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 cmH2O 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 6430 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 metho

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Measurement of the nuclear modification factor for muons from charm and bottom hadrons in Pb+Pb collisions at 5.02 TeV with the ATLAS detector

Heavy-flavour hadron production provides information about the transport properties and microscopic structure of the quark-gluon plasma created in ultra-relativistic heavy-ion collisions. A measurement of the muons from semileptonic decays of charm and bottom hadrons produced in Pb+Pb and pp collisions at a nucleon-nucleon centre-of-mass energy of 5.02 TeV with the ATLAS detector at the Large Hadron Collider is presented. The Pb+Pb data were collected in 2015 and 2018 with sampled integrated luminosities of 208 mu b(-1) and 38 mu b(-1), respectively, and pp data with a sampled integrated luminosity of 1.17 pb(-1) were collected in 2017. Muons from heavy-flavour semileptonic decays are separated from the light-flavour hadronic background using the momentum imbalance between the inner detector and muon spectrometer measurements, and muons originating from charm and bottom decays are further separated via the muon track's transverse impact parameter. Differential yields in Pb+Pb collisions and differential cross sections in pp collisions for such muons are measured as a function of muon transverse momentum from 4 GeV to 30 GeV in the absolute pseudorapidity interval vertical bar eta vertical bar < 2. Nuclear modification factors for charm and bottom muons are presented as a function of muon transverse momentum in intervals of Pb+Pb collision centrality. The bottom muon results are the most precise measurement of b quark nuclear modification at low transverse momentum where reconstruction of B hadrons is challenging. The measured nuclear modification factors quantify a significant suppression of the yields of muons from decays of charm and bottom hadrons, with stronger effects for muons from charm hadron decays

A search for an unexpected asymmetry in the production of e+μ− and e−μ+ pairs in proton-proton collisions recorded by the ATLAS detector at root s = 13 TeV

This search, a type not previously performed at ATLAS, uses a comparison of the production cross sections for e(+)mu(-) and e(-)mu(+) pairs to constrain physics processes beyond the Standard Model. It uses 139 fb(-1) of proton-proton collision data recorded at root s = 13 TeV at the LHC. Targeting sources of new physics which prefer final states containing e(+)mu(-) and e(-)mu(+), the search contains two broad signal regions which are used to provide model-independent constraints on the ratio of cross sections at the 2% level. The search also has two special selections targeting supersymmetric models and leptoquark signatures. Observations using one of these selections are able to exclude, at 95% confidence level, singly produced smuons with masses up to 640 GeV in a model in which the only other light sparticle is a neutralino when the R-parity-violating coupling lambda(23)(1)' is close to unity. Observations using the other selection exclude scalar leptoquarks with masses below 1880 GeV when g(1R)(eu) = g(1R)(mu c) = 1, at 95% confidence level. The limit on the coupling reduces to g(1R)(eu) = g(1R)(mu c) = 0.46 for a mass of 1420 GeV

Differential cross-section measurements of the production of four charged leptons in association with two jets using the ATLAS detector

Differential cross-sections are measured for the production of four charged leptons in association with two jets. These measurements are sensitive to final states in which the jets are produced via the strong interaction as well as to the purely-electroweak vector boson scattering process. The analysis is performed using proton-proton collision data collected by ATLAS at √s = 13 TeV and with an integrated luminosity of 140 fb−1. The data are corrected for the effects of detector inefficiency and resolution and are compared to state-of-the-art Monte Carlo event generator predictions. The differential cross-sections are used to search for anomalous weak-boson self-interactions that are induced by dimension-six and dimension-eight operators in Standard Model effective field theory

An?lise de sensibilidade do desempenho da sondagem aos par?metros operacionais.

Programa de P?s-Gradua??o em Engenharia Geot?cnica. N?cleo de Geotecnia, Escola de Minas, Universidade Federal de Ouro Preto.Nos dias atuais, com o aumento da competitividade pela busca de mercado, somado ? queda no pre?o da commodity min?rio de ferro, ? fundamental trabalhar com baixo custo operacional. Este trabalho, desenvolvido em um furo de sondagem testemunhada a diamante na mina de Alegria, Complexo Minerador de Mariana, Estado de Minas Gerais, teve como objetivo principal o monitoramento da opera??o de sondagem atrav?s do sistema EDR e o estabelecimento de procedimentos para subsidiar operadores, fiscais de sonda e ge?logos na tomada de decis?es, atrav?s dos par?metros de perfura??o, antes e durante a opera??o de sondagem. Os dados obtidos do acompanhamento deste furo foram compilados e correlacionados com as perfilagens geof?sicas, descri??es geol?gicas e geomec?nicas, boletins de sondagem e fotografias das caixas de testemunhos. Os resultados mostraram que com a implanta??o do EDR poderemos obter ganhos em produtividade, aumento no percentual de recupera??o dos testemunhos, diminui??o no consumo de coroas diamantadas, diminui??o no trancamento de furos, diminui??o no desgaste de hastes e barriletes, controle do fluido de perfura??o, implanta??o de boletim de sondagem eletr?nico, controle de performance e gest?o de equipe. Contudo, somente com execu??o de mais furos monitorados ser? poss?vel criar um padr?o operacional (furos de correla??o) para a otimiza??o do planejamento da opera??o de sondagem.Nowadays increased competition for market share, in addition to the fall in the iron ore price, becomes low operating costs an obligation. This work, developed into a diamond drilled borehole in Alegria mine of the Mariana Complex, Minas Gerais, aimed to monitor the drilling operation through the EDR system and the establishment of procedures to support operators, drill witnesses and geologists in decision-making, through drilling parameters, before and during the drilling operation. The data obtained from the monitoring of this hole were compiled and correlated with the geophysical borehole logging data, geological descriptions, geomechanical properties, coring reports and photographs of core boxes. The results showed that EDR allowed an increase in productivit and recovery of drilling cores, as well as a decrease in bit consumption, hole obstructions, and abrasion of rods and barrels, drilling fluid control, establishment of the electronic drilling report, team management and performance control. The operational system, however, needs a bigger amount of monitored holes to be implemented, allowing parameter definition for a particular target as an optimization process. However, more monitored holes are needed to create an operating pattern for future core drilled holes

Custo-benef?cio do uso de um supressor de poeira aplicado no controle de emiss?es fugitivas de vias de acesso de mina : um estudo na Samarco Minera??o S.A.

Com a inten??o de investigar a viabilidade do uso de um supressor de poeira no controle de emiss?es de poeira fugitiva de vias de acesso em uma mina de min?rio de ferro, foi desenvolvido um estudo por meio de levantamento de campo na ?rea da mina da Samarco Minera??o S.A unidade de Germano em Minas Gerais. Como resultado, demonstrou-se que os valores obtidos para o controle de poeira nos acessos da mina da Samarco, utilizando-se o supressor de poeira, apresentam ganhos financeiros (redu??o de R$167.622,00) e ambientais (n?o emiss?o de 16.621,9 Kg CO2.ano-1 dentre outros). Secundariamente criou-se um roteiro de an?lise para o mapeamento de processos em minera??o voltados para a mina, destacando-se os principais pontos e atividades que merecem aten??o do ponto de vista de emiss?es.Aiming to investigate the feasibility of using dust suppressant for mining dust control, a study was conducted, through field survey, on Samarco Mining Operations, Germano?s site, located in the state of Minas Gerais. Financial and environmental gains, (cost reduction of R$ 167.622,00 and non-emission of 16.621,9 Kg CO2.year-1 respectively, and others) were demonstrated by the study. Secondarily, the study implemented an analysis script to map mining processes, focused on Samarco?s mine, highlighting the main points and activities which deserve attention related to atmospheric emissions, and the major technological alternatives to control those emissions

An?lise do custo de um supressor de poeira aplicado em vias de acesso de mina : um estudo na Samarco Minera??o S.A.

Com a inten??o de investigar a viabilidade do uso de um supressor de poeira no controle de emiss?es de poeira fugitiva de vias de acesso em uma mina de min?rio de ferro, foi desenvolvido um estudo por meio de levantamento de campo na ?rea da mina da Samarco Minera??o S.A unidade de Germano em Minas Gerais. Como resultado, demonstrou-se que os valores obtidos para o controle de poeira nos acessos da mina da Samarco, utilizando-se o supressor de poeira, apresentaram relevantes ganhos financeiros (redu??o de R$167.622,00).Aiming to investigate the feasibility of using dust suppressant for mining dust control, a study was conducted, through field survey, on Samarco Mining Operations, Germano?s site, located in the state of Minas Gerais. Financial gains (cost reduction of R$ 167.622,00) were demonstrated by the study

Maytenus salicifolia Reissek (Celastraceae) : avalia??o da atividade de extratos e constituintes contra Helicobacter pylori e micro-organismos patog?nicos da cavidade oral.

Maytenus salicifolia Reissek ? conhecida como "cafezinho" em Minas Gerais, Brasil. Suas folhas s?o utilizadas na medicina popular no tratamento de ?lceras estomacais. Neste trabalho ? reportado o isolamento de 4?-Ometilepigalocatequina (1) e proantocianidina A (2) dos extratos polares da raiz (1; 4,36%; 2, 2,17%) e tronco (1, 4,16%; 2, 0,26%) de M. salicifolia. Pela primeira vez, esses compostos foram encontrados na raiz dessa esp?cie. Esses constituintes foram encontrados em quantidades expressivas, o que torna M. salicifolia uma fonte alternativa desses compostos. Al?m disto, a atividade antimicrobiana de extratos polares (etan?lico das ra?zes, etan?lico e acetato-et?lico dos galhos) e apolares (hex?nico das ra?zes) dessa planta foi avaliada in vitro contra os pat?genos da cavidade oral: Candida albicans, Streptococcus mutans, Streptococcus sanguinis e Staphylococcus aureus. Todos os extratos exibiram atividade antimicrobiana e C. albicans foi o micro-organismo mais sens?vel. Os triterpenos nepeticina, rigidenol, gloquidona, 11- hidroxigloquidona e 16- -hidroxipristimerina, previamente isolados desta esp?cie, tamb?m foram testados contra Helicobacter pylori. Rigidenol e 16- -hidroxipristimerina foram ativos contra essa bact?ria. Os resultados contribuem para confirmar o uso na medicina popular de M. salicifolia no tratamento de ?lceras e outros problemas estomacais e indicam que extratos dessa planta apresentam grande potencial para o uso no tratamento de doen?as infecciosas da cavidade oral.Maytenus salicifolia Reissek is known as "cafezinho" in Minas Gerais State, Brazil. Its leaves have been used in folk medicine to treat stomach ulcers. The present study reports the isolation of 4?-O-methylepigallocatechin (1) and proanthocyanidin A (2) of root (1; 4.36%; 2, 2.17%) and branch (1, 4.16%; 2, 0.26%) polar extracts from M. salicifolia. These compounds were found in the roots of this species for the first time. These constituents were found in large amounts and it makes M. salicifolia a suitable source of these compounds. Moreover, the antimicrobial activity of polar (ethanolic from roots, ethanolic and ethylacetate from branches) and non-polar (hexanic from roots) extracts from this plant was evaluated in vitro against oral pathogens such as Candida albicans, Streptococcus mutans, Streptococcus sanguinis and Staphylococcus aureus. All extracts showed antimicrobial activity and C. albicans was the most sensitive microorganism. The triterpenes nepeticin, rigidenol, glochidone, 11-? hydroxyglochidone and 16-?-hydroxypristimerin, which were previously isolated from this species, were also assayed against Helicobacter pylori. Rigidenol and 16-?-hydroxypristimerin exhibited activity against this bacterium. These results contribute to confirm the traditional use of M. salicifolia to treat ulcer and other gastrointestinal problems. They also indicated that the extracts from this plant have the potential to be used in the treatment of infectious diseases of the oral cavity