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Aims of this assessment were to describe requirements for physicians to engage in CME/CPD; explore perceptions of In-Country SMEs of their CME/CPD systems; describe perceptions of In-Country physicians about interprofessional continuing education (IPCE) and independent CME/CPD; and provide recommendations that may be adopted to improve quality and effectiveness. This assessment used a mixed-methods approach that included 1:1 interviews with in-country subject matter experts and an electronic survey capturing qualitative and quantitative data from practicing in-country physicians. This assessment reflects a country invested in the education of its physician workforce. CME/CPD systems have embedded governance structures, organizations authorized to provide education, and a recognized credit system. Governing bodies have implemented regulations to limit influence from commercial interest organizations on CME/CPD, and there is opportunity to expand delivery systems to reach physicians across diverse geographic regions, better align content to individual physicians' gaps and learning needs, and reduce cost. There is opportunity to invest in IPCE within a country with a strong professional hierarchy system. This assessment reflects CME/CPD systems that are relatively mature and identifies several opportunities to expand and enhance systems to better meet educational needs of physicians and to positively impact practice and patient outcomes. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) commonly occurs in approximately 2% of cancer patients, and the incidence of AF among cancer patients is greater than in the general population. This observational study presented the incidence risk of AF among cancer patients, including specific cancer types, using a population database. The Taiwan Cancer Registry was used to identify cancer patients between 2008 and 2017. The diagnosis of AF was based on the International Classification of Diseases codes (ICD-9-CM: 427.31 or ICD-10-CM: I48.0, I48.1, I48.2, and I48.91) in Taiwan national health insurance research datasets. The incidence of developing AF in the cancer population was calculated as the number of new-onset AF cases per person-year of follow-up during the study period. The overall incidence of AF among cancer patients was 50.99 per 100,000 person-years. Patients aged older than 65 years and males had higher AF incidence rates. Lung cancer males and esophageal cancer females showed the highest AF incidence risk (185.02 and 150.30 per 100,000 person-years, respectively). Our findings identified esophageal, lung, and gallbladder cancers as the top three cancers associated with a higher incidence of AF. Careful monitoring and management of patients with these cancers are crucial for early detection and intervention of AF. [ABSTRACT FROM AUTHOR]

Objective: The healthcare challenge driven by an aging population and rising demand is one of the most pressing issues leading to emergency department (ED) overcrowding. An emerging solution lies in machine learning's potential to predict ED dispositions, thus leading to promising substantial benefits. This study's objective is to create a predictive model for ED patient dispositions by employing ensemble learning. It harnesses diverse data types, including structured and unstructured information gathered during ED visits to address the evolving needs of localized healthcare systems. Methods: In this cross-sectional study, 80,073 ED patient records were amassed from a major southern Taiwan hospital in 2018–2019. An ensemble model incorporated structured (demographics, vital signs) and pre-processed unstructured data (chief complaints, preliminary diagnoses) using bag-of-words (BOW) and term frequency-inverse document frequency (TF-IDF). Two random forest base-learners for structured and unstructured data were employed and then complemented by a multi-layer perceptron meta-learner. Results: The ensemble model demonstrates strong predictive performance for ED dispositions, achieving an area under the receiver operating characteristic curve of 0.94. The models based on unstructured data encoded with BOW and TF-IDF yield similar performance results. Among the structured features, the top five most crucial factors are age, pulse rate, systolic blood pressure, temperature, and acuity level. In contrast, the top five most important unstructured features are pneumonia, fracture, failure, suspect, and sepsis. Conclusions: Findings indicate that utilizing ensemble learning with a blend of structured and unstructured data proves to be a predictive method for determining ED dispositions. [ABSTRACT FROM AUTHOR]

Defining the oxygen level that induces cell death within 3-D tissues is vital for understanding tissue hypoxia; however, obtaining accurate measurements has been technically challenging. In this study, we introduce a noninvasive, high-throughput methodology to quantify critical survival partial oxygen pressure (pO2) with high spatial resolution within spheroids by using a combination of controlled hypoxic conditions, semiautomated live/dead cell imaging, and computational oxygen modeling. The oxygen-permeable, micropyramid patterned culture plates created a precisely controlled oxygen condition around the individual spheroid. Live/dead cell imaging provided the geometric information of the live/dead boundary within spheroids. Finally, computational oxygen modeling calculated the pO2 at the live/dead boundary within spheroids. As proof of concept, we determined the critical survival pO2 in two types of spheroids: isolated primary pancreatic islets and tumor-derived pseudoislets (2.43 ± 0.08 vs. 0.84 ± 0.04 mmHg), indicating higher hypoxia tolerance in pseudoislets due to their tumorigenic origin. We also applied this method for evaluating graft survival in cell transplantations for diabetes therapy, where hypoxia is a critical barrier to successful transplantation outcomes; thus, designing oxygenation strategies is required. Based on the elucidated critical survival pO2, 100% viability could be maintained in a typically sized primary islet under the tissue pO2 above 14.5 mmHg. This work presents a valuable tool that is potentially instrumental for fundamental hypoxia research. It offers insights into physiological responses to hypoxia among different cell types and may refine translational research in cell therapies. NEW & NOTEWORTHY: Our study introduces an innovative combinatory approach for noninvasively determining the critical survival oxygen level of cells within small cell spheroids, which replicates a 3-D tissue environment, by seamlessly integrating three pivotal techniques: cell death induction under controlled oxygen conditions, semiautomated imaging that precisely identifies live/dead cells, and computational modeling of oxygen distribution. Notably, our method ensures high-throughput analysis applicable to various cell types, offering a versatile solution for researchers in diverse fields. [ABSTRACT FROM AUTHOR]

An awareness of antecedents of acceptance of digital contact tracing (DCT) can enable healthcare authorities to design appropriate strategies for fighting COVID-19 or other infectious diseases that may emerge in the future. However, mixed results about these antecedents are frequently reported. Most prior DCT acceptance review studies lack statistical synthesis of their results. This study aims to undertake a systematic review and meta-analysis of antecedents of DCT acceptance and investigate potential moderators of these antecedents. By searching multiple databases and filtering studies by using both inclusion and exclusion criteria, 76 and 25 studies were included for systematic review and meta-analysis, respectively. Random-effects models were chosen to estimate meta-analysis results since Q, I2, and H index signified some degree of heterogeneity. Fail-safe N was used to assess publication bias. Most DCT acceptance studies have focused on DCT related factors. Included antecedents are all significant predictors of DCT acceptance except for privacy concerns and fear of COVID-19. Subgroup analysis showed that individualism/collectivism moderate the relationships between norms/privacy concerns and intention to use DCT. Based on the results, the mean effect size of antecedents of DCT acceptance and the potential moderators may be more clearly identified. Appropriate strategies for boosting the DCT acceptance rate can be proposed accordingly. [ABSTRACT FROM AUTHOR]

Background: With rising incidence of skin cancer and relatively increased mortality rates, an improved diagnosis of such a potentially fatal disease is of vital importance. Although frequently curable, it nevertheless places a considerable burden upon healthcare systems. Among the various types of skin cancers, non-melanoma skin cancer is most prevalent. Despite such prevalence and its associated cost, scant proof concerning the diagnostic accuracy via Artificial Intelligence (AI) for non-melanoma skin cancer exists. This study meta-analyzes the diagnostic test accuracy of AI used to diagnose non-melanoma forms of skin cancer, and it identifies potential covariates that account for heterogeneity between extant studies. Methods: Various electronic databases (Scopus, PubMed, ScienceDirect, SpringerLink, and Dimensions) were examined to discern eligible studies beginning from March 2022. Those AI studies predictive of non-melanoma skin cancer were included. Summary estimates of sensitivity, specificity, and area under receiver operating characteristic curves were used to evaluate diagnostic accuracy. The revised Quality Assessment of Diagnostic Studies served to assess any risk of bias. Results: A literature search produced 39 eligible articles for meta-analysis. The summary sensitivity, specificity, and area under receiver operating characteristic curve of AI for diagnosing non-melanoma skin cancer was 0.78, 0.98, & 0.97, respectively. Skin cancer typology, data sources, cross validation, ensemble models, types of techniques, pre-trained models, and image augmentation became significant covariates accounting for heterogeneity in terms of both sensitivity and/or specificity. Conclusions: Meta-analysis results revealed that AI is predictive of non-melanoma with an acceptable performance, but sensitivity may become improved. Further, ensemble models and pre-trained models are employable to improve true positive rating. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the leading causes of death worldwide and a major cause of ill health. Without treatment, the mortality rate of TB is approximately 50%; with treatment, most patients with TB can be cured. However, anti-TB drug treatments may result in many adverse effects. Therefore, it is important to detect and predict these adverse effects early. Our study aimed to build models using an artificial intelligence/machine learning approach to predict acute hepatitis, acute respiratory failure, and mortality after TB treatment. Materials and Methods: Adult patients (age ≥ 20 years) who had a TB diagnosis and received treatment from January 2004 to December 2021 were enrolled in the present study. Thirty-six feature variables were used to develop the predictive models with AI. The data were randomly stratified into a training dataset for model building (70%) and a testing dataset for model validation (30%). These algorithms included XGBoost, random forest, MLP, light GBM, logistic regression, and SVM. Results: A total of 2248 TB patients in Chi Mei Medical Center were included in the study; 71.7% were males, and the other 28.3% were females. The mean age was 67.7 ± 16.4 years. The results showed that our models using the six AI algorithms all had a high area under the receiver operating characteristic curve (AUC) in predicting acute hepatitis, respiratory failure, and mortality, and the AUCs ranged from 0.920 to 0.766, 0.884 to 0.797, and 0.834 to 0.737, respectively. Conclusions: Our AI models were good predictors and can provide clinicians with a valuable tool to detect the adverse prognosis in TB patients early. [ABSTRACT FROM AUTHOR]

To minimize the stress shielding effect of metallic biomaterials in mimicking bone, the body-centered cubic (bcc) unit cell-based porous CoCrMo alloys with different, designed volume porosities of 20, 40, 60, and 80% were produced via a selective laser melting (SLM) process. A heat treatment process consisting of solution annealing and aging was applied to increase the volume fraction of an ε-hexagonal close-packed (hcp) structure for better mechanical response and stability. In the present study, we investigated the impact of different, designed volume porosities on the compressive mechanical properties in as-built and heat-treated CoCrMo alloys. The elastic modulus and yield strength in both conditions were dramatically decreased with increasing designed volume porosity. The elastic modulus and yield strength of the CoCrMo alloys with a designed volume porosity of 80% exhibited the closest match to those of bone tissue. Different strengthening mechanisms were quantified to determine their contributing roles to the measured yield strength in both conditions. The experimental results of the relative elastic modulus and yield strength were compared to the analytical and simulation modeling analyses. The Gibson–Ashby theoretical model was established to predict the deformation behaviors of the lattice CoCrMo structures. [ABSTRACT FROM AUTHOR]

Patients with chronic obstructive pulmonary disease (COPD) had higher risk of atrial fibrillation (AF). The treatment of AF includes medicines to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm. To reduce the stroke, patients with AF may prescribe some type of antithrombotic medication (such as warfarin, one of the new non-vitamin K antagonist oral anticoagulants [NOACs]-dabigitran, apixaban, rivoraxaban, or edoxaban) or maybe aspirin. The aim of our study was to exam the prescription pattern in patients with COPD and AF. We selected COPD population in Taiwan older than 40 years and less than 90 years old with an COPD diagnosis at least two outpatient claims or at least one inpatient claim coded and also need at least one prescription of bronchodilators. We followed this COPD cohort until they have AF and their prescription pattern. We included 267,740 patients with COPD who meet the inclusion and exclusion criteria and 6,582 patients concomitant with COPD and AF. The mean age was 75 years, and about 77% of the patients were older than 70 years. Three-fourths of patients with COPD were male. The common comorbidities were hypertension (17.58%), diabetes (7.47%), ischemic heart disease (4.66%), and dyslipidemia (3.68%). we found that most patients received aspirin which accounting for 31%, followed by coumadin (8.22%) and clopidogrel. Prescribing NOAC within 30 days after AF diagnosis was low in patients with COPD and the percentage of NOAC usage was also lower than warfarin. [ABSTRACT FROM AUTHOR]

To tackle the spread of COVID-19 since its outbreak in January 2020, the police have been given additional powers in Taiwan. Studies have consistently revealed that police legitimacy, the belief that the police are trustworthy and allowed to exercise their authority to maintain order, is the main factor determining whether people are willing to cooperate with the police and comply with laws. This paper explores police legitimacy in Taiwan in terms of whether it exists and whether the Taiwanese police have built or damaged their legitimacy during the unprecedented challenges presented by the COVID-19 pandemic. Using the relevant literature, historical events, public opinion survey results, and official crime data, we find that police legitimacy existed before and has continued to exist during the pandemic in Taiwan. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "BMP2 Modified by the m6A Demethylation Enzyme ALKBH5 in the Ossification of the Ligamentum Flavum Through the AKT Signaling Pathway" published in Calcified Tissue International. The correction states that there was an error in panel E of Figure 4, specifically in the Alizarin red staining and ALP staining sections. The corrected version of Figure 4 is provided. The document also includes a note from the publisher stating their neutrality regarding jurisdictional claims and institutional affiliations. The authors of the article are Hai-Feng Wang, Ming-jie Kuang, Shi-jie Han, An-bang Wang, Jie Qiu, Feng Wang, Bing-yi Tan, and Da-Chuan Wang. [Extracted from the article]

This study presents a clinical treatment decision support system (CTDSS) through which clinicians can simplify the shared-decision making (SDM) process for treating knee osteoarthritis (OA). This system enables patients to participate in selecting the optimum treatment. There has been broad international acceptance of SDM, but its practical implementation in clinical setting has posed challenges. The proposed method incorporates analytic hierarchy process and fuzzy multi-choice goal programming (AHP-FMCGP) into CTDSS to determine treatment standards, beginning with a literature review and expert surveys. The method provides patients with flexibility to modify treatment goals and constraints during the decision-making (DM) process to achieve their preferred treatment and simplifying the traditional SDM. A total of 240 knee OA patients participated in this pilot study, and the results indicated a significant improvement in patient satisfaction (F = 4.104; P < 0.05) with the implementation of CTDSS. This study demonstrates the effectiveness of CTDSS by resolving several challenges in clinical implementation: (1) Improved efficiency of implementing SDM, promoting better clinician-patient communication and higher healthcare quality. (2) Eliminating the need for extensive health literacy and disease knowledge in patients during the DM process. (3) Saving time for physicians, by allowing them to better understand the patients' preferences and select the most appropriate treatment option. (4) This method can be extended to primary clinics to benefit other patients. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is one of the leading cancers worldwide. This study aimed to investigate the mortality differences between 2 primary tumor locations, the proximal/distal colon and rectosigmoid junction (RSJ)/rectum, after adjusting for comorbidities. Methods: The Taiwan Cancer Registry linked with Taiwan's National Health Insurance Research Database was used to estimate the 5-year mortality rate among patients with colorectal cancer. A total of 73 769 individuals were enrolled in the study, which included 44 234 patients with proximal and distal colon cancers and 29 535 patients with RSJ and rectal cancers. Potential mortality risk was calculated using Cox regression analysis. Results: The mortality rates due to the location of the cancer in the proximal/distal colon and RSJ/rectum were 45.27% and 42.20%, respectively. After adjustment for age, sex, comorbidities, and clinical stages, the proximal/distal colon had a 1.03-fold higher 5-year overall mortality rate than RSJ/rectal cancer (95% confidence interval = 1.00–1.05). Proximal and distal colon cancers had a worse prognosis and survival than RSJ and rectal colon cancers in women and older patients (⩾70 years). Comorbidities had different effects on mortality in the proximal/distal colon and RSJ/rectum. Conclusions: Tumor location is associated with the prognosis of patients with colorectal cancer. It is important to treat patients beyond their cancer treatment, and to manage their comorbidities. [ABSTRACT FROM AUTHOR]

A substantial body of research supports the existence of the victim–offender overlap in the general population. However, few scholars have investigated this phenomenon in the prison context. Drawing on survey data collected from 2,065 male inmates residing in Taiwan's nine prisons, this study tested the victim–offender overlap hypothesis and identified the most common characteristics of inmates assuming the dual role. Bivariate probit analyses revealed that the victim–offender overlap in the general population also applies to the incarcerated. Four common risk factors were found among inmates who were both victims and offenders. The findings have clear implications for researchers, practitioners and policymakers and shed light on the understudied topic of the victim–offender overlap phenomenon in prison. [ABSTRACT FROM AUTHOR]

Successful weaning from prolonged mechanical ventilation (MV) is an important issue in respiratory care centers (RCCs). Delayed or premature extubation increases both the risk of adverse outcomes and healthcare costs. However, the accurate evaluation of the timing of successful weaning from MV is very challenging in RCCs. This study aims to utilize artificial intelligence algorithms to build predictive models for the successful timing of the weaning of patients from MV in RCCs and to implement a dashboard with the best model in RCC settings. A total of 670 intubated patients in the RCC in Chi Mei Medical Center were included in the study. Twenty-six feature variables were selected to build the predictive models with artificial intelligence (AI)/machine-learning (ML) algorithms. An interactive dashboard with the best model was developed and deployed. A preliminary impact analysis was then conducted. Our results showed that all seven predictive models had a high area under the receiver operating characteristic curve (AUC), which ranged from 0.792 to 0.868. The preliminary impact analysis revealed that the mean number of ventilator days required for the successful weaning of the patients was reduced by 0.5 after AI intervention. The development of an AI prediction dashboard is a promising method to assist in the prediction of the optimal timing of weaning from MV in RCC settings. However, a systematic prospective study of AI intervention is still needed. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a common comorbidity in chronic obstructive pulmonary disease (COPD). There are limited data regarding the incidence of bronchiectasis in COPD. The purpose of the study was to use a nationwide database to evaluate the incidence of bronchiectasis in COPD in Taiwan. We used a cohort of 2,000,000 individuals followed from 2005 to 2018. Patients with COPD diagnosed between January 1, 2011, and December 31, 2017, were selected, and those with bronchiectasis before COPD were excluded. In total, 134,366 patients with COPD were enrolled, and propensity score matching was used to ensure homogeneity of baseline characteristics between the COPD and non-COPD groups. The incidence rate of bronchiectasis was higher in the COPD group than in the non-COPD group (87.83 vs 69.80 per 10,000 person-years). The adjusted hazard ratio (1.9; 95% confidence interval 1.75–2.05; P < 0.001) of bronchiectasis indicated that the risk of bronchiectasis was 1.9 times higher for patients with COPD than for patients without COPD. In the COPD group, the age-stratified incidence rates of bronchiectasis increased with age (55.01, 80.92, 101.52, and 105.23 for 40–49, 50–59, 60–69, and over 70 years, respectively). The incidence of bronchiectasis was higher in patients with COPD than in the general population, the risk of bronchiectasis increased with age in COPD, and post-tuberculosis status was an important risk factor for bronchiectasis. [ABSTRACT FROM AUTHOR]

This paper investigates the benefits of distributed hybrid power systems employing multiple fuel-cell vehicles. In earlier work, our optimization of hybrid power systems showed that a single fuel cell acting as backup power to guarantee energy sustainability operates for less than 3% of the time but incurs more than 16% of the system costs. Therefore, the system cost could be reduced when applying a fuel-cell vehicle to dynamically support twelve power stations. Here, we extend this idea by employing multiple fuel-cell vehicles to support more power stations. We develop a power management strategy and optimize the management parameters by the genetic algorithm. The results show a reduction of more than 21% by applying multiple fuel-cell vehicles in the distributed systems. Experiments also confirm the feasibility of using multiple fuel-cell vehicles. Based on the results, the proposed systems are deemed effective for reducing system costs while maintaining system sustainability. [Display omitted] • We develop distributed hybrid power systems employing multiple FCVs. • We propose the power management strategies to schedule the FCVs. • The genetic algorithm is applied to optimize the management parameters. • The system costs were reduced by more than 21% when sharing multiple FCVs. • Experiments confirm the feasibility of using multiple FCVs. [ABSTRACT FROM AUTHOR]

After traumatic brain injury (TBI), an inflammatory response in the brain might affect the immune system. The risk of pulmonary infection reportedly increases in patients with TBI. We aimed to evaluate the risk of tuberculosis (TB) in patients with TBI in Taiwan. All participants were selected from the intensive care unit (ICU). Patients with TBI were defined as patients in ICU with intracranial injury, and comparison cohort were patients in ICU without TBI diagnosis. There was a significant difference in TB risk between the patients with TBI and the comparison cohort according to age and the Charlson's comorbidity index (CCI) score. Thus, we divided patients based on CCI into three groups for further analysis: mild (CCI = 0), moderate (CCI = 1/2), severe (CCI > 2). Mild-CCI group had a lower TB incidence rate (0.74%) and longer time to TB development (median: 2.43) than the other two groups. Moderate-CCI group had 1.52-fold increased risk of TB infection (p < 0.0001) compared with mild-CCI group. In the severe-CCI group, patients aged ≥ 80 years had 1.91-fold risk of TB compared with mild-CCI group (p = 0.0481). Severe-CCI group had significantly higher mortality than the mild-CCI group (p = 0.0366). Patients with TBI and more comorbidities had higher risk of TB infection with higher mortality rate. [ABSTRACT FROM AUTHOR]

This paper investigates the benefits of sharing a proton exchange membrane fuel cell (PEMFC) in a distributed hybrid power system. The PEMFC is usually used as backup power in stationary hybrid power systems; however, in that scenario, it might be working only 2% of the time while incurring 20% of the system expenses. Therefore, this paper examines the potential of sharing a PEMFC among multiple power systems. We develop a distributed hybrid power system that comprises several immovable power stations and a fuel-cell vehicle (FCV). Each power station is equipped with solar panels and batteries, while the FCV contains a PEMFC module and can move among the stations to provide sustainable power as needed. We propose power management strategies and show that the total system costs can be significantly reduced by 10.83% and 17.89% when sharing one FCV between three and twelve power stations, respectively. We also design experiments to demonstrate the feasibility of the proposed distributed hybrid power system. In the future, the developed model can be extended to provide further cost reductions by optimizing distributed hybrid power systems with multiple FCVs. Image 1 • We develop a distributed hybrid power system. • The system consists of several immovable power stations and a fuel-cell vehicle. • The fuel-cell vehicle can provide sustainable power to different stations. • A simulation model shows that sharing the PEMFC can reduce system costs. • Experiments demonstrate the feasibility of the distributed hybrid power system. [ABSTRACT FROM AUTHOR]

Ossification of the ligamentum flavum (OLF) is characterized by a process of ectopic bone formation in the ligamentum flavum. The definitive pathophysiology of OLF still remains unclear, but the epigenetic m6A modification plays an important role in OLF. In addition, no studies have reported the function of ALKBH5 in OLF development. In this study, we investigated the function of the m6A demethylation enzyme ALKBH5 in OLF. To evaluate the function of ALKBH5, OLF tissues and normal ligamentum flavum tissues were collected. In vitro methods, including HE, IHC and western blotting assays, were used to evaluate the association of ALKBH5 with OLF. In addition, we verified the effects of ALKBH5 on osteogenesis using alizarin red and ALP staining. MeRIP q-PCR was performed to investigate the methylation level of BMP2. Moreover, the mechanism of ALKBH5-mediated regulation of the ossification of the ligamentum flavum cells through the AKT signaling pathway was also verified. The present study showed that the expression of ALKBH5 increased in OLF tissues. The overexpression of ALKBH5 increased the expression of osteogenic genes and promoted the ossification of ligamentum flavum cells. Furthermore, BMP2 was significantly enriched in the ligamentum flavum cells of the anti-m6A group compared with those of the IgG group. The overexpression of ALKBH5 led to the activation of p-AKT, and BMP2 was regulated by ALKBH5 through the AKT signaling pathway. ALKBH5 promoted the osteogenesis of the ligamentum flavum cells through BMP2 demethylation and AKT activation. ALKBH5 was shown to be an important demethylation enzyme in OLF development. [ABSTRACT FROM AUTHOR]

Disuse osteoporosis (DOP) is a common complication resulting from the lack of or disuse of mechanical loading and has been unsatisfactorily treated. We hypothesized that exosomes derived from human umbilical cord mesenchymal stem cells (HUCMSCs) could reduce bone marrow mesenchymal stem cell (BMSC) apoptosis in rat DOP via the miR-1263/Mob1/Hippo signaling pathway. To evaluate the function of exosomes derived from HUCMSCs (HUCMSC-Exos) in DOP, hind limb unloading (HLU)-induced DOP rat models were prepared. In vitro, the proliferation of BMSCs were evaluated using CCK-8 assays. Further, the apoptosis of BMSCs were evaluated using annexin V–FITC assay and Western blots. In vivo, the protective effects of HUCMSC-Exos were evaluated using HE staining and microCT analysis. The underlying molecular mechanism of exosome action on BMSC apoptosis through the miR-1263/Mob1/Hippo pathway was also investigated by high-throughput RNA sequencing, luciferase reporter assays, RNA-pull down assays and Western blots. The RNA-seq and q-PCR results showed that the level of miR-1263 was most abundant among differentially expressed microRNAs. Exosomal miR-1263 could bind to the 3′untranslated region (3′ UTR) of Mob1 and exert its function by directly targeting Mob1 in recipient cells. The inhibition of Mob1 could activate YAP expression. Hippo inhibition reversed the in vitro HLU-induced apoptotic effect on BMSCs. The microCT and HE staining results indicated that HUCMSC-Exos ameliorated DOP in vivo. Exosomes derived from HUCMSCs are effective at inhibiting BMSC apoptosis and preventing rat DOP. This mechanism is mediated by the miR-1263/Mob1/Hippo signaling pathway. • HUCMSCs derived exosomes inhibit apoptosis in DOP. • Exosomal miR-1263 inhibit BMSCs apoptosis. • Exosomal miR-1263 regulated Mob1 to inhibit apoptosis in DOP. [ABSTRACT FROM AUTHOR]

Aims: To explore the child‐rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non‐native culture. Background: Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture. Design: A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers' unique lived reality through their subjective experiences and perceptions. Methods: Semi‐structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016–February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants. Results: Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers' experience in child‐rearing was identified as 'Where my child is, is home.' Conclusion: Immigrant mothers bond emotionally and physically to their new land via their children. Their child‐raising experiences are interwoven with their roles in their new familial and cultural homes. Impact: Immigrant brides often become mothers soon after marrying to continue their husbands' family line. Understanding their unique child‐rearing experiences and challenges in providing a secure home in a non‐native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers. [ABSTRACT FROM AUTHOR]

Background ‒ Rheumatoid arthritis (RA) can lead to various pulmonary manifestations. Evidence shows the possible association between RA and pleural empyema. Methods ‒ We conducted a retrospective cohort study to investigate the risk of pleural empyema in patients with RA. The RA group (n = 29,061) included newly diagnosed adult patients between 2000 and 2012. The comparison group (n = 1,16,244) included individuals without RA at a 1:4 ratio of frequency matched by age, gender, and diagnosis year. The occurrence of pleural empyema was monitored until the end of 2013. Results ‒ Patients with RA had a higher risk of developing pleural empyema than those without RA (23.6 vs 1.82 per 10,000 person-years, adjusted hazard ratio = 11.0, 95% confidence interval [CI] = 8.90–13.5). Furthermore, intensive care unit admission rates of pleural empyema were 37.7% in the RA group and 37.2% in the comparison group (adjusted odds ratio [OR] = 1.02, 95% CI = 0.66−1.57). The 30-day mortality rates of pleural empyema were 11.2% in the RA group and 10.9% in the comparison group (adjusted OR = 1.01, 95% CI = 0.51−1.88). Conclusion ‒ Patients with RA are at a greater risk of developing pleural empyema than those without RA. [ABSTRACT FROM AUTHOR]

Background: Androgen deprivation therapy (ADT) in the treatment of prostate cancer may be associated with an increased risk of thromboembolic disease. The aim of our study was to investigate the association of ADT in the treatment of prostate cancer with ischemic stroke risk.Methods: We identified individuals older than 20 years of age who were newly diagnosed with prostate cancer between January 1, 2005, and December 31, 2012. Patients who experienced ischemic stroke or transient ischemic stroke before the index date were excluded. Patients who received at least one prescription for ADT within 6 months were defined as the ADT user group. Patients who did not receive at least one prescription for ADT within 6 months were defined as the ADT nonuser group. The patients were followed until the first occurrence of one of the primary outcome measures (ischemic stroke or death) or until December 31, 2013. The primary composite outcome was the time to any cause of death or ischemic stroke.Results: There was no significant difference in the primary composite outcomes in the prostate cancer patients between the ADT user and nonuser groups. Prostate cancer patients who received ADT had a higher mortality rate than those who were not treated with ADT, and the adjusted hazard ratio was 1.907 (95% confidence interval: 1.278-2.844; P = 0.0016) after adjusting for age, comorbidities and comedication use.Conclusion: ADT in the treatment of prostate cancer may not be associated with an increased risk of ischemic stroke. The differences in thromboembolic effects in cardiovascular disease and ischemic stroke secondary to ADT should be further discussed and evaluated prospectively. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended. [ABSTRACT FROM AUTHOR]

Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is a common disease following long-term use or large doses of glucocorticoids. The pathogenesis of GIONFH remains controversial, and abnormal bone metabolism caused by glucocorticoids(GCs) may be one of the important factors. Due to its positive effect on bone remodeling, naringin shows potential therapeutic effects in bone metabolism-related diseases. In this study, we hypothesized that naringin regulated bone metabolism in rat GIONFH via the Akt/Bad signal cascades. In vitro, a dexamethasone (Dex)- or naringin-treated cell model was used to evaluate the function of naringin. In vivo, methylprednisolone (MPS)-treated rat model was used to evaluate the function of naringin in GIONFH. In vitro, Cell Counting Kit-8 (CCK-8) and Edu staining was used to evaluate the proliferation of osteocytes, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, Annexin V-FITC-PI, and western blotting were used to evaluate the apoptosis of osteocytes. We also verified the effects of naringin on osteogenesis and osteoclastogenesis. In vivo, we used micro-CT (computed tomography), histological, and immunohistochemical analysis to evaluate the effect of naringin. Moreover, the mechanism of naringin regulating the bone metabolism through the Akt/Bad pathway was also investigated using bioinformatics analysis and western blotting. The results of in vitro study showed that Akt activated by naringin promoted osteogenesis and osteocyte proliferation; in addition, osteocyte apoptosis and osteoclastogenesis was inhibited by Akt activation and Bad suppression. According to the in vivo study, naringin prevented GIONFH in a rat model as shown by micro-CT scanning and histological and immunohistochemical analysis. Therefore, we concluded that naringin is an effective compound for promoting bone repair and preventing bone loss in rats with GIONFH through Akt/Bad signal cascades. • Akt activated by naringin promoted osteogenesis and osteocyte proliferation. • Naringin inhibite osteocyte apoptosis and osteoclastogenesis. • Naringin prevented GIONFH in a rat model. [ABSTRACT FROM AUTHOR]

Cerebral infarction (CI) is a common cerebrovascular disease worldwide, and the burden caused by the sequelae of CI has increased significantly. However, current treatment guidelines lack standardized recommendations for pharmacotherapy of sequelae of CI. This retrospective study collected and analyzed 1.98 million prescriptions concerning sequelae of CI from patients admitted to Zhiyun Health Internet Hospital in 2022. The mean age of patients was 66.2 ± 11.4 years, and 52.40% were male. 79.73% had one or more comorbidities. For treatment, the prescriptions of 1-, 2- and ≥ 3-drug accounted for 64.55%, 23.77% and 11.68% respectively. Chinese patent medicine (CPM) prescriptions, western medicine (WM) prescriptions, and CPM and WM combined (CPM + WM) prescriptions accounted for 53.81%, 27.33%, and 18.86% respectively. In CPM prescriptions, the most frequently prescribed medications were Salvia miltiorrhiza (34.81%), Ginkgo biloba (24.96%), Panax notoginseng (20.67%), Gastrodia (7.15%) and Ligusticum Wallichii (4.90%). For WM prescriptions, the most commonly prescribed agents were anti-hypertensive (32.82%), anti-thrombotic (16.06%), vasodilator (15.70%), anti-dementia (10.88%), and lipid-lowering (9.58%) drugs. Among CPM + WM prescriptions, 72.61% had CPM/WM = 1, 21.20% had CPM/WM < 1, and 6.19% had CPM/WM > 1. This research utilized real-world data extracted from internet hospitals in China to present valuable evidence of online prescription patterns among patients experiencing sequelae of CI. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to investigate factors that motivate nurses to protect privacy in electronic medical records, based on the Decomposed Theory of Planned Behavior.Methods: This cross-sectional study used questionnaires to collect data from nurses in a large tertiary care military hospital in Taiwan.Results: The three hundred two (302) valid questionnaires returned resulted in a response rate of 63.7 %. Structural equation modeling identified that the factors of attitude, subjective norm, and perceived behavioral control of the nurses significantly predicted the nurses' intention to protect the privacy of electronic medical records. Further, perceived usefulness and compatibility, peer and superior influence, self-efficacy and facilitating conditions, respectively predicted these three factors.Conclusions: The results of our study may provide valuable information for education and practice in predicting nurses' intention to protect privacy of electronic medical records. [ABSTRACT FROM AUTHOR]

Abstract Purpose large doses of glucocorticoids (GCs) are the most common cause of glucocorticoid-induced osteonecrosis of femoral head (GIONFH). Although awareness of GIONFH among patients with GCs history has increased over recent years, several studies indicate that its mechanism remains unclear. Methods To evaluate the function of circUSP45 in GIONFH, femoral heads in GIONFH patients or femoral heads in fracture patients were collected. In vitro, RT-PCR, FISH, RNA pull down and Western blotting assay were used to evaluate the function of circUSP45. In addition, we also verified the effects of circUSP45 on osteogenesis using alizarin red staining. In vivo, we used HE staining and microCT analysis to evaluate the bone mass. Moreover, the mechanism of circUSP45 regulating osteogenesis through the miR-127-5p/PTEN/AKT pathway was also investigated. Results The results showed that expression of circUSP45 increased in GIONFH patients. The overexpression of circUSP45 decreases osteogenic gene expression and inhibits the proliferation of BMSCs. Furthermore, circUSP45 was located mainly in the cytoplasm and directly interacted with miR-127-5p. MiR-127-5p acts with its targets PTEN to regulate the osteogenesis. MicroCT and HE staining verify the function of circUSP45 in GIONFH rat model. Conclusion CircUSP45 decreases osteogenesis in bone GIONFH by sponging miR-127-5p through PTEN/AKT signal pathway. Highlights • CircUSP45 was upregulated in GIONFH patients. • CircUSP45 inhibited osteogenesis by sponging miR-127-5p. • miR-127-5p regulated PTEN to inhibit AKT axis resulting in GIONFH. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore a calculated method used to measure the cardiac output using the aortic impedance change component of reconstructed impedance cardiography. Methods: Routine impedance cardiography was measured using Kubicek's method with four ring electrodes. The thoracic mixed impedance changes were measured by six leads, which consisted of 15 electrodes. The aortic impedance change component was separated from six thoracic mixed impedance changes through waveform reconstruction. The square root formula used to calculate the cardiac output was deduced based on the thoracic impedance change equation and the aortic volume change hypothesis during the systole period. The cardiac outputs of 180 normal adults and 72 patients with cardiac insufficiency who could still walk freely were contrastively computed with both Kubicek's formula and the square root formula. Results: For 180 normal adults, the cardiac index (CI) computed with the square root formula was 3.60 ± 0.45 L/min/m2, with normal values ranging from 2.7 to 4.5 L/min/m2. A total of 163 cases (90.6%) had a CI in the standard range (2.7–4.3 L/min/m2) adopted in clinical applications. The CI computed with Kubicek's formula was 3.61 ± 0.86 L/min/m2, with normal values ranging from 1.9 to 5.3 L/min/m2, and only 115 cases (63.9%) had a CI in the above standard range. Among the 72 patients with cardiac insufficiency, 20 (27.8%) patients had a CI < 2.0 L/min/m2 with Kubicek's formula. Of these 20 cases, 9 cases had a CI < 1.5 L/min/m2, and 4 cases had a CI < 1.1 L/min/m2. In contrast, none of the 72 patients had a CI < 2.0 L/min/m2 with the square root formula. In addition, the influence of the chest circumference on the CI was lower for the square root formula than for Kubicek's formula. Conclusions: The CI calculated with the square root formula had a better normal value range, was more accurate for the patients with cardiac insufficiency, and was less affected by the chest circumference than the CI calculated with Kubicek's formula. [ABSTRACT FROM AUTHOR]

Herein, we describe an improved procedure for the green synthesis of chondroitin sulfate stabilized silver nanoparticles (ChS-AgNPs). Glucose was used as a reducing agent under alkaline conditions to obtain a small particle size (<10 nm), and the reduction was complete within one hour at room temperature. The concentration of NaOH affected the reaction rate, formation yield, and particle size of ChS-AgNPs. The formation of AgNPs was confirmed using UV-vis, TEM, XRD, and XPS. ChS-AgNPs showed excellent catalytic activities in the reduction of 4-nitrophenol by NaBH 4 , and the reaction rate increased linearly with increasing catalyst amounts. The antimicrobial activities of ChS-AgNPs against A. baumannii (including multidrug-resistant strains), E. coli , P. aeruginosa , and S. aureus were evaluated using the broth microdilution method. Finally, from the morphological observations and cell cycle analysis of L929 cells, we found that ChS-AgNPs exhibited antimicrobial and biocompatible activities. [ABSTRACT FROM AUTHOR]

Hospitals have become increasingly aware that electronic medical records (EMR) may bring about tangible/intangible benefits to managing institutions, including reduced medical errors, improved quality-of-care, curtailed costs, and allowed access to patient information by healthcare professionals regardless of limitations. However, increased dependence on EMR has led to a corresponding increase in the influence of EMR breaches. Such incursions, which have been significantly facilitated by the introduction of mobile devices for accessing EMR, may induce tangible/intangible damage to both hospitals and concerned individuals. The purpose of this study was to explore factors which may tend to inhibit nurses' intentions to violate privacy policy concerning EMR based upon the deterrence theory perspective. Utilizing survey methodology, 262 responses were analyzed via structural equation modeling. Results revealed that punishment certainty, detection certainty, and subjective norm would most certainly and significantly reduce nurses' intentions to violate established EMR privacy policy. With these findings, recommendations for health administrators in planning and designing effective strategies which may potentially inhibit nurses from violating EMR privacy policy are discussed. [ABSTRACT FROM AUTHOR]

The TRIM family protein was known to play an important role in many cellular processes, including potential antiviral activity, which has attracted lots of attention. In this study, a TRIM47 homolog from common carp ( Cyprinus carpio ) was cloned and the full length coding DNA sequence (CDS) of this gene was analyzed, results showed that there was a 97% similarity between common carp and zebrafish ( Danio rerio ), but only 18% similarity with that of human ( Homo sapiens ) and mouse ( Mus musculus ). The tissue distribution analysis showed TRIM47 had the highest mRNA level in the brain, a few immune related organs such as liver and kidney also had a relatively high level of TRIM47 expression. SVCV infection decreased TRIM47 mRNA level significantly both in vitro and in vivo , but its expression was not affected by the virus at the protein level. The recombinant plasmid pcDNA4-TRIM47-His was constructed, the subcellular localization in FHM cells showed that TRIM47 uniformly distributed in the cytoplasm at the form of tiny spots, and partially localized in the mitochondria. Overexpression TRIM47 in FHM cells significantly decreased the mRNA level of SVCV-G gene, and it was accompanied with the increasing of IFN1, a member of type I IFN, at the case of SVCV stimulation. In summary, our results had first demonstrated that TRIM47 of the common carp played an important role in viral resistance processes as well as the regulation of IFN signaling pathway. [ABSTRACT FROM AUTHOR]

The low-density lipoprotein receptor-related protein 1 ( LRP1 ) gene is associated with increased levels of plasma factor VIII (FVIII). We aimed to explore eight functional genetic LRP1 variants for their potential roles in regulating FVIII levels and acute ischemic stroke (AIS). This genetic association study enrolled 192 patients with AIS and 134 controls. There were no significant differences in the genetic frequency of the eight functional single-nucleotide polymorphisms (SNPs) between the control and AIS groups. However, while analyzing the association between the eight SNPs and plasma FVIII levels, subjects with T/T genotype of rs1800137 (vs. CC + CT) were found to be associated with higher FVIII levels (23.5 IU/dL; 95% confidence interval, 7.4–39.5 IU/dL; P = 0.0044) after adjusting for age, gender, estimated glomerular filtration rate, O blood type, inflammatory state, and body mass index. An analysis of the mRNA stability and abundance was designed and performed using minigene system transfected into HepG2 cells to assess the possible differences in mRNA stabilities between rs1800137 CC (rs1800137C) and TT (rs1800137T) genotypes. Site-directed mutagenesis revealed that rs1800137T accounts for the observed decrease in mRNA stability. The SNP rs1800137, located in exon 8, has been identified as an exon-splicing enhancer in silico. However, alternative splicing of LRP1 without inclusion of exon 8 was not identified. In transfected HepG2 cells, cycloheximide slowed down the degradation of the rs1800137T-containing minigene. These results demonstrate that synonymous SNP rs1800137 can lead to increased plasma FVIII levels due to decreased mRNA stability via translation-dependent mRNA degradation associated with codon optimality. [ABSTRACT FROM AUTHOR]

This study derived a full-field stress series solution to multi-loads with small contact area uniformly distributed around the circumference of a disk, and an analytical solution to concentrated forces spaced evenly around the circumference of a disk using the contribution of the full-field analytical solution of the Brazilian test model. Relative errors between the analytic solution and the series solution revealed that when $$2\alpha $$ , the angle between the uniformly-distributed loads with small contact area, is less than $$5^{\circ }$$ , the full-field stress series solution can be reliably replaced with the full-field stress analytical solution. Based on a photoelastic experiment, we derived a formula by which to determine the full-field stress, resulting from concentrated forces isotopically arranged around the circumference of the disk. The numerical findings are in good agreement with those obtained in the photoelastic experiment, thereby verifying the efficacy of the simple theoretical formula derived in this study. This study provides a full-field stress analytical solution for forces evenly spaced around the circumference of a disk. This solution can be used to evaluate the internal stress distribution of disk structures and optical components clamped at the edges. [ABSTRACT FROM AUTHOR]

Background: Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses' bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses' personality traits in regard to technology readiness toward MEMR acceptance.Methods: The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data.Results: Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage.Conclusions: Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses' requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses' work practices as these will also greatly enhance nurses' willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals should also include more employees' characteristics beyond socio-demographic profiles in their personnel databases. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the performance of ultrasound (US) and contrast-enhanced ultrasound (CEUS) within 2 h after irreversible electroporation (IRE) ablation of porcine liver. Six IRE ablations were performed on porcine liver in vivo; ultrasound assessments were performed within 2 h after IRE ablation. On US images, the ablation zone appeared as a hypo-echoic area within 10 min after the ablation, and then the echo of the ablation zone gradually increased. On CEUS images, the ablation zone appeared as a non-enhanced area within 10 min after ablation and then was gradually centripetally filled by microbubbles. A hyper-echoic rim on US images and a hyper-enhanced rim on CEUS images appeared in the periphery of the ablation zone 60 min after the ablation. Characteristic and dynamic ultrasound images of the IRE ablation zone were obtained within 2 h after IRE ablation of in vivo porcine liver. [ABSTRACT FROM AUTHOR]

Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes. [ABSTRACT FROM AUTHOR]

Background: Self-care management is becoming an important part of care for chronic patients. However, various kinds of self-management educational materials which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients' use intention could be patients' perceived information overload regarding the self-management educational materials.Purpose: This study proposed an extended model of the Theory of Planned Behavior (TPB), which incorporated perceived information overload, to explore if information overload will prevent chronic patients from reading educational materials for self-care management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the self-management educational materials. Perceived information overload is also referred to as an antecedent variable which may has impacts on attitude and perceived behavior control.Methods: The cross-sectional study interviewed newly diagnosed chronic patients with coronary artery disease, who are the potential users of the self-management educational materials, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the respondents, and structural equation modeling to study the reliability and validity for testing hypotheses.Results: A total of 110 respondents were enrolled in this study and successful interview data were collected from 106 respondents. The result indicates that the patients' perceived information overload of self-management educational materials was validated to have impacts on attitude and perceived behavioral control constructs of the TPB as well as contributing a direct impact on patients' intentions to use self-management educational materials. Besides, subjective norm and perceived behavioral control constructs were validated to have significant impacts on behavioral intentions, whereas the attitude construct was not. Finally, the relationships between information overload and attitude, information overload and intention, subjective norm and intention, as well as perceived behavioral control and intention varied significantly between highly- and less-educated respondents. Differing self-management educational materials for respondents of various educational levels could be formulated to substantially boost the use of self-management educational materials.Conclusions: This study demonstrated a comprehensive framework, which extended perceived information overload into the TPB model, to predict patients' behavioral intention of using self-management educational materials. We expect the results of this study will provide useful insights for studying self-management educational materials usage and information overload from the perspectives of academia, governments, and healthcare providers. [ABSTRACT FROM AUTHOR]

In this report, we introduce a 1D photonic crystal (PhC) nanocavity with waveguide-like strain amplifiers within a soft polydimethylsiloxane substrate, presenting it as a potential candidate for highly sensitive pressure and position optical sensors. Due to its substantial optical wavelength response to uniform pressure, laser emission from this nanocavity enables the detection of a minimum applied uniform pressure of 1.6‰ in experiments. Based on this feature, we further studied and elucidated the distinct behaviors in wavelength shifts when applying localized pressure at various positions relative to the PhC nanocavity. In experiments, by mapping wavelength shifts of the PhC nanolaser under localized pressure applied using a micro-tip at different positions, we demonstrate the nanocavity's capability to detect minute position differences, with position-dependent minimum resolutions ranging from tens to hundreds of micrometers. Furthermore, we also propose and validate the feasibility of employing the strain amplifier as an effective waveguide for extracting the sensing signal from the nanocavity. This approach achieves a 64% unidirectional coupling efficiency for leading out the sensing signal to a specific strain amplifier. We believe these findings pave the way for creating a highly sensitive position-sensing module that can accurately identify localized pressure in a planar space. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) has a strong negative impact on patients. Finding ways to improve CKD patients' conditions by shared decision-making is receiving much attention. However, little attention has been paid to influencing antecedents and effects of shared decision-making. Meanwhile, as advanced technologies bring in new communication devices, effects of different types of communications used in shared decision-making need to be addressed.Objective: This study proposes a research framework to determine the influencing antecedents of shared decision-making, and to evaluate the effects of shared decision-making on patient outcomes when they are computer-mediated and when the decision-makers communicate face-to-face.Methods: A cross-section survey was conducted and a total of 48 valid samples were obtained. The participants were CKD Stage III, IV, or V patients who had received medical treatment in a hospital in Taiwan. The collected data were subjected to an independent t-test and partial least squares analysis to validate the research framework.Results: Doctor-patient communication (DPC) and doctor-patient relationship (DPR) have no significant direct impact on patient outcomes. Nevertheless, both DPC and DPR significantly impact shared decision-making which in turn impacts patient outcomes. Moreover, patients who use computer-mediated communication were found to have significantly higher perceptions of shared decision-making than those who did not.Conclusions: The incidence and prevalence of end-stage renal disease in Taiwan are among the highest in the world. The results of this study can serve as a reference for hospitals to improve CKD patients' outcomes. Meanwhile, during the COVID-19 pandemic, this study suggested hospitals should encourage shared decision-making with computer-mediated communication to ensure that patients receive proper treatment and have the desired outcomes. [ABSTRACT FROM AUTHOR]

Acute bacterial meningitis causes high morbidity and mortality; the associated clinical symptoms often are insensitive or non-specific; and the pathogenic bacteria are geographically diverse. Clinical diagnosis requires a rapid and accurate methodology. This study aimed to develop a new multiplex polymerase chain reaction (mPCR) assay to detect simultaneously six major bacteria that cause adult bacterial meningitis in Taiwan: Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii. Species-specific primers for the six bacteria were developed using reference strains. The specificities of the mPCRs for these bacteria were validated, and the sensitivities were evaluated via serial dilutions. The mPCR assay specifically detected all of the six pathogens, particularly with sensitivities of 12 colony forming units (CFU)/mL, 90 CFU/mL, and 390 CFU/mL for E. coli, S. pneumoniae, and K. pneumoniae, respectively. This mPCR assay is a rapid and specific tool to detect the six major bacterial pathogens that cause acute adult meningitis in Taiwan, particularly sensitive for detecting E. coli, S. pneumoniae, and K. pneumoniae. The assay may facilitate early diagnosis and guidance for antimicrobial therapy for adult patients with this deadly disease in Taiwan. [ABSTRACT FROM AUTHOR]

The purposes of this study are threefold: 1) to find out what characteristics are required for the successful use of ePortfolios; 2) to discover what activities best represent reflective thinking during the use of ePortfolios; and, 3) to investigate the interrelationship between nursing staff users' perceived success levels with ePortfolios and with their reflective thinking activities. Survey methodology was used to gather responses from 78 nurses from a medical center located in southern Taiwan via questionnaires. Factor analysis and canonical correlation analysis were used to analyze the collected data. The results demonstrated that system quality, information quality, and user satisfaction are important variables in successful ePortfolio usage; while habitual action, understanding, reflection, and critical reflection are major variables of reflective thinking. Further, we found a significant relationship exists between the relative success of ePortfolios and reflective thinking activities of ePortfolios users. The subject hospital should pay special attention to important characteristics including system quality, information quality, and user satisfaction when employing ePortfolios to help nursing staff users to achieve their learning goals through this form of reflective thinking. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to propose and empirically test a theoretical model that considers the predictors of an individual’s perceptions of information privacy, and also how it relates to his/her behavioral intention toward approaching hospital web sites. Design/methodology/approach – This paper collects data using survey methodology. A total of 331 usable participants are gathered and analyzed via structural equation modeling. Findings – Significant predictors of information privacy concerns include a stated online privacy policy and a hospital’s reputation. Further, online privacy policy predicts a hospital’s reputation. Finally, hospital reputation and information privacy concerns significantly predict an individual’s behavioral intention toward approaching hospital web sites. Research limitations/implications – The study confirmed that an online privacy policy and reputation can effectively alleviate specific information privacy concerns; therefore, this may indicate that these two factors should be considered whenever investigating individuals’ information privacy concerns. Practical implications – To acquire a good reputation and to diminish individuals’ information privacy concerns toward hospital web sites, hospitals should pay attention to the posting of an online privacy policy and communicating such policies to given individuals. Originality/value – This paper fulfils the gap of exploring the relationship among online privacy policy, organization reputation, and information privacy concerns. Further, the hypothesized model and its findings could also provide useful information for managers who are intent on boosting hospital web site usage frequency patterns. [ABSTRACT FROM AUTHOR]

Background: The purposes of this study were to explore the factors influencing physicians' intention of adopting telemedicine and to conduct a multigroup analysis comparing the perceptions about telemedicine adoption between experienced and inexperienced physicians. Based on the Theory of Planned Behavior, we conducted a cross-sectional survey to collect data from 15 hospitals in Taiwan. Materials and Methods: In total, 106 valid questionnaires were returned. We used structural equation modeling to analyze the collected data. Results: Attitude (AT), subjective norm (SN), and perceived behavioral control (PBC) were found to be positively related to behavioral intention (BI) for combined data. Moreover, the relationships between AT→BI, SN→BI, and PBC→BI varied significantly between experienced and inexperienced physicians. Experienced physicians held stronger beliefs about the relationship between AT→BI than inexperienced physicians. Conclusions: According to the results, our study suggests that differing strategies for experienced and inexperienced physicians must be formulated to substantially boost the adoption of telemedicine technology. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 is a novel, severely contagious disease with enormous negative impact on humanity as well as the world economy. An expeditious, feasible tool for detecting COVID-19 remains yet elusive. Recently, there has been a surge of interest in applying machine learning techniques to predict COVID-19 using non-image data. We have therefore undertaken a meta-analysis to quantify the diagnostic performance of machine learning models facilitating the prediction of COVID-19.Materials and Methods: A comprehensive electronic database search for the period between January 1st, 2021 and December 3rd, 2021 was undertaken in order to identify eligible studies relevant to this meta-analysis. Summary sensitivity, specificity, and the area under receiver operating characteristic curves were used to assess potential diagnostic accuracy. Risk of bias was assessed by means of a revised Quality Assessment of Diagnostic Studies.Results: A total of 30 studies, including 34 models, met all of the inclusion criteria. Summary sensitivity, specificity, and area under receiver operating characteristic curves were 0.86, 0.86, and 0.91, respectively. The purpose of machine learning models, class imbalance, and feature selection are significant covariates useful in explaining the between-study heterogeneity, in terms of both sensitivity and specificity.Conclusions: Our study findings show that non-image data can be used to predict COVID-19 with an acceptable performance. Further, class imbalance and feature selection are suggested to be incorporated whenever building models for the prediction of COVID-19, thus improving further diagnostic performance. [ABSTRACT FROM AUTHOR]

Background : Klebsiella pneumoniae has emerged as one of the major pathogens for community-acquired and nosocomial infections. A four-gene locus that had a high degree similarity with Escherichia coli pgaABCD and Yersinia pestis hmsHFRS was identified in K. pneumoniae genomes. The pgaABCD in E. coli encodes the envelope-spanning Pga machinery for the synthesis and secretion of poly-β-linked N -acetylglucosamine (PNAG). In a limited number of phylogenetically diverse bacteria, PNAG was demonstrated to mediate biofilm formation and had a role in the host-bacteria interactions. The presence of conserved pgaABCD locus among various K. pneumoniae strains suggested a putative requirement of PNAG for this bacterium. Results : In this study, an in-frame deletion of pgaC was generated in K. pneumoniae CG43 and named Δ pgaC . The loss of pgaC affected the production of PNAG and attenuated the enhancement of in vitro biofilm formation upon the addition of bile salts mixture. In mouse models, Δ pgaC exhibited a weakened ability to colonize the intestine, to disseminate extraintestinally, and to induce a systemic infection when compared to K. pneumoniae CG43. Conclusions : Our study demonstrated that pgaC participated in the bile salts induced biofilm formation and was required for K. pneumoniae virulence in vivo. [ABSTRACT FROM AUTHOR]

Highlights: [•] Green synthesis of highly stable silver nanoparticles with narrow size distribution. [•] We use chondroitin sulfate as both reducing and stabilizing agent. [•] DLS use as a routinely analytical tool for the measuring size and distribution. [•] Surface charge can switch from negative to positive via an ionic gelation method. [Copyright &y& Elsevier]

The introduction of electronic medical records (EMRs) can expose patients to the risk of infringement of their privacy. The purpose of this study was to explore the relationship between patients’ concerns about information privacy and their protective responses. A questionnaire survey conducted in a Taiwanese hospital revealed that, regarding information privacy, patients’ concerns about the collection of information about themselves, the secondary use of this information and the possibility of errors in the recorded information were associated with their information privacy-protective responses, while concern for unauthorised access to their information by other staff in the medical facility was not. Medical facilities should devote every effort to alleviate patients’ concerns about the invasion of their information privacy to avoid eroding the reputation of medical facilities and impeding the promotion of EMRs. [ABSTRACT FROM AUTHOR]