9 research outputs found

    Application de la stéréo PIV pour la mesures des écoulements bidirectionnels de fumée d'incendie traversant une trémie horizontale

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    International audienceL’écoulement des fumées à un passage d’une ouverture horizontale reliant deux compartiments superposés est étudié expérimentalement. Dans cette étude la technique de stéréo PIV est appliquée pour l’écoulement en convection mixte et en convection naturelle. Cet échange est gouverné à la fois par les effets de flottabilité dûs à une différence de température du fluide contenu dans les deux compartiments, et les effets d’une ventilation mécanique appliqué dans le compartiment inférieur. Une telle configuration entraîne un échange uni- ou bi-directionnel à travers l’orifice. Dans les expériences, la flottabilité est induite dans le compartiment inférieur grâce à une résistance électrique. Les résultats en convection naturelle montrent une forte similitude avec les résultats en convection mixte dans le régime bi-directionel

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Evaluación del sistema de aire acondicionado del Oficentro El Cedral como edificio sustentable

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    El desarrollo de la humanidad ha generado un gran impacto al medio ambiente y a los recursos naturales. En particular la industria de la construcción y urbanismo y la fabricación de los materiales para los edificios, son algunos de los factores que inciden en esta problemática. El nuevo Oficentro El Cedral en su fase final de construcción, se concibió para ser un edificio sustentable, incluyendo su sistema de aire acondicionado, el cual es una carga importante en el consumo energético del edificio. Parte de este trabajo consiste en investigar sobre edificios sustentables y la metodología de evaluación, analizar las normas relacionadas con el consumo energético y calidad del aire interior para aplicarlas al sistema de aire acondicionado de la edificación en estudio y determinar si califica dentro de los parámetros de las guías y normas disponibles como edificio sustentable. Por el desarrollo constructivo del Oficentro El Cedral se siguieron los lineamientos del sistema de evaluación voluntaria del programa de Liderazgo en Diseño Energético y Ambiental (LEED, de sus siglas en inglés de Leadership in Energy and Environvental Design) tipo Envolvente y Núcleo (Core and Shell, CS), LEED-CS, y en particular para el sistema de aire acondicionado, las normas 90.1 y 62.1 aplicables para edificios altos de la Sociedad Norteamericana de Ingenieros en Calefacción, Refrigeración y Aire Acondicionado (ASHRAE, de sus siglas en inglés de American Society of Heating, Refrigeration and Air-Conditioning Engineers), realizando una simulación energética mediante un programa de cómputo desarrollado por la empresa norteamericana Carrier Corporation, Hourly Analysis Program (HAP v.4.41), para diferentes escenarios. Del análisis de la simulación y de los resultados obtenidos de la evaluación cualitativa del sistema LEED, se determinó que el Oficentro El Cedral tiene un sistema de aire acondicionado que cumple con requerimientos mínimos de un edificio de alto desempeño energético pero con ciertas excepciones, sin embargo no califica para una certificación del sistema de evaluación LEED para Envolvente y Núcleo (LEED-CS). En Costa Rica no se ha alcanzado un desarrollo en la construcción y diseño para la elaboración y una implementación propia de un sistema de evaluación de edificios sustentables, lo cual motiva al sector de la ingeniería y arquitectura a investigar en este campo para desarrollar políticas de eficiencia energética, manejo de las aguas y conservación del ambiente para nuestras futuras generaciones.UCR::Vicerrectoría de Investigación::Sistema de Estudios de Posgrado::Ingeniería::Maestría Profesional en Ingeniería Mecánic

    Experimental contributions concerning the flow through a horizontal opening in natural convection : application to natural smoke removal of buildings

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    Ce travail de recherche porte sur l’étude de l'écoulement d'échange naturel à travers un évent horizontal situé au plafond d'une enceinte munie d'une ouverture verticale en partie basse. Cet échange est contrôlé à la fois par les effets de flottabilité, dus à une différence de température entre le fluide contenu dans le compartiment et l’extérieur, et par le taux de confinement du compartiment, exprimé par le rapport entre la section d'admission d'air en partie basse aB et celle de l’évent aT. L'écoulement à travers l’évent présente deux régimes caractéristiques, monodirectionnel et bidirectionnel, suivant le rapport des sections des ouvertures. Une étude expérimentale à échelle réduite est conduite en se focalisant sur la problématique du remplissage et de la vidange simultanés d’un local ventilé naturellement avec une source de flottabilité. L’objectif est de caractériser la transition et de faire le lien entre ces deux régimes. D'abord, la zone de transition est déterminée à partir de l’analyse de signaux de température recueillis au sein de l’évent couplée à des observations par nappe laser. Les résultats en régime thermique établi délimitent la zone de transition dans une plage(aB / aT) crit ∈ [0.09, 0.18]. Ensuite, les écoulements au niveau de l’évent sont caractérisés grâce à la technique de vélocimétrie par imagerie de particules stéréoscopique (SPIV, par ses sigles en anglais) sur une large plage du rapport des sections des ouvertures. Sur la base des débits mesurés par SPIV, une modélisation du débit est proposée afin de faire le raccordement entre un régime bidirectionnel pour une condition de confinement (aB / aT = 0) et un régime monodirectionnelThis work focuses on the study of the natural exchange flow through a horizontal vent located on the ceiling of an enclosure with a vertical opening at low-level. This exchange flow is controlled by both the buoyancy effects, due to a temperature difference between the fluid contained in the compartment and the outside, and the containment rate of the compartment, expressed by the ratio of the opening areas, aB in the lower part and aT at the vent. The flow through the vent has two characteristic regimes, unidirectional and bidirectional, depending on the ratio of the opening areas. A small-scale experimental study is conducted focusing on the problem of simultaneous filling and emptying of a naturally ventilated room subject to a source of buoyancy. The purpose is to characterize the transition and to make the link between these two regimes. First, the transition zone between the two types of flow is determined from the analysis of temperature signals collected within the horizontal opening coupled with laser observations. The established thermal results delineate the transition zone in a range of (aB / aT)crit ∈ [0.09,0.18]. Then, the vent flows are characterized using the stereo particle image velocimetry technique (SPIV) over a wide range of the ratio of the opening areas. Based on the flows measured by SPIV, a flow modelling at the vent is proposed to make the connection between a bidirectional regime for a confined condition (aB / aT = 0) and a unidirectional regim

    Application de la stéréo PIV pour la mesures des écoulements bidirectionnels de fumée d'incendie traversant une trémie horizontale

    No full text
    International audienceL’écoulement des fumées à un passage d’une ouverture horizontale reliant deux compartiments superposés est étudié expérimentalement. Dans cette étude la technique de stéréo PIV est appliquée pour l’écoulement en convection mixte et en convection naturelle. Cet échange est gouverné à la fois par les effets de flottabilité dûs à une différence de température du fluide contenu dans les deux compartiments, et les effets d’une ventilation mécanique appliqué dans le compartiment inférieur. Une telle configuration entraîne un échange uni- ou bi-directionnel à travers l’orifice. Dans les expériences, la flottabilité est induite dans le compartiment inférieur grâce à une résistance électrique. Les résultats en convection naturelle montrent une forte similitude avec les résultats en convection mixte dans le régime bi-directionel

    Application de la stéréo PIV pour la mesures des écoulements bidirectionnels de fumée d'incendie traversant une trémie horizontale

    Get PDF
    International audienceL’écoulement des fumées à un passage d’une ouverture horizontale reliant deux compartiments superposés est étudié expérimentalement. Dans cette étude la technique de stéréo PIV est appliquée pour l’écoulement en convection mixte et en convection naturelle. Cet échange est gouverné à la fois par les effets de flottabilité dûs à une différence de température du fluide contenu dans les deux compartiments, et les effets d’une ventilation mécanique appliqué dans le compartiment inférieur. Une telle configuration entraîne un échange uni- ou bi-directionnel à travers l’orifice. Dans les expériences, la flottabilité est induite dans le compartiment inférieur grâce à une résistance électrique. Les résultats en convection naturelle montrent une forte similitude avec les résultats en convection mixte dans le régime bi-directionel

    Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

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    BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas
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