Tratamento do lixiviado de aterro sanitário e do concentrado de unidade de osmose inversa pelo processo de fenton em um reator de leito fluidizado

O presente trabalho teve por objetivo tratar o lixiviado de aterro sanitário e o concentrado da unidade de osmose inversa num reator de leito fluidizado usando o processo Fenton, no qual utiliza ferro (II) e peróxido de hidrogénio como catalisador e agente oxidante, respectivamente, formando grupos hidroxilos altamente reativos a compostos indesejáveis. A caracterização dos efluentes brutos apresentou CQO de 12000 mg O2.L-1 para o lixiviado e 25000 mg O2.L-1 para o concentrado, indicando clara necessidade de tratamento. Os ensaios Fenton constaram de otimizações, como razão Fe+2:H202, presença de leito fluidizado (carvão ativado e material plástico) e utilização dum pré tratamento por coagulação/floculação. A relação escolhida para os prosseguir os ensaios foi a de 1Fe+2:10H202 por demonstrar valores satisfatórios quer para remoção de CQO (Lixiviado – 57%; Concentrado – 63%), quer no volume de lama gerada (Lixiviado – 260 mL.L-1; Concentrado – 410 mL.L-1). Relativamente à % de remoção de CQO, destacou-se o ensaio na presença de leito de carvão ativado (Lixiviado - 68%; Concentrado - 82%), não diferindo significativamente a percentagem de lama formada. O processo de tratamento prévio por coagulação/floculação, mostrou-se um possível aliado no aumento de remoção de CQO: 90% e 83% para o lixiviado e concentrado, respectivamente. Contudo, pouco favorável foi o volume de lama gerado no processo (Lixiviado – 910 mL.L-1; Concentrado – 870 mL.L-1). Foi comprovado que a reação de Fenton em reator de leito fluidizado, enchimento de carvão – 40% em volume, permite uma elevada eficiência de remoção de CQO.info:eu-repo/semantics/publishedVersio

Produção de biogás por digestão anaeróbia de glicerol bruto

Biodiesel é uma interessante forma de energia renovável. A tendência dessa produção está a aumentar, gerando preocupações ambientais, pelo fato de provocar um excedente do resíduo, o glicerol. Uma alternativa atrativa ao tratamento desse resíduo é mediante o processo de digestão anaeróbia (DA), possibilitando simultaneamente um controlo da poluição e a recuperação de energia. Torna-se, pois, necessário aprimorar o tratamento de resíduos orgânicos através da digestão anaeróbia e melhorar o seu desempenho: rendimento, produção cumulativa de metano e taxa máxima de produção. Elevadas cargas de glicerol, aliado à complexidade da molécula, podem facilmente acarretar a inibição dos microrganismos envolvidos. Neste contexto, o presente estudo tem como principal objetivo avaliar diferentes Tempo de Retenção Hidráulico (TRH) de 11 e 23 d e Carga Orgânica Volumétrica (COV) de 05, 1,0 e 2,0 g CQO.L-1.d-1 na tentativa de otimizar a produção de biogás e a sua qualidade (% CH4). Para os ensaios experimentais da digestão anaeróbia do glicerol bruto foi utilizado um reator em acrílico de 1400 mL, operado em regime semi-contínuo e em condições mesófilas. O volume de metano gerado foi medido, em contínuo numa proveta, mediante a deslocação duma solução de NaOH e a sua produção avaliada em termos da Carência Química de Oxigénio (CQO) removida. Para os dois valores do tempo de retenção hidráulico testados com COV de 1 g CQO.L-1.d-1, o aumento de TRH traduziu-se num acréscimo de 11% no volume de CH4 gerado (de 190 para 211 mL CH4. g-1 CQO removido). Os resultados mais satisfatórios foram obtidos para uma COV de 2 g CQO.L-1.d-1 e TRH de 23 dias, tendo sido alcançada uma produção de 256 mL CH4.g-1 CQO removido, com SV/ST de 0,62 (remoção final da CQO de 75%).info:eu-repo/semantics/publishedVersio

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Analysis of the Impact of Communication Campaigns under the Project “Syphilis No”: A National Tool for Inducing and Promoting Health

Syphilis is increasingly prevalent around the world as a result of complex factors. In Brazil, the government declared a syphilis epidemic in 2016 and then set a strategic agenda to respond to this serious public health problem. In a joint effort, Brazil’s Federal Court of Accounts (TCU) recommended that novel and diversified health communication strategies should be developed, which the “Syphilis No” project (SNP) later conducted through nationwide mass communication campaigns. We performed exploratory data analysis to identify and understand the results of three health communication campaigns by considering syphilis data trends in Brazil. The SNP, by using traditional and innovative means of communication, focused on multiple target audiences to encourage behavior changes through awareness and syphilis knowledge acquisition via the internet. In addition, the SNP disseminated information on syphilis testing, prevention, and treatment through social media and multiple media outlets. We observed that the period of the health campaigns corresponded to the period when the syphilis testing uptake increased and the number of reported cases dropped. Thus, our findings indicate that public health responses could substantially benefit from the use of health communication campaigns as a tool for health promotion, education, and transformation

The unrestricted global effort to complete the COOL trial

Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) (https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study.Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer.Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. Trial registration: National Institutes of Health (https://clinicaltrials.gov/ct2/show/NCT03163095). Keywords Intraperitoneal sepsis, Septic shock, Peritonitis, Open abdomen, Multiple organ dysfunction, Laparotomy, Randomized controlled trial, Global healthPeer reviewe