Applying CBM and PHM concepts with reliability approach for Blowout Preventer (BOP): a literature review

The sensibility originated by the Blowout Preventer (BOP) theme, due to all attention gathered after the Macondo event, established a high level of requirements from regulatory agencies, clients and Drilling Contractors themselves. Based on these pillars, the concept of reliability has been constantly applied in the oil industry, especially in the Well Safety and Control System, where it is extremely important for the equipment to be reliable and operational when required. In parallel, the Condition Based Maintenance (CBM) and Prognostic Health Management (PHM) concepts, widely used in critical industries, which require high reliability levels, are being pointed out as the future for the BOP system management. Within this context, the purpose of this paper is to review the literature on Condition Based Maintenance and Prognostic Health Management, integrated with reliability concepts, and to enable them to be applied in the BOP health management. The paper identifies different concepts needed to support the main theme and, through research and selection criteria, it brings together a set of publications to obtain consistent theoretical framework. This research outlines important techniques used in high reliability industries and the way they can be applied on the BOP system and it also provides many useful references and case studies to assist on further development works in terms of well control and operational safety

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

O objetivo deste trabalho foi realizar um estudo bacteriológico comparativo entre os sistemas de umidificação aquoso aquecido (UAA) e filtro trocador de calor e umidade (FTCU) quanto à colonização bacteriana e a incidência de infecção respiratória em pacientes submetidos à ventilação mecânica (VM). Trata-se de uma pesquisa prospectiva, controlada e randomizada, na qual 15 pacientes internados na Unidade de Terapia Intensiva (UTI) foram distribuídos em dois grupos. O primeiro fez uso de UAA (n=7) e o outro de FTCU (n=8). Foram coletadas amostras da secreção traqueal, condensado do circuito e FTCU na admissão do paciente, no quarto e oitavo dias, e realizada análise bacteriológica dos mesmos. Quanto às características antropométricas, não observou-se diferenças entre os grupos estudados. A prevalência de pneumonia associada à ventilação (PAV) foi de 57,1% no UAA e 62,5% no FTCU. Ao realizar a análise bacteriológica quantitativa entre eles, não foram observadas variações, sugerindo não haver diferença na prevenção de PAV entre os sistemas de umidificação; porém a presença das mesmas bactérias na secreção traqueal e no condensado e ausência destas na membrana do FTCU podem indicar que a principal fonte de contaminação é o próprio paciente.The aim of this study was to conduct a bacteriological research comparing the aqueous heated humidification systems (HH) and filter heat and moisture exchanger (FHME) and to bacterial colonization and the incidence of respiratory infection in patients undergoing mechanical ventilation. It is a prospective, controlled trial, in that 15 intensive care unit (ICU) patients were divided into two groups. The first made use of HH (n=7) and the other, FHME (n=8). We collected samples of tracheal secretions, and condensate circuit FHME at admission in the fourth and eighth day and bacteriological analysis of the same place. Regarding the anthropometric characteristics, no differences were observed between the groups. The prevalence of ventilator associated pneumonia (VAP) was 57.1% in the HH and 62.5% in FHME. When performing quantitative bacteriological analysis between the group and HH and FHME, differences were not observed, suggesting no variation in the prevention of VAP between the humidification systems, but the presence of these bacteria in the tracheal and condensate and in the absence of these membrane FHME may indicate that the main source of contamination is the patient himself

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The Combination of Stereotactic Radiosurgery with Immune Checkpoint Inhibition or Targeted Therapy in Melanoma Patients with Brain Metastases: a Retrospective Study

Introduction : Jusqu'à la deuxième décennie du vingtième siècle le mélanome au stade métastatique était considéré comme une maladie incurable. Le développement de l'immuno-oncologie a transformé le pronostique de cette maladie, ayant permis l'obtention de rémissions complètes et durables de la maladie tumorale. Néanmoins, peu d'études se sont portées sur les caractéristiques cliniques et la survie des patients avec un mélanome métastatique au niveau cérébral traités par une approche multimodale. Un faisceau d'évidence semble indiquer un synergisme potentiel de l'administration concomitante d'un traitement systémique d'immunothérapie humorale par inhibiteurs de point de contrôle et local de radiochirurgie stéréotaxique. Notre objectif a été d'analyser l'effet sur la survie globale des inhibiteurs de point de contrôle ou les thérapies ciblées par inhibiteurs de kinase BAAF/MEK initiés dans les 9 semaines entourant la radiochirurgie dans une cohorte de patients avec des métastases cérébrales de mélanome nouvellement diagnostiquées. Un de nos objectifs secondaires a été également d'évaluer l'impact pronostique des caractéristiques cliniques des patients et de leur mélanome. Méthodologie : Nous avons identifié les patients traités par radiochirurgie dans notre centre entre 2011 et 2018 et inclus dans notre étude ceux avec un diagnostic de mélanome cutané ou de primitif inconnu. Résultats : Huitante-quatre patients ont été inclus dans notre étude. La survie médiane était de 12 mois (95%CI 9-20). Le suivi médian des patients dans notre cohorte était de 30 mois (95%CI 28-49). Vingt-huit patients ont initié un traitement d'anticorps monoclonaux anti-PD-1+/-CTLA-4 (n=18) ou lpilimumab seul (n=10) durant les 9 semaines entourant leur première session de radiochirurgie cérébrale. Les patients dans le groupe anti-PD-1+/-CTLA-4 ont démontré une survie globale supérieure à celle du groupe lpilimumab seul (OS 24 vs. 7.5 mois; HA 0.32, 95% 0.12- 0.83, p=0.02) ainsi qu'à celle du groupe traité par inhibiteur de BAAF+/-MEK (OS 24 vs. 7 mois, respectivement ; HA 0.11, 95% 0.04 - 0.34, p=0.0001). Une analyse multivariée par modèle de Cox a permis d'identifier un âge supérieur à 65 ans, l'occurrence simultanée du diagnostic de métastases cérébrales et systémiques, une extension de la maladie systémique à plus de deux sites, un nombre de métastases cérébrales &gt;2, et un indice de performance &gt;1 comme des facteurs de mauvais pronostique. Un taux de lactate déshydrogénase sérique supérieur à deux fois la norme lors du diagnostic était facteur pronostique négatif en analyse univariée. Un traitement d'anti-PD-1+/-CTLA-4 était quant à lui associé à une meilleure survie globale. Conclusions et perspectives : L'administration concomitante d'un traitement systémique d'anticorps anti-PD-1+/-CTLA-4 avec la radiochirurgie cérébrale démontre dans notre cohorte unicentrique une amélioration de la survie des patients en comparaison à l'administration d'ipilimumab seul ou d'inhibiteurs BAAF/MEK. En sus de l'extension intracrânienne de la maladie métastasique, son extension sur le plan systémique retient une valeur pronostique péjorative indépendante. Ces résultats doivent encourager l'élaboration d'études cliniques prospectives sur ce sujet

Transovarial passage of Leishmania infantum kDNA in artificially infected Rhipicephalus sanguineus

Submitted by Kamylla Nascimento ([email protected]) on 2018-08-29T13:22:58Z No. of bitstreams: 1 Transovarial passage of Leishmania infantum kDNA in artificially infected.pdf: 114960 bytes, checksum: a15764cf775561b6a73eb082fb9092f1 (MD5)Approved for entry into archive by Kamylla Nascimento ([email protected]) on 2018-08-29T13:30:41Z (GMT) No. of bitstreams: 1 Transovarial passage of Leishmania infantum kDNA in artificially infected.pdf: 114960 bytes, checksum: a15764cf775561b6a73eb082fb9092f1 (MD5)Made available in DSpace on 2018-08-29T13:30:41Z (GMT). No. of bitstreams: 1 Transovarial passage of Leishmania infantum kDNA in artificially infected.pdf: 114960 bytes, checksum: a15764cf775561b6a73eb082fb9092f1 (MD5) Previous issue date: 2010Università degli Studi di Bari. Dipartimento di Sanità Pubblica e Zootecnia. Valenzano, BA, Italy.Universidade de São Paulo. Departamento de Medicina Veterinária Preventiva e Saúde Animal. São Paulo, SP, Brazil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Imunologia. Recife, PE, Brasil.Università degli Studi di Bari. Dipartimento di Sanità Pubblica e Zootecnia. Valenzano, BA, Italy.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Imunologia. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Imunologia. Recife, PE, Brasil.Phlebotomine sand flies are the only proven biological vectors of Leishmania parasites. However, Rhipicephalus sanguineus ticks have long been suspected to transmit Leishmania infantum in studies carried out in laboratory and natural conditions. In the present study, 5 microl of L. infantum promastigotes (1x10(6) cells per ml) was injected into the hemocel through the coxa I of four engorged females (F1, F2, F3 and F4). Control ticks (F5 and F6) were injected with sterile phosphate-buffered saline (PBS) using the same procedure. Then, these females, their eggs, and the originated larvae were tested by real time polymerase chain reaction (real-time PCR) for the presence of L. infantum kinetoplast DNA (kDNA). Females and eggs were tested after the end of the oviposition period (about 5 weeks post-inoculation) whereas larvae were tested about 4 months after the inoculation of females. All artificially infected females were positive for L. infantum kDNA. In addition, two pools of eggs (one from F2 and other from F4) and four pools of larvae (one from each F1 and F4 and two from F2) were positive for L. infantum kDNA. These results showed, for the first time, the transovarial passage of L. infantum kDNA in R. sanguineus ticks, thus suggesting that the transovarial transmission of L. infantum protozoa in ticks is worth to be investigated

Donor characteristics and hematopoietic stem cell transplantation outcome : experience of a single center in Southern Brazil

Background: Hematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor–recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome. Objective: To evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center. Results: Three hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1–61) and 33 (range: 3–65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1–29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11–2.24; p-value = 0.013) were associated with higher transplant-related mortality. Conclusions: In transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible

Donor characteristics and hematopoietic stem cell transplantation outcome : experience of a single center in Southern Brazil

Background: Hematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor–recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome. Objective: To evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center. Results: Three hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1–61) and 33 (range: 3–65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1–29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11–2.24; p-value = 0.013) were associated with higher transplant-related mortality. Conclusions: In transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible

A investigação em fonologia do português Research in Portuguese phonology

Neste artigo pretende-se traçar uma panorâmica dos estudos de fonologia realizados em Portugal, com especial incidência nas análises formalizadas que se desenvolveram a partir da obra de Chomsky e Halle (1968). Na Introdução referem-se obras que marcaram a fonologia do Português Europeu antes dessa data, e apresentam-se os principais trabalhos de carácter dialectal e filológico, os estudos fonéticos e as obras que se integram na linguística estrutural. Na apresentação das análises formais distingue-se a fonologia generativa clássica das teorias que lhe sucederam O artigo tem um anexo que contém a bibliografia exaustiva dos livros e artigos publicados em Portugal a partir dos anos 70.<br>This paper is an overview of the phonological studies in Portuguese starting with the formal analyses developed in Portugal after the publication of The Sound Pattern of English (1968). The relevant works on European Portuguese published before Chomsky & Halle are included in the Introduction: the most important dialectal and philological works, phonetic studies as well as structural descriptions. Formal analyses are divided in two parts: those that follow standard generative phonology and those oriented by subsequent theories. The annex includes a comprehensive bibliography of all phonological books and papers published in Portugal after the seventies