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Background: Nursing students with master degrees have the strong potential to serve as future leaders in medical teams. Implementing a well-developed and integrated educational program for nursing leadership at the master's level can strengthen the leadership of advanced practice nurses and promote a positive nursing practice environment. Purpose: To develop a leadership integrated educational program for master's nursing students and conduct a preliminary evaluation of the effectiveness of this program in cultivating leadership competencies in these students. Methods: Phase 1: A modified Delphi survey conducted on 14 experts with clinical or academic backgrounds was used to identify the teaching objectives and strategies of the leadership integrated educational program. Phase 2: These teaching objectives and strategies were embedded into nine compulsory courses within a current training program for master's nursing students at a national university. The core elements of the leadership integrated educational program were incorporated into each compulsory course. The objectives of each compulsory course directly reflected the objectives of the integrated program. The leadership integrated educational program was implemented for one academic year, and its effectiveness was evaluated using a quasi-experimental test with a single group pre- and posttest design. A self-developed, 10-item "Master Nursing Student's Leadership Competence Scale" covering four core elements was applied to measure the self-reported leadership competencies of the participants. A paired sample t-test was applied to analyze the differences in leadership competencies between pre- and post-intervention. Results: A consensus on the teaching objectives and strategies of the leadership integrated educational program was achieved in the first round of the Delphi survey. The overarching teaching objective of the leadership integrated educational program was to "lead the healthcare team with the leadership and competencies, and demonstrate the advanced nursing practice skills for improving quality of care." In addition, the four core elements under the overarching goal, i.e., personal characteristics, leading people, business management, and vision building, were proposed. Forty-eight master's nursing students participated in this study. The results showed the average total score of leadership competency was 42.33 ± 12.16 (potential range: 10 - 70), indicating that the participants had a middle level of leadership competency prior to program participation. After participating in the Leadership Integrated Educational Program for one academic year, the average total score for leadership competency increased to 51.27 ± 9.74, indicating that the participants still had a middle level of leadership competency. Nevertheless, the 8.94 increase in the post-intervention score was statistically significant (p < .01). Moreover, the scores for each subscale (personal characteristics, leading people, business management, and vision building) had all increased significantly increased from 13.52 to 15.71, 12.65 to 15.35, 8.15 to 10.31, and 8.02 to 9.90, respectively (p < .01). Conclusions/Implications for Practice: This study offers proactive recommendations for reforming master's degree programs in nursing. The proposed multidisciplinary-expert-informed leadership integrated educational program may be used to strengthen leadership competencies in this student population. Furthermore, the findings provide a benchmark for developing an effective nursing leadership integrated educational program that may be incorporated into domestic master's degree programs. [ABSTRACT FROM AUTHOR]

AIM: The aim of the study was to identify baccalaureate nursing leadership objectives and evaluate their effectiveness when embedded into an undergraduate nursing curriculum. BACKGROUND: The objectives of nursing leadership competencies cannot be met in one semester but must be gradually developed over successive courses. METHOD: A list of learning objectives for leadership competence was generated and reviewed by 12 experts using the Delphi method. The consensuses objectives were embedded into a four-year nursing baccalaureate curriculum in Taiwan. Nursing students (N = 120) who participated in the courses evaluated the embedded objectives of leadership competency introduced in their undergraduate nursing program. Leadership competence was improved among students on nine items (t = 2.282 to 5.741, p = .001 to .030) of the Nursing Leadership Competence Assessment Scale for Undergraduate Nursing Students. CONCLUSION: The results can serve as a reference for universities seeking to promote nursing leadership education. [ABSTRACT FROM AUTHOR]

In Taiwan, adult hyperuricemia affects as many as 1 in 4 males and 1 in 6 females, who are predominantly young adults aged 19–45. In this study, lactic acid bacteria (LAB) with acid tolerance, bile salt tolerance and high affinity to intestinal cells were extracted from the side products of alcohol fermentation (distillers’ grains). These bacteria were evaluated for their ability to lower uric acid levels. Qualitative identification and quantitative analysis were performed using high-performance liquid chromatography (HPLC) on the purine-degrading enzymes to select purine-decomposing LAB for animal testing. When the final concentration of purine compounds reached 0.1% and 1%, seven strains of LAB showed potential in degrading purine compounds. HPLC was used to analyze their purine-degrading abilities, and the three best performing LAB strains, (107) 8–16, (107) tau 1–3, and (107) 6–10 were screened for further animal testing with Wistar rats. By the third week, the results showed that strain (107) 6–10 could prevent formation and reduce the levels of blood urea nitrogen (BUN) in yeast extract/potassium oxonate-induced hyperuricemia. The multi-strain lactic acid bacteria (MLAB) performed best for uric acid reduction in the serum and down regulated BUN. Yeast extract/potassium oxonate-induced hyperuricemia had no impact on serum creatinine, while LAB did not affect the creatinine concentration. In summary, MLAB not only protects kidney function but is also effective in regulating uric acid concentration in the body. Hence, MLAB can be used as a functional food supplement that prevents or aids the treatment of hyperuricemia in a rodent model. [ABSTRACT FROM AUTHOR]

Background. This study examined the effectiveness of various vaccine policies against influenza. The transmission rate was calculated by use of the time-series influenza-like illness case during the year of 2009 and recent epidemics in Taiwan. Methods. We developed a stochastic compartmental model to analyze the transmission of influenza, where the population was stratified by location and age group, and the vaccine distribution was considered using the current policy. The simulation study compared the previous vaccine policy and a new policy with expanded coverage and various lengths of the vaccination campaign. The sensitivity analysis investigated different levels of vaccine efficacy to confirm the robustness of the recommended policies. Results. Doubling vaccine coverage can decrease the number of infections effectively in the regular epidemic scenario. However, a peak of infections occurs if the duration of implementing vaccination is too long. In the 2009-like pandemic scenario, both increasing vaccine doses and reducing the program's duration can mitigate infections, although the early outbreak restricts the effectiveness of vaccination programs. Conclusions. The finding indicates that only increasing vaccine coverage can reduce influenza infections. To avoid the peak of infections, it is also necessary to execute the vaccination activity immediately. Vaccine efficacy significantly impacts the vaccination policy's performance. When vaccine efficacy is low, neither increasing vaccination doses nor reducing vaccination timeframe prevents infections. Therefore, the variation in vaccine efficacy should be taken into account when making immunization policies against influenza. [ABSTRACT FROM AUTHOR]

Background: While language barriers between healthcare providers and minority-language-speaking patients often lead to miscommunication and jeopardize patient safety, language audits of the former have received little attention. Goal: Based on the context in Southern Taiwan, where the elderly population mainly speaks the local dialect Taiwanese, this study examines nurses' perceptions of their proficiency in and need for medical Taiwanese ('MED-TW'), and attitudes toward it. Method: A questionnaire survey was conducted among 859 nurses from three levels of healthcare units: primary care stations (H1), a regional hospital (H2) and a medical center (H3). Results: Nurses from the rural-based H1 unit displayed significantly stronger needs for Taiwanese (TW) than those from urban-based H2 and H3. Specifically, H1 nurses reported encounters with the largest proportion of TW-speaking clients (p<0.001) and the highest frequency of using TW with clients (p<0.001). However, H1 nurses' self-evaluation of their TW proficiency revealed a lower score than those of the H2 and H3 nurses, especially with regard to medical TW proficiency (p<0.05). Finally, while nurses with a high command of TW felt it helped their work, those with a low level did not feel this impacted their performance. Conclusion: Nurses working in locations where the use of the minority language is prevalent would benefit more from learning this language. [ABSTRACT FROM AUTHOR]

Background: Loss of upper-extremity motor function is one of the most debilitating deficits following stroke. Two promising treatment approaches, action observation therapy (AOT) and mirror therapy (MT), aim to enhance motor learning and promote neural reorganization in patients through different afferent inputs and patterns of visual feedback. Both approaches involve different patterns of motor observation, imitation, and execution but share some similar neural bases of the mirror neuron system. AOT and MT used in stroke rehabilitation may confer differential benefits and neural activities that remain to be determined. This clinical trial aims to investigate and compare treatment effects and neural activity changes of AOT and MT with those of the control intervention in patients with subacute stroke.Methods/design: An estimated total of 90 patients with subacute stroke will be recruited for this study. All participants will be randomly assigned to receive AOT, MT, or control intervention for a 3-week training period (15 sessions). Outcome measurements will be taken at baseline, immediately after treatment, and at the 3-month follow-up. For the magnetoencephalography (MEG) study, we anticipate that we will recruit 12 to 15 patients per group. The primary outcome will be the Fugl-Meyer Assessment score. Secondary outcomes will include the modified Rankin Scale, the Box and Block Test, the ABILHAND questionnaire, the Questionnaire Upon Mental Imagery, the Functional Independence Measure, activity monitors, the Stroke Impact Scale version 3.0, and MEG signals.Discussion: This clinical trial will provide scientific evidence of treatment effects on motor, functional outcomes, and neural activity mechanisms after AOT and MT in patients with subacute stroke. Further application and use of AOT and MT may include telerehabilitation or home-based rehabilitation through web-based or video teaching.Trial Registration: ClinicalTrials.gov, ID: NCT02871700 . Registered on 1 August 2016. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the treatment effects of bilateral robotic priming combined with the taskoriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. Design: A randomized controlled trial. Setting: Occupational therapy clinics in medical centers. Subjects: Thirty-one subacute stroke patients were recruited. Interventions: Participants were randomly assigned to receive bilateral priming combined with the taskoriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. Main measures: Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. Results: The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale (p = 0.012) and a trend for greater improvement on the modified Rankin Scale (p = 0.065) than the unprimed group. Conclusion: Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings. [ABSTRACT FROM AUTHOR]

In national fiscal expenditures, there used to be controversial discussions on the trade-off relations between military security and social welfare development. Most empirical researches merely focus on the single effect of defense expenditure or social welfare expenditure on economic growth but few on the tri-integrated research of the causal relationships among defense expenditure, social welfare expenditure and economic growth performance. This paper utilizes the Unit Root Test and Granger Causality Model to measure and discuss the causal relationships among defense expenditure, social welfare expenditure and economic growth of Taiwan from 1964 to 2015. The results show there is a bilateral negative feedback causal relationship between economic growth and defense expenditure and Taiwan has to ensure its national security, social stability and stable economic growth while facing China's long-term military threats and provocations. Its enlarged defense budget has created a phenomenon of defense expenditure increase with economic growth. Moreover, creasing defense expenditure intensifies domestic circumstances, reduces market- purchase intention and indirectly affects investment. Such negative feedback relationship seems to echo related researches that have shown the non-linear relationship between the two factors. This paper's empirical data has demonstrated that there is non-significant causal relationship between social welfare expenditure and economic growth. [ABSTRACT FROM AUTHOR]

OBJECTIVE. A subgroup of patients benefiting most from robot-assisted therapy (RT) has not yet been described. We examined the predictors of improved outcomes after RT. METHOD. Sixty-six patients with stroke receiving RT were analyzed. The outcome measures were the Fugl- Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The potential predictors were age, side of lesion, time since onset, Modified Ashworth Scale (MAS) scores, accelerometer data, Box and Block Test (BBT) scores, and kinematic parameters. RESULTS. BBT scores were predictive of FMA (29%) and MAL (9% - 15%) improvements. Reduced shoulder flexion synergy, as measured by less shoulder abduction during forward reach, and MAS-distal were predictive of WMFT-function improvements. MAS-distal was predictive of SIS-physical improvements. Demographic variables did not predict outcomes. CONCLUSION. Manual dexterity was a valuable predictor of motor impairment and daily function after RT. Outcomes at different levels may have different predictors. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP). METHOD. Forty-three children (aged 4-12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM). RESULTS. A higher PDMS-2 Visual-Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R2 = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R2 = .06-.08) after home-based CIT. CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children who will benefit most after home-based constraint-induced therapy. [ABSTRACT FROM AUTHOR]

The article discusses research on the zooplankton distribution patterns along the riverine, estuarine and marine parts of the Danshuei ecosystem in Northern Taiwan. It references a study by Jiang-Shiou Hwang at the National Taiwan Ocean University Institute of Marine Biology, and his colleagues, published in an issue of "Zoological Studies." The researchers examined the abundance and spatiotemporal distributions of mesozooplankton diversity as well as the estimated levels of ammonia to indicate water quality at five different stations in Taipei City. They conclude that marine zooplankton contributes significantly to the estuarine portion of the ecosystem in Danshuei.

From survey data we can find that the rate of relocation has declined significantly in the past decade in Taiwan. To understand the nature of this change, a conceptual model is developed to identify all factors that affect the joint decision regarding moving and location choice. Then a two-level nested logit model is used to empirically estimate the model. The result shows the effect of education level on whether to move or not significantly increased from 1992 to 2002. This demonstrates that the advantage in employability in different locations with a higher education level has increased in this past decade. The result also shows that the probability of moving into the Taipei and Kaoshiung areas greatly decreased in the past ten years, while the probability of moving to Keelung, Taoyuan and Taichung increased. This shows the enlargement of the Taipei metropolitan area and the rise of Taichung metropolitan area. [ABSTRACT FROM AUTHOR]

In this study, we compared the responsiveness and validity of the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the Action Research Arm Test (ARAT). We randomized 59 patients with stroke into one of three rehabilitation treatments for 3 weeks. We administered six outcome measures (BBT, NHPT, ARAT, Fugl-Meyer Assessment [FMA], Motor Activity Log [MAL], and Stroke Impact Scale [SIS] hand function domain) pretreatment and posttreatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman rank correlation coefficient (rho) to examine concurrent validity. The BBT, NHPT, and ARAT were moderately responsive to change and not significantly different (SRM = 0.64-0.79). The correlations within the BBT, NHPT, and ARAT were moderate to good at pretreatment (rho = -0.55 to -0.80) and posttreatment (rho = -0.57 to -0.71). The BBT and ARAT showed fair to moderate correlations with the FMA, MAL, and SIS hand function domain at pretreatment and posttreatment (rho = 0.31-0.59), whereas the NHPT demonstrated low to fair correlations with the FMA and MAL (rho = -0.16 to -0.33) and moderate correlations with the SIS hand function domain (rho = -0.58 to -0.66). Our results indicate that the BBT, NHPT, and ARAT are suitable to detect changes over time. While simultaneously considering the responsiveness and validity attributes, the BBT and ARAT can be considered more appropriate for evaluating dexterous function than the NHPT. Further studies with larger samples are needed to validate these findings. [ABSTRACT FROM AUTHOR]