10 research outputs found

    Forestry for a low carbon future. Integrating forests and wood products in climate change strategies

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    Following the introduction, Chapter 2 provides an overview of mitigation in the forest sector, addressing the handling of forests under UNFCCC. Chapters 3 to 5 focus on forest-based mitigation options – afforestation, reforestation, REDD+ and forest management – and Chapters 6 and 7 focus on wood-product based options – wood energy and green building and furnishing. The publication describes these activities in the context of UNFCCC rules, assessing their mitigation potential and economic attrac tiveness as well as opportunities and challenges for implementation. Chapter 8 discusses the different considerations involved in choosing the right mix of options as well as some of the instruments and means for implementation. Chapter 8 also highlights the co-benefits generated by forest-based mitigation and emphasizes that economic assessment of mitigation options needs to take these benefits into account. The concluding chapter assesses national commitments under UNFCCC involving forest miti gation and summarizes the challenges and opportunities

    Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group

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    Revisitando os efeitos da assinatura de um tratado internacional: da obrigação de boa-fé à sujeição internacional do estado

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    A natureza das obrigações impostas ao Estado que assina um tratado internacional figura na ordem do dia dos debates internacionais. Isso porque muitos Estados têm adotado a prática de assinar tratados internacionais em função de compromissos políticos sem, entretanto, pretender ratificá-los, caso que assumiriam a obrigação de respeitar seu conteúdo. O objetivo deste artigo é analisar a gradação e a importância de tais obrigações no que tange aos tratados em forma solene e aos tratados em forma simplificada. Para isso, recorreu-se à análise de conteúdo cujo ponto de partida foi o texto da Convenção de Viena sobre o Direito dos Tratados de interpretação e a análise do texto da Convenção foram realizadas segundo os critérios gramatical, histórico, teleológico e prático e foram baseadas principalmente nos debates prévios à sua adoção realizados pela Comissão de Direito Internacional da ONU e em textos doutrinários. Ao final, concluiu-se que, como pretenderam os redatores da referida Convenção, a assinatura tem tido crescente importância no que tange às obrigações de um Estado na esfera internacional, podendo gerar, no caso dos acordos em forma solene, uma obrigação de boa-fé que não poderá ser negligenciada, e até mesmo a efetiva responsabilização do Estado no caso dos acordos em forma simplificada, que atualmente dominam o cenário internacional e brasileiro

    Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

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    IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022
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