Search

Objectives: Home healthcare (HHC) is an important care choice for ageing people with disabilities; however, the risk factors for emergency department (ED) visits, a poor outcome index, remain unclear. Therefore, we conducted this study to clarify it. Methods: We conducted a case-control study from a medical center in Taiwan by identifying HHC patients between Aug 1, 2019, and July 31, 2021. Age, sex, iatrogenesis, underlying comorbidities, and ED visit data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of ED visits. Results: We identified 240 patients, including 133 patients with and 107 patients without ED visits, for this study. The mean ages were 83.9 and 83.3 years and females accounted for 71% and 60.9% of patients without and with ED visits, respectively. Multivariable logistic regression analyses showed that urinary catheters (adjusted odds ratio [aOR]: 5.84; 95% confidence interval [CI]: 1.48-23.01, p = 0.012) and peptic ulcer disease (PUD)/gastroesophageal reflux disease (GERD) (aOR: 2.27; 95%CI: 1.12-4.61, p = 0.023) were independent predictors of ED visits. Stratified analyses according to sex and age showed that PUD/GERD and dyslipidemia were significant predictors of ED visits in female patients. Conclusions and clinical implications: This study identified independent predictors of ED visits in HHC patients. Our results provide an important reference for the early prevention, recognition, and adjustment of care plans for at-risk patients. Further studies recruiting more patients and external validation are warranted. [ABSTRACT FROM AUTHOR]

Background: While the impact of telephone follow-up (TFU) for older emergency department (ED) patients is controversial, its effects on the Asian population remain uncertain. In this study, we evaluated the effectiveness of a novel computer assisted TFU model specifically for this demographic. Methods: At a Taiwanese tertiary medical center, we developed a TFU protocol that included a referral and case management system within the ED hospital information system. We provided TFU to older discharged patients between April 1, 2021, and May 31, 2021. We compared this cohort with a non-TFU cohort of older ED patients and analyzed demographic characteristics and post-ED discharge outcomes. Results: The TFU model was successfully implemented, with 395 patients receiving TFU and 191 without TFU. TFU patients (median age: 76 years, male proportion: 48.9%) differed from non-TFU patients (median age: 74 years, male proportion: 43.5%). Compared with the non-TFU cohort, the multivariate logistic regression analysis revealed that the TFU cohort had a lower total medical expenditure < 1 month (adjusted odds ratio [AOR]: 0.32; 95% CI: 0.21 − 0.47 for amounts exceeding 5,000 New Taiwan Dollars), and higher satisfaction (AOR: 2.80; 95% CI: 1.46 − 5.36 for scores > 3 on a five-point Likert Scale). However, the TFU cohort also had a higher risk of hospitalization < 1 month (AOR: 2.50; 95% CI: 1.31 − 4.77) compared to the non-TFU cohort. Conclusion: Computer-assisted TFU appears promising. Further research involving a larger number of patients and validation in other hospitals is necessary to bolster the evidence and extend the findings to a broader context. [ABSTRACT FROM AUTHOR]

Background: Diagnosing underlying causes of nonneurogenic male lower urinary tract symptoms associated with bladder outlet obstruction (BOO) is challenging. Video-urodynamic studies (VUDS) and pressure-flow studies (PFS) are both invasive diagnostic methods for BOO. VUDS can more precisely differentiate etiologies of male BOO, such as benign prostatic obstruction, primary bladder neck obstruction, and dysfunctional voiding, potentially outperforming PFS. Objective: These examinations' invasive nature highlights the need for developing noninvasive predictive models to facilitate BOO diagnosis and reduce the necessity for invasive procedures. Methods: We conducted a retrospective study with a cohort of men with medication-refractory, nonneurogenic lower urinary tract symptoms suspected of BOO who underwent VUDS from 2001 to 2022. In total, 2 BOO predictive models were developed—1 based on the International Continence Society's definition (International Continence Society–defined bladder outlet obstruction; ICS-BOO) and the other on video-urodynamic studies–diagnosed bladder outlet obstruction (VBOO). The patient cohort was randomly split into training and test sets for analysis. A total of 6 machine learning algorithms, including logistic regression, were used for model development. During model development, we first performed development validation using repeated 5-fold cross-validation on the training set and then test validation to assess the model's performance on an independent test set. Both models were implemented as paper-based nomograms and integrated into a web-based artificial intelligence prediction tool to aid clinical decision-making. Results: Among 307 patients, 26.7% (n=82) met the ICS-BOO criteria, while 82.1% (n=252) were diagnosed with VBOO. The ICS-BOO prediction model had a mean area under the receiver operating characteristic curve (AUC) of 0.74 (SD 0.09) and mean accuracy of 0.76 (SD 0.04) in development validation and AUC and accuracy of 0.86 and 0.77, respectively, in test validation. The VBOO prediction model yielded a mean AUC of 0.71 (SD 0.06) and mean accuracy of 0.77 (SD 0.06) internally, with AUC and accuracy of 0.72 and 0.76, respectively, externally. When both models' predictions are applied to the same patient, their combined insights can significantly enhance clinical decision-making and simplify the diagnostic pathway. By the dual-model prediction approach, if both models positively predict BOO, suggesting all cases actually resulted from medication-refractory primary bladder neck obstruction or benign prostatic obstruction, surgical intervention may be considered. Thus, VUDS might be unnecessary for 100 (32.6%) patients. Conversely, when ICS-BOO predictions are negative but VBOO predictions are positive, indicating varied etiology, VUDS rather than PFS is advised for precise diagnosis and guiding subsequent therapy, accurately identifying 51.1% (47/92) of patients for VUDS. Conclusions: The 2 machine learning models predicting ICS-BOO and VBOO, based on 6 noninvasive clinical parameters, demonstrate commendable discrimination performance. Using the dual-model prediction approach, when both models predict positively, VUDS may be avoided, assisting in male BOO diagnosis and reducing the need for such invasive procedures. [ABSTRACT FROM AUTHOR]

This prospective study investigated whether integrating the Clinical Frailty Scale (CFS) with a triage system would improve triage for older adult emergency department (ED) patients. We enrolled ED patients aged 65 years or older at 5 study sites in Taiwan between December 2020 and April 2021. All eligible patients were assigned a triage level by using the Taiwan Triage and Acuity Scale (TTAS) in accordance with usual practice. A CFS score was collected from them. The primary outcome was critical events, defined as ICU admission or in-hospital mortality. The secondary outcomes were ED medical expenditures, number of orders in the ED, and length of hospital stay (LOS). We applied a reclassification concept and integrated the CFS and TTAS to create the Triage Frailty Acuity Scale (TFAS). We compared the outcomes achieved between the TTAS and TFAS. Of 1023 screened ED patients, 890 were enrolled. The majority were assigned to TTAS level 3 (73.26%) and had CFS scores of 4 to 9 (55.96%). The primary outcomes were better predicted by the TFAS than the TTAS (area under the curve [AUC] 0.82 vs. 064). Using multivariable approach, TTAS level 1 (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.7–13.4) and CFS score (OR, 5.8; 95% CI, 1.9–17.2) were significantly associated with the primary outcomes. For older adults at the highest triage level, the TFAS was not associated with an increase in the primary outcomes compared with the TTAS; however, the TFAS was associated with a significant decrease in the number of older ED patients assigned to triage levels 3 to 5. In addition, TFAS had a longer average LOS but did not have a higher average number of orders or ED medical expenditures compared to TTAS. The TFAS identified more older ED patients who had been triaged as less emergent but proceeded to need ICU admission or in-hospital death. Incorporating the CFS into triage may reduce the under-triage of older adults in the ED. [ABSTRACT FROM AUTHOR]

Marine litter and microplastics (MPs) represent pressing environmental challenges. However, the impact of marine litter on airborne MPs near marine litter hotspot remains unexplored. In this study, we simultaneously collected airborne MPs, weather factors, and air pollutants in a village near a marine litter hotspot across different seasons in Taiwan. Multiple methods were employed to evaluate whether the marine litter hotspot was a source of airborne MPs. The average MP concentration was 1.35 ± 1.33 particles/m³, with the highest concentration recorded in spring (3.06 ± 1.63 particles/m³) and the lowest in winter (0.61 ± 0.49 particles/m³). The dominant shapes and size ranges of MPs were fragment and 3–50 μm, respectively. The major polymer composition of the MPs was identified as polyamide. Wind rose, bivariate polar plot, and backward trajectories illustrated that the air mass passing through the marine litter hotspot exhibited higher MP concentrations in the study area in spring, fall, and winter. Factor analysis suggested that thermal and ultraviolet (UV) light exposure induced the emission of MPs from plastic items. In contrast, local activities may be a source of MPs in the study area during summer. Overall, this study revealed that higher MP concentrations were observed in the village near marine litter hotspot when the predominant directions from marine litter hotspot, with thermal and UV light exposure being the degradation mechanisms. This study also highlighted the need to reduce marine litter to mitigate MP pollution near hotspots in the atmosphere. [Display omitted] • Airborne microplastic pollution was significant in spring in our study village. • The primary sizes and shape were 3–50 μm and fragment, respectively. • Marine litter hotspot was a major contributor to airborne microplastics. • Heat and UV degradation play major roles in altering microplastic concentrations. • Wind event change the impact of marine litter hotspot on airborne microplastics. [ABSTRACT FROM AUTHOR]

Aims: A computerized tool and interdisciplinary care were implemented to develop a novel model for older patients with delirium in the emergency department (ED). Methods: We developed a computerized tool using a delirium triage screen and brief confusion assessment in the hospital information system, performed education for the healthcare providers, and developed a continuous care protocol. Comparisons for outcomes between pre- and post-intervention periods were performed. Results: Compared with the pre-intervention period, patients in the post-intervention period had shorter hospitalization stay, lower expenditure of hospitalization, more likely to return home, lower ED revisits of ≤ 3 days, re-hospitalization of ≤ 14 days, and mortality of ≤ 1 month. All mentioned differences were not statistically significant. Conclusions: A novel model was successfully developed for delirium management in older patients in the ED. Outcome differences were not significant; however, the result is promising, which gives us an important reference in the future. [ABSTRACT FROM AUTHOR]

Background: The study aims to improve the success rate and the rapidity in creating artificial ascites before starting the treatment for subcapsular hepatocellular carcinomas. Methods: Two hundred and forty-six consecutive hepatocellular carcinoma patients who required the instillation of artificial ascites for better visualization or prevention from organ injury were recruited between November 2011 and September 2017. Initially, 95 patients were using the Seldinger technique, while the remaining 151 patients were using the one-step method. The proportions of patients who had undergone surgery, transarterial chemoembolization, or radiofrequency ablation therapy before performing artificial ascites infusion were 11.6% (11/95), 3% (3/95), and 37% (35/95) in the Seldinger group, and 15.9% (24/151), 15.2% (23/151), and 52.3% (79/151), respectively, in the one-step group. Results: The complete success rate, partial success rate, and failure rate in creating artificial ascites using the Seldinger technique and the one-step method were 76.8% (73/95), 11.6% (11/95), 11.6% (11/95) and 88.1% (133/151), 7.9% (12/151), 4% (6/151), respectively. The complete success rate was significantly higher in the one-step method group (P < 0.05) than that of the Seldinger group. The mean time required from starting the procedure to successful intraperitoneal instillation of glucose water was 145.79 ± 133.37 s in the one-step method, which was statistically shorter than that of 238.68 ± 95.58 s in the Seldinger group (P < 0.05). Conclusion: The one-step method has a higher success rate than the Seldinger method in creating artificial ascites and is faster, especially in treatment-experienced patients. [ABSTRACT FROM AUTHOR]

Aim: Home healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification. Methods: A computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts. Results: The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant. Conclusion: An innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact. [ABSTRACT FROM AUTHOR]

Previous studies have suggested a possible association between carbon monoxide poisoning (COP) and hypothyroidism, but the evidence is limited. Therefore, the aim of this study was to further investigate this relationship. Using data from the Taiwan National Health Research Database, we identified 32,162 COP patients and matched with 96,486 non-COP patients by age and index date for an epidemiological study. The risk of hypothyroidism was compared between the two cohorts until 2018. Independent predictors of hypothyroidism were analyzed using competing risk analysis. An animal study was also conducted to support the findings. COP patients had an increased risk of hypothyroidism compared to non-COP patients in the overall analysis (adjusted hazard ratio [AHR]= 3.88; 95 % confidence interval [CI]: 3.27−4.60) and in stratified analyses by age, sex, and comorbidities. The increase in the overall risk persisted even after more than six years of follow-up (AHR= 4.19; 95 % CI: 3.18−5.53). Independent predictors of hypothyroidism, in addition to COP, included age ≥65 years, female sex, hyperlipidemia, and mental disorder. The animal study showed damages in the hypothalamus, pituitary gland, and thyroid, as well as altered hormone levels 28 days after COP exposure. The epidemiological results showed an increased risk of hypothyroidism in COP patients, which was further supported by the animal study. These findings suggest the need for close monitoring of thyroid function in COP patients, especially in those who are age ≥65 years, female, and have hyperlipidemia or mental disorder. • Carbon monoxide poisoning triples hypothyroidism risk. • Study links carbon monoxide exposure to thyroid dysfunction. • Monitoring urged for carbon monoxide -exposed individuals. • Carbon monoxide impacts neuroendocrine system in rats. • Findings highlight long-term carbon monoxide effects. [ABSTRACT FROM AUTHOR]

Spinal cord ischemia (SCI) is one of the major concerns of postoperative paraplegia during major vascular or aortic surgery. Since mitochondrial dysfunction develops at the early stage of SCI, this study tested the neuronal protective effect of transplantation of viable mitochondria to the ischemic cord in rats. SCI was induced by crossclamping of thoracic aorta at T6 level for 25 minutes, followed by release of vascular clip to restore aortic blood flow in the anesthetized rats. Mitochondria (100 μg) were isolated from freshly harvested soleus muscle and delivered via the internal jugular vein before releasing of vascular clip. The motor function was assessed independently up to 7 days after reperfusion. Spinal cords were harvested and analyzed for molecular and histological changes. Whole-body in vivo images acquired by an in vivo imaging system confirmed the enhancement of MitoTracker fluorescence at the regions below crossclamping and in the ischemic cord. Compared with control vehicles, transplantation of mitochondria significantly improved the lower-limb locomotor function of rats subjected to cord ischemia up to 7 days after surgery. Mitochondrial transplantation suppressed the regional endoplasmic reticulum stress in the ischemic cord by attenuating CCAAT-enhancer-binding protein homologous protein expression and restoring binding immunoglobulin protein levels. In accordance, tissue levels of interleukin-6, tumor necrosis factor-α, and caspase-3 were attenuated in the mitochondrial transplanted group. Histologic examination also showed significant increase in numbers of Nissls bodies in the neurons at the ventral horn of ischemic cord following mitochondrial transplantation. Our study showed that transplantation of freshly isolated mitochondria during the early stage of spinal cord ischemia–reperfusion injury suppressed the oxidative stress in endoplasmic reticulum of the injured cord, thereby reducing neuroapoptosis and improving locomotor function of rats with SCI. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Older adults have a higher mortality for dengue fever (DF). However, the best method for predicting mortality is still unclear. Aims: We conducted this study to evaluate the shock index (SI) for this issue. Methods: A retrospective case–control study was conducted by recruiting older patients (≥ 65 years old) with DF who visited the study hospital in southern Taiwan during the 2015 DF outbreak. Demographic data, vital signs, past histories, decision groups, complications, and mortality were included in the analyses. We evaluated the accuracy of SI ≥ 1 for predicting 30-day mortality in this population. Results: A total of 626 patients with a mean age of 74.1 years and nearly equal sex distribution were recruited. The mean of SI (± standard deviation [SD]) was 0.6 (± 0.2) and patients with a SI ≥ 1 accounted for 3.5% of the total patients. Logistic regression showed that patients with SI ≥ 1 had a higher mortality than those with SI < 1 (odds ratio: 8.49; 95% confidence interval: 1.76–17.92). The area under the receiver-operating characteristic was 0.76, and the Hosmer–Lemeshow goodness of fit test was 0.48. The SI ≥ 1 had a sensitivity, specificity, positive predictive value, and negative predictive value of 14.8%, 97.0%, 18.2%, and 96.2% for predicting mortality. Conclusions: The SI ≥ 1 is an easy tool that can be potentially used to predict 30-day mortality in older DF patients, especially in DF outbreak. It has a high specificity and negative predictive value for excluding patients with high-risk mortality. [ABSTRACT FROM AUTHOR]

• Plant-scale 25 kW SOFC dynamic system was presented. • Model scale-up process was revealed. • Pilot-scale 1 kW SOFC data was used to regress the parameters for model scale-up. • H 2 /CO electrochemical modules should be employed to match data in plant-scale SOFC. • Plant-scale SOFC model was validated in steady-state and dynamic status. Large-scale solid oxide fuel cell (SOFC) systems create operational challenges owing to their size and scale. An SOFC dynamic digital twin model can help users understand the system status and determine the operating action. In this study, a dynamic digital twin of a 25 kW SOFC plant was presented as a simulator to help operators safely and stably determine the operating conditions for a real commercial SOFC plant. In the scale-up process, the data from the 1 kW SOFC pilot plant were used to analyze the reliability and electrode parameters and develop a digital twin model that matches actual conditions at the plant. The scale-up digital twin model is applied to a 25 kW SOFC system, in which the SOFC is connected with upstream reformers, downstream burners, and multiple heat exchangers. The 25 kW SOFC digital twin model was validated by steady-state data and applied to on-site operation prediction with very high accuracy. The digital twin was used as an operating reference in the field, and the results showed that it could effectively help operators determine operation strategies using simulations to safely and stably execute the process. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Background: Physicians have better medical knowledge, which may decrease the risk of dementia; however, this issue remains unclear. This study was performed to clarify it. Methods: We conducted a nationwide population-based study that recruited 29,388 physicians, 50,000 participants from the general population, and 30,446 other healthcare professionals (HCPs; excluding physicians) for this study. The prevalence of dementia was compared among the three groups and physician subgroups by tracing their medical histories from 2006 to 2012. Results: Physicians had a lower prevalence of dementia than the general population after adjusting for age, sex, head trauma, hypothyroidism, hypertension, diabetes mellitus, stroke, vascular disease, atrial fibrillation, hypercholesterolemia, depression, and alcoholism [adjusted odds ratio (AOR) 0.56; 95% confidence interval (CI) 0.47–0.67]. Other HCPs also had a lower prevalence for dementia than the general population (AOR 0.46; 95% CI 0.36–0.60). Compared with other HCPs, physicians had no difference in the prevalence for dementia (AOR 0.98 95% CI 0.71–1.36). Physicians who were older, specialized in pediatrics and worked at local hospitals and clinics had a higher prevalence for dementia than their counterparts did. Conclusions: Physicians had a lower prevalence for dementia than the general population. The prevalence for dementia in specific subgroups of physicians was higher, which needs to be clarified by further studies. [ABSTRACT FROM AUTHOR]

Purpose: The quick Sepsis-Related Organ Failure Assessment (qSOFA) score was designed to predict mortality among sepsis patients. However, it has never been used to identify prolonged length of hospital stay (pLOS) in geriatric patients with influenza infection. We conducted this study to clarify this issue.Methods: We conducted a retrospective case-control study, including geriatric patients (aged ≥ 65 years) with influenza infection visiting the emergency department (ED) of a medical center between January 01, 2010 and December 31, 2015. The included patients were divided into two groups on the basis of their qSOFA score: qSOFA < 2, and qSOFA ≥ 2. Data regarding demographics, vital signs, qSOFA score, underlying diseases, subtypes of influenza, and outcomes were included in the analysis. We investigated the association between qSOFA score ≥ 2 and pLOS (>9 days) via logistic regression.Results: Four hundred and nine geriatric patients were included in this study with a mean age of 79.5 (standard deviation [SD], 8.3) years. The median length of stay (LOS) was 7.0 (interquartile range [IQR], 4-12) days, while the rate of pLOS (> 9 days) was 32%. The median LOS in the qSOFA ≥ 2 group, 11.0 (7-15) days, was longer than the qSOFA < 2 group, 6.0 (4-10) days (p-value <0.01). Logistic regression showed that qSOFA ≥ 2 predicts pLOS with an odds ratio of 3.78 (95% confidence interval, 2.04-6.97).Conclusion: qSOFA score ≥ 2 is a prompt and simple tool to predict pLOS in geriatric patients with influenza infection. [ABSTRACT FROM AUTHOR]

Background: Physicians in Taiwan work in stressful workplaces and have heavy workloads, both of which may contribute to the occurrence of a stroke. However, it is not clear whether they have a higher risk of stroke. Therefore, we conducted a population-based cohort study to compare the risks of stroke between physicians and the general population and among subgroups of physicians in Taiwan.Methods: In the National Health Insurance Research Database of Taiwan, we identified 28,062 physicians and selected 84,186 age- and sex-matched nonmedical staff beneficiaries as the references. Using conditional logistic regression, we compared the prevalence of stroke between physicians and references. In addition, we made comparisons among subgroup of physicians defined by age, sex, comorbidity, specialty, and the level of hospital.Results: During the study period, physicians had higher prevalence rates of hypertension (23.6% vs. 19.1%), hyperlipidemia (21.4% vs. 12.9%), and coronary artery disease (CAD) (6.4% vs. 5.7%) than the referent group, but they had a lower risk of stroke with an odds ratio of 0.61 (95% confidence interval = 0.55, 0.66) after adjusting for hypertension, diabetes, hyperlipidemia, CAD, and active worker. Among physicians, the risks were higher in those who were older or had hypertension, diabetes, hyperlipidemia, or CAD.Conclusions: Despite having higher prevalence rates of hypertension, hyperlipidemia, and CAD and working in stressful workplaces with heavy workloads, our study suggests that physicians in Taiwan have a lower risk of stroke compared with the general population. These results may indicate the benefits of higher awareness and more knowledge of diseases. [ABSTRACT FROM AUTHOR]

Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-yr period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622-0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011-1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399-1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations. [ABSTRACT FROM AUTHOR]

Background/purpose: Nonalcoholic fatty liver disease (NAFLD) is now a global liver disease. The fatty liver index (FLI), which is calculated by the equation comprising waist circumference, body mass index (BMI), triglyceride, and gamma glutamyl transpeptidase (GGT), is frequently used for hepatic steatosis evaluation. This study aimed to evaluate the optimal cut-off point of FLI to select subjects for abdominal ultrasonography (US) screening for NAFLD in the community.Methods: From August 2013 to August 2016, a community-based study was performed in the northeastern region of Taiwan. All subjects participated in a demographic survey, blood testing, and abdominal US. The formula for FLI is: FLI = [e 0.953×loge (TG)+0.139×BMI+0.718×loge (GGT) +0.053×waist circumference-15.745]/[1 + e 0.953×loge (TG)+0.139×BMI+0.718×loge (GGT)+0.053×waist circumference-15.745] × 100.Results: A total of 1371 subjects were included (746 in NAFLD group and 625 in the control group). The mean ages were 57.1 years in the control group and 56.3 years in the NAFLD group. The optimal cut-off points of FLI to discriminate fatty liver by abdominal US were 20 in male and 10 in female (sensitivity 80.3% and 76.1%; specificity 66.9% and 65.5%, respectively). FLI was correlated with the severity of fatty liver by abdominal US, predict fat component percent and NAFLD fibrosis score, especially in the female subjects.Conclusion: FLI could be a tool to select subjects for abdominal US in a large community survey. The cut-off point of FLI might be set to 10 for female and 20 for male subjects, to increase the sensitivity for selecting subjects to receive abdominal US. [ABSTRACT FROM AUTHOR]

The removal of arsenic from groundwater is an important issue for environmental safety and human health. Research focused on the comparative assessment of arsenic removal from arsenic-bearing groundwater and arsenic-containing-synthetic water (2 mg/L) using natural magnetic material (NMM) (rock) and synthesized magnetic material (SMM) by Bacillus pasteurii and humic acid. The arsenic-bearing groundwater (97.56 ± 0.05 μg/L) exceed the WHO limit (10 μg/L) of arsenic concentration for drinking water. The NMM contains dominantly magnetite, hematite, ferrihydrate, coesite, quartz, and stishovite. The NMM of natural rock exhibited the existence of iron (6.25–8.86% Fe 3 O 4), which is widespread and important component in sedimentary rocks. The investigation on vibrating sample magnetometers (VSM) of NMM and SMM demonstrated the typical magnetization properties, which can be separated after arsenic removal process. The thermogravimetric analysis (TGA) of SMM displayed the existence of organic matter decomposition during particle synthesis. The TEM and SEM exhibited the nanoparticle particle formation within the range of 10–39 nm (10–20 nm particle Fe 3 O 4 through B. pasteurii). FTIR spectrum (before and after removal of arsenic) indicated the existence and binding nature in between arsenic and iron. >90% of arsenic was removed from arsenic-bearing groundwater using Fe 3 O 4 , Fe 3 O 4 (N 2 -Environment), Fe 3 O 4 with humic acid, and Fe 3 O 4 with B. pasteurii after 25 min, 8 min, 13 min and 120 min, respectively. In case of NMM in Site-A, the arsenic removal was observed very fast as 85–87% within 30 s, whereas 95–99%, 93–95% and 88–91% removal detected using the sample of Site-A, Site-B, and Site-C respectively, after 120 min at natural pH (8.31 ± 0.05) of arsenic-bearing groundwater. Thus, NMM, (ecofriendly green material), can be applicable for arsenic removal from arsenic-bearing groundwater. Image 108338 • Natural (NMM)/Synthesized (SMM) magnetic material useful for groundwater As removal. • >90% As removal: Fe 3 O 4 , Fe 3 O 4 (N 2), Fe 3 O 4 -HA, Fe 3 O 4 - B.P. after 25, 8, 13, 120 min. • NMM: As removal: 95–99% Site-A , 93–95% Site-B , and 88–91% Site-C within 120 min. • Arsenic removal order of NMM: Site-A > Site-B > Site-C. • As removal order: Fe 3 O 4 (N 2)>Fe 3 O 4 >HA > Fe 3 O 4 >Fe 3 O 4 - B. pasteurii (B.P.) The removal of arsenic from arsenic-bearing groundwater in In-situ and Ex-situ environment using novel natural and synthesized magnetic rock material. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: There is no clear information regarding the long-term mortality in the older population with chronic pain (CP), and therefore, we conducted this study to clarify it. Findings: Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP. Message: Early detection and intervention for treating CP are suggested for this population. Purpose: This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear. Methods: We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015. Results: The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14–1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10–1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases. Conclusions: Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population. [ABSTRACT FROM AUTHOR]

Background: Carbon monoxide poisoning (COP) accounts for a large number of emergency department visits worldwide and is fatal in many cases. In surviving patients, neurological sequelae (NS) attributable to cerebral hypoxia are the most devastating outcome, but reliable predictors are limited. Therefore, we conducted a study to identify predictors of NS in patients with COP and evaluate their effects.Methods: In this retrospective case-control study, we identified patients with COP in a medical center in Southern Taiwan between January 2005 and December 2014. Cases were patients with NS, and controls were patients without NS. We obtained information on potential predictors of NS from medical records and evaluated their association with NS, including demographic characteristics, exposure source, suicide attempts, duration of exposure (by tertile), histories, symptoms, signs, laboratory data, treatment, and the length of hospital stay.Results: We included 371 patients with COP. Of them, 93 developed NS, and their mean ages (41.4 ± 14.7 years vs. 39.7 ± 14.2 years) and proportions of males (59.1% vs. 58.6%) were similar to those in the 298 controls. Multivariate logistic regression showed that a history of hypertension (adjusted odds ratio = 2.1; 95% confidence interval = 1.0, 4.5) and a longer duration of carbon monoxide exposure (adjusted odds ratio = 1.7; 95% confidence interval = 1.1, 2.8; the longest tertile [>5 hours] vs. the other two tertiles [≤5 hours]) were independent predictors for NS, but not the level of carboxyhemoglobin.Conclusions: This study identified two independent predictors for NS that may be useful for public healthcare workers and physicians in predicting outcomes and deciding on treatment strategies for COP patients. [ABSTRACT FROM AUTHOR]

Background: The effects of ionized radiation on the thyroid have been extensively studied. However, most studies have focused on high-dose radiation received accidentally or through therapy, and few were on low-dose occupational exposure.Methods: Using a retrospective cohort study design, we collected health examination reports from employees who worked on jobs with occupational exposure to radiation at a hospital to evaluate possible changes in the serum thyroid hormones and determine whether there is a dose-response effect. After excluding those with diseases that may affect thyroid function and who were pregnant at any given examination during the study periods we followed the remaining 326 workers for 12 years and evaluated the associations between radiation exposure and changes in serum thyroid hormones using the generalized estimating equation for repeated measures. Data from an external comparison cohort were used to adjust for changes over time.Results: We observed declines in triiodothyronine (T3) and thyroxine (T4) over the study period, but not in thyroid-stimulating hormone (TSH). In addition, we found negative dose-response relationships between exposure duration and declines in the serum levels of T3 (a change of -0.037 ng/ml/year after adjusting for sex and age at the beginning of follow-up; 95% confidence interval [CI] = -0.042, -0.032 ng/ml/year) and T4 (-0.115 µg/dl/year; 95% CI = -0.140, -0.091 µg/dl/year). We also observed an increase in the TSH level (0.683 µIU/ml/year; 95% CI = 0.151, 1.214 µIU/ml/year) after the ninth year of follow-up.Conclusions: We concluded that despite low exposure doses, occupational exposure to ionizing radiation in healthcare workers still may be associated with the declines in the serum levels of T3 and T4. [ABSTRACT FROM AUTHOR]

This paper proposes a new adaptive proportional–integral–derivative (PID) control method using predictive control and output recurrent fuzzy wavelet neural network (ORFWNN) for a group of nonlinear digital time-delay dynamic systems. The presented controller, called ORFWNN-APPID controller, is rigorously derived and proved by including an ORFWNN identifier with online parameter learning and identification, and an adaptive ORFWNN-based predictive PID controller to achieve precise setpoints tracking and disturbance rejection. The effectiveness and superiority of the constructed ORFWNN-APPID control approach are well demonstrated by performing numerical simulations on step-like disturbance rejection and precise setpoint tracking of two well-known digital nonlinear processes. The practicability of the presented method is illustrated by carrying out two experimental results on a real PET temperature control process. [ABSTRACT FROM AUTHOR]