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

Evaluaci?n del crecimiento de terneros de lecher?a con leche artificial optimizada por programaci?n lineal

Tesis (M. Sc) -- IICA, Turrialba (Costa Rica), 197

Efeitos de diferentes substratos e da profundidade de semeadura na germinação de sementes de mata-pasto e malva Effects of different substrata and sowing depth o germination of mata-pasto and malva seeds

As flutuações na germinação de sementes no campo são governadas por um conjunto de fatores ambientais. No presente trabalho são analisados os efeitos do pH, da salinidade e do alumínio sobre a germinação de sementes, e da profundidade de semeadura sobre a taxa de emergência de plântulas das invasoras de pastagens mata-pasto (Cassia tora) e malva (Urena lobata). À exceção dos estudos de profundidade de semeadura, que foram realizados em casa de vegetação, os demais foram realizados em laboratório. A germinação e a taxa de emergência de plântulas foram monitoradas em períodos de 15 e 20 dias, respectivamente. Os resultados obtidos mostraram que o pH na faixa de 3 a 11 e a concentração de alumínio de 0 a 2,0 meq/100 ml não afetaram a germinação das sementes das duas invasoras. Mata-pasto e malva responderam similarmente à salinidade até o nível de 150 mM. Entretanto, para a concentração de 300 mM, malva foi mais tolerante à salinidade do que o mata-pasto, cujas sementes não germinaram nesta concentração do sal. A relação entre taxa de emergência de plântulas e profundidade de semeadura foi quadrática para ambas as espécies. Mata-pasto, entretanto, evidenciou maior capacidade para emergir da profundidade de 8 cm do que a malva, que apresentou taxa de emergência zero, quando semeada nesta profundidade.The flotations in the germination of seeds in the field are governed by a group of environmental factors. In the present work it was analysed the effects of the pH, salinity and aluminium on the germination of seeds, and of the sowing depth on the rate of seedling emergency of the pasture weeds Cassia tora and Urena lobata. All studies were carried out in laboratory, excpet those of sowing depht which were accomplished at a greenhouse. The germination and the seedling emergency rate were monitored in period of 15 and 20 days, respectively. The results showed that the pH in the band from 3 to 11 and the concentration of aluminium of 0 to 2,0 meq/100 ml, did not affect seed germination of the two weeds Cassia tora and Urena lobata answered similarly to salinity until the level of 150 mM. However, for the concentration of 300 mM Urena lobata was more tolerant to salinity than the Cassia tora, whose seeds did not germinate in this salt concentration. The relationship between seedling emergency rate and sowing depth was quadratic for both species. Cassia tora, however, showed larger capacity to emerge than the Urena lobata at the depth of 8 cm, this later species presenting a rate of emergency zero when sowed in this depth

Depósito de pigmentos

Voçoroca da região de Itabirito, Minas GeraisEducação Superior::Linguística, Letras e Artes::ArtesEducação Profissional::Recursos NaturaisEnsino Médio::ArtesEnsino Fundamental::Séries Finais::Arte

Tintas - secagem de amostras

Ensino Fundamental::Séries Finais::ArtesEnsino Médio::ArtesSecagem de amostras de pigmentos minerais para teste de tintas acrílica e guacheEducação Profissional::Recursos NaturaisEducação Superior::Linguística, Letras e Artes::Arte