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Objective This study compares different nonpharmacological interventions for persons with behavioral symptoms and dementia on frequency of use and perceived efficacy in terms of change in behavior and interest. Methods Participants were 89 nursing home residents from six Maryland nursing homes with a mean age of 85.9 years (SD: 8.6 years). Research assistants presented interventions tailored to the participants' needs and preferences in a pre-intervention trial phase and in an intervention phase. The impact of each intervention on behavioral symptoms and on the person's interest was rated immediately after the intervention by a research assistant. Results The most utilized interventions in both trial and treatment phases were the social intervention of one-on-one interaction, simulated social interventions such as a lifelike doll and respite video, the theme intervention of magazine, and the sensory stimulation intervention of music. In contrast, the least utilized interventions in both phases were sewing, fabric book, and flower arrangement. Interventions with the highest impact on behavioral symptoms included one-on-one social interaction, hand massage, music, video, care, and folding towels. Other high impact interventions included walking, going outside, flower arranging, food or drink, sewing, group activity, book presentation, ball toss, coloring or painting, walking, and family video. Conclusions The results provide initial directions for choosing specific interventions for persons with dementia and also demonstrate a methodology for increasing knowledge through ongoing monitoring of practice.

Through-silicon-via (TSV) technology is conceptually simple, but there are many process control issues in volume manufacturing. An important parameter is TSV depth, because the product yield will be reduced if TSV depth is either too shallow or too deep. Recently, it has been shown that TSV depth can be measured using an interferometric sensor operated at infrared (IR) wavelengths. In this paper, we demonstrate that small variations in TSV depth (

Intelligent personal devices interacting with smart spaces will create a world where your environment itself anticipates and is ready to serve your every need. Many disciplines and technologies are realizing this vision of context awareness, which was science fiction just 25 years ago. In particular, your smartphone will evolve into your “sixth” sense — autonomously alerting you to your environment and notifying your social network of your interests, concerns and goals. Research challenges include ultra-low power always-on sensing and inference technologies, near-zero overhead peer-to-peer networking, and automated reasoning. Models derived from deep learning and knowledge-based reasoners in the proximate cloud will combine to create sentient immersive spaces. Advances in low power silicon, energy harvesting and scavenging will ensure that these smart environments are sustainable. This panel brings together leading experts to tell us about what sixth-sense functions are round the corner and what further breakthroughs are needed to realize this contextual awareness vision.

The etiology of chronic prostatitis chronic pelvic pain syndrome (CP/CPPS) is still unclear. As no pathological findings exist the diagnosis of CP/CPPS is essentially a diagnosis by exclusion and functional disorders, so-called somatoform disorders play a more important role. Osteopathy treats functional disorders of the musculoskeletal system including all associated internal organs but little attention has so far been paid to this treatment method. Therefore, the 5-year follow-up period was intended to show that this is a sustainable form of therapy using exclusively manual and gentle techniques and simple treatment procedures resulting in manageable costs.The aim of this study was to investigate whether sustainability of osteopathic treatment could be demonstrated even after 5 years. This was a randomized controlled study initially involving 5 treatment sessions, a follow-up without treatment after 6 weeks and further follow-up after 1.5 and 5 years. Of the 20 patients 19 in the test group participated in the 5-year follow-up. The control group were not asked because it would have been unacceptable to expect the patients to refrain from having treatment for as long as 5 years. The men were aged between 29 and 70 years. The patients were asked to complete the international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life (QOL) questionnaires once again and in particular to state whether they had received osteopathic treatment specifically for the prostate problem and how often they had been treated.The follow-up assessment of the symptoms of chronic prostatitis (NIH-CPSI) showed that they had further improved after 1.5 years (intragroup difference -1.8 points, 95 % confidence interval CI=-3.8 to 0.3) and also after 5 years (intragroup difference -1.3 points 95 % CI=-3.4 to 0.8). The urinary tract symptoms (IPSS) showed a statistically significant improvement (intergroup difference 8.9 points, 95 % CI=4.7-13.1, p0.0005). At the second follow-up after 1.5 years there was a further improvement (intragroup difference -2.2 points, 95% CI=-3.9 to -0.4, p=0.02) which was found to remain constant after 5 years (intragroup difference 0.2 points). The quality of life (QOL) with respect to the symptoms showed a statistically significant improvement in comparing both groups during the study phase (intergroup difference χ 2: p0.005). At follow-up after 5 years out of 19 patients 15 answered the question"how would you feel if the symptoms currently present would not change in the future?" with excellent or satisfactory and 11 patients would not have wanted further osteopathic treatment. Of the patients 8 reported that since the second follow-up (within 3.5 years) they had received osteopathic treatment one to eight times; however, this was partially more prophylactic than due to pain.Due to the sustainability of osteopathic treatment and the low amount of time involved, osteopathy should be taken seriously as a treatment for patients with CP/CPPS. Furthermore, due to the osteopathic treatment the patients learnt to alleviate or even eliminate their own symptoms in treating themselves. In order to help many other affected persons out of their dilemma it would be desirable if more urologists and internists would become acquainted with osteopathy in order to be able to offer this to patients at an early stage. Further studies with larger numbers of patients should be carried out to confirm these results.

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged.

OBJECTIVE: To evaluate patient education and resident education strategies to promote advance directives in the outpatient setting, and to assess barriers to implementation. DESIGN: Controlled clinical trial. SETTING: The internal medicine residents’ practice of an urban, university medical center. PATIENTS/PARTICIPANTS: Medical residents and 250 patients seen at least twice in the 3 months prior to the study. INTERVENTIONS: We randomized practice days: one to patient education, one to resident education, and three controls. Resident education consisted of a lecture, a videotape of a model advance directives discussion, and videotaping of an actual discussion by each resident, followed by individual review. Patient education consisted of distributing pamphlets in the waiting room and offering all patients an opportunity to discuss advance directives. MEASUREMENTS AND MAIN RESULTS: We interviewed 187 of these patients (response rate 75%) and surveyed 62 residents (response rate 70%). After 18 months, there were no significant differences in the number of advance directives in charts among the three groups. Documented advance directives discussions with patients in the resident education group increased from 3% to 17% (p

The friction and wear behavior of sliding bearings made from high temperature thermoplastics was investigated to determine the possibility of dry sliding applications. A test apparatus for plain bearing testing was designed and built to enable load, speed, and temperature to be controlled and temperature, friction and wear to be continuously monitored. Bulk material bearings (polyaryletherketone-based composites and neat polybenzimidazole) and metal-thermoplastic compound bearings with a sliding layer of polyetheretherketone were investigated. Their suitability for dry sliding bearing applications was assessed using the values of friction coefficient, wear rate and friction induced temperature. In general, the operating performance is mainly influenced by the operating conditions and the precise construction of the bearing. A fiber reinforcement of the thermoplastic matrix is necessary at high loads, whereas it is unnecessary at low loads. A further increase of the operational limits is made possible by improving the heat conduction from the contact area, as comparison with results of pin-on-disk investigations indicates. The materials tested provide operation of dry sliding bearings to temperatures over 200°C.

A prospective study of vision-related outcomes of cataract surgery as well as cognitive functioning, activities of daily living (ADL) functioning, and depressed affect was conducted with 19 nursing home residents scheduled for cataract surgery. Also studied were 22 candidates for cataract surgery who decided against it. Comparison of both groups at baseline revealed that residents who chose cataract surgery were less cognitively and ADL impaired. Analysis after cataract surgery showed that visual acuity improved significantly at 4 months and was maintained at 1 year after surgery.

BACKGROUND A randomized, placebo-controlled clinical trial was undertaken to determine the efficacy of nonpharmacologic individualized interventions (individualized to address unmet needs such as boredom or pain) in decreasing agitation in persons with dementia. METHOD Agitated nursing home residents with advanced dementia (from 9 nursing homes in 5 locations in Maryland, United States) were randomized into an intervention group (n = 89) and a placebo control group (n = 36). On the basis of data from baseline assessment, a systematic methodology for individualizing nonpharmacologic interventions, Treatment Routes for Exploring Agitation (TREA), was used with the intervention group: an unmet need was hypothesized, a corresponding treatment category was identified, and specifics of the treatment were chosen to fit the person's need, past identity, preferences, and abilities. (Unmet needs were hypothesized based on physician evaluations, structured staff interviews, relative questionnaires, direct observations of agitation with the Agitation Behavior Mapping Instrument [the primary outcome measure] and affect with Lawton's Modified Behavior Stream [the secondary outcome measure], and resident assessments.) TREA interventions were implemented for 2 weeks, and observations of agitation and affect were recorded. The study was conducted from June 2006 until December 2011. RESULTS Relative to a control group, TREA interventions for unmet needs produced statistically significant declines in total (P < .001), physical nonaggressive (P < .001), and verbal agitation (P = .004) and significant increases in pleasure (P < .001) and interest (P < .05). CONCLUSIONS This is the first large randomized controlled trial to demonstrate the efficacy of TREA and one of only a few such trials of nonpharmacologic interventions for agitation in persons with dementia. The translation of these findings into practice is sorely needed and would require structural changes dedicating staff time to observing each agitated resident, determining unmet needs, obtaining appropriate intervention materials, conducting the individualized nonpharmacologic interventions, and evaluating results. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00820859.

As semiconductor devices become smaller and smaller, to keep up with Moore's law, their manufacturing cost increases. Transistors have been continuing to scale and improve in performance. However, the performance improvement gained by scaling is gradually becoming insignificant compared to the negative effects of the interconnect scaling. This had been already predicted by Bohr et al. in 1995 [1]. One of the workable ways forward is by reducing the average length of the interconnects. This can be done by forming a new type of vertical interconnect technology that achieves micron scale connections known as TSVs. In order to make this new technology a success several metrology and inspection requirements need to be tackled. In general, the critical 3D processes have been identified to be (i) TSV formation (ii) IC wafer thinning (iii) Debonding and stacking module. In the table below the key challenges within each of the modules have been identified and also the possible solutions for each one of the challenges have been mentioned.

Through-Silicon-Via depth inline monitoring is one of the key requirements for implementing TSV technology into high volume production. The Tamar tool using IR from the backside of wafer is demonstrated to have the capability to provide non-destructive inline monitoring of trench depth after plasma etch, even when the backside wafer surface is rough. However, the etch profile is found to be critical to the effectiveness of this tool. A flat TSV bottom with a minimum of at least 1um in width is required for accurate and repeatable measurements.

Agitation is a major problem in the demented elderly, and may be related to pain and discomfort. The aim of this article is to investigate the relationship between agitation and infection in three highly agitated cognitively impaired nursing home residents. Agitation was assessed using the Agitation Behavior Mapping Instrument (ABMI), a nonobtrusive assessment tool used for direct observation and recording ofagitated behaviors. Information concerning antibiotic drug use was extractedfrom the participants'charts. A relationship was inferred between the presence of an infection (as suggested by antibiotic medication use) and higher levels of agitation. Elucidating the possible antecedents of the agitated behaviors is the first step in the management of these disruptive behaviors.

Liquid-liquid equilibrium data were measured for the 1-propanol-NaCl−H2O system at 25°C. Liquid-liquid equilibrium in aqueous biphasic salt systems containing salts and alcohols or polymers was modelled using an expression for the excess Gibbs energy of the solution. The model is based on modified forms of the nonprimitive Mean Spherical Approximation, the Bromley equation, and the Flory-Huggins theory and requires three and five adjustable parameters for ternary and quaternary systems, respectively. The model accurately correlated binary water-polymer or water-alcohol vapor-liquid equilibrium data and liquidliquid equilibrium data for seven ternary and three quaternary aqueous biphasic salt systems.

It has been estimated that perhaps onefourth to one-third of U.S. health care dollars buy care that has only marginal benefit, if any. To lower this figure, some medical professionals have placed their hope in the increasing use of practice guidelines, in conjunction with other efforts aimed at fostering greater efficiency in the American health care system. This interest has come about despite the challenge that practice guidelines pose to the traditional autonomy that physicians have enjoyed in determining what procedures are medically necessary or effective, and that patients have had in receiving whatever treatment they desire. Guideline proponents argue that while the lessening of physician and patient autonomy might be regrettable, the larger good of providing at least basic health care to more people is the greater consideration. Of eight organizations participating in a survey on practice guidelines, all indicated that they developed guidelines primarily to improve “clinical effectiveness” and “quality of care,” but six stated that cost control was a secondary goal. Studies show that in some circumstances the adoption of guidelines can indeed lead to cost savings. For example, the institution of guidelines at the Yale-New Haven Hospital reduced the number of emergency room x-rays by 15 percent without compromising quality of care. Most proponents of practice guidelines, particularly in Congress, have argued that reducing costs might be a byproduct of the adoption of guidelines based upon medical effectiveness (through the elimination of unnecessary or marginally beneficial diagnostic procedures and treatments). To date, financial factors typically have not been incorporated explicitly into practice guide

With flocculent cells of Zymomonas mobilis levan was produced in a continuous upflow-tower fermentation with a productivity of up to 16 gl−1h−1. A large-scale process basing on whole Zymomonas cells is thought to be economical, if levan and ethanol production can be carried out simultaneously. Levan sucrase as the enzyme responsible for levan biosynthesis was purified and partially characterized.

We examined the impact of environmental, person, and stimulus characteristics on pleasure in persons with dementia. Study participants were 193 residents of 7 Maryland nursing homes who were presented with 25 stimuli from these categories: live human social stimuli, live pet social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Systematic observations of pleasure in the natural environment were conducted using Lawton's Modified Behavior Stream. Analysis showed that pleasure is related to stimulus category, personal attributes and environmental conditions. In the multivariate analyses, all types of social stimuli (live and simulated, human and nonhuman), self-identity stimuli, and music were related to significantly higher levels of pleasure than the control condition. Females and persons with higher ADL and communication functional status exhibited more pleasure. Pleasure was most likely to occur in environments with moderate noise levels. These results demonstrate that these nursing home residents are indeed capable of showing pleasure. Caregivers of nursing home residents with dementia should incorporate social, self-identity, and music stimuli into their residents' care plans so that eliciting pleasure from each resident becomes the norm rather than a random occurrence.

International audience; We examined whether antidepressants alter expression of psychopathic personality traits in patients with major depressive disorder (MDD). Data were collected from a double-blind, placebo-controlled 8-week trial evaluating the efficacy of sertraline (50-200 mg/day) combined with either tri-iodothyronine (T3) or matching placebo in adult outpatients with major depressive disorder. Administration of sertraline was open-label; T3/placebo was double-blind. At the baseline and week 8 visits, patients completed the short form of the Psychopathic Personality Inventory (PPI), a well-validated self-report measure assessing two major factors of psychopathy: Fearless Dominance (PPI-1) and Self-Centered Impulsivity (PPI-2). Change in PPI scores were assessed using paired t-tests for all participants who completed a baseline and postrandomization PPI. Ninety patients (84 completers and six who terminated the trial early) were eligible for the analysis. Both PPI factors changed significantly from baseline to endpoint, but in opposing directions. The mean score on PPI-1 increased significantly during treatment; this change was weakly correlated with change in depression scores. In contrast, the mean score on PPI-2 decreased significantly, but these changes were not correlated with changes in depression scores. Independent of their effects on depression, antidepressants increase adaptive traits traditionally observed in psychopathic individuals, such as social charm and interpersonal and physical boldness. Antidepressants reduce other, more maladaptive, traits associated with psychopathy, including dysregulated impulsivity and externalization.

The main objective of this study was to identify if there is any change in wafer warpage after bevel clean process, which might lead to higher film stress at device area in further processes. Correlation between bevel film Etch Rate (ER) and wafer warpage was also investigated. 25 kA thermal oxides (Tox) were etched on back side with various thicknesses remaining to generate a different amount of wafer warpage and thus different film stress on the front side of wafers. It was found that the thinner backside thickness leads to higher warpage with dome shape and film stress on front side. Test results indicate that bevel clean process did not increase the wafer warpage, on the other hand reduced the warpage about 1∼4% compared to pre-bevel clean process in case of Tox. 3 kA silicon nitride (SiN) also showed the higher warpage of bowl shape with no films on back side compared to the un-etched one. No significant change in warpage was also observed in SiN. The correlation relationship of bevel ER and wafer warpage was significantly low, which provides a steady ER performance regardless of the warpage of monitor wafers.

The present study examined the impact of different attributes of social stimuli using the stimulus attributes aspect of the Comprehensive Process Model of Engagement (Cohen-Mansfield et al., (2009a) Am J Geriatr Psychiatry. 17:299–307). Participants were 193 residents of 7 Maryland nursing homes with a diagnosis of dementia. Stimuli were chosen to represent different levels of the following social attributes: social versus not social, realistic versus not realistic, animated versus nonanimated, human versus nonhuman, and alive versus not alive. Participants had significantly longer engagement, were significantly more attentive, and displayed a significantly more positive attitude with social stimuli than with nonsocial stimuli. Longer durations and higher ratings of attention and attitude were seen with realistic and animated stimuli as compared to their counterparts. Human and live stimuli resulted in significantly more engagement than their counterparts. Giving any social stimulus to the residents is preferable to providing none, and the social attributes of stimuli should be maximized.

We examined the impact of setting characteristics and presentation effects on engagement with stimuli in a group of 193 nursing home residents with dementia (recruited from a total of seven nursing homes). Engagement was assessed through systematic observations using the Observational Measurement of Engagement (OME), and data pertaining to setting characteristics (background noise, light, and number of persons in proximity) were recorded via the environmental portion of the Agitation Behavior Mapping Inventory (ABMI; Cohen-Mansfield, Werner, & Marx, (1989). An observational study of agitation in agitated nursing home residents. International Psychogeriatrics, 1, 153–165). Results revealed that study participants were engaged more often with moderate levels of sound and in the presence of a small group of people (from four to nine people). As to the presentation effects, multiple presentations of the same stimulus were found to be appropriate for the severely impaired as well as the moderately cognitively impaired. Moreover, modeling of the appropriate behavior significantly increased engagement, with the severely cognitively impaired residents receiving the greatest benefit from modeling. These findings have direct implications for the way in which caregivers could structure the environment in the nursing home and how they could present stimuli to residents in order to optimize engagement in persons with dementia.

Objectives To determine which stimuli are 1) most engaging 2) most often refused by nursing home residents with dementia, and 3) most appropriate for persons who are more difficult to engage with stimuli. Methods Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Stimulus engagement was assessed by the Observational Measure of Engagement. Results The most engaging stimuli were one-on-one socializing with a research assistant, a real baby, personalized stimuli based on the person's self-identity, a lifelike doll, a respite video, and envelopes to stamp. Refusal of stimuli was higher among those with higher levels of cognitive function and related to the stimulus' social appropriateness. Women showed more attention and had more positive attitudes for live social stimuli, simulated social stimuli, and artistic tasks than did men. Persons with comparatively higher levels of cognitive functioning were more likely to be engaged in manipulative and work tasks, whereas those with low levels of cognitive functioning spent relatively more time responding to social stimuli. The most effective stimuli did not differ for those most likely to be engaged and those least likely to be engaged. Conclusion Nursing homes should consider both having engagement stimuli readily available to residents with dementia, and implementing a socialization schedule so that residents receive one-on-one interaction. Understanding the relationship among type of stimulus, cognitive function, and acceptance, attention, and attitude toward the stimuli can enable caregivers to maximize the desired benefit for persons with dementia.

W.F.J. Steenkamp en/and H.J.J. Reynders (Hoofredakteurs/Chief Edi-tors. Ekonomiese en Bedryfswoordeboek: Engels–Afrikaans/Dictionary of Eco-nomics and Business: English–Afrikaans. Tweede, hersiene en vermeerder-de uitgawe/Second, revised and enlarged edition. 2004, xii + 1199 pp. ISBN 1868900312. Kaapstad/Cape Town: Pharos Woordeboeke/Dic-tionaries. Prys/Price: R400.

This study describes the characteristics of the social environment of 24 highly agitated and cognitively impaired nursing home residents, and the relationship between manifestations of agitation and attributes of the social environment. Results showed that the composition of the social environment of the agitated nursing home resident does not vary much with respect to time of day or day of the week. Additionally, most agitated behaviors were not generally affected by attributes of the social environment. The interaction of agitated behaviors with persons in the social environment is also examined. When agitated behaviors were directed towards someone, they were most likely to be directed towards staff members. Agitated behaviors were rarely triggered by any observable event, and few reactions to agitation were observed.

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation—aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors—are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behaviors for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

A 3-month observational study of 24 agitated and severely cognitively impaired nursing home residents was conducted to document the typical ways in which residents spend their time and how time use relates to the manifestation of agitated behaviors. We found that these residents were involved in no activity during 63% of the observations. In addition, residents spent little time in structured activities (e.g., music therapy) or social activities (e.g., receiving visitors). Yet data analysis revealed that residents manifested a greater number of agitated behaviors when they were unoccupied and fewer agitated behaviors when involved in structured or social activities. We discuss implications for caregivers.

Syndromes of agitation (aggressive, physically nonaggressive, verbal) were compared to dimensions of the social network (intimacy, size/density) in 408 nursing home residents. Results showed that the social networks of aggressive residents and verbally agitated residents were lacking in intimacy. Social networks of physically nonaggressive residents were neutral, even though these persons were severely cognitively impaired, as were the aggressive residents. The size/density of the social network did not differentiate agitated individuals from other residents.

To examine how presentation of different stimuli impacts affect in nursing home residents with dementia.Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton's Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant's self-identity. The dates of data collection were 2005-2007.Differences between stimulus categories were significant for pleasure (F(6,144) = 25.137, P.001) and interest (F(6,144) = 18.792, P.001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F(1,97) = 6.27, P.05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F(6,92) = 2.31, P.05). Overall, social stimuli have the highest impact on affect in persons with dementia.The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person's degree of interest in stimuli prior to developing an intervention.

Integration of a polarization insensitive inverted taper-based fiber coupling structure with silicon etched V-grooves is demonstrated in CMOS silicon photonics. Coupling loss of 7.5dB are measured at λ=1.55µm. A spectrum broader than 70nm is observed.

We report a process development route towards 300 mm production-worthy non-Bosch through-silicon-via (TSV) etch with critical dimensions and via spacing between 1–5 µm and aspect ratios (ARs) up to 20∶1 for 3D logic integration. This was performed on an experimental alpha-tool from Tokyo Electron: a magnetically enhanced capacitively coupled plasma etcher with a dipole ring magnet upgrade that aims to capture the strengths (anisotropicity, profile uniformity) while reducing the weaknesses (scalloping, undercut, residues) of a nominal Bosch process. Trending experiments were performed to understand key modulators that contribute to the control of sidewall taper and roughness, etched TSV volume and depth, mask undercut, local bowing effects, and within wafer (WIW) center-to-edge depth and profile uniformity. Selected process-of-records in fabricating TSVs with nominal sizes of 5 µm × 25 µm, 5 µm × 40 µm and 1 µm × 20 µm with ∼ 1 % WIW depth uniformity, negligible silicon scalloping/mask undercut, and good profile control were developed. These include vertical TSVs and tapered TSVs for different 3D wafer stacking applications. For TSV metrology, assessments were conducted using wafer thickness sensor technology (Tamar Technology, Inc) that is not limited by AR: an optical, non-invasive, and high throughput sensor that measures the etched depth of vias using backside IR illumination. In having a continuous 2kA TEOS oxide liner/100 A Ta(TaN) barrier/5kA Cu seed stack enabled by TSV etch, Cu-filled TSVs of 3 µm × 20 µm and 5 µm × 25 µm were demonstrated.

The Wafer Thickness Sensor (WTS) is an optical, non-destructive sensor that directly measures the etch depth of vias, without regard to aspect ratio. The high throughput measurements of via depth after the etching of through silicon vias (TSV) will allow timely feedback for process control, process development, and the prevention of process excursions in 3D IC process technology. In this paper, we report the capabilities and limitations of the WTS for the measurement of TSV etched depth. Etch depth measurement results are presented for a variety of vias, including 1µm, 3µm, and 5µm diameter vias, vias with an aspect ratio of 28∶1, and both isolated and densely packed vias. Results include accuracy and repeatability data, with a route towards providing a high volume manufacturing TSV etch metrology solution for 3D IC process technology.

Prostatitis is the most common urological disease in males under [corrected] the age of 50 years old. As bacteria are detected in only5% of cases the disease can mostly be classified as chronic nonbacterial prostatitis. The symptoms of this problem complex, often described as chronic prostatitis and chronic pelvic pain syndrome (CP-CPPS), seem to be multifactorial so that an improvement can only rarely be achieved with conventional forms of therapy.The aim of this study was to investigate whether osteopathic treatment can influence the symptoms of CP-CPPS (randomized controlled study, 5 sessions, follow-up after 6 weeks and 1.5 years without treatment). The study was carried out in a practice for osteopathy. Patients were recruited by referral from urologists, newspaper articles and lectures on the topic. A total of 35 males with medically diagnosed CP-CPPS aged 29-70 years old took part in the study. Of the patients 20 were allocated to the treatment group and 15 to the placebo group whereby 2 patients had to retire from the study prematurely. Patients in the treatment group received 5 osteopathic treatment sessions separated by 1 week at the beginning and by up to 3 weeks at the end (total period 8 weeks). The osteopathic dysfunctions of the patients were treated according to the principles of osteopathy. The placebo treatment in the control group consisted of a training program with simple gymnastic and physiotherapeutic exercises. Improvements of the complaints by urination (LUTS), chronic pelvic pain (CPPS) and quality of life (QOL) were measured using the questionnaires for international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life index (QOL).Comparison of the results from the osteopathy and placebo groups revealed statistically significant differences in favor of the osteopathy group (p0.0005). During the study period the average IPSS in the osteopathy group improved from 19.7 to 10.3 points (48%, p0.0005), the NIH from 26.0 to 12.0 (54%; p0.0005) and the QOL from 4.4 to 1.9 points (58%, p0.0005). In contrast the corresponding values in the placebo group remained relatively constant. At the follow-up 6 weeks after the last session the improvements in the osteopathy group were found to be stabile and remained so at least up to the second follow-up after 1.5 years.The positive results of this study indicate that osteopathic treatment can be considered a genuine alternative to the conventional treatment of CP-CPPS and a closer cooperation between urologists/internists and osteopaths would be desirable. Further studies with larger numbers of patients should be carried out to substantiate these results.

Purpose The aim of this article is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement. Setting/Subjects The sample included 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Methodology The authors describe a model of factors that affect engagement of persons with dementia. Moreover, the authors present the psychometric qualities of an assessment designed to capture the dimensions of engagement (Observational Measurement of Engagement). Finally, the authors detail plans for future research and data analyses that are currently underway. Discussion This article lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli. Additionally, the study examines what factors are associated with interest and negative and positive feelings in engagement.

In this work a compact green laser light source is presented based on a single-pass second harmonic generation (SHG) in non-linear material. The green light source consists of a distributed feedback (DFB) laser with a monolithically integrated power amplifier (PA) and a periodically poled lithium niobate (PPLN) crystal with a ridge waveguide. To achieve the smallest size and to reduce the number of parts to be assembled, a direct coupling approach is implemented without using any lens. The waveguide of the laser is bent and the facet of the crystal is tilted and AR-coated in order to reduce undesired reflections and to increase the stability of operation. By varying the injection current of the amplifier the infrared output power of the laser changes proportionally. The wavelength remains stable during current variation and in that way the green optical output power can also be modulated. No additional external modulator is required for the generation of distinct green light levels. At a wavelength of 530 nm, a green optical output power of more than 35 mW is achieved for injection currents of 93 mA and 400 mA through the DFB section and amplifier section respectively.

The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was conducted (n = 961). Thirty-seven percent of physicians reported regularly asking new adult patients about their sexual practices; 60% asked new adolescent patients. STD/HIV risk questioning was associated with physicians' confidence in their ability to help prevent HIV, comfort with discussing patients' sexual practices, and perception of a large STD/HIV problem in their practice. These findings suggest that continuing medical education should target improvement in physicians' sexual practice questioning skills.

The purpose of the present study was to determine the relationship between nurses' and social worker'perceptions of the well-being of elderly nursing home residents. Four-hundred and eight residents were rated by both nurses and social workers in three areas: cognitive functioning, depression and the social network. Results showed that there was a strong relationship between the nurses' and social workers' ratings on all measures in the three domains of functioning. However, differences between nurses' and social workers' ratings were found on several measures. Nurses consistently rated the residents as more impaired than social workers on all measures of cognitive functioning. Nurses also rated the residents as being less depressed, having a lower activity level and having less frequent social interactions than did social workers. In the area of the social network, social workers thought residents had more frequent contacts with staff. However, nurses rated the residents as being more intimate with staff...

Two studies concerning pacing by nursing home residents are presented. The first was a cross-sectional survey of 402 residents, which found that 39% of the subjects were pacers. In comparison to residents who did not pace, the pacers had fewer medical diagnoses, better appetites, and had resided in the facility for fewer years. Additionally, pacing was positively related to cognitive impairment and to past life-threatening experiences. Results of the second study, an observational study of six cognitively impaired residents who paced frequently, showed that these residents paced more when the environmental conditions were conducive to pacing (e.g., adequate lighting, enough room within which to pace). We believe that pacing is a reflection of good health within the nursing home population and suggest that caregivers may want to encourage rather than inhibit this behavior in some nursing home residents.

In a previous article, we discussed a theoretical framework asserting that a combination of stimulus attributes, personal attributes and environmental attributes as well as interactions among these affects engagement with stimuli by persons with dementia [Cohen-Mansfield, J., Dakheel-Ali, M., Marx, M.S., 2009. Engagement in persons with dementia: The concept and its measurement. American Journal of Geriatric Psychiatry 7, 299-307]. Based on this framework, we tested the impact on engagement of the personal meaning of stimuli, specifically examining work-like stimuli, stimuli based on the person's identity, and gender role-based activities. We hypothesized that having such meanings will render stimuli more engaging than stimuli without these meanings. Participants were 193 residents of 7 Maryland nursing homes. All participants had a diagnosis of dementia. Results confirmed the hypotheses, demonstrating that the meaning of the stimulus impacts engagement shown by persons with dementia. Interventions that involve objects or tasks with meaning specific to the person with dementia will be more likely to engage that person. Future research could explore more identity roles as well as other mechanisms affecting engagement.

We examined the influence of stimulus attributes on the engagement of 69 nursing home residents with dementia. Specifically, we looked at work-related stimuli versus manipulative block stimuli, and whether the color, size, and material of a stimulus affect the duration and quality of engagement. Engagement was assessed using the Observational Measurement of Engagement (OME). Results revealed a clear preference for the work-related rather than manipulative block stimuli. In addition, the study participants showed a significant preference for small rather than large blocks, regardless of color or material. The effect of material and color was not statistically significant. These findings may assist nursing home caregivers who wish to provide appropriate stimuli for engaging nursing home residents with dementia.

A green laser source was assembled consisting of a multi-section distributed feedback laser and a periodically poled lithium niobate crystal in single-pass configuration. Butt-coupling between the tilted output facet of the laser and the second harmonic generation waveguide crystal was applied allowing the assembly of the green emitter being without further optical elements. An output power of 35 mW and a single frequency operation with an SMSR of 50 dB were achieved for the green emitter developed.

Trained observers recorded both the physical location and the specific agitated behaviors manifested by 24 highly agitated and cognitively impaired nursing home residents for 3 months. Results showed that agitation was observed frequently at a variety of locations on the unit, including the toilet, corridor, nurses' station, and another resident's room. Although these residents spent a great deal of time in their own rooms, agitation was not observed most frequently at this locale. Additionally, the type of agitation was found to be directly related to locations in the nursing home. Pacing was frequently observed at many locations (in particular, the corridor, nurses' station, another resident's room), while verbally agitated behaviors and aggressive behaviors were observed primarily at locations in which the residents might be in need of help (e.g., the toilet).

The occurrence of falls and the manifestations of three dimensions of agitation (aggressive behaviors, physically nonaggressive behaviors, verbal behaviors) were recorded in 408 nursing home residents during each of the three nursing shifts. Falls occurred most frequently during the busiest shift (the day shift) and least frequently during the night shift when most residents were sleeping and nursing staff were not as busy, a result that confirms previous reports. In comparison to residents who did not fall, residents who fell manifested significantly more physically nonaggressive behaviors, more aggressive behaviors, more verbally agitated behaviors, and overall, a greater total number of agitated behaviors.

Nursing staff rated the manifestations of agitation and the characteristics of sleep in 408 nursing home residents. In addition, level of cognitive impairment was independently rated by nurses and social workers. Multiple regressions revealed that both sleep disturbances and cognitive impairment were important variables for explaining agitated behaviors. Moreover, the practice of awakening residents during the night for toileting was found to be significantly related to a greater number of aggressive behaviors (e.g., hitting) and physically nonaggressive behaviors (e.g., pacing) during the day. Implications of these findings for the caregivers of agitated nursing home residents are discussed.