2012 Cancer in Iowa Report: A Focus on Lung Cancer, 2012

Cancer is a reportable disease as stated in the Iowa Administrative Code. Cancer data are collected by the State Health Registry of Iowa, located at The University of Iowa in the College of Public Health’s Department of epidemiology. The staff includes more than 50 people. Half of them, situated throughout the state, regularly visit hospitals, clinics, and medical laboratories in Iowa and neighboring states to collect cancer data. A follow-up program tracks more than 99 percent of the cancer survivors diagnosed since 1973. This program provides regular updates for follow-up and survival. The Registry maintains the confidentiality of the patients, physicians, and hospitals providing data. In 2012 data will be collected on a projected 17,500 new cancers among Iowa residents. In situ cases of bladder cancer are included in the projections for bladder cancer, to be in agreement with the definition of reportable cases of the Surveillance, Epidemiology, and End Results (SEER) Program of the NCI. Since 1973 the Iowa Registry has been funded by the SEER Program of the NCI. Iowa represents rural and Midwestern populations and provides data included in many NCI publications. Beginning in 1990 about 5-10 percent of the Registry’s annual operating budget has been provided by the state of Iowa. Beginning in 2003, the University of Iowa has also been providing cost-sharing funds. The Registry also receives funding through grants and contracts with university, state, and national researchers investigating cancer-related topics.

2013 Cancer in Iowa Report, 2013

Cancer is a reportable disease as stated in the Iowa Administrative Code. Cancer data are collected by the State Health Registry of Iowa, located at The University of Iowa in the College of Public Health’s Department of Epidemiology. The staff includes more than 50 people. Half of them, situated throughout the state, regularly visit hospitals, clinics, and medical laboratories in Iowa and neighbor-ing states to collect cancer data. Hospital cancer programs approved by the American College of Surgeons also report their data. A follow-up program tracks more than 99 percent of the cancer survivors diagnosed since 1973. This program provides regular updates for follow-up and survival. The Registry maintains the confidentiality of the patients, physicians, and hospitals providing data. In 2013 data will be collected on an estimated 17,300 new cancers among Iowa residents. In situ cases of bladder cancer are included in the estimates for bladder cancer, to be in agreement with the definition of reportable cases of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Since 1973 the Iowa Registry has been funded by the SEER Program of the National Cancer Institute. Iowa represents rural and Midwestern populations and provides data included in many NCI publications. Beginning in 1990 about 5-10 percent of the Registry’s annual operating budget has been provided by the state of Iowa. Starting in 2003, the University of Iowa has also been providing cost-sharing funds. In addition the Registry receives funding through grants and contracts with university, state, and national researchers investigating cancer-related topics.

2014 Cancer in Iowa Report, 2014

Cancer is a reportable disease as stated in the Iowa Administrative Code. Cancer data are collected by the State Health Registry of Iowa, located at The University of Iowa in the College of Public Health’s Department of Epidemiology. The staff includes more than 50 people. Half of them, situated throughout the state, regularly visit hospitals, clinics, and medical laboratories in Iowa and neighboring states to collect cancer data. A follow-up program tracks more than 99 percent of the cancer survivors diagnosed since 1973. This program provides regular updates for follow-up and survival. The Registry maintains the confidentiality of the patients, physicians, and hospitals providing data. In 2014 data will be collected on an estimated 17,400 new cancers among Iowa residents. In situ cases of bladder cancer are included in the estimates for bladder cancer, to be in agreement with the definition of reportable cases of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Since 1973 the Iowa Registry has been funded by the SEER Program of the National Cancer Institute. Iowa represents rural and Midwestern populations and provides data included in many NCI publications. Beginning in 1990 about 5-10 percent of the Registry’s annual operating budget has been provided by the state of Iowa. Beginning in 2003, the University of Iowa has also been providing cost-sharing funds. The Registry also receives funding through grants and contracts with university, state, and national researchers investigating cancer-related topics.

2015 Cancer in Iowa Report, 2015

Cancer is a reportable disease as stated in the Iowa Administrative Code. Cancer data are collected by the State Health Registry of Iowa, located at The University of Iowa in the College of Public Health’s Department of Epidemiology. The staff includes more than 50 people. Half of them, situated throughout the state, regularly visit hospitals, clinics, and medical laboratories in Iowa and neighboring states to collect cancer data. A follow-up program tracks more than 99 percent of the cancer survivors diagnosed since 1973. This program provides regular updates for follow-up and survival. The Registry maintains the confidentiality of the patients, physicians, and hospitals providing data. In 2014 data will be collected on an estimated 17,400 new cancers among Iowa residents. In situ cases of bladder cancer are included in the estimates for bladder cancer, to be in agreement with the definition of reportable cases of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Since 1973 the Iowa Registry has been funded by the SEER Program of the National Cancer Institute. Iowa represents rural and Midwestern populations and provides data included in many NCI publications. Beginning in 1990 about 5-10 percent of the Registry’s annual operating budget has been provided by the state of Iowa. Beginning in 2003, the University of Iowa has also been providing cost-sharing funds. The Registry also receives funding through grants and contracts with university, state, and national researchers investigating cancer-related topics.

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey.

BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.

Moniensiöinen muuntaja taajuudenmuuttajakäytössä

Suuritehoisissa pumppu- ja puhallinkäytöissä käytetään usein suurnopeusmoottoria,jota syötetään välijännitteellä. Suurjännitetaajuudenmuuttajat ovat kalliita, eikä niitä ole aina edes mahdollista valmistaa. Tutkimuksen kohteena on rinnakkaisilla pienjännitetaajuudenmuuttajilla toteutettu sähkökäyttö, jossa pienjännite nostetaan moniensiöisellä muuntajalla suurjännitteeksi (6,6 kV) ja syötetään edelleen kuormana olevalle suurnopeusmoottorille. Opinnäytetyössä tutkitaan moniensiöisen muuntajan syöttöä rinnakkaisilla taajuudenmuuttajilla sekä niiden aiheuttamia häiriöitä toisilleen. Työssä tutkitaan myös harmonisten yliaaltojen vaikutuksia muuntajan häviöihin ja magnetointiominaisuuksiin. Taajuudenmuuttajan lähtöjännite ja -virta suodatetaan sinisuotimella, jonka parametreja simuloidaan Simulink- ohjelmistolla. Tavoite on löytää optimaaliset parametrit taajuudenmuuttajanlähtösuotimelle käyrämuotojen ja suotimeen jäävän tehon suhteen. Työssä tarkasteltiin sinisuodinta, johon jää 3 prosenttia syöttöjännitteestä. LC-suodin kompensoi sähkökäytön loistehon lähes kokonaan, joten taajuudenmuuttajien antotehon kannalta suotimet ovat perusteltuja. Taajuudenmuuttajan näennäisteho putoaa 22 prosenttia, joten taajuudenmuuttajat voidaan vastaavasti mitoittaa pienemmiksi.

Prevalence and risk factors for therapy escalation in ulcerative colitis in the Swiss IBD Cohort Study

BACKGROUND: Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors. METHODS: Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy. RESULTS: Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery. CONCLUSIONS: The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.

Postsurgical Prophylaxis in Crohn's Disease: Which Patients, Which Agents?

NlmCategory="UNASSIGNED">Crohn's disease (CD) evolution is characterized by increasing proportions of patients developing complications such as strictures, abscesses and fistulas that require surgical management. After resection of a diseased intestinal segment, CD recurrence concerns up to 60% of patients within a year post surgery. The mucosa just above the site of the intestinal anastomosis is at particularly high risk of relapse. Prophylactic medical therapy to prevent recurrence has been shown to be effective with a variety of medications, but the recurrence rate remains high, demanding that a better risk stratification of patients be achieved. Recognized risk factors for postsurgical CD recurrence include young age at diagnosis and at surgery, smoking, need for repeated surgeries and penetrating disease. These patients require full dose immunosuppressive or anti-tumor necrosis factor (anti-TNF) therapy, which should be initiated in the immediate postoperative period, to prevent the onset of an inflammatory activity in the bowel. Systematic follow-up by endoscopy to monitor treatment benefit should also be part of the management, as endoscopic recurrence heralds clinical relapse in these patients. The role of noninvasive markers of mucosal inflammation, such as stool calprotectin levels, show promise to complete this monitoring. Although the efficacy of mesalazine and imidazole antibiotics has been long recognized, more aggressive approaches, such as thiopurines and anti-TNF antibodies, have shown higher efficacies in direct comparison trials. The potential place of anti-homing agents is not yet defined, but these agents should in principle be of interest for this prophylactic indication due to their mode of action and interesting side-effect profile. The current recommendations are based on a step-up approach that includes immunosuppressors and/or imidazole antibiotics, followed by an anti-TNF agent, such as infliximab and adalimumab, both already tested in randomized trials in this indication. When endoscopic recurrence is identified during follow-up, upscaling to anti-TNF or dose escalation is advocated.

Diskreettiaikainen liukuvan moodin säätö kiinteäoksidipolttokennon DC-tasonnostossa

Huoli ympäristön tilasta ja fossiilisten polttoaineiden hinnan nousu ovat vauhdittaneet tutkimusta uusien energialähteiden löytämiseksi. Polttokennot ovat yksi lupaavimmista tekniikoista etenkin hajautetun energiantuotannon, varavoimalaitosten sekä liikennevälineiden alueella. Polttokenno on tehonlähteenä kuitenkin hyvin epäideaalinen, ja se asettaa tehoelektroniikalle lukuisia erityisvaatimuksia. Polttokennon kytkeminen sähköverkkoon on tavallisesti toteutettu käyttämällä galvaanisesti erottavaa DC/DC hakkuria sekä vaihtosuuntaajaa sarjassa. Polttokennon kulumisen estämiseksi tehoelektroniikalta vaaditaan tarkkaa polttokennon lähtövirran hallintaa. Perinteisesti virran hallinta on toteutettu säätämällä hakkurin tulovirtaa PI (Proportional and Integral) tai PID (Proportional, Integral and Derivative) -säätimellä. Hakkurin epälineaarisuudesta johtuen tällainen ratkaisu ei välttämättä toimi kaukana linearisointipisteestä. Lisäksi perinteiset säätimet ovat herkkiä mallinnusvirheille. Tässä diplomityössä on esitetty polttokennon jännitettä nostavan hakkurin tilayhtälökeskiarvoistusmenetelmään perustuva malli, sekä malliin perustuva diskreettiaikainen integroiva liukuvan moodin säätö. Esitetty säätö on luonteeltaan epälineaarinen ja se soveltuu epälineaaristen ja heikosti tunnettujen järjestelmien säätämiseen.

Jännitettä nostavan hakkurin käyttö akkukäyttöisessä audiolaitteessa

Audiovahvistimet pohjautuvat yhä useammin D-luokan vahvistimiin niiden korkean hyötysuhteen takia. Tämä mahdollistaa pidemmän käyttöajan tai vastaavasti tehon lisäämisen kannettavissa audiolaitteissa. Kuitenkin, jotta akkukäyttöisestä audiolaitteesta saataisiin suurempaa tehoa, se vaatii yleensä korkeamman jännitteen kuin yksittäisen akun lähtöjännite on. Korkeampi jännite voidaan saavuttaa lisäämällä akkuja tai käyttämällä jännitettä nostavaa hakkuria. Hakkureissa syntyy kuitenkin kytkennästä johtuvaa värettä, mille D-luokan vahvistimet ovat alttiita. Tässä työssä tutkitaan boost- ja Čuk-hakkurin soveltuvuutta jännitteen nostoon akkukäyttöisessä audiolaitteessa. Käytännön sovelluksena toimii Porsas, josta halutaan saada 500 W teho. Työssä tutkitaan audiolaitteen asettamia ehtoja jännitelähteelle sekä hakkurien mitoittamista ehtojen mukaisesti. Työn tutkimustapana on kirjallisuustutkimus ja simulointi. Audiolaitteen jännitelähteeltä vaatima teho vaihtelee suuresti. Tämä tulee ottaa huomioon hakkurin komponenttien mitoituksessa. Lisäksi hakkurin lähtöjännitteen väre pyritään minimoimaan, koska sillä on suuri vaikutus vahvistimen toimintaan. Tulovirran väreen minimoinnilla on pidentävä vaikutus akun purkusykliin. Hakkurien laskennalliset komponenttien arvot sekä simuloinnit osoittavat, että hakkurit olisivat myös mahdollista tehdä käytännössä. Simulointien perusteella boost-hakkurin komponenttien arvot ovat pienempiä kuin Čuk-hakkurin. Boost-hakkurille löytyy myös valmiita ohjainpiirejä enemmän. Toisaalta Čuk-hakkurilla on mahdollista tehdä myös energiansäästötila. Hakkurien ohjaus ja jäähdytys vaatisivat jatkotutkimusta.

Programme de suivi de deuil pour des parents ayant un enfant décédé dans une unité de soins intensifs pédiatriques

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maîtrise ès sciences (M. Sc.) en sciences infirmières, option expertise-conseil

Une intervention de groupe post-parcours au cœur de l'insertion socioprofessionnelle des jeunes adultes

Essai critique présenté à la Faculté des études supérieures en vue de l’obtention du grade de maîtrise en Service Social

Studies on nitrifying microorganisms in Cochin Estuary and adjacent coastal waters

This thesis entitled “Studies on Nitrifying Microorganisms in Cochin Estuary and Adjacent Coastal Waters” reports for the first time the spatial andtemporal variations in the abundance and activity of nitrifiers (Ammonia oxidizingbacteria-AOB; Nitrite oxidizing bacteria- NOB and Ammonia oxidizing archaea-AOA) from the Cochin Estuary (CE), a monsoon driven, nutrient rich tropicalestuary along the southwest coast of India. To fulfil the above objectives, field observations were carried out for aperiod of one year (2011) in the CE. Surface (1 m below surface) and near-bottomwater samples were collected from four locations (stations 1 to 3 in estuary and 4 in coastal region), covering pre-monsoon, monsoon and post-monsoon seasons. Station 1 is a low saline station (salinity range 0-10) with high freshwater influx While stations 2 and 3 are intermediately saline stations (salinity ranges 10-25). Station 4 is located ~20 km away from station 3 with least influence of fresh water and is considered as high saline (salinity range 25- 35) station. Ambient physicochemical parameters like temperature, pH, salinity, dissolved oxygen (DO), Ammonium, nitrite, nitrate, phosphate and silicate of surface and bottom waters were measured using standard techniques. Abundance of Eubacteria, total Archaea and ammonia and nitrite oxidizing bacteria (AOB and NOB) were quantified using Fluorescent in situ Hybridization (FISH) with oligonucleotide probes labeled withCy3. Community structure of AOB and AOA was studied using PCR Denaturing Gradient Gel Electrophoresis (DGGE) technique. PCR products were cloned and sequenced to determine approximate phylogenetic affiliations. Nitrification rate in the water samples were analyzed using chemical NaClO3 (inhibitor of nitrite oxidation), and ATU (inhibitor of ammonium oxidation). Contribution of AOA and AOB in ammonia oxidation process was measured based on the recovered ammonia oxidation rate. The contribution of AOB and AOA were analyzed after inhibiting the activities of AOB and AOA separately using specific protein inhibitors. To understand the factors influencing or controlling nitrification, various statistical tools were used viz. Karl Pearson’s correlation (to find out the relationship between environmental parameters, bacterial abundance and activity), three-way ANOVA (to find out the significant variation between observations), Canonical Discriminant Analysis (CDA) (for the discrimination of stations based on observations), Multivariate statistics, Principal components analysis (PCA) and Step up multiple regression model (SMRM) (First order interaction effects were applied to determine the significantly contributing biological and environmental parameters to the numerical abundance of nitrifiers). In the CE, nitrification is modulated by the complex interplay between different nitrifiers and environmental variables which in turn is dictated by various hydrodynamic characteristics like fresh water discharge and seawater influx brought in by river water discharge and flushing. AOB in the CE are more adapted to varying environmental conditions compared to AOA though the diversity of AOA is higher than AOB. The abundance and seasonality of AOB and NOB is influenced by the concentration of ammonia in the water column. AOB are the major players in modulating ammonia oxidation process in the water column of CE. The distribution pattern and seasonality of AOB and NOB in the CE suggest that these organisms coexist, and are responsible for modulating the entire nitrification process in the estuary. This process is fuelled by the cross feeding among different nitrifiers, which in turn is dictated by nutrient levels especially ammonia. Though nitrification modulates the increasing anthropogenic ammonia concentration the anthropogenic inputs have to be controlled to prevent eutrophication and associated environmental changes.

Synthesis of N-amino compounds and C2 symmetric N-amino compounds and transformation into aziridines using olefins

Aziridine, Stickstoffanaloga der Epoxide, können regio- und stereoselektive Ringöffnungsreaktionen eingehen, wodurch ihnen als „building blocks“ in der Organischen Synthese eine große Bedeutung zukommt. In dieser Arbeit wurden unterschiedliche N-Aminoverbindungen synthetisiert sowie die Anwendungsmöglichkeit dieser Hydrazinderivate als Stickstoffquellen in Aziridinierungen von Olefinen untersucht. In der vorliegenden Dissertation wurde eine neue Methode zur Darstellung von N-Aminosuccinimid entwickelt und die Einsatzmöglichkeit als Stickstoffquelle in Aziridinierungsreaktionen in einer Reihe von Umsetzungen mit funktionalisierten ebenso wie mit nicht-funktionalisierten Olefinen demonstriert. Die ableitbaren Aziridine wurden hierbei in Ausbeuten von bis zu 80 % erhalten. In der Aziridinierungsreaktion von N-Aminosuccinimid mit 4,7-Dihydro-2-isopropyl-1,3-dioxepin resultieren bicyclische Aziridinierungsprodukte, die als endo/exo-Isomere in einem 1:1-Verhältnis anfallen. Es ist in dieser Arbeit gelungen, die Isomere in guten Ausbeuten zu erhalten, sie säulenchromatographisch zu trennen und ihre Konfiguration im festen Zustand mittels Kristallstrukturanalyse eindeutig zu bestimmen. Enantiomerenangereicherte Olefine, wie z. B. in 2-Position alkylsubstituierte 5-Methyl-4H-1,3-dioxine mit Enantiomerenüberschüssen von 92% ee liefern in der Aziridinierung mit N-Aminosuccinimid und Iodosylbenzol ein 4-Methyl-1,3-oxazolidin-4-carbaldehydderivat in einer zweistufigen Reaktion- der Aziridinierung und einer Umlagerung- ein 4-Methyl-1,3-oxazolidin-4-carbaldehydderivat. Für die Diastereoselektivität des Aziridinierungsschrittes wurde 65 % de bestimmt. In einer neuen Synthese über zwei Stufen ausgehend von (+)-3,4-Dimethoxysuccinanhydrid konnte ein chiraler Stickstoffüberträger - (+)-N-Amino-3,4-dimethoxysuccinimid - in Ausbeuten bis zu 86 % synthetisiert. Die Umsetzung dieser optisch aktiven Stickstoffquelle mit einer Vielzahl prochiraler Alkene führt zu diastereomeren Aziridinen in Ausbeuten bis zu 65% und Diastereoselektivitäten von bis zu 66% de. Anhand ausgewählter Verbindungen konnten die Absolutkonfigurationen der Reaktionsprodukte mittels Kristallstrukturanalyse eindeutig geklärt werden.

Uveítis pediática no infecciosa, una experiencia de una cohorte colombiana

Resumen: •Antecedentes: La uveítis pediátrica no infecciosa tiene el potencial de desencadenar severas complicaciones visuales y su manejo farmacológico convencional está asociado a importantes efectos secundarios. 1 Infliximab (INF) y Adalimumab (ADA), son dos medicamentos biológicos disponibles para el manejo de la uveítis pediátrica refractaria. Se unen específicamente al TNFα y previenen la unión del mismo con los receptores celulares; interacción directamente implicada en el proceso inflamatorio y el subsecuente daño tisular. 2,3 •Métodos: Se realizó estudio de tipo cohorte retrospectiva mediante revisión de historias clínicas de 35 pacientes pediátricos diagnosticados con uveítis durante los años 2009-2015. Se comparó control de la inflamación ocular, tiempo de respuesta y eventos adversos en pacientes tratados con ADA o INF con dosis bajas de Metotrexate vs. Metotrexate (MTX) como única terapia. •Resultados: El 45.7% de la población estudiada correspondía al sexo femenino, cuya edad promedio de inicio de síntomas y de diagnósticos fue de 9 años. El 80% de los casos fueron uveítis idiopáticas, seguido por Vogt-Koyanagi-Harada (8,5%) y AIJ (5,7%). El 91,4% presentó compromiso ocular bilateral y se documentaron 2 casos de ambliopía. El 12,9% de los pacientes que recibieron MTX como tratamiento de primera línea requirieron escalonamiento terapéutico por presentar eventos adversos (Elevación de enzimas hepáticas e intolerancia gastrointestinal (GI)). El tiempo promedio para alcanzar control de la inflamación con MTX fue 9 semanas, y para Adalimumab fue de 8,75 semanas (P: 0,90). Se comparó la capacidad de controlar la inflamación del MTX vs Anti-TNF, y no se observaron diferencias significativas (P: 0.88).