THE IDENTIFICATION AND ANALYSIS OF LATENT ESD DAMAGE ON CMOS INPUT GATES

Abstract Latent electrostatic discharge (LESD) damage sites are normally identified and analyzed after the damaged oxide has been transformed from a low to a high level leakage. Failure analys 1 is typically focuses only on the primary rupture site, neglecting the remaining LESD damage sites. The purpose of this work is to present a new method of analysis which allows compromised oxides to be rapidly identified and then show the existence of multiple LESD damage sites. Images from the Scanning Electron Microscope and the Atomic Force Microscope associated with the LESD damage sites are compared

Too Much Medicine in older people? Deprescribing through Shared Decision Making

Too much medicine is an increasingly recognised problem,1 2 and one manifestation is inappropriate polypharmacy in older people. Polypharmacy is usually defined as taking more than five regular prescribed medicines.3 It can be appropriate (when potential benefits outweigh potential harms)4 but increases the risk of older people experiencing adverse drug reactions, impaired physical and cognitive function, and hospital admission.5 6 7 There is limited evidence to inform polypharmacy in older people, especially those with multimorbidity, cognitive impairment, or frailty.8 Systematic reviews of medication withdrawal trials (deprescribing) show that reducing specific classes of medicines may decrease adverse events and improve quality of life.9 10 11 Two recent reviews of the literature on deprescribing stressed the importance of patient involvement and shared decision making.12 13 Patients and clinicians typically overestimate the benefits of treatments and underestimate their harms.14 When they engage in shared decision making they become better informed about potential outcomes and as a result patients tend to choose more conservative options (eg, fewer medicines), facilitating deprescribing.15 However, shared decision making in this context is not easy, and there is little guidance on how to do it.16 We draw together evidence from the psychology, communication, and decision making literature (see appendix on thebmj.com). For each step of the shared decision making process we describe the unique tasks required for deprescribing decisions; identify challenges for older adults, their companions, and clinicians (figure); give practical advice on how challenges may be overcome; highlight where more work is needed; and identify priorities for future research (table). Key messages Deprescribing is a process of planned and supervised tapering or ceasing of inappropriate medicines Shared decision making should be an integral part of the deprescribing process Many factors affect this process, including trust in clinicians’ advice, contradictory patient attitudes about medication, cognitive biases that lead to a preference for the status quo and positive information, and information processing difficulties There is uncertainty about the effect of risk communication and preference elicitation tools in older people Older people’s preferences for discussing life expectancy and quality of life vary widely, but even those who wish to delegate their decisions still appreciate discussion of optionsJJ is supported by a National Health and Medical Research Council (NHMRC) early career fellowship (1037028) and KM is supported by an NHMRC career development fellowship (1029241

1990: Abilene Christian College Bible Lectures - Full Text

LUKE: A GOSPEL FOR THE WORLD Being the Abilene Christian University Annual Bible Lectures 1990 Published by ACU PRESS 1634 Campus Court Abilene, Texas 7960

Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries.

INTRODUCTION: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART. METHODS: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics. RESULTS: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were government-run; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high-risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania. CONCLUSION: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intra-country differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV

Unifying Theories of Reactive Design Contracts

Design-by-contract is an important technique for model-based design in which a composite system is specified by a collection of contracts that specify the behavioural assumptions and guarantees of each component. In this paper, we describe a unifying theory for reactive design contracts that provides the basis for modelling and verification of reactive systems. We provide a language for expression and composition of contracts that is supported by a rich calculational theory. In contrast with other semantic models in the literature, our theory of contracts allow us to specify both the evolution of state variables and the permissible interactions with the environment. Moreover, our model of interaction is abstract, and supports, for instance, discrete time, continuous time, and hybrid computational models. Being based in Unifying Theories of Programming (UTP), our theory can be composed with further computational theories to support semantics for multi-paradigm languages. Practical reasoning support is provided via our proof framework, Isabelle/UTP, including a proof tactic that reduces a conjecture about a reactive program to three predicates, symbolically characterising its assumptions and guarantees about intermediate and final observations. This allows us to verify programs with a large or infinite state space. Our work advances the state-of-the-art in semantics for reactive languages, description of their contractual specifications, and compositional verification

The deprescribing rainbow: a conceptual framework highlighting the importance of patient context when stopping medication in older people

Abstract The area of “deprescribing” has rapidly expanded in recent years as a positive intervention to reduce inappropriate polypharmacy and improve health outcomes for (older) people with multimorbidity. While our understanding of deprescribing as a process has greatly improved and existing approaches all have patient-centered elements, there is still limited literature exploring the importance of the individual patient context in deprescribing decision-making. This is clearly an important consideration to ensure that any deprescribing approach is ethical, respectful, and successful. To address this gap in the literature, we have developed a conceptual framework in the form of a rainbow – with five different deprescribing determinants – and place the person at the center of the deprescribing process. This framework is informed by literature on patient-centered care for older people and people with multimorbidity. We illustrate the potential application of this framework to a complex patient case to highlight the importance of the different clinical, psychological, social, financial and physical deprescribing determinants, and how this approach could be adopted by those working in clinical practice

Gastrointestinal nematode control in sheep under three grazing management systems and factors influencing faecal worm egg count

A six-year study on 50 ha farmlets on the northern tablelands of NSW compared control of gastrointestinal nematode (GIN) infection of sheep under typical (TYP), high input (HI) or intensive rotational grazing (IRG) management systems. The major sources of variation in faecal worm egg count (WEC) were also examined. The data set comprised 5644 faecal worm egg count (WEC) records and 322 larval differentiation tests. Worm infections in ewes, lambs, hoggets and wethers were, with some exceptions, adequately controlled through a combination of regular monitoring of WEC, anthelmintics and grazing management. The IRG farmlet had lower mean WEC (444 epg) and annual anthelmintic treatment frequency (3.1 treatments/yr) over the whole experimental period than TYP (1122 epg, 4.3 treatments/yr) or HI (1374 epg, 4.7 treatments/yr). The main factors influencing WEC were the time since the last anthelmintic treatment, and the anthelmintic used at that treatment. The magnitude of these effects dwarfed those climatic and management factors that might be expected to influence the epidemiology of GIN infections via environmental or host-mediated mechanisms. Nevertheless management factors associated with stocking rate and grazed proportion (proportion of each farmlet grazed at any one time), and climatic indicators of both temperature and moisture availability had significant effects on WEC. The results show that in a region with 'Haemonchus contortus' as the major GIN, improved host nutrition under the HI system did not provide more effective control of GIN than typical management, while IRG did provide considerably better control. Tactical worm control based on WEC monitoring provided adequate control of worms on all three farmlets for much of the experimental period but failed to prevent significant spikes in WEC on the TYP and HI farmlets to values associated with significant production loss on multiple occasions, and mortality on one occasion