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BACKGROUND AND AIMS:The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians. METHODS:Using reimbursement claims data of Taiwan's National Health Insurance from 2008-2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist's care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician's care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist's care. RESULTS:Patients who received a cardiologist's care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53-0.70), septicemia (OR = 0.49; 95% CI, 0.39-0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66-0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29-0.47) than did patients who received an NC physician's care. The association between a cardiologist's care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years. CONCLUSION:We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.

Background: Since the advent of a new generation of inflow-sensitive inversion recovery (IFIR) technology, three-dimensional non-contrast-enhanced magnetic resonance angiography is being used to obtain hepatic vessel images without applying gadolinium contrast agent. The purpose of this study was to explore the diagnostic efficacy of non-contrast-enhanced magnetic resonance angiography (non-CE MRA), contrast-enhanced magnetic resonance angiography (CMRA), and computed tomography angiography (CTA) in the preoperative evaluation of living liver donors. Methods: A total of 43 liver donor candidates who were evaluated for living donor liver transplantation completed examinations. Donors’ age, gender, renal function (eGFR), and previous CTA and imaging were recorded before non-CE MRA and CMRA. CTA images were used as the standard. Results: Five different classifications of hepatic artery patterns (types I, III, V, VI, VIII) and three different classifications of portal vein patterns (types I, II, and III) were identified among 43 candidates. The pretransplant vascular anatomy was well identified using combined non-CE MRA and CMRA of hepatic arteries (100%), PVs (98%), and hepatic veins (100%) compared with CTA images. Non-CE MRA images had significantly stronger contrast signal intensity of portal veins (p < 0.01) and hepatic veins (p < 0.01) than CMRA. No differences were found in signal intensity of the hepatic artery between non-CE MRA and CMRA. Conclusion: Combined non-CE MRA and CMRA demonstrate comparable diagnostic ability to CTA and provide enhanced biliary anatomy information that assures optimum donor safety.

Surface modification is a highly effective strategy for addressing issues in lithium-rich layered oxide (LLO) cathodes, including phase transformation, particle cracking, oxygen gas release, and transition-metal ion dissolution. Existing single-/double-layer coating strategies face drawbacks such as poor component contact and complexity. Herein, we present the results of a low-temperature atomic layer deposition (ALD) process for creating a TiO 2 /Al 2 O 3 bilayer on composite cathodes made of AS200 (Li 1.08 Ni 0.34 Co 0.08 Mn 0.5 O 2 ). Electrochemical analysis demonstrates that TiO 2 /Al 2 O 3 -coated LLO electrodes exhibit improved discharge capacities and enhanced capacity retention compared with uncoated samples. The TAA-5/AS200 bilayer-coated electrode, in particular, demonstrates exceptional capacity retention (∼90.4%) and a specific discharge capacity of 146 mAh g -1 after 100 cycles at 1C within the voltage range of 2.2 to 4.6 V. The coated electrodes also show reduced voltage decay, lower surface film resistance, and improved interfacial charge transfer resistances, contributing to enhanced stability. The ALD-deposited TiO 2 /Al 2 O 3 bilayer coatings exhibit promising potential for advancing the electrochemical performance of lithium-rich layered oxide cathodes in lithium-ion batteries.

Occupational accidents and diseases cause the loss of valuable workers and lead to high healthcare expenses. Because occupational accidents and diseases are ascribed to inadequate working conditions and work environments, they can be prevented through a well-established occupational safety and health management system, which can ensure workers’ health and reduce the expense of healthcare. The study investigated the shortage of work-related occupational safety and health (OSH) measures in medium-sized manufacturing industries. This study mainly focused on qualitative interviews with 15 labor inspectors and 25 business executives from OSH participating to investigate the problems of occupational safety and health in the manufacturing industries in Taiwan. The results of a qualitative study show that the most important problems with OSH management are employers’ negligence and workers’ insufficient knowledge about OSH management. The research results revealed the following eighteen significant shortcomings of OSH management: employers care mostly about production profit and do not care much for OSH; OSH data collection and OSH planning are not suitable for the workplace; many managers of OSH affairs are not qualified, in terms of their professional or academic backgrounds; and the repair of workplaces’ roofs often results in falling accidents, especially before or after a typhoon, because of workers’ failure to use safety belts and/or to follow OSH guidelines. In order to address the shortcomings and bottlenecks, the study also presented recommendations for how to implement and revise the OSH Act and how to research and enhance OSH management. The results of this study will not only supply the Ministry of Labor (Taiwan) with data to plan the strategy of OSH management but also will allow employers and workers to improve OSH management in the workplace in order to prevent the occurrence of occupational accidents.

Due to the fact that previous studies have rarely investigated the recognition rate discrepancy and pathology data error when applied to different databases, the purpose of this study is to investigate the improvement of recognition rate via deep learning-based liver lesion segmentation with the incorporation of hospital data. The recognition model used in this study is H-DenseUNet, which is applied to the segmentation of the liver and lesions, and a mixture of 2D/3D Hybrid-DenseUNet is used to reduce the recognition time and system memory requirements. Differences in recognition results were determined by comparing the training files of the standard LiTS competition data set with the training set after mixing in an additional 30 patients. The average error value of 9.6% was obtained by comparing the data discrepancy between the actual pathology data and the pathology data after the analysis of the identified images imported from Kaohsiung Chang Gung Memorial Hospital. The average error rate of the recognition output after mixing the LiTS database with hospital data for training was 1%. In the recognition part, the Dice coefficient was 0.52 after training 50 epochs using the standard LiTS database, while the Dice coefficient was increased to 0.61 after adding 30 hospital data to the training. After importing 3D Slice and ITK-Snap software, a 3D image of the lesion and liver segmentation can be developed. It is hoped that this method could be used to stimulate more research in addition to the general public standard database in the future, as well as to study the applicability of hospital data and improve the generality of the database.

Background/Aims: Recent studies provided compelling evidence that stimulation of the calcium sensing receptor (CaSR) exerts direct renoprotective action at the glomerular podocyte level. This protective action may be attributed to the RhoA-dependent stabilization of the actin cytoskeleton. However, the underlying mechanisms remain unclear. Methods: In the present study, an immortalized human podocyte cell line was used. Fluo-3 fluorescence was utilized to determine intracellular Ca2+ concentration ([Ca2+]i), and western blotting was used to measure canonical transient receptor potential 6 (TRPC6) protein expression and RhoA activity. Stress fibers were detected by FITC-phalloidin. Results: Activating CaSR with a high extracellular Ca2+ concentration ([Ca2+]o) or R-568 (a type II CaSR agonist) induces an increase in the [Ca2+]i in a dose-dependent manner. This increase in [Ca2+]i is phospholipase C (PLC)-dependent and is smaller in the absence of extracellular Ca2+ than in the presence of 0.5 mM [Ca2+]o. The CaSR activation-induced [Ca2+]i increase is attenuated by the pharmacological blockage of TRPC6 channels or siRNA targeting TRPC6. These data suggest that TRPC6 is involved in CaSR activation-induced Ca2+ influx. Consistent with a previous study, CaSR stimulation results in an increase in RhoA activity. However, the knockdown of TRPC6 significantly abolished the RhoA activity increase induced by CaSR stimulation, suggesting that TRPC6-dependent Ca2+ entry is required for RhoA activation. The activated RhoA is involved in the formation of stress fibers and focal adhesions in response to CaSR stimulation because siRNA targeting RhoA attenuated the increase in the stress fiber mediated by CaSR stimulation. Moreover, this effect of CaSR activation on the formation of stress fibers is also abolished by the knockdown of TRPC6. Conclusion: TRPC6 is involved in the regulation of stress fiber formation and focal adhesions via the RhoA pathway in response to CaSR activation. This may explain the direct protective action of CaSR agonists.

Abstract Background The objective of this study was to investigate the prevalence and factors associated with purchasing Chinese herbal medicine (CHM) without a physician’s prescription among adults. Methods Using data from the 2005 National Health Interview Survey and National Health Insurance, we identified 16,756 individuals aged 20 years and older. Socio-demographic factors, lifestyle, medical services utilization and health behaviors were compared between people with and without a history of purchasing CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis. Results The one-month prevalence of purchasing CHM without a physician’ prescription was 5.2% in Taiwan. People more likely to purchase CHM included people aged ≥70 years (OR 2.84, 95% CI 2.03-3.99), women (OR 1.28, 95% CI 1.11-1.48), non-indigenous people (OR 2.61, 95% CI 1.29–5.30), and people with an illness not receiving medical care (OR 2.69, 95% CI 2.19-3.31). Conclusion The prevalence of purchasing CHM without a physician’s prescription is high in Taiwan and is correlated with factors such as socio-demographics, disease history, and behaviors surrounding the utilization of medical care.

The study proposed an optimal cooperative learning grouping technique to facilitate medical university students’ English learning process, considering their complementary competencies. A quasi-experimental design was adopted to evaluate the feasibility of using the grouping technique. TOEIC (Test of English for International Communication) pretest and posttest were given to both the experimental group (32 students) and the control group (31 students) before and after a 16-week intervention. After the intervention, the posttest results showed that the experimental group had significantly higher mean scores than the control group. As for effect sizes, there were moderate effects on listening, reading, and writing competencies and a large effect on speaking competency. The results confirm that the proposed optimal cooperative learning grouping technique is effective for improving students’ English learning. In other words, the grouping method considering students’ complementary competencies is worth recommending for cooperative learning.

Vibrational behavior of psyllids was first documented more than six decades ago. Over the years, workers have postulated as to what the exact signal producing mechanisms of psyllids might be but the exact mechanism has remained elusive. The aim of this study is to determine the specific signal producing structures and mechanisms of the psyllids. Here we examine six hypotheses of signal producing mechanisms from both previous and current studies that include: wingbeat, wing-wing friction, wing-thorax friction, wing-leg friction, leg-abdomen friction, and axillary sclerite-thorax friction. Through selective removal of possible signal producing structures and measuring wing beat frequency with high speed videos, six hypotheses were tested. Extensive experiments were implemented on the species Macrohomotoma gladiata Kuwayama, while other species belonging to different families, i.e., Trioza sozanica (Boselli), Mesohomotoma camphorae Kuwayama, Cacopsylla oluanpiensis (Yang), and Cacopsylla tobirae (Miyatake) were also examined to determine the potential prevalence of each signal producing mechanism within the Psylloidea. Further, scanning electron microscope (SEM) was used to examine possible rubbing structures. The result of high speed video recordings showed that wingbeat frequency did not match the dominant frequency of vibrational signals, resulting in the rejection of wingbeat hypothesis. As for the selective removal experiments, the axillary sclerite-thorax friction hypothesis is accepted and wing-thorax friction hypothesis is supported partially, while others are rejected. The SEM showed that the secondary axillary sclerite of the forewing bears many protuberances that would be suitable for stridulation. In conclusion, the signal producing mechanism of psyllids may involve two sets of morphological structures. The first is stridulation between the axillary sclerite of the forewing and the mesothorax. The second is stridulation between the axillary cord and anal area of the forewing.

Will Russia's invasion of Ukraine bring China and Russia closer together or drive them farther apart, or will it be business as usual? This article addresses this question by conceptualizing the main characteristics of the China–Russia strategic partnership. It argues that a strategic partnership, characterized as it is by informality, equality, and inclusivity, is essentially different from an alliance or alignment. These characteristics allow Beijing to distance itself from Moscow's invasion of Ukraine. This makes it unlikely that China will attempt any simultaneous aggression in East Asia or that it will be able to mediate in the conflict. This effectively rules out the rise of a China–Russia axis. As China strives to balance its close ties with Russia and its economic engagement with the West, Beijing is more likely to maintain, rather than strengthen or weaken, its strategic partnership with Moscow. [ABSTRACT FROM AUTHOR]

Cancer is one of the common diseases. Quantitative biomarkers extracted from standard-of-care computed tomography (CT) scan can create a robust clinical decision tool for the diagnosis of hepatocellular carcinoma (HCC). According to the current clinical methods, the situation usually accounts for high expenditure of time and resources. To improve the current clinical diagnosis and therapeutic procedure, this paper proposes a deep learning-based approach, called Successive Encoder-Decoder (SED), to assist in the automatic interpretation of liver lesion/tumor segmentation through CT images. The SED framework consists of two different encoder-decoder networks connected in series. The first network aims to remove unwanted voxels and organs and to extract liver locations from CT images. The second network uses the results of the first network to further segment the lesions. For practical purpose, the predicted lesions on individual CTs were extracted and reconstructed on 3D images. The experiments conducted on 4300 CT images and LiTS dataset demonstrate that the liver segmentation and the tumor prediction achieved 0.92 and 0.75 in Dice score, respectively, by as-proposed SED method.