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

Impact of 18F-FDG PET/CT on Clinical Management of Suspected Radio-Iodine Refractory Differentiated Thyroid Cancer (RAI-R-DTC).

Background: As reported in the literature, [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) provides useful qualitative and semi-quantitative data for the prognosis of advanced differentiated thyroid cancer. Instead, there is a lack of data about the real clinical impact of 18F-FDG PET/CT on the choice of the more effective therapeutic approach for advanced differentiated thyroid cancer (DTC) that starts to lose iodine avidity. The primary aim of this retrospective study was to assess how 18F-FDG PET/CT can guide the choice of the best therapeutic approach to RAI-refractory DTC (RAI-R-DTC) in patients with a doubtful iodine uptake/negative 18F-FDG PET/CT I whole-body scan after several radioactive iodine therapies (RAIT). The secondary aim was to assess the prognostic role of clinical and semi-quantitative metabolic 18F-FDG PET/CT parameters in comparison to published data. Materials and methods: A monocentric retrospective observational study was performed, reviewing the medical records of 53 patients recruited from a database of 208 patients treated at our Institution between 2011 and 2019, with advanced DTC that underwent FDG PET/CT scan for a suspected RAI-R-DTC. Selected patients had to perform a 18F-FDG PET/CT scan after the second RAIT based on a doubtful iodine uptake/negative 131 I whole-body scan and/or persistent elevated thyroglobulin levels. Metabolic response was defined according to positron emission tomography response criteria in solid tumors (PERCIST) guidelines. Standardized uptake value (SUV)max, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. The association between metabolic features, clinical parameters and progression free survival (PFS) was assessed applying Kruskal-Wallis, chi-square-Pearson correlation tests, and Cox regression analyses when appropriate. Results: Among our sample of 53 patients (mean age 52.0 ± 19.9 years; 31 women and 22 men), 27 (51.0%) presented a positive 18F-FDG PET/CT scan: 16 (59.0%) underwent watchful waiting, 4 (15.0%) received external-beam radiation therapy (EBRT), 4 (15.0%) underwent surgery, 2 (7.4%) received another course of RAI therapy, and 1 underwent surgery + EBRT. PERCIST response was evaluated in 14/27 patients. Median follow-up was 5.8 ± 3.9 years and median PFS was 38.0 ± 21.8 months. At the last follow-up assessment, 14/53 (26.4%) demonstrated disease progression, 13/53 (24.5) persistence of structural disease, 25/53 (47%) persistence of biochemical disease, and 15/53 (28%) had an excellent response. A significant association was found between therapeutic approach, metabolic response, and final disease response evaluation, as well as a linear correlation between MTV and TLG with thyroglobulin level. Conclusions: Our Institutional experience confirmed the role of 18F-FDG PET/CT as a useful guide in the clinical management of RAI-R-DTC and obviated further unnecessary RAIT

Engineering Design and Prototype Fabrication of HOM Couplers for HL-LHC Crab Cavities

The High-Luminosity upgrade for the LHC relies on a set of RF Crab Cavities for reaching its goals. Two parallel concepts, the Double Quarter Wave (DQW) and the RF Dipole (RFD), are going through a comprehensive design process along with preparation of fabrication in view of extensive tests with beam in SPS. High Order Modes (HOM) couplers are critical in providing damping in RF cavities for operation in accelerators. HOM prototyping and fabrication have recently started at CERN. In this paper, an overview of the final shape is provided along with an insight in the mechanical and thermal analyses performed to validate the design of these critical components. Emphasis is also given to test campaigns, material selection, prototyping and initial fabrication that are aimed at fulfilling the highly demanding tolerances of the couplers

Fibras residuais de pupunha: estudo de aplicações ao design sustentável.

Sustentabilidade apresenta-se como um termo importante no mundo contemporâneo, o que aumentou a busca e o desenvolvimento de materiais derivados de fibras naturais e residuais. Nesse contexto, agregando conceitos de ecodesign, design social e economia circular, utilizaram-se resíduos fibrosos do processamento do palmito pupunha para desenvolvimento de novos materiais, representados por papéis de diferentes qualidades. Foram realizados estudos, geração de alternativas e um brainstorming de possíveis aplicações para os materiais gerados, que resultaram no projeto de acessórios para o uso em restaurantes, tais como envelopes para talheres, bem como outros produtos que não foram englobados nesse artigo, como papéis bandeja e porta-copos. Com ensaios laboratoriais fora possível analisar aspectos físicos e testar a resistência dos itens perante forças externas, bem como avaliar em microscópio a aglutinação das fibras de pupunha. Dentre as características observadas destacaram-se a maleabilidade, a grande variabilidade de aplicações, a possibilidade de reprodução artesanal e a contribuição para a sustentabilidade ambiental, uma vez que se trata de materiais residuais aplicados ao Design de produto, podendo futuramente apresentar amplo uso em áreas como arquitetura e bioengenharia principalmente na parte de revestimentos.Online

Design of Dressed Crab Cavities for the HL-LHC Upgrade

The HL-LHC upgrade relies on a set of RF crab cavities for reaching its goals. Two parallel concepts, the Double Quarter Wave (DQW) and the RF Dipole (RFD), are going through a comprehensive design process along with preparation of fabrication in view of extensive tests with beam in SPS. High Order Modes (HOM) couplers are critical in providing damping in RF cavities for operation in accelerators. HOM prototyping and fabrication have recently started at CERN. In this paper, an overview of the final geometry is provided along with an insight in the mechanical and thermal analyses performed to validate the design of this critical component. Emphasis is also given to material selection, prototyping, initial fabrication and test campaigns that are aimed at fulfilling the highly demanding tolerances of the couplers

A strategy to characterize the LISA-Pathfinder cold gas thruster system

The cold gas micro-propulsion system that will be used during the LISA-Pathfinder mission will be one of the most important component used to ensure the "free-fall" of the enclosed test masses. In this paper we present a possible strategy to characterize the effective direction and amplitude gain of each of the 6 thrusters of this system

In-flight thermal experiments for LISA pathfinder: simulating temperature noise at the inertial sensors

Thermal Diagnostics experiments to be carried out on board LISA Pathfinder (LPF) will yield a detailed characterisation of how temperature fluctuations affect the LTP (LISA Technology Package) instrument performance, a crucial information for future space based gravitational wave detectors as the proposed eLISA. Amongst them, the study of temperature gradient fluctuations around the test masses of the Inertial Sensors will provide as well information regarding the contribution of the Brownian noise, which is expected to limit the LTP sensitivity at frequencies close to 1 mHz during some LTP experiments. In this paper we report on how these kind of Thermal Diagnostics experiments were simulated in the last LPF Simulation Campaign (November, 2013) involving all the LPF Data Analysis team and using an end-to-end simulator of the whole spacecraft. Such simulation campaign was conducted under the framework of the preparation for LPF operations

Free-flight experiments in LISA Pathfinder

The LISA Pathfinder mission will demonstrate the technology of drag-free test masses for use as inertial references in future space-based gravitational wave detectors. To accomplish this, the Pathfinder spacecraft will perform drag-free flight about a test mass while measuring the acceleration of this primary test mass relative to a second reference test mass. Because the reference test mass is contained within the same spacecraft, it is necessary to apply forces on it to maintain its position and attitude relative to the spacecraft. These forces are a potential source of acceleration noise in the LISA Pathfinder system that are not present in the full LISA configuration. While LISA Pathfinder has been designed to meet it's primary mission requirements in the presence of this noise, recent estimates suggest that the on-orbit performance may be limited by this `suspension noise'. The drift-mode or free-flight experiments provide an opportunity to mitigate this noise source and further characterize the underlying disturbances that are of interest to the designers of LISA-like instruments. This article provides a high-level overview of these experiments and the methods under development to analyze the resulting data.Comment: 13 pages, 5 figures. Accepted to Journal Of Physics, Conference Series. Presented at 10th International LISA Symposium, May 2014, Gainesville, FL, US