RESUMO
Construction and demolition waste (CDW) is an environmental problem that affects all regions of the world. Particularly in the Brazilian Amazon Forest region, the volume of CDW generated almost doubled between 2007 and 2019. Indeed, despite Brazil having environmental regulations for waste management, these have been insufficient to solve the environmental problem because there is no CDW reverse supply chain (RSC) properly developed in the Amazon region. Previous studies have proposed a conceptual model of a CDW RSC but have hitherto failed to apply them against real world practice. This paper, therefore, attempts to test existing conceptual models that describe a CDW RSC against real industry practice prior to developing an applied model of a CDW RSC for the Brazilian Amazon. To modify the conceptual model for CDW RSC, qualitative data through 15 semi-structured interviews with five different types of stakeholders of the Amazonian CDW RSC were collected and analyzed using qualitative content analysis methods using NVivo software. The proposed applied model includes present and future reverse logistics (RL) practices, and strategies and tasks necessary for the implementation of a CDW RSC in the city of Belém of Pará, in the Brazilian Amazon. Findings reveal that several overlooked problems, particularly the limitations of the existing legal framework in Brazil, are not enough to promote a robust CDW RSC. This is perhaps the first study to examine CDW RSC in the Amazonian rainforest. Arguments provided in this study highlight the necessity for an Amazonian CDW RSC that must be promoted and regulated by the government. This can be addressed by the utilizing public-private partnership (PPP) for developing a CDW RSC.
RESUMO
El carcinoma in situ testicular (CisT) es una lesión considerada precursora de los tumores testiculares de células germinales (TCG). Estudios en pacientes con TCG han mostrado que un 50 porciento de los que tienen un CisT en biopsias del testículo contralateral desarrollan una enfermedad invasora a 5 años, si no sontratados. El objetivo de esta comunicación fue describir la evolución a largo plazo de un grupo de pacientes con diagnóstico de CisT contralateral, en nuestra serie de pacientes con TCG. Este estudio retrospectivo incluye 194 pacientes con orquidectomías radicales por TCG entre enero 1985 y diciembre 1992. Se registraron: datos demográficos de los pacientes, tratamiento, realización de biopsia testicular contralateral, anatomía patológica y seguimiento. La información clínica fue obtenida de una base de datos computarizada y el seguimiento de los pacientes con CisT se realizó a través de registros clínicos, entrevista telefónica y visita médica. La edad promedio de los pacientes fue de 32,2 (4-82) años. Se realizó biopsia testicular contralateral en 30 pacientes (15 porciento). En las biopsias testiculares se observan 5 pacientes (16 porciento) con CisT, 8 (27 porciento) conatrofia y 17 (57 porciento) con tejido normal. Ninguno de los 5 pacientes con CisT tenía antecedentes decriptorquídea. El tiempo de seguimiento medio fue de 159 (138-210) meses para los pacientes con CisT. De éstos, 3 pacientes se controlaron en forma periódica sin recibir tratamiento complementario, un pacientere cibió radioterapia testicular y el otro se realizó una orquidectomía contralateral. De los 4 pacientescon testículo in situ ninguno ha presentado clínica sugerente de tumor testicular. Tampoco han presentado recidiva de enfermedad hasta septiembre de 2003. La prevalencia de CisT (16 porciento) en este grupo de pacientes es superior a la reportada por series extranjeras. No se observó evolución hacia una forma invasora en ninguno de los pacientes con diagnóstico luego de 13 años de seguimiento.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias Testiculares , Células Intersticiais do Testículo/patologia , Chile , Estudos Retrospectivos , SeguimentosRESUMO
We compared the neurodevelopmental outcome of extremely premature, surfactant-deficient infants who received either prophylactic surfactant at birth, "rescue" surfactant after the clinical diagnosis of respiratory distress syndrome was established, or placebo. Infants studied were participants in a randomized, bicenter (San Diego, Calif., and Helsinki, Finland), controlled trial of human surfactant therapy. One hundred fifty infants (prophylaxis group, 63 infants; rescue group, 57; placebo group, 30) were prospectively enrolled at 38 weeks of gestational age. There were no neonatal intergroup differences in the incidence or severity of sonographic central nervous system abnormality or retinopathy. One hundred forty-five infants were alive at 1 year of adjusted age, at which time growth, neurosensory, and neurologic outcome were similar in all three treatment groups at both centers. Cerebral palsy occurred in 20% overall. Five infants (3.5%) were functionally blind. However, infants treated at birth had lower mean mental and motor scores on the Bayley Scales of Infant Development compared with those of infants rescued with surfactant after the onset of respiratory distress syndrome (Mental Development Index: 78 vs 96, p = 0.02; Psychomotor Development Index: 73 vs 87, p = 0.04). Chronic lung disease occurred more frequently in the prophylactically treated group and contributed to the subjects' neurologic and developmental morbidity. Because prophylactic surfactant treatment offered no neurodevelopmental advantage and may contribute to poorer outcome, we currently recommend early surfactant replacement only for those infants who have postnatal evidence of respiratory distress syndrome.
Assuntos
Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Pulmão/embriologia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Encéfalo/crescimento & desenvolvimento , Hemorragia Cerebral/etiologia , Paralisia Cerebral/etiologia , Feminino , Maturidade dos Órgãos Fetais , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal , Pneumopatias/etiologia , Masculino , Placebos , Desempenho Psicomotor , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Retinopatia da Prematuridade/etiologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Rats were exposed for 10 minutes to one of several enclosures graded in novelty. In one experiment they were then simply sacrificed and plasma corticosterone determinations made in order to obtain an index of the relative stressfulness of these enclosures. In a second experiment the animals received haloperidol and were tested for catalepsy, 2 hours or two weeks following the novel experience. The most novel experience, exposure to a black box, resulted in the highest corticosterone levels and was the only one of our pre-treatments to induce significant enhancement of catalepsy as well as alteration of nucleus accumbens dopamine levels, 2 weeks--but not 2 hours--later. These findings indicate that brief exposure of adult animals to a psychological stressor can induce a long-term alteration in both behavioral and neurochemical responses to a drug and that this effect requires a minimum level of stress to get started and once triggered gets stronger with the passage of time.
Assuntos
Catalepsia/etiologia , Corticosterona/sangue , Dopamina/metabolismo , Haloperidol/farmacologia , Estresse Psicológico/complicações , Animais , Catalepsia/induzido quimicamente , Catalepsia/metabolismo , Abrigo para Animais , Masculino , Núcleo Accumbens/efeitos dos fármacos , Núcleo Accumbens/metabolismo , Ratos , Ratos Endogâmicos , Estresse Psicológico/metabolismo , Fatores de TempoRESUMO
We inquired whether a single exposure to amphetamine (AM) or haloperidol (HALO) could modify the plasma corticosterone (CORT) response to a second injection of AM 2 weeks later. Male rats were injected with 4 mg/kg d-AM sulfate and tested for water intake for 5 h before sacrifice. Overall, AM induced water intake but none of the pretreatments altered this effect. By contrast, preexposure to AM, HALO or its vehicle 2 weeks earlier prevented the elevation of plasma CORT obtained when AM was administered without pretreatment. A combined pretreatment of HALO or its vehicle with AM produced an even greater blockade of AM-induced CORT elevation. Manipulations which prevented AM-induced drinking reduced the effectiveness of AM pretreatment in attenuating AM-induced elevation in CORT, suggesting that the pretreatment may have been sensitizing the effectiveness of a coping response--drinking--in reducing the CORT effect. Our findings also indicate that a dopamine agonist (AM), a dopamine antagonist (HALO) and a nonspecific stressor (acidic vehicle) can all induce the same, long-lasting action on CORT. This strongly suggests that the effects of AM and HALO in this instance cannot be explained in terms of their pharmacological actions, which are opposite to one another, but instead relate to their properties as stressful/foreign agents to the organism.
Assuntos
Anfetamina/farmacologia , Corticosterona/sangue , Haloperidol/farmacologia , Estresse Psicológico/sangue , Anfetamina/antagonistas & inibidores , Animais , Ingestão de Líquidos/efeitos dos fármacos , Masculino , Ratos , Ratos EndogâmicosRESUMO
A randomized, placebo-controlled trial of human surfactant given intratracheally at birth (prophylactic) versus rescue administration after the onset of severe respiratory distress syndrome (RDS) was conducted among preterm infants born at 24 to 29 weeks of gestation. Singleton fetuses were randomly assigned to receive (1) placebo (air), (2) prophylactic surfactant treatment, or (3) rescue surfactant treatment; infants of multiple births received either (1) prophylactic or (2) rescue treatment. Of 282 potentially eligible fetuses, 246 infants received treatments at birth and 200 infants had RDS. Outcomes are presented both as an intention-to-treat analysis (including infants who met exclusion criteria at or after birth) and as a full treatment protocol analysis for those infants with RDS and likely to benefit from surfactant. Preterm infants (mean 1.0 kg birth weight, 27 to 28 weeks of gestational age) randomly assigned to receive prophylactic treatment received surfactant soon after birth; those assigned to receive rescue surfactant had instillation at a mean age of 220 minutes if the lecithin-sphingomyelin ratio was less than or equal to 2.0 and no phosphatidylglycerol was detected in either amniotic fluid or initial airway aspirate, oxygen requirements were a fraction of inspired oxygen of greater than 0.5, and mean airway pressure was greater than or equal to 7 cm H2O from 2 to 12 hours after birth. Up to four treatment doses (or air) were permitted within 48 hours; approximately 60% of surfactant-treated infants required two or more doses. Surfactant-treated infants had significantly less pulmonary interstitial emphysema than placebo-treated infants (p = 0.02), but there were no other significant differences in mortality rates or morbidity. Indexes of oxygenation and ventilation were improved in surfactant recipients during the first 24 hours. An intention-to-treat analysis found no significant differences between infants given placebo and surfactant-treated infants or between prophylactic- and rescue-treated infants; an improved total mortality rate (p = 0.002) was found among surfactant-treated infants in Helsinki but not in San Diego. Among infants with RDS, the total mortality rate was significantly improved (p = 0.004) with surfactant treatment but not the proportion alive and without bronchopulmonary dysplasia at 28 days (p = 0.052), or the proportion alive and without bronchopulmonary dysplasia at 38 weeks of postconceptional age (p = 0.18) to adjust for differences in prematurity. Deaths caused by RDS or bronchopulmonary dysplasia were significantly reduced among surfactant recipients (p = 0.0001). Neither among singletons nor among multiple-birth infants was there a selective advantage to prophylactic versus rescue treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Recém-Nascido de Baixo Peso , Pulmão/embriologia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/mortalidade , Feminino , Maturidade dos Órgãos Fetais , Humanos , Recém-Nascido , Tempo de Internação , Masculino , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Taxa de SobrevidaRESUMO
1. Prior exposure to a stressor can either increase or decrease subsequent behavioral, neurochemical, and endocrine reactivity to stress, depending on the pattern of stress exposure. 2. Massed or frequent exposures typically induce a reduction in reactivity whereas intermittent or widely spaced exposures increase subsequent reactivity. 3. In the present study, the authors examined whether a single presentation of a temporally remote stressor would increase the immunosuppressive effects of a subsequent stressor. Specifically, the authors investigated the effectiveness of 2-deoxy-D-glucose (2-DG) in suppressing the responsiveness of splenic lymphocytes in male, Sprague-Dawley rats that received either no prior treatment, or immobilization either one hour or 12 days earlier. 4. Splenic lymphocyte responsiveness to the T-cell mitogens, Concanavalin A (Con-A) and phytohemagglutinin (PHA) was suppressed following a single injection of 2-DG. 5. The group exposed to the stress of immobilization one hour prior to 2-DG demonstrated a comparable level of immune suppression. 6. In contrast, animals immobilized 12 days prior to the administration of 2-DG showed a more pronounced suppression of immune responsiveness which was significantly greater than the other groups injected with 2-DG. 7. Neither the stress-induced elevation in corticosterone, nor the suppression of blood lymphocyte reactivity to Con-A and PHA was enhanced by prior immobilization. 8. The results indicate that the immunosuppressive effects of an acute stressor can sensitize with the passage of time.
Assuntos
Desoxiglucose/farmacologia , Terapia de Imunossupressão , Estresse Psicológico/imunologia , Animais , Concanavalina A/farmacologia , Corticosterona/sangue , Imobilização , Contagem de Leucócitos , Linfócitos/imunologia , Masculino , Mitógenos/farmacologia , Fito-Hemaglutininas/farmacologia , Ratos , Ratos Endogâmicos , Baço/citologia , Baço/imunologia , Fatores de TempoRESUMO
The term hemifacial microsomia refers to unilateral defects in development of structures derived from the first and second branchial arches. Recently we evaluated three unrelated children who had a similar pattern of unilateral craniofacial defects that was associated with other structural abnormalities having a disruptive vascular pathogenesis. The clinical findings in these patients suggest that one cause of hemifacial microsomia is in utero interruption of blood flow.
Assuntos
Região Branquial/irrigação sanguínea , Ossos Faciais/anormalidades , Crânio/anormalidades , Adolescente , Artérias Carótidas/anormalidades , Artérias Carótidas/diagnóstico por imagem , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Masculino , Microftalmia/etiologia , Radiografia , SíndromeRESUMO
We performed a randomized, prospective clinical trial comparing intratracheal administration of human surfactant with conventional treatment with intermittent mandatory mechanical ventilation alone for treatment of severe respiratory distress syndrome in preterm infants of less than 30 weeks gestation. Twenty-two infants (mean gestational age 27.0 weeks, mean birth weight 987 gm) were given surfactant, and 23 infants (mean gestational age 27.2 week, mean birth weight 1055 gm) received intermittent mandatory ventilation. Infants given surfactant required less FiO2 during the first week, had lower mean airway pressure during the first 48 hours, and had improved ventilatory index and a/A PO2 ratio. Death or the occurrence of bronchopulmonary dysplasia was significantly less among infants given surfactant (P = 0.019). Pneumothorax, pulmonary interstitial emphysema, and need for FiO2 greater than or equal to 0.3 for greater than 30 days was significantly less in the surfactant group. This trial confirms the efficacy of treatment with human surfactant in preterm infants with severe respiratory distress syndrome.