Synthesis and Characterization of New Ceramic Thermoelectrics Implemented in a Thermoelectric Oxide Module

Novel thermoelectric oxides were developed, produced, and characterized to demonstrate their promising thermoelectric conversion potential in a thermoelectric converter. Four-leg thermoelectric oxide modules were fabricated by combining p- and n-type oxide thermoelements made of pressed polycrystalline GdCo0.95Ni0.05O3 and CaMn0.98Nb0.02O3, respectively. In these modules, the p- and n-type thermoelements were connected electrically in series and thermally in parallel. The materials were joined by electrical contacts consisting of a Ag/CuO composite material. Fairly good thermal contacts were ensured by pressing the thermoelements between alumina substrates. Cross-sections of the alumina/Ag-CuO mixture/thermoelement interface were investigated by scanning electron microscopy. The temperature distribution across the module was monitored using K-type thermocouples and a micro-infrared (IR) camera. The open-circuit voltage and the load voltages of the module were measured up to a temperature difference of ΔT=500K while keeping the temperature of the cold side at 300K. The output power and internal resistance were calculated. The characteristics of the module evaluated from electrical measurements were compared with respective values of the p- and n-type leg materials. An output power of 0.04W at ΔT=500K led to a power density of ~0.125W/cm3, where the volume of thermoelectric material was determined by a cross-section of 4mm×4mm and a leg length of 5m

Management of pelvic lymphoceles after radical prostatectomy: A multicentre community based study

<p>Abstract</p> <p>Introduction</p> <p>Pelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients.</p> <p>Objectives</p> <p>To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study.</p> <p>Patients and methods: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions.</p> <p>Results</p> <p>Median age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36 ml (range 20-1800 ml). There were more complications for LCs with ≥100 ml volume than those < 100 ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p < 0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm.</p> <p>Conclusions</p> <p>This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.</p

Micro-endoscopy of the human vas deferens: a feasibility study of a novel device in several ex vivo models

The aim of this study was to show limitation as well as potential of micro-endoscopy techniques as an innovative diagnostic and therapeutic approach in andrology. Two kinds of custom-made micro-endoscopes (ME) were tested in ex vivo vas deferens specimen and in post-mortem whole body. The semi-rigid ME included a micro-optic (0.9mm outer diameter [OD], 10.000 pixels, 120 degrees vision angle [VE], 3-20mm field depth [FD]) and an integrated fibre-optic light source. The flexible ME was composed of a micro-optic (OD=0.6mm, 6.000 pixels, 120 degrees VE, 3-20mm FD). The ex vivo study included retrograde investigation of the vas deferens (surgical specimen n=9, radical prostatectomy n=3). The post-mortem investigation (n=4) included the inspection of the vas deferens via both approaches. The results showed that antegrade and retrograde rigid endoscopy of the vas deferens were achieved as a diagnostic tool. The working channel enabled therapeutic use including biopsies or baskets. Using the flexible ME, the orifices of the ejaculatory ducts were identified. In vivo cadaveric retrograde cannulation of the orifices was successful. Post-mortem changes of verumontanum hindered the examinations beyond. Orifices were identified shaded behind a thin transparent membrane. Antegrade vasoscopy using flexible ME was possible up to the internal inguinal ring. Further advancement was impossible because of anatomical angle and lack adequate vision guidance. The vas deferens interior was clearly visible and was documented by pictures and movies. Altogether, the described ME techniques were feasible and effective, offering the potential of innovative diagnostic and therapeutic approaches for use in the genital tract. Several innovative indications could be expected

Impact of the 'Repositioning Test' on Postoperative Outcome of Retroluminar Transobturator Male Sling Implantation

OBJECTIVE: To evaluate prospectively the value of the ‘repositioning test’ (RT) in preoperative patient selection for the efficacy of male stress urinary incontinence (SUI) treatment using a retroluminar transobturator male sling (AdVance sling). PATIENTS AND METHODS: 65 consecutive patients with SUI after radical prostatectomy were included in this singlecenter prospective study. Preoperatively, patients were classified into those with ‘positive’ and ‘negative’ RT. Postoperative results were analyzed and the association between the result of the RT and postoperative outcome was evaluated. RESULTS: 53 patients (81.5%) showed preoperatively a positive RT and 12 patients (18.5%) a negative RT. After a followup of 12 months, patients with positive RT showed a cure rate (0 pads/day) of 83% and patients with a negative RT showed only a cure rate of 25%. A positive RT significantly correlated with cure in outcome (p < 0.001). CONCLUSIONS: Patients with positive RT have a significantly better hance for successful AdVance sling implantation. The RT is minimally invasive, easy to learn and easy to perform. Therefore, the RT is a very useful tool for preoperative patient selection

Does it Really Make a Difference? Health Care Utilization with Two High Deductible Health Care Plans

Deductibles are commonly used to tame increasing health care costs. Numerous studies find that higher deductibles reduce health care utilization. In this paper we compare utilization in Switzerland between two health care plans with deductibles of 1,500 CHF and 2,500 CHF (1CHF = 1$) per calendar year. While there is a minimum deductible level in Switzerland, individuals are free to increase their deductible and thereby reduce their insurance premium. In order to distinguish between selection and moral hazard we use regional variation in premiums as an instrument. Moreover, we take advantage of a policy change in 2005 that introduced the higher deductible for the first time. The results show that selection leads to considerable differences in utilization between the two groups, while we find no behavioral differences across both groups. If anything health care expenditures are higher for male individuals with the higher deductible, while for females there are no differences between the two deductible levels

Auswirkungen eines Hochrisikopools auf die Risikoselektion im Schweizer Krankenversicherungs-Wettbewerb: Eine empirische Klärung

In der Volksabstimmung vom 11. März 2007 unterstützte eine grosse Mehrheit der Schweizer Stimmberechtigten einmal mehr den Wettbewerb in der sozialen Krankenversicherung. Die Diskussionen im Vorfeld des Urnengangs zeigten aber ebenso deutlich, dass die Risikoselektion auf wenig Verständnis stösst. Besonders stark wird – inzwischen auch von einer Mehrheit der Krankenversicherer selbst - das Aushöhlen der Einheitsprämie durch billige Tochterkassen kritisiert. Die wissenschaftliche Diskussion des letzten Jahrzehnts unterstreicht, dass der Anreiz zur Risikoselektion systembedingt ist. Solange die Einheitsprämie mit einer allzu groben Berechnung des Risikoausgleichs kombiniert wird, stellt die Risikoselektion die optimale Marktstrategie dar. Im Wettbewerb, wo jeder Versicherer gezwungen ist, seinen Kunden möglichst günstige Prämien zu offerieren, wächst daher der Druck, zum Mittel der Selektion zu greifen, auch wenn der Mehrheit der Versicherer bewusst ist, dass Risikoselektion in einer obligatorischen Sozialversicherung eine Verschwendung volkswirtschaftlicher Ressourcen darstellt. Zur Behebung des Problems haben die Schweizer Gesundheitsökonomen grundsätzlich zwei wissenschaftlich unbestrittene Lösungsvorschläge eingebracht: Der Wechsel von der Einheitsprämie zu risikogerechten Prämien oder eine morbiditätsorientierte Berechnung des Risikoausgleichs. Der erste Vorschlag fand in der Politik keinen Widerhall, während der zweite Vorschlag in den Revisionsvorschlag des Ständerats vom 8. März 2006 aufgenommen wurde. Nach Ansicht des Ständerats soll die Risikoausgleichsberechnung um das Kriterium „Spitalaufenthalt im Vorjahr“ ergänzt werden. In jüngster Zeit brachte Bundesrat Couchepin als Alternative zur Ständeratsposition die Idee eines Hochrisikopools in die Diskussion ein. In diesem Pool sollten die teuersten Versicherten zusammengefasst und in Rahmen eines staatlichen Disease Management-Programms betreut werden. Die vorliegende Arbeit untersucht, gestützt auf die Angaben von 180'000 Versicherten während eines Zeitraums von 8 Jahren, wie sich der Hochrisikopool auf den Anreiz zur Risikoselektion auswirkt. Der Befund ist eindeutig. Da nur wenige Versicherte für einen Hochrisikopool in Frage kommen, reduziert er die Prämienvorteile der Risikoselektion kaum und Risikoselektion bleibt für den einzelnen Versicherer die erfolgreichste Strategie. Zudem werden durch staatliche Disease-Management Programme die Möglichkeiten privatwirtschaftlicher Innovationen sowie die Wahlfreiheit gewisser Patienten eingeschränkt, was dem aktuell geäusserten Willen der stimmenden Bevölkerung nicht entspricht. Durch den ständerätlichen Revisionsvorschlag hingegen werden die Anreize zur Selektion signifikant reduziert, die Auswirkung der Selektion auf die Prämienvorteile abgedämpft und das (vom Gesetzgeber gewünschte) Kostensparen durch Managed Care zur gewinnbringenden Strategie im Markt gemacht. Die vorliegenden Resultate werden von der vergleichbaren Literatur gut gestützt. Sowohl betreffend der Effektivität des Ständeratsvorschlags als auch der relativen Wirkungslosigkeit des Hochrisikopools, gibt es unter den zahlreichen empirischen Analysen keine, die einen widersprechenden Befund liefern würde