Enlarging neck masses in the elderly – Histological and surgical considerations

AbstractINTRODUCTIONAnaplastic carcinoma of the thyroid is a rare but aggressive malignancy which can present with a rapidly enlarging neck mass or compressive sequelae of cough, dyspnoea, dysphagia and hoarseness. Treatment of such tumours is commonly palliative however they occasionally represent surgical challenges due to their rapid growth, diagnostic difficulty and locoregional spread.PRESENTATION OF CASEA 75 year-old retired veterinary surgeon was referred with a 2 month history of a painless, enlarging neck mass. The patient denied any secondary compressive symptoms or general symptoms of malignancy. On examination a large right-sided neck mass measuring 7cm×5cm was appreciated which was fixed, hard and irregular with associated adenopathy.DISCUSSIONWe discuss the diagnostic challenges posed by anaplastic carcinoma of the thyroid and the difficulties in selecting the appropriate intervention in this aggressive disease process.CONCLUSIONAnaplastic carcinoma of the thyroid is encountered infrequently in clinical practice and can generate diagnostic and therapeutic challenges

OH/IR stars and their superwinds as observed by the Herschel Space Observatory

Aim : In order to study the history of mass loss in extreme OH/IR stars, we observed a number of these objects using CO as a tracer of the density and temperature structure of their circumstellar envelopes. Method : Combining CO observations from the Herschel Space Observatory with those from the ground, we trace mass loss rates as a function of radius in five extreme OH/IR stars. Using radiative transfer modelling, we modelled the dusty envelope as well as the CO emission. The high-rotational transitions of CO indicate that they originate in a dense superwind region close to the star while the lower transitions tend to come from a more tenuous outer wind which is a result of the mass loss since the early AGB phase. Result : The models of the circumstellar envelopes around these stars suggest that they have entered a superwind phase in the past 200 - 500 years. The low 18O/17O (~ 0.1 compared to the solar abundance ratio of ~ 5) and 12C/13C (3-30 cf. the solar value of 89) ratios derived from our study support the idea that these objects have undergone hot-bottom burning and hence that they are massive M >= 5 solar-mass AGB stars.Comment: 10 pages with 11 figures Accepted for publication by Astronomy & Astrophysic

The residuals analysis project: Evaluating disposal options for treated mixed low-level waste

For almost four years, the U.S. Department of Energy (DOE) through its Federal Facility Compliance Act Disposal Workgroup has been working with state regulators and governors` offices to develop an acceptable configuration for disposal of its mixed low-level waste (MLLW). These interactions have resulted in screening the universe of potential disposal sites from 49 to 15 and conducting ``performance evaluations`` for those fifteen sites to estimate their technical capabilities for disposal of MLLW. In the residuals analysis project, we estimated the volume of DOE`s MLLW that will require disposal after treatment and the concentrations of radionuclides in the treated waste. We then compared the radionuclide concentrations with the disposal limits determined in the performance evaluation project for each of the fifteen sites. The results are a scoping-level estimate of the required volumetric capacity for MLLW disposal and the identification of waste streams that may pose problems for disposal based on current treatment plans. The analysis provides technical information for continued discussions between the DOE and affected States about disposal of MLLW and systematic input to waste treatment developers on disposal issues

THE PROTECTION OF DOCUMENT PRINTING IN HEALTHCARE

Članak opisuje nedostatke u poslovnim procesima sa naglaskom na zaštitu ispisa dokumenata u zdravstvu. Izmjenama poslovnih procesa u zdravstvu napravile bi se ogromne uštede u proračunu, smanjile bi se liste čekanja te povećala efikasnost cijelog sustava. Svi nedostatci su opisani tablično i kroz primjere, te su date i preporuke za izmjenu poslovnih procesa. Jedan od nedostataka je i ispis dokumenata poput otpusnog pisma ili povijesti bolesti kojima se da lako manipulirati. U članku se navodi moguće rješenje, odnosno smanjeno ili u potpunosti onemogućeno falsificiranje upotrebom tehnologije zaštite u infra red području. IRDSPB (Infra Red Design Security Print Box) donosi mogućnost zaštite dokumenata u samom njihovom nastajanju, uz minimalan trošak. Članak opisuje IRDSPB tehnologiju, koje su mogućnosti implementacije te prednosti u odnosu na postojeće rješenje bez zaštite.This article describes disadvantages of business processeses with the focus on protection of document printing in healthcare. Modifications of business processes in healthcare could make huge savings in the budget, decrease waiting lists and increase the efficiency of the entire system. All weaknesses are described in tables and through examples. Also, recommendations are made to modify business processes. One of the disadvantages is printing documents such as a discharge letter or medical history which can be easily manipulated. The article offers a possible solution, that is, a decreased or completely prevented falsification by using technology protection in infra-red area. IRDSPB (Infra Red Design Security Print Box) brings the possibility of protecting documents in the print time at minimal cost. This article describes IRDSPB technology, what are the possibilities of implementation and advantages over existing solutions without protection

A Mathematical Model of Liver Cell Aggregation In Vitro

The behavior of mammalian cells within three-dimensional structures is an area of intense biological research and underpins the efforts of tissue engineers to regenerate human tissues for clinical applications. In the particular case of hepatocytes (liver cells), the formation of spheroidal multicellular aggregates has been shown to improve cell viability and functionality compared to traditional monolayer culture techniques. We propose a simple mathematical model for the early stages of this aggregation process, when cell clusters form on the surface of the extracellular matrix (ECM) layer on which they are seeded. We focus on interactions between the cells and the viscoelastic ECM substrate. Governing equations for the cells, culture medium, and ECM are derived using the principles of mass and momentum balance. The model is then reduced to a system of four partial differential equations, which are investigated analytically and numerically. The model predicts that provided cells are seeded at a suitable density, aggregates with clearly defined boundaries and a spatially uniform cell density on the interior will form. While the mechanical properties of the ECM do not appear to have a significant effect, strong cell-ECM interactions can inhibit, or possibly prevent, the formation of aggregates. The paper concludes with a discussion of our key findings and suggestions for future work

Activation of chimeric and full-length growth hormone receptors by growth hormone receptor monoclonal antibodies: A specific conformational change may be required for full-length receptor signaling

Signal transduction by the growth hormone receptor (GHR) occurs through growth hormone (GH)-induced dimerization of two GHRs to form a trimeric complex, It is thought that dimerization alone is sufficient for signaling, since monoclonal antibodies (mAbs) against the extracellular domain of the GHR elicit proliferation of FDC-P1 cells transfected with a chimeric receptor comprising the extracellular domain of the GHR and the fibronectin and cytoplasmic domains of the murine granulocyte colony-stimulating factor receptor, We have screened 14 GHR mAbs for proliferative activity against characterized FDC-P1 and BaF-B03 cell lines stably expressing the full-length human, rabbit, or rat GHR, or the chimeric human GHR/granulocyte colony-stimulating factor receptor, and for transactivation of the c-fos promoter and STAT activation. With the chimeric receptor, eight mAbs were able to elicit proliferation, although there was no correlation between inhibition of hormone binding and agonist activity. In contrast, no mAbs were able to act as agonists with the full-length GHR FDC-P1 cell lines, although nine competed with GH for binding, A weak proliferative response was observed in the BaF-B03 cell lines with two of the mAbs (263 and 1C9), and the addition of anti-mouse F(ab)(2) resulted in increased signaling in the hGHR BaF-B03 cell line to a plateau of 28 +/- 4% of the GH maximum for mAb 263. These data could indicate considerable stringency in the ability of mAbs to correctly dimerize the full-length GI-IR. However, the ability of mAb 263 to stimulate a mutant hGHR altered in the F'-G' loop of domain 2 was nearly abolished, concurrent with an increased affinity of this mAb for the receptor. Since the F'-G' loop undergoes a conformational change on GH binding and is necessary for full proliferative signaling, we propose that in addition to promoting receptor dimerization, mAb 263 may induce specific changes in receptor conformation similar to GH, which are required for the biological response

On Birthing Dancing Stars: The Need for Bounded Chaos in Information Interaction

While computers causing chaos is acommon social trope, nearly the entirety of the history of computing is dedicated to generating order. Typical interactive information retrieval tasks ask computers to support the traversal and exploration of large, complex information spaces. The implicit assumption is that they are to support users in simplifying the complexity (i.e. in creating order from chaos). But for some types of task, particularly those that involve the creative application or synthesis of knowledge or the creation of new knowledge, this assumption may be incorrect. It is increasingly evident that perfect order—and the systems we create with it—support highly-structured information tasks well, but provide poor support for less-structured tasks.We need digital information environments that help create a little more chaos from order to spark creative thinking and knowledge creation. This paper argues for the need for information systems that offerwhat we term ‘bounded chaos’, and offers research directions that may support the creation of such interface

Influence of storm surge on tidal range energy

The regular and predictable nature of the tide makes the generation of electricity with a tidal lagoon or barrage an attractive form of renewable energy, yet storm surges affect the total water-level. Here, we present the first assessment of the potential impact of storm surges on tidal-range power. Water-level data (2000–2012) at nine UK tide gauges, where tidal-range energy is suitable for development (e.g. Bristol Channel), was used to predict power. Storm surge affected annual resource estimates −5% to +3%, due to inter-annual variability, which is lower than other sources of uncertainty (e.g. lagoon design); therefore, annual resource estimation from astronomical tides alone appears sufficient. However, instantaneous power output was often significantly affected (Normalised Root Mean Squared Error: 3%–8%, Scatter Index: 15%–41%) and so a storm surge prediction system may be required for any future electricity generation scenario that includes large amounts of tidal-range generation. The storm surge influence to tidal-range power varied with the electricity generation strategy considered (flooding tide only, ebb-only or dual; both flood and ebb), but with some spatial and temporal variability. The flood-only strategy was most affected by storm surge, mostly likely because tide-surge interaction increases the chance of higher water-levels on the flooding tide