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We have demonstrated a hybrid-integrated silicon photonic (SiPh) tunable laser in a miniaturized package suitable for coherent modules in small form factors such as OSFP and QSFP-DD. Through the integration of an in-house-designed high-power semiconductor optical amplifier (SOA), the developed SiPh laser has achieved a record-high output power of 21.5 dBm across the C-band. Also, this laser exhibits narrow linewidths down to 60 kHz, SMSR larger than 50 dB, low relative intensity noise below −150 dB/Hz, and a broad tuning range of 65 nm. These performance parameters are preferable for 400 Gb/s and beyond coherent communications using advanced high-order modulation formats. Moreover, an on-chip integrated sensor technology was developed for accurate laser frequency control. We have achieved 1 GHz frequency stability of SiPh laser against SOA current changes or package temperature variations between 10 °C and 80 °C. We further show the feasibility of this developed SiPh laser for 64 Gbaud, 16/64 QAM coherent transmission by integrating with an in-house InP-PLC hybrid coherent optical subassembly (COSA).

Purpose Fundus images are typically used as the sole training input for automated diabetic retinopathy (DR) classification. In this study, we considered several well-known DR risk factors and attempted to improve the accuracy of DR screening. Metphods Fusing nonimage data (e.g., age, gender, smoking status, International Classification of Disease code, and laboratory tests) with data from fundus images can enable an end-to-end deep learning architecture for DR screening. We propose a neural network that simultaneously trains heterogeneous data and increases the performance of DR classification in terms of sensitivity and specificity. In the current retrospective study, 13,410 fundus images and their corresponding nonimage data were collected from the Chung Shan Medical University Hospital in Taiwan. The images were classified as either nonreferable or referable for DR by a panel of ophthalmologists. Cross-validation was used for the training models and to evaluate the classification performance. Results The proposed fusion model achieved 97.96% area under the curve with 96.84% sensitivity and 89.44% specificity for determining referable DR from multimodal data, and significantly outperformed the models that used image or nonimage information separately. Conclusions The fusion model with heterogeneous data has the potential to improve referable DR screening performance for earlier referral decisions. Translational relevance Artificial intelligence fused with heterogeneous data from electronic health records could provide earlier referral decisions from DR screening.

Objective: The efficacy of dipeptidyl-peptidase 4 inhibitors (DPP4is) in advanced diabetic kidney disease (DKD) is unknown. We investigated whether DPP4is confer renal protective benefits in DKD patients. Methods: We conducted a retrospective cohort study between 2012 and 2018 in Taiwan. We only included type 2 diabetes patients with estimated glomerular filtration rate (eGFR) between 30 and 90 mL/min/1.73 m2 and urine albumin to creatinine ratio between 300 and 5,000 mg/g. Patients with DPP4i prescriptions were selected as cases, while non-DPP4i users served as controls. We followed these patients until the presence of composite primary renal endpoints, which was defined by the earliest occur-rence of clinical renal outcomes. Results: A total of 522 patients were included in the analysis, comprising 273 patients with a DPP4i prescription who were selected as cases and 249 patients without DPP4i prescription who were assigned as controls. Median follow-up duration for DPP4i users and nonusers was 2.2 years and 3.4 years, respectively. At baseline, the mean glycated hemoglobin levels for DPP4i users and nonusers were 8.1% and 8.3%, respectively. Among patients with DPP4i prescriptions, there was no reduction in composite primary renal outcome, with a crude hazard ratio (HR) of 1.50 (95% confidence interval [CI], 0.95 to 2.36). Similar results were observed for the risk of persistent eGFR Conclusion: DPP4i prescription did not reduce the risk of composite renal endpoints in DKD patients. Abbreviations: BMI = body mass index; CI = confidence interval; CVOT = cardiovascular outcomes trial; DPP4i = dipeptidyl-peptidase 4 inhibitor; DKD = diabetic kidney disease; eGFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; HbA1c = glycated hemoglobin; HR = hazard ratio; SGLT2i = sodium-glucose cotransporter 2 inhibitor; T2D = type 2 diabetes; UACR = urine albumin to creatinine ratio

Few studies on hyperthyroidism treatment have been reported in the past 3 decades. We used a nationwide population-based database to evaluate the current practices and management of hyperthyroidism in Taiwan.This retrospective study included a random selection of 1 million people in Taiwan between 2004 and 2010. We identified patients with hyperthyroidism who received antithyroid drugs (ATD), radioactive iodine (RAI), or surgery. We calculated the proportions and treatment trends of those 3 treatment options annually. A Poisson regression model was used to determine whether trends changed.The prevalence of overt hyperthyroidism in Taiwan steadily increased from 2,666 (0.27%) in 2004 to 3,464 (0.37%) in 2010. The incidence of hyperthyroidism (per 1,000 persons) also increased from 0.97 in 2004 to 1.06 in 2010. The major proportion of hyperthyroidism in this study was Graves disease (95%), followed by toxic nodular goiter (2%), and other causes (3%). ATD is the most commonly used (96-97%) treatment for hyperthyroidism, followed by surgery (2-3%) and RAI (1%). There was a significant decreasing trend for surgery, from 2.9% in 2004 to 2% in 2010, especially in female patients (3.3% in 2004 to 2.3% in 2010, P.01) and patients younger than 40 (3.8% in 2004 to 2.9% in 2010, P.01). Meanwhile, the proportions of ATD and RAI remained unchanged. The most common ATD prescription was methimazole (45-50%), followed by propylthiouracil (30-32%) and carbimazole (19-21%).Between 2004 and 2010, ATD was the treatment of choice in Taiwan, followed by surgery and RAI.ATA = American Thyroid Association; ATD = antithyroid drug; LHID2005 = Longitudinal Health Insurance database 2005 dataset; NHI = National Health Insurance; RAI = radioactive iodine.

Purpose: Low-dose aspirin is commonly used for preventing cardiovascular disease in people with diabetes, but its association with cancer remains controversial. This study used a nationwid...

A high power oscillation occurring on a porous silicon diode with an obvious dc N-shaped negative differential resistance (NDR) at room temperature is presented for the first time. The voltage oscillation swing was up to 12.4 V and oscillation frequency was 101.3 kHz, which belongs to the radio frequency range. The oscillation was based on a porous silicon superlattice diode structure, which was observed to provide a stable NDR with a high peak-to-valley current ratio as high as 7.9 for dc current–voltage characteristics at room temperature. A superlattice diode structure was formed by an electrochemical etching method on an n-type (100) silicon wafer with an alternating etching current. In addition, a dc constant current source was used as the power supply for the diode oscillation. In particular, two steady operating points were observed for the dc NDR current–voltage characteristics of the circuit load line. The system produced a steady oscillation between these two operating points in a harmonic form.

Objectives: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a seven-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥ 3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥ 3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥ 3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥ 3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk.

The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown.This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure.A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction.Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure.

Background Conflicting data exist regarding the relationship between dual infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) with type 2 diabetes mellitus (T2DM). We assessed dual infection of HBV and HCV with the levels of blood glucose and development of DM. Methods A total of 9621 participants in a community-based study were enrolled from 18 towns in Maoli county of Taiwan. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg) and antibodies (HBsAb), antibodies against hepatitis C virus (anti-HCV) and fasting plasma glucose. DM was defined as fasting plasma glucose≥126 mg per 100 ml. Results Only 0.7% of total participants had HBV/HCV coinfection. The prevalence of HBV and HCV monoinfection were 9.9 and 5.7%, respectively. Adjusted blood glucose levels and development risk of T2DM (odds ratio [OR], 2.55; p Conclusions Our study shows HBV/HCV coinfection was significantly correlated with blood glucose levels. A significant proportion (28%) of participants with HBV/HCV coinfection developed T2DM. Although the precise mechanisms of dual positive infection of HBV and HCV are unclear, there is increasing evidence that dual infection of HCV and HBV is strongly associated with the development of T2DM.

We report a silicon photonic tunable laser for coherent communication, with output power reaching 140 mW across the C-band, linewidth narrower than 80 kHz, SMSR larger than 50 dB, and precise gridless frequency tuning.

Aims Severe hypoglycaemia is associated with a high risk of cardiovascular events in patient with diabetes. The aim of this study was to clarify the temporal relationship between hypoglycaemia and cardiovascular events. Materials and methods This observational cohort study was conducted using Taiwan's Longitudinal Cohort of Diabetes Patients Database, which included 360 000 patients with newly diagnosed diabetes during the period 1999 to 2001. Patients with the first severe hypoglycaemia after 2002 served as the study cohort. Each patient in the study cohort was matched with two control patients without severe hypoglycaemia, based on a propensity score. A joinpoint regression model was used to determine trends in all-cause mortality and incidence of cardiovascular disease (CVD) events in both cohorts. Results A total of 10 157 patients with severe hypoglycaemia and 20 314 matched controls were recruited. Patients with severe hypoglycaemia had a significantly higher risk of CVD (HR, 7.28; 95% CI, 5.19-10.20) and all-cause mortality (HR, 19.92; 95% CI, 13.42-29.56) during the first month compared with those without. In patients with severe hypoglycaemia, the incidence of CVDs dropped by 17.29% monthly during the first 4 months and slowly decreased (-0.67%) during subsequent months. All-cause mortality decreased by 16.55% and 3.24% monthly during months 0-6 and months 6-17, respectively. Conclusions Severe hypoglycaemia is associated with a greater risk of cardiovascular events and death, especially during the first month following a hypoglycaemic episode. Patients prone to severe hypoglycaemia should be made aware of the elevated risk of subsequent cardiovascular events.

With the advent of an aging society, the number of people suffering from degenerative diseases, which often lead to communication disorders such as motor speech disorders (MSDs). Intensive and repeated practice is essential for individuals with MSDs. Because of work overload, speech and language therapists (SLTs) might cope with the excess load of treatment, which may lead to reduce of rehabilitation effects. Nowadays smart mobile devices such as the iPad and tablet PC have changed the way of therapy. Therefore, this study proposes the feasibility of assistive technology intervention through the user-centered design process in MSDs treatment. First, it uses Delphi expert assessment interviewing the SLTs to realize how they work about MSDs. Second, the SLTs define the weighting of requirements using the analytic hierarchy process. The most two important two criteria are: evaluate willing to practice, and easy to review the home exercises. Third, it transfers the requirements into design criteria and develop the assistive APP, MOUTH EXERCISE. SLTs can select and demonstrate correct video to the individuals instead of exercising their oral muscles. Finally, SLTs participate the usability evaluation to validate the APP. They suggest that MOUTH EXERCISE can not only as an assistive manner of speech therapy, but also reduce the workload of them. It concludes that the developed APP is a useful tool for STLs. In the future, it will develop home practice mode to enhance the rehabilitation motivation of individuals.

We review studies measuring people's perceptions of technology learning environments.A framework conceptualizing technology learning environments (TSLEs) is proposed.It includes six dimensions: technical, content, cognitive, metacognitive, social, & affective.The studies considered more the technical, cognitive and social dimensions.The results provide insights into an overview of the instruments used for TSLEs. In this study we reviewed 22 studies on developing instruments that measure teachers', students' and adult students' perceptions of learning environments enhanced by a certain type of technology. We conducted a review of all the instruments to propose a new framework conceptualizing technology-supported learning environments (TSLEs) for future instructional designs, and research on learning environments. This framework was also confirmed with the literature on learning theories. The framework consists of six dimensions: technical, content, cognitive, metacognitive, social, and affective. We found that the studies took more into consideration the technical, cognitive and social dimensions, and less the content, metacognitive, and affective dimensions. Moreover, usability in the technical dimension, relevance in the content dimension, inquiry learning in the cognitive dimension, student autonomy in the metacognitive dimension, and teacher support in the social dimension are the salient features most often investigated in TSLEs. The results provide insights into an overview of the instruments used for TSLEs, implications for the instructional design of TSLEs, and trends in the current and future research on perceptions of TSLEs.

This paper presents artificial neural network (ANN)-based models for forecasting precipitation, in which the training parameters are adjusted using a parameter automatic calibration (PAC) approach. A classical ANN-based model, the multilayer perceptron (MLP) neural network, was used to verify the utility of the proposed ANN–PAC approach. The MLP-based ANN used the learning rate, momentum, and number of neurons in the hidden layer as its major parameters. The Dawu gauge station in Taitung, Taiwan, was the study site, and observed typhoon characteristics and ground weather data were the study data. The traditional multiple linear regression model was selected as the benchmark for comparing the accuracy of the ANN–PAC model. In addition, two MLP ANN models based on a trial-and-error calibration method, ANN–TRI1 and ANN–TRI2, were realized by manually tuning the parameters. We found the results yielded by the ANN–PAC model were more reliable than those yielded by the ANN–TRI1, ANN–TRI2, and traditional regression models. In addition, the computing efficiency of the ANN–PAC model decreased with an increase in the number of increments within the parameter ranges because of the considerably increased computational time, whereas the prediction errors decreased because of the model’s increased capability of identifying optimal solutions.

The miniaturization of a gully for building drainage system is attempted by installing a streamlined bump in the discharge pipe to maintain the minimum water trap height of 50 mm. The hydrodynamic performances of the air–water flows with or without glass balls through the two types of four-entry gullies with beveled or vertical nozzle flows are experimentally and numerically studied. The images of air–water–solid flow, maximum flow rates, self-purification properties and sustainable water traps subject to static and dynamic loadings are experimentally detected. The predictions of Computational Fluid Dynamics (CFD) unravel the characteristic flow structures to assist the interpretation of experimental results. In this respect, the observed entrained air bubbles and clustered glass balls in each gully correspond favorably to the regions with negative static pressures and weak flow momentums as disclosed by the CFD predictions. The measured ratios between discharged and supplied glass balls are consistently higher for the gully with beveled nozzle flows. The less efficient transportation of glass balls out of the drum for the gully with downward nozzle flow is attributed to the larger pressure gradients with considerable air entrainments. The relaxations of the form and friction drags over the nozzle-tip region and the reductions of air entrainments are essential for upgrading the maximum flow rate and the self-purification performance of a miniaturized gully.

Parkinson’s disease (PD) is a progressive and incurable neurodegenerative disease. If PD can be diagnosed and treated as early as possible, not only can it effectively delay the degeneration of the brain, but also further maintain the follow-up quality of patients’ life. This study focuses on developing an early vocal screening service of PD to detecting the stage of PD and helps healthy people to do an early screening of the possibility of developing PD. There are four patients with PD and three neurology physicians that were interviewed. In addition, a questionnaire survey of the healthy people on the acceptance of early screening services. For patients, they have to spend a long time to confirm the diagnosis during the observation period of suspected PD. The existing diagnosis is very dependent on the physician’s expertise and clinical experience, especially the initial diagnosis. Thus, it delays the golden period of delaying correction, and early administration and treatment. Healthy people with the condition of PD likely possess little knowledge about it. But, they were willing to try the service of early screening to see whether they are suffering from suspected PD symptoms in a few minutes. According to the results, an early vocal screening service model is developed. The possibility of contracting PD can be detected as early as possible by subtle changes in speech as shown in the voice recording of 3 to 5 minutes left by healthy people, such as trembling, breathing pause, and other factors that are not easily identified by voice detection analysis.

The objective of this study is to evaluate the healthy and unhealthy behaviors as risk factors for chronic constipation and self-rated health status. Eight hundred tenth students enrolled from a university in Miaoli city, Taiwan. Chronic constipation was assessed using Chinese questionnaire. Information of unhealthy and healthy lifestyles was interviewed by constructed questionnaire. Thirty-six percentage of university students were assessed as chronic constipation. Using multivariate logistic regression adjusted for age, sex, race and BMI, we found chronic constipation significantly correlated with frequency of consumption from snack, fast food, fried food, daily consumption of water, physical activity and junk food used as regular food. Moreover, these unhealthy behaviors significantly correlated with self-rated health status. Students with chronic constipation had poor self-rated health status. It is urgent to create healthy behaviors to reduce the risk for chronic constipation or upgrade self-rated health status in university students.

Aims The association of blood glucose in advanced diabetic kidney disease (DKD) is unclear. This study investigated the association between blood glucose and renal endpoints in DKD patients. Methods This retrospective cohort study enrolled type 2 diabetic patients with advanced DKD with an estimated glomerular filtration rate (eGFR) between 30 and 90 ml/min/1.73 m2 and urine albumin-to-creatinine ratio (UACR) of 300–5000 mg/g. We classified patients into 2 groups according to their 1-year average HbA1c: 7%. We followed up the patients until the occurrence of primary renal endpoints. Results A total of 345 patients were included in the analysis for the period 2012–2018. Mean baseline eGFR was 58 ml/min/1.73 m2 and mean albuminuria levels were 1146 and 1313 mg/g, respectively. Median study duration was 3 years. The risk of primary renal endpoints was not decreased in patients with HbA1c less than 7% with an adjusted hazard ratio (aHR) of 0.62, 95% CI 0.26–1.45. The risks of persistent eGFR lower than 15 ml/min/1.73 m2 and doubling of serum creatinine level were similar between 2 group with aHR of 0.58 (95% CI 0.19–1.83) and 0.61 (95% CI 0.26–1.44), respectively. Conclusions Intensive blood sugar control did not prevent renal failure in advanced DKD.

In order to bring Ebook reader to the next stage, we have developed a prototype and concept design that combine flexible color electrophoretic display (EPD), flexible projected capacitive touch panel (TP) and amorphous-silicon gate driver circuit on array (GOA) technologies. This prototype has been fabricated successfully with the white reflectivity of 23.5%, contrast ratio of 16:1 and 16 gray-level color images. In terms of the flexible TP, it is capable of detecting multi-touch events and transmittance is more than 73.2%. GOA circuit operation is also verified with a 9-inch flexible color EPD.

Objective This study was undertaken to explore the association of estimated glomerular filtration rate (GFR) with exposure to aristolochic acids (ALAs) and nephrotoxic metals in herbalists after the ban of herbs containing ALAs in Taiwan. Methods This cross-sectional study recruited a total of 138 herbalists without end-stage renal disease or urothelial carcinoma from the Occupational Union of Chinese Herbalists in Taiwan in 2007. Aristolochic acid I (ALA-I) was measured by ultra-high-pressure liquid chromatography/ tandem mass spectrometry (UHPLC-MS/ MS) and heavy metals in blood samples were analysed by Agilent 7500C inductively coupled plasma-mass spectrometry. Renal function was assessed by using a simplified Modification of Diet in Renal Disease Study equation to estimate GFR. Results Blood lead was higher in herbal dispensing procedures (p=0.053) and in subjects who self-prescribe herbal medicine (p=0.057); mercury was also higher in subjects living in the workplace (p=0.03). Lower estimated GFR was significantly associated with lead (β=−10.66, 95% CI −18.7 to −2.6) and mercury (β=−12.52, 95% CI −24.3 to −0.8) with a significant interaction (p=0.01) between mercury and lead; however, estimated GFR was not significantly associated with high ALA-I level groups, arsenic and cadmium after adjusting for other confounding factors. Conclusions We found that lower estimated GFR was associated with blood lead and mercury in herbalists after the ban of herbs containing ALAs in Taiwan. The ALA-I exposure did not show a significant negative association of estimated GFR, which might due to herbalists having known how to distinguish ALA herbs after the banning policy. Rigorous monitoring is still needed to protect herbalists and the general population who take herbs.

Most patients with Parkinson’s disease suffer from speech disorders which can be effectively improved through continuous speech therapy. However, there are very few speech therapists in Taiwan, so the patients do not have enough access to rehabilitation therapy, thereby contributing to poor rehabilitation outcomes. Based on motor speech disorder therapy and the service design process, this study proposed a Speech Rehabilitation mobile application software (App) interfaces for patients with Parkinson’s disease. The sound interface usability is verified by the actual operation of two patients, and the pronunciation is significantly improved after a short-term use. In the future, the results could be extended to develop long-distance rehabilitation services, expecting to enhance the rehabilitation motivation and effectiveness of patients.

With the fast advance of GPS technology and mobile devices, the location-based queries that can provide useful location information for the user have attracted much attention in the database research community. In this paper, we focus on developing a location-based query system, called the QTWN, which provides various queries to retrieve points of interest (POI) on Taiwan maps. The provided queries are classified into the distance-based queries, the attribute-based queries, and the mixed distance/attribute queries. We dedicate to improve the usability of QTWN, design the user-friendly interface, and provide a consistent user experience for all cross-devices.

This study proposes a Wiki-based collaborative writing approach to the writing process for EFL (English as a foreign language) learners. A five-stage computer-mediated collaborative writing project including collaborative planning, partitioned drafting, peer-revising, peer-editing, and individual publishing was blended with on-campus English composition course. Fifty-one L2 learners at a university in central Taiwan participated in this project. Procedural scaffolding and collective scaffolding were provided to promote students' self-regulation and thus to foster the development of students' writing skills. A cross-referencing questionnaire survey was adopted to investigate students' perceptions of Wiki-based collaborative writing and students' perceptions of their work in each stage of collaborative writing. As the results indicated, a high percentage of students' satisfaction showed positive perceptions of this Wiki-based collaborative writing environment, and the instructional design of implementing a ...

Background/Purpose It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed. Methods We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan. Results There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists. Conclusion The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity.

To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.Within-subject comparison.University hospital.Patients with stroke (N=16; age range, 42-72y;8wk poststroke) with hypertonia in the affected leg.Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).Modified Ashworth Scale scores were significantly lower (P.05) and relaxation index and peak velocity values were significantly higher (P.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.

Objective Many Chinese herbs contain aristolochic acids (ALAs) which are nephrotoxic and carcinogenic. The objective of this study was to identify whether exposure to herbs containing ALAs increased the risk of kidney disease among Chinese herbalists. Methods A nested case–control study was carried out on 6538 Chinese herbalists registered between 1985 and 1998. All incident cases of chronic renal failure reported to the Database of Catastrophic Illness of the National Health Insurance Bureau between 1995 and 2000 were defined as the case group. Up to four controls without renal failure were randomly matched to each case by sex and year of birth. A structured questionnaire survey was administered between November and December 2002. The Mantel–Haenszel method and conditional logistic regression were used to estimate the risks. Results 40 cases and 98 matched controls were included in the final analysis. After adjusting for age, frequent analgesic use, and habitual consumption of alcohol, fermented or smoked food, we found manufacturing and selling Chinese herbal medicine (OR 3.43, 95% CI 1.16 to 10.19), processing, selling or dispensing herbal medicines containing Fangji (OR 4.17, 95% CI 1.36 to 12.81), living in the workplace (OR 3.14, 95% CI 1.11 to 8.84) and a history of taking of herbal medicines containing Fangji (frequently or occasionally) (OR 5.42, 95% CI 1.18 to 24.96) were significantly associated with renal failure. Conclusion Occupational exposure to and consumption of herbs containing ALAs increases the risk of renal failure in Chinese herbalists.

Background: A national survey in Taiwan has shown that Chinese herbal therapy increases the risk of chronic kidney disease. However, it is unknown whether herbal therapy will increase the risk of urological cancers. The purpose of this study was to determine whether Chinese herbalists are at higher risk for urological cancers. Methods: We studied all Chinese herbalists in Taiwan that were registered in the Chinese Herbalist Labor Union between 1985 and 2000. We retrospectively followed their survival status and causes of death using the National Mortality Registry Database from 1985 to 2004. Standardized mortality ratios (SMRs) for urological cancers in herbalists were calculated and compared with those of the general population of Taiwan. Results: A total of 6548 Chinese herbalists were enrolled and 88,289 person-years were accrued during the observation period. After adjustment for age and sex, the SMR for urological cancers was significantly higher for Chinese herbalists than for the general population (SMR = 3.10; 95% CI: 1.41–5.87). When further stratified by location, the SMR for kidney cancer and other urinary organ cancers (SMR = 3.81; 95% CI: 1.39–8.28) except bladder cancer (SMR = 2.26; 95% CI: 0.47–6.59) were significantly higher for the Chinese herbalists. The SMR for chronic and unspecified nephritis, renal failure, and renal sclerosis were also significantly higher for herbalists (SMR = 2.40; 95% CI: 1.40–3.84). Conclusions: Chinese herbalists have a significantly higher risk for urological cancers. This increased risk among herbalists highlights the urgent need for safety assessments of Chinese herbs.

Objective: To determine whether short-term propulsion of a functional electrical stimulation-assisted leg-cycling wheelchair (FES-LW) in patients with stroke can reduce spasticity of the affected leg and whether FES has additional effects on reducing spasticity. Design: Within-subject comparison. Subjects: A total of 17 patients after stroke were recruited from the university hospital. Methods: Subjects propelled 2 leg-cycling wheelchairs (the FES-LW and the LW) and a manual wheelchair along an oval pathway. The Modified Ashworth Scale (MAS), H reflex/maximal M response (H/M ratio) and relaxation index were used to evaluate the immediate effects on leg spasticity. The changes in MAS, H/M and relaxation index were used to evaluate the effect of FES in comparing 2 leg-cycling wheelchairs. Results: The MAS and H/M ratio were significantly decreased and the relaxation index significantly increased by FES-LW and LW usage. For subjects with higher muscle tone, significant lowering of the changes in MAS, H/M ratio and higher relaxation index were found for FESLW usage compared with LW usage. Conclusion: Leg spasticity is reduced after short-term propulsion of the FES-LW and LW. The application of FES has an additional effect on reducing spasticity in subjects with higher muscle tone.

Short Message Service is usually used to transport unclassified information, but with the rise of mobile commerce it has become an integral tool for conducting business. However, SMS does not guarantee confidentiality and integrity of the message content. This paper proposes a protocol called SMSSec that can be used to secure an SMS communication sent by Java's Wireless Messaging API. The physical limitations of the intended devices such as mobile phones, made it necessary to develop a protocol which would make minimal use of computing resources. SMSSec has a two-phase protocol with the first handshake using asymmetric cryptography which occurs only once, and a more efficient symmetric nth handshake which is used more dominantly. What distinguishes this work from conventional protocols is the ability to perform the secure transmission with limited size messages. Performance analysis showed that the encryption speed on the mobile device is faster than the duration of the transmission. To achieve security in the mobile enterprise environment, this is deemed a very acceptable overhead. Furthermore, a simple mechanism handles fault tolerance without additional overhead is proposed.

Hemiplegic stroke patients are physically able to use only one arm and leg, those on the unaffected side, to propel and steer a manual wheelchair; therefore, it is difficult for them to use current manual wheelchairs. Although there have been a number of outstanding studies on wheelchair propulsion, very few have dealt with the wheelchair propulsion problems for stroke patients, whose propulsion styles are greatly different from users with healthy upper limbs. The purpose of this study was to develop a novel wheelchair for stroke patients based on their needs. A planar four-bar chain mechanism was introduced to develop the new wheelchair, and a clinical evaluation in a rehabilitation center was also done to evaluate the chair's usability. The prototype we developed allows stroke patients to use their legs and arms together to propel the wheelchair, and permits them to steer the wheelchair safely and efficiently. Eleven stroke patients with right hemiplegia were recruited to clinically evaluate the newly designed prototype, the unilaterally propelled wheelchair (UPW), in a comparison with a commercial two-handrim propelled wheelchair (TPW). The results revealed that the velocity, deviation frequency, and deviation period of the UPW were superior to those of the TPW. We concluded that it is easier, safer, and more efficient for hemiplegic stroke patients to use the UPW than the TPW. Relevance to industry The manual wheelchair has many demonstrable benefits for users who have mobility problems and sufficient upper-limb strength to propel one. However, it can be difficult for stroke patients to propel current manual wheelchairs. This study offers an innovative wheelchair, designed with the needs of hemiplegic stroke patients in mind, that offers improved efficiency and safety, thereby promoting independent living.

Background. Nasopharyngeal carcinoma (NPC) is associated with Epstein-Barr virus (EBV) and has high meta- static potential. Discoidin domain receptors (DDR1, DDR2) are receptor-type tyrosine kinases activated by collagen. Their abil- ity to induce expression of matrix metalloproteinase is related with tumor invasion. Therefore, we aim to investigate DDRs gene expression and its regulation in NPC. Methods and Results. By use of real-time quantitative poly- merase chain reaction (Q-PCR), DDR2 gene expression but not DDR1 was significantly higher in primary and metastatic NPC. DDR2 was predominantly distributed in NPC tumor cells rather than in infiltrating lymphocytes. EBV Z-transactivator (Zta) trans- fection may distinctly elevate DDR2 level. Furthermore, data from reporter assay indicate that Zta could transactivate DDR2 pro- moter activity, suggesting the possible upregulation mechanism. Conclusion. DDR2 was differentially upregulated in NPC and modulated by EBV Zta protein. DDR2 may play a role in NPC invasion and serve as a diagnostic and therapeutic target.

Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS), which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI) between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 (p=0.046) and in force plate the stand balance has also improved by 0.29 (p=0.031); thus both methods show the significant difference.

Home-use glucose meters provide a simple real-time means for diabetic mellitus patients to monitor their blood sugar. However, there are still many interface design defects in current glucose meter products which can easily cause operation errors. The aim of this study is to identify the perceptional information of commercial home-use glucose meter interfaces for the elderly. First, three aspects of perception information of glucose meters was examined, consisting of the behavioral information (BI), assemblage information (AI), and conventional information (CI) of glucose meters. Then, five elderly test subjects older than 65 years who never used home-use glucose meters before were recruited to perform usability tests in order to identify perceptional information. The results demonstrated that five parts should be used, and nine assembly processes should be operated during glucose measurement. The application for assembly-disassembly ability is required for the part-part category; the AI and CI provide effective support for this application. The critical factors that may cause operation errors involved lancing devices and test strips rather than glucose meters. Possible reasons for this might arise from poor design of product perceptual information or unclear symbols. The conclusion is that product designers should provide more perception information, especially in terms of AI, to assist elderly users to understand how to use home-use medical devices such as glucose meters.

We demonstrated a HD+ resolution (1600 × 900) full color AMOLED display panel by applying optical cavity design on white OLED and combined with high transparency color filter. This panel achieved a record-high real pixel density as 413 ppi for mobile apparatus and should be suitable for applications pursuing high-quality display.

This note points out that some results in the paper (Fuzzy sets and systems 129 (2002) 295) are incorrect.

Home use medical device industry prospers due to the ageing society. In both physiological and psychological domain, home use medical devices have received much attention in recent years. Seniors usually feel depressed or anxious because of losing health and living abilities. They can use the heart rate variability (HRV) device in analyzing their emotional response, however the interface of commercial HRV devices are not easy for them to operate. Therefore, the usability test of these devices was introduced for the senior users. Five senior user were recruited to conduct usability test of the two commercial HRV devices: ANSWatch (Taiwan Scientific Corp.) and CheckMyHeart Handheld HRV (DailyCare BioMedical Inc.) follow the typical operation task. Then the in-depth interview were conducted to find operational failure factors. All of senior users indicated that the serious failure factors are: “unable to understand English instructions” and “unable to determine the meaning of illustration”. Four of them indicated that the minor ones are: “no appropriate guide”; “text is too small”; and “layout is not appropriate”. Three of them indicated that “illustration surface reflection” is another problem. Therefore, we suggests that the home use HRV device interface design should consider principles such as (1) the language and icon properties, (2) step guides and text properties, (3) consistency of interface configuration, (4) color scheme to improve the operational satisfaction for the senior users.

To promote the feasibility of using photonic crystals to enhance light extraction of light-emitting diodes (LEDs) for industrial applications, the request for the high-yield and simple exposure process to pattern two-dimensional photonic crystals (2DPCs) becomes rather urgent. In this work, we developed a one-shot three-beam laser interference system to fabricate a 2DPC on an InGaN-based green LED to address its performance for backlight display applications. Using the current exposure system we develop here, a submicro-patterned area of 6 mm in diameter can be achieved. The experimental results show that the operating voltage of a 1 times 1 mm2 in-area LED incorporated with the 2DPC is around 4 V, and the light extraction efficiency is enhanced by a factor of 2.1.

Self-monitoring of blood glucose technique provides diabetic mellitus patients a simple and real-time method to monitor their blood sugar at home. In order to understand the interface design problems in home-use glucose meters, the aim of this study was to realize if senior users were able to easily and effectively operate glucose meters via usability evaluation. Five senior users of above 65 years old who never use home-use glucose meters before were recruited to operate typical tasks: a. changing lancet, b. inserting a strip to turn on the meter, c. lancing, d. waiting for the result and e. discarding lancet. The experiment process was recorded for further interview. The results demonstrated that the key factors that caused operation errors were found on lancing device and test strip instead of the glucose meter. Especially for seniors that had memory degradations, they needed side by side assistance to finish the tasks.

Ecological niche modeling (ENM) coupled with 3S has become increasingly important for environment monitoring. Chamaecyparis formosensis (Taiwan red cypress, TRC) only grows in Huisun's Shou-Cheng Mountain. We used GIS to overlay physiographic variables and vegetation index with TRC samples. We developed ENMs by using generalized linear model (GLM), maximum likelihood (ML), maximum entropy (MAXENT) and BIOCLIM. Results indicated that the accuracies of four models increased linearly with the sample size and also the mean kappa value of SPA methods (0.95) was better than that of SPO methods (0.85) for predicting the suitable habitat of TRC forests in the study. The variables used except elevation could not reflect the relationship between humidity and topographic sheltering characteristics (wind). Hence, we proposed a hypothesis: northeastern seasonal wind with humidity cannot fully blow into Huisun due to its topographic sheltering effects. We will attempt to incorporate proxy indicators of wind and humidity into models.

An edge effect caused by a spontaneous bias on the anodizing current density at the edged area is found during electrochemical etching. On the porous silicon films formed by the electrochemical etching method, evidence of the edge effect appearing on the photoluminescence pattern is first proposed in the study. With an appropriate electrolytic cell design where a halo baffle is placed between the anode and cathode as a barrier to reactant flux on the outer ring, the flux at the edge would be curved. It results in various degrees of electrochemical reactions and various porous structures on the silicon wafer. The experimental results propose an exhaustive view at the edge area in electrochemical etching process, and also propose an optional selection for free-mask patterning technology of porous silicon.

Aristolochic acid can cause urothelial carcinoma. Herbal remedies containing aristolochic acids were previously categorized as proven group 1 human carcinogens by the WHO cancer agency, the International Agency for Research on Cancer. However, the health effect on workers exposed to aristolochic acid is unclear. Fangchi, a representative herb containing aristolochic acid, is commonly used in the Chinese herbal medicine industry. We determined whether workers exposed to fangchi are at increased risk for urothelial carcinoma.We designed a case-control study based in a national representative cohort of Chinese herbalists. This study analyzed 6,564 Chinese herbalists employed between 1985 and 1998. All incident cases of urothelial carcinoma that occurred between 1988 and 2001 were defined as the case group. Controls were selected from the baseline cohort in a randomized manner. A total of 24 cases and 140 controls were included in analysis. Information about fangchi exposure was obtained in a questionnaire survey administered in 2002.Processing, selling or dispensing herbs containing fangchi significantly increased the risk of urothelial carcinoma (HR 2.4, 95% CI 1.1-5.3, p = 0.03). This relationship was independent of cigarette smoking or potential arsenic exposure from drinking water from deep wells.Exposure to the Chinese herbal drug fangchi increases the risk of urothelial carcinoma in herbalists. Appropriate medical monitoring is warranted for workers who have similar exposure.

This paper presents a dual-band 4-port diversity antenna for LTE MIMO applications. The antenna element employs a dual-band design covering the 700 MHz band for LTE applications and the 2.4 GHz band for WLAN systems. The presented antenna was implemented on a laptop panel for evaluating the system performances of four-port MIMO configuration in a non-line of sight environment. Correlation coefficient and channel capacity are simulated and measured. Correlation between signals is found between 0.17 and 0.32. The calculated channel capacity from the measured results is about 90% of the ideal case. The experimental results suggest that the presented 4-port MIMO antenna is effective and suitable for the laptop LTE applications.

People with neurological damage may develop physical impairments such as hemiplegia, and interlimb coordination deficits are common among stroke patients. Leg-cycling exercise is an alternative and symmetrical bilateral leg movement. However, stroke patients are generally reluctant to attend leg-cycling trainings. Virtual reality (VR) is a new and promising computer-based technology to promote leg-cycling training among stroke patients. A new force-detect leg-cycling training system which combined with a virtual community environment has been developed by our research team. Two healthy subjects were recruited to attend the preliminary case study. The results showed that the two healthy users could successfully operate the VR leg-cycling training system and control the direction of the virtual car in the virtual environment. In the next stage, patients with interlimb coordination deficits should be recruited in the training courses so as to verify the rehabilitative effect of the VR leg-cycling system.

The IEEE 802.16 standard for broadband wireless access, known as Worldwide Interoperability for Microwave Access (WiMAX), provides high throughput over long-range transmission. The key developments in the physical (PHY) layer include Orthogonal Frequency-Division Multiple Access (OFDMA) and the Multiple-Input-Multiple-Output (MIMO) antenna technology, which enhance transmission quality and throughput.

Adequate reminding would facilitate the management of emotion. That would prevent out control of destructive rage, and facilitate the emotion expression and balance. This study developed a portable system for emotion assessment basing on HRV method, which would feedback to user with proper advices for help the management of emotion. The system is constructed with an embedded system and a PDA phone, which firstly measures the ECG signal, and then analyzes HRV, finally presents the emotion status.

The aim of this study is to determine whether short term functional electrical stimulation (FES)-assisted cycling training can affect the postural control of stroke patients, and whether the application of FES can enhance the effect of cycling training. 20 stroke patients were randomly assigned to the FES-cycling group (FES-CG) or the cycling group (CG). Measurements were completed before and immediately after each 20 min training sessions. The measurements included a balance test (to quantify the postural control ability), a Hoffmann's reflex/motor response ratio (H/M ratio) test and a pendulum test (to quantify the muscle tone). In the balance test, some parameters in all directions exhibited significant intervention effects between the FES-CG group and the CG group. The H/M ratios (p=.014; .005, FES-CG and CG respectively) and relaxation index (p=.005; .047, FES-CG and CG respectively) revealed significant difference between FES-CG and CG group. The change ratios of directional control in the forward direction and H/M ratio revealed significant difference (p=.022; .015) between FES-CG and CG among subjects with higher muscle tone. The stroke subjects' postural control was improved while their muscle tone was reduced after the 20 min cycling training program both with and without FES. We conclude that cycling training, with or without FES may reduce spasticity in stroke patients. The application of FES in cycling exercise was shown to be more effective in stroke patients with higher muscle tone.

A full C-Band tunable 10G DWDM XFP using external cavity laser (ECL) technology is presented. Using this approach, we demonstrate performance on par with traditional 300-pin transponders, enabling the system equipment transition to higher density with pluggable optics.

Background The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. Objective This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). Method Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample ( n =125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. Results Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. Conclusions Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.