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Kawasaki Disease (KD) is a rare febrile illness affecting infants and young children, potentially leading to coronary artery complications and, in severe cases, mortality if untreated. However, KD is frequently misdiagnosed as a common fever in clinical settings, and the inherent data imbalance further complicates accurate prediction when using traditional machine learning and statistical methods. This paper introduces two advanced approaches to address these challenges, enhancing prediction accuracy and generalizability. The first approach proposes a stacking model termed the Disease Classifier (DC), specifically designed to recognize minority class samples within imbalanced datasets, thereby mitigating the bias commonly observed in traditional models toward the majority class. Secondly, we introduce a combined model, the Disease Classifier with CTGAN (CTGAN-DC), which integrates DC with Conditional Tabular Generative Adversarial Network (CTGAN) technology to improve data balance and predictive performance further. Utilizing CTGAN-based oversampling techniques, this model retains the original data characteristics of KD while expanding data diversity. This effectively balances positive and negative KD samples, significantly reducing model bias toward the majority class and enhancing both predictive accuracy and generalizability. Experimental evaluations indicate substantial performance gains, with the DC and CTGAN-DC models achieving notably higher predictive accuracy than individual machine learning models. Specifically, the DC model achieves sensitivity and specificity rates of 95%, while the CTGAN-DC model achieves 95% sensitivity and 97% specificity, demonstrating superior recognition capability. Furthermore, both models exhibit strong generalizability across diverse KD datasets, particularly the CTGAN-DC model, which surpasses the JAMA model with a 3% increase in sensitivity and a 95% improvement in generalization sensitivity and specificity, effectively resolving the model collapse issue observed in the JAMA model. In sum, the proposed DC and CTGAN-DC architectures demonstrate robust generalizability across multiple KD datasets from various healthcare institutions and significantly outperform other models, including XGBoost. These findings lay a solid foundation for advancing disease prediction in the context of imbalanced medical data., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Autoimmunity occurs when the immune system mistakenly attacks the body, but the presence of autoantibodies, such as antinuclear antibodies (ANAs), does not always lead to autoimmune diseases. Globally, autoimmunity is on the rise, influenced by socioeconomic factors, environmental exposure, diet, and stress. Climate change and pollution further exacerbate risks. The COVID-19 pandemic has worsened the issue, with unvaccinated individuals showing higher rates of autoimmune conditions postinfection. Preventive strategies, including healthy diets, stress management, and vaccination, are crucial in combating this growing epidemic. Collaboration between individuals, healthcare providers, and policymakers is critical to mitigate the rise in autoimmune disorders and enhance public health., (© 2024 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Halobacteria trueperi, an extremophilic microorganism thriving in high-salt environments, produces extracellular polysaccharides with potential anti-inflammatory and anti-aging properties. However, its clinical efficacy in skin improvement remains unclear. This study focuses on H. trueperi TCI66207, isolated from the Pacific Ocean at a depth of 662 m near Hualien, and its potential to enhance skin parameters, aiming to develop a novel functional formulation for pharmaceutical and cosmetic use., Aims: This sudy aims to evaluate the clinical efficacy of H. trueperi TCI66207 on various skin parameters and its potential for developing new functional cosmetic formulations., Patients/methods: A total of 40 subjects were recruited and randomly divided into two groups: the test group applied a serum containing H. trueperi TCI66207, while the placebo group used a basic serum. Subjects were instructed to apply the serum twice daily for 4 weeks. Skin parameters, including moisture, brightness, elasticity, pigmentation (spots and UV spots), texture, wrinkles, pores, and collagen density, were assessed before and after the 4-week application period., Results: After 4 weeks of using the H. trueperi TCI66207 serum, significant improvements were observed in all measured skin parameters compared to baseline, with notable enhancements in moisture, brightness, elasticity, texture, and collagen density, along with reductions in wrinkles, spots, and pore size., Conclusions: Halobacteria trueperi TCI66207 serum demonstrates a clear ability to improve skin conditions and delay signs of aging, making it a promising candidate for the development of new cosmetic formulations with potent anti-aging and skin-rejuvenating properties., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Improving hazards in maritime transport is essential to maintain the reliability and sustainability of the industry, ensure safety and security, and support global trade and economic growth. This paper is aimed at analyzing the hazards of passenger-cargo ferries (PCFs). The novelty of this paper is fourfold: (1) developing a revised risk matrix (RRM) model with considering the adaptability-based resilience of organization to assess PCFs' hazards, (2) identifying risk factors (RFs) in ferry navigation and developing adaptive strategies to mitigate hazards, (3) applying the fuzzy best-worst method (BWM) to determine the RFs' weight, and (4) employing the leading Taiwanese passenger-cargo ferry operator (the Taiwan-ferries case) as an empirical study to verify the proposed model. The empirical result can provide pragmatic information for ferry operators to improve the safety of their ferry navigations. Additionally, the proposed RRM model can provide a methodological reference for related research in hazard management., Competing Interests: Declarations. Ethical approval: This study was approved by the Administration Committee of College of Marine, NKUST, ROC. Consent to participate: There are no human subjects in this article; so, informed consent is not applicable. Consent for publication: The authors agree that if the manuscript is accepted by the Editor-in-Chief, it will be published in the Journal. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate the psoriatic disease risk among patients with previous appendicitis., Methods: This study was a nationwide population-based case-control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared., Results: A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p < .05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill-defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill-defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill-defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03-1.31, 1.05-1.11, 1.65-1.74, and 1.20-1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders., Conclusion: Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged., (© 2024 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Lymphedema is a debilitating condition that significantly affects quality of life due to its chronic nature and visible symptoms. Lymphaticovenous anastomosis (LVA) has emerged as a promising surgical intervention, yet its effects on body image and spiritual health alongside physical symptoms have not been thoroughly examined. This study evaluates the efficacy of LVA in improving symptoms, quality of life (QOL), body image, and spiritual well-being in lymphedema patients., Methods: A prospective cohort study was conducted at Kaohsiung Chang Gung Memorial Hospital, Taiwan, involving 44 patients with lymphedema undergoing LVA surgery. Evaluations were made pre-surgery, one month post-surgery, and six months post-surgery using the 36-Item Short Form Health Survey (SF-36), Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and a spiritual health scale. Statistical analysis was performed using one-way repeated measures ANOVA., Results: Significant improvements were observed in lymphedema symptoms and QOL measures at six months post-operation. SF-36 results showed enhanced scores in nearly all domains, particularly in physical functioning and role-physical. The appearance orientation scores from the MBSRQ-AS significantly increased, indicating improved perceptions in some dimensions of body image., Conclusions: LVA surgery significantly enhances physical and psychological outcomes in patients with lymphedema, with marked improvements in symptoms, QOL, and body image perceptions. The findings suggest that while LVA is effective in addressing the physical and psychological aspects of lymphedema, it does not impact spiritual dimensions. This underscores the need for holistic approaches in the management of lymphedema to address all facets of patient well-being.

Background: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality., Objective: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality., Methods: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality., Results: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the "Assurance" dimension yielded the least favorable results, registering a negative review rate as high as 58.3%. Closely trailing, the "Responsiveness" dimension recorded a negative review rate of 34.2%. When evaluating the service process, the subitem "In Service: Diagnosis/Examination/Medical/Hospitalization" exhibited the least satisfactory performance, with a negative review rate of 46.2%. This was followed by the subitem "In Service: Pre-diagnosis Waiting," which had a negative review rate of 20.2%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01)., Conclusions: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area., (©Ching-Yuan Huang, Po-Chun Lee, Long-Hui Chen. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.05.2024.)

Introduction: How parents think and feel about their children's use of technology can influence how their kids behave online. The family's socioeconomic status (SES) may also affect this influence. In light of this, this research emphasizes the need for more investigation into parental attitudes and the role of SES in shaping how children consume media., Methods: This study surveyed 629 Taiwanese parents to explore their attitudes toward their young children's use of information communication technology (ICT), usage patterns, and the interplay with socioeconomic status., Results: The findings revealed a significant disconnect: although approximately 50% of parents considered above six years old to be a suitable age for children to start ICT, over 80% of children had already engaged with ICT before that age, indicating a large disparity between parental expectations and actual initiation. Furthermore, parents highlighted "learning interest" and "various content" as the most positive impacts of children's ICT use, while "addiction and overreliance" emerged as their primary concern. Notably, parents, as a whole, tended to perceive their child's ICT use more negative than positively, with fathers displaying greater acceptance of negative viewpoints than mothers. Parental attitudes toward children's ICT use were categorized into five clusters, ranging from balanced and optimistic views to value emphasis, conservatism, and negative doubts. This classification underscores the intricate and multifaceted nature of parental perspectives, encompassing both positive and negative outlooks on children's ICT utilization., Discussion: The findings underscore the nuanced character of parents' attitudes toward technology, shaped by the intricacies and challenges posed by the digital era. These insights emphasize that parental attitudes go beyond a simplistic positive-negative divide, reflecting a comprehensive response to the opportunities and complexities inherent in the digital age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Luo, Yang, Chou and Lee.)

Background: Maintaining cognitive and physical function is essential to healthy aging., Aim: This study aims to investigate the effect of an exercise-cognitive dual-task program in Chinese language on cognitive function and functional fitness in older adults., Methods: Seventy adults aged 60-84 years were conveniently assigned to one of the three groups: exercise-cognitive dual-task (EC) group (n = 28), exercise group (n = 22), and control group (n = 20). The EC group received a 90-min class including multicomponent exercise-cognitive dual-task twice a week. The exercise group received a 90-min class including multicomponent exercise twice a week. The control group maintained their regular level of physical activity and general lifestyle. Cognitive functions and functional fitness were measured before and after the 12-week intervention., Results: The participants in the EC and exercise group significantly improved scores in Taiwanese Frontal Assessment Battery, the Chang Gung University Orthographical Fluency Test, and the Mini-Mental State Examination; however, those in the control group did not. The participants in the EC and exercise group showed significant increases in almost all functional fitness tests. The participants in the EC group showed significantly higher improvements in Chang Gung University Orthographical Fluency Test score and aerobic endurance than the exercise group and in Chang Gung University Orthographical Fluency Test score and lower body strength than the control group. In addition, the changes in Taiwanese Frontal Assessment Battery and Mini-Mental State Examination scores were significantly correlated with the changes in functional fitness., Conclusion: The dual-task intervention resulted in greater improvements in verbal fluency, endurance, and muscular strength than exercise alone and control., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

An ammonia sensor based on a delay-line surface acoustic wave (SAW) device is developed in this study by coating the delay line area of the device with a nano-structured molybdenum disulfide (MoS 2 ) sensitive material. A SAW device of 122 MHz was designed and fabricated with a pair of interdigital transducers (IDTs) defined on a 128° y-cut LiNbO 3 substrate using photolithography technologies, and the aluminum IDT electrodes were deposited by a DC magnetron sputtering system. By adjusting the pH values of precursor solutions, molybdenum disulfide (MoS 2 ) nanospheres were prepared with various structures using a hydrothermal method. Finally, an NH 3 gas sensor with high sensitivity of 4878 Hz/ppm, operating at room temperature, was successfully obtained. The excellent sensitivity performance may be due to the efficient adsorption of NH 3 gas molecules on the surfaces of the nanoflower-like MoS 2 , which has a larger specific surface area and provides more active sites, and results in a larger change in the resonant frequency of the device due to the mass loading effect.

Osteoarthritis is one of the most common diseases and poses a significant medical burden worldwide. Currently, the diagnosis and treatment of osteoarthritis primarily rely on clinical symptoms and changes observed in radiographs or other image modalities. However, identification based on reliable biomarkers would greatly improve early diagnosis, help with precise monitoring of disease progression, and provide aid for accurate treatment. In recent years, several biomarkers for osteoarthritis have been identified, including image modalities and biochemical biomarkers such as collagen degradation products, pro- or anti-inflammatory cytokines, micro RNAs, long non-coding RNAs, and circular RNAs. These biomarkers offer new insights in the pathogenesis of osteoarthritis and provide potential targets for further research. This article reviews the evolution of osteoarthritis biomarkers from the perspective of pathogenesis and emphasizes the importance of continued research to improve the diagnosis, treatment, and management of osteoarthritis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Importance: The incidence of inflammatory bowel disease (IBD) is increasing in newly industrialized countries but disease etiologies remain unclear., Objective: To investigate the association between physical fitness and subsequent IBD risk among children and adolescents in Taiwan., Design, Setting, and Participants: This nationwide cohort study was conducted between January 1, 2010, and December 31, 2018. Data sources included the Taiwan National Health Insurance Research Database, the National Student Fitness Tests Database, and the Air Quality Monitoring System Database. This study included students who were aged 10 years, completed physical fitness tests between grades 4 and 13, and had at least 1 year of follow-up. Data analysis was last performed on January 15, 2023., Exposures: Physical fitness tests included cardiorespiratory endurance (CE; number of minutes to complete an 800-m run), musculoskeletal endurance (ME; number of bent-leg curl-ups in 1 minute), musculoskeletal power (MP; standing broad jump distance), and flexibility fitness (FF; 2-leg sit-and-reach distance)., Main Outcomes and Measures: Subsequent risk of IBD was compared among students based on physical fitness test results. Six-year cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality. Performance was reported in quantiles, ranging from 1 (best) to 4 (poorest)., Results: There were 4 552 866 students who completed physical fitness tests between grades 4 and 13; among these students, 1 393 641 were aged 10 years and were included in the analysis. Six-year cumulative incidence of IBD risk was lowest among students in the best-performing quantile of CE (quantile 1, 0.74% [95% CI, 0.63%-0.86%]; P < .001), ME (0.77% [0.65%-0.90%]; P < .001), and MP (0.81% [0.68%-0.93%]; P = .005) compared with students in quantiles 2 through 4, respectively; however, no association was observed for quantiles of FF. After adjusting for competing HRs for mortality and other confounders, better CE was inversely associated with IBD risk (adjusted HR, 0.36 [95% CI, 0.17-0.75]; P = .007). Other measures of physical fitness were not independently associated with IBD risk., Conclusions and Relevance: The results of this study suggest that CE was inversely associated with IBD risk among children and adolescents, but ME, MP, and FF were not independently associated with IBD risk. Future studies that explore the mechanisms are needed.

Background: The advancement of digital technology implies the importance of polychronic learning. Since polychronicity is not equivalent to multitasking behavior, they need to be considered separately. However, less research has been explored on how polychronicity is related to multitasking behavior in the educational field., Objective: To explore the relationships among polychronicity, multitasking behavior and learning performance (including knowledge acquisition and learning satisfaction) in an online learning environment., Methods: The relationship among variables was analyzed from 865 responses obtained from a questionnaire survey, and independent sample t tests and SEM analysis were used to examine the research hypotheses., Results: College students showed a higher frequency of multitasking behavior, time tangibility and scheduling preference, and learning satisfaction in multitasking online learning environments than high school students. Additionally, college students were different from high school students on the paths of involvement with people to multitasking behavior (Δ  χ 2 = 5.42, p  = 0.02) and scheduling preference to learning satisfaction (Δ χ 2  = 9.54, p  = 0.002)., Conclusion: The relationship among polychronicity, multitasking behavior and perceived learning performance in an online learning environment varies by student educational stage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Luo, Kang, Yang and Lu.)

Tumor necrosis factor inhibitors have been widely used in the field of axial spondyloarthritis, with current guidelines now recommending dose reduction instead of withdrawal of biologics. Systemic review and meta-analyses in literature have summarized present tapering strategies and principles in published heterogeneous studies. In this study, we reviewed and provided an update on present evidence based on prospective and retrospective studies from 2008 to 2022 by performing a literature review of related publications on remission or relapse from PubMed. We further stated the core issues concerning dose reduction, including the timing, optimization, intensity, maintenance, monitoring, factors associated with tapering and solutions to de-escalation failure. Remission/relapse should be the principal consideration in dose reduction implementation for individuals without comorbidities. As a treat-to-target scope of this multifaceted systemic disease, extra-articular manifestations such as uveitis, psoriasis, inflammatory bowel disease, cardiovascular complication, hip involvement and progressed structural damage influence patient-tailored dose reduction plans. Safety concerns and costs should be integrated into the decision-making schedule to optimize the individualized dose reduction paradigm., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50−2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55−2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62−3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47−1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66−2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.

Objective: Patients with schizophrenia are living at the border of society and their sexuality is often neglected. The aim of the study is to explore the association among The Brief Psychiatric Rating Scale (BPRS), quality of life (QoL), Taiwanese Depression Questionnaire, and Sexual Desire Inventory in people with schizophrenia (PwS)., Methods: This study used a cross-sectional design with 277 psychiatric inpatients. A descriptive analysis, difference analysis, and logistic regression model were presented to identify relevant variables that may affect the probability of good QoL., Results: The study showed that male PwS had higher scores of standard deviation (SD) than females in PwS. The study also showed that smoking, early illness onset age, and shorter illness duration demonstrated a significantly higher SD. The logistic regression analysis showed that BPRS, depression, and SD significantly affected the probability of QoL. By structural equation model, SD would be positively correlated with mental status and SD would indirectly influence QoL., Conclusion: Our results showed psychological and sociological factors interactions may contribute to the QoL and SD for PwS. This study also demonstrated a close relationship between SD, depression, and BPRS. These factors may predict the probability of good life quality for the PwS.

Taiwan's coronavirus (COVID-19) vaccine procurement was delayed until October 2021. With the vaccine's introduction in Taiwan, the public will have an opportunity to choose vaccination. Choosing to vaccinate involves considerations regarding the trade-off between the protective power of the vaccine and its side effects, which is a planned behavior. College students have considered high-risk objects for COVID-19 outbreaks given their lifestyle, and their efficient vaccination may help reduce mutual infection between college students and the general public. This study obtained 707 valid questionnaires from Taiwan college students (20 years old and above). We investigated several factors during our college students' survey regarding vaccination. Among this integrated TPB model, "Attitude," "Subjective Norm," "Perceived Behavioral Control," and "COVID-19 Information Asymmetry" had a positive impact on vaccination "Behavioral Intention." COVID-19 information asymmetry positively and significantly affected behavioral intention through perceived behavioral control, while perceived behavioral control had a mediating effect. To promote the behavioral intention of college students to choose COVID-19 vaccination, public and private departments for epidemic prevention must aim to overcome the self-efficacy barriers of perceived behavioral control and promote the primary group influence effect of subjective norm and the self-interest factor of attitude. Governments and NGOs should also ensure prompt and accurate transmission of epidemic and vaccine information and actively investigate and prohibit misleading details from unknown sources and no scientific basis. Such a policy will generate trust, effectively increasing the vaccination rate and reducing cluster infection.

Background: In recent years, studies have shown that electronic WOM (eWOM) directly reflects consumers' post-purchase psychological perception and directly affects repurchase behavior. This information is valued by institutions in various fields. Within the scope of the evaluation of service characteristics, medical service is the least visible and most difficult service attribute to evaluate. Service organizations must have high trust attributes. Therefore, an eWOM review significantly influences people's decision-making process when choosing a healthcare provider. The purpose of this research is to combine eWOM reviews with the SERVQUAL scale in a comparative study of positive and negative eWOM reviews of a regional teaching hospital in Taiwan., Methods: This research obtained data from publicly available eWOM reviews on Google Maps of a regional teaching hospital in Taiwan over the past 10 years (from June 24, 2011, to December 31, 2021) using website scraping technology. The semantic content analysis method was used in this study to classify eWOM reviews according to the revised PZB SERVQUAL scale., Results: Statistical analysis was conducted. During the COVID-19 pandemic, positive reviews showed a downward trend. Among the five determinants of the SERVQUAL of PZB, positive eWOM reviews performed best in "assurance" with a positive review rate of 60.00%, followed by 42.11% for "reliability". For negative eWOM reviews, "assurance" performed the worst with a positive rate of 72.34%, followed by "responsiveness" at 28.37% and "reliability" at 26.95%., Conclusion: Since the onset of COVID-19 in 2020, negative eWOM has increased significantly and exceeded the amount of positive eWOM. Regardless of positive and negative reviews, what patients care most about is "assurance" of the professional attitude and skills of medical staff, which urgently needs to be strengthened. In addition, good "reliability" will help to develop positive eWOM. However, "responsiveness" as indicated by poor service waiting time can easily lead to the spread of negative eWOM. Hospital management should focus on these service-oriented qualities., (© 2022. The Author(s).)

As a result of the trend toward economic globalization, the vigorous development of cross-border e-commerce has attracted many scholars to study this field, involving many related fields, such as consumer behavior, advertising, information systems, and supply chain management. Throughout the existing literature, it can be found that most of the research focuses on certain influencing factors of the development of cross-border e-commerce, and there is no systematic and macro- overview of the development trend of research in this field in recent years, nor the integration and analysis of keywords. Given that the research in the field of cross-border e-commerce is fragmented to a large extent, to effectively explore the research trend in this field, we must understand the current situation of cross-border e-commerce. Systematic bibliometric analysis can solve this problem by providing publishing trends and information on various topics. Therefore, based on the scientific database web, this study collected 198 references related to cross-border e-commerce from 2016 to 2021, briefly introduced the current situation and development trend of cross-border e-commerce, visually analyzed and refined the journals, authors, research institutions, countries, publication years, keywords, citations of academic publications in this field, and other key information, and summarized the development trend and path of CEBC in the existing research. It is helpful for researchers to solve the current research gap, understand the future research direction in this field, and help academia establish a strict knowledge system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chen, Li, Song, Ma, Jiang, Wu and Chen.)

Ankylosing spondylitis (AS) has been associated with an increased cardiovascular disease (CVD) risk, with current guidelines recommending multiple CVD-related risk assessment strategies. CVD risk prediction using a scoring model with lipids might be another promising alternative, for which ultrasound screening for subclinical atherosclerosis may be considered together with surrogate markers. Theoretically, tumor necrosis factor inhibitors (TNFi), which are known to inhibit endothelial activation and inflammation caused by the disease and underlying metabolic dysfunction, might prevent microvascular events. In this narrative review, we summarized the evidence of TNFi effects on CVD in AS. Although early case reports revealed that CVD occurred during TNFi treatment, more recent evidence shows that it could be successfully treated. Studies of TNFi on lipid changes and subclinical atherosclerosis have shown controversial results, possibly due to genetic predisposition, differences in affinity for membrane-bound TNF leading to insufficient inhibition of inflammation or primary failure response to TNFi, and not enough follow-up time to identify potential significance. Overall, patients vulnerable to CVD could benefit from long-term administration of TNFi when inflammation is under control. Besides healthy lifestyle modification, traditional CVD risk factors and metabolic syndrome-related diseases should be further assessed and treated if necessary., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Orchalgia is a common andrological disorder and usually results from pathognomonic change of testes and regional structures. However, responsible cause is still unknown in more than one-fourth of patients., Methods: We report two men who initially suffered an acute, isolated orchalgia and posteriorly complicated with paraparesis. They had previous history of prostate cancer and cervical myelitis. The urological examination was negative in both of them. Finally, prostate cancer metastasis and recurrent myelitis at T2/3 level was identified, respectively. Although their orchalgia progressively subsided, their urological, sexual and neurological dysfunction persisted., Conclusions: In the literature, the responsible pathology of spinal orchalgia was exclusively found below T10 level, frequently delaying affirmative diagnosis. Therefore, a thorough evaluation of spinal cord above T10 level should be alerted for idiopathic orchalgia with a pre-existing history or risk of spinal cord disorder and a negative urological examination., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

This study aimed to develop cross-domain deep learning courses of artificial intelligence in vocational senior high schools and explore its impact on students' learning effects. It initially adopted a literature review to develop a cross-domain SPOC-AIoT Course with SPOC (small private online courses) and the Double Diamond 4D model in vocational senior high schools. Afterward, it adopted participatory action research (PAR) and a questionnaire survey and conducted analyses on the various aspects of the technology acceptance model by SmartPLS. Further, this study explored the impact on the effects of deep learning and knowledge-ability learning of artificial intelligence after 16 weeks of course teaching among 36 Grade I students from the electrical and electronic group of a vocational senior high school. This study revealed that (1) the four stages of the SPOC-AIoT Teaching Mode of the Double Diamond 4D model may effectively guide students to learn AIoT knowledge and skills. (2) Based on the technology acceptance model, the analysis of learning and participation in SmartPLS indicated that this model conformed to the academic fitness requirements of the overall model. (3) After learning with the SPOC-AIoT Teaching Mode, the learning effects of students in AIoT have been significantly improved to a positive aspect. Finally, some suggestions were put forward to promote the development of the SPOC-AIoT Teaching Mode Course in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tsai, Chung, Cheng and Lou.)

Over the past decade, neuroscience has been integrated into information systems as a new methodology and perspective to study and solve related problems. Therefore, NeuroIS has emerged as a new cutting-edge research field. This review aimed to identify, summarize, and classify existing NeuroIS publications through knowledge mapping and bibliometric analysis. To effectively understand the development trend of NeuroIS, this study referred to the journal selection index of the Association of Business Schools in 2021 and journals above three stars in the field of information management as the main selection basis. A total of 99 neuroscience papers and their citation data were included from 19 major information systems journals of SCI/SSCI. This study analyzed bibliometric data from 2010 to 2021 to identify the most productive countries, universities, authors, journals, and prolific publications in NeuroIS. To this end, VOSviewer was used to visualize mapping based on co-citation, bibliographic coupling, and co-occurrence. Keywords with strong citation bursts were also identified in this study. This signifies the evolution of this research field and may reveal potential research directions in the near future. In selecting research methods and analysis tools for NeuroIS, content analysis was used to further conclude and summarize the relevant trends. Moreover, a co-citation network analysis was conducted to help understand how the papers, journals, and authors in the field were connected and related, and to identify the seminal or pioneering major literature. For researchers, network maps visualized mainstream research and provided a structural understanding of NeuroIS. The review concludes by discussing potential research topics in this field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lin, Chen, Jiang, Chen and Jin.)

Aim: To investigate the association between ankylosing spondylitis (AS) and alopecia., Methods: In this cohort study, data from over 1 000 000 patients in the Taiwan Longitudinal Health Insurance Database were extracted. We selected newly diagnosed (outpatient department visit three or more times or admission at least once) patients with AS (ICD-9-CM = 720.0) from 2000 to 2012. For the non-AS comparison group, patients never diagnosed with AS were chosen from 1999 to 2013. In all, 3640 AS patients and 14 560 non-AS controls were selected. Cox proportional hazard model and Kaplan-Meier analysis were used to present the results. The adjusted hazard ratio (HR) in the Cox proportional hazard model was adjusted for age, sex, hypertension, hyperlipidemia, diabetes, atopic dermatitis, and mental disorder., Results: No increased risk of alopecia in AS patients was shown in the Cox proportional hazard model (crude HR 1.16, P = 0.595; adjusted HR 1.16, P = 0.599). Negative results are found as well in subgroup analysis of different age, sex (age 20-40 y: HR 1.03, P = 0.925; Age ≥40 y: HR 1.49, P = 0.406; Female: HR 1.17, P = 0.759; Male: HR 1.15, P = 0.667), and phenotypes of alopecia (androgenetic alopecia: HR 1.19, 95% confidence interval [CI] 0.58-2.41; alopecia areata: HR 0.98, 95% CI 0.37-2.62). A significant positive correlation is found between atopic dermatitis and alopecia (adjusted HR 8.05, P = 0.039)., Conclusion: In this population-based cohort study, we found no association of risk of alopecia and AS., (© 2022 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

The study examined the effects of swimming pools on healthcare professionals' willingness to engage in recreational activities, physical anxiety, and physical and mental well-being in the context of COVID-19. The research adopted the mixed research method, used SPSS 26.0 statistical software to test the reliability of the questionnaire, and then collected 840 valid questionnaires; first analyzed the data with basic statistics, t -test, ANOVA, and PPMCC test methods, and then used the interview method to collect expert opinions. A multi-check approach assembled all data and discussions. The study found that the use of personnel dynamic tracking systems or measures, combined with sodium hypochlorite and repeated filtration to stabilize water quality, could maintain the confidence of most medical workers in the swimming pool sports environment for epidemic prevention and avoid violations. The government could formulate safety prevention and control mechanisms in traffic and establish appropriate traffic routes. Next, formulated a prescription for swimming or other physical activity mechanisms for men aged 31-50 and redesigned measures for medical staff over 51 years old to have tense head issues and physical fatigue, promote blood circulation and improve sleep quality. This will promote the purpose of relieving stress and regulating the physical and mental health of medical staff after engaging in swimming., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lu, Tseng, Lin, Perng and Tseng.)

Objective: Few large-scale studies have focused on the effect of gynecologic cancer compared with other biopsychosocial factors on willingness to seek treatment among women with sexual dysfunction. The aim of study was to identify predictors of the intention to treat female sexual dysfunction (FSD) among sociodemographic factors, physiologic factors, psychologic factors, gynecologic cancer, and health belief model (HBM)., Materials and Methods: This study was a cross-sectional, hospital-based survey conducted from October 2013 to September 2019. Participants included healthy women and gynecologic cancer survivors who were aged 20 years or older and had been in a monogamous relationship for at least 12 months. They were enrolled in the gynecologic departments in southern Taiwan. Those who met DSM-5 criteria of sexual dysfunction were analyzed with Structural equation modeling. Intention to seek treatment was the primary outcome., Results: 448 of 643 women met DSM-5 sexual dysfunction. The mean age was 42.0 years (range: 21.8-68.1 years). Fifty-eight percent of women reported sexual treatment intention. The model fit was good: χ2 = 367.42, P < .001, χ2/df = 2.83, CFI = 0.933, TLI = 0.921, and RMSEA = 0.066 (95%CI: 0.058-0.074). Perceived severity, perceived benefits, perceived barriers, cue to action, self-efficacy and university education at least significantly predicted treatment intention. There were no significant differences in treatment intention regarding age and gynecologic cancer. Self-efficacy was the strongest predictor, which directly affected treatment intention (P = .001). Perceived severity was the second strongest predictor, mainly affecting treatment intention indirectly (P = .01). Perceived barriers was the third strongest predictor (P = .001), indirectly and negatively affected treatment intention., Conclusions: Five out of six HBM factors and university education at least could significantly predict the intention to treat FSD. Gynecologic cancer was not a significant predictor., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2022. Published by Elsevier B.V.)