Taiwan Society Research Articles

Association of Heart Rate Trajectory Patterns with the Risk of Adverse Outcomes for Acute Heart Failure in a Heart Failure Cohort in Taiwan.

Heart rate trajectory with multiple heart rate measurements is considered to be a more sensitive predictor of outcomes than single heart rate measurements. The association of heart rate trajectory patterns with acute heart failure outcomes has not been well studied. We examined the association of heart rate trajectory patterns with post-discharge outcomes. This prospective cohort study was based on an acute heart failure registry in Taiwan. A total of 1509 patients were enrolled in the Taiwan Society of Cardiology - Heart Failure with Reduced Ejection Fraction Registry from May 2013 to October 2015. The outcomes were post-discharge all-cause mortality and heart failure re-admission. Two heart trajectory patterns were identified in group-based trajectory analysis. One started with a higher heart rate and had an increasing trend over 6 months then a subsequent decline (high-increasing-decreasing group; n = 352; 23.9%). The other started with a lower heart rate and had a relatively stable pattern (low-stable group; n = 1121; 76.1%). Compared with those in the low-stable group, patients in the high-increasing-decreasing group had a higher risk of events (all-cause mortality: hazard ratio 3.10 and 95% confidence interval 1.24-7.77; heart failure re-admission: hazard ratio 1.13 and 95% confidence interval 0.55-2.32). Patients with a high-increasing-decreasing heart rate trajectory pattern had a higher risk of all-cause mortality than those with a low-stable pattern.

Taiwan Society of Colon and Rectal Surgeons (TSCRS) Consensus for Cytoreduction Selection in Metastatic Colorectal Cancer.

Taiwan has witnessed a surge in the incidence of colorectal cancer (CRC), of which 40-60% metastasize. Continuous updating of cytoreductive strategies in metastatic CRC (mCRC) has contributed to median overall survival reaching 40months. In this changing scenario, to standardize the approaches across Taiwan, a group of experts from the Taiwan Society of Colon and Rectal Surgeons (TSCRS) convened to establish evidence- and opinion-based recommendations for defining the criteria of "resectability" in mCRC. Over the course of one-on-one consultations, lasting 30-40min each, with 30 medical specialists (19 colorectal surgeons, 4 general surgeons, and 7 medical oncologists) from 16 hospitals in Taiwan followed by a 2-h meeting with 8 physician experts (3 general surgeons, 4 colorectal surgeons, and 1 thoracic surgeon), 12 key questions on cytoreduction were addressed. This was further contextualized based on published literature. The final consensus includes eight recommendations regarding the criteria for metastasis resection, role of local control treatment in liver potentially resectable patients, management of synchronous liver metastases, approach for peritoneal metastasis, place for resection in multiple-organ metastasis, and general criteria for resectability. mCRC patients undergoing R0 resection have the greatest survival advantage following surgery. Our role as a multidisciplinary team (MDT) should be to treat potentially resectable mCRC patients as rapidly and safely as possible, and achieve R0 resection as far as possible and for as long as possible (continuum of care). This TSCRS consensus statement aims to help build clinical capacity within the MDTs, while making better use of existing healthcare resources.

Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis

To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA). The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group meetings. The nine critical issues were recognized to provide updated information and internationally acceptable protocols. When screening for PA by using the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR), withdrawal or adjustment of antihypertensive medication is not always necessary on the first patient visit. Hypokalemia should be corrected before ARR screening. In spontaneous hypokalemia, plasma renin below detection levels, and PAC higher than 20 ng/dL (550 pmol/L), further confirmatory testing is unnecessary for PA diagnosis. Direct renin concentration (DRC) could be used for PA diagnosis if PRA is unavailable. Although additional confirmatory tests are suggested, the result of a single test is still reliable. For patient safety, discontinuation or adjustment of antihypertensive medications is indicated before adrenal venous sampling (AVS). ACTH could be beneficial for successful adrenal vein cannulation but is not necessary for determining lateralization in AVS. Simultaneous technique is preferred for AVS. Adrenal NP-59 scintigraphy integrated with SPECT/CT could guide PA management. With introduction of these new concepts to the clinicians, we expect better identification, management and treatment of PA patients.

Impacts of Attitudes Toward Government and Corporations on Public Trust in Artificial Intelligence

ABSTRACT Artificial intelligence (AI) has alarmed the society of Taiwan believing it is responsible for potential surveillance, data theft and abuse, and other privacy infringements. By adopting the theory of motivated reasoning, this study explores how Taiwanese people’s perceptions of AI are affected by their institutional trust, attitudes toward the government and corporations, which are the two most common sponsors of scientific development. First, findings establish that respondents’ science trust in AI is made up of perceptions of AI and its science community, and they have lower faith in the AI science community than in AI alone. Second, the perceptions of both AI and its science community are positively associated with trust in government and corporations. Third, scientific news has a direct bearing on AI trust, but not on either government or corporation trust. By contrast, political news has no effect on either trust in AI or its science community, yet trust in government and corporations mediates the influence of political news on trust in AI and its science community. Finally, demographic variables hardly predict trust in AI, AI science community, government, and corporations, but education and gender are directly related to news consumption, which further influences institutional and science trust.

Cultural Impact on the Intention to Use Nursing Information Systems of Nurses in Taiwan and China: Survey and Analysis.

BackgroundNursing workforce shortage has emerged as a global problem. Foreign nurse importation is a popular strategy to address the shortage. The interactions between nursing staff on either side of the Taiwan Strait continue to increase. Since both nurses in Taiwan and nurses in China have adopted nursing information systems to improve health care processes and quality, it is necessary to investigate factors influencing nursing information system usage in nursing practice.ObjectiveThis study examined the effects of cultural and other related factors on nurses’ intentions to use nursing information systems. The findings were expected to serve as an empirical base for further benchmarking and management of cross-strait nurses.MethodsThis survey was conducted in two case hospitals (one in Taiwan and one in China). A total of 880 questionnaires were distributed (n=440 in each hospital).ResultsThe results showed effort expectancy had a significant effect on the intention to use nursing information systems of nurses in China (P=.003) but not nurses in Taiwan (P=.16).ConclusionsFindings suggest nursing managers should adopt different strategies to motivate cross-strait nurses to use nursing information systems. Promoting effort expectancy is more likely to motivate nurses in China than in Taiwan. This discrepancy is probably due to the less hierarchical and more feminine society in Taiwan.

2020 Focused Update of the 2012 Guidelines of the Taiwan Society of Cardiology for the Management of ST-Segment Elevation Myocardial Infarction.

One of the major missions of the Taiwan Society of Cardiology is to publish practice guidelines that are suitable for local use in Taiwan. The ultimate purpose is to continuously improve cardiovascular health care from the implementation of the recommendations in the guidelines. Despite recent improvement of medical care, patients with ST-segment elevation myocardial infarction (STEMI) still carry a high morbidity and mortality. There have been many changes in the concepts of STEMI diagnosis and treatment in recent years. The 2020 focused update of the 2012 guidelines of the Taiwan Society of Cardiology for the management of STEMI is an amendment of the 2012 guidelines based on the newest published scientific data. The recommendations in this focused update provide the diagnosis and treatment strategy for STEMI that should be generally implemented in Taiwan. Nevertheless, guidelines never completely replace clinical judgment and medical decision still should be determined individually.

Do Specific Pedagogies and Problem-Based Teaching Improve Student Employability? A Cross-Sectional Survey of College Students.

Higher education policy and manpower training have failed to meet the requirement of rapidly changing society and employers’ expectation in Taiwan, resulting in a significant gap between university education and employment. Student employability should also be a focus of all higher education institutions, although whether a high degree of student learning outcomes can represent a high degree of student employability is still unclear. This study explores the relationships among pedagogy for employability, the problem-based teaching mode, absorptive capacity, and student employability in higher education institutions (HEIs). Based on analysis of a total sample of 553 undergraduates from 16 Taiwanese HEIs using structural equation modeling, the results show that the influences of pedagogy for employability and the problem-based teaching mode on absorptive capacity and student employability are positively statistically significant. Based on the findings, specific suggestions and managerial implications for HEIs, curriculum and instruction planning, and future research are provided.

Clinicopathological features and outcome of esophageal neuroendocrine tumor: A retrospective multicenter survey by the digestive endoscopy society of Taiwan

Esophageal neuroendocrine tumors (NET) are very rare and mostly carcinomic, carrying poor prognosis. There is still no guideline or consensus on the treatment for esophageal NET. Patients with histologically-proven esophageal neuroendocrine tumor were recruited from 9 hospitals in Taiwan between 2002 and 2017. Clinical, laboratory, radiological, endoscopic, pathological data, treatment strategies, follow-up periods, and survivals were collected retrospectively. In total, 39 esophageal NET were analyzed and 38 were neuroendocrine carcinoma (NEC). Sixteen (41%) patients had mixed components with either adenocarcinoma (N=9, 23%) or squamous-cell carcinoma (SCC) (N=7, 18%). 64.1% of the patients experienced dysphagia and ulcerative mass was the most comment endoscopic finding. There was a higher proportion of drinkers (54.1%), betel chewers (21.6%) and smokers (64.9%) among the patients than in the general population in Taiwan. Five patients (12.8%) had been diagnosed with other cancers. Definite chemoradiotherapy (N=14, 35.9%) and surgery (N=7, 17.9%) were the major treatment. Patients with Ki-67% above the median level (50%) in the tumors tended to have worse survival (P=0.06). However, presence of mixed component was not a significant survival predictor in our study (P=0.56). Mixed component of an esophageal NET is commonly observed. Staged workup and the principle of treatment can follow that for the common cancer type of esophagus. The risk factors and behaviors of esophageal NEC in Taiwan seem to be similar to that of esophageal SCC.

Clinical Guidance of Mild to Moderate Sedation-An Expert Consensus by Taiwan Society of Anesthesiologists.

Clinical Guidance of Mild to Moderate Sedation-An Expert Consensus by Taiwan Society of Anesthesiologists.

2020 Consensus of Taiwan Society of Cardiology on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases.

The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. The total diabetic population is expected to increase from 415 million in 2015 to 642 million by 2040. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of patients with type 2 diabetes died of ASCVD. The association between hyperglycemia and elevated cardiovascular (CV) risk has been demonstrated in multiple cohort studies. However, clinical trials of intensive glucose reduction by conventional antidiabetic agents did not significantly reduce macrovascular outcomes.In December 2008, U.S. Food and Drug Administration issued a mandate that every new antidiabetic agent requires rigorous assessments of its CV safety. Thereafter, more than 200,000 patients have been enrolled in a number of randomized controlled trials (RCTs). These trials were initially designed to prove noninferiority. It turned out that some of these trials demonstrated superiority of some new antidiabetic agents versus placebo in reducing CV endpoints, including macrovascular events, renal events, and heart failure. These results are important in clinical practice and also provide an opportunity for academic society to formulate treatment guidelines or consensus to provide specific recommendations for glucose control in various CV diseases.In 2018, the Taiwan Society of Cardiology (TSOC) and the Diabetes Association of Republic of China (DAROC) published the first joint consensus on the "Pharmacological Management of Patients with Type 2 Diabetes and Cardiovascular Diseases." In 2020, TSOC appointed a new consensus group to revise the previous version. The updated 2020 consensus was comprised of 5 major parts: (1) treatment of diabetes in patients with multiple risk factors, (2) treatment of diabetes in patients with coronary heart disease, (3) treatment of diabetes in patients with stage 3 chronic kidney disease, (4) treatment of diabetes in patients with a history of stroke, and (5) treatment of diabetes in patients with heart failure. The members of the consensus group thoroughly reviewed all the evidence, mainly RCTs, and also included meta-analyses and real-world evidence. The treatment targets of HbA1c were finalized. The antidiabetic agents were ranked according to their clinical evidence. The consensus is not mandatory. The final decision may need to be individualized and based on clinicians' discretion.

Teachers' transformational leadership and students' employability development: A social cognitive career perspective

Higher education policy and talent training are failing to meet the ever-changing expectations of employers and society in Taiwan, resulting in a gap between university education and employment. We used social cognitive career theory to explore the relationships between problem-based learning, teachers' transformational leadership, and students' self-efficacy and employability. Participants were 619 undergraduates from 12 Taiwanese higher education institutions. We performed structural equation modeling and found that there were significant positive correlations between students' self-efficacy, problem-based learning, and employability, along with teachers' transformational leadership. Further, problem-based learning and the students' self-efficacy were key mediators of the relationship between teachers' transformational leadership and students' employability. Implications are discussed for related issues and future research involving models of students' employability.

Comparison between ticagrelor versus clopidogrel in long term outcomes of Taiwanese diabetic subjects with acute coronary syndrome undergoing successful revascularization: From TSOC ACS-DM registry.

Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15–0.80]; P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.

Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy.

New “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is responsible for a clinical entity named Coronavirus Disease 2109 (COVID-19) by the World Health Orgazination, which is now a pandemic (1). In Europe, Italy was the first, and so far the largest, epicenter of the epidemic. It is now clear that many asymptomatic and paucisymptomatic patients went undetected, causing significant diffusion of the disease. Asymptomatic infections are common: among 634 confirmed patients on board the “Diamond Princess” cruise ship, 306 were symptomatic and 328 asymptomatic at the time of testing (2). It is now clear that when a patient with atypical severe pneumonia was diagnosed as COVID-19 in a small city, Codogno, in a previously healthy 38-year-old man, on February 20, 2020, more patients with undetected COVID-19 were present in Northern Italy. In addition to the cluster around Codogno, about 50 km south of Milan, which was promptly put under strict lockdown, two additional relevant clusters emerged near the cities of Bergamo and Brescia. The delay in enforcing a lockdown in the latter areas is probably one of the leading causes of the more severe outbreak now affecting these provinces. Extensive testing in the initial phase of disease diffusion was adopted in the Italian Veneto area, resulting in better containment of new cases. A nationwide lockdown measure was passed by the Italian government when Northern Italy, which has the highest concentration of well organized hospitals in the country, started showing signs of difficulty handling the rapid increase of patients in need of treatment in intensive care units (ICUs). A comparison of Chinese and Italian data on COVID-19 may be of interest to other countries where the disease is now spreading. The Chinese Center for Disease Control and Prevention described the characteristics of a large cohort of COVID-19 patients (3), showing that …

One-Year Mortality Risk Stratification in Patients Hospitalized for Acute Decompensated Heart Failure: Construction of TSOC-HFrEF Risk Scoring Model.

Most previous risk prediction models in patients hospitalized for heart failure (HF) are derived from populations in Western countries, and it is unclear whether these models are applicable to Asian populations. This study aimed to construct a risk score system for predicting one-year mortality risk in Asian patients and to compare the applicability of this risk score system with the 3C-HF score system. We used the population in the Taiwan Society of Cardiology-Heart Failure with Reduced Ejection Fraction (TSOC-HFrEF) registry, which is a prospective cohort of patients admitted for acute decompensated heart failure (ADHF) in Taiwan. The risk score system was constructed using multivariate Cox-model derived coefficients. A bootstrapping procedure was also used for bias-corrected evaluations. Comparisons between this constructed model and the 3C-HF score prediction model were evaluated using calibration plots and area under curve (AUC)/receiver operating characteristic (ROC) curve. Patients with complete data (n = 1127) in the TSOC-HFrEF registry were analyzed. During one year of follow-up, 14.5% (n = 163) of the patients died. A risk score system was constructed with the following predictors: body mass index, diastolic blood pressure, dyslipidemia, diabetes, aortic regurgitation, QRS duration, hemoglobin concentration, and digoxin usage. Compared to the 3C-HF score system, this risk score system had a similar discriminatory ability (AUC/ROC values of 0.675 and 0.636, p = 0.127) and both were well-calibrated in the Taiwan population. The proposed risk score system for predicting one-year all-cause mortality in Taiwanese patients with ADHF may facilitate risk stratification in Asian patients with HF.

Социокультурные мифы КНР и Тайваня (конец 1950-х гг. — настоящее время)

<p>В статье исследуются социокультурные нарративы в парадигме основных национальных мифов Китая. Являясь специфическими онтологическими системами, социокультурные мифы выполняют функцию сглаживания социальных противоречий в определенном обществе и адаптируют своих последователей к изменяющимся историческим обстоятельствам. Будучи модульными системами, они легко входят в повествование глобальных и долговечных национальных мифов «Китай — великое государство и семья народов, каждый из которых обладает своей спецификой и самобытностью» и «Китай и Тайвань — единая гражданская нация, имеющая общих предков в лице основоположников китайского мира». Также они обеспечивают нормальное восприятие изменяющейся действительности.</p><p>Возникновение таких нарративов связано с ситуацией кризиса и социальной нестабильности. Современные китайские социокультурные мифы являются производными от порождающего национального мифа и содержат переносимый модульный компонент, например, в виде базовых понятий конфуцианства, актуализируемых к модернизированному обществу КНР и КР, зафиксированных в оригинальном китайском письме. Этот модуль эффективно применим в продуктах репрезентации как мифов, так и национальных идей и инициатив китайского правительства. Благодаря емкости содержания и эргономичности плана выражения, модульные компоненты базовых социокультурных нарративов включены в агитационную продукцию и легко узнаваемы.</p><p>Характерной чертой продуктов неомифологии является также их абсолютное соответствие форме научных парадигм, хотя мифопотребители по-прежнему склонны принимать на веру повествование мифа, не подвергая его эмпирической проверке.</p>

Recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan.

Clostridioides difficile infection (CDI) is a major enteric disease associated with antibiotic use and a leading cause of hospital-acquired infections worldwide. This is the first guideline for treatment of CDI in Taiwan, aiming to optimize medical care for patients with CDI. The target audience of this document includes all healthcare personnel who are involved in the medical care of patients with CDI. The 2018 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group was formed, comprising of infectious disease specialists from 13 medical centers in Taiwan, to review the evidence and draft recommendations using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations during a consensus meeting in March 2019. The recommendation is endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline describes the epidemiology and risk factors of CDI, and provides recommendations for treatment of CDI in both adults and children. Recommendations for treatment of the first episode of CDI, first recurrence, second and subsequent recurrences of CDI, severe CDI, fulminant CDI, and pediatric CDI are provided.

Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5.

In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overestimated. Poor interobserver concordance of diagnosis and TPS criteria was revealed. Compared with other cytological features, the N/C ratio assessment was quantitative and more reproducible, but a tendency to overestimate cells was noted when the N/C ratio was approximately 0.5. Continuing education programs should emphasize the accurate assessment of N/C ratio to improve the application of TPS.

International consensus statements for endoscopic management of distal biliary stricture.

Distal biliary strictures (DBS) are common and may be caused by both malignant and benign pathologies. While endoscopic procedures play a major role in their management, a comprehensive review of the subject is still lacking. Our consensus statements were formulated by a group of expert Asian pancreatico‐biliary interventional endoscopists, following a proposal from the Digestive Endoscopy Society of Taiwan, the Thai Association for Gastrointestinal Endoscopy, and the Tokyo Conference of Asian Pancreato‐biliary Interventional Endoscopy. Based on a literature review utilizing Medline, Cochrane library, and Embase databases, a total of 19 consensus statements on DBS were made on diagnosis, endoscopic drainage, benign biliary stricture, malignant biliary stricture, and management of recurrent biliary obstruction and other complications. Our consensus statements provide comprehensive guidance for the endoscopic management of DBS.

Improved appropriateness of anti-tuberculosis prescription by the expert prescription review program in Taiwan

A nationwide program initiated by Taiwan CDC was conducted by the Taiwan Society of Tuberculosis and Lung Disease to improve the appropriateness of anti-TB prescriptions in Taiwan. All anti-TB prescriptions from 12 hospitals across Taiwan were reviewed by experienced pulmonologists, according to the 2011 Taiwan TB treatment guidelines, between May and October 2013. The investigation period was divided into three stages: May to June, July to August, and September to October. The concordance rates between anti-TB prescriptions and the guidelines were compared among the three stages and between medical centers and regional hospitals. A total of 2574 new anti-TB prescriptions were reviewed. The appropriateness of anti-TB prescriptions was 82.0%. The most dominant error was inappropriate dosage of anti-TB medications. The appropriateness improved significantly with prescription review, and the concordance rates were 78.7%, 80.6%, and 87.6% in stages 1, 2, and 3, respectively (P<0.001). The inappropriateness of medication dosage also improved significantly, with the rates of inappropriate dosage dropping from 10.2% in stage 1-5.4% in stage 3 (Odds ratio 0.491, P<0.001). The appropriateness rates showed no significant difference between regional hospitals and medical centers (82.5% vs. 81.3%, Odds ratio 0.915, P=0.393), but the improvement of prescription appropriateness was significant in regional hospitals but not in medical centers. Prescription review by TB experts is an effective approach to improve the appropriateness of anti-TB prescriptions.

Youth and Political Music in Taiwan: Resignifying the Nation at Inland Rock and Tshingsan Fest

This article uses musical events in Taiwan to examine the changing contestation of Taiwanese politics. It shows how youth activists remake political practices by connecting people to constructions of local culture through musical performances. Whereas civil society and youth participation in Taiwan's elections have attracted increased scholarly attention, this article focuses on politically charged activities outside election campaigns. The article sources politics in musical practices, highlighting localized reproductions of global genres of popular music and its significance for Taiwanese youth activism. Drawing on historical analyses of the development of Taiwanese music throughout the twentieth century as localizing global influences in the production of indigenized music, the author argues that music has been more than just a communicative medium for contesting establishment politics, because activists use it to resignify sociocultural symbols and practices in productions of Taiwanese identity. The author examines two 2016 music festivals, Inland Rock and Tshingsan Fest, to analyze active constructions of identity and political action through a framework of music as politics. It demonstrates how, by appropriating space and symbols of Nantou County and Monga district for new cultural festivities, activists reterritorialized physical and conceptual terrain to reconnect people to indigenized constructions of Taiwanese identities.