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Purpose: Short- and long-term complications of gestational diabetes mellitus (GDM) involving pregnancies and offspring warrant the development of an effective individualized risk prediction model to reduce and prevent GDM together with its associated co-morbidities. The aim is to use machine learning (ML) algorithms to study data gathered throughout the first trimester in order to predict GDM. Methods: Two independent cohorts with forty-five features gathered through first trimester were included. We constructed prediction models based on three different algorithms and traditional logistic regression, and deployed additional two ensemble algorithms to identify the importance of individual features. Results: 4799 and 2795 pregnancies were included in the Xinhua Hospital Chongming branch (XHCM) and the Shanghai Pudong New Area People's Hospital (SPNPH) cohorts, respectively. Extreme gradient boosting (XGBoost) predicted GDM with moderate performance (the area under the receiver operating curve (AUC) = 0.75) at pregnancy initiation and good-to-excellent performance (AUC = 0.99) at the end of the first trimester in the XHCM cohort. The trained XGBoost showed moderate performance in the SPNPH cohort (AUC = 0.83). The top predictive features for GDM diagnosis were pre-pregnancy BMI and maternal abdominal circumference at pregnancy initiation, and FPG and HbA1c at the end of the first trimester. Conclusion: Our work demonstrated that ML models based on the data gathered throughout the first trimester achieved moderate performance in the external validation cohort. [ABSTRACT FROM AUTHOR]

Healthcare call centers serve an important role in the healthcare system to support patients' access to care and satisfaction and optimize medical resource allocation. Limited research has provided sufficient evidence on how to increase healthcare call center's efficiency from managerial aspects. In this study, a simulation model is built based on real-life healthcare call center settings and call information, to identify the opportunities for improvement. This call center processes approximately 2638 calls for 25 clinic sites every day. The call abandon rate was at 16.7%, which was far from the organization's goal of 5%. Some improvement opportunities based on managerial interests such as cross-coverage, non-scheduling call transition, staff availability and staff allocation without increasing staff numbers, are identified and their operational impacts are evaluated by the simulation model. Moreover, a genetic algorithm is used to find the optimal shift for staff allocation. The simulation results demonstrate the validity of the proposed model, provide valuable insights for decision-making before the implementation and provide other healthcare call centers' alternatives to improve performance. The recommendations were communicated to call center staff and consentaneous opportunities were implemented. The results showed a significant reduction of 39.5% in the call abandon rate. [ABSTRACT FROM AUTHOR]

An algorithm for the two-stage robust optimization surgery-to-operating room allocation problem is presented. The second-stage problem is an integer linear program whose convex hull is approximated using three types of specialized valid inequalities and Chvátal-Gomory cuts. The resulting linear relaxation of the second-stage problem is then dualized and integrated into the first-stage problem. The resulting mixed integer linear program, which is an approximation of the original problem, is then solved using a commercial solver. If the solution of this model is not optimal for the second-stage problem, valid inequalities for the second-stage problem are generated, yielding a type of column-generation based approach that we refer to as the sequential follower refinement (SFR) algorithm. Data from an academic medical center are used to compare the computational performance of SFR with the constraint and column generation (C&CG) algorithm, which is the only exact approach that has been specifically applied for this problem in the literature. An extensive numerical study of SFR and its computational characteristics is presented that shows that SFR yields better-quality solutions compared with C&CG, even as the termination criterion of SFR is met much sooner, especially for problems involving higher number of surgeries. History: Accepted by Paul Brooks, Area Editor for Applications in Biology, Medicine, & Healthcare. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information (https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2022.0191) as well as from the IJOC GitHub software repository (https://github.com/INFORMSJoC/2022.0191). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/. [ABSTRACT FROM AUTHOR]

Ferroelectric materials are fascinating for their non-volatile switchable electric polarizations induced by the spontaneous inversion-symmetry breaking. However, in all of the conventional ferroelectric compounds, at least two constituent ions are required to support the polarization switching1,2. Here, we report the observation of a single-element ferroelectric state in a black phosphorus-like bismuth layer3, in which the ordered charge transfer and the regular atom distortion between sublattices happen simultaneously. Instead of a homogenous orbital configuration that ordinarily occurs in elementary substances, we found the Bi atoms in a black phosphorous-like Bi monolayer maintain a weak and anisotropic sp orbital hybridization, giving rise to the inversion-symmetry-broken buckled structure accompanied with charge redistribution in the unit cell. As a result, the in-plane electric polarization emerges in the Bi monolayer. Using the in-plane electric field produced by scanning probe microscopy, ferroelectric switching is further visualized experimentally. Owing to the conjugative locking between the charge transfer and atom displacement, we also observe the anomalous electric potential profile at the 180° tail-to-tail domain wall induced by competition between the electronic structure and electric polarization. This emergent single-element ferroelectricity broadens the mechanism of ferroelectrics and may enrich the applications of ferroelectronics in the future.A single-element ferroelectric state is observed in a black phosphorus-like bismuth layer, in which the ordered charge transfer and the regular atom distortion between sublattices happen simultaneously and ferroelectric switching is further visualized experimentally. [ABSTRACT FROM AUTHOR]

Cervical cancer is the most common cancer among women worldwide. The diagnosis and classification of cancer are extremely important, as it influences the optimal treatment and length of survival. The objective was to develop and validate a diagnosis system based on convolutional neural networks (CNN) that identifies cervical malignancies and provides diagnostic interpretability. A total of 8496 labeled histology images were extracted from 229 cervical specimens (cervical squamous cell carcinoma, SCC, n = 37; cervical adenocarcinoma, AC, n = 8; nonmalignant cervical tissues, n = 184). AlexNet, VGG-19, Xception, and ResNet-50 with five-fold cross-validation were constructed to distinguish cervical cancer images from nonmalignant images. The performance of CNNs was quantified in terms of accuracy, precision, recall, and the area under the receiver operating curve (AUC). Six pathologists were recruited to make a comparison with the performance of CNNs. Guided Backpropagation and Gradient-weighted Class Activation Mapping (Grad-CAM) were deployed to highlight the area of high malignant probability. The Xception model had excellent performance in identifying cervical SCC and AC in test sets. For cervical SCC, AUC was 0.98 (internal validation) and 0.974 (external validation). For cervical AC, AUC was 0.966 (internal validation) and 0.958 (external validation). The performance of CNNs falls between experienced and inexperienced pathologists. Grad-CAM and Guided Gard-CAM ensured diagnoses interpretability by highlighting morphological features of malignant changes. CNN is efficient for histological image classification tasks of distinguishing cervical malignancies from benign tissues and could highlight the specific areas of concern. All these findings suggest that CNNs could serve as a diagnostic tool to aid pathologic diagnosis. [ABSTRACT FROM AUTHOR]

Resource coordination in surgical scheduling remains challenging in health care delivery systems. This is especially the case in highly-specialized settings such as coordinating Intraoperative Neurophysiologic Monitoring (IONM) resources. Inefficient coordination yields higher costs, limited access to care, and creates constraints to surgical quality and outcomes. To maximize utilization of IONM resources, optimization-based algorithms are proposed to effectively schedule IONM surgical cases and technologists and evaluate staffing needs. Data with 10 days of case volumes, their surgery durations, and technologist staffing was used to demonstrate method effectiveness. An iterative optimization-based model that determines both optimal surgery and technologist start time (operational scenario 4) was built in an Excel spreadsheet along with Excel's Solver settings. It was compared with current practice (operational scenario 1) and optimization solution on only surgery start time (operational scenario 2) or technologist start time (operational scenario 3). Comparisons are made with respect to technologist overtime and under-utilization time. The results conclude that scenario 4 significantly reduces overtime by 74% and under-utilization time by 86% as well as technologist needs by 10%. For practices that do not have flexibility to alter surgeon preference on surgery start time or IONM technologist staffing levels, both scenarios 2 and 3 also result in substantial reductions in technologist overtime and under-utilization. Moreover, IONM technologist staffing options are discussed to accommodate technologist preferences and set constraints for surgical case scheduling. All optimization-based approaches presented in this paper are able to improve utilization of IONM resources and ultimately improve the coordination and efficiency of highly-specialized resources. [ABSTRACT FROM AUTHOR]

Owing to treatment complexity in chemotherapy administration, nurses are usually required at the beginning, end, and at certain times during the treatment period to ensure high-quality infusion. It is, thus, critical for an outpatient chemotherapy unit to design a scheduling template that can effectively match nursing resources with treatment requirements. The template contains appointment slots of different lengths and thus allows schedulers to place patients into these slots according to the provider's order. As the template is often used over a period of several months, there usually exists a mismatch between the daily patient mix and the fixed structure of the given template. Hence, override policies must be employed to adjust to demand. However, these policies are often manually performed by schedulers. We propose a mixed-integer linear programming model to systematically develop optimal override policies in place of the manual process to improve template utilization while maintaining template stability. Numerical experiments based on real-life data from a chemotherapy unit are conducted to demonstrate the effectiveness of the proposed approach. [ABSTRACT FROM AUTHOR]

Did rating agencies tighten their rating standard after the overwhelming critique on their generous ratings before 2008? This study aims to examine whether 2008 is the cutoff year to investigate whether the bank rating standard was loosened prior to the 2008 crisis and became stringent after the crisis. We discuss the rating standard for three objects, namely, issuer ratings, individual ratings, and government support. Our results show the rating standard for issuer rating was loosened before 2008 and is not tighter after 2008. The rating standard for individual rating did not change before the crisis but became increasingly stringent after the crisis. Third, the agencies highly evaluate government support, especially during 2007–2011 and 2015–2016. [ABSTRACT FROM AUTHOR]

Structural design simultaneously governed by earthquakes and environmental vibrations has received a lot of attention in recent years. Base-isolated composite structures are typically used in the above-mentioned structural design. The corresponding analysis involves validating structural safety under earthquakes and human comfort under environmental vibrations through a time-history analysis. Thus, a reasonable damping model is essential. In this work, the representatives of viscous damping model and rate-independent damping model, namely the Rayleigh damping model and uniform damping model, were adopted to investigate the influence of damping models on the time-history analysis of such structural designs. The energy dissipation characteristics of the above-mentioned damping models were illustrated via a dynamic test of recycled aggregate concrete specimens. A case study was performed on a base-isolated steelconcrete composite structure. The dynamic responses under the excitation of earthquakes and environmental vibrations were compared using different damping models. The uniform damping model was found to be more flexible than the Rayleigh damping model in dealing with excitations with different frequency components. The uniform damping model is both theoretically advantageous and easy to use, demonstrating its potential in dynamic analysis of structures designed simultaneously governed by earthquakes and environmental vibrations. [ABSTRACT FROM AUTHOR]

In this article, we address a two-stage scheduling problem that requires coordination between clinical and surgical appointments for specialized surgeries. First, patients have a clinical appointment with a surgeon to determine whether they are an appropriate candidate for the surgical procedure. Subsequently, if the decision to pursue the surgery is made the patient undergoes the procedure on a later date. However, the scheduling process aims to book both the clinical and surgical appointments for a patient at the time of the initial appointment request. Two sources of uncertainty make this scheduling process challenging: (i) the patient may or may not need surgery after the clinical appointment and (ii) the surgery duration for each patient and procedure is unknown. We present a Distributionally Robust Optimization (DRO) approach for coordinating clinical and surgical appointments under these uncertainties. A case study of the Transcatheter Aortic Valve Replacement procedure at Mayo Clinic, Rochester, MN is presented. Numerical results include comparisons with the current practice and four heuristic scheduling policies from the literature. Results show that the DRO-based scheduling policies lead to lower total surgeon idle-time and overtime per day. The proposed policies also restrict the under and over utilization of clinical capacity. [ABSTRACT FROM AUTHOR]

Phosphorus is an important non‐metal element with many allotropes and tunable electronic properties. As one of the most important allotropes of phosphorus, two‐dimensional (2D) black phosphorus (BP) possesses many extraordinary properties, such as high charge carrier mobility with high on/off ratio, thickness‐dependent direct bandgap varying from 0.3 to 2 eV, and anisotropic electrical, optical and thermal properties. Inspiring by the success of 2D BP, other 2D phosphorus allotropes with intriguing properties for next‐generation electronic and optoelectronic devices have also attracted much attention. However, large‐scale growth of high‐quality 2D single/few‐layer phosphorus remains a great challenge. In this review, we highlight recent progress achieved on 2D phosphorus, with special focus on the epitaxial growth of 2D BP films, blue phosphorus (BlueP) monolayers as well as phosphorus‐metal porous networks. The remaining challenges and future perspectives on the development of monolayer phosphorus or phosphorus‐metal alloys are also provided. [ABSTRACT FROM AUTHOR]

Patient wait time can negatively impact treatment quality in a proton therapy center, where multiple treatment rooms share one proton beam. Wait time increases patient discomfort that can lead to patient motion, dissatisfaction, and longer treatment delay. This study was to develop a patient call-back model that reduced patient wait while efficiently utilizing the proton beam. A "Gatekeeper" logic allowing therapists to adjust the time of a patient's call-back to the treatment room was developed. It uses a two-pronged approach to minimize overlap of long treatment and the possibility of excessive wait in the queue to receive the proton beam. The goal was to reduce the maximum wait time to less than eight minutes per field for a four-room facility. The effectiveness of this logic was evaluated through simulation, and five scenarios were compared. Four scenarios implementing various levels of gatekeeper logic were compared with the original scenario without the logic. The best performing model provided a reduction of the maximum field wait by 26% and met the predefined goal. Adjusting call-back extended the treatment day length by an average of 6 min and a maximum of 12 min in total. The use of this gatekeeper logic significantly reduces patient field wait with minimal impact on treatment day length for a four-room proton facility. A sample interface that adopts this logic for therapists to make informed decision on patient call-back time is demonstrated. [ABSTRACT FROM AUTHOR]

Organic–2D material heterostructures have attracted intensive research interest due to their intriguing properties, with a wide range of potential applications in multifunctional flexible electronic and optoelectronic devices. Central to the realization of such devices is a fundamental understanding of the electronic structures at organic–2D material heterointerfaces. The energy level alignment (ELA) at the interface is of paramount importance because it determines the charge transfer barriers between the two materials in contact. In this paper, we discuss the physical mechanisms determining the ELAs, with special attention on interfacial charge transfer at the heterostructures. We review the current understanding of electronic properties at the heterointerfaces formed by the integration of organics with graphene and 2D transition metal dichalcogenides (TMDs), and conclude with a perspective on the future development of organic–2D material heterostructure. [ABSTRACT FROM AUTHOR]

Background. This study aimed to describe the clinical symptoms, laboratory findings, treatment, and outcomes of coronavirus disease 2019-related multisystem inflammatory syndrome in children to provide a reference for clinical practice. Methods. We employed a literature search of databases such as PubMed, Web of Science, EMBASE, and Johns Hopkins University for articles on COVID-19-related multisystem inflammatory syndrome in children published between April 1, 2020, and January 15, 2021. High-quality articles were selected for analysis on the basis of their quality standard scores. Using R3.6.3 software, meta-analyses of random- or fixed-effects models were used to determine the prevalence of comorbidities. Subgroup analysis was also performed to determine heterogeneity. Results. A total of 57 articles (2,290 pediatric patients) were included in the study. Clinical Manifestations. :ncidences of fever, gastrointestinal symptoms, respiratory symptoms, and musculoskeletal symptoms (myalgias or arthralgias) were 99.91% (95% CI: 99.67–100%), 82.72% (95% CI: 78.19–86.81%), 53.02% (45.28–60.68%), and 14.16% (95% CI: 8.4–21.12%), respectively. The incidences of rash, conjunctival injection, lymphadenopathy, dry cracked lips, neurologic symptoms (headache, altered mental status, or confusion), swollen hands and feet, typical Kawasaki disease, and atypical Kawasaki disease were 59.34% (95% CI: 54.73–63.87%), 55.23% (95% CI: 50.22–60.19%), 27.07% (95% CI: 19.87–34.93%), 46.37% (95% CI: 39.97–52.83%), 28.87% (95% CI: 22.76–35.40%), 28.75% (95% CI: 21.46–36.64%), 17.32% (95% CI: 15.44–19.29%), and 36.19% (95% CI: 21.90–51.86%), respectively. The incidences of coronary artery dilation, aneurysm, pericardial effusion, myocarditis, myocardial dysfunction, high troponin, and N-terminal pro-B-type natriuretic peptide were 17.83%, 6.85%, 20.97%, 35.97%, 56.32%, 76.34%, and 86.65%, respectively. The incidences of reduced lymphocytes, thrombocytopenia, hypoalbuminemia, elevated C-reactive protein, ferritin, LDH, interleukin-6, PCT, and FIB were 61.51%, 26.42%, 77.92%, 98.5%, 86.79%, 80.59%, 89.30%, 85.10%, and 87.01%, respectively. PICU Hospitalization Rate and Mortality. The incidences of PICU hospitalization or with shock were 72.79% and 55.68%, respectively. The mortality rate was 1.00%. Conclusion and Relevance. PICU hospitalization and shock rates of multisystem inflammatory syndrome in children associated with COVID-19 were high, and its cumulative multiorgans and inflammatory indicators are increased, but if treated in time, the mortality rate was low. [ABSTRACT FROM AUTHOR]

The field of two‐dimensional (2D) magnets has expanded rapidly during the past several years since the first demonstration of intrinsic 2D magnetism in atomically thin CrI3 and Cr2Ge2Te6 in 2017. 2D transition metal chalcogenides (TMCs), a class of strongly correlated materials, have exhibited a wide variety of novel electronic and optical properties, and more recently magnetism. Here, we review recent experimental progress achieved in the growth of 2D magnetic TMC materials using chemical vapor deposition and molecular beam epitaxy methods. Outstanding examples include the demonstration of room temperature intrinsic and extrinsic ferromagnetism in monolayer VSe2, MnSe2, Cr3Te4, V‐doped WSe2, and so on. A brief discussion on the origin of the exotic magnetic properties and emergent phenomena is also presented. Finally, we summarize the remaining challenges and future perspective on the development of 2D magnetic materials for next‐generation spintronic devices. [ABSTRACT FROM AUTHOR]

This study examines whether government ownership can affect bank risk. We use Moody's individual and issuer ratings as proxies for banks' operating and default risks. We find that whether government ownership increases or reduces default risk depends on where the banks are from and when the banks obtain government support. We find that government injections of funds into banks depends on this government's income level and whether the distressed banks are in crisis periods. Even during a crisis, we have to identify the nature of the crisis. [ABSTRACT FROM AUTHOR]

The Transcatheter Aortic Valve Replacement (TAVR) procedure requires an initial consultation and a subsequent procedure by an interventionalist (IC) and surgeon. The IC-surgeon pair coordination is extremely challenging, especially at Mayo Clinic due to provider time commitments distributed across practice, research, and education activities. Current practice aims to establish the coordination manually, resulting in a scheduling process that is cumbersome and time consuming for the schedulers. We develop an algorithm for pairing ICs and surgeons that minimizes the lead time (days elapsed between the clinic consult and procedure). As compared to current practice, this algorithm is able to reduce average lead time by 59% and increase possible IC-surgeon pairs by 7%. The proposed algorithm is shown to be flexible enough to incorporate practice variations such as lead time upper bound and two procedure days for a single consult day. Algorithm alternatives are also presented for practices who may find the proposed algorithm infeasible for their practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to develop a chemotherapy scheduling template that accounts for nurse resource availability and patient treatment needs to alleviate the mid-day patient load and provide quality services for patients.Design/methodology/approach: Owing to treatment complexity in chemotherapy administration, nurses are required at the beginning, end and during treatment. When nurses are not available to continue treatment, the service is compromised, and the resource constraint is violated, which leads to inevitable delay that risks service quality. Consequently, an optimization method is used to create a scheduling template that minimizes the violation between resource assignment and treatment requirements, while leveling patient load throughout a day. A case study from a typical clinic day is presented to understand current scheduling issues, describe nursing resource constraints, and develop a constraint-based optimization model and leveling algorithm for the final template.Findings: The approach is expected to reduce the variation in the system by 24 percent and result in five fewer chemo chairs used during peak hours. Adjusting staffing levels could further reduce resource constraint violations and more savings on chair occupancy. The actual implementation results indicate a 33 percent reduction on resource constraint violations and positive feedback from nursing staff for workload.Research Limitations/implications: Other delays, including laboratory test, physician visit and treatment assignment, are potential research areas.Originality/value: The study demonstrates significant improvement in mid-day patient load and meeting treatment needs using optimization with a unique objective. [ABSTRACT FROM AUTHOR]

This study creates a Chinese financial cycle index to examine the lead-and-lag relations between business and financial cycles. We examine the macroeconomic performance when these cycles are in boom, bust, and other combinations. We have four interesting results. First, financial cycles occur less frequently than business cycles. Second, the upturn phase of a financial cycle is significantly longer than the downturn phase. Third, gross domestic product growth rates are at their lowest when the two cycles are in troughs and the highest when they reach their peaks. We find similar results for employment, inflation, and consumption rates. Fourth, financial cycles lead business cycles but not vice versa. Hence, policymakers should consider the financial system before bailing out the real economy, which alone is insufficient for the recovery of the macro economy. [ABSTRACT FROM AUTHOR]

Abstract: This study investigates how two forms of external support, namely, government and foreign ownership, affect bank default and operating risks. The results show, first, that government ownership reduces default risk and increases operating risk, while foreign ownership reduces both default and operating risks. Second, government ownership decreases default risk especially for banks from advanced countries and countries with better national governance. Third, foreign ownership from countries with better sovereign ratings decreases both default and operating risks. Our results suggest that Asian countries should increase income or national governance for more effective government support and open the domestic bank market. [ABSTRACT FROM AUTHOR]

Since the first isolation of graphene, new classes of two-dimensional (2D) materials have offered fascinating platforms for fundamental science and technology explorations at the nanometer scale. In particular, 2D transition metal dichalcogenides (TMD) such as MoS2 and WSe2 have been intensely investigated due to their unique electronic and optical properties, including tunable optical bandgaps, direct–indirect bandgap crossover, strong spin–orbit coupling, etc., for next-generation flexible nanoelectronics and nanophotonics applications. On the other hand, organics have always been excellent materials for flexible electronics. A plethora of organic molecules, including donors, acceptors, and photosensitive molecules, can be synthesized using low cost and scalable procedures. Marrying the fields of organics and 2D TMDs will bring benefits that are not present in either material alone, enabling even better, multifunctional flexible devices. Central to the realization of such devices is a fundamental understanding of the organic–2D TMD interface. Here, we review the organic–2D TMD interface from both chemical and physical perspectives. We discuss the current understanding of the interfacial interactions between the organic layers and the TMDs, as well as the energy level alignment at the interface, focusing in particular on surface charge transfer and electronic screening effects. Applications from the literature are discussed, especially in optoelectronics and p–n hetero- and homo-junctions. We conclude with an outlook on future scientific and device developments based on organic–2D TMD heterointerfaces. [ABSTRACT FROM AUTHOR]

This study compares credit ratings between FHC affiliated banks and independent banks using Taiwan bank and FHC data. The results show banks that join Insurance- or Security-FHCs obtain better ratings than those that join Bank-FHCs. Second, banks that join FHCs with higher activity diversification can obtain better credit ratings. Third, joining government-owned FHCs enhances bank credit ratings and mitigates bank default risk compared to joining non-government-owned FHCs. Fourth, prior to the financial crisis, banks joining FHCs can obtain better credit ratings and reduce the cost of debt. However, during the financial crisis, rating agencies stopped regarding banks joining privately owned bank-based FHCs as risk diversification and assigning better credit ratings on this basis. [ABSTRACT FROM PUBLISHER]

Objective: To investigate lung function associated with asthma and body mass index (BMI) among adolescents at 96 northern Taiwan junior high schools participating in an asthma screening program. Methods: The questionnaires and lung function test results measured for 3669 boys and 3523 girls were included in this study for data analysis. Measures of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC ratio were compared by sex, asthma status and BMI. Results: Overall mean FVC levels were similar between students with and without asthma, 3.71 L vs. 3.71 L for boys (p = 0.991) and 2.79 vs. 2.78 for girls (p = 0.517). The overall mean FEV1 levels were also similar between girls with and without asthma. Asthmatic boys had lower FEV1 than non-asthmatic boys. Mean FEV1/FVC was significantly lower in students with asthma than those without asthma. Mean FVC and FEV1 increased with BMI in both sexes. A lower mean FEV1/FVC was observed among students with asthma and high BMI, and was more pronounced in boys than in girls. Multivariable regression analysis also showed that FEV1/FVC ratios were negatively associated with asthma and high BMI, stronger in boys than in girls for asthma (β = −2.176 (standard errors (SE) = 0.268) vs. −1.085 (SE = 0.258) and for BMI (β = −0.309 (SE = 0.025) vs. −0.218 (SE = 0.029)). Conclusion: This northern Taiwan study suggests that FEV1/FVC is negatively associated with asthma and high BMI in adolescents, stronger for boys than for girls. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to evaluate the performance on standardizing appointment slot length in a primary care clinic to understand the impact of providers' preferences and practice differences. Design/methodology/approach - The treatment time data were collected for each provider. There were six patient types: emergency/urgent care (ER/UC), follow-up patient (FU), new patient, office visit (OV), physical exam, and well-child care. Simulation model was developed to capture patient flow and measure patient wait time, provider idle time, cost, overtime, finish time, and the number of patients scheduled. Four scheduling scenarios were compared: scheduled all patients at 20 minutes; scheduled ER/UC, FU, OV at 20 minutes and others at 40 minutes; scheduled patient types on individual provider preference; and scheduled patient types on combined provider preference. Findings - Standardized scheduling among providers increase cost by 57 per cent, patient wait time by 83 per cent, provider idle time by five minutes per patient, overtime by 22 minutes, finish time by 30 minutes, and decrease patient access to care by approximately 11 per cent. An individualized scheduling approach could save as much as 14 per cent on cost and schedule 1.5 more patients. The combined preference method could save about 8 per cent while the number of patients scheduled remained the same. Research limitations/implications - The challenge is to actually disseminate the findings to medical providers and adjust scheduling systems accordingly. Originality/value - This paper concluded standardization of providers' clinic preference and practice negatively impact clinic service quality and access to care. [ABSTRACT FROM AUTHOR]

This study evaluated biohydrogen production by co-culture of Clostridium butyricum and Rhodopseudomonas palustris. C. butyricum and R. palustris were grown separately and together as batch cultures. Hydrogen production, growth, NH4-N, total volatile fatty acid production, and sucrose degradation were monitored. The hydrogen production of the co-culture produced 562 ml, R. palustris 426 ml, and C. butyricum 333 ml. The co-culture produced 2.16 mol H2/mol sucrose, C. butyricum and R. palustris produced 1.77 and 1.64 mol H2/mol sucrose, respectively. The co-culture was more efficient in the hydrogen production. Therefore, the co-culture is a good method for biohydrogen fermentation. [ABSTRACT FROM PUBLISHER]

Purpose - The purpose of this paper is to develop evident-based predictive no-show models considering patients' each past appointment status, a time-dependent component, as an independent predictor to improve predictability. Design/methodology/approach - A ten-year retrospective data set was extracted from a pediatric clinic. It consisted of 7,291 distinct patients who had at least two visits along with their appointment characteristics, patient demographics, and insurance information. Logistic regression was adopted to develop no-show models using two-thirds of the data for training and the remaining data for validation. The no-show threshold was then determined based on minimizing the misclassification of show/no-show assignments. There were a total of 26 predictive model developed based on the number of available past appointments. Simulation was employed to test the effective of each model on costs of patient wait time, physician idle time, and overtime. Findings - The results demonstrated the misclassification rate and the area under the curve of the receiver operating characteristic gradually improved as more appointment history was included until around the 20th predictive model. The overbooking method with no-show predictive models suggested incorporating up to the 16th model and outperformed other overbooking methods by as much as 9.4 per cent in the cost per patient while allowing two additional patients in a clinic day. Research limitations/implications - The challenge now is to actually implement the no-show predictive model systematically to further demonstrate its robustness and simplicity in various scheduling systems. Originality/value - This paper provides examples of how to build the no-show predictive models with time-dependent components to improve the overbooking policy. Accurately identifying scheduled patients' show/no-show status allows clinics to proactively schedule patients to reduce the negative impact of patient no-shows. [ABSTRACT FROM AUTHOR]

Floods are known to cause serious environmental damage and health impacts. Studies on flood-related diseases have been primarily on individual events, and limited evidence could be drawn on potential health impacts from floods using large population data. This study used reimbursement records of one million people of the Taiwan National Health Insurance program to compare incident diseases of the eyes, skin and gastrointestinal (GI) tract associated with floods. Incidence rates for the selected diseases were calculated according to outpatient/emergency visit data. The incidence rates were evaluated by flood status: in 10 days before floods, during floods and within 10 days after the floods receded. Outpatient/emergency visit rates for the eye, skin and GI tract diseases were highest after floods and lowest during floods. Results from multivariate Poisson regression analyses showed that, when compared with the incidence in 10 days before floods, the incidence rate ratios (IRR) of diseases within 10 days after floods were 1.15 (95% confidence interval (CI) = 1.10–1.20) for eyes, 1.08 (95% C.I. = 1.05–1.10) for skin, and 1.11 (95% CI = 1.08–1.14) for GI tract, after controlling for covariates. All risks increased with ambient temperature. V-shaped trends were found between age and eye diseases, and between age and GI tract diseases. In contrast, the risk of skin diseases increased with age. In conclusion, more diseases of eyes, skin and GI tract could be diagnosed after the flood. [ABSTRACT FROM AUTHOR]

We investigate the effect of sovereign credit ratings on bank credit ratings, known as the sovereign effect. Our study differs from the literature in three respects. First, we examine whether bank ratings below, at, or above the sovereign ceiling impact the sovereign effect. We find that the sovereign effect holds in all cases. Next, we consider the asymmetric impact of the sovereign effect on bank ratings with or without the ceiling effect. We find that a downgrade exhibits a stronger sovereign effect than an upgrade. Third, we examine whether the asset deterioration or the stable foreign fund hypotheses are possible explanations for the sovereign effect. Our results support both hypotheses. [ABSTRACT FROM AUTHOR]

The prevalence of human adenoviruses (HAdV) in river waters was investigated in this study. Water samples were collected from 13 rivers in Taiwan, concentrated, and assessed for the presence of HAdVs using nested polymerase chain reaction (PCR). Human AdV positive samples were then subjected to real-time PCR (qPCR) to quantify the viral genomes and further subjected to primer-based genotyping to identify the various serotypes present. For each water sample, several water quality parameters were evaluated, including heterotrophic plate count, total coliform, Escherichia coli, water temperature, pH, conductivity, and dissolved oxygen. Among the 13 rivers examined, four rivers (30.8 %) were found to contain HAdVs. The major genotype was F species HAdV serotype 41. The mean HAdVs concentrations ranged from 6.10 × 10 to 8.51 × 10 copies/L. No significant differences were observed between the presence of HAdVs, and all of the water quality parameters evaluated (heterotrophic plate count, total coliform, E. coli, water temperature, pH, conductivity, and dissolved oxygen). Given the potential health risks posed by the presence of enteric viruses in environmental waters, further assessment is desirable with respect to possible sources, virus transport, and survival of viruses in the aquatic environment. [ABSTRACT FROM AUTHOR]

In this study, antibiotic resistance and major phenol and genotypes of non-typhoid Salmonella spp. from riversheds in Taiwan were examined. In 236 water samples tested, 54 (22.9 %) contained Salmonella spp. Fifteen Salmonella serovars were identified from the Salmonella isolates, and some common serovars are associated with infections of human and livestock, including Albany (27.8 %), Newport (14.8 %), Bareilly (13.0 %), Derby (11.1 %), and Typhimurium (7.4 %). Various environmental factors may also affect the presence and proportion of different serovars in the receiving waters. In contrast, serovars with narrower range of hosts, e.g., Dublin, were rarely detected. The Salmonella isolates were subjected to eight antibiotics for drug resistance, and 51.9 % of the samples were resistant to at least one tested antibiotics. Tetracycline and sulfadiazine were the two most ineffective antibiotics against the Salmonella isolates, and the results were indicative of long-term antibiotics abuse as fodder supplements in animal husbandry. The more commonly detected serovars such as Albany, Derby, and Typhimurium were also more likely to be resistant to multiple antibiotics. Finally, a significant correlation was observed between resistance to chloramphenicol and the resistance gene cmlA, suggesting that the resistance genotypes could persist in the environment even long after prohibition of the drug use. The high prevalence of antibiotic-resistant Salmonella spp. infers elevated infection risks that must be further examined. [ABSTRACT FROM AUTHOR]

In this study, the presence of Legionella in major water reservoirs of Taiwan was examined with respect to seasonal variation, geographical variation, and water quality parameters using TaqMan real-time qPCR. Water samples were collected quarterly at 19 reservoirs in Taiwan between November 2012 and August 2013. The detection rate for Legionella was 35.5 % (27/76), and Legionella was detected in all seasons. The Legionella concentration was relatively high in spring and summer, reaching 3.86 × 10 and 7.35 × 10 cells/L, respectively. By sampling the area, Legionella was detected at a higher proportion in reservoirs in the northern and southern areas, and the difference was consistent in all seasons. Significant association was found between detection of Legionella and various water quality parameters, including conductivity, chlorophyll a, and dissolved oxygen (Mann-Whitney U test, P < 0.05). Results of Spearman rank test showed negative correlation for Legionella detection with pH ( P = 0.030, R = −0.497) and dissolved oxygen ( P = 0.007, R = −0.596) in fall and positive correlation with Carlson's trophic state index ( P = 0.049, R = 0.457) in spring. The identified species included Legionella pneumophila and Legionella drancourtii. The detection of Legionella in reservoirs was indicative of a potential public health risk and should be further evaluated. [ABSTRACT FROM AUTHOR]

In order to detect the presence/absence of Acanthamoeba along with geographical variations, water quality variations and seasonal change of Acanthamoeba in Taiwan was investigated by 18S ribosomal RNA (rRNA) gene TaqMan quantitative real-time PCR. Samples were collected quarterly at 19 drinking water reservoir sites from November 2012 to August 2013. Acanthamoeba was detected in 39.5 % (30/76) of the water sample, and the detection rate was 63.2 % (12/19) from samples collected in autumn. The average concentration of Acanthamoeba was 3.59 × 10 copies/L. For geographic distribution, the detection rate for Acanthamoeba at the northern region was higher than the central and southern regions in all seasons. Results of Spearman rank test revealed that heterotrophic plate count (HPC) had a negative correlation ( R = −0.502), while dissolved oxygen (DO) had a positive correlation ( R = 0.463) in summer. Significant differences were found only between the presence/absence of Acanthamoeba and HPC in summer (Mann-Whitney U test, P < 0.05). T2 and T4 genotypes of Acanthamoeba were identified, and T4 was the most commonly identified Acanthamoeba genotypes. The presence of Acanthamoeba in reservoirs presented a potential public health threat and should be further examined. [ABSTRACT FROM AUTHOR]

Patient no-show in outpatient clinics has been a long recognized issue, which negatively impacts clinic operational efficiency in terms of costs and patient access to care. One way to reduce these negative impacts is to allow urgent walk-ins during a clinic day. Some clinics allow random walk-ins and some purposely leave open time slots to accommodate them. The objective of this paper is to develop a cost-effective urgent care policy that is added on top of a full schedule and takes into account scheduled patients' no-show rates to improve patient access to care in a dynamic clinic environment. The findings indicate that the proposed approach outperforms the current random and urgent slot approaches. This paper demonstrates a dynamic approach for accommodating urgent patients into a patient scheduling system, based on the prediction of an individual patient's no-show probability and the maximum number of urgent patients allowed. [ABSTRACT FROM AUTHOR]

Salmonella is a leading cause of waterborne diseases. Salmonella can survive for a long time in aquatic environments, and its persistence in the environment is of great concern to public health. Nonetheless, the presence and diversity of Salmonella in the aquatic environments in most areas remain relatively unknown. In this study, we examined three analytical processes for an optimum Salmonella detection method, and the optimized method was used to evaluate seasonal variations of Salmonella in aquatic environments. In addition, Salmonella strains were isolated by selective culture medium to identify the serotypes by biochemical testing and serological assay, and to identify the genotypes by pulsed-field gel electrophoresis based on the genetic patterns. A total of 136 water samples were collected in the study area in 9 months. Forty-one (30.1%) samples were found to contain Salmonella-specific invA gene, and most (24/41) of the detections occurred in summer. The serovars of Salmonella enterica were identified, including Bareilly, Isangi, Newport, Paratyphi B var. Java, Potsdam and Typhimurium. [ABSTRACT FROM AUTHOR]

Purpose – The paper aims to provide a simulation optimization solution to improve patient scheduling that accounts for varying ancillary service time such as x-ray to minimize patient wait time. Design/methodology/approach – The two-step approach is to: identify patients' needs for ancillary services while scheduling appointments; and propose an algorithm to determine ancillary service time via simulation optimization. The main aim is to provide sufficient time between arrival at the clinic and the actual examination time for a patient to complete pre-visit activities without contributing significantly to patient wait time. Two case studies are included to demonstrate the approach. Findings – Triaging at the appointment-scheduling time saves an average 17 minutes for physician's first consultation in a clinic day, and a 7 percent reduction on current average patient wait time for case 1. Case 2 results in a 9 percent reduction on average patient wait time. The scheduled ancillary service time depends on the frequency and the ancillary service time, and appointment slot design. Research limitations/implications – One limitation is the impact of modeling error on the account of ancillary service times and the modeling assumptions. Practical implications – The proposed approach provides a studying method for clinic staff to account for ancillary services prior to physicians' visits for a better patient care. Two case studies demonstrated the practicability and promising results on reducing patient waiting. Originality/value – This article presents a unique approach to considering the required ancillary services in outpatient scheduling system that minimizes patient wait times. The approach will strengthen the existing scheduling methods to allow the time for ancillary services. [ABSTRACT FROM AUTHOR]

In this study, a SYBR green quantitative real-time PCR was developed to quantify and detect the Legionella spp. in various environmental water samples. The water samples were taken from watershed, water treatment plant, and thermal spring area in Taiwan. Legionella was detected in 13.6 % (24/176), and the detection rate for river water, raw drinking water, and thermal spring water was 10, 21.4, and 16.6 %, respectively. Using real-time PCR, concentration of Legionella spp. in detected samples ranged between 9.75 × 10 and 3.47 × 10 cells/L in river water, 6.92 × 10 and 4.29 × 10 cells/L in raw drinking water, and 5.71 × 10 and 2.12 × 10 cells/L for thermal spring water samples. The identified species included Legionella pneumophila (20.8 %), Legionella jordanis (4.2 %), Legionella nautarum (4.2 %), Legionella sp. (4.2 %), and uncultured Legionella sp. (66.6 %). The presence of L. pneumophila in aquatic environments suggested a potential public health threat that must be further examined. [ABSTRACT FROM AUTHOR]

Legionella are commonly found in natural and man-made aquatic environments and are able to inhabit various species of protozoa. The relationship between the occurrence of Legionella spp. within protozoa and human legionellosis has been demonstrated; however, the proportions of intracellular and extracellular Legionella spp. in the aquatic environment were rarely reported. In this study, we developed a new method to differentiate intracellular and extracellular Legionella spp. in the aquatic environment. Water samples from three thermal spring recreational areas in southeastern Taiwan were collected and analyzed. For each water sample, concurrent measurements were performed for Legionella spp. and their free-living amoebae hosts. The overall detection rate was 32 % (16/50) for intracellular Legionella spp. and 12 % (6/50) for extracellular Legionella spp. The most prevalent host of Legionella spp. was Hartmannella vermiformis. The identified Legionella spp. differed substantially between intracellular and extracellular forms. The results showed that it may be necessary to differentiate intracellular and extracellular forms of Legionella spp. [ABSTRACT FROM AUTHOR]

The objectives of this study are to investigate the volatile organic compound (VOC) distribution using passive samplers and to assess the resulting health risks in a high-tech science industrial park. With the advantages of passive sampling techniques, long-term and wide-area samples are collected. The results show TVOC concentrations in summer, fall, winter, and spring are 7.14 ± 5.66 ppb, 18.17 ± 5.81 ppb, 10.30 ± 3.54 ppb, and 14.56 ± 4.53 ppb, respectively; those on weekdays and weekends are 14.36 ± 6.80 ppb and 9.87 ± 4.86 ppb, respectively; and those in industrial and residential zones are 12.97 ± 0.39 ppb and 11.13 ± 0.68 ppb, respectively. Based on concentration variations, and benzene, toluene, ethylbenzene, and xylene ratios, we can resolve the source origins. Health risks are assessed based on the resulting concentrations. In the case of non-cancer chronic effects, long-term exposure to these concentrations does not support there is a risk of adverse health effects. However, potential cancer risks of exposure to these concentrations may occur, especially to carbon tetrachloride and benzene. By applying this study's procedures, information on VOC concentration distribution, source identification, and health assessment can be obtained and they are applicable to similar studies. [ABSTRACT FROM AUTHOR]

Background aims. We investigated bone marrow stromal cell (BMSC) transplantation combined with angiotensin-converting enzyme inhibitor (ACEI) treatment in acute myocardial infarction (AMI) and the role of insulin-like growth factor-1 (IGF-1). Methods. AMI models were established in Sprague-Dawley rats by ligation of the left anterior descending coronary artery and grouped into blank control (BC), ACEI treatment (ACEI), BMSC transplantation (BMSC) and BMSC transplantation plus ACEI (combined). Perindopril (2.5 mg/kg) was administered by gavage to ACEI and combined groups from the day after AMI. BMSC (2 × 108) were injected into the border of the MI area a week later in the BMSC and combined groups. Results. After 4 weeks, hemodynamics in the BMSC and combined groups were significantly improved ( P < 0.05 versus BC), with the greatest improvement in the combined group ( P < 0.05). In addition, an increased number of BMSC survived in the combined group ( P < 0.05 versus BMSC). A proportion of BMSC was positive for troponin T, as detected by immunofluorescence. The number of apoptotic cardiomyocytes was decreased in the BMSC and ACEI groups, and even further in the combined group ( P < 0.05). IGF-1 expression was up-regulated in the BMSC and combined groups ( P < 0.05 versus BC), but not in the ACEI group. B cell lymphoma-2 (Bcl-2) expression was up-regulated in the ACEI, BMSC and combined groups, with the highest expression in the combined group ( P < 0.05). Conclusions. Our results show that BMSC engrafted in AMI can survive well and secrete IGF-1 and preserve cardiac function significantly. These data suggest that BMSC transplantation inhibits apoptosis of cardiomyocytes by up-regulation of Bcl-2 expression in the myocardium, and this effect might be sensitized by ACEI. [ABSTRACT FROM AUTHOR]

Patient wait time has long been a recognized problem in modern outpatient health care delivery systems. Despite all the efforts to develop appointment rules and solutions, the problem of long patient waits persists. Regardless of the reasons for this problem, the fact remains that there are few implemented models for effective scheduling that consider patient wait times as well as physician idle time and are generalized sufficiently to accommodate a variety of outpatient clinic settings. This paper presents a solution of designing appointment slots for scheduling appointments in outpatient facilities that both patient wait time and physician idle time meet the declared scheduling policies without overbooking and double-booking. Furthermore, this paper provides the implementation results from three case studies to support the approach. The results confirm that the system can effectively reduce patient wait time as much as 56% without significantly increasing physician idle time per patient and still allow physician to see and schedule exactly same number of patients per clinic session. Consequently, this research improves the outpatient experience for both patients and the medical professions, changes the perception of long waits in a physician's office and ultimately enhances the quality of care. [ABSTRACT FROM PUBLISHER]

Objective: To explore the effects of insulin-like growth factor-1 (IGF-1) on migration, proliferation and differentiation of mesenchymal stem cells (MSCs). Methods: MSCs were obtained from Sprague-Dawley rats by a combination of gradient centrifugation and cell culture techniques and treated with IGF-1 at concentrations of 5-20 ng/ml. Proliferation of MSCs was determined as the mean doubling time. Expression of CXC chemokine receptor 4 (CXCR4) and migration property were determined by flow cytometry and transwell migration essay, respectively. mRNA expression of GATA-4 and collagen II was determined by reverse transcription-polymerase chain reaction (RT-PCR). Results: The mean doubling time of MSC proliferation was decreased, and the expression of CXCR4 on MSCs and migration of MSCs were increased by IGF-1, all in a dose-dependent manner, while the optimal concentration of IGF-1 on proliferation and migration was different. IGF-1 did not affect the expression of GATA-4 or collagen II mRNA. Conclusions: IGF-1 dose-dependently stimulated the proliferation of MSCs, upregulated the expression of CXCR4, and accelerated migration. There was no apparent differentiation of MSCs to cardiomyocytes or chondrocytes after culturing with IGF-1 alone. [ABSTRACT FROM AUTHOR]