Aproximadamente 40% dos casos de Linfoma não Hodgkin (LNH) se originam fora dos linfonodos, sendo então denominados linfomas extralinfonodais. No trato gastrointestinal (TGI), o estômago é o local mais freqüentemente envolvido, representado pelo linfoma MALT e pelo linfoma difuso de grandes células B (LDGCB). No Brasil, apesar da sua freqüência e importância, existem poucos dados epidemiológicos em relação aos linfomas, especialmente no que se refere aos linfomas de origem extralinfonodal. Para avaliar as características dos linfomas primários gástricos em uma população brasileira, 60 casos foram avaliados retrospectivamente. Trinta e oito (63,3%) foram classificados como LDGCB e 22 (36,6%) como MALT. Entre os dois grupos, não houve diferenças significativas em termos de sexo, idade, sintomas dispépticos, sintomas B, presença de massa Bulky, infiltração de medula óssea, estádio, infecção por H. pylori, achados laboratoriais e endoscópicos. Foram adotados diferentes protocolos de tratamento. A taxa de remissão completa foi de 73,1% no LDGCB e de 95% no linfoma MALT. A taxa de sobrevida livre de doença em 7 anos foi de 84,8% no LDGCB e de 94,1% no linfoma MALT. A taxa de sobrevida global em 7 anos foi de 65,7% no LDGCB e de 92,9% em 5 anos no linfoma MALT. Como não conseguimos demonstrar diferenças entre os dois tipos histológicos, concluímos que o diagnóstico histológico correto é essencial para a terapêutica mais adequada. / Approximately 40% of the non-Hodgkins Lymphoma arises outside lymph node tissue, being then termed extranodal lymphoma. In the gastrointestinal tract, gastric is the commonest localization represented by MALT and diffuse large B-cell lymphoma (DLBCL). In Brazil, despite its importance and frequency there are very few epidemiological data concerning lymphomas, specially the extranodal ones. In order to study the primary gastric lymphoma features in a Brazilian population, 60 patients were retrospectively evaluated. Thirty eight cases (63.3%) were classified as DLBCL and 22 (36.6%) as MALT lymphoma. There were no significant differences between the 2 groups in terms of sex, age, gastric symptoms, B symptoms, Bulky disease, bone marrow infiltration, stage, H. pylori infection, laboratory and endoscopic findings. Different treatment methods were adopted. The complete remission rate was 73.1% for DLBCL and 95% for MALT lymphoma. The disease free survival in 7 years was 84.8 for DLBCL and 94.1% for MALT lymphoma. The 7 year overall survival (OS) rate for DLBCL was 65.7% and 5 year OS for MALT was 92.9%. Because we could not demonstrate differences between the two histological groups, we conclude that the correct histological diagnosis is essential for choosing the best therapeutic approach.

A exenteração pélvica é método efetivo no tratamento de tumores pélvicos localmente avançados. As cirurgias mais conservadoras, com preservação funcional dos esfíncteres e reconstrução continente dos tratos intestinal e urinário podem melhorar a qualidade de vida e estimular os pacientes a aceitar a cirurgia. O objetivo deste estudo foi avaliar os resultados da exenteração pélvica no tratamento dos tumores pélvicos localmente avançados em relação à preservação dos esfíncteres e fatores associados ao prognóstico. Analisou-se retrospectivamente os fatores relacionados à preservação dos esfíncteres bem como os fatores associados ao prognóstico em pacientes submetidos à exenteração pélvica. Dos 96 pacientes submetidos à exenteração pélvica, preservou-se pelo menos um dos esfíncteres em 36 (37,5%). Na década de 1990 a taxa de preservação esfincteriana foi significativamente maior do que na década de 1980 (47,6 versus 18,2%) (p = 0,005). As variáveis independentemente relacionadas à preservação de esfíncter foram tratamento realizado na década de 1990 e tumor de origem coloproctológica. A taxa de complicação pós-operatória não foi influenciada pela preservação dos esfíncteres (p = 0,276). Não se observou diferença estatisticamente significativa nas taxas de morbidade entre as décadas de 1990 e 1980 (55,6% versus 75,8%; p = 0,075). Na década de 1990 houve redução da taxa de mortalidade pós-operatória em relação à década de 1980 (9,5% versus 27,3%; p = 0,023). Em nove pacientes, as margens de ressecção estavam microscopicamente comprometidas (R1) e, em cinco macroscopicamente comprometidas (R2). As margens de ressecção não foram influenciadas pelo tipo de cirurgia (p = 0,104), nem pela preservação dos esfíncteres (p = 0,881). A taxa de sobrevida livre de doença em cinco anos foi de 40,5%. Observou-se associação da recorrência com perda de peso (p = 0,006), índice de Karnofsky (p = 0,035) e a topografia do tumor (p = 0,027). No modelo multivariado, a perda de peso e os tumores de origem ginecológica foram as variáveis independentes para recorrência. Pacientes portadores de tumores ginecológicos ou com perda de peso foram considerados de alto risco para recorrência e os pacientes portadores de tumores não ginecológicos e sem perda de peso, de baixo risco. O grupo de alto risco apresentou chance de recorrência cerca de sete vezes maior do que o de baixo risco. A sobrevida livre de doença em 5 anos para os grupos de baixo e de alto risco foram, respectivamente, de 78,0% e 21,2%. As variáveis associadas ao óbito foram a idade superior a 60 anos (p = 0,007), a perda de peso (p = 0,004), radioterapia pré-operatória (p = 0,043), década de trata mento (p = 0,050) e preservação de esfíncter (p=0,026). No modelo multivariado as variáveis associadas ao óbito foram tratamento realizado na década de 1980, a idade superior a 60 anos e a perda de peso. Com os resultados deste estudo podemos concluir que houve aumento significante da preservação dos esfíncteres na década de 1990 sem aumento da freqüência de margens cirúrgicas comprometidas nem prejuízo na sobrevida dos pacientes submetidos à exenteração pélvica com preservação dos esfíncteres / Pelvic exenteration (PE) is an effective method for treating locally advanced pelvic tumors. More conservative surgeries, preserving sphincters and continent reconstruction of the intestinal and urinary tract, which could contribute to a better quality of life and encourage patients to accept this procedure. The objective of this study was to evaluate the results of PE in the treatment of locally advanced pelvic tumors, mainly considering sphincter preservation and factors associated to the prognosis. Between 1980 and 2000, 96 PE were performed. Factors related to sphincter preservation as well as factors associated to prognosis were respectively analyzed. Of the 96 patients treated with pelvic exenteration, at least one sphincter in 36 patients was preserved (37.5%). In the 1990\'s, the sphincter preservation rate was significantly higher than in the 1980\'s (47.6 vs. 18.2 %) (p = 0.005). Independent variables related to the sphincter preservation were decades from the realization of surgery 1990\'s and coloproctological tumors. The postoperative complication rate was not influenced by sphincter preservation (p = 0.276). Statistically, there was no differentiation between the morbidity rates during the 1980\'s and 1990\'s (55.6% versus 75.8%, p = 0.075). In the 1990\'s, there was a reduction in the post-operative mortality rate compared to the 1980s\' rate (9.5% versus 27.3%; p = 0.023). In nine patients, the resection margins were compromised microscopically (R1) and in five patients, macroscopically compromised (R2). The resection margins were not influenced by the type of surgery (p = 0.104), nor by the preservation of sphincters (p = 0.881). Disease free survival at five years was 40.5%. Among the clinical variables, there was an association between recurrence and weight loss (p = 0.006) and the Karnofsky index (p = 0.035). The topography of the tumor showed links with recurrence (p = 0.027). In the multivariable model, the independent variables related to recurrence were weight loss and gynecological tumors. Patients with gynecological tumors or with weight loss were considered high risk for recurrence, while patients with no gynecological tumors and without weight loss were considered low risk. The high risk group showed 7 times more chance of recurrence than the low risk group. Survival rates of patients, who remained disease-free, after 5 years, for the low and high risk group were 78.0% and 21.2% respectively. Death was linked to ages over 60 (p = 0.007), weight loss (p = 0.004), pre-surgery radiotherapy (p = 0.043), decades from the realization of surgery (p = 0.050) and the sphincter preservation (p = 0.026). The independent variables related to death were treatments in the 1980\'s, ages over 60 and weight loss. Taking into account the results in this research, we conclude that there was a significant increase of sphincter preservation during the 1990\'s and neither the type of surgery nor sphincter preservation were associated to a higher number of surgeries with compromised margins allows pelvic exenteration to be performed with sphincter preservation, without harming survival rates

L'objectif de cette thèse est l'étude rétrospective du développement de la couronne de quelques grands arbres de la forêt tropicale humide guyanaise. Nous avons retenu plusieurs espèces possédant des tempéraments écologiques, des modèles architecturaux et des cycles phénologiques variés, mais présentant toutes au moins un marqueur morphologique ou anatomique susceptible d'être utilisé dans le cadre d'une analyse rétrospective de l'appareil caulinaire. Nous avons décrit des branches sommitales représentatives de la croissance en hauteur et de la reproduction des individus. Parallèlement, nous avons mis en place un suivi phénologique mensuel afin de pouvoir confronter les résultats issus des descriptions rétrospectives aux résultats du suivi phénologique. L'analyse rétrospective de l'appareil caulinaire permet de reconstituer l'histoire des structures ramifiées sur 10 à 15 cycles de développement en moyenne, mais nous avons pu remonter jusqu'à 40 cycles chez certaines espèces. Les informations recueillies nous renseignent sur l'organisation intrinsèque du cycle phénologique de l'organisme ainsi que sur les modalités de construction et de reproduction de l'espèce. Le fait de pouvoir reconstituer l'histoire des différents méristèmes permet dans certains cas d'approcher les relations trophiques qu'ils entretiennent dans l'espace et dans le temps au sein des structures ramifiées. Finalement, le cadre temporel relatif dans lequel sont replacés les processus développementaux autorise la comparaison d'espèces dont les cycles phénologiques ont des dimensions temporelles absolues différentes dans un cadre temporel relatif identique, dont « l'unité » est l'expression morphologique du cycle phénologique dans son ensemble. L'analyse rétrospective de l'appareil caulinaire des arbres tropicaux apparait donc comme une méthode à la fois souple et robuste, complémentaire des suivis de croissance et de suivis phénologiques plus traditionnels. Les résultats obtenus sont originaux et nouveaux dans le domaine de l'écologie tropicale et ils ouvrent des perspectives intéressantes et prometteuses. / The aim of this thesis is to study retrospectively the crown development of large canopy trees of French Guiana. We choose several species expressing various ecological behaviors, architectural developments and phenologies which had at least one morphological or anatomical marker usable in retrospective analysis. We described well sun exposed branches that were representative of individuals' height-growth and reproduction. Simultaneously, we conducted a monthly phenological survey in order to compare our hypotheses from the retrospective analysis to the phenological data. The retrospective analysis allowed us to reconstruct the last 10 to 15 developmental cycles within the branches in mean, sometimes up to 40 cycles in some species. Data give information on the species' intrinsic phenological organization as on growth modalities and reproduction. We could access to the meristems history within the branches and in some case, we could approach meristems interactions on a trophic level. Finally, we could compare species with various phenological strategies within the same relative temporal frame given that is given by the retrospective analysis. The retrospective analysis appears to be a reliable complementary tool that gives access to new and original results in tropical tree study.

The major goal of this dissertation is to enhance software security by provably correct enforcement of in-depth policies. In-depth security policies allude to heterogeneous specification of security strategies that are required to be followed before and after sensitive operations. Prospective security is the enforcement of security, or detection of security violations before the execution of sensitive operations, e.g., in authorization, authentication and information flow. Retrospective security refers to security checks after the execution of sensitive operations, which is accomplished through accountability and deterrence. Retrospective security frameworks are built upon auditing in order to provide sufficient evidence to hold users accountable for their actions and potentially support other remediation actions. Correctness and efficiency of audit logs play significant roles in reaching the accountability goals that are required by retrospective, and consequently, in-depth security policies. This dissertation addresses correct audit logging in a formal framework. Leveraging retrospective controls beside the existing prospective measures enhances security in numerous applications. This dissertation focuses on two major application spaces for in-depth enforcement. The first is to enhance prospective security through surveillance and accountability. For example, authorization mechanisms could be improved by guaranteed retrospective checks in environments where there is a high cost of access denial, e.g., healthcare systems. The second application space is the amelioration of potentially flawed prospective measures through retrospective checks. For instance, erroneous implementations of input sanitization methods expose vulnerabilities in taint analysis tools that enforce direct flow of data integrity policies. In this regard, we propose an in-depth enforcement framework to mitigate such problems. We also propose a general semantic notion of explicit flow of information integrity in a high-level language with sanitization. This dissertation studies the ways by which prospective and retrospective security could be enforced uniformly in a provably correct manner to handle security challenges in legacy systems. Provable correctness of our results relies on the formal Programming Languages-based approach that we have taken in order to provide software security assurance. Moreover, this dissertation includes the implementation of such in-depth enforcement mechanisms for a medical records web application.

Abstract The purpose of this study was to describe and understand the evolution of the content and characteristics of Finnish geriatric nursing from the 1930s till the 2000s. The research approach was based on three underlying assumptions: historicity, multi-level analysis and the dimensions of goals and actual practice. Historicity implied both a long-term analysis of the phenomenon and the use of historical methodology. Multi-level analysis implied that the phenomenon was analyzed at both a macro-level and a micro-level. The macrolevel consisted of the societal geriatric policies (level I). The micro-level was divided into functional environments comprising the municipal context (level II) and nursing organizations (level III) as well as the nursing practice (level IV). The focal aim in the multi-level analysis was to compare the goals (at levels I-III) to the actual practice (level IV). The underlying theoretical premises of the multi-level analysis consisted of system-oriented thinking, and the data were organized in terms of the guidance model. The evolution of geriatric nursing was analyzed on the basis of official documents at the level I, the municipal documents of three municipalities in northern Finland at the level II, the documents of geriatric nursing organizations in selected municipalities at the level III, and retrospective knowledge of nursing aids and assistants and practical nurses at the level IV. In addition to this, contemporary material as well as relevant literature, magazines and research findings were used to shed light on the historico-sociocultural context. The manner of reading applied was systematic interpretation, which allowed the macro- and micro-level information of geriatric nursing in different historical periods to be integrated into a comprehensible whole. The study highlighted the basic dimensions of both goals and actual practice. Using a theoretical societal frame of analysis, they were combined into the general guidelines of geriatric nursing: the retaining nursing of the activation stage (1930-1950), the collective nursing of the preliminary stage (1950-1970), the individual nursing of the revitalizing stage (1970-1990) and the balancing nursing of the renovative stage (1990-). The findings indicated that the evolution of geriatric nursing was shaped by the goal-oriented dimensions of the geriatric policies, the municipal organizations and the functional contexts of the nursing organizations as well as the nurses' role in the actual practice. The findings also indicated that the goals defined in geriatric policies were implemented in the actual nursing practice with some delay. The purpose of the study was to produce synthesizing basic nursing research. It thus opened up a new perspective into the research questions motivated by nursing science. The findings can also be utilized in efforts to understand the value and knowledge base of geriatric nursing and in nurse education. In order to be able to develop nursing further, it is important not to approach nursing as a separate phenomenon, but to integrate it into a wider historico-sociocultural analysis. The methodological solutions made here can also be applied to other nursing research. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja ymmärtää suomalaisen vanhusten hoitotyön sisällön ja luonteen muotoutumista 1930-luvulta 2000-luvulle. Tutkimuksen tarkastelunäkökulmana oli kolme perusolettamusta: historiallisuus, monitasoisuus sekä tavoitteiden ja tosiasiallisen toiminnan ulottuvuudet. Historiallisuus viittasi sekä ilmiön tarkasteluun pitkällä aikavälillä että historialliseen tutkimusmenetelmään. Monitasoisuus liitti ilmiön tarkastelun makro- ja mikrotasoille. Makrotason muodosti yhteiskunnallinen vanhuspolitiikka (I-taso). Mikrotaso jakaantui kunnalliseen (II-taso) ja hoito-organisaatioiden (III-taso) muodostamiin toimintaympäristöihin sekä käytännön hoitotyöhön (IV-taso). Monitasotarkastelun lävistävänä näkökulmana oli heijastaa tavoitteellisia ulottuvuuksia (I-III-taso) käytännön tosiasialliseen toimintaan (IV-taso). Tutkimuksen väljänä monitasotarkastelua ohjaavana teoreettisena lähtökohtana oli systeemiajattelu ja jäsennyksenä toimi ohjausmalli. Vanhusten hoitotyön muotoutumista haettiin I-tasolla virallisten dokumenttien, II-tasolla kolmen pohjoissuomalaisen kunnan kunnallisten asiakirjojen, III-tasolla valittujen kuntien vanhusten hoito-organisaatioiden dokumenttien sekä IV-tasolla apu-, perus- ja lähihoitajien muistitiedon avulla. Tämän lisäksi ajan historiallis-sosiokulttuurisen kontekstin ymmärtämiseksi hyödynnettiin aikalaisaineiston ohella myös ilmiötä koskevaa kirjallisuutta, aikakauslehdistöä ja tutkimustietoa. Tutkimuksen luentatapana oli systematisoiva tulkinta, jonka avulla integroitiin makro- ja mikrotason tiedot vanhusten hoidosta eri aikakausilta yhteen ymmärrettäväksi kokonaisuudeksi. Tutkimus tuotti sekä tavoitteellisten että tosiasiallisen toiminnan ulottuvuuksien peruslinjat. Näistä muodostettiin teoreettista yhteiskunnallista jäsennyskehystä hyödyntäen hoitotyön yleiset kehityslinjat: aktivointivaiheen säilyttävä hoitotyö (1930-1950), luonnosteluvaiheen kollektisoiva hoitotyö (1950-1970), elävöittämisvaiheen yksilöllinen hoitotyö (1970-1990) sekä uudentamisvaiheen tasapainoileva hoitotyö (1990-). Tutkimus osoitti, että hoitotyön muotoutumiseen vaikuttivat vanhuspolitiikan, kunnallisen ja hoito-organisaatioiden toimintaympäristöjen tavoitteelliset ulottuvuudet sekä hoitajan rooli tosiasiallisessa toiminnassa. Tuloksista kävi ilmi, että vanhuspolitiikan tavoitteet heijastuivat hoitotyön tosiasialliseen toimintaan viiveellä. Tutkimuksen ideana oli tuottaa kokoavaa hoitotieteellistä perustutkimusta. Tutkimus avasi siten uutta näkökulmaa hoitotieteen tieteenalasta nouseviin tutkimuskysymyksiin. Tuloksia voidaan hyödyntää myös vanhusten hoitotyön arvo- ja tietoperustan ymmärtämiseen sekä hoitotyön opetukseen. Hoitotyön edelleen kehittämisen kannalta on tärkeää, että hoitotyötä ei tarkastella vain yksittäisenä ilmiönä, vaan se liitetään laajempaan ajan historiallis-sosiokulttuuriseen tarkasteluun. Tutkimuksen menetelmällisiä ratkaisuja voidaan soveltaa myös muissa hoitotieteellisissä tutkimuksissa.

The data-driven adaptive algorithms are explored as a means of increasing the accuracy of Reynolds-averaged turbulence models. This dissertation presents two new data-driven adaptive computational models for simulating turbulent flow, where partial-but-incomplete measurement data is available. These models automatically adjust (i.e., adapts) the closure coefficients of the Reynolds-averaged Navier-Stokes (RANS) k-ω turbulence equations to improve agreement between the simulated flow and a set of prescribed measurement data. The first approach is the data-driven adaptive RANS k-ω (D-DARK) model. It is validated with three canonical flow geometries: pipe flow, the backward-facing step, and flow around an airfoil. For all 3 test cases, the D-DARK model improves agreement with experimental data in comparison to the results from a non-adaptive RANS k-ω model that uses standard values of the closure coefficients. The second approach is the Retrospective Cost Adaptation (RCA) k-ω model. The key enabling technology is that of retrospective cost adaptation, which was developed for real-time adaptive control technology, but is used in this work for data-driven model adaptation. The algorithm conducts an optimization, which seeks to minimize the surrogate performance, and by extension the real flow-field error. The advantage of the RCA approach over the D-DARK approach is that it is capable of adapting to unsteady measurements. The RCA-RANS k-ω model is verified with a statistically steady test case (pipe flow) as well as two unsteady test cases: vortex shedding from a surface-mounted cube and flow around a square cylinder. The RCA-RANS k-ω model effectively adapts to both averaged steady and unsteady measurement data.

Global health is an emerging concern in a rapidly changing world in which health issues transcend international borders. This study developed and validated a new self-report questionnaire to assess self-perceived global health competencies among international medical students and how they are influenced by international clinical experiences. A tool consisted of two scales and four subscales with moderate internal consistency. Comparisons between participants who completed retrospective pretest (after the intervention retrospectively) and those who completed traditional pretest (before the intervention) revealed that those participants who completed the questionnaires retrospectively provided lower pretest scores, suggesting that response-shift bias had occurred. Significant increases in scores after international clinical experience were reported for the majority of global health competency measures in IFMSA group. Linear regression identified participant’s age, gross national income (GNI) of country of medical studies, GNI of the country visited, duration of international clinical experience and years of medical school completed, as significant predictors of global health scores. This study contributes valuable information about the newly developed global health competencies measurement tool.

This thesis was focused on the influence of the tax practice of the courts on the assessment of a tax and the retrospective assessment in the Czech Republic. The purpose was to find out if the present law about the tax and fees administration is a sufficient procedural tax norm and if the existing practice of the courts provides us by its interpretation and integral attitude with reasonable juristic certainty of the tax subjects as well as the tax administrator when in the assessment of a tax and retrospective assessment process. Furthermore the new procedural norm which is just being approved these days in law area was examined: if it brings more suitable legal regulations in the selected areas and if it takes into account the conclusions of the practice of the courts. Finally the conclusions which confirmed expectations in the beginning of this thesis were made. The tax administration law can't act as the basic tax norm because its actual reading contains too many deficiencies. Thereunto from the downright analysis arises that the practice of the courts, which is disunited in its resolutions, for ensuring the integral and right procedure of tax assessment and retrospective assessment can't act. The present situation could be improved by coming into enter be of the new procedural tax law -- The Tax Regulation.

The literature predicts a paradoxical effect on time perception under the influence of positive emotion and high cognitive load in the retrospective paradigm. High cognitive load is expected to increase time perception, whereas positive emotion is expected to decrease time perception. A quasi-experimental within-subjects design was devised that manipulated emotion on two levels (positive and neutral) as well as cognitive load on two levels (high and low) to investigate the effect on time perception. The findings of the study prove disappointing with no main effects witnessed along any of the four experimental conditions. Participants overestimated all the durations, but under the high cognitive load, positive emotion condition, the mean time perception scores where the closest to the chronological time. / Mini-dissertation (MA)--University of Pretoria, 2015. / Psychology / Unrestricted

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23067号 / 医博第4694号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 武藤 学, 教授 妹尾 浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM