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Measurement of real-ear-to-coupler differentials (RECDs) is a critical part of the hearing aid (HA) verification process. This study examines the validity of reference RECD values preset by the HA analyzer, Audioscan RM500, for deaf-and-hard-of-hearing (DHH) children in Taiwan. RECD measurements were performed on 658 ears of DHH children. A linear mixed model was used to analyze the reference and measured RECD values. The findings revealed slight disparities between normative RECD values from North America and those observed in Taiwanese DHH children. While generally small (less than 5 dB), these differences imply potential challenges in achieving optimal HA fitting in specific scenarios. Therefore, we recommend individualized RECD/REM measurements for cases of poor auditory performance, certain frequency ranges, or notable variations in ear canal volume. From a clinical perspective, while broadly applicable, the use of North American RECD normative data in Taiwan requires cautious consideration of potential minor variations. This study contributes to current knowledge by affirming the use of a Western RECD database for Taiwanese DHH children. However, we underscore the ongoing importance of individualized HA fitting strategies, particularly for cases with stagnant intervention progress. While built-in RECD reference values can offer preliminary fitting guidance, especially in busy clinical settings, our study sheds light on the circumstances where caution is essential. Audiologists can efficiently allocate their time and effort by focusing on personalized RECD measurements for cases exhibiting suboptimal intervention outcomes, thereby effectively optimizing HA gain settings. [ABSTRACT FROM AUTHOR]

Background: Neuromuscular blockade agents (NMBAs) can be used to facilitate mechanical ventilation in critically ill patients. Accumulating evidence has shown that NMBAs may be associated with intensive care unit (ICU)-acquired weakness and poor outcomes. However, the long-term impact of NMBAs on mortality is still unclear. Methods: We conducted a retrospective analysis using the 2015–2019 critical care databases at Taichung Veterans General Hospital, a referral center in central Taiwan, as well as the Taiwan nationwide death registry profile. Results: A total of 5709 ventilated patients were eligible for further analysis, with 63.8% of them were male. The mean age of enrolled subjects was 67.8 ± 15.8 years, and the one-year mortality was 48.3% (2755/5709). Compared with the survivors, the non-survivors had a higher age (70.4 ± 14.9 vs 65.4 ± 16.3, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (28.0 ± 6.2 vs 24.7 ± 6.5, p < 0.001), a longer duration of ventilator use (12.6 ± 10.6 days vs 7.8 ± 8.5 days, p < 0.001), and were more likely to receive NMBAs for longer than 48 h (11.1% vs 7.8%, p < 0.001). After adjusting for age, sex, and relevant covariates, the use of NMBAs for longer than 48 h was found to be independently associated with an increased risk of mortality (adjusted HR: 1.261; 95% CI: 1.07–1.486). The analysis of effect modification revealed that this association was tended to be strong in patients with a Charlson Comorbidity Index of 3 or higher. Conclusions: Our study demonstrated that prolonged use of NMBAs was associated with an increased risk of long-term mortality in critically ill patients requiring mechanical ventilation. Further studies are needed to validate our findings. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer (OC) is prevalent cancer worldwide, with varying incidence rates in different regions. To analyze the secular trend of the incidence of OC in Taiwan, this study used data from the national cancer registry database between 1980 and 2019. The study used the age-period-cohort model and average annual percentage change (AAPC) to examine the characteristic of incidence. The study also used Spearman's correlation to determine the correlation between age-standard incidence rates (ASR) of OC and related risk factors. Results indicated that ASR of OC increased in men and women from 1980–1984 to 2015–2019. The age-period-cohort model revealed a peak incidence rate in the 1975 cohort in men, followed by a declining trend. The study found a correlation between the incidence of OC and changes in cigarette and alcohol consumption and the production of betel quid. Therefore, the study recommends avoiding these risk factors to prevent OC. Oral cancer (OC) is one of the most common cancers worldwide, and its incidence has regional differences. In this study, the cancer registry database obtained from 1980 to 2019 was used to analyze the characteristic of incidence of OC by average annual percentage change (AAPC) and an age–period–cohort model. Spearman's correlation was used to analyze the relationship between the age-standard incidence rates (ASR) of OC and related risk factors. Our results showed that the ASR of OC increased from 4.19 to 27.19 per 100,000 population with an AAPC of 5.1% (95% CI = 3.9–6.3, p value < 0.001) in men and from 1.16 to 2.8 per 100,000 population with an AAPC of 3.1% (95% CI = 2.6–3.6, p value < 0.001) in women between 1980–1984 and 2015–2019. The age–period–cohort model reported a trend of rising then declining for the rate ratio in men, with peaks occurring in the 1975 cohort, with a rate ratio of 6.80. The trend of incidence of oral cancer was related to changes in the consumption of cigarettes and alcohol and production of betel quid, with r values of 0.952, 0.979 and 0.963, respectively (all p values < 0.001). We strongly suggest avoiding these risk factors in order to prevent OC. [ABSTRACT FROM AUTHOR]

Meningiomas are the most frequently diagnosed primary intracranial tumors in adults. Surgical resection is preferred if the meningioma is accessible; for those that are not suitable for surgical resection, radiotherapy should be considered to improve local tumor control. However, recurrent meningiomas are challenging to treat, as the recurrent tumor might be located in the previously irradiated area. Boron Neutron Capture Therapy (BNCT) is a highly selective radiotherapy modality in which the cytotoxic effect focuses mainly on cells with increased uptake of boron-containing drugs. In this article, we describe four patients with recurrent meningiomas treated with BNCT in Taiwan. The mean boron-containing drug tumor-to-normal tissue uptake ratio was 4.125, and the tumor mean dose was 29.414 GyE, received via BNCT. The treatment response showed two stable diseases, one partial response, and one complete response. We also introduce and support the effectiveness and safety of BNCT as an alternative salvage treatment for recurrent meningiomas. [ABSTRACT FROM AUTHOR]

An objective approach to determine a dataset from which a correlation model of solar diffuse fraction is fitted and tested is proposed. A typical meteorological year (TMY) of global radiation data that is measured in Tainan, Taiwan over 10 years (2011–2020) is used to construct the training dataset and the remaining data (90% data base) is used as a test dataset. Two multiple-predictor and one single-predictor correlation models for the hourly diffuse fraction are developed by using more theoretically rigorous techniques for determining the breaking points for segmentation (excluding the modified Boland-Ridley-Lauret (BRL) model) and how many significant predictors required in each segmented interval for the regression model with piece-wise linear multiple-predictor correlation. The performance of each developed correlation model is superior to that of the existing same-type model using a part (one year or two years) of the same data base. The re-modeled piece-wise linear multiple-predictor correlation model has the best long-term performance of the three developed correlation models. The modified BRL model on basis of the TMY data is second. The re-modeled Liu-Jordan-type (single predictor) model allows real time prediction and has a simpler form than the other two models but prediction accuracy is inferior. [ABSTRACT FROM AUTHOR]

This paper presents a deep neural network (DNN)‐based model to recognize fishing vessels. In Taiwan, the vast majority of small fishing vessels are not equipped with an automatic identification system (AIS). As a consequence, the staff in a fishing port administration become heavily loaded when monitoring and managing the fishing vessels accessing a port. The workload is expected to be eased using this work. For the first time in the literature, a captured fishing vessel image was converted to a 128‐dimensional embedding for recognition purposes. The presented model gave a false positive rate (FPR) as low as 1.13% and an accuracy up to 99.47% at threshold = 0.772379. Finally, all the performance metrics, namely, the true positive rate (TPR), the FPR, precision and accuracy, are actually functions of the threshold which can be specified by users to meet specific requirements. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have identified common risk factors for cerebral stroke worldwide. Some of these factors include hypertension, diabetes, smoking, excessive drinking, and dyslipidemia. It is important to note, however, that genetic factors can also contribute to the occurrence of stroke. Here, we evaluated the association of ischemic stroke with rs12514417 polymorphism of the alcohol metabolizing gene, aldehyde dehydrogenase 7A1 (ALDH7A1) and alcohol consumption. Methods: Taiwan Biobank (TWB) data collected between 2008 and 2015 were available for 17,985 subjects. The odd ratios for stroke were obtained using logistic regression models. Results: Among eligible subjects (n = 17,829), 897 had ischemic stroke and 70 had hemorrhagic stroke. Subjects with ischemic stroke were older (mean ± SE, 58.45 ± 8.19 years vs. 48.33 ± 10.89 years, p < 0.0001) and had a higher body mass index (BMI) than the stroke-free individuals. The risk of ischemic stroke was significantly higher among subjects with the ALDH7A1 rs12514417 TG + GG genotype who also consumed alcohol at least 150 ml/week (odds ratio (OR), 1.79; 95% confidence interval (CI), 1.18–2.72). We found that rs12514417 genotype and alcohol consumption (at least 150 ml/week) showed a significant interaction (p for interaction = 0.0266). Stratification based on alcohol exposure and ALDH7A1 rs12514417 genotypes indicated that ischemic stroke risk was significantly higher among alcohol drinkers with the TG + GG genotype than in those with the TT genotype (OR, 1.64, 95% CI: 1.15–2.33). Conclusion: Our study suggests that the combination of ALDH7A1 rs12514417 TG + GG genotype and alcohol exposure of at least 150 ml/week may increase the risk of ischemic stroke in Taiwanese adults. [ABSTRACT FROM AUTHOR]

To investigate whether patients with chronic kidney disease (CKD) are at increased risk of uveitis. Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with CKD between 2000 and 2012. The endpoint of interest was a diagnosis of uveitis. 30,256 CKD patients and 121,024 matched comparisons were analyzed. CKD patients were found to have a significantly higher cumulative uveitis incidence. Through multivariate Cox regression analysis, the CKD group was found to have higher risk of developing uveitis (adjusted hazard ratio 1.51). After stratified by gender, age, and comorbidities (hypertension, diabetes, and hyperlipidemia), the increased risk of uveitis in CKD patients remained significant. Patients with CKD were found to have higher risk of developing uveitis. For patients over 18 years old and with hypertension, diabetes, or hyperlipidemia, the presence of CKD was demonstrated as an additional crucial factor for uveitis development. [ABSTRACT FROM AUTHOR]

The basements of large hospitals in Taiwan are usually working areas for image radiometry, radiation therapy, and nuclear medicine, where the radon concentration can be accumulated. This study investigated radon concentrations in the basement working environments of 30 hospitals in different regions with various geology of Taiwan, aiming to explore the relationship between geological conditions and radon concentrations and estimate the radiation dose received by the working staff. Portable MR107+ semiconductor radon detectors calibrated with a radon chamber were used for radon measurement at the hospital basement working areas according to the protocol of MAH-2019 instrument placement recommendations from the US EPA. The excess lung cancer risk (ELCR) as well as the lung cancer cases per million persons (LCC) were further derived from the radiation dose. The basement working areas investigated are located on the first to sixth underground floors of hospitals in Taiwan mainland and islands, Penghu and Kinmen. The 222Rn concentration higher than 100 Bq/m3 was observed at CH-1 (122.1 Bq/m3) in Changhua City and CY-1 (114.7 Bq/m3) in Chiayi City. This is attributed to that the central air conditioning systems of these hospitals were turned off during off-duty hours. The radon concentrations of all hospitals were lower than the action level, 150 Bq/m3, regulated by the US EPA. No significant relationship was found between radon concentration and the geological characteristics of the measured sites. That is, the ventilation of the basement working areas in hospitals is more important than local geological characteristics on indoor radon concentration, and therefore proper ventilation is crucial for reducing radon gas concentration in the hospital basements. Estimated annual effective dose from 222Rn for the hospital staff was higher than 1 mSv/y at YL (1.24 mSv/y), CH-1 (1.64 mSv/y), CY-1 (1.54 mSv/y), CY-2 (1.34 mSv/y), and PH-2 (1.14 mSv/y), and that for the rest sites was <1 mSv/y. The maximum mean ELCR was found to be 0.63% at CH-1, and the related LCC was estimated to be 29.5 per million persons. • Higher radon levels were observed in hospital basements after the air conditioning systems were turned off. • Proper ventilation is crucial for reducing radon concentration. • No apparent effect of geological characteristics, temperature and humidity was observed on radon concentration. • Radon levels in all hospital basements were lower than the action level of US EPA. [ABSTRACT FROM AUTHOR]

Background: Thoracic empyema is a disease with high mortality and morbidity. Video-assisted thoracoscopic surgery (VATS) is recommended to treat advanced stage empyema. The purpose of this study was to explore risk factors associated with post-surgery mortality for community-acquired empyema. Patients and Methods: We retrospectively reviewed 440 patients who received VATS for community-acquired empyema, higher than stage 2, in a tertiary medical center in Taiwan. Patients' age, comorbidities, pleural effusion analysis, and post-surgery outcome were compiled. Cox regression model for survival was applied to identify risk factors of 90-day death after surgery. Results: Fifty-three patients (12.05%) had died within 90 days post-surgery. The risk factors of mortality were advanced age (hazard ratio [HR], 1.027; 95% confidence interval [CI], 1.001-1.052), chronic kidney disease (HR, 5.322; 95% CI, 2.635-10.746), cancer (HR, 6.038; 95% CI, 2.737-13.321), pleural effusion pH ≤7 (HR, 2.61; 95% CI, 1.344-5.069), pleural effusion protein ≤4 (HR, 2.021; 95% CI, 1.035-3.947), and late surgery (HR, 3.014; 95% CI, 1.595-5.696). The 90-day mortality in the early surgery group versus the late group was 6.85% versus 26.05%. The increased mortality risk from late surgery was observed in most subgroups, except for patients who were female, had chronic renal disease, and had coronary artery disease. Conclusions: Patients who are elderly, have chronic kidney disease, cancer history, low pleural effusion pH, low pleural effusion protein, and late surgery are associated with post-surgery mortality for community-acquired advanced empyema. Early VATS surgery for advanced empyema or treatment failure of chest tube drainage appears to beneficial and is recommended. [ABSTRACT FROM AUTHOR]

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04–1.77), high-stable (aOR = 2.01; CI: 1.28–3.15), or increasing (aOR = 1.97; CI: 1.26–3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk and time trends of heart failure (HF) leading to hospitalization in individuals newly diagnosed as having polymyositis/dermatomyositis (PM/DM) relative to non‐PM/DM controls at the general population level. Methods: A retrospective cohort study was conducted using data from a nationwide insurance database in Taiwan. Patients with incident PM/DM and without a history of HF were selected between 2000 and 2013. Unmatched and propensity score–matched cohorts were established separately. A multivariable Cox proportional hazards regression model was used to estimate the adjusted hazard ratio (HR) for the risk of HF in the unmatched cohort. In the propensity score–matched cohort, general population controls were selected and matched at a 1:1 ratio to the patients with PM/DM based on propensity scores, which accounted for the confounding factors of age, sex, index date (year) of first diagnosis, comorbidities, and medication usage. The cumulative incidence of HF was estimated using the Kaplan‐Meier method. A stratified Cox proportional hazards model was used to calculate the HR for the risk of HF events at different follow‐up time points among patients with PM/DM compared with non‐PM/DM controls in the propensity score–matched cohort. Results: In the unmatched cohort, the study assessed 2,025 patients with PM/DM and 196,109 general population controls. Results of multivariable Cox regression analysis, adjusted for age, sex, comorbidities, and medication usage, revealed a greater risk of HF leading to hospitalization in the PM/DM group than in the control group (adjusted HR 3.29, 95% confidence interval [95% CI] 2.60–4.18). After matching based on propensity score, a total of 1,997 pairs of PM/DM patients and general population controls were identified. In this propensity score–matched cohort, the cumulative incidence of HF in patients with PM/DM at 3 years, 5 years, and 10 years was 3.3%, 4.4%, and 7.4%, respectively. The absolute difference in HF risk in the PM/DM group compared with the control group was 1.8% at 3 years, 2.1% at 5 years, and 3.0% at 10 years. Compared with general population controls, patients with PM/DM exhibited an augmented risk of HF (HR 2.06, 95% CI 1.36–3.12). Analyses stratified according to follow‐up time point revealed that the increased risk of HF persisted for up to 10 years after the PM/DM diagnosis. Conclusion: These results indicate that the risk of HF leading to hospitalization was increased in patients with PM/DM throughout the study period, supporting the need for greater vigilance in the monitoring of patients with PM/DM for the development of this potentially lethal complication. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether patients with thyroid disease are at increased risk of uveitis.Methods: Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with thyroid disease from 2000 to 2012. The endpoint of interest was a diagnosis of uveitis.Results: In analyzing 21,396 patients with thyroid disease, yielding 85,584 matched comparisons, patients with thyroid disease to have a significantly higher cumulative incidence of uveitis when compared to the control cohort with the Kaplan-Meier analysis. This result was further confirmed by Cox regression analysis. The increased risk was persistent in both genders. The association between thyroid disease and uveitis was stronger in patients without diabetes or hypertension.Conclusion: Patients with thyroid disease were found to have a higher risk for uveitis. For certain age groups or patients without diabetes or hypertension, the role of thyroid disease might be more crucial for uveitis development. [ABSTRACT FROM AUTHOR]

In 2014 and 2015, Southern Taiwan experienced two unprecedented outbreaks, with more than 10,000 laboratory-confirmed dengue cases in each outbreak. The present study was aimed to investigate the influence of meteorological and spatial factors on dengue outbreaks in Southern Taiwan and was conducted in Kaohsiung City, which is the most affected area in Taiwan. The distributed lag nonlinear model was used to investigate the role of climatic factors in the 2014 and 2015 dengue outbreaks. Spatial statistics in the Geographic Information System was applied to study the relationship between the dengue spreading pattern and locations of traditional markets (human motility) in the 2015 dengue outbreak. Meteorological analysis results suggested that the relative risk of dengue fever increased when the weekly average temperature was more than 15°C at lagged weeks 5 to 18. Elevated relative risk of dengue was observed when the weekly average rainfall was more than 150 mm at lagged weeks 12 to 20. The spatial analysis revealed that approximately 83% of dengue cases were located in the 1000 m buffer zone of traditional market, with statistical significance. These findings support the influence of climatic factors and human motility on dengue outbreaks. Furthermore, the study analysis may help authorities to identify hotspots and decide the timing for implementation of dengue control programs. [ABSTRACT FROM AUTHOR]

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) ensures favorable outcomes and reduces the risk of cardiac events in patients on dialysis. However, the effect of PPSV23 vaccination on renal function remains unknown, particularly in patients with chronic kidney disease (CKD). Therefore, we investigated the association between PPSV23 efficacy and renal progression in older patients (age ≥ 75 years) with CKD. This multicenter, longitudinal cohort study was conducted using data (2008–2016) from the Epidemiology and Risk Factors Surveillance of CKD database. This database was associated with Taiwan's National Health Insurance Research Database (for period: 2008–2019). A total of 1195 older patients with CKD were recruited from 14 hospitals and communities across Taiwan. Renal progression was defined as a > 25% reduction in estimated glomerular filtration rate from the baseline value. A significant reduction in the risk of renal progression was observed in patients who had received PPSV23 (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.35–0.91). However, when stratified by CKD stage, this significant reduction was observed in patients with early-stage CKD but not in those with late-stage CKD. Furthermore, a significant reduction in the risk of renal progression was noted in male patients and those with hypertension. Our findings support the protective effect of PPSV23 against renal deterioration in older patients with CKD. • This study shows that PPSV23 can mitigate renal deterioration in older CKD patients. • PPSV23 could reduce the risk of renal progression, particularly in early-stage CKD. • PPSV23 benefits in reducing renal progression are observed in men but not in women. • PPSV23 markedly reduces renal decline in patients with both CKD and hypertension. [ABSTRACT FROM AUTHOR]

Background: Decisions about end-of-life care often raise clinical and ethical challenges, especially when the person's capacity to contribute in the decision making at the end of life is limited. Aim: This study aimed to explore Taiwanese adults' preferences associated with communication, healthcare planning, life-sustaining treatments and palliative care and experiences of end-of-life care. Methods: Semi-structured interviews were conducted with 16 adults aged 20 years and above. The sampling approach was a convenience strategy in a community centre located in a metropolitan area in the Southern region of Taiwan. A qualitative content analysis approach was used to elicit key themes from the data. Results: Significant findings related to the two main themes of adults' experiences, including the observed distress of those who were dying and the distress experienced by the family. Other key findings pertain to personal preferences for end-of-life care, such as preferred end-of-life communication, preparing for the end-of-life and maintenance of quality of life. Conclusions: This exploratory study offers insight into 16 Taiwanese community-dwelling adults' views of preferences regarding end-of-life communication, preparation for the end of life and maintenance of quality of life, as well as their experiences of end-of-life care. A further exploration is suggested to elicit how personal end-of-life experiences shape individuals' health practices in advance care planning for end-of-life care. [ABSTRACT FROM AUTHOR]

Microplastic pollution is an urgent threat to the biota of aquatic ecosystems and is generally recognized as a global issue. Identifying the sources of microplastics is acknowledged as the most effective approach for mitigating microplastic pollution. However, the factors that regulate the spatiotemporal dynamics of microplastics in urban river networks, such as microplastic sources and other variables, have not been studied together at the watershed scale, let alone regarding their impact on internal microplastics. Here, we define "internal microplastics" as microplastics in biota, either in the digestive system or internal organs of organisms. We estimated the effects of anthropogenic activities (land cover and wastewater treatment plants) and seasonality on the concentration of internal microplastics in midge larvae (Diptera: Chironomidae) in an urban river system at a watershed scale in Taiwan. Agricultural activities, but not industrial activities, had a significant negative nonlinear effect on microplastic concentration. However, seasonality was the most crucial factor, as the microplastic concentration was significantly lower during the wet season. Although the presence of a wastewater treatment plant significantly increased the microplastic concentration at downstream sampling sites, its effect appeared to be minor. We conclude that seasonality overrides the effects of anthropogenic activities on the variation in the concentration of internal microplastics in midge larvae in an urban river system. [Display omitted] • Seasonality is the most crucial factor influencing internal microplastics (IMs). • Intensive agricultural activities decrease IM concentrations. • Wastewater treatment plants increase IM concentrations downstream. [ABSTRACT FROM AUTHOR]

• We examined the relationship between SNS users' switching intention and behavior. • The qualitative and quantitative analyses were used to analyze. • Functional, emotional, and social values positively affected switching intentions. • Switching intentions positively affected switching behaviors. • Habits negatively moderated switching intentions on switching behaviors. The increasing integration of computers and networks into society has profoundly affected our lives in recent years. In Taiwan, use of SNSs – especially Facebook – has become the main action for the Internet users; accordingly, a number of scholars have explored people's intention to use, or actual use of, SNSs. However, few studies have investigated how and why users stop using one SNS and begin using another from the linear perspective. The findings are incomplete for the human behaviors which are complex and nonlinear systems. The purpose of this study is therefore to explore the relationship between SNS users' switching intention and switching behavior based on structural equation modeling (SEM) and cusp catastrophe model (CCM). The key factors for the switching intentions and behaviors of SNS users were examined through empirical research, and a structural model was established. The model, which involved habits as a mediating factor, was used to conduct a qualitative and quantitative analysis on the switching behaviors of SNS users from a nonlinear perspective. This model will provide a new method for future researchers to analyze nonlinear behaviors as well as a dynamic decision support model for service providers to improve their business operation. [ABSTRACT FROM AUTHOR]

• With the advance of handheld devices, a number of application service provider provided desktop and mobile versions, and users may use either or both of them. Mobile instant messaging application is representative one. • One of major focuses of this study is to investigate the platform selection behavior of instant messaging users and discover the influence factors. • Our findings shown that consumer values have significant effects on users' continuance usage intention and recommendation intention in single- platform use case. However, perceived interactivity and perceived playfulness did not have significant effects in multi-platform use case. • The main contribution of the study is the differences between single- and multi- platform use cases and providing guidance for cross-platform application developers. The purpose of this study is to investigate the factors that influence the usage intention for different instant messaging application platforms. This study targeted the widespread instant messaging software LINE, for which a survey of 485 valid respondents was conducted in Taiwan. Statistical and model structure analyses were applied to validate the hypotheses proposed in this study. We examined the differences between single- and multi-platform use cases in terms of the relationship between consumer value and behavioral intention. The results show that perceived interactivity, perceived playfulness, and perceived usefulness have significant effects on the continued usage and recommendation intentions of users in a single-platform use case. However, perceived interactivity and perceived playfulness did not have significant effects in multi-platform use cases. The findings of this study provide a new perspective for investigating the intention to continue using a multiplatform application. The results will benefit subsequent studies in this area and provide guidance for the development of instant messaging and other social media applications. [ABSTRACT FROM AUTHOR]

The crypto and digital assets ecosystems have attracted investment, regulators, and speculators to their environment. As the blockchain-based framework can reduce transaction costs, generate distributed trust, and enable decentralized platforms, it has become a potential new base for decentralized business models. Previous studies have highlighted the advantages and drawbacks of each platform, such as interest rates, cost concerns, transparency issues, hacking issues, and hazards. Consequently, it is challenging for investors to evaluate the cryptocurrency trading system which determines the optimum exchanges and crucial aspects. Therefore, in order to rank the optimal digital token trading system, this paper develops an evaluation architecture to determine the various token trading systems. The developed architecture integrates fuzzy theory and the best-worst method (BWM) into the decision-making process to assess decision behaviors regarding preference for digital token trading systems in investors in Taiwan. First, this work establishes the views and parameters by modifying the Delphi method based on a literature review and survey. Second, the fuzzy-BWM is applied to obtain the fuzzy weights of the views and parameters. Then, defuzzification and BWM are used to rank the optimal alternatives of the digital token trading systems for investors. The results indicate that the optimal digital token trading system is the decentralized platform, and the critical parameters are gas fees, interest rates, and the mechanism of savings under fuzzy uncertain scenarios. This means that when considering the uncertain and ambiguous characteristics of the expert decision process in digital token trading systems, the evaluation is decentralized and the gas fees are the most important parameter in the digital token investment platform. Academically, the fuzzy BWM-based decision-making architecture can provide corporations and investors with valuable guidance to rank the optimal digital token trading systems based on fuzzy uncertain scenarios. Commercially, the proposed architecture could provide corporations and investors with a useful model to measure the optimal digital token trading system. [ABSTRACT FROM AUTHOR]

Emotion is a compelling factor in the retention and job satisfaction of professionals, and the impacts of emotional feelings and reactions have become an indispensable issue in the nursing workforce. Drawing on the cognitive theory of emotions, this study bridges the research gap to investigate the relationships among emotional blackmail, emotional intelligence, job satisfaction, and turnover intentions of nurses. A cross-sectional design was used to collect data from a sample of 374 full-time nurses in Northern Taiwan. Hypotheses were tested and analyzed by means of SPSS 22, structural equation modeling (SEM), and PROCESS v3.3. The results revealed the direct relationships between emotional blackmail, job satisfaction, and turnover intentions, and job satisfaction partially mediated the relationship between emotional blackmail and turnover intentions. However, there is no statistical support that emotional intelligence moderates the relationships between emotional blackmail and job satisfaction and turnover intentions. Healthcare organizations must take the initiative and form strategies that will help balance nurses' work stresses. These strategies should aim to reduce unnecessary demands from supervisors, patients, and co-workers, as well as in the socio-emotional domain. [ABSTRACT FROM AUTHOR]

The results of many studies indicate that cadmium (Cd) exposure is harmful to humans, with the proximal tubule of the kidney being the main target of Cd accumulation and toxicity. Studies have also shown that Cd has the effect of activating the pathway of epidermal growth factor receptor (EGFR) signaling and cell growth. The EGFR is a family of transmembrane receptors, which are widely expressed in the human kidney. The aim of this study was to investigate the kidney function estimated glomerular filtration rate (eGFR), and its relationship with plasma Cd level and EGFR gene polymorphism. Using data from Academia Sinica Taiwan biobank, 489 subjects aged 30–70 years were analyzed. The demographic characteristics was determined from questionnaires, and biological sampling of urine and blood was determined from physical examination. Kidney function was assessed by the eGFR with CKD-EPI formula. Plasma Cd (ug/L) was measured by inductively coupled plasma mass spectrometry. A total of 97 single-nucleotide polymorphisms (SNPs) were identified in the EGFR on the Taiwan biobank chip, however 4 SNPs did not pass the quality control. Multiple regression analyses were performed to achieve the study aim. The mean (±SD) plasma Cd level of the study subjects was 0.02 (±0.008) ug/L. After adjusting for confounding variables, rs13244925 AA, rs6948867 AA, rs35891645 TT and rs6593214 AA types had higher eGFR (4.89 mL/min/1.73 m2 (p = 0.035), 5.54 mL/min/1.73 m2 (p = 0.03), 4.96 mL/min/1.73 m2 (p = 0.048) and 5.16 mL/min/1.73 m2 (p = 0.048), respectively). Plasma cadmium and rs845555 had an interactive effect on eGFR. In conclusion, EGFR polymorphisms could be modifiers of Cd kidney toxicity, in which rs13244925 AA, rs6948867 AA, rs35891645 TT and rs6593214 AA may be protective, and Cd interacting with rs845555 may affect kidney function. [ABSTRACT FROM AUTHOR]

During enterprise foundation and development, internal finance and debt finance are of vital importance to start-up entrepreneurs. Therefore, the purpose of this study is mainly to focus on how start-ups can make the optimal evaluation among different external equity crowdfunding solutions and to establish a network decision support model that evaluates the optimal financing solution of start-ups for external equity crowdfunding based on decision science and network architecture. The Lending Company in Financial Technology Industry (LCFTI) was taken as an example. The results indicate that equity crowdfunding is the optimal financing plan in LCFTI. Academically, the results of this study not only help propose a network decision support model using decision science methods and implementing the network analysis to establish an architecture to evaluate the optimal financing plans of start-ups for external equity crowdfunding, they also makes up for the gap in the optimal financing plans of entrepreneurs or start-ups for external equity financing, which has not been specified in the POT theory in the past. Practically, this study provides a useful tool for the entrepreneur of LCFTI to understand the key factors affecting the optimal financing plans for external equity financing and enables LCFTI to measure the optimal financing plans for external equity financing to improve the success rate of finance. [ABSTRACT FROM AUTHOR]

Based on the theoretical frameworks of the theory of triadic influence (TTI) and the buffering hypothesis, this study was designed to examine whether the relationship between depression and Internet addiction (IA) was mediated by refusal self-efficacy of Internet use and whether real-life and online social support moderated the effect of depression on refusal self-efficacy of Internet use among adolescents. A sample of 1127 junior high school students from Taiwan completed a self-report battery that included measures of depression, online social support, real-life social support, refusal self-efficacy of Internet use, and IA. The prevalence of depression and IA are 44.6% and 23% respectively. Structural equation modeling and bootstrapping analysis results showed that IA was significantly and positively predicted by depression and mediated by refusal self-efficacy of Internet use. Moreover, the results of the moderated mediation analyses revealed that real-life and online social support played a moderating role in the indirect effects of depression on IA through refusal self-efficacy of Internet use, such that indirect effects were attenuated by an increase of online social support, and in contrast, those effects promoted the increase of real-life social support. The results supported the TTI framework and the buffering hypothesis. The moderated mediating role of online and real-life social support and refusal of self-efficacy of Internet use in the relationship between depression and IA were discussed. [ABSTRACT FROM AUTHOR]

Anterior uveitis is the most common anatomical type of uveitis. Patients with noninfectious anterior uveitis may develop various ocular complications and eventually visual impairment. Appropriately differentiating the etiologies can help clinicians to predict the outcome, arrange clinical follow-up, and decide the treatment or prevention strategy. Adequate treatment and effective prevention strategies can reduce the frequency of recurrence and the risk of developing complications. Human leukocyte antigen (HLA)-B27 is the most common positive finding in patients with noninfectious AAU in many countries including Taiwan. To report a consensus from experienced uveitis specialists and rheumatologists was made in Taiwan. A panel of nine ophthalmologists from nine different referral centers with expertise in the management of uveitis and an experienced rheumatologist was held on January 16, 2022. A comprehensive literature review was performed. Differential diagnoses for etiologies, general treatments, and prevention strategies were discussed. Each statement in the consensus was made only if more than 70% of the experts agreed. A flow chart and seven statements regarding the differential diagnoses for etiologies, treatments and preventions, and co-management with rheumatologists were included in the consensus. This article discusses the general diagnosis, treatment, and prevention of noninfectious acute anterior uveitis, with or without HLA-B27, in adults for general ophthalmologists to improve overall outcomes of these patients [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. Design: This population‐based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. Methods: 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age‐ and sex‐matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. Findings: Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person‐years compared to the control cohort (2248 per 100,000 person‐years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64–1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. Conclusions: Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. Clinical relevance: The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention. [ABSTRACT FROM AUTHOR]

Aims: To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. Design: Cross‐sectional retrospective chart review. Methods: This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. Results: A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88–4.54), nutrition (aOR =3.22, 95%CI =1.08–9.59), cognition (aOR =2.61, 95%CI =1.32–5.16) and pain (aOR =5.01, 95%CI=1.63–15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48–90.45) and nutrition (aOR =12.90, 95%CI =1.67–99.06) had significantly higher odds of developing new problems. Discussion: Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. Impact: Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries. [ABSTRACT FROM AUTHOR]

Purpose: To understand how emergency nurses develop resilience in the context of workplace violence. Design: This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018. Methods: Semistructured interviews were used to collect data. Interviews were audio‐recorded and transcribed verbatim. Findings: The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care. Conclusions: The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs. Clinical Relevance: Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence. [ABSTRACT FROM AUTHOR]

To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on therapy for metformin affects diabetic retinopathy (DR) progression in patients with type 2 diabetes mellitus (T2DM). This nationwide population-based study conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, income, comorbidities, diabetes complication severity index score, staging of kidney disease, anti-diabetic medications, and index year were included. The outcome was DR progression, determined by procedure codes or the addition of ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the study. Sensitivity analyses were performed to validate the findings. The adjusted hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, relative to the control group [95% confidence interval (CI) 0.81–0.99, P = 0.026]. The Kaplan–Meier curve of the cumulative incidence rate showed that the cumulative incidence of DR progression was considerably decreased in the SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 1–2 years were associated with a significant increase in the risk of DR progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 0.35–0.48; P < 0.001). The serial sensitivity analysis showed consistent findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy findings within 1 year before the outcome date (95% Cl 0.71–0.95; P = 0.009). Co-administration of metformin and SGLT2is may reduce the risk of DR progression. Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged use SGLT2is may significantly decrease it. [ABSTRACT FROM AUTHOR]

To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on therapy for metformin affects diabetic retinopathy (DR) progression in patients with type 2 diabetes mellitus (T2DM). This nationwide population-based study conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, income, comorbidities, diabetes complication severity index score, staging of kidney disease, anti-diabetic medications, and index year were included. The outcome was DR progression, determined by procedure codes or the addition of ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the study. Sensitivity analyses were performed to validate the findings. The adjusted hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, relative to the control group [95% confidence interval (CI) 0.81–0.99, P = 0.026]. The Kaplan–Meier curve of the cumulative incidence rate showed that the cumulative incidence of DR progression was considerably decreased in the SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 1–2 years were associated with a significant increase in the risk of DR progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 0.35–0.48; P < 0.001). The serial sensitivity analysis showed consistent findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy findings within 1 year before the outcome date (95% Cl 0.71–0.95; P = 0.009). Co-administration of metformin and SGLT2is may reduce the risk of DR progression. Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged use SGLT2is may significantly decrease it. [ABSTRACT FROM AUTHOR]

Fatigue is a prevalent subjective sensation, affecting both office workers and a significant global population. In Taiwan alone, over 2.6 million individuals—around 30% of office workers—experience chronic fatigue. However, fatigue transcends workplaces, impacting people worldwide and potentially leading to health issues and accidents. Gaining insight into one's fatigue status over time empowers effective management and risk reduction associated with other ailments. Utilizing photoplethysmography (PPG) signals brings advantages due to their easy acquisition and physiological insights. This study crafts a specialized preprocessing and peak detection methodology for PPG signals. A novel fatigue index stems from PPG signals, focusing on the dicrotic peak's position. This index replaces subjective data from the brief fatigue index (BFI)-Taiwan questionnaire and heart rate variability (HRV) indices derived from PPG signals for assessing fatigue levels. Correlation analysis, involving sixteen healthy adults, highlights a robust correlation (R > 0.53) between the new fatigue index and specific BFI questions, gauging subjective fatigue over the last 24 h. Drawing from these insights, the study computes an average of the identified questions to formulate the evaluated fatigue score, utilizing the newfound fatigue index. The implementation of linear regression establishes a robust fatigue assessment system. The results reveal an impressive 91% correlation coefficient between projected fatigue levels and subjective fatigue experiences. This underscores the remarkable accuracy of the proposed fatigue prediction in evaluating subjective fatigue. This study further operationalized the proposed PPG processing, peak detection method, and fatigue index using C# in a computer environment alongside a PPG device, thereby offering real-time fatigue indices to users. Timely reminders are employed to prompt users to take notice when their index exceeds a predefined threshold, fostering greater attention to their physical well-being. [ABSTRACT FROM AUTHOR]

Whole exome sequencing (WES) has been used to detect rare causative variants in neurological diseases. However, the efficacy of WES in genetic diagnosis of clinically heterogeneous familial stroke remains inconclusive. We prospectively searched for disease-causing variants in unrelated probands with defined familial stroke by candidate gene/hotspot screening and/or WES, depending on stroke subtypes and neuroimaging features at a referral center. The clinical significance of each variant was determined according to the American College of Medical Genetics guidelines. Among 161 probands (mean age at onset 53.2 ± 13.7 years; male 63.4%), 33 participants (20.5%) had been identified with 19 pathogenic/likely pathogenic variants (PVs; WES applied 152/161 = 94.4%). Across subtypes, the highest hit rate (HR) was intracerebral hemorrhage (ICH, 7/18 = 38.9%), particularly with the etiological subtype of structural vasculopathy (4/4 = 100%, PVs in ENG, KRIT1, PKD1, RNF213); followed by ischemic small vessel disease (SVD, 15/48 = 31.3%; PVs in NOTCH3, HTRA1, HBB). In contrast, large artery atherosclerosis (LAA, 4/44 = 9.1%) and cardioembolism (0/11 = 0%) had the lowest HR. NOTCH3 was the most common causative gene (16/161 = 9.9%), presenting with multiple subtypes of SVD (n = 13), ICH (n = 2), or LAA (n = 1). Importantly, we disclosed two previously unreported PVs, KRIT1 p.E379* in a familial cerebral cavernous malformation, and F2 p.F382L in a familial cerebral venous sinus thrombosis. The contribution of monogenic etiologies was particularly high in familial ICH and SVD subtypes in our Taiwanese cohort. Utilizing subtype-guided hotspot screening and/or subsequent WES, we unraveled monogenic causes in 20.5% familial stroke probands, including 1.2% novel PVs. Genetic diagnosis may enable early diagnosis, management and lifestyle modification. Among 161 familial stroke probands, 33 (20.5%) had been identified pathogenic or likely pathogenic monogenic variants related to stroke. The positive hit rate among all subtypes was high in intracerebral hemorrhage (ICH) and ischemic small vessel disease (SVD). Notably, two previously unreported variants, KRIT1 p.E379* in a familial cerebral cavernous malformation and F2 p.F382L in familial cerebral venous sinus thrombosis, were disclosed. CVT cerebral venous thrombosis; HTN Hypertensive subtype; LAA large artery atherosclerosis; SV structural vasculopathy; U Undetermined. [ABSTRACT FROM AUTHOR]

Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal–medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown. We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse. Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61–5.68] and 1.71 [1.19–2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts. Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program. • A joint legal–medical intervention program provides 12-month addiction treatment. • We followed 449 individuals with methamphetamine offense receiving the treatment. • 37.8 % had methamphetamine relapse and 26.5 % discontinued the 12-month treatment. • Baseline urine positive of methamphetamine and high craving increased relapse risk. • Tailored treatment incorporating these findings is warranted in the joint program. [ABSTRACT FROM AUTHOR]

• Stages of Epiretinal Membrane can be classified with deep learning methods. • Fusing different convolutional neural networks increases classification accuracy. • Deep learning can support ophthalmologists in making diagnosing decisions. • Explainable artificial intelligence is necessary for ophthalmologists to verify the diagnosing features. The gold standard for diagnosing epiretinal membranes is to observe the surface of the internal limiting membrane on optical coherence tomography images. The stages of the epiretinal membrane are used to decide the condition of the health of the membrane. The stages are not detected because some of them are similar. To accurately classify the stages, a deep-learning technology can be used to improve the classification accuracy. Methods: A combinatorial fusion with multiple convolutional neural networks (CNN) algorithms are proposed to enhance the accuracy of a single image classification model. The proposed method was trained using a dataset of 1947 optical coherence tomography images diagnosed with the epiretinal membrane at the Taichung Veterans General Hospital in Taiwan. The images consisted of 4 stages; stages 1, 2, 3, and 4. Results: The overall accuracy of the classification was 84%. The combination of five and six CNN models achieves the highest testing accuracy (85%) among other combinations, respectively. Any combination with a different number of CNN models outperforms any single CNN algorithm working alone. Meanwhile, the accuracy of the proposed method is better than ophthalmologists with years of clinical experience. Conclusions: We have developed an efficient epiretinal membrane classification method by using combinatorial fusion with CNN models on optical coherence tomography images. The proposed method can be used for screening purposes to facilitate ophthalmologists making the correct diagnoses in general medical practice. [ABSTRACT FROM AUTHOR]

Older drivers with mild cognitive impairment (MCI) often show declining driving performance. Evidence is lacking regarding whether their driving skills can be improved after practice. To compare the practice effects of older drivers with MCI and drivers with normal cognition in an unfamiliar, standardized driving course with three practices. Single-blind two-group observational design. Twelve drivers with confirmed MCI as the experimental group and ten with normal cognition (NC) as the control, all ≥ 55 years old. The primary outcome was to assess the practice effects, measured with an in-car global-positioning-system mobile application to compare the speed and directional control of a complex manoeuvre after practices. Secondary outcomes were to assess the pass/fail rate and mistakes observed for the 3rd/final on-road driving practice. No instructions were given during practice. Descriptive statistics and the Mann–Whitney U test were used for data analysis. No significant inter-group difference in the pass/fail rate and number of mistakes. Some MCI drivers performed better in the speed and directional control of the S-Bend manoeuvre after practices. The driving performance of drivers with MCI may improve with practice. Older drivers with MCI may potentially benefit from driver retraining. ClinicalTrials.gov (Identifier: NCT04648735). [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is known to increase the risk of hepatocellular carcinoma (HCC) among individuals with chronic hepatitis C (CHC). We aimed to evaluate whether metformin reduces HCC risk among individuals with DM and CHC after successful antiviral therapy. Individuals with CHC who achieved a sustained virological response (SVR) after interferon-based therapy were enrolled in a large-scale, multicenter cohort in Taiwan (T-COACH). Cases of HCC at least 1 year after SVR were identified through linkage to the catastrophic illness and cancer registry databases. Of 7,249 individuals with CHC enrolled in the study, 781 (10.8%) had diabetes and 647 (82.8%) were metformin users. During a median follow-up of 4.4 years, 227 patients developed new-onset HCC. The 5-year cumulative HCC incidence was 10.9% in non-metformin users and 2.6% in metformin users, compared to 3.0% in individuals without DM (adjusted hazard ratio [aHR] 2.83; 95% CI 1.57-5.08 and aHR 1.46; 95% CI 0.98-2.19, respectively). Cirrhosis was the most important factor significantly associated with higher HCC risk in Cox regression analysis, followed by DM non-metformin use, older age, male sex, and obesity; whereas hyperlipidemia with statin use was associated with a lower HCC risk. Using the two most crucial risk factors, cirrhosis and DM non-metformin use, we constructed a simple risk model that could predict HCC risk among individuals with CHC after SVR. Metformin use was shown to reduce the risk of all liver-related complications. Metformin use greatly reduced HCC risk after successful antiviral therapy in individuals with diabetes and CHC. A simple risk stratification model comprising cirrhosis and DM non-metformin use could predict long-term outcomes in individuals with CHC after SVR. The current study provides evidence that metformin could reduce hepatocellular carcinoma (HCC) incidence after successful antiviral therapy among those with diabetes and chronic hepatitis C in a large-scale nationwide cohort study. Although successful antiviral therapy greatly reduces HCC risk in individuals with chronic hepatitis C, those with cirrhosis, diabetes, obesity, and the elderly remain at high risk of HCC development. We demonstrated that a simple risk model composed of two crucial unfavorable factors, cirrhosis and diabetes without metformin use, predicts the risk of HCC and major liver-related complications after successful antiviral therapy in individuals with chronic hepatitis C. Metformin use is highly recommended for individuals with diabetes and chronic hepatitis C after viral eradication to reduce the risk of HCC. [Display omitted] • Diabetes mellitus is associated with an increased risk of HCC in individuals with CHC. • Diabetes mellitus still increases the risk of HCC after successful antiviral therapy. • Use of metformin for DM greatly reduces HCC risk after successful antiviral therapy. • A simple risk stratification model could predict the risk of HCC and other major liver-related complications. [ABSTRACT FROM AUTHOR]

Defect pattern detection and classification are challenging for thin-film-transistor liquid-crystal display (TFT-LCD) manufacturing. Limitations of the existing solutions for automatic optical inspection can be traced in part to the lack of a framework within which different existing and new defect patterns can be analyzed, while integrating domain knowledge and effective technologies. This study aims to develop a framework for image-based defect classification that employs the convolution neural networks without using complex and time-consuming image-processing processes in advance. An empirical study was conducted in a leading TFT-LCD manufacturing in Taiwan for validation. The results have shown that the defect patterns can be effectively classified by the proposed convolutional neural networks that outperform the existing approaches such as Support Vector Machine and Random Forest. The developed solution is implemented to effectively support the engineers. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that the origins of the panzootic amphibian pathogens Batrachochytrium dendrobatidis (Bd) and Batrachochytrium salamandrivorans (Bsal) are in Asia. In Taiwan, an island hotspot of high amphibian diversity, no amphibian mass mortality events linked to Bd or Bsal have been reported. We conducted a multi-year study across this subtropical island, sampling 2517 individuals from 30 species at 34 field sites, between 2010 and 2017, and including 171 museum samples collected between 1981 and 2009. We analyzed the skin microbiome of 153 samples (6 species) from 2017 in order to assess any association between the amphibian skin microbiome and the probability of infection amongst different host species. We did not detect Bsal in our samples, but found widespread infection by Bd across central and northern Taiwan, both taxonomically and spatially. Museum samples show that Bd has been present in Taiwan since at least 1990. Host species, geography (elevation), climatic conditions and microbial richness were all associated with the prevalence of infection. Host life-history traits, skin microbiome composition and phylogeny were associated with lower prevalence of infection for high altitude species. Overall, we observed low prevalence and burden of infection in host populations, suggesting that Bd is enzootic in Taiwan where it causes subclinical infections. While amphibian species in Taiwan are currently threatened by habitat loss, our study indicates that Bd is in an endemic equilibrium with the populations and species we investigated. However, ongoing surveillance of the infection is warranted, as changing environmental conditions may disturb the currently stable equilibrium. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES In Taiwan, endovascular aneurysm repair for treating abdominal aortic aneurysms (AAA) was introduced in 2004 and became reimbursable in February 2010. We evaluated the real-world practice and safety of endovascular aneurysm repair in Taiwan. METHODS Patients who underwent repair operations for AAA (open or endovascular) from 2000 to 2016 were enrolled (n = 11485). Outcome statistics (during the index hospitalization: length of stay, rate of ischaemic bowel disease and 30-day mortality; after discharge: 30-day readmission rate, 2-year mortality, 2-year reintervention rate and 2-year paraplegia rate) were calculated for each half-year cohort. Propensity score-based stabilized weights were used to balance covariates among each half-year cohort. Interrupted time-series analysis was then performed. RESULTS The elective and emergency ratio of AAA repair was 50:50 from 2000 to 2004 and became 60:40 from 2010 to 2016. The half-year rate of endovascular aneurysm repair was 0% in 2000 to 2004/06, 83.16% in 2010 and 98.1% in 2016. Interrupted time series analysis revealed that after endovascular aneurysm repair became reimbursable, both elective and emergency groups had a reduction in length of stay (−4.2 days, P  < 0.0001; −1.5 days, P  = 0.0928) and 30-day mortality (−5.22%, P  = 0.0702; −7.76%, P  = 0.0086) but a significant increase in the reintervention rate (5.05%, P  = 0.0031; 4.36%, P  = 0.0097). CONCLUSIONS Endovascular aneurysm repair was predominantly used in treating AAAs after it was reimbursed in Taiwan. Endovascular aneurysm repair is efficacious regarding short-term outcomes but increased the 2-year reintervention rate in both groups. [ABSTRACT FROM AUTHOR]

In most countries, the current goal for greenhouse gas emission reduction is to achieve a 50% reduction by 2050 with a carbon neutrality target. Most energy policies have been to adopt at least 20% renewable energies in the country energy portfolio. This study conducted a comparative cost analysis on various carbon emission reduction options: reducing fossil energies (including coal, natural gas, and petroleum), increasing renewable energies (including hydroelectric power, wind power, photovoltaics, and wood fuel), and increasing afforestation (including coniferous forests, broadleaved forests, and mixed coniferous-broadleaved forests). In analyzing the discounted costs per unit of carbon reduction, this study explored the costs of these options at a fixed amount of carbon reduction, which means the lower the costs, the more effective the carbon emission reduction. Taking Taiwan as an example, the results indicated that coal-fired power has the lowest cost (US$24.80 per ton of CO 2). The costs of other energy sources (i.e., natural gas, petroleum, hydroelectric power, wind power, solar power, and wood fuel) are US$79.72–182.17 per ton of CO 2. The cost of afforestation for reducing carbon emissions is US$34.68–64.82 per ton of CO 2 , lower than the cost of adopting renewable energies assuming no technological advancement in current renewable energies. • Emission reduction options include reducing fossil energies, increasing renewable energies, and increasing afforestation. • A comparative cost analysis was conducted on the above options to achieve the carbon reduction target. • The lower the costs, the more effective the emission reduction. • Producing forest carbon sequestration indeed costs lower than other options. [ABSTRACT FROM AUTHOR]

Introduction: Pangenotypic direct-acting antivirals are expected to cure hepatitis C virus (HCV) in more than 95% of treated patients. However, data on the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) in Taiwan are limited. This study aims to characterize the patient population in the nationwide Taiwan Association for the Study of the Liver (TASL) HCV Registry and evaluate treatment outcome in Taiwanese patients receiving SOF/VEL. Methods: This study was a retrospective-prospective, observational, multicenter, real-world analysis. Adults with chronic hepatitis C were treated with SOF/VEL 400/100 mg ± ribavirin for 12 weeks. The primary outcome was sustained virologic response 12 weeks after end of therapy (SVR12). Factors associated with not achieving SVR12 were evaluated using logistic regression and covariate analysis. Safety was also assessed. Results: In total, 3480 patients were included: 86.8% genotype 1/2, 2.8% genotype 3, 0.1% genotype 4/5, 9.6% genotype 6; unclassified, 0.8%; 12.2% compensated cirrhosis; 3.3% decompensated cirrhosis; and 15.8% chronic kidney disease. Overall SVR12 rate was 99.4% (genotype 1, 99.5%; genotype 2, 99.4%; genotype 3, 96.9%; genotype 4, 100%; genotype 6, 99.7%). SVR12 rates among patients with compensated cirrhosis, decompensated cirrhosis, and chronic kidney disease stages 4–5 were 99.5%, 100%, and 100%, respectively. There were 21 patients (0.6%) who did not achieve SVR12. Factors associated with failure were treatment adherence below 60%, high viral load, and genotype 3 (p < 0.001, p = 0.028, and p = 0.001, respectively). Adverse events occurred in 10% of patients; 0.6% were serious and one was related to treatment. Treatment discontinuation occurred in 0.3% of patients; none were treatment related. The estimated glomerular filtration rate remained stable throughout treatment and follow-up, regardless of baseline values and cirrhosis status. Conclusion: SOF/VEL was highly effective and well tolerated in Taiwanese patients, irrespective of viral genotype, liver disease severity, and comorbidities. [ABSTRACT FROM AUTHOR]

Background and Aim: It is currently unknown how hepatitis C virus (HCV) eradication with pegylated interferon and ribavirin (PR) therapy affects the incidence of new‐onset liver cirrhosis (LC) in patients without cirrhosis and the incidence of decompensated liver disease (DLD) or hepatocellular carcinoma (HCC) in patients with cirrhosis. Methods: Taiwanese chronic hepatitis C cohort (T‐COACH) is a nationwide HCV registry cohort from 23 hospitals in Taiwan recruited between 2003 and 2015. This study enrolled 10 693 patients with chronic hepatitis C (CHC), linked to the Taiwan National Health Insurance Research Database, receiving PR therapy for at least 4 weeks for new‐onset LC and liver‐related complications (DLD or HCC). Results: Of the 10 693 patients, 1372 (12.8%) patients had LC, and the mean age was 54.0 ± 11.4 years. The mean follow‐up duration was 4.38 ± 2.79 years, with overall 46 798 person‐years. The 10‐year cumulative incidence rates of new‐onset LC were 5.0% (95% confidence interval [CI]: 3.2–7.7) in patients without cirrhosis with a sustained virologic response (SVR) and 21.9% (95% CI: 13.4–32.4) in those without SVR (hazard ratio [HR]: 0.22, P < 0.001). The 10‐year cumulative incidence rates of liver‐related complications were 21.4% (95% CI: 11.1–37.2) in patients with cirrhosis with SVR and 47.0% (95% CI: 11.1–86.0) in those without SVR after adjustment for age, sex, and competing mortality (HR: 0.52, P < 0.001). Conclusions: Hepatitis C virus eradication with PR therapy decreased the incidence of new‐onset LC in noncirrhotic patients and the incidence of liver‐related complications in cirrhotic patients with CHC. [ABSTRACT FROM AUTHOR]

Objectives: To explore the mechanisms mediating the different levels of gentamicin resistance in enterococci.Methods: Susceptibility testing with gentamicin and PCR of resistance determinants were performed in 149 enterococcal isolates. Genetic relatedness was characterized by MLST and PFGE analysis. Sequences of the aac(6')-Ie-aph(2'')-Ia gene and its surrounding environment were determined by Illumina sequencing. Stability assays of gentamicin resistance were carried out to evaluate the probability of loss of the high-level gentamicin resistance (HLGR) phenotype.Results: A total of 17 (11.4%) aac(6')-Ie-aph(2'')-Ia-positive enterococcal isolates (2 Enterococcus faecalis and 15 Enterococcus faecium) with non-HLGR phenotype were found. MLST analysis revealed that the 2 E. faecalis belonged to ST116 and ST618, while all the 15 E. faecium belonged to clonal complex 17. Sequence analysis demonstrated that IS1216V was inserted into the 5'-end of aac(6')-Ie-aph(2'')-Ia, leading to loss of HLGR phenotype. Three IS1216V insertion types were found, and type II and III were frequently found in E. faecium. Interestingly, a total of 38 aac(6')-Ie-aph(2'')-Ia-positive E. faecium with HLGR phenotype also had type II or type III IS1216V insertion. Sequencing of the aac(6')-Ie-aph(2'')-Ia-positive HLGR E. faecium E37 revealed that an intact aac(6')-Ie-aph(2'')-Ia was located adjacent to IS1216V-disrupted aac(6')-Ie-aph(2'')-Ia. In a non-antibiotic environment, E37 tended to lose HLGR phenotype with a probability of 1.57 × 10-4, which was largely attributed to homologous recombination between the intact and disrupted aac(6')-Ie-aph(2'')-Ia.Conclusions: This is first study to elucidate that the E. faecium is capable of changing its HLGR phenotype, which may contribute to adaptation to hospital environments with decreased usage of gentamicin. [ABSTRACT FROM AUTHOR]

• Low-elevation mountainous (LEM) areas are reclaimed for agriculture, impacting biodiversity and ecology. • Ecosystem service value and WTP of tea plantations in LEM areas was assessed by contingent valuation method. • Negative correlation between willingness-to-pay and education level in organic farming methods existed. • Farmers with high income & using both conventional and organic farming methods were willing to pay more. • Provisioning ecosystem services preferred; ecological value of tea plantations not inferior to some landscapes. Low-elevation mountainous (LEM) areas in some countries are reclaimed for agriculture (especially, for deep cultivation of tea trees) due to their accessibility, higher temperature, and more rainfall, contributing to biodiversity and ecological balance. However, extensive development in these areas causes lasting ecological damage; and hence it is crucial to evaluate the ecological value of these areas for formulating relevant ecological protection policies. Therefore, this study evaluated the ecosystem service value of tea plantations in LEM areas using the contingent valuation method based on the subjective consciousness of farmers, rather than an objective assessment. A questionnaire survey was conducted on tea farmers in Mingjian Township (which is one of the major tea-producing LEM areas in Mid-Taiwan); and ecosystem service values of tea plantations between conventional farming methods (CFMs) and organic farming methods (OFMs) were compared. Firstly, the differences in willingness to pay (WTP) for the samples including and excluding protest responses were investigated, and then a regression analysis to estimate the WTP price for maintaining the tea plantation ecology was conducted. Empirical results showed a significantly negative correlation between the WTP price and the education level of farmers in tea plantations using CFMs, but a significantly positive correlation in tea plantations using both CFMs and OFMs. Most respondents were male and used CFMs to operate tea plantations; and those with higher monthly income and using both CFMs and OFMs were willing to pay more. Regarding ecosystem services of tea plantations, the respondents preferred the "provisioning" ecosystem services, and were willing to pay an average of NT$ 718.92 and NT$ 794.32 per year for maintaining the ecology of tea plantations using CFMs and OFMs, respectively. The unit ecological value of tea plantations was not inferior to those of coniferous and broad-leaved forests, paddy fields, and algae reefs from previous studies. Finally, some suggestions are proposed for a reference in formulating relevant ecological protection policies. [ABSTRACT FROM AUTHOR]

Differences in the clinical phenotypes and outcomes of fungus-associated asthma remain unclear. We aimed to investigate the presentation of asthmatics with fungal sensitization and/or positive fungal isolates. Clinical characteristics, pulmonary function, microbiological data, allergy test reports, emergency department (ED) visits and hospitalizations were retrieved from the Chang Gung Research Database between 2010 and 2018; the largest electronic medical record-based database in Taiwan. Follow-up care was provided to each patient for 3 years. A total of 30,754 asthmatics were enrolled, and 7976 were eligible for analysis after applying the exclusion criteria. Of these patients, 694 had sputum examinations for fungi. The patients were divided into four groups: group 1, neither fungal sensitization nor fungal isolates in the sputum (n = 386); group 2, positive fungal sensitization (n = 58); group 3, positive fungal isolates (n = 217); and group 4, concomitant positive fungal sensitization and positive fungal isolates (n = 33). Asthmatic patients with fungal sensitization (groups 2 and 4) demonstrated significantly higher IgE levels compared with those without (groups 1 and 3). Group 4 patients had a higher frequency of hospitalization. Amongst patients under Global Initiative for Asthma (GINA) step 4–5 therapies, group 4 asthmatics possessed significantly higher incidence of respiratory failure. The prevalence of fungal sensitization and fungal isolates from sputum were even across asthmatic severities, but the clinical impact of fungi may be more significant among patients with more severe disease. [ABSTRACT FROM AUTHOR]

Uranium- and thorium-series isotopes are able to dissolve in hot spring waters and decay into radon, which could potentially cause health risk of the public. Besides, several environmental investigations can be carried out by measuring radon concentrations in hot spring waters. Accordingly, the measurement of radon in hot spring water is a significant issue. A practical method for measuring radon in hot spring water was developed by using a silicon semiconductor detector, RAD-7. The overall effect of detection efficiency and radon leakage of the measuring system were examined to calibrate the measured concentration of radon in hot spring waters. In addition, the effect of water temperature and pH on emanation of radon from standard 226Ra solutions as well as that of the measuring time on precision of the measurement were investigated. The correlation among temperature, pH and emanation of radon was then obtained. Further, the established method was applied to in-situ measurement to investigate the concentration of radon in hot spring waters from different geological areas in Taiwan. According to the percent error of the measurement, the measuring time for environmental samples was set as 50 min. The overall effect of radon leakage and detection efficiency of the measuring system was estimated to be 99.19 ± 7.47% with a standard rock source of 222Rn from NIST. Standard sources of 222Rn were prepared from 226Ra standard solutions with different pH values. The 226Ra standard solutions were sealed and stand for 38 days in a 250 mL vial specific for the RAD-7. After measured by the WAT250 mode of the RAD-7, the data were measured as (52.5 ± 8.9)%∼(83.6 ± 11.0)% of the prepared concentration of 222Rn (from 226Ra). The emanation rate of 222Rn from standard solution under pH 1.44–9.07 was (53.2 ± 6.9)% ∼(84.3 ± 11.1)% and decreased with pH to a minimum value at 7.00. Moreover, the effect of temperature increases with pH. High correlated trend curves (r2 = 0.9829–0.9999) for 222Rn emanation rate versus pH under different temperature were obtained. A smooth curved surface fitted by the MATLAB for emanation rate of 222Rn was accordingly derived. The 222Rn concentrations in waters of the Beitou Hot Spring (acid-digestion sulfate spring on sedimentary rock strata), Wulai Hot Spring (sodium bicarbonate spring on metamorphic rock strata), Choshuitan (sodium bicarbonate spring on mudstone strata) and Zhaori Hot Spring (acid-digestion sulfate spring on andesite strata) were measured with RAD-7 by WAT250 for 50 min and then calibrated by 222Rn emanation rate estimated above, which were 215 ± 37 (Bq/m3), 6797 ± 1073 (Bq/m3), 2124 ± 577 (Bq/m3) and 26644 ± 2768 (Bq/m3). • A practical method for measuring Rn in hot spring water was developed. • Correlation among water temperature, pH and emanation of Rn was obtained. • A smooth curved surface fitted by the MATLAB for Rn emanation was derived. • This method was applied to in-situ measurement of Rn in hot spring waters in Taiwan. [ABSTRACT FROM AUTHOR]

An increased incidence of pulmonary tuberculosis (PTB) among patients with pulmonary diseases exposed to air pollution has been reported. To comprehensively investigate the association between pneumonia (PN) and air pollution with PTB through a large-scale follow-up study. We conducted a retrospective study using data from the Kaohsiung Medical University Hospital Research Database and the Taiwan Air Quality Monitoring Database. We included adult patients with PN, PTB and other comorbidities according to ICD-9 codes. Control subjects without PN were matched by age, sex and ten comorbidities to each PN patient at a ratio of 4:1. A total of 82,590 subjects were included. The PTB incidence rate was significantly higher in the PN group (2,391/100,000) than in the control group (1,388/100,000). The crude hazard ratio (HR) of PN-associated PTB incidence decreased with time, and the overall 7 years the HR (95% confidence interval; CI) was 1.74 (1.55-1.96). The overall adjusted HR and 95% CI of PN-related PTB in the multivariate Cox regression analysis was 3.38 (2.98-3.84). In addition, there was a cumulative lag effect of all air pollutants within 30 days of exposure. The peak adjusted HRs for PTB were noted on the 3rd, 8th, 12th and 12th days of PM 2.5 , O 3 , SO 2 and NO exposure, respectively. The overall peak HRs (95% CI) of PM 2.5 , O 3 , SO 2 and NO were 1.145 (1.139-1.152), 1.153 (1.145-1.161), 1.909 (1.839-1.982) and 1.312 (1.259-1.367), respectively, and there was a synergistic effect with pneumonia on the risk of PTB. A strong association was found between past episodes of PN and the future risk of PTB. In addition, air pollutants including PM 2.5 , SO 2 , O 3 and NO, together with previous episodes of PN, had both long-term and short-term impact on the incidence of PTB. [Display omitted] • Past pneumonia (PN) episode is strongly related with later tuberculosis (TB) risk. • The adjusted hazard ratio (aHR) for TB risk after PN episode is 3.38 (2.98–3.84). • PM 2.5 , O 3 , SO 2 and NO have both long-term and short-term effects on TB risk. • The peak aHR of PM 2.5 , O 3 , SO 2 and NO noted on occurred 3, 8, 12 and 12 days before TB onset. • PM 2.5 , SO 2 , O 3 , NO and PN have synergistic effects on TB, especially SO 2 and PM 2.5 [ABSTRACT FROM AUTHOR]

Background: The results of long-term renal evolution in HCV-infected patients using sofosbuvir and velpatasvir (SOF/VEL), with or without ribavirin (RBV), are lacking. Aims: We evaluated the renal safety for HCV-infected patients receiving SOF/VEL. Methods: Between 1 June 2019 and 6 July 2020, we included 594 HCV-infected patients receiving SOF/VEL +/− RBV for 12 weeks in Taiwan. Viral eradication rate (defined by sustained virological response at week 12 post-treatment; SVR12) and changes to renal function were considered. Results: SVR12 was achieved in 99.3% (590/594) upon per-protocol analysis. Patients saw improved hepatobiliary function and fibrosis after the start of SOF/VEL therapy. For renal function, those with baseline estimated glomerular filtration rate (eGFR) ≥ 60 (mL/min/1.73 m2) experienced transient on-treatment reduction in renal function that improved upon ending treatment, but recurrent eGFR degradation during one-year follow-up. The use of RBV (OR = 5.200, 95% CI: 1.983–13.634, p = 0.001) was a significant risk factor at SVR24, while diabetes mellitus (OR = 2.765, 95% CI: 1.104–6.922, p = 0.030) and the use of RBV (OR = 3.143, 95% CI: 1.047–9.435, p = 0.041) were identified as significant risk factors of worsening renal function at SVR48. SOF/VEL did not worsen renal function among those with stage 4–5 chronic kidney disease (CKD) who were not receiving dialysis. Conclusions: A trend of decline in eGFR at 1 year after SOF/VEL treatment was observed among diabetic patients with baseline eGFR ≥ 60 (mL/min/1.73 m2) and concomitant use of RBV. The close monitoring of renal function is warranted. Further study should be conducted in order to weigh the risks and benefit of RBV. [ABSTRACT FROM AUTHOR]

A retrospective cohort study was conducted using claims data from Taiwan's National Health Insurance program to assess the effect of diabetic pay-for-performance (P4P) program on major adverse limb events (MALE) and major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). This study included patients with T2DM who had completed or not completed a 1-year P4P program from 2002 to 2013. Propensity-score matching was used to balance the baseline characteristics between groups. The Cox proportional-hazard model and Fine and Gray subdistribution hazard model were used to examine the association between P4P and the risks of MALE, MACE, systemic thromboembolism (ST), heart failure (HF) hospitalization, and all-cause mortality. Patients who underwent the P4P program had a significantly decreased incidence of MALE (2.0% vs. 2.6%, subdistribution hazard ratio [SHR] 0.73, 95% CI 0.71-0.76). Regarding the individual components, the P4P group demonstrated lower risks for foot ulcer (1.1% vs 1.3%, SHR 0.80, 95% CI 0.77-0.84), gangrene (0.57% vs 0.93%, SHR 0.59, 95% CI 0.56-0.63), percutaneous transluminal angioplasty (0.61% vs 0.79%, SHR 0.72, 95% CI 0.68-0.77), and amputation (0.46% vs 0.75%, SHR 0.58, 95% CI 0.55-0.62). In addition, the risks of MACE, ST, HF hospitalization, and all-cause mortality were remarkably lower in the P4P group. The P4P program might significantly reduce critical events of MALE, MACE, ST, HF, and mortality in the diabetic population. [ABSTRACT FROM AUTHOR]

Background: preterm and critically ill neonates often experience clinically suspected sepsis during their prolonged hospitalization in the neonatal intensive care unit (NICU), which can be the initial sign of final adverse outcomes. Therefore, we aimed to utilize machine learning approaches to predict neonatal in-hospital mortality through data-driven learning. Methods: a total of 1095 neonates who experienced clinically suspected sepsis in a tertiary-level NICU in Taiwan between August 2017 and July 2020 were enrolled. Clinically suspected sepsis was defined based on clinical features and laboratory criteria and the administration of empiric antibiotics by clinicians. The variables used for analysis included patient demographics, clinical features, laboratory data, and medications. The machine learning methods used included deep neural network (DNN), k-nearest neighbors, support vector machine, random forest, and extreme gradient boost. The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). Results: the final in-hospital mortality of this cohort was 8.2% (90 neonates died). A total of 765 (69.8%) and 330 (30.2%) patients were randomly assigned to the training and test sets, respectively. Regarding the efficacy of the single model that most accurately predicted the outcome, DNN exhibited the greatest AUC (0.923, 95% confidence interval [CI] 0.953–0.893) and the best accuracy (95.64%, 95% CI 96.76–94.52%), Cohen's kappa coefficient value (0.74, 95% CI 0.79–0.69) and Matthews correlation coefficient value (0.75, 95% CI 0.80–0.70). The top three most influential variables in the DNN importance matrix plot were the requirement of ventilator support at the onset of suspected sepsis, the feeding conditions, and intravascular volume expansion. The model performance was indistinguishable between the training and test sets. Conclusions: the DNN model was successfully established to predict in-hospital mortality in neonates with clinically suspected sepsis, and the machine learning algorithm is applicable for clinicians to gain insights and have better communication with families in advance. [ABSTRACT FROM AUTHOR]