Search results for: Ying Jie Zheng
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 426

Search results for: Ying Jie Zheng

126 The Therapeutic Effects of Acupuncture on Oral Dryness and Antibody Modification in Sjogren Syndrome: A Meta-Analysis

Authors: Tzu-Hao Li, Yen-Ying Kung, Chang-Youh Tsai

Abstract:

Oral dryness is a common chief complaint among patients with Sjőgren syndrome (SS), which is a disorder currently known as autoantibodies production; however, to author’s best knowledge, there has been no satisfying pharmacy to relieve the associated symptoms. Hence the effectiveness of other non-pharmacological interventions such as acupuncture should be accessed. We conducted a meta-analysis of randomized clinical trials (RCTs) which evaluated the effectiveness of xerostomia in SS. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chongqing Weipu Database (CQVIP), China Academic Journals Full-text Database, AiritiLibrary, Chinese Electronic Periodicals Service (CEPS), China National Knowledge Infrastructure (CNKI) Database were searches through May 12, 2018 to select studies. Data for evaluation of subjective and objective xerostomia was extracted and was assessed with random-effects meta-analysis. After searching, a total of 541 references were yielded and five RCTs were included, covering 340 patients dry mouth resulted from SS, among whom 169 patients received acupuncture and 171 patients were control group. Acupuncture group was associated with higher subjective response rate (odds ratio 3.036, 95% confidence interval [CI] 1.828 – 5.042, P < 0.001) and increased salivary flow rate (weighted mean difference [WMD] 3.066, 95% CI 2.969 – 3.164, P < 0.001), as an objective marker. In addition, two studies examined IgG levels, which were lower in the acupuncture group (WMD -166.857, 95% CI -233.138 - -100.576, P < 0.001). Therefore, in the present meta-analysis, acupuncture improves both subjective and objective markers of dry mouth with autoantibodies reduction in patients with SS and is considered as an option of non-pharmacological treatment for SS.

Keywords: acupuncture, meta-analysis, Sjogren syndrome, xerostomia

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125 Examining the Predicting Effect of Mindfulness on Psychological Well-Being among Undergraduate Students

Authors: Piyanee Klainin-Yobas, Debbie Ramirez, Zenaida Fernandez, Jenneth Sarmiento, Wareerat Thanoi, Jeanette Ignacio, Ying Lau

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In many countries, university students experience various stressors that may negatively affect their psychological well-being (PWB). Hence, they are at risk for physical and mental problems. This research aimed to examine the predicting effects of mindfulness, self-efficacy, and social support on psychological well-being among undergraduate students. A non-experimental research was conducted at a university in the Philippines. All students enrolled in undergraduate programs were eligible for this study unless they had chronic medical or mental health problems. Power analysis was used to calculate an adequate sample size and a convenience sampling of 630 was recruited. Data were collected through online self-reported questionnaires from year 2013 to 2015. All self-reported scales used in this study had sound psychometric properties. Descriptive statistics, correlational analyses, and structural equation modeling were performed to analyze the research data. Results showed that the participants were mostly Filipino, female, Christian, and in Schools of Nursing. Mindfulness, self-efficacy, support from family, support from friends, and support from significant others were significant predictors of psychological well-being. Mindfulness was the strongest predictor of positive psychological well-being whereas self-efficacy was the strongest predictor of negative psychological well-being. In conclusion, findings from this study add knowledge to the existing literature regarding the predictors of psychological well-being. Psychosocial interventions, with the focus on strengthening mindfulness and self-efficacy, could be delivered to undergraduate students to help them enhance psychological well-being. More studies can be undertaken to test the interventions and multi-centered research can be conducted to enhance generalizability of research findings.

Keywords: mindfulness, self-efficacy, social support, psychological wellbeing

Procedia PDF Downloads 401
124 Development of the New York Misophonia Scale: Implications for Diagnostic Criteria

Authors: Usha Barahmand, Maria Stalias, Abdul Haq, Esther Rotlevi, Ying Xiang

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Misophonia is a condition in which specific repetitive oral, nasal, or other sounds and movements made by humans trigger impulsive aversive reactions of irritation or disgust that instantly become anger. A few measures exist for the assessment of misophonia, but each has some limitations, and evidence for a formal diagnosis is still lacking. The objective of this study was to develop a reliable and valid measure of misophonia for use in the general population. Adopting a purely descriptive approach, this study focused on developing a self-report measure using all triggers and reactions identified in previous studies on misophonia. A measure with two subscales, one assessing the aversive quality of various triggers and the other assessing reactions of individuals, was developed. Data were gathered from a large sample of both men and women ranging in age from 18 to 65 years. Exploratory factor analysis revealed three main triggers: oral/nasal sounds, hand and leg movements, and environmental sounds. Two clusters of reactions also emerged: nonangry attempts to avoid the impact of the aversive stimuli and angry attempts to stop the aversive stimuli. The examination of the psychometric properties of the scale revealed its internal consistency and test-retest reliability to be excellent. The scale was also found to have very good concurrent and convergent validity. Significant annoyance and disgust in response to the triggers were reported by 12% of the sample, although for some specific triggers, rates as high as 31% were also reported. These findings have implications for the delineation of the criteria for identifying misophonia as a clinical condition.

Keywords: adults, factor analysis, misophonia, psychometric properties, scale

Procedia PDF Downloads 174
123 Combinational Therapeutic Targeting of BRD4 and CDK7 Synergistically Induces Anticancer Effects in Hepatocellular Carcinoma

Authors: Xinxiu Li, Chuqian Zheng, Yanyan Qian, Hong Fan

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Objectives: In hepatocellular carcinoma (HCC), oncogenes are continuously and robustly transcribed due to aberrant expression of essential components of the trans-acting super-enhancers (SE) complex. Preclinical and clinical trials are now being conducted on small-molecule inhibitors that target core-transcriptional components, including as transcriptional bromodomain protein 4 (BRD4) and cyclin-dependent kinase 7 (CDK7), in a number of malignant tumors. This study aims to explore whether co-overexpression of BRD4 and CDK7 is a potential marker of worse prognosis and a combined therapeutic target in HCC. Methods: The expression pattern of BRD4 and CDK7 and their correlation with prognosis in HCC were analyzed by RNA sequencing data and survival data of HCC patients from TCGA and GEO datasets. The protein levels of BRD4 and CDK7 were determined by immunohistochemistry (IHC), and survival data of patients were analyzed using the Kaplan-Meier method. The mRNA expression levels of genes in HCC cell lines were evaluated by quantitative PCR (q-PCR). CCK-8 and colony formation assays were conducted to assess cell proliferation of HCC upon treatment with BRD4 inhibitor JQ1 or/and CDK7 inhibitor THZ1. Results: It was shown that BRD4 and CDK7 were often overexpressed in HCCs and were associated with poor prognosis of HCC by analyzing the TCGA and GEO datasets. BRD4 or CDK7 overexpression was related to a lower survival rate. It's interesting to note that co-overexpression of CDK7 and BRD4 was a worse prognostic factor in HCC. Treatment with JQ1 or THZ1 alone had an inhibitory effect on cell proliferation; however, when JQ1 and THZ1 were combined, there was a more notable suppression of cell growth. At the same time, the combined use of JQ1 and THZ1 synergistically suppresses the expression of HCC driver genes. Conclusion: Our research revealed that BRD4 and CDK7 coupled can be a useful biomarker in HCC prognosis and the combination of JQ1 and THZ1 can be a promising therapeutic therapy against HCC.

Keywords: BRD4, CDK7, cell proliferation, combined inhibition

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122 Biodistribution of Fluorescence-Labelled Epidermal Growth Factor Protein from Slow Release Nanozolid Depots in Mouse

Authors: Stefan Gruden, Charlott Brunmark, Bo Holmqvist, Erwin D. Brenndorfer, Martin Johansson, Jian Liu, Ying Zhao, Niklas Axen, Moustapha Hassan

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Aim: The study was designed to evaluate the ability of the calcium sulfate-based NanoZolid® drug delivery technology to locally release the epidermal growth factor (EGF) protein while maintaining its biological activity. Methods: NanoZolid-formulated EGF protein labelled with a near-infrared dye (EGF-NIR) depots or EGF-NIR dissolved in PBS were injected subcutaneously into mice bearing EGF receptor (EGFR) positive human A549 lung cancer tumors inoculated subcutaneously. The release and biodistribution of the EGF-NIR were investigated in vivo longitudinally up to 96 hours post-administration, utilizing whole-body fluorescence imaging. In order to confirm the in vivo findings, histological analysis of tumor cryosections was performed to investigate EGF-NIR fluorescent signal and EGFR expression level by immunofluorescence labelling. Results: The in vivo fluorescence imaging showed a controlled release profile of the EGF-NIR loaded in the NanoZolid depots compared to free EGF-NIR. Histological analysis of the tumors further demonstrated a prevailing distribution of EGF-NIR in regions with high levels of EGFR expression. Conclusion: Calcium sulfate based depots can be used to formulate EGF while maintaining its biological activity, e.g., receptor binding capability. This may have good clinical potential for local delivery of biomolecules to enhance treatment efficacy and minimize systemic adverse effects.

Keywords: bioresorbable, calcium sulfate, controlled release, NanoZolid

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121 Structural Health Monitoring of the 9-Story Torre Central Building Using Recorded Data and Wave Method

Authors: Tzong-Ying Hao, Mohammad T. Rahmani

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The Torre Central building is a 9-story shear wall structure located in Santiago, Chile, and has been instrumented since 2009. Events of different intensity (ambient vibrations, weak and strong earthquake motions) have been recorded, and thus the building can serve as a full-scale benchmark to evaluate the structural health monitoring method developed. The first part of this article presents an analysis of inter-story drifts, and of changes in the first system frequencies (estimated from the relative displacement response of the 8th-floor with respect to the basement from recorded data) as baseline indicators of the occurrence of damage. During 2010 Chile earthquake the system frequencies were detected decreasing approximately 24% in the EW and 27% in NS motions. Near the end of shaking, an increase of about 17% in the EW motion was detected. The structural health monitoring (SHM) method based on changes in wave traveling time (wave method) within a layered shear beam model of structure is presented in the second part of this article. If structural damage occurs the velocity of wave propagated through the structure changes. The wave method measures the velocities of shear wave propagation from the impulse responses generated by recorded data at various locations inside the building. Our analysis and results show that the detected changes in wave velocities are consistent with the observed damages. On this basis, the wave method is proven for actual implementation in structural health monitoring systems.

Keywords: Chile earthquake, damage detection, earthquake response, impulse response, layered shear beam, structural health monitoring, Torre Central building, wave method, wave travel time

Procedia PDF Downloads 348
120 Main Control Factors of Fluid Loss in Drilling and Completion in Shunbei Oilfield by Unmanned Intervention Algorithm

Authors: Peng Zhang, Lihui Zheng, Xiangchun Wang, Xiaopan Kou

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Quantitative research on the main control factors of lost circulation has few considerations and single data source. Using Unmanned Intervention Algorithm to find the main control factors of lost circulation adopts all measurable parameters. The degree of lost circulation is characterized by the loss rate as the objective function. Geological, engineering and fluid data are used as layers, and 27 factors such as wellhead coordinates and WOB are used as dimensions. Data classification is implemented to determine function independent variables. The mathematical equation of loss rate and 27 influencing factors is established by multiple regression method, and the undetermined coefficient method is used to solve the undetermined coefficient of the equation. Only three factors in t-test are greater than the test value 40, and the F-test value is 96.557%, indicating that the correlation of the model is good. The funnel viscosity, final shear force and drilling time were selected as the main control factors by elimination method, contribution rate method and functional method. The calculated values of the two wells used for verification differ from the actual values by -3.036m3/h and -2.374m3/h, with errors of 7.21% and 6.35%. The influence of engineering factors on the loss rate is greater than that of funnel viscosity and final shear force, and the influence of the three factors is less than that of geological factors. Quantitatively calculate the best combination of funnel viscosity, final shear force and drilling time. The minimum loss rate of lost circulation wells in Shunbei area is 10m3/h. It can be seen that man-made main control factors can only slow down the leakage, but cannot fundamentally eliminate it. This is more in line with the characteristics of karst caves and fractures in Shunbei fault solution oil and gas reservoir.

Keywords: drilling and completion, drilling fluid, lost circulation, loss rate, main controlling factors, unmanned intervention algorithm

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119 Foreign Artificial Intelligence Investments and National Security Exceptions in International Investment Law

Authors: Ying Zhu

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Recent years have witnessed a boom of foreign investments in the field of artificial intelligence (AI). Foreign investments provide critical capital for AI development but also trigger national security concerns of host states. A notable example is an increasing number of cases in which the Committee on Foreign Investment in the United States (CFIUS) has denied Chinese acquisitions of US technology companies on national security grounds. On July 19, 2018, the Congress has reached a deal on the final draft of a new provision to strengthen CFIUS’s authority to review overseas transactions involving sensitive US technology. The question is: how to reconcile the emerging tension between, on the one hand, foreign AI investors’ expectations of a predictable investment environment, and on the other hand, host states’ regulatory power on national security? This paper provides a methodology to reconcile this tension under international investment law. Based on an examination, the national security exception clauses in international investment treaties and the application of national security justification in investor-state arbitration jurisprudence, the paper argues that a traditional interpretation of the national security exception, based on the necessity concept in customary international law, fails to take into account new risks faced by countries, including security concerns over strategic industries such as AI. To overcome this shortage, the paper proposes to incorporate an integrated national security clause in international investment treaties, which includes a two-tier test: a ‘self-judging’ test in the pre-establishment period and a ‘proportionality’ test in the post-establishment period. At the end, the paper drafts a model national security clause for future treaty-drafting practice.

Keywords: foreign investment, artificial intelligence, international investment law, national security exception

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118 Water-Controlled Fracturing with Fuzzy-Ball Fluid in Tight Gas Reservoirs of Deep Coal Measures in Sulige

Authors: Xiangchun Wang, Lihui Zheng, Maozong Gan, Peng Zhang, Tong Wu, An Chang

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The deep coal measure tight gas reservoir in Sulige is usually reformed by fracturing, because the reservoir thickness is small, the water layers can be easily communicated during fracturing, which will lead to water production of gas wells and lower production of gas wells. Therefore, it is necessary to control water during fracturing in deep coal measure tight gas reservoir. Using fuzzy-ball fluid to control water fracturing can not only increase the output but also reduce the water output. The fuzzy-ball fluid was prepared indoors to carry out evaluation experiments. The fuzzy ball fluid was mixed in equal volume with the pre-fluid and formation water to test its compatibility. The core displacement device was used to test the gas and water breaking through the matrix and fractured cores blocked by fuzzy-ball fluid. The breakthrough pressure of the plunger tests its water blocking performance. The experimental results show that there is no precipitation after the fuzzy-ball fluid is mixed with the pad fluid and the formation water, respectively. The breakthrough pressure gradients of gas and water after the fuzzy-ball fluid plugged the cracks were 0.02MPa/cm and 0.04MPa/cm, respectively, and the breakthrough pressure gradients of gas and water after the matrix was plugged were 0.03MPa/cm and 0.2MPa/cm, respectively, which meet the requirements of field operation. Two wells A and B in the Sulige Gas Field were used on site to implement water control fracturing. After the pre-fluid was injected into the two wells, 50m3 of fuzzy-ball fluid was pumped to plug the water. The construction went smoothly. After water control and fracturing, the average daily output in 161 days was increased by 13.71% and 6.99% compared with that of adjacent wells in the same layer. The adjacent wells were bubbled for 3 times and 63 times respectively, while there was no effusion in A and B construction wells. The results show that fuzzy-ball fluid is a water plugging material suitable for water control fracturing in tight gas wells, and its water control mechanism can also provide a new idea for the development of water control fracturing materials.

Keywords: coal seam, deep layer, fracking, fuzzy-ball fluid, reservoir reconstruction

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117 Characteristics of the Particle Size Distribution and Exposure Concentrations of Nanoparticles Generated from the Laser Metal Deposition Process

Authors: Yu-Hsuan Liu, Ying-Fang Wang

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The objectives of the present study are to characterize nanoparticles generated from the laser metal deposition (LMD) process and to estimate particle concentrations deposited in the head (H), that the tracheobronchial (TB) and alveolar (A) regions, respectively. The studied LMD chamber (3.6m × 3.8m × 2.9m) is installed with a robot laser metal deposition machine. Direct-reading instrument of a scanning mobility particle sizer (SMPS, Model 3082, TSI Inc., St. Paul, MN, USA) was used to conduct static sampling inside the chamber for nanoparticle number concentration and particle size distribution measurements. The SMPS obtained particle number concentration at every 3 minutes, the diameter of the SMPS ranged from 11~372 nm when the aerosol and sheath flow rates were set at 0.6 and 6 L / min, respectively. The resultant size distributions were used to predict depositions of nanoparticles at the H, TB, and A regions of the respiratory tract using the UK National Radiological Protection Board’s (NRPB’s) LUDEP Software. Result that the number concentrations of nanoparticles in indoor background and LMD chamber were 4.8×10³ and 4.3×10⁵ # / cm³, respectively. However, the nanoparticles emitted from the LMD process was in the form of the uni-modal with number median diameter (NMD) and geometric standard deviation (GSD) as 142nm and 1.86, respectively. The fractions of the nanoparticles deposited on the alveolar region (A: 69.8%) were higher than the other two regions of the head region (H: 10.9%), tracheobronchial region (TB: 19.3%). This study conducted static sampling to measure the nanoparticles in the LMD process, and the results show that the fraction of particles deposited on the A region was higher than the other two regions. Therefore, applying the characteristics of nanoparticles emitted from LMD process could be provided valuable scientific-based evidence for exposure assessments in the future.

Keywords: exposure assessment, laser metal deposition process, nanoparticle, respiratory region

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116 VR in the Middle School Classroom-An Experimental Study on Spatial Relations and Immersive Virtual Reality

Authors: Danielle Schneider, Ying Xie

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Middle school science, technology, engineering, and math (STEM) teachers experience an exceptional challenge in the expectation to incorporate curricula that builds strong spatial reasoning skills on rudimentary geometry concepts. Because spatial ability is so closely tied to STEM students’ success, researchers are tasked to determine effective instructional practices that create an authentic learning environment within the immersive virtual reality learning environment (IVRLE). This study looked to investigate the effect of the IVRLE on middle school STEM students’ spatial reasoning skills as a methodology to benefit the STEM middle school students’ spatial reasoning skills. This experimental study was comprised of thirty 7th-grade STEM students divided into a treatment group that was engaged in an immersive VR platform where they engaged in building an object in the virtual realm by applying spatial processing and visualizing its dimensions and a control group that built the identical object using a desktop computer-based, computer-aided design (CAD) program. Before and after the students participated in the respective “3D modeling” environment, their spatial reasoning abilities were assessed using the Middle Grades Mathematics Project Spatial Visualization Test (MGMP-SVT). Additionally, both groups created a physical 3D model as a secondary measure to measure the effectiveness of the IVRLE. The results of a one-way ANOVA in this study identified a negative effect on those in the IVRLE. These findings suggest that with middle school students, virtual reality (VR) proved an inadequate tool to benefit spatial relation skills as compared to desktop-based CAD.

Keywords: virtual reality, spatial reasoning, CAD, middle school STEM

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115 Exploring Women’S Leadership in China’S Sport National Governing Bodies

Authors: Han Zheng

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This research is being conducted to explore women's leadership in China's National Governing Bodies ( in order to identify the barriers to women's leadership and provide feasible solutions. Extensive research has been undertaken internationally, which has identified and acknowledged the underrepresentation of women in leadership positions across multiple industries and global contexts. According to these studies, leadership specifically within the sports industry was both historically and is still currently male-dominated. Within China, the underrepresentation of women in leadership positions is also evident, which women only occupy 16% of the leadership in business enterprises and 5.6% in scientific and technological research institutions, yet there is limited research that has looked to examine why this is the case regarding women's leadership in China, especially within in sports industry. Therefore, this research gap drives the purpose, which aims to explore the current situation of women's leadership in sports National Governing Bodies (NGBs) in China. By using both questionnaires and interviews, data from NGBs in China will be collected. This research will achieve the following three goals: 1, determine the representation level of women's leadership in the target organizations. 2, identify barriers to women's leadership and their causes. 3, provide feasible solutions. Based on the multi-level framework, this study develops a "barrier matrix" framework: according to the analysis of the previous literature, it concludes that there are eight main barriers that hinder the development of women's leadership. The research combines qualitative and quantitative analysis, using questionnaires and interviews. Key findings according to the analysis of the primary data collected: 1. The average proportion of female occupational leadership in China's sports NGBs is less than 17.5%. 2. 50.8% of China's sports NGBs have no equal employment opportunity policy. 3. According to the preliminary qualitative analysis of the interviews, it is found that the core barriers affecting women's leadership development are mainly in the following areas: male-dominated culture and gender stereotyping (macro-level), biased organizational policies and procedures (meso-level), work-family conflicts and self-limiting behaviors (micro-level).

Keywords: women leadership, sport management, gender equality, sport leadership, sport NGBs

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114 Characterizing Nanoparticles Generated from the Different Working Type and the Stack Flue during 3D Printing Process

Authors: Kai-Jui Kou, Tzu-Ling Shen, Ying-Fang Wang

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The objectives of the present study are to characterize nanoparticles generated from the different working type in 3D printing room and the stack flue during 3D printing process. The studied laboratory (10.5 m× 7.2 m × 3.2 m) with a ventilation rate of 500 m³/H is installed a 3D metal printing machine. Direct-reading instrument of a scanning mobility particle sizer (SMPS, Model 3082, TSI Inc., St. Paul, MN, USA) was used to conduct static sampling for nanoparticle number concentration and particle size distribution measurements. The SMPS obtained particle number concentration at every 3 minutes, the diameter of the SMPS ranged from 11~372 nm when the aerosol and sheath flow rates were set at 0.6 and 6 L/min, respectively. The concentrations of background, printing process, clearing operation, and screening operation were performed in the laboratory. On the other hand, we also conducted nanoparticle measurement on the 3D printing machine's stack flue to understand its emission characteristics. Results show that the nanoparticles emitted from the different operation process were the same distribution in the form of the uni-modal with number median diameter (NMD) as approximately 28.3 nm to 29.6 nm. The number concentrations of nanoparticles were 2.55×10³ count/cm³ in laboratory background, 2.19×10³ count/cm³ during printing process, 2.29×10³ count/cm³ during clearing process, 3.05×10³ count/cm³ during screening process, 2.69×10³ count/cm³ in laboratory background after printing process, and 6.75×10³ outside laboratory, respectively. We found that there are no emission nanoparticles during the printing process. However, the number concentration of stack flue nanoparticles in the ongoing print is 1.13×10⁶ count/cm³, and that of the non-printing is 1.63×10⁴ count/cm³, with a NMD of 458 nm and 29.4 nm, respectively. It can be confirmed that the measured particle size belongs to easily penetrate the filter in theory during the printing process, even though the 3D printer has a high-efficiency filtration device. Therefore, it is recommended that the stack flue of the 3D printer would be equipped with an appropriate dust collection device to prevent the operators from exposing these hazardous particles.

Keywords: nanoparticle, particle emission, 3D printing, number concentration

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113 New Roles of Telomerase and Telomere-Associated Proteins in the Regulation of Telomere Length

Authors: Qin Yang, Fan Zhang, Juan Du, Chongkui Sun, Krishna Kota, Yun-Ling Zheng

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Telomeres are specialized structures at chromosome ends consisting of tandem repetitive DNA sequences [(TTAGGG)n in humans] and associated proteins, which are necessary for telomere function. Telomere lengths are tightly regulated within a narrow range in normal human somatic cells, the basis of cellular senescence and aging. Previous studies have extensively focused on how short telomeres are extended and have demonstrated that telomerase plays a central role in telomere maintenance through elongating the short telomeres. However, the molecular mechanisms of regulating excessively long telomeres are unknown. Here, we found that telomerase enzymatic component hTERT plays a dual role in the regulation of telomeres length. We analyzed single telomere alterations at each chromosomal end led to the discoveries that hTERT shortens excessively long telomeres and elongates short telomeres simultaneously, thus maintaining the optimal telomere length at each chromosomal end for an efficient protection. The hTERT-mediated telomere shortening removes large segments of telomere DNA rapidly without inducing telomere dysfunction foci or affecting cell proliferation, thus it is mechanistically distinct from rapid telomere deletion. We found that expression of hTERT generates telomeric circular DNA, suggesting that telomere homologous recombination may be involved in this telomere shortening process. Moreover, the hTERT-mediated telomere shortening is required its enzymatic activity, but telomerase RNA component hTR is not involved in it. Furthermore, shelterin protein TPP1 interacts with hTERT and recruits it on telomeres to mediate telomere shortening. In addition, telomere-associated proteins, DKC1 and TCAB1 also play roles in this process. This novel hTERT-mediated telomere shortening mechanism not only exists in cancer cells, but also in primary human cells. Thus, the hTERT-mediated telomere shortening is expected to shift the paradigm on current molecular models of telomere length maintenance, with wide-reaching consequences in cancer and aging fields.

Keywords: aging, hTERT, telomerase, telomeres, human cells

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112 Multi-Impairment Compensation Based Deep Neural Networks for 16-QAM Coherent Optical Orthogonal Frequency Division Multiplexing System

Authors: Ying Han, Yuanxiang Chen, Yongtao Huang, Jia Fu, Kaile Li, Shangjing Lin, Jianguo Yu

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In long-haul and high-speed optical transmission system, the orthogonal frequency division multiplexing (OFDM) signal suffers various linear and non-linear impairments. In recent years, researchers have proposed compensation schemes for specific impairment, and the effects are remarkable. However, different impairment compensation algorithms have caused an increase in transmission delay. With the widespread application of deep neural networks (DNN) in communication, multi-impairment compensation based on DNN will be a promising scheme. In this paper, we propose and apply DNN to compensate multi-impairment of 16-QAM coherent optical OFDM signal, thereby improving the performance of the transmission system. The trained DNN models are applied in the offline digital signal processing (DSP) module of the transmission system. The models can optimize the constellation mapping signals at the transmitter and compensate multi-impairment of the OFDM decoded signal at the receiver. Furthermore, the models reduce the peak to average power ratio (PAPR) of the transmitted OFDM signal and the bit error rate (BER) of the received signal. We verify the effectiveness of the proposed scheme for 16-QAM Coherent Optical OFDM signal and demonstrate and analyze transmission performance in different transmission scenarios. The experimental results show that the PAPR and BER of the transmission system are significantly reduced after using the trained DNN. It shows that the DNN with specific loss function and network structure can optimize the transmitted signal and learn the channel feature and compensate for multi-impairment in fiber transmission effectively.

Keywords: coherent optical OFDM, deep neural network, multi-impairment compensation, optical transmission

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111 Analysis of the Impact of Suez Canal on the Robustness of Global Shipping Networks

Authors: Zimu Li, Zheng Wan

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The Suez Canal plays an important role in global shipping networks and is one of the most frequently used waterways in the world. The 2021 canal obstruction by ship Ever Given in March 2021, however, completed blocked the Suez Canal for a week and caused significant disruption to world trade. Therefore, it is very important to quantitatively analyze the impact of the accident on the robustness of the global shipping network. However, the current research on maritime transportation networks is usually limited to local or small-scale networks in a certain region. Based on the complex network theory, this study establishes a global shipping complex network covering 2713 nodes and 137830 edges by using the real trajectory data of the global marine transport ship automatic identification system in 2018. At the same time, two attack modes, deliberate (Suez Canal Blocking) and random, are defined to calculate the changes in network node degree, eccentricity, clustering coefficient, network density, network isolated nodes, betweenness centrality, and closeness centrality under the two attack modes, and quantitatively analyze the actual impact of Suez Canal Blocking on the robustness of global shipping network. The results of the network robustness analysis show that Suez Canal blocking was more destructive to the shipping network than random attacks of the same scale. The network connectivity and accessibility decreased significantly, and the decline decreased with the distance between the port and the canal, showing the phenomenon of distance attenuation. This study further analyzes the impact of the blocking of the Suez Canal on Chinese ports and finds that the blocking of the Suez Canal significantly interferes withChina's shipping network and seriously affects China's normal trade activities. Finally, the impact of the global supply chain is analyzed, and it is found that blocking the canal will seriously damage the normal operation of the global supply chain.

Keywords: global shipping networks, ship AIS trajectory data, main channel, complex network, eigenvalue change

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110 Developing Serious Games to Increase Children’s Knowledge of Diet and Nutrition

Authors: N. Liu, N. Tuah, D. Ying

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This research aims to identify and test whether serious games can help children learn and pick up healthy eating habits. The practical component takes the form of digitalizing an already existing educational board game called “All you can eat” (AYCE), designed with the nutritious subject matter in mind. This time with the added features of online playability, which will widen its availability and accessibility to reach more players compared to the physical iteration. The game will be deployed alongside the conducting of theoretical research, which also involves teachers leading children to play said digital version. The research methodology utilizes two experiments, such as handing out surveys to gather feedback from both the partners and students. The research was carried out in several countries, namely Brunei, Malaysia, and Taiwan. The results are to be used for validating the concept of “serious games,” particularly when tied to the health aspect of the players, which in this case were children. As for the research outcomes, they can be applied to a variety of serious games that are related to health topics more broadly and not simply limited to healthy eating habits alone, adopting a balanced combination of practical and theoretical considerations. The study will also help other researchers in the correlated fields of serious game development and pediatrics to better comprehend the needs of children. On the theoretical side, these findings can enable further technological advancements to be made possible, a case in point being more serious games, to provide the appropriate social support precisely on the matter of health-related issues. Not just individuals but rather communities could benefit from improved health and well-being as a result of the project, which, when done right, will potentially improve their quality of life and have fun while doing it. AYCE will be demonstrated to support a wide range of health issues as a result of this research case.

Keywords: culture heritage, digital games, digitalization, traditional religious culture

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109 Nonlinear Multivariable Analysis of CO2 Emissions in China

Authors: Hsiao-Tien Pao, Yi-Ying Li, Hsin-Chia Fu

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This paper addressed the impacts of energy consumption, economic growth, financial development, and population size on environmental degradation using grey relational analysis (GRA) for China, where foreign direct investment (FDI) inflows is the proxy variable for financial development. The more recent historical data during the period 2004–2011 are used, because the use of very old data for data analysis may not be suitable for rapidly developing countries. The results of the GRA indicate that the linkage effects of energy consumption–emissions and GDP–emissions are ranked first and second, respectively. These reveal that energy consumption and economic growth are strongly correlated with emissions. Higher economic growth requires more energy consumption and increasing environmental pollution. Likewise, more efficient energy use needs a higher level of economic development. Therefore, policies to improve energy efficiency and create a low-carbon economy can reduce emissions without hurting economic growth. The finding of FDI–emissions linkage is ranked third. This indicates that China do not apply weak environmental regulations to attract inward FDI. Furthermore, China’s government in attracting inward FDI should strengthen environmental policy. The finding of population–emissions linkage effect is ranked fourth, implying that population size does not directly affect CO2 emissions, even though China has the world’s largest population, and Chinese people are very economical use of energy-related products. Overall, the energy conservation, improving efficiency, managing demand, and financial development, which aim at curtailing waste of energy, reducing both energy consumption and emissions, and without loss of the country’s competitiveness, can be adopted for developing economies. The GRA is one of the best way to use a lower data to build a dynamic analysis model.

Keywords: China, CO₂ emissions, foreign direct investment, grey relational analysis

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108 Objective-Based System Dynamics Modeling to Forecast the Number of Health Professionals in Pudong New Area of Shanghai

Authors: Jie Ji, Jing Xu, Yuehong Zhuang, Xiangqing Kang, Ying Qian, Ping Zhou, Di Xue

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Background: In 2014, there were 28,341 health professionals in Pudong new area of Shanghai and the number per 1000 population was 5.199, 55.55% higher than that in 2006. But it was always less than the average number of health professionals per 1000 population in Shanghai from 2006 to 2014. Therefore, allocation planning for the health professionals in Pudong new area has become a high priority task in order to meet the future demands of health care. In this study, we constructed an objective-based system dynamics model to forecast the number of health professionals in Pudong new area of Shanghai in 2020. Methods: We collected the data from health statistics reports and previous survey of human resources in Pudong new area of Shanghai. Nine experts, who were from health administrative departments, public hospitals and community health service centers, were consulted to estimate the current and future status of nine variables used in the system dynamics model. Based on the objective of the number of health professionals per 1000 population (8.0) in Shanghai for 2020, the system dynamics model for health professionals in Pudong new area of Shanghai was constructed to forecast the number of health professionals needed in Pudong new area in 2020. Results: The system dynamics model for health professionals in Pudong new area of Shanghai was constructed. The model forecasted that there will be 37,330 health professionals (6.433 per 1000 population) in 2020. If the success rate of health professional recruitment changed from 20% to 70%, the number of health professionals per 1000 population would be changed from 5.269 to 6.919. If this rate changed from 20% to 70% and the success rate of building new beds changed from 5% to 30% at the same time, the number of health professionals per 1000 population would be changed from 5.269 to 6.923. Conclusions: The system dynamics model could be used to simulate and forecast the health professionals. But, if there were no significant changes in health policies and management system, the number of health professionals per 1000 population would not reach the objectives in Pudong new area in 2020.

Keywords: allocation planning, forecast, health professional, system dynamics

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107 Research on Coordinated Development Mechanism of Semi-urbanized Areas under the Background of Guangdong-Hong Kong-Macao Greater Bay Area: A Case Study of 'Baiyun-Nanhai' Pilot Area

Authors: Cheng Fang Wang, Fu Li Gao, Jian Ying Zhou

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The '1+4' integration pilot area in the border area of Guangzhou-Foshan is an important platform for Guangzhou-Foshan strategic cooperation, as well as a typical semi-urbanized area with mixed urban and rural landscapes, of which the Baiyun-Nanhai pilot area is one of them. Baiyun district and Nanhai district are only separated by the Pearl River. In this paper, the three dimensions, which include production, living, and ecology, have been put forward, as well as cross-regional multi-agency negotiation mechanism has been discussed. Taking 'Baiyun-Nanhai' pilot area as a case study, POI (Point of Interest) data to analyze the distribution characteristics of 'production-living-ecological space' from the spatial dimension has been introduced in this paper, as well as the land-use change of 'production-living-ecological space' in western region of Baiyun district in 2007 and 2017 from the temporal dimension has been analyzed. Based on the above analysis, the integration development strategy and rethinking of cross-administrative region based on 'production-living-ecological integration' mechanism have been discussed later. It will explore the mechanism of industrial collaborative innovation, infrastructure co-construction, and ecological co-protection in semi-urban areas across borders. And it is expected to provide a reference for the integrated construction of the Guangdong-Hong Kong-Macao Greater Bay Area.

Keywords: semi-urbanization, production-living-ecological integration, multi-agency negotiation, Guangzhou-Foshan integration, synergetic development

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106 Mannosidase Alpha Class 1B Member 1 Targets F Severe Acute Respiratory Syndrome Coronavirus 2 Spike Protein and Ebola Virus Glycoprotein to Endoplasmic Reticulum-To-Lysosome-Associated Degradation by Micro-Endoplasmic Reticulum-Phagy

Authors: Yong-Hui Zheng

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Viruses hijack host machineries to propagate and spread, which disrupts cellular homeostasis and activates various counteractive mechanisms. Infection of enveloped viruses is dependent on their fusion proteins, which bind to viral receptors to allow virus entry into cells. Fusion proteins are glycoproteins and expressed in the endoplasmic reticulum (ER) by hijacking the secretory pathway. Previously, we reported that Zaire ebolavirus (EBOV)-glycoprotein (GP) expression induces ER stress, and EBOV-GP is targeted by the calnexin cycle to macro-ER-phagy for degradation. We now report that expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/SARS2)-spike (S) protein also causes ER stress, and its expression is strongly downregulated by mannosidase alpha class 1B member 1 (MAN1B1), a class I α-mannosidase from the ER. MAN1B1 co-localizes with SARS2-S in the ER, and its downregulation of SARS2-S is blocked by inhibitors targeting lysosomes and autophagy, but not proteasomes, indicating SARS2-S degradation by autolysosomes. Notably, the SARS2-S degradation does not require the core autophagy machinery including ATG3, ATG5, ATG7, and phosphatidylinositol 3-kinase catalytic subunit type 3 (PI3KC3)/vacuolar protein sorting 34 (VPS34), and instead, it requires Beclin 1 (BECN1), a core component in the PI3KC3 complex. In addition, MAN1B1 does not trigger SARS2-S polyubiquitination, and consistently, the SARS2-S degradation does not require the autophagy receptor sequestosome 1 (SQSTM1)/p62. MAN1B1 also downregulates EBOV-GP similarly, but this degradation does not require BECN1. Collectively, we conclude that MAN1B1 downregulates viral fusions by micro-ER-phagy, and importantly, we have identified BECN1-dependent and BECN1-independent mechanisms for micro-ER-phagy.

Keywords: Micro-ER-phagy, reticulophagy, fusion proteins, ER stress

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105 Map UI Design of IoT Application Based on Passenger Evacuation Behaviors in Underground Station

Authors: Meng-Cong Zheng

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When the public space is in an emergency, how to quickly establish spatial cognition and emergency shelter in the closed underground space is the urgent task. This study takes Taipei Station as the research base and aims to apply the use of Internet of things (IoT) application for underground evacuation mobility design. The first experiment identified passengers' evacuation behaviors and spatial cognition in underground spaces by wayfinding tasks and thinking aloud, then defined the design conditions of User Interface (UI) and proposed the UI design.  The second experiment evaluated the UI design based on passengers' evacuation behaviors by wayfinding tasks and think aloud again as same as the first experiment. The first experiment found that the design conditions that the subjects were most concerned about were "map" and hoping to learn the relative position of themselves with other landmarks by the map and watch the overall route. "Position" needs to be accurately labeled to determine the location in underground space. Each step of the escape instructions should be presented clearly in "navigation bar." The "message bar" should be informed of the next or final target exit. In the second experiment with the UI design, we found that the "spatial map" distinguishing between walking and non-walking areas with shades of color is useful. The addition of 2.5D maps of the UI design increased the user's perception of space. Amending the color of the corner diagram in the "escape route" also reduces the confusion between the symbol and other diagrams. The larger volume of toilets and elevators can be a judgment of users' relative location in "Hardware facilities." Fire extinguisher icon should be highlighted. "Fire point tips" of the UI design indicated fire with a graphical fireball can convey precise information to the escaped person. "Fire point tips" of the UI design indicated fire with a graphical fireball can convey precise information to the escaped person. However, "Compass and return to present location" are less used in underground space.

Keywords: evacuation behaviors, IoT application, map UI design, underground station

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104 Re-Differentiation Effect of Sesquiterpene Farnesol on De-Differentiated Rabbit Chondrocytes

Authors: Chun Hsien Wu, Guan Xuan Wu, Hsia Ying Cheng, Shyh Ming Kuo

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Articular cartilage is composed of chondrocytes and extracellular matrix, such as collagen fibers, glycosaminoglycans, etc., which play an important role in lubricating and cushion joint activities. The phenotypic expression and metabolic activity of chondrocytes are extremely important in maintaining the functions of articular cartilage. In in vitro passaged culture of chondrocytes, chondrocytes gradually lose their original cell phenotype and morphology, which is called dedifferentiation. After continuous passaged culture of chondrocytes or induction by inflammatory factor IL-1, chondrocytes changed their phenotype and morphology. Also, the extracellular matrix type II collagen and GAG secretion were significantly reduced, while type I and X collagen were synthesized. Farnesol is an anti-inflammatory and antioxidant sesquiterpene compound that has the specific property of promoting collagen production. The purpose of this study was to investigate whether farnesol could restore the original type II collagen synthesis and, furthermore, the mechanisms of farnesol on the synthesis of type II collagen from the de-differentiated chondrocytes. The obtained results showed that the de-differentiated chondrocytes significantly restored to secret type II collagen and GAG (2.5-folds increases), and the secretion of collagen I and X and PGE2 synthesis were also significantly reduced after being treated with farnesol, indicating that farnesol had a restoration/re-differentiation effect on de-differentiated chondrocytes. The de-differentiated chondrocytes exhibited decreased expression of PPAR-γ and upregulated TGF-β expression to increase the MMP-13 expression. Higher expression of MMP-13 caused chondrocytes to secret type X collagen. On the contrary, increasing the expression of PPAR-γ would benefit the production of type II collagen. As shown, the PPAR-γ expression increased, and MMP-13 expression decreased after being treated with farnesol, indicating a possible signal pathway of farnesol to restore the production of type II collagen. However, more detailed mechanisms still need to evaluate.

Keywords: chondrocytes, de-differentiation, farnesol, re-differentiation

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103 Temperature Control and Comfort Level of Elementary School Building with Green Roof in New Taipei City, Taiwan

Authors: Ying-Ming Su, Mei-Shu Huang

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To mitigate the urban heat island effect has become a global issue facing the challenge of climate change. Through literature reviews, plant photosynthesis can reduce the carbon dioxide and mitigate the urban heat island effect relatively. Because there are not enough open space and park, green roof has become an important policy in Taiwan. We selected elementary school buildings in northern New Taipei City as research subjects since elementary school is asked priority to build green roof and important educational place to promote green roof concept. Testo 175-H1 recording device was used to record the temperature and humidity difference between roof surface and interior space below roof with and without green roof for the long-term. We also use questionnaire to investigate the awareness of comfort level of green roof and sensation of teachers and students of the elementary school. The results indicated the temperature of roof without greening was higher than that with greening about 2°C. But sometimes during noontime, the temperature of green roof was higher than that of non-green roof related to the character of the accumulation and dissipation of heat of greening probably. The temperature of interior space below green roof was normally lower than that without green roof about 1°C showed that green roof could lower the temperature. The humidity of the green roof was higher than the one without greening also indicated that green roof retained water better. Teachers liked to combine green roof concept in the curriculum, students wished all classes can take turns to maintain the green roof. Teachers and students that school had integrated green roof concept in the curriculum were more willing to participate in the maintenance work of green roof. Teachers and students who may access and touch the green roof can be more aware of the green roof benefit. We suggest architect to increase the accessibility and visibility of green roof, such as a part of the activity space. This idea can be a reference of the green roof curriculum design.

Keywords: comfort level, elementary school, green roof, heat island effect

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102 A Perspective on Education to Support Industry 4.0: An Exploratory Study in the UK

Authors: Sin Ying Tan, Mohammed Alloghani, A. J. Aljaaf, Abir Hussain, Jamila Mustafina

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Industry 4.0 is a term frequently used to describe the new upcoming industry era. Higher education institutions aim to prepare students to fulfil the future industry needs. Advancement of digital technology has paved the way for the evolution of education and technology. Evolution of education has proven its conservative nature and a high level of resistance to changes and transformation. The gap between the industry's needs and competencies offered generally by education is revealing the increasing need to find new educational models to face the future. The aim of this study was to identify the main issues faced by both universities and students in preparing the future workforce. From December 2018 to April 2019, a regional qualitative study was undertaken in Liverpool, United Kingdom (UK). Interviews were conducted with employers, faculty members and undergraduate students, and the results were analyzed using the open coding method. Four main issues had been identified, which are the characteristics of the future workforce, student's readiness to work, expectations on different roles played at the tertiary education level and awareness of the latest trends. The finding of this paper concluded that the employers and academic practitioners agree that their expectations on each other’s roles are different and in order to face the rapidly changing technology era, students should not only have the right skills, but they should also have the right attitude in learning. Therefore, the authors address this issue by proposing a learning framework known as 'ASK SUMA' framework as a guideline to support the students, academicians and employers in meeting the needs of 'Industry 4.0'. Furthermore, this technology era requires the employers, academic practitioners and students to work together in order to face the upcoming challenges and fast-changing technologies. It is also suggested that an interactive system should be provided as a platform to support the three different parties to play their roles.

Keywords: attitude, expectations, industry needs, knowledge, skills

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101 Effect of vr Based Wii Fit Training on Muscle Strength, Sensory Integration Ability and Walking Abilities in Patients with Parkinson's Disease: A Randomized Control Trial

Authors: Ying-Yi Laio, Yea-Ru Yang, Yih-Ru Wu, Ray-Yau Wang

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Background: Virtual reality (VR) systems are proved to increase motor performance in stroke and elderly. However, the effects have not been established in patients with Parkinson’s disease (PD). Purpose: To examine the effects of VR based training in improving muscle strength, sensory integration ability and walking abilities in patients with PD by a randomized controlled trial. Method: Thirty six participants with diagnosis of PD were randomly assigned to one of the three groups (n=12 for each group). Participants received VR-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by treadmill training for another 15 minutes for 12 sessions in 6 weeks. Participants in the control group received no structured exercise program but fall-prevention education. Outcomes included lower extremity muscle strength, sensory integration ability, walking velocity, stride length, and functional gait assessment (FGA). All outcomes were assessed at baseline, after training and at 1-month follow-up. Results: Both VRWii and TE groups showed more improvement in level walking velocity, stride length, FGA, muscle strength and vestibular system integration than control group after training and at 1-month follow-up. The VRWii training, but not the TE training, resulted in more improvement in visual system integration than the control. Conclusions: VRWii training is as beneficial as traditional exercise in improving walking abilities, sensory integration ability and muscle strength in patients with PD, and such improvements persisted at least for 1 month. The VRWii training is then suggested to be implemented in patients with PD.

Keywords: virtual reality, walking, sensory integration, muscle strength, Parkinson’s disease

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100 The Effects of Green Manure Returning on Properties and Fungal Communities in Vanadium/Titanium Magnet Tailings

Authors: Hai-Hong Gu, Yan-Jun Ai, Zheng Zhou

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Vanadium and titanium are rare metals with superior properties and are important resources in aerospace, aviation, and military. The vanadium/titanium magnetite are mostly ultra-lean ores, and a large number of tailings has been produced in the exploitation process. The tailings are characterized by loose structure, poor nutrient, complex composition and high trace metal contents. Returning green manure has been shown to not only increase plant biomass and soil nutrients but also change the bioavailability of trace metals and the microbial community structure. Fungi play an important role in decomposing organic matter and increasing soil fertility, and the application of organic matter also affects the community structure of fungi. The effects of green manure plants, alfalfa (Medicago sativa L.), returned to the tailings in situ on community structure of fungi, nutrients and bioavailability of trace metals in vanadium/titanium magnetite tailings were investigated in a pot experiment. The results showed that the fungal community diversity and richness were increase after alfalfa green manure returned in situ. The dominant phyla of the fungal community were Ascomycota, Basidiomycota and Ciliophora, especially, the phyla Ciliophora was rare in ordinary soil, but had been found to be the dominant phyla in tailings. Meanwhile, the nutrient properties and various trace metals may shape the microbial communities by affecting the abundance of fungi. It was found that the plant growth was stimulated and the available N and organic C were significantly improved in the vanadium/titanium magnetite tailing with the long-term returning of alfalfa green manure. Moreover, the DTPA-TEA extractable Cd and Zn concentrations in the vanadium/titanium magnetite tailing were reduced by 7.72%~23.8% and 8.02%~24.4%, respectively, compared with those in the non-returning treatment. The above results suggest that the returning of alfalfa green manure could be a potential approach to improve fungal community structure and restore mine tailing ecosystem.

Keywords: fungal community, green manure returning, vanadium/titanium magnet tailings, trace metals

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99 A Study on Exploring Employees' Well-Being in Gaming Workplaces Prior to and after the Chinese Government Crackdowns on Corruption

Authors: Ying Chuan Wang, Zhang Tao

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The aim of this article intends to explore the differences of well-being of employees in casino hotels before and after the Chinese government began to fight corruption. This researcher also attempted to find out the relationship between work pressure and well-being of employees in gambling workplaces before and after the Chinese government crackdowns the corruption. The category of well-being including life well-being, workplace well-being, and psychological well-being was included for analyzing well-being of employees in gaming workplaces. In addition, the psychological pressure classification was applied into this study and the Job Content Questionnaire (JCQ) would be adopted on investigating employees’ work pressure in terms of decision latitude, psychological demands, and workplace support. This study is a quantitative approach research and was conducted in March 2017. A purposive sampling was used in this study. A total of valid 339 responses were collected and the participants were casino hotel employees. The findings showed that decision latitude was significantly different prior to and after Chinese government crackdowns on corruption. Moreover, workplace support was strongly significantly related to employees’ well-being before Chinese government crackdowns. Decision latitude was strongly significantly related to employees’ well-being after Chinese government crackdowns. The findings suggest that employees’ work pressure affects their well being. In particular, because of workplace supports, it may alleviate employees’ work pressure and affect their perceptions of well-being but only prior to fighting the crackdowns. Importantly, decision latitude has become an essential factor affecting their well-being after the crackdown. It is finally hoped that the findings of this study provide suggestion to the managerial levels of hospitality industries. It is important to enhance employees’ decision latitude. Offering training courses to equip employees’ skills could be a possible way to reduce work pressure. In addition, establishing career path for the employees to pursuit is essential for their self-development and the improvement of well being. This would be crucial for casino hotels’ sustainable development and strengthening their competitiveness.

Keywords: well-being, work pressure, Casino hotels’ employees, gaming workplace

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98 Exploring the Effectiveness of End-Of-Life Patient Decision Add in the ICU

Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Ju-Jen Shie, Wen-Ju Yang, Yuann-Meei Tzeng, Chien-Ying Wang

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Background: The quality of care in intensive care units (ICUs) is crucial, especially for terminally ill patients. Shared decision-making (SDM) with families is essential to ensure appropriate care and reduce suffering. Aim: This study explores the effectiveness of an end-of-life decision support Patient Decision Aid (PDA) in an ICU setting. Methods: This study employed a cross-sectional research design conducted in an ICU from August 2020 to June 2023. Participants included family members of end-of-life patients aged 20 or older. A total of 319 participants. Family members of end-of-life patients received the PDA, and data were collected after they made medical decisions. Data collection involved providing family members with a PDA during family meetings. A post-PDA questionnaire with 17 questions assessed PDA effectiveness and anxiety levels. Statistical analysis was performed using SPSS 22.0. Results: The PDA significantly reduced anxiety levels among family members (p < 0.001). It helped them organize their thoughts, prepare for discussions with doctors, and understand critical decision factors. Most importantly, it influenced decision outcomes, with a shift towards palliative care and withdrawal of life-sustaining treatment. Conclusion: This study highlights the importance of family-centered end-of-life care in ICUs. PDAs promote informed decision-making, reduce conflicts, and enhance patient and family involvement. These tools align patient values and goals with medical recommendations, ultimately leading to decisions that prioritize comfort and quality of life. Implementing PDAs in healthcare systems can ensure that patients' care aligns with their values.

Keywords: shared decision-making, patient decision aid, end-of-life care, intensive care unit, family-centered care

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97 Factors Affecting Autistic Children's Development during the Early Years in Elementary School: A Longitudinal Study in Taiwan

Authors: Huang Ying

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The present study was to investigate factors affecting children's improvement through the first two years of elementary school on a population-based sample of children with autism in Taiwan. All the children were diagnosed with autism spectrum disorder (ASD) by clinical psychologists according to DSM-IV. Children's development was assessed by the Vineland Adaptive Behavior Scales-Chinese version (VABS-C) on the first and the third grade. Children's improvement was measured by the difference between the standardized total score of the third and the first year. In Taiwan, school-age children with special-education needs will be arranged into different classes, including normal classes (NC), resource classes (RC), and special classes (SC) by the government. Therefore, type of class was one of the independent variables. Moreover, as early intervention is considered to be crucial, the earliest age when intervention begins was collected from parents. Attention was also included in the analysis. Teachers were asked to evaluate children's attention with a 3-item Likert Scale. The frequency of paying attention to the class or the task was recorded and scores were summed up. Additionally, standardized scores of the VABS-C in the first grade were used as pretest scores representing children's developmental level at the beginning of elementary school. Multiple regression was conducted with improvement as the dependent variable. Results showed that children in special classes had smaller improvement compared to those in normal or resource classes. Attention positively predicted improvement yet the effect of earliest intervention age was not significant. Furthermore, scores in the first grade negatively predicted improvement, which indicated that children with higher developmental levels would make less progress in the following years. Results were to some degree consistent with previous findings through meta-analysis that the effectiveness of conventional intervention methods lacked sufficient evidence to support.

Keywords: attention, early intervention, elementary school, special education in Taiwan

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