Railroad and environment in São Paulo: environmental communication in the early 20th century / Ferrovia e meio ambiente em São Paulo: comunicação ambiental no início do século XX

A expansão das ferrovias em São Paulo contribuiu para a modificação da paisagem paulista. A extração de madeira para suprir as necessidades energéticas (lenha) ou para manufatura de insumos básicos como dormentes no início do século XX de alguma maneira preocupou as autoridades competentes na gestão e concessão das estradas de ferro em São Paulo e no Brasil. Este trabalho tem como objetivo correlacionar dois processos documentais da Secretaria da Agricultura, Comércio e Obras Públicas de São Paulo – SACOP do início do século XX com os conceitos atuais da Ecologia Industrial e Comunicação Ambiental. O método escolhido foi a análise qualitativa e documental dos processos. O resultado da investigação histórica foi a existência de comunicação ambiental e a preocupação com o “fechamento do ciclo produtivo” nas ferrovias paulistas no início do século passado

USO DO RESÍDUO DE SILÍCIO DA PRODUÇÃO DE SEMICONDUTORES NAS CULTURAS AGRÍCOLAS

Estudos indicam que o silício é um mineral que pode ser usado no controle de algumas pragas, bem como proporcionar aumento na produção e na qualidade de algumas culturas agrícolas. Este trabalho, propõe o uso de lodo residuário da operação de corte de lâminas de silício da produção de semicondutores, como substrato/co-produto na agricultura. Experimentos preliminares foram conduzidos realizando-se a semeadura de sementes de girassol e de feijão a fim de se avaliar o desenvolvimento das plantas em misturas de lodo da Estação de Tratamento de efluentes (ETE) e terra vegetal. Avaliou-se, ainda, a toxicidade terrestre deste resíduo, no bioensaio com minhocas, Eisenia andrei. Apesar de serem preliminares, os resultados de germinação destes experimentos apontam para o potencial benefício do resíduo de silício para a germinação e o desenvolvimento normais das espécies estudadas. O lodo apresentou também, como característica, a capacidade de retenção de umidade, que foi maior que a amostra de terra controle somente. O teste de toxicidade foi negativo, tanto para a mortalidade, quanto para a mobilidade dos organismos, atestando a inocuidade do resíduo

USO DE BIOINDICADORES NO MONITORAMENTO DA QUALIDADE DO AR “INDOOR” NUMA PLANTA DE TRATAMENTO DE RESÍDUOS SÓLIDOS DE SAÚDE

The atmospheric pollutant´s emission above limit concentrations is called atmospheric pollution, including air pollutants in occupational environments, whose concentrations may be many times higher than in open areas, problaby due to the absence of adequate ventilation systems. Our aim was to evaluate the potential health risk of workers using as bioindicator the Tradescantia pallida micronuclei production in exposed plants.The plants were grown under controlled conditions were placed at strategically points within the waste processing plant for a period of 30 days.Mutagenic activity was observed in exposed plants, especially at the point near the vapor emissions of autoclave.Our results highlight the importance of not only monitoring the work environment, but particularly in this case, the concern must precede the treatment plant, since chemical compounds should not be part of this waste type, since its presence denotes segregation failures in its origin.A emissão de poluentes atmosféricos acima de concentrações-limite denomina-se poluição atmosférica, que pode ser encontrada, inclusive, em ambientes ocupacionais, cujas concentrações podem ser superiores às de áreas abertas, pela ausência de sistemas de ventilação adequados. A partir de uma situação problema numa planta de tratamento de resíduos de saúde suspeitou-se da possibilidade de exposição ocupacional a vapores tóxicos. O objetivo foi avaliar, por meio de bioindicadores o potencial risco à saúde dos trabalhadores e a T. pallida foi usada como bioindicador de mutagênese. As plantas foram cultivadas em condições controladas e colocadas em 5 pontos escolhidos dentro da planta de tratamento de resíduos durante 30 dias. Observou-se atividade mutagênica nas plantas expostas, principalmente no ponto próximo à saída de vapores da autoclave. Os resultados ressaltam a importância de se realizar o monitoramento do ambiente de trabalho e oscuidados devem anteceder a planta de tratamento, pois a presença de compostos químicos denota falhas de segregação na origem

USO DE BIOINDICADORES NO MONITORAMENTO DA QUALIDADE DO AR “INDOOR” NUMA PLANTA DE TRATAMENTO DE RESÍDUOS SÓLIDOS DE SAÚDE

The atmospheric pollutant´s emission above limit concentrations is called atmospheric pollution, including air pollutants in occupational environments, whose concentrations may be many times higher than in open areas, problaby due to the absence of adequate ventilation systems. Our aim was to evaluate the potential health risk of workers using as bioindicator the Tradescantia pallida micronuclei production in exposed plants.The plants were grown under controlled conditions were placed at strategically points within the waste processing plant for a period of 30 days.Mutagenic activity was observed in exposed plants, especially at the point near the vapor emissions of autoclave.Our results highlight the importance of not only monitoring the work environment, but particularly in this case, the concern must precede the treatment plant, since chemical compounds should not be part of this waste type, since its presence denotes segregation failures in its origin.A emissão de poluentes atmosféricos acima de concentrações-limite denomina-se poluição atmosférica, que pode ser encontrada, inclusive, em ambientes ocupacionais, cujas concentrações podem ser superiores às de áreas abertas, pela ausência de sistemas de ventilação adequados. A partir de uma situação problema numa planta de tratamento de resíduos de saúde suspeitou-se da possibilidade de exposição ocupacional a vapores tóxicos. O objetivo foi avaliar, por meio de bioindicadores o potencial risco à saúde dos trabalhadores e a T. pallida foi usada como bioindicador de mutagênese. As plantas foram cultivadas em condições controladas e colocadas em 5 pontos escolhidos dentro da planta de tratamento de resíduos durante 30 dias. Observou-se atividade mutagênica nas plantas expostas, principalmente no ponto próximo à saída de vapores da autoclave. Os resultados ressaltam a importância de se realizar o monitoramento do ambiente de trabalho e oscuidados devem anteceder a planta de tratamento, pois a presença de compostos químicos denota falhas de segregação na origem

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc