346 resultados para Gastroplasty,Biliopancreatic diversion
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No Brasil, a Política Nacional de Recursos Hídricos apresenta a cobrança pelo uso da água como um instrumento de gestão de recursos hídricos de caráter econômico. Considerando esse caráter, a cobrança deve ter como objetivos: racionalizar o uso do recurso baseado na sua escassez; reconhecer a água como um bem de valor econômico, refletindo os custos ambientais advindos de sua utilização; e diminuir os conflitos entre os usos, induzindo uma alocação que considere o gerenciamento da demanda e as prioridades da sociedade. Além dessas metas, como instrumento de gestão de uma política que lista como primeiro objetivo \"assegurar à atual e às futuras gerações a necessária disponibilidade de água, em padrões de qualidade adequados aos respectivos usos\", a cobrança deve ser implementada de maneira que o agente usuário direcione seu comportamento no sentido da sustentabilidade ambiental. Mediante esses fundamentos, o que se pretende desenvolver neste trabalho é a aplicação de um modelo de cobrança sobre o uso da água que considera como princípio base a manutenção da qualidade ambiental medida pela adequada gestão da escassez de água e, compondo a busca dessa qualidade, a racionalização econômica e a viabilização financeira. Essa predominância do ambiente sobre aspectos econômicos vem no sentido de desqualificar argumentos segundo os quais, os impactos advindos dos usos da água serão corrigidos indefinidamente mediante investimentos financeiros em infra estrutura. Admitir que o desenvolvimento tem esse poder é supor equivocadamente que o meio econômico é limitante do meio ambiente e não o contrário. Esta constatação mostra qual é o problema da maioria das propostas de cobrança que valoram a água baseadas em custos de tratamento de resíduos e de obras hidráulicas. Por mais elaborados que sejam essas fórmulas de cobrança, chegando a ponto de se conseguir que fique mais caro, mediante um padrão ambiental corretamente definido, captar água ou lançar poluentes do que racionalizar usos, o preço da água não pode estar baseado em fatores cuja \"sustentabilidade\" pode acabar no curto prazo, dependendo do ritmo de crescimento econômico. A sustentabilidade dos recursos hídricos só será base da cobrança pelo uso da água se o valor cobrado for dificultando esse uso à medida que os recursos tornarem se escassos, e não quando os custos de medidas mitigadoras dessa escassez se tornarem muito elevados. Portanto, o modelo de cobrança proposto neste trabalho procura garantir que o agente econômico que está exaurindo o meio ambiente não possa ter capacidade de pagar por essa degradação, ajudando efetivamente a política de outorga do direito de uso da água na observância da capacidade de suporte do meio.
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The Municipality of Anchorage (MOA) is required to better manage, operate and control municipal solid waste (MSW) after the Anchorage Assembly instituted a Zero Waste Policy. Two household curbside recycling programs (CRPs), pay-as-you-throw (PAYT) and single-stream, were compared and evaluated to determine an optimal municipal solid waste diversion method for households within the MOA. The analyses find: (1) a CRP must be designed from comprehensive analysis, models and data correlation that combine demographic and psychographic variables; and (2) CRPs can be easily adjusted towards community-specific goals using technology, such as Geographic Information System (GIS) and Radio Frequency Identification (RFID). Combining resources of policy-makers, businesses, and other viable actors are necessary components to produce a sustainable, economically viable curbside recycling program.
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En el presente trabajo se describen y analizan las principales obras hidráulicas del sistema de riego tradicional de la comarca de la Vega Baja del Segura, concretamente, los azudes y los acueductos. Los azudes de toma, construidos en el cauce del río Segura, representan el inicio del sistema, desde donde parte una extensa y compleja red de acueductos constituida por acequias y azarbes, como elementos fundamentales, que distribuyen el agua para el regadío. En este estudio se ha llevado a cabo una amplia y profunda investigación documental, tomado datos de campo y captado imágenes in situ que, junto con los diagramas aportados, resultan imprescindibles para comprender la magnitud del sistema. Los resultados obtenidos han servido no sólo para catalogar y caracterizar los elementos que integran el sistema hidráulico del regadío tradicional de la Vega Baja del Segura, sino también para poner de manifiesto un ejemplo real de optimización de recursos hídricos en una zona del sureste peninsular español de escasa e irregular pluviometría. Asimismo, el estudio efectuado revela un sistema de riego sumamente eficiente desde un punto de vista cuantitativo y no tanto desde el cualitativo, debido a la presencia, entre otros contaminantes, de altas concentraciones de sales.
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After the construction of the San Carlos bastion in Alicante in the final decade of the seventeenth century, and the great trench which the English built around the district of San Francisco during their years of dominance in the War of Succession, the waters of the San Blas gully caused serious damage to these fortifications of the city and to the trade buildings of the port. In 1772, the diversion canal was built. It was designed to divert the riverbed of the gully and send the waters directly to the sea. The project had been initially designed by the Engineer General, Jorge Próspero de Verboom in 1721. This unique work of engineering had some defects, principally in the breakwater which prevented the waters from flowing down the former river course. On several occasions, the water returned to its original riverbed due to the weakness of the breakwater, the narrowness of the channel’s bed and its lack of regularisation, causing serious damage to the bastion, the Babel-facing façade, the traders’ warehouses and other buildings. This study describes the project that the military engineer Leandro Badarán carried out in 1794 in order to technically improve this canal and examines his report on the state of the fortifications. Similar works built in Spain are also explained. It also analyses the repeated disputes between the war department and the port throughout these years over finding a technical solution to the problem.
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The primary aims of this survey were to assess household waste management practices; participation in waste diversion practices; knowledge of local waste management politics; willingness to participate in local decision making regarding the development of a local waste processing facility; attitudes and perceptions of waste, waste management policies, and waste management technologies.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014
Morbilidade global das colostomias derivativas temporárias na abordagem cirúrgica do cancro do recto
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014
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A deep, comprehensive and ambitious TTIP should not undermine or otherwise negatively affect the WTO and its signatories. Among other things, this means that trade diversion ought to be minimised and positive spillovers stimulated. The present CEPS Special Report provides some elementary quantification, which helps to understand the economic incentives for third countries to seek regulatory alignment with TTIP results, where relevant, and for which TTIP should be ‘open’. It focuses on ‘indirect’ spillovers and employs a rather aggregate economic approach. We find that, of three groups of countries that are important for trade with the EU and the US, the ‘closest’ neighbours (NAFTA, EEA, Switzerland and Turkey) exhibit powerful incentives to align so as to benefit from positive spillovers. This is less clear for two other groups. Of the (seven) ‘biggest traders’ (in manufactured goods, for which spillovers matter most), China turns out to have the greatest interest in alignment in selected sectors, followed by Israel, Japan and South Korea. Whereas the latter three either have or are negotiating FTAs with the US and the EU, precisely China has none and remains outside TPP as well. In terms of sectors, the chemical sector followed by electronic equipment are by far the most important, with agro-products and fish as a good third (SPS issues). However, in chemicals and electrical equipment, the TTIP negotiations so far, and recent US/EU regulatory cooperation, do not indicate an ambitious approach, which could reduce regulatory barriers to market access drastically.
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Unlike some previous EU enlargements (e.g. with the UK and with Spain/Portugal) the present EU enlargement to Central Europe has not prompted much, let alone a fierce, debate about the external dimension. This BEEP briefing discusses the main economic aspects of the external dimension, in particular whether there is a threat of (how much) trade diversion. Attention is paid to the three main topics of interest for third countries: industrial trade effects, impact on FDI and agricultural trade effects. Agriculture is arguably the most sensitive of the three, given the very high CAP border protection, and although large-scale trade diversion may eventually occur under certain scenarios (such as an unreformed CAP), these fears are greatly exaggerated in the short to medium term (5-7 years): the time frame considered is therefore all-important. This conclusion becomes less surprising if one takes a closer look at the current sorry state of agriculture in the CEECs. Separate sections treat the somewhat sensitive subject of U.S.-CEEC Bilateral Investment Treaties, as well as the longterm development perspective, which addresses the prospects for catch-up growth by the accession countries. In the end, non-European stakeholders in the accession process will greatly benefit from sustained catch-up growth by the CEECs, which are locking-in deep reforms due to EU accession.
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The EU began railway reform in earnest around the turn of the century. Two ‘railway packages’ have meanwhile been adopted amounting to a series of directives and a third package has been proposed. A range of complementary initiatives has been undertaken or is underway. This BEEP Briefing inspects the main economic aspects of EU rail reform. After highlighting the dramatic loss of market share of rail since the 1960s, the case for reform is argued to rest on three arguments: the need for greater competitiveness of rail, promoting the (market driven) diversion of road haulage to rail as a step towards sustainable mobility in Europe, and an end to the disproportional claims on public budgets of Member States. The core of the paper deals respectively with market failures in rail and in the internal market for rail services; the complex economic issues underlying vertical separation (unbundling) and pricing options; and the methods, potential and problems of introducing competition in rail freight and in passenger services. Market failures in the rail sector are several (natural monopoly, economies of density, safety and asymmetries of information), exacerbated by no less than 7 technical and legal barriers precluding the practical operation of an internal rail market. The EU choice to opt for vertical unbundling (with benefits similar in nature as in other network industries e.g. preventing opaque cross-subsidisation and greater cost revelation) risks the emergence of considerable coordination costs. The adoption of marginal cost pricing is problematic on economic grounds (drawbacks include arbitrary cost allocation rules in the presence of large economies of scope and relatively large common costs; a non-optimal incentive system, holding back the growth of freight services; possibly anti-competitive effects of two-part tariffs). Without further detailed harmonisation, it may also lead to many different systems in Member States, causing even greater distortions. Insofar as freight could develop into a competitive market, a combination of Ramsey pricing (given the incentive for service providers to keep market share) and price ceilings based on stand-alone costs might be superior in terms of competition, market growth and regulatory oversight. The incipient cooperative approach for path coordination and allocation is welcome but likely to be seriously insufficient. The arguments to introduce competition, notably in freight, are valuable and many e.g. optimal cross-border services, quality differentiation as well as general quality improvement, larger scale for cost recovery and a decrease of rent seeking. Nevertheless, it is not correct to argue for the introduction of competition in rail tout court. It depends on the size of the market and on removing a host of barriers; it requires careful PSO definition and costing; also, coordination failures ought to be pre-empted. On the other hand, reform and competition cannot and should not be assessed in a static perspective. Conduct and cost structures will change with reform. Infrastructure and investment in technology are known to generate enormous potential for cost savings, especially when coupled with the EU interoperability programme. All this dynamism may well help to induce entry and further enlarge the (net) welfare gains from EU railway reform. The paper ends with a few pointers for the way forward in EU rail reform.
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BACKGROUND Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function. METHODS This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion. Patients were randomized to receive either a G5K (G5K group) solution or a Ringer's maleate solution (control group). Fluid management aimed for a zero fluid balance. Primary endpoint was time to first defecation. Secondary endpoints were time to normal GI function, need for electrolyte substitution, and renal dysfunction. RESULTS Time to first defecation was not significantly different between groups (G5K group, 93 h [19 to 168 h] and control group, 120 h [43 to 241 h]); estimator of the group difference, -16 (95% CI, -38 to 6); P = 0.173. Return of normal GI function occurred faster in the G5K group than in the control group (median, 138 h [range, 54 to 262 h] vs. 169 h [108 to 318 h]); estimator of the group difference, -38 (95% CI, -74 to -12); P = 0.004. Potassium and magnesium were less frequently substituted in the G5K group (13.6 vs. 54.5% [P = 0.010] and 18.2 vs. 77.3% [P < 0.001]), respectively. The incidence of renal dysfunction (Risk, Injury, Failure, Loss and End-stage kidney disease stage "risk") at discharge was 9.1% in the G5K group and 4.5% in the control group; P = 1.000. CONCLUSIONS Perioperative administration of a G5K did not enhance first defecation, but may accelerate recovery of normal GI function, and reduces potassium and magnesium substitution after radical cystectomy and urinary diversion.
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"March 1993."
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"October 1993."
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"March 1993."