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Introduction: Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are prevalent in Taiwan. Few studies have investigated the associations between obesity indices with GERD and PUD simultaneously. This study aimed to investigate the correlations among obesity indices with GERD and PUD in a large cohort of participants, around 120,000, in the Taiwan Biobank (TWB). Methods: A total of 121,583 participants (male: 43,698; female: 77,885; mean age 49.9 ± 11.0 years) were included to analyze the associations among obesity indices, including body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), abdominal volume index (AVI), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose index (TyG index), with GERD and PUD. Self-reported GERD and PUD were obtained by questionnaires. Multivariate logistic regression analysis was employed to analyze the relationship between obesity indices with GERD and PUD. Results: The prevalence of GERD and PUD was 13.7% and 14.6%, respectively. After multivariable analysis, high WHR (odds ratio [OR] = 1.009, p < 0.001), WHtR (OR = 1.005, p = 0.003), BRI (OR = 1.022, p = 0.005), AVI (OR = 1.013, p < 0.001), LAP (OR = 1.001, p < 0.001), TyG index (OR = 1.068, p < 0.001), and VAI (OR = 1.013, p = 0.002) were significantly associated with GERD, except BMI (p = 0.384). On the other hand, low BMI (OR = 0.984; p < 0.001) and AVI (OR = 0.994; p = 0.036) were significantly associated with PUD. However, the values of WHR (p = 0.151), WHtR (p = 0.304), BRI (p = 0.452), LAP (p = 0.799), VAI (p = 0.347), and TyG index (p = 0.642) were not. Conclusion: This study found that high obesity indices are associated with GERD, but low obesity indices are associated with PUD in a large Taiwanese population study. Our findings may alert physicians to notice that different obesity index may be associated with different gastrointestinal disorder.

Balance control, a complex sensorimotor skill, declines with age. Assessing balance is crucial for identifying fall risk and implementing interventions in the older population. This study aimed to measure age-dependent changes in static and dynamic balance using inertial measurement units in a clinical setting. This study included 82 healthy participants aged 20–85 years. For the dynamic balance test, participants stood on a horizontally swaying balance board. For the static balance test, they stood on one leg. Inertial measurement units attached to their bodies recorded kinematic data, with average absolute angular velocities assessing balance capabilities. In the dynamic test, the younger participants had smaller average absolute angular velocities in most body parts than those of the middle-aged and older groups, with no significant differences between the middle-aged and older groups. Conversely, in the single-leg stance tests, the young and middle-aged groups outperformed the older group, with no significant differences between the young and middle-aged groups. Thus, dynamic and static balance decline at different stages with age. These results highlight the complementary role of inertial measurement unit-based evaluation in understanding the effect of age on postural control mechanisms, offering valuable insights for tailoring rehabilitation protocols in clinical settings.

The exhaust back pressure of diesel engines is becoming increasingly higher nowadays. In order to keep discharging exhaust unhindered and operating smoothly under high exhaust back pressure, a large reduction in engine maximum brake output is often observed, as well as increased fuel consumption and lower combustion efficiency with heavy exhaust smokes. In our previous study, “Applicability of Reducing Valve Timing Overlap for Diesel Engines under High Exhaust Back Pressure”, a reduced valve timing overlap of 12 °CA partially improves the brake output and BSFC for a fixed-geometry turbocharged diesel engine under high exhaust back pressures. A potential solution for restoring the brake output under high exhaust back pressures could be the use of variable-geometry turbochargers. In this study, a variable-geometry turbocharger is applied to a diesel engine to study the engine performance characteristics and applicability, especially the further improvement of brake output and the brake-specific fuel consumption of the engine. Continuing with the results of our previous research, a basic setting of 12 °CA for the valve timing overlap is set up for the subsequent engine performance simulations in this study (using GT-Power SW). Via simulation, exhaust back pressures of 25 kPa, 45 kPa, and 65 kPa gauge are studied for a turbocharged diesel engine. The results for the engine parameters, including brake output, brake-specific fuel consumption, compressor outlet temperature, turbine inlet temperature, intake air mass flow rate, and exhaust mass flow rate are analyzed. The results of the variable-geometry turbocharger, including turbocharger speed, pressure ratios and efficiencies of compressor and turbine are also analyzed. The results indicate that the brake output and brake-specific fuel consumption are effectively improved under full-load operation with an adequate variable-geometry turbocharger rack position. Operable ranges of rack position are also set up for different back pressures.

Spasticity measured using clinical scales, such as the modified Ashworth scale (MAS), may not sufficiently evaluate the effectiveness of therapeutic interventions and predict prognosis. This study aimed to compare changes in H-reflex excitability in the spastic and unimpaired upper and lower limbs of patients with acute and chronic stroke. We also investigated the relationship between the degree of spasticity as assessed by the MAS and motor neuron pool excitability with by analyzing H-reflex excitability. Sixty adult patients with a first-ever stroke were recruited for this study. MAS scores were recorded in the post-stroke upper and lower limb muscles. H-reflexes and M-responses of the bilateral flexor carpi radialis and soleus were tested by stimulating the median and tibial nerves. The results showed that both the ratio of the maximal size of the H-reflex (Hmax) to the maximal size of the M-response (Mmax) and the ratio of the developmental slope of H-reflex (Hslp) to that of the M-responses (Mslp) were significantly higher on the spastic side than on the unimpaired side for the upper and lower limbs. In contrast, the ratio of the threshold of the H-reflex (Hth) to the threshold of the M-response (Mth) only showed significant differences between the two sides in the upper limbs. The Hslp/Mslp paretic/non-paretic ratio was increased in patients with MAS scores of 2 or 3 compared to MAS scores of 1 for both the upper and lower limbs, whereas the Hmax/Mmax paretic/non-paretic ratio showed significant differences between MAS scores of 2 or 3 and 1 only in the upper limbs. Moreover, in either the spastic or unimpaired sides, there were no significant differences in any of the three motoneuron pool excitability parameters, Hmax/Mmax, Hslp/Mslp, and Hth/Mth, between the shorter chronicity (time post-stroke ≤6 months) and longer chronicity groups (time post-stroke >6 months) for both the upper and lower limbs. These results suggest that Hslp/Mslp could be a potential neurophysiological indicator for evaluating the degree of spasticity in both the upper and lower limbs of patients with hemiplegia. The MAS and Hslp/Mslp characterize clinical and neurophysiologic spasticity, respectively, and could be used as an integrated approach to evaluate and follow up post-stroke spasticity.

In today’s digital age, the financial industry, a cornerstone of the global economy, is undergoing monumental shifts. While business performance hinges on proficient leadership, the seismic wave of digital transformation poses new challenges and magnifies the need for specific leadership competencies. The urgency is clear: adapt or become obsolete. However, there is a lack of clarity regarding which competencies are essential during such transformations. To address this gap, the purpose of this study is to identify the leadership competencies that leaders in the financial industry should possess during the digital transformation process and to determine the influential relationships among these competencies and which ones are highly influential. This paper extensively investigates the criteria for evaluating leadership competencies and integrates expert judgments to construct an evaluation framework for leadership competencies during digital transformation. The Z-based decision-making trial and evaluation laboratory (Z-DEMATEL) technique was applied to identify the influential relationships among the criteria and generate influence weights for each criterion. In addition, based on the results of Z-DEMATEL, an Influence Classification Map (ICM) was plotted that categorized the criteria into four groups: core, driving, independent, and impact. Management implications and improvement suggestions are provided accordingly. Z-DEMATEL enhances the general form of fuzzy DEMATEL. By integrating the Z-fuzzy theory, Z-DEMATEL not only accounts for the uncertainty of the evaluation environment but also measures the confidence level of experts. Taking Taiwan’s financial industry as a case study, this study revealed that “vision and imagination,” “critical analysis,” and “strategic perspective” were the top three criteria with higher weights, while “critical analysis” and “interpersonal sensitivity” were the core criteria. Business managers can use the results to design leadership training programs that meet the requirements of digital transformation and ultimately improve the performance of organizations during the transformation. Moreover, the concepts and methods presented in this study can be applied to other industries that are embarking on their digital transformation journeys.