Passado, Presente e Futuro

As primeiras expressões Arquitetónicas surgem a partir do momento em que o homem primitivo sente a necessidade de abandonar as cavernas e desenvolver um novo estilo de vida. Definida como “a ciência nativa da construção”, a Arquitetura Vernacular distinguese pela forma como responde às necessidades do homem atendendo a fatores como o clima, a cultura, as técnicas de construção, os materiais disponíveis e a economia local. A forma com a Arquitetura Vernacular atende a todos estes fatores faz com que a mesma se distinga das restantes vertentes Arquitetónicas, pela forma caraterística das suas construções, sempre enquadrada e integrada nos valores locais e ambientais de onde esta se insere. A sua evolução ao longo do tempo é apresentada nesta dissertação, demonstrando de que forma a mesma influencia outras Vertentes Arquitetónicas. O objetivo desta dissertação é demonstrar de que forma a Arquitetura Vernacular evoluiu ao longo dos tempos. Através de uma análise que permita explicar a sua origem, quais os seus ideais e de que forma a mesma foi trabalhada ao longo do tempo, pretende-se com esta dissertação reunir informação credível, direta e simples, que permita uma análise fluida e sequencial da evolução da Arquitetura Vernacular. Para isso, serão analisadas as diferentes caraterísticas da Arquitetura Vernacular, em especial o tipo de material de construção e a forma como ela responde aos diferentes climas a que se encontra exposta. Pretende-se compreender de que forma a mesma pode ter influenciado outros movimentos Arquitetónicos e, analisar de acordo com a evolução global, como a Arquitetura Vernacular se irá adaptar ao novo mundo tecnológico. Com esta dissertação pretende-se ainda consciencializar o mundo académico da Arquitetura para os problemas ambientais, causados pelo processo de construção e pelo uso abusivo de materiais de construção industriais, que estão a causar um impacto drástico no nosso meio ambiente.The first architectural expressions arise from the moment that the primitive man feels the need to leave the caves and develop a new lifestyle. Defined as “the native science of construction”, Vernacular Architecture is distinguished by the way it responds to the needs of man, taking into account factors such as climate, culture, construction techniques, available materials and the local economy. The way Vernacular Architecture meets all these factors makes it stand out from the other architectural trends, by the characteristic shape of its buildings, always framed and integrated in the local and environmental values of where it is inserted. Its evolution over time is presented in this dissertation, demonstrating how it influences other Architectural Strands. The aim of this dissertation is to demonstrate how Vernacular Architecture has evolved over time. Through an analysis that explains its origin, its ideals and how it was worked on over time, this dissertation aims to gather credible, direct and simple information that allows a fluid and sequential analysis of the evolution of Vernacular Architecture. To this end, the different characteristics of Vernacular Architecture will be analyzed, especially the type of building material and the way it responds to the different climates to which it is exposed. The aim is to understand how it may have influenced other architectural movements, and to analyze, in accordance with global evolution, how Vernacular Architecture will adapt to the new technological world. This dissertation also aims to raise awareness in the academic world of Architecture for environmental problems, caused by the construction process and the abusive use of industrial building materials, which are causing a drastic impact on our environment

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

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