Development of esophageal hypersensitivity following experimental duodenal acidification

OBJECTIVES: As visceral afferents from different regions of the gastrointestinal tract converge at the level of the spinal cord, we hypothesized that sensitization of one gut organ would induce visceral hypersensitivity in another gut organ, remote to the sensitizing stimulus. METHODS: Protocol 1: Eight healthy male volunteers, age 30 +/- 8.2 yr, underwent three studies on different days. Esophageal pain thresholds (PT) were recorded at 10-min intervals prior to and for 2 h following a 30-min duodenal infusion of either 0.15 M hydrochloric acid (HCl), saline, or no infusion. Five subjects repeated the study to demonstrate reproducibility. Protocol 2: Esophageal evoked potentials (EEP) were studied in six subjects on two occasions prior to and 1 h after a 30-min duodenal infusion of 0.15 M HCl or saline. RESULTS: Protocol 1: After acid infusion, there were reproducible reductions in esophageal PT (ICC = 0.88), which were maximal at 110 min (15.05 +/- 2.25 mA) (p < 0.002). Following saline infusion there was an increase in esophageal PT (ICC = 0.71), which was similar to the no-infusion condition (6.21 +/- 1.54 mA vs 8.5 + 7.6 mA; p > 0.05). Protocol 2: Esophageal sensation scores increased (p= 0.02) after acid, but not after saline infusion (p= 0.1). A comparison of the latencies of EEP components prior to and following acid and saline infusion revealed a reduction in the N1 (p= 0.02) and P2 components (p= 0.04). CONCLUSION: This study provides the first objective evidence that duodenal acidification can induce esophageal hypersensitivity associated with changes in sensitivity of the central visceral pain pathway. As the esophagus was remote from the sensitizing stimulus, central sensitization of spinal dorsal horn neurons is likely to have contributed to these changes.

Central neural mechanisms mediating human visceral hypersensitivity

Although visceral hypersensitivity is thought to be important in generating symptoms in functional gastrointestinal disorders, the neural mechanisms involved are poorly understood. We recently showed that central sensitization (hyperexcitability of spinal cord sensory neurones) may play an important role. In this study, we demonstrate that after a 30-min infusion of 0.15 M HCl acid into the healthy human distal esophagus, we see a reduction in the pain threshold to electrical stimulation of the non-acid-exposed proximal esophagus (9.6 ± 2.4 mA) and a concurrent reduction in the latency of the N1 and P2 components of the esophageal evoked potentials (EEP) from this region (10.4 ± 2.3 and 15.8 ± 5.3 ms, respectively). This reduced EEP latency indicates a central increase in afferent pathway velocity and therefore suggests that hyperexcitability within the central visceral pain pathway contributes to the hypersensitivity within the proximal, non-acid-exposed esophagus (secondary hyperalgesia/allodynia). These findings provide the first electrophysiological evidence that central sensitization contributes to human visceral hypersensitivity.

Does expert psychological testimony improve juror sensitivity to lineup suggestiveness?

Previous research has examined the validity of behavioral assumptions underlying the presumed effectiveness of safeguards against erroneous conviction resulting from mistaken eyewitness identification. In keeping with this agenda, this study examined juror sensitivity to lineup suggestiveness in the form of foil, instruction, and presentation biases and whether expert psychological testimony further sensitizes jurors to the factors that influence the likelihood of false identifications. One hundred and sixty jury eligible citizens watched versions of a videotaped trial that included information about the identification of the defendant by an eyewitness and that varied the suggestiveness of the eyewitness identification procedure. In addition, half of the mock-jurors heard the testimony of an expert psychologist regarding the factors that influence lineup suggestiveness. Mock-jurors rendered individual verdicts, rated the defendant's culpability and the suggestiveness and fairness of the identification procedure. Results indicated that jurors are somewhat sensitive to foil bias but are insensitive to instruction and presentation biases. No evidence was found to suggest that expert testimony leads to juror skepticism or juror sensitization. These results question the effectiveness of cross-examination and expert testimony as safeguards against erroneous convictions resulting from mistaken identification. ^

Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India

Background While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations. Methods A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery. Results Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery. Conclusion The results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.

Aspects Allogenic Memory in the Gorgonian Coral Swiftia Exserta

Accelerated graft rejection can be used to determine immune memory in the gorgonian coral swiftia exserta. The extent ofthe persistence of immune memory will be determined in this experiment using replicate sets that are time elapsed from 1, 3, and 6 month. Although corals lack circulatory systems which can be a component of adaptive systemic immunity, this study will attempt to determine whether this gorgonian coral is capable of transmitting immune information throughout its colonial body. Results showed that at each of the time points; one, three, and six months the secondary response group and the primary response group were significantly different (at p=0.001) therefore, demonstrating long term immune memory. While the primary response group and the 3rd party specificity response group were similar, both were significantly different (at p=O. 001) from the secondary response group which shows the response to be specific, with memory applicable to the original antigen. Systemic immunity was not determined to be present for 15 em and one week after initial sensitization.

Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Percepção ambiental como ferramenta diagnóstica para o processo de integração entre uma unidade de conservação e a comunidade do entorno

It is remarkable the current planet’s situation of degradation and modification of natural assets and the considerable loss of the recovery power inherent to the ecosystems. Concomitant with this, all communities and species are suffering the consequences of these changes without planning. The creation of conservation units (UCs) through the National System of Conservation Units (SNUC) was a concrete action on the deliberateness of halting these processes, which, on the other hand, generated socio-environmental, geo-economical and cultural-political conflict of interests between traditional communities in the vicinity of these units, institutions, governmental entities and society in general. The country’s National Program of Environmental Education (ProNEA) provides the integration of the communities and UCs’ managers in a co-participative administration to solve these conflicts. The principles of Environmental Education (EA) leads the methodology found to change the socio-educational paradigms of traditional teaching, still existing in our society and intrinsically related to environmental problems, which are contrary to the dialogic pedagogy from Paulo Freire, that valorize popular knowledge, pro-active citizenship, as well as contrary to Ecopedagogy, that re-integrate human being on its natural environment, the Earth. One of the tools for starting environmental sensitization is the diagnosis by environmental perception of individuals. In this context, the objective of our work was to identify the environmental perception of Tenda do Moreno community located nearby Pau Furado State Park (PEPF) in Uberlândia – MG. To reach this objective, the research sought, in a first moment, to evaluate the environmental perception of residents of this community through semi-structured interviews applied in their homes and, in a second moment, we evaluated the environmental perception of community’ school students and made Environmental Education intervention activities with the intention to make children aware of the importance of conservation and function of PEPF. Using the Content analysis methodology, we found in nearly 60% of the 118 residents a systemic perception of nature, while approximately 32% expressed an anthropocentric perception. Mixed perceptions were found in 21%. A considerable part of the residents (47 individuals) indicated not knowing the park, although many of them recognize its importance. Among the 46 interviewed students, half expressed an anthropocentric perception of nature, while almost 36% had a systemic view. Seventeen children said they did not know the park and almost half of the students recognize some aspect of the importance of its existence. During the intervention activities, we had huge participation and dedication of students, beyond the massive expression of their personal views and daily experiences. In relation to the ten students that subjected the second evaluation about their environmental perception after the intervention, 80% showed systemic perception and emphasized the importance of conservation and of park. We believe that the continuity of the intervention activities could generate positive perspectives of socio-environmental effective changes in the daily school. Activities lead by Ecopedagogy and that encourage the citizen leadership in the young students are fundamental, while in the community, closer ties and dialog by UC’s managers would be important elements to generate effective change.

The role of inflammatory mediators in the overactive and bladder pain syndromes

The Overactive Bladder (OAB) and Bladder Pain Syndrome (BPS) are debilitating disorders for which the pathophysiological mechanisms are poorly understood. Injury or dysfunction of the protective urothelial barrier layer, specifically the proteoglycan composition and number, has been proposed as the primary pathological characteristic of BPS. For OAB, the myogenic theory with dysfunction of the muscarinic receptors is the most reiterated hypothesis. For both over activity of the inflammatory response has been posited to play a major role in these diseases. We hypothesise that BPS and OAB are peripheral sensory disorders, with an increase in inflammatory mediators, such as cytokines and chemokines, which are capable of activating, either directly or indirectly, sensory nerve activity causing the disease. The aim of the PhD is to identify potential new therapeutic targets for the treatment of BPS and OAB. We used medium throughput quantitative gene expression analysis of 96 inflammation associated mediators to measure gene expression levels in BPS and OAB bladder biopsies and compared them to control samples. Then we created a novel animal model of disease by specific proteoglycan deglycosylation of the bladder mucosal barrier, using the bacterial enzymes Chondroitinase ABC and Heparanase III. These enzymes specifically remove the glycosaminoglycan side chains from the urothelial proteoglycan molecules. We tested role of the identified mediators in this animal model. In addition, in order to determine on which patients peripheral treatment strategies may work, we assessed the effect of local anaesthetics on patients with bladder pain. Gene expression analysis did not reveal a difference in inflammatory genes in the OAB versus control biopsies. However, several genes were upregulated in BPS versus control samples, from which two genes, FGF7 and CLL21 were correlated with patient clinical phenotypes for ICS/PI symptom and problem indices respectively. In order to determine which patients are likely to respond to treatment, we sought to characterise the bladder pain in BPS patients. Using urodynamics and local anaesthetics, we differentiated patients with peripherally mediated pain and patients with central sensitisation of their pain. Finally to determine the role of these mediators in bladder pain, we created an animal model of disease, which specifically replicates the human pathology: namely disruption in the barrier proteoglycan molecules. CCL21 led to an increase in painrelated behaviour, while FGF7 attenuated this behaviour, as measured by cystometry, spinal c-fos expression and mechanical withdrawal threshold examination. In conclusion, we have identified CCL21 and FGF7 as potential targets for the treatment of BPS. Manipulation of these ligands or their receptors may prove to be valuable previously unexploited targets for the treatment of BPS.

Temporomandibular joint pain: a critical role for Trpv4 in the trigeminal ganglion.

Temporomandibular joint disorder (TMJD) is known for its mastication-associated pain. TMJD is medically relevant because of its prevalence, severity, chronicity, the therapy-refractoriness of its pain, and its largely elusive pathogenesis. Against this background, we sought to investigate the pathogenetic contributions of the calcium-permeable TRPV4 ion channel, robustly expressed in the trigeminal ganglion sensory neurons, to TMJ inflammation and pain behavior. We demonstrate here that TRPV4 is critical for TMJ-inflammation-evoked pain behavior in mice and that trigeminal ganglion pronociceptive changes are TRPV4-dependent. As a quantitative metric, bite force was recorded as evidence of masticatory sensitization, in keeping with human translational studies. In Trpv4(-/-) mice with TMJ inflammation, attenuation of bite force was significantly less than in wildtype (WT) mice. Similar effects were seen with systemic application of a specific TRPV4 inhibitor. TMJ inflammation and mandibular bony changes were apparent after injections of complete Freund adjuvant but were remarkably independent of the Trpv4 genotype. It was intriguing that, as a result of TMJ inflammation, WT mice exhibited significant upregulation of TRPV4 and phosphorylated extracellular-signal-regulated kinase (ERK) in TMJ-innervating trigeminal sensory neurons, which were absent in Trpv4(-/-) mice. Mice with genetically-impaired MEK/ERK phosphorylation in neurons showed resistance to reduction of bite force similar to that of Trpv4(-/-) mice. Thus, TRPV4 is necessary for masticatory sensitization in TMJ inflammation and probably functions upstream of MEK/ERK phosphorylation in trigeminal ganglion sensory neurons in vivo. TRPV4 therefore represents a novel pronociceptive target in TMJ inflammation and should be considered a target of interest in human TMJD.

The ins of the striatum: Utilizing chemogenetics to define the contribution of cortical and thalamic afferents during addiction behaviors

Thesis (Ph.D.)--University of Washington, 2016-08

Contact dermatitis from shoes: an update

Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. There are two forms of contact dermatitis: irritant and allergic. Irritant contact dermatitis is caused by the non–immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis is a delayed hypersensitivity reaction in which a foreign substance comes into contact with the skin; skin changes occur after reexposure to the substance. A medical condition referred to as “shoe dermatitis” is a form of contact dermatitis caused by the contact of the foot with parts of the shoe due to these materials. Shoe dermatitis is a diagnostic and therapeutic challenge and is a common type of contact dermatitis. It is imperative the foot and ankle physician become familiar with recognizing signs and symptoms of shoe dermatitis so that their patients can be accurately diagnosis and appropriately treated to avoid secondary infections and disability. This review will first present causative factors for the etiology of shoe contact dermatitis supported by clinical-based evidence as found in the medical literature. Secondly, a description of the signs and symptoms of shoe contact dermatitis will be presented in a narrative fashion. Finally, both treatment options and preventative measures to avoid shoe.

Plano de ação para a sustentabilidade energética do Município de Vale de Cambra

O crescimento exponencial da população mundial que assentou essencialmente na utilização de combustíveis fósseis e o facto de aproximadamente ¾ da população mundial viver em cidades, criou uma situação insustentável de emissões de CO2 para a atmosfera. No sentido de minimizar e tentar reverter este comportamento a União Europeia criou o programa Pacto dos Autarcas, que visa o comprometimento de um território em reduzir as suas emissões de CO2 em, pelo menos, 20% até 2020, através do chamado Plano de Ação. O presente trabalho pretende desenvolver um possível Plano de Ação para a Sustentabilidade Energética para o município de Vale de Cambra. Da realização da matriz energética para este município foi inventariado o consumo de 47.154 tep e respectivas emissões de CO2 associada de 108.084 toneladas, para o ano de referência 2012. Face ao estudo compreendido entre 2002 e 2012 são previstos consumos e emissões na ordem de 54.327 tep e 123.059 toneladas de CO2 respetivamente até 2020 caso não sejam tomadas medidas para inverter essa tendência. Baseado na interpretação da matriz energética criada, propõe-se um conjunto de ações nas áreas da indústria, mobilidade, edifícios, energias renováveis, eficiência energética, governabilização e ainda sensibilização/formação para obter uma redução de 20% das emissões e consumo em 2020, passando para 98.447 toneladas de CO2 emitidas e 43.462 tep respetivamente. Conclui-se que o planeamento energético de um território é de elevada importância porque permite articular vários aspectos, conseguindo aumentar a protecção do ambiente (com a redução de emissões de gases efeito de estufa) e aumentando a eficiência energética do território, aumenta a sua competitividade económica e consequentemente maior oportunidade de investimentos externos, criando mais oportunidades de emprego e bem-estar social.

A educação ambiental e a interdisciplinaridade através da horta : um estudo de caso entre duas escolas da cidade de Rio Grande

O presente estudo de caso tem como objetivo relacionar a Educação Ambiental (EA) aos aspectos multidisciplinares de conteúdos das ciências naturais, tendo por base o tema da “horta escolar” e de sua interpretação por estudantes de duas escolas da cidade do Rio Grande/RS, uma delas situada no contexto urbano, e a outra, no meio rural. Para esta análise, consideramos a Escola Estadual de Ensino Fundamental Dr. Pedro Francisco Bertoni em Domingos Petroline e a Escola Estadual de Ensino Fundamental Barão de Cerro Largo no bairro Centro de nossa cidade. Desse modo, realizamos um debate teórico e analítico da escola enquanto possível instrumento de aprendizagem sobre conteúdos científicos relacionados ao meio ambiente, associada a uma abordagem de natureza participativa e lúdica fundada na sensibilização dos atores envolvidos em seus respectivos cenários.Como procedimento metodológico,foi elaborado um questionário discutindo junto às escolas em reuniões agendadas anteriormente e dúvidas pertinentes às questões propostas foram esclarecidas servindo de base para investigação desta pesquisa, feita com aproximadamente vinte e seis alunos entre as duas escolas.Assim,uma parcela de estudantes de ambas as escolas foram envolvidos na coleta de um grupo de questões objetivas e descritivas relacionadas a temas ambientais do cotidiano, realizando-se posteriormente um estudo comparativo entre as respostas de cada escola considerada conforme as faixas etárias nelas existentes.De um modo geral, as manifestações textuais dos educandos foram agrupadas em diferentes eixos tematizados da seguinte forma: Agricultura Orgânica e Interdisciplinaridade/Ensino de Ciências Naturais/Meio Ambiente.Como resultados, podemos compreender que a horta escolar constitui-se numa potencial “laboratório vivo” que transcende até mesmo os domínios da sala de aula, uma vez que se revela como um sistema ecológico em que há interação dinâmica entre todos os seus elementos constitutivos observados de forma direta pelos alunos: o solo, as plantas, a atmosfera e suas relações. Neste sentido, foi possível apreender o potencial ecológico-educativo que a horta proporciona in loco aos interessados em se aprofundar nos complexos mecanismos da natureza, e assim, um melhor entendimento dos conteúdos estudados nas disciplinas de ciências naturais.

Early allergen exposure and atopic eczema

Background The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen. Objectives To extend the exposure–response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants. Methods A total of 593 children (92Æ4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth. Results By age 8 years, 150 (25Æ3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28Æ0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1Æ37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0Æ66 and 0Æ71) even after controlling for confounding factors. Conclusions The lack of any clear exposure–disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.

Propostas de gestão participativa para o desenvolvimento sustentável dos recursos naturais e biodiversidade de Santa Maria

Os Açores reúnem nove ilhas com singularidades peculiares em termos paisagísticos, arquitetónicos e riqueza dos seus recursos naturais. Este panorama levanta contudo grandes desafios de sustentabilidade, de entre eles a reorientação de estratégias, atendendo à especificidade da região (segundo os objetivos à escala nacional em sede da Estratégia Nacional Desenvolvimento Sustentável (ENDS)). No caso da Ilha de Santa Maria (SMA), pequena ilha em que as estratégias tendem a ser ignoradas, a participação da população e dos dirigentes locais é minorada por interesses económicos desvinculados do desenvolvimento sustentável (DS). Para inverter esta situação é necessário conhecer para preservar, proteger para conservar, planificar e orientar os comportamentos e atitudes visando a sustentabilidade dos recursos naturais (RN) da ilha. Aplicando uma metodologia que conjugou os métodos quantitativos e qualitativos, com uma componente prática, utilizando um método de amostragem não casual dirigida, não probabilística com um método de amostragem por clusters, agrupado em grupos (workshop, séniores e jovens), pretendeu-se descrever os conhecimentos, as práticas e as perceções sobre a gestão dos RN’s, DS e instrumentos de gestão territorial (IGT’s). Os resultados mostram que os conhecimentos, práticas e perceções dos diferentes grupos são insuficientes no que respeita ao conhecimento dos conceitos e dimensões do DS (independentemente das idades ou habilitações literárias), verificando-se contudo melhorias, por vezes significativas, após as ações de sensibilização e educação. É imperativo continuar o esforço de valorização dos RN’s, envolvendo a população nas estratégias de conservação, objetivando uma proposta orientadora e participada numa visão para sustentabilidade da Ilha (SMA). Recomenda-se uma proposta de modelo de Estratégia DS dos recursos naturais e biodiversidade para SMA e diversas propostas de ações para colocar em prática essa estratégia como desenvolvimentos futuros.