Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.

BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. METHODS: We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. RESULTS: Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant. CONCLUSIONS: The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.

Technical improvements possibly linked to higher success rate with intracytoplasmic single sperm injection

info:eu-repo/semantics/nonPublished

Continuous-wave ultrahigh-repetition-rate pulse train generation through modulational instability in a passive fiber cavity

Thanks to a passive cavity configuration, modulational instability in fibers is successfully observed, for the first time to our knowledge, in the continuous-wave regime. Our technique provides a new means of generating all-optically ultrahigh-repetition-rate pulse trains and opens up new possibilities for the fundamental study of modulational instability and related phenomena. © 2001 Optical Society of America.

Estimating the flow rate capacity of an overturned rail carriage end exit in the presence of smoke

While incidents requiring the rapid egress of passengers from trains are infrequent, perhaps the most challenging scenario for passengers involves the evacuation from an overturned carriage subjected to fire. In this paper we attempt to estimate the flow rate capacity of an overturned rail carriage end exit. This was achieved through two full-scale evacuation experiments, in one of which the participants were subjected to non-toxic smoke. The experiments were conducted as part of a pilot study into evacuation from rail carriages. In reviewing the experimental results, it should be noted that only a single run of each trial was undertaken with a limited — though varied — population. As a result it is not possible to test the statistical significance of the evacuation times quoted and so the results should be treated as indicative rather than definitive. The carriage used in the experiments was a standard class Mark IID which, while an old carriage design, shares many features with those carriages commonly found on the British rail network. In the evacuation involving smoke, the carriage end exit was found to achieve an average flow rate capacity of approximately 5.0 persons/min. The average flow rate capacity of the exit without smoke was found to be approximately 9.2 persons/min. It was noted that the presence of smoke tended to reduce significantly the exit flow rate. Due to the nature of the experimental conditions, these flow rates are considered optimistic. Finally, the authors make several recommendations for improving survivability in rail accidents. Copyright © 2000 John Wiley & Sons, Ltd.

Comparison between weight loss of bends in a pneumatic conveyor and erosion rate obtained in a centrifugal erosion tester for the same materials

In order to find a link between results obtained from a laboratory erosion tester and tests carried out on a pneumatic conveyor, a comparison has been made between weight loss from bends on an industrial-scale pneumatic conveyor and erosion rates obtained in a small centrifugal erosion tester, for the same materials. Identical test conditions have been applied to both experiments so that comparable test results have been obtained. The erosion rate of mild steel commonly used as the wall material of conveyor pipes and pipe bends was determined individually on both test rigs. A relationship between weight loss from the bends and erosion rate determined from the tester has been developed. A discussion based on the results and their applicability to the prediction of wear in pneumatic conveyors concludes the paper.

Effect of particle concentration on erosion rate of mild steel bends in a pneumatic conveyor

Particle concentration is known as a main factor that affects erosion rate of pipe bends in pneumatic conveyors. With consideration of different bend radii, the effect of particle concentration on weight loss of mild steel bends has been investigated in an industrial scale test rig. Experimental results show that there was a significant reduction of the specific erosion rate for high particle concentrations. This reduction was considered to be as a result of the shielding effect during the particle impacts. An empirical model is given. Also a theoretical study of scaling on the shielding effect, and comparisons with some existing models, are presented. It is found that the reduction in specific erosion rate (relative to particle concentration) has a stronger relationship in conveying pipelines than has been found in the erosion tester.

Effect of 0.5 wt % Cu addition in Sn–3.5% Ag solder on the dissolution rate of Cu metallization

The dissolution of thin film under-bump-metallization (UBM) by molten solder has been one of the most serious processing problems in electronic packaging technology. Due to a higher melting temperature and a greater Sn content, a molten lead-free solder such as eutectic SnAg has a faster dissolution rate of thin film UBM than the eutectic SnPb. The work presented in this paper focuses on the role of 0.5 wt % Cu in the base Sn–3.5%Ag solder to reduce the dissolution of the Cu bond pad in ball grid array applications. We found that after 0.5 wt % Cu addition, the rate of dissolution of Cu in the molten Sn–3.5%Ag solder slows down dramatically. Systematic experimental work was carried out to understand the dissolution behavior of Cu by the molten Sn–3.5%Ag and Sn–3.5%Ag–0.5%Cu solders at 230–250 °C, for different time periods ranging from 1 to 10 min. From the curves of consumed Cu thickness, it was concluded that 0.5 wt % Cu addition actually reduces the concentration gradient at the Cu metallization/molten solder interface which reduces the driving force of dissolution. During the dissolution, excess Cu was found to precipitate out due to heterogeneous nucleation and growth of Cu6Sn5 at the solder melt/oxide interface. In turn, more Cu can be dissolved again. This process continues with time and leads to more dissolution of Cu from the bond pad than the amount expected from the solubility limit, but it occurs at a slower rate for the molten Sn–3.5%Ag–0.5%Cu solder. © 2003 American Institute of Physics.

Multiphysics simulation of microwave curing in micro-electronics packaging applications

Purpose – This paper aims to present an open-ended microwave curing system for microelectronics components and a numerical analysis framework for virtual testing and prototyping of the system, enabling design of physical prototypes to be optimized, expediting the development process. Design/methodology/approach – An open-ended microwave oven system able to enhance the cure process for thermosetting polymer materials utilised in microelectronics applications is presented. The system is designed to be mounted on a precision placement machine enabling curing of individual components on a circuit board. The design of the system allows the heating pattern and heating rate to be carefully controlled optimising cure rate and cure quality. A multi-physics analysis approach has been adopted to form a numerical model capable of capturing the complex coupling that exists between physical processes. Electromagnetic analysis has been performed using a Yee finite-difference time-domain scheme, while an unstructured finite volume method has been utilized to perform thermophysical analysis. The two solvers are coupled using a sampling-based cross-mapping algorithm. Findings – The numerical results obtained demonstrate that the numerical model is able to obtain solutions for distribution of temperature, rate of cure, degree of cure and thermally induced stresses within an idealised polymer load heated by the proposed microwave system. Research limitations/implications – The work is limited by the absence of experimentally derived material property data and comparative experimental results. However, the model demonstrates that the proposed microwave system would seem to be a feasible method of expediting the cure rate of polymer materials. Originality/value – The findings of this paper will help to provide an understanding of the behaviour of thermosetting polymer materials during microwave cure processing.

Microwave curing for high density package

Summary form only given. Currently the vast majority of adhesive materials in electronic products are bonded using convection heating or infra-red as well as UV-curing. These thermal processing steps can take several hours to perform, slowing throughput and contributing a significant portion of the cost of manufacturing. With the demand for lighter, faster, and smaller electronic devices, there is a need for innovative material processing techniques and control methodologies. The increasing demand for smaller and cheaper devices pose engineering challenges in designing a curing systems that minimize the time required between the curing of devices in a production line, allowing access to the components during curing for alignment and testing. Microwave radiation exhibits several favorable characteristics and over the past few years has attracted increased academic and industrial attention as an alternative solution to curing of flip-chip underfills, bumps, glob top and potting cure, structural bonding, die attach, wafer processing, opto-electronics assembly as well as RF-ID tag bonding. Microwave energy fundamentally accelerates the cure kinetics of polymer adhesives. It provides a route to focus heat into the polymer materials penetrating the substrates that typically remain transparent. Therefore microwave energy can be used to minimise the temperature increase in the surrounding materials. The short path between the energy source and the cured material ensures a rapid heating rate and an overall low thermal budget. In this keynote talk, we will review the principles of microwave curing of materials for high density packing. Emphasis will be placed on recent advances within ongoing research in the UK on the realization of "open-oven" cavities, tailored to address existing challenges. Open-ovens do not require positioning of the device into the cavity through a movable door, hence being more suitable for fully automated processing. Further potential advantages of op- - en-oven curing include the possibility for simultaneous fine placement and curing of the device into a larger assembly. These capabilities promise productivity gains by combining assembly, placement and bonding into a single processing step. Moreover, the proposed design allows for selective heating within a large substrate, which can be useful particularly when the latter includes parts sensitive to increased temperatures.

Comparison of encapsulant curing with convention and microwave systems

Comparison of the performance of a conventional convection oven system with a dual-section microwave system for curing thermosetting polymer encapsulant materials has been performed numerically. A numerical model capable of analysing both the convection and microwave cure processes has been developed and is breifly outliines. The model is used to analyse the curing of a commercially available encapsulant material using both systems. Results obtained from numerical solutions are presented, confirming that the VFM system enables the cure process to be carried out far more rapidly than with the convection oven system. This capability stems from the fundamental heating processes involved, namely that microwave processing enables the heating rate to be varied independently of the material temperature. Variations in cure times, curing rates, maximum temperatures and residual stresses between the processes are fully discussed.

Advanced microwave oven for rapid curing of encapsulant

The curing of a thermosetting polymer materials utilized on micro-electronics packaging applications can be performed using microwave systems. The use of microwave energy enables the cure process to be completed more rapidly than with alternative approaches due to the ability to heat volumetrically. Furthermore, advanced dual-section microwave systems enable curing of individual components on a chip-on-board assembly. The dielectric properties of thermosetting polymer materials, commonly used in microelectronics packaging applications, vary significantly with temperature and degree of cure. The heating rate within a material subjected to an electric field is primarily dependant on the dielectric loss properties of the material itself. This article examines the variation in dielectric properties of a commercially available encapsulant paste with frequency and temperature and the resulting influence on the cure process. The 'FAMOBS' dual section microwave system and its application to microelectronics manufacture are described. The measurement of the dielectric properties of 'Henkel EO1080' encapsulant paste uses a commercially available 'dielectric probe kit' and is described in this paper. The FAMOBS heating system is used to encapsulate a small op-amp chip. A numerical model formulated to assess the cure process in thermosetting polymer materials under microwave heating is outlined. Numerical results showing that the microwave processing systems is capable of rapidly and evenly curing thermosetting polymer materials are presented.

Numerical simulation of encapsulant curing within a variable frequency microwave processing system

Curing of encapsulant material in a simplified microelectronics package using an open oven Variable Frequency Microwave (VFM) system is numerically simulated using a coupled solver approach. A numerical framework capable of simulating electromagnetic field distribution within the oven system, plus heat transfer, cure rate, degree of cure and thermally induced stresses within the encapsulant material is presented. The discrete physical processes have been integrated into a fully coupled solution, enabling usefully accurate results to be generated. Numerical results showing the heating and curing of the encapsulant material have been obtained and are presented in this contribution. The requirement to capture inter-process coupling and the variation in dielectric and thermophysical material properties is discussed and illustrated with simulation results.

Microwave curing of thermosetting polymer materials in microelectronics applications

Thermosetting polymer materials are widely utilised in modern microelectronics packaging technology. These materials are used for a number of functions, such as for device bonding, for structural support applications and for physical protection of semiconductor dies. Typically, convection heating systems are used to raise the temperature of the materials to expedite the polymerisation process. The convection cure process has a number of drawbacks including process durations generally in excess of 1 hour and the requirement to heat the entire printed circuit board assembly, inducing thermomechanical stresses which effect device reliability. Microwave energy is able to raise the temperature of materials in a rapid, controlled manner. As the microwave energy penetrates into the polymer materials, the heating can be considered volumetric – i.e. the rate of heating is approximately constant throughout the material. This enables a maximal heating rate far greater than is available with convection oven systems which only raise the surface temperature of the polymer material and rely on thermal conductivity to transfer heat energy into the bulk. The high heating rate, combined with the ability to vary the operating power of the microwave system, enables the extremely rapid cure processes. Microwave curing of a commercially available encapsulation material has been studied experimentally and through use of numerical modelling techniques. The material assessed is Henkel EO-1080, a single component thermosetting epoxy. The producer has suggested three typical convection oven cure options for EO1080: 20 min at 150C or 90 min at 140C or 120 min at 110C. Rapid curing of materials of this type using advanced microwave systems, such as the FAMOBS system [1], is of great interest to microelectronics system manufacturers as it has the potential to reduce manufacturing costs, increase device reliability and enables new device designs. Experimental analysis has demonstrated that, in a realistic chip-on-board encapsulation scenario, the polymer material can be fully cured in approximately one minute. This corresponds to a reduction in cure time of approximately 95 percent relative to the convection oven process. Numerical assessment of the process [2] also suggests that cure times of approximately 70 seconds are feasible whilst indicating that the decrease in process duration comes at the expense of variation in degree of cure within the polymer.

Application of particle swarm optimisation to evaluation of polymer cure kinetics models

A particle swarm optimisation approach is used to determine the accuracy and experimental relevance of six disparate cure kinetics models. The cure processes of two commercially available thermosetting polymer materials utilised in microelectronics manufacturing applications have been studied using a differential scanning calorimetry system. Numerical models have been fitted to the experimental data using a particle swarm optimisation algorithm which enables the ultimate accuracy of each of the models to be determined. The particle swarm optimisation approach to model fitting proves to be relatively rapid and effective in determining the optimal coefficient set for the cure kinetics models. Results indicate that the singlestep autocatalytic model is able to represent the curing process more accurately than more complex model, with ultimate accuracy likely to be limited by inaccuracies in the processing of the experimental data.