bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Pressure Ulcer Staging Accuracy Through a Nursing Student Experiential Intervention
Authors: Tschannen Dana , Mckay Mary , Steven Mary 
Published: April 2016

Background:
Staging of pressure ulcers (PUs) is often inaccurate. The purpose of this study was to evaluate the effectiveness of a student-focused intervention to improve PU staging accuracy in nursing students.

Method:

Nursing students from two universities were included. The control group (
n
= 103) received a standard lecture about PUs; the intervention group (
n
= 55) completed a PU module, participated in Skin Day at a local hospital, and received the standard lecture. All students completed a PU staging tool to determine their staging accuracy. Scores were compared using analysis of variance.

Results:
Students in the intervention group were significantly more accurate in PU staging, especially stage II PUs and suspected deep tissue injury. Stage III PUs were the most difficult to stage for all students.

Conclusion:

Skin Day provided students with hands-on clinical experience, which assisted them in becoming better at staging PUs. This type of experiential opportunity should be considered for all students, as accurate staging is necessary for best practice adherence. [
J Nurs Educ.
2016;55(5):266–270.]
A Case-Based Curriculum With the Nurse as Coach
Authors: Shostrom Brenda L. , Schofer Karna K. 
Published: April 2016

Background:
Nurses need new skill sets that emphasize health outcomes and cost reduction. A bachelor of science in nursing (BSN) program partnered with community agencies to design a curriculum to address these skills.

Method:
Two focus groups were conducted with 24 participants employed as care coordinators, nurse coaches, or health navigators.

Results:
Three themes and subgroups emerged that guided a curriculum design that emphasized case-based rather than place-based client focus, coaching as a curriculum thread, and new and varied community experiences. Community health concepts were introduced early and reinforced throughout. Health coaching was identified as a powerful framework and tool to address client needs. Further study is needed to measure outcomes of the new curriculum.

Conclusion:

Changing paradigms in nursing education is challenging. Care coordination and coaching skills can broaden the competency base of RNs and can be included in a BSN curriculum. More study is needed to measure outcomes. [
J Nurs Educ.
2016;55(5):292–295.]
Properdin-Mediated C5a Production Enhances Stable Binding of Platelets to Granulocytes in Human Whole Blood
Authors: Blatt Adam Z. , Saggu Gurpanna , Kulkarni Koustubh V. , Cortes Claudio , Thurman Joshua M. , Ricklin Daniel , Lambris John D. , Valenzuela Jesus G. , Ferreira Viviana P. 
Published: April 2016

Abstract
Enhanced levels of platelet/granulocyte aggregates (PGAs) are found in patients suffering from many different inflammatory vascular diseases, and their formation in animal models of vascular disease is associated with increased thromboinflammation and worsened outcomes. The complement system, a part of the innate immune system, influences PGA formation, but the mechanisms for its effects are unknown. In this study, we have defined complement-mediated mechanisms that enhance PGA formation in human whole blood stimulated with thrombin receptor–activating peptide (TRAP) using ex vivo flow cytometry assays. We demonstrate that physiological properdin, a positive regulator of complement alternative pathway activity, increases PGA formation when added to TRAP-stimulated blood. All physiological properdin forms increase PGA formation, but properdin tetramers are the most efficient at increasing complement activity and PGA formation. Inhibition of endogenous properdin, either circulating in the blood or produced locally by leukocytes, impairs TRAP-mediated PGA formation to the same level as specific inhibition of either the alternative or classical pathway. Additionally, blocking the interaction of C5a with its cellular receptor prevents properdin-mediated increases in PGA formation. Adding either properdin tetramers or C5a to whole blood increases CD11b expression on granulocytes, and this increase is prevented by blockade of the C5a–C5a receptor axis. Finally, we demonstrate that the effects of properdin on PGA formation are tightly regulated by Factor H. Cumulatively, our data indicate that properdin enhances PGA formation via increased production of C5a, and that inhibition of properdin function has therapeutic potential to limit thromboinflammation in diseases characterized by increased PGA formation.
Advances in Aligned Wafer Bonding Enable by High Vacuum Processing
Authors: Pabo Eric F. , Floetgen Christoph , Rebhan Bernhard , Nasser Razek 
Published: April 2016

High volume aligned wafer bonding processes typically separate the wafer to wafer alignment process from the wafer bonding process and this wafer to wafer alignment is normally done in an ambient atmosphere. While this process flow has worked well and enabled the proliferation of MEMS devices in the last decade, it does have limitations. The primary issue is the exposure to water vapor and ambient atmosphere which limits the preprocessing that can be done and maintained on the wafers to be bonded. Performing the wafer to wafer alignment, handling, and wafer bonding in a high vacuum environment allow specialized preprocessing of the wafers prior to alignment and bonding.
The most basic preprocessing enabled by this high vacuum environment is the open face dehydration bake of wafers prior to alignment to alignment and bonding. When done in a cluster tool, a chamber can be dedicated to baking out the wafers to minimizing the effect of outgassing on the final vacuum level in the MEMS device. If one wafer needs a high temperature bakeout and getter activation and one wafer is limited to a low temperature bakeout this is possible by using two chamber in the cluster tool – one for the high temperature backout and one for the low temperature bakeout. Microbolometers that use vanadium oxide as the sensor layer are an example of a device needing high and low temperature bakeout.
Another preprocessing enabled by the high vacuum cluster tool is a surface treatment which removes oxides from the surface, increases the surface energy, and enables the formation of covalent bonds at room temperature in the case of Si-Si bonding.
This low temperature covalent bond has been shown to have an oxide free interface with a minimized amorphous layer as well as very low metal contamination. Also, because the bonding is done at or near room temperature it is possible to bond materials with substantially different CTES such a GaN to SiC
This new technology will enable improved vacuum encapsulation as well as the manufacture of new, high performance engineered substrates.
The latest process results as well as process flows and required equipment capabilities will be presented.
Innovated Process Integration for Panel Size Glass Substrate Manufacturing for SiP Application
Authors: Chen Yu-Hua , Hsieh Yu-Chung , Lin Wei-Di , Chien Chun-Hsien , Hu Dyi-Chung 
Published: April 2016

Although Silicon interposer has good performance, however high cost is still the major issue and limits its high volume adoption. Therefore to decrease the assembly cost or develop low cost, high density interconnect interposer technology is the keys to enable 2.5D SiP integration. One possibility is to develop low cost interposer by adopting the alternative materials instead of Silicon. The glass, low CTE polymer material, ceramic, etc. may be included.
Glass represents an attractive choice with potential of tailorable properties dependent on specific glass composition. By targeting the coefficient of thermal expansion (CTE), the CTE of glass can be made to match perfectly with silicon dies and for reliable package. In addition, the advantages of using glass for interposer derive from process flexibility for size and thickness since the glass fusion process provides sheets with dimensions of more than three meters. It is straight forward to provide glass substrate of almost any size needed. Large glass panels are ideally suited for fabrication of interposer where the panel process is expected to provide large number of interposers in each run compared with wafer processing. Additionally, the two sided processing of the panel, the avoidance of Si wafer CMP processes further enable lower unit cost for the interposer Consequently, glass is an ideal interposer material due to its insulating property, large panel size availability, high modulus and ability to tailor CTE.
In this paper, we successfully demonstrate manufacturing feasibility of glass substrate with 4 build-up layers starting with a thin glass panel in 508mm×508mm panel size format and under the IC substrate manufacturing environment. Glass thickness of 100~300um could be processed through the IC substrate HVM line. The laser via in via or direct metallization technology could be selected for double side electrical connection. The copper line width/space of 8/8um was demonstrated by current substrate HVM line. By adopting advanced lithography process and material, line width/space less than 2/2um was achievable. TCT Reliability test without glass crack results will also be discussed.
Critical Process Parameters And Failure Analysis For Temporary Bonded Wafer Stacks
Authors: Brandl Elisabeth , Abadie Karine , Wimplinger Markus , Burggraf Juergen , Uhrmann Thomas , Bravin Julian , Fournel Frank , Montmeat Pierre 
Published: April 2016

Temporary bonding is a ley process for almost any 3D integration scheme. It offers not only more stability during the thinning process but also allows handling for backside processing of thin wafers like interposers during subsequent process steps [1–2]. Although the temporary bonding technology is already used in high volume manufacturing and has proven high yield process, nevertheless, some limitation appears for some specific applications [3-4-5]. One critical failure origin is delamination, which can lead to wafer breakage and therefore yield loss.
This separation of the device wafer and the carrier wafer typically occurs when the temporary bonded wafer stack (device wafer, carrier wafer and temporary bonding adhesive in between) experiences further processing done under high temperature and low vacuum like PECVD deposition. Further insight into processing parameters and a better understanding of the key contributing factors as well as its dependencies help to prevent this failure.
To investigate the root cause of the delamination, thermoplastic materials, which are widely used for temporary bonding and debonding applications have been used as temporary bonding adhesives in this work.
Different process parameters were investigated individually but also in combination to find the origin of the delamination. These parameters include post thinning annealing temperature, which was varied up to 370C, vacuum level, thermal gradient, bow and warp and intrinsic stress of the thin device wafer. After evaluation of the main parameters affecting the delamination appearance, two extreme cases were experimented in order to check the hypothesis. The first one exhibits delaminations even using a very soft processing conditions for a temporary bonding integration and the second case is able to withstand extreme processing conditions like high temperature up to 370C under vacuum of about 1mbar without delamination appearance.
In addition, during this work, the mechanical coupling existing between the carrier and the device wafer thanks to the adhesive has been investigated. Here, a thermoplastic material was used in a temporary bonded structures using wafers with different coefficients of thermal expansion (CTE). During thermal treatment, this CTE difference induce important internal stress bow of the wafer stack. The temperature dependence of the mechanical coupling is monitored during the annealing. A mechanical decoupling between the two wafers occurs when above the polymer glass transition temperature. As a result, the rheology of the thermoplastic layer is found as a contributor to the delamination mechanism.
Critical combinations of process parameters in temporary bonding process are then clearly identified and will be presented in this work.
A Novel Third Order Analog Chaotic Oscillator
Authors: Rhea Benjamin K. , Werner Frank T. , Harrison Remington C. , Dean Robert N. 
Published: April 2016

Chaotic oscillators, which are characterized by a spread spectrum response, have a wide range of possible applications including random number generation, communication systems, noise signal generation, and jamming. A novel chaotic oscillator design and implementation that reduces design complexity, component count, and size over a traditional approach is presented.
The oscillator design approach can be divided into three primary subsystems. The first subsystem is called the stretching mechanism, which exhibits an exponential unstable sinusoidal response as a standalone system. This unstable subsystem is bounded by a feedback network. The feedback network consists of guard condition and a folding mechanism. The stretching mechanism will grow until a criterion for the guard condition is met which triggers when the folding mechanism should fold, or double.
The motivation behind this design was inspired by the linear second-order set of differential equations with an exactly solvable solution. The electronic implementation of this design focuses on reducing the complexity of the stretching mechanism subsystem, which typically consists of a network of operational amplifiers (op amps) to realize a negative RLC circuit. This can be simplified by replacing the op amps with a single common base amplifier to achieve similar unstable sinusoidal responses. This reduces the design complexity as well as the overall footprint of the stretching mechanism.
While the op amp network design approach results in a linear second-order system, the introduction of the additional active bi-polar junction transistor (BJT) in the common base amplifier results in a third-order system. These higher order terms are often undesirable in applications due to increased design complexity of the peripheral systems. An example of this would be in a communication system, where a third-order matched filter would be required to recover the signal in presence of additive white Gaussian noise (AWGN). Detailed analysis of the second-order and third-order system have been done to show that the third-order terms introduced by the common base amplifier do not adversely affect the dynamics of the system when used in a communication system with a second-order matched filter.
Tubercular meningitis in children: Clinical, pathological, and radiological profile and factors associated with mortality
Authors: Israni Anil V. , Dave Divya A. , Mandal Anirban , Singh Amitabh , Sahi Puneet K. , Ranjan Rashmi Das , Shah Arpita 
Published: April 2016

ABSTRACT
Context: Childhood tuberculosis is a major public health problem in developing countries with tubercular meningitis being a serious complication with high mortality and morbidity. Aim: To study the clinicopathological as well as radiological profile of childhood tuberculous meningitis (TBM) cases. Settings and Design: Prospective, observational study including children <14 years of age with TBM admitted in a tertiary care hospital from Western India. Subjects and Methods: TBM was diagnosed based on predefined criteria. Glassgow coma scale (GCS) and intracranial pressure (ICP) was recorded. Staging was done as per British Medical Council Staging System. Mantoux test, chest X-ray, cerebrospinal fluid (CSF) examination, neuroimaging, and other investigations were done to confirm TB. Statistical Analysis Used: STATA software (version 9.0) was used for data analysis. Various risk factors were determined using Chi-square tests, and a P< 0.05 was considered significant. Results: Forty-seven children were included, of which 11 (24.3%) died. Fever was the most common presenting symptom, and meningismus was the most common sign. Twenty-nine (62%) children presented with Stage III disease. Stage III disease, low GCS, and raised ICP were predictors of mortality. Findings on neuroimaging or CSF examination did not predict mortality. Conclusions: Childhood TBM presents with nonspecific clinical features. Stage III disease, low GCS, lack of Bacillus Calmette–Guérin vaccination at birth and raised ICP seem to the most important adverse prognostic factors.
Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs
Authors: Kamak Gulen , Yildirim Eren , Rencber Emin 
Published: April 2016

ABSTRACT
Objective: To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR). Materials and Methods: A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss. Results: CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk. Conclusion: Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.
Maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width groups
Authors: Shahid Fazal , Alam Mohammad Khursheed , Khamis Mohd Fadhli 
Published: April 2016

ABSTRACT
Objective: To investigate the maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width (intercanine, interpremolar, and intermolar) groups. Materials and Methods: The calculated sample size was 128 subjects. The crown width/height, arch length, arch perimeter, and arch width of the maxilla and mandible were obtained via digital calliper (Mitutoyo, Japan). A total of 4325 variables were measured. The sex differences in the crown width and height were evaluated. Analysis of variance was applied to evaluate the differences between arch length, arch perimeter, and arch width groups. Results: Males had significantly larger mean values for crown width and height than females (P ≤ 0.05) for maxillary and mandibular arches, both. There were no significant differences observed for the crown width/height ratio in various arch length, arch perimeter, and arch width (intercanine, interpremolar, and intermolar) groups (P ≤ 0.05) in maxilla and mandible, both. Conclusions: Our results indicate sexual disparities in the crown width and height. Crown width and height has no significant relation to various arch length, arch perimeter, and arch width groups of maxilla and mandible. Thus, it may be helpful for orthodontic and prosthodontic case investigations and comprehensive management.
Allergic effects of the residual monomer used in denture base acrylic resins
Authors: Rashid Haroon , Sheikh Zeeshan , Vohra Fahim 
Published: April 2016

ABSTRACTDenture base resins are extensively used in dentistry for a variety of purposes. These materials can be classified as chemical, heat, light, and microwave polymerization materials depending upon the factor which starts the polymerization reaction. Their applications include use during denture base construction, relining existing dentures, and for fabrication of orthodontic removable appliances. There have been increased concerns regarding the safe clinical application of these materials as their biodegradation in the oral environment leads to harmful effects. Along with local side effects, the materials have certain occupational hazards, and numerous studies can be found in the literature mentioning those. The purpose of this article is to outline the cytotoxic consequences of denture base acrylic resins and clinical recommendations for their use.
Evaluation of root morphology and root canal configuration of premolars in the Turkish individuals using cone beam computed tomography
Authors: Bulut Duygu Goller , Kose Emre , Ozcan Gozde , Sekerci Ahmet Ercan , Canger Emin Murat , Sisman Yıldıray 
Published: April 2016

ABSTRACT
Objective: The aim of the present study is to assess the root and root canal morphology of maxillary and mandibular premolars in a Turkish population by using cone beam computed tomography (CBCT). Materials and Methods: In this study, CBCT images of 2134 premolars (987 maxillary, 1147 mandibular) were obtained from 404 patients. Details of gender, age, number of roots and canals, and canal configuration in each root were recorded. The canal configuration was classified and evaluated according to Vertucci's criteria. Results: The majority of maxillary premolars had two separate roots; although, three roots were identified in 1% of maxillary first premolars. However, most of the mandibular premolars had a single root. The two canals (69.9%) and type I (62.6%) and type II (34.1%) configuration for upper first premolar, one canal (82.1%) and type I (77.6%) canal configuration for second premolar was the most prevalent root canal frequency. The most prevalent root canal frequency was the one canal (96.2%) and type I (94.2%) and type V (3.2%) configuration for mandibular first premolar, one canal (98.9%) and type I (98.9%) canal configuration for second premolar. There was no difference in the root canal configurations and the numbers of canals between the left and the right side of both females and males (P > 0.05). Conclusions: Recognition of morphology and anatomy of the root canal system is one of the most important factors for successful endodontic treatment. Preoperative CBCT examination allows determination of root canal configuration of premolar teeth and helps clinicians in root canal treatment.
Effect of dry cryogenic treatment on Vickers hardness and wear resistance of new martensitic shape memory nickel-titanium alloy
Authors: Vinothkumar Thilla Sekar , Kandaswamy Deivanayagam , Prabhakaran Gopalakrishnan , Rajadurai Arunachalam 
Published: April 2016

ABSTRACT
Objectives: The aim of this study is to investigate the role of dry cryogenic treatment (CT) temperature and time on the Vickers hardness and wear resistance of new martensitic shape memory (SM) nickel-titanium (NiTi) alloy. The null hypothesis tested was that there is no difference in Vickers hardness and wear resistance between SM NiTi alloys following CT under two soaking temperatures and times. Materials and Methods: The composition and the phase transformation behavior of the alloy were examined by X-ray energy dispersive spectroscopy and differential scanning calorimetry, respectively. Fifteen cylindrical specimens and 50 sheet specimens were subjected to different CT conditions: Deep cryogenic treatment (DCT) 24 group: −185°C, 24 h; DCT six group: −185°C, 6 h; shallow cryogenic treatment (SCT) 24 group: −80°C, 24 h; SCT six group: −80°C, 6 h; and control group. Wear resistance was assessed from weight loss before and after reciprocatory wet sliding wear. Results: The as-received SM NiTi alloy contained 50.8 wt% nickel and possessed austenite finish temperature (Af) of 45.76°C. Reduction in Vickers hardness of specimens in DCT 24 group was highly significant (P < 0.01; Tukey's honest significant difference [HSD]). The weight loss was significantly higher in DCT 24 group (P < 0.05; Tukey's HSD). Conclusion: Deep dry CT with 24 h soaking period significantly reduces the hardness and wear resistance of SM NiTi alloy.