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

Scientia Agricola Energy generation in a Microbial Fuel Cell using anaerobic sludge from a wastewater

ABSTRACT: In microbial fuel cells (MFCs), the oxidation of organic compounds catalyzed by microorganisms (anode) generates electricity via electron transfer to an external circuit that acts as an electron acceptor (cathode). Microbial fuel cells differ in terms of the microorganisms employed and the nature of the oxidized organic compound. In this study, a consortium of anaerobic microorganisms helped to treat the secondary sludge obtained from a sewage treatment plant. The microorganisms were grown in a 250 mL bioreactor containing a carbon cloth. The reactor was fed with media containing acetate (as the carbon source) for 48 days. Concomitantly, the electrochemical data were measured with the aid of a digital multimeter and data acquisition system. At the beginning of the MFC operation, power density was low, probably due to slow microorganism growth and adhesion. The power density increased from the 15 th day of operation, reaching a value of 13.5 μW cm -2 after ca. 24 days of operation, and remained stable until the end of the process. Compared with data in the literature, this power density value is promising; improvements in the MFC design and operation could increase this value even further. The system investigated herein employed excess sludge as a biocatalyst in an MFC. This opens up the possibility of using organic acids and/or carbohydrate-rich effluents to feed MFCs, and thereby provide simultaneous effluent treatment and energy generation

Energy generation in a Microbial Fuel Cell using anaerobic sludge from a wastewater treatment plant

In microbial fuel cells (MFCs), the oxidation of organic compounds catalyzed by microorganisms (anode) generates electricity via electron transfer to an external circuit that acts as an electron acceptor (cathode). Microbial fuel cells differ in terms of the microorganisms employed and the nature of the oxidized organic compound. In this study, a consortium of anaerobic microorganisms helped to treat the secondary sludge obtained from a sewage treatment plant. The microorganisms were grown in a 250 mL bioreactor containing a carbon cloth. The reactor was fed with media containing acetate (as the carbon source) for 48 days. Concomitantly, the electrochemical data were measured with the aid of a digital multimeter and data acquisition system. At the beginning of the MFC operation, power density was low, probably due to slow microorganism growth and adhesion. The power density increased from the 15th day of operation, reaching a value of 13.5 μW cm–2 after ca. 24 days of operation, and remained stable until the end of the process. Compared with data in the literature, this power density value is promising; improvements in the MFC design and operation could increase this value even further. The system investigated herein employed excess sludge as a biocatalyst in an MFC. This opens up the possibility of using organic acids and/or carbohydrate-rich effluents to feed MFCs, and thereby provide simultaneous effluent treatment and energy generation

Energy generation in a Microbial Fuel Cell using anaerobic sludge from a wastewater treatment plant

ABSTRACT In microbial fuel cells (MFCs), the oxidation of organic compounds catalyzed by microorganisms (anode) generates electricity via electron transfer to an external circuit that acts as an electron acceptor (cathode). Microbial fuel cells differ in terms of the microorganisms employed and the nature of the oxidized organic compound. In this study, a consortium of anaerobic microorganisms helped to treat the secondary sludge obtained from a sewage treatment plant. The microorganisms were grown in a 250 mL bioreactor containing a carbon cloth. The reactor was fed with media containing acetate (as the carbon source) for 48 days. Concomitantly, the electrochemical data were measured with the aid of a digital multimeter and data acquisition system. At the beginning of the MFC operation, power density was low, probably due to slow microorganism growth and adhesion. The power density increased from the 15th day of operation, reaching a value of 13.5 μW cm–2 after ca. 24 days of operation, and remained stable until the end of the process. Compared with data in the literature, this power density value is promising; improvements in the MFC design and operation could increase this value even further. The system investigated herein employed excess sludge as a biocatalyst in an MFC. This opens up the possibility of using organic acids and/or carbohydrate-rich effluents to feed MFCs, and thereby provide simultaneous effluent treatment and energy generation

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

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data