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Objectives The multi-center clinical microbiological study in Taiwan aimed to evaluate the impact of childhood PCV13 immunization on pneumococcal disease, and the magnitude of serotype replacement in invasive and non-invasive pneumococcal disease among all age groups. Methods The study of culture-confirmed pneumococcal disease (CCPD) was conducted at four hospitals across Taiwan in 2015-2018. Pneumococcal pneumonia was defined as clinical diagnosis with positive sputum or bronchoalveolar lavage culture. Serotyping, multi-locus sequence typing, and antimicrobial susceptibility testing for penicillin and ceftriaxone were performed. Results A total of 1413 CCPD cases were identified. Invasive pneumococcal disease (IPD) accounted for 13.4% (190/1413) of CCPD. PCV7-type CCPD incidence declined among all age groups between 2015 and 2018. In adults aged 50-64 years, PCV7-type pneumococcal pneumonia incidence in 2018 was 72% lower than that in 2015, and all pneumococcal pneumonia incidence was 35% lower than that in 2015. In children, CCPD incidence was higher in 2018 than in 2015 (IRR 1.75 for age 5 years, IRR 1.56 for age 5-17 years). Incidence of CCPD caused by non-PCV13-types, mainly 15A and 23A, increased significantly in those younger than 50 years. Serotypes 19A and 19F constituted the largest clonal complex, CC236/320 (n = 280, 19.8%). The rates of penicillin and ceftriaxone non-susceptibility were higher in PCV13-type isolates. Conclusions Childhood PCV13 immunization exerted an indirect protection to vaccine serotype clinically defined non-bacteremic pneumococcal pneumonia among adults, especially those between 50 and 64 years of age. Emerging non-PCV13 serotypes mainly caused non-invasive mucosal disease among children.

This study investigates an abnormal degradation induced in a moist environment. Although devices maintain optimal performance under bias stress operation in a vacuum, an abnormal hump is observed in capacitance–voltage ( ${C}$ – ${V}$ ) electrical characteristics under negative bias stress (NBS) operation in a moist environment. Electrolysis of the H2O model is proposed to explain the degradation. An asymmetric stress condition, with ${V} _{\text {GD}} = {0}$ V, is designed to confirm that a vertical electric field causes the electrolysis of H2O, which is the reason for the hump phenomenon in the ${C}$ – ${V}$ curve. Moreover, COMSOL simulation and ${C}$ – ${V}$ measurement of the source and drain parasitic capacitances are utilized to clarify the precise degradation position and support the mechanism. The results from electrical measurement suggest that a vertical electric field can cause instability in a moist environment.

In this article, an n-type double-gate low-temperature polysilicon (LTPS) TFT is investigated. Previous work has confirmed that the hot-carrier effect will cause impact ionization. Here we observed that, after hot-carrier stress (HCS), the transfer curve in the saturation region has a negative $\text{V}_{\mathrm {th}}$ shift, and a hump is also observed. The reverse output characteristic shows that gate induced drain leakage (GIDL) of the transistor gradually increases and the subthreshold swing (S.S.) has a tendency to collapse. In structures with longer lightly doped drain (LDD) lengths, the electric field at both source/drain side can be effectively dispersed. Thereby, an extended LDD can reduce the overall degradation, and a physical model of explanation is proposed. By using the energy band diagram, we clarify how the additional electron hole pairs affect the output property. Next, Silvaco TCAD simulation is utilized to illustrate the electric field distribution and validate the physical model.

The study aimed to investigate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) immunization on the overall pneumococcal disease in children in Taiwan by surveillance of culture-confirmed pneumococcal disease (CCPD). This study was conducted in a medical center from 2012 to 2016. Clinical isolates of Streptococcus pneumoniae were prospectively collected from pediatric patients. Serotyping, multi-locus sequence typing, and antimicrobial susceptibility testing were performed. A total of 473 patients with CCPD, including 58 with invasive pneumococcal disease (IPD), were identified. The incidence of CCPD per 10,000 admissions decreased from 71.7 in 2012 to 27.0 in 2016. The proportion of additional PCV13 serotypes significantly decreased from 52.0% in 2012 to 21.7% in 2015 but increased slightly to 26.7% because of serotype 19A in 2016 (P < 0.0001). The proportion of non-vaccine serotypes (NVTs) increased significantly from 18.4% in 2012 to 66.7% in 2016, but the increase of the incidence of CCPD caused by NVTs was not considered significant (P = 0.0885). Genotyping identified predominant clones, ST6315A, ST8315B, and ST166/33823A, for major NVTs. The penicillin non-susceptibility of PCV13 serotypes was significantly higher than that of NVTs (P < 0.0001). Surveillance of CCPD appears superior to IPD alone for evaluation of the overall impact of pneumococcal immunization. Serotype replacement occurred quickly after the use of PCV13, while the incidence of NVT infection did not show a significant increase in children over the years. The gradual introduction of PCV13 into national immunization program is effective in reducing overall pneumococcal disease in children.

To block the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) a number of non-pharmaceutical interventions (NPIs) are being implemented. Taiwan successfully controlled coronavirus disease of 2019 (COVID-19) mainly by NPIs that were centered on facial masking, enhanced hand hygiene, social distancing, international travel controls, effective quarantine and contact-tracing policy [1, 2]. After the first case of COVID-19 was detected on January 21 2020, a rise in local demand for surgical masks and N95 respirators was observed and at least 50% of people spontaneously wore a facial mask in public places since early February 2020 [3, 4]. Among the total 799 COVID-19 cases reported in 2020, annual incidence rate of COVID-19 in Taiwan was remarkably low (0.238/100,000; n=56) for locally acquired (local) cases and high (3.153/100,000; n=743) for internationally acquired (imported) cases (Taiwan CDC, https://data.cdc.gov.tw/en/dataset). It is perceived that NPIs that are currently being implemented to reduce the COVID-19 should also prevent both acquisition and transmission of other viral and bacterial respiratory tract infections [5‒9]. In this observational study we examined the monthly incidence rates of invasive pneumococcal disease (IPD) and serotype distribution in age groups at high risk and from high pneumococcal transmission settings between January 2020 and February 2021. The differential serotype transmission dynamics revealed by various level of reduction in IPD caused by different serotypes was discussed., Significant reduction in the incidence rates of both vaccine and non-vaccine serotype invasive pneumococcal disease among children and adults during the COVID-19 pandemic were observed after the implementation of non-pharmaceutical interventions.

An ongoing outbreak of multidrug-resistant Salmonella enterica serovar Anatum began in Taiwan in 2015. Pork and poultry were identified as vehicles for transmission. Contaminated meat contributed to the high rate of infections among children. Nearly identical Salmonella Anatum strains have been identified in the United Kingdom, the United States, and the Philippines.

Background Nontyphoidal Salmonella (NTS) is an important foodborne pathogen worldwide. We investigated a 2018 outbreak of highly antimicrobial-resistant Salmonella enterica serotype Goldcoast in northern Taiwan. Methods We collected 30 clinical isolates and 2 meat isolates from this outbreak in New Taipei and Taoyuan, Taiwan in 2018. The clinical manifestations and the treatment of the patients were reviewed. To trace the source, we examined NTS isolated from food samples collected from the markets in northern Taiwan. All of the isolates along with an additional human isolate from China were sequenced and compared with the sequences of Salmonella Goldcoast reported by other countries. Results The outbreak involved 14 pediatric patients (256 μg/mL and 1 μg/mL, respectively, and a conjugative 278-kilobase plasmid harboring blaCTX-M-55 and qnrS1 contributed towards the resistance. Whole-genome sequencing revealed a clonal relationship among the outbreak isolates and the 2 collected from the retail meats. The outbreak clone was phylogenetically close to that of Salmonella Goldcoast reported in the United Kingdom, Poland, and China, whereas similar resistance plasmids were found in China and Cambodia. Conclusions The clinical spectrum of the high-level cephalosporin-resistant Salmonella Goldcoast is similar to that of other NTS serotypes, but severe cases required carbapenem treatment. The study confirmed the emergence of a highly antimicrobial-resistant clone of Salmonella Goldcoast, highlighting the importance of surveillance for food safety., An outbreak caused by ceftriaxone- and ciprofloxacin-resistant Salmonella Goldcoast was investigated. A conjugative 278-kb plasmid harboring blaCTX-M-55 and qnrS1 contributed to the resistance. Whole-genome sequencing revealed a clonal relationship among the clinical isolates and another 2 from retail meats.

The deposition ZnO thin films using an atmospheric pressure plasmas jet (APPJ)-assisted process using different precursors is presented. In this process, nebulized salt solutions droplets or precursor vapor were injected into the downstream of the APPJ to perform deposition of ZnO thin films. Zinc chloride (ZC)-, zinc acetate (ZA)-, and zinc nitrate (ZN)-containing solution and zinc acetylacetonate (ZAA) were precursors tested. For all precursors tested, formation of ZnO was observed based on X-ray diffraction analysis. ZC, however, was the only precursor that yields smooth films, which yields average transmittance in the visible wavelength range well >70%. When ZN, ZA, and ZAA were used as the precursors, rather rough films were obtained due to the fact that these precursors decomposed and formed ZnO readily upon heating. A high rate of volume nucleation, therefore, occurs in the gas phase. The above observation serves as the guideline for the selection of precursors for APPJ-assisted thin-film deposition processes.

Atmospheric pressure plasma jet (APPJ) technology is a versatile technology that has been applied in many energy harvesting and storage devices. This feature article provides an overview of the advances in APPJ technology and its application to solar cells and batteries. The ultrafast APPJ sintering of nanoporous oxides and 3D reduced graphene oxide nanosheets with accompanying optical emission spectroscopy analyses are described in detail. The applications of these nanoporous materials to photoanodes and counter electrodes of dye-sensitized solar cells are described. An ultrashort treatment (1 min) on graphite felt electrodes of flow batteries also significantly improves the energy efficiency.

A one-step process to fabricate crystalline Li4Ti5O12(LTO) particles directly from solution using an atmospheric pressure plasma jet (APPJ) is reported. This process uses Ti and Li ions-containing salt solutions as the precursor, which is ultrasonically nebulized and then transported to the downstream of the APPJ using a carrier gas. With an extremely short contact time (

We investigate the nanoporous TiO 2 films sintered by atmospheric pressure plasma jets (APPJs) and their applications as photoanodes of dye-sensitized solar cells (DSSCs). A 30-s APPJ-sintered nanoporous TiO 2 layer exhibits an additional absorption band between 400 and 500 nm in wavelength, attributed to incomplete removal of the organic solvents in the pastes. For TiO 2 layers sintered by APPJs for 60 s and beyond, the absorption spectra are nearly identical to those of a conventional 15 min, 510 °C calcined sample. The XRD and XPS results indicate similar characteristics for APPJ-sintered and furnace-sintered TiO 2 films. A DSSC with a 30-s APPJ-sintered TiO 2 photoanode shows poor cell efficiency with an extremely large TiO 2 /dye/electrolyte electron transport interfacial resistance and a short carrier lifetime. As the APPJ treatment time reaches 60 s and beyond, the power conversion efficiencies become comparable to that of a sample with a 510 °C conventionally calcined TiO 2 photoanode. Our experimental results verify that a 60-s APPJ sintering process is sufficient to replace a conventional 15 min, 510 °C furnace calcination process for TiO 2 photoanodes of DSSCs. The ultra-short sintering process is made possible by the synergistic effect of the temperature and the reactivity of the APPJ, which can lower the fabrication cost.

The ZnO thin film deposition process by using an atmospheric pressure (AP) plasma jet is studied. In this process, nebulized ZnCl 2 solution is sprayed into the downstream of the nitrogen plasma jet to perform thin film deposition. X-ray diffraction analysis confirms that this AP jet has the capability to convert ZnCl 2 solution to well-crystallized ZnO thin films with a hexagonal wurtzite structure in a short time. This film exhibits a smooth and mirror-like appearance visually. Scanning electron microscopy and atomic force microscopy show that the deposited film is dense and continuous with a root mean square surface roughness of 8.6 nm. A 1.29 nm/s deposition rate is obtained using this process. Given the fast deposition rate, we believe that both the temperature and the reactivity of the plasma play important roles. A ZnO film on a larger substrate is fabricated, which suggests the process capability in large area and continuous processing applications.

In Taiwan, beginning in 2013, the 13-valent pneumococcal conjugate vaccine (PCV13) was provided free of charge to children 2–5 years of age. In 2014, this was extended to children 1–5 years old. During 2012–2014, 953 cases of culture-confirmed pneumococcal disease (CCPD), including 104 invasive pneumococcal disease (IPD), were prospectively identified and analyzed at a 3,700-bed hospital in Taiwan. From 2012 to 2014, the incidence per 10,000 admissions decreased from 26.7 to 20.4 for CCPD (P P P 15A, ST8315B and ST33823A. From 2012 to 2014, isolates with penicillin minimum inhibitory concentrations >2 mg/L decreased from 27.8% to 8.1% (P

Background Onychomycosis is a fungal infection of nails, leading to the gradual destruction of the nail plate. Treatment of onychomycosis may need long-time oral antifungal therapy that can have potential side effects, thus accurate diagnosis of the disease before treatment is important. Culture for diagnosis of onychomycosis is time-consuming and has high false-negative rates. To expedite the diagnosis, an oligonucleotide array, based on hybridization between immobilized oligonucleotide probes and PCR products, for direct detection of dermatophytes and Candida albicans in clinical specimens was evaluated. Methods Species-specific oligonucleotide probes designed from the internal transcribed spacer (ITS) regions of the rRNA gene were immobilized on a nylon membrane. The assay procedures consisted of PCR amplification of the ITS using universal primers, followed by hybridization of the digoxigenin-labeled amplicons to probes on the array. Thirty two nail samples (29 patients) were analyzed by the array, and the results were compared with those obtained by culture. Array-positive but culture-negative samples were confirmed by cloning and re-sequencing of the amplified ITS and by reviewing patient’s clinical data. The total recovery of culture and confirmed array-positive but culture-negative results was considered 100% and was used for performance evaluation of both methods. Results Concordant results were obtained in 21 samples (10 positives and 11 negatives) by both methods. Eleven samples were array-positive but culture-negative; among them, 9 samples were considered true positives after discrepant analysis. Comparing with culture, the array had significantly higher sensitivity [100% (95% CI 82.2% −100%) vs 52.6% (28.9% −75.5%), p

The characterization of the downstream of an oxygen atmospheric pressure plasma jet (APPJ) is performed. This APPJ is sustained by pulsed power with a repetitive frequency up to 25 kHz. The reactivity of the plasma at different operating conditions is characterized using the intensities of O 2 (759 nm) and O (777 nm) optical emission lines. The jet downstream temperature is measured by a thermocouple. It is shown that the intensity of O 2 emission is not sensitive to the flow rate while it increases with the increase in the applied voltage. O emission is only observed at high flow rate. The temperature measurement shows that it slightly increases with the applied voltage. At the jet exit, the temperature monotonically increases with the flow rate while at 1 cm downstream of the jet, it shows an opposite trend. It is shown that the existence of an external surface at the downstream greatly influences the emission spectra adjacent to the surface. When the jet downstream is shielded with a glass tube, the O radical emission intensity increases by more than one order of magnitude. Preliminary studies show that the presence of the surface potentially enhances certain surface reactions. Such an enhancement leads to the increase of the O radical density, as suggested by the spatial-resolved optical emission spectra.

The growth mechanism of ZnO thin films deposited by an atmospheric pressure plasma jet (APPJ) is study. The APPJ used is sustained by a pulsed power source with a repetitive frequency up to 25 kHz using N 2 or O 2 as plasma gases. Nebulized zinc chloride solution is used as the precursor and is sprayed into the downstream of the plasma jet to deposit thin films on Si wafers. X-ray diffraction spectra show that the crystalline structure changes with the operating parameters, namely plasma gas flow rate and the applied voltage, which influence the jet temperature and reactivity. It is found that upon exposure of the precursor to the plasma jet, sheet-like zinc hydroxide chloride (ZHC) are formed first, and is converted to zinc oxide if the jet temperature is high enough. Under relatively low temperature, the conversion of the precursor end at ZHC. The grain size of the films is greatly influenced by the nucleation and growth rate. High jet temperature leads to a larger number of the nuclei and results in smaller grain sizes and denser ZnO thin films. O 2 plasma jets are also utilized. Preliminary studies show that the O 2 plasma jet is able to convert the precursor to ZnO thin films under optimized conditions. Finally, the key parameters that influence the electrical and optical properties will be identified.

Identification of dermatophytes using the traditional method is sometimes problematic because of atypical microscopic or macroscopic morphology. The aim of this study was to evaluate the feasibility of using sequencing of the ribosomal internal transcribed spacer (ITS)1 and ITS2 regions for identification of 17 dermatophyte species. The ITS regions of 188 strains (62 reference strains and 126 clinical isolates) were amplified by PCR and sequenced. Species identification was made by sequence comparison with an in-house database comprising ITS sequences of type or neotype strains or by blast searches for homologous sequences in public databases. Strains producing discrepant results between conventional methods and ITS sequence analysis were analysed further by sequencing the D1–D2 domain of the large-subunit rRNA gene for species clarification. The identification rates by ITS1 and ITS2 sequencing were higher than 97 %. Based on reference sequences of type or neotype strains, it was noted that most strains of Trichophyton mentagrophytes were misidentifications of Trichophyton interdigitale. In addition, barcode sequences were present in species of the Microsporum canis complex and Trichophyton rubrum complex. These barcode sequences are useful for species delineation when the results of ITS sequencing are ambiguous. In conclusion, ITS sequencing provides a very accurate and useful method for the identification of dermatophytes.

Species of dermatophytes are classified into three anamorphic (asexual) genera, Epidermophyton , Microsporum , and Trichophyton . Conventional methods used to identify dermatophytes are often lengthy and may be inconclusive because of atypical microscopic or colony morphology. Based on the internal transcribed spacer 1 (ITS-1) and ITS-2 sequences of the rRNA genes, an oligonucleotide array was developed to identify 17 dermatophyte species. The method consisted of PCR amplification of the ITS regions using universal primers, followed by hybridization of the digoxigenin-labeled PCR products to an array of oligonucleotides (17- to 30-mers) immobilized on a nylon membrane. Of 198 dermatophyte strains and 90 nontarget strains tested, the sensitivity and specificity of the array were 99.5% and 97.8%, respectively. The only strain not identified ( Microsporum audouinii LMA 597) was found to have a nucleotide insertion at the ITS-2 region where the probe was designed. Two nontarget strains, Microsporum equinum LMA 40396666 and Trichophyton gourvilii var. intermedium CBS 170.65, were misidentified as Microsporum canis and Trichophyton soudanense , respectively. Sequence analysis of the ITS regions revealed that the two misidentified strains displayed high sequence homology with the probes designed for M. canis and T. soudanense , respectively. The present method can be used as a reliable alternative to conventional identification methods and can be completed with isolated colonies within 24 h.

Infections caused by fungi have increased in recent years. Accurate and rapid identification of fungal pathogens is important for appropriate treatment with antifungal agents. On the basis of the internal transcribed spacer 1 (ITS 1) and ITS 2 sequences of the rRNA genes, an oligonucleotide array was developed to identify 64 species (32 genera) of clinically important filamentous (or dimorphic) fungi. These 64 species included fungi causing superficial, cutaneous, subcutaneous, and invasive infections. The method consisted of PCR amplification of the ITS regions using a pair of universal primers, followed by hybridization of the digoxigenin-labeled PCR products to a panel of species- or group-specific oligonucleotides immobilized on a nylon membrane. Of 397 fungal strains (290 target and 107 nontarget strains) tested, the sensitivity and specificity of the array was 98.3% (285/290) and 98.1% (105/107), respectively. Misidentified strains were usually those belonging to the same genus of the target species or having partial homology with oligonucleotide probes on the membrane. The whole procedure can be finished within 24 h starting from isolated colonies; reproductive structures, which are essential for the conventional identification methods, are not needed. In conclusion, the present array is a powerful tool for identification of clinically important filamentous fungi and may have the potential to be continually extended by adding further oligonucleotides to the array without significantly increasing the cost or complexity.

Rf-sputtered ZnO films, annealed by atmospheric pressure plasma jet (APPJ), are characterized and used for MgZnO/ZnO heterostructures. The highly reactive N2 plasma generated by APPJ allows much shorter treatment time compared with conventional thermal anneals. The APPJ treatment can increase the crystallinity of ZnO films and release the compressive residue stresses, verified by XRD and UV‐Vis transmission measurements. In our previous studies, we demonstrate that thermal anneal is the critical step for the formation of two-dimensional electron gases in defective rf-sputtered MgZnO/ZnO heterostructures. This paper reports the experimental results that APPJ treatments can be used for the same purpose with a much shorter processing time. A thirty-second APPJ anneal on ZnO can be used to replace 400 ◦ C×30min furnace-anneal to promote the formation of 2DEGs in MgZnO/ZnO heterostructure. The ultra-short processing time is attributed to the synergy of plasma reactivity and temperature of APPJ. (Some figures may appear in colour only in the online journal)