Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30

Aim: To use published literature and experts' opinion to investigate the clinical meaning and magnitude of changes in the Quality of Life (QOL) of groups of patients measured with the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Methods: An innovative method combining systematic review of published studies, expert opinions and meta-analysis was used to estimate large, medium, and small mean changes over time for QLQ-C30 scores. Results: Nine hundred and eleven papers were identified, leading to 118 relevant papers. One thousand two hundred and thirty two mean changes in QOL over time were combined in the meta-analysis, with timescales ranging from four days to five years. Guidelines were produced for trivial, small, and medium size classes, for each subscale and for improving and declining scores separately. Estimates for improvements were smaller than respective estimates for declines. Conclusions: These guidelines can be used to aid sample size calculations and interpretation of mean changes over time from groups of patients. Observed mean changes in the QLQ-C30 scores are generally small in most clinical situations, possibly due to response shift. Careful consideration is needed when planning studies where QOL changes over time are of primary interest; the timing of follow up, sample attrition, direction of QOL changes, and subscales of primary interest are key considerations. (C) 2012 Elsevier Ltd. All rights reserved.

Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer

Objective: To evaluate whether immunohistochemical marker studies performed on core needle biopsy (CNB) specimens accurately reflect the marker status of the tumor obtained from final surgical specimen. Methods: This was a retrospective study that used the database of the Division of Mastology of the Hospital das Clinicas, Sao Paulo, Brazil. Sixty-nine patients submitted to ultrasound-guided CNB diagnosed with breast cancer were retrospectively analyzed. Immunohistochemistry (IHC) on core biopsy specimens was compared to that of excisional biopsy regarding estrogen receptor (ER), progesterone receptor (PR), human epidermal gowth factor receptor 2 gene (HER2), p53, and Ki67. The analysis of the concordance between CNB and surgical biopsy was performed using the kappa (k) coefficient (95% CI). Results: A perfect concordance between the labeling in the surgical specimens and the preoperative biopsies in p53 (k = 1.0; 95% CI: 0.76-1.0) was identified. There was an almost perfect concordance for ER (k = 0.89; 95% CI: 0.65-1.0) and a substantial concordance for PR (k = 0.70; 95% CI: 0.46-0.93). HER2 (k = 0.61; 95% CI: 0.38-0.84) and Ki-67 (k = 0.74; 95% CI: 0.58-0.98) obtained a substantial concordance this analysis. Conclusion: The results of this study indicate that the immunohistochemical analysis of ER, PR, Ki-67, and p53 from core biopsy specimens provided results that accurately reflect the marker status of the tumor. The concordance rate of HER2 was less consistent; although it produced substantial concordance, values were very close to moderate concordance.

Mechanical Performance of Cylindrical and Dual-Core Pedicle Screws After Repeated Insertion

Study Design. Ex vivo study of the mechanical performance of cylindrical and dual-core pedicle screws after insertion, removal, and reinsertion in the same hole. Objective. To evaluate the effect of repeated use of same screw hole on the insertion torque and the retentive strength of the cylindrical and dual-core screws. Summary of Background Data. Insertion and removal of pedicle screws is sometimes necessary during surgical procedure to assess the integrity of the pilot-hole wall. However, this maneuver may compromise the implant-holding capacity. Methods. Sixty thoracolombar vertebrae (T13-L5), harvested from 10 healthy calves, were used to insert 2 different designs of pedicle screws: cylindrical (5.0-mm outer diameter) and dual-core screws (5.2-mm outer diameter). Three experimental groups were created on the basis of the number of insertions of the screws and 2 subgroups were established according to the core pedicle screw design (dual-core and cylindrical). The insertion torque was measured during initial insertion, second insertion, and third insertion. Pullout screw tests were performed using a universal testing machine to evaluate the pullout strength after initial insertion, second insertion, and third insertion. Results. Significant reductions of 38% in mean insertion torque and 30% in mean pullout strength of dual-core screw were observed between the initial insertion and the third insertion. The cylindrical screw observed significant reductions of 52.5% in mean insertion torque and 42.3% in mean pullout strength between the initial insertion and the third insertion. A reduction of mean insertion torque and pullout strength between the first insertion and the second insertion but without significance was also observed for both types of screws. Conclusion. Insertions and reinsertion of either cylindrical or dual-core pedicle screws have compromised insertion torque and pullout strength of the implants as measured by mechanical tests.

Thermo and mechanical cycling and veneering method do not influence Y-TZP core/veneer interface bond strength

Objectives: The purpose of this study was to evaluate the influence of thermal and mechanical cycling and veneering technique on the shear bond strength of Y-TZP (yttrium oxide partially stabilized tetragonal zirconia polycrystal) core–veneer interfaces. Materials and methods: Cylindrical Y-TZP specimens were veneered either by layering (n = 20) or by pressing technique (n = 20). A metal ceramic group (CoCr) was used as control (n = 20). Ten specimens for each group were thermal and mechanical cycled and then all samples were subjected to shear bond strength in a universal testing machine with a 0.5 mm/min crosshead speed. Mean shear bond strength (MPa) was analysed with a 2-way analysis of variance and Tukey’s test ( p < 0.05). Failure mode was determined using stereomicroscopy and scanning electron microscopy (SEM). Results: Thermal and mechanical cycling had no influence on the shear bond strength for all groups. The CoCr group presented the highest bond strength value ( p < 0.05) (34.72 7.05 MPa). There was no significant difference between Y-TZP veneered by layering (22.46 2.08 MPa) or pressing (23.58 2.1 MPa) technique. Failure modes were predominantly adhesive for CoCr group, and cohesive within veneer for Y-TZP groups. Conclusions: Thermal and mechanical cycling, as well as the veneering technique does not affect Y-TZP core–veneer bond strength. Clinical significance: Different methods of veneering Y-TZP restorations would not influence the clinical performance of the core/veneer interfaces.

A core calculus for the analysis and implementation of biologically inspired languages

The application of Concurrency Theory to Systems Biology is in its earliest stage of progress. The metaphor of cells as computing systems by Regev and Shapiro opened the employment of concurrent languages for the modelling of biological systems. Their peculiar characteristics led to the design of many bio-inspired formalisms which achieve higher faithfulness and specificity. In this thesis we present pi@, an extremely simple and conservative extension of the pi-calculus representing a keystone in this respect, thanks to its expressiveness capabilities. The pi@ calculus is obtained by the addition of polyadic synchronisation and priority to the pi-calculus, in order to achieve compartment semantics and atomicity of complex operations respectively. In its direct application to biological modelling, the stochastic variant of the calculus, Spi@, is shown able to model consistently several phenomena such as formation of molecular complexes, hierarchical subdivision of the system into compartments, inter-compartment reactions, dynamic reorganisation of compartment structure consistent with volume variation. The pivotal role of pi@ is evidenced by its capability of encoding in a compositional way several bio-inspired formalisms, so that it represents the optimal core of a framework for the analysis and implementation of bio-inspired languages. In this respect, the encodings of BioAmbients, Brane Calculi and a variant of P Systems in pi@ are formalised. The conciseness of their translation in pi@ allows their indirect comparison by means of their encodings. Furthermore it provides a ready-to-run implementation of minimal effort whose correctness is granted by the correctness of the respective encoding functions. Further important results of general validity are stated on the expressive power of priority. Several impossibility results are described, which clearly state the superior expressiveness of prioritised languages and the problems arising in the attempt of providing their parallel implementation. To this aim, a new setting in distributed computing (the last man standing problem) is singled out and exploited to prove the impossibility of providing a purely parallel implementation of priority by means of point-to-point or broadcast communication.

Core-shell macromolecules with dendritic polyphenylene core and polymer shells

Core-shell macromolecules with dendritic polyphenylene core and polymer shell Zusammenfassung / Abstract Core-shell macromolecular structures have become of great interest in materials science because they gave an opportunity to combine a large variety of chemical and physical properties in the single molecule, by combination of different (in terms of chemistry and physics) cores and shells. The interest in such complex structures was provoked by their potential applications in the coating and painting industry (latexes), as supports for catalysts in polymer industry, or as nano-containers and transporters for genes or drug delivery. The aim of this study was the synthesis, characterization and further application of core-shell macromolecules possessing a hydrophobic stiff core (polyphenylene dendrimers) surrounded with a hydrophilic, soft, covalently bonded polymer shell (poly(ethylene oxide) and its copolymers). The requirements for such complex substances were that they should be well-defined in terms of molecular weight (narrow molecular weight distribution) and in molecular structure. The preparation of core-shell molecules containing dendrimer as a core was possible via two synthetic routs: “grafting-onto” and “grafting-from”. The resulting core-shell macromolecules possessed narrow polydispersity as guaranteed by the excellent structural and functional definition of the dendrimer and the narrow polydispersity of the PEO, PS-b-PEO and PI-b-PEO attached to the dendrimer surface. Additional investigation of the size of the particles indicated a relation between both the length and the number of the polymer chains and the hydrodynamic radius determined by Dynamic Light Scattering and Fluorescent Correlation Spectroscopy. Core-shell nano-particles were applied as metallocene supports in heterogeneous olefin polymerizations. Our results indicate that such catalyst systems, that have a size of at least one order of magnitude smaller than the used by now organic supports, could be very useful as model compounds for investigations on catalyst fragmentation and its influence on the product parameters.

Spinal cord injury: assessment of autonomic state-dependent control of cardiovascular system and body core temperature

Spinal cord injury (SCI) results not only in paralysis; but it is also associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. The entity of the autonomic dysfunction is related to the level and severity of injury to descending autonomic (sympathetic) pathways. For many years there was limited awareness of these issues and the attention given to them by the scientific and medical community was scarce. Yet, even if a new system to document the impact of SCI on autonomic function has recently been proposed, the current standard of assessment of SCI (American Spinal Injury Association (ASIA) examination) evaluates motor and sensory pathways, but not severity of injury to autonomic pathways. Beside the severe impact on quality of life, autonomic dysfunction in persons with SCI is associated with increased risk of cardiovascular disease and mortality. Therefore, obtaining information regarding autonomic function in persons with SCI is pivotal and clinical examinations and laboratory evaluations to detect the presence of autonomic dysfunction and quantitate its severity are mandatory. Furthermore, previous studies demonstrated that there is an intimate relationship between the autonomic nervous system and sleep from anatomical, physiological, and neurochemical points of view. Although, even if previous epidemiological studies demonstrated that sleep problems are common in spinal cord injury (SCI), so far only limited polysomnographic (PSG) data are available. Finally, until now, circadian and state dependent autonomic regulation of blood pressure (BP), heart rate (HR) and body core temperature (BcT) were never assessed in SCI patients. Aim of the current study was to establish the association between the autonomic control of the cardiovascular function and thermoregulation, sleep parameters and increased cardiovascular risk in SCI patients.

Core-shell particles and their application for superhydrophobic surfaces

During the last years great effort has been devoted to the fabrication of superhydrophobic surfaces because of their self-cleaning properties. A water drop on a superhydrophobic surface rolls off even at inclinations of only a few degrees while taking up contaminants encountered on its way. rnSuperhydrophobic, self-cleaning coatings are desirable for convenient and cost-effective maintenance of a variety of surfaces. Ideally, such coatings should be easy to make and apply, mechanically resistant, and long-term stable. None of the existing methods have yet mastered the challenge of meeting all of these criteria.rnSuperhydrophobicity is associated with surface roughness. The lotus leave, with its dual scale roughness, is one of the most efficient examples of superhydrophobic surface. This thesis work proposes a novel technique to prepare superhydrophobic surfaces that introduces the two length scale roughness by growing silica particles (~100 nm in diameter) onto micrometer-sized polystyrene particles using the well-established Stöber synthesis. Mechanical resistance is conferred to the resulting “raspberries” by the synthesis of a thin silica shell on their surface. Besides of being easy to make and handle, these particles offer the possibility for improving suitability or technical applications: since they disperse in water, multi-layers can be prepared on substrates by simple drop casting even on surfaces with grooves and slots. The solution of the main problem – stabilizing the multilayer – also lies in the design of the particles: the shells – although mechanically stable – are porous enough to allow for leakage of polystyrene from the core. Under tetrahydrofuran vapor polystyrene bridges form between the particles that render the multilayer-film stable. rnMulti-layers are good candidate to design surfaces whose roughness is preserved after scratch. If the top-most layer is removed, the roughness can still be ensured by the underlying layer.rnAfter hydrophobization by chemical vapor deposition (CVD) of a semi-fluorinated silane, the surfaces are superhydrophobic with a tilting angle of a few degrees. rnrnrn

Use of shared memory in the context of embedded multi-core processors: exploration of the technology and its limits

Modern embedded systems embrace many-core shared-memory designs. Due to constrained power and area budgets, most of them feature software-managed scratchpad memories instead of data caches to increase the data locality. It is therefore programmers’ responsibility to explicitly manage the memory transfers, and this make programming these platform cumbersome. Moreover, complex modern applications must be adequately parallelized before they can the parallel potential of the platform into actual performance. To support this, programming languages were proposed, which work at a high level of abstraction, and rely on a runtime whose cost hinders performance, especially in embedded systems, where resources and power budget are constrained. This dissertation explores the applicability of the shared-memory paradigm on modern many-core systems, focusing on the ease-of-programming. It focuses on OpenMP, the de-facto standard for shared memory programming. In a first part, the cost of algorithms for synchronization and data partitioning are analyzed, and they are adapted to modern embedded many-cores. Then, the original design of an OpenMP runtime library is presented, which supports complex forms of parallelism such as multi-level and irregular parallelism. In the second part of the thesis, the focus is on heterogeneous systems, where hardware accelerators are coupled to (many-)cores to implement key functional kernels with orders-of-magnitude of speedup and energy efficiency compared to the “pure software” version. However, three main issues rise, namely i) platform design complexity, ii) architectural scalability and iii) programmability. To tackle them, a template for a generic hardware processing unit (HWPU) is proposed, which share the memory banks with cores, and the template for a scalable architecture is shown, which integrates them through the shared-memory system. Then, a full software stack and toolchain are developed to support platform design and to let programmers exploiting the accelerators of the platform. The OpenMP frontend is extended to interact with it.

Many-Core Architectures: Hardware-Software Optimization and Modeling Techniques

During the last few decades an unprecedented technological growth has been at the center of the embedded systems design paramount, with Moore’s Law being the leading factor of this trend. Today in fact an ever increasing number of cores can be integrated on the same die, marking the transition from state-of-the-art multi-core chips to the new many-core design paradigm. Despite the extraordinarily high computing power, the complexity of many-core chips opens the door to several challenges. As a result of the increased silicon density of modern Systems-on-a-Chip (SoC), the design space exploration needed to find the best design has exploded and hardware designers are in fact facing the problem of a huge design space. Virtual Platforms have always been used to enable hardware-software co-design, but today they are facing with the huge complexity of both hardware and software systems. In this thesis two different research works on Virtual Platforms are presented: the first one is intended for the hardware developer, to easily allow complex cycle accurate simulations of many-core SoCs. The second work exploits the parallel computing power of off-the-shelf General Purpose Graphics Processing Units (GPGPUs), with the goal of an increased simulation speed. The term Virtualization can be used in the context of many-core systems not only to refer to the aforementioned hardware emulation tools (Virtual Platforms), but also for two other main purposes: 1) to help the programmer to achieve the maximum possible performance of an application, by hiding the complexity of the underlying hardware. 2) to efficiently exploit the high parallel hardware of many-core chips in environments with multiple active Virtual Machines. This thesis is focused on virtualization techniques with the goal to mitigate, and overtake when possible, some of the challenges introduced by the many-core design paradigm.

Connection between x-ray and radio properties of cool-core galaxy clusters hosting radio mini-halos

Gli ammassi di galassie sono gli oggetti gravitazionalmente legati più grandi dell’Universo. Questi emettono principalmente in banda X tramite bremsstrahlung. Una frazione mostra anche emissione radio diffusa da parte di elettroni relativistici che spiraleggiano nel campo magnetico. Si possono classificare tre tipi di emissione: alon, relitti e mini-aloni radio (MH). I MH sono sorgenti radio su scale di ≥ 200 – 500 kpc, osservate al centro di ammassi caratterizzati dalla presenze di cool-core (CC). L’origine dei MH non è ancora chiara. Gli elettroni relativistici che emettono in banda radio hanno tempi di vita radiativi di molto inferiori a quelli necessari per diffondere sulle scale dell’emissione diffusa. Quindi non sono semplicemente iniettati dalle galassie presenti negli ammassi ed è necessario un meccanismo di accelerazione “in-situ” nell’ICM. I MH testimoniano la presenza di meccanismi che canalizzano parte del budget energetico disponibile nei CC nell’ICM.Quindi lo studio è importante per comprendere la fisica dell’ICM e l’interazione fra le componenti non termiche e termiche. I MH si formano attraverso la riaccelerazione delle particelle relativistiche ad opera della turbolenza del gas. L’origine di questa turbolenza tuttavia non è ancora ben compresa. Gli ammassi CC sono caratterizzati da un picco della brillanza X nelle regioni centrali e da un drop della temperatura verso il centro accompagnata da aumento della densità del gas. Si ritiene che questo sia dovuto al raffreddamento del gas che quindi fluisce nelle zone centrali. Recenti osservazioni in X risultan inconsistenti con il modello classico di CF, suggerendo la presenza di una sorgente di riscaldamento del gas su scale del core degli ammassi. Recentemente Zhuravleva (2014) hanno mostrato che il riscaldamento dovuto alla turbolenza prodotta dall'AGN centrale è in grado di bilanciare il processo di raffreddamento. Abbiamo assunto che la turbolenza responsabile del riscaldamento del gas è anche responsabile dell’accelerazione delle particelle nei MH. Nell’ambito di questo scenario ci si aspetta una correlazione tra la potenza del cooling flow, PCF, che è una misura del tasso di energia emessa dal gas che raffredda nei CC, e la luminosità radio, che è una frazione dell’energia della turbolenza che è canalizzata nell’accelerazione delle particelle. In questo lavoro di tesi abbiamo utilizzato il più grande campione disponibile di MH, allo scopo di studiare la connessione fra le proprietà dei MH e quelle del gas termico nei core degli ammassi che li ospitano. Abbiamo analizzato i dati di 21 ammassi e ricavato i parametri fisici all’interno del raggio di cooling e del MH. Abbiamo ricavato la correlazione fra luminosità radio, e PCF. Abbiamo trovato che le due quantità correlano in modo quasi-lineare confermando i risultati precedenti. Tale correlazione suggerisce uno stretto legame fra le proprietà del gas nei CC e l’origine dei MH.

Aggregate Programming in Scala: a Core Library and Actor-Based Platform for Distributed Computational Fields

La programmazione aggregata è un paradigma che supporta la programmazione di sistemi di dispositivi, adattativi ed eventualmente a larga scala, nel loro insieme -- come aggregati. L'approccio prevalente in questo contesto è basato sul field calculus, un calcolo formale che consente di definire programmi aggregati attraverso la composizione funzionale di campi computazionali, creando i presupposti per la specifica di pattern di auto-organizzazione robusti. La programmazione aggregata è attualmente supportata, in modo più o meno parziale e principalmente per la simulazione, da DSL dedicati (cf., Protelis), ma non esistono framework per linguaggi mainstream finalizzati allo sviluppo di applicazioni. Eppure, un simile supporto sarebbe auspicabile per ridurre tempi e sforzi d'adozione e per semplificare l'accesso al paradigma nella costruzione di sistemi reali, nonché per favorire la ricerca stessa nel campo. Il presente lavoro consiste nello sviluppo, a partire da un prototipo della semantica operazionale del field calculus, di un framework per la programmazione aggregata in Scala. La scelta di Scala come linguaggio host nasce da motivi tecnici e pratici. Scala è un linguaggio moderno, interoperabile con Java, che ben integra i paradigmi ad oggetti e funzionale, ha un sistema di tipi espressivo, e fornisce funzionalità avanzate per lo sviluppo di librerie e DSL. Inoltre, la possibilità di appoggiarsi, su Scala, ad un framework ad attori solido come Akka, costituisce un altro fattore trainante, data la necessità di colmare l'abstraction gap inerente allo sviluppo di un middleware distribuito. Nell'elaborato di tesi si presenta un framework che raggiunge il triplice obiettivo: la costruzione di una libreria Scala che realizza la semantica del field calculus in modo corretto e completo, la realizzazione di una piattaforma distribuita Akka-based su cui sviluppare applicazioni, e l'esposizione di un'API generale e flessibile in grado di supportare diversi scenari.