Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers.

BACKGROUND: Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. OBJECTIVE: To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. DESIGN: In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. RESULTS: Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. CONCLUSIONS: These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.

Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

Development of a GEM Electronic Board (GEB) for triple-GEM detectors

Developed for use with triple GEM detectors, the GEM Electronic Board (GEB) forms a crucial part of the electronics readout system being developed as part of the CMS muon upgrade program. The objective of the GEB is threefold; to provide stable powering and ground for the VFAT3 front ends, to enable high-speed communication between 24 VFAT3 front ends and an optohybrid, and to shield the GEM detector from electromagnetic interference. The paper describes the concept and design of a large-size GEB in detail, highlighting the challenges in terms of design and feasibility of this deceptively difficult system component.

Turbulence modelling and its impact on CFD predictions for cooling of electronic components

This paper will discuss Computational Fluid Dynamics (CFD) results from an investigation into the accuracy of several turbulence models to predict air cooling for electronic packages and systems. Also new transitional turbulence models will be proposed with emphasis on hybrid techniques that use the k-ε model at an appropriate distance away from the wall and suitable models, with wall functions, near wall regions. A major proportion of heat emitted from electronic packages can be extracted by air cooling. This flow of air throughout an electronic system and the heat extracted is highly dependent on the nature of turbulence present in the flow. The use of CFD for such investigations is fast becoming a powerful and almost essential tool for the design, development and optimization of engineering applications. However turbulence models remain a key issue when tackling such flow phenomena. The reliability of CFD analysis depends heavily on the turbulence model employed together with the wall functions implemented. In order to resolve the abrupt fluctuations experienced by the turbulent energy and other parameters located at near wall regions and shear layers a particularly fine computational mesh is necessary which inevitably increases the computer storage and run-time requirements. The PHYSICA Finite Volume code was used for this investigation. With the exception of the k-ε and k-ω models which are available as standard within PHYSICA, all other turbulence models mentioned were implemented via the source code by the authors. The LVEL, LVEL CAP, Wolfshtein, k-ε, k-ω, SST and kε/kl models are described and compared with experimental data.

Accuracy of turbulence models and CFD for thermal characterisation of electronic systems

A major percentage of the heat emitted from electronic packages can be extracted by air cooling whether by means of natural or forced convection. This flow of air throughout an electronic system and the heat extracted is highly dependable on the nature of turbulence present in the flow field. This paper will discuss results from an investigation into the accuracy of turbulence models to predict air cooling for electronic packages and systems.

Investigation into the performance of turbulence models for fluid flow and heat transfer phenomena in electronic applications

Computational Fluid Dynamics (CFD) is gradually becoming a powerful and almost essential tool for the design, development and optimization of engineering applications. However the mathematical modelling of the erratic turbulent motion remains the key issue when tackling such flow phenomena. The reliability of CFD analysis depends heavily on the turbulence model employed together with the wall functions implemented. In order to resolve the abrupt changes in the turbulent energy and other parameters situated at near wall regions a particularly fine mesh is necessary which inevitably increases the computer storage and run-time requirements. Turbulence modelling can be considered to be one of the three key elements in CFD. Precise mathematical theories have evolved for the other two key elements, grid generation and algorithm development. The principal objective of turbulence modelling is to enhance computational procedures of efficient accuracy to reproduce the main structures of three dimensional fluid flows. The flow within an electronic system can be characterized as being in a transitional state due to the low velocities and relatively small dimensions encountered. This paper presents simulated CFD results for an investigation into the predictive capability of turbulence models when considering both fluid flow and heat transfer phenomena. Also a new two-layer hybrid kε / kl turbulence model for electronic application areas will be presented which holds the advantages of being cheap in terms of the computational mesh required and is also economical with regards to run-time.

Lifetime assessment of electronic components for high reliability aerospace applications

This paper details a modelling approach for assessing the in-service (field) reliability and thermal fatigue life-time of electronic package interconnects for components used in the assembly of an aerospace system. The Finite Element slice model of a Plastic Ball Grid Array (PBGA) package and suitable energy based damage models for crack length predictions are used in this study. Thermal fatigue damage induced in tin-lead solder joints are investigated by simulating the crack growth process under a set of prescribed field temperature profiles that cover the period of operational life. The overall crack length in the solder joint for all different thermal profiles and number of cycles for each profile is predicted using a superposition technique. The effect of using an underfill is also presented. A procedure for verifying the field lifetime predictions for the electronic package by using reliability assessment under Accelerated Thermal Cycle (ATC) testing is also briefly outlined.

Decision support systems for eco-friendly electronic products

This paper discusses an optimisation based decision support system and methodology for electronic packaging and product design and development which is capable of addressing in efficient manner specified environmental, reliability and cost requirements. A study which focuses on the design of a flip-chip package is presented. Different alternatives for the design of the flip-chip package are considered based on existing options for the applied underfill and volume of solder material used to form the interconnects. Variations in these design input parameters have simultaneous effect on package aspects such as cost, environmental impact and reliability. A decision system for the design of the flip-chip that uses numerical optimisation approach is used to identify the package optimal specification which satisfies the imposed requirements. The reliability aspect of interest is the fatigue of solder joints under thermal cycling. Transient nonlinear finite element analysis (FEA) is used to simulate the thermal fatigue damage in solder joints subject to thermal cycling. Simulation results are manipulated within design of experiments and response surface modelling framework to provide numerical model for reliability which can be used to quantify the package reliability. Assessment of the environmental impact of the package materials is performed by using so called Toxic Index (TI). In this paper we demonstrate the evaluation of the environmental impact only for underfill and lead-free solder materials. This evaluation is based on the amount of material per flip-chip package. Cost is the dominant factor in contemporary flip-chip packaging industry. In the optimisation based decision support system for the design of the flip-chip package, cost of materials which varies as a result of variations in the design parameters is considered.

"System in package technology" - design for manufacture challenges

Purpose – To present key challenges associated with the evolution of system-in-package technologies and present technical work in reliability modeling and embedded test that contributes to these challenges. Design/methodology/approach – Key challenges have been identified from the electronics and integrated MEMS industrial sectors. Solutions to optimising the reliability of a typical assembly process and reducing the cost of production test have been studied through simulation and modelling studies based on technology data released by NXP and in collaboration with EDA tool vendors Coventor and Flomerics. Findings – Characterised models that deliver special and material dependent reliability data that can be used to optimize robustness of SiP assemblies together with results that indicate relative contributions of various structural variables. An initial analytical model for solder ball reliability and a solution for embedding a low cost test for a capacitive RF-MEMS switch identified as an SiP component presenting a key test challenge. Research limitations/implications – Results will contribute to the further development of NXP wafer level system-in-package technology. Limitations are that feedback on the implementation of recommendations and the physical characterisation of the embedded test solution. Originality/value – Both the methodology and associated studies on the structural reliability of an industrial SiP technology are unique. The analytical model for solder ball life is new as is the embedded test solution for the RF-MEMS switch.

Computational approach for reliable and robust system-in-package design

A computational modelling approach integrated with optimisation and statistical methods that can aid the development of reliable and robust electronic packages and systems is presented. The design for reliability methodology is demonstrated for the design of a SiP structure. In this study the focus is on the procedure for representing the uncertainties in the package design parameters, their impact on reliability and robustness of the package design and how these can be included in the design optimisation modelling framework. The analysis of thermo-mechanical behaviour of the package is conducted using non-linear transient finite element simulations. Key system responses of interest, the fatigue life-time of the lead-free solder interconnects and warpage of the package, are predicted and used subsequently for design purposes. The design tasks are to identify the optimal SiP designs by varying several package input parameters so that the reliability and the robustness of the package are improved and in the same time specified performance criteria are also satisfied

Reliability based design optimisation for system-in-package

This paper discusses a reliability based optimisation modelling approach demonstrated for the design of a SiP structure integrated by stacking dies one upon the other. In this investigation the focus is on the strategy for handling the uncertainties in the package design inputs and their implementation into the design optimisation modelling framework. The analysis of fhermo-mechanical behaviour of the package is utilised to predict the fatigue life-time of the lead-free board level solder interconnects and warpage of the package under thermal cycling. The SiP characterisation is obtained through the exploitation of Reduced Order Models (ROM) constructed using high fidelity analysis and Design of Experiments (DoE) methods. The design task is to identify the optimal SiP design specification by varying several package input parameters so that a specified target reliability of the solder joints is achieved and in the same time design requirements and package performance criteria are met

A dynamically reconfigurable automotive control system architecture

This paper proposes a vehicular control system architecture that supports self-configuration. The architecture is based on dynamic mapping of processes and services to resources to meet the challenges of future demanding use-scenarios in which systems must be flexible to exhibit context-aware behaviour and to permit customization. The architecture comprises a number of low-level services that provide the required system functionalities, which include automatic discovery and incorporation of new devices, self-optimisation to best-use the processing, storage and communication resources available, and self-diagnostics. The benefits and challenges of dynamic configuration and the automatic inclusion of users' Consumer Electronic (CE) devices are briefly discussed. The dynamic configuration and control-theoretic technologies used are described in outline and the way in which the demands of highly flexible dynamic configuration and highly robust operation are simultaneously met without compromise, is explained. A number of generic use-cases have been identified, each with several specific use-case scenarios. One generic use-case is described to provide an insight into the extent of the flexible reconfiguration facilitated by the architecture.

An architectural approach to autonomics and self-management of automotive embedded electronic systems

Embedded electronic systems in vehicles are of rapidly increasing commercial importance for the automotive industry. While current vehicular embedded systems are extremely limited and static, a more dynamic configurable system would greatly simplify the integration work and increase quality of vehicular systems. This brings in features like separation of concerns, customised software configuration for individual vehicles, seamless connectivity, and plug-and-play capability. Furthermore, such a system can also contribute to increased dependability and resource optimization due to its inherent ability to adjust itself dynamically to changes in software, hardware resources, and environment condition. This paper describes the architectural approach to achieving the goals of dynamically self-configuring automotive embedded electronic systems by the EU research project DySCAS. The architecture solution outlined in this paper captures the application and operational contexts, expected features, middleware services, functions and behaviours, as well as the basic mechanisms and technologies. The paper also covers the architecture conceptualization by presenting the rationale, concerning the architecture structuring, control principles, and deployment concept. In this paper, we also present the adopted architecture V&V strategy and discuss some open issues in regards to the industrial acceptance.