868 resultados para Case reports


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Life Cycle Assessment (LCA) is a chain-oriented tool to evaluate the environment performance of products focussing on the entire life cycle of these products: from the extraction of resources, via manufacturing and use, to the final processing of the disposed products. Through all these stages consumption of resources and pollutant releases to air, water, soil are identified and quantified in Life Cycle Inventory (LCI) analysis. Subsequently to the LCI phase follows the Life Cycle Impact Assessment (LCIA) phase; that has the purpose to convert resource consumptions and pollutant releases in environmental impacts. The LCIA aims to model and to evaluate environmental issues, called impact categories. Several reports emphasises the importance of LCA in the field of ENMs. The ENMs offer enormous potential for the development of new products and application. There are however unanswered questions about the impacts of ENMs on human health and the environment. In the last decade the increasing production, use and consumption of nanoproducts, with a consequent release into the environment, has accentuated the obligation to ensure that potential risks are adequately understood to protect both human health and environment. Due to its holistic and comprehensive assessment, LCA is an essential tool evaluate, understand and manage the environmental and health effects of nanotechnology. The evaluation of health and environmental impacts of nanotechnologies, throughout the whole of their life-cycle by using LCA methodology. This is due to the lack of knowledge in relation to risk assessment. In fact, to date, the knowledge on human and environmental exposure to nanomaterials, such ENPs is limited. This bottleneck is reflected into LCA where characterisation models and consequently characterisation factors for ENPs are missed. The PhD project aims to assess limitations and challenges of the freshwater aquatic ecotoxicity potential evaluation in LCIA phase for ENPs and in particular nanoparticles as n-TiO2.

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Hypokalemia is a recognized cause of rhabdomyolysis but very few reports document its association with inborn renal tubular disorders. We report our experience with hypokalemic rhabdomyolysis in 5 pediatric patients affected by inborn renal tubular disorders and the results of a careful review of the literature disclosing 9 further cases for a total of 14 patients (8 male and 6 female subjects, aged between 1.6 and 46, median 16 years). The inborn renal tubular disorders underlying rhabdomyolysis were classic distal renal tubular acidosis (n = 7), Gitelman syndrome (n = 5), classic Bartter syndrome (n = 1), and antenatal Bartter syndrome (n = 1). In 8 patients rhabdomyolysis followed an acute intestinal disease, an upper respiratory illness or the discontinuation of regular medication. Five patients experienced two or more episodes of rhabdomyolysis. In 10 patients the underlying renal tubular disorder was recognized concurrently with the episode of rhabdomyolysis or some weeks later. In conclusion some congenital renal tubular disorders predispose to hypokalemic rhabdomyolysis. Prevention of discontinuation of regular medication and electrolyte repair in the context of acute intercurrent illnesses might avoid the development of hypokalemic rhabdomyolysis.

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Clinical-forensic examination of strangulation victims is an increasing part of the routine of many forensic pathology institutes. The cases examined between 2004 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In total, the study material comprised 218 victims (175 females and 43 males). In 80.7 %, the clinical-forensic examination was performed within 24 hours after the incident. In the overwhelming number of cases, the alleged perpetrator was no stranger. 128 victims (58.7 %) had strangulation marks, 32 victims (14.7 %) ligature marks and 65 victims (29.8 %) nail marks. Four victims showed injuries of the laryngeal and pharyngeal structures (reddening, hematomas, swelling and in one case a fracture of the cricoid cartilage on both sides). Extensive petechiae were predominantly seen in the conjunctivae, the buccal mucosa and the skin of the face in cases where the victims suffered a loss of consciousness. 87 cases (39.9% were classified as potentially life-threatening and 30 cases (13.8 %) as acute life-threatening events. This classification is of legal relevance for the penalty. In addition, 60 victims experienced sexual violence. These results suggest that early clinical-forensic examination is crucial for documenting forensic evidence in support of police investigations and may deliver significant details relevant in court.

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In an effort to understand some of the ways that accountability-based reform efforts have influenced teacher education, this article details the politics of accountability in Pennsylvania that motivated sweeping changes in the policies governing teacher preparation in 2006. This case study provides a poignant example of the kind of complex accountability systems now being constructed across the United States in an effort to change teacher preparation. By analyzing primary documents including the legal statutes governing teacher preparation in Pennsylvania, correspondence from the Pennsylvania Department of Education, related newsletters, memos, reports, transcripts of meetings, and testimony before the Pennsylvania House of Representatives, the complex nature of the conflicts underlying the development and implementation of teacher education reform is brought into focus. The study's findings suggest that a deep and uncritical acceptance of accountability-based teacher education reform on the part of educational policy makers is likely to do more harm than good. The article concludes by outlining a framework for developing more intelligent measures of accountability that might preserve professional autonomy and judgment.

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It is well known that the treatment protocols for hematopoetic neoplasms carry a high risk of long-term oncogenicity. However, few reports have been published of sarcomas as secondary malignancies. An unusual case report of a soft tissue sarcoma appearing as a secondary cancer is presented, with a review of the published data. The present report involves a soft tissue sarcoma of the neck that occurred 18 years after curative treatment of acute myeloid leukemia by induction chemotherapy and bone marrow transplantation. Consecutive graft-versus-host disease affected the cervical skin. Soft tissue sarcomas appearing as secondary tumors are rare in oncology. The presented case describes the appearance of a sarcoma 18 years after curative treatment of acute myeloid leukemia. This is only the second case of this type reported in published studies.

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Management of homozygous familial hypercholesterolaemia is notoriously difficult. For these patients, LDL apheresis is considered the treatment of choice. Treatment initiation is advocated generally from the age of seven years onwards (Thompson et al., Atherosclerosis 198:247-255, 2008). Here, we present the case of a young girl from a large inbred family of Turkish descent with homozygous familial hypercholesterolaemia and fatal outcome at the early age of 4(1/2) years.In conclusion, this case suggests that management of homozygous familial hypercholesterolaemia may require earlier and more aggressive treatment, including LDL apheresis before the age of seven years.

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BACKGROUND: Endovascular therapy is a rapidly expanding option for the treatment of patients with peripheral arterial disease (PAD), leading to a myriad of published studies reporting on various revascularization strategies. However, these reports are often difficult to interpret and compare because they do not utilize uniform clinical endpoint definitions. Moreover, few of these studies describe clinical outcomes from a patients' perspective. METHODS AND RESULTS: The DEFINE Group is a collaborative effort of an ad-hoc multidisciplinary team from various specialties involved in peripheral arterial disease therapy in Europe and the United States. DEFINE's goal was to arrive at a broad based consensus for baseline and endpoint definitions in peripheral endovascular revascularization trials for chronic lower limb ischemia. In this project, which started in 2006, the individual team members reviewed the existing pertinent literature. Following this, a series of telephone conferences and face-to-face meetings were held to agree upon definitions. Input was also obtained from regulatory (United States Food and Drug Administration) and industry (device manufacturers with an interest in peripheral endovascular revascularization) stakeholders, respectively. The efforts resulted in the current document containing proposed baseline and endpoint definitions in chronic lower limb PAD. Although the consensus has inevitably included certain arbitrary choices and compromises, adherence to these proposed standard definitions would provide consistency across future trials, thereby facilitating evaluation of clinical effectiveness and safety of various endovascular revascularization techniques. CONCLUSION: This current document is based on a broad based consensus involving relevant stakeholders from the medical community, industry and regulatory bodies. It is proposed that the consensus document may have value for study design of future clinical trials in chronic lower limb ischemia as well as for regulatory purposes.

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Forested wetlands throughout the world are valuable habitats; especially in relatively species-poor northern regions, they can be considered biological hotspots. Unfortunately, these areas have been degraded and destroyed. In recent years, however, the biological importance of wetlands has been increasingly recognized, resulting in the desire to restore disturbed habitats or create in place of destroyed ones. Restoration work is taking place across the globe in a diversity of wetland types, and research must be conducted to determine successful techniques. As a result, two studies of the effects of wetland restoration and creation were conducted in forested wetlands in northern Michigan and southern Finland. In North America, northern white-cedar wetlands have been declining in area, despite attempts to regenerate them. Improved methods for successfully establishing northern white-cedar are needed; as a result, the target of the first study was to determine if creating microtopography could be beneficial for white-cedar recruitment and growth. In northern Europe, spruce swamp forests have become a threatened ecosystem due to extensive drainage for forestry. As part of the restoration of these habitats, i.e. rewetting through ditch blocking, Sphagnum mosses are considered to be a critical element to re-establish, and an in-depth analysis of how Sphagnum is responding to restoration in spruce swamp forests has not been previously done. As a result, the aim of the second study was to investigate the ecophysiological functioning of Sphagnum and feather mosses across a gradient of pristine, drained, and restored boreal spruce swamp forests.

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As environmental problems became more complex, policy and regulatory decisions become far more difficult to make. The use of science has become an important practice in the decision making process of many federal agencies. Many different types of scientific information are used to make decisions within the EPA, with computer models becoming especially important. Environmental models are used throughout the EPA in a variety of contexts and their predictive capacity has become highly valued in decision making. The main focus of this research is to examine the EPA’s Council for Regulatory Modeling (CREM) as a case study in addressing science issues, particularly models, in government agencies. Specifically, the goal was to answer the following questions: What is the history of the CREM and how can this information shed light on the process of science policy implementation? What were the goals of implementing the CREM? Were these goals reached and how have they changed? What have been the impediments that the CREM has faced and why did these impediments occur? The three main sources of information for this research came from observations during summer employment with the CREM, document review and supplemental interviews with CREM participants and other members of the modeling community. Examining a history of modeling at the EPA, as well as a history of the CREM, provides insight into the many challenges that are faced when implementing science policy and science policy programs. After examining the many impediments that the CREM has faced in implementing modeling policies, it was clear that the impediments fall into two separate categories, classic and paradoxical. The classic impediments include the more standard impediments to science policy implementation that might be found in any regulatory environment, such as lack of resources and changes in administration. Paradoxical impediments are cyclical in nature, with no clear solution, such as balancing top-down versus bottom-up initiatives and coping with differing perceptions. These impediments, when not properly addressed, severely hinder the ability for organizations to successfully implement science policy.

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A major deficiency in disaster management plans is the assumption that pre-disaster civil-society does not have the capacity to respond effectively during crises. Following from this assumption a dominant emergency management strategy is to replace weak civil-society organizations with specialized disaster organizations that are often either military or Para-military and seek to centralize decision-making. Many criticisms have been made of this approach, but few specifically addresses disasters in the developing world. Disasters in the developing world present unique problems not seen in the developed world because they often occur in the context of compromised governments, and marginalized populations. In this context it is often community members themselves who possess the greatest capacity to respond to disasters. This paper focuses on the capacity of community groups to respond to disaster in a small town in rural Guatemala. Key informant interviews and ethnographic observations are used to reconstruct the community response to the disaster instigated by Hurricane Stan (2005) in the municipality of Tectitán in the Huehuetenango department. The interviews were analyzed using techniques adapted from grounded theory to construct a narrative of the events, and identify themes in the community’s disaster behavior. These themes are used to critique the emergency management plans advocated by the Guatemalan National Coordination for the Reduction of Disasters (CONRED). This paper argues that CONRED uncritically adopts emergency management strategies that do not account for the local realities in communities throughout Guatemala. The response in Tectitán was characterized by the formation of new organizations, whose actions and leadership structure were derived from “normal” or routine life. It was found that pre-existing social networks were resilient and easily re-oriented meet the novel needs of a crisis. New or emergent groups that formed during the disaster utilized social capital accrued by routine collective behavior, and employed organizational strategies derived from “normal” community relations. Based on the effectiveness of this response CONRED could improve its emergency planning on the local-level by utilizing the pre-existing community organizations rather than insisting that new disaster-specific organizations be formed.

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Fuelwood is a major resource in rural areas. Fuelwood collection and consumption habits were monitored in Lupeta, Tanzania through household interviews and fuelwood collection walks. Social dimensions, economic aspects of fuelwood, and alternative fuel sources were also examined. The study found that for all wealth classes, fuelwood is the primary source of fuel used within the village, with the middle and upper classes occasionally supplementing fuelwood with charcoal. Women collect and consume fuelwood for cooking. The majority of women (69%) prefer to use charcoal because fuelwood collection is labor intensive and time consuming. While the use of charcoal would provide more time for other required household activities, local economic constraints inhibit their adoption. The fuel shift from biomass fuels to transition fuels is happening slowly in Lupeta from fuelwood to charcoal. As fuelwood becomes scarcer, improved methods will need to be adopted or the fuel source will change.

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Worldwide, rural populations are far less likely to have access to clean drinking water than are urban ones. In many developing countries, the current approach to rural water supply uses a model of demand-driven, community-managed water systems. In Suriname, South America rural populations have limited access to improved water supplies; community-managed water supply systems have been installed in several rural communities by nongovernmental organizations as part of the solution. To date, there has been no review of the performance of these water supply systems. This report presents the results of an investigation of three rural water supply systems constructed in Saramaka villages in the interior of Suriname. The investigation used a combination of qualitative and quantitative methods, coupled with ethnographic information, to construct a comprehensive overview of these water systems. This overview includes the water use of the communities, the current status of the water supply systems, histories and sustainability of the water supply projects, technical reviews, and community perceptions. From this overview, factors important to the sustainability of these water systems were identified. Community water supply systems are engineered solutions that operate through social cooperation. The results from this investigation show that technical adequacy is the first and most critical factor for long-term sustainability of a water system. It also shows that technical adequacy is dependent on the appropriateness of the engineering design for the social, cultural, and natural setting in which it takes place. The complex relationships between technical adequacy, community support, and the involvement of women play important roles in the success of water supply projects. Addressing these factors during the project process and taking advantage of alternative water resources may increase the supply of improved drinking water to rural communities.

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Small-scale village woodlots of less than 0.5ha are the preferred use of land for local farmers with extra land in the village of Isangati, a small community located in the southern highlands of Tanzania. Farmers view woodlots as lucrative investments that do not involve intensive labor or time. The climate is ideal for the types of trees grown and the risks are minimal with no serious threats from insects, fires, thieves, or grazing livestock. It was hypothesized that small-scale village woodlot owners were not maximizing timber outputs with their current timber stand management and harvesting techniques. Personal interviews were conducted over a five month period and field data was collected at each farmer’s woodlots over a seven month period. Woodlot field data included woodlot size, number of trees, tree species, tree height, dbh, age, and spacing. The results indicated that the lack of proper woodlot management techniques results in failure to fully capitalize on the investment of woodlots. While farmers should continue with their current harvesting rotations, some of the reasons for not maximizing tree growth include close spacing (2m x 2m), no tree thinning, extreme pruning (60% of tree), and little to no weeding. Through education and hands-on woodlot management workshops, the farmers could increase their timber output and value of woodlots.

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Ensuring water is safe at source and point-of-use is important in areas of the world where drinking water is collected from communal supplies. This report describes a study in rural Mali to determine the appropriateness of assumptions common among development organizations that drinking water will remain safe at point-of-use if collected from a safe (improved) source. Water was collected from ten sources (borehole wells with hand pumps, and hand-dug wells) and forty-five households using water from each source type. Water quality was evaluated seasonally (quarterly) for levels of total coliform, E.coli, and turbidity. Microbial testing was done using the 3M Petrifilm™ method. Turbidity testing was done using a turbidity tube. Microbial testing results were analyzed using statistical tests including Kruskal-Wallis, Mann Whitney, and analysis of variance. Results show that water from hand pumps did not contain total coliform or E.coli and had turbidity under 5 NTUs, whereas water from dug wells had high levels of bacteria and turbidity. However water at point-of-use (household) from hand pumps showed microbial contamination - at times being indistinguishable from households using dug wells - indicating a decline in water quality from source to point-of-use. Chemical treatment at point-of-use is suggested as an appropriate solution to eliminating any post-source contamination. Additionally, it is recommended that future work be done to modify existing water development strategies to consider water quality at point-of-use.

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Public participation is an important component of Michigan’s Part 632 Nonferrous Mining law and is identified by researchers as important to decision-making processes. The Kennecott Eagle Project, which is located near Marquette, Michigan, is the first mine permitted under Michigan’s new mining regulation, and this research examines how public participation is structured in regulations, how the permitting process occurred during the permitting of the Eagle Project, and how participants in the permitting process perceived their participation. To understand these issues, this research implemented a review of existing mining policy and public participation policy literature, examination of documents related to the Kennecott Eagle Project and completion of semi-structured, ethnographic interviews with participants in the decision-making process. Interviewees identified issues with the structure of participation, the technical nature of the permitting process, concerns about the Michigan Department of Environmental Quality’s (DEQ) handling of mine permitting, and trust among participants. This research found that the permitting of the Kennecott Eagle Mine progressed as structured by regulation and collected technical input on the mine permit application, but did not meet the expectations of some participants who opposed the project. Findings from this research indicated that current mining regulation in Michigan is resilient to public opposition, there is need for more transparency from the Michigan DEQ during the permitting process, and current participatory structures limit the opportunities for some stakeholder groups to influence decision-making.