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

Trigger and Aperture of the Surface Detector Array of the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory consists of 1600 water-Cherenkov detectors, for the study of extensive air showers (EAS) generated by ultra-high-energy cosmic rays. We describe the trigger hierarchy, from the identification of candidate showers at the level of a single detector, amongst a large background (mainly random single cosmic ray muons), up to the selection of real events and the rejection of random coincidences. Such trigger makes the surface detector array fully efficient for the detection of EAS with energy above $3\times 10^{18}$ eV, for all zenith angles between 0$^\circ$ and 60$^\circ$, independently of the position of the impact point and of the mass of the primary particle. In these range of energies and angles, the exposure of the surface array can be determined purely on the basis of the geometrical acceptance.Comment: 29 pages, 12 figure

Ultrahigh energy neutrinos at the Pierre Auger observatory

The observation of ultrahigh energy neutrinos (UHEνs) has become a priority in experimental astroparticle physics. UHEνs can be detected with a variety of techniques. In particular, neutrinos can interact in the atmosphere (downward-going ν) or in the Earth crust (Earth-skimming ν), producing air showers that can be observed with arrays of detectors at the ground. With the surface detector array of the Pierre Auger Observatory we can detect these types of cascades. The distinguishing signature for neutrino events is the presence of very inclined showers produced close to the ground (i.e., after having traversed a large amount of atmosphere). In this work we review the procedure and criteria established to search for UHEνs in the data collected with the ground array of the Pierre Auger Observatory. This includes Earth-skimming as well as downward-going neutrinos. No neutrino candidates have been found, which allows us to place competitive limits to the diffuse flux of UHEνs in the EeV range and above.P. Abreu ... K. B. Barber ... J. A. Bellido ... R. W. Clay ... M. J. Cooper ... B. R. Dawson ... T. A. Harrison ... A. E. Herve ... V. C. Holmes ... J. Sorokin ... P. Wahrlich ... B. J. Whelan ... et al

As sa\ufavas de Mato Grosso, Brasil (Hymenoptera Formicidae)

Volume: 54Start Page: 249End Page: 25

Phylogeny and revision of the bee genus Rhinocorynura Schrottky (Hymenoptera, Apidae, Augochlorini), with comments on its female cephalic polymorphism

Phylogeny and revision of the bee genus Rhinocorynura Schrottky (Hymenoptera, Apidae, Augochlorini), with comments on its female cephalic polymorphism. A taxonomic revision and a phylogeny for the species of Rhinocorynura are provided. Six species are recognized: R. briseis, R. crotonis, R. inflaticeps and R. vernoniae stat. nov., the latter removed from synonymy with R. inflaticeps, in addition to two newly described species, R. brunnea sp. nov. and R. viridis sp. nov. Lectotypes for Halictus crotonis Ducke, 1906 and Halictus inflaticeps Ducke, 1906 are hereby designated. Another available name included in Rhinocorynura, Corynuropsis ashmeadi Schrottky, 1909, is removed from the genus and treated as species inquerenda in Augochlorini. Rhinocorynura is monophyletic in the phylogenetic analysis and the following relationships were found among its species: (R. crotonis (R. briseis ((R. brunnea sp. nov. + R. viridis sp. nov.) (R. inflaticeps + R. vernoniae)))). Biogeographic relationships within the genus and comparisons with related taxa are presented. Females of all species exhibit pronounced variation in body size, in two of them, R. inflaticeps and R. vernoniae, with structural modifications possibly linked to division of labor. Identification key and illustrations for the species are provided.<br>Filogenia e revisão taxonômica das abelhas do gênero Rhinocorynura Schrottky (Hymenoptera, Apidae, Augochlorini), com comentários sobre o poliformismo cefálico das fêmeas. São apresentadas uma revisão taxonômica e filogenia para as espécies de Rhinocorynura. Seis espécies são reconhecidas, duas descritas como novas, R. brunnea sp. nov. e R. viridis sp. nov., e quatro com nomes disponíveis, R. briseis, R. crotonis, R. inflaticeps e R. vernoniae stat. nov., esta última removida da sinonímia com R. inflaticeps. Designam-se aqui lectótipos para Halictus crotonis Ducke, 1906 e Halictus inflaticeps Ducke, 1906. Outro nome disponível incluído em Rhinocorynura, Corynuropsis ashmeadi Schrottky, 1909, é removido do gênero e tratado como species inquerenda em Augochlorini. O gênero Rhinocorynura resultou monofilético nas análises filogenéticas, com as seguintes relações encontradas para suas espécies: (R. crotonis (R. briseis ((R. brunnea sp. nov. + R. viridis sp. nov.) (R. inflaticeps + R. vernoniae)))). As relações biogeográficas dentro do gênero e comparações com táxons relacionados são apresentadas. Fêmeas de todas as espécies exibem variação pronunciada de tamanho corporal, em duas delas, R. inflaticeps e R. vernoniae, com modificações estruturais possivelmente relacionadas à divisão de trabalho. São apresentadas chave de identificação e ilustrações para as espécies

Varia\ue7\ue3o geogr\ue1fica em caracteres cranianos quantitativos de Kerodon rupestris (Wied, 1820) (Rodentia, Caviidae)

Volume: 63Start Page: 75End Page: 8

Changes in wild bee fauna of a grassland in Brazil reveal negative effects associated with growing urbanization during the last 40 years

Bee fauna and associated flora from a grassland site in Brazil, surveyed 40 and 20 years ago, were newly surveyed with comparable methodology to evaluate changes in the bee fauna of this site, considering that human population and urbanization has exponentially increased in the last 40 years. In general, bee species richness has declined in 22%, as well as their abundance. Some of the previously abundant species are now absent, including Bombus bellicosus Smith, 1879, Gaesischia fulgurans (Holmberg, 1903) and Thectochlora basiatra (Strand, 1910). No particular trend of differential decrease among either taxonomic or functional groups was observed, except for a minor increase in the proportion of oligolectic species and a 50% reduction in the number of large species. The first two surveys were more similar to each other in species richness per bee genus, while the two most recent grouped together based on measures of anthropogenic impact. Furthermore, the number of plant species visited by bees increased, with a pronounced increase in ruderal and exotic species. Crop cultivation, competition with honeybees and climate changes may all be related to bee decline. Nevertheless, the effects of urbanization, in particular intense land occupation and few preserved natural areas can be pointed as the main causes of species decline. Due to continuing increase in human population, increased erosion in diversity is expected. Habitat protection is an additional challenge to bee conservation in the region, with no local conservation units set aside for grasslands. State and municipal agencies should urgently consider the establishment of reserves for the few remaining patches of natural grasslands

COMPARISON OF THE FERTILITY BETWEEN LOXOSCELES INTERMEDIA AND LOXOSCELES LAETA SPIDERS (ARANEAE, SICARIIDAE)

Volume: 28Start Page: 245End Page: 24

Lista de esp\ue9cies da ordem Ephemeroptera (Insecta) ocorrentes no Estado do Rio de Janeiro, Brasil

Volume: 67Start Page: 383End Page: 39