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Learning in a virtual environment has been found to foster students' affective responses, indicating the importance of exploring the factors which affect students' learning when engaged in a virtual game. This study aimed to explore the relationships among students' epistemic curiosity, situational interest, and learning engagement in an exploratory 3D virtual game environment. A virtual game was designed for elementary school students to learn concepts of evaporation and condensation in real-life situations. Data were collected using questionnaires from a total of 121 sixth-grade elementary school students, and were analyzed using partial least square structural equation modeling (PLS-SEM). The reliability and validity of the instruments employed in this study were verified. The structural relationships showed that I-type epistemic curiosity showed a stronger influence on the design of the virtual game environment compared to D-type epistemic curiosity. Challenge was found to be negatively predicted by I-type epistemic curiosity, but positively predicted by D-type epistemic curiosity. Instant enjoyment was also found to play a significant mediating role between I-type epistemic curiosity and emotional engagement. It is suggested that future research should consider providing students with interesting contexts and challenging tasks as a critical approach to designing virtual game learning environments.

The present study employed the draw-a-picture technique and epistemic network analysis (ENA) to reveal university students' viewpoints on ChatGPT-supported learning, as well as the conceptions, roles, and educational objectives of ChatGPT-supported learning among university students with different learning attitudes. The results showed that university students' conceptions of ChatGPT-supported learning were diverse and interrelated. Most students agreed that ChatGPT could facilitate learning anytime and anywhere, and held positive emotions and attitudes. In the conceptions of ChatGPT-supported learning, there were significant differences in the four categories of locations, learning content, learning activities, and objects between the low learning attitude (LLA) and the high learning attitude (HLA) groups. Besides, the HLA group preferred to use ChatGPT for specific learning content, and showed higher levels of engagement in discussions and consultations. The LLA group was inclined to use ChatGPT at home or in places with traditional classroom equipment for completing reports or assignments. Most students in the HLA group regarded ChatGPT as a tutor, while those in the LLA group viewed it as a tool. Based on the above findings, this study puts forward some suggestions for how to implement ChatGPT-supported learning in higher education as a reference for educators, researchers and training developers.

This study provides research-based evidence to profile: (1) the roles of artificial intelligence in nursing; (2) its research applications; and (3) the research trends for future study. On the basis of the PRISMA statement, a series of AI and nursing education related keywords from the literature were used to retrieve high-quality journal articles from the Web of Science. A total of 112 AI-supported nursing education research articles were analyzed based on a three-dimensional framework, including interaction (e.g. the roles of AI, types of AI systems), research (e.g. methods and fields), and performance (e.g. research groups and measurement foci). The results revealed that AI played a primary role in profiling and prediction in nursing research (63%), and the most used AI system in nursing was intelligent agents (53%). The quantitative approach (87%) was the dominant research method, and the most relevant studies concerned health and medicine (92%). Regarding sample and measurement matters, patients and medical staff (75%) were the two primary research samples, and the performance evaluation of AI-related tools and systems (90%) was the core measurement focus. Additional content analysis across the three research interests was performed and discussed. Directions for future studies are provided.

With the rapid development of generative artificial intelligence (GAI), the performance and usability of related tools, such as ChatGPT, have significantly improved. The advancement has fostered researchers to increasingly focus on students' perceptions and application of the roles, functionalities, and interaction patterns of these tools in higher education. The present study adopted the draw-a-picture technique to explore the viewpoints and conceptions of undergraduates with different growth mindsets regarding the roles and functionalities of ChatGPT in learning. It also analyzed their interaction process with ChatGPT, especially their interaction skills and question types. The results showed that there were significant differences in the conceptions of "locations," "learning content," and "learning activities" of students with different growth mindsets. In the interaction process between undergraduates and ChatGPT, significant differences existed in the interaction skills and question types of students with different growth mindsets. Besides, students with different growth mindsets also had different learning achievements and critical thinking tendencies. The findings revealed the conceptions of students with different growth mindsets regarding the roles and functionalities of ChatGPT in learning, and also provided valuable insights for teachers. These findings are beneficial for educators to more accurately adjust and optimize the application of these tools in teaching activities based on students' different growth mindsets.

In recent years, smart healthcare technologies used to facilitate precision medicine in clinical practice have increasingly become a topic of discussion. Nurses and nurse preceptors are critical professionals in hospitals, and are also the frontline staff using smart healthcare. The purpose of this study was to investigate nurses' and nurse preceptors' perceptions of smart healthcare (including learning motivation, learning attitudes, and personal innovativeness) and the differences in their conceptions of learning in smart healthcare technology contexts. The research findings showed that nurse preceptors had higher mean scores than nurses for learning motivation, learning attitudes, and personal innovativeness in smart healthcare, especially for learning attitudes and personal innovativeness. The nurse preceptors' conceptions of learning in smart healthcare technology contexts were also more diverse than those of nurses. The main differences are that nurses' drawings showed a healthcare setting where learners (both patients and nurses) use computers to connect to cloud services for online visits, and where patients can engage in online health education learning activities via computers or mobile devices. The nurse preceptors' drawings focused on the delivery of nursing knowledge and skills to learners via VR technologies, helping diagnose patients, analyzing medical data, and predicting healthcare through smart healthcare technologies.

This study investigates the roles, applications, and trends of concept map-supported education (CMSE) by reviewing the studies published from 1992 to 2020. Several dimensions, such as the media of concept maps, roles of concepts, sample groups, research methods, application domains, learning contexts, research foci, as well as the citation and co-citation relationships, are taken into account based on the technology-based learning model. From the review results, two thematic clusters were found, namely concept map-facilitated knowledge construction in collaborative learning, and concept map-based learning design to improve learning achievement and motivation. The research focused more on the applications in engineering courses, followed by science and language courses, and potential was also found in arts, business or management, and mathematics. Learning contexts for CMSE are mainly in-class activities, followed by online discussion activities; moreover, it was found that the number of applications in digital game-based learning contexts is increasing. In terms of research foci, more studies investigated learners' performance, attitude/motivation, and perceptions, while less emphasis was put on developing learners' skills, higher order thinking, as well as collaboration and communication competences. Accordingly, several suggestions for future research of CMSE are provided as a reference for researchers and policy makers.

Introduction: Many tactile graphics designed for individuals with visual impairments consider single factors. According to the results of our previous study, there may be interactions among scale, representation, and complexity factors. We conducted this integrative study with these three factors. Additionally, for the representation factor, we introduced a new level that mixed the two common levels (line drawing, (LD), and texture picture, (TP)), into a textured-line drawing, (TLD). Methods: We included 18 participants with congenital blindness. They were asked to identify and name tactile graphics. The design of tactile graphics involved three factors, each at different levels, including scale (large, medium, and small), representation (TP, LD, and TLD), and complexity (easy and complex). We recorded the identification time and accuracy and conducted three-way analysis of variance to investigate interactions. Results: The identification time for small-scale graphics was shorter than that for large-scale graphics. The accuracy for small-scale graphics was higher than medium-scale graphics. Under the TLD mode, the accuracy for small and medium-scale graphics was higher than that for large-scale graphics. For medium-scale graphics, TLD performed better than LD. Discussion: Because the sizes of small-scale graphics were similar to those of actual objects, they were easy to identify. If the TLD mode is used for medium-scale graphics, the components in the operation area can be completely presented, which is helpful for identification. However, if large-scale graphics are used under the TLD mode, the operation area is relatively small and difficult to identify. Implications for Practitioners: It is recommended to present objects at 1:1 under the small-scale. Under the medium-scale, the operation area can be presented by closed plains, while non-operation areas can be presented using lines. Under the large-scale, it is recommended to reduce the size of the graphics to an extent where both hands can be used to explore.

Employing Oliver's disconfirmation theory as a theoretical basis, we examined the relationships between school teachers' attitudes, expectations and satisfaction with collaborating with school counsellors. Also, structural equation modelling was used to determine the effects of counsellors' professional traits on teacher satisfaction. Stratified sampling yielded a sample of 395 homeroom teachers from 26 public schools in Taoyuan City, Taiwan, representing a 94.4% response rate. We found: (1) teachers were highly satisfied with their collaborations with school counsellors, (2) teachers' collaborative attitudes and expectations were significant predictors of their satisfaction, supporting Oliver's theory, and (3) counsellor's professional traits significantly affected teachers' collaborative attitudes, expectations, and satisfaction.

Introduction: Three-dimensional (3D) printing can be used to produce tactile teaching materials for individuals with visual impairments. Although 3D and 2.5D teaching materials are based on realistic content, no systematic conversion model for 2D materials exists. Here, we combined the previous findings and this study's results and technology to develop procedure recommendations for tactile-graphic design. Methods: We enrolled 19 participants with congenital blindness to identify and name the tactile graphics. The tactile graphic design involved height differences, materials, and operation zone areas. We recorded the identification time, accuracy, and National Aeronautics and Space Administration--Task Load Index assessment performance and conducted a three-way analysis of the variance to investigate the interactions. Results: A larger area resulted in a better performance in seconds; model 3 (high lines and low planes) under large areas obtained the lowest speed and accuracy performances. Large areas were associated with a better intelligent load, physical load, mental load, and self-performance scores. Model 1 (equal line and plane heights) yielded better physical-load performance. Model 3 was found to be superior when thermoplastic elastomers were used under large areas. Discussion: Larger area ratios could increase the identification performance. As model 3 is not recommended, model 1 was found to be better than model 4 (non-operation-guiding zones become planes) in terms of physical load. Model 2 (low lines and high planes) required more time than model 1; hence model 1 is recommended. Fused deposition modeling (FDM) materials such as FDM_TPE (thermoplastic elastomer) increases the identification steps and should not be used first. The FDM_PLA (polylactic acid) platform is inexpensive and easier to operate than stereolithography (SLA) materials such as SLA_ABS (acrylonitrile butadiene styrene); hence FDM_PLA is recommended. Implications for Practitioners: When designing the graphics, a plan view photograph of the object can be obtained for delineating the contours first. Adjustments should be made after confirming the presentation model. The graphic may then be transferred for 3D printing with PLA materials.

Due to the rapid changes in global economic environments, enterprises have to continually enhance their business competitiveness. To improve business, planning educational training has been regarded as a channel to educate outstanding employees. Recently, most of the companies in the securities industry in Taiwan have adopted web-based educational training as a form of employee training. However, low e-learning acceptance on the part of employees is the essential obstacle when enterprises attempt to promote web-based continuing learning. Previous studies have shown that hardiness and Internet self-efficacy may be important factors that influence whether an individual will continue with web-based learning when facing pressure. Securities practitioners are required to deal with high pressure and persist in enhancing their professional knowledge in their working environment; therefore, continuing learning is crucial to maintaining the quality of professional service. The present study recruited securities practitioners as the research participants, and examined the effects of hardiness and Internet self-efficacy on their attitudes towards web-based learning when they were participating in web-based learning. The findings revealed that securities practitioners' hardiness and Internet self-efficacy both had direct positive effects on their attitudes towards web-based continuing learning. Meanwhile, their Internet self-efficacy had a mediating effect on the relationships between hardiness and attitudes towards web-based continuing learning.

Precision medicine has become an essential issue in the medical community as the quality of medical care is being emphasized nowadays. The technological data analysis and predictions made by Artificial Intelligence (AI) technologies have assisted medical staff in designing personalized medicine for patients, making AI technologies an important path to precision medicine. During the implementation of the new emerging technology, medical staff's learning intentions will have a great influence on its effectiveness. With reference to the Technology Acceptance Model, this study explored medical staff's attitudes, intentions, and relevant influencing factors in relation to AI application learning. A total of 285 valid questionnaires were collected. Five major factors, perceived usefulness (PU), perceived ease of use (PEU), subjective norms (SN), attitude towards AI use (ATU), and behavioral intention (BI), were used for analyzing the AI learning of medical staff in a hospital. Based on the SEM analytical results and the research model, the four endogenous constructs of PU, PEU, SN, and ATU explained 37.4% of the changes in BI. In this model, SN and PEU were the determining factors of BI. The total effects of SN and PEU were 0.448 and 0.408 respectively, followed by PU, with a total effect of 0.244. As a result, the intentions of medical staff to learn to use AI applications to support precision medicine can be predicted by SN, PEU, PU, and ATU. Among them, subjective norms considering the influences of both supervisors and peers, such as encouragement, communication, and sharing, may assist precision education in supporting the learning attitudes and behavior regarding precision medicine. The research results can provide recommendations for examining medical staff's intention to use AI applications.

This research aims to analyze the correlation between family support, love attitude, and well-being of junior high school students. After analyzing related literature, it is found that demographic variables like gender, grade, family structure, socioeconomic position have difference in perception of well-being. In addition, family support and love attitude has correlation with well-being as well. In order to accomplish the research purpose, this study extracted 686 junior high school students as the research subjects to conduct the home-edited youngster's family support scale, love attitude scale, and well-being scale. The three scales have all been pretested, and have good reliability and validity. We analyzed the then current condition of the collected effective questionnaire data with hierarchical regression to understand the explanatory power of the four demographic variables--gender, family support, love attitude--for well-being. The results show: 1. Junior high school students' family support, love attitude, and well-being reaches middle to high level. 2. The explanatory power of the four demographic variables-- gender, grade, family structure, and socio-economic status--is 2.40% in respect with well-being. 3. The explanatory power of love attitude for well-being is 4.00%, and the total explanatory is 34.70%. According to the research findings, this research suggests that 1. Parents should provide more affection support. 2. Grade-12 students should deal with pressures from the heavy schoolwork. 3. The studies in the future cam further explore and analyze the factors that influence well-being.

This study aims to develop Taiwan undergraduates' volunteer service motivation scale. To begin with, item pool was proposed on the basis of literature. After discussing with three Taiwan undergraduates, item pool, exploratory factor analysis (EFA) (N = 150) was proceeded, where three tests were conducted EFA: 1. Item analysis: comparisons of extreme groups and correlation analysis were employed. The former's critical ratios are all more than 3, and reach significant standard, showing the 20 items have discriminating power. The latter shows that the r value of all items and the total score are all more than .60, and reach significant standard (p<0.001), showing the items can measure the same concept. 2. Factor analysis: primary axis factoring and the promax method of oblique rotation were adopted. In the first EFA, the 5 items concerning interpersonal relationship were distributed to other factors; and, due to incompatibility with other factors, so this dimension of Interpersonal Relationship was deleted. The 2nd EFA's results are consistent with the original design, which is categorized into Self-Growth, Serving Others, and Social Identification, and has appropriate total variation and total reliability. In order to verify the stability of the EFA factors, another batch of samples (N = 452) were investigated through confirmatory factor analysis (CFA). In accordance with the CFA's results, the initial model's test are acceptable without offending estimations, the basic fit of the initial model is in good fitness (including individual reliability, composite reliability, the average variance extracted, construct discrimination). To conclude, these 15 items 3 factors of Taiwan Undergraduates' Volunteer Service Motivation Scale has acceptable reliability and validity; therefore, it can serve as the scale to investigate Taiwan undergraduates' volunteer service motivation for proceeding the relative studies.

This paper explored the relationships among career development, personality trait, and organizational commitment and examines whether career development mediates the relationship between personality trait and organizational commitment. The sample was 275 sport communication technology talents in Taiwan. The instrument included the Personality Trait Scale, Career Development Scale, and Organizational Commitment Scale. The relationship between personality trait and organizational commitment was mediated by career development. According the findings, some suggestions and recommendations for administration agency, and further researchers were made.

This study examined the effectiveness of a Green Food and Beverage (GFB) blended learning approach. A quasi-experimental research design was employed to verify the learning outcomes of implementing the GFB blended learning. Junior hospitality students were the research subjects. The experimental group participated in an 18-week GFB blended learning course, while the control group experienced traditional teaching. A total of 99 valid subjects were recruited. Statistical analyses were used to examine whether the participants of two groups had different green food literacy, transformative abilities, unit learning achievements, and learning experiences. The results confirmed that the blended learning course was more suitable for capturing students' attention and satisfying them through the course learning and could promote students' green food knowledge, green food responsibility, commitment to green food, and civic green food behavior. It could also enhance the psychological empowerment of students related to green food practices and problem solving to ensure food sustainability.

This study investigated the function of social supports and computer self-efficacy in predicting high school students' perceived effect of computer use. The study was survey method to collect data. The questionnaires were distributed to the high school students in Taiwan. 620 questionnaires were distributed and 525 questionnaires were gathered back with 84.67% return rate. The results of structural equation modeling (SEM) and model invariance analysis indicate that perceived peer support played an important role in predicting the effects of advanced computer self-efficacy. However, general computer self-efficacy was the factor more strongly associated with student computer use. The results were analyzed to provide useful insight into the development of student computer competency. The modified scale was a valid and reliable instrument for large scale population. This study provided representative results for further related studies. Educational implications and suggestions for future research are proposed. (Contains 6 tables and 2 figures.)

Integrating Internet-related applications into preschool instructional activities can enable children to develop multiple aspects of their learning abilities as well as their cognitive, affective, and relevant skills. Because of the trends toward an Internet society and parents' expectations from preschools, many teachers have considered parents' perceptions about the usefulness of the Internet in daily life and in workplace settings. This study examined the impacts of parents' attitudes toward Internet use and their expectations of preschools to use Internet-related applications. We administered a questionnaire in Taiwan comprising five factors: usefulness, work value, preschool expectations, teacher competence, and learning performance. The survey data were analyzed using structural equation modeling. The findings revealed that parents perceived the Internet as an innovative and useful tool that enhances their lives and improves their work performance. Their perceptions toward the usefulness and work value of Internet-related practices positively influenced their attitudes toward preschool expectations, and acknowledge the pedagogical advantages associated with integrating Internet-related applications into teaching for developing young children's learning abilities. The implications of the findings are also discussed in this paper.

During the last decade, environmental issues have become a global concern. According to a report by the Taiwan Environmental Protection Administration, more than 95% of consumers prioritize purchasing green products. Therefore, enterprises should consider environmental concerns in their operational strategies. This study identified how enterprises can successfully operate green brands, and focused on enterprises manufacturing daily necessities. Through a literature review, rules and an operational strategy were derived. Subsequently, 6 experts were interviewed and completed a questionnaire, then analytic hierarchy process was used to obtain the key success factors of green brands selling daily necessities. The resulting 10 key success factor findings provide a reference for enterprises seeking to act with social responsibility; develop high-quality green products, brands, and services; and protect the environment.

With the rapid progress of technology, the popularity of tablet computers and the development of e-book applications have brought the use of e-books as a learning tool under the spotlight. In the meantime, the aim of school education lies not only in providing students with knowledge but also in encouraging them to construct knowledge actively. Consequently, in this study, an approach of integrating the guided peerfeedback strategy into e-book design was proposed. An experiment was conducted on an elementary school natural science course to explore its effectiveness in comparison with the conventional e-book development activity. It was expected that the guided peer-feedback approach could engage students in knowledge organizing and in-depth thinking while stimulating more innovative ideas. To assess the impacts of this approach, a quasi-experimental design method was adopted. The students were divided into two groups: the experimental group, in which the students learned with the guided peer-feedback strategy together with the e-book development approach, and the control group, in which the students learned with the conventional ebook development approach. The experimental results indicated that the integrated guided peer-feedback and e-book development strategy had significant impacts on the students' learning achievements and ebook project outcomes while reducing their cognitive load and increasing their innovative thinking tendency in the design process.

This study proposes a new efficient predictor called a three-dimensional (3D) membership function-based Type-2 Fuzzy Brain-Emotional Learning Predictor (T2FBELP) to model and predict Taiwan stock prices. This study has primarily contributed to improve the learning ability and flexibility of type-2 fuzzy system by changing the structure in the membership function space. The use of a 3D Gaussian membership function in the fuzzy network allows for fewer rules while maintaining accurate predictions, especially when dealing with nonlinear time series such as stock prices. Additionally, learning-rate parameters are optimized using the Modified Social Ski-Driver (MSSD) algorithm to further impoving the predict ability. The T2FBELP is then used to predict the stock prices for including the Taiwan Semiconductor Manufacturing Company (TSMC), the Honhai Precision Industry and the Formosa Plastics Corporation. These efforts show the effectiveness of T2FBELP in predicting the Taiwan stock market. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients' clinical manifestations and identify risk factors for shock. We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9–7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01–668.89). MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission. [ABSTRACT FROM AUTHOR]

Confirmatory tests for diagnosis of primary aldosteronism (PA) play an important role in sparing patients with a false-positive aldosterone-to-renin ratio (ARR) screening test from undergoing invasive subtyping procedures. We recommend that patients with a positive ARR test should undergo at least one confirmatory test to confirm or exclude the diagnosis of PA before directly proceeding to subtype studies, except for patients with significant PA phenotypes, including spontaneous hypokalemia, plasma aldosterone concentration >20 ng/dL plus plasma renin activity below a detectable level. Although a gold standard confirmatory test has not been identified, we recommend that saline infusion test and captopril challenge test, which were widely used in Taiwan. Patients with PA have been reported to have a higher prevalence of concurrent autonomous cortisol secretion (ACS). ACS is a biochemical condition of mild cortisol overproduction from adrenal lesions, but without the typical clinical features of overt Cushing's syndrome. Concurrent ACS may result in incorrect interpretation of adrenal venous sampling (AVS) and may lead to adrenal insufficiency after adrenalectomy. We recommend screening for ACS in patients with PA scheduled for AVS examinations as well as for adrenalectomy. We recommend the 1-mg overnight dexamethasone suppression test as screening method to detect ACS. [ABSTRACT FROM AUTHOR]

As proof of educational quality and upgrading competitiveness of graduates in the global job market, business schools in Taiwan committed towards the goal of obtaining accreditation from Association to Advance Collegiate Schools of Business (AACSB), this paper exams the impact of AACSB accreditation on students' Organization Socialization, Person-Organization Fit (P-O Fit), and learning outcomes. In addition, this study compares organizations with AACSB and those without AACSB accreditation, examining whether significant differences exist regarding student behavior, effectiveness of learning, organizational identification, organizational citizenship behavior, learning satisfaction, and wishes to transfer to another department or school. The results show that Organization Socialization, through P-O Fit, would positively affect students' effectiveness of learning, organizational identification, organizational citizenship behavior, and learning satisfaction, and inversely affect students' desire to transfer to other school. Overall speaking, this research offers proof of AACSB accreditation as guarantee of educational quality.

The research is now an instructor in the department of animation in a college, discovering that students can not pay attention to their study and lack of motivation to learn. Therefore, the research motivation is how to restore students' learning motivation and have them plunge into course learning. The study aimed to develop "design strategy of peer learning" and to conduct observation in the classroom. The researcher took "observation survey" as a research method and utilize it to design teaching methods, hoping to improve class learning atmosphere and learning attitude.Finally, based on the survey data analysis, it is concluded that (1) students consider it is appropriate that the teacher leads the curriculum but peer tutor's help is also needed; (2) design strategy of peer learning reduces learning difficulties and enhance students' learning motivation; (3) design strategy of peer learning is more helpful on female students than male students.

Group identity is a critical component in developing effective classroom management. While there have been numerous studies on group identity, they have primarily focused on its effects on the physical classroom entity. Advances in information technology, however, have enabled the creation of virtual communities, which have become a vital channel of communication in classroom management, though there are few systematic collations that explore the effects of virtual communities on classroom management. This study integrates social capital theory and social exchange theory into an integrated research model that examines a Facebook-based virtual classroom community, with an emphasis on group identity formation during social capital exchange via computer-mediated communication. A total of 344 valid questionnaires were obtained and analyzed using structural equation modeling. The results of this study found that the fair and reciprocal exchange of social capital generates affective commitment and emotional support among members maintaining or enhancing the development of social network relations and facilitating the formation of group identity. Finally, this study's theoretical and practical implications for classroom group management are presented.

Augmented reality (AR) has been recognized as a potential technology to help students link what they are observing in the real world to their prior knowledge. One of the most challenging issues of AR-based learning is the provision of effective strategy to help students focus on what they need to observe in the field. In this study, a competitive gaming approach is proposed to support AR-based learning activities conducted in real-world contexts. An experiment has been conducted on an elementary school ecology course to explore the effectiveness of the proposed approach in comparison with the conventional AR-based mobile learning approach in field trips. The experimental results show that the AR-based gaming approach can improve not only students' learning attitudes, but also their learning performance on the field trip. Accordingly, discussions and some suggestions for future work are provided.

This article presents a study of the university-industry linkages in art and design higher education, focusing on the collaborative efforts between universities and the creative sector in Indonesia and Taiwan. Using a qualitative approach, in-depth interviews and literature reviews were conducted. An automated content analysis of seven semi-structured interviews with lecturers, designers, and the government stressed the importance of university and industry linkages. This study found that despite the prevalent practice of industrial cooperation with universities in the Indonesian higher education system, challenges persist in effectively connecting graduates with employment opportunities in the creative industry sectors. In response, the Indonesian government and universities have implemented policies to support collaboration programs to address these challenges. Conversely, Taiwan has recognized the potential of its creative industry assets to create a promising market and has placed significant value on the benefits derived from industry-university collaboration. Consequently, Taiwan has proactively developed its creative industries, receiving substantial encouragement and support from the local government. [ABSTRACT FROM AUTHOR]

This research aims to apply a depth sensor to create a human-body-sensing context for outdoor learning paths; it is conducted by incorporating both quasi-experiment and survey to compare students' cognitive learning outcome within the context and understand students' attitudes toward the context created. The result of ANCOVA indicates that the context of an introductory film activated by the depth sensor produces better cognitive learning outcome. Furthermore, the survey of students' attitudes also shows positive attitudes from both experimental and control groups toward the additional use of a human-body-sensing system activated by the depth sensor. The experimental results show the depth sensor can be used to improve conventional learning paths, i.e. with information boards only, for it enables students to participate in wireless sensing learning with their hands free from holding any device.

In Taiwan, the prevalence of COVID-19 was low before April 2022. The low SARS-CoV-2 seroprevalence in the population of Taiwan provides an opportunity for comparison with fewer confounding factors than other populations globally. Cycle threshold (Ct) value is an easily accessible method for modeling SARS-CoV-2 dynamics. In this study, we used clinical samples collected from hospitalized patients to explore the Ct value dynamics of the Omicron variant infection. From Jan 2022 to May 2022, we retrospectively included hospitalized patients tested positive by nasopharyngeal SARS-CoV-2 PCR. We categorized the test-positive subjects into different groups according to age, vaccination status, and use of antiviral agents. To investigate the nonlinear relationship between symptom onset days and Ct value, a fractional polynomial model was applied to draw a regression line. We collected 1718 SARS-CoV-2 viral samples from 812 individuals. The Ct values of unvaccinated individuals were lower than those of vaccinated persons from Day 4 to Day 10 after symptom onset. The Ct value increased more rapidly in those individuals with antiviral drug treatment from Day 2 to Day 7. In elderly individuals, the Ct values increased slowly from Day 5 to Day 10, and the increasing trend was unique compared with that in children and adults. Our study demonstrated the primary viral infection dynamics of the Omicron variant in hospitalized patients. Vaccination significantly affected viral dynamics, and antiviral agents modified viral dynamics irrespective of vaccination status. In elderly individuals, viral clearance is slower than that in adults and children. [ABSTRACT FROM AUTHOR]

This paper examines the scalability of intimacy permissiveness measures in Taiwan by using island-wide survey data. Among models for scaling analysis, the Guttman scaling model and two latent class models--the latent-distance model and Goodman's scale model--were employed to examine the scalability of the scale measures. The data were drawn from the 2002 Taiwan Social Change Survey (Questionnaire No. 2), conducted by Academia Sinica. A total of 1983 completed interviews were obtained. This study found that the measures of intimacy permissiveness scale (IPS) were able to form a reasonable Guttman-type scale based on three scaling models. In order to understand whether the attitudinal patterns of Taiwanese toward premarital intimacy permissiveness, particularly the existence of sexual double standards, are consistent with those suggested by the previous literature, we conducted multinomial logistic regression of socio-demographic variables on the scale. Gender and age differences were found consistent with previous studies and mostly reconfirmed the appropriateness of the measures of IPS designed for the Taiwan Social Change Survey.

Purpose--The study aims to examine the age differences of job satisfaction between Taiwanese and Chinese higher education faculty. Design/methodology/approach--The data on job satisfaction were obtained from 194 Taiwanese faculty and 211 Chinese faculty at college levels in one city. Findings--No statistically significant differences were found for full-time Taiwanese and Chinese faculty in the overall job satisfaction of age at higher education after educational reforms, but differences exist between countries. Originality/value--This article applies to strategies on job satisfaction for the current Taiwanese and Chinese faculty at colleges. (Contains 4 tables.)

Examines educational technology applications in Taiwan. Highlights include historical background; learning technology integration; computer availability; teacher training; student and teacher attitudes; computer-mediated communication and collaboration; curriculum planning; distance education; and an educational technology model that includes learning, technology, administration, and society to form a learning community. (Author/LRW)

Diabetes mellitus (DM) and hepatitis C virus (HCV) infection are prevalent diseases globally and emerging evidence demonstrates the bidirectional association between the two diseases. Direct-acting antivirals (DAAs) for HCV have a high treatment success rate and can significantly reduce the risks of short and long-term complications of HCV infection. However, despite the evidence of the association between diabetes and HCV and the benefits of anti-HCV treatment, previously published guidelines did not focus on the universal HCV screening for patients with diabetes and their subsequent management once confirmed as having HCV viremia. Nonetheless, screening for HCV among patients with diabetes will contribute to the eradication of HCV infection. Thus, the three major Taiwan medical associations of diabetes and liver diseases endorsed a total of 14 experts in the fields of gastroenterology, hepatology, diabetology, and epidemiology to convene and formulate a consensus statement on HCV screening and management among patients with diabetes. Based on recent studies and guidelines as well as from real-world clinical experiences, the Taiwan experts reached a consensus that provides a straightforward approach to HCV screening, treatment, and monitoring of patients with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Limited data exist on asthma medication patterns in Taiwan. The objectives of the SABINA III cross-sectional study in Taiwan were thus, to describe patient demographics and clinical features and estimate short-acting β2-agonist (SABA) and inhaled corticosteroids (ICS) prescriptions per patient.Methods: Patients (≥18 years) with asthma were classified by investigator-defined asthma severity per the 2017 Global Initiative for Asthma (GINA) recommendations. Data on asthma symptom control (per GINA 2017 recommendations), severe exacerbation history, and prescribed treatments in the 12 months before study visit were collected using electronic case-report forms. Analyses were descriptive.Results: Overall, all 294 analyzed patients (mean [SD] age, 57.9 [15.6] years; female, 69%) were enrolled by specialists and had fully reimbursed healthcare. Most patients were classified with moderate-to-severe asthma (93.2%; GINA steps 3-5), were obese (53.4%) and nonsmokers (79.6%), reported high school or university and/or postgraduate education (61.9%), and had ≤2 comorbidities (89.1%). Mean (SD) asthma duration was 8.3 (10.0) years, with 37.8% of patients experiencing ≥1 severe exacerbation 12 months before the study visit. Overall, 62.2%, 26.2%, and 11.6% of patients had well-controlled, partly controlled, and uncontrolled asthma, respectively. Crucially, 19.3% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (overprescription). ICS, ICS + long-acting β2-agonist fixed-dose combination, and oral corticosteroid bursts were prescribed to 6.5%, 97.3%, and 31.6% of patients, respectively.Conclusion: Despite treatment by specialists and fully reimbursed healthcare, findings indicate room for improvement in asthma control and SABA prescription practices in Taiwan, emphasizing the need to adhere to latest evidence-based guidelines. [ABSTRACT FROM AUTHOR]

In mid-2022, the COVID-19 cases have reached close to 562 million, but its overall infection rate is hard to confirm. Even with effective vaccines, break-through infections with new variants occur, and safe and reliable testing still plays a critical role in isolation of infected individuals and in control of an outbreak of a COVID-19 pandemic. In response to this urgent need, the diagnostic tests for COVID-19 are rapidly evolving and improving these days. The health authorities of many countries issued requirements for detecting SARS-CoV-2 diagnosis tests during the pandemic and have timely access to these tests to ensure safety and effectiveness. In this study, we compared the requirements of EUA in Taiwan, Singapore, and the United States. For the performance evaluations of nucleic acid extraction, inclusivity, limit of detection (LoD), cross-reactivity, interference, cutoff, and stability, the requirements are similar in the three countries. The use of natural clinical specimens is needed for clinical evaluation in Taiwan and the United States. However, carry-over and cross-contamination studies can be exempted in Taiwan and the United States but are required in Singapore. This review outlines requirements and insight to guide the test developers on the development of IVDs. Considering the rapidly evolving viruses and severe pandemic of COVID-19, timely and accurate diagnostic testing is imperative to the management of diseases. As noted above, the performance requirements for SARS-CoV-2 nucleic acid tests are similar between Taiwan, Singapore and the United States. The differences are mainly in two points: the recommended microorganisms for cross-reactivity study, and the specimen requirement for clinical evaluation. This study provides an overview of current requirements of SARS-CoV-2 nucleic acid tests in Taiwan, Singapore, and the United States. [ABSTRACT FROM AUTHOR]

Medical radiography students in Taiwan are required to completed internships at hospitals before taking the national examination. During the internships, students understanding theoretical knowledge, the latest technologies, and become familiar with operating different imaging equipment. This practical experience aims to enhance their practical skills and medical decision-making abilities, as well as provide insights into industry trends and future challenges. Self-development App was used to integrate education information system. Competency-based medical education (CBME) was used to assess operational ability, we recorded and track daily learning status in the examination room. Self-development App improved students' learning effect, the scores were improved in post-test by 10 %-50 %. The average student satisfaction score was 4.86. Most teachers (84.6 %) agree that "Self-development App" will be an essential tool. Our study provided an easy education App to improve students' learning effect efficiently and reduce teachers' workload. [ABSTRACT FROM AUTHOR]

Lumpy skin disease is an arthropod-borne bovine disease caused by lumpy skin disease virus. A suspect lumpy skin disease case in a breeding cattle farm on Kinmen Island, Taiwan was reported on July 8, 2020 and later confirmed the first occurrence of lumpy skin disease in the country by molecular biological detections, electron microscopy, and sequence comparison. Implementation of control measures including blanket vaccination on the island effectively ceased the outbreaks. Phylogenetic analyses revealed that the virus discovered in the outbreaks was most similar to those identified in China in 2019. Identifying this virus in the coastal areas in East Asia indicated the rapid eastward spread of lumpy skin disease in Asia. [ABSTRACT FROM AUTHOR]

Data on Taiwanese adolescents with self-inflicted injuries are limited. We describe the epidemiology of children and adolescents visiting the emergency department for self-inflicted injuries in two geographically distinct teaching hospitals. Medical records of children 0–18 years old who visited the emergency department of Taipei Tzu Chi Hospital and Chi Mei Medical Center, Tainan between 2016 and 2019 coded with relevant diagnoses were reviewed. Visits with documented self-inflicted injury were included. During the 4-year period, 62 children made 74 emergency visits for self-inflicted injury. A total of 88% of visits were made by children with a psychiatric diagnosis, with depressive disorders being the most common (57%). Interpersonal relationship issue was cited as a trigger for self-harm in 49% of visits. Adjusted for annual visit volumes, self-harm visits per 10,000 pediatric emergency visits increased nearly 5 fold between 2016 and 2019, with the most prominent increase in the final year. Poisoning was the most common mechanism of injury and was frequently used by females, as compared to males who tended to jump from heights. Up to 96% of adolescents with previous self-harm seen at the emergency department had sought psychiatric help in the past year. Urban-rural inequity in mental health resource utilization was observed. Visits to the emergency department for self-inflicted injuries among children and adolescents increased, most remarkably in 2019, for both hospitals. Intentional poisoning with prescription and over-the-counter medications was the most common method. There was a high prevalence of psychiatric disorders in our study population. As the emergency department is likely the first point of medical contact for such visits, emergency personnel should be trained appropriately on managing such patients. [ABSTRACT FROM AUTHOR]

The present study included the first case of mucopolysaccharidosis (MPS) type VII in Taiwan. During pregnancy, the patient was diagnosed with hydrops fetalis and had ascites aspiration 4 times. In the following years, she presented gradually with chronic lung disease, developmental delay, short stature, dysmorphic features of coarse face, macroglossia and pigeon chest with scoliosis. Upon referral at age 4 years, she had corneal clouding, mild limitation of range of motion (ROM) and hepatosplenomegaly. X-ray showed paddle ribs and dysplastic vertebral bodies. MPS was suspected and urine glycosaminoglycans (GAGs) elevated were noted. The leukocyte enzymatic analyses for MPS I, MPS II, MPS IIIB, MPS IVA, and MPS VI were all normal. Afterward, the molecular analysis showed two heterozygous genetic variants of c.104C > A and c.1454C > T in trans in the GUSB gene (NM_000181.4) which were the causes for MPS VII. Then, we checked the leukocyte β-glucuronidase activity for MPS VII and showed extremely low, therefore confirmed the diagnosis. Clinicians should increase the awareness on the early signs of MPS to have a prompt diagnosis and offer the correct treatment like enzyme replacement therapy (ERT) as early as possible. [ABSTRACT FROM AUTHOR]

Psychiatric disorders in first-degree relatives (FDRs) often differ from the index patient's diagnosis, suggesting that there is genetic contribution to psychiatric disorders in which related cases do not all map to the same diagnosis as the index case. Our aim is to look for psychiatric comorbidities across major mental illnesses using three approaches, genetics, clinical diagnosis, and brain imaging to address common associations and pathology among mental illnesses. Genome-wide association studies from the Psychiatric Genomics Consortium showed single gene polymorphisms are common across 5 major psychiatric disorders, including schizophrenia (SZ), bipolar disorder (BD), major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Clinically, results of Taiwan's nationwide population studies showed that other major psychiatric disorders were more likely to coaggregate in families with an index case of an individual with a psychiatric disorder, compared to control families. Finally, resting functional connectivity (FC) magnetic resonance imaging (MRI) and whole-brain connectomic analysis of SZ, BD I, BD II, MDD, and healthy controls revealed that the four groups of patients shared similar patterns of abnormal neural substrate in the brain that differed from controls. In conclusion, using big data from genetics, administrative health claims, and brain imaging, we identified concordance, indicating dimensional coherence of genetic heritability, clinical mutual associations, and common neurobiological substrates across major psychiatric disorders. These results will challenge the current diagnostic classification system and possibly move psychiatry beyond descriptive syndromes towards a nosology informed by disease cause. [ABSTRACT FROM AUTHOR]

Background/purpose: Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population.Methods: The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions.Results: The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population.Conclusion: The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered. [ABSTRACT FROM AUTHOR]

Background/purpose: Typhoon Morakot in August 2009 caused significant damages and health and socio-economic impacts in Taiwan. Therefore, we evaluated the mental health status of adult and patients who lived in the affected area after the disaster.Methods: An observational, prospective population-based study was conducted. Adults living in the affected area were selected as the affected population in the National Health Insurance Database from January 2008 to December 2011. Prevalence and incidence of stress-associated illnesses, such as insomnia, anxiety, depressive, adjustment and mood disorders, post-traumatic stress disorder (PTSD) in the psychiatry department were analysed after the disaster.Results: A total of 897,689 adult patients were studied. Of the affected population without pre-existing chronic mental health illness, the monthly visits for stress-associated illnesses, such as insomnia, anxiety, depressive disorders and PTSD increased about twice after the disaster in elderly and non-elderly groups. Comparing to the non-elderly group, the elderly group has more increased in the incidence of insomnia (356% vs. 318% increase) and depressive disorders (308% vs. 245%) but was affected to a lesser extent increase in the anxiety (269% vs. 307%), PTSD, episodic mood disorders (82% vs. 158%), and adjustment reaction (160% vs. 202%).Conclusion: The mental health statuses of patients who experienced a major natural disaster deteriorated in the elderly population after the disaster. However, we still need pay more attentions on the elderly of the affected population to decrease the risk for insomnia and depressive disorders after the disaster. [ABSTRACT FROM AUTHOR]

Background: To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA).Methods: The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group meetings. The nine critical issues were recognized to provide updated information and internationally acceptable protocols.Results: When screening for PA by using the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR), withdrawal or adjustment of antihypertensive medication is not always necessary on the first patient visit. Hypokalemia should be corrected before ARR screening. In spontaneous hypokalemia, plasma renin below detection levels, and PAC higher than 20 ng/dL (550 pmol/L), further confirmatory testing is unnecessary for PA diagnosis. Direct renin concentration (DRC) could be used for PA diagnosis if PRA is unavailable. Although additional confirmatory tests are suggested, the result of a single test is still reliable. For patient safety, discontinuation or adjustment of antihypertensive medications is indicated before adrenal venous sampling (AVS). ACTH could be beneficial for successful adrenal vein cannulation but is not necessary for determining lateralization in AVS. Simultaneous technique is preferred for AVS. Adrenal NP-59 scintigraphy integrated with SPECT/CT could guide PA management.Conclusion: With introduction of these new concepts to the clinicians, we expect better identification, management and treatment of PA patients. [ABSTRACT FROM AUTHOR]

Background: Reports on the effectiveness of pneumococcal conjugate vaccines (PCVs) on pediatric parapneumonic effusion are limited. We report the changes in cases and etiologies of pediatric parapneumonic effusion in a children's hospital before and after national PCV13 vaccination programs.Methods: We screened medical records of children 0-18 years admitted to the National Taiwan University Hospital with diagnoses of lobar pneumonia and parapneumonic effusion between 2008 and 2017. Patients with effusion analyses were included. Results of blood, pleural fluid, and respiratory specimens surveyed as standard care were analyzed.Results: Diagnostic testing revealed at least a pathogen in 85% of 202 children with lobar pneumonia and parapneumonic effusion. After national PCV13 immunization, pneumococcal empyema decreased by 72% among 2- to 5-year olds. Mycoplasma pneumoniae was the second most common etiology. There were marked differences in effusion characteristics, metabolic, and respiratory parameters between children infected with pneumococcus and M. pneumoniae.Conclusion: The effectiveness of the national PCV13 immunization programs on pneumococcal empyema was evident and remained substantial after 4 years in Taiwan. Continuous surveillance is important to monitor the emergence of other pathogens including non-PCV serotypes and M. pneumoniae. [ABSTRACT FROM AUTHOR]

Background/purpose: Inflammatory bowel disease (IBD) is a chronic gastrointestinal (GI) disorder that causes relapsing inflammation and severe mucosal damage in the intestine. Crohn's disease (CD)-related stricturing complications are a major cause of surgery, disability, and reduced quality of life. Endoscopic balloon dilation (EBD) has been shown to reliably delay or prevent surgery in patients with stricturing CD. However, cases of EBD performed for stricture in CD in Taiwan are rare. In this study, we want to evaluate the experiences regarding EBD for stricturing CD in Taiwan.Methods: We conducted a retrospective analysis of 9 medical centers in Taiwan. Patients with CD-related strictures who were treated with EBD were included and analyzed.Results: In nine medical centers, a total of 26 CD patients (19 male, 7 female, mean disease duration 75.4 ± 65.2 months) underwent 42 EBD procedures during the study period. Among the subjects, an 83.3% (35/42) EBD success rate was seen, but 26.9% (7/26) patients underwent surgery after ineffective EBD. In the surgery group, the the small bowel strictures was high compared with the non-surgery group (p = 0.01). There were no significant differences in disease phenotype, disease duration or history of fistulizing disease. In the surgery group, immunosuppressant use was high, and 5-aminosalicylic acid (5-ASA) use was low compared with the non-surgery group. After EBD, the physicians tended to change the drugs, especially increasing the use of biologic agents.Conclusion: EBD is a safe and effective procedure for CD-related stricture, with a 83.3% success rate in Taiwan. [ABSTRACT FROM AUTHOR]

Background: The recommended target low-density lipoprotein cholesterol (LDL-C) level for coronary artery disease (CAD) patients has been lowered from 100 to 70 mg/dL in several clinical guidelines for secondary prevention. We aimed to assess whether initiating statin treatment in CAD patients with baseline LDL-C 70-100 mg/dL in Taiwan could be cost-effective.Methods: A Markov model was developed to simulate a hypothetical cohort of CAD patients with a baseline LDL-C level of 90 mg/dL. The incidence and recurrence of MI and stroke related to specific LDL-C levels as well as the statin effect, mortality rate, and health state utilities were obtained from the literature. The direct medical costs and rate of fatal events were derived from the national claims database. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) was calculated, and sensitivity analyses were performed.Results: Moderate-intensity statin use, a treatment regimen expected to achieve LDL <70 mg/dL in the base case, resulted in a net gain of 562 QALYs but with an additional expenditure of $11.4 million per 10,000 patients over ten years. The ICER was $20,288 per QALY gained. The probabilities of being cost-effective at willingness-to-pay thresholds of one and three gross domestic product per capita ($24,329 in 2017) per QALY were 51.1% and 94.2%, respectively. Annual drug cost was the most influential factor on the ICER.Conclusion: Lowering the target LDL-C level from 100 to 70 mg/dL among treatment-naïve CAD patients could be cost-effective given the health benefits of preventing cardiovascular events and deaths. [ABSTRACT FROM AUTHOR]

Background/purpose: Diabetes mellitus (DM) prevalence has been rapidly increasing in Taiwan and globally. Team care for DM has been provided through diabetes shared-care networks in Taiwan more than 20 years.Methods: The study analyzed the National Health Insurance (NHI) claims data from 2005 to 2014 to better understand diabetes care accountability and utilization in Taiwan.Results: The completion rate of annual check-ups for various metabolic measurements increased significantly, which indicates improvement in diabetes management quality. The average annual visits and drug cost for each patient increased enormously from 2005 to 2014. The annual number of outpatient department/inpatient department (OPD/IPD) patients with diabetes undergoing dialysis increased. The number of OPD visits in patients with diabetes was 1.9 times higher than that in all patients in general. IPD cost appeared to increase, whereas both drug cost and the average length of hospitalization per patient decreased. Endocrine and metabolic diseases were still the leading cause of OPD expenses. The leading cause of IPD expenses was respiratory diseases. An increasing trend was noted in the medical cost for patients with microvascular instead of macrovascular complications. OPD care for patients with diabetes was rather evenly distributed since 2009. Regarding IPD care, medical centers and regional hospitals each hospitalized 37% of the diabetic outpatients in 2014.Conclusion: Accountability of diabetes care in Taiwan improved significantly till 2014. The ongoing fight against DM and tracing, examining and learning from the overall outcomes in future decades is still required. [ABSTRACT FROM AUTHOR]

The 2019 Diabetes Atlas delineated both accomplishments and challenges in diabetes care in Taiwan between 2005 and 2014. The series reported that Taiwan had significantly improved aspects of care quality for patients with diabetes. For example, the mortality rate decreased, the difference between the life expectancies of patients with diabetes and those of the general population decreased, and the rates of hospitalization because of heart diseases, cerebrovascular diseases, chronic kidney diseases, and unsatisfactory glycemic control decreased. However, despite these achievements, the 2019 Diabetes Atlas also reported some substantial challenges that have not been overcome. For example, the incidence of diabetes among women aged <19 years and 20-39 years increased by 27% and 33%, respectively. Furthermore, a high prevalence of macrovascular complications, a continuous increase in the dialysis prevalence rates among men with diabetes of all ages, and a low participation rate (<20%) of patients with diabetes in the pay-for-performance program were observed. The publication of the 2019 Diabetes Atlas is a milestone that demonstrates a strong will in medical societies to improve the quality of diabetes care. We expect this initiative can be reorganized every 5 years to report the results of continuous monitoring and surveillance and update the epidemiological features of diabetes in Taiwan. [ABSTRACT FROM AUTHOR]