Reducing the psychological burden of isolated oncological patients by means of decision trees

This century has seen several outbreaks of epidemics caused by a common sub-family of coronaviruses such as the responsible for COVID-19 outbreak. The most ominous variants have developed a peculiar viral mechanisms that allows the virus to directly attack the pulmonary tissues often causing a set of dangerous symptoms. It made quite evident that we need a global response to prepare health systems for future epidemics. Unfortunately, during such kind of diseases’ outbreaks a large amount of time is required to the caregivers for sanitization and cleaning operations, therefore tampering with number and duration of visits to patients, especially in oncology wards. Such patients are then left alone for a long time, it follows that their perceived quality of service is greatly diminished, often determining ill-fated consequences also on the psychological side, with significant fallbacks on the recovery possibilities and speed. In this paper we explore an algorithmic approach to automatic communication interfaces that could enhance and enforce the perceived quality of care by the patients in in order to reduce predisposing factors that could potentially tamper with the patient’s ability to recover, also preventing the occurrence of precipitating factors that could lead a therapy to complete failure. The proposed interface could be used to connect the patients with a psychological support when it is most needed, and, moreover, to connect them with their physicians and families, and also to the outside world. In particular we aim to provide the psychological support that is actually excluded in pandemics such as the COVID-19 emergency, mainly in order to enforce the healthcare and sanification protocols, due to its potential unsafety related to the introduction of more personnel into the hospital

A cloud-oriented architecture for the remote assessment and follow-up of hospitalized patients

During the last months the dramatic COVID-19 outbreak has exposed the fragility of our healthcare system, as well as the need for a smart remote follow-up system for the patients, in order to less the burden on the healthcare service and reduce the average hospitalization time. In this paper we proposed a solution designed to grant maximum flexibility by means of the allocation of resources on a cloud service for the remote follow-up of patients. Such resources can be used as a remote support for the caregiver both when planning or enforcing a therapeutic path. A major explanation behind follow-up regards the location and treatment of potentially adverse reactions after treatments. Physical side effects of the different modalities of treatment might be various and crippling after chemotherapy and radiotherapy. Moreover remote follow up can be a life-changing solution also on the economical side, due to the implication of therapeutic attendances for patients as far as missed work and travel costs that must likewise be comprehended in the overall economical burden. In an investigation of patients with testicular disease, Campbell et al. Finally such a solution could effectively improve the patient's adherence to the therapeutic plan. The ability to remotely follow follow-up is therefore a monetarily alluring choice as far as investment funds, also given the improved efficiencies, reduced cost and number of missed working days for the patient. Patients with a patient-held record may also take advantage of a more conscious and motivated interest over their own wellbeing, illness and treatment, with a direct impact on patient's adherence to the therapeutic plan

A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects

Introduction: Metastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bulky tumor masses. When this happens, the classic care approach is just for palliative intent due to a likely unfavorable benefit–risk balance typical of aggressive treatments. Here we proposed a novel radiotherapy (RT) technique to treat bulky metastases from cSCC in the context of an overall limited tumor burden and tried to explain its clinical outcome by the currently available mathematical radiobiological and ad hoc developed models. Methods: We treated a case of facial cSCC with three metastases: two of them by classic stereotactic RT and the other by lattice RT supported by metabolic imaging (18F-FDG PET) due to its excessively large dimensions. For the latter lesion, we compared four treatment plans with different RT techniques in order to define the best approach in terms of normal tissue complication probability (NTCP) and tumor control probability (TCP). Moreover, we developed an ad hoc mathematical radiobiological model that could fit better with the characteristics of heterogeneity of this bulky metastasis for which, indeed, a segmentation of normoxic, hypoxic, and necrotic subvolumes might have been assumed. Results: We observed a clinical complete response in all three disease sites; the bulky metastasis actually regressed more rapidly than the other two treated by stereotactic RT. For the large lesion, NTCP predictions were good for all four different plans but even significantly better for the lattice RT plan. Neither the classic TCP nor the ad hoc developed radiobiological models could be totally adequate to explain the reported outcome. This finding might support a key role of the host immune system. Conclusions: PET-guided lattice RT might be safe and effective for the treatment of bulky lesions from cSCC. There might be some need for complex mathematical radiobiological models that are able to take into account any immune system’s role in order to explain the possible mechanisms of the tumor response to radiation and the relevant key points to enhance it

First Measurement of Hard Exclusive π- Δ++ Electroproduction Beam-Spin Asymmetries off the Proton

The polarized cross-section ratio σLT′/σ0 from hard exclusive π-Δ++ electroproduction off an unpolarized hydrogen target has been extracted based on beam-spin asymmetry measurements using a 10.2 GeV/10.6 GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. The study, which provides the first observation of this channel in the deep-inelastic regime, focuses on very forward-pion kinematics in the valence regime, and photon virtualities ranging from 1.5 GeV2 up to 7 GeV2. The reaction provides a novel access to the d-quark content of the nucleon and to p→Δ++ transition generalized parton distributions. A comparison to existing results for hard exclusive π+n and π0p electroproduction is provided, which shows a clear impact of the excitation mechanism, encoded in transition generalized parton distributions, on the asymmetry

Measurement of the helicity asymmetry E for the γ→ p→ → pπ reaction in the resonance region: The CLAS Collaboration

The double-spin-polarization observable E for γ→ p→ → pπ has been measured with the CEBAF Large Acceptance Spectrometer (CLAS) at photon beam energies Eγ from 0.367 to 2.173GeV (corresponding to center-of-mass energies from 1.240 to 2.200GeV) for pion center-of-mass angles, cosθπ0c.m. , between - 0.86 and 0.82. These new CLAS measurements cover a broader energy range and have smaller uncertainties compared to previous CBELSA data and provide an important independent check on systematics. These measurements are compared to predictions as well as new global fits from The George Washington University, Mainz, and Bonn-Gatchina groups. Their inclusion in multipole analyses will allow us to refine our understanding of the single-pion production contribution to the Gerasimov-Drell-Hearn sum rule and improve the determination of resonance properties, which will be presented in a future publication

Strong Interaction Physics at the Luminosity Frontier with 22 GeV Electrons at Jefferson Lab

This document presents the initial scientific case for upgrading the Continuous Electron Beam Accelerator Facility (CEBAF) at Jefferson Lab (JLab) to 22 GeV. It is the result of a community effort, incorporating insights from a series of workshops conducted between March 2022 and April 2023. With a track record of over 25 years in delivering the world's most intense and precise multi-GeV electron beams, CEBAF's potential for a higher energy upgrade presents a unique opportunity for an innovative nuclear physics program, which seamlessly integrates a rich historical background with a promising future. The proposed physics program encompass a diverse range of investigations centered around the nonperturbative dynamics inherent in hadron structure and the exploration of strongly interacting systems. It builds upon the exceptional capabilities of CEBAF in high-luminosity operations, the availability of existing or planned Hall equipment, and recent advancements in accelerator technology. The proposed program cover various scientific topics, including Hadron Spectroscopy, Partonic Structure and Spin, Hadronization and Transverse Momentum, Spatial Structure, Mechanical Properties, Form Factors and Emergent Hadron Mass, Hadron-Quark Transition, and Nuclear Dynamics at Extreme Conditions, as well as QCD Confinement and Fundamental Symmetries. Each topic highlights the key measurements achievable at a 22 GeV CEBAF accelerator. Furthermore, this document outlines the significant physics outcomes and unique aspects of these programs that distinguish them from other existing or planned facilities. In summary, this document provides an exciting rationale for the energy upgrade of CEBAF to 22 GeV, outlining the transformative scientific potential that lies within reach, and the remarkable opportunities it offers for advancing our understanding of hadron physics and related fundamental phenomena.Comment: Updates to the list of authors; Preprint number changed from theory to experiment; Updates to sections 4 and 6, including additional figure

The CLAS12 Spectrometer at Jefferson Laboratory

The CEBAF Large Acceptance Spectrometer for operation at 12 GeV beam energy (CLAS12) in Hall B at Jefferson Laboratory is used to study electro-induced nuclear and hadronic reactions. This spectrometer provides efficient detection of charged and neutral particles over a large fraction of the full solid angle. CLAS12 has been part of the energy-doubling project of Jefferson Lab's Continuous Electron Beam Accelerator Facility, funded by the United States Department of Energy. An international collaboration of 48 institutions contributed to the design and construction of detector hardware, developed the software packages for the simulation of complex event patterns, and commissioned the detector systems. CLAS12 is based on a dual-magnet system with a superconducting torus magnet that provides a largely azimuthal field distribution that covers the forward polar angle range up to 35∘, and a solenoid magnet and detector covering the polar angles from 35° to 125° with full azimuthal coverage. Trajectory reconstruction in the forward direction using drift chambers and in the central direction using a vertex tracker results in momentum resolutions of <1% and <3%, respectively. Cherenkov counters, time-of-flight scintillators, and electromagnetic calorimeters provide good particle identification. Fast triggering and high data-acquisition rates allow operation at a luminosity of 1035 cm−2s−1. These capabilities are being used in a broad program to study the structure and interactions of nucleons, nuclei, and mesons, using polarized and unpolarized electron beams and targets for beam energies up to 11 GeV. This paper gives a general description of the design, construction, and performance of CLAS12