Voluntariado e Nova Direita: reflexões sobre as estratégias de proteção social em tempos de pandemia

Este artigo tem o objetivo de analisar o voluntariado como estratégia de proteção social no contexto de pandemia de COVID-19 no Brasil à luz da ideologia da Nova Direita. Parte-se da compreensão de que existem diferentes formas de proteção social, que recebem significados político-ideológico distintos. O percurso metodológico escolhido utilizou a pesquisa documental, com base em documentos oficiais, reportagens e pesquisas públicas que versam sobre o tema. Os resultados apontam para a histórica institucionalização de programas de incentivo ao voluntariado no Brasil, que no atual momento, fortalecem de maneira distinta a redução da responsabilidade do Estado. Aponta-se também que no atual contexto, ao ser apresentado como principal estratégia de proteção social do governo Bolsonaro, o voluntariado se orienta pela privatização da assistência e pela moralização do trabalho e da pobreza

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

Volunteering and the new right : reflections about social protection strategies in times of pandemic

Este artigo tem o objetivo de analisar o voluntariado como estratégia de proteção social no contexto de pandemia de COVID-19 no Brasil à luz da ideologia da Nova Direita. Parte-se da compreensão de que existem diferentes formas de proteção social, que recebem significados político-ideológico distintos. O percurso metodológico escolhido utilizou a pesquisa documental, com base em documentos oficiais, reportagens e pesquisas públicas que versam sobre o tema. Os resultados apontam para a histórica institucionalização de programas de incentivo ao voluntariado no Brasil, que no atual momento, fortalecem de maneira distinta a redução da responsabilidade do Estado. Aponta-se também que no atual contexto, ao ser apresentado como principal estratégia de proteção social do governo Bolsonaro, o voluntariado se orienta pela privatização da assistência social e pela moralização do trabalho e da pobreza.This article aims to analyze volunteering as a social protection strategy in the context of the COVID-19 pandemic in Brazil based in ideology of the New Right. There are different forms of social protection, which receive distinct political-ideological meanings. The chosen methodological path used documentary research, based on official documents, reports and public research on the theme. The results point to the historical institutionalization of incentive programs for volunteer work in Brazil, which now, distinctly strengthen the reduction of the State's responsibility. It is also pointed in the current context, when presented as main social protection strategy of the Bolsonaro government, volunteering is guided by privatization of social assistance and the moralization of work and poverty.Instituto de Ciências Humanas (ICH)Departamento de Serviço Social (ICH SER)Programa de Pós-Graduação em Política Socia

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