Medical therapy of gastroesophageal reflux disease in secondary and tertiary care settings.

Gastroesophageal reflux disease (GERD) is common. Many patients with recurring or troublesome symptoms are referred for endoscopic examination. Patients seen in secondary care usually have failed OTC or primary care anti-reflux therapy. Acid suppression is the mainstay of healing and maintenance therapy. Increasingly proton pump inhibitors (PPIs) are preferred above H2 receptor antagonists (H2RAs), not only for the more severe end of the GERD spectrum but also for patients with mild degrees of esophagitis. Not all patients respond symptomatically to acid suppression, not even with high dose PPI. Prokinetics are mainly useful in the milder degrees of GERD. It is still not clear whether a particular symptom cluster can be recognized for which prokinetics are especially useful. The concept of "step-up versus step-down" approach remains in need for proper validation. Switching from PPIs to cisapride for "step-down" maintenance appears inadequate in practice. All current therapies have shortcomings; H2RAs insufficiently block meal-stimulated acid secretion; long-term strong acid suppression worsens Helicobacter pylori-associated inflammation in the corpus and may accelerate development of atrophy; PPI-potency is substantially weaker in non-H. pylori infected individuals. Optimization of individualized therapy will require more potent and more precisely targeted motility modulating drugs and superior acid/peptic inhibiting pharmaceuticals

The Future of Acid Inhibition

There are many unmet needs with current gastric acid suppression with proton pump inhibitors (PPIs). Recommended prescription of one standard morning dose for all patients and for all medical conditions must be scientifically inappropriate and far from individualized personal medicine. For several diseases, especially gastroesophageal reflux disease and Barrett esophagus, more intense, more prolonged diurnal acid suppression is indicated. Especially inhibition of nocturnal acid secretion with our current delayed-release PPIs turns out to be difficult. This overview summarizes the actual attempts to improve the control of acid secretion, which is necessary to adapt the degree of acid inhibition to the individual patient needs. To be discussed are: immediately release PPIs, extended PPI formulations, PPIs with a much longer half-life, potassium competitive acid blockers, gastrin antagonists, etc. Future studies have to proof that those novel drug approaches indeed contribute to reduce the unmet needs

The Upgrade of the CMS RPC System during the First LHC Long Shutdown

The CMS muon system includes in both the barrel and endcap region Resistive Plate Chambers (RPC). They mainly serve as trigger detectors and also improve the reconstruction of muon parameters. Over the years, the instantaneous luminosity of the Large Hadron Collider gradually increases. During the LHC Phase 1 (~first 10 years of operation) an ultimate luminosity is expected above its design value of 10^34/cm^2/s at 14 TeV. To prepare the machine and also the experiments for this, two long shutdown periods are scheduled for 2013-2014 and 2018-2019. The CMS Collaboration is planning several detector upgrades during these long shutdowns. In particular, the muon detection system should be able to maintain a low-pT threshold for an efficient Level-1 Muon Trigger at high particle rates. One of the measures to ensure this, is to extend the present RPC system with the addition of a 4th layer in both endcap regions. During the first long shutdown, these two new stations will be equipped in the region |eta|<1.6 with 144 High Pressure Laminate (HPL) double-gap RPCs operating in avalanche mode, with a similar design as the existing CMS endcap chambers. Here, we present the upgrade plans for the CMS RPC system for the fist long shutdown, including trigger simulation studies for the extended system, and details on the new HPL production, the chamber assembly and the quality control procedures.Comment: 9 pages, 6 figures, presented by M.Tytgat at the XI workshop on Resistive Plate Chambers and Related Detectors (RPC2012), INFN - Laboratori Nazionali di Frascati, February 5-10, 201

Particle Dark Matter Candidates

I give a short overview on some of the favorite particle Cold Dark Matter candidates today, focusing on those having detectable interactions: the axion, the KK-photon in Universal Extra Dimensions, the heavy photon in Little Higgs and the neutralino in Supersymmetry. The neutralino is still the most popular, and today is available in different flavours: SUGRA, nuSUGRA, sub-GUT, Mirage mediation, NMSSM, effective MSSM, scenarios with CP violation. Some of these scenarios are already at the level of present sensitivities for direct DM searches.Comment: 7 pages, 4 figures, 3 references added. Contribution to the proceedings of the TAUP 07 conference, Sep. 11-15, Sendai, Japa

Production of Polarized Vector Mesons off Nuclei

Using the light-cone QCD dipole formalism we investigate manifestations of color transparency (CT) and coherence length (CL) effects in electroproduction of longitudinally (L) and transversally (T) polarized vector mesons. Motivated by forthcoming data from the HERMES experiment we predict both the A and Q^2 dependence of the L/T- ratios, for rho^0 mesons produced coherently and incoherently off nuclei. For an incoherent reaction the CT and CL effects add up and result in a monotonic A dependence of the L/T-ratio at different values of Q^2. On the contrary, for a coherent process the contraction of the CL with Q^2 causes an effect opposite to that of CT and we expect quite a nontrivial A dependence, especially at Q^2 >> m_V^2.Comment: Revtex 24 pages and 14 figure

Aplicação de estratégias da Técnica Alexander para prevenção da ansiedade para alunos do ensino vocacional de piano

A presente dissertação insere-se no âmbito do Mestrado em Ensino da Música –variante de instrumento e classe de conjunto. Incide no estudo da temática da ansiedade na performance, para uma amostra de seis crianças e adolescentes com idades compreendidas entre os seis e os catorze anos, que frequentam a disciplina de Piano. A ansiedade na performance é um tema bastante complexo. Abordado por autores diversos, é uma problemática que está longe de ser consensual, em torno dos seus mais diversificados aspectos. Assim, também o seu “tratamento” pertence ao campo da incerteza. A Técnica Alexander incide num método que opera sobre o hábito errado, conferindo ao praticante uma nova abordagem na senda do autoconhecimento e autocontrolo. Tem auxiliado, um pouco por todo o mundo, diversos músicos a vencer o medo do palco, tendo inclusivamente salvo carreiras. O objectivo deste estudo passa pela transmissão e trabalho do método de Alexander, de forma a quemelhor se possa compreender e aceitar o fenómeno da ansiedade na performance, a fim de contribuir para uma vida musical mais feliz e proveitosa, por parte dos alunos que estudam o instrumento.Abstract : This monograph stands for the Master Degree on Musical Teaching –instrument and group music. It incides on the performance anxiety thematic, considering a sample of six children and teenagers, from six to fourteen years old, that attend to Piano course. Performance anxiety is a truly complex theme. It’s approached by several authors and it’s a far from being concensual problematic, from the most diverse aspects of it’s nature. Alexander’s Technique is a method that works on the wrong habits and it allows it’s user to explore self-knowledge as well as self-control. It’s been effective in helping musicians worldwide to face stage fear and sometimes save their own careers. The objective of thisstudy is to transmit and work on Alexander’s Technique, to help understanding and accepting perfomance anxiety phenomenon, so to contribute to a happy and profitable musical life of the piano students

Vacuum Structure and the Axion Walls in Gluodynamics and QCD with Light Quarks

Large N gluodynamics was shown to have a set of metastable vacua with the gluonic domain walls interpolating between them. The walls may separate the genuine vacuum from an excited one, or two excited vacua which are unstable at finite N (here N is the number of colors). One may attempt to stabilize them by switching on the axion field. We study how the light quarks and the axion affect the structure of the domain walls. In pure gluodynamics (with the axion field) the axion walls acquire a very hard gluonic core. Thus, we deal with a wall "sandwich" which is stable at finite N. In the case of the minimal axion, the wall "sandwich" is in fact a "2-pi" wall, i.e., the corresponding field configuration interpolates between identical hadronic vacua. The same properties hold in QCD with three light quarks and very large number of colors. However, in the realistic case of three-color QCD the phase corresponding to the axion field profile in the axion wall is screened by a dynamical phase associated with the eta-prime, so that the gluon component of the wall is not excited. We propose a toy Lagrangian which models these properties and allows one to get exact solutions for the domain walls.Comment: 22 pages Latex, no figure

Construction and commissioning of a technological prototype of a high-granularity semi-digital hadronic calorimeter

A large prototype of 1.3m3 was designed and built as a demonstrator of the semi-digital hadronic calorimeter (SDHCAL) concept proposed for the future ILC experiments. The prototype is a sampling hadronic calorimeter of 48 units. Each unit is built of an active layer made of 1m2 Glass Resistive Plate Chamber(GRPC) detector placed inside a cassette whose walls are made of stainless steel. The cassette contains also the electronics used to read out the GRPC detector. The lateral granularity of the active layer is provided by the electronics pick-up pads of 1cm2 each. The cassettes are inserted into a self-supporting mechanical structure built also of stainless steel plates which, with the cassettes walls, play the role of the absorber. The prototype was designed to be very compact and important efforts were made to minimize the number of services cables to optimize the efficiency of the Particle Flow Algorithm techniques to be used in the future ILC experiments. The different components of the SDHCAL prototype were studied individually and strict criteria were applied for the final selection of these components. Basic calibration procedures were performed after the prototype assembling. The prototype is the first of a series of new-generation detectors equipped with a power-pulsing mode intended to reduce the power consumption of this highly granular detector. A dedicated acquisition system was developed to deal with the output of more than 440000 electronics channels in both trigger and triggerless modes. After its completion in 2011, the prototype was commissioned using cosmic rays and particles beams at CERN.Comment: 49 pages, 41 figure

Performance of Glass Resistive Plate Chambers for a high granularity semi-digital calorimeter

A new design of highly granular hadronic calorimeter using Glass Resistive Plate Chambers (GRPCs) with embedded electronics has been proposed for the future International Linear Collider (ILC) experiments. It features a 2-bit threshold semi-digital read-out. Several GRPC prototypes with their electronics have been successfully built and tested in pion beams. The design of these detectors is presented along with the test results on efficiency, pad multiplicity, stability and reproducibility.Comment: 16 pages, 15 figure