Desenhando Memórias em Espaços Solidários: um registro de emoções no abrigo de idosos Vila Vicentina

The article proposes reflections on interdisciplinary relationships that consider space, emotion and memory. It explores aspects of design’s cultural influence and social responsibility, possibilities for dialogue with other areas of knowledge, and the ability to weave relationships between knowledge. A creative project experience in the field of Social Design is set in motion, whose theoretical principles and methodological practices underlie a photographic essay. The unique experience resulted in the book “Old memories, memories of life”, inspired by the affective reports of fourteen elderly people housed in Vila Vicentina, a space of ‘a solidarity happening’. Although displaced from their origins, the sense of reality is not lost and the new space becomes definitive for reminiscences of the past to live with the present and propose a look to the future.El artículo propone reflexiones sobre las relaciones interdisciplinarias que consideran el espacio, la emoción y la memoria. Explora aspectos de la influencia cultural y de responsabilidad social del Diseño en la actualidad, las posibilidades de diálogo con otras áreas del conocimiento y de la capacidad de tejer relaciones entre saberes. Se pone en escena una experiencia proyectual creativa en el campo del diseño social, cuyos principios teóricos y prácticas metodológicas fundamentaron un ensayo fotográfico. La experiencia única resultó en el libro “Viejos recuerdos, memorias de vida”, inspirado en los informes afectivos de catorce personas ancianas alojadas en la Vila Vicentina, un espacio de «un evento solidario”. Aunque desplazados de sus orígenes, el sentido de la realidad no se pierde y el nuevo espacio se convierte en definitivo, para que las reminiscencias del pasado convivan con el presente y propongan una mirada al futuro.O artigo propõe reflexões acerca das relações interdisciplinares que consideram espaço, emoção e memória. Explora aspectos da influência cultural e responsabilidade social do Design na atualidade, possibilidades de diálogo com outras áreas do conhecimento e capacidade de tecer relações entre saberes. Coloca-se em cena uma experiência projetual criativa na área do Design Social, cujos princípios teóricos e práticas metodológicas fundamentaram um ensaio fotográfico. A vivência singular resultou no livro “Velhas lembranças, memórias de vida”, inspirado nos relatos afetivos de quatorze idosos abrigados na Vila Vicentina, espaço de ‘um acontecer solidário’. Embora deslocados de suas origens, a sensação de realidade não se perde e o novo espaço torna-se definitivo para que reminiscências do passado convivam com o presente e proponham um olhar para o futuro

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022