Investimentos privados, impactos ambientais e qualidade de vida num empreendimento mineral amazônico: o caso da mina de manganês de Serra do Navio (Amapá) Private investments, environmental impact, and the quality of life at a mining venture in the Amazon: the case of the Serra do Navio manganese mine in Amapá

O texto discute as conseqüências ambientais e socioeconômicas de um grande empreendimento de extração mineral na Amazônia brasileira. Entre 1957 e 1998, a Indústria e Comércio de Minérios S. A. (ICOMI) explorou manganês no Amapá, em Serra do Navio, uma das maiores minas desse minério no mundo. Foi o primeiro e o mais durável empreendimento mineral de grande escala e intensivo de capital na região amazônica brasileira. O texto apresenta um perfil biofísico e socioeconômico do Amapá, caracterizando-o como fronteira de expansão da sociedade nacional. Discute o volume da produção, as características da companhia mineradora, mostrando seu sucesso comercial, os principais impactos ambientais do empreendimento, especialmente o desmatamento, o status da qualidade de água e a recuperação ambiental da área minerada, concluindo que esses impactos foram localizados e moderados. Na conclusão, são apresentados os resultados de um exercício de mensuração dos níveis de bem-estar socioeconômico da população do Amapá entre 1953 e 1993: as melhoras foram sensíveis.<br>The text examines the environmental and socioeconomic consequences of a major mining venture in the Brazilian Amazon. From 1957 to 1998, Indústria e Comércio de Minérios S. A. (ICOMI) extracted ore from one of the world’s largest manganese mines, located in the Serra do Navio highlands region of the state of Amapá. ICOMI was the first and longest-running large-scale, capital-intensive mining operation in the Brazilian Amazon. Based on a biophysical and socioeconomic profile of Amapá, the region is characterized as a frontier for an expanding Brazilian society. After discussing the mining company’s characteristics, its production volume and commercial success, main environmental impacts (particularly deforestation), area water quality, and the environmental recovery of the mined area, it is concluded that impacts have been localized and moderate. Furthermore, measurements of the levels of socioeconomic well being in Amapá between 1953 and 1993 indicate significant improvements

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)