Prevalence of adrenal carcinoma among incidentally discovered adrenal masses. A retrospective study from 1989 to 1994. Gruppo Piemontese Incidentalomi Surrenalici

BACKGROUND: The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequent benign masses and the infrequent malignant ones that require surgery. Univocal guidelines to approach this problem are unavailable. OBJECTIVE: To perform a survey of the clinical management of incidentally discovered adrenal masses (ie, adrenal incidentalomas). DESIGN: A multicentric retrospective analysis of hospital medical records of adrenal incidentalomas diagnosed during a 5-year period; the medical records were scrutinized for demographic data and clinical details by means of a specifically tailored questionnaire. SETTING: The major surgical and medical centers of Piedmont, a northern Italian region with approximately 4 million inhabitants. The recruitment pattern of these centers was unselected. PATIENTS: The definition of adrenal incidentaloma was limited to patients with a physical examination and a clinical history unindicative of adrenal disease. Exclusion criteria also included hypertension of suspected endocrine origin and a history of neoplasms known to metastasize frequently in the adrenal glands. Two hundred twenty-four medical records were collected, and 210 were analyzed (14 excluded a posteriori). RESULTS: Most patients were in their 50s and 60s, and women were predominantly affected. The frequency of adrenocortical cancer was 13% among patients operated on. The tumor diameter was highly correlated with the risk of cancer; a cutoff at 5 cm had a sensitivity of 93% with a specificity of 64% in discriminating between benign and malignant cortical lesions. CONCLUSIONS: The occurrence of adrenocortical carcinoma among adrenal incidentalomas is not rare. The evaluation of the mass size is a simple and effective method for selecting patients at risk for cancer. The indication for surgery of masses larger than 5 cm, or of masses of any diameter that have suspicious imaging characteristics, limits unnecessary operations and costs.     

Perinatal problems and the prevention of premature labor]

The article describes the experience of implementing patient-focused care from a physician's perspective. Pitfalls that guarantee failure are presented, many of which are avoidable with early participation by all parties involved: administrators, nursing staff, physicians, and patients. Contamination of the process with downsizing needs, lack of support for staff in dealing with necessary change, loss of administrative commitment, and withholding of appropriated funds are among the key errors to be avoided.     

Design and performance evaluation of a banyan network basedinterconnection structure for ATM switches

This paper presents a new self-routing packet network called the plane interconnected parallel network (PIPN). In the proposed design, the traffic arriving at the network is shaped and routed through two banyan network based interconnected planes. The interconnections between the planes distribute the incoming load more homogeneously over the network. The throughput of the network under uniform and heterogeneous traffic requirements is studied analytically and by simulation. The results are compared with the results of the baseline network and another banyan network based parallel interconnection network. It is shown that, for the proposed design, a higher degree of heterogeneity results in better performance     

Asymmetric dilation of multiwavelength cross-connect switches forlow-crosstalk WDM optical networks

We predict that, for wavelength division multiplexing optical-network applications, an asymmetrically dilated configuration of a 2×2 cross-connect is significantly better in terms of overall crosstalk when the levels of the bar-port crosstalk and the cross-port crosstalk are significantly different from each other, as is the case with optical-frequency filters which utilize grating-assisted coupling. As a verification, we present a simulation study with 2×2 polarization-diversified acousto-optic tunable filters. We present a recursive method to extend the principle of asymmetric dilation to larger-size cross-connect switches, and make a recommendation for an asymmetrically dilated 4×4 cross-connect configuration     

Positive temperature dependence of the electron impact ionizationcoefficient in In0.53Ga0.47As/InP HBTs

Impact ionization is a major limiting factor to the maximum operating voltage of InGaAs-based, high-speed transistors. In this work, data on the positive temperature dependence of the electron impact ionization coefficient α_n in In_0.53Ga_0.47As at medium-low electric fields are reported for the first time. The increase of α_n with temperature is opposite to the behavior normally observed in most semiconductors. This anomalous behavior implies the onset of a positive feedback between power dissipation and avalanche generation which may adversely affect the power handling capability of In_0.53Ga _0.47As-based devices, and which should be taken into account in device thermal modeling. In the experimental procedure, based on the measurement of the multiplication factor M-1 in npn In_0.53Ga _0.47As/InP Heterojunction Bipolar Transistors (HBT), particular care has been taken in order to rule out possible spurious, temperature-dependent contributions to the measured multiplication current     

A fully soft-switched extended-period quasi-resonantpower-factor-correction circuit

This paper presents the design criteria, procedure, and implementation of a soft-switched power-factor-correction (PFC) circuit based on the extended-period quasi-resonant (EPQR) principles. All power electronic devices including switches and diodes in the circuit are fully soft switched. The design method is demonstrated in a prototype circuit. The operating principles are confirmed with computer simulation and experimental results. A comparison of the EP-QR operation and zero-voltage-transition (ZVT) pulse-width modulation (PWM) method     

Application of neural networks and machine learning in networkdesign

Communication network design is becoming increasingly complex, involving making networks more usable, affordable, and reliable. To help with this, we have proposed an expert network designer (END) for configuring, modeling, simulating, and evaluating large structured computer networks, employing artificial intelligence, knowledge representation, and network simulation tools. We present a neural network/knowledge acquisition machine-learning approach to improve the END's efficiency in solving the network design problem and to extend its scope to acquire new networking technologies, learn new network design techniques, and update the specifications of existing technologies     

Series equivalence/operation of current-controlled boost-typesingle-phase voltage source converters for bidirectional power flow

Single-phase voltage source power converters (VSCs) under consideration are AC-DC current-controlled boost-type power converters with bidirectional power-handling capability. Equivalence between two series-connected two-level power converters and a single three-level power converter is considered here. Further considered is the series operation of three-level power converters. Simulation results and experimental verification for both are provided. Economical configurations of three-level power converters leading to multilevel waveforms are presented thereafter