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

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

The colour and stereo surface imaging system (CaSSIS) for the ExoMars Trace Gas Orbiter

The Colour and Stereo Surface Imaging System (CaSSIS) is the main imaging system onboard the European Space Agency’s ExoMars Trace Gas Orbiter (TGO) which was launched on 14 March 2016. CaSSIS is intended to acquire moderately high resolution (4.6 m/pixel) targeted images of Mars at a rate of 10–20 images per day from a roughly circular orbit 400 km above the surface. Each image can be acquired in up to four colours and stereo capability is foreseen by the use of a novel rotation mechanism. A typical product from one image acquisition will be a 9.5 km×∼45 km swath in full colour and stereo in one over-flight of the target thereby reducing atmospheric influences inherent in stereo and colour products from previous high resolution imagers. This paper describes the instrument including several novel technical solutions required to achieve the scientific requirements