Metodologia para Seleção de Áreas Aptas à Instalação de Aterros Sanitários Consorciados Utilizando SIG

http://dx.doi.org/10.5902/2179460X15973Nowadays, one of the financial and environmental problems faced by cities is related to the adequate final disposal of solid waste in municipal sanitary landfills. The selection of the areas implies in several factors as the proximity of watercourses, soil resistance to contaminating effects, protection of conservation areas, size of the area available, distance between collection and disposal, which are the main issues that make the topic relevant. Thereby, was employed a methodology to assess the potential for selected of areas with the capacity to receive a landfill, considering as the study areas intercropping municipalities, by using techniques of Geographic Information Systems. The method used, considered as criteria of exclusion for unsuitable areas, the airport security zones, conservation unities and others operational and technical aspects of environmental, weighted according to their influence within the theme, generate the ranking of the most suitable areas for 20-years operation of landfill installation. Therefore, after applying the criteria, it was found that less than 50% of the entire region area is suitable for such an initiative leading to 31ranked sites with great aptitude to implementation of the landfill sanitary, according to multicriteria analysis by weighted overlay.Um dos atuais problemas ambientais e financeiros, enfrentado pelas cidades está relacionado a disposição final e adequada dos resíduos sólidos urbanos em aterro sanitário. A escolha do local adequado está condicionada a diversos fatores como, a proximidade dos cursos d´água, resistência do solo aos efeitos contaminantes, proteção de áreas de preservação,  tamanho da área disponível, distância entre a coleta e a disposição, ou seja, são questões que tornam os estudos sobre o tema relevantes. Neste contexto, utilizou-se uma metodologia para avaliar o potencial de seleção de áreas para implantação de aterro sanitário, considerando como área de estudo municípios consorciados e técnicas de Sistemas de Informações Geográficas. O método utilizado considerou como critérios para exclusão de áreas inaptas, as zonas de segurança aeroportuária, Unidades de Conservação e outros aspectos técnicos operacionais e ambientais que, ponderados segundo sua influência dentro do tema, geraram o ranqueamento de áreas mais indicadas para a instalação de um aterro sanitário com horizonte de operação de 20 anos. Desta forma, o estudo detectou que menos de 50% da área estudada está apta a tal empreendimento, ranqueando 31 locais com maior aptidão à implantação de aterro sanitário segundo a análise multicriterial por sobreposição ponderada

Geodésia como Ferramenta de Apoio a Compreensão da Neotectônica do Pantanal: Exemplo na Estação Fluviométrica de Corumbá, Mato Grosso do Sul, Brasil

Os Sistemas Globais de Navegação por Satélite (GNSS) foram inicialmente projetados para ampliar o nível de cobertura e de precisão de sistemas de navegação, mas dada as aplicações possíveis, pode-se a partir de metodologias específicas se analisarem os mais diferentes fenômenos terrestres, tais como estimar a velocidade e direção das placas tectônicas ou de blocos onde as estações repousam. No presente trabalho se buscou ampliar e derivar aplicações do GNSS, buscando entender melhor a geotectônica regional da Bacia Sedimentar do Pantanal. Neste sentido, modelou-se a combinação de dados de velocidade de estações GNSS do SIRGAS (Sistema de Referência Geocêntrico para as Américas) com dados da superfície da lâmina d’água em épocas de cheia e seca. A partir dos resultados obtidos, pode-se concluir que a variação no volume e peso da água durante as épocas de cheia e de seca se refletem na posição da régua de altura situada em Corumbá-MS. Este volume de água, além de promover a reativação de estruturas tectônicas, exerce efeito lubrificante nas falhas e fraturas regionais, podendo agir como facilitadora ou indutora de sismos regionais

Utilization of mechanical power and associations with clinical outcomes in brain injured patients. a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

BackgroundThere is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes.MethodsIn this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale <= 12 before intubation) who required mechanical ventilation (MV) >= 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS).ResultsWe included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22).ConclusionsExposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Abstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Geodésia como ferramenta de apoio a compreensão da neotectônica do pantanal: Exemplo na estação fluviométrica de corumbá, mato grosso do sul, Brasil

Global Navigation Satellite Systems (GNSS) were initially designed to extend the coverage and accuracy of navigation systems, but given the possible applications, it is possible to analyze the different terrestrial phenomena from a specific methodology. how to estimate the speed and direction of the plate tectonics or blocks where the stations rest. In the present work we sought to extend and derive GNSS applications, seeking to better understand the regional geotectonics of the Pantanal Sedimentary Basin. In this sense, the combination of SIRGAS (Geocentric Reference System for the Americas) GNSS speed data with water surface data in times of flood and drought was modeled. From the obtained results, it can be concluded that the variation in the volume and weight of the water during the times of flood and of drought are reflected in the position of the height ruler located in Corumbá-MS. This volume of water, in addition to promoting the reactivation of tectonic structures, exerts a lubricating effect on regional faults and fractures, and may act as a facilitator or inducer of regional earthquakes.Universidade Federal de Mato Grosso do Sul Faculdade de Engenharias Arquitetura e Urbanismo e Geografia Laboratório de Geoprocessamento para Aplicação Ambiental Unidade 7AUniversidade de São Paulo Instituto de Geociências, Rua do Lago, 562Universidade Estadual Paulista - UNESP Faculdade de Ciências e Tecnologia, Rua Roberto Simonsen, 305Laboratório de Geotecnologias Núcleo de Pesquisa em Produção e Conservação do Cerrado da Universidade Federal de Mato Grosso (NUPEC) Universidade Federal de Mato Grosso, Campus Universitário de Rondonópolis, MT 270 km 06Universidade Estadual Paulista - UNESP Faculdade de Ciências e Tecnologia, Rua Roberto Simonsen, 30

Risk factors of extubation failure in neurocritical patients with the most impaired consciousness

No abstract availabl

Extubation in neurocritical care patients. the ENIO international prospective study

Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24&nbsp;h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71-0.87] and 0.71 CI95 [0.61-0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7-21] vs 6 [3-11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort

Association of age with extubation failure in neurocritical intensive care unit patients––Insight from an international prospective study named ENIO

Objective: To assess the association of age with extubation failure in neurocritical care patients. Design: Posthoc analysis of the 'Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes (ENIO) study', an international prospective observational study. Setting: ENIO was conducted in 73 centers in 18 countries from 2018 to 2020. Patients: Neurocritical care patients with a Glasgow Coma Scale score &lt;= 12 and receiving ventilation for at least 24 h were included. We categorized patients into four age groups based on age quartiles. Main results: This analysis included 1095 patients with a median age of 53 [35 to 65] years. Younger patients were more likely to be admitted with traumatic brain injury, whereas older patients more often had cerebral hemorrhage, ischemic stroke, central nervous infection, or brain malignancies. Extubation failure occurred in 209 (19 %) patients. In the unadjusted analysis, older patients had a higher risk of extubation failure (odds ratio (OR), 1.012 [95 %-confidence interval (CI) 1.004 to 1.021]; P = 0.006). However, after adjusting for confounding factors, the effect of age on extubation failure was no longer significant (OR, 1.008 [0.997 to 1.019]; P = 0.172). Conclusions: In this international cohort of intubated and ventilated neurocritical care patients, after adjusting for baseline covariates and for previously identified risk factors for extubation failure, age was not associated with extubation failure. Age may not be a factor to consider in extubation decisions for brain-injured patients. Registration: ENIO is registered at clinicaltrials.gov (study identifier NCT 03400904)