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Bike-sharing systems have been popular in addressing the “last mile” problem in public transit. However, service providers have found challenges when soliciting travellers to shift from their private vehicles: more stations do not always mean higher switching by private vehicle users. Considering the possible non-linear relationship between service provision and intention to use, this study utilises the cusp catastrophe model to analyse travellers’ intentions to use a bike-sharing system. The proposed model employs usage intention as the state variable, while switching barriers and accessibility are used as splitting factor and normal factor, respectively. This study measures participants’ usage intentions for two trip purposes and nine accessibility scenarios for CityBike, a public docked bike-sharing system in an Asian city where the majority of travellers use private vehicles. The results support a non-linear relationship between service provision and intention to use with the catastrophe characteristics including divergence, sudden transitions, and hysteresis of usage intention. In particular, travellers with higher switching barriers show a sudden, yet delayed response to improvements in a service only when it reaches a threshold in accessibility (e.g., 100 m away from the station and the lead time for rental within 3 min), whereas those with low switching barriers respond immediately to service improvements. We discuss marketing implications in facilitating switching to docked bike-sharing services among different segments. This research has made theoretical and empirical contributions, by supporting the non-linearity between accessibility and usage intention, along with diverse marketing materials and service provision catering to different usage occasions.

Owing to extreme climatic events caused by global environmental changes, the frequency and magnitude of natural hazards in Taiwan have increased in recent years, leading to deaths, injuries, and substantial damages to properties. Disruptions to critical infrastructures have impaired the ability to ensure sustainable daily operations and have caused further failures in other systems. Along with resource allocation and pre-evacuation, highway networks profoundly impact disaster response and recovery, particularly emergency disaster logistics and rescues. This study reviews the highway vulnerability assessments in Taiwan and examines the resilience of highway networks in regard to failures from the perspectives of interdependency. Analytical results demonstrate that the accessibility of emergency medical facilities plays an essential role in highway resilience in Taiwan. Moreover, the connectivity is critical for metropolitan road network resilience, whereas remote highway resilience is associated with the exposures with insufficient self-protection capacities. The proposed method can assist planners in understanding the assessment tools for highway resilience and help decision makers prioritise their adaptation strategies to improve serviceability of the road network during hazardous conditions.

New shipping routes have been proposed to be more efficient than conventional routes, resulting in huge commercial opportunities, while reducing shipping costs and formidable technological challenges. However, few earlier studies have examined the resilience of container lines to evolving shipping networks and new routes. This study thus discusses the important factors affecting operational resilience of container lines and assesses their performance through a fuzzy cognitive map: a semi-quantitative simulation framework which considers interdependencies among factors. The Europe-Far East (E/F) routes are employed as empirical cases, and then the resilience of container lines using the Arctic shipping route, the Thai Kra Canal and the traditional Suez route are simulated and compared. Results indicate that E/F route carriers can improve their operational resilience through a possible future Kra Canal in Thailand, but this would not be the case with Arctic shipping because of the worsening of navigational incidents and other operational deficiencies.

Background The need for patients to wear compression stockings after varicose vein surgery and the duration of compressions tocking therapy has been debated. This study isa meta-analysis of randomized controlled trials (RCTs) to determine the optimal duration of compression stocking therapy after endovenous thermal ablation (ETA) of the great saphenous vein. Methods The PubMed, Embase, and Cochrane Library databases were searched before January 2019. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using a random effects model. The primary outcome was the severity of pain in the postoperative period. Secondary outcomes were quality of life (QoL), leg volume, bruising scores, consumptionof analgesic agents, recovery time off work, satisfaction, and the incidence rates of postoperative complications including paresthesia and phlebitis. Results Five RCTsinvolving775 patients were reviewed. The long-duration (1–2 weeks) group significantly reduced postoperative pain at 1 week (mean difference [MD] 1.19; 95% confidence interval [CI]: 0.58–1.80) and recovery time off work (MD: 1.01 day, 95% CI: 0.06–1.96)when compared with the short-duration (24–48 h) group. However, the mean pain scores at 2 (0.1; 95% CI: 0–0.2) and 6 weeks postoperatively (−0.3; 95% CI: −1.09-0.49) did not differ significantly between the two groups. Moreover, the incidence rates of complication, paresthesia, and phlebitis did not differ significantly between the short-duration and long-duration groups. Conclusion The use of compression therapy for a long time (1–2 weeks) is better than short-term (24–48 h) use in terms of postoperative pain at 1 week and recovery off work. Hence, we recommend the prescription of 1-week compression stocking therapy after ETA in routine clinical practice. However, the available evidence is of variable quality, further well-structured RCTs with improved standardization of compression treatment, types of stockings, and target populations are warranted.

Triple-negative breast cancer (TNBC) is highly aggressive and responds poorly to conventional chemotherapy. The challenge of TNBC therapy is to maximize the efficacies of conventional chemotherapeutic agents and reduce their toxicities. Metronomic chemotherapy using continuous low-dose chemotherapy has been proposed as a new treatment option, but this approach is limited by the selection of drugs. To improve antitumor therapeutic effects, we developed electrospun paclitaxel-loaded poly-d-l-lactide-co-glycolide (PLGA) nanofibers as a topical implantable delivery device for controlled drug release and site-specific treatment. The subcutaneously implanted paclitaxel-loaded nanofibrous membrane in mice was compatible with the concept of metronomic chemotherapy; it significantly enhanced antitumor activity, inhibited local tumor growth, constrained distant metastasis, and prolonged survival compared with intraperitoneal paclitaxel injection. Furthermore, under paclitaxel-loaded nanofiber treatment, systemic toxicity was low with a persistent increase in lean body weight in mice; in contrast, body weight decreased in other groups. The paclitaxel-loaded nanofibrous membranes provided sustained drug release and site-specific treatment by directly targeting and changing the tumor microenvironment, resulting in low systemic toxicity and a significant improvement in the therapeutic effect and safety compared with conventional chemotherapy. Thus, metronomic chemotherapy with paclitaxel-loaded nanofibrous membranes offers a promising strategy for the treatment of TNBC.

Introduction: Seizure is a common poisoning-related neurological presentation in the emergency department (ED). Although brain computed tomography (CT) is recommended in patients presenting with first seizures, its role in patients with a suspected drug/substance-induced seizure (DSS) remains inconclusive. This study evaluated whether brain CT examination changes the management and outcome of DSS patients. Methods: We retrospectively reviewed adult patients presenting to the ED with a DSS in Linkou and Taipei Chang Gung Memorial Hospital, Taiwan, from January 2008 to December 2015. We also analyzed whether the brain CT examinations found meaningful acute abnormalities and their impact on subsequent management. We compared the differences between DSS patients undergoing CT scans or not to identify factors that affect the decision to arrange brain CT. Results: The study enrolled 97 patients (69 males). The most common cause of DSS was alcohol withdrawal (58.76%), followed by carbon monoxide (12.37%) and stimulants (8.25%). Eight (8.25%) patients developed status epilepticus, 15 (15.46%) were intubated, and 37 (37.76%) were admitted, including 12 (12.26%) to the intensive care unit. Brain CT was performed in 64 (66.0%) patients and four had abnormal reports that led to further imaging studies. The abnormal findings ultimately had no significant clinical impact. Patients who underwent CT scans had a worse Glasgow Coma Scale score (p = 0.024) and higher rate of status epilepticus (p = 0.031). Conclusion: Brain CT does not provide substantial information for the care of DSS patients. Multi-center prospective studies are needed to obtain stronger evidence.

Protobothrops mucrosquamatus, also known as the brown spotted pit viper or Taiwanese habu, is a medically significant venomous snake in Taiwan, especially in the northern area. To more fully understand the proteome profile of P. mucrosquamatus, we characterized its venom composition using a bottom-up proteomic approach. Whole venom components were fractionated by RP-HPLC and then analyzed by SDS-PAGE. Each protein band in gels was excised and subjected to protein identification by LC-MS/MS. A subsequent proteomic analysis revealed the presence of 61 distinct proteins belonging to 19 families in P. mucrosquamatus venom. Snake venom metalloproteinase (SVMP; 29.4%), C-type lectin (CLEC; 21.1%), snake venom serine protease (SVSP; 17.6%) and phospholipase A

Deinagkistrodon acutus, also known as the hundred-pace viper or Chinese moccasin, is a clinically significant venomous snake in Taiwan. To address the lack of knowledge on the venom proteome of D. acutus, the venom composition was studied by a bottom-up proteomic approach combining reverse phase high-performance liquid chromatography, SDS-PAGE, and LC-MS/MS analysis. The immunoreactivity and cross-reactivity of Taiwanese freeze-dried D. acutus antivenom (DA-AV) and hemorrhagic antivenom (FH-AV) were investigated, as well. The proteomic analysis revealed the presence of 29 distinct proteins from D. acutus venom belonging to 8 snake venom protein families. Snake venom metalloproteinase (SVMP, 46.86%), C-type lectin (CLEC, 37.59%), phospholipase A2 (PLA2, 7.33%) and snake venom serine protease (SVSP, 6.62%) were the most abundant proteins. In addition to DA-AV, FH-AV also showed a profile of broad immunorecognition toward the venom of D. acutus. Remarkably, both antivenoms specifically reacted with the HPLC fractions containing SVMPs, and the titer was 5-10 times higher than fractions of other components. This information helps us to deeply understand the pathophysiology of D. acutus envenomation and guide us to development of more effective antivenom for clinical treatment.

Naja atra envenomation is one of the most significant clinical snakebite concerns in Taiwan. Taiwanese freeze-dried neurotoxic antivenom (FNAV) is currently used clinically for the treatment of cobra snakebite, and has been shown to limit the mortality of cobra envenomation to less than 1%. However, more than half of victims (60%) require surgery because of local tissue necrosis, a major problem in patients with cobra envenomation. Although the importance of evaluating the neutralizing effect of FNAV on this pathology is recognized, whether FNAV is able to prevent the local necrosis extension induced by N. atra venom has not been investigated in detail. Cytotoxins (CTXs) are considered as the major components of N. atra venom that cause necrosis. In the current study, we isolated CTXs from whole cobra venom and used both whole venom and purified CTXs to develop animal models for assessing the neutralization potential of FNAV against venom necrotizing activity. Local necrotic lesions were successfully produced in mice using CTXs in place of whole N. atra venom. FNAV was able to rescue mice from a subcutaneously injected lethal dose of cobra venom; however, it was unable to prevent CTX-induced dermo-necrosis. Furthermore, using the minimal necrosis dose (MND) of CTXs and venom proteome data, we found a dose of whole N. atra venom suitable for FNAV and developed a workable protocol for inducing local necrosis in rodent models that successfully imitated the clinical circumstance of cobra envenoming. This information provides a more comprehensive understanding of the pathophysiology of N. atra envenomation, and serves as a guide for improving current antivenom strategies and advancing clinical snakebite management in Taiwan., Author summary Naja atra envenomation is an important public health issue in Taiwan. Although the mortality rate of cobra snakebite is controlled using antivenom, more than half of victims develop symptoms of local necrosis and require surgical intervention. Whether the Taiwanese freeze-dried neurotoxic antivenom (FNAV) currently in clinical use is able to prevent the local necrosis extension induced by N. atra venom is still unclear. In this study, we developed a dermo-necrosis animal model using purified cytotoxins (CTXs), the major necrosis-related proteins from N. atra venom. We found that FNAV was able to neutralize the lethality of whole cobra venom, but was unable to neutralize the necrosis induced by CTXs in vivo. This finding introduced an example that supplementary quality control assays may be necessary to determine the effectiveness of antivenoms in neutralizing specific pathology induced by the venom; only evaluating the rodent lethality prevention is insufficient. Our results provide insights that should help improve current antivenoms and advance cobra snakebite management in Taiwan.

Protobothrops mucrosquamatus, also known as the brown spotted pit viper or Taiwanese habu, is a medically significant venomous snake in Taiwan, especially in the northern area. To more fully understand the proteome profile of P. mucrosquamatus, we characterized its venom composition using a bottom-up proteomic approach. Whole venom components were fractionated by RP-HPLC and then analyzed by SDS-PAGE. Each protein band in gels was excised and subjected to protein identification by LC-MS/MS. A subsequent proteomic analysis revealed the presence of 61 distinct proteins belonging to 19 families in P. mucrosquamatus venom. Snake venom metalloproteinase (SVMP; 29.4%), C-type lectin (CLEC; 21.1%), snake venom serine protease (SVSP; 17.6%) and phospholipase A2 (PLA2; 15.9%) were the most abundant protein families, whereas several low-abundance proteins, categorized into eight protein families, were demonstrated in P. mucrosquamatus venom for the first time. Because PLA2 is known to make a major contribution to venom lethality, we evaluated whether the known PLA2 inhibitor, varespladib, was capable of preventing the toxic effects of P. mucrosquamatus venom. This small-molecule drug demonstrated the ability to inhibit PLA2 activity in vitro (IC50 = 101.3 nM). It also blunted lethality in vivo, prolonging survival following venom injection in a mouse model, but it showed limited potency against venom-induced local hemorrhage in this model. Our findings provide essential biological and pathophysiological insights into the composition of P. mucrosquamatus venom and suggest PLA2 inhibition as an adjunctive or alternative therapeutic strategy in the clinical management of P. mucrosquamatus envenoming in emergency medicine. Significance P. mucrosquamatus envenomation is a significant medical concern in Taiwan, especially in the northern region. Although antivenom is commonly used for rescuing P. mucrosquamatus envenoming, severe clinical events still occur, with more than 20% of cases requiring surgical intervention. Small-molecule therapy offers several advantages as a potential adjunctive, or even alternative, to antivenom treatment, such as heat stability, low antigenicity and ease of administration, among others. A deeper understanding of the venom proteome of P. mucrosquamatus would aid in the discovery of small-molecule drugs that could be repurposed to target specific venom proteins. Here, we applied a bottom-up proteomic approach to characterize the protein profile of P. mucrosquamatus venom. Varespladib, a small-molecule drug used to treat inflammatory disease, was repurposed to inhibit the toxicity of P. mucrosquamatus venom, and was shown to reduce the lethal effects of P. mucrosquamatus envenomation in a rodent model. Varespladib might be used as a first-aid therapeutic against P. mucrosquamatus envenoming in the pre-referral period and/or as an adjunctive agent administered together with anti-P. mucrosquamatus antivenom.

Because of the extreme climate and environmental changes, container hub-ports in East Asia focus on port vulnerability rather than competitiveness. To sustain their competitive advantage, port operators adopt appropriate operational strategies based on various factors. We found that the strategies which container carriers adopt at hub ports have the most significant influence on hub-port vulnerability. The primary strategies include route diversity, sufficient cargo sources and transshipment containers, stable collaboration and incentives in the form of subsidies and rewards. These strategies demonstrate the dependence of container carriers on ports, and implementing such measures could reduce port vulnerability. Compared with the neighbouring Hong Kong and Xiamen ports, Kaohsiung Port is the most vulnerable and Hong Kong the least. Regarding all operating conditions that can be offered to carriers, Hong Kong Port possesses a competitive advantage that combats vulnerability.

Global environmental changes have led to frequent occurrences of climatic extremes. The increasingly frequent and high-magnitude natural disasters in Taiwan have caused significant mortality, injury, and property damage. In response, there have been requests to improve the capacity to cope with extreme climatic conditions through increased awareness and identification of vulnerability. Disruptions to transportation systems affect the resilience for sustaining daily operations. Among the various types of transportation systems, ports provide substantial employment and industrial activity, contributing to national and regional development. In addition, ports integrate the functions of supply chains such as services in logistics, information, and business, becoming the location of industrial clusters. Therefore, this study examines the risk of port failures from the perspective of vulnerability. Specifically, seven vulnerable factors derived from the extant literature and lessons learned from the previous disaster cases are evaluated using geographic information systems. The results reveal that port capacity and efficiency have a significant effect on port vulnerability in which the efficiency of gantry cranes, labor productivity, free trade zone business volume, and ground access networks play crucial roles in port failure. Moreover, the risks associated with port operation are evaluated by overlapping a hazard map of areas prone to debris flows and tsunami inundation. The risk maps can assist decision makers in understanding the vulnerability and adopting appropriate strategies to minimize disaster risks.

Road networks are instrumental in resource allocation and preevacuation, and profoundly affect disaster response and recovery, particularly emergent-disaster logistics and island rescues. Disruptions to road networks impair daily operations, irrespective of whether they are damaged by external forces or failures in interacting elements. However, functional interdependency is absent from transportation vulnerability assessments. This study thus constructed a framework to assess the interdependent vulnerability of road network failures. Based on eleven fragile factors developed in the literature and an empirical case study in the Taipei metropolitan area, road network vulnerability is determined by fuzzy cognitive maps and geographic information systems for functional and spatial interactions, respectively. The analytical results indicate that road network vulnerability is underestimated if the interdependency is neglected. Delay time on the shortest substitution, level of service on adjacent links, and inaccessibility to hospital emergency centers significantly affect vulnerability. Whereas certain socioeconomic resilience is performed in the short term, spatial–functional interdependency dilutes those effects in the long term. The framework developed facilitates decision makers in understanding interdependent vulnerabilities and adopting appropriate strategies to improve vulnerability. Key words: road network vulnerability, interdependency, geographic information system (GIS), fuzzy cognitive maps (FCMs)

Effects of price promotions for high-speed rail (HSR) on the choice behaviours of potential consumers are analysed for public transit marketing purposes. A questionnaire survey, with 300 valid samples collected from private vehicle drivers with long-distance trips through freeways, is conducted. Factor analysis is employed to determine the constructs of service quality, while a discrete choice model considering individual heterogeneity, namely a mixed logit model, with stated preference is utilised to explore the diversion of passengers from private vehicle drivers due to price promotions. Analytical results reveal that service qualities, socio-economic characteristics and price promotions significantly affect choice behaviours. Finally, some strategies are developed from these analytical results to help a HSR operator increase its market share.

The increasing damages and losses bring requests to improve coping capacities for extreme conditions on the identification of and improvement to socioeconomic vulnerabilities. Disruptions to critical infrastructure (CI) influence the capacities for resilience and sustainable daily operations both directly and by causing failures in one system that in turn affects other systems. Among the transportation systems widely identified as national CI that should be protected, ports provide substantial employment, industrial activity, along with national and regional development. This study thus examines the vulnerability of port failures from an interdependency perspective. Fourteen vulnerable factors are developed by literatures as well as in-depth interviews. Four international commercial ports in Taiwan are employed as empirical cases to evaluate port vulnerability through semi-quantitatively systematic methods, including fuzzy cognitive maps and sensitivity model, while geographic information systems are used...

In the study highly active dual-site TiO2 supported Pt catalysts were prepared for catalytic oxidation of formaldehyde (HCHO) at ambient temperature. We used (3-aminopropyl)triethoxysilane to modify the TiO2 supported Pt catalysts, resulting in amino groups grafted on their surfaces and thus dual sites on supports. Characterization of the dual-site catalysts and the corresponding catalytic activity for HCHO decomposition were analyzed and evaluated. The TiO2 supported Pt catalysts featuring amino groups showed significant enhancement on the catalytic activity for HCHO removal. Compared to the supported catalyst with Pt active sites only, the presence of amino groups on the surface of the TiO2 supported Pt catalyst enhanced the catalytic oxidation of HCHO by a factor of 2.8 times at 5-ppm inlet HCHO concentration. The optimal enhancement occurred on the moderate gas hourly space velocity and low HCHO concentration. We speculate that the enhancement may result from the synergistic effect of Pt active sites and amino groups. The affinity of amino groups as capture sites to HCHO or formate molecules leads to higher localized HCHO concentration in the vicinity of Pt active sites, thereby resulting in a higher catalytic activity for the dual-site catalysts.

Convenience stores in Taiwan have integrated e-commerce systems into their logistics systems to develop a new retail delivery model. Store-to-store delivery service is the one of the retail delivery systems served by FamilyMart.com and 7-11.com. The delivery system is complicated and risky. This paper are explores the structure of logistic for store-to-store delivery service for electronic commerce and develops a hierarchical framework and evaluation model to evaluate the logistics vulnerability of two store-to-store delivery service providers in Taiwan. With the results of the most vulnerable parts in store-to-store delivery system, managers could add resources and formulate strategies to strengthen them and reduce the frequency of the events that have higher failure probabilities.

In this study we evaluated the effects of the surface functional groups of light-scattering particles (LSPs) and the nature of the resin on the haze of anti-glare (AG) films. We fabricated LSPs with amino groups on their surfaces from commercial crosslinked polystyrene microbeads, and LSPs presenting aliphatic chains through reactions of these amino groups with stearic acid. X-ray photoelectron spectroscopy and contact angle analysis revealed that these surface-modified LSPs had different elemental compositions on their surfaces and different wettabilities, respectively. To fabricate AG films, we incorporated the LSPs presenting the different surface functional groups into resins having various affinities. At the same LSP concentration and with the same resin, the AG films incorporating LSPs with aliphatic chains exhibited greater outer haze than did those featuring amino groups. The outer haze increased upon decreasing the ratio of the viscosity of the mixture of LSPs and resin to that of the resin. We speculate that the outer haze was affected by the interactions between the LSPs and the resin.

We previously reported that, in rodents, a diet with a high oxidised frying oil (OFO) content leads to glucose intolerance associated with a reduction in insulin secretion. The present study aimed at investigating the impairment of pancreatic islets caused by dietary OFO. C57BL/6J mice were divided into three groups to receive a low-fat basal diet containing 5 g/100 g of fresh soyabean oil (LF group) or a high-fat diet containing 20 g/100 g of either fresh soyabean oil (HF group) or OFO (HO group). After 8 weeks, mice in the HO group showed glucose intolerance and hypoinsulinaemia, and their islets showed impaired glucose-stimulated insulin secretion (P v. LF and HF groups). Significantly higher oxidative stress and a lower mitochondrial membrane potential were observed in the islets in the HO group compared with the LF and HF groups. Immunoblots showed that the reduction in insulin levels in HO islets was associated with activation of the c-Jun NH2-terminal kinase and a reduction in levels of pancreatic and duodenal homeobox factor-1. In a second study, when dietary OFO-induced tissue vitamin E depletion was prevented by large-dose vitamin E supplementation (500 IU(1·06 mmol all-rac-α-tocopherol acetate)/kg diet; HO+E group), the OFO-mediated reduction in islet size and impairment of glucose tolerance and insulin secretion were significantly attenuated (P v. HO+E group). We conclude that a high level of dietary OFO ingestion impairs glucose metabolism by causing oxidative damage and compromising insulin secretion in pancreatic islets, and that these effects can be prevented by vitamin E supplementation.

Different transport stakeholders have different needs for transport infrastructure and services. Achieving stakeholder satisfaction implies a total quality management (TQM) that continuously improves service quality. However, few studies have discussed service quality in relation to urban transport systems. This study proposes an instrument based on SERVQUAL for measuring urban transport service quality from a stakeholder perspective. The proposed instrument is developed and tested through exploratory and confirmatory factor analyses. The gaps between stakeholder expectations and actual received and the gaps associated with stakeholders' expectations and the perceptions of these expectations by professionals are examined. Importance-performance analysis is used to construct a service attribute evaluation map for determining resource allocation to improve service quality. The application is illustrated through an empirical study to discuss the managerial implications in the Taipei metropolitan area. The an...

Different transport stakeholders have different needs for transport infrastructure and services. Meeting the needs of all stakeholders implies a trade-off of benefits and costs between supply and demand and creates transport diversity issues. However, the literature has largely ignored these issues. Transport diversity can assess the level to which important needs are satisfied equitably, and monitor whether transportation systems are moving towards sustainability by confirming the targets and basic level of quality of life. Based on the concept of transport diversity, this study utilizes fuzzy multi-objective programming to solve non-linear multi-objective problems involving urban public transit systems to determine the impact of resource allocation on needs satisfaction in relation to stakeholder behaviors. The proposed approach avoids problems of inefficient and inequitable resource allocation. A real-life case is presented to demonstrate the feasibility of applying the proposed methodology. Furthermore, empirical outcomes show that recent investments allocated to public transit systems considered equitable stakeholder satisfaction for both mass rapid transit (MRT) and bus, and also promoted transport diversity in the Taipei metropolitan area.

Different transport stakeholders have different needs for transport infrastructure and services. Meeting the needs of stakehold- ers implies a tradeoff of benefits and costs between supply and demand and creates issues of transport diversity. However, the literature has largely ignored these issues. This study aims to provide a framework evaluating transport diversity to promote quality of life. Transport diversity is defined as the satisfied level of stakeholder needs in this study and measured as the gap between the expected goal and present values of stakeholder needs in the form of the Shannon-Weaver index. Transport diversity can assess whether the level to which important needs are satisfied equitably, and monitor whether the transportation system is moving toward sustainability via con- firming the targets and the basic level of quality of life. This study hopes that the conceptual framework developed can assist decision makers in understanding the relationship between transport diversity and sustainability, and provide a new assessment method for improvements in quality of life.

The liquid precipitation method using zinc acetate dihydrate was applied for the synthesis of uniform and spherical ZnO nanoparticles. The ultrafine zinc oxid was prepared in a water-ethanol mixture solution. The solution containing zinc cation was soluble in water. The surface-active agent triethanolamine (TEA) was soluble in ethanol. Then alkali precipitated by adding n-propylamine. The spherical zinc oxide particle morphology was found to be highly dependent on the zinc salt concentration, ethanol-water ratio, and the surface-active agent additive. The process can produce white ZnO powder of 50-90 nm in size. The morphology of zinc oxide showed a powder shape by transmission electron microscopy (TEM), the crystallization phase structure of zinc oxide by X-ray diffraction (XRD), and the zinc oxide remaining by using an organic analysis by infrared spectroscopy (IR).

Polymers constitute an extremely large class of materials generally based on carbon chemistry. Their long chain structures and unique molecular architecture make them distinct from metals and ceramics and provided them with a very wide range of properties.

OBJECTIVE: We have previously shown that bitter melon seed oil (BMSO), which is rich in cis-9, trans-11, trans-13 conjugated linolenic acid, is more potent than soybean oil in attenuating body fat deposition in high-fat diet-induced obese C57BL/6J mice. The aim of this study was to obtain a comprehensive insight into how white adipose tissue (WAT) is affected by BMSO administration and to explore the underlying mechanisms of the anti-adiposity effect of BMSO. METHODS AND RESULTS: A proteomic approach was used to identify proteins differentially expressed in the WAT of mice fed diets with or without BMSO for 11 wks. The WAT was also analyzed histologically for morphological changes. Two-dimensional gel electrophoresis (pH 4-7) revealed 32 spots showing a statistically significant difference (P2-fold change). Combined with histological evidence of macrophage infiltration and brown adipocyte recruitment, the proteomic and immunoblotting data showed that the WAT in mice subjected to long-term high dose BMSO administration was characterized by reduced caveolae formation, increased ROS insult, tissue remodeling/repair, mitochondria uncoupling, and stabilization of the actin cytoskeleton, this last change being putatively related to an increased inflammatory response. CONCLUSION: The anti-adiposity effect of BMSO is associated with WAT delipidation, inflammation, and browning. Some novel proteins participating in these processes were identified. In addition, the BMSO-mediated WAT browning may account for the increased inflammation without causing adverse metabolic effects.

Clinical introduction A 60-year-old man had a long history of chronic hepatitis C. He presented to the emergency department with 2 days of progressive dyspnoea. Clinical manifestations included respiratory distress, cyanosis, digital clubbing, spider naevi on the upper chest and shifting dullness in the abdomen (see online supplementary figure S1). The ECG showed sinus tachycardia and left axis deviation. The chest radiography depicted blunting of right costophrenic angle with small pleural effusions and bilateral prominent pulmonary vascular markings (see online supplementary figure S2). The dyspnoea was exacerbated by upright posture and improved with recumbency. The hypoxaemia could not be corrected with administration of 100% oxygen. Contrast-enhanced transthoracic echocardiography was performed with injection of agitated saline (see figure 1 and online supplementary video). CT scan of the chest revealed some vascular abnormalities (see online supplementary figure S3–S6). Question Which of the following is the next best step in management? Catheter-based closure of intracardiac shunt Liver transplantation Pulmonary angiography and embolisation Thoracentesis Transjugular intrahepatic portosystemic shunt

A 76-year-old woman with a history of hypertension and diabetes mellitus presented to the ED with abdominal pain for 1 week. On physical examination, the patient was found to have epigastric and bilateral costovertebral angle tenderness. Laboratory tests reported elevations of white blood cell count, creatinine and serum lipase. A chest radiograph was obtained (figure 1). Figure 1 A chest radiograph of the patient. What is …

Received 2 April 2012; returned 27 May 2012; revised 28 October 2012; accepted 31 October 2012Background: Studies on the effect of inadequate empirical antibiotic therapy on the outcome of patients withsystemic infection have led to inconsistent results.Methods: We analysed data from a comprehensive clinical database collected prospectively in a university hos-pital between 2008 and 2009. All adult patients who registered in the emergency department (ED) with abloodstream infection (BSI) were enrolled. Empirical therapy was considered adequate if it included antimicro-bials to which the specific isolate displayed in vitro susceptibility and that were administered within 24 h of EDadmission. The propensity score (PS) was created by a logistic regression model predicting inadequate empiricaltherapy. PS-adjusted multivariate analysis was performed by the Cox regression model. The Mortality in Emer-gency Department Sepsis (MEDS) score was used for the adjustment of residual confounding due to differencesin the baseline clinical severity of disease.Results: Out of 937 episodes of bacteraemia, 255 (27.2%) patients received inadequate empirical antimicrobialtherapy. A crude analysis showed that inadequate antibiotic therapy was associated with higher mortality rates(hazard ratio 1.78, 95% CI 1.30–2.45). PS-adjusted multivariate analyses also showed a significant adverseimpact (hazard ratio 1.59, 95% CI 1.14–2.28). The clinical disease severity significantly modified the effectof inadequate antibiotic therapy on survival. The magnitude of the adverse impact of inadequate antibiotictherapy decreased with the increasing severity of sepsis (P¼0.009).Conclusions: Inadequate empirical antimicrobial therapy for community-onset BSI was associated with higher30 day mortality rates. Study populations with different clinical severities may have different results, which mayhelp to partly explain the heterogeneous findings in many similar studies.Keywords: mortality, effect modification, propensity score

The aim of this study was to investigate the antiadiposity effect of bitter melon seed oil (BMSO), which is rich in the cis-9, trans-11, trans-13 isomer of conjugated linolenic acid. In Expt. 1, C57BL/6J mice were fed a butter-based, high-fat diet [HB; 29% butter + 1% soybean oil (SBO)] for 10 wk to induce obesity. They then continued to receive that diet or were switched to an SBO-based, high-fat diet alone (HS; 30% SBO) or containing bitter melon seed oil (BMSO) (HBM; 15% SBO + 15% BMSO) for 5 wk. The body fat percentage was significantly lower in mice fed the HBM diet (21%), but not the HS diet, compared with mice fed the HB diet. In Expt. 2, mice were fed an SBO-based, high-fat diet containing 0 (HS), 5 (LBM), 10 (MBM), or 15% (HBM) BMSO for 10 wk. In the LBM, MBM, and HBM groups, the body fat percentage was significantly lower by 32, 35, and 65%, respectively, compared with the HS control. The reduction in the HBM group was significantly greater than that in the LBM or MBM group. BMSO administration increased phosphorylation of acetyl-CoA carboxylase, cAMP-activated protein kinase (PKA), and signal transducer and activator of transcription 3 in the white adipose tissue (WAT), suggesting that PKA and leptin signaling might be involved in the BMSO-mediated reduction in lipogenesis and increase in thermogenesis and lipolysis. However, compared with the HS control, the HBM group had a significantly higher TNFα concentration in the WAT accompanied by TUNEL-positive nuclei. We conclude that BMSO is effective in attenuating body fat accumulation through mechanisms associated with PKA activation and programmed cell death in the WAT, but safety concerns need to be carefully addressed.

Spontaneous rupture of a hepatocellular carcinoma is a rare and lethal complication in the emergency department. A cau-date lobe hepatoma rupture is even rarer. It can be treated with vascular embolization, surgical intervention or supportive care. A 70-year-old woman with underlying hepatocellular carcinoma presented to our emergency department with severe abdominal pain encompassing the entire region for half a day. Abdominal computer tomography scans with and without contrast medium revealed a large hematoma confined to the lesser sac of the abdomen. It was initially diagnosed as a ruptured aneurysm. A ruptured caudate lobe hepatoma with acute hemorrhage into the lesser sac was diagnosed after reviewing and discussing the imaging findings with the radiologist. The patient was treated with supportive care without vascular embolization or surgical intervention because there was no imaging evidence of active contrast extravasation and the vital signs were within the normal range. After reviewing the literature, our case appears to be the second only case treated with supportive care and discharged without complications.

Ordering books on the Internet is obviously becoming a significant market. Retailing delivery (RD) service provides consumers with a self pick-up approach, so it is popular for those who cannot conveniently use home delivery service. E-service quality and logistics service quality are the key issues in e-commerce. A nonlinear model of loyalty is suggested by past studies. The main purpose of this study is to explore how of the logistics service quality and switching cost influence the pick-up point choice behavior by using a catastrophe model. Firstly, the latent variable is defined in the confirmatory factor analysis (CFA). Secondly, the catastrophe model was used to analyze the linkages between service quality and switching cost on pick-up point service loyalty. The results indicated that the switching cost plays the splitting factor in the catastrophe model, and a high switching cost makes the discontinuous choice behavior, implications of these results for practice and research are provided.

Background High-energy blunt chest injury will bring out severe cardiac and pulmonary injuries. It may cause cardiac contusion, rupture, cardiac valve dysfunction, and aortic laceration [1]. As traumatic hemopericardium occurs, ultrasound is a convenient and reliable tool for diagnosis. We presented a 55-year-old male victim of blunt chest trauma complicated with hemopericardium, cardiac tamponade, cardiac contusion and epicardial hematoma.

A 34-year-old man presented with a 1 day history of upper abdomen pain. Physical examination showed epigastric tenderness and rebounding pain. There was no abnormality in standing chest radiography. The plain abdomen revealed vertical oriented …