An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study.

BACKGROUND: We aimed to develop a consensus on the need for and priorities of exercise to treat preexisting sarcopenia with hemiplegic stroke. METHODS: A modified three-round Delphi study was conducted. The panelists responded to the questionnaire on a 7-point Likert scale. Responses were returned with descriptive statistics in the next round. Consensus was defined as >75% agreement (score of 5-7) with a median > 5. The percentage of strong agreement (score of 6-7) and Kendall's coefficient of concordance were calculated to demonstrate a more refined interpretation of the consensus. RESULTS: Fifteen panelists contributed to all rounds. The need for exercise was demonstrated. The consensus was reached on 53 of 58 items in the first round and all items in the second and final rounds. The percentage of strong agreement was high for all but eight items. CONCLUSIONS: This study is the first Delphi study to investigate the need for and priorities of exercise for treating preexisting sarcopenia in stroke hemiplegia. We present a standard recommendation including 57 priorities and a strong recommendation including 49 priorities. The eight items that were excluded reflected factors that are less important to hemiplegic patients with poor balance, cognitive decline, or mental vulnerability.

Systematic Review of Descriptions and Justifications Provided for Single-Case Quantification Techniques.

There are currently a multitude of quantification techniques that have been developed for use with single-case designs. As a result, choosing an appropriate quantification technique can be overwhelming and it can be difficult for researchers to properly describe and justify their use of quantification techniques. However, providing clear descriptions and justifications is important for enhancing the credibility of single-case research, and allowing others to evaluate the appropriateness of the quantification technique used. The aim of this systematic literature review is to provide an overview of the quantification techniques that are used to analyze single-case designs, with a focus on the descriptions and justifications that are provided. A total of 290 quantifications occurred across 218 articles, and the descriptions and justifications that were provided for the quantification techniques that were used are systematically examined. Results show that certain quantification techniques, such as the non-overlap indices, are more commonly used. Descriptions and justifications provided for using the quantification techniques are sometimes vague or subjective. Single-case researchers are encouraged to complement visual analysis with the use of quantification techniques for which they can provide objective and appropriate descriptions and justifications, and are encouraged to use tools to guide their choice of quantification techniques.

Investigating the Impact of Voice Impairment on Quality of Life in Stroke Patients: The Voice Handicap Index (VHI) Questionnaire Study.

The Voice Handicap Index (VHI) is a patient-centered evaluation tool specifically designed for assessing voice-related quality of life. Although the VHI has been extensively used in patients with voice disorders, its applicability in stroke patients has not been fully established. This prospective cross-sectional study aimed to investigate the feasibility of using the VHI questionnaire in identifying stroke patients with voice problems. The study included a cohort of acute to subacute first-ever stroke patients (n = 48), with or without voice problems, as well as other non-stroke patients (n = 31) who agreed to complete the VHI questionnaire. Stroke patients with self-reported voice problems demonstrated significantly higher VHI scores and poorer life quality scores compared to the control groups. These patients also had lower Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), and Euro-QoL-5D-5L (EQ-5D-5L) scores. Spearman correlation analysis revealed an inverse association between VHI scores and EQ-5D-5L (rho = -0.77, p < 0.001), Korean Mann Assessment of Swallowing Ability (rho = -0.51, p < 0.001), and other functional parameters, including the National Institutes of Health Stroke Scale, MMSE, and MBI scores. Multiple regression analysis indicated that the VHI score was the biggest contributing factor to EQ scores. This is the first study to demonstrate that stroke patients with voice problems may experience reduced quality of life, even after controlling for other confounding factors such as dysphagia or neurological deficits. Future studies are needed whether addressing these issues by implementing the VHI may facilitate the improvement of patients' quality of life.

Investigations on Practical Issues in Solid Immersion Lens Based Sub-Wavelength Terahertz Imaging Technique: System Stability Verification and Interference Pattern Removal.

Terahertz (THz) imaging techniques are attractive for a wide range of applications, such as non-destructive testing, biological sensing, and security imaging. We investigate practical issues in THz imaging systems based on a solid immersion lens (SIL). The system stability in terms of longitudinal misalignment of the SIL is experimentally verified by showing that the diffraction-limited sub-wavelength beam size (0.7 λ) is maintained as long as the SIL is axially located within the depth-of-focus (~13 λ) of the objective lens. The origin of the fringe patterns, which are undesirable but inevitable in THz imaging systems that use continuous waves, is analytically studied, and a method for minimizing the interference patterns is proposed. By combining two THz images obtained at different axial positions of the object and separated by λ/4, the interference patterns are significantly reduced, and the information hidden under the interference patterns is unveiled. The broad applicability of the proposed method is demonstrated by imaging objects with different surface profiles. Our work proves that the resolution of conventional THz imaging systems can easily be enhanced by simply inserting a SIL in front of the object with high tolerance in the longitudinal misalignment and provides a method enabling THz imaging for objects with different surface profiles.

Remote N2O gas sensing by enhanced 910-m propagation of THz pulses.

We modified our 910-m long path THz system to increase the signal-to-noise ratio (S/N) with a nanostructure plasmonic THz transmitter (Tx) chip and a seven-mirror array reflector with 1 m diameter. When the THz pulse propagates the 910-m distance in the atmosphere, the S/N is up to 1170:1, which made the THz pulse measurable at a high water vapor density (WVD) of up to 25.2 g/m3. The time shift of the THz pulse according to the WVD measured for each meteorological season was matched well with the theoretical result. Due to the modified long-distance THz system, we were able to measure for the first time the resonances of N2O gas, which is located 455 m away from the Tx and receiver (Rx) chips and contained in a 1.5-m diameter rubber balloon under atmospheric pressure. Seven resonances can be detected except for one overlay of resonant frequency by water vapor.

Terahertz continuous wave system using phase shift interferometry for measuring the thickness of sub-100-µm-thick samples without frequency sweep.

A terahertz continuous wave system is demonstrated for thickness measurement using Gouy phase shift interferometry without frequency sweep. One arm of the interferometer utilizes a collimated wave as a reference, and the other arm applies a focused beam for sample investigation. When the optical path difference (OPD) of the arms is zero, a destructive interference pattern is produced. Interference signal intensity changes induced by the OPD changes can be easily predicted by calculations. By minimizing the difference between the measured and the calculated signal against the OPD, the thicknesses of sub-100-µm-thick samples are determined at 625 GHz.

Polarization-selective control of nonlinear optomechanical interactions in subwavelength elliptical waveguides.

Photonic devices that exhibit all-optically reconfigurable polarization dependence with a large dynamic range would be highly attractive for active polarization control. Here, we report that strongly polarization-selective nonlinear optomechanical interactions emerge in subwavelength waveguides. By using full-vectorial finite element analysis, we find, at certain core ellipticities (or aspect ratios), that the forward simulated light scattering mediated by a specific acoustic resonance mode is eliminated for one polarization mode. Whereas, that for the other polarization mode is rather enhanced. This intriguing phenomenon can be explained by the interplay between the electrostrictive force and radiation pressure and turns out to be tailorable by the choice of waveguide materials.

Terahertz rectifier exploiting electric field-induced hot-carrier effect in asymmetric nano-electrode.

Rectifiers have been used to detect electromagnetic waves with very low photon energies. In these rectifying devices, different methods have been utilized, such as adjusting the bandgap and the doping profile, or utilizing the contact potential of the metal-semiconductor junction to produce current flow depending on the direction of the electric field. In this paper, it is shown that the asymmetric application of nano-electrodes to a metal-semiconductor-metal (MSM) structure can produce such rectification characteristics, and a terahertz (THz) wave detector based on the nano-MSM structure is proposed. Integrated with a receiving antenna, the fabricated device detects THz radiation up to a frequency of 1.5 THz with responsivity and noise equivalent power of 10.8 V/W and [Formula: see text] respectively, estimated at 0.3 THz. The unidirectional current flow is attributed to the thermionic emission of hot carriers accelerated by the locally enhanced THz field at the sharp end of the nano-electrode. This work not only demonstrates a new type of THz detector but also proposes a method for manipulating ultrafast charge-carrier dynamics through the field enhancement of the nano-electrode, which can be applied to ultrafast photonic and electronic devices.

Terahertz radiation using log-spiral-based low-temperature-grown InGaAs photoconductive antenna pumped by mode-locked Yb-doped fiber laser.

We demonstrate a terahertz (THz) radiation using log-spiral-based low-temperature-grown (LTG) InGaAs photoconductive antenna (PCA) modules and a passively mode-locked 1030 nm Yb-doped fiber laser. The passively mode-locked Yb-doped fiber laser is easily implemented with nonlinear polarization rotation in the normal dispersion using a 10-nm spectral filter. The laser generates over 250 mW of the average output power with positively chirped 1.58 ps pulses, which are dechirped to 127 fs pulses using a pulse compressor outside the laser cavity. In order to obtain THz radiation, a home-made emitter and receiver constructed from log-spiral-based LTG InGaAs PCA modules were used to generate and detect THz signals, respectively. We successfully achieved absorption lines over 1.5 THz for water vapor in free space. Therefore, we confirm that a mode-locked Yb-doped fiber laser has the potential to be used as an optical source to generate THZ waves.

Electrically controllable terahertz square-loop metamaterial based on VO2 thin film.

An electrically controllable square-loop metamaterial based on vanadium dioxide (VO2) thin film was proposed in the terahertz frequency regime. The square-loop shaped metamaterial was adopted to perform roles not only as a resonator but also as a micro-heater for the electrical control of the VO2. A dual-resonant square-loop structure was designed to realize band-pass characteristics in the desired frequency band. The measured Q-factors of the basic and scaled-down metamaterials fabricated on VO2 thin films were 2.22 and 1.61 at the center frequencies of 0.44 and 1.14 THz in the passbands, respectively. The transmittances of the proposed metamaterial were successfully controlled by applying a bias voltage without an external heater. The measured transmittance on-off ratios of the metamaterials were over 40 at the center frequencies in the passbands. In the future, electrically controllable terahertz metamaterial based on VO2 metamaterial could be employed as high-performance active filters or sensors.

Bias field tailored plasmonic nano-electrode for high-power terahertz photonic devices.

Photoconductive antennas with nano-structured electrodes and which show significantly improved performances have been proposed to satisfy the demand for compact and efficient terahertz (THz) sources. Plasmonic field enhancement was previously considered the dominant mechanism accounting for the improvements in the underlying physics. However, we discovered that the role of plasmonic field enhancement is limited and near-field distribution of bias field should be considered as well. In this paper, we clearly show that the locally enhanced bias field due to the size effect is much more important than the plasmonic enhanced absorption in the nano-structured electrodes for the THz emitters. Consequently, an improved nano-electrode design is presented by tailoring bias field distribution and plasmonic enhancement. Our findings will pave the way for new perspectives in the design and analysis of plasmonic nano-structures for more efficient THz photonic devices.

Metal-VO2 hybrid grating structure for a terahertz active switchable linear polarizer.

An active terahertz (THz) wave hybrid grating structure of Au/Ti metallic grating on VO2/Al2O3 (0001) was fabricated and evaluated. In our structure, it is shown that the metallic gratings on the VO2 layer strengthen the metallic characteristics to enhance the contrast of the metallic and dielectric phases of a VO2-based device. Especially, the metal grating-induced optical conductivity of the device is greatly enhanced, three times more than that of a metallic phase of bare VO2 films in the 0.1-2.0 THz spectral range. As an illustrative example, we fabricated an actively on/off switchable THz linear polarizer. The fabricated device has shown commercially comparable values in degree of polarization (DOP) and extinction ratio (ER). A high value of 0.89 in the modulation depth (MD) for the transmission field amplitude, superior to other THz wave modulators, is achieved. The experimental results show that the fabricated device can be highly useful in many applications, including active THz linear polarizers, THz wave modulators and variable THz attenuators.

Frequency modulation based continuous-wave terahertz homodyne system.

In this study, inspired by the frequency-modulated continuous-wave (FMCW) method, an operation scheme of continuous-wave (CW) terahertz (THz) homodyne system is proposed and evaluated. For this purpose, we utilized the fast and stable wavelength tuning characteristics of a dual-mode laser (DML) as a beating source. Using the frequency-modulated THz waves generated by DML, a cost-effective and robust operation of CW THz system to be applicable to the measurements of thickness or refractive index of a sample is demonstrated. We believe that the proposed scheme shows a potential to the implementations of compact and fast CW THz measurement systems that can be useful in many THz applications.

Real-time continuous-wave terahertz line scanner based on a compact 1 × 240 InGaAs Schottky barrier diode array detector.

We demonstrate real-time continuous-wave terahertz (THz) line-scanned imaging based on a 1 × 240 InGaAs Schottky barrier diode (SBD) array detector with a scan velocity of 25 cm/s, a scan line length of 12 cm, and a pixel size of 0.5 × 0.5 mm². Foreign substances, such as a paper clip with a spatial resolution of approximately 1 mm that is hidden under a cracker, are clearly detected by this THz line-scanning system. The system consists of the SBD array detector, a 200-GHz gyrotron source, a conveyor system, and several optical components such as a high-density polyethylene cylindrical lens, metal cylindrical mirror, and THz wire-grid polarizer. Using the THz polarizer, the signal-to-noise ratio of the SBD array detector improves because the quality of the source beam is enhanced.

Continuous-wave terahertz system based on a dual-mode laser for real-time non-contact measurement of thickness and conductivity.

Terahertz (THz) waves have been exploited for the non-contact measurements of thickness and refractive index, which has enormous industrial applicability. In this work, we demonstrate a 1.3-µm dual-mode laser (DML)-based continuous-wave THz system for the real-time measurement of a commercial indium-tin-oxide (ITO)-coated glass. The system is compact, cost-effective, and capable of performing broadband measurement within a second at the setting resolution of 1 GHz. The thickness of the glass and the sheet conductivity of the ITO film were successfully measured, and the measurements agree well with those of broadband pulse-based time domain spectroscopy and Hall measurement results.

Low-temperature-grown InGaAs terahertz photomixer embedded in InP thermal spreading layer regrown by metalorganic chemical vapor deposition.

A novel buried photomixer for integrated photonic terahertz devices is proposed. The active region of the mesa-structure InGaAs photomixer is buried in an InP layer grown by metalorganic chemical vapor deposition (MOCVD) to improve heat dissipation, which is an important problem for terahertz photomixers. The proposed photomixer shows good thermal properties compared to a conventional planar-type photomixer. The MOCVD regrowth process indicates the possibility for THz photomixers to be integrated monolithically with conventional photonic devices.

InGaAs Schottky barrier diode array detector for a real-time compact terahertz line scanner.

We present a terahertz (THz) broadband antenna-integrated 1 × 20 InGaAs Schottky barrier diode (SBD) array detector with an average responsivity of 98.5 V/W at a frequency of 250 GHz, which is measured without attaching external amplifiers and Si lenses, and an average noise equivalent power (NEP) of 106.6 pW/√Hz. The 3-dB bandwidth of the SBD detector is also investigated at approximately 180 GHz. For implementing an array-type SBD detector by a simple fabrication process to achieve a high yield, a structure comprising an SiN(x) layer instead of an air bridge between the anode and the cathode is designed. THz line beam imaging using a Gunn diode emitter with a center frequency of 250 GHz and a 1 × 20 SBD array detector is successfully demonstrated.

Dynamic sensor interrogation using wavelength-swept laser with a polygon-scanner-based wavelength filter.

We report a high-speed (~2 kHz) dynamic multiplexed fiber Bragg grating (FBG) sensor interrogation using a wavelength-swept laser (WSL) with a polygon-scanner-based wavelength filter. The scanning frequency of the WSL is 18 kHz, and the 10 dB scanning bandwidth is more than 90 nm around a center wavelength of 1,540 nm. The output from the WSL is coupled into the multiplexed FBG array, which consists of five FBGs. The reflected Bragg wavelengths of the FBGs are 1,532.02 nm, 1,537.84 nm, 1,543.48 nm, 1,547.98 nm, and 1,553.06 nm, respectively. A dynamic periodic strain ranging from 500 Hz to 2 kHz is applied to one of the multiplexed FBGs, which is fixed on the stage of the piezoelectric transducer stack. Good dynamic performance of the FBGs and recording of their fast Fourier transform spectra have been successfully achieved with a measuring speed of 18 kHz. The signal-to-noise ratio and the bandwidth over the whole frequency span are determined to be more than 30 dB and around 10 Hz, respectively. We successfully obtained a real-time measurement of the abrupt change of the periodic strain. The dynamic FBG sensor interrogation system can be read out with a WSL for high-speed and high-sensitivity real-time measurement.

Simple and cost-effective thickness measurement terahertz system based on a compact 1.55 µm λ/4 phase-shifted dual-mode laser.

A simple thickness measurement method based on the coherent homodyne CW THz system was demonstrated; it does not require precise control of the frequencies of the beat source, and only accurate scanning of the optical delay line is needed. Three beat frequencies are sufficient for measuring the thickness of a sample without considering the modulo 2π ambiguity. A novel compact 1.55 µm λ/4 phase-shifted dual-mode laser (DML) was developed as an optical beat source for the CW THz system. The thickness of a sample was accurately estimated from the measurements using the proposed method. Our results clearly show the possibility of a compact, simple, and cost-effective CW THz system for practical applications.

Distributed feedback laser diode integrated with distributed Bragg reflector for continuous-wave terahertz generation.

A widely tunable dual mode laser diode with a single cavity structure is demonstrated. This novel device consists of a distributed feedback (DFB) laser diode and distributed Bragg reflector (DBR). Micro-heaters are integrated on the top of each section for continuous and independent wavelength tuning of each mode. By using a single gain medium in the DFB section, an effective common optical cavity and common modes are realized. The laser diode shows a wide tunability of the optical beat frequency, from 0.48 THz to over 2.36 THz. Continuous wave THz radiation is also successfully generated with low-temperature grown InGaAs photomixers from 0.48 GHz to 1.5 THz.