Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of ED staff who experienced WPV over a 4-year period (2013–2016). We analyzed data on the reasons for the incident, the time of day, the manner of violence, the consequences, and the migratory background of the aggressor. In total, 83 cases of WPV were reported over a four-year period. The average age of the violent person was 33.1 years; in 35 cases (42.0%), aggressors were younger than 30 years old, 53 (63.8%) were male, 49 (59%) were of Swiss nationality, and 35–40% had a migratory background. The odds ratio of people originating from a low- to middle-income country versus those originating from a high-income country was 1.8. Furthermore, 45.8% of the patients arrived by ambulance (n = 38) and 19 patients (22.9%) were self-presenting. Most cases (92.8%) involved verbal aggression, but in more than half of the cases, physical assault (56.6%) was also reported. In addition, 43 (51.8%) of the events occurred during the night. Results also showed that 42 (50.6%) of patients who were involved in WPV were under the influence of alcohol and 29 (34.9%) suffered from psychiatric disorders. Security personnel and police were involved in 53 (63.9%) and 47 (56.6%) cases, respectively. Twenty patients (24.1%) were sedated and 16 (19.3%) were restrained. In 18 cases (21.7%), the psychiatrist ordered compulsory hospitalization in a psychiatric institution. Taken together, WPV is a relatively common event in our ED and persons with a migratory background are involved more often relative to their frequency of ED visits.

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This paper describes the system packaging and technologies of the IBM System z9e enterprise-class server. The central electronic complex of the system consists of four nodes, each housing a multichip module (MCM) with 16 chips consuming up to 1,200 W. The z9e server doubles the multiprocessor performance of the System z990 by increasing the central processing unit (CPU) configuration and using an internally developed elastic interface to increase interconnect speed on all high-speed buses. In contrast to all previous zSeriest designs, which were running at half of the processor speed, the packaging interconnects on the multichip module run at the same speed as the processor (1.72 GHz). High frequencies and massively parallel connectivity lead to a raw packaging bandwidth of up to 1,764 GB/s between processors and cache within a single frame for a fully configured four-node z9 system.

In this paper, we describe the first-and second-level system packaging structure of the IBM zEnterprise A 196 (z196) enterprise-class server. The design point required a more than 50% overall increase in system performance (in millions of instructions per second) in comparison to its predecessor. This resulted in a new system design that includes, among other things, increased input/output bandwidth, more processors with higher frequencies, and increased current demand of more than 2,000 A for the six processor chips and two cache chips per multichip module. To achieve these targets, we implemented several new packaging technologies. The z196 enterprise-class server uses a new differential memory interface between the processor chips and custom-designed server memory modules. The electrical power delivery system design follows a substantially new approach using Vicor Factor Power A blocks, which results in higher packaging integration density and minimized package electrical losses. The power noise decoupling strategy was changed because of the availability of deep-trench technology on the new processor chip generation.

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