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Abstract Background and Objectives Nintedanib, a tyrosine kinase inhibitor, is integral in slowing pulmonary fibrosis progression in chronic fibrotic interstitial lung disease (ILD). However, the occurrence of adverse drug reactions (ADRs) often limits its use, leading to treatment discontinuation, typically within 3–12 months. Discontinuation adversely affects patient outcomes. The study investigated whether aggressive ADR management can prolong nintedanib therapy and improve patient outcomes. Methods This retrospective, single-center study enrolled Taiwanese patients with chronic fibrotic ILD who were treated with nintedanib from January 2016 to December 2022 in Kaohsiung Chang Gung Memorial Hospital. Patients were categorized into those who discontinued treatment within 180 days and those continuing beyond. Management of ADRs was identified through concurrent prescriptions for symptoms such as nausea, vomiting, diarrhea, or hepatic dysfunction. Baseline demographics, comorbidities, pulmonary function tests, and instances of acute exacerbation were analyzed. Results The study enrolled 94 patients, with 71 (75.5%) experiencing ADRs. Among these, 41 (43.6%) discontinued nintedanib within 180 days. The administration of medications for managing nausea/vomiting [17 (41.5%) versus 36 (67.9%), p = 0.0103] and diarrhea [12 (29.3%) versus 33 (62.3%), p = 0.0015] was less frequent in the discontinued group compared with the continued group. Additionally, a higher incidence of acute exacerbation was observed in the discontinued group (34.1% versus 20.8%, p = 0.016). Conclusion Aggressive management of ADRs may enhance patient tolerance to nintedanib, potentially prolonging treatment duration and improving outcomes in chronic fibrotic ILD.

Background A mysterious skin rash (papular lesions) outbreak broke out for unknown reasons in Taiwan’s Pescadores Islands in mid-autumn 2021, causing much anxiety in the population already nervous about the ongoing COVID-19 epidemic. Objectives We conducted a field survey for possible culprit agents. Methods Skin samples were taken with rapid-glue adhesives from the affected skin. Electron microscopy from the skin samples as well as caterpillar seta was performed. Additional neurotransmitter analysis by mass spectrometry (MS) was conducted on the skin samples. Results A field survey found a large increase in caterpillars, Euproctis taiwana, in September 2021, the warmest September in recent years. Electron microscopy performed on superficial skin samples (3–6 cells thick) of affected and healthy skin (n = 5 and 3, respectively) and caterpillar setae revealed ultrastructural similarities between setae spurs (0.15–0.2 μm) and tiny pits (0.2 μm) on the affected skin as well as similar vegetative debris (0.75 μm) on both setae and affected skin. MS showed large increases in tyrosine, serine, and histamine, known mediators of arthropod insult. Conclusion The co-occurrence of E. taiwana population growth, excessive warming, and strong monsoon winds may lead to this unusual autumn outbreak in late September. The lifting of COVID-19-related travel restrictions against earlier that month probably exacerbated it.

Coastal wetlands play an important role in the global water and biogeochemical cycles. Climate change makes it more difficult for these ecosystems to adapt to the fluctuation in sea levels and other environmental changes. Given the importance of eco-geomorphological processes for coastal wetland resilience, many eco-geomorphology models differing in complexity and numerical schemes have been developed in recent decades. However, their divergent estimates of the response of coastal wetlands to climate change indicate that substantial structural uncertainties exist in these models. To investigate the structural uncertainty of coastal wetland eco-geomorphology models, we developed a multi-algorithm model framework of eco-geomorphological processes, such as mineral accretion and organic matter accretion, within a single hydrodynamics model. The framework is designed to explore possible ways to represent coastal wetland eco-geomorphology in Earth system models and reduce the related uncertainties in global applications. We tested this model framework at three representative coastal wetland sites: two saltmarsh wetlands (Venice Lagoon and Plum Island Estuary) and a mangrove wetland (Hunter Estuary). Through the model–data comparison, we showed the importance of using a multi-algorithm ensemble approach for more robust predictions of the evolution of coastal wetlands. We also found that more observations of mineral and organic matter accretion at different elevations of coastal wetlands and evaluation of the coastal wetland models at different sites in diverse environments can help reduce the model uncertainty.

Abstract The original Harris hawks optimization (HHO) algorithm has the problems of unstable optimization effect and easy to fall into stagnation. However, most of the improved HHO algorithms can not effectively improve the ability of the algorithm to jump out of the local optimum. In this regard, an integrated improved HHO (IIHHO) algorithm is proposed. Firstly, the linear transformation escape energy used by the original HHO algorithm is relatively simple and lacks the escape law of the prey in the actual nature. Therefore, intermittent energy regulator is introduced to adjust the energy of Harris hawks, which is conducive to improving the local search ability of the algorithm while restoring the prey's rest mechanism; Secondly, to adjust the uncertainty of random vector, a more regular vector change mechanism is used instead, and the attenuation vector is obtained by modifying the composite function. Finally, the search scope of Levy flight is further clarified, which is conducive to the algorithm jumping out of the local optimum. Finally, in order to modify the calculation limitations caused by the fixed step size, Cardano formula function is introduced to adjust the step size setting and improve the accuracy of the algorithm. First, the performance of IIHHO algorithm is analyzed on the Computational Experimental Competition 2013 (CEC 2013) function test set and compared with seven improved evolutionary algorithms, and the convergence value of the iterative curve obtained is better than most of the improved algorithms, verifying the effectiveness of the proposed IIHHO algorithm. Second, the IIHHO is compared with another three state of the art (SOTA) algorithms with the Computational Experimental Competition 2022 (CEC 2022) function test set, the experiments show that the proposed IIHHO algorithm still has a strong ability to search for the optimal value. Third, IIHHO algorithm is applied in two different engineering experiments. The calculation results of minimum cost prove that IIHHO algorithm has certain advantages in dealing with the problem of search space. All these demonstrate that the proposed IIHHO is promising for numeric optimization and engineering applications.

Abstract Coastal zone compound flooding (CF) can be caused by the interactive fluvial and oceanic processes, particularly when coastal backwater propagates upstream and interacts with high river discharge. The modeling of CF is limited in existing Earth System Models (ESMs) due to coarse mesh resolutions and one‐way coupled river‐ocean components. In this study, we present a novel multi‐scale coupling framework within the Energy Exascale Earth System Model (E3SM), integrating global atmosphere and land with interactively coupled river and ocean models using different meshes with refined resolutions near the coastline. To evaluate this framework, we conducted ensemble simulations of a CF event (Hurricane Irene in 2011) in a Mid‐Atlantic estuary. The results demonstrate that the novel E3SM configuration can reasonably reproduce river discharge and sea surface height variations. The two‐way river‐ocean coupling improves the representation of coastal backwater effects at the terrestrial‐aquatic interface that are caused by the combined actions of tide and storm surge during the CF event, thus providing a valuable modeling tool for better understanding the river‐estuary‐ocean dynamics in extreme events under climate change. Notably, our results show that the most significant CF impacts occur when the highest storm surge generated by a tropical cyclone meets with a moderate river discharge. This study highlights the state‐of‐the‐art advancements developed within E3SM for simulating multi‐scale coastal processes.

AbstractBackground Although medical literature has highlighted the importance of role modelling, hardly any reveals how humanistic qualities and role modelling should be taught. This study aimed to determine whether the use of Bandura’s social cognitive learning for humanistic professional role modelling could elicit any positive effect on medical university students’ awareness of humanistic professionalism, caring behaviours, and school-to-work transitional anxiety.Methods We conducted a 16-week quasi-experimental study to examine whether the intervention could elicit any differences between the experimental group (BanduraSCLT – HPRM – Literature-and-Film Study; N = 34) and the control group (non-BanduraSCLT – HPRM – Literature-and-Film Study; N = 33), comprising of medical university students from the central part of Taiwan. The quantitative instruments included the Humanistic Professional Awareness Scale (HPAS-HSP), Caring Behaviour Scale (CBS-HSP) and School-to-Work Transitional Anxiety Scale (StWTA-HS). One-way MANOVA (multivariate analysis of variance) and one-way MANCOVA (multivariate analysis of covariance) were used for statistical analysis.Results The results revealed that students who received Bandura’s social cognitive learning for humanistic professional role modelling had significantly stronger humanistic professional awareness in terms of ‘personal integrity and accountability’, ‘sensitivity to others’ and ‘professional competence’. They also had more effective caring behaviour in terms of ‘support and attentiveness’, ‘professional knowledge and skills’, ‘gratifying needs and responsiveness’ and ‘confidentiality and trust’. In addition, they had less school-to-work transitional anxiety in terms of ‘inexperience in professional knowledge and skills’, ‘fear of death’, ‘fear of being infected’ and ‘interpersonal interactions.’Conclusion The findings suggest that using Bandura’s social cognitive learning for humanistic professional role modelling can have a positive impact on awareness of humanistic professionalism, caring behaviour and school-to-work transitional anxiety. Hence, it can be an effective teaching tool for medical education.

BackgroundBoth the size of the older population and the use of complementary and alternative medicine are increasing worldwide. This study evaluated the long-term trend in utilization of traditional Chinese medicine (TCM) and associated factors among older people in Taiwan.MethodsUsing the database of population-based interview surveys, we evaluated the one-month prevalence of TCM use among 13,945 older people aged over 65 years from 2001-2017. The sociodemographic status and medical comorbidities of older people who did and did not use TCM were compared by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multiple logistic regressions.ResultsThe one-month prevalence of TCM use increased from 5.5% in 2001 to 9.1% in 2017 among older people in Taiwan. Overall, 7.3% of older people had used TCM within the previous month. People with a history of heart disease (OR 1.62, 95% CI 1.24-2.12), use of folk therapy (OR 3.16, 95% CI 2.00-4.99), and purchase of non-prescribed Chinese herbal medicine (OR 2.08, 95% CI 1.48-2.91) were more likely to use TCM than the comparison group. However, age ≥80 years (OR 0.48, 95% CI 0.31-0.72) and previous hospitalization (OR 0.59, 95% CI 0.41-0.85) were associated with the reduced use of TCM.ConclusionFrom 2001-2017, the use of TCM increased in the older population in Taiwan. The use of folk medicine and purchase of non-prescribed Chinese herbal medicine were significant predictors for the use of TCM.

Abstract Background Previous observational studies have shown that people with dental scaling (DS) had decreased risk of stroke. However, limited information is available on the association between DS and poststroke outcomes. The present study aimed to evaluate the effects of regular DS on the complications and mortality after stroke. Methods We conducted a retrospective cohort study of 49,547 hospitalized stroke patients who received regular DS using 2010–2017 claims data of Taiwan’s National Health Insurance. Using a propensity-score matching procedure, we selected 49,547 women without DS for comparison. Multiple logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality associated with regular DS. Results Stroke patients with regular DS had significantly lower risks of poststroke pneumonia (OR 0.58, 95% CI 0.54–0.63), septicemia (OR 0.58, 95% CI 0.54–0.63), urinary tract infection (OR 0.68, 95% CI 0.66–0.71), intensive care (OR 0.81, 95% CI 0.78–0.84), and in-hospital mortality (OR 0.66, 95% CI 0.62–0.71) compared with non-DS stroke patients. Stroke patients with regular DS also had shorter hospital stays (p

ABSTRACTBackground Narrative medicine can serve as a tool to empathize with human beings’ predicament and suffering. The research intended to examine whether the use of narrative medicine to form an empathetic connection could bring any positive impacts on health professions students.Methods A two-group quasi-experimental design was adopted to examine whether the intervention of narrative medicine to form an empathetic connection could demonstrate differences between the experimental group (35 students) and the control group (32 students) with regard to professional identity, self-reflection, emotional catharsis, and reflective writing competency. These 67 participants were health professions students in a medical university (mean age = 20.02; SD = 0.23), with varied majors in health disciplines. The 16-week intervention was the use of narrative medicine to form an empathetic connection with those suffering, via the three stages of narrative medicine: attention → representation → affiliation. The quantitative instruments included a professional identity scale (PIS-HSP), a reflective thinking scale (RTS-HSP), and an emotional catharsis scale (ECS-IN), as well as an analytic reflective writing scoring rubric (ARWSR-HSP). To triangulate the quantitative results, the study also used the student interviews. The SPSS software was used to analyze the data.Results The quantitative results demonstrated that the narrative medicine-based intervention could bring positive effects on the health professions students. After going through the intervention, the students in the experimental group had stronger professional identity, a higher reflective thinking level, more emotional catharsis, and greater improvement in reflective writing competency than those not receiving the intervention, though some subscales not reaching statistical significance.Conclusion This research results proved that the use of narrative medicine to form an empathetic connection could bring positive impacts on health professions students regarding professional identity, self-reflection, emotional catharsis, and self-reflective writing competency.

Abstract Flow direction modeling consists of (a) an accurate representation of the river network and (b) digital elevation model (DEM) processing to preserve characteristics with hydrological significance. In part 1 of our study, we presented a mesh‐independent approach to representing river networks on different types of meshes. This follow‐up part 2 study presents a novel DEM processing approach for flow direction modeling. This approach consists of (a) a topological relationship‐based hybrid breaching‐filling method to conduct stream burning for the river network and (b) a modified depression removal method for rivers and hillslopes. Our methods reduce modifications to surface elevations and provide a robust two‐step procedure to remove local depressions in DEM. They are mesh‐independent and can be applied to both structured and unstructured meshes. We applied our new methods with different model configurations to the Susquehanna River Basin. The results show that topological relationship‐based stream burning and depression‐filling methods can reproduce the correct river networks, providing high‐quality flow direction and other characteristics for hydrologic and Earth system models.

Both intensive farming of paddy field crops and conventional farm management techniques have been a major cause of environmental issues in recent years. A more ecosystem-based, sustainable agricultural methodology should be utilized to help solve this dilemma. However, the joint effects of landscape and farming on arthropod communities in paddy fields are unexplored. In eco-friendly paddy fields, we postulate the arthropod diversity to be higher in fields that use ecosystem-based methods. In this study, we collected arthropods monthly using a blower-vac during the first rice crop of 2019 in Taiwan. A total of 53,522 individuals of 14 orders, 96 families, and 445 morphospecies were collected. All arthropods were identified into four functional groups. The result showed that insect communities are different between sustainable and conventional fields. Results showed that sustainable fields had a higher abundance of arthropod fauna than conventional fields. It was also apparent that the arthropod community changed along with the developmental growth of rice and in different areas. Three functional groups, viz., herbivores, parasitoids, and detritivores, present the best model when the farming type was assigned as the fixed effect, while the predator reveal the best model when the farming type, landscape, and their interaction were assigned as the fixed effects. The arthropod communities have also been affected by the surrounding landscape. This study reveals that both agricultural management and landscape can have a joint effect on arthropod communities in paddy fields.

Abstract Background The influence of alcoholic liver disease (ALD) on the postoperative outcomes is not completely understood. Our purpose is to evaluate the complications and mortality after nonhepatic surgeries in patients with ALD. Methods We conducted a retrospective cohort study included adults aged 20 years and older who underwent nonhepatic elective surgeries using data of Taiwan’s National Health Insurance, 2008–2013. Using a propensity-score matching procedure, we selected surgical patients with ALD (n = 26,802); or surgical patients without ALD (n = 26,802) for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with ALD. Results Patients with ALD had higher risks of acute renal failure (OR 2.74, 95% CI 2.28–3.28), postoperative bleeding (OR 1.64, 95% CI 1.34–2.01), stroke (OR 1.51, 95% CI 1.34–1.70) septicemia (OR 1.47, 95% CI 1.36–1.58), pneumonia (OR 1.43, 95% CI 1.29–1.58), and in-hospital mortality (OR 2.64, 95% CI 2.24–3.11) than non-ALD patients. Patients with ALD also had longer hospital stays and higher medical expenditures after nonhepatic surgical procedures than the non-ALD patients. Compared with patients without ALD, patients with ALD who had jaundice (OR 4.82, 95% CI 3.68–6.32), ascites (OR 4.57, 95% CI 3.64–5.74), hepatic coma (OR 4.41, 95% CI 3.44–5.67), gastrointestinal hemorrhage (OR 3.84, 95% CI 3.09–4.79), and alcohol dependence syndrome (OR 3.07, 95% CI 2.39–3.94) were more likely to have increased postoperative mortality. Conclusion Surgical patients with ALD had more adverse events and a risk of in-hospital mortality after nonhepatic surgeries that was approximately 2.6-fold higher than that for non-ALD patients. These findings suggest the urgent need to revise the protocols for peri-operative care for this population.

BackgroundThe influence of recent influenza infection on perioperative outcomes is not completely understood.MethodUsing Taiwan’s National Health Insurance Research Data from 2008 to 2013, we conducted a surgical cohort study, which included 20,544 matched patients with a recent history of influenza and 10,272 matched patients without. The main outcomes were postoperative complications and mortality. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the complications and for mortality in patients with a history of influenza within 1–14 days or 15–30 days compared with non-influenza controls.ResultsCompared with patients who had no influenza, patients with influenza within preoperative days 1–7 had increased risks of postoperative pneumonia (OR 2.22, 95% CI 1.81–2.73), septicemia (OR 1.98, 95% CI 1.70–2.31), acute renal failure (OR 2.10, 95% CI 1.47–3.00), and urinary tract infection (OR 1.45, 95% CI 1.23–1.70). An increased risk of intensive care admission, prolonged length of stay, and higher medical expenditure was noted in patients with history of influenza within 1–14 days.ConclusionWe found that there was an association between influenza within 14 days preoperatively and the increased risk of postoperative complications, particularly with the occurrence of influenza within 7 days prior to surgery.

Abstract River networks are important features in surface hydrology. However, accurately representing river networks in spatially distributed hydrologic and Earth system models is often sensitive to the model's spatial resolution. Specifically, river networks are often misrepresented because of the mismatch between the model's spatial resolution and river network details, resulting in significant uncertainty in the projected flow direction. In this study, we developed a topological relationship‐based river network representation method for spatially distributed hydrologic models. This novel method uses (a) graph theory algorithms to simplify real‐world vector‐based river networks and assist in mesh generation; and (b) a topological relationship‐based method to reconstruct conceptual river networks. The main advantages of our method are that (a) it combines the strengths of vector‐based and DEM raster‐based river network extraction methods; and (b) it is mesh‐independent and can be applied to both structured and unstructured meshes. This method paves a path for advanced terrain analysis and hydrologic modeling across different scales.

Macrophages play a pivotal role in mediating inflammation and subsequent resolution of inflammation. The availability of selenium as a micronutrient and the subsequent biosynthesis of selenoproteins, containing the 21st amino acid selenocysteine (Sec), are important for the physiological functions of macrophages. Selenoproteins regulate the redox tone in macrophages during inflammation, the early onset of which involves oxidative burst of reactive oxygen and nitrogen species. SELENOW is a highly expressed selenoprotein in bone marrow-derived macrophages (BMDMs). Beyond its described general role as a thiol and peroxide reductase and as an interacting partner for 14-3-3 proteins, its cellular functions, particularly in macrophages, remain largely unknown. In this study, we utilized Selenow knock-out (KO) murine bone marrow-derived macrophages (BMDMs) to address the role of SELENOW in inflammation following stimulation with bacterial endotoxin lipopolysaccharide (LPS). RNAseq-based temporal analyses of expression of selenoproteins and the Sec incorporation machinery genes suggested no major differences in the selenium utilization pathway in the Selenow KO BMDMs compared to their wild-type counterparts. However, selective enrichment of oxidative stress-related selenoproteins and increased ROS in Selenow−/− BMDMs indicated anomalies in redox homeostasis associated with hierarchical expression of selenoproteins. Selenow−/− BMDMs also exhibited reduced expression of arginase-1, a key enzyme associated with anti-inflammatory (M2) phenotype necessary to resolve inflammation, along with a significant decrease in efferocytosis of neutrophils that triggers pathways of resolution. Parallel targeted metabolomics analysis also confirmed an impairment in arginine metabolism in Selenow−/− BMDMs. Furthermore, Selenow−/− BMDMs lacked the ability to enhance characteristic glycolytic metabolism during inflammation. Instead, these macrophages atypically relied on oxidative phosphorylation for energy production when glucose was used as an energy source. These findings suggest that SELENOW expression in macrophages may have important implications on cellular redox processes and bioenergetics during inflammation and its resolution.

Abstract The association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

ABSTRACT Almost all known Liberibacters can be transmitted by psyllids. This suggests that there is a coevolutionary relationship between these two groups of organisms. However, detailed investigation of Liberibacters and psyllids have often focused on only a few species, thus potentially limiting knowledge on Liberibacter-psyllid associations. This study investigated the infection patterns of a Liberibacter inhabiting Macrohomotoma gladiata, a psyllid species feeding on Ficus microcarpa. Comparison of the Liberibacter’s near-full-length 16S rDNA sequence with those of other known Liberibacters revealed that it is closely related to Candidatus Liberibacter asiaticus. A survey of different M. gladiata populations in Taiwan using conventional and quantitative PCR (qPCR) indicated that the Liberibacter could be detected with variable frequencies in all the tested populations; the proportions of individuals carrying large Liberibacter populations also differed depending on the population. Additional analysis of a larger set of samples collected from one specific population revealed that the psyllid’s gender and abdominal color were associated with Liberibacter infection density. Significantly greater proportions of individuals with a blue/green abdomen carried high Liberibacter titers. Analysis of the psyllids’ body lengths revealed that body size was not affected by Liberibacter infection status and that females, particularly those with an orange abdomen, tended to be larger. The infection patterns of Liberibacter in nymph-infested and nymph-free twigs of F. microcarpa were also determined, and Liberibacter distribution was found to be associated with the presence of nymphs. These findings broaden the understanding of Liberibacter ecology in general and have implications for managing Liberibacter-associated diseases. IMPORTANCE Despite the ever-increasing interest in Liberibacter-psyllid interactions, most of the current knowledge on the subject has been established from studies focusing on species associated with crop diseases. To obtain a more holistic understanding of Liberibacter ecology, we investigated the infection patterns of a Liberibacter recently detected in Macrohomotoma gladiata, a psyllid pest of Ficus microcarpa. We showed that a Liberibacter closely related to Candidatus Liberibacter asiaticus is widely distributed across M. gladiata populations in Taiwan. The study also identified factors associated with the Liberibacter infection patterns, both in M. gladiata and in F. microcarpa. The effects of Liberibacter infection status on psyllid body sizes were also examined. Some of the patterns detected in this work were similar those found in well-known Liberibacters, while some were the opposite. The findings in this work broaden our understanding of Liberibacter ecology in general and may facilitate development of strategies for managing plant diseases.

This study intended to develop and assess the psychometric properties of a caring behavior scale on healthcare students and providers (CBS-HSP) in a Taiwanese population. After a literature review was conducted and an expert panel was consulted for item generation, 104 items for the CBS-HSP scale were derived on a nine-point Likert scale, with 9 indicating ‘extremely important’ and 1 indicating ‘extremely unimportant.’ A pilot study was then conducted with seven hundred forty-eight healthcare students and providers in Taiwan for further data analysis. The statistic software used in the study was SPSS for the exploratory factor analysis (EFA) and AMOS for the confirmatory factor analysis (CFA). Also, to examine the psychometric properties of the scale, internal consistency, convergent validities, discriminant validities, and model fit indices were calculated in the study. The EFA results derived 31 items in four factors, with 65.742% of the total variance explained: ‘support and attentiveness’ (11 items; 48.714% of the variance explained), ‘professional knowledge and skills’ (8 items; 8.226% of the variance explained), ‘gratifying needs and responsiveness’ (7 items; 5.236% of the variance explained), and ‘confidentiality and trust’ (5 items; 3.566% of the variance explained). The Cronbach’s alphas for the four subscales and the overall scale ranged from 0.894 to 0.964. The CFA results yielded the same 31 items, with the same four factors. The CFA results demonstrated good to excellent model fit in the χ2/df ratio (1.242), GFI (0.988), CFI (0.988), TFI (0.985), and RMSEA (0.031). The Cronbach’s alphas ranged between 0.866 and 0.971; the composite alphas ranged between 0.854 and 0.964. The convergent and discriminant validities also proved the stability of the CBS-HSP scale. The research results indicated that the developed CBS-HSP appeared to be a reliable instrument to measure healthcare students’ and providers’ caring behaviors.

Abstract Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.

Abstract The risk and outcomes of diabetes in patients with epilepsy remains unclear. We evaluated these risks using an epilepsy cohort analysis and a diabetes admission analysis. In the epilepsy cohort analysis, we identified 2854 patients with newly diagnosed epilepsy in 2000–2008 from the research data of National Health Insurance in Taiwan. Using Propensity-score matching by sociodemographic factors and medical conditions, we selected 22,832 people without epilepsy as a non-exposed cohort for comparison. Follow-up events of diabetes from January 1, 2000 until December 31, 2013 were ascertained from medical claims. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with epilepsy were calculated using multiple Cox proportional hazard models. In the diabetes admission analysis, we identified 92,438 hospitalized diabetes patients, 930 of whom had a history of epilepsy. Adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes associated with previous epilepsy were calculated using multiple logistic regressions. The adjusted HR of diabetes in the cohort with epilepsy was 1.31 (95% CI 1.14–1.50) compared to the non-epilepsy cohort. Previous epilepsy was associated with post-diabetes adverse events, such as pneumonia (OR 1.68, 95% CI 1.37–2.07), urinary tract infection (OR 1.83, 95% CI 1.55–2.16), and septicemia (OR 1.34, 95% CI 1.09–1.65). In conclusion, epilepsy was associated with higher risk of diabetes and adverse post-diabetes outcomes. Diabetes prevention and attention to post-diabetes adverse events are needed for this susceptible population.