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

Mycorrhizas in South American Anthropic Environments

The agricultural expansion has leaded to increase the irrigated cropland area and the use of fertilizers, resulting in water degradation, increased energy use, and common pollution. Of particular concern is the increased interest to reduce the environmental impacts of high quantities of water dedicated to irrigation by agricultural activities We are now truly recognizing the importance of sustainable measures in agriculture such as conservation of the vegetation cover and management approach to understand surface and deep soil responses to global change. The agroecology management based on key processes from natural ecosystems can help to solve some agricultural difficulties. Increasing studies on the Arbuscular mycorrhizal fungi (AMF) has showed their importance for soil ecology and studies on their biodiversity have spread in some agro-ecosystems such as corn and soybean monocultures. Therefore, it is needed to deeply study the mycorrhizal functions under global change. In this chapter, we examine the major developments and advances on mycorrhizal fungi based on recent research from South American countries. New reports on the occurrence of mycorrhizas in Amazonian dark earth, as well as the inoculum production of arbuscular mycorrhizal fungi native of soils under native forest covers, have resulted in a more detailed understanding of the soil biology from South America. Reports from Amazonian dark earth or “Terra preta do índio” soil has stimulated the use of biochar worldwide as a soil conditioner that can add value to non-harvested agricultural products and promote plant growth. Few reports from Brazil showed that the addition of inorganic fertilizer, compost and chicken manure resulted in increases in plant cover and plant species richness. In this sense, the biochar/mycorrhizae interactions also can be prioritized for sequestration of carbon in soils to contribute to climate change mitigation

A many-analysts approach to the relation between religiosity and well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N=10,535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β=0.120). For the second research question, this was the case for 65% of the teams (median reported β=0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates

Constru??o de um livro digital como tecnologia educacional sobre judicializa??o da sa?de p?blica

Introdu??o: ? crescente a busca por garantia do direito ? sa?de por via judicial. Portanto, ? necess?rio informar e educar o p?blico sobre a judicializa??o da sa?de p?blica e suas implica??es. Nesse sentido, a inser??o de tecnologias educacionais digitais torna-se ?til para os gestores da sa?de compartilharem informa??es atualizadas aos interessados no tema. Objetivos: apresentar a cria??o de uma tecnologia educacional para compartilhamento digital de informa??es sobre judicializa??o da sa?de p?blica. M?todo: estudo com abordagem metodol?gica, desenvolvido em 4 etapas: 1. defini??o dos itens relacionados ao desenvolvimento do material educativo; 2. Desenvolvimento da mensagem; 3. Ilustra??es e layout; e 4: Reuni?o dos especialistas para adapta??o final e conclus?o da tecnologia em formato livro digital. O estudo ocorreu entre janeiro e julho de 2021, integrado ? disserta??o de A.F.G, mestranda de um Programa de P?s-Gradua??o Stricto Sensu de uma Universidade P?blica de Minas Gerais. Utilizou-se as plataformas digitais e ambientes virtuais: Canva?, Google forms? e WhatsApp? e Messenger. Resultados: este estudo descreveu a cria??o de um livro digital educativo intitulado ?Judicializa??o da Sa?de P?blica: direitos do cidad?o e deveres do estado?. Com 12 temas o livro digital foi elaborado em formatos compat?veis para compartilhamento em redes sociais. Conclus?es: Com esse estudo foi poss?vel descrever e construir uma tecnologia educacional em formato de livro digital. A tecnologia foi destinada aos gestores, mas pode ser compartilhada com os usu?rios do SUS e profissionais das ?reas da sa?de e do direito que buscam informa??es sobre a judicializa??o da sa?de p?blica no Brasil. Espera-se que este tipo de estudo possa trazer contribui??es para abordar o tema junto ao p?blico-alvo por conter informa??es gerais acerca da judicializa??o da sa?de p?blica no Brasil. Al?m disso, a versatilidade do livro digital para utiliza??o nas redes sociais ? um diferencial que poder? complementar a??es de informa??o, comunica??o e educa??o em sa?de sobre o tema

Judicializa??o da sa?de p?blica: direitos do cidad?o e deveres do Estado

Este e-book foi elaborado para o projeto An?lise de v?deos do YouTube sobre a judicializa??o da sa?de: a proficuidade da informa??o audiovisual gratuita no Brasil, sendo parte de uma disserta??o do Programa de P?s-Gradua??o Stricto sensu em Sa?de, Sociedade e Ambiente (SaSA) da Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM). Foi criado com o intuito de orientar os gestores municipais de sa?de. Seu conte?do foi baseado nas recomenda??es da Constitui??o da Organiza??o Mundial de Sa?de, CF/88, Lei 8080 e 8142 e visa contribuir para a melhor compreens?o sobre a judicializa??o da sa?de p?blica no Brasil.Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES)Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM

Urinary fluoride output in children following the use of a dual-fluoride varnish formulation

OBJECTIVE: This study evaluated the bioavailability of fluoride after topical application of a dual-fluoride varnish commercially available in Brazil, when compared to DuraphatTM. MATERIAL AND METHODS: The urinary fluoride output was evaluated in seven 5-year-old children after application of the fluoride varnishes, in two different phases. In the first phase (I), children received topical application of the fluoride varnish Duofluorid XII (2.92% fluorine, calcium fluoride + 2.71% fluorine, sodium fluoride, FGM TM). After 1-month interval (phase II), the same amount (0.2 mL) of the fluoride varnish Duraphat (2.26% fluorine, sodium fluoride, ColgateTM) was applied. Before each application all the volunteers brushed their teeth with placebo dentifrice for 7 days. Urinary collections were carried out 24 h prior up to 48 h after the applications. Fluoride intake from the diet was also estimated. Fluoride concentration in diet samples and urine was analyzed with the fluoride ion-specific electrode and a miniature calomel reference electrode coupled to a potentiometer. Data were tested by ANOVA and Tukey's post hoc test (p<0.05). RESULTS: There were significant differences in the urinary fluoride output between phases I and II. The use of Duofluorid XII did not significantly increase the urinary fluoride output, when compared to baseline levels. The application of Duraphat caused a transitory increase in the urinary fluoride output, returning to baseline levels 48 h after its use. CONCLUSIONS: The tested varnish formulation, which has been shown to be effective in in vitro studies, also can be considered safe