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Even though spring ecosystems are ecologically unique and socio-culturally important worldwide, they hardly attract research attention. The aims of this study were to evaluate the environmental status of water quality, and to inventory the species diversity of aquatic animals in 65 springs in Taiwan from 2012 to 2017, of which seven springs were unable to be sampled due the fact that they were dried or sealed up. The environmental status of 58 springs with complete water quality data was assessed by the River Pollution Index (RPI). Based on the RPI, the water quality of these 58 sampled springs was mainly non-/mildly polluted (26 springs, 44.8%) and lightly polluted (23 spring, 39.6%), and nine (15.5%) springs were moderately polluted. However, when applied to springs, the RPI may intensify the pollution rankings because dissolved oxygen is an assessing factor, and hypoxia may naturally be observed in the springs. To avoid this concern, we suggest choosing the concentration of coliform instead of dissolved oxygen content in the RPI when it is applied to springs. During the 6 years of the study period, we collected 48 fish species in 44 springs, 24 gastropoda and bivalve species in 46 springs, 16 shrimp species in 34 springs, and 14 crab species in 18 springs. Within the species collected, 31 fish, 20 gastropoda and bivalves, 12 shrimps, and 14 crabs are native species of Taiwan. They totaled 27.2 to 35% of the known aquatic native species of the island. Thus, springs in Taiwan may be considered to be a conservation hotspot of aquatic animals. Other than native species, exotic aquatic animals also represent threats, as seventeen fishes (35.4%), four gastropoda and bivalves (16.6%), and two shrimps (12.5%) were found in the springs of Taiwan. The springs in Taiwan show diverse and vital ecosystem services, such as delivering social, cultural, and economic value, conserving native and endangered freshwater animals, developing new academic theories, and supplying habitat refugees from climate change. Unfortunately, springs in Taiwan currently are also threatened by multiple anthropogenic disturbances, such as the overconsumption of groundwater by land development and urbanization, deterioration of water quality by agricultural, domestic, and industrial pollution, and inappropriate tourism and management tactics. To restore and sustain the springs in Taiwan, effective strategies and practical measures are urgently required to minimize human-caused threats and revitalize social awareness of springs. [ABSTRACT FROM AUTHOR]

Background: A variety of risk factors have been identified that contribute to the development of acute mountain sickness (AMS), including past history, ascent rate, exertion prior to ascent, and cardio-pulmonary comorbidities. Ascent rate and other factors associated with AMS-induction are currently examined. Research question: It was hypothesized that rapid ascent is more likely to result in AMS than slow ascent. Type of study: Prospective study. Methods: Group allocation was by subject's preference. Young adults (18-26 years old) (N=91) chose to participate in 1 of 2 groups: Group 1 (fast ascent [3 days]; n=43) and Group 2 (slow ascent [4 days]; n=48). Groups hiked from 2370m to 3350m. Physiological measurements, including heart rate, oxygen saturation, and symptoms of AMS were monitored each morning and evening during the 5-day expedition to Jiaming Lake, Taiwan. Results: Baseline characteristics were similar between groups, except for significant differences in alcohol consumption (P=0.009) and climbing experience above 3000m (P<0.001). The incidence of AMS was not associated with the rate of ascent and was similar between groups. AMS-incidence was most prevalent in Group 1 at day 2 evening and Group 2 at day 3 evening that correlated with the initial reduction in SaO2 in each group. BMI>24 kg/m² was identified as a risk factor for AMS. Conclusions: The incidence of AMS was not associated with the rate of ascent. The development of AMS was closely associated with initial reduction of SaO2. BMI>24 kg/m² also contributed to the occurrence of AMS. [ABSTRACT FROM AUTHOR]

Background: The rising global elderly population increases the demand for caregiving, yet traditional methods may not fully assess the challenges faced by vital informal caregivers., Objective: To investigate the efficacy of Large Language Model (LLM) in detecting overburdened informal caregivers, benchmarking against rule-based and machine learning methods., Methods: 1,791 eligible informal caregivers from Southern Taiwan and utilized their textual case summary reports for the LLM. We also employed structured questionnaire results for machine learning models. Furthermore, we leveraged the visualization of the LLM's attention mechanisms to enhance our understanding of the model's interpretative capabilities., Results: The LLM achieved an Area Under the Receiver Operating Characteristic (AUROC) curve of 0.84 and an Area Under the Precision-Recall Curve (AUPRC) of 0.70, marking an 8% and 14% improvement over traditional methods. The visualization of the attention mechanism accurately reflected the evaluations of human experts, concentrating on descriptions of high-burden descriptions and the relationships between caregivers and recipients., Conclusion: This research demonstrates the notable capability of LLM to accurately identify high-burden caregivers in Long-term Care (LTC) settings. Compared to traditional approaches, LLM offers an opportunity for the future of LTC research and policymaking., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC)., Objective: This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiver burden, while the original dataset did not fully cover evaluation items commonly included in international assessments. Subsequently, we utilized the CSI-based score to pinpoint key caregiver burden risk factors, examine the initial timing of LTC services adoption, and assess the impact of LTC services on reducing caregiver burden., Methods: The study analyzed over 28,000 LTC cases in Southern Taiwan from August 2019 to December 2022. Through multiple regression analysis, we identified significant risk factors associated with caregiver burden and examined changes in this burden after utilizing various services. Survival analysis was employed to explore the relationship between adopting the first LTC services and varying levels of caregiver burden., Results: We identified 126 significant risk factors for caregiver burden. The most critical factors included caregiving for other disabled family members or children under the age of three (β = 0.74, p < 0.001), the employment status of the caregiver (β = 0.30-0.53, p < 0.001), the frailty of the care recipient (β = 0.28-0.31, p < 0.001), and the behavioral symptoms of dementia in care recipients (β = 0.28-2.60, p < 0.05). Generally, caregivers facing higher burdens sought LTC services earlier, and providing home care services alleviated the caregiver's burden., Conclusion: This comprehensive study suggests policy refinements to recognize high-risk caregivers better early and provide timely support to improve the overall well-being of both informal caregivers and care recipients., (© 2024. The Author(s).)

Introduction: We investigated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) in individuals without known diabetes in Taiwan and developed a risk prediction model for identifying undiagnosed diabetes and IFG., Research Design and Methods: Using data from a large population-based Taiwan Biobank study linked with the National Health Insurance Research Database, we estimated the standardized prevalence of undiagnosed diabetes and IFG between 2012 and 2020. We used the forward continuation ratio model with the Lasso penalty, modeling undiagnosed diabetes, IFG, and healthy reference group (individuals without diabetes or IFG) as three ordinal outcomes, to identify the risk factors and construct the prediction model. Two models were created: Model 1 predicts undiagnosed diabetes, IFG&#95;110 (ie, fasting glucose between 110 mg/dL and 125 mg/dL), and the healthy reference group, while Model 2 predicts undiagnosed diabetes, IFG&#95;100 (ie, fasting glucose between 100 mg/dL and 125 mg/dL), and the healthy reference group., Results: The standardized prevalence of undiagnosed diabetes for 2012-2014, 2015-2016, 2017-2018, and 2019-2020 was 1.11%, 0.99%, 1.16%, and 0.99%, respectively. For these periods, the standardized prevalence of IFG&#95;110 and IFG&#95;100 was 4.49%, 3.73%, 4.30%, and 4.66% and 21.0%, 18.26%, 20.16%, and 21.08%, respectively. Significant risk prediction factors were age, body mass index, waist to hip ratio, education level, personal monthly income, betel nut chewing, self-reported hypertension, and family history of diabetes. The area under the curve (AUC) for predicting undiagnosed diabetes in Models 1 and 2 was 80.39% and 77.87%, respectively. The AUC for predicting undiagnosed diabetes or IFG in Models 1 and 2 was 78.25% and 74.39%, respectively., Conclusions: Our results showed the changes in the prevalence of undiagnosed diabetes and IFG. The identified risk factors and the prediction models could be helpful in identifying individuals with undiagnosed diabetes or individuals with a high risk of developing diabetes in Taiwan., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR., Objective: To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods., Methods: We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10: 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR., Results: Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A*33:03 (Pc = 5.17 × 10 -3 , OR: 25.97, 95% CI: 3.08-219.33). Meta-analysis showed that HLA-A*33:03 was associated with SR-SJS (P = 5.01 × 10 -5 ; sensitivity: 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%., Conclusions: Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*33:03 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs., (© 2020 European Academy of Dermatology and Venereology.)

Despite the development of vaccines in 2006, rotavirus is still a major cause of acute gastroenteritis worldwide. This study was performed to analyze the presence of circulating rotaviruses before and after the introduction of rotavirus vaccines to allow phylogenetic comparisons of vaccine strains in northern Taiwan.Rotavirus genotyping and sequencing of rotavirus VP7 and VP4 PCR products were performed by Reverse Transcriptase Polymerase Chain Reaction and DNA autosequencing. Phylogenies were constructed by the neighbor-joining and maximum-likelihood methods using CLUSTAL W software included in the MEGA software package (version 6.0).Between April 2004 and December 2012, a total of 101 rotavirus specimens from pediatric patients with acute gastroenteritis hospitalized in Chang Gung Children's Hospital were amplified, and their VP4 and VP7 sequences were determined. These 101 specimens consisted of 55 pre-vaccine strains (G1 [13, 23.6%], G2 [12, 21.8%], G3 [16, 29.1%], and G9 [14, 25.5%]) and 46 post-vaccine strains (G1 [25, 54.3%], G2 [12, 26.1%], G3 [5, 10.9%], and G9 [4, 8.7%]). The most common combination of the G and P types was G2P[4], accounting for 36% cases, followed by G9P[8] (25%), G1P[8] (20%), G3P[4] (15%), G3P[8] (10%), G1P[4] (5%), and G2P[8] (5%). Phylogenetic analysis showed that only the G1 and P[8] genotypes clustered in the same lineages with the rotavirus vaccine strains.Based on our results, the inclusion of G9, modified G2 and G3 with target lineages, and the combination G2P[4] and G9P[8] in the rotavirus vaccines in Taiwan is warranted as a vaccination strategy.