Cost-effective complete genome sequencing using the MinION platform for identification of recombinant enteroviruses.

IMPORTANCE: By employing a cost-effective approach for complete genome sequencing, the study has enabled the identification of novel enterovirus strains and shed light on the genetic exchange events during outbreaks. The success rate of genome sequencing and the scalability of the protocol demonstrate its practical utility for routine enterovirus surveillance. Moreover, the study's findings of recombinant strains of EVA71 and CVA2 contributing to epidemics in Malaysia and Taiwan emphasize the need for accurate detection and characterization of enteroviruses. The investigation of the whole genome and upstream ORF sequences has provided insights into the evolution and spread of enterovirus subgenogroups. These findings have important implications for the prevention, control, and surveillance of enteroviruses, ultimately contributing to the understanding and management of enterovirus-related illnesses.

[Pathway and Policy for China's Provincial Carbon Emission Peak].

An effective way for China to achieve a carbon emission peak by 2030 is to encourage developed regions to take the lead in attaining carbon peaking at the regional level. Considering Jiangsu Province as an example, this study established a provincial low emissions analysis platform (LEAP-Jiangsu) model. It combined the improved multilevel logarithmic mean Divisia index (M-LMDI) model, Tapio decoupling model, and the synergistic effect of pollution and carbon reduction model to explore the key influencing factors of carbon emissions and carbon reduction paths. The improved M-LMDI model was used to analyze the factors influencing historical and future carbon emissions in Jiangsu Province. Based on the analysis results and planning objectives, a LEAP-Jiangsu model involving various development scenarios was established to predict the time and value of carbon emission peaks. The Tapio decoupling and synergistic effect models were used to clarify the relationship between carbon emissions and economic development, the synergistic effect of carbon, and air pollutant emission reduction. The prediction results demonstrated that the total primary energy demand of Jiangsu Province in 2035 was predicted to be approximately 401.2-474.6 Mt, and the final energy demand would be approximately 319.2-382.3 Mt. Jiangsu Province was most likely to achieve the goal of carbon peaking in 2025-2030, and the peak carbon emission was approximately 815.3-845.7 Mt. The contribution rates of energy conservation and emission reduction measures such as energy intensity reduction, industrial structure optimization, terminal electrification improvement, and energy structure adjustment were 33.1%, 26.8%, 21%, and 15.2%, respectively.

Construction cost prediction system based on Random Forest optimized by the Bird Swarm Algorithm.

Predicting construction costs often involves disadvantages, such as low prediction accuracy, poor promotion value and unfavorable efficiency, owing to the complex composition of construction projects, a large number of personnel, long working periods and high levels of uncertainty. To address these concerns, a prediction index system and a prediction model were developed. First, the factors influencing construction cost were first identified, a prediction index system including 14 secondary indexes was constructed and the methods of obtaining data were presented elaborately. A prediction model based on the Random Forest (RF) algorithm was then constructed. Bird Swarm Algorithm (BSA) was used to optimize RF parameters and thereby avoid the effect of the random selection of RF parameters on prediction accuracy. Finally, the engineering data of a construction company in Xinyu, China were selected as a case study. The case study showed that the maximum relative error of the proposed model was only 1.24%, which met the requirements of engineering practice. For the selected cases, the minimum prediction index system that met the requirement of prediction accuracy included 11 secondary indexes. Compared with classical metaheuristic optimization algorithms (Particle Swarm Optimization, Genetic Algorithms, Tabu Search, Simulated Annealing, Ant Colony Optimization, Differential Evolution and Artificial Fish School), BSA could more quickly determine the optimal combination of calculation parameters, on average. Compared with the classical and latest forecasting methods (Back Propagation Neural Network, Support Vector Machines, Stacked Auto-Encoders and Extreme Learning Machine), the proposed model exhibited higher forecasting accuracy and efficiency. The prediction model proposed in this study could better support the prediction of construction cost, and the prediction results provided a basis for optimizing the cost management of construction projects.

Vertebral bone quality score provides preoperative bone density assessment for patients undergoing lumbar spine surgery: a retrospective study.

OBJECTIVE: The novel MRI-based vertebral bone quality (VBQ) score has been described as an opportunistic screening tool for osteoporosis, but the stability and practical value of this score deserve further investigation. The purpose of this study was to assess whether preoperative VBQ scores could assist in identifying reduced bone mineral density (BMD) or osteoporosis and evaluating the consistency between MRI systems with different field strengths. METHODS: The VBQ scores of the patients who underwent surgery for lumbar disc herniation and the single-level VBQ scores of each L1-4 vertebral body were measured and calculated with preoperative lumbar MRI noncontrast T1-weighted phases. The VBQ scores were evaluated for correlation analysis using dual-energy x-ray absorptiometry (DEXA) T-scores. The receiver operating characteristic (ROC) curve was used to evaluate the ability of the VBQ scores to identify patients with reduced BMD and with osteoporosis. Differences in CSF measurements at different levels of L1-4 were compared. Twenty-four patients who had been examined using another MRI machine were used as controls to test the interdevice agreement of the VBQ scores. RESULTS: The study included 100 patients with mean VBQ scores of 2.81 ± 0.28 (normal BMD), 3.06 ± 0.36 (osteopenia), and 3.43 ± 0.37 (osteoporosis). VBQ scores differed significantly between BMD subgroups (p < 0.001). The Pearson correlation coefficient showed a moderate negative linear correlation between novel VBQ scores and the lowest DEXA T-scores (r = -0.524). ROC analysis showed good discrimination of VBQ scores in patients with reduced BMD (area under the curve [AUC] 0.793) and with osteoporosis (AUC 0.810). The diagnostic thresholds of reduced BMD and osteoporosis according to the maximum Youden index were 3.06 (sensitivity 0.636, specificity 0.870, positive predictive value [PPV] 0.942, negative predictive value [NPV] 0.417) and 3.05 (sensitivity 0.875, specificity 0.618, PPV 0.519, NPV 0.913), respectively. CSF measurements at the L2, L3, and L4 levels were essentially identical and did not significantly affect the final VBQ scores (p > 0.05), whereas CSF measurements at the L1 level were found to be heterogeneous (p < 0.001). No significant differences were found in VBQ scores between the same brand of MRI machines at different field strengths (1.5 and 3.0 T, p = 0.107). CONCLUSIONS: The new VBQ score provides an additional screening opportunity for preoperative BMD assessment. A VBQ score < 3.05 essentially excludes osteoporosis, whereas a VBQ score ≥ 3.05 (especially ≥ 3.06) suggests the need for further examination. The VBQ score is comparable between different MRI systems.

A retrospective assessment of real-world experience with venetoclax and azacitidine therapy in elderly acute myeloid leukemia.

This study aimed to examine the effect of venetoclax coupled with azacytidine in treating older adults with relapsed and refractory (R/R) acute myeloid leukemia (AML). The clinical data of 10 senior patients with AML over 65 years old who were treated with venetoclax and azacytidine, including six patients with R/R AML, were retrospectively evaluated. This study comprised seven males and three females with a median age of 71 years. Five patients had at least one relapse, and one patient did not achieve remission after four cycles of azacytidine monotherapy, considering it resistant. AML with myelodysplasia-related changes was found in four cases. One of the 10 patients died early after 1-13 cycles of venetoclax plus azacytidine treatment due to a protracted period of neutropenia and severe lung infection induced by medications. Six of the remaining nine patients, including six R/R patients, achieved a complete remission (CR) or a CR with incomplete hematologic recovery (CRi). After two cycles of therapy, one patient did not react. Neutropenia lasted an average of 10.5 (6-15) days in all patients, with the most severe cases occurring in the second and third weeks of therapy. Three patients who tested positive for the TP53 gene mutation had the following outcomes: One relapsed patient has been in progression-free remission (PFS) for the past 24 months, whereas another has been in full remission but relapsed 2 months later. Another patient experienced complete remission in myelology for 4 months, but the variable allele fraction (VAF) value steadily rose, suggesting that the illness was on the verge of progressing. IDH2 gene alterations were found in three of four patients who obtained maintained CR for more than 18 months following recurrence. Venetoclax in combination with azacytidine is a successful and well-tolerated therapy for R/R AML in the elderly. Venetoclax and azacytidine may help patients with TP53 mutations and reduce VAF. The IDH2 mutation might be a good predictor of veneclax sensitivity. A notable adverse response in the treatment phase of the regimen is severe infection induced by neutropenia.

Multi-Phase Environmental Impact Assessment of Marine Ecological Restoration Project Based on DPSIR-Cloud Model.

In order to achieve a comprehensive evaluation of the environmental impact of ecological restoration projects (ERP) under the current destruction and restoration of coastal ecological areas, this paper takes into account the impact of positive and negative indicators on the environment; analyzes the positive and negative benefits of ERP; and establishes a comprehensive environmental impact index system for marine ERP from ecological, economic, and social perspectives through the DPSIR model. On this basis, the cloud model and Monte Carlo simulation are used to obtain the comprehensive assessment grade of the construction period, short-term operation, and long-term operation in the project life cycle. The results show that the benefits of ERP, considering the impact of negative factors, are significantly reduced, and the benefits of ERP will increase remarkably in the long-term operation period. In engineering practice, the environmental pressure factor caused by excessive human activities during construction and operation periods is a key negative factor affecting the overall benefits of ERP. For project decision makers and other stakeholders, the comprehensive assessment grade considering negative impacts is more practical. At the same time, decision makers should take active response measures in the framework of long-term sustainable development, set a tolerance threshold for negative pressure indicators, and strengthen the management of ERP.

Fine-Grained Assessment of COVID-19 Severity Based on Clinico-Radiological Data Using Machine Learning.

BACKGROUND: The severe and critical cases of COVID-19 had high mortality rates. Clinical features, laboratory data, and radiological features provided important references for the assessment of COVID-19 severity. The machine learning analysis of clinico-radiological features, especially the quantitative computed tomography (CT) image analysis results, may achieve early, accurate, and fine-grained assessment of COVID-19 severity, which is an urgent clinical need. OBJECTIVE: To evaluate if machine learning algorithms using CT-based clinico-radiological features could achieve the accurate fine-grained assessment of COVID-19 severity. METHODS: The clinico-radiological features were collected from 78 COVID-19 patients with different severities. A neural network was developed to automatically measure the lesion volume from CT images. The severity was clinically diagnosed using two-type (severe and non-severe) and fine-grained four-type (mild, regular, severe, critical) classifications, respectively. To investigate the key features of COVID-19 severity, statistical analyses were performed between patients' clinico-radiological features and severity. Four machine learning algorithms (decision tree, random forest, SVM, and XGBoost) were trained and applied in the assessment of COVID-19 severity using clinico-radiological features. RESULTS: The CT imaging features (CTscore and lesion volume) were significantly related with COVID-19 severity (p < 0.05 in statistical analysis for both in two-type and fine-grained four-type classifications). The CT imaging features significantly improved the accuracy of machine learning algorithms in assessing COVID-19 severity in the fine-grained four-type classification. With CT analysis results added, the four-type classification achieved comparable performance to the two-type one. CONCLUSIONS: CT-based clinico-radiological features can provide an important reference for the accurate fine-grained assessment of illness severity using machine learning to achieve the early triage of COVID-19 patients.

Mortality-to-Incidence Ratio for Nasopharyngeal Carcinoma Is Associated with Health Expenditure.

Geographic and gender-specific disparity can be observed in nasopharyngeal carcinoma (NPC). While screening and more effective therapies, such as induction chemotherapy, could improve survival rates, they are costly. This study aims to explore the correlation between healthcare expenditure and the mortality-to-incidence ratio (MIR) in NPC. Data were obtained from the World Health Organization and the Global Cancer Observatory. The correlation was evaluated by Spearman's rank correlation coefficient. Most new cases and deaths occur in Asia, and more males are affected than females. Our study shows that countries with higher MIRs have lower levels of health expenditure regardless of the NPC's gender-specific incidence. Correspondingly, MIRs are all significantly negatively associated with current health expenditure (CHE) per capita and CHE as a percentage of gross domestic product (CHE/GDP) in both genders. CHE per capita and CHE/GDP have a significant impact on NPC outcomes. Moreover, economic status is a potential major factor in MIR differences between countries.

Early Warning of Enterprise Financial Risk Based on Decision Tree Algorithm.

To improve enterprise financial early warning, we propose an algorithm based on a decision tree. According to the shortcomings and defects of the classical algorithm and the traditional decision tree algorithm, in the ordinary decision tree improved algorithm based on PCA, there is a problem that the representativeness of the data after dimensionality reduction processing are not high, resulting in the fact that the accuracy of the algorithm can be improved slightly after multiple data runs. Based on the classical algorithm, attribute eigenvalues before classification are extracted twice, and the amount of data to be classified is calculated. That is, the most important attributes of the original data are selected. After the subtree is established, the dimension reduction and merging selection of the data are performed, and the improved algorithm is verified by using three data sets in the UCI database. The results show that the average accuracy in the three datasets is 94.6%, which is improved by 1.6% and 0.6% for the traditional classical algorithm and the ordinary PCA decision tree optimization algorithm, respectively. PCA-based decision tree algorithms can improve the accuracy of the results to some extent, which is of practical importance. In the future, a classic algorithm improved for secondary modeling will be used to obtain a more efficient decision tree model. The decision tree algorithm has been proven to recognize an early warning of an enterprise's financial risks, which enhances the effectiveness of an enterprise's early financial warning.

The clinical efficiency of transcriptome-based endometrial receptivity assessment (Tb-ERA) in Chinese patients with recurrent implantation failure (RIF): A study protocol for a prospective randomized controlled trial.

Background: Today, approximately 10% of participants in assisted reproductive technology (ART) are defined as having recurrent implantation failure (RIF). Recent studies show that endometrial receptivity array can improve pregnancy and implantation rates by nearly 20% in women with RIF. However, these studies are limited, with little published data in the Chinese population. Recently, we have established a transcriptome-based endometrial receptivity assessment (Tb-ERA) method of predicting the endometrial window of implantation (WOI) using transcriptome-profiling data of different phases of the menstrual cycle from healthy fertile Chinese women by RNA-Seq. It is meaningful to conduct a randomized controlled trial (RCT) to assess the clinical efficiency of Tb-ERA in Chinese patients with RIF. Methods: In this RCT, a total of 200 RIF patients will be recruited and randomized into 2 groups. Patients in the Tb-ERA group will undergo a Tb-ERA test, after which embryo transfer time will be adjusted according to Tb-ERA results and embryo transfer will be performed again in the next cycle. Patients in the control group will not receive any interventions until the next transfer cycle. We will perform statistical analysis on both groups at the primary endpoint (clinical-pregnancy rate) and at secondary endpoints (rate of WOI displacement, embryo implantation, biochemical pregnancy, early abortion, and ectopic pregnancy). Implications: This study aims to evaluate the effectiveness of our Tb-ERA test in Chinese RIF patients and to determine that whether Tb-ERA could improve the clinical-pregnancy rate in these RIF patients. Trial registration: NCT04497558, registered August 4, 2020.

Long-term effects of a community-based positive youth development program for Black youth: health, education, and financial well-being in adulthood.

BACKGROUND: Childhood poverty is known to be associated with poor health. For youth living in extreme poverty, community-based programs focused on youth development are one strategy to improve health and well-being outcomes. However, very few evaluations of the long-term effectiveness of youth development programs have been conducted. The aim of this study was to assess the long-term effectiveness of a positive youth development program (PYD), serving a segregated housing project with a history of community violence, to improve the health, education, and financial well-being of its alumni. METHODS: A quasi-experimental causal comparative study design was used to study the effectiveness of the Cabrini-Green Youth Program (CGYP). CGYP alumni (mean: 16.8 +/- 7.4 years after program participation) were surveyed. For comparison, participants from the same housing project who were eligible to participate in the CGYP but did not, were identified. RESULTS: In total, 246/417 (59%) eligible alumni were located. 221 alumni were available to be interviewed; 191/221 (86%) completed the interview survey along with 143 in the comparison group. Both groups self-identified as being Black, African American, and of Other race. Alumni were younger (34.6 vs. 38.1 years, p < .001), less likely to be female (62% vs. 74%, p =.03), and more likely to have been abused as a child (26% vs. 11%, p = .001). The majority in both groups reported to be in good to excellent health (83% of alumni vs. 74% of comparison group). After adjusting for comparison group differences, alumni were more likely to have completed college, 24% vs. 12% (adjusted odds ratio (aOR) 2.47, 95% CI, 1.25-4.86), and to end up with some money at the end of the month, 35% vs. 19% (aOR 2.16, 95% CI, 1.17, 3.97). CONCLUSIONS: Participation in a PYD program starting at a young age may be associated with reduced poverty in adulthood, possibly aided by higher educational attainment and resultant increased income. PYD may be an effective strategy to supplement evidenced-based poverty reducing policies. This study of a voluntary, community-based PYD program is unique in its up to 33-year follow-up and an outcome assessment that measures more than knowledge change.

Multiple psychological characteristics predict housing mortgage loan behavior: A holistic model based on machine learning.

The factors that influence consumers' house choice are debatable. Previous studies have examined the effects of demographic and socioeconomic attributes, physical and environmental features of the house, and isolated single psychological characteristics on housing behavior. However, these factors are still not sufficient to predict consumer housing behavior, particularly when they are measured separately. We construct a holistic model that integrates psychological characteristics including values, personality traits, motivation, decision-making style, and risk-seeking together with demographic and socioeconomic factors to jointly predict housing mortgage loan behavior. This study aims to use a newly developed statistical method, "machine learning," to examine the relationship between multiple psychological characteristics and consumer housing mortgage loan behavior. Data were collected through an online survey (N = 2,270). The results show that the holistic psychological model is effective for predicting consumer housing mortgage loan behavior in the life context. Moreover, by analyzing and comparing the relative impact of all predictors, we find that psychological characteristics made a more important contribution to predicting housing mortgage loan behavior than did traditional factors (demographic and socioeconomic factors). The results provide a new perspective for understanding the effects of how multiple psychological characteristics integrally predict consumers' housing mortgage loan behavior in the real estate market. Theoretical and practical implications for marketing and sales are discussed.

Improved trends of lung cancer mortality-to-incidence ratios in countries with high healthcare expenditure.

BACKGROUND: Lung cancer stage has a significant impact on prognosis, and early detection of lung cancer relies on screenings. Despite the strong relationship between screening and lung cancer staging, the role of healthcare expenditure in lung cancer outcomes remains unknown. The aim of this study was to evaluate the relationship between economic status and clinical outcomes in lung cancer. METHODS: Data were obtained from GLOBOCAN and the World Health Organization. Mortality-to-incidence ratios (MIRs) and their change over time, calculated as the difference between the MIRs of 2012 and 2018 (δMIR), were used to evaluate their correlation to expenditures on healthcare and human development index (HDI) disparities via Spearman's rank correlation coefficient. RESULTS: Regions such as North America have relatively high crude incidence rates but low MIR values. Furthermore, countries with lower crude incidence rates spent less on healthcare. The results show significant negative associations between HDI, current health expenditure (CHE) per capita, CHE as a percentage of gross domestic product (CHE/GDP), and MIR. As for MIR and δMIR, countries with favorable MIRs also showed improving MIRs based on δMIR. CONCLUSIONS: HDI, CHE per capita, CHE/GDP, and development status play noticeable roles in the prognosis of lung cancer, leading to large disparities in clinical outcomes.

The development of a Chinese Healthy Eating Index for School-age Children and its Application in children from China Health and Nutrition Survey.

This study aimed to develop a Chinese Healthy Eating Index for School-age Children (CHEI-SC), apply it in the 2011 China Health and Nutrition Survey (CHNS) to assess dietary quality, and compared it with our former developed index named CHEI. Data of 3-day 24-hour diet recalls and household food inventory survey from 1600 school-age children in CHNS-2011 were used to develop the CHEI-SC, using the methods of standard portion size, energy-density-based approach, and least restrictive approach. The CHEI-SC included 19 components with a total score (T-score) ranging from 0 to 100. The investigated children had a median score of 49.6. Children with a higher T-score were more likely to have higher social economic status (SES), higher level of urbanisation, fewer family size, and regularly attending school. The CHEI-SC was able to assess dietary quality of Chinese school-age children, was sensitive to demographics, and more comprehensive and accurate than the CHEI.

[Impacts of one-off fertilization on nitrogen leaching and economic benefits for rice-rape rotation system]. / 一次性施肥技术对水稻-æ²¹èœè½®ä½œç³»ç»Ÿæ°®ç´ æ·‹å¤±ç‰¹å¾åŠç»æµŽæ•ˆç›Šçš„å½±å“.

One-off fertilization is a new technology of one-time applying base fertilizer near the rhizosphere during whole crop cultivation period. It has the advantages of simplifying fertilization manage-ment and reducing labor costs, but its impacts on environment, such as leaching characteristics need further analysis. We set five treatments in the typical rice-rape rotation system in the middle and lower reaches of the Yangtze River, including control treatment (CK), farmers' practice treatment (FP), optimal fertilizer treatment (OPT), one-off application of urea fertilizer treatment (UA) and one-off application of controlled release urea treatment (CRF). Using in situ leaching monitoring method, nitrogen (N) leaching characteristics at 90 cm depth of soil in rice-rape rotation system under different treatments were obtained, the impacts of one-off fertilization on N lea-ching were evaluated and its economic benefits were comprehensively analyzed. The results showed that the main forms of N in leachate were different for rape and rice. In the rape season, NO3--N was the major component of leachate, while for rice season NO3--N and NH4+-N were equally important. In the whole rotation period, the inorganic N leaching mainly occurred in the rice season, and compared with FP, OPT and UA, the total amount of inorganic N leached by CRF were significantly reduced by 33.7%, 20.8%, and 20.7%, respectively. However, the effects of different fertilization treatments on N leaching in rape season were not significantly different. Under the same N application rates, compared with OPT, UA ensured the stable yield of rape and rice and significantly increased the NAE in rape season by 15.1%, but failed to improve the NAE in rice season. There was no significant difference between OPT and CRF in rice yield and NAE, but rape yield and NAE of CRF significantly increased by 10.7% and 18.9%, respectively. From the economic front, compared with OPT, UA and CRFincreased rapeseed income by 3660 and 3048 yuan·hm-2, and rice income by 3162 and 2220 yuan·hm-2. Therefore, considering the effects of various fertilizer treatments on N leaching, crop yield, and economic benefits, one-off base fertilization application of controlled release fertilizer technology could ensure stable or increase crop yields, and improve farmers' income, while significantly reduce the inorganic N leaching loss. Such technology is recommended for future rice-rape rotation cultivation.

Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones.

BACKGROUND: A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation. AIM: To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196). RESULTS: At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups. CONCLUSION: Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.

Risk factors for child maltreatment by the utilization of medical service and socioeconomic environment in Taiwan.

Child maltreatment is complicated by cultural, welfare, and socioeconomic factors. However, the relationship between child maltreatment and socioeconomic factors has not been completely understood. We investigated risk factors for child abuse and neglect in Taiwan.The data in our study was obtained from Taiwan National Statistics at county level from 2004 to 2015. We included 4 areas (eastern, western, southern, northern) involving 20 cities and counties. The trends of child maltreatment rate based on different years and different areas were surveyed. In addition, panel data analysis was used to analyze the links between child maltreatment rate and socioeconomic factors.An increasing trend of child maltreatment rate in Taiwan was observed. During the past decade, child maltreatment rate increased from 14.5 in 2004 to 23.4 cases per 10000 children in 2014. The peak, which was 43 cases per 10000 children, occurred in 2012. Significant geographical differences were observed, and the highest child maltreatment rate was seen in eastern Taiwan. Panel data analysis revealed a lag effect of the unemployment rate on child maltreatment rate at the county level: the child maltreatment rate increased by 7 percent, while the prior unemployment rate increased by one percent. In addition, the medical personnel density was related to the child maltreatment rate within the county.Previous unemployment rate had a lag impact on child maltreatment occurrence. Unemployment rate has not only a direct impact on the economy but also sequential effects on child maltreatment.

Pleural drainage using drainage bag for thoracoscopic lobectomy.

Objective This study was designed to compare the effectiveness and convenience of a drainage bag and a chest bottle following thoracoscopic lobectomy. Methods We conducted a test to ensure that the drainage bag was characterized by easy drainage and an antireflux effect. Thereafter, the drainage bag was used in all thoracic operations in our service. To understand the usefulness of the drainage bag, a retrospective cohort study enrolled 30 patients who had a drainage bag after thoracoscopic lobectomy and compared them with 30 similar patients operated on previously who had chest bottles. Variables studied included total drainage volume, duration of drainage, complications, and satisfaction of the care providers. Results There was no significant difference between the chest bottle and drainage bag groups respectively in terms of total drainage (697.5 ± 89.7 vs. 614.1 ± 76.6 mL, p = 0.483) or duration of drainage (4.23 ± 0.38 vs. 4.43 ± 0.38 days, p = 0.713). No device-related complication was observed. After our experience with the drainage bag, we abandoned use of the chest bottle. The drainage bag was more convenient for patients and promoted early ambulation as well improving cost effectiveness. Most care providers preferred to use the drainage bag (p = 0.000). Conclusion The drainage bag is superior to the chest bottle for postoperative drainage.

[Sharing Perspectives on Home Healthcare].

The baby boom after World War II, coupled with the rapid advances in medical technology and public health, has led to the current rapid aging in the world's population. Countries in Asia are experiencing a faster rate of aging than most other countries around the world. Taiwan is expected to advance from an aged society to a super-aged society in the next 7~10 years. Consequently, the demand for long-term care is increasing. The focus of healthcare has changed from acute to chronic, from disease-oriented to function-oriented and from cure to care. Families, once the cornerstone of care, have become overwhelmed by the effects of the declining birthrate and aging. Encountering the public demand for a balance between healthcare and quality of life has led to the increasing role of home-based care in the medical system. The elderly-care profession is diverse and growing. The trend of transdisciplinary team which integrating care professions, nursing professions, family medicine, geriatric medicine, rehabilitation medicine, telemedicine, and medical aids with the resource of social welfare enables home health care services to better provide well-rounded medical care. Before end of life, hospice home care services increase the likelihood of dying at home in accordance with the patient's preference, easing the symptoms of terminal illness and reducing the sorrow experienced by family members. The single insurer model used by the National Health Insurance system will inevitably replace some hospital and institutional services with home health care services that more effectively and flexibly use medical resources and attenuate the increase in medical costs.