Grundversorgung: Der Weg aus der Krise führt auch über die MPA

Die meisten Hausärzte und Hausärztinnen in der Schweiz sind dauerhaft überlastet. Um zusätzliche Kapazitäten zu schaffen, sind ihre Leistungen auf mehr Schultern zu verteilen und die Betreuung im (Praxis-)Team zu verstärken. Besonders dafür geeignet ist die Begleitung von chronisch kranken Patienten durch die Medizinische Praxisassistentin. Das Problem: Der Arzt kann diese Leistungen nicht abrechnen. Dies ist so rasch wie möglich zu ändern, damit die MPA endlich den Wert erhält, den sie längst verdient

Management of epilepsy in elderly

The prevalence of seizures and epilepsy in the elderly is generally underestimated. Epileptic seizures are not a rare occurrence in the elderly and their prevalence increases with age. The clinical manifestations of seizures, the aetiology, the treatment and the psychosocial impact of the epilepsy diagnosis may differ in the elderly. Differential diagnosis with episodes of unconsciousness and/or fall or other non-epileptic manifestations is often difficult. The presence of comorbidities, the polypharmatherapy and the age-related pharmacokinetic changes can represent a problem for the treatment of epilepsy in the elderly, with a higher risk of adverse effects and potentially inappropriate drug interactions. Epileptic seizures in the elderly can have semiological characteristics similar to those of other age groups. On the other hand, the richness of the electroclinical syndromes of childhood and adolescence is not found in the elderly, and, in particular, idiopathic generalized epilepsies are rarely expressed at this age. Symptomatic seizures related to acute structural injury or metabolic causes are particularly frequent. Therapy management of the elderly with an epileptic seizure should concern not only neurologists, but also general practitioners, geriatricians, and cardiologists, therefore involving a wide range of clinical specialties. This review aims to summarize the management of epilepsy in the elderly, reporting also differences in epidemiology, electroclinical features, aetiology and diagnostic procedures

Gate stability of GaN-Based HEMTs with P-Type Gate

status: publishe

Kinetics and metabolism of Bifidobacterium adolescentis MB 239 growing on glucose, galactose, lactose, and galactooligosaccharides

The kinetics and the metabolism of Bifidobacterium adolescentis MB 239 growing on galactooligosaccharides (GOS), lactose, galactose, and glucose were investigated. An unstructured unsegregated model for growth in batch cultures was developed, and kinetic parameters were calculated with a recursive algorithm. The growth rate and cellular yield were highest on galactose, followed by lactose and GOS, and were lowest on glucose. Lactate, acetate, and ethanol yields allowed the calculation of carbon fluxes toward fermentation products. Distributions between two- and three-carbon products were similar on all the carbohydrates (55 and 45%, respectively), but ethanol yields were different on glucose, GOS, lactose, and galactose, in decreasing order of production. Based on the stoichiometry of the fructose-6-phosphate shunt and on the carbon distribution among the products, the ATP yield was calculated. The highest yield was obtained on galactose, while the yields were 5, 8, and 25% lower on lactose, GOS, and glucose, respectively. Therefore, a correspondence among ethanol production, low ATP yields, and low biomass production was established, demonstrating that carbohydrate preferences may result from different distributions of carbon fluxes through the fermentative pathway. During the fermentation of a GOS mixture, substrate selectivity based on the degree of polymerization was exhibited, since lactose and the trisaccharide were the first to be consumed, while a delay was observed until longer oligosaccharides were utilized. Throughout the growth on both lactose and GOS, galactose accumulated in the cultural broth, suggesting that beta(1-4) galactosides can be hydrolyzed before they are taken up

Interventions addressing the adolescent HIV continuum of care in South Africa: a systematic review and modified Delphi analysis

INTRODUCTION: Compared with adults, adolescents in South Africa have larger gaps at each step of the HIV continuum of care resulting in low levels of viral suppression. METHODS: We conducted a systematic review and modified Delphi analysis of interventions addressing the HIV continuum of care for adolescents in South Africa. We searched PubMed, Science Direct, and Google Scholar and online conference proceedings from the International AIDS Society, the International AIDS Conference, and the Conference on Retrovirology and Opportunistic Infections from 1 January 2010 to 30 September 2020. We then conducted a modified Delphi analysis with 29 researchers involved in the National Institutes of Health's Fogarty International-supported Adolescent HIV Implementation Science Alliance-South Africa to evaluate interventions for efficacy, feasibility and potential for scale-up. RESULTS: We identified nine initial published articles containing interventions addressing the adolescent HIV continuum of care in South Africa, including five interventions focused on HIV diagnosis, two on antiretroviral therapy adherence and two on retention in care. No studies addressed linkage to care or transition from paediatric to adult care. Two studies discussed intervention costs. In-home and HIV self-testing, community-based adherence support, and provision of adolescent-friendly services were the most impactful and scalable interventions addressing the adolescent HIV continuum of care. CONCLUSION: Future interventions should work comprehensively across the adolescent HIV continuum of care and be tailored to the specific needs of adolescents

Characterization of charge trapping mechanisms in GaN vertical Fin FETs under positive gate bias

In this paper, we present a comprehensive analysis of the charge trapping mechanisms that affect the GaN based vertical Fin FETs when the devices are submitted to positive gate bias. Devices with higher channel width show lower threshold voltage: with 2D simulations of the electron density we are able to explain the phenomenon and propose a trade-off to improve the technology. By using double pulse measurements and threshold voltage transients, two trapping/detrapping mechanisms under positive gate bias can be identified according to two voltage ranges. At low positive gate bias, electrons (previously trapped inside the oxide during the fabrication process) are detrapped towards the gate metal (mechanism 1). At higher gate bias, electrons are trapped at the GaN/oxide interface, moving the threshold towards positive values (mechanism 2). The second mechanism is observable at higher time of stress and it is predominant for higher voltages. Moreover, mechanism 2 is found to be recoverable only when the device is exposed to UV-light and electrons trapped in a specific level in the oxide acquire the energy necessary to escape and reach the n-type GaN and/or the UV-generated holes accumulate at the interface may reduce the trapped electron density. We demonstrate our hypothesis by calculating the interface state density in trapping/detrapping conditions by using photo-assisted Capacitance-Voltage measurements

Design and Vertical Tests of SPS-series Double-Quarter Wave (DQW) Cavity Prototypes for the HL-LHC Crab Cavity System

Crab crossing is essential for high-luminosity colliders. The High Luminosity Large Hadron Collider (HL-LHC) will equip one of its Interaction Points (IP1) with Double-Quarter Wave (DQW) crab cavities. A DQW cavity is a new generation of deflecting RF cavities that stands out for its compactness and broad frequency separation between fundamental and first high-order modes. The deflecting kick is provided by its fundamental mode. Each HL-LHC DQW cavity shall provide a nominal deflecting voltage of 3.4 MV, although up to 5.0 MV may be required. A Proof-of-Principle (PoP) DQW cavity was limited by quench at 4.6 MV. This paper describes a new, highly optimized cavity, designated DQW SPS-series, which satisfies dimensional, cryogenic, manufacturing and impedance requirements for beam tests at SPS and operation in LHC. Two prototypes of this DQW SPS-series were fabricated by US industry and cold tested after following conventional SRF surface treatment. Both units outperformed the PoP cavity, reaching a deflecting voltage of 5.3-5.9 MV. This voltage - the highest reached by a DQW cavity - is well beyond the nominal voltage of 3.4 MV and may even operate at the ultimate voltage of 5.0MVwith sufficient margin. This paper covers fabrication, surface preparation and cryogenic RF test results and implications

Sensory and chemical profile of a phenolic extract from olive mill waste waters in plant-base food with varied macro-composition

Phenols from olive mill waste water (OMWW) represent valuable functional ingredients. The negative impact on sensory quality limits their use in functional food formulations. Chemical interactions phenols/biopolymers and their consequences on bioactivity in plant-base foods have been widely investigated, but no studies to date have explored the variation of bitterness, astringency and pungency induced by OMWW phenols as a function of the food composition. The aim of the paper was to profile the sensory and chemical properties of phenols from OMWW in plant-base foods varied in their macro-composition. Four phenol concentrations were selected (0.44, 1.00, 2.25, 5.06 g/kg) to induce significant variations of bitterness, sourness, astringency and pungency in three plant-base food: proteins/neutral pH \u2013 bean pur\ue9e (BP), starch/neutral pH \u2013 potato pur\ue9e (PP), fiber/low pH \u2013 tomato juice (TJ). The macro-composition affected the amount of the phenols recovered from functionalized food. The highest recovery was from TJ and the lowest from BP. Two groups of 29 and 27 subjects, trained to general Labelled Magnitude Scale and target sensations, participated in the evaluation of psychophysical curves of OMWW phenols and of functionalized plant-base foods, respectively. Target sensations were affected by the food macro-composition. Bitterness increased with phenol concentration in all foods. Astringency and sourness slightly increased with concentration, reaching the weak-moderate intensity at the highest phenol concentration in PP and TJ only. Pungency was suppressed in BP and perceived at weak-moderate intensity in PP and TJ sample at the highest phenol concentration. Proteins/neutral pH plant-food (BP) resulted more appropriate to counteract the impact of added phenol on negative sensory properties thus allowing to optimize the balance between health and sensory properties

Sensory and chemical profile of a phenolic extract from olive mill waste waters in plant-base food with varied macro-composition

Phenols from olive mill waste water (OMWW) represent valuable functional ingredients. The negative impact on sensory quality limits their use in functional food formulations. Chemical interactions phenols/biopolymers and their consequences on bioactivity in plant-base foods have been widely investigated, but no studies to date have explored the variation of bitterness, astringency and pungency induced by OMWW phenols as a function of the food composition. The aim of the paper was to profile the sensory and chemical properties of phenols from OMWW in plant-base foods varied in their macro-composition. Four phenol concentrations were selected (0.44, 1.00, 2.25, 5.06 g/kg) to induce significant variations of bitterness, sourness, astringency and pungency in three plant-base food: proteins/neutral pH \u2013 bean pur\ue9e (BP), starch/neutral pH \u2013 potato pur\ue9e (PP), fiber/low pH \u2013 tomato juice (TJ). The macro-composition affected the amount of the phenols recovered from functionalized food. The highest recovery was from TJ and the lowest from BP. Two groups of 29 and 27 subjects, trained to general Labelled Magnitude Scale and target sensations, participated in the evaluation of psychophysical curves of OMWW phenols and of functionalized plant-base foods, respectively. Target sensations were affected by the food macro-composition. Bitterness increased with phenol concentration in all foods. Astringency and sourness slightly increased with concentration, reaching the weak-moderate intensity at the highest phenol concentration in PP and TJ only. Pungency was suppressed in BP and perceived at weak-moderate intensity in PP and TJ sample at the highest phenol concentration. Proteins/neutral pH plant-food (BP) resulted more appropriate to counteract the impact of added phenol on negative sensory properties thus allowing to optimize the balance between health and sensory properties

Surgical approaches for possible positions of an olfactory implant to stimulate the olfactory bulb

Introduction: Current scientific developments seem to allow for an "olfactory implant"in analogy to cochlear implants. However, the position and surgical approaches for electrical stimulation of the olfactory system are unclear. Methods: In a human anatomic cadaver study, we investigated different endoscopic approaches to electrically stimulate the olfactory bulb (OB) based on the following considerations: (1) the stimulating electrode should be close to the OB. (2) The surgical procedure should be as non-invasive and safe as possible and (3) as easy as possible for an experienced ENT surgeon. Results: In summary, the endoscopic intracranial positioning of the electrode via a widened ostium of the fila olfactoria or a frontal sinus surgery like a Draf IIb procedure is a good option in terms of patients' risk, degree of difficulty for ENT surgeons, and position to the OB. Endoscopic intranasal positioning appeared to be the best option in terms of patient risk and the degree of difficulty for ENT surgeons. Although a bigger approach to the OB using a drill and the combined intranasal endoscopic and external approach enabled a close placement of the electrode to the OB, they do not seem relevant in practice due to their higher invasiveness. Conclusion: The study suggested that an intranasal positioning of a stimulating electrode is possible, with placements beneath the cribriform plate, extra- or intracranially, applying elegant surgical techniques with low or medium risk to the patient and a close placement to OB