Fiber-Reinforced Equibiaxial Dielectric Elastomer Actuator for Out-of-Plane Displacement.

Dielectric elastomer actuators (DEAs) have gained significant attention due to their potential in soft robotics and adaptive structures. However, their performance is often limited by their in-plane strain distribution and limited mechanical stability. We introduce a novel design utilizing fiber reinforcement to address these challenges. The fiber reinforcement provides enhanced mechanical integrity and improved strain distribution, enabling efficient energy conversion and out-of-plane displacement. We discuss an analytical model and the fabrication process, including material selection, to realize fiber-reinforced DEAs. Numerical simulations and experimental results demonstrate the performance of the fiber-reinforced equibiaxial DEAs and characterize their displacement and force capabilities. Actuators with four and eight fibers are fabricated with 100 µm and 200 µm dielectric thicknesses. A maximal out-of-plane displacement of 500 µm is reached, with a force of 0.18 N, showing promise for the development of haptic devices.

A new case-mix based payment system for the psychiatric day care sector in Switzerland: proposed methods for developing the tariff structure.

In many European countries, there has been a shift towards outpatient psychiatric care over the past decades, as it is more cost-effective and resources for health care are limited. Switzerland, however, still has a high number of inpatient psychiatric hospital beds and a comparatively high length of stay. The existence of differing remuneration systems between inpatient and outpatient settings creates a distortion of incentives regarding the choice of treatment setting and an inefficient allocation of resources. To address this issue, a new tariff structure for day care treatment is suggested, based on the development and evaluation of the DRG-based inpatient remuneration system tariff psychiatry (TARPSY), using inpatient data from 2018, 2019, and 2021. The method involves three steps: estimating the day care treatment setting potential by delimiting cases from the inpatient patient data, adjusting the costs of this subset to approximate a day care treatment setting, and calculating daily cost weights based on the existing cost weights. The resulting reimbursements are about half of the inpatient reimbursements. To implement the tariff structure, this paper suggests that a number of framework conditions and regulations must be defined or modified. Additionally, subsequent cost data surveys from the day care setting can be incorporated into the calculation as part of a learning system. The remuneration system outlined in this paper could potentially be applied for day care psychiatry in other countries with DRG systems, especially in countries with conflicting remuneration systems in the inpatient and out patient sector.

TARPSY: A New System of Remuneration for Psychiatric Hospitalization in Switzerland.

As financing mental health care is becoming more challenging, governments are progressively introducing new remuneration systems. At the beginning of 2018, Switzerland introduced TARPSY, a new tariff system based on diagnosis-related psychiatric cost groups that takes into consideration ratings of severity and complexity. TARPSY is expected to provide incentives for medically and economically meaningful treatment, increase transparency, and improve the quality of the provided services by triggering competition between hospitals. Yet some fear that TARPSY will lead to an economization of mental health, encouraging a reduction in length of stay and medically indicated treatment.

Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges.

In 2012, Kazakhstan introduced Diagnosis-Related Groups (DRGs), as part of a package of reforms which sought to contain costs and to improve efficiency and transparency in the health system; but the main challenge was to design and implement a DRG system in just one year. In 2011-2012, Kazakhstan developed its own DRG system. Initially 180 DRGs were defined to group inpatient cases but this number was subsequently expanded to more than 400. Because of time limits, the cost weights had to be derived in the absence of existing standard hospital cost accounting systems, and a national patient data transfer system also needed developing. Most importantly, huge efforts were needed to develop a regulatory framework and build up DRG capabilities at a national level. The implementation of DRGs was facilitated by strong political will for their introduction as part of a coherent package of health reforms, and consolidated efforts to build capacity. DRGs are now the key payment mechanism for hospitals. However the reforms are not fully institutionalized: the DRG structure is continuously being refined in a context of data limitations, and the revision of cost weights is most affected by insufficient data and the lack of standardized reporting mechanisms. Capacity around DRG coding is also still being developed. Countries planning to introduce DRG systems should be aware of the challenges in moving too quickly to implement DRGs as the main hospital reimbursement mechanism.

Advanced Information Retrieval Using XML Standards.

The bulk of clinical data is available in an electronic form. About 80% of the electronic data, however, is narrative text and therefore limited with respect to machine interpretation. As a result, the discussion has shifted from "electronic versus paper based data" towards "structured versus unstructured electronic data". The XML technology of today paves a way towards more structured clinical data and several XML based standards such as the Clinical Document Architecture (CDA) emerge. The implementation of XML based applications is yet a challenge. This paper will focus on XML retrieval issues and describe the difficulties and prospects of such an approach. The result of our work is a search technique called "topic matching" that exploits structured data in order to provide a search quality that is superior to established text matching methods. With this solution we are able to utilize large numbers of heterogeneously structured documents with only a minimum of effort.

Accurate searching using XML and topic maps.

Most clinical data is narrative text and often not accessible and searchable at the clinical workstation. We have therefore developed a search engine that allows indexing, searching and linking different kinds of data using web technologies. Text matching methods fail to represent implicit relationships between data, e.g. the relationship between HIV and AIDS. The ISO topic maps standard provides a data model that allows representing arbitrary relationships between resources. Such relationships form the basis for context sensitive searching and accurate search results. XML standards are used for the interchange of data relationships. Our approach has been applied to medical classification systems and clinical practice guidelines with promising results.

Supporting clinical practice guidelines: lifecycle of guidelines for oncology within an XML-based guideline framework.

Clinical Practice Guidelines (CPGs) have become important instruments for supporting patient care. Many structure models for CPGs have been developed to explicitly gain structured CPG documents, some of them using XML. Often, however, problems arise in filling these structures with content and integrating CPG applications into an EPR/HIS The Universities of Giessen and Heidelberg have each presented an XML-based CPG structure, which are actually being merged into one. The obtained CPG structure will build our common "xCPG core model" embedded in an "XML framework", an authoring environment. This paper shows how this model used in the framework could support the entire 5-step CPG lifecycle, spanning CPG development, the integration of a CPG into an EPR/HIS, as well as maintenance. Furthermore, this paper points out how the method draws on the different information management services as a precondition for successful CPG implementation.