Simulação numérica da distribuição de concentração de monóxido de carbono no túnel Santa Bárbara

A qualidade do ar é uma preocupação nas grandes cidades, especialmente devido aos veículos automotores. Estes contribuem significativamente para a poluição atmosférica por emitirem diversos poluentes como monóxido de carbono, material particulado, óxidos de nitrogênio e compostos orgânicos voláteis. Em ambientes confinados, como túneis e garagens, deve haver controle dos poluentes por causa dos riscos à saúde humana. Ainda que vários poluentes sejam emitidos pelos veículos automotores, este estudo avaliou apenas a dispersão de monóxido de carbono no interior do Túnel Santa Bárbara, localizado na cidade do Rio de Janeiro. Para as simulações numéricas, foi utilizada a Fluidodinâmica Computacional (CFD). A geometria e a malha foram feitas nos softwares Design Modeler e ICEM e as simulações foram realizadas no CFX, todos da Ansys. Foram comparadas as condições atuais do túnel, que funciona com galerias separadas, e uma situação do túnel sem a parede divisória. Para o primeiro caso, foi observado um aumento linear da concentração de CO ao longo do túnel e as menores concentrações foram obtidas para a maior velocidade de ar fornecida pelos ventiladores. O movimento dos carros gera um efeito pistão que contribui para a remoção dos poluentes, possibilitando que, ainda que os ventiladores estejam desligados, a concentração de CO não atinja níveis preocupantes. O túnel sem parede divisória com os ventiladores desligados gera um grande acúmulo de poluentes na região central do túnel, devido a uma recirculação de ar existente nesta região provocada pelo movimento dos carros trafegando em sentidos opostos. Com os ventiladores funcionando por todo o período avaliado (8 às 20 h) e soprando ar em uma mesma direção, o túnel poderia operar sem a parede divisória

Proyecto de reforma de la mendicidad

2 ej. de la misma obraEnc. Pape

Preventing Ovarian Cancer through early Excision of Tubes and late Ovarian Removal (PROTECTOR): protocol for a prospective non-randomised multi-center trial.

BACKGROUND: Risk-reducing salpingo-oophorectomy is the 'gold standard' for preventing tubo-ovarian cancer in women at increased risk. However, when performed in pre-menopausal women, it results in premature menopause and associated detrimental health consequences. This, together with acceptance of the central role of the fallopian tube in etiopathogenesis of high-grade serous carcinoma, by far the most common type of tubo-ovarian cancer, has led to risk-reducing early salpingectomy with delayed oophorectomy being proposed as a two-step surgical alternative for pre-menopausal women declining/delaying oophorectomy. PRIMARY OBJECTIVE: To evaluate the impact on sexual function of risk-reducing early salpingectomy, within a two-step, risk-reducing, early salpingectomy with delayed oophorectomy tubo-ovarian cancer prevention strategy in pre-menopausal women at increased risk of tubo-ovarian cancer. STUDY HYPOTHESIS: Risk-reducing early salpingectomy is non-inferior for sexual and endocrine function compared with controls; risk-reducing early salpingectomy is superior for sexual/endocrine function, non-inferior for quality-of-life, and equivalent in satisfaction to the standard risk-reducing salpingo-oophorectomy. TRIAL DESIGN: Multi-center, observational cohort trial with three arms: risk-reducing early salpingectomy with delayed oophorectomy; risk-reducing salpingo-oophorectomy; controls (no surgery). Consenting individuals undergo an ultrasound, serum CA125, and follicle-stimulating hormone measurements and provide information on medical history, family history, quality-of-life, sexual function, cancer worry, psychological well-being, and satisfaction/regret. Follow-up by questionnaire takes place annually for 3 years. Women receiving risk-reducing early salpingectomy can undergo delayed oophorectomy at a later date of their choosing, or definitely by the menopause. MAJOR INCLUSION/EXCLUSION CRITERIA: Inclusion criteria: pre-menopausal; aged >30 years; at increased risk of tubo-ovarian cancer (mutation carriers or on the basis of a strong family history); completed their family (for surgical arms). EXCLUSION CRITERIA: post-menopausal; previous bilateral salpingectomy or bilateral oophorectomy; pregnancy; previous tubal/ovarian/peritoneal malignancy; <12 months after cancer treatment; clinical suspicion of tubal/ovarian cancer at baseline. PRIMARY ENDPOINT: Sexual function measured by validated questionnaires. SAMPLE SIZE: 1000 (333 per arm). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: It is estimated recruitment will be completed by 2023 and results published by 2027. TRIAL REGISTRATION NUMBER: ISRCTN registry: 25 173 360 (https://doi.org/10.1186/ISRCTN25173360)

Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study.

BACKGROUND: Acceptance of the role of the fallopian tube in 'ovarian' carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360). METHODS: In-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12. RESULTS: Informational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied. CONCLUSION: Multiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach

Literae Ab Olivario Protectore Angliae &c. Ad Sacram Regiam Maiestatem Sueciae. Datae 7. Februarii Anno M.DC.LVI.

Auch in: Actorum Et Gestorum Sueco-Polonicorum Semestrale: Das ist: Halb-Jährige Erzehl- und Darstellung aller im Jüngsten von Ihr. Kön. Mayestät zu Schweden/ [et]c. in das Königreich Polen fürgenommenen Feldzug/ vom Herbst deß 1655. biß Ostern 1656. fürgenommener und verrichteter Handlungen/ gewechselter Schrifften/ und anderer Begebenheiten/ [et]c. - 1656. - Und auch in: Actorum Et Gestorum Sueco-Polonicorum Semestrale: Das ist: Halb-Jährige Erzehl- und Darstellung aller im Jüngsten von Ih. Königl. Majestät zu Schweden/ [et]c. in das Königreich Pohlen fürgenommenen Feldzug/ vom Herbst/ deß 1655. biß Ostern 1656. fürgenommener und verrichteter Handlungen/ gewechselter Schrifften/ und anderer Begebenheiten/ [et]c. - 165

Annual reports of the State Fish and Game Protector : first and second annual reports

Covers the period from March 1, 1893-November 30, 1894. Discusses fisheries and game legislation and enforcement, dams, hatcheries, financial reporting and organizational structure, and fisheries statistics