OBIETTIVO: sintetizzare le evidenze disponibili sulla relazione tra i fattori di rischio (personali e lavorativi) e l’insorgenza della Sindrome del Tunnel Carpale (STC). METODI: è stata condotta una revisione sistematica della letteratura su database elettronici considerando gli studi caso-controllo e di coorte. Abbiamo valutato la qualità del reporting degli studi con la checklist STROBE. Le stime studio-specifiche sono state espresse come OR (IC95%) e combinate con una meta-analisi condotta con un modello a effetti casuali. La presenza di eventuali bias di pubblicazione è stata valutata osservando l’asimmetria del funnel plot e con il test di Egger. RISULTATI: Sono stati selezionati 29 studi di cui 19 inseriti nella meta-analisi: 13 studi caso-controllo e 6 di coorte. La meta-analisi ha mostrato un aumento significativo di casi di STC tra i soggetti obesi sia negli studi caso-controllo [OR 2,4 (1,9-3,1); I(2)=70,7%] che in quelli di coorte [OR 2,0 (1,6-2,7); I(2)=0%]. L'eterogeneità totale era significativa (I(2)=59,6%). Risultati simili si sono ottenuti per i diabetici e soggetti affetti da malattie della tiroide. L’esposizione al fumo non era associata alla STC sia negli studi caso-controllo [OR 0,7 (0,4-1,1); I(2)=83,2%] che di coorte [OR 0,8 (0,6-1,2); I(2)=45,8%]. A causa delle molteplici modalità di valutazione non è stato possibile calcolare una stima combinata delle esposizioni professionali con tecniche meta-analitiche. Dalla revisione, è risultato che STC è associata con: esposizione a vibrazioni, movimenti ripetitivi e posture incongrue di mano-polso. CONCLUSIONI: I risultati della revisione sistematica confermano le evidenze dell'esistenza di un'associazione tra fattori di rischio personali e STC. Nonostante la diversa qualità dei dati sull'esposizione e le differenze degli effetti dei disegni di studio, i nostri risultati indicano elementi di prova sufficienti di un legame tra fattori di rischio professionali e STC. La misurazione dell'esposizione soprattutto per i fattori di rischio professionali, è un obiettivo necessario per studi futuri. / OBJECTIVE: The aim of this review was to synthesize the evidence on the potential relationship between work-related and personal risk factors and the occurrence of Carpal Tunnel Syndrome (CTS). METHODS: A systematic review of the literature was conducted by searching in multiple databases for case-control and cohort studies on risk factors for CTS. We assessed study reporting using STROBE checklist. The associations between risk factors and CTS were expressed in OR (95%CI). We combined the study-specific estimates with a random effects meta-analysis model. We assessed publication bias by observing funnel plot asymmetry and performing the Egger’s test to ascertain bias due to small studies. RESULTS: We identified 29 studies of which 19 were included in meta-analysis: 13 case-control and 6 cohort studies. The meta-analysis of 11 studies showed a significant increase of CTS for obese subjects in case-control studies [OR 2.4, 95%CI 1.9-3.1; I(2)=70.7%] and in cohort studies [OR 2.0, 95%CI 1.6-2.7; I(2)=0%]. Heterogeneity was significant overall (I(2)=59.6%, 11 studies). Results for diabetes subjects and thyroid diseases were similar. Smoking exposure was not associated to CTS in case-control studies [OR 0.7, 95%CI 0.4-1.1; I(2)=83.2%] and in cohort studies [OR 0.8, 95%CI 0.6-1.2; I(2)=45.8%]. No meta-analysis was conducted for work-related risk factors due to different ways of detecting exposures. The occurrence of CTS was associated with exposure to vibration, repetitive movements and hand-wrist awkward postures. The psycho-social risk factors have no association with CTS. CONCLUSIONS: This systematic review provides consistent indications that CTS is associated with the personal risk factors. Based on the different quality of exposure data and the difference in effect by study design, our findings indicate sufficient evidence for a link between work-related risk factors and the occurrence of CTS. Objective prospective exposure measurement, especially for work-related risk factors, is needed in future studies.

Introduzione. La movimentazione manuale di carichi è stata recentemente proposta come un possibile determinante del distacco di retina. Al fine di confortare quest’ipotesi, sono stati analizzati i tassi di incidenza di distacco di retina regmatogeno (DRR) idiopatico, trattato chirurgicamente, tra i residenti in Toscana addetti ad attività lavorative manuali, non manuali e casalinghe. Metodi. Le schede di dimissione ospedaliera (SDO) della Toscana contengono anche informazioni codificate sulla categoria generica di impiego. Sono stati utilizzati i dati di tutti i pazienti residenti in Toscana con una SDO emessa da un qualsiasi ospedale italiano nel periodo 1997-2009, con diagnosi principale di DRR (ICD-9: 361,0-361,07 e 361,9) e con DRG 36 (“interventi sulla retina”). Dopo l’eliminazione dei soggetti che non soddisfacevano i criteri di eligibilità, è stato deciso di restringere la popolazione in studio ai soggetti di età 25-59 anni, successivamente classificati in addetti ad attività lavorative manuali, non manuali o casalinghe. Risultati. Sono stati identificati 1.946 casi. Tra gli uomini, gli addetti ad attività lavorative manuali hanno riportato un tasso di incidenza standardizzato per età 1,8 volte più alto rispetto agli addetti ad attività lavorative non manuali (17,4 [IC95%, 16,1–18,7] vs. 9,8 [IC95%, 8,8–10,8]). Tra le donne, i tassi di incidenza standardizzati per età erano 1,9 volte più alti negli addetti ad attività lavorative manuali (11,1 [IC95%, 9,8–12,3]) e 1,7 volte più alti nelle casalinghe (9,5 [IC95%, 8,3–10,8]) rispetto agli addetti ad attività lavorative non manuali (5,7 [IC95%, 4,8–6,6]). Conclusioni. Lo studio mette in evidenza come gli addetti ad attività lavorative manuali siano maggiormente affetti da DRR idiopatico rispetto agli addetti ad attività lavorative non manuali. Questi risultati supportano l’ipotesi che la movimentazione manuale di carichi, che difficilmente può ritrovarsi come compito di attività lavorative non manuali, possa avere un ruolo causale nella genesi della patologia. / Background. Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva’s maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy. Methods. In Italy, both public and private hospitals are obliged to compile coded discharge records (including day-cases) for archival in patients’ regions of residence; Tuscan hospitals additionally record employment information, allowing classification of patients as manual workers, non-manual workers or full-time housewives. We retrieved all discharge records bearing a principal diagnosis corresponding to RRD (ICD-9 code 361.0–361.07, 361.9) coupled with retinal surgery (DRG code 36) for any resident of Tuscany during 1997-2009. After elimination of repeated admissions and patients with coexistent, associated conditions (including recent trauma), subjects aged 25–59 years were classified as manual workers, non-manual workers or housewives. We extracted population data from the 2001 census and calculated age- and sex-specific rates as well as age-standardized rates (per 100,000 person-years) based on the WHO Standard European Population. Results. We identified 1,946 eligible cases (1,142 men). Among men, manual workers experienced a 1.8-fold higher age-standardized rate than non-manual workers (17.4 [95% CI, 16.1–18.7] vs. 9.8 [95% CI, 8.8–10.8]). Age-standardized rates among women were 1.9-fold higher for manual workers (11.1 [95% CI, 9.8–12.3]) and 1.7-fold higher for housewives (9.5 [95% CI, 8.3–10.8]) than in non-manual workers (5.7 [95% CI, 4.8–6.6]). Conclusion. This large population-based study suggests that manual workers are affected by idiopathic RRD requiring surgical treatment, more often than non-manual workers. The higher rates of surgically treated RRD experienced by manual workers accord with the hypothesis that heavy manual handling has a causal role.

Ο καρκίνος του θυρεοειδούς αδένα είναι ο πιο συχνός κακοήθης όγκος του ενδοκρινικού συστήματος και αποτελεί περίπου το 1% όλων των περιπτώσεων καρκίνου που διαγιγνώσκονται για πρώτη φορά. Θεωρείται υπεύθυνος για την πλειονότητα των θανάτων από ενδοκρινικό καρκίνο κάθε χρόνο. Περίπου 30.000 νέες περιπτώσεις κακοήθων θυρεοειδικών νεοπλασιών διαγιγνώσκονται ανά έτος και η επίπτωση αυξάνεται κατά 5-6 % κάθε χρόνο στις Η.Π.Α. Σύμφωνα με πρόσφατη μελέτη ο θυρεοειδικός καρκίνος υπερδιπλασιάστηκε τα τελευταία 30 χρόνια στην Αμερική. Διάφοροι παράγοντες έχουν ενοχοποιηθεί για την ανάπτυξη του θυρεοειδικού όγκου. Ο καλύτερα μελετημένος αιτιολογικός παράγοντας είναι η ακτινοβολία. Προηγούμενες βλάβες του θυρεοειδούς όπως βρογχοκήλη ή καλοήθεις όζοι αποτελούν ισχυρούς παράγοντες κινδύνου για ανάπτυξη κακοήθειας. Έχουν επίσης αναφερθεί ότι σχετίζονται με τις κακοήθειες του θυρεοειδούς και αρκετοί παράγοντες που συσχετίζονται με την αναπαραγωγική δραστηριότητα των γυναικών, όπως αριθμός κυήσεων, θηλασμός, ηλικία εμμηναρχής, χρήση αντισυλληπτικών, διαιτητικοί παράγοντες, δίαιτα πλούσια ή πτωχή σε ιώδιο, κατανάλωση ζωικού λίπους, λαχανικών και οστρακοειδών όπως και ένας αριθμός ογκογονιδίων. Μέσα από την διπλωματική αυτή εργασία έγινε φανερό πως η έρευνα σχετικά με τους μοριακούς μηχανισμούς που εμπλέκονται στην παθογένεια του καρκινώματος του Θ.Α. συνεχίζεται με εντατικούς ρυθμούς. Δυο θεωρίες επικρατούν. Αυτή της πολυσταδιακής καρκινογένεσης (multi-step carcinogenesis) και η.fetal cell carcinogenesis. Φαίνεται πως σε κάθε ιστολογικό τύπο καρκίνου του θυρεοειδούς κυριαρχούν διαφορικές μοριακές ανωμαλίες που σχετίζονται με την εξέλιξη του φυσιολογικού σε καλοήθη, καλά διαφοροποιημένο και αναπλαστικό καρκίνο του αδένα. Ωστόσο, είναι σαφές πως υπάρχουν ακόμα πολλά αναπάντητα ερωτήματα σχετικά με τα μοριακά μονοπάτια που οδηγούν στην ανάπτυξη των θυρεοειδικών νεοπλασιών. Στόχος της μελέτης αυτής είναι να συνοψίσει τα σημαντικότερα δεδομένα που εμπλέκονται στην παθογένεια του θυρεοειδικού καρκινώματος και που θα αποτελέσουν πολύτιμο εργαλείο για την περαιτέρω επιστημονική έρευνα με απώτερο σκοπό την μελλοντική μοριακή θεραπευτική παρέμβαση. / -

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Η παρούσα διπλωματική εργασία πραγματεύεται τη μελέτη, την ανάλυση καθώς και την κατασκευή ενός μετατροπέα συνεχούς τάσεως σε συνεχή, ο οποίος μπορεί να χρησιμοποιηθεί σε ένα φωτοβολταϊκό σύστημα. Κατόπιν, η σύνδεση ενός αντιστροφέα στην έξοδο του μετατροπέα dc-dc επιτρέπει τη διασύνδεση του φωτοβολταϊκού συστήματος με το δίκτυο χαμηλής τάσης. Ο μετατροπέας dc-dc, που εξετάζεται στην παρούσα διπλωματική εργασία, είναι ένας νέος τύπος μετατροπέα που συνδυάζει ένα μετατροπέα Βoost με έναν Flyback με τη χρήση, όμως, ενός μόνο ημιαγωγικού στοιχείου. Με το μετατροπέα αυτό επιτυγχάνεται ανύψωση της τάσεως εισόδου, σε επίπεδα ικανά να οδηγηθεί η επόμενη βαθμίδα. Η εργασία αυτή εκπονήθηκε στο Εργαστήριο Ηλεκτρομηχανικής Μετατροπής Ενέργειας του Τμήματος Ηλεκτρολόγων Μηχανικών και Τεχνολογίας Υπολογιστών της Πολυτεχνικής Σχολής του Πανεπιστημίου Πατρών. Έχοντας ως πρώτο στόχο τη θεωρητική ανάλυση του προαναφερθέντος μετατροπέα και την εξαγωγή των χαρακτηριστικών καμπυλών εξόδου του, αυτό που αρχικά έγινε ήταν μια θεώρηση πως ο νέος αυτός μετατροπέας ισοδυναμεί με δύο άλλους, έναν Βoost και έναν Flyback συνδεδεμένους σε σειρά, και επομένως έχει τη δυνατότητα να περιγραφεί από τις εξισώσεις τους. Με βάση τη θεώρηση αυτή χρησιμοποιήθηκαν οι εξισώσεις του κάθε μετατροπέα για να προκύψουν οι χαρακτηριστικές καμπύλες εξόδου. Στη συνέχεια, προσομοιώθηκε με τη βοήθεια του προγράμματος PSpice τόσο ο σύνθετος μετατροπέας, όσο και ο συνδυασμός των δύο μετατροπέων και συγκρίθηκαν τα θεωρητικά αποτελέσματα με αυτά της προσομοίωσης και για τις δύο περιπτώσεις με στόχο την επιβεβαίωση της προτεινόμενης θεωρητικής ανάλυσης. Τέλος πραγματοποιήθηκε η κατασκευή του μετατροπέα αυτού με απώτερο σκοπό τη σύγκριση πειραματικών και θεωρητικών αποτελεσμάτων. / This study presents a detailed analysis of the overall behavior of a dc-dc single-switch boost-flyback step-up converter. The behavioral investigation is carried out supposing it consists of a boost in series with a flyback. The interesting thing of this converter is its modes of operation (continuous, discontinuous and mixed), which are depicted analytically. Simulation and experimental results by the construction of this converter validate the theoretical analysis.

(EN) The aim of this thesis is to analyse a decision of the Court of Justice of the European Union ("ESD") in the case of Allianz SpA (formerly Riunione Adriatica Di Sicurta SpA) and Others v West Tankers Inc. ("West Tankers"), in which the Court ruled that an anti- suit injunction, issued to enforce an arbitration agreement, is incompatible with the Council Regulation (EC) No 44/2001 on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters ("Brussels I Regulation"). The thesis is divided into eight chapters, whereas as to the methodology, a case study approach is applied. The first chapter is an introduction to the legal context of the dispute, with determination of the relevant law and legal concepts. The most important legal concept is the power to grant an anti-suit injunction, which could be defined as an order preventing a party from beginning or continuing to commence legal proceedings in another forum. The second chapter deals with the use of anti-suit injunctions by the English courts prior West Tankers decision with a special emphasis on its compatibility with the Brussels I Regulation. Also, we will introduce the abusive delaying tactics of "torpedo actions", as well as the problems caused by the interpretation of the arbitration exception...

Orientador: Heloise de Oliveira Pastore / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Quimica / Made available in DSpace on 2018-08-04T07:57:52Z (GMT). No. of bitstreams: 1 Martins_GesleyAlexVeloso_M.pdf: 1455290 bytes, checksum: 08f03d8c3470e472f93117bab22182ac (MD5) Previous issue date: 2005 / Mestrado / Quimica Inorganica / Mestre em Química

Der Schutz der Umwelt und eine darauf ausgerichtete (Umwelt-)Politik gehören zu den wichtigsten Zukunftsaufgaben der Menschheit. Umweltpolitik wird dabei verstanden als Gesamtheit aller Handlungen, die darauf abzielen, Umwelteingriffe zu vermeiden, zu vermindern und eingetretene Umweltschäden zu beseitigen. Wesentliche Ziele sind in diesem Zusammenhang die Realisierung eines integrierten Umweltschutzes, d. h. die Einbeziehung aller Politikbereiche, und die Orientierung am Leitbild der nachhaltigen Entwicklung. Politische Querschnittsaufgaben wie die Umweltpolitik sind im Gegensatz zu herkömmlichen Fachaufgaben jedoch grundsätzlich dadurch charakterisiert, daß sie nicht in der Federführung desjenigen Ressorts liegen, welches die Probleme bewältigen soll. Seit Etablieren der staatlichen deutschen Umweltpolitik vor rund 30 Jahren wurde zwar im Bereich der sichtbaren Umweltbelastungen viel erreicht. Der geforderten Querschnitts- und Präventionsaufgabe der Umweltpolitik wurde aber aufgrund staatlicher Strategie-, Regelungs- und Vollzugsdefizite nicht Rechnung getragen. Diese Kritik konkretisiert sich letztendlich im Begriff des umweltpolitischen Staatsversagens.

Introduction: Successful treatment of class II Division 1 malocclusion is also implied to the long-term stability of treatment changes and many are the factors that can influence that. Objective: This research aimed to evaluate the long-term stability of the cephalometric changes obtained during Class II malocclusion correction with the MARA (Mandibular Anterior Repositioning Appliance) associated with fixed appliances. Methods: The treatment group comprised 12 patients who were evaluated at three stages: pretreatment (T1), posttreatment (T2) and long-term posttreatment (T3). The mean initial age of the patients was 12.35 years and the mean final age was 15.65 years. The mean age at the long-term posttreatment stage was 22.53 years and the mean long-term posttreatment period was 6.88 years. The control group comprised 12 subjects with normal occlusion and no orthodontic treatment with ages comparable to the treatment group at the posttreatment and long-term posttreatment stages. Intra-treatment group comparison between the three stages was performed with repeated measures analysis of variance (ANOVA), followed by Tukey tests. Intergroup comparison of posttreatment changes and normal growth changes of the treatment group were performed with t tests. Results: reduction of the maxillary protrusion and improvement of the maxillomandibular relationships remained stable during the long-term posttreatment period. Maxillary incisors inclination and overjet presented a tendency to relapse in relation to the control group Conclusions: Despite the different amount of growth potential, the reduction of the maxillary protrusion and maxillomandibular relationship improvement remained stable with no difference from normal occlusion behavior. Palatal inclination of the maxillary incisors and the overjet improvement showed a slight tendency towards relapse when compared to normal occlusion. Therefore, an increase of active retention time could be recommended to prevent that. / Introdução: o tratamento bem-sucedido da má oclusão de classe II Divisão 1 está implícito na estabilidade em longo prazo das correções e muitos são os fatores que podem influenciar esta estabilidade. Objetivos: observando que a terapia com o aparelho MARA (Mandibular Anterior Repositioning Appliance) associado ao aparelho ortodôntico fixo mostrou-se eficaz na correção da Classe II, este trabalho estabeleceu como objetivo avaliar cefalometricamente a estabilidade em longo prazo das correções obtidas durante este tratamento. Materiais e métodos: foram analisadas as alterações durante e após o tratamento através das telerradiografias em norma lateral de 12 pacientes (09 meninos e 03 meninas) nas fases: inicial (T1), final (T2) e pós-tratamento (T3), com idade média inicial de 12,35 anos e 15,65 anos ao final do tratamento. A idade media no estágio de pós tratamento em longo prazo foi de 22,53 e o tempo de acompanhamento pós tratamento foi em media 6,88 anos. As alterações foram comparadas a um Grupo Controle com oclusão normal, não tratados ortodonticamente, com idades compatíveis ao grupo experimental nos estágios final e pós tratamento em longo prazo. Os dados obtidos foram analisados através da análise de variância (ANOVA) para medidas repetidas e o teste de comparações múltiplas de Tukey. As alterações ocorridas no período de póstratamento foram comparadas com as alterações do Grupo Controle durante o período correspondente utilizando o teste t independente. Resultados: Observou-se uma redução da protrusão maxilar, assim como, uma melhora das relações maxilomandibulares, as quais, permaneceram estáveis durante o período de póstratamento. A inclinação dos incisivos superiores e o overjet apresentaram tendência à recidiva em relação ao grupo controle. Conclusões: A redução da protrusão maxilar e melhora da relação maxilomandibular mantiveram-se estáveis, sem diferença estatisticamente significante do comportamento na oclusão normal. A retroinclinação dos incisivos superiores e a melhora do overjet mostraram uma ligeira tendência à recidiva quando comparada ao comportamento da oclusão normal. Portanto, um aumento do tempo de retenção ativo pode ser recomendado para evitar essa recidiva.