bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pylori density and cagA status in cirrhotic patients: A case–control study
Authors: ZULLO ANGELO , SANCHEZ‐METE LUPE , HASSAN CESARE , DIANA FABIO , FESTUCCIA FEDERICA , ATTILI ADOLFO FRANCESCO , MORINI SERGIO
Published: December 2004

Background and Aim:  Despite a similar Helicobacter pylori prevalence, peptic ulcer is more frequent in cirrhotic patients than in controls. We evaluated whether cirrhotic patients had an increased bacterial density and/or a higher prevalence of H. pylori cagA‐positive strains than controls.

Methods:  A total of 36 dyspeptic cirrhotic patients with H. pylori infection and 72 matched controls were enrolled. H. pylori infection was detected at histology on Giemsa staining, bacterial density was assessed using difference over baseline (DOB) values at 13C urea breath test, and cagA status was established at serology.

Results:  Overall, both DOB values and prevalence of cagA did not significantly differ between cirrhotic patients and controls. However, peptic ulcer controls showed significantly higher DOB value (27.9 ± 17.4 vs 19.4 ± 9.3, respectively; P = 0.009) and cagA positive rate (85%vs 48%; P = 0.01) than non‐ulcer dyspepsia patients. Although not statistically significant, a similar trend was observed in cirrhotic patients with peptic ulcer for DOB values (26.5 ± 16.3 vs 18.3/1000 ± 9.2, respectively; P = 0.07), whereas the cagA‐positive rate was similar between peptic ulcer and non‐ulcer dyspepsia patients (60%vs 50%; P = 0.30).

Conclusions:  The present data showed that both bacterial density and cagA prevalence did not differ between cirrhotic patients and controls.
Quantitative analysis of endosonographic parenchymal echogenicity in patients with chronic pancreatitis
Authors: IRISAWA ATSUSHI , MISHRA GIRISH , HERNANDEZ LYNDON V , BHUTANI MANOOP S
Published: December 2004

Background and Aim:  The aim of the study was to develop a method of quantitation of endoscopic ultrasonography (EUS) changes of chronic pancreatitis (CP).

Methods:  Twenty‐three patients with chronic pancreatitis by EUS were compared with nine normal subjects. Hyperechogenicity was evaluated as the size of the hyperechoic area that was over a threshold echogenicity level. Mean echo density was expressed using the average gray‐scale value within the region of interest. The quantitative data were compared with the diagnosis using conventional EUS criteria.

Results:  The size of the hyperechoic area over the threshold level was 0.86 ± 0.67 mm2 (mean ± SD) in the normal pancreas using EUS criteria. In chronic pancreatitis, the size of the hyperechoic area was 7.28 ± 2.98 mm2 in patients with mild CP, 18.12 ± 2.56 mm2 in patients with moderate CP, and 18.02 ± 10.81 mm2 in patients with severe CP, respectively. These changes in hyperechoic size area were statistically significant in all patients having mild to severe CP when compared with normal controls.

Conclusion:  Computer analysis of EUS images may provide objective information for the diagnosis of CP and may be useful in quantitating the severity of disease and overcoming interobserver variability in analyzing individual echo features supporting the diagnosis of CP.
Error Correction Models for Fractionally Cointegrated Time Series
Authors: Dittmann Ingolf
Published: December 2004

This paper provides a proof of Granger's (1986) error correction model for fractionally cointegrated variables and points out a necessary assumption that has not been noted before. Moreover, a simpler, alternative error correction model is proposed which can be employed to estimate fractionally cointegrated systems in three steps.
Seasonal Unit Root Tests Under Structural Breaks*
Authors: Hassler Uwe , Rodrigues Paulo M. M.
Published: December 2004

Abstract. In this paper, several seasonal unit root tests are analysed in the context of structural breaks at known time and a new break corrected test is suggested. We show that the widely used HEGY test, as well as an LM variant thereof, are asymptotically robust to seasonal mean shifts of finite magnitude. In finite samples, however, experiments reveal that such tests suffer from severe size distortions and power reductions when breaks are present. Hence, a new break corrected LM test is proposed to overcome this problem. Importantly, the correction for seasonal mean shifts bears no consequence on the limiting distributions, thereby maintaining the legitimacy of canonical critical values. Moreover, although this test assumes a breakpointa priori, it is robust in terms of misspecification of the time of the break. This asymptotic property is well reproduced in finite samples. Based on a Monte‐Carlo study, our new test is compared with other procedures suggested in the literature and shown to hold superior finite sample properties.
Improved prediction intervals for stochastic process models
Authors: Vidoni Paolo
Published: December 2004

Abstract. This paper reviews some recent results on the construction of improved prediction limits for time series models and presents a simple solution based on a fully conditional approach. A prediction limit, expressed as a modification of the estimative one, is obtained so that its conditional and unconditional coverage probability equals the target value to third‐order accuracy. Although the specification of the ancillary statistic is not required, it respects the conditionality principle, to the relevant order of approximation. Moreover, the corresponding predictive density is specified in a relatively simple closed form. Simple examples show the usefulness of this conditional approach to prediction.
FALLIBILISM, FAITH AND THEOLOGY: PUTTING NICHOLAS RESCHER TO THEOLOGICAL WORK1
Authors: MURRAY PAUL D.
Published: December 2004

This essay explores the possible theological relevance of Nicholas Rescher's pragmatic‐idealist account of human reason. An initial case is made for the prospective hospitality of Christian theology to Rescher's thought, contrary to his early misgivings. The intrinsic relationship between Christian faith and a fallibilist self‐regard is then explored. Next Rescher's more recent constructive reflections are considered and their limitations identified. Finally the lineaments of a thoroughgoing Trinitarian appropriation of Rescher's thought are traced together with its implications for the character of Christian theology and ecclesial reality.
“SIN IS BEHOVELY” IN JULIAN OF NORWICH's REVELATIONS OF DIVINE LOVE1
Authors: TURNER DENYS
Published: December 2004

Julian, showing no inclination to accept the ‘free‐will’ defence nonetheless says that “sin is behovely”. She cannot mean by this that sin is necessary within the created order nor can she mean that it is completely contingent and outside the remit of divine providence. Sin's being behovely means, I argue, that it is conveniens, in a sense recognisable within some standard medieval scholastic theologies. This is to say that sin ‘fits’ with some story which God wills, a story of salvation history, in the way that events in any narrative can be said to ‘fit’ with the narrative they are events within. That for Julian we do not and cannot know the story shows her commitment to a negative theology.
The Causal and Unification Approaches to Explanation Unified—Causally
Authors: Strevens Michael
Published: December 2004

Two major modern accounts of explanation are the causal and the unification accounts. My aim in this paper is to provide a kind of unification of the two, by using the central technical apparatus of the unification account to solve a central problem faced by the causal account, namely, the problem of determining which parts of a causal network are explanatorily relevant to the occurrence of an explanandum. The result is a causal account of explanation that has many of the advantages of the unification account.
Clashing Rights, the Welfare of the Child and the Human Rights Act
Authors: Fenwick Helen
Published: December 2004

Under the Human Rights Act so far there has been until very recently little judicial or even academic recognition of the difference between resolving clashes of Convention rights and addressing conflicts between utilitarian concerns and such rights. This article has chosen to illustrate that failure of recognition and to consider methods of resolving the conflict between rights, by concentrating on one particular clash of rights – that between media free speech under Article 10 and the privacy of children under Article 8. It argues for presumptive equality for the two rights and for conducting a ‘parallel analysis’ of their application to the circumstances of a particular case. It contends that therefore the principle that the child's welfare is paramount must be abandoned in its present form, as must the presumptive priority accorded to Article 10 where that principle is not found to apply.
Legal Consciousness: Some Observations
Authors: Cowan Dave
Published: December 2004

This article argues that US studies of ‘legal consciousness’ have much to offer UK socio‐legal studies. It is, perhaps, surprising that so little attention has been paid to this set of understandings. I seek to rectify that imbalance in the transatlantic relationship by outlining legal consciousness and its critiques. I then draw on homelessness applicant interview data to discuss their ‘legal consciousness’, illustrating the importance of the value of dignity; how they make sense of their decisions; and the spaces in which legal consciousness may be produced. The study is a limited examination, but it enables us to question the assertion that welfare applicants ‘know the law’ and (ab‐)use it.
Simultaneous continuous recording of accommodation and pupil size using the modified Shin‐Nippon SRW‐5000 autorefractor
Authors: Wolffsohn J. S. , O'Donnell C. , Charman W. N. , Gilmartin B.
Published: December 2004

The internal optics of the recent models of the Shin‐Nippon SRW‐5000 autorefractor (also marketed as the Grand Seiko WV‐500) have been modified by the manufacturer so that the infrared measurement ring has been replaced by pairs of horizontal and vertical infrared bars, on either side of fixation. The binocular, open field‐of‐view, allowing the accommodative state to be objectively monitored while a natural environment is viewed, has made the SRW‐5000 a valuable tool in further understanding the nature of the oculomotor response. It is shown that the root‐mean‐square of model eye measures was least (0.017 ± 0.002D) when the separation of the horizontal measurement bars were averaged twice. The separation of the horizontal bars changes by 3.59 pixels/dioptre (r2 = 0.99), allowing continuous on‐line analysis of the refractive state at up to 60 Hz temporal resolution to an accuracy of <0.001D, with pupils >3 mm. The pupil edge is not obscured in the diagonal axis by the measurement bars, unlike the ring of the original optics, so in the newer model pupil size can be measured simultaneously at the same rate with a resolution of <0.001 mm. The measurements of accommodation and pupil size are relatively unaffected by eccentricity of viewing up to ±10° from the visual axis and instrument focusing inaccuracies over a range of 10 mm towards the eye and 5 mm away from the eye. The resolution and temporal properties of the analysis are therefore ideal for the simultaneous measurement of dynamic accommodation and pupil responses.
Hormone Use and Cognitive Performance in Women of Advanced Age
Authors: Galen buckwalter J. , Crooks Valerie C. , Robins Sean B. , Petitti Diana B.
Published: December 2004

Objectives: To explore the association between hormone replacement therapy (HRT) and cognitive performance in a group of elderly women (≥75) using a battery of well‐standardized neuropsychological instruments.

Design: Equivalent samples from existing cohort.

Setting: Healthcare provider organization.

Participants: All women enrolled were participants in an ongoing study of the association between HRT and the prevalence and incidence of dementia. Prescription records were used to establish HRT status. Fifty‐eight users and 47 nonusers of HRT participated in this substudy.

Measurements: Given previous reports that HRT has a positive effect on verbal memory, the California Verbal Learning Test and the Logical Memory Test were used as primary outcomes. A range of validated tests that assess other cognitive domains was also included.

Results: There were no significant differences between users and nonusers of HRT on any cognitive measures.

Conclusion: Given equivalent groups of users and nonusers of HRT no support was found for the hypothesis that use of HRT improves cognitive performance in older women.
Older Adults' Views of “Successful Aging”—How Do They Compare with Researchers' Definitions?
Authors: Phelan Elizabeth A. , Anderson Lynda A. , Lacroix Andrea Z. , Larson Eric B.
Published: December 2004

Objectives: To determine whether older adults have thought about aging and aging successfully and to compare their perceptions of successful aging with attributes of successful aging identified in the published literature.

Design: A cross‐sectional, mailed survey.

Setting: King County, Washington.

Participants: Nondemented participants from two cohorts. The first cohort, referred to as Kame, which means turtle, a symbol of longevity for Japanese, enrolled 1,985 Japanese Americans aged 65 and older and was established in 1992–94. The second cohort, Adult Changes in Thought, enrolled 2,581 white men and women aged 65 and older from a health maintenance organization and was established in 1994–96.

Measurements: Respondents were asked whether they had ever thought about aging and aging successfully and whether these thoughts had changed over the previous 20 years and about how important specific attributes, originating from the published literature, were in characterizing successful aging.

Results: Overall, 90% had previously thought about aging and aging successfully, and approximately 60% said their thoughts had changed over the previous 20 years. The Japanese‐American group rated 13 attributes as important to successful aging; the white group rated the same 13 as important and added one additional attribute, learning new things.

Conclusion: Older adults' definition of successful aging is multidimensional, encompassing physical, functional, psychological, and social health. In contrast, none of the published work describing attributes of successful aging includes all four dimensions. Future work would benefit from an expanded definition to adequately reflect the perceptions of older adults.
Incidence and Prevalence of Dementia in the Cardiovascular Health Study
Authors: Fitzpatrick Annette L. , Kuller Lewis H. , Ives Diane G. , Lopez Oscar L. , Jagust William , Breitner John C. S. , Jones Beverly , Lyketsos Constantine , Dulberg Corinne
Published: December 2004

Objectives: To estimate the incidence and prevalence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in the Cardiovascular Health Study (CHS) cohort.

Design: Longitudinal cohort study using prospectively and retrospectively collected data to evaluate dementia.

Setting: Four U.S. communities.

Participants: There were 3,602 CHS participants, including 2,865 white and 492 African‐American participants free of dementia, who completed a cranial magnetic resonance image between 1992 and 1994 and were followed for an average of 5.4 years.

Measurements: Dementia was classified by neurologist/psychiatrist committee review using neuropsychological tests, neurological examinations, medical records, physician questionnaires, and proxy/informant interviews. Demographics and apolipoprotein E (APOE) genotype were collected at baseline. Incidence by type of dementia was determined using National Institute of Neurological and Communicative Disorders and Stroke‐Alzheimer's Disease and Related Disorders Association criteria for AD and Alzheimer's Disease Diagnostic and Treatment Center's State of California criteria for VaD.

Results: Classification resulted in 227 persons with prevalent dementia at entry into the study and 480 incident cases during follow‐up. Incidence rates of dementia scaled to age 80 were 34.7 per 1,000 person‐years for white women, 35.3 for white men, 58.8 for African‐American women, and 53.0 for African‐American men. Sex differences were not significant within race. Adjusted for age and education, racial differences were only of borderline significance and may have been influenced by ascertainment methodology. Rates differed substantially by educational attainment but were only significant for whites. Those with the APOE ɛ4 allele had an incidence rate at age 80 of 56.4, compared with 29.6 for those without this allele (P<.001). In whites, type‐specific incidence at age 80 was 19.2 for AD versus 14.6 for VaD. These rates were 34.7 and 27.2 for African Americans. At termination of observation, women had only a slightly higher prevalence of dementia (16.0%) than men (14.7%).

Conclusion: Sex and racial differences were not found, and VaD was higher than reported in other studies. These data provide new estimates of dementia incidence in a community sample for projection of future burden.
Radiographic Resolution of Community‐Acquired Bacterial Pneumonia in the Elderly
Authors: El Solh Ali A. , Aquilina Alan T. , Gunen Hakan , Ramadan Fadi
Published: December 2004

Objectives: To investigate the radiographic clearance of proven community‐acquired nontuberculous bacterial pneumonia in nonimmunocompromised older patients to provide working estimates of the rate of radiographic resolution as a function of the patient cumulative comorbidities, extent of initial radiographic involvement, functional status, and causative pathogens.

Design: A prospective study.

Participants: Seventy‐four patients aged 70 and older, consecutively admitted to a hospital for community‐acquired bacterial pneumonia.

Setting: A university‐affiliated teaching hospital.

Measurements: Chest radiographs were performed every 3 weeks from the date of admission for a total period of 12 weeks or until all radiographic abnormalities had resolved or returned to baseline.

Results: Sixty‐four patients (86%) completed the study. The rate of radiographic clearance was estimated at 35.1% within 3 weeks, 60.2% within 6 weeks, and 84.2% within 12 weeks. Radiographic resolution was significantly slower for those with high comorbidity index, bacteremia, multilobar involvement, and enteric gram‐negative bacilli pneumonias. Multivariate regression analysis demonstrated that the comorbidity index (relative risk for clearance=0.67 per class index, P<.001) and multilobar disease (relative risk for clearance=0.24 for more than one lobe, P<.001) had independent predictive value (Cox proportional hazards regression model) on the rate of resolution.

Conclusion: The radiographic resolution of nontuberculous bacterial pneumonia in the elderly should take into account the extent of lobar disease and the burden of underlying illnesses. A waiting period of 12 to 14 weeks is recommended for slowly resolving pneumonia to be considered nonresolving.
Alfacalcidol Reduces the Number of Fallers in a Community‐Dwelling Elderly Population with a Minimum Calcium Intake of More Than 500 Mg Daily
Authors: Dukas Laurent , Bischoff Heike A. , Lindpaintner Lyn S. , Schacht Erich , Birkner‐binder Dagmar , Damm Thomas N. , Thalmann Beat , Stähelin Hannes B.
Published: December 2004

Objectives: To study the effect of alfacalcidol (1α(OH)D3) on fall risk in community‐dwelling elderly men and women.

Design: Randomized, double‐blind, placebo‐controlled intervention trial.

Setting: Basel, Switzerland.

Participants: Three hundred seventy‐eight community‐dwelling elderly (191 women/187 men).

Intervention: Participants were randomly assigned to receive 1 μg of alfacalcidol or matched placebo daily for 36 weeks.

Measurements: Serum 25‐hydoxyvitamin D3 (25(OH) D,1,25‐dihydroxyvitamin D3 (D‐hormone), and intact parathormone (iPTH) levels were measured using radioimmunoassay at baseline and every 12 weeks. Numbers of fallers and falls were assessed using a questionnaire during each study site visit. Dietary calcium intake was assessed at baseline using a food frequency questionnaire.

Results: At baseline, participants had, on average, normal vitamin D and D‐hormone serum levels. Over 36 weeks, alfacalcidol treatment was associated with fewer fallers (odds ratio (OR)=0.69, 95% confidence interval (CI)=0.41–1.16) than placebo. In a post hoc subgroups analysis by medians of total calcium intake, this reduction reached significance in alfacalcidol‐treated subjects with a total calcium intake of more than 512 mg/d (OR=0.45, 95% CI=0.21–0.97, P=.042) but not in those who consumed less than 512 mg/d (OR=1.00, 95% CI= 0.47–2.11, P=.998). Alfacalcidol treatment was also, independent of total calcium intake, associated with a significant 37.9% reduction in iPTH serum levels (P<.0001). No cases of clinically relevant hypercalcemia were observed.

Conclusion: Provided a minimal calcium intake of more than 512 mg/d, alfacalcidol treatment significantly and safely reduces number of fallers in an elderly community dwelling population.
The Vulnerability of Middle‐Aged and Elderly Patients to Hepatitis C Virus Infection in a High‐Prevalence Hospital‐Based Hemodialysis Setting
Authors: Saxena Anil K. , Panhotra Bodh R.
Published: December 2004

Objectives: To determine the relationship between advancing age and the risk of acquiring hepatitis C virus (HCV) infection, through evaluation and statistical comparison of seroprevalence and seroconversion rates in different age groups of patients on long‐term hemodialysis (HD).

Design: Retrospective cohort study.

Setting: Hemodialysis facility of King Fahad Hospital and Tertiary Care Center, Al‐Hasa region of the eastern province of Saudi Arabia.

Participants: One hundred ninety‐eight patients with end‐stage renal disease enrolled for long‐term HD therapy from September 1995 to September 2000.

Measurements: HCV seroprevalence and seroconversion rates.

Results: The overall HCV seroprevalence of 43.4% (86/198) and seroconversion rate of 8.6% per year were recorded. Patients aged 55 to 64 had the highest anti‐HCV prevalence (55.3% (26/47)) and annual seroconversion rates (11.0%). Those aged 65 to 74 had the next‐highest prevalence (48.9% (24/49)) and seroconversion rate (9.7%), and patients aged 15 to 24 had the lowest prevalence (12.5% (1/8)) and seroconversion rate (2.5%) (reference group).

Conclusion: Significantly higher annual seroconversion rates in those aged 55 to 64 and 65 to 74 during a shorter dialysis period (35.6 and 32.7 vs 58.0 months), suggest the greater susceptibility of the middle‐aged and elderly patients to acquisition of HCV infection than the younger (15–24 years) group. This could be attributed to the combined effect of immunosuppression associated with advancing age, uremia, and undernutrition, but multicenter molecular follow‐up studies with larger sample sizes would be needed to corroborate these findings and plan appropriate strategies for these high‐risk groups.
The Effect of Short‐Term Estradiol Therapy on Cognitive Function in Older Men Receiving Hormonal Suppression Therapy for Prostate Cancer
Authors: Taxel Pamela , Stevens Michael C. , Trahiotis Margaret , Zimmerman Jill , Kaplan Richard F.
Published: December 2004

Objectives: To determine the effect of estrogen (E) alone (without the influence of testosterone (T)) on cognitive function in older men, using 17‐β micronized estradiol versus placebo in older men rendered hypogonadal (low T and E) by treatment for prostate cancer.

Design: Short‐term double‐blind, randomized, controlled trial.

Setting: An outpatient General Clinical Research Center.

Participants: Twenty‐seven community‐dwelling men aged 65 and older receiving neoadjuvant or established therapy with luteinizing‐hormone releasing‐hormone agonists for treatment of prostate cancer enrolled in a short‐term randomized, controlled trial of 17‐β micronized estradiol versus placebo on the effect on biochemical markers of bone turnover.

Measurements: Hormone levels, including E, T, and sex hormone–binding globulin; standardized neurocognitive tests, including measures of sustained attention, executive function, and memory; and questionnaires to assess subjects' perception of cognitive deficits and symptoms of depression.

Results: There were no significant differences between patients receiving E or placebo on 15 of 17 neurocognitive measures and no significant differences in self‐reported cognitive deficits or number of depressive symptoms.

Conclusion: Although studies have suggested that E replacement therapy may improve cognitive function, most notably memory performance in postmenopausal woman, there was no evidence in the present study that the addition of short‐term E therapy was more beneficial than placebo in tests of cognitive performance in hypogonadal men.
Clinical Phenotype of Families with Longevity
Authors: Atzmon Gil , Schechter Clyde , Greiner William , Davidson Deborah , Rennert Gad , Barzilai Nir
Published: December 2004

Objectives: To determine whether offspring of centenarians acquired protection from age‐related diseases.

Design: Case‐control study.

Setting: The study was part of the Longevity Genes Project at Albert Einstein College of Medicine.

Participants: Centenarians (n=145), offspring of centenarians (n=180), and spouses of the offspring of centenarians (n=75) as a control group. Two additional groups served as controls: age‐matched Ashkenazi Jews, and an age‐matched control group from the Third National Health and Nutrition Examination Survey.

Measurements: Self‐reported family history of longevity; prevalence of hypertension, diabetes mellitus, heart attacks, and strokes; and objective measurements of body mass index and fat mass.

Results: Parents of centenarians (born in approximately 1870) had a markedly greater (∼sevenfold) “risk” for longevity (reaching ages 90–99), supporting the notion that genetics contributed to longevity in these families. The offspring of long‐lived parents had significantly lower prevalence of hypertension (by 23%), diabetes mellitus (by 50%), heart attacks (by 60%), and strokes (no events reported) than several age‐matched control groups.

Conclusion: Offspring of centenarians may inherit significantly better health. The authors suggest that a cohort of these subjects and their spouses is ideal to study the phenotype and genotype of longevity and its interaction with the environment.
Progress in Elder Abuse Screening and Assessment Instruments
Authors: Fulmer Terry , Guadagno Lisa , Bitondo dyer Carmel , Connolly Marie Therese
Published: December 2004

The responsibility of identifying elder mistreatment (EM) often falls on the healthcare professional. Many different screening and assessment instruments have been developed to aid healthcare professionals in making determinations about EM. The purpose of this article is to review existing EM screening and assessment instruments to examine progress in this field. The value and limitations of these instruments with regard to their use in different clinical and healthcare settings are discussed. The settings in which EM screening and assessment are conducted are also considered. The authors conclude that there is much to be done in terms of achieving consensus on what constitutes an appropriate screen or assessment instrument for detecting EM. Effort must be focused on instruments that can be used for brief, rapid screenings and those that can be used for more‐detailed diagnostic assessments.
The Effect of Changing Practice on Fall Prevention in a Rehabilitative Hospital: The Hospital Injury Prevention Study
Authors: Vassallo Michael , Vignaraja Raj , Sharma Jagdish C. , Hallam Helen , Binns Kath , Briggs Roger , Ross Ian , Allen Steve
Published: December 2004

Objectives: To determine whether a change in practice to introduce a multidisciplinary fall‐prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital.

Design: A quasi‐experimental study.

Setting: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix.

Participants: Eight hundred twenty‐five consecutive patients.

Intervention: The patients' fall‐risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall‐prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety.

Measurements: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality.

Results: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60).

Conclusion: This study shows that falls might be reduced in a multidisciplinary fall‐prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients.
Mechanisms of Unexplained Anemia in the Nursing Home
Authors: Artz Andrew S. , Fergusson Dean , Drinka Paul J. , Gerald Melvin , Bidenbender Rex , Lechich Anthony , Silverstone Felix , Mccamish Mark A. , Dai Jinlu , Keller Evan , Ershler William B.
Published: December 2004

Objectives: To characterize anemia in elderly nursing home residents.

Design: Prospective multiinstitutional cohort study.

Setting: Five nursing homes.

Participants: From retrospective analysis, residents found to be anemic using chart review were prospectively randomized. Of the 81 residents enrolled, 60 were anemic.

Measurements: Chart review for medical history and factors related to treatment or history of anemia, extensive laboratory evaluation for causes of anemia, and classification of anemia by two hematologists.

Results: Among the 60 anemic residents, the causes of anemia were idiopathic (n=27), iron‐deficiency (n=14), anemia associated with chronic disease (n=8), anemia of renal insufficiency (n=6), and other (n=5). The eryrthropoietin (EPO) response to anemia was lower in residents with idiopathic anemia (IA) than in those with iron‐deficiency anemia, and this correlated with renal function as estimated using calculated creatinine clearance. In this elderly population, advancing age was not correlated with lower EPO response.

Conclusion: IA is common in nursing home residents. A lower EPO response contributes to the high prevalence of anemia in this setting and may be due, in part, to occult renal dysfunction.
Stroke Prophylaxis in Institutionalized Elderly Patients with Atrial Fibrillation
Authors: Lau Elaine , Bungard Tammy J. , Tsuyuki Ross T.
Published: December 2004

Objectives: To identify patterns and predictors of antithrombotic use and to evaluate the appropriateness of antithrombotic therapy for stroke prophylaxis in institutionalized elderly patients with atrial fibrillation.

Design: Retrospective study.

Setting: Seventeen long‐term care institutions in Edmonton, Alberta.

Subjects: Two hundred sixty‐five long‐term care residents, aged 65 and older, with atrial fibrillation.

Measurements: The proportion of patients who were prescribed warfarin, acetylsalicylic acid (ASA), both, or neither was determined. Odds ratios were calculated to identify risk factors for stroke and bleeding that are predictive of the receipt of anticoagulant therapy. Appropriateness of therapy was evaluated based on whether patients were prescribed antithrombotic therapy in accordance with their risk factors for stroke and bleeding.

Results: Warfarin was prescribed for 49% of patients, ASA for 22%, both for 8%, and neither for 20%. Nearly all patients (97%) were considered to be at high risk for stroke, with age being the predominant risk factor (88%>75), whereas about half were considered to be at low risk for bleeding. Multivariate analyses did not find any associations between individual risk factors for bleeding and anticoagulant treatment, with the exception of recent surgery (odds ratio=0.59, 95% confidence interval=0.37–0.94). Overall, 54.8% of patients received appropriate antithrombotic therapy. Of patients who were optimal candidates for anticoagulation, 60% received appropriate therapy (warfarin with or without ASA).

Conclusion: Although warfarin was the most appropriate treatment in nearly all of this population at high risk for stroke, it was prescribed in fewer than two‐thirds of patients. Antithrombotic therapy was not always prescribed in accordance with patients' risk factors for stroke and bleeding. There is a need for systematic identification of appropriate candidates for anticoagulation in the long‐term care setting.
Predictors of Nursing Facility Admission: A 12‐Year Epidemiological Study in the United States
Authors: Bharucha Ashok J. , Pandav Rajesh , Shen Changyu , Dodge Hiroko H. , Ganguli Mary
Published: December 2004

Objectives: To identify predictors of institutionalization in a community‐based cohort of older adults.

Design: Prospective, longitudinal. After initial assessment at study entry, surviving participants were reassessed in a series of approximately biennial waves until October 2001; baseline for the current analysis was Wave 2 (1989–91).

Setting:

Largely rural, blue‐collar community in the mid‐Monongahela Valley of southwestern Pennsylvania.

Participants: A population‐based cohort of 1,147 adults, aged 66 and older (mean 74.1) at baseline, who were not already institutionalized and who had complete data on all variables of interest.

Measurements: Cox proportional hazards models were used to identify predictors of institutionalization from among selected variables measured at baseline, including age, sex, education, marital status, living arrangements, ability to perform instrumental activities of daily living (IADLs), depressive symptoms, number of prescription medications (as an index of overall morbidity), self‐reported social support, hospitalization during the preceding year, and cognitive functioning. Dementia was defined according to the operational criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and by a Clinical Dementia Rating of 0.5 or greater, based on a standardized clinical assessment. The outcome variable was institutionalization, defined as entry into in a nursing home.

Results: Significant predictors of institutionalization were dementia (hazard ratio (HR)=5.09, 95% confidence interval (CI)=2.92–8.84), measured as a time‐dependent variable; older age (HR=1.06, 95% CI=1.03–1.10); IADL disability (HR=1.31, 95% CI=1.15–1.50); worse/less social support (HR=1.27, 95% CI=1.10–1.46); and number of prescription medications (HR=1.21, 95% CI=1.11–1.32), measured at baseline. The interaction between number of prescription drugs and dementia was also significant, suggesting that prescription medication count had less effect on institutionalization in those with dementia than in those without.

Conclusion: Dementia emerged as the most potent risk factor for institutionalization in this 12‐year community‐based epidemiological study. Medical burden conferred greater vulnerability to institutionalization in nondemented persons than in those with dementia.
Predictors of Nursing Home Placement in African Americans with Dementia
Authors: Gaugler Joseph E. , Leach Corinne R. , Clay Ted , Newcomer Robert C.
Published: December 2004

The objective of the present study was to identify predictors of institutionalization in African Americans who suffer from dementia. Data were derived from the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE), which collected information on Alzheimer's patients and their family caregivers over a 3‐year period. The baseline MADDE sample included 667 older African Americans suffering from dementia recruited from eight catchment areas in the United States. A Cox proportional hazards model was used to create a predictive model of institutionalization. Subsequent analyses found that care recipient age, sex, Medicaid eligibility, and cognitive impairment; site; and caregiving burden were significant predictors of time to placement. The results, among the first to examine predictors of nursing home placement of cognitively impaired African Americans, emphasize the clinical implications and complex interplay of race, dementia, and caregiving context in the institutionalization process.
Extreme ultraviolet microexposures at the Advanced Light Source using the 0.3 numerical aperture micro-exposure tool optic
Authors: Naulleau Patrick P. , Goldberg Kenneth A. , Anderson Erik , Cain Jason P. , Denham Paul , Jackson Keith , Morlens Anne-Sophie , Rekawa Seno , Salmassi Farhad
Published: December 2004

In an effort to continue the rapid pace of extreme ultraviolet (EUV) learning, the focus of developmental EUV lithography has shifted from low numerical aperture (NA) tools such as the 0.1NA engineering test stand to higher NA tools such as the 0.3NA micro-exposure tool (MET). To support this generation of lithographic optics, a static printing station has been developed at the Advanced Light Source. This synchrotron-based printing system relies on a scanning illuminator to provide real-time coherence (pupil-fill) control. Here, we describe a MET printing station and present early printing results obtained with the Sematech Set-2 MET optic. The resolution limit of baseline EUV resist is presented as well as 30nm equal-line-space printing in an experimental resist.
Technique for separately viewing multiple levels
Authors: Jiang L. , Feldman M.
Published: December 2004

It is often desired to measure the accuracy of image placement in an integrated circuit, as well as the overlay between two levels printed on the same wafer. Such measurements yield information not only about alignment, but also about wafer, mask, and imaging distortions. Image placement measurements require state-of-the-art equipment. Overlay measurements are difficult to make if the patterns overlap each other, since one pattern may obscure parts of the other. In addition, the presence of an edge in one pattern may produce an error in the location of a nearby edge in the other pattern. This article describes a method of patterning that permits optical separation of the two levels so that they can be viewed independently. The method is based on the use of a resist containing a dye, such that the resist has a high contrast at one wavelength, but is completely transparent at another. In addition, the use of a precision grating for one of the levels provides a simple way to obtain highly accurate absolute image placement measurements.
Deep-ultraviolet–microelectromechanical systems stencils for high-throughput resistless patterning of mesoscopic structures
Authors: van den Boogaart M. A. F. , Kim G. M. , Pellens R. , van den Heuvel J.-P. , Brugger J.
Published: December 2004

We describe a combination of 100-mm wafer scale deep-ultraviolet (DUV) exposure and a microelectromechanical systems (MEMS) process to fabricate silicon nitride membranes with submicrometer apertures to be used as miniature shadow masks or nanostencils. Apertures down to a lateral resolution of 200nm were made in a 500-nm-thick membrane by DUV exposure and dry plasma etching. The membranes were released by a combination of wet silicon etching using potassium hydroxide (KOH) and dry silicon etching using a plasma process. The millimeter-size stencils were used for single-step, local deposition of metal micro- and nano-patterns without the need for photoresist process steps. We have performed stencil deposition on full wafer scale for micro- and nano-patterns in a variety of metals (e.g. Al, Au, Ni, etc.). Dry under-etching of the nanowires resulted in free-standing cantilevered nanoelectromechanical systems (NEMS) structures with resonance frequencies in the megahertz range. The resistless method allows us to pattern micrometer and nanometer scale patterns in a single step without any further processing. It is promising for the surface processing of MEMS/NEMS devices having sensitive or fragile surfaces, such as biochips, organic polymer layers, and self-assembled monolayers.
Optimized HT-AttPSM blanks using Al2O3∕TiO2 multilayer films for the 65nm technology node
Authors: Lai Fu-Der
Published: December 2004

The optical properties of (Al2O3)x̸(TiO2)1−x superlattice films have been shown to satisfy the effective medium approximation theory and, therefore, can be tunable. It is found that (Al2O3)x∕(TiO2)1−x superlattice films with x=79%–84% as π-phase shifters can be used as high-transmittance attenuated phase-shift mask (HT-AttPSM) blanks at a wavelength of 193nm. Lower transmittance at an inspection wavelength of 257nm is desirable for a better inspection. Due to the fact that the transmittance is less than 25% at a wavelength of 257nm, this means that these layers allow for good inspection. Lower reflectance at an exposure wavelength of 193nm is desirable, as this leads to better aerial images. To achieve a better aerial image, it is best to select a four-stack (Al2O3)x̸(TiO2)1−x film as the HT-AttPSM blank layer because a four-stack film has the lower reflectance than others. The thickness fraction range of Al2O3 in the four-stack (Al2O3)x̸(TiO2)1−x films used for the HT-AttPSM blanks at a wavelength of 193nm is found to be between about 79% and about 85%. We fabricate a four-stack (Al2O3)x̸(TiO2)1−x film sample for HT-AttPSM that has the optimized optical properties, which include a transmittance of 19.9% and a lower reflectance (3.2%) at a wavelength of 193nm and a good inspection transmittance (less than 20%) at a wavelength of 257nm. The four-stack (Al2O3)x̸(TiO2)1−x film can be used to design a desirable HT-AttPSM at the exposure wavelength of 193nm.
Modeling of electronic transport in GaN n-i-p junctions
Authors: Mayer A. , Miskovsky N. M. , Cutler P. H.
Published: December 2004

We propose a model and an algorithm for computing the transport properties of GaN n-i-p devices. The formalism yields the band diagram and I–V characteristics of these systems, and accounts for the effects of an external resistance in series with the diode and the generator. For the conditions considered, the device obeys essentially the ideal diode equation with deviations due to the external resistance and the transfer of charges between the different layers. Compared to n-p devices, the isolating layer enables one to decrease the external resistance and obtain more diode current for the same voltage. The external resistance allows one also to control and reduce appreciably the height of the barrier that characterizes the n-i interface. This barrier may serve as an energy discriminator, which can be important in applications for thermal management.
Fabrication of sub-5nm gaps between metallic electrodes using conventional lithographic techniques
Authors: Steinmann Philipp , Weaver J. M. R.
Published: December 2004

The reproducible fabrication of nanoscale gaps below 5nm between metallic electrodes is key to the study of the electronic characteristics of individual molecules, but is hampered by the resolution limit and mechanical instabilities of commonly used electron-sensitive resists. We describe a fabrication process for the creation of nanoscale gaps between metallic electrodes based on conventional lithographic techniques. The process involves the patterning of a lithographic gap of 5–∼20nm between metallic electrodes on an oxidized silicon substrate. The SiO2 not covered by the electrodes is undercut and another metal film is thermally evaporated onto the substrate. Due to the slow buildup of material at the edges of the patterned electrode, the gap size can be reduced in a controllable way, and the final gap size is determined by the thickness of the evaporated metal film. This batch fabrication process is suitable for high-density fabrication of nanoscale gaps with the attractive feature that a self-aligned gate can be formed underneath the gap. We have investigated the effect of annealing samples for a short period at 125°C in air. Scanning electron microscopy data of a batch of identical gaps is presented which illustrates the variation in gap size and morphology after annealing. Gaps down to 1–∼2nm can be resolved directly using a scanning electron microscope. For gaps below 1nm, the separation between the two metallic electrodes cannot be resolved. To determine whether a tunnel gap is present, electrical measurements are required. Use of the Simmons tunnel model to fit an analytical curve to the measured IV characteristics of a gap gives a separation of 1.2±0.2nm and also verifies the consistency of parameters such as the effective barrier height in air indicating the presence of contaminants on the electrodes.
Lithographic performance of diamond-like carbon membrane mask in electron projection lithography
Authors: Yamashita Hiroshi , Amemiya Isao , Yamabe Masaki , Arimoto Hiroshi
Published: December 2004

We have studied the lithographic performance of high-performance diamond-like carbon (DLC) membrane masks by demonstrating exposure experiments using Nikon’s electron beam stepper, NSR-EB1A. We estimated the inelastic mean free path of 100keV electrons in a membrane analytically using the measurement results of zero-loss electron transmittance and found it to be about 50nm. We then used this value to find the relationship between membrane thickness and zero-loss electron transmittance. The resolution for high-performance membrane masks is equivalent to that of a stencil mask and was not deteriorated by chromatic aberration due to inelastic electron scattering. Electrons undergoing inelastic scattering did not appear to affect resolution. The nominal exposure dose was proportional to the inverse of zero-loss electron transmittance. We also discussed the optimum membrane thickness in terms of throughput and electron inelastic scattering, focusing on plasmon excitation.
Impact of residual layer uniformity on UV stabilization after embossing
Authors: Wissen M. , Schulz H. , Bogdanski N. , Scheer H.-C. , Hirai Y. , Kikuta H. , Ahrens G. , Reuther F. , Glinsner T.
Published: December 2004

A low-Tg resist material, mr-L 6000XP, was investigated for low-temperature imprint. Its stabilization requires UV exposure and a postexposure bake. To approach the UV-induced crosslinking process, the local distribution of light intensity within the imprinted pattern was simulated. To account for a nonuniformity of the residual layer caused by pattern size and pattern density effects during imprint, different residual layer heights were adopted. The simulations show that not only the residual layer height but also the pattern size influences the resulting local intensity distribution. Experiments performed for selected residual layer heights (50, 100, 150, and 200nm) document that in fact the residual layer height affects the pattern quality obtained after stabilization. The effects identified are different for differing pattern sizes. Beyond stabilization, the results have consequences for mix and match of nanoimprint with UV lithography.