RESUMO
The automotive industry has used plastics almost since the beginning. The lightness, flexibility, and many qualities of plastics make them ideal for the automotive industry, reducing cars' overall weight and fuel consumption. Engineering plastics in this industry belong to the high-performance segment of non-renewable resources. These plastics exhibit higher properties than commodity plastics. Fortunately, unlike recycled commodity plastics, the super properties and high-performance characteristics make engineering plastics effectively reused after recycling. The substitution of these fossil-fuel-derived plastics adds to the solution of lightweighting, a much-needed solution to waste management, and solves industrial and ecological issues surrounding plastic disposal. All major vehicle manufacturers worldwide use bioplastics and bio-based plastics, including natural-fiber composites and engineering plastics reinforced with natural fibers. Changing the source of plastics to raw materials from renewable resources is the logical approach to sustainability. Thus, high-quality plastics, recycled plastics, bio-based plastics, and biodegradable plastics could be exploited from design, making sustainability an integral concept of mobility development. This review analyzes that switching from fossil-fuel- to renewable-sources-derived plastics is a step toward meeting the current environmental goals for the automotive industry, including electric cars.
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Resumen El artículo introduce el concepto de las culturas del malgasto público en el marco del estudio de la ineficiencia estatal. Estas culturas engloban comportamientos aprendidos en el trabajo inercial de la administración pública. Utilizando un estudio de caso sobre el malgasto en camionetas blindadas para el Estado, en Colombia, se ilustran las culturas del malgasto. El rol de las narrativas de políticas públicas es crucial para comprender dichas culturas, al sustituir y relegar discusiones técnicas sobre la ineficiencia a un segundo plano, favoreciendo tradiciones institucionales que incluyen el incrementalismo. El artículo contribuye a la literatura interdisciplinaria sobre la ineficiencia estatal, incorporando el rol del storytelling, las narrativas, y los cálculos de costo-efectividad. Resalta, desde el estudio de caso, la necesidad de que la política pública comprenda las complejidades que rodean a las prácticas del gasto público para así mejorarlo.
Resumo O artigo introduz o conceito de culturas do mal gasto público no âmbito do estudo da ineficiência do Estado. Essas culturas abrangem comportamentos aprendidos no trabalho inercial da administração pública. As culturas do mal gasto são ilustradas através de um estudo de caso sobre o mal gasto em compras públicas de carros blindados para o Estado na Colômbia. O papel das narrativas de políticas públicas é crucial para a compreensão dessas culturas, substituindo e relegando as discussões técnicas sobre ineficiência para o segundo plano, favorecendo assim tradições institucionais que incluem o incrementalismo. O artigo contribui para a literatura interdisciplinar sobre a ineficiência do Estado, incorporando o papel do storytelling, das narrativas e dos cálculos de custo-efetividade. Destaca, a partir do estudo de caso, a necessidade de políticas públicas para entender melhor as complexidades que envolvem as práticas de gasto público, a fim de melhorá-o.
Abstract The article introduces the concept of "wasteful public spending cultures" in the framework of state efficiency studies. The concept refers to learned behavioral patterns in the inertial work of government agencies. A case study from Colombia is presented. The study reports practices that lead to the wasteful procurement of armored cars to be used by the government. The role of policy narratives is crucial to understanding these "cultures," as they contribute to replacing and downgrading technical discussions about inefficiency, favoring institutional traditions that include incrementalism. The work contributes to the interdisciplinary body of literature on government inefficiency, as it incorporates the role of storytelling, narratives, and cost-effectiveness calculations. The case study highlights the need to understand the complexity around spending practices in order to improve them.
Assuntos
Política Pública , Administração Pública , Efetividade , Análise Custo-Benefício , Custos e Análise de Custo , Estado , Eficiência , Despesas PúblicasRESUMO
CAR-T cell therapy, as a novel immunotherapy approach, has indicated successful results in the treatment of hematological malignancies; however, distinct results have been achieved regarding solid tumors. Tumor immunosuppressive microenvironment has been identified as the most critical barrier in CAR-T cell therapy of solid tumors. Developing novel strategies to augment the safety and efficacy of CAR-T cells could be useful to overcome the solid tumor hurdles. Similar to other cancer treatments, CAR-T cell therapy can cause some side effects, which can disturb the healthy tissues. In the current review, we will discuss the practical breakthroughs in CAR-T cell therapy using the multi-targeted and programmable CARs instead of conventional types. These superior types of CAR-T cells have been developed to increase the function and safety of T cells in a controllable manner, which would diminish the incidence of relevant side effects. Moreover, we will describe the capability of these powerful CARs in targeting multiple tumor antigens, redirecting the CAR-T cells to specific target cells, incrementing the safety of CARs, and other advantages that lead to promising outcomes in cancer CAR-T cell therapy.
Assuntos
Imunoterapia Adotiva , Neoplasias/terapia , Receptores de Antígenos Quiméricos/uso terapêutico , HumanosRESUMO
Inflammatory myofibroblastic tumor (IMT) is a lesion of intermediate biological potential with local recurrences and rare metastases found in multiple anatomical locations. We present a case of a pure intraarticular IMT of the knee, a location that has not been previously documented, with genetic confirmation of ALK-CARS fusion detected with next-generation sequencing. A 20-year-old healthy male was admitted to the orthopedic oncology department due to several months of pain and restriction in movement of his left knee. On magnetic resonance imaging, multiple intraarticular nodular lesions were seen. The patient underwent 2 synovectomies within the course of 1 year. The initial biopsy was interpreted as nodular fasciitis. The second biopsy revealed exuberant tissue displaying compact fascicles of spindle cells intermixed with myxoid areas in a background of inflammatory cells, highly suggestive for IMT. Due to the unusual intraarticular location, equivocal ALK immunostaining and the differential diagnosis with nodular fasciitis, we performed targeted next-generation sequencing using Archer FusionPlex Sarcoma panel, which can identify multiple fusions in a single assay. An ALK-CARS fusion was found, supporting the diagnosis of IMT. This report emphasizes the added value of broad molecular analysis in cases with unusual clinical presentation, equivocal immunohistochemistry, and a wide differential diagnosis.
Assuntos
Articulação do Joelho/patologia , Proteínas de Fusão Oncogênica/genética , Neoplasias de Tecidos Moles/diagnóstico , Membrana Sinovial/patologia , Aminoacil-tRNA Sintetases/genética , Quinase do Linfoma Anaplásico/genética , Biópsia , Procedimentos Cirúrgicos de Citorredução , Diagnóstico Diferencial , Fasciite/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/imunologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/imunologia , Neoplasias de Tecidos Moles/cirurgia , Sinovectomia , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/imunologia , Adulto JovemRESUMO
Los accidentes de tránsito son un problema de salud pública global. En América Latina, la tasa de mortalidad por accidentes de tránsito en niños es casi el doble que el promedio mundial. Se presenta nuestra experiencia en la formulación de una política pública de seguridad vial infantil en Panamá, basada en la evidencia científica generada por nuestro grupo de investigación. Además, se propone un modelo para la formulación de políticas públicas que podría usarse en otros países latinoamericanos. Se trata de un vector de formulación que es parte del ciclo de las políticas públicas e incluye la identificación de un problema público, la ejecución de la investigación científica, la publicación y la socialización de los productos científicos para la formulación de la política pública con la participación incluyente de los científicos, la sociedad civil y los tomadores de decisiones cuando estos comparten espacios de diálogo.
Road traffic accidents are a global public health problem. In Latin America, the mortality rate among children due to road traffic accidents almost doubles the global average. We describe our experience formulating a public policy on child road safety in Panama, based on the scientific evidence produced by our research group. Moreover, we propose a model for public policy-making that may be used in other Latin American countries. It is a formulation vector that is part of the public policy-making cycle and entails identifying a public problem, conducting scientific research, publishing and disseminating scientific products for public policy-making with the participation of scientists, the civil society, and decision-makers by sharing spaces for dialog.
Assuntos
Humanos , Política Pública , Medidas de Segurança , Medicina Baseada em Evidências , Panamá , Automóveis , Acidentes de Trânsito , Sistemas de Proteção para CriançasRESUMO
Road traffic accidents are a global public health problem. In Latin America, the mortality rate among children due to road traffic accidents almost doubles the global average. We describe our experience formulating a public policy on child road safety in Panama, based on the scientific evidence produced by our research group. Moreover, we propose a model for public policy-making that may be used in other Latin American countries. It is a formulation vector that is part of the public policy-making cycle and entails identifying a public problem, conducting scientific research, publishing and disseminating scientific products for public policy-making with the participation of scientists, the civil society, and decision-makers by sharing spaces for dialog.
Los accidentes de tránsito son un problema de salud pública global. En América Latina, la tasa de mortalidad por accidentes de tránsito en niños es casi el doble que el promedio mundial. Se presenta nuestra experiencia en la formulación de una política pública de seguridad vial infantil en Panamá, basada en la evidencia científica generada por nuestro grupo de investigación. Además, se propone un modelo para la formulación de políticas públicas que podría usarse en otros países latinoamericanos. Se trata de un vector de formulación que es parte del ciclo de las políticas públicas e incluye la identificación de un problema público, la ejecución de la investigación científica, la publicación y la socialización de los productos científicos para la formulación de la política pública con la participación incluyente de los científicos, la sociedad civil y los tomadores de decisiones cuando estos comparten espacios de diálogo.
Assuntos
Acidentes de Trânsito/prevenção & controle , Proteção da Criança , Prática Clínica Baseada em Evidências , Política de Saúde , Segurança , Acidentes de Trânsito/mortalidade , Criança , Humanos , Panamá/epidemiologiaRESUMO
Introducción: las alteraciones en la función ejecutiva, especialmente en flexibilidad cognoscitiva, planeación,control inhibitorio y memoria de trabajo constituyen un elemento cardinal dentro las manifestaciones deltrastorno del espectro autista (TEA).Objetivo: el objetivo de este trabajo fue evaluar el desempeño de las pruebas de función ejecutiva en unapoblación de pacientes con trastorno del espectro autista (TEA).Materiales y métodos: se realizó un estudio observacional en niños de una institución de rehabilitación. Seevaluó el desempeño en las subpruebas de la evaluación neuropsicológica infantil, el puntaje de CARS (ChildhoodAutism Rating Scale) y otras variables, mediante un análisis de correlación de Spearman. El estudio fueaprobado por el Comité de Ética en Investigación y se obtuvo consentimiento de los padres.Resultados: se evaluaron ocho niños con edad promedio de 8,9 años (6,1-13,7) y puntaje CARS entre 32 y 46.Se encontró mejor desempeño en habilidades gráficas y menor fluidez gráfica y verbal y de flexibilidad cognitiva.La edad tuvo correlación directa con el puntaje en memoria de trabajo y con la capacidad de planeación.Un puntaje de CARS alto se correlacionó con bajo rendimiento en flexibilidad cognitiva, memoria de trabajoy fluidez gráfica no semántica.Conclusión: los niños con TEA son susceptibles de presentar alteraciones significativas en tareas relacionadascon las funciones ejecutivas, lo que puede explicar la tendencia a la perseveración, incapacidad de cambio decriterio y conductas estereotipadas. Esta disfunción se correlaciona con la severidad del autismo y varía segúnla edad. Aunque esta alteración no es un fenómeno que se presente exclusivamente en el TEA, constituye unelemento a tener en cuenta al momento de evaluar estos niños.
Introduction: executive function disturbances, especially in cognitive flexibility planning, inhibitory control and working memory constitute a cardinal element within the manifestations of autism spectrum disorder (ASD).Objective: the aim of this research was to evaluate the performance of executive function tests in children with ASD.Materials and methods: an observational study was conducted in children attending a rehabilitation institution. An analysis between the performance of the Childhood Neuropsychological assessment subtests, scores of CARS (Childhood Autism Rating Scale) and other variables was performed by a Spearman correlation test. The study was approved by the Institutional Ethics Committee and parental consent was obtained.Results: we evaluated eight children with a mean age of 8.9 years (min: 6.1, max: 13.7) and CARS score between 32 and 46. Better performance was found in graphical abilities, less in graphical and verbal fluency and in cognitive flexibility. Age was directly correlated with scores on working memory and planning. A high CARS score was correlated with poor performance on cognitive flexibility, working memory and non-semantic graphic fluency.Conclusion: children with ASD are prone to show disturbances in executive functions related tasks which may explain the inflexible adherence to routines, the persistence of stereotypical behaviors and the perseveration observed in ASD patients. This dysfunction correlates with the severity of autism and varies with age. Although this condition is not present exclusively in ASD, it is a factor to consider when evaluating children with autism.
Assuntos
Humanos , Transtorno AutísticoRESUMO
The objective of this study was to describe how the Childhood Autism Rating Scale (CARS) behaves in relation to the Autism Diagnostic Observation Schedule (ADOS) and to clinical diagnosis based on the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition (DSM-IV) for children of immigrant parents. Forty-nine children of parents who had immigrated to Canada were evaluated. In this sample, the ADOS and the DSM-IV showed complete agreement. Using the standard cut-off point of 30, the CARS showed high specificity and poor sensitivity. The study proposes a cut-off point for the CARS that would include pervasive developmental disorder – not otherwise specified (PDD-NOS). Reducing the cut-off point to 20/21 increased the specificity of the instrument for this group of children without significantly reducing its sensitivity.
O objetivo deste estudo é descrever como a Childhood Autism Rating Scale (CARS) se comporta em relação à Autism Diagnostic Observation Schedule (ADOS) e ao diagnóstico clínico baseado nos critérios definidos pelo Manual Diagnóstico e estatístico dos Transtornos Mentais (DSM-IV - 4ª Edição) do em crianças filhas de imigrantes. Foram avaliadas 49 crianças cujos pais imigraram para o Canadá. Nessa amostra os resultados das avaliações pelo ADOS e DSM-IV foram totalmente concordantes. Usando o ponto-de-corte padrão de 30, a CARS mostrou elevada especificidade e baixa sensibilidade. Esse estudo propõe um ponto de corte para a CARS que possa incluir o transtorno invasivo do desenvolvimento não especificado. A redução do ponto de corte para 20/21 aumentou a especificidade do instrumento para esse grupo de crianças, sem reduzir significativamente a sensibilidade.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos Globais do Desenvolvimento Infantil/diagnóstico , Emigrantes e Imigrantes , Inquéritos e Questionários/normas , Canadá , Testes Neuropsicológicos , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica/normas , Valores de Referência , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To investigate differences in sepsis mortality between prepubertal and postpubertal males and females. STUDY DESIGN: This was a retrospective review of the Virtual PICU Systems (VPS) database (including 74 pediatric intensive care units [PICUs]) for 2006-2008. We included prepubertal (aged 2-7 years) and postpubertal (aged 16-21 years) children with a primary diagnosis of sepsis admitted to a participating PICU. RESULTS: Prepubertal females (n = 272; 9.9% mortality) and prepubertal males (n = 303; 10.9% mortality) had similar mortality and severity of illness (Pediatric Index of Mortality 2 risk of mortality [PIM 2 ROM]). Postpubertal females (n = 233; mortality, 5.6%) had lower mortality than postpubertal males (n = 212; mortality, 11.8%; P = .03). PIM 2 ROM was higher for postpubertal males than postpubertal females (P = .02). After controlling for hospital specific effects with multivariate modeling, in postpubertal children, female gender was independently associated with a lower initial severity of illness (PIM 2 ROM: OR, 0.77; 95% CI, 0.62-0.96; P = .02). CONCLUSION: Sepsis mortality is similar in prepubertal males and females. However, postpubertal males have a higher sepsis mortality than postpubertal females, likely related to their greater severity of illness on PICU admission. These outcome differences in postpubertal children may reflect a hormonal influence on the response to infection or differences in underlying comorbidities, source of infection, or behavior.
Assuntos
Mortalidade Hospitalar , Puberdade , Sepse/mortalidade , Índice de Gravidade de Doença , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica , Modelos Lineares , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Introducción: Conducir bajo los efectos del alcohol aumenta el riesgo de sufrir accidentes de tránsito y la tasa de accidentalidad vial tiende a incrementarse. Sin embargo, no es claro en qué grado la presencia de alcohol en la sangre logra desviar al conductor de su carril. Objetivos: Determinar las concentraciones mínimas de alcohol en la sangre que se deben alcanzar para alterar la habilidad de conducción en las personas y definir qué habilidades se ven afectadas con mayor rapidez en la desviación del carril. Método: Revisión sistemática de la literatura en ocho bases de datos. Se limitó a publicaciones de los últimos diez años (1999-2009) y a artículos en los que se hizo la evaluación a través de simuladores y donde se midieron las concentraciones de alcohol en la sangre. Resultados: De todos los subgrupos estudiados es evidente que las personas con algún consumo de alcohol tienden a desviarse más de la línea que las personas que no lo han consumido. Entre los conductores que presentaron alcohol en la sangre, sólo se encontró una pequeña diferencia entre las desviaciones de la línea de aquellos con cifras mayores o menores a 0,05 (0,65 vs. 0,78). Conclusiones: En todos los desenlaces se evidenció que, independientemente de la cantidad de alcohol en la sangre, el haber consumido hace que el conductor tienda a desviarse de su carril. En términos generales se puede decir que la desviación de la línea se convierte en una medida muy sensible al consumo de alcohol...
Introduction: Driving under the influence of alcohol increases the risk of traffic accidents and road accident. However, it is not clear to what extent the presence of alcohol in the blood can divert a driver of the lane. Objectives: To determine the minimum concentration of alcohol in the blood that must be reached to alter the driving ability in people and define what skills are affected more quickly in the deviation of the lane test. Method: Systematic review of the literature in eight databases, limited to publications of the last ten years (1999-2009) and articles in which the assessment was made through simulators and concentrations of alcohol in the blood were measured. Results: Of all the subgroups studied, it is clear that persons with any alcohol consumption tend to drift over the line more than people who have not consumed. Among the drivers who had alcohol in the blood, there was only a slight difference between the deviations from the line of those with levels greater or less than 0.05 (0.65 vs. 0.78). Conclusions: In all the endpoints was demonstrated that, regardless of the amount of alcohol in the blood, a driver with any alcohol use tend to deviate from the lane. Overall we can say that the deviation of the line becomes a very sensitive evidence of alcohol use...