Nietzsche has often been interpreted as the champion of heroic, self-sufficient individuals, who manage to fashion some order out of the raw material of Nature through the exercise of free will. On the face of things, Nietzsche's doctrine of eternal recurrence creates a problem for such an interpretation. If history must eternally repeat itself, then it can take only one possible route. Individuals' future actions would then be constrained by the sole possible path of history, and free will would seem to be undermined. In order to avoid the conclusion that eternal recurrence obviates free will, scholars have attempted to show that: (1) Nietzsche does not wish to establish a link between eternal recurrence and cosmology - that is, eternal recurrence should not be read as the cyclical repetition of history; (2) eternal recurrence can be construed so that it aggrandizes the importance of free choice. Contrary to these two trends in scholarship about eternal recurrence, I believe that Nietzsche intends to draw a connection between eternal recurrence and cosmology, and this connection undermines free will. In order to establish this, I examine the textual evidence on eternal recurrence from The Gay Science and Zarathustra to show that Nietzsche employs eternal recurrence as a metaphor for determinism in those works. As a metaphor for a deterministic cosmos, eternal recurrence undercuts free will. Turning to Nietzsche's late works, I show that Nietzsche broadens the scope of eternal recurrence. Eternal recurrence comes to serve as a metaphor for the Dionysian character of Nature. Only by relinquishing one's desire for free will and submitting to necessity and to the trans-individual potency of Nature can the individual see herself as powerful. Hence, it is argued that Nietzsche does not believe individuals manifest strength by asserting their free wills against Nature, as commentators often maintain. Instead, Nietzsche enjoins individuals to cede their desires for free will and to participate in the trans-individual vitality of Nature.

TB recurrence is defined as a new episode of bacteriologically positive TB in a patient previously declared successfully completed treatment. Our study objective was to identify risk factors of recurrence among HIV-infected and HIV-uninfected TB patients. Based on a population-based TB/HIV surveillance database of Chiang Rai Province, Thailand, a retrospective cohort of TB patients with successful completions of treatment between 1997 and 2008 was constructed. Poisson regression was used to model independent effects of risk factors. TB recurrence rates were 5.4/1,000 PYs and 9.7/1,000 PYs for HIV-uninfected and infected TB patients, respectively. We identified that among HIV-uninfected patients, older age, being hilltribe, being prisoners, were at higher risk of recurrence. While among HIV-infected patients, younger age, being male, and having been cured from initial episode were associated with higher recurrence rates. Targeted, practical preventive and treatment strategies for those patients need to be implemented to lower the TB recurrence rates. / Epidemiology

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Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, rarely metastatic, spindle cell tumor. It is most commonly found on the trunk and rarely on the head and neck. Recurrence has been found to be more common in the head and neck region, which may be attributable to delayed patient presentation or a reluctance for wide excision in that region. The authors report a rare case of DFSP presenting as a large mass of the face. Surgical treatment required aggressive local resection of the tumor, including the underlying maxillary antrum. The soft tissue was cleared by Mohs technique. More than one procedure was required to obtain clear bone margins. Adjuvant radiation therapy was used to gain local control. Reconstruction was performed using a cheek advancement flap, as well as a forehead flap and split-thickness graft to the donor site.

Diese Arbeit beschäftigt sich mit verschiedenen Aspekten und Anwendungen von Recurrence Plots. Nach einer Übersicht über Methoden, die auf Recurrence Plots basieren, werden neue Komplexitätsmaße eingeführt, die geometrische Strukturen in den Recurrence Plots beschreiben. Diese neuen Maße erlauben die Identifikation von Chaos-Chaos-Übergängen in dynamischen Prozessen. In einem weiteren Schritt werden Cross Recurrence Plots eingeführt, mit denen zwei verschiedene Prozesse untersucht werden. Diese bivariate Analyse ermöglicht die Bewertung von Unterschieden zwischen zwei Prozessen oder das Anpassen der Zeitskalen von zwei Zeitreihen. Diese Technik kann auch genutzt werden, um ähnliche Abschnitte in zwei verschiedenen Datenreihen zu finden. Im Anschluß werden diese neuen Entwicklungen auf Daten verschiedener Art angewendet. Methoden, die auf Recurrence Plots basieren, können an die speziellen Probleme angepaßt werden, so daß viele weitere Anwendungen möglich sind.<br /> <br /> Durch die Anwendung der neu eingeführten Komplexitätsmaße können Chaos-Chaos-Übergänge in Herzschlagdaten vor dem Auftreten einer lebensbedrohlichen Herzrhythmusstörung festgestellt werden, was für die Entwicklung neuer Therapien dieser Herzrhythmusstörungen von Bedeutung sein könnte. In einem weiteren Beispiel, in dem EEG-Daten aus einem kognitiv orientierten Experiment untersucht werden, ermöglichen diese Komplexitätsmaße das Erkennen von spezifischen Reaktionen im Gehirn bereits in Einzeltests. Normalerweise können diese Reaktionen erst durch die Auswertung von vielen Einzeltests erkannt werden.<br /> <br /> Mit der Hilfe von Cross Recurrence Plots wird die Existenz einer klimatischen Zirkulation, die der heutigen El Niño/ Southern Oscillation sehr ähnlich ist, im Nordwesten Argentiniens vor etwa 34000 Jahren nachgewiesen. Außerdem können mit Cross Recurrence Plots die Zeitskalen verschiedener Bohrlochdaten aufeinander abgeglichen werden. Diese Methode kann auch dazu genutzt werden, ein geologisches Profil mit Hilfe eines Referenzprofiles mit bekannter Zeitskala zu datieren. Weitere Beispiele aus den Gebieten der Molekularbiologie und der Spracherkennung unterstreichen das Potential dieser Methode. / In this work, different aspects and applications of the recurrence plot analysis are presented. First, a comprehensive overview of recurrence plots and their quantification possibilities is given. New measures of complexity are defined by using geometrical structures of recurrence plots. These measures are capable to find chaos-chaos transitions in processes. Furthermore, a bivariate extension to cross recurrence plots is studied. Cross recurrence plots exhibit characteristic structures which can be used for the study of differences between two processes or for the alignment and search for matching sequences of two data series. The selected applications of the introduced techniques to various kind of data demonstrate their ability. Analysis of recurrence plots can be adopted to the specific problem and thus opens a wide field of potential applications. <br /> <br /> Regarding the quantification of recurrence plots, chaos-chaos transitions can be found in heart rate variability data before the onset of life threatening cardiac arrhythmias. This may be of importance for the therapy of such cardiac arrhythmias. The quantification of recurrence plots allows to study transitions in brain during cognitive experiments on the base of single trials. Traditionally, for the finding of these transitions the averaging of a collection of single trials is needed. <br /> <br /> Using cross recurrence plots, the existence of an El Niño/Southern Oscillation-like oscillation is traced in northwestern Argentina 34,000 yrs. ago. In further applications to geological data, cross recurrence plots are used for time scale alignment of different borehole data and for dating a geological profile with a reference data set. Additional examples from molecular biology and speech recognition emphasize the suitability of cross recurrence plots.

Yes / Context: Urinary biomarkers are promising as simple alternatives to cystoscopy for the diagnosis of de novo and recurrent bladder cancer. Objective: To identify a highly sensitive and specific biomarker candidate set with potential clinical utility in bladder cancer. Materials and methods: Urinary biomarkers concentrations were determined by ELISA. The performance of individual markers and marker combinations was assessed using ROC analysis. Results: A 5-biomarker panel (IL8, MMP9, VEGFA, PTGS2 and EN2) was defined from the candidate set. Discussion and conclusion: This panel showed a better overall performance than the best individual marker. Further validation studies are needed to evaluate its clinical utility in bladder cancer. / This work has been supported in part by the European Commission Program DIPROMON - HEALTH-F5-2012-306157-2: Development of an integrated protein- and cell-based device for non-invasive diagnostics in the urogenital tract.