Multisystem Langerhans' cell histiocytosis (Hand-Schüller-Christian disease) in an adult: a case report and review of the literature.

Langerhans' cell histiocytosis (LCH) is a rare and enigmatic clonal disorder that affects mainly children. It is characterized by single or multiple granulomatous mass lesions composed of cells with the Langerhans' cell phenotype. Clinical presentation and behavior are heterogeneous and can range from a solitary lytic bone lesion (i.e., eosinophilic granuloma) with a favorable course to a fatal disseminated leukaemia-like form, with a wide spectrum of intermediate clinical presentations between these two extremes. Although LCH typically involves the bone, lesions can be found in almost all organs. We are reporting the case of a multisystem LCH in a 47-year-old patient who presented with a panhypopituitarism and diabetes insipidus, and who, 5 years later, developed mandibular, mastoid and femoral lesions. The final diagnosis of LCH was made on mandibular biopsy.

Guideline adaptation: an approach to enhance efficiency in guideline development and improve utilisation.

BACKGROUND: Developing and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness. METHODS: Based on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process. RESULTS: The ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered individuals (46 countries), 144 completed the questionnaire. A majority found the ADAPTE process clear (78%), comprehensive (69%) and feasible (60%), and the manual useful (79%). However, 21% found the ADAPTE process complex. 44% feared that they will not find appropriate and high-quality source guidelines. DISCUSSION: A comprehensive framework for guideline adaptation has been developed to meet the challenges of timely guideline development and implementation. The ADAPTE process generated important interest among guideline developers and implementers. The majority perceived the ADAPTE process to be feasible, useful and leading to improved methodological rigour and guideline quality. However, some de novo development might be needed if no high quality guideline exists for a given topic.

Fenologia da floração da nogueira macadâmia (Macadamia integrifolia Maiden & Betche) nas condições climáticas de Jaboticabal, São Paulo, Brasil

Com o objetivo de conhecer a fenologia da floração da nogueira macadâmia, foram efetuadas observações, durante o período de maio de 1993 a outubro de 1995, em plantas do pomar da FCAV-UNESP, Jaboticabal, São Paulo, Brasil (latitude 21º 15'S, longitude 48º 18'W). Foram utilizadas plantas de 6 anos de idade, das cultivares IAC 5-10 e IAC 8-17, selecionadas no Brasil. Verificou-se que o período de intumescimento das gemas florais ocorreu a partir de maio. As gemas florais são mistas e localizam-se principalmente em ramos finos (0,2 a 0,7 cm). Das três gemas existentes na axila foliar, a gema superior e a mediana geralmente originam inflorescências. O período ocorrido entre o início de crescimento da gema floral e a antese foi de 48 a 55 dias ou 330 a 350 graus-dia (temperatura-base = 12,8 ºC). A inflorescência e a flor + pedicelo apresentaram um padrão de crescimento do tipo sigmoidal simples. O período de flores em antese concentrou-se entre meados de agosto e meados de setembro.

Equip per a la recuperació de fluids d'un automòbil

El projecte defineix un equip per a l'extracció de fluids d'un vehicle fora d'ús. Aquest extreu per separat els combustibles, els olis, el líquid de frens i l'anticongelant. El sistema d'extracció es realitza per una bomba de buit, a partir del buit creat en un calderí hi entra el líquid corresponent per diferència de pressió i conduint els líquids als dipòsits d'emmagatzematge. L'equip consta d'un conjunt de conductes, vàlvules, filtres i sensors i també inclou un autòmat pel seu control automàtic.

Projecte d’una instal·lació fotovoltaica connectada a la xarxa de baixa tensió sobre la coberta d’una nau agroindustrial

El present Projecte Final de Carrera té com a objectiu la instal·lació de mòduls fotovoltaics en la coberta d’una nau situada a un polígon industrial de Lleida, de dimensions 70 x 30 m, orientada amb un acimut de -30º, per tal de vendre l’energia produïda a la companyia distribuïdora i aconseguir un benefici econòmic. La instal·lació consta de 690 mòduls de silici monocristal·lí de 235 Wp (model HEE215MA65-235) i de dos camps de captació diferenciats en cada ala de la nau, tots ells orientats cap el sud (0º acimut) i inclinats 30º. El camp 1 consta de 360 mòduls i el camp 2 de 330 mòduls, connectats al seu corresponent inversor de 76 kW i 68 kW (models Sunway TG 100-800V i Sunway TG 90-600V). El cost total de la instal·lació és de 707.201,36 Є euros i té un període de retorn de 9 anys. És un projecte rendible i una bona opció ambiental que aconsegueix reduir les emissions de CO2 en 117,6 tones anuals.

Fractional slot permanent magnet synchronous motors for low speed applications

This study compares different rotor structures of permanent magnet motors with fractional slot windings. The surface mounted magnet and the embedded magnet rotor structures are studied. This thesis analyses the characteristics of a concentrated two-layer winding, each coil of which is wound around one tooth and which has a number of slots per pole and per phase less than one (q < 1). Compared to the integer slot winding, the fractional winding (q < 1) has shorter end windings and this, thereby, makes space as well as manufacturing cost saving possible. Several possible ways of winding a fractional slot machine with slots per pole and per phase lessthan one are examined. The winding factor and the winding harmonic components are calculated. The benefits attainable from a machine with concentrated windingsare considered. Rotor structures with surface magnets, radially embedded magnets and embedded magnets in V-position are discussed. The finite element method isused to solve the main values of the motors. The waveform of the induced electro motive force, the no-load and rated load torque ripple as well as the dynamic behavior of the current driven and voltage driven motor are solved. The results obtained from different finite element analyses are given. A simple analytic method to calculate fractional slot machines is introduced and the values are compared to the values obtained with the finite element analysis. Several different fractional slot machines are first designed by using the simple analytical methodand then computed by using the finite element method. All the motors are of thesame 225-frame size, and have an approximately same amount of magnet material, a same rated torque demand and a 400 - 420 rpm speed. An analysis of the computation results gives new information on the character of fractional slot machines.A fractional slot prototype machine with number 0.4 for the slots per pole and per phase, 45 kW output power and 420 rpm speed is constructed to verify the calculations. The measurement and the finite element method results are found to beequal.

La tienda en Internet: cómo diseñar y dar a conocer un establecimiento virtual con éxito

En este artículo se explican las claves que debe poseer una tienda virtual establecida en Internet para tener éxito. En primer lugar se analizan las principales características que tiene un establecimiento virtual, que le diferencia de una tienda real. A la hora de realizar una iniciativa comercial en Internet, al igual que en el mundo físico, tenemos que definir un diseño adecuado de nuestro establecimiento que se ajuste a nuestra idea de negocio y a nuestro público objetivo. A su vez tenemos que elegir un buen nombre de dominio, ya que será una de las puertas de entrada principales de nuestro local. Finalmente, es necesario dar a conocer nuestro negocio, tanto en la red como en el mundo real, ya que estamos inmersos en un océano de más de 1.000 millones de páginas web.

Adensamento, desbaste e análise econômica na produção do maracujazeiro-amarelo

O objetivo deste trabalho foi avaliar o efeito de diferentes densidades de plantas sobre as características de produção, qualidade de fruto e sobre a rentabilidade econômica do maracujazeiro-amarelo. O experimento foi instalado no município de São Tiago, Minas Gerais. Os tratamentos constituíram-se de diferentes densidades de plantas na linha de plantio: T1=1,0 m (3.330 plantas/ha); T2=2,0 m (1.660 plantas/ha); T3=3,0 m (1.110 plantas/ha); T4= 4,0 m (830 plantas/ha); T5=1,0 m (3.330/1.660 plantas/ha); T6=1,5 m (2.220/1.110 plantas/ha), e T7=2,0 m (1.660/830 plantas/ha). Nos tratamentos T5, T6 e T7, foi feito desbaste de plantas alternadas logo após o término da colheita da primeira safra. A maior produtividade foi estimada em 11,9 t ha-1 na densidade de 1.841 plantas/ha na primeira safra, média de 10,9 t ha-1 na segunda safra e 5,46 t ha-1 na terceira safra. A produtividade total foi menor para o sistema menos adensado (830 plantas/ha), com 25,6 t ha-1 e média de 27,96 t ha-1 para os demais tratamentos. O peso médio de fruto não foi alterado com o adensamento, com exceção da segunda safra, que produziu frutos maiores no plantio adensado. O adensamento não alterou a qualidade do fruto. A média das três safras para as características de qualidade foi: peso médio de fruto (126 g), rendimento de suco (34,9%), sólidos solúveis totais (14,6%) e acidez total titulável (4,9%). A máxima eficiência econômica foi alcançada na densidade de 1.110 plantas/ha.

Adubação nitrogenada e potássica em bananeira 'Pacovan' (musa AAB, subgrupo prata) na chapada do Apodi, Estado do Ceará

Este trabalho teve por objetivo avaliar o efeito do nitrogênio e do potássio na produção de bananeiras 'Pacovan', sob irrigação, durante três ciclos, e a qualidade dos frutos obtidos no primeiro ciclo de cultivo na chapada do Apodi, no Estado do Ceará, Brasil. A adubação de base consistiu na aplicação de 20 L planta-1 de esterco de curral, 200 g planta-1 de fosfato monoamônico e 100 g planta-1 de FTE-BR12. A partir de 4,5 meses do plantio, mensalmente, aplicou-se 1/12 das doses de N:K2O (180:330; 180:770; 420:330; 420:770; 30:330; 570:770; 180:55; 420:1.045 e 300:550 kg ha-1), utilizando-se como fonte da uréia e do cloreto de potássio. Não houve influência do potássio na produtividade durante os três ciclos de cultivo, sugerindo-se a dose de 55 kg de K2O ha-1 ano-1. Entretanto, a adubação nitrogenada aumentou o número de frutos no cacho durante o segundo ciclo, permitindo estimar a dose ótima (198,3 kg de N ha-1 ano-1). Os teores de sólidos solúveis, açúcares solúveis e acidez titulável total das bananas colhidas durante o primeiro ciclo foram afetados pela adubação nitrogenada e potássica.

Explaining rapid transitions in the practice of flood risk management

This article draws on empirical material to reflect on what drives rapid change in flood risk management practice, reflecting wider interest in the way that scientific practices make risk landscapes and a specific focus on extreme events as drivers of rapid change. Such events are commonly referred to as a form of creative destruction, ones that reveal both the composition of socioenvironmental assemblages and provide a creative opportunity to remake those assemblages in alternate ways, therefore rapidly changing policy and practice. Drawing on wider thinking in complexity theory, we argue that what happens between events might be as, if not more, important than the events themselves. We use two empirical examples concerned with flood risk management practice: a rapid shift in the dominant technologies used to map flood risk in the United Kingdom and an experimental approach to public participation tested in two different locations, with dramatically different consequences. Both show that the state of the socioenvironmental assemblage in which the events take place matters as much as the magnitude of the events themselves. The periods between rapid changes are not simply periods of discursive consolidation but involve the ongoing mutation of such assemblages, which could either sensitize or desensitize them to rapid change. Understanding these intervening periods matters as much as the events themselves. If events matter, it is because of the ways in which they might bring into sharp focus the coding or framing of a socioenvironmental assemblage in policy or scientific practice irrespective of whether or not those events evolve the assemblage in subtle or more radical ways.

Proceso electoral y prosopografía de los diputados de las Cortes Extraordinarias de Cádiz (1810-1813)

En el presente trabajo analizamos el proceso de elección de los diputados españoles en las Cortes Extraordinarias de Cádiz (1810-1813), la sociología de estos parlamentarios y su asistencia en el Parlamento. Después de efectuar el análisis observamos en primer lugar que hubo cuatro modalidades de elección de los diputados y que, una vez escogidos, nunca se cubrieron todos los puestos de diputado otorgados. En segundo lugar, detectamos que los diputados elegidos por los diversos entes que participaron en el proceso electoral fueron en su mayoría de condición social acomodada y representativos de la sociedad española, sobresaliendo en número el grupo de diputados eclesiásticos, de leyes y funcionarios.

Financiación de la formación: inicial, ocupacional y continua

La formación, en su vertiente inicial, ocupacional y continua se considera un eje fundamental para el correcto funcionamiento del mercado de trabajo, para la promoción personal y profesional de los trabajadores y como factor esencial para la competitividad de las empresas y la calidad de los servicios y los productos. La importancia del argumento anterior obliga a analizar las principales características de organización y financiación del sistema español de formación, sin olvidar la función de apoyo y complemento de las políticas comunitarias en este ámbito

Fluence plays a critical role on the subsequent distribution of chemotherapy and tumor growth delay in murine mesothelioma xenografts pre-treated by photodynamic therapy.

BACKGROUND: The pre-conditioning of tumor vessels by low-dose photodynamic therapy (L-PDT) was shown to enhance the distribution of chemotherapy in different tumor types. However, how light dose affects drug distribution and tumor response is unknown. Here we determined the effect of L-PDT fluence on vascular transport in human mesothelioma xenografts. The best L-PDT conditions regarding drug transport were then combined with Lipoplatin(®) to determine tumor response. in vivo. Lasers Surg. Med. 47:323-330, 2015. © 2015 Wiley Periodicals, Inc. METHODS: Nude mice bearing dorsal skinfold chambers were implanted with H-Meso1 cells. Tumors were treated by Visudyne(®) -mediated photodynamic therapy with 100 mW/cm(2) fluence rate and a variable fluence (5, 10, 30, and 50 J/cm(2) ). FITC-Dextran (FITC-D) distribution was assessed in real time in tumor and normal tissues. Tumor response was then determined with best L-PDT conditions combined to Lipoplatin(®) and compared to controls in luciferase expressing H-Meso1 tumors by size and whole body bioluminescence assessment (n = 7/group). RESULTS: Tumor uptake of FITC-D following L-PDT was significantly enhanced by 10-fold in the 10 J/cm(2) but not in the 5, 30, and 50 J/cm(2) groups compared to controls. Normal surrounding tissue uptake of FITC-D following L-PDT was significantly enhanced in the 30 J/cm(2) and 50 J/cm(2) groups compared to controls. Altogether, the FITC-D tumor to normal tissue ratio was significantly higher in the 10 J/cm(2) group compared others. Tumor growth was significantly delayed in animals treated by 10 J/cm2-L-PDT combined to Lipoplatin(®) compared to controls. CONCLUSIONS: Fluence of L-PDT is critical for the optimal distribution and effect of subsequently administered chemotherapy. These findings have an importance for the clinical translation of the vascular L-PDT concept in the clinics. Lasers Surg. Med. 47:323-330, 2015.

Análisis de la esperanza de vida libre de discapacidad a lo largo de la biografía: de la madurez a la vejez

Objetivo: determinar en qué etapas del curso de vida previo a los setenta años se acortan las expectativas de vida en salud. Método: análisis longitudinal retrospectivo. La población a estudio es una cohorte de 1286 individuos de entre 70 y 74 años de edad que viven en áreas metropolitanas no institucionalizados. La discapacidad se mide mediante el desarrollo de las actividades instrumentales de la vida diaria (AIVD) y las actividades básicas de la vida diaria (ABVD). Se calculan las esperanzas de vida libre de discapacidad y la probabilidades de supervivencia mediante Kaplan-Meier Resultados: La incidencia de discapacidad básica se incrementó a partir del tramo de 50 a 54 años acelerándose progresivamente hasta los 65-69 años donde la probabilidad de padecer discapacidad instrumental fue ligeramente superior en hombres que en mujeres (0,23 en hombres versus 0,19 en mujeres). La supervivencia sin discapacidad de las mujeres fue peor que la de los hombres tanto para cualquier tipo de discapacidad (LogRank = 5,80; p = 0,016) como para la discapacidad básica (LogRank = 4,315; p = 0,038). Conclusiones: se pone de manifiesto el importante peso que para la autonomía de la población masculina de estas edades tiene la falta de habilidad instrumental para cuestiones domésticas. Además, las mujeres ostentan un peor pronóstico de supervivencia sin discapacidad tanto para cualquier tipo de discapacidad como para la discapacidad básica. Para ambos sexos, desde los 40 hasta los 60 años de edad, hay un ligero descenso de la supervivencia sin discapacidad. A partir de esta edad, el descenso se acelera notablemente.

Adaptando Metalib al usuario : la experiencia de la UOC

The implementation of Metalib in UOC's Library was framed within a project centred on the end user. For the adaptation of Metalib to the users' needs and search behaviour, we carried out three tests: - One with students, conducted by a consulting company; - A second one with teachers, carried out by the Library; - The third, with teachers and staff, also was carried out by the Library, after having made some changes resulting from the first and second tests. The tests, made with the software Morae, underlined a number of difficulties to understand the concepts related to metasearching. The tests also showed difficulties in navigating and in managing search results. All the information gathered was used to improve navigation through the interface. The presentation tells about the tests' methodology, the conclusions reached through this experience, and the decisions finally taken by the Library to improve the Metalib interface.