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Mines are mostly located in the mountains and national forestlands in Taiwan. The development and use of mines have severely damaged the environment. Despite the long history of mining, the value of forest ecological services lost during mining operations have not yet been incorporated into the expenses borne by miners, and miners are not liable for compensation for ecological damage. This study evaluated the forest ecosystem service benefits lost since mining began, with the aim of providing future reference for calculating ecological damage related to mining. We investigated Mount Taibai mines in Yilan (northeast Taiwan) and Mount Yongshi mines in Hualian (east Taiwan), which are richly forested areas. According to Article 13 of the Mining Act in Taiwan, mining rights have a limitation of 20 years, and the two mines in this study have been in operation for 20 years. By using four ecological services—forest production, carbon sequestration, water resource replenishment, and forest recreation—we estimated the loss of ecological values in both mining regions. The result indicated that the loss of total forest production benefits over 20 years was 7,498.6 k New Taiwanese dollars (NTD) in Mount Taibai mines and 6,543.1 k NTD for Mount Yongshi mines, while the loss for the total carbon sequestration benefits over 20 years was 19,950 k NTD in Mount Taibai mines and 17,400 k NTD in Mount Yongshi mines. The loss of value for the total water conservation benefits over 20 years was 11,160 k NTD in Mount Taibai mines and 5,070 k NTD in Mount Yongshi mines. The loss value of forest recreation over 20 years was 1,443,855 k NTD for the two mines. [ABSTRACT FROM AUTHOR]

Currently, Taiwan has a very complete education system of oral hygiene, but there is still no licensing system for oral hygienists. This study explored mainly the profile of education system for oral hygienists in Taiwan from 2017 to 2021. This study used the documentary analysis and secondary data analysis to survey mainly the development of oral hygiene education system in Taiwan, and the changes of oral hygiene students and graduates from 2017 to 2021. In Taiwan, currently, there are 8 oral hygiene schools which offer associate, bachelor, and master degrees in oral hygiene. The oral hygiene enrollment quotas determined by the Ministry of Education increased from 343 quotas in 9 programs in 2017 to 500 quotas in 13 programs in 2021, while new oral hygiene students who completed registration increased from 282 students in 2017 to 353 students in 2021. The registration rate of the five-year training program of junior college was significantly higher than the other programs. The number of oral hygiene students with official student status increased from 604 students in 2017 to 1349 students in 2021. The total increase was 745 students from 2017 to 2021 with a total increase rate of 123.34%. In Taiwan, although the manpower of oral hygienists is important for public oral health, they usually work as dental assistants or change their careers. It is imperative to continue to promote the certification system for oral hygienists to improve the professionalism of this occupation. [ABSTRACT FROM AUTHOR]

COVID-19 global pandemic has caused massive disruption of travel behaviors along with other aspects of human life, such as social distancing, staying at home, and avoiding crowds. People substituted outdoor activities for indoor activities, and the forest environment has become a popular alternative. Taiwan has a high population density, but it had few COVID-19 confirmed cases in 2020 during the first wave of the COVID-19 pandemic. No forest areas have been closed due to the COVID-19 outbreak. In light of this generally increased demand for suburban forests for recreational uses, the current COVID-19 pandemic situation poses specific challenges regarding forest use, management, and policy. This study integrates visitation numbers of the popular forest recreation area and selects the unblocking index and social distancing index as the COVID-19 index to capture the impacts of forest recreation area on the COVID-19 outbreak in Taiwan. The results show both COVID-19 indices have high explanatory power for suburban forest visitation and both have a significant impact on the number of visitors. Although the number of visitors to suburban forests decreased during the COVID-19 pandemic alert, it bounced when the COVID-19 outbreak was under control. This study provides a brief overview of management implications for recreational visits during COVID-19. We posed an early warning to forest managers for greater revenge traveling post-COVID-19. [ABSTRACT FROM AUTHOR]

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

PM 2.5 concentrations are higher during rush hours at background stations compared to the average concentration across these stations. Few studies have investigated PM 2.5 concentration and its spatial distribution during rush hours using machine learning models. This study employs a geospatial-artificial intelligence (Geo-AI) prediction model to estimate the spatial and temporal variations of PM 2.5 concentrations during morning and dusk rush hours in Taiwan. Mean hourly PM 2.5 measurements were collected from 2006 to 2020, and aggregated into morning (7 a.m.–9 a.m.) and dusk (4 p.m.–6 p.m.) rush-hour mean concentrations. The Geo-AI prediction model was generated by integrating kriging interpolation, land-use regression, machine learning, and a stacking ensemble approach. A forward stepwise variable selection method based on the SHapley Additive exPlanations (SHAP) index was used to identify the most influential variables. The performance of the Geo-AI models for morning and dusk rush hours had accuracy scores of 0.95 and 0.93, respectively and these results were validated, indicating robust model performance. Spatially, PM 2.5 concentrations were higher in southwestern Taiwan for morning rush hours, and suburban areas for dusk rush hours. Key predictors included kriged PM 2.5 values, SO 2 concentrations, forest density, and the distance to incinerators for both morning and dusk rush hours. These PM 2.5 estimates for morning and dusk rush hours can support the development of alternative commuting routes with lower concentrations. [Display omitted] • Rush-hour exposure to PM 2.5 is high, but the spatiality is less understood. • PM 2.5 variations during morning and dusk rush hours are captured by Geo-AI models. • The Geo-AI model performance for morning/dusk is 0.95 and 0.93, respectively. • PM 2.5 is higher in southern Taiwan and urban areas in the morning. • Low-exposure commuting routes could be identified by the rush-hour Geo-AI models. [ABSTRACT FROM AUTHOR]

Objectives: Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain whether periodontal disease affects the risk of mortality and morbidity in patients with advanced CKD. Materials and methods: Taiwan's National Health Insurance Research Database was used to conduct a nationwide population-based cohort study. Propensity score matching procedures were performed to select people with stage 5 CKD and to compare the long-term risk of mortality, end-stage renal disease, and major adverse cardiovascular events (MACE) between people with and without periodontal disease. Multivariable Cox regression analyses were conducted to calculate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the outcome of interest. Results: A total of 8119 subjects with stage 5 CKD were initially included. After matching to demographic and clinical covariates, 1254 subjects with 7099 person-years of follow-up were selected for analyses. Periodontal disease was not associated with long-term risks of all-cause mortality (aHR: 0.77, 95% CI: 0.49–1.22), progression to end-stage renal disease (aHR: 0.91, 95% CI: 0.75–1.10), or MACE (aHR: 1.18, 95% CI: 0.91–1.53). These findings were generally consistent across subgroups of age, sex, comorbid diabetes, uses of systemic antibiotic, and different dental procedures. Conclusions: Periodontal disease is not a predictor for long-term mortality or morbidity in patients with advanced CKD. Clinical relevance: These results provide important evidence to elucidate the relationship between periodontitis and critical clinical outcomes of advanced CKD. [ABSTRACT FROM AUTHOR]

[Display omitted] • Greenspace coverage and greenness are negatively associated with suicide. • Association between landscape indices for greenspace and suicide risk is revealed. • Mean patch area and proximity index are negatively associated with suicide. • Area-weighted mean fractal dimension index is positively associated with suicide. Previous studies have demonstrated the preventive effects of greenness and greenspace using three classes of exposure metrics (greenspace coverage, greenness, and landscape indices for greenspace) on suicide. Nevertheless, most studies were individually employed for each metric using a single-phase method, representing the short-term exposure. We hierarchically investigated the association between three classes of exposure metrics and suicide using long-term data from 2000 to 2018 in Taiwan. Normalized difference vegetation index (NDVI) was used to represent the greenness exposure, while mean patch area (area and edge), area-weighted mean fractal dimension index (shape), and proximity index (proximity) were opted to represent landscape indices for greenspace. Using the generalized additive mixed model, we revealed that the relative risk (95% confidence interval) of greenspace coverage, NDVI, mean patch area, area-weighted mean fractal dimension index, and proximity index was 0.998 (0.997, 0.999), 0.860 (0.811, 0.912), 0.999 (0.999, 0.999), 1.485 (1.056, 2.088), and 0.999 (0.999, 0.999), respectively. This indicates that long-term exposure to both greenspace coverage and greenness is associated with a reduced suicide ratio. Similarly, long-term exposure to greenspace that is greater in size, simpler in shape, and closer in proximity is associated with a decreased suicide risk. For formulating future afforestation policies, the layout and connectivity of greenspaces should be considered besides increasing green areas. This study not only demonstrated the significance of long-term exposure to greenspace for reducing the suicide ratio, but also illustrated a hierarchical approach to examine the effects of greenspace. [ABSTRACT FROM AUTHOR]

• Low-elevation mountainous (LEM) areas are reclaimed for agriculture, impacting biodiversity and ecology. • Ecosystem service value and WTP of tea plantations in LEM areas was assessed by contingent valuation method. • Negative correlation between willingness-to-pay and education level in organic farming methods existed. • Farmers with high income & using both conventional and organic farming methods were willing to pay more. • Provisioning ecosystem services preferred; ecological value of tea plantations not inferior to some landscapes. Low-elevation mountainous (LEM) areas in some countries are reclaimed for agriculture (especially, for deep cultivation of tea trees) due to their accessibility, higher temperature, and more rainfall, contributing to biodiversity and ecological balance. However, extensive development in these areas causes lasting ecological damage; and hence it is crucial to evaluate the ecological value of these areas for formulating relevant ecological protection policies. Therefore, this study evaluated the ecosystem service value of tea plantations in LEM areas using the contingent valuation method based on the subjective consciousness of farmers, rather than an objective assessment. A questionnaire survey was conducted on tea farmers in Mingjian Township (which is one of the major tea-producing LEM areas in Mid-Taiwan); and ecosystem service values of tea plantations between conventional farming methods (CFMs) and organic farming methods (OFMs) were compared. Firstly, the differences in willingness to pay (WTP) for the samples including and excluding protest responses were investigated, and then a regression analysis to estimate the WTP price for maintaining the tea plantation ecology was conducted. Empirical results showed a significantly negative correlation between the WTP price and the education level of farmers in tea plantations using CFMs, but a significantly positive correlation in tea plantations using both CFMs and OFMs. Most respondents were male and used CFMs to operate tea plantations; and those with higher monthly income and using both CFMs and OFMs were willing to pay more. Regarding ecosystem services of tea plantations, the respondents preferred the "provisioning" ecosystem services, and were willing to pay an average of NT$ 718.92 and NT$ 794.32 per year for maintaining the ecology of tea plantations using CFMs and OFMs, respectively. The unit ecological value of tea plantations was not inferior to those of coniferous and broad-leaved forests, paddy fields, and algae reefs from previous studies. Finally, some suggestions are proposed for a reference in formulating relevant ecological protection policies. [ABSTRACT FROM AUTHOR]

Background: Limited information is available on the association between influenza vaccination and postoperative outcomes.Methods: Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination.Results: Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls.Conclusions: Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes. [ABSTRACT FROM AUTHOR]

This study conducts a survey on the urban forest parks in Taiwan to assess the benefits and affecting factors. The results show that the larger the area of the park, the higher the degree of satisfaction with the landscape and the status of the plants, and the higher the density of trees, the lower the degree of satisfaction with the scenic view. The shading effect is positively correlated with the diameter of plants at breast height, canopy cover area, and proportion of green coverage. However, higher green coverage is associated with lower satisfaction regarding the scenic view and the uniqueness of the landscape. Most visitors are less satisfied with the area of plants and landscape attractiveness. The study results can be used to evaluate the impacts of setting up urban forest parks. The outcomes also provide guidance for the relevant authorities for sustainable management and future policy making. [ABSTRACT FROM AUTHOR]

Since the early 2000s, the growth rate of real wages in Taiwan has been very low, even negative for high-skilled workers. This paper sheds light on the potential causes of this puzzling development through a comparison of Taiwan's performance with that of South Korea. In many dimensions, most notably wages and labour productivity, both economies developed quite similarly between 1995 and 2001-02, but diverged thereafter. We relate the development of wages and labour productivity in the two economies to sectoral structural change and to sectoral differences in labour productivity growth, skills upgrading, and foreign trade. [ABSTRACT FROM AUTHOR]

In most countries, the current goal for greenhouse gas emission reduction is to achieve a 50% reduction by 2050 with a carbon neutrality target. Most energy policies have been to adopt at least 20% renewable energies in the country energy portfolio. This study conducted a comparative cost analysis on various carbon emission reduction options: reducing fossil energies (including coal, natural gas, and petroleum), increasing renewable energies (including hydroelectric power, wind power, photovoltaics, and wood fuel), and increasing afforestation (including coniferous forests, broadleaved forests, and mixed coniferous-broadleaved forests). In analyzing the discounted costs per unit of carbon reduction, this study explored the costs of these options at a fixed amount of carbon reduction, which means the lower the costs, the more effective the carbon emission reduction. Taking Taiwan as an example, the results indicated that coal-fired power has the lowest cost (US$24.80 per ton of CO 2). The costs of other energy sources (i.e., natural gas, petroleum, hydroelectric power, wind power, solar power, and wood fuel) are US$79.72–182.17 per ton of CO 2. The cost of afforestation for reducing carbon emissions is US$34.68–64.82 per ton of CO 2 , lower than the cost of adopting renewable energies assuming no technological advancement in current renewable energies. • Emission reduction options include reducing fossil energies, increasing renewable energies, and increasing afforestation. • A comparative cost analysis was conducted on the above options to achieve the carbon reduction target. • The lower the costs, the more effective the emission reduction. • Producing forest carbon sequestration indeed costs lower than other options. [ABSTRACT FROM AUTHOR]

It is a common practice for many studies using the contingent valuation method (CVM) to censor protest responses, but this practice may make data structures incomplete and lead to sample selection bias at the final analysis stage for economic evaluation. This study adopted the CVM to assess the economic value of Qiedong-Wang-Gong (Bischofia javanica) (QWG), the only urban heritage tree over a thousand years old in Taiwan, and analyzed the effect of protest reponses. A total of 307 valid samples were collected and 27% of the respondents were categorized to protest responses. This study used discriminant analysis and multinomial logistic regression to distinguish the types of protest samples. The results showed that the overall classification performance of the multinomial logistic regression is better than that of the discriminant analysis. The Tobit model was applied to deal protest responses as legitimate zero responses and the result showed that the model underestimated the economic values of QWG significantly. The Heckman two-stage model was utilized to evaluate the effect of censoring protest responses. The result revealed that excluding protest responses from further valuation analysis did not lead to significant sample selection bias. In this study, many respondents failed to quantify their preferences toward protecting QWG in terms of willingness to pay. This study suggested further studies could highlight the current policy about ancient urban trees management to decrease respondents' protest beliefs in CVM studies. [ABSTRACT FROM AUTHOR]

Garcinia multiflora is an evergreen arbor, which belongs to the family of Guttiferae. It grows mainly at the lower altitudes of the mountains in the Hengchun Peninsula, which is in southern Taiwan. In this study, bioactivity-guided screening was conducted to evaluate the anti-hepatocellular carcinoma bioactivity of the fruit's methanol extract of G. multiflora. The methanol extract residue was partitioned with various solvents. It was then separated and purified using flash chromatography. The active component was confirmed to be guttiferone F. In our present study, cytotoxicity assay revealed that the IC50 of guttiferone F was 14.15±2.36μM in PLC/PRF/5 cells, 10.17±0.51μM in HepG2 cells and 9.71±1.28μM in Hep3B cells. In the in vitro anticancer study, we found guttiferone F induced apoptosis by up-regulating cleaved pro-caspase-3 and PARP expressions in PLC/PRF/5 cells. The antitumor potency is similar to sorafenib, a therapeutic drug for liver cancer. Further in vivo study showed that guttiferone F inhibits minor tumor growth on s.c. xenograft tumor of human liver cancer cell line in female SCID mice. Although antitumor efficiency of guttiferone F is not superior to sorafenib, the dose (i.p., 25mg/kg×5days) is proved safe to animal. According to our studies, guttiferone F can be a promising lead for liver cancer therapy and become a new liberator for liver cancer patients after modification of the drug. [ABSTRACT FROM AUTHOR]

Summary: This paper addresses the public concern of hollowing-out effects of FDI by analyzing firm-specific data on Taiwanese manufacturing multinationals. We estimate ordered probit models with the firms’ own assessment of domestic production and employment effects as dependent variables to investigate whether such effects depend on the size, location, and type of FDI. We find that the probability of negative effects increases slightly with the size of FDI. Furthermore, the effects of locating in China differ from those of locating in advanced countries. In contrast to vertical and export-platform FDI, employment effects of horizontal FDI tend to be positive. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the determinants of Taiwan's manufacturing firm growth, in particular, the effects of financial structure, corporate financing choices and Taiwanese outward FDI in China on firm growth in different industries besides other physical factors discussed in the literature. We construct an unbalanced dynamic panel data using 280 listed and OTC manufacturing firms over the period 1991–2002. The empirical method utilized is the generalized method of moments (GMM) proposed by Arellano and Bond (1991). Our results find that (1) the growth rates of firms are positively related to firm size, age, capital intensity, lagged R&D, export ratio, investment ratio, and profits; (2) high debt-to-equity ratio is associated with low corporation growth, while high return on total assets is associated with high corporation growth, which reflects that a firm with a relatively sound financial structure will facilitate their growth; (3) higher liquidity of stock market relative to the banking sector lead to higher growth of firms. However, larger size of stock market relative to the banking sector leads to lower the firm's growth, i.e., the smaller the indirect finance, the lower the firm growth; (4) firms engaged in FDI toward China might be hollowing-out; (5) individual firms that could be financed more from either bank or equity market will enjoy higher rates of growth compared to others in the same industries, but, those effects on traditional and basic industries are weaker; (6) high bank-financing ratio and internal financing are associated with higher firm growth, while firms using more bonds or equity financing tend to experience lower growth. However, the net positive effects of equity financing on traditional and basic firm growth are significantly greater. [ABSTRACT FROM AUTHOR]

This study aimed to construct an effective model to estimate the recreation value and total annual recreation benefits of the Alishan National Forest Recreation Area (ANFR) through the travel cost method. Negative binomial regression was also employed to estimate the demand function. This study sorted participants based on gender, age, level of education, personal monthly income, occupation, and place of residence to examine their differences in perceived recreation value and recreation demand. The survey responses revealed that most tourists were mainly middle aged, and took family vacations. The findings indicate that the recreation benefits of traveling to Alishan per person each year equaled NTD 1703. Furthermore, the annual recreation benefits of Alishan were approximately between NTD 2,157,121,944 and NTD 2,452,136,112 based on a total of 1,353,276 visits traveling to Alishan in 2019. Recommendations and suggestions are drawn for ANFR based the results. [ABSTRACT FROM AUTHOR]

Forests account for 60% of lands in Taiwan. Climate change impacts forests in many aspects and is increasingly likely to undermine the ability of forests to provide basic ecosystem services. To help reduce the impact of climate change on Taiwan's forests, people must be made aware of the relationship between climate change and forests. Based on questionnaires collected from 17 cities in Taiwan, this study applied spatial analysis to assess the respondents' understanding of climate change and adaptation strategies for forest management. A total of 650 questionnaires were distributed and 488 valid ones were collected. The results show that (1) Most respondents believe that climate change is true and more than half of the respondents have experienced extreme weather events, especially extreme rainfall; (2) Most respondents believe that climate change will affect Taiwan's forests with the majority recognizing the increasing impact of extreme events being the primary cause, followed by changes in the composition of tree species and the deterioration of forest adaptability due to climate change; (3) Most respondents expressed that forest management should be adjusted for climate change and called for measures being taken to establish mixed forests as well as monitoring forest damage; (4) In order to address the difficulties faced by forest owners on the impact of climate change, the majority of respondents felt that the government should raise forest owners' understanding on climate change and adaptation policies, while the subsidy incentives must also be adjusted. The results of this study show that the respondents do realize the importance of climate change and forest management so much so their awareness in this matter led to their support for forest adaptation measures and policies. [ABSTRACT FROM AUTHOR]

Urban forests offer multiple functions: they can balance negative effects from the environment and provide the public with a place for leisure and recreation. Hence, urban forests are crucial to urban ecology and have been widely studied. In addition, relevant study results were applied for policymaking in urban development and forest park management. This study evaluated the ecological value of the Sinhua Forest Park and examined whether the socioeconomic background of participants influences their willingness to pay (WTP) for ecological conservation. Questionnaires were distributed to visitors in the Sinhua Forest Park in Tainan, Taiwan, and the payment card format of the contingent valuation method was employed to evaluate the ecological value. The results showed that the visitors had an annual WTP of $22.01 per person. However, when samples with protest responses were excluded, the WTP rose to $24.58. By considering the total number of visitors of a year, the total ecological value was $1,426,964.14/year and reached $1,593,257.31/year after excluding the protest samples. This study also analyzed participants' within-variable socioeconomic background (e.g., gender and education) and discovered that male participants who are aged 60 years or older, with an education level of senior/vocational high school, and those who visited green spaces two to three times per week presented a high WTP score on average. A Tobit regression model was employed for examination, and the results indicated that participants' education and frequency of visiting green spaces significantly influenced their WTP for the ecological conservation of the Sinhua Forest Park. [ABSTRACT FROM AUTHOR]

• This study aims to supply an analytical apparatus assessing the level of service quality provided by forest parks. • Impact Range Performance Analysis (IPRA) and Impact-Asymmetry Analysis (IAA) are applied. • The priority order of service quality attributes requiring improvement in Xinhua Urban Forest Park is evaluated. • By results, service quality attributes should be improved with priority, to increase satisfaction of the visitors. This study draws a structured questionnaire survey on visitors to the National Xinhua Urban Forest Park, located in the southern part of Taiwan. Consequently, it deploys the Impact Range Performance Analysis (IRPA) and Impact-Asymmetry Analysis (IAA) in evaluating the service quality of the park under investigation, which shed some light on the service/management areas calling for amelioration. It shows that the dimensions measuring the service quality, touching on the natural resource (e.g., river water quality), management (e.g., appropriateness of designing trails), transportation convenience (e.g., external transportation and shuttle buses), price (e.g., entrance ticket and merchandise), and public facility (e.g., trash cans, toilets, gazebo, rest chairs, and barrier-free space) should be improved with priority, to increase the satisfaction of the visitors to the forest park. [ABSTRACT FROM AUTHOR]

• This study analyzes the relations among tourists' environmental attitude, vandalism and cognitive dissonance. • This study finds there exists a significant difference in the behavior of emotional reactions among environmental attitude, vandalism and cognitive dissonance considering the tourists' socio-demographic backgrounds. • The results of this study show that the older tourists have higher pro-environmental attitudes. • The tourists who are older and more frequently for outdoor activities are less likely to litter. In contrast, the younger tourists intend to litter and their reactions of cognitive dissonance are stronger. This study takes the littering of tourists in Xitou Nature Education Area in Taiwan as an example to analyze the relationships among tourists' environmental attitude, vandalism and cognitive dissonance. In this study, 500 questionnaires are distributed, and 499 questionnaires are returned. The subjects are the tourists of over 18 years of age in the Xitou Nature Education Area by convenience sampling between November 2015 and March 2016. The results of this study show that the older tourists have higher pro-environmental attitudes. The tourists who are older and more engaging in outdoor activities are less likely to litter. In contrast, the younger tourists intend to litter and their reactions of cognitive dissonance are stronger. This study suggests that the authorities shall strengthen environmental protection campaign and environmental education for younger tourists with a higher possibility of vandalism behavior. The probability of tourists' vandalism can be reduced by improving the quality of outdoor facilities and promoting benefits of the natural environment experiencing. [ABSTRACT FROM AUTHOR]

Many studies have shown that the weather greatly affects the tourist count. Understanding weather information, climate change, and how they influence the tourist count in different tourist seasons (peak season, second peak season, off season) can help park planners and managers to analyze the opportunities and risks caused by climate change. This study aimed to predict the visitor count through information on the number of visitors and the weather day for three tourist seasons in a 12-month period. The study was conducted in the Huisun Forest Park of Taiwan based on the peak season (February, July, August, and October), the second peak season (January, April, May, November, and December), and the off-season (March, June, and September), using weather factors and virtual factors (such as whether it is a weekend or not) to establish three multivariate regression models for predicting the daily visitor count. This study assessed the impact of climate change on the visitor count and analyzed possible scenarios of climate change using representative concentration pathways (RCPs), as stated in the fifth assessment report of the Intergovernmental Panel on Climate Change (IPCC). The results of this study indicated that the impacts of weather factors on the visitor count is the same for the peak season and the off season. The temperature and relative humidity have a significant impact on the visitor count, and precipitation is not significant. In the second peak season, only the temperature has a significant impact on the visitor count. The relative humidity and precipitation are not significant. The temperature is the most influential factor in all three seasons, and has the highest influence on the peak season, followed by the low season, and then the second peak season. In addition, the number of visitors in Huisun Forest Park is on the rise, according to an analysis of various climate change scenarios (RCP2.6, RCP4.5, RCP6.0, RCP8.5). The results of this study can be used as a reference by forest park managers and future researchers. It is noted that the results were based on the current economic and political situation. The worsening of the entire world situation could break the relationships. [ABSTRACT FROM AUTHOR]

The transportation problems faced by the elderly and people with disabilities have received attention from policymakers and practitioners. Eden Social Welfare Foundation (Eden) has observed the challenges and expectations from the elderly and people with disabilities while operating Rehabuses and long-term care services in Taiwan. This study presents a social business model for people with disabilities based on Eden's mobile-based service platform for barrier-free transportation. This social business model illustrates how information and communication technology (ICT) is integrated with transport service providers and government resources to satisfy the transportation needs of disabled people. • Propose a social business model for barrier-free transportation. • Integrate service providers and government resources to build a sharing platform. • Satisfy the transportation needs of people with disabilities. [ABSTRACT FROM AUTHOR]

PM 2.5 concentrations are higher during rush hours at background stations compared to the average concentration across these stations. Few studies have investigated PM 2.5 concentration and its spatial distribution during rush hours using machine learning models. This study employs a geospatial-artificial intelligence (Geo-AI) prediction model to estimate the spatial and temporal variations of PM 2.5 concentrations during morning and dusk rush hours in Taiwan. Mean hourly PM 2.5 measurements were collected from 2006 to 2020, and aggregated into morning (7 a.m.-9 a.m.) and dusk (4 p.m.-6 p.m.) rush-hour mean concentrations. The Geo-AI prediction model was generated by integrating kriging interpolation, land-use regression, machine learning, and a stacking ensemble approach. A forward stepwise variable selection method based on the SHapley Additive exPlanations (SHAP) index was used to identify the most influential variables. The performance of the Geo-AI models for morning and dusk rush hours had accuracy scores of 0.95 and 0.93, respectively and these results were validated, indicating robust model performance. Spatially, PM 2.5 concentrations were higher in southwestern Taiwan for morning rush hours, and suburban areas for dusk rush hours. Key predictors included kriged PM 2.5 values, SO 2 concentrations, forest density, and the distance to incinerators for both morning and dusk rush hours. These PM 2.5 estimates for morning and dusk rush hours can support the development of alternative commuting routes with lower concentrations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Hepatitis C virus (HCV) reinfections after successful treatment with direct-acting antivirals (DAAs) pose a significant challenge to HCV elimination, especially among high-risk people living with HIV (PLWH). In this study, PLWH who had achieved HCV viral clearance with DAAs were included between January 2018 and June 2021. PLWH having acquired HCV infections after 2017 were classified as "recent-infection group," and those before 2017 as "remote-infection group," and the incidences of HCV reinfection were compared between two groups. Clinical and behavioural characteristics were evaluated to identify associated factors with HCV reinfection. A total of 284 PLWH were included: 179 in the recent-infection group and 105 in the remote-infection group. After a median follow-up of 2.32 years (interquartile range [IQR], 0.13-3.94), the overall incidence of HCV reinfection was 5.8 per 100 person-years of follow-up (PYFU). The incidence in the recent-infection group was significantly higher than that in the remote-infection group (9.8 vs. 0.4 per 100 PYFU, p  < 0.001). The leading HCV genotypes before DAA treatment were genotypes 2 (31.0%), 1b (26.8%), and 6 (21.8%); however, genotype 6 (58.8%) became predominant upon reinfection. Younger age (adjusted odds ratio [aOR] per 1-year increase, 0.95; 95% CI, 0.90-0.99), condomless receptive anal sex (aOR, 14.5; 95% CI, 2.37-88.8), rimming (aOR, 3.87; 95% CI, 1.14-13.1), and recent syphilis (aOR, 2.73; 95% CI, 1.26-5.91) were linked to HCV reinfections. In conclusion, PLWH acquiring HCV after 2017 had a significantly higher risk for sexually-transmitted HCV reinfections. The predominance of HCV genotype 6 reinfections suggests possible on-going clustered HCV infections among at-risk PLWH.

Periodontitis is prevalent in patients with chronic kidney disease (CKD) and is also associated with kidney function decline. It is unclear whether dental scaling treatment prevents the progression of CKD. In a nationwide cohort study, Taiwan's National Health Insurance Research Database was used to select people with CKD. Propensity score-matching procedures were performed to compare the long-term risk of end-stage renal disease (ESRD) between CKD patients with and without the receipt of dental scaling. A total of 33,637 matched pairs with CKD were included, with 503,373 person-years of follow-up for analyses. Dental scaling was significantly associated with a lower risk of ESRD (adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.77-0.90). In addition, there was a dose-dependent relationship between the frequency of dental scaling and a reduced risk of ESRD. Dental scaling was also linked to reduced risks of major adverse cardiovascular events (aHR: 0.91, 95% CI: 0.87-0.95), sepsis (aHR: 0.81, 95% CI: 0.77-0.85), and all-cause mortality (aHR: 0.81, 95% CI: 0.76-0.87). Dental scaling was significantly associated with lower risks of progression to ESRD in patients with CKD. Regular dental scaling may serve as a prophylactic measure for kidney function decline.

Hypervirulent Klebsiella pneumoniae strains are the major cause of liver abscesses throughout East Asia, and these strains are usually antibiotic susceptible. Recently, multidrug-resistant and hypervirulent (MDR-HV) K. pneumoniae strains have emerged due to hypervirulent strains acquiring antimicrobial resistance determinants or the transfer of a virulence plasmid into a classic MDR strain. In this study, we characterized the clinical and microbiological properties of K. pneumoniae liver abscess (KPLA) caused by MDR-HV strains in Taiwan. Patients with community onset KPLA were retrospectively identified at Taipei Veterans General Hospital during January 2013 to May 2018. Antimicrobial resistance mechanisms, capsular types, and sequence types were determined. MDR-HV strains and their parental antimicrobial-susceptible strains further underwent whole-genome sequencing (WGS) and in vivo mice lethality tests. Thirteen MDR-HV strains were identified from a total of 218 KPLA episodes. MDR-HV strains resulted in similar outcomes to antimicrobial-susceptible strains. All MDR-HV strains were traditional hypervirulent clones carrying virulence capsular types. The major resistance mechanisms were the overexpression of efflux pumps and/or the acquisition of ESBL or AmpC β-lactamase genes. WGS revealed that two hypervirulent strains had evolved to an MDR phenotype due to mutation in the ramR gene and the acquisition of an SHV-12-bearing plasmid, respectively. Both these MDR-HV strains retained high virulence compared to their parental strains. The spread of MDR-HV K. pneumoniae strains in the community raises significant public concerns, and measures should be taken to prevent the further acquisition of carbapenemase and other resistance genes among these strains in order to avoid the occurrence of untreatable KPLA., (Copyright © 2020 American Society for Microbiology.)

Forests play an important role as carbon sinks by sequestrating carbon through photosynthesis. Thinning treatments have large impacts on carbon storage, in addition to strengthening quality and quantity of plantations. This study analyzed the effects of different thinning treatments on carbon stocks in both individual trees and stands of Taiwania (Taiwania cryptomerioides) plantations. Repeated field measurements and allometric equations were used to calculate total C storage and sequestration rates of live trees. The results of this study showed that the total carbon stock of stands with thinning treatments was less than that of the non-thinned stands. The non-thinned 23-year old stands had an estimated carbon stock of 96.8 Mg C ha -1 , which is higher than the carbon stock found in either medium- (84.1 Mg C ha -1 ) or heavily-thinned (74.7 Mg C ha -1 ) treatment plots of the same age. If the objective of Taiwania plantations was to store large amounts of carbon in the young growth stage, without regard to the initial rate of storage, a better option is no-thinning. However, the medium thinned forests seem to be more promising for carbon sequestration than the no-thinned forests if a longer period is considered.

Background: Limited information is available on the association between influenza vaccination and postoperative outcomes., Methods: Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination., Results: Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls., Conclusions: Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes., (© The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

A large number of diesel vehicles carrying gravel and sand shuttle back and forth every day on the major thoroughfares (Tai-16 and Tai-21) from Shinyi to Jiji in Nantou, Taiwan. A total of 10 stations along the major thoroughfares were selected as the exposure sites, whereas a small village located ∼9 km from a main traffic route was selected as the control site. Outdoor and indoor aerosol samples were collected using high-volume samplers and Harvard samplers, respectively. The metal concentrations of outdoor and indoor PM(10) at the exposure sites were, respectively, higher than those at the control site. The plots between metal contents in the aerosols and road dust showed that diesel vehicles contributed significant amounts of metals to the outdoor and indoor aerosols at the exposure sites. Household dust samples along the roadside within 30 m of the main road in the small towns were collected using the wipe method. Based on the results of principal component analysis (PCA), three major components for household dust were identified: resuspended from road dust, brake wear and diesel emissions. Enrichment factors were applied to assess the contribution of pollution sources to household dust. These factors were calculated with respect to unpolluted river dust samples (EF(river)) and road dust (EF(road)). The differences between EF(river) and EF(road) could be mainly attributed to the effects of resuspension by passing vehicles. Approximately 72%, 68%, 68%, 73% and 86% of the vehicle-related metals Pb, Zn, Cu, Ni and Mo content, respectively, in household dust were the result of the resuspension of road dust by passing vehicles. The data of daily intakes of five metals (i.e., Fe, Pb, Cu, Ni and Mo) from inhalation and ingestion pathways showed that the doses from the ingestion pathway were much higher than those from the inhalation pathway.

Background and Objectives: Hyperuricemia is an independent risk factor for mortality, cardiovascular disease, and renal disease in general population. However, the relationship between hyperuricemia with clinical outcomes in CKD remains controversial., Design, Setting, Participants, & Measurements: The study investigated the association between uric acid with all-cause mortality, cardiovascular events, renal replacement therapy, and rapid renal progression (the slope of estimated GFR was less than -6 ml/min per 1.73 m(2)/y) in 3303 stages 3-5 CKD patients that were in the integrated CKD care system in one medical center and one regional hospital in southern Taiwan., Results: In all subjects, the mean uric acid level was 7.9 ± 2.0 mg/dl. During a median 2.8-year follow-up, there were 471 (14.3%) deaths, 545 (16.5%) cardiovascular events, 1080 (32.3%) participants commencing renal replacement therapy, and 841 (25.5%) participants with rapid renal progression. Hyperuricemia increased risks for all-cause mortality and cardiovascular events (the adjusted hazard ratios for quartile four versus quartile one of uric acid [95% confidence interval] were 1.85 [1.40-2.44] and 1.42 [1.08-1.86], respectively) but not risks for renal replacement therapy (0.96 [0.79-1.16]) and rapid renal progression (1.30 [0.98-1.73])., Conclusions: In stages 3-5 CKD, hyperuricemia is a risk factor for all-cause mortality and cardiovascular events but not renal replacement therapy and rapid renal progression.

Background: Patients with chronic kidney disease (CKD) are associated with increased cardiovascular (CV) morbidity and mortality. Echocardiographic measures of heart structure and function have been reported to predict adverse CV outcomes in various pathologic conditions. The aim of this study is to assess whether echocardiographic parameters are independently associated with increased CV events in patients with CKD Stages 3-5., Methods: We consecutively enrolled 505 CKD patients from our outpatient department of internal medicine. CV events were defined as CV death, hospitalization for unstable angina, non-fatal myocardial infarction, sustained ventricular arrhythmia, hospitalization for congestive heart failure, transient ischemia attack and stroke. The relative CV events' risk was analyzed by Cox regression methods., Results: In the multivariate analysis, old age, the presence of diabetes, coronary artery disease and atrial fibrillation; decreased serum albumin and hematocrit levels; left atrial diameter (LAD) >4.7 cm [hazard ratio (HR), 2.141; 95% confidence interval (CI), 1.155-3.971, P = 0.016]; increased left ventricular mass index (LVMI) (HR, 1.006; 95% CI, 1.002 to 1.010, P = 0.003) and left ventricular ejection fraction (LVEF) <55% (HR, 2.007; 95% CI, 1.007-3.743, P = 0.028) were independently associated with increased CV events., Conclusions: Our findings show that LAD >4.7 cm, increased LVMI and LVEF <55% are independently associated with adverse CV outcomes in CKD patients. Screening CKD patients by means of echocardiography may help identify a high-risk group of poor CV prognosis.

Introduction: Brachial-ankle pulse wave velocity (baPWV) was a marker of arterial stiffness, and increased baPWV was associated with renal function progression in patients with chronic kidney disease (CKD). However, there was no study to evaluate the longitudinal change of baPWV in patients with CKD. The aims of this study were to assess whether there was a longitudinal change in baPWV and to find out the determinants of this change in patients with CKD., Methods: This study enrolled 52 patients with CKD stages 3 to 5 from outpatient Department of Internal Medicine. The values of baPWV were measured by an ankle-brachial index-form device at baseline and at 2-year follow-up. Changes of parameters (Δ) were used to evaluate the relationship between biological markers, blood pressures, medications and baPWV., Results: The values of baPWV decreased during the 2-year follow-up (2108.4 ± 893.9 and 1897.1 ± 472.4; P = 0.016). There were also significant reductions in systolic and diastolic blood pressures during the 2-year follow-up, and Δsystolic blood pressure and baseline baPWV were the major determinants of ΔbaPWV., Conclusions: The present longitudinal study showed that the values of baPWV decreased during the 2-year follow-up, and the major determinants of ΔbaPWV were Δsystolic blood pressure and baseline baPWV in patients with CKD. Good control of systolic blood pressure may be associated with the regression of baPWV in patients with CKD.

Butachlor is the most commonly used herbicide on paddy fields in Taiwan and throughout Southeast Asia. Since paddy fields provide habitat for pond breeding amphibians, we examined growth, development, time to metamorphosis, and survival of alpine cricket frog tadpoles (Fejervarya limnocharis) exposed to environmentally realistic concentrations of butachlor. We documented negative impacts of butachlor on survival, development, and time to metamorphosis, but not on tadpole growth. The 96 h LC(50) for tadpoles was 0.87 mg/l, much lower than the 4.8 mg/l recommended dosage for application to paddy fields. Even given the rapid breakdown of butachlor, tadpoles would be exposed to concentrations in excess of their 96 h LC(50) for an estimated 126 h. We also documented DNA damage (genotoxicity) in tadpoles exposed to butachlor at concentrations an order of magnitude less than the 4.8 mg/l recommended application rate. We did not find that butachlor depressed cholinesterase activity of tadpoles, unlike most organophosphorus insecticides. We conclude that butachlor is likely to have widespread negative impacts on amphibians occupying paddy fields with traditional herbicide application.

Aim: The ankle brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in advanced chronic kidney disease (CKD) and haemodialysis patients, respectively. However, it is seldom studied in Taiwan, an area with high prevalence of CKD and end-stage renal disease. The aim of this study was to investigate the predictors for mortality by using ABI value in patients with CKD and undergoing haemodialysis in Taiwan., Methods: One hundred and sixty-nine patients with CKD stage 3-5 and 231 haemodialysis patients were enrolled in one regional hospital. The mean follow-up period was 23.3 + or - 3.3 months. Patients were stratified into three groups according to ABI value (<0.9, > or = 0.9 to < 1.3, and > or = 1.3). The relative mortality risk was analyzed by Cox-regression methods., Results: In multivariate analysis, an ABI of 1.3 or more (hazard ratio, 3.846; P = 0.043) and coronary artery disease (P = 0.012) were positively associated with overall mortality, and serum low-density lipoprotein cholesterol level (P = 0.042) was negatively associated with overall mortality. In addition, an ABI of less than 0.9 (P = 0.049), an ABI of 1.3 or more (P = 0.033), coronary artery disease (P = 0.024) and haemodialysis treatment (P = 0.043) were strong predictors for cardiovascular mortality., Conclusion: Our findings show that an ABI of 1.3 or more predicts for both overall and cardiovascular mortality, and an ABI of less than 0.9 predicts for cardiovascular mortality in CKD and haemodialysis patients. Screening patients with chronic renal failure by means of ABI may help to identify a high-risk group for increased mortality.

High prevalences of peripheral artery occlusive disease (PAOD) and increased arterial stiffness have been reported in patients with chronic kidney disease (CKD). However, these have not been assessed in Taiwan where the prevalence of CKD is high. The aim of this study was to investigate the determinants of PAOD and arterial stiffness in patients with CKD in southern Taiwan. We enrolled 169 patients with stage 3-5 CKD in one regional hospital. Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity were measured using an ABI-form device (Colin VP1000). In multivariate analysis, ABI<0.9 was positively correlated with the presence of diabetes mellitus (p=0.014) and negatively correlated with the estimated glomerular filtration rate (eGFR) (p=0.049), and increased brachial-ankle pulse wave velocity was correlated with increased age, diabetes mellitus, increased systolic blood pressure, decreased pulse pressure and decreased eGFR. This study identified determinants of PAOD and arterial stiffness in patients with CKD in one hospital in southern Taiwan. In addition to the traditional atherosclerotic risk factors, decreased eGFR was also correlated with PAOD and increased arterial stiffness in these patients.