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Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate. Implementation of a HHP reduces preventable HAIs and is cost effective.

Perianal infection is a common problem for patients with acute leukemia. However, neutropenia and bleeding tendency are relatively contraindicated to surgical intervention. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are also rarely discussed. The medical records of 1102 adult patients with acute leukemia at a tertiary medical center in Taiwan between 2001 and 2010 were retrospectively reviewed and analyzed. The prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia. Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections. Patients with acute myeloid leukemia had higher recurrent rates than acute lymphoblastic leukemia patients (p = 0.028). More than half (n = 61, 53%) of the perianal infections were caused by gram-negative bacilli, followed by gram-positive cocci (n = 36, 31%), anaerobes (n = 18, 15%) and Candida (n = 1, 1%) from pus culture. Eighteen patients experienced bacteremia (n = 24) or candidemia (n = 1). Overall 41 (68%) of 60 patients had polymicrobial infection. Escherichia coli (25%) was the most common micro-organism isolated, followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), and Bacteroides species (11%). Twenty-five (34%) of 74 patients received surgical intervention. Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067). Four (5%) patients died within 30 days after diagnosis of perianal infection. Univariate analysis of 30-day survival revealed the elderly (≧ 65 years) (p = 0.015) and patients with shock (p<0.001) had worse outcome. Multivariate analysis showed septic shock to be the independent predictive factor of 30-day crude mortality of perianal infections (p = 0.016). Perianal infections were common and had high recurrence rate in adult patients with acute leukemia. Empirical broad-spectrum antibiotics with anaerobic coverage should be considered. Shock independently predicted 30-day crude mortality. Surgical intervention for perianal infection remains challenging in patients with acute leukemia.

Objective. Mild cognitive impairment (MCI) is a transitional state between normal aging and early dementia. It has a heterogeneous etiology and clinical course. This study aimed to examine the factors associated with the progression of MCI in different types of dementia disorders. Method. A retrospective, longitudinal, observational study of outpatients with MCI was conducted at a medical center in northern Taiwan. Patient medical records were reviewed, and risk factors were analyzed by multivariate analysis. Results. Among 279 patients with MCI, 163 (58.4%), 68 (24.4%), and 48 (17.2%) were diagnosed with Alzheimer’s disease, vascular cognitive impairment, and Lewy body diseases, respectively. During the observation period, 37.2% of patients progressed to dementia. Older age and a higher Clinical Dementia Rating Scale-Sum of Boxes were associated with the risk of progression. Hyperlipidemia was associated with a decreased risk. Converters were more likely to receive an antidementia prescription. Conclusion. Our study suggests the importance of comprehensive clinical profiling, risk factor assessment, and detailed drug history evaluations in improving our understanding and management of dementia subtypes.

Wind power has become an indispensable part of renewable energy development in various countries. Due to the high cost and complex structure of wind turbines, it is important to design a method that can quickly and effectively determine the structural health of the generator set. This research proposes a method that could determine structural damage or weaknesses in the blades at an early stage via a model to monitor the sound of the wind turbine blades, so as to reduce the quantity of labor required and frequency of regular maintenance, and to repair the damage rapidly in the future. This study used the operating sounds of normal and abnormal blades as a dataset. The model used discrete wavelet transform (DWT) to decompose the sound into different frequency components, performed feature extraction in a statistical measure, and combined with outlier exposure technique to train a deep neural network model that could capture abnormal values deviating from the normal samples. In addition, this paper observed that the performance of the monitoring model on the MIMII dataset was also better than the anomaly detection models proposed by other papers.

This study analyzes the mistakes students are prone to make in programming and uses the GDB and Valgrind tools to implement dynamic analysis techniques for their eventual application to programs created by students. In the analysis process, spectral error localization technology is used to strengthen the dynamic analysis to find errors more accurately. The analyzed results are sorted and corresponding feedback is given to students in order for them to better understand the content of errors when revising the program and classifying and counting the types of errors made. This study sorts mistakes frequently made by students and topics in which students are likely to make certain mistakes. The developed system was implemented in experiments including students from a programming course who were divided into two groups, namely the experimental group and the control group. A system for both groups of students to upload and submit assignments and a code analysis and feedback improvement system were used. Students in the control group only used the assignment uploading and submitting system for basic assignment uploading, verification, and the comparison of test data. After the program was entered, declarative sentence disassembly and dynamic slicing were suggested. Data were sent to GNU Debugger (GDB) and Valgrind for spectral error location; the classification and recording of error types; and the interpretation of the number of error lines, error types, and related variables. Feedback and a generated report were sent back to the student interface to provide effective and useful feedback to the students in the experimental group for them to revise their homework and record the types and number of errors they made in that week’s homework in the database. The answers provided by the students to the questions were recorded. The analysis of the pass rates of the students in the experimental and control groups for each homework test aided the understanding of the differences in the learning success of the two groups of students each week. The weekly pass rates and the numbers of measured errors in the experimental group compared with in the control group were input into a distribution map to allow us to better understand whether there was any positive correlation between the detected information, feedback to the students, pass rates of the tests, and other related data. The system statistically obtained feedback and the degree of improvement of homework programs; then, it distributed specially designed questionnaires to all students to directly obtain and quantify their feedback and perceived benefits of this system, thereby verifying the effectiveness of the system and its practicality.

Dementia with Lewy bodies (DLB) is a complex, multisymptom disorder. When making decisions regarding the treatment of DLB, the patient’s quality of life (QoL) should always be the main consideration. To our knowledge, this is the first review article focusing on the QoL in DLB patients. We searched the PubMed database using the keywords “quality of life” and “dementia with Lewy bodies.” Previously, no specific instrument had been developed for assessing the QoL in DLB patients. Patients with DLB have a decreased QoL compared to patients with Alzheimer’s disease, which is reportedly caused by several factors including level of independence in instrumental activities of daily living, whether the patient is living with the caregiver, apathy, delusion, and dysautonomia. The direct effect of visual hallucination, sleep, and movement disorders on the QoL in DLB patients has not been previously studied. The role of cognitive function on the QoL is still controversial. In a randomized controlled study, memantine may improve the QoL in PDD or DLB patients. We concluded that it is important to develop a specific instrument to assess the QoL in DLB patients. Furthermore, there is an urgent need for large clinical trials to identify factors associated with the QoL and how they can be managed.

We theoretically demonstrate that a family of vortex-lattice structures can be flexibly generated using a multi-beam interference approach. Numerical calculation presents a variety of crystalline and kaleidoscopic patterns. Based on the numerical analysis, we experimentally realized these structure beams by combining an amplitude mask with multiple apertures and a spiral phase plate. The excellent agreement between the experimental and theoretical results not only validates the presented method, but also manifests the structure of vortex lattices.

Background Frontotemporal degeneration (FTD) is a clinically and genetically heterogeneous neurodegenerative disorder characterized by deficits in executive function that frequently overlaps with parkinsonism and motor neuron disorders. Several genes have been identified to cause autosomal dominant forms of FTD, including the gene coding for the protein associated with microtubule tau ( MAPT ). While most reported pathogenic mutations in MAPT occur in exons 9–13, few families have been reported with mutations outside of this region. Herein, we report a first Taiwanese family having the exon 1 p.Arg5His mutation in MAPT with intrafamilial phenotype heterogeneity. Case presentation A 63-year-old man presented with progressive non-fluent speech and impaired memory for 3 years. He then developed apraxia, myoclonus and parkinsonism feature at his right hand. Extensive neurologic and neurocognitive examination lead to a diagnosis of FTD mixed with corticobasal syndrome. Magnetic resonance imaging revealed asymmetric atrophy in the left frontal and temporal lobes and single-photon emission computed tomography indicated decreased metabolism in the same areas as well as the left basal ganglia. The patient’s mother had been diagnosed with amyotrophic lateral sclerosis (ALS) at the age of 60 and was deceased 10 years later due to respiratory failure. The patient’s younger sister had persistent depressive disorder in her early forties and did not have any prominent cognitive or motor dysfunctions. We performed genetic analysis applying a targeted next generation sequencing (NGS) panel covering MAPT , GRN , VCP , FUS , CHMP2B , and TARDBP on the proband, followed by Sanger sequencing of candidate genes in eight family members. Hexanucleotide repeat expansion of C9Orf72 was determined by repeat-primed PCR. We identified a missense mutation in exon 1 of MAPT gene, c.14G > A (p.R5H), which was previously reported in only two Japanese patients in a literature review. This substitution co-segregated with the disease phenotypes in the family. Conclusions This is the first report of the occurrence of the MAPT p.R5H mutation in the Taiwanese population. Our findings extend the current knowledge of phenotypic heterogeneity among family members carrying the MAPT p.R5H mutation.

The harmonic drive is an essential industrial component. In industry, the efficient and accurate determination of machine faults has always been a significant problem to be solved. Therefore, this research proposes an anomaly detection model which can detect whether the harmonic drive has a gear-failure problem through the sound recorded by a microphone. The factory manager can thus detect the fault at an early stage and reduce the damage loss caused by the fault in the machine. In this research, multi-layer discrete wavelet transform was used to de-noise the sound samples, the Log Mel spectrogram was used for feature extraction, and finally, these data were entered into the EfficientNetV2 network. To assess the model performance, this research used the DCASE 2022 dataset for model evaluation, and the area under the characteristic acceptance curve (AUC) was estimated to be 5% higher than the DCASE 2022 baseline model. The model achieved 0.93 AUC for harmonic drive anomaly detection.

The spontaneous vertical alignment of liquid crystals (LCs) in gelator (12-hydroxystearic acid)-doped LC cells was studied. Gelator-induced alignment can be used in both positive and negative LC cells. The electro-optical characteristics of the gelator-doped negative LC cell were similar to those of an LC cell that contained a vertically aligned (VA) host. The rise time of the gelator-doped LC cell was two orders of magnitude shorter than that of the VA host LC cell. The experimental results indicate that the gelator-induced vertical alignment of LC molecules occurred not only on the surface of the indium tin oxide (ITO) but also on the homogeneous alignment layer. Various LC alignments (planar, hybrid, multistable hybrid, and vertical alignments) were achieved by modulating the doped gelator concentrations. The multistable characteristic of LCs doped with the gelator is also presented. The alignment by doping with a gelator reduces the manufacturing costs and provides a means of fabricating fast-responding, flexible LC displays using a low-temperature process.