The governance of E-waste recycling networks: Insights from São Paulo City.

Electronic waste is an environmental problem because its production volume exceeds its recycling capacity. Academic and managerial production affirm two reasons: (a) dominant market logic and; (b) unresolved asymmetries among actors, causing conflicts to work together. Following the qualitative methodology, we investigate the e-waste situation in São Paulo City. The results allow us to propose that governance constructed by local actors could be a thoughtful way to promote e-waste recycling. Examples from around the world sustain this proposition. The theoretical principle is that the social process of constructing the mechanisms for collective action can solve challenges because the rules, roles, and actions are discussed and assumed by the actors working together. We present a matrix of indicators to be used in future studies in order to refine the proposition of constructed governance.

De "bandido" a "trabalhador": um estudo sobre a relação dos jovens com o trabalho a partir das medidas socioeducativas / From "criminal" to "worker": a study on the relationship of young people with work from socio-educational measure

O artigo apresenta os resultados de uma pesquisa realizada com jovens autores de atos infracionais no município de Belo Horizonte (MG). Adentrando a temática relativa ao eixo profissionalização, proposto pelas medidas socioeducativas, seu objetivo foi o de compreender o sentido que o trabalho assume para o jovem, considerando sua vivência anterior no trabalho informal e frequentemente ilícito, e sua nova experiência com as atividades propostas no contexto das medidas. A partir desse eixo norteador, tenta-se apreender melhor as categorizações sociais "trabalhadores" formais e "bandidos", considerando as mudanças ocorridas a partir da formação do jovem e sua inserção no mundo do trabalho formal. Os dados foram coletados por meio de entrevistas coletivas e individuais, sendo que estas últimas permitiram a elaboração de dois estudos de caso, escolhidos para serem expostos no artigo como forma de ilustração das novas perspectivas descobertas pelo jovem a partir de sua inserção em um projeto socioeducativo. Os resultados permitiram desvelar os sentidos atribuídos à categoria trabalho nos períodos anterior e posterior ao acautelamento, revelando que os sujeitos tendem a considerar como trabalho apenas as atividades lícitas que exerceram.

The article presents the results of a research performed with young people who committed infractions in the city of Belo Horizonte (MG). Entering the theme related to the professionalization axis proposed by social-educational measure, this study aimed to understand the meaning the work assumes for young people, considering their previous experience in informal - and often illicit - work and their new experience with the proposed activities in the context of the measures. From this guiding axis, we try to better understand the social categorizations of formal "workers" and "criminals", considering the changes that have occurred since the formation of the young person and their insertion in the world of formal work. Data were collected through collective and individual interviews, and the latter allowed the elaboration of two case studies chosen to be exposed in this article as a way of illustrating the new perspectives discovered by the young people from their insertion in a social-educational project. The results allowed to reveal the meanings attributed to the work category in the periods before and after the caution, revealing that the subjects tend to consider work only the licit activities they have practiced.

Influência dos Hipnóticos no bloqueio neuromuscular produzido pelo cisatracúrio: emprego da aceleromiografia / Influence of hypnotics on cisatracurium-induced neuromuscular block: use of acceleromyograhpy / Influencia de los hipnóticos en el bloqueo neuromuscular producido por el cisatracurio: uso de la aceleromiografía

JUSTIFICATIVA E OBJETIVOS: Os efeitos farmacodinâmicos dos bloqueadores neuromusculares (BNM) podem ser influenciados por diferentes drogas, entre elas os hipnóticos. O objetivo deste estudo foi avaliar a influência do propofol e do etomidato sobre o bloqueio neuromuscular produzido pelo cisatracúrio. MÉTODO: Foram incluídos 60 pacientes, ASA I e II, submetidos a cirurgias eletivas sob anestesia geral, distribuídos aleatoriamente em dois grupos de acordo com o hipnótico empregado: GI (propofol) e GII (etomidato). As pacientes receberam midazolam (0,1 mg.kg-1) por via muscular como medicação pré-anestésica, a indução foi com propofol (2,5 mg.kg-1) ou etomidato (0,3 mg.kg-1) precedido de fentanil (250 µg) e seguido de cisatracúrio (0,1 mg.kg-1). Os pacientes foram ventilados com oxigênio a 100% até a obtenção de redução de 95% ou mais na amplitude da resposta do adutor do polegar, quando foi feita a laringoscopia e a intubação traqueal. A função neuromuscular foi monitorizada com aceleromiografia. Avaliaram-se o início de ação do cisatracúrio, as condições de intubação traqueal e as repercussões hemodinâmicas. RESULTADOS: Os tempos médios e os desvios padrão para o início de ação do cisatracúrio foram: GI (86,6 ± 14,3") e GII (116,9 ± 11,6"), com diferença significativa (p < 0,0001). As condições de intubação traqueal foram aceitáveis em 100% dos pacientes do GI e em 53,3% no GII (p < 0,0001). CONCLUSÕES: A instalação do bloqueio neuromuscular com o cisatracúrio foi mais rápida e as condições de intubação traqueal foram melhores nos pacientes que receberam propofol em relação ao grupo que recebeu etomidato, sem repercussões hemodinâmicas.

BACKGROUND AND OBJECTIVE: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. METHOD: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1 mg.kg-1) as premedication and we performed induction with propofol (2.5 mg.kg-1) or etomidate (0.3 mg.kg-1), preceded by fentanyl (250 mg) and followed by cisatracurium (0.1 mg.kg-1). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. RESULTS: The mean time and standard deviations of cisatracurium onset were: GI (86.6 ± 14.3 s) and GII (116.9 ± 11.6 s), with a significant difference (p < 0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p < 0.0001). CONCLUSION: Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions.

JUSTIFICATIVA Y OBJETIVOS: Los efectos farmacodinámicos de los bloqueantes neuromusculares (BNM) pueden estar influenciados por diferentes fármacos, entre ellos los hipnóticos. El objetivo de este estudio, fue evaluar la influencia del propofol y del etomidato sobre el bloqueo neuromuscular producido por el cisatracurio. MÉTODO: Se incluyeron en el estudio 60 pacientes, con ASA I y II, sometidos a cirugías electivas bajo anestesia general, distribuidos aleatoriamente en dos grupos de acuerdo con el hipnótico usado: GI (propofol) y GII (etomidato). Las pacientes recibieron midazolam (0,1 mg.kg-1) por vía muscular como medicación preanestésica, la inducción fue con propofol (2,5 mg.kg-1) o etomidato (0,3 mg.kg-1) precedido de fentanilo (250 µg) y seguido de cisatracurio (0,1 mg.kg-1). Los pacientes fueron ventilados con oxígeno al 100% hasta la obtención de la reducción de un 95% o más en la amplitud de la respuesta del aductor del pulgar cuando se hizo la laringoscopia y la intubación traqueal. La función neuromuscular fue monitorizada con aceleromiografía. Se evaluaron el inicio de acción del cisatracurio, las condiciones de intubación traqueal y las repercusiones hemodinámicas. RESULTADOS: Los tiempos promedios y las desviaciones estándar para el inicio de acción del cisatracurio fueron: GI (86,6 ± 14,3") y GII (116,9 ± 11,6"), con una diferencia significativa (p < 0,0001). Las condiciones de intubación traqueal fueron aceptables en un 100% de los pacientes del GI y en 53,3% en el GII (p < 0,0001). CONCLUSIONES: La instalación del bloqueo neuromuscular con el cisatracurio fue más rápida y las condiciones de intubación traqueal fueron mejores en los pacientes que recibieron propofol con relación al grupo que recibió etomidato, sin repercusiones hemodinámicas.

Influence of hypnotics on cisatracurium-induced neuromuscular block. Use of acceleromyograhpy.

BACKGROUND AND OBJECTIVE: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. METHOD: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1mg.kg(-1)) as premedication and we performed induction with propofol (2.5mg.kg(-1)) or etomidate (0.3mg.kg(1)), preceded by fentanyl (250mg) and followed by cisatracurium (0.1mg.kg(-1)). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. RESULTS: The mean time and standard deviations of cisatracurium onset were: GI (86.6±14.3s) and GII (116.9±11.6s), with a significant difference (p<0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p<0.0001). CONCLUSION: Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions.

Evaluation of exhaled nitric oxide in patients undergoing myocardial revascularization with cardiopulmonary bypass.

BACKGROUND AND OBJECTIVES: Cardiopulmonary bypass (CPB) can cause pulmonary dysfunction. Inflammatory changes may affect the release of nitric oxide (NO). The objective of this study was to evaluate exhaled NO in patients undergoing myocardial revascularization (MR) with CPB. METHODS: This is a prospective study with nine adult patients undergoing MR with CPB. Initially, air samples were collected to analyze the presence of NO in the system that feeds the anesthesia equipment. Intravenous anesthesia was then initiated with ethomidate (0.3 mg x kg-1), sufentanil (0.3 microg x kg-1), and pancuronium (0.08 mg x kg-1), and maintained with isoflurane (MAC from 0.5 to 1.0) and sufentanil (5 microg x kg-1 x h-1). Tidal volume was fixed at 8 mL.kg-1 and FiO2 0.6, except during CPB. Thirty minutes after induction and 30 minutes after CPB, three sequential samples of exhaled air were collected for NO analysis by chemiluminescence. Data were analyzed by the Student t test. RESULTS: The level of NO in room air was 5.05 +/- 3.37 ppb. Levels of exhaled NO decreased after CPB, varying from 11.25 +/- 5.65 ppb to 8.37 +/- 3.71 ppb (p = 0.031). CONCLUSIONS: The reduction of exhaled NO after CPB observed in this study does not confirm the role of this molecule as a marker of pulmonary lesion. However, the different degrees of pulmonary parenchymal collapse, the method used to collect the data, and the drugs, among others, could have contributed for this reduction.

Avaliação do óxido nítrico exalado em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea / Evaluation of exhaled nitric oxide in patients undergoing myocardial revascularization with cardiopulmonary bypass / Evaluación del óxido nítrico exhalado en pacientes sometidos a la revascularización del miocardio con circulación extracorpórea

JUSTIFICATIVA E OBJETIVOS: A circulação extracorpórea (CEC) pode causar disfunção pulmonar. As alterações inflamatórias podem afetar a liberação de óxido nítrico (NO). Objetivou-se avaliar o NO exalado em pacientes submetidos à revascularização do miocárdio (RM) com CEC. MÉTODO:Foram estudados prospectivamente nove pacientes adultos submetidos à RM com CEC. Inicialmente, foi coletada amostra de ar para análise de NO no sistema que alimenta o aparelho de anestesia. A seguir, anestesia iniciada por via venosa com etomidato (0,3 mg.kg-1), sufentanil (0,3 µg.kg-1), pancurônio (0,08 mg.kg-1) e mantida com isoflurano (0,5 a 1,0 CAM) e sufentanil (0,5 µg.kg-1.h-1). O volume corrente fixado a 8 mL.kg-1, com FIO2 de 0,6, exceto durante a CEC. Trinta minutos depois da indução, e trinta após a CEC, três amostras sequenciais de ar exalado foram colhidas para análise de NO, por quimioluminescência. Os dados foram analisados por meio do teste t de Student. RESULTADOS: O valor do NO do ar ambiente foi de 5,05 ± 3,37 ppb. O NO exalado decresceu após a CEC, variando de 11,25 ± 5,65 ppb para 8,37 ± 3,17 ppb (p = 0,031). CONCLUSÕES: A redução do NO exalado pós-CEC observada nesse estudo não permite confirmar o papel dessa molécula como marcador de lesão pulmonar. Entretanto, os variados graus de colapso do parênquima pulmonar, o método de obtenção dos dados, os fármacos utilizados, dentre outros, podem ter contribuído para a redução.

BACKGROUND AND OBJECTIVES: Cardiopulmonary bypass (CPB) can cause pulmonary dysfunction. Inflammatory changes may affect the release of nitric oxide (NO). The objective of this study was to evaluate exhaled NO in patients undergoing myocardial revascularization (MR) with CPB. METHODS: This is a prospective study with nine adult patients undergoing MR with CPB. Initially, air samples were collected to analyze the presence of NO in the system that feeds the anesthesia equipment. Intravenous anesthesia was then initiated with ethomidate (0.3 mg.kg-1), sufentanil (0.3 µg.kg-1), and pancuronium (0.08 mg.kg-1), and maintained with isoflurane (MAC from 0.5 to 1.0) and sufentanil (5 µg.kg-1.h-1). Tidal volume was fixed at 8 mL.kg-1 and FiO2 0.6, except during CPB. Thirty minutes after induction and 30 minutes after CPB, three sequential samples of exhaled air were collected for NO analysis by chemiluminescence. Data were analyzed by the Student t test. RESULTS: The level of NO in room air was 5.05 ± 3.37 ppb. Levels of exhaled NO decreased after CPB, varying from 11.25 ± 5.65 ppb to 8.37 ± 3.71 ppb (p = 0.031). CONCLUSIONS: The reduction of exhaled NO after CPB observed in this study does not confirm the role of this molecule as a marker of pulmonary lesion. However, the different degrees of pulmonary parenchymal collapse, the method used to collect the data, and the drugs, among others, could have contributed for this reduction.

JUSTIFICATIVA Y OBJETIVOS: La circulación extracorpórea (CEC), puede causar una disfunción pulmonar. Las alteraciones inflamatorias pueden afectar la liberación de óxido nítrico (NO). Se buscó evaluar el NO exhalado en pacientes sometidos a la revascularización del miocardio (RM) con CEC. MÉTODO: Se estudiaron prospectivamente nueve pacientes adultos sometidos a la RM con CEC. Inicialmente fue recolectada una muestra de aire para el análisis de NO en el sistema que alimenta el aparato de anestesia. A continuación, se inició la anestesia por vía venosa con etomidato (0,3 mg.kg-1), sufentanil (0,3 µg.kg-1), pancuronio (0,08 mg.kg-1) y se mantiene con isoflurano (0,5 a 1,0 CAM) y sufentanil (0,5 µg.kg-1.h-1). El volumen corriente fijado fue 8 mL.kg-1, con FiO2 de 0,6 excepto durante la CEC. Treinta minutos después de la inducción y treinta minutos después de la CEC, tres muestras secuenciales de aire exhalado fueron recogidas para análisis de NO, por quimioluminescencia. Los datos fueron analizados por medio del test t Student. RESULTADOS: El valor del NO del aire ambiente fue de 5,05 ± 3,37 ppmm. El NO exhalado se redujo después de la CEC, variando de 11,25 ± 5,65 ppmm para 8,37 ± 3,17 ppmm (p = 0,031). CONCLUSIONES: La reducción del NO exhalado pos-CEC, observada en este estudio, no permite confirmar el papel de esta molécula como marcador de lesión pulmonar. Sin embargo, los variados grados de colapso del parénquima pulmonar, el método de obtención de los datos, y los fármacos utilizados, entre otros, pueden haber contribuido para esa reducción.