Northern Taiwan Research Articles

The effects of rehabilitation potential on activities of daily living in patients with stroke in Taiwan: a prospective longitudinal study.

This study aimed to explore the effect of three-dimensional rehabilitation potential on the activity of daily living (ADL) among patients with stroke in rehabilitation wards. Prospective longitudinal study. Two rehabilitation wards situated within a nationally recognized referral centre in Northern Taiwan, followed by subsequent discharge. A total of 101 participants were admitted due to either a primary or recurring incident of infarction or haemorrhagic stroke, subsequently being transferred to the rehabilitation ward of a medical centre. Not applicable. Rehabilitation potential included biological (swallowing ability, muscle power, and urinary incontinence), psychological (rehabilitation motivation and cognitive function), and social (social support) dimensions. The rehabilitation treatment outcome was activities of daily living measured using the Barthel Index. Time-variant variables, including swallowing ability, rehabilitation motivation, social support, and ADL, were collected at the time of transfer to the rehabilitation ward, 1-3 days before discharge, and 1 month after discharge. The results of the generalized estimating equations model revealed that poor swallowing ability, lower muscle power, and urinary incontinence in the biological dimension, along with lower rehabilitation motivation and moderate cognitive impairment in the psychological dimension, are significant indicators of rehabilitation potential among stroke patients. When the different dimensional rehabilitation potential was considered overall, both biological and psychological indicators can still predict ADL outcomes during and after inpatient rehabilitation therapy. Of these indicators, swallowing ability and rehabilitation motivation were positively correlated with ADL over time. Further, increased rehabilitation motivation enhanced the protective effect of swallowing ability on ADL. Important indicators of rehabilitation potential, which can predict ADL outcomes, were identified for stroke patients in the rehabilitation ward. Policymakers can design appropriate intervention plans to enhance the rehabilitation potential and improve the effectiveness of inpatient rehabilitation treatment for stroke patients.

Prediction of the ideal gestational weight gain for reducing the risk of macrosomia/large for gestational age in women with gestational diabetes mellitus in northern Taiwan

BackgroundAppropriate weight gain reduces the risk of fetal macrosomia and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM), especially in the second and third trimester. This study aims to identify the optimal weight g–ain for such women across several pre-pregnancy body mass index (BMI) categories to lower the risk of macrosomia and LGA. MethodsThis retrospective cohort study enrolled women with GDM in north Taiwan who delivered between January 2012 and July 2022. BMI cut-offs were based on Chinese-specific guidelines and used to classify the participants as underweight (<18.5 kg/m2), normal weight (18.5–24.0 kg/m2), overweight (24.0–28.0 kg/m2), or obese (>28 kg/m2). Receiver operator curve analysis was used to determine the optimum GWG cut-off ranges to predict macrosomia / LGA, and uni- and multivariate analyses were used to analyze risk factors. In addition, a multivariable model predicting macrosomia and LGA in infants was developed. ResultsA total of 963 participants was included in our analysis. Optimal mean weekly rates of GWG in the second and third trimesters were 0.43 kg/week and 0.61 kg/week, respectively, in the underweight and normal weight group, and 0.33 kg/week and 0.32 kg/week, respectively, in the overweight and obesity group. ConclusionThe 2009 IOM guidelines, offering weight gain recommendations for pregnant women, appear to be applicable to Asian women diagnosed with GDM. This indicates that it is essential for such women to maintain an adequate total GWG throughout pregnancy. Physicians should address GWG using the IOM guidelines and trigger intervention when it is required to reduce macrosomia and LGA occurrence.

Psychological impact of the COVID-19 pandemic on Taiwanese youth: soldiers and college students

Researchers have identified university students and military personnel as highly susceptible to the stress and emotional challenges imposed by the Coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to compare the psychological impact of COVID-19 on soldiers and students based on risk factors identified in self reports. We recruited 258 students (male: female = 58: 204, average age = 19.73 ± 1.52 years) and 194 active soldiers (male: female = 172: 22, average age = 24.88 ± 4.11 years) from northern Taiwan. Analysis was performed on demographic data, history of COVID-19 infection, vaccinations, and the subjective psychological impact of the pandemic, as well as their current (within one month) anxiety levels, depression level, and symptoms of post-traumatic stress disorder (PTSD). Descriptive statistics and linear regression analysis models were used to compare soldier vs. student status and male vs. female. Overall, roughly 54% of the subjects had been infected by COVID-19 at least once, and the psychological impact of the pandemic was more pronounced in the infected group. The students reported more pronounced symptoms of PTSD (elevated anxiety and depression levels) than did the soldiers. All regression models other than those associated with age and sex revealed that the link between COVID-19 infection and the symptoms of PTSD was more salient among soldiers and males than among students and females. It appears that the psychological impact of COVID-19 is underreported by soldiers. These findings indirectly support previous research indicating that soldiers are less likely than students to disclose emotions related to trauma, indicating the need for psychological support for military personnel.

Genetic relationships of populations of the Black Kite Milvus migrans (Accipitriformes: Accipitridae) in the east of its range in Asia and Australia

While the Black Kite Milvus migrans is one of the most widespread birds of prey, occurring over Eurasia, Africa and Australia, it remains poorly understood outside of Europe, with southeast Asian populations particularly mysterious as their taxonomy is based on outdated morphological data. The subspecies M. m. formosanus, described in 1920, is thought to inhabit Taiwan and Hainan; however, populations in these areas have experienced dramatic changes over the past fifty years. Furthermore, M. m. formosanus is the only officially recognised subspecies for which almost no genetic data is yet available. Based on two mitochondrial genes, we compared Taiwanese Black Kites with northeast Asian and Japanese M. m. lineatus, Indian M. m. govinda and Australian M. m. affinis to reconstruct details of their population history. While Indian and Australian Black Kites are descendants of the same population, they do not share common haplotypes, probably having diverged by the end of the last glaciation. The Japanese population is distinctive in showing genetic uniformity, and it may be isolated from the mainland population. Nesting Taiwanese kites carry two previously known M. m. lineatus haplogroups and a new haplogroup possibly inherited from M. m. formosanus previously occurring in the area. A recent decline in the local population, along with expansion of M. m. lineatus, most likely led to Taiwan now being inhabited by descendants of both subspecies, which form two genetically isolated populations in southern and northern Taiwan.

Identifying the Layout of Retrofitted Rainwater Harvesting Systems with Passive Release for the Dual Purposes of Water Supply and Stormwater Management in Northern Taiwan

Due to its unique climate and geography, Taiwan experiences abundant rainfall but still faces significant water scarcity. As a result, rainwater harvesting systems (RWHSs) have been recognized as potential water resources within both water legal and green building policies. However, the effects of climate change—manifested in more frequent extreme rainfall events and uneven rainfall distribution—have heightened the risks of both droughts and floods. This underscores the need to retrofit existing RWHSs to function as stormwater management tools and water supply sources. In Taiwan, the use of simple and cost-effective passive release systems is particularly suitable for such retrofits. Four key considerations are central to designing passive release RWHSs: the type of discharge outlet, the size of the outlet, the location of the outlet, and the system’s operational strategy. This study analyzes three commonly used outlet types—namely, the orifice, short stub fitting, and drainage pipe. Their respective discharge flow formulas and design charts have been developed and compared. To determine the appropriate outlet size, design storms with 2-, 5-, and 10-year return periods in the Taipei area were utilized to examine three different representative buildings. Selected combinations of outlet diameters and five different outlet locations were assessed. Additionally, probably hazardous rainfall events between 2014 and 2023 were used to verify the results obtained from the design storm analysis. Based on these analyses, the short stub fitting outlet type with a 15 mm outlet diameter was selected and verified. For determining the suitable discharge outlet location, a three-step process is recommended. First, the average annual water supply reliability for different scenarios and outlet locations in each representative building is calculated. Using this information, the maximum allowable decline in water supply reliability and the corresponding outlet location can be identified for each scenario. Second, break-even points between average annual water supply and regulated stormwater release curves, as well as the corresponding outlet locations, are identified. Finally, incremental analyses of average annual water supply and regulated stormwater release curves are conducted to determine the suitable outlet location for each scenario and representative building. For the representative detached house (DH), scenario 2, which designates 50% of the tank’s volume as detention space (i.e., the discharge outlet located halfway up the tank), and scenario 3, which designates 75% (i.e., the discharge outlet at one-quarter of the tank height), are the most suitable options. For the four-story building (FSB), the outlet located at one-quarter of the tank’s height is suitable for both scenarios 2 and 3. For the eight-story building (ESB), scenario 2, with the outlet at one-quarter of the tank’s height, and scenario 3, with the outlet at the lowest point on the tank’s side, are preferred. The framework developed in this study provides drainage designers with a systematic method for determining the key parameters in passive-release RWHS design at the household scale.

Effectiveness of Walking Exercise in Improving Physical Fitness and Depression in Patients With Schizophrenia.

Patients with schizophrenia often lack physical activity, which, together with physical complications, can lower their expected lifespan. Exercise strengthens their physical and mental health. The primary aim of this study was to examine the effectiveness of a walking exercise intervention in improving physical fitness, body mass index, waist-to-hip ratio, and depressive symptoms in patients with schizophrenia. A quasi-experimental study design was used. Seventy-six participants were recruited from the psychiatric daycare center at a hospital in Northern Taiwan. They were divided into two groups. The intervention group received a walking exercise intervention, while the control completed their daily courses at the psychiatric daycare center. The changes in both groups' physical fitness, BMI, waist-to-hip ratio, and depressive symptoms were monitored. Cardiorespiratory endurance significantly improved in the intervention group, attesting to the effectiveness of the walking exercise intervention. Their depression level significantly decreased across all measurement stages. The group walking exercise reduced sedentary behaviors and increased the participants' autonomous motivation, hip circumference, and cardiorespiratory fitness. Structured exercise programs may increase the patients' hippocampal neuroplasticity and reduce their depressive symptoms. The walking exercise intervention positively affected physiological traits, physical fitness, and mental health of the participants.

Population connectivity of the swordtip squid Uroteuthis edulis between southern Japan and northern Taiwan using statolith trace elemental analysis

Uroteuthis edulis (Hoyle, 1885) is an Indo-Pacific squid species widely distributing in the western Pacific, and commercially important especially in Japan and Taiwan. It has been suggested that some individuals are possibly transported from the spawning ground in north Taiwan to the coasts of Japan, however, the strength of population connectivity between those areas and its influence on U. edulis population dynamics were unveiled. To understand the U. edulis population connectivity in this area, the correlations between statolith trace elements and abiotic/biotic factors were examined first, and then squid experienced environments were postulated throughout their entire life cycle. Sr/Ca ratio showed a strongly negative correlation with ambient water temperature but no correlation with individual growth rate, suggesting that Sr/Ca ratio can be used to reflect squid experienced temperatures. Most squid caught in the Sea of Japan hatched in the areas having similar water temperature with where Taiwanese squid hatched, that would be off the north Taiwan or even warmer area. Statolith trace elements successfully distinguished the catch locations but not the hatching grounds, implying that hatching grounds of Japan and Taiwan squid were largely overlapped. Thus, we suggest that there is strong population connectivity of U. edulis population between southern Japan and northern Taiwan. As there was no clear evidence for existence of local population hatched in the Sea of Japan in this study, U. edulis population might display a source-sink population dynamics, that is, population in Taiwanese waters and/or further south as the source, and the one in the Sea of Japan as a sink population. As U. edulis should be considered as a metapopulation, collaboration among countries in the northwestern Pacific is required for sustainable fishery management of this species.

Coping strategies of intensive care units nurses in alarm management: a qualitative research study

BackgroundIntensive care units are critical environments where various alarm systems play a pivotal role in patient monitoring and safety. Alarm fatigue can lead to slower response times and missed alarms, compromising patient safety and increasing stress and burnout among intensive care unit nurses. Understanding how intensive care unit nurses respond to and manage these alarms is crucial in evaluating their impact on patient care and nursing well-being.MethodsThis descriptive qualitative study explored the experiences of intensive care unit nurses in alarm management. Conducted in the medical and surgical intensive care units of a Northern Taiwan medical center, the study involved 15 nurses. Semi-structured interviews were utilized to investigate the working experiences of ICU nurses in alarm management and to identify their coping strategies for dealing with the constant inundation of medical device alarms. The interviews were transcribed, and content analysis was applied to identify key themes in the responses.ResultsThe study revealed five main themes in intensive care unit nurses’ strategies for managing alarms: (1) Mastering alarm signals and acting; (2) Team monitoring for life preservation; (3) Enhancing senses and distinguishing carefully; (4) Learning from the lessons of incidents for vigilant reflection; and (5) Detach alarms’ influence on daily life. These coping strategies are effective in alarm management, safeguarding patients’ lives, enhancing the serenity of the clinical environment, and mitigating the physical and mental exhaustion caused by alarm fatigue.ConclusionsIntensive Care Unit nurses develop various coping strategies to manage medical device alarms, based on their experience. These strategies are crucial in maintaining patient safety and reducing nurse alarm fatigue. They can also be used for nursing education and clinical training.

Novel age constraints on offshore islets around Taiwan with implications for the Northern Taiwan Volcanic Zone

Determining the exact age of volcanic activity in the Northern Taiwan Volcanic Zone (NTVZ) is essential for comprehending Taiwan's tectonic evolution. The timing and duration of the volcanic processes that formed the NTVZ remain uncertain despite the availability of geochronological, geochemical, and geophysical data. While extensive efforts have been directed towards investigating the age of the Tatun Volcanic Group, the primary feature of the NTVZ, many other aspects require further examination. This study concentrates on two offshore islets in the northern region of the NTVZ. We present new 40Ar/39Ar ages of 0.252 ± 0.018 Ma for a lava flow, representing an early stage of volcanic activity, and 0.118 ± 0.012 Ma for a dike, representing the latest stage of volcanic activity around Pengjia Islet. A sample collected from Mianhua Islet did not yield a reasonable age due to high uncertainty, likely attributable to young and low radiogenic argon. Field observations support the interpretation that volcanic activity on both islets is considerably younger than previously estimated. This study corroborates the hypothesis from geophysical studies that submarine NTVZ features to record a potentially active magmatic reservoir offshore of northern Taiwan. By refining our understanding of spatio-temporal patterns in volcanic activity, this study contributes to volcanic hazard assessment in Taiwan and surrounding areas.

The Experiences of Healthy Adults Participating in Advance Care Planning

After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses. This study was implemented to understand the experiences of healthy adults participating in ACP. A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis. A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics. During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.

Mediating role of obstructive sleep apnea in altering slow-wave activity and elevating Alzheimer’s disease risk: Pilot study from a northern Taiwan cohort

ObjectivesObstructive sleep apnea is associated with alterations in slow-wave activity during sleep, potentially increasing the risk of Alzheimer’s disease. This study investigated the associations between obstructive sleep apnea manifestations such as respiratory events, hypoxia, arousal, slow-wave patterns, and neurochemical biomarker levels. MethodsIndividuals with suspected obstructive sleep apnea underwent polysomnography. Sleep disorder indices, oxygen metrics, and slow-wave activity data were obtained from the polysomnography, and blood samples were taken the following morning to determine the plasma levels of total tau (T-Tau) and amyloid beta-peptide 42 (Aβ42) by using an ultrasensitive immunomagnetic reduction assay. Subsequently, the participants were categorized into groups with low and high Alzheimer’s disease risk on the basis of their computed product Aβ42 × T-Tau. Intergroup differences and the associations and mediation effects between sleep-related parameters and neurochemical biomarkers were analyzed. ResultsForty-two participants were enrolled, with 21 assigned to each of the low- and high-risk groups. High-risk individuals had a higher apnea–hypopnea index, oxygen desaturation index (≥3%, ODI-3%), fraction of total sleep time with oxygen desaturation (SpO2-90% TST), and arousal index and greater peak-to-peak amplitude and slope in slow-wave activity, with a correspondingly shorter duration, than did low-risk individuals. Furthermore, indices such as the apnea–hypopnea index, ODI-3% and SpO2-90% TST were found to indirectly affect slow-wave activity, thereby raising the Aβ42 × T-Tau level. ConclusionsObstructive sleep apnea manifestations, such as respiratory events and hypoxia, may influence slow-wave sleep activity (functioning as intermediaries) and may be linked to elevated neurochemical biomarker levels. However, a longitudinal study is necessary to determine causal relationships among these factors. Statement of significanceThis research aims to bridge gaps in understanding how obstructive sleep apnea is associated with an elevated risk of Alzheimer’s disease, providing valuable knowledge for sleep and cognitive health.

Prevalence and Correlates of Depressive Symptoms among Patients with Cancer: A Cross-Sectional Study.

The purpose of this study was to identify the correlates of depressive symptoms and the prevalence of depression, distress, and demoralization among patients with cancer in Taiwan in relation to their sociodemographics. A cross-sectional study design with convenience sampling was used to recruit 191 consecutive patients with cancer from the Cancer Center of a teaching hospital in northern Taiwan. Multiple linear regression was applied to analyze the determinants of depressive symptoms. The prevalence rates of depression (including suspected cases), distress, and demoralization were 17.8%, 36.1%, and 32.5%, respectively. The regression model explained 42.2% of the total variance, with significant predictors including marital status, life dependence, comorbidity, demoralization, and distress. The results demonstrated that higher levels of distress and demoralization were associated with more depressive symptoms. Demoralization and distress played vital roles in moderating depressive symptoms among patients with cancer. Nursing interventions should integrate appropriate mental health services, such as alleviating distress and demoralization, to prevent the occurrence of depression in patients with cancer.

A new species of Pseudodiaptomus (Copepoda, Calanoida, Pseudodiaptomidae) from the coastal waters of northern Taiwan with notes on co-occurring and previously recorded species

Abstract We investigated the species diversity of the demersal copepod genus Pseudodiaptomus in the coastal waters of northern Taiwan, and recorded four species new to Taiwanese waters: P. echinatus n. sp., P. ishigakiensis Nishida, 1985, P. philippinensis Walter, 1986, and P. zhengi Wang &amp; Guo, 2019. Pseudodiaptomus echinatus n. sp. is distinguished from the allied species P. serricaudatus (Scott T., 1894) by the female genital double-somite, which is laterally swollen and of subequal length and width, and the male fifth leg, the right endopod of which is oval with a row of spinules increasing in size toward the tip, and the first exopod segment of which has a distomedial digitiform process with rounded tip. In addition, out of the 11 nominal species previously recorded from Taiwanese waters, we found only three species (P. annandalei Sewell, 1919, P. bispinosus Walter, 1984, P. trihamatus Wright, 1937). We were unable to confirm the presence of P. forbesi (Poppe &amp; Richard, 1890), P. incisus Shen &amp; Lee, 1963, P. inopinus Burckhardt, 1913, P. marinus Sato, 1913, P. pacificus Walter, 1986, P. penicillus Li &amp; Huang, 1984, P. poplesia (Shen, 1955), and P. serricaudatus (T. Scott, 1894) by a critical review of available literature based on morphology, locality, habitat, etc. In this regard, it is necessary for a future study to try to verify the presence of these eight species in Taiwanese waters.

Investigating the mechanisms of an intense coastal rainfall event during TAHOPE/PRECIP-IOP3 using a multiscale radar ensemble data assimilation system

Abstract The joint Taiwan-Area Heavy Rain Observation and Prediction Experiment (TAHOPE)/Prediction of Rainfall Extremes Campaign In the Pacific (PRECIP) field campaign between Taiwan and the United States took place from late May to mid-August in 2022. The field campaign aimed to understand the dynamics, thermodynamics, and predictability of heavy rainfall events in the Taiwan area. This study investigated the mechanisms of a heavy rainfall event that occurred on 6–7 June during the intensive observation period-3 (IOP3) of the field campaign. Heavy rainfall occurs on Taiwan’s western coast when a Meiyu front hovers in northern Taiwan. A multiscale radar ensemble data assimilation system based on the successive covariance localization (SCL) method is used to derive a high-resolution analysis for forecasts. Two numerical experiments are conducted with the use of convective-scale (RDA) or multiscale (MRDA) corrections in the assimilation of the radial velocity from operational radars at Chigu and Wufen, and the additional S-Pol radar deployed at Hsinchu during the field campaign. Compared with RDA, MRDA results in large-area wind corrections, which help reshape and relocate a low-level mesoscale vortex, a key element of this heavy rainfall event, offshore of western central Taiwan and enhances the front intensity offshore of northwestern Taiwan. Consequently, MRDA improves the 6-h heavy rainfall prediction over the coast of western Taiwan and better represents the elongated rainband in northern Taiwan during the 3- to 6-h forecast. Sensitivity experiments demonstrate the importance of assimilating winds from Chigu and S-Pol radar in establishing low-level mesoscale vortex and convergence zones.

Sporelings and growth of the marine red alga, Gelidium elegans (Gelidiaceae), from Northern Taiwan

Sporelings and growth of the marine red alga, Gelidium elegans (Gelidiaceae), from Northern Taiwan

The association of the comorbidity status of metabolic syndrome and cognitive dysfunction with health-related quality of life.

Both metabolic syndrome (MetS) and cognitive dysfunction impair health-related quality of life (HRQOL). This study aims to determine whether individuals experiencing both MetS and cognitive dysfunction have lower HRQOL. This cross-sectional study enrolled 567 participants who attended outpatient clinics at a medical center in northern Taiwan. MetS was diagnosed according to the modified criteria for the Asian population. Cognitive function was categorized as normal, mild cognitive dysfunction, and advanced cognitive dysfunction according to the score of the Montreal Cognitive Assessment, Taiwanese version. HRQOL was assessed using the SF-36v2® Health Survey (SF-36v2). The associations of the comorbidity status of MetS and cognitive dysfunction with HRQOL were analyzed using linear regression models, adjusting for age, sex, marital status, education level, income groups, and activities of daily living. Out of 567 participants, 33 (5.8%) had MetS with mild cognitive dysfunction, and 34 (6.0%) had MetS with advanced cognitive dysfunction. Participants with both MetS and advanced cognitive dysfunction exhibited the lowest scores in the physical component summary and almost all scales of HRQOL. MetS exacerbated the inverse association between mild cognitive dysfunction and the mental component summary. For those with MetS, the scores on scales of role physical, bodily pain, vitality, and social functioning worsened as cognitive function deteriorated (all Ptrend<0.05). As the severity of comorbidity between MetS and cognitive dysfunction varies, patients exhibited poorer performance in different aspects of HRQOL. Future research is needed to find solutions to improve HRQOL for patients with both MetS and cognitive dysfunction.

Evaluating the effectiveness of illness script teaching on clinical reasoning skills in post-baccalaureate nursing students

BackgroundTypically, nurse education curricula are separated into the teaching of theoretical knowledge and practical skills. This separation may hinder nursing students' development of clinical reasoning skills, making it difficult for them to prioritize tasks and make decisions about interventions. Illness scripts have been shown to help medical students improve their clinical reasoning skills; however, they are rarely used in nurse education. ObjectivesTo evaluate the influence of illness script teaching method on post-baccalaureate nursing students' clinical reasoning skills. DesignThe study adopted a single-arm quantitative pre-experimental research design and incorporated qualitative focus group discussions. Settings/participantsThis study was conducted at a university in northern Taiwan. Participants included 35 post-baccalaureate nursing students who were enrolled in an elective course focused on clinical skills. MethodsTo enhance nursing students' clinical reasoning skills, illness scripts for five clinical scenarios were developed and implemented as part of their curriculum. The Nurses Clinical Reasoning Scale was utilized to assess self-rated clinical reasoning abilities, while dual-teacher scoring was used to evaluate clinical reasoning objectively. The VARK learning preference questionnaire was used to examine how learning preferences affect learning outcomes. After the course, semi-structured focus groups were held to collect student feedback on the effectiveness of the teaching methods and the learning outcomes. ResultsThis study's quantitative and qualitative results show that illness script-based teaching improves nursing students' clinical reasoning. Quantitative results showed significant objective reasoning score improvements. However, minimal changes in self-rated scores suggest a learning style-influenced gap between perceived and actual abilities. Qualitative findings showed that students valued linking clinical issues to practical applications but struggled with knowledge gaps and engagement. ConclusionsThe illness script teaching method improved students' understanding of clinical scenarios and enhanced their clinical reasoning abilities. Incorporating illness scripts into nurse education was beneficial for nursing students.

PM2.5 episodes in northern Taiwan under southerly winds in late winter

When northern Taiwan is influenced locally, PM2.5 events occur in specific conditions. If it is also affected by long-range transport from mainland China in the northwest, the probability of these PM2.5 events increases. The current study applies WRF/CMAQ to study such case but focus on the local. From April 7 to 9, 2019, the Pacific high pressure extended westward, causing the prevailing weak southerly wind near Taiwan. The intensity of the Pacific high pressure weakened, and the wind speed near Taiwan also weakened. Therefore, the PM2.5 concentration in Taiwan increased. In northern Taiwan, the hourly PM2.5 concentration will inevitably increase to approximately 70 μg m−3. The ISAM of the CMAQ model demonstrates that local contributions to daily PM2.5 concentrations at the four representative monitoring stations in northern Taiwan are 3.5 to 16.2 μg m−3, greater than those from central, southern, and eastern Taiwan, from 1.8 to 6.7 μg m−3. We use the integrated process rate (IPR) and integrated reaction rate (IRR) of CMAQ to explore the formation mechanisms of PM2.5. The main causes of the increase in PM2.5 concentration are horizontal advection (HADV), aerosol processes (AERO), emissions (EMIS), and a small amount of cloud processes and aqueous chemistry (CLDS). The main source of NO3− is the reaction between OH and NO2 during the day and the reaction between N2O5 and water vapor at night. The gaseous HNO3 concentration reaches a peak near noon or soon after. The aerosol ANO3 concentration is high in the early morning. We also use the Sulfur Tracking Method (STM) of CMAQ to explore the sources of SO42−. Mainly it is from the local reaction of SO2 and H2O2. Finally, we apply AERO7 in CMAQ to explore the main sources of carbon components. The organic carbon (OC) concentration is much greater than the element carbon (EC) concentration, which indicates a strong local photochemical effect in northern Taiwan. OC mainly comes from low-volatility/semivolatile oxidized combustion OC, followed by low-volatility/semivolatile POA. Similar weather conditions occur in autumn, winter, and spring. When the weak southerly wind was around Taiwan, PM2.5 in northern Taiwan was noticed.

The emergence of transposon-driven multidrug resistance in invasive nontypeable Haemophilus influenzae over the last decade

Nontypeable Haemophilus influenzae (NTHi), once considered a harmless commensal, has emerged as a significant concern due to the increased prevalence of multidrug-resistant (MDR) strains and their association with invasive infections. This study aimed to explore the epidemiology and molecular resistance mechanisms of 51 NTHi isolates collected from patients with invasive infections in northern Taiwan between 2011 and 2020. This investigation revealed substantial genetic diversity, encompassing 29 distinct sequence types and 18 clonal complexes. Notably, 68.6% of the isolates exhibited ampicillin resistance, with 28 categorised as MDR and four isolates were even resistant to up to six antibiotic classes. Among the MDR isolates, 18 pulsotypes were identified, indicating diverse genetic lineages. Elucidation of their resistance mechanisms revealed 18 β-lactamase-producing amoxicillin–clavulanate-resistant (BLPACR) isolates, 12 β-lactamase-producing ampicillin-resistant (BLPAR) isolates, and 5 β-lactamase-nonproducing ampicillin-resistant (BLNAR) isolates. PBP3 analysis revealed 22 unique substitutions in BLPACR and BLNAR, potentially contributing to cephem resistance. Notably, novel transposons, Tn7736-Tn7739, which contain critical resistance genes, were discovered. Three strains harboured Tn7739, containing seven resistance genes [aph(3′)-Ia, blaTEM-1, catA, sul2, strA, strB, and tet(B)], while four other strains carried Tn7736, Tn7737, and Tn7738, each containing three resistance genes [blaTEM-1, catA, and tet(B)]. The emergence of these novel transposons underscores the alarming threat posed by highly resistant NTHi strains. Our findings indicated that robust surveillance and comprehensive genomic studies are needed to address this growing public health challenge.