Modern Trends in Microelectronics Packaging Reliability Testing.

In this review, recent trends in microelectronics packaging reliability are summarized. We review the technology from early packaging concepts, including wire bond and BGA, to advanced techniques used in HI schemes such as 3D stacking, interposers, fan-out packaging, and more recently developed silicon interconnect fabric integration. This review includes approaches for both design modification studies and packaged device validation. Methods are explored for compatibility in new complex packaging assemblies. Suggestions are proposed for optimizations of the testing practices to account for the challenges anticipated in upcoming HI packaging schemes.

Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals.

BACKGROUND: Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. METHODS: A U.S. health-care system's hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. RESULTS: There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. CONCLUSIONS: In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Median survival following geriatric hip fracture among 17,868 males from the Veterans Health Administration.

Background: The expected value of treatments for geriatric femoral neck fracture is influenced by the predicted duration of survival after injury. Specifically, total hip arthroplasty is more suited for patients likely to live long enough to reap its longer-term benefits. For predicting short- and medium-term survival, there are many tools available, but for longer-term survival prognosis the current literature is insufficient. Our hypothesis is that patient age at the time of injury correlates with median life expectancy and survival rates, and these values can anchor a prediction regarding a given patient's life expectancy. We therefore sought to determine median and fractional survival rates at 30 days, and 1, 2, 5 and 10 years after surgery for a large cohort of elderly patients with hip fracture as a function of age. Methods: 17,868 male patients, 65-89 years of age, treated surgically for hip fracture within the Veterans Affairs system were assessed. From this set, 10,000 patients were randomly selected, and their ages at surgery and death (if any) were recorded at least 10 years post-operatively. Median and fractional survival rates were recorded at 1 month and 1, 2, 5, and 10 years. The mathematical relationship between age and median survival was determined. All findings from the 10,000-patient cohort were compared to corresponding values of the remaining 7,868 patients, to assess the predictive power of the initial observations. Results: The median survival rate for the entire cohort was 2.2 years, with 90.4% of the group surviving at 30 days. The percentage of the cohort surviving at 1, 2, 5 and 10 years after treatment was 64.5%, 52.3%, 27.1% and 8.9% respectively. Median survival was approximately (13 - (0.13 × age-at-time-of-surgery) years for patients of all ages. Conclusions: Median survival after geriatric hip fracture can be accurately predicted by the patient's age at the time of injury. Median survival and fractional survival at key milestones can help estimate life-expectancy and thereby help guide treatment.

Estimating Median Survival Following Hip Fracture Among Geriatric Females: (100 - Patient Age) ÷ 4.

BACKGROUND:  Estimated life expectancy for patients with geriatric hip fracture can help guide treatment selection, especially the choice between hemiarthroplasty and total hip arthroplasty for a femoral neck fracture. The purpose of the present study is to determine the survival pattern of a large cohort of geriatric female patients with hip fracture, as a function of age, for 10 years or more after injury. METHODS:  All female patients between the ages of 65 and 99 who were treated surgically for hip fractures within the Veterans Affairs healthcare system from 2000 to 2010 were assessed. For every patient, the age at surgery and the age at death (if any) were recorded as of August 2021, a date at least 10.5 years after surgery.  Results: There were 818 patients in the cohort. The mean age at the time of fracture treatment was 81.2 years. Femoral neck fractures were found in 58% of the population. The survival rate for the entire group at one year was 73.7%; at two years, 62.7%; at five years, 38.6%; and at 10 years,13.7%. The median length of survival was 3.42 years, decreasing by age: for the 65-69 cohort, median survival was 8.18 years, whereas, for those 90 and above, median survival was 1.75 years. Median life expectancy could be approximated by the equation (100 - Patient Age) ÷ 4. Survival was not meaningfully affected by fracture type.  Conclusions: Geriatric hip fracture is associated with a high mortality rate. The median survival is highly correlated with age, such that an estimation equation, (100 - Patient Age) ÷ 4, offers a reliable shorthand for approximating it.