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We sought to determine if a novel online health tool, called Down Syndrome Clinic to You (DSC2U), could improve adherence to national Down syndrome (DS) guidelines. We also sought to determine if primary care providers (PCPs) and caregivers are satisfied with this personalized online health tool. In a national, randomized controlled trial of 230 caregivers who had children or dependents with DS without access to a DS specialist, 117 were randomized to receive DSC2U and 113 to receive usual care. The primary outcome was adherence to five health evaluations indicated by national guidelines for DS. DSC2U is completed electronically, in all mobile settings, by caregivers at home. The outputs—personalized checklists—are used during annual wellness visits with the patient’s PCP. A total of 213 participants completed a 7-month follow-up evaluation. In the intention-to-treat analysis, the intervention group had a 1.6-fold increase in the number of indicated evaluations that were recommended by the primary care provider or completed compared with controls. Both caregivers and PCPs reported high levels of satisfaction with DSC2U. DSC2U improved adherence to the national DS health-care guidelines with a novel modality that was highly valued by both caregivers and PCPs.

Printed Circuit Boards (PCBs) are epoxy resin-impregnated and cured sheets of counter woven glass fabric (e.g. FR4) laminated between thin sheets of Copper. The nature of the PCB is inherently anisotropic and inhomogeneous but previous modal FEMs of PCBs have assumed isotropic, anisotropic (transversely isotropic and orthotropic) material properties and shown good correlation with test data for specific scenarios [1-3]. This paper details part of a research program aimed at gaining a better understanding of accurately modeling PCB’s dynamic behavior. New investigations into the impact of material anisotropy and, in particular, the effect of material orthogonal plane definition (Ex and Ey) on eigenfrequencies is analysed. A modal FEM of a JEDEC PCB is created, verified, and validated using well established theories by Steinberg and empirical data by others [4, 5]. The relative contributions of Ex, Ey and Ez on PCB eigenfrequencies is examined using a parametric modal FEM, analysing the role of material isotropy verses anisotropy. The impact of transversely isotropic material properties is also analysed for a typical JEDEC PCB. This analysis details the mesh density required for accurately modeling the PCB eigenfrequencies. The results show that a 100 % increase in Ez has only a 0.2 % difference in the eigenfrequency where as a 100 % increase in Ey has a 1.2 % difference in the eigenfrequency. The effect of orthotropic plane definition (alternating Ex with Ey) on the JEDEC PCB amount to a 7.95 % delta in eigenfrequency.

The coronavirus disease 2019 (COVID-19) pandemic created a major challenge for clinical trials recruitment as early attention was focused on matters of public health and clinical care, and research--outside of COVID-19-- essentially shut down. Rally with Partners (rally.partners.org), an Internet-based portal for clinical research volunteer recruitment, continued to support studies that continued their recruitment during this period and additionally, implemented several measures to support COVID-19 research. In this paper, we summarize our experiences and preliminary results.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

This is a video article. To play the video, please click on the link at the bottom of this page.Co-creation of learning and student engagement in shaping their curricula are becoming more widespread as pedagogic practice in Higher Education. The literature surrounding co-creating the learning experience has focussed primarily on the benefits for staff and students involved in terms of increased student engagement (Cook-Slather et al, 2014). The barriers to co-creation, which include perceived threats to ‘academic as expert’ and role-blurring, in part derive from a lack of transparency about the strategies for embedding co-creation of learning in established learning and teaching practices (Allin, 2014). The procedure and mechanics of co-creating curricula appear obfuscated by theoretical and academic discussions about the intersection of partnership, co-creation and student engagement. The current project seeks to throw light on and explore two different approaches to co-creating the curricula on level 6 option modules run by Psychology and Business programmes.

In this work, the SEMI specification for reticle and pod management (E109) with internal reticle library support has been integrated for the first time on KLA-Tencor’s TeronTM and TeraScanTM reticle inspection tools. Manufacturing Execution System scheduling reticle jobs and Automated Material Handling System scheduling to transfer pods simultaneously have also been integrated and tested. GLOBALFOUNDRIES collaboratively worked with KLA-Tencor to successfully implement these capabilities. Both library and non-library scenarios have been demonstrated for comparison in a real production environment resulting in productivity increase of approximately 29% by making use of the library. Reticle re-qualification test cases were used for the comparison in this work.

High frequency mechanical vibrations (20–50 kHz), delivered via small diameter flexible wire waveguides represent a minimally invasive technology for the treatment of chronic total occlusions (CTOs) and in other tissue ablation applications. Tissue disruption is reported to be caused by repetitive mechanical contact and cavitation. This work focuses on the effects of vibrating wire waveguides in contact with arterial tissue. An apparatus with clinically relevant parameters was used, characterized as operating at 22.5 kHz and delivering amplitudes of vibration of 17.8 - 34.3 µm (acoustic intensity, ISATA: 1.03 - 3.83 W/cm2) via 1.0 mm diameter waveguides. Inertial cavitation (in water at 370C) was determined to occur above amplitudes of vibration greater than 31.4 µm (ISATA = 3.21 W/cm2). The energized waveguides were advanced through tissue samples (porcine aorta) and the force profiles were measured for a range of acoustic intensities. The results show that the tissue perforation initiation force, perforation initiation energy and total energy required to perforate the tissue reduces with increasing acoustic intensity. No significant reduction in perforation force or energy was observed in the inertial cavitation region. Multistage perforation was evident through the force profile and histological examination of the tissue samples post wire waveguide perforation.

Certain minimally invasive cardiology procedures, such as balloon angioplasty and stent implantation, critically require that the site of an arterial blockage be crossed by an intraluminal guidewire. Plaques resulting in near or totally occluded arteries are known as chronic total occlusions (CTOs), and crossing them with conventional guidewires is a significant challenge. Among the most promising proposed solutions is the delivery of high power, low frequency ultrasonic vibrations to the occlusion site via an intraluminal wire waveguide. The vibrating distal-tip of the ultrasound wire waveguide is used to transmit energy to the surrounding plaques, tissues and fluids in order to ablate or weaken atherosclerotic plaque. Potential mechanisms of interaction with the plaque and adjacent fluids identified in the literature include; (i) direct contact with the waveguide distal tip, (ii) subcavitational acoustic fluid pressure fluctuations, (iii) cavitation, and (iv) acoustic streaming. This article will summarize developments in this area over more than two decades, describing experimental methods for device performance characterization, preclinical tests, early clinical investigations and, later, full clinical trials. The article will also review theoretical foundations, and numerical models suitable for device design and analysis. Finally, important issues for future research and for the development of this technology will be considered.

The use of EUV photomasks in a semiconductor manufacturing environment requires their periodic inspection to ensure they are continually free of defects that could impact device yield. Defects typically occur from fall-on particles or from surface degradation such as “haze”. The proposed use of a polycrystalline-based EUV pellicle to prevent fall-on particles would preclude periodic through-pellicle mask defect inspection using e-beam, as well as, DUV inspection tools (the pellicle is opaque at DUV wavelengths). Thus, to use these types of defect inspection tools would require removal of the EUV pellicle before inspection. After inspection, the pellicle would need to be re-attached and the mask re-qualified using a test wafer, thus causing expense and delays. While EUV-wavelength inspection tools could inspect through such a pellicle precluding the need to remove the pellicle, these tools are not likely to be available in the commercial marketplace for many years. An alternate EUV pellicle material has been developed that is semi-transparent to 193nm wavelengths, thus allowing through-pellicle inspection using existing ArF-based, or other 193nm wavelength mask inspection tools. This eliminates the requirement to remove the pellicle for defect inspection and the associated time and expense. In this work, we will conduct an initial evaluation of through-pellicle EUV mask defect inspection using an existing 193nm mask inspection tool. This initial evaluation will include durability of the pellicle to defect inspection, and impact of the pellicle on inspection tool performance.

Die-to-die reticle inspections are among the simplest and most sensitive reticle inspections because of the use of an identical-design neighboring-die for the reference image. However, this inspection mode can have two key disadvantages: (1) The location of the defect is indeterminate because it is unclear to the inspector whether the test or reference image is defective; and (2) nuisance and false defects from mask manufacturing noise and tool optical variation can limit the usable sensitivity. The use of a new sequencing approach for a die-to-die inspection can resolve these issues without any additional scan time, without sacrifice in sensitivity requirement, and with a manageable increase in computation load. In this paper we explore another approach for die-to-die inspections using a new method of defect processing and sequencing. Utilizing die-to-die double arbitration during defect detection has been proven through extensive testing to generate accurate placement of the defect in the correct die to ensure efficient defect disposition at the AIMS step. The use of this method maintained the required inspection sensitivity for mask quality as verified with programmed-defectmask qualification and then further validated with production masks comparing the current inspection approach to the new method. Furthermore, this approach can significantly reduce the total number of defects that need to be reviewed by essentially eliminating the nuisance and false defects that can result from a die-to-die inspection. This "double-win" will significantly reduce the effort in classifying a die-to-die inspection result and will lead to improved cycle times.

Aloe barbadensis polysaccharide was partially digested with cellulase and further purified by dialysis, stepwise ethanol precipitation, and size exclusion chromatography. Crude modified Aloe polysaccharide (MAP) activated macrophage cells and stimulated fibroblast growth. Under the same conditions, native Aloe barbadensis gel had no effect on macrophage activation. MAP prevented ultraviolet B (UVB) irradiation-induced immune suppression as determined by contact hypersensitivity (CHS) response in C3H/HeN mice. This in vivo activity was correlated with the activity of MAP to inhibit UVB irradiation-induced tumor necrosis factor alpha (TNF-alpha) release from human epidermoid carcinoma cells (KB cells). MAP with an average molecular weight of 80,000 Dalton (Da) contained mannose, galactose, and glucose in a ratio of 40:1.4:1.0. MAP was likely a linear, highly acetylated molecule.

193nm binary photomasks are still used in the semiconductor industry for the lithography of some critical layers for the nodes 90nm and 65nm, with high volumes and over long periods. However, these 193nm binary photomasks can be impacted by a phenomenon of chrome oxidation leading to critical dimensions uniformity (CDU) degradation with a pronounced radial signature. If not detected early enough, this CDU degradation may cause defectivity issues and lower yield on wafers. Fortunately, a standard cleaning and repellicle service at the mask shop has been demonstrated as efficient to remove the grown materials and get the photomask CD back on target.Some detection methods have been already described in literature, such as wafer CD intrafield monitoring (ACLV), giving reliable results but also consuming additional SEM time with less precision than direct photomask measurement. In this paper, we propose another approach, by monitoring the CDU directly on the photomask, concurrently with defect inspection for regular requalification to production for wafer fabs. For this study, we focused on a Metal layer in a 90nm technology node. Wafers have been exposed with production conditions and then measured by SEM-CD. Afterwards, this photomask has been measured with a SEM-CD in mask shop and also inspected on a KLA-Tencor X5.2 inspection system, with pixels 125 and 90nm, to evaluate the Intensity based Critical Dimension Uniformity (iCDU) option. iCDU was firstly developed to provide feed-forward CDU maps for scanner intrafield corrections, from arrayed dense structures on memory photomasks. Due to layout complexity and differing feature types, CDU monitoring on logic photomasks used to pose unique challenges.The selection of suitable feature types for CDU monitoring on logic photomasks is no longer an issue, since the transmitted intensity map gives all the needed information, as shown in this paper. In this study, the photomask was heavily degraded after more than 18,000 300mm wafers exposed and the cleaning brought it back almost to its original state after manufacture. Wafer CD, photomask CD and iCDU results can be compared, before and after a standard mask shop cleaning. Measurement points have be chosen in logic areas and SRAM areas, so that their respective behaviours can be studied separately. Transmitted maps before and after cleaning were analysed in terms of CD shift and CDU degradation. The delta map shows a nice correlation with photomask CD shift. iCDU demonstrated the capability to detect a reliable CD range degradation of 5nm on photomask by a comparison between a reference inspection and the current inspection. Die to die inspection mode provides also valuable data, highlighting the degraded chrome sidewalls, more in the photomask centre than on the edges. Ultimately, these results would enable to trigger the preventive cleanings rather than on predefined thresholds. The expected gains for wafer fabs are cost savings (adapted cleanings frequency), increased photomask availability for production, longer photomask lifetime, no additional SEM time neither for photomask nor on wafer.

Motivational interviewing (MI) has been investigated within a range of healthcare environments though to date no studies have systematically assessed its application and effectiveness within musculoskeletal health. The aim of this study is to identify interventions that have utilised MI to create change within musculoskeletal healthcare, evaluate quality and effectiveness, as well as identify the level of training received by those utilising the approach. The search strategy identified both published and unpublished or grey literature through electronic resources, reference list and content searches. Five studies were identified for quality assessment. Due to variations in delivery modality, musculoskeletal condition and type of MI application it was not possible to provide direct comparative interpretations for these factors. A data synthesis was used to provide a summary of study characteristics, a narrative overview and conduct a quality assessment as well as considering authors comments on study limitations. The results of the quality assessment highlighted a number of methodological issues which supported and expanded upon those expressed by the studies authors. None of the studies contained children or young people and in terms of training there were variations in training provider, duration and competency, as well as variation in the fidelity of MI. The findings have highlighted the need for well designed randomised controlled trials that are suitability powered to measure the effectiveness of MI within musculoskeletal health. Future studies may consider the application of MI within musculoskeletal conditions in terms of self-management and its application to creating lifestyle changes (e.g., diet, exercise) for adults, as well as children and young people. Research currently being conducted may expand upon the evidence, feasibility and validity of MI within areas such as fibromyalgia, osteoporosis, arthritis, understanding of knee replacement and rehabilitation.

The use of ultrasonic vibrations transmitted via small diameter wire waveguides represents a technology that has potential for minimally invasive procedures in surgery. This form of energy delivery results in distal tip mechanical vibrations with amplitudes of vibration of up to 50 μm and at frequencies between 20-50 kHz commonly reported. This energy can then be used by micro-cutting surgical tools and end effectors for a range of applications such as bone cutting, cement removal in joint revision surgery and soft tissue cutting. One particular application which has gained regulatory approval in recent years is in the area of cardiovascular surgery in the removal of calcified atherosclerotic plaques and chronic total occlusions. This paper builds on previous work that was focused on the ultrasonic perforation of soft vascular tissue using ultrasonically activated mechanical waveguides and the applied force required to initiate failure in soft tissue when compared with non-ultrasonic waveguides. An ultrasonic device and experimental rig was developed that can deliver ultrasonic vibrations to the distal tip of 1.0 mm diameter nickel-titanium waveguides. The operation of the ultrasonic device has been characterized at 22.5 kHz with achievable amplitudes of vibration in the range of 16 – 40μm. The experimental rig allows the ultrasonically activated waveguide to be advanced through a tissue sample over a range of feedrates and the waveguide-tissue interaction force can be measured during perforation into the tissue. Preliminary studies into the effects of feedrate on porcine aortic arterial tissue perforation forces are presented as part of this work. A range of amplitudes of vibration at the wire waveguide distal tip were examined. The resulting temperature increase when perforating artery wall when using the energized wire waveguides is also examined. Results show a clear multistage failure of the tissue. The first stage involves a rise in force up to some critical force and tissue displacement whereby the cut is initiated. The results show that with increasing ultrasonic amplitude of vibration the perforation force decreases considerably. The current results show that for the range of feedrates investigated 19-95 mm/min at an amplitude of vibration of 34.3 μm there was no significant effect on the perforation initiation force. The ΔT in the tissue 3.0 mm from the point of entry is also presented for a range of amplitudes of vibration.

The delivery of high-power ultrasonic energy via small diameter wire waveguides represents a new alternative therapy for the treatment of chronic totally occluded arteries (CTOs). This type of energy manifests itself as a mechanical vibration at the distal-tip of the waveguide with amplitudes of vibration up to 60 µm and at frequencies of 20–50 kHz. Disruption of diseased tissue is reported to be a result of direct mechanical ablation, cavitation, pressure components and acoustic streaming and that ablation was only evident above the cavitation threshold. This work presents a linear finite element acoustic fluid–structure model of an ultrasonic angioplasty waveguide in vivo. The model was first verified against a reported analytical solution for an oscillating sphere. It was determined that 140 elements per wavelength (EPW) were required to predict the pressure profile generated by the wire waveguide distal-tip. Implementing this EPW count, the pressure field surrounding a range of distal-tip geometries was modelled. For validation, a model was developed with parameters based on a bench-top experiment from the literature of an ultrasonic wire waveguide in a phantom leg. This model showed good correlation with the experimental measurements. These models may aid in the further development of this technology. Copyright © 2010 John Wiley & Sons, Ltd.

The Critical Dimension Uniformity (CDU) specification on photomasks continues to decrease with each successive node. The ITRS roadmap for optical masks indicates that the CDU (3 sigma) for dense lines on binary or attenuated phase shift mask is 3.4nm for the 45nm half-pitch (45HP) node and will decrease to 2.4nm for the 32HP node. The current capability of leading-edge mask shop patterning processes results in CDU variation across the photomask of a similar magnitude. Hence, we are entering a phase where the mask CDU specification is approaching the limit of the capability of the current Process of Record (POR). Mask shops have started exploring more active mechanisms to improve the CDU capability of the mask process. A typical application is feeding back the CDU data to adjust the mask writer dose to compensate for non-uniformity in the CDs, resulting in improved quality of subsequent masks. Mask makers are currently using the CD-SEM tool for this application. While the resolution of SEM data ensures its position as the industry standard and continued requirement to establish the photomask CD Mean to Target value, a dense measurement of CDs across the reticle with minimal cycle time impact would have value. In this paper, we describe the basic theory and application of a new, reticle inspection intensity-based CDU approach that has the advantage of dense sampling over larger areas on the mask. The TeraScanHR high NA reticle inspection system is used in this study; it can scan the entire reticle at relatively high throughput, and is ideally suited for collecting dense CDU data. We describe results obtained on advanced memory masks and discuss applications of CDU maps for optimizing the mask manufacturing process. A reticle inspection map of CDU is complementary to CD-SEM data. The dense data set has value for various applications, including feedback to mask writer and engineering analysis within the mask shop.

The use of therapeutic ultrasound delivered via small diameter wire waveguides may represent an emerging minimally invasive approach in the treatment of chronic total occlusions (CTOs), calcified and fibrous plaques. The distal-tip mechanical vibrations (typically 0-210 microm peak-to-peak) have been reported to debulk rigid calcified and fibrous tissues while healthy elastic arterial tissue remains largely unaffected. The risk of arterial (healthy tissue) perforation with energized waveguides is not fully understood. An ultrasonic apparatus capable of delivering a range of wire waveguide distal-tip displacements, up to 80 microm peak-to-peak (p-p), at an operational frequency of 22.5 KHz (+/- 6%) has been developed. For three distal-tip displacement settings (32, 50 and 80 microm p-p) with 1.0 mm diameter waveguides, the force required to perforate healthy porcine aortic tissue was experimentally determined. The results show a distinct two stage perforation, thought to be the result of different mechanical properties of the layers in the arterial wall. The average maximum force (N) required to cause perforation with the 1.0 mm diameter ultrasonic waveguide activated at the three settings was experimentally determined to be 2.7 N (32 microm p-p), 2.6 N (50 microm p-p) and 2 N (80 microm p-p). The force required to cause perforation of the tissue with no ultrasound was found to be approximately 4 N. These results highlight that when ultrasound energy is applied to the waveguide, less force is required to perforate healthy arterial tissue. This reduction in perforation force is more pronounced at higher ultrasonic displacements, similar to those reported in clinical studies for the effective removal of diseased calcified and fibrous plaques.

Conventional photomask inspection techniques utilize global sensitivity for all inspected area in the die; SRAF and OPC features become the sensitivity-limiters for advanced photomasks which can result in reduced sensitivity to defects of interest (DOI). We describe the implementation of Sensitivity Control Layer (SCL), a novel database inspection methodology for the KLA-Tencor TerascanHR platform to improve sensitivity and reduce nuisance detections. This methodology enables inspection at maximum sensitivity in critical die-areas via "layer definition" and reducing sensitivity to sub-resolution features during inspection which can dramatically improve false-rate. DRAM and FLASH inspection performance was improved through the use of up to 6-control layers to increase sensitivity in the active area while reducing false detections by as much as 100X. Post-inspection defect analysis, and improved disposition accuracy of the SCL-enabled inspections will also benefit cycle time and higher throughput. In all test cases, sensitivity parameters were increased in the regions of interest over baseline inspections run with typical, production-type inspection methodologies. SCL inspection-sensitivity management, and layer partitioning of OPC structures, SRAF's, and other sub-resolution features is discussed in detail.

Conventional photomask inspection techniques utilize global sensitivity for all inspected area in the die; SRAF and OPC features become the sensitivity-limiters, which can result in reduced visibility to defects of interest (DOI). We describe the implementation of Sensitivity Control Layer (SCL), a novel database inspection methodology for the KLA-Tencor TerascanHR platform. This methodology enables inspection at maximum sensitivity in critical die-areas via “layer definition” during job set-up and sensitivity management of the layers during inspection. Memory device inspection performance was improved through the use of up to six control layers to increase sensitivity in the active area while reducing nuisance detections by as much as 100X. The corresponding inspection time was reduced by 30%, illustrating the potential for substantial throughput advantage using SCL. Post-inspection analysis and improved disposition accuracy of the SCL-enabled inspections will also benefit cycle time and higher throughput. In all test cases, sensitivity parameters were increased in the regions of interest over baseline inspections run with typical production-use methodologies. SCL inspection management and application on OPC structures, SRAFs, and MRC violations (slivers) are discussed in detail.