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

Heavy metals in cowpea (Vigna unguiculata L.) after tannery sludge compost amendment

Repeated soil amendment with industrial waste can affect the accumulation of chemical elements, mainly heavy metals, in plants. We therefore evaluated the accumulation of Cr, Cd, Ni, and Pb in cowpea (Vigna unguiculata [L.] Walp.) shoots and grains in soil amended for three consecutive years with tannery sludge compost (TSC). Tannery sludge compost was applied annually starting in 2009 at 0, 2.5, 5, 10, and 20 t ha(-1) and cowpea was sown. At 40 and 60 d after cowpea sowing, the accumulation of Cr, Cd, Pb, and Ni was evaluated in the shoots and grains, respectively. The experiment used completely randomized design with four replicates and data were subjected to ANOVA and F-test (5%). Only Cr accumulation was significant (P < 0.05) in the cowpea shoots after 3 yr of TSC amendment; accumulation increased as TSC rates were applied. However, there was no significant Cr, Cd, Ni, and Pb accumulation in grains. After 3 yr of consecutive TSC soil amendments, Cr accumulated in the shoots, but it was not translocated to the grains.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Chromium, Cadmium, Nickel, and Lead in a Tropical Soil after 3 Years of Consecutive Applications of Composted Tannery Sludge

Agricultural use of tannery sludge (TS) may increase risks to soils. Thus, composting is recognized as one of the most suitable alternatives for TS recycling. Field experiments were carried out to evaluate the effects of composted tannery sludge (CTS) on chromium (Cr), cadmium (Cd), nickel (Ni), and lead (Pb) accumulation in soil after 3 years. Soil samples were collected 60 days after CTS application. After 3 years, The CTS increased Cr and Ni content, while Cd and Pb contents decreased. The third year, Cr contents showed linear increases as CTS rates were applied. The application of CTS, after 3 years, in the 2.5, 5, and 10 Mg ha(-1) increased Cr significantly (140.7%, 159.7%, and 19%, respectively) and Ni (32%, 53%, and 43.8%, respectively) contents in the soil surface layer. This means that consecutive amendments of CTS increase Cr contents in the soil and plants

Heavy metals in cowpea ( Vigna unguiculata L.) after tannery sludge compost amendment

Repeated soil amendment with industrial waste can affect the accumulation of chemical elements, mainly heavy metals, in plants. We therefore evaluated the accumulation of Cr, Cd, Ni, and Pb in cowpea ( Vigna unguiculata [L.] Walp.) shoots and grains in soil amended for three consecutive years with tannery sludge compost (TSC). Tannery sludge compost was applied annually starting in 2009 at 0, 2.5, 5, 10, and 20 t ha-1 and cowpea was sown. At 40 and 60 d after cowpea sowing, the accumulation of Cr, Cd, Pb, and Ni was evaluated in the shoots and grains, respectively. The experiment used completely randomized design with four replicates and data were subjected to ANOVA and F-test (5%). Only Cr accumulation was significant (P < 0.05) in the cowpea shoots after 3 yr of TSC amendment; accumulation increased as TSC rates were applied. However, there was no significant Cr, Cd, Ni, and Pb accumulation in grains. After 3 yr of consecutive TSC soil amendments, Cr accumulated in the shoots, but it was not translocated to the grains

Soil microbial properties after 5 years of consecutive amendment with composted tannery sludge

Composting has been recognised an alternative method to tannery sludge recycling and afterwards to be used in agriculture. As the tannery sludge contains salts and chromium, the application of composted tannery sludge (CTS) should be performed carefully to minimise negative effects on soil microbial properties. Therefore, this study evaluated the effects of 5-year repeated CTS amendment on soil microbial biomass (SMB) and enzyme activities in a tropical soil. CTS was applied during 5 years at 0, 2.5, 5, 10 and 20 Mg ha(-1), and at the fifth year, the microbial biomass C (MBC) and N (MBN), basal and substrate-induced respiration (SIR), metabolic quotient (qCO(2)) and dehydrogenase (DHA) and fluorescein diacetate (FDA) hydrolysis were determined in the soil samples. Soil MBC and MBN showed the highest values with the amendment of 5 Mg ha(-1) CTS. Soil respiration increased with the increase in CTS rates, while SIR showed the highest values with the amendment of 0, 2.5 and 5 Mg ha(-1) CTS. DHA activity showed the highest values with the amendment up to 2.5 Mg ha(-1), while FDA hydrolysis increased up to the rate of 5 Mg ha(-1) CTS. The results show that after 5 years of permanent amendment of CTS, soils amended with 2.5 Mg ha(-1) have SMB and enzymatic activities similar to those in unamended soil.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Time-dependent effect of composted tannery sludge on the chemical and microbial properties of soil

Composting has been suggested as an efficient method for tannery sludge recycling before its application to the soil. However, the application of composted tannery sludge (CTS) should be monitored to evaluate its effect on the chemical and microbial properties of soil. This study evaluated the time-dependent effect of CTS on the chemical and microbial properties of soil. CTS was applied at 0, 2.5, 5, 10, and 20 Mg ha−1 and the soil chemical and microbial properties were evaluated at 0, 45, 75, 150, and 180 days. Increased CTS rates increased the levels of Ca, Cr, and Mg. While Soil pH, organic C, and P increased with the CTS rates initially, this effect decreased over time. Soil microbial biomass, respiration, metabolic quotient, and dehydrogenase increased with the application of CTS, but decreased over time. Analysis of the Principal Response Curve showed a significant effect of CTS rate on the chemical and microbial properties of the soil over time. The weight of each variable indicated that all soil properties, except β-glucosidase, dehydrogenase and microbial quotient, increased due to the CTS application. However, the highest weights were found for Cr, pH, Ca, P, phosphatase and total organic C. The application of CTS in the soil changed the chemical and microbial properties over time, indicating Cr, pH, Ca, phosphatase, and soil respiration as the more responsive chemical and microbial variables by CTS application.</p

Growth, nodulation and nitrogen fixation of cowpea in soils amended with composted tannery sludge

Tannery wastes generation is increasing every year and a suitable method for tannery sludge management is necessary in order to decrease this environmental problem. The composting is recognized as a suitable method for sludge recycling.. The effect of tannery sludge compost (TSC) rates on growth, nodulation and N fixation of cowpea was investigated. Sandy and clayey soils were amended with TSC at rates of 0, 7.5, 15, 30, and 60 t ha(-1). The shoot dry weight of cowpea plants 45 days after emergence (DAE) was greater in the TSC-amended than in the unamended soil. In the sandy soil, nodule dry weight increased with TSC application 45 DAE. In the clayey soil, 45 DAE, nodule dry weight decreased with TSC amendment levels greater than 7.5 t ha(-1) compared to the unamended control. The application of TSC increased N accumulation in the cowpea plants. The results suggest that cowpea responds differently to TSC depending on the amendment rate and initial soil type.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Chromium accumulation in maize and cowpea after successive applications of composted tannery sludge

<div><p>ABSTRACT. Chromium (Cr) accumulation in soil and plants has been reported after successive applications of tannery sludge, which is a matter of concern because Cr can promote environmental contamination and affect the food chain. In this study, we evaluated the growth of and Cr accumulation in maize and cowpea after seven years of consecutive applications of composted tannery sludge (CTS) under field conditions. The experiment consisted of application of CTS at five levels: 0 (control), 2.5, 5, 10, and 20 Mg ha-1 (dry basis). The growth of and Cr accumulation in maize and cowpea were evaluated at 75 and 65 days after plant emergence, respectively. CTS application increased the shoot biomass of maize and cowpea. Accumulation of Cr was similar for both plant species, with higher accumulation in roots. However, Cr accumulation in grains differed as the CTS doses increased; cowpea accumulated more Cr while maize did not accumulate more Cr in grains with higher CTS doses. In conclusion, application of CTS led to higher growth of maize and cowpea plants, and both species exhibited similar Cr accumulation in roots and shoots.</p></div