Material Characterization of Intermetallic Compound Formation with Respect to Thermosonic Bonding Duration

Intermetallic Metallic Compounds (IMCs) formation is a common cause for wire bond failures. This research studied the effect of US vibration duration on IMC formation and growth in Copper-Aluminum (Cu-Al) wire bonded samples. Wire bonded samples, using 2.5 mil (63.5 μm) thick Palladium coated Copper wire, is ultrasonically bonded on a 2 cm thick Aluminum (1”x1”) coupon. Segmented bonding technique using 200 gf force and 220 gf force are applied during segment 1 and segment 2 of the bonding respectively. Ultrasonic (US) vibration frequency of 115-117 khz and a bonding temperature of 175°C is used. A pair of 5 samples with bonding duration: 20 milliseconds (ms), 40ms, 60ms, 80ms, 100ms is created. Keeping the temperature constant at 250 °C, a tube furnace is used to annealing one set for 2 hours and the other set for 4 hours. Backscattered Electrons (BSE) images were used to detect IMC growth. Backscattered images revealed formation of IMC at the Cu-Al bond interface, mostly around the center of and bond periphery. Using BSE images to identify location of IMC, Energy Dispersive Spectroscopy (EDS) linescans were then performed. Only EDS analysis was taken into account for final results assuming it was more accurate than visual inspection of BSE images. EDS linescan analysis for 2 hour heat treated samples showed IMC thickness growing from 0.6 μm to 1 μm as bond duration increased from 20ms to 100ms. Linescan results for 4 hour samples had IMC thickness ranging from 0.8μm to 1.5 μm, and hence showed an increase xiv with bond duration from 20ms to 100 ms. Using micro indentations, hardness of both Cu ball and Al was measured. Change in hardness for Cu and Al was compared with bond duration and annealing time. Cu hardness decreased from 20ms to 60ms bond time and then increased in value from 80ms to 100ms bond time. When compared to anneal time, overall hardness in Cu increased with increase in annealing time. Overall hardness in Aluminum increased with increasing bond duration but decreased with increase in anneal time, such behavior is related to the concurrent effect of annealing and IMC growth

A Hybrid Transfer Learning Assisted Decision Support System for Accurate Prediction of Alzheimer Disease

Alzheimer's disease (AD) is the most common long-term illness in elderly people. In recent years, deep learning has become popular in the area of medical imaging and has had a lot of success there. It has become the most effective way to look at medical images. When it comes to detecting AD, the deep neural model is more accurate and effective than general machine learning. Our research contributes to the development of a more comprehensive understanding and detection of the disease by identifying four distinct classes that are predictive of AD with a high weighted accuracy of 98.91%. A unique strategy has been proposed to improve the accuracy of the imbalance dataset classification problem via the combination of ensemble averaging models and five different transfer learning models in this study. EfficientNetB0+Resnet152(effnet+res152) and InceptionV3+EfficientNetB0+Resnet50(incep+effnet+res50) models have been fine-tuned and have reached the highest weighted accuracy for multi-class AD stage classifications

Workplace mistreatment and mental health in female surgeons in Pakistan

Background: Despite workplace mistreatment, which includes harassment, bullying and gender discrimination(GD)/bias, being serious problems for female surgeons, there are limited data from lower-middle-income countries like Pakistan. This study explored harassment and GD/bias experienced by female surgeons in Pakistan, and the effects of these experiences on mental health and well-being.Methods: A nationwide survey was conducted between July and September 2019 in collaboration with the Association of Women Surgeons of Pakistan, an organization consisting of female surgeons and trainees in Pakistan. An anonymous online survey was emailed directly, disseminated via social media platforms (such as Facebook, Twitter and Instagram), and sent to surgical programmes in Pakistan.Results: A total of 146 women surgeons responded to the survey; 67.1 per cent were trainees and the rest attending surgeons. Overall, 57.5 per cent of surgeons reported experiencing harassment, most common being verbal (64.0 per cent) and mental (45.9 per cent), but this mostly went unreported (91.5 per cent). On multivariable analysis adjusted for age and specialty, workplace harassment (odds ratio 2.02 (95 per cent c.i. 1.09 to 4.45)) and bullying (odds ratio 5.14 (95 per cent c.i. 2.00-13.17)) were significantly associated with severe self-perceived burnout, while having a support system was protective against feelings of depression (odds ratio 0.35 (95 per cent c.i. 0.16 to 0.74)). The overwhelming majority (91.3 per cent) believed that more institutional support groups were needed to help surgeons with stress reduction (78.8 per cent), receiving mentorship (74.7 per cent) and work-life balance (67.8 per cent).Conclusion: Workplace mistreatment, in particular harassment and bullying, has a damaging impact on the mental well-being of female surgeons, particularly trainees. The absence of support groups in Pakistan should be urgently addressed so that surgeons, especially trainees, may cope better with potentially harmful workplace stressors

CAN SHOE SIZE CORRECTLY PREDICT THE SIZE OF COMPONENTS OF TOTAL KNEE REPLACEMENT PRE-OPERATIVELY

Objective: To ascertain the correlation between shoe size and sizes of femoral and tibial components of total knee replacement preoperatively in patients undergoing total knee arthroplasty. Study design: Prospective cohort study Study settings and duration: This study was conducted at department of orthopedic surgery, Shifa International Hospital, Islamabad from July 2020 – December 2020. Material and methods: Sample size was calculated using WHO calculator and it was 43 patients in total. Patients were approached through non-probability consecutive sampling. Shoe size of patients was measured using a Brannock device. During surgery, Implant model and sizes of the femoral and tibial components implanted during knee replacement were noted. Data was analyzed with the help of SPSS version 24. We applied Pearson’s correlation cofficeint. P value ≤ 0.05 was considered significant. Results: Out of 43, there were 9(20.9%) male and female 34(79.1%). Mean age of patients was 51.7±6.8 (SD). We found good positive correlation between shoe size and tibial component (p=<0.001). Positive co relation was found between femoral component and shoe size (p=0.001). Shoe size predict 72% of Tibial component and 65% femoral component. Conclusion: Shoe size is effective and safe predictors of total knee replacement components pre-operatively. This procedure is more accurate and less labor intensive. Accurate templating result in less surgical duration and provide several benefits to patients and health care providers.  

Gender discrimination against female surgeons: A cross-sectional study in a lower-middle-income country

Introduction: Although gender discrimination and bias (GD/bias) experienced by female surgeons in the developed world has received much attention, GD/bias in lower-middle-income countries like Pakistan remains unexplored. Thus, our study explores how GD/bias is perceived and reported by surgeons in Pakistan.Method: A single-center cross-sectional anonymous online survey was sent to all surgeons practicing/training at a tertiary care hospital in Pakistan. The survey explored the frequency, source and impact of GD/bias among surgeons.Results: 98/194 surgeons (52.4%) responded to the survey, of which 68.4% were males and 66.3% were trainees. Only 19.4% of women surgeons reported \u27significant\u27 frequency of GD/bias during residency. A higher percentage of women reported \u27insignificant\u27 frequency of GD/bias during residency, as compared to males (61.3% vs. 32.8%; p = 0.004). However, more women surgeons reported facing GD/bias in various aspects of their career/training, including differences in mentorship (80.6% vs. 26.9%; p \u3c 0.005) and differences in operating room opportunities (77.4% vs. 32.8%; p \u3c 0.005). The source was most frequently reported to be co-residents of the opposite gender. Additionally, a high percentage of female surgeons reported that their experience of GD/bias had had a significant negative impact on their career/training progression, respect/value in the surgical team, job satisfaction and selection of specialty.Conclusion: Although GD/bias has widespread impacts on the training/career of female surgeons in Pakistan, most females fail to recognize this GD/bias as significant . Our results highlight a worrying lack of recognition of GD/bias by female surgeons, representing a major barrier to gender equity in surgery in Pakistan and emphasizing the need for future research

Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta-analysis and meta-regression

Background: Older adults (≥70-year-old) are under-represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD).Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD.Methods: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta-analyses (4880 patients) of clinical outcomes [all-cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12-24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta-regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random-effects model.Results: All-cause mortality between PCI and CABG was comparable at 30-days (OR0.77, 95% CI 0.42- 1.41) and 12-24-months (OR 1.22, 95% CI 0.78-1.93). PCI was associated with a markedly lower rate of stroke at 30-day follow-up in octogenarians (OR 0.14, 95% CI 0.02-0.76) but an overall higher rate of repeat revascularization. At ≥36-months, MACCE (OR 1.26,95% CI 0.99-1.60) and all-cause mortality (OR 1.39, 95% CI 1.00-1.93) showed a trend favoring CABG but did not reach statistical significance. On meta-regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042).Conclusions: PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All-cause mortality was comparable between the two arms with a trend favoring CABG at ≥36-months.PCI was however associated with increasing mortality with advancing age as compared to CABG

Spatio-temporal patterns of pre-eclampsia and eclampsia in relation to drinking water salinity at the district level in Bangladesh from 2016 to 2018

This analysis examines whether salinity in drinking water is associated with pre-eclampsia and eclampsia (PE/E), a leading cause of maternal morbidity and mortality. Bangladesh’s national health information system data were extracted at the district level (n = 64) to assess PE/E rates, and these were overlaid with three environmental measures approximating drinking water salinity, remotely sensed low-elevation coastal zone (LECZ), monthly rainfall data, and electrical conductivity of groundwater (i.e., water salinity). Results from a negative binomial fixed effects model suggest PE/E rates are higher with less rainfall (dry season), lower population density, and that district level rates of PE/E increase with higher groundwater salinity and in the high risk LECZ category closest to the coast. Results suggest that drinking water salinity may be associated with PE/E and that using national health surveillance data can improve understanding of this association. This approach can potentially be leveraged in the future to inform targeted interventions to high risk regions and times

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey.Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting

Fuel classification and adulteration detection using a highly sensitive plasmonic sensor

In this paper, a plasmonic refractive index sensor is proposed based on a square ring-type resonator with gratings, which is coupled with a straight metal-insulator-metal (MIM) waveguide that has two triangular stubs. The adulteration of fuel may have detrimental effects on a variety of systems, including automobiles, people's health, and even the environment, in addition to reducing fuel economy. That is why this sensor has been designed for classifying different types of fuels and detecting the extent of adulteration in fuel. The finite element method (FEM) has been applied for numerical analysis of the structure. The sensor monitors the changes in the resonant wavelength and how light passes through the resonator to figure out the unknown material's refractive index. The sensor exhibits high sensitivity, and the maximum achievable sensitivity is 3270.3 nm/RIU with a figure of merit (FOM) of 31.154, when the refractive index of the dielectric is 1.01 and the sensor is functioning in mode-4. For mode-1, both the FOM and the quality factor are found to have their highest values, 45.28 and 46.508, respectively. According to the simulation results for different ranges of refractive index, when analyzing values between 1.3 and 1.4, the sensitivity reached its peak at 3138.8 nm/RIU. This means that while operating in mode-4, it is suitable for use in bio-sensing applications. Furthermore, our new sensor can detect change in the temperature in a broad spectral range using the wavelength-dependent refractive index of ethanol with a maximum achievable temperature sensitivity of 1.159 nm/°C

Coronary artery occlusion following low-power catheter ablation

Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablation procedures. This case describes the occurrence of acute myocardial infarction following low-power ablation in a young patient and highlights the importance of maintaining high index of suspicion following catheter ablation irrespective of the ablation power used. A 22-year-old patient had low-power ablation of the right posteroseptal accessory pathway in the ostium of the coronary sinus on account of persistently symptomatic WPW syndrome with orthodromic re-entrant tachycardia. Two hours after the procedure, she developed moderately severe chest pain. Electrocardiogram showed ST elevation in the inferior leads. Coronary angiography showed 100% stenosis of the right coronary artery just beyond the posterior descending artery. She failed balloon angioplasty and a drug eluting stent was placed in the posterolateral branch of the right coronary artery. The symptoms resolved and follow up echocardiogram showed normal left ventricular systolic and diastolic functions with no regional wall motion abnormality. This case demonstrates the occurrence of MI following low-power catheter ablation. Patients should be monitored for this complication irrespective of the ablation power used