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The tumor control probability (TCP) model has been used for estimating the response of the radiation (photon) therapy for a given treatment dose (distribution). In Taiwan, boron neutron capture therapy (BNCT) is still at the stage of the clinical trials without standard dose prescription. In this study, universal survival curve (USC) model was selected as the TCP model for BNCT. The tumor response and dose distribution from protocol I of the clinical trial of the recurrent head and neck (H&N) cancer conducted by Taipei Veterans General Hospital and National Tsing Hua University were used to verify the TCP model established in this study. The results showed that, using the USC model as a biological model of dose conversion, the TCP calculated by the generalized Equivalent Uniform Dose (gEUD)–based TCP model can be used to well correlate the relationship between the tumor response and dose distribution of the patients of recurrent H&N cancer. The result shows that 25% and 60% of TCP correspond to partial response and complete response of H&N cancer, respectively. This study also indicated that, when BNCT was used to treat recurrent H&N cancer, the minimum dose was an important factor on the efficacy of the treatment. Minimum dose of 18 Gy-w corresponds to at least 60% of TCP. [ABSTRACT FROM AUTHOR]

Background: Diffuse large B-cell lymphoma (DLBCL) of the head-and-neck area primarily involvesthe Waldeyer ring (WR) and sinonasal area (SN). However, the differential clinical outcomes between patients with WR-DLBCL and those with SN-DLBCL in the rituximab era remain unclear. Methods: To avoid confounding factors contributed by advanced DLBCL with WR and SN involvement, we assessed the clinical outcomes of patients with stage I/II WR-DLBCL and SN-DLBCL and compared them with those having corresponding stages of DLBCL in the lymph nodes but without other extranodal involvement (LN-DLBCL) in the same period. We compared the patients' clinical characteristics, treatment modalities, event-free survival (EFS), and overall survival (OS) among the three subgroups. Results: We analyzed 67, 15, and 106 patients with WR-DLBCL, SN-DLBCL, and LN-DLBCL, respectively, between January 2000 and December 2019. All patients received front-line rituximab-based regimens, and>80% received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone-based regimens More patients with SN-DLBCL had revised International Prognostic Index (RIPI) score 3 (27%) when compared with those with WR-DLBCL (7%) and those with LN-DLBCL (10%, p=0.181). Patients with WR-DLBCL, LN-DLBCL, and SN-DLBCL had 5-year EFS and OS rates of 80.7%, 59.5%, and 41.9% (p=0.021) and 83.7%, 70.8%, and 55.8% (p=0.032), respectively. Compared to patients with LN-DLBCL, those with WR-DLBCL also had a significantly favorable 5-year EFS rate (p=0.021) and 5-year OS rate (p=0.023). Three of the 15 patients with SNDLBCL experienced lymphoma recurrence in the brain after front-line treatment. In multivariate analyses, R-IPI scores of 1–2 and 3 served as significantly poor prognostic factors for patients with poor EFS and OS. Conclusions: Compared to patients with LN-DLBCL, patients with WR-DLBCL receiving front-line rituximab-based treatments had favorable clinical outcomes; however, patients with SN-DLBCL had worse clinical outcomes. Further studies on molecular prognostic factors and treatment strategies for SN-DLBCL are warranted. [ABSTRACT FROM AUTHOR]

People with limited health literacy comprise a high-risk group for adverse health outcomes. Nurses must be made aware of the importance of health literacy and communicate with patients in plain language, which will solve the obstacles for patients using health care services. Providing health literacy education for nurses is an important strategy for health literacy practices. This study aimed to develop a refined health literacy course for nursing students and evaluate its effectiveness. The study used a single-group pre- and post-test quasi-experimental design and conducted focus group interviews. The intervention was an eight-hour course and applied team-based learning combined with various teaching methods. The study enrolled second-year nursing students of a university in eastern Taiwan via convenient sampling. A self-reported structured questionnaire was used to compare the participants' familiarity with health literacy, attitude, confidence in oral communication, and ability in written communication before and after the course. To discuss the learning experience of the course, the study held two focus groups with 12 participants. A total of 81 participants completed the pre- and post-test questionnaires. The results showed that familiarity with health literacy (t=9.12, t<.001), attitude (t=4.89, t<.001), confidence in oral communication (t=4.12, t<.001), and ability in written communication (t=8.83, t<.001) showed improvement after the course. Data analysis of focus group interviews yielded two categories and seven themes for the learning experience, most of which showed participants' positive learning experiences in the health literacy course. The course effectively enhanced the nursing students' knowledge and attitude toward health literacy and the ability to communicate with patients using health literacy principles. The results can provide a reference for integrating health literacy education into the undergraduate nursing curriculum. [ABSTRACT FROM AUTHOR]

Background Occult scaphoid fractures on initial radiographs of an injury are a diagnostic challenge to physicians. Although artificial intelligence models based on the principles of deep convolutional neural networks (CNN) offer a potential method of detection, it is unknown how such models perform in the clinical setting. Questions/purposes (1) Does CNN-assisted image interpretation improve interobserver agreement for scaphoid fractures? (2) What is the sensitivity and specificity of image interpretation performed with and without CNN assistance (as stratified by type: normal scaphoid, occult fracture, and apparent fracture)? (3) Does CNN assistance improve time to diagnosis and physician confidence level?. Methods This survey-based experiment presented 15 scaphoid radiographs (five normal, five apparent fractures, and five occult fractures)with andwithout CNNassistance to physicians in a variety of practice settings across the United States and Taiwan. Occult fractures were identified by follow-up CT scans or MRI. Participants met the following criteria: Postgraduate Year 3 or above resident physician in plastic surgery, orthopaedic surgery, or emergency medicine; hand fellows; and attending physicians. Among the 176 invited participants, 120 completed the survey and met the inclusion criteria. Of the participants, 31% (37 of 120) were fellowship-trained hand surgeons, 43% (52 of 120) were plastic surgeons, and 69% (83 of 120) were attending physicians. Most participants (73% [88 of 120]) worked in academic centers, whereas the remainder worked in large, urban private practice hospitals. Recruitment occurred between February 2022 and March 2022. Radiographs with CNNassistancewere accompanied by predictions of fracture presence and gradient-weighted class activation mapping of the predicted fracture site. Sensitivity and specificity of the CNN-assisted physician diagnoses were calculated to assess diagnostic performance. We calculated interobserver agreement with the Gwet agreement coefficient (AC1). Physician diagnostic confidence was estimated using a self-assessment Likert scale, and the time to arrive at a diagnosis for each case was measured. Results Interobserver agreement among physicians for occult scaphoid radiographs was higher with CNN assistance than without (AC1 0.42 [95% CI 0.17 to 0.68] versus 0.06 [95% CI 0.00 to 0.17], respectively). No clinically relevant differences were observed in time to arrive at a diagnosis (18 ± 12 seconds versus 30 ± 27 seconds, mean difference 12 seconds [95% CI 6 to 17]; p < 0.001) or diagnostic confidence levels (7.2 ± 1.7 seconds versus 6.2 ± 1.6 seconds; mean difference 1 second [95% CI 0.5 to 1.3]; p < 0.001) for occult fractures. Conclusion CNN assistance improves physician diagnostic sensitivity and specificity as well as interobserver agreement for the diagnosis of occult scaphoid fractures. The differences observed in diagnostic speed and confidence is likely not clinically relevant. Despite these improvements in clinical diagnoses of scaphoid fractures with the CNN, it is unknown whether development and implementation of such models is cost effective. [ABSTRACT FROM AUTHOR]

Background: Postradiotherapy carotid vasculopathy is a clinically relevant complication in patients with head and neck cancer receiving radiotherapy. In this study, we investigated the factors associated with the development and progression of carotid artery stenosis (CAS) in such patients. Methods: Patients who received radiotherapy for head and neck cancers between October 2011 and May 2019 at a medical center in Taiwan were eligible for inclusion in this study. This study included patients who underwent two consecutive carotid duplex examinations within an interval of 1 to 3 years. The factors associated with =50% CAS at baseline and follow-up were analyzed. Results: In total, 694 patients (mean age, 57.8 ± 9.9 years; men, 75.2%; nasopharyngeal cancer, 73.3%) were included. The mean interval between radiotherapy and carotid duplex examination was 9.9 ± 5.9 years. At baseline, 103 patients had =50% CAS, which was significantly associated with tobacco smoking, hypercholesterolemia, and a prolonged interval between radiotherapy and carotid duplex examination. A total of 586 patients did not have CAS at baseline; of them, 68 developed =50% CAS during follow-up. Hypertension and hypercholesterolemia were identified as independent risk factors for CAS progression. Conclusion: Modifiable vascular risk factors, such as hypertension and hypercholesterolemia, appear to be significantly associated with the rapid progression of postradiotherapy CAS in patients with head and neck cancer. [ABSTRACT FROM AUTHOR]

Background: Goslings in several Taiwanese farms experienced gosling feather loss disease (GFL) at 21-35 days and goose broke feather disease (GBF) at 42-60 days. The prevalence ranges from a few birds to 500 cases per field. It is estimated that about 12,000 geese have been infected, the morbidity is 70-80% and the mortality is 20-30%. Objectives: This study aims to investigate the pathogens that cause GFL and GBF. Focus on the study of the correlation between goose circovirus (GoCV) and goose parvovirus (GPV) with the goose feather loss in southern Taiwan. Furthermore, a phylogenetic tree was established to align the differences between southern and northern Taiwan and compare with virus strains from China and Europe. Methods: Samples were collected from animal hospitals. Molecular and microscopy diagnostics were used to examine 92 geese. Specific quantitative polymerase chain reaction (Q-PCR) assays are performed to evaluate GPV and GoCV viral loads and simultaneously evaluated the feather loss conditions in geese with the scoring method. Results: High prevalence of GoCV and GPV infection in geese showing signs of GFL and GBF. Inclusion body was detected in the feather follicles and Lieberkühn crypt epithelial cells. The Q-PCR showed the high correlation between feather loss and viruses during 3rd-5th week. However, the infection was not detected using the same test in 60 healthy geese. Conclusions: Thus, GFL and GBF appear to be significantly closely related to GoCV and GPV. The geese feathers showed increasing recovery after being quarantined and disinfected. [ABSTRACT FROM AUTHOR]

Located in tropical and subtropical region, Taiwan is an island with high algal species diversity. In this study, a number of fungal strains were isolated from marine macroalgae collected from northeastern intertidal zone of Taiwan. Preliminary anti-inflammatory screening has shown that the methanolic extracts of solid fermented products of the red alga Mastophora rosea-derived fungal strain Acremonium sp. NTU492 exhibited significant bioactivity. In an attempt to disclose the active principles from this fungal strain, a series of separation and purification was thus undertaken, which has led to the isolation and characterization of seven compounds including four new peptides, namely acrepeptins A-D (1-4), along with previously reported destruxin B (5), guangomide A (6), and guangomide B (7). Their structures were elucidated by spectroscopic analysis and compared with literatures. Of these, acrepeptins A (1) and C (3) showed markedly inhibitory activities on nitric oxide production in lipopolysaccharide-activated microglial BV-2 cells with IC50 values of 12.0 ± 2.3 and 10.6 ± 4.0 mM, respectively. Furthermore, acrepeptins A (1) and C (3) significantly attenuated the expression of inducible nitric oxide synthase in a concentration-dependent manner (5-40 mM). [ABSTRACT FROM AUTHOR]

Health promotion was defined at the first International Conference on Health Promotion held by the World Health Organization in 1986 as a process that enables the public to improve their health. Moreover, the United Nations High-Level Meeting on the Prevention and Control of Non- Communicable Diseases in 2011 highlighted that non-communicable diseases (NCDs) account for 63% of deaths worldwide, with major NCD-related risk behaviors including tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diet. In 2013, the WHO announced the Global Action Plan for the Prevention and Control of NCDs 2013-2020, with the United Nations listing NCDs prevention and control as a major topic for nations in Sustainable Development Goal 3 (Health). Both Taiwan and the world face the dual threats of population aging and NCDs, adding to the importance of health promotion and NCDs prevention and control. This article first introduces the relevant global health trends and the corresponding status of Taiwan and then examines the major NCDs prevention and health promotion policies in Taiwan. In creating a health-supportive environment for all people and enhancing health literacy and empowerment among the general public, we hope to ensure that every individual, family, and city joins the ongoing effort in Taiwan to enable all individuals to make the best, informed decisions for their health. [ABSTRACT FROM AUTHOR]

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

Background: Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated. Objective: The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery. Methods: For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach. Results: Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P < .001), heart rate recovery (P = .04), and self-efficacy (P = .002) at hospital discharge. Furthermore, the intervention effects on 6MWT distance (PG .001) and self-efficacy (PG .001) were sustained at 1 month after hospital discharge. Conclusion: Our inpatient multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later. [ABSTRACT FROM AUTHOR]

Organizational capacity building for health promotion (HP) is beneficial to the effective implementation of HP in organizational settings. The World Health Organization (WHO) Health Promoting Hospitals' (HPHs) initiative encourages hospitals to promote the health of their stakeholders by developing organizational capacity. This study analyzes an application case of one hospital of the HPH initiative in Taiwan, characterizes actions aiming at building organizational support to strengthen health gains and identifies facilitators of and barriers to the implementation of the HP in this hospital. Case study methodology was used with a triangulation of various sources; thematic analysis was used to analyze qualitative information. This study found a positive impact of the HPH initiative on the case hospital, such as more support from leadership, a fine-tuned HP mission and strategy, cultivated pro-HP habits of physical activities, a supportive intramural structure, an HP-inclusive system, improved management practices and enhanced staff participation. Transformational and transactional enablers are of equal importance in implementing HPH. However, it was also found that the case hospital encountered more transactional barriers than transformational ones. This hospital was hindered by insufficient support from external environments, leadership with limited autonomy and authority, a preference for ideals over professionalism, insufficient participation by physicians, a lack of manpower and time, a merit system with limited stimulating effect, ineffective management practices in weak central project management, a lack of integration, insufficient communication and an inability to inculcate the staff on the importance of HP, and inadequate staff participation. Several implications for other hospitals are suggested. [ABSTRACT FROM AUTHOR]

The deep water off Kueishan Island, NE Taiwan, is a traditional fishing ground for the deep-water fishing vessels based at Dasi fishing port. Since the opening of the deep-water fishing ports at Dasi in the late 1960s, the fishing grounds off Kueishan Island have been continuously trawled, for over 50 years now. The present study compares the decapod assemblages in the catches of Dasi fishing port among four periods of time, spanning more than 30 years, namely, 1981-1990, 1991-2000, 2001- 2010, 2011-2012. A total of 66 families, 203 genera and 420 species of decapod crustaceans have thus been recorded in the catches landed at Dasi fishing port from 1981 to 2012. During 1981-1990, 202 species were recorded, followed by 262 species from 1991-2000, 236 species from 2001-2010, and 265 species from 2011-2012. In all four periods, crabs (Brachyura) were the largest group, representing more than 30%, followed by Dendrobranchiata. Comparing the species composition among the four periods, each period contains a group of species exclusively found at that particular period of time. There were 26 exclusive species in 1981-1990, 49 in 1991-2000, 21 in 2001-2010 and 50 in 2011-2012. On the other hand, there are 94 species common to all four periods. Trajectory plots in the nMDS ordinations shows a gradual directional change in species composition from 1981-1990 to 1991-2000, 2001-2010 and 2011-2012. Since each consecutive period has a higher similarity with the previous than with the other periods, this suggests that the observed trend is not a random pattern. The decapod community in the waters off Kueishan Island has a very high diversity, but the species composition is unstable over time and also changing with time. Under the locally prevailing circumstances, we hypothesize this likely is a succession process in response to the continuous disturbance from the trawl fisheries. [ABSTRACT FROM AUTHOR]

We report here that the Jun dimerization protein 2 (JDP2) plays a critical role as a cofactor for the transcription factors nuclear factor-erythroid 2-related factor 2 (Nrf2) and MafK in the regulation of the antioxidants and production of reactive oxygen species (ROS). JDP2 associates with Nrf2 and MafK (Nrf2-MafK) to increase the transcription of antioxidant response element-dependent genes. Oxidative-stress-inducing reagent led to an increase in the intracellular accumulation of ROS and cell proliferation in Jdp2 knock-out mouse embryonic fibroblasts. In Jdp2-Cre mice mated with reporter mice, the expression of JDP2 was restricted to granule cells in the brain cerebellum. The induced pluripotent stem cells (iPSC)-like cells were generated from DAOY medulloblastoma cell by introduction of JDP2, and the defined factor OCT4. iPSC-like cells expressed stem cell-like characteristics including alkaline phosphatase activity and some stem cell markers. However, such iPSC-like cells also proliferated rapidly, became neoplastic, and potentiated cell malignancy at a later stage in SCID mice. This study suggests that medulloblastoma cells can be reprogrammed successfully by JDP2 and OCT4 to become iPSC-like cells. These cells will be helpful for studying the generation of cancer stem cells and ROS homeostasis. [ABSTRACT FROM AUTHOR]

Seaports participate in hinterland economic development through partnerships with dry ports, and the combined seaport-dry port network serves as the backbone of regional logistics. This paper constructs a location-allocation model for the regional seaport-dry port network optimization problem and develops a greedy algorithm and a genetic algorithm to obtain its solution. This model is applicable to situations under which the geographic distribution of demand is known. A case study involving configuration of dry ports near the west bank of the Taiwan Strait is conducted, and the model is successfully applied. [ABSTRACT FROM AUTHOR]

Compelling evidence indicates that bone marrow-derived endothelial progenitor cells (EPCs) can contribute to postnatal neovascularization and tumor angiogenesis. EPCs have been shown to play a "catalytic" role in metastatic progression by mediating the angiogenic switch. Understanding the pharmacological functions and molecular targets of natural products is critical for drug development. Butein, a natural chalcone derivative, has been reported to exert potent anticancer activity. However, the antiangiogenic activity of butein has not been addressed. In this study, we found that butein inhibited serum- and vascular endothelial growth factor- (VEGF-) induced cell proliferation, migration, and tube formation of human EPCs in a concentration dependent manner without cytotoxic effect. Furthermore, butein markedly abrogated VEGF-induced vessels sprouting from aortic rings and suppressed microvessel formation in the Matrigel implant assay in vivo. In addition, butein concentration-dependently repressed the phosphorylation of Akt, mTOR, and the major downstream effectors, p70S6K, 4E-BP1, and eIF4E in EPCs. Taken together, our results demonstrate for the first time that butein exhibits the antiangiogenic effect both in vitro and in vivo by targeting the translational machinery. Butein is a promising angiogenesis inhibitor with the potential for treatment of cancer and other angiogenesis-related diseases. [ABSTRACT FROM AUTHOR]

Recent studies of infectious diseases have attempted to construct more realistic parameters of interpersonal contact patterns from diary-approach surveys. To ensure that such diary-based contact patterns provide accurate baseline data for policy implementation in densely populated Taiwan, we collected contact diaries from a national sample, using 3-stage systematic probability sampling and rigorous in-person interviews. A representative sample of 1,943 contact diaries recorded a total of 24,265 wide-range, face-to-face interpersonal contacts during a 24-hour period. Nearly 70% of the contacts occurred outside of respondents' households. The most active age group was schoolchildren (ages 5-14), who averaged around 16-18 daily contacts, about 2-3 times as many as the least active age groups. We show how such parameters of contact patterns help modify a sophisticated national simulation system that has been used for years to model the spread of pandemic diseases in Taiwan. Based on such actual and representative data that enable researchers to infer findings to the whole population, our analyses aim to facilitate implementing more appropriate and effective strategies for controlling an emerging or pandemic disease infection. [ABSTRACT FROM AUTHOR]

Objective: This study examined the predictors of self-efficacy in reducing risky injection behaviors among heroin users receiving methadone maintenance treatment (MMT). Method: The Methadone Maintenance Treatment Outcome Study was an 18-month prospective study from March 2007 to July 2008. Data collection was conducted in the substance use disorders treatment outpatient clinics of three hospitals in southern Taiwan. A total of 368 opioid-dependent heroin users (13.6% women) were interviewed at baseline and at 3-, 6-, 9-, 12-, 15- and 18-month follow-ups. The level of self-efficacy in reducing risky injection behaviors was repeatedly assessed using the Self-Efficacy Scale for HIV Risk Behaviors. Demographic and substance use characteristics, HIV serostatus, family fimetion, depression, and pros and cons of heroin use were collected at baseline, and methadone dosage at each follow-up interview and the duration of retention in the MMT program were also recorded. Results: The results of the generalized estimating equation indicated that a lower educational level, concurrent methamphetamine use, a younger age at first heroin use, a lower methadone dosage, a higher level of depression, and a shorter duration of retention in the MMT program were predictive of a lower level of self-efficacy in reducing risky injection behaviors. Conclusions: This study found that personal and MMT-related factors were predictive of a lower level of self-efficacy among heroin users receiving MMT. Programs implemented to promote a higher level of self-efficacy should be provided to heroin users in the MMT program. [ABSTRACT FROM AUTHOR]

In this study, we aimed to explore the experiences of 10 female Taiwanese childhood sexual abuse (CSA) survivors (age range = 20-39 years) to broaden our understanding of the post-abuse coping process in a Chinese sociocultural context. This investigation was grounded on a feminist paradigm, and the consensual qualitative research method (Hill et al., 2005; Hill, Thompson, & Williams, 1997) was utilized as the strategy of inquiry. The transactional and ecological model of coping that emerged from the data describes the dynamic interplay among (a) intrapersonal, interpersonal, and sociocultural factors and (b) the coping process and outcomes of CSA survivors. Implications for research on CSA recovery and culturally appropriate interventions in a collectivistic sociocultural context are discussed. [ABSTRACT FROM AUTHOR]

To examine the effect of regular ongoing exercise lifestyle on mental and physical health in a group of independent community-dwelling Taiwanese older adults over a 2-year period. 197 older adults (mean age 72.5 years; 106 men and 91 women) who were independent in walking, instrumental and basic activities of daily living completed the baseline and a 2-year follow-up assessment. Older adults regularly performing exercises during the 2-year study period were grouped into regular exercise group; otherwise in the irregular exercise group. Baseline and follow-up assessments included a face-to-face interview and a battery of performance tests. The regular exercise group showed significantly less depression ( P= 0.03) and tended to regress less on the performance tests ( P= 0.025-0.410) across 2 years compared to the irregular exercise group. Regular exercise is important for maintaining or even improving mental and functional health, even for independent community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Five serial cross-sectional surveys were done at eight gay bathhouses in Taiwan to investigate the trends of HIV and sexually transmitted infections (STIs) and estimated HIV incidence between 2004 and 2008. Bathhouse attendees completed a questionnaire and tests for HIV, syphilis, hepatitis C virus, and amoebiasis. Twenty-nine (38.6%) were identified as having recent HIV-1 infections. There was a significant increase in HIV incidence, from 7.8% in 2004 to 15% in 2007 (χ = 17.59, P-trend <0.001). Recreational drug use is the primary risk behavior. Comprehensive screening programs in gay bathhouses for early detection of HIV and STIs are important. [ABSTRACT FROM AUTHOR]

Early data from the 2009 H1N1 pandemic (H1N1pdm) suggest that previous studies over-estimated the within-country rate of spatial spread of pandemic influenza. As large spatially resolved data sets are constructed, the need for efficient simulation code with which to investigate the spatial patterns of the pandemic becomes clear. Here, we present a significant improvement to the efficiency of an individual-based stochastic disease simulation framework commonly used in multiple previous studies. We quantify the efficiency of the revised algorithm and present an alternative parameterization of the model in terms of the basic reproductive number. We apply the model to the population of Taiwan and demonstrate how the location of the initial seed can influence spatial incidence profiles and the overall spread of the epidemic. Differences in incidence are driven by the relative connectivity of alternate seed locations. The ability to perform efficient simulation allows us to run a batch of simulations and take account of their average in real time. The averaged data are stable and can be used to differentiate spreading patterns that are not readily seen by only conducting a few runs. [ABSTRACT FROM AUTHOR]

Introduction: Asymptomatic erosive esophagitis is a common yet rarely reported disease. The purpose of this study is to investigate the prevalence of asymptomatic erosive esophagitis and to identify the risk factors for this disease.Materials and Methods: In this study, we investigated 572 asymptomatic subjects undergoing health check-ups after upper gastrointestinal endoscopy. The severity of esophagitis was evaluated by the Los Angeles classification, and the independent risk factors for asymptomatic esophagitis were analyzed by the logistic regression method.Results: The results showed the prevalence of erosive esophagitis in asymptomatic subjects was 12% (70/572). In all asymptomatic subjects, erosive esophagitis was grade A (71%) or B (29%). Univariate analysis revealed that male gender, high body mass index (BMI), and consumption of tobacco, alcohol, tea, spicy foods, and betel nut were associated with the development of erosive esophagitis. Multivariate analysis revealed that male gender (OR, 3.8, 95% CI, 1.5-9.3) and high BMI (BMI 25-30: OR, 2.3, 95% CI, 1.3-4.2; BMI >30: OR, 3.8, 95% CI, 1.3-10.9) were independent predictors of erosive esophagitis.Conclusion: Our data revealed male gender and high BMI are independent risk factors for asymptomatic erosive esophagitis. [ABSTRACT FROM AUTHOR]

Background: Buffer analyses have shown that air pollution is associated with an increased incidence of asthma, but little is known about how air pollutants affect health outside a defined buffer. The aim of this study was to better understand how air pollutants affect asthma patient visits in a metropolitan area. The study used an integrated spatial and temporal approach that included the Kriging method and the Generalized Additive Model (GAM). Results: We analyzed daily outpatient and emergency visit data from the Taiwan Bureau of National Health Insurance and air pollution data from the Taiwan Environmental Protection Administration during 2000-2002. In general, children (aged 0-15 years) had the highest number of total asthma visits. Seasonal changes of PM[sub10], NO[sub2], O[sub3] and SO[sub2] were evident. However, SO[sub2] showed a positive correlation with the dew point (r = 0.17, p < 0.01) and temperature (r = 0.22, p < 0.01). Among the four pollutants studied, the elevation of NO[sub2] concentration had the highest impact on asthma outpatient visits on the day that a 10% increase of concentration caused the asthma outpatient visit rate to increase by 0.30% (95% CI: 0.16% 0.45%) in the four pollutant model. For emergency visits, the elevation of PM[sub10] concentration, which occurred two days before the visits, had the most significant influence on this type of patient visit with an increase of 0.14% (95% CI: 0.01% 0.28%) in the four pollutants model. The impact on the emergency visit rate was non-significant two days following exposure to the other three air pollutants. Conclusion: This preliminary study demonstrates the feasibility of an integrated spatial and temporal approach to assess the impact of air pollution on asthma patient visits. The results of this study provide a better understanding of the correlation of air pollution with asthma patient visits and demonstrate that NO[sub2] and PM[sub10] might have a positive impact on outpatient and emergency settings respectively. Future research is required to validate robust spatiotemporal patterns and trends. [ABSTRACT FROM AUTHOR]

An outbreak of human metapneumovirus (hMPV) among children in southern Taiwan in 2004 prompted the investigation of the molecular epidemiology of hMPV from September 2003 to August 2005. Respiratory specimens that were culture negative for a panel of respiratory viruses were examined for the presence of hMPV by RT-PCR. The results indicated that 59 out of 546 (10.8%) children were hMPV-positive. The majority of these hMPV-positive children were less than 2 years old (59.4%), females (61%), and inpatients (67.8%). Infections occurred throughout the year, but peaked during the spring and/or summer months. Sequence analysis of the fusion gene from the isolates revealed two phylogenetic groups with five possible lineages (A1, A2a/A2b, B1, and B2). Among these co-circulating strains, A2 strains were most frequently observed and demonstrated the greatest divergence. Deduced amino acid sequence analysis identified several variant amino acids specific to the A2 lineage. Lineage-specific amino acid substitutions were noted at aa233, aa286, aa312, aa348, and aa296. This study indicated that genetically divergent strains of hMPV which caused respiratory disease and hospitalization were circulating among children in Taiwan. [ABSTRACT FROM AUTHOR]

The article presents a study on the delineation of spatial redox zones using discriminant analysis and geochemical modeling in arsenic-affected alluvial aquifers of the Lanyang plain, Taiwan. The study adopts a discriminant analysis to define three redox zones in different aquifers and yielded 92.3% correctness on groundwater quality data. The study cites that the Arsenic released to groundwater in the found zone is due to the oxidations of arsenic-rich pyrite minerals, in which arsenate is the predominant form. Moreover, the study suggests that the dissolution of arsenic-rich Fe-oxides due to the onset of reducing conditions in zones are responsible for the quality of arsenic and likely to be the primary cause of arsenic release to groundwater in the Lanyang plain.

The article reports on the high concentrations of arsenic in both aquifers and aquitards in the southern Choushui River alluvial fan of Taiwan. It also determines the association among arsenic concentration distribution, material in the core sample, and geologic ages of evolution. Chang-Hwa and Yun-lin county are a part of the Choushui River alluvial fan of Taiwan. It has been found that the Choushui River alluvial fan was formed in the late Quaternary and is segmented mainly into the proximal-, mid-, and distal-fan areas. In southern Yun-Lin county, geological core samples from 13 drilling station were collected. In the shallow monitoring wells of the Choushui River alluvial fan the arsenic concentration of ground water was high. A total of 655 geological core samples were examined for arsenic content. The horizontal and vertical cross-sections of the arsenic distributions show that the arsenic content is high mainly in sediments of marine origin aquitards. Concentration of arsenic in shallow strata is higher than those in the other strata.

To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one-leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older. A prospective study. Shin-Sher Township of Taichung County, west-central Taiwan. Twelve hundred community-dwelling older people. During an initial assessment at their residences, participants were interviewed for demographics, cognition, fall history, use of a walking aid, and activities of daily living (ADLs), in addition to completing the four balance tests. Falls were ascertained by telephone every 3 months for a 1-year follow-up; the four balance measures and ADLs were also reassessed at the end of the follow-up year. Of the four balance measures, the OLS had the lowest participation rate, and participation of people who were cognitively impaired had fallen in the previous year, used a walking aid, or suffered from an ADL disability was lower than for their counterparts. The time to complete the tests ranged from 58 seconds for OLS, to 160 seconds for the TB. All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status. The TB showed better discriminant, convergent, and predictive validities and responsiveness to ADL changes than the other three tests. According to psychometric properties, the most suitable performance measure for evaluating balance in community-dwelling older people was the TB, followed by the TUG. [ABSTRACT FROM AUTHOR]

The construction industry in Taiwan is reaching the turning point of industry upgrade and is confronted by such problems as slow productivity growth; increases in labour costs, and awareness of environmental protection requirements. In addition, Taiwan is vigorously preparing to join the World Trade Organization (WTO), and the Agreement on Government Procurement will be signed. Then the market of local public works will be able to be opened. After Taiwan has joined the WTO, local contractors will no longer enjoy special protection, and will compete with foreign contractors on equal grounds. To address these problems, Taiwan is launching the first phase of a construction automation plan (1990-2000), trying to assist local contractors in boosting their global competitiveness through automation. This paper establishes a Taiwanese approach to measuring the overall effectiveness of automation implemented in the construction industry in Taiwan. With this approach, 30%, 71% and 94% increases in commitment aspects and 15%, 20% and 24% increases in benefit aspects have been achieved from 1991 to 1993 (taking 1990 as the base year): significant improvements after the launch of the construction automation plan. The effectiveness of the commitment aspects, however, is far greater than that of the benefit aspects. [ABSTRACT FROM AUTHOR]

Aims Current criteria of metabolic syndrome (MetS) give equal weight to each component and apply mostly the same cut-off values to all ages. The contribution of each component to MetS and the effects of age and sex on each component and MetS were explored. Methods We carried out a survey on residents aged 40-74 years of the northern coastal area of Taiwan. The prevalent rates of MetS in 646 males and 961 females were 32.4% and 27.8%, respectively. Logistic regression analyses were used to assess the main and interactive effects of age and sex. The Cronbach's α coefficient was calculated as the indicator of internal consistency of MetS components. Results There were significant age trends for MetS components, except for low HDL-C in both sexes and high fasting triglyceride in males. Logistic regression analyses showed that the effects of age and sex on MetS and its component were all different. The age-sex-specific Cronbach's α coefficients for MetS ranged from 0.43 to 0.61. The age trends of the coefficients in males and females were opposite. The exclusion of some components from the MetS resulted in an increase of the coefficients. Conclusions Our results indicate that the internal consistency of MetS was questionable. It seems that the currently defined MetS components of MetS did not formulate a single pathophysiological entity. Given equal weight to each component and used the same cut-off values for the subjects of all age groups in both sexes need to be reconsidered. [ABSTRACT FROM AUTHOR]

Recently, we reported that diploid sequence type (DST) 140 was a predominant type of Candida tropicalisamong isolates with fluconazole minimum inhibitory concentrations (MICs) ≥64 μg/ml collected in the Taiwan Surveillance of Antimicrobial Resistance of Yeasts (TSARY) in 1999. To determine if DST140 persists in Taiwan, we have used multilocus sequence typing to characterize the genetic profiles of 31 resistant isolates (MICs ≥64 μg/ml), together with 19 susceptible isolates (MICs ≤16 μg/ml) collected in TSARY 2006. Among the 50 isolates, 33 distinct DSTs were detected. Of the 31 resistant isolates, 11 (35.5%) belonged to two closely related DSTs (140 and 98), whereas none of the 19 susceptible isolates did (p= 0.004). The isolates belonging to DST140 and 98 were from different geographic regions instead of a restricted area. Thus, our data show temporal and spatial transmission of C. tropicalisclones with high fluconazole MICs in Taiwan from 1999 to 2006. [ABSTRACT FROM AUTHOR]

Spatial distributions of groundwater quality are commonly heterogeneous, varying with depths and locations, which is important in assessing the health and ecological risks. Owing to time and cost constraints, it is not practical or economical to measure arsenic everywhere. A predictive model is necessary to estimate the distribution of a specific pollutant in groundwater. This study developed a logistic regression (LR) model to predict the residential well water quality in the Lanyang plain. Six hydrochemical parameters, pH, NO3- -N, NO2- -N, NH4+ -N, Fe, and Mn, and a regional variable (binary type) were used to evaluate the probability of arsenic concentrations exceeding 10 μg/L in groundwater. The developed parsimonious LR model indicates that four parameters in the Lanyang plain aquifer, (pH, NH4+, Fe(aq), and a component to account for regional heterogeneity) can accurately predict probability of arsenic concentration ≥ 10 μg/L in groundwater. These parameters provide an explanation for release of arsenic by reductive dissolution of As-rich Fe00H in NH4+ containing groundwater. A comparison of LR and indicator kriging (IK) show similar results in modeling the distributions of arsenic. LR can be applied to assess the probability of groundwater arsenic at sampled sites without arsenic concentration data apriori. However, arsenic sampling is still needed and required in arsenic-assessment stages in other areas, and the need for long-term monitoring and maintenance is not precluded. [ABSTRACT FROM AUTHOR]

This work analyzed spatially potential carcinogenic risks associated with ingesting arsenic (As) contents in aquacultural tilapia (Oreochromis mossambicus) in coastal regions of southwestern Taiwan, where the blackfoot disease prevails. Sequential indicator simulation (SIS) was used to reproduce As exposure distributions in groundwater based on their three-dimensional variability. A target cancer risk (TR) associated with ingesting As in aquacultural tilapia was calculated to evaluate the potential risk to human health. Owing to sparse measured data, Monte Carlo simulation and SIS properly accounted for the uncertainty of assessed parameters. The probabilistic risk assessment formulated suitable strategies under various remedial stages. Aquacultural regions with high risks were mapped to elucidate the safety of groundwater use at different depths. Many TRs determined from the risks at the 75th and 95th percentiles exceed one millionth in the regions, indicating that ingesting tilapia farmed in the highly As-polluted regions poses potential cancer threats to human health. The 75th percentile of TR is considered in formulating a remedial strategy for the aquacultural use of groundwater in the preliminary stage. Additionally, this study suggests reducing the use of groundwater in aquaculture or changing the depths from which groundwater is withdrawn in the areas with high risks of cancer. [ABSTRACT FROM AUTHOR]