Tunable Polarization Conversion and Rotation based on a Reconfigurable Metasurface.

Polarization is an important property of electromagnetic (EM) wave and different polarization manipulations are required for varied optical applications. Here we report a reconfigurable metasurface which achieves both the polarization conversion and the polarization rotation in THz regime. The metasurface is reconfigured through the micro-electro-mechanical-systems (MEMS) actuation. The cross polarization transmittance from a linear polarized incidence is experimentally tuned from 0 to 28% at 2.66 THz. In addition, the polarization rotation angle is effectively changed from -12.8° to 13.1° at 1.78 THz. The tunable bi-functional metasurface for polarization conversion and the polarization rotation can be flexibly applied in various applications such as imaging, polarization microscopy and material analysis, etc.

Impact of Malnutrition on Physical, Cognitive Function and Mortality among Older Men Living in Veteran Homes by Minimum Data Set: A Prospective Cohort Study in Taiwan.

OBJECTIVES: To evaluate the prevalence of malnutrition and its impact on mortality, functional decline and cognitive impairment among elder residents in long-term care settings. DESIGNS: A prospective cohort study. SETTINGS: Two veteran homes in Taiwan. PARTICIPANTS: A total of 1,248 male residents aged equal or more than 65 years. MEASUREMENTS: Charlson's comorbidity index (CCI), Minimum data set (MDS), resident assessment protocols (RAP), Activity of daily living-Hierarchy scale, Cognitive Performance Scale, MDS Social engagement scale. RESULTS: The mean age of participants is 83.1 ± 5.1 years, and the prevalence of malnutrition was 6.1%. Inadequate dietary content (57.9%) and unintentional weight loss (31.6%) account for the majority of malnutrition identified by MDS tool. Higher 18-month mortality rate (25% vs. 14.2%), higher baseline CCI (median 1 vs. 0), and higher baseline sum of RAP triggers (median 8.5 vs. 5) were noted among residents with malnutrition. Furthermore, malnutrition was shown predictive for functional decline (OR: 3.096, 95% CI: 1.715-5.587) and potential cognitive improvement (OR: 2.469, 95% CI: 1.188-5.128) among survivors after adjustment for age, body mass index and CCI. CONCLUSION: Malnutrition among elder men residing in veteran homes was associated with multimorbidities and higher care complexity, and was predictive for mortality and functional decline.

Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan.

OBJECTIVES: Our aim is to develop the psychometric property of the Minimum Data-Set-Based Depression Rating Scale (MDS-DRS) to ensure its use to assess service needs and guide care plans for institutionalized residents. METHODS: 378 residents were recruited from the Haoran Senior Citizen Home in northern Taiwan. The MDS-DRS and GDS-SF were used to identify observable features of depression symptoms in the elderly residents. RESULTS: A total of 378 residents participated in this study. The receiver operating characteristic (ROC) curve indicated that the MDS-DRS has a 43.3% sensitivity and a 90.6% specificity when screening for depression symptoms. The total variance, explained by the two factors 'sadness' and 'distress,' was 58.1% based on the factor analysis. CONCLUSIONS: Reliable assessment tools for nurses are important because they allow the early detection of depression symptoms. The MDS-DRS items perform as well as the GDS-SF items in detecting depression symptoms. Furthermore, the MDS-DRS has the advantage of providing information to staff about care process implementation, which can facilitate the identification of areas that need improvement. Further research is needed to validate the use of the MDS-DRS in long-term care facilities.

The determinants of traditional Chinese medicine and acupuncture utilization for cancer patients with simultaneous conventional treatment.

This paper investigates the determinants of traditional Chinese medicine (TCM) and acupuncture utilization for cancer patients who are simultaneously having conventional Western medical treatments. This study used five leading cancers in Taiwan, namely cervical, breast, lung, liver and colorectal cancers. A total of 2499 cancer patients were interviewed, of which 2034 had full information and were analysed. Logistic regressions were used for both TCM and acupuncture. The results showed that type of cancer and cancer duration determine the utilization for alternative treatments. While socio-economic factors also affect choice of alternative medicine, the magnitude differs by types of alternative treatment and cancer. Compared with men and older patients, women and younger patients tend to prefer alternative medicine, and patients from south have higher preference for alternative medicine, which could be a reflection of local culture. Our results are useful for the government to determine higher users of TCM and acupuncture among cancer patients, and make policies to suit these patients' needs.

EMS characteristics in an Asian Metropolis.

A prospective citywide cohort study was conducted from August 1, 1993, through May 31, 1994 to analyze the epidemiological characteristics of emergency medical services (EMS) in an Asian city. Of 5,459 studied cases, the leading 3 causes were trauma (49.7%), alcohol intoxication (8.6%), and altered mental status (AMS) (6.9%). Half of the studied cases needed no prehospital care and 16.4% needed advanced life support (ALS) care. Traffic accidents accounted for 68% of trauma cases. Of 897 cases requiring ALS care, the two most common causes were AMS and dead on arrival (DOA) (32.1% and 21.2% in medical group, 10.1% and 4.5% in trauma group, respectively). The response time, time on scene, and transportation time were 4.6, 4.3, and 9.4 minutes, respectively. This Oriental EMS system experienced very short prehospital times, many traffic accidents, and extremely few DOA cases. Because few patients required ALS care, an emergency medical technician-based EMS system would probably be able to handle the majority of prehospital patients.

Fluoride in drinking water and the bone mineral density of women in Taiwan.

BACKGROUND: The current evidence on effect of fluoridation in drinking water on bone is inconsistent. This study was undertaken to assess the effect of fluoride concentration in drinking water on bone mineral density (BMD) in Taiwanese women. METHODS: The study subjects included 248 women aged > or = 40 years who reside in naturally fluoridated and adjacent areas. The individual fluoride concentration of the drinking water and the BMD of the subjects' lumbar spines were assessed. RESULTS: Women aged 46-65 years living in areas which have fluoride levels < 0.6 mg/l (mean = 0.18 mg/l; n = 130) had slightly lower bone densities than women living in areas with levels > or = 0.6 mg/l (mean 0.98 mg/l, n = 118). Only the age groups 46-50 and 61-65 years proved to be statistically significant. After controlling for age and body mass index, the BMD of those who had a dose > or = 1.0 mg/l is notably higher than the reference group (< or = 0.6 mg/l). After stratification by menopausal status, fluoride appeared to have no association with bone density in postmenopausal women. CONCLUSIONS: The BMD of the subjects from the area with a fluoride dose > 1 mg/l were significantly higher than those from the reference group (fluoride < 0.6 mg/l) for premenopausal women. There is no significant association between BMD and fluoride for postmenopausal women in Taiwan.

Incidence of stroke in Taiwan.

BACKGROUND AND PURPOSE: Few epidemiological studies concerning the incidence of stroke have been conducted in Taiwan. In an attempt to investigate this common disease, we studied the incidence of stroke in Taiwan in a prospective incidence study. METHODS: A cohort of 8,562 stroke-free people were followed up for 4 years to observe new stroke occurrence. The methods of sampling the study population have been reported elsewhere. In addition to the help of local doctors, who reported the new stroke cases, we also sent public nurses to visit the study population annually to screen the new cases of stroke. RESULTS: There were 104 (61 men and 43 women) first-ever stroke cases identified by a neurologist in a period between October 1, 1986 and December 31, 1990. The average annual incidence rate of first-ever stroke for people aged 36 years or older in this study was 330 per 100,000. Incidence rate was higher in eastern Taiwan and in rural communities. Percentages of the major types of stroke were as follows: cerebral infarction, 71%; cerebral hemorrhage, 22%; subarachnoid hemorrhage, 1%; and unclassified, 6%. The significant risk factors for stroke were hypertension and intake of food with a high sodium content. CONCLUSIONS: The age-specific incidence rates in this study are higher than those reported from the United Kingdom and the United States. The rates are close to those in a report from Japan and a report from a city in mainland China at the same latitude. Cerebral hemorrhages are more common among people in Taiwan than among Occidental people.

[Willingness to share costs of health insurance].

The purpose of this investigation, undertaken in 1988, was to find out citizens' willingness to share the costs of health insurance in metropolitan Taipei. The individuals sampled were from three groups: government employee insurer GEI, Labor insurer LI, and others OT. A stratified random sampling method and a closed-format questionnaire were used in this study. A total of 300 samples were taken from GEI, 500 form LI and 300 from OT. The total number of effective questionnaires were 1065. The questionnaire had 8 parts including individual basic data, consciousness of self health conditions, knowledge of LI, knowledge of GEI, degree of satisfaction with medical services, medical care utilization, willingness of health insurance, and willingness to share costs. The results showed that most people pay, most respondents would only be willing to pay a limited amount. The different factors positively influencing a willingness to cost share were level of education, average income and knowledge of health insurance, while the degree of satisfaction towards medical services was a negative influence. Since the public is not yet willing to accept a cost-sharing system, this study was of limited value in trying to find out the explanatory or predicting factors. Nevertheless, because of the negative reactions of respondents, we are obliged to more carefully and circumspectly rethink the implementation of a cost-sharing system.

Prevalence of stroke in Taiwan.

We investigated the prevalence of stroke in Taiwan in an epidemiologic study of stroke, diabetes, and cardiovascular disease that used a two-phase survey design. The study population was drawn by cluster sampling and consisted of both urban and rural communities from four regions of Taiwan. There were 8,705 people 36 years of age or older interviewed during the period of October 1 to December 31, 1986, and 143 cases of completed stroke were later identified by a neurologist. The point prevalence rate for people aged 36 or older in our study was 1,642/100,000 population (95% confidence interval 1,389-1,942/100,000). Prevalence rates differed significantly among the four study regions and between urban and rural communities; prevalence was greater in northern Taiwan and in urban communities. Percentages of the major types of stroke in 143 stroke survivors were as follows: cerebral infarction 67.1% (96 cases), cerebral hemorrhage 14.0% (20 cases), subarachnoid hemorrhage 4.2% (six cases), and unclassified 14.7% (21 cases). Of the stroke survivors, 67.1% were independent in activities of daily living, and 75.5% were independent in ambulation. Hypertension, heart disease, diabetes mellitus, and a family history of stroke were significantly more common in stroke survivors than in strokefree individuals.

Mutagenicity and polycyclic aromatic hydrocarbons analysis of airborne particulate matters from Taipei City.

The mutagenic activity of dichloromethane extracts of 147 air particulate samples collected from 8 stations during December 1986-June 1987 in Taipei city was consistently higher in S. typhimurium strain TA 98 than in strain TA 100 in the presence of S9 mixture. Among the 8 stations, Nan Kang Police Station, Fu Hsing Elementary School, and Chung Hsing University which were located in the industrial district, downtown area, and heavy traffic zone, respectively, had significantly higher levels of PAHs than the other stations. In contrast, the levels of PAHs were much lower in the suburban station, near Pei Tou Elementary School. However, PAH contents of the air particulate samples collected from these stations did not show good correlation with their mutagenicity. The air particulates collected at some stations on Sunday when the traffic changed from heavy to light showed lower mutagenicity and PAH contents as compared with the other weekdays at the same stations. On the contrary, the samples collected at Pei Tou station in a suburban area where the traffic changed from light to heavy on Sunday showed higher mutagenicity and PAH contents. The monthly average of PAHs of air particulate samples collected over a 7-month period from 8 stations in Taipei city was lower than the average in 1980. Moreover, when compared with other countries, such as U.S.A., the Netherlands, West Germany, Italy, Norway, and Japan, the levels of PAHs and mutagenicity of air particulate matters in Taipei city were similar or slightly lower. The mutagenicity and contents of PAHs of air particulates collected from burnt ABS were significantly higher than those of burnt PVC. One sample PT-6-3 was collected while a nearby garbage collection area was on fire. The mutagenicity of that sample increased 3 to 16 fold and contained an 11 to 33 times higher content of the six PAHs (BaP, BeP, BbF, BaA, Chr, and DbA) as compared with the other samples collected at the same location at a different time. The higher mutagenicity and PAH contents of that sample might be due to the pollution of the air from combustion of the garbage containing products made of ABS.

Decision making on the adoption of advanced medical technology in Taiwan.

This paper discusses both the current interest in and approaches to the employment of advanced medical technology in Taiwan. It describes the formation of the national policy, including funding, reimbursement, and regulatory processes, on adopting innovative and expensive medical technologies. Using the case of extracorporeal shockwave lithotripsy (ESWL), the key players who affect organizational decision making on the adoption and diffusion of medical technology have also been analyzed. Finally, it examines some of the salient features of medical technology adoption and assessment in Taiwan, and in other countries which depend heavily upon imported advanced medical technology. It is hoped that an understanding of Taiwan's attempts to use innovative medical technology wisely while incorporating the practice of technology assessment and appropriate policies, will assist other countries with similar conditions to gain maximal benefit from technological advancement.