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Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Cellulitis is a common infection of the skin and soft tissue. Susceptibility to cellulitis is related to microorganism virulence, the host immunity status and environmental factors. This retrospective study from 2001 to 2013 investigated relationships between the monthly incidence rate of cellulitis and meteorological factors using data from the Taiwanese Health Insurance Dataset and the Taiwanese Central Weather Bureau. Meteorological data included temperature, hours of sunshine, relative humidity, total rainfall and total number of rainy days. In otal, 195 841 patients were diagnosed with cellulitis and the incidence rate was strongly correlated with temperature (γS = 0.84, P < 0.001), total sunshine hours (γS = 0.65, P < 0.001) and total rainfall (γS = 0.53, P < 0.001). The incidence rate of cellulitis increased by 3.47/100 000 cases for every 1° elevation in environmental temperature. Our results may assist clinicians in educating the public of the increased risk of cellulitis during warm seasons and possible predisposing environmental factors for infection.
We consider the second order nonlinear ordinary differential equation u″ (t) = u1+α (α > 0) with positive initial data u(0) = a0, u′(0) = a1, whose solution becomes unbounded in a finite time T. The finite time T is called the blow-up time. Since finite difference schemes with uniform meshes can not reproduce such a phenomenon well, adaptively-defined grids are applied. Convergence with mesh sizes of certain smallness has been considered before. However, more iterations are required to obtain an approximate blow-up time if smaller meshes are applied. As a consequence, we consider in this paper a finite difference scheme with a rather larger grid size and show the convergence of the numerical solution and the numerical blow-up time. Application to the nonlinear wave equation is also discussed.
A series of self-assembled WO3–BiVO4 nanostructured thin films with 17, 25, 50, 67, and 100 mol% WO3 were grown on the (001) yttria-stabilized zirconia (YSZ) substrate by pulsed laser deposition method. The microstructures including crystalline phases, epitaxial relationship, interface structures, and chemical composition distributions were investigated by a combination of various electron microscopy techniques including scanning electron microscopy, transmission electron microscopy, and X-ray energy dispersive spectroscopy. The monoclinic BiVO4 formed the matrix, in which WO3 nanopillars were embedded with specific epitaxial relationships. In BiVO4-rich sample, orthorhombic Bi2WO6 was formed. However, metastable hexagonal WO3 phase and orthorhombic WO3 phase coexisted in other composite samples. The thin amorphous layer at the film/substrate interface indicated that the mismatch strain between films and substrate is released. The hydrostatic tensile strain due to thermal expansion mismatch between BiVO4 and WO3 as well as the diffusion of Bi into the WO3 stabilized the metastable h-WO3. A WO3–BiVO4 pseudobinary phase diagram was proposed based on the magnitude of the thermal expansion mismatch and the distance of Bi diffusion, which can be applied to design the microstructures of WO3–BiVO4 heterojunctions and optimize their photoelectrochemical properties.
Revising the diffusionist view of current scholarship on the Pasteur Institutes in China, this paper demonstrates the ways in which local networks and circumstances informed the circulation and construction of knowledge and practices relating to smallpox prophylaxis in the Southwest of China during the early twentieth century. I argue that the Pasteur Institute of Chengdu did not operate in a natural continuity with the preceding local French medical institutions, but rather presented an intentional break from them. This Institute, as the first established by the French in China, strove for political and administrative independence both from the Chinese authority and from the Catholic Church. Yet, its operation realized political independence only partially. The founding of this Institute was also an attempt to satisfy the medical demand for local vaccine production. However, even though the Institute succeeded at producing the Jennerian vaccine locally, its production needed to accommodate local conditions pertaining to the climate, vaccine strains, and animals. Furthermore, vaccination had to conform to Chinese variolation, including its social and medical practices, in order to achieve the collaboration of local Chinese traditional practitioners with French colonial physicians, who were Pastorian-trained and worked at the Pasteur Institute of Chengdu. Thus the nature of the Pastorian work in Chengdu was not an imposition of foreign standards and practices, but rather a mutual compromise and collaboration between the French and the Chinese.
X-ray absorption spectroscopy (XAS) is a widely used characterization technique to explore the local geometric and electronic structures of materials with element specificity. XAS measurements are performed at synchrotron radiation sources that provide brilliant, tunable, and monochromatic energy photons. The advantages of XAS include good elemental, chemical, and orbital sensitivities, which all stem from inherent electron excitation and transition processes. XAS is categorized into soft (<2000 eV) and hard (>5000 eV) x-ray regimes, based on the incident photon energy. Soft x-rays can probe the K-edges of low-Z (atomic number) elements, including Li, C, N, O, and F, and the L-edges of 3d transition metals, whose K-edge is within the hard x-ray regime. All of these elements are essential components of energy materials. This article introduces the principle of XAS and reviews some recent applications in energy storage and energy conversion, illustrating the capabilities of XAS to investigate the fundamental properties of materials from the points of view of atomic and electronic structures, which play crucial roles in understanding the reaction mechanisms in high-performance devices.
The age and growth of Kwangtung skate, Dipturus kwangtungensis, in the waters off northern Taiwan were estimated from 422 specimens collected between July 2006 and July 2008 at the Tashi fishing market in north-eastern Taiwan. The sexes-combined relationship between total length (TL) and centrum diameter (D) was estimated as follows: TL = 14.11D0.888 (N = 411, r2 = 0.94, P < 0.001). Growth band pairs (comprised of translucent and opaque bands) in vertebrae were determined to form once annually, based on the centrum edge analysis. Up to 14 band pairs were found for both sexes. The von Bertalanffy growth function (VBGF), two-parameter VBGF, the Robertson function, and the Gompertz function were used to fit the observed length-at-age data. The Akaike information criterion corrected indicated that the Gompertz function best fit the observed length at age data. Sex-specific growth functions were not significantly different; the sexes-combined growth parameters were estimated as follows: asymptotic length (L∞) = 96.7 cm TL, growth coefficient (kG) = 0.144 year−1 and constant (t0) = 5.45 year (N = 364, P < 0.01).
Previous studies in western countries have shown that about 30%–50% of patients with frontotemporal lobar degeneration (FTLD) have a positive family history, whereas the few epidemiological studies on FTLD done in Asia reported much lower frequencies. It is not clear the reason why the frequencies of FTLD with positive family history were lower in Asia. Furthermore, these findings were not from studies focused on family history. Therefore, it is necessary to conduct further studies on the family history of FTLD in Asia. This international multi-center research aims to investigate the family histories in patients with FTLD and related neurodegenerative diseases such as progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and motor neuron diseases in a larger Asian cohort.
Participants were collected from five countries: India, Indonesia, Japan, Taiwan, and Philippines. All patients were diagnosed with behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive non-fluent aphasia (PA), frontotemporal dementia with motor neuron disease (FTD/MND), PSP, and corticobasal degeneration (CBD) according to international consensus criteria. Family histories of FTLD and related neurodegenerative diseases were investigated in each patient.
Ninety-one patients were included in this study. Forty-two patients were diagnosed to have bvFTD, two patients had FTD/MND, 22 had SD, 15 had PA, one had PA/CBS, five had CBS and four patients had PSP. Family history of any FTLD spectrum disorder was reported in 9.5% in bvFTD patients but in none of the SD or PA.
In contrast to patients of the western countries, few Asian FTLD patients have positive family histories of dementia.
Knowledge of the control of the musculoskeletal system in patients with knee osteoarthritis (OA) during gait is helpful for the development of intervention programs in the management of these patients. The current study aimed to investigate the leg and joint stiffness, aswell as the associated joint kinematics and kinetics, in patients with bilateral medial knee OA during gait. Joint angles, moments and stiffness, as well as leg stiffness from fifteen patients with bilateral knee OA and fifteen normal controls during level walking, were obtained and their values at the beginning and end of single leg stance were compared using a t-test.
Patients with knee OA were found to modulate their leg and joint stiffness through acquired specific biomechanical strategies in order to maintain normal temporal-spatial patterns of gait. During weight acceptance, they increased their leg stiffness with increased knee stiffness but unalterd hip and ankle stiffness. During weight release, they modulated their hip and ankle kinetics with increased knee and ankle stiffness to improve the control stability of the limb with unaltered leg stiffness. It is suggested that muscle strengthening exercise intervention and/or rehabilitation for patients with knee OA should focus on activities that develop and/or maintain functions not only of the knee, but also of the overall lower extremity.
The Cu-type and (Cu-Fe)-type film catalysts have been successfully prepared by the electroless plating on ZnO nanorods/stainless steel substrates. The microstructure features of the (Cu-Fe)-type films are high porosity and plate-type grains. The addition of iron into Cu-type film can improve the reducibility and the stability of the film catalysts. The reduction temperature of the (Cu-Fe)-type film catalysts decreases with increasing the addition of Fe. For Cu-5 at% Fe film, the reduction temperature is in the range of 195°C to 216°C as comparison in the range of 208°C to 233°C of the Cu-type film catalysts.
The effect of minor transition metal (TM) additives of Ni, Co, or Zn on the interfacial reactions of the solder joints between Sn–Ag–Cu (SAC) solder and the Cu/Ni(P)/Au substrate was investigated, especially subsequent to multi-reflowing. (Cu,Ni)6Sn5 formed at the interface of all the joints except that of SAC–Ni, of which the interfacial compound was (Ni,Cu)6Sn5. The interfacial compounds of the SAC–Co and SAC–Zn contained a small amount of alloying elements of less than 3 at.%. Two P-rich layers, Ni3P and Ni–Sn–P emerged at the interface of the SAC joints. Nanoindentation analysis indicates that the hardness and Young’s modulus of these two phases were slightly higher than those of the Ni(P) substrate, which were in turn much greater than those of the Cu–Ni–Sn compounds. Worthy of notice is that with TM additions, the Ni–Sn–P phase between Ni3P and interfacial compounds was absent even after 10 reflows. For the SAC–Co joints, the growth of Ni-containing intermetallic compounds within the solder gave rise to the excess Ni dissolution, which caused a discrete Ni3P layer and over-consumed Ni(P) substrate underneath the grooves in-between (Cu, Ni)6Sn5 scallop grains at the interface. This phenomenon is presented for the first time, and the mechanism is proposed in this study.
Coordinating and collecting satellite data of changing polar environments is one of the prime activities of International Polar Year (IPY) 2007–08 (Rapley et al. 2004). Within this framework, the requirements to obtain spaceborne snapshots of the Polar Regions and key high latitude processes have been prepared by the international cryospheric community under the auspices of the approved IPY project titled the Global Inter-agency IPY Polar Snapshot Year (GIIPSY). Earlier efforts in manoeuvring Radarsat-1 in a special mode provided radar images with a spatial resolution of 30 m over the entirety of Antarctica during September–October 1997 (Jezek et al. 1998). Limited to their altitude (AL), swath (SW) and pointing capability (PC), however, the operation of optical satellites with high-spatial-resolution sensors is generally restricted to certain latitudes. For example, Landsat (AL:705 km/SW:185 km/PC:0°) mission has been able to provide high-spatial-resolution optical imagery only to ~81°N to ~81°S since the 1980s. The coverage is now extended to ~86° by ASTER (AL:705 km/SW:60 km/PC:24°) (Kargel et al. 2005), but there has been no availability of space-borne optical image of the polar regions with a resolution equivalent or higher than Landsat type sensors with latitudes higher than 86°, until the successful operation of Formosat-2 (AL:891 km/SW:24 km/PC: ± 45° across and along track). Equipped with two-axes high torque reaction wheels, Formosat-2 is able to point not only to ± 45° across track, but also to ± 45° along track (Liu et al. 2007). Figure 1 shows the accessible areas (longer lines: along track ± 0°, across track ± 45°; shorter lines: along track ± 0°, across track ± 30°) and the corresponding ground tracks (solid curves) of Formosat-2 in the Polar Regions. Note that the accessible areas would be even greater if the pointing direction is also set to ± 45° along track. The detailed comparison of Formosat-2 with other similar sensors, including the multi-spectral bands and imaging repeat period, can be found in table I in Liu et al. (2007). To support IPY 2007–08, the National Space Organization (NSPO) of Taiwan launched a Polar Imaging Campaign (PIC) in March 2006. Up to September 2007, a total of 1 131 624 km2 in the North Polar Region and a total of 57 408 km2 in the South Polar Region had been imaged by Formosat-2. All Formosat-2 images taken during the NSPO PIC are available from the authors.
The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and the lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum ‘doing-the-month’ ritual.
Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0·3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured.
Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, β-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant.
Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.
Highly porous Ti and TiZrV getter film coatings have been successfully grown on (100) silicon substrates using the glancing-angle direct-current magnetron sputtering method. The evolution of the microstructures of the Ti and the TiZrV films strongly depends on the sputtering flux rate, surface diffusion rate, nucleation rate, compositions, and self-shadowing geometry of the nuclei on the sputtering flux. The larger the glancing angle, the higher the porosity and specific surface area of the Ti and TiZrV films. The weight-gain results strongly depend on several factors, such as specific surface area, the surface structure of the getter film, the diffusion rate of O in the getter film, the reactivity of Ti, Zr, and V on O, and the order of the stabilities of Ti, Zr, and V oxides on the film’s surface. Porous Ti film absorbs oxygen better than porous TiZrV film does due to its higher surface area and the high diffusion rate of O in Ti films.
We investigated a cluster of postoperative febrile episodes and episodes of Acinetobacter baumannii bacteremia in obstetrics and gynecology wards after an electrical blackout and loss of the water supply. The use of patient-controlled analgesia was the only independent risk factor associated with postoperative fever, and A. baumannii isolates recovered from the blood of patients who had received patient-controlled analgesia were genetically related to an isolate recovered from the diluted morphine solution used for this procedure. After inappropriate preparation of the morphine solution was identified and stopped, the outbreak ended.
The isozymes of 10 enzymes connected with energy metabolism in Tegillarca granosa were analysed by vertical polyacrylamide gel electrophoresis. Esterase and α-amylase are enzymes related to energy intake, their activities were high in the digestive gland. Malate dehydrogenase, malic enzyme, isocitrate dehydrogenase, succinate dehydrogenase, alcohol dehydrogenase, lactate dehydrogenase, 6-phosphogluconate dehydrogenase (G-6-PDH) and adenosine triphosphatase (ATPase) are enzymes related to energy metabolism. The main energy supply of T. granosa comes from aerobic respiration; anaerobic metabolism and the pentose phosphate pathway take an auxiliary role in energy metabolism. The high activity of G-6-PDH in T. granosa might mean a considerable proportion of carbohydrates metabolized through this pathway. This reaction could provide abundant NADP for metabolism in T. granosa. Compared with other shellfish, T. granosa had lower activity of ATPase, which might have some relationship with the amnicolous life and low motility of this animal.
A novel polymeric composite material, polystyrene (PS)-grafted carbon nanocapsules (CNCs), has been prepared. sec-butyllithium was first used to introduce negative charges on CNCs, and these CNC carbanions acted then as initiators for anionic polymerization of styrene. Based on a weight loss at the decomposition temperature of the butyl groups, the quantity of the butyls attached to the CNC surface was determined as 1.18 wt%, corresponding to 0.25 mol% initiator per mol of carbon atom on the CNC surface. Furthermore, the decomposition temperature of butylated CNCs was lower than that of the pristine CNCs by nearly 200 °C. The polystyrene content in our PS-grafted CNC sample was approximately 20%, and the molecular weight of the grafted PS on the surface of CNCs was calculated as 1200 gmol−1. Compared with the molecular weight of the ungrafted PS, the molecular weight of grafted PS was lower, thus indicating rates of initiation and/or propagation for CNC-bound carbanions lower than those of the free sec-butyllithium. The PS-grafted CNCs had good dispersion in toluene, tetrahydrofuran, cyclohexane, and other common organic solvents in which polystyrene was dissolvable and thus indicated good compatibility when further blended with other styrenic polymers. The PS-grafted CNCs were characterized and examined by Fourier transform infrared, thermogravimetric analysis, atomic force microscopy, differential scanning calorimetry, ultraviolet-visible spectroscopy, Raman spectroscopy, scanning electron microscopy, and transmission electron microscopy. The electron microscopy images indicated that the PS-grafted CNCs were homogeneous composites containing uniform polymer/CNC ratios.
The authors report the study of the dependence of the device performance of polymer solar cells based on single 50-nm heterojunction poly(3-hexylthiophene)/[6,6]-phenyl-C61-butyric acid methylester (P3HT/PCBM) layer on annealing process. Annealing before and after cathode deposition were performed for comparison. In the case of post-annealing at 150¢XC for 60 min., the device attains a conversion efficiency of 4.9%, a fill factor of 53 %, and an open-circuit voltage of 0.67 V. These values are comparable with the highest values reported previously. The annealing process is expected to modify the network morphology of the P3HT/PCBM layer. This study demonstrates that it is possible to attain good solar cell performance with the combination of single thin active layer and post-annealing treatment. This may open up an opportunity to fabricate tandem polymer solar cells.
In this report, we demonstrate that the performance and stability of pentacene top-contact field-effect transistor can be greatly improved with post-annealing treatment. After post-annealing at 90°C for 12 hours in nitrogen environment, the hole field-effect mobility of 0.3 cm2/Vs and the on/off current ratio of 107 were achieved, demonstrating 100% improvement in performance after the post-annealing treatment. The decay rate of drain current at constant gate and drain-source voltage was found to be decreased by more than 40%. The improved performance is attributed to the elimination of trapped holes and lattice defects in the organic semiconductor layer due to the post-annealing process.
We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community.
We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures.
A 2,300-bed medical center in Kaohsiung, Taiwan.
A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later.
Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.