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This study aims to investigate how a teacher's creative teaching is affected by the teacher's imagination and his or her school principal's visionary leadership, and how the contextual moderating effects are at play among the cross-hierarchical factors. The research framework is divided into two levels: the individual level on how "teacher's imagination" affects "teacher's creative teaching" and the group level on the impact of "the principal's visionary leadership." From the teachers of 65 primary schools in southern Taiwan invited to participate in the survey study, 861 valid data were returned. The cross-level moderating effects were further examined via hierarchical linear modeling (HLM). The result shows that the "teacher's imagination" will impact the "creative teaching" positively. The "vision practice" will affect "autonomous learning and challenge-presenting" positively as well. Moreover, the "vision feedback" plays a positive moderator role in how "creative imagination" contributes to "interactive discussion and open-mindedness." The implication of the study is to discover the predictive model which inspired the students' creativity potential by cross-hierarchical perspective.

Drawing on Dewey's pragmatic perspective on talent cultivation and previous research on promoting employee creativity in industry, this study investigates student creativity performance in relation to teacher's encouragement, intrinsic motivation, and creative process engagement. Based on survey data collected from 140 vocational high school students who participated in a nation-wide contest in Taiwan, path analyses were performed using structure equation modeling techniques. The results indicate that both teacher's encouragement and intrinsic motivation have a significant, although indirect, effect on student creativity, and that creative process engagement, as opposed to teacher encouragement or intrinsic motivation, has a direct and significant mediating effect on student creativity. This finding is in partial agreement with prior research which reports student creativity is positively associated with teacher encouragement and intrinsic motivation, highlighting the mediating role of creative process engagement in facilitating student creative performance.

Groundwater nitrate–N pollution is common in agricultural regions, mainly originating from surface agricultural activities. Integrating spatial information on nitrate–N observations and agricultural land uses is crucial for establishing groundwater pollution zones. To combine agricultural land uses into groundwater nitrate–N pollution, this study used regression kriging (RK) to determine groundwater pollution zones in the Choushui River alluvial fan in Taiwan. First, a multivariate linear regression (MLR) model was employed to explore the relationship between groundwater nitrate–N pollution and agricultural land-use types. Then, simple kriging (SK) was adopted to analyze residuals obtained from gaps between nitrate–N observations and MLR predictions; the SK estimates of the residuals with the addition of the MLR predictions served as the RK estimates for groundwater nitrate–N pollution. Finally, groundwater pollution zones were determined according to a specific anthropogenic nitrate–N pollution level. The study results revealed that the "orchard" land-use type positively contributed to groundwater nitrate–N in contract to the "livestock house" and "agricultural facility" land-use types, which were negatively related to groundwater nitrate–N. Moreover, the RK estimates, which had the ability to characterize the potential pollution source of the orchard land-use type and enhanced the accuracy of the classification of polluted and unpolluted areas through modification of the residuals, were suitable for establishing groundwater pollution zones. In addition, feasible management strategies of orchards located in the groundwater pollution zones must be implemented to reduce nitrate–N leaching. [ABSTRACT FROM AUTHOR]

Empirical studies have found that participation in international service increases learners' intercultural competence, language skills, appreciation of cultural differences, and tolerance for ambiguity. While previous studies suggest that international service experience is potentially transformative in nature, the present study examined international service experience and explored the factors that encourage transformation. Based on transformative learning and social psychology, the theoretical framework of the present study included three perspectives: environment-person interaction, schema adjustment, and the Johari Window. Data were obtained from 10 international service participants by observation, semistructured interviews, and written documents. Analysis of the data identified three components that enhanced transformation through environment-person interaction in cross-cultural settings: exploring the unknown world, relearning from the basic levels, and the unknown self revealed. (Contains 2 figures.)

The characteristics of nitrogen contamination of shallow groundwater were evaluated through current status analysis and trend detection of ammonium–N and nitrate–N concentrations under various cropping patterns to assess the effectiveness of rational fertilization in the Choushui River alluvial fan, central Western Taiwan. The influence of cropping patterns on both ammonium–N and nitrate–N contamination associated with redox conditions/dissolved oxygen (DO) in shallow groundwater was also discussed in this study. The analysis revealed that shallow groundwater beneath double rice cropping and rotational cropping regions is still characterized by high ammonium–N concentration despite rational fertilization promotion. However, very few monitoring wells showed an upward trend of ammonium–N/nitrate–N concentrations, indicating that shallow groundwater is not further deteriorated by nitrogen pollution in most parts of the study area. Therefore, the remediation of nitrogen contaminated groundwater will be a long-term process and more effort must be invested. Moreover, the strict redox conditions defined by a single DO threshold value may not account for groundwater nitrogen pollution in the study area. It is difficult to determine the redox conditions and predominant nitrogen pollution patterns of shallow groundwater purely from cropping patterns. Instead, contamination may have resulted from an integrated process governed by several other factors. Tracing the potential sources of nitrogen pollution and establishing a more integral monitoring network should be implemented to formulate a more comprehensive nitrogen pollution control strategy in this area. [ABSTRACT FROM AUTHOR]

Nowadays, enterprises are trying hard to reach sustainability when the industry faces the challenge of high cost in the era of meager profit. Companies with corporate sustainable approaches based on cost leadership are trying to reduce operational expenses, increase business efficiency, and implement comprehensive cost reductions within their organisations. Cost is a strategic issue for businesses to survive and stand out. The deployment of profit costs is becoming strategically important to be sustainable and competitive in the market. The research design of this study integrates both qualitative and quantitative methods. 143 valid responses to snowball sampling in Taiwan (108 responses) and mainland China (35 responses) and 24 interviews with executive-level employees in Taiwan were conducted. In addition, a total of 51 companies' financial statements were reviewed to triangulate the foundation of research findings. Reducing costs strategically should be considered as a principal concern of a firm that wants to make its efforts for business sustainability. The result shows that nonstrategic costs are between 10 and 30 percent of the sales turnover (revenue) in a firm, and strategic costs normally account for 70 to 90 percent of its all costs. Furthermore, only 20% really makes a difference to stand out from other market players. This provides a new orientation of cost management opinion that there is a need for paying more attention and extending the concept of strategic cost management to the management of nonstrategic costs. It is also supported that the dichotomy of nonstrategic and strategic is a viable and practical way for managing all costs across sectors, industries, and business scales from a strategic and sustainable perspective. [ABSTRACT FROM AUTHOR]

Short-term load forecast (STLF) plays an important role in power system operations. This paper proposes a spline bases-assisted Recurrent Neural Network (RNN) for STLF with a semi-parametric model being adopted to determine the suitable spline bases for constructing the RNN model. To reduce the exposure to real-time uncertainties, interpolation is achieved by an adapted mean adjustment and exponentially weighted moving average (EWMA) scheme for finer time interval forecast adjustment. To circumvent the effects of forecasted apparent temperature bias, the forecasted temperatures issued by the weather bureau are adjusted using the average of the forecast errors over the preceding 28 days. The proposed RNN model is trained using 15-min interval load data from the Taiwan Power Company (TPC) and has been used by system operators since 2019. Forecast results show that the spline bases-assisted RNN-STLF method accurately predicts the short-term variations in power demand over the studied time period. The proposed real-time short-term load calibration scheme can help accommodate unexpected changes in load patterns and shows great potential for real-time applications. [ABSTRACT FROM AUTHOR]

Selection of the most appropriate contractor is critical for a successful project. There has been no practical analytic model for objective determination of the most appropriate contractor selection method (CSM) before the tendering evaluation. Most existing models adopt the posttendering bidding data for a specific procurement project rather than those from all potential bidders who may enter the procurement market. To resolve the long-unsolved problem of the existing models, this paper proposes a pretendering contractor selection analysis model (PreCSAM) based on historical procurement data, which can determine the most appropriate of the three prevailing contractor selection methods, e.g., lowest tender (LT), best value (BV), and prequalified lowest tender (PQLT). The three-stage model validation of the proposed method revealed that the proposed PreCSAM is able to suggest a CSM with 100% correctness compared with those reported in literature; it also achieved a high precision rate (94.12%) of market range prediction for a retrospective analysis of 23 public building construction projects from 2012 to 2018 procurements by the Construction and Planning Agency of the Ministry of Interior, Taiwan. Most importantly, the proposed PreCSAM overcomes the limitations of posttendering analysis of all existing methods in determining CSM. [ABSTRACT FROM AUTHOR]

This study aims to expose the "causal core" items of LibQUAL+™ from professional librarians' views. The objective is to prioritize limited resources to improve the most influential factors affecting the library service quality. Valid LibQUAL+™ questionnaires from thirty-two university library administrators in Taiwan are collected for analysis. The Decision Making Trial and Evaluation Laboratory (DEMATEL) technique is employed to build causal maps that can clearly locate the twenty-two LibQUAL+™ question items into four quadrants: core causal, inferior causal, inferior effect, and core effect. The DEMATEL causal maps can facilitate the library administrators to prioritize the limited resources for improvement. Five "causal core" items of LibQUAL+™ are identified, including the library staff should be motivated with high willingness to help users and giving users individual attention; the library amenities should provide a quiet space for individual activities; the library Web site should allow users to locate and access information easily and individually. The survey data represent what professional librarians' think of the service quality in their libraries. The findings may serve as useful guidance to allocate limited budgets for library service improvement. This paper has pinpointed the "core causal" items of LibQUAL+™ for advancing library administration. It is the first of its kind in the literature to use the DEMATEL technique to identify the "core causal" items of LibQUAL+™ for improving library service quality. [ABSTRACT FROM AUTHOR]

Introduction: The effectiveness of varenicline compared with nicotine replacement therapy (NRT) in achieving smoking cessation in older smokers has not been investigated. This study prospectively compared the effectiveness of varenicline relative to NRT in smokers aged 25-54 years and separately in smokers aged 55 years or older.Methods: Among 13 397 smokers participating in the Smoking Cessation Program in Taiwan, 2012-2015, 6336 (19.2%, aged ≥55) received varenicline and 7061 received NRT patch or gum (23.2%, aged ≥55). Participants self-reported smoking behaviors by phone interview after 6 months. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for 7-day, 1-month, and 6-month point-prevalence abstinence. Age-specific models adjusted for sex, education, marital status, smoke-years, nicotine dependence, medical institution, clinic visit number, and duration of medication received.Results: Among smokers aged 25-54 years, varenicline users had a greater point-prevalence abstinence than NRT users (e.g., 7-day point-prevalence: 34.0% vs. 23.5%), with adjusted OR ranging from 1.23 (CI: 1.09-1.39; 6-month point-prevalence) to 1.37 (CI: 1.24-1.50; 1-month point-prevalence). Among smokers aged 55 years or older, point-prevalence was similar for varenicline and NRT users (e.g., 7-day point-prevalence: 32.3% vs. 33.1%), and ORs did not suggest that varenicline has greater effectiveness than NRT. Sex and level of nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT.Conclusions: Varenicline did not offer greater effectiveness in achieving abstinence than NRT for smokers 55 years or older, whereas it was more effective than NRT in smokers aged 25-54 years. These findings highlighted the need for age-specific approaches for effective tobacco control.Implications: In this prospective investigation of a national cohort, older smokers (aged ≥55 years) who received varenicline did not have a greater point-prevalence abstinence after 6 months compared with those who used NRT patch or gum. Younger smokers (aged 25-54 years) who received varenicline had a greater likelihood of abstinence than NRT users. Sex and nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT patch or gum. Age-appropriate approaches for effective tobacco control are needed. [ABSTRACT FROM AUTHOR]

Background While the impact of burnout on organisational commitment has been widely observed, its impact on nursing professional commitment has not previously been investigated. The literature has clarified that professional commitment has three distinct components: affective, continuance and normative. Aims This study aims to investigate the relationships between burnout and the three components of nursing professional commitment. Methods This was a cross-sectional study using questionnaires to collect data in one large medical centre. Responses from 571 nurses were used for regression analysis. Among the sampled nurses, 90.9% had <15 years of nursing experience. MBI- HSS was used for measuring burnout. Three components of nursing professional commitment came from Meyer et al. (J Appl Psychol, 78, 1993 and 538) a formally validated instrument. Results Analytical results indicated that burnout is negatively related to affective and normative professional commitment (B ≤ −0.09, p < 0.01), but not related to continuance professional commitment (B = 0.05, p > 0.05). Linking evidence to action Nurse managers aiming to improve nurses' professional commitment should consider reducing nurses' burnout, for example improving nursing optimism and reducing administrative tasks, as suggested by the literature. [ABSTRACT FROM AUTHOR]

Methadone maintenance therapy is an effective treatment for opiate dependence, but more than three-quarters of persons receiving the treatment report sleep quality disturbances. In this double-blind, randomized, controlled trial, we recruited 90 individuals receiving methadone for at least one month who reported sleep disturbances and had Pittsburgh Sleep Quality Index (PSQI) scores > 5. The purpose of this study was to determine whether Suan Zao Ren Tang, one of the most commonly prescribed traditional Chinese medications for treatment of insomnia, improves subjective sleep among methadone-maintained persons with disturbed sleep quality. Ninety patients were randomly assigned to intervention group (n=45) and placebo group (n=45), and all participants were analyzed. Compared with placebo treatment, Suan Zao Ren Tang treatment for four weeks produced a statistically significant improvement in the mean total PSQI scores (P=0.007) and average sleep efficiency (P=0.017). All adverse events (e.g., lethargy, diarrhea, and dizziness) were mild in severity. Suan Zao Ren Tang is effective for improving sleep quality and sleep efficiency among methadone-maintained patients with sleep complaints. [ABSTRACT FROM AUTHOR]

Scant scientific evidence supports the efficacy of acupuncture in the treatment of opiate dependence. The purpose of this study was to examine the effectiveness of acupuncture for heroin addicts on methadone maintenance by measuring the daily consumption of methadone, variations in the 36-item Short Form Health Survey-36 (SF-36) and Pittsburgh Sleep Quality Index (PSQI) scores, and heroin craving. Sixty heroin addicts were randomly assigned to true acupuncture (electroacupuncture at the Hegu [LI4] and Zusanli [ST36] acupoints, as well as acupuncture at the Ear Shenmen) or sham acupuncture (minimal acupuncture at the Hegu and Zusanli acupoints without electrical stimulation and superficial acupuncture at the Ear Shenmen), twice weekly for 4 weeks. From week 2 onwards, the daily dose of methadone was reduced by a significantly greater amount with true acupuncture compared with sham acupuncture. True acupuncture was also associated with a greater improvement in sleep latency at follow-up. All adverse events were mild in severity. Acupuncture appears to be a useful adjunct to methadone maintenance therapy (MMT) in heroin addiction. [ABSTRACT FROM AUTHOR]

Although many scoring models have been developed in literature to offer financial institutions guidance in credit granting decision, the purpose of most scoring models are to improve their discrimination ability, not their explanatory ability. Therefore, the conventional scoring models can only provide limited information in the relationship among customer demographics, default risk, and credit card attributes, such as APR (annual percentage rate) and credit limits. In this paper, a Bayesian behavior scoring model is proposed to help financial institutions identify factors which truly reect customer value and can affect default risk. To illustrate the proposed model, we applied it to the credit cardholder database provided by one major bank in Taiwan. The empirical results show that increasing APR will raise the default probability greatly. Single cardholders are less accountable for credit card repayment. High income, female, or cardholders with higher education are more likely to have good repayment ability. [ABSTRACT FROM AUTHOR]

Gastric cancer is one of the most common malignant cancers due to poor prognoses and high mortality rates worldwide. However, an effective chemotherapeutic drug without side effects remains lacking. Saussurea involucrata (SI) Kar. et Kir., also known as snow lotus, grows in mountainous rocky habitats at 2600 m elevation in the Tian Shan and Aer Tai regions of China. The ethyl acetate extract of SI had been shown to inhibit proliferation and induce apoptosis in various tumor cells. In this study, we demonstrated that Hispidulin, active ingredients in SI, inhibits the growth of AGS gastric cancer cells. After Hispidulin treatment, NAG-1 remained highly expressed, whereas COX-2 expression was downregulated. Flow cytometric analysis indicated that Hispidulin induces G1/S phase arrest and apoptosis in time- and concentration-dependent manners. G1/S arrest correlated with upregulated p21/WAF1 and pl6 and downregulated cyclin D1 and cyclin E, independent of p53 pathway. In addition, Hispidulin can elevate Egr-1 expression and ERK½ activity, whereas ERK½ inhibitor markedly attenuated NAG-1 mediated apoptosis. Taken together, Hispidulin can efficiently activate ERK½ signaling followed by NAG-1 constitutive expression and trigger cell cycle arrest as well as apoptosis in cancer cell. It can be a potential compound for combination therapy of gastric cancer in the future. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan. This retrospective study evaluated the clinical and microbiological characteristics of bacteremic community-acquired pneumonia due to K. pneumoniae in Taiwanese adults. Methods: The clinical characteristics of bacteremic community-acquired pneumonia (CAP) in adults due to K. pneumoniae were compared to those of adults with bacteremic CAP due to Streptococcus pneumoniae at a tertiary medical center in Taiwan from 2001-2008. Risk factors for mortality of bacteremic CAP due to K. pneumoniae were analyzed. All clinical isolates of K. pneumoniae were examined for capsular serotypes, hypermucoviscosity phenotype, aerobactin and rmpA gene. Results: K. pneumoniae was the dominant cause of bacteremic CAP and was associated with a more fulminant course and a worse prognosis than bacteremic CAP due to Streptococcus pneumoniae. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality. Serotype K1 and K2 comprised around half of all isolates. There were no significant differences in the clinical characteristics of patients with bacteremic CAP due to K1/K2 and non-K1/K2 isolates. Hypermucoviscosity phenotype as well as the aerobactin and rmpA genes were highly prevalent in the K. pneumoniae isolates. Conclusions: K. pneumoniae continued to be the dominant cause of bacteremic CAP in Taiwanese adults during 2001-2008. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality from K. pneumoniae bacteremic CAP. Serotypes K1/K2 comprised around half of all isolates, but did not predispose patients to a poor clinical outcome. Physicians should be aware of the poor prognosis of any patient with bacteremic K. pneumoniae CAP and monitor these patients more closely. [ABSTRACT FROM AUTHOR]

Background: To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan.Methods: We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders.Results: Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p < 0.001).Conclusions: The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible. [ABSTRACT FROM AUTHOR]

Taiwan is an aging society and the ratio of falls among the older persons is high. Most falls occur at home, and multiple risk factors including home safety are involved. We propose a novel model of emergency medical technicians (EMTs) to assess home safety using scalable checklists. This study was conducted to evaluate its feasibility. This study was conducted between April 1, 2020 and March 31, 2021. The development of the risk factor assessment scale for falls in the home environment was divided into 2 stages. In stage 1, 2 researchers reviewed the extant literature. In stage 2, 6 experts judged the content validity index. According to EMT findings, emergency department (ED) nurses checked the items in the Checklist of Risk Factors for Falls in the Home Environment. The checklists were provided to the geriatric care manager (GCM) in the ED, who then discussed potential solutions with the patients or primary caregivers. A total of 235 participants were enrolled, and EMTs carried out environment assessment for 93.2% (219/235) of them. A total of 207 participants were at risk of falls at home and 79.7% (165/207) of them received intervention measures from the GCM according to the risk items. Education was the main intervention method, with 158 subjects. Moreover, seven subjects (4.2%, 7/165) were provided long-term care resources by the GCM with occupational therapists to help improve the environment at home. Our study provides an efficient method for EMTs to assess home fall hazards., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Importance: Psychometric examinations for patients with stroke remain insufficient. The Center for Epidemiologic Studies Depression Scale (CES-D), Beck Depression Inventory-II (BDI-II), and Geriatric Depression Scale (GDS) are promising outcome measures., Objective: To examine and compare the reliability and validity of three depression measures in a sample of patients with stroke., Design: Repeated-measures design., Setting: A hospital in southern Taiwan., Participants: Fifty-nine outpatients, who completed three depression measures., Outcomes and Measures: Cronbach's α and intraclass correlation coefficients (ICCs) were used to examine the internal consistency and test-retest reliability, respectively, of the three measures. An independent-samples t test was conducted to compare two groups of patients with different levels of disability to investigate discriminative validity. Pearson's rs were calculated among the three measures to examine concurrent validity., Results: The three measures had good internal consistency (α = .85-.92) and sufficient test-retest reliability (ICC = .84-.91). The minimal detectable change (percentage of minimal detectable change) was 10.6 (63.3%), 13.5 (98.3%), and 5.8 (49.9%) for the CES-D, BDI-II, and GDS, respectively. There was a statistically significant difference between the two groups in CES-D score (p = .032) and no significant differences on the other two measures (p = .095-.187). The correlations among the three measures ranged from .79 to .89., Conclusion and Relevance: All three depression measures had sound internal consistency, test-retest reliability, and concurrent validity in patients with stroke. What This Article Adds: Of the three measures, the CES-D had better discriminative validity, and the GDS demonstrated greater reliability and smaller random measurement error in patients with stroke., (Copyright © 2022 by the American Occupational Therapy Association, Inc.)

Mungbean ( Vigna radiata (L.) R. Wilczek), an important legume crop in Asia, is primarily cultivated in the central-southern region of western Taiwan. In 2020, mungbean exhibiting typical phytoplasma-induced disease symptoms such as witches' broom, phyllody, virescence, and proliferation was observed in Yunlin County, Taiwan. Moreover, the seed harvested from diseased plants displayed premature germination. Transmission electron microscopy examination of leaf veins prepared from symptomatic mungbean demonstrated that the occlusion of sieve tubes resulted from the accumulation of phytoplasma-like bodies in sieve elements along with filament-like structures in sieve pores. The association of phytoplasma in symptomatic mungbean was confirmed by PCR analyses of the 16S ribosomal RNA (rRNA) and immunodominant membrane protein genes. Further analyses of the 16S rRNA-based phylogenetic tree and the i PhyClassifier-based virtual restriction fragment length polymorphism study demonstrated that the phytoplasma-associated mungbean phyllody disease identified in this study belongs to the 16SrII-V subgroup. BLAST analysis and the phylogenetic analysis indicated that the SAP11-like protein identified in mungbean phyllody disease is identical to peanut witches' broom phytoplasma SAP11, which explains the witches' broom phenotype observed in symptomatic mungbean. The results described in this report confirm that the 16SrII-V phytoplasma, a widely distributed phytoplasma associated with peanut witches' broom disease in Taiwan, has also infected mungbean. This is not only the first instance of mungbean phyllody disease found in Taiwan but also the first instance of mungbean phyllody disease caused by 16SrII-V subgroup phytoplasma.

Background: Surgical excision with adjuvant radiotherapy has gained attention as an effective treatment of keloid. The Asian population is challenged with a high incidence of keloid occurrence with a specific genetic predominance. The annual reported incidence of new keloid cases in Taiwan is around 30,000, but the disease control rate and effectiveness by means of surgical excision with adjuvant radiotherapy is not yet clear., Methods: A retrospective chart review of the included consecutive keloid patients receiving surgical excision and radiotherapy was performed from 2013 to 2016 in a single institute. The reported risk factors were collected to investigate according to the outcome analysis. The Vancouver Scar Scale and the Japan Scar Workshop (JSW) Scar Scale were used to evaluate the correlation with keloid recurrence., Results: In this series, the overall recurrence rate was 32%, reported with an average follow-up of 28 months. Independent risk factors varied according to the different outcome variables. Only JSW classification score independently predicted the risk of keloid recurrence (odds ratio, 1.305; P = 0.02). Both the Vancouver Scar Scale and the JSW system showed a good correlation with keloid recurrence (correlation efficiency, 0.529 and 0.54; P = 0.0437 and 0.0165, respectively)., Conclusions: This preliminary report revealed convincing evidence of feasibility and effectiveness of applying adjuvant radiotherapy after keloid excision in the Taiwanese population. A more delicate biological equivalent dose of radiotherapy with an effective local control should be considered to improve the final outcome.

Background/purpose: Reports detailing bacteremia caused by Chryseobacterium indologenes remain limited, with most cases reported in Taiwan. The clinical significance of C. indologenes has not been fully established. This retrospective study investigated the clinical features and antimicrobial susceptibility of C. indologenes bacteremia., Methods: Patients with C. indologenes bacteremia were identified at a medical center/teaching hospital in northern Taiwan between January 1, 2004 and January 31, 2008. Clinical features and the antimicrobial susceptibilities of these patients were analyzed., Results: Sixteen isolates of C. indologenes from 16 episodes in 16 patients were identified, with all patients having underlying diseases. Two patients (12.5%) had polymicrobial bacteremia. The portal of bacteremia was not determined in most cases. Other clinical syndromes included catheter-related bacteremia, urinary tract infection and peritonitis. The majority of patients had undergone invasive procedures. Other associated conditions included immunosuppression, neutropenia and prolonged use of antibiotics. Only three patients were treated with appropriate antibiotics according to minimum inhibitory concentrations. The susceptibilities of isolates to trimethoprim-sulfamethoxazole (75.0%), levofloxacin (62.5%), piperacillin-tazobactam (50.0%), ciprofloxacin (43.75%) and cefepime (12.5%) were variable and the bacteremia-related mortality rate was 6.25%., Conclusion: C. indologenes isolates are resistant to multiple antibiotics, with newer fluoroquinolones and trimethoprim-sulfamethoxazole possibly representing the most appropriate antimicrobial agents to treat infections caused by this pathogen. However, the pathogenicity and factors of virulence for C. indologenes remain unclear, with our study revealing favorable outcomes of C. indologenes bacteremia. Epidemiological surveillance of this organism in Taiwan and extensive worldwide surveillance programs are required., (Copyright © 2010 Taiwan Society of Microbiology. Published by Elsevier B.V. All rights reserved.)

Background: Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan. This retrospective study evaluated the clinical and microbiological characteristics of bacteremic community-acquired pneumonia due to K. pneumoniae in Taiwanese adults., Methods: The clinical characteristics of bacteremic community-acquired pneumonia (CAP) in adults due to K. pneumoniae were compared to those of adults with bacteremic CAP due to Streptococcus pneumoniae at a tertiary medical center in Taiwan from 2001-2008. Risk factors for mortality of bacteremic CAP due to K. pneumoniae were analyzed. All clinical isolates of K. pneumoniae were examined for capsular serotypes, hypermucoviscosity phenotype, aerobactin and rmpA gene., Results: K. pneumoniae was the dominant cause of bacteremic CAP and was associated with a more fulminant course and a worse prognosis than bacteremic CAP due to Streptococcus pneumoniae. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality. Serotype K1 and K2 comprised around half of all isolates. There were no significant differences in the clinical characteristics of patients with bacteremic CAP due to K1/K2 and non-K1/K2 isolates. Hypermucoviscosity phenotype as well as the aerobactin and rmpA genes were highly prevalent in the K. pneumoniae isolates., Conclusions: K. pneumoniae continued to be the dominant cause of bacteremic CAP in Taiwanese adults during 2001-2008. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality from K. pneumoniae bacteremic CAP. Serotypes K1/K2 comprised around half of all isolates, but did not predispose patients to a poor clinical outcome. Physicians should be aware of the poor prognosis of any patient with bacteremic K. pneumoniae CAP and monitor these patients more closely.

Purpose: Recently, functional MRI (fMRI) using word generation (WG) tasks has been shown to be effective for mapping the Chinese language-related brain areas. In clinical applications, however, patients' performance cannot be easily monitored during WG tasks. In this study, we evaluated the feasibility of a word choice (WC) paradigm in the clinical setting and compared the results with those from WG tasks., Method: Intrasubject comparisons of fMRI with both WG and WC paradigms were performed on six normal human subjects and two tumor patients. Subject responses in the WC paradigm, based on semantic judgments, were recorded. Activation strength, extent, and laterality were evaluated and compared., Results: Our results showed that fMRI with the WC paradigm evoked weaker neuronal activation than that with the WG paradigm in Chinese language-related brain areas. It was sufficient to reveal language laterality for clinical use, however. In addition, it resulted in less nonlanguage-specific brain activation., Conclusion: Results from the patient data demonstrated strong evidence for the necessity of incorporating response monitoring during fMRI studies, which suggested that fMRI with the WC paradigm is more appropriate to be implemented for the prediction of Chinese language dominance in clinical environments.