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Renggli L, Plüss-Suard C, Gasser M, Sonderegger B, Kronenberg A. Assessing the conversion of electronic medical record data into antibiotic stewardship indicators. J Antimicrob Chemother 2023; 78:2297-2305. [PMID: 37527399 PMCID: PMC10477111 DOI: 10.1093/jac/dkad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Measuring the appropriateness of antibiotic use is crucial for antibiotic stewardship (ABS) programmes to identify targets for interventions. OBJECTIVES To assess the technical feasibility of converting electronic medical record (EMR) data into ABS indicators. METHODS In this observational feasibility study covering a period of 2 years, the EMRs of patients hospitalized at a large non-university hospital network and receiving at least one dose of a systemic antibiotic were included. ABS indicators measuring steps in the process of antibiotic prescription proposed by the literature were collected and rephrased or defined more specifically to be calculable if needed. Algorithms were programmed in R to convert EMR data into ABS indicators. The indicators were visualized in an interactive dashboard and the plausibility of each output value was assessed. RESULTS In total, data from 25 337 hospitalizations from 20 723 individual patients were analysed and visualized in an interactive dashboard. Algorithms could be programmed to compute 89% (25/28) of all pre-selected indicators assessing treatment decisions automatically out of EMR data, with good data quality for 46% (13/28) of these indicators. According to the data quality observed, the most important issues were (i) missing or meaningless information on indication (e.g. 'mild infection') and (ii) data processing issues such as insufficiently categorized metadata. CONCLUSIONS The calculation of indicators assessing treatment decisions from EMRs was feasible. However, better data structure and processing within EMR systems are crucial for improving the validity of the results.
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Affiliation(s)
- L Renggli
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - C Plüss-Suard
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - M Gasser
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - B Sonderegger
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - A Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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2
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Fechner C, Strobel K, Treumann T, Sonderegger B, Azzola A, Fornaro J, Schrading S, Roos JE. COVID-19 and the role of imaging: early experiences in Central Switzerland. Swiss Med Wkly 2020; 150:w20304. [PMID: 32580213 DOI: 10.4414/smw.2020.20304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The SARS-CoV-2 virus (COVID-19) was initially observed in a group of Chinese patients with unclear pneumonia in Wuhan, Hubei [1] in late December 2019. The first positive case in Switzerland was confirmed on 25 February 2020 in a patient from canton Tessin, who most likely caught the virus during a visit to Milan, Italy [2]. The country has since been preparing for an imminent public health emergency caused by the pandemic. As of 14 May 2020, the Swiss healthcare system is facing a total of 30,463 corona virus-positive people [3]. With numbers of new infections decreasing after the first pandemic wave, the continuing endemic situation will continue to be a major challenge for the Swiss healthcare system. It remains crucial to separate the clinically low-symptomatic from the severely affected patients in order to offer a specific therapeutic strategy to every SARS-CoV-2 patient. Reports from Chinese cohorts describe an increasing role of imaging strategies in the detection and surveillance of COVID-19 patients because of insufficient testing sensitivity of real-time reverse transcription polymerase chain reaction (RT-PCR) tests [4]. Chest computed tomography (CT), with a reported sensitivity of up to 97% [5, 6], gained importance particularly in patients with false negative RT-PCR results. In this short communication, we describe our first clinical experiences with 55 COVID-19 patients in Central Switzerland, who were either imaged with a standard chest x-ray, chest CT, or both. We provide an illustrative and schematic description of typical COVID-19 imaging features and suggest that imaging plays an important role in the clinical work-up of suspected or confirmed COVID-19 patients. This study was approved by the national ethics review committee (EKNZ, Switzerland) and patients’ informed consent was waived.
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Affiliation(s)
- Carsten Fechner
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Klaus Strobel
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Thomas Treumann
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Beat Sonderegger
- Institute of Infectious Diseases, Cantonal Hospital Lucerne, Switzerland
| | - Andrea Azzola
- Institute of Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Jürgen Fornaro
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Simone Schrading
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Justus E Roos
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Switzerland
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3
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Veit O, Domingo C, Niedrig M, Staehelin C, Sonderegger B, Héquet D, Stoeckle M, Calmy A, Schiffer V, Bernasconi E, Flury D, Hatz C, Zwahlen M, Furrer H. Long-term Immune Response to Yellow Fever Vaccination in Human Immunodeficiency Virus (HIV)-Infected Individuals Depends on HIV RNA Suppression Status: Implications for Vaccination Schedule. Clin Infect Dis 2019; 66:1099-1108. [PMID: 29140432 DOI: 10.1093/cid/cix960] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background In human immunodeficiency virus (HIV)-infected individuals, the immune response over time to yellow fever vaccination (YFV) and the necessity for booster vaccination are not well understood. Methods We studied 247 participants of the Swiss HIV Cohort Study (SHCS) with a first YFV after HIV diagnosis and determined their immune responses at 1 year, 5 years, and 10 years postvaccination by yellow fever plaque reduction neutralization titers (PRNTs) in stored blood samples. A PRNT of 1:≥10 was regarded as reactive and protective. Predictors of vaccination response were analyzed with Poisson regression. Results At vaccination, 82% of the vaccinees were taking combination antiretroviral therapy (cART), 83% had suppressed HIV RNA levels (<400 copies/mL), and their median CD4 T-cell count was 536 cells/μL. PRNT was reactive in 46% (95% confidence interval [CI], 38%-53%) before, 95% (95% CI, 91%-98%) within 1 year, 86% (95% CI, 79%-92%) at 5 years, and 75% (95% CI, 62%-85%) at 10 years postvaccination. In those with suppressed plasma HIV RNA at YFV, the proportion with reactive PRNTs remained high: 99% (95% CI, 95%-99.8%) within 1 year, 99% (95% CI, 92%-100%) at 5 years, and 100% (95% CI, 86%-100%) at 10 years. Conclusions HIV-infected patients' long-term immune response up to 10 years to YFV is primarily dependent on the control of HIV replication at the time of vaccination. For those on successful cART, immune response up to 10 years is comparable to that of non-HIV-infected adults. We recommend a single YFV booster after 10 years for patients vaccinated on successful cART, whereas those vaccinated with uncontrolled HIV RNA may need an early booster.
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Affiliation(s)
- Olivia Veit
- Department of Infectious Diseases, Bern University Hospital, University of Bern.,Department of Medicine, Swiss Tropical and Public Health Institute.,University of Basel, Switzerland.,Institute of Epidemiology, Biostatistics and Prevention, University of Zürich, Switzerland
| | | | | | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern
| | - Beat Sonderegger
- Department of Infectious Diseases, Bern University Hospital, University of Bern
| | - Delphine Héquet
- Division of Infectious Diseases, University Hospital of Lausanne
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital of Geneva
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital of Lugano
| | - Domenica Flury
- Division of Infectious Diseases, Cantonal Hospital of St Gallen
| | - Christoph Hatz
- Department of Medicine, Swiss Tropical and Public Health Institute.,University of Basel, Switzerland.,Institute of Epidemiology, Biostatistics and Prevention, University of Zürich, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern
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4
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Sendi P, Wustmann K, Büchi AE, Noti F, Klaeser B, Sonderegger B, Auf der Maur C, Mercier T, Schwerzmann M, Ruppen C. Cardiac Implantable Electronic Device-Related Infection Due to Granulicatella adiacens. Open Forum Infect Dis 2019; 6:ofz130. [PMID: 31008142 PMCID: PMC6467393 DOI: 10.1093/ofid/ofz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Cardiac implantable electronic device–related infection is clinically challenging. Curative treatment commonly includes system removal. A case caused by Granulicatella adiacens occurred in a 32-year-old woman. Clinical course, literature review, and biofilm investigations enabled successful antibiotic management without system removal.
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Affiliation(s)
- Parham Sendi
- Institute for Infectious Diseases, University of Bern.,Department of Infectious Diseases, University of Bern
| | - Kerstin Wustmann
- Center for Congenital Heart Disease, Inselspital, University Hospital Bern, University of Bern.,Department of Cardiology, Inselspital, University Hospital Bern, University of Bern
| | - Annina E Büchi
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern
| | - Fabian Noti
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern
| | - Bernd Klaeser
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern
| | - Beat Sonderegger
- Department of Infectious Diseases and Hospital Epidemiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Christoph Auf der Maur
- Paediatric and Adult Cardiology, Kantonsspital Lucerne, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Thomas Mercier
- Service and Laboratory of Clinical Pharmacology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, Inselspital, University Hospital Bern, University of Bern.,Department of Cardiology, Inselspital, University Hospital Bern, University of Bern
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5
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Hench J, Roschanski N, Hewer E, Rösler U, Lass-Flörl C, Stippich C, Tolnay M, Rusche N, Sonderegger B, Sailer M, Lyrer P, Peters N, Frank S. Granulomatous encephalitis: protothecosis excluded? Histopathology 2016; 69:1082-1084. [PMID: 27334617 DOI: 10.1111/his.13020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Juergen Hench
- Division of Neuropathology, Institute for Pathology, Basel University Hospital, Basel, Switzerland
| | - Nicole Roschanski
- Division of Veterinary Medicine, Institute for Animal and Environmental Hygiene, Center for Infection Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ekkehard Hewer
- Institute for Pathology, University of Berne, Berne, Switzerland
| | - Uwe Rösler
- Division of Veterinary Medicine, Institute for Animal and Environmental Hygiene, Center for Infection Medicine, Freie Universität Berlin, Berlin, Germany
| | - Cornelia Lass-Flörl
- Sektion für Hygiene und Medizinische Mikrobiologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Christoph Stippich
- Department of Neuroradiology, Basel University Hospital, Basel, Switzerland
| | - Markus Tolnay
- Division of Neuropathology, Institute for Pathology, Basel University Hospital, Basel, Switzerland
| | - Norman Rusche
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Beat Sonderegger
- Department of Infectiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin Sailer
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Nils Peters
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Stephan Frank
- Division of Neuropathology, Institute for Pathology, Basel University Hospital, Basel, Switzerland
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6
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Berkmann S, Fischer I, Sonderegger B, Fischli S, Fandino J. Sellar Toxoplasmosis and Nonfunctioning Pituitary Adenoma. World Neurosurg 2015; 84:1495.e1-4. [PMID: 26026632 DOI: 10.1016/j.wneu.2015.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/08/2015] [Accepted: 05/09/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sellar toxoplasmosis is associated with congenital infections or immunodeficiency. The finding of Toxoplasma bradycysts in a pituitary adenoma is very unusual. CASE DESCRIPTION An otherwise healthy 27-year-old woman presented with secondary amenorrhea and moderately elevated prolactin levels. A macroprolactinoma was suspected on magnetic resonance imaging, and cabergoline was initiated. Although dopamine levels decreased, the tumor did not show significant shrinkage; after 2 years, transsphenoidal resection was indicated to clarify the diagnosis and to cure hyperprolactinemia. Histology showed an inactive pituitary adenoma and Toxoplasma bradycysts. Seropositivity for Toxoplasma gondii, but neither immunodeficiency nor intracerebral spread, was found. During a postoperative follow-up period of 15 months, the patient did not show any recurrence. CONCLUSIONS Sellar toxoplasmosis in conjunction with pituitary adenoma is extremely rare. Nonfunctioning lesions should be suspected in cases of sellar masses and moderate hyperprolactinemia.
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Affiliation(s)
- Sven Berkmann
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Ingeborg Fischer
- Department of Pathology, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Sonderegger
- Department of Infectious Diseases and Hospital Epidemiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Stefan Fischli
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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7
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Sendi P, Meier R, Sonderegger B, Bonel HM, Schäfer SC, Vögelin E. Reactivated Moraxella osteitis presenting as granulomatous disease. Neth J Med 2014; 72:491-493. [PMID: 25431395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Granulomatous infections are commonly associated with mycobacteria, brucellosis, actinomycosis, nocardiosis, spirochetes, and fungi. Rarely, granuloma formation is a host response to other bacterial infection. Osteomyelitis and osteitis that reactivate many years after the primary episode is a known phenomenon. A reactivation that presents as a granulomatous disease is rare. We present a case of reactivated osteitis due to Moraxella osloensis with consecutive granuloma formation.
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Affiliation(s)
- P Sendi
- Department of Infectious Diseases, University Hospital of Bern and University of Bern, Bern, Switzerland
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8
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Sonderegger B, Hachler H, Dobler G, Frei M. Imported aseptic meningitis due to Toscana virus acquired on the island of Elba, Italy, August 2008. Euro Surveill 2009; 14:19079. [PMID: 19161712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We describe a case of aseptic meningitis due to Toscana Virus imported to Switzerland and discuss the epidemiological situation. To our knowledge this is the first description of this infection acquired on the Island of Elba.
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Affiliation(s)
- B Sonderegger
- Department of Medicine, Hospital of Lucerne, Switzerland.
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9
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Sonderegger B, Hächler H, Dobler G, Frei M. Imported aseptic meningitis due to Toscana virus acquired on the island of Elba, Italy, August 2008. Euro Surveill 2009. [DOI: 10.2807/ese.14.01.19079-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a case of aseptic meningitis due to Toscana Virus imported to Switzerland and discuss the epidemiological situation. To our knowledge this is the first description of this infection acquired on the Island of Elba.
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Affiliation(s)
- B Sonderegger
- Department of Medicine, Hospital of Lucerne, Switzerland
| | - H Hächler
- Institute of Medical Microbiology, Hospital of Lucerne, Switzerland
| | - G Dobler
- Institute of Microbiology of the Bundeswehr, Munich, Germany
| | - M Frei
- Medical Practice for Tropical and Travel Medicine, Lucerne, Switzerland
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10
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Sonderegger B. Modifications of stereological correction methods for precipitate parameters using transmission microscopy. Ultramicroscopy 2006; 106:941-50. [PMID: 16765517 DOI: 10.1016/j.ultramic.2006.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 03/17/2006] [Accepted: 04/07/2006] [Indexed: 12/01/2022]
Abstract
Energy filtered transmission electron microscopy (EFTEM), dark field imaging and light microscopy are well established methods to evaluate size, volume fraction and number density of precipitates on different size scales. The stereological problems are well known and analogous for all methods. Many evaluation methods can be found in literature, each of them valid for special sample geometries or special size distributions. Despite this variety, serious errors can occur if the assumptions do not exactly represent the real situation. In this paper, available and newly developed correction methods are tested for evaluating these parameters for different precipitate size distributions in a sample of arbitrary topography. It is shown that the newly proposed methods produce significantly lower deviations and are more assessable regarding their systematic errors.
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Affiliation(s)
- B Sonderegger
- Institute for Materials Science, Welding and Forming, Graz University of Technology, A-8010 Graz, Austria.
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11
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Resel R, Tamas E, Sonderegger B, Hofbauer P, Keckes J. A heating stage up to 1173 K for X-ray diffraction studies in the whole orientation space. J Appl Crystallogr 2003. [DOI: 10.1107/s0021889802019568] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A multi-purpose heating attachment designed primarily for X-ray four-circle diffractometers but applicable also for classical powder diffraction is presented. When working in reflection geometry, the air-cooled heating stage allows diffraction studies to be performed on plate-like samples up to 1173 K in the whole orientation space. This paper gives a detailed description of the assembly and important technical specifications for the performance of experiments. The heating characteristics of the heating stage, the displacement of the sample from the goniometer centre as a result of thermal expansion and the influence of the protecting dome on the diffraction experiment are presented. The simple technical construction, the low weight, the small size and good heating performance make this equipment a general purpose heating attachment for X-ray diffraction experiments in reflection geometry.
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12
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Sonderegger B, Keckes J, Leising G, Resel R. Temperature Dependent X-ray Stress Analysis on MBE- Grown GaN- Films On Sapphire. Acta Crystallogr A 2000. [DOI: 10.1107/s0108767300028282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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