Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia

OBJECTIVE: We hypothesized that institutionalized patients with dementia, who frequently have feeding problems and require supervised and assisted feeding, would lose more weight during their residency than nondemented, independently functioning residents and have compromised survival. To test this hypothesis, we examined the survival and longitudinal changes in weight of two cohorts of institutionalized residents with dementia and compared these cohorts with a cohort of nondemented residents. We also measured the resting energy expenditures of a subset of the subjects with dementia as an indicator of their energy needs. DESIGN: A longitudinal cohort study with retrospective baseline chart review and subsequent follow-up of monthly weights and mortality over 4 years. SETTING: A 725-bed long-term care institution with specified levels of care. SUBJECTS: Two cohorts of residents with dementia, one consisting of subjects who required total care throughout their institutional stay (n = 31) and another group who did not initially require total care (n = 48); these were compared with a cohort with normal mentation who were functionally independent in their daily activities (n = 26). The total number of subjects was 105. MEASUREMENTS: Demographics, medical problems, and medications by chart review; functional and mental status evaluations; longitudinal monthly weights and mortality for the 48-month study period; and resting energy expenditures by indirect calorimetry. MAIN RESULTS: Residents with dementia had lower weights on admission and throughout their stay than nondemented, independently functioning residents, and they were more likely to have a weight loss of 10 lbs or more at some point during the 4-year study period. However, their mean weights did not change during the study period. The mean survival from admission of those demented residents who died was more than 3 years. Resting energy expenditures of women residents with advanced dementia were 12% lower than predicted from the Harris Benedict equations. CONCLUSION: Dementia is not necessarily associated with unremitting weight loss during institutionalization despite the frequent occurrence of feeding difficulties and temporary weight loss. This may be caused partly by the lower than expected resting energy expenditures and, hence, energy needs of affected residents as their dementia progresses. Demented residents weighed significantly less than nondemented, independently functioning residents throughout their institutional stay. Nevertheless, nursing staff are able to maintain weight and survival for extended periods even in very impaired residents.     

Electrical linewidth test structures fabricated in monocrystallinefilms for reference-material applications

The physical widths of reference features incorporated into electrical linewidth test structures patterned in films of monocrystalline silicon have been determined from Kelvin voltage measurements. The films in which the test structures are patterned are electrically insulated from the bulk-silicon substrate by a layer of silicon dioxide provided by SIMOX (Separation by the IMplantation of OXygen) processing. The motivation is to facilitate the development of linewidth reference materials for critical-dimension (CD) metrology-instrument calibration. The selection of the (110) orientation of the starting silicon and the orientation of the structures' features relative to the crystal lattice enable a lattice-plane-selective etch to generate reference-feature properties of rectangular cross section and atomically planar sidewalls. These properties are highly desirable for CD applications in which feature widths are certified with nanometer-level uncertainty for use by a diverse range of CD instruments. End applications include the development and calibration of new generations of CD instruments directed at controlling processes for manufacturing devices having sub-quarter-micrometer features     

Biodegradation of indole at high concentration by persolvent fermentation with Pseudomonas sp. ST-200

The value of flexible videoendoscopy as a biofeedback tool in conservative swallowing rehabilitation of patients suffering from aspiration after head and neck surgery was examined. For this purpose, the outcomes of conventional swallowing therapy and of swallowing therapy with support of videoendoscopic biofeedback were compared. In the first 40 days of swallowing therapy, videoendoscopic biofeedback significantly increased the chance of therapeutic success, shortening the period of functional rehabilitation in comparison to conventional swallowing therapy. Limitations of this visual biofeedback procedure are poor cognitive skills of the patient, rejection of the procedure by the patient and local factors that make the positioning of the endoscope difficult.     

Conditions for reliable dewatering systems based on voidless drainage in slightly permeable soils

Conclusions 1. Use of dewatering systems based on voidless drainage is most effective when dewatering slightly permeable soils in regions with a deep seasonal frost. 2. Two-story drainage with the upper and lower stories spaced 30 m apart accelerates the discharge of gravitational water from the arable layer. Results of observations on two-story drainage in experimental-production sections indicated that it discharges 2 – 3.8 times more water than systematic tubular drainage with an interdrain spacing of 10 m and a 0.2-m thick three-dimensional filter of a sandy-gravelly mixture. 3. It is recommended to use crushed stone and porous-clay gravel with a fineness of 10 – 20 mm as a filler. In that case, protection of the drain filler is, as a rule, required only from the intrusion of soil from above during construction in cohesive soils with a plasticity indexW _p≥7. 4. seepage rate in a voidless drain should be lower than the scouring velocity for the soil in which the voidless drainage is placed. In the opposite case, it is necessary to lower the grade of the drains or select a filler gradation such that the seepage rate in the drain be lower than the scouring velocity. Translated from Gidrotekhnicheskoe Stroitel’stvo, No. 8, pp. 41–43, August, 1998.     

Processor membership in asynchronous distributed systems

Presents protocols for determining processor membership in asynchronous distributed systems that are subject to processor and communication faults. These protocols depend on the placement of a total order on broadcast messages. The types of systems for which each of these protocols is applicable are characterized by the properties of the communication mechanisms and by the availability of stable storage. In the absence of stable storage or of a mechanism for distinguishing promptly delivered messages, the authors show that no membership protocol can exist. They also discuss their experience in implementing these membership protocols     

Partitioned encoding schemes for algorithm-based fault tolerance inmassively parallel systems

Considers the applicability of algorithm based fault tolerance (ABET) to massively parallel scientific computation. Existing ABET schemes can provide effective fault tolerance at a low cost For computation on matrices of moderate size; however, the methods do not scale well to floating-point operations on large systems. This short note proposes the use of a partitioned linear encoding scheme to provide scalability. Matrix algorithms employing this scheme are presented and compared to current ABET schemes. It is shown that the partitioned scheme provides scalable linear codes with improved numerical properties with only a small increase in hardware and time overhead     

Unstructured tree search on SIMD parallel computers

We present new methods for load balancing of unstructured tree computations on large-scale SIMD machines, and analyze the scalability of these and other existing schemes. An efficient formulation of tree search on an SIMD machine consists of two major components: a triggering mechanism, which determines when the search space redistribution must occur to balance the search space over processors, and a scheme to redistribute the search space. We have devised a new redistribution mechanism and a new triggering mechanism. Either of these can be used in conjunction with triggering and redistribution mechanisms developed by other researchers. We analyze the scalability of these mechanisms and verify the results experimentally. The analysis and experiments show that our new load-balancing methods are highly scalable on SIMD architectures. Their scalability is shown to he no worse than that of the best load-balancing schemes on MIMD architectures. We verify our theoretical results by implementing the 15-puzzle problem on a CM-2 SIMD parallel computer     

Weight smoothing to improve network generalization

A weight smoothing algorithm is proposed in this paper to improve a neural network's generalization capability. The algorithm can be used when the data patterns to be classified are presented on an n-dimensional grid (n>/=1) and there exists some correlations among neighboring data points within a pattern. For a fully-interconnected feedforward net, no such correlation information is embedded into the architecture. Consequently, the correlations can only be extracted through sufficient amount of network training. With the proposed algorithm, a smoothing constraint is incorporated into the objective function of backpropagation to reflect the neighborhood correlations and to seek those solutions that have smooth connection weights. Experiments were performed on problems of waveform classification, multifont alphanumeric character recognition, and handwritten numeral recognition. The results indicate that (1) networks trained with the algorithm do have smooth connection weights, and (2) they generalize better.     

Network information criterion-determining the number of hiddenunits for an artificial neural network model

The problem of model selection, or determination of the number of hidden units, can be approached statistically, by generalizing Akaike's information criterion (AIC) to be applicable to unfaithful (i.e., unrealizable) models with general loss criteria including regularization terms. The relation between the training error and the generalization error is studied in terms of the number of the training examples and the complexity of a network which reduces to the number of parameters in the ordinary statistical theory of AIC. This relation leads to a new network information criterion which is useful for selecting the optimal network model based on a given training set.     

Quantization effects in digitally behaving circuit implementationsof Kohonen networks

Implementing a neural network on a digital or mixed analog and digital chip yields the quantization of the synaptic weights dynamics. This paper addresses this topic in the case of Kohonen's self-organizing maps. We first study qualitatively how the quantization affects the convergence and the properties, and deduce from this analysis the way to choose the parameters of the network (adaptation gain and neighborhood). We show that a spatially decreasing neighborhood function is far more preferable than the usually rectangular neighborhood function, because of the weight quantization. Based on these results, an analog nonlinear network, integrated in a standard CMOS technology, and implementing this spatially decreasing neighborhood function is then presented. It can be used in a mixed analog and digital circuit implementation.