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

Molecular Typing of Mastitis-Causing Staphylococcus aureus Isolated from Heifers and Cows

Staphylococcus aureus is among the main etiologic agents of bovine mastitis. A total of 83 isolates of S. aureus from mammary glands of primiparous heifers were collected in the prepartum, calving and during lactation. For lactating cows, a total of 27 isolates of S. aureus from mammary glands were collected during lactation. The samples were taken in two dairy farms located in Sao Paulo State, Brazil. The highest frequency of S. aureus isolation in heifers was at the end of lactation. Strains were typified through Pulsed-field gel electrophoresis (PFGE) and grouped according to patterns of restriction enzyme SmaI. PFGE generated seven clonal profiles that were grouped into three different lineages, with the LA lineage being predominant and identified in heifers, as well as in the cows from the two regions studied. It was concluded that the cows showed a significant source of dispersion of S. aureus. At the first lactation the heifers were infected by the same clonal profiles of S. aureus which were isolated from multiparous lactating cows. The heifers were infected during milking over the months of lactation

Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation

ABSTRACT Background Cardiac risk stratification is related to the risk of the occurrence of events induced by exercise. Despite the existence of several protocols to calculate risk stratification, studies indicating that there is similarity between these protocols are still unknown. Objective To evaluate the agreement between the existing protocols on cardiac risk rating in cardiac patients. Method The records of 50 patients from a cardiac rehabilitation program were analyzed, from which the following information was extracted: age, sex, weight, height, clinical diagnosis, medical history, risk factors, associated diseases, and the results from the most recent laboratory and complementary tests performed. This information was used for risk stratification of the patients in the protocols of the American College of Sports Medicine, the Brazilian Society of Cardiology, the American Heart Association, the protocol designed by Frederic J. Pashkow, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Société Française de Cardiologie, and the Sociedad Española de Cardiología. Descriptive statistics were used to characterize the sample and the analysis of agreement between the protocols was calculated using the Kappa coefficient. Differences were considered with a significance level of 5%. Results Of the 21 analyses of agreement, 12 were considered significant between the protocols used for risk classification, with nine classified as moderate and three as low. No agreements were classified as excellent. Different proportions were observed in each risk category, with significant differences between the protocols for all risk categories. Conclusion The agreements between the protocols were considered low and moderate and the risk proportions differed between protocols

Oficina de expressão no Projeto Rondon em Marianópolis do Tocantins : um relato de experiência

Expressão é a exteriorização dos pensamentos e dos sentimentos por meio da comunicação. A comunicação é o processo de interação no qual compartilhamos mensagens, através de gestos ou palavras, podendo influenciar o comportamento de outros, que reagem a partir de suas crenças, histórias de vida e cultura. Neste sentido, a Oficina de Expressão, uma ação realizada pela equipe da Universidade Federal do Rio Grande do Sul (UFRGS), na cidade de Marianópolis do Tocantins, na Operação Tocantins, durante o Projeto Rondon, no período de janeiro e fevereiro de 2017, objetivou propiciar, dentro de uma perspectiva de educação emancipatória e através de uma abordagem sensível e lúdica, um espaço para exercer a liberdade de expressão por meio de práticas de comunicação, ao passo que propunha questionamentos sobre os limites das ações, onde o espaço e os direitos de outrem sejam respeitados. A oficina teve duração de uma hora e 30 minutos e contou com 20 estudantes, jovens e adolescentes. O presente artigo é um relato de experiência da Oficina de Expressão, a partir dos olhares de rondonistas da UFRGS, expondo o porquê e a forma como ela foi planejada, a sua execução e os seus desdobramentos.Expression is the externalization of thoughts and feelings through communication. Communication is the process of interaction in which we share messages, through gestures or words, and it can influence the behavior of others, who react based on their beliefs, life histories and culture. In this sense, the Workshop of Expression, an action carried out by the team from the Federal University of Rio Grande do Sul (UFRGS), in the city of Marianópolis do Tocantins, in the Operation Tocantins, during the Rondon Project, in January and February 2017, aimed at providing, within a perspective of emancipatory education and through a sensitive and playful approach, a space to exercise freedom of expression through communication practices, while proposing questions about the limits of actions, where space and rights are respected. The workshop lasted one hour and 30 minutes and had 20 students, young people and adolescents. The present article is an experience report of the Expression Workshop, based on the views of the UFRGS ‘rondonistas, explaining why and how it was planned, its execution and its development