The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments.

To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma. Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire. Inpatients orthopaedic rehabilitation with vocational aspects. In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper (n = 55), lower-limb (n = 51) or spine (n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25). Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables. High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; exp <sup>ß</sup> = 1.02) and social costs (ß = 0.03; P = 0.006, exp <sup>ß</sup> = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, exp <sup>ß</sup> = 1.04). Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs

Psychiatric Comorbidity and Complex Regional Pain Syndrome Through the Lens of the Biopsychosocial Model: A Comparative Study.

To compare the prevalence of psychiatric comorbidity between patients with complex regional pain syndrome (CRPS) of the hand and non-CRPS patients and to assess the association between biopsychosocial (BPS) complexity profiles and psychiatric comorbidity in a comparative study. We included a total of 103 patients with CRPS of the hand and 290 patients with chronic hand impairments but without CRPS. Psychiatric comorbidities were diagnosed by a psychiatrist, and BPS complexity was measured by means of the INTERMED. The odds ratios (OR) of having psychiatric comorbidities according to BPS complexity were calculated with multiple logistic regression (adjusted for age, sex, and pain). Prevalence of psychiatric comorbidity was 29% in CRPS patients, which was not significantly higher than in non-CRPS patients (21%, relative risk=1.38, 95% CI: 0.95 to 2.01 p=0.10). The median total scores of the INTERMED were the same in both groups (23 points). INTERMED total scores (0-60 points) were related to an increased risk of having psychiatric comorbidity in CRPS patients (OR=1.46; 95% CI: 1.23-1.73) and in non-CRPS patients (OR=1.21; 95% CI: 1.13-1.30). The four INTERMED subscales (biological, psychological, social, and health care) were correlated with a higher risk of having psychiatric comorbidity in both groups. The differences in the OR of having psychiatric comorbidity in relation to INTERMED total and subscale scores were not statistically different between the two groups. The total scores, as well as all four dimensions of BPS complexity measured by the INTERMED, were associated with psychiatric comorbidity, with comparable magnitudes of association between the CRPS and non-CRPS groups. The INTERMED was useful in screening for psychological vulnerability in the two groups

BMI Course Over 10 Years After Bariatric Surgery and Biopsychosocial Complexity Assessed with the INTERMED: a Retrospective Study.

While bariatric surgery is an effective therapy for patients with severe obesity, not all patients benefit equally. An explanation might be that psychosocial risk factors hamper outcome. The study aimed to evaluate if biopsychosocial case complexity predicts evolution of BMI over 10 years after bariatric surgery. Charts of patients (N = 236) of the Cohort of Obesity Lausanne (COOL) were retrospectively reviewed and rated with the INTERMED, a reliable and validated instrument, which assesses biopsychosocial case complexity and has been proven to predict outcome of medical treatments in different patient populations. The sample was stratified into BMI quartiles, computed from the patients' baseline BMI. For each quartile, BMI evolution was analyzed using individual growth curve analysis. Growth curve analyses showed that in quartiles 1, 2, and 3, none of the INTERMED domain scores significantly predicted the BMI evolution after surgery. However, in the fourth quartile-including patients with the highest pre-surgical BMI-the social domain score of the INTERMED significantly predicted BMI evolution: patients with more social complexity showed higher increase in BMI. Effectiveness of interventions targeted at social complexity, especially when patients suffer from severe obesity, may therefore be evaluated in future studies

Test and simulation results of LIVE-L4 + LIVE-L5L. (KIT Scientific Reports ; 7593)

The objective of the LIVE program is to study the core melt phenomena during the late phase of core melt progression in the RPV both experimentally in large-scale 3D geometry and with CFD simulation. LIVE-L4 and LIVE-L5L experiments investigate the transient and steady state behaviors of the molten pool and the crust at the melt/vessel wall interface influenced by the several melt relocation numbers and different heat generation rate during external cooling. The melt pool behaviour and crust thickness in L4 test are calculated by CONV-code

Results of the LIVE-L3A Experiment. (KIT Scientific Reports ; 7542)

The sequence of a postulated core melt down accident in the reactor pressure vessel (RPV) of a pressurised water reactor (PWR) involves a large number of complex physical and chemical phenomena. The main objective of the LIVE program is to study the core melt phe-nomena during the late phase of core melt progression in the RPV both experimentally in large-scale 3D geometry in supporting separate-effects tests and analytically using CFD codes in order to provide a reasonable estimate of the remaining uncertainty band under the aspect of safety assessment. The main objective of the LIVE-L3A experiment was to investigate the behaviour of the mol-ten pool and the formation of the crust at the melt/vessel wall interface influenced by the melt relocation position and initial cooling conditions. The test conditions in the LIVE- L3A test were similar to the LIVE-L3 test except the initial cooling conditions. In both tests the melt was poured near to the vessel wall. In the LIVE-L3 test the vessel was initially cooled by air and then by water; in the LIVE-L3A test the vessel was cooled by water already at the start of the experiment. The information obtained in the test includes horizontal and vertical heat flux distribution through the RPV wall, crust growth velocity and dependence of the crust properties on the crust growth velocity and cooling conditions. Supporting post-test analysis contributes to the characterization of solidification processes of binary non-eutectic melts. The results of the LIVE-L3 and LIVE-L3A tests are compared in order to characterize the impact of transient cooling condition on the crust solidification characteristics and melt pool behaviour including interface temperature, time to reach thermal hydraulic steady-state and the steady-state heat flux distribution. The report summarizes the objectives of the LIVE program and presents the main results obtained in the LIVE-L3A test compared to the LIVE-L3 test