Search

This study explored the research question: How can project-based inquiry (PBI) in STEM teaching be designed, planned, and implemented in two preschool settings? A case study was conducted, using a collaborative action research approach. This research was conducted with 11 teachers and 300 children from 11 classes at two preschools in Taiwan. The data sources included research logs, observations, interviews, and documents. The collected data were analyzed qualitatively (e.g., iterative coding). The results indicate that PBI in STEM teaching can be integrated successfully into preschool curricula. Children can engage enthusiastically in STEM activities in a well-planned learning environment. We provide some suggestions for readers who have an interest in STEM teaching or research at the preschool level.

This study examined whether one Taiwan's heritage language immersion influences children's preference for the heritage language or cross-language. The research questions are: (1) What are children's attitudes toward the Hakka language (HL)? Does a significant difference exist in children's attitudes between those in the Hakka Language Immersion Program (HLIP) and children not participating in the program? (2) What are children's language preferences? Is there a significant difference in children's language preference between HLIP and non-HLIP (NHLIP)? This study used a causal comparative method to identify relationships between independent and dependent variables after the HLIP was implemented. The participants were selected from one HLIP (n = 37) and one NHLIP (n = 39). Both groups of children received a pretest and posttest, namely, the 'HL attitude measurement test,' which included 'HL opinion' and 'language preference' tests and had satisfactory reliability and validity. This study used covariate analysis to determine if a significant difference could be observed. The results demonstrated that the preference for the HL or cross-language in the HLIP was not significantly higher than those in the comparison group. Nevertheless, the children's HL preference in the cognitive domain and cross-language preference in the behavior domain exhibited a significantly positive effect.

This study analyzed early childhood preservice teachers' specific components of self-efficacy to provide a more exhaustive comprehension of the relationships among STEM self-efficacy, pedagogical belief, and the self-reported need for professional development (PD). The participants were undergraduate or graduate preservice teachers recruited from the early childhood education department of a university in Taiwan. The research used instruments including the "Teacher STEM Self-efficacy Scale," "Teacher STEM Pedagogical Belief Scale," and "Need for PD Scale" to collect the data. In total, 150 preservice preschool teachers completed the survey. MANOVA and structural equation modeling were used to analyze the data. The results revealed that preservice teachers' scores on STEM self-efficacy and the three components of self-efficacy were positively correlated with their STEM pedagogical beliefs and self-reported need for PD. Furthermore, affective attitude predicted teachers' need for PD directly or indirectly through STEM pedagogical belief. In addition, the result indicated that STEM pedagogical belief acted as an intermediary in the association between the two components of self-efficacy ("cognitive concept" and "affective attitude") and the self-reported need for PD. However, STEM pedagogical belief cannot mediate the relationship between the "equipped skill" component of self-efficacy and the self-reported need for PD. Preservice preschool teachers who had STEM teaching experience, reported interests in STEM, or participated in STEM-related activities had higher levels of STEM self-efficacy in terms of cognitive concept, affective attitude, and equipped skill. Based on these findings, the researchers provide suggestions for future research and practical implications in teacher development program.

This study explored how specific inquiry-related learning activities were related to student enjoyment of learning science and intended choice of future STEM career. Analysis of Taiwan and Australia PISA 2015 data revealed that three activities, namely, "debating and planning experiments, drawing conclusions and doing hands-on experiments, teachers and students explaining ideas," were significantly related to students' enjoyment of learning science and intended choice of STEM careers in these two countries. Cross-national comparisons indicated that the percentages of inquiry-related activities for high or low scientific competency students in Australia were higher than for Taiwanese students. The activity of "teachers and students explaining ideas" was a significant determinant of enjoyment of learning for Taiwanese high scientific competency students and Australian high and low scientific competency students, while "debating and planning experiments" was a positive determinant for Taiwanese low scientific competency students. High scientific competency students from both Taiwan and Australia demonstrated significantly higher preferences for future STEM careers than low scientific competency students.

Self-determination is a complex process with several components, such as making choices and independence. However, limited research on self-determination has focused on individuals with moderate to severe autism spectrum disorder. This study aimed to support independent leisure engagement and choice-making of leisure activities for this population by using a visual support intervention package, including the use of a visual activity schedule, video modeling, structured environment, preference assessment, and prompt procedures. The study used a single case research multiple baseline probe design to test the effectiveness of the intervention on three adults with autism spectrum disorder. Findings showed that implementing the visual support package was effective in promoting independent leisure engagement and facilitating choice-making of leisure activities. The study highlights the need for and advantages of incorporating video modeling and preference assessment into the visual activity schedule for this particular population. Self-determination encompasses various components, including decision-making and independence, making it a complex process. While the importance of self-determination for individuals with autism spectrum disorder has been explored in previous studies, there is limited research focusing on individuals with moderate to severe autism spectrum disorder. Evidence-based practices such as visual activity schedules and video modeling have shown effectiveness in promoting independence among individuals with autism spectrum disorder. To address the need for independence and choice-making among individuals with moderate to severe autism spectrum disorder, this study developed a visual support package incorporating visual activity schedules, video modeling, preference assessments, and prompt procedures. By investigating the intervention's effectiveness in three participants, this study contributes to the existing literature on the use of a visual activity schedule and video modeling in enhancing choice-making and independent leisure engagement. Following the intervention, all participants were able to select three leisure activities, develop their own visual schedules, and complete them. Notably, this study conducted preference assessments to determine participants' preferred leisure activities and did not provide additional reinforcement. Practical implications of this research include incorporating video prompting as needed and adjusting activity engagement time. Future research should explore the long-term effectiveness of the visual support package and its application in developing novel skills or vocational activities for individuals with moderate to severe autism spectrum disorder. This study fills a critical gap in the literature, providing important insights for practices and research in the field of autism spectrum disorder interventions. [ABSTRACT FROM AUTHOR]

The World Health Organization emphasizes the importance of providing integrated care for older people. Taiwan is the fastest aging country in the world. In 2016, Taiwan implemented the Long-Term Care Plan 2.0 (TLTCP 2.0), aimed at providing integrated long-term care (LTC) services in communities. However, LTC service agencies have not been able to evaluate the level of integrated care they provide due to the lack of an effective assessment tool. To address this need, this study sets out to develop an integration assessment tool, namely the Self-Assessment for Service Integration in Long-Term Care (SASI-LTC), which will allow LTC agencies to self-evaluate their current level of integration from multiple perspectives. The SASI-LTC was developed based on Evashwick's framework, underwent two rounds of Delphi panels with twenty-six experts, and a pilot test with 243 valid questionnaires from administrators of Tier A agencies who are responsible for integrating LTC. The Delphi experts assessed the content with high levels of agreement using medians, the scale content validity index (SCVI) and item content validity index (ICVI). The SASI-LTC included four domains (inter-entity organization and management, integrated care coordination, integrated resources, and integrated information systems) with thirty items. The SASI-LTC showed good reliability (Cronbach's α = 0.94) and good validity, and a confirmatory factor analysis showed a good model fit index [χ2/df = 1.38; RMSEA = 0.040; CFI = 0.963; SRMR = 0.049] in pilot testing. While the SASI-LTC is a useful and feasible tool for Taiwan's LTC service agencies to evaluate their level of integration in providing LTC services, it could also be used in other countries with minor adjustments to localization of items related to financial integration. [ABSTRACT FROM AUTHOR]

Background: As inquiry-based instruction is not universally implemented in science classrooms, it is crucial to introduce instructional strategies through the use of contextualized learning activities to allow students with different background knowledge and abilities to learn the essential competencies of scientific inquiry and promote their emotional perception and engagement. Purpose: This study explores how essential scientific competencies of inquiry can be integrated into classroom teaching practices and investigates both typical and gifted secondary students' emotional perception and engagement in learning activities. Sample: A case teacher along with 226 typical and 18 gifted students from a suburban secondary school at Taiwan participated in this study. Design and methods: After attending twelve 3-hour professional development workshops that focused on scientific inquiry teaching, the case teacher voluntarily developed and elaborated her own teaching activities through the discussions and feedback that she received from workshop participants and science educators. Quantitative and qualitative data were collected through activity worksheet, questionnaire, video camera, and tape recorders. Frequency distribution, Mann-Whitney U test, and discourse analysis were used for data analyses. Results: Case teacher's teaching activities provide contextual investigations that allow students to practice making hypotheses, planning investigations, and presenting and evaluating findings. Students' learning outcomes reveal that typical students can engage in inquiry-based learning with positive emotional perception as well as gifted students regardless of their ability level. Both gifted and typical students' positive emotional perception of and active engagement in learning provide fresh insight into feasible instructions for teachers who are interested in inquiry-based teaching but have little available time to implement such instructions into their classrooms. Conclusions: The results of our work begin to address the critical issues of inquiry-based teaching by providing an exemplary teaching unit encompassing essential scientific competencies.

Problem Statement: Inter-instituted collaboration has attracted broad attention for educational quality improvement in the last decade. The team performance of these innovative team projects received foremost attention, particularly with knowledge-sharing, emotional intelligence, and team conflicts. Purpose of Study: The purpose of the study was to empirically investigate the relationships among these three factors. The sample of this study was 178 professors, involving collaboration projects from twenty vocational institutes at the higher-education level. Methods: The collected data were statistically analyzed using SPSS 17.0 for Windows and LISREL 8.70 for Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). Also, the study undertook the Maximum Likelihood Estimation to analyze the linear relationships among the three major variables. Results: The statistical analysis result indicated that knowledge-sharing created a positive effect on team performance. On the other hand, team conflict caused a negative effect on team performance. Emotional intelligence did not have any significant direct effect on team performance but played a moderating role. Conclusions and Recommendations: This study concluded that vocational institutes are academic organizations where knowledge-sharing is a crucial mission and where strategies are put into place to fulfill that mission; team conflict should be avoided for better team performance. This study finally proposed several suggestions for improved team performance.

Systems thinking has been an educational priority for more than a decade, yet its related assessment and teaching strategies have been understudied in the chemistry education research community. Through the lens of systems thinking, this study explores how undergraduate students connect and translate their conceptual representations when they are involved in contextualised problem-solving. The 'Contextualised Problem Solving' (CPS) assessment instrument contains four open-ended questions about gas law. Three different cohorts of students registered in a physical science course (2016 Fall, 2017 Spring, 2017 Fall semesters) participated in the problem-solving component of CPS. The results showed that only 8% of students were capable of higher order systems thinking ability when they engaged in problem solving. Over half of the students failed to retrieve essential concepts in problem situations. Most of the participants demonstrated difficulties in organising related systems' components, understanding the cyclic nature of relationships among systems, and identifying limitations in a specific problem context. By identifying the difficulties and challenges of systems thinking experienced by undergraduate students in solving complex chemistry problems, these findings have the potential to provide fresh insights into effective teaching strategies to promote students' higher order thinking skills.

Simple Summary: Rodents have become increasingly popular as household pets, but few studies have focused on tumors in pet rodents. Pet rodents differ from their laboratory counterparts in many aspects such as geographical preference of pet species or breeds, household raising conditions, population density, and life expectancy. Therefore, it is worth conducting this pathological study of 77 spontaneous tumors from 70 pet rodents. Overall, mammary gland tumors were common. In the meantime, mouse mammary tumor virus (MMTV)-like sequences were found in the tissues of dogs, cats, and humans, raising the concern of whether these pets may incidentally serve as a vehicle for the cross-species transmission of MMTV to household personnel. For that purpose, nuclei acid extracted from the formalin-fixed paraffine-embedded tissues of 20 rodent mammary gland tumors was detected for MMTV env gene sequences. All tumors revealed negative results of MMTV detection. Compared to the number of studies on the neoplasms of laboratory rodents, fewer studies have focused on spontaneous neoplasms in pet rodents. Notably, the mouse mammary tumor virus (MMTV) is associated with mammary tumors in rodents. In this study, 77 tumors and tumor-like lesions of biopsy samples were collected from 70 pet rodents, including hamsters (n = 47), guinea pigs (n = 16), unknown species (n = 4), rats (n = 2), and a gerbil. Fifty tumors were collected from 47 hamsters, in which the most common tumors were mammary tumors (13/50), followed by fibrosarcoma (9/50), mast cell tumors (4/50), and squamous cell carcinoma (4/50). The collected subtypes of mammary tumors in hamsters included tubular carcinoma (n = 5), tubular adenoma (n = 4), carcinoma and malignant myoepithelioma (n = 1), simple tubular carcinoma (n = 1), adenosquamous carcinoma (n = 1), and tubulopapillary adenoma (n = 1). In addition, twenty tumors were collected from guinea pigs, in which the most common tumor was lipoma (6/20), followed by adenocarcinoma of the mammary gland (4/20), trichofolliculoma (2/20), and collagenous hamartomas (2/20). In guinea pigs, the subtypes of mammary gland tumors were tubular carcinoma (n = 2), tubular and solid carcinoma (n = 1), and tubulopapillary carcinoma (n = 1). In 20 cases of mammary tumors, MMTV was not detected, implicating no evidence of MMTV infection in mammary oncogenesis in pet rodents in Taiwan. [ABSTRACT FROM AUTHOR]

A new job position, "educare giver," which was created after kindergartens and preschools in Taiwan were integrated in 2012, has caused several problems such as ambiguity in the role of childcare givers and inequity in the division of labour. Studies have provided a limited scope and have not examined the identities and struggles of educare givers at the individual and organisational levels. This study investigated the effect of contextual factors on the professional identities of educare givers during their socialisation. The researchers adopted a qualitative research design and conducted in-depth interviews with 20 educare givers at public preschools. The findings reveal that educare giver identities are those as teachers, labourers, and teaching and administrative assistants. Contextual factors that affect the construction of their identities at the three stages of their socialisation are information channels, educational background, the recruitment process, titles, the attitudes of stakeholders, and job assignments.

Objectives: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI). Methods: Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines. Results: This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study's operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively. Conclusions: The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients' drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended. [ABSTRACT FROM AUTHOR]

Participation in service-learning courses has always been considered a part of the informal education in tertiary education worldwide. Originating from the assumption that service-learning courses increase students' civic engagement and bridge the gap between knowledge and practice, service-learning courses have gradually acquired the status of compulsory courses at universities. This being as it may be, it would seem that the nature of such courses would benefit from further analysis and discussion regarding their function in knowledge reproduction, and their role in teaching and education. The aim of this article is to examine and analyze a university service-learning course--the National Taiwan University (NTU) Star-Rain course with a commitment to serving children with autism--from a Foucaultian perspective, and reflect on how the process of putting knowledge during a service-learning course into practice comes to constitute the subjectivity of students who work with children who are autistic. We argue that the course under investigation has, in effect, become wholly entangled in the medical system's treatment of autism in Taiwan. The service-learning process involves knowledge acquisition as well as long-term, detailed, concrete hands-on experience, and shapes, in a very complete way, students' construction of their subject knowledge of autism.

This quasi-experimental study explores how student cumulative situational interest, short-term preference generated by particular conditions such as novel experiences can be developed into better individual interest, an enduring predisposition to engage in certain activity such as chemistry lessons. A continuous intervention of integrating novelty and aesthetic experience into teaching was used for the experimental group ("n"?=?64) while another class of 105 students studying another course of physical science without the intervention of novelty and aesthetics served as a comparison group. The analysis of covariance comparing the two group students' pre-and post-test perceptions of learning science revealed that the experimental group outperformed the comparison group in their perceptions of interest, enjoyment, and aesthetics. The weekly assessment of student situational interest indicated that the experimental group students' situational interests were well maintained by two leading learning activities: demonstrations and hands-on experiments with novelty and aesthetic experience. The above results provide empirical evidence to support the theory of interest development, which proposes that the development goes through a cumulative and progressive procedure.

Background: In Taiwan, the National Health Insurance Administration initiated the integrated home‐based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival. Methods: All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan–Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates. Results: A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one‐year survival rates were 72.1%, 67.4%, and 14.7% in the home‐based primary care (HBPC), home‐based primary care plus (HBPC‐Plus), and home‐based palliative care (HBPalC), respectively. Nearly two‐thirds of the HBPC‐Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables. Conclusions: Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. Methods: This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. Results: Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10–0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16–0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04–0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17–3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53–4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16–8.63; p = 0.024). Conclusion: PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes. Trial registration: ClinicalTrials.gov NCT Identifier: NCT05452395. [ABSTRACT FROM AUTHOR]

Background: Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). Aim: The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. Methods: This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. Results: The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. Conclusion: Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages. [ABSTRACT FROM AUTHOR]

Background and purpose: The NOTCH3 mutation is a common cause of hereditary cerebral small vessel disease (CSVD) and may be a cause of spontaneous intracerebral haemorrhage (ICH). The aim was to investigate the clinical/imaging features for identifying the NOTCH3‐mutation‐related ICH. Methods: The study was based on a cohort of 749 CSVD patients in Taiwan who received next‐generation sequencing of CSVD genes including NOTCH3. Patients with a history of ICH (n = 206) were included for analysis. The CSVD neuroimaging markers were compared between the patients with NOTCH3 and those without known genetic mutations. Results: After excluding patients with other causes of ICH (structural lesions, systemic/medication related or amyloid angiopathy) and those without neuroimaging, 45 NOTCH3 mutation patients and 109 nongenetic ICH patients were included. The NOTCH3 mutation patients were more likely to have thalamic haemorrhage, a family history of stroke and more severe CSVD neuroimaging markers. A five‐point NOTCH3‐ICH score was constructed and consisted of a history of stroke in siblings, thalamic haemorrhage, any deep nuclei lacunae, any hippocampal cerebral microbleed (CMB) and a thalamic CMB >5 (one point for each). A score ≥2 had a sensitivity of 88.9% and a specificity of 64.2% in identifying the NOTCH3 mutation. The NOTCH3 mutation patients had a higher risk of recurrent stroke (9.1 vs. 4.5 per 100 person‐years, log‐rank p = 0.03) during follow‐up. Conclusion: The patients with NOTCH3‐mutation‐related ICH had a higher burden of CMBs in the hippocampus/thalamus and a higher recurrent stroke risk. The NOTCH3‐ICH score may assist in identifying genetic causes of ICH. [ABSTRACT FROM AUTHOR]

Our study aimed to explore the impact of different home‐ and community‐based service (HCBS) use patterns on older adults' physical function. The cohort data were drawn from two national datasets, the National Ten‐Year Long‐Term Care Plan 1.0 database and the National Health Insurance Program claims data. Participants were care recipients ages 65 and over, first evaluated and prescribed HCBS from 2010 through 2013 and evaluated again after 6 months (n = 32,392). Latent class analysis was used to identify subgroups with different HCBS use patterns. Multiple regression was used to examine the impact of different HCBS use patterns on change over time in disability related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The analysis was stratified by respondents' levels of disability. Four subgroups of HCBS recipients were identified, with patterns of home‐based personal care, home‐based personal care and medical care, home‐based medical care and community care services. Older adults in the Home‐based MpC had significantly more improvement in both ADL (p < 0.05) and IADL (p < 0.001) scores compared with adults in the other three groups, while the community care group regressed the most. In the stratified analysis of the severely disabled, the IADL outcome of the Home‐based MC group was better than the home‐based PC group (p < 0.001). Study findings shed light on the benefits of promoting the use of integrated HCBS that combines personal and medical care, especially for community care services. [ABSTRACT FROM AUTHOR]

For its second decade, Taiwan's National 10‐Year Long‐Term Care Plan launched a policy of reinforcing home‐ and community‐based services (HCBSs) with a focus on reablement. This study aimed to (1) identify the distinct service use patterns of reablement‐embedded HCBS and (2) examine the effects of these service patterns on functional improvements among older care recipients, including among groups with different levels of care needs. We collected 2018 data from the Long‐Term Care Service Management System for care recipients in one county located in central Taiwan (N = 4735). Three recipient groups were assigned based on level of care needs. We included data on use of the following services: reablement, home care, respite care, applications for assistive devices and home environmental modifications, transportation to medical appointments and community‐based services. Outcome variables were measured by change scores between successive assessments of activities of daily living (ADL) and instrumental activities of daily living (IADL). Latent class analysis and multivariate linear regression analyses were used to analyse relationships between use patterns, participant subgroups and outcomes. Four subgroups of HCBS use patterns were found. Care recipients with low care needs had greater potential to improve their physical function in ADL through reablement‐embedded HCBS. Care recipients in the groups with low and high care needs showed overall benefits in functional improvements in ADL and IADL from personal care–based HCBS. Care recipients in the community‐based and multiple services–based use pattern subgroups showed the least improvement in physical function. Our study indicates that the effects of reablement‐embedded HCBS use strategies may vary among older adults with different levels of care needs. We recommend further research to examine how to design HCBS with a reablement focus to better fit the needs of those with moderate and high levels of care needs. [ABSTRACT FROM AUTHOR]

This research evaluates whether the attainment of certification could affect the career perspectives of hospitality and tourism graduates. It collects a set of survey data on 729 tourism and hospitality graduates from 38 colleges and vocational schools in Taiwan. The resultant data demonstrate that those acquiring a professional certificate are more likely to have a full-time job. The level of starting salaries mainly depends on academic credentials, language proficiency, and academic performance. Findings show that students often develop a secondary job skill (e.g., a foreign language) to enhance their career path. Surprisingly, the possession of tourism/hospitality-related certificates has no significant impact on starting salaries, a departure from students' general perception. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreaks associated with mass religious gatherings which have the potential of invoking epidemics at large scale have been a great concern. This study aimed to evaluate the risk of outbreak in mass religious gathering and further to assess the preparedness of non-pharmaceutical interventions (NPIs) for preventing COVID-19 outbreak in this context.Methods: The risk of COVID-19 outbreak in mass religious gathering was evaluated by using secondary COVID-19 cases and reproductive numbers. The preparedness of a series of NPIs for preventing COVID-19 outbreak in mass religious gathering was then assessed by using a density-dependent model. This approach was first illustrated by the Mazu Pilgrimage in Taiwan and validated by using the COVID-19 outbreak in the Shincheonji Church of Jesus (SCJ) religious gathering in South Korea.Results: Through the strict implementation of 80% NPIs in the Mazu Pilgrimage, the number of secondary cases can be substantially reduced from 1508 (95% CI: 900-2176) to 294 (95% CI: 169-420) with the reproductive number (R) significantly below one (0.54, 95% CI: 0.31-0.78), indicating an effective containment of outbreak. The expected number of secondary COVID-19 cases in the SCJ gathering was estimated as 232 (basic reproductive number (R0) = 6.02) and 579 (R0 = 2.50) for the first and second outbreak, respectively, with a total expected cases (833) close to the observed data on high infection of COVID-19 cases (887, R0 = 3.00).Conclusion: We provided the evidence on the preparedness of NPIs for preventing COVID-19 outbreak in the context of mass religious gathering by using a density-dependent model. [ABSTRACT FROM AUTHOR]

Background and Objectives Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced 2 new payment mechanisms in 2018. This study assesses these mechanisms' impact on growth in numbers of home care workers and use of home care services in Taiwan. Research Design and Methods Data were collected from the Ministry of Health and Welfare (2014–2019) and the Division of Long-Term Care (2017–2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. Results Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post-implementation of the payment mechanisms (p <.05), the number of home care recipients (p <.05) and monthly home care visits (p <.05) also increased. Discussion and Implications The new payment mechanisms improved home care workers' autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined. [ABSTRACT FROM AUTHOR]

Background: Primary liver cancer (PLC) is the fifth and second leading cause of death in Japan and Taiwan, respectively. The aim of this study was to compare the economic burden of PLC between the two countries using the cost of illness (COI) method and identify the key factors causing the different trends in the economic burdens of PLC. Materials and methods: We calculated the COI every 3 years using governmental statistics of both countries (1996–2014 data for Japan and 2002–2014 data for Taiwan). The COI was calculated by summing the direct costs, morbidity costs, and mortality costs. We compared the COIs of PLC in both countries at the USD-based cost. The average exchange rate during the targeted years was used to remove the impact of foreign exchange volatility. Results: From 1996 to 2014, the COI exhibited downward and upward trends in Japan and Taiwan, respectively. In Japan, the COI in 2014 was 0.70 times the value in 1996, and in Taiwan, the COI in 2014 was 1.16 times greater than that in 1996. The mortality cost was the greatest contributor in both countries and had the largest contribution ratio to the COI increase in Japan. However, the direct cost in Taiwan had the largest contribution ratio to the COI decrease. Conclusions: To date, the COI of PLC in Japan has continuously decreased, whereas that in Taiwan has increased. Previous health policies and technological developments are thought to have accelerated the COI decrease in Japan and are expected to change the trend of COI of PLC, even in Taiwan. [ABSTRACT FROM AUTHOR]

Although the survival rate of burn patients in the Formosa Fun Coast Explosion disaster increased significantly, for patients facing long-term rehabilitation, there remained great stress. Therefore, the aim of this study was to explore the predictors of resilience among burn patients in this major disaster. We conducted a cross-sectional, descriptive study in a medical center in northern Taiwan, with a total of 30 burn patients enrolled. Patients' demographics were collected, and the Resilience Scale and Perceived Stress Scale were administered. Multivariate statistical analysis by stepwise and linear regression was used to test these predictors of resilience. The results showed that perceived stress was the key predictor of resilience in the stepwise regression analysis and by adjusting variables including stress level, gender, and education level. These results indicate that the stress level of burn patients should be determined first to provide more targeted methods for reducing stress and improving resilience. [ABSTRACT FROM AUTHOR]

The purpose of this project is to improve clinical care competencies of continuous venovenous hemofiltration (CVVH) in intensive care units (ICUs). The nurses are vital to maintain CVVH treatment in ICU settings. CVVH was administered only 66.0% correctly, and CVVH-related knowledge was only 56.8% correct. The reasons of these problems were inadequate educational trainings, standard protocols, and operationl guidelines and draining assistance were subsequently implemented. Educational training, protocols, digital selflearning videos, troubleshooting guidelines, and draining assistance were subsequently implemented. After the implementation, CVVH was administered 96.7% and the accuracy of knowledge raised up to 95.3% correct. This project significantly enhances ICU nurses' performance on CVVH. [ABSTRACT FROM AUTHOR]

This article explores the interaction between media policy and the development of minority language media, in this case, Hakka language radio stations. It examines how media policy has been caught between neo-liberal economic development and election politics and delineates the extent to which media policy has impacted the establishment, programming and performance of minority language media, especially in the context of political democratization. This article argues that the mission to promote cultural diversity and to 'make more voices heard' should not fall on minority language media alone, and that the government and mainstream media ought to take the lead if this goal is to be achieved. [ABSTRACT FROM AUTHOR]

• Gender, employment, marital status, injury area, and facial burns affect QoL. • Patients' simple abilities had the best recovery, improving significantly over time. • Employment and body image showed no significant improvement over three years. • Patients with more severe symptoms had lower QoL and higher risk of PTSD. Nearly 500 people were injured in the dust explosion at the Formosa Fun Coast water park in 2015, making it the accident with the largest number of burn victims in Taiwan. Severe burn injuries are often accompanied by long-term impacts on physical, psychological, social, occupational, and aesthetic wellness. Survivors usually require several years or even decades of medical rehabilitation and psychological counseling, which inevitably affect their quality of life (QoL). The purpose of this study was to assess the changes in the QoL and the risk of posttraumatic stress disorder (PTSD) among the survivors of the 2015 dust explosion at the Formosa Fun Coast water park and discuss the potential influencing factors. Data were collected from the burn victims using a self-administered sociodemographic and injury characteristics questionnaire, the adapted Chinese version of the Burn Specific Health Scale-Brief (ACV BSHS-B), and the Impact of Event Scale for Burns (IESB). IBM-SPSS (Version 21.0) was used for the statistical analysis of the data. A total of 81 patients were enrolled in this study from July 2016 to August 2018. The study results revealed that gender, employment status after the burn injury, marital status, injury area, and the presence of facial burns greatly affected survivors' QoL three years following the injury. Survivors' simple abilities (Mean: 3.91 out of 4 on average, SD:.21) showed the best recovery and improved significantly over time. Employment (Mean: 2.33, SD:.98) and body image (Mean: 1.94, SD:.95) were considered the most influential factors on QoL, with no significant improvement over the three years. Moderate to severe pain, itching, and sleep problems caused by the dust explosion still affected 29.2%, 46.6%, and 58.1% of survivors after three years, respectively. Survivors with more severe symptoms had worse QoL and a higher risk of PTSD. The burn accident affected not only the injured individuals but also their entire families. In order to help injured individuals reintegrate into society and maintain better overall health, our study suggested providing family-based healthcare plans and necessary follow-up visits in a timely manner. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence and characteristics of ocular manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in patients treated at a tertiary referral center in Taiwan during a time of highly active antiretroviral therapy (HAART) Materials and Methods: A retrospective cohort study in Taiwan was performed between January 2006 and July 2016. Ocular examination and systemic information were recorded from the HIV-infected patients. Results: 1242 patients with HIV/AIDS were identified. Ninety patients had ophthalmic records, and HIV-related ocular manifestations were reported in 57 patients. The most prevalent ocular manifestations were cytomegalovirus (CMV) retinitis, ocular syphilis, and HIV microvasculopathy. Mean CD4 count was significantly lower in patients with HIV-related ocular manifestations compared to those without. Conclusion: We found that lower CD4 count, especially <200 cells/μL, was a significant factor for detecting HIV-related ocular manifestations. Comprehensive ophthalmic screening in high-risk group is helpful for early diagnosis and prompt treatment of sight-threatening ocular complications. [ABSTRACT FROM AUTHOR]

The prevalence of temporomandibular disorder (TMD) among elderly people with Parkinson’s disease (PD) is relatively high, but a population-based study of the relationship between PD and TMD is still lacking. This study, therefore, sought to investigate the association between TMD and PD by using data for one million randomly sampled beneficiaries of Taiwan’s National Health Insurance program, including 6,185 PD patients who were matched through propensity score matching with 18,555 non-PD patients. Both the PD and non-PD cohorts were followed until death, any diagnosis of TMD, or December 31, 2013, whichever occurred first. Each diagnosis of TMD was made by a qualified physician according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), using the diagnosis codes 524.60, 524.62, 524.63, and 524.69 while excluding tooth abscess, wisdom tooth eruption, herpes zoster and postherpetic neuralgia, mastoiditis, otitis externa, otitis media, parotitis, sialadenitis, and trigeminal neuralgia. We used Cox proportional hazard regression models to calculate the relative risk of TMD and found a 2.11-fold (95% CI: 1.35–3.30) increased risk of TMD overall in the PD group compared with the non-PD group. Stratified by follow-up period, there was a 4.25-fold (95% CI: 1.51–11.93) increased risk in the PD group in the first year after the initial PD diagnosis and a 3.88-fold (95% CI: 1.33–11.28) increased risk in the second year. Over the long-term (>5 years), PD was significantly associated with an increased risk of TMD. These findings suggest that it is important to closely monitor the temporomandibular joint health of PD patients. [ABSTRACT FROM AUTHOR]

The article explores historically and theoretically the phenomenon of shen-ti wen-hua (culture of the body) in the context of Taiwan's experimental performance in the 1980s–1990s. By highlighting different corporeal discourses in various sociopolitical contexts across time, it addresses such critical issues as the relation between the individual and the collective in the history of Taiwanese modernity, the quests for identity in art and culture, the transformation of the role of the avant-garde in aesthetic and political pursuits, and the ultimate question of the relationship between art and society from the colonial era to a contemporary world dominated by consumer culture and global capitalism. The body, with its materiality and rich semiotic possibilities, has at certain historical moments served as a potent metaphor for questioning the sociopolitical status quo and envisioning new identities and alternative power relations in Taiwanese society: the period under consideration in the article was one of those moments. [ABSTRACT FROM AUTHOR]

Purpose: To compare the characteristics, visual outcome, and prognostic factors of patients with endogenous endophthalmitis and to determine the association of endophthalmitis with Klebsiella pneumoniae infection.Methods: We retrospectively analyzed records of patients diagnosed with endogenous endophthalmitis from January 2002 to August 2013.Results: A total of 86 patients were diagnosed with endogenous endophthalmitis; 48 patients were infected with K. pneumoniae, 28 patients were infected with other pathogens, and 10 were culture-negative. Diabetes mellitus was more prevalent among patients infected with K. pneumoniae. Liver abscess and urinary tract infection were the leading sources of infection in patients with and without a K. pneumoniae infection, respectively. In patients with endogenous endophthalmitis, poor initial vision (p<0.001) and K. pneumoniae infection (p = 0.048) were significantly associated with a poor visual outcome.Conclusions: Poor initial vision and K. pneumoniae infection were significantly associated with poorer visual outcome for patients with endogenous endophthalmitis. [ABSTRACT FROM AUTHOR]

Background Significant differences exist between eastern and western diets, and the way in which Chinese dietary intake relates to specific cognitive domains remains unclear. We aimed to assess the association between dietary patterns ( DPs) and cognitive decline in Chinese elderly. Setting Participants were recruited from the elderly health checkup program of a teaching hospital in Taipei, Taiwan. Participants A total of 475 elders (age ≥65) were included in this prospective cohort study. Measurements The outcome comprised the decline of global and domain-specific cognition between baseline (2011-2013) and follow-up (2013-2015). Dietary data from the previous year were collected via a food frequency questionnaire at baseline, and a factor analysis was performed to identify DPs. Multivariable linear regression and logistic regression models were used to assess associations between Chinese DPs and cognitive decline over 2 years adjusting for selected covariates. Results Three DPs (vegetable, meat, and traditional) were identified. Moderate- or high-score 'vegetable' DP significantly protected against decline of logical memory (recall I: β = 0.16-0.18, odds ratio ( OR) = 0.42-0.48; recall II: β = 0.17-0.21); while high-score DP increased executive function decline (β = −0.22). A high-score 'meat' DP was related to decline of verbal fluency-total score (β = −0.19); while moderate- or high-score 'meat' DP protected against attention decline (β = 0.20-0.22). High-score 'traditional' DP protected against decline of logical memory-recall I (β = 0.18). No significant association was observed for global cognition. Conclusion These findings suggest that three DPs identified in Chinese elderly were associated with different cognitive domains. Further research is needed to explore the efficacy of dietary interventions in reducing cognitive decline in older adults. [ABSTRACT FROM AUTHOR]

• Using 50% EtOH at 75 °C reflux and -20 °C frozen preservation maximizes TQC extraction. • Yogurt 3 consortia yielded highest quercetin production after 9d fermentation. • Extracts frozen for 84 days at -20 °C increase TQC 1.5–1.75 fold. • OPEs fermentation can better stimulate bioenergy generation in MFCs. • 2–3 cycles of bacterial acclimation are enough for maximal quercetin production. As a highly populated and resource-limited Taiwan, material recycling and reuse are of great importance to satisfy net-zero waste accumulation while simultaneously developing value-added production for circular economy. Herein, quercetin-rich onion peel wastes were chosen as a model to consider the technical feasibility of material recycling through fermentation. Pretreatment of onion peels extracts (OPEs) through frozen-preservation methods and serial acclimation via lactose-degrading bacteria was implemented for comparative optimization. Optimal extraction conditions (e.g., solvent, temperature of extraction, and frozen-preservation time) were first determined. Batch cultures of Lactobacillus sp. and Yogurt mixed consortia were implemented to maximize quercetin product formation using OPEs as sole nutrient sources via fermentation. Comparative assessment was performed by assessing total phenolic content, total quercetin content, and quercetin concentration. Microbial fuel cells were used to investigate time courses of electrochemical characteristics of residual OPEs during fermentation. Comparative assessment revealed that OPEs could be optimized under extraction conditions of 50% ethanol as solvent, 75 °C extraction temperature, and frozen-preservation temperature of -20 °C. Yogurt mixed consortia yielded higher quercetin production that Lactobacillus sp. at 9 days fermentation. Phase-plane trajectories also revealed that using extracts frozen for 84 days at -20 °C through 9-day fermentation could achieve maximal quercetin production (ca. 1.5–1.75-fold compared to no fermentation). MFC results suggested that OPE fermentation was electrochemically favorable to enhance quercetin generation. Approximately two or three cycles of bacterial acclimation is sufficient to obtain maximal quercetin productivity and stable power-stimulating characteristics (ca. 1.35–1.5 fold power density amplification). To the best of our knowledge, this study was the first work to quantitatively decipher the most appropriate operation strategy for quercetin production from agricultural wastes (OPEs). [Display omitted] [ABSTRACT FROM AUTHOR]

Bladder cancer is one of the major cancer types and both environmental factors and genetic background play important roles in its pathology. Kaohsiung is a high industrialized city in Taiwan, and here we focused on this region to evaluate the genetic effects on bladder cancer. Muscarinic acetylcholine receptor M3 (CHRM3) was reported as a key receptor in different cancer types. CHRM3 is located at 1q42-43 which was reported to associate with bladder cancer. Our study attempted to delineate whether genetic variants of CHRM3 contribute to bladder cancer in Chinese Han population in south Taiwan. Five selected SNPs (rs2165870, rs10802789, rs685550, rs7520974, and rs3738435) were genotyped for 30 bladder cancer patients and 60 control individuals and genetic association studies were performed. Five haplotypes (GTTAT, ATTGT, GCTAC, ACTAC, and ACCAC) were found significantly associated with low CHRM3 mRNA level and contributed to increased susceptibility of bladder cancer in Kaohsiung city after rigid 10000 consecutive permutation tests. To our knowledge, this is the first genetic association study that reveals the genetic contribution of CHRM3 gene in bladder cancer etiology. [ABSTRACT FROM AUTHOR]

Purpose: This study explored how changes in leisure time activities interplayed with changes in functional disability among Taiwanese older adults. Method: A parallel process and multiple-indicator latent growth curve modeling was adopted for analysis of the data. Longitudinal data from four waves of the Taiwan Longitudinal Study on Aging, collected between 1996 and 2007, were used for analysis. Data included responses of 5451 older adults with a mean age of 67.16 years (SD = 2.51) in 1996. Results: Compared to baseline level of leisure time activities, increasing the rate of change in leisure time activities has more than three times the effect on slowing down the progression of functional disabilities. The baseline functional disabilities did not significantly predict the changes in leisure time activity participation. Conclusion: Engagement in leisure time activity in later life is associated with a slower speed of progression toward functional disability. Early functional disability may not inhibit leisure time activity participation in later life. [ABSTRACT FROM AUTHOR]

Objective: With global population aging, great business opportunities are driven by the various needs that the elderly face in everyday living. Internet development makes information spread faster, also allows elderly and their caregivers to more easily access information and actively participate in value co-creation in the services. This study aims to investigate the designs of value co-creation by the supply and demand sides of the senior industry.Design: This study investigated senior industry in Taiwan and analyzed bussiness models of 33 selected successful senior enterprises in 2013. We adopted series field observation, reviews of documentations, analysis of meeting records and in-depth interviews with 65 CEOs and managers.Setting: Thirty-three quality enterprises in senior industry.Participants: Sixty-five CEOs and managers in 33 senior enterprises.Interventions: None.Main Outcome Measures: Value co-creation design, value co-creating process.Results: We constructed a conceptual model that comprehensively describes essential aspects of value co-creation and categorized the value co-creation designs into four types applying for different business models: (i) interaction in experience spaces co-creation design, (ii) on-site interacting co-creation design, (iii) social networking platform co-creation design and (iv) empowering customers co-creation design. Through value co-creation platform design, the senior enterprises have converted the originally passive roles of the elderly and caregivers into active participants in the value co-creation process.Conclusions: The new paradigm of value co-creation designs not only promote innovative development during the interactive process, lead enterprises reveal and meet customers' needs but also increase markets and profits. [ABSTRACT FROM AUTHOR]

​Impaired homocysteine metabolism plays an important role in alcoholic liver disease (ALD); however, there are limited data about its relationship with the risk and severity of patients with ALD in Taiwan. To understand plasma homocysteine and related vitamin concentrations in patients with ALD in Taiwan, we recruited 50 male patients with ALD from Cathay General Hospital, with 49 age-and gender-matched healthy adults as the control group. The Institutional Review Board for Human Studies approved the study, and informed consent was obtained from all patients prior to blood collection. Significantly higher plasma homocysteine concentrations but lower folate concentrations were obtained from patients with ALD. In addition, patients with ALD showed a significant lower erythrocyte reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio but higher plasma thiobarbituric acid-reactive substance (TBARS) concentration, which indicated that oxidative stress was occurring in patients with ALD. A negative correlation between plasma folate and homocysteine was observed in all subjects. There was also a negative correlation between plasma homocysteine and the erythrocyte GSH/GSSG ratio which indicated impaired homocysteine metabolism may have disrupted the antioxidative status. In addition, patients in Child-Pugh Class B and C showed higher plasma vitamin B12 concentrations than did patients without cirrhosis and patients in Child-Pugh Class A. These findings show that impaired homocysteine metabolism was observed in patients with ALD in Taiwan. In addition, the plasma vitamin B12 concentration may reflect the degree of liver injury. [ABSTRACT FROM AUTHOR]

Our aim was to identify disablement factors, including predisposing, intra-individual, and extra-individual factors, which predict the rate of change in general functional disability (GFD) in older adults. This study utilized the Taiwan Longitudinal Study on Aging Survey in 1996–2007 ( N = 3,186). Multiple-indicator latent growth curve modeling was used to examine how 12 disablement factors predicted the rate of change in GFD. GFD trajectories were modeled using Nagi’s functional limitations, activities of daily living, and instrumental activities of daily living. Greater age ( B = .025), female gender ( B = .114), and greater numbers of comorbidities ( B = .038) were associated with faster increase in GFD. Education ( B = −.005) and participation in physically active leisure time activities ( B = −.031) were associated with slower increase in GFD. Our findings add to the understanding of how disablement factors contribute to the rate of change in GFD. Predisposing factors played the main role. However, the factors we found to be associated with the rate of change in GFD in older adults were slightly different from the factors reported in the literature. Decreasing the number of comorbidities and increasing the level of physically active leisure time activity should be considered priorities for preventing disability as people age. [ABSTRACT FROM AUTHOR]

Isothiocyanates (ITCs) occur in many cruciferous vegetables. These compounds, which have significant anticancer actions, can induce apoptosis in different human cancer cell lines. In the present study, we investigated if allyl isothiocyanate (AITC) would induce toxicity in human breast cancer MCF-7 (estrogen receptor positive) and MDA-MB-231 (estrogen receptor negative) cells. We found that AITC stimulated reactive oxygen species and Ca production, and decreased the mitochondrial membrane potential. Activity of caspase-8, -9 and -3 was increased by AITC in both cell lines. AITC also induced mitochondrial-mediated apoptosis, as shown by cytochrome c, AIF and Endo G release from mitochondria, activation of caspase-9 and caspase-3, and formation of DAPI-positive cells. There was a significant reduction in the levels of the anti-apoptotic protein Bcl-2 along with a marked increase in the pro-apoptotic protein Bax in both cell lines. AITC induced apoptosis in human breast cancer MCF-7 cells via AIF and Endo G signaling pathways, but in MDA-MB-231 cells apoptosis occurred via the GADD153 pathway. This study has revealed novel anti-cancer mechanisms of AITC, a compound that is ordinarily present in human diets and may have potential therapeutic effects in various cancers. [ABSTRACT FROM AUTHOR]

Copyright of International Journal for Quality in Health Care is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Moyamoya disease (MMD) is a disorder characterized by stenosis of bilateral internal carotid arteries with compensatory angiogenesis of the perforating blood vessels. Familial transmission in MMD is common. Recently, mutations in human RNF213 and ACTA2 genes were identified to be responsible for MMD. The present study was to determine whether Taiwanese MMD patients carried mutations in these two genes. Of the 36 MMD patients, eleven was found to have RNF213 mutations. Direct genetic sequencing identified four different RNF213 mutations in the 11 patients from 8 families: five with a p.R4810K, one with p.A1622V, one with p.V3933M, and the other one with p.R4131C. The latter three represent novel missense mutations. No mutation in ACTA2 gene was identified. Clinically, cerebral infarction was common in patients with an RNF213 mutation (9/11). In addition, four mutant patients had developmental delay (4/11) and two had mental dysfunction (2/11). The magnetic resonance angiography of asymptomatic mutant carriers demonstrated high incidence of multiple stenosis of intracranial vessels (3/6, 50%). Since 30.6% (11/36) of Taiwanese moyamoya patients carry an RNF213 mutation and intracranial arterial stenosis was found in half of the asymptomatic mutant carriers, it is suggested that the RNF213 mutation should form part of the diagnostic workup for MMD in clinical practice. [ABSTRACT FROM AUTHOR]

Melioidosis results from an infection with the soil-borne pathogen Burkholderia pseudomallei, and cases of melioidosis usually cluster after rains or a typhoon. In an endemic area of Taiwan, B. pseudomallei is primarily geographically distributed in cropped fields in the northwest of this area, whereas melioidosis cases are distributed in a densely populated district in the southeast. We hypothesized that contaminated cropped fields generated aerosols contaminated with B. pseudomallei, which were carried by a northwesterly wind to the densely populated southeastern district. We collected soil and aerosol samples from a 72 km2 area of land, including the melioidosis-clustered area and its surroundings. Aerosols that contained B. pseudomallei-specific TTSS (type III secretion system) ORF2 DNA were well distributed in the endemic area but were rare in the surrounding areas during the rainy season. The concentration of this specific DNA in aerosols was positively correlated with the incidence of melioidosis and the appearance of a northwesterly wind. Moreover, the isolation rate in the superficial layers of the contaminated cropped field in the northwest was correlated with PCR positivity for aerosols collected from the southeast over a 2-year period. According to pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) analyses, PFGE Type Ia (ST58) was the predominant pattern linking the molecular association among soil, aerosol and human isolates. Thus, the airborne transmission of melioidosis moves from the contaminated soil to aerosols and/or to humans in this endemic area. Author Summary: Cases of melioidosis, an emerging disease, are usually clustered after rains or typhoons. In Taiwan, the endemic area includes rural cropped fields contaminated with B. pseudomallei in the northwest and a densely populated district in the southeast, where melioidosis-cluster is distributed. We hypothesized that contaminated cropped fields generated aerosols contaminated with B. pseudomallei, which were carried by a northwesterly wind and enveloped the southeastern densely populated district. In a prospective study, aerosols that contained B. pseudomallei-specific DNA were well distributed in the densely populated districts but were rarely found in their surrounding areas. The concentration of specific DNA in aerosols correlated with the melioidosis incidence and the northwesterly wind in this endemic area. The isolation rate in the superficial layers of the contaminated cropped field in the northwest correlated with the PCR positivity of aerosols collected from the southeastern district over a 2-year period. We used genetic typing to identify a molecular association among the soil, aerosols and human isolates. We suggest that melioidosis is airborne and is transmitted from the contaminated soils to aerosols and/or to humans in this area. [ABSTRACT FROM AUTHOR]

Background: Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei with a high case-fatality rate. Epidemiological and animal studies show the possibility of inhalation transmission. However, no B. pseudomallei concentrations in ambient air have been researched. Here, we developed a method to quantify ambient B. pseudomallei and then measured concentrations of ambient B. pseudomallei during the typhoon season and the non-typhoon season to determine the factors influencing ambient B. pseudomallei levels. Methods: We quantified ambient B. pseudomallei by using a filter/real-time qPCR method in the Zoynan Region in Kaohsiung, southern Taiwan. Twenty-four hour samples were collected at a sampling rate of 20 L/min every day from June 11 to December 21, 2012 including during the typhoon season (June to September) and reference season (October to December). Results: We successfully developed a filtration/real-time qPCR method to quantify ambient B. pseudomallei. To our knowledge, this is the first report describing concentrations of ambient B. pseudomallei. Ambient B. pseudomallei were only detected during the typhoon season when compared to the reference season. For the typhoons affecting the Zoynan Region, the positive rates of ambient B. pseudomallei were very high at 80% to 100%. During June to December, rainfall was positively correlated with ambient B. pseudomallei with a statistical significance. Sediment at a nearby pond significantly influenced the concentration of ambient B. pseudomallei. During the typhoon month, the typhoon was positively correlated with ambient B. pseudomallei whereas wind speed was reversely correlated with ambient B. pseudomallei. Conclusions: Our data suggest the possibility of transmission of B. pseudomallei via inhalation during the typhoon season. Author Summary: Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei with a high case-fatality rate. Epidemiological and animal studies show the possibility of inhalation transmission. However, no B. pseudomallei concentrations in ambient air have been researched. Here, we successfully developed a method to quantify ambient B. pseudomallei by using a filter/real-time qPCR method. Twenty-four hour samples were collected every day from June 11 to December 21, 2012 including during the typhoon season (June to September) and reference season (October to December) in the Zoynan Region in Kaohsiung, southern Taiwan. To our knowledge, this is the first report describing concentrations of B. pseudomallei in ambient air. For the typhoons affecting the Zoynan Region, the positive rates of ambient B. pseudomallei were very high. Our data imply the possibility of air transmission of Melioidosis during the typhoon season. In addition, ambient B. pseudomallei aerosolized from sediment of a nearby lake should be a concern as an important source of transmission. Our results could provide deeper insight into Melioidosis transmissibility and infection control. [ABSTRACT FROM AUTHOR]

Background: Oral health is crucial to individual growth and development. However, oral health care is often overlooked in children with special health care needs (CSHCN). We investigated current oral health status and unmet dental needs of CSHCN in Taiwan. Methods: We performed a retrospective study of consecutive CSHCN cases receiving first-time comprehensive dental treatment under general anesthesia at Taipei Veterans General hospital from 2001 to 2010. We retrieved clinical data including age, sex, types, and severity of disability, caries experience index [decayed, extracted, and filled teeth (deft) index for primary dentition/decayed, missing, and filled teeth (DMFT) index for permanent dentition], malocclusion, and treatment modalities from medical charts for analysis. The correlation between different groups of CSHCN regarding the deft/DMFT indices and treatment modalities was analyzed statistically. Results: Our study included 96 children, ranging in age from 2.4 years to 14.3 years (mean age 6.8 ± 3.3 years). The deft/DMFT index was significantly higher in the younger age group (2–6 years; 13.8 ± 4.3) compared with the older group (> 6 years; 10.5 ± 5.3; p < 0.001). The mean number of total treated teeth was 14.2 ± 3.8, and no differences existed among disability groups (p = 0.528) and age groups (p = 0.992). For the treatment modality, the number of pulp therapies with crown restoration was higher in the younger age group than in the older group. At the time of the study, 53 CSHCN had reached their full permanent dentition. We observed significantly more malocclusion of full permanent dentition in the older age group (91%) than in the younger group (35%; p < 0.001). Conclusion: Unmet dental needs and caries experience indices remain high in CSHCN, regardless of the types and severity of disability. However, the younger the age at which CSHCN received their first dental treatment, the more effective the dental rehabilitation was. Parental education regarding early dental intervention and a preventive approach for enhanced oral care is mandatory. [ABSTRACT FROM AUTHOR]