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This study divides health care expenditures into observable effects and structural shifts to explore the impacts of population ageing and high technology on the growth in outpatient service, inpatient service, and prescription drug expenditures in a health care system that has experienced a shift in payment schemes from a cost-based to a global budget system. By using the quantile decomposition method to examine data from Taiwan, the study shows that, in the short run, all expenditures exhibit an increasing trend in the higher percentiles. In the long run, an observable effect dominates the growth of health care expenditures. Specifically, population ageing leads to the growth of prescription drug expenditures in the higher percentiles. The adoption of high technology drives the growth of the top outpatient and inpatient service expenditures. These results suggest that while the government health care agency aims to control health care expenditures, improving the management of high-cost patients is likely to be one important avenue to improving the effectiveness of the cost control policy.

Recent reports show that at least 95% of the world's population is breathing polluted air. However, the impact of air quality on air pollution-related medical expenditure and utilization is sparse. This study estimates the short-term health care cost impacts of air pollution using a meteorological phenomenon-thermal inversion-as an instrumental variable for air quality. Using information on outpatient care for respiratory diseases from universal health insurance claim data in Taiwan during 2006-2012, our estimates suggest that a one-unit reduction in the air quality index (AQI) leads to NT$2.3 billion (nearly US$74 million) of savings in respiratory-related outpatient expenditure per year. Given that the average AQI is equal to 32 during our study period, completely removing air pollution would reduce the national health expenditure by approximately 8% annually. Our results provide the important implication that the cost of controlling air pollutant emissions can be offset by curtailing health care expenditure.

The study uses Taiwan as an example to explore whether the budget allocation of risk reduction depends on income-related political power. Specifically, we empirically examine the effect of household income on the probability of flooding. Beginning in 2006, the government implemented an 8-year project referred to as the “Regulation Project for Flood-Prone Areas” with a budget of NT$115.9 billion (US$3.86 billion). Over half of the budget was allocated to local authorities in southern Taiwan to help them carry out flood risk mitigation projects. As it was not clear how the local authorities set their priorities in allocating their budgets, this study investigates whether high-income individuals may have used their political influence to influence the budget allocation to improve the flood risk reduction facilities in their communities. Villages, whose average household income was within the top 10 % in the county or city, were selected as high-income villages and assigned to the treatment group, whereas other villages were included in the control group. The results using propensity score matching (PSM) show that the flood probability of the high-income group (13 % and 16.9 %, respectively) was lower than that of low-income group (22 % and 28 %) during Typhoon Morakot and Typhoon Fanapi, suggesting that high-income areas are less prone to flooding, which might stem from their political power.

Background/Aims: Preeclampsia (PE) is a gestational disorder defined as hypertension and proteinuria, which is deemed a major cause of maternal and neonatal mortality and morbidity worldwide. The aim of this study was to investigate the expression patterns of placental laminin (LN)-α5 expression in normal and PE pregnancies, as well as evaluating the effects of LN-α5 on trophoblast proliferation, apoptosis, and invasion. Methods: LN-α5 expression levels were examined by reverse-transcriptase polymerase chain reaction (RT-PCR), and further confirmed by western blotting and immunofluorescence staining. Cell proliferation and apoptosis were measured by CCK-8 assay and flow cytometry. Cell invasion was assessed by matrigel-based transwell assay. LN-α5 DNA methylation in placentas was determined by bisulfite sequencing PCR (BSP). Results: LN-α5 expression levels in PE placentas were significantly lower than that of normal pregnancies. Deficiency in LN-α5 expression resulted in decreased trophoblast proliferation and invasion but increased cell apoptosis, meanwhile, PI3K/AKT/mTOR signaling pathway was impaired by LN-α5 silencing. LN-α5 promoter methylation didn’t show significant difference between PE and normal placentas. Conclusion: LN-α5 downregulation is associated with PE placenta and impairs trophoblast viability and invasiveness, which could be a causative factor of PE pathogenesis.

The South American foreland basin is rich in oil and gas resources, but the distribution is uneven. This paper analyzes the hydrocarbon accumulation and distribution characteristics of this area, and clarifies the main control factors to provide reference for oil and gas exploration in this area. Firstly, the reservoir formation, resource types and plane distribution of each basin are analyzed, and the distribution characteristics of oil and gas are summarized. Then study the ages and sedimentary evolution of source rocks in each basin, and clarify the characteristics of resources, potential and migration and accumulation. Finally, the relationship between source rock and oil and gas distribution is analyzed and compared, and its internal law is summarized. Oil and gas are mainly accumulated in the foreland slope areas around kitchens with belt distribution. The oil and gas distribution is significantly different from north to south. The oil production in the north basins is mainly concentrated in the Cretaceous and Tertiary systems; the gas production in the central basins is mainly in the Devonian and Carboniferous; the oil and gas in the south basins are mainly distributed in the Jurassic and Lower Cretaceous. Three sets of main source rock are developed: the Upper Cretaceous mudstone in the north basins is dominated by oil generation, and the hydrocarbon generation ability is the strongest; the central is the Devonian mudstone, which is dominated by the gas generation; the south is the Lower Cretaceous mudstone, and the oil and gas generation are both important. Source rock is the main controlling factor of oil and gas distribution in this area. The source rock quality determines the resource volume. The age of the source rock determines the hydrocarbon type, migration distance and oil and gas distribution. For the first time, the oil and gas distribution and source rocks in the foreland of South America are divided into three categories: south, central and north, and the source rocks are the main controlling factors. The results can provide reference for oil and gas exploration and new project evaluation in the foreland basin of South America.

On May 14, 1999, LSI Logic Corporation's Fab in Santa Clara, California experienced a leak of BF3 which was not detected by the Telosense Air Composition Monitoring system. This event lead to a question-the reliability of leak detection techniques currently employed for toxic BF3. In this work, a novel FRET fluorescence chemosensor RN for BF3 has been designed and synthesized conveniently by incorporating rhodamine B and 1, 8-naphthalimide. Compared with other chemosensors, this chemosensor displayed ratiometric fluorescence that can overcome shortcomings of intensity-based fluorescent chemosensors. The ratio (I-586/I-533) of chemosensor RN showed a remarkable increase (21-fold) in less than 1 min and a distinct colour change for naked-eye detection in present BF3. The response of BF3 at this sensor was linear in the wide range of 130-200 mu M with a detection limit of 2.7 x 10(-5) M. This chemosensor also had excellent reversibility. The F-19 NMR and H-1 NMR test were performed to investigate the mechanism of the chemosensor RN towards BF3. Furthermore, we evaluated its feasibility for real-time detection of BF3 in a portable manner. The facts and evidence indicated that this chemosensor had potential applications in industrial production. (C) 2016 Elsevier B.V. All rights reserved.

A novel turn-on fluorescence probe based on rhodamine B for Fe3+ has been synthesized and characterized by various analytical techniques. Compared with other commonly coexisting metal ions, the probe showed 100-fold fluorescence enhancement for detecting Fe3+ with a 1:1 stoichiometry in MeOH/H2O (1:1, v/v) solution. After adding Fe3+, the rapid enhancement of fluorescence intensity provided a rapid method for detection of Fe3+ The color change was visible, so it could be used for naked-eye detection. The association constant between the probe and Fe3+ was detected to be 0.67 x 10(4) M-1 and the corresponding detection limit were calculated to be 5.7 x 10(-8) M according to fluorescence titration analysis. The reversible binding of probe L to Fe3+ was confirmed by reacting with Na4P2O7, which captured the Fe3+ from the L-Fe3+ complex and turned off the L-Fe(3+)complex. Fluorescence imaging experiments demonstrated that this probe was cell permeable and suitable for monitoring intracellular Fe3+ in living cells by confocal microscopy. What's more, MU assay indicated that this probe had no significant cytotoxicity to living cells. (C) 2016 Elsevier B.V. All rights reserved.

Objective: To observe the effect of Danshu capsules combined with Xiyanping on acute cholecystitis treatment and offer help to acute cholecystitis treatment. Methods: A total of 180 patients with acute cholecystitis were selected and randomly divided into groups: the observation group (90 people) and the control group (90 people). The patients in the control group were treated with conventional therapy and the patients in the observation group were treated with Danshu capsules combined with Xiyanping on the basis of conventional therapy. Immunological cell, cholecystitis related factors, inflammatory factors, and the coagulation function related factors were detected and analyzed before and after treatment. Results: Coagulation function related factors (PT and APTT), CD8+ , cholecystitis related factors (total bilirubin, amylase and PCT), inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in both groups after treatment significantly decreased. PA, immunological cell (CD3+ , CD4+ and CD4+ /CD8+ ) significantly increased compared with that before treatment (P0.05). Coagulation function related factors (PT and APTT), CD8+ , cholecystitis related factors (total bilirubin, amylase and PCT), and inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in observation group after treatment decreased more significantly than that in control group (P

To investigate the effect of 2-deoxy-d-glucose (2-DG) combined with hydroxycamptothecin (HCPT) on anti-tumor activity of breast cancer cells and its mechanism.MDA-MB-231 and MCF-7 breast cancer cells were incubated with varying concentrations of 2-DG (0, 1.25, 2.5, 5, 10, 20 mmol/L), HCPT(0, 5, 10, 20, 40 μmol/L) and 2-DG (5 mmol/L) combined with HCPT. Cell viability was measured using the MTT assay; Propidium iodide (PI) detected the apoptosis of MDA-MB-231 cells by 5 mmol/L 2-DG, 10 μmol/L HCPT alone or in combination; MDA-MB-231 cells were treated with 2-DG (0, 2.5, 5, 10, 20 mmol/L) and the level of ATP was detected by ATP kit; the expression of Akt, p-Akt, Bcl-2/Bax, PARP, Caspase-8 and Caspase-3 proteins in MDA-MB-231 cells were measured by Western blot assay.The combination of 2-DG (5 mmol/L) and HCPT had a synergistic effect. The 48 h combination index (CI1) was higher than that of the single-use group (The combination of 2-DG and HCPT can synergistically induce the apoptosis of breast cancer cells, which may be caused by inhibiting the energy generation of tumor cells, inhibiting the phosphorylation of Akt protein and enhancing the activity of caspase-3 protein.

Objectives As populations are growing older, the prevalence of chronic diseases such as diabetes mellitus is rapidly increasing. Meanwhile, many new drugs are introduced each year as a result of technological advances. This study uses diabetes as an example to investigate the relative importance of population aging and technological innovation in accounting for the growth of health expenditures. Methods The retrospective cohort study was conducted based on claims data covering 1997 to 2006 taken from Taiwan’s National Health Insurance. Patients were selected based on whether they received antidiabetic drugs. Growth in health expenditure was decomposed into 3 parts: number of patients, mean treatment cost, and the interaction between the change in the mean treatment cost and the change in the number of patients. Results The results indicated that 75% of the growth in expenditures for treating diabetic patients is attributable to the effect of population aging, as reflected by the increase in the diabetes prevalence rate (45%) and disease severity (30%). Technological innovation, in the form of treatment substitution (10%) and treatment expansion effects (15%), accounted for only about 25% of the growth in expenditures for treating diabetic patients. Conclusions Population aging plays a more significant role than technological innovation in driving up health expenditures for the treatment of diabetic patients. This suggests that population aging may contribute significantly to the future growth of the healthcare sector in Asian countries such as Taiwan.

Background This study empirically estimates the magnitude and associated determinants of profit margins that medical providers earn from prescription drugs based on Taiwan’s pharmaceutical market. Methods Our main data set is from the population-based claims data compiled by the National Health Insurance Research Database covering three waves of price adjustment: July–December 2004, October 2007–September 2008 and October 2009–September 2010. Only drugs whose reimbursement prices were adjusted using the R-zone formula were used as samples for this study. By calculating the difference between retail and wholesale prices for 796 pharmaceutical products, we can estimate the profit margin determinants using the regression model. Results We found evidence that suppliers of generic drugs tend to offer larger discounts to medical providers than suppliers of brand-name drugs. In addition, the countervailing power of wholesale pharmaceuticals, as measured by the discount rate offered by pharmaceutical manufacturers, is positively associated with the degree of competition within the pharmaceutical market and the size of the market itself. Conclusions Our findings imply that the profit-seeking behaviour exhibited by medical providers is the engine of competitive forces in Taiwan’s prescription drug market. This creates financial incentives for them, which in turn influences their choices of prescription drugs.

Objective To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. Methods We utilized Taiwan’s National Health Insurance Research Database (NHIRD) 1997–2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan’s population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin–SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin–TZD), and metformin plus glinides (Metformin–glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. Results Metformin–glinides was most cost-effective in the base-case analysis; Metformin–glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin–SU. However, for the elderly or those with severe diabetic complications, Metformin–TZD, especially pioglitazone, was more suitable; as compared to Metformin–SU, Metformin–TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin–pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin–rosiglitazone. Conclusions When CVD is considered an important clinical outcome, Metformin–pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications.

Background Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase-4 inhibitors [DPP-4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP-4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs. Methods Cases of type 2 diabetes were derived from Taiwan's National Health Insurance Research Database. Antidiabetic drug use was measured in terms of total quantity of drug exposure and healthcare spending in each calendar year from 2008 to 2103. Multiple logistic regression analysis was used to assess factors associated with drug choice. Results The use of and healthcare spending on DPP-4i increased significantly from 2008 to 2013, whereas healthcare spending on sulfonylureas decreased. For monotherapy, sulfonylureas were the most common alternatives to metformin, whereas in dual and triple antidiabetic therapies, a DPP-4i was the most common alternative to initial regimens. The use of a DPP-4i was positively associated with the use of beta-blockers, angiotensin II-converting enzyme inhibitors and/or angiotensin receptor blockers, and lipid-lowering agents, but negatively correlated with age, hypertension, severity of diabetes complications, and the use of diuretics and calcium channel blockers. Conclusions With growing spending on newer antidiabetic drugs, future research on the comparative cost-effectiveness and safety of antidiabetic drugs is anticipated.

A reversible fluorescent probe L based on rhodamine 6G is synthesized for the optical detection of Fe3+ in water. This probe displays favorable selectivity for Fe3+ with a 1 : 1 stoichiometry. It displays a fluorescence turn-on response in the process of rhodamine ring opening with Fe3+ and a fluorescence turn-off response with the addition of Na4P2O7 to the L-Fe3+ complex. The association constant between the probe and Fe3+ was detected to be 3.5 × 104 M−1, and the corresponding detection limit was calculated to be 1.9 × 10−8 M according to fluorescence titration analysis. Furthermore, bioimaging investigations indicated that this probe was cell permeable and suitable for monitoring intracellular Fe3+ in living cells by confocal microscopy.

To investigate the role of SRC kinase inhibitor PP2 in drug resistance to adriamycin (ADM) in breast cancer cells and invasion, metastasis of cells.MTT assay was used to detect the inhibitory effect of ADM on MCF-7 and MCF-7/ADM cells. The 50% inhibitory concentration (ICADM inhibited the proliferation of MCF-7 more than MCF-7/ADM cells (The resistance of MCF-7 to ADM is accompanied by increased expression of SRC. SRC inhibitor PP2 can reduce the cell resistance, ability of invasion and metastasis.

Astaxanthin is a carotenoid with wide applications because of its strong antioxidant properties. It is mainly produced from the green alga Haematococcus pluvialis, but large-scale production remains a challenge. To provide another source, here, Synechocystis sp. PCC6803 was adopted as the chassis cell, and its carotenoid biosynthesis pathway was genetically extended to produce astaxanthin. The β-carotene ketolase gene (bkt) and carotenoid hydroxylase gene (crtR-B) from H. pluvialis, which wild-type Synechocystis sp. PCC6803 lacks, were optimized based on the codon preference of Synechocystis sp. PCC6803 and heterologously expressed in that bacterium to create a strain capable of producing astaxanthin. The Synechocystis sp. PCC6803 mutant synthesized 4.81 ± 0.06 mg astaxanthin per gram of cells (dry weight) after nitrogen starvation for 14 days. More than 30% of the total astaxanthin was in the free form, and 82.61% was the strong antioxidant 3S, 3′S-astaxanthin isoform. These results show the industrial application potential of metabolically-engineered Synechocystis sp. PCC6803 for astaxanthin production.

The catalytic oxidation process of SO 2 and the effects of NH 3 , NO and O 2 on its oxidation behavior was investigated with FT-IR spectroscopy. It was found that the SO 2 oxidation occurred via the following steps. SO 2 first absorbed on V 2 O 5 and occupied at O position to form SO 3 2− . Then, it reacted with V 5+ -OH to generate VOSO 4 -like intermediate species, which was promoted to transform into SO 3 and V 2 O 5 by re-oxidizing V 4+ to V 5+ by O 2 . The oxidation of SO 2 was suppressed in the presence of NH 3 and NO due to their competitive absorption on the V 2 O 5 . This indicates that removal of NO x and oxidation of SO 2 are contradictory.

A novel "turn-on" phosphorescent chemodosimeter based on a cyclometalated Ir(III) complex has been designed and synthesized, which displays high selectivity and sensitivity toward Hg(2+) in aqueous media with a broad pH range of 4-10. Furthermore, by time-resolved photoluminescence techniques, some interferences from the short-lived background fluorescence can be eliminated effectively and the signal-to-noise ratio of the emission detection can be improved distinctly by using the chemodosimeter. Finally, the chemodosimeter can be used to monitor Hg(2+) effectively in living cells by confocal luminescence imaging.

Cement, phosphorus slag, silica sand, fly ash and water reducing agent were well-mixed, and then stirred with polypropylene fiber and water for preparation of phosphorus slag mortar. Performance of the mortar was tested according to relevant standards. The results showed that polypropylene fiber can improve flexural strength and tensile bond strength of the mortar. However the polypropylene fiber has little contribution to the compressive strength of the mortar. Fluidity of phosphorus slag mortar reduces with length of the fiber increasing. Polypropylene fibers distributed evenly in the phosphorus slag mortar can obstruct generation and propagation of micro cracks, thus crack-control property of mortar can be improved. When polypropylene fiber’s length and content are 10 mm and 4 g (by weight) respectively, the properties of phosphorus slag mortar are as follow: fluidity 209 mm, tensile bond strength 0.71 MPa, flexural strength 4.32 MPa, Compressive strength 10.83 MPa, and ratio of compressive strength to flexural strength 2.51 on 28 days.

In this paper, a computational fluid dynamics (CFD) model of a 600 MW opposed swirling coal-fired utility boiler has been established to numerically study the NOx emission characteristics under different ratios of over fire air (OFA) and modes of in-service burner layers. The current CFD model had adopted a chemical percolation devolatilization (CPD) model and been validated by comparing the simulated results with the experimental data. The numerical simulation results show that, with increasing the ratio of OFA, the carbon content in fly-ash increase somewhat linearly and the NOx emission reduce significantly, and the OFA ratio of 30% is optimal with higher burnout of pulverized coal and lower NOx emission. The different in-service burner layer modes have different influences on the residence time of the pulverized-coal particles, effect of air staging in the burner region and flue gas temperature at the exit of the lower furnace. Stopping the upper burner layers can increases the residence time of the pulverized-coal particles, resulting in the reduction of the carbon content in the fly ash and the increase of the pulverized-coal burnout. The flue gas temperature at the exit of the lower furnace can also decrease, which would be helpful to reducing the slagging tendency on the surfaces of the platen superheaters.

An EPDDMAC-GE polymer (hydrophilic molecule) has been synthesized based on epoxypropyl dodecyl dimethyl ammonium chloride (EPDDMAC) and gelatin. A DEEPSAC-GE polymer (hydrophobic molecule) has been synthesized based on diethyl-2,3-epoxypropyl-[3-methyldimethoxyl] silpropyl ammonium chloride (DEEPSAC) and gelatin. Compared with initial gelatin, the gelatin modified with quaternary ammonium salts containing epoxide groups exhibits stronger antibacterial activity.

To realized highly selective detection for sulfide anion, a simple and hydrophilic fluorescent chemosensor, sodium 2-(2-(1H-benzo[d]imidazol-2-yl)quinolin-8-yloxy)acetate (HL) based on quinoline derivative was designed and synthesized. Once combined with Cu2+ in aqueous solution, the forming quinoline-ligated copper complex displayed a rapid response with high selective and sensitive detection for sulfide anion. The fluorescent signal transduction occurs via formation-separation of complex (CuL) and CuS, which achieve reversible “ON–OFF–ON” fluorescence change, and the complex (CuL) through the combination of HL and Cu2+ was further confirmed by crystal structure. The detection limits of complex (CuL) to sulfide anion was estimated to be 1.7 × 10−7 M. Furthermore, its potential utility for biological application was explored by fluorescence microscopic imaging in live cells.

Human beta2-glycoprotein I (beta2-GPI) binds to recombinant hepatitis B surface antigen (rHBsAg) and can bind specifically to annexin II, which is located on the cell membrane of human hepatoma SMMC-7721 cells. Viral envelope proteins are essential for mediating cellular entry. The aim of this study was to investigate the role of beta2-GPI in the early stages of hepatitis B virus (HBV) infection. Western blot and qRT-PCR analyses revealed that beta2-GPI expression was upregulated in HepG2.2.15 cells at both the mRNA and protein level and was almost non-existent in 293T and CHO cells. Furthermore, annexin II was expressed at lower levels in HepG2.2.15 cells compared to L02, HepG2, and SMMC-7721 cells. Additionally, ELISA analyses demonstrated that beta2-GPI enhanced the ability of HBsAg to bind to cell surfaces, and there was differential adhesion to L02, HepG2, HepG2.2.15, and 293T cells. Western blot and ELISA were then performed to assess the effects of HBV and the HBsAg domain on beta2-GPI expression in co-transfected 293T cells. This study revealed that HBV and the large HBV envelope protein increased beta2-GPI expression. Further investigation indicated that beta2-GPI colocalized with HBsAg in the cytosol of HepG2.2.15 cells, with sodium taurocholate co-transporting polypeptide (NTCP) on the cell membrane in NTCP-complemented HepG2 cells, and with annexin II in the cytosol of HepG2 and HepG2.2.15 cells. These data suggest that high expression of beta2-GPI enhances HBsAg binding to cell surfaces, thus contributing to virus particle transfer to the NTCP receptor and interaction with annexin II for viral membrane fusion.

As the support of the daily-use ceramic products design by using digital development platform, nowadays advanced digital technology –– 3D print technique can directly design and develop the daily-use ceramic products. The design software illustrates three-dimensional model and convert it to the appropriate number format, then this hi-tech print technology can make the real full scale mock up. Use this digital way to present the daily-use ceramic products, to create a graphic database, and eventually establish a systematic research and development about the daily-use ceramic products design.

Promoting competition between brand-name and generic drugs has long been recognized as an approach adopted to save on health care costs. However, there are substantial variations in the extent of the generic competition across countries. This study empirically estimates the determinants of the generic market share in Taiwan, where medical providers are in a position to profit directly from the sale of prescription drugs. Our empirical results point out that the profit-seeking behavior of medical providers plays an important and dominant role behind generic competition in the pharmaceutical market. As a result, there is a positive association between the generic-to-brand price ratio and the generic market share in Taiwan’s pharmaceutical market, which contrasts with the conventional empirical finding that the relationship between the generic-to-brand price ratio and generic market share is negative. An important implication of our study is that the profit-seeking behavior of medical providers undermines the policy effectiveness of using generic competition as the cost containment strategy in the health care market.

Grouting fill is one of the main methods of coal gob treatment. The grouting properties directly affect the effect of grouting treatment. Cement-fly ash grout is widely used in the treatment of coal gob. But in many gob grouting fill projects, due to the lack of fly ash, we need to look for other low-cost grouting materials. Study was made through laboratory experiment on the properties of cement-coal gangue materials used for the gob grouting. In this paper, the correlation of water-solid ratio, cement content, admixture, concretion compression strength, setting time, viscosity, water segregation rate and hardening rate is discussed in the case of use of large gangue content cement. The test results show that compared with the grout not go through the activation process, the blended cement grout mixed with coal gangue powder activated by low temperature and mechanical crushing has high concretion compression strength. Water glass has a great effect on the viscosity, initial setting time and final setting time, which can be used to adjust the grout properties to accommodate grouting environment requirements. This grout has the advantage of wide range sources of raw materials, and can be used to solve the lack of fly ash and gangue resource utilization problems.

Objectives This paper investigates the determinants of generic entry in the regulated Taiwanese prescription drug market, where physicians both prescribe and dispense drugs. Methods Using a sample of 29 ingredients and a population claim data set from 1997–2007, we employ the negative binomial regression to empirically examine the determinants of generic entry in Taiwan. Results This study finds that the lagged number of competitors, market size, and market share of large-scale medical providers affect generic entry. Conclusions The negative effect of large buyers on generic entry implies that rent-seeking behavior appears to create a barrier for generic manufacturers to enter into the Taiwanese prescription drug market.

Aim To investigate the relationship between nursing hours per patient day and the inpatient mortality rate in Taiwan. Background Nursing hours per patient day has been associated with better patient outcomes. The literature is inconclusive on the relationship between nursing hours per patient day and the inpatient mortality rate, and no studies have yet examined this issue in Taiwan. Methods A retrospective longitudinal study analysed data from the ‘Nursing Utilization of Resources, Staffing and Environment on Outcome Study: NURSE-outcome study’. Hierarchical regression estimated the relationship between nursing hours per patient day and in-hospital mortality rate after controlling for confounding variables. Results The mean nursing hours per patient day in Taiwan was 2.3, while the mean inpatient mortality rate was 0.73% higher nursing hours per patient day was associated with a lower inpatient mortality rate after controlling for confounding variables. The total explained variance of this study in inpatient mortality rate was 19.9%. Significant relationships to inpatient mortality were found in levels of hospitals, seasonal variation and nurses’ work experience. Conclusion Nursing hours per patient day affects the mortality rate among hospitalised patients in Taiwan. Implications for nursing management According to the results, we suggested the government and managers in Taiwan double the nursing hours per patient day so that the inpatient mortality rate will decline by 1.1%. This might be the optimal nurse configuration that could provide a balance between cost-effectiveness and patient safety.

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase-4 inhibitors [DPP-4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP-4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.Cases of type 2 diabetes were derived from Taiwan's National Health Insurance Research Database. Antidiabetic drug use was measured in terms of total quantity of drug exposure and healthcare spending in each calendar year from 2008 to 2103. Multiple logistic regression analysis was used to assess factors associated with drug choice.The use of and healthcare spending on DPP-4i increased significantly from 2008 to 2013, whereas healthcare spending on sulfonylureas decreased. For monotherapy, sulfonylureas were the most common alternatives to metformin, whereas in dual and triple antidiabetic therapies, a DPP-4i was the most common alternative to initial regimens. The use of a DPP-4i was positively associated with the use of beta-blockers, angiotensin II-converting enzyme inhibitors and/or angiotensin receptor blockers, and lipid-lowering agents, but negatively correlated with age, hypertension, severity of diabetes complications, and the use of diuretics and calcium channel blockers.With growing spending on newer antidiabetic drugs, future research on the comparative cost-effectiveness and safety of antidiabetic drugs is anticipated.

A transient numerical model and experimental study of combustion and heat transfer for methane and oxygen within a two-section porous burner are presented in this paper. It is found that the maximum flame velocity is influenced by the combined effects of extinction coefficient and convection heat transfer coefficient, and that the minimum flame velocities of ceramics with various pore densities have slight differences at different equivalence ratios, while maximum flame velocities have large differences. In addition, the flame velocity depends not only on the interfacial convection heat transfer, but also on the radiation heat transfer of the ceramic foams, which is in accordance with our numerical simulation. Meanwhile, the numerical research in the present paper indicates that radiation extinction coefficient or pores per inch is not the only reason to characterize the heat regeneration effect of ceramic foams.

This article investigates the determinants of the prices of pharmaceuticals and their impact on the demand for prescription drugs in the context of Taiwan's pharmaceutical market where medical providers earn profit directly from prescribing and dispensing drugs. Based on product-level data, we find evidence that the profit-seeking behavior of the medical providers in the prescription drug market transfers the force of competition from the unregulated wholesale market to the regulated retail market and hence market competition still plays an important role in the determination of the regulated price. We also find that the profit-seeking behavior plays a similar role to advertising in that it increases the brand loyalty and hence lowers price elasticity. An important implication of our study is that the institutional features in the pharmaceutical market matter in shaping the nature of pharmaceutical competition and the responsiveness of pharmaceutical consumption with respect to changes in price.

In this study, SPMD parallel computation of compressible turbulent jet flow with an explicit finite difference method by direct numerical method is performed on the IBM Linux Cluster. The conservation equations, boundary conditions including NSCBC (charactering boundary conditions), grid generation method, and the solving processing are carefully presented in order to give other researchers a clear understanding of the large scale parallel computing of compressible turbulent flows using explicit finite difference method, which is scarce in the literatures. The speedup factor and parallel computational efficiency are presented with different domain decomposition methods. In order to use our explicit finite method for large scale parallel computing, the grid size imposed on each processor, the speedup factor, and the efficiency factor should be carefully chosen in order to design an efficient parallel code. Our newly developed parallel code is quite efficient from that of implicit finite difference method or spectral method on parallel computational efficiency. This is quite useful for future research for gas and particle two-phase flow, which is still a problem for highly efficient code for two-phase parallel computing.

Objective To provide an overview of the use of biologics in Taiwan, including the access to new biologics, the impact of this access on the growth of health-care expenditure, and the utilization patterns. Methods We first conducted a market-level analysis to investigate the availability of global biologics in Taiwan as well as the growth and concentration of aggregate spending on biologics. We then conducted a patient-level analysis to investigate the costs and utilization patterns for selected new biologics. Results We found that the concentration index is such that the 20 leading biologics in Taiwan account for more than 90% of the total spending on biologics. In our patient-level study on four biologics, the annual cost of treatment per patient ranged from NT$100,000 to NT$400,000. The prevalence rate of the user was between 6.5 and 37.2 per 100,000 of population. The treatment costs were inversely related to the prevalence rate of users. We also found that physicians in larger and public hospitals were more likely to prescribe new biologics to their patients compared with their counterparts practicing in smaller and private hospitals. In addition, we found that physicians were more likely to prescribe biologics to patients with more severe diseases and higher comorbidities. Conclusions We conclude that public spending on biologics in Taiwan is highly targeted toward about 20 products with higher annual expenditures and growth rates and that the utilization of these biologics is targeted at a small number of patients. In addition, the access to these costly biologics is not uniform among patients in a country with universal coverage for prescription drugs.

Two new 13,28-epoxy oleanane-type triterpenoids, namely heterogenoside E and F, were isolated from Lysimachia heterogenea Klatt, together with the eight known compounds: palmitic acid, β-stigmasterol, kaempferol, quercetin, hyperin, isorhamnetin, isorhamnetin-3-O-galactopyranoside and anagallisin C. Heterogenoside F possesses acetoxyl groups at the unusual C-21 and C-22 positions of its oleanane skeleton. The cytotoxic activities of anagallisin C, heterogenoside E and F were weak.

This study empirically examines the effect of hospital competition on prescribing behaviors of oral hypoglycemic agents (OHAs) for ambulatory care in a market setting where hospitals are classified into three levels according to the Taiwanese accreditation system. Without distinguishing the types of market structures and hospital levels, there might be no significant relationship between hospital competition and prescribing behavior. However, the relationship between competition and prescribing behaviors may differ among hospitals at various levels under each type of market structure. Our findings suggest that a market mechanism may improve the prescribing quality of regional and district hospitals under a market structure composed of three level hospitals where more medical resources and information are likely allocated.

The antecedents of brand equity are considered to be brand attitude and brand image, and the consequences of brand equity are considered to be brand preference and purchase intentions. This study concentrates on service brands, selecting 18 from 3 service categories. A structural equation model is presented. Not only does it show a good fit with the research constructs but also the relationships between brand image and brand equity, and brand attitude and brand equity. The impact of brand equity on customer preference and purchase intentions is confirmed as well, which tends to validate the proposed research framework.

Under microwave irradiation (75 W), treatment of 2-alkynylbenzonitriles with 1.5 equiv of sodium azide in DMSO at 140 °C gave 4,5-disubstituted-2 H -1,2,3-triazoles in 60–99% yields. Additionally, adding 8 equiv of ZnBr 2 and using 8 equiv of sodium azide in DMF at 100 °C lead to the formation of tetrazolo[5,1- a ]isoquinolines up to 87% yield.

This paper tests the hypothesis of whether or not financial incentives affect a physician's prescription decision on the choice of generic versus brand-name drugs within a system in which physicians prescribe and dispense drugs. By using data obtained from Taiwan and focusing on diabetic patients, our empirical results provide several consistent findings in support of the hypothesis that profit incentives do affect the physician's prescribing decision, suggesting that physicians act as imperfect agents. An important implication of our findings is that rent seeking for profit margin between the reimbursement and the acquisition price instead of reducing costs is the major driving force behind generic substitution. As a result, the providers instead of the payers or consumers reap the financial benefits of generic substitution.

Rare earth binuclear complexes, [Ln(NAA) 3 (phen)] 2 nDMF (NAA = 1-naphthylacetic acid, phen = 1, 10-phenanthroline, Ln = Y, Eu, Gd, Pr, Sm, Tb, Yb, DMF = N,N′-dimethylformamide), have been prepared and have been characterized by elemental analysis, infrared spectra, electronic spectra, and X-ray crystallography. All complexes crystallize in the monoclinic system, space group P2 1 /c(Eu, Gd, Sm, Tb, Y) and triclinic system, space group P 1 (Pr, Yb). These isostructural complexes display bidentate chelating, bidentate bridging, and tridentate chelating-bridging carboxylate binding modes. At the same time, the luminescent properties and the antibacterium activity of the complexes in solvents were also investigated. At room temperature, the Eu, Sm, and Tb complexes exhibited characteristic luminescence emissions of the central metal ions under UV light excitation and could be significant in the field of supramolecular photonic devices. These complexes were active against Escherichia coli, Staphylococcus aure...

Stimuli-responsive luminescent materials, which are dependent on changes in physical molecular packing modes, have attracted more and more interest over the past ten years. In this study, 2,2-dihydroxy-1,1-naphthalazine was synthesized and shown to exhibit different fluorescence emission in solution and solid states with characteristic aggregation-induced emission (AIE) properties. A remarkable change in the fluorescence of 2,2-dihydroxy-1,1-naphthalazine occurred upon mechanical grinding, heating, or exposure to solvents. According to the characterization by solid-state fluorescence spectroscopy, X-ray crystallography, differential scanning calorimetry, and X-ray powder diffraction, the fluorescence change could be attributed to transitions between two structurally different polymorphs. These significant properties could also give 2,2-dihydroxy-1,1-naphthalazine more potential applications as a multifunctional material.

This paper empirically analyses hospital non-price competition in a market characterized by a government accreditation system in Taiwan. Outpatient services for diabetes patients were used to measure the quality of patient care in outpatient departments in three types of hospitals. The hypothesis that an increase in the number of highest accredited hospitals – medical centres – would improve the quality of care in other types of hospitals is rejected. However, after carefully controlling endogeneity and measurement error of the hospital competition index by using instrumental variables, empirical findings based on the National Health Insurance Research Database from 1997 to 1999 show that different types of hospitals may respond to competitive pressure from the various levels of hospitals differently. Positive spillover effects were found from competition from regional and district hospitals. These findings may deserve serious consideration when forming policy to allocate medical resources to different le...

Human beta2-glycoprotein I (beta2-GPI) binds to recombinant hepatitis B surface antigen (rHBsAg) and can bind specifically to annexin II, which is located on the cell membrane of human hepatoma SMMC-7721 cells. Viral envelope proteins are essential for mediating cellular entry. The aim of this study was to investigate the role of beta2-GPI in the early stages of hepatitis B virus (HBV) infection. Western blot and qRT-PCR analyses revealed that beta2-GPI expression was upregulated in HepG2.2.15 cells at both the mRNA and protein level and was almost non-existent in 293T and CHO cells. Furthermore, annexin II was expressed at lower levels in HepG2.2.15 cells compared to L02, HepG2, and SMMC-7721 cells. Additionally, ELISA analyses demonstrated that beta2-GPI enhanced the ability of HBsAg to bind to cell surfaces, and there was differential adhesion to L02, HepG2, HepG2.2.15, and 293T cells. Western blot and ELISA were then performed to assess the effects of HBV and the HBsAg domain on beta2-GPI expression in co-transfected 293T cells. This study revealed that HBV and the large HBV envelope protein increased beta2-GPI expression. Further investigation indicated that beta2-GPI colocalized with HBsAg in the cytosol of HepG2.2.15 cells, with sodium taurocholate co-transporting polypeptide (NTCP) on the cell membrane in NTCP-complemented HepG2 cells, and with annexin II in the cytosol of HepG2 and HepG2.2.15 cells. These data suggest that high expression of beta2-GPI enhances HBsAg binding to cell surfaces, thus contributing to virus particle transfer to the NTCP receptor and interaction with annexin II for viral membrane fusion.