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Ventilação manual e insuflação pulmonar sustentada em modelo experimental: influência do tipo de equipamento e do treinamento dos responsáveis pela operação / Manual ventilation and sustained lung inflation in an experimental model: influence of equipment type and operator trainingCristiane do Prado 26 February 2016 (has links)
INTRODUÇÃO: Picos de pressão inspiratória excessivos e elevados volumes correntes (VT) durante a ventilação manual podem iniciar a resposta inflamatória no pulmão do prematuro. A manobra de insuflação pulmonar sustentada (IPS) tem sido estudada como um procedimento para melhorar a aeração pulmonar imediatamente após o nascimento. OBJETIVO: Avaliar a influência do ventilador manual em T (peça T) e do balão autoinflável (BAI) nas variáveis de mecânica respiratória durante a ventilação manual e a manobra de IPS, além da influência do treinamento como instrutor do Programa de Reanimação Neonatal da Sociedade Brasileira de Pediatria (PRN-SBP), na qualidade da ventilação. MÉTODOS: Em um estudo experimental, prospectivo e randomizado, 114 indivíduos, entre instrutores e não instrutores do PRN-SBP, ventilaram um manequim neonatal intubado, equivalente a um recém-nascido de 2500 gramas, por períodos de três minutos, utilizando um BAI e a peça T. A escolha do primeiro equipamento foi feita por randomização e os operadores não tinham acesso aos dados de mecânica respiratória durante a gravação. Ao final da ventilação manual, foi solicitado que cada indivíduo realizasse uma manobra de IPS durante 10 segundos, a uma pressão de 20 cmH2O. Para cada parâmetro de mecânica respiratória obtido durante a ventilação manual e a IPS, foi realizada uma comparação direta entre os equipamentos, considerando a formação e o treinamento dos participantes. Os dados foram obtidos por um sistema informatizado que permitiu a análise posterior. RESULTADOS: Em relação à ventilação manual, foi encontrada uma diferença nos valores do VT e do TI entre os equipamentos. Com o uso do BAI o VT foi de 28,5 (12,6) mL, mediana (amplitude interquartil) no grupo instrutores e 31,6 (14,0) mL no grupo não instrutores, enquanto que com a peça T foi de 20,1 (8,4) mL e 22,3 (8,8) mL, respectivamente. O TI encontrado com o uso do BAI foi de 0,5 (0,2) segundos, mediana (amplitude interquartil), tanto para instrutores como para não instrutores, enquanto que com a peça T foi de 1,0 (0,6) segundos e 1,1 (0,9) segundos, respectivamente. Em ambos os parâmetros não foram observadas diferenças entre os grupos de profissionais. A capacidade do operador de manter uma pressão alvo de 20 cmH2O durante os 10 segundos de IPS foi avaliada através da área sob a curva de pressão (ASC), que foi 1,7 vezes maior com o uso da peça T em relação ao BAI (p < 0,05). A pressão inspiratória máxima aplicada para a realização da IPS foi maior com o uso do BAI, enquanto que a pressão média das vias aéreas, avaliada entre o início e o final dos 10 segundos de procedimento, foi maior com o uso da peça T. Novamente não foram observadas diferenças entre os grupos de profissionais. CONCLUSÃO: A peça T resultou em menores valores de VT e maiores valores de TI independente do treinamento como instrutor do PRNSBP. A peça T permitiu uma maior eficácia na realização da manobra de IPS, representada pela manutenção da pressão alvo pelo período desejado e por uma maior pressão média nas vias aéreas em relação ao BAI / INTRODUCTION: During manual resuscitation of neonates, excessive peak inspiratory pressure (PI) and high tidal volume (VT) may trigger an inflammatory response in the lungs. The sustained lung inflation (SLI) maneuver has been studied as a procedure to improve pulmonary aeration immediately after birth. OBJECTIVE: To assess the influence of a T-piece manual resuscitator versus a self-inflating bag (SIB) on respiratory mechanics during manual ventilation and the SLI maneuver and the influence of training as a Brazilian Society of Pediatrics Neonatal Resuscitation Program instructor on the quality of ventilation. METHODS: In this experimental, prospective, randomized trial, 114 operators, including Brazilian Society of Pediatrics Neonatal Resuscitation Program instructors and non-instructors, ventilated an intubated neonatal resuscitation trainer (equivalent to a 2500g neonate) for 3-minute periods using an SIB or a Tpiece device. The choice of first device was random, and operators had no access to respiratory mechanics data during recording. At the end of the manual ventilation period, each operator was asked to perform an SLI maneuver for 10 seconds at 20 cmH2O. For each respiratory mechanics parameter obtained during manual ventilation and SLI, a direct comparison between devices was performed, taking operator training into account. Data were obtained through a computerized system for later analysis. RESULTS: During manual ventilation, differences in VT and TI were found between the two devices. The SIB was associated with a median (interquartile range) VT of 28.5 (12.6) mL in the instructor group and 31.6 (14.0) mL in the noninstructor group, whereas the T-piece was associated with a VT of 20.1 (8.4) mL in the instructor group and 22.3 (8.8) mL in the non-instructor group. Regarding TI, the SIB was associated with a median (interquartile range) value of 0.5 (0.2) seconds in instructors and non-instructors alike, whereas the T-piece was associated with a value of 1.0 (0.6) seconds in the instructor group and 1.1 (0.9) seconds in the non-instructor group. No differences between the operator groups were found in either parameter. Operator ability to maintain a 20-cmH2O pressure during the 10-second SLI maneuver was assessed by the area under the pressure curve (AUC), which was 1.7 times greater with the T-piece device than with the SIB (p < 0.05). Peak PI during the SLI maneuver was higher with the SIB, whereas mean airway pressure, assessed between start and end of the 10-second maneuver, was higher with the T-piece. Again, there were no differences between the operator groups. CONCLUSION: The T-piece was associated with lower VT and higher TI values regardless of training as a Brazilian Society of Pediatrics Neonatal Resuscitation Program instructor. The T-piece provided greater efficacy in performing the SLI maneuver, as represented by maintenance of target pressure throughout the desired period and by a higher mean airway pressure as compared with SIB use
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FORAMINÍFEROS DE MANGUEZAIS ASSOCIADOS AO ESTUÁRIO DO RIO MAPARI, MUNICÍPIO DE HUMBERTO DE CAMPOS (MA): BASES ECOLÓGICAS PARA A SUSTENTABILIDADE AMBIENTAL. / FORAMINIFERA OF MANGROVE ASSOCIATED WITH THE RIVER ESTUARY MAPARI, MUNICIPALITY OF HUMBERTO DE CAMPOS (MA): ecological bases for environmental sustaninabilityFuno, Rogério Hideki Ferreira 28 November 2008 (has links)
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Previous issue date: 2008-11-28 / Intertidal foraminifera are widely recognized as efficient tools for reconstructing Holocene
sea-level changes. They are also used to detect water circulation patterns and to diagnose the
physical and chemical characteristics of estuarine water, revealing the steady state of the
ecosystem. In this work, surface sediment samples were collected to study recent
foraminiferal assemblages in an estuarine portion of the Mapari river basin, Humberto de
Campos (MA), Brazil, in two ways: (1) sixteen samples collected landwards along a
mangrove transect in the Gato Island, near the mouth of the Mapari river, in the Tubarão Bay,
from the tidal muddy flat to the hyperhaline bare flat ( apicum ); (2) nineteen samples
collected upstreamwards along the Mapari river, from the Gato Island to the Rampa
settlement, where salinity is zero. In the Gato Island transect, salinity and pH were measured
and the subaerial exposure time (TES) was calculated for each point. Height and DBH were
also measured for the main arboreous individuals. The salinity varied from euhaline to
hyperhaline (maximum of 56 ), and demonstrated no relation to TES. It was observed the
dominance of Rotaliina suborder almost all along the transect, which means that a vertical
zonation of foraminiferal assemblages was not found. However, eight of the sixteen points
were collected surrounding a meanderin tidal creek that follows the transect. Considering just
these eight points, there is a zonation in two compartments: a lower compartment that groups
six samples (TES varying from 36,46% to 58,51%), dominated by Elphidium gunteri, and an
upper compartment that groups two samples (TES varying from 61,95% to 75,27%),
dominated by Arenoparrela mexicana. In the Mapari river, salinity and pH were measured in
surface and bottom water column, and the floristic composition of the channel margins was
verified, with special attention to the species of Rhizophora genus. These species have a
distribution related to the salinity gradient, that varied from freshwater to euhaline. Four
ecofacies were defined: (1) ecofacies 1, that groups the six closest samples to the Tubarão
Bay, with polyhaline-euhaline salinity, high diversity index (H ranging from 1,44 to 2,23 and
D ranging from 0,48 a 0,69), with dominance of Elphidium gunteri and Nonion sp.,
significant presence of Ammonia tepida, Quinqueloculina seminulum and Arenoparrela
mexicana, and almost exclusive dominance of Rhizophora mangle; (2) ecofacies 2, that
groups the next five samples upstreamwards, with mesohaline-polyhaline salinity, dominance
of Nonion sp. and E. gunteri, and coexistence of R. mangle, R. harrisonii and R. racemosa;
(3) ecofacies 3, that groups five samples with salinity varying from freshwater to mesohaline,
wide dominance of Miliammina fusca, with mangrove fringe dominated by R. harrisonii and
R. racemosa; (4) ecofacies 4, that groups the three upstream samples, in freshwater
environment, where foraminifera are virtually absent. The results corroborate that
foraminiferal assemblages can be used as an efficient tool for recognizing the steady state of
the complex estuarine environment, where abiotic parameters are highly variable. / Foraminíferos da zona entre-marés são amplamente reconhecidos como eficientes ferramentas
para a reconstrução de variações do nível relativo do mar no Holoceno. São também usados
para detectar padrões de circulação e diagnosticar as características físicas e químicas das
massas d água em ambiente estuarino, revelando as condições dominantes desse ecossistema.
Neste trabalho, foram coletadas amostras de sedimento superficial para estudo das
associações de foraminíferos recentes, em uma porção estuarina da bacia do rio Mapari,
município de Humberto de Campos (MA), Brasil, de duas formas: (1) dezesseis amostras
coletadas ao longo de um perfil transversal a um manguezal na Ilha do Gato, próximo ao
encontro do rio Mapari com a Baía de Tubarão, partindo da planície lamosa ao apicum; (2)
dezenove amostras ao longo do rio Mapari, partindo da Ilha do Gato, com salinidade euhalina,
até o povoado Rampa, onde a salinidade é zero. No perfil Ilha do Gato, foram feitas medições
de salinidade e pH, e foi calculado o tempo de exposição subaérea (TES) em cada ponto, além
de medições de altura e DAP dos principais indivíduos arbóreos. A salinidade varia variou de
euhalina a hiperhalina (máximo de 56 ), e não demonstrou nenhuma relação com o TES. Foi
observado o domínio da subordem Rotaliina em quase todo o perfil, de forma que não foi
encontrada zonação altimétrica das associações de foraminíferos. Oito dos dezesseis pontos,
entretanto, foram coletados na borda de um pequeno canal de maré que acompanha o perfil,
sendo que, considerando apenas eles, há uma zonação em dois compartimentos, sendo o
inferior, com 6 amostras (TES variando de 36,46% a 58,51%), dominado por Elphidium
gunteri, e o superior, com 2 amostras (TES variando de 61,95% a 75,27%), dominado por
Arenoparrela mexicana. No rio Mapari, foram feitas medições de salinidade e pH (superficial
e de fundo para ambos), e foi verificada a composição florística das margens do canal, com
especial atenção para as espécies do gênero Rhizophora. Estas espécies se distribuem segundo
o gradiente de salinidade, que variou do euhalino à água doce. Quatro ecofácies foram
definidas: (1) ecofácies 1, agrupando as 6 amostras mais próximas da Baía de Tubarão, com
salinidade polihalina-euhalina, altos índices de diversidade (H variando de 1,44 a 2,23 e D
variando de 0,48 a 0,69), domínio de Elphidium gunteri e Nonion sp., presença significativa
de Ammonia tepida, Quinqueloculina seminulum e Arenoparrela mexicana, e domínio quase
exclusivo de Rhizophora mangle; (2) ecofácies 2, agrupando as cinco amostras da seqüência,
com salinidade mesohalina-polihalina, domínio de Nonion sp. e E. gunteri, e coexistência de
R. mangle, R. harrisonii and R. racemosa; (3) ecofácies 3, agrupando cinco amostras, com
salinidade variando de água doce a mesohalina, amplo domínio de Miliammina fusca, e
ocorrência de Rhizophora harrisonii e Rhizophora racemosa; (4) ecofácies 4, agrupando 3
amostras, em ambiente de água doce, onde foraminíferos são virtualmente ausentes. As
associações de foraminíferos se mostraram uma eficiente ferramenta para reconhecimento das
condições dominantes do complexo ambiente estuarino, onde os parâmetros abióticos são
muito variáveis.
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OTIMIZAÇÃO DA GERAÇÃO DE ELETRICIDADE A PARTIR DE FONTE MAREMOTRIZ. / OPTIMIZATION OF ELECTRICITY GENERATION FROM SOURCE TIDAL POWER.LEITE NETO, Pedro Bezerra 23 November 2012 (has links)
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Previous issue date: 2012-11-23 / CNPQ, CAPES / The challenges on the world’s energy sector, such as environmental questions and the rising
on demand, has been stimulated the use of several kind of energy sources, such as tidal
energy. These challenges associated to development of the technologies used in
electromechanical devices enable the tidal exploitation attractive under technological and
economic aspects. In this work, a methodology to estimating the energetic performance of a
tidal power plant on the estuary of Bacanga is presented. Moreover, a dispatch strategy based
on Genetic Algorithms was developed to maximize the total energy generated by the plant
through an optimal scheduling of the turbines during the generation process. By modeling
components and tidal cycle, several generation scenarios were simulated and analyzed
considering single-effect and double-effect operation over one year of operation. From results
obtained, it can be concluded that, although some constraints to the full exploitation of the
potential of the estuary, it is still possible to exploit a significant amount of energy. This is
due to improvements in efficiency of electromechanical devices currently available that allow
the exploitation of energy in very low heads, as is the case of Bacanga. / Os grandes desafios do setor energético mundial tais como questões ambientais e a crescente
demanda por energia, têm estimulado a utilização de diversas fontes alternativas de energia,
inclusive as marés. Tais desafios associados ao desenvolvimento das tecnologias utilizadas
em dispositivos eletromecânicos tornaram a exploração da energia das marés atrativa sob os
aspectos tecnológicos e econômicos. Neste trabalho, é apresentada uma metodologia para a
estimação de indicadores energéticos de uma usina maremotriz. Foi desenvolvida uma
estratégia de despacho baseada em Algoritmos Genéticos visando-se maximizar a energia
total gerada pela usina através do despacho ótimo das turbinas durante o processo de geração.
Através da modelagem de componentes e do ciclo de mares, foram simulados e analisados
cenários de geração em efeito-simples e efeito-duplo para um ano de operação. Como estudo
de caso foi considerado o estuário do Bacanga, localizado na área urbana de São Luís,
Maranhão. Dos resultados obtidos pode-se concluir que, embora algumas restrições impeçam
o pleno aproveitamento do potencial do estuário, ainda é possível um aproveitamento
significativo do mesmo. Isto se deve em grande parte às melhorias, em termos de eficiência,
dos equipamentos eletromecânicos disponíveis atualmente, que possibilitam a exploração
energética de baixíssimas quedas, como é o caso do Bacanga.
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Transients From Rare, Violent Stellar DeathsAdithan Kathirgamaraju (6726401) 16 October 2019 (has links)
Some of the brightest and most energetic events in the Universe are associated with the death of stars. These stellar deaths power transient electromagnetic emission which are routinely observed on Earth. This dissertation presents our research on various such transients. Its topics includes, supernova remnants, kilonovae, gamma-ray bursts (GRBs): The "long'' type produced from core-collapse supernovae and the "short'' type associated with neutron star merger events. It also focuses on the disruption of stars by the tidal forces of supermassive black holes i.e., tidal disruption events (TDEs). We model the emission from these transients and compare them to observations in order to draw a number of conclusions and make predictions for future detections. For example, we find that the non-thermal emission from supernovae and kilonovae associated with GRBs can produce long term emission which may be detected as a re-brightening in the overall emission. The sharp cut off observed in some TDE flares can be caused by a pre-existing accretion disk present around a supermassive black hole, which is expected in active galactic nuclei. Our work successfully predicted the nature of the very first electromagnetic detection from a neutron star merger, and was able to reproduce the emission that had been observed for more than one hundred days after the merger. This dissertation also provides frameworks on how the observable features of these transients can be leveraged to probe the properties of the progenitor system and their environment. <br>
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Eco-sedimentological environments of an inter-tidal reef platform, Warraber Island, Torres StraitHart, Deirdre E., Physical, Environmental & Mathematical Sciences, Australian Defence Force Academy, UNSW January 2003 (has links)
This thesis examines functional relationships between the morphologic, hydrodynamic, ecological and sedimentological characteristics of the Warraber reef platform, an inter-tidal reef island system, Central Torres Strait, Australia (10[degrees] 12??? S, 142 [degrees] 49??? E). Hydrodynamic and sediment-transport experiments were conducted on the reef flat using current meters, water level recorders and directional sediment traps. Results showed dominantly SE flows during the dry season and more variable NW to SE flows during the wet season. Topography and reefal water levels modulated the direction and strength of currents and the generation of wind-waves on the reef flat as well as the passage of waves over the reef rim. These hydrodynamic conditions are sufficient to induce significant transport of moderately fast to slow settling sediment (>-5.25 symbol psi) on the reef flat, though the platform as a whole is a relatively closed transport system. Carbonate production was estimated based on the key ecological variables of live assemblage distribution and cover. Overall, only 24% of the reef flat was occupied by carbonate-producing organisms. The average estimated carbonate-production rate for the reef was 1.6 kgm -2y-1 (0.07-4.37 kgm-2y-1). Production is dominated by coral (73%), with subordinate proportions contributed by coralline algae (19%). And molluscs, foraminifera and Halimeda (<4%) though actual reef-flat sediments did not reflect this potential. Instead, they were dominated by molluscs (35-55%), coralline algae (16-26%), coral (8-13%), Halimeda (7-8%) and foraminifera (5-10%). Differential rates of carbonate to sediment conversion meant the reef-platform sediments were more closely related to the cover of live organisms than to the contribution of carbonate production by each parent organism. The settling properties of the least altered particles of the five commonest constituents were measured and these provided the basis for an eco-sedimentological model of the reef-platform system. Modelled textures were compared to the actual textures, indicating the degree of textural alteration resulting from a combination of biological and physical processes, including sediment production, hydraulic sorting and mechanical breakdown. This analysis, integrated with the hydrodynamic, exposure and other data, was used to determine reef-platform surface-sediment sources, sinks and transport pathways. In using both the textual and constituent compositional properties of sediments, as well as information on local biological and physical processes, the model approach developed offers progress towards an integrative, interdisciplinary analysis of carbonate environments.
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Architecture du bassin rhodano-provençal miocène (Alpes, SE France) : relations entre déformation, physiographie et sédimentation dans un bassin molassique d'avant-paysBesson, David 15 April 2005 (has links) (PDF)
Dans un cadre stratigraphique revu le remplissage miocène du bassin molassique rhodano-provençal (BMRP) a été découper en 10 séquences de dépôt (IIIrd). Trois grandes phases d'érosion fluviatile ont été caractérisées : entre l'Aquitanien et le Burdigalien inférieur et entre le Burdigalien terminal et le Langhien puis à la base du Tortonien. Les transgressions marines miocènes du BMRP sont contrôlées par l'existence de ces réseaux fluviatiles successifs. Un modèle séquentiel haute fréquence du remplissage par des carbonates bioclastiques de faciès « foramol » du premier complexe de vallées incisées est proposé. Ces réseaux miocènes qui alimentent la plate-forme et le talus du golfe du Lion permettent de mieux comprendre comment l'ouverture du Golfe du Lion, son ralentissement puis son arrêt interagissent avec le raccourcissement alpin. Les vallées aquitano-burdigaliennes sont généralement superposées et emboîtées dans les dépôts oligo-aquitaniens. Ils sont en relation direct avec l'héritage morphostructural de ce bassin d'avant-pays et signent une déformation régionale de grande longueur d'onde rapportée à une remise en compression à la base du Miocène. Les réseaux suivant en quasi-conformité avec les structures pyrénéo-provençales sont en relation avec l'activation des plis et des chevauchements et signent une déformation plicative de plus courte longueur d'onde associée pour le réseau du Burdigalien terminal à un soulèvement régional. Leur superposition souligne la pérennité d'un contrôle tectonique. Leur déboîtement est la conséquence de l'activation des plis et des chevauchements provoquant la migration des dépôts-centres et des réseaux successifs de vallées dont cette déformation amplifie le creusement.
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Tidal range changes in the Delaware Bay : past conditions and future scenariosHall, George F. 21 May 2012 (has links)
Throughout the Holocene, appreciable changes in bathymetry are hypothesized to have resulted in large changes to tidal datums in coastal and estuarine areas. An understanding of tidal change is an important contribution to the knowledge of relative historical sea-level change and future coastal planning. To test this hypothesis, the Advanced Circulation (ADCIRC) model was used, with representative bathymetric grids based on glacial isostatic adjustment models and semi-empirical sea level rise predictions, in order to model the time-varying tidal behavior of the Delaware Bay. Model runs were conducted at various time slices between 10,000 years before present and 300 years into the future on high resolution grids that allowed for inundation moving forward in time. Open boundary tidal forcing was held constant in time to highlight the effect of the changing regional bathymetry. With each change in sea level, the shape of the Delaware Bay was considerably altered, leading to changes in the tides. Resonance and shallow water dissipation appeared to be the primary mechanisms behind these changes. Results showed that tidal ranges have nearly doubled in the upper Delaware Bay over the past 3000 years, while decreasing in the lower bay by 8%. Tidal range change represents a possible correction to past sea level rise estimates from the geologic record. Scenarios incorporating future sea level predictions primarily showed a small decrease in tidal range, potentially impacting future water levels and tidal sediment transport. Trends modeled were consistent with field measurements of relative change over similar time periods. / Graduation date: 2012
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Wave modeling at the mouth of the Columbia RiverKassem, Sarah 05 September 2012 (has links)
As the second largest river in the U.S., the entrance to the Columbia River is home to some of the most extreme wave conditions on the Pacific Coast. Winter storms commonly generate waves 6-8 m in height, which in combination with strong tidal currents, can produce dangerous navigation conditions. To improve understanding of the wave dynamics in this complex setting, the SWAN model is applied; 2 hindcasts are conducted and an operations forecast is developed. The model is forced with offshore wave heights obtained from a buoy located in 134 m water depth (for the hindcasts) and a specialized WaveWatchIII forecast (for the forecast). In both cases tidal currents are obtained from SELFE, a circulation model of the Columbia River. The hindcasts are validated through measurements obtained from an inshore buoy located in 25 m water depth, a 4-week field experiment and remote sensing methods. The model performs best at the location of the buoy, with a normalized root-mean-squared error (NRMSE) of 11%, primarily because it is outside the area of strong tidal currents. Within the river mouth, the model is able to predict the changes in the wave field due to currents, but its performance is limited by errors in velocity estimates and strong shears in the tidal current profile. From the modeling work, it is evident that wave transformations at the mouth of the river are dominated by the tidal currents. The forecast has been operational since August 2011 and provides 45-hours of predictive wave information. In comparison with measured wave heights at the buoy, the forecast performs well, with a NRMSE of 16%. The majority of errors are caused by errors in the input conditions, since they themselves are forecasted. Additional errors arise from phase-resolved properties in the wave field that the model is unable to produce; these errors are also present in the hindcasts. Despite the limitations, this forecast provides valuable information to bar pilots since it includes the effects of the tidal currents. / Graduation date: 2013
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Low Speed Energy Conversion from Marine CurrentsThomas, Karin January 2007 (has links)
The focus of this thesis is research on the performance of very low speed direct drive permanent magnet generators for energy conversion from marine and tidal currents. Various aspects involved in the design of these generators and their electromagnetic modelling using the finite element simulations are presented. For a detailed study, a 5 kW prototype generator has been designed and constructed based on finite element based simulations. Several experiments were conducted on the prototype generator. The experimental results were compared with the corresponding case simulations on the designed generator. The differences between the results predicted by the simulations and those predicted by the measurements were less than 10%. The part and overload performance of the generator has been investigated and it is found from both simulations and measurements that the generator is capable to efficiently operate at varying speeds. The tests on the experimental generator were made for speeds between 2 and 16 rpm and for load variations of 0.5 to 2 per unit. In this thesis it is shown that it is possible to design a very low speed direct drive generator for more or less any given marine current site and this is beneficial for projects aiming to develop a technical and economical viable marine current energy conversion system.
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The Independent Effect of Three Inline Suction Adapters and Lung Compliance change on Amplitude and delivered Tidal Volume during High Frequency Oscillatory Ventilation in an adult patient with ARDS: Bench ModelThacker, Shreya 01 August 2011 (has links)
Introduction: The use of high frequency oscillatory ventilation is increasing in treatment ofacute respiratory distress syndrome over the past decade. The technique of HFOV of ventilatingthe lungs at volumes less than the anatomical dead space calms the clinical concerns surroundingventilating stiff ARDS lungs with high pressures and volumes. This largely reduces theprobability of barotraumas and/or atelectrauma.
Purpose: The study was on an in vitro bench model that answered the following researchquestions: 1. The effect of three inline closed suction adapters on delivered tidal volume duringHFOV with varying lung compliance 2. The effect of varying compliance on the amplitudedelivered by HFOV; and 3. The effect of compliance on tidal volume delivered by HFOV.
Method: An in vitro bench model using high fidelity breathing simulator (ASL 5000, IngMarMedical) simulating an adult patient with ARDS was set up with 3100B SensorMedic highfrequency ventilator. The simulation included varying the compliance for each lung at 50, 40, 30and 20cmH2O while maintaining fixed resistance of 15 cmH2O/L/sec. The ventilator was set tothe following parameters: power of 6, frequency (f) of 5, inspiratory time (Ti) of 33%, bias flow(BF) of 30 LPM and oxygen concentration of 50%. The breathing simulator was connected withthe high frequency ventilator using a standard HFOV circuit and a size 8.0mm of endotrachealtube. Fourteen French Kimberly Clark suction catheters (with T and Elbow adapters) and Air-Life suction catheters (Y adapter) were placed in-line with the circuit successively to carry outthe study. Each run lasted for 1 minute after achieving stable state conditions. Thisapproximated to 300 breaths. The data was collected from the stimulator and stored by the hostcomputer.
Data Analysis: The data was analyzed using SPSS v.11 to determine the statistical significance.A probability value (P value) of ≤ 0.001 was considered to be statistically significant.
Results: The data analysis showed that Air-Life Y-adapter suction catheters caused the least lostin tidal volume when placed in line with HFOV and hence proved to be the most efficient. Thestudy also showed a direct relationship between amplitude and lung compliance i.e. an increasein lung compliance caused an associated increase in amplitude (power setting remainingunaltered). Lastly, the study did not show a statistically significant change in tidal volume withchanges in lung compliance. Future studies may be required to further evaluate the clinicalsignificance of the same.
Conclusion:1. Many factors affect delivery of tidal volume during high frequency ventilation and thus it isnot constant. Choice of in-line suction system to be placed in line is one of the determinants ofthe same.2. Lung compliance changes lead to associated changes in amplitude delivery by HFOV. Thisshould be adjusted as patient condition improves by altering the power settings to ensure optimalventilation and to avoid trauma to the lungs.
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