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Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort.From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed.After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%).In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAg-negative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Objective To investigate the neonatal and maternal outcomes of patients treated with belimumab during pregnancy. Materials and methods We retrospectively collected patients who were treated with belimumab during pregnancy from January 2018 to October 2020 in a tertiary referral hospital in Taiwan. All patients had clinical and serological features of systemic lupus erythematosus or antiphospholipid syndrome and had been treated accordingly. The patients’ medical and obstetric history, obstetric complications and fetal outcomes were collected by chart review. Results A total of 13 pregnancies in 13 patients were included. The median age was 38 years (interquartile range 32–41 years), 46.2% had a history of recurrent pregnancy loss, and the median number of treatment courses with belimumab (400 mg per dose) was two. There were 11 live births (84.6%, 11 of 13). One episode of omphalitis was noted in one fetus, who recovered well with antibiotic treatment. No fetus had leukopenia, lymphopenia, neutropenia, or thrombocytopenia in the days after birth. No fetal anomalies were found in this series. Among the six patients with a past history of recurrent pregnancy loss, four had live births. Conclusion This study provides new evidence for the use of belimumab in pregnant patients. No increase in the risk of fetal anomalies or severe infection was noted in the patients who were exposed to belimumab during pregnancy. Cautious monitoring is necessary if belimumab is used in pregnant patients, and more data are still needed to validate its safety.

In this study, we use village-level data to examine the impact of geographic proximity on inequality in higher education. We define higher education oases as the area collectively constructed by all the universities within a 15-km travel distance radius from research-intensive universities. Based on the coarsened exact matching method, we identified villages with comparable socioeconomic statistics that differed only in terms of their proximity to highly concentrated higher education resources, thus mimicking a treatment and a control group. Evidence based on this quasi-experimental design shows that villages located in higher education oases have a significantly higher percentage of residents aged 25–34 who have earned a master’s degree or above compared to those not located in higher education oases. However, there is no significant difference in the percentage of residents aged 20–24 with a bachelor’s degree or above between the two groups of villages. This study sheds light on the impact of the geography of opportunity on inequality in higher education in Taiwan.

Background Rituximab is known to be associated with a high resolved hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation in rheumatic patients receiving rituximab is limited. Aims To assess the HBV reactivation in HBsAg-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. Methods From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcomes and factors associated with HBV reactivation were analyzed. Results After a median follow-up period of 3.3 years, 21 patients developed HBV reactivation, among which 17 patients were positive for anti-HBc and 4 were negative. Thirteen patients had clinical hepatitis flare, while 8 patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, and undetectable serum anti-HBs level at rituximab initiation were associated with HBV reactivation. There was no significant difference in the HBV reactivation risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBV reactivation (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). Conclusions In HBV endemic areas, patients with negative anti-HBc, especially those without vaccination at birth, were still at risk for HBV reactivation after receiving rituximab. Regular monitoring of HBV serology should be considered for all HBsAg-negative patients receiving rituximab for autoimmune diseases.

Until now, there are no approved treatment against COVID-19. Hydroxychloroquine (HCQ) was hypothesized to be active against SARS-CoV2 via antiviral and anti-inflammatory effect; however, HCQ for COVID-19 in clinical use remained debating. In this preliminary report, we presented six patients with mild to moderate COVID-19. They were treated with HCQ for 14 days from the day of COVID-19 diagnosis. Serial viral load from respiratory specimens were performed every other day. Cytokine profile was checked before HCQ initiation and on the 14th day of HCQ treatment. All patients receiving HCQ completed 14-day course without complication. Among the six patients, the mean duration from symptom onset to last detectable viral load was 34 ± 12 days, which was similar to those without specific treatment in previous reports. Low level of interferon-gamma was noted in all patients of different stage of infection and three patients had elevation of IL-17 level. Prolonged virus shedding is still observed regardless HCQ. The impact of HCQ on cytokine kinetics remained unclear; however, IL-17 could be an inflammatory marker for disease status monitor and a potential therapeutic target.

What this research may achieve points towards the need to progressively improve the reasonableness in establishing Social Welfare Agencies (SWAs). The service capacity of SWAs is far below the population of the level III extremely disabled. This is a serious problem. This evaluation can assist social welfare and public health departments to determine what locations to approve for establishing SWAs in the short term and plan for new SWAs more precisely, as well as rein in budgetary priorities. As an illustration, in considering the distance between SWAs and the extremely disabled, the service quality of SWAs and fairness in the planning have to be taken into account. Introducing a Service Quantity Needed-Index for SWAs (SNIS) into the current measure of approving and planning new SWAs shall assist the departments in distributing social welfare resources to areas most in need of help. In addition, using the modified data to recalculate SNIS can examine needs regularly. Employing basic statistical areas for short-term applications in Taipei City SWA projects, considering the distance between SWAs and the extremely disabled, the agencies’ service quality and fairness in the planning of SWAs need to receive more attention. Previous research mostly employed straight-line distances rather than road distances. To a certain extent, this overlooked the actual capacity of roads as well as led to some degree of discrepancies in evaluations. This essay focuses on calculating SNIS, mainly towards guiding the establishment of facilities and concretely proposing how to optimize their locations. Future research can add in needs at that time in accordance with current evaluation results to propose plans to optimize the locations, or maybe integrate weights of disability to adjust multiple requirements of SWAs.

According to previous research, the most important factor for patient’s survival is based on the emergency treatment in the ambulance and the effective allocation of emergency resource when emergency patients experience out-of-hospital cardiac arrest (OHCA) before arriving the hospital. This study intended to combine the regional information of emergency medical resources and the data base of geographic information for ambulance to assess the best method of medical treatment for OHCA patients, such as the closest medical center, the level of first-aid capabilities, the proper medical department, the information for hospital beds and the special need for medical section, so that EMD can make decision based on these suggestions. For providing the strategy of emergency ambulance, this research proposed the impact of the optimized population, the level of regional development, the allocation of emergency medical resource, the best timing of executing the chain of survival and the advanced cardiac life support, on the survival rate of OHCA patients through big data analysis. Or through increasing the spatial allocation and flexibility of EMT-P, it can reflect the importance of spatial factors in the challenge for the allocation of emergency medical resources. The results of this study can provide the recommendations for the policy of medical resource allocation.

We read with great interest the article by Petri et al demonstrating that higher hydroxychloroquine (HCQ) blood levels were associated with lower risk of thrombotic event in patients with systemic lupus erythematosus (SLE). (1) A mean blood level of 1068 ng/mL and a most recent level of 1192 ng/mL and above had a protective effect. The dose response implied a therapeutic threshold of HCQ. However, a previous study indicated a range of HCQ blood level from 1177 to 3513 ng/mL predicted later development of HCQ retinopathy. (2) Obviously, there's a great overlap between the protective level from thrombosis and toxic level of retinopathy. The optimal therapeutic range is so narrow (1068 to 1177 ng/mL) that dose titration to target this level would be difficult in clinical practice. It seems that the dilemma of avoiding retinopathy while maintaining the benefit of HCQ still exists.

Out-of-Hospital Cardiac Arrest (OHCA) is a critical issue of emergency medical service (EMS).Ubiquitous computing technologies could significantly improve the survival rate of OHCA patients.Public health institutions should manage first-aid resources more efficiently and make EMS policies more effectively.New Taipei City, Taiwan was chosen as the scope of this study. Spatial Analysis and Data Mining Techniques were used.Spatial clustering of OHCA events was found. Risk factors to 2-hour survival rate after OHCA were identified. Out-of-Hospital Cardiac Arrest (OHCA) is a critical issue of emergency medical service (EMS). In addition to the first aids given to OHCA patients by witnesses or bystanders, time factors such as arrival of ambulance and transportation from site to EMS are also important. Comprehensive coverage of EMS, especially enhanced by ubiquitous computing technologies, could significantly improve the survival rate of OHCA patients. However, it heavily challenges the resource allocation and management policy in the public health system of a metropolis. ObjectivesIn this study, we first used spatial analysis techniques with a finer granularity to identify high risk areas of OHCA in a metropolis. We then used data mining techniques to elucidate the effects of patients' characteristics, pre-hospital resuscitation treatments, and spatial factors on post-OHCA survivability. With this information, public health institutions can enhance the EMS by allocating properly first-aid resources at the right places to improve the survival rate of OHCA patients. MethodsWe used New Taipei City, Taiwan as the scope of this study. Data of all registered OHCA cases in New Taipei City in 2011 were reviewed retrospectively. The dataset was combined with the National Doorplate Database to enhance the granularity of spatial analyses. Global and local spatial analyses based on Global Moran's Index, Local Moran's Index, and Getis-Ord Gi* statistic were performed to cluster high risk districts for OHCA in New Taipei City. Statistical methods such as Chi-square test, logistic regression, and decision tree were then adopted to analyze factors influencing 2-h survivability after OHCA. ResultsSignificant spatial clustering of OHCA events was found (p

The University’s multi-entry program has been in place since 2002, and the number of students and some of the star-pushing pipelines has reached 70% of the total enrollment ratio. To identify the image of multi-entry for students and many students to conduct an analysis of the university’s multi-entry program policy. The research on the university’s multi-entry program explores the results of the students’ experience after the students enter the university from different admission pipelines.

With the gradual development of the global information technology and mobile communication networks, medical system with information and network technologies has become an inevitable trend. All countries are also accelerating their efforts to replace traditional paper books with Electronic Medical Record (EMR). Medical records and electronic medical record implementation can save costs annually, increase economic efficiency by improving the efficiency and safety of medical systems, and accelerate innovation in the medical industry. The implementation of EHR will undoubtedly bring many conveniences, stakeholders who are concerned with EHR at this stage are still not satisfied with the privacy disclosure and information security regarding the possible implementation of electronic medical records. And the information between them still lacks good interoperability.

Background:Interstitial lung disease (ILD) is one of the main contributor to morbidity and mortality in patients with primary Sjogren syndrome (pSS), and whether immunosuppressive treatments are effective for pSS-ILD is uncertain. Cyclophosphamide (CYC) and rituximab (RTX) are effective in stabilizing pulmonary function in patients with ILD caused by systemic sclerosis, inflammatory myositis, and rheumatoid arthritis1,2. Reports regarding the treatment response for cyclophosphamide or rituximab in pSS-ILD patients are lacking.Objectives:To investigate whether add-on CYC or RTX in addition to steroid and oral DMARDs leads to greater improvement in pulmonary function test than conventional treatment in patients with pSS-ILD with impaired baseline pulmonary function.Methods:pSS-ILD patients with ILD confirmed by a chest computed tomography were screened. Those with imparied baseline pulmonary function test (FVCResults:This study enrolled 22 patients. The median age of these patients was 65. Among them, 68% were female and 18% were smokers. The median baseline FVC was 63.5% and the median DLCO was 54.4%. The predominant CT pattern was NSIP (54%), followed by UIP (22%), LIP (13.6%) and OP (9%) (table 1).Five patients received steroid and oral DMARDs alone (hydroxychloroquine +/- azathioprine), while 17 patients received add-on CYC and/or RTX (8 patients received CYC, 3 received RTX, and 6 received CYC and RTX). There was no significant difference in baseline characteristic between these two groups (table 1).With a median follow-up period of 9.8 months (interquartile range 7.6 - 13.4 months) after treatment, the FVC improved significantly from 61.3% to 65.5% (p=0.013) in CYC/RTX group, while the FVC improvement was not significant in steroid/oDMARD group (figure 1A). In CYC/RTX group, patients with non-UIP pattern (NSIP, LIP and OP) on chest CT had significant FVC improvement (p=0.021), contrasting to the patients with UIP pattern on chest CT (figure 1B).Conclusion:In pSS patients with ILD and impairment of pulmonary function at baseline (FVCReferences:[1]Wells AU, Denton CP. Interstitial lung disease in connective tissue disease--mechanisms and management. Nat Rev Rheumatol. 2014 Dec;10(12):728-39.[2]Gao Y, Moua T. Treatment of the Connective Tissue Disease-Related Interstitial Lung Diseases: A Narrative Review. Mayo Clin Proc. 2020 Mar;95(3):554-573.Table 1.Baseline characteristics of patients with Sjögren’s syndrome and interstitial lung diseaseTotal(n = 22)Steroid/oDMARDs (n = 5)Add-on CYC/RTX(n = 17)Comparison between two groups (p-value)Age, year, median (IQR)65.1 (61.7 - 69.1)64 (64.6 - 67.4)65.6 (61.6 - 69.2)0.88Female sex, n (%)15 (68%)4 (80%)12 (70%)1.00Smoking, n (%)4 (22%)0 (0%)4 (21%)0.54Baseline FVC, % of predicted value, median (IQR)63.6% (53.8 - 68.2)63.9% (63.7 - 67.5)61.3% (50.2 - 68.2)0.43Baseline DLCO, % of predicted value, median (IQR)54.4% (39.4 - 66.4)69.1% (57.8 - 75.5)52.1% (38.5 - 58.1)0.12CT pattern, n (%)NSIP - 12 (54%)NSIP 1 (20%)NSIP - 11 (65%)-UIP - 5 (22%)UIP 1 (20%)UIP - 4 (24%)LIP - 3 (13.6%)LIP 2 (40%)LIP -1 (6%)OP - 2 (9%)OP 1 (20%)OP -1 (6)UIP pattern, n (%)5 (22%)1 (20%)4 (24%)1.00CYC, cyclophosphamide; oDMARDs, oral DMARDs; RTX, rituximabFigure 1.FVC change before and after the immunosuppressive treatmentDisclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) could affect multiple parts of the eye. (1,2) Also, there is risk of ocular toxicity associated with treatment, such as hydroxychloroquine.(3) Early diagnosis is essential to avoid major ocular complications. However, complaints of eye discomfort may be vague, and various presentations may pose challenges on rheumatologists. Knowing the real-world prevalence of ocular problems in patients with SLE is important and helpful, yet this has been less common to be reported.Objectives:To describe the prevalence of various ophthalmologic diagnoses in patients with SLE.Methods:This is a retrospective observational study conducted in a tertiary hospital in Taipei, Taiwan. Patients diagnosed with SLE in the period between 1st Jan, 2002 and 31th Dec, 2015 and evaluated by ophthalmologists in 2 years before 29th Jan, 2021 were included. Demographic and clinical data, and ophthalmologic diagnoses were recorded by chart review.Results:A total of 121 patients were included, and 118 (97.5%) were female. Average age was 46.2 years [standard deviation (SD) 11.4 years] upon ophthalmologic evaluation, and average duration suffering from lupus was 11.6 years (SD 3.3 years). Keratoconjunctivitis sicca (n = 48, 39.7%), myopia (n = 39, 32.2%), and cataract (n = 21, 17.4%) were the most common findings. It was also noted that suspicious finding of hydroxychloroquine retinal toxicity was found in 12 patients (9.9% of total patients). Also, two patients had lupus retinopathy, and another two were diagnosed with cytomegalovirus retinitis. In addition, glaucoma was diagnosed in 9 patients (7.4%), which seemed to be higher than the general population.Conclusion:Higher prevalence of different ocular problems is noted in this cohort of SLE patients. Keratoconjunctivitis sicca was the most common ocular diagnosis, which is consistent with literature. However, high rates of myopia, cataract, glaucoma, and suspicious hydroxychloroquine retinal toxicity were also found. Above result warrants more aggressive ophthalmologic evaluation in SLE patients. More research on the association of lupus and different ocular diseases is needed in the future.References:[1]Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol. 2016 Jan;100(1):135–41.[2]Sivaraj RR, Durrani OM, Denniston AK, Murray PI, Gordon C. Ocular manifestations of systemic lupus erythematosus. Rheumatology (Oxford). 2007 Dec;46(12):1757–62.[3]Jorge A, Ung C, Young LH, Melles RB, Choi HK. Hydroxychloroquine retinopathy - implications of research advances for rheumatology care. Nat Rev Rheumatol. 2018;14(12):693–703.Table 1.Demographic data and ophthalmologic diagnosis of patients with systemic lupus erythematosus (N = 121)Variablen (% of N)Age (years) average (SD)46.2 (11.4)Disease duration average (SD)11.6 (3.3)Female sex118 (97.5)Chronic medical disease Hypertension28 (23.1) Diabetes mellitus4 (3.3) Dyslipidemia7 (5.8) Cancer3 (2.5) End-stage renal disease1 (0.8)Ophthalmologic diagnosis Keratoconjunctivitis sicca48 (39.7) Myopia39 (32.2) Cataract21 (17.4) Glaucoma9 (7.4) Suspicious retinopathy related to HCQ12 (9.9) Unspecified retinopathy5 (4.1) Lupus retinopathy2 (1.7) CMV retinitis2 (1.7) Central retinal vein thrombosis1 (0.8) Retinal break1 (0.8) Optic neuritis1 (0.8) Vitreal hemorrhage1 (0.8) Myodesopia4 (3.3) Scleritis1 (0.8)SD, standard deviation; HCQ, hydroxychloroquine; CMV, cytomegalovirus.Disclosure of Interests:None declared

Like everyone else, the disabled have the human rights towards independence and autonomy. Owing to various factors, their disabilities lead to their often requiring external assistance for a life of independence and autonomy. Living independently on their own for the disabled has gradually become the systematic goal which society strives for. Under this presupposition, measures and facilities to support autonomous and independent living of the disabled should be the research focus, regarding the design and how they could become social progressive measures for the disabled. Spatial analysis will be introduced to discover zones in urgent needs of insertion of social welfare resources. The research mainly makes use of the 2015 Taipei City Government database of the disabled and statistical information of the Department of Social Welfare, Taipei City Government. Through GIS displays, states of distribution of the disabled and related resources are depicted. By integrating Taipei City road network diagrams and statistical information of the disabled from the Department of Social Welfare, areas of coverage of social welfare agencies (SWAs) supporting the disabled are calculated, as zones which these agencies are capable to serve the disabled. For areas which they cannot serve, improved relaxed variable kernel density estimator is employed to discover the hotspots. Combining the hotspots with the Ministry of the Interior’s basic statistical areas, calculating weighted population center points, and suitable candidate locations for establishing SWAs supporting the disabled are found. Results of our research indicate in highlighted fashions the importance of strengthening social assistance programs within the health provision system as well as the necessity for co-operation between social workers and health workers to improve the accessibility of medical and health service for the disabled. This research focuses on expounding the disabled and SWAs supporting them, and analyzing the degree of match between their needs and welfare resources, so as to review changes to the behaviors of the disabled and their chances of survival from policy execution, and also the necessity of social workers and health workers to work together to improve the disabled obtaining medical and health service.

Since the first ambulance has been introduced to Taiwan, the members of fire departments have been dedicating themselves to emergency service training. Though all the emergency rescue measures have been improved, the causes and problems of Out-of Hospital-cardiac Arrest (OHCA) caused are still actively being explored by the experts from emergency medicine. The main causes of Out-of-Hospital Cardiac Arrest are classified into two categories: medical causes and surgical causes, the later ones mainly caused by car accidents or falls. There are some chronic disease such as heart disease (myoeardial infaracriton), chronic kidney disease, and diabetes are highly associated with Out-of-Hospital-Cardiac Arrest medical causes (Patel et al. 2014). However, in Taiwan, heart disease, hypertension, and diabetes mellitus are recognized as the three main medical causes for Out-of-Hospital-Cardiac Arrest.

Physically and mentally disabled citizens are just like the general population who have independent human rights, but outside assistance is frequently needed to achieve independency due to the disabilities. An independent life for people with disabilities has gradually become the goal of social promotion. Under the circumstances, the support strategies and facilities for the independency of physically and mentally disabled citizens should be focusing on the design and the goal of exploring the areas needing resources of social welfare by introducing spatial analysis. According to the demographic analysis on the population sizes of physically and mentally disabled citizens in Taiwan between 2008 and 2015, the highest percentage of pathogenesis in different counties/cities was 71.95% caused by illness (organ defects), and the proportion and average life expectancy of people with disabilities in the individual county/city were significantly correlated. That is, the longer average life expectancy, the higher proportion of physically and mentally disabled citizens. Because the demands on healthcare and service are gradually increasing, the establishment of support measures and facilities has become an important topic at present to achieve of the goal of well life independency. The study used a database of disabled persons published by the Taipei City Government in 2015, which was based on the statistics analyzed by the Department of Social Welfare, Taipei City Government. The description of the distribution of physically and mentally disabled citizens and resources was presented by using geographic informatics, and the coverage areas of supportive institutions were calculated based on the information network of route map combining with the statistics of physically and mentally disabled citizens made by Taipei City Government. Hop spots that cannot be covered were explored by applying the Kriging Method. Furthermore, the adequate candidate locations for setting social welfare institutions to support physically and mentally disabled citizens were calculated based on hot spots, minimal statistical areas as well as weighted population center points. Due to the lack of statistical analysis on physically and mentally disabled citizens, the characteristics of demographics were hard to be clarified. This study emphasized the relationships between physically and mentally disabled citizens and their support institutions as well as the analysis on conformity between demands and the resource of social welfare. The aim was to discuss the impacts of policy implementation on the changes in behavior or survival of physically and mentally disabled citizens.

This study has several segments: reviewing and collecting the OHCA patients with Registry Data of New Taipei city from 2010 to 2011: analyzing and appling International Utestein formula standards for data extraction; using regression analysis to search for the relationship between the variations and OHCA 2 h survival rate; appliing OHCA modeling to identify risk factors coefficient; using Apriori to analize the association rules, and adapting decision tree to create a Risk Decision Model. The correlation chronic diseases: Heart Disease, Diabetes Disease, and Hypertensive Disease have a significant correction on OHCA 2 h survival risk factors. Meanwhile, senior citizens have had high risk could not be revive form standard emergency measure. OHCA Decision tree model helped EMDand rescue units to allocate pre-hospital medical resources and contributes to an accurate clinical quality assessments to assist researchers to analyze medical policy for different OHCA patients.

Out of Hospital Cardiac Arrest (OHCA) is an important medical and public health issue. Emergency first aid service prior to hospital admission is an important indicator for the quality evaluation of the emergency medical service. OHCA frequently occurs without warning, and while there are clear steps in emergency first aid concerning the treatment of OHCA patients, their survivability diminishes if they cannot receive emergency first aid services in time. Using statistical methods such as chi-square test, logistic regression, and decision tree, the influence factors were analyzed and extracted. In addition, combining the strengths of three independent spatial clustering analysis methods, namely, the Global Moran’s Index for finding the spatial clustering, as well as the Local Moran’s Index and spatial autocorrelation analysis Getis-Ord Gi* algorithm, a novel summary approach to identify high-risk OHCA areas. The Global Moran’s Index of OHCA event locations were 0.025861, with a Z-score of 8.178045, indicating significance spatial clustering phenomenon of OHCA locations, Getis-Ord Gi* covers more towns (urban areas), but the High-High area reaching statistical standards obtained through the Local Moran’s Index also has also appeared in the high clusters Area found through search using the Getis-Ord Gi*. In addition, the important factors found through the decision tree analysis method have more space distribution coverage. When OHCA occurs, based on findings in this study, the 119-dispatch duty officer may make further inquiries regarding medical history of heart disease or diabetes, which shall serve as a reference for future dispatch of senior technicians. Based on the OHCA-prone hot zone generated by the Getis-Ord Gi* and targeting OHCA patients’ past medical history of heart disease or diabetes, public health units may adopt information technology or wearable devices as intervention in order to increase the probability of eyewitnesses and prioritize the dispatch of emergency aid resources into the hot zone, thereby enhancing OHCA patient survival rates.

The purposes of this research is using the Data Mining techniques, and explore the potential information from the National Health Insurance Research Database, analysis lung cancer patients which has the highest mortality in Taiwan, as a reference of the analysis of Bureau of National Health Insurance files and the clinical index of hospitals. By using statistical software, “SPSS Clementine 12.0”, this research merged “The detail file of hospital medical expenses inventory” and “The basic data file of medical institution” between 06’ and 09’ as the study data, then hospitalized lung cancer patients screened for the study sample, and using Two-Step clustering technique to produce the results that are effective. The hospitalized patients that with lung cancer and death patients, males have a higher percentage than females, lung cancer people are usually accompanied with comorbidities, especially for pneumonia; most lung cancer patients go to the center of medical, and most patients make booking as out-patient. The treatment of lung cancer patients should notice the factor that lead to pneumonia, and this research shows that most patients make booking as out-patient, therefore, taking drug treatment for patients can regarded as the main dependence for curing.

In this study, data mining is applied to the use of an Enterprise Resource Planning (ERP) database to explore the core value of business operations by revising the RFM model into an RFGP model through “customer value analysis”. This model is used as a tool by enterprises to make proper adjustment to business strategies in a timely manner. By using an RFM model to “analyze dependence on suppliers”, enterprises can properly plan to reduce internal procurement costs and suppliers can properly manage their risks. With this two-prong focus on “profit maximization” and “cost reduction”, enterprises can maximize their profits. The findings of this study indicate that high-value customers are stable customers and accounted for 31 % of total customers. The statistics also show that customers of LED backlight modules constituted 18 % of the total and were the primary source of profit for the enterprises. However, there remains much uncertainty in the LED lighting market and the rate of return was low. With limited operational resources, enterprises should explore technologies related to backlight products, purchase automation equipment, train professionals in related disciplines and seek to enhance their overall competitive power. Suppliers of key materials are suppliers of high dependence, accounting for 11 % of the total and including suppliers of heavy reliance and exclusive suppliers. Enterprises are strongly advised to establish new sources of supplies to ensure a proper procurement balance and reduce materials supply related risks. In addition, enterprises should take the top 10 key materials suppliers as targets for price reductions in order to cut costs and maximize profits. Enterprises are also strongly advised to invest in the suppliers of key materials. The recycled use of enterprise resources could feedback to the enterprises themselves and helps to maximize enterprise profits.

In recent years, the rapid development of trade and traffic in our country has resulted in the increasing occurrence of various types of disasters and emergency injuries. According to the statistics from Fire Departments of Taiwan, medical emergency dispatch frequencies have exceeded 300,000, and the frequency of medical emergency dispatches has increased each year. These figures reflect the phenomenon that, despite the continual growth and progression of the community, various accidents and unforeseen situations are becoming increasingly common. Therefore, fire units have established a medical emergency care system with the objective of minimizing injuries, patient suffering, and the risk of mortality, reducing social medical costs, and alleviating the financial burden of medical emergencies on families. Many countries have special medical emergency dispatch systems, but these do not meet Taiwan's rules and emergency procedures. Thus, our research has focused on compiling a symptom-based medical emergency dispatch guide designed to match Taiwan's medical emergency dispatch system. We collate national medical emergency dispatch guides and present a medical emergency dispatch system to support medical staff and to educate these staff on the correct methodology in a short time. This system achieves the following objectives: (1) to enhance the quality of medical emergency services in Taiwan, (2) to reduce the response time of medical emergency dispatch, (3) to reduce the unnecessary waste of medical resources.

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. The electroencephalogram (EEG) signals play an important role in the diagnosis of epilepsy. In addition, multi-channel EEG signals have much more discrimination information than a single channel. However, traditional recognition algorithms of EEG signals are lack of multichannel EEG signals. In this paper, we propose a new method of epileptic seizure detection based on multichannel EEG signals. Both unipolar and bipolar EEG signals are considered in our approach. We make use of approximate entropy (ApEn) and statistic values to extract features. Furthermore, we tested the performance of four different Support Vector Machines (SVMs). The results reveal that the grid SVM achieves the highest totally classification accuracy (98.91%).

The increasing dengue burden and epidemic severity worldwide have highlighted the need to improve surveillance. In non-endemic areas such as Taiwan, where outbreaks start mostly with imported cases from Southeast Asia, a closer examination of surveillance dynamics to detect cases early is necessary. To evaluate problems with dengue surveillance and investigate the involvement of different factors at various epidemic stages, we investigated 632 laboratory-confirmed indigenous dengue cases in Kaohsiung City, Taiwan during 2009-2010. The estimated sensitivity of clinical surveillance was 82.4% (521/632). Initially, the modified serological surveillance (targeting only the contacts of laboratory-confirmed dengue cases) identified clinically unrecognized afebrile cases in younger patients who visited private clinics and accounted for 30.4% (35/115) of the early-stage cases. Multivariate regression indicated that hospital/medical center visits [Adjusted Odds Ratio (aOR): 11.6, 95% confidence interval (CI): 6.3-21.4], middle epidemic stage [aOR: 2.4 (1.2-4.7)], fever [aOR: 2.3 (2.3-12.9)], and musculo-articular pain [aOR: 1.9 (1.05-3.3)] were significantly associated with clinical reporting. However, cases with pruritus/rash [aOR: 0.47 (0.26-0.83)] and diarrhea [aOR: 0.47 (0.26-0.85)] were underreported. In conclusion, multiple factors contributed to dengue surveillance problems. To prevent a large-scale epidemic and minimize severe dengue cases, there is a need for integrated surveillance incorporating entomological, clinical, serological, and virological surveillance systems to detect early cases, followed by immediate prevention and control measures and continuous evaluation to ensure effectiveness. This effort will be particularly important for an arbovirus, such as Zika virus, with a high asymptomatic infection ratio. For dengue- non-endemic countries, we recommend serological surveillance be implemented in areas with high Aedes mosquito indices or many breeding sites. Syndromic surveillance, spatial analysis and monitoring changes in epidemiological characteristics using a geographical information system, as well as epidemic prediction models involving epidemiological, meteorological and environmental variables will be helpful for early risk communication to increase awareness.