PubMed · 4497870
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T C Yin. 1974. [Water pollution and its control].. https://pubmed.ncbi.nlm.nih.gov/4497870/
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Nontuberculous mycobacteria (NTM) are diverse, and species-level identification remains challenging in routine diagnostics. We analyzed NTM isolates collected at three regional centers of the National Taiwan University Hospital (NTUH) from 2019 to 2024 to assess geographic variation and identification performance after implementation of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Among 3,188 cases meeting the microbiological criteria for probable pulmonary NTM disease, the species distribution differed by region: Mycobacterium avium complex predominated in central Taiwan (Yunlin, 47.3%), whereas M. abscessus complex (Taipei, 26.5%) and M. kansasii (Hsinchu, 12.4%) were more common in northern Taiwan. In 2019, 14.5% of isolates were reported to be unidentified by MALDI-TOF MS; with workflow optimization and database updates, this percentage decreased but plateaued at 4.5-4.8%. Whole-genome sequencing (WGS) of 61 randomly selected persistently unidentified isolates revealed eight average nucleotide identity (ANI)-defined clusters; 55 isolates (90.2%) could not be assigned to known species using current reference databases. Two clusters detected only in Hsinchu were phylogenetically closest to M. kyorinense, with ANI values below the species demarcation threshold. Overall, we observed marked regional heterogeneity of NTM in Taiwan and a persistent identification gap that remained after MALDI-TOF MS optimization and follow-up WGS.IMPORTANCEThis study characterized regional differences in the NTM species distribution across Taiwan, and the results highlight the limitations of current identification approaches. MALDI-TOF MS identifies most isolates, but locally circulating lineages represent a persistent gap in global reference libraries. Even with whole-genome sequencing (WGS), 90.2% (55/61) of persistently unresolved isolates could not be assigned to known species in the current reference databases despite the formation of clear ANI- and phylogeny-defined clusters. These findings show that both proteomic and genomic reference resources for clinical NTM remain incomplete. Expanding regionally representative databases and performing WGS for isolates that remain unresolved by MALDI-TOF MS will be necessary to improve species-level resolution for surveillance and clinical interpretation.
A great number of hospitals have already started to develop women-centered wards and out-patient services, but there has been no evaluation from the perspective of gender of the quality of these so-called women-centered health service models and whether they are truly based on women's needs. This article evaluates these service models from a feminist perspective. We performed content analysis of cases at those hospitals that took part in the Department of Health's women-centered health care program in 2002. The results showed that the program's content was based on improvements in hardware and work flow, and, furthermore, enhanced patient privacy and the humanized nature of the patient environment. Some issues, like the interaction between doctor and patient, women's consultation needs, the right to make one's own decisions, and body awareness, were somewhat neglected. Some of the hospitals, however, had achieved break-through reforms and outcomes in management of procedures, innovative services (e.g., women's health centers and databases of women's health management), growth groups and health consultation rooms. In many hospitals, levels of satisfaction among women were raised, but standards of retention and continued development of the effects of the program remain imperfect. Common problems were confusion of the concepts of mother-infant centered and women centered care, lack of consideration of gender mainstreaming, lack of needs assessment, and inadequacy of outcomes evaluation skills.
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