POR UMA DEFINIÇÃO DE UM PONTO DE VISTA PERTINENTE E COERENTE NA ANÁLISE DO TEXTO LITERÁRIO

Este trabalho se propõe o exame dos estudos de estilo de L. Spitzer e E. Auerbach, da critica temática de J.P. Richard e J. Rousset e de certas proposições do estruturalismo, numa tentativa de busca de uma interpretação da obra literária orientada para a fusão de textos e contexto

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

STRENGTHENING THE EUROPEAN RARE EARTHS SUPPLY-CHAIN Challenges and policy options A REPORT BY THE EUROPEAN RARE EARTHS COMPETENCY NETWORK (ERECON)

ERECON (2014) Strengthening the European rare earths supply chain: Challengesand policy options. Kooroshy, J., G. Tiess, A. Tukker, and A. Walton (eds.).Policy recommendations:1.Maintaining and strengthening the European Rare Earth Elements (REE) skills and knowledge base through research funding, science and technology education and international cooperation.Without cutting-edge research and technical expertise, a European high-tech REE industry cannot flourish. The EC and Member States should support funding for research grants, scholarships, and training networks, and enhance European and international cooperation through coordinated calls, researcher exchanges, and joint high-level conferences.2.Creating the basis for informed decision-making on REEs through a European Critical Materials Observatory.Mapping and monitoring of REE supply chains is necessary for informed decision-making. Expertise in Europe could be pooled in a virtual Critical Materials Observatory that provides the public with consistent and authoritative knowledge on REEs (e.g., information on advanced exploration projects, prices, key demand and supply trends, and the urban mine potential).3.Support promising technologies through funding industry-led pilot plants for innovative HREE processing.The EC, industry and Member States should accelerate the commercialization and scaling up of key technologies through co-financing industry-led pilot plants. This should include pilots for REE recovery from heavy rare earths-rich minerals, direct-alloy recycling routes, process and sensor equipment for REE recycling, and REE recovery from industrial residues.4.Levelling the playing field for European HREE exploration through co-funding for prefeasibility and bankable feasibility studies.Support from federal and state governments in the U.S., Australia and Canada has played a critical role in advancing project exploration. The EC and Member States should evaluate possibilities for supporting the extensive R&D necessary for pre-feasibility and bankable feasibility studies, to avoid high quality deposits in Europe simply going unexplored.5.Making waste management REE-friendly through eco-design, incentive schemes for collecting priority waste products, and streamlining policy and waste regulation.The EC and Member States should promote recycling-friendly design to help identify and recover REE components in waste more easily. Potential incentives for stimulating REE waste collection should be evaluated and the shipment of REE wastes should be facilitated. More consistency should also be created in implementing and applying existing waste regulations.6.Boost supply security and de-risk strategic REE investment cases through enhanced cooperation among European end-users and other stakeholders.Leading end-users should engage in strategic cooperation across industry and with governments. This could include setting up a voluntary European ‘critical raw materials fund’, establishing a ‘European Resource Alliance’ similar to the German Rohstoffallianz, and convening a high-level taskforce to examine ways in which public funding could support resilient REE supply chains for Europe

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791