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

Elementos de estímulo à exportação como alternativa estratégica de negócios: um estudo comparativo nos setores têxtil e de calçados.

Exportado OPUSMade available in DSpace on 2019-08-14T18:38:12Z (GMT). No. of bitstreams: 1 disserta__o_fl_vio_jos__passos_coelho.pdf: 1612059 bytes, checksum: 4064443d65b3beaed52324953fe0ad86 (MD5) Previous issue date: 9Diversos são os fatores que podem influir na decisão de uma empresa rumo à internacionalização de seus negócios. No Brasil, muitas organizações lançaram-se aos mercados externos motivadas pelos estímulos fiscais e creditícios oferecidos pelo governo, nas décadas de 70 e 80 do século passado. Esse aspecto histórico, associado a outros, de cunho cultural, contribuíram para delinear o perfil nem sempre favorável do exportador brasileiro. Nesse momento em que se intensifica o debate acerca da importância dos saldos positivos na balança comercial, ganha destaque a discussão sobre o papel dos mecanismos oficiais de estímulo à exportação. Este trabalho, realizado a partir de dados obtidos junto aos principais dirigentes de 62 empresas industriais dos setores têxtil e de calçados, em Minas Gerais, procura demonstrar como são percebidos hoje os estímulos à atividade exportadora. Para a elaboração da análise, foram realizadas comparações entre os diferentes setores pesquisados e entre os fatores externos de incentivo à exportação, com o auxílio dos testes deKruskal-Wallis e de Friedman, além da análise de correlação de Pearson. Uma abordagem qualitativa, com a aplicação de entrevistas em profundidade, proporcionou não somente o pano de fundo para a elaboração do questionário aplicado, mas também o refinamento dasinformações proporcionadas pela análise quantitativa. Os resultados obtidos mostram que, na visão dos dirigentes, os estímulos oferecidos pelo governo constituem ainda um aspecto crucial para a internacionalização das empresas brasileiras. Por fim, além das limitações inerentes ao estudo, são apresentadas as implicações teóricas e gerenciais do trabalho.There are numerous factors that can influence the decision-making process of turning a companys business international. In Brazil, many organizations entered the external market because they were motivated by tax incentives and credit facilities offered by the government during the 1970s and 1980s. This historical aspect, along with other culturalaspects, contributed to establishing a certain profile, not always favorable, of the Brazilian exporter. It is at the moment in which the debate regarding the importance of favorable trade balance intensifies, that the discussion about the role of official mechanisms of exportationincentives gains significance. This work, which relies upon data obtained from managers of 62 textile and shoe industries in Minas Gerais, attempts to demonstrate how the exportation incentives are perceived today. For the elaboration of the analysis, comparisons were madebetween different sectors and external factors of exportation incentives, by using the auxiliary tests of Kruskal-Wallis and Friedman, and the Pearsons correlation analysis. A qualitative approach, with the application of deep interviews, served as a means of elaborating theapplied questionnaire as well as highlighting information provided by the quantitative analysis. The results show that managers believe the incentives offered by the government are a crucial aspect for turning Brazilian businesses international. Furthermore, despite theinherent limitations of the study, theoretical and management implications can be drawn by this work

Effect of osteoporosis on periodontal therapy among post-menopausal women

BARRETO, Mauricio Lima; SANTOS, Carlos Antonio de Souza Teles “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-16T18:42:25Z No. of bitstreams: 1 Gomes Filho IS Effect of osteoporosis on periodontal ....pdf: 196500 bytes, checksum: 774e7e7ac810cfe0b40e379a1b58c954 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-16T19:02:45Z (GMT) No. of bitstreams: 1 Gomes Filho IS Effect of osteoporosis on periodontal ....pdf: 196500 bytes, checksum: 774e7e7ac810cfe0b40e379a1b58c954 (MD5)Made available in DSpace on 2018-02-16T19:02:45Z (GMT). No. of bitstreams: 1 Gomes Filho IS Effect of osteoporosis on periodontal ....pdf: 196500 bytes, checksum: 774e7e7ac810cfe0b40e379a1b58c954 (MD5) Previous issue date: 2013National Council for Scientific and Technological Development (CNPq), the Research Support Foundation of the State of Bahia (FAPESB) and Feira de Santana State UniversityFeira de Santana State University. Department of Periodontics. Feira de Santana, BA, BrazilFeira de Santana State University. Department of Periodontics. Feira de Santana, BA, BrazilFeira de Santana State University. Department of Periodontics. Feira de Santana, BA, BrazilFeira de Santana State University. Department of Biological Sciences. Feira de Santana, BA, BrazilFederal University of Vale do São Francisco. Epidemiology Section. Vale do São Francisco. PE, BrazilFederal University of Bahia. Public Health Institute. Salvador, BA, BrazilFeira de Santana State University. Department of Biological Sciences. Feira de Santana, BA, BrazilFeira de Santana State University. Department of Periodontics. Feira de Santana, BA, BrazilFeira de Santana State University. Department of Statistics. Salvador, BA, BrazilFeira de Santana State University. Department of Periodontics. Feira de Santana, BA, BrazilThis intervention study aimed to investigate the effect of osteoporosis on periodontal condition among 48 post-menopausal women undergoing periodontal therapy. Material and methods: The experimental group, which underwent non-surgical periodontal therapy, was composed of 16 women with periodontitis to be treated, and the control group was formed by 32 women without periodontitis. Oral condition was assessed on three occasions: at the start of the treatment (first examination), 1 month (first re-examination) and 4 months after the end of the therapy (second re-examination). In the second re-examination, recurrence of periodontal disease was evaluated by comparing the clinical measurements obtained pre- and post-treatment. The diagnosis of osteoporosis was made by investigating densitometry reports obtained previously. Descriptive analysis, analysis of variance and the Bonferroni post hoc test were applied to the data gathered, with statistical significance level of 5%. Results: The frequency of periodontitis was 50% in the treated group and 25% in the group without periodontitis. In both groups, this recurrence was greater in subjects with osteoporosis (37.5 and 18.75%, respectively) than in the individuals without osteoporosis (12.5 and 6.25%, respectively). Conclusions: The preliminary results indicate that osteoporosis possibly has an influence on periodontal condition among individuals undergoing non-surgical periodontal treatment

Incidence and risk factors for agranulocytosis in Latin American countries - the Latin study

Purpose LATIN is a multinational case-control study designed to identify risk factors for agranulocytosis and to estimate the incidence rate of the disease in some Latin American countries. Methods Each study site in Brazil, Argentina and Mexico conducted an active search of agranulocytosis patients in hematology clinics and looked for possible associations with drug use. Results The overall incidence rate was 0.38 cases per 1 million inhabitant-years. Agranulocytosis patients more often took medications already associated with agranulocytosis than controls (p=0.01), mainly methimazole (OR 44.2, 95% CI 6.8 to infinity). The population attributable risk percentage (etiologic fraction) was 56%. The use of nutrient supplements was more frequent among patients than controls (p=0.03). Conclusions Agranulocytosis seems to be very rare in Latin America. The lower than expected number of cases identified during the study period precluded estimation of the risk associated to individual drugs, with the exception of methimazol. However, this is the longest series of agranulocytosis cases ever gathered in Latin America, and information on drug exposures was collected prospectively. The conclusion is that drug-induced agranulocytosis does not seem to be a major public health problem in the study regions

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications