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Chip-package interaction (CPI) and the related thermomechanical stress in microchips increase the risk of failure in on-chip interconnect stacks, caused by delamination along Cu/dielectrics interfaces (adhesive failure) and fracture in dielectrics (cohesive failure). High-resolution transmission X-ray microscopy (TXM) is a unique technique to image crack propagation in on-chip interconnect stacks. The visualization of crack evolution in Cu/low-k Backend-of-Line (BEoL) structures is demonstrated using an experimental setup which combines high-resolution X-ray imaging with mechanical loading. The application of an indenter manipulator at the TXM beamline of the synchrotron radiation source BESSY II provides an unprecedented level of details on the fracture behavior of microchips. This in-situ experiment allows to identify the weakest layers and interfaces and to evaluate the robustness of the BEoL stack against CPI.
The objective of this study was to investigate whether different staffing models are associated with variation in radiograph use for children seen for bronchiolitis, croup, and asthma and discharged home from emergency departments (EDs) in Ontario.
We surveyed all Ontario EDs regarding physician staffing models and use of clinical protocols. We used a population-based ED database to determine radiograph rates and patient characteristics. Regression techniques that controlled for patient factors and clustering within EDs were applied.
From April 2004 to March 2006, 5,186, 10,408, and 35,150 children were discharged home from an ED with bronchiolitis, croup, and asthma, respectively. Radiograph rates were 42.7% for bronchiolitis, 10.1% for croup, and 25.9% for asthma. Over 50% of children were treated in EDs with nonpediatric front-line care but with consultant pediatricians available. Compared to children in these settings, those seen in EDs with front-line pediatric staff were less likely to have radiographs for all three conditions (adjusted odds ratios [ORs] 0.47 [95% CI 0.24–0.95], 0.47 [95% CI 0.27–0.82], 0.13 [95% CI 0.02–0.66] for bronchiolitis, croup, and asthma, respectively). Children in community hospitals with pediatricians were significantly more likely to have a radiograph if seen by a consultant pediatrician (OR 1.40, 95% CI 1.20–1.63 [bronchiolitis]; OR 2.76, 95% CI 2.16–3.53 [croup]; and OR 1.97, 95% CI 1.64–2.36 [asthma]). We found no association between clinical protocol use and radiograph rates.
High rates of discretionary radiograph use exist for common respiratory problems of children seen across ED settings. Quality improvement efforts should be focused in this area, and radiograph use in EDs staffed by front-line pediatrics-trained staff could serve as an initial benchmark target for other institutions.