Modeling of Turbulent Cavitating Flows.

The goal is to establish a predictive tool for turbulent cavitating flows, including those under cryogenic conditions with noticeable thermal effects. The modeling framework consists of a transport-based cavitation model with ensemble-averaged fluid dynamics equations and turbulence closures. The cavitation models include a phenomenological model with empirical supports and an interfacial dynamics model that utilizes continuity and force balance across the interfaces. For the turbulence closure, a filter-based approach and density correction approach has been imposed to the two equation k-ε model. The reported experimental investigations contain insufficient details regarding the inlet turbulence characteristics of the flow field. However, the inlet turbulent quantities can substantially impact the outcomes because the viscous effect can modify the effective shape of a solid object, which causes noticeable variations in the predicted multiphase flow structures. A filter-based turbulence closure is utilized to reduce the impact of the inlet turbulent quantities based on the local resolution. Its effectiveness is confirmed by both isothermal and cryogenic cavitation. In addition, the thermal effect and the competing effect between the cavitation number and the density ratio effects are investigated by evaporation and condensation dynamics under the cryogenic conditions. Based on the surrogate-based global sensitivity analysis under cryogenic conditions, one can assess the role of model parameters and uncertainties in material properties. It is revealed that variables represented for the evaporation rate are more critical than those for the condensation rate. Furthermore, the recommended model parameter values are optimized by tradeoffs between pressure and temperature predictions. For unsteady cavitating flows, the phenomenological model and interfacial dynamics model are utilized by the turbulence closure with the filter-based approach, the density correction approach, and a hybrid approach that blends the previous two methods. It is discovered that the eddy viscosity near the closure region can significantly influence the capture of the detached cavity. From the experimental validations, no single model combination performs best in all aspects. Furthermore, the implications of the parameters contained in the different cavitation models are investigated. The phase change process is more pronounced near the detached cavity, which is more substantial in the interfacial dynamics model.Ph.D.Mechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/78793/1/tsengch_1.pd

Flow Structures of Gaseous Jets Injected into Water for Underwater Propulsion

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90659/1/AIAA-2011-185-740.pd

RISK OF SLEEP DISORDERS IN PATIENTS WITH DECOMPRESSION SICKNESS: A NATIONWIDE, POPULATION-BASED STUDY IN TAIWAN

Background: Decompression sickness (DCS) primarily manifests musculoskeletal pain, cutaneous manifestations, lymphatic symptoms, and neurological symptoms. DCS might affect the central nervous system and induce the stress in the patients, but few studies about the psychiatric morbidity after DCS have been conducted. This study aimed to investigate the association between DCS and the risk of developing psychiatric disorders. Subjects and methods: This study was a population-based, matched cohort design. A total of 738 enrolled patients, with 123 study subjects who had suffered from DCS, and 615 controls matched for sex and age, from the Longitudinal Health Insurance Databank from 2000-2010 in Taiwan, and selected from the National Health Insurance Research Database. After adjusting for the confounding factors, Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 10 years of follow-up period. Results: Of the study subjects, 10 (8.13%) developed psychiatric disorders when compared to 35 (5.69%) in the control group. The study subjects were more likely to develop psychiatric disorders (crude hazard ratio [HR]: 2.79 (95% CI=1.37-5.69, P<0.01). After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 3.83 (95% CI=1.60-9.16, P<0.01). Sleep disorders was associated with DCS with the adjusted HR as 5.74 (95% CI=1.04-31.56, P<0.01). Hyperbaric oxygenation therapy was not associated with a lower risk of psychiatric disorders. Conclusions: Patients who suffered from DCS have a 3.8-fold risk of developing psychiatric disorders, and a 5.7-fold risk of sleep disorders. This finding is a reminder for the clinicians that a regular psychiatric follow-up might well be needed for these patients

The Clinical COPD Questionnaire Correlated with BODE Index-A Cross-Sectional Study

The Global initiative for Chronic Obstructive Lung Disease (GOLD) staging has widely used in the stratification of the severity of COPD, while BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index was proven superior to FEV1 in predicting mortality, exacerbation and disease severity in patients with COPD. Clinical COPD Questionnaire (CCQ), a questionnaire with ten items categorized into three domains (symptoms, functional state and mental state) was developed to measure health status of COPD patients. However, little is known about the relationship between CCQ score and BODE index. We performed a prospective study with the inclusion of 89 patients who were clinically stable after a 6-week-therapy for COPD symptoms comparing their health status assessed by CCQ, BODE index and GOLD staging. We found that the total CCQ score was correlated with BODE score (P < 0.001) and GOLD staging (P < 0.001); of three CCQ domains, the functional status correlated the most with BODE index (rS = 0.670) and GOLD staging (rS = 0.531), followed by symptoms (rS = 0.482; rS = 0.346, respectively), and mental status (rS = 0.340; rS = 0.236, respectively). Our data suggest that CCQ is a reliable and convenient alternative tool to evaluate the severity of COPD

Risk Analysis of Cargos Damages for Aquatic Products of Refrigerated Containers: Shipping Operators’ Perspective in Taiwan

As the development of refrigerated container, transportation of aquatic products is growing rapidly in recent years. It is very important to avoid cargos damages for aquatic products of refrigerated containers, while the shipping operators are running this scope of business. Hence, the risk issue of adopting various improvement strategies would be important for the container shipping operators. In the light of this, the main purpose of this paper is to analyze the risks of cargos damages for aquatic products of refrigerated containers based on the container shipping operators’ perspective in Taiwan. We use four risk assessment procedures - risk identification, risk analysis and evaluation, risk strategies, and risk treatment - as the research method in this paper. The risk factors are generated from literature review and experts interviewing. Then, three dimensions with nineteen risk factors are preliminary identified. We used these risk factors to proceed with the empirical study via questionnaires. Three points of empirical results are presented. At first, the top factor of perceived risk as well as of risk severity is ‘container data setting errors.’ Secondly, the top factor of risk frequency is ‘lack of the goods’ pre-cooling themselves.’ Thirdly, three risk factors are classified into the low-risk area, whereas sixteen risk factors are placed on the medium-risk area. There is no risk factor fix on the high-risk area. Furthermore, three risk strategies - risk prevention, risk reduction, and risk transfer - are suggested to adopt by different risk factors

Multiplex PCR System for Rapid Detection of Pathogens in Patients with Presumed Sepsis – A Systemic Review and Meta-Analysis

Background: Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies. Method Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables. Results: A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65–0·83) and 0·92 (95%CI:0·90–0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70–0·88) and a specificity of 0·95(95%CI: 0·93–0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48–0·72) and a specificity of 0·99 (95%CI: 0·99–0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup. Conclusion: LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia

Epidemiological investigation of a case of nosocomial Legionnaires' disease in Taiwan: implications for routine environmental surveillance

AbstractAn epidemiological investigation with Legionella and molecular subtyping was conducted to determine the source of a case of nosocomial Legionnaires' disease (LD) who was hospitalized in three hospitals within a month. Legionella pneumophila serogroup 3, an uncommon serogroup for infection, was isolated from the patient's sputum. Environmental surveillance revealed Legionella colonization in all three hospitals; the patient isolate matched the isolate from the first hospital by molecular typing. Culturing the hospital water supply for Legionella is a pro-active strategy for detection of nosocomial LD even in hospitals experiencing no previous cases

Mortality risk factors in patients with Acinetobacter baumannii ventilator-associated pneumonia

Background/PurposeVentilator-associated pneumonia (VAP) caused by Acinetobacter baumannii has contributed to high mortality rate, prolonged stays in the intensive care unit, and the rapid development of antimicrobial resistance to commonly used antimicrobials. This study sought to determine predictors of mortality and carbapenem resistance for patients with A baumannii VAP.MethodsWe retrospectively reviewed 541 adult patients with A baumannii pneumonia, who were admitted to a medical center between 2005 and 2007; of which 180 (33.3%) had been treated with mechanical ventilation. Of the 180 patients, 98 (54.4%) who survived were categorized as the survivor group, and 82 (45.6%) who died as the mortality group. Eighty-seven (48.3%) with imipenem-sensitive A baumannii VAP were categorized as the IS-AB group, and the remaining 93 (51.7%) with imipenem-resistant VAP as the IR-AB group.ResultsCompared with the survivor group, the mortality group had significantly higher Charlson comorbidity index scores, and more neoplastic disease, other sites of infection, bloodstream infections, altered mental status, confusion, urea >7 mmol/L, respiratory rate >30/min, low blood pressure (systolic <90 mmHg or diastolic <60 mmHg), age >65 years (CURB-65) ≥ 3, creatinine > 1.6 mg/dL, C-reactive protein ≥ 100 mg/L, and imipenem resistance. The survivor group had more cases of tracheostomy and diabetes mellitus than the mortality group had. Compared with the IS-AB group, the IR-AB group had higher Charlson comorbidity index scores, longer stays before VAP onset, an increase in other sites of infection, white blood cell count <4/μL or >1.1 × 104/μL, and higher hospital mortality rates.ConclusionInadequate initial empiric antimicrobial therapy and higher disease severity scores, including CURB ≥ 3 and C-reactive protein ≥ 120 mg/L, were independent risk factors associated with higher mortality rates for A baumannii pneumonia. Length of stay before VAP and white blood cell count <4/μL or >1.1 × 104/μL were independent risk factors for carbapenem resistance