Increased Readmission Risk and Healthcare Cost for Delirium Patients without Immediate Hospitalization in the Emergency Department

I Chun Ma,Kao Chin Chen,Wei Tseng Chen,Hsin Chun Tsai,Chien-Chou Su,Ru-Band Lu,Po See Chen,Wei Hung Chang,Yen Kuang Yang 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.4

Objective: Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit. Methods: Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson’s comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed. Results: Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities (CCI≥3) or older patients (≥65 years). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period. Conclusion: Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

Thermometry for Dirac Fermions in Graphene

Fan-Hung Liu,Chang-Shun Hsu,Shun-Tsung Lo,Chiashain Chuang,Lung-I Huang,Tak-Pong Woo,Chi-Te Liang,Y. Fukuyama,Y. Yang,R. E. Elmquist,Pengjie Wang,Xi Lin 한국물리학회 2015 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.66 No.1

We use both the zero-magnetic-field resistivity and the phase coherence time determined by weaklocalization as independent thermometers for Dirac fermions (DF) in multilayer graphene. In thehigh current (I) region, there exists a simple power law TDF / I0.5, where TDF is the effective Diracfermion temperature for epitaxial graphene on SiC. In contrast, TDF / I1 in exfoliated multilayergraphene. We discuss possible reasons for the different power laws observed in these multilayergraphene systems. Our experimental results on DF-phonon scattering may find applications ingraphene-based nanoelectronics.

Market in Medical Devices of Blockchain-Based IoT and Recent Cyberattacks

Shih-Shuan WANG(Shih-Shuan WANG),Hung-Pu (Hong-fu) CHOU(Hung-Pu (Hong-fu) CHOU),Aleksander IŻEMSKI(Aleksander IŻEMSKI ),Alexandru DINU(Alexandru DINU ),Eugen-Silviu VRĂJITORU(Eugen-Silviu VRĂJITORU ) 한국인공지능학회 2023 인공지능연구 (KJAI) Vol.11 No.2

The creativity of thesis is that the significance of cyber security challenges in blockchain. The variety of enterprises, including those in the medical market, are the targets of cyberattacks. Hospitals and clinics are only two examples of medical facilities that are easy targets for cybercriminals, along with IoT-based medical devices like pacemakers. Cyberattacks in the medical field not only put patients' lives in danger but also have the potential to expose private and sensitive information. Reviewing and looking at the present and historical flaws and vulnerabilities in the blockchain-based IoT and medical institutions' equipment is crucial as they are sensitive, relevant, and of a medical character. This study aims to investigate recent and current weaknesses in medical equipment, of blockchain-based IoT, and institutions. Medical security systems are becoming increasingly crucial in blockchain-based IoT medical devices and digital adoption more broadly. It is gaining importance as a standalone medical device. Currently the use of software in medical market is growing exponentially and many countries have already set guidelines for quality control. The achievements of the thesis are medical equipment of blockchain-based IoT no longer exist in a vacuum, thanks to technical improvements and the emergence of electronic health records (EHRs). Increased EHR use among providers, as well as the demand for integration and connection technologies to improve clinical workflow, patient care solutions, and overall hospital operations, will fuel significant growth in the blockchain-based IoT market for linked medical devices. The need for blockchain technology and IoT-based medical device to enhance their health IT infrastructure and design and development techniques will only get louder in the future. Blockchain technology will be essential in the future of cybersecurity, because blockchain technology can be significantly improved with the cybersecurity adoption of IoT devices, i.e., via remote monitoring, reducing waiting time for emergency rooms, track assets, etc. This paper sheds the light on the benefits of the blockchain-based IoT market.

Landau-level mixing, floating-up extended states, and scaling behavior in a GaAs-based two-dimensional electron system containing self-assembled InAs dots

Liu, Chieh-Wen,Liu, Chieh-I,Liang, C-T,Kim, Gil-Ho,Huang, C F,Hang, D R,Chang, Y H,Ritchie, D A Institute of Physics 2017 Semiconductor science and technology Vol.32 No.8

<P>Temperature-driven flow lines are studied in the conductivity plane in a GaAs-based two-dimensional electron system containing self-assembled InAs dots when Landau level filling factor <I>ν</I> = 2-4. In the insulator-quantum Hall (I-QH) transition resulting from the floating-up of the extended states, the flow diagram shows the critical behavior and we observed the expected semicircle in the strongest disorder case. By decreasing the effective disorder, we find that such flow lines can leave the I-QH regime and correspond to the plateau–plateau transition between <I>ν</I> = 4 and 2. The evolution of the conductivity curve at low magnetic fields demonstrates the importance of Landau-level mixing to the semicircle when the extended states float up.</P>

Metformin Inhibits Nuclear Receptor TR4–Mediated Hepatic Stearoyl-CoA Desaturase 1 Gene Expression With Altered Insulin Sensitivity

Kim, Eungseok,Liu, Ning-Chun,Yu, I-Chen,Lin, Hung-Yun,Lee, Yi-Fen,Sparks, Janet D.,Chen, Lu-Min,Chang, Chawnshang American Diabetes Association 2011 Diabetes Vol.60 No.5

<P><B>OBJECTIVE</B></P><P>TR4 is a nuclear receptor without clear pathophysiological roles. We investigated the roles of hepatic TR4 in the regulation of lipogenesis and insulin sensitivity in vivo and in vitro.</P><P><B>RESEARCH DESIGN AND METHODS</B></P><P>TR4 activity and phosphorylation assays were carried out using hepatocytes and various TR4 wild-type and mutant constructs. Liver tissues from TR4 knockout, C57BL/6, and <I>db/db</I> mice were examined to investigate TR4 target gene stearoyl-CoA desaturase (<I>SCD</I>) 1 regulation.</P><P><B>RESULTS</B></P><P>TR4 transactivation is inhibited via phosphorylation by metformin-induced AMP-activated protein kinase (AMPK) at the amino acid serine 351, which results in the suppression of SCD1 gene expression. Additional mechanistic dissection finds TR4-transactivated <I>SCD1</I> promoter activity via direct binding to the TR4-responsive element located at −243 to −255 on the promoter region. The pathophysiological consequences of the metformin→AMPK→TR4→SCD1 pathway are examined via TR4 knockout mice and primary hepatocytes with either knockdown or overexpression of TR4. The results show that the suppression of <I>SCD1</I> via loss of TR4 resulted in reduced fat mass and increased insulin sensitivity with increased β-oxidation and decreased lipogenic gene expression.</P><P><B>CONCLUSIONS</B></P><P>The pathway from metformin→AMPK→TR4→SCD1→insulin sensitivity suggests that TR4 may function as an important modulator to control lipid metabolism, which sheds light on the use of small molecules to modulate TR4 activity as a new alternative approach to battle the metabolic syndrome.</P>

Preliminary Development of Humanistic Care Indicators for Residents in Nursing Homes: A Delphi Technique

I Lee,Hsiu-Hung Wang 한국간호과학회 2014 Asian Nursing Research Vol.8 No.1

Purpose: The overwhelming majority of residents among nursing homes are the elderly in Taiwan. Previous studies have shown the dissatisfaction with care from the viewpoints of nursing home residents. For improving the care quality of nursing homes, the study aims to develop humanistic care indicators (HCIs). Methods: The Delphi technique was used to develop the HCIs through the consensus of 23 experts. Through three rounds of questionnaires, the expert panel reached a consensus. Results: Forty-four HCIs for nursing home were identified and grouped into eight elements: friendly environment, holistic care, empathy, individualization, autonomy, decision-making participation, appropriate use of tools, and serious assessment of customer opinion. Conclusion: This study compiled related literature and conducted a Delphi survey to transform humanistic care from an abstract concept into concrete indicators for evaluation. These findings could serve as a guideline for the care providers in nursing homes. Further studies are needed to test the practicability of HCIs and evaluate the outcomes of applying HCIs in nursing homes.

Virtual Reality Psychotherapy for Agoraphobia

Jang, Dong P.,Ku, Jeong H.,Shin, Min B.,Jo, Hang J.,Kim, In Y.,Kim, Sun I. 한양대학교 환경및산업의학연구소 2001 環境과 産業醫學 Vol.10 No.1

In Vivo, systematic desensitization has been effective in the treatment of agoraphobia.Currently, computer and display technology allows the creation of virtual reality enviornments. Virtual reality therapy based on this high technology has been used in the treatment of a subject who has suffered from agoraphobia, a disorder that is defined as being fearful of being in places or situations from which escape might be difficult or embarrassing. But these studies have been performed by using only subjetive tools for the validation of effectiveness of therapy. The goal of this study is to evaluate the effectiveness of VRT by using not only the subjective tools but also the objective ones such as blood pressure, respiration and hear rate. The virtual environment tunnel scene with traffic jam was created for this study, one of the most fearful situation to our patients. The subjects were seven agoraphobics with panic attacks, diagnosed using Diagnostic and Statistical Manual of Mental Disorders criteria. As a result, we failed to get valid objective data. More improvements of virtual reality therapy system for evaluating the effectiveness of VRT are indicated.

Real-time biofeedback device for gait rehabilitation of post-stroke patients

I-Hung Khoo,Panadda Marayong,Vennila Krishnan,Michael Balagtas,Omar Rojas,Katherine Leyba 대한의용생체공학회 2017 Biomedical Engineering Letters (BMEL) Vol.7 No.4

In this work, we develop a device, called ‘Walk-Even’, that can provide real-time feedback to correct gaitasymmetry commonly exhibited in post-stroke survivorsand persons with certain neurological disorders. The devicecomputes gait parameters, including gait time, swing time,and stance time of each leg, to detect gait asymmetry andprovide corresponding real-time biofeedback by means ofauditory and electrotactile stimulation to actively correctthe user’s gait. The system consists of customized forcesensor-embedded insoles adjustable to fit any shoe size,electrotactile and auditory feedback circuits, microcontroller,and wireless XBee transceivers. The device alsooffers data saving capability. To validate its accuracy andreliability, we compared the gait measurements from ourdevice with a commercial gait and balance assessmentdevice, Zeno Walkway. The results show good correlationand agreement in a validity study with six healthy subjectsand reliability study with seventeen healthy subjects. Inaddition, preliminary testing on six post-stroke patientsafter an 8-week training shows that the Walk-Even devicehelps to improve gait symmetry, foot pressure and forefootloading of the affected side. Thus, initial testing indicatesthat the device is accurate in measuring the gait parametersand effective in improving gait symmetry using real-timefeedback. The device is portable and low cost and has thepotential for use in a non-clinical setting for patients thatcan walk independently without assistance. A moreextensive testing with stroke patients is still ongoing.

A Study on the Indirect Evaluation Method of Difficult-to-Measure Nuclides in Nuclear Decommissioning Radioactive Waste

Hang-Rae Cho,Ji-Soo Yoon,i-Hoon Lee 한국방사성폐기물학회 2020 한국방사성폐기물학회 학술논문요약집 Vol.2020 No.12

Computerized numerical assignment for the nucleotide sequence of T24 human bladder carcinoma oncogene

( I Hung Pan,Shun Chin Hsu ) 한국유전학회 1989 Genes & Genomics Vol.11 No.4

A proper order number for the nucleotide sequence of an oncogene of T24 human bladder carcinoma was calculated by a computer. The total oncogene was able to be shown by a proper order number by the alphabetical arrangement of nucleotides with terminal change. Many nucleotide sequences, such as plasmids, exons and introns, and viral origin are known and then many proper order number for these sequences can be calculated. As the proper order numbers are the continuous integers starting from 1, new nucleotide sequences will be obtained from unknown order numbers. These points were discussed.