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The purpose of this study was to explore the relationships among physical education teachers' psychological capital, work stress, and creative teaching at junior and senior high school levels. The questionnaire was distributed to 58 schools in Taiwan and research sample were junior and senior high school physical education teachers. 395 questionnaires were distributed, 369 questionnaires were valid for statistical analysis. Hierarchical regression was used to test the impact of teachers' psychological capital on their work stress and creative teaching. The findings showed that while self-efficacy, hope, and optimism of psychological capital significantly influenced teachers' creative teaching positively, personal interaction and professional knowledge of work stress express negative impacts. In addition, it was found that teachers with higher personal interaction stress and higher professional knowledge stress had lower creative teaching. The study suggests to increase physical education teachers' psychological capital and enhance teachers' creative teaching and students' satisfaction.

Purpose: Undertaking a standard-setting exercise is a common method for setting pass/fail cut scores for high-stakes examinations. The recently introduced equal Z standard-setting method (EZ method) has been found to be a valid and effective alternative for the commonly used Angoff and Hofstee methods and their variants. The current study aims to estimate the minimum number of panelists required for obtaining acceptable and reliable cut scores using the EZ method. Methods: The primary data were extracted from 31 panelists who used the EZ method for setting cut scores for a 12-station of medical school's final objective structured clinical examination (OSCE) in Taiwan. For this study, a new data set composed of 1,000 random samples of different panel sizes, ranging from 5 to 25 panelists, was established and analyzed. Analysis of variance was performed to measure the differences in the cut scores set by the sampled groups, across all sizes within each station. Results: On average, a panel of 10 experts or more yielded cut scores with confidence more than or equal to 90% and 15 experts yielded cut scores with confidence more than or equal to 95%. No significant differences in cut scores associated with panel size were identified for panels of 5 or more experts. Conclusion: The EZ method was found to be valid and feasible. Less than an hour was required for 12 panelists to assess 12 OSCE stations. Calculating the cut scores required only basic statistical skills. [ABSTRACT FROM AUTHOR]

Objective: Return visit to emergency department (ED) is a common phenomenon and has been a clinical indicator of quality of care in ED. Most of previous articles focused on the characteristics of the patients returning within 72 h after ED discharge, while those on subsequent admission are numbered. This study's purpose is to identify risk factors for admission among 72-h return visit in the ED adult population. Materials and Methods: This retrospective cohort study was conducted at a medical center in Eastern Taiwan. The study period was from January 1, 2013, to December 31, 2013. We excluded patients who left against medical advice or without being seen, who was admitted or transferred at the index ED visit, whose medical records were incomplete, and whose age was below 18 years old. Significant variables were selected based on univariate analysis and later entered into multivariate logistic regression analysis to identify risk factors for 72-h return admission. Results: We identified 1575 eligible visits, and there were 1,119 visits entering into the final analysis. Male gender (odds ratio [OR] = 1.44), ambulance-transport at return visit (OR = 3.68), senior staff (OR = 1.52), work-up (OR = 3.03), and longer length of stay (LOS) were associated with higher risks of admission among ED 72-h return visits. Age, comorbidity, mode of transport at index visit, consultation, triage, type of illness, outpatient department visit between ED visits, and interval between index and return visits were not significantly associated with return admission. Conclusion: Gender, mode of transportation, staff experience, check-up, and LOS are associated with ED return admission. [ABSTRACT FROM AUTHOR]

An increase in fungal spores in ambient air is reported during a spike in particulate matter (PM2.5 and PM10) aerosols generated during dust or smog events. However, little is known about the impact of ambient bioaerosols on fungal infections in humans. To identify the correlation between the incidence of pulmonary aspergillosis and PM-associated bioaerosols (PM2.5 and PM10), we retrospectively analyzed data between 2015 and 2018 (first stage) and prospectively analyzed data in 2019 (second stage). Patient data were collected from patients in three medical institutions in Tainan, a city with a population of 1.88 million, located in southern Taiwan. PM data were obtained from the Taiwan Air Quality Monitoring Network. Overall, 544 non-repeated aspergillosis patients (first stage, n = 340; second stage, n = 204) were identified and enrolled for analysis. The trend of aspergillosis significantly increased from 2015 to 2019. Influenza A (H1N1) and ambient PMs (PM2.5 and PM10) levels had significant effects on aspergillosis from 2015 to 2018. However, ambient PMs and influenza A (H1N1) in Tainan were correlated with the occurrence of aspergillosis in 2018 and 2019, respectively. Overall (2015–2019), aspergillosis was significantly correlated with influenza (p = 0.002), influenza A (H1N1) (p < 0.001), and PM2.5 (p = 0.040) in Tainan City. Using a stepwise regression model, influenza A (H1N1) (p < 0.0001) and Tainan PM10 (p = 0.016) could significantly predict the occurrence of aspergillosis in Tainan. PM-related bioaerosols and influenza A (H1N1) contribute to the incidence of pulmonary aspergillosis. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) set out to eliminate hepatitis C virus (HCV) infection by 2030, a goal Taiwan might achieve before 2025. Using effective direct antiviral agents (DAAs) against chronic hepatitis C (CHC) in Taiwan, the treatment of CHC has been initiated in rural areas. Here, we aimed to elucidate the clinical and virological characteristics of HCV infection, and the treatment efficacy of DAAs in patients from Pingtung county in southern Taiwan. Methods: A total of 152 chronic hepatitis patients treated with DAAs were consecutively enrolled. Baseline characteristics and therapeutic efficacy were evaluated. Results: HCV genotype 2 was the most common viral genotype (39.5%), followed by 1b (36.8%), 6 (10.5%), and 1a (9.2%). The sustained virological response (SVR) rate was 98.7%. Hakka patients accounted for 22.4% of the study cohort, of which 14.7% had HCV genotype 6. There were no differences in clinical characteristics between Hakka and non-Hakka patients. Patients with HCV genotype 6 were younger in age (OR/CI: 0.95/0.91-1.00, p = 0.04) and composed of more people who inject drugs (PWID) (OR/CI: 17.6/3.6-85.5, p <0.001), when compared with other patients. Conclusion: We demonstrated that DAA therapy can achieve a 98.7% SVR rate among CHC patients in Pingtung county of southern Taiwan, with a relative higher prevalence of genotype 6. The most important factor attributed to genotype 6 infection was PWID. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to determine the risk of subsequent keratitis in prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT). Materials and Methods: Three thousand three hundred and nine patients with PCa were identified using data from Taiwan's National Health Insurance Research Database for 2001 through 2013. Among those patients, 856 treated with ADT comprised the study group, while 856 non-ADT-treated patients matched with 1:1 propensity-score-matched analysis comprised the control group. The demographic characteristics and comorbidities of all the patients were analyzed, and Cox proportional hazards regression was utilized to determine the hazard ratios (HRs) for subsequent keratitis. Results: A total of 157 (9.2%) patients had newly diagnosed keratitis. Compared to the non-ADT-treated patients, the ADT-treated patients had a reduced risk of subsequent keratitis, with an adjusted HR of 0.38 (95% confidence interval: 0.27-0.55; P < 0.001). Conclusion: ADT treatment apparently decreased the risk of subsequent keratitis in the investigated PCa patients, but the clinical significance of this finding should be further assessed in additional studies. [ABSTRACT FROM AUTHOR]

Rue belongs to a perennial herb of the Sapindale order. Rue has been reported with many pharmacological properties, such as anti-cancer, anti-viral, antibacterial and anti-inflammatory effects, primarily because of large amounts of indole alkaloids and harmine in its seeds. It has been documented that the plant has been cultivated endogenously in Taiwan as a medicinal plant since the Dutch occupancy period; however, due to its long history of discontinuity and the popularity of modern medicine, the local large-scale cultivation and its corresponding downstream industries seem to have lost sight. Therefore, we collected seeds from the field and markets in the city of Chiayi as the starting materials in the present study. The seeds were germinated in a solid medium containing MS (Murashige & Skoog 1962) basic salts, and then the germinated shoot apex and cotyledons were cut out from the seedlings as explants. Subsequently, 6-benzylaminopurine (BAP) was used to induce multiple shoots. The resulting shoots were cut into single pieces and cultured in the media of 1/2 MS basic salts supplemented with 4-(indol-3-yl) butyric acid for root formation. Finally, the whole plant was transplanted out of the bottle for soil-based growth. Seeds were harvested and semi-purified by acid extraction. The content of harmine was confirmed by high-performance liquid chromatography (HPLC). The results indicate that productive rue plants can be successfully preserved using tissue culture technology, and the presence of harmine alkaloids can also be confirmed from the seeds. [ABSTRACT FROM AUTHOR]

In nature, foliar variegation has varied origins, and can be ascribed to two major mechanisms: pigment-related variegation and structural variegation caused by the optical properties of leaf structure. However, understanding of these mechanisms is still lacking, and structural mechanisms are often misinterpreted. In this study, six variegated plants native to Taiwan and two ornamental plants, with novel and unusual foliar variegation patterns, are studied to reveal their mechanisms of variegation. Two newly understood variegation patterns, the silvery white leaf surface of Begonia aptera and the varnish on basal leaflets of Oxalis corymbosa, are reported here. White to light green patches on leaf surfaces characterize the foliar variegation in the other six study species, Nervilia nipponica, O. acetosella subsp. griffithii var. formosana, Paphiopedilum concolor, Selaginella picta, Smilax bracteata subsp. verruculosa and Valeriana hsuii. All six Taiwan native plants exhibit structural variegation, five of which have air space type variegation. Surprisingly the silvery white leaf surface of B. aptera results from numerous sand-like white spots caused by intercellular space. The varnish on leaves of O. corymbosa is the epidermis type of variegation comprised of two newly identified subtypes, larger epidermal cells and thicker outer cell walls. The two ornamental plants have variegation caused by pigments: the chloroplast type from fewer chloroplasts in P. concolor and the chlorophyll type, from absence of chloroplasts in S. picta. This study extends understanding of the mechanisms of natural foliar variegation, illustrating the diversity of mechanisms by which plants may change the appearance of their leaves. [ABSTRACT FROM AUTHOR]

Purpose: Senior nursing and medical interns' lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees' self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne's learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan. Methods: From 2017 to 2019, the VR system was developed and applied in training of59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors. Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention. Conclusion: This self-developed VR game system using Gagne's flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship. [ABSTRACT FROM AUTHOR]

Taiwan is expected to become a "super-aged" nation in 2065. Modern medical advancements, while extending the average human lifespan, has led to higher incidence of patient suffering and greater medical expenses due to chronic disease and terminal illnesses. As the concept and services of hospice and palliative care have become increasingly accepted by the public, the issue of final care for a good death has become a priority concern for both patients and their families. Experiencing a good death at home is a common last wish for terminal patients. However, guidelines for good death at home are still unavailable in Taiwan. The promotion of this concept thus remains a challenge with many limitations. This article aims to explore: (1) the importance of hospice care; (2) the selection of a proper location for good death; (3) the requirements for nursing education in the care of dying patients; and (4) the challenges and strategies of a good death at home, including "the family dimension- connections with the family members" and "the education dimension-promotion of home-based dying in nursing education". The goal is to help terminal patients experience a good death at home, to assist family members embrace the good death of their loved ones, and, eventually, to facilitate peaceful and successful home-based dying for both the patient and their family members. [ABSTRACT FROM AUTHOR]

Background/purpose: The role of directly-acting antivirals (DAA)-containing regimens in the treatment of patients dually-infected with hepatitis C virus (HCV) and hepatitis B virus (HBV) remains unclear. The pilot study aimed to explore the safety and efficacy of a protease inhibitor, boceprevir, in combination with peginterferon/ribavirin for HCV genotype 1 (HCV-1)/HBV dually-infected patients refractory to prior peginterferon/ribavirin.Methods: Twelve peginterferon-experienced patients dually-infected with HCV-1/HBV were assigned to receive boceprevir 800 mg, twice a day, plus peginterferon-α 2b 1.5 μg/kg/week and ribavirin 800-1400 mg/day for 36 or 48 weeks. The primary endpoint was HCV sustained virological response (SVR, HCV RNA undetectable 24 weeks after end-of-treatment).Results: Five patients terminated treatment early due to adverse events (one at week 4, one at week 46), virological failures (one non-response and one breakthrough), and patient request (n = 1). Eight patients achieved HCV SVR (66.7% in full-analysis set and 72.7% in modified intention-to-treat population). The HCV SVR rate was 71.4% (5/7) in prior relapsers, 60.0% (3/5) in prior null responder; 75% in non-cirrhotic and 50% in cirrhotic patients. All four patients of prior non-cirrhotic relapsers received 36-week regimen and achieved HCV SVR. There was no HBV-related hepatic flare. All patients experienced at least one adverse event. Two had serious adverse events.Conclusion: Boceprevir plus peginterferon/ribavirin is effective in the treatment of HCV-1/HBV dually infected patients' refractory to prior peginterferon/ribavirin combination therapy. [ABSTRACT FROM AUTHOR]

This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizingmaps and K-means method is applied to segment 1,462 patients into twelve clusters.The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F.When different types of patients are identified, marketing strategies can be designed to meet different patients' needs. [ABSTRACT FROM AUTHOR]

Background: Perfluorinated compounds (PFCs) are ubiquitous pollutants. Experimental data suggest that they may be associated with adverse health outcomes, including asthma. However, there is little supporting epidemiological evidence. Methods: A total of 231 asthmatic children and 225 nonasthmatic controls, all from northern Taiwan, were recruited in the Genetic and Biomarkers study for Childhood Asthma. Structure questionnaires were administered by face-to-face interview. Serum concentrations of 11 PFCs and levels of immunological markers were also measured. Associations of PFC quartiles with concentrations of immunological markers and asthma outcomes were estimated using multivariable regression models. Results: Nine PFCs were detectable in most children (≥ 84.4%), of which perfluorooctane sulfonate (PFOS) was the most abundant (median serum concentrations of 33.9 ng/mL in asthmatics and 28.9 ng/mL in controls). Adjusted odds ratios for asthma among those with the highest versus lowest quartile of PFC exposure ranged from 1.81 (95% CI: 1.02, 3.23) for the perfluorododecanoic acid (PFDoA) to 4.05 (95% CI: 2.21, 7.42) for perfluorooctanic acid (PFOA). PFOS, PFOA, and subsets of the other PFCs were positively associated with serum IgE concentrations, absolute eosinophil counts (AEC), eosinophilic cationic protein (ECP) concentrations, and asthma severity scores among asthmatics. Conclusions: This study suggests an association between PFC exposure and juvenile asthma. Because of widespread exposure to these chemicals, these findings may be of potential public health concern. [ABSTRACT FROM AUTHOR]

Background: This study is to determine the seroprevalence of the pandemic influenza A H1N1 virus (pH1N1) in Taiwan before and after the 2009 pandemic, and to estimate the relative severity of pH1N1 infections among different age groups. Methodology/Principal Findings: A total of 1544 and 1558 random serum samples were collected from the general population in Taiwan in 2007 and 2010, respectively. Seropositivity was defined by a hemagglutination inhibition titer to pH1N1 (A/Taiwan/126/09) &ges;1:40. The seropositivity rate of pH1N1 among the unvaccinated subjects and national surveillance data were used to compare the proportion of infections that led to severe diseases and fatalities among different age groups. The overall seroprevalence of pH1N1 was 0.91% (95% confidence interval [CI] 0.43-1.38) in 2007 and significantly increased to 29.9% (95% CI 27.6-32.2) in 2010 (p<0.0001), with the peak attack rate (55.4%) in 10-17 year-old adolescents, the lowest in elderly &ges;65 years (14.1%). The overall attack rates were 20.6% (188/912) in unvaccinated subjects. Among the unvaccinated but infected populations, the estimated attack rates of severe cases per 100,000 infections were significantly higher in children aged 0-5 years (54.9 cases, odds ratio [OR] 4.23, 95% CI 3.04-5.90) and elderly &ges; 65years (22.4 cases, OR 2.76, 95% CI 1.99-3.83) compared to adolescents aged 10-17 years (13.0 cases). The overall case-fatality rate was 0.98 per 100,000 infections without a significant difference in different age groups. Conclusions/Significance: Pre-existing immunity against pH1N1 was rarely identified in Taiwanese at any age in 2007. Young children and elderly - the two most lower seroprotection groups showed the greatest vulnerability to clinical severity after the pH1N1 infections. These results imply that both age groups should have higher priority for immunization in the coming flu season. [ABSTRACT FROM AUTHOR]

Background: The C-type lectin DC-SIGN (CD209) is known to be the major dengue receptor on human dendritic cells, and a single nucleotide polymorphism (SNP) in the promoter region of CD209 (2336 A/G; rs4804803) is susceptible to many infectious diseases. We reason that variations in the DC-SIGN gene might have a broad influence on viral replication and host immune responses. Methods and Findings: We studied whether the rs4804803 SNP was associated with a susceptibility to dengue fever (DF) and/or dengue hemorrhagic fever (DHF) through genotyping analysis in a Taiwanese cohort. We generated monocytederived dendritic cells (MDDCs) from individuals with AA or AG genotype of rs4804803 to study the viral replication and immune responses for functional validation. A total of 574 DNA samples were genotyped, including 176 DF, 135 DHF, 143 other non-dengue febrile illnesses (OFI) and 120 population controls. A strong association between GG/AG genotypes of rs4804803 and risk of DHF was found when compared among DF, OFI and controls (p = 0.004, 361025 and 0.001, respectively). The AA genotype was associated with protection against dengue infection compared with OFI and controls (p = 0.002 and 0.020, respectively). Moreover, MDDCs from individuals with AG genotype with a higher cell surface DC-SIGN expression had a significantly higher TNFa, IL-12p40, and IP-10 production than those with AA genotype in response to dengue infection. However, the viral replication in MDDCs with AG genotype was significantly lower than those with AA genotype. With both genotypes, MDDCs revealed an increase in viral replication following the addition of anti-IP-10 neutralizing antibody. Conclusions/Significance: The rs4804803 SNP in the CD209 promoter contributed to susceptibility to dengue infection and complication of DHF. This SNP with AG genotype affects the cell surface DC-SIGN expression related to immune augmentation and less viral replication. [ABSTRACT FROM AUTHOR]

Classification, which is the task of assigning objects to one of several predefined categories, is a pervasive problem that encompasses many diverse applications. Decision tree classifier, which is a simple yet widely used classification technique, employs training data to yield decision rules; moreover, it can create thresholds and then split the list of continuous attributes into descrete intervals for handling continuous attributes (Quinlan in Journal of Artificial Intelligence Research 4:77–90, 1996). Rough set theory (Pawlak in International Journal of Computer and Information Sciences 11:341–356, 1982; International Journal of Man-Machine Studies 20:469–483, 1984; Rough sets: theoretical aspects of reasoning about data. Kluwer, Dordrecht, 1991) has been applied to a wide variety of decision analysis problems for the extraction of rules from databases. This paper proposes a hybrid approach that takes advantage of combining decision tree and rough sets classifier and applies it to plant classification. The introduced approach starts with decision tree classifier (C4.5) as preprocessing technique to make interval-discretization, subsequently, and uses rough set method for extracting rules. The proposed approach aims at finding out classification rules via analyzing lamina attributes (leaf stalk, leaf width, leaf length, length/width ratio) of Cinnamomum, which are gathered and measured by plant specialists in the field of Taiwan. A comparison with the widely used algorithms (e.g., decision tree, multilayer perceptrons, naïve Bayes, and rough sets classifier) is carried out to show numerous advantages of the proposed approach. Finally, employing with test data in which species are unknown, results of classification are approved by consulting the relative plant specialists. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study investigating the risk factors for mortality among patients with Vibrio vulnificus septicemia in Taiwan. Septic shock is a determinant of fatality in patients with V. vulnificus in patients without hemorrhagic bullous necrotic cutaneous lesion. The combination of a third-generation cephalosporin and tetracycline is a better choice in antimicrobial treatment of V. vulnificus septicemia patients with hemorrhagic bullous necrotic cutaneous lesion.

Residents in Taiwan are often exposed to marine microorganisms through seafood and occupational exposure. The number of reported cases of infection attributable to this organism has increased since the first case was reported in 1985. The increasing number of cases may be caused by greater disease activity of improved recognition by clinicians or laboratory workers. We analyze a clinical case series of 84 patients with Vibrio vulnificus infection from 1995 to 2000 and describe the molecular epidemiologic features of pathogens isolated from these patients. The spectrum of clinical manifestations and outcomes, options of antimicrobial therapy, and virulence mechanisms were investigated. Results of molecular typing of isolates from humans and marine environment in this country had a high genetic divergence among these isolates. Education and measures are needed to prevent this emerging disease. [ABSTRACT FROM AUTHOR]

Salmonella enterica serotype Choieraesuis is a highly invasive pathogen that infects humans and causes systemic infections that require antimicrobial therapy. Surveillance in Taiwan showed that fluoroquinolone resistance in S. Choleraesuis markedly increased from 2000 to 2003, reaching approximately 70% in 2003. [ABSTRACT FROM AUTHOR]