Surgical treatment of papillary thyroid carcinoma without lymph nodal involvement

Background. In the treatment of differentiated thyroid cancer (DTC), in absence of enlarged lymph nodes, the role of routine central lymph node dissection (RCLD) remains controversial. The aim of this study is to analyze data resulting from total thyroidectomy (TT) not combined with RCLD in the treatment of DTC. Methods. We retrospectively evaluated the clinical records of 80 patients treated between January 1996 and December 2003 with TT without RCLND, in absence of suspected enlarged lymph nodes at preoperative ultrasonography and intraoperatively during neck exploration. In this series, 75 patients (93.7%) underwent radioiodine (RAI) ablation, followed by Thyroid Stimulating Hormone (TSH) suppression therapy. In case of locoregional lymph nodal recurrence, a central (VI) and ipsilateral (III-IV) selective lymph node dissection was performed. Results. Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and unilateral temporary vocal fold paralysis were respectively 2.55% and 2.55%. Locoregional recurrence, with positive cervical lymph nodes, after a 10.3 ± 4.7 years mean follow-up was observed in 3 patients (3.75%). They were submitted to a central (VI) and ipsilateral (III-IV) selective neck dissection without significant complications. Conclusions. In our series, TT not combined with RCLD was associated to a low locoregional recurrence rate, even if the lack of a control group treated with RCLD does not allow any generalized assumption. RCLD may be indicated in high risk patients, in whom lymph nodal recurrence is more frequent. More prospective randomized studies are needed to better define the role of RCLD and postoperative radioiodine ablation.

Low temperature magneto-photoluminescence characterization of high purity gallium arsenide and indium phosphide

Low-temperature magneto-photoluminescence is a very powerful technique to characterize high purity GaAs and InP grown by various epitaxial techniques. These III-V compound semiconductor materials are used in a wide variety of electronic, optoelectronic and microwave devices. The large binding energy differences of acceptors in GaAs and InP make possible the identification of those impurities by low-temperature photoluminescence without the use of any magnetic field. However, the sensitivity and resolution provided by this technique rema1ns inadequate to resolve the minute binding energy differences of donors in GaAs and InP. To achieve higher sensitivity and resolution needed for the identification of donors, a magneto-photoluminescence system 1s installed along with a tunable dye laser, which provides resonant excitation. Donors 1n high purity GaAs are identified from the magnetic splittings of "two-electron" satellites of donor bound exciton transitions 1n a high magnetic field and at liquid helium temperature. This technique 1s successfully used to identify donors 1n n-type GaAs as well as 1n p-type GaAs in which donors cannot be identified by any other technique. The technique is also employed to identify donors in high purity InP. The amphoteric incorporation of Si and Ge impurities as donors and acceptors in (100), (311)A and (3ll)B GaAs grown by molecular beam epitaxy is studied spectroscopically. The hydrogen passivation of C acceptors in high purity GaAs grown by molecular beam epitaxy (MBE) and metalorganic chemical vapor deposition (MOCVD) 1s investigated using photoluminescence. Si acceptors ~n MBE GaAs are also found to be passivated by hydrogenation. The instabilities in the passivation of acceptor impurities are observed for the exposure of those samples to light. Very high purity MOCVD InP samples with extremely high mobility are characterized by both electrical and optical techniques. It is determined that C is not typically incorporated as a residual acceptor ~n high purity MOCVD InP. Finally, GaAs on Si, single quantum well, and multiple quantum well heterostructures, which are fabricated from III-V semiconductors, are also measured by low-temperature photoluminescence.

[Map of the city of Washington : showing the sub-divisions, grades, and the general configuration of the ground /

Cadastral map showing lot lines, lot numbers, and block numbers.

Implementación de un programa de conservación tipo mantenimiento rutinario, en la vía Yopal - Punto Nuevo, Sector Yopal - Vereda Palomas, Municipio de Yopal, Departamento de Casanare

71 p.

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study.

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score. Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Applications of perceptual sparse representation (Spikegram) for copyright protection of audio signals

Chaque année, le piratage mondial de la musique coûte plusieurs milliards de dollars en pertes économiques, pertes d’emplois et pertes de gains des travailleurs ainsi que la perte de millions de dollars en recettes fiscales. La plupart du piratage de la musique est dû à la croissance rapide et à la facilité des technologies actuelles pour la copie, le partage, la manipulation et la distribution de données musicales [Domingo, 2015], [Siwek, 2007]. Le tatouage des signaux sonores a été proposé pour protéger les droit des auteurs et pour permettre la localisation des instants où le signal sonore a été falsifié. Dans cette thèse, nous proposons d’utiliser la représentation parcimonieuse bio-inspirée par graphe de décharges (spikegramme), pour concevoir une nouvelle méthode permettant la localisation de la falsification dans les signaux sonores. Aussi, une nouvelle méthode de protection du droit d’auteur. Finalement, une nouvelle attaque perceptuelle, en utilisant le spikegramme, pour attaquer des systèmes de tatouage sonore. Nous proposons tout d’abord une technique de localisation des falsifications (‘tampering’) des signaux sonores. Pour cela nous combinons une méthode à spectre étendu modifié (‘modified spread spectrum’, MSS) avec une représentation parcimonieuse. Nous utilisons une technique de poursuite perceptive adaptée (perceptual marching pursuit, PMP [Hossein Najaf-Zadeh, 2008]) pour générer une représentation parcimonieuse (spikegramme) du signal sonore d’entrée qui est invariante au décalage temporel [E. C. Smith, 2006] et qui prend en compte les phénomènes de masquage tels qu’ils sont observés en audition. Un code d’authentification est inséré à l’intérieur des coefficients de la représentation en spikegramme. Puis ceux-ci sont combinés aux seuils de masquage. Le signal tatoué est resynthétisé à partir des coefficients modifiés, et le signal ainsi obtenu est transmis au décodeur. Au décodeur, pour identifier un segment falsifié du signal sonore, les codes d’authentification de tous les segments intacts sont analysés. Si les codes ne peuvent être détectés correctement, on sait qu’alors le segment aura été falsifié. Nous proposons de tatouer selon le principe à spectre étendu (appelé MSS) afin d’obtenir une grande capacité en nombre de bits de tatouage introduits. Dans les situations où il y a désynchronisation entre le codeur et le décodeur, notre méthode permet quand même de détecter des pièces falsifiées. Par rapport à l’état de l’art, notre approche a le taux d’erreur le plus bas pour ce qui est de détecter les pièces falsifiées. Nous avons utilisé le test de l’opinion moyenne (‘MOS’) pour mesurer la qualité des systèmes tatoués. Nous évaluons la méthode de tatouage semi-fragile par le taux d’erreur (nombre de bits erronés divisé par tous les bits soumis) suite à plusieurs attaques. Les résultats confirment la supériorité de notre approche pour la localisation des pièces falsifiées dans les signaux sonores tout en préservant la qualité des signaux. Ensuite nous proposons une nouvelle technique pour la protection des signaux sonores. Cette technique est basée sur la représentation par spikegrammes des signaux sonores et utilise deux dictionnaires (TDA pour Two-Dictionary Approach). Le spikegramme est utilisé pour coder le signal hôte en utilisant un dictionnaire de filtres gammatones. Pour le tatouage, nous utilisons deux dictionnaires différents qui sont sélectionnés en fonction du bit d’entrée à tatouer et du contenu du signal. Notre approche trouve les gammatones appropriés (appelés noyaux de tatouage) sur la base de la valeur du bit à tatouer, et incorpore les bits de tatouage dans la phase des gammatones du tatouage. De plus, il est montré que la TDA est libre d’erreur dans le cas d’aucune situation d’attaque. Il est démontré que la décorrélation des noyaux de tatouage permet la conception d’une méthode de tatouage sonore très robuste. Les expériences ont montré la meilleure robustesse pour la méthode proposée lorsque le signal tatoué est corrompu par une compression MP3 à 32 kbits par seconde avec une charge utile de 56.5 bps par rapport à plusieurs techniques récentes. De plus nous avons étudié la robustesse du tatouage lorsque les nouveaux codec USAC (Unified Audion and Speech Coding) à 24kbps sont utilisés. La charge utile est alors comprise entre 5 et 15 bps. Finalement, nous utilisons les spikegrammes pour proposer trois nouvelles méthodes d’attaques. Nous les comparons aux méthodes récentes d’attaques telles que 32 kbps MP3 et 24 kbps USAC. Ces attaques comprennent l’attaque par PMP, l’attaque par bruit inaudible et l’attaque de remplacement parcimonieuse. Dans le cas de l’attaque par PMP, le signal de tatouage est représenté et resynthétisé avec un spikegramme. Dans le cas de l’attaque par bruit inaudible, celui-ci est généré et ajouté aux coefficients du spikegramme. Dans le cas de l’attaque de remplacement parcimonieuse, dans chaque segment du signal, les caractéristiques spectro-temporelles du signal (les décharges temporelles ;‘time spikes’) se trouvent en utilisant le spikegramme et les spikes temporelles et similaires sont remplacés par une autre. Pour comparer l’efficacité des attaques proposées, nous les comparons au décodeur du tatouage à spectre étendu. Il est démontré que l’attaque par remplacement parcimonieux réduit la corrélation normalisée du décodeur de spectre étendu avec un plus grand facteur par rapport à la situation où le décodeur de spectre étendu est attaqué par la transformation MP3 (32 kbps) et 24 kbps USAC.

Un aporte a la comprensión de las estrategias emergentes en las organizaciones a través del concepto de improvisación y la metáfora musical

Este trabajo se inscribe en uno de los grandes campos de los estudios organizacionales: la estrategia. La perspectiva clásica en este campo promovió la idea de que proyectarse hacia el futuro implica diseñar un plan (una serie de acciones deliberadas). Avances posteriores mostraron que la estrategia podía ser comprendida de otras formas. Sin embargo, la evolución del campo privilegió en alguna medida la mirada clásica estableciendo, por ejemplo, múltiples modelos para ‘formular’ una estrategia, pero dejando en segundo lugar la manera en la que esta puede ‘emerger’. El propósito de esta investigación es, entonces, aportar al actual nivel de comprensión respecto a las estrategias emergentes en las organizaciones. Para hacerlo, se consideró un concepto opuesto —aunque complementario— al de ‘planeación’ y, de hecho, muy cercano en su naturaleza a ese tipo de estrategias: la improvisación. Dado que este se ha nutrido de valiosos aportes del mundo de la música, se acudió al saber propio de este dominio, recurriendo al uso de ‘la metáfora’ como recurso teórico para entenderlo y alcanzar el objetivo propuesto. Los resultados muestran que 1) las estrategias deliberadas y las emergentes coexisten y se complementan, 2) la improvisación está siempre presente en el contexto organizacional, 3) existe una mayor intensidad de la improvisación en el ‘como’ de la estrategia que en el ‘qué’ y, en oposición a la idea convencional al respecto, 4) se requiere cierta preparación para poder improvisar de manera adecuada.

Treatment rationale study design for the MetLung trial : a randomized, double-blind phase III study of onartuzumab (MetMAb) in combination with erlotinib versus erlotinib alone in patients who have received standard chemotherapy for stage IIIB or IV met-positive non-small-cell lung cancer

We present the treatment rationale and study design of the MetLung phase III study. This study will investigate onartuzumab (MetMAb) in combination with erlotinib compared with erlotinib alone, as second- or third-line treatment, in patients with advanced non-small-cell lung cancer (NSCLC) who are Met-positive by immunohistochemistry. Approximately 490 patients (245 per treatment arm) will receive erlotinib (150 mg oral daily) plus onartuzumab or placebo (15 mg/kg intravenous every 3 weeks) until disease progression, unacceptable toxicity, patient or physician decision to discontinue, or death. The efficacy objectives of this study are to compare overall survival (OS) (primary endpoint), progression-free survival, and response rates between the 2 treatment arms. In addition, safety, quality of life, pharmacokinetics, and translational research will be investigated across treatment arms. If the primary objective (OS) is achieved, this study will provide robust results toward an alternative treatment option for patients with Met-positive second- or third-line NSCLC. © 2012 Elsevier Inc. All Rights Reserved.

Typing early Australian healthcare-associated MRSA : confirmation of major clones and emergence of ST1-MRSA-IV and novel ST2249-MRSA-III

AIMS: To investigate the evolutionary origins of Australian healthcare-associated (HCA) methicillin-resistant Staphylococcus aureus (MRSA) strains from a panel of historical isolates typed using current genotyping techniques. METHODS: Nineteen MRSA isolates from 1965 to 1981 were examined and antibiotic susceptibility profiles determined. Genetic characterisation included real-time (RT) polymerase chain reaction (PCR) assays to identify single nucleotide polymorhpism (SNP) clonal complexes (SNP CC) and sequence type (SNP ST), multi locus sequence typing (MLST) and staphylococcal chromosomal cassette mec typing. RESULTS: All SNP CC30 isolates belonged to a novel sequence type, ST2249. All SNP CC239 isolates were confirmed as ST239-MRSA-III, except for a new single locus variant of ST239, ST2275. A further new type, ST2276, was identified. CONCLUSIONS: The earliest MRSA examined from 1965 was confirmed as ST250-MRSA-I, consistent with archaic European types. Identification of ST1-MRSA-IV in 1981 is the earliest appearance of this clinically important lineage which manifested in Australia and the United States in the 1990s. A previously unknown multi-resistant clone, ST2249-MRSA-III, was identified from 1973. Gentamicin resistance first appeared in this novel strain from 1976 and not ST239 as previously suspected. Thus, ST2249 was present in the earliest phase of the HCA MRSA epidemic in eastern Australia and was perhaps related to the emergence of the globally epidemic strain ST239.

Rearrangements in the cerium(IV) and manganese(III) oxidations of substituted naphthalenes and the nih shift mechanism

Ceric ammonium sulphate oxidation of 1- and 1,4- disubstituted naphthalenes gives 2- and/or 2,3- disubstituted 1,4- naphthoquinones through migration of substituents (D, Br, Ph). Similar rearrangements are also observed in the manganese(III) oxidation and also in the anodic oxidation of these substrates. The results are consistent with the proposal that these oxidations go through the formation of radical cation followed by reaction with H2O and further oxidation of the radical to the carbocationic intermediate on the way to the corresponding 1,4-naphthoquinone. Oxidation of 1,4-diphenylnaphthalene gives 2,3-diphenyl-1,4-naphthoquinone or 4-hydroxy- 2,4- diphenyl - 1(4)R - naphthalenone. The results are in accordance with the conclusion that such rearrangements do not require prior formation of arene oxide intermediates, originally proposed for the NM shift mechanism.

I. Foehn winds of southern California. II. Foehn wind cyclo-genesis. III. Weather conditions associated with the Akron disaster. IV. The Los Angeles storm of December 30, 1933 to January 1, 1934

I. Foehn winds of southern California.
An investigation of the hot, dry and dust laden winds occurring in the late fall and early winter in the Los Angeles Basin and attributed in the past to the influences of the desert regions to the north revealed that these currents were of a foehn nature. Their properties were found to be entirely due to dynamical heating produced in the descent from the high level areas in the interior to the lower Los Angeles Basin. Any dust associated with the phenomenon was found to be acquired from the Los Angeles area rather than transported from the desert. It was found that the frequency of occurrence of a mild type foehn of this nature during this season was sufficient to warrant its classification as a winter monsoon. This results from the topography of the Los Angeles region which allows an easy entrance to the air from the interior by virtue of the low level mountain passes north of the area. This monsoon provides the mild winter climate of southern California since temperatures associated with the foehn currents are far higher than those experienced when maritime air from the adjacent Pacific Ocean occupies the region.

II. Foehn wind cyclo-genesis.
Intense anticyclones frequently build up over the high level regions of the Great Basin and Columbia Plateau which lie between the Sierra Nevada and Cascade Mountains to the west and the Rocky Mountains to the east. The outflow from these anticyclones produce extensive foehns east of the Rockies in the comparatively low level areas of the middle west and the Canadian provinces of Alberta and Saskatchewan. Normally at this season of the year very cold polar continental air masses are present over this territory and with the occurrence of these foehns marked discontinuity surfaces arise between the warm foehn current, which is obliged to slide over a colder mass, and the Pc air to the east. Cyclones are easily produced from this phenomenon and take the form of unstable waves which propagate along the discontinuity surface between the two dissimilar masses. A continual series of such cyclones was found to occur as long as the Great Basin anticyclone is maintained with undiminished intensity.

III. Weather conditions associated with the Akron disaster.
This situation illustrates the speedy development and propagation of young disturbances in the eastern United States during the spring of the year under the influence of the conditionally unstable tropical maritime air masses which characterise the region. It also furnishes an excellent example of the superiority of air mass and frontal methods of weather prediction for aircraft operation over the older methods based upon pressure distribution.

IV. The Los Angeles storm of December 30, 1933 to January 1, 1934.
This discussion points out some of the fundamental interactions occurring between air masses of the North Pacific Ocean in connection with Pacific Coast storms and the value of topographic and aerological considerations in predicting them. Estimates of rainfall intensity and duration from analyses of this type may be made and would prove very valuable in the Los Angeles area in connection with flood control problems.

Heteroepitaxy of Group IV and Group III-V semiconductor alloys for photovoltaic applications

Photovoltaic energy conversion represents a economically viable technology for realizing collection of the largest energy resource known to the Earth -- the sun. Energy conversion efficiency is the most leveraging factor in the price of energy derived from this process. This thesis focuses on two routes for high efficiency, low cost devices: first, to use Group IV semiconductor alloy wire array bottom cells and epitaxially grown Group III-V compound semiconductor alloy top cells in a tandem configuration, and second, GaP growth on planar Si for heterojunction and tandem cell applications.

Metal catalyzed vapor-liquid-solid grown microwire arrays are an intriguing alternative for wafer-free Si and SiGe materials which can be removed as flexible membranes. Selected area Cu-catalyzed vapor-liquid solid growth of SiGe microwires is achieved using chlorosilane and chlorogermane precursors. The composition can be tuned up to 12% Ge with a simultaneous decrease in the growth rate from 7 to 1 μm/min^-1. Significant changes to the morphology were observed, including tapering and faceting on the sidewalls and along the lengths of the wires. Characterization of axial and radial cross sections with transmission electron microscopy revealed no evidence of defects at facet corners and edges, and the tapering is shown to be due to in-situ removal of catalyst material during growth. X-ray diffraction and transmission electron microscopy reveal a Ge-rich crystal at the tip of the wires, strongly suggesting that the Ge incorporation is limited by the crystallization rate.

Tandem Ga_1-xIn_xP/Si microwire array solar cells are a route towards a high efficiency, low cost, flexible, wafer-free solar technology. Realizing tandem Group III-V compound semiconductor/Si wire array devices requires optimization of materials growth and device performance. GaP and Ga_1-xIn_xP layers were grown heteroepitaxially with metalorganic chemical vapor deposition on Si microwire array substrates. The layer morphology and crystalline quality have been studied with scanning electron microscopy and transmission electron microscopy, and they provide a baseline for the growth and characterization of a full device stack. Ultimately, the complexity of the substrates and the prevalence of defects resulted in material without detectable photoluminescence, unsuitable for optoelectronic applications.

Coupled full-field optical and device physics simulations of a Ga_0.51In_0.49P/Si wire array tandem are used to predict device performance. A 500 nm thick, highly doped "buffer" layer between the bottom cell and tunnel junction is assumed to harbor a high density of lattice mismatch and heteroepitaxial defects. Under simulated AM1.5G illumination, the device structure explored in this work has a simulated efficiency of 23.84% with realistic top cell SRH lifetimes and surface recombination velocities. The relative insensitivity to surface recombination is likely due to optical generation further away from the free surfaces and interfaces of the device structure.

Finally, GaP has been grown free of antiphase domains on Si (112) oriented substrates using metalorganic chemical vapor deposition. Low temperature pulsed nucleation is followed by high temperature continuous growth, yielding smooth, specular thin films. Atomic force microscopy topography mapping showed very smooth surfaces (4-6 Å RMS roughness) with small depressions in the surface. Thin films (~ 50 nm) were pseudomorphic, as confirmed by high resolution x-ray diffraction reciprocal space mapping, and 200 nm thick films showed full relaxation. Transmission electron microscopy showed no evidence of antiphase domain formation, but there is a population of microtwin and stacking fault defects.

Caracterização das lesões impalpáveis (lesões III E IV), e das alterações em TP53 (p53) na detecção precoce do câncer de mama

As lesões impalpáveis da mama que muitas das vezes são assintomáticas, podem corresponder à um estágio de progressão de câncer difícil de ser detectado, durante os exames de rotina de palpação da mulher. O único método possível para a descoberta dessas lesões é através dos exames de imagem da mama, de modo geral, através da mamografia, que geralmente ocorre após os 45 anos. Devido a esses fatores, lesões impalpáveis, são frequentemente, descobertas apenas quando o estágio de desenvolvimento da doença já está avançado e as intervenções terapêuticas são menos reparadoras. Com a finalidade de iniciar a caracterização de tumores impalpáveis iniciais, objetivamos analisar o perfil genético (mutação) e epigenético (metilação de região promotora) de regiões do DNA relacionadas ao gene supressor tumoral TP53, provenientes de biópsias de mulheres residentes do Estado do Rio de Janeiro. Neste trabalho, foram investigadas 34 amostras de tecido de tumor de mama, por sequenciamento de DNA, nos exons de 5 a 8 do gene TP53. Nesta região, não foi encontrada nenhuma mutação. Este resultado pode estar relacionado ao tipo inicial de lesão, de acordo com os dados radiológicos das lesões de categorias 3 e 4 da escala BIRADS. Para verificar o estado de metilação da região promotora do gene TP53, analisamos 30 pares de amostras (sangue e tumor) de pacientes com suspeita de câncer de mama, pela técnica MSP-PCR. Nenhuma amostra tumoral apresentou alteração no estado de metilação na região promotora do gene TP53, quando comparada à amostra normal. Um motivo possível para a disparidade de resultados em relação à outros trabalhos pode ter sido a utilização da técnica. A caracterização das lesões impalpáveis apenas foi iniciada neste trabalho, no qual pudemos constatar que a mutação em TP53 pode ser um evento mais tardio. Portanto, a lesão mamária, em suas diferentes formas, continuará a ser o assunto investigado por nosso grupo, ampliando o número de amostras e alcançando melhor conexão da conduta e dos métodos clínicos já existentes, com as novas possibilidades de diagnóstico via marcadores moleculares em tumores e fluidos biológicos