Deforestation within breeding ranges may still drive population trends of migratory forest birds in the East Asian Flyway.

The East Asian Flyway (EAF) is the most species diverse of global flyways, with deforestation in its migratory landbird's non-breeding range suspected to be the main driver of population decline. Yet range-wide habitat loss impact assessments on EAF migratory landbirds are scarce, and seasonal variation in habitat preference of migratory species further increases the complexity for conservation strategies. In this study, we reviewed population trends of migratory forest breeding birds in the EAF along with their seasonal habitat preference from the literature and assessed the impact of forest cover change in species' breeding and non-breeding ranges on population trends. We found that 41.3% of the bird species with trend data available are declining, and most have higher forest preference in the breeding season. Despite 93.4% of the species experienced deforestation throughout their annual cycle, forest cover change in the non-breeding range was not identified as the main driver of population trend. However, forest cover change in species' regional breeding range interacts positively with the degree of breeding season forest preference in predicting population trends. We therefore stress that regional breeding habitat protection may still be important while following the call for cross-border collaboration to fill the information gap for flyway conservation.

Evaluation of Persistent Efficacy of Diabetes Remission and Decline of Cardiovascular Risk After Laparoscopic Sleeve Gastrectomy: a Preliminary 1-Year Study.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a relative safe procedure in bariatric surgery. However, relatively few studies had been assessed its comprehensive efficacies. In the current study, the efficacies of LSG were comprehensively explored on glycemic control and cardiovascular disease (CVD) risk reduction. METHODS: A total of 95 obese patients, who owned body mass index (BMI) of more than 35, were recruited. All of them primarily underwent LSG from 2014 to 2016. Type 2 diabetes mellitus (T2DM) remission was defined as levels of glycated hemoglobin (A1C) and fasting blood glucose (FBG) of less than 6.4% and 125 mg/dL, respectively. The further efficacies of LSG on CVD and coronary heart disease (CHD) risks were explored by using original- and recalibrated Framingham 10-year CHD risk scores and the other 3 well-established CVD risk prediction models. RESULTS: Systolic blood pressure (SBP), serum FBG, A1C, triglyceride (TG), BMI, and body weight showed significantly declined and high-density lipoprotein-cholesterol (HDL) displayed twice higher than beginning level after LSG. The 71 of 95 patients with obesity were T2DM; 62 of them exhibited persistent DM remission until 1 year after LSG. Cardiovascular age, general cardiovascular risk (GCVR), and atherosclerotic cardiovascular disease risk (ASCVD) also showed significant decrements after LSG. We also observed significant reductions in estimated CVD and CHD risks. CONCLUSION: LSG resulted in a persistent T2DM remission and corrected metabolic abnormalities. Subsequently, LSG also benefits declined risks of CVD and 10-year CHD developments. LSG may be helpful for primary CVD care in obese patients with BMI of more than 35.

Range map datasets for terrestrial vertebrates across Taiwan.

Accurate data describing the geographic distribution of specific species form the basis for effective conservation management policies. However, for most species the freely available distributional information is usually confined to either expert maps or purely theoretical maps constructed by using a variety of modeling frameworks. These maps usually do not provide enough resolution for conservation applications or do not accurately describe the current distribution status. In this study, we constructed a novel workflow designed to integrate data from various species distribution models and expert knowledge into a single unified modeling process. Under this workflow, we systematically constructed current distribution maps for a selection of terrestrial vertebrates found across Taiwan. We used species distribution modeling as the base and then aggregated multiple open datasets describing species occurrence and environmental factors as data sources. Thereafter, we estimated the primary broad-scale and high spatial resolution species range maps using the MaxEnt modeling algorithm, and then consulted experts on each taxa to refine these maps. This dataset provides up-to-date species distribution maps for 379 terrestrial vertebrates in Taiwan, with members from across four taxa (27 amphibians, 52 reptiles, 264 birds, and 36 mammals). This dataset helps to fill the spatial knowledge gaps for conservation concerns and improves our understanding of the geographic distribution of more than half (61%) of the vertebrate species of Taiwan. Furthermore, by stacking the range maps of multiple species, we can identify vertebrate diversity hotspots and identify priority areas for conservation.

Response of waterbird abundance and flight behavior to a coastal wind farm on the East Asian-Australasian Flyway.

Coastal wetlands along migratory flyways are crucial in supporting staging or wintering waterbirds, yet they are often targeted for wind energy development. Potential conflicts are likely to be strong in densely populated East and Southeast Asia, where many bird species along the flyway are endangered, and wind energy projects are just flourishing. We investigated waterbird abundance and flight behavior at a coastal wind farm at the mid of the East Asian-Australasian Flyway. For shorebirds roosting in the aquacultural ponds, the abundance showed no significant change in the study area compared with the control area across all development stages of the wind farm. For egrets breeding in the mangroves, fewer Cattle Egrets Bubulcus ibis were observed in the year of wind farm construction and the first year of wind farm operation, then the number recovered afterwards. Since the operation of the wind farm, birds avoided crossing closely spaced (200 m) turbines while travelling through widely spaced (500 m) ones more frequently. Shorebirds, egrets, and landbirds flew lower when turbines were present, reducing the overlap of their flight height with the swept zone. Our study suggests that coastal wind farms are not necessarily a great threat to waterbirds. Yet environmentally sound planning and rigorous monitoring are crucial in minimizing potential impacts.

[From Monologue to Dialogue: The Evolution of Diabetes Self-Management Education].

Diabetes is a chronic disease. Patients with diabetes must actively change their eating and exercise habits and cannot rely solely on medication. Moreover, these patients need to control high blood glucose, high blood pressure, and high blood cholesterol, commonly known as control of the "three highs". As the current state of diabetes control is not ideal in the United States and Taiwan, disease-related complications such as blindness and the need for dialysis is expected to continue to increase in these countries in the future. This article highlights the possible factors of poor control of the "three highs" such as the therapeutic inertia of physicians (also known as clinical inertia), patient adherence, and current challenges in diabetes self-management education. In the past, courses in health education at our institution have been frequently delivered in monologue format. In recent years, we have tried a form of group therapy known as shared medical appointment (SMA) in order to encourage dialogue among patients and minimize didactic teaching. The preliminary results have been promising. In recent weeks, we began to discuss targeting SMA therapy on the topics of food metabolism and the typical effects and side effects of new and old drugs. We hope this will ease our introduction of shared decision making (SDM) in the near future. Promoting time-consuming procedures such as SDM is difficult in Taiwan because national-insurance health insurance payments to the healthcare provider are based on volume rather than value. We hope that the Health Insurance Bureau begins to recognize and appreciate the contribution of nurse educators and dietitians in the care of patients with diabetes and approve compensation for their hard work.

Indigenous Wildlife Rabies in Taiwan: Ferret Badgers, a Long Term Terrestrial Reservoir.

The emerging disease of rabies was confirmed in Taiwan ferret badgers (FBs) and reported to the World Organization for Animal Health (OIE) on July 17, 2013. The spread of wildlife rabies can be related to neighborhood countries in Asia. The phylogenetic analysis was conducted by maximum likelihood (ML) methods and the Bayesian coalescent approach based on the glycoprotein (G) and nucleoprotein (N) genes. The phylogeographic and spatial temporal dynamics of viral transmission were determined by using SPREAD, QGIS. Therefore, the origin and the change with time of the viruses can be identified. Results showed the rabies virus of FB strains in Taiwan is a unique clade among other strains in Asia. According to the phylogeographic coalescent tree, three major genotypes of the FB rabies virus have circulated in three different geographical areas in Taiwan. Two genotypes have distributed into central and southern Taiwan between two ecological river barriers. The third genotype has been limited in southeastern Taiwan by the natural mountain barrier. The diversity of FB rabies viruses indicates that the biological profile of FBs could vary in different geographical areas in Taiwan. An enhanced surveillance system needs to be established near the currently identified natural barriers for early warnings of the rabies virus outbreak in Taiwan.

User Experience-Take Multimedia Registration Panel as an Example.

Follow the transfer method that the popular technology products users share new item online, to encourage nursing staffs express their real experience, attract them involve the clinical IT development. Help the Technology Products more useful to improve clinical provider quality.

Lessons from the Largest Epidemic of Avian Influenza Viruses in Taiwan, 2015.

The largest epidemic of avian influenza (AI) in history attacked poultry and wild birds throughout Taiwan starting January 6, 2015. This study analyzed surveillance results, epidemiologic characteristics, and viral sequences by using government-released information, with the intention to provide recommendations to minimize future pandemic influenza. The H5 clade 2.3.4.4 highly pathogenic AI viruses (HPAIVs) had not been detected in Taiwan before 2015. During this epidemic, four types of etiologic agents were identified: the three novel subtypes H5N2, H5N8, and H5N3 clade 2.3.4.4 HPAIVs and one endemic chicken H5N2 subtype (Mexican-like lineage) of low pathogenic AI viruses. Cocirculation of mixed subtypes also occurred, with H5N2 clade 2.3.4.4 HPAIVs accompanied by the H5N8 and H5N3 subtypes or old H5N2 viruses in the same farm. More than 90% of domestic geese died from this AI epidemic; geese were affected the most at the early outbreaks. The epidemic peaked in mid-January for all three novel H5 subtypes. Spatial epidemiology found that most affected areas were located in southwestern coastal areas. In terrestrial poultry (mostly chickens), different geographic distributions of AI virus subtypes were detected, with hot spots of H5N2 clade 2.3.4.4 vs. past-endemic old H5N2 viruses in Changhwa (P = 0.03) and Yunlin (P = 0.007) counties, respectively, of central Taiwan. Phylogenetic and sequence analyses of all the early 10 Taiwan H5 clade 2.3.4.4 isolates covering the three subtypes showed that they were very different from the HA of the past local H5 viruses from domestic ducks (75%-80%) and chickens (70%-75%). However, they had the highest sequence identity percentages (99.53%-100%), with the HA of A/crane/Kagoshima/KU13/2014(H5N8) isolated on December 7, 2014, in Japan being higher than those of recent American and Korean H5 HPAIVs [A/Northern pintail/Washington/40964/2014 (H5N2) and A/gyrfalcon/Washington/41088-6/2014 (H5N8): 99.02%-99.54% and A/Baikal teal/Korea/Donglim3/2014 (H5N8): 98.61%-99.08%], implying a likely common ancestor of these H5 clade 2.3.4.4 viruses. The multiple subtypes of H5 clade 2.3.4.4 HPAIVs imply high viral reassortment. We recommend establishing an integrated surveillance system, involving clinical, virologic, and serologic surveillance in poultry and wild birds, swine and other mammals prevalent on multiple-animal mixed-type traditional farms, and high-risk human populations, as a crucially important step to minimize future pandemic influenza.

Bayesian spatial modelling and the significance of agricultural land use to scrub typhus infection in Taiwan.

Scrub typhus is transmitted by the larval stage of trombiculid mites. Environmental factors, including land cover and land use, are known to influence breeding and survival of trombiculid mites and, thus, also the spatial heterogeneity of scrub typhus risk. Here, a spatially autoregressive modelling framework was applied to scrub typhus incidence data from Taiwan, covering the period 2003 to 2011, to provide increased understanding of the spatial pattern of scrub typhus risk and the environmental and socioeconomic factors contributing to this pattern. A clear spatial pattern in scrub typhus incidence was observed within Taiwan, and incidence was found to be significantly correlated with several land cover classes, temperature, elevation, normalized difference vegetation index, rainfall, population density, average income and the proportion of the population that work in agriculture. The final multivariate regression model included statistically significant correlations between scrub typhus incidence and average income (negatively correlated), the proportion of land that contained mosaics of cropland and vegetation (positively correlated) and elevation (positively correlated). These results highlight the importance of land cover on scrub typhus incidence: mosaics of cropland and vegetation represent a transitional land cover type which can provide favourable habitats for rodents and, therefore, trombiculid mites. In Taiwan, these transitional land cover areas tend to occur in less populated and mountainous areas, following the frontier establishment and subsequent partial abandonment of agricultural cultivation, due to demographic and socioeconomic changes. Future land use policy decision-making should ensure that potential public health outcomes, such as modified risk of scrub typhus, are considered.

Bird species migration ratio in East Asia, Australia, and surrounding islands.

Bird migration and its relationship with the contemporary environment have attracted long-term discussion. We calculated the avian migration ratio (the proportion of breeding species that migrate) in the areas from 70°E to 180°E and examined its relationship with the annual ranges of ambient temperature, primary productivity (estimated by the Enhanced Vegetation Index), and precipitation, along with island isolation and elevational range. The avian migration ratio increased with increasing latitude in general but varied greatly between the two hemispheres. Additionally, it showed minimal differences between continents and islands. Our analyses revealed that the seasonality of ambient temperature, which represents the energy expenditure of birds, is the dominant factor in determining bird species migration. Seasonality in primary productivity and other environmental factors play an indirect or limited role in bird species migration. The lower avian migration ratio in the Southern Hemisphere can be attributed to its paleogeographical isolation, stable paleoclimate, and warm contemporary environment. Under current trends of global warming, our findings should lead to further studies of the impact of warming on bird migration.

Analysis of precore/core covariances associated with viral kinetics and genotypes in hepatitis B e antigen-positive chronic hepatitis B patients.

Hepatitis B virus (HBV) is one of the most common DNA viruses that can cause aggressive hepatitis, cirrhosis and hepatocellular carcinoma. Although many people are persistently infected with HBV, the kinetics in serum levels of viral loads and the host immune responses vary from person to person. HBV precore/core open reading frame (ORF) encoding proteins, hepatitis B e antigen (HBeAg) and core antigen (HBcAg), are two indicators of active viral replication. The aim of this study was to discover a variety of amino acid covariances in responses to viral kinetics, seroconversion and genotypes during the course of HBV infection. A one year follow-up study was conducted with a total number of 1,694 clones from 23 HBeAg-positive chronic hepatitis B patients. Serum alanine aminotransferase, HBV DNA and HBeAg levels were measured monthly as criteria for clustering patients into several different subgroups. Monthly derived multiple precore/core ORFs were directly sequenced and translated into amino acid sequences. For each subgroup, time-dependent covariances were identified from their time-varying sequences over the entire follow-up period. The fluctuating, wavering, HBeAg-nonseroconversion and genotype C subgroups showed greater degrees of covariances than the stationary, declining, HBeAg-seroconversion and genotype B. Referring to literature, mutation hotspots within our identified covariances were associated with the infection process. Remarkably, hotspots were predominant in genotype C. Moreover, covariances were also identified at early stage (spanning from baseline to a peak of serum HBV DNA) in order to determine the intersections with aforementioned time-dependent covariances. Preserved covariances, namely representative covariances, of each subgroup are visually presented using a tree-based structure. Our results suggested that identified covariances were strongly associated with viral kinetics, seroconversion and genotypes. Moreover, representative covariances may benefit clinicians to prescribe a suitable treatment for patients even if they have no obvious symptoms at the early stage of HBV infection.

Spatial analysis of scrub typhus infection and its association with environmental and socioeconomic factors in Taiwan.

We analyzed the spatial distribution of human cases of scrub typhus on the main island of Taiwan from 2003 to 2008 and implemented an island-wide survey of scrub typhus vectors (trombiculid chiggers) in 2007 and 2008. The standardized incidence rate 'SIR' incorporating inter-district variations in population, gender and age was correlated with environmental and socioeconomic variables. Higher incidence and SIR rates were clustered in the less developed, mountainous regions of central and eastern Taiwan. Higher SIRs were also associated with a higher proportion of dry-field farmers in the population, a higher normalized difference vegetation index (NDVI) and lower mean annual temperature, but was not associated with rainfall. Small mammal hosts in high-SIR districts harbored more chiggers and had higher rates of seropositivity against Orientia tsutsugamushi Hyashi, the etiologic agent of scrub typhus, compared to low-SIR districts. The concurrence of a higher proportion of dry-field farmers and higher NDVI has likely led to the clustering of scrub typhus in the mountainous regions of Taiwan. Further individual-level study of the risk factors associated with scrub typhus, and a better understanding of the effect of environmental factors on chigger abundance, should help to prevent scrub typhus in Taiwan.

Recent range-wide demographic expansion in a Taiwan endemic montane bird, Steere's Liocichla (Liocichla steerii).

BACKGROUND: The subtropical island of Taiwan is an area of high endemism and a complex topographic environment. Phylogeographic studies indicate that vicariance caused by Taiwan's mountains has subdivided many taxa into genetic phylogroups. We used mitochondrial DNA sequences and nuclear microsatellites to test whether the evolutionary history of an endemic montane bird, Steere's Liocichla (Liocichla steerii), fit the general vicariant paradigm for a montane organism. RESULTS: We found that while mountains appear to channel gene flow they are not a significant barrier for Steere's Liocichla. Recent demographic expansion was evident, and genetic diversity was relatively high across the island, suggesting expansion from multiple areas rather than a few isolated refugia. Ecological niche modeling corroborated the molecular results and suggested that populations of Steere's Liocichla are connected by climatically suitable habitat and that there was less suitable habitat during the Last Glacial Maximum. CONCLUSIONS: Genetic and ecological niche modeling data corroborate a single history--Steere's Liocichla was at lower density during the Last Glacial Maximum and has subsequently expanded in population density. We suggest that such a range-wide density expansion might be an overlooked cause for the genetic patterns of demographic expansion that are regularly reported. We find significant differences among some populations in FST indices and an admixture analysis. Though both of these results are often used to suggest conservation action, we affirm that statistically significant results are not necessarily biologically meaningful and we urge caution when interpreting highly polymorphic data such as microsatellites.

Structural and autooxidation profiles of myoglobins from three species and one hybrid of tilapia (Cichlidae, Perciformes).

cDNAs encoding myoglobin were cloned from the slow skeletal muscles of three representative species of tilapia, namely, Nile tilapia Oreochromis niloticus, blue tilapia O. aureus, Mozambique tilapia O. mossambicus and one hybrid O. niloticus female symbol x O. aureus male symbol, and the primary structures were deduced. All cDNAs contained an open reading frame of 444 base pairs, encoding 147 amino acids. The amino acid sequences of Mb were completely conserved among these species, though species variations in the nucleotide sequences were recognized both in coding and non-coding regions. The amino acid sequence identity was around 70-80% compared to other teleostean Mbs. In comparison of each alpha-helical segment (A through H) and the intersegment regions to the counterparts of tuna myoglobin, the alpha-helical segments C and F as well as the intersegment regions F-G and G-H were identical. The identities of alpha-helical segments B and H and the intersegment region F-G were relatively low. Differences were also recognized in the hydropathy plot and the tertiary structures obtained by homology modeling. The autooxidation rates at 25 degrees C of myoglobin fraction from the slow skeletal muscle were essentially the same among the above tilapia species, as expected from the conserved amino acid sequences.

What is the out-patient nurse thinking-from hand-written to information system uses.

Information systems auxiliary lot of nursing activities, what is nurse thinking about that information system for work; compared to the period of hand-written what are the differences between them? How was the situation that nurse work across the era from hand-written to information system uses? Use in-depth interview study of the phenomenological approach, then summarizing by Collaizzi phenomenological analysis, to know the nurse how to cross working style change, help hospital implement new technology in the future could be more smoothly into the situation, effectively reducing the operating costs.

Two clustering diffusion patterns identified from the 2001-2003 dengue epidemic, Kaohsiung, Taiwan.

This study analyzed the spatio-temporal patterns of 4,587 (94% of the total) confirmed dengue cases in Kaohsiung and Fengshan Cities (a two-city area) that occurred in Taiwan from 2001 to 2003. The epidemic had two simultaneous distinct diffusion patterns. One was a contiguous pattern, mostly limited to 1 km from an initial cluster, reflecting that there was a rapid dispersal of infected Aedes aegypti and viremic persons. The second followed a relocation pattern, involving clusters of cases that diffused over 10 weeks starting from the southern and moving to the northern parts of the two-city area. The virus from one clustering site jumped to several distant areas where it rapidly dispersed through a series of human-mosquito transmission cycles to several localities. In both patterns, transmission of disease quickly enlarged the epidemic areas. Future dengue control efforts would benefit from a timely syndromic surveillance system plus extensive public education on how to avoid further transmission.

Uniform genetic diversity, low differentiation, and neutral evolution characterize contemporary refuge populations of Taiwan fir (Abies kawakamii, Pinaceae).

Based on fossil pollen, the distribution range of Taiwan fir [Abies kawakamii (Hay.) Ito] (Pinaceae) is smaller than it was 50 000 years ago. To characterize the present refuge populations of A. kawakamii, which survive only in subalpine forests in Taiwan, we surveyed nuclear genes and chloroplast intergenic spacers to assess the genetic diversity of Taiwan fir. Populations maintain high genetic diversity and contain similar numbers of haplotypes for the GapC (cytosolic glyceraldehyde 3-phosphate dehydrogenase) fragment. Haplotypes for GapC are generally widespread, and population-specific haplotypes accounted for 2.5% of the total. Differentiation among populations is very low (G(ST) = 0.01). Only three haplotypes were detected for the cpDNA marker, and every population had one or two haplotypes. In a neutrality test, the variation in nucleotides did not deviate from that expected with neutral evolution for either marker. A retreat route to higher elevations was not evident from either the GapC or cpDNA markers. Hsuehshan was the site of the most divergent population in Taiwan. We concluded that uniform genetic diversity, low differentiation, low numbers of population-specific haplotypes, and neutral evolution characterize contemporary refuge populations of Taiwan fir.