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Introduction: Depression and aphasia impair the quality of life after a stroke. Studies linking depression risk to post-stroke aphasia (PSA) lacked confirmation using a large database. Methods: Using Taiwan's National Health Insurance claims data, we identified ≥18 years old patients hospitalized for stroke from 2005 to 2009, and those diagnosed with aphasia during hospitalization or within three months after discharge were selected to form the aphasic group. We estimated depression incidence by December 31, 2018, and used the Cox proportional hazards model to estimate aphasia group to non-aphasia group hazard ratios (HRs). Results: With a median follow-up period of 7.91 and 8.62 years for aphasia (n=26,754) and non-aphasia groups (n=139,102), respectively, the incidence of depression was higher in the aphasia group than in the non-aphasia group (9.02 vs.8.13 per 1000 person-years), with an adjusted HR (95% confidence intervals, CI) of 1.21 (1.15-1.29) for depression. The adjusted HRs [95% CI] of depression were homogenous for females, 1.26 [1.15-1.37] and for males, 1.18 [1.09-1.27] and for hemorrhagic stroke, 1.22 [1.09-1.37] and ischemic stroke, 1.21 [1.13-1.30]. Results in analyzing 25939 propensity score matched pairs demonstrated an equivalent effect. Conclusion: Patients with PSA are at an increased risk of developing depression regardless of sex or stroke type.

Although findings from published studies suggest post-stroke aphasia is associated with an increased risk of dementia, few studies have evaluated its association in a nationally representative cohort with long-term follow-up. No studies have reported data by type of stroke. Therefore, we examined the association between post-stroke aphasia and the risk of developing dementia.Using claims data from Taiwan's universal health insurance program, a cohort of patients ≥18 years old with an initial hospitalization for stroke in 2002-2005 were identified and followed up until December 31, 2016. Patients with newly diagnosed aphasia during stroke hospitalization or within 6 months of discharge were defined as the aphasia group. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing overall, vascular, and non-vascular dementia in patients with and without post-stroke aphasia.During a median follow-up period of 7.9 and 8.6 years for the aphasia (n=17063) and non-aphasia groups (n=105940), respectively, overall dementia incidence was similar, whereas vascular dementia incidence was higher in the aphasia group (7.52 vs. 5.52 per 1000 person-years). The adjusted HRs (95% confidence intervals) were 1.11 (1.06-1.17), 1.42 (1.31-1.53), and 0.94 (0.88-1.01) for overall, vascular, and non-vascular dementia, respectively. The association between aphasia and the risk of vascular dementia did not differ by stroke type (P for interaction=0.43). The analysis of 16856 propensity score-matched pairs revealed similar results.Patients with post-stroke aphasia have an increased risk of developing vascular dementia irrespective of the type of stroke.

This study evaluates technological catch-up in the electronics industry by Chinese indigenous firms compared with foreign firms operating in the country. We make use of firm-level data for the period 2001–2012, a period during which the Chinese government encouraged engagement with foreign partners and entry into the global supply chain in hopes of fostering technology transfer. We apply data envelope analysis to estimate group technology frontiers for private, state, and foreign firms, and decompose total factor productivity growth into technological change and technical efficiency change. The picture that emerges is one of mixed success. Indigenous firms on the cutting edge have pushed their group productivity frontier outward at a rapid pace even as the broad mass of indigenous firms has slipped further inside this expanding frontier. For private firms as a whole, the strongest period for technological catch-up was the mid-2000s, with progress relative to the foreign standard slowing again after that. Achievement has been greatest in sub-industries at the lower end of the technological ladder (e.g., appliances) and less notable at the upper end (e.g., computers). Evidence of a contribution by research and development and by worker training is found only beyond a cumulative threshold and for firms advantaged by location or joint venture partnership.

(1) Background: The coronavirus disease 2019 (COVID-19) pandemic had overwhelming impacts on medical services. During its initial surge, Taiwan was unique in maintaining its medical services without imposing travel restrictions, which provided an ideal environment in which to test if the fear of becoming infected with COVID-19 interfered with health-seeking behavior (HSB). We tested this hypothesis among adults with acute complicated appendicitis (ACA). (2) Methods: Adults with acute appendicitis were enrolled between 1 January and 30 June 2020 (COVID-19 period). The first two quarters of the preceding 3 years were defined as a historical control group. Outcome measures included the rate of ACA and the number of hospital stays. (3) Results: The COVID-19 era included 145 patients with acute appendicitis. Compared to the historical control (320 patients), the COVID-19 era was significantly associated with a higher length of symptom duration until presentation to the emergency room within >48 h (17.2% vs. 9.1%, p = 0.011), a higher incidence of ACA (29.7% vs. 19.4%, p = 0.014), and a longer length of hospital stays (5.0 days vs. 4.0 days, p = 0.043). The adjusted models showed that the COVID-19 period had a significant relationship with a higher rate of ACA (odds ratio (OR) = 1.87; 95% confidence interval (CI): 1.23–2.52; p = 0.008) and longer length of hospital stays (OR= 2.10; 95% CI: 0.92 to 3.31; p < 0.001). (4) Conclusions: The fear of COVID-19 may prohibit patients from seeking medical help, worsening their clinical outcomes. The surgical community should take action to provide scientific information to relive mental stress.

This study examines whether the intellectual property rights (IPR) protection in the host countries has a significant moderating effect on the relationship between local R&D outsourcing strategy and subsidiary productivity. Due to the subsidiary mandate in the host country being categorized as exploitation-orientation or exploration-orientation, we further examine whether there is a different moderating effect for different types of a subsidiary mandate. This analysis takes advantage of the data-set on Taiwan-based subsidiaries and the IPR indices by the World Economic Forum over the 2006–2009 period. The empirical results show that a stronger degree of IPR protection is, on average, found to play a significant moderating role in the influence of R&D outsourcing strategy based on local collaboration relationships. Interestingly, the moderating effects are found to differ between exploitation-orientation and exploration-orientation.

The purpose of this study is to examine how offshore research and development (R&D) strategy based on the local collaborative relationships plays a significant role in enhancing firm productivity. Due to the specific feature of technological assets, which are highly dependent on the different kinds of subsidiary mandate, we further examine the different effects of offshore R&D between exploitation-oriented and exploration-oriented mandate. This analysis takes advantage of the longitudinal data set on Taiwan-based firms for the period 2008–2011 and employs a propensity score matching of multinomial treatment method to estimate the causal effects, that is, the average treatment effect on the treated. The empirical results show that offshore R&D strategy plays a significant role in enhancing productivity. Moreover, for exploration-oriented mandate the offshore R&D strategy based on the local collaborative relationships will result in an immediate effect on their productivity, while for exploitation-oriented ...

This study examined the moderating effects of two kinds of internal R&D (parent R&D and subsidiary R&D) on the relationship between local R&D outsourcing and subsidiary productivity as internal R&D challenges the collaborative relationships in the local environment. Due to the specific feature of a subsidiary mandate, we further investigate whether two distinct kinds of internal R&D have different moderating effects between exploitation-oriented subsidiaries and exploration-oriented subsidiaries, based on a sample of longitudinal data set of 263 Taiwan-based manufacturing subsidiaries over the period 2006–2009. The empirical results show that for exploitation-oriented subsidiaries parent R&D plays a significant and negative moderating role on the impact of local R&D outsourcing based on local collaboration, while a positive moderating role is observed with parent R&D and subsidiary R&D for exploration-oriented subsidiaries.

In modeling the foreign direct investment (FDI) behavior of firms, existing studies tend to classify multinational enterprises’ (MNEs) production activities into two broad strategies, namely, standard vertical integration and horizontal integration. In practice, the production behavior of multinational enterprises is much more complex. Based on the production relations between parent firms and their foreign subsidiaries, this study divides MNEs’ production behavior into five strategies: vertical integration, foreign concentration, home concentration, horizontal integration, and heterogeneous horizontal integration. We then propose three sets of interesting hypotheses associated with the five different production strategies. A uniquely compiled firm-level data set of Taiwanese manufacturing firms over the 2004–2007 period is adopted to empirically verify the proposed hypotheses. The empirical estimates are in general consistent with the proposed predictions and suggest that the various production behaviors of MNEs depend on the foreign market size, trade costs, factor advantage, fixed investment costs and firm characteristics. Moreover, each production strategy is influenced by different determinants as implied by our hypotheses.

The purpose of this study is to examine whether the host country?s institutional quality has a significant moderating effect on the relationship between the offshore R&D strategy in the local environment and firm productivity. In addition, due to the firm?s operating mode in the host country being distinguished as either exploitation-oriented or exploration-oriented, we further examine whether the moderating effects of institutional quality is influenced by the different types of operating mode in the host country. This analysis takes advantage of a longitudinal dataset of Taiwan-based firms and their most prominent subsidiary as well as the institutional quality indices developed by the World Economic Forum (WEF) over the 2006-2009 period. The empirical results show that there are different moderating role of institutional quality between the exploitation-oriented and exploration-oriented mode in terms of the relationship between offshore R&D and firm productivity, which indicates that the institutional quality in the host countries does not necessarily strengthen the positive influence of the offshore R&D strategy on firm productivity as do the extant studies in the previous literature.

The purpose of this study is to examine whether the host country’s institutional quality has a significant moderating effect on the relationship between the offshore R&D strategy in the local environment and firm productivity. In addition, due to the firm’s operating mode in the host country being distinguished as either exploitation-oriented or exploration-oriented, we further examine whether the moderating effects of institutional quality is influenced by the different types of operating mode in the host country. This analysis takes advantage of a longitudinal dataset of Taiwan-based firms and their most prominent subsidiary as well as the institutional quality indices developed by the World Economic Forum (WEF) over the 2006-2009 period. The empirical results show that there are different moderating role of institutional quality between the exploitationoriented and exploration-oriented mode in terms of the relationship between offshore R&D and firm productivity, which indicates that the institutional quality in the host countries does not necessarily strengthen the positive influence of the offshore R&D strategy on firm productivity as do the extant studies in the previous literature.

Background Few studies have evaluated whether people infected with human immunodeficiency virus (HIV) are at an increased risk of stroke in an Asian population. We investigated the association between HIV infection and the risk of developing stroke by age, calendar year of HIV diagnosis, and follow-up duration in Taiwan. Methods Using the claims data of a universal health insurance program, we identified 5,961 patients with HIV and 23,844 matched non-HIV subjects without previous stroke from 1998 to 2005 and followed them up until the end of 2011 to measure the incidence of stroke. Cox proportional hazards models adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), with the non-HIV group as reference. Results During a median follow-up of 8 years, the incidence rates for total, ischemic, and hemorrhagic stroke per 1000 person-years were 2.12, 1.22, and 0.60, respectively, in patients with HIV infection, and 1.98, 1.14, and 0.54, respectively, in the comparison group. HIV infection was associated with an elevated risk of developing total stroke (adjusted HR [95% CI], 1.57 [1.15–2.14]) and ischemic stroke (1.91 [1.25–2.91]) in patients aged less than 45 years, but no association was observed in other age groups (P for interaction with age, p = 0.048 and 0.024, respectively). Patients diagnosed with HIV infection in 1998–1999 had a greater HR for total stroke and ischemic stroke than those diagnosed in 2000–2002 and 2003–2005 (P for interaction, for total stroke p = 0.034, for ischemic stroke p = 0.056). The HRs did not differ by follow-up duration. Conclusions HIV infection among a young age group is associated with increased risk of developing overall and ischemic stroke. The findings highlight the importance of screening and correcting risk factors for young stroke prevention immediately and aggressively.

As China adopts a government-supported agglomeration model to develop high-tech industries, it is crucial to examine whether the spatial concentration of manufacturing and R&D activities enhance firm-level productivity. Based on a panel dataset of Chinese electronics firms from 2005 to 2007, the calculated Ellison–Glaeser (EG) index indicates that both production and R&D activities are highly spatially concentrated. Crucially, we find that production agglomeration has a positive relationship with firms' productivity, especially for smaller firms. In contrast, R&D agglomeration seems to negatively relate with productivity. It implies that the possible congestion effect and/or free rider problems erode the benefit derived from knowledge spillovers.

Numerous studies have attempted to examine industry performance from an agglomeration perspective. However, many are still focused on the manufacturing sector. This study examines the travel and tourism service industry's economic position using an agglomeration perspective and whether this relates to its economic performance. This study discovered that, apart from being related to its intra-region position relative to other industries within the region, the economic performance of an industry in a region is also related to its intra-industry position relative to other distributive regions within the industry and to its national geographical concentration. A more significant finding is that regardless of either the intra-industry or intra-region position of the industry in a region, enhancing agglomeration not only increases competition and profit erosion but also improves labour productivity. For employment creation, it is more effective to develop an industry with more uniform national geographical dist...

In July 2008, Taiwan passed a legislation allowing Chinese tourists to travel into Taiwan. We are interested in crowding-out effects which may have a negative impact on Taiwan's tourism. However, lack of data compels us to employ monthly tourist arrivals from China to Japan as a reference for impacts of opening policies. We project that Chinese tourists into Taiwan due to the opening policy for individual tourists would increase substantially. We also analyze tourist arrivals from Japan, Hong Kong, and the United States to explore the crowding-out effect. Using seasonal ARIMA models with joint estimation of intervention and outlier effects, we find that Chinese tourists significantly crowd out Taiwan's international tourists from Japan and the United States, but not those from Hong Kong, even with Taiwan's increased tourism capacity. Therefore, our results indicate that Taiwan should either further enhance tourism capacity or decelerate its opening policy to avoid severe crowding-out effects.

This paper systematically investigates the impacts of openness on regional innovation in China, especially the role of absorptive capacity in mediating the spillover effect brought about by openness. Based on provincial-level data over the period 1997 – 2007 and adopting patents as indicator of innovation, the empirical results show that the estimated patents – R&D elasticity is lower than that for OECD countries, while there is a significant R&D spillover effect across regions in China. Technology import overall has no significant influence on fostering innovations, but it is significantly positive for coastal regions. Openness to trade, in terms of FDI and high-tech product exports, is witnessed to exhibit a significantly positive impact on promoting regional innovation. Crucially, the effects of technology imports and FDI on innovations vary significantly between coastal and noncoastal regions. Using human capital as a proxy for absorptive capacity, we find it helps in learning external sources of knowledge and then contributes to innovations. Moreover, absorptive capacity is expected to play an important role in mediating the spillover effect brought about by openness to trade. Keywords: innovation, patent, spillover, absorptive capacity

Is the spatial concentration of manufacturing activity able to enhance firm-level productivity? This question is particularly relevant to production in China, which has a huge territory and population, but a skewed distribution in terms of urban–rural development. This paper aims to examine the dynamics of industrial agglomeration and the impact of agglomeration on firm-level productivity in China's textile industry by using a firm-level panel dataset from 2000 to 2005. First, the average value of the Ellison–Glaeser (EG) index (city level) is found to be approximately 0.00019. Moreover, the calculated city EG index of spatial concentration for each year exhibits a decreasing trend of spatial agglomeration for garments and other fiber products, but an increasing trend for the textile industries' agglomeration in China. The above findings are similar to the findings of Lu and Tao (2009) . Secondly and importantly, this study finds an inverted U-shape relationship between agglomeration and productivity. It suggests that while industrial agglomeration enhances firms' productivity, agglomeration diseconomies may appear if the degree of agglomeration is too high.

The purpose of this paper is to examine the influence of intellectual property rights (IPRs) protection on the overseas R&D activities of multinational enterprises (MNEs) in emerging economies and to determine whether the influence differs among the various host countries. To provide further empirical evidence, this analysis takes advantage of the longitudinal dataset and IPRs indices developed by the World Economic Forum (WEF) over the 2002–2006 period. The empirical results show that the IPRs protection in the host countries has a significant influence on the overseas R&D activities of MNEs in emerging economies. Interestingly, the influence of IPRs protection is found to differ significantly between developing and developed countries. A stronger degree of IPRs protection in developing countries is found to result in more overseas R&D activities, while a stronger degree of IPRs protection in developed countries, particularly in industrialised countries, tends to reduce the overseas R&D activities of MNE...

Does outward investment induce more domestic innovation or simply move local innovative efforts to foreign plants? This question is topical and relevant to Taiwan in view of its large share of outward investment concentrated in China and the special political relationship between the two sides of the Taiwan Strait. The purpose of this paper is to examine the effect of outward investment in China on domestic innovative activity in Taiwan. Overall, this study finds that a positive relationship exists between outward investment and innovation in terms of R&D intensity and patents, implying that investing in China is part of a global resource allocation strategy of Taiwanese multinational enterprises to allocate production in China and pay more attention to innovative activity in their domestic plants. Moreover, the deregulation of the policy regarding investing in China in 2001 has induced an upsurge in investment in China, although it does not seem to have brought about an outflow of technologies.

This article investigates the relationship between foreign direct investment (FDI, including outward FDI and inward FDI), imports and exports, and product innovation. Our theoretical model predicts that inward FDI, outward FDI, imports, and exports have positive influences on firm innovative activities, which would evaluate the effects of the relative magnitude of different sources on innovation. The empirical results based on the 2003 First Taiwan Technological Innovation Survey confirm three of the proposed hypotheses for the entire sample. However, when focusing on the manufacturing sector, outward FDI, inward FDI, imports, and exports all exhibit strongly positive effects on the determination of conducting product innovation (i.e., the four hypotheses are verified). A consistent trend is that outward FDI has the largest effect on innovation, regardless of the measurement of product innovation and the division of the entire sample, which may imply that in Taiwan a positive effect of "deindustrialization" is to innovate more.

Based on role theory, a household-based convoy (HbC) was proposed as a support system comprised of four kinds of networks: household types, family, kinship, and friendship. To test the feasibility of the support network concept, data from the 2001 Taiwan Social Change Survey were used to derive a latent structure with four latent classes. These classes consisted of the “prefamily convoy,” “pro-social convoy,” “mature convoy,” and the “extended convoy.” Their network characteristics revealed that the four latent classes corresponded to stages in the family life course. Moreover, these convoy subtypes had differential intergenerational support functions. Respondents from the pre-family and the pro-social convoys were found to provide fewer types of support to their parents but received more types of support from them. The findings also indicate that the household-based convoy is a role-related support network.

Aims Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US–Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. Design Distances (proximity) between the US–Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239 070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990–2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). Setting Coterminous United States. Findings Methamphetamine, cocaine and heroin purity generally decreased with distance from the US–Mexico border. Heroin purity, however, after initially declining with distance, turned upwards—a U-shaped association. During 2000–04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (

This paper analyzes technical efficiency in China's banking system by large banks and small city banks as well as the pre-WTO and post-WTO accession periods. Using an unbalanced panel dataset for 63 banks over 1997–2006 and employing the stochastic frontier function approach, the empirical results reveal that the new entrants, small city banks, experienced a slightly higher efficiency score than incumbent large banks, on average. Compared with the pre-WTO accession period, the efficiency score is found to have improved significantly after entry into the WTO as a result of the competition effect. This competition effect is particularly relevant for small city banks. Finally, determinants of X-inefficiency are examined.

Outward direct investment (ODI) and domestic R&D are interrelated, but empirical evidence is affected by the nature of a firm's data, which are heavily censored. Firm data contain a firm's yes/no decision to invest in China, yes/no decision of R&D, and the decision of R&D intensity. We thus adopt a two-hurdle model and allow the China investment decision to be endogenous in an R&D model in order to examine the effect of ODI in China on domestic R&D investment in Taiwan's electronics industry. In the model, a two-equation simultaneous subsystem is formed, in which three regression equations are specified: a decision of R&D intensity, and a yes/no decision of location to conduct R&D together with a yes/no decision to invest in China Our results indicate that China investment and R&D intensity are positively related such that ODI in China helps to raise significantly a firm's R&D intensity as compared to the estimate if the endogeneity of China investment and the nature of data were not properly accounted.

The purpose of this paper is to examine the effect of the FDI decision on domestic investment in the case of Taiwanese manufacturing firms. In addition, we also consider the deferral effect of the FDI decision and the role of firm size. To this end, this paper takes advantage of an endogenous switching model from which consistent estimators are obtained after correcting for the self-selection problem. The empirical results show that the effect of these manufacturing firms’ FDI decisions on domestic investment is significant within the firms. Furthermore, a crowding-out effect of FDI on domestic investment is found when Taiwanese firms engage in defensive FDI. Finally, FDI is found to have a positive influence on the domestic investment of the larger firms, while the influence is negative in the case of the smaller firms.

Taiwan’s paradox of family decline is examined with a household-based convoy, which allows us to explore the paradox from two perspectives, namely, the modified extended family and the household-based convoy. The modified extended family refers to the reunion of spatially separated families covering two generations. The household-based convoy is an extension of the modified extended family that includes relatives and friends with whom there is frequent contact. A probability sample survey with 1,979 cases completed is used to answer two questions: (1) Has there been a change in Taiwan’s family function because of structural change? (2) Is the family’s function being replaced by relatives and friends with whom there is frequent contact? The results of this study show that the coverage of the modified extended family is as high as 81%, indicating a high coherence among spatially separated households covering two generations. The proportions of the respondents who have provided five types of support including sick care, household chores, advice, regular allowances, and irregular allowances to non-coresiding parents are mostly around 40%. Moreover, the members of a modified extended family do have independent functions in relation to most types of support. These findings all lend evidence to refute the view that the family is declining in Taiwan.

This research used two samples of enterprises, 123 that invested in China and 213 that did not, to examine why many Taiwanese enterprises stay home despite others that have invested in China. Our results found that most Taiwanese enterprises are pushed to invest abroad by increasing wages at home and increasing competition in the export market, which lowers their profitability. The key factors determining to invest or not to invest in China are whether they are satisfied with their profits, and whether they are able to upgrade organizational capability, if they are not satisfied with the profits. However, this conclusion does not totally apply to large enterprises. For large enterprises, their investment in China has little to do with profitability and R&D intensity, but more to do with export competition and technological capability. Furthermore, investment in Southeast Asia is complementary to investment in China for large enterprises, but a trade-off for small and medium ones.

Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity.Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239,070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM).Coterminous United States.Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards-a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (10 g) were typically more dynamic in areas closer to the US-Mexico border.Geographic variance in methamphetamine, cocaine and heroin purity throughout the coterminous United States was associated with US-Mexico border proximity. The U-shaped associations between border-distance and purity for heroin and methamphetamine may be due to imports of those drugs via the eastern United States and southeast Canada, respectively. That said, areas closer to the US-Mexico border generally had relatively high illicit drug purity, as well as more dynamic change in the purity of small ('retail level') drug amounts.

This paper analyzes the determinants of international tourist arrivals in China, especially for World Heritage Sites and various kinds of travel spots. Utilizing annual provincial panel data over the 2000–2005 period, the empirical results suggest that key determinants include the relative income, population in the original country, cost of travel, and tourism infrastructure. In addition, World Heritage Sites are also found to be significant in explaining the numbers of international tourists and have a greater tourist-enhancing effect. Other famous tourist sites rated 4A- and 3A-class are also attractive to foreign tourism. Moreover, cultural rather than natural sites attract more interest among foreign tourists, because China is internationally renowned for its long-standing historical and cultural assets. Finally, the importance of the determinants of the demand for tourism varies from country to country.

Intracerebral hemorrhage is an unusual complication of autonomic dysreflexia and can be fatal if massive bleeding occurs with brain herniation. We report the case of a man in his midthirties with incomplete tetraplegia who suffered right putaminal hemorrhage during an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factors of autonomic dysreflexia quickly brought his blood pressure under control and the patient had a favorable functional outcome after rehabilitation. A review of the literature suggests that the location of hemorrhage in autonomic dysreflexia-induced cases is similar to that in the general population. The most common triggering factors are bladder distension in men and labor induction in women. Hemorrhagic stroke can also occur in patients with incomplete spinal cord injury (SCI) who develop autonomic dysreflexia. The role of sympathetic skin response examination is also discussed. This life-threatening complication should be kept in mind in the case of people with SCI.

This note replies Cellini's comment on the real effect of WHL in inducing more tourist arrivals in Yang, Lin and Han (2010, Tourism Management). Due to the time-invariant feature of the WHL number in the short-run, the fixed effect of panel data model seems to be inadequate on evaluating the impact of WHL on attracting international tourists. However, pooling estimates show that a region with more WHLs can attract more tourists.