associated adverse outcomes. Furthermore, the use of bisphosphonates after TJA is also associated with a reduced need for subsequent arthroplasty. Research Registration Unique Identifying Number (UIN): ClinicalTrials.gov Identifier—NCT05623540 (https://clinicaltrials.gov/show/NCT05623540). [ABSTRACT FROM AUTHOR]

FORMOSAT-7/COSMIC-2 was launched in June 2019 and provides high spatial resolution radio occultation (RO) profile data. The data can be beneficial for weather and climate studies and increase the accuracy of weather forecasts. This study aims to assess the two-year COSMIC-2 RO-PWV (precipitable water vapor) accuracy. Ten years of GNSS-PWV data inverted from PPP (precise point positioning) are better than those from the DD (double difference) method when taking radiosonde-observed data as the true reference values in Taiwan. Hence, in this study, GNSS-PWV from PPP is compared with COSMIC-2 RO-PWV to verify the accuracy of RO-PWV. Removing the elevation of the lowest point of an RO event above 5 km can prevent an RO event with an error exceeding 40 mm. The mean GNSS-PWV is higher than the mean RO-PWV, which are 45.7 mm and 39.9 mm, respectively, from 2020 to 2021. RO-PWV derived from COSMIC-2 in 2020 and 2021 is underestimated when taking GNSS-PWV as a reference. The mean RO error is 6.8 mm, and the mean error on land is higher than that on the ocean, with magnitudes of 8.0 mm and 6.6 mm, respectively. The higher RO-PWV accuracy on the ocean than on land is one of the reasons for the higher RO-PWV accuracy for RO events matched at the Japan GEONET stations (99.2 % on the ocean; mean error of 6.1 mm) than that at the Taiwan CWB stations (68.2 % on the ocean; mean error of 7.7 mm). In the monthly mean RO-PWV data from 2020 to 2021, the RO-PWV and its error show seasonal variations, with high values in summer (51.0 ± 9.2 mm) and low values in winter (31.9 ± 5.0 mm). The seasonal trend of RO-PWV is consistent with that of temperature. Here, we verify that the accuracy of COSMIC-2 RO-PWV is comparable to that of GNSS-PWV. [ABSTRACT FROM AUTHOR]

COVID-19 has been a significant global concern due to its contagious nature. In May 2021, Taiwan experienced a severe outbreak, leading the government to enforce strict Pandemic Alert Level 3 restrictions in order to curtail its spread. Although previous studies in Taiwan have examined the effects of these measures on air quality, further research is required to compare different time periods and assess the health implications of reducing particulate matter during the Level 3 lockdown. Herein, we analyzed the mass concentrations, chemical compositions, seasonal variations, sources, and potential health risks of PM1.0 and PM2.5 in Central Taiwan before and during the Level 3 lockdown. As a result, coal-fired boilers (47%) and traffic emissions (53%) were identified as the predominant sources of polycyclic aromatic hydrocarbons (PAHs) in PM1.0, while in PM2.5, the dominant sources of PAHs were coal-fired boilers (28%), traffic emissions (50%), and iron and steel sinter plants (22.1%). Before the pandemic, a greater value of 20.9 ± 6.92 μg/m3 was observed for PM2.5, which decreased to 15.3 ± 2.51 μg/m3 during the pandemic due to a reduction in industrial and anthropogenic emissions. Additionally, prior to the pandemic, PM1.0 had a contribution rate of 79% to PM2.5, which changed to 89% during the pandemic. Similarly, BaPeq values in PM2.5 exhibited a comparable trend, with PM1.0 contributing 86% and 65% respectively. In both periods, the OC/EC ratios for PM1.0 and PM2.5 were above 2, due to secondary organic compounds. The incremental lifetime cancer risk (ILCR) of PAHs in PM2.5 decreased by 4.03 × 10-5 during the pandemic, with PM1.0 contributing 73% due to reduced anthropogenic activities. [ABSTRACT FROM AUTHOR]

Previous studies have found associations between the incidence of metabolic syndrome (MetS) and exposure to air pollution or road traffic noise. However, investigations on environmental co-exposures are limited. This study aimed to investigate the association between co-exposure to air pollution and road traffic noise and MetS and its subcomponents. Participants living in Taipei City who underwent at least two health checkups between 2010 and 2016 were included in the study. Data were sourced from the MJ Health database, a longitudinal, large-scale cohort in Taiwan. The monthly traffic noise exposure (Lden and Lnight) was computed using a dynamic noise map. Monthly fine particulate data at one kilometer resolution were computed from satellite imagery data. Cox proportional hazards regression models with month as the underlying time scale were used to estimate hazard ratios (HRs) for the impact of PM2.5 and road traffic noise exposure on the risk of developing MetS or its subcomponents. Data from 10,773 participants were included. We found significant positive associations between incident MetS and PM2.5 (HR: 1.88; 95% CI 1.67, 2.12), Lden (HR: 1.10; 95% CI 1.06, 1.15), and Lnight (HR: 1.07; 95% CI 1.02, 1.13) in single exposure models. Results further showed significant associations with an elevated risk of incident MetS in co-exposure models, with HRs of 1.91 (95% CI 1.69, 2.16) and 1.11 (95% CI 1.06, 1.16) for co-exposure to PM2.5 and Lden, and 1.90 (95% CI 1.68, 2.14) and 1.08 (95% CI 1.02, 1.13) for co-exposure to PM2.5 and Lnight. The HRs for the co-exposure models were higher than those for models with only a single exposure. This study provides evidence that PM2.5 and noise exposure may elevate the risk of incident MetS and its components in both single and co-exposure models. Therefore, preventive approaches to mitigate the risk of MetS and its subcomponents should consider reducing exposure to PM2.5 and noise pollution. [ABSTRACT FROM AUTHOR]

Glycidyl esters (GEs) and 3-monochloropropanediol esters (3-MCPDEs) are process contaminants commonly found in refined edible oils which are often added to infant formulas. The Taiwan Food and Drug Administration (TFDA) launched regulations for GEs in infant formulas that went into effect on 1 July 2021. To investigate levels of GEs and 3-MCPDEs in infant formula powder, 45 products were sampled and analysed during 2020–2021. The contents of GEs and 3-MCPDEs in formulas of different brands significantly varied, but their concentrations in all of the formulas complied with European Union (EU) regulations. Infant formulas containing palm oil had significantly higher 3-MCPDE levels in both extracted oils and milk powder than those without palm oil. Concentrations of GEs and 3-MCPDEs in infant formula powder and extracted oils were significantly lower in products from Europe than those from Australia and New Zealand. Infants aged 0–1 years in Taiwan who consumed only infant formula showed a margin of exposure (MoE) exceeding 25,000. Mean consumer exposures to 3-MCPDEs stayed below the tolerable daily intake (TDI), while high exposures at the 95th percentile (P95) exceeded the TDI by 1.7-fold. Herein, we present the changing trends in the risk assessment results of infant formula across various countries in the decade. Implementation of regulations and mitigation strategy effectively reduced the risk of infants being exposed to GEs and 3-MCPDEs through infant formula. [ABSTRACT FROM AUTHOR]

Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan. Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015–2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis. A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness. Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide. [ABSTRACT FROM AUTHOR]

In this study, deep learning network technology is employed to solve the problem of rapid changes in underwater channels. The modulation techniques employed are frequency-shift keying (FSK) and the BELLHOP module of MATLAB; they are used to create water with multipath, Doppler shifts, and additive Gaussian white noise such that underwater acoustic receiving signals simulating the actual ocean environment can be obtained. The southwest coastal area of Taiwan is simulated in the manuscript. The results reveal that optimizing the environment by using the virtual time reversal mirror (VTRM) technique can generally mitigate the bit error rates (BERs) of the deep learning network's model receiver and traditional demodulation receiver. Lastly, seven deep learning networks are deployed to demodulate the FSK signals, and these approaches are compared with traditional demodulation techniques to determine the deep learning network techniques that are most suitable for marine environments. [ABSTRACT FROM AUTHOR]

Anti-hypertensive medications may affect plasma renin activity and/or plasma aldosterone concentration, misleading the interpretation of the aldosterone-to-renin ratio when screening for primary aldosteronism. The Task Force of Taiwan PA recommends that, when necessary, using α-adrenergic receptor blocking agents, centrally acting α-adrenergic agonists, and/or non-dihydropyridine calcium channel blockers should be considered to control blood pressure before screening for PA. We recommend temporarily holding β-adrenergic receptor blocking agents, mineralocorticoid receptor antagonists, dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and all diuretics before screening for PA. Further large-scale randomized controlled studies are required to confirm the recommendations. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the factors associated with prolonged progression‐free survival (PFS) (>36 months) of advanced non‐small cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) mutations treated with first‐line afatinib. Methods: We performed a retrospective analysis of data of patients with advanced EGFR‐mutated NSCLC receiving first‐line afatinib at two tertiary care referral centers, Linkou and Kaohsiung Chang Gung Memorial Hospital, in Taiwan between June 2014 and April 2022. Results: The data of 546 treatment‐naïve EGFR‐mutated advanced NSCLC patients were analyzed. Median PFS and overall survival were 14.5 months and 27.2 months, respectively. The PFS of 462 patients (84.6%) was less than 36 months and of 84 patients (15.4%) was more than 36 months. The PFS > 36 months group had a significantly higher percentage of patients with uncommon mutations (p = 0.002). The PFS ≤36 months group had significantly higher incidences of bone, liver, and adrenal metastases (all p < 0.05) and a higher rate of multiple distant metastases. Multivariate logistic regression analysis showed that liver metastasis was negatively and independently associated with prolonged PFS (adjusted odds ratio = 0.246 [95% CI: 0.067–0.908], p = 0.035). The median overall survival of the PFS >36 months group was 46.0 months and that of the PFS ≤36 months group was 22.9 months (log‐rank test, p < 0.001). Conclusions: We found that EGFR‐mutated NSCLC patients receiving first‐line afatinib were prone to shorter PFS if they had distant organ metastasis, especially liver metastasis. [ABSTRACT FROM AUTHOR]

Objective We aimed to assess the efficacy of cefoperazone/sulbactam (CPZ/SUL) in extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections and identify factors influencing outcomes. Methods This retrospective multicentre study was conducted in Taiwan (January 2015 to December 2020) and examined the efficacy of CPZ/SUL treatment in ESBL-producing Enterobacterales bacteraemia. The minimum inhibitory concentrations (MICs) were determined using agar dilution; ESBL/AmpC genes were detected using polymerase chain reaction. The primary outcome was clinical success, whereas the secondary outcome was 30-day mortality. Clinical success was defined as the complete resolution of clinical signs and symptoms of K. pneumoniae or E. coli infection, with no evidence of persistent or recurrent bacteraemia. The factors influencing outcomes were identified using a multivariate analysis. Results CPZ/SUL demonstrated a clinical success rate of 82.7% (91/110) in treating ESBL-producing Enterobacterales bacteraemia, with a 30-day mortality rate of 9.1% (10/110). Among 110 ESBL-producing isolates, a high clinical success rate was observed at an MIC of ≤32/32 mg/L. Multivariate analysis revealed that a Charlson comorbidity index (CCI) of ≥6 was associated with lower clinical success [odds ratio (OR): 5.80, 95% confidence interval (CI): 1.15–29.14, P = 0.033]. High Sequential Organ Failure Assessment scores (≥6) were significantly associated with increased 30-day mortality (OR: 14.34, 95% CI: 1.45–141.82, P = 0.023). Discussion CPZ/SUL demonstrated a clinical success rate of 82.7% (91/110) in treating ESBL-producing Enterobacterales bacteraemia. Treatment success was evident when the CPZ and SUL MIC was ≤32/32 mg/L. Comorbidities (CCI ≥6) were associated with lower clinical success, while disease severity (Sequential Organ Failure Assessment score ≥6) correlated with higher mortality. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis C (CHC) virus infection is a global health concern that is associated with significant liver-related morbidity and mortality. Owing to the inflammatory pathway, CHC can causefatty liver, liver cirrhosis, and liver cancer and is associated with cardiometabolic diseases, such as hypertension and diabetes. Fatty liver is associated with metabolic disorders, cardiovascular diseases, diabetes, and liver cancer. Hence, the early detection of fatty liver through noninvasive screening in adults with CHC is important in primary healthcare settings. This study aimed to explore the prevalence of fatty liver and its association with metabolic syndrome amongrural adults with CHC. Methods: This was a series of cohort studies related to the elimination of the CHC burden around the western coastal Yunlin County, Taiwan, between August 2018 and July 2021. A cross-sectional study was conducted after hepatitis C virus RNA confirmation in a hepatitis C- endemic area. A gastrointestinal physician or radiologist assessed fatty liver by ultrasonography. Fatty liver was classified into four grades: normal, mild, moderate, and severe. Three liver enzyme biomarkers were identified. According to the Taiwan national standard, metabolic syndrome was defined based on the presence of three or more of the five abnormal biomarkers, including increased waist circumference, elevated blood pressure, elevated fasting blood glucose level, elevated triglyceride level, and low high-density lipoprotein cholesterol level. Results: A total of 256 rural adults with CHC were enrolled. The mean age of the participants was 67.5 (standard deviation = 11.8) years, with a low educational level. High prevalence of fatty liver (79%), central obesity (54.3%), elevated blood pressure (55.5%),elevated fasting blood glucose (FBG) level (44.9%), and metabolic syndrome (37.9%) were observed.The results showed that adults with CHC with moderate to severe fatty liver were significantly associated with an increased risk of increased waist circumference (P < 0.001), increased blood pressure (P < 0.001), low high-density lipoprotein cholesterol level (P < 0.05), and elevated liver enzyme biomarker levels (all P < 0.05) after adjusting for age, sex, and educational level. Furthermore, adults with CHC with moderate to severe fatty liver were significantly associated with a greater risk of metabolic syndrome (odds ratio = 2.85, 95% confidence interval = 1.66 to 4.92). Conclusions: The findings demonstrate a high prevalence of fatty liver in rural adults with CHC, which is significantly associated with obesity, metabolic syndrome, and elevated liver biomarker levels. Clinicians and primary healthcare providers must encourage patients with CHC to receive antiviral therapy combined with weight loss management and lifestyle modification, allowing general improvements in their liver and cardiometabolic health. [ABSTRACT FROM AUTHOR]

Background: To implement the ACGME Anesthesiology Milestone Project in a non-North American context, a process of indigenization is essential. In this study, we aim to explore the differences in perspective toward the anesthesiology competencies among residents and junior and senior visiting staff members and co-produce a preliminary framework for the following nation-wide survey in Taiwan. Methods: The expert committee translation and Delphi technique were adopted to co-construct an indigenized draft of milestones. Descriptive analysis, chi-square testing, Pearson correlation testing, and repeated-measures analysis of variance in the general linear model were employed to calculate the F values and mean differences (MDs). Results: The translation committee included three experts and the consensus panel recruited 37 participants from four hospitals in Taiwan: 9 residents, 13 junior visiting staff members (JVSs), and 15 senior visiting staff members (SVSs). The consensus on the content of the 285 milestones was achieved after 271 minor and 6 major modifications in 3 rounds of the Delphi survey. Moreover, JVSs were more concerned regarding patient care than were both residents (MD = − 0.095, P < 0.001) and SVSs (MD = 0.075, P < 0.001). Residents were more concerned regarding practice-based learning improvement than were JVSs (MD = 0.081; P < 0.01); they also acknowledged professionalism more than JVSs (MD = 0.072; P < 0.05) and SVSs (MD = 0.12; P < 0.01). Finally, SVSs graded interpersonal and communication skills lower than both residents (MD = 0.068; P < 0.05) and JVSs (MD = 0.065; P < 0.05) did. Conclusions: Most ACGME anesthesiology milestones are applicable and feasible in Taiwan. Incorporating residents' perspectives may bring insight and facilitate shared understanding to a new educational implementation. This study helped Taiwan generate a well-informed and indigenized draft of a competency-based framework for the following nation-wide Delphi survey. Highlight: 1. Most ACGME anesthesiology milestones are applicable in Taiwan. 2. Experienced anesthesiologists achieved consensus faster than young practitioners. 3. Residents mirrored milestone competencies through participation. 4. Experience status affected the weight that anesthesiologists gave to milestone competencies. [ABSTRACT FROM AUTHOR]

In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer. The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55–75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov , NCT02611570 , and is ongoing. Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis. TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer. Ministry of Health and Welfare of Taiwan. [ABSTRACT FROM AUTHOR]

Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients. [ABSTRACT FROM AUTHOR]