21 research outputs found

    Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

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    BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

    Lift and the leading-edge vortex

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    Flapping wings often feature a leading-edge vortex (LEV) that is thought to enhance the lift generated by the wing. Here the lift on a wing featuring a leading-edge vortex is considered by performing experiments on a translating flat-plate aerofoil that is accelerated from rest in a water towing tank at a fixed angle of attack of 15°. The unsteady flow is investigated with dye flow visualization, particle image velocimetry (PIV) and force measurements. Leading-and trailing-edge vortex circulation and position are calculated directly from the velocity vectors obtained using PIV. In order to determine the most appropriate value of bound circulation, a two-dimensional potential flow model is employed and flow fields are calculated for a range of values of bound circulation. In this way, the value of bound circulation is selected to give the best fit between the experimental velocity field and the potential flow field. Early in the trajectory, the value of bound circulation calculated using this potential flow method is in accordance with Kelvin's circulation theorem, but differs from the values predicted by Wagner's growth of bound circulation and the Kutta condition. Later the Kutta condition is established but the bound circulation remains small; most of the circulation is contained instead in the LEVs. The growth of wake circulation can be approximated by Wagner's circulation curve. Superimposing the non-circulatory lift, approximated from the potential flow model, and Wagner's lift curve gives a first-order approximation of the measured lift. Lift is generated by inertial effects and the slow buildup of circulation, which is contained in shed vortices rather than bound circulation. © 2013 Cambridge University Press

    Impulsively started flat plate circulation

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    Experiments were performed using simplified flapping wing kinematics that is representative of a low Reynolds number flyer. Measurements were made at half-span in order to avoid three-dimensional effects. A Pegasus laser was used to illuminate a chordwise slice of the wing at half-span. Leading-edge vortices (LEV) circulation is approximately equal and opposite to TEV circulation in the first chord and a half of travel after an impulsive start. This suggests that the aerofoil's bound circulation is negligible shortly after an impulsive start when an LEV is formed. An absence of bound circulation is consistent with previous observations of the net force acting normal to the wing chord. The large lift observed immediately after an impulsive start must therefore be caused by a combination of noncirculatory effects and the circulatory lift generated by the LEV-TEV pair, rather than by bound circulation

    Micro-ramp control for oblique shock wave/boundary layer interactions

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    Supersonic engine intakes operating supercritically feature shock wave / boundary layer interactions (SBLIs), which are conventionally controlled using boundary layer bleed. The momentum loss of bleed flow causes high drag, compromising intake performance. Micro-ramp sub-boundary layer vortex generators (SBVGs) have been proposed as an alternative form of flow control for oblique SBLIs in order to reduce the bleed requirement. Experiments have been conducted at Mach 2.5 to characterise the flow details on such devices and investigate their ability to control the interaction between an oblique shock wave and the naturally grown turbulent boundary layer on the tunnel floor. Micro-ramps of four sizes with heights ranging from 25% to 75% of the uncontrolled boundary layer thickness were tested. The flow over all sizes of microramp was found to be similar, featuring streamwise counter-rotating vortices which entrain high momentum fluid, locally reducing the boundary layer displacement thickness. When installed ahead of the shock interaction it was found that the positioning of the micro-ramps is of limited importance. Micro-ramps did not eliminate flow separation. However, the previously two-dimensional separation was broken up into periodic three-dimensional separation zones. The interaction length was reduced and the pressure gradient across the interaction was increased

    An impulse-based approach to estimating forces in unsteady flow

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    The ready availability of full-field velocity measurements in present-day experiments has kindled interest in using such data for force estimation, especially in situations where direct measurements are difficult. Among the methods proposed, a formulation based on impulse is attractive, for both practical and physical reasons. However, evaluation of the impulse requires a complete description of the vorticity field, and this is particularly hard to achieve in the important region close to a body surface. This paper presents a solution to the problem. The incomplete experimental-vorticity field is augmented by a vortex sheet on the body, with strength determined by the no-slip boundary condition. The impulse is then found from the sum of vortex-sheet and experimental contributions. Components of physical interest can straightforwardly be recognised; for example, the classical 'added mass' associated with fluid inertia is represented by an explicit term in the formulation for the vortex sheet. The method is implemented in the context of two-dimensional flat-plate flow, and tested on velocity-field data from a translating wing experiment. The results show that the vortex-sheet contribution is significant for the test data set. Furthermore, when it is included, good agreement with force-balance measurements is found. It is thus recommended that any impulse-based force calculation should correct for (likely) data incompleteness in this way

    Microramp control of supersonic oblique shock-wave/boundary-layer interactions

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