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The purpose of this study was to explore the potential of capture systems in improving high school students' dancing skills through the use of experimental design. The major findings were as follows: First, using a MoCap system and high-speed camera to document dancers' movements can provide reference materials for students to improve their skills through self-practice. Second, using a MoCap system and high-speed camera as teaching aids at dance studio can enhance the effectiveness of dancing teaching. Third, incorporating MoCap and high-speed camera technologies into dance art is becoming necessary for achieving peak performance. [ABSTRACT FROM AUTHOR]

Background: Signing advance directives (ADs) ensures that terminally ill patients receive end-of-life care, according to their wishes, thereby promoting human dignity and sparing them from unnecessary suffering. Despite the enactment of the Hospice Palliative Care Act in Taiwan in 2000, the completion rates of ADs have been found to be low among patients with chronic illness conditions. To date, limited existing research is available regarding the factors associated with AD completion in terminally ill patients in Taiwan. To explore signed AD characteristics, compare differences in signing ADs between patients with and without cancer, and examine the factors associated with signing ADs in terminally ill patients. Methods: A nationwide study was conducted using data collected via a retrospective review of medical death records from 18 randomly selected hospitals in the northern, central, and southern parts of Taiwan. We collected 200 records, including both cancer and non-cancer-related deaths, from each hospital. Univariate and multivariate logistics regressions were conducted to examine factors associated with signing advance directives among all patients- with and without cancer. Results: Among the 3004 reviewed medical records, 79% had signed ADs, with most (95%) being signed by patients' caregivers. A higher education level (OR = 1.52, 95% CI = 1.10, 2.08, p = 0.010); cancer diagnosis (OR = 2.37, 95% CI = 1.79, 3.16, p < 0.001); having family members (OR = 5.62, 95% CI = 2.95, 10.69, p < 0.001), care homes (OR = 4.52, 95% CI = 1.97, 10.38, p < 0.001), friends, or maids (OR = 3.82, 95% CI = 1.76, 8.29, p = 0.001) as primary caregivers; and patients knowing about their poor prognosis (OR = 15.39, 95% CI = 5.66, 41.83, p < 0.001) were associated with a higher likelihood of signing ADs. Conclusions: Patients with non-malignant chronic illnesses were less likely to have ADs signed by either patients or family caregivers than those with cancer, with the lowest likelihood observed in patients with cardiovascular diseases. Whenever possible, primary caregivers should be involved in discussing ADs with patients, and the importance of truth telling should be reinforced. Following these principles, each patient's end-of-life care preferences can be respected, thereby promoting quality of care before the patient's death. [ABSTRACT FROM AUTHOR]

Aims: The number of ventilator-dependent patients is rapidly increasing globally. As a result, long-term mechanical ventilation (LTMV) patients face the choice of receiving health care in respiratory care wards (RCWs) rather than at home. In this study, we applied Andersen's behavioral theoretical model (ABM) to investigate the determinants of the health care service decisions of patients receiving LTMV. Methods: A cross-sectional research design and cluster random sampling were used to select 365 participants from nine RCWs and eight home care facilities in northern Taiwan. Data were collected in face-to-face interviews using a structured questionnaire. Results: Of the predisposing factors, advanced age and an education level of at least junior high school influenced the choice to use RCW services. Being married, living with extended family, and medium or higher socioeconomic status were associated with the decision to use home care services. Of the enabling factors, patients with more caregivers, those whose family caregivers held strong beliefs about providing care, and those who perceived greater social support from health care providers were more likely to choose home care services. Of the need factors examined, poor cognitive function and higher dependence on assistance for activities of daily living (ADL) increased the probability of patients choosing RCW services. Hierarchical logistic regression analysis indicated that our final model accounted for 44.8% of the observed variance in health care service choice. Conclusions: ABM enables an improved understanding of the health care service choices of LTMV patients. Our findings also highlight the importance of rigorously assessing patient needs and helping patients choose the most appropriate health care service. [ABSTRACT FROM AUTHOR]

Erysiphe is the largest genus of powdery mildews (PMs), a group of obligate plant pathogenic fungi. Exploration of biodiversity generally relies on regional surveys and our aim is to investigate the PMs in Taiwan. Collections of the fungi on five plant species around agricultural environments were subjected to morphological and molecular characterization, using both internal transcribed spacer (ITS) and β-tubulin gene (TUB2) regions for the phylogenetic analyses. Erysipheipomoeae comb. nov., a species able to infect Ipomoea obscura and I. aquatica demonstrated by pathogenicity tests, has been neotypified. The two buckwheat species, Fagopyrum esculentum and F. tataricum, are found to be hosts of E. aff. betae. These results suggest that hosts in some plant families can be infected by more than one Erysiphe pathogen, e.g., Convolvulaceae by E. ipomoeae and E. convolvuli and Polygonaceae by E. polygoni and E. aff. betae, respectively. In addition, phylogenetic analyses of PMs on Cardiospermum halicacabum and tomato belonging to the E. aquilegiae complex are allocated under E. neolycopersici comb. nov. This extends the potential host range of E. aquilegiae complex to the plant family Sapindaceae. We conclude that awareness of the host associations of PMs can potentially benefit crop disease management. [ABSTRACT FROM AUTHOR]

Accumulating evidence has indicated that Vibrio parahaemolyticus stains resistant to multiple drugs may pose a serious threat to public health and could lead to global economic. Phage therapy is an alternative and eco-friendly biocontrol strategy for the prevention and control of diseases in the aquatic systems. Therefore, this study was oriented to isolate and characterize the applicability of phages for V. parahaemolyticus (VP) lysis in aquaculture. Here, twenty-two lytic bacteriophages (BP1–22) were isolated from sewage collected in a local shrimp farming area and from the tissue of AHPND-infected shrimp and oysters collected in Taiwan. Among these, phage BP14 could effectively lyse V. parahaemolyticus , this bacterium causes acute hepatopancreatic necrosis disease (AHPND), resulting in severe mortality in Litopenaeus vannamei and Penaeus monodon , two marine shrimp species that are commonly grown in aquaculture farms. Characterization of the morphology of the virion particle via electron microscopy revealed that the virus belonged to the family Inoviridae , as suggested by its filamentous shape. The genome of phage BP14 was composed of 9071 bp with a 43.85% GC content and was inserted into a chromosome depending on the occurrence of Xer site-specific recombination. Furthermore, phage BP14 established a chronic productive infection, thus continuously releasing virions from infected cells. A viral load of approximately 12 plaque-forming units (PFUs) per cell was determined for phage BP14 under laboratory growth conditions. Western blotting and ELISA analyses revealed that phage BP14 decreased the levels of toxin-PirB and PirA protein by approximately 40%–60% compared to the wild-type VP. Collectively, our findings demonstrated the potential applicability of phage BP14 for the biological control of VP AHPND. • A total of 22 phages lysis the V. parahaemolyticus (VP) were collected in Taiwan. • Phage BP14 can infect a broad range of VPs including VP AHPND PD2 in Taiwan and 3HP in Thailand. • Phage BP14 belongs to the family Inoviridae. • Phage BP14 establishes a chronic productive infection, thus continuously releasing virions from infected cells. • Phage BP14 decreased the production of toxin-proteins, demonstrating its potential as a biological agent against VP AHPND. [ABSTRACT FROM AUTHOR]

Purpose: Multiple chronic illnesses, such as those associated with advanced age, are leading causes of poor health, disability, death, and high healthcare expenditures. Tele‐homecare is a novel method for providing home care to patients with chronic illnesses. The purpose of this study was to evaluate the effectiveness of an integrated nurse‐led tele‐homecare program for patients with multiple chronic illnesses and a high risk for readmission. Design: A randomized controlled trial. Methods: Two hundred patients from a regional hospital who were scheduled to receive home care after discharge were randomly assigned to the intervention group (n = 100) or the control group (n = 100). The patients in the intervention group participated in an integrated tele‐homecare program. For outcome evaluation, primary outcomes included the number of emergency department (ED) visits as well as readmittance and mortality. Secondary outcomes included patients' medication adherence, activities of daily living, health status, and quality of life (QOL). Data were collected at three time points: pretest baseline (T0), 3 months after intervention (T3), and 6 months after intervention (T6). A generalized estimating equation model was used to compare changes and evaluate the effect of differences between the two groups over time. Findings: For primary outcome evaluation, we found that the tele‐homecare program significantly reduced mortality and ED visits, whereas no significant effect on readmission was observed. For secondary outcome evaluation, patients' QOL indicated significant improvement. Conclusions and Clinical Relevance: The nurse‐led tele‐homecare program involves daily 24‐hr remote monitoring and surveillance. In this study, the system detected patients' physical changes early and provided timely and appropriate management, consequently reducing ED visits and mortality. Additionally, it improved patients' QOL. On the basis of our findings, nurses' independent roles and functions revealed that the effectiveness of this nurse‐led tele‐homecare program strengthened the care of patients with multiple chronic illnesses. [ABSTRACT FROM AUTHOR]

Background. To evaluate the feasibility and applicability of using office hysteroscopy in women with intact hymen. Methods. We recruited 836 patients with intact hymen with different indications who underwent diagnostic hysteroscopy without anesthesia in an outpatient setting from 2007 to 2016 at Chang Gung Memorial Hospital at Linkou. Results. Patients' mean age was 35 ± 10.6 years (range 3–69 years). Most patients (86.4%) with postmenopausal bleeding had intrauterine lesions, and they were especially at high risk (50%) for endometrial hyperplasia or malignancy. Five hundred thirty (63.3%) patients had histologic findings confirming concordance between hysteroscopic and histologic findings. Submucosal myoma had the highest concordance (96.3%), whereas endometrial hyperplasia had the lowest concordance (50%). Forty-eight patients (5.7%) had endometrial hyperplasia, and 35 patients (4.2%) had endometrial malignancy. Two patients who were thought to have nonspecific endometrial thickening actually had endometrial pathology. Conclusions. Hysteroscopy through vaginoscopic approach is feasible and well-tolerated in the patients with intact hymen. This outpatient procedure provides accurate evaluation of lesions of the genital tract and should be considered in patients without a history of intercourse. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the impact of the new American College of Radiology (ACR) digital mammography (DM) phantom in evaluating phantom image quality (IQ) and average glandular dose (AGD) in a nationwide survey on DM systems.Methods: On-site surveys of 239 DM units were conducted in 2017 and 2018, and comparisons were made between ACR screen-film mammography (SFM) phantom and DM phantom for accessing phantom IQ and AGD. The phantom IQ was assessed using the weighted phantom score, considering the size of each detail.Results: When switching from SFM phantom to DM phantom, no significant difference was found in AGD (p = 0.06). The mean weighted phantom score was significantly higher for DM phantom than for SFM phantom in terms of fibers and specks, and so was the total weighted phantom score (DM phantom vs. SFM phantom: 8.61 ± 1.04 vs. 8.23 ± 0.77, p < 0.0001). The phantom IQ is thus more precise and can detect small differences when using DM phantom and investigating DM systems, especially for specks and fibers. However, the overall passing rate was lower for DM phantom (84.1%) than for SFM phantom (91.2%). This can be explained by the lower passing rate for mass (84.5%) with the DM phantom.Conclusion: The ACR DM phantom provides better discernment to assess specks and fibers in DM systems. This study may serve as a reference for implementing a DM quality control program and when conducting large-scale surveys with the new DM phantom in the digital era. [ABSTRACT FROM AUTHOR]

Digenetic trematodes of the genus Clinostomum are widely distributed in many species of freshwater fish and are known to cause the zoonotic disease Halzoun. Humans may become accidental hosts if they ingest raw freshwater fish containing metacercaria of Clinostomum complanatum, which causes pharyngitis or laryngitis. The yellow grub parasitizing cultivated ayu ( Plecoglossus altivelis) and loach ( Misgurnus anguillicaudatus) was one of the most serious problems in fish farms from 1977 to 1979 in Taiwan. The present study revealed, for the first time, frequent occurrence of C. complanatum metacercaria in various fish species in a natural environment, the Dahan River, in Taiwan. We examined 1503 fish specimens belonging to four families and 162 snails representing six species. C. complanatum metacercaria was mainly from the fish family Cyprinidae, and only cercaria from the snail Radix swinhoei was recovered. The prevalence and mean intensity of metacercaria were 9.8% and 9.35 parasites/infected fish, respectively. The prevalence of cercaria was low, 0.62%, in snails. Acrossocheilus paradoxus, Zacco barbata, Zacco pachycephalus, Zacco platypus, Onychostoma barbatula, and Hemibarbus labeo are new host records. Metacercariae were primarily found in the operculum, mandible, muscle, and oral cavity of fish. Morphological description and molecular analysis with 18S rDNA sequencing allowed for rapidly identifying C. complanatum. Encysted and excysted metacercariae cultivated at 22 °C in physiological saline died within 60 h. The mean intensity of infection increased with an increasing length of Z. pachycephalus. We found no association between monthly parasite prevalence and mean intensity at each sampling location. No C. complanatum metacercaria survived after 8 h of salting. The Dahan River has suitable conditions and hosts (snails, fish, and fish-eating birds) for maintaining the life cycle of C. complanatum. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to propose a theoretical model and apply it to examine the structural relationships among nurse characteristics, leadership characteristics, safety climate, emotional labour and intention to stay for hospital nurses. Background Global nursing shortages negatively affect the quality of care. The shortages can be reduced by retaining nurses. Few studies have independently examined the relationships among leadership, safety climate, emotional labour and nurses' intention to stay; more comprehensive theoretical foundations for examining nurses' intention to stay and its related factors are lacking. Design Cross-sectional. Methods A purposive sample of 414 full-time nurses was recruited from two regional hospitals in Taiwan. A structured questionnaire was used to collect data from November 2013-June 2014. Structural equation modelling was employed to test the theoretical models of the relationships among the constructs. Results Our data supported the theoretical model. Intention to stay was positively correlated with age and the safety climate, whereas working hours per week and emotional labour were negatively correlated. The nursing position and transformational leadership indirectly affected intention to stay; this effect was mediated separately by emotional labour and the safety climate. Conclusion Our data supported the model fit. Our findings provide practical implications for healthcare organizations and administrators to increase nurses' intent to stay. Strategies including a safer climate, appropriate working hours and lower emotional labour can directly increase nurses' intent to stay. Transformational leadership did not directly influence nurses' intention to stay; however, it reduced emotional labour, thereby increasing intention to stay. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the annual effective dose per capita attributed to computed tomography (CT) examinations in 2013 and to predict the population effective dose from 2000 to 2013 in Taiwan. Methods: A CT examination database collected from 30 hospitals was divided into 22 procedures and classified into six regions: head, neck, chest, abdomen, pelvis, and other, respectively. The effective doses in different regions were evaluated by dose-length product (DLP) multiplied by conversion factors. Results: The CT scan dose parameters were collected from 4,407 patients. For the six scanned regions, the percentages of patients scanned were: head (39.8%), neck (3.9%), chest (23.3%), abdomen (26.7%), pelvis (4.8%), and other (1.6%), respectively. The DLPs per patient (mGy·cm/patient) were head (1,071±225), neck (1,103±615), chest (724±509), abdomen (1,315±550), pelvis (1,231±620) and other (1,407±937), respectively. The number of CT examinations increased rapidly, with an average annual growth rate of 7.6%. The number of CT examinations in 2013 was 2.6 times that in 2000. The population effective dose was 0.30 mSv per capita in 2000 and increased to 0.74 mSv per capita in 2013, with an annual growth rate of 7.2%. The growth trend indicates that the effective dose will continue to rise in Taiwan. Conclusion: Some strategies should be applied to cope with this growth. Defining the CT dose reference level stipulated in official recommendations and encouraging the use of iterative reconstruction imaging instead of filtered back-projection imaging could be a useful method for optimizing the effective dose and image quality. [ABSTRACT FROM AUTHOR]

Background: Physical restraints are used to enhance the safety of patients and to avoid injury. However, physical restraints may cause injuries if improperly used or if they are used in the absence of continuous monitoring. Nursing staff who use physical restraints often lack sufficient related knowledge, which may increase the risk to patient safety. Purpose: This study investigates the impact of an in-service education program for nursing staff that is designed to improve physical-restraint-related knowledge, attitudes, behaviors, and techniques. Methods: A pretest-posttest design and a quasi-experimental method were employed to evaluate the effectiveness of the in-service education program. One hundred thirty-six nursing staff from four adult intensive care units (ICUs), including two medical ICUs and two surgical ICUs, in a medical center in central Taiwan were enrolled as participants. The experimental group (EG) and the control group (CG) were composed of patients from one randomly assigned medical ICU and one randomly assigned surgical ICU each. The pretest data on physical-restraint-related knowledge, attitudes, behaviors, and techniques were collected before the in-service education program. The EG received 2 hours of classroom education on guidelines and techniques related to physical restraints. The posttest data for the two groups were collected a month after implementation of the in-service education program. General Estimation Equation was used to measure and analyze the data repeatedly. Results: The posttest scores of the EG for knowledge and technique were significantly higher than the pretest scores (p < .0001). However, the posttest scores of the EG for attitudes and behaviors did not significantly differ from the pretest scores. Conclusions/Implications for Practice: In-service education for physical restraints enhances relevant knowledge and techniques but does not significantly affect attitudes or behaviors. Correct implementation of physical restraints not only promotes the quality of nursing care for patients in the ICU but also reduces the risk of physical-restraint-related complications. This study highlights the importance of changing the thoughts and concepts related to the use of physical restraints within the overall caring strategy of hospitals. [ABSTRACT FROM AUTHOR]

Ambient monitor and phantom studies were carried out in the international arrival hall of Taichung Airport, Taiwan. A total of 172 thermoluminescent dosimeters (TLDs) were used for ambient monitoring. The sites of the export conveyor, the outward face of the x-ray scanning chamber, and the x-ray image monitor were assessed as low-radiation areas because the possible annual effective doses were 0.12, 0.39, and 0.16 mSv, all less than 1 mSv per year. In addition, a phantom filled with 126 TLDs was used to simulate a 10-year-old child being exposed by the x-ray baggage scanner. The effective dose was evaluated as 3.39 ± 0.33 μSv/scan, using the tissue weighting factor of the International Commission on Radiological Protection (ICRP) 103 report. This figure is a useful reference should a person be accidentally scanned by the x-ray baggage scanner. [ABSTRACT FROM PUBLISHER]

Background: This study presents the exercise capacity of postmitral valve surgery patients and determines predictors capable of affecting recovery.Methods: A total of 302 patients with mitral regurgitation who had undergone mitral surgery at the Heart Center in Taiwan from 1 August 2013 to 31 December 2015 were included in the present study. Data related to specific predictors of operative outcome were collected, including demographic data, intraoperative factors, exercise tolerance, echocardiogram data, concurrent cardiovascular disease history, comorbidities, lifestyle risk factors, and surgery types. Postoperative exercise capacity was presented as peak oxygen consumption (VO2 ; mL of O 2 /kg/min) determined by exercise tests 3 weeks after surgery. Subjects were separated into two groups: a preserved recovery (peak VO 2  ≥ 65% of predicted VO 2max ) group and a poor recovery group (peak VO 2  < 65% of predicted VO 2max ). Preliminary univariate analysis was performed to test for possible relationships between predictive variables and exercise capacity. An analysis of all items shown to be significantly different between the two groups was then subjected to multivariate logistic regression analysis. Detected differences with P < .05 were considered significant.Results: Among the 302 patients sampled, female sex (odds ratio [OR], 2.65; 95% confidence interval [95% CI], 1.58-4.47), obesity (OR, 0.26; 95% CI, 0.10-0.64), sedentary lifestyle (OR, 0.47; 95% CI, 0.28-0.79), and high preoperative New York Heart Association Functional Classification level (OR, 0.52; 95% CI, 0.31-0.87) were significant predictors of poor exercise capacity.Conclusions: Without complicated clinical procedures, physicians and medical teams could easily use these items of information to screen the exercise capacity of mitral valve surgery patients and prepare a suitable after surgery plan if needed or request a consultation as early as possible. [ABSTRACT FROM AUTHOR]

• Increased rifabutin-resistance associated with refractory Helicobacter pylori infection. • Multiple mutations in RpoB conferred H. pylori rifabutin-resistance. • More mutations in RpoB correlated with higher minimal inhibitory concentration of H. pylori rifabutin-resistance. • Precise diagnosis of H. pylori resistance helps to optimize the current available regimen. To explore the molecular characteristics of rpoB , encoding β-subunit of DNA-directed RNA polymerase, and unravel the link to rifabutin-resistance in patients with refractory Helicobacter pylori infection. From January 2018-March 2021, a total of 1590 patients were screened for eligibility to participate in the study. Patients with refractory H. pylori infection were confirmed by using the (13C)-urea breath assay. All enrolled patients underwent esophagogastroduodenoscopy, and biopsies were taken for H. pylori culture and antibacterial susceptibility testing. Sequence analysis of rpoB was conducted for all rifabutin-resistant isolates. In total, 70 patients were diagnosed with refractory H. pylori infection, and 39 isolates were successfully cultured. Amongst, 10 isolates were identified as rifabutin-resistance and nine isolates exhibited at least one amino acid substitution in RpoB. Isolates with a minimal inhibitory concentration >32 mg/l displayed a higher number of mutational changes in RpoB than the others. Additionally, more amino acid substitutions in RpoB correlated with developing a higher minimal inhibitory concentration for H. pylori rifabutin-resistance. Our findings highlight the relationship between rifabutin-resistance in refractory H. pylori infection and specific mutations in RpoB, which will aid the clinical selection of appropriate antibacterial agents with better therapeutic effects. [ABSTRACT FROM AUTHOR]

Many subtropical fishes spawn multiple batches throughout a year. To understand plasticity in their reproductive output, we evaluated variation in oocyte size and batch fecundity for an exploited subtropical cutlassfish, Trichiurus japonicus, between two temperature periods (warm vs. cold) on the NE and SW coasts of Taiwan, northwestern Pacific. Given greater temperature variability on NE compared with SW coast, we hypothesized greater changes between warm and cold periods in oocyte size and fecundity for T. japonicus on the NE coast. We found opposite changes in sizes of ripe oocytes between periods (cold > warm on the NE but warm > cold on the SW coast) but consistent patterns in batch fecundity between coasts (warm > cold). Furthermore, the between‐period patterns in female length were consistent on both coasts (warm > cold). The differential between‐period patterns in oocyte size were related to potential adaptive responses to differential thermal environments between coasts, whereas the changes in fecundity mainly involved plastic processes (e.g., changes in population demography or movement). Together, our findings suggest that variability of temperature and maternal effects underlie recruitment variability of T. japonicus. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the factors predictive of clinical outcome in advanced hepatocellular carcinoma patients receiving ramucirumab treatment. Methods: We conducted a retrospective study using a multi‐institutional electronic medical records database in Taiwan. We included advanced HCC patients newly receiving ramucirumab as second‐line or beyond systemic therapy between January 2016 and February 2022. The clinical outcomes were median progression‐free survival (PFS) based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST), overall survival (OS) and adverse events. We applied Kaplan–Meier methods to estimate median PFS and OS. Uni‐variable and multi‐variable Cox regression models were applied to identify the prognostic factors. Results: We included 39 ramucirumab naive users with a median age of 65.5 (IQR: 57.0–71.0) years and treatment time of 5.0 (3.0–7.0) cycles, of whom 82.1% were male and 84.6% were Barcelona Clinic Liver Cancer (BCLC) stage C. After median follow‐up time of 6.0 months, 33.3% of patients' AFP level had decreased more than 20% within 12 weeks. The median PFS and OS were 4.1 months and non‐reach, respectively. Moreover, tumor burden beyond the up‐to‐11 criteria (HR: 2.95, 95% CI: 1.04–8.38) and a decrease in estimated glomerular filtration rate of more than 10% within 12 weeks (HR: 0.31, 0.11–0.88) were significantly related to PFS in the multi‐variable analysis. No patient discontinued ramucirumab during the treatment on account of side effects. Conclusion: Ramucirumab was an effective treatment option with good AFP response for advanced HCC patients in real‐world experience. Tumor burden beyond the up‐to‐11 criteria and a decrease in estimated glomerular filtration rate were independent predictive factors for progression‐free survival. [ABSTRACT FROM AUTHOR]

Abstract Alkylphenol ethoxylates (APEOs) are one of the most widely used classes of surfactants, but they are also ubiquitous environmental pollutants and known endocrin-disrupting chemicals. This study is the first to investigate the spatiotemporal variations and possible sources of APEOs and their metabolites, including nonylphenol ethoxylates (NPEOs) and octylphenol ethoxylates (OPEOs), in coastal sediments off southwestern Taiwan. The highest APEO concentration in the dry season was observed for the Kaohsiung coastal area, whereas the highest alkylphenol (AP) concentration in the wet season was found offshore at the Tainan Canal exit. No continuous accumulation of alkylphenol metabolites was evident in the area. One possible reason is that seasonal current and wind waves disperse the coastal pollutants. Application of multivariate statistical tools (hierarchical cluster analysis and principal component analysis) confirmed the role of rivers and the Tainan Canal in transporting contaminants to coastal environments, suggesting influences of industrial and human activities on APEO distribution. A further comparison with the predicted no-effect concentrations (PNECs) proposed by the European Union indicates that nonylphenol (NP) and octylphenol (OP) might pose potential ecological risks to the aquatic environment in the studied area. These findings provide useful information for environmental policy implementation and ecological assessments of different types of endocrine-disrupting chemicals and raise warnings about surfactant applications. Graphical abstract Image 1 Highlights • First study on alkylphenol metabolite sources and levels in southern Taiwan coasts. • Confirmed a role for rivers and canals in transporting pollutants to coastal zones. • Ocean currents disperse coastal pollutants, reducing alkylphenol ethoxylate buildup. • Total organic carbon is important in controlling alkylphenol metabolite transport. • Aquatic organisms were at higher risk near the canal, harbor, and outfall areas. [ABSTRACT FROM AUTHOR]

With data from Taiwanese jiggers that targeted the Argentine shortfin squid (Illex argentinus) in the southwest Atlantic between 1986 and 2010, we used log-transformed catch per unit of effort (logU) as an index of the abundance of this squid to explore squid recruitment strength in response to environmental conditions. The logU was negatively correlated with subsurface seawater temperature (at a depth of 5 m) observed during February and April on the southern Patagonian shelf during the fishing season. The logU was also correlated with the Antarctic Oscillation (AAO), positively correlated in December of the fishing season and in March and May of the previous 2 years, and negatively correlated in November and December of the previous 2 years. A generalized linear model selected 4 environmental variables as predictors of annual catches that accounted for 83% catch variation: AAOs in November and March of the previous 2 years and subsurface seawater temperatures in March of the current and previous year in the southern location. The AAO would not directly affect the squid abundance more than 1 year later and biotic and abiotic linkages between atmospheric circulation patterns and stock fluctuations are not understood. [ABSTRACT FROM AUTHOR]

Background This nationwide population-based study investigated the risk of Parkinson's disease (PD) after zolpidem use in patients with sleep disturbance using the National Health Insurance Research Database (NHIRD) in Taiwan. Material and methods In total, 59,548 adult patients newly diagnosed with sleep disturbance and who used zolpidem were recruited as the study cohort, along with 42,171 subjects who did not use zolpidem as a comparison cohort from 2002 to 2009. Each patient was monitored for 5 years, and those who subsequently had PD were identified. A Cox proportional hazards model was used to compare the risk of PD between the study and comparison cohorts after adjusting for possible confounding risk factors. Results The patients who received zolpidem had a higher cumulative rate of PD than those who did not receive zolpidem during the 5-year follow-up period (1.2% vs. 0.5%, P < 0.001). The adjusted hazard ratios were 1.10 (95% CI, 0.88-1.37), 1.41 (95% CI, 1.17-1.72), and 1.27 (95% CI, 1.05-1.55) for zolpidem use with 28-90, 91-365, and more than 365 cumulative defined daily doses (cDDDs), respectively, compared to those who did not use zolpidem. Conclusions Among the patients with sleep disturbance, zolpidem use increased the risk of PD after 5 years of follow-up. Further mechanistic research of zolpidem effect in PD is needed. [ABSTRACT FROM AUTHOR]

Simple Summary: The comparative effectiveness and safety of the standard dose and lower doses of pembrolizumab in non-small-cell lung cancer (NSCLC) patients still remains limited. We conducted a retrospective multi-institutional cohort study of patients newly initiating pembrolizumab in Taiwan. We found that the median overall survival (OS) and rate for all classes of immune-related adverse events (irAEs) were similar for both the standard-dose and low-dose pembrolizumab groups. Moreover, we found that patients with a pembrolizumab dose ≥1.8 mg/kg were associated with better OS than those receiving <1.8 mg/kg. Our findings suggested that a pembrolizumab dose ≥1.8 mg/kg may be the clinically minimally efficient dose. Fixed doses at 200 mg of pembrolizumab or 2 mg/kg every 3 weeks are the standard dosages for first- and second-line treatment of non-small-cell lung cancer (NSCLC); however, in clinical practice, patients with NSCLC may receive lower doses of pembrolizumab due to drug product availability or economic factors. To date, the comparative effectiveness and safety of the standard dose and lower doses of pembrolizumab in these patients still remains limited. We conducted a retrospective cohort study by analyzing electronic medical records data from the largest multi-institutional hospital system in Taiwan. Advanced NSCLC patients newly receiving pembrolizumab with or without chemotherapy were included. Patients were classified into: (1) the standard-dose group (≥2 mg/kg), and (2) the low-dose group (<2 mg/kg). We applied inverse probability of treatment weighting (IPTW) to compare the overall survival (OS) and immune-related adverse events (irAEs) between the two treatment groups, and to evaluate the minimum clinically effective dose of pembrolizumab. We included a total of 147 NSCLC patients receiving standard-dose pembrolizumab (mean [range] age: 63.7 [58.0–73.0] years; male: 62.6%; mean [range] body weight: 60.5 [58.0–73.0] kg) and 95 patients receiving low-dose pembrolizumab (mean [range] age: 62.0 [50.0–68.8] years; male: 64.2%; mean [range] body weight: 63.9 [55.0–73.8] kg). After IPTW adjustments, the median OS was similar for both the standard-dose and low-dose pembrolizumab groups (19.3 vs. 14.3 months, log-rank p = 0.15). Also, the rate for all classes of irAEs was similar for both groups. We found that patients with a pembrolizumab dose ≥1.8 mg/kg were associated with better OS than those receiving <1.8 mg/kg. Our findings suggested no significant difference in OS and irAEs between patients receiving pembrolizumab ≥2 mg/kg and <2 mg/kg in clinical practice. A pembrolizumab dose ≥1.8 mg/kg may be the clinically most efficient dose. [ABSTRACT FROM AUTHOR]

We conducted a multi-institutional study in Taiwan and a systematic review of the literature for reports of Guillain-​Barré syndrome after coronavirus disease vaccination. This condition, mostly the classic form and the acute inflammatory demyelinating polyneuropathy subtype, has been reported in 39 cases and has occurred within 2 weeks of vaccine administration. [ABSTRACT FROM AUTHOR]

Background: Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods: We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016–2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results: A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: − 1.06%, p < 0.001; liraglutide: − 0.83%, p < 0.001), with a significant between-group difference (− 0.23%, 95% confidence interval − 0.38 to − 0.08%, p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: − 1.14 kg, − 3.08 U/L and − 2.08 mL/min/1.73 m2, p < 0.01; liraglutide: − 1.64 kg, − 3.65 U/L and − 2.33 mL/min/1.73 m2, p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (− 2.47 mmHg, p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions: In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of pharmacists' dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate (DER). Method: This was an observational study in northern and southern Taiwan's two largest medical centers, from 2012 to 2018. We calculated monthly PDW as number of prescriptions divided by number of pharmacist working days. We used monthly PSR and DER as outcome indicators for pharmacists' review and dispensing services, respectively. We used Poisson regression model with generalized estimation equation methods to evaluate the influence of PDW on PSR and DER. Results: The monthly mean of 463,587 (SD 32,898) prescriptions yielded mean PDW, PSR and DER of 52 (SD 3) prescriptions per pharmacist working days, 30 (SD 7) and 8 (SD 2) per 10,000 prescriptions monthly, respectively. There was significant negative impact of PDW on PSR (adjusted rate ratio, aRR: 0.9786; 95%CI: 0.9744–0.9829) and DER (aRR: 0.9567; 95%CI: 0.9477–0.9658). Stratified analyses by time periods (2012–2015 and 2016–2018) revealed the impact of PDW on PSR to be similar in both periods; but with positive association between PDW and DER in the more recent one (aRR: 1.0086, 95%CI: 1.0003–1.0169). Conclusions: Reduced pharmacist workload was associated with re-allocation of pharmacy time to provide prescription suggestions and, more recently, decrease dispensing errors. Continuous efforts to maintain appropriate workload for pharmacists are recommended to ensure prescription quality. [ABSTRACT FROM AUTHOR]

Objective. The aim was to estimate familial relative risk (RR) for RA and other autoimmune diseases and the genetic contribution to RA phenotypic variance (heritability). Methods. This study used the Taiwan National Health Insurance Research Database to identify all National Health Insurance registered beneficiaries (n = 23 658 577) in 2010; among them, 37 482 individuals had RA. We estimated familial RRs and 95% CIs of RA and other autoimmune diseases using marginal Cox proportional models and heritability of RA using a threshold liability model. Results. The RR (95% CI) for RA was 328.27 (135.95, 795.63) for twins of RA patients; 11.97 (8.68, 16.52) for siblings; 4.86 (4.16, 5.67) for parents; 4.65 (3.92, 5.50) for offspring; and 2.32 (1.83, 2.95) for spouses. Using a threshold liability model, we estimated that familial transmission was 59.4% (95% CI: 50.3, 69.5%) and that heritability was 43.5% (33.9, 54.1%). The RR (95% CI) in individuals with a first-degree relative with RA was 2.91 (2.49, 3.42) for SLE; 2.92 (1.62, 5.25) for SSc; 3.13 (2.50, 3.93) for primary SS; 0.95 (0.36, 2.51) for idiopathic inflammatory myositis; 1.96 (1.54, 2.48) for type 1 diabetes mellitus; 3.32 (1.82, 5.95) for multiple sclerosis; 1.31 (1.31, 2.43) for IBD; 2.76 (2.46, 3.10) for AS; and 1.65 (1.54, 1.77) for psoriasis. Conclusion. The risks of RA and other autoimmune diseases increased in individuals with an RA family history. Approximately two-thirds of RA phenotypic variation is explained by familial factors. [ABSTRACT FROM AUTHOR]

Background: To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin. Methods: We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium–glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. We performed multivariable Cox proportional hazard modeling, adjusting for patients' age, sex, laboratory data, co-morbidities, and concomitant medications. Results: We identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users. A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91; 95% CI 0.73–1.14), cardiovascular death (adjusted HR: 0.54; 95% CI 0.14–2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49–1.19) and ischemic stroke (adjusted HR: 1.15; 95% CI 0.80–1.65), but a lower risk of heart failure (adjusted HR: 0.68; 95% CI 0.49–0.95). Conclusion: The risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Future prospective studies are required to confirm the findings. [ABSTRACT FROM AUTHOR]

The article presents a 2015 national prospective cohort study in Taiwan which examined whether screening for the human leukocyte antigen (HLA)-B*58:01 allele before allopurinol treatment is effective in preventing severe cutaneous adverse reactions (SCAR). The study results were compared to the National Health Insurance research database of Taiwan. Based on the results, screening along with alternative drug treatment for carriers is effective in lowering incidence of allopurinol induced SCARs.