O objetivo principal deste trabalho é apresentar um protocolo para avaliação de compatibilidade entre a gestão de procedimentos e a complexidade do sistema sócio-técnico em que esses são aplicados. Tal protocolo consiste das seguintes etapas: (a) delimitação do sistema sócio-técnico a ser estudado; (b) caracterização do sistema sócio-técnico; (c) caracterização da complexidade do sistema em estudo; (d) aplicação de dois tipos de questionários aos membros do sistema investigado; um deles destinado a avaliar a percepção em relação a um conjunto de princípios acerca de como os procedimentos deveriam ser gerenciados em um sistema complexo; outro destinado a avaliar a percepção acerca da extensão pela qual os princípios realmente são usados; (e) uma reunião de retorno dos resultados da avaliação aos membros do sistema sócio-técnico; (f) elaboração de recomendações para melhorar a gestão de procedimentos. A aplicação do protocolo é ilustrada por meio de um estudo de caso na sala de controle de uma refinaria de petróleo.

Introdução: A aparência dentária é cada vez mais importante na sociedade moderna pois a procura de satisfação pessoal aumenta a procura por um sorriso atraente. Existem vários produtos e técnicas para o branqueamento dentário vital, que variam quanto à concentração e tipo de produtos finais libertados. Mesmo que o branqueamento dentário seja considerado uma modalidade de tratamento conservador e não invasivo, ele apresenta alguns efeitos adversos nomeadamente a sensibilidade dentária. O desgaste dos dentes pode ser definido como uma perda progressiva dos tecidos dentários duros devido aos processos de erosão. Esta é uma perda irreversível de substância dentária. Materiais e métodos: Foi efetuada uma pesquisa eletrónica utilizando as bases de dados PubMed/Medline®, Scielo® e Web of Science® com uma estratégia de pesquisa específica combinando termos controlados. O estudo baseou-se nos critérios de avaliação sistemática estabelecidos pela norma PRISMA. Os estudos pertinentes foram selecionados e avaliados após leitura do texto completo. Resultados: Através de estratégia de pesquisa foram identificados 228 artigos, dos quais 184 resultados na Pubmed, 39 na SciELO e 5 na Web of Science. Após a realização do processo de seleção, de acordo com os critérios de inclusão e elegibilidade previamente definidos, foram incluídos na revisão 13 artigos. Conclusão: Na evidência científica pode-se concluir que o branqueamento dentário em pacientes com erosão pode aumentar as alterações no esmalte causando maiores efeitos colaterais.

Atherosclerotic renal artery stenosis (RAS) is a well-known cause of secondary hypertension and progressive renal insufficiency. In patients with a solitary functioning kidney, it is uncommon but high-risk, posing a dilemma between revascularization and medical management. Revascularization is usually reserved for selected high-risk cases. We report a 54-year-old woman with hypertension, prior ischemic heart disease, superficially invasive squamous cell carcinoma of the cervix, and a solitary functional kidney, who was admitted with acute renal failure and recurrent episodes of flash pulmonary edema. CT angiography revealed occlusion of the left renal artery and severe stenosis of the right. Angioplasty and stent placement in the left renal artery restored blood flow, leading to recovery of renal function and adequate blood pressure control. Renal revascularization can improve blood pressure, renal function, and cardiovascular profile. Despite trials such as STAR, ASTRAL, and CORAL not showing overall benefit over medical therapy, international guidelines recommend considering revascularization in selected high-risk patients. This case illustrates that endovascular revascularization can be effective in patients with a solitary kidney and severe RAS, emphasizing the importance of a multidisciplinary, individualized approach to optimize clinical outcomes.

The goal of this research it to evaluate the Milpa system interspersed with Fruit Trees (MIAF, by their acronyms in spanish) during a productive cycle (2020-2021) in Icalumtic village, Municipality of Chamula, Chiapas, a local community that has developed a ten-year experience with this agroforestry system. An agroecological sustainability evaluation method proposed by Altieri and Nicholls (2002) was used using 30 quantitative and qualitative indicators, which were defined with the community in a participatory manner. These indicators were categorized into three axes of sustainability: ecological-technical-productive axis, socioeconomic axis and socio-political-cultural axis, approached from the concepts of sustainable agriculture and agroforestry systems. The questionnaire was applied to eight men and eight women and in each plot area samples were made in squares of 5x5m. The results were systematized in excel sheets, to be analyzed with ameba graphs, for which a scale from 0 to 10 was used to rate the sustainability of the system according to the proposed indicators, 0 for the least sustainable and 10 for the most sustainable. Descriptive statistics and discourse analysis were also used for the analysis of the results of the samplings in plots and the questionnaires. Results and discussion: Based on a general average and by means of the analysis of the radial graphs, we found an average of 8.16 for the productive technical ecological axis, of 7.23 for the sociopolitical-cultural axis, both within moderately acceptable sustainability; for the socioeconomic axis it was 4.04, within unacceptable sustainability.

Background: Delayed post-polypectomy bleeding (DPPB) is the most common adverse event following colonic polypectomy, yet its management remains highly heterogeneous and lacks standardization. A considerable number of colonoscopies performed for DPPB may be unnecessary and do not result in hemostatic intervention.Objectives: To develop evidence-based statements to guide clinical decision-making in DPPB.Design: Multidisciplinary Delphi consensus statement.Methods: A panel of 29 experts in gastroenterology, hematology, radiology, and surgery was assembled. Through a systematic review of the literature and a modified Delphi process, consensus statements were developed through iterative rounds of anonymous voting. Statements were revised following anonymous voting and feedback at each round. Those achieving 80% agreement were accepted.Results: The expert panel reached a consensus on 36 statements, covering areas such as antithrombotic management, bowel preparation, colonoscopy indications, and therapeutic hemostatic modalities. Key recommendations include guidance for managing self-limited bleeding and risk stratification to reduce the rate of unnecessary colonoscopies, as well as recommendations for hemodynamically unstable patients who may require primary angioembolization. A practical clinical algorithm is proposed.Conclusion: This document provides a consensus-based framework for managing DPPB. These recommendations aim to improve patient outcomes and optimize healthcare resources while fostering a standardized approach to this common adverse event.

The GEOTRACES Intermediate Data Product 2014 (IDP2014) is the first publicly available data product of the international GEOTRACES programme, and contains data measured and quality controlled before the end of 2013. It consists of two parts: (1) a compilation of digital data for more than 200 trace elements and isotopes (TEIs) as well as classical hydrographic parameters, and (2) the eGEOTRACES Electronic Atlas providing a strongly inter-linked on-line atlas including more than 300 section plots and 90 animated 3D scenes. The IDP2014 covers the Atlantic, Arctic, and Indian oceans, exhibiting highest data density in the Atlantic. The TEI data in the IDP2014 are quality controlled by careful assessment of intercalibration results and multi-laboratory data comparisons at cross-over stations. The digital data are provided in several formats, including ASCII spreadsheet, Excel spreadsheet, netCDF, and Ocean Data View collection. In addition to the actual data values the IDP2014 also contains data quality flags and 1-σ data error values where available. Quality flags and error values are useful for data filtering. Metadata about data originators, analytical methods and original publications related to the data are linked to the data in an easily accessible way. The eGEOTRACES Electronic Atlas is the visual representation of the IDP2014 data providing section plots and a new kind of animated 3D scenes. The basin-wide 3D scenes allow for viewing of data from many cruises at the same time, thereby providing quick overviews of large-scale tracer distributions. In addition, the 3D scenes provide geographical and bathymetric context that is crucial for the interpretation and assessment of observed tracer plumes, as well as for making inferences about controlling processes.

The GEOTRACES Intermediate Data Product 2017 (IDP2017) is the second publicly available data product of the international GEOTRACES programme, and contains data measured and quality controlled before the end of 2016. The IDP2017 includes data from the Atlantic, Pacific, Arctic, Southern and Indian oceans, with about twice the data volume of the previous IDP2014. For the first time, the IDP2017 contains data for a large suite of biogeochemical parameters as well as aerosol and rain data characterising atmospheric trace element and isotope (TEI) sources. The TEI data in the IDP2017 are quality controlled by careful assessment of intercalibration results and multi-laboratory data comparisons at crossover stations. The IDP2017 consists of two parts: (1) a compilation of digital data for more than 450 TEIs as well as standard hydrographic parameters, and (2) the eGEOTRACES Electronic Atlas providing an on-line atlas that includes more than 590 section plots and 130 animated 3D scenes. The digital data are provided in several formats, including ASCII, Excel spreadsheet, netCDF, and Ocean Data View collection. Users can download the full data packages or make their own custom selections with a new on-line data extraction service. In addition to the actual data values, the IDP2017 also contains data quality flags and 1-s data error values where available. Quality flags and error values are useful for data filtering and for statistical analysis. Metadata about data originators, analytical methods and original publications related to the data are linked in an easily accessible way. The eGEOTRACES Electronic Atlas is the visual representation of the IDP2017 as section plots and rotating 3D scenes. The basin-wide 3D scenes combine data from many cruises and provide quick overviews of large-scale tracer distributions. These 3D scenes provide geographical and bathymetric context that is crucial for the interpretation and assessment of tracer plumes near ocean margins or along ridges. The IDP2017 is the result of a truly international effort involving 326 researchers from 25 countries. This publication provides the critical reference for unpublished data, as well as for studies that make use of a large cross-section of data from the IDP2017. This article is part of a special issue entitled: Conway GEOTRACES-edited by Tim M. Conway, Tristan Horner, Yves Plancherel, and Aridane G. Gonzalez.