Vertical axis non-linearities in wavelength scanning interferometry

The uncertainty of measurements made on an areal surface topography instrument is directly influenced by its metrological characteristics. In this work, the vertical axis deviation from linearity of a wavelength scanning interferometer is evaluated. The vertical axis non-linearities are caused by the spectral leakage resulting from the Fourier transform algorithm for phase slope estimation. These non-linearities are simulated and the results are compared with experimental measurements. In order to reduce the observed non-linearities, a modification of the algorithm is proposed. The application of a Hamming window and the exclusion of edge points in the extracted phase are shown to increase the accuracy over the whole instrument range

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

BACKGROUND: We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients' emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. METHODS/DESIGN: We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient's allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient's satisfaction will also be collected at the baseline and 12 months later. DISCUSSION: Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01934322

The determinants of individual health care expenditures in prison: evidence from Switzerland.

Prison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland. We use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures. We find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs. By identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison

Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland.

Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population

Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry

The study was funded in part by EU Grant 005-GW02-067D (H.M. and O.B.) and the Swiss Heart Foundation (J.S.)

Using case management in a universal health coverage system to improve quality of life of frequent Emergency Department users: a randomized controlled trial

Frequent Emergency Department users are likely to experience poor quality of life (QOL). Case management interventions are efficient in responding to the complex needs of this population, but their effects on QOL have not been tested yet. Therefore, the aim of our study was to examine to what extent a case management intervention improved frequent Emergency Department users' QOL in a universal health coverage system. Data were part of a randomized controlled trial designed to improve frequent Emergency Department users' QOL at the Lausanne University Hospital, Switzerland. A total of 250 frequent Emergency Department users (≥ 5 attendances during the previous 12 months) were randomly assigned to the control (n = 125) or the intervention group (n = 125). The latter benefited from case management intervention. QOL was evaluated using the WHOQOL-BREF at baseline, two, five and a half, nine, and twelve months later. It included four dimensions: physical health, psychological health, social relationship, and environment. Linear mixed-effects models were used to analyze the change in the patients' QOL over time. Patients' QOL improved significantly (p < 0.001) in both groups for all dimensions after two months. However, environment QOL dimension improved significantly more in the intervention group after 12 months. Environment QOL dimension was the most responsive dimension for short-term interventions. This may have been due to case management's assistance in obtaining income entitlements, health insurance coverage, stable housing, or finding general health care practitioners. Case management in general should be developed to enhance frequent users' QOL. http://www.clinicaltrials.gov , Unique identifier: NCT01934322

Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease

The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary heart disease (CHD) in patients with stable angina symptoms in Switzerland. Methods and results A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective. We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular (CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR

Plutonium and surrogate fission products in a composite ceramic waste form.

Argonne National Laboratory is developing a ceramic waste form to immobilize salt containing fission products and transuranic elements. Preliminary results have been presented for ceramic waste forms containing surrogate fission products such as cesium and the lanthanides. In this work results from scanning electron microscopy/energy dispersive spectroscopy and x-ray diffraction are presented in greater detail for ceramic waste forms containing surrogate fission products. Additionally, results for waste forms containing plutonium and surrogate fission products are presented. Most of the surrogate fission products appear to be silicates or aluminosilicates whereas the plutonium is usually found in an oxide form. There is also evidence for the presence of plutonium within the sodalite phase although the chemical speciation of the plutonium is not known

Accelerated alpha radiation damage in a ceramic waste form, interim results

Interim results are presented on the alpha-decay damage study of a {sup 238}Pu-loaded ceramic waste form (CWF). The waste form was developed to immobilize fission products and transuranic species accumulated from the electrometallurgical treatment of spent nuclear fuel. To evaluate the effects of {alpha}-decay damage on the waste form the {sup 238}Pu-loaded material was analyzed by (1) x-ray diffraction (XRD), (2) microstructure characterization by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) with energy and wavelength dispersive spectroscopy (EDS/WDS) and electron diffraction, (3) bulk density measurements and (4) waste form durability, performed by the product consistency test (PCT). While the predominate phase of plutonium in the CWF, PuO{sub 2}, shows the expected unit cell expansion due to {alpha}-decay damage, currently no significant change has occurred to the macro- or microstructure of the material. The major phase of the waste form is sodalite and contains very little Pu, although the exact amount is unknown. Interestingly, measurement of the sodalite phase unit cell is also showing very slight expansion; again, presumably from {alpha}-decay damage

Accelerated Alpha Radiation Damage in a Ceramic Waste Form, Interim Results

Interim results are presented on the alpha-decay damage study of a {sup 238}Pu-loaded ceramic waste form (CWF). The waste form was developed to immobilize fission products and transuranic species accumulated from the electrometallurgical treatment of spent nuclear fuel. To evaluate the effects of {alpha}-decay damage on the waste form the {sup 238}Pu-loaded material was analyzed by (1) x-ray diffraction (XRD), (2) microstructure characterization by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) with energy and wavelength dispersive spectroscopy (EDS/WDS) and electron diffraction, (3) bulk density measurements and (4) waste form durability, performed by the product consistency test (PCT). While the predominate phase of plutonium in the CWF, PuO{sub 2}, shows the expected unit cell expansion due to {alpha}-decay damage, currently no significant change has occurred to the macro- or microstructure of the material. The major phase of the waste form is sodalite and contains very little Pu, although the exact amount is unknown. Interestingly, measurement of the sodalite phase unit cell is also showing very slight expansion; again, presumably from {alpha}-decay damage