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The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan.
Methods
Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up.
Results
In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender (p = .003), who perceived greater levels of microaggression (p < .001), and who had greater levels of problematic Internet use at baseline (p = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up (p = .023).
Conclusion
Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.
For the launch vehicle attitude control problem, traditional methods can seldom accurately identify the fault types, making the control method lack of pertinence, which largely affects the effect of attitude control. This paper proposes an active fault tolerant control strategy, which mainly includes fault diagnosis and fault tolerant control. In the fault diagnosis part, a small deviation attitude dynamics model of the launch vehicle is established, Kalman filters with different structures are designed to detect and isolate faults through residual changes, and the fault quantity of the actuator is further estimated. In the fault tolerant control part, the following control scheme is adopted according to the above diagnostic information: when the sensor fault is detected, the sensor measurement data is reconstructed; when the actuator fault is identified, the control allocation matrix is reconstructed. Simulation results show that the proposed method can effectively diagnose sensor fault and actuator faults, and significantly improve attitude tracking accuracy and control adjustment time.
National health insurance (NHI) Taiwan has provided additional markups on dental service fees for people with specific disabilities, and the expenditure has increased significantly from TWD473 million (USD15 million) in 2016 to TWD722 million (USD24 million) in 2022. The purpose of this study was to determine oral health risk and to develop a risk assessment model for capitation outpatient dental payments in children with Autism.
Methods
Based on the literature and expert opinion, we developed a level of oral health risk model from the claim records of 2019. The model uses oral outpatient claim data to analyze: (i) the degree of caries disease; (ii) the level of dental fear or cooperation; and (iii) the level of tooth structure. Each factor was given a score from zero to four and a total score was calculated. Low-, medium-, and high-risk groups were formed based on the total points. The oral health risk capitation models are estimated by ordinary least squares using an individual’s annual outpatient dental expenditure in 2019 as the dependent variable. For subgroups based on age group and level of disability, expenditures predicted by the models are compared with actual outpatient dental expenditures. Predictive R-squared and predictive ratios were used to evaluate the model’s predictability.
Results
The demographic variables, level of oral health risk, preventive dental care, and the type of dental health care predicted 30 percent of subsequent outpatient dental expenditure in children with autism. For subgroups (age group and disability level) of high-risk patients, the model substantially overpredicted the expenditure, whereas underprediction occurred in the low-risk group.
Conclusions
The risk-adjusted model based on principal oral health was more accurate in predicting an individual’s future expenditure than the relevant study in Taiwan. The finding provides insight into the important risk factor in the outpatient dental expenditure of children with autism and the fund planning of dental services for people with specific disabilities.
Universal admission screening and follow-up symptom-based testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may play critical roles in controlling nosocomial transmission. We describe the performance of test strategies for inpatients and their companions during various disease incidences in Taiwan.
Design:
Retrospective population-based cohort study.
Setting:
The study was conducted across 476 hospitals in Taiwan.
Methods:
The data for both testing strategies by reverse transcription-polymerase chain reaction for SARS-CoV-2 in newly admitted patients and their companions during May 2021—June 2022 were extracted and analyzed.
Results:
The positivity rate of universal admission screening was 0.76% (14,640 of 1,928,676) for patients and 0.37% (5,372 of 1,438,944) for companions. The weekly community incidences of period 1 (May 2021–June 2021), period 2 (July 2021–March 2022), and period 3 (April 2022–June 2022) were 6.57, 0.27, and 1,261, respectively, per 100,000 population. The positivity rates of universal admission screening for patients and companions (4.39% and 2.18%) in period 3 were higher than those in periods 1 (0.29% and 0.04%) and 2 (0.03% and 0.003%) (all P < .01). Among the 22,201 confirmed cases, 9.86% were identified by symptom-based testing. The costs and potential savings of universal admission screening for patients and companions achieved a breakeven point when the test strategy was implemented in a period with weekly community incidences of 27 and 358 per 100,000 population, respectively.
Conclusions:
Universal admission screening and follow-up symptom-based testing is important for reducing nosocomial transmission. Implementing universal admission screening at an appropriate time would balance the benefits with costs and potential unintended harms.
Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials.
Aims
We aimed to explore the perceptions of individuals who self-harm toward a brief intervention, the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response.
Method
Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analysed with the framework method.
Results
The participants could understand the intended goal of the VHS-C by reading the written instructions, but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C was helpful (e.g. relatable contents, useful coping strategies and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C, and suggested that the format and frequency of follow-up reminders could leave the patient to decide.
Conclusions
The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.
Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space–time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts.
Methods
Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space–time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes.
Results
A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004–2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012–2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10–29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts.
Conclusions
Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.
The SAF is arguably ‘the most impressive military force in contemporary Southeast Asia’ (Huxley, 2000, p 249). Yet, the threat of military intervention in Singapore’s political system, what Feaver (1999, p 214) terms the ‘civil–military problematique’ – wherein the ‘very institution created to protect the polity is given sufficient power to become a threat to the polity’ – is unlikely (Tan, 2011, p 148). Scholars have contended that Singapore’s civil–military relations transcend Feaver’s problematique. Four decades earlier, Chan (1985, p 136) already noted ‘the most striking feature of the Singapore scene is the undisputed predominance of the civilian sector over the military.’ We broadly agree with Tan (2001, p 276), who explains that such control is achieved through ‘civil–military fusion’ whereby ‘the military, both in leadership and in structural terms, functions as an integral part of a centralized, bureaucratic state’; and also with Chong and Chan (2016), who observed civilian society is arguably built in the likeness of a quintessential military force, with a seeming permeation of martial values. We, however, suggest an alternative for such integration. Rather than one world enfolding the other into a hyphenated whole, a ‘civilianized military’ or ‘militarized civilian’, we argue that the foundational cultural values of Singapore society and government, and its armed forces, are the same, precluding separate ‘civilian’ and ‘military’ worlds in the first place.
In Singapore’s history, such ontologically distinct worlds never existed to a significant extent, nor did Singapore’s development allow them to be created. Consequently, there is no civil–military gap – a key concern in civil–military relations scholarship – in Singapore, transcending the civil–military problematique. While the military naturally plays a different role, it does not occupy a different world. Singapore presents a curious case of how its military evolution has existed within the operational role of the SAF as opposed to a changing relationship between different worlds.
Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10–24 years.
Methods
Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder.
Results
A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20–24 years (57.0%) was higher than among adolescents aged 10–19 years (48.0%).
Conclusions
Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.
The objective of this study was to examine the relationships between students’ perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.
Design:
Cross-sectional study.
Setting:
Primary, middle and high schools in Taiwan.
Participants:
A nationally representative sample of 2433 primary school (5th–6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.
Results:
Multivariate analysis results showed that after controlling for school level, gender and age, the students’ perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools’ campaigns promoting the eating of vegetables and fruit were positively associated with students’ consumption of vegetables. In addition, schools’ initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students’ engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.
Conclusions:
Students’ perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.
We aimed to investigate the associations between dietary branched-chain amino acids (BCAA) intake and long-term risks of CVD, cancer and all-cause mortality in nationwide survey participants aged ≥ 18.
Design:
This was a prospective cohort study. Dietary intakes of BCAA (leucine, isoleucine and valine) were determined from the total nutrient intake document. The main outcomes were CVD, cancer and all-cause mortality.
Setting:
A nationally representative sample of US adults were recruited by the National Center for Health Statistics (NCHS) from 1988 to 1994.
Participants:
A total of 14 397 adults aged ≥ 18 who participated in the United States National Health and Nutrition Examination Survey III (NHANES III) were included.
Results:
During 289 406 person-years of follow-up, we identified 4219 deaths, including 1133 from CVD and 926 from cancer. After multivariate adjustment, the hazard ratios (95 % confidence intervals) of all-cause mortality in the highest dietary BCAA and isoleucine intake quintile (reference: lowest quintiles) were 0·68 (0·48, 0·97) and 0·68 (0·48, 0·97), respectively. Each one-standard-deviation increase in total dietary BCAA or isoleucine intake was associated with an 18 % or 21 % decrease in the risk of all-cause mortality, respectively. The serum triglyceride (TAG) concentration was found to modify the association between the dietary BCAA intake and all-cause mortality (Pfor interaction = 0·008).
Conclusions:
In a nationally representative cohort, higher dietary intakes of BCAA and isoleucine were independently associated with a lower risk of all-cause mortality, and these associations were stronger in participants with higher serum TAG concentrations.
We investigate deterministic and stochastic bifurcations in electroconvecitve flows of a dielectric liquid confined between two parallel plates subjected to a strong unipolar injection by direct numerical simulations. A long-standing discrepancy of linear instability criteria between the experiment and theory exists in this flow. We here test the hypothesis that the discrepancy may be related to the inhomogeneity in ion-exchange membranes used in experiments, contrasted by the homogeneous ion injection assumed in theoretical and numerical analyses. To study this effect, we consider stochastic boundary conditions around linear criticality and first bifurcations in this flow. For a complete presentation of flow bifurcations, deterministic bifurcation analysis (without stochasticity) is first performed to investigate primary bifurcations in this flow by progressively increasing the strength of electric field. Lyapunov spectrum and dimension are calculated and probed to characterise the chaotic motion therein. Our results confirm the high dimensionality of chaos in electroconvective flows and reveal for the first time that its chaos is extensive in a range of finite-sized systems. We then conduct stochastic bifurcation analyses by considering random perturbations in the boundary conditions of charge density and electric potential. Owing to the subcritical nature of electroconvective flows, the linear instability criteria under stochastic boundaries are closer to the experimental values than former theoretical and numerical results (assuming the homogeneous charge injection) for different levels of stochasticity, which confirms the hypothesis aforementioned. Furthermore, stochasticity can also enhance the efficiency of ionic transport.
In this process-based study, we introduced a collocation tool with a new interface and advanced search features and examined how a class of EFL college students interacted with it. To elicit their tool consultation behaviors, a vocabulary test with collocation questions was designed. The students’ use of the tool to answer the vocabulary questions was screen-recorded for further analysis, serving as the major data source. One-on-one interviews with selected students were then conducted to clarify issues related to the study and their experience in using the tool. The findings indicated that the pattern-based tool was efficient in helping students solve collocation problems. This paper concludes with some pedagogical implications and suggestions for further research.
Salmonella is a leading cause of foodborne outbreaks in Taiwan. On 27 April 2018, a salmonellosis outbreak among customers of a restaurant was reported to the Taiwan CDC. We investigated the outbreak to identify infection sources and prevent further transmission. We interviewed ill customers and their dining companions. We conducted a case-control study to identify foods associated with the illness. Case-patients were those who had diarrhoea within 72 h after eating at the restaurant during 16–27 April 2018. Specimens, food samples and environmental samples were collected and tested for enteric pathogens. Salmonella isolates were analysed with pulse-field gel electrophoresis and whole-genome sequencing. We inspected the restaurant sanitation and reviewed kitchen surveillance camera recordings. We identified 47 case-patients, including one decedent. Compared with 44 controls, case-patients were more likely to have had a French toast sandwich (OR: 102.4; 95% CI: 18.7–952.3). Salmonella Enteritidis isolates from 16 case-patients shared an indistinguishable genotype. Camera recordings revealed eggshell contamination, long holding time at room temperature and use of leftovers during implicated food preparation. Recommendations for restaurant egg-containing food preparation are to use pasteurised egg products and ensure a high enough cooking temperature and long enough cooking time to prevent Salmonella contamination.
To investigate the spatial distribution of self-harm incidence rates, their socioeconomic correlates and sex/age differences using data on self-harm presentations to emergency departments from The Manchester Self-Harm Project (2003–2013).
Methods
Smoothed standardised incidence ratios for index self-harm episodes (n = 14 771) and their associations with area-level socioeconomic factors across 258 small areas (median population size = 1470) in the City of Manchester municipality were estimated using Bayesian hierarchical models.
Results
Higher numbers and rates of self-harm were found in the north, east and far southern zones of the city, in contrast to below average rates in the city centre and the inner city zone to the south of the centre. Males and females aged 10–24, 25–44 and 45–64 years showed similar geographical patterning of self-harm. In contrast, there was no clear pattern in the group aged 65 years and older. Fully adjusted analyses showed a positive association of self-harm rates with the percentage of the unemployed population, households privately renting, population with limiting long-term illness and lone-parent households, and a negative association with the percentage of ethnicity other than White British and travel distance to the nearest hospital emergency department. The area-level characteristics investigated explained a large proportion (four-fifths) of the variability in area self-harm rates. Most associations were restricted to those aged under 65 years and some associations (e.g. with unemployment) were present only in the youngest age group.
Conclusions
The findings have implications for allocating prevention and intervention resources targeted at high-risk groups in high incidence areas. Targets for area-based interventions might include tackling the causes and consequences of joblessness, better treatment of long-term illness and consideration of the accessibility of health services.
Self-poisoning using pesticides is among the major methods of suicide worldwide, and accounts for one-fifth of suicides in 2006–2010 in South Korea. We investigated long-term trends in pesticide suicide rates in South Korea and factors related to these trends.
Methods
We calculated age-standardised rates of pesticide suicide in South Korea (1983–2014) using registered death data. We used graphical approach and joinpoint regression analysis to examine secular trends in pesticide suicide by sex, age and area, and a time-series analysis to investigate association of pesticide suicide rate with socioeconomic and agriculture-related factors. Age, period and cohort effects were examined using the intrinsic estimator method.
Results
Age-standardised rate of pesticide suicide fluctuated between 1983 and 2000 before it markedly increased in 2000–2003 (annual percent change 29.7%), followed by a gradual fall (annual percent change −6.3%) in 2003–2011. Following the paraquat ban (2011–2012), there was a marked reduction (annual percent change −28.2%) in 2011–2014. Trend in pesticide suicide was associated with divorce rate but not with other factors studied. Declines in pesticide suicide in 2003–2011 were most noticeable in younger groups and metropolises; by contrast, elderly adults aged 70+ living in rural areas showed an upward trend until after the 2011–2012 paraquat ban, when it turned downward. In the age–period–cohort modelling, having been born between 1938 and 1947 was associated with higher pesticide suicide rates.
Conclusions
Pesticide suicide trend changed substantially in South Korea over the last three decades. Effective prevention should include close monitoring of trends and strong regulations of toxic pesticides.
In this paper, we first derive the CR volume doubling property, CR Sobolev inequality, and the mean value inequality. We then apply them to prove the CR analogue of Yau’s conjecture on the space consisting of all pseudoharmonic functions of polynomial growth of degree at most $d$ in a complete noncompact pseudohermitian $(2n+1)$-manifold. As a by-product, we obtain the CR analogue of the volume growth estimate and the Gromov precompactness theorem.
Weeds represent a major cause of agricultural losses worldwide. Most weeds
share a common set of life history characteristics that predispose them to
weediness, two of which are self-compatibility, which allows for ease of
colonization through reproductive assurance, and high trait plasticity,
which allows for tolerance of a wide variety of environments and abiotic
conditions. However, self-fertilization typically comes at the cost of
inbreeding depression. This study investigates the role of inbreeding
depression and trait plasticity under abiotic stress in the tall
morningglory, a widespread self-compatible agricultural weed in the
southeastern United States. Results show very little inbreeding depression
in this species, likely due to purging of deleterious alleles through
repeated founder events in agricultural landscapes. In contrast, abiotic
stress induced substantial plasticity in ecophysiological traits,
reproductive traits, and biomass allocation. In terms of performance,
drought sharply impacted reproduction but not vegetative growth, and
nitrogen limitation sharply impacted both. These findings are applicable to
the control of weedy morningglory and underscore the usefulness of
evolutionary ecology to weed management.
In this paper, a switch function-based gas-kinetic scheme (SF-GKS) is presented for the simulation of inviscid and viscous compressible flows. With the finite volume discretization, Euler and Navier-Stokes equations are solved and the SF-GKS is applied to evaluate the inviscid flux at cell interface. The viscous flux is obtained by the conventional smooth function approximation. Unlike the traditional gas-kinetic scheme in the calculation of inviscid flux such as Kinetic Flux Vector Splitting (KFVS), the numerical dissipation is controlled with a switch function in the present scheme. That is, the numerical dissipation is only introduced in the region around strong shock waves. As a consequence, the present SF-GKS can well capture strong shock waves and thin boundary layers simultaneously. The present SF-GKS is firstly validated by its application to the inviscid flow problems, including 1-D Euler shock tube, regular shock reflection and double Mach reflection. Then, SF-GKS is extended to solve viscous transonic and hypersonic flow problems. Good agreement between the present results and those in the literature verifies the accuracy and robustness of SF-GKS.
A three-dimensional (3D) lattice Boltzmann flux solver (LBFS) is presented in this paper for the simulation of both isothermal and thermal flows. The present solver combines the advantages of conventional Navier-Stokes (N-S) solvers and lattice Boltzmann equation (LBE) solvers. It applies the finite volume method (FVM) to solve the N-S equations. Different from the conventional N-S solvers, its viscous and inviscid fluxes at the cell interface are evaluated simultaneously by local reconstruction of LBE solution. As compared to the conventional LBE solvers, which apply the lattice Boltzmann method (LBM) globally in the whole computational domain, it only applies LBM locally at each cell interface, and flow variables at cell centers are given from the solution of N-S equations. Since LBM is only applied locally in the 3D LBFS, the drawbacks of the conventional LBM, such as limitation to uniform mesh, tie-up of mesh spacing and time step, tedious implementation of boundary conditions, are completely removed. The accuracy, efficiency and stability of the proposed solver are examined in detail by simulating plane Poiseuille flow, lid-driven cavity flow and natural convection. Numerical results show that the LBFS has a second order of accuracy in space. The efficiency of the LBFS is lower than LBM on the same grids. However, the LBFS needs very less non-uniform grids to get grid-independence results and its efficiency can be greatly improved and even much higher than LBM. In addition, the LBFS is more stable and robust.