A Pilot Study to Explore the Improvements in Pulmonary and Cognitive Functions With a Kazoo Intervention Among Middle-Aged and Older Adults in a Rural Community.

Dementia is a leading cause of disability and dependence in older adults worldwide. The aim of this pilot study was to explore the effect of using a kazoo instrument to improve pulmonary function and cognitive reserve in middle-aged and older adults in rural areas. This quasi-experimental study was conducted at two community care stations selected using cluster sampling from a rural district in southern Taiwan. We enrolled 85 middle-aged and older adults who were randomly assigned into self-learner and in-class groups. Both groups received a 6-month kazoo program. Cognitive and pulmonary function were compared before and after the intervention between the two groups. Significantly improved pulmonary function with regards to forced vital capacity (p < .05) was found in the self-learner group, and significantly improved maximum expiratory flow 75% (p < .001) was found in both groups. Mini-Mental State Examination scores significantly improved in the self-learner group (p < .01), but there was no significant change in the in-class group. Our results suggest that community care stations could consider implementing wind instrument programs such as a kazoo to enhance pulmonary function and cognitive reserve in middle-aged and older adults residing in rural areas.

Determining the Optimal Vacuum Frying Conditions for Silver Herring (Spratelloides gracilis) Using the Response Surface Methodology.

Vacuum frying (VF) is a selective technique for producing high-quality fried food that is mostly used on vegetables, fruits, and potato chips. It is rarely applied to the production of aquatic (especially fish) products. The purpose of this study is to explore whether VF technology can be applied to the preparation of dried silver herring products and to obtain the optimal VF conditions. The response surface methodology (RSM) was used to examine the factors affecting the quality of silver herring (Spratelloides gracilis) products after VF, namely temperature (75, 90, and 105 °C), duration (25, 35, and 45 min), and concentration (0, 15, and 30%) of maltose solution used to immerse the samples during pre-processing. The results indicated that VF temperatures had significant impacts on water activity (Aw), moisture content, yield, oil content, lightness (L* value), and colour difference (ÄE). The higher the VF temperature, the lower the Aw, moisture content, yield, and oil content of the product, but the higher the L* value and ΔE. Next, a longer VF duration resulted in higher oil content of the product. Maltose concentration was significantly and positively correlated with the yield and fracturability of the product. RSM analysis indicated that the optimal combination of processing conditions was a VF temperature of 105 °C, VF duration of 25 min, and maltose concentration of 27%. Under these VF conditions, the silver herring products had a moisture content of 3.91%, Aw of 0.198, oil content of 21.69%, L* value of 28.19, ΔE of 27.31, and fracturability of 359 g/s. In summary, vacuum frying technology is suitable for the preparation of dried silver herring products, and this study can provide the optimal processing conditions for seafood processors to obtain better quality.

Compact Sub 6 GHz Dual Band Twelve-Element MIMO Antenna for 5G Metal-Rimmed Smartphone Applications.

In this paper, a twelve-antenna system is designed for 5G smartphones with metal frames. The system is compact and operates on dual bands within the sub-6 GHz frequency range using multiple-input multiple-output (MIMO) technology. Two sets of six-antenna units are included in the system, arranged in a diagonal mirror-image configuration, and positioned at the center of the circuit board's longer edges. The profile height of each of the six-antenna units is only 3 mm, and the overall array dimensions are 105 × 3 × 3.1 mm3. A single antenna unit is 15 × 3 × 3.1 mm3 (0.173 λ × 0.035 λ × 0.036 λ, where λ equals the free-space wavelength of 3450 MHz). The arrangement of the antennas in the six-antenna units is parallel, with a 3 mm separation between adjacent antennas. The antenna structure comprises of an inverted L-shaped feed branch and two inverted L-shaped short-circuit branches integrated into part of the metal frame. The proposed array can form multiple resonance paths, achieving dual-band operation at 3300-3600 MHz and 4800-5000 MHz. The measured isolation of this twelve-antenna system within the operating frequency band is over 10 dB, and the measured antenna efficiency is greater than 36%. Therefore, the system is suitable for use in smartphones with high screen-to-body ratios and metal frames.

Compact Sub 6 GHz Slot Multiantenna System for 5G Laptops.

A sub 6 GHz dual-band closed-slot multiantenna system for 5G laptops is proposed in this paper. It was installed in a clearance space, with dimensions og 217 × 3 mm2 and 1 mm away from the upper edge of the screen ground plane. The dimensions of the clearance space were the same as those of a multisystem consisting of six antennas. The dimensions of the single closed-slot antenna were 32 × 3 mm2 (0.368 λ × 0.034 λ, where λ equals the free-space wavelength of 3450 MHz. The antenna was coupled to an asymmetric T-shaped feed-in section equipped with a chip capacitor for exciting one-half and full wavelength resonance modes of the closed-slot to encompass sub 6 GHz 3300-3600 MHz and 4800-5000 MHz dual-band operations. The design of the antenna features a long and straight slot to generate the high-order mode of the closed slot in the high-frequency (4800-5000 MHz) band (not the low-frequency (3300-3600 MHz) multiplier band). Its structure is simple, and the width of its slot is only 3 mm. The antennas were arranged to be 5 mm apart in the same direction and in parallel to form a six-antenna system in order to utilize the weak electric fields located at the two closed ends of the closed-slot structure when the closed slot was excited. It showed excellent envelope correlation coefficients (ECCs) and isolation performance without the installation of isolation elements. The measured fractional bandwidth of the antenna was 10.15% and 6.73% at the center frequencies of 3450 MHz and 4900 MHz, respectively. Its measured isolation was always over 10 dB, and the efficiency was between 46% and 76%. The ECCs of the system calculated from the measured complex E-field radiation pattern were all below 0.2, which means that it is ideal for use in laptop devices with a high screen-to-body ratio and a metal back cover.

Association of interferon-based therapy with risk of autoimmune diseases in patients with chronic hepatitis C virus infection: A population-based Taiwanese cohort study.

Background: Interferon in combination with ribavirin has been the standard of care for chronic hepatitis C virus infection (HCV) for the past few decades. However, its effect on the risk of autoimmune diseases (ADs) among patients with HCV infection remains unclear. We assessed the potential association between interferon-based therapy (IBT) and AD risk in patients with HCV infection. Methods: This retrospective cohort study identified patients diagnosed with HCV infection between January 1, 2006, and December 31, 2015, from Taiwan's National Health Insurance Research Database. In total, 16,029 patients with HCV infection who received IBT and 141,214 patients with HCV infection who did not receive IBT were included. Both cohorts were followed up to assess the development of ADs. Hazard ratios (HRs) were calculated using the Cox proportional hazards regression model, which was adjusted for potential confounders. Results: The median follow-up period for IBT and non-IBT users was 4.53 and 3.34 years, respectively. No significant difference in the risk of overall ADs (adjusted HR [aHR]: 0.96, 95% confidence interval [CI]: 0.81-1.14) or systemic ADs (aHR: 0.88, 95% CI: 0.71-1.10) was noted during the study period. However, a slight increase in the risk of organ-specific ADs was noted among IBT users (incidence rate ratio: 1.33, 95% CI: 1.02-1.72). Furthermore, analysis of AD subgroups revealed a significant increase in the risks of Graves' disease (aHR: 6.06, 95% CI: 1.27-28.8) and Hashimoto's thyroiditis (aHR 1.49, 95% CI 1.01-2.21) among IBT users. Conclusions: IBT use increases the risk of autoimmune thyroid diseases (Hashimoto's thyroiditis and Graves' disease) in patients with HCV infection to a greater extent than non-IBT use.

The Impact of Engagement with the PARO Therapeutic Robot on the Psychological Benefits of Older Adults with Dementia.

OBJECTIVES: This study aimed to examine the effect of 8-weeks of a 60-minute PARO intervention to reduce depressive symptoms and loneliness in older adults with dementia and investigated changes in their emotional or behavioral expressions and level of engagement with the PARO robot. METHODS: This was a quasi-experimental study with a repeated measures design. The outcome measures were evaluated at four time-points: before the intervention, week 4, immediately after the intervention, and one month after the PARO intervention. RESULTS: Fifty-two participants were recruited. The age of the participants ranged from 65 to 96 years, with a mean age of 81.81 years (SD = 8.54) in the PARO group and 79.08 years (SD = 7.71) in the control group. Using a mixed between-within subjects' analysis of variance, the results showed that there were significant interaction effects between the groups and time-periods for depression (p < .000), loneliness (p < .000), and engagement (p < .000). CONCLUSIONS: The PARO intervention alleviated depression and loneliness for older adults. Furthermore, the process of engagement with PARO may play an important role in the PARO effects. CLINICAL IMPLICATIONS: A tailored PARO intervention of at least 4 weeks could engender positive psychological benefits for older adults.

Internet of Things: Development Intelligent Programmable IoT Controller for Emerging Industry Applications.

The Internet of Things (IoT) has become critical to the implementation of Industry 4.0. The successful operation of smart manufacturing depends on the ability to connect everything together. In this research, we applied the TOC (Theory of Constraints) to develop a wireless Wi-Fi intelligent programmable IoT controller that can be connected to and easily control PLCs. By applying the TOC-focused thinking steps to break through their original limitations, the development process guides the user to use the powerful and simple flow language process control syntax to efficiently connect to PLCs and realize the full range of IoT applications. Finally, this research uses oil-water mixer equipment as the target of continuous improvement and verification. The verification results meet the requirements of the default function. The IoT controller developed in this research uses a marine boiler to illustrate the application. The successful development of flow control language by TOC in this research will enable academic research on PLC-derivative applications. The results of this research will help more SMEs to move into smart manufacturing and the new realm of Industry 4.0.

Non-B, Non-C Hepatocellular Carcinoma in an HBV- and HCV-Endemic Area: A Community-Based Prospective Longitudinal Study.

A large community cohort of adults who participated in a health screening program from 2003 to 2013 were prospectively analyzed for the risk factors of non-B, non-C (NBNC) hepatocellular carcinoma (HCC). The serostatus of hepatitis B and C of 52,642 participants was linked to the mortality and cancer registration data of the Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan. During a median follow-up of 6 years, 35 of the 43,545 participants who were negative for both HBsAg and anti-HCV antibody developed HCC. Multivariate Cox regression analysis revealed that old age (hazard ratio, 95% CI: 1.058, 1.019−1.098, p = 0.003); male sex (2.446, 1.200−4.985, p = 0.014); high aspartate aminotransferase levels (6.816, 2.945−15.779, p < 0.001); fibrosis index based on four factor score (1.262, 1.154−1.381, p < 0.001); blood sugar (1.009, 1.002−1.015, p = 0.006); and alpha-fetoprotein ≥15 ng/mL (143.938, 43.094−480.760, p < 0.001) were independent risk factors for HCC. By contrast, triglyceride >150 mg/dL was associated with a decreased risk of HCC (0.216, 0.074−0.625, p = 0.005). This prospective community-based study provided insights into the potential HCC risk factors which may shed some light in HCC prevention and screening.

A novel HIF1α-STIL-FOXM1 axis regulates tumor metastasis.

BACKGROUND: Metastasis is the major cause of morbidity and mortality in cancer that involves in multiple steps including epithelial-mesenchymal transition (EMT) process. Centrosome is an organelle that functions as the major microtubule organizing center (MTOC), and centrosome abnormalities are commonly correlated with tumor aggressiveness. However, the conclusive mechanisms indicating specific centrosomal proteins participated in tumor progression and metastasis remain largely unknown. METHODS: The expression levels of centriolar/centrosomal genes in various types of cancers were first examined by in silico analysis of the data derived from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and European Bioinformatics Institute (EBI) datasets. The expression of STIL (SCL/TAL1-interrupting locus) protein in clinical specimens was further assessed by Immunohistochemistry (IHC) analysis and the oncogenic roles of STIL in tumorigenesis were analyzed using in vitro and in vivo assays, including cell migration, invasion, xenograft tumor formation, and metastasis assays. The transcriptome differences between low- and high-STIL expression cells were analyzed by RNA-seq to uncover candidate genes involved in oncogenic pathways. The quantitative polymerase chain reaction (qPCR) and reporter assays were performed to confirm the results. The chromatin immunoprecipitation (ChIP)-qPCR assay was applied to demonstrate the binding of transcriptional factors to the promoter. RESULTS: The expression of STIL shows the most significant increase in lung and various other types of cancers, and is highly associated with patients' survival rate. Depletion of STIL inhibits tumor growth and metastasis. Interestingly, excess STIL activates the EMT pathway, and subsequently enhances cancer cell migration and invasion. Importantly, we reveal an unexpected role of STIL in tumor metastasis. A subset of STIL translocate into nucleus and associate with FOXM1 (Forkhead box protein M1) to promote tumor metastasis and stemness via FOXM1-mediated downstream target genes. Furthermore, we demonstrate that hypoxia-inducible factor 1α (HIF1α) directly binds to the STIL promoter and upregulates STIL expression under hypoxic condition. CONCLUSIONS: Our findings indicate that STIL promotes tumor metastasis through the HIF1α-STIL-FOXM1 axis, and highlight the importance of STIL as a promising therapeutic target for lung cancer treatment.

Can the Paro be my Buddy? Meaningful experiences from the perspectives of older adults.

This study aimed to explore meaningful experiences of older Taiwanese adults who had received a Paro (social robot) companion. Semi-structured qualitative interviews elicited the perspectives of 25 older adults living in a long-term care facility after they had interacted with an individual Paro companion for 8 weeks. Thematic analysis was used in this study as it allows for rich, detailed, and complex descriptions of qualitative data. Analysis identified four themes: Bridging my social bonds; Acting as a comfort Buddy; Relieving my emotional distress; and Encountering Paro with distancing. Although Paro's functioning has some limits, such as lacking speech, most participants expressed that the experience was positive. These findings revealed that the meaningful experiences expressed by participants at the end of the intervention with Paro might provide the value of companionship and improve interpersonal relationships for older adults in geriatric nursing.

Self-Participation Experiences among Well-Adapted Hemodialysis Patients.

A successful self-participation experience empowers patients to adapt to living with hemodialysis. However, few studies regarding the subjective experiences of such patient participation have been conducted. This study's purpose was to describe hemodialysis patients' perspectives on integrating hemodialysis into a new life regarding self-participation experience. A qualitative study using the grounded theory method was applied. Thirty-two well-adaptive hemodialysis Taiwanese patients attended in-depth interviews. "Integrating hemodialysis into a new life journey" was identified as the core category guiding the entire self-participation experience of hemodialysis patients. The three antecedent themes were "Sense of worthlessness", "Life is still worth living", and "Friendly and joyful atmosphere of the hemodialysis room". Once the patients went through the three antecedent themes, they gradually began making efforts to participate more fully in their hemodialysis. Within this participation experience, the hemodialysis patients exhibited these four interactive themes: "Overcoming one's predicament", "Integrating self-care skills into my life", "Resuming previous roles and tasks", and "Adapting to independent living". Finally, most adaptive patients master the hemodialysis life. Encouraging patients to discover that their life is worth living and providing a friendly and joyful atmosphere in hemodialysis units are the keys to facilitating patients' self-participation more fully.

A Restless Stone.

Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus usually presents on elderly patients with multiple underlying diseases. Typically, the way of gallstone migration to small bowel is through biliary-enteric flstula, which is a rare complication of chronic cholecystitis. Patients present with diffuse abdominal pain and vomiting when the gallstone lodges in distal small bowel. The goals of surgical intervention include release of the bowel obstruction and closure of biliary-enteric flstula.

The C-degron pathway eliminates mislocalized proteins and products of deubiquitinating enzymes.

Protein termini are determinants of protein stability. Proteins bearing degradation signals, or degrons, at their amino- or carboxyl-termini are eliminated by the N- or C-degron pathways, respectively. We aimed to elucidate the function of C-degron pathways and to unveil how normal proteomes are exempt from C-degron pathway-mediated destruction. Our data reveal that C-degron pathways remove mislocalized cellular proteins and cleavage products of deubiquitinating enzymes. Furthermore, the C-degron and N-degron pathways cooperate in protein removal. Proteome analysis revealed a shortfall in normal proteins targeted by C-degron pathways, but not of defective proteins, suggesting proteolysis-based immunity as a constraint for protein evolution/selection. Our work highlights the importance of protein termini for protein quality surveillance, and the relationship between the functional proteome and protein degradation pathways.

A social robot intervention on depression, loneliness, and quality of life for Taiwanese older adults in long-term care.

OBJECTIVES: To investigate the effect of a social robot intervention on depression, loneliness, and quality of life of older adults in long-term care (LTC) and to explore participants' experiences and perceptions after the intervention. DESIGN: A mixed-methods approach consisting of a single group, before and after quasi-experimental design, and individual interview. PARTICIPANTS: Twenty older adults with depression from four LTC facilities in Taiwan were recruited. INTERVENTION: Each participant participated in 8 weeks of observation and 8 weeks of intervention. In the observation stage, participants received usual care or activities without any research intervention. In the intervention stage, each participant was given a Paro (Personal Assistive RobOt) to keep for 24 hours, 7 days a week. MEASUREMENTS: The Geriatric Depression Scale, the UCLA Loneliness Scale Version 3, and the World Health Organization Quality of Life Questionnaire for older adults were administered at four time points. Individual qualitative interviews with thematic analysis followed. RESULTS: A repeated multivariate analysis of variance and Friedman's test showed no significant changes during the observation stage between T1 and T2 for depression and quality of life (p >.5). For the intervention stage, statistically significant changes in decreasing depression and loneliness and improving quality of life over time were identified. Three themes emerged from the interviews: (i) humanizing Paro through referring to personal experiences and engagement; (ii) increased social interaction with other people; and (iii) companionship resulting in improved mental well-being. CONCLUSIONS: There were significant improvements in mental well-being in using Paro. Further research may help us to understand the advantages of using a Paro intervention as depression therapy.

Music, heart rate variability, and symptom clusters: a comparative study.

PURPOSE: This study aimed to explore the possible range of change of a single-session music intervention (SMI) on symptom clusters and neurological reactivity for women with breast cancer undergoing chemotherapy. METHODS: A parallel and randomized, controlled study with repeated measures design was used. A total of 100 women with breast cancer were randomly assigned to the SMI or a control group. The outcome measurements of symptom cluster were collected using the Multidimensional Fatigue Symptom Inventory, Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and the neurological reactivity with heart rate variability at four time points: before commencement of the intervention (T0), immediately afterward (T1), 1 week later (T2), and 3 weeks after the intervention (T3). RESULTS: Of the 50 women in each group, 46 in the SMI and 48 in the control group completed the post-test at T3. Multivariate analysis of variance indicated that the SMI group had a medium effect in change of symptom clusters compared to the control group at T2. Moreover, after adjusting for baseline between normal and higher levels of sympathetic tone activity, significant differences existed in fatigue and depression at T2 and sleep disturbance at T3. CONCLUSIONS: A single-session music intervention can be effectively used to reduce symptom clusters for women with breast cancer. Targeting those who have a higher level of sympathetic tone activity is recommended.

Factors associated with the intention to use adult preventive health services in Taiwan.

OBJECTIVE: This research aimed to examine the factors associated with the intention to use adult preventive health services in Taiwan. DESIGN AND SAMPLE: Using Andersen's behavioral model, we employed a cross-sectional descriptive design to investigate 500 samples from four communities in southern Taiwan. MEASURES: We used a self-reported survey to assess participants' intention to use adult preventive health services, and the predisposing, enabling, and need factors influencing their intention. RESULTS: Intention to use adult preventive health services was more significantly explained by predisposing and enabling factors than by need factors. In addition, a lack of fixed medical facilities (enabling factor) and Taiwanese origin (predisposing factor) were associated with decreased odds of intention to use adult preventive health services. An educational level of high school or below (predisposing factor), higher amounts of exercise (predisposing factor), and lower barriers to use preventive health services (predisposing factor) were associated with increased odds of intention to use adult preventive health services. CONCLUSION: The findings can assist public health nurses in identifying high-risk groups with lower intentions of using adult preventive health services. Additionally, community-based health education program can be developed to increase people's intention to use adult preventive health services.

Feasibility and Effect of a Multidimensional Support Program to Improve Gerotranscendence Perception and Depression for Older Adults: A Pragmatic Cluster-Randomized Control Study.

Improving perception of gerotranscendence can increase life satisfaction in older adults to achieve successful aging. The purpose of this study was to evaluate the feasibility and effect of a multidimensional support program (MSP) on gerotranscendence and depression in community-dwelling older adults. Using a cluster-randomized control trial design, four sites (98 participants) were randomly assigned to a MSP or control group. The Gerotranscendence Scale and Geriatric Depression Scale were administered pre- and postintervention. A total of 91 participants completed the study. The mean attendance rates in the MSP and control groups were 85.5% and 84.3%, respectively. The MSP was found to significantly enhance the perception of gerotranscendence in older adults but not their level of depression. This study demonstrated the MSP is a feasible and effective program to improve perception of gerotranscendence and may potentially lead to positive psychological well-being for older adults. [Res Gerontol Nurs. 2019; 12(3):148-158.].

Comparison of FIB-4 and transient elastography in evaluating liver fibrosis of chronic hepatitis C subjects in community.

BACKGROUND AND AIM: The role of non-invasive methods to evaluate fibrosis severity of chronic hepatitis C (CHC) subjects in community needs to be explored. This study investigated FIB-4 and transient elastography (TE) in staging liver fibrosis of CHC subjects in community. METHODS: A total of 905 subjects who were positive for anti-HCV antibody from five districts of Tainan City of Taiwan were invited to participate in surveillance activities for CHC. FIB-4 and TE were measured for each participant. RESULTS: A total of 502 subjects with detectable HCV RNA and valid TE were enrolled. The distribution of FIB-4 and TE values differed markedly. Both methods exhibited a strongest correlation in subjects with at age 50~60 years (r = 0.655, p <0.001). FIB-4 score increased proportionally with age (p <0.001), but TE did not (p = 0.142). The intraclass correlation efficient of both methods was 0.255 (p <0.001). Subjects with TE defined advanced fibrosis exhibited younger age, higher BMI, higher platelet count, lower FIB-4 score, higher incidence of fatty liver and splenomegaly, and higher controlled attenuation parameter value than those defined by FIB-4. By multivariate logistic regression analysis, higher ALT levels, higher incidence of fatty liver, and presence of splenomegaly were the independent factors associated with advanced fibrosis defined by TE rather than defined by FIB-4. CONCLUSIONS: FIB-4 and TE defined different distribution of fibrosis stages in same HCV population. FIB-4 was deeply influenced by age whereas TE was not. TE had the advantages over than FIB-4 in strong association with splenomegaly and in detecting the role of non-alcoholic fatty liver disease in advanced fibrosis.