Secondary organizing pneumonia (bronchiolitis obliterans with organizing pneumonia) associated with adalimumab for treatment of chronic plaque psoriasis

Organizing pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. The pathological pattern of organizing pneumonia may be idiopathic or related to a determined cause, termed secondary organizing pneumonia. We report a 68-year-old woman with a longstanding history of chronic plaque psoriasis, treated with the tumor necrosis factor (TNF) inhibitor, adalimumab. After 8 years of treatment, she developed a gradual-onset, non-productive cough with associated generalized fatigue and mild dyspnea. Radiological investigations demonstrated ground-glass opacities in the left lower lobe and bronchoscopy revealed a fibroinflammatory process consistent with organizing pneumonia. Her biologic treatment was ceased and corticosteroid treatment commenced, with resolution of both her symptoms and the radiological findings. Given the increasing incidence of biologic treatment in the management of dermatological conditions, clinicians should be aware of secondary organizing pneumonia as a possible side effect of TNF inhibitor therapy

Projeto Horta Viva na escola

The presence of vegetable gardens in schools is increasingly uncommon due to the great ease and practicality of the use of industrialized products to feed students, which causes the devaluation of natural foods and the growing disinterest of children for using vegetables in food. However, the use of vegetables is of great importance for the nutritional development of children who are growing. Therefore, with the present work, the objective was to implement gardens in schools of Early Childhood, Elementar School and High School. During the year 2017 the project was developed in four schools in different locations in Novo Cabrais, Cachoeira do Sul and Santiago, in the state of Rio Grande do Sul. An informative lecture was held dealing with information about the preparation of the gardens and importance of the consumption of healthy foods. At the end of the development of the project, it was possible to observe how satisfactory and relevant it was for each of the students, regardless of age, to help planting the seedlings, to observe the growth and development of each plan. A presença de hortas nas escolas é cada vez mais incomum devido à grande facilidade e praticidade do uso de produtos industrializados para alimentação dos alunos, o que acarreta na desvalorização dos alimentos naturais e no desinteresse crescente das crianças por usar vegetais na alimentação. No entanto, o uso de vegetais é de grande importância para o desenvolvimento nutricional das crianças que se encontram em fase de crescimento. Portanto, com o presente trabalho, objetivou-se implantar hortas em escolas de Educação Infantil, Ensino Fundamental e Ensino Médio. Durante o ano de 2017 o projeto foi desenvolvido em quatro escolas, em diferentes localidades, em Novo Cabrais, Cachoeira do Sul e Santiago, no estado do Rio Grande do Sul. Foi realizada uma palestra informativa tratando de informações sobre o preparo das hortas e importância do consumo de alimentos saudáveis. Ao final do desenvolvimento do projeto, foi possível observar o quanto foi satisfatório e relevante para cada um dos alunos, independente da idade, ajudar no plantio das mudas, poder observar o crescimento e desenvolvimento de cada planta

A horta como laboratório vivo para trabalhar a interdisciplinaridade no ensino médio

Nowadays, education undergoes a process of restructuring and interdisciplinarity is fundamental to minimize the existing limits between the disciplines of High School. The origin of interdisciplinarity lies in the transformations of the ways of producing science and of perceiving reality. In this sense, the school garden can be a way to relate the knowledge of the various disciplines. With this extension work, the objective was to implement a vegetable garden at the Ruy Barbosa State High School, in the municipality of Novo Cabrais - RS, in order to promote interdisciplinary actions. Before the implementation of the garden, a lecture was given to students and teachers. It was chosen an idle place with potential for the cultivation of vegetables, where the vegetable garden was implanted. Lettuce, arugula, tomato, cassava, beet, sweet potato, popcorn, beans, Japanese moranga, fennel, pumpkin, radish and almeirão, among others crops. Among the interdisciplinary activities to be worked in High School are the calculation of the total production of each species cultivated in the garden, study of the centers of origin of each species, scientific names of the cultivated species, use of natural insecticides and organic fertilizer, regions that use the species grown in food and / or as medicinal plants.Atualmente a educação passa por um processo de reestruturação e a interdisciplinaridade é fundamental para minimizar os limites existentes entre as disciplinas do Ensino Médio. A origem da interdisciplinaridade está nas transformações dos modos de produzir a ciência e de perceber a realidade. Nesse sentido, a horta escolar pode ser um meio de relacionar os conhecimentos das diversas disciplinas. Com este trabalho de extensão objetivou-se implantar uma horta na Escola Estadual de Ensino Médio Ruy Barbosa, no município de Novo Cabrais - RS, com a finalidade de promover ações interdisciplinares. Antes da implantação da horta foi realizada palestra direcionada aos alunos e professores. Foi escolhido um local ocioso e com potencial para o cultivo de hortaliças, onde foi implantada a horta. Foram cultivadas alface, rúcula, tomate, mandioca, beterraba, batata-doce, milho pipoca, feijão, moranga japonesa, funcho, abóbora, rabanete e almeirão, dentre outras espécies. Dentre as atividades interdisciplinares para serem trabalhadas no Ensino Médio destacam-se o cálculo da produção total de cada espécie cultivada na horta, estudo dos centros de origem de cada espécie, nomes científicos das espécies cultivadas, uso de inseticidas naturais e adubo orgânico, povos de diferentes regiões que utilizam as espécies cultivadas na alimentação e/ou como plantas medicinais

O papel da horta nas escolas de educação infantil

During Early Childhood Education, it is very important to provide experiences of approach children with everyday problems. Thus, the project entitled "Horta Viva na Escola", at the Federal University of Santa Maria - Campus Cachoeira do Sul, aimed to set up vegetable gardens in Early Childhood Schools, in order to contribute to practical and meaningful learning for the integral formation of children. Two gardens were set up in two schools for children, one at the Municipal School of Child Education in the city of Santiago and the other at the Totem College in Cachoeira do Sul. The gardens were set up in idle space in the schoolyard, where students were responsible for planting and managing the garden, together with the teacher responsible for the class. With the project, activities such as planting of seedlings and sowing of vegetables were carried out, in which the children were able to follow and observe the phases of the development of the plants, performing daily care necessary for their cultivation and future harvest. In this sense, the garden inserted in the school environment has a very important role for becoming a living laboratory, which enables the development of various practical and necessary pedagogical activities within the school contextDurante a Educação Infantil é muito importante proporcionar experiências de aproximação das crianças com as problemáticas do cotidiano. Assim, o projeto intitulado “Horta Viva na Escola”, da Universidade Federal de Santa Maria - Campus Cachoeira do Sul, objetivou implantar hortas em Escolas de Educação Infantil, a fim de contribuir com aprendizagens práticas e significativas para a formação integral das crianças. Foram implantadas hortas em duas Escolas de Educação Infantil, uma na Escola Municipal de Educação Infantil Sol Criança localizada na cidade de Santiago e a outra no Colégio Totem em Cachoeira do Sul. As hortas foram implantadas em espaço ocioso no pátio das escolas, onde os alunos foram os responsáveis pelo plantio e manejo da horta, juntamente com a professora responsável pela turma. Com a realização do projeto foram desenvolvidas atividades como o plantio de mudas e semeadura de hortaliças, em que as crianças puderam acompanhar e observar as fases do desenvolvimento das plantas, realizando cuidados diários necessários para seu cultivo e futura colheita. Nesse sentido, a horta inserida no ambiente escolar tem papel muito importante por tornar-se um laboratório vivo, que possibilita o desenvolvimento de diversas atividades pedagógicas práticas e necessárias dentro do contexto escolar

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Unit commitment optimization of thermal power plants using evolutionary algorithms and a new parameterization

110 σ.Σκοπός της παρούσας διπλωματικής εργασίας είναι η δημιουργία και πιστοποίηση μίας μεθόδου-λογισμικού βελτιστοποίησης του προγράμματος λειτουργίας ενός θερμικού ηλεκτροπαραγωγικού σταθμού και η βέλτιστη ανάθεση φορτίου στις μονάδες που τον συγκροτούν. Στόχος είναι η κάλυψη μιας καθορισμένης βραχυπρόθεσμης χρονοσειράς ζήτησης με το ελάχιστο κόστος. Το πρόβλημα αυτό αποτελεί αντικείμενο συνδυαστικής βελτιστοποίησης και για την επίλυση του χρησιμοποιείται η στοχαστική μέθοδος των εξελικτικών αλγορίθμων (Evolutionary Algorithms - ΕΑ). Η εργασία προτείνει μία, πρακτικά, νέα μέθοδο σε σύγκριση με τον σχετικό αλγόριθμο της διδακτορικής διατριβής της Δρ. Γεωργοπούλου, που αναπτύχθηκε στο Εργαστήριο Θερμικών Στροβιλομηχανών του ΕΜΠ. Βασική παραλλαγή είναι η χρήση ακέραια κωδικοποιημένου χρωμοσώματος, αντί δυαδικού, μειώνοντας σημαντικά το μήκος του. Μία ‘βάση δεδομένων’ βέλτιστης ανάθεσης φορτίου ολοκληρώνεται πριν την εκκίνηση του ΕΑ και εφαρμόζεται μόνο σε αποδεκτά ωριαία σενάρια λειτουργίας, σε σενάρια δηλαδή που καλύπτουν τη ζήτηση του δικτύου, περιορίζοντας το πλήθος των συνολικών αξιολογήσεων. Τα νέα αυτά στοιχεία σε συνδυασμό με τη χρήση χρονικής κατάτμησης του ορίζοντα προγραμματισμού επιφέρουν ραγδαία επιτάχυνση της διαδικασίας, απαλείφοντας έτσι το κύριο μειονέκτημα των ΕΑ που είναι ο αργός ρυθμός σύγκλισης τους. Αφού προηγηθεί η παρουσίαση της μεθόδου, ο αλγόριθμος δοκιμάζεται σε περιπτώσεις που αφορούν τις αρχικές καταστάσεις των μονάδων, την υπερπαραγωγής ενέργειας και την κάλυψη του ελλείμματος παραγωγής από εξωτερική πηγή. Τέλος, λαμβάνοντας υπόψη και τον περιορισμό της στρεφόμενης εφεδρείας, γίνεται πιστοποίηση σε εφαρμογές από τη βιβλιογραφία ώστε να είναι δυνατή η σύγκριση των αποτελεσμάτων.The purpose of this diploma thesis is to develop and assess a method-software for the solution of the unit commitment problem of a thermal power plant, in an optimal way, along with the economic load dispatch problem of the generators that compose it. The aim is to cover a specified short-term load demand at minimum cost. The proposed technique for solving this combinatorial optimization problem is a stochastic population-based method, namely the evolutionary algorithm (EA). This study suggests a, practically, new method compared to the algorithm presented at the PhD thesis of Dr. Georgopoulou and developed at the Lab Of Thermal Turbomachines of NTUA. A key structural change is the use of integer-coded instead of binary-coded chromosome and, thus the chromosome length is significantly reduced. In addition, the economic load dispatch is completed before the beginning of the EA, by forming a database of possible hour scenarios to use during the optimization, and is applied only for feasible hourly-operating scenarios which leads to a limited number of evaluations. The scheduling horizon is also partitioned in sub-periods which are solved using semi-autonomous EAs. These new features result to a noticeable acceleration of the optimization algorithm eliminating, thus, the main disadvantage of EAs which is their slow convergence. After the current method is thoroughly presented, the algorithm is tested for some cases relating to the initial states of the units, the energy overproduction and a possible energy deficit that needs to be covered by third-party sources. Finally, the assessment of this method is based on test-cases taken from the relevant literature which allows comparison of results.Ιωάννης Κ. Δολιανίτη

Secondary organizing pneumonia (bronchiolitis obliterans with organizing pneumonia) associated with adalimumab for treatment of chronic plaque psoriasis

Organizing pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. The pathological pattern of organizing pneumonia may be idiopathic or related to a determined cause, termed secondary organizing pneumonia. We report a 68-year-old woman with a longstanding history of chronic plaque psoriasis, treated with the tumor necrosis factor (TNF) inhibitor, adalimumab. After 8 years of treatment, she developed a gradual-onset, non-productive cough with associated generalized fatigue and mild dyspnea. Radiological investigations demonstrated ground-glass opacities in the left lower lobe and bronchoscopy revealed a fibroinflammatory process consistent with organizing pneumonia. Her biologic treatment was ceased and corticosteroid treatment commenced, with resolution of both her symptoms and the radiological findings. Given the increasing incidence of biologic treatment in the management of dermatological conditions, clinicians should be aware of secondary organizing pneumonia as a possible side effect of TNF inhibitor therapy