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Taiwan has implemented a Medical Home Healthcare (MHHC) policy to provide home healthcare services to residents in need. First was the Ordinary Medical Home Healthcare (OMHHC) program in 1997 and then expanded to Integrated Medical Home Healthcare (IMHHC) in 2016. The OMHHC is provided care for residents with tubes at home or in institutions by physicians and nurses, and the IMHHC include additional professions, such as pharmacists and dentists. This study analyzed the longitudinal data from 2013 to 2020 with respect to overall home health services utilizations, and the type of services, and compared the differences between areas with and without healthcare shortages. Our results showed that the IMHHC program enhanced the accessibility of home healthcare to those in needs, especially those in healthcare shortage areas. However, some services in the IMHHC program may still have low utilization rates. It is necessary to investigate the potential barriers for residents to access those services.

Abstract Translation initiation in bacteria is frequently regulated by various structures in the 5′ untranslated region (5′UTR). Previously, we demonstrated that G-quadruplex (G4) formation in non-template DNA enhances transcription. In this study, we aim to explore how G4 formation in mRNA (RG4) at 5′UTR impacts translation using a T7-based in vitro translation system and in E. coli. We show that RG4 strongly promotes translation efficiency in a size-dependent manner. Additionally, inserting a hairpin upstream of the RG4 further enhances translation efficiency, reaching up to a 12-fold increase. We find that the RG4-dependent effect is not due to increased ribosome affinity, ribosome binding site accessibility, or mRNA stability. We propose a physical barrier model in which bulky structures in 5′UTR biases ribosome movement toward the downstream start codon, thereby increasing the translation output. This study provides biophysical insights into the regulatory role of 5′UTR structures in in vitro and bacterial translation, highlighting their potential applications in tuning gene expression.

Abstract The objective of this study is to investigate the relationship between metabolic syndrome (MetS), and bone density in a 30- to 50-year-old Taiwanese population, and to explore the combined effects of BMI and health behaviors on this association. A total of 52,912 individuals aged 30–50 years from the Taiwan Biobank were included in this cross-sectional study. Bone density status was assessed using quantitative ultrasound (QUS). The joint effect was assessed by including an interaction term in the multi-logistic regression models to test the association between MetS, BMI, and bone density while controlling for potential confounders. MetS was associated with reduced bone density, with the risk of severe low bone density (SLBD) higher among BMI

Background: The effectiveness of hyperbaric oxygen (HBO) therapy for chronic osteomyelitis remains inconclusive. In particular, recent studies have shown that chronic osteomyelitis is a crucial risk factor for cardiovascular diseases. However, the preventive effect of HBO on cardiovascular events has not been reported in patients with chronic osteomyelitis. Methods: We conducted a population-based cohort study to evaluate the impact of HBO on patients with chronic osteomyelitis. Overall, 5312 patients with chronic osteomyelitis were selected from the Taiwan National Health Insurance Database to evaluate the impact of HBO in patients with chronic osteomyelitis. Propensity-score (PS) matching and inverse probability weighting (IPTW) were employed to balance covariates between the HBO and non-HBO groups. The primary outcome was all-cause mortality. The secondary outcomes were myocardial infarction (MI) and stroke hospitalisation. Furthermore, we evaluated the appropriate timing for HBO intervention by the restricted cubic spline (RCS) functions. Results: After 1:4 PS-matching, the HBO group (n = 265) was associated with lower 1-year mortality (hazard ratio [HR], 0.49; 95 % confidence interval [CI], 0.25–0.95) than the non-HBO group (n = 994); this was consistent with the IPTW weighting results (HR, 0.25; 95 % CI, 0.20–0.33). The risk of stroke was lower in the HBO group (HR, 0.46; 95 % CI, 0.34–0.63) than that in the non-HBO group. However, HBO therapy failed to reduce the risk of MI. Using the RCS model, patients with intervals within 90 days (HR, 1.38; 95 % CI, 1.04–1.84) presented a significant risk of 1-year mortality. After 90 days, as the length of interval increased, the risk gradually decreased and became insignificant. Conclusion: The present study revealed that adjunctive HBO could benefit the 1-year mortality and stroke hospitalisation in patients with chronic osteomyelitis. HBO was recommended to be initiated within 90 days of chronic osteomyelitis hospitalisation.

Abstract Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30–60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (− 0.55 kg, p = 0.02) and change of body weight percentage (− 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future. Clinical Trial Registration: ISRCTN16082909.

PCR is an essential method for the amplification and manipulation of nucleic acids, but the requirement for a thermocycler limits access. Here, authors engineer a helicase to replace the heating step of PCR with enzymatic unwinding, allowing the isothermal amplification of fragments up to 6 kb.

In this study, the corrosion-wear behavior of a Fe-based amorphous alloy coating was analyzed using a pin-on-ring corrosion abrasion system. The Fe-based amorphous alloy coating was prepared by the high velocity oxygen fuel (HVOF) method. The purpose of this article is to study the corrosion-wear behavior of this Fe-based amorphous alloy coating in sea water. The dynamic potential polarization curve and friction coefficient measurement were used to explore the influence of different polarization potentials on the corrosion-wear of the Fe-based amorphous alloy coating. The corrosion behavior of the coating was also analyzed using SEM, TEM and XPS. The experimental results show that under low polarization potential, after the iron oxide is dissolved, the chromium element in the Fe-based amorphous alloy coating will form chromium trioxide to produce a passivation protective layer. However, when the polarization potential is increased, the chromium trioxide will begin to dissolve. Subsequently, the molybdate formed by the passivation layer of molybdenum dioxide and molybdenum trioxide will provide more effective corrosion resistance of this Fe-based amorphous alloy coating. In terms of corrosion-wear behavior, owing to high hardness of the Fe-based amorphous alloy, the wear rate under low polarization potential is very small. When the polarization potential increases, a softer passivation layer will be formed on the surface of the coating, which will cause the wear rate to increase. As the polarization potential is +200 mVSCE, the wear mechanism of the coating is mainly a plowing type. While at high polarization potential (+600 mVSCE), it changes to a corrosive wear type.

Core competencies are the focus of the 12-year basic education curriculum reform. The purposes of the study were to introduce the development and validation of two physics competence tests through the cooperation of the seed teachers in the physics curriculum center, K-12 Education Administration, Ministry of Education, with a science education researcher, and to investigate strategies for developing competency items based on the analysis of multidimensional partial credit model, one of the Rasch models, and the interpretation of Wright maps. Forty-two physics competence items were selected and divided into test A and test B with a similar difficulty level. Stratified and convenience sampling was adopted. Two tests were administered to 1119 Grade 12 students from 19 public senior high schools in Taiwan. The results showed that most of the items in the two tests fit the multidimensional partial credit model, and the average of item difficulty for test A and test B were approximately 0. However, based on the Wright maps, some items were easier, and there was a lack of items with higher difficulty to assess students with higher ability. The study intends to inspire practical educators to build a national assessment framework for scientific literacy and to develop constructed-response items, items assessing the competence of evaluating and designing scientific inquiry, and items with high difficulty. The use of Wright maps may enhance teachers’ sensitivity to item difficulty and their understanding of students’ ability.

(1) Background: Non-alcoholic fatty liver disease (NAFLD) is a major global health concern. The increasing prevalence of NAFLD has been related to type 2 diabetes mellitus (T2D). However, the relationship between short-chain fatty acids (SCFAs) and NAFLD severity is ambiguous in T2D subjects. This study aimed to explore the association of SCFAs with the severity of NAFLD in T2D patients. (2) Methods: We employed echography to examine the severity of hepatic steatosis. The serum levels of nine SCFAs, namely, formate, acetate, propionate, butyrate, isobutyrate, methylbutyrate, valerate, isovalerate, and methylvalerate, were measured using gas chromatography mass spectrometry. (3) Results: A total of 259 T2D patients was enrolled in this cross-sectional study. Of these participants, 117 with moderate to severe NAFLD had lower levels of formate, isobutyrate, and methylbutyrate than the 142 without NAFLD or with mild NAFLD. Lower circulating levels of isobutyrate and methylbutyrate were associated with an increased severity of NAFLD. A relationship between NAFLD severity and circulating isobutyrate and methylbutyrate levels was found independently of a glycated hemoglobin (HbA1C) level of 7.0%. (4) Conclusion: Circulating levels of isobutyrate and methylbutyrate were significantly and negatively correlated with NAFLD severity in the enrolled T2D patients. SCFAs may be related to NAFLD severity in T2D patients.

The compare operation is widely used in many applications, from fundamental sorting to primitive operations in the database and AI systems. We present SRAM-based 3-D-CAM circuit designs using a monolithic 3-D (M3D) integration process for realizing beyond-Boolean in-memory compare operation without any area overheads. We also fabricated a processing-in-memory (PiM) macro with the same 3-D-CAM circuit using M3D for performing massively parallel compare operations used in the database, machine learning, and scientific applications. We show various system designs with the 3-D-CAM supporting operations, such as data filtering, sorting, and sparse matrix–matrix multiplication (SpGEMM). Our systems exhibit up to $272\times $ , $200\times $ , and $226\times $ speedups and $151\times $ , $37\times $ , and $156\times $ energy savings compared to systems using near memory compute for the data filtering, sorting, and SpGEMM applications, respectively.

G-quadruplex (G4) forming sequences are highly enriched in the human genome and function as important regulators of diverse range of biological processes. Here the authors show that while G4 structures on template strand block transcription, folding on the non-template strand enhances transcription by means of successive R-loop formation.

Negative and positive emotions are the risk and protective factors for the cause and prognosis of hypertension. This study aimed to use five photoplethysmography (PPG) waveform indices and affective computing (AC) to discriminate the emotional states in patients with hypertension. Forty-three patients with essential hypertension were measured for blood pressure and PPG signals under baseline and four emotional conditions (neutral, anger, happiness, and sadness), and the PPG signals were transformed into the mean standard deviation of five PPG waveform indices. A support vector machine was used as a classifier. The performance of the classifier was verified by using resubstitution and six-fold cross-validation (CV) methods. Feature selectors, including full search and genetic algorithm (GA), were used to select effective feature combinations. Traditional statistical analyses only differentiated between the emotional states and baseline, whereas AC achieved 100% accuracy in distinguishing between the emotional states and baseline by using the resubstitution method. AC showed high accuracy rates when used with 10 waveform features in distinguishing the records into two, three, and four classes by applying a six-fold CV. The GA feature selector further boosted the accuracy to 78.97%, 74.22%, and 67.35% in two-, three-, and four-class differentiation, respectively. The proposed AC achieved high accuracy in categorizing PPG records into distinct emotional states with features extracted from only five waveform indices. The results demonstrated the effectiveness of the five indices and the proposed AC in patients with hypertension.

Individuals with mild cognitive impairment (MCI) are at high risk of developing into dementia (e. g., Alzheimer's disease, AD). A reliable and effective approach for early detection of MCI has become a critical challenge. Although compared with other costly or risky lab tests, electroencephalogram (EEG) seems to be an ideal alternative measure for early detection of MCI, searching for valid EEG features for classification between healthy controls (HCs) and individuals with MCI remains to be largely unexplored. Here, we design a novel feature extraction framework and propose that the spectral-power-based task-induced intra-subject variability extracted by this framework can be an encouraging candidate EEG feature for the early detection of MCI. In this framework, we extracted the task-induced intra-subject spectral power variability of resting-state EEGs (as measured by a between-run similarity) before and after participants performing cognitively exhausted working memory tasks as the candidate feature. The results from 74 participants (23 individuals with AD, 24 individuals with MCI, 27 HC) showed that the between-run similarity over the frontal and central scalp regions in the HC group is higher than that in the AD or MCI group. Furthermore, using a feature selection scheme and a support vector machine (SVM) classifier, the between-run similarity showed encouraging leave-one-participant-out cross-validation (LOPO-CV) classification performance for the classification between the MCI and HC (80.39%) groups and between the AD vs. HC groups (78%), and its classification performance is superior to other widely-used features such as spectral powers, coherence, and the complexity estimated by Katz's method extracted from single-run resting-state EEGs (a common approach in previous studies). The results based on LOPO-CV, therefore, suggest that the spectral-power-based task-induced intra-subject EEG variability extracted by the proposed feature extraction framework has the potential to serve as a neurophysiological feature for the early detection of MCI in individuals.

The performance improvement of advanced electronic packaging material is an important topic to meet the stringent demands of modern semiconductor devices. This paper studies the incorporation of nano-alumina powder and thermoplastic elastomer (TPE) into thermoplastic polystyrene matrix to tune the thermal and mechanical properties after injection molding process. In the sample preparation, acetone was employed as a solvent to avoid the powder escape into surrounding during the mechanical mixing in a twin-screw mixer. The pressure and shear force were able to mix the composite with good uniformity in compositions. The samples with different compositions were fabricated using injection molding. The measured results showed that adding 5 wt.% of TPE into the simple polystyrene was able to raise the melt flow index from 12.3 to 13.4 g/10 min while the thermal decomposition temperature remained nearly unchanged. Moreover, the addition of small amount of nano-alumina powder could quickly improve the mechanical property by raising its storage modulus. For example, the addition of 3 wt.% of nano-alumina powder had an increase of 7.3% in storage modulus. Over doping of nano-alumina powder in the composite, such as 10 wt.%, on the other hand, lowered the storage modulus from 2404 MPa to 2069 MPa. The experimental study demonstrated that the tuning in the polystyrene’s thermal and mechanical properties is feasible by composition modification with nano-alumina powder and TPE. The better concentration of the additives should be determined according to the specific applications.

Adolescents with comparable personal risk factors may have different lipid profiles because of the school’s context. Lipid determinants in adolescents should be considered using a multilevel perspective. This multilevel study investigated the effects of individual-level and school-level factors on lipid profiles in adolescents and evaluated the cross-level influence of lipid determinants. A representative adolescent cohort (n = 2727) was randomly selected from 36 schools in three diverse economic areas in Taiwan and assessed for their personal dietary patterns, physical parameters, and lipid profiles. For individual-level factors, both low physical activity and high body mass index (BMI) were associated with elevated triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) levels, and a sugar-sweetened beverage intake of >500 mL/day was associated with increases of 5.97 and 6.12 mg/dL in LDL-C and TC levels, respectively, compared with abstinence. Regarding school-level factors, students in schools with ≥2 health promotion programs per year had a 5.27 mg/dL lower level of LDL-C than those in schools with 0–1 program, and students in schools with ≥46 food outlets within 600 m of the school had 6.90 and 13.3 mg/dL higher levels of TG and TC, respectively, than those in schools with p-value for the random-slope effect was 0.003). In conclusion, individual-level and school-level factors exert a multilevel effect on adolescent lipid profiles. The food environment near the school has a stronger cross-level impact on individual TG levels in adolescents with a high BMI than in those with a normal BMI.

Underlying pathophysiological mechanisms drive excessive clustering of cardiometabolic risk factors, causing metabolic syndrome (MetS). MetS status may transform as adolescents transition to young adulthood. This study investigated the latent clustering structure and its stability for MetS during adolescence, and assessed the anthropometric and clinical metabolic determinants for MetS transformation. A community-based representative adolescent cohort (n = 1516) was evaluated for MetS using four diagnostic criteria, and was followed for 2.2 years to identify new-onset MetS. The clustering structure underlying cardiometabolic parameters was stable across adolescence; both comprised a fat—blood pressure (BP)—glucose three-factor structure (total variance explained: 68.8% and 69.7% at baseline and follow-up, respectively). Among adolescents with MetS-negative at baseline, 3.2–4.4% had incident MetS after 2.2 years. Among adolescents with MetS-positive at baseline, 52.0–61.9% experienced MetS remission, and 38.1–48.0% experienced MetS persistence. Increased systolic BP (SBP) was associated with a high MetS incidence risk, while decreased levels of SBP and glucose were associated with MetS remission. Compared with adolescents with a normal metabolic status at baseline, those with an initial abdominal obesity and increased triglycerides level had a 15.0- and 5.7-fold greater risk for persistent abnormality, respectively. Abdominal obesity and low high-density lipoprotein cholesterol are two abnormal MetS components that highly persist during adolescence, and are the intervention targets for reducing the future risk of cardiometabolic disorders.

In this study, Fe40Cr19Mo18C15B8 amorphous coatings were prepared using high velocity oxygen fuel (HVOF) technology. Different temperatures were used in the heat treatment (600 °C, 650 °C, and 700 °C) and the annealed coatings were analyzed by DSC, SEM, TEM, and XRD. XRD and DSC results showed that the coating started to form a crystalline structure after annealing at 650 °C. From the SEM observation, it can be found that when the annealing temperature of the Fe-based amorphous alloy coating reached 700 °C, the surface morphology of the coating became relatively flat. TEM observation showed that when the annealing temperature of the Fe-based amorphous alloy coating was 700 °C, crystal grains in the coating recrystallized with a grain size of 5–20 nm. SAED analysis showed that the precipitated carbide phase was M23C6 phase with different crystal orientations (M = Fe, Cr, Mo). Finally, the corrosion polarization curve showed that the corrosion current density of the coating after annealing only increased by 9.13 μA/cm2, which indicated that the coating after annealing treatment still had excellent corrosion resistance. It also proved that the Fe-based amorphous alloy coating can be used in high-temperature environments. XPS analysis showed that after annealing FeO and Fe2O3 oxide components increased, and the formation of a large number of crystals in the coating resulted in a decrease in corrosion resistance.

Classification between individuals with mild cognitive impairment (MCI) and healthy controls (HC) based on electroencephalography (EEG) has been considered a challenging task to be addressed for the purpose of its early detection. In this study, we proposed a novel EEG feature, the kernel eigen-relative-power (KERP) feature, for achieving high classification accuracy of MCI versus HC. First, we introduced the relative powers (RPs) between pairs of electrodes across 21 different subbands of 2-Hz width as the features, which have not yet been used in previous MCI-HC classification studies. Next, the Fisher’s class separability criterion was applied to determine the best electrode pairs (five electrodes) as well as the frequency subbands for extracting the most sensitive RP features. The kernel principal component analysis (kernel PCA) algorithm was further performed to extract a few more discriminating nonlinear principal components from the optimal RPs, and these components form a KERP feature vector. Results carried out on 51 participants (24 MCI and 27 HC) show that the newly introduced subband RP feature showed superior classification performance to commonly used spectral power features, including the band power, single-electrode relative power, and also the RP based on the conventional frequency bands. A high leave-one-participant-out cross-validation (LOPO-CV) classification accuracy 86.27% was achieved by the RP feature, using a simple linear discriminant analysis (LDA) classifier. Moreover, with the same classifier, the proposed KERP further improved the accuracy to 88.24%. Finally, cascading the KERP feature to a nonlinear classifier, the support vector machine (SVM), yields a high MCI-HC classification accuracy of 90.20% (sensitivity = 87.50% and specificity = 92.59%). The proposed method demonstrated a high accuracy and a high usability (only five electrodes are required), and therefore, has great potential to further develop an EEG-based computer-aided diagnosis system that can be applied for the early detection of MCI.

Epoxy with low viscosity and good fluidity before curing has been widely applied in the packaging of electronic and electrical devices. Nevertheless, its low flexibility and toughness renders the requirement of property improvement before it can be widely acceptable in dynamic loading applications. This study investigates the possible use of 2-hydroxyethyl methacrylate (HEMA) toughening agent and nano-powders, such as alumina, silicon dioxide, and carbon black, to form epoxy composites for dynamic property improvement. Considering the different combinations of the nano-powders and HEMA toughener, the Taguchi method with an L9 orthogonal array was adopted for composition optimization. The dynamic storage modulus and loss tangent of the prepared specimen were measured by employing a dynamic mechanical analyzer. With polynomial regression, the curve-fitted relationships of the glass transition temperature and storage modulus with respect to the design factors were obtained. It was found that although the raise in the weight fraction of nano-powders was beneficial in increasing the rigidity of the epoxy composite, an optimal amount of HEMA toughener existed for its best damping improvement.

A simple, robust, and characterized adiposity indicator may be appropriate to be used as a risk screening tool for identifying metabolic syndrome (MetS) in adolescents. This study used dual adolescent populations to develop and validate efficient adiposity indicators from 12 characterized candidates for identifying MetS that may occur during the transition from adolescence to young adulthood. Data from the adolescent Nutrition and Health Survey in Taiwan (n = 1920, 12–18 years) and the multilevel Risk Profiles for adolescent MetS study (n = 2727, 12–16 years) were respectively used as training and validation datasets. The diagnostic criteria defined by the International Diabetes Federation for adolescents (IDF-adoMetS) and the Joint Interim Statement for adults (JIS-AdMetS) were employed to evaluate MetS. In the training dataset, principal component analysis converted 12 interrelated obesity indices into bodyfat-, lipid-, and body-shape-enhanced groups, with the first two characteristic-groups having a higher discriminatory capability in identifying IDF-adoMetS and JIS-AdMetS. In the validation dataset, abdominal volume index (AVI) among girls and waist circumference (WC) among boys were respectively validated to have a higher Youden’s index (0.740–0.816 and 0.798–0.884) in identifying the two MetS. Every 7.4 and 4.3 positive tests of AVI (cutoff = 13.96) had an accurate IDF-adoMetS and JIS-AdMetS, respectively, and every 32.4 total tests of WC (cutoff = 90.5 cm) had a correct identification for the two MetS. This study stresses the discriminatory capability of bodyfat- and lipid-enhanced adiposity indicators for identifying MetS. AVI and WC were, respectively, supported as a risk screening tool for identifying female and male MetS as adolescents transition to adulthood.

Sugar-sweetened beverages (SSBs) are the principle source of added sugar in diets. Cardiometabolic disturbances can occur from early childhood to adulthood. The aim of this cross-sectional study was to examine the gender-specific association of SSB intake with metabolic syndrome (MetS) and its components among adolescents in Taiwan. A total of 2727 adolescents aged 12 to 16 years randomly selected from three diverse economic areas in Southern Taiwan by using a multistage-sampling strategy participated in this study. Demographic, dietary, physical and anthropometric parameters were measured, and serum lipid profiles and glucose levels were determined. The International Diabetes Federation (IDF) specifies that MetS requires abdominal obesity and ≥2 abnormal components, and Cook criteria for MetS require ≥3 abnormal components. We applied survey-data modules to data analyses, and used multiple regression and logistic models to adjust for covariates. An increased SSB intake was linked to a greater waist circumference in both sexes and to systolic blood pressure in boys (P for trend: ≤0.043). Male moderate and high consuming SSB drinkers exhibited triglyceride levels that were 8.0 and 8.2 mg/dL significantly higher, respectively, than those of nondrinkers. Compared with nondrinkers, boys who consumed >500 mL/day (high quantity) of SSBs exhibited 10.3-fold (95% confidence intervals (CIs): 1.2-90.2) and 5.1-fold (95% CIs: 1.01-25.5) risks of contracting MetS, as defined by the IDF and Cook criteria for MetS, respectively. In girls, the risk estimates for the same comparison were not significant by the IDF criteria (6.5-fold risk, 95% CIs: 0.9-∞) or Cook criteria (5.9-fold risk, 95% CIs: 0.8-43.8) for MetS. High SSB consumption was also linked to 1.9-fold (95% CIs: 1.1-3.1) and 2.7-fold (95% CIs: 1.3-5.7) higher risks of being at a greater overall metabolic risk in girls and boys, respectively. In conclusion, a high SSB intake is associated with adolescent MetS among boys but not girls in Taiwan.

Clustering of metabolic syndrome (MetS) risk components in childhood has been linked to a higher risk of diabetes and cardiovascular diseases in adulthood. By using data from the 2010–2011 Nutrition and Health Survey in Taiwan, this study investigated epidemic patterns and correlates for the clustering of MetS risk components. A total of 1920 adolescents aged 12–18 years were included in this study. The MetS diagnostic criteria defined by the Taiwan Pediatric Association (TPA) and International Diabetes Federation (IDF) for adolescents and the criteria defined by the Joint Interim Statement for adults (JIS-Adult) were used to evaluate MetS and its abnormal components. The prevalence of TPA-, IDF-, and JIS-Adult-defined MetS was 4.1%, 3.0%, and 4.0%, with 22.1%, 19.3%, and 17.7%–18.1% of adolescents having high fasting glucose, low high-density lipoprotein cholesterol, and central obesity, respectively. A 0.4-to-0.5-fold decreased risk of having ≥2 MetS abnormal components was detected among adolescents who consumed ≥1 serving/week of dairy products and fresh fruits. Boys who consumed ≥7 drinks/week of soda and girls who consumed ≥7 drinks/week of tea had a 4.6- and 5.2-fold risk of MetS, respectively. In conclusion, our findings revealed significant dimensions of adolescent MetS, including detecting population-specific prevalent patterns for MetS risk components and their clustering, and emphasized on health promotion activities that reduce sugar-sweetened beverage intake.

Obesity can augment insulin resistance (IR), leading to increased risk of diabetes and heart disease. Leptin, ghrelin, and various fatty acids present in the cell membrane may modulate IR. In this study, we aimed to investigate the impact of weight loss on IR, serum leptin/ghrelin levels, and erythrocyte fatty acids, and studied the associations between changes in these variables. A total of 35 obese (body mass index ≥ 27) adults participated in a weight loss program for 3 months. IR was assessed using homeostasis model assessment for insulin resistance (HOMA-IR). The obese participants had a mean weight loss of 5.6 ± 3.8 kg followed by a 16.7% and 23.3% reduction in HOMA-IR and leptin (p 0.05) levels. After adjusting for age, gender, changes in ghrelin, and body fat, we found a significant correlation between decreases in leptin and less risk of no improvement in HOMA-IR levels [odds ratio (OR) = 0.69, p = 0.039]. In conclusion, a moderate weight reduction in obese participants over a short period significantly improved IR. This weight reduction concomitantly decreased serum leptin, increased ghrelin, and elevated some erythrocyte unsaturates. Only leptin correlated independently with IR improvement upon multivariable logistic regression analysis, which indicates that leptin may play a role in the modulation of IR following weight loss.

Obesity is a well known risk factor for insulin resistance and type 2 diabetes. Recently discovered adipocyte-derived proteins (leptin and adiponectin) might contribute to the pathologic mechanism linking obesity and insulin resistance. A total of 190 non-diabetic women were recruited from the Obesity Clinic of Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, between February 2003 and February 2004. All participants completed a simple questionnaire. Blood pressure and body mass index were measured; blood samples for fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglyceride, leptin, adiponectin, and fasting insulin level were collected after an overnight fast. Two-hour glucose level after a 75-g glucose tolerance test was determined. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as the index of insulin resistance. Multivariate linear regression analyses were used to analyze the relationship between adipocytokines and insulin resistance after adjusting for possible confounding factors. Leptin and adiponectin were found to be independently associated with HOMA-IR and fasting insulin concentration, but in divergent directions, after adjusting for potential confounding factors. Adiponectin, but not leptin, was associated with impaired glucose tolerance after adjusting for potential confounding factors. The results suggest that leptin and adiponectin may be involved in the pathophysiologic link between obesity and insulin resistance independently. Low levels of adiponectin may increase the risks of developing impaired glucose metabolism and type 2 diabetes.

This study presents vibration control using actively tunable vibration absorbers (ATVA) to suppress vibration of a thin plate. The ATVA is made of a sandwich hollow structure embedded with electrorheological fluid (ERF). ERF is considered to be one of the most important smart fluids and it is suitable to be embedded in a smart structure due to its controllable rheological property. ERF’s apparent viscosity can be controlled in response to the electric field and the change is reversible in 10 microseconds. Therefore, the physical properties of the ERF-embedded smart structure, such as the stiffness and damping coefficient, can be changed in response to the applied electric field. A mathematical model is difficult to be obtained to describe the exact characteristics of the ERF embedded ATVA because of the nonlinearity of ERF’s viscosity. Therefore, a fuzzy modeling and experimental validations of ERF-based ATVA from stationary random vibrations of thin plates are presented in this study. Because Type-2 fuzzy sets generalize Type-1 fuzzy sets so that more modeling uncertainties can be handled, a semi-active vibration controller is proposed based on Type-2 fuzzy sets. To investigate the different performances by using different types of fuzzy controllers, the experimental measurements employing both type-1 fuzzy and interval type-2 fuzzy controllers are implemented by the Compact RIO embedded system. The fuzzy modeling framework and solution methods presented in this work can be used for design, performance analysis, and optimization of ATVA from varying harmonic vibration of thin plates.

Due to its widely tunable mechanical property and incompatibility with most solders, Ni-Mn alloy can become a viable candidate in the fabrication of testing probe for microelectronic devices. In this study, the electrodeposition of Ni-Mn alloy in nickel sulphamate electrolyte with the addition of manganese sulphate was investigated under direct current (DC) power source. The effects of current density and Mn2+ concentration in the electrolyte on the coating composition, cathodic efficiency, microstructure and mechanical properties were explored. The results showed that the raise of the Mn2+ concentration in the electrolyte alone did not effectively increase the Mn content in the coating but reduce the cathodic efficiency. On the other hand, increasing the current density facilitated the codeposition of the Mn and rendered the crystallite from coarse columnar grain to the refined one. Thus, both hardness and internal stress of the coating increased. The fabrication of testing probes at 1 A/dm2 was shown to satisfy the high hardness, low internal stress, reasonable fatigue life, and nonsticking requirements for this microelectronic application.

BACKGROUND: The metabolic effect of fructose in sugar-sweetened beverages (SSB) has been linked to de novo lipogenesis and uric acid (UA) production. OBJECTIVES: This study investigated the biological effects of SSB consumption on serum lipid profiles and retinol-binding protein 4 (RBP4) among Taiwanese adolescents. METHODS: We evaluated the anthropometric parameters and biochemical outcomes of 200 representative adolescents (98 boys and 102 girls) who were randomly selected from a large-scale cross-sectional study. Data were analyzed using multiple regression models adjusted for covariates. RESULTS: Increased SSB consumption was associated with increased waist and hip circumferences, body mass index (BMI) values and serum UA, triglyceride (TG) and RBP4 levels. Adolescents who consumed >500 ml/day of beverages half-to-heavily sweetened with high-fructose corn syrup (HFCS) exhibited TG and RBP4 levels 22.7 mg/dl and 13.92 ng/ml higher than non-drinkers, respectively. HFCS drinkers with hyperuricemia had higher TG levels than HFCS drinkers with normal UA levels (98.6 vs. 81.6 mg/dl). The intake of HFCS-rich SSBs and high value of BMI (≥24) interactively reinforced RBP4 levels among overweight/obese adolescents. Circulating RBP4 levels were significantly correlated with weight-related outcomes and TG and UA concentration among HFCS drinkers (r = 0.253 to 0.404), but not among non-drinkers. CONCLUSIONS: High-quantity HFCS-rich beverage consumption is associated with higher TG and RBP4 levels. Hyperuricemia is likely to intensify the influence of HFCS-rich SSB intake on elevated TG levels, and in overweight and obese adolescents, high BMI may modify the action of fructose on higher circulating levels of RBP4.

Cardiometabolic risk factors or their precursors are observed in childhood and may continue into adulthood. We investigated the effects of parental overweight and cardiometabolic diseases and pediatric lifestyle factors on the clustering of cardiovascular risk factors among adolescents, and examined the mediating and modifying effects of pediatric adiposity on these associations. Representative adolescents (n = 2727; age, 12–16 years) were randomly recruited through multistage stratified sampling from 36 schools in Southern Taiwan. Adolescent and parent surveys were conducted in schools and participant homes, respectively. Their demographic factors, diet patterns, and physical, anthropometric, and clinical parameters were collected and analyzed. Adolescents with 1–2 and ≥3 risk components for pediatric metabolic syndrome (MetS) were defined as potential MetS (pot-MetS) and MetS, respectively. Adolescents whose parents were overweight/obese, or with diabetes and hypertension had a higher prevalence ratio of pot-MetS and MetS (1.5–1.6 and 1.9–4.2-fold, respectively). Low physical activity (500 mL/day) were associated with a 3.3- (95% confidence intervals (CI) = 1.5–7.3), 2.2- (95% CI = 1.1–4.4), and 26.9-fold (95% CI = 3.2–229.0) odds ratio (OR) of MetS, respectively. Pediatric body mass index (BMI) accounted for 18.8%–95.6% and 16.9%–60.3% increased prevalence ratios of these parental and pediatric risk factors for MetS. The OR of pot-MetS + MetS for sugar-sweetened beverage consumption was multiplicatively enhanced among adolescents with overweight/obesity (combined OR, 8.6-fold (95% CI = 4.3–17.3); p for multiplicative interaction, 0.009). The results suggest that parental overweight and cardiometabolic diseases and pediatric sedentary and high sugar-intake lifestyles correlate with the development of adolescent MetS, and an elevated child BMI explains a part of these associations. Pediatric adiposity might be multiplicatively associated with sugar-sweetened beverage consumption for enhancing the MetS prevalence ratio among adolescents.

Bearings are common components used in the transmission system of tool machinery and linear drive equipment. With increasing demand for higher efficiency and faster production under the required accuracy, the control of bearing temperature rise under high operational speed becomes a critical issue. The improper control of temperature rise can lead to the thermal deformation and life reduction of the machinery. Conventionally, a circulating oil lubrication system is utilized with journal bearings. In this study, a similar lubrication system was adopted for the ball bearing with a retrofit design. Three control factors, i.e., rotational speed, bearing preload, and the viscosity of the lubricant used, were chosen to study their effects on the temperature performance of the proposed lubrication system. Experimental measurements showed that the lubrication system was able to lower the temperature rise of the bearing considerably compared with its unlubricated counterpart, especially at high rotational speeds. Even with the enhanced cooling from the oil circulation system, temperature rise still increased with rotational speed. However, with increased preload, the temperature rise first dropped and then increased owing to the different contact characteristics of the balls and rings of the bearing. A fitted function for the temperature rise of the bearing under different operational conditions was demonstrated to have a prediction accuracy within 3%. Therefore, the retrofitted bearing oil cooling system should be applicable in the design of high-speed machinery for industry. [ABSTRACT FROM AUTHOR]