Energy efficient core designs for upcoming process technologies

Energy efficiency has been a first order constraint in the design of micro processors for the last decade. As Moore's law sunsets, new technologies are being actively explored to extend the march in increasing the computational power and efficiency. It is essential for computer architects to understand the opportunities and challenges in utilizing the upcoming process technology trends in order to design the most efficient processors. In this work, we consider three process technology trends and propose core designs that are best suited for each of the technologies. The process technologies are expected to be viable over a span of timelines. We first consider the most popular method currently available to improve the energy efficiency, i.e. by lowering the operating voltage. We make key observations regarding the limiting factors in scaling down the operating voltage for general purpose high performance processors. Later, we propose our novel core design, ScalCore, one that can work in high performance mode at nominal Vdd, and in a very energy-efficient mode at low Vdd. The resulting core design can operate at much lower voltages providing higher parallel performance while consuming lower energy. While lowering Vdd improves the energy efficiency, CMOS devices are fundamentally limited in their low voltage operation. Therefore, we next consider an upcoming device technology -- Tunneling Field-Effect Transistors (TFETs), that is expected to supplement CMOS device technology in the near future. TFETs can attain much higher energy efficiency than CMOS at low voltages. However, their performance saturates at high voltages and, therefore, cannot entirely replace CMOS when high performance is needed. Ideally, we desire a core that is as energy-efficient as TFET and provides as much performance as CMOS. To reach this goal, we characterize the TFET device behavior for core design and judiciously integrate TFET units, CMOS units in a single core. The resulting core, called HetCore, can provide very high energy efficiency while limiting the slowdown when compared to a CMOS core. Finally, we analyze Monolithic 3D (M3D) integration technology that is widely considered to be the only way to integrate more transistors on a chip. We present the first analysis of the architectural implications of using M3D for core design and show how to partition the core across different layers. We also address one of the key challenges in realizing the technology, namely, the top layer performance degradation. We propose a critical path based partitioning for logic stages and asymmetric bit/port partitioning for storage stages. The result is a core that performs nearly as well as a core without any top layer slowdown. When compared to a 2D baseline design, an M3D core not only provides much higher performance, it also reduces the energy consumption at the same time. In summary, this thesis addresses one of the fundamental challenges in computer architecture -- overcoming the fact that CMOS is not scaling anymore. As we increase the computing power on a single chip, our ability to power the entire chip keeps decreasing. This thesis proposes three solutions aimed at solving this problem over different timelines. Across all our solutions, we improve energy efficiency without compromising the performance of the core. As a result, we are able to operate twice as many cores with in the same power budget as regular cores, significantly alleviating the problem of dark silicon

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk