General practitioners' reasons for removing patients from their lists: postal survey in England and Wales

The removal of patients from doctors' lists causes con­ siderable public and political concern, with speculation that patients are removed for inappropriate, including financial, reasons. In 1999 the House of Commons Select Committee on Public Administration noted that little evidence was available on either the frequency of, or the reasons for, removal of patients. National statistics do not distinguish between patients removed after moving out of a practice area and those removed for other reasons. Two postal surveys have reported why general practitioners might, in general, remove patients, and one small study has described the reasons doctors give for particular removals. We therefore determined the current scale of, and doctors' reasons for, removal of patients from their lists in Eng­ land and Wales

Preparing Aspiring Superintendents to Lead School Improvement: Perceptions of Graduates for Program Development

Changes in the design and delivery of educational leadership preparation programs are advocated in order to meet the needs of leadership for 21st century schools (Byrd, 2001; Cox, 2002; McKerrow, 1998; Smylie & Bennett, 2005). The changing needs of the 21st century, coupled with accountability standards and more diverse populations of students within school districts, create challenges for leaders who are attempting to increase student achievement (Firestone & Shipps, 2005; Schlechty, 2008). Further, student performance demands have increased at the state and national level because of the No Child Left Behind Act (Wong & Nicotera, 2007). These standards have thus increased the emphasis of the administrator\u27s responsibility to positively impact student achievement (Taylor, 2001). With the graying of the profession and the need for exemplary school superintendents, the preparation of school superintendents who can successfully lead school improvement is vitally important (Lashway, 2006). According to the National Council for the Accreditation of Teacher Education (NCATE, 2002), university preparation programs should seek current leaders\u27 perspectives of critical content components and the processes to be used in the preparation of educational leaders who can lead school improvement practices and processes

Electrostatic Discharge Effects on Thin Film Resistors

Recently, open circuit failures of individual elements in thin film resistor networks have been attributed to electrostatic discharge (ESD) effects. This paper will discuss the investigation that came to this conclusion and subsequent experimentation intended to characterize design factors that affect the sensitivity of resistor elements to ESD. The ESD testing was performed using the standard human body model simulation. Some of the design elements to be evaluated were: trace width, trace length (and thus width to length ratio), specific resistivity of the trace (ohms per square) and resistance value. However, once the experiments were in progress, it was realized that the ESD sensitivity of most of the complex patterns under evaluation was determined by other design and process factors such as trace shape and termination pad spacing. This paper includes pictorial examples of representative ESD failure sites, and provides some options for designing thin film resistors that are ESD resistant. The risks of ESD damage are assessed and handling precautions suggested

Update - Body of Knowledge (BOK) for Copper Wire Bonds

Copper wire bond technology developments continue to be a subject of technical interest to the NASA (National Aeronautics and Space Administration) NEPP (NASA Electronic Parts and Packaging Program) which funded this update. Based on this new research, additional copper bond wire vulnerabilities were found in the literature - Crevice corrosion, intrinsic degradation of palladium coated copper wire, congregation of palladium near ball bond interface leading to failure, residual aluminum pad metallization impact on device lifetimes, stitch cracking phenomena, package delamination's that have resulted in wire bond failures and device failure due to elemental sulfur. A search of the U.S.A. patent web site found 3 noteworthy patents on the following developments: claim of a certain IMC (Intermetallic Compound) thickness as a mitigation solution to chlorine corrosion; claim of using materials with different pHs to neutralize contaminants in a package containing copper wire bonds; and a discussion on ball shear test threshold values for different applications. In addition, an aerospace contractor of military hardware had a presentation on copper bond wires where it was reported that there was a parametric shift and noise susceptibility of devices with copper bond wires which affected legacy design performance. A review of silver bond wire (another emerging technology) technical papers found that an electromigration failure mechanism was evident in device applications that operate under high current conditions. More studies may need to be performed on a comprehensive basis. Research areas for consideration are suggested, however, these research and or qualification/standard test areas are not all inclusive and should not be construed as the element (s) that delivers any potential copper wire bond solution. A false sense of security may occur, whenever there is a reliance on passing any particular qualification, standard, or test protocol

Body of Knowledge (BOK) for Copper Wire Bonds

Copper wire bonds have replaced gold wire bonds in the majority of commercial semiconductor devices for the latest technology nodes. Although economics has been the driving mechanism to lower semiconductor packaging costs for a savings of about 20% by replacing gold wire bonds with copper, copper also has materials property advantages over gold. When compared to gold, copper has approximately: 25% lower electrical resistivity, 30% higher thermal conductivity, 75% higher tensile strength and 45% higher modulus of elasticity. Copper wire bonds on aluminum bond pads are also more mechanically robust over time and elevated temperature due to the slower intermetallic formation rate - approximately 1/100th that of the gold to aluminum intermetallic formation rate. However, there are significant tradeoffs with copper wire bonding - copper has twice the hardness of gold which results in a narrower bonding manufacturing process window and requires that the semiconductor companies design more mechanically rigid bonding pads to prevent cratering to both the bond pad and underlying chip structure. Furthermore, copper is significantly more prone to corrosion issues. The semiconductor packaging industry has responded to this corrosion concern by creating a palladium coated copper bonding wire, which is more corrosion resistant than pure copper bonding wire. Also, the selection of the device molding compound is critical because use of environmentally friendly green compounds can result in internal CTE (Coefficient of Thermal Expansion) mismatches with the copper wire bonds that can eventually lead to device failures during thermal cycling. Despite the difficult problems associated with the changeover to copper bonding wire, there are billions of copper wire bonded devices delivered annually to customers. It is noteworthy that Texas Instruments announced in October of 2014 that they are shipping microcircuits containing copper wire bonds for safety critical automotive applications. An evaluation of copper wire bond technology for applicability to spaceflight hardware may be warranted along with concurrently compiling a comprehensive understanding of the failure mechanisms involved with copper wire bonded semiconductor devices

A role for TSPO in mitochondrial Ca2+ homeostasis and redox stress signaling

The 18 kDa translocator protein TSPO localizes on the outer mitochondrial membrane (OMM). Systematically overexpressed at sites of neuroinflammation it is adopted as a biomarker of brain conditions. TSPO inhibits the autophagic removal of mitochondria by limiting PARK2-mediated mitochondrial ubiquitination via a peri-organelle accumulation of reactive oxygen species (ROS). Here we describe that TSPO deregulates mitochondrial Ca2+ signaling leading to a parallel increase in the cytosolic Ca2+ pools that activate the Ca2+-dependent NADPH oxidase (NOX) thereby increasing ROS. The inhibition of mitochondrial Ca2+ uptake by TSPO is a consequence of the phosphorylation of the voltage-dependent anion channel (VDAC1) by the protein kinase A (PKA), which is recruited to the mitochondria, in complex with the Acyl-CoA binding domain containing 3 (ACBD3). Notably, the neurotransmitter glutamate, which contributes neuronal toxicity in age-dependent conditions, triggers this TSPO-dependent mechanism of cell signaling leading to cellular demise. TSPO is therefore proposed as a novel OMM-based pathway to control intracellular Ca2+ dynamics and redox transients in neuronal cytotoxicity

Macrophage transactivation for chemokine production identified as a negative regulator of granulomatous inflammation using agent-based modeling

Cellular activation in trans by interferons, cytokines and chemokines is a commonly recognized mechanism to amplify immune effector function and limit pathogen spread. However, an optimal host response also requires that collateral damage associated with inflammation is limited. This may be particularly so in the case of granulomatous inflammation, where an excessive number and / or excessively florid granulomas can have significant pathological consequences. Here, we have combined transcriptomics, agent-based modeling and in vivo experimental approaches to study constraints on hepatic granuloma formation in a murine model of experimental leishmaniasis. We demonstrate that chemokine production by non-infected Kupffer cells in the Leishmania donovani-infected liver promotes competition with infected KCs for available iNKT cells, ultimately inhibiting the extent of granulomatous inflammation. We propose trans-activation for chemokine production as a novel broadly applicable mechanism that may operate early in infection to limit excessive focal inflammation