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

Música pós-minimalista em cena: uma análise do uso de trance 4 em Closet monster

The movie Closet Monster, written and directed by Stephen Dunn and consi-dered one of the top ten Canadian movies of 2015 by the Toronto International Film Festival (TIFF), is heavily influenced by queer cinema and uses music as a fundamental element to characterize the protagonist, follow the plot, and give a meaning to the film that would not be the same without it. This paper focuses on a scene near the end of the movie (71’32”-75’43”) that uses the post-mi-nimalist music piece, Trance 4 (1995), by American composer Michael Gordon and performed by the band Icebreaker. Based on the short, this paper offers an analysis that aims to highlight the track’s contribution to the composition of the scene and to discuss the mutual influence of musical and visual languages, both located in trends with certain characteristics — namely queer cinema and post-minimalism, respectively. To that end, the analysis shifts between concepts such as musivisual language, synchronization points, and musical post-minima-lism. The paper opens with some thoughts about post-minimalist music, queer cinema, and the protagonists of Trance, by way of contextualization, followed by an exploration of the Closet Monster scene, set to the track “Trance 4.” To con-clude, the paper emphasizes the role of music in the composition of the scene. With this paper, we seek to contribute to broadening the debate on the use of post-minimalist music in queer cinemaO filme Closet Monster, escrito e dirigido por Stephen Dunn, considerado um dos dez melhores filmes canadenses do ano 2015 pelo Toronto International Film Festival (TIFF), apresenta fortes influências do cinema queer e utiliza a música como elemento funda-mental para caracterizar o protagonista, acompanhar a trama e conceder à obra um sentido que não seria o mesmo sem ela. Este artigo foca-se em uma cena próxima ao desenlace do filme (71’32”-75’43”), que se serve da peça musical pós-minimalista Trance 4, concebida em 1995 pelo compositor americano Michael Gordon e interpreta-da pelo grupo musical Icebreaker.. Desse recorte, emerge uma análise que tem como objetivos distinguir a contribuição da peça na composição da cena e discutir a influência mútua das linguagens musical e visual, ambas localizadas em tendências com carac-terísticas determinadas, quais sejam o cinema queer e o pós-minimalismo, respecti-vamente. Para tanto, a análise transita entre conceitos como linguagem musivisual, pontos de sincronização e pós-minimalismo musical. O artigo inicia com considerações sobre música pós-minimalista, cinema queer e os protagonistas de Trance, à guisa de contextualização, seguidas pela exploração da cena fílmica de Closet Monster, am-bientada pela faixa musical Trance 4. Como conclusão, ressalta-se o papel da música na composição da cena. Pretende-se contribuir com este artigo para a ampliação dos debates sobre o uso de música pós-minimalista no cinema queer.La película Closet Monster, escrita y dirigida por Stephen Dunn, considerada uno de las diez mejores películas canadienses de 2015 por el Toronto International Film Festival (TIFF), presenta fuertes influencias del cine queer y utiliza la música como elemento fundamental para caracterizar al protagonista, seguir la trama y darle a la obra un significado que no sería el mismo sin ella. Este artículo se enfoca en una es-cena cerca al desenlace de la película (71’32”-75’43”), que hace uso de la obra musi-cal postminimalista, Trance 4, concebida en 1995 por el compositor estadounidense Michael Gordon e interpretada por el grupo musical Icebreaker. De este corto surge un análisis que pretende distinguir el aporte de la obra en la composición de la esce-na y discutir la influencia mutua de los lenguajes musical y visual, ambos ubicados en tendencias con determinadas características, que son el cine queer y el posmini-malismo, respectivamente. Para tal fin, el análisis se mueve entre conceptos como el lenguaje musivisual, los puntos de sincronización y el post-minimalismo musical. El artículo empieza con algunas consideraciones sobre la música post-minimalista, el cine queer y los protagonistas de Trance, a modo de contextualización, seguida de la exploración de la escena cinematográfica Closet Monster, ambientada por la pista Trance 4. Como conclusión, se resalta el papel de la música en la composición de la escena. Con este artículo, se busca contribuir para ampliar los debates sobre el uso de música postminimalista en el cine queer

LT‐Brazil: a database of leaf traits across biomes and vegetation types in Brazil

Motivation Leaf traits represent an important component of plant functional strategies, and those related to carbon fixation and nutrient acquisition form the leaf economics spectrum. However, observations of functional leaf traits are underrepresented in tropical regions in comparison with those in temperate areas. Brazil, a country with continental scale and vast biodiversity is a timely example, where many biomes are impacted by human activities and climate change. However, leaf traits relevant to understand vegetation responses to these impacts remain poorly quantified for many species found in the country. We compiled an extensive data set of four functional leaf traits for native woody species occurring in the Brazilian territory. In addition to trait observations, sampling dates and geo-references were compiled and climatic parameters and soil properties of each sampling site were extracted from several databases. Main types of variables contained The LT-Brazil data set contains 3,479, 1,216, 775 and 775 clean observations of leaf mass per area, leaf nitrogen (N) concentration per unit mass, leaf phosphorus (P) concentration per unit mass, and leaf N : P ratio, respectively, from native woody species, encompassing information of biome, vegetation, taxonomic data, geographical coordinates, climatic parameters, as well as soil properties. Spatial location and grain We compiled trait observations from 223 sites under native vegetation distributed in all main biomes (i.e., Amazônia, Caatinga, Cerrado, Mata Atlântica, Pampa and Pantanal) across the Brazilian territory. Time period and grain The data represent information published and/or sampled during the last 25 years. Major taxa and level of measurement Our compilation was focused on trait data observed for native woody species, excluding monocots, palm trees, herbs, and hemiparasitic plants. Thus, 108, 478 and 1,321 botanical families, genera and species were included, covering c. 9% of the woody angiosperm flora of Brazil. Software format Data are provided as comma-separated value (.csv) files

Resumos em andamento - Educação

Resumos em andamento - Educaçã

Resumos em andamento - Educação

Resumos em andamento - Educaçã