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

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Comparing the establishment of an invasive and an endemic palm species in the Atlantic rainforest

Background: Biological invasions are one of the major causes of biodiversity loss, yet remain rather understudied in tropical environments. The Australian palm tree Archontophoenix cunninghamiana was introduced into Brazil for ornamental purposes, but has become an invasive species in urban and suburban forest patches. The substitution of A. cunninghamiana by the native palm Euterpe edulis has been proposed as a management action. Aims: We aimed to evaluate the regeneration potential of these two palm species in an Atlantic forest remnant in south-eastern Brazil where both species occur. Methods: We compared seedling establishment and seed longevity of both species through seed sowing, and also measured the contribution of A. cunninghamiana to the local seed rain and seed bank. Results: Nearly half of the non-anemochoric diaspores collected from the seed rain belonged to A. cunninghamiana, which represented a high propagule pressure in the community. The distribution of the alien palm seeds in the seed rain correlated with the distribution of nearby young and adult individuals inside the forest. Neither A. cunninghamiana nor E. edulis appeared to have a persistent seed bank in a burial experiment; seedling survival experiments suggested a much better performance for A. cunninghamiana, which had a survival rate of ca. 30% compared with a rate of only 3.5% for E. edulis. Conclusions: The results suggest a higher regeneration capacity for the alien palm over the native species when co-occurring in a forest fragment. Management actions are thus proposed to reduce a potential biological invasion process.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo) [proc. 2008/56015-8]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Luminescence Property of Perovskite Structure

The photoluminescence property (PL) is a desired property for materials and the luminescence of perovskite type compounds have been known for a long time. This property was first identified to crystalline perovskite and it has only been recently identified in structurally disordered perovskite. In this work, we present a study about photoluminescence of structural disordered perovskite-structured compounds. There will be a special focus on the PL emission of titanates and zirconates: the main representants of these materials class. It will be discussed the origin of PL emission in these compounds. In addition, it will be related rare earth ion-doped structural disordered perovskite and PL emission