High-frequency forcing of a turbulent axisymmetric wake

A high-frequency periodic jet, issuing immediately below the point of separation, is used to force the turbulent wake of a bluff axisymmetric body, its axis aligned with the free stream. It is shown that the base pressure may be varied more or less at will: at forcing frequencies several times that of the shear layer frequency, the time-averaged area-weighted base pressure increases by as much as 35 %. An investigation of the effects of forcing is made using random and phase-locked two-component particle image velocimetry (PIV), and modal decomposition of pressure fluctuations on the base of the model. The forcing does not target specific local or global wake instabilities: rather, the high-frequency jet creates a row of closely spaced vortex rings, immediately adjacent to which are regions of large shear on each side. These shear layers are associated with large dissipation and inhibit the entrainment of fluid. The resulting pressure recovery is proportional to the strength of the vortices and is accompanied by a broadband suppression of base pressure fluctuations associated with all modes. The optimum forcing frequency, at which amplification of the shear layer mode approaches unity gain, is roughly five times the shear layer frequency

Patients' Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil

Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.The aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER) of the directly observed treatment (DOT) strategy per completed treatment in Rio de Janeiro, Brazil.We interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses) and indirect (hours lost) costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT) was calculated.DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US$194 for patients and U$ 189 for the health system in SAT facilities, compared to US$336 and US$ 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO

Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti

BACKGROUND: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. METHODS: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. RESULTS: Starting in 2003, DOTS expansion in Haiti is anticipated to cost$4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. CONCLUSION: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion

Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study

<p>Abstract</p> <p>Background</p> <p>The development of a successful new tuberculosis (TB) vaccine would circumvent many limitations of current diagnostic and treatment practices. However, vaccine development is complex and costly. We aimed to assess the potential cost effectiveness of novel vaccines for TB control in a sub-Saharan African country - Zambia - relative to the existing strategy of directly observed treatment, short course (DOTS) and current level of bacille Calmette-Guérin (BCG) vaccination coverage.</p> <p>Methods</p> <p>We conducted a decision analysis model-based simulation from the societal perspective, with a 3% discount rate and all costs expressed in 2007 US dollars. Health outcomes and costs were projected over a 30-year period, for persons born in Zambia (population 11,478,000 in 2005) in year 1. Initial development costs for single vaccination and prime-boost strategies were prorated to the Zambian share (0.398%) of global BCG vaccine coverage for newborns. Main outcome measures were TB-related morbidity, mortality, and costs over a range of potential scenarios for vaccine efficacy.</p> <p>Results</p> <p>Relative to the status quo strategy, a BCG replacement vaccine administered at birth, with 70% efficacy in preventing rapid progression to TB disease after initial infection, is estimated to avert 932 TB cases and 422 TB-related deaths (prevention of 199 cases/100,000 vaccinated, and 90 deaths/100,000 vaccinated). This would result in estimated net savings of $3.6 million over 30 years for 468,073 Zambians born in year 1 of the simulation. The addition of a booster at age 10 results in estimated savings of$5.6 million compared to the status quo, averting 1,863 TB cases and 1,011 TB-related deaths (prevention of 398 cases/100,000 vaccinated, and of 216 deaths/100,000 vaccinated). With vaccination at birth alone, net savings would be realized within 1 year, whereas the prime-boost strategy would require an additional 5 years to realize savings, reflecting a greater initial development cost.</p> <p>Conclusions</p> <p>Investment in an improved TB vaccine is predicted to result in considerable cost savings, as well as a reduction in TB morbidity and TB-related mortality, when added to existing control strategies. For a vaccine with waning efficacy, a prime-boost strategy is more cost-effective in the long term.</p

Open-loop control of a turbulent axisymmetric wake

A high-frequency periodic jet, issuing parallel to the freestream from immediately below the point of separation, is used to force the turbulent wake of a bluff axisymmetric body. It is shown that, at the optimum jet forcing frequency and momentum flux coefficient, the time-averaged area-weighted base pressure increases by as much as 33%. A detailed investigation of the effects of forcing is made using modal decomposition of pressure fluctuations on the base of the model and phaselocked two-component PIV. The high-frequency jet creates a row of closely spaced vortices, immediately adjacent to which are regions of large irrotational dissipation on each side. These shear layers inhibit the entrainment of fluid. The resulting pressure recovery is proportional to the strength of the vortices produced by the jet, and is accompanied by a broadband suppression of base pressure fluctuations associated with all modes. The optimum forcing frequency, at which amplification of the shear layer approaches unity gain, is roughly five times the shear-layer frequency

Low-dimensional dynamics of a turbulent axisymmetric wake

The coherent structures of a turbulent wake generated behind a bluff three-dimensional axisymmetric body are investigated experimentally at a diameter-based Reynolds number of ∼2 × 105. Proper orthogonal decomposition of base pressure measurements indicates that the most energetic coherent structures retain the structure of the symmetry-breaking laminar instabilities and are manifested as unsteady vortex shedding with azimuthal wavenumber m=±1. In a rotating reference frame, the shedding preserves the reflectional symmetry and is linked with a reflectionally symmetric mean pressure distribution on the base. Due to a slow rotation of the symmetry plane of the turbulent wake around the axis of the body, statistical axisymmetry is recovered in the time average. The ratio of the time scales associated with the slow rotation of the symmetry plane and the vortex shedding is of order 100. © Cambridge University Press 2014

Passive control of base pressure on an axisymmetric blunt body using a perimetric slit

The effect on the base pressure of a thin slit located at the base edge of a blunt axisymmetric body, communicating an internal cavity with the external flow, is investigated. A parametric study is performed of the effect on base pressure of changes in slit size and cavity depth. The base pressure increases initially with increasing cavity depth, but saturates at a depth which depends on the slit size. The base pressure increases monotonically up to 5 % with increasing slit size for the geometries tested. An upper limit of base pressure recovery of 20 % is extrapolated from the data. It is observed that the main effect of the slit is to reduce the instantaneous pressure asymmetry, which is linked to the total base pressure in a similar fashion for all the slit sizes. As a second-order effect, for highly asymmetric pressure distributions, the slit produces a base pressure increase not associated with the base pressure asymmetry. The results suggest a global effect of the slit on the wake due to a diametrical flow within the cavity driven by the pressure differences across the slit and regulated by the largest of the pressure drops between the slit and cavity. The slit also reduces the periodic base pressure fluctuations, corresponding mainly to the vortex shedding, and increases the rotational speed of the wake

High-frequency forcing of a turbulent axisymmetric wake

A high-frequency periodic jet, issuing immediately below the point of separation, is used to force the turbulent wake of a bluff axisymmetric body, its axis aligned with the free stream. It is shown that the base pressure may be varied more or less at will: at forcing frequencies several times that of the shear layer frequency, the time-averaged area-weighted base pressure increases by as much as 35 %. An investigation of the effects of forcing is made using random and phase-locked two-component particle image velocimetry (PIV), and modal decomposition of pressure fluctuations on the base of the model. The forcing does not target specific local or global wake instabilities: rather, the high-frequency jet creates a row of closely spaced vortex rings, immediately adjacent to which are regions of large shear on each side. These shear layers are associated with large dissipation and inhibit the entrainment of fluid. The resulting pressure recovery is proportional to the strength of the vortices and is accompanied by a broadband suppression of base pressure fluctuations associated with all modes. The optimum forcing frequency, at which amplification of the shear layer mode approaches unity gain, is roughly five times the shear layer frequency.</jats:p

Use of interferon gamma-based assay to diagnose tuberculosis infection in health care workers after short term exposure

<p>Abstract</p> <p>Background</p> <p>We intended to assess the risk for health care workers (HCWs) of acquiring <it>M. tuberculosis </it>infection after exposure to patients with sputum-smear positive pulmonary tuberculosis at three University Hospitals (Ullevål, Akershus, and Haukeland) in Norway.</p> <p>Methods</p> <p>We tested 155 exposed health care workers and 48 healthy controls both with a tuberculin skin test (Mantoux) and the T-SPOT.<it>TB </it>test, a recently developed interferon-γ release assays based on the <it>M. tuberculosis</it>-specific ESAT-6 and CFP10 antigens, to investigate if this test might improve infection control measures.</p> <p>Results</p> <p>Among the 155 exposed HCWs tested in this study, 27 individuals were defined as newly infected cases by TST after recent exposure, while only 3 of these had a positive T-SPOT.<it>TB </it>test. The number of T-SPOT.<it>TB </it>positives represents 11% of the individuals defined as recently infected by TST after exposure (3/27) and 2% of the total number of exposed people tested (3/155). In addition, 15 individuals had been previously defined as infected by TST before exposure of whom 2 subjects were T-SPOT.<it>TB </it>positive. All individuals detected as T-SPOT.<it>TB </it>positive belonged to the TST positive group (> 15 mm), and the percentage concordance between T-SPOT.<it>TB </it>and TST, including both previously and newly infected subjects, was 12% (5/42). The 48 control participants used in the study were all T-SPOT.<it>TB </it>negative, but 3 of these subjects were TST positive.</p> <p>Conclusion</p> <p>Our data indicate that the frequency of latent TB in the total cohort of HCWs is 3%, whereas the rate of transmission of TB to exposed individuals is approximately 2% and occurs through exposure periods of short duration. Thus, the risk of TB transmission to HCWs following TB exposure in a hospital setting in Norway is low, and improved screening approaches will benefit from the application of specific interferon-γ release assays.</p