Le traitement initial des cancers différenciés de la thyroïde (CTD) consiste en une thyroïdectomie totale suivie, dans de nombreux cas par l’administration d’iode 131. Après thyroïdectomie totale, un traitement par iode 131 est indiqué en fonction des caractéristiques tumorales initiales. Chez les patients à risque élevé de rechute il est recommandé d’administrer une forte activité d’iode 131. Chez les patients à très faible risque il est recommandé de ne pas administrer d’iode 131. Dans le groupe intermédiaire, il a été montré par deux études prospectives multicentriques randomisées (ESTIMABL et HILO) qu’une activité de 1,1 GBq (30 mCi) administrée après TSHrh (Thyroid Stimulating Hormon recombinante humaine) était adaptée. La désescalade thérapeutique se poursuit dans le cadre d’un autre essai prospectif randomisé (ESTIMABL 2) comparant une activité de 30 mCi après injection de TSHrh à une simple surveillance. Chez les patients avec maladie résiduelle la tomographie par émission de positon couplée à un scanner (TEP/TDM) au fluorodesoxyglucose (FDG) est un examen clé avec une valeur à la fois diagnostique et thérapeutique. Les fixations de FDG permettent de localiser la maladie résiduelle, surtout lorsqu’elle ne capte pas l’iode. Chez les patients dont le site de récidive n’est pas déterminé par l’échographie cervicale, la TEP/TDM au FDG est plus sensible que la scintigraphie post-thérapeutique réalisée après administration d’une forte activité d’iode 131 (dite activité empirique) et est considéré comme l’examen de première intention. La réalisation d’une stimulation par TSHrh avant la TEP au FDG augmente le nombre de lésions détectées et donc sa sensibilité sans que les modifications thérapeutiques qui en découlent soient néanmoins significatives. Le rôle de la TEP FDG dans la sélection des patients nécessitant un traitement par inhibiteur de tyrosine kinase et dans l’évaluation antitumorale des inhibiteurs de tyrosine kinase reste à démontrer. L’utilisation d’ITK pour ré-induire les fixations d’iode 131 sont une voie majeure de développement pour les patients ayant une maladie réfractaire à l’iode 131. / Initial treatment of differentiated thyroid cancer is based on a total thyroidectomy and in many cases on the administration of radioactive iodine. Following total thyroidectomy, radioactive iodine is given, based on the primary tumor characteristics. In case of a very low risk of recurrence it is recommended not to give radioactive treatment. In case of high risk patients, a high activity of radioactive iodine is given after TSH stimulation. In case of intermediate risk patients, two randomized prospective studies (ESTIMABL and HILO) have shown that an activity of 1,1 GBq (30 mCi) given after rhTSH (recombinant human Thyroid Stimulating Hormon) was adequate. A further step is taken towards less treatment has now been undertaken with the ESTIMABL2 study, a prospective randomized study comparing a treatment with 1,1 GBq (30 mCi) of radioactive iodine treatment to follow-up without ablation. In patients with persistent disease, positron emission tomography with computed tomography (PET/CT) is a key examination used for its diagnostic and prognostic value. Foci of FDG uptake can localize residual disease, especially when it does not take up radioactive iodine. In patients in whom the site of recurrence remains unknown after a neck ultrasonography PET/CT with FDG is more sensitive than a post-therapeutic whole body scan performed after the administration of a high activity of radioactive iodine (empiric iodine) and should be considered as the first examination to perform. Injections of rhTSH before doing FDG PET/CT allow to increase the number of lesions detected, however the treatment changes linked to this preparation remains minor. The role of FDG PET/CT in the selection of patients to tyrosine kinase inhibitors (TKI) and to assess metabolic tumor response remains to be explored. The use of TKI to reinduce radioactive iodine uptake is a major research subject for patients with radioactive iodine refractory disease.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T15:10:17Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T15:10:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) / Made available in DSpace on 2017-09-29T15:10:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) Previous issue date: 2013 / Hospital Icaraí / O líquen escleroso vulvar está envolvido em uma das vias da carcinogênse da vulva ligada à neoplasia intraepitelial vulvar diferenciada. A metilação da região promotora do DNA é a principal alteração epigenética pela qual um gene é inativado em seres humanos. A metilação do gene P16INK4a, que é um supressor de tumor e atua como inibidor da cinase dependente da ciclina, tem sido descrita como um evento precoce na carcinogênese vulvar. A metilação do gene TIMP-2, que atua como regulador de metaloproteinases, tem sido descrito como marcador de matriz extracelular. Esta pesquisa tem como objetivo estudar a presença da metilação dos genes P16INK4a e TIMP-2 no líquen escleroso vulvar e avaliar a associação das variáveis idade, doença de tireóide, tabagismo, uso de hormônio e prurido vulvar com a metilação dos referidos genes. Trata-se de um estudo transversal, onde foram analisadas 32 amostras obtidas por biópsia de pacientes com líquen escleroso vulvar. As amostras foram submetidas à extração do DNA por meio da técnica do fenol:clorofórmio e à avaliação da metilação dos genes P16INK4a e TIMP-2 pela modificação química do DNA pelo método do bissulfito. O DNA modificado foi submetido à PCR e a visualização do produto pelo gel de poliacrilamida. O estudo da associação de cada uma das variáveis com a metilação de ambos genes não mostrou significado estatístico. Notou-se que 39% (11/28) das amostras exibiram metilação somente para o gene TIMP-2, e nenhuma para o gene P16INK4a isoladamente, enquanto 32% (9/28) apresentaram metilação em ambos genes de forma simultânea. A análise da associação da metilação entre ambos genes mostrou significado estatístico (p=0,0292). Esses resultados sugerem que a associação da metilação entre os genes P16INK4a e TIMP-2 possa promover instabilidade genômica, podendo funcionar como marcador na evolução da doença. Estudos futuros sobre alterações moleculares da matriz extracelular, que por precederem as alterações morfológicas, talvez possam funcionar como sinalizador, individualizando as pacientes com maior risco de evolução do líquen escleroso vulvar para a NIV diferenciada e/ou câncer de vulva / The vulvar lichen sclerosus is involved in one of the pathways of vulvar carcinogenesis linked to differentiated vulvar intraepithelial neoplasia. The methylation of the promoter region of the DNA is the main epigenetic modification in humans in which a gene is inactivated. Methylation of P16INK4a gene, which is a tumor suppressor and acts as an inhibitor of cyclin-dependent kinase, has been described as an early event in carcinogenesis vulva. Methylation of TIMP-2 gene, which acts as a regulator of metalloproteinases, has been described as a marker of extracellular matrix. This research aims to study the presence of methylation of the P16INK4a gene and TIMP-2 in vulvar lichen sclerosus and evaluate the association of age, thyroid disease, smoking, hormone use and vulvar itching with methylation of these genes. It is a cross-sectional study, which analyzed 32 samples obtained by biopsy from patients with vulvar lichen sclerosus. The samples were subjected to DNA extraction by using the technique of phenol: chloroform and evaluation of methylation of the p16INK4a gene and TIMP-2 by chemical modification of DNA by the method of bisulfite. The modified DNA was subjected to PCR and visualization of the product by polyacrylamide gel electrophoresis. The association of each variable in the methylation of both genes showed no statistical significance. It was noted that 39% (11/28) samples showed methylation only to TIMP-2 gene, and none only for the P16INK4a gene, while 32% (9/28) exhibited methylation on both genes simultaneously. The analysis of the association between methylation of both genes showed statistical significance (p = 0.0292). These results suggest that the association between methylation of the P16INK4a gene and TIMP-2 can promote genomic instability, which can act as a marker in the evolution of the disease. Future studies on the molecular alterations of the extracellular matrix, which precede morphological changes, maybe they can function as a signal, separating the patients with higher risk of evolution of vulvar lichen sclerosus to differentiated VIN and / or cancer of the vulva

O objetivo do presente trabalho é a análise da legislação penal de emergência e, mais especificamente, do regime disciplinar diferenciado, previsto pela Lei nº. 10.792/03, sob o enfoque dos conceitos de eficácia técnico-jurídica, sociológica e, sobretudo, simbólica. Inicialmente, busca-se traçar um quadro das transformações sociais, políticas e econômicas que vêm ocasionando modificações relevantes no sistema penal, na tentativa de utilizá-lo como resposta aos novos problemas político-criminais, contrapondo-o, assim, ao modelo de direito concebido pelo Estado liberal. Em seguida, são examinadas as políticas de segurança pública do governo Fernando Henrique Cardoso, com o intuito de entender como foram pensadas e implementadas tais políticas em um período em que o governo foi constantemente desafiado a se posicionar sobre o crescimento da violência nas grandes cidades brasileiras. Parte-se, então, para a análi/se específica do regime disciplinar diferenciado, explicitando-se, em primeiro lugar, o contexto em que foi criado e, depois, o conteúdo dos dispositivos que permeiam o texto da lei e as decisões judiciais emanadas sobre o tema. Por fim, o trabalho propõe um estudo crítico sobre o impacto, na ordem jurídica, do Direito Penal de emergência e, mais especificamente, do regime disciplinar diferenciado, a partir do estudo de sua eficácia social e simbólica. / The objective of this dissertation is to analyze the criminal law of emergency and, more specifically, the differentiated disciplined regime, according to the Law nº. 10.792/03, focusing on the concepts of juridical, sociological, and, mainly, symbolical efficacy. Firstly, it is pictured the social, political and economical transformations that have been modified significantly the penal system in order to attempt using them as an answer to the new criminal problems, at the same time that they are compared to the principles and rules conceptualized by the liberal State. Secondly, the public securities politics of Fernando Henrique Cardoso are examined with the purpose of understanding how these politics were wondered and implemented in a period that the government was often challenged because of the increasing of violence in Brazilian big cities. Then, it was analyzed specifically the differentiated disciplined regime, showing at first place the context that it was created, and after the content of this law text and judicial decisions related to the subject. In summary, this dissertation proposes a critical study about the impact on justice system of criminal law of emergency and, more specifically of differentiated disciplined regime, from the study of its social and symbolical efficacy

Made available in DSpace on 2016-04-27T14:30:50Z (GMT). No. of bitstreams: 1 Maria Marcia Mariani Guirardi.pdf: 3335910 bytes, checksum: 56f8098a0329da69b12d3d54720d8cf9 (MD5) Previous issue date: 2011-11-18 / Secretaria de Educação de Santos / This study discusses the recovery process of learning in public primary schools. The intention of the problem was "The recovery process of learning schools of Santos provides students of elementary school training, working conditions and opportunities for success in learning for continuing their education?", with the overall goal: "Identify and evaluate the recovery process of learning of the students of local elementary schools of Santos (SP)". It was adopted as the theoretical assumptions of the formative evaluation of training practices and differentiated pedagogy, supported by Abrecht (1994), Allal (1986), Perrenoud (1999/2000/2002), Cardinet (1982), Cappelletti (2005), Abramowicz (2005) and others. The qualitative research used the following procedures: analysis of official documents of the recovery rooms of learning; analysis of Federal, State and Municipal legislation; participant observation during the year 2009 in two public schools and weekly follow-up in three recovery rooms, as well as moments of collective participation of the school; interviews and individual questionnaires with teachers of recovery, academic advisor, director and assistant director of two schools, and analysis of theses and dissertations that deal with the issue. The fieldwork of this study revealed that recovery can contribute to the learning of students having difficulties, for the practice carried out by the teachers demonstrates a differentiated alternative for the development and monitoring of teaching / learning process in favor of the students. The observation during the year 2009 concluded that the pedagogical practice of teachers is effective. This research revealed that a teaching / learning process that has at its center a training practice is a possible route for the Brazilian public school get a quality education / O presente estudo discute o processo de recuperação da aprendizagem em escolas públicas do ensino fundamental. O problema norteador foi ―O processo de recuperação da aprendizagem das escolas municipais de Santos propicia aos alunos do Ensino Fundamental formação, condições e oportunidades de sucesso na aprendizagem para a continuidade de seus estudos?‖, tendo como objetivo geral: ―Identificar e avaliar o processo de recuperação da aprendizagem dos alunos das escolas municipais de Ensino Fundamental de Santos (SP)‖. Adotou-se como referencial teórico os pressupostos da avaliação formativa, de práticas formativas e pedagogia diferenciada, sustentados por Abrecht (1994), Allal (1986), Perrenoud (1999/2000/2002), Cardinet (1982), Cappelletti (2005), Abramowicz (2005) e outros autores. A pesquisa de cunho qualitativo utilizou os seguintes procedimentos: análise de documentos oficiais das salas de recuperação da aprendizagem; análise da legislação Federal, Estadual e Municipal; observação participante durante o ano de 2009 em duas escolas públicas municipais e acompanhamento semanal em três salas de recuperação, além da participação de momentos coletivos da escola; entrevista e questionários individuais com professoras da recuperação, coordenadoras pedagógicas, diretora e assistente de direção das duas escolas; e, análise de teses e dissertações que tratam do tema. A pesquisa de campo deste estudo revelou que a recuperação pode contribuir para a aprendizagem dos alunos que apresentam dificuldades, pois a prática realizada pelas professoras demonstra uma alternativa diferenciada para o desenvolvimento e acompanhamento do processo ensino/aprendizagem favorável aos alunos. A observação durante o ano de 2009 permitiu concluir que a prática pedagógica das professoras é eficaz. Esta pesquisa revelou que um processo ensino/aprendizagem que tenha em seu centro uma prática formativa é um dos caminhos possíveis para que a escola pública brasileira obtenha uma educação de qualidade

This multiple case, qualitative study explored the experiences of six early childhood teachers as they implemented a structured, differentiated literacy framework (The Daily Five™) in a rural northeast Tennessee school system. This study investigated teachers’ perceptions of professional development, specifically the professional development components of coaching including ongoing online discussion, collaboration, and reflective journaling, on changing their literacy planning and instruction. Data were collected through interviews, journal entries, and transcribed meeting conversations. Findings revealed that teachers perceived coaching and collaboration as instrumental professional development components that directly contributed to changing their literacy planning and instruction. Both coaching and collaboration offered necessary support for teachers to feel successful as they made changes in thinking and practice. However, teachers did not find the reflective practice of journaling helpful as they sought to make changes in planning and instructional strategies. The results of this study are significant for teachers and administrators as they seek to increase meaningful professional development aimed at improving literacy instruction.

Despite a rural Georgia school district's effort to increase the academic performance of all students, the achievement gap persists between general education and special education students. The purpose of the study was to explore what factors hindered coteachers from consistently applying differentiated instruction in elementary inclusion classrooms. The conceptual framework for the study emanated from Vygotsky's social development theory as it related to teachers learning from each other through professional collaboration. The research questions explored coteachers' perceptions about differentiated instruction for students with disabilities. Using a case study methodology and purposeful sampling of 6 general education and 6 special education teachers, who met the criteria and agreed to participate, qualitative data were gathered through surveys, semistructured teacher interviews, and lesson plan documentation. Open-ended surveys, transcribed interviews, and lesson plans were coded and analyzed through open and axial coding to generate themes. The major themes identified included teacher perceptions of differentiated instruction, implementing differentiated instructional practices, and supports needed for successful differentiated instructional practices. The findings indicated a need for a systematic approach to professional development on differentiated instructional strategies to improve educational growth for students with disabilities. The recommended professional development may contribute to positive social change by increasing coteachers' impact on the learning environment for special needs students. This increased impact may lead to higher graduation rates and more self-sufficiency among students.

The past decade has seen a significant increase in the emergence of English Language Learners (ELLs) in the United States. Nationally, a disparity in achievement exists between ELLs and non-ELLs. Relatedly, this problem was evident in a northeastern school district, where ELLs had not made Adequate Yearly Progress 2 years in a row. The purpose of this study was to examine how much time English as Second Language (ESL) teachers spend on a variety of best instructional practices. Constructivism, Vygotsky's zone of proximal development, and Tomilinson's differentiated instruction were the frameworks used to guide this research. A within-group design was utilized to identify how much time 25 ESL educators spent on 5 types of instructional practices. The Survey of Instructional Practices for ESL/ELD Teachers for Grades K-12 was used to collect data. A 1-way analysis of variance revealed statistically significant differences between the amounts of time ESL teachers spent on the 5 instructional practices. The greatest time was spent on individualized instructional activities and a variety of educational tasks. Less time was spent on small group activities, and the least amount of time was spent on inquiry-based activities and technology activities. Findings supported the creation of a professional development for ESL teachers at the local site focusing on (a) best instructional practices for teaching ESL students, (b) professional learning community network of support, and (c) resources to support educators in their lesson planning of instructional activities. The study findings and culminating project may positively affect social change by improving ESL instruction at the local site and ultimately decreasing the disparity in achievement between ELL and non-ELL students.

School personnel are concerned that reading gaps of grade 3 and grade 4 students have persisted in 4 rural elementary schools in the southern United States despite the use of ability grouping to improve student reading proficiency scores. Between the 2014-2016 school years, less than 50% of students in grades 3 and grade 4 scored at the proficient level in reading at the 4 target rural schools. The purpose of this qualitative case study was to examine the teachers' and administrators' perceptions regarding the influence of grouping on the reading performance of students in grades 3 and 4. Using Vygotsky's framework, the research investigated teachers' and administrators' perceptions of grouping and nongrouping in relation to students' reading progress, socioeconomic status, and achievement gaps between minority and non-minority students. Using purposeful sampling, interview data were collected from 4 administrators who met the criteria of working in a target site that used ability and nonability grouping. Teacher data came from focus groups, and surveys from 15 teacher participants who met the criteria of being certified in English Language Arts, and assigned to Grades 3 and/or 4 in ability or nonability grouping environments. Using emergent coding, themes supported the findings that assessment strategies are positively and negatively perceived, nonability grouping is preferred, reading achievement is perceived as higher in nonability grouping, and gaps in learning are influenced by socioeconomic status. Based on this research the use of nonability grouping may promote greater positive social change that will enhance student success in reading.

Differentiated instruction is a pedagogical method used by classroom teachers to enhance student learning. Researchers have described how students benefit from differentiated lessons, but have not explored the relationship between teachers' perceptions of differentiation and student success. This gap is problematic because teachers' instruction directly affects student achievement. The purpose of this hermeneutic phenomenological study was to explore how elementary (K-5) teachers define, familiarize, use, and perceive differentiation. The conceptual framework was rooted from a synthesis of ideas found in current refereed literature, and the educational concepts and constructionist theories of Piaget and Vygotsky. Purposeful sampling identified 12 participants for individual or focus group interviews. Data were analyzed through an interpretative analysis of open, axial, and selective coding; interpretations were subject to member checking to bolster trustworthiness. The findings revealed that teacher participants understood the textbook definition of differentiated instruction and focused on student grouping to create differentiated classrooms. Despite that understanding of differentiation, participants perceived differentiation as time consuming and challenging due to a lack of materials and diverse populations. Implications for social change focus on mindset and instruction. Administrators and teachers may use these findings to broaden the definition of differentiation. Furthermore, teachers may use this study to gain insight of their personal perception of differentiation, identify materials, and commit to improved pedagogical practices that focus on its versatility in classrooms and improve student learning. Teachers may consider the participants' experiences and change their own existing classroom environments, thus improving student successes.

Students with disabilities who participate in a fully inclusive educational program have failed to meet district or state goals for adequate yearly progress. This student population is explicitly recognized in state and federal accountability systems. The purpose for this study was to determine how certain factors affected the implementation of inclusive services at one school. This study investigated how teachers' attitudes and perceptions toward inclusion, level of education, exposure to people/students with disabilities, level of support, and knowledge of laws governing the education of students with disabilities affected inclusive classrooms. Gardner's theory of multiple intelligences was used as the theoretical framework to present information about multiple intelligences and differentiated strategies that assisted in the implementation of inclusive services. The sample included 40 teachers who were working in inclusive settings. Teacher Attitudes Toward Inclusion Scale, 1-on-1 interviews, and end-of course scores were used in this sequential explanatory mixed methods study. The quantitative data were analyzed with t tests and ANOVAs, and the qualitative data were analyzed through hand transcription and locating emerging themes. Data showed that teachers had a slightly negative attitude toward inclusion, and student test scores were affected as a result. There were 2 statistically significant differences in attitudes of special education compared to regular education teachers and an average level of knowledge compared to those having very good knowledge of special education laws. The project created based on these results was a series of workshops for school staff. These workshops on inclusive practices could close the achievement gap for this student population and increase teacher effectiveness.