Computation of compressible quasi-axisymmetric slender vortex flow and breakdown

The unsteady, compressible Navier-Stokes equations are used to compute and analyze compressible quasi-axisymmetric isolated vortices. The Navier-Stokes equations are solved using an implicit, upwind, flux difference splitting finite volume scheme. The developed three dimensional solver was verified by comparing its solution profiles with those of a slender, quasi-axisymmetric vortex solver for a subsonic, quasi-axisymmetric vortex in an unbounded domain. The Navier-Stokes solver is then used to solve for a supersonic, quasi-axisymmetric vortex flow in a configured circular duct. Steady and unsteady vortex-shock interactions and breakdown were captured. The problem was also calculated using the Euler solver of the same code; the results were compared with those of the Navier-Stokes solver. The effect of the initial swirl was investigated

Supersonic quasi-axisymmetric vortex breakdown

An extensive computational study of supersonic quasi-axisymmetric vortex breakdown in a configured circular duct is presented. The unsteady, compressible, full Navier-Stokes (NS) equations are used. The NS equations are solved for the quasi-axisymmetric flows using an implicit, upwind, flux difference splitting, finite volume scheme. The quasi-axisymmetric solutions are time accurate and are obtained by forcing the components of the flowfield vector to be equal on two axial planes, which are in close proximity of each other. The effect of Reynolds number, for laminar flows, on the evolution and persistence of vortex breakdown, is studied. Finally, the effect of swirl ration at the duct inlet is investigated

Navier-Stokes Simulation of Quasi-Axisymmetric and Three-Dimensional Supersonic Vortex Breakdown

Computational simulation of supersonic vortex breakdown is considered for internal and external flow applications. The interaction of a supersonic swirling flow with a shock wave in bounded and unbounded domains is studied. The problem is formulated using the unsteady, compressible, full Navier-Stokes equations which are solved using an implicit, flux-difference splitting, finite-volume scheme. Solutions are obtained for quasi-axisymmetric and three-dimensional flows. The quasi-axisymmetric solutions are obtained by forcing the components of the flowfield vector to be equal on two axial planes, which are in close proximity to each other. For the flow in a bounded domain, a supersonic swirling flow is introduced into a configured circular duct. The duct is designed such that a shock wave intersects with the incoming swirling flow in the inlet portion. For the quasi-axisymmetric flow problem, a parametric study is performed which includes the effects of the Reynolds number, Mach number, swirl ratio and the type of exit-boundary conditions on the development and behavior of vortex breakdown. The effect of the duct wall boundary-layer flow on the vortex breakdown is also investigated. For the same duct geometry, three-dimensional effects are studied along with the effect of the duct wall boundary-layer flow. For the external flow application, a supersonic swirling jet is issued from a nozzle into a uniform supersonic flow of lower Mach number. For the quasi-axisymmetric flow problem, the effects of the Reynolds number and the type of downstream-boundary conditions are studied. For the three-dimensional flow problem, the effects of the grid fineness, grid-point distribution, grid shape and swirl ratio on the vortex breakdown are studied. The results show several modes of vortex breakdown such as no-breakdown, transient single-bubble breakdown, transient multi-bubble breakdown, periodic multi-bubble multi-frequency breakdown and helical spiral breakdown. In another application, a subsonic steady quasi-axisymmetric flow of an isolated slender vortex core is considered. The solution is obtained using a simple set of parabolic equations. The results are in excellent agreement with those of the full Navier-Stokes equations

Why honey is effective as a medicine. 1. Its use in modern medicine

Honey has been used as a medicine for thousands of years and its curative properties are well documented. However, modern medicine turned its back on honey and it is only now, with the advent of multi-resistant bacteria, that the antibiotic properties of honey are being rediscovered

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Vortex generators as a passive cleaning method for solar PV panels

This work discusses the numerical investigation of dust deposition behaviour on solar PV panels. Moreover, installing vortex generators (VGs) as a passive cleaning method on the PV panels is introduced and analysed. Multiphase computational fluid dynamics (CFD) simulations are performed to predict the influence of VGs on both the air flow fields and the dust deposition on the basis of the environmental properties of Cairo, Egypt. The dust deposition reduction is predicted for different dust particle sizes and for different VGs sizes to find the optimum VG size that causes the highest reduction. It is found that installing VGs is effective for dust particles that are smaller than 50 µm. The results show that installing VGs will result in a deposition reduction of about 35%. It is concluded that installing VGs is effective in reducing the dust deposition when wind direction is from north, south, east, or west

Life cycle assessment for photovoltaic integrated shading system with different end of life phases

The aim of this study is to conduct a novel life cycle assessment (LCA) process for a window-mounted building attached photovoltaic panel that is used as a photovoltaic integrated shading (PVIS) device, using GaBi software. Also, the study takes into consideration three different scenarios of the LCA process to reach the most environmentally-friendly system. The three scenarios differ mainly in the end of life processes phase, which in response affects the inputs of the stages within the LCA process. The newly proposed end of life phases are disposing the wastes in the landfill scenario, recycling scenario and recovery scenario. The results showed that the 30 Wp PVIS is environmentally wise to apply to buildings. For the three proposed scenarios, the highest emissions are generated during the production and end of life phases. Consequently, the recycling and the recovery scenarios are more environmentally-friendly in the long run compared to the landfill scenario