Publications by authors named "Wei-Chun Lin"

81 Publications

Analysis of the Warpage Phenomenon of Micro-Sized Parts with Precision Injection Molding by Experiment, Numerical Simulation, and Grey Theory.

Polymers (Basel) 2022 Apr 30;14(9). Epub 2022 Apr 30.

Department of Mechanical Engineering, Faculty of Engineering, National University of Singapore, Singapore 119077, Singapore.

In this study, we determined the effects of design and processing parameters of precision injection molding (PIM) to minimize warpage phenomena of micro-sized parts using various plastics (polyoxymethylene (POM), acrylonitrile-butadiene-styrene (ABS), polypropylene (PP), polyamide (PA), and ABS+ polycarbonate (PC)). We applied a numerical simulation (Moldflow) to determine the runner's balance in multi-cavities of the micro-sized part and simulate the warpage phenomenon of micro-parts with PIM. We used simulation data to fabricate a steel mold by computer numerical control (CNC) machining. In this, we study manufactured a micro-sized part and measured its warpage value using various PIM process parameters (melt temperature, mold temperature, injection pressure, and filling time). In order to obtain optimal results (i.e., minimum warpage), we employed the Taguchi method and grey theory to discern the influence of each process parameter on PIM. Finally, we determined that the most significant PIM process parameter influencing the warpage phenomenon of micro-sized parts was the mold temperature, regardless of whether in terms of the experimental results, numerical simulations, or grey theory. The PA material had the most suitable properties for application for micro-sized parts, regardless of whether in terms of experimental results, numerical simulations, or grey theory for PIM. This study also illustrates that micro-sized parts can be fabricated by PIM without the use of micro-injection molding, and we determined that the mold temperature required for molding does not need to be higher than the glass-transition temperature of the material.
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http://dx.doi.org/10.3390/polym14091845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104427PMC
April 2022

Protective Behaviors for COVID-19 Were Associated With Fewer Psychological Impacts on Nurses: A Cross-Sectional Study in Taiwan.

Inquiry 2022 Jan-Dec;59:469580221096278

Department of Business Management, 121864National Sun Yat-Sen University, Kaohsiung, Taiwan.

Objective: The COVID-19 pandemic has increased psychological distress among common people and has caused health care providers, such as nurses, to experience tremendous stress.

Methods: This prospective cross-sectional study assessed the psychological impacts on nurses in a community hospital in Taiwan, including major depressive disorder (MDD), posttraumatic stress (PTS), and pessimism. According to transactional theory, coping strategies and personal factors have psychological impacts. We hypothesized that behavioral responses to COVID-19 (problem-focused coping) are more effective in reducing psychological impacts than emotional responses to COVID-19 (emotion-focused coping). Independent variables were the use of behavioral and emotional coping strategies for COVID-19 and 3 personal factors, namely sleep disturbance, physical component summary (PCS-12), and mental component summary (MCS-12) of the 12-Item Short Form Health Survey (SF-12) obtained from the Medical Outcomes Study. Dependent variables comprised 3 psychological impacts, namely MDD, PTS, and pessimism.

Results: We determined that behavioral coping strategies had significant negative effects on PTS and pessimism; however, emotional coping strategies had significantly positive effects on PTS and pessimism. Sleep disturbance was significantly associated with increased MDD and pessimism. PCS-12 had a significant negative effect on PTS, whereas MCS-12 was not significantly associated with any of the 3 psychological impacts.

Conclusions: Nurses who adopted protective behavior against COVID-19, such as washing hands, wearing masks, avoiding touching eyes, and mouth, and avoiding personal contact, were associated with less posttraumatic stress and pessimism. Healthcare providers should consider strategies for improving preventive behaviors to help ease their worries and fears concerning COVID-19.
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http://dx.doi.org/10.1177/00469580221096278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092574PMC
May 2022

Optimal Processing Parameters of Transmission Parts of a Flapping-Wing Micro-Aerial Vehicle Using Precision Injection Molding.

Polymers (Basel) 2022 Apr 4;14(7). Epub 2022 Apr 4.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia.

In this study, we designed and fabricated transmission parts for a flapping-wing micro-aerial vehicle (FW-MAV), which was fabricated by precision injection molding, and analyzed its warpage phenomena. First, a numerical simulation (Moldflow) was used to analyze the runner balance and temperature, pressure, and stress distributions of the base, gears, and linkage of the transmission structures in an FW-MAV. These data were then applied to fabricate a steel mold for an FW-MAV. Various process parameters (i.e., injection temperature, mold temperature, injection pressure, and packing time) for manufacturing transmission parts for the FW-MAV by precision injection molding were compared. The Taguchi method was employed to determine causes of warpage in the transmission parts. The experimental results revealed that the causes of warpage in the transmission parts were, in order of importance, the mold temperature, injection pressure, packing time, and injection temperature. After the transmission parts were assembled on the FW-MAV, experiments revealed that the MAV could achieve a flight time of 180 s. Mass production of the FW-MAV by precision injection molding could potentially produce substantial savings in time, manpower, and cost.
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http://dx.doi.org/10.3390/polym14071467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9003489PMC
April 2022

Extraction of Active Medications and Adherence Using Natural Language Processing for Glaucoma Patients.

AMIA Annu Symp Proc 2021 21;2021:773-782. Epub 2022 Feb 21.

Medical Informatics & Clinical Epidemiology.

Accuracy of medication data in electronic health records (EHRs) is crucial for patient care and research, but many studies have shown that medication lists frequently contain errors. In contrast, physicians often pay more attention to the clinical notes and record medication information in them. The medication information in notes may be used for medication reconciliation to improve the medication lists' accuracy. However, accurately extracting patient's current medications from free-text narratives is challenging. In this study, we first explored the discrepancies between medication documentation in medication lists and progress notes for glaucoma patients by manually reviewing patients' charts. Next, we developed and validated a named entity recognition model to identify current medication and adherence from progress notes. Lastly, a prototype tool for medication reconciliation using the developed model was demonstrated. In the future, the model has the potential to be incorporated into the EHR system to help with realtime medication reconciliation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861739PMC
April 2022

Current-Smoking-Related COPD or COPD With Acute Exacerbation is Associated With Poorer Survival Following Oral Cavity Squamous Cell Carcinoma Surgery.

Chronic Obstr Pulm Dis 2022 Apr;9(2):181-194

Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.

Background: The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) before surgery on patients with oral cavity squamous cell carcinoma (OCSCC) is unclear.

Methods: Using the Taiwan Cancer Registry Database, we enrolled patients with OCSCC (pathologic stages I-IVB) receiving surgery. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into 2 groups by using propensity score matching based on the pre-existing COPD status (≤1 year before surgery) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD).

Results: In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) of all-cause mortality in Group 2 compared with Group 1 was 1.07 (1.02-1.16, = 0.041). The aHR (95% CIs) of all-cause mortality for ≥1 hospitalizations for COPDAE within 1 year before surgery for patients with OCSCC was 1.31 (1.02-1.64; = 0.011) compared with no COPDAE in patients with OCSCC receiving surgery. Among patients with OCSCC undergoing curative surgery, current smokers with smoking-related COPD demonstrated poorer survival outcomes than did nonsmokers without COPD, for both OCSCC death and all-cause mortality. Hospitalization for COPDAE within 1 year before surgery was found to be an independent risk factor for overall survival in these patients with OCSCC.

Conclusion: Prevention of COPD progression to COPDAE may lead to an increase in overall survival in patients with OCSCC receiving curative surgery.
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http://dx.doi.org/10.15326/jcopdf.2022.0286DOI Listing
April 2022

The relationships between self-efficacy, self-care ability, and burnout and compassion satisfaction among hospice staff in Taiwan.

Support Care Cancer 2022 Jun 19;30(6):5491-5497. Epub 2022 Mar 19.

Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

Objectives: Professional quality of life involves the negative and positive effects of proving care to terminal patients on health care professionals, including burnout and compassion satisfaction. Around 18% of hospice staff have experienced burnout, and few studies explore the role of an innate ability to cope with burnout. The aim of this study was to explore the significant predictors of burnout and compassion satisfaction as well as the coping strategies among hospice staff in Taiwan.

Methods: A cross-sectional study was conducted, and 220 hospice staff were recruited. Standardized questionnaires were used to collect self-rated stress and growth due to hospice care, self-efficacy, self-awareness, and managing emotion.

Results: Hospice staff who perceived higher stress and lower growth due to hospice care and had lower self-efficacy in providing hospice care experienced higher burnout and lower compassion satisfaction. Those who had a lower level of ability related to self-awareness and managing emotion tended to experience higher burnout. The common coping strategies included seeking social support, taking professional courses for clinical skills, and developing hobbies.

Conclusion: Hospice staff have to develop professional abilities in regard to hospice care as well as an ability to maintain awareness and manage emotions related to work.
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http://dx.doi.org/10.1007/s00520-022-06980-0DOI Listing
June 2022

Photolysis of Chlorine Dioxide under UVA Irradiation: Radical Formation, Application in Treating Micropollutants, Formation of Disinfection Byproducts, and Toxicity under Scenarios Relevant to Potable Reuse and Drinking Water.

Environ Sci Technol 2022 02 13;56(4):2593-2604. Epub 2022 Jan 13.

Institute of Environmental Engineering, National Yang Ming Chiao Tung University, 1001 University Rd., Hsinchu City 30010, Taiwan.

Conversion of potable reuse water utilities and drinking water utilities from a low-pressure UV/HO (LPUV/HO) advanced oxidation process (AOP) to alternative AOPs in which oxidants can effectively absorb photons and rapidly generate radicals has attracted great interest. Herein, we propose a novel UVA/ClO AOP for different water treatment scenarios because of reduced photon absorption by the background matrix and high molar absorptivity for ClO at UVA wavelengths. While the photolysis of ClO produces Cl + O or ClO + O(P) via distinct product channels, we determined the parameters needed to accurately model the loss of oxidants and the formation of byproducts and combined a kinetic model with experimental data to determine quantum yields (Φ). Modeling incorporating the optimized Φ simultaneously predicted oxidant loss and the formation of major products -HOCl, Cl, and ClO. We also systematically investigated the removal of three contaminants exhibiting different radical reactivities, the formation of 35 regulated and unregulated halogenated disinfection byproducts (DBPs), DBP-associated toxicity, and -acetylcysteine thiol reactivity in synthetic or authentic RO permeates/surface waters treated by different AOPs. The kinetic model developed in this study was used to optimize operating conditions to control undesired products and improve contaminant removal efficiency. The results indicate that UVA/ClO can outperform LPUV/HO in terms of electrical energy per order of contaminant degradation, disinfection byproduct formation, and toxicity indices.
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http://dx.doi.org/10.1021/acs.est.1c05707DOI Listing
February 2022

Auger Electron Spectroscopy Analysis of the Thermally Induced Degradation of MAPbI Perovskite Films.

ACS Omega 2021 Dec 29;6(50):34606-34614. Epub 2021 Nov 29.

Department of Photonics, National Sun Yat-Sen University, No. 70, Lianhai Rd., Gushan Dist., Kaohsiung City 804, Taiwan (ROC).

Organometal halide perovskites are highly promising materials for photovoltaic applications due to the rapid growth of power conversion efficiency in recent years. However, thermal stability is still a major hurdle for perovskite solar cells toward commercialization. Herein, we first explore the slow thermal response of the CHNHPbI perovskite crystal investigated via Auger electron spectroscopy (AES). AES image mapping directly observes the evolution of morphology and elemental distribution over time. The AES small spot analysis demonstrates the precise initial degradation position of perovskite with both information regarding physical changes in crystals and chemical changes in elemental bonding at the nanometer scale. X-ray photoelectron spectroscopy (XPS) was used to confirm the surface chemical bonding and composition of the perovskite crystals. This work provides the first insights into the physical and chemical changes of perovskites investigated by AES upon long-term exposure to heat under ambient conditions.
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http://dx.doi.org/10.1021/acsomega.1c05002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697411PMC
December 2021

Optimized Micro-Pattern Design and Fabrication of a Light Guide Plate Using Micro-Injection Molding.

Polymers (Basel) 2021 Dec 3;13(23). Epub 2021 Dec 3.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia.

This study examined the uniformity of illuminance field distributions of light guide plates (LGPs). First, the authors designed microstructural patterns on the surface of an LGP. Then, a mold of the LGP with the optimal microstructural design was fabricated by a photolithography method. Micro-injection molding (μIM) was used to manufacture the molded LGPs. μIM technology can simultaneously manufacture large-sized wedge-shaped LGPs and micro-scale microstructures. Finally, illuminance values of the field distributions of the LGPs with various microstructures were obtained through optical field measurements. This study compared the illuminance field distributions of LGPs with various designs and structures, which included LGPs without and those with microstructure on the primary design and the optimal design. The average illuminance of the LGP with microstructures and the optimal design was roughly 196.1 cd/m. Its average illuminance was 1.3 times that of the LGP without microstructures. This study also discusses illuminance field distributions of LGPs with microstructures that were influenced by various μIM process parameters. The mold temperature was found to be the most important processing parameter affecting the illuminance field distribution of molded LGPs fabricated by μIM. The molded LGP with microstructures and the optimal design had better uniformity than that with microstructures and the primary design and that without microstructures. The uniformity of the LGP with microstructures and the optimal design was roughly 86.4%. Its uniformity was nearly 1.65 times that of the LGP without microstructures. The optimized design and fabrication of LGPs with microstructure exhibited good uniformity of illuminance field distributions.
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http://dx.doi.org/10.3390/polym13234244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8659901PMC
December 2021

Thoracic surgery improved overall survival in patients with stage IIIB-IV epidermal growth factor receptor-mutant lung adenocarcinoma who received and responded to tyrosine kinase inhibitor treatment.

Lung Cancer 2021 12 13;162:29-35. Epub 2021 Oct 13.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. Electronic address:

Purpose: No large-scale, prospective, randomized study has evaluated the effect of thoracic surgery on patients with unresectable stage IIIB-IV epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma who received and responded to EGFR tyrosine kinase inhibitor (TKI) treatment. Therefore, we designed a propensity-score-matched, nationwide, population-based, cohort study to investigate the effects of thoracic surgery on patients with EGFR-mutant lung adenocarcinoma.

Patients And Methods: We included patients with unresectable stage IIIB-IV EGFR-mutant lung adenocarcinoma and categorized them into two groups according to their treatment modalities and compared their outcomes: the case group consisted of patients who underwent thoracic surgery for lung tumors after receiving and responding to EGFR-TKI treatment and the comparison group consisted of patients who received EGFR-TKI treatment alone until tumor progression. Patients in both groups were matched at a ratio of 1:4.

Results: The matching process yielded a final cohort of 1395 patients (279 and 1,116 in the case and comparison groups, respectively) who were eligible for further analysis. According to multivariable Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) for thoracic surgery for lung tumors after EGFR-TKI use and tumor response (group 2) compared with EGFR-TKI treatment alone (group 1) was 0.445 (0.351-0.564).

Conclusions: Thoracic surgery prolonged overall survival in patients with unresectable stage IIIB-IV EGFR-mutant lung adenocarcinoma who received and responded to EGFR-TKI treatment.
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http://dx.doi.org/10.1016/j.lungcan.2021.10.003DOI Listing
December 2021

Comparison of Dental Surface Image Registration and Fiducial Marker Registration: An In Vivo Accuracy Study of Static Computer-Assisted Implant Surgery.

J Clin Med 2021 Sep 16;10(18). Epub 2021 Sep 16.

School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan.

This study compared the accuracy of static computer-assisted implant surgery (sCAIS) planned through dental surface image registration and fiducial marker registration. Stone models of 30 patients were converted into digital dental casts by using a desktop scanner. Cone-beam computed tomography (CBCT) was performed and superimposed to the digital dental casts with two methods: matching the dental surface images or matching the fiducial markers on a stereolithographic radiographic template. Following the implant planning, stereolithographic surgical guides were fabricated, and 56 fully guided implants were inserted by the same doctor. Deviations between planned and inserted implants were measured and compared using postoperative CBCT images. After adjustment for other potential influencing factors, compared with the fiducial marker registration group, significantly larger mean lateral deviations were noted in the dental surface registration group at both the implant platform and apex ( = 0.0188 and 0.0371, respectively). However, the mean lateral deviations for the dental surface registration (0.83 ± 0.51 mm at implant platform and 1.24 ± 0.68 mm at implant apex) were comparable to the literature. In conclusion, our findings indicate that although sCAIS planned using dental surface image registration was not statistically as accurate as that using fiducial marker registration, its accuracy was satisfactory for clinical use.
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http://dx.doi.org/10.3390/jcm10184183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466254PMC
September 2021

Bioactivity and Bone Cell Formation with Poly-ε-Caprolactone/Bioceramic 3D Porous Scaffolds.

Polymers (Basel) 2021 Aug 13;13(16). Epub 2021 Aug 13.

Taiwan Society of Blood Biomaterials, New Taipei City 221, Taiwan.

This study applied poly-ε-caprolactone (PCL), a biomedical ceramic powder as an additive (nano-hydroxyapatite (nHA) or β-tricalcium diphosphate (β-TCP)), and sodium chloride (NaCl) and ammonium bicarbonate ((NH)HCO) as porogens; these stuffs were used as scaffold materials. An improved solvent-casting/particulate-leaching method was utilized to fabricate 3D porous scaffolds. In this study we examined the physical properties (elastic modulus, porosity, and contact angle) and degradation properties (weight loss and pH value) of the 3D porous scaffolds. Both nHA and β-TCP improved the mechanical properties (elastic modulus) of the 3D porous scaffolds. The elastic modulus (0.15~1.865 GPa) of the various composite scaffolds matched that of human cancellous bone (0.1~4.5 GPa). Osteoblast-like (MG63) cells were cultured, a microculture tetrazolium test (MTT) was conducted and alkaline phosphatase (ALP) activity of the 3D porous scaffolds was determined. Experimental results indicated that both nHA and β-TCP powder improved the hydrophilic properties of the scaffolds. The degradation rate of the scaffolds was accelerated by adding nHA or β-TCP. The MTT and ALP activity tests indicated that the scaffolds with a high ratio of nHA or β-TCP had excellent properties of in vitro biocompatibility (cell attachment and proliferation).
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http://dx.doi.org/10.3390/polym13162718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401466PMC
August 2021

Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study.

Cancers (Basel) 2021 Aug 22;13(16). Epub 2021 Aug 22.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.

Purpose: The survival effect of current smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) is unclear for patients with rectal adenocarcinoma undergoing curative resection.

Methods: We recruited patients with clinical stage I-IIIC rectal adenocarcinoma from the Taiwan Cancer Registry Database who had received surgery. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on COPD status to compare overall survival outcomes: Group 1 (current smokers with COPD) and Group 2 (nonsmokers without COPD).

Results: In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality for Group 1 compared with Group 2 was 1.25 (1.04-1.51). The aHRs (95% cis) of all-cause mortality for frequency of ≥1 hospitalizations for COPDAE or ≥2 hospitalizations within 1 year before diagnosis were 1.17 (1.05-1.51) and 1.48 (1.03-2.41) compared with no COPDAE in patients with rectal adenocarcinoma undergoing curative resection.

Conclusion: In patients with rectal adenocarcinoma undergoing curative resection, being a current smoker with COPD (Group 1) was associated with worse survival outcomes than being a nonsmoker without COPD (Group 2). Being hospitalized at least once for COPDAE within 1 year before the diagnosis of rectal adenocarcinoma is an independent risk factor for poor overall survival in these patients, and a higher number of hospitalizations for COPDAE within 1 year before diagnosis was associated with poorer survival.
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http://dx.doi.org/10.3390/cancers13164221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391389PMC
August 2021

An educational bereavement program to decrease clinical staff's barriers and improve self-efficacy of providing bereavement care.

Support Care Cancer 2022 Jan 14;30(1):835-841. Epub 2021 Aug 14.

Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

Purpose: Clinicians face personal barriers that impede the provision of bereavement care and require education in hospice care. This study aims to investigate the effects of an educational bereavement program on emotional and cognitive barriers, self-efficacy, and professional quality of life among clinicians in hospice care.

Methods: A pretest-posttest design was implemented. A total of 194 clinicians with working experience in hospice care were recruited. The participants underwent a 12-h workshop. The content included lectures, role-play, and group discussion. Emotional and cognitive barriers, self-efficacy, and professional quality of life were measured before and after the program and at 3-month follow-up.

Results: After the educational program, negative emotional barriers (F (2, 386) = 17.07, p < 0.001), lack of ability (F (2, 386) = 20.11, p < 0.001), belief in avoidance (F (2, 386) = 7.10, p = 0.001), outcome expectancy (F (2, 386) = 11.32, p < 0.001), and burnout (F (2, 386) = 5.59, p = 0.005) decreased significantly. Self-efficacy (F (2, 386) = 5.37, p = 0.006) and compassion satisfaction (F (2, 386) = 127.99, p < 0.001) increased significantly.

Conclusion: The educational program addressed personal barriers to bereavement care. Role-play and group discussion about emotional and cognitive barriers can reduce barriers and improve self-efficacy in clinicians in hospice care.
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http://dx.doi.org/10.1007/s00520-021-06497-yDOI Listing
January 2022

Impact of Smoking-Related Chronic Obstruction Pulmonary Disease on Mortality of Invasive Ductal Carcinoma Patients Receiving Standard Treatments: Propensity Score-Matched, Nationwide, Population-Based Cohort Study.

Cancers (Basel) 2021 Jul 21;13(15). Epub 2021 Jul 21.

Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450052, China.

Purpose: the survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) is unclear for patients with invasive ductal carcinoma (IDC) receiving standard treatments.

Methods: we recruited women with clinical stage I-III IDC from the Taiwan Cancer Registry Database who had received standard treatments between 1 January 2009 and 31 December 2018. The time-dependent Cox proportional hazards model was used to analyze all-cause mortality. To reduce the effects of potential confounders when all-cause mortality between Groups 1 and 2 were compared, 1:2 propensity score matching (PSM) was performed. We categorized the patients into two groups based on COPD status to compare overall survival outcomes: Group 1 (current smokers with COPD) and Group 2 (nonsmokers without COPD group).

Results: PSM yielded 2319 patients with stage I-III IDC (773 and 1546 in Groups 1 and 2, respectively) eligible for further analysis. In the multivariate time-dependent Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality for Group 1 compared with Group 2 was 1.04 (0.83-1.22). The aHRs (95% CIs) of all-cause mortality for ≥1 hospitalization for COPDAE within one year before breast surgery was 1.51 (1.18-2.36) compared with no COPDAE.

Conclusion: smoking-related COPD was not a significant independent risk factor for all-cause mortality in women with stage I-III IDC receiving standard treatments. Being hospitalized at least once for COPDAE within one year before breast surgery is highly associated with high mortality for women with IDC receiving standard treatments. The severity of smoking-related COPD before treatments for breast cancer might be an important prognostic factor of survival. Thus, the information of the severity of COPD before treatment for breast cancer might be valuable for increasing the survival rate in treatment of breast cancer, especially in the prevention of progress from COPD to COPDAE.
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http://dx.doi.org/10.3390/cancers13153654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345139PMC
July 2021

Electronic health record note review in an outpatient specialty clinic: who is looking?

JAMIA Open 2021 Jul 31;4(3):ooab044. Epub 2021 Jul 31.

National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.

Note entry and review in electronic health records (EHRs) are time-consuming. While some clinics have adopted team-based models of note entry, how these models have impacted note review is unknown in outpatient specialty clinics such as ophthalmology. We hypothesized that ophthalmologists and ancillary staff review very few notes. Using audit log data from 9775 follow-up office visits in an academic ophthalmology clinic, we found ophthalmologists reviewed a median of 1 note per visit (2.6 ± 5.3% of available notes), while ancillary staff reviewed a median of 2 notes per visit (4.1 ± 6.2% of available notes). While prior ophthalmic office visit notes were the most frequently reviewed note type, ophthalmologists and staff reviewed no such notes in 51% and 31% of visits, respectively. These results highlight the collaborative nature of note review and raise concerns about how cumbersome EHR designs affect efficient note review and the utility of prior notes in ophthalmic clinical care.
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http://dx.doi.org/10.1093/jamiaopen/ooab044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325486PMC
July 2021

Pre-screening for osteoporosis with calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry bone density.

Sci Rep 2021 08 3;11(1):15709. Epub 2021 Aug 3.

Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.

Calcaneal quantitative ultrasonography (QUS) is a useful prescreening tool for osteoporosis, while the dual-energy X-ray absorptiometry (DXA) is the mainstream in clinical practice. We evaluated the correlation between QUS and DXA in a Taiwanese population. A total of 772 patients were enrolled and demographic data were recorded with the QUS and DXA T-score over the hip and spine. The correlation coefficient of QUS with the DXA-hip was 0.171. For DXA-spine, it was 0.135 overall, 0.237 in females, and 0.255 in males. The logistic regression model using DXA-spine as a dependent variable was established, and the classification table showed 66.2% accuracy. A receiver operating characteristic (ROC) analyses with Youden's Index revealed the optimal cut-off point of QUS for predicting osteoporosis to be 2.72. This study showed a meaningful correlation between QUS and DXA in a Taiwanese population. Thus, it is important to pre-screen for osteoporosis with calcaneus QUS.
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http://dx.doi.org/10.1038/s41598-021-95261-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8333105PMC
August 2021

Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy.

Cancers (Basel) 2021 Jun 28;13(13). Epub 2021 Jun 28.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.

Background: To date, no data are available regarding the effect of chronic obstruction pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on survival in patients with lung squamous cell carcinoma (SCC) receiving definitive concurrent chemoradiotherapy (CCRT).

Patients And Methods: We enrolled 3986 patients with clinical stage IIIA-IIIB, unresectable lung SCC, who had received standard definitive CCRT, and categorized them into two groups based on their COPD status to compare overall survival outcomes. We also examined the effects of COPD severity (0, 1, or ≥2 hospitalizations for COPDA within 1 year before CCRT).

Results: In the inverse probability of treatment weighting (IPTW)-adjusted model, the adjusted hazard ratio (aHR) (95% confidence interval (CI)) of all-cause death for COPD was 1.04 (1.01, 1.16), compared no COPD in patients with stage IIIA-IIIB lung SCC receiving definitive CCRT. In the IPTW-adjusted model, the aHRs (95% CIs) of 1 and ≥ 2 hospitalizations for COPDAE within 1 year before CCRT were 1.32 (1.19, 1.46) and 1.81 (1.49, 2.19) respectively, compared with no hospitalization for COPDAE.

Conclusion: COPD and its severity are significant independent risk factors for all-cause death in patients with stage IIIA-IIIB lung SCC receiving definitive CCRT. Hospitalization for COPDAE within 1 year before CCRT is the significant independent risk factor for lung cancer death in the patients with stage IIIA-IIIB lung SCC receiving definitive CCRT.
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http://dx.doi.org/10.3390/cancers13133231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268442PMC
June 2021

Application of Machine Learning to Predict Patient No-Shows in an Academic Pediatric Ophthalmology Clinic.

AMIA Annu Symp Proc 2020 25;2020:293-302. Epub 2021 Jan 25.

Department of Ophthalmology, Casey Eye Institute, and.

Patient "no-shows" are missed appointments resulting in clinical inefficiencies, revenue loss, and discontinuity of care. Using secondary electronic health record (EHR) data, we used machine learning to predict patient no-shows in follow-up and new patient visits in pediatric ophthalmology and to evaluate features for importance. The best model, XGBoost, had an area under the receiver operating characteristics curve (AUC) score of 0.90 for predicting no-shows in follow-up visits. The key findings from this study are: (1) secondary use of EHR data can be used to build datasets for predictive modeling and successfully predict patient no-shows in pediatric ophthalmology, (2) models predicting no-shows for follow-up visits are more accurate than those for new patient visits, and (3) the performance of predictive models is more robust in predicting no-shows compared to individual important features. We hope these models will be used for more effective interventions to mitigate the impact ofpatient no-shows.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075453PMC
June 2021

Optimization Shape-Memory Situations of a Stimulus Responsive Composite Material.

Polymers (Basel) 2021 Feb 25;13(5). Epub 2021 Feb 25.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia.

In these times of Industrial 4.0 and Health 4.0, people currently want to enhance the ability of science and technology, to focus on patient aspects. However, with intelligent, green energy and biomedicine these days, traditional three-dimensional (3D) printing technology has been unable to meet our needs, so 4D printing has now arisen. In this research, a shape-memory composite material with 3D printing technology was used for 4D printing technology. The authors used fused deposition modeling (FDM) to print a polylactic acid (PLA) strip onto the surface of paper to create a shape-memory composite material, and a stimulus (heat) was used to deform and recover the shape of this material. The deformation angle and recovery angle of the material were studied with various processing parameters (heating temperature, heating time, pitch, and printing speed). This research discusses optimal processing related to shape-memory situations of stimulus-responsive composite materials. The optimal deformation angle (maximum) of the stimulus-responsive composite material was found with a thermal stimulus for an optimal heating temperature of 190 °C, a heating time of 20 s, a pitch of 1.5 mm, and a printing speed of 80 mm/s. The optimal recovery angle (minimum) of this material was found with a thermal stimulus for an optimal heating temperature of 170 °C, a heating time of 90 s, a pitch of 2.0 mm, and a printing speed of 80 mm/s. The most important factor affecting both the deformation and recovery angle of the stimulus-responsive composite material was the heating temperature.
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http://dx.doi.org/10.3390/polym13050697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956782PMC
February 2021

Functional Superhydrophobic Surfaces with Spatially Programmable Adhesion.

Polymers (Basel) 2020 Dec 12;12(12). Epub 2020 Dec 12.

Department of Photonics, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.

A superhydrophobic surface that has controllable adhesion and is characterized by the lotus and petal effects is a powerful tool for the manipulation of liquid droplets. Such a surface has considerable potential in many domains, such as biomedicine, enhanced Raman scattering, and smart surfaces. There have been many attempts to fabricate superhydrophobic films; however, most of the fabricated films had uniform adhesion over their area. A patterned superhydrophobic surface with spatially controllable adhesion allows for increased functions in the context of droplet manipulation. In this study, we proposed a method based on liquid-crystal/polymer phase separation and local photopolymerization to realize a superhydrophobic surface with spatially varying adhesion. Materials and topographic structures were analyzed to understand their adhesion mechanisms. Two patterned surfaces with varying adhesion were fabricated from a superhydrophobic material to function as droplet guides and droplet collectors. Due to their easy fabrication and high functionality, superhydrophobic surfaces have high potential for being used in the fabrication of smart liquid-droplet-controlling surfaces for practical applications.
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http://dx.doi.org/10.3390/polym12122968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763520PMC
December 2020

Evaluation of Polyvinyl Alcohol/Cobalt Substituted Hydroxyapatite Nanocomposite as a Potential Wound Dressing for Diabetic Foot Ulcers.

Int J Mol Sci 2020 Nov 22;21(22). Epub 2020 Nov 22.

Graduate Institute of Oral Sciences, Chung Shan Medical University, Taichung City 40201, Taiwan.

Diabetic foot ulcers (DFUs) caused by diabetes are prone to serious and persistent infections. If not treated properly, it will cause tissue necrosis or septicemia due to peripheral blood vessel embolism. Therefore, it is an urgent challenge to accelerate wound healing and reduce the risk of bacterial infection in patients. In clinical practice, DFUs mostly use hydrogel dressing to cover the surface of the affected area as an auxiliary treatment. Polyvinyl alcohol (PVA) is a hydrophilic hydrogel polymer widely used in dressings, drug delivery, and medical applications. However, due to its weak bioactivity and antibacterial ability, leads to limited application. Filler adding is a useful way to enhance the biocompatibility of PVA. In our study, cobalt-substituted hydroxyapatite (CoHA) powder was prepared by the electrochemically-deposited method. PVA and PVA-CoHA nanocomposite were prepared by the solvent casting method. The bioactivity of the PVA and composite was evaluated by immersed in simulated body fluid for 7 days. In addition, L929 cells and were used to evaluate the cytotoxicity and antibacterial tests of PVA and PVA-CoHA nanocomposite. The results show that the addition of CoHA increases the mechanical properties and biological activity of PVA. Biocompatibility evaluation showed no significant cytotoxicity of PVA-CoHA composite. In addition, a small amount of cobalt ion was released to the culture medium from the nanocomposite in the cell culture period and enhanced cell growth. The addition of CoHA also confirmed that it could inhibit the growth of . PVA-CoHA composite may have potential applications in diabetic trauma healing and wound dressing.
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http://dx.doi.org/10.3390/ijms21228831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700235PMC
November 2020

Applications of Artificial Intelligence to Electronic Health Record Data in Ophthalmology.

Transl Vis Sci Technol 2020 02 27;9(2):13. Epub 2020 Feb 27.

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.

Widespread adoption of electronic health records (EHRs) has resulted in the collection of massive amounts of clinical data. In ophthalmology in particular, the volume range of data captured in EHR systems has been growing rapidly. Yet making effective secondary use of this EHR data for improving patient care and facilitating clinical decision-making has remained challenging due to the complexity and heterogeneity of these data. Artificial intelligence (AI) techniques present a promising way to analyze these multimodal data sets. While AI techniques have been extensively applied to imaging data, there are a limited number of studies employing AI techniques with clinical data from the EHR. The objective of this review is to provide an overview of different AI methods applied to EHR data in the field of ophthalmology. This literature review highlights that the secondary use of EHR data has focused on glaucoma, diabetic retinopathy, age-related macular degeneration, and cataracts with the use of AI techniques. These techniques have been used to improve ocular disease diagnosis, risk assessment, and progression prediction. Techniques such as supervised machine learning, deep learning, and natural language processing were most commonly used in the articles reviewed.
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http://dx.doi.org/10.1167/tvst.9.2.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347028PMC
February 2020

Predicting Wait Times in Pediatric Ophthalmology Outpatient Clinic Using Machine Learning.

AMIA Annu Symp Proc 2019 4;2019:1121-1128. Epub 2020 Mar 4.

Departments of Medical Informatics and Clinical Epidemiology and.

Patient perceptions of wait time during outpatient office visits can affect patient satisfaction. Providing accurate information about wait times could improve patients' satisfaction by reducing uncertainty. However, these are rarely known about efficient ways to predict wait time in the clinic. Supervised machine learning algorithms is a powerful tool for predictive modeling with large and complicated data sets. In this study, we tested machine learning models to predict wait times based on secondary EHR data in pediatric ophthalmology outpatient clinic. We compared several machine-learning algorithms, including random forest, elastic net, gradient boosting machine, support vector machine, and multiple linear regressions to find the most accurate model for prediction. The importance of the predictors was also identified via machine learning models. In the future, these models have the potential to combine with real-time EHR data to provide real time accurate estimates of patient wait time outpatient clinics.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153152PMC
August 2020

Emotional and cognitive barriers of bereavement care among clinical staff in hospice palliative care.

Palliat Support Care 2020 12;18(6):676-682

Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Objective: Bereavement care is one of the major components of hospice palliative care. Previous studies revealed the barriers to the success of the system, including lack of time or support from mental health professionals. Few studies have explored the intrapersonal barriers to bereavement care by clinical staff. The aims of the study were to explore (1) the emotional and cognitive barriers of bereavement care by hospice palliative care staff and (2) the demographic and work characteristics related to these emotional and cognitive barriers.

Method: The participants were clinical staff (n = 301) who were working in hospice palliative care units, including hospice wards, home care, and hospital-based palliative care teams. Their professional backgrounds included physicians (n = 12), nurses (n = 172), social workers (n = 59), psychologists (n = 34), spiritual care specialists (n = 15), and others (n = 9). A cross-sectional design was used and a standardized questionnaire including emotional and cognitive barriers was developed. Information on demographic and work characteristics was also collected. Content validity index, an exploratory factor analysis, and multiple regression analysis were conducted.

Results: One emotional barrier, "negative emotional reactions" (13 items, Cronbach's α = 0.92), and three cognitive barriers, "lack of ability" (7 items, Cronbach's α = 0.85), "belief in avoidance" (5 items, Cronbach's α = 0.86), and "outcome expectancy" (4 items, Cronbach's α = 0.85) were identified. Clinical staff who had higher working stress, lower self-rated ability for bereavement care, and higher negative impact from major life loss tended to have higher emotional and cognitive barriers.

Significance Of Results: Clinical staff should be aware of intrapersonal barriers to bereavement care. Educational programs should be developed to improve the ability to engage in bereavement care.
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http://dx.doi.org/10.1017/S147895152000022XDOI Listing
December 2020

Redundancy of Progress Notes for Serial Office Visits.

Ophthalmology 2020 01 21;127(1):134-135. Epub 2019 Jun 21.

Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.

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http://dx.doi.org/10.1016/j.ophtha.2019.06.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925342PMC
January 2020

Use of an Ecological Momentary Assessment Application to Assess the Effects of Auricular Point Acupressure for Chronic Low Back Pain.

Comput Inform Nurs 2019 May;37(5):276-282

Author Affiliation: University of Pittsburgh School of Nursing, PA (Drs Lin, Burke, and Schlenk); Johns Hopkins School of Nursing, Baltimore, MD (Dr Yeh).

The purpose of this pilot study was to assess the feasibility and usability of an ecological momentary assessment smartphone application. The app collected real-time data on chronic low back pain and time-contingent ecological momentary assessment surveys during a 4-week auricular point acupressure intervention, and on the consistency between recalled and momentary clinical measures. Eighteen participants received auricular point acupressure treatment weekly for 4 weeks. Each participant was provided a smartphone with the ecological momentary assessment application installed, along with instructions for use. The primary outcomes comprised pain intensity, pain interference with daily activity, sleep quality score, and medication usage. System Usability Scale and adherence were also measured. According to the results, the rate of adherence for completion of the random ecological momentary assessment survey was 87%. The usability score for the ecological momentary assessment application was reported as 78. The average recalled pain intensity was higher than the mean momentary pain intensity. Self-reported average pain interference with daily activities showed a similar result. Spearman rank correlation coefficients were greater than +0.70; P < .01 for the associations among recalled and momentary measurements. In conclusion, the study demonstrated promising adherence rates and supported the usability and feasibility of using an ecological momentary assessment application on a smartphone to collect real-time data on chronic lower back pain, which eliminated recall bias.
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http://dx.doi.org/10.1097/CIN.0000000000000478DOI Listing
May 2019

Long-term in vitro degradation behavior and biocompatibility of polycaprolactone/cobalt-substituted hydroxyapatite composite for bone tissue engineering.

Dent Mater 2019 05 8;35(5):751-762. Epub 2019 Mar 8.

Graduate Institute of Oral Science, Chung Shan Medical University, Taichung 40201, Taiwan; Chung Shan Medical University Hospital, Taichung 40201, Taiwan. Electronic address:

Objective: Currently, infections due to foreign-body reactions caused by bacteria or implant materials at the wound site are one of the major reasons for the failure of guided tissue regeneration (GTR) and guided bone regeneration (GBR) in clinical applications. The purpose of this study was to develop regeneration membranes with localized cobalt ion release to reduce infection and inflammation by polycaprolactone (PCL)/cobalt-substituted hydroxyapatite (CoHA).

Methods: The PCL composite membrane containing 20 wt% CoHA powders was prepared by solvent casting. The surface morphology, crystal structure, chemical composition and thermal properties of PCL composite membranes were characterized. The biocompatibility, osteogenic differentiation and antibacterial properties of composite membrane were also investigated. Then, in biodegradability was assessed by immersing phosphate buffer solution (PBS) for 6 months.

Results: Physicochemical analyses revealed that CoHA is evenly mixed in the membranes and assistance reduce the crystallinity of PCL for getting more degradation amounts than PCL membrane. Osteoblast cells culture on the membrane showed that the CoHA significantly increases cell proliferation and found the calcium deposition production increased over 90% compared with PCL after 7 days of culture. A good antibacterial effect was achieved by the addition of CoHA powder. The results were confirmed by 2.4 times reduction of proliferation of Escherichia coli (E. coli) seeded on the composite membrane after 24 h. Immersing in PBS for 6 months indicated that PCL-CoHA composite membrane has improved biodegradation and can continuously remove free radicals to reduce the inflammatory response.

Significance: The PCL-CoHA composite membrane with suitable releasing of cobalt ion can be considered as a potential choice for bone tissue regeneration.
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http://dx.doi.org/10.1016/j.dental.2019.02.023DOI Listing
May 2019

Secondary Use of Electronic Health Record Data for Prediction of Outpatient Visit Length in Ophthalmology Clinics.

AMIA Annu Symp Proc 2018 5;2018:1387-1394. Epub 2018 Dec 5.

Departments of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR.

Electronic health record systems have dramatically transformed the process of medical care, but one challenge has been increased time requirements for physicians. In this study, we address this challenge by developing and validating analytic models for predicting patient encounter length based on secondary EHR data. Key findings from this study are: (1) Secondary use of EHR data may be captured to predict provider interaction time with patients; (2) Modeling results using secondary data may provide more accurate predictions of provider interaction time than an expert provide; (3) These findings suggest that secondary use of EHR data may be used to develop effective customized scheduling methods to improve clinical efficiency. In the future, this has the potential to contribute toward methods for improved clinical scheduling and efficiency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371379PMC
January 2020

Clinical Documentation in Electronic Health Record Systems: Analysis of Similarity in Progress Notes from Consecutive Outpatient Ophthalmology Encounters.

AMIA Annu Symp Proc 2018 5;2018:1310-1318. Epub 2018 Dec 5.

Medical Informatics & Clinical Epidemiology.

Content importing technology enables duplication of large amounts of clinical text in electronic health record (EHR) progress notes. It can be difficult to find key sections such as Assessment and Plan in the resulting note. To quantify the extent of text length and duplication, we analyzed average ophthalmology note length and calculated novelty of each major note section (Subjective, Objective, Assessment, Plan, Other). We performed a retrospective chart review of consecutive note pairs and found that the average encounter note was 1182 ± 374 words long and less than a quarter of words changed between visits. The Plan note section had the highest percentage of change, and both the Assessment and Plan sections comprised a small fraction of the full note. Analysis of progress notes by section and unique content helps describe physician documentation activity and inform best practices and EHR design recommendations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371381PMC
January 2020
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