本論文主要分為三個部分，旨以聯合國(United Nations)與中華民國合作開發海埔新生地為例，分析援外機構與中華民國的互動關係，探討雙方在技術合作上的外交斡旋與成效。 第一部分「聯合國與國際合作」，從國際合作的源流角度切入，介紹聯合國成立前後如何吸納國際合作的概念，規劃各時期的合作發展政策；並且著重在冷戰框架下，分析親美國家為了拉攏新興國家，鞏固聯合國票源，如何在1950、60年代推動聯合國援外機構的成立；以及制定各項扶貧政策。第二部分「聯合國協助臺灣開發海埔新生地」，將技術合作層面轉以臺灣開發海埔地為例，首先介紹新生地的成因，敘述中華民國建設海埔新生地的背景因素。接著探討技協機構與中華民國的技術合作，論述來自聯合國的外籍專家與國內技術人員的合作情形，並以聯合國特別基金(United Nations Special Fund)的技術協助與世界糧食方案(World Food Programme)的食糧援助為主要論點。第三部分「國際合作的成效與檢討」，討論聯合國特別基金與世糧方案的開發計畫結束後，各區新生地移交給中華民國政府的維護情形。主要包含中華民國如何回應聯合國提出的建議，國內專家學者對此次合作的評價，以及中華民國政府如何藉由國際合作的名義，發展與周邊國家的關係，突破外交逆境等。 當今的中華民國不時嘗試如何突破外交困境、推動重返聯合國。除了政治性的議題外，我們還應瞭解國際組織存在的意義，是在推動國際合作。1950、1960年代的中華民國，曾與聯合國進行深入的國際合作，也促成了臺灣的發展。因此，本研究由國際合作的觀察入手，俾能為戰後我國國際關係之研究略盡綿薄之力。

Le long des littoraux sableux tels que la côte Aquitaine, les vagues et principalement les courants moyens induits par celles-ci jouent un rôle majeur dans l’évolution morphologique des plages. Que ce soit d’un point de vue socio-économique (aménagement des plages, protection de l’environnement) ou sécuritaire (noyade), comprendre la dynamique de tels environnements est devenu un réel enjeu scienti?que ces dernières années. Le développement d’une plateforme de modélisation morphodynamique opérationnelle a été menée au cours de cette thèse. Ce modèle est basé sur le couplage du modèle spectral de houle SWAN (Delft University of Technology) avec le modèle MARS 2DH (Ifremer), initialement conçu pour calculer les courants induits par la marée et les vents. Après avoir ajouté les phénomènes liés à la houle, un modèle sédimentaire a été développé pour estimer les évolutions morphodynamiques. La campagne de mesures Biscarrosse-PréECORS menée en juin 2007 sur la plage de Biscarrosse a permis de valider le modèle pour une large gamme d’état de mer. Le modèle a montré son e?cacité et sa robustesse pour décrire les courants et des circulations induites par les vagues au dessus de fortes hétérogénéités bathymétriques. Nous avons mis en évidence la forte modulation tidale des courants sagittaux qui sont intenses même pour de faibles conditions de vagues. La plateforme de modélisation morphodynamique a permis d’analyser la formation et le développement de morphologies tridimensionnelles rythmiques pour des systèmes simple et double barre. Pour les environnements à double barre comme la côte Aquitaine, l’intense couplage morphologique entre la barre externe et la barre interne a été étudié en réponse aux conditions de forçages. Nous avons mis en évidence l’in?uence de la marée sur la croissance des barres et révélé la corrélation existant entre croissance des barres et dissipation d’énergie des vagues sur les barres. Cette thèse a abouti au développement d’un modèle complet permettant d’appréhender la dynamique des environnements littoraux sableux. / Along many sandy environments as the Aquitanian Coast, waves and wave-induced currents play a key role on the beach morphodynamics. Within a socio-economic (human interventions, natural environment protection) and touristic (human safety) framework, understand the complex dynamics of these systems is a real scienti?c challenge these last decades. The development of an operational morphodynamical modeling platform was performed during this PhD thesis. The modeling strategy consists in coupling the spectral wave model SWAN (Delft Univer- sity of Technology) with the non-linear shallow water model MARS 2DH (Ifremer). The MARS model was initially designed to compute tide- and wind-induced currents. Thus, the wave processes and a sed- imentary unit were implemented inside MARS to compute morphological evolutions of wave-dominated sandy beached. The Biscarrosse-PréECORS ?eld experiment carried out in June 2007 at Biscarrosse Beach was used to validate our modeling platform for a large range of o?shore wave conditions. Results have proved the e?ciency and the robustness of our model to calculate wave-induced currents and circulations over alongshore non-uniformities. The strong tidal modulation of currents and the intense rip currents for low-energy conditions were highlighted. The morphodynamical modeling platform was also used to analyze the generation and the development of rhythmic three-dimensional morphologies for one- and double-barred systems. For double-barred en- vironments, the intense morphological coupling between the inner and outer bar was studied in the response of wave and tide forcing. We have highlighted the in?uence of the tide on the bar growth and showed the correlation between the growth and the wave dissipation over the bar. This thesis has succeeded in the development of a complete model for understanding the dynamics of sandy coastal environments.

Title: Physiological response of competitors Fireball dinghy class in the model sailing race. Objectives: The main intention of the thesis is to detect the physical demands (difficulties) of sailing boat race categorized as Fireball double crew. The variables of physiological response to the load of competitors recorded are being measured using simulated race under laboratory conditions. At that point, this opportunity enabled us to carry out further comparisons and examine the physical demands of individual post at various directions of wind. Methods: The entire investigation of detecting physiological functions of competitors will be carried out noninvasively throughout the simulation of sailing using metabolic analyser tool and sport tester. From the feedback, we will obtained figures and originate the physiological response of human body to the load. Due to the investigation is being implemented on the double crew boat Fireball; both competitors (crew/helmsman) performing different tasks will be simulated and examined individually. Simulated race will last 24 minutes and competitors will have to face different wind courses, precisely cruising upwind, crosswind and tailwind. Results: From the measured results, we can state that most of the time during simulated race, the performance of racers...

Notre travail de thèse présente une contribution à l'étude du comportement d'un jet flottant horizontal, représentatif de la dispersion de rejets dans un milieu marin. Il consiste à modéliser ce type d'écoulement par une approche mathématique basée sur la résolution numérique moyennant la méthode des volumes finis, à valider le modèle numérique par des mesures à échelle réduite sur des maquettes expérimentales, et, enfin, à simuler la dispersion de polluants à grande échelle sur un cas réel. Trois cas d’étude ont été abordés:Le premier cas est relatif à l’étude numérique et expérimentale d'un jet flottant turbulent rond et "non-Boussinesq", injecté horizontalement dans un milieu statique et homogène. Les résultats ont permis de décrire la nature du jet et son comportement en fonction des conditions initiales d’éjection. La deuxième étude a concerné un autre cas représentatif des rejets des émissaires de stations d'épuration. Il s’agit d’un jet pariétal admettant l’approximation de Boussinesq en régime de convection mixte. L’objectif ici est d’étudier l'influence de l'effet combiné de la turbulence et de la présence de la paroi sur le comportement du jet. Dans le dernier cas d’étude, on a modélisé, en 2D et en 3D, à grande échelle un processus côtier de dispersion de rejets en surface libre appliqué sur le cas de la pollution de la baie de Tanger. Les résultats ont permis de visualiser le mécanisme de la dispersion et d’avoir des informations précieuses sur l’écoulement généré au voisinage des plages par l’interaction des rejets et des mouvements de flux et de reflux de la marée. / This work is a contribution to the study of horizontal buoyant jet behavior that presents the dispersion of discharges into the marine environment. It consists in the modeling of this flow by a mathematical approach based on numerical simulation by means of the finite volume method, the validation of a numerical model by measurements on experimental model at a small, and, finally, the simulation of pollutant dispersion on a large scale on a real case. Three cases of study were broached: The first case relates to the experimental and numerical study of horizontal round turbulent non-Boussinesq buoyant jet in a static homogeneous environment. The results were used to describe the nature and the behavior of the jet as a function of the initial conditions of ejection. The second study involved another case of discharges from outfalls. We investigated a numerical and experimental study about a horizontal buoyant wall turbulent jet in a static homogeneous environment. The aim was to analyze the influence the effect of both turbulence and wall boundary on the behavior of the jet. The latter case of study focused on numerical simulation in 2D and 3D of the coastal process of discharges dispersion on a free surface. This modeling dealt more precisely with the dispersion of discharges into a marine environment in the presence of cross flows. The bay of Tangier in Morocco was chosen as an application site. The results made it possible to visualize the dispersion mechanism and to gain valuable information on the flow generated by the interaction of discharges and high/low tide movements near the beaches of the bay.

Cette thèse vise à étudier les effets de la transition laminaire - turbulent et du contrôle actif de l’angle de calage des pales sur les performances de l’hydrolienne à axe transverse SHIVA (Système Hydrolien Intelligent à Variation d’Angle) développée à l’institut de Recherche de l’Ecole-Navale (IRENav). L’écoulement transitionnel autour d’un hydrofoil est, d’abord étudié en comparant des résultats expérimentaux et numériques. Les résultats expérimentaux ont été obtenus dans le tunnel hydrodynamique de l’IRENav. La transition s’effectue par un mécanisme de bulbe de séparation laminaire. Les comparaisons sont fondées sur l’analyse locale des pressions, des profils de vitesse dans la zone du bulbe de séparation laminaire et sur l’analyse des portances, traînées et moments mesurés sur un profil fixe et en mouvement de tangage forcé. Des calculs RANS 2D, avec et sans modèle de transition (ɣ— Reo), RANS 3D et LES 2.5D ont été menés afin de comparer les approches et évaluer la précision des simulations. L’étude montre que le modèle de transition ɣ — Reo améliore nettement les résultats obtenus par rapport à un modèle tout turbulent (k — w SST) dans le cas d’un écoulement transitionnel. L’influence de la transition laminaire - turbulent sur les performances de la turbine SHIVA est ensuite étudiée en comparant les résultats de calculs effectués avec et sans modèle de transition. L’approche est bidimensionnelle. L’utilisation du modèle de transition est intéressante au paramètre d’avance ʎ = 2 pour lequel les pales subissent un décrochage dynamique important. Le développement du tourbillon de bord d’attaque, favorisé par le modèle de transition, permet en effet une meilleure prédiction du décrochage. Les valeurs de ʎ supérieures sont moins concluantes du fait de la prédiction d’une tramée trop faible par le modèle de transition. Enfin, l’influence du contrôle actif du calage des pales sur les performances de la turbine est étudiée au point de fonctionnement optimal de la turbine ʎ = 3. Des lois de calage avancées sont développées, permettant d’agir indépendamment sur la moitié amont ou aval de la turbine. La meilleure loi testée permet une augmentation du coefficient de puissance de 34% tout en lissant la répartition du couple. / This work studies the laminar-turbulent transition and the pitch control effects on the performances of a vertical axis tidal turbine (SHIVA) developed at the French naval academy research institute. Firstly, experimental and numerical results are compared to study the transitional flow around a hydrofoil. The experiments were carried out in the hydrodynamic tunnel of the French naval academy research institute and the laminar-turbulent transition was triggered by a laminar separation bubble mechanism. Comparisons are based on the local analysis of pressure data and velocity profiles in the vicinity of the laminar separation bubble. Lift, drag and moment coefficients measured on a fixed hydrofoil and on a hydrofoil undergoing a pitching movement are also used for comparison. 2D RANS calculations carried out with or without a transition modal (ɣ — Reo), 3D RANS calculations and 2.5D LES calculations were run so as to assess the accuracy of each type of simulation. This study shows that the ‘y Reo transition modal clearly improves the accuracy of the results compared to a fully turbulent turbulence model (k— w SST) when considering a transitional flow. The influence of the laminar-turbulent transition on the performance of the SHIVA turbine is then studied. Results of 2D calculations run with and without transition model are compared. The use of the transition modal is relevant at the tip speed ratio value ʎ = 2 for which the blades undergo dynamic stall. The transition modal leads to a better prediction of the leading edge vortex development and then allows a better prediction of the dynamic stall. The use of the transition model at higher ʎ values is less relevant since the transition modal appears to predict a drag too low. Finally, the effect of the pitch control on the SHIVA turbine performance is .studied at ʎ = 3, for which the power coefficient is the highest. Advanced pitching laws are developed to modify the blades’ angle of attack independently on the upstream and downstream halves of the turbine. The best pitching law tested in this study leads to an improvement of the power coefficient by 34% and smooths the torque distribution.

Introdução: A tomografia de impedância elétrica (TIE) é uma técnica de imagem não invasiva que mensura o potencial elétrico na superfície torácica através de eletrodos colocados ao redor do tórax. Essas medidas são transformadas em uma imagem bidimensional da distribuição da impedância elétrica no tórax. Esse instrumento detecta modificações da densidade pulmonar e distribuição do volume corrente. Entretanto, é necessário melhor avaliação da sua eficiência em estimar o volume corrente (VT) a cada ciclo ventilatório. O objetivo do estudo é avaliar a correlação do volume estimado pela TIE com o VT aplicado durante o suporte ventilatório mecânico. Métodos: Inicialmente, foram estudados cinco suínos da raça Landrace. Os animais foram sedados, intubados e monitorados com a TIE. Foram aplicados volumes incrementais (100, 250, 500, 750 e 1000 mL) com a seringa de precisão em ZEEP e com PEEP de 5, 10 e 20 cmH2O, antes e depois da promoção de lesão pulmonar com lavagem com solução salina. Posteriormente, outros cinco animais foram monitorados com a tomografia computadorizada de tórax por raios X (TC) e a TIE. Foram aplicados volumes incrementais (250, 500 e 1000 mL) com a seringa de precisão em ZEEP e com PEEP de 10 e 20 cmH2O, também antes e depois da promoção de lesão pulmonar. A amplitude da variação de impedância mensurada pela TIE foi convertida em volume e foi calculado o volume de ar na TC. Análises de correlação e concordância foram realizadas com o programa \"R\" (© R Foundation for Statistical Computing). Resultados: Em ZEEP, o coeficiente de correlação entre os volumes estimado pela TIE e calculado pela TC foram, respectivamente, 0,90 e 0,96 na comparação com a seringa de precisão. O coeficiente de determinação entre a TIE e a seringa de precisão foi progressivamente reduzindo (0,90; 0,89 e 0,81 com PEEP de 5; 10 e 20, respectivamente) com o aumento do volume pulmonar promovido pela elevação da PEEP. A TC mostrou um deslocamento progressivo do conteúdo aéreo no sentido caudal com o aumento do volume pulmonar. Conclusões: Há uma boa correlação entre o volume estimado pela TIE e o VT aplicado durante o suporte ventilatório mecânico quando utilizados volumes e pressões usuais na prática clínica / Rationale: Electrical impedance tomography (EIT) is a noninvasive imaging tool that reconstructs a cross-sectional image of the lung\'s regional conductivity using electrodes placed circumferentially around the thorax. It is able to detect changes of lung air content and tidal volume (VT) distribution. However, better evaluation of its capacity to quantify VT variations is necessary. The aim of our study was to assess the correlation between volume estimated by EIT and tidal volume applied at different positive end-expiratory pressures (PEEP). Methods: Initially, in an experimental study five mechanically ventilated pigs monitored by EIT were studied. VT increments (100, 250, 500, 750 and 1000 mL) were applied with a calibrated syringe at zero end-expiratory pressure (ZEEP) and PEEP levels of 5, 10 and 20 cmH2O before and after lung-injury (induced by saline lavage). Another five pigs was monitored by EIT and x-ray computed tomography (CT). VT increments (250, 500 and 1000 mL) were applied with a calibrated syringe at zero end-expiratory pressure (ZEEP) and PEEP levels of 10 and 20 cmH2O before and after lung-injury. Lung air volume was calculated at CT scan and the amplitude of impedance change measured by EIT was converted to volume (mL). Correlation and agreement analysis was performed at \"R\" program (© R Foundation for Statistical Computing). Results: At ZEEP, volume estimated by EIT and volume calculated at CT obtained r2 = 0.90 and 0.96 respectively, when compared to calibrated syringe. The coefficient of correlation between EIT and calibrated syringe impaired (0.90; 0.89 and 0.81 with PEEP of 5; 10 and 20, respectively) with increase of the lung volume due to increased PEEP. CT showed a progressive displacement of the air content to the caudal thoracic levels with the increase of the lung volume. Conclusion: EIT is able to estimate tidal volume during mechanical ventilatory support when used volumes and pressures usually applied at bedside

INTRODUÇÃO: Estudos recentes sugerem que o uso da estratégia protetora de ventilação mecânica no intra-operatório pode reduzir a incidência de complicações pulmonares pós-operatórias (CPP). O objetivo desta meta-análise de dados individuais de pacientes é avaliar o efeito independente do volume corrente e da pressão positiva ao final da expiração (PEEP) na ocorrência de CPP. MÉTODOS: Foram incluídos ensaios clínicos randomizados que compararam a estratégia protetora de ventilação mecânica com a estratégia convencional em pacientes submetidos à anestesia para cirurgia. O desfecho primário foi o desenvolvimento de CPP. Diversos fatores prognósticos pré-definidos foram testados por meio da regressão logística multivariada. RESULTADOS: Quatorze ensaios clínicos randomizados foram incluídos (2.095 pacientes). Houve 97 casos de CPP em 1.102 pacientes (8,8%) ventilados com a estratégia protetora e 148 casos em 993 pacientes (14,9%) ventilados com a estratégia convencional (risco ajustado relativo [RR], 0,64; 95% intervalo de confiança [IC], 0,46 - 0,88, p < 0,01). Houve 85 casos de CPP em 957 pacientes (8,9%) ventilados com volume corrente baixo e PEEP alto e 63 casos em 525 pacientes (12%) ventilados com volume corrente baixo e PEEP baixo (RR, 0,93; 95% CI, 0,64 - 1,37, p = 0,72). Foi encontrada uma relação de dose-resposta entre o aparecimento de CPP e o volume corrente (R2 por meio termo quadrático = 0,390), mas não entre o aparecimento de CPP e o nível de PEEP (R2 = 0,082). A manutenção de uma driving pressure inferior a 13 cmH2O durante a cirurgia está associado a menor incidência de síndrome do desconforto respiratório agudo (SDRA). CONCLUSÃO: Esta meta-análise de dados individuais suporta os efeitos benéficos da estratégia protetora de ventilação mecânica em pacientes submetidos à cirurgia e sugere que altos níveis de PEEP, na vigência de volume corrente baixo, não acrescentam benefícios / INTRODUCTION: Recent studies show that intraoperative mechanical ventilation using low tidal volumes can prevent postoperative pulmonary complications (PPC). The aim of this individual patient data meta-analysis is to evaluate the individual associations between tidal volume size and PEEP level, and occurrence of PPC. METHODS: Randomized controlled trials comparing protective ventilation and conventional ventilation in patients undergoing general surgery were screened for inclusion. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. RESULTS: Fourteen randomized controlled trials were included (2095 patients). There were 97 cases of PPC in 1102 patients (8.8%) assigned to protective ventilation and 148 cases in 993 patients (14.9%) assigned to conventional ventilation (adjusted relative risk [RR], 0.64; 95% confidence interval [CI], 0.46 - 0.88; p < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low tidal volume and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low tidal volume and low PEEP levels (RR, 0.93; 95% CI, 0.64 - 1.37; p = 0.72). A dose-response relationship was found between the appearance of PPC and tidal volume size (R2 for mean quadratic term = 0.390), but not between the appearance of PPC and PEEP level (R2 = 0.082). The maintenance of a driving pressure below 13 cmH2O during surgery is associated with reduced incidence of acute respiratory distress syndrome. CONCLUSION: This individual data meta-analysis supports the beneficial effects of protective ventilation settings in patients undergoing surgery and suggests no benefit from high PEEP levels with use of low tidal volume

Introdução: A tomografia de impedância elétrica (TIE) é uma técnica de imagem não invasiva que mensura o potencial elétrico na superfície torácica através de eletrodos colocados ao redor do tórax. Essas medidas são transformadas em uma imagem bidimensional da distribuição da impedância elétrica no tórax. Esse instrumento detecta modificações da densidade pulmonar e distribuição do volume corrente. Entretanto, é necessário melhor avaliação da sua eficiência em estimar o volume corrente (VT) a cada ciclo ventilatório. O objetivo do estudo é avaliar a correlação do volume estimado pela TIE com o VT aplicado durante o suporte ventilatório mecânico. Métodos: Inicialmente, foram estudados cinco suínos da raça Landrace. Os animais foram sedados, intubados e monitorados com a TIE. Foram aplicados volumes incrementais (100, 250, 500, 750 e 1000 mL) com a seringa de precisão em ZEEP e com PEEP de 5, 10 e 20 cmH2O, antes e depois da promoção de lesão pulmonar com lavagem com solução salina. Posteriormente, outros cinco animais foram monitorados com a tomografia computadorizada de tórax por raios X (TC) e a TIE. Foram aplicados volumes incrementais (250, 500 e 1000 mL) com a seringa de precisão em ZEEP e com PEEP de 10 e 20 cmH2O, também antes e depois da promoção de lesão pulmonar. A amplitude da variação de impedância mensurada pela TIE foi convertida em volume e foi calculado o volume de ar na TC. Análises de correlação e concordância foram realizadas com o programa \"R\" (© R Foundation for Statistical Computing). Resultados: Em ZEEP, o coeficiente de correlação entre os volumes estimado pela TIE e calculado pela TC foram, respectivamente, 0,90 e 0,96 na comparação com a seringa de precisão. O coeficiente de determinação entre a TIE e a seringa de precisão foi progressivamente reduzindo (0,90; 0,89 e 0,81 com PEEP de 5; 10 e 20, respectivamente) com o aumento do volume pulmonar promovido pela elevação da PEEP. A TC mostrou um deslocamento progressivo do conteúdo aéreo no sentido caudal com o aumento do volume pulmonar. Conclusões: Há uma boa correlação entre o volume estimado pela TIE e o VT aplicado durante o suporte ventilatório mecânico quando utilizados volumes e pressões usuais na prática clínica / Rationale: Electrical impedance tomography (EIT) is a noninvasive imaging tool that reconstructs a cross-sectional image of the lung\'s regional conductivity using electrodes placed circumferentially around the thorax. It is able to detect changes of lung air content and tidal volume (VT) distribution. However, better evaluation of its capacity to quantify VT variations is necessary. The aim of our study was to assess the correlation between volume estimated by EIT and tidal volume applied at different positive end-expiratory pressures (PEEP). Methods: Initially, in an experimental study five mechanically ventilated pigs monitored by EIT were studied. VT increments (100, 250, 500, 750 and 1000 mL) were applied with a calibrated syringe at zero end-expiratory pressure (ZEEP) and PEEP levels of 5, 10 and 20 cmH2O before and after lung-injury (induced by saline lavage). Another five pigs was monitored by EIT and x-ray computed tomography (CT). VT increments (250, 500 and 1000 mL) were applied with a calibrated syringe at zero end-expiratory pressure (ZEEP) and PEEP levels of 10 and 20 cmH2O before and after lung-injury. Lung air volume was calculated at CT scan and the amplitude of impedance change measured by EIT was converted to volume (mL). Correlation and agreement analysis was performed at \"R\" program (© R Foundation for Statistical Computing). Results: At ZEEP, volume estimated by EIT and volume calculated at CT obtained r2 = 0.90 and 0.96 respectively, when compared to calibrated syringe. The coefficient of correlation between EIT and calibrated syringe impaired (0.90; 0.89 and 0.81 with PEEP of 5; 10 and 20, respectively) with increase of the lung volume due to increased PEEP. CT showed a progressive displacement of the air content to the caudal thoracic levels with the increase of the lung volume. Conclusion: EIT is able to estimate tidal volume during mechanical ventilatory support when used volumes and pressures usually applied at bedside

INTRODUÇÃO: Estudos recentes sugerem que o uso da estratégia protetora de ventilação mecânica no intra-operatório pode reduzir a incidência de complicações pulmonares pós-operatórias (CPP). O objetivo desta meta-análise de dados individuais de pacientes é avaliar o efeito independente do volume corrente e da pressão positiva ao final da expiração (PEEP) na ocorrência de CPP. MÉTODOS: Foram incluídos ensaios clínicos randomizados que compararam a estratégia protetora de ventilação mecânica com a estratégia convencional em pacientes submetidos à anestesia para cirurgia. O desfecho primário foi o desenvolvimento de CPP. Diversos fatores prognósticos pré-definidos foram testados por meio da regressão logística multivariada. RESULTADOS: Quatorze ensaios clínicos randomizados foram incluídos (2.095 pacientes). Houve 97 casos de CPP em 1.102 pacientes (8,8%) ventilados com a estratégia protetora e 148 casos em 993 pacientes (14,9%) ventilados com a estratégia convencional (risco ajustado relativo [RR], 0,64; 95% intervalo de confiança [IC], 0,46 - 0,88, p < 0,01). Houve 85 casos de CPP em 957 pacientes (8,9%) ventilados com volume corrente baixo e PEEP alto e 63 casos em 525 pacientes (12%) ventilados com volume corrente baixo e PEEP baixo (RR, 0,93; 95% CI, 0,64 - 1,37, p = 0,72). Foi encontrada uma relação de dose-resposta entre o aparecimento de CPP e o volume corrente (R2 por meio termo quadrático = 0,390), mas não entre o aparecimento de CPP e o nível de PEEP (R2 = 0,082). A manutenção de uma driving pressure inferior a 13 cmH2O durante a cirurgia está associado a menor incidência de síndrome do desconforto respiratório agudo (SDRA). CONCLUSÃO: Esta meta-análise de dados individuais suporta os efeitos benéficos da estratégia protetora de ventilação mecânica em pacientes submetidos à cirurgia e sugere que altos níveis de PEEP, na vigência de volume corrente baixo, não acrescentam benefícios / INTRODUCTION: Recent studies show that intraoperative mechanical ventilation using low tidal volumes can prevent postoperative pulmonary complications (PPC). The aim of this individual patient data meta-analysis is to evaluate the individual associations between tidal volume size and PEEP level, and occurrence of PPC. METHODS: Randomized controlled trials comparing protective ventilation and conventional ventilation in patients undergoing general surgery were screened for inclusion. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. RESULTS: Fourteen randomized controlled trials were included (2095 patients). There were 97 cases of PPC in 1102 patients (8.8%) assigned to protective ventilation and 148 cases in 993 patients (14.9%) assigned to conventional ventilation (adjusted relative risk [RR], 0.64; 95% confidence interval [CI], 0.46 - 0.88; p < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low tidal volume and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low tidal volume and low PEEP levels (RR, 0.93; 95% CI, 0.64 - 1.37; p = 0.72). A dose-response relationship was found between the appearance of PPC and tidal volume size (R2 for mean quadratic term = 0.390), but not between the appearance of PPC and PEEP level (R2 = 0.082). The maintenance of a driving pressure below 13 cmH2O during surgery is associated with reduced incidence of acute respiratory distress syndrome. CONCLUSION: This individual data meta-analysis supports the beneficial effects of protective ventilation settings in patients undergoing surgery and suggests no benefit from high PEEP levels with use of low tidal volume

As the demands for energy increased with the global increase in population, there is a need to create and invest in more clean and renewable energy sources. Energy derived from the movement of the tides is an ancient concept that is currently being harnessed in a handful of large tidal range locations. However, the need to move from fossil fuel driven energy sources to those that are clean and non-polluting is a priority for a sustainable future. Globally, hydropower potential is estimated to be more than 16,400-Terawatt hours annually. Given that the electricity consumption worldwide was at 15,068-Terawatt hours in 2016, if properly utilized, hydropower could supply a substantial percentage of current demand. Most of the current hydropower supply is drawn from well-established dams and tidal barrage systems. However, tidal power plants that harness the change in water height and flow along the coast (i.e. using tidal energy) have the potential to push these figures even higher. Although there is no exact number for lengths of global coastlines, there are estimates that put that number between 220,000 and 880,000 miles of coasts. These opportunities in tidal energy technologies that harness energy from the sea may one day be the key to solving our energy crises. This research explored in detail a closed, convergent system for optimal extraction of head-driven tidal energy with minimal adverse environmental effects. The long-term goal of this project is to create a system that is viable in low tidal range locations traditionally not considered for locations of tidal energy systems, therefore increasing the overall global tidal energy portfolio. By implementing a closed system of ‘bladders’ and convergent nozzles to optimize the flow rate of the contained fluid, the proposed system can 1) derive tidal energy in low tidal range geographies 5 2) avoid typical hazards like system biofouling, marine life propeller impacts, and 3) allow for ease of installation, operation, and maintenance.