Warpage issues in large area mould embedding technologies

The need for higher communications speed, heterogeneous integration and further miniaturisation have increased demand in developing new 3D integrated packaging technologies which include wafer-level moulding and chip-to-wafer interconnections . Wafer-level moulding refers to the embedding of multiple chips or heterogeneous systems on the wafer scale. This can be achieved through a relatively new technology consisting of thermal compression moulding of granular or liquid epoxy moulding compounds. Experimental measurements from compression moulding on 8” blank wafers have shown an unexpected tendency to warp into a cylindrical-shape following cooling from the moulding temperature to room temperature. Wafer warpage occurs primarily as a result of a mismatch between the coefficient of thermal expansion of the resin compound and the Si wafer. This paper will delve into possible causes of such asymmetric warpage related to mould, dimensional and material characteristics using finite element (FE) software (ANSYS Mechanical). The FE model of the resin on wafer deposition will be validated against the measurement results and will be used to deduce appropriate guidelines for low warpage wafer encapsulation.peer-reviewe

A longitudinal analysis of trends in the number of positive cases and swabbing activities during the first eighteen months of the COVID-19 pandemic in Malta

In March 2020, at the onset of the COVID-19 pandemic teams were set up to execute the processes needed to implement COVID-19 related activities. The Helpline team was responsible for the booking of appointments for swabbing, the first step in the process. The Helpline also received calls from the public for other reasons.peer-reviewe

The national helpline during the COVID-19 pandemic : a pillar of support for the public

Soon after the onset of the COVID-19 pandemic in Malta in March 2020, the number of calls from the public escalated so much that a helpline service, Helpline 111, was set at a private call centre. Calls from the public were answered by a team of trained agents, supported onsite by officials from the Public Health Response Team. The reasons for the calls varied and guidelines for answering the calls were continuously updated in line with the current standards and mitigation measures.peer-reviewe

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Xjenza Online -Journal of The Malta Chamber of Scientists www

Abstract. The need for higher communications speed, heterogeneous integration and further miniaturisation have increased demand in developing new 3D integrated packaging technologies which include wafer-level moulding and chip-to-wafer interconnections. Wafer-level moulding refers to the embedding of multiple chips or heterogeneous systems on the wafer scale. This can be achieved through a relatively new technology consisting of thermal compression moulding of granular or liquid epoxy moulding compounds. Experimental measurements from compression moulding on 8" blank wafers have shown an unexpected tendency to warp into a cylindrical-shape following cooling from the moulding temperature to room temperature. Wafer warpage occurs primarily as a result of a mismatch between the coefficient of thermal expansion of the resin compound and the Si wafer. This paper will delve into possible causes of such asymmetric warpage related to mould, dimensional and material characteristics using finite element (FE) software (ANSYS Mechanical). The FE model of the resin on wafer deposition will be validated against the measurement results and will be used to deduce appropriate guidelines for low warpage wafer encapsulation

Spatial and within-season variation in the diet of a declining seabird described through digital photography and citizen science

Understanding an animal’s diet is a crucial component of conservation, but diet data are often labor intensive to collect and are frequently scarce. Atlantic Puffins ( Fratercula arctica ; hereafter Puffins) are vulnerable to global extinction and have declined in some parts of their UK and Irish range. Differences in population trajectories may relate to diet, but Puffin diet data are currently only collected at a handful of colonies. We explored whether citizen science could address this data gap by inviting visitors to Puffin colonies in 2017 to submit their photographs of Puffins carrying prey. In total, 602 people submitted 1402 images from 35 colonies. We identified the species group, size, and number of prey items in each bill load. Photograph quality was excellent, with 89% of birds in images providing useable diet information. In total 11,150 prey items were counted and measured from 1198 Puffins across 27 colonies. We demonstrated a lack of bias in the sample of photos provided by citizen scientists and described how Puffin chick diet varies in prey composition, prey length, number of prey per bill load, and load biomass over large spatial scales and throughout the breeding season. The diet of Puffin chicks from regions where severe declines have occurred, most notably Shetland, were characterized by a lower prey biomass, higher numbers of fish per load, and a high proportion of small, transparent sandeels consistently through the season. By contrast, in regions where Puffin populations are thought to be increasing, load biomass was high, the number of prey per load low, and larger non-transparent sandeels were the dominant prey, which persisted right through the breeding season. Results from our study show colonies and regions where birds may be expending more effort (collecting more prey items) for lesser returns (lower load biomass) and emphasize the value of collecting diet data across large spatial scales