Solidarity with Whom? The Boundary Problem and the Ethical Origins of Solidarity of the Health System in Taiwan.

Publicly-funded health systems, including those national health services and social or National Health Insurances, are institutionalized solidarity in health. In Europe, solidarity originated from the legacies of labor movements, the Judeo-Christian traditions, and nationalist sentiments in the re-construction Era after the WWII. In middle-to-high income East Asian countries, such as Japan, Taiwan, Korea, the health systems were built on different grounds and do not have such ethical origins of solidarity. As health systems in Europe and East Asia are both facing sustainability crises due to aging population, stagnant economy, changing boundaries, and advancing medical technologies, how those systems with the European solidaristic ethical traditions can be revived and how those without the European traditions could survive become a matter of theoretical interests and an urgent policy problem to be addressed. Drawing on contemporary theories of solidarity, this essay analyzes the boundary problem and its impact on the sustainability of the health system in Taiwan. It then considers two plausible origins of solidarity in Taiwan. One is the re-emerged civic nationalism, and the other is an ethos of common life. It is argued that after years of implementation, the National Health Insurance in Taiwan might have shaped the social values and people's habits and formed an ethos of common life. Such ethos could be an ethical origin of solidarity in non-western societies and help the health systems endure the prolonged sustainability crises.

Using a machine learning approach to predict mortality in critically ill influenza patients: a cross-sectional retrospective multicentre study in Taiwan.

OBJECTIVES: Current mortality prediction models used in the intensive care unit (ICU) have a limited role for specific diseases such as influenza, and we aimed to establish an explainable machine learning (ML) model for predicting mortality in critically ill influenza patients using a real-world severe influenza data set. STUDY DESIGN: A cross-sectional retrospective multicentre study in Taiwan SETTING: Eight medical centres in Taiwan. PARTICIPANTS: A total of 336 patients requiring ICU-admission for virology-proven influenza at eight hospitals during an influenza epidemic between October 2015 and March 2016. PRIMARY AND SECONDARY OUTCOME MEASURES: We employed extreme gradient boosting (XGBoost) to establish the prediction model, compared the performance with logistic regression (LR) and random forest (RF), demonstrated the feature importance categorised by clinical domains, and used SHapley Additive exPlanations (SHAP) for visualised interpretation. RESULTS: The data set contained 76 features of the 336 patients with severe influenza. The severity was apparently high, as shown by the high Acute Physiology and Chronic Health Evaluation II score (22, 17 to 29) and pneumonia severity index score (118, 88 to 151). XGBoost model (area under the curve (AUC): 0.842; 95% CI 0.749 to 0.928) outperformed RF (AUC: 0.809; 95% CI 0.629 to 0.891) and LR (AUC: 0.701; 95% CI 0.573 to 0.825) for predicting 30-day mortality. To give clinicians an intuitive understanding of feature exploitation, we stratified features by the clinical domain. The cumulative feature importance in the fluid balance domain, ventilation domain, laboratory data domain, demographic and symptom domain, management domain and severity score domain was 0.253, 0.113, 0.177, 0.140, 0.152 and 0.165, respectively. We further used SHAP plots to illustrate associations between features and 30-day mortality in critically ill influenza patients. CONCLUSIONS: We used a real-world data set and applied an ML approach, mainly XGBoost, to establish a practical and explainable mortality prediction model in critically ill influenza patients.

Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study.

BACKGROUND: During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF. METHODS: In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan's National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF. RESULTS: From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/105). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29-83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28-16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94-18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27-17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89-6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001). CONCLUSION: Maternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or gestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had a higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.

2-Adamantanamine produces prolonged spinal block in rats.

We aimed to investigate the local anesthetic effect of 2-adamantanamine in spinal anesthesia. The dose-response curves were constructed after intrathecally injecting the rats with five doses of 2-adamantanamine and a common local anesthetic mepivacaine. The quality and duration of 2-adamantanamine at producing spinal nociceptive, proprioceptive and motor block were compared with that of mepivacaine. We revealed that 2-adamantanamine provoked spinal nociceptive, proprioceptive and motor block dose-dependently. On the 50% effective dose (ED50) basis, the rank of potency was mepivacaine >2-adamantanamine at producing spinal nociceptive, proprioceptive and motor block (p<0.05 for the differences). 2-Adamantanamine, but not mepivacaine produced more nociceptive block than motor block (p<0.05). At the equianesthetic doses (ED75, ED50, and ED25), the nociceptive block duration caused by 2-adamantanamine was greater than that caused by mepivacaine (p<0.01 for the differences). These preclinical data showed that 2-adamantanamine is less potent than mepivacaine, while 2-adamantanamine provokes greater duration of spinal nociceptive block than mepivacaine. Furthermore, 2-adamantanamine demonstrates a more nociceptive-selective action over motor block.

Pseudomonas stutzeri necrotizing pneumonia in pre-existing pulmonary tuberculosis.

Pseudomonas stutzeri (P. stutzeri) is a Gram-negative, non-fermenting rod. It is a rare pathogen; therefore, its isolation is often associated with colonization or contamination. We herein describe the first reported case of necrotizing pneumonia caused by P. stutzeri in a non-HIV infected patient with previously undiagnosed pulmonary tuberculosis. The isolate was found to be antibiotic resistant, which led to the failure of the initial treatment. This case highlights the unique presentation of necrotizing pneumonia caused by P. stutzeri and the importance of emerging antimicrobial resistance in P. stutzeri.

Effect of molecular structure on wetting behavior of water+amphiphile mixtures: a density functional approach.

A density functional approach is applied to investigate the effect of molecular structure on wetting behavior of water+amphiphile mixtures. The interaction-site model is employed to describe isomeric amphiphile structures. The hydrogen bonding between water and amphiphile is mimicked by energy enhancement according to specific molecular orientation. The calculations show that these systems exhibit Cahn-type criticality-related wetting transitions and pronounced adsorption behavior difference between isomeric systems. Excellent qualitative agreements with experiments are achieved.

Bulk and interfacial wetting behavior of binary mixtures induced by associating between unlike-pair molecules.

The statistical associating fluid theory of Wertheim is applied to describe binary mixtures with associating between unlike-pair molecules. The phase behavior of this binary mixture would fall into five different types (I, II, III, V, and VI) of the classification scheme of van Konynenburg and Scott by varying the associating strength and the energy parameters. Both interfacial wetting behavior and wetting transitions are carefully examined in all the vapor-liquid-liquid (gamma-beta-alpha) three-phase-coexisting regions of the binary mixtures. The global wetting behavior and wetting transitions are delineated by scanning the parameter space. In certain regions, the middle beta phase exhibits interfacial phase transitions sequentially, nonwetting --> partial-wetting --> nonwetting, at the interface separating lower alpha and upper gamma phases along with increasing temperature.