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Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other.

The global incidence of early-onset colorectal cancer (EO-CRC) is increasing. Although the mortality rate is relatively stable, some comorbidities have been associated with a higher mortality rate. This study estimated the mortality risk in patients with EO-CRC with various comorbidities using real-world data to identify the high-risk group using Cox proportional regression for overall and cancer-specific mortality. The incidence rate of EO-CRC significantly increased from 6.04 per 100,000 population in 2007 to 12.97 per 100,000 population in 2017. The five-year overall mortality rate was 101.50 per 1000 person year and the cancer-specific mortality rate was 94.12 per 1000 person year. Patients with cerebrovascular disease (CVD) had a higher mortality risk (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.25-2.28; p=0.0007). After subgroup analyses based on age, sex, clinical stage, and treatment type, patients with CVD had a higher overall mortality risk compared to non-CVD patients, except for patients undergoing surgery and chemotherapy. Patients with chronic kidney disease had a higher mortality risk in the early clinical stages (HR: 2.31; 95% CI: 1.08-4.96; p=0.0138). Patients who underwent radiotherapy had a higher overall mortality risk (HR: 1.38; 95% CI: 1.04-1.85; p=0.0285) than those without liver disease. Identifying specific comorbidity mortality risks in patients with EO-CRC allows for risk stratification when screening target groups and may lower disease mortality.

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

Additional file 1. Supplementary figures.

Additional file 11. Review history.

Additional file 6: Table S5. The sequence of the primers used in this study.

Additional file 7: Table S6. The sequence of the crRNAs and gRNAs used in this study.

Additional file 8. Uncropped western blot images.

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

Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.

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

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

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

Kuang-Ming Liao,1 Yi-Ju Chen,2 Chuan-Wei Shen,2 Shao-Kai Ou,2 Chung-Yu Chen2– 4 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanCorrespondence: Chung-Yu Chen, School of Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan, Tel +886-7-3121101 ext 2375, Fax +886-7-3210683, Email jk2975525@hotmail.comIntroduction: Chronic obstructive pulmonary disease (COPD) is a common disease and is preventable and treatable. A previous study showed that influenza virus infections were also associated with the risk of acute exacerbation in patients with COPD, and other studies showed that the influenza virus might increase the risk of stroke. However, studies on the influence of influenza infection among COPD patients are limited. In this study, we review the role of influenza infection in contributing to mortality, pneumonia, respiratory failure, COPD acute exacerbation, and ischemic stroke among COPD patients.Materials and Methods: We performed a population-based cohort study of COPD patients using data from Taiwan between January 1, 2011, and December 31, 2019. We excluded patients with lung cancer, lung transplantation and asthma. We also excluded patients who lacked COPD medication prescriptions and those treated with anti-influenza drugs without flu diagnosis records. Patients with missing or incomplete data were also excluded from the study cohort.Results: After 1:1 matching by age, sex, COPD duration, diagnosed years and comorbidities, we enrolled 10,855 cases and controls for further analysis. The risks of pneumonia, respiratory failure, COPD acute exacerbation, and ischemic stroke were 1.770 (95% CI=1.638– 1.860; P< 0.0001), 1.097 (95% CI=1.008– 1.194; P=0.0319), 1.338 (95% CI=1.248– 1.435; P< 0.0001), and 1.134 (95% CI=1.039– 1.239, P=0.0051), respectively, in the influenza infection group compared with COPD patients without influenza infection.Conclusion: Influenza infections are linked to an increased risk of ischemic stroke, pneumonia, respiratory failure, and COPD acute exacerbation among COPD patients. In conclusion, patients with COPD need to be closely monitored after having an influenza infection.Keywords: acute exacerbation, chronic obstructive pulmonary disease, influenza virus, pneumonia, stroke, respiratory failure

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

In an effort to help organizations understand consumers, our study deconstructs task–technology fit into two segments: ideal task–technology fit and individual use context–technology fit. Users’ continuous use of cloud-based bookstores is studied through survey methodology to collect consumer experience data related to the use of such cloud-based bookstores. In total, 185 samples were collected. Analytical results demonstrated that both ideal task–technology fit and individual use context–technology fit were significantly associated with the confirmation of users’ expectations as related to cloud-based bookstores. Expectation confirmation and ideal task–technology fit also have a significant link to users’ perceived usefulness and satisfaction, respectively. Furthermore, perceived usefulness significantly predicts satisfaction. Finally, perceived usefulness and satisfaction are also significantly associated with a users’ continuous use of cloud-based bookstores. As a result of this study’s findings, system administrators may foster suitable strategies for an improvement of users’ continuous use of cloud-based bookstores.

An increasing number of cybercrimes has presented new global challenges to law enforcement agencies that traditionally operate within designated geographical jurisdictions and patrol territories. The borderless nature of cyberspace has brought substantial opportunities—both legal and illegal—to its users, and many local law enforcement agencies have encountered motivated offenders taking advantage of the globally connected Internet and causing damage locally and transnationally. This study examines a high-profile case of European criminals who hacked into a Taiwanese financial institution—First Commercial Bank (FCB)—and programmed its ATMs to “spit out” cash netting the thieves $2.6 million US dollars in 2016 summer. Before the incident of FCB, this European criminal group committed more than a hundred similar ATMs hackings, victimizing dozens of financial institutions across several European countries, and profiting over one billion Euros. FCB is the only case revealing specific details about the modus operandi of ATM hacking thus far, in addition to disclosing reactions from law enforcement. By analyzing qualitative data collected from different branches of law enforcement involved in the investigations, this unique case study underscores the importance of national-local law enforcement collaboration in fighting transnational cybercrime. Empirical implications are particularly valuable in the law enforcement context of “turf jealousies” when defending homeland security.

Chien-An Chen,1,2,&ast; Chung-Han Ho,3– 5,&ast; Yu-Cih Wu,3 Yi-Chen Chen,3 Jhi-Joung Wang,3 Kuang-Ming Liao6 1Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 2Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 3Department of Medical Research, Chi Mei Medical Center, Tainan, 71004, Taiwan; 4Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, 71005, Taiwan; 5Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, 11696, Taiwan; 6Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan&ast;These authors contributed equally to this workCorrespondence: Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan, Tel +886 6 726 3333, Email abc8870@yahoo.com.twPurpose: The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017.Patients and Methods: Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year.Results: Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: < 0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14– 2.48, p value: < 0.0001) higher risk of mortality than those without aspergillosis.Conclusion: The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.Keywords: aspergillosis, cancer patients, Taiwan Cancer Registry, incidence rate

Background: Overactive bladder (OAB) syndrome is defined as urinary urgency, with or without urge incontinence in the absence of an underlying pathological or metabolic cause. Treatment for OAB involves anti-muscarinic agents and beta 3-adrenoceptor agonists. As a previous study showed that treatment may increase the risk of urinary tract infection (UTI), we conducted a nationwide, population-based, retrospective study to assess UTI risk associated with OAB medication adherence, and different types of OAB medication.Methods: The source of data was medical records from National Health Insurance Research Database (NHIRD). Patients who were diagnosed with OAB in outpatient records from January 1, 2014 to December 31, 2016 were included. Outpatient visits included an attendance at primary care or the emergency department. The index date was the first prescription medication for OAB treatment after diagnosis. The targeted population was those diagnosed with OAB, and targeted drugs were anti-muscarinic agent (including flavoxate, oxybutynin, propiverine, solifenacin, tolterodine, and trospium) and mirabegron. Adherence was assessed based on the proportion of days covered in 12 months among mirabegron and anti-muscarinic agents. A multivariate Cox proportional-hazards model was used to compare the risk of UTI with OAB medication adherence, and different types of OAB medication.Results: There were 39,975 outpatients diagnosed with OAB in the database from 2014 to 2016. Excluding those younger than 20 years old and for whom the information was incomplete in the database, 21,869 patients were included in the final OAB cohort. Overall, risk of UTI was not influenced by the targeted drugs or adherence during the follow-up period, regardless of UTI history or sex.Conclusion: OAB is a common problem in Taiwan. After 12 months of follow-up, there was no difference between anticholinergic medications and beta-3 agonists, nor between high and low adherence in the risk of UTI.

Additional file 2: Supplementary Figure 2. HBA-MR images of a 63-year-old man in low-risk population with an HCC being classified to LR-M (definite malignancy). HCC is with Edmondson II grade and its size was 6×5×4cm. Liver fibrosis degree was F2. AFP was 3.98ng/ml.T1-weighted (a) and T2-weighted (b) phase shows a nodule with haemorrhage sign in hepatic segment VI/VII. A rim hyperenhancement and delayed central enhancement with tumor necrosis show in (d) the portal venous phase, venousphase (e) and transitional phase (g). Lesion shows hypointense in hepatobiliary phase (h). T2-weighted fat suppressed unenhanced MR image (i) and DWI (c) also showed a hyperintense lesion. The white asterisk showed the hyperintense area in plain scan where it thought to be intra-tumorous hemorrhage. The white arrow showed the necrotic area where it was unenhanced and hypointense during each phase.

Additional file 1. Section S1: The specific process of Focal liver lesion puncture biopsy procedure. Section S2: Image archiving and scanning parameters of CT and MRI. Table S1: FLLs with TIV images characteristics. Except where indicated, data are numbers of nodules or TIV cases and numbers in parentheses are percentages. * datas are Mean ± SD. / means NA. AP: Arterial phase; APHE: Arterial phase hyperenhancement; CEUS: Contrast-enhanced ultrasound; FLLs: Focal liver lesions; HCC: Hepatocellular Carcinoma; TIV: Tumor in vein; US: Ultrasound.

Additional file 1. Development of U model and the important features.

Additional file 3: SupplementaryTable 1. Patients and nodules characteristics of institution 1 and 2. Supplementary Table 2. The number of each liver lesion according to pathological classification. Supplementary Table 3. Performance ofancillary features for HCC diagnosis. SupplementTable 4. Univariate analysis of baseline characteristics with P

Supplemental material, sj-docx-1-onc-10.1177_11795549221111713 for Impact of Tumor Location on Survival in Patients With Colorectal Cancer: A Retrospective Cohort Study Based on Taiwan’s Cancer Registry Database by Shou-Chun Yu, Kuang-Ming Liao, Chia-Lin Chou, Yu-Feng Tian, Jhi-Joung Wang, Chung-Han Ho and Yow-Ling Shiue in Clinical Medicine Insights: Oncology

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

Chatbots, empowered by artificial intelligence, are becoming increasingly popular in many fields and have much potential for application in real life situations. However, little attention has been paid to medical chatbots and most existing evidence focuses on technical issues while behavioral research is still lacking.This study seeks to examine the key factors that can motivate individuals to use medical chatbots. To that end, we have extended the theory of planned behavior by incorporating pertinent constructs derived after interviews with users. A research model and hypotheses are then proposed and tested.Interviews were first conducted to collect qualitative data from 20 participants based on purposive sampling. Content analysis was then used to find evidence supporting important constructs for a research model. A survey methodology based on convenience sampling was then used to collect data. Totally, 205 valid responses were gathered and analyzed by using partial least squares structural equation modeling to validate the research model.Health consciousness and perceived convenience were found positively associated with individuals' attitudes towards the use of medical chatbots. Moreover, attitude and subjective norm were found to be significantly and positively related to individuals' intentions to use medical chatbots.The proposed model with the extended theory of planned behavior is able to predict individuals' intention to use medical chatbots well. Hospital managers can formulate strategies to improve individuals' health consciousness and perceptions of convenience to develop the desired attitudes among individuals, using medical chatbots. Further, strategies to improve patients' awareness of medical chatbots should also be formulated.

The need for maintaining cell-spheroid viability and function within high-density cultures is unmet for various clinical and experimental applications, including cell therapies. One immediate application is for transplantation of pancreatic islets, a clinically recognized treatment option to cure type 1 diabetes; islets are isolated from a donor for subsequent culture prior to transplantation. However, high seeding conditions cause unsolicited fusion of multiple spheroids, thereby limiting oxygen diffusion to induce hypoxic cell death. Here we introduce a culture dish incorporating a micropyramid-patterned surface to prevent the unsolicited fusion and oxygen-permeable bottom for optimal oxygen environment. A 400 µm-thick, oxygen-permeable polydimethylsiloxane sheet topped with micropyramid pattern of 400 µm-base and 200 µm-height was fabricated to apply to the 24-well plate format. The micropyramid pattern separated the individual pancreatic islets to prevent the fusion of multiple islets. This platform supported the high oxygen demand of islets at high seeding density at 260 islet equivalents cm−2, a 2–3-fold higher seeding density compared to the conventional islet culture used in a preparation for the clinical islet transplantations, demonstrating improved islet morphology, metabolism and function in a 4 d-culture. Transplantation of these islets into immunodeficient diabetic mice exhibited significantly improved engraftment to achieve euglycemia compared to islets cultured in the conventional culture wells. Collectively, this simple design modification allows for high-density cultures of three-dimensional cell spheroids to improve the viability and function for an array of investigational and clinical replacement tissues.

Objective: The survival of prostate cancer (PC) patients after radiotherapy (RT) has improved over time, but it raises the debate of increased risk of secondary colorectal cancer (SCRC). This study aimed to assess whether RT for PC treatment increases the risk of SCRC in comparison with radical prostatectomy (RP). Methods: A population-based cohort of PC patients treated only with RT or only with RP between January 2007 and December 2015 was identified from the Taiwan Cancer Registry. The incidence rate of SCRC development was estimated using Cox regression model. Results: In this study, total 8,797 PC patients treated with either RT (n = 3,219) or RP (n =5,578). Patients subjected to RT were elder (higher percentage of 70≧years, p < 0.0001) and more advanced clinically (stage III: 22.90% vs. 11.87%; stage IV: 22.15% vs. 13.80%, p < 0.0001), compared to those subjected to RP. More patients subjected to RT had a much higher percentage of autoimmune disease (22.34% vs. 18.75%, p < 0.0001) and osteoarthritis and allied disorders (16.31% vs. 12.98%, p < 0.0001). Besides, RT patients had a higher percentage of underlying Crohn's disease (0.25% vs. 0.05%, p = 0.0230). Although almost all selected factors were not statistically significant, they presented the positive risk of SCRC for those under RP compared with those among RT. Besides, for PC patients in clinical stage I and II, patients with RP may have borderline significantly protective effects of SCRC compared with those under RT (stage I, HR: 0.14; 95% C.I.:0.01-1.39; p = 0.0929; stage II, HR: 1.92; 95% C.I.:0.93-3.95; p = 0.0775). Kaplan-Meier curves for a 3-year-period, which demonstrated no statistical difference in the risk of SCRC free between PC patients undergoing RT and RP (p = 0.9766). Conclusion: Whether or not pelvic RT for PC is associated with an increased risk for SCRC on a population-based level remains a matter of considerable debate. From a clinical perspective, these PC survivors should be counseled accordingly and received continued cancer surveillance with regular colonoscopy follow-up.

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

To explore the child-rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non-native culture.Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture.A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers' unique lived reality through their subjective experiences and perceptions.Semi-structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016-February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants.Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers' experience in child-rearing was identified as 'Where my child is, is home.'Immigrant mothers bond emotionally and physically to their new land via their children. Their child-raising experiences are interwoven with their roles in their new familial and cultural homes.Immigrant brides often become mothers soon after marrying to continue their husbands' family line. Understanding their unique child-rearing experiences and challenges in providing a secure home in a non-native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers.目的: 探讨在跨国婚姻家庭和非本土文化背景下,移民母亲的育儿经验及其对儿童家庭环境的关注。 背景: 移民母亲往往由于相对缺乏有关儿童医疗保健的信息和获取途径而处于不利地位,但关于跨国婚姻家庭中的母亲经历的研究很少,因为她们试图在陌生的文化中提供一个安全的家庭环境。 设计: 采用基于直觉的描述性现象学研究设计,透过移民母亲的主观经验与看法,探讨其独特的生活实相。 方法: 2016年5月至2017年2月,对来自15个跨国婚姻家庭的15名移民母亲进行半结构式访谈。叙述使用描述现象学方法进行分析,因为它允许从研究参与者的角度系统地发现生活经验。 结果: 确定了三大主题:(a)努力为儿童维持一个安全的家;(b)在困难中受苦挣扎;和(c)努力克服困难,建立一个适当的家庭环境。移民母亲育儿经验的基本的、流行的概念被确定为“我的孩子在哪里,哪里就是家”。 结论: 移民母亲通过她们的孩子在情感和身体上与新国家联系在一起。她们的育儿经历与她们在新的家庭和文化家园中的角色交织在一起。 影响: 移民新娘往往在结婚后不久就成为母亲,延续丈夫家族的香火。了解她们独特的育儿经验和在非本土文化中提供安全家园的挑战,将有助于护士提供有效的护理。研究结果将有益于为跨国婚姻家庭提供护理的任何环境中的儿科/家庭护士,这些家庭本身,公共政策制定者和未来的研究人员。.

The present study investigated factors associated with health literacy in community-dwelling Taiwanese women, particularly focusing on those associated with prevalent unhealthy behaviors. This cross-sectional study recruited 353 community-dwelling women aged 39-89 years from February to October 2015 in urban, suburban, and rural areas. Variables investigated included physical activity, community activity, tobacco usage, alcohol consumption, and betel-nut chewing. Degree of health literacy was evaluated using the Chinese-language version of the European Health Literacy Survey Questionnaire. Most respondents had inadequate (17.6%), or problematic (49.3%), general health literacy. Multiple logistic regression analyses showed that low educational attainment was closely associated with inadequate or problematic general health literacy. Women who did not engage in regular physical activity or direct community activity were more likely to have inadequate and problematic general health literacy, respectively. Selected unhealthy behaviors (tobacco usage, alcohol consumption, betel-nut chewing) were not associated with health literacy. Low health literacy was prevalent among participants. Lower educational attainment and a lack of physical or community activity were associated with low health literacy. Health literacy should be considered during the process of delivering health information, and health education programs must enhance health literacy tailored to address individuals' lifestyles.

Objective Chronic obstructive pulmonary disease (COPD) is associated with atherosclerosis. Previous studies including limited sample sizes have shown the prevalence of peripheral arterial occlusive disease (PAOD) among COPD patients. We sought to investigate the incidence of PAOD among COPD patients in Taiwan using a national database. Methods COPD patients were collected from the National Health Insurance Research Database of Taiwan from 1996 to 2010. The COPD cohort was propensity score matched according to age, sex, and comorbidities of atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease to patients without COPD (the control cohort). We evaluated the incidence of PAOD in COPD patients and the risk of PAOD associated with atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease. Results The study included 51,869 COPD patients and 51,869 control patients without COPD. The incidence of PAOD was 1.23-fold higher (95% confidence interval [CI] =1.17-1.29) in the COPD group than in the non-COPD group. Moreover, COPD and atrial fibrillation alone (adjusted hazard ratio (aHR) 2.99; P=0.001), hypertension alone (aHR, 2.05; P

Purpose To describe nurses' views on the potential use of robots in the pediatric unit. Design and methods A qualitative descriptive design was employed. Semi-structured interviews were conducted with 23 nursing staff who worked in the pediatric unit. The interviews were audiotaped, transcribed, and analyzed using qualitative content analysis. Results Three themes emerged related to the nurses' views on the potential use of robots in the pediatric unit (1) care impact - advantages, which included: (a) reducing healthcare providers' workload and (b) adequately meeting the needs of pediatric patients and their families; (2) care impact - shortcomings, which included: (a) deficiency of individualized care and (b) reduced employment opportunities for skilled nursing staff; and (3) attitude impact, including (a) lifelong learning and (b) integrating culture and technology to meet pediatric care needs. Conclusions Robots' application may ameliorate the overall quality of pediatric care, allowing for better apportioning of nurses' time and energies to focus on direct patient care and reducing nurses' workloads. However, some possible disadvantages need attention, including robots' inability to provide genuine human touch, demonstrate human emotions associated with pediatric care, and exhibit cultural sensitivity. It is desirable to embed nursing practice needs in the advanced functions of robots and thereby ensure safe, reliable robotics suitable for pediatric care usage. Practice implications The findings can be used as a reference for nurses encountering challenges in working with robots, and for lifelong learning needs for pediatric nurses.

Objective: The aim of this study was to investigate the outcomes of patients with COPD after laparoscopic cholecystectomy (LC). Patients and methods: All COPD patients who underwent LC from 2000 to 2010 were identified from the Taiwanese National Health Insurance Research Database. The outcomes of hospital stay, intensive care unit (ICU) stay, and use of mechanical ventilation and life support measures in COPD and non-COPD populations were compared. Results: A total of 3,954 COPD patients who underwent LC were enrolled in our study. There were significant differences in the hospitalization period, ICU stay, and use of mechanical ventilation and life support measures between the COPD and non-COPD populations. The mean hospital stay, ICU stay and number of mechanical ventilation days in the COPD and non-COPD groups were 7.81 vs 6.01 days, 5.5 vs 4.5 days and 6.40 vs 4.74 days, respectively. The use of life support measures, including vasopressors and hemodialysis, and the rates of hospital mortality, acute respiratory failure and pneumonia were also increased in COPD patients compared with those in non-COPD patients. Conclusion: COPD increased the risk of mortality, lengths of hospital and ICU stays, ventilator days and poor outcomes after LC in this study.

Kuang-Ming Liao,1 Chao-Ming Hung,2 Chin-Chung Shu,3,4 Ho-Sheng Lee,5 Yu-Feng Wei6,7 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 2Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 4National Taiwan University College of Medicine, Taipei, Taiwan; 5Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; 6School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 7Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, TaiwanCorrespondence: Yu-Feng WeiDepartment of Internal Medicine, E-Da Hospital, No. 1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung, 824, TaiwanTel +886-7-6150011Fax +886-7-6150927Email yufeng528@gmail.comBackground: Limited studies have focused on the impact of the coexistence of small cell lung cancer (SCLC) and chronic obstructive pulmonary disease (COPD). The study was to examine the impact of COPD on mortality in SCLC patients.Methods: We analyzed SCLC patients from the Taiwan Cancer Registry Database between January 1, 1997, and December 31, 2015. The COPD population was composed of patients with a COPD diagnosis before the diagnosis of SCLC. The control group was composed of randomly selected SCLC patients without COPD who were propensity score matched with those with concomitant COPD according to age, sex, index date, cancer staging and comorbidities at a 1:1 ratio.Results: Among 9425 SCLC patients in the database, eligible subjects were divided into the COPD group (n = 4235) and the non-COPD group (n = 2334). Compared to patients in the non-COPD group, the patients in the COPD group were older (71.4 versus 65.7 years, p< 0.0001), had a lower percentage of stage IV disease (60.1% versus 68.3%, p< 0.0001) and had more comorbidities. After matching, there were 1457 patients in each group. Older age, lower body mass index (BMI), and some comorbidities were associated with higher mortality, and comorbid COPD was associated with lower 1-year mortality in SCLC patients. Multivariate analysis identified older age, lower BMI, and concomitant congestive heart failure or diabetes as risk factors for OS.Conclusion: A diagnosis of COPD was associated with reduced 1-year mortality in SCLC patients, but no significant difference after 1-year in this population.Keywords: chronic obstructive pulmonary disease, small cell lung cancer

Background The imaging findings of combined hepatocellular cholangiocarcinoma (CHC) may be similar to those of hepatocellular carcinoma (HCC). CEUS LI-RADS may not perform well in distinguishing CHC from HCC. Studies have shown that radiomics has an excellent imaging analysis ability. This study aimed to establish and confirm an ultrasomics model for differentiating CHC from HCC. Methods Between 2004 and 2016, we retrospectively identified 53 eligible CHC patients and randomly included 106 eligible HCC patients with a ratio of HCC:CHC = 2:1, all of whom were categorized according to Contrast-Enhanced (CE) ultrasonography (US) Liver Imaging Reporting and Data System (LI-RADS) version 2017. The model based on ultrasomics features of CE US was developed in 74 HCC and 37 CHC and confirmed in 32 HCC and 16 CHC. The diagnostic performance of the LI-RADS or ultrasomics model was assessed by the area under the curve (AUC), accuracy, sensitivity and specificity. Results In the entire and validation cohorts, 67.0% and 81.3% of HCC cases were correctly assigned to LR-5 or LR-TIV contiguous with LR-5, and 73.6% and 87.5% of CHC cases were assigned to LR-M correctly. Up to 33.0% of HCC and 26.4% of CHC were misclassified by CE US LI-RADS. A total of 90.6% of HCC as well as 87.5% of CHC correctly diagnosed by the ultrasomics model in the validation cohort. The AUC, accuracy, sensitivity of the ultrasomics model were higher though without significant difference than those of CE US LI-RADS in the validation cohort. Conclusion The proposed ultrasomics model showed higher ability though the difference was not significantly different for differentiating CHC from HCC, which may be helpful in clinical diagnosis.

This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40-23.26) of having no previous Pap smear screening or3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research.

Cell transplantation is a way of treatment in which lost cellular functions can be recovered by transplanted cells. However, hypoxic conditions on the transplanted site hinder the survival of the cells. This paper presents an oxygenation device for cell transplantations to improve the engraftment and transplanted cell survival. The flexible and thin polymeric hollow mesh working as gas capillaries can effectively transport oxygen between microvessels and transplanted cells, maintaining adequate oxygen tension for cell survival and functionality. Devices are designed, fabricated, and characterized in this study. Both in silico and in vivo models demonstrate a 4-5 fold increase in cell viability compared to the control group without oxygen-transporting mesh. The results showed that a broad spectrum of cell transplantations could benefit from such MEMS oxygen-transporting device.

Background: Patients with chronic obstructive pulmonary disease (COPD) are at risk for pulmonary hypertension (PH). The aim of our study was to investigate the benefit of statins for PH in patients with COPD.Methods: The study enrolled 23 million individuals from Taiwan’s population database from January 1, 2002, to December 31, 2017. COPD patients who met the inclusion criteria were enrolled, and patients with lung cancer, less than one year of observation, specific drug therapy for PH and lung transplantation were excluded.Results: A total of 643,131 COPD patients were included in the study, and only 12,308 patients developed PH during follow-up. Based on the inclusion and exclusion criteria, 8,577 PH patients were included in the cohort of patients with PH related to COPD for analysis. According to the definition of statin exposure, the final study population had 1,487 statin users and 7,090 statin non-users. The statin user group had a lower mortality related to PH than the non-user group (3.87 vs. 5.55 per 100 person-years, p < 0.001). The mortality rate for PH in the multivariate analysis (aHR = 0.78, 95% CI = 0.62–0.98, p = 0.046) was significantly lower for statin users than for non-users.Conclusion: Statins seem to benefit patients with PH and COPD.

Additional file 2.

Additional file 2.

Most of the oil and gas reserves in the carbonate field of interest reside in the fractured regions of the reservoir. Natural fractures are commonly observed in the reservoir. In order to support efficient workflow design, commercial software systems are providing templates of fracture description processes with utilizing discrete fracture network. To study the role of natural fractures in water influx in bottom water gas reservoirs, single-porosity, dual-porosity dual-permeability (DPDK) and embedded discrete fracture (EDFM) models were used to simulate the effect of water influx along with the fractures in fractured bottom-water-drive gas reservoirs. The saturation field and the computation time of the model of the bottom water in the matrix and the fracture were the optimized indexes of the model. The results show that under the same conditions, the EDFM model is apparently better than the former two models in simulating the phenomena of fracture water channeling, and its computation speed was increased by 48%. Based on the EDFM bottom water gas reservoir model, the influence of gas well pay-zone opening degree and gas production rate on gas reservoir development effects were analyzed under different fracture permeability and fracture density conditions. Studies have shown that when fracture permeability or fracture density increases, the gas well is more likely to show water breakthrough. When the gas well pay-zone opening degree is up to 70%, the final recovery degree is relatively higher, while the gas recovery rate is 4%, water-free production is optimal. Different fracture permeability can result in a difference of 2.4% in ultimate recovery, and the difference in water-free production is 96.6%.