Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Ecology and adaptations of the tiger beetle Pentacomia egregia (Chaudoir) (Cicindelinae: Carabidae) to Central Amazonian floodplains.

The diurnal soil-dwelling cicindelid species Pentacomia egregia (Chaud.) inhabits Central Amazonian inundation forests. Adults pass the aquatic phase of several months duration on tree trunks. Experiments under simulated flood conditions with young beetles in climate-controlled chambers and in natural climatic conditions showed: (1) males have a shorter life span than females, (2) the mean temperature of the air influences gonad development in females but not in males, males will even copulate with immature females; (3) the presence of soil prevents gonad dormancy in females and continuous oviposition is observed. Results suggest, that the availability of soil is the primary or proximate (eco)factor which induces a rapid maturation of gonads and subsequent oviposition in females. The mean temperature of the air induces gonad dormancy and enhances longevity in females during inundation. It apparently has evolved as a cue for an adaptation to survive inundation as an ultimate factor. An increase in the mean ambient air temperature is correlated with seasonal changes in the water-level of the Solimões-Amazon River and the general climate in Central Amazoni

On ecology, life history and survival strategies of a wing- dimorphic ground beetle (Col.: Carabidae: Odacanthini: Colliuris) inhabiting Central Amazonian inundation forests.

The discovery of a lowland Amazonian wing-dimorphic carabid species, colliuris batesi Chaudoir, prompted a complete study of its biology and behaviour over a period of more than 4 years. Studies were made on development, fecundity, gonad development, life span and habitat shifts. Survival strategies and possible adaptations are examined with respect to seasonal flooding of their habitat. It is proposed that evolution of brachyptery in this species is rather recent in origin because macropterous specimens are widespread across the upper Amazon Basin, and because the only body change associated with short wings has been narrowing of the humeri

On ecology, life history and survival strategies of a wing-dimorphic ground beetle (col.: carabidae: odacanthini: Colliuris) inhabiting central amazonian inundation forests

The discovery of a lowland Amazonian wing-dimorphic carabid species, Colliuris batesi Chaudoir, prompted a complete study of its biology and behaviour over a period of more than 4 years. Studies were made on development, fecundity, gonad development, life span and habitat shifts. Survival strategies and possible adaptations are examined with respect to seasonal flooding of their habitat. It is proposed that evolution of brachyptery in this species is rather recent in origin because inacropterous specimens are widespread across the upper Amazon Basin, and because the only body change associated with short wings has been narrowing of the humeri. © Swets & Zeitlinger

On occurrence, habitat specificity and natural history of adult tiger beetles (Coleoptera: Carabidae: Cicindelinae) near Manaus, Central Amazonia, and key to the larvae of tiger beetle genera

Over a seven year period from 1991 to 1997, 22 species of tiger beetles, representing nine genera, were recorded near Manaus, Brazil. In the whitewater floodplains along the Rio Solimoes-Amazonas (Ilha de Marchantaria), three diurnal species inhabit inundation forests and six species (two diurnal, four nocturnal) live in open areas. Data on their natural history and adaptation to living conditions in floodplains are presented. Fifteen species were located on non-flooded uplands (Reserva Florestal A. Ducke). Five diurnal species inhabit the forest floor, two species are canopy dwellers, and eight species (seven diurnal, one nocturnal) live in open areas on whitesand or laterite. Only one species, Pentacomia lacordairei, was found in both floodplain and upland forests. A key to the larvae of tiger beetle genera located near Manaus is presented

Social cognitive skills and social information processing in children with mild to borderline intellectual disabilities. Journal of Intellectual Disability Research, 56, 673

<div><p>Due to recent large outbreaks, peanuts have been considered a product of potential risk for <i>Salmonella</i>. Usually, peanut products show a low water activity (a_w) and high fat content, which contribute to increasing the thermal resistance and survival of <i>Salmonella</i>. This study evaluated the long-term kinetics of <i>Salmonella</i> survival on different peanut products under storage at 28°C for 420 days. Samples of raw in-shell peanuts (a_w = 0.29), roasted peanuts (a_w = 0.39), unblanched peanut kernel (a_w = 0.54), peanut brittle (a_w = 0.30), <i>paçoca</i> (a_w = 0.40) and <i>pé-de-moça</i> (a_w = 0.68) were inoculated with <i>Salmonella</i> Typhimurium ATCC 14028 at two inoculum levels (3 and 6 log cfu/ g). The <i>Salmonella</i> behavior was influenced (p<0.05) by a_w, lipid, carbohydrate and protein content. In most cases for both inoculum levels, the greatest reductions were seen after the first two weeks of storage, followed by a slower decline phase. The lowest reductions were verified in <i>paçoca</i> and roasted peanuts, with counts of 1.01 and 0.87 log cfu/ g at low inoculum level and 2.53 and 3.82 log cfu/ g at high inoculum level at the end of the storage time. The highest loss of viability was observed in <i>pé-de-moça</i>, with absence of <i>Salmonella</i> in 10-g after 180 days at low inoculum level. The Weibull model provided a suitable fit to the data (R²≥0.81), with δ value ranging from 0.06 to 49.75 days. Therefore, the results demonstrated that <i>Salmonella</i> survives longer in peanut products, beyond the shelf life (>420 days), especially in products with a_w around 0.40.</p></div