Nave para Volkswagen en Ravenna, Italia

This factory hall is meant to house an exhibition, workshops, stores and offices of the Italian subsidiary of the Volkswagen firm. It is sited in an urbanized, but not yet built up, area. Its ground area is 54 by 38 m. Part of the frontage, about 36 m, is set back 8 m with respect to the remaining 18 m; the latter correspond to the part of the building occupied by the exhibition hall. As the ground is weak, it has been necessary to use piles to support the foundations. The structure is metallic, and the enclosing walls and roof consist of prefabricated panels and metals sheets. The roof contains a special chamber, where the air conditioning ducts and other services are housed. Great care has been taken over the colour patterns, both inside and outside. The type of structure and use of prefabricated panels has greatly lowered the overall cost of the building. All the foundation elements have been suitable waterproofed.<br><br>Esta nave industrial está destinada a albergar los servicios de exposición, talleres, depósito y oficinas para la empresa concesionaria, en Italia, de la marca de automóviles Volkswagen. Se halla situada en una zona urbanizada, pero sin edificar, y tiene 54x38 m en planta. Parte de la fachada principal—unos 36 m—está retranqueada 8 m respecto de la alineación; los 18 m restantes corresponden al salón de exposiciones. Como el terreno es de escasa capacidad de sustentación, ha sido necesario el empleo de pilotes en los puntos de apoyo. La estructura resistente es metálica y se ha cerrado y cubierto con paneles prefabricados y placas metálicas. Los forjados de cubierta tienen una cámara que permite la colocación de conductos para el acondicionamiento. Se han cuidado mucho los colores para la estructura vista y paramentos interiores. La disposición de la estructura y el empleo de paneles prefabricados han permitido obtener costos muy favorables. Todas las partes de la infraestructura han sido debidamente impermeabilizadas

Efficacy of radiotherapy in normalizing serum IGF-I, acid-labile subunit (ALS) and IGFBP-3 levels in acromegaly

OBJECTIVE: Radiotherapy (RT) has been used for many years in order to complete the cure of unsuccessfully operated acromegalic patients. Several studies have shown its efficacy in normalizing GH levels, while reports about IGF-I normalization are conflicting. Moreover, data regarding other markers of disease activity, such as IGFBP-3 and acid-labile subunit (ALS), i.e. the other two components of the circulating 150 kDa complex, are lacking. DESIGN: Retrospective study. PATIENTS AND MEASUREMENTS: Sixty-seven acromegalic patients (20 males and 47 females, aged 40 \ub1 6 years) who underwent postoperative RT (in fractionated doses for a total of 40-75 Gy) were followed-up for 11 \ub1 6 years (range: 1-26 years, median: 10 years). Serum GH and IGF-I levels off medical therapy were measured in all patients; ALS and IGFBP-3 were measured in 11 patients with normalization of IGF-I concentrations. Computed tomography or nuclear magnetic resonance imaging periodically assessed possible development of pituitary deficiency along with imaging of the hypothalamic-pituitary region. RESULTS: Forty-one out of 67 patients (58%) achieved GH levels < 2.5 \u3bcg/l by 1-15 years after RT (mean 8 \ub1 6) and 37/67 patients (55%) had normal or low IGF-I levels 1-26 years after RT (mean: 12 \ub1 6), a normalization of both parameters being seen in 37 patients. GH < 2.5 \u3bcg/l and normal IGF-I levels were achieved in 17/26 (65%) patients followed-up for at least 15 years. ALS and IGFBP-3 concentrations paralleled IGF-I levels in all patients studied. With respect to secondary pituitary insufficiency, acquired ACTH deficiency was found in 25 patients, TSH deficiency in 20, gonadotropin deficiency in 23 and GH deficiency in seven. In total, two cases of meningioma and one pineal tumour, possibly related to RT, were seen 9-22 years after RT. CONCLUSIONS: RT is an effective, although slow-acting, therapeutic tool for acromegaly, with 'safe' GH levels and normal IGF-I concentrations being achieved in 65% of patients after 15 years. IGF-I levels normalize more slowly than GH levels. Radiotherapy is able to normalize the concentration of all three components of the circulating 150 kDa complex. Checks for loss of pituitary function and appearance of second brain tumours must be carried out life-long

Gamma-Knife Radiosurgery in Acromegaly: A 4-Year Follow-Up Study

Stereotactic radiosurgery by gamma-knife (GK) is an attractive therapeutic option after failure of microsurgical removal in patients with pituitary adenoma. In these tumors or remnants of them, it aims to obtain the arrest of cell proliferation and hormone hypersecretion using a single precise high dose of ionizing radiation, sparing surrounding structures. The long-term efficacy and toxicity of GK in acromegaly are only partially known. Thirty acromegalic patients (14 women and 16 men) entered a prospective study of GK treatment. Most were surgical failures, whereas in 3 GK was the primary treatment. Imaging of the adenoma and target coordinates identification were obtained by high resolution magnetic resonance imaging. All patients were treated with multiple isocenters (mean, 8; range, 3\u201311). The 50% isodose was used in 27 patients (90%). The mean margin dose was 20 Gy (range, 15\u201335), and the dose to the visual pathways was always less than 8 Gy. After a median follow-up of 46 months (range, 9\u201396), IGF-I fell from 805 \u3bcg/liter (median; interquartile range, 640\u2013994) to 460 \u3bcg/liter (interquartile range, 217\u2013654; P = 0.0002), and normal age-matched IGF-I levels were reached in 7 patients (23%). Mean GH levels decreased from 10 \u3bcg/liter (interquartile range, 6.4\u201315) to 2.9 \u3bcg/liter (interquartile range, 2\u20135.3; P < 0.0001), reaching levels below 2.5 \u3bcg/liter in 11 (37%). The rate of persistently pathological hormonal levels was still 70% at 5 yr by Kaplan-Meier analysis. The median volume was 1.43 ml (range, 0.20\u20133.7). Tumor shrinkage (at least 25% of basal volume) occurred after 24 months (range, 12\u201336) in 11 of 19 patients (58% of assessable patients). The rate of shrinkage was 79% at 4 yr. In no case was further growth observed. Only 1 patient complained of side-effects (severe headache and nausea immediately after the procedure, with full recovery in a few days with steroid therapy). Anterior pituitary failures were observed in 2 patients, who already had partial hypopituitarism, after 2 and 6 yr, respectively. No patient developed visual deficits. GK is a valid adjunctive tool in the management of acromegaly that controls GH/IGF-I hypersecretion and tumor growth, with shrinkage of adenoma and no recurrence of the disease in the considered observation period and with low acute and chronic toxicit

Radiation techniques for acromegaly

Radiotherapy (RT) remains an effective treatment in patients with acromegaly refractory to medical and/or surgical interventions, with durable tumor control and biochemical remission; however, there are still concerns about delayed biochemical effect and potential late toxicity of radiation treatment, especially high rates of hypopituitarism. Stereotactic radiotherapy has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. Radiation can be delivered in a single fraction by stereotactic radiosurgery (SRS) or as fractionated stereotactic radiotherapy (FSRT) in which smaller doses are delivered over 5-6 weeks in 25-30 treatments. A review of the recent literature suggests that pituitary irradiation is an effective treatment for acromegaly. Stereotactic techniques for GH-secreting pituitary tumors are discussed with the aim to define the efficacy and potential adverse effects of each of these techniques

Institutional change and business system diversity : continuities and contradictions in postcolonial Cyprus

This thesis analyses institutions and business system characteristics in Cyprus with the aim of describing economic organisation patterns in the country and discussing issues of institutional change and business system diversity. More specifically, by reviewing the development and current features of the legal, financial and education systems, industrial relations and authority relations, the extent and kind of British colonial influence on each institution is examined and the ways in which transformed institutions shape ownership and control of firms, relations between them and employment practices are explored. Research findings are expected to contribute to existing empirical knowledge regarding the different ways of organising and controlling economic activities by describing arrangements in a postcolonial society and inform theoretical analyses of processes of institutional change and the impact of colonial rule on economic organisation. Results indicate that the colonial experience transformed completely institutions like the legal system and greatly influenced aspects of the development of others, such as the education and financial systems, authority relations and industrial relations. These institutional changes contributed, first, to the creation of a significantly different institutional environment compared to neighbouring countries that were not colonised by a major European power and, second, led to considerable heterogeneity in some if its aspects. This institutional environment offered more potential for business system diversity and two major groups of firms may be identified with distinct business system characteristics in Cyprus, private firms and banks. The former group consists of firms that are largely family owned and controlled, are characterised by authority relations that are more paternalistic and exhibit employment practices that are more informal whereas in banks, ownership is largely market based, control more decentralised, relations with other firms more adversarial, authority relations less paternalistic and employment practices more formal. The empirical analysis suggests a number of theoretical points regarding colonialism, institutional change and business system diversity. First, it highlights that the three key mechanisms driving institutional change - the coercive, the mimetic and the normative - can be identified as contributing to institutional conversion during colonial rule. Coercive mechanisms may include the introduction of a new government administration system whereas mimetic processes, such as copying some of the colonial power's systems, and normative pressures due to the interaction between colonial power and colony were also common. Second, it shows that both radical and evolutionary change of institutions take place. The introduction of a new legal system is an example of abrupt change whereas the influence on the education system, and indirectly on people's values, is more incremental. Third, it suggests that the kind, extent and the rate of institutional conversion depends on the nature of each institution but also on power dynamics and preferences of individual and collective actors in both the exporter and receiving country. These observations highlight, fourth, the role of institutional entrepreneurs who influence institutional development by reflecting on structures, using their analytical and political skills and mobilizing others. Finally, these multiple influences on institutions are likely to result in considerable diversity within them, something that gives firms more 'social and economic space' from which to choose and formulate their own distinctive business system characteristics.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Nave para Volkswagen en Ravenna, Italia

This factory hall is meant to house an exhibition, workshops, stores and offices of the Italian subsidiary of the Volkswagen firm. It is sited in an urbanized, but not yet built up, area. Its ground area is 54 by 38 m. Part of the frontage, about 36 m, is set back 8 m with respect to the remaining 18 m; the latter correspond to the part of the building occupied by the exhibition hall. As the ground is weak, it has been necessary to use piles to support the foundations. The structure is metallic, and the enclosing walls and roof consist of prefabricated panels and metals sheets. The roof contains a special chamber, where the air conditioning ducts and other services are housed. Great care has been taken over the colour patterns, both inside and outside. The type of structure and use of prefabricated panels has greatly lowered the overall cost of the building. All the foundation elements have been suitable waterproofed.<br><br>Esta nave industrial está destinada a albergar los servicios de exposición, talleres, depósito y oficinas para la empresa concesionaria, en Italia, de la marca de automóviles Volkswagen. Se halla situada en una zona urbanizada, pero sin edificar, y tiene 54x38 m en planta. Parte de la fachada principal—unos 36 m—está retranqueada 8 m respecto de la alineación; los 18 m restantes corresponden al salón de exposiciones. Como el terreno es de escasa capacidad de sustentación, ha sido necesario el empleo de pilotes en los puntos de apoyo. La estructura resistente es metálica y se ha cerrado y cubierto con paneles prefabricados y placas metálicas. Los forjados de cubierta tienen una cámara que permite la colocación de conductos para el acondicionamiento. Se han cuidado mucho los colores para la estructura vista y paramentos interiores. La disposición de la estructura y el empleo de paneles prefabricados han permitido obtener costos muy favorables. Todas las partes de la infraestructura han sido debidamente impermeabilizadas