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Measurement of real-ear-to-coupler differentials (RECDs) is a critical part of the hearing aid (HA) verification process. This study examines the validity of reference RECD values preset by the HA analyzer, Audioscan RM500, for deaf-and-hard-of-hearing (DHH) children in Taiwan. RECD measurements were performed on 658 ears of DHH children. A linear mixed model was used to analyze the reference and measured RECD values. The findings revealed slight disparities between normative RECD values from North America and those observed in Taiwanese DHH children. While generally small (less than 5 dB), these differences imply potential challenges in achieving optimal HA fitting in specific scenarios. Therefore, we recommend individualized RECD/REM measurements for cases of poor auditory performance, certain frequency ranges, or notable variations in ear canal volume. From a clinical perspective, while broadly applicable, the use of North American RECD normative data in Taiwan requires cautious consideration of potential minor variations. This study contributes to current knowledge by affirming the use of a Western RECD database for Taiwanese DHH children. However, we underscore the ongoing importance of individualized HA fitting strategies, particularly for cases with stagnant intervention progress. While built-in RECD reference values can offer preliminary fitting guidance, especially in busy clinical settings, our study sheds light on the circumstances where caution is essential. Audiologists can efficiently allocate their time and effort by focusing on personalized RECD measurements for cases exhibiting suboptimal intervention outcomes, thereby effectively optimizing HA gain settings. [ABSTRACT FROM AUTHOR]

Background: Neuromuscular blockade agents (NMBAs) can be used to facilitate mechanical ventilation in critically ill patients. Accumulating evidence has shown that NMBAs may be associated with intensive care unit (ICU)-acquired weakness and poor outcomes. However, the long-term impact of NMBAs on mortality is still unclear. Methods: We conducted a retrospective analysis using the 2015–2019 critical care databases at Taichung Veterans General Hospital, a referral center in central Taiwan, as well as the Taiwan nationwide death registry profile. Results: A total of 5709 ventilated patients were eligible for further analysis, with 63.8% of them were male. The mean age of enrolled subjects was 67.8 ± 15.8 years, and the one-year mortality was 48.3% (2755/5709). Compared with the survivors, the non-survivors had a higher age (70.4 ± 14.9 vs 65.4 ± 16.3, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (28.0 ± 6.2 vs 24.7 ± 6.5, p < 0.001), a longer duration of ventilator use (12.6 ± 10.6 days vs 7.8 ± 8.5 days, p < 0.001), and were more likely to receive NMBAs for longer than 48 h (11.1% vs 7.8%, p < 0.001). After adjusting for age, sex, and relevant covariates, the use of NMBAs for longer than 48 h was found to be independently associated with an increased risk of mortality (adjusted HR: 1.261; 95% CI: 1.07–1.486). The analysis of effect modification revealed that this association was tended to be strong in patients with a Charlson Comorbidity Index of 3 or higher. Conclusions: Our study demonstrated that prolonged use of NMBAs was associated with an increased risk of long-term mortality in critically ill patients requiring mechanical ventilation. Further studies are needed to validate our findings. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer (OC) is prevalent cancer worldwide, with varying incidence rates in different regions. To analyze the secular trend of the incidence of OC in Taiwan, this study used data from the national cancer registry database between 1980 and 2019. The study used the age-period-cohort model and average annual percentage change (AAPC) to examine the characteristic of incidence. The study also used Spearman's correlation to determine the correlation between age-standard incidence rates (ASR) of OC and related risk factors. Results indicated that ASR of OC increased in men and women from 1980–1984 to 2015–2019. The age-period-cohort model revealed a peak incidence rate in the 1975 cohort in men, followed by a declining trend. The study found a correlation between the incidence of OC and changes in cigarette and alcohol consumption and the production of betel quid. Therefore, the study recommends avoiding these risk factors to prevent OC. Oral cancer (OC) is one of the most common cancers worldwide, and its incidence has regional differences. In this study, the cancer registry database obtained from 1980 to 2019 was used to analyze the characteristic of incidence of OC by average annual percentage change (AAPC) and an age–period–cohort model. Spearman's correlation was used to analyze the relationship between the age-standard incidence rates (ASR) of OC and related risk factors. Our results showed that the ASR of OC increased from 4.19 to 27.19 per 100,000 population with an AAPC of 5.1% (95% CI = 3.9–6.3, p value < 0.001) in men and from 1.16 to 2.8 per 100,000 population with an AAPC of 3.1% (95% CI = 2.6–3.6, p value < 0.001) in women between 1980–1984 and 2015–2019. The age–period–cohort model reported a trend of rising then declining for the rate ratio in men, with peaks occurring in the 1975 cohort, with a rate ratio of 6.80. The trend of incidence of oral cancer was related to changes in the consumption of cigarettes and alcohol and production of betel quid, with r values of 0.952, 0.979 and 0.963, respectively (all p values < 0.001). We strongly suggest avoiding these risk factors in order to prevent OC. [ABSTRACT FROM AUTHOR]

Meningiomas are the most frequently diagnosed primary intracranial tumors in adults. Surgical resection is preferred if the meningioma is accessible; for those that are not suitable for surgical resection, radiotherapy should be considered to improve local tumor control. However, recurrent meningiomas are challenging to treat, as the recurrent tumor might be located in the previously irradiated area. Boron Neutron Capture Therapy (BNCT) is a highly selective radiotherapy modality in which the cytotoxic effect focuses mainly on cells with increased uptake of boron-containing drugs. In this article, we describe four patients with recurrent meningiomas treated with BNCT in Taiwan. The mean boron-containing drug tumor-to-normal tissue uptake ratio was 4.125, and the tumor mean dose was 29.414 GyE, received via BNCT. The treatment response showed two stable diseases, one partial response, and one complete response. We also introduce and support the effectiveness and safety of BNCT as an alternative salvage treatment for recurrent meningiomas. [ABSTRACT FROM AUTHOR]

An objective approach to determine a dataset from which a correlation model of solar diffuse fraction is fitted and tested is proposed. A typical meteorological year (TMY) of global radiation data that is measured in Tainan, Taiwan over 10 years (2011–2020) is used to construct the training dataset and the remaining data (90% data base) is used as a test dataset. Two multiple-predictor and one single-predictor correlation models for the hourly diffuse fraction are developed by using more theoretically rigorous techniques for determining the breaking points for segmentation (excluding the modified Boland-Ridley-Lauret (BRL) model) and how many significant predictors required in each segmented interval for the regression model with piece-wise linear multiple-predictor correlation. The performance of each developed correlation model is superior to that of the existing same-type model using a part (one year or two years) of the same data base. The re-modeled piece-wise linear multiple-predictor correlation model has the best long-term performance of the three developed correlation models. The modified BRL model on basis of the TMY data is second. The re-modeled Liu-Jordan-type (single predictor) model allows real time prediction and has a simpler form than the other two models but prediction accuracy is inferior. [ABSTRACT FROM AUTHOR]

This paper presents a deep neural network (DNN)‐based model to recognize fishing vessels. In Taiwan, the vast majority of small fishing vessels are not equipped with an automatic identification system (AIS). As a consequence, the staff in a fishing port administration become heavily loaded when monitoring and managing the fishing vessels accessing a port. The workload is expected to be eased using this work. For the first time in the literature, a captured fishing vessel image was converted to a 128‐dimensional embedding for recognition purposes. The presented model gave a false positive rate (FPR) as low as 1.13% and an accuracy up to 99.47% at threshold = 0.772379. Finally, all the performance metrics, namely, the true positive rate (TPR), the FPR, precision and accuracy, are actually functions of the threshold which can be specified by users to meet specific requirements. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have identified common risk factors for cerebral stroke worldwide. Some of these factors include hypertension, diabetes, smoking, excessive drinking, and dyslipidemia. It is important to note, however, that genetic factors can also contribute to the occurrence of stroke. Here, we evaluated the association of ischemic stroke with rs12514417 polymorphism of the alcohol metabolizing gene, aldehyde dehydrogenase 7A1 (ALDH7A1) and alcohol consumption. Methods: Taiwan Biobank (TWB) data collected between 2008 and 2015 were available for 17,985 subjects. The odd ratios for stroke were obtained using logistic regression models. Results: Among eligible subjects (n = 17,829), 897 had ischemic stroke and 70 had hemorrhagic stroke. Subjects with ischemic stroke were older (mean ± SE, 58.45 ± 8.19 years vs. 48.33 ± 10.89 years, p < 0.0001) and had a higher body mass index (BMI) than the stroke-free individuals. The risk of ischemic stroke was significantly higher among subjects with the ALDH7A1 rs12514417 TG + GG genotype who also consumed alcohol at least 150 ml/week (odds ratio (OR), 1.79; 95% confidence interval (CI), 1.18–2.72). We found that rs12514417 genotype and alcohol consumption (at least 150 ml/week) showed a significant interaction (p for interaction = 0.0266). Stratification based on alcohol exposure and ALDH7A1 rs12514417 genotypes indicated that ischemic stroke risk was significantly higher among alcohol drinkers with the TG + GG genotype than in those with the TT genotype (OR, 1.64, 95% CI: 1.15–2.33). Conclusion: Our study suggests that the combination of ALDH7A1 rs12514417 TG + GG genotype and alcohol exposure of at least 150 ml/week may increase the risk of ischemic stroke in Taiwanese adults. [ABSTRACT FROM AUTHOR]

To investigate whether patients with chronic kidney disease (CKD) are at increased risk of uveitis. Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with CKD between 2000 and 2012. The endpoint of interest was a diagnosis of uveitis. 30,256 CKD patients and 121,024 matched comparisons were analyzed. CKD patients were found to have a significantly higher cumulative uveitis incidence. Through multivariate Cox regression analysis, the CKD group was found to have higher risk of developing uveitis (adjusted hazard ratio 1.51). After stratified by gender, age, and comorbidities (hypertension, diabetes, and hyperlipidemia), the increased risk of uveitis in CKD patients remained significant. Patients with CKD were found to have higher risk of developing uveitis. For patients over 18 years old and with hypertension, diabetes, or hyperlipidemia, the presence of CKD was demonstrated as an additional crucial factor for uveitis development. [ABSTRACT FROM AUTHOR]

The basements of large hospitals in Taiwan are usually working areas for image radiometry, radiation therapy, and nuclear medicine, where the radon concentration can be accumulated. This study investigated radon concentrations in the basement working environments of 30 hospitals in different regions with various geology of Taiwan, aiming to explore the relationship between geological conditions and radon concentrations and estimate the radiation dose received by the working staff. Portable MR107+ semiconductor radon detectors calibrated with a radon chamber were used for radon measurement at the hospital basement working areas according to the protocol of MAH-2019 instrument placement recommendations from the US EPA. The excess lung cancer risk (ELCR) as well as the lung cancer cases per million persons (LCC) were further derived from the radiation dose. The basement working areas investigated are located on the first to sixth underground floors of hospitals in Taiwan mainland and islands, Penghu and Kinmen. The 222Rn concentration higher than 100 Bq/m3 was observed at CH-1 (122.1 Bq/m3) in Changhua City and CY-1 (114.7 Bq/m3) in Chiayi City. This is attributed to that the central air conditioning systems of these hospitals were turned off during off-duty hours. The radon concentrations of all hospitals were lower than the action level, 150 Bq/m3, regulated by the US EPA. No significant relationship was found between radon concentration and the geological characteristics of the measured sites. That is, the ventilation of the basement working areas in hospitals is more important than local geological characteristics on indoor radon concentration, and therefore proper ventilation is crucial for reducing radon gas concentration in the hospital basements. Estimated annual effective dose from 222Rn for the hospital staff was higher than 1 mSv/y at YL (1.24 mSv/y), CH-1 (1.64 mSv/y), CY-1 (1.54 mSv/y), CY-2 (1.34 mSv/y), and PH-2 (1.14 mSv/y), and that for the rest sites was <1 mSv/y. The maximum mean ELCR was found to be 0.63% at CH-1, and the related LCC was estimated to be 29.5 per million persons. • Higher radon levels were observed in hospital basements after the air conditioning systems were turned off. • Proper ventilation is crucial for reducing radon concentration. • No apparent effect of geological characteristics, temperature and humidity was observed on radon concentration. • Radon levels in all hospital basements were lower than the action level of US EPA. [ABSTRACT FROM AUTHOR]

Background: Thoracic empyema is a disease with high mortality and morbidity. Video-assisted thoracoscopic surgery (VATS) is recommended to treat advanced stage empyema. The purpose of this study was to explore risk factors associated with post-surgery mortality for community-acquired empyema. Patients and Methods: We retrospectively reviewed 440 patients who received VATS for community-acquired empyema, higher than stage 2, in a tertiary medical center in Taiwan. Patients' age, comorbidities, pleural effusion analysis, and post-surgery outcome were compiled. Cox regression model for survival was applied to identify risk factors of 90-day death after surgery. Results: Fifty-three patients (12.05%) had died within 90 days post-surgery. The risk factors of mortality were advanced age (hazard ratio [HR], 1.027; 95% confidence interval [CI], 1.001-1.052), chronic kidney disease (HR, 5.322; 95% CI, 2.635-10.746), cancer (HR, 6.038; 95% CI, 2.737-13.321), pleural effusion pH ≤7 (HR, 2.61; 95% CI, 1.344-5.069), pleural effusion protein ≤4 (HR, 2.021; 95% CI, 1.035-3.947), and late surgery (HR, 3.014; 95% CI, 1.595-5.696). The 90-day mortality in the early surgery group versus the late group was 6.85% versus 26.05%. The increased mortality risk from late surgery was observed in most subgroups, except for patients who were female, had chronic renal disease, and had coronary artery disease. Conclusions: Patients who are elderly, have chronic kidney disease, cancer history, low pleural effusion pH, low pleural effusion protein, and late surgery are associated with post-surgery mortality for community-acquired advanced empyema. Early VATS surgery for advanced empyema or treatment failure of chest tube drainage appears to beneficial and is recommended. [ABSTRACT FROM AUTHOR]

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04–1.77), high-stable (aOR = 2.01; CI: 1.28–3.15), or increasing (aOR = 1.97; CI: 1.26–3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk and time trends of heart failure (HF) leading to hospitalization in individuals newly diagnosed as having polymyositis/dermatomyositis (PM/DM) relative to non‐PM/DM controls at the general population level. Methods: A retrospective cohort study was conducted using data from a nationwide insurance database in Taiwan. Patients with incident PM/DM and without a history of HF were selected between 2000 and 2013. Unmatched and propensity score–matched cohorts were established separately. A multivariable Cox proportional hazards regression model was used to estimate the adjusted hazard ratio (HR) for the risk of HF in the unmatched cohort. In the propensity score–matched cohort, general population controls were selected and matched at a 1:1 ratio to the patients with PM/DM based on propensity scores, which accounted for the confounding factors of age, sex, index date (year) of first diagnosis, comorbidities, and medication usage. The cumulative incidence of HF was estimated using the Kaplan‐Meier method. A stratified Cox proportional hazards model was used to calculate the HR for the risk of HF events at different follow‐up time points among patients with PM/DM compared with non‐PM/DM controls in the propensity score–matched cohort. Results: In the unmatched cohort, the study assessed 2,025 patients with PM/DM and 196,109 general population controls. Results of multivariable Cox regression analysis, adjusted for age, sex, comorbidities, and medication usage, revealed a greater risk of HF leading to hospitalization in the PM/DM group than in the control group (adjusted HR 3.29, 95% confidence interval [95% CI] 2.60–4.18). After matching based on propensity score, a total of 1,997 pairs of PM/DM patients and general population controls were identified. In this propensity score–matched cohort, the cumulative incidence of HF in patients with PM/DM at 3 years, 5 years, and 10 years was 3.3%, 4.4%, and 7.4%, respectively. The absolute difference in HF risk in the PM/DM group compared with the control group was 1.8% at 3 years, 2.1% at 5 years, and 3.0% at 10 years. Compared with general population controls, patients with PM/DM exhibited an augmented risk of HF (HR 2.06, 95% CI 1.36–3.12). Analyses stratified according to follow‐up time point revealed that the increased risk of HF persisted for up to 10 years after the PM/DM diagnosis. Conclusion: These results indicate that the risk of HF leading to hospitalization was increased in patients with PM/DM throughout the study period, supporting the need for greater vigilance in the monitoring of patients with PM/DM for the development of this potentially lethal complication. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether patients with thyroid disease are at increased risk of uveitis.Methods: Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with thyroid disease from 2000 to 2012. The endpoint of interest was a diagnosis of uveitis.Results: In analyzing 21,396 patients with thyroid disease, yielding 85,584 matched comparisons, patients with thyroid disease to have a significantly higher cumulative incidence of uveitis when compared to the control cohort with the Kaplan-Meier analysis. This result was further confirmed by Cox regression analysis. The increased risk was persistent in both genders. The association between thyroid disease and uveitis was stronger in patients without diabetes or hypertension.Conclusion: Patients with thyroid disease were found to have a higher risk for uveitis. For certain age groups or patients without diabetes or hypertension, the role of thyroid disease might be more crucial for uveitis development. [ABSTRACT FROM AUTHOR]

In 2014 and 2015, Southern Taiwan experienced two unprecedented outbreaks, with more than 10,000 laboratory-confirmed dengue cases in each outbreak. The present study was aimed to investigate the influence of meteorological and spatial factors on dengue outbreaks in Southern Taiwan and was conducted in Kaohsiung City, which is the most affected area in Taiwan. The distributed lag nonlinear model was used to investigate the role of climatic factors in the 2014 and 2015 dengue outbreaks. Spatial statistics in the Geographic Information System was applied to study the relationship between the dengue spreading pattern and locations of traditional markets (human motility) in the 2015 dengue outbreak. Meteorological analysis results suggested that the relative risk of dengue fever increased when the weekly average temperature was more than 15°C at lagged weeks 5 to 18. Elevated relative risk of dengue was observed when the weekly average rainfall was more than 150 mm at lagged weeks 12 to 20. The spatial analysis revealed that approximately 83% of dengue cases were located in the 1000 m buffer zone of traditional market, with statistical significance. These findings support the influence of climatic factors and human motility on dengue outbreaks. Furthermore, the study analysis may help authorities to identify hotspots and decide the timing for implementation of dengue control programs. [ABSTRACT FROM AUTHOR]

Mosquitoes such as the disease-vectoring genus Aedes lay their eggs in containers of stagnant water. Some species prefer plant containers, or phytotelmata. We tested the hypothesis that bacteria inside these containers, which are known from experiments to affect mosquito oviposition choices, correlate with insect presence or absence in the field. We sampled natural containers from two localities in northern Taiwan: the Fushan Botanical Garden (Yilan County) and the Cherry Blossom Lane of Pingjing Street (Taipei City), the latter thrice over two years. In addition to identifying mosquito larvae, we performed culturing-enriched molecular profiling of the total bacterial communities in the container waters and the larva themselves. Phytotelmata mosquito diversity and microbial diversity were low (less than five species of either) and differed over time. In this study, the presence of mosquitoes, including medically significant genera, did not seem to correlate with bacterial communities or plant species. Both mosquito and microbe communities in these containers vary too greatly with time and on a microgeographic scale to identify specific microbe-insect interactions using metabarcoding. Research should focus on single-species experiments with cultured microbes, or long-term field studies covering all seasons. [ABSTRACT FROM AUTHOR]

Purpose: In the face of a changing and turbulent environment, an organizational learning culture (OLC) is crucial for the long-term operation of an organization. A learning culture provides the capacity to effectively integrate employees, and it also provides structure so that an organization can move forward via continuous learning and change. Few empirical results are available from Chinese companies enduring an organizational change. To bridge this research gap, this study investigated the relationships among an OLC, job satisfaction, turnover intentions and job performance during organizational change. Design/methodology/approach: A quantitative approach with structural equation modeling (SEM) and bootstrapping estimation was used to test hypotheses developed from a sample of 434 employees in a restructured telecommunications company in Taiwan. Findings: Employees who experienced a higher learning culture had lower levels of turnover intentions and exhibited better job performance. Job satisfaction had a negative impact on employee turnover intentions but a positive impact on job performance. Moreover, job satisfaction fully mediated the relationships between an OLC and employee turnover intentions and job performance. When encountering organizational planned changes, a vibrant learning culture gave employees a higher level of satisfaction in their jobs and workplace. Although unexpected challenges often appeared during the organizational changes, employees with a higher level of job satisfaction tended to fulfill their own job duties and showed fewer turnover intentions. Originality/value: In investigating issues related to organizational change, this study provides managerial insights and addresses strategies for facilitating the adoption of an OLC into the design and implementation of a better workplace environment. [ABSTRACT FROM AUTHOR]

• The consumption of alcohol for hand hygiene and personal prevention resources has increased during the COVID-19 outbreak. • The increased consumption of personal prevention resources did not affect the overall nosocomial infection incidence density in our hospital. • Incidence density of certain multidrug resistant organism significantly decreased during the COVID-19 pandemic with strict personal hygiene. During the coronavirus disease 2019 (COVID-19) pandemic, strict infection control measures have been implemented in healthcare settings and hospitals, including respiratory and hand hygiene. This study investigated the impact of these control measures on the incidence rates of hospital-acquired infections (HAI) and multidrug-resistant organisms (MDRO) in a Taiwan medical center. This study compared the consumption of personal prevention resources and the incidence density of HAI and MDRO in a medical center in Taiwan from January to May 2020, encapsulating the COVID-19 outbreak period in the study, to baseline data from the same timeframe in 2018 and 2019. There was no significant difference between the number of inpatient days in 2020, 2018 and 2019. The consumption of either alcohol for hand hygiene or surgical masks significantly increased in 2020. However, the overall HAI incidence density did not significantly differ from the rate at the baseline period. It was found that the incidence density of MDRO was significantly lower in 2020, especially in carbapenem-resistant Acinetobacter baumannii and vancomycin-resistant Enterococcus. A collateral benefit of the COVID-19 prevention measures on the incidence density of MDRO was observed in a hospital in Taiwan where the incidence of COVID-19 was low. [ABSTRACT FROM AUTHOR]

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) ensures favorable outcomes and reduces the risk of cardiac events in patients on dialysis. However, the effect of PPSV23 vaccination on renal function remains unknown, particularly in patients with chronic kidney disease (CKD). Therefore, we investigated the association between PPSV23 efficacy and renal progression in older patients (age ≥ 75 years) with CKD. This multicenter, longitudinal cohort study was conducted using data (2008–2016) from the Epidemiology and Risk Factors Surveillance of CKD database. This database was associated with Taiwan's National Health Insurance Research Database (for period: 2008–2019). A total of 1195 older patients with CKD were recruited from 14 hospitals and communities across Taiwan. Renal progression was defined as a > 25% reduction in estimated glomerular filtration rate from the baseline value. A significant reduction in the risk of renal progression was observed in patients who had received PPSV23 (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.35–0.91). However, when stratified by CKD stage, this significant reduction was observed in patients with early-stage CKD but not in those with late-stage CKD. Furthermore, a significant reduction in the risk of renal progression was noted in male patients and those with hypertension. Our findings support the protective effect of PPSV23 against renal deterioration in older patients with CKD. • This study shows that PPSV23 can mitigate renal deterioration in older CKD patients. • PPSV23 could reduce the risk of renal progression, particularly in early-stage CKD. • PPSV23 benefits in reducing renal progression are observed in men but not in women. • PPSV23 markedly reduces renal decline in patients with both CKD and hypertension. [ABSTRACT FROM AUTHOR]

The presence of microplastics (MPs) in the environment has generated global concerns. However, the explicit assessment of the effect of multiple anthropogenic activities on the existence of MPs in the freshwater system is scarcely reported. This study quantified anthropogenic activities and analyzed their relationship with MPs on a freshwater organism: the midge larvae (Diptera: Chironomidae). The study took place in an urban river and consisted of comparing the abundance and types of MPs. Our results highlight that, while industrial area was the most important variable contributing to the total MP concentration in midge larvae, residential area also influenced the concentration of microfibers in midge larvae. The impact of a residential area on the relative abundance of microfibers in each sample site was diluted by the proximity to an industrial area. In conclusion, we suggest that industrial areas are a potential source of MP pollution in river sediment, and midge larvae can be a good indicator of the MP concentrations in urban river systems. Quantifying anthropogenic activities can help discern their effects on MP concentration in a river system and promote management strategies. [ABSTRACT FROM AUTHOR]

Medication distribution service can be delivered based on a combination of home delivery and customer pickup. That is, medications are delivered either to customers' homes directly or to the pickup facilities (e.g. lockers) close to customers' homes. In Taiwan, there are more than 11,000 convenience stores that provide a 24-h service for customers to pick up the ordered items from e-commerce, which is unique to the world. In the medication distribution system, convenience stores can provide a unique opportunity for customers to more conveniently collect medications at stores, and also can reduce the operating cost for a logistics company providing the medication delivery service. Therefore, this work proposes a medication distribution system through convenience stores, lockers, and home delivery. Under this system, this work investigates how to simultaneously determine employment of convenience store chains, the convenience store locations to be visited, locations of lockers, vehicle routes for convenience stores and lockers, and vehicle routes for customers' homes, so that the total operating cost is minimized. This work further proposes a genetic algorithm to solve the medication distribution problem. Through simulation, the experimental results show that the proposed algorithm is able to solve the problem efficiently. [ABSTRACT FROM AUTHOR]

Cinnamomum osmophloeum ct. linalool is one chemotype of indigenous cinnamon in Taiwan. Its leaf essential oil (LEO) and main component S-(+)-linalool both possess great anxiolytic activities. The aim of this study was to establish ultrasound-assisted microextraction (UAME) for extracting LEO from C. osmophloeum ct. linalool. The absolute content of S-(+)-linalool and chemical composition of LEO were analyzed using GC-MS and GC-FID. To obtain the optimal conditions for UAME, four parameters (ultrasonic extraction duration, power of ultrasound, times of extraction, and leaf weight of extraction) were investigated according to the S-(+)-linalool content extracted. Results showed that the optimal condition was 10 mg of leaf extracted using n-hexane in an ultrasonicator with ultrasonic power of 80 W for 1 min. Furthermore, the absolute content of S-(+)-linalool obtained by UAME (28.3 ± 0.5 mg/g leaf) was comparable with that extracted by the 30-min hydrodistillation (HD) (26.9 ± 2.7 mg/g leaf). UAME was then employed to extract S-(+)-linalool from leaves at different stages of maturity (young, semi-mature, and mature). Results indicated that only mature leaf contains large amounts of S-(+)-linalool. Of note is that the LEO extracted by UAME contains coumarin, while that extracted by HD does not. Coumarin is an important ingredient in a number of cosmetic products due to its odor-fixing properties. With UAME, the leaf of C. osmophloeum ct. linalool has potential to be used as an aromatic material for further applications. In conclusion, UAME established in the present study provides a simple and rapid method for the determination of S-(+)-linalool and chemical composition of LEO from C. osmophloeum ct. linalool. [ABSTRACT FROM AUTHOR]

This study proposes the use of cradle-to-cradle production programming for waste furniture and aims to achieve optimal efficiency by reusing waste furniture and maximizing the corresponding benefits so that the furniture industry is in line with cradle-to-cradle manufacturing. This study is increasingly important to manage products through a comprehensive green reverse logistics system that consists of three procedures, i.e., recycling, reuse, and remanufacturing of waste items. This study proposes a mathematical formula to establish a cradle-to-cradle production programming model for waste furniture. The fuzzy set theory is used to define the attributes that reflect production and market demands such as degree of damage, technical feasibility, market demands, environmental protection laws and regulations, and environmental performance. In addition, particle swarm optimization is adopted to ascertain the optimal profit from waste furniture sales. Through situational simulations and analyses, the fuzzy set information from Taiwan, Germany, and China is compared. The result reveals that the qualitative information proposed has a significant impact on the profit of waste furniture reuse. The production model can effectively assist in the production programming of waste furniture, thereby optimizing profit for cradle-to-cradle production planning. [ABSTRACT FROM AUTHOR]

Indigenous cinnamon (Cinnamomum osmophloeum) is an endemic tree in Taiwan. The leaf essential oil is rich in trans-cinnamaldehyde, and its excellent antifungal activity has been reported. Since trans-cinnamaldehyde is a volatile compound, it is here evaluated for whether it is more effective via fumigant action. This study illustrates the antifungal action of trans-cinnamaldehyde against wood-decay fungi. Two ways that trans-cinnamaldehyde inhibits the growth of fungi, namely direct contact and fumigation, were examined using the agar dilution method (AD) and the inverted paper disc method (IPD). In addition, the amount of trans-cinnamaldehyde vapor in the headspace of the Petri dish was quantified using solid-phase microextraction and GC–MS. Antifungal results showed that the antifungal indices observed in the IPD method were clearly higher than those in the AD method, indicating that trans-cinnamaldehyde vapor had stronger antifungal activity. Results from the quantitative analysis also revealed that the amounts of trans-cinnamaldehyde vapor measured by the IPD method were significantly greater than those by the AD method. Accordingly, with higher amount of trans-cinnamaldehyde evaporated, stronger antifungal activity was observed. It is clear that the antifungal action of trans-cinnamaldehyde was primarily attributed to fumigation instead of direct contact. [ABSTRACT FROM AUTHOR]

The host–parasitoid relationship and species identity of aquatic parasitoids of two damselflies Coeliccia cyanomelas (Platycnemididae) and Psolodesmus mandarinus dorothea (Calopterygidae) from Fushan and Lienhuachih in Taiwan were studied using morphological characters and DNA barcoding sequences. The parasitoids reared from the damselflies' eggs, and the field-collected parasitoids, were morphologically identified as Hydrophylita emporos (Trichogrammatidae), a recently described parasitoid of the damselfly P. m. mandarinus from Northern Taiwan. The CO1 (cytochrome c oxidase I) gene tree supported the identification as H. emporos, as well as all parasitoid samples from C. cyanomelas, P. m. dorothea and P. m. mandarinus. The sampled H. emporos populations did not differ genetically despite their different host associations. However, some genetic differences were found between H. emporos populations from Northern and Central Taiwan, indicating that the dispersal of H. emporos may be limited by geographical distances. Our results suggest that H. emporos can parasitise not only closely related sister subspecies, P. m. mandarinus and P. m. dorothea, but also phylogenetically distant species of another damselfly family, C. cyanomelas. This is the first record of multiple damselfly hosts for the aquatic parasitoid genus Hydrophylita. This finding implies that the host range of H. emporos and congeneric species may be broader than previously thought. [ABSTRACT FROM AUTHOR]

Chamaecyparis formosensis (Cupressaceae) is among the most precious endemic conifers in Taiwan. Field study was conducted on seasonal variations in emission rates and compositions of terpenoids from this tree species of two different ages. A total of 21 terpenoids were detected, of which there were 13 monoterpenoids (MTs), 4 sesquiterpenoids (STs), and 4 diterpenoids (DTs). MTs dominated the emissions in both saplings and adult trees and produced more than 80% of terpene emissions. Contrasting seasonal pattern between saplings and adult trees was found. Total actual emissions from saplings were higher in cold seasons (range, 64.40 ± 13.18 to 140.74 ± 18.90 ng g−1 h−1) than in warm seasons (range, 55.63 ± 15.84 to 63.48 ± 11.85 ng g−1 h−1). Photosynthetically active radiation (PAR) was found to be the most important factor affecting terpene emissions from saplings. On the contrary, higher emissions were found in warm seasons for adult trees (range, 101.49 ± 12.29 to 181.35 ± 80.15 ng g−1 h−1), and the emissions were mainly in response to temperature. Some compounds in C. formosensis of both ages (e.g., β-myrcene, α-terpinene, trans -β-ocimene, terpinen-4-ol, α-cedrene and trans -β-farnesene) showed comparably higher contents in cold seasons. Results presented here provide important fundamental information for better understanding of forest bathing and estimating air quality in Taiwan. Image 1 • BVOCs emitted from Chamaecyparis formosensis were measured over seasons in situ. • An opposite emission pattern was found between saplings and adult trees. • Monoterpenoids with less volatility showed variations in different seasons. • PAR and temperature play critical roles in BVOC emission of this tree species. [ABSTRACT FROM AUTHOR]

Guided by the general incentives rational action model and deliberative participatory democracy framework, we investigated whether deliberative beliefs, including normative and personal aspects, mediate the relationship between distributive, procedural, and interactive organizational justice and intention to participate in professional associations. Self-report measures of organizational justice, deliberative belief, and intention of participation were obtained from 789 early childhood educators in Taiwan. Structural equation modeling was used to analyze the proposed model. According to the results of the study, there is a relationship between organizational justice and intention of professional association participation, and a fully significant mediation effect was found for deliberative beliefs between organizational justice and intention to participate. These findings are discussed with respect to improving professional association participation and applying deliberative pedagogy. [ABSTRACT FROM AUTHOR]

Purpose. To report the epidemiological and clinical data as well as surgical outcomes of canalicular lacerations with Mini-Monoka insertion at a tertiary center in Taiwan and to discuss differences in traumatic pattern, pathogenesis, and surgical outcomes between Taiwan and other countries. Methods. From 2009 to 2018, all 48 patients who underwent canalicular laceration repair with Mini-Monoka stent at a tertiary center in Taiwan were retrospectively analyzed. Demographic and clinical data and surgical outcomes were recorded. Results. The mean age of the 48 patients was 38 years. Single lower canaliculus was involved in 37 (77.1%) patients, upper canaliculus in 10 (20.8%) patients, and both in 1 (2.1%) patient. The most common etiology was motorcycle accident (41.7%), and all traffic accident injuries accounted for 68.75% of cases. Subgroup classification revealed 64.6% of patients (n=31) were categorized in the deep laceration group, and lower anatomical and functional outcomes were noted in deep laceration. The mean follow-up time was 14.5 months. Overall, the anatomical success rate was 87.5%, and the functional success rate was 91.7% after stent removal. Conclusion. Canalicular laceration caused by traffic accidents occurred with a relatively high frequency in Taiwan. Affected patients tended to be middle-aged, and deep laceration accounted for 64.6% of patients. These were contributed by the avulsive eyelid injury mechanism caused by traffic accidents. Furthermore, the deeper lacerated site was located, and the lower anatomical and functional success rates were observed. Early repair after trauma with Mini-Monoka stents achieved good eyelid position (100%) as well as good anatomical (87.5%) and functional (91.7%) success without serious complication. [ABSTRACT FROM AUTHOR]

Objective: Previous case–control studies have suggested that women with migraine have lower risk of developing breast cancer, but conflicting results were noted in cohort studies. We investigated the association between migraine and breast cancer incidence in a nationwide population-based cohort study. Methods: We identified 25,606 women with migraine between 2000 and 2013 from the National Health Insurance Research Database in Taiwan. Each migraineur was randomly frequency matched with four women without migraine by age and index year of migraine diagnosis. Cox's proportional hazard regression analysis was performed to estimate the association between migraine on the risk of developing breast cancer. Results: With a mean follow-up of 7.3 years, 234 and 978 breast malignancies occurred in the migraine cohort and matched cohort, respectively. Migraine was not associated with the risk of breast cancer (adjusted hazard ratio = 1.03, 95% confidence interval = 0.89–1.21). Among women with migraine, independent risk factors for breast cancer included older age, alcohol-related illness, and receipt of a greater number of breast cancer screening examinations, and independent protective factors included the use of antihypertensive agents, statins, and nonsteroidal anti-inflammatory drugs. Further analyses indicated that women with ≥4 medical visits for migraine per year had a significantly greater risk of breast cancer than the matched cohort. Conclusions: Migraine was not associated with a decreased risk of developing breast cancer among Taiwanese women. Further prospective studies on other geographic populations or on the association between migraine frequency and the risk of developing breast cancer are warranted to validate our findings. [ABSTRACT FROM AUTHOR]

There is a growing demand for using non-destructive geophysical techniques to internally image dam condition and facilitate the early detection of anomalous phenomena. Near surface geophysical techniques have advanced significantly in the last few decades, and can play a significant role in the siting, construction, and operational safety and sustainable management of dams. Application of engineering geophysics in site characterization during feasibility investigation phase is already part of the standard of practice. This paper introduces newer applications of engineering geophysics during construction phase, dam safety assessment, and sustainable management, including quality control of compacted soils, investigation of abnormal leakage in an earth dam, evaluation of an aged concrete dam, geophysical health monitoring for a newly-constructed dam, and monitoring of sediment transport for sediment management. The applications were presented with more emphases on the needs of dam engineering and adapting appropriate geophysical methods to make assessment more effective and consequential. The collage of these case studies is to broaden the view of how geophysical methods can be applied to a dam project throughout a dam's life cycle and strengthen the linkage between geophysical surveillance and engineering significance at all stages. [ABSTRACT FROM AUTHOR]

Abstract: Citrus tristeza virus (CTV), the causal agent of tristeza disease, causes the devastating diseases worldwide. In Taiwan, complex cultivars and long‐term infection by CTV result in more than 90% of infected citrus trees, but local strain identification and classification are still incomplete. Here, six CTV strains were categorized by grafting onto eight citrus cultivars and the pathological characteristics of the stem‐pitting mild strains were identified. After 6 months of inoculation, the pummelo stem‐pitting severe strain (CTV‐Pum/SP/T1) only caused severe symptoms in Wentan pummelo (WP) and the mild strain (CTV‐Pum/M/T5) was symptomless in every cultivar; the sweet orange (SO) stem‐pitting severe strain (CTV‐SwO/SP/T7) affected SO, WP and Ponkan mandarin (PM), and the mild strain (CTV‐SwO/M/T51) caused no symptoms in SO except for WP; the mandarin stem‐pitting severe strain (CTV‐Man/SP/T46) caused severe impacts in PM, WP and Eureka lemon, whereas the mild strain (CTV‐Man/M/T2) only caused severe stem‐pitting in WP. The full‐length sequencing of both pummelo stem‐pitting strains and phylogenetic analysis revealed that CTV‐Pum/SP/T1 and CTV‐Pum/M/T5 were related to the HA18‐9 and HA16‐5 strains from Hawaii, respectively. Moreover, recombination analysis revealed that TCT repeat sequences existed at open reading frame 1a in both the CTV‐Pum/SP/T1 and the T36 strains from the United States, indicating that the possible evolution relationship between two regions. Furthermore, improved universal and specific primer pairs were designed for more specific, sensitive detection to meet the needs for quarantine and early prevention. The understanding of strain pathogenicity and genomic analysis provided further characterization of each strain and enabled practical challenge inoculation against CTV disease. [ABSTRACT FROM AUTHOR]

Background: Decisions about end-of-life care often raise clinical and ethical challenges, especially when the person's capacity to contribute in the decision making at the end of life is limited. Aim: This study aimed to explore Taiwanese adults' preferences associated with communication, healthcare planning, life-sustaining treatments and palliative care and experiences of end-of-life care. Methods: Semi-structured interviews were conducted with 16 adults aged 20 years and above. The sampling approach was a convenience strategy in a community centre located in a metropolitan area in the Southern region of Taiwan. A qualitative content analysis approach was used to elicit key themes from the data. Results: Significant findings related to the two main themes of adults' experiences, including the observed distress of those who were dying and the distress experienced by the family. Other key findings pertain to personal preferences for end-of-life care, such as preferred end-of-life communication, preparing for the end-of-life and maintenance of quality of life. Conclusions: This exploratory study offers insight into 16 Taiwanese community-dwelling adults' views of preferences regarding end-of-life communication, preparation for the end of life and maintenance of quality of life, as well as their experiences of end-of-life care. A further exploration is suggested to elicit how personal end-of-life experiences shape individuals' health practices in advance care planning for end-of-life care. [ABSTRACT FROM AUTHOR]

Qigong is a gentle exercise that promotes health and well-being. This study evaluated the acute physiological and psychological effects of one session of qigong exercise in older practitioners. A total of 45 participants (mean age, 65.14 years) were recruited. Meridian electrical conductance, State-Trait Anxiety Inventory (STAI), heart rate variability (HRV), and Short Form 36 (SF-36) were evaluated and compared before and after one session of qigong exercise. The results revealed that the electrical conductance of all meridians, except spleen and bladder meridians, increased significantly (p<0.05). Compared with baseline values, upper to lower body ratio and sympathetic/vagal index were significantly improved and closer to 1 (p=0.011 and p=0.007, resp.). STAI-S and STAI-T scores decreased significantly (p<0.001 and p=0.001, resp.). The RR interval of HRV decreased significantly (p=0.035), a significant positive correlation was observed between kidney meridian electrical conductance and SF-36 physical scores (r=0.74, p=0.018), and a positive correlation was observed between pericardium meridian electrical conductance and SF-36 mental scores (r=0.50, p=0.06). In conclusion, one session of qigong exercise increased meridian electrical conductance, reduced anxiety, and improved body and autonomic nervous system balance. These findings provide scientific evidence for acute physiological and psychological effects of qigong exercise in older practitioners. [ABSTRACT FROM AUTHOR]

During December 2003 and March 2004, large scale epidemics of low-pathogenic avian influenza (LPAI) H5N2 occurred in poultry farms in central and southern Taiwan. Based on genomic analysis, these H5N2 viruses contain HA and NA genes of American-lineage H5N2 viruses and six internal genes from avian influenza A/H6N1 viruses endemic in poultry in Taiwan. After disappearing for several years, these novel influenza H5N2 viruses caused outbreaks in poultry farms again in 2008, 2010 and 2012, and have evolved into high pathogenic AI (HPAI) since 2010. Moreover, asymptomatic infections of influenza H5N2 were detected serologically in poultry workers in 2012. Therefore, we evaluated antigenicity and pathogenicity of the novel H5N2 viruses in ferrets. We found that no significant antigenic difference was detected among the novel H5N2 viruses isolated from 2003 to 2014 and the novel H5N2 viruses could cause mild infections in ferrets. Monitoring zoonotic transmission of the novel H5N2 viruses is necessary. [ABSTRACT FROM AUTHOR]

Microplastic pollution is an urgent threat to the biota of aquatic ecosystems and is generally recognized as a global issue. Identifying the sources of microplastics is acknowledged as the most effective approach for mitigating microplastic pollution. However, the factors that regulate the spatiotemporal dynamics of microplastics in urban river networks, such as microplastic sources and other variables, have not been studied together at the watershed scale, let alone regarding their impact on internal microplastics. Here, we define "internal microplastics" as microplastics in biota, either in the digestive system or internal organs of organisms. We estimated the effects of anthropogenic activities (land cover and wastewater treatment plants) and seasonality on the concentration of internal microplastics in midge larvae (Diptera: Chironomidae) in an urban river system at a watershed scale in Taiwan. Agricultural activities, but not industrial activities, had a significant negative nonlinear effect on microplastic concentration. However, seasonality was the most crucial factor, as the microplastic concentration was significantly lower during the wet season. Although the presence of a wastewater treatment plant significantly increased the microplastic concentration at downstream sampling sites, its effect appeared to be minor. We conclude that seasonality overrides the effects of anthropogenic activities on the variation in the concentration of internal microplastics in midge larvae in an urban river system. [Display omitted] • Seasonality is the most crucial factor influencing internal microplastics (IMs). • Intensive agricultural activities decrease IM concentrations. • Wastewater treatment plants increase IM concentrations downstream. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the experiences and concerns of patients in the emergency department during inpatient boarding. Background Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. Design The qualitative approach of phenomenography was used in the study. Methods The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July-September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study - familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting - were employed to develop an understanding of participants' experiences and concerns during their inpatient boarding in the emergency department. Results The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. Conclusion The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. Relevance to clinical practice Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a care model and associated intervention measures for emergency department patients during the boarding process. The results of this study will help health regulatory authorities to develop an appropriate emergency department boarding system so that patients receive better emergency care. [ABSTRACT FROM AUTHOR]

• We examined the relationship between SNS users' switching intention and behavior. • The qualitative and quantitative analyses were used to analyze. • Functional, emotional, and social values positively affected switching intentions. • Switching intentions positively affected switching behaviors. • Habits negatively moderated switching intentions on switching behaviors. The increasing integration of computers and networks into society has profoundly affected our lives in recent years. In Taiwan, use of SNSs – especially Facebook – has become the main action for the Internet users; accordingly, a number of scholars have explored people's intention to use, or actual use of, SNSs. However, few studies have investigated how and why users stop using one SNS and begin using another from the linear perspective. The findings are incomplete for the human behaviors which are complex and nonlinear systems. The purpose of this study is therefore to explore the relationship between SNS users' switching intention and switching behavior based on structural equation modeling (SEM) and cusp catastrophe model (CCM). The key factors for the switching intentions and behaviors of SNS users were examined through empirical research, and a structural model was established. The model, which involved habits as a mediating factor, was used to conduct a qualitative and quantitative analysis on the switching behaviors of SNS users from a nonlinear perspective. This model will provide a new method for future researchers to analyze nonlinear behaviors as well as a dynamic decision support model for service providers to improve their business operation. [ABSTRACT FROM AUTHOR]

• With the advance of handheld devices, a number of application service provider provided desktop and mobile versions, and users may use either or both of them. Mobile instant messaging application is representative one. • One of major focuses of this study is to investigate the platform selection behavior of instant messaging users and discover the influence factors. • Our findings shown that consumer values have significant effects on users' continuance usage intention and recommendation intention in single- platform use case. However, perceived interactivity and perceived playfulness did not have significant effects in multi-platform use case. • The main contribution of the study is the differences between single- and multi- platform use cases and providing guidance for cross-platform application developers. The purpose of this study is to investigate the factors that influence the usage intention for different instant messaging application platforms. This study targeted the widespread instant messaging software LINE, for which a survey of 485 valid respondents was conducted in Taiwan. Statistical and model structure analyses were applied to validate the hypotheses proposed in this study. We examined the differences between single- and multi-platform use cases in terms of the relationship between consumer value and behavioral intention. The results show that perceived interactivity, perceived playfulness, and perceived usefulness have significant effects on the continued usage and recommendation intentions of users in a single-platform use case. However, perceived interactivity and perceived playfulness did not have significant effects in multi-platform use cases. The findings of this study provide a new perspective for investigating the intention to continue using a multiplatform application. The results will benefit subsequent studies in this area and provide guidance for the development of instant messaging and other social media applications. [ABSTRACT FROM AUTHOR]

Background: Second-generation antipsychotics (SGA) augmentation treatment has showed better efficacy in patients with major depressive disorder (MDD). However, the association between SGA and diabetes mellitus (DM) in MDD patients deserves further investigation. The study aimed to examine the risk of new onset type II DM in MDD patients receiving SGA treatment.Methods: From the Psychiatric Inpatient Medical Claim Dataset, MDD patients treated with SGA continuously for more than 8 weeks were analyzed in a 1:1 propensity score matched pair sample to 1,049 patients that had never been treated with SGA. Patients were followed up to 5 years based on ICD-9 CM codes indicating incident type II DM. Cumulative incidences of type II DM were calculated and the Cox proportional hazards model with competing risk was applied to determine the risk factors for type II DM onset.Results: Cumulative incidences of new-onset type II DM between the two groups were similar. Use of SGA showed no significant increase in risk for new-onset type II DM (hazard ratio [HR] = 0.898; 95% confidence interval [CI], 0.605-1.334; P-value = 0.596). Increased risk for type II DM was shown to be associated with aging (per year) (HR = 1.039; 95% CI, 1.026-1.053; P-value < 0.001) and history of hyperlipidemia (HR = 2.323; 95% CI, 1.469-3.675; P-value < 0.001).Conclusions: This study indicated that there is no significant difference in the risk of developing type II DM between MDD patients with and without SGA exposure. More studies focused on the benefit-risk assessment of SGA treatment in patients with MDD are warranted. [ABSTRACT FROM AUTHOR]

In the backdrop of a spatial effect, this paper reconsiders the importance of life cycle in explaining the evolution of regional household income inequality in Taiwan. For the empirical period examined (1998-2006), a fixed effect panel data analysis reveals a high level of spatial clustering across 22 regions of Taiwan. When we control for spatial dependence we observe a positive relation between aging and income inequality. This regional inequality is explained by a decline in the multigenerational families followed by a rise in the elderly households with no additional income. Further, the level of inequality in income distribution of own province is positively and significantly determined by inequality in the neighboring province. To investigate further the process of regional development in Taiwan, we analyze the convergence-divergence dynamics employing spatial econometric methods. We observe both absolute and conditional beta divergence. The result points to the famous catching up or falling behind phenomenon. Failure to account for such spatial effect may cause biased results and incorrect policy implications. [ABSTRACT FROM AUTHOR]

The crypto and digital assets ecosystems have attracted investment, regulators, and speculators to their environment. As the blockchain-based framework can reduce transaction costs, generate distributed trust, and enable decentralized platforms, it has become a potential new base for decentralized business models. Previous studies have highlighted the advantages and drawbacks of each platform, such as interest rates, cost concerns, transparency issues, hacking issues, and hazards. Consequently, it is challenging for investors to evaluate the cryptocurrency trading system which determines the optimum exchanges and crucial aspects. Therefore, in order to rank the optimal digital token trading system, this paper develops an evaluation architecture to determine the various token trading systems. The developed architecture integrates fuzzy theory and the best-worst method (BWM) into the decision-making process to assess decision behaviors regarding preference for digital token trading systems in investors in Taiwan. First, this work establishes the views and parameters by modifying the Delphi method based on a literature review and survey. Second, the fuzzy-BWM is applied to obtain the fuzzy weights of the views and parameters. Then, defuzzification and BWM are used to rank the optimal alternatives of the digital token trading systems for investors. The results indicate that the optimal digital token trading system is the decentralized platform, and the critical parameters are gas fees, interest rates, and the mechanism of savings under fuzzy uncertain scenarios. This means that when considering the uncertain and ambiguous characteristics of the expert decision process in digital token trading systems, the evaluation is decentralized and the gas fees are the most important parameter in the digital token investment platform. Academically, the fuzzy BWM-based decision-making architecture can provide corporations and investors with valuable guidance to rank the optimal digital token trading systems based on fuzzy uncertain scenarios. Commercially, the proposed architecture could provide corporations and investors with a useful model to measure the optimal digital token trading system. [ABSTRACT FROM AUTHOR]

Emotion is a compelling factor in the retention and job satisfaction of professionals, and the impacts of emotional feelings and reactions have become an indispensable issue in the nursing workforce. Drawing on the cognitive theory of emotions, this study bridges the research gap to investigate the relationships among emotional blackmail, emotional intelligence, job satisfaction, and turnover intentions of nurses. A cross-sectional design was used to collect data from a sample of 374 full-time nurses in Northern Taiwan. Hypotheses were tested and analyzed by means of SPSS 22, structural equation modeling (SEM), and PROCESS v3.3. The results revealed the direct relationships between emotional blackmail, job satisfaction, and turnover intentions, and job satisfaction partially mediated the relationship between emotional blackmail and turnover intentions. However, there is no statistical support that emotional intelligence moderates the relationships between emotional blackmail and job satisfaction and turnover intentions. Healthcare organizations must take the initiative and form strategies that will help balance nurses' work stresses. These strategies should aim to reduce unnecessary demands from supervisors, patients, and co-workers, as well as in the socio-emotional domain. [ABSTRACT FROM AUTHOR]

Land subsidence attributable to the overuse of groundwater has resulted in severe damage in both urban and rural areas and in developed and developing countries. By incorporating the externality of groundwater use in aquacultural farming, we analyse how the government can mitigate the land subsidence levels without reducing the farmers’ profits, by both reusing the retired aquacultural land and through adjustments in the locations of the species currently being farmed in Tong-shi Township, Taiwan. The simulation results indicate that if the species with high profit can be sustainably raised and moved to aquacultural lands that are less sensitive to groundwater extraction, the total profit could exceed that without the regulation. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of higher education expansion on the phenomena of credentialism and gender discrimination in education. Using the survey data of Family Income and Expenditure by DGBAS, Taiwan from 1980 to 2009, we examine the time path of the effect of higher education expansion on household expenditures for children's education in Taiwan for five sub-periods: 1980-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2009. We show that, surprisingly, although the higher education expansion during the 1990s lowers the requirement of college entrance, credentialism seems to continue to prevail in the Taiwanese society. However, the higher education expansion does change parents' attitude on female children's education and increase the possibility for female children to attain higher education. [ABSTRACT FROM AUTHOR]

Abstract: Mastoparans, a family of small peptides, are isolated from the wasp venom. In this study, six mastoparans were identified in the venom of six Vespa species in Taiwan. The precursors of these mastoparans are composed of N-terminal signal sequence, prosequence, mature mastoparan, and appendix glycine at C-terminus. These mature mastoparans all have characteristic features of linear cationic peptides rich in hydrophobic and basic amino acids without disulfide bond. Therefore, these peptides could be predicted to adopt an amphipathic α-helical secondary structure. In fact, the CD (circular dichroism) spectra of these peptides show a high content α-helical conformation in the presence of 8mM SDS or 40% 2,2,2-trifluoroethanol (TFE). All mastoparans exhibit mast cell degranulation activity, antimicrobial activity against both Gram-positive and -negative bacteria tested, various degree of hemolytic activity on chicken, human, and sheep erythrocytes as well as membrane permeabilization on Escherichia coli BL21. Our results also show that the hemolytic activity of mastoparans is correlated to mean hydrophobicity and mean hydrophobic moment. [Copyright &y& Elsevier]

Background & Aims: The impact of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection upon B vitamins status and antioxidative defense in infected patients was examined. Methods: Dietary record and blood levels of B vitamins and oxidative stress-associated biomarkers were determined for 195 healthy controls, 132 HBV, and 114 HCV patients. Results: HBV-infected patients had significantly higher levels of total cholesterol, free fatty acids (FFA), and lower ghrelin level ( p < 0.05); and HCV-infected patients had significantly higher Ishak inflammation score and lactate dehydrogenase activity ( p < 0.05). HBV patients had significantly lower red blood cell (RBC) vitamins B and B levels, and HCV infection significantly decreased vitamins B B and folate levels in RBC and/or plasma ( p < 0.05). Correlation coefficients of RBC vitamin B versus serum FFA in HBV patients, RBC vitamins B and B versus HCV RNA and Ishak inflammation score, and plasma vitamin B vs Ishak inflammation score in HCV patients were <−0.5. HBV-infected patients had significantly higher oxidized glutathione level and lower glutathione peroxidase activity ( p < 0.05), but HCV patients had significantly lower superoxide dismutase and catalase activities ( p < 0.05). Conclusion: HBV or HCV infection enhanced oxidative stress and lowered B vitamins in circulation. In order to avoid other healthy risk, nutrition status should be monitored and limitation or supplementation of certain nutrients might be helpful for HBV- or HCV-infected patients. [ABSTRACT FROM AUTHOR]

Small village populations in which there is a high amount of kinship can cause complications in cases of disaster victim identification. This problem was highlighted by the loss of life after Typhoon Morakot struck Taiwan where over 500 people from small isolated communities lost their lives. Most of the victims were buried by landslides in the remote mountainous areas of southern Taiwan. Only 146 pieces of human remains were recovered after searching for 4 months. Most of the human remains were received for examination as severely damaged fragments prevented possible identification by morphological features. DNA testing using the traditional duo parent/child or sibling screening by STR data opens the possibility of including not only the actual victim but also false positives. Variable likelihood ratios were obtained when comparing DNA types from human remains to those from potential relatives; however, with the DNA typing of numerous members of the same living family, multiple matches to potential families were avoided. Of the 146 samples obtained and collapsed to 130 victims, they were linked to 124 individuals resulting in their identification when compared to a pool of 588 potential relatives. Six of the human remains could not be linked to any living relative and remain unknown. [ABSTRACT FROM AUTHOR]

Abstract: Aqueous characteristics and activity concentrations of U/Th-series radionuclides were investigated in the birthplace of hokutolite – the Peito Hot Spring Area in Taiwan. Water samples were taken in 12 locations from the hot spring pond and the Peito Creek in this study. Temperature, acidity and redox potential exhibited similar trends decreasing from the hot spring pond toward downstream Peito Creek. The aqueous environment of this area existed in an acidic and oxidative state and was found influenced by hot spring water drawing and wastewater discharge. Major ions in water were Fe3+, Ca2+, Sr2+, Ba2+, Pb2+, Cl− and SO4 2−, which (except for Ba2+) generally varied with sampling locations in a tendency similar to those of temperature, acidity and redox potential. U/Th-series radionuclides were examined by α spectrometry while 226Ra were determined with ICP-QMS. Th-series was found predominant over U-series in this area. Activity concentrations of 238U (0.09±0.02 to 2.69±0.13pCi/L) and 234U (0.10±0.02 to 2.64±0.13pCi/L) were similar and the activity ratios for 234U/238U were greater than unity. For 230Th and 226Ra, the activity concentrations were respectively 0.07±0.03 to 0.86±0.06pCi/L and 0.17±0.02 to 1.49±0.06pCi/L, which led to activity ratios of 230Th/234U lower than unity while those of most 226Ra/230Th greater than unity. In Th-series, the activity concentrations of 232Th (0.06±0.02 to 0.90±0.06pCi/L) and 230Th were similar at the sampling area. Apparent disequilibria were discovered between 228Ra and 232Th resulting from abundant 228Ra (6.01±0.41 to 10.5±0.8pCi/L). The variation for activity concentration of 228Th (0.43±0.06 to 9.26±0.18pCi/L) with sampling locations was similar to that of 232Th. However, significant disequilibria were discovered between 228Th and 232Th. The reported data contribute to the assessment of radionuclides distribution and the investigation of hokutolite recovery in the studied area. [Copyright &y& Elsevier]

Abstract: Relationships between aquatic parameters and nuclide activities of uranium/thorium-series as well as radiochemical processes occurred in Peito Hot Spring Area were investigated in this research. Artificial mixing of tap water with channeled spring water were found causing temperature decrease, lowering Ra2+ concentration and inhibiting hokutolite crystallization. A novel mechanism was derived from this work to interpret the vanishment of hokutolite, which could also be applied in studying radiochemistry, migration of the radionuclides as well as the recovery and conservation of hokutolite. [Copyright &y& Elsevier]

Abstract: The Taiwan Environmental Protection Administration (Taiwan EPA) launched a national Extended Producer Responsibility (EPR) system after integrating eight private recycling organizations in 1998. After that, the environmental performance of the EPR system brought a lot of attention to policy makers. Many studies show positive environmental effects of the EPR system in Taiwan. However, there are controversial questions remained, such as whether the performance indicators used are the right choice to estimate the environmental effects of the recycling policy? Can those estimated results really reflect the performance of the system? This paper would therefore like to more accurately evaluate the performance indicators of the EPR system based on data observed over the past decade in Taiwan. In the process of evaluating the performance indicators, we have found that the collection rates for durable goods are often ignored in countries that pursue a zero waste policy. This may affect the actual recycling outcome and resource direction targeted by producers. However, in order for the collection rate to be adopted as a policy indicator, how to estimate the amounts of retired or waste products during a period is critical. In this paper, we estimate the collection rate for electrical and electronic waste by using the survival analysis and ownership data analysis approaches. We also provide a comparison of both approaches and put forward suggestions for directions in the future in solid waste management. [Copyright &y& Elsevier]

Two major educational expansions in Taiwan have resulted in a remarkable improvement of human capital accumulation for the last three decades, which is consistent with the long-run goal of education in improving individual well-being and international competitiveness. This study focuses on the expansion of higher education starting from the late 1980s. As the number of higher-educated workers entering the labor market each year has increased rapidly, this higher education expansion policy has encountered some critiques from the public. Evidence shows that the incidence of over-educated workers in the labor market has been continuously increasing after the expansion, which is considered to be a short-run problem from the policy. We also find that the overall educational inequality drops sharply, which is mainly contributed by the within age group component after decomposing educational inequality using the decomposable Theil index. Along with a larger increase in average schooling for women, a larger reduction in educational inequality for women than for men implies women have benefited more than men from the policy and the educational inequality between men and women is narrowing. [ABSTRACT FROM AUTHOR]