Danno sfinteriale rettale esteso da lesioni traumatiche pelvi perineali: prospettive terapeutiche e risultati a lungo termine della ricostruzione mediante Gracileplastica dinamica

Nei traumi pelvi perineali l’apparato sfinteriale rettale è coinvolto con una incidenza stimabile attorno al 20% del totale e l’eziologia è riconducibile in massima parte (89% dei casi) a traumi di tipo penetrante. Nella realtà epidemiologica europea prevalgono le lesioni di tipo chiuso (crushing pelvi-perineale, stretching del pavimento pelvico, avulsione/extrarotazione) e raramente le lesioni rettali esitano in una perdita completa della funzione. Fermo restando che ogni tattica riparativa e/o sostitutiva deve essere pianificata solo a stabilizzazione avvenuta, la necessità di una sostituzione sfinteriale si presenta, quindi, solo in casi selezionati. La procedura più affidabile, in tal senso, è la Gracileplastica Dinamica o Elettrostimolata (GPES). Nella trattazione vengono riportati i risultati e le tecniche in 16 casi di lesioni anorettali gravi, di cui 9 secondarie a "devastating injury"(5 M; 4 F; età media 24.5 anni; range 14-46) trattati con GPES nel periodo 1992-2003: 5 per trauma penetrante e 4 per trauma chiuso. Negli altri 7 casi, periodo 2003-2007(5 M; 2 F; età media 31,5 anni; range 13-49; 6 interessati da trauma penetrante e 1 da trauma chiuso), l’analisi precoce e tardiva ha consentito di adottare una tattica "semplicemente" ricostruttiva (associata o no a protocolli riabilitativi)

Visiones y ventanas. Algunos encuadres de lo maravilloso

Arrancando de la visión de un “hombre que camina cortado por la mitad por una ventana transversal al eje de su cuerpo”, que André Breton describe en el “primer manifiesto del surrealismo”, el ensayo propone un recorrido por algunos imaginarios provenientes de la tradición poética, mística y psicoanalítica, que hacen de la ventana el marco a través del cual aparece lo maravilloso, resultado de un encuentro entre la realidad exterior y la experiencia interior

Seismic control of rocking structures using inerters

When subjected to lateral excitations, a variety of structures, such as museum artefacts, historical buildings, bridge piers and post-tensioned walled buildings, might uplift and set into rocking motion. Although this mechanism can efficiently limit the internal forces at their base, the possibility of overturning or experiencing increased lateral deformations and accelerations may severely affect the functionality of rocking structures. Nevertheless, suitable seismic control strategies are presently limited and consist mostly in preventing rocking motion altogether, which may induce undesirable stress concentrations and lead to impractical interventions. This thesis examines the alternative of using supplemental rotational inertia devices to control the seismic response of rocking structures. The newly proposed strategy employs inerters, which are mechanical devices that develop resisting forces proportional to the relative acceleration between their terminals and can be combined with a clutch to ensure they act only in opposition to the motion. The fundamental dynamic behaviour of the system is firstly examined considering a free-standing rigid block model. By deriving the corresponding equations of motion, it is demonstrated that the inclusion of the inerter effectively reduces the frequency parameter of the block, resulting in lower seismic demands and enhanced stability due to the well‐known size effects of the rocking behaviour. In subsequent chapters, this simplified single-degree-of-freedom model is gradually extended in order to incorporate the effects of post-tensioned tendons, structural flexibility and higher modes on the response. Overall, the analyses conducted under coherent pulses and real ground motion records show that inerter-equipped structures experience reduced seismic demands and lower probabilities of exceeding limit states usually associated with structural and non-structural damage. The fundamental knowledge acquired in the first part of this thesis is finally applied to control the seismic response of rocking timber buildings. To this end, a set of three post-tensioned rocking walled buildings, comprising 3, 6 and 9 storeys, is designed following direct-displacement-based design guidelines. Additionally, a set of clutched and non-clutched ball-screw and gear inerters is designed using a newly proposed pre-dimensioning procedure. The performance of bare and protected structures with different levels of apparent mass ratios is then compared in terms of peak inter-storey drifts and floor accelerations. Special attention is paid to the resisting forces developed in the inerters and the mechanism to transfer them to the structural diaphragm. Likewise, the ability of the inerters to control higher-mode effects is closely examined. Finally, a performance-based assessment with particular emphasis on non-structural and contents damage is conducted considering a database of 202 pulse-like ground motion records. Overall, the results of this assessments confirm the trends observed in the analytical examinations of the earlier chapters.Open Acces

Patterns of Change and Their Relationship to Outcome and Follow-up in Group and Individual Psychotherapy for Depression

[eng] The study explored the presence of different patterns of change in a sample of patients who received cognitive therapy for depression in group and individual sequential formats. Our hypothesis was that some patients would respond better to group than to individual therapy, and that for others the opposite trend would be found. OBJECTIVE: To identify differential patterns of response, to describe the differences in the patients’ characteristics in each pattern, and to predict pattern membership from these characteristics. Also, we wanted to gauge the relationship between each pattern and treatment outcome at termination and follow-up. METHOD: 108 adults who met criteria for major depressive disorder and/or dysthymia completed the treatments included in a randomized controlled trial combining group and individual therapy. They were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, the Beck Depression Inventory-II, the Clinical Outcome in Routine Evaluation, the Global Assessment of Functioning, and the Repertory Grid Technique. Growth mixture modeling was used to identify the patterns of change in each treatment phase. Mixed linear models and repeated measures analysis of variance were performed to compare patients’ characteristics in each pattern. Multinomial logistic regression was used to compute predictive models for the patterns from patients’ baseline characteristics. Finally, hierarchical linear regression was used to establish the power of each pattern to predict treatment outcome at termination and at 3-month and 1-year follow-up. Results: A 3-class solution was obtained: group therapy improvers, individual therapy improvers and non-improvers. Patients in each pattern differed in terms of initial symptom severity, psychological distress, functioning, self-ideal discrepancy, perception of social isolation, and conflictual construction of the self. Some of these variables also worked as predictors for pattern membership. More than half of the explained variance of the outcome at termination and at 1-year follow-up was accounted for by initial depression scores and pattern of change. CONCLUSIONS: The results supported the hypothesis of differential patterns of response to cognitive therapy. Profiles of patients who obtained better results in group or individual therapy for depression could be identified as well.[spa] El estudio exploró la presencia de diferentes patrones de cambio en una muestra de pacientes que recibió terapia cognitiva para la depresión en dos formatos secuenciales: grupal e individual. Nuestra hipótesis fue que algunos pacientes responderían mejor a la terapia grupal que a la individual, y que para otros pacientes se encontraría el patrón opuesto. OBJETIVO: Identificar patrones diferenciales de respuesta, describir las diferencias entre las características de los pacientes en cada patrón y, desde estas características, predecir la pertenencia de los pacientes a cada patrón. También quisimos evaluar la relación entre cada patrón y el resultado de la terapia al final del tratamiento y al seguimiento. MÉTODO: 108 adultos que cumplieron criterios para el diagnóstico de trastorno depresivo mayor y/o distimia completaron los tratamientos como parte de un ensayo clínico aleatorizado que combinaba terapia grupal e individual. Los pacientes fueron evaluados con la Entrevista Clínica Estructurada para los Trastornos del Eje I del DSM-IV, el Inventario de Depresión de Beck – II, el Clinical Outcome in Routine Evaluation, la Escala de Evaluación de la Actividad Global, y la técnica de la rejilla. Se utilizaron modelos de crecimiento mixtos para identificar los patrones de cambio en cada fase de tratamiento. Se utilizaron modelos lineales mixtos y análisis de la varianza de medias repetidas para estimar las diferencias en las características de los pacientes entre cada patrón. A través de regresión logística multinomial se estimaron modelos predictivos de los patrones de cambio desde las características iniciales de los pacientes. Finalmente, a través de regresión lineal jerárquica se estimó el poder predictivo de cada patrón para explicar los resultados de la terapia al final del tratamiento, al seguimiento a los tres meses y al seguimiento a un año. RESULTADOS: Se obtuvo una solución de tres clases: quienes mejoraron en terapia grupal, quienes mejoraron en terapia individual y quienes no mejoraron. Los pacientes pertenecientes a cada patrón se diferenciaron en el nivel inicial de sintomatología, malestar psicológico, funcionamiento, discrepancia yo-ideal, aislamiento social auto- percibido y construcción conflictiva del sí-mismo. Algunas de estas variables también funcionaron como predictores de la pertenencia de los pacientes a cada patrón. Más de la mitad de la varianza explicada del resultado de la terapia al final del tratamiento y al seguimiento a un año fue representada por las puntuaciones iniciales de depresión y los patrones de cambio. CONCLUSIONES: Los resultados tendieron a apoyar nuestra hipótesis acerca de patrones diferenciales de respuesta en terapia cognitiva. Los perfiles de los pacientes que obtuvieron mejores resultados en terapia grupal que en terapia individual para depresión pudieron ser identificados

Seismic protection of rocking structures with inerters

The seismic behaviour of a wide variety of structures can be characterized by the rocking response of rigid blocks. Nevertheless, suitable seismic control strategies are presently limited and consist mostly on preventing rocking motion all together, which may induce undesirable stress concentrations and lead to impractical interventions. In this paper, we investigate the potential advantages of using supplemental rotational inertia to mitigate the effects of earthquakes on rocking structures. The newly proposed strategy employs inerters, which are mechanical devices that develop resisting forces proportional to the relative acceleration between their terminals and can be combined with a clutch to ensure their rotational inertia is only employed to oppose the motion. We demonstrate that the inclusion of the inerter effectively reduces the frequency parameter of the block, resulting in lower rotation seismic demands and enhanced stability due to the well-known size effects of the rocking behaviour. The effects of the inerter and inerter-clutch devices on the response scaling and similarity are also studied. An examination of their overturning fragility functions reveals that inerter-equipped structures experience reduced probabilities of overturning in com- parison with un-controlled bodies, while the addition of a clutch further improves their seismic stability. The concept advanced in this paper is particularly attractive for the protection of rocking bodies as it opens the possibility of non-locally modifying the dynamic response of rocking structures without altering their geometry

Aplicaciones de 1 - MCP en precosecha en peras cv. Packham S Triumph : efecto sobre el retraso en cosecha y comportamiento en almacenaje refrigerado

43 p.La presente investigación se realizó durante la temporada 2007/2008, en peras cv. Packham’s Triumph provenientes de un huerto comercial, ubicado en la comuna de San Clemente (35° 30´ L.S; 71° 28´ L.O), Región del Maule, Chile. El ensayo tuvo como objetivo general, evaluar el efecto de la aplicación de distintas formulaciones y dosis de 1-MCP en huerto (p.c. HarvistaTM Technology), sobre el comportamiento de madurez a cosecha y después de almacenaje refrigerado. Se evaluaron seis tratamientos: Control, AFxRD-038 (formulación en polvo, 150 g i.a/ha); AF-600 (formulación líquida, 75 y 150 g i.a./ha) y AF-700 (formulación líquida, 75 y 150 g i.a/ha). La aplicación de los tratamientos se realizó 7 días previo a la primera cosecha comercial del huerto, mediante una bomba de espalda, con un mojamiento de 2000 L/ha. Se realizaron 3 cosechas, 7, 14 y 21 días después de la aplicación (E1, E2 y E3, respectivamente), las que fueron almacenadas en frío convencional (-1ºC, 90-95% HR). Los índices de madurez evaluados fueron color de piel, firmeza de pulpa y tasa de producción de etileno (TPE), a cosecha y después de almacenaje refrigerado más 1 y 7 días a temperatura ambiente. Además, a cosecha, se pesaron frutos individuales para obtener la curva de distribución de calibre. Los resultados obtenidos muestran que la aplicación de HarvistaTM Technology, no logró reducir el avance en madurez a cosecha. Sin embargo, esto se revirtió después de 60 y 90 días de almacenaje, donde fruta tratada con HarvistaTM Technology de E1 y E2 fue más verde, más firme y presentó menor TPE que aquella Control. Estos efectos fueron más notorios al exponer la fruta por 7 días a temperatura ambiente. En E3 de los 60 y 90 días de almacenaje, no hubo diferencias entre fruta control y tratada con HarvistaTM Technology, en ninguno de los índices de madurez evaluados. La firmeza mínima de embarque (12 lb) sólo se alcanzó para E1 y E2 a los 60 días de almacenaje; mientras que la condición de consumo (ablandamiento y amarillamiento) se alcanzó en E2 y E3 de ambos periodos de almacenaje. Debido al retraso en la cosecha de 7 y 14 días, se logró un incremento de 3,4 y 12,2%, respectivamente, en los calibres 70 y mayores

Caratteristiche idrochimiche delle acque di Occhiobello (RO)

L’analisi chimica delle acque di dieci pozzi, di una località posta a N del fiume Po, (44°54’51.10” N; 11°36’42.49”E), ha mostrato la presenza di acque clorurato sodiche, che si suppone derivino da miscelazione (complessa) tra acque di origine marina (acqua di strato) e un’acqua dolce madre (acqua teorica, end member). Si è tentato di calcolare teoricamente la composizione dell’end member, che è risultata un’acqua bicarbonato sodica, e si è proposta la possibile giacitura delle facies idrochimiche riscontrate all’interno dello schema idrostratigrafico regionale Emiliano-Romagnolo. È emerso che le acque analizzate sono presenti ad una profondità anormalmente ridotta, rispetto alle giaciture degli end members di miscelazione: le acque saline di Ambrogio e Diamantina e l’acqua dolce teorica. Considerando la distribuzione geografica delle acque clorurato sodiche nella regione Emilia-Romagna ed il chiaro rapporto che queste hanno con la verticale degli alti strutturali appenninici sepolti si propone una origine influenzata dalla tettonica per la risalita delle acque studiate