Urban people's preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions.

BACKGROUND: The Patient Right to Autonomy Act (PRAA), implemented in Taiwan in 2019, enables the creation of advance decisions (AD) through advance care planning (ACP). This legal framework allows for the withholding and withdrawal of life-sustaining treatment (LST) or artificial nutrition and hydration (ANH) in situations like irreversible coma, vegetative state, severe dementia, or unbearable pain. This study aims to investigate preferences for LST or ANH across various clinical conditions, variations in participant preferences, and factors influencing these preferences among urban residents. METHODS: Employing a survey of legally structured AD documents and convenience sampling for data collection, individuals were enlisted from Taipei City Hospital, serving as the primary trial and demonstration facility for ACP in Taiwan since the commencement of the PRAA in its inaugural year. The study examined ADs and ACP consultation records, documenting gender, age, welfare entitlement, disease conditions, family caregiving experience, location of ACP consultation, participation of second-degree relatives, and the intention to participate in ACP. RESULTS: Data from 2337 participants were extracted from electronic records. There was high consistency in the willingness to refuse LST and ANH, with significant differences noted between terminal diseases and extremely severe dementia. Additionally, ANH was widely accepted as a time-limited treatment, and there was a prevalent trend of authorizing a health care agent (HCA) to make decisions on behalf of participants. Gender differences were observed, with females more inclined to decline LST and ANH, while males tended towards accepting full or time-limited treatment. Age also played a role, with younger participants more open to treatment and authorizing HCA, and older participants more prone to refusal. CONCLUSION: Diverse preferences in LST and ANH were shaped by the public's current understanding of different clinical states, gender, age, and cultural factors. Our study reveals nuanced end-of-life preferences, evolving ADs, and socio-demographic influences. Further research could explore evolving preferences over time and healthcare professionals' perspectives on LST and ANH decisions for neurological patients..

Factors Impacting Advance Decision Making and Health Care Agent Appointment among Taiwanese Urban Residents after the Passage of Patient Right to Autonomy Act.

In recent years, advance care planning (ACP) promotion in Taiwan has expanded beyond clinical practice to the broader population. This study aims to investigate people's attitudes toward ACP and to identify factors influencing their signing of advance directives (ADs) and appointment of health care agents (HCAs). METHODS: We identified 2337 ACP participants from consultation records between 2019 and 2020. The relationships among the participants' characteristics, AD completion, and HCA appointment were investigated. RESULTS: Of 2337 cases, 94.1% completed ADs and 87.8% were appointed HCAs. Welfare entitlement (OR = 0.47, p < 0.001), the place ACP progressed (OR = 0.08, p < 0.001), the participation of second-degree relatives (OR = 2.50, p < 0.001), and the intention of not being a family burden (OR = 1.65, p = 0.010) were significantly correlated with AD completion. The probability of appointing HCAs was higher in participants with family caregiving experience (OR = 1.42, p < 0.05), who were single (OR = 1.49, p < 0.05), and who expected a good death with dignity (OR = 1.65, p < 0.01). CONCLUSIONS: Our research shows that adopting ACP discussion in Taiwan is feasible, which encourages ACP conversation and facilitates AD completion. IMPLICATIONS: Male and younger adults may need extra encouragement to discuss ACP matters with their families. LIMITATIONS: due to sampling restrictions, our data were chosen from an urban district to ensure the integrity of the results. Furthermore, interview data could be collected in future research to supplement the quantitative results.

Disentangling the impact of anthropogenic and natural processes on the environment in a subtropical subalpine lake catchment in northeastern Taiwan over the past 150 years.

Human activities impose significant changes on sedimentation processes and vegetation cover within lake catchments. However, the needed time for an anthropogenically disturbed natural state to be reversed back to its natural state by environmental protection programs is still ambiguous. Here we employ a multi-proxy approach to delineate major environmental disturbances such as logging and forest fires on the catchment in Cueifong Lake, a subtropical subalpine lake in northeastern Taiwan. X-ray Fluorescence (XRF) core scanning, bulk total organic carbon (TOC), bulk total nitrogen (TN), stable carbon isotope (δ13Corg) analysis, and macro-charcoal counting were utilized to reconstruct changes in the catchment environment based on a sediment core from Cueifong Lake. The results show that the element content changed distinctly around 1975 CE, which coincided with the onset of profound deforestation in the lake vicinity recorded in historical documents and aerial photos. After the cessation of the logging event, the detrital input increased, accompanied by decreasing C/N ratios and increasing δ13Corg values. This suggests that increased terrestrial nutrient input promoted algae growth. After the deforestation phase, our results imply a gradual recovery of elemental composition in the catchment environment. By extrapolating the XRF element records, we suggest that it might take >50 years for the sedimentary regime to reach its pre-logging baseline. In contrast to the depositional system, the C/N and δ13Corg shifted significantly - potentially irreversibly - towards an algae-dominant environment instead of recovering to the pre-logging condition. This could be due to both 1) the changes in the different vegetation species used for reforestation and/or 2) anthropogenically introduced fishes in the 1980s. This study proposes the first assessment of the needed recovery time for subtropical Asian subalpine forests after large-scale logging activity and thus provides an apparent reference for policy decisions on natural resource development and environmental protection.

Demographics, employment, and proximity to covid-19 as predictors of preparedness among Taiwanese health social workers.

COVID-19 struck the world violently and cause negative psychological consequences on health professionals. The preparedness of social workers for the pandemic is critical while facing these challenges and pressures. The study aimed to explore what are the roles of demographic, employment, and proximity to Covid-19 in predicting preparedness for the next wave of COVID among social workers in Taiwan. A total of 158 participants were conveniently sampled and multiple regression, univariate analysis, and two-way ANOVA were conducted. The results demonstrated that the demographic and employment variables significantly predicted preparedness, and there were significant differences among demographics on preparedness and an interaction effect between seniority and age. Consequently, middle-aged social workers with junior seniority years may have more difficulties in their preparation for the current situation. The implication of our findings is also discussed.

A Methodology to Predict and Optimize Ease of Assembly for Injected Parts in a Family-Mold System.

In this study, the assembly behavior for two injected components made by a family mold system were investigated. Specifically, a feasible method was proposed to evaluate the characteristic length of two components within a family mold system using numerical simulation and experimental validation. Results show that as the packing pressure increases, the product index (characteristic length) becomes worse. This tendency was consistent for both the simulation prediction and experimental observation. However, for the same operation condition setting through a basic test, there were some differences in the product index between the simulation prediction and experimental observation. Specifically, the product index difference of the experimental observation was 1.65 times over that of the simulation prediction. To realize that difference between simulation and experiment, a driving force index (DFI) based on the injection pressure history curve was proposed. Through the DFI investigation, the internal driving force of the experimental system was shown to be 1.59 times over that of the simulation. The DFI was further used as the basis for machine calibration. Furthermore, after finishing machine calibration, the integrated CAE and DOE (called CAE-DOE) strategy can optimize the ease of assembly up to 20%. The result was validated by experimental observation.

Different perceptions of interprofessional collaboration and factors influencing the one-stop service for sexual assault victims in Taiwan.

The purpose of interprofessional collaboration is to bring better services for sexual assault victims. In order to avoid secondary victimisation and improve the quality of forensic examination and prosecution rate, a one-stop service has been developed recently in Taiwan. However, whether the collaboration is successful may depend on participants' professional backgrounds and personal experiences and can be influenced by a number of factors. This study used the Index of Interdisciplinary Collaboration to examine the different perceptions of collaboration in team members and the related influences on collaboration. Surveys were conducted in 140 team members including social workers, doctors, nurses, and police officers. The result indicated that collaboration was perceived differently in different professionals and significantly lower by social workers in the domain of interdependence and reflection on process. Factors such as professional roles, structural characteristics, personal characteristics, and history of collaboration were positively associated with the overall perception of collaboration. Only structural and personal characteristics predicted the type of profession. This study highlights the importance to acknowledge different experiences. Additional efforts and investments for improving mutual help and trust by the organisations are recommended.