Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese.

[[abstract]]"The objective of this study was to determine the population-specific cut-points of body mass index (BMI), midarm circumference (MAC) and calf circumference (CC) for identifying subnormal nutritional status in elderly Taiwanese, and to evaluate the possibility of improving the functionality of the Mini Nutritional Assessment (MNA) by adopting these cut-points. This study analyzed data from 1583 men and 1307 women, 65 years or older, of a national survey. The survey involved in-home, face-to-face, interviews and anthropometric measurements. Results showed that based on the cumulative percentile curves, the fifth percentile values were: BMI, 17 kg/m2 for both men and women; MAC, 22.5 cm for men and 21 cm for women; and CC, 28 cm for men and 25 cm for women. Substitution of these population-specific cut-points for respective values in the MNA screen resulted in lowered proportions of elderly classified malnourished or at risk of malnutrition. The prevalence of malnutrition was reduced from 1.7% to 1.4% in men and from 2.4% to 1.5% in women. The proportions classified at risk of malnutrition were reduced from 10.1% to 8.9% for men and 16.8% to 12.8% for women. In conclusion, results suggest that the MNA is a valuable tool for geriatric nutritional risk assessment. However, in populations where significant differences exist in anthropometric measurements from the Caucasian populations, population-specific cut-points should be used.

Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. OBJECTIVES: We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. METHODS: We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. RESULTS: LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6–15.3) vs. 12.0 (10.2–13.7); p = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); p < 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement <0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70–0.86) among all LA wall indices. CONCLUSIONS: Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF

Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. Objectives: We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. Methods: We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. Results: LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6–15.3) vs. 12.0 (10.2–13.7); p = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); p &lt; 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement &lt;0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70–0.86) among all LA wall indices. Conclusions: Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF.</p

Socio-legal perspectives on biobanking: the case of Taiwan

This thesis investigates in depth the phenomenon of biobanking from an anthropological and socio-legal approach. In recent years there has been an evertighter alliance formed between discoveries in life sciences and capital accumulation. The rapid advances in genomics introduce a new form of capital in the development of technoscience. In order to find biomarkers for genetic association studies in the susceptibility of common complex diseases, the generation of large-scale population resources is deemed to be an important step to support the development of genomics which now transforms its imagery from informatics to therapeutics. Biobanks - collections of human biological materials linked through genetic information - have attracted considerable attention across the globe. These global assemblages of capital and vital politics have led to innovative institutions and arrangements in fields of technoscience and ethics. Though biobanking is an apparently global phenomenon, diverse political innovations and ethical configurations emerge from the specific social and cultural milieux, in which its establishment and operation are situated. This thesis uses recent developments of a longitudinal population-based research resource in Taiwan as a specific instance to analyse the delicate entanglement between politics, capital and life sciences. It explores not only the legal and ethical issues posed by biobanks, such as consent, privacy and property, but also the political and economic aspects of the biobanks that are embedded in the broader global bio-economies. This emphasis, focusing on the way in which biovalue is produced, politico-scientific decisions are made and ethical configurations are framed, allows an opportunity to reassess law and ethics, capital and politics, as well as the role of the state and its populations in this new form of biotechnology

Analysis of Occupational Stressors of Public Health Nurses in Taiwan

[[abstract]]ABSTRACT Objective(s): to determine the major work stressors and their impacting factors on public health nurses in Taiwan. Materials and Methods: The sample came from 359 public health nurses working in Township health stations in a tri-county area in central Taiwan. A questionnaire survey of self-reports of 35 stressful conditions with Likert type responses in four subscales, and the impacts of sociodemographic variables on the major stressors were analyzed, the response rate was 74.9%. Results: Among the four subscales of stressors, including workload, drab work content social role and managerial structure, the workload subscale was found to be the source of most stressors for public health nurses in Taiwan. Conclusions: The major stressors were the diverse and complicated work content, heavy job responsibility and too much work, these stressors usually exists on most days of the week. These results should provide useful information for the administrators in formulating strategies to relieve work stress in public health nurses in Taiwan

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[[abstract]]研究背景與目的：近來SARS事件，引起國人高度恐慌，醫護人員受到SARS的影響，表達不滿、請假、離職的行為時有耳聞。本研究目的在於瞭解SARS流行期間，醫院內部行銷作為與醫護人員工作滿意度、SARS事件後離職傾向的相關性，俾以提供醫院再度面臨類似之緊急事件時，在內部顧客管理上採取措施之參考。 研究對象：以北部及中部某區域醫院之醫護人員(於我國出現第一位SARS可能病例前即任職於醫院之人員)為各別研究母體，以普查方式進行SARS事件醫院內部行銷作為認同度、工作滿意度及SARS事件後離職傾向之問卷調查。除分析個別醫院之情形外，也加以探討兩院間之差異。A醫院方面回收有效問卷共275份，有效問卷回收率為43%;B醫院方面回收有效問卷共296份，有效問卷回收率為58%。 研究結果：A醫院方面發現(1) SARS事件醫院內部行銷作為認同度愈高，則工作滿意度愈高(正相關)、SARS事件後離職傾向愈低(負相關);(2)工作滿意度之預測因子為：「工作環境」、「生涯發展」、「個人條件」及性別;(3)SARS事件後離職傾向之預測因子為：「福利薪資」、「決策參與」、工作年資及復院後醫院工作是否遭家人反對。B醫院方面發現(1)SARS事件醫院內部行銷作為認同度愈高，則工作滿意度愈高(正相關)、SARS事件後離職傾向愈低(負相關);(2)工作滿意度之預測因子為： 「內部溝通」、「個人條件」、「教育訓練」、「生涯發展」、「決策參與」及婚姻狀況;(3)SARS事件後離職傾向之預測因子為：「個人條件」及年資。 結論與建議：二院間醫護人員SARS事件醫院內部行銷作為認同度、工作滿意度及SARS事件後離職傾向，皆呈現出一致之相關情形，因此未來院方在處理類似之事件時，加強院內內部行銷，實為提高工作滿意度及降低事件後離職傾向的一劑強心針。在將員工視為內部顧客，盡力滿足員工所需的情形下，相信應能使員工獲得最佳激勵，盡其心力完成醫院所託之任務，達成醫院經營目標

Effects of a Tobacco Prevention Education Program on Adolescents Knowledge of and Attitude Toward Smoking.

[[abstract]]　Purpose. To evaluate the effectiveness of a smoking prevention program on the perception of and attitudes toward smoking in adolescents. Methods. First graders of eight randomly selected junior high schools in Taichung were recruited into two groups. A total of 412 students from four schools served as the experimental group and 440 students from the other four schools comprised the control group. All of the students received an educational brochure after completing a structured pre-intervention questionnaire to measure their knowledge of and attitudes toward smoking. After two weeks, an intervention program consisting of a two-hour lecture was provided to the experimental group only; then, each group completed the same post-intervention questionnaire. A total of 778 students completed the pre-and post-intervention questionnaires. Results. The results indicated that adolescents' knowledge of and attitudes toward smoking in the experimental group (0.18>0.12, p=0.039; 0.25>0.17, p<0.001) improved significantly after the intervention program. Furthermore, after controlling for possible confounding factors such as gender, family structure, smoking experience, and baseline knowledge and attitudes, adolescents' knowledge of and attitudes toward smoking in the experimental group still improved significantly more than those in the control group (β=1.203, p<0.001; β=l.21, p=0.027). Conclusion. The tobacco prevention education program improved adolescents' knowledge of and attitudes toward the hazards of cigarette smoking

The Medical Outcomes Distribution and the Interpretation of Clinical Data Based on C4.5 Algorithm for the RCC Patients in Taiwan

The aim of our study is to explore the medical outcomes among patients in the respiratory care center (RCC) and related factors. A cross-sectional study was performed at a regional hospital in central Taiwan from January 2018 to December 2018. The sample consisted of 236 patients who received RCC medical services. The chi-square test, multiple ordinal logistic regression analyses, and C4.5 decision tree algorithm were performed. The risk factors for medical outcomes in critical or deceased patients were obesity (BMI ≥ 27.0) (OR = 2.426, 95% C.I. = 1.106–5.318, p = 0.027), being imported from home (OR = 2.104, 95% C.I. = 1.106–3.523, p = 0.005), and with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 25 (OR = 2.640, 95% C.I. = 1.283–5.433, p = 0.008). The results of the C4.5 algorithm showed a precision of 79.80%, a recall of 78.80%, an F-measure of 78.20%, a receiver operating characteristic curve (ROC) area of 89.20%, and a precision-recall curve (PRC) area of 81.70%. It is important to design effective intervention strategies for patients who are obese and with high APACHE II scores and propose timely treatments for the patients’ onset of disease at home. Moreover, by using the C4.5 algorithm, data can be interpreted in terms of decision trees to aid the understanding of the medical outcomes of the RCC patients

Managing Defects In Dram Stack Capacitors Using In-Line E-Beam Inspection

DRAM-stacked capacitor structures require high-aspect-ratio contacts, and the narrow etch process window adds risk of yield excursions whenever the contacts are not well formed. An alternative method for detecting yield-limiting defect excursions at reduced cost involves electron beam inspection prior to the landing plug poly (LPP) CMP step. The use of new electron beam tool features, such as ultra-low beam current, low landing energy, and pre-charging techniques, allows for inspection at the landing poly contact (LPC) etch step. This new inspection detects defects more than two days earlier than prior techniques, and eliminates the need to scrap wafers as part of the inspection process