IMPLANTAÇÃO DE EMBALAGENS REUTILIZÁVEIS NA INDÚSTRIA AUTOMOTIVA: ESTUDO DE CASO

This article describes a case study on the replacement of disposable packaging for reusable packaging in the international flow of materials in a auto parts company in the Mercosur. The study concerns the automotive parts exported from Brazil to Argentina by the road modal. Initially, it presents a theoretical review about reverse logistics, returnable packaging and international logistics. The following describes the case, according to the information collected by researchers at the company studied. Describe the facts, investigate the causes that originated and compares the process prior to that contemplates the use of disposable packaging, with a new process, based in returnable packaging. This article aims to answer the following research question: How can it be implemented an international flow of return reusable packaging in the automotive industry? Substantive economic, logistics, and environmental gains were yield.Este artigo descreve um estudo de caso sobre a substituição de embalagens descartáveis por embalagens reutilizáveis no fluxo internacional de materiais na indústria de autopeças no Mercosul. O estudo diz respeito a peças exportadas do Brasil para a Argentina pelo modal rodoviário. Inicialmente apresenta-se uma revisão teórica a respeito de logística reversa, embalagens retornáveis e logística internacional. A seguir, descreve-se o caso, de acordo com as informações colhidas pelos pesquisadores junto à empresa estudada.  Descrevem-se os fatos, investigam-se as causas que os originaram, e compara-se o processo anterior, baseado em embalagens descartáveis, com o novo processo, baseado em embalagens reutilizáveis. O artigo visa a responder a seguinte questão de pesquisa: como pode ser organizado o fluxo reverso de embalagens reutilizáveis em uma empresa da indústria automotiva

Viabilidade da terminação de gado de corte em confinamento na dinâmica em uma propriedade agrícola

This article sought to demonstrate the feasibility of confinement in the dynamics of an agricultural property in the municipality of Tangará da Serra - MT, with 4452 Nelore cattle being confined in 116 days. The following values were determined: average daily weight gain; dry matter intake; carcass yield; food conversion; dry matter intake in relation to live weight. From data collection and analysis, the effective operating cost, total operating cost and profitability of the system can be determined. The costs of acquiring the animals, food, sanitation, labor and other charges were added together and generated an effective operating cost per animal of R$2,698.81. When taxes, insurance and depreciation are added to these costs, a total operating cost per animal of R$ 2,767.08 was generated. Gross revenue, which directly represents the number of animals sold (90,019.44 arrobas) to the slaughterhouse, was R$12,917,786.60. Operating profit was R$ 598,746.44. This represents a cycle profitability index of 4.63%. Confinement allows for short and long-term analyzes of the activity for livestock, as it is a profitable and viable activity, mainly because it results in a quick return.Este artículo buscó demostrar la viabilidad del confinamiento en la dinámica de una propiedad agrícola en el municipio de Tangará da Serra - MT, con 4452 bovinos Nelore confinados en 116 días. Se determinaron los siguientes valores: ganancia de peso diaria promedio; consumo de materia seca; rendimiento de la canal; conversión de alimentos; consumo de materia seca en relación con el peso vivo. A partir de la recopilación y el análisis de datos, se puede determinar el costo operativo efectivo, el costo operativo total y la rentabilidad del sistema. Los costos de adquisición de animales, alimentos, saneamiento, mano de obra y otros cargos se sumaron y generaron un costo operativo efectivo por animal de R$2.698,81. Cuando a estos costos se le suman impuestos, seguros y depreciación, se generó un costo total de explotación por animal de R$ 2.767,08. El ingreso bruto, que representa directamente el número de animales vendidos (90.019,44 arrobas) al matadero, fue de R$12.917.786,60. El beneficio operativo fue de R$ 598.746,44. Esto representa un índice de rentabilidad del ciclo de 4,63%. El confinamiento permite realizar análisis a corto y largo plazo de la actividad ganadera, ya que es una actividad rentable y viable, principalmente porque se traduce en un rápido retorno.Com esse artigo buscou-se evidenciar a viabilidade do confinamento na dinâmica de uma propriedade agrícola no município de Tangará da Serra – MT, sendo que, 4452 bovinos da raça nelore foram confinados em 116 dias. Durante esse período, foram determinados os valores de: ganho de peso médio diário; consumo de matéria seca; rendimento de carcaça; conversão alimentar; consumo de matéria seca em relação ao peso vivo. Da coleta e análise dos dados pode-se determinar o custo operacional efetivo, custo operacional total e a rentabilidade do sistema. Os custos com aquisição dos animais, alimentação, sanidade, mão de obra e encargos e diversos foram somados e gerou um custo operacional efetivo por animal de R$2.698,81. Quando acrescentados a esses custos os valores de impostos, seguro e depreciação, foi gerado o custo operacional total por animal de R$ 2.767,08. A receita bruta, que representa diretamente o número de animais vendidos (90.019,44 arrobas) para o frigorífico, foi de R$12.917.786,60. O lucro operacional foi de R$ 598.746,44. Isso representa um índice de lucratividade no ciclo de 4,63%. O confinamento permite à pecuária análises de curto e longo prazo para a atividade, apresenta ser uma atividade rentável e viável, sobretudo por resultar em rápido retorno

Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

Sem informação113478788

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

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

Hantavirus Pulmonary Syndrome: Report of the first three cases in São Paulo, Brazil

The hantavirus pulmonary syndrome was first recognized in cases that occurred in the U.S. in 1993, which served as an alert not only for American physicians but also for physicians in other countries for the identification of the disease. In the city of São Paulo, Brazil, 3 cases of the syndrome were recorded in 1993. The patients were young brothers residing in the Mata Atlântica (Atlantic Forest) region submitted to recent deforestation. Two of the patients died of acute respiratory insufficiency and the third recovered without sequelae. In the surviving patient the diagnosis was established by a laboratory criterion based on the detection of specific IgM and IgG class antibodies by indirect immunofluorescence. In the two patients who died, the diagnosis was confirmed by laboratory tests using immunoperoxidase technique for hantavirus in tissue, in histological lung and heart sections in one case, and by clinical and epidemiological data in the othe

Brain natriuretic peptide based strategy to detect left ventricular dysfunction in Chagas disease : a comparison with the conventional approach.

Background: Left ventricular dysfunction (LVd) is the main predictor of mortality in Chagas disease (ChD). Aims: To compare the diagnostic performance of the conventional approach (ECG and chest X-ray) in the recognition of LVd in ChD, with a new strategy, in which BNP is measured in patients with an abnormal ECG. Methods: Consecutive ChD patients recruited at an Outpatient Reference Center in Belo Horizonte, Brazil, without other systemic diseases, in 1998–99 (sample 1, n =165) and in 2001–02 (sample 2, n =62) underwent ECG, chest X-ray, BNP measurement and echocardiography. Results: The prevalence of LVd (ejection fraction _0.40) was 9.1% in the sample 1. The conventional strategy recognized all patients with LVd (sensitivity: 100%, 95% CI: 79.6–100% and negative predictive value _PV 100%, 92.1–100%), but with low specificity (30%, 95% CI: 23.2–37.8) and +PV (12.5%, 95% IC: I7.7–19.6). The BNP/ECG strategy showed significantly better specificity (96.0%, 95% CI: 91.5–98.2, p <0.001) and +PV (66.7%, 95% CI: 43.7–83.7, p <0.001), and non-significantly lower sensitivity (80.0%, 95% CI: 54.8–93.0, p =0.25) and _PV (98.0%,95% CI: 94.2–99.3, p =0.08). Overall accuracy was improved with the new strategy. (94.5%,95% CI: 90.0– 97.1_36.4%, 95% CI: 29.4–43.9, p <0.001). Similar results were obtained for the sample 2. Conclusions: The BNP-based strategy was more accurate than the conventional approach in the detection of LVd in ChD patients and should be considered as a valid option

Development of a laparoscopic training model using a smartphone

ABSTRACT Objective: to develop a model of training in video-surgery, of low cost and that uses a smartphone as an image-generating source. Methods: We developed a 38cm high, 40cm wide, 40cm long hexagonal-shaped training box, with a front opening of 12x8 cm for coupling the smartphone. The internal illumination is made with LED lamps and for the support of the smartphone, we used a selfie stick, fixed in the upper part of the box, that allows control of height, distance, angulation, and the coupling of devices with different formats. We selected 20 undergraduate students without previous training in video-surgery, who performed four exercises in the box, with assessment of the time and amount of errors in the execution of the tasks. Each student completed the training for three consecutive weeks. We collected the data in spreadsheets for later analysis. Results: Nineteen students completed the training program, with significant improvement in the times and in the number of errors. Conclusion: the developed model was feasible and promoted the acquisition of skills in this group of students. In addition, it presents low cost, is portable and uses common equipment, such as smartphones

Development of a laparoscopic training model using a smartphone

<div><p>ABSTRACT Objective: to develop a model of training in video-surgery, of low cost and that uses a smartphone as an image-generating source. Methods: We developed a 38cm high, 40cm wide, 40cm long hexagonal-shaped training box, with a front opening of 12x8 cm for coupling the smartphone. The internal illumination is made with LED lamps and for the support of the smartphone, we used a selfie stick, fixed in the upper part of the box, that allows control of height, distance, angulation, and the coupling of devices with different formats. We selected 20 undergraduate students without previous training in video-surgery, who performed four exercises in the box, with assessment of the time and amount of errors in the execution of the tasks. Each student completed the training for three consecutive weeks. We collected the data in spreadsheets for later analysis. Results: Nineteen students completed the training program, with significant improvement in the times and in the number of errors. Conclusion: the developed model was feasible and promoted the acquisition of skills in this group of students. In addition, it presents low cost, is portable and uses common equipment, such as smartphones.</p></div