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目的：營養不良是老年中常見的健康問題。在台灣，老年人必須在巴氏量表（BI）達到90分以上，才有資格申請入護理機構；但是，不需要有營養評估。本研究的目的是當老年人要求轉診護理機構時，是否可以以BI去評估營養狀況。方法：這是一個多中心的橫斷式研究。在2010年11月至2011年5月之間對台灣三個療養院的居民進行評估。其中包括251位年齡在70歲以上的個案。我們收集了個案的背景資料、BI評分、迷你營養評估以及調查牙齒健康和吞嚥能力的問卷。結果：平均年齡和BI評分分別為82.9（SD5.6）和88.8（SD21.7）。在研究樣本中，確定有營養不良風險的個案為123名（49.0％）。在預測營養不良的風險上，BI有高度的準確性（ROC曲線為79.1％）。較低的BI分數與較高的營養不良風險相關。所有BI項目中，爬樓梯項目與營養狀況之間的相關性最強（Cohen：0.90），其次是活動能力和輪椅到床的移動（ES：0.76）。結論：我們強調早期預防老年營養不良是相當重要。本研究顯示，BI可以協助初步評估營養狀況。 Objective: Malnutrition is a common health concern among the older population. In Taiwan, older adults are required to score 90 or higher on the Barthel Index (BI) to qualify for admission to public long-term care institutions; however, they are not ob-ligated to undergo nutritional assessments. This study demonstrated the utility of the BI in determining nutritional status when older adults are referred to public long-term institutions. Methods: In this multicentre cross-sectional study, 251 residents aged 70 years or older at three nursing homes in Taiwan were evaluated between November 2010 and May 2011. Information on participants’ health history was collected, in-cluding BI scores, Mini Nutritional Assessment results, and previous responses to a questionnaire on dental health and swallowing capacity. Results: The mean age and BI score were 82.9 (SD 5.6) and 88.8 (SD 21.7), respectively. Among the study sample, 123 (49.0%) participants were identified as having a risk of malnutrition. The BI had high accuracy (area under the receiver operating characteristic curve, 79.1%) when used to predict the risk of malnutrition. Lower BI scores were associated with a higher risk of malnutrition. Of all BI items, the stair-climbing item had the highest correlation with nutritional status (Cohen’s standardised effect size [ES]: 0.90), followed by mobility and chair–bed transfers (both ESs: 0.76). Conclusion: We emphasise that preventing worsening malnutrition in older long-term care residents is crucial. The present study revealed that the BI can help with the primary assessment of nutritional status in older adult men, although it cannot be a decisive tool by itself for nutritional status assessment. &nbsp

Missing or compromised permanent molars can complicate orthodontic treatment planning and mechanics. Molar extraction should be considered in appropriate situations, but clinicians must decide between closing and regaining the edentulous space. Several factors should be taken into consideration to achieve appropriate molar space management, such as the need for space, asymmetry, periodontal status, sinus pneumatization, and the terminal molar position. Herein, three sample cases are reported to demonstrate the treatment options for molar space closure and maintenance with these factors taken into consideration during treatment planning. The understanding of mechanics played a crucial role in anchorage preparation and side effect prevention. If the third molar substitution was managed in advance and adequate space between the ramus and third molar was obtained via second molar protraction, the tooth spontaneously erupted in a favorable position without requiring further treatment. This case series can aid clinicians in molar space management. Regardless of whether the space is to be closed or regained, the treatment plan should conform to the patient’s expectations and improve occlusion with minimal side effects and treatment duration.

Text-mining algorithms can identify the most prevalent factors of risk-benefit assessment on the use of complementary and integrative health approaches that are found in healthcare professionals' written notes. The aims of this study were to discover the key factors of decision-making on patients' complementary and integrative health use by healthcare professionals and to build a consensus-derived decision algorithm on the benefit-risk assessment of complementary and integrative health use in diabetes. The retrospective study of an archival dataset used a text-mining method designed to extract and analyze unstructured textual data from healthcare professionals' responses. The techniques of classification, clustering, and extraction were performed with 1398 unstructured clinical notes made by healthcare professionals between 2019 and 2020. The most important factor for decision-making by healthcare professionals about complementary and integrative health use in patients with diabetes was the ingredients of the product. Other important factors were the patient's diabetes control, the undesirable effects from complementary and integrative health, evidence-based complementary and integrative health, medical laboratory data, and the product's affordability. This exploratory text-mining study provides insight into how healthcare professionals decide complementary and integrative health use for patients with diabetes after a risk-benefit assessment from clinical narrative notes.

Background: Tobacco control activities have mostly influenced those smokers who found it easier to quit and, thus, remaining smokers are those who are less likely to stop smoking. This phenomenon is called “hardening hypothesis,” which individuals unwilling or unable to quit smoking and likely to remain so. The aim of this study was to identify the factors correlated with smoking cessation among hardcore smokers. Methods: A cross-sectional descriptive correlational research design was employed. Hardcore smokers from communities in Taiwan were recruited to participate in the study (N = 187). Self-report questionnaires were used to collect demographic data as well as data on nicotine dependence, quitting self-efficacy, social smoking motives, attitudes towards the Tobacco Hazards Prevention Act (THPA), and smoking cessation. Logistic regression analysis was used to examine the factors that were related to quit smoking. Results: About 30.3% (n = 54) reported having experienced quitting smoking over 7 days in the past year. Logistic regression analysis indicated that attitudes towards the THPA was identified as a particularly important factor contributing to the increase in smoking cessation among hardcore smokers. Conclusions: Nurses should cooperate with smoking cessation coaches to facilitate the improvement of attitudes towards the THPA as a key means through which to increase the smoking cessation rate among hardcore smokers.

A versatile phase transformation strategy was proposed to synthesize novel BiVO4 nanosheets (NSs)@WO3 nanorod (NR) and nanoplate (NP) arrays films. The strategy was carried out by following a three-step hydrothermal process (WO3→WO3/Bi2WO6→WO3/BiVO4). According to the characterization results, plenty of BiVO4 NSs grew well on the surface of WO3 NR and NP arrays films, thus forming the WO3/BiVO4 heterojunction structure. The prepared WO3/BiVO4 heterojunction films were used as the photoanodes for the photoelectrochemical (PEC) water splitting. As indicated by the results, the photoanodes exhibited an excellent PEC activity. The photocurrent densities of the WO3/BiVO4 NR and NP photoanodes at 1.23 V (vs RHE) without cocatalyst under visible light illumination reached up to about 1.56 and 1.20 mA/cm b respectively.

PurposePlaying exergames may resemble doing conventional exercise and thus has the potential to enhance users’ health. However, no study has yet examined whether and how a need for exercise impacts users’ intention to continuously play exergames, i.e. continuance intention and its antecedents. We developed a model grounded in the uses and gratifications theory (UGT) to address this issue.Design/methodology/approachWe recruited 583 participants to play exergames and collected their psychological responses and physical information. Structural equation modeling (SEM) was used to test the hypotheses.FindingsWe found that health consciousness and perceived exercise benefits are positively related to a need for exercise, which is, in turn, positively related to continuance intention. Moreover, perceived exergame similarity with exercise strengthens the positive link between the need for exercise and continuance intention.Originality/valueThis is the first study using the UGT to explain the underlying mechanism linking health consciousness to continuance intention in the playing of exergames. In addition, we introduced the need for exercise as a novel construct in this study. Our findings provide insights to managers on incorporating health-related features into their exergame products to motivate users' engagement in playing exergames.

Helminthostachys zeylanica (HZ), which is also called "Dao-Di-U-Gon" in Taiwan, has anti-inflammatory and antiedema effects and is commonly used to treat edema in patients with fractures. The ugonin K component of HZ can induce osteogenesis and promote bone mineralization, its therapeutic effect, however, its therapeutic effect remains unclear. Therefore, the purpose of the present study was to investigate the effect of HZ on functional recovery in patients with ankle fractures requiring surgical treatment.A double-blinded, randomized, controlled study was conducted. A total of 45 patients with ankle fractures requiring surgical treatment were assigned to either the control group (n = 23 patients), which received the oral administration of HZ placebo 1.0 g t.i.d. for 42 days continuously, or to the treatment group (22 patients), which received HZ for 42 days.The serum amino-terminal propeptide of type 1 procollagen (PINP) levels were similar in the first assessment (V1) between the control (45.90 ± 16.31 ng/mL) and treatment groups (52.61 ± 21.02 ng/mL; p = 0.240); the differences in PINP level between the third assessment (V3) and V1 were greater in the treatment group (35.84 ± 24.56 ng/mL) than in the control group (16.34 ± 11.97 ng/mL; p = 0.002). Radiographic healing time (RHT) was 9.09 ± 1.15 weeks in the treatment group, which was shorter than the 9.91 ± 0.79 weeks (p = 0.012) in the control group.Oral administration of HZ for 42 days can increase serum PINP level and reduce the RHT. Therefore, HZ can be used to treat patients with ankle fractures requiring surgical treatment. However, a larger sample size is needed in future studies.

The short neuropeptide F (sNPF) signaling system, consisting of sNPF and its receptor (sNPFR), influences many physiological processes in insects, including feeding, growth and olfactory memory. We previously showed that sNPF regulates olfactory sensitivity in the oriental fruit fly Bactrocera dorsalis (Hendel) during starvation. However, the functional analysis of sNPFR is constrained by the failure of RNA interference in this species. Here, we generated a null sNPFR mutant using the CRISPR/Cas9 system to investigate the physiological roles of this receptor in more detail. G0 adults were produced at a frequency of 60.8%, and sNPFR−/− mutants were obtained after several generations of backcrossing followed by self-crossing among heterozygous flies. We found that the mutants were significantly less successful at foraging for certain foods and showed increased foraging latency. Electroantennogram (EAG) assays indicated that the mutants had significantly lower electrophysiological responses to three tested odorants. Furthermore, qPCR data revealed the inhibition of several olfactory receptor genes, including Orco. Immunohistochemistry showed that BdsNPFR was localized in cells under the sensillum on the antennae. Based on their shape and size, the BdsNPFR+ cells differ from odorant receptor neurons (ORNs), which were labeled using a Drosophila melanogaster Orco antibody. Our data suggest that sNPFR regulates olfaction-mediated foraging behavior by mediating interactions between BdsNPFR+ cells and selected ORNs.

A hybrid host combined with rigid and flexible structural moieties to confine sulfur species physically and chemically is designed and applied for the lithium-sulfur battery. The self-assembled graphene aerogel with nano-MnO2 modified walls serves as the rigid sulfur container while the cross-linked PVP-PVA interpenetrating network acts as the flexible polysulfide trap. The synergic actions enable the hybrid host to present not only good electronic and ionic 3D transfer pathways, but also superior physical and chemical sulfur confinement. Consequently, the MGPP@S composite cathode exhibits excellent electrochemical energy storage performance. It shows initial discharge capacity of 1492, 1054, 833, 659 mAh g−1 at 0.1C, 0.2C, 0.5C, 1C, respectively; meantime it retains a capacity over 755 mAh g−1 during 250 cycles at 0.2C and only has 0.06% capacity decay per cycle during 500 cycles at 1C. The major capacity decay on first several cycling is accounted for sulfurous consumption in saturating the electrolyte and building the interfacial layer; afterwards, the composite electrode can perform consistent capability upon extending cycling.

Objective: Exergames are popular technology applications that encourage individuals to engage in exercise and create positive moods for players. However, little is known as to whether play...

Bladder cancer, the ninth most common cancer worldwide, requires fast diagnosis and treatment to prevent disease progression and improve patient survival. However, patients with bladder cancer often experience considerable delays in diagnosis. One reason for such delays is that hematuria, a major symptom of bladder cancer, has a high probability of also being a warning sign for urinary tract diseases. Another reason is that the sensitivity of the body parts affected by bladder cancer deters patients from undergoing cystoscopy and influences patients’ “physician shopping” behavior. In this study, the analytic hierarchy process was used to determine critical variables influencing delayed diagnosis; moreover, the variables were used to construct models for predicting delayed diagnosis in patients with hematuria by using several machine learning techniques. Furthermore, the critical variables associated with delayed diagnosis of bladder cancer in patients with hematuria were evaluated using GainRatio technology. The study sample was selected from a population-based database. The model evaluation results indicated that the prediction model established using decision tree algorithms outperformed the other models. The critical risk factors for delayed diagnosis of bladder cancer were as follows: (1) cystoscopy performed 6 months after hematuria diagnosis and (2) physician shopping.

BackgroundPost-intensive care syndrome (PICS) seriously affects the quality of life of patients and their caregivers. This study systematically evaluates PICS related guidelines and consensuses to provide methodological and strategic guidance for the development and improvement of these guidelines and consensus.MethodsAn Internet search of PICS specific or related guidelines and consensus statements was conducted among academic databases and the websites. The AGREE II was used to evaluate their methodological quality. The themes and contents were evaluated based on the definition of PICS and the “patient-clinical problem-intervention-target” framework.ResultsWe included fourteen guidelines and 10 expert consensuses. The mean AGREE II score for scope and purpose was 86.89% ± 16.12%/ 79.47% ± 11.80%, 55.86% ± 29.17%/16.72% ± 16.39% for stakeholder involvement, 76.35% ± 15.82% /36.09% ±26.05% for rigor of development, 88.03% ± 15.55%/58.84% ± 28.94% for clarity of presentation, 61.79% ± 23.16/32.95% ± 20.91% for applicability, and 66.67% ± 37.96% /28.79% ± 36.54% for editorial independence in Guidelines/Consensus. Most only described a single or series of clinical related issues of PICS; only applicable for critically ill patients with clinical problems of ICUAW, pain, sleep disruption, agitation, and delirium. The interventions included risk assessment, monitoring/diagnosis, prevention, treatment, safety criteria, and home care of one or more symptoms of PICS.ConclusionsOur results suggested that development and improvement of guidelines/consensus should focus on refining the methodology, strengthening quality control, and improving presentation clarity, editorial independence, and applicability. The results may provide new idea for a future guidelines and consensus statements.

Background: To further determine the clinical efficacy and survival of intrathoracic infusion with TPs and chemical irritants and their therapeutic threshold and optimal control regimen to achieve a desired response in malignant pleural effusion (MPE). Methods: We collected all randomized controlled trials (RCTs) of TPs with chemical irritants from Chinese and English databases (from inception until September 2019), and performed a new meta-analysis following the PRISMA guidelines. We measured their bias risk, summarized data using meta-analysis, and evidence quality using the Grades of Recommendation Assessment, Development and Evaluation approach. Results: We collected 24 trials involving three TPs and platinum and 1,592 patients. Most trials had unclear bias risk. TPs with platinum significantly improved complete response [4.02 (3.12 to 5.18)] and quality of life [3.64 (2.34 to 5.66)], the 0.5-year overall survival (OS) rate [5.75 (3.02 to 10.92)], and 1-year OS rate [5.29, (1.71 to 16.36)], and reduced the treatment failure, myelosuppression, and gastrointestinal toxicity. For patients with moderate to large volume of pleural effusion, KPS score ≥50 to 60, or AST ≥3 months, the thymosin (200–300mg/time), thymopentin (2mg/time) or thymosin alpha 1 (3.2mg/time) with cisplatin (30–40mg/m 2 ), carboplatin (400mg/m 2 ), or oxaliplatin (100mg/m 2 ) are possible regimens for achieving a desired success, and low failure. Most results were robust and moderate quality. Conclusion: The moderate evidence suggests that the TPs with platinum is beneficial to the patient with MPE, and provides evidence for the therapeutic threshold and possible regimens that may achieve a desired success and reduce the failure.

Background: Opioid dependence, a major global public health concern, can be alleviated through methadone maintenance treatment (MMT). However, MMT possibly increases motor vehicle accident risk. The aim of this study was to determine motor vehicle accident risk in MMT users. Methods: We performed preliminary estimation of motor vehicle accident incidence rates in Taiwan. In this population-based retrospective cohort study with frequency-matched controls, adult opiate users receiving MMT and not receiving MMT (control) were identified at a 1:2 ratio by linking data from several nationwide administrative registry databases. All individuals were followed for motor vehicle accident events. Data were adjusted for potential covariates and assessed using Kaplan–Meier and Cox proportional hazard model analyses. Findings: From 2009 to 2016, the crude incidence rate of motor vehicle accidents was the lowest in the general adult population, followed by that in adult opiate users, and it was the highest in adults receiving MMT. Among opiate users, motor vehicle accident incidence rates were significantly higher in those receiving MMT than in those not receiving MMT (adjusted hazard ratio [aHR] 2.75, 95% CI 1.87–4.04; p

Exergames are popular computer applications. However, exergaming literature has insufficiently explained the formulation of user-experienced flow and what user needs may facilitate such a formulation, indicating a gap. To fill the gap, this study adopts the flow theory to construct a framework and examines how enjoyment and challenge impact the creation of flow, and how users’ need for achievement and need for exercise may facilitate it. We recruited 583 participants who were asked to play exergames and complete a survey. The analytical results indicate that exercise enjoyment is positively linked to flow, while the need for exercise strengthens such a link. Moreover, challenge is positively linked to flow, and the need for achievement strengthens that link. This study is the first using the flow theory to explain the process by which exergamers experience flow.

By integrating the perspectives of the DeLone and McLean information systems success model, media synchronicity theory, and organisational support, this study develops a theoretical model to examin...

Pulsed electric field (PEF) was efficient in inactivating lipase in wheat grains. To understand the modification in wheat components, the functional, rheological, and structural properties of vital wheat gluten (VWG) were evaluated after PEF treatment. The results showed that the PEF parameters, electric field intensity (EFI), pulse frequency, pulse width, and material residence time significantly (P 0.05). The amount of free and total sulfhydryl increased and decreased significantly (P

Fe-N-C composite catalyst was prepared by thermal decomposition of chelate precursors based on Fe(III) central ions and o-phenylenediamine ligands. Scanning electron microscopy characterization showed that the crumpled carbon micro- and nano-sheets were intertwined and formed a free-standing tremella-like 3D structure. Notrogen adsorption/desorption experiments revealed that the composite contained ample micro-pores and meso-pores and had a specific surface area of 290 m2 g−1. Graphitic carbon and multi-crystal Fe3C as main components were confirmed by X-ray diffraction, and N-doping in the general form of graphite-N and pyridine-N was also verified by X-ray photoelectron spectroscopy. The electrochemical measurements showed that the tremella-like Fe-N-C composite catalyzed oxygen reduction through a four-electron path in an alkaline solution, and its activity was comparable to that of the commercial Pt/C catalyst. After 2000 cycles, the limiting current density of the Fe-N-C catalytic electrode only decreased less than 5%, and the half-wave potential negatively shifted 5 mV, suggesting that the Fe-N-C composite catalyst had better catalytic stability than the commercial Pt/C catalyst.

Aderivative of Shiitake mushrooms, Lentinan is used to control malignant pleural effusion (MPE) through intrathoracic infusion.To determine the clinical response, survival and safety of Lentinan plus chemical irritants, and the optimal combinations with chemical irritants, indication, threshold and optimal regimen for achieving the desired responses.We performed a new systematic review and meta-analysis following the PRISMA guidelines.We collected all randomized controlled trials (RCTs) regarding Lentinan plus chemical irritants from Chinese and English electronic databases (from inception until March 2019). We evaluated their bias risk, synthesized data using meta-analysis, and summarized evidence quality following the Grades of Recommendation Assessment, Development and Evaluation approach.We included 65 RCTs involving 4,080 patients and nine chemical irritants. Most trials had unclear bias risk. Lentinan with cisplatin significantly improved complete response [Risk ratio (RR) = 1.68, 95% confidence intervals (CI) (1.51 to 1.87), p0.00001, Fig.3a] and quality of life [RR = 1.51 95% CI (1.41 to 1.62), p0.00001, Fig.4], and decreased the risk of treatment failure, myelosuppression, gastrointestinal reaction, and chest pain. For patients with moderate to large volume of the pleural effusion, primary treatment, KPS score ≥ 50-60, or anticipated survival time ≥ 3months, Lentinan (3-4 mg/time, once a week for three to four times) withcisplatin (30-40 mg/mThe results suggest that Lentinan with chemical irritants, especially cisplatin is beneficial to the patient with MPE, and provide evidence for the indication, threshold, and optimal regimen that may achieve success and decrease failure.

A health risk assessment for the Lin-Yuan Petrochemical Industrial Complex (LYPIC) in southern Taiwan was conducted in this study. The main aims of the study were to develop an emission inventory for the 21 processing plants in the LYPIC, conduct hazard identification based on the emission inventory, perform an exposure assessment by applying air dispersion modeling to obtain the annual average concentration of hazardous air pollutants near the LYPIC, and estimate the lifetime risk of cancer associated with volatile organic compound exposure for residents living in the vicinity of the LYPIC. Comparing with the reported monitoring data from several petrochemical and refinery plants in the world, the estimated exposure concentrations in this study were within reasonable range. The results of cancer risk assessment showed that the cumulative excess lifetime cancer risk (ELCR) at four representative residential sites surrounding the LYPIC were in the range of 9.3 × 10–5 to 1.7 × 10–4. From a risk management perspective, in order to protect human health, greater emphasis on the reduction of emissions of benzene, 1,3-butadiene, acrylonitrile, and vinyl chloride is recommended. This study provides a feasible risk assessment procedure to identify the key carcinogenic chemicals emitted from a petrochemical industrial complex.

The literature on exergames has examined their impact on user-perceived psychological health (i.e., user-perceived happiness), but little is known about whether such an impact depends on user characteristics. Therefore, this study used the perspective of social cognitive theory (SCT) to identify potential moderators (i.e., whether the user is optimistic or attempting to control his or her weight) of the impact of playing exergames on user-perceived happiness.This large-scale randomized controlled trial recruited 337 college students (of whom 57.3% were female and all were aged 20-40 years) as participants. The participants were randomly assigned to the intervention group or the control group. Participants in the intervention group were asked to use an Xbox 360 to play 1 of 10 exergame programs for 30 minutes once a week for 2 weeks. Participants in the control group were not required to do so. Repeated-measures ANOVA was used for the analyses.The analytical results indicate that playing exergames helped to maintain happiness levels and prevented them from decreasing. The maintained happiness was more prominent among participants who were trying to control their weight, but did not differ between participants who were highly optimistic and those who were less optimistic. This study is the first using SCT to explain the contingent effect of playing exergames on user happiness.Exergames can maintain happiness among users, and such maintenance can be the strongest among users who are trying to control their weight.

Background/Aim Cerebral white matter changes (WMC) are commonly observed in magnetic resonance imaging (MRI) scans of elderly people. Information about the prevalence of WMC is limited, and little is known about site-specific risk factors for the subcortical and periventricular regions in patients with ischaemic stroke. The study aims to analyse the prevalence and severity of WMC and investigate the risk factors of periventricular WMC (PVWMC) and deep WMC (DWMC) separately in patients with ischaemic stroke. Methods The data were collected between January and December 2013 from a medical centre in southern Taiwan. Every patient underwent a cerebral MRI scan, and WMC was separately rated as PVWMC and DWMC by using the modified Fazekas scale. Results In total, 527 patients who had experienced ischaemic stroke were included. The mean age of the patients was 67.0 ± 12.5 years (range: 31–94) and 62% of them were men. The mean age was significantly different among the four grades of severity in both the PVWMC (P < 0.001) and DWMC (P < 0.001) groups after adjustments for sex and vascular risk factors. Hypertension was independently correlated with severity of DWMC (P = 0.032) but not with PVWMC (P = 0.222). In multiple logistic regressions model, hypertension was a significant independent indicator of DWMC (odds ratio = 4.30; 95% confidence interval = 1.70–10.89). Conclusion Our results suggest a region-specific pathogenesis of cerebral white matter in Asian patients with ischaemic stroke that may differ from those in the general population.