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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of salinity on performance and body composition of Pacific white shrimp juveniles reared in a super-intensive system

The objective of this study was to evaluate the effect of salinity on the culture water quality, performance and body composition of Litopenaeus vannamei juveniles (1.16±0.30 g) reared for 36 days in a super-intensive system without water exchange at salinities of 4, 16 and 32‰. Groups of 200 animals (140/m2) were stocked, with three replicates, in nine fiber-cement tanks (1.11 × 1.29 × 0.70 m) with a useful volume of 400 L. Physical and chemical parameters of water, such as temperature and dissolved oxygen before and after midday, pH, alkalinity, total suspended solids, total ammonium nitrogen, nitrite, nitrate, and phosphate, were monitored. Performance parameters like survival, weight gain, specific growth rate, feed conversion ratio and protein retention rate, were also evaluated. The proximate composition of the juveniles was analyzed through the moisture, protein, lipid and ash contents. The physical and chemical parameters of the water were influenced by the treatments. The increased salinity produced a significant increase in the alkalinity and the concentrations of total suspended solids, nitrite and phosphate. Of the parameters that were examined to evaluate the performance and proximate composition of the shrimp, only survival, protein retention rate and body lipid content were significantly influenced. The highest values were found at a salinity of 32‰. However, the analysis of the proximate composition of the bioflocs showed that the moisture, protein and lipid contents increased as the salinity decreased. Growth, use of feed and survival of L. vannameijuveniles reared in a super-intensive system without water exchange is positively influenced by an increase of salinity from 4 to 32‰

Porosity measurement of solid pharmaceutical dosage forms by gamma-ray transmission

The aim of the present work is the determination of porosity in tablets by using the gamma-ray transmission technique Tablet dissolution depends on some inherent characteristics of the manufacturing process, such as compression force, tablet volume, density and porosity, nature of excipients, preparation methods and its physical-chemical properties Porosity is a measure of empty spaces in a material and can be determined by various techniques In this paper, we propose the use of a gamma-lay transmission technique to obtain the porosity of experimental formulation of tablets. The results of porosity were compared with those obtained by using conventional methodology (density and mercury intrusion) The experimental setup for gamma-ray transmission consists of a gamma-ray source of (241)Am (photons of 59.6 keV and an activity of 3.7 x 10(9) Bq), an Nal(Tl) scintillation detector, collimators and a standard gamma-ray spectrometry electronics. Our results suggest that the gamma-ray transmission technique is a powerful tool for non-destructive porosity quantification of solid pharmaceutical forms and presents smaller errors than those obtained with conventional methodologies (C) 2010 Elsevier Ltd. All rights reservedFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

USO DAS TECNOLOGIAS DIGITAIS COMO SUPORTE PARA A APRENDIZAGEM NA ERA DA EDUCAÇÃO E INDÚSTRIA 4.0 - vol. 2

Chamamos aqui de principais tecnologias digitais de informação e comunicação, as comunidades virtuais de aprendizagem, a robótica, os sistemas tutoriais inteligentes, os sistemas hipermídia adaptativos, as simulações e laboratórios tradicionais e remotos e as tecnologias da realidade. Neste segundo volume do livro, discutimos o que chamamos acima de principais tecnologias digitais de informação, na forma de capítulos separados. Nele, procuramos integrar as informações teóricas trazidas no volume 1 com a prática no uso dessas tecnologias no ensino formal. Nossa esperança é que este material seja útil como bibliografia básica em cursos de pedagogia e licenciaturas, para disciplinas que tratem do uso de tecnologias digitais.&nbsp

Ano IX, número 19

Espaço e Economia: Revista Brasileira de Geografia Econômica, além dos artigos em fluxo contínuo, inclui nesta edição o Dossiê Oeste Metropolitano do Rio de Janeiro, organizado pelos professores Marcio Rufino Silva, Denise de Alcantara, Leandro Dias de Oliveira e André Santos da Rocha (PPGGEO e PPGDT-UFRRJ)

Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019

sem informação113344966

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