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Humans introduced paper mulberry (Broussonetia papyrifera) from Taiwan into the Pacific over 5000 years ago as a fiber source to make barkcloth textiles that were, and still are, important cultural artifacts throughout the Pacific. We have used B. papyrifera, a species closely associated to humans, as a proxy to understand the human settlement of the Pacific Islands. We report the first genetic analysis of paper mulberry textiles from historical and archaeological contexts (200 to 50 years before present) and compare our results with genetic data obtained from contemporary and herbarium paper mulberry samples. Following stringent ancient DNA protocols, we extracted DNA from 13 barkcloth textiles. We confirmed that the fiber source is paper mulberry in nine of the 13 textiles studied using the nuclear ITS-1 marker and by statistical estimates. We detected high genetic diversity in historical Pacific paper mulberry barkcloth with a set of ten microsatellites, showing new alleles and specific genetic patterns. These genetic signatures allow tracing connections to plants from the Asian homeland, Near and Remote Oceania, establishing links not observed previously (using the same genetic tools) in extant plants or herbaria samples. These results show that historic barkcloth textiles are cultural materials amenable to genetic analysis to reveal human history and that these artifacts may harbor evidence of greater genetic diversity in Pacific B. papyrifera in the past. [ABSTRACT FROM AUTHOR]

Paper mulberry, Broussonetia papyrifera (L.) L’Hér. ex Vent. (Moraceae), a dioecious species, was transported by humans from Taiwan to the islands of Remote Oceania. Its introduction and cultivation in Remote Oceania was intentional due to its cultural importance as a fiber source for barkcloth textiles. The aim of this study was to explore the genetic diversity and structure of paper mulberry populations within Remote Oceania in order to infer dispersal patterns that may reflect past human interaction among island groups. We present the integrated analysis of 380 samples (313 contemporary and 67 herbarium specimens) collected in Near and Remote Oceania. Genetic characterization was based on a set of ten microsatellites developed for B. papyrifera and complemented with the analysis of the ribosomal internal transcribed spacer ITS-1 sequence, a sex marker and the chloroplast ndhF–rpl32 intergenic spacer. Microsatellite data identify a total of 64 genotypes, despite this being a clonally propagated crop, and show three major dispersal hubs within Remote Oceania, centered on the islands of Fiji, Tonga, and Pitcairn. Of 64 genotypes identified, 55 correspond to genotypes associated to female-sexed plants that probably descend from plants introduced by the prehistoric Austronesian-speaking voyagers. The ratio of accessions to genotypes between herbarium and contemporary samples, suggests recent loss of genetic diversity. In addition to the chloroplast haplotypes described previously, we detected two new haplotypes within Remote Oceania both originating in Taiwan. This is the first study of a commensal species to show genetic structuring within Remote Oceania. In spite of the genetic bottleneck, the presence of only one sex, a timespan of less than 5000 years, and asexual propagation of this crop in Remote Oceania, we detect genetic diversity and regional structuring. These observations suggest specific migration routes between island groups within Remote Oceania. [ABSTRACT FROM AUTHOR]

A multimedia version of Piers-Harris Children's Self-Concept Scale 2 (Piers-Harris 2) was created with audio and cartoon animation to facilitate the measurement of self-concept among younger children. This study aimed to assess the psychometric qualities of the computer version of Piers-Harris 2 scores, examine its score equivalence with the paper-and-pencil version, and survey the respondent preference of the two versions. Two hundred and forty eight Taiwanese students from the first to fourth grade were recruited. In regard to the psychometric properties, high internal consistency (α = .91) was found for the total score of multimedia Piers-Harris 2. High interscale correlations (.77 to .83) of the multimedia Piers-Harris 2 scores and the results of confirmatory factor analysis suggested the multimedia Piers-Harris 2 contained good structural characteristics. The scores of the multimedia Piers-Harris 2 also had significant correlations with the scores of the Elementary School Children's Self Concept Scale. The equality of convergence and criterion-related validities of Piers-Harris 2 scores for the multimedia and paper-and-pencil versions and the results of ICCs between the scores of the multimedia and paper-and-pencil Piers-Harris 2 suggested their high level of equivalence. Participants showed more positive attitudes towards the multimedia version.

Altruistic communication by non-profit organizations plays a crucial role in shaping individuals' perceptions and beliefs about altruism. One of the indicators of effective communication is the anchoring of the messages. Therefore, understanding the underlying determinants of anchoring in altruistic communication is essential. Despite the importance of anchoring in the communication of altruism, extant research has not done much to examine the determinants of anchoring in altruistic communication. This paper investigates the determinants of anchoring in non-profit organizations' altruistic communication through the lens of the dual process theory. It applies the Fuzzy Decision Making Trial and Evaluation Laboratory (F-DEMATEL) method to analyze the causal and effect factors. Data were gathered from 12 social communication experts based in Taiwan. Out of the 12 proposed determinants, three factors, namely consistency, cultural consideration, and emotional anchoring, were established as significant causal factors. Consistency had causal effects on five other factors, namely, the use of metaphors, the use of antinomies, thematic anchoring, understanding the cognitive ability of the audience, and crafting engaging information. Cultural consideration had causal effects on feedback, naming, use of antinomies, thematic anchoring, emotional anchoring, and repetition. Emotional anchoring had causal effects on thematic anchoring, use of antinomies, use of metaphors, consistency, naming, feedback, understanding the cognitive ability of the audience, and repetition. On the other hand, feedback, naming, and use of antinomies were established as significant effect factors. The study's findings offer crucial contributions to the social communication literature and provide important insights for social communication practitioners. [ABSTRACT FROM AUTHOR]

Significant heat-related casualties underlie the urgency of establishing a heat-health warning system (HHWS). This paper presents an evidence-based pilot HHWS developed for Taipei City, Taiwan, through a co-design process engaging stakeholders. In the co-design process, policy concerns related to biometeorology, epidemiology and public health, and risk communication aspects were identified, with knowledge gaps being filled by subsequent findings. The biometeorological results revealed that Taipei residents were exposed to wet-bulb globe temperature (WBGT) levels of health concern for at least 100 days in 2016. The hot spots and periods identified using WBGT would be missed out if using temperature, underlining the importance of adopting an appropriate heat indicator. Significant increases in heat-related emergency were found in Taipei at WBGT exceeding 36°C with reference-adjusted risk ratio (RaRR) of 2.42, taking 30°C as the reference; and residents aged 0–14 had the highest risk enhancement (RaRR = 7.70). As for risk communication, occurring frequency was evaluated to avoid too frequent warnings, which would numb the public and exhaust resources. After integrating knowledge and reconciling the different preferences and perspectives, the pilot HHWS was co-implemented in 2018 by the science team and Taipei City officials; accompanying responsive measures were formulated for execution by ten city government departments/offices. The results of this pilot served as a useful reference for establishing a nationwide heat-alert app in 2021/2022. The lessons learnt during the interactive co-design processes provide valuable insights for establishing HHWSs worldwide. [ABSTRACT FROM AUTHOR]

For a long time, governments of all countries have attached great importance to the development of underground economic activities. The reason is that the characteristics of the underground economy are hidden and the information disclosure is not sufficient, which not only distorts the economic data indicators, but more importantly, the existence of the underground economy has led to the loss of a large amount of tax base, affecting the long-term economic development of the country. Whether raising the tax burden rate boosts the tax revenue or expand the scale of the underground economy. In this paper, we use Kuznet Tax Curve (KTC) method to analyze the relationship between GDP and TTR/DTR/ITR. We find that the tax base erosion rate of indirect tax is lower than that of direct tax. In addition, we explore the relationship among economic growth, tax rate and tax revenue and adopt SUR-OLS method and Threshold approach to estimate the response of economic growth on total tax revenue(TTR), direct tax revenue(DTR) and indirect tax revenue (ITR) in Taiwan from 1991-2020. Our empirical research shows that when DTR tax rates are between 12.59% and 13%, an increase in income leads to a decrease, not an increase, in DTR, leading to severe tax base erosion. That is, the relationship between GDP and DTR presents a N-shaped relationship. However, ITR does not exist any tax rate threshold effect. Obviously, with the increase of GDP, ITR also increases. This reflects that the difference of tax structure between direct tax and indirect tax plays a key role in the relationship between tax rate and tax base erosion. [ABSTRACT FROM AUTHOR]

Healthcare has been one of the most affected sectors during the coronavirus disease 2019 (COVID-19) pandemic. The utilization of related services for non-COVID-19 diseases fell dramatically following the point at which the virus broke out; however, little is known about whether this observed decline in healthcare use was due to voluntary behaviors or enforced measures. This paper quantifies the spontaneous change in healthcare utilization during the pandemic. We utilize a county-by-week-level dataset from Taiwan's National Health Insurance (NHI) record, covering the entire Taiwanese population, and a difference-in-differences design. Our results indicate that even if there were no human mobility restrictions or supply-side constraints, people voluntarily reduced their demand for healthcare, due to fears of contagion, or COVID-related precautionary behaviors. We find that the number of outpatient visits (inpatient admissions) decreased by 19% (10%) during the pandemic period (February to May 2020). Furthermore, the demand response of healthcare for Influenza-like illness (ILI) was much greater and more persistent than for non-ILI, thereby suggesting that the substantial decline in accessing healthcare was induced by positive public health externality of prevention measures for COVID-19. Finally, we find that the demand for healthcare services did not get back to the pre-pandemic baseline, even when there were no local coronavirus cases for 253 consecutive days (mid-April to December 2020) in Taiwan. [ABSTRACT FROM AUTHOR]

Accurate PM2.5 prediction is part of the fight against air pollution that helps governments to manage environmental policy. Satellite Remote sensing aerosol optical depth (AOD) processed by The Multi-Angle Implementation of Atmospheric Correlation (MAIAC) algorithm allows us to observe the transportation of remote pollutants between regions. The paper proposes a composite neural network model, the Remote Transported Pollutants (RTP) model, for such long-range pollutant transportation that predicts more accurate local PM2.5 concentrations given such satellite data. The proposed RTP model integrates several deep learning components and learns from the heterogeneous features of various domains. We also detected remote transportation pollution events (RTPEs) at two reference sites from the AOD data. Extensive experiments using real-world data show that the proposed RTP model outperforms the base model that does not account for RTPEs by 17%-30%, 23%-26% and 18%-22% and state-of-the-art models that account for RTPEs by 12%-22%, 12%-14%, and 10%-11% at +4h to +24h, +28h to +48 hours, and +52h to +72h hours respectively. [ABSTRACT FROM AUTHOR]

Background: Several meta-analyses of the relationship between endothelial nitric oxide synthase (eNOS) T-786C gene polymorphism and chronic kidney disease (CKD) have been published. However, the results of these studies were inconsistent, and it is undetermined whether sample sizes are sufficient to reach a definite conclusion. Objective: To elucidate the relationship between T-786C and CKD by combining previous studies with our case-control sample and incorporate trial sequential analysis (TSA) to verify whether the sample size is adequate to draw a definite conclusion. Methods: PubMed and Embase databases were searched for relevant articles on eNOS T-786C and CKD before February 28, 2021. TSA was also incorporated to ascertain a conclusion. A total of 558 hemodialysis cases in the case-control study was recruited from nine dialysis centers in the northern area of Taiwan in 2020. Additionally, 640 healthy subjects of the control group, with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, were selected from participants of the annual elderly health examination program at the Tri-Service General Hospital. The functional analysis was based on eQTL data from GTExPortal. Results: After screening with eligibility criteria, 15 papers were included and eventually combined in a meta-analysis. The result of the TSA showed that the sample size for Caucasians was adequate to ascertain the correlation between eNOS T-786C and CKD but was insufficient for Asians. Therefore, we added our case-control samples (n = 1198), though not associated with CKD (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.69–1.46), into a meta-analysis, which supported that eNOS T-786C was significantly associated with CKD in Asians (OR = 1.39, 95% CI = 1.04–1.85) by using an adequate cumulative sample size (n = 4572) analyzed by TSA. Data of eQTL from GTEx showed that T-786C with the C minor allele exhibited relatively lower eNOS mRNA expression in whole blood, indicating the hazardous role of eNOS T-786C in CKD. Conclusions: eNOS T-786C genetic polymorphism was of conclusive significance in the association with CKD among Asians in our meta-analysis. Our case-control samples play a decisive role in changing conclusions from indefinite to definite. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is an inflammatory vasculitis disorder of unknown etiology. It is a rare but fatal disease and the leading cause of acquired coronary heart disease in children under the age of 5 years. We examined the association of KD with the demographics of family members, parents' characteristics, and perinatal factors in Taiwanese children. This nested case–control study used data from Taiwan's Health and Welfare Data Science Center and initially included children born in Taiwan between January 1, 2006, and December 31, 2015 (n = 1,939,449); the children were observed for KD development before the age of 5 years (n = 7870). The control group consisted of children without KD who were matched with each KD case by sex and birth date at a ratio of 8:1. The odds ratio (ORs) of the aforementioned associations were estimated using conditional logistic regression. The risk of KD decreased in children with younger parents [<25 years; younger maternal age, OR = 0.72, 95% confidence interval (CI), 0.66–0.79; younger paternal age, OR = 0.68, 95% CI, 0.59–0.78], lower socioeconomic status, more than 2 siblings (OR = 0.80, 95% CI, 0.73–0.89), and siblings with a history of KD (OR = 4.39, 95% CI, 3.29–5.86). Children living in suburban (OR = 0.95, 95% CI, 0.90–1.00) and rural (OR = 0.81, 95%CI, 0.74–0.90) areas exhibited a lower risk of KD than children living in urban areas. In conclusion, a higher incidence rate of KD was observed in children aged <5 years who had an urban lifestyle, had siblings with KD, were born to older mothers, and belonged to high-income and smaller families. Parental allergic or autoimmune diseases were not associated with the risk of KD. [ABSTRACT FROM AUTHOR]

The COVID-19 data analysis is essential for policymakers to analyze the outbreak and manage the containment. Many approaches based on traditional time series clustering and forecasting methods, such as hierarchical clustering and exponential smoothing, have been proposed to cluster and forecast the COVID-19 data. However, most of these methods do not scale up with the high volume of cases. Moreover, the interactive nature of the application demands further critically complex yet compelling clustering and forecasting techniques. In this paper, we propose a web-based interactive tool to cluster and forecast the available data of Taiwan COVID-19 confirmed infection cases. We apply the Model-based (MOB) tree and domain-relevant attributes to cluster the dataset and display forecasting results using the Ordinary Least Square (OLS) method. In this OLS model, we apply a model produced by the MOB tree to forecast all series in each cluster. Our user-friendly parametric forecasting method is computationally cheap. A web app based on R's Shiny App makes it easier for practitioners to find clustering and forecasting results while choosing different parameters such as domain-relevant attributes. These results could help in determining the spread pattern and be utilized by medical researchers. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about the gender and age differences associated with the effects of economic fluctuations on hospitalization for cardiovascular diseases. This paper investigates the impact of economic fluctuations on hospitalization for ischemic heart disease (IHD), stroke, and hypertension by age and gender between January 1996 and December 2012 in Taiwan. Methods: We adopted a multiple-input time series analysis to examine the strength of the immediate and latent effects of the 17-year quarterly unemployment rates (UR), air pollution exposure (APE), gross domestic product (GDP), per capita consumption expenditure in cigarette and alcohol (ECA), and per capita healthcare expenditure (HE) on the adjusted quarterly incidence rate of hospitalization. The data used in this paper were retrieved from the National Health Insurance Research Database and the website of the Directorate-General of Budget, Accounting and Statistics (DGBAS), Executive Yuan. Results: Our findings indicate that higher UR increased IHD hospitalization in young men and women and middle-aged women but reduced stroke hospitalization in young men. Higher APE increased IHD hospitalization in young men but reduced it for young women, increased stroke hospitalization in old men and middle-aged women but reduced it for young men, and increased hypertension hospitalization in middle-aged men and young women. Higher ECA reduced IHD hospitalization in middle-aged men, increased stoke hospitalization in middle-aged and old men and middle-aged women. Higher HE reduced IHD hospitalization in old men, young and old women, reduced stroke hospitalization in old women, and reduced hypertension hospitalization in young and middle-aged women. Conclusions: Overall, we found that the economic fluctuations caused increased harmful effects in certain population subgroups but also brought some soothing effects to some groups. [ABSTRACT FROM AUTHOR]

Background: Decision-making in healthcare policy involves assessing both costs and benefits. In determining the cost-effectiveness (CE) threshold, willingness to pay (WTP) per quality-adjusted life year (QALY), GDP per capita, and other factors are important. However, the relationship between WTP/QALY or GDP per capita and the CE threshold is unclear. It is important to clarify the relationship between WTP/QALY and GDP to provide a clear basis for setting the CE threshold. Objective: The purpose of this study was to compare WTP/QALY and GDP per capita, and to develop a new CE threshold range based on WTP using GDP per capita. The relationship between WTP/QALY and healthy life expectancy (HALE) was also investigated. Methods: We searched MEDLINE, EMBASE and Web of Science from 1980/01/01 to 2020/12/31 using the following selection criteria (latest search: Dec 2021):1, studies that estimated WTP/QALY; 2, the general population was surveyed; 3, the article was in English. From the collected articles, we obtained average values of WTP/QALY for various countries and compared WTP/QALY with GDP per capita. The correlation between WTP/QALY and HALE was also examined. Results: We identified 20 papers from 17 countries. Comparison of mean WTP/QALY values with GDP per capita showed that most WTP/QALY values were in the range of 0.5–1.5 times GDP per capita, though the median values were less than 0.5 times. Comparison of WTP/QALY with HALE showed a statistically significant positive correlation when Taiwan was excluded as an outlier. Conclusions: Our results suggest a CE threshold range of 0.5–1.5 times GDP per capita is appropriate but lower than the WHO-recommended range of 1–3 times. The correlation between WTP/QALY and HALE suggests that investment in healthcare is reflected in an increased healthy life expectancy. Since WTP is based on consumer preferences, this range could be used to set a generally acceptable criterion. [ABSTRACT FROM AUTHOR]

After a violent earthquake, the supply of medical services may fall short of the rising demand, leading to overcrowding in hospitals, and, consequently, a collapse in the healthcare system. This paper takes the emergency care system in Taiwan as the research context, where first-aid hospitals are ranked to three levels, advanced, intermediate, and general, and, currently, emphasizes on a general emergency responsibility hospital. Having limited capacity and capability, a general emergency responsibility hospital treats minor and moderate injuries, from which the majority of earthquake-induced casualties suffer. The purpose of this study is to analyze the impact of this group of earthquake-induced non-urgent patients on the performance of a hospital. A patient flow model was built to represent patients' paths throughout emergency care. Based on the model, discrete event simulation was applied to simulate patients' trajectories and states of a hospital under four seismic scenarios, where patient visits are 1.4, 1.6, 1.9, and 2.3 times the normal number. A healthcare performance index, Crowdedness Index (CI), is proposed to measure crowdedness on a daily basis, which is defined as the ratio of the average waiting time for treatment to the recommended maximal waiting time. Results of simulations rendered the establishment of empirical equations, describing the relation between the maximum CIs and the patient growth ratios. In the most severe case in this study, the maximum CI exceeds 92 and it takes 10 days to recover from the quality drop. This highlights the problem a general emergency responsibility hospital may encounter if no emergency response measure is implemented. Findings are provided pertaining to the predication of a recovery curve and the alarming level of patient increase, which are supportive information for preparedness planning as well as response measure formulation to improve resilience. [ABSTRACT FROM AUTHOR]

Starting renal replacement therapy (RRT) for patients with chronic kidney disease (CKD) at an optimal time, either with hemodialysis or kidney transplantation, is crucial for patient's well-being and for successful management of the condition. In this paper, we explore the possibilities of creating forecasting models to predict the onset of RRT 3, 6, and 12 months from the time of the patient's first diagnosis with CKD, using only the comorbidities data from National Health Insurance from Taiwan. The goal of this study was to see whether a limited amount of data (including comorbidities but not considering laboratory values which are expensive to obtain in low- and medium-income countries) can provide a good basis for such predictive models. On the other hand, in developed countries, such models could allow policy-makers better planning and allocation of resources for treatment. Using data from 8,492 patients, we obtained the area under the receiver operating characteristic curve (AUC) of 0.773 for predicting RRT within 12 months from the time of CKD diagnosis. The results also show that there is no additional advantage in focusing only on patients with diabetes in terms of prediction performance. Although these results are not as such suitable for adoption into clinical practice, the study provides a strong basis and a variety of approaches for future studies of forecasting models in healthcare. [ABSTRACT FROM AUTHOR]

Background: This pilot study aimed to investigate medication nonadherence among Taiwanese patients with diabetes, hypertension, and hyperlipidemia using the Chinese version of the Two-Part Medication Nonadherence Scale (C-TPMNS) and the National Health Insurance (NHI) Medicloud system. The study revealed insights into the factors contributing to nonadherence and the implications for improving patient adherence to medications for chronic conditions. However, the small sample size limits the generalizability of the findings. Additionally, the study identified the need for further research with larger and more diverse samples to validate the preliminary findings. Methods: The study conducted surveys individuals in central Taiwan who received three-high medications and those who returned expired medications from chain pharmacies. A structured questionnaire including the C-TPMNS was administered, and additional data on medical history and HbA1c, LDL, and blood pressure levels were collected from the NHI Medicloud system. Data analysis was performed using multiple ordered logistic regression and Wald test methods. Setting interpretation cutoff point to determine medication nonadherence. Results: The study found that 25.8% of participants were non-adherent to prescribed medications. Non-adherent individuals had significantly higher systolic blood pressure (SBP ≥ 140 mmHg) than adherent participants. Non-adherence was also associated with factors such as lower education, single status, living alone, abnormal glucose postprandial concentration, and triglyceride levels. The C-TPMNS demonstrated good reliability (Cronbach's alpha = 0.816) and validity (area under the ROC curve = 0.72). Conclusion: The study highlighted the complexity of medication nonadherence with diverse determinants and emphasized the importance of tailored interventions. The findings underscored the need for region-specific research to comprehensively address medication nonadherence, especially focusing on adherence to medications for hypertension, hyperlipidemia, and diabetes. The study also identified the need for larger, more diverse studies to validate and expand upon the initial findings and emphasized the importance of pharmacist interventions and patient empowerment in managing chronic conditions and improving overall health outcomes. [ABSTRACT FROM AUTHOR]

Austronesian (AN) is the second-largest language family in the world, particularly widespread in Island Southeast Asia (ISEA) and Oceania. In Mainland Southeast Asia (MSEA), groups speaking these languages are concentrated in the highlands of Vietnam. However, our knowledge of the spread of AN-speaking populations in MSEA remains limited; in particular, it is not clear if AN languages were spread by demic or cultural diffusion. In this study, we present and analyze new data consisting of complete mitogenomes from 369 individuals and 847 Y-chromosomal single nucleotide polymorphisms (SNPs) from 170 individuals from all five Vietnamese Austronesian groups (VN-AN) and five neighboring Vietnamese Austroasiatic groups (VN-AA). We found genetic signals consistent with matrilocality in some, but not all, of the VN-AN groups. Population affinity analyses indicated connections between the AN-speaking Giarai and certain Taiwanese AN groups (Rukai, Paiwan, and Bunun). However, overall, there were closer genetic affinities between VN-AN groups and neighboring VN-AA groups, suggesting language shifts. Our study provides insights into the genetic structure of AN-speaking communities in MSEA, characterized by some contact with Taiwan and language shift in neighboring groups, indicating that the expansion of AN speakers in MSEA was a combination of cultural and demic diffusion. [ABSTRACT FROM AUTHOR]

Background: Absolute lymphocyte count (ALC) is a crucial indicator of immunity in critical illness, but studies focusing on long-term outcomes in critically ill patients, particularly surgical patients, are still lacking. We sought to explore the association between week-one ALC and long-term mortality in critically ill surgical patients. Methods: We used the 2015–2020 critical care database of Taichung Veterans General Hospital (TCVGH), a referral hospital in central Taiwan, and the primary outcome was one-year all-cause mortality. We assessed the association between ALC and long-term mortality by measuring hazard ratios (HRs) with 95% confidence intervals (CIs). Furthermore, we used propensity score-matching and -weighting analyses, consisting of propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and covariate balancing propensity score (CBPS), to validate the association. Results: A total of 8052 patients were enrolled, with their one-year mortality being 24.2%. Cox regression showed that low ALC was independently associated with mortality (adjHR 1.140, 95% CI 1.091–1.192). Moreover, this association tended to be stronger among younger patients, patients with fewer comorbidities and lower severity. The association between low ALC and mortality in original, PSM, IPTW, and CBPS populations were 1.497 (95% CI 1.320–1.697), 1.391 (95% CI 1.169–1.654), 1.512 (95% CI 1.310–1.744), and 1.511 (95% CI 1.310–1.744), respectively. Additionally, the association appears to be consistent, using distinct cutoff levels to define the low ALC. Conclusions: We identified that early low ALC was associated with increased one-year mortality in critically ill surgical patients, and prospective studies are warranted to confirm the finding. [ABSTRACT FROM AUTHOR]

This study aims to investigate the temporal and spatial attributes of the exit of Taiwanese enterprises from mainland China between 2001 and 2021, by applying enterprise database data. Furthermore, the influence of strategic coupling on Taiwanese enterprises' exit from mainland China was also investigated. The following are the key findings: The spatial distribution pattern of the exit rate of Taiwanese enterprises in mainland China varied at different phases. In contrast, the inland regions of the country's central and western zones, which are characterized by comparatively less developed economies, maintained consistently high exit rates, whereas the eastern coastal region retained a low exit rate. Particularly, the relationship between Taiwanese enterprises and the invested areas changed from Captive coupling to Cooperative coupling and subsequently to Absorptive Coupling. Similarly, the coupling modes significantly influenced the exit of Taiwanese enterprises from mainland China. Moreover, the COVID-19 pandemic has contributed to the backward connection of Taiwanese corporations, which have become more reliant on the mainland China market and local suppliers than earlier. Taiwan-favoring policies and the regional innovation environment have consequently emerged as the primary locational advantages for retaining Taiwanese enterprises in the aftermath of the global financial crisis. Therefore, the aforementioned factors may help to reduce the Taiwanese enterprises' exit from mainland China and possess valuable policy implications for Taiwan investment zones in mainland China. [ABSTRACT FROM AUTHOR]

Urban heat islands will occur if city neighborhoods contain insufficient green spaces to create a comfortable environment, and residents' health will be adversely affected. Current satellite imagery can only effectively identify large-scale green spaces and cannot capture street trees or potted plants within three-dimensional building spaces. In this study, we used a deep convolutional neural network semantic segmentation model on Google Street View to extract environmental features at the neighborhood level in Taipei City, Taiwan, including the green vegetation index (GVI), building view factor, and sky view factor. Monthly temperature data from 2018 to 2021 with a 0.01° spatial resolution were used. We applied a linear mixed-effects model and geographically weighted regression to explore the association between pedestrian-level green spaces and ambient temperature, controlling for seasons, land use information, and traffic volume. Their results indicated that a higher GVI was significantly associated with lower ambient temperatures and temperature differences. Locations with higher traffic flows or specific land uses, such as religious or governmental, are associated with higher ambient temperatures. In conclusion, the GVI from street-view imagery at the community level can improve the understanding of urban green spaces and evaluate their effects in association with other social and environmental indicators. [ABSTRACT FROM AUTHOR]

Marek's disease (MD) is an important neoplastic disease caused by serotype 1 Marek's disease virus (MDV-1), which results in severe economic losses worldwide. Despite vaccination practices that have controlled the MD epidemic, current increasing MD-suspected cases indicate the persistent viral infections circulating among vaccinated chicken farms in many countries. However, the lack of available information about phylogeny and molecular characterization of circulating MDV-1 field strains in Taiwan reveals a potential risk in MD outbreaks. This study investigated the genetic characteristics of 18 MDV-1 strains obtained from 17 vaccinated chicken flocks in Taiwan between 2018 and 2020. Based on the sequences of the meq oncogene, the phylogenetic analysis demonstrated that the circulating Taiwanese MDV-1 field strains were predominantly in a single cluster that showed high similarity with strains from countries of the East Asian region. Because the strains were obtained from CVI988/Rispens vaccinated chicken flocks and the molecular characteristics of the Meq oncoprotein showed features like vvMDV and vv+MDV strains, the circulating Taiwanese MDV-1 field strains may have higher virulence compared with vvMDV pathotype. In conclusion, the data presented demonstrates the circulation of hypervirulent MDV-1 strains in Taiwan and highlights the importance of routine surveillance and precaution strategies in response to the emergence of enhanced virulent MDV-1. [ABSTRACT FROM AUTHOR]

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

This paper investigates the relationship between candidates’ online popularity and election results, as a step towards creating a model to forecast the results of Taiwanese elections even in the absence of reliable opinion polls on a district-by-district level. 253 of 354 legislative candidates of single-member districts in Taiwan’s 2016 general election had active public Facebook pages during the election period. Hypothesizing that the relative popularity of candidates’ Facebook posts will be positively related to their election results, I calculated each candidate’s Like Ratio (i.e. proportions of all likes on Facebook posts obtained by candidates in their district). In order to have a measure of online interest without the influence of subjective positivity, I similarly calculated the proportion of daily average page views for each candidate’s Wikipedia page. I ran a regression analysis, incorporating data on results of previous elections and available opinion poll data. I found the models could describe the result of the election well and reject the null hypothesis. My models successfully predicted 80% of winners in single-member districts and were effective in districts without local opinion polls with a predictive power approaching that of traditional opinion polls. The models also showed good accuracy when run on data for the 2014 Taiwanese municipal mayors election. [ABSTRACT FROM AUTHOR]

Background: A growing body of research supports dispositional mindfulness as important in influencing physical and mental health as well as physical activities in patients with chronic illnesses. Knee osteoarthritis (OA), which often causes health problems, is one of the most common chronic illnesses, but less is known about dispositional mindfulness in relation to this condition. Objective: To explore possible associations between dispositional mindfulness and physical and mental health as well as physical activity in knee OA patients. Methods: For this cross-sectional study, we recruited a purposive sample of orthopedic clinic patients in hospitals in Southern Taiwan. Instruments included the Mindful Attention Awareness Scale (MAAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health-related characteristics were also measured. Demographic statistics, bivariate correlations, and multiple linear regression informed our exploration of potentially related factors for dispositional mindfulness. Results: Participants with knee OA (N = 250) were mostly elderly (88%), female (70.5%), and married (84%). Marital status, perceived health status, depression, and physical activity were associated with dispositional mindfulness. Better perceived health, lower depression, and greater physical activity were significantly associated with greater dispositional mindfulness. However, the severity of symptoms, fear of falling, and exercise self-efficacy did not reach statistical significance in relation to dispositional mindfulness. Conclusion: Greater emphasis should be placed on the cultivation of mindfulness to enhance individuals' perceived health, decrease their depressive mood, and promote their engagement in physical activity, which could indirectly alleviate their experience of pain and improve their physical function, yielding better quality of life and well-being. Future research should focus on interventions to apply dispositional mindfulness in order to determine whether dispositional mindfulness can effectively improve physical and mental health as well as physical activity in those with knee OA. [ABSTRACT FROM AUTHOR]

Background: Taiwan was a coronavirus disease 2019 (COVID-19) outlier, with an extraordinarily long transmission-free record: 253 days without locally transmitted infections while the rest of the world battled wave after wave of infection. The appearance of the alpha variant in May 2021, closely followed by the delta variant, disrupted this transmission-free streak. However, despite low vaccination coverage (<1%), outbreaks were well-controlled. Methods: This study analyzed the time to border closure and conducted one-sample t test to compare between Taiwan and Non-Taiwan countries prior to vaccine introduction. The study also collected case data to observe the dynamics of omicron transmission. Time-varying reproduction number,Rt, was calculated and was used to reflect infection impact at specified time points and model trends of future incidence. Results: The study analyzed and compare the time to border closure in Taiwan and non-Taiwan countries. The mean times to any border closure from the first domestic case within each country were -21 and 5.98 days, respectively (P <.0001). The Taiwanese government invested in quick and effective contact tracing with a precise quarantine strategy in lieu of a strict lockdown. Residents followed recommendations based on self-discipline and unity. The self-discipline in action is evidenced in Google mobility reports. The central and local governments worked together to enact non-pharmaceutical interventions (NPIs), including universal masking, social distancing, limited unnecessary gatherings, systematic contact tracing, and enhanced quarantine measures. The people cooperated actively with pandemic-prevention regulations, including vaccination and preventive NPIs. Conclusions: This article describes four key factors underlying Taiwan's success in controlling COVID-19 transmission: quick responses; effective control measures with new technologies and rolling knowledge updates; unity and cooperation among Taiwanese government agencies, private companies and organizations, and individual citizens; and Taiwanese self-discipline. [ABSTRACT FROM AUTHOR]

This study employs a bivariate EGARCH model to examine the Taiwan Futures Exchange's regular and after-hours trading, focusing on the critical aspects of spillover and expiration effects, as well as volatility clustering and asymmetry. The objective of this study is to observe the impact on the trading sessions in Taiwan by the influences of the European and American markets, focusing on the essential roles of the price discovery function and risk disclosure effectiveness of the regular hours trading. This research is imperative considering the increasing interconnectedness of global financial markets and the need for comprehensive risk assessment for investment strategies. It also examines the hedging behavior of after-hours traders, thereby aiming to contribute to pre-investment analysis by future investors. This examination is vital for understanding the dynamics of after-hours trading and its influence on market stability. Results indicate price continuity between both trading sessions, with regular trading often determining after-hours price ranges. Consequently, after-hours price changes can inform regular trading decisions. This finding highlights the importance of after-hours trading for shaping market expectations. Significant profit potential exists in after-hours trading open interest, which serves speculative and hedging purposes. While regular trading volatility influences after-hours trading, the reverse is not true. This suggests Taiwan market information poses a higher risk impact than European and American market data, emphasizing the unique position of the Taiwan market in the global financial ecosystem. After-hours trading volatility reflects the absorption of international market information and plays a crucial role in advance revelation of risks. This underscores the importance of after-hours trading in global risk management and strategy formulation. [ABSTRACT FROM AUTHOR]

Background: Patients diagnosed with stage III breast cancer often undergo surgery, radiation therapy, and chemotherapy as part of their treatment. The choice of anesthesia technique during surgery has been a subject of interest due to its potential association with immune changes and prognosis. In this study, we aimed to compare the mortality rates between stage III breast cancer patients undergoing surgery with propofol-based intravenous general anesthesia and those receiving inhaled anesthetics. Methods: Using data from Taiwan's National Health Insurance Research Database and Taiwan Cancer Registry, we identified a cohort of 10,896 stage III breast cancer patients. Among them, 1,506 received propofol-based intravenous anesthetic maintenance, while 9,390 received inhaled anesthetic maintenance. To ensure comparability between the two groups, we performed propensity-score matching. Results: Our findings revealed a significantly lower mortality rate in patients who received inhaled anesthetics compared to those who received propofol-based intravenous anesthesia. Sensitivity analysis further confirmed the robustness of our results. Conclusions: This study suggests that inhaled anesthesia technique is associated with a lower mortality rate in clinical stage III breast cancer. Further research is needed to validate and expand upon these results. [ABSTRACT FROM AUTHOR]

Filial piety is viewed as strong family support for older Chinese people, and strongly associated with depressive symptoms. It is unknown if there exists gender difference in the mediation effects of filial piety on the relationship between chronic obstructive pulmonary disease (manifested as lung function) and depression. We investigated whether filial piety mediates the association between lung function and depression in community-dwelling older men and women using the Healthy Aging Longitudinal Study in Taiwan (HALST). Community dwelling adults aged 65 and above were analyzed. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed. We found that in older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (β = -0.1281, p = 0.004) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (β = 0.0605, p = 0.12). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p< 0.001). In older women, the correlation between FEV1 was complete mediation of RFP. Results indicate that feelings of insufficient filial piety may increase the likelihood of depression, especially in elderly women with worse lung function. Although modest, the main mediation effect of filial piety was improvement of lung function in older subjects, which might decrease depression. [ABSTRACT FROM AUTHOR]

DNA methylation plays a key role in the development and plant responses to biotic and abiotic stresses. This work aimed to evaluate the DNA methylation in contrasting cassava genotypes for water deficit tolerance. The varieties BRS Formosa (bitter) and BRS Dourada (sweet) were grown under greenhouse conditions for 50 days, and afterwards, irrigation was suspended. The stressed (water deficit) and non-stressed plants (negative control) consisted the treatments with five plants per variety. The DNA samples of each variety and treatment provided 12 MethylRAD-Seq libraries (two cassava varieties, two treatments, and three replicates). The sequenced data revealed methylated sites covering 18 to 21% of the Manihot esculenta Crantz genome, depending on the variety and the treatment. The CCGG methylated sites mapped mostly in intergenic regions, exons, and introns, while the CCNGG sites mapped mostly intergenic, upstream, introns, and exons regions. In both cases, methylated sites in UTRs were less detected. The differentially methylated sites analysis indicated distinct methylation profiles since only 12% of the sites (CCGG and CCNGG) were methylated in both varieties. Enriched gene ontology terms highlighted the immediate response of the bitter variety to stress, while the sweet variety appears to suffer more potential stress-damages. The predicted protein-protein interaction networks reinforced such profiles. Additionally, the genomes of the BRS varieties uncovered SNPs/INDELs events covering genes stood out by the interactomes. Our data can be useful in deciphering the roles of DNA methylation in cassava drought-tolerance responses and adaptation to abiotic stresses. [ABSTRACT FROM AUTHOR]

We investigate the dynamic characteristics of Covid-19 daily infection rates in Taiwan during its initial surge period, focusing on 79 districts within the seven largest cities. By employing computational techniques, we extract 18 features from each district-specific curve, transforming unstructured data into structured data. Our analysis reveals distinct patterns of asymmetric growth and decline among the curves. Utilizing theoretical information measurements such as conditional entropy and mutual information, we identify major factors of order-1 and order-2 that influence the peak value and curvature at the peak of the curves, crucial features characterizing the infection rates. Additionally, we examine the impact of geographic and socioeconomic factors on the curves by encoding each of the 79 districts with two binary characteristics: North-vs-South and Urban-vs-Suburban. Furthermore, leveraging this data-driven understanding at the district level, we explore the fine-scale behavioral effects on disease spread by examining the similarity among 96 age-group-specific curves within urban districts of Taipei and suburban districts of New Taipei City, which collectively represent a substantial portion of the nation's population. Our findings highlight the implicit influence of human behaviors related to living, traveling, and working on the dynamics of Covid-19 transmission in Taiwan. [ABSTRACT FROM AUTHOR]

Up until now montane cloud forest (MCF) in Taiwan has only been mapped for selected areas of vegetation plots. This paper presents the first comprehensive map of MCF distribution for the entire island. For its creation, a Random Forest model was trained with vegetation plots from the National Vegetation Database of Taiwan that were classified as “MCF” or “non-MCF”. This model predicted the distribution of MCF from a raster data set of parameters derived from a digital elevation model (DEM), Landsat channels and texture measures derived from them as well as ground fog frequency data derived from the Moderate Resolution Imaging Spectroradiometer. While the DEM parameters and Landsat data predicted much of the cloud forest’s location, local deviations in the altitudinal distribution of MCF linked to the monsoonal influence as well as the Massenerhebung effect (causing MCF in atypically low altitudes) were only captured once fog frequency data was included. Therefore, our study suggests that ground fog data are most useful for accurately mapping MCF. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan. Methods: The study of 23,781 people who were diagnosed with DM by using population—based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient’s job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors. Results: The 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81–1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04–3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups. Conclusion: DM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES. [ABSTRACT FROM AUTHOR]

This study examined 70 Klebsiella pneumoniae isolates derived from companion animals with urinary tract infections in Taiwan. Overall, 81% (57/70) of the isolates carried extended-spectrum β-lactamase (ESBL) and/or plasmid-encoded AmpC (pAmpC) genes. ESBL genes were detected in 19 samples, with blaCTX-M-1, blaCTX-M-9, and blaSHV being the predominant groups. pAmpC genes were detected in 56 isolates, with blaCIT and blaDHA being the predominant groups. Multilocus sequence typing revealed that sequence types (ST)11, ST15, and ST655 were prevalent. wabG, uge, entB, mrkD, and fimH were identified as primary virulence genes. Two isolates demonstrated a hypermucoviscosity phenotype in the string test. Antimicrobial susceptibility testing exhibited high resistance to β-lactams and fluoroquinolones in ESBL-positive isolates but low resistance to aminoglycosides, sulfonamides, and carbapenems. Isolates carrying pAmpC genes exhibited resistance to penicillin-class β-lactams. These findings provide valuable insights into the role of K. pneumoniae in the context of the concept of One Health. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) is a common life-threatening condition in critically ill patients. Itis also an important public health issue because it can cause substantial mortality and health care burden worldwide. The objective of this study was to investigate therisk factors that impact ARDS mortality in a medical center in Taiwan. Methods: This was a single center, observational study thatretrospectively analyzed data from adults in 6 intensive care units (ICUs) at Taichung Veterans General Hospital in Taiwan from 1st October, 2018to30th September, 2019. Patients needing invasive mechanical ventilation and meeting the Berlin definition criteria were included for analysis. Results: A total of 1,778 subjects were screened in 6 adult ICUs and 370 patients fulfilled the criteria of ARDS in the first 24 hours of the ICU admission. Among these patients, the prevalenceof ARDS was 20.8% and the overall hospital mortality rate was 42.2%. The mortality rates of mild, moderate and severe ARDS were 35.9%, 43.9% and 46.5%, respectively. In a multivariate logistic regression model, combination of driving pressure (DP) > 14cmH2O and oxygenation (P/F ratio)≤150 was an independent predictor of mortality (OR2.497, 95% CI 1.201–5.191, p = 0.014). Patients with worse oxygenation and a higher driving pressure had the highest hospital mortality rate(p<0.0001). Conclusions: ARDS is common in ICUs and the mortality rate remains high. Combining oxygenation and respiratory mechanics may better predict the outcomes of these ARDS patients. [ABSTRACT FROM AUTHOR]

Background: This study examined the long-term risks of heart failure (HF) and coronary heart disease (CHD) following traumatic brain injury (TBI), focusing on gender differences. Methods: Data from Taiwan's National Health Insurance Research Database included 29,570 TBI patients and 118,280 matched controls based on propensity scores. Results: The TBI cohort had higher incidences of CHD and HF (9.76 vs. 9.07 per 1000 person-years; 4.40 vs. 3.88 per 1000 person-years). Adjusted analyses showed a significantly higher risk of HF in the TBI group (adjusted hazard ratio = 1.08, 95% CI = 1.01–1.17, P = 0.031). The increased CHD risk in the TBI cohort became insignificant after adjustment. Subgroup analysis by gender revealed higher HF risk in men (aHR = 1.14, 95% CI = 1.03–1.25, P = 0.010) and higher CHD risk in women under 50 (aHR = 1.32, 95% CI = 1.15–1.52, P < 0.001). TBI patients without beta-blocker therapy may be at increased risk of HF. Conclusion: Our results suggest that TBI increases the risk of HF and CHD in this nationwide cohort of Taiwanese citizens. Gender influences the risks differently, with men at higher HF risk and younger women at higher CHD risk. Beta-blockers have a neutral effect on HF and CHD risk. [ABSTRACT FROM AUTHOR]

Background: Physical therapy (PT) is beneficial for critically ill patients, but the extent of its application in the intensive care unit (ICU) differs between countries. Here, we compared the extent of PT intervention in the ICU in Japan, the Philippines, and Taiwan by evaluating the sociodemographic and ICU-related profiles of ICU physical therapists. Materials and methods: In this cross-sectional study, a semistructured nationwide online survey was distributed to ICU physical therapists in the three countries. Results: We analyzed the responses of 164 physical therapists from Japan, Philippines, and Taiwan. Significant differences were observed between the countries in all sociodemographic variables and the following ICU-related profiles of physical therapists: ICU work experience, duration of the ICU posting, number of hours per day spent in the ICU, on-call ICU PT service engagement, source of ICU patient referral, therapist–patient ratio, and ICU-related PT training participation (p < 0.05). Medical, surgical, and neurologic ICUs were the most common ICU workplaces of the ICU physical therapists, but only surgical and neurologic ICUs exhibited significant differences between the countries (p < 0.05). Standard PT techniques in the ICU were passive and active-assisted range of motion, positioning, and breathing exercises but were implemented with significantly different frequencies between the countries (p < 0.05). The most common challenge faced in ICU PT service delivery by respondents from all three countries was lack of training prior to ICU duty, and lack of training was even bigger challenge in Japan than in other two countries after adjustment of age, highest educational attainment, and work experience. Conclusion: The differences in the health-care system between Japan, the Philippines, and Taiwan were related to differences in the compliance with internationally recommended PT practice standards in the ICU, differences in the type of PT intervention prioritized, and the challenges encountered in ICU PT service delivery. [ABSTRACT FROM AUTHOR]

This study examined methylmercury (MeHg) concentrations in fish, the daily MeHg exposure dose, and the risk–benefit of MeHg, ω-3 polyunsaturated fatty acid (ω-3 PUFA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) related to fish intake among pregnant and infertile women in Taiwan. The measured MeHg concentrations in fish did not exceed the Codex guideline level of 1 mg/kg. Swordfish (0.28 ± 0.23 mg/kg) and tuna (0.14 ± 0.13 mg/kg) had the highest MeHg concentrations. The MeHg concentration in the hair of infertile women (1.82 ± 0.14 mg/kg) was significantly greater than that of pregnant women (1.24 ± 0.18 mg/kg). In addition, 80% of infertile women and 68% of pregnant women had MeHg concentrations in hair that exceeded the USEPA reference dose (1 mg/kg). The MeHg concentrations in hair were significantly and positively correlated with the estimated daily MeHg exposure dose. Based on the risk–benefit evaluation results, this paper recommends consumption of fish species with a low MeHg concentration and high concentrations of DHA + EPA and ω-3 PUFA (e.g., salmon, mackerel, and greater amberjack). [ABSTRACT FROM AUTHOR]

Taiwan currently has one of the lowest fertility rates in the world, leading to projections of rapid population ageing and decline. In common with other territories in Pacific Asia, policies designed to support childbearing have recently been introduced. Some optimism for the future success of these policies has been drawn from the fact that the ‘ideal’ number of children stated in Taiwanese surveys is over two. In this way, Taiwan appears to fit the ‘two-child norm’ model identified for Europe and North America. Furthermore, this feature has led commentators to state that Taiwan is not in a ‘low fertility trap’–where positive feedback mechanisms emanating from the normalisation of small families, slow economic growth and ageing/declining population mean attempts to increase fertility become ever less likely to succeed. Using a recent national representative survey, and arguing that ‘intentions’ are a more reliable guide to understanding the circumstances of family formation, this paper explores fertility intentions in Taiwan with a special focus on women at parity one and parity two. This will form the first full-length examination of fertility intentions in Taiwan published in English and one of the few studies of Pacific Asia that reports a micro-level analysis. We argue that using intentions should provide a better ‘barometer’ of attitudes towards childbearing in Taiwan, and that through micro-level analysis, we can better identify the predictors of intentions that could, in turn, provide useful clues both for projections as well as shaping policy responses. While we found some evidence for a ‘two-child norm’ among childless women, this could be an unrealistic ideal. This is supported by the fact that a majority of women with one child do not intend to have another. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a common atopic disease worldwide, and it was found that babies with constipation in their early life might have an increased risk of atopic diseases, including AR. Furthermore, recent studies also indicate that the maternal gut microbiota may influence babies. Thus, we extended the definition of early life in utero and evaluated the association between maternal constipation and the risk of AR in their babies. Using the Longitudinal Health Insurance Database, a subset of Taiwan's National Health Insurance Research Database, we identified 102,820 constipated mothers and 102,820 matched controls between 2005 and 2015. Propensity score analysis was used to match birth year, child sex, birth weight, gestational age, mode of delivery, maternal comorbidities, and children antibiotics taken. Multiple Cox regression and subgroup analyzes were conducted to estimate the adjusted hazard ratio of childhood AR. The incidence of childhood AR was 83.47 per 1,000 person-years in constipated mothers. Adjusting children's sex, birth weight, gestational age, mode of delivery, maternal comorbidities, and children antibiotic use, the results showed that the children whose mothers had constipation had a 1.20-fold risk of AR compared to children of mothers without constipation. Maternal constipation was associated with an increased risk of AR. Therefore, it is important to pay close attention to pregnant mothers with constipation. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a highly heterogeneous disorder. Untangling this variability could lead to personalized treatments and improve participant recruitment for clinical trials. We investigated the cognitive subgroups by using a data-driven clustering technique in an AD cohort. People with mild–moderate probable AD from Taiwan was included. Neuropsychological test results from the Cognitive Abilities Screening Instrument were clustered using nonnegative matrix factorization. We identified two clusters in 112 patients with predominant deficits in memory (62.5%) and non-memory (37.5%) cognitive domains, respectively. The memory group performed worse in short-term memory and orientation and better in attention than the non-memory group. At baseline, patients in the memory group had worse global cognitive status and dementia severity. Linear mixed effect model did not reveal difference in disease trajectory within 3 years of follow-up between the two clusters. Our results provide insights into the cognitive heterogeneity in probable AD in an Asian population. [ABSTRACT FROM AUTHOR]

One of the most promising strategies for the management of plastic waste is microbial biodegradation, but efficient degraders for many types of plastics are still lacking, including those for polystyrene (PS). Genomics has emerged as a powerful tool for mining environmental microbes that may have the ability to degrade different types of plastics. In this study, we use 16S rRNA sequencing to analyze the microbiomes for multiple PS samples collected from sites with different vegetation in Taiwan to reveal potential common properties between species that exhibit growth advantages on PS surfaces. Phylum enrichment analysis identified Cyanobacteria and Deinococcus-Thermus as being the most over-represented groups on PS, and both phyla include species known to reside in extreme environments and could encode unique enzymes that grant them properties suitable for colonization on PS surfaces. Investigation of functional enrichment using reference genomes of PS-enriched species highlighted carbon metabolic pathways, especially those related to hydrocarbon degradation. This is corroborated by the finding that genes encoding long-chain alkane hydroxylases such as AlmA are more prevalent in the genomes of PS-associated bacteria. Our analyses illustrate how plastic in the environment support the colonization by different microbes compared to surrounding soil. In addition, our results point to the possibility that alkane hydroxylases could confer growth advantages of microbes on PS. [ABSTRACT FROM AUTHOR]

Changes in health-related quality of life (HRQOL) among elderly patients with cancer before and after receiving curative treatment, such as chemotherapy, have always been an important consideration in physician–patient treatment decision-making. Although frailty assessment can help predict the effects of chemotherapy, there is a lack of relevant literature on its effectiveness in predicting post-chemotherapy HRQOL. Therefore, this study investigated the early predictive value of pre-chemotherapy frailty assessment for post-chemotherapy HRQOL among elderly patients with cancer receiving curative chemotherapy. From September 2016 to November 2018, this study enrolled elderly patients with cancer aged ≥ 65 years (N = 178), who were expected to receive chemotherapy at three hospitals in Taiwan. The mean age of patients was 71.70 years (SD = 5.46 years) and half of them were female (n = 96, 53.9%). A comprehensive geriatric assessment was performed to measure frailty in 178 participants one week before receiving chemotherapy (T0). Further, the HRQOL of the elderly patients with cancer was assessed again, four weeks after chemotherapy (T1). After controlling for demographic variables, this study evaluated the predictive value of frailty for HRQOL using a hierarchical regression analysis. A total of 103 (57.9%) participants met the frailty criteria. The results showed that 31.1%–56.7% of the variance in the seven domains of HRQOL could be explained by demographic variables and the presence or absence of frailty. This suggests that the presence or absence of frailty is an important predictor of the illness burden domain (β = 9.5; p <.05) of HRQOL. Frailty affects the illness burden domain of HRQOL in elderly patients with cancer. Finally, the administration of frailty assessments before treatment is recommended as a reference for patient treatment decision-making. [ABSTRACT FROM AUTHOR]

The water requirements of crops should be investigated to improve the efficiency of water use in irrigated agriculture. The main objective of the study was to assess the effects of water deficit stress on rice yields throughout the major cropping seasons. We analyzed rice yield data from field experiments in Taiwan over the period 1925–2019 to evaluate the effects of water-deficit stress on the yield of 12 rice cultivars. Weather data, including air temperatures, humidity, wind speed, sunshine duration, and rainfall were used to compute the temporal trends of reference evapotranspiration and crop water status (CWS) during rice growth stages. A negative CWS value indicates that the crop is water deficient, and a smaller value represents a lower water level (greater water-deficit stress) in crop growth. The CWS on rice growth under the initial, crop development, reproductive, and maturity stages declined by 96.9, 58.9, 24.7, and 198.6 mm in the cool cropping season and declined by 63.7, 18.1, 8.6, and 3.8 mm in the warm cropping season during the 95 years. The decreasing trends in the CWSs were used to represent the increases in water-deficit stress. The total yield change related to water-deficit stress on the cultivars from 1925–1944, 1945–1983, and 1996–2019 under the initial, crop development, reproductive, and maturity stages are -56.1 to 37.0, -77.5 to -12.3, 11.2 to 19.8, and -146.4 to 39.1 kg ha-1 in the cool cropping season and -16.5 to 8.2, -12.9 to 8.1, -2.3 to 9.0, and -9.3 to 8.0 in the warm cropping season, respectively. Our results suggest that CWS may be a determining factor for rice to thrive during the developmental stage, but not the reproductive stage. In addition, the effect of water-deficit stress has increasingly affected the growth of rice in recent years. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers, especially nurses, were one of the most vulnerable groups for developing posttraumatic stress disorder (PTSD) during the coronavirus disease 2019 (COVID-19) pandemic, which also affected their quality of life. However, only limited research has investigated the individual psychological factors as well as the environmental factors responsible for these effects of the pandemic. Demoralization is a state of loss of meaning and anhedonia, which we thought to be an important mediator between fear and PTSD among frontline nurses during the pandemic. This study aimed to explore the role of demoralization in the mechanisms of posttraumatic stress symptoms of nurses facing different infection risks and influencing factors on their well-being. Method: A cross sectional study was conducted from September 16, 2021 to October 8, 2021 in a medical center in Northern Taiwan. Online questionnaires were used to collect data, including age, sex, vaccination status, working years, previous quarantine experiences, psychiatric history, traumatic events and scales for measuring fear of COVID-19, demoralization, symptoms of posttraumatic stress, depression, anxiety and stress, burnout level, teamwork performance and quality of life. Hierarchical regression analysis and mediation analysis were utilized to identify associated risk factors and mechanisms. Result: Among 351 included nurses, 148 worked in high-risk areas directly exposed to COVID-19 patients or patients with respiratory symptoms, while 203 nurses worked in low-risk areas. Overall, nurses in the low-risk group had greater fear of COVID-19, and greater demoralization and burnout level, along with poorer teamwork and quality of life. Demoralization was found to have mediating effect in both the high-risk group and low-risk group on the relationships between fear of COVID-19 and posttraumatic stress symptoms. Levels of burnout and teamwork may serve as mediators between depression, anxiety, stress and quality of life. Conclusion: Hospital-based nurses appear to be at high risk for developing posttraumatic stress disorder during the COVID-19 pandemic. Study findings demonstrated specific associated factors that should be the focus of nursing administration and hospital management while employing preventive measures, psychological resilience of nurses or systematic managements. Future longitudinal research is needed to improve management in pandemic conditions. [ABSTRACT FROM AUTHOR]

This study investigates age-specific prostate-specific antigen (PSA) distributions in Taiwanese men and recommends reference ranges for this population after comparison with other studies. From January 1999 to December 2016, a total of 213,986 Taiwanese men aged above 19 years old without history of prostate cancer, urinary tract infection, or prostate infection were recruited from the Taiwan MJ cohort, an ongoing prospective cohort of health examinations conducted by the MJ Health Screening Center in Taiwan. Participants were divided into seven age groups. Simple descriptive statistical analyses were carried out and quartiles and 95th percentiles were calculated for each group as reference ranges for serum PSA in screening for prostate cancer in Taiwanese men. Serum PSA concentration correlated with age (r = 0.274, p<0.001). The median serum PSA concentration (5th to 95th percentile) ranged from 0.7 ng/ml (0.3 to 1.8) for men 20–29 years old (n = 6,382) to 1.6 ng/ml (0.4 to 8.4) for men over 79 years old (n = 504). The age-specific PSA reference ranges are as follows: 20–29 years, 1.80 ng/ml; 30–39 years, 1.80 ng/ml; 40–49 years, 2.0 ng/ml; 50–59 years, 3.20 ng/ml; 60–69 years, 5.60 ng/ml; 70–79 years, 7.40 ng/ml; over 80 years, 8.40 ng/ml. Almost no change occurred in the median serum PSA value in men 50 years old or younger, while a gradual increase was observed in men over 50. Taiwanese men aged 60 years above showed higher 95th percentile serum PSA values compared to Caucasian men and men in other Asian countries but were closer to those of Asian American and African American men. Results indicate significantly different PSA levels correlating to different ethnicities, suggesting that Oesterling's age-specific PSA reference ranges might not be appropriate for Taiwanese men. Our results should be further studied to validate the age-specific PSA reference ranges for Taiwanese men presented in this study. [ABSTRACT FROM AUTHOR]

The housing prices in many Asian cities have grown rapidly since mid-2000s, leading to many reports of bubbles. However, such reports remain controversial as there is no widely accepted definition for a housing bubble. Previous studies have focused on indices, or assumed that home prices are lognomally distributed. Recently, Ohnishi et al. showed that the tail-end of the distribution of (Japan/Tokyo) becomes fatter during years where bubbles are suspected, but stop short of using this feature as a rigorous definition of a housing bubble. In this study, we look at housing transactions for Singapore (1995 to 2014) and Taiwan (2012 to 2014), and found strong evidence that the equilibrium home price distribution is a decaying exponential crossing over to a power law, after accounting for different housing types. We found positive deviations from the equilibrium distributions in Singapore condominiums and Zhu Zhai Da Lou in the Greater Taipei Area. These positive deviations are dragon kings, which thus provide us with an unambiguous and quantitative definition of housing bubbles. Also, the spatial-temporal dynamics show that bubble in Singapore is driven by price pulses in two investment districts. This finding provides a valuable insight for policymakers on implementation and evaluation of cooling measures. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. Methods: This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. Results: Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10–0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16–0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04–0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17–3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53–4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16–8.63; p = 0.024). Conclusion: PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes. Trial registration: ClinicalTrials.gov NCT Identifier: NCT05452395. [ABSTRACT FROM AUTHOR]

Domestic violence's most frequently reported outcomes are preterm delivery and low birthweight, both of which are the strongest correlates of mortality and morbidity. Several studies have shown that pregnant women with domestic violence during pregnancy were more likely to deliver low-birthweight and preterm neonates. However, there has been no consensus on associations between domestic violence and low-birthweight and preterm delivery. To examine the impact of domestic violence on birthweight stratified by preterm or full-term delivery, a population-based retrospective cohort study was conducted that linked four national databases in Taiwan. A total of 1,322 subjects associated with a report of domestic violence during pregnancy were compared with 485,981 subjects without any record of reported domestic violence. The percentage of low birthweight in the group exposed to domestic violence was significantly higher than in the unexposed group with full-term delivery (4.9% vs. 3.3%, p = 0.001). Multivariable logistic regression analysis showed that pregnant women exposed to domestic violence had an OR of 1.37 (95% CI 1.05, 1.79) for low birthweight in full-term delivery. However, domestic violence was not significantly associated with low birthweight in preterm delivery. Screening for intimate partner violence in the perinatal health care system should be seen as especially important for women who have had full-term low-birthweight neonates. [ABSTRACT FROM AUTHOR]

During an investigation program of faunal diversity in the shallow reef zone of the active volcanic island off northeastern Taiwan in July and September 2020, numerous individuals of the starfish Echinaster luzonicus (Gray, 1840) were found, and some individuals were found with associated symbionts. Starfish sampling in the 150-m coral reef zone was undertaken at a depth of 8 m through scuba diving. For each type of potential macrosymbiont, both the dorsal and ventral sides were carefully examined. The prevalence of macrosymbionts on the starfish E. luzonicus was recorded. The most common symbiotic organism on E. luzonicus was the ectoparasitic snail Melanella martinii (A. Adams in Sowerby, 1854), followed by the pontoniine shrimp Zenopontonia soror (Nobili, 1904) and the rare polychaete scaleworm Asterophilia carlae Hanley, 1989. The prevalence ratio with host E. luzonicus was low and varied by 8.62% and 4.35%, 6.03% and 0%, and 0.86% and 0.72% in July and September 2020 for M. martinii, Z. soror, and A. carlae, respectively. The present study is the first to discover the scaleworm A. carlae as a macrosymbiont of the tropical starfish E. luzonicus, with a widespread distribution, off Taiwan's northeastern coast, an area influenced by the Kuroshio Current. [ABSTRACT FROM AUTHOR]

The amount of solar radiation intercepted by the plant canopy drives crop plant photosynthesis and the formation and development of plant organs. Radiation-use efficiency (RUE) is an index used to quantify the relationship between solar radiation and biomass, and crop yield can be increased by increasing RUE. The main goals of this study were to initially investigate the effects of plant densities on the aboveground dry matter of corn, and subsequently examine the effects of plant densities on RUE and leaf area index (LAI), and the effects of LAI on RUE. Finally, we provide a comparative assessment of the approaches used to determine RUE. Analyses were conducted using growth and meteorological data obtained for two field corn varieties (TNG1 and TNG7) grown under four different plant density conditions in central Taiwan in 2017. The RUE values obtained in this study were primarily estimated from the slope of the linear relationship between aboveground dry matter measured at periodic harvests and the corresponding cumulative intercepted photosynthetically active radiation up to the time of harvest. TNG1 and TNG7 with a row spacing of 37.5 cm × 20 cm had the largest amounts of aboveground dry matter and highest RUE values of 4.41 and 4.55 g MJ-1, respectively. We established that the higher the plant density, the higher were the values obtained for RUE and LAI. We also compared the different methods of estimating RUE and make recommendations in this regard. Our findings in this study will enable farmers to gain information on the dynamics of crop yield variation at an early stage of growth, and also provide reference values that can be incorporated in future crop yield models. [ABSTRACT FROM AUTHOR]