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This paper develops a conceptual framework and empirically investigates the effects of implementing environmental-friendly activities on improving sustainable performance for logistics industry. A literature review of case-study and theory-based journal papers is the approach taken to develop a conceptual framework. An online survey of 297 senior managers of Australian logistics companies is conducted to empirically investigate the conceptual framework. This is the first study ranking nine measures of sustainable performance by AHP and using them to prioritise eight environmental-friendly activities from seven perspectives. The results show that the effects of implementing these activities on improving sustainable performance are different. The proposed conceptual framework is a basis for further research examining the relationship between implementing environmental activities and sustainable performance. This conceptual framework will enable logistics managers to evaluate their business potential to improve sustainable performance by implementing environmental activities. The result could be used by public policymakers to initiate and support sustainable development.

The interdependence of container shipping operations (CSOs) creates a hotbed of multiple operational risks. Risk analysis and assessment (RAA) is, therefore, a growing research focus on container shipping policy and management. Currently, it is challenging to grasp a state-of-the-art understanding of the field due to the fragmentation of the central concepts and overlapping taxonomies. This critical review paper clearly indicates this fragmentation by an overarching framework to cover both CSO and RAA aspects. The results revealed the attention toward ports and container shipping companies as the primary subjects of research; and Asia-Pacific and Europe as the fruitful regions of empirical studies. Thirty-five typical information, physical, and financial risks were identified in various CSOs. Regarding the CSO aspect, besides more empirical applications of RAA models, approaches and methods to support the collaborative mitigation and prevention efforts are considered critical tasks of the field, especially in the upcoming era of digitalization in container shipping. Regarding the RAA aspect, the establishment of a common framework that acknowledges uncertainty as a core component of risk is necessary to support the CSO aspect in dealing with emerging issues.

Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic-hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students.The aim of this study was to explore the experiences of students currently participating in the academic-hospital partnership nursing program.A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic-hospital partnership nursing program. Data were analyzed using thematic analysis.Six themes were identified: (a) incentives for participating in the academic-hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support.The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic-hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.

PurposeContainer shipping is a crucial component of the global supply chain that is affected by a large range of operational risks with high uncertainty, threatening the stability of service, manufacture, distribution and profitability of involved parties. However, quantitative risk analysis (QRA) of container shipping operational risk (CSOR) is being obstructed by the lack of a well-established theoretical structure to guide deeper research efforts. This paper proposes a methodological framework to strengthen the quality and reliability of CSOR analysis (CSORA).Design/methodology/approachFocusing on addressing uncertainties, the framework establishes a solid, overarching and updated basis for quantitative CSOR analysis. The framework consists of clearly defined elements and processes, including knowledge establishing, information gathering, aggregating multiple sources of data (social/deliberative and mathematical/statistical), calculating risk and uncertainty level, and presenting and interpreting quantified results. The framework is applied in a case study of three container shipping companies in Vietnam.FindingsVarious methodological contributions were rendered regarding CSOR characteristics, settings of analysis models, handling of uncertainties and result interpretation. The empirical study also generated valuable managerial implications regarding CSOR management policies.Originality/valueThis paper fills the gap of an updated framework for CSOR analysis considering the recent advancements of container shipping operations and risk management. The framework can be used by both practitioners as a tool for CSOR analysis and scholars as a test bench to facilitate the comparison and development of QRA models.

Fang Wang,1,&ast; Feng-Hua Wang,2,3,&ast; Kaiyu Sun,4,&ast; Chang Jiang,2,5 Sui Peng,6 Li-Xia Xu,1 Ming Kuang,7 Gui-Fang Guo,2,5,8 Shu-Ling Chen9 1Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2State Key Laboratory of Oncology in South China, The Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China; 3Department of Oncology, The Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China; 4Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 5Collaborative Innovation Center for Cancer Medicine, The Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China; 6Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 7Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 8VIP Department, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China; 9Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shu-Ling Chen; Gui-Fang Guo, Email chenshling@mail.sysu.edu.cn; guogf@sysucc.org.cnIntroduction: Advanced biliary tract carcinoma (BTC) has a poor prognosis and few treatment options. We compared the efficacy of the PD-1 monoclonal antibody (PD-1-mAb) combined regimens with the standard chemotherapy in the first-line and second-line treatment of advanced BTC.Methods: We retrospectively assessed the patients with advanced BTC, who received treatment at the First Affiliated Hospital of Sun Yat-Sen University and the Sun Yat-Sen University Cancer Center. The patients were treated with PD-1-mAb combined regimens or standard chemotherapy at the first line or treated with PD-1-mAb combined regimens or systematic therapy at the second line. Further subgroup analyses were assessed to identify superior regimens.Results: This study included 210 patients. The first-line PD-1-mAb combination group (n = 83) achieved longer median PFS (mPFS) (7.3 vs 5.3 months, p=0.001) and median OS (mOS) (15.6 vs 11.4 months, p=0.002) than the first-line standard chemotherapy group (n=76). Similarly, the second-line PD-1-mAb combination group (n=50) yielded longer mPFS (6.1 vs 2.6 months, p< 0.001) and mOS (11.7 vs 7.2 months, p=0.008) than the second-line systematic therapy group (n=51). Subgroup analyses showed that the PD-1-mAb combined with TKI group achieved better mPFS than the chemotherapy group whether in the first-line (HR = 0.468, p=0.005) or the second-line setting (HR = 0.45, p=0.009), but did not achieve superiority in mOS (both p> 0.05). Compared with the chemotherapy group, the PD-1-mAb combined with chemotherapy group achieved longer mOS (HR = 0.53, p=0.023) in the first-line setting and longer mPFS in the second-line setting (HR = 0.54, p=0.044).Conclusion: The PD-1-mAb combination therapy is superior to the standard chemotherapy in advanced or unresectable BTC, whether as a first-line or second-line treatment. Among the combination therapy, both the PD-1-mAb combined with TKI and combined with standard chemotherapy were promising options for advanced BTC patients.Keywords: biliary tract carcinoma, PD-1-mAb, PD-1 plus anti-angiogenesis TKI, PD-1 plus chemotherapy, the first-line chemotherapy, the second-line chemotherapy

PurposeAlthough being considered for adoption by stakeholders in container shipping, application of blockchain is hindered by different factors. This paper investigates the potential operational risks of blockchain-integrated container shipping systems as one of such barriers.Design/methodology/approachLiterature review is employed as the method of risk identification. Scientific articles, special institutional reports and publications of blockchain solution providers were included in an inclusive qualitative analysis. A directed acyclic graph (DAG) was constructed and analyzed based on network topological metrics.FindingsTwenty-eight potential risks and 47 connections were identified in three groups of initiative, transitional and sequel. The DAG analysis results reflect a relatively well-connected network of identified hazardous events (HEs), suggesting the pervasiveness of information risks and various multiple-event risk scenarios. The criticality of the connected systems' security and information accuracy are also indicated.Originality/valueThis paper indicates the changes of container shipping operational risk in the process of blockchain integration by using updated data. It creates awareness of the emerging risks, provides their insights and establishes the basis for further research.

Rice is the most important food crop in Taiwan, directly feeding more than 23 million people in the country. Information on rice production is thus crucial for crop management and food policymaking...

For patients with inoperable huge hepatocellular carcinoma (H-HCC, tumor size ≥10 cm), treatment options are limited. This study aimed to evaluate the characteristics and outcomes of patients with H-HCC who use Chinese herbal medicine (CHM). Multi-institutional cohort data were obtained from the Chang Gung Research Database (CGRD) between 1 January 2002 and 31 December 2018. All patients were followed up for 3 years or until the occurrence of death. Characteristics of CHM users and risk of all-cause mortality were assessed, and core CHMs with potential pharmacologic pathways were explored. Among 1618 patients, clinical features of CHM users (88) and nonusers (1530) were similar except for lower serum α-fetoprotein (AFP) and higher serum albumin levels in CHM users. CHM users had significantly higher 3 year overall survival rates (15.0% vs. 9.7%) and 3 year liver-specific survival rates (13.4% vs. 10.7%), about 3 months longer median survival time, and lower risk of all-cause mortality. Core CHMs were discovered from the prescriptions, including Hedyotis diffusa Willd combined with Scutellaria barbata D.Don, Salvia miltiorrhiza Bunge., Curcuma longa L., Rheum palmatum L., and Astragalus mongholicus Bunge. CHM use appears safe and is possibly beneficial for inoperable H-HCC patients; however, further clinical trials are still required.

Although self-determination theory has important implications for service management literature and implies that leader autonomy support is critical to facilitating successful service delivery, sur...

Uncertainty is a fundamental obstacle in container shipping operational risks (CSORs) evaluation and management. This study presents a model to quantitatively analyze CSORs with comprehensive uncertainty handling. The model features a Delphi risk communication platform (RCP) designed to establish a deliberative environment for expert interaction and cooperation. The risk level is assessed through a Bayesian network while a fuzzy-based system is implemented to evaluate the attached base of knowledge. Besides the validation of reliability and robustness by a sensitivity analysis, the conducted case study confirms the feasibility and functionality of the model, especially the impact of the implemented Delphi RCP.

Introduction Today's global nursing shortage is having an adverse impact on health systems around the world and in Taiwan. Many universities in the United States have implemented accelerated BSN (ABSN) programs to create a shortcut for students who have bachelor's degrees in other fields to become nurses. Previous studies have revealed that students feel stress during the programs, especially in their first year. Students' first-year experiences in an ABSN program in the Taiwanese context are worthy of study. Study aim The purpose of the study was to understand nursing students' first-year experiences in an ABSN program in Taiwan. Design A qualitative research design was used in this study. Setting and participations A total of 25 students from a university in central Taiwan participated in this study to share their first-year experiences of studying in an ABSN program. Methods Data were collected from 3 focus group interviews and students' written reflections and were analyzed by qualitative content analysis with the help of ATLAS.ti 7.0. Findings Five themes were identified: (1) pursuing a brighter future, (2) positively facing doubts (3) challenges of surviving, (4) changing their learning attitudes and methods, and (5) seeking support. Conclusions The findings of this study may help nursing schools to provide the support students need and serve school administrators as a reference for refining such programs in the future.

PurposeThe implementation of reverse logistics (RL) as a strategic decision has gained significant attention amongst organisations due to its benefits to sustainable development. The purpose of this paper is to provide a comprehensive review of the literature to evaluate the performance of the RL process based on the three dimensions of sustainability including environmental, economic and social aspects.Design/methodology/approachContent analysis was adopted to collect and analyse the information.FindingsThe findings of this research show that most of the studies have focused on the performance evaluation of RL by considering the factors associated with economic and environmental performance. The social aspect of RL has been overlooked and requires investigation due to its contribution to positive social outcomes. In addition, no research has been conducted to assess the impact of each of the disposition options on the triple-bottom-line sustainability performance in one study.Originality/valueAlthough RL can make a significant contribution to improving the sustainability performance of firms, little research has been undertaken on exploring the relationship between RL and sustainability performance. This paper provides practitioners, academics and researchers a broad and complete view of the relationship between RL and sustainability performance with suggestion for future research.

Background To evaluate the relationship of patients with a history of alcohol use disorders (AUD) and its diagnostic categories with risk of subsequent mesenteric ischemia in Taiwan. Methods A nationwide population-based cohort study was conducted using data from the Taiwan’s National Health Insurance Research Database. We identified 73,583 patients hospitalized for AUD between 2001 and 2010, and matched each case with four comparison patients based on age, gender, Charlson comorbidity index, and the index date. Cox proportional hazard models were used to evaluate the risk of mesenteric ischemia between the AUD and non-AUD cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results Patients with AUD exhibited a significantly increased risk of developing mesenteric ischemia (HR = 2.25; 95% CI 1.92–2.64) compared with those with non-AUD after adjustment for patient sociodemographic, coexisting comorbid conditions, and hospital characteristics. Furthermore, a 2.29- and 2.17-fold higher risk of mesenteric ischemia was observed in patients with alcohol abuse/dependence (HR = 2.29; 95% CI 1.94–2.71) and alcoholic psychosis (HR = 2.17; 95% CI 1.72–2.73), respectively, than in non-AUD comparisons after covariate adjustment. Conclusions This study confirmed that the risk of mesenteric ischemia was significantly higher among patients with different diagnostic categories of AUD, particularly for those with alcohol abuse/dependence.

PURPOSE/OBJECTIVE(S) Post-operative spine SBRT presents unique clinical challenges. Spinal hardware produces CT and high-field strength MRI artifacts that obscure visualization of the spinal cord and unresected disease. Existing workflows incorporate additional invasive procedures with CT myelogram and quality control for these procedures can introduce uncertainty into SBRT planning. Reducing metallic imaging artifact with a low-field strength (0.35 T) MRI integrated into a MR-Linac (MRL) may facilitate superior visualization of the spinal cord, improved target delineation and treatment localization. The primary objective is to determine the feasibility of MRL-based simulation workflow to facilitate MR-guided post-operative spine SBRT without the need for CT myelogram or CT-based target delineation. MATERIALS/METHODS A single-institution, single-arm interventional feasibility study is planned. A total of 10 patients who underwent surgical resection of solid tumor spinal metastases with an indication for post-operative SBRT will be enrolled and undergo radiation planning and treatment on a MRL platform that combines a 6MV Linac and 0.35 T on-board MRI system. Enrolled subjects will undergo CT and MR simulation followed by standard-of-care post-operative spine SBRT and follow-up spine imaging every 3 months. RESULTS The primary endpoint is feasibility of MR-guided post-operative spine SBRT without CT myelogram. Feasibility is defined as > 70% of participants with clinically acceptable visualization/delineation as determined by blinded dual neuroradiologist review for clinically acceptable visualization/delineation of organs-at-risk (OARs) and target volume(s). Exploratory endpoints involve radiation dosimetry analysis of OARs and target volumes as well as documenting the use of adaptive planning. Radiation site progression-free survival will be recorded at 6-months after SBRT. CONCLUSION If feasible, an MRL-based workflow for post-operative spine SBRT represents a patient-centric approach to improve efficiency, minimize treatment delays, and avoid invasive procedures that may improve clinical management of solid tumor spinal metastases.

Anorexia nervosa (AN), which primarily affects adolescent girls and young women, is characterized by excessive dieting, leading to severe weight loss and a pathological fear of becoming overweight, or unhealthy behaviours that hinder weight gain. Caring for patients who have AN is particularly challenging for nursing staff, who are on the front line and have the closest contact with patients. However, little is known about how nursing staff care for adolescent patients with AN in Taiwan. This study aimed to explore nurses' perceptions on and experiences in conflict situations in caring for adolescents with AN. A qualitative study approach was conducted. Through semi-structured interviews, ten nursing staff from the paediatric ward at a university-affiliated medical centre in central Taiwan shared their experiences. Recorded interviews were transcribed and analysed by content analysis. This analysis identified three themes with eight subthemes: (i) struggling to develop therapeutic relationships, (ii) selective focusing, and (iii) difficulty changing minds. The findings of this study indicated a need for ongoing support for nursing staff, the development of therapeutic relationships with adolescent patients with AN, extensive nursing staff preparation, and the development of in-service training programs to enable nursing staff to care for these patients with greater understanding.

We remain in the midst of the global COVID-19 epidemic. As of November 11th, 2020, cases of COVID-19 have been confirmed in 189 countries/regions around the world, with a total of 51,510,611 confirmed cases and more than 1,275,211 deaths, with a global fatality rate of 2.48% (Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020b). Therefore, countries are facing lockdown crises and their populations face daily lives full of chaos, anxiety, and reorganization. The characteristics of this epidemic are most often described as "unprecedented" and replete with "uncertainty" (Davidson et al., 2020). In order to prevent the spread of this virus, health measures such as quarantine, wearing protective masks, and enforced lockdowns have been adopted by governments around the world, producing psychosocial (emotional distress, anxiety, suicide) and economic side-effects (Lima et al., 2020; Montemurro, 2020). Despite its close geographical proximity to China, Taiwan's number of confirmed infections has been relatively small (584 people diagnosed as of November 11th, with 7 total COVID-19-related fatalities; Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020b). Taiwan's tragic experience 17 years ago with the SARS epidemic helped prepare the government to respond rapidly to the COVID-19 threat, make thorough preparations and advanced deployments, and formulate relevant anti-epidemic border control measures, quarantine and isolation measures, mask-wearing requirements, and public education strategies. Actions such as mask wearing, washing hands frequently, and practicing proper social distancing by the public and the government maintaining a master travel history, occupation, contact history, and cluster (TOCC) database have proven effective in detecting and diagnosing cases early (Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020a; Yang et al., 2020). Furthermore, providing first-line personnel with appropriate protective equipment, education, and training as well as timely and transparent information and epidemic prevention guidelines have kept nurses supplied with appropriate personal protective equipment, infection-prevention and control education, training and exercises, and sufficient professional knowledge and skills to provide care safely to patients (Chen et al., 2020; HuangChen, 2020; Yang et al., 2020). Concurrently, it has been a challenge to nursing educators regarding how to suspend classes while not stopping academic education and to plan meaningful, alternative clinical experiences during the pandemic (Morin, 2020) and how to redefine and evaluate student performance to maintain teaching quality and learning effectiveness. In addition, "disaster nursing" is a critical area of professional knowledge for nurses in the 21st century, and all nurses should have an appropriate level of competence in professional disaster nursing. Therefore, core concepts related to infection control, disasters, and disaster preparedness should be incorporated into the curriculum and objectives. Finally, although we in Taiwan have faced the COVID-19 challenge in an environment in which the pandemic risk has been relatively well controlled, our daily lives are no longer taken for granted. When we look back on this experience, what will we learn from these experiences and how will this experience change how we approach healthcare and pandemic threats in the future? These changes will bring us more thoughts and challenges in nursing.新型冠狀病毒肺炎疫情下的回顧與護理省思.全球疫情仍持續延燒著，截至2020年11月11日止，已在全球189個國家／地區確診病例，累計51,510,611人確診超過1,275,211人死亡，全球致死率2.48%（衛生福利部疾病管制署，2020b）。因此各國陷入封城危機，日常充滿混亂、不安與重整。最常以「前所未有」（unprecedented）和「不確定」（uncertain）來描述這種流行病特徵（Davidson et al., 2020）。為了防止病毒傳播，世界各國政府已採取健康措施（例如隔離，戴防護面罩，封城鎖國）產生了心理社會（情緒困擾、焦慮、自殺）和經濟影響（Lima et al., 2020; Montemurro, 2020）。儘管台灣地理位置與中國非常接近，但與許多國家相比，台灣確診感染人數相對少（截至11月11日止584人確診，7人死亡；衛生福利部疾病管制署，2020b）。由於台灣經歷17年前SARS的慘烈突擊，政府對COVID-19能及早因應，做好周全準備與超前部署，制定相關防疫政策，包括：邊境管制、檢疫隔離措施、口罩政策、宣導教育（戴口罩、勤洗手、保持社交距離），也掌握旅遊史、職業別、接觸史及是否群聚（TOCC: travel history, occupation, contact history, cluster）可早期偵測及發現個案，即時安置個案與暴觸者（衛生福利部疾病管制署，2020a；Yang et al., 2020），提供第一線人員適當防護裝備、教育訓練，快速、公開、透明的資訊與防疫指引，使護理師能獲得適當個人防護裝備，接受感染預防與控制教育訓練及演練，具備足夠的專業知識與技能，提供病人安全的照護（陳等，2020；黃、陳，2020；Yang et al., 2020）。同時，也挑戰著護理教育者，如何在不可抗之疫情下，停課不停學和計畫有意義的替代臨床經驗（Morin, 2020），重新定義如何評值學生之表現，以確保教學品質及學習成效。此外，「災難護理」是廿一世紀護理人員必備的專業知能，護理人員應有緊急救災的專業能力，因此，有關感染控制、災難和備災的核心概念宜納入課程與宗旨。最後，在台灣的我們雖有驚無險地共同經歷挑戰，日常也不再理所當然。當我們回顧此經驗時，我們將從這些經驗中學到什麼，以及這些學習可能帶來的變化？這些變化，將帶給我們護理更多省思與挑戰。.

Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan provides biennial mammogram tests for all women aged 45 to 69 years. A recommendation for further investigation is sent via post to women with a BI-RADS result of 0. The proportion of women who followed-up with a recall request for further investigation after an abnormal mammogram has been below 92.5% in recent years. Therefore, we aimed to explore the experiences of these women who refused recall for further investigation despite an abnormal mammogram. Purposive sampling was conducted on 13 women who refused recall for further examination of abnormal screening mammograms. Data collection included inductive, in-depth interviews or telephone interviews. A content analysis was applied. Three themes were identified: (1) negative screening experiences, (2) struggling with ’to go or not to go’, and (3) rationalizing without a follow-up examination. The first theme included three subthemes: (1) pain of examination, (2) the inconvenience of medical treatment; waiting, and (3) dissatisfaction with having to pay for further examination. The second major theme included three subthemes: (1) perceiving one’s susceptibility to breast cancer as very low, (2) questioning the accuracy of the results, and (3) procrastinating with a “head-in-the-sand” mentality. The third major theme included two subthemes: (1) fatalism and (2) paying attention to self-cultivation. In conclusion, the findings provide important information to healthcare providers involved in case management related to the actual living experiences of women with abnormal screening mammogram results and the additional education required to raise breast cancer awareness in the general public to achieve overall caring goals.

Hyperglycemia accelerates the progression of Alzheimer’s disease (AD), and GSK3β plays a potential link between AD and hyperglycemia. Therefore, a direct or indirect GSK3β inhibition may have potential to delay the progression of AD. Our previous biochemical assay identified AM404 as a GSK3β inhibitor at high dose (IC50 = 5.353 μM); however, other study suggests that AM404 impaired synaptic plasticity of hippocampus at high dose (10 mg/kg; i.p.). Therefore, the dose and duration of treatment are crucial for the effects of AM404. The effects and molecular mechanisms of AM404 at low dose were evaluated from in vitro to in vivo models. AM404 (0.1–0.5 μM) was tested on tau hyperphosphorylated mouse hippocampal primary cultures treated with Wortmannin (WT) and GF109203X (GFX). Hyperglycemic triple transgenic AD (3×Tg-AD) mice at 6 months old were intraperitoneally injected with AM404 (0.25 mg/kg) for 4 weeks. The spatial learning and memory of mice were measured using the Morris water maze. Mouse brain and serum samples were collected for pathological analyses. AM404 (0.5 μM) exhibited significantly augmented neuroprotection toward tau hyperphosphorylation in primary cultures. The chronic systemic administration of AM404 (0.25 mg/kg) attenuated cognitive deficits in hyperglycemic 3×Tg-AD mice. Moreover, chronic low dose of AM404 significantly attenuated Aβ production, tau protein phosphorylation, and inflammation associated with an increase of pS473Akt and pS9-GSK3β. Therefore, AM404 at low dose, not only increased neuroprotection, but also ameliorated cognitive deficit, could be partly by regulating the Akt/GSK3β signaling, which may contribute to downregulation of Aβ, tau hyperphosphorylation, and inflammation in hyperglycemic 3×Tg-AD mice. These results highlight that chronic administration of AM404 at low dose may be through the Akt/GSK3β pathway to ameliorate the impairment in hyperglycemic 3×Tg-AD mice.

Grounded on the Job Demands–Resources model, the present study conducted 2 studies to test a multilevel model of work engagement. Using data from 606 leader–employee pairs taken from 40 gas station...

The concepts of intermodal logistics and distribution networks have made integration of the inland freight distribution system essential for an efficient container seaport system. Inland components, such as dry ports, which exist within the seaport system, have become important in shaping the performance and competitive strategies of container seaports. Owing to the importance of interdependence between dry ports and container seaports, this paper aims to investigate the impact of dry port operations on container seaport competitiveness. It conducted an empirical study in Malaysia through 120 online surveys to key stakeholders of dry ports, including freight forwarders, shippers, seaports, rail operator, shipping lines and haulers. The data collected were analysed using exploratory factor analysis (EFA). The results from EFA show that Malaysian dry port operations have impacts on seaport competitiveness. These include enhancing seaport performance, increasing service variations for seaports, improving seaport-hinterland proximity, increasing seaport trade volume and enhancing seaport capacity.

An appropriate description of freight rate behaviors is important to maritime forecasting and portfolio diversification in shipping freight markets. We employ general autoregressive conditional heteroscedasticity-copula models to capture the dynamics and interdependencies among shipping freight rates. Using weekly data from 5 January 2002 to 24 March 2018, our main findings are first, Granger causality tests confirm the presence of one-way causality running from the dry bulk and the clean tanker freight rate returns to the container and the dirty tanker freight rate returns, respectively. Second, volatility persistence exists in individual shipping freight market and, in particular, it is much less persistent in the clean tanker freight market. Third, nonlinear dynamic interdependencies among freight rate returns are captured by performing time-varying copulas. The results not only deepen our understanding of freight rate behaviors but also offer new insights into portfolio diversification and risk management in the shipping freight markets.

The maritime industry underpins international business and world trade. As to be expected, business management is critical for the maritime industry, requiring highly trained individuals and teams to lead the development, implementation and control of sound contemporary management practices. Maritime business degrees are developed by universities to meet such demand by providing graduates with sufficient skills for the onshore business-related roles. This empirical study conducted in Australia, USA and Canada, investigates current and future industry employability skills for maritime business graduates through focus groups, individual interviews and an online survey with senior managers in maritime organisations. This study found the important employability skills for maritime business graduates which include communication, problem solving, adaptability, self-management, team work, and digital literacy and technology. Demand for digital literacy and technology knowledge and skills have increased due to the maritime industry having a trend of moving towards digitalisation and automation. However, the survey findings revealed that a skills focus for maritime business graduates will not be the technology itself but the use and management of technology. In relation to future skills/knowledge required from maritime business degree graduates in 10 years’ time, communication and adaptability are recognised as being the most important. Employers expect that maritime business graduates should be able to adopt new technology and be competent in communication, and be more adaptable given the highly dynamic nature of the maritime industry. Moreover, they require graduates to be equipped with a higher level of computer skills, have a strong work ethic and multilingual skills.

The Chinese governments have worked out numbers of schemes at national or provincial levels to encourage port cooperation. The new geo-economic policy the Belt and Road Initiative brings new opportunities and challenges for port cooperation and development in China and the regions along the Belt and Road. This paper analyses port collaboration strategy adopted and implemented in China. It identifies the evolution of domestic port cooperation in China and the modes of international port cooperation of China. The paper concludes the trend of domestic port cooperation is towards the provincial port group. It also draws the insightful conclusion that the majority of international port cooperation cases of China happened along the Belt and Road after the year 2013. This paper proposes the implications with regard to the dynamic port cooperation development for Chinese ports and terminal operators. In theory, the research enriches the current studies by discussing the recent development systematically on port cooperation incentives and trend in China, as well as the modes of China's international port cooperation strategy. In practice, it draws implications on the performance evaluation and risks associated with Chinese port cooperation strategies.

Regional ports, as infrastructure in regions, influence transport and regional development policies and planning. The interaction and involvement of regional ports with their stakeholders in the region are pivotal. The conundrum on what constitutes a regional port and thus its region has further complicated this limited researched area. In the extant literature, port and region relationship mainly centres on major metropolitan ports, and pays little heed to regional ports. In this context, this study investigates on how the Australian regional ports can be better involved in regional development. The study adopts a qualitative methodology to explore the Australian regional port stakeholders’ perceptions on port’s role in regional development through 38 semi-structured telephone interviews. Thematic analysis of data assisted by a mixture of NVivo software and manual techniques proposes a conceptual model that may assist policy-making. The key findings suggest that symbiotic growths of ports and concerned regions accelerate regional development. To contribute to regional development, the Australian regional ports can be proactive in building collaboration with regional organisations. The findings have major implications for port managers and port policy-makers for developing a region-oriented long-term port planning and for creating environment for Australian regional ports for regional resource configuration.

This paper presents the latest trend in Australian port privatisation, long-term leasehold sale, and discusses its impact on port governance structure and port management. Since 2010, Australia has been exercising port privatisation at major capital city ports, driven by the government's policy of recycling capital for funding other infrastructure projects and the budgetary goal of reducing State Governments' debts. Except for land, the State Government transfers major port assets and the port corporation to a state-owned holding company and then sells it to a private winning bidder. Of notice is that the privatisation involves private equity ownership and foreign ownership of Australian ports. Consequently, the governance structure at the privatised ports is a private/public model, with the private port company being the port authority and landlord managing the port. The regulatory function following the privatisation is the public sector's responsibility while operator functions are undertaken by stevedores. Although the Australian port privatisation has positive effects on State Governments' balance sheets in the short term, it may result in a risk of undervaluing port assets, increased port charges, impeded port competition, less port investment, and less concern for the public interest in the long term. In terms of these findings, this paper provides some thoughts for further port privatisation in Australia.

The introduction of dry ports to transport networks facilitates trade, allows containers to be distributed between transport modes and ensures optimal use of networks. However, dry ports face several challenges, which have a significant impact on their operations, often reducing the benefits from developing dry ports in national or regional freight transport systems. In this regard, this paper investigates the influential factors of dry port operations. We firstly identify five categories of influencing factors and their respective sub-factors. Subsequently, we conduct an empirical study through a web-based survey of Malaysian dry port stakeholders. Multiple regression is employed for data analysis. Findings suggest 12 factors of significant importance to Malaysian dry port operations, including the need for sufficient information sharing; accurate freight forecasting, customs clearance, value-added services, adequate highway infrastructure; existence of appropriate operational equipment and sufficient space for current and future container storage; implementation of public–private partnerships; impact of seaport and short sea shipping policy; road connectivity and the location itself of dry ports. The paper is expected to be of managerial value to dry port operators, when developing strategies to enhance operational efficiency.

The concept of body image has been applied in various disciplines, including neurology, clinical psychology, psychopathology, behavioral science, and nursing (Cash, 2004; Rhoten, 2017). Meleau-Ponty (1962) identified the body as the subject of perception and considered the body not as an object but as an embodied subject that lives in the world. "Body image" refers to an individual's body, which generates a sensory message through contact with the environment during internal physiological operations and establishes a preliminary mental understanding of the body (Schilder, 1970). Body image is also affected by the external environment. As Plato remarked, "We are bound to our bodies like an oyster is to its shell." Indeed, our life experiences are integrally influenced by the body we happen to live in (Cash, 2004). Because body image is formed primarily by individuals interacting with others, Schilder (1970) called body image a social entity. People desire to keep their body image intact and unaffected by changes, damage, or losses in terms of function or body parts. Any change is perceived as a threat and thus induces anxiety and fear (Rochlin, 1973). In caring for a patient facing body-image changes, a nurse may help the patient using her in-depth knowledge of the potential impacts of this change on the body, mind, social relationships, bodily functions, self-concept, and self-esteem (Roberts, 1978). Under what circumstances do individuals experience body image change? The most common clinical conditions of body image change are: perceiving sensational change (physical discomfort/signs and symptoms), receiving medical treatments/procedures (receiving blood transfusions, injections, punctures), receiving nursing interventions/ procedures (enema, urethral catheterization) pain, taking medications (moon face), experiencing amputation/dysfunction or alteration/disfigurement, becoming pregnant or undergoing labor, acquiring physical diseases or injuries (cancer, HIV/AIDS, skin diseases, burns), and experiencing role failure (Cash, 2004; Rhoten, 2017; Roberts, 1978). Therefore, when a patient complains to a nurse about physical discomforts, it is necessary to understand that the patient is experiencing body image change and will benefit from timely and effective assistance to overcome and accept this change. Body image change is an important issue that should continue to be better understood and addressed in the field of nursing. This article provides a rich account of body image discourse that may be used as a reference in clinical nursing care, education, and research.身體意象於臨床的重要性.「身體意象」概念已被各種學科所應用，包括神經學、臨床心理學、精神病理學、行為科學、以及護理學（Cash, 2004; Rhoten, 2017）。Meleau-Ponty（1962）將身體視為知覺的主體（the subject of perception），認為我們的身體不是一個客體，而是生活於世界中一個體現的主體（an embodied subject），所以，人都是經由我們身體來知覺世界，也因而能生活於世界中。而身體意象是指一個人的身體，經由身體內在生理運作與環境接觸後產生知覺訊息，在腦中建立起對自己身體的一種初步認識的結果（Schilder, 1970）。身體意象也受外在環境所影響，如同柏拉圖評論「我們的身體像牡蠣一樣被它的外殼所束縛」，我們的生活經驗完全受到我們身體所處環境的影響（Cash, 2004），這些多變的身體意象，它的形成主要是個人與其他人的互動，因此，Schilder（1970）稱身體意象是一個社會整體（social entity）。人都希望保持身體意象的完整，不要有改變、損壞，不要失去功能或身體的部分。任何改變都是一種威脅，會引起焦慮和害怕（Rochlin, 1973）。當護理人員照顧一位經歷身體意象改變（body image change）的病人時，若能深入了解身體意象的改變會帶給病人身、心及社會面的衝擊，而致影響其身體功能、自我看法以及身為一個人的自尊，才是一位對病人有幫助的護理人員（Roberts, 1978）。然何種情況下，個體會經驗身體意象改變？臨床上最常見的情況就如，當病人抱怨著身體感覺的改變（身體不適／徵象和症狀）、接受醫療措施（抽血、打針、穿刺等)或護理措施（灌腸、導尿等）、疼痛、服用藥物（月亮臉）、截肢／功能喪失或改變、缺陷、或懷孕和生產，罹患疾病或損傷（癌症、愛滋病、皮膚病或燒傷等）以及角色功能的喪失等（Cash, 2004; Rhoten, 2017; Roberts, 1978）比比皆是。因此當病人向護理人員主訴身體不適時，要能理解此時病人正經歷身體意象改變之衝擊，而要如何適時地、有效地協助病人克服並接受身體意象改變，是一門有待護理界繼續學習的一大課題。本期刊提供豐富的身體意象論述，可提供臨床實務照護、教學以及研究之參考。.

Although the concept of body image was first introduced to Taiwan nursing in 1975, its application in the context of clinical nursing with regard to promoting humanistic patient-centered care has yet to be examined. This paper adopts a field-study approach to reinterpret the concept of body image with deeper and broader strength using patient vignettes, nursing case studies, and the findings of prior nursing research. The four main issues covered in this paper are: 1. The body image concept, 2. Building body schema and a postural model based on body experiences, 3. The characteristics of body image, and 4. The extended meaning of body image, including self-concept and the role function of relationship. This paper is expected to help nurses better understand the concept of body image and further apply this concept in clinical practice in order to improve the provision of humanistic patient-centered care.身體意象與臨床護理之應用.「身體意象」概念最初是於1975年引介到台灣護理界，然應用此概念於護理情境，促進「以人為本」的護理仍有待重新檢視。本文的目的是以更深更廣的個案觀點，個案研究和使用護理田野研究法的結果，來重新詮釋「身體意象」概念。因此，本文藉由介紹四個議題：(1)「身體意象」是什麼；(2)透過身體經驗建構「身體基模」與「身體姿態模式」；(3)有關「身體意象」特性；(4)「身體意象」延伸意義：與「自我概念」及「角色功能」關係，期望護理人員應用「身體意象」概念於病人照護，能讓護理走向「以人為本」境界的最有效途徑。.

We used the status of microvascular invasion (MVI) at primary resection to help treatment selection for hepatitis B virus-positive (HBV+) recurrent hepatocellular carcinoma (rHCC) patients in Barcelona Clinic Liver Cancer (BCLC) stage B-C.From 2009 to 2017, we enrolled 221 consecutive HBV+ rHCC patients at BCLC stage B-C who underwent re-resection (RR), radiofrequency ablation (RFA), or transarterial chemoembolization (TACE). Post recurrence survival (PRS) and overall survival (OS) were compared between RR/RFA and TACE according to MVI status. A one-to-one propensity score matching analysis was performed.For MVI(-) patients, the median PRS was 62.3 months for the RR/RFA group and 21.1 months for the TACE group (p = 0.039). The corresponding OS was 71.4 months and 26.6 months, respectively (p = 0.010). For MVI(+) patients, the median PRS in the RR/RFA group and TACE group was 14.7 months and 10.1 months (p = 0.115). The corresponding OS was 23.4 months and 16.4 months, respectively (p = 0.067). After matching, the dominance of RR/RFA over TACE remained in MVI(-) patients for both PRS (62.3 months vs 15.3 months, p = 0.019) and OS (98.1 months vs 33.4 months, p = 0.046). No significant difference was found in MVI(+) patients for either PRS (14.7 months vs 11.8 months, p = 0.593) or OS (23.4 months vs 28.1 months, p = 0.662).MVI status definitely helps select treatment options in HBV+ rHCC patients. For MVI(-) patients, RR/RFA provided better survival than TACE while for MVI(+) patients, TACE shared similar survival outcomes.• This study aimed at the determination of the optimal treatment options (ablation /resection vs TACE) in case of recurrent HBV-related HCC. • It showed that MVI status, established at primary resection of HCC, was a powerful marker for selecting the best treatment option in these patients. • In MVI(-) patients, RR/RFA achieved a better survival than TACE. In MVI(+) patients, TACE shared similar survival.

Many protein aggregation diseases (PAD) affect the nervous system. Deposits of aggregated disease-specific proteins are found within or around the neuronal cells of neurodegenerative diseases. Although the main protein component is disease-specific, oligomeric aggregates are presumed to be the key agents causing the neurotoxicity. Evidence has shown that protein aggregates cause a chronic inflammatory reaction in the brain, resulting in neurodegeneration. Therefore, strategies targeting anti-inflammation could be beneficial to the therapeutics of PAD. PHA-767491 was originally identified as an inhibitor of CDC7/CDK9 and was found to reduce TDP-43 phosphorylation and prevent neurodegeneration in TDP-43 transgenic animals. We recently identified PHA-767491 as a GSK-3β inhibitor. In this study, we established mouse hippocampal primary culture with tau-hyperphosphorylation through the activation of GSK-3β using Wortmannin and GF109203X. We found that PHA-767491 significantly improved the neurite outgrowth of hippocampal primary neurons against the neurotoxicity induced by GSK-3β. We further showed that PHA-767491 had neuroprotective ability in hippocampal primary culture under oligomeric Aβ treatment. In addition, PHA-767491 attenuated the neuroinflammation in mouse cerebellar slice culture with human TBP-109Q agitation. Further study of SCA17 transgenic mice carrying human TBP-109Q showed that PHA-767491 ameliorated the gait ataxia and the inflammatory response both centrally and peripherally. Our findings suggest that PHA-767491 has a broad spectrum of activity in the treatment of different PAD and that this activity could be based on the anti-inflammation mechanism.

Recently, the use of natural food supplements to reduce the side effects of chemical compounds used for the treatment of various diseases has become popular. Lithium chloride (LiCl) has some protective effects in neurological diseases, including Alzheimer&rsquo, s disease (AD). However, its toxic effects on various systems and some relevant interactions with other drugs limit its broader use in clinical practice. In this study, we investigated the in vitro and in vivo pharmacological functions of LiCl combined with Momordica charantia (MC) in the treatment of AD. The in vitro results show that the order of the neuroprotective effect is MC5, MC3, MC2, and MC5523 under hyperglycemia or tau hyperphosphorylation. Therefore, MC5523 (80 mg/kg, oral gavage) and/or LiCl (141.3 mg/kg, intraperitoneal injection) were applied to ovariectomized (OVX) 3&times, Tg-AD female and C57BL/6J (B6) male mice that received intracerebroventricular injections of streptozotocin (icv-STZ, 3 mg/kg) for 28 days. We found that the combined treatment not only increased the survival rate by reducing hepatotoxicity but also increased neuroprotection associated with anti-gliosis in the icv-STZ OVX 3&times, Tg-AD mice. Furthermore, the cotreatment with MC5523 and LiCl prevented memory deficits associated with reduced neuronal loss, gliosis, oligomeric A&beta, level, and tau hyperphosphorylation and increased the expression levels of synaptic-related protein and pS9-GSK3&beta, (inactive form) in the icv-STZ B6 mice. Therefore, MC5523 combined with LiCl could be a potential strategy for the treatment of AD.

This paper adopts a qualitative methodology to assess the Malaysian container seaport-hinterland connectivity from the perspective of its physical properties. The findings reveal that although Malaysia's major container seaports are connected to the hinterlands through road and rail transport, they are highly dependent on road. These seaports are also connected to inland freight facilities such as dry ports and ICDs, which are positioned as transit points to help connect exporters and importers in the hinterlands to seaports as well as facilitating regional and cross-border trades. This paper suggests that the quality of hinterland connectivity of Malaysian container seaports could be improved by implementing strategies which tackle the existing challenges including overcoming an extremely imbalanced modal split, insufficient rail capacity and limited train services, increasing road congestion and the limitations of space restriction in some inland facilities.

SummaryBackground Neurofibrillary tangles formed from tau misfolding have long been considered one of the pathological hallmarks of Alzheimer's disease (AD). The misfolding of tau in AD correlates with the clinical progression of AD and inhibition or reversal of tau misfolding may protect the affected neurons. Methods We generated 293 and SH-SY5Y cells expressing DsRed-tagged pro-aggregation mutant of repeat domain of tau (ΔK280 tauRD) to test indole/indolylquinoline derivatives for reducing tau misfolding and neuroprotection. Results Four of the 10 derivatives tested displayed good misfolding-inhibitory effects on Tet-On 293 cells. Among them, NC009-1 and NC009-7 enhanced heat-shock 27 kDa protein 1 (HSPB1) expression to increase ∆K280 tauRD-DsRed solubility and promoted neurite outgrowth in Tet-On SH-SY5Y cells. Knockdown of HSPB1 resulted in decreased ∆K280 tauRD-DsRed solubility and reduced neurite outgrowth, which were rescued by addition of NC009-1/NC009-7. Treatment with indole/indolylquinoline derivatives also improved neuronal cell viability and neurite outgrowth in mouse hippocampal primary culture under tau cytotoxicity. Conclusion Our results demonstrate how indole/indolylquinoline derivatives are likely to work in tau misfolding reduction, providing insight into the possible working mechanism of indole and indolylquinoline derivatives in AD treatment.

Background Hospital nurses are frontline health care workers in controlling the spread of infectious diseases. It is not known if nurses working in negative pressure isolation wards (NPIWs) are better prepared than before to safely care for patients with common infectious diseases. Methods For this qualitative descriptive study, 10 nurses were interviewed in depth about their experiences caring for patients in an NPIW. Tape recordings were transcribed verbatim and analyzed by qualitative content analysis. Results The following 5 themes were identified: (1) complexity of patient care, (2) dissatisfaction with the quantity and quality of protective equipment, (3) shortage of nursing staff, (4) continued worries about being infected, and (5) sensitivity to self-protection. Our participants' anxiety and uncertainty about being infected in the NPIW were increased by the complexity of patients' health problems and organizational factors. To protect themselves against infection before and during patient care, participants also developed sensitivity to, concepts about, and strategies to improve self-protection. Conclusions NPIW administrators should pay more attention to nurses' concerns about improving the NPIW working environment, supply good quality protective equipment, and provide appropriate psychologic support and ongoing education to ensure that nurses feel safe while working. This ongoing education should refresh and update nurses' knowledge about disease transmission, therefore decreasing unnecessary anxiety based on misunderstandings about becoming infected.

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

The main aim of this article is to examine the factors influential to the practical process of port infrastructure tariff design. The analysis is based on the survey data of 67 seaports representing the Australasian, East Asian, European, North American and South American regions. Exploratory factor analysis (EFA) was first carried out to identify the factors influential to the selection of the infrastructure tariff design model. Subsequently, confirmatory factor analysis (CFA) was used to confirm the relationship between the variables. The findings showed that demand, knowledge about pricing theories, the dynamics of port and shipping sectors (including competition and ship size), pricing objectives and port cost consideration are influential factors in infrastructure tariff design. Most ports use a mix of pricing approaches including price discrimination, cost-based pricing and market-based pricing. Ports are aware of the basic pricing approaches but have limited knowledge of their application. ...