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The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.
Design and Setting:
This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.
The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.
The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.
A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.
Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.
There has been a lack of prevalence estimates of DSM-5 mental disorders in child populations at the national level worldwide. This study estimated the lifetime and 6-month prevalence of mental disorders according to the DSM-5 diagnostic criteria in Taiwanese children.
Taiwan's National Epidemiological Study of Child Mental Disorders used the stratified cluster sampling to select 69 schools in Taiwan resulting in a nationally representative sample of 4816 children in grades 3 (n = 1352), 5 (n = 1297) and 7 (n = 2167). All the participants underwent face-to-face psychiatric interviews using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological version, modified for the DSM-5, and they and their parents completed questionnaires. The inverse probability censoring weighting (IPCW)-adjusted prevalence was reported to minimise non-response bias.
The IPCW-adjusted prevalence rates of mental disorders decreased by 0.1–0.5% than raw weighted prevalence. The IPCW-adjusted weighted lifetime and 6-month prevalence rates for overall mental disorders were 31.6 and 25.0%, respectively. The most prevalent mental disorders (lifetime, 6-month) were anxiety disorders (15.2, 12.0%) and attention-deficit hyperactivity disorder (10.1, 8.7%), followed by sleep disorders, tic disorders, oppositional defiant disorder and autism spectrum disorder. The prevalence rates of new DSM-5 mental disorders, avoidant/restrictive food intake disorder and disruptive mood dysregulation disorder were low (<1%).
Our findings, similar to the DSM-IV prevalence rates reported in Western countries, indicate that DSM-5 mental disorders are common in the Taiwanese child population and suggest the need for public awareness, early detection and prevention.
After the closing of Bureau International de L'Heure (BIH) and the establishment of International Earth Rotation Service (IERS) at the end of 1987. Shanghai Observatory has been the institute where the astrometric latitude and time observational data are collected and treated. During the past four years, about 75,293 measurements in latitude or time determination have been obtained by the 64 optical astrometric instruments over the world from which the five-day Earth Rotation Parameters of the 1988–1990 period have still been reduced. Twelve Quarterly Report on the optical ERP have been distributed. Since the beginning of 1991 the regular reduction of the ERP has been stopped but the collecting of the observational data is still going on in Shanghai Observatory in order to meet the requirements of the scientists who are still interested on the studies concerned with these observations. There are still 42 optical astrometric instruments taking part into the regular observations at the moment.
The purpose of this study was to investigate the effects of 8-week green tea extract (GTE) supplementation on promoting postexercise muscle glycogen resynthesis and systemic energy substrate utilisation in young college students. A total of eight healthy male participants (age: 22·0 (se 1·0) years, BMI: 24·2 (se 0·7) kg/m2, VO2max: 43·2 (se 2·4) ml/kg per min) participated in this study. GTE (500 mg/d for 8 weeks) was compared with placebo in participants in a double-blind/placebo-controlled and crossover study design with an 8-week washout period. Thereafter, all participants performed a 60-min cycling exercise (75 % VO2max) and consumed a carbohydrate-enriched meal immediately after exercise. Vastus lateralis muscle samples were collected immediately (0 h) and 3 h after exercise, and blood and gaseous samples were collected during the 3-h postexercise recovery period. An 8-week oral GTE supplementation had no effects on further promoting muscle glycogen resynthesis in exercised human skeletal muscle, but the exercise-induced muscle GLUT type 4 (GLUT4) protein content was greater in the GTE supplementation trial (P<0·05). We observed that, during the postexercise recovery period, GTE supplementation elicited an increase in energy reliance on fat oxidation compared with the placebo trial (P<0·05), although there were no differences in blood glucose and insulin responses between the two trials. In summary, 8-week oral GTE supplementation increases postexercise systemic fat oxidation and exercise-induced muscle GLUT4 protein content in response to an acute bout of endurance exercise. However, GTE supplementation has no further benefit on promoting muscle glycogen resynthesis during the postexercise period.
While entertainment activities in private business settings (i.e., business entertainment) are widely seen all over the world, issues about their prevalence have remained unresolved in the literature. This study takes an institutional approach to elucidate (1) the governance role of business entertainment in economic exchanges, (2) the mechanism through which business entertainment plays this role, and (3) the conditions under which business entertainment plays a greater role to facilitate economic exchanges. Our starting point is that economic transactions are governed through a combination of market rules, legal restraints, and social norms. We argue that business entertainment plays a governance role by boosting the power of social norms to regulate the behaviors of economic actors. As such, business entertainment should be more prevalent under the conditions where social fabrics are dense but market and legal infrastructures are underdeveloped. This governance approach provides a common ground to accommodate the positive versus negative views on business entertainment advocated by two camps of researchers in management, economics, and sociology. It also offers useful guidelines for policymakers to regulate, and for executives to manage, this prevalent but often misunderstood business practice.
In C-Band transfer measuring systems, the Precise Orbit Determination (POD) precision of Geostationary Earth Orbit (GEO) satellites is limited by signal biases such as the station delay biases, transponder delay biases, the ionospheric delay model bias, etc. In order to improve the POD precision, the signal biases of the Chinese Area Positioning System (CAPS) are calibrated using Satellite Laser Ranging (SLR) and C-Band Transfer Ranging (CBTR) observations. Since the Changchun SLR site and C-Band station are close to each other, the signal biases of the Changchun C-Band station are calibrated using the co-location comparison method. Then the signal biases of the other two CAPS C-Band stations, located in Linton and Kashi, are calibrated using the combined POD method, with the signal biases of the Changchun C-Band station being fixed. After the signal biases are calibrated, the RMS of the line-of-sight residuals of the Changchun SLR observations decrease by 0·4 m, with the percentage improvement being 75·19%.
Using new product announcement events made by group member firms in Taiwan, this study examines whether the firms’ multiple network ties within business groups benefit member firms or whether they provide a channel for controlling shareholders to tunnel. We find that the announcement of new products by group member firms has a positive effect on the market value of other, non-announcing group peers. This evidence is consistent with the value-added hypothesis. More importantly, this effect is stronger when member firms are connected via equity ties. Furthermore, we also offer an original analysis of how family control in business groups affects the impact of network ties on value creation. Our results suggest that the controlling family may discount the market value of member firms.
As in many developed countries, foreign care-givers have made up a short-term labour force to help shoulder the responsibilities of older adult care in Taiwan since 1992. This study uses the dual labour market and the occupational segregation theoretical frameworks and a mixed-method approach to examine whether foreign care-givers are supplementary or have replaced Taiwanese care-givers in Taiwan's long-term care (LTC) industry, and to understand better the status of care workers and their influx into the secondary labour market. As of 2012, 189,373 foreign workers joined the care services, compared to 7,079 Taiwanese, indicating they are no longer supplementary. The gap between the dual care system and workforce regulation has resulted in occupation segregation, and the secondary care labour market has been divided into ‘institutional’ and ‘home’ spheres, segregating care-givers into three levels: all Taiwanese care-givers, foreign institutional care-givers, and foreign home care-givers, the latter being the cheapest, most obedient and most adaptable LTC products. This case exhibits the ‘particularistic’ associations between nationality and care-givers’ workplace, which should be abolished. Only by squarely facing the changes and impacts caused by importing workers into the secondary labour market can one propose concrete, effective LTC labour plans and retention policies.
Carotid intima-media thickness (IMT) is a validated surrogate marker of preclinical atherosclerosis and is predictive of cardiovascular morbidity and mortality. Research on the association between IMT and diet, however, is lacking, especially in low-income countries or low-BMI populations.
Cross-sectional analysis. Dietary intakes were measured using a validated, thirty-nine-item FFQ at baseline cohort recruitment. IMT measurements were obtained from 2010–2011.
Participants (n 1149) randomly selected from the Health Effects of Arsenic Longitudinal Study, an ongoing, population-based, prospective cohort study established in 2000. Average age at IMT measurement was 45·5 years.
Principal component analysis of reported food items yielded a ‘balanced’ diet, an ‘animal protein’ diet and a ‘gourd and root vegetable’ diet. We observed a positive association between the gourd/root vegetable diet and IMT, as each 1 sd increase in pattern adherence was related to a difference of 7·74 (95 % CI 2·86, 12·62) μm in IMT (P<0·01), controlling for age, sex, total energy intake, smoking status, BMI, systolic blood pressure and diabetes mellitus diagnoses. The balanced pattern was associated with lower IMT (−4·95 (95 % CI −9·78, −0·11) μm for each 1sd increase of adherence; P=0·045).
A gourd/root vegetable diet in this Bangladeshi population positively correlated with carotid IMT, while a balanced diet was associated with decreased IMT.
Previous evidence has shown positive associations between post-traumatic
stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes
mellitus, which are all risk factors for stroke, but the role of PTSD in
the subsequent development of stroke is still unknown.
To investigate the temporal association between PTSD and the development
Identified from the Taiwan National Health Insurance Research Database,
5217 individuals aged 18 years, with PTSD but with no history of stroke,
and 20 868 age- and gender-matched controls were enrolled between 2002
and 2009, and followed up until the end of 2011 to identify the
development of stroke.
Individuals with PTSD had an increased risk of developing any stroke
(hazard ratio (HR) 3.37, 95% CI 2.44–4.67) and ischaemic stroke (HR =
3.47, 95% CI 2.23–5.39) after adjusting for demographic data and medical
comorbidities. Sensitivity tests showed consistent findings (any stroke
HR = 3.02, 95% CI 2.13–4.28; ischaemic stroke HR = 2.89, 95% CI
1.79–4.66) after excluding the first year of observation.
Individuals with PTSD have an increased risk of developing any stroke and
ischaemic stroke. Further studies are required to investigate the
This study identified possible risk factors for newly diagnosed mood disorders, including depressive and bipolar disorders, in prostate cancer patients.
From 2000 to 2006, two cohorts were evaluated on the occurrence of mood disorder diagnosis and treatment. For the first cohort, data of patients diagnosed with prostate cancer was obtained from the Taiwan National Health Insurance (NHI) Research Database. As the second cohort, a cancer-free comparison group was matched for age, comorbidities, geographic region, and socioeconomic status.
Final analyses involved 12,872 men with prostate cancer and 12,872 matched patients. Increased incidence of both depressive (IRR 1.52, 95% CI 1.30–1.79, P <0.001) and bipolar disorder (IRR 1.84, 95% CI 1.25–2.74, P = 0.001) was observed among patients diagnosed with prostate cancer. Multivariate matched regression models show that cerebrovascular disease (CVD) and radiotherapy treatment could be independent risk factors for developing subsequent depressive and bipolar disorders.
We observed that the risk of developing newly diagnosed depressive and bipolar disorders is higher among Taiwanese prostate cancer patients. Clinicians should be aware of the possibility of increased depressive and bipolar disorders among prostate cancer patients in Taiwan. A prospective study is necessary to confirm these findings.
Geostationary Earth Orbit (GEO) satellites play a significant role in the space segment of the Chinese Area Navigation System. The C-Band transfer ranging method developed by the National Time Service Center (NTSC) has been widely used in the Chinese Area Positioning System (CAPS), with its advantages of separating satellite ranging from time synchronization and being unaffected by weather. The explicit ranging correction models for the C-Band transfer ranging method are introduced in detail in this article for the first time. Precise Orbit Determination (POD) using C-Band pseudo-range observation of GEO satellite 2010-001A in July 2012 has been conducted. The residual Root Mean Square (RMS) of each site and POD are analysed with orbit difference over overlaps of adjacent orbit arcs. Moreover, the orbit of the GEO satellite has been evaluated by Satellite Laser Ranging (SLR) data from both domestic and foreign SLR sites for the first time. The residual RMS of POD using C-Band observation is better than 0·1 m, and the orbit difference over overlaps of adjacent orbit arcs is better than 3 m. In addition, the residual RMS in line-of-sight for a SLR site in China are better than 1 m, while the RMS for the Yarragadee site in Australia is about 3·4 m. It has been shown that the GEO satellite orbit accords very well with the C-Band observation. Also, the distribution of CAPS stations affects the orbit precision. All sites in CAPS are now located in China with low and medium latitudes. The residual RMS of the SLR site in the southern hemisphere is larger than that of the site in China.
Taiwan has 145 breeding bird species, but so far no comprehensive attempt has been made to model their distributions. For the first time, we bring together various datasets to model the distributions of the 116 bird species with sufficient sampling coverage. We improved on previous limited modelling efforts by using ensemble modelling, based on five well-performing modelling approaches: multiple discriminant analysis, logistic regression, genetic algorithm for rule-set production, ecological niche factor analysis and maximum-entropy. We then used these ensemble models to improve our knowledge of the status of each bird species by (1) calculating each species’s coverage of Taiwan, (2) calculating each species’s coverage by Taiwan’s protected area network, and (3) comparing these two conservation-relevant measures with already established measures to highlight those species whose status may need to be reassessed. We categorised each species’s coverage of the entire study area as measured by their modelled distributions into four quartiles, thus establishing a new measure of rarity called ‘range quartile’ which we used to highlight the 22 species with a limited distribution on mainland Taiwan. We also calculated that overall, 29.8% of the distribution ranges of the 116 modelled species are covered by Taiwanese protected areas. We then identified those species whose status may need to be reassessed because of possible conflicts between the respective conservation-relevant measures. Thus we identified 10 species which are first-quartile species < 5% of whose distributions are protected, of which only five are considered threatened. We also identified another 12 species with limited distributions, 30 species with limited protection and 19 species whose status may need to be reassessed for various reasons. We recommend that range quartile and protected area coverage be incorporated into future assessments of the conservation status and protected area coverage of Taiwanese birds.
Background: The caregiver burden on foreign paid caregivers (FPCs) is currently not well understood. This study identified predictors and differences in caregiver burden between FPCs and family caregivers who provided care for patients with dementia.
Methods: We recruited 489 patients with dementia (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition) and used the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) Scale to assess their neuropsychiatric behavioral problems and severity of dementia. All caregivers [FPCs (n = 42) and family caregivers with (n = 42) and without (n = 447) FPCs] completed three questionnaires: the Zarit Burden Interview (ZBI), the Center for Epidemiological Studies–Depression Scale (CES-D), and caregivers’ knowledge of dementia (KD). To understand caregiver burden, we analyzed the correlations between ZBI and other variables and investigated the differences between family caregivers and FPCs.
Results: NPI and CDR scores were higher among patients assisted by FPCs than among those whose families did not employ FPCs. Burdens were greater among family caregivers assisted by FPCs than among FPCs and family caregivers who were not assisted by FPCs. Family caregivers had greater knowledge of dementia than did FPCs. For family caregivers, CES-D scores (Spearman's r = 0.650; p < 0.01) and patients’ NPI scores (Spearman's r = 0.471; p < 0.01) were correlated with caregiver burden. For FPCs, only CES-D scores (Spearman's r = 0.511; p < 0.01) were correlated with caregiver burden. A linear regression model showed that CES-D scores contributed most to caregiver burden in all groups [β = 0.560 (family caregivers without FPCs), 0.546 (family caregivers with FPCs), and 0.583 (FPCs); p < 0.005].
Conclusion: Both family caregivers and FPCs need emotional support. Adequate treatment to reduce the neuropsychiatric symptoms of patients with dementia might reduce the burden on family caregivers.
In our recent study, we first reported that mutation in vascular endothelial growth factor-A is associated with bicuspid aortic valve stenosis. However, to date no groups have explored the role of vascular endothelial growth factor-A variations in the aetiology of congenital tricuspid aortic valve stenosis.
We sequenced all eight coding exons and exon–intron boundaries of the vascular endothelial growth factor-A gene in deoxyribonucleic acid samples of a cohort of 32 sporadic patients with tricuspid aortic valve stenosis, 300 normal controls, and 103 disease controls – conotruncal defects – in order to identify sequence variants.
We identified a c.973C > T heterozygous nonsense variation in exon 6 of the vascular endothelial growth factor-A gene in a patient with an isolated tricuspid aortic valve stenosis. The c.973C > T variation, which was absent in all controls, changes a highly conserved arginine at amino acid position 325 to a stop codon (p.Arg325X) and is predicted to produce a truncated protein of 324 amino acid residues. The proband's parents had a normal cardiac phenotype; however, his father was a carrier of the p.Arg325X variation, which indicates that the p.Arg325X variation is inherited and incompletely penetrant.
We report for the first time that the p.Arg325X nonsense variation in the vascular endothelial growth factor-A gene may be associated with congenital tricuspid aortic valve stenosis.
This paper introduces a highly reliable Cu interconnect technology at the 32 nm node with CuMn alloy seed. A CuMn alloy liner seed process combined with a non-gouging liner has been integrated into the minimum-pitch wiring level. Stress migration fails with CuMn seed at plate-below-via structures were shut down by a non-gouging liner process. Integration with gouging liner and non-gouging liner is compared, and results of interaction with CuMn seed are discussed in this paper.
A systematic study is reported about the amount-dependent morphology change in a series of Au-Pt bimetallic nanoparticles synthesized using chemical reduction. The amount of Au precursor is kept constant throughout whole series of compounds to obtain fixed Au core size (∼7.5 nm). The Au/Pt ratio is varied from 1/1 to 1/4 in order to synthesize Pt shell layer of different thickness. We observed a remarkable shift of surface plasmon band around 410 nm. With the aid of high resolution transmission electron microscope (HRTEM) and energy-dispersive spectrometer (EDS), the composition of shell layer is found to be Pt enriched Au-Pt alloy. As the amount of Pt increases, the Pt clusters formed a string-like shape on the surface of nanoparticles. The average diameter of these Pt clusters is about 2 nm. This special structure may exhibit unique catalytic property.