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.     

Magnet Safety Assessment for ITER

The ITER magnet system consists of structurally linked sets of toroidal (TF) and poloidal (PF) field coils, central solenoid (CS), and various support structures. The coils are superconducting, force flow Helium cooled with a Kapton-Glass-Epoxy multilayer insulation system. The stored magnetic energy is about 100GJ in the TF system and 20GJ in the PF-CS. Coils and structure are maintained at 4 K by enclosing them in a vacuum cryostat. The cryostat, comprising an outer envelope to the magnets, forms most of the second radioactivity confinement barrier. The inner primary barrier is formed by the vacuum vessel, its ports and their extensions. To keep the machine size within acceptable bounds, it is essential that the magnets are in close proximity to both of the nuclear confinement barriers. The objective of the magnet design is that, although local damage to one of the barriers may occur in very exceptional circumstances, large scale magnet structural or thermal failure leading to simultaneous breaching of both barriers is not credible. Magnet accidents fall into three categories: thermal (which includes arcing arising from insulation failure and local overheating due to discharge failure in the event of a superconductor quench), structural (which includes component mechanical failure arising from material inadequacies, design errors and exceptional force patterns arising from coil shorts or control failures), and fluid (Helium release due to cooling line failure). After a preliminary survey to select initial faults conceivable within the present design, these faults are systematically analyzed to provide an assessment of the damage potential. The results of this damage assessment together with an assessment of the reliability of the monitoring and protective systems, shows that the magnets can operate with the required safety condition.     

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     

Optimal deterministic timeouts for reliable scalable multicast

Reliable multicast protocols suffer from the problem of feedback implosion. To avoid this problem, the number of receivers sending feedback in case of loss must be small. However, losses experienced by different receivers are strongly correlated, since receivers share common resources in the multicast tree. One approach to feedback implosion avoidance relies on delaying feedback at the receivers. We present deterministic timeouts for reliable multicast (DTRM), a distributed algorithm to compute optimal deterministic timeouts for each receiver in a multicast tree as a function of the tree topology and the sender-to-receiver round-trip delays. DTRM has several desirable properties. First, feedback implosion is provably avoided for a single loss anywhere in the tree, provided delay jitter is bounded. Second, the computation of the timeouts can be entirely distributed; receivers and intermediate nodes only rely on local topology information. Third, the timeouts computed by DTRM are optimal with respect to the maximum response time     

Finite element beam propagation method for three-dimensionaloptical waveguide structures

A beam propagation method (BPM) based on the finite element method (FEM) is described for longitudinally varying three-dimensional (3-D) optical waveguides. In order to avoid nonphysical reflections from the computational window edges, the transparent boundary condition is introduced. The present algorithm using the Pade approximation is, to our knowledge, the first wide-angle finite element beam propagation method for 3-D waveguide structures. To show the validity and usefulness of this approach, numerical results are shown for Gaussian-beam excitation of a straight rib waveguide and guided-mode propagation in a Y-branching rib waveguide     

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     

Densification involved in the UV-based photosensitivity of silicaglasses and optical fibers

A comprehensive survey of photosensitivity in silica glasses and optical fiber is reviewed. Recent work on understanding the mechanisms contributing to germanium or aluminum doped fiber photosensitivity is discussed within the framework of photoelastic densification models     

A wafer level monitoring method for plasma-charging damage usingantenna PMOSFET test structure

A novel monitoring method for plasma-charging damage is proposed. This method performs a quick and accurate evaluation using antenna PMOSFET. It was found that not only hot-carrier (HC) lifetime but transistor parameters such as initial gate current and substrate current were changed according to the degree of plasma-charging damage. However, the present work suggests that monitoring the shift of drain current after a few seconds of HC stress is a more accurate method to indicate plasma-charging damage. The monitoring method using the present test structure is demonstrated to be useful for realizing highly reliable devices