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Background: Poor sleep quality is associated with multiple factors in cardiac surgery patients. Aim: To examine the trajectory of sleep quality and its associated factors over 3 months in Taiwanese patients undergoing cardiac surgery. Study Design: A longitudinal study. This study enrolled 95 patients undergoing cardiac surgery in northern Taiwan. Sleep quality was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale before surgery, at discharge, and at 1 month and 3 months postsurgery. Results: The majority of participants reported poor sleep quality before cardiac surgery (76.8%) and at discharge (81.6%), and they showed significant improvements in sleep quality at 1 month (B = −0.93, p =.023) and 3 months postsurgery (B = −1.50, p <.001). Significant daytime sleepiness was reported by 25.3% of patients before cardiac surgery, and this proportion significantly decreased at 3 months postsurgery (B = −2.59, p <.001). The significant predictors of sleep quality in cardiac surgery patients were symptom distress, sleep medications, occupation, left ventricular ejection fraction, ACE‐I drugs and potassium ions, which explained 53.7% of the total variance in sleep quality. Having a nap habit was an independent predictor of daytime sleepiness in cardiac surgery patients, which could explain 3.7% of the total variation. Conclusion: Poor sleep quality was common in patients undergoing cardiac surgery and was associated with multiple factors, including symptom distress, cardiac function, medications, and psychosocial and environmental factors. Relevance to Clinical Practice: Poor sleep quality was observed in cardiac surgical patients before surgery and at discharge postsurgery. Patient education on symptom management, medication adherence and sleep hygiene are suggested to improve sleep quality in patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Fatigue is associated with multidimensional factors in heart failure patients. Investigating longitudinal changes in fatigue and its association in patients undergoing cardiac surgery is needed to create interventions for improving fatigue during recovery. Aims: This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery. Methods: This longitudinal study enrolled 125 patients undergoing cardiac surgery in northern Taiwan. Patients completed questionnaires before surgery, at discharge, and at 1, 3 and 6 months post‐discharge. Fatigue was measured using the General Fatigue Scale. Generalised estimating equation models were fitted to identify variables associated with fatigue over time. This study complied with the STROBE checklist. Results: The sample (mean age = 60.70 ± 10.42) was mostly male (68%). High fatigue was found in 73.6% of patients before cardiac surgery and significantly decreased over the six months after discharge. NYHA III/IV, lower haemoglobin level, more symptom distress, poor sleep quality, higher anxiety and depression and lower social and family support were significantly associated with an increase in fatigue levels over time. Compared with before discharge, decreases in sleep quality at 1, 3 and 6 months were significantly associated with an increase in fatigue levels (p <.001). The increases in social support (B = 0.20, p =.016) and family support (B = 0.37, p =.002) at 6 months were significantly associated with an increase in the fatigue scores. Conclusion: Fatigue was common and associated with symptoms, sleep quality, emotion and social support in patients undergoing cardiac surgery. In addition to symptom management, improving sleep quality and social support are important to manage fatigue for the long‐term care of patients undergoing cardiac surgery. Relevance to clinical practice: Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery. [ABSTRACT FROM AUTHOR]

Several researchers have highlighted the potential of applying adventure video games in second language acquisition; however, few studies have investigated the impact of adventure games on foreign language learning. This study aimed to examine the effects of a commercial adventure video game on foreign language learning and learners' perceptions toward this game. Twenty-two college students in Taiwan were asked to play an English adventure game "BONE." One group was allowed to take notes while playing and the other group was not. After playing, both groups were asked to take a vocabulary post-test. The results indicated that both groups picked up some new words after playing the adventure game, but there was no significant difference between the two groups' post-gaming performances. To better understand the strengths and weaknesses of using adventure games for foreign language learning, another study was conducted to explore 35 college students' perceptions toward this adventure game. The results showed that students considered the game helpful in improving their language skills and motivation. Students also reported they enjoyed playing the game because of the intriguing game design. The findings in this study suggest that adventure video games such as "BONE" can provide useful input to help college students enhance their English listening, reading, vocabulary skills and learning motivation. (Contains 8 tables and 1 figure.)

Aims: A computerized tool and interdisciplinary care were implemented to develop a novel model for older patients with delirium in the emergency department (ED). Methods: We developed a computerized tool using a delirium triage screen and brief confusion assessment in the hospital information system, performed education for the healthcare providers, and developed a continuous care protocol. Comparisons for outcomes between pre- and post-intervention periods were performed. Results: Compared with the pre-intervention period, patients in the post-intervention period had shorter hospitalization stay, lower expenditure of hospitalization, more likely to return home, lower ED revisits of ≤ 3 days, re-hospitalization of ≤ 14 days, and mortality of ≤ 1 month. All mentioned differences were not statistically significant. Conclusions: A novel model was successfully developed for delirium management in older patients in the ED. Outcome differences were not significant; however, the result is promising, which gives us an important reference in the future. [ABSTRACT FROM AUTHOR]

This paper aimed to test the influences of perceived usefulness on travelers’ willingness to create usergenerated content (UGC) through attitudes toward social media, travel planning attitude, and electronic word of mouth, as mediating variables, and compare the proposed model results between two culturally and geographically distinct nations. The research model and the interactions among the constructs were tested and validated through structural equation modeling. Randomly selected qualified responses from Mexican (N=192) and Taiwanese (N=200) participants were analyzed. The comparative analysis of statistical results showed that in Mexico, travel planning attitude does not directly influence travelers’ involvement in UGC. Instead, choosing a travel destination is the reason why Mexicans would generate content. However, in Taiwan the non-significant direct relationship is between electronic word of mouth and user-generated content. Despite the massive social media affect in Taiwan, reading and collecting information online is not the reason for Taiwanese to get involved in providing online content. Research findings assist the destination marketers and tourism stakeholders to identify essential elements that positively motivate and inspire travelers’ intention to share opinions through social media in order to promote or adjust plans and adopt compatible strategies to successfully form and influence travelers’ decision-making behavior. [ABSTRACT FROM AUTHOR]

Satellite altimetry has been proven as an effective technology to accurately measure water level, ice elevation, and flat land surface changes since the 1990s. To overcome limitations of pulse-limited altimetry, new altimetric missions such as Cryosat-2 and Satellite with ARgos and AltiKa (SARAL/AltiKa), have been designed to have higher along-track spatial resolution to measure more accurately inland water levels for small water bodies, and coastal sea level changes. In this study, we evaluate the performance of Cryosat-2 low-resolution (LRM) and SARin modes and SARAL/AltiKa Ka-band data on two connected lakes in central Tibetan Plateau, and in the coastal region of Taiwan. Results are compared with in situ tide gauge data in Taiwan and altimetric lake level time series from the CNES Hydroweb database. Our results show that water level change trends observed by Cryosat-2 20-Hz retracked observations, the SARAL/AltiKa 40-Hz Ice-1 retracked data, and the Hydroweb measurements are consistent with the estimated water level trend of ∼0.30 m/y, during 2011–2017, and 2013–2015, for the Tibetan Migriggyangzham Co and Dorsoidong Co, respectively. For the coastal region, the performance of SARAL/AltiKa is better than that of Cryosat-2 LRM data in Taiwan. This finding demonstrates the superiority of the Ka-band over Ku-band radar altimetry. [ABSTRACT FROM AUTHOR]

The adoption of environmentally friendly farming practices, such as organic farming, is promoted as a promising option for meeting the sustainable development goals in Taiwan. Taking the paddy rice as an example, this study examines the determining factors of organic farming adoption with an emphasis on farm households' socio-economic characteristics. Based on data drawn from the 2015 Census of Agriculture, Forestry, Fishery and Animal Husbandry, rice farm households' adoption of organic farming is defined as allocating part of the farmland to rice plantation without using any chemical fertilizers and pesticides. In line with previous research, farm operators' age, educational level and on-farm workdays are found to be significant determinants of organic farming adoption. Socio-economic characteristics of the farm household are also found to be relevant to the adoption decision. The results suggest that household-level human capital such as proportion of middle-aged or elder members, and proportion of members with college degree, have significantly positive effect on the adoption probability. Since organic farming is more labor-demanding than conventional farming, this study performs a further analysis to examine the differences in the determining factors between full-time and part-time households. Relative to the young operators, middle-aged operators in the full-time households are found to be less likely to adopt organic farming, whereas the elder operators in the part-time households have a higher adoption probability. Additionally, share of members with a college degree is found to be another significant driving factor of adoption, which is however only true for the part-time households. Exploring the diverse impacts of socio-economic factors for the two groups of households contributes to the extant literature by narrowing the gap in understanding the relation between farm management strategy and organic farming adoption. [ABSTRACT FROM AUTHOR]

Background: Giardia duodenalis is a zoonotic protozoan parasite causing diarrhea through waterborne or fecal-oral infection. The cysts can live in the drinking water and cause pandemic diseases. In Taiwan, very little information is available regarding the epidemiology of G. duodenalis in domestic animals., Methods: Fecal samples were collected from cattle (n = 156) and pigs (n = 141) in Hualien country, eastern Taiwan. Detection and genotyping were done by microscopy examination of fecal samples and amplification of the β-giardin gene using nested PCR., Results: The prevalence of G. duodenalis infection was 19.87% for cattle (31/156) and 4.26% for pigs (6/141). Using nested PCR, 30 infected samples found in cattle belonged to Assemblage E, and one sample belonged to Assemblage D. For pigs, four samples belonged to Assemblage E, one belonged to Assemblage D, and another one belonged to Assemblage A. In addition, these results showed that G. duodenalis Assemblage A was detected in pigs and may cause zoonotic transmission., Conclusion: This is the first epidemiological investigation of G. duodenalis infection in animals in Hualien, Taiwan. These results could provide epidemiological information for disease control and public health protection., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest related to this article., (Copyright © 2020. Published by Elsevier B.V.)

Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity and the fourth leading malignancy and cause of cancer-related death in the male population of Taiwan. Most cases are detected at advanced stages, resulting in poor prognosis. Therefore, improved detection of early oral health disorders is indispensable. The involvement of oral bacteria in inflammation and their association with OSCC progression provide a feasible target for diagnosis. Due to the nature of oral neoplasms, the diagnosis of epithelial precursor lesions is relatively easy compared with that of other types of cancer. However, the transition from an epithelial precursor lesion to cancer is slow and requires further and continuous follow-up. In this study, we investigated microbiota differences between normal individuals, epithelial precursor lesion patients, and cancer patients with different lifestyle habits, such as betel chewing and smoking, using next-generation sequencing. Overall, the oral microbiome compositions of five genera, Bacillus, Enterococcus, Parvimonas, Peptostreptococcus, and Slackia, revealed significant differences between epithelial precursor lesion and cancer patients and correlated with their classification into two clusters. These composition changes might have the potential to constitute a biomarker to help in monitoring the oral carcinogenesis transition from epithelial precursor lesion to cancer.

The genetic susceptibility to and vaccine effectiveness against rotavirus gastroenteritis were different in distinct ethnic groups. The case-control study was aimed to evaluate the effectiveness of rotavirus vaccines and associations between the histo-blood group antigens and susceptibility to rotavirus infections in a Taiwanese population. Cases were children <18 years old who were hospitalized because of laboratory-confirmed rotavirus infection. Controls were healthy children matched to cases by age and gender. The secretor status and Lewis antigen and ABO types were determined by molecular methods. A total of 68 cases and 133 controls were included. Rotavirus immunization was recorded in 8 (12%) cases and 77 (58%) controls, indicating a vaccine effectiveness of 90.3% (95% confidence interval [CI], 78.1% - 95.7%). The secretor and Lewis-positive genotypes were independently associated with increased risk of rotavirus infections (matched odds ratio [mOR] 28.5, 95% CI 2.94-277, P = 0.003 and mOR 16.8, 95% CI 1.08-2601, P = 0.04, respectively). The distribution of ABO blood types did not differ significantly between cases and controls (P = 0.47). In conclusion, Taiwanese children with the secretor genotype and Lewis-positive genotype were at increased risk of moderate-to-severe rotavirus infections. The illness can be effectively prevented by immunization in this population.

Background/purpose: Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder that usually presents as cervical lymphadenopathy. Extranodal involvement occurs in up to 40% of patients. The disease is most prevalent in blacks and rare in Asians. This study analyzed the characteristics of RDD in patients from Taiwan., Methods: Fourteen patients with a diagnosis of RDD were identified by review of records from 1995 to 2004 at National Taiwan University Hospital. Tissue sections from each patient were reviewed and immunohistochemical staining was performed. Data on clinical presentations, associated diseases, treatment and outcome were analyzed. In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNAs (EBER-1) was also performed. Sets of primers specific for the conservative region of bacterial 16S-rDNA, IS6110 of Mycobacterium tuberculosis complex and consensus region of human herpes virus (HHV) DNA polymerase genome were used to detect the presence of these infectious agents in the specimens., Results: There were six men and eight women with a mean age of onset of 44 years. Nine patients presented with skin lesions, four with lymph node involvement and one with nasal tumor. All lesions followed a chronic and indolent course. Most of the lesions regressed spontaneously, and no patients died as a result of this disease during follow-up. Three patients had associated immune-mediated disease, i.e. hemolytic anemia, ankylosing spondylitis and asthma. Two patients had a history of tuberculosis. Histologically, all lesions were characterized by a mixed infiltrate of large pale histiocytes, abundant plasma cells and lymphocytes regardless of the site of involvement. The strong immunoreactivities of these histiocytes to S-100 protein, CD68 and CD14 with occasional lymphophagocytosis were helpful in confirming the diagnosis, polymerase chain reaction analysis of 16S-rDNA, IS6110 and HHV gene and in situ hybridization for EBV were all negative., Conclusion: RDD in Taiwan is characterized by older age of onset compared to Western countries (44 years vs. 20 years) and more frequent extranodal involvement. The skin was the most common site of extranodal involvement, with about two-thirds of patients presenting with cutaneous lesions. There was no evidence of bacterial, mycobacterial or HHV infection in this series.