Analysis of Root Cause of Failure of a Turbo Generator Stator Winding

Abstract The paper reports the investigation on the root cause of source-drain leakage in bulk FinFET devices. While the failing device was readily isolated by nanoprobing technique and the electrical analysis pinpointed the potential defect location inside the Fin channel, the identification of physical root cause went through extreme challenges imposed by the tiny-sized device and the unique FinFET 3D architecture. The initial TEM analysis was misled by the projection of a species in the lamella surface and thus could not explain the electrical data. Careful analysis on the device structure was able to identify the origin of the species and led to the discovery of the actual root cause. This paper will provide the analysis details leading to the findings, and highlight the role of electrical understanding in not only providing guidance for physical analysis but also revealing the true root cause of failure in FinFET devices.

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Failure Localization in a Multistage S-Band Power Amplifier

ISTFA 2016: Conference Proceedings from the 42nd International Symposium for Testing and Failure Analysis ◽

10.31399/asm.cp.istfa2016p0373 ◽

2016 ◽

Author(s):

Clarence Rebello ◽

Ted Kolasa ◽

Parag Modi

Keyword(s):

Output Power ◽

Power Amplifier ◽

Fault Tree ◽

Root Cause ◽

Failure Investigation ◽

Band Power ◽

Cause Of Failure ◽

Design Materials ◽

Board Level ◽

Failure Localization

Abstract During the search for the root cause of a board level failure, all aspects of the product must be revisited and investigated. These aspects encompass design, materials, and workmanship. In this discussion, the failure investigation involved an S-Band Power Amplifier assembly exhibiting abnormally low RF output power where initial troubleshooting did not provide a clear cause of failure. A detailed fault tree drove investigations that narrowed the focus to a few possible root causes. However, as the investigation progressed, multiple contributors were eventually discovered, some that were not initially considered.

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Case Study—Failure Analysis of a Multiplexer

ISTFA 2016: Conference Proceedings from the 42nd International Symposium for Testing and Failure Analysis ◽

10.31399/asm.cp.istfa2016p0243 ◽

2016 ◽

Author(s):

Michael Woo ◽

Marcos Campos ◽

Luigi Aranda

Keyword(s):

Failure Analysis ◽

High Reliability ◽

Component Failure ◽

Root Cause ◽

Knowing That ◽

Cause Of Failure ◽

The Cost

Abstract A component failure has the potential to significantly impact the cost, manufacturing schedule, and/or the perceived reliability of a system, especially if the root cause of the failure is not known. A failure analysis is often key to mitigating the effects of a componentlevel failure to a customer or a system; minimizing schedule slips, minimizing related accrued costs to the customer, and allowing for the completion of the system with confidence that the reliability of the product had not been compromised. This case study will show how a detailed and systemic failure analysis was able to determine the exact cause of failure of a multiplexer in a high-reliability system, which allowed the manufacturer to confidently proceed with production knowing that the failure was not a systemic issue, but rather that it was a random “one time” event.

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Troubleshooting Cable Deployed Thru Tubing Electrical Submersible Pumps: A Case Study from South East Asia

10.2118/205614-ms ◽

2021 ◽

Author(s):

Saurabh Anand ◽

Eadie Azahar B Rosland ◽

Elsayed Ouda Ghonim ◽

Latief Riyanto ◽

Khairul Azhar B Abu Bakar ◽

...

Keyword(s):

Low Cost ◽

Power Cable ◽

Related Data ◽

Root Cause ◽

Artificial Lift ◽

Electrical Submersible Pumps ◽

Cause Of Failure ◽

Water Cut ◽

Discharge Pressure

Abstract PETRONAS had embarked on an ambitious thru tubing ESP journey in 2016 and had installed global first truly rig less offshore Thru Tubing ESP (TTESP) in 2017. To replicate the success of the first installation, TTESP's were installed in Field – T. However, all these three TTESP's failed to produce fluids to surface. This paper provides the complete details of the troubleshooting exercise that was done to find the cause of failure in these wells. The 3 TTESP's in Field – T were installed as per procedure and was ready to be commissioned. However, during the commissioning, it was noticed that the discharge pressure of the ESP did not build-up and the TTESP's tripped due to high temperature after 15 – 30 mins of operation. Hence none of the 3 TTESP's could be successfully commissioned. Considering the strategic importance of TTESP's in PETRONAS's artificial lift plans, detailed troubleshooting exercise was done to find the root cause of failure to produce in these three wells. This troubleshooting exercise included diesel bull heading which gave some key pump performance related data. The three TTESP's installed in Field – T were of size 2.72" and had the potential to produce an average 1500 BLPD at 80% water cut. The TTESP deployment was fully rigless and was installed using 0.8" ESP power cable. The ESP and the cable was hung-off from the surface using a hanger – spool system. The entire system is complex, and the installation procedure needs to be proper to ensure a successful installation. The vast amount of data gathered during the commissioning and troubleshooting exercise was used for determining the failure reason and included preparation of static and dynamic well ESP model. After detailed technical investigative work, the team believes to have found the root cause of the issue which explains the data obtained during commission and troubleshooting phase. The detailed troubleshooting workflow and actual data obtained will be presented in this paper. A comprehensive list of lessons learnt will also be presented which includes very important aspects that needs to be considered during the design and installation of TTESP. The remedial plan is finalized and will be executed during next available weather window. The key benefit of a TTESP installation is its low cost which is 20% – 30% of a rig-based ESP workover in offshore. Hence it is expected that TTESP installations will pick-up globally and it's important for any operator to fully understand the TTESP systems and the potential pain points. PETRONAS has been a pioneer in TTESP field, and this paper will provide details on the learning curve during the TTESP journey.

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Observational Study of Medication Error in Outpatient Pharmacy RSUP Dr. Hasan Sadikin Bandung

JURNAL ILMU KEFARMASIAN INDONESIA ◽

10.35814/jifi.v15i2.522 ◽

2017 ◽

Vol 15 (2) ◽

pp. 210

Author(s):

Viki Hestiarini ◽

Lia Amalia ◽

Eni Margayani

Keyword(s):

Medication Error ◽

Medication Errors ◽

Drug Information ◽

Data Entry ◽

Care Process ◽

Analysis Method ◽

Risk Priority Number ◽

Effect Analysis ◽

Root Cause ◽

Cause Of Failure

Medication error can occur at all stages, starting from prescribing, dispensing and administration of drugs. This study aims to assess the medication errors that occur in the pharmaceutical care process and analyze the cause of failure using the root cause analysis method, to improvement action and decrease the incidence of medication errors. The data were completeness prescription, frequency of dispensing error and completeness of drug information. The number of sample was 1100 prescriptions Prescribing errors were found the potential injury 15.69±11.51% and near missed error 0.5±0.55%. At dispensing stage, occur 427 incidences (9.71%), consist of two incidences (0.04%) for validation assessment regulations, 224 incidences (5.09%) of data entry, 113 incidences (2.57%) of retrieval of drugs, 19 incidences (0.43%) of fi ll in drugs, 69 incidences (1.57%) of fi nal check. At dispensing stage, near missed 330 incidences (7.51%) of near missed and 97 incidences (2.21%) of potential injury. Failure mode and effect analysis calculate of risk priority number, the drug retrieval (RPN 210) and data entry (RPN 126) were analyzed root cause of the analysis for man, material, method, facility and environment.

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