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目的：隨著台灣人口快速老齡化和生活習慣的改變，骨質疏鬆症的盛行率日益增加，可能嚴重影響患者的生活品質，並且是重要的公共衛生問題。因此，尋找並理解造成骨密度降低的危險因素，對於預防及早期診斷骨質疏鬆症十分重要。本研究旨在探討血清尿酸與骨密度之間的關係。 方法：在2016年1月至2016年12月期間，本研究共納入2,564名接受過雙能量X光吸收儀骨密度掃描健康檢查的參與者。經過篩選條件排除後，共有1,540名大於等於50歲之個案被納入分析，本研究使用多元羅吉斯迴歸分析用於檢查血清尿酸值和骨質減少/骨質疏鬆症與結果的關聯性。 結果：簡單羅吉斯迴歸顯示血清尿酸值較高的族群其低骨質密度（包含骨缺乏或骨質疏鬆症）風險比較低(OR 0.82, 95% CI 0.76-0.88)。在亞組分析中，依據血清尿酸值進行分組並調整干擾變項後，血清尿酸值較高的族群仍有較低的低骨質密度風險。 結論：本研究發現在中老年族群中，血清尿酸值較高者其低骨質密度的風險較低。 Background/Purpose: The prevalence of osteoporosis is rising along the rapid population aging in Taiwan, posing a grave public health concern due to its negative impacts on the quality of life among older adults. Identifying and understanding the risk factors of decreased bone mineral density is therefore essential for osteoporosis prevention and early diagnosis. The study aimed to investigate the associations between serum uric acid (sUA) and bone mineral density. Methods: Between January 2016 and December 2016, 2,564 participants who had undergone health examinations with a dual-energy X-ray absorptiometry scan were recruited. After exclusion, the study was conducted with 1,540 eligible subjects aged 50 years and order. Multiple logistic regression was used to examine associations of sUA and osteopenia/osteoporosis with outcomes. Results: Participants with higher sUA levels had significant lower risk of osteopenia/osteoporosis in simple logistic regression (OR 0.82, 95% CI 0.76-0.88). On subgroup analyses, stratified by sUA level, groups with higher sUA still had lower risk of osteopenia/osteoporosis after adjusting for other confounders. Conclusion: The study reveals that middle-aged and older adults with higher sUA levels had significant lower risk of osteopenia/osteoporosis. &nbsp

BACKGROUND Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process—(1) conduct fall risk assessments; (2) develop tailored fall prevention plans with the evidence-based interventions; and (3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all 3 steps of the fall prevention process. Over the past decade, our team developed 3 Fall TIPS modalities—the original electronic health record (EHR) version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patients’ fall prevention plan based on the clinical documentation in the EHR. However, the relative effectiveness of each Fall TIPS modality for engaging patients and family in the 3-step fall prevention process remains unknown. OBJECTIVE This study aims to examine if the Fall TIPS modality impacts patient engagement in the 3-step fall prevention process and thus Fall TIPS efficacy. METHODS To assess patient engagement in the 3-step fall prevention process, we conducted random audits with the question, “Does the patient/family member know their fall prevention plan?” In addition, audits were conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from 3 hospitals reported data from April to June 2017 on 6 neurology and 7 medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection. RESULTS Overall, 1209 audits were submitted for the patient engagement measure and 1401 for the presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. While some units maintained high levels of patient engagement and adherence with the poster protocol, others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection. CONCLUSIONS Each Fall TIPS modality effectively facilitates patient engagement in the 3-step fall prevention process, suggesting all 3 can be used to integrate evidence-based fall prevention practices into the clinical workflow. The 3 Fall TIPS modalities may prove an effective strategy for the spread, allowing diverse institutions to choose the modality that fits with the organizational culture and health information technology infrastructure.

This paper investigates the relationship between the collapse timing of exchange rate regime and degree of substitutability of foreign currency for domestic currency as a medium of exchange. According to the spirit of Chen et al. (1981), Tsaur (1987), Chang et al. (1991), we set up a transaction-based monetary model in which money provides liquidity services to reduce transaction costs, domestic and foreign currencies are introduced into the system. The results of study showed (1) no matter what degree of substitutability of foreign currency for domestic currency, the collapse timing of the exchange rate regime is earlier than the natural collapse timing, and (2) the collapse timing depends on the degree of currency substitution or complement. We found that the extreme degree of substitutability of currencies led to earlier currency crisis; however, moderate degree of substitutability of currencies postponed currency crisis. We also explored the dynamic transition process from the fixed to the crawling peg, and then to the flexible exchange rate regimes. We found that the extent of the decrease in foreign exchange reserves is the key whether the fixed exchange rate is able to transform into the crawling peg exchange rate regime.

The purpose of this study was to evaluate information visualization of publicly-reported central line-associated blood stream infection (CLABSI) outcome data for decision making by diverse target audiences – health care consumers and practitioners. We describe the challenges in publicly reporting of healthcare-associated infections (HAIs) data and the interpretation of an evaluation metric. Several options for visualization of CLABSI data were designed and evaluated employing exploratory working group, two confirmatory focus groups’ observations, and experts’ committee validation of the final designs. Survey-data collection and evaluation criteria results, collected from the two focus groups, are presented and are used to develop the final recommendations for how to visualize publicly-reported CLABSI data from Maryland acute care hospitals. Both health care consumer and practitioner’s perspectives are highlighted and categorized based on the visualizations’ dimensions framework. Finally, a recommended format for visualizing CLABSI outcome data based on the evaluation study is summarized.

With the increasing knowledge and the awareness of their contractual rights, parties involved in construction, namely employers, consultants, main contractors and subcontractors had shaped a rising trend of hauling each other to court or arbitration. The financial crisis in the region in 1997/98 had made the situation worst. Master of Science (International Construction Management)