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Educational games are becoming increasingly prevalent. Recently, adaptive game-based learning to accommodate diverse learners has received considerable attention. The current study aims to explore the effect of adaptive scaffolding from a multidimensional engagement perspective. A total of 61 students from a Taiwan secondary school studied Newton's laws in a computer-based interactive game environment. The students were assigned to either a fixed scaffolding group or an adaptive scaffolding group to test the effect of adaptive scaffolding. The findings suggest that adaptive scaffolding can have a significant effect on students' learning performance and engagement. The study offers significant implications for the design and integration of adaptive scaffold to promote learning engagement in digital game-based learning.

With the rapid development of artificial intelligence in many disciplines, computational thinking (CT) has become an important skill for the 21st century. To promote vocational high school students' CT skills in learning about programmable logic controllers, this study intended to examine how cognitive and metacognitive prompts separately or together influenced students' development of CT. The findings revealed that metacognitive prompts significantly improved students' CT outcomes, self-efficacy, and motivation for learning. The study offers important implications regarding the strategies to promote CT in vocational high schools.

Many studies focus on Chinese-speaking international students' adaptation issues inside and outside educational settings in the West. A strong emphasis has been placed on identifying Chinese-speaking international students' problems and solving them through educational programs, pedagogies, and curricula. This emphasis potentially categorizes these students as a cohort that, in particular, have issues learning and living in Western societies, a categorization that ignores identity as complex and context-dependent. Drawing on a Bourdieuian poststructuralist perspective, this 18-month-long study documented the experiences of nine Taiwanese international students at different Australian universities before, during, and after their 1-year postgraduate education in Australia. This study compared their experiences and highlighted the complexity of identity movements. The findings present habitus modification and habitus improvisation, two notions developed from a Bourdieuian perspective. In conclusion, this study encourages reassessment of the standard notions of adaptation and prompts further exploration of how international students use their overseas experiences in the home context.

This paper draws on an ethnographic research that examined Taiwanese international students' identity movements before, during, and after their overseas education in Australia. Previous studies on nonnative-English-speaking teachers (NNESTs) studying TESOL in the West focused on the formation of their professional identity before and after the completion of TESOL programs abroad. This study pioneers a model which examines NNESTs' multilayered complexity of identity formation by drawing on the Douglas Fir Group's (2016) multifaceted nature of language learning and teaching and Wenger's (1998) identification and negotiability of identity formation to analyze one Taiwanese student's developing NNEST identity. We found the participant's social life experiences reshaped her professional identity as NNEST. The user experience as a nonnative English speaker prompted her critical reflection on the notion of functional English user and teaching. This notion, shaped by social aspects of learning, was later demonstrated in her teaching practice. The study suggests: 1) that future research includes NNESTs' social aspects of experiences as nonnative English users; 2) that SLA researchers for TESOL programs continue analyzing NNESTs' deficit discourse with transdisciplinary approach.

Higher education in Taiwan faces various challenges, such as the low-birth rate, blurred positioning, and lack of marketing concepts. In order to sustain, more effect strategies and actions resource should be implemented to enhance service of the colleges and universities. Therefore, image asset management becomes a critical start. This study aims to identify the image asset management indicators by applying the modified Delphi technique and the analytic hierarchy process. These two methods can retrieve the critical factors out of literature, and configure how they were operated. The study finally developed a three-layer framework of college image asset management, including 5 dimensions, 13 sub-dimensions, and 77 indicators. According to the participants' perspectives, the dimensions of the stakeholder image and student image were on the top priority. Next, among the sub-dimensions, the internal stakeholder image and the brand image had higher priority than the rest.

Key Points: Question: Among people invited for colon cancer screening with fecal immunochemical testing (FIT), does adding a Helicobacter pylori stool antigen test to FIT reduce rates of gastric cancer incidence and gastric cancer mortality, compared with FIT alone? Findings: In a randomized clinical trial that included 152 503 people, there were no significant differences in incidence of gastric cancer or gastric cancer mortality between people invited to undergo screening with H pylori stool antigen and FIT compared with people invited to undergo FIT screening alone (0.032% vs 0.037%, respectively, for gastric cancer incidence and 0.015% vs 0.013%, respectively, for gastric cancer mortality). Meaning: An invitation to test for H pylori stool antigen in combination with FIT did not significantly reduce rates of gastric cancer, compared with an invitation for FIT alone, but results may have been affected by differences in screening participation and length of follow-up between the 2 groups. Importance: Effects of screening for Helicobacter pylori on gastric cancer incidence and mortality are unknown. Objective: To evaluate the effects of an invitation to screen for H pylori on gastric cancer incidence and mortality. Design, Setting, and Participants: A pragmatic randomized clinical trial of residents aged 50 to 69 years in Changhua County, Taiwan, eligible for biennial fecal immunochemical tests (FIT) for colon cancer screening. Participants were randomized to either an invitation for H pylori stool antigen (HPSA) + FIT assessment or FIT alone. The study was conducted between January 1, 2014, and September 27, 2018. Final follow-up occurred December 31, 2020. Intervention: Invitation for testing for H pylori stool antigen. Main Outcomes and Measures: The primary outcomes were gastric cancer incidence and gastric cancer mortality. All invited individuals were analyzed according to the groups to which they were randomized. Results: Of 240 000 randomized adults (mean age, 58.1 years [SD, 5.6]; 46.8% female), 63 508 were invited for HPSA + FIT, and 88 995 were invited for FIT alone. Of the 240 000 randomized, 38 792 who were unreachable and 48 705 who did not receive an invitation were excluded. Of those invited, screening participation rates were 49.6% (31 497/63 508) for HPSA + FIT and 35.7% (31 777/88 995) for FIT alone. Among 12 142 participants (38.5%) with positive HPSA results, 8664 (71.4%) received antibiotic treatment, and eradication occurred in 91.9%. Gastric cancer incidence rates were 0.032% in the HPSA + FIT group and 0.037% in the FIT-alone group (mean difference, −0.005% [95% CI, −0.013% to 0.003%]; P =.23). Gastric cancer mortality rates were 0.015% in the HPSA + FIT group and 0.013% in the FIT-alone group (mean difference, 0.002% [95% CI, −0.004% to 0.007%]; P =.57). After adjusting for differences in screening participation, length of follow-up, and patient characteristics in post hoc analyses, an invitation for HPSA + FIT was associated with lower rates of gastric cancer (0.79 [95% CI, 0.63-0.98]) but not with gastric cancer mortality (1.02 [95% CI, 0.73-1.40]), compared with FIT alone. Among participants who received antibiotics, the most common adverse effects were abdominal pain or diarrhea (2.1%) and dyspepsia or poor appetite (0.8%). Conclusions and Relevance: Among residents of Taiwan, an invitation to test for HPSA combined with FIT did not reduce rates of gastric cancer or gastric cancer mortality, compared with an invitation for FIT alone. However, when differences in screening participation and length of follow-up were accounted for, gastric cancer incidence, but not gastric cancer mortality, was lower in the HSPA + FIT group, compared with FIT alone. Trial Registration: ClinicalTrials.gov Identifier: NCT01741363 This randomized clinical trial evaluates the effects of Helicobacter pylori stool antigen assessment plus fecal immunochemical testing (FIT), vs FIT alone, on gastric cancer incidence and mortality among adults in Taiwan. [ABSTRACT FROM AUTHOR]

Background: The outcomes of recent advancements in pediatric tracheostomy remain unclear. This study was conducted to identify the trends in pediatric tracheostomy in Taiwan. Methods: This population-based survey was conducted using data from Taiwan's National Health Insurance Research Database. We identified inpatients younger than 18 years who had undergone tracheostomy in Taiwan between 2000 and 2019. The study period was divided into subperiods (2000-2004, 2005-2009, 2010-2014, and 2015-2019). We analyzed patient characteristics and trends related to age, gender, hospital level, surgical indications, hospital stay duration, and mortality rates. The trends were analyzed for all pediatric patients (age <18 years) and infants (age <1 year). Results: This study included 2465 pediatric patients (mean age: 8.7 ± 6.9 years; boys: 64%). The incidence of pediatric tracheostomy decreased from 3.3 events per 100,000 individuals in 2000 to 2.1 events per 100,000 individuals in 2019 (P for trend <.001). The proportion of infants who received tracheostomy increased from 22.8% in 2000-2004 to 32.5% in 2015-2019 (P for trend =.06). The proportion of pediatric patients who received tracheostomy at medical centers increased and those at regional hospitals or district hospitals decreased (74.7%-81.0% vs 25.3%-19.0%, P for trend =.003). The proportion of pediatric patients with trauma or brain injury as a surgical indication decreased from 36.6% to 28.7% (P for trend =.001). The duration of intensive care unit (ICU) stays increased from 30 days in 2000-2004 to 50 days in 2015-2019 (P for trend <.001), and that of hospital stay increased from 58 days in 2000-2004 to 71 days in 2015-2019 (P for trend =.001). The 5-year mortality rate slightly decreased from 38.0% in 2000-2004 to 33.3% in 2005-2009 and 31.0% in 2010-2014 (P for trend =.006). Conclusions: Our findings revealed that during the study period, the number of pediatric patients receiving tracheostomy decreased, but the proportion of infants receiving tracheostomy increased. The trends in pediatric tracheostomy indicated extended ICU stay, prolonged hospital stay, and reduced 5-year mortality rates. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. This was a systematic review and meta-analysis. A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48–0.73) and CKD (OR = 0.73; 95% CI = 0.67–0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities. [ABSTRACT FROM AUTHOR]

Cognitive stimulation therapy (CST) was found to significantly improve cognitive function and quality of life (QOL) in patients with mild-to-moderate dementia in the UK. However, indigenous research on older adults with dementia in Taiwan is scarce. Therefore, this study developed and investigated the effects of a Taiwan version of group CST (CST-T) through a quasi-experimental trial. Excluding the dropouts, there were 13 experimental participants (M = 78.9 ± 9.0) and 13 control participants (77.9 ± 5.6). The results indicated significant improvements in cognitive function, QOL, and daily life functioning in the experimental group compared with the control group, and these effects remained evident at a 3-month follow-up. [ABSTRACT FROM AUTHOR]

Background: A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. Purpose: To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Study Design: Case series; Level of evidence, 4. Methods: We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. Results: A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score–Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P >.05). Conclusion: The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture. [ABSTRACT FROM AUTHOR]

This study investigated the factorial invariance of the Taiwan Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) across age and gender. A higher order five-factor model was tested on a nationally representative sample of 1,034 children aged 6-16 years. The results demonstrated full factorial invariance for Taiwan children of different ages and gender. The WISC-V subtests demonstrated the same underlying theoretical latent constructs, strength of relations among factors and subtests, validity of each first-order factor, and communalities, regardless of age and gender, which supported the same interpretive approach of the WISC-V. These results accord with findings in the United States, indicating a full factorial invariance of the WISC-V five-factor structure across ages and gender.

Although the complexity of identity transformation among Chinese-speaking international students (CSIS) has been emphasized in previous research, there is a perceived linear and causal pattern between studying abroad and being intercultural. This pattern of thinking results in the risk of treating all the CSIS as the same in each cohort of students. Drawing on Bourdieu's notion of habitus, in this auto/ethnographic study 3 Taiwanese international postgraduate students were followed for 1 year to elucidate the complexity of their identity transformations. The findings suggest a variety of identity changes resulting from the participants' evaluation of their past, present, and future situations.

Accurately imaging seismogenic structures is crucial for seismic hazard assessment. This is especially important around the deformation front (DF) region off SW Taiwan, where seismic potential is high but the fault structure and seismic activity are still poorly understood. Here, we present a comprehensive delineation of seismogenic structures along the onshore and offshore DF of SW Taiwan, utilizing hypocenter relocations and first-motion focal mechanism solutions from January 1991 to March 2019. Five distinctive seismogenic structures are delineated. Particularly, the energetic seismic activity initialled after the 2017 Mw5.3 Tainan earthquake and migrated northeastward along the western side of the DF. The offshore trace of the DF could serve as a boundary delimiting the seismic activity driven by the flexural stress of the subducted Eurasia Plate to the west of the DF. This observation could constrain the magnitude estimation of future earthquakes offshore SW Taiwan. Meanwhile, the areas with higher seismic moment release are located near the DF rather than known faults, indicating that the DF may dominate the seismic moment release. However, further study is warranted into the intricate relationship among seismic strain variation, the structure of DF, and seismic activity to further understand the seismic potential. Our first-motion focal mechanism solutions show that several earthquakes in SW Taiwan were characterized by P-axis orientations parallel to the strike of the Taiwan orogeny. Those events are preferably explained by the lateral compression induced by the ongoing collision between the Eurasia and Philippine Sea plates. Key Points: The deformation front has high seismic potential but seismogenic structure remains unclear. The deformation front confined seismic activity and released relatively large seismic moments. The role of the deformation front must be considered in seismic hazard assessment. [ABSTRACT FROM AUTHOR]

Background: Psychological well-being (PWB) facilitates good health. Few studies have taken into consideration gender and how it can affect PWB within a sociocultural context. This study aims to determine if relationships between social, health, behavioral, and socioeconomic factors on PWB among older Taiwanese adults are affected by gender. Methods: Data were obtained from the 2016 Taiwan Mental Health Survey. A representative sample, of 2,286 individuals, was created using multistage proportional probability. Participants were interviewed at their homes using a structured questionnaire. Inclusion criteria were Taiwanese citizenship, age = 55 years, and the ability to provide informed consent. Participants 65 years and above were selected for the study sample n = 1,533. An 18-item version of Ryff's PWB scale was used to determine PWB. The median value was used to categorize low and high PWB. Logistic regression analyses were used to examine predictors of PWB stratified by gender. Results: Chronic disease, unemployment, and financial dependence negatively impacted men's PWB. Satisfaction with living environment and family relationships positively impacted women's PWB. Unique characteristics of older men, women, and culture account for this. Conclusion: Gender-specific interventions aimed at promoting PWB in older adults are needed. Recommendations include educational programs, social support workshops, and community engagement initiatives. [ABSTRACT FROM AUTHOR]

Aim: To evaluate real‐world abatacept retention and clinical outcomes in patients with rheumatoid arthritis in Taiwan. Methods: This prospective, observational study enrolled patients with rheumatoid arthritis aged ≥20 years who received abatacept in real‐world practice. The primary endpoint was the abatacept retention rate at 24 months. Patients were categorized into subgroups based on abatacept treatment status and previous biological disease‐modifying antirheumatic drug (bDMARD) therapy. Risk factors affecting abatacept retention were determined by regression analysis. Results: A total of 212 patients were enrolled. The overall abatacept retention rate at 24 months among all patients was 59.9% (95% confidence interval 53.0%–66.6%). Patients who were ongoing users of abatacept and bDMARD‐naïve had the highest retention rate (76.3%); of these, 31.6% achieved low disease activity or remission after 2 years. Previous treatment with bDMARDs was associated with an increased risk of abatacept discontinuation (hazard ratio 1.99; p =.002). The most common reasons for abatacept discontinuation were drug switch (11.3%) and loss to follow‐up (6.1%). Abatacept was well‐tolerated with no new safety signals. Conclusion: The 24‐month retention rate of abatacept was 59.9%; abatacept was associated with improved clinical outcomes and was well‐tolerated in the real‐world setting in Taiwan. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 virus has been a global public health threat since December 2019. This study aims to investigate the neurological characteristics and risk factors of coronavirus disease 2019 (COVID-19) in Taiwanese children, using data from a collaborative registry. A retrospective, cross-sectional, multi-center study was done using an online network of pediatric neurological COVID-19 cohort collaborative registry. A total of 11160 COVID-19-associated emergency department (ED) visits and 1079 hospitalizations were analyzed. Seizures were the most common specific neurological symptom, while encephalitis and acute disseminated encephalomyelitis (ADEM) was the most prevalent severe involvement. In ED patients with neurological manifestations, severe neurological diagnosis was associated with visual hallucination, seizure with/without fever, behavior change, decreased GCS, myoclonic jerk, decreased activity/fatigue, and lethargy. In hospitalized patients with neurological manifestations, severe neurological diagnosis was associated with behavior change, visual hallucination, decreased GCS, seizure with/without fever, myoclonic jerk, fatigue, and hypoglycemia at admission. Encephalitis/ADEM was the only risk factor for poor neurological outcomes at discharge in hospitalized patients. Neurological complications are common in pediatric COVID-19. Visual hallucination, seizure, behavior change, myoclonic jerk, decreased GCS, and hypoglycemia at admission are the most important warning signs of severe neurological involvement such as encephalitis/ADEM. [ABSTRACT FROM AUTHOR]

Systemic vascular endothelial growth factor (VEGF) blockade has been the top adjunctive chemotherapy since 1990. Anti-VEGF therapy has also been associated with worsened renal function in some patients. However, the association between patient outcomes and use of intravitreal VEGF inhibitors remains controversial. Thus, it is necessary to determine the action mechanism and long-term renal effects of ranibizumab. The National Health Insurance Research Database (NHIRD) is one of the largest global databases that are extensively used for epidemiological research. NHIRD contains the medical information of all insureds, such as inpatient, outpatient, emergency, and traditional Chinese medicine records. We selected subjects aged ≥ 20 years who recently administered ranibizumab for the ranibizumab cohort. Non-ranibizumab cohort consisted of subjects who did not receive ranibizumab, and the index date was a random date between 2008 and 2018. We excluded subjects with missing sex and age records and those in which the date of primary outcome was before the index date. The two cohorts were matched via 1:1 propensity score matching based on sex, age, index year, hypertension, diabetes mellitus, hyperlipidemia, stroke, coronary artery disease, alcoholism, chronic obstructive pulmonary disease, and age-related macular degeneration, retinal vein occlusion, and diabetic macular edema. Medical confounders were angiotensin I-converting enzyme inhibitors, statins, corticosteroids, VEGF inhibitors including bevacizumab and aflibercept, lithium, amphotericin B, adefovir, NSAIDS, cisplatin, and calcineurin inhibitors. Among 48,248 participants aged ≥ 20 years, 24,136 (50%) received ranibizumab (13,565 male [56.20%] and 10,571 female [43.80%]). Moreover, 24,136 participants who did not receive ranibizumab were matched by age, sex, comorbidities, and medications. Subjects who received ranibizumab exhibited a significantly higher risk of CKD than those who did not receive ranibizumab (adjusted hazard ratio = 1.88, 95% CI = 1.79–1.96). Our findings revealed that exposure to intravitreal ranibizumab is an independent risk factor for CKD. Therefore, physicians and ophthalmologists should make the patients aware of such a correlation to increase patient safety and decrease the CKD burden. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common forms of dementia. However, their neuropsychological and pathological features often overlap, making it difficult to distinguish between AD and VaD. In addition to clinical consultation and laboratory examinations, clinical dementia diagnosis in Taiwan will also include Tc-99m-ECD SPECT imaging examination. Through machine learning and deep learning technology, we explored the feasibility of using the above clinical practice data to distinguish AD and VaD. We used the physiological data (33 features) and Tc-99m-ECD SPECT images of 112 AD patients and 85 VaD patients in the Taiwanese Nuclear Medicine Brain Image Database to train the classification model. The results, after filtering by the number of SVM RFE 5-fold features, show that the average accuracy of physiological data in distinguishing AD/VaD is 81.22% and the AUC is 0.836; the average accuracy of training images using the Inception V3 model is 85% and the AUC is 0.95. Finally, Grad-CAM heatmap was used to visualize the areas of concern of the model and compared with the SPM analysis method to further understand the differences. This research method can quickly use machine learning and deep learning models to automatically extract image features based on a small amount of general clinical data to objectively distinguish AD and VaD. [ABSTRACT FROM AUTHOR]

This study aims to explore the effects of applying game-based learning to webcam motion sensor games for autistic students' sensory integration training for autistic students. The research participants were three autistic students aged from six to ten. Webcam camera as the research tool wad connected internet games to engage in motion sensor games. Through the motion sensor games, the researchers were able to collect data from physiological monitoring, observation (including sensory integration observation and process observation), and interviews. The findings of the study reveal that: (1) the teacher and the participants possess positive attitude toward applying webcam motion sensor games to sensory integration training; (2) Webcam motion sensor games can enhance autistic students' learning interest; and (3) applying the game-based learning to webcam motion sensor games can improve the effect of autistic students' muscle training and endurance. (Contains 4 tables and 5 figures.)

Energy education has been conducted to equip learners with relevant energy conservation knowledge for many years. However, learners seldom put the knowledge into practice and even have few ideas about how to reduce energy consumption. To this end, there is a need to address this issue to improve the efficiency of energy education. One of the strategies is digital game-based learning, which can enhance learning motivation and interaction with learners. In this vein, this study develops an Energy COnservation PET (ECOPET) system using a game-based learning strategy. With the use of a pet avatar, learners were encouraged to use home-energy conservatively in a playful and engaging way. The aim is not simply to teach learners how to reduce energy use, but to engage them in adopting appropriate energy conservation measures. An empirical study was conducted to examine if the ECOPET system could promote learners' understanding of energy conservation. The results demonstrated that the system significantly promoted learners' self-awareness, learning motivation, as well as willingness to conserve energy. (Contains 4 tables and 5 figures.)

In order to encourage students to participate in online learning forums, prompt responses to their questions are essential. To answer students' online questions, teaching assistants are assigned to manage discussions and answer questions in online learning forums. To minimize the response time, many teaching assistants may be needed to interact with learners. We investigated the trade-off between the request-response time and the cost of labor for handling the requests since this has become a challenging and important issue for education managers. In this study, a queuing-based model is proposed to construct the relationship between response time and the human resource requirement in a learning forum. In addition, an experiment using students in a Computer Science Introduction course at a vocational high school was conducted to verify the model and determine the average number of assistants required so that the students' questions can be answered within an acceptable time interval, providing valuable information for managing online discussion forums for educational purposes. Finally, the participants' perceptions were investigated using a questionnaire revised from the Technology Acceptance Model (TAM) in order to identify whether feelings of the perception-of-usefulness and the perception-of-satisfaction during the response wait time showed significant differences when the number of teaching assistants was reduced. The results revealed no significant difference in learners' perceptions after reducing the number of teaching assistants. It confirms that using the model to predict the number of required teaching assistants is highly reliable, and effective in reducing labor costs without jeopardizing student satisfaction. (Contains 4 figures and 3 tables.)

Online games represent a burgeoning market sector of increasing economic importance. However, most previous studies have focused on the utilitarian perspectives of the technology. In other words, there is limited the investigation to social influence on college students' attitude. The aims of this study is to understand the effect of social influence on college students' attitude in playing online game and to discuss gender effect of social influence on college students' attitude of playing online game. Focus group interview and survey of the mix research method were conducted. The authors find: (a) the effect of social influence affects college students' attitudes to online game. Female students are much easier to be affected than male ones, (b) Males tend to be more interested in playing online game than females, and (c) Gender difference might be caused by involvement and benefit while they play online game. (Contains 4 tables.)

Background: The percentage of male teachers in preschools in Taiwan is very low, and thus they have become the disadvantaged minority in preschool teacher training classrooms. Consequently, it is worth investigating the experience of such individuals, and whether the training they receive is both appropriate and adequate. Specifically, should they be taught with teaching methods that are more suited to their educational backgrounds? Or do they have to passively accept the concept that "real" preschool teachers are female? Aims: The aims of this study are to explore the reasons why males decide to study early childhood care, and to discuss their learning experiences. Sample: Three male pre-service preschool teachers in Taiwan were selected as the research subjects for this study. Method: The data collected for this study included records from official and unofficial interviews and observation notes, to which content analysis was applied. Results: The main reasons why males are willing to enter the realm of preschool education include to start their own business and to get a degree, but interest in the topic itself is not a motivating factor. In their learning experiences, they tend to constantly doubt the value of their jobs as preschool teachers. However, if these men are able to re-position their jobs and develop second specialties, their learning attitudes can become more positive, and they can start to enjoy their careers. Conclusion: There are far more female than male professionals in the field of preschool education. It is thus necessary to provide male preschool teachers with appropriate levels of support, so that they can feel both confident and appreciated in their work, as they still often face considerable resistance from the wider society.

This paper intends to explore how Taiwanese students perceive the relationship between their language learning strategy and anxiety in the foreign language classroom. Due to their previous learning experience, most of the participants hold an unfavorable attitude toward a grammar-translation teaching approach. Consequently, learner-centered instruction has been widely accepted and acknowledged as a welcome concept and feasible teaching approach in the English Foreign Language (EFL) context. To improve the proficiency of language learners in EFL classrooms, it is very important to take into account the need of the learners. The present study utilizes Foreign Language Classroom Anxiety Scale (FLCAS) and Communicative Language Teaching Attitude Scale (COLTAS) to examine the participants' perceptions about learning English. The results indicate that most of the participants express a favorable attitude toward the Communicative Language Teaching (CLT) approach; however, they also reveal their high level of anxiety in the language classroom. Language anxiety is usually reported to have adverse effects on the learning of a second language. It is the language instructors' mission to accelerate the language learning of their students. One way is to teach students how to learn more effectively and efficiently. Language learning strategies (LLS) are procedures that learners can use to facilitate learning. Both teachers and students should develop an awareness of the learning process and strategies that lead to success. The ultimate goal of this paper is to analyze the factors that affect the participants' learning strategies and their language anxiety, and offer some pedagogical suggestions.

This paper intends to explore how Taiwanese university students perceive their native-speaking English teachers (NESTs). Mutual expectations between the NESTs and students are also investigated. Collected data include questionnaires from 107 students and interviews with three NESTs and 19 students who have filled out the questionnaire. The result shows that students expect more encouragement and interaction with the NESTs, and more relaxed activities with fewer assignments and tests. A third of the students expect NEST with a standard accent, while a quarter do not care about accent at all. The NESTs reveal their dissatisfaction toward the students' passiveness and lack of responsiveness. While students expect their NESTs to be interactive, they themselves seem to give the NESTs an impression of unwillingness to participate. The discussion centers on this dilemma and offers some suggestions for English teachers.

Objective: Memory loss affects a large proportion of older adults. Research indicates a positive association between memory training and better memory performance as people age. However, studies on specific memory training using an experimental design are limited. This study explored whether memory training has improved memory performance in a group of older adults.Method: A convenience sample of 48 participants was recruited from two communities. Disregarding dropouts, this left 23 experimental (mean age = 65.4 ± 6.0, range = 56-80) and 19 control participants (mean age = 64.5 ± 4.9, range: 57-72). The intervention consisted of 60-min classes held on a weekly basis continuing for 8 weeks. The class session was held after a 1-h exercise class and before a 1-h session of cognitive games. The pre-post objective memory performances, including associative, list, text, place, grocery learning, and transfer-effect of daily event memory (ecology validity), were examined to determine whether the intervention was effective.Results: Intragroup: With Wilcoxon test, the findings showed that the intervention of both the list and place learning had significant differences for the experimental group, but not for the control group. Intergroup: The main effects were found for the associative and text learning. The mixed design ANOVA indicated that there is an interaction (time x group) on the dependent variable of the place learning test. Daily events memory: We found within group that the pre-post differences were significant for the experimental group but not for the control group.Conclusion: The study showed that memory training can help older adults to ameliorate memory loss problems and these findings deserve more attention.

Background: A rising population faces challenges with healing-impaired cutaneous wounds, often leading to physical disabilities. Adipose-derived stem cells (ASCs), specifically in the cell sheet format, have emerged as a promising remedy for impaired wound healing. Human platelet lysate (HPL) provides an attractive alternative to fetal bovine serum (FBS) for culturing clinical-grade ASCs. However, the potential of HPL sheets in promoting wound healing has not been fully investigated. This study aimed to explore the anti-fibrotic and pro-angiogenic capabilities of HPL-cultured ASC sheets and delve into the molecular mechanism. Methods: A rat burn model was utilized to evaluate the efficacy of HPL-cultured ASC sheets in promoting wound healing. ASC sheets were fabricated with HPL, and those with FBS were included for comparison. Various analyses were conducted to assess the impact of HPL sheets on wound healing. Histological examination of wound tissues provided insights into aspects such as wound closure, collagen deposition, and overall tissue regeneration. Immunofluorescence was employed to assess the presence and distribution of transplanted ASCs after treatment. Further in vitro studies were conducted to decipher the specific factors in HPL sheets contributing to angiogenesis. Results: HPL-cultured ASC sheets significantly accelerated wound closure, fostering ample and organized collagen deposition in the neo-dermis. Significantly more retained ASCs were observed in wound tissues treated with HPL sheets compared to the FBS counterparts. Moreover, HPL sheets mitigated macrophage recruitment and decreased subsequent wound tissue fibrosis in vivo. Immunohistochemistry also indicated enhanced angiogenesis in the HPL sheet group. The in vitro analyses showed upregulation of C–C motif chemokine ligand 5 (CCL5) and angiogenin in HPL sheets, including both gene expression and protein secretion. Culturing endothelial cells in the conditioned media compared to media supplemented with CCL5 or angiogenin suggested a correlation between CCL5 and the pro-angiogenic effect of HPL sheets. Additionally, through neutralizing antibody experiments, we further validated the crucial role of CCL5 in HPL sheet-mediated angiogenesis in vitro. Conclusions: The present study underscores CCL5 as an essential factor in the pro-angiogenic effect of HPL-cultured ASC sheets during the wound healing process. These findings highlight the potential of HPL-cultured ASC sheets as a promising therapeutic option for healing-impaired cutaneous wounds in clinical settings. Furthermore, the mechanism exploration yields valuable information for optimizing regenerative strategies with ASC products. Brief acknowledgment: This research was supported by the National Science and Technology Council, Taiwan (NSTC112-2321-B-002-018), National Taiwan University Hospital (111C-007), and E-Da Hospital-National Taiwan University Hospital Joint Research Program (111-EDN0001, 112-EDN0002). [ABSTRACT FROM AUTHOR]

Background: Non-insulin-based insulin resistance (NI-IR) indices have been reported to have an association with prevalent hypertension, however, no cohort studies to date have compared their prediction of hypertension among young adults. Methods: A total of 2,448 military men and women, aged 18–39 years, without baseline hypertension in Taiwan were followed for incident hypertension events from 2014 until the end of 2020. All subjects underwent annual health examinations including measurements of blood pressure (BP) in mmHg. Systolic BP (SBP) 130–139/diastolic BP (DBP) < 80, SBP < 130/DBP 80–89, and SBP 130–139/DBP 80–89 were respectively defined as stage I isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined hypertension (CH). The cut-off levels of stage II hypertension for SBP and DBP were 140–159 and 90–99, respectively. Four NI-IR indices included the ratio of serum triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), TyG index defined as ln[TG* fasting glucose (FG)/2], Metabolic Score for IR (METS-IR) defined as ln[(2* FG) + TG)* body mass index (BMI)/(ln(HDL-C))], and ZJU index defined as BMI + FG + TG + 3* alanine transaminase/aspartate transaminase (+ 2 if female). Multivariable Cox regression analysis was performed with adjustments for baseline age, sex, body mass index, BP, substance use, family history for early onset cardiovascular diseases or hypertension, low-density lipoprotein cholesterol, kidney function, serum uric acid and physical activity to determine the associations. Results: During a median follow-up of 6.0 years, there were 920 hypertension events (37.6%). Greater TyG, TG/HDL-C and METS-IR indices were associated with a higher risk of stage I IDH (hazard ratios (HRs) and 95% confidence intervals: 1.376 (1.123–1.687), 1.082 (1.039–1.127) and 3.455 (1.921–6.214), respectively), whereas only greater ZJU index was associated with a higher risk of stage II IDH [HRs: 1.011 (1.001–1.021)]. In addition, greater ZJU index was associated with a higher risk of stage II ISH [HR: 1.013 (1.003–1.023)], and greater TyG index was associated with a higher risk of stage II CH [HR: 2.821 (1.244–6.395)]. Conclusion: Insulin resistance assessed by various NI-IR indices was associated with a higher risk of hypertension in young adults, while the assessment ability for specific hypertension category may differ by NI-IR indices. [ABSTRACT FROM AUTHOR]

It is unclear about whether the oral health has impact on physical performance. Therefore, this study aimed to examine the association between oral health and physical performance in 300 military adults in Taiwan. Oral health was assessed by the presence of periodontitis and dental caries. The status of cardiorespiratory and muscular endurance capacity was respectively assessed by tertiles of time for a 3000-m run and 2-min push-up numbers. Multivariable logistic and linear regression analyses with adjustments for age, smoking, alcohol drinking, blood pressure, anthropometric variables, lipid profile, fasting glucose and physical activity were used to determine the association. Participants with periodontitis were more likely to have worse 3000-m running performance classified in the lowest tertile [odds ratio (OR) and 95% confidence interval: 1.94 (1.03, 3.66)]. Participants with any dental caries were more likely to have worse push-ups performance classified in the lowest tertile [OR: 2.50 (1.27, 4.92)]. In linear regression analyses, dental caries numbers were inversely correlated with 2-min push-ups numbers [β = −1.04 (−2.07, −0.01)]. This study suggests that oral health is crucial to maintain physical fitness, and dental caries and periodontitis may affect differently on aerobic and muscular endurance capacities. [ABSTRACT FROM AUTHOR]

Orientia tsutsugamushi is an obligate intracellular bacterium associated with trombiculid mites and is the causative agent of scrub typhus, a life-threatening febrile disease. Strain typing of O. tsutsugamushi is based on its immunodominant surface antigen, 56-kDa type-specific antigen (TSA56). However, TSA56 gene sequence-based phylogenetic analysis is only partially congruent with core genome-based phylogenetic analysis. Thus, this study investigated whether concatenated surface antigen sequences, including surface cell antigen (Sca) proteins, can reflect the genome-scale phylogeny of O. tsutsugamushi. Complete genomes were obtained for two common O. tsutsugamushi strains in Taiwan, TW-1 and TW-22, and the core genome/proteome was identified for 11 O. tsutsugamushi strains. Phylogenetic analysis was performed using maximum likelihood (ML) and neighbor-joining (NJ) methods, and the congruence between trees was assessed using a quartet similarity measure. Phylogenetic analysis based on 691 concatenated core protein sequences produced identical tree topologies with ML and NJ methods. Among TSA56 and core Sca proteins (ScaA, ScaC, ScaD, and ScaE), TSA56 trees were most similar to the core protein tree, and ScaA trees were the least similar. However, concatenated ScaA and TSA56 sequences produced trees that were highly similar to the core protein tree, the NJ tree being more similar. Strain-level characterization of O. tsutsugamushi may be improved by coanalyzing ScaA and TSA56 sequences, which are also important targets for their combined immunogenicity. [ABSTRACT FROM AUTHOR]

With the increasing attention to the role of parents in children's learning, what issues parents consider and how they behave when learning with their children when confronted with the emerging augmented reality (AR) technology may be worth exploring. This study was therefore conducted to qualitatively understand parents' conceptions of AR learning and approaches to learning by AR with their children. A total of 90 pairs of parents and children were invited to participate in an AR book reading activity held in 2015; all of the parents were then interviewed to acquire the research data. Through the phenomenographic method, this study generated several categories of the parents' conceptions of and approaches to AR learning. Further analysis identified the relationships between parents' conceptions and approaches. For example, the parents holding cohesive conceptions (e.g., learning by AR as attaining in-depth understanding) tended to use deep approaches (e.g., offering guidance to connect life experiences with the book content for thorough reading). Based on the findings, a framework of interactive AR book systems for child-parent shared reading is proposed. This study was expected to initiate research in the area of learning by AR in informal learning environments.

A visual representation involves delivering messages through visually communicated images. The study assumed that semantic recognition can affect visual interpretation ability, and the result showed that students graduating from a general high school achieve satisfactory results in semantic recognition and image interpretation tasks than students graduating from a vocational high school. Twenty students with low semantic recognition performance participated in our study and completed 24 hours of an intensive Chinese semantics-training course after the design foundation course. The results revealed that the Chinese intensive training improved their semantic recognition in design performance, thereby is confirming the assumption. Our study results suggest that design teachers must not only provide strong practical design training, but also develop skills such as semantic comprehension and object interpretation in young designers.

The technological and vocational higher education system in Taiwan is offering an undergraduate degree for design-based vocational high school students and general high school students whose qualitative and quantitative abilities are evaluated through a student selection examination. This study focused on the conceptual understandings of 64 freshmen with different backgrounds in design who have taken a full 18-week basic design course. Through this curriculum arrangement, the research team aimed to understand the distinctive learning achievements and basic design capacity of people in those two diverse background groups. The results revealed that general high school students received higher evaluations on overall performance capabilities than vocational high school students did in the experiment, contradicting the common notion that students who graduate from vocational school have stronger design skills than students of other backgrounds do. We conclude that the technical and vocational education system might not effectively execute the design practical training curriculum. Another reason may be the credentialism present in Taiwanese society.

An increasing amount of research has focused on the exploration of English as a Foreign Language teachers' technological pedagogical and content knowledge (TPACK). However, in the field of native language teaching, such as Taiwanese, Hakka, Aboriginal languages in Taiwan, few studies have paid attention to understanding the teachers' perceptions of TPACK. A survey was therefore conducted to examine 172 in-service Hakka language teachers' perceptions of TPACK in Taiwan. The survey framework includes seven constructs: content knowledge (CK), pedagogical knowledge (PK), technological knowledge (TK), pedagogical content knowledge (PCK), technological pedagogical knowledge (TPK), technological content knowledge (TCK), and TPACK. According to the results, although the native language teachers were satisfied with their TPACK on average, they had relatively low confidence in CK, TK, and TPK. While the older male teachers tended to be more confident in their CK, the older female teachers were inclined to have less confidence in their TK. Teaching experience was positively related to the teachers' perceived CK, PK, and PCK. Particularly, the importance of the teachers' TCK, PK, and TK in their synthesized TPACK was identified. This study also provides suggestions for native language teacher training program design in the future.

Since augmented reality (AR) has been increasingly applied in education recently, the investigation of students' learning experiences with AR could be helpful for educators to implement AR learning. With a quantitative survey using three questionnaires, this study explored the relationships among 153 students' perceived cognitive load, motivation, and attitudes of perceived control, perceived usefulness, behaviour of learning, and behaviour of AR learning, when they engaged in an AR book reading activity. The results indicated that, in general, the students perceived less cognitive load, stronger motivation, and more positive attitudes towards the experiences when reading an AR book. However, dissimilar to past studies, the perceptions of low level cognitive load cannot be guaranteed to lead to positive intentions to learn. Interestingly, motivation mediated the relationships between the students' perceived cognitive load and behavioural intention to learn. Only when the students' perceptions of motivational factors such as attention or confidence were significant did the perceived usefulness and cognitive load play a role in their behavioural intentions to take part in future AR learning. The findings of this study may provide insights for future AR-related studies to explore the role of cognitive load in learning performance with consideration of motivational factors.

Exercise systematically improves physical and psychological performances on a wide range of measures, but the links between them are rarely examined for the high homogeneous group of institutionalized veterans. This study aims to investigate the exercise intervention effects on both depressive symptoms and body-balance. Samples were divided into experimental-group (N = 11, mean age = 80.67) and the control-group (N = 10, mean-age = 82.54). The experimental-group received 10 sessions of exercise intervention, including aerobic cycling and leg stretching (muscular endurance), while the control-group attended lecture sessions on health education. Depressive symptoms: the findings show the intervention has no significant intragroup effect on either the experimental-group or the control-group; but a high and median effect-size (EF with Cohen's d) was found for both the experimental and the control group (d = 0.916 and 0.504, respectively). The intergroup difference was small (p = 0.748; d = 0.136). Balance-ability: the findings show no statistically significant intragroup effect on the 5-stage balance test within the experimental-group, and the EF is low. In the control-group, health education intervention had no improvement on the 5-stage balance test, but there was a moderate decrease in balance Stage-4 (d = -0.626). Additionally, the strong intergroup effect (d = 1.621, p = 0.003) indicated that the experimental-group is superior to the control-group at Stage-4, and there was a moderate effect at stage-3 and stage-5 (d = 0.567 and 0.495, respectively). The current study shows that exercise can help adults older than 80 to ameliorate depressive symptoms and enhance body balance ability, and the findings deserve more attention.

Background: Ritodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma. Case presentation: A 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation, with an undiagnosed placental chorioangioma, underwent tocolysis due to preterm uterine contractions. Her clinical condition deteriorated, attributed to mirror syndrome and adverse events induced by ritodrine. An emergency cesarean section was performed at 27 1/7 weeks of gestation, delivering an infant with generalized subcutaneous edema. A placental tumor measuring 8.5 cm was discovered during the operation, and pathology confirmed chorioangioma. Gradual improvement in her symptoms and laboratory data was observed during the postpartum period. Identifying mirror syndrome and ritodrine-induced side effects poses challenges. Therefore, this case is educational and warrants discussion. Conclusion: Our case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload. [ABSTRACT FROM AUTHOR]

Summary: Most studies investigating the association between physical activity and osteoporosis prevention only focused on specific types of physical activity. This study's evidence regarding the combined effects or interaction of sleep duration and physical activity. The findings emphasize the role of sleep duration and physical activity in association with osteoporosis. Purpose: The associations between physical activity, sleep duration, and prevalent osteoporosis in Taiwanese adults were studied in this cross-sectional study. Methods: The Taiwan Biobank enrolled a community-based cohort of ~ 120,000 volunteers (as of April 30, 2020) between 30 and 76 years of age with no history of cancer. Amongst, bone mineral density (BMD) measures by dual-energy X-ray absorptiometry (DXA) were available in 22,402 participants. After excluding individuals who had no complete data of BMI (n = 23), MET score (n = 207), T-score (n = 8,826), and sleep duration (n = 16), 13,330 subjects were included as the primary cohort. Univariate and multivariable regression analyses were performed to determine the associations between the presence of osteoporosis, physical activity level, sleep duration, and other variables. Results: The results showed that after adjustment, subjects with physical activity < 20 METs/week and ≥ 20 METs/week (aOR = 1.017 and 0.767, respectively) were associated with risk of osteoporosis than those with zero MET. The odds of osteoporosis were not significantly lower in subjects who slept for ≥ 8 h/day (aOR = 0.934,p=0.266). In addition, compared to short sleepers with no physical activity, adults with increased physical activity ≥ 20 METs/week and sleep ≥ 8 h/day had a significantly lowest likelihood of osteoporosis (aOR = 0.702). Those with medium physical activity (< 20 METs/week) plus average sleep duration (6.5–8 h/day) did not have significant higher odds of osteoporosis (aOR = 1.129,p=0.151). Conclusion: The findings emphasize the joint role of sleep duration and physical activity in association with osteoporosis. Adults with high physical activity plus high sleep hours have the highest BMD and lowest risk of osteoporosis. [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: Chronic kidney disease (CKD) is one of the most common diseases worldwide. The increasing prevalence and incidence of CKD have contributed to the critical problem of high medical costs. Due to stressful environments, aircrew members may have a high risk of renal dysfunction. A better strategy to prevent CKD progression in Air Force personnel would be to diagnosis CKD at an early stage. Since few studies have been conducted in Taiwan to examine the long-term trends in early CKD in Air Force aircrew members, this study is highly important. We investigated the prevalence of CKD and established a predictive model of disease variation among aircrew members. Materials and Methods: In this retrospective study, we included all subjects who had received physical examinations at a military hospital from 2004 to 2010 and who could be tracked for four years. The Abbreviated Modification of Diet in Renal Disease Formula (aMDRD) was used to estimate the glomerular filtration rate (GFR) and was combined with the National Kidney Foundation/ Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) to identify CKD patients. Results: A total of 212 aircrew members were assessed. The results showed that the prevalence of CKD was 3.8%, 9.4%, 9.0%, and 9.4% in each of the four years. According to the logistic regression analysis, abnormal urobilinogen levels, ketones, and white blood cell (WBC) counts in urine and a positive urine occult blood test increased the risk of CKD. A positive urine occult blood test can be used to predict the future risk of CKD. Moreover, the generalized estimating equation (GEE) model showed that a greater risk of CKD with increased examination time, age and seniority had a negative effect. In conclusion, abnormal urobilinogen levels, ketones, and urine WBC counts in urine as well as a positive urine occult blood test might serve as independent predictors for CKD. Conclusion: In the future, we can focus not only on annual physical examinations but also on simple and accurate examinations, such as urine occult blood testing, to determine the risk of CKD and prevent its progression in our aircrew members. [ABSTRACT FROM AUTHOR]

It may be possible to enhance adults' cognitive health and promote healthy aging through processing speed training using the Useful Field of View (UFOV) related activities and software. This study investigated the impact of utilizing UFOV on processing speed improvement in older adults in response to the growing global attention on cognitive health and aging issues. In this quasi-experimental study, 22 individuals (mean age ± SD = 71.9 ± 4.8) participated in the experimental group, and 20 community-based participants (mean age ± SD = 67.1 ± 4.8) were in the control group. The intervention involved ten sessions of UFOV training, each lasting 60 min, conducted twice a week for the experimental group while the control group engaged in volunteer service activities. Measurements of Counting Back, Fabrica, Double-Decision, and Hawkeye were administered to all participants before and after the intervention. The results showed significant improvements in the experimental group for the four measurements (p ≤ 0.01, 0.05, 0.001, 0.001) and non-significant gains in the control group (p ≥ 0.05) for all. Furthermore, mixed repeated-measures ANOVA analysis, with time 1 pre-test measures as the covariate, revealed significant interaction effects between time and group for all measurement indicators (p = 0.05, 0.01, 0.05) except for Fabrica (p > 0.05). In conclusion, these findings support the effectiveness of UFOV cognitive training interventions in enhancing specific cognitive abilities. [ABSTRACT FROM AUTHOR]

Aim: Similar environmental selection pressures drive the occurrence of convergent evolution among species. However, studies on this phenomenon are scarce at the population level. Here, we used two waist‐shaped bugs to test the hypothesis that similar high‐elevation habitat environments could lead to similar genetic adaptations among populations of different species. Location: East Asia. Taxa: Malcus sinicus Štys, 1967 & Malcus insularis Štys, 1967. Methods: Population genetic structure was determined by phylogenetic and phylogeographical analyses. Demographic history was inferred by comparing simulated history models. Suitable habitat from the last interglacial period (LIG) to the present was predicted by ecological niche modelling (ENM). Convergent evolutionary processes were jointly assessed by the comparison of population ecological differences and the principal component analysis of environmentally related single‐nucleotide polymorphisms (SNPs). Results: Our results showed that the land bridge in the Pleistocene helped ancestral populations of M. sinicus and M. insularis diffuse from mainland China to Taiwan Island. Subsequently, the geographical barrier imposed by the Taiwan Strait promoted the species differentiation. Geographic isolation and adaptive evolution jointly promoted the population differentiation in M. sinicus. Genetic similarity was found between the populations of M. sinicus in southwestern China (sin‐YN) and M. insularis on Taiwan Island (ins‐TW). Temperature‐related environmental factors and elevation were found to similarly and significantly clustered with ins‐TW and sin‐YN and were clearly distinguished from the other low−/mid‐elevation populations of M. sinicus (sin‐EA). Furthermore, the SNPs related to these environmental factors presented the same clustering results. Main Conclusions: Our study revealed a novel disjunct distribution pattern between southwestern China and Taiwan Island at the population level and provided evidence of convergent evolution of local populations in high‐elevation environments. Here, we revealed that similar environmental selection pressures can drive the occurrence of convergent evolution at the population level among different species. [ABSTRACT FROM AUTHOR]

(1) Background: Pneumonia stands as a prevalent infectious disease globally, contributing significantly to mortality and morbidity rates. In Taiwan, pneumonia ranks as the third leading cause of death, particularly affecting the elderly population (92%). This study aims to investigate factors associated with community-acquired pneumonia (CAP) among elderly individuals receiving home-based care. (2) Methods: Conducted between January 2018 and December 2019, this retrospective study involved a medical chart review of elderly patients under home-based care. A multiple logistic regression model was employed to identify factors associated with CAP in this demographic. (3) Results: Analysis encompassed 220 elderly patients with an average age of 82.0 ± 1.1 years. Eighty-five patients (38.6%) were hospitalized for CAP. Predominant diagnoses included cancer (32.3%), stroke (24.5%), and dementia (23.6%). Significant predictors of CAP for elderly patients under home-based care included male gender (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.95–8.60, p < 0.001), presence of a nasogastric (NG) tube (OR = 8.85, 95% CI: 3.64–21.56, p < 0.001), and a borderline negative association with the use of proton pump inhibitors (PPIs) (OR = 0.37, 95% CI: 0.13–1.02, p = 0.0546). End-of-life care indicators for these patients with CAP included an increased number of hospital admission days in the last month of life (OR = 1.13, 95% CI: 1.08–1.18, p < 0.001) and a higher likelihood of hospital death (OR = 3.59, 95% CI: 1.51–8.55, p = 0.004). (4) Conclusions: In the current study, significant predictors of CAP among elderly patients receiving home-based care included the presence of an NG tube and male gender, while the use of PPIs was borderline inversely associated with the risk of CAP. Notably, more admission days in the last month of life and death in the hospital were found to be associated with end-of-life care for this group. [ABSTRACT FROM AUTHOR]

Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients. [ABSTRACT FROM AUTHOR]

Mindfulness-based relapse prevention (MBRP) has been found to be effective to reduce the likelihood of relapse. We aimed to confirm the effects of the MBRP on frequency of drug use, negative outcome expectancies, positive outcome expectancies, treatment readiness, depression, anxiety, and mindfulness of community-dwelling people with illicit drug abuse issues. In this study, we designed a randomized clinical trial (RCT) to test the efficacy of MBRP in reducing relapse compared with the treatment as usual (TAU). The participants in this study were 49 people (experimental group: 24, control group: 25) enrolled in one community treatment center located in Taoyuan City in Taiwan. In the experimental group, the mindfulness-based relapse prevention program was applied once a week for 2 h over 8 weeks. Baseline, post-session, and 3-month follow-up assessments were conducted. Generalized estimating equations were used to examine the efficacy of the intervention. Compared with the control group, the experimental group showed significantly mitigated depression, anxiety, and decreased positive outcome expectancies of drug use. Mindfulness-based relapse prevention was an effective intervention as a relapse prevention strategy during a 3-month follow-up period. We found that mindfulness is especially beneficial to regulate emotions, thereby reducing the severity of drug addiction for illegal drug abusers. [ABSTRACT FROM AUTHOR]

In 2020, metabolic Associated Fatty Liver Disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD) with new diagnostic criteria. The prevalence and clinical outcomes of MAFLD subtypes remained unclear. The participants from Taiwan bio-bank cohort were included. MAFLD was defined as the presence of fatty liver, plus any of the following three conditions: overweight/obesity, diabetes mellitus (DM), or metabolic dysfunction. The patients with positive HBsAg or anti-HCV were considered as chronic HBV or HCV infection. NAFLD fibrosis score (NFS) > 0.676 plus fibrosis 4 (FIB-4) score > 2.67 was defined as advanced liver fibrosis. Atherosclerosis was diagnosed as having carotid plaques on duplex ultrasounds. The clinical outcomes were assessed among four subtypes of MAFLD including DM, obesity, chronic HBV infection, and chronic HCV infection. A total of 21,885 participants (mean age 55.34 ± 10.31; 35.69% males) were included in the final analysis. Among them, 38.83% were diagnosed with MAFLD. The prevalence of MAFLD was 66.95% in DM patients, 65.07% in obese participants, 33.74% in chronic HBV patients, and 30.23% in chronic HCV patients. Logistic regression analysis showed that the subtypes of DM and chronic HCV infection were associated with an increased risk of advanced liver fibrosis in MAFLD patients. Additionally, the subtypes of DM and lean were associated with an increased risk of atherosclerosis, but a decreased risk of atherosclerosis in the subtype of chronic HBV infection. This population-based study proves the concept that subtypes of MAFLD can help risk stratification of clinical outcomes. [ABSTRACT FROM AUTHOR]

It is unclear about whether the guideline-based physical activity (PA) level for cardiovascular health also benefits periodontal health. Therefore, this study aimed to clarify the association between guideline-based PA levels and periodontitis in young adults. This was a cross-sectional study which included 334 military participants, aged 18–44 years in Taiwan. The PA level was assessed by total running time per week (wk) in the past 6 months from a self-reported questionnaire, and was classified as moderate intensity PA <150, 150–299, and ≥300 min/wk according to the American guideline for cardiovascular health. Periodontitis was defined based on the 2017 World Workshop. Multiple logistic regression analysis was used to determine the association with adjustment for age, sex, educational level, tobacco smoking, alcohol intake, body mass index, waist circumference, blood pressure and teeth brushing frequency. As compared to the PA: 150–299 min/wk, the PA <150 min/wk was associated with a greater possibility of periodontitis (odds ratio (OR): 2.45 (95% confidence interval (CI): 1.24–4.82), whereas the PA ≥300 min/wk was not associated with periodontitis (OR: 0.98 (95% CI: 0.13–1.09)) in young adults. The guideline-based moderate intensity PA level ≥150 min/wk is found to have superior periodontal health in young adults. However, there is no additional benefit in more exercise time to obtain better periodontal health when the suggested PA level has been achieved. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) plays a significant role as a pro-angiogenic and pro-permeability factor within the kidney. Bevacizumab is a pharmaceutical monoclonal anti-VEGF antibody that inhibits the growth of new blood vessels, which blocks blood supply and thereby restricts tumor growth. Thus, we conducted a nationwide study to explore the risk of chronic kidney disease (CKD) development in Taiwan residents after bevacizumab therapy. We drew data from the extensive National Health Insurance Research Database (NHIRD), which encompasses data from >99% of Taiwan's population from 1995 onwards. Individuals who received bevacizumab between 2012–2018 were identified as the bevacizumab cohort, with the index date set at the first usage. We randomly selected dates within the study period for the control group to serve as index dates. We excluded patients with a history of CKD prior to the index date or those <20 years old. In both cohorts, patients' propensity scores matched in a 1:1 ratio based on sex, age, index year, income, urbanization level, comorbidities, and medications. We found patients treated with bevacizumab had a significantly higher risk of contracting CKD than patients without bevacizumab (adjusted hazard ratio = 1.35, 95% confidence interval = 1.35–1.73). The risk of CKD was 1.35-fold higher in participants with bevacizumab treatment than those in the control group. These findings suggest that close monitoring of CKD development after bevacizumab administration is needed. [ABSTRACT FROM AUTHOR]