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Purpose: This study explored the neural marker indexing deficits in discriminating lexical tone changes in Mandarin-speaking children with developmental language disorders (DLDs) using mismatch negativity, an event-related potential component for auditory change detection. Mandarin has four lexical tones characterized by a high-level tone (T1), high-rising tone (T2), low-dipping tone (T3), and high-falling tone (T4), in which the T2/T3 contrast is acoustically less discriminable in developmental groups. Therefore, this study further examined how deficits in children with DLD would vary with tonal contrasts' acoustic saliency. Method: Event-related potentials were measured using the multideviant oddball paradigm described by Lee et al. (2012), who used Mandarin syllables [i] in T3 as the standard sound (80%), T1 as the large deviant (10%), and T2 as the small deviant (10%). Twelve children with DLD aged between 4 and 6 years participated in this study, and 12 age-matched children with typical development were selected from the data set of Lee et al. (2012) as the controls. Results: The T1/T3 change elicited adultlike mismatch negativity in both the DLD and control groups, while no group difference was revealed. The T2/T3 change elicited a robust positive mismatch response (P-MMR) in children with DLD, while the P-MMR was less significant in the control group. The group comparisons revealed a larger P-MMR in children with DLD than in the control group. Furthermore, children with lower scores in language assessments tend to reveal larger P-MMRs. Conclusions: This study demonstrated that deficits in children with DLD in discriminating subtle lexical tone changes reflect greater positivity of P-MMR to T2/T3 change. This implies that MMR to T2/T3 may serve as a neural marker for evaluating language delay in preschoolers.

Objective: Aortic stenosis (AS) is a heart valve disease characterized by left ventricular outflow fixed obstruction. It can be managed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). However, real-world evidence for TAVI or SAVR outcomes is lacking in Taiwan. This study aimed to compare the clinical outcomes of TAVI and SAVR for treating of AS in Taiwan. Materials and methods: The National Health Insurance Research Database is a nationally representative cohort that contains detailed registry and claims data from all 23 million residents of Taiwan. This retrospective cohort study used this database to compare patients who underwent SAVR (bioprosthetic valves) or TAVI from 2017 to 2019. Survival outcomes and length of hospital stay (LOS) and intensive care unit (ICU) stay between TAVI and SAVR in the matched cohort. A Cox proportional hazards model was performed to identify the effect of treatment type on survival rates while controlling variables including age, gender, and comorbidities. Results: We identified 475 and 1605 patients who underwent TAVI and SAVR with a bioprosthetic valve, respectively. Patients who underwent TAVI were older (82.19 vs. 68.75 y/o) and more likely to be female (55.79% vs. 42.31%) compared with patients who underwent SAVR. Propensity score matching (PSM) on age, gender, and Elixhauser Comorbidity Index (ECI) score revealed that 375 patients who underwent TAVI were matched with patients who underwent SAVR. A significant difference was found in survival rates between TAVI and SAVR. The 1-year mortality rate was 11.44% with TAVI and 17.55% with SAVR. Both the mean total LOS (19.86 vs. 28.24 days) and mean ICU stay (6.47 vs. 11.12 days) for patients who underwent TAVI were shorter than those who underwent SAVR. Conclusion: Patients who had undergone TAVI had better survival outcomes and shorter LOS compared with patients who had undergone SAVR in Taiwan. [ABSTRACT FROM AUTHOR]

Introduction: Mitral regurgitation (MR) is characterized by systolic blood flow reversal from the left ventricle to the left atrium. A 2019 study indicated that in the USA, clinically significant MR (sMR) is associated with a substantial healthcare cost burden. In Taiwan, few data are available to describe the clinical characteristics, treatment patterns, and economic burden of patients with sMR. Methods: Using the National Health Insurance Research Database (NHIRD), a national, detailed claims database of all 23 million residents of Taiwan, we conducted a retrospective cohort study to identify patients with sMR and quantify the impact of the disease on Taiwan's healthcare system. We classified patients with sMR into three cohorts based on disease etiology: functional MR (sFMR), degenerative MR (sDMR), and uncharacterized MR (sUMR). Results: We compared patient characteristics across cohorts and estimated attributable healthcare utilization and costs during the 12-month follow-up period. Our research shows that in Taiwan, patients with sFMR were older, sicker, and presented at casualty (emergency department) more frequently than those with sDMR and sUMR. Meanwhile, patients with sDMR had the highest 12-month healthcare expenditures across the cohorts. Conclusion: These findings are inconsistent with what has been shown in the USA, which warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Acute abdomen is a common disease in the emergency department (ED) and usually results in huge medical expenditure. To relieve abdominal pain effectively and reduce bed occupancy rate in emergency rooms, electroacupuncture is a practical method in the treatment of abdominal pain.Methods/design: Five hundred patients will be randomly and evenly divided into experimental and control groups. Both groups should have their basic information taken and their bilateral acupuncture points ( Hegu (LI 4), Neiguan (PC6), Zusanli (ST 36), Shangjuxu (ST37), Xiajuxu (ST39), Taichong (LR3), and Taibai (SP3)) will be intervened by electroacupuncture or vaccaria Seeds, in this clinical study. Electroacupuncture has been introduced to this experiment as an auxiliary technique. The experimental group will receive real electroacupuncture, but the control group will receive a placebo electroacupuncture in which transcutaneous electrical nerve stimulation will not be turned on. After the intervention, we will evaluate the difference in abdominal pain, the length of stay at the emergent observation ward, and the proportion of revisits with abdominal pain.Discussion: In Taiwan, medical expenditure is increasing annually because of the higher bed occupancy caused by acute abdominal pain in the hospital. We expect that the combined treatment of electroacupuncture and modern medical treatment will not only reduce bed occupancy and the length of ED stay but also effectively decrease the rate of readmission and revisits by 72 h. By means of electroacupuncture, the spiraling cost of health care can eventually be reduced.Trial Registration: ClinicalTrials.gov identifier: NCT03199495. Registered on 27 June 2017. [ABSTRACT FROM AUTHOR]

Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n=45) received a series of fixed points of acupuncture. The control group (n=14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001) for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely. [ABSTRACT FROM AUTHOR]

This study demonstrated that semantic transparency as a linguistic property modulates the recognition memory for two-character Chinese words, with opaque words (i.e., words whose meanings cannot be derived from constituent characters-e.g., '光[/guang/, light]棍[/gun/, stick]', bachelor) remembered better than transparent words (i.e., words whose meanings can be derived from constituent characters-e.g., '茶[/cha/, tea]杯[/bei/, cup]', teacup). In Experiment 1, the participants made lexical decisions on transparent words, opaque words, and nonwords in the study and then engaged in an old/new recognition test. Experiment 2 employed a concreteness judgment as the encoding task to ensure equivalent semantic processing for opaque and transparent words. In Experiment 3, the neighborhood size of the two-character words was manipulated together with their semantic transparency. In all three experiments, opaque words were found to be better remembered than transparent words. We concluded that the conceptual incongruence between the meanings of a whole word and its constituent characters made opaque words more distinctive and, hence, better remembered than transparent words. [ABSTRACT FROM AUTHOR]

The article discusses the cloud system developed for mobile medical services for the provision of the traditional Chinese medicine practice of acupuncture to sample patients at the Lukang Branch of the Changhua Christian Hospital (CCH) in Taiwan. Topics discussed include the website set up for database information sharing, the Android mobile devices with the PC cloud server and the need for medical cloud system compatibility with the different operating systems such as Android or iOs.

Background: Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) offer diverse benefits and drawbacks for critically ill children with acute kidney injury (AKI). Sustained low-efficiency daily diafiltration (SLEDD-f) involves a conceptual and technical hybrid of CRRT and IHD. We report our SLEDD-f application to critically ill children in the pediatric intensive care unit (PICU). Methods: SLEDD-f was delivered by the new Fresenius 5008 therapy system with blood flow 5 ml/kg/min, dialysate flow 260 ml/min, hemofiltration 35 ml/kg/h for 8-10 h daily. Changes in blood pressure, blood gas, electrolyte, hemoglobulin (Hb), and hematocrit (Hct) were closely monitored. Results: From February 2010 to June 2011, 14 critical patients with a total of 60 SLEDD-f sessions were studied retrospectively. Heparin was used in 46 sessions (76.6%) with no bleeding complications. Hypertension above 135 mmHg returned to normal, hypotension below 90 mmHg showed no drop. Metabolic acidosis and hyperkalemia normalized. Elevated Hb, Hct, and their ratio revealed improving hemodilution. Three episodes of intradialytic hypotension (5.0%) and one of circuit clotting (1.7%) led to premature termination. The 28-day survival rate was 71.4%. Conclusions: This pilot investigation demonstrates that SLEDD-f provides good hemodynamic tolerance and correction of fluid overload, pH, and electrolyte imbalance for critically ill children with AKI. [ABSTRACT FROM AUTHOR]

In this study, we used satellite observations, in-situ measurements, and numerical modelling to investigate an extreme temperature change triggered by a typhoon in the ocean near the Kuroshio region off eastern Taiwan. With the westward passage of Typhoon Morakot in 2009 through Taiwan, a distinct cool wake was generated at the southeastern corner of Taiwan (CWSET) and moved towards the downstream Kuroshio region; it involved a precipitous cooling of at least 4 °C within 10–20 km of the coast. Rapid and drastic temperature drops triggered by the CWSET and advected by the strong conveyor belt effect of the Kuroshio Current are highly probable sources of cold shocks in summer. We clarified the mechanism that generated the CWSET through a series of sensitivity experiments using the Regional Oceanic Modeling System. The cold shock was mainly triggered by local wind stress associated with the typhoon. In addition, the Kuroshio Current was demonstrated to have played a crucial role in both the generation of upwelling off the southeastern coast of Taiwan during the passage of the typhoon and the transporting of this impact downstream. This process was verified through a systematic analysis of all typhoons moving westward through Taiwan from 2005 to 2013. Cold-shock stress is thought to be linked with naturally occurring ‘fish kills’, and obtaining a more thorough understanding of the CWSET will be helpful for protecting aquaculture off the eastern coast of Taiwan from the impacts of cold shocks triggered by typhoons moving westward through Taiwan in summer. [ABSTRACT FROM AUTHOR]

A real-time air quality forecasting (AQF) system was developed in Taiwan using the Weather Research and Forecasting meteorological model and Community Multiscale Air Quality model framework. This study evaluated the performance of the one-year archived AQF PM 2.5 forecasts (October 2018 to September 2019) and developed a bias-correction method to improve the accuracy of the PM 2.5 forecasts. The bias-correction method incorporates a cluster-analysis-based synoptic weather pattern (WP) classification (one type of analog method). In principle, the historical model errors are categorized according to the synoptic WP and used to adjust the PM 2.5 forecast. First, the synoptic WPs are determined using K-means cluster analysis (six WPs were identified). Second, the historical AQF PM 2.5 bias at each surface station is estimated for each classified WP. Third, a linear-regression relationship between the AQF PM 2.5 bias and PM 2.5 forecasts for the six WPs is developed to postprocess the PM 2.5 forecasts. The AQF PM 2.5 bias is found to have a strong dependency on the synoptic WP. A performance assessment of the AQF PM 2.5 forecasts reveals systematic PM 2.5 underprediction, with the most pronounced underprediction occurring on days associated with weak synoptic weather conditions. Under these conditions, a severe PM 2.5 event is likely to occur in Taiwan. The bias-correction method is able to reduce the PM 2.5 forecast error and improve the root mean square error (RMSE) and mean bias (MB) calculations. The improvement is most significant on days associated with a weak synoptic WP and in regions where high PM 2.5 concentrations are likely to occur. The method is shown to be effective at reducing the AQF PM 2.5 bias. Image 1 • Development of an air quality forecasting system using WRF-CMAQ model framework. • Assessment of one-year PM 2.5 forecasts indicate a consistent under-prediction. • Variation of synoptic weather pattern has a significant impact on PM 2.5 problem. • Apply a bias-correction method that accounts for the synoptic weather patterns. • The bias-correction method effectively reduces the PM 2.5 forecasting bias. [ABSTRACT FROM AUTHOR]

Studies conducted in developed nations have shown that increase in life expectancy has brought with it a rise in the incidence and treatment of degenerative aortic and mitral heart valve diseases. Current standards recommend valve replacement among even some asymptomatic patients. In this research, we examine the epidemiology of valvular heart disease and rate of valve replacement in Taiwan, where life expectancy now stands at 80.69 years. Patients were enrolled based on claims from a widely used national database and categorized into cohorts defined by type of valve disease and, further, by valve replacements and type of valve (mechanical, porcine, or bovine). Data, including disease type, age, and gender, were analyzed to determine annual and cumulative incidence rates and prosthetic usage from 2000 to 2017. Results showed that across the cohorts, the cumulative incidence rate in 2017 was 3.59%, and in the aortic valve cohort, the percentage of surgical valve replacement for those ≥60 years was 6.99%. Compared with other developed nations, this demonstrates that incidence rates are slightly higher, yet surgical replacements are less than half that of other developed nations. This under-treatment of patients with valvular heart disease presents an important public health challenge in Taiwan.

Objectives: To determine work stress, and stress-coping strategies, and to analyze their the relationships in order to improve health-promoting lifestyle of nurses in Taiwan., Methods: Three hundred eighty-five nurses who had work experience for more than 6 mo, were selected from four district hospitals in Kaohsiung and Ping Tung. We used a stratified cluster random sampling method for the selection. The nurses answered a self-report questionnaire, which was categorized into four sections: personal background data, work stress, stress-coping strategies, and health-promoting lifestyle., Results: The findings indicate work stress and the health promoting lifestyle of nurses are at a higher level, with stress-coping strategies being at a medium level. Work stress and stress-coping strategies were significantly and positively correlated. Professional relationships, managerial role, personal responsibility, and recognition of work stress and the responsibilities of a health-promoting lifestyle were negatively correlated. Managerial role, personal responsibility, and organizational atmosphere of work stress as well as realization, an item of health-promoting lifestyle, were negatively correlated. Recognition of work stress and stress management, items of health-promoting lifestyle, were negatively correlated. Health responsibility, and self-actualization, items of health-promoting lifestyle, as well as stress-coping strategies were negatively correlated. Nutrition, an item of health-promoting lifestyle, and the support stress-coping strategy was negatively correlated., Conclusions: Nurses have greater work pressure and better work stress-coping strategies, but worse health responsibility and realization of a health-promoting lifestyle. We suggest hospitals build good relationships and appropriately increase employment of nurses through a good work atmosphere to achieve nurses' realization of a health-promoting lifestyle.

The role of phonological coding for character identification was examined with the benefit of processing parafoveal characters in eye fixations while reading Chinese sentences. In Experiment 1, the orthogonal manipulation of phonological and orthographic similarity can separate two types of phonological benefits for homophonic previews, according to whether these previews share the same phonetic radical with the targets or not. The significant phonological benefits indicate that phonological coding is activated early when the character is in the parafovea. Experiment 2 manipulated the character's consistency value and found that the phonological preview benefits are reliable only when the targets are high consistency characters. The results of two experiments suggest that phonological computation is rapid and early at both character and radical levels for Chinese character identification.

Knowing how the brain processes Chinese characters of different frequencies of occurrence may shed light on the extent to which orthographic variations of different languages can influence reading processes in the brain. In the present study, event-related fMRI was used to investigate frequency effects on Chinese character processing. Reading low-frequency characters invoked higher activation in several brain regions including the left premotor/inferior frontal gyrus, supplementary motor area, left anterior insula, left posterior inferior temporal gyrus, left superior parietal cortex, and lingual cortex, while reading high-frequency characters resulted in higher activation in the left supramarginal/angular gyrus and left precuneus. The activation pattern of reading infrequently encountered characters reflects a more demanding processing procedure of retrieving, formulating, and coordinating the phonological output. Access to the lexical route may benefit the reading of high-frequency characters. By uncovering the differential brain responses in reading Chinese characters of different occurrence frequencies, not only has a substantial overlap between functional neuroanatomy of reading Chinese and alphabetical languages been demonstrated, but also features permitting the separation of language-specific content from universal mechanisms.