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In response to the growing demand for high-resolution rainfall data to support disaster prevention in Taiwan, this study presents an innovative approach for downscaling precipitation data. We employed a hierarchical architecture of Multi-Scale Residual Networks (MSRN) to downscale rainfall from a coarse 0.25-degree resolution to a fine 0.0125-degree resolution, representing a substantial challenge due to a resolution increase of over 20 times. Our results demonstrate that the hierarchical MSRN outperforms both the one-step MSRN and linear interpolation methods when reconstructing high-resolution daily rainfall. It surpasses the linear interpolation method by 15.1 and 9.1% in terms of mean absolute error and root mean square error, respectively. Furthermore, the hierarchical MSRN excels in accurately reproducing high-resolution rainfall for various rainfall thresholds, displaying minimal biases. The threat score (TS) highlights the hierarchical MSRN's capability to replicate extreme rainfall events, achieving TS scores exceeding 0.54 and 0.46 at rainfall thresholds of 350 and 500 mm per day, outperforming alternative methods. This method is also applied to an operational global model, the ECMWF's daily rainfall forecasts over Taiwan. The evaluation results indicate that our approach is effective at improving rainfall forecasts for thresholds greater than 100 mm per day, with more significant improvement for the 1- to 3-day lead forecast. This approach also offers a realistic visual representation of fine-grained rainfall distribution, showing promise for making significant contributions to disaster preparedness and weather forecasting in Taiwan. [ABSTRACT FROM AUTHOR]

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

Mango (Mangifera indica) is a widely enjoyed tropical fruit that is rich in numerous nutrients, but it is also a common allergenic fruit that can induce anaphylactic shock in some mango-sensitized individuals. To protect allergic consumers, a TaqMan real-time PCR is developed herein by targeting the major mango allergen GAPDH gene to identify mango in foods. To prevent interference by other ingredients in the foods, an internal amplification control (IAC) is established and incorporated into the developed qPCR. Under the optimized assay conditions, the developed assay can detect mango genomic DNA down to 10 pg/μL and effectively differentiate mango from 21 other fruits and vegetables. In the incurred assay, the developed qPCR has a limit of detection (LOD) of 10 μg/g and 330 μg/g of mango powder in juice and cookie, respectively. The assay exhibits a board spectrum, successfully detecting six mango cultivars, and has good accuracy and precision as calculated intra- and inter-assay CV values < 10%. Forty commercial processed foods were simultaneously analyzed using the developed method and a qPCR method that is officially recognized by the Taiwan FDA. The sensitivity and specificity of this assay were estimated to be 85% and 100%, respectively, based on the ingredient labeling of these products. Hence, this developed qPCR is an effective method for screening mango in processed foods. [ABSTRACT FROM AUTHOR]

Asset-based youth development has been proposed to be associated with health behaviors and psychological well-being in adolescents. This study aims to extend the current knowledge regarding the effects of positive youth development on weight status and psychosocial health outcomes in young adulthood using a large representative longitudinal sample. Data were retrieved from the Taiwan Youth Project that comprised a longitudinal cohort of adolescents (N = 2688) surveyed at grades 7, 8, 9, and 12, and at age 22. Principal component analysis was used to construct developmental asset scores based on 35 items selected from the relevant questions at wave 1. Outcomes were standardized scores of body mass index, self-rated healthiness and happiness, depressive symptomology and deviant behaviors in the subsequent waves. Generalized estimating equation analysis was applied to assess the impact of developmental assets on these repeatedly measured outcome variables. As compared to those with the highest quintile level of developmental assets, individuals with the lowest quintile level were more likely to rate themselves unhealthy (β = 0.33 [95% confidence interval 0.26, 0.40]) and unhappy (β = 0.47 [0.41, 0.54]) and report more depressive symptomatology (β = 4.18 [3.35, 5.01]) and deviant behaviors (β = 0.63 [0.44, 0.81]). No association was found between body mass index and developmental asset scores. The results concluded a longitudinal association between adolescent developmental assets and psychological and behavioral health outcomes. Further research may be required to investigate whether positive youth development could be translated into long-term benefits in adult physical conditions, such as obesity. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the association between daily steps recommendation and older adults' lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults.Methods: There were 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) attending both baseline and follow-up surveys. This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test).Results: This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95 % confidence interval [CI]: 1.04, 13.95; p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR = 3.53; 95 % CI: 1.05, 11.84; p = 0.04).Conclusions: Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults' lower-extremity performance. [ABSTRACT FROM AUTHOR]

Objectives: We examined the association between anogenital human papillomavirus (HPV) infection and sexual networks in men who have sex with men (MSM). Methods: A total of 253 MSM, 20 years of age and older, were recruited from the community in Southern Taiwan in 2015–2016. At baseline and at each follow-up visit, MSM were screened for HPV to identify 37 HPV genotypes. At the six-month follow-up, MSM were asked to fill out an egocentric network assessment and to report the last five persons with whom they had sex regarding the characteristics of sexual behavior with each network member. Results: A total of 182 participants (71.9%) returned for the follow-up and one third had at least one HPV type detected. A higher level of bridging network position calculated by the level of constraints in the network was significantly less likely to have HPV detection at the anal site. A high level of concurrency was associated with penile HPV detection (AOR = 3.16, 95% CI = 1.01–9.86). Conclusions: Identifying network-related characteristics can advance our understanding of high-risk populations and for prioritizing HPV vaccine recommendations. [ABSTRACT FROM AUTHOR]

Previous studies have unanimously agreed that despite the challenges of postmodernism, militaries should not and cannot be governed using an occupational model. However, what the notion of the value type of a postmodern army is should be clarified. This study investigates the changing values of postmodern militaries caused by external economic factors. For this research, a questionnaire and long-term investigation method were adopted to collect 262 cadet samples from the Taiwanese military, navy, and air force. The results of a cluster analysis showed that the cadets primarily comprised 3 types, that is, the devotion (DE) type, socially competent (SC) type, and the comfortable (CO) type. This study shows that the socially competent type best satisfies the value demands of the military. In addition, the enlistment motivations of this type of cadet are generally to alleviate family financial burdens, non-economic-related reasons, self-actualization, and patriotism. [ABSTRACT FROM AUTHOR]

In this study, an ensemble typhoon quantitative precipitation forecast (ETQPF) model was developed to provide typhoon rainfall forecasts for Taiwan. The ETQPF rainfall forecast is obtained by averaging the pick-out cases, which are screened using certain criterion based on given typhoon tracks from an ensemble prediction system (EPS). Therefore, the ETQPF model resembles a climatology model. However, the ETQPF model uses the quantitative precipitation forecasts (QPFs) from an EPS instead of historical rainfall observations. Two typhoon cases, Fanapi (2010) and Megi (2010), are used to evaluate the ETQPF model performance. The results show that the rainfall forecast from the ETQPF model, which is qualitatively compared and quantitatively verified, provides reasonable typhoon rainfall forecasts and is valuable for real-time operational applications. By applying the forecast track to the ETQPF model, better track forecasts lead to better ETQPF rainfall forecasts. Moreover, the ETQPF model provides the 'scenario' of the typhoon QPFs according to the uncertainty of the forecast tracks. Such a scenario analysis can provide valuable information for risk assessment and decision making in disaster prevention and reduction. Deficiencies of the ETQPF model are also presented, including that the average over the pick-out case usually offsets the extremes and reduces the maximum ETQPF rainfall, the underprediction is especially noticeable for weak phase-locked rainfall systems, and the ETQPF rainfall error is related to the model bias. Therefore, reducing model bias is an important issue in further improving the ETQPF model performance. [ABSTRACT FROM AUTHOR]

Background/purpose: Despite effective vaccine programs, tetanus is occasionally observed in adults. We reviewed clinical presentation data for adult patients with tetanus in the post-vaccine era in Taiwan.Methods: We retrospectively reviewed the medical records of all adult patients (age >18 years) discharged from Chang-Gung Memorial Hospital at Lin-Ko (CGMHLK) after treatment for tetanus between January 1996 and July 2005. Data regarding demographic characteristics, clinical manifestation, treatment, and outcome were collected. To assess the features for different age groups, patients were divided into those aged ≥65 years and those aged <65 years. To identify risk factors for respiratory failure, the patients were classified as those with and without respiratory failure.Results: Twenty-three patients with tetanus, 11 (48%) women and 12 (52%) men, were included in the study. The average age was 57 ± 18 years (range 18-84 years). Eighteen (78%) patients had a history of acute injury. The average incubation period was 8 ± 5 days. The most common clinical presentation at onset was trismus (78%). Thirteen (57%) patients developed respiratory failure and underwent endotracheal intubation. The most common complication was pneumonia (30%). All the patients survived and recovered. Age ≥65 years was significantly associated with trismus, dysphagia, dysarthria, and pneumonia. Generalized tetanus subtype and pneumonia were significant risk factors for respiratory failure.Conclusion: This study revealed several characteristics of adult tetanus cases in the post-vaccine era in Taiwan. Further serological studies and improved tetanus vaccinations may be needed to ensure better protection, especially for high-risk populations. The exceptionally good prognosis for our patients confirms that appropriate treatment, including wound care, early diagnosis, proper medication, and prevention of complications, is essential in managing this traditional curable disease. [ABSTRACT FROM AUTHOR]

This study aims to propose a strategy to optimize the performance of the Support Vector Machine (SVM) scheme for extreme Meiyu rainfall prediction over southern Taiwan. Variables derived from Climate Forecast System Reanalysis (CFSR) dataset are the candidates for predictor selection. A series of experiments with different combinations of predictors and domains are designed to obtain the optimal strategy for constructing the SVM scheme. The results reveal that the accuracy (ACC), positive predictive values (PPV), probability of detection (POD), and F1-score can exceed 0.6 on average. Choosing the predictors associated with the Meiyu system and determine the domain associated with the correlations between selected predictors and predictand can improve the forecast performance. Our strategy shows the potential to predict extreme Meiyu rainfall in southern Taiwan with lead times from 16 h to 64 h. The F1-score analysis further demonstrates that the forecast performance of our scheme is stable, with slight inter-annual fluctuations from 1990 to 2019. Higher performance would be expected when the north of the South China Sea is characterized by stronger southwesterly flow and abundant low-level moisture for a given year. [ABSTRACT FROM AUTHOR]

Operational monsoon moisture surveillance and severe weather prediction is essential for timely water resource management and disaster risk reduction. For these purposes, this study suggests a moisture indicator using the COSMIC-2/FORMOSAT-7 radio occultation (RO) observations and evaluates numerical model experiments with RO data assimilation. The RO data quality is validated by a comparison between sampled RO profiles and nearby radiosonde profiles around Taiwan prior to the experiments. The suggested moisture indicator accurately monitors daily moisture variations in the South China Sea and the Bay of Bengal throughout the 2020 monsoon rainy season. For the numerical model experiments, the statistics of 152 moisture and rainfall forecasts for the 2020 Meiyu season in Taiwan show a neutral to slightly positive impact brought by RO data assimilation. A forecast sample with the most significant improvement reveals that both thermodynamic and dynamic fields are appropriately adjusted by model integration posterior to data assimilation. The statistics of 17 track forecasts for typhoon Hagupit (2020) also show the positive effect of RO data assimilation. A forecast sample reveals that the member with RO data assimilation simulates better typhoon structure and intensity than the member without, and the effect can be larger and faster via multi-cycle RO data assimilation. [ABSTRACT FROM AUTHOR]

The Model for Prediction Across Scales (MPAS) is used to simulate the East Asian winter monsoon (EAWM) over the 2011–2020 winter. The 45 day hindcasts are made with 30 km horizontal resolution and constructed to a time-lagged ensemble system. The climatology, the major modes of EAWM variability, and the blocking activities are examined. The evaluation results reveal that MPAS can simulate the climatologic characteristics of EAWM reasonably, with a surface cold bias of 4% and a positive rainfall bias of 9% over East Asia. MPAS can perform skillfully in the forecasts of surface temperature probability of East Asia and is more reliable in detecting below normal and above normal events. The features that influence the EAWM variability are also analyzed. MPAS simulates reasonably in the occurrence frequency of blocking high in both locations and duration time. The empirical orthogonal function analysis also shows that MPAS can capture the two major modes of the surface temperature of EAWM. On the other hand, it is also found that a biased sea surface temperature may modify the circulations over the Western Pacific and affect the simulated occurrence frequency of cold events near Taiwan during winter. [ABSTRACT FROM AUTHOR]

A pluvial flash flood is rapid flooding induced by intense rainfall associated with a severe weather system, such as thunderstorms or typhoons. Additionally, topography, ground cover, and soil conditions also account for the occurrence of pluvial flash floods. Pluvial flash floods are among the most devastating natural disasters that occur in Taiwan, and these floods always /occur within a few minutes or hours of excessive rainfall. Pluvial flash floods usually threaten large plain areas with high population densities; therefore, there is a great need to implement an operational high-performance forecasting system for pluvial flash flood mitigation and evacuation decisions. This study developed a high-performance two-dimensional hydrodynamic model based on the finite-element method and unstructured grids. The operational high-performance forecasting system is composed of the Weather Research and Forecasting (WRF) model, the Storm Water Management Model (SWMM), a two-dimensional hydrodynamic model, and a map-oriented visualization tool. The forecasting system employs digital elevation data with a 1-m resolution to simulate city-scale pluvial flash floods. The extent of flooding during historical inundation events derived from the forecasting system agrees well with the surveyed data for plain areas in southwestern Taiwan. The entire process of the operational high-performance forecasting system prediction of pluvial flash floods in the subsequent 24 h is accomplished within 8–10 min, and forecasts are updated every six hours. [ABSTRACT FROM AUTHOR]

Flash floods are different from common floods because they occur rapidly over short time scales, and they are considered to be one of the most devastating natural hazards worldwide. Mountainous areas with high population densities are particularly threatened by flash floods because steep slopes generate high flow velocities. Therefore, there is a great need to develop an operational forecasting system (OFS) for better flash flood prediction and warning in mountainous regions. This study developed an OFS through the integration of meteorological, hydrological, and hydrodynamic models. Airborne light detection and ranging (LiDAR) data were used to generate a digital elevation model (DEM). The OFS employs high-density and high-accuracy airborne LiDAR DEM data to simulate rapid water level rises and flooding as the result of intense rainfall within relatively small watersheds. The water levels and flood extent derived from the OFS are in agreement with the measured and surveyed data. The OFS has been adopted by the National Science and Technology Center for Disaster Reduction (NCDR) for forecasting flash floods every six hours in a mountainous floodplain in Taiwan. The 1D and 2D visualization of the OFS is performed via the National Center for Atmospheric Research Command Language (NCL). [ABSTRACT FROM AUTHOR]

Typhoon-induced storm surges are catastrophic disasters in coastal areas worldwide, although typhoon surges are not extremely high in Taiwan. However, the rising water level around an estuary could be a block that obstructs the flow of water away from the estuary and indirectly forms an overflow in the middle or lower reaches of a river if the occurrence of the highest storm surge (HSS) coincides with the highest astronomical tide (HAT). Therefore, assessing the highest storm tide (HST, a combination of the HSS and HAT) hazard level along the coast of Taiwan is particularly important to an early warning of riverine inundation. This study hindcasted the storm surges of 122 historical typhoon events from 1979 to 2018 using a high-resolution, unstructured-grid, surge-wave fully coupled model and a hybrid typhoon wind model. The long-term recording measurements at 28 tide-measuring stations around Taiwan were used to analyze the HAT characteristics. The hindcasted HSSs of each typhoon category (the Central Weather Bureau of Taiwan classified typhoon events into nine categories according to the typhoon's track) were extracted and superposed on the HATs to produce the individual potential HST hazard maps. Each map was classified into six hazard levels (I to VI). Finally, a comprehensive potential HST hazard map was created based on the superposition of the HSSs from 122 typhoon events and HATs. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) causes superficial infections such as cellulitis or invasive infections such as osteomyelitis; however, differences in MRSA isolates from cellulitis (CL-MRSA) and from osteomyelitis (OM-MRSA) at the same local area remain largely unknown. A total of 221 MRSA isolates including 106 CL-MRSA strains and 115 OM-MRSA strains were collected at Chang-Gung Memorial Hospital in Taiwan between 2016 and 2018, and their genotypic and phenotypic characteristics were compared. We found that OM-MRSA isolates significantly exhibited higher rates of resistance to multiple antibiotics than CL-MRSA isolates. Genotypically, OM-MRSA isolates had higher proportions of the SCCmec type III, the sequence type ST239, and the spa type t037 than CL-MRSA isolates. Besides the multidrug-resistant lineage ST239-t037-SCCmecIII more prevalent in OM-MRSA, higher antibiotic resistance rates were also observed in several other prevalent lineages in OM-MRSA as compared to the same lineages in CL-MRSA. Furthermore, when prosthetic joint infection (PJI) associated and non-PJI-associated MRSA strains in osteomyelitis were compared, no significant differences were observed in antibiotic resistance rates between the two groups, albeit more diverse genotypes were found in non-PJI-associated MRSA. Our findings therefore suggest that deep infections may allow MRSA to evade antibiotic attack and facilitate the convergent evolution and selection of multidrug-resistant lineages. [ABSTRACT FROM AUTHOR]

The strategies of the extrapolation adjusted by model prediction (ExAMP) blending scheme, which trusts the field pattern predicted by extrapolation and allows the field intensity to be adjusted by numerical weather prediction (NWP), for rainfall nowcasting are analyzed in this study. The McGill algorithm for precipitation nowcasting by Lagrangian extrapolation (MAPLE) and the Weather Research and Forecasting (WRF) model serve as the extrapolation and NWP models, respectively. Seven 150-min rainfall nowcasting experiments with different strategies are carried out for 37 sampled periods from seven heavy rainfall events in Taiwan in 2019. The results of the overall statistics indicate that, for the extrapolation component, extrapolating the current rainfall rate estimated from the lowest dual-polarimetric radar observations is a superior strategy. The ExAMP scheme that blends the MAPLE and WRF forecasts can surpass both components in 150-min rainfall nowcasting, and an empirical limitation on the innovation of intensity during the blending procedure is found unnecessary in this study. Moreover, the spatial performance for two contrasting events reveals the ability of ExAMP in grasping the rainfall strengthening and weakening in different areas. The skill statistics separately at rainfall strengthening gauges and weakening gauges further prove the effectiveness of ExAMP even though it is effective in intensity correction instead of pattern correction. [ABSTRACT FROM AUTHOR]

In Taiwan, the coastal hazard from typhoon-induced storm waves poses a greater threat to human life and infrastructure than storm surges. Therefore, there has been increased interest in assessing the storm wave hazard levels for the nearshore waters of Taiwan. This study hindcasted the significant wave heights (SWHs) of 124 historical typhoon events from 1978 to 2017 using a fully coupled model and hybrid wind fields (a combination of the parametric typhoon model and reanalysis products). The maximum SWHs of each typhoon category were extracted to create individual storm wave hazard maps for the sea areas of the coastal zones (SACZs) in Taiwan. Each map was classified into five hazard levels (I to V) and used to generate a comprehensive storm wave hazard map. The results demonstrate that the northern and eastern nearshore waters of Taiwan are threatened by a hazard level IV (SWHs ranging from 9.0 to 12.0 m) over a SACZ of 510.0 km2 and a hazard level V (SWHs exceeding 12.0 m) over a SACZ of 2152.3 km2. The SACZs threatened by hazard levels I (SWHs less than 3.0 m), II (SWHs ranging from 3.0 to 6.0 m), and III (SWHs ranging from 6.0–9.0 m) are of 1045.2 km2, 1793.9 km2, and 616.1 km2, respectively, and are located in the western waters of Taiwan. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) have an increased risk of human papillomavirus (HPV) infection. This study aimed to assess the incidence, persistence, and clearance of anogenital HPV infections among MSM and the correlates in a 3-year community cohort study., Methods: From 2015 to 2019, MSM were recruited and followed up at 6, 12, 24, and 36 months in Taiwan. Questionnaires and anogenital swabs were collected at baseline and each follow-up visit. Thirty-seven HPV genotypes were tested and genotyped using the linear array HPV genotyping test. The incidence, persistence, and clearance rates of anogenital HPV infection and 95% confidence intervals (CIs) were estimated through Poisson regression. Correlates of the incidence and clearance rates were examined using a generalized estimating equations (GEE) model., Results: A total of 201 MSM were retained in the cohort study with a median age of 27 years (interquartile range [IQR]: 24-32) at baseline. The incidence, persistence, and clearance rates of any anal HPV infection among MSM were 43.6 (95% CI: 33.7-55.6), 23.4 (17.7-30.2), and 58.3 (45.1-74.1) per 1,000 person months (pms), respectively. The incidence, persistence, and clearance rates of any penile HPV infection among MSM were 26.8 (20.1-34.9), 13.4 (8.0-20.9), and 51.5 (37.8-68.5) pms, respectively. MSM who did not consistently use a condom in receptive sex (adjusted odds ratio [AOR]: 2.06, 95% CIs: 1.14-3.72) were more likely to acquire any anal HPV infection. Age at recruitment (1.05, 1.01-1.09) was positively associated with any penile HPV incidence. MSM with over one sex partner in receptive anal sex (0.53, 0.30-0.94) were less likely to clear any anal HPV infection. MSM who were unemployed/students (0.55, 0.30-0.98) were less likely to clear any penile HPV infection., Conclusion: High incidence and low clearance of anogenital HPV infection among MSM in the study serve as a reminder that this population needs to be targeted for HPV vaccination. It is essential for MSM to scale up HPV screening and adhere to safe sex., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhou, Tian, Lu, Yu, Li, Zhou, Lin, Strong and Zou.)

Abstract: Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Adolescence is a critical transition period in the course of human development. Although food insecurity (FI) has been shown to be associated with adverse mental health and sleep outcomes in US adolescents, there is a paucity of research examining the relationships between FI, mental health, and sleep outcomes in Taiwanese adolescents. Furthermore, it is unknown how the change of FI over time (i.e., the trajectory of FI) is related to health outcomes., Methods: The data come from the Taiwan Database of Children and Youth in Poverty, which is a national longitudinal project measuring FI in five survey waves (2009-2017). We employed group-based trajectory modeling to classify various FI trends over the five waves using STATA. Furthermore, a generalized estimating equation analysis was conducted with FI trajectories as the independent variable to see how FI trajectory is related to mental health and sleep outcomes., Results: In total, 1921 participants aged 12-18 years in the first wave were deemed valid for the analysis. We classified the participants into four FI trajectory groups: persistently low FI (24.8%), persistently moderate FI (64.7%), declining from high to low FI (4.1%), and food-secure groups (6.4%). As compared to food-secure adolescents, the persistently moderate FI group was more likely to have mental problems (β = 0.30, [95% confidence interval 0.21-0.38]), while the other FI groups were only marginally associated with mental health problems. Moreover, adolescents in the persistently low FI group (β = 0.13, [0.02-0.23]) and persistently moderate FI group (β = 0.39, [0.29-0.48]) were found to have more sleep problems than those in the food-secure group., Conclusions: Our study describes the FI profile of adolescents from economically disadvantaged families and the difficulties they might encounter. With this information, healthcare providers can aid adolescents in the early stages of mental health problems and provide guidance when appropriate.

Cabin crews being first responders, passengers' health assurance is also one of their main responsibilities. This study explored the association among first aid affect, work-related hardiness and self-efficacy of first aid, as well as the mediation role of work-related hardiness in airline cabin crews. Three self-reporting instruments were applied in this study: one was the first aid affect questionnaire, the second was a work-related hardiness questionnaire, the third was self-efficacy of the first aid questionnaire. Data were collected from 525 cabin crew members across five airlines in Taiwan (480 females and 45 males). The results showed that both exploratory and confirmatory factor analyses indicated that three instruments had satisfactory validity and reliability. Positive significant relationships were found among cabin crews' first aid affect, work-related hardiness and self-efficacy of first aid. Cabin crews' commitment dimension of work-related hardiness turned out to be positively related to self-efficacy of first aid. In addition, the results of the study also revealed that cabin crews' work commitment plays a mediating role between their first aid affect and self-efficacy of first aid. To enhance the self-efficacy of first aid, it is necessary for the airlines to strengthen cabin crews' work commitment. Furthermore, fostering cabin crews' first aid affect is also one an important training goal.

Background: To compare the outcomes after surgical intervention, including external fixation (EF) with the optional addition of K-pins or open reduction and internal fixation (ORIF) with a volar locking plate (VLP), in patients with distal radius fracture aged > 80 years., Methods: We reviewed 69 patients with a distal radius fracture aged > 80 years who treated under surgical intervention from 2011 to 2017 retrospectively. Their demographic data and complications were recorded. Preoperative, postoperative, and last follow-up plain films were analyzed. The functional outcomes of wrist range of motion were also evaluated., Results: 41 patients were treated with EF with the optional addition of K-pins, while 28 patients were treated with ORIF with a VLP. The radiological parameters, including ulnar variance and radial inclination, at the last follow-up were significantly more acceptable in the VLP group (p = 0.01, p = 0.03, respectively). The forearm supination was significantly better in patients treated with VLP (p = 0.002). The overall incidence of complications was lower in the VLP group (p = 0.003)., Conclusion: VLP provides better radiological outcomes, wrist supination and lower complication rates than EF. Therefore, although EF is still widely used because of its acceptable results and easy application, we recommend VLP as a suitable treatment option for distal radius fracture in the geriatric population aged > 80 years.

Objective: To investigate the correlation between the utilization of nuclear medicine diagnostic procedures and the mortality of women with breast cancer., Subjects and Methods: Based on the National Health Insurance Research Database (NHIRD), we studied female breast cancer patients in 2012 who underwent whole-body bone scan, lymphoscintigraphy, or fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for possibly managing breast cancer metastases. The mortality of breast cancer was then followed up in 2017. Multiple linear regression analysis was applied to analyze the correlation between the use of any of these three nuclear medicine procedures and the mortality of breast cancer., Results: For patients with early-stage breast cancer, single lymphoscintigraphy was the most frequently performed nuclear medicine procedure, accounting for 36.4% of all three nuclear medicine procedures. For patients with late-stage breast cancer, single whole-body bone scan was the most frequently performed nuclear medicine procedure, accounting for 67.2% of all three nuclear medicine procedures. Mortality of breast cancer significantly increased with the prevalence of late-stage breast cancer (b=2.87, P=0.001) and significantly decreased in cases in which whole-body bone scan was used (b=-4.28, P=0.003)., Conclusion: The mortality of women with late-stage breast cancer was negatively related to the utilization of whole-body bone scan but not to the utilization of lymphoscintigraphy or the 18 F-FDG PET/CT scan. In women with early-stage breast cancer, no significant correlation existed between breast cancer mortality and the utilization of the above three nuclear medicine procedures.

Introduction: In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database., Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000-2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED., Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001)., Conclusion: This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it's crucial in early identification and treatment of ED in post-TBI patients.

Pomegranate ( Punica granatum L.) fruit has been demonstrated to have the inhibitory activities to various tumors. In this study, we try to uncover the molecular mechanism underlying the inhibitory capability of Taiwanese local pomegranate fruit to urinary bladder urothelial carcinoma. The results collected from the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay indicated that the ethanol extract of pomegranate peel exhibited better inhibitory activity to human urinary bladder urothelial carcinoma T24 and J82 cells than that of pulp. Furthermore, the ethylacetate layer of peel ethanol extract was observed to have the best inhibitory activity against urinary bladder urothelial carcinoma cells. One of the eight fractions (PEPE2 fraction) collected from the ethylacetate layer with Diaion HP-20 column chromatography demonstrated the highest inhibitory activity in urinary bladder urothelial carcinoma cells. The results of the flow cytometry and apoptotic pathway studies suggested that the inhibitory activity of PEPE2 fraction were attributed to the UBUC cell apoptosis. To confirm the above results, our results of xenograft-induced bladder tumor in nude mice showed that the oral consumption of the ethylacetate layer (2, 5, 10 and 100 mg/kg) could decrease the volume and weight of T24 tumors and caused the apoptosis in the xenografted tumors, which was observed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling assay. This study provided the likelihood that the traditionally non-edible pomegranate peel waste is re-utilized to make an affordable and promising chemopreventive product to prevent UBUC incidence or recurrence.

Objective: Primary quadriceps weakness/atrophy is a rare disorder with variable etiologies; therefore, this disorder has been regarded as a clinical syndrome rather than a distinct entity. However, three affected patients of a Taiwanese family demonstrate a uniform pattern of quadriceps weakness and atrophy, their clinical manifestations and pattern of inheritance may suggest a new disease entity., Patients and Methods: Three patients in a Taiwanese kindred with selective quadriceps weakness and atrophy, which began after age 40 years, were examined. To disclose the confines of this disorder, muscle CT scans, electromyography, nerve conduction studies and muscle biopsies were performed; and to unravel and better understand the nature of this disorder, histopathological, ultrastructural, immunocytochemical and genetic studies were carried out., Results: In two patients with long-standing disease, muscle imaging showed marked atrophy and fat replacement of the anterior thigh muscles and electromyography showed a mixture of myopathic and neuropathic changes. Muscle histopathology on the mildly affected tibialis anterior showed myopathic changes with myofibrillar degeneration and secondary neurogenic alterations. Immunocytochemical staining was not diagnostic but excluded the dystrophinopathies and other well-known muscular dystrophies., Conclusion: All previously identified diseases resulting in quadriceps weakness and atrophy have been ruled out and the present disorder appears to be a new disease entity of autosomal dominant late onset quadriceps myopathy.

The aim of this study was to establish a set of occupational safety and health (OSH) issues and development policies suitable for adoption in Taiwan. A survey was conducted on a sample of 102 experts and 235 industrial work safety personnel in Taiwan for statistical analysis of the general consensus, with the results showing such consensus in 104 individual policy indicators. Our results reveal that the most appropriate targets were considered to be annual 10% reductions in the 'occupational accident disability rate', 'occupational accident injury rate' and 'occupational diseases before 2010'. Responding to the specific question of the appropriate method of achieving a reduction in the number of accidents in Taiwan, the primary consideration for 13.4% of the experts and 10.6% of the industry personnel was 'promoting OSH awareness and enhancing the overall safety culture'. As regards the current OSH policy focus, 11.2% of the experts considered 'improving OSH legislation, standards and systems' to be the most important, whilst 8.9% of the industry personnel felt that 'recognizing work stress, overwork and emerging OSH issues' were the most important.

Species of bacteria associated with Stylophora pistillata were determined by analyses of 16S ribosomal genes. Coral samples were taken from two distinct sites at Kenting, in the far south of Taiwan; three coral colonies at each site were tagged and sampled in the winter and summer of 2007. Six hundred 16S rRNA gene clones were selected and sequenced for diversity analysis and community comparison. LIBSHUFF and nonparametric multiple dimensional scaling analyses showed variations in the composition of the coral-associated bacteria in the different samples, suggesting that seasonal and geographic factors and variations in individual coral colonies were all vital drivers of the structure of the S. pistillata-associated bacterial community. To examine the association between species specificity and environmental impacts on the structure of the coral-associated bacterial community, we conducted an integrated, comparative analysis of 44 coral-associated bacterial data sets, including the present study's data. The clustering analysis suggests that the influence of spatial and temporal factors on the coral-associated bacteria population structure is considerable; nonetheless, the effect of species specificity is still detectable in some coral species, especially those from the Caribbean Sea.

A 52-year-old male chemical worker was admitted to the hospital with a history of paroxysmal microscopic hematuria for about 2 years and nocturia with gross hematuria about five times per night for 2 months. He was a nonsmoker and denied a history of any other bladder carcinogen exposure except for occasional pesticide application during agricultural work. Intravenous urogram imaging showed a mass occupying half of the bladder capacity. Cystoscopy revealed a mass over the left dome of the bladder. Cystoscopic biopsy revealed a grade 3 invasive transitional cell carcinoma with marked necrosis. From 1987 until hospital admission in 2001, the patient had worked in a company that produced the 4,4 -methylenebis(2-chloroaniline) (MBOCA) curing agent. He did not wear any personal protective equipment during work. Ambient air MBOCA levels in the purification process area (0.23-0.41 mg/m3) exceeded the U.S. Occupational Safety and Health Administration's permissible exposure level. Urinary MBOCA levels (267.9-15701.1 microg/g creatinine) far exceeded the California Occupational Safety and Health Administration's reference value of 100 microg/L. This patient worked in the purification process with occupational exposure to MBOCA for 14 years. According to the environmental and biologic monitoring data and latency period, and excluding other potential bladder carcinogen exposure, this worker was diagnosed as having occupational bladder cancer due to high exposure to MBOCA through inhalation or dermal absorption in the purification area. This case finding supports that MBOCA is a potential human carcinogen. Safe use of skin-protective equipment and respirators is required to prevent workers from MBOCA exposure.

A voluntary compliance program for occupational health and safety management, Voluntary Protection Programs (VPP), was implemented with a strategy of cooperation and encouragement in Taiwan. Due to limitations on increasing the human forces of inspection, a regulatory-based guideline addressing the essence of Occupational Health and Safety Management Systems (OHSMS) was promulgated, which combined the resources of third parties and insurance providers to accredit a self-improving worksite with the benefits of waived general inspection and a merit contributing to insurance premium payment reduction. A designated institute accepts enterprise's applications, performs document review and organizes the onsite inspection. A final review committee of Council of Labor Affairs (CLA) confers a two-year certificate on an approved site. After ten years, the efforts have shown a dramatic reduction of occupational injuries and illness in the total number of 724 worksites granted certification. VPP worksites, in comparison with all industries, had 49% lower frequency rate in the past three years. The severity rate reduction was 80% in the same period. The characteristics of Taiwan VPP program and international occupational safety and health management programs are provided. A Plan-Do-Check-Act management cycle was employed for pursuing continual improvements to the culture fostered. The use of a quantitative measurement for assessing the performance of enterprises' occupational safety and health management showed the efficiency of the rating. The results demonstrate that an employer voluntary protection program is a promising strategy for a developing country.

Phytochemical investigation of Ajuga taiwanensis resulted in the isolation of seven neoclerodane diterpenes, four of which ajugalide-A (1), -B (2), -C (3), and -D (4), are new and the remaining three are known diterpenes, ajugamacrin B (5), ajugapantin A (6), and ajugamarin C1 (7). Their structures were elucidated in spectral and chemical transformation studies.