Mass balance of pilot-scale pretreatment of sugarcane bagasse by steam explosion followed by alkaline delignification

Five pilot-scale steam explosion pretreatments of sugarcane bagasse followed by alkaline delignification were explored. The solubilised lignin was precipitated with 98% sulphuric acid. Most of the pentosan (82.6%), and the acetyl group fractions were solubilised during pretreatment, while 90.2% of cellulose and 87.0% lignin were recovered in the solid fraction. Approximately 91% of the lignin and 72.5% of the pentosans contained in the steam-exploded solids were solubilised by delignification, resulting in a pulp with almost 90% of cellulose. The acidification of the black liquors allowed recovery of 48.3% of the lignin contained in the raw material. Around 14% of lignin, 22% of cellulose and 26% of pentosans were lost during the process. In order to increase material recovery, major changes, such as introduction of efficient condensers and the reduction in the number of washing steps, should be done in the process setup. (C) 2012 Elsevier Ltd. All rights reserved.Alexander von Humboldt FoundationConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazi

Evolution and determinants of weight gain (weight-for-height and weight-for-age) in children between two and 72 months old in Sorocaba, São Paulo: evidences from a serial quasi-experimental study.

OBJECTIVES: to review the main aspects of a project conducted by the authors during the last decade with the aim of presenting elements of nutritional supplement in childhood in relation to public policies. METHODS: the growth and development indicators had been accompanied every three months during one year in a population of two to 72 month old children in the outskirts of Sorocaba, São Paulo, Brazil. After completing a child census in two regions of the city, children who had received nutrional assistance (in number of 164) were compared to 280 who had not. A quantitative analysis was performed by Kappa's and Goodman's tests, and by multivariate models. Bias and confounding were investigated and controlled. RESULTS: the main information obtained refers to the characteristics of the assisted group: 1) higher average age; 2) lower rates of natural milk feeding; 3) lower values of weight/height at admission and greater gains during evolution; 4) this improvement grew with the length of exposure and was greater in the oldest children. CONCLUSIONS: emphasize that today in our country assistance to preschool children should be a mandatory social policy.OBJETIVOS: recupera-se síntese dos principais aspectos das publicações referentes a projeto conduzido pela equipe, na década passada, com o objetivo de subsidiar a avaliação de política pública setorial de suplementação alimentar na infância. MÉTODOS: acompanharam-se trimestralmente, durante um ano, indicadores de crescimento e desenvolvimento em populações periféricas de dois a 72 meses de idade, em Sorocaba, São Paulo. Após realização do censo infantil de duas regiões da cidade, as crianças freqüentes a creches (em número de 164) foram comparadas às demais (280). O impacto nutricional foi quantificado através de análises univariadas (testes inferenciais Kappa e de Goodman) e multivariadas. Vieses e confundimento foram averiguados e controlados. RESULTADOS: observou-se, entre muitas outras informações obtidas, que o grupo assistido apresentou: 1) idade média superior; 2) menor taxa de aleitamento natural; 3) menores valores de peso/altura à admissão, com maiores ganhos durante a evolução; 4) essa melhora aumentou com a duração da exposição e foi maior entre os mais velhos. CONCLUSÕES: avalia-se que assistir apropriadamente pré-escolares constitui hoje, em nosso meio, relevante imperativo de ordem social.17717

The management of COVID-19 cases through telemedicine in Brazil

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil’s response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (Telessa´udeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were “asymptomatic” patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.Telemedicin

Combined treatment with oestradiol benzoate, d‐cloprostenol and oxytocin permits cervical dilation and nonsurgical embryo recovery in ewes

This study examined the feasibility of transcervical embryo recovery after the hormonal treatment to induce cervical dilation, following the 7‐day oestrous synchronization protocol in multiparous Santa Inês ewes. A total of 23 cyclic ewes received two doses of 37.5 μg of d‐cloprostenol by latero‐vulvar route 7 days apart. After the second injection of d‐cloprostenol, the ewes were checked for oestrus (every 12 hr) and then mated by fertile rams throughout the oestrous period. All ewes received 37.5 μg of d‐cloprostenol (latero‐vulvar) and 1 mg of oestradiol benzoate by either intramuscular (EBim group; n = 12) or intravaginal (EBivg group; n = 11) route 16 hr before embryo flushing. Twenty minutes before the flushing, 50 IU of oxytocin were administered intravenously. The oestrous response (i.e., the percentage of ewes that showed signs of oestrous behaviour after the second d‐cloprostenol injection) was 91.3% (21/23). The proportion of successfully penetrated ewes (81.8% compared with 80.0%), the mean duration of embryo flushing (24.7 ± 2.0 min compared 26.2 ± 1.9 min), the flushing fluid recovery rate (94.8 ± 1.3% compared with 91.0 ± 2.9%) and the average number of structures recovered per ewe (0.5 ± 0.4 compared with 0.8 ± 0.4) did not vary (p > 0.05) between the EBim and EBivg groups. Viable embryos were recovered from 41.2% (7/17) of successfully penetrated ewes. It can be concluded that nonsurgical (i.e., transcervical) embryo collection can be performed in oestrous‐synchronized Santa Inês ewes pretreated with d‐cloprostenol, oxytocin and oestradiol benzoate, with the latter hormone administered by either the intramuscular or intravaginal route

The role of telehealth in the covid-19 pandemic : a brazilian experience

O SARS-CoV-2, vírus causador da Covid-19, é o terceiro coronavírus a causar doença grave em humanos e que apresentou disseminação global nas duas últimas décadas. Nesse contexto, diversos departamentos nacionais de saúde pú- blica, entre eles o Ministério da Saúde do Brasil, trouxeram destaque àquilo que era, até então, considerado um serviço de apoio ao sistema de saúde: a telessaúde e a telemedicina. Pretendemos apresentar as ações realizadas por um serviço nacional de telessaúde no Brasil, tanto no suporte aos profissionais de saúde da Atenção Primá- ria à Saúde quanto a pacientes, além de discutir o potencial de reorganizar um sistema de saúde. Estudo de prevalência que sumariza as ações de telemedicina adotadas pelo TelessaúdeRS-UFRGS no período da 9ª à 27ª semana epidemiológica de 2020 para apoio aos serviços de saúde do Sistema Único de Saúde (SUS). Houve aumento de 76,8% da demanda de teleconsultorias telefônicas no período avaliado em comparação com o mesmo período em 2019, sendo 28,8% dessa demanda total decorrente de dúvidas relacionada à Covid-19. A pandemia por Covid-19 demandou rápida resposta com a organização de materiais sobre a doença, uma nova equipe para execução das atividades de telemonitoramento e teleconsultas, além da elaboração de um manual para teleconsultas na Atenção Primária à Saúde.SARS-CoV-2, the virus that causes Covid-19, is the third coronavirus to cause severe disease in humans and to spread globally in the past two decades. In this context, several national public health departments, including the Brazilian Ministry of Health, highlighted what was, until then, considered a support service to the health system: telehealth and telemedicine. We intend to present the actions carried out by a national telehealth service in Brazil, both as a Primary Health Care (PHC) support service to professionals and to patients, as well as discussing the potential to reorganize a health system. This is a prevalence study that summarizes the measures adopted by Brazilian Telehealth Center from the 9th to the 27th epidemiological weeks of 2020 to support the health services of the Brazilian Unified Health System (SUS). There was an increase of 76.8% in the demand for telephone teleconsultations during the evaluated period compared to the same period in 2019, with 28.8% of the entire demand arising from doubts related to Covid-19. The Covid-19 pandemic demanded a quick response, with the organization of materials about the disease, a new team to carry out telemonitoring and teleconsultation activities, in addition to the creation of a manual for teleconsultations in Primary Health Care.Telemedicin

Social distancing, mask use, and transmission of severe acute respiratory syndrome coronavirus 2, Brazil, April–June 2020

We assessed the associations of social distancing and mask use with symptomatic, laboratory-confi rmed severe acute respiratory syndrome coronavirus 2 infection in Porto Alegre, Brazil. We conducted a population-based casecontrol study during April–June 2020. Municipal authorities furnished case-patients, and controls were taken from representative household surveys. In adjusted logistic regression analyses of 271 case-patients and 1,396 controls, those reporting moderate to greatest adherence to social distancing had 59% (odds ratio [OR] 0.41, 95% CI 0.24– 0.70) to 75% (OR 0.25, 95% CI 0.15–0.42) lower odds of infection. Lesser out-of-household exposure (vs. going out every day all day) reduced odds from 52% (OR 0.48, 95% CI 0.29–0.77) to 75% (OR 0.25, 95% CI 0.18–0.36). Mask use reduced odds of infection by 87% (OR 0.13, 95% CI 0.04–0.36). In conclusion, social distancing and mask use while outside the house provided major protection against symptomatic infection

PERFIL EPIDEMIOLÓGICO DA COVID-19 EM MUNICÍPIOS DO ESTADO DO RIO DE JANEIRO, BRASIL

Introdução: Em 2019 surgiu um novo quadro epidêmico, na China, de uma doença que foi denominada SARS-Cov-2. No Brasil o primeiro caso foi constatado em fevereiro de 2020 e o número de infectados e mortos cresceu abruptamente, vindo o país a se tornar um dos mais atingidos. Objetivo: Avaliar o perfil epidemiológico da Covid-19 em municípios do estado do Rio de Janeiro, visando avaliar a incidência e letalidade da cidade de Valença comparada a outras 14 cidades do estado. Materiais e Métodos: Foi realizada pesquisa, de caráter descritivo, baseada em boletins epidemiológicos da Secretaria Municipal de Saúde de Valença/RJ e da Secretaria Estadual de Saúde do Rio de Janeiro e calculados os Riscos Relativos. Resultados: Verificou-se que, no comparativo com outras cidades, o município de Valença/RJ possui baixos índices de infectados por Covid-19, provavelmente, devido às medidasprecoces tomadas, junto às políticas organizacionais hospitalares e ambulatoriais e educação higiênica para a população. Conclusão: Os índices de letalidade não apresentaram padrão uniforme, o que pode ser explicado pelo perfil de atendimento hospitalar de casos de maior gravidade e à população rural

The use of telemedicine to support Brazilian primary care physicians in managing eye conditions : the TeleOftalmo Project

Purpose: To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. Methods: We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients’ eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. Results: Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged �65 years, while the highest was 89.7% among subjects aged 13–17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001). Conclusions: With telemedicine support, primary care physicians solved over two-thirds of patients’ eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral

Dezoito anos em dois dias: os próximos passos para a consulta remota no Brasil

This is an opinion article that aims to support the Disease caused by the New Coronavirus of 2019 (COVID-19) post-pandemic regarding the regulation of care through digital resources. Through a literature review, an attempt was made to conceptualize remote consultation and to survey both the historical evolution of technological appropriation by health and the regulation on the subject. Texts covering the pre-pandemic and pandemic periods in Brazil, the United States, the European Union and Australia were evaluated. We tried to highlight the main fallacies, sophisms and dissensions that orbit the theme, as well as the real points where there is a need for greater commitment for decision makers: data security and privacy, reimbursement parity and interstate licensing. It is concluded that the technological appropriation by health has divided the world into at least three segments: those that maintained the autonomy of professionals and patients; those who retarded technological advancement through bureaucracy; and those who forbade advances. The pandemic has generated positive reallocations among these groups and there is a need to refine progress and avoid setbacks.Este es un artículo de opinión que tiene como objetivo apoyar la discusión pospandémica de la Enfermedad causada por el Nuevo Coronavirus de 2019 (COVID-19) en cuanto a la regulación de la atención a través de recursos digitales. A través de una revisión de la literatura, se intentó conceptualizar la consulta remota y relevar tanto la evolución histórica de la apropiación tecnológica por parte de la salud como la regulación sobre el tema. Se evaluaron los textos que cubren los períodos prepandémico y pandémico en Brasil, Estados Unidos, la Unión Europea y Australia. Intentamos resaltar las principales falacias, sofismas y disensiones que orbitan el tema, así como los puntos reales donde existe la necesidad de un mayor compromiso de los tomadores de decisiones: seguridad y privacidad de los datos, paridad de reembolso y licencias interestatales. Se concluye que la apropiación tecnológica por parte de la salud ha dividido al mundo en al menos tres segmentos: los que mantenían la autonomía de profesionales y pacientes; los que retrasaron el avance tecnológico a través de la burocracia; y los que prohibieron los avances. La pandemia ha generado reasignaciones positivas entre estos grupos y es necesario perfeccionar el progreso y evitar retrocesos.Este é um artigo de opinião que objetiva subsidiar a discussão pós-pandemia da Doença causada pelo Novo Coronavírus de 2019 (COVID-19) a respeito da regulamentação do atendimento por meio de recursos digitais. Buscou-se, por meio de revisão de literatura, conceituar a consulta remota e fazer um levantamento tanto da evolução histórica da apropriação tecnológica pela saúde como da regulamentação sobre o tema. Foram avaliados textos cobrindo os períodos pré-pandêmico e pandêmico no Brasil, Estados Unidos, União Europeia e Austrália. Procurou-se evidenciar as principais falácias, sofismas e dissensos que orbitam o tema, bem como os reais pontos onde há necessidade de maior empenho para os tomadores de decisão: segurança de dados e privacidade, paridade de reembolso e licenciamento interestadual. Conclui-se que a apropriação tecnológica pela saúde dividiu o mundo em pelo menos três segmentos: os que mantiveram a autonomia de profissionais e pacientes; os que retardaram o avanço tecnológico por meio de burocracia; e os que proibiram os avanços. A pandemia gerou realocações positivas entre esses grupos e existe a necessidade de refinar avanços e evitar retrocessos

Facing a new enemy with old weapons : use of masks, hand and surface hygiene, isolation, social distance, quarantine and blocking to control covid-19

Após sua descrição inicial em dezembro de 2019, a infecção causada pelo SARS-CoV-2, Covid-19, espalhou-se rapidamente pelo mundo, sendo classificada em março de 2020 como pandemia. Experiências de epidemias anteriores mostram que, de acordo com as características do agente etiológico, medidas não farmacológicas, como lavagem das mãos, higienização de superfícies, uso de máscaras, isolamento de casos confirmados, quarentena, distanciamento social e lockdown, são eficazes e fundamentais para evitar a propagação de doenças infecciosas. Informações sobre a forma de transmissão do vírus e sua dinâmica no organismo do hospedeiro permitem propor a adesão dessas estratégias. Ao avaliar evidências do uso dessas medidas no controle de doenças com dinâmica semelhante à causada pelo novo coronavírus, encontra-se embasamento para sua aplicação prática. Além disso, a experiência de outros países no enfrentamento a essa doença ao longo do ano 2020 corroboram ainda mais para a adoção dessas condutas. À luz da história mundial, das evidências científicas e das experiências de outros países, faz-se necessária a aplicação dessas estratégias no combate contra a Covid-19, enquanto as medidas complementares, como as vacinas, ainda não estão disponíveis de forma ampla para toda a população.After its initial description in December 2019, the infection caused by SARS-CoV-2, Covid-19, spread rapidly around the world, being classified in March 2020 as a pandemic. Experiences from previous epidemics show that, according to the characteristics of the etiologic agent, non-pharmacological measures such as hand washing, surface cleaning, use of masks, isolation of confirmed cases, quarantine, social distance and lockdown, are effective and essential to avoid the spread of infectious diseases. Information on the form of transmission of the virus and its dynamics in the host organism, allow us to propose the adherence of these strategies. When evaluating evidence of the use of these measures in the control of diseases with dynamics similar to that caused by the new coronavirus, there is a basis for its practical application. In addition, the experience of other countries in tackling this disease throughout 2020, further corroborates the adoption of these conducts. In the light of world history, scientific evidence and the experiences of other countries, it is necessary to apply these strategies in the fight against Covid-19, while complementary measures, such as vaccines, are not yet widely available for all the population