Automatic quantitation of multiple sclerosis lesions on MR images

A two-pronged approach for the automatic quantitation of multiple sclerosis (MS) lesions on magnetic resonance (MR) images has been developed. This method includes the design and use of a pulse sequence for improved lesion-to-tissue contrast (LTC) and seeks to identify and minimize the sources of false lesion classifications in segmented images. The new pulse sequence, referred to as AFFIRMATIVE (Attenuation of Fluid by Fast Inversion Recovery with MAgnetization Transfer Imaging with Variable Echoes), improves the LTC, relative to spin-echo images, by combining Fluid-Attenuated Inversion Recovery (FLAIR) and Magnetization Transfer Contrast (MTC). In addition to acquiring fast FLAIR/MTC images, the AFFIRMATIVE sequence simultaneously acquires fast spin-echo (FSE) images for spatial registration of images, which is necessary for accurate lesion quantitation. Flow has been found to be a primary source of false lesion classifications. Therefore, an imaging protocol and reconstruction methods are developed to generate "flow images" which depict both coherent (vascular) and incoherent (CSF) flow. An automatic technique is designed for the removal of extra-meningeal tissues, since these are known to be sources of false lesion classifications. A retrospective, three-dimensional (3D) registration algorithm is implemented to correct for patient movement which may have occurred between AFFIRMATIVE and flow imaging scans. Following application of these pre-processing steps, images are segmented into white matter, gray matter, cerebrospinal fluid, and MS lesions based on AFFIRMATIVE and flow images using an automatic algorithm. All algorithms are seamlessly integrated into a single MR image analysis software package. Lesion quantitation has been performed on images from 15 patient volunteers. The total processing time is less than two hours per patient on a SPARCstation 20. The automated nature of this approach should provide an objective means of monitoring the progression, stabilization, and/or regression of MS lesions in large-scale, multi-center clinical trials. ^

THE IMPACT OF FAMILY HISTORY ON MEDULLARY THYROID CANCER IN MEN2A PATIENTS

The American Thyroid Association recently classified all MEN2A-associated codons into increasing risk levels A-C and stated that some patients may delay prophylactic thyroidectomy if certain criteria are met. One criterion is a less aggressive family history of MTC but whether families with the same mutated codon have variable MTC aggressiveness is not well described. We developed several novel measures of MTC aggressiveness and compared families with the same mutated codon to determine if there is significant inter-familial variability. Pedigrees of families with MEN2A were reviewed for codon mutated and proportion of RET mutation carriers with MTC. Individuals with MTC were classified as having local or distant MTC and whether they had progressive MTC. MTC status and age were assessed at diagnosis and most advanced MTC stage. For those without MTC, age was recorded at prophylactic thyroidectomy or last follow-up if the patient did not have a thyroidectomy. For each pedigree, the mean age of members without MTC, with MTC, and the proportion of RET mutation carriers with local or distant and progressive MTC were calculated. We assessed differences in these variables using ANOVA and the Fisher’s exact test. Sufficient data for analysis were available for families with mutated codons 609 (92 patients from 13 families), 618 (41 patients from 7 families), and 634 (152 patients from 13 families). The only significant differences found were the mean age of patients without MTC between families with codon 609 and 618 mutations even after accounting for prophylactic thyroidectomy (p=0.006 and 0.001, respectively), and in the mean age of MTC diagnosis between families with codon 618 and 634 mutations even after accounting for symptomatic presentation (p=0.023 and 0.014, respectively). However, these differences may be explained by generational differences in ascertainment of RET carriers and the availability of genetic testing when the proband initially presented.

An integrated framework for assessing the accuracy of geobia landcover products.

Se establece un metodología para evaluar la cartografía de capas GIS

Novel parameters for evaluating the Spatial and Thematic accuracy of land cover maps.

Se proponen novedosas fórmulas para evaluar la certeza de la cartografía

Wide bandwidth envelope trackers with reduced switching frequency for RF power amplifier

El requerimiento de proveer alta frecuencia de datos en los modernos sistema de comunicación inalámbricos resulta en complejas señales moduladas de radio-frequencia (RF) con un gran ancho de banda y alto ratio pico-promedio (PAPR). Para garantizar la linealidad del comportamiento, los amplificadores lineales de potencia comunes funcionan típicamente entre 4 y 10 dB de back-o_ desde la máxima potencia de salida, ocasionando una baja eficiencia del sistema. La eliminación y restauración de la evolvente (EER) y el seguimiento de la evolvente (ET) son dos prometedoras técnicas para resolver el problema de la eficiencia. Tanto en EER como en ET, es complicado diseñar un amplificador de potencia que sea eficiente para señales de RF de alto ancho de banda y alto PAPR. Una propuesta común para los amplificadores de potencia es incluir un convertidor de potencia de muy alta eficiencia operando a frecuencias más altas que el ancho de banda de la señal RF. En este caso, la potencia perdida del convertidor ocasionado por la alta frecuencia desaconseja su práctica cuando el ancho de banda es muy alto. La solución a este problema es el enfoque de esta disertación que presenta dos arquitecturas de amplificador evolvente: convertidor híbrido-serie con una técnica de evolvente lenta y un convertidor multinivel basado en un convertidor reductor multifase con control de tiempo mínimo. En la primera arquitectura, una topología híbrida está compuesta de una convertidor reductor conmutado y un regulador lineal en serie que trabajan juntos para ajustar la tensión de salida para seguir a la evolvente con precisión. Un algoritmo de generación de una evolvente lenta crea una forma de onda con una pendiente limitada que es menor que la pendiente máxima de la evolvente original. La salida del convertidor reductor sigue esa forma de onda en vez de la evolvente original usando una menor frecuencia de conmutación, porque la forma de onda no sólo tiene una pendiente reducida sino también un menor ancho de banda. De esta forma, el regulador lineal se usa para filtrar la forma de onda tiene una pérdida de potencia adicional. Dependiendo de cuánto se puede reducir la pendiente de la evolvente para producir la forma de onda, existe un trade-off entre la pérdida de potencia del convertidor reductor relacionada con la frecuencia de conmutación y el regulador lineal. El punto óptimo referido a la menor pérdida de potencia total del amplificador de evolvente es capaz de identificarse con la ayuda de modelo preciso de pérdidas que es una combinación de modelos comportamentales y analíticos de pérdidas. Además, se analiza el efecto en la respuesta del filtro de salida del convertidor reductor. Un filtro de dampeo paralelo extra es necesario para eliminar la oscilación resonante del filtro de salida porque el convertidor reductor opera en lazo abierto. La segunda arquitectura es un amplificador de evolvente de seguimiento de tensión multinivel. Al contrario que los convertidores que usan multi-fuentes, un convertidor reductor multifase se emplea para generar la tensión multinivel. En régimen permanente, el convertidor reductor opera en puntos del ciclo de trabajo con cancelación completa del rizado. El número de niveles de tensión es igual al número de fases de acuerdo a las características del entrelazamiento del convertidor reductor. En la transición, un control de tiempo mínimo (MTC) para convertidores multifase es novedosamente propuesto y desarrollado para cambiar la tensión de salida del convertidor reductor entre diferentes niveles. A diferencia de controles convencionales de tiempo mínimo para convertidores multifase con inductancia equivalente, el propuesto MTC considera el rizado de corriente por cada fase basado en un desfase fijo que resulta en diferentes esquemas de control entre las fases. La ventaja de este control es que todas las corrientes vuelven a su fase en régimen permanente después de la transición para que la siguiente transición pueda empezar muy pronto, lo que es muy favorable para la aplicación de seguimiento de tensión multinivel. Además, el control es independiente de la carga y no es afectado por corrientes de fase desbalanceadas. Al igual que en la primera arquitectura, hay una etapa lineal con la misma función, conectada en serie con el convertidor reductor multifase. Dado que tanto el régimen permanente como el estado de transición del convertidor no están fuertemente relacionados con la frecuencia de conmutación, la frecuencia de conmutación puede ser reducida para el alto ancho de banda de la evolvente, la cual es la principal consideración de esta arquitectura. La optimización de la segunda arquitectura para más alto anchos de banda de la evolvente es presentada incluyendo el diseño del filtro de salida, la frecuencia de conmutación y el número de fases. El área de diseño del filtro está restringido por la transición rápida y el mínimo pulso del hardware. La rápida transición necesita un filtro pequeño pero la limitación del pulso mínimo del hardware lleva el diseño en el sentido contrario. La frecuencia de conmutación del convertidor afecta principalmente a la limitación del mínimo pulso y a las pérdidas de potencia. Con una menor frecuencia de conmutación, el ancho de pulso en la transición es más pequeño. El número de fases relativo a la aplicación específica puede ser optimizado en términos de la eficiencia global. Otro aspecto de la optimización es mejorar la estrategia de control. La transición permite seguir algunas partes de la evolvente que son más rápidas de lo que el hardware puede soportar al precio de complejidad. El nuevo método de sincronización de la transición incrementa la frecuencia de la transición, permitiendo que la tensión multinivel esté más cerca de la evolvente. Ambas estrategias permiten que el convertidor pueda seguir una evolvente con un ancho de banda más alto que la limitación de la etapa de potencia. El modelo de pérdidas del amplificador de evolvente se ha detallado y validado mediante medidas. El mecanismo de pérdidas de potencia del convertidor reductor tiene que incluir las transiciones en tiempo real, lo cual es diferente del clásico modelos de pérdidas de un convertidor reductor síncrono. Este modelo estima la eficiencia del sistema y juega un papel muy importante en el proceso de optimización. Finalmente, la segunda arquitectura del amplificador de evolvente se integra con el amplificador de clase F. La medida del sistema EER prueba el ahorro de energía con el amplificador de evolvente propuesto sin perjudicar la linealidad del sistema. ABSTRACT The requirement of delivering high data rates in modern wireless communication systems results in complex modulated RF signals with wide bandwidth and high peak-to-average ratio (PAPR). In order to guarantee the linearity performance, the conventional linear power amplifiers typically work at 4 to 10 dB back-off from the maximum output power, leading to low system efficiency. The envelope elimination and restoration (EER) and envelope tracking (ET) are two promising techniques to overcome the efficiency problem. In both EER and ET, it is challenging to design efficient envelope amplifier for wide bandwidth and high PAPR RF signals. An usual approach for envelope amplifier includes a high-efficiency switching power converter operating at a frequency higher than the RF signal's bandwidth. In this case, the power loss of converter caused by high switching operation becomes unbearable for system efficiency when signal bandwidth is very wide. The solution of this problem is the focus of this dissertation that presents two architectures of envelope amplifier: a hybrid series converter with slow-envelope technique and a multilevel converter based on a multiphase buck converter with the minimum time control. In the first architecture, a hybrid topology is composed of a switched buck converter and a linear regulator in series that work together to adjust the output voltage to track the envelope with accuracy. A slow envelope generation algorithm yields a waveform with limited slew rate that is lower than the maximum slew rate of the original envelope. The buck converter's output follows this waveform instead of the original envelope using lower switching frequency, because the waveform has not only reduced slew rate but also reduced bandwidth. In this way, the linear regulator used to filter the waveform has additional power loss. Depending on how much reduction of the slew rate of envelope in order to obtain that waveform, there is a trade-off between the power loss of buck converter related to the switching frequency and the power loss of linear regulator. The optimal point referring to the lowest total power loss of this envelope amplifier is identified with the help of a precise power loss model that is a combination of behavioral and analytic loss model. In addition, the output filter's effect on the response is analyzed. An extra parallel damping filter is needed to eliminate the resonant oscillation of output filter L and C, because the buck converter operates in open loop. The second architecture is a multilevel voltage tracking envelope amplifier. Unlike the converters using multi-sources, a multiphase buck converter is employed to generate the multilevel voltage. In the steady state, the buck converter operates at complete ripple cancellation points of duty cycle. The number of the voltage levels is equal to the number of phases according the characteristics of interleaved buck converter. In the transition, a minimum time control (MTC) for multiphase converter is originally proposed and developed for changing the output voltage of buck converter between different levels. As opposed to conventional minimum time control for multiphase converter with equivalent inductance, the proposed MTC considers the current ripple of each phase based on the fixed phase shift resulting in different control schemes among the phases. The advantage of this control is that all the phase current return to the steady state after the transition so that the next transition can be triggered very soon, which is very favorable for the application of multilevel voltage tracking. Besides, the control is independent on the load condition and not affected by the unbalance of phase current. Like the first architecture, there is also a linear stage with the same function, connected in series with the multiphase buck converter. Since both steady state and transition state of the converter are not strongly related to the switching frequency, it can be reduced for wide bandwidth envelope which is the main consideration of this architecture. The optimization of the second architecture for wider bandwidth envelope is presented including the output filter design, switching frequency and the number of phases. The filter design area is restrained by fast transition and the minimum pulse of hardware. The fast transition needs small filter but the minimum pulse of hardware limitation pushes the filter in opposite way. The converter switching frequency mainly affects the minimum pulse limitation and the power loss. With lower switching frequency, the pulse width in the transition is smaller. The number of phases related to specific application can be optimized in terms of overall efficiency. Another aspect of optimization is improving control strategy. Transition shift allows tracking some parts of envelope that are faster than the hardware can support at the price of complexity. The new transition synchronization method increases the frequency of transition, allowing the multilevel voltage to be closer to the envelope. Both control strategies push the converter to track wider bandwidth envelope than the limitation of power stage. The power loss model of envelope amplifier is detailed and validated by measurements. The power loss mechanism of buck converter has to include the transitions in real time operation, which is different from classical power loss model of synchronous buck converter. This model estimates the system efficiency and play a very important role in optimization process. Finally, the second envelope amplifier architecture is integrated with a Class F amplifier. EER system measurement proves the power saving with the proposed envelope amplifier without disrupting the linearity performance.

Metodología para la estimación de indicadores armonizados a partir de los inventarios forestales nacionales europeos con especial énfasis en la biodiversidad forestal

Durante las últimas décadas el objetivo principal de la silvicultura y la gestión forestal en Europa ha pasado de ser la producción de madera a ser la gestión sostenible de los ecosistemas, por lo que se deben considerar todos los bienes y servicios que proporcionan los bosques. En consecuencia, es necesario contar con información forestal periódica de diversos indicadores forestales a nivel europeo para apoyar el desarrollo y la implementación de políticas medioambientales y que se realice una gestión adecuada. Para ello, se requiere un seguimiento intensivo sobre el estado de los bosques, por lo que los Inventarios Forestales Nacionales (IFN), (principal fuente de información forestal a gran escala), han aumentado el número de variables muestreadas para cumplir con los crecientes requerimientos de información. Sin embargo, las estimaciones proporcionadas por los diferentes países no son fácilmente comparables debido a las diferencias en las definiciones, los diseños de muestreo, las variables medidas y los protocolos de medición. Por esto, la armonización de los datos que proporcionan los diferentes países es fundamental para la contar con una información forestal sólida y fiable en la Unión europea (UE). La presente tesis tiene dos objetivos principales: (i) establecer el diseño de una metodología para evaluar la biodiversidad forestal en el marco del Inventario forestal nacional de España teniendo en cuenta las diferentes iniciativas nacionales e internacionales, con el objetivo de producir estimaciones comparables con las de otros países de la UE y (ii) armonizar los indicadores más relevantes para satisfacer los requerimientos nacionales e internacionales. Como consecuencia del estudio realizado para alcanzar el primer objetivo, la metodología diseñada para estimar la biodiversidad fue adoptada por el Tercer Inventario forestal nacional. Ésta se componía de indicadores agrupados en: cobertura del suelo, composición de árboles y especies de arbustos, riqueza de especies herbáceas y helechos, especies amenazadas, estructura, madera muerta, y líquenes epífitos. Tras el análisis del diseño metodológico y de los datos proporcionados, se observó la conveniencia de modificarla con el fin de optimizar los costes, viabilidad, calidad y cantidad de los datos registrados. En consecuencia, en el Cuarto Inventario Forestal Nacional se aplica una metodología modificada, puesto que se eliminó el muestreo de especies herbáceas y helechos, de líquenes epífitos y de especies amenazadas, se modificaron los protocolos de la toma de datos de estructura y madera muerta y se añadió el muestreo de especies invasoras, edad, ramoneo y grado de naturalidad de la masa. En lo que se refiere al segundo objetivo, se ha avanzado en la armonización de tres grupos de variables considerados como relevantes en el marco de los IFN: los indicadores de vegetación no arbórea (que juegan un papel relevante en los ecosistemas, es donde existe la mayor diversidad de plantas y hasta ahora no se conocían los datos muestreados en los IFN), la determinación de los árboles añosos (que tienen un importante papel como nicho ecológico y su identificación es especialmente relevante para la evaluación de la biodiversidad forestal) y el bosque disponible para el suministro de madera (indicador básico de los requerimientos internacionales de información forestal). Se llevó a cabo un estudio completo de la posible armonización de los indicadores de la vegetación no arbórea en los IFN. Para ello, se identificaron y analizaron las diferentes definiciones y diseños de muestreo empleados por los IFN, se establecieron definiciones de referencia y se propusieron y analizaron dos indicadores que pudiesen ser armonizados: MSC (mean species cover) que corresponde a la media de la fracción de cabida cubierta de cada especie por tipo de bosque y MTC (mean total cover). Se estableció una nueva metodología que permite identificar los árboles añosos con los datos proporcionados por los inventarios forestales nacionales con el objetivo de proporcionar una herramienta eficaz para facilitar la gestión forestal considerando la diversidad de los sistemas forestales. Se analizó el concepto de "bosque disponible para el suministro de madera" (FAWS) estudiando la consistencia de la información internacional disponible con el fin de armonizar su estimación y de proporcionar recomendaciones para satisfacer los requerimientos europeos. Como resultado, se elaboró una nueva definición de referencia de FAWS (que será adoptada por el proceso paneuropeo) y se analiza el impacto de la adopción de esta nueva definición en siete países europeos. El trabajo realizado en esta tesis, puede facilitar el suministrar y/o armonizar parcial o totalmente casi la mitad de los indicadores de información forestal solicitados por los requerimientos internacionales (47%). De éstos, prácticamente un 85% tienen relación con los datos inventariados empleando la metodología propuesta para la estimación de la biodiversidad forestal, y el resto, con el establecimiento de la definición de bosque disponible para el suministro de madera. No obstante, y pese a que esta tesis supone un avance importante, queda patente que las necesidades de información forestal son cambiantes y es imprescindible continuar el proceso de armonización de los IFN europeos. ABSTRACT Over the last few decades, the objectives on forestry and forest management in Europe have shifted from being primarily focused on wood production to sustainable ecosystem management, which should consider all the goods and services provided by the forest. Therefore, there is a continued need for forest indicators and assessments at EU level to support the development and implementation of a number of European environmental policies and to conduct a proper forest management. To address these questions, intensive monitoring on the status of forests is required. Therefore, the scope of National Forest Inventories (NFIs), (primary source of data for national and large-area assessments), has been broadened to include new variables to meet these increasing information requirements. However, estimates produced by different countries are not easily comparable because of differences in NFI definitions, plot configurations, measured variables, and measurement protocols. As consequence, harmonizing data produced at national level is essential for the production of sound EU forest information. The present thesis has two main aims: (i) to establish a methodology design to assess forest biodiversity in the frame of the Spanish National Forest Inventory taking into account the different national and international initiatives with the intention to produce comparable estimates with other EU countries and (ii) to harmonize relevant indicators for national and international requirements. In consequence of the work done related to the first objective, the established methodology to estimate forest biodiversity was adopted and launched under the Third National Forest Inventory. It was composed of indicators grouped into: cover, woody species composition, richness of herbaceous species and ferns, endangered species, stand structure, dead wood, and epiphytic lichens. This methodology was analyzed considering the provided data, time costs, feasibility, and requirements. Consequently, in the ongoing Fourth National Forest Inventory a modified methodology is applied: sampling of herbaceous species and ferns, epiphytic lichens and endangered species were removed, protocols regarding structure and deadwood were modified, and sampling of invasive species, age, browsing impact and naturalness were added. As regards the second objective, progress has been made in harmonizing three groups of variables considered relevant in the context of IFN: Indicators of non-tree vegetation (which play an important role in forest ecosystems, it is where the highest diversity of plants occur and so far the related sampled data in NFIs were not known), the identification of old-growth trees (which have an important role as ecological niche and its identification is especially relevant for the assessment of forest biodiversity) and the available forest for wood supply (basic indicator of international forestry information requirements). A complete analysis of ground vegetation harmonization possibilities within NFIs frame was carried on by identifying and analyzing the different definitions and sampling techniques used by NFIs, providing reference definitions related to ground vegetation and proposing and analyzing two ground vegetation harmonized indicators: “Mean species cover” (MSC) and “Mean total cover” (MTC) for shrubs by European forest categories. A new methodology based on NFI data was established with the aim to provide an efficient tool for policy makers to estimate the number of old-growth trees and thus to be able to perform the analysis of the effect of forest management on the diversity associated to forest systems. The concept of “forest available for wood supply” (FAWS) was discussed and clarified, analyzing the consistency of the available international information on FAWS in order to provide recommendations for data harmonization at European level regarding National Forest Inventories (NFIs). As a result, a new reference definition of FAWS was provided (which will be adopted in the pan-European process) and the consequences of the use of this new definition in seven European countries are analyzed. The studies carried on in this thesis, can facilitate the supply and/or harmonization partially or fully of almost half of the forest indicators (47%) needed for international requirements. Of these, nearly 85% are related to inventoried data using the proposed methodology for the estimation of forest biodiversity, and the rest, with the establishment of the definition of forest available for wood supply. However, despite this thesis imply an important development, forest information needs are changing and it is imperative to continue the process of harmonization of European NFIs.

Promoção, comunicação e educação em saúde: a prática da acupuntura e da fitoterapia

Esta pesquisa discute a Comunicação em Saúde no contexto das Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS), no que concerne ao tratamento do câncer realizado num hospital público de Campinas. O arcabouço teórico se debruça sobre as diretrizes do ideário da Promoção da Saúde e sobre as discussões da Educação em Saúde, por serem premissas fundamentais para que a Comunicação em Saúde seja participativa e democrática, e que a Comunicação das PIC conquiste maior espaço na Saúde Pública. O objetivo geral foi investigar o processo de comunicação entre profissionais de saúde e usuários do SUS participantes do Projeto de Construção do Cuidado Integrativo (PCCI). A metodologia utilizada foi a qualitativa tendo como instrumentos pesquisa documental e entrevistas semi-estruturadas para a coleta dos dados. Os participantes do estudo foram usuários que fizeram parte do grupo de Acupuntura e de Fitoterapia e usaram práticas complementares ao tratamento convencional do câncer, e também os profissionais de saúde envolvidos no PCCI realizado no Hospital de Clínicas da Universidade Estadual de Campinas (UNICAMP)/SP. Os dados foram analisados por meio da análise temática de conteúdo de Bardin, que permitiu identificar as seguintes categorias: Medo da intervenção, Analgesia como resultado, Continuidade do tratamento, Falta de informação e Divulgação das práticas. Os resultados mostraram que houve dificuldades de comunicação, indicando lacunas importantes em relação à infraestrutura, à falta de divulgação e continuidade do tratamento complementar com as PIC, a falta de valorização da participação popular e estímulo à autonomia como preconiza o ideário da Promoção da Saúde. Concluiu-se que o modelo de saúde vigente, de base biomédica, não tem permitido a participação dos usuários, e, mais ainda, tem dificultado o desenvolvimento da comunicação democrática, humanizada e solidária. O Projeto (PCCI) foi importante em sua execução, uma vez que trouxe resultados positivos com o uso das PIC por melhorar as condições da qualidade de vida dos usuários e ter promovido analgesia, conferido maior disposição e recuperação dos movimentos. Entretanto, o Projeto (PCCI) não teve potencial o suficiente para provocar uma mudança na lógica do tratamento convencional que está hegemonicamente imerso no modelo biomédico, com isso limitando a inserção e a comunicação das PIC na Saúde Pública e dificultando a abertura para o diálogo entre os diferentes saberes. Entende-se que este é um dos principais desafios da Medicina Tradicional e Complementar (MTC).

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Archaeal diversity in two thermophilic chalcopyrite bioleaching reactors

This study used a culture-independent molecular approach to investigate the archaeal community composition of thermophilic bioleaching reactors. Two culture samples, MTC-A and MTC-B, grown with different concentrations of chalcopyrite (CuFeS2), a copper sulfidic ore, at a temperature of 78 degrees C and pH 1.6 were studied. Phylogenetic analysis of the 16S rRNA genes revealed that both cultures consisted of Archaea belonging to the Sulfolobales. The 16S rRNA gene clone library of MTC-A grown with 4% (w/v) chalcopyrite was dominated by a unique phylotype related to Sulfolobus shibatae (69% of total clones). The remaining clones were affiliated with Stygiolobus azoricus (11%), Metallosphaera sp. J1 (8%), Acidianus infernus (2%), and a novel phylotype related to Sulfurisphaera ohwakuensis (10%). In contrast, the clones from MTC-B grown with 12% (w/v) chalcopyrite did not appear to contain Sulfolobus shibatae-like organisms. Instead the bioleaching consortium was dominated by clones related to Sulfurisphaera ohwakuensis (73.9% of total clones). The remaining microorganisms detected were similar to those found in MTC-A.

The tectonically-confined Firenzuola turbidite system (Miocene, Marnoso-arenacea Formation, northern Apennines, Italy): an example of facies variations related to the basin morphology

The Firenzuola turbidite system formed during a paroxysmal phase of thrust propagation, involving the upper Serravallian deposits of the Marnoso-arenacea Formation (MAF). During this phase the coeval growth of two major tectonic structures, the M. Castellaccio thrust and the Verghereto high, played a key role, causing a closure of the inner basin and a coeval shift of the depocentre to the outer basin. This work focuses on this phase of fragmentation of the MAF basin; it is based on a new detailed high-resolution stratigraphic framework, which was used to determine the timing of growth of the involved structures and their direct influence on sediment dispersal and on the lateral and vertical turbidite facies distribution. The Firenzuola turbidite system stratigraphy is characterized by the occurrence of mass-transport complexes (MTCs) and thick sandstone accumulation in the depocentral area, which passes to finer drape over the structural highs; the differentiation between these two zones increases over time and ends with the deposition of marly units over the structural highs and the emplacement of the Visignano MTC. According to the stratigraphic pattern and turbidite facies characteristics, the Firenzuola System has been split into two phases, namely Firenzuola I and Firenzuola II: the former is quite similar to the underlying deposits, while the latter shows the main fragmentation phase, testifying the progressive isolation of the inner basin and a coeval shift of the depocentre to the outer basin. The final stratigraphic and sedimentological dataset has been used to create a quantitative high-resolution 3D facies distribution using the Petrel software platform. This model allows a detailed analysis of lateral and vertical facies variations that can be exported to several reservoirs settings in hydrocarbon exploration and exploitation areas, since facies distributions and geometries of the reservoir bodies of many sub-surface turbidite basins show a significant relationship to the syndepositional structural activity, but are beyond seismic resolution.

Maritime expressions:a corpus based exploration of maritime metaphors

This study uses a purpose-built corpus to explore the linguistic legacy of Britain’s maritime history found in the form of hundreds of specialised ‘Maritime Expressions’ (MEs), such as TAKEN ABACK, ANCHOR and ALOOF, that permeate modern English. Selecting just those expressions commencing with ’A’, it analyses 61 MEs in detail and describes the processes by which these technical expressions, from a highly specialised occupational discourse community, have made their way into modern English. The Maritime Text Corpus (MTC) comprises 8.8 million words, encompassing a range of text types and registers, selected to provide a cross-section of ‘maritime’ writing. It is analysed using WordSmith analytical software (Scott, 2010), with the 100 million-word British National Corpus (BNC) as a reference corpus. Using the MTC, a list of keywords of specific salience within the maritime discourse has been compiled and, using frequency data, concordances and collocations, these MEs are described in detail and their use and form in the MTC and the BNC is compared. The study examines the transformation from ME to figurative use in the general discourse, in terms of form and metaphoricity. MEs are classified according to their metaphorical strength and their transference from maritime usage into new registers and domains such as those of business, politics, sports and reportage etc. A revised model of metaphoricity is developed and a new category of figurative expression, the ‘resonator’, is proposed. Additionally, developing the work of Lakov and Johnson, Kovesces and others on Conceptual Metaphor Theory (CMT), a number of Maritime Conceptual Metaphors are identified and their cultural significance is discussed.

Diatoms and biomarkers in sediments from the Antarctic Peninsula

The Antarctic Peninsula (AP) has been identified as one of the most rapidly warming region on Earth. Satellite monitoring currently allows for a detailed understanding of the relationship between sea ice extent and duration and atmospheric and oceanic circulations in this region. However, our knowledge on ocean-ice-atmosphere interactions is still relatively poor for the period extending beyond the last 30 years. Here, we describe environmental conditions in Northwestern and Northeastern Antarctic Peninsula areas over the last century using diatom census counts and diatom specific biomarkers (HBIs) in two marine sediment multicores (MTC-38C and -18A, respectively). Diatom census counts and HBIs show abrupt changes between 1935 and 1950, marked by ocean warming and sea ice retreat in both sides of the AP. Since 1950, inferred environmental conditions do not provide evidence for any trend related to the recent warming but demonstrate a pronounced variability on pluri-annual to decadal time scale. We propose that multi-decadal sea ice variations over the last century are forced by the recent warming, while the annual-to-decadal variability is mainly governed by synoptic and regional wind fields in relation with the position and intensity of the atmospheric low-pressure trough around the AP. However, the positive shift of the SAM since the last two decades cannot explain the regional trend observed in this study, probably due to the effect of local processes on the response of our biological proxies.

Un poison même à petite dose : étude de la structure latente et des facteurs développementaux du sadisme sexuel

Les délinquants sexuels sadiques sont généralement décrits comme une entité clinique particulière commettant des délits graves. Or, la notion même de sadisme sexuel pose un nombre important de problèmes. Parmi ceux-ci, on retrouve des problèmes de validité et de fidélité. Perçu comme une maladie dont on est atteint ou pas, le sadisme a été étudié comme si les sadiques étaient fondamentalement différents. À l’heure actuelle, plusieurs travaux laissent croire que la majorité des troubles psychologiques se présentent comme une différence d'intensité (dimension) plutôt qu’une différence de nature (taxon). Même si la conception médicale prévaut encore en ce qui concerne le sadisme sexuel, plusieurs évoquent l’idée qu’il pourrait être mieux conceptualisé à l’aide d’une approche dimensionnelle. En parallèle, nos connaissances sur les facteurs contributifs au développement du sadisme sexuel sont limitées et reposent sur de faibles appuis empiriques. Jusqu'à présent, très peu d'études se sont intéressées aux facteurs menant au développement du sadisme sexuel et encore moins ont tenté de valider leurs théories. En outre, nos connaissances proviennent majoritairement d'études de cas portant sur les meurtriers sexuels, un sous-groupe très particulier de délinquants fréquemment motivé par des intérêts sexuels sadiques. À notre connaissance, aucune étude n'a proposé jusqu'à présent de modèle développemental portant spécifiquement sur le sadisme sexuel. Pourtant, l'identification de facteurs liés au développement du sadisme sexuel est essentielle dans notre compréhension ainsi que dans l'élaboration de stratégie d'intervention efficace. La présente thèse s'inscrit dans un contexte visant à clarifier le concept de sadisme sexuel. Plus spécialement, nous nous intéressons à sa structure latente, à sa mesure et à ses origines développementales. À partir d'un échantillon de 514 délinquants sexuels évalué au Massachusetts Treatment Center, la viabilité d’une conception dimensionnelle du sadisme sexuel sera mise à l’épreuve à l'aide d'analyses taxométriques permettant d'étudier la structure latente d'un construit. Dans une seconde étape, à l'aide d'analyses de Rasch et d'analyses appartenant aux théories de la réponse à l'item à deux paramètres, nous développerons la MTC Sadism Scale (MTCSS), une mesure dimensionnelle du sadisme sexuel. Dans une troisième et dernière étape, un modèle développemental sera élaboré à l'aide d'équations structurales. La présente thèse permettra de contribuer à la clarification du concept de sadisme sexuel. Une clarification de la structure latente et des facteurs développementaux permettra de saisir les devis de recherche les plus à même de capturer les aspects essentiels. En outre, ceci permettra d'identifier les facteurs pour lesquels une intervention est la plus appropriée pour réduire la récidive, ou la gravité de celle-ci.

Multiple endocrine neoplasia, the old and the new: a mini review

Multiple endocrine neoplasia syndromes have since been classified as types 1 and 2, each with specific phenotypic patterns. MEN1 is usually associated with pituitary, parathyroid and paraneoplastic neuroendocrine tumours. The hallmark of MEN2 is a very high lifetime risk of developing medullary thyroid carcinoma (MTC) more than 95% in untreated patients. Three clinical subtypesdMEN2A, MEN2B, and familial MTC (FMTC) have been defined based on the risk of pheochromocytoma, hyperparathyroidism, and the presence or absence of characteristic physical features). MEN2 occurs as a result of germline activating missense mutations of the RET (REarranged during Transfection) proto-oncogene. MEN2-associated mutations are almost always located in exons 10, 11, or 13 through 16. Strong genotype-phenotype correlations exist with respect to clinical subtype, age at onset, and aggressiveness of MTC in MEN2. These are used to determine the age at which prophylactic thyroidectomy should occur and whether screening for pheochromocytoma or hyperparathyroidism is necessary. Specific RET mutations can also impact management in patients presenting with apparently sporadic MTC. Therefore, genetic testing should be performed before surgical intervention in all patients diagnosed with MTC. Recently, Pellegata et al. have reported that germline mutations in CDKN1B can predispose to the development of multiple endocrine tumours in both rats and humans and this new MEN syndrome is named MENX and MEN4, respectively. CDKN1B. A recent report showed that in sporadic MTC, CDKN1B V109G polymorphism correlates with a more favorable disease progression than the wild-type allele and might be considered a new promising prognostic marker. New insights on MEN syndrome pathogenesis and related inherited endocrine disorders are of particular interest for an adequate surgical and therapeutic approach.

Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience

Background. Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-secerning parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. Objectives. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. Methods. A retrospective review of 26 patients treated for MTC at the “Antonio Cardarelli” Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. Conclusions. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.