Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

<p>Abstract</p> <p>Background</p> <p>The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.</p> <p>Methods</p> <p>167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.</p> <p>Results</p> <p>We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.</p> <p>Conclusion</p> <p>The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.</p

Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice : the VELO study

Background: The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs. Methods: 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression. Results: We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression. Conclusion: The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed

Energy Loss, Range, and Electron Yield Comparisons of the CRANGE Ion-Material Interaction Code

We present comparisons of the CRANGE code to other well-known codes, SRIM and ASTAR, and to experimental results for ion-material interactions such as energy loss per unit length, ion range, and ion induced electron yield. These ion-material interaction simulations are relevant to the electron cloud effect in heavy ions accelerators for fusion energy and high energy density physics. Presently, the CRANGE algorithms are most accurate at energies above 1.0 MeV/amu. For calculations of energy loss per unit length of a potassium ion in stainless steel, results of CRANGE and SRIM agree to within ten percent above 1.0 MeV/amu. For calculations of the range of a helium ion in aluminum, results of CRANGE and ASTAR agree to within two percent above 1.0 MeV/amu. Finally, for calculations of ion induced electron yield for hydrogen ions striking gold, results of CRANGE agree to within ten percent with measured electron yields above 1.0 MeV/amu

Electron Cloud Effects in Intense, Ion Beam Linacs: Theory and Experimental Planning for Heavy-Ion Fusion

Heavy-ion accelerators for HIF will operate at high aperture-fill factors with high beam current and long pulses. This will lead to beam ions impacting walls: liberating gas molecules and secondary electrons. Without special preparation a large fractional electron population ({approx}&gt;1%) is predicted in the High-Current Experiment (HCX), but wall conditioning and other mitigation techniques should result in substantial reduction. Theory and particle-in-cell simulations suggest that electrons, from ionization of residual and desorbed gas and secondary electrons from vacuum walls, will be radially trapped in the {approx}4 kV ion beam potential. Trapped electrons can modify the beam space charge, vacuum pressure, ion transport dynamics, and halo generation, and can potentially cause ion-electron instabilities. Within quadrupole (and dipole) magnets, the longitudinal electron flow is limited to drift velocities (E x B and {del}B) and the electron density can vary azimuthally, radially, and longitudinally. These variations can cause centroid misalignment, emittance growth and halo growth. Diagnostics are being developed to measure the energy and flux of electrons and gas evolved from walls, and the net charge and gas density within magnetic quadrupoles, as well as the their effect on the ion beam

Heavy-Ion-Induced Electronic Desorption of Gas from Metals

During heavy-ion operation in several particle accelerators worldwide, dynamic pressure rises of orders of magnitude were triggered by lost beam ions that bombarded the vacuum chamber walls. This ion-induced molecular desorption, observed at CERN, GSI, and BNL, can seriously limit the ion beam lifetime and intensity of the accelerator. From dedicated test stand experiments we have discovered that heavy-ion-induced gas desorption scales with the electronic energy loss (dEe/dx) of the ions slowing down in matter; but it varies only little with the ion impact angle, unlike electronic sputtering

New experimental measurements of electron clouds in ion beams with large tune depression

We study electron clouds in high perveance beams (K = 8E-4) with a large tune depression of 0.2 (defined as the ratio of a single particle oscillation response to the applied focusing fields, with and without space charge). These 1 MeV, 180 mA, K+ beams have a beam potential of +2 kV when electron clouds are minimized. Simulation results are discussed in a companion paper [J-L. Vay, this Conference]. We have developed the first diagnostics that quantitatively measure the accumulation of electrons in a beam [1]. This, together with measurements of electron sources, will enable the electron particle balance to be measured, and electron-trapping efficiencies determined. We, along with colleagues from GSI and CERN, have also measured the scaling of gas desorption with beam energy and dE/dx [2]. Experiments where the heavy-ion beam is transported with solenoid magnetic fields, rather than with quadrupole magnetic or electrostatic fields, are being initiated. We will discuss initial results from experiments using electrode sets (in the middle and at the ends of magnets) to either expel or to trap electrons within the magnets. We observe electron oscillations in the last quadrupole magnet when we flood the beam with electrons from an end wall. These oscillations, of order 10 MHz, are observed to grow from the center of the magnet while drifting upstream against the beam, in good agreement with simulations

Electronic Desorption of gas from metals

During heavy ion operation in several particle accelerators world-wide, dynamic pressure rises of orders of magnitude were triggered by lost beam ions that bombarded the vacuum chamber walls. This ion-induced molecular desorption, observed at CERN, GSI, and BNL, can seriously limit the ion beam lifetime and intensity of the accelerator. From dedicated test stand experiments we have discovered that heavy-ion induced gas desorption scales with the electronic energy loss (dE{sub e}/dx) of the ions slowing down in matter; but it varies only little with the ion impact angle, unlike electronic sputtering

Simulating Electron Effects in Heavy-Ion Accelerators with Solenoid Focusing

Contamination from electrons is a concern for solenoid-focused ion accelerators being developed for experiments in high-energy-density physics. These electrons, produced directly by beam ions hitting lattice elements or indirectly by ionization of desorbed neutral gas, can potentially alter the beam dynamics, leading to a time-varying focal spot, increased emittance, halo, and possibly electron-ion instabilities. The electrostatic particle-in-cell code WARP is used to simulate electron-cloud studies on the solenoid-transport experiment (STX) at Lawrence Berkeley National Laboratory. We present self-consistent simulations of several STX configurations and compare the results with experimental data in order to calibrate physics parameters in the model

Self-Consistent Simulations of Heavy-Ion Beams Interacting with Electron-Clouds

Electron-clouds and rising desorbed gas pressure limit the performance of many existing accelerators and, potentially, that of future accelerators including heavy-ion warm-dense matter and fusion drivers. For the latter, self-consistent simulation of the interaction of the heavy-ion beam(s) with the electron-cloud is necessary. To this end, we have merged the two codes WARP (HIF accelerator code) and POSINST (high-energy e-cloud build-up code), and added modules for neutral gas molecule generation, gas ionization, and electron tracking algorithms in magnetic fields with large time steps. The new tool is being benchmarked against the High-Current Experiment (HCX) and good agreement has been achieved. The simulations have also aided diagnostic interpretation and have identified unanticipated physical processes. We present the ''roadmap'' describing the different modules and their interconnections, along with detailed comparisons with HCX experimental results, as well as a preliminary application to the modeling of electron clouds in the Large Hadron Collider