Search

Guided by the Second Language Motivational Self System (L2MSS) framework, this study examined to what extent the L2MSS components of ideal self, ought-to self, and learning experience described the motivation of learners who chose to enroll in college elective courses of modern languages other than English (LOTEs) in the monolingual social setting of Taiwan. Questionnaire surveys were conducted at the end of two consecutive semesters and learners were interviewed. Triangulation of survey and interview data suggested that a positive learning experience was the strongest variable in motivating effort. Although some classroom factors were known, others worth further exploration in instructional settings were pointed out. The ought-to L2 self was found to be an insignificant predictor with questionable validity. Instead, academic responsibility and instrumentality were found to be more relevant factors. Results on ideal self were less straightforward, suggesting that the ideal self for LOTEs may be qualitatively different from the English ideal self. Comparisons of data sets across time and learner groups indicated motivation did not change over time. By considering major L2MSS components and related constructs together, this study uncovered their relative adequacy in explaining LOTE motivation and suggested possible new perspectives for studying LOTE motivation in instructional settings.

English language education in Taiwan has experienced a number of modifications over the past decade. The Ministry of Education (MOE) has initiated several reforms since 1994 to change the historical grammar-translation pedagogy into one emphasizing more communication. The purpose of these alterations was to increase learners' communication proficiency, so they could meet the new demands resulting from increased internationalization and globalization. Previous studies regarding Communicative Language Teaching (CLT) in many other EFL (English as a foreign language) settings and Taiwan have shown promising results, yet the process of implementing CLT has often been challenging. Many factors, such as large class sizes and parents' negative attitudes toward CLT, have been found to negatively influence teachers' willingness to implement CLT. Using a multi-methodological approach of quantitative surveys and qualitative interviews, this study aims to examine teachers' needs for better communication-oriented practices in the classrooms of Taiwan. In total, 75 teachers were surveyed. Based on their degree of willingness to participate, 15 of them were further contacted for more in-depth interviews. The findings of the study revealed that to make CLT more applicable, teachers demanded in-service training and assistance from native English-speaking teachers (NESTs). In addition, students' and parents' re-education to value the development of communication proficiency, and to gain more knowledge about CLT, and the support from school authorities, were considered crucial.

This paper reports the design of learning-oriented formative assessments in an EFL writing course that involved learners in regularly responding to teacher feedback. Following major assessment and feedback frameworks developed recently, these formative assessments were explicated in three aspects: the scheduling of learning and assessment activities, instruments used to encourage learner responses to teacher assessment feedback, and the arrangement of gradually removing scaffolds provided by the teacher and peers. Four batches of learner essays written throughout the semester were rated for quality. Results revealed significant improvement from the first to the second, from the second to the third, and from the third to the fourth assignment. To further examine the characteristics of learning, analysis was conducted on the teacher-learner dialogues documented in teacher feedback forms and learner revision reports. Two learners were chosen as cases to exhibit their gradual development on cognitive and affective dimensions. It was found that, with the repetitive opportunities to perform, assess, articulate, and reflect as afforded by conversations on these formative assessments, learners could revisit major themes and deepen understanding, receive consistent support adjusted for their personalities, and co-construct meaning through challenges and scaffolds.

English education in Taiwan has experienced a number of modifications over the past decade. The Ministry of Education (MOE) has initiated several reforms since 1994 with a purpose of changing the pedagogy, focusing on grammar-translation, to a more communicative one aim at cultivating learners of greater communication proficiency for the demands resulting from internationalization and globalization. Although the outcome may be promising, the process has proven to be challenging. The studies regarding Communicative Language Teaching (CLT) in many EFL settings suggested that factors, associated with socio-culture, school administration, classroom dynamics and personnel, have negatively influenced teachers' willingness to implement CLT. Notwithstanding the comprehensive discussion about the difficulties, rare were they related directly to rural teachers whose experiences might be different from their urban peers. Their distinct insight and impressions are necessary, and therefore worthy of the investigation in order to further understand the whole CLT-resulted phenomena. Using a multi-methodological approach of quantitative survey and qualitative interview, this study aims at uncovering the difficulties rural EFL teachers have encountered when implementing CLT in their classrooms. Seventy-five teachers were surveyed. Based on their participating willingness, 15 of them were further contacted for in-depth interviews. The result of the study revealed that besides the repeated issues, the teachers have faced problems, including students' low L1 cognitive resources, parents' indifferent attitudes toward communicative-English education, and the assortment of students of heterogeneous language skills into the same class, which are unique to the rural setting because of geographical and socio-economic confinement.

Informed by Dörnyei's L2 Motivational Self System and intended to fill a gap in learning motivation research on languages other than English (LOTEs), this study investigated learners' motivation for three language clusters -- Southeast Asian (Vietnamese, Thai and Malay), Northeast Asian (Japanese and Korean) and European (German, Spanish and French) -- and compared the results against the same learners' English learning motivation. Regression analyses revealed that for all three language groups, the strongest predictors of intended effort were learning experience, followed by ideal self and culture/community interest. Ought-to self and instrumentality, both promotional and preventive, were ruled out in all three LOTE regression models. The significance of learning experience as a motivational predictor was comparatively new in LOTE-related findings. These learners' English learning motivation presented a similar but more complicated picture, with predictive variables being, in descending order, learning attitude, culture/community interest, learning experience, ideal self and instrumentality. While externally imposed motivators played a role in English, they did not do so for the same learners in LOTE situations. Discrepancies with earlier results concerning LOTE motivation as well as with similar learner populations are discussed. Implications for both pedagogical practice and the theoretical development of foreign language motivation are suggested.

Background: In Taiwan, residents with and without dementia mostly co-live in long-term care facilities. The behavioral and psychiatric symptoms of dementia residents often pose challenges for others living together. This study explored the symbiotic experiences of residents without dementia co-living with those with dementia in long-term care facilities in Taiwan to present their experiences of living together. Methods: This was a cross-sectional descriptive study with a phenomenological design. Semi-structured face-to-face interviews were conducted with 30 residents without dementia from three long-term care institutions in Taiwan. Colaizzi's data processing steps were used for analysis. Results: The analysis of interview transcripts revealed that the experiences of residents who lived with those with dementia were that of a "symbiosis." Three core themes were found: "the impact of co-living," "facing difficulties and coping," and "companionship and reciprocity." This study showed that residents without dementia may be affected by the behavioral and psychiatric symptoms of residents with dementia when co-living in long-term care facilities. However, there are also positive and mutually beneficial interactions between them. By helping people with dementia in their daily lives, residents without dementia feel happy and accomplished and their self-worth is enhanced. Furthermore, residents with dementia have more opportunities for social engagement and co-living interactions. Conclusion: These results can guide long-term care facilities without special care dementia units to support residents without dementia, reduce the interference of the behavioral and psychiatric symptoms of residents with dementia, and promote mutual benefits. However, these findings warrant further investigation. [ABSTRACT FROM AUTHOR]

This study explores the specific language learning strategies (LLS) employed by student-athletes in Higher Education institutions in Taiwan. Given these student-athletes' challenges in balancing academic and athletic commitments, understanding their adoption of LLS provides valuable pedagogical insights. This quantitative research gathered 150 responses, considering variables such as academic year, gender, duration of English study, and athletic specialization. Our findings indicate a moderate overall LLS usage, with a pronounced preference for metacognitive strategies. Strategies such as watching English shows and actively engaging in conversations were particularly favored. Conversely, kinesthetic and mnemonic approaches were less popular, such as acting out words or using rhymes. Delving deeper into the data, there were limited gender-based differences in LLS adoption. However, athletic specialization significantly influenced LLS preferences. Especially, martial arts or combat sports athletes had the highest LLS mean scores across all categories. These results highlight the distinct LLS preferences among Taiwanese student-athletes and suggest potential pedagogical adaptations to enhance their language learning experiences. [ABSTRACT FROM AUTHOR]

This study proposes a model to view and analyse college students' written peer feedback after they assess each other's formative task assignment and provide comments. The model was developed by: (a) revisiting learning-oriented assessment and feedback theories, (b) reviewing and summarising existing peer feedback analysis approaches as detailed in published empirical studies, and (c) analysing a small set of primary learner peer feedback data. In the proposed GEARed model of peer feedback, each complete piece of comment on one improvable unit may have four cognitive elements, i.e. identification of the "G"ap between performance and goal, "E"xplanation of the gap, gap-bridging "A"spirations, and being "R"esourceful to reach beyond the current knowledge/skill level. Two social-affective-interactive elements also play a part, i.e. being "e"ncouraging to the peer feedback receiver and "d"oubtful toward the provider self. Each feedback comment may contain any or all of these incremental elements rather than being assigned only to one category. It is argued that the absent or unresolved aspects in feedback leave room for the receiver to reflect and may suggest instructional actions for teachers. Finally, different patterns of GEARed component combinations are hypothesised and their implications for learning and teaching are discussed.

Background: Rotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR. Methods: A total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant–Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations. Results: At three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = − 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up. Conclusions: Higher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR. [ABSTRACT FROM AUTHOR]

Confirmatory tests for diagnosis of primary aldosteronism (PA) play an important role in sparing patients with a false-positive aldosterone-to-renin ratio (ARR) screening test from undergoing invasive subtyping procedures. We recommend that patients with a positive ARR test should undergo at least one confirmatory test to confirm or exclude the diagnosis of PA before directly proceeding to subtype studies, except for patients with significant PA phenotypes, including spontaneous hypokalemia, plasma aldosterone concentration >20 ng/dL plus plasma renin activity below a detectable level. Although a gold standard confirmatory test has not been identified, we recommend that saline infusion test and captopril challenge test, which were widely used in Taiwan. Patients with PA have been reported to have a higher prevalence of concurrent autonomous cortisol secretion (ACS). ACS is a biochemical condition of mild cortisol overproduction from adrenal lesions, but without the typical clinical features of overt Cushing's syndrome. Concurrent ACS may result in incorrect interpretation of adrenal venous sampling (AVS) and may lead to adrenal insufficiency after adrenalectomy. We recommend screening for ACS in patients with PA scheduled for AVS examinations as well as for adrenalectomy. We recommend the 1-mg overnight dexamethasone suppression test as screening method to detect ACS. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure the association between ambient heat and hypoglycemia-related emergency department visit or hospitalization in insulin users. RESEARCH DESIGN AND METHODS: We identified cases of serious hypoglycemia among adults using insulin aged ≥65 in the U.S. (via Medicare Part A/B/D-eligible beneficiaries) and Taiwan (via National Health Insurance Database) from June to September, 2016–2019. We then estimated odds of hypoglycemia by heat index (HI) percentile categories using conditional logistic regression with a time-stratified case-crossover design. RESULTS: Among ∼2 million insulin users in the U.S. (32,461 hypoglycemia case subjects), odds ratios of hypoglycemia for HI >99th, 95–98th, 85–94th, and 75–84th percentiles compared with the 25–74th percentile were 1.38 (95% CI, 1.28–1.48), 1.14 (1.08–1.20), 1.12 (1.08–1.17), and 1.09 (1.04–1.13) respectively. Overall patterns of associations were similar for insulin users in the Taiwan sample (∼283,000 insulin users, 10,162 hypoglycemia case subjects). CONCLUSIONS: In two national samples of older insulin users, higher ambient temperature was associated with increased hypoglycemia risk. [ABSTRACT FROM AUTHOR]

Objectives: The role of autoimmune diseases on the risk for acute epiglottitis remains uncertain. This study aimed to delineate the association between epiglottitis and autoimmune diseases using population database. Methods: A population-based retrospective study was conducted to analyze claims data from Taiwan National Health Insurance Research Database collected over January, 2000, to December, 2013. Results: In total, 2339 patients with epiglottitis were matched with 9356 controls without epiglottitis by sex, age, socioeconomic status, and urbanization level. The correlation between autoimmune diseases and epiglottitis was analyzed by multivariate logistic regression. Compared with controls, patients with epiglottitis were much more likely to have preexisting Sjögren syndrome (adjusted odds ratio [aOR]: 2.37; 95% CI: 1.14-4.91; P =.021). In addition, polyautoimmunity was associated with increased risk of epiglottitis (aOR: 2.08; 95% CI: 1.14-3.80; P =.018), particularly in those aged >50 years (aOR: 2.61; 95% CI: 1.21-5.66; P =.015). Conclusions: Among autoimmune diseases, we verify the association between epiglottitis and Sjögren syndrome in Taiwan. Furthermore, we present the novel discovery that patients with epiglottitis have an increased risk of polyautoimmunity, particularly those aged >50 years. [ABSTRACT FROM AUTHOR]

The European System for Cardiac Operative Risk Evaluation (EuroSCORE II) is a well-established scoring system for predicting mortality in cardiac surgery. This system was derived predominantly from a European patient cohort; however, no validation of this system has been conducted in Taiwan. We sought to assess the performance of EuroSCORE II at a tertiary centre. The 2161 adult patients receiving cardiac surgery between 2017 and 2020 in our institution were included. Overall, the in-hospital mortality rate was 7.89%. The performance of EuroSCORE II was assessed using the area under the receiver operator curve (AUC) for discrimination and the Hosmer–Lemeshow (H–L) test for calibration. Data were analysed for type of surgery, risk stratification, and status of the operation. EuroSCORE II had good discriminative power (AUC=0.854, 95% Confidence Interval (CI): 0.822–0.885) and good calibration (χ2=5.19, p=0.82) for all types of surgery except ventricular assist devices (AUC=0.618, 95% CI: 0.497–0.738). EuroSCORE II also showed good calibration for most types of surgery except coronary artery bypass surgery (CABG) combined procedure (P=0.033), heart transplantation (HT) (P=0.017), and urgent operation (P=0.041). EuroSCORE II significantly underestimated the risk for CABG combined procedure and urgent operations, and overestimated the risk for HT. EuroSCORE II had satisfactory discrimination and calibration power to predict surgical mortality in Taiwan. However, the model is poorly calibrated for CABG combined procedure, HT, urgent operation, and, likely, lower- and higher-risk patients. [ABSTRACT FROM AUTHOR]

Purpose: The present study aims to examine the disparate effects of health behavior models, namely exercise self-efficacy (ESE), health belief model (HBM), and planned behavior theory (PBT), applied to clarify the degree of regular exercise among workers in Taiwan.Methods: A cross-sectional research design was adopted. A questionnaire was distributed to obtain information pertaining to regular exercise level, demographic characteristics, and the scores of ESE, HBM, and PBT. In total, 400 full-time workers voluntarily participated in this study.Results: The results showed that only 20.5% of the participants exercised regularly, 37.3% exercised irregularly, and 42.3% did not exercise currently. "Perceived benefits" and "perceived barriers" pertaining to HBM; "attitude" and "perceived behavioral control" pertaining to PBT; and ESE were associated with regular exercise level in the multiple linear regression analyses of each health behavior model. When all three models were considered simultaneously, ESE provided the greatest explanation of the variances for regular exercise levels. PBT total made a smaller contribution in the prediction of regular exercise level, while the effect of HBM did not show statistical significance. In order to explore the practicality of moving beyond theoretical models and focusing on the components across health behavior models to enhance workers' exercise behavior, the components showing statistical significance in separate analysis were put into the multiple linear regression simultaneously. The results showed that ESE, perceived barriers of health behavior, attitude, and perceived behavioral control were significantly associated with regular exercise level.Conclusion: A low percentage of workers exercising regularly should be a notable issue for workplace health promotion. Neither utilizing cues to exercise nor advertising health threats of physical inactivity is sufficient to enable workers to exercise regularly. Enhancing workers' ESE and behavior control and removing the exercise barriers would constitute efficient strategies for maintaining the exercise habit of workers. [ABSTRACT FROM AUTHOR]

Problem-based learning (PBL) is regarded as an effective learning strategy to enhance cognition not only in traditional learning but also in e-learning. In e-learning settings, blogs and micro-blogs can plausibly provide a platform to conduct PBL. Recently, most studies on blogs and micro-blogs have respectively probed satisfaction and learning effectiveness. However, little effort has been made to explore their effectiveness on learning. Therefore, this study explored an application of a PBL approach on a micro-blog and blog by seventh-grade students taking an information ethics course; in particular, the effect of a micro-blog and blog on student learning with different learning achievement levels. Moreover, results showed that the micro-blog had more effect on PBL for low achievement students compared to the blog. This study suggests that using a micro-blog for PBL is more appropriate for the sake of maximizing learning effectiveness, if generally considering students with different learning achievement levels.

This study examines university learners' self-assessment and self-feedback on performance as captured in audio files from a foreign language speaking test. The learners' were guided to listen, transcribe and analyse their own speaking samples, as well as propose future actions for improvement. Content of learners' self-feedback was scrutinised against a feedback model, with data coded into various feedback categories as stipulated in the model for analysis. Results indicated that learners' self-feedback was far reaching and multifaceted. Through self-feedback, learners' identified discrepancies, answered feed up, feedback and feed forward questions, and inspected performance at task, process, self-regulation, and self-levels. Much of the feedback involved reflections on past learning history, other areas of learning, deviation of performance from preparation and learner personality traits. The self-feedback went largely beyond most teachers' feedback capacity and bore great potential for learning and instruction. In particular, contrary to theoretical presumptions, self-level feedback seemed quite enlightening. Whether the observed quality self-feedback could actually help learners improve their performance, however, was not clear. It was suggested that some teachers' time and effort be directed to the endeavour of facilitating learners' self-assessment and self-feedback. Learners' self-feedback capability should also be explored further in the development of relevant pedagogies and theories.

This study examined the effects of goal setting for revision in an EFL writing classroom where principles of assessment "for" learning (AfL) were followed. Following draft writing, instruction, and assessment, college freshmen were put into control, goal, and goal+ groups. Before students started to revise their drafts, individuals in the goal group were told to decide their revision goals. Those in the goal+ group were further aided with a list of strategies. The control group did nothing prior to revision but only reflected on what they had done after revision. The three groups were compared on three dependent variables: quality of drafts, quality of revisions, and draft to revision improvements. On quality of revisions, the goal+ group performed best, the control group performed second best, and the goal group received the lowest scores. However, there were no differences in the overall quality of drafts nor in the degree of draft-revision improvements among three groups. The study showed that goal setting can be a helpful tool for learners in an AfL-oriented classroom when instruction and practice were repeated and scaffolds were concurrently provided.

Background: Hip fracture can lead to long-term loss of mobility and self-care ability in older adults. Despite initial decreases in functional performance after hip fracture surgery, patients tend to gradually recover. However, recovery can vary, with some regaining their abilities quickly while others becoming functionally dependent. In this study, we investigated whether the level of short-term postoperative decline in activity of daily living (ADL) performance and quality of life (QoL) can predict the 1-year outcomes for both following hip fracture surgery in older Taiwanese adults. Methods: This prospective cohort study included 427 older adults (≥ 60 years) who underwent hip fracture surgery at a single tertiary medical center in Taiwan between November 2017 and March 2021. We collected pre-fracture data, including the patients' demographics, Charlson comorbidity index (CCI) scores, and responses to a questionnaire (Short Portable Mental State Questionnaire [SPMSQ]) for dementia screening. Moreover, their scores on the EuroQol-5D questionnaire (for evaluating QoL) and the Barthel Index (for assessing ADL performance) were collected at pre-fracture status and at 3- and 12-months following surgery. Changes in ADL and QoL three months post-surgery compared to pre-fracture status were evaluated, and the associations of these parameters (and other potential factors) with 1-year outcomes for ADL and QoL were investigated. Results: We analyzed the data of 318 patients with hip fracture and complete follow-up data regarding ADL performance and QoL at 3- and 12-months post-surgery. After adjusting for covariates, multivariate linear regression revealed that changes in ADL and QoL at 3 months post-surgery from pre-fracture status were positively and significantly associated with 1-year outcomes for both (p <.001 for both). Furthermore, pre-fracture CCI and SPMSQ scores were independent predictive factors associated with 1-year ADL outcomes (p =.042 and <.001, respectively). Conclusions: Patients who exhibit a smaller decline in functional performance and quality of life three months after hip fracture surgery from pre-fracture status are likely to have improved long-term ADL and QoL. Trial registration: TMU-JIRB N201709053. [ABSTRACT FROM AUTHOR]

This study examined two types of classroom assessment events, the more closed convergent assessments (CA) versus the more open-ended divergent assessments (DA), to see if they influence learners differently in terms of motivation and learning strategies. Participants were 105 college freshmen in Taiwan with the same instructor placed under one listening and two speaking classes. In these intact groups, each student experienced two types of assessment, a more traditional test (the CA) and a group performance assessment (the DA). Immediately after they experienced each assessment event, participants reported on their task-specific motivation and learning strategies. Results indicated that CAs were better received by high self-efficacious students and DAs by low scorers. After controlling for self-efficacy, a comparison revealed that students reacted differently in the listening and speaking classes. More specifically, in speaking student motivation and strategy were higher for the DA than for the CA, whereas in the listening class the pattern was reversed. Local educational culture and the nature of assessment events are then discussed. (Contains 6 tables.)

A context-aware ubiquitous learning environment is an authentic learning environment with personalized digital supports. While showing the potential of applying such a learning environment, researchers have also indicated the challenges of providing adaptive and dynamic support to individual students. In this paper, a decision-tree-oriented mechanism is developed for that purpose, enabling digital guidance for students to observe and classify real-world objects in the learning activities of natural science courses. To show the effectiveness of the innovative approach, a context-aware ubiquitous learning environment was implemented for the "butterfly and ecology" unit of a fourth-grade natural science course in Taiwan, and 42 students participated in the learning activity. From the surveys and interviews that were conducted to understand the functionalities of the system and the learning effectiveness for the students, the results show that the system had a positive impact on students' learning, especially on the affective domain, including participation, motivation, and interaction. (Contains 6 tables and 4 figures.)

Researchers have conducted various studies on applying wireless communication and ubiquitous computing technologies to education, so that the technologies can provide learners and educators with more active and adaptive support. This study proposes a Ubiquitous Performance-support System (UPSS) that can facilitate the seamless use of powerful new technologies in the school setting. In order to help the readers visualize these novel technologies in practice, we present one case study of a butterfly-ecology training course facilitated by the UPSS. The aim behind the case study is to inform the design and the development of context-aware ubiquitous computing system and its learning materials. The research inquiry centers around three themes: (1) the critical features to the data-driven decision making of teachers, (2) the perceptions of teachers and students to the UPSS, and (3) implementation issues. The results of the two rounds of formative evaluation indicate positive effects of the UPSS regarding motivation, interactivity, and effectiveness. In addition, teachers' attitudes and teachers' pedagogical approaches toward UPSS use are two key factors in the successful implementation of teaching with such innovative technology. This study can be a useful reference for those who are interested in conducting studies applying context-aware ubiquitous computing to educational contexts. Finally, this study presents suggestions and implications for future research and system development. (Contains 2 tables and 5 figures.)

Coronavirus disease 2019 (COVID-19) pandemic challenges pediatric health globally by limited medical accessibility. In response to COVID-19 epidemic in Taiwan, public restrictions were applied and the Level 3 alert was announced from May to July in 2021 for local outbreak. This study aims to analyze patients' clinical features and outcomes in the pediatric intensive care unit (PICU) during the COVID-19 epidemic with the Level 3 alert in Taiwan. Medical records were retrospectively collected in patients admitted to the PICU of National Taiwan University Children's Hospital from May to July 2021 (Level 3 alert) and May to July 2019 and 2020 (control periods). Clinical characteristics and outcomes were compared between patients in the period with the Level 3 alert and control periods. During the study period, PICU monthly admissions significantly decreased in the Level 3 alert period and were negatively correlated with monthly newly confirmed COVID-19 cases. Patients admitted during the Level 3 alert were older, had higher disease severity, lower proportion of cardiovascular disease, and higher proportion of hematology-oncology diseases than those in the control group. After adjusting for the above factors, admission during Level 3 alert was an independent factor for higher mortality rate and prolonged length of stay (>14 days) in the PICU. During the COVID-19 epidemic with strict public restrictions, critically ill patients admitted to the PICU decreased but had increased disease severity, prolonged length of stay in the PICU, and higher mortality, reflecting the impact of quarantine and limited medical access. [ABSTRACT FROM AUTHOR]

Information on age and growth is essential to modern stock assessment and the development of management plans for fish resources. To provide quality otolith-based estimates of growth parameters, this study performed five types of analyses on the two important croakers that were under high fishing pressure in southwestern Taiwan: Pennahia macrocephalus (big-head pennah croaker) and Atrobucca nibe (blackmouth croaker): (1) Estimation of length–weight relationships (LWR) with discussion on the differences with previous studies; (2) validation of the periodicity of ring formation using edge analysis; (3) examination of three age determination methods (integral, quartile and back-calculation methods) and selection of the most appropriate one using a k-fold cross-validation simulation; (4) determination of the representative growth models from four candidate models using a multimodel inference approach; and, (5) compilation of growth parameters for all Pennahia and Atrobucca species published globally for reviewing the clusters of estimates using auximetric plots of logged growth parameters. The study observed that features of samples affected the LWR estimates. Edge analysis supported the growth rings were formed annually, and the cross-validation study supported the quartile method (age was determined as the number of opaque bands on otolith plus the quartile of the width of the marginal translucent band) provided more appropriate estimates of age. The multimodel inference approach suggested the von Bertalanffy growth model as the optimal model for P. macrocephalus and logistic growth model for A. nibe, with asymptotic lengths and relative growth rates of 18.0 cm TL and 0.789 year−1 and 55.21 cm, 0.374 year−1, respectively. Auximetric plots of global estimates showed a downward trend with clusters by species. Growth rates of the two species were higher than in previous studies using the same aging structure (otolith) and from similar locations conducted a decade ago, suggesting a possible effect of increased fishing pressure and the need to establish a management framework. This study adds updated information to the global literature and provides an overview of growth parameters for the two important croakers. [ABSTRACT FROM AUTHOR]

Crab-eating mongooses (Herpestes urva) are widely distributed across Southeast Asia. In Taiwan, the mongoose (H. urva formosanus, endemic subspecies) is a protected species under the Wildlife Protection Act. Crab-eating mongooses have been observed near streams, riversides, agricultural lands, and shallow mountain areas. Additionally, as described in this short communication, by using a remote camera, we observed a small population of mongooses in the coastal forest in Kenting National Park in Taiwan. The mongooses in the coastal forest were observed eating land hermit crabs, which is the first-ever recorded observation of this behavior. Mongooses are known to consume crabs (Brachyura), insects, and some small reptiles. However, this article presents the first record case of mongooses using stone anvil to crack open land hermit crabs. From our observations and field records, we determined that mongooses use flat rocks as anvils and their front paws to tap hermit crabs' shells repeatedly to break the shells and remove the hermit crabs. We also observed that the mongooses only ate the abdomens of large hermit crabs. Additional studies are necessary to determine why the mongooses migrated to the coastal forest and how they learned to open hermit crab shells. This behavior of mongooses might help them move into living in coastal forests. [ABSTRACT FROM AUTHOR]

With the increasing awareness of the importance of sustainable development, the evaluation of sustainability performance for the manufacturing has become an emerging issue of importance. Although many scholars have studied the issue of enterprise sustainability, to date, the institutional and risk control perspectives of sustainability have received less attention, particularly in manufacturing practices. To address research gap, this study develops a comprehensive framework for evaluating enterprise sustainability that encompasses the economic, social, environmental, institutional, and risk control dimensions. A novel group decision-making approach, called the Rough-Fermatean Fuzzy Decision-Making Trial and Evaluation Laboratory technique is proposed, which identifies the mutual relationships among the 15 evaluation criteria and generates the influence weights. Fermatean fuzzy theory is used to reflect the subjective judgment of experts and the inherent uncertainty in evaluation. Moreover, rough set theory is used to aggregate the multiple experts' opinions and to retain potential information in the form of interval values. A case study of Taiwan's electronics manufacturers is carried out to demonstrate the practicality and validity of the proposed approach. The results show that goodwill and corporate image, zero emission of pollutants and waste discharge, and corporate governance are the most influential sustainability criteria. This study can assist decision-makers in the manufacturing sector in developing more appropriate improvement strategies. Enterprises can improve their competitiveness and move towards sustainable development by first focusing on the more influential criteria. For academic researchers, the proposed framework and methodology can be applied to the discussion of sustainability evaluation in other industries. [ABSTRACT FROM AUTHOR]

Amid increasing interest in city branding in East Asia, the municipalities of Gunsan (South Korea) and Chiayi (Taiwan) chose colonial heritage-making as their city branding strategies to recreate their cities' identities and regenerate their economies. Both cities were mostly built by Japanese imperial authorities and thrived in the 1920s and 1930s but deteriorated in the post-colonial period. Seeking to overcome long economic recessions, these two small cities endeavoured to rebrand in the twenty-first century. Their cases illustrate novel approaches to adopting colonial heritage-making at the small city level in national contexts where the management of colonial heritage is conducted mostly as part of the nation-building process. By comparing post-colonial Gunsan and Chiayi, this study presents comparative perspectives on post-colonial city branding processes and sheds light on different post-colonial responses to colonial heritage-making. The strategic and pragmatic preservation of colonial heritage in these two small cities has simultaneously produced city narratives of 'commodified' colonial modernity that represented the would-be cities' aspiration for being identified on the global map. We analysed the effects of 'commodified' colonial modernity – the recolonisation of past by now – and identified possibilities for alternatives. [ABSTRACT FROM AUTHOR]

The introductory pharmacy practice experiences (IPPE) in Taiwan, which are traditionally conducted in physical hospital settings, incorporated up to 30% distance learning from May 2021 due to Coronavirus Disease 2019 (COVID-19). A web-based cross-sectional survey was adopted to investigate pharmacy students' experiences and perceptions of transitioning from in-hospital internships to distance learning due to COVID-19 in the pharmacy department of a university in Southern Taiwan. We analyzed the results to discover factors that significantly affected students' perceptions of transitioning from in-hospital internships to distance learning. In total, 81 interns from the university's pharmacy department responded to the questionnaire. Approximately half of the participants felt happy when they learned, before the internship began, that the internship would be partially replaced with distance learning. The overall satisfaction rate was 67.9%, and no significant differences was observed in students' satisfaction between hospital size or distance-learning time. However, more students in the medical center felt they had insufficient time to finish assignments compared to those in the regional hospitals, and the students who had 11–15 days of distance learning felt that they interacted more smoothly with their peers compared to those who had other durations. Program designers should make distance internship courses more student-centered, with a focus on increasing interactions between students, teachers, and peers to compensate for the lack of physical presence. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is known to decrease the incidences of autoimmune diseases and inflammatory bowel disease(IBD). Our aim was investigating the effect of H. pylori treatment in diabetes mellitus(DM) patients. Methods: Adults with newly-diagnosed H. pylori infection or peptic ulcer disease(PUD) within the general population and DM population were identified from the National Health Insurance Research Database of Taiwan from 2000–2010. 79,181 patients were assigned to the 3 groups: general population with PUD without H. pylori treatment(PUD-HPRx in general population), DM patients with PUD without H. pylori treatment(PUD-HPRx in DM), and DM patients with PUD who received H. pylori treatment(PUD+HPRx in DM). Results: Higher incidences of autoimmune diseases and IBD were observed in the PUD+HPRx in DM group than in the PUD-HPRx in general population and PUD-HPRx in DM groups (autoimmune diseases = 5.14% vs 3.47% and 3.65%; IBD = 5.60% vs 3.17% and 3.25%; P<0.0001). A lower all-cause mortality was noted in the PUD+HPRx in DM group (HR: 0.937, P<0.001) than in the PUD-HPRx in DM group. Trends of a higher incidence of IBD and a lower mortality in younger patients in the PUD+HPRx in DM group compared with the PUD-HPRx in DM group were noted. Conclusions: The results revealed that H. pylori treatment increased the incidences of autoimmune diseases and IBD and decreased the all-cause mortality in the DM group with PUD. The effect was more significant in younger patients. This finding assists in realizing the influence of H. pylori treatment in the DM population. [ABSTRACT FROM AUTHOR]

Purpose: Although cigarette smoking is a well-known risk factor for anastomotic leakage during rectal surgery, the proper duration of smoking cessation that can decrease anastomotic leakage in patients undergoing sphincter-preserving surgery is unclear. This study aimed to investigate the optimal duration of smoking cessation that can reduce this complication. Methods: Between January 1, 2000, and December 31, 2012, we enrolled 1246 consecutive patients who underwent curative-intent sphincter-preserving surgery without preventive stoma at the Division of Colorectal Surgery of a tertiary referral center in Taiwan. Questionnaires were used to record their pre-surgical smoking status. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off duration of smoking cessation. Multivariate analysis was used to verify the effect of cigarette cessation on anastomotic leakage. Results: The ROC curve showed a cut-off value of 10.5 years of cessation duration. Therefore, the former-smoker group was further divided using a cessation duration of 10 years. The overall anastomotic leakage rate was 5.29%. However, the anastomotic leakage rate in current smokers (9.3%) and in those who quit for < 10 years (12.9%) was significantly higher than that in non-smokers (3.3%) and those who quit for ≥ 10 years (4.5%). On multivariate analysis, current smokers (p = 0.022), former smokers with < 10 years of smoking cessation (OR 2.725; p = 0.029), male sex (p = 0.015), and low rectal cancer (p < 0.001) were all independently related to the development of anastomotic leakage. Conclusion: Smoking cessation for < 10 years remains a risk factor for anastomotic leakage in patients with mid-to-low rectal cancer undergoing sphincter-preserving surgery. [ABSTRACT FROM AUTHOR]

Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor health outcomes in older adults. However, its association with the risk of fracture risk is yet to be clarified. Therefore, this study aimed to assess the incidence and consequence of osteoporosis-related fractures among patients with sarcopenia in Taiwan. A retrospective, population-based study on 616 patients with sarcopenia, aged >40 years, and 1232 individuals without sarcopenia was conducted to evaluate claims data from Taiwan's National Health Insurance Research Database collected in the period January 2000–December 2013. The incidence rate of osteoporosis-related fracture was 18.13 and 14.61 per 1000 person years in the patients with sarcopenia and comparison cohort, respectively. Patients with sarcopenia had a greater osteoporotic fracture risk (adjusted hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.47–3.04) after correcting for possible confounding. Additionally, females showed statistically significant correlations of sarcopenia with osteoporosis-related fracture risk (HR 1.53; CI 0.83–2.8 for males and HR 2.40, CI 1.51–3.81 for females). During this retrospective study on the fracture risk in Taiwan, an adverse impact of sarcopenia was observed, which substantiates the need to work toward sarcopenia prevention and interventions to reverse fracture susceptibility in patients with sarcopenia. [ABSTRACT FROM AUTHOR]

Marine protected areas (MPAs) are important conservation tools; however, many fail to achieve their full potential because of design and management deficiencies. Evaluating MPA management effectiveness (ME) is essential for identifying deficiency issues in conservations and guiding improvements. This study established an indicator-based framework to evaluate ME tailored to Taiwan's MPAs through literature reviews, expert consultations, and stakeholder workshops. We applied 28 indicators to the ME evaluation of 30 fishery conservation zones (FCZs), utilizing semi-structured interviews with stakeholders, questionnaires, analysis of ecological reports, and on-site visits. Only two MPAs were rated as highly effective; most were poorly managed, with deficiencies in ecological monitoring, enforcement, and stakeholder participation. A case study combined a quantitative ME evaluation with collaborative action research involving governments, scientists, and communities to address issues and accelerate enhancements in the Qimei FCZ. Initial low scores prompted workshops to engage stakeholders in identifying problems such as incorrect boundaries, lack of ecological data, and enforcement challenges. This led to boundary revisions, citizen scientist training, and proposals for no-take zones to improve enforcement. The evaluation revealed management deficiencies in Taiwan's MPAs, while action research catalyzed solutions through participative processes. Region-specific indicator frameworks aligned with local priorities are vital for optimizing MPA benefits. This study provides an exemplary quantitative–qualitative approach, coupling evidence-based evaluations and collaborative action research to improve MPA management. [Display omitted] • Region-specific indicator frameworks aligned with local priorities are vital for optimizing MPA benefits • Evaluation coupled with participatory action research engages stakeholders to address management issues effectively • Participatory action research enhanced stakeholder collaboration and accelerated the policymaking process [ABSTRACT FROM AUTHOR]

Background: Of the types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) may be cured through pulmonary endarterectomy (PEA). In this study, we investigated patient experiences with PEA for CTEPH treatment in Taiwan.Methods: We retrospectively reviewed the records of patients who underwent PEA in two medical centers between January 2005 and December 2019. We measured the following outcomes: in-hospital complications, improvements in cardiac function and exercise capacity, survival using Kaplan-Meier analysis after PEA.Results: Twenty-seven patients (female: 17) with a mean age of 52.6 years underwent PEA. Pre-operatively, most patients were New York Heart Association functional class (NYHA FC) III (n = 19) and IV (n = 7). The mean periods from the onset of symptoms to diagnosis and from diagnosis to operation were 22.6 and 22.3 months, respectively. After PEA, mean intubation time, and length of intensive care unit and hospital stay were 9, 11, and 20 days, respectively. Most patients' NYHA FCs improved to I (n = 15) and II (n = 10). The mean 6-min walk test (6MWT) result improved by 60.5%. The in-hospital mortality, mean follow-up period, and 5- and 10-year overall survival rates were 3.7%, 77.0 months, 96.3%, and 84.3%, respectively. Furthermore, 5- and 10-year disease-specific survival rates were both 96.3%.Conclusion: When pre-operative and post-operative statuses were compared, we found a significant improvement in NYHA FC and 6MWT distance. Our study also found a lower in-hospital mortality rate compared to other published studies, except compared to the newer data provided by the University of California, San Diego group. [ABSTRACT FROM AUTHOR]

The seasonal and meteorological factors in predicting infections after urological interventions have not been systematically evaluated. This study aimed to determine the seasonality and the effects of the weather on the risk and severity of infectious complications (IC) after a transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Using retrospectively collected data at the tertiary care hospital in Taiwan, we investigated the seasonal and meteorological differences in IC after TRUS-Bx. The IC included urinary tract infection (UTI), sepsis, and a positive culture finding (PCF). The severity was assessed on the basis of the Common Terminology Criteria for Adverse Events grading system. The prevalences of the infectious complications (UTI, sepsis, PCF and grade ≥ 3 IC) were significantly higher in the summer than in the winter. Monthly temperature and average humidity were significant factors for IC. After adjusting the demographic factors, multivariate regression revealed that UTI, sepsis, PCF, and grade ≥ 3 IC increased by 12.1%, 16.2%, 21.3%, and 18.6% for every 1 °C increase in the monthly average temperature, respectively (UTI: p = 0.010; sepsis: p = 0.046; PCF: p = 0.037; grade ≥ 3 IC: p = 0.021). In conclusion, the development and severity of IC after TRUS-Bx had significant seasonality. These were dose-dependently associated with warmer weather. Infectious signs after TRUS-Bx should be monitored more closely and actively during warm weather. [ABSTRACT FROM AUTHOR]

It is being debated whether prostate-specific antigen (PSA)-based screening effectively reduces prostate cancer mortality. Some of the uncertainty could be related to deficiencies in the age-based PSA cut-off thresholds used in screening. Current study considered 2779 men with prostate cancer and 1606 men without a cancer diagnosis, recruited for various studies in New Zealand, US, and Taiwan. Association of PSA with demographic, lifestyle, clinical characteristics (for cases), and the aldo–keto reductase 1C3 (AKR1C3) rs12529 genetic polymorphisms were analysed using multiple linear regression and univariate modelling. Pooled multivariable analysis of cases showed that PSA was significantly associated with demographic, lifestyle, and clinical data with an interaction between ethnicity and age further modifying the association. Pooled multivariable analysis of controls data also showed that demographic and lifestyle are significantly associated with PSA level. Independent case and control analyses indicated that factors associated with PSA were specific for each cohort. Univariate analyses showed a significant age and PSA correlation among all cases and controls except for the US-European cases while genetic stratification in cases showed variability of correlation. Data suggests that unique PSA cut-off thresholds factorized with demographics, lifestyle and genetics may be more appropriate for prostate cancer screening. [ABSTRACT FROM AUTHOR]

Background: Idiopathic (isolated) hypogonadotropic hypogonadism (IHH) is a rare disease that can be classified as Kallmann syndrome (KS) or normosmic IHH (nIHH). This study investigated the phenotype and genotype of IHH in Taiwanese patients.Methods: Twenty-six unrelated IHH patients were included in this study and their clinical, hormonal, and radiological findings were analyzed retrospectively. Whole exome sequencing (WES) was performed to identify the etiology.Results: The 26 patients (M:F = 19:7) were divided into a KS group (n = 11) and a nIHH group (n = 15). The diagnosis was earlier in boys than in girls. Fifteen patients were found to have pathogenic/likely pathogenic (P/LP) variants of IHH-associated genes, and the mutation detection rate was 58%. CHD7, FGFR1, and ANOS1 were the most common genetic etiologies identified in this group. Two patients with nIHH were found to have de novo SOX11 mutations and Coffin-Siris syndrome features. After treatment, the height outcomes and secondary sexual characteristics were significantly improved. There were no obvious differences between the genetically resolved (GR), variants of uncertain significance (VUS) and genetically unresolved groups (GUR).Conclusion: Whole exome sequencing is useful in patients with IHH, and we identified the SOX11 gene as a causal factor in this study. We described the clinical, hormonal, and molecular characteristics, and the treatment outcomes, of Taiwanese patients with IHH, which should aid therapeutic planning and further research. [ABSTRACT FROM AUTHOR]

Measuring company efficiency is an important issue for both managers and investors. Efficiency measurement is always important because organizations are constantly striving to increase internal productivity. However, investors are more concerned about sustainability than many executives believe. Almost 75% of investment community respondents strongly believed that improvements in operational efficiency were often accompanied by progress in terms of sustainability. This study examined companies listed on the Taiwan 50 and Taiwan Mid-Cap 100 Indexes and measured and ranked their operational efficiencies, identifying representatives with high investment potential among these highly capitalized blue chip stocks from various industries. The results will provide managers with recommendations for improving operational efficiency through competitive mapping, as well as a list of the most attractive targets for investment. [ABSTRACT FROM AUTHOR]

In Taiwan, English is termed English for General Purposes (EGP) and is a mandatory subject for university students as part of their general education curriculum. Despite previous discussions on various issues related to EGP, there is limited research on students' overall learning effectiveness of EGP and the influence of language proficiency and gender on EGP learners' learning outcomes. This study collected and analyzed the English test scores of over 2000 undergraduate first-year students from three consecutive academic years. The results indicate that many students showed noticeable progress after receiving EGP instruction. The improvement was more significant for female students than male students, with female students at elementary and intermediate levels most benefiting from the EGP learning experience. • Students made considerable progress after receiving a year of English for general purposes instruction. • Female students improved more than males. • Females at elementary and intermediate levels benefited the most from the EGP learning experience. • Grouping EGP instruction had a positive impact on the mastery of English for the students. [ABSTRACT FROM AUTHOR]

The past decade has witnessed an emerging interest in growing quinoa in indigenous townships in Taiwan, which has overlapped with the recovery effort from disasters following Typhoon Morakot in 2009. This paper critically examines the acclaim given to the quinoa boom as testifying to the community resilience of the indigenous people displaced by disasters and relocation policies. Tracing the changing socio-ecologies of the indigenous communities, the case study observes the simultaneous reagrarianization and depeasantization of indigenous farmers in response to a series of crises. It illustrates the ongoing depeasantization underneath the expansion of quinoa growing, which is engendering a set of paradoxical practices of community resilience that is restructuring the landscape of communities. • Quinoa boom as a practice of community resilience by indigenous farmers displaced by disasters. • Simultaneous re-agarianisation and depeasantisation of indigenous farmers in response to crises. • A set of paradoxical practices of community resilience that bring about changes, uncertainties and possibilities of reterritorializing lost lands. • The multivalent nature of "community resilience". [ABSTRACT FROM AUTHOR]

The marked decrease in the number of mainland tourists visiting Taiwan may turn from a temporary phenomenon to a normalized one because of the potential harm it represents to the Taiwan tourism industry. The purpose of this study is to use hierarchical cluster analysis combined with entropy to derive clustering and to identify appropriate performers by measuring operational performance levels. These clusters may serve as the benchmarks for under-performing tourist hotels (classified into five groups according to the numbers of employees) to improve in response to the reduced number of Chinese tourists coming to Taiwan. This study provides a different insight into the tourist hotels industry in benchmarking comparable to previous research groups. The measurement of five criteria has been both statistically different and significant for the clusters in order to support a view that the clusters contain hotels with a similar numbers of employees while maintaining distinct performance profiles and developing strategies for improvement. [ABSTRACT FROM AUTHOR]

This descriptive study aimed to explore the physiological factors that determine tolerance to exertion during high-intensity interval effort. Forty-seven young women (15–28 years old) were enrolled: 23 athletes from Taiwan national or national reserve teams and 24 moderately active females. Each participant underwent a maximal incremental INC (modified Bruce protocol) cardiopulmonary exercise test on the first day and high-intensity interval testing (HIIT) on the second day, both performed on a treadmill. The HIIT protocol involved alternation between 1-min effort at 120% of the maximal speed, at the same slope reached at the end of the INC, and 1-min rest until volitional exhaustion. Gas exchange, heart rate (HR), and muscle oxygenation at the right vastus lateralis, measured by near-infrared spectroscopy, were continuously recorded. The number of repetitions completed (Rlim) by each participant was considered the HIIT tolerance index. The results showed a large difference in the Rlim (range, 2.6–12.0 repetitions) among the participants. Stepwise linear regression revealed that the variance in the Rlim within the cohort was related to the recovery rates of oxygen consumption (V˙O2), HR at the second minute after INC, and muscle tissue saturation index at exhaustion (R = 0.644). In addition, age was linearly correlated with Rlim (adjusted R = −0.518, p < 0.0001). In conclusion, the recovery rates for V˙O2 and HR after the incremental test, and muscle saturation index at exhaustion, were the major physiological factors related to HIIT performance. These findings provide insights into the role of the recovery phase after maximal INC exercise testing. Future research investigating a combination of INC and HIIT testing to determine training-induced performance improvement is warranted. [ABSTRACT FROM AUTHOR]

Manufacturing content knowledge is an important part for Mechanical Engineering Students. In Taiwan, two path for high school students to learn mechanical engineering content, general high school or technique high school. For technique high school students, they would learn basic mechanical engineering content through practical course and lecture in-class. Generally, the connection between practical course and in-class course are weak. Students hardly learn to connect the manufacturing content with practical course. Therefore, students need more effective method to connect the content. Focus group discussions is one of effective method to connect learning activities with content knowledge. It based on participates' observation and reflection ability. In this study, we proposed to use focus group discussions as a framework for practical courses in high school. Students who learning manufacturing content knowledge, metal welding by practical course. Based on the background and motivation, we investigated two research questions as follows: (1) Does student learning with focus group discussions to acquire manufacturing content knowledge better than without FGD?; (2) What is the difference between student learning with and without focus group discussions to acquire manufacturing content knowledge? According to the result, we found that learn manufacturing content knowledge with FGD in a practical course can improving student learning performance. It can provide a reference for teachers who teach the practical courses. For future work, we would deeply find the correction between different backgrounds of the student, like learning style, course interesting. [ABSTRACT FROM AUTHOR]

Objective: The association of interleukin-10 (IL-10) polymorphism with diabetes and its complication was recently established, while there were few researches considering the potential role of IL-10 in gestational diabetes (GDM). This study aimed to investigate the association between IL-10 gene rs1800896 (−1082 A/G), rs1800871 (−819 T/C), rs1800872 (−592 A/C), and rs3021094 (3388 A/C) single nucleotide polymorphisms (SNPs) and GDM susceptibility. Methods: This study included 72 GDM patients and 100 healthy pregnant women. Direct sequencing of the products from polymerase chain reactions of the extracted genomic DNA from study subjects were conducted for analyzing IL-10 gene polymorphism and further genotype frequencies were compared. Plasma IL-10 concentration was measured by ELISA method. Results: The results revealed no significant difference in −592 A/C, −819 T/C, and −1082 A/G genotypes. Significantly increased prevalence of A allele (P = 0.028, OR = 1.69, 95% CI = 1.081–2.64) and A/A genotype (P = 0.031, OR = 2.881, 95% CI = 1.145–7.250) at a previously un-characterized rs3021094 SNP were discovered in the GDM group. Increased IL-10 levels and insulin resistance were also related to the genotype of rs3021094. The risk of GDM was increased when IL-10 level was over 6.5 pg/ml. Conclusion: Our study demonstrated that A allele and A/A genotype of rs3021094 SNP in IL-10 gene were linked to increased risk for GDM, IL-10 plasma level and insulin resistance, which could be potential targets for early screening and detection of GDM. [ABSTRACT FROM AUTHOR]

Approximately 17% of agricultural lands in the western plain of Taiwan were converted to other uses during 1971–2006 due to rapidly industrial and urban development and high population density. Previous studies on the loss of farmland due to urbanization have focused on changes in the agricultural landscape such as fragmentation and irregular shape of farmlands. The shrinkage and fragmentation of agricultural land due to urbanization not only reduces food production but also results in the decrease and degradation of other agro-ecosystem services. Emergy synthesis has been used to assess land use changes in agricultural lands. However, the relationship between farmland fragmentation and the energy flows in agricultural systems has not been studied. This paper investigates empirically how ecological energetic flows of agricultural land were affected by landscape change in the western coastal plain of Taiwan by using emergy synthesis to assess the changes in ecological energetic flows of agricultural systems in each township from 1971 to 2006. Landscape metrics were also chosen to analyze the agricultural landscape change in each township. These metrics were then correlated with the results of emergy synthesis to study the relationship between farmland fragmentation and energy flows in the agricultural system. The results show that the fragmentation of farmlands tends to intensify the inflows of goods and services from the human economic system for farmland operations. For the counties closer to metropolitan areas, maintaining larger farm sizes and preventing farmland fragmentation decreases the proportion of resource inflows from the economic system and mitigates environmental loading in agricultural systems. [ABSTRACT FROM AUTHOR]

Background: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses’ reaction to dilemma such as moral distress is relatively less noticed. Objective: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. Research design: This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect nurses’ opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements. Ethical considerations: The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents’ right to withdraw from the study was respected. Findings: Five types of responses were identified regarding the nurses’ perspectives. These types were “conflict with personal values,” “excessive of workload,” “curbing of autonomy,” “constraint engendered by organizational norms,” and “self-expectation frustration.” Conclusion: The findings regarding nurses’ experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs. [ABSTRACT FROM AUTHOR]

Spatial planning plays an increasingly significant role in climate change mitigation by providing energy efficient settlements and promoting the utilization of renewable energy resources. However, the effect of urban spatial planning on spatial pattern of carbon dioxide emissions in cities is rarely discussed. The relationships between the changes in urban zoning plans and carbon dioxide emissions of major economic sectors has yet to be investigated on a scale smaller than an entire city. Using the Taipei metropolitan area as a case study, this study hypothesizes that: (1) carbon dioxide emissions have a spatial dimension within the city due mainly to the heterogeneous nature of land use activities and urbanization, and (2) changes in spatial planning can influence the urban form, and consequentially affect carbon dioxide emissions through changes in traffic demand and energy consumption. A downscaling analysis approach was used to estimate carbon dioxide emissions of different sectors for each administrative district in the Taipei metropolitan area. The analytical results reveal that the total carbon dioxide emissions of the four sectors in the Taipei metropolitan area increased with the increases in the growth of urban planned zones during the period 1981–2011.The carbon dioxide emission increases were correlated with the distribution of land uses in each administrative district. A negative correlation was found between the population density and the per-capita carbon dioxide emissions in the transportation sector. The compact development and planning of urban transit systems are believed to be the source of decreasing per -capita carbon dioxide emissions. While many studies have emphasized that spatial planning is important addressing climate change, this work demonstrates understanding the historic links between spatial planning and carbon dioxide is equally valuable. [ABSTRACT FROM AUTHOR]

This article discusses three issues based on the author’s experience of teaching anthropology in the US for 30 years (1975–2005), and then in Taiwan over the past decade (2006–2015), when he was heavily involved in Taiwan’s anthropological education. The first issue is the positionality of anthropology in Taiwan, including the origin of anthropology as a body of transplanted knowledge or a disciplinary subject established in Taiwan’s university curricula. The second issue this article will briefly comment upon is the current condition of anthropology in Taiwan in terms of teaching, faculty recruitment, and perspectives on professional development. Third, this article will discuss how and why Taiwanese anthropologists have deviated from what might be seen as the US model and subsequently gained a different type of hegemonic power in Taiwan that would actually put their intellectual masters in the US to shame. This article will close with a short, albeit optimistic, conclusion. [ABSTRACT FROM PUBLISHER]

Objective. This study assessed the possible associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging Taiwanese males and investigated the impact of various aspects of LUTS on ED. Methods. A free health screening for aging males (≥40 years old) was conducted in Kaohsiung Medical University Hospital. All the subjects had completed clinical data and answered questionnaires. ED and LUTS were assessed by validated symptom scales: the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS). Results. A total of 339 eligible patients enrolled in this study with a mean age of 60.1 years old. In multiple logistic regression analysis, age and IPSS ( p < 0.001 and p = 0.013, respectively) were significantly associated with ED after controlling other comorbidities. In a further age-adjusted multiple regression analysis, our results showed that irritative symptoms ( p = 0.042) have a more significant association with ED than the obstructive symptoms ( p = 0.101). Conclusions. Our results indicate that age and LUTS are the two most independent risk factors for ED. Aging Taiwanese males with LUTS are at increasing risk for ED, especially for those with significant irritative symptoms. [ABSTRACT FROM AUTHOR]

Rice bacterial leaf blight, caused by Xanthomonas oryzae pv. oryzae [(Ishiyama) Swings et al. 1990] ( Xoo), is a major rice disease of the second crop season in Taiwan. A total of 88 Xoo strains collected from 10 major rice cultivating areas in Taiwan from 1986, 1997, 2000, 2004, and 2011 were characterized by repetitive-element PCR ( REP- PCR) fingerprinting and virulence analyses. Among the five genetic clusters identified by the pJEL1/ pJEL2 ( IS 1112-based) and REP1R-Dt/ REP2-D [repetitive extragenic palindromic ( REP)-based] primer sets, clusters A, C and D contained Xoo strains from geographically distant regions, which suggests a high frequency of Xoo dispersal in Taiwan. The 88 Xoo strains were evaluated by inoculations on IRBB near-isogenic lines and five Taiwan rice cultivars. A subset of 45 moderately or highly virulent strains were classified into 15 pathotypes by their compatible or incompatible reactions on IR24 and 12 IRBB near-isogenic lines, each containing a single resistance gene. Analysis of molecular haplotypes and pathotypes revealed a partial relationship. IRBB5, IRBB21 and IRBB4 were incompatible with 96%, 96% and 73% of the strains, so xa5, Xa21 and Xa4 can recognize most of the Xoo strains in Taiwan and elicit resistance. In contrast, IRBB3 ( Xa3), IRBB8 ( xa8), IRBB10 ( Xa10), IRBB11 ( Xa11), IRBB13 ( xa13) and IRBB14 ( Xa14) were susceptible to almost all of the 45 Xoo strains. Inoculation trials revealed significant differences in the susceptibility of five Taiwan cultivars to Xoo (from high to low susceptibility: Taichung Sen 10 > IR24, Taichung Native 1 > Taichung 192, Taikeng 9, Tainan 11). This study provides useful information for resistance breeding and the development of disease management strategies against bacterial blight disease of rice. [ABSTRACT FROM AUTHOR]

Objectives: Metabolic syndrome (MtS) and kidney stone are two common aging diseases with male dominant. This is the first study regarding the potential impact of MtS and its components on kidney stone in aging Chinese population.Methods: A total of 694 males with a mean age of 55.6 years were enrolled. The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Subjects were classified as having a disease of kidney stones according to diagnosis by a physician with available medical records or evidence from ultrasonography judged by an investigator of urologist.Results: Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with kidney stone had significantly higher prevalence of MtS (p = 0.04, OR = 1.74, 95% CI: 1.0 1-3.00). The presence of MtS had significant correlation with kidney stone (p = 0.01, OR = 1.83, 95% CI: 1.1 4-2.93), which were associated with the increment of MtS components (p < 0.01). After adjusting for age and testosterone level, abnormal blood pressure (BP) was the most significantly independent component of MtS for kidney stone among the MtS components (p < 0.01, OR = 2.81, 95% CI: 1.46-5.39).Conclusions: In aging Taiwanese males, the presence of MtS and its components are strongly associated with kidney stone. Abnormal BP is the most significant risk component of MtS for kidney stone. [ABSTRACT FROM AUTHOR]