Applying the Resilience to the Community Development in Taiwan

In 1999, the Shishui community in Nantou County, Taiwan was severely damaged by the 921 earthquakes, with many houses collapsing and community facilities suffering unprecedented damage. In late 2001, a community development association was established, and with the efforts of residents, the community was awarded the title of Classic Rural Area by the government in 2007, becoming a nationally recognized leisure agriculture demonstration base. However, with the subsequent reduction of external resources, continuous loss of internal talents, and operational dysfunction of community organizations, the Shishui community eventually stagnated. How can we evaluate the community\u27s resilience in this situation? This study takes the Shishui community as its research field, integrates expert and scholar research on community resilience, constructs the elements of Shishui community development resilience through in-depth interviews with community residents, and analyzes Shishui community resilience indicators using the Fuzzy Delphi Method (FDM), with five main dimensions: sustainable development capacity, organizational leadership capacity, financial management capacity, community cohesion, and network resource capacity. Then, using the Similarity-based Importance-Performance Analysis (SBIPA) method, the study analyzes the evaluations of Shishui community residents on the satisfaction and importance of each resilience indicator. Finally, a total of 18 issues that residents consider important but have not yet reached the expected level of performance are identified, such as community resources and mechanisms to support young people returning to their hometowns and fair distribution of community resources by community organizations, which will become important directions for future community governance improvement

Machine learning ensures rapid and precise selection of gold sea-urchin-like nanoparticles for desired light-to-plasmon resonance

Sustainable energy strategies, particularly solar-to-hydrogen production, are anticipated to overcome the global reliance on fossil fuels. Thereby, materials enabling the production of green hydrogen from water and sunlight are continuously designed,; e.g.; , ZnO nanostructures coated by gold sea-urchin-like nanoparticles, which employ the light-to-plasmon resonance to realize photoelectrochemical water splitting. But such light-to-plasmon resonance is strongly impacted by the size, the species, and the concentration of the metal nanoparticles coating on the ZnO nanoflower surfaces. Therefore, a precise prediction of the surface plasmon resonance is crucial to achieving an optimized nanoparticle fabrication of the desired light-to-plasmon resonance. To this end, we synthesized a substantial amount of metal (gold) nanoparticles of different sizes and species, which are further coated on ZnO nanoflowers. Subsequently, we utilized a genetic algorithm neural network (GANN) to obtain the synergistically trained model by considering the light-to-plasmon conversion efficiencies and fabrication parameters, such as multiple metal species, precursor concentrations, surfactant concentrations, linker concentrations, and coating times. In addition, we integrated into the model's training the data of nanoparticles due to their inherent complexity, which manifests the light-to-plasmon conversion efficiency far from the coupling state. Therefore, the trained model can guide us to obtain a rapid and automatic selection of fabrication parameters of the nanoparticles with the anticipated light-to-plasmon resonance, which is more efficient than an empirical selection. The capability of the method achieved in this work furthermore demonstrates a successful projection of the light-to-plasmon conversion efficiency and contributes to an efficient selection of the fabrication parameters leading to the anticipated properties

Numerical Analysis on a Perforated Muffler Applied in the Discharge Chamber of a Twin Screw Refrigeration Compressor Based on Fluid-Acoustic Coupling Method

The twin screw compressor has been widely used in the refrigeration systems due to advantages such as compact structure, stable operation, high efficiency and good adaptability. Intermittent gas flow generates gas pulsation that cause serious problems such as structural vibration and noise in the twin screw refrigeration compressor. Because the mechanical noise can be controlled well with the improvement of machining and assembly accuracy, the aerodynamic noise induced by gas pulsation even has become the main noise source of the twin screw refrigeration compressor. In order to reduce the pressure pulsation, a broadband perforated panel muffler applied in the discharge chamber of the twin screw refrigeration compressor is proposed based on the noise spectrum and flow characteristics of the compressor. In order to obtain the noise spectrum of the twin screw refrigeration compressor, the pressure fluctuation in discharge chamber based on a three-dimensional CFD simulation model is calculated, and the acoustical model is established based on fluid-acoustic coupling method. Then the impacts of different structural parameters on the performance of a perforated panel muffler are investigated, including perforation rate, perforation diameter and panel thickness. Through the optimization of the perforated muffler, a better reduction effect of broadband noise can be achieved. Results of fluid-acoustic coupled analysis can provide guidance on the design and optimization of the perforated muffler and noise reduction of the twin screw refrigeration compressor

Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems

Background/purposeCarbapenem-resistant Pseudomonas aeruginosa infections have been a challenge and issue in hospital settings. However, the clinical impact of P. aeruginosa blood isolates resistant only to carbapenems has never been discussed previously.MethodsTo assess the risk factors and clinical significance of bacteremia caused by carbapenem resistance only P. aeruginosa (CROPA), a 6-year retrospective case–control study was conducted. The CROPA strains were defined as isolates susceptible to ciprofloxacin, antipseudomonal penicillins and cephalosporins, and aminoglycosides but resistant to one antipseudomonal carbapenem (imipenem or meropenem) or both. The controls were selected among patients with bacteremia due to P. aeruginosa susceptible to all above classes of antipseudomonal antibiotics, which was defined as all-susceptible P. aeruginosa.ResultsTwenty-five patients had at least one blood culture positive for CROPA, and 50 controls had all-susceptible P. aeruginosa bacteremia. CROPA bacteremia had a high 30-day mortality rate (72.0%), as compared to 26.0% for the controls (p < 0.001). Through multivariate analysis, carbapenem exposure was the only risk factor for developing CROPA bacteremia (p = 0.002). A comparison between the surviving and deceased patients with CROPA bacteremia showed that nine (50%) of those who died, but none of the survivors, received carbapenems as the initial empirical therapy (p = 0.027).ConclusionCarbapenem exposure was associated with emergence of CROPA infections. Repeated carbapenem use in such patients might increase rates of inappropriate initial empirical treatment and mortality. Prudent carbapenem use is important to reduce the emergence of CROPA

Second-trimester Maternal Serum Quadruple Test for Down Syndrome Screening: A Taiwanese Population-based Study

SummaryObjectiveTo assess the usefulness of quadruple test screening for Down syndrome in Taiwan.Materials and MethodsMaternal serum concentrations of a-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A were measured in 21,481 pregnant women from 15 to 20 weeks of gestation.ResultsOf the 21,481 women, 977 returned values greater than the high-risk cut-off value (1 in 270). Most of these women (86.2%) decided to have an invasive procedure for genetic diagnosis. Nine cases of Down syndrome and 19 cases of other chromosomal anomalies were detected prenatally. Two children with Down syndrome were diagnosed after delivery even though a low estimated risk was determined following the quadruple test. The detection rate was 81.8% (nine out of 11 cases), with a 4.4% false-positive rate. The median multiple of the median value for a-fetoprotein, human chorionic gonadotropin, unconjugated estriol and inhibin A were 0.87, 2.34, 0.77 and 2.16, respectively, in affected cases.ConclusionThis is the first study of the quadruple test for Down syndrome in a Chinese population. Our findings suggested that the second-trimester quadruple test provides an effective screening tool for Down syndrome in Taiwan

Thrombocytosis is associated with worse survival in patients with hepatocellular carcinoma

Background & AimsThrombocytosis is associated with more aggressive tumour biology in many malignancies. There are limited data in patients with hepatocellular carcinoma (HCC), which often occurs in patients with cirrhosis and portal hypertension. We aimed to explore the prognostic value of thrombocytosis in two cohorts of patients with HCC.MethodsWe included 3561 patients from Taiwan and 1145 patients from the USA. Thrombocytopenia was defined as platelet count < 150à 109/L and thrombocytosis as - ¥Â 300 à  109/L at HCC diagnosis. We used multivariable Cox proportional hazard models to identify independent predictors of survival.ResultsThrombocytosis was present in 9.0% and 6.9% of Taiwan and USA patients respectively. Compared to patients with normal platelet counts and those with thrombocytopenia, patients with thrombocytosis had larger tumours, increased vascular invasion and a higher proportion had extrahepatic metastases in both cohorts. In multivariable analysis, thrombocytosis (aHR 1.40, 95% CI 1.23- 1.60) and thrombocytopenia (aHR 1.13, 95% CI 1.04- 1.23) were both associated with worse survival after adjusting for age, gender, liver disease aetiology, Child- Pugh score, maximal tumour size, tumour nodularity, vascular invasion, lymph node or distant metastasis, performance status and alpha- fetoprotein level. Patients with thrombocytosis had a median survival of 6 and 4 months in the Taiwan and USA cohorts, compared to 32 and 14 months for those with normal platelet counts and 38 and 16 months for thrombocytopenic patients.ConclusionThrombocytosis is independently associated with increased tumour burden and worse overall survival among HCC patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162769/2/liv14560.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162769/1/liv14560_am.pd

High aspect ratio nanoimprinted grooves of poly(lactic-co-glycolic acid) control the length and direction of retraction fibers during fibroblast cell division

Retraction fibers (RFs) determine orientation of the cell division axis and guide the spreading of daughter cells. Long and unidirectional RFs, which are especially apparent during mitosis of cells in three-dimensional (3D) environments, enable improved control over cell fate, following division. However, 3D gel environments lack the cues necessary for predetermining the orientation of RFs to direct tissue architecture. While patterning of focal adhesion regions by microcontact printing can determine orientation of the RFs through enhancing focal adhesion numbers along particular directions, the RFs remain short due to the two-dimensional culture environment. Herein, the authors demonstrate that nanoimprinted grooves of polylactic acid glycolic acid (PLGA) with a high aspect ratio (A.R. of 2.0) can provide the cues necessary to control the direction of RFs, as well as enable the maintenance of long and unidirectional RFs as observed within 3D cultures, while the same is not possible with PLGA grooves of lower A.R. (1.0 or lower). Based on enhanced levels of contact guidance of premitotic fibroblast protrusions at high A.R. grooves and deeper levels of focal adhesion due to filopodia extensions into these grooves, it is suggested that submicron (800 nm width) PLGA grooves with A.R. of 2 are capable of supporting mechanical forces from cell protrusions to a greater depth, thereby enabling the maintenance of the protrusions as long and unidirectional RFs during cell division. Given the scalability and versatility of nanoimprint techniques, the authors envision a platform for designing nanostructures to direct tissue regeneration and developmental biology.This is the publisher’s final pdf. The article is copyrighted by the American Vacuum Society and published by Springer. It can be found at: http://link.springer.com/journal/13758See supplementary material at http://dx.doi.org/10.1116/1.4936589 for movies on cell trajectories during division on the grooves, as well as for alignment and elongation of pre-mitotic protrusions on PLGA grooves

Albuminâ bilirubin gradeâ based nomogram of the BCLC system for personalized prognostic prediction in hepatocellular carcinoma

Background & AimsThe prognostic accuracy of individual hepatocellular carcinoma (HCC) patient in each Barcelona Clinic Liver Cancer (BCLC) stage is unclear. We aimed to develop and validate an albuminâ bilirubin (ALBI) gradeâ based nomogram of BCLC to estimate survival for individual HCC patient.MethodsBetween 2002 and 2016, 3690 patients with newly diagnosed HCC were prospectively enrolled and retrospectively analysed. Patients were randomly split into derivation and validation cohort by 1:1 ratio. Multivariate Cox proportional hazards model was used to generate the nomogram from tumour burden, ALBI grade and performance status (PS). The concordance index and calibration plot were determined to evaluate the performance of this nomogram.ResultsBeta coefficients from the Cox model were used to assign nomogram points to different degrees of tumour burden, ALBI grade and PS. The scores of the nomogram ranged from 0 to 24, and were used to predict 3â and 5â year patient survival. The concordance index of this nomogram was 0.77 (95% confidence interval [CI]: 0.71â 0.81) in the derivation cohort and 0.76 (95% CI: 0.71â 0.81) in the validation cohort. The calibration plots to predict both 3â and 5â year survival rate well matched with the 45â degree ideal line for both cohorts, except for ALBIâ based BCLC stage 0 in the validation cohort.ConclusionsThe proposed ALBIâ based nomogram of BCLC system is a simple and feasible strategy in the precision medicine era. Our data indicate it is a straightforward and userâ friendly prognostic tool to estimate the survival of individual HCC patient except for very early stage patients.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153250/1/liv14249_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153250/2/liv14249.pd

Low neutrophil-to-lymphocyte ratio predicts overall survival benefit in advanced NSCLC patients with low PD-L1 expression and receiving chemoimmunotherapy

Although combination therapy including chemotherapy and immune checkpoint inhibitors (ICIs) improves overall survival (OS) of patients with non-small-cell lung cancer (NSCLC), there is a higher incidence of adverse events and treatment discontinuation. Since programmed death-ligand 1 (PD-L1) could not serve as a predictive biomarker, we investigated the neutrophil-to-lymphocyte ratio (NLR) as a predictive biomarker. In our previous research, we demonstrated that a low NLR could predict survival benefits when patients with high PD-L1 expression (&gt; 50%) received chemoimmunotherapy as opposed to immunotherapy alone. In this current study, our objective is to evaluate this predictive capacity in patients with low PD-L1 expression (&lt; 50%). A total of 142 patients were enrolled, 28 receiving combination therapy and 114 receiving chemotherapy alone. Progression-free survival (PFS) and OS were estimated using the Kaplan-Meier method and compared using the log-rank test. Patients who received combination therapy had significantly better PFS and OS than those who received monotherapy. In the subgroup of patients with low NLR, those who received combination therapy exhibited extended PFS and OS with clinical significance, which was also confirmed by multivariate Cox regression analysis. Our study demonstrates the potential use of NLR as a biomarker for predicting survival benefits when receiving combination therapy with chemotherapy and ICIs in patients with advanced NSCLC and low PD-L1 expression

Detection of SARS-associated Coronavirus in Throat Wash and Saliva in Early Diagnosis

Early detection of SARS-CoV in throat wash and saliva suggests that these specimens are ideal for SARS diagnosis