Cognitive remediation therapy: Does it generalize to significant outcome areas?

Objective: Cognitive remediation therapy (CRT) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia. However, there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome and negative symptoms. Method: This 8-site randomized controlled trial evaluated the efficacy of a novel cognitive-behavioral group therapy approach called integrated neurocognitive therapy (INT). INT includes manual-based exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative by compensation and restitution. One hundred and fifty-six outpatients with a diagnosis of schizophrenia or schizoaffective disorder accord- ing to DSM-IV-TR were randomly assigned to receive 15 weeks of INT or treatment as usual (TAU). INT patients received 30 bi-weekly therapy sessions. Each session lasted 90min. Mixed models were applied to assess changes in neurocognition, social cognition, symptoms, and functional outcome at post-treatment and at 9-month follow-up. Results: Compared to TAU, INT patients showed significant improvements on multiple neuro- and social-cognitive domains, negative symptoms, and functional outcome after therapy and at 9-month follow-up. Number-needed-to-treat analyses indicate that only five INT patients are necessary to produce durable and meaningful improvements in functional outcome. Conclusions: Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome and negative symptoms. These findings are important as treatment guidelines for schizophrenia have criticized CRT for their poor generalization effects.

A novel organ-slice culturing system to simulate meniscal repair: Proof of concept using a synovium-based pool of meniscoprogenitor cells.

Meniscal injuries can occur secondary to trauma or be instigated by the changes in knee-joint function that are associated with aging, osteo- and rheumatoid arthritis, disturbances in gait and obesity. Sixty per cent of persons over 50 years of age manifest signs of meniscal pathology. The surgical and arthroscopic measures that are currently implemented to treat meniscal deficiencies bring only transient relief from pain and effect but a temporary improvement in joint function. Although tissue-engineering-based approaches to meniscal repair are now being pursued, an appropriate in-vitro model has not been conceived. The aim of this study was to develop an organ-slice culturing system to simulate the repair of human meniscal lesions in vitro. The model consists of a ring of bovine meniscus enclosing a chamber that represents the defect and reproduces its sequestered physiological microenvironment. The defect, which is closed with a porous membrane, is filled with fragments of synovial tissue, as a source of meniscoprogenitor cells, and a fibrin-embedded, calcium-phosphate-entrapped depot of the meniscogenic agents BMP-2 and TGF-ß1. After culturing for 2 to 6 weeks, the constructs were evaluated histochemically and histomorphometrically, as well as immunohistochemically for the apoptotic marker caspase 3 and collagen types I and II. Under the defined conditions, the fragments of synovium underwent differentiation into meniscal tissue, which bonded with the parent meniscal wall. Both the parent and the neoformed meniscal tissue survived the duration of the culturing period without significant cell losses. The concept on which the in-vitro system is based was thus validated. This article is protected by copyright. All rights reserved.

Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus

INTRODUCTION Daylight-mediated photodynamic therapy has been shown to be an effective therapy for actinic keratoses (AKs) and a simple and tolerable treatment procedure in three randomized Scandinavian studies and two recent Phase III randomized controlled studies in Australia and Europe. OBJECTIVES To establish consensus recommendations for the use of daylight photodynamic therapy (DL-PDT) using topical methyl aminolaevulinate (MAL) in European patients with AKs. METHODS The DL-PDT consensus recommendations were developed on behalf of the European Society for Photodynamic Therapy in Dermatology and comprised of 10 dermatologists from different European countries with experience in how to treat AK patients with PDT. Consensus was developed based on literature review and experience of the experts in the treatment of AK using DL-PDT. RESULTS The recommendations arising from this panel of experts provide general guidance on the use of DL-PDT as a dermatological procedure with specific guidance regarding patient selection, therapeutic indications, when to treat, pre-treatment skin preparation, MAL application and daylight exposure for patients with AK in different countries of Europe. CONCLUSIONS This consensus recommendation provides a framework for physicians to perform DL-PDT with MAL cream while ensuring efficiency and safety in the treatment of patients with AK in different European countries.

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys.

OBJECTIVES Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. DESIGN Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. SETTING All PCPs in the canton of Vaud, Switzerland. PARTICIPANTS Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. INTERVENTION A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. OUTCOME MEASURES The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. RESULTS Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001). CONCLUSIONS An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.

Using Leading Indicators to Forecast US Home Sales in a Bayesian VAR Framework

This paper uses Bayesian vector autoregressive models to examine the usefulness of leading indicators in predicting US home sales. The benchmark Bayesian model includes home sales, the price of homes, the mortgage rate, real personal disposable income, and the unemployment rate. We evaluate the forecasting performance of six alternative leading indicators by adding each, in turn, to the benchmark model. Out-of-sample forecast performance over three periods shows that the model that includes building permits authorized consistently produces the most accurate forecasts. Thus, the intention to build in the future provides good information with which to predict home sales. Another finding suggests that leading indicators with longer leads outperform the short-leading indicators.

Are there age-, strain-, and sex-differences in the prolonged exposure to methylphenidate?

Repeated treatment with psychostimulants produces behavioral sensitization that results in increased locomotor responses so that lower drug doses are required to obtain the same effect and cross-sensitization with other stimulants. Methylphenidate (MPD; Ritalin) is most frequently prescribed to treat children having attention deficit hyperactivity disorder (ADHD), a syndrome with onset in childhood characterized by high levels of inattention, hyperactivity, and impulsivity. Little is known of the consequences involving the long-term use of MPD as treatment for ADHD. This study investigates if there are age, genetic/strain, and sex differences in the prolonged exposure to MPD and cross-sensitization with amphetamine. The objective is to determine whether (a) early exposure to MPD in adolescent rats increases their sensitivity to the drug when they are adult rats, (b) there are strain and sex differences in the response to MPD, and (c) treatment with MPD in adolescent and adult Wistar-Kyoto (WKY), spontaneously hyperactive/hypertensive rat (SHR), and Sprague-Dawley (SD) rat results in cross-sensitization with amphetamine. The hypotheses are that (1) early exposure to MPD in adolescent rats increases their sensitivity to the drug when they reach adulthood, and that this hypersensitivity is dose-, strain-, and sex-dependent and (2) adult rats treated with MPD as adolescents will show a greater cross-sensitization to amphetamine than those adult rats treated with saline as adolescents, and that this cross-sensitization is dose-, strain-, and sex-dependent. The study consists of recording and evaluating locomotor activity of female and male WKY, SHR, and SD rats before and after acute and repeated MPD administration when these rats are young and as adults follows by an amphetamine treatment. Results showed that repeated treatment with MPD elicited behavioral sensitization and cross-sensitization with amphetamine in these animals. The study also found that strain and sex play a crucial role in the differentiated sensitivity to the acute and chronic effects of MPD. The development of behavioral sensitization and cross-sensitization are also dependent on the dose of MPD and the age of the rat. ^

Physician's adherence to the standard protocol for diabetes treatment in Brooke Army Medical Center (BAMC)

The level of compliance with clinical practice guidelines for patients with Type II Diabetes Mellitus was evaluated in 157 patients treated at BAMC from 1 January 2006 to 1 January 2007. This retrospective analysis was conducted reviewing data from medical records and following the VA/DOD protocols that health care providers are expected to follow at this facility. Data collected included patient’s age and gender, presence or absence of complications of diabetes, physical examination findings, glycemic and lipid control, eye care, foot care, kidney function, and self-management and education. Subjects were selected performing systematic random sampling, and included both male and female patients, from a variety of ages and ethnic groups. The Diabetes complications screened for included glycemic and lipid complications, retinopathy, cardiovascular complications, peripheral circulation complications, and nephropathy. The results revealed that 19.10% had no complications and that the most common complications were: cardiovascular (49.68%), glycemic and lipid control (10.82%), retinopathy and peripheral circulation (8.28% each), and nephropathy (2.54%). Only 2.54% of the records reviewed did not include information on complications. Strictly following the Department of Defense guidelines, six treatment modules were evaluated independently and together to get a final percentage of adherence to the clinical practice guidelines. It was established that the level of adherence was going to be graded as follows: Extremely deficient: 0-15%; very poor: 16-30%; Poor and in need of improvement: 31-45%. Acceptable: 46-60%; Good: 61-80%, and Excellent: 81-100%. The results indicated that the percentage of physicians' adherence to each protocol was as follows: 88.31%, 89.93%, 90.63%, 89.42%, 89.42% and 89.64%. When the results were pooled, the level of adherence to the clinical practice guidelines was 89.55%, proving my hypothesis that Brooke Army Medical Center physicians have excellent adherence to the standard protocols for Diabetes Type II to treat their patients. ^

The effect of exposure to antibiotics on incidence and spontaneous clearance of childhood Helicobacter pylori infection

It is claimed often in the H. pylori literature that spontaneous clearance (infection loss without attempts to treat) is uncommon, though little evidence supports this claim. Emerging evidence suggests that spontaneous clearance may be frequent in young children; however, factors that determine persistence of untreated H. pylori infection in childhood are not well understood. The author hypothesized that antibiotics taken for common infections cause spontaneous clearance of H. pylori infection in children. The Pasitos Cohort Study (19982005) investigated predictors of acquisition and persistence of H. pylori infection in children from El Paso, Texas, and Juarez, Mexico, enrolled prenatally at maternal-child clinics. Children were screened for infection at target intervals of 6 months from 6-84 months of age by the 13C-urea breath test corrected for body-size-dependent variation in CO2 production. This dissertation aimed to estimate the risk of spontaneous clearance at the next test following an initial detected H. pylori infection (first detected clearance), estimate the effect of antibiotic exposure on the risk of first detected clearance (risk difference), and estimate the effect of antibiotic exposure on the rate of first detected infection (rate ratio). Data on infection status and medication history were available for 608 children followed for a mean of 3.5 years. Among 265 subjects with a first detected infection, 218 had a subsequent test, and among them, the risk of first detected clearance was 68% (95% CI: 61-74%). Children who took antibiotics during the interval between first detected infection and next test had an increased probability (risk difference of 10 percentage points) of a first detected clearance. However, there was also a similar effect of average antibiotic use >0 courses across all intervals preceding the next test. Average antibiotic exposure across all intervals preceding the first detected infection appeared to have a much stronger protective effect than interval/specific exposure when estimating incidence rate ratios (0.45 vs. 1.0). Incidental antibiotic exposure appears to influence the acquisition and duration of childhood H. pylori infection, however, given that many exposed children acquired the infection and many unexposed children cleared the infection, antibiotic exposure does not explain all infection events. ^

Relevant drug to drug interactions between itraconazole and non-nucleoside reverse transcriptase inhibitors in HIV-infected patients on maintenance therapy for disseminated histoplasmosis

Objective. Itraconazole is recommended life-long for preventing relapse of disseminated histoplasmosis in HIV-infected patients. I sought to determine if serum itraconazole levels are affected by the type of Highly Active Anti-Retroviral Therapy (NNRTI or PI) being taken concomitantly to treat HIV. ^ Design. Retrospective cohort. ^ Methods. De-identified data were used from an IRB-approved parent study which identified patients on HAART and maintenance itraconazole for confirmed disseminated histoplasmosis between January 2003 and December 2006. Available itraconazole blood levels were abstracted as well as medications taken by each patient at the time of the blood tests. Mean itraconazole levels were compared using the student's t-test. ^ Results. 11 patients met study criteria. Patient characteristics were: median age 36, 91% men, 18% white, 18% black, 55% Hispanic and 9% Asians, median CD4 cell count 120 cells/mm3. 14 blood levels were available for analysis—8 on PI, 4 on NNRTI and 2 on both. 8/8 itraconazole levels obtained while taking concomitant PI were therapeutic (>0.4 μg/mL) in contrast to 0/4 obtained while taking NNRTI. Two patients switched from NNRTI to PI and reached therapeutic levels. Mean levels on NNRTI (0.05 μg/mL, s.d. 0.0) and on PI (2.45 μg/mL, s.d. 0.21) for these two patients were compared via a paired t-test (t = 16.00, d.f. = 1, P = 0.04). Remaining patient levels were compared using an unpaired t-test. Mean itraconazole on concomitant PI (n = 6) was 1.37 μg/mL (s.d. 0.74), while the mean on concomitant NNRTI was 0.05 μg/mL (s.d. 0.0), t = 2.39, d.f. = 6, P = 0.05. ^ Conclusions. Co-administration of NNRTI and itraconazole results in significant decreases in itraconazole blood levels, likely by inducing the CYP3A4 enzyme system. Itraconazole drug levels should be monitored in patients on concomitant NNRTI. PI-based HAART may be preferred over NNRTI-based HAART when using itraconazole to treat HIV-infected patients with disseminated histoplasmosis. ^

Barriers to adolescent and young men's access of reproductive health care

Purpose. The purpose of this study was to identify the health needs and barriers that young men face in accessing health care and family planning services and to identify what health centers can do to attract young men to the clinic. A focus group format was used to elicit ideas from participants. ^ Methods. Forty-eight young men participated in nine focus groups. The young men were asked about the health issues they have, the barriers they face in accessing reproductive health care, and what clinics can do to attract young men to the clinic. Thematic analysis principles were used to identify the main themes that emerged in the focus groups. ^ Results. Sexually transmitted infections (STIs), mental health problems, and drug use were the major health issues that were mentioned in the majority of the focus groups. The main barriers discussed in the focus groups were attitudinal factors such as young men thinking it is unmanly to seek help, emotional factors such as young men not seeking help because of their ego or pride, and institutional factors such as the location of the clinic. The main suggestions for improvements in the health clinic included decreasing waiting times, emphasizing the fact that the clinics are free for males, having more female nurses, and encouraging clinic staff to treat the young men with respect. Young men suggested advertising and promoting the clinic in schools, in the community, and through the media. Focus group participants also provided their input about the design and format of the clinic flyer. ^ Conclusions. Many studies focus on the reproductive health care needs of adolescent and young females. This study has helped to show that young men also have health care needs and face barriers to accessing reproductive health care services.^

Rifaximin-mediated changes to the epithelial cell proteome: 2-D gel analysis

Diarrhea remains a significant cause of worldwide morbidity and mortality. Over 4 million children die of diarrhea annually. Although antibiotics can be used as prophylaxis or for treatment of diarrhea, concern remains over antibiotic resistance. Rifaximin is a semi-synthetic rifamycin derivative that can be used to treat symptoms of infectious diarrhea, inflammatory bowel syndrome, bacterial overgrowth of the small bowel, pouchitis, and fulminant ulcerative colitis. Rifaximin is of particular interest because it is poorly adsorbed in the intestines, shows no indication of inducing bacterial resistance, and has minimal effect on intestinal flora. In order to better understand how rifaximin functions, we sought to compare the protein expression profile of cells pretreated with rifaximin, as compared to cells treated with acetone, rifamycin (control antibiotic), or media (untreated). 2-D gel electrophoresis identified 38 protein spots that were up- or down-regulated by over 2-fold in rifaximin treated cells compared to controls. 16 of these spots were down-regulated, including keratin, annexin A5, intestinal-type alkaline phosphatase, histone h4, and histone-binding protein RbbP4. 22 spots were up-regulated, including heat shock protein HSP 90 alpha, alkaline phosphatase, and fascin. Many of the identified proteins are associated with cell structure and cytoskeleton, transcription and translation, and cellular metabolism. A better understanding of the functionality of rifaximin will identify additional potential uses for rifaximin and determine for whom the drug is best suited. ^

Circumvention of cellular defense responses to DNA -directed nucleoside analogues by the protein kinase inhibitor, UCN-01

DNA-directed nucleoside analogues, such as ara-C, fludarabine, and gemcitabine, are antimetabolites effective in the treatment of a variety of cancers. However, resistance to nucleoside analogue-based chemotherapy in treatments is still a major problem in therapy. Therefore, it is essential to develop rationales for optimizing the use of nucleoside analogues in combination with other anticancer drugs or modalities such as radiation. The present study focuses on establishing mechanism-based combination strategy to overcome resistance to nucleoside analogues. ^ I hypothesized that the cytostatic concentrations of nucleoside analogues may cause S-phase arrest by activating an S-phase checkpoint that consists of a series of kinases. This may allow cells to repair damaged DNA over time and spare cytotoxicity. Thus, the ability of cells to enact an S-phase arrest in response to incorporation of potentially lethal amounts of nucleoside analogue may serve as a mechanism of resistance to S-phase-specific agents. As a corollary, the addition of a kinase inhibitor, such as UCN-01, may dysregulate the checkpoint response and abrogate the survival of S-phase-arrested cells by suppression of the survival signaling pathways. Using gemcitabine as a model of S-phase-specific nucleoside analogues in human acute myelogenous leukemia ML-1 cells, I demonstrated that cells arrested in S-phase in response to cytostatic conditions. Proliferation continued after washing the cells into drug-free medium, suggesting S-phase arrest served as a resistance mechanism of cancer cells to spare cytotoxicity of nucleoside analogues. However, nontoxic concentrations of UCN-01 rapidly killed S-phase-arrested cells by apoptosis. Furthermore, the molecular mechanism for UCN-01-induced apoptosis in S-phase-arrested cells was through inhibition of survival pathways associated with these cells. In this regard, suppression of the PI 3-kinase-Akt-Bad survival pathway as well as the NF-κB signaling pathway were associated with induction of apoptosis in S-phase-arrested cells by UCN-01, whereas the Ras-Raf-MEK-ERK pathway appeared not involved. This study has provided the rationales and strategies for optimizing the design of effective combination therapies to overcome resistance to nucleoside analogues. In fact, a clinical trial of the combination of ara-C with UCN-01 to treat relapsed or refractory AML patients has been initiated at U.T.M.D. Anderson Cancer Center. ^

The Experience of the National Rainbow Coalition (NARC) : Political Parties in Kenya from 1991 to 2007

This paper first examines splits and mergers among Kenya’s political parties (and inner-party factions) from the restoration of a multi-party system in 1991 until 2007, before the turbulent 10th general elections were conducted. It then considers what functions “political parties” have in Kenya with special reference to the period since 2002, the year in which President Moi announced his intention to retire. A look back at NARC’s five years of rule reveals that, although it succeeded in changing the government, NARC, as a “political party,” remained throughout an organization without any real substance. The paper looks at (1) NARC’s de facto split after its overwhelming win in the ninth general election, (2) malfunctions of the anti-defection laws that were introduced in the 1960s, and (3) Kenya’s election rules that require candidates to be nominated by registered political parties in general elections. The paper proceeds to argue that as a result of the operation of these three elements, Kenya’s political parties, and especially the victorious coalition sides, tend to end up being nothing more than temporary vehicles for political elites angling for post-election posts.

From eventual to atomic and locally atomic CC programs: A concurrent semantics

We present a concurrent semantics (i.e. a semantics where concurrency is explicitely represented) for CC programs with atomic tells. This allows to derive concurrency, dependency, and nondeterminism information for such languages. The ability to treat failure information puts CLP programs also in the range of applicability of our semantics: although such programs are not concurrent, the concurrency information derived in the semantics may be interpreted as possible parallelism, thus allowing to safely parallelize those computation steps which appear to be concurrent in the net. Dually, the dependency information may also be interpreted as necessary sequentialization, thus possibly exploiting it to schedule CC programs. The fact that the semantical structure contains dependency information suggests a new tell operation, which checks for consistency only the constraints it depends on, achieving a reasonable trade-off between efficiency and atomicity.

Multiphase Design and Control Techniques Applied to a Forward Micro-Inverter

En la última década la potencia instalada de energía solar fotovoltaica ha crecido una media de un 49% anual y se espera que alcance el 16%del consumo energético mundial en el año 2050. La mayor parte de estas instalaciones se corresponden con sistemas conectados a la red eléctrica y un amplio porcentaje de ellas son instalaciones domésticas o en edificios. En el mercado ya existen diferentes arquitecturas para este tipo de instalaciones, entre las que se encuentras los módulos AC. Un módulo AC consiste en un inversor, también conocido como micro-inversor, que se monta en la parte trasera de un panel o módulo fotovoltaico. Esta tecnología ofrece modularidad, redundancia y la extracción de la máxima potencia de cada panel solar de la instalación. Además, la expansión de esta tecnología posibilitará una reducción de costes asociados a las economías de escala y a la posibilidad de que el propio usuario pueda componer su propio sistema. Sin embargo, el micro-inversor debe ser capaz de proporcionar una ganancia de tensión adecuada para conectar el panel solar directamente a la red, mientras mantiene un rendimiento aceptable en un amplio rango de potencias. Asimismo, los estándares de conexión a red deber ser satisfechos y el tamaño y el tiempo de vida del micro-inversor son factores que han de tenerse siempre en cuenta. En esta tesis se propone un micro-inversor derivado de la topología “forward” controlado en el límite entre los modos de conducción continuo y discontinuo (BCM por sus siglas en inglés). El transformador de la topología propuesta mantiene la misma estructura que en el convertidor “forward” clásico y la utilización de interruptores bidireccionales en el secundario permite la conexión directa del inversor a la red. Asimismo el método de control elegido permite obtener factor de potencia cercano a la unidad con una implementación sencilla. En la tesis se presenta el principio de funcionamiento y los principales aspectos del diseño del micro-inversor propuesto. Con la idea de mantener una solución sencilla y de bajo coste, se ha seleccionado un controlador analógico que está originalmente pensado para controlar un corrector del factor de potencia en el mismo modo de conducción que el micro-inversor “forward”. La tesis presenta las principales modificaciones necesarias, con especial atención a la detección del cruce por cero de la corriente (ZCD por sus siglas en inglés) y la compatibilidad del controlador con la inclusión de un algoritmo de búsqueda del punto de máxima potencia (MPPT por sus siglas en inglés). Los resultados experimentales muestran las limitaciones de la implementación elegida e identifican al transformador como el principal contribuyente a las pérdidas del micro-inversor. El principal objetivo de esta tesis es contribuir a la aplicación de técnicas de control y diseño de sistemas multifase en micro-inversores fotovoltaicos. En esta tesis se van a considerar dos configuraciones multifase diferentes aplicadas al micro-inversor “forward” propuesto. La primera consiste en una variación con conexión paralelo-serie que permite la utilización de transformadores con una relación de vueltas baja, y por tanto bien acoplados, para conseguir una ganancia de tensión adecuada con un mejor rendimiento. Esta configuración emplea el mismo control BCM cuando la potencia extraída del panel solar es máxima. Este método de control implica que la frecuencia de conmutación se incrementa considerablemente cuando la potencia decrece, lo que compromete el rendimiento. Por lo tanto y con la intención de mantener unos bueno niveles de rendimiento ponderado, el micro-inversor funciona en modo de conducción discontinuo (DCM, por sus siglas en inglés) cuando la potencia extraía del panel solar es menor que la máxima. La segunda configuración multifase considerada en esta tesis es la aplicación de la técnica de paralelo con entrelazado. Además se han considerado dos técnicas diferentes para decidir el número de fases activas: dependiendo de la potencia continua extraída del panel solar y dependiendo de la potencia instantánea demandada por el micro-inversor. La aplicación de estas técnicas es interesante en los sistemas fotovoltaicos conectados a la red eléctrica por la posibilidad que brindan de obtener un rendimiento prácticamente plano en un amplio rango de potencia. Las configuraciones con entrelazado se controlan en DCM para evitar la necesidad de un control de corriente, lo que es importante cuando el número de fases es alto. Los núcleos adecuados para todas las configuraciones multifase consideradas se seleccionan usando el producto de áreas. Una vez seleccionados los núcleos se ha realizado un diseño detallado de cada uno de los transformadores. Con la información obtenida de los diseños y los resultados de simulación, se puede analizar el impacto que el número de transformadores utilizados tiene en el tamaño y el rendimiento de las distintas configuraciones. Los resultados de este análisis, presentado en esta tesis, se utilizan posteriormente para comparar las distintas configuraciones. Muchas otras topologías se han presentado en la literatura para abordar los diferentes aspectos a considerar en los micro-inversores, que han sido presentados anteriormente. La mayoría de estas topologías utilizan un transformador de alta frecuencia para solventar el salto de tensión y evitar problemas de seguridad y de puesta a tierra. En cualquier caso, es interesante evaluar si topologías sin aislamiento galvánico son aptas para su utilización como micro-inversores. En esta tesis se presenta una revisión de inversores con capacidad de elevar tensión, que se comparan bajo las mismas especificaciones. El objetivo es proporcionar la información necesaria para valorar si estas topologías son aplicables en los módulos AC. Las principales contribuciones de esta tesis son: • La aplicación del control BCM a un convertidor “forward” para obtener un micro-inversor de una etapa sencillo y de bajo coste. • La modificación de dicho micro-inversor con conexión paralelo-series de transformadores que permite reducir la corriente de los semiconductores y una ganancia de tensión adecuada con transformadores altamente acoplados. • La aplicación de técnicas de entrelazado y decisión de apagado de fases en la puesta en paralelo del micro-inversor “forward”. • El análisis y la comparación del efecto en el tamaño y el rendimiento del incremento del número de transformadores en las diferentes configuraciones multifase. • La eliminación de las medidas y los lazos de control de corriente en las topologías multifase con la utilización del modo de conducción discontinuo y un algoritmo MPPT sin necesidad de medida de corriente. • La recopilación y comparación bajo las mismas especificaciones de topologías inversoras con capacidad de elevar tensión, que pueden ser adecuadas para la utilización como micro-inversores. Esta tesis está estructurada en seis capítulos. El capítulo 1 presenta el marco en que se desarrolla la tesis así como el alcance de la misma. En el capítulo 2 se recopilan las topologías existentes de micro-invesores con aislamiento y aquellas sin aislamiento cuya implementación en un módulo AC es factible. Asimismo se presenta la comparación entre estas topologías bajo las mismas especificaciones. El capítulo 3 se centra en el micro-inversor “forward” que se propone originalmente en esta tesis. La aplicación de las técnicas multifase se aborda en los capítulos 4 y 5, en los que se presentan los análisis en función del número de transformadores. El capítulo está orientado a la propuesta paralelo-serie mientras que la configuración con entrelazado se analiza en el capítulo 5. Por último, en el capítulo 6 se presentan las contribuciones de esta tesis y los trabajos futuros. ABSTRACT In the last decade the photovoltaic (PV) installed power increased with an average growth of 49% per year and it is expected to cover the 16% of the global electricity consumption by 2050. Most of the installed PV power corresponds to grid-connected systems, with a significant percentage of residential installations. In these PV systems, the inverter is essential since it is the responsible of transferring into the grid the extracted power from the PV modules. Several architectures have been proposed for grid-connected residential PV systems, including the AC-module technology. An AC-module consists of an inverter, also known as micro-inverter, which is attached to a PV module. The AC-module technology offers modularity, redundancy and individual MPPT of each module. In addition, the expansion of this technology will enable the possibility of economies of scale of mass market and “plug and play” for the user, thus reducing the overall cost of the installation. However, the micro-inverter must be able to provide the required voltage boost to interface a low voltage PV module to the grid while keeping an acceptable efficiency in a wide power range. Furthermore, the quality standards must be satisfied and size and lifetime of the solutions must be always considered. In this thesis a single-stage forward micro-inverter with boundary mode operation is proposed to address the micro-inverter requirements. The transformer in the proposed topology remains as in the classic forward converter and bidirectional switches in the secondary side allows direct connection to the grid. In addition the selected control strategy allows high power factor current with a simple implementation. The operation of the topology is presented and the main design issues are introduced. With the intention to propose a simple and low-cost solution, an analog controller for a PFC operated in boundary mode is utilized. The main necessary modifications are discussed, with the focus on the zero current detection (ZCD) and the compatibility of the controller with a MPPT algorithm. The experimental results show the limitations of the selected analog controller implementation and the transformer is identified as a main losses contributor. The main objective of this thesis is to contribute in the application of control and design multiphase techniques to the PV micro-inverters. Two different multiphase configurations have been applied to the forward micro-inverter proposed in this thesis. The first one consists of a parallel-series connected variation which enables the use of low turns ratio, i.e. well coupled, transformers to achieve a proper voltage boost with an improved performance. This multiphase configuration implements BCM control at maximum load however. With this control method the switching frequency increases significantly for light load operation, thus jeopardizing the efficiency. Therefore, in order to keep acceptable weighted efficiency levels, DCM operation is selected for low power conditions. The second multiphase variation considered in this thesis is the interleaved configuration with two different phase shedding techniques: depending on the DC power extracted from the PV panel, and depending on the demanded instantaneous power. The application of interleaving techniques is interesting in PV grid-connected inverters for the possibility of flat efficiency behavior in a wide power range. The interleaved variations of the proposed forward micro-inverter are operated in DCM to avoid the current loop, which is important when the number of phases is large. The adequate transformer cores for all the multiphase configurations are selected according to the area product parameter and a detailed design of each required transformer is developed. With this information and simulation results, the impact in size and efficiency of the number of transformer used can be assessed. The considered multiphase topologies are compared in this thesis according to the results of the introduced analysis. Several other topological solutions have been proposed to solve the mentioned concerns in AC-module application. The most of these solutions use a high frequency transformer to boost the voltage and avoid grounding and safety issues. However, it is of interest to assess if the non-isolated topologies are suitable for AC-module application. In this thesis a review of transformerless step-up inverters is presented. The compiled topologies are compared using a set benchmark to provide the necessary information to assess whether non-isolated topologies are suitable for AC-module application. The main contributions of this thesis are: • The application of the boundary mode control with constant off-time to a forward converter, to obtain a simple and low-cost single-stage forward micro-inverter. • A modification of the forward micro-inverter with primary-parallel secondary-series connected transformers to reduce the current stress and improve the voltage gain with highly coupled transformers. •The application of the interleaved configuration with different phase shedding strategies to the proposed forward micro-inverter. • An analysis and comparison of the influence in size and efficiency of increasing the number of transformers in the parallel-series and interleaved multiphase configurations. • Elimination of the current loop and current measurements in the multiphase topologies by adopting DCM operation and a current sensorless MPPT. • A compilation and comparison with the same specifications of suitable non-isolated step-up inverters. This thesis is organized in six chapters. In Chapter 1 the background of single-phase PV-connected systems is discussed and the scope of the thesis is defined. Chapter 2 compiles the existing solutions for isolated micro-inverters and transformerless step-up inverters suitable for AC-module application. In addition, the most convenient non-isolated inverters are compared using a defined benchmark. Chapter 3 focuses on the originally proposed single-stage forward micro-inverter. The application of multiphase techniques is addressed in Chapter 4 and Chapter 5, and the impact in different parameters of increasing the number of phases is analyzed. In Chapter 4 an original primary-parallel secondary-series variation of the forward micro-inverter is presented, while Chapter 5 focuses on the application of the interleaved configuration. Finally, Chapter 6 discusses the contributions of the thesis and the future work.