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Background: The global aging population presents a significant challenge, with older adults experiencing declining physical and cognitive abilities and increased vulnerability to chronic diseases and adverse health outcomes. This study aims to develop an interpretable deep learning (DL) model to predict adverse events in geriatric patients within 72 hours of hospitalization. Methods: The study used retrospective data (2017– 2020) from a major medical center in Taiwan. It included non-trauma geriatric patients who visited the emergency department and were admitted to the general ward. Data preprocessing involved collecting prognostic factors like vital signs, lab results, medical history, and clinical management. A deep feedforward neural network was developed, and performance was evaluated using accuracy, sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC). Model interpretation utilized the Shapley Additive Explanation (SHAP) technique. Results: The analysis included 127,268 patients, with 2.6% experiencing imminent intensive care unit transfer, respiratory failure, or death during hospitalization. The DL model achieved AUCs of 0.86 and 0.84 in the validation and test sets, respectively, outperforming the Sequential Organ Failure Assessment (SOFA) score. Sensitivity and specificity values ranged from 0.79 to 0.81. The SHAP technique provided insights into feature importance and interactions. Conclusion: The developed DL model demonstrated high accuracy in predicting serious adverse events in geriatric patients within 72 hours of hospitalization. It outperformed the SOFA score and provided valuable insights into the model's decision-making process. [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]

Background: Metabolic syndrome (MetS) is a prevalent health condition in Taiwan that places individuals at higher risk of cardiovascular disease, diabetes, and stroke. Therefore, the identification of risk factors associated with MetS is crucial. The aim of this study was to investigate the association of uric acid and MetS in a Taiwanese community with a middle-aged and elderly population. Methods: This cross-sectional study enrolled residents aged 50–90 years living in one community. All of the subjects received a standardized personal interview, including a structured questionnaire, anthropometric measurements, and blood samples were collected for laboratory testing. MetS was defined as excess waist circumference, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). Multiple logistic regression models were used to evaluate uric acid tertiles associated with MetS. Results: A total of 400 subjects were enrolled in the analysis. The overall prevalence of MetS was 35.8%. The prevalence of MetS increased gradually with increasing serum uric acid levels (p value < 0.001). A significant association between uric acid and cardiometabolic risk factors was confirmed, with a Pearson's correlation coefficient for waist circumference of 0.30 (p < 0.001), a coefficient for systolic blood pressure of 0.13 (p = 0.01), a coefficient for triglycerides of 0.33 (p < 0.001), and a coefficient for high-density lipoprotein of −0.30 (p < 0.001). The adjusted odds ratio (OR) of the high uric acid tertile level for MetS was 2.48 (95% CI = 1.31–4.71, p = 0.01). The area under the ROC curve (AUC) for uric acid in predicting MetS was 0.621 (p < 0.001). Conclusions: The prevalence of MetS in our study population is high. High serum uric acid levels are independently associated with the presence of MetS among the middle-aged and elderly Taiwanese population. [ABSTRACT FROM AUTHOR]

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: 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]

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]

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]

The coronavirus disease 2019 (COVID-19) pandemic had a great impact on healthcare system and patients. This study aimed to evaluate the effect of the COVID-19 pandemic on the perceptions of patients with inflammatory bowel disease (IBD). This prospective multicenter study was conducted between July 2021 and December 2021. Patients with IBD answered a structured questionnaire, and their degree of anxiety was assessed using a visual analogue scale (VAS) before and after reading educational materials. A total of 225 (47.67%) patients with Crohn's disease, 244 (51.69%) with ulcerative colitis and 3 (0.64%) with indeterminate colitis were enrolled. Common concerns were adverse events from vaccination (20.34%), and higher risks of developing severe COVID-19 (19.28%) and COVID-19 infection (16.31%) than the general population. Medications deemed by the patients to increase the risk of COVID-19 were immunomodulators (16.10%), anti-tumor necrosis factor-α antagonists (9.96%), and corticosteroids (9.32%). Thirty-five (7.42%) patients self-discontinued IBD medication, of whom 12 (34.28%) had worse symptoms. Older age (>50 years) (OR 1.10, 95% CI 1.01–1.19, p = 0.03), IBD-related complications (OR 1.16, 95% CI 1.04–1.28, p = 0.01), education status below senior high school (OR 1.22, 95% CI 1.08–1.37, p = 0.001), and residing in north–central Taiwan (OR 1.21, 95% CI 1.10–1.34, p < 0.001) were associated with more anxiety. None of the enrolled patients contracted COVID-19. The anxiety VAS score (mean ± SD) improved after reading the educational materials (3.84 ± 2.33 vs. 2.81 ± 1.96, p < 0.001). The medical behavior of IBD patients was influenced by the COVID-19 pandemic, and their anxiety could be mitigated after education. [ABSTRACT FROM AUTHOR]

The 2008 sub-prime mortgage crisis in the United States brought many financial institutions to the brink of bankruptcy. Securities firms were not immune to such issues, given their prominence in the financial market. Consequently, evaluating the performance of securities companies' post-recession is important when determining how to confront market-shaking macroeconomic problems. Consequently, this paper employs a non-radial model of data envelopment analysis (DEA) to measure the performance of revival on Taiwan's securities industry. The research findings suggest that Tachan Securities (TCS) outperformed its peers in the operational period immediately after the global financial crisis, while Capital Securities (CAPITAL) is the best performer in the profit-making period. This paper applies the Boston Consulting Group (BCG) Matrix to analyze strategic positioning and trajectory on the basis of the efficiency value of the two-stage of non-radial DEA model. In order to validate any variances between the efficiencies of different stages after the global financial crisis, this paper conducts non-parametric statistical analysis to examine the variances in the efficiency values of the single-stage and the two-stage model. Finally, the purpose is to understand the impact of the post-crisis environmental variables on the efficiency of the securities industry. The empirical findings can serve as a reference for industry management on the assessment of operating performances and profitability by the characteristic of radial efficiency. Decision-makers in the industry may also refer to the findings as a benchmarking tool for the evaluation of business performance after the global financial crisis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore nurses' care experiences for COVID-19 patients during the pandemic in Taiwan. The qualitative approach of phenomenography was used. Thirty-four nurses were recruited from two assigned hospitals in which COVID-19 patients were treated in Taiwan from July to May 2021. The method of data collection in the study involved a semi-structured interview and drawing. Interviews were audio-recorded and transcribed verbatim. Phenomenographic analysis was used to analyze the qualitative data. Four categories of description of experiences of caring for COVID-19 patients were identified: facing uncountable stresses from all sides, strict implementation of infection control interventions to provide safe care, confronting ethical dilemmas and making difficult decisions, and reflecting on the meaning of care in nursing. Professional accountability was the core theme found to represent the central meaning of nurses caring for COVID-19 patients. Nurses were under enormous stress while caring for COVID-19 patients during the pandemic and were negatively affected physically, psychologically, and socially. Professional accountability in caring for COVID-19 patients can be enhanced through adequate support from nursing managers and by in-service training designed to update knowledge and skills related to infection control intervention. [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]

This study investigates the impact of foreign direct investment (FDI) motivations and technological resource commitment on headquarters' employment of process control over subsidiaries, to better understand the process control mechanisms. Drawing on agency theory and the resource dependence perspective, a cross-sectional data model is developed among the 1541 Taiwanese manufacturing firms engaged in foreign investments, 1015 headquarters–subsidiary (HQ–Sub) relationships in China were selected from the database; in each of these relationships, the headquarters is located in Taiwan, while the subsidiary is located in China. Our findings reveal that the headquarters will use process control if the primary motivation for setting up a subsidiary in a host country is resource-seeking, but not use process control with market-seeking motivation. This control process relationship is enhanced/weakened/weakened by the headquarters'/subsidiaries'/partners' technological resource commitment. Taiwanese multinational corporations (MNCs) from newly industrialized economies (NIEs) seeking to choose control mechanisms that fit their technological resources and FDI motivations in China are given guidelines. It adds to the use of control mechanisms with HQ-Sub literature. Both resource-seeking and market-seeking motivations shed light on technological resource commitment by various units of an MNC, to ward off information asymmetry. [ABSTRACT FROM AUTHOR]

Objective: Primary myocardial involvement is an important cause of death in systemic sclerosis (SSc). Subclinical diastolic/systolic heart dysfunction is recognized; however, whether this indicates a subsequent increased risk of clinically overt heart failure (HF) remains largely unknown. We aimed to investigate the risk of clinically overt HF in a large, unselected SSc cohort. Methods: This matched, retrospective cohort study was conducted using a nationwide insurance database in Taiwan. Incident SSc patients with no history of HF were identified, and non‐SSc comparison groups were selected and matched to the SSc groups by age, sex, and cohort entry time. The cumulative HF incidence was estimated using the Kaplan‐Meier method. Multivariable Cox proportional hazards regression was used to calculate adjusted hazard ratios (HRs) for HF hospitalization. Results: A total of 1,830 SSc patients and 27,981 controls were identified. The cumulative incidence of hospitalized HF at 3, 5, and 10 years among patients with SSc were 3.5%, 5.3%, and 9.7%, respectively. Compared with non‐SSc individuals, SSc patients had an increased risk of HF (adjusted HR 3.26 [95% confidence interval (95% CI) 2.49–4.28]). Subgroup analyses revealed that the impact of SSc on the occurrence of HF was greater among patients ages <50 years than those ages ≥50 years (HR 7.8 [95% CI 4.03–15.1] versus HR 2.78 [95% CI 2.06–3.76]). Conclusion: SSc is associated with a markedly higher risk of clinically evident HF and not asymptomatic ventricular dysfunction alone. These findings provide real‐world evidence suggesting the use of appropriate screening strategies to detect these lethal complications early in SSc. [ABSTRACT FROM AUTHOR]

This study aimed to determine clinical instructors' perceptions of the assessments used to evaluate the clinical knowledge of undergraduate nursing students. This study uses a descriptive phenomenological approach. Purposive sampling was used to recruit sixteen clinical instructors for semi-structured interviews between August and December 2019. All interviews were audio recorded and transcribed verbatim. Data were analyzed using a modified Colaizzi's seven-step method. Four criteria were used to ensure the study's validity: credibility, transferability, dependability, and confirmability. Three themes were identified in the clinical instructors' views on evaluating the clinical performance of student nurses: familiarity with students, patchwork clinical learning, and differing perceptions of the same scoring system. The study results suggest a need for a reliable, valid, and consistent approach to evaluating students' clinical knowledge. If the use of patchwork clinical internships for student nurses is unavoidable, a method for assessing student nurses' clinical performance that requires instructor consensus is necessary. [ABSTRACT FROM AUTHOR]

This study utilized a two-dimensional numerical viscous wave tank to simulate the run-up and run-down processes of non-breaking solitary waves on a steep seawall. The research aimed to investigate the transformation between wave potential energy and kinetic energy, the evolution mechanisms of the wave and flow fields, and the correlation between the dynamic pressure gradient and the reverse flow near the sloping bed. The numerical model results were consistent with laboratory measurements of free surface elevations and flow velocity profiles, demonstrating the accuracy of the numerical model. This study focused on a solitary wave with a wave-height-to-water-depth ratio of 0.15, propagating on a representative seawall with a steep slope of 1:3 along the western coast of Taiwan. The simulation results indicate that the maximum run-up height occurs when the potential energy is at its highest. Undertow is caused by the adverse pressure gradient within the flow field, and the dynamic pressure on the sloping bed is directly proportional to the free surface elevation. Therefore, by observing the spatial changes in the free surface elevation, we can indirectly determine the occurrence time of undertow. [ABSTRACT FROM AUTHOR]

Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who returned to the ED within 72 h after discharge from ED. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 h. The highest revisit rate occurred within 24 h after discharge. Factors associated with return ED visits within 24 h by elders were difficulty walking and having discharge care needs. The factor associated with ED return visits within 24–48 h was polypharmacy. Difficulty walking, having discharge care needs, and hospitalization within the past 120 days were associated with return visits made within 48–72 h following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits. [ABSTRACT FROM AUTHOR]

The forecast of typhoon tracks remains uncertain and is positively related to the accuracy of the storm surge forecast. The storm surge prediction error increases dramatically when the forecast track error is larger than 100 km. This study aims to develop an ensemble storm surge prediction system using parametric weather models to account for the uncertainty in typhoon track prediction. The storm surge model adopted in this study is COMCOT-SS storm surge forecast system. Two methods are introduced and analyzed to generate the ensemble members in this study. One is from the weather ensemble prediction system (WEPS), and the other is from the error distribution of the deterministic forecasts (EDF). The ensemble prediction results show that the ensemble mean of WEPS performs similarly to the deterministic forecast. However, the maximum surge height of WEPS is often lower than one from EDF. The verification results suggest that, for disaster prevention, EDF provides stronger warnings to the coastal region than WEPS. However, it may provide overestimated forecasts in some cases. [ABSTRACT FROM AUTHOR]

In-group heterogeneity is often neglected during investigations of motor development patterns in children. Moreover, the variation in motor development patterns over time has seldom been examined. In this work, 1884 three-year-old preschoolers were selected from a panel study conducted in Taiwan called the National Longitudinal Study of Child Development and Care. A confirmatory factor analysis was applied to analyze the construct validity of the assessments of motor development used for these children. A latent profile analysis and latent transition analysis (LTA) were sequentially applied to clarify their motor development patterns at the ages of three and four years and their transitions between these two ages. The following findings were obtained: (1) The motor development assessment had good validity. (2) Considerable heterogeneity regarding motor development in preschoolers was observed, in which four and three subgroups displaying distinct levels of mastery with respect to their gross and fine motor skills were identified at the ages of three and four years, respectively. (3) From age three to age four, a large proportion of the preschoolers exhibited improvements or retentions in both gross and fine motor skills, whereas some of the preschoolers were classified into subgroups displaying "gross motor retention and fine motor progression," "gross motor progression and fine motor retention," "gross motor retention and fine motor regression," and "gross motor regression and fine motor progression." Few preschoolers exhibited "general motor regression." The present results suggest that there were considerable heterogeneous groups in the motor development in preschoolers in the middle of early childhood, and this phenomenon has rarely been addressed in former studies. The LTA results implied that effective interventions should be given sequentially to preschoolers in subgroups whose motor development presented regression and retention tendencies. [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]

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]

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]

The 2020 Taiwan Stroke Society (TSS) guidelines for blood pressure (BP) control related to ischemic stroke update the 2015 TSS BP guidelines. The early management of acute ischemic stroke has evolved rapidly in the previous two decades. Since the publication of the previous version of the TSS BP guidelines, many studies have addressed BP management in ischemic stroke. Particularly, several successful endovascular thrombectomy (EVT) trials published in 2015 led to a new era of acute treatment for ischemic stroke. With the ever-increasing use of EVT, evidence-based guidelines for ideal BP management during and after EVT are urgently needed. Consequently, the 2020 guidelines are updating and providing recommendations on BP control for the treatment and prevention of ischemic stroke based on new evidence. The present study encompasses the most important chapter of the 2020 Taiwan BP guidelines: BP control at the acute stage of ischemic stroke. We incorporated the most updated evidence regarding BP control at the acute stage of ischemic stroke in patients receiving or not receiving acute reperfusion therapy and provided specific recommendations for different treatment subgroups accordingly. [ABSTRACT FROM AUTHOR]