Hungkuang University

In the original publication [...].

The journal retracts the article entitled “A Fuzzy Multicriteria Decision-Making (MCDM) Model for Sustainable Supplier Evaluation and Selection Based on Triple Bottom Line Approaches in the Garment Industry” [...]

Acute respiratory distress syndrome (ARDS) is a life-threatening form of non-cardiogenic respiratory failure that can occur after severe systemic or traumatic insults. We report a rare case of ARDS in a 17-year-old female who sustained a burst fracture at the second lumbar vertebra and bilateral calcaneal fractures after jumping from a height of six meters. She underwent uneventful spinal decompression and instrumentation six hours post-injury, with stable hemodynamics and balanced fluid administration. Initial chest CT showed no lung abnormalities. On postoperative day 2, she developed respiratory distress preceded by a metallic, blood-like taste during breathing. Follow-up CT revealed new bilateral diffuse lung consolidations. Bronchoscopy showed diffuse pulmonary hemorrhage without active bleeding, suggesting lung contusion. Echocardiography excluded cardiac causes, and extensive microbiological testing, including bronchoalveolar lavage and viral panels, yielded no infectious pathogens. Although broad-spectrum antibiotics were used in response to perioperative fever and elevated inflammatory level, no definitive infection was identified, and inflammatory markers normalized with ventilatory support. This case illustrates a potential underrecognized mechanism of ARDS: pulmonary contusion from high-energy vertical deceleration in the absence of external chest trauma. To our knowledge, no prior literature has reported ARDS following spinal fractures due to vertical falls without chest wall injury. We propose that sudden deceleration during impact can transmit force through the thoracic cage, causing occult microvascular lung injury. Early recognition and close respiratory monitoring are essential in similar trauma scenarios, even when initial imaging is unremarkable.

Abstract Distinguishing between neurogenic and vascular claudication can be challenging in older patients with degenerative spinal changes and cardiovascular risk factors. We report the case of a 71-year-old male with a 4-year history of exertional left buttock pain without initial presentation of diminished peripheral pulses, skin discoloration, temperature variations, poor hair growth, or trophic skin changes presumed to be neurogenic based on magnetic resonance imaging of L2–L3 lumbar spinal stenosis. He underwent two diagnostic transforaminal epidural steroid injections, followed by endoscopic interlaminar decompression without improvement. Subsequent evaluation revealed a reduced left ankle-brachial index (ABI; 0.71), and computed tomography angiography revealed total occlusion of the left common iliac artery with segmental involvement of other pelvic arteries. The patient underwent successful percutaneous transluminal angioplasty with stenting, which resolved symptoms. Proximal iliac disease could be easily missed in clinical settings with normal distal pulses due to collateral circulation. ABI testing and vascular imaging should be integrated into the diagnostic pathway.

Abstract Grounded in self-determination theory, this chapter investigates the impact of work meaning on service innovation behavior among travel agency employees and explores the moderating influence of perceived organizational support. A survey was conducted across 30 travel agencies in Taiwan, yielding 337 valid responses. The proposed hypotheses were tested using multiple regression analysis. The analysis indicates that a strong sense of work meaning enhances employees’ service innovation behavior. Furthermore, perceived organizational support strengthens this relationship, suggesting that when employees recognize supportive actions from their organization, they are more prone to translate meaningful work into innovative service practices. These findings expand the existing theoretical knowledge of service innovation by emphasizing the psychological and organizational factors that drive it. Additionally, this chapter provides practical insights for travel agencies, highlighting the importance of fostering a meaningful work environment and organizational support to encourage innovation. Future research directions are also proposed to expand on these findings.

Emotional exhaustion among ICU professionals poses a significant threat to both health care quality and staff well-being. While patient safety culture (PSC) is recognized as a potential buffer, its longitudinal impact on emotional exhaustion remains underexplored, particularly within high-intensity clinical environments like ICUs. This study investigates how ICU professionals' perceptions of PSC influence the progression of emotional exhaustion over a 5-year period, highlighting shifts in organizational and psychological predictors. A 5-year longitudinal survey (2020-2024) was conducted in a regional teaching hospital in Taiwan. A total of 1213 valid responses were collected from ICU physicians and nurses using the Chinese version of the Safety Attitudes Questionnaire (CSAQ), which includes 6 PSC dimensions and an emotional exhaustion scale. Stepwise multiple regression was used annually to identify significant predictors of emotional exhaustion. Findings revealed a temporal shift in the predictors of emotional exhaustion. In 2020, organizational support factors-job satisfaction (β=-0.523, p<0.001) and perceptions of management (β=-0.443, p<0.001)-were significant negative predictors, while safety climate showed a counterintuitive positive association (β=0.264, p=0.004). From 2021 to 2024, stress recognition emerged as the most consistent protective factor (β range=-0.366 to -0.537, p<0.001). Interestingly, teamwork climate, often considered beneficial, was positively associated with emotional exhaustion in later years, suggesting added interpersonal burdens in collaborative ICU settings. Emotional exhaustion in ICU professionals is shaped by dynamic interactions between organizational structures and individual-level coping resources. Early burnout prevention should focus on institutional support, while long-term strategies should promote stress awareness and carefully manage team-based expectations. These findings provide health care leaders with actionable insights to design adaptive, stage-specific interventions to sustain psychological resilience in high-stress clinical environments.

Background/Objectives: Late-life depression is prevalent yet frequently underdiagnosed, underscoring the need for accessible and safe non-pharmacological approaches. Pet-assisted interventions, including live animal-assisted therapy and robotic pets, have gained attention, but their comparative effectiveness remains unclear. This study aimed to evaluate and rank different pet-assisted approaches for reducing depressive symptoms in older adults using network meta-analysis. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library up to August 2025 for randomized controlled trials involving adults aged 60 years or older with depression. The protocol was prospectively registered on INPLASY (INPLASY2025100023). Depression severity, assessed using validated scales, was synthesized using a frequentist random-effects network meta-analysis framework. Results: Twenty trials involving 1073 participants were included. Live animal-assisted therapy produced the greatest reduction in depressive symptoms versus passive control (SMD −2.04; 95% CI −3.03 to −1.04). Combining it with gait training (structured walking-based activity conducted with the animal) was associated with a reduction in depressive symptoms (SMD −4.82; 95% CI −6.69 to −2.95). Robotic pets showed a directionally beneficial but non-significant effect (SMD −1.21; 95% CI −2.79 to 0.38). Conclusions: Pet-assisted interventions are effective in reducing depressive symptoms among older adults. Live animal-assisted therapy, particularly when delivered in structured or combined formats, shows the greater benefit. Robotic pets may serve as a practical alternative when live animals cannot be implemented.