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Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.
The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.
A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.
Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.
A satellite-image map with surface-elevation contours of Filchner Ronne Ice Shelf has been published previously as a topographic map. The image map was constructed from a mosaic of 69 Landsat Multispectral Scanner (MSS) images and NOAA AVHRR data. The standard deviation in position in the central part of the mosaic is ±125m. Topographic-glaciologic features were taken from Landsat scenes and represent the best coastline of this region. Surface elevations have been calculated from airborne and ground measurements of either ice thickness (by assuming hydrostatic equilibrium) or barometric pressure. Accuracies vary from ±2 to ±7 m, Oversnow trigonometric levelling in the northeastern part of the ice shelf, tied to sea level at the ice front, has given accuracies of ± 1m. Accuracies reduce to about ±20 m in the grounded ice areas,
ERS-I radar-altimeter data over the ice shelf have been processed to give ellipsoidal heights elevation above the ellipsoid), Geoidal reductions have been used to convert these to orthometric heights (elevation above sea level). No tidal corrections have been applied. The overall accuracy of the radar-altimeter-derived elevations is estimated to be better than ±5m. There are noticeable differences from the topographic map in the central part where the radar data indicate a lower surface. However, the maps agree to within the stated error figures.
The possible importance of the reaction of a low-mass star to external irradiation for the long-term evolution of compact binaries has been noted only rather recently; first in the context of the evolution of low-mass X-ray binaries (e.g. Podsiadlowski 1991; Harpaz & Rappaport 1991; Frank, King & Lasota 1992; Hameury et al. 1993) and subsequently by Ritter, Zhang & Kolb (1995a,b, hereafter RZK) also for the evolution of cataclysmic variables (CVs). Based on a simple model for describing the reaction of a low-mass star to irradiation RZK showed that CVs can be dynamically unstable against irradiation-induced mass transfer and that, as a consequence of this, mass transfer could occur via cycles in which phases of high, irradiation-enhanced mass transfer alternate with phases of little or no mass transfer. The occurrence of such mass transfer cycles in CVs was subsequently discussed from a more general point of view by King (1995) and King et al. (1995). Whereas the possibility of mass transfer cycles in CVs is now fully recognised, the question as to which systems can undergo such cycles and which cannot has not yet been addressed in detail. It is the purpose of this contribution to provide at least a partial answer to this question.
Background and Purpose: Carotid artery stenting (CAS) has been, historically, an alternative to open endarterectomy (CEA) for stroke prevention in high risk patients with carotid atherosclerosis. We sought to determine the rates of periprocedural and long-term stroke or death and the risk factors for complications after CAS in our high risk patient population. Methods: Clinical and treatment variables of consecutive CAS procedures performed between 2002 and 2011 were analyzed. Using univariate and multivariate logistic regression analyses we examined how patient characteristics influenced outcomes and changes in modified Rankin Score (mRS). Results: In 152 patients, the composite total of periprocedural death, stroke, transient ischemic attack (TIA) and myocardial infarction (MI) rate was 3.95% (6/152). Chronic kidney disease (CKD) was strongly associated with periprocedural complications (p<0.001). Coronary artery disease/peripheral vascular disease (CAD/PVD) (p=0.03), dyslipidemia (p=0.02), CKD (p=0.01), and contralateral internal carotid artery stenosis (p=0.02) were non-modifiable risk factors for mRS increase. There were 25 deaths, 8 strokes, 11 TIAs, and 1 MI (mean follow-up 38.4 months, range 0-116 months). The presence of CAD/PVD (p=0.009) and dyslipidemia (p=0.002) were significantly associated with long-term complications. Conclusion: CAS was performed with low periprocedural complications in high-risk patients. Our rates compare very favorably to large-scale trials that have ideal patients. This data encourages the consideration of CAS in patients considered high risk for CEA and provides possible patient characteristics (CKD) to help with periprocedural risk stratification.
Ionically self-assembled monolayer (ISAM) films are a recently developed class of materials that allows detailed structural and thickness control at the sub-nanometer level combined with ease of manufacturing and low cost. The ISAM fabrication method simply involves the dipping of a charged substrate alternately into polycationic and polyanionic aqueous solutions at room temperatures. Importantly, the ISAM technique yields exceptionally homogeneous, large area films with excellent control of total film thickness. We describe detailed studies of ISAM light emitting diodes incorporating poly(para-phenylene vinylene) (PPV) as the light emitting polymer. The individual thickness of each monolayer and the interpenetration of adjacent layers can be precisely controlled through the parameters of the electrolyte solutions. The effects of the pH and ionic strength of the immersion solutions, the total film thickness, and the PPV thermal conversion parameters on the photoluminescence and electroluminescence yields have been systematically studied. The ISAM process also allows the advantage of depositing well-defined thicknesses of separate polymers at the indium tin oxide and the aluminum electrode interfaces.
Pulsed Laser Deposition (PLD) has been proven as an effective means of depositing films from refractory targets. In our earlier work, either Nd/YAG or excimer lasers, interacting directly with target surfaces, were used to deposit thin films of high Tc superconductors, high dielectric constant BaTiO3 and ferroelectric PbZr0.53Ti0.47Os3 (PZT). Time-resolved molecular beam mass spectrometry and optical emission spectroscopic techniques have been developed to characterize the vapor plumes responsible for film formation. More recently, this work has been extended to the PLD of magnetic thin films of Ag-Fe3O4 nanocomposites using excimer (ArF*, 193 nm) laser excitation. Optical emission spectra of the excited vapor phase species, formed during the plume generation and material deposition process, indicate that physically compressed powdered metal targets have inadequate homogeneity for film production, compared to targets that are chemically produced. An in situ Laser-induced Vaporization Mass Spectrometry (LVMS) technique utilizing a Nd/YAG (1064 nm) laser has been used to determine Time-of-Arrival (TOA) profiles of the atomic, molecular, and ionic species produced in the plumes of Ag-Fe3O4 The neutral species TOA profiles indicate velocity distributions that are multimodal and not Maxwellian. These observations are in contrast to the TOA profiles observed from one-component targets (Ag or Fe3O4), where a single Maxwellian velocity distribution is found. Mossbauer effect measurements of the thin films have been made for correlation with the gas phase studies.
Laser synthesized silicon powders have been used to make reaction bonded silicon nitride samples. Maximum hardness (11.3 GNm−2), fracture toughness (3.6 MNm−3/2), pore size (Hg porosimetry 50–300Å radius) and strength (∼460 MNm−2) values reflect the superior microstructures that are observed. With anaerobic anhydrous processing, these powders nitride to completion in less than 7 hours at 1400°C.
Homogeneous gelled composites of iron and silica containing 5-40 wt.%Fe prepared by low temperature polymerization of aqueous solutions of ferric nitrate, tetraethoxysilane, and ethanol (with an HF catalyst) were heated to 380°C in the presence of hydrogen gas. X-ray diffraction and M6ssbauer effect measurements, and transmission electron microscope (TEM) observations show these materials are comprised of nanometer-sized regions of iron compounds embedded in a silica gel matrix. Magnetic susceptibility data indicate the materials became either superparamagnetic or ferromagnetic at room temperature. On cooling, the magnetization data furthermore show that the hydrogenated materials containing ll-30% Fe become magnetic spin glasses at temperatures less than 30 K. Magnetic history effects are observed in addition to displaced hysteresis loops below their spin freezing temperatures (Tf). For field-cooled materials at 10 K, the displacement of the hysteresis loops along the field axis indicates the presence of a unidirectional anisotropy which decreases with the cooling field. Both superparamagnetic-to-spin glass and ferromagnetic-to-spin glass transitions are observed in these nanocomposites. Tf varies with the Fe content from ∼30 K for the 11%Fe nanocomposite to ∼10 K for a content near 33%Fe.
The controlled reductive dehalogenation of elemental halides has been studied as a low temperature approach to boride and carbide precursors. We have shown that SiCl4 and CCl4 can be reacted with metallic sodium at 130° in a non-polar solvent to give the precursor to SiC. Similar type reactions with TiCl4 and BCl3 or with BCl3 and CC14 have produced the precursors to TiB2 and B4C respectively. This procedure has also been used to generate the precursors to the two-phase composites SiC/TiC and SiC/TiN. The method is generally applicable to any combination of elemental halides which can be reduced by alkali metals or alkali metal alloys.
Homogeneous gelled composites of iron and vitreous alumina containing 10-40% Fe have been prepared by room temperature polymerization of aqueous aluminum alkoxide solutions containing ferric nitrate and nitric acid at low pH. Scanning electron microscopy, x-ray diffraction, and Mossbauer spectroscopy demonstrated that this bulk material is comprised of nanometer-sized regions of iron compounds embedded in a vitreous alumina gel matrix. Magnetization data showed that in the as-cured condition these nanocomposites are paramagnetic at room temperature and become either superparamagnetic or ferromagnetic on cooling to 10 K. The magnetic susceptibility increased with the Fe content and with decreasing temperature. Analysis of the temperature dependence of the magnetic susceptibility indicated the magnetic moment per Fe atom was 1.87 µB for the 10% Fe nanocomposite and that it increased linearly with composition to 1.96 µB for the 40% Fe material. Mössbauer effect data showed that subsequent treatment of these materials in a gaseous environment of hydrogen at elevated temperatures (T<400 C) changed the form of the iron in the magnetic regions. These results are compared to that observed for similar nanocomposites prepared using a silica gel matrix.
Dynamical X-ray diffraction studies have been carried out for lattice-matched InGaAs/InP superlattices grown by modified molecular beam epitaxy (MBE) techniques. The (400) X-ray satellite pattern, which is predominantly affected by the strain modulation, was analyzed. The strain and thickness of the actual layers including the presence of strained interfacial regions were determined.
For a soft coating on a hard substrate the overall hardness of the coating/substrate system increases substantially when the indenter penetrates into the substrate sincethe substrate can now directly support some of the indenter load. A model for the overall hardness is developed by accounting for the indentation load shared by the coating andsubstrate. This model accounts for the additional load supported by the coating due to the pile-up of coating material underneath the indenter. The model predicts the overall hardness as a function of coating and substrate bulk hardness and coating thickness. Comparison of the model to experimental data for two polymer coatings (epoxy and epoxy acrylate) on soda-lime glass substrates shows good agreement.
Subcritical crack growth at polymer/glass interfaces can occur due to a stress dependent chemical reaction at the crack tip at a crack driving force less than the critical fracture energy for catastrophic crack propagation. A four—point flexure apparatus coupled with an inverted microscope allows observation in situ of the subcritical crack growth at the polymer/glass interface. The specimen consists of soda—lime glass plates bonded together with epoxy acrylate. In the four—point flexure test, the strain energy release rate is independent of the interfacial crack length. This test technique allows for subcritical crack growth at the polymer/glass interface to be measured as a function of the applied crack driving force and relative humidity. The results are discussed in terms of a fracture mechanics model.
Based on theoretical calculations Polyarenemethylidenes (PAM) 1 have been predicted to be low gap polymers with good semiconducting and photoelectrical properties. The preparation of such a polymer with a well defined structure affords the synthesis of suitable precursors. We have been able to synthesize and characterize a variety of monomers in which the inner quinonoid system is present. Also more extended systems containing one or two additional benzene rings at the quinonoid system have been prepared. The chemical and electrochemical polymerization of the precursors is reported, leading to polymers 1 in a great structural variety.
Nanoindentation experiments are now widely used to study the elastic and plastic properties of thin films. Simulation of these experiments has been performed using finite element analysis. Results show the large influence that pile-up or sink-in behavior have on hardness calculations. Results also show that a compliant substrate significantly affects the measured hardness of a stiffer coating. The measured hardness of a compliant coating is less effected by a stiffer substrate.
Moisture-assisted crack growth in polymer/glass interfaces was measured as a function of the applied energy release using a four-point flexure test coupled with an inverted microscope. The specimens consisted of two glass plates bonded together with a thin layer of epoxy adhesive. Roughening the surface of one of the interfaces increased its fracture resistance sufficiently so that crack growth on this interface was inhibited. Thus, crack growth would occur only on the “smooth” interface (one with the least fracture resistance) or in the case where both interfaces were smooth, dual cracking occurred. Finite element analysis was used to explain the observed crack growth results.
The interfacial adhesive shear strengths of epoxy and acrylate coatings on glass substrates were measured by the indentation and lap shear tests. The lap shear strengths were about an order of magnitude less and exhibited considerably more variability than those measured by indentation. It is believed that the lap shear strength is controlled by large processing flaws (pores in this study); whereas, the indentation test measures the “intrinsic” strength of the coating.
The paper presented discusses certain topographical effects being significant for the coverage of nonplanar structures with undoped and doped thin SiGe films. They are essential for new integrated heterojunction Si/SiGe devices. To investigate the coverage of topographical surfaces SiGe layers have been deposited on different trench structures in a Rapid Thermal Low Pressure single wafer CVD reactor (RTCVD) from the system SiH4, GeH4, and H2 using B2H6/ H2 and PH3/ H2 for the in-situ doping, respectively. Various deposition conditions and different film compositions have been used. The results especially the differences of the thickness distribution within trenches and on the surface have been discussed with regard to different CVD models taking into account distinguished reaction mechanisms.